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Defector’s Condition Indicates Serious Health Issues in North Korea

Parasitic worms found in a North Korean soldier, critically injured during a desperate defection, highlight nutrition and hygiene problems that experts say have plagued the isolated country for decades.

At a briefing Wednesday, lead surgeon Lee Cook-jong displayed photos showing dozens of flesh-colored parasites, including one 27 cm (10.6 in) long, removed from the wounded soldier’s digestive tract during a series of surgeries to save his life.

“In my over 20 year-long career as a surgeon, I have only seen something like this in a textbook,” Lee said.

The parasites, along with kernels of corn in his stomach, may confirm what many experts and previous defectors have described about the food and hygiene situation for many North Koreans.

“Although we do not have solid figures showing health conditions of North Korea, medical experts assume that parasite infection problems and serious health issues have been prevalent in the country,” said Choi Min-Ho, a professor at Seoul National University College of Medicine who specializes in parasites.

The soldier’s condition was “not surprising at all considering the North’s hygiene and parasite problems,” he said.

A South Korean soldier runs along a military fence on the road leading to the truce village of Panmunjom at a South Korean military checkpoint in the border city of Paju near the Demilitarized Zone (DMZ), Nov. 14, 2017.

A South Korean soldier runs along a military fence on the road leading to the truce village of Panmunjom at a South Korean military checkpoint in the border city of Paju near the Demilitarized Zone (DMZ), Nov. 14, 2017.

Hail of bullets

The soldier was flown by helicopter to hospital Monday after his dramatic escape to South Korea in a hail of bullets fired by North Korean soldiers.

He is believed to be an army staff sergeant in his mid-20s who was stationed in the Joint Security Area in the United Nations truce village of Panmunjom, according to Kim Byung-kee, a lawmaker of South Korea’s ruling party, briefed by the National Intelligence Service.

North Korea has not commented on the defection.

While the contents of the soldier’s stomach don’t necessarily reflect the population as a whole, his status as a soldier with an elite assignment would indicate he would at least be as well nourished as an average North Korean.

He was shot in his buttocks, armpit, back shoulder and knee among other wounds, according to the hospital where the soldier is being treated.

‘The best fertilizer’

Parasitic worms were also once common in South Korea 40 to 50 years ago, Lee noted during his briefing, but have all but disappeared as economic conditions greatly improved.

Other doctors have also described removing various types of worms and parasites from North Korean defectors.

Their continued prevalence north of the heavily fortified border that divides the two Koreas could be in part tied to the use of human excrement, often called “night soil.”

“Chemical fertilizer was supplied by the state until the 1970s, but from the early 1980s, production started to decrease,” said Lee Min-bok, a North Korean agriculture expert who defected to South Korea in 1995. “By the 1990s, the state could not supply it anymore, so farmers started to use a lot of night soil instead.”

In 2014, supreme leader Kim Jong Un personally urged farmers to use human waste, along with animal waste and organic compost, to fertilize their fields. A lack of livestock, however, made it difficult to find animal waste, said Lee, the agriculture expert.

Even harder to overcome, he said, is the view of night soil as the “best fertilizer in North Korea,” despite the risk of worms and parasites.

“Vegetables grown in it are considered more delicious than others,” Lee said.

FILE - North Korean leader Kim Jong Un smiles as children eat during his visit to the Pyongyang Orphanage on International Children's Day in this undated photo.

FILE – North Korean leader Kim Jong Un smiles as children eat during his visit to the Pyongyang Orphanage on International Children’s Day in this undated photo.

Limited diets

The medical briefing described the wounded soldier as being 170 cm (5 feet 5 inches) and 60 kg (132 pounds) with his stomach containing corn. It’s a staple grain that more North Koreans may be relying on in the wake of what the United Nations has called the worst drought since 2001.

Imported corn, which is less preferred but cheaper to obtain than rice, has tended to increase in years when North Koreans are more worried about their seasonal harvests.

Between January and September this year, China exported nearly 49,000 tons of corn to North Korea, compared with 3,125 tons in all of 2016, according to data released by Beijing.

Despite the drought and international sanctions over Pyongyang’s nuclear program, the cost of corn and rice has remained relatively stable, according to a Reuters analysis of market data collected by the defector-run Daily NK website.

Since the 1990s, when government rations failed to prevent a famine, North Koreans have gradually turned to markets and other private means to feed themselves.

The World Food Program says a quarter of North Korean children 6-59 months old, who attend nurseries that the organization assists, suffer from chronic malnutrition.

On average North Koreans are less nourished than their southern neighbors. The WFP says around 1 in 4 children have grown less tall than their South Korean counterparts. A study from 2009 said pre-school children in the North were up to 13 cm (5 inches) shorter and up to 7 kg (15 pounds) lighter than those brought up in the South.

“The main issue in DPRK is a monotonous diet — mainly rice/maize, kimchi and bean paste — lacking in essential fats and protein,” the WFP told Reuters in a statement last month.

