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Democrats ran and won on health care. Now what?

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9 Things Your Ability To Focus Says About Your Health

An ability or inability to focus is not as simple an issue and diagnosis as it may seem. A variety of physical and mental conditions, as well as lifestyle factors, can lead to someone having trouble focusing. Whether a new doctor or just a new sleep schedule is needed, your ability to focus can say a lot about your health.

Struggling with concentration is more than just an inconvenience. Lack of focus can become first in a line of more serious issues. If you can focus, however, you’re more honed into some important mental strengths. “The ability to focus increases your mental performance,” Dr. David Greuner, of NYC Surgical Associates, tells Bustle. “You’re better able to problem solve and make decisions more effectively. It’s important to strengthen your concentration by bringing your wandering mind back to your point of focus [... and] when you’re struggling to focus, most likely it’s a sign that you’re under stress and need to slow down.” If you struggle bringing yourself back to a point of concentration, then you may have an underlying health issue.

Even if you feel like you’re simply too stressed to focus, that in an of itself can affect your health. It is important, therefore, to break down the variety of things that can cause focusing to become difficult, and check in with a doctor if you’re noticing any serious changes.

Here are nine things your ability to focus says about your health, according to experts.

1You Could Have A Hormonal Imbalance

Andrew Zaeh for Bustle

2You May Be Experiencing Anxiety

Andrew Zaeh for Bustle

Anxiety doesn’t just feel like worry. If you’ve noticed an inability to focus, perhaps coupled with racing thoughts, then you might be dealing with anxiety’s other effects.

“When our brains are unable to sit comfortably with just one thought at a time, concentration is inevitably impaired,” Backe says. “This can be down to anxiety or stress and can affect your overall cognitive performance.” Anxiety relief techniques may help you rebuild your concentration skills.

3You Could Be Dealing With A Lack Of Sleep

Andrew Zaeh for Bustle

Not getting enough sleep can be a pretty straightforward reason for struggling to concentrate.

“When your brain lacks sleep, connections between cells are weakened, leading to less cognitive ability,” Backe says. “These could be disturbances that you don’t even pick up on, so it’s worth visiting your local doctor if you think you’re getting enough sleep but are always fatigued.” Conditions like sleep apnea can cause interruptions you may not notice, and adults need seven to nine hours of sleep, even if everyone around you says they’re getting five.

4You May Be Feeling The Effects Of Chronic Stress

Ashley Batz/Bustle

Chronic stress is different than an anxiety disorder, but similarly harmful. Stress can also be a major factor when it comes to your ability to focus.

“While acute stress or anxiety over an exam or project that is due for example may cause us to focus more and get the work done, chronic stress [...] can make it very difficult to stay focused, sometimes on even the simplest of task,” Adam Perlman, MD, MPH, FACP, an Integrative Health and Wellbeing expert at Duke University, tells Bustle. If you’ve found the stress in your life is adding up, it may be time to find a doctor and make a change.

5You Could Be Experiencing The Effects Of Chronic Pain

Ashley Batz/Bustle

Most people living with chronic pain are familiar with the term “brain fog” — a serious cognitive side effect of long-term health problems. Pain and brain fog can be major factors that impede concentration.

“Certain health related conditions may make the ability to focus more difficult,” Dr. Perlman says. “[...] Pain can zap our ability to focus and chronic pain [...] can directly impact our ability to focus as well as indirectly, through things like disrupting our sleep.” Finding innovative ways to treat and care for chronic pain may help those experiencing these problems not also have to deal with issues like lack of focus.

6You Could Have ADHD

Hannah Burton/Bustle

Unfortunately, the stigma around ADHD, and the misunderstanding of the symptoms of ADHD in women, means that sometimes, it takes a long time to get the diagnosis a person needs.

“[...] Attention deficit [hyperactivity] disorder or [ADHD] is a classic condition where one’s ability to focus is impacted,” Dr. Perlman says. “Certainly, if ability to stay focused is a concern, this should be discussed with a healthcare provider.” If a lack of focus has been bothering you, you deserve a proper diagnosis and treatment.

7You Could Being Going Through Menopause

Rocketclips, Inc./Shutterstock

8You Might Be Iron-Deficient

Hannah Burton/Bustle

Being deficient in essential nutrients can cause a variety of physical and mental symptoms. This is worth noting when it comes to your ability to focus.