Article source: https://www.voanews.com/a/north-korean-defector-health-hygiene/4125169.html

After Hurricane Maria, mental-health issues haunt Puerto Rico

SAN JUAN, Puerto Rico — Her memories of the storm come in flashes: neighbors’ screams, gushing water, swimming against the current with her son.

For Milagros Serrano Ortiz, a 37-year-old grandmother, the nightmare didn’t end when the storm did.

After two days of sheltering upstairs in a house across the street, she returned to find the walls of her own home caked with mud and a vile stench emanating from her cherished possessions, which were rotting in the heat.

Anguished and overwhelmed, she confessed recently to a psychologist at an emergency clinic that she had begun to have disturbing thoughts and worries that she might act on them.

“Like what?” the doctor asked.

Like swallowing a bottle of pills, she said. “Never waking up, and not feeling pain anymore.”

The violent winds and screeching rains of Hurricane Maria were a 72-hour assault on the Puerto Rican psyche.

Now, there are warning signs of a full-fledged mental-health crisis on the island, public-health officials say, with much of the population showing symptoms of post-traumatic stress.

Many Puerto Ricans are reporting intense feelings of anxiety and depression for the first time in their lives. Some are paranoid that a disaster will strike again. And people who had mental illnesses before the storm, and who have been cut off from therapy and medication, have seen their conditions deteriorate.

“When it starts raining, they have episodes of anxiety because they think their house is going to flood again,” said Dr. Carlos del Toro Ortiz, the clinical psychologist who treated Serrano Ortiz. “They have heart palpitations, sweating, catastrophic thoughts. They think, ‘I’m going to drown,’ ‘I’m going to die,’ ‘I’m going to lose everything.’”

With the island about to mark two months since the hurricane roared into Puerto Rico, its residents are still in shock. They are haunted by dozens of deaths caused by the storm, and many more life-threatening near-misses. The reminders are inescapable. They lie in piles of rotting debris as tall as homes that still line many streets and in cellphones that are useless for checking on family members.

Returning to a routine is the most important step toward overcoming trauma, according to physicians and public-health officials. But for most Puerto Ricans, logistical barriers such as scarce water and electricity, as well as closed schools and businesses, make that impossible.

Since Sept. 20, when the storm came ashore at 6:15 a.m., more than 2,000 calls have overwhelmed an emergency hot line for psychiatric crises — double the normal number for that period of time, even though most residents still do not have working phones. Puerto Rican officials said that suicides have increased — 32 have been reported since the storm — and many more people than normal have been hospitalized after being deemed dangerous to themselves or others.

At the emergency health clinic in Toa Baja, where Serrano Ortiz lives, Toro said that he had been frantically calling for help from colleagues in other cities because the facility was overrun with people in need of mental-health care.

Because it is in a flood zone, Toa Baja was one of the worst affected areas in Puerto Rico. At least four people died there and water levels peaked at more than 12 feet. The city of 80,000 west of San Juan flooded multiple times, each time that it rained after Maria passed.

In his nearly 20 years of practicing medicine, Toro said, he had never before hospitalized as many people with suicidal or homicidal thoughts in such a short time period. Of about 2,500 people who had been to the clinic since it opened two weeks earlier, more than 90 percent were referred for mental-health screenings, Toro said. He and other practitioners at the clinic had referred at least 20 people to psychiatric wards elsewhere on the island.

‘‘This is an emergency situation,’’ he said. ‘‘It’s still affecting us. There are people that we haven’t seen.’’

Prolonged losses of electricity, water, communications or infrastructure have been linked to the onset of mental health crises, said Dr. Domingo Marqués, the director of clinical psychology at Albizu University, a prominent graduate school of psychology on the island with clinics in two major cities. All of those elements have been relentlessly present in Puerto Rico.

‘‘And this is all happening at once,’’ he said. ‘‘What we have lost is the foundation that holds a society together.’’

He said that Puerto Ricans would have to adjust their definition of normalcy just to function: ‘‘It’s ‘I survived. My family didn’t die.’ That’s the new definition of OK.’’

This hurricane season has caused mental distress, and strained resources for treating it, throughout the Caribbean, according to reports from the U.S. Virgin Islands, Dominica and Antigua.

The mental-health division of the Puerto Rican health department received $3 million from the Federal Emergency Management Agency to coordinate a response to Maria, said Suzanne Roig, the administrator of the Puerto Rican agency.

Its doctors have been knocking on doors in the worst-hit parts of the island and visiting emergency shelters where people who lost their homes have been living.

‘‘We are trying to reach people to tell them that this crisis will pass,’’ she said, ‘‘and that they should not make permanent decisions.’’

The agency also started an initiative to monitor social media, and staged interventions in a handful of homes of people who posted what appeared to be suicide notes.

During high-volume hours, its staff members have been taking on extra shifts and working overtime to respond to the increase in phone calls to the 24-hour emergency crisis hot line.

For Serrano Ortiz, another threat to her mental and physical health loomed.