“Iron is an essential micronutrient that is needed for carrying oxygen throughout your body to the tissues that need it,” Dr. Roussell says. “Iron deficiency is twice as likely to impact women than men and one of the primary symptoms is fatigue which makes focusing difficult.” Luckily, iron deficiency can be diagnosed through a blood test and treated with supplements and dietary changes.

9You May Have Thyroid Problems

Ashley Batz/Bustle

A final health condition that could be affecting your ability to focus is thyroid problems.

“Many people with thyroid problems experience issues with their memory span and ability to concentrate,” Dr. Greuner says. Thyroid problems often have a variety of symptoms, and can also be diagnosed with blood work. These conditions are another reason that a prolonged inability to focus warrants a trip to the doctor.

An inability to focus can be due to everyday stress and fatigue, but over a long period of time can become a serious issue. Also, difficulty concentrating is often a common symptom of a variety of health conditions, usually coupled with other symptoms. If your inability to focus has been affecting your daily life, it’s important to seek professional help and find the treatment plan you deserve.

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What will wildfire smoke do to my health? Long term, even experts don’t know

Kaitlyn Daut was in her third trimester in October 2017, when the Wine Country fires spread to Solano County, not far from her Vacaville home.

Daut’s family and home survived the fire unscathed but she, like thousands of other Bay Area residents, spent days breathing smoky air caused by the wildfires. The same is happening now as the Camp Fire rages in Butte County, creating noxious air throughout much of Northern California. And climate experts say larger and more frequent blazes are likely to happen again.

“I was certainly worried,” said Daut, 28, who delivered her son Evan in December. “The smoke did affect me, and I thought, ‘Well, if I’m breathing in all these potential toxins, what is it doing to my baby, since we are one system?’”

Evan, now 11 months old, is healthy and has not shown any signs of respiratory problems, Daut said. Still, she wonders if he may be more likely to develop asthma or experience other longer-term health effects from the fires. So last spring, when UC Davis researchers began recruiting Bay Area women who were pregnant at the time of the fires — or became pregnant shortly after — to try to answer that very question, Daut signed up. Researchers collected samples of her blood, breast milk and saliva, and saliva from Evan as well.

The study of pregnant women, and a second UC Davis study focusing on the general population, are among the first to try to uncover the long-term health effects of wildfire smoke exposure on people who lived in the fire zone and in surrounding counties, researchers said. Both are funded by the National Institute of Environmental Health Sciences, part of the National Institutes of Health, for two years.

There is little data on the long-term health impacts of wildfire smoke on the general population — those that would capture changes in one’s health 18 months or longer after exposure. This is in part because it’s difficult to conduct long-term studies on sporadic events, and because of a lag time in getting grants approved for event-specific research projects.

Most research has focused on how smoke exposure affects firefighters or how air pollution, not wildfire smoke specifically, affects people’s health. Many large studies have linked air pollution to heart and lung diseases; one 2012 study found that pregnant women who were exposed to smoke during the 2003 wildfires in Southern California delivered babies with slightly lower birth weight than normal.

“We knew these questions were on moms’ minds,” said Rebecca Schmidt, a UC Davis molecular epidemiologist who is leading the study of pregnant women. “It’s a particularly vulnerable time for the mom and the developing fetus, especially with recent fires hitting urban areas burning all kinds of plastics. Who knows what is going into the air?”

Schmidt’s team has collected specimen samples and survey responses from about 200 women from the 2017 North Bay fires, and it is seeking university approval to expand the study to include pregnant women from the Camp Fire.

The researchers are examining, among other things, what pregnant women did to limit their exposure, such as wearing masks. They are also looking at indirect health effects, such as prolonged stress from being displaced or losing family members or friends. They are just starting to analyze the data. Anecdotally, they have learned that some women delivered healthy babies while others did not — though that could be due to many factors other than the fires.

“We tell moms, ‘Right now we just don’t know,’” Schmidt said. “The flip side is the fetus is more protected than we think; maybe we’ll show there aren’t major effects. Either way, it’s good to know what they’ve done during the fires, any action they can take to limit their risk to exposure.”

Schmidt’s colleague Irva Hertz-Picciotto, a UC Davis environmental epidemiologist who is leading the study on the general population, has collected data from about 6,000 people from 2,000 households, mostly in Sonoma County. She is tracking whether they are experiencing respiratory problems, mental health issues like depression, trouble sleeping, and increased use of alcohol or cigarettes.

There are similarities between particles found in air pollution from fossil fuels and those found in wildfire smoke. Both contain toxic particles that are invisible to the naked eye that can penetrate into lung tissue and get into the bloodstream. These particles are 2.5 micrometers in size — about one-fortieth the width of a strand of hair. There are also differences, though, that scientists don’t fully understand.

When residential areas burn, they release chemicals into the atmosphere that aren’t emitted when wooded or grassy areas burn. Plastics, household cleaning products, metals from vaporized stoves and washing machines, and synthetic materials from carpets add to poor air conditions. Researchers don’t know what kind of long-term health conditions could be caused or exacerbated by exposure to these compounds.

“Our guess is that it’s much more toxic when that is involved, versus a pure forest fire,” said Dr. Mary Prunicki, an instructor at Stanford School of Medicine who has been studying the health effects of air pollution for five years and recently began shifting her focus to wildfires as they became more frequent. “But that’s not the easiest question to answer — what’s in wildfire smoke as opposed to air pollution caused by cars.”

One way to learn more about this could be to collect hair samples from people who were exposed to wildfire smoke, said Hertz-Picciotto, who is considering doing so for people who were close to the Camp Fire. Researchers know how quickly hair grows — about a fifth of an inch per month — and could work backward to see what chemicals someone was exposed to around the time of the fires. If small particles got into the bloodstream, they could eventually make their way to the hair follicles and into the hair shaft.

“My hope is we’ll be able to follow these people,” she said. “We also want to compare different neighborhoods — did the smoke affect people differently? Did recovery for people in wealthier neighborhoods who may have had better access to health care and resources to rebuild (differ)? We have a lot of questions we hope to answer.”

Catherine Ho is a San Francisco Chronicle staff writer. Email: Twitter: @Cat_Ho

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Public Health Experts On New FDA E-Cigarette Rules: It’s Complicated

In this Oct. 13, 2018, photo, Max Chan, owner of an e-cigarette shop, arranges e-cigarette devices and e-liquid at his shop in Hong Kong. Hong Kong’s leader says the semi-autonomous Chinese territory plans to ban e-cigarettes and other new smoking products such as heat-not-burn products and herbal cigarettes to protect public health. (AP Photo/Kin Cheung)ASSOCIATED PRESS

Nearly all e-cigarette flavorings can no longer be sold in convenience stores or any other brick-and-mortar store except adult-only vaping shops, according to new regulations announced by FDA Commissioner Scott Gottlieb this week. Only mint, menthol and tobacco flavorings can still be sold alongside unflavored e-cigarettes and traditional cigarettes in food and convenience stores, and any flavorings sold online must have stringent age verification requirements that are still being developed, as I reported here yesterday.

The new measures, along with restrictions on flavored cigars and continuing steps to ban menthol cigarettes, are part of Gottlieb’s stated commitment to address rapidly increasing rates of teen vaping, or e-cigarette use. But adults who have successfully used e-cigarettes to quit smoking worry the restrictions will make it harder for others to make the switch from traditional to electronic cigarettes and reduce harm to their health caused by nicotine dependence.

The research, both on vaping as a “gateway” to smoking and on e-cigarettes as an effective smoking cessation strategy, is growing but still far from definitive in either case. So in the midst of strengthening but still inadequate research, and the tension between protecting kids and helping adults quit the number one cause of cancer and other chronic diseases in the US, what do public health experts think about the FDA’s moves?

Understandably, most public health experts have been cautious about taking too strong a stance, recognizing the competing priorities and the ambiguities in the data. Some, however, such Stanton A. Glantz, PhD, director of the Center for Tobacco Research Control Education at the University of California San Francisco, are vocal opponents of e-cigarettes and their potential as smoking cessation tools. He is among the voices who have criticized Gottlieb for being slow to act on rising teen vaping rates and risks of e-cigarettes.

Others see potential benefits and drawbacks to the FDA’s announcement. I communicated with two public researchers who generally believe in the value of vaping as a harm reduction alternative to smoking but don’t view e-cigarettes as harmless.

“I don’t envy FDA,” Kenneth Warner, professor emeritus of the University of Michigan School of Public Health, told me in an email. “Finding the ‘sweet spot’ of e-cigarette regulation is tough. Most anything they do to discourage youth vaping will risk reducing the usefulness of vaping as smoking cessation aid.”

Warner said it’s impossible to tell right now whether the new FDA measures specific to e-cigarettes will affect teen vaping rates, but his best educated guess is that they will have “a favorable impact,” though how much is anyone’s guess.