Before the storm, a scan of her throat had indicated that she might have cancer for the second time. But she has not been able to get any more information about her prognosis because her doctor’s offices have been closed.

At the emergency clinic, she told Toro that she might not have the energy to fight the disease again. When she looked in the mirror, she said, she saw in herself a reflection of her home — something dirty, smelly and tainted.

‘‘I don’t feel like myself anymore,’’ she said. 

Article source: http://www.dispatch.com/news/20171119/after-hurricane-maria-mental-health-issues-haunt-puerto-rico

A health-care plan from 2000 years ago could help America today

 (iStock)

There’s a group of Christians who have peace of mind even while America’s health-care system seems to spiral out of control. As an expression of our faith, we’ve opted out of health insurance entirely and decided to directly share one another’s medical costs.

We are inspired by a 2,000-year-old Christian tradition first practiced by the early church. The first Christians “had everything in common” and “shared everything they had,” says the Book of Acts. They met each other’s needs.

Our ministry, Medi-Share, was founded upon this principle in 1993, and today we help more than 300,000 people share each other’s medical costs. In that 24-year window of time, our members have shared over $1.4 billion of health-care expenses within our community and saved an additional $690 million through discounts we’ve directly negotiated with providers on our members’ behalf.

We’ve managed to do all this with our average member contributing about $350 a month.

As a not-for-profit religious community, we do our work exclusively as a service to society. And contrary to the largely impersonal experience that is the American health-care system, we strive to make our members feel like they’re part of an extended family.

Our members don’t just share medical expenses like strangers vaguely connected by their checks going into the same giant pool of money. Each month, they know precisely whose expenses they are contributing to, and they have the opportunity to connect with each other via prayer requests. This allows them to encourage and get to know one another.

Our members celebrate together when a new child is born or cancer is beaten. They grieve together when a loved one is lost or when tragedy befalls. No one has to navigate life’s ups and downs alone.

Health-care sharing isn’t right for everyone. Some people should use insurance. But sharing has been the right choice for our members. It’s connected families from coast to coast and transformed the health-care experience of hundreds of thousands of members.

A member of four years recently started struggling with heart problems and just a few months ago had surgery with severe complications. He ended up spending 26 days in the hospital and accumulating more than $170,000 in bills. After we negotiated down his fees, our community stepped up and took care of the balance.

He wrote us recently: “I can’t thank you enough for doing exactly what you said you would do when I joined.”

These are the kind of health-care solutions America needs – initiatives that will connect us to one another and help us help each other. That’s what health care should be about.

There’s just one thing I hope for in whatever comes of the debate happening between Republicans and Democrats in Congress, and it is that they understand and empathize with the health-care needs of the American people.

In this time of constant and confusing change in our nation’s health insurance markets, Medi-Share offers protection and peace of mind for millions of Americans whose plans are in peril, or who just want the security and satisfaction that comes from being part of a community committed to the biblical model of meeting each other needs. After all, there’s nothing more important than our faith and our health.

Ted Squires is the chief executive officer of Christian Care Ministry, a not-for-profit organization based in Melbourne, Florida that operates Medi-Share, one of the leading healthcare sharing ministries in the United States. Visit www.medishare.com.

Article source: http://www.foxnews.com/opinion/2017/11/19/health-care-plan-from-2000-years-ago-could-help-america-today.html

California Today: Rain Brings Health Hazards to the Homeless

But California has far more unsheltered homeless — around 66 percent of the state’s homeless live on the streets. By comparison, in New York state, just 4 percent of homeless people are unsheltered.

Dr. Reinking says the damp conditions outdoors are particularly dangerous for diabetics, who are more susceptible to foot infections that can sometimes become so severe they require amputation. He struggles to keep up with needs of his patients.

“Homelessness is an epidemic in California,” Dr. Reinking said. “We are grossly understaffed and under-resourced to respond.”

Winters are of course not as extreme in Northern California compared with cities in the Midwest or New England.

But a number of deaths from exposure were reported last winter in the Bay Area.

Oakland has winter shelters, which opened this week, but some homeless people are reluctant to use them because it means leaving their belongings behind, according to Lara Tannenbaum, the manager of Community Housing Services for the City of Oakland.

The city also hands out hats, coats and blankets.

At dusk on Thursday, groups of men and women huddled in camping tents under a freeway in Oakland, sheltered from the steady rain but not the dampness. “It’s hard to get warm,” said Eugene Jacobs, 27, who has been homeless for the past three years. “We have to change clothes three or four times a day. Everything keeps getting wet.”

“This is going to be hard,” Mr. Jacobs said about the onset of winter. “And this is the least of it.”

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California Online

(Please note: We regularly highlight articles on news sites that have limited access for nonsubscribers.)

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Senator Al Franken, Democrat of Minnesota, during a Judiciary committee hearing last month.

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Al Drago for The New York Times

• A Los Angeles radio newscaster accused Senator Al Franken on Thursday of kissing and groping her without consent in 2006, before he took public office. Mr. Franken, a Democrat of Minnesota, has apologized. [The New York Times]

• With help from 11 California Republicans, the House passed a tax overhaul that is expected to negatively effect state residents. Three Republicans joined California’s Democrats in opposing the bill. [The Los Angeles Times]

• California’s state budget is looking good. New projections from a nonpartisan office show the state is on track to finish its 2018-19 budget year with more than $19 billion in reserves. Analysts are recommending that lawmakers sock the surplus away. [The Sacramento Bee]

• State licensing agencies released a package of long-awaited rules that will regulate the sale of recreational marijuana when it becomes legal on Jan. 1. No, you will not be able to get your marijuana delivered by drone. [The San Francisco Chronicle]

• A man described as a “pathological predator” escaped a psychiatric facility in Hawaii on Sunday morning. Three days later the authorities arrested the man in Stockton. Exactly how he pulled off his far-flung escape remains unclear. [The New York Times]

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Elon Musk, chief executive of Tesla, revealed the company’s new electric semi truck at a Thursday night presentation in Hawthorne, Calif.

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Alexandria Sage/Reuters

• In a presentation in Hawthorne, Tesla unveiled a prototype for a battery-powered, nearly self-driving semi truck. The company promises that it will prove more efficient and less costly to operate than the diesel trucks that now haul goods across the country. And it won’t emit exhaust. [The New York Times]

• Starting next January, anyone who brings a car to Muir Woods National Monument will need a reservation. The new policy makes Muir Woods the first national park unit in the country to require year-round reservations for all vehicles. [The Mercury News]

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• In the decades since the Rat Pack era, Palm Springs has gradually shed its conservative political identity. Nowadays, it’s a mecca for gay and transgender people. And next month, every member of its City Council will be a member of that community. [The Los Angeles Times]

• The Los Angeles Philharmonic lost its lauded leader, Deborah Borda, to the New York Philharmonic. Now its stealing Simon Woods from the Seattle Symphony to replace her. [The New York Times]

• California’s getting older, fast. According to a new statewide report, the number of people 60 and older will jump 40 percent by 2030 — an aging boom that figures to have a wide ripple effect. [The Orange County Register]

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The Warriors’ Stephen Curry warmed up as Bob Fitzgerald (striped tie) and Jim Barnett did a pregame television broadcast last month. Barnett has been Golden State’s TV analyst since 1985, and Fitzgerald has done play-by-play for the team since 1993.

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Peter DaSilva for The New York Times

• Remember when the Golden State Warriors stunk? The three guys who have been calling the team’s games for decades do, and they appreciate the current hot streak. [The New York Times]

• Our reporter went hiking in California’s gold country with the composer John Adams. It was Mr. Adams way of mining for the real-life tumult of the early 1850s for his latest opera, “Girls of the Golden West.” It will premiere next week in San Francisco. [The New York Times]

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Les Gourmands in San Francisco’s South of Market neighborhood opened several weeks ago. A loaf of its brioche that serves four people costs $29.

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via Yelp

And Finally …

Yes, life has gotten pretty pricey in San Francisco. Rents are astronomical. Parking downtown for a few days will cost you a car payment. And now, some have complained, bread isn’t cheap either.

To be fair: Les Gourmands’ $29 “bread” — the target of recent internet scorn — is actually brioche; and it’s a four-person loaf that costs $29; a smaller taste for one will run you $3.50.

Sylvain Chaillout, the founder of Les Gourmands, is a fifth-generation baker who says the cost accounts for “a bit of everything.” Brioche, he notes, has always been a luxury item that requires great ingredients; his grandfather would be proud, Mr. Chaillout added, because the recipe is exactly the same as it’s always been.

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“It’s a reasonable price for a good product,” he said, drawing a parallel between his brioche and top-shelf champagne.

“We’re in San Francisco,” he added. “People have money.”

The New York Times has dozens of journalists based in California. They will be contributing to California Today while we seek a permanent California Today columnist. Check out the job posting for the weekday newsletter here.

California Today goes live at 6 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com.

California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.

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Article source: https://www.nytimes.com/2017/11/17/us/california-today-rain-brings-health-hazards-to-the-homeless.html

VA explores merging health system with Pentagon

WASHINGTON — As part of its effort to expand private health care, the Department of Veterans Affairs is exploring the possibility of merging its health system with the Pentagon’s, a cost-saving measure that veterans groups say could threaten the viability of VA hospitals and clinics.

VA spokesman Curt Cashour called the plan a potential “game-changer” that would “provide better care for veterans at a lower cost to taxpayers,” but he provided no specific details.

Griffin Anderson, a spokesman for the Democrats on the House Veterans Affairs Committee, said the proposal — developed without input from Congress — would amount to a merger of the VA’s Choice and the military’s TRICARE private health care programs. Committee Democrats independently confirmed the discussions involved TRICARE.

News of the plan stirred alarm from veterans groups, who said they had not been consulted, even as VA urges a long-term legislative fix for Choice by year’s end.