“Because kids are attracted to flavors (especially fruit flavors) and because the policy will reduce (not eliminate) their access to flavored products, it should reduce the attraction of vaping somewhat,” Warner said, but he then acknowledged the potential negative consequences for current adult smokers.

“E-cigarettes are now the number one aid to quitting among smokers—used more frequently than the FDA-approved nicotine replacement pharmaceuticals,” Warner said. He said reduced switching among adults from vaping to smoking cannot be an entirely “unintended” effect because Gottlieb himself acknowledged “the need to ‘slow the off-ramp’ from smoking [adults switching] in order to decrease ‘the on ramp’” [kids starting to smoke after vaping].

FDA Is Not Doing Enough About Smoking

Michael Siegel, MD, MPH, a professor of community health sciences at the Boston University School of Public Health, goes even further, calling out the FDA for perceived hypocrisy. Though he acknowledges that restricting e-cigarette sales to adult-only stores should help reduce youth access to them, he points to the far greater threat of traditional combustible cigarettes—still sold in ordinary stores—to teens’ health.  An estimated 8% of high school students smoke traditional cigarettes, according to the CDC, and more than 3,000 adolescents try their first cigarette every day, he said.

“There is absolutely no valid public health rationale behind prohibiting the sale of most e-cigarettes, but allowing the real toxic cigarettes to remain on the shelves,” Siegel told me. “Although Juul use among youth clearly needs to be addressed, we have to be careful not to completely lose our sense of perspective. Smoking still kills more than 1,000 people every day. There is no evidence that vaping kills anyone.”

As a scientist who has long vocally supported the use of e-cigarettes to quit smoking, Siegel worries about a net negative impact on public health from the FDA’s actions.

“It is going to force many ex-smokers who stay smoke-free using e-cigarettes to return to smoking when their favored products are no longer available on retail store shelves,” he said. “Some will find alternate sources or will switch brands, but many will probably find it easier to must return to smoking.”

The decision to ban menthol cigarettes, however, appears much more clear-cut, with seemingly universal support from public health experts, especially considering the increased burden of nicotine addiction among black teens, menthol cigarettes’ biggest customer. Warner also considers it sensible to keep mint and menthol flavors available in e-cigarettes.

“If e-cigarettes are to have any utility in helping adults to quit smoking, they have to be consumer-attractive products,” Warner said. “Maintaining mint/menthol seems like a bare minimum,” though he noted other flavorings will still be available in vaping shops and online.

Experts also support strict age verification for online sales of e-cigarette products. It’s the question of their sales in ordinary stores, particularly in rural areas that may not have vaping shops, that becomes problematic.

Competing Priorities: Pay the Price Now or Later?

One of the challenges in balancing smokers’ right to have accessible flavored e-cigarettes as a cessation aid versus stopping a wave of new nicotine dependence in youth is the long delay in health effects of the latter compared to the former.

“Kids who might become addicted to nicotine by vaping and then become regular vapers or—much worse—smokers, are not going to begin to experience the most serious chronic disease consequences of their behaviors for 25-30 years,” Warner said. “In contrast, adult smokers 40 and older are very much at risk of those diseases now. Further, quitting smoking has immediate health benefits and can reduce the enormity of the toll of smoking right away.”

About a half million Americans die from smoking every year, Warner said, which translates to one death caused by smoking for every four or five deaths from other causes.

“We have to keep our eye on the prize: eliminating the use of combusted tobacco,” Warner said. “Smokers need to understand that it is not the nicotine per se that kills smokers. Rather it is the scores of serious toxins in the 7,000 chemicals in cigarette smoke that is responsible for all those deaths.”

The best thing any smoker can do for their health is to quit smoking, Warner said. But nicotine is one of the most addictive substances in the world. Contrary to what many still believe, quitting smoking nearly always requires more than simple willpower. It requires overcoming deeply tread physical and chemical pathways in the brain, and for an indeterminate number of smokers, vaping satisfies the same needs and cravings as smoking without as many of those 7,000 chemicals.

What Else Can Be Done to Reduce Teen Vaping?

The moves announced by Gottlieb aren’t the only options for reducing teen vaping, public health experts also say, and some of the measures he is taking are long overdue. Eliminating menthol cigarettes, for example, should have happened long ago, Warner says.

“The agency needs to focus on risk-proportionate regulation, focusing on discouraging use of the most dangerous tobacco products, those that are combusted [traditional],” Warner said. “The single most important [policy] would be establishing age 21 as the minimum age for purchase of e-cigarettes (and, especially, for cigarettes and other tobacco products).”