Health care experts also expressed surprise that VA would consider a TRICARE merger to provide private care for millions of active-duty troops, military retirees and veterans. The two departments generally serve very different patient groups —older, sicker veterans treated by VA and generally healthier service members, retirees and their families covered by TRICARE.

TRICARE is insurance that is paid by the government, but uses private doctors and hospitals. The VA provides most of its care via medical centers and clinics owned and run by the federal government, though veterans can also see private doctors through VA’s Choice program with referrals by VA if appointments aren’t readily available.

“My overarching concern is these are very dramatic changes in the way health care is delivered to veterans,” said Carrie Farmer, a senior policy researcher on military care at Rand Corp., who has conducted wide-ranging research for VA. “There haven’t been studies on what the consequences are in terms of both costs and quality of care.”

Navy Commander Sarah Higgins, a Pentagon spokeswoman, confirmed it was exploring with VA “many possible opportunities to strengthen and streamline the health of our service members and veterans.” She declined to comment on specifics “unless and until there is something to announce.”

In its statement to The Associated Press, Cashour explained that VA Secretary David Shulkin was working with the White House and the Pentagon to explore “the general concept” of integrating VA and Pentagon health care, building upon an already planned merger of electronic health care records between VA and the Pentagon. Because Shulkin has said an overhaul of VA’s electronic medical records won’t be completed for another seven to eight years, an effort such as a TRICARE merger couldn’t likely happen before then.

“This is part of the president’s efforts to transform how government works and is precisely the type of businesslike, commonsense approach that rarely exists in Washington,” Cashour said.

At least four of the nation’s largest veterans’ organizations — The American Legion, Veterans of Foreign Wars, AMVETS and Disabled American Veterans — called a TRICARE merger a likely “non-starter” if it sought to transform VA care into an insurance plan.

“VA is a health care provider and the VFW would oppose any effort to erode the system specifically created to serve the health care needs of our nation’s veterans by reducing VA’s role to a payer of care for veterans,” said Bob Wallace, executive director of VFW’s Washington office.

Louis Celli, director of veterans’ affairs and rehabilitation for The American Legion, said any attempts to outsource services away from VA medical centers and clinics would be financially unsustainable and likely shift costs unfairly onto veterans with service-connected disabilities.

He noted something similar occurred with TRICARE — military retirees were promised free care from military base hospitals. But then TRICARE began offering insurance to use private-sector care and TRICARE beneficiary co-pays are now rising. “The precedent the TRICARE model sets is not something we would accept on the VA side,” Celli said.

During the 2016 campaign, President Donald Trump pledged to fix VA by expanding access to private doctors. In July, he promised to triple the number of veterans “seeing the doctor of their choice.” More than 30 percent of VA appointments are made in the private sector.

Some groups have drawn political battle lines, with the left-leaning VoteVets and the American Federation of Government Employees warning of privatization and Concerned Veterans for America, backed by the billionaire conservative Koch brothers, pledging a well-funded campaign to give veterans wide freedom to see private doctors.

Rep. Tim Walz of Minnesota, the top Democrat on the House Veterans Affairs Committee, said the quiet discussions to integrate TRICARE with VA’s Choice were evidence “the White House was taking steps to force unprecedented numbers of veterans into the private sector for their care.”

“The fact that the Trump administration has been having these secret conversations behind the backs of Congress and our nation’s veterans is absolutely unacceptable,” said Walz, the highest-ranking enlisted service member to serve in Congress. He called for an immediate public explanation “without delay.”

A spokeswoman for Rep. Phil Roe of Tennessee, the Republican chairman of the House committee, said he planned to continue proceeding with his bipartisan legislative plan to fix Choice without integrating TRICARE. — (AP)

Article source: http://www.phillytrib.com/news/va-explores-merging-health-system-with-pentagon/article_47a4e4eb-717f-5b7e-8aa9-3c1788d41f18.html

Health giant Sutter destroyed evidence in crucial antitrust case over high prices, judge says

Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.

In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”

Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.

Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.

Famine in pregnancy impacts offspring’s mental health in adulthood

A new study looks at malnutrition and unborn children’s future mental health.

A study using historical data found that the offspring of mothers who endure famine during pregnancy have a higher risk of mental health issues in later life.

To a certain extent, what a pregnant mother experiences, so does her unborn child.

However, investigating the effects of adverse life events on a pregnant woman’s offspring can be challenging. The studies need long follow-ups, and, of course, there is no ethical way that pregnant women can be put under experimental duress.

Recently, researchers set out to uncover whether or not malnutrition during pregnancy would impact the future mental health of women’s offspring. To gain insight, they poured over historical data from the Dutch famine of 1944–1945.

The Dutch famine

During the last stage of World War Two, cities in the west of Holland were cut off from supplies. Throughout the majority of the war, the availability of food remained relatively constant, but in October 1944, it began to fall.

Daily rations dropped below 1,000 calories in the second half of November 1944, and then to fewer than 500 calories per day by April 1945.

At the end of April, the allies dropped 11,000 tons of food, and in May, the cities were liberated, rapidly restoring food supplies to normal levels.

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Due to the fact that the Dutch famine affected specific locations over a well-established time frame, it creates a perfect situation to study malnutrition’s effects; it is relatively simple to understand who bore the brunt and for exactly how long. For this reason, some researchers have referred to the Dutch famine as a human laboratory.

A number of studies have explored the health outcomes of prenatal famine exposure, but most of them have concentrated on physical conditions such as diabetes, obesity, and coronary heart disease, rather than any potential psychiatric outcomes.

Researchers who have examined mental health in this context have focused more on major psychiatric disorders, such as psychosis and schizoid personality disorder.

For the new study, the authors looked at a broader picture. They set out to “assess the long-term impact of prenatal exposure to the Dutch famine on mental health-related quality of life,” and their findings were published recently in the journal Aging and Mental Health.

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The impact of famine during pregnancy

The researchers took data from the Netherlands Kinship Panel Study. They focused on 673 people from the Netherlands born between 16 November 1942 and 3 February 1948.

This date range allowed the team to compare those whose mothers had experienced malnutrition during pregnancy as well as those whose mothers were pregnant years before and after the event but in the same locations.

All the participants completed a questionnaire designed to pick up affective disorder, anxiety, and depression. This was completed at an average age of 57. The data were adjusted for childhood poverty — a factor already linked with poorer mental health in later life.

Their analysis showed that mental health was, as expected, poorer for those whose mothers had suffered malnutrition during pregnancy. According to the authors:

[I]n the affected cities, mental health was significantly better for the pre-famine and post-famine cohorts compared to the famine cohort.”

They also found that the effect was more pronounced among women than men. For other areas of the Netherlands unaffected by famine, there were no differences in mental health between groups.

The results are interesting, but the authors note certain shortfalls in the study. For instance, they only knew where the children were living at the age of 15, rather than their exact place of birth. And, the sample size was relatively small.

It is also impossible to look at malnutrition in isolation; a pregnant woman who is struggling to find food will also be experiencing high levels of psychological stress, which could, in itself, influence her offspring’s long-term mental health.

That being said, the study does add a new layer to our understanding of the effects of famine on the unborn child, backing up earlier studies that had similar outcomes. The authors hope to continue their work and investigate the gender differences they measured in more detail.

Article source: https://www.medicalnewstoday.com/articles/320068.php

Millions of kids may lose health insurance over missed deadline by Congress

The diagnosis was dire: Roland Williams, a St. Louis boy with a megawatt smile and a penchant for painting, had an extremely rare form of lung cancer, oncologists told his mother in May 2016.

“They didn’t think he would make it to see his 10th birthday,” Myra Gregory said. “But thankfully the insurance was covering everything at that time, so we were happy to make it to see number 10 and 11.”

Roland is covered under the Children’s Health Insurance Program (CHIP), a federal health insurance program that provides inexpensive coverage to nearly 9 million children in low-income families.

Image: Roland Williams, 11, makes Christmas ornaments with his mother, Myra Gregory, at their home in St. Louis, MO.


Image: Roland Williams, 11, makes Christmas ornaments with his mother, Myra Gregory, at their home in St. Louis, MO.

For many kids, CHIP covers annual check-ups and other pediatrician visits; for Roland, it has made chemotherapy, radiation and surgery possible, all of which has made the difference between life and death.

But now Roland — who this week spent time getting ready for Christmas by painting ornaments in between hospital visits — is facing another blow: His health insurance may run out.

CHIP has enjoyed bipartisan support since its inception in 1997, but this year, legislators let the deadline for reauthorizing it pass as they bickered over other health care issues, primarily the latest Republican-led push to repeal and replace the Affordable Care Act.

While Americans are split over how to handle Obamacare, three-quarters of the public want CHIP renewed, according to the September Kaiser Health Tracking Poll.

If Congress doesn’t renew CHIP soon, the consequences could be far-reaching. The program provides health insurance for children and pregnant mothers in families that don’t qualify for Medicaid, yet can’t afford private insurance — people like Gregory, a single mother to Roland and his two younger brothers.

“There are so many other families out there that won’t even get treatment or be able to find out what’s wrong, or know that anything is wrong with their child,” Gregory, who does temp work at warehouses and factories, said. “I am very appreciative of all the help that I’ve received. But not receiving this is detrimental and can mean my son’s life.”

Image: A snapshot of the federal Children Health Insurance Program (CHIP)


Image: A snapshot of the federal Children Health Insurance Program (CHIP)

CHIP is funded by a combination of state and federal dollars. An estimated 11 states will run out of federal CHIP funding by the end of the year, according to a study by the Kaiser Family Foundation, a nonpartisan research organization, and 21 more states, including Missouri, where Roland is, will be depleted by March 2018.

“Don’t ask me why they can’t find 10 minutes to just call up this bill and pass it, but nothing is ever simple,” said Sara Rosenbaum, a professor of law and policy at the Milken Institute of Public Health at George Washington University, who has served as a presidential and congressional adviser since the 1970s.

“Popular programs are not above this,” she added. “In some ways, they become proxy wars for these controversial issues.”

Experts say the program’s payoffs have been astounding, citing Census Bureau data that shows that the rate of uninsured children in the U.S. in the past 20 years has dropped from 14 to about 4.5 percent.

“CHIP and Medicaid have worked together, particularly over the past decade, to reduce the number of uninsured children to historic levels,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

The program needs to be periodically reauthorized, but up until recently it wasn’t considered a particularly controversial piece of legislation.

Why legislators missed the Sept. 30 deadline to renew CHIP had more to do with other health care bills in Congress than it did with CHIP itself, experts say.



“It just fell through the cracks. The efforts were on the repeal and replace effort and Graham-Cassidy, and it just didn’t get the priority it deserved,” said Swapna Reddy, a professor at the School for the Science of Health Care Delivery at Arizona State University, referring to one of the bills aimed at Obamacare. “Nobody thought it would expire.”

An Office of Management and Budget official, speaking on the condition of anonymity, told NBC News that the Trump administration fully supports CHIP reauthorization and expects Congress to pass it quickly.

But how, or when, it will be reauthorized remains up in the air.

Both the House and the Senate have written nearly identical language to get CHIP through Congress. Earlier this month, the House passed a five-year CHIP reauthorization, but loaded the bill with offsets like cuts in programs for the elderly that don’t have bipartisan support and are unlikely to pass in the Senate.

The Senate has a CHIP bill that is more likely to pass, but haven’t scheduled a vote on it.

“There’s agreement on what the future of CHIP should look like in both the House and the Senate, but there’s not agreement on how to get that over the finish line,” said Jesse Cross-Call, senior policy analyst at the Center on Budget and Policy Priorities, a nonpartisan think tank that focuses on issues that affect low-income populations.

Hillary Clinton, who as first lady championed CHIP, chastised Congress for waiting.

“This is the first time where we’re really playing roulette with these kids and their families,” Clinton said on Nov. 9 at a health care symposium in Pennsylvania. “States are going to start shutting down these programs because they don’t have a funding stream.”

In the meantime, families like Roland’s are asking for help. Gregory has a GoFundMe set up and wrote an op-ed in The St. Louis Post-Dispatch begging Congress to take action.

“I hope that maybe if they really saw how this affected us, even one family, that they would do what they had to do to get it passed,” she told NBC News.

Article source: https://www.nbcnews.com/news/us-news/millions-kids-may-lose-health-insurance-over-missed-deadline-congress-n820261

Canadians Root For An Underdog Health Policy Idea From The US

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images


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Jay Mallin/Bloomberg via Getty Images

The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.

Jay Mallin/Bloomberg via Getty Images

Ask people in Canada what they make of U.S. health care, and the answer typically falls between bewilderment and outrage.

Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there’s anybody in the United States who can’t afford a visit to the doctor.

So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare Medicaid Innovation.

Obamacare's Test Kitchen For Payment Experiments Faces An Uncertain Future

CMMI was a hot topic on a reporter’s recent visit to Toronto to study the single-payer health care system.

Wonky as it seems, the center’s mission — testing innovations to hold down health care costs while increasing quality — is drawing praise from many policy analysts. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think creatively about payment and reimbursement models.

“It is gaining traction in many circles here,” says Dr. Robert Reid, who researches health care quality at the University of Toronto.

Thanks to the ACA, the center for innovation is equipped with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches for health care services that reward quality and efficiency, rather than the number of procedures performed.

“There have been some good efforts — they have tried more things than we have,” agrees Dr. Kaveh Shojania, an internist at same university who studies health care quality and safety.

Still, despite the praise emanating from north of the border, the U.S. program doesn’t get the same love on the homefront. Since taking office, President Donald Trump has moved to roll back the center’s reach.

Canada has its own reasons for seeing potential in this sort of systemic test kitchen.

Hospitals Worry Repeal Of Obamacare Would Jeopardize Innovations In Care

Health care’s growing price tag — and a payment system that doesn’t always reward keeping people healthy — is not just an American problem. The vast majority of Canadian doctors are paid through what Americans call the “fee-for-service” model. And Canadian policymakers are also looking for strategies to curb health care costs — which are a big part of federal and provincial budgets in Canada, too.

“The whole world is confronting the same issue, which is, ‘How do you pay and incentivize doctors to keep people out of the hospital and keep them healthy?’ ” says Dr. Ezekiel Emanuel, a former adviser to President Barack Obama, who pushed for the center’s initial development.

“Different places are looking at how to break out of that system, because everyone knows its perversions,” Emanuel says. “This is one place where … we are in the world among the most innovative groups.”

Emanuel says he’s not surprised to hear of the center’s appeal in Canada. He has received similar feedback from health ministers in Belgium and France, he says.

Even so, U.S. critics say CMMI’s work is a waste of money or a federal overreach.

And, so far, the Trump administration has taken steps to reduce by half the size of one high-profile Obama administration project that bundles payments for hip and knee replacements. Under the bundling program, the hospitals performing those are paid a set amount, rather than for individual services. The administration has also canceled other scheduled “bundling” projects that target payment for cardiac care and other joint replacements.

Seema Verma, Trump’s administrator of the Centers for Medicare and Medicaid Services, wrote in The Wall Street Journal in September that the innovation center was going to begin moving “in a new direction.”

A federal document recently issued by CMS suggests that the center for innovation will now emphasize cutting health care costs through strategies like market competition, eliminating fraud and helping consumers actually shop for care. It also says the innovation center will favor smaller-scale projects.

At least for now, it’s hard to interpret exactly what this means, says Jack Hoadley, a health policy analyst at Georgetown University who has previously worked at the Department of Health and Human Services.

Limiting CMMI’s footprint in the U.S. would be problematic, Emanuel says.

Meanwhile, the center’s influence in Canada, seems to be growing.

“We definitely looked to it as a model as something we can do. Like look, this happened, and why can’t we do the same thing here?” says Dr. Tara Kiran, a Toronto-based primary care doctor who also researches health care quality.

The nonprofit health newsroom Kaiser Health News is an editorially independent part of the Kaiser Family Foundation. Shefali Luthra covers health care for KHN. She’s on Twitter @shefalil.

Article source: https://www.npr.org/sections/health-shots/2017/11/17/564605223/canadians-root-for-an-underdog-health-policy-idea-from-the-u-s

Mental health trusts restrain patients ‘every 10 minutes’

Mental health trusts in England are restraining patients on average every 10 minutes, figures have revealed.

They show the number of incidents of restraint has increased each year since 2013.

Former health minister Norman Lamb said use of force was “endemic” in many units.

The Department of Health said it was working with the Care Quality Commission (CQC) to ensure the use of restraint is minimised.

Six restraints an hour

Figures from 40 mental health trusts in England revealed patients were restrained 59,808 times in 2016-17, equivalent to between six and seven incidents an hour.

This compares with 46,499 times in 2013-14.

The figures, released to the Liberal Democrats under the Freedom of Information Act, also showed an increase in injuries to patients and staff

However, use of the most extreme restraints, where patients are forced to the ground, fell 9% across 33 trusts.

Mental health trusts say they have improved their reporting of their use of restraint, which may have contributed to some of the rise.

Physical restraint is classed as “any direct physical contact where the intention is to prevent, restrict, or subdue movement of the body (or part of the body) of another person”.

The Department of Health says there must be “a real possibility of harm to the person or to staff, the public or others” for restraint to be used.

‘Treated like an animal’

Image copyright
Mind

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Liz Rotherham believes it was unnecessary to restrain her

Liz Rotherham suffers from psychotic episodes and said she has been restrained in hospital on three occasions.

She claimed it happened at the The Linden Centre in Chelmsford and The Lakes in Colchester. The most recent was in 2013.

“I don’t know why they felt the need to it,” said the 46-year-old from Essex. “I wasn’t throwing things around, I wasn’t being abusive or anything like that.

“They actually hurt me, which wasn’t very nice. I had six people holding me down on a crash mat. They pulled down the side of my knickers and injected me.”

She said that a female police officer attending the unit once told her “don’t be a wuss”.

“I will never, ever forget that. I felt like I was being treated like an animal.”

Ms Rotherham said she believed someone could have sat down and talked to her without the need for restraint.

The Essex Partnership University NHS Foundation Trust, which runs the hospitals, said it could not comment on an individual patient’s case.

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Getty Images

‘Concerning rise’

Dr Sridevi Kalidindi of the Royal College of Psychiatrists said the data showed some trusts were making progress but consistent improvements were not being seen across the board.

“The increase in the number of restraints recorded is concerning,” she said. “Cuts to bed numbers and community care programmes mean you now have to be more ill to be admitted to a mental health unit.”

Dr Kalidindi said increasing use of agency staff meant fewer permanent staff trained to de-escalate situations were available.

Mental health: 10 charts on the scale of the problem

Mental health staff on stress leave up 22%

‘Humiliating, terrifying’

Lib Dem health spokesman Norman Lamb said: “Many inspiring units have demonstrated how you can very significantly reduce the use of force, training staff in de-escalation.

“This can avoid situations which lead to stress and conflict. This needs to be given much greater priority by the Government.”

Vicki Nash of mental health charity Mind, said: “Physical restraint can be humiliating, terrifying, dangerous and even life-threatening.

“There is currently a Private Members’ Bill going through parliament which, if it becomes law, has the opportunity to increase transparency and accountability around the use of force in mental health settings.”

A Department of Health spokeswoman said: “Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this.

“We want patients to be treated and cared for in a safe environment and we are actively working with the regulator, the Care Quality Commission, to ensure the use of restraint is minimised.”

Article source: http://www.bbc.com/news/uk-england-41914555