He also suggested much more punitive consequences for stores that sell to underage people, such as costlier fines for first offense and temporary or permanent loss of license for subsequent offenses.

Siegel described two other evidence-based approaches to reducing teen vaping:

“First is raising the price of e-cigarettes by imposing excise taxes on these products,” he said, though adding that “there should be an even higher tax imposed on tobacco cigarettes, so that the price advantage for e-cigarettes is maintained.”

The other is the same strategy that successfully helped turn the tide on smoking by de-glamourizing it: “run media campaigns to try to change social norms regarding vaping,” Siegel said. “I would argue that Juuling is what absolutely needs to be addressed, as this is the real threat in terms of youth addiction to nicotine, not other forms of vaping.”

Neither Dr. Warner nor Dr. Siegel receives funding from tobacco or e-cigarette companies or trade groups.

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Exclusive: House Democrats will introduce a bill to protect millions of health care workers

A group of House Democrats will introduce a bill on Friday to help protect millions of nurses and other health care workers from the high rates of violence they experience on the job.

The new bill, called the Workplace Violence Prevention for Health Care and Social Service Workers Act, would require hospitals, nursing homes, rehab centers, and jails to develop a workplace safety plan to protect their workers from violence they experience at the hands of patients — a surprisingly common phenomenon. The bill would also require employers to record and investigate all complaints of violence, and prohibits retaliation against employees who call 911. A draft of the bill was shared with Vox.

In 2016, health care and social service workers suffered 69 percent of all workplace violence injuries, according to the Bureau of Labor Statistics, and were nearly five times more likely to experience violence on the job than the average US worker. They are more likely to get injured at work than even police officers and prison guards. Nurses suffer in particular.

“Registered Nurses are often threatened, punched, kicked, beaten, and assaulted on the job, sometimes with deadly consequences,” said Jean Ross, a registered nurse and co-president of the National Nurses United labor union, in a statement to Vox. The union has been pushing for federal legislation for years.

The bill, which is sponsored by Rep. Joe Courtney (D-CT), would essentially turn into law current guidelines from the Occupational Safety and Health Administration at the Department of Labor. A hospital’s violence prevention plan could involve hiring more security guards, installing surveillance cameras, and training staff in how to respond to violent incidents.

The rule covers all employees, whether hired directly by a hospital or employed as a subcontractor.

Violence against health care workers is a national problem

There are currently no federal rules that require that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. In October 2016, California passed the toughest rules in the country, requiring health care employers to develop tailored violence prevention plans for each workplace with employees’ input. But the problem is not unique to California.

Between 2005 and 2014, there was a 110 percent spike in the rate of violent incidents reported against health care workers. In one informal survey, as many as one in four nurses suggested that they had been attacked at work between 2013 and 2014 alone. Patients often kick, scratch, and grab them, and in rare cases, even kill them.

I also spoke to several nurses about their experiences for the Atlantic in 2016:

Rose Parma, a registered nurse in California’s Central Valley, says … patients have spit on her, slapped her, and even threatened her life during the five years she has worked as a hospital nurse. But it reached an intolerable level about a year into her career, when a delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground. She was two months pregnant. The pain was not as shocking as her supervisor’s response when she reported the incident. “The manager seemed so surprised and said ‘Has this never happened to you? Is this really the first time?’ As if it weren’t a big deal,” Parma says. The manager then told Parma she would see her the next day at work. “I literally thought I was going to die [during the attack], and they didn’t even offer me counseling.” (Her baby survived.)

Nurses say that not only do employers expect them to put up with violence on the job, but they often get punished if they call police.

And it keeps happening. In 2017, health care and social service workers were still more likely to experience violent injuries than those in any other industry. Which is why Reps. Courtney and Ro Khanna (D-CA) and some of their colleagues decided congressional action is needed.

“This legislation compels OSHA to do what employees, safety experts, and Members of Congress have been calling for years — create an enforceable standard to ensure that employers are taking these risks seriously, and creating safe workplaces that their employees deserve,” said Courtney in a statement provided to Vox.

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Brainstorm Health: Health Care Business Leaders, FDA E-Cigs Ban, Health Care on the Blockchain

Long-awaited e-cig rules roll out. As expected, the Food and Drug Administration (FDA) has rolled out proposed rules that would largely make e-cigarette sales at convenience stores a thing of the past. The agency is moving to ban flavored vape products from convenience stores (and, eventually, menthol cigarettes, too) and limit them to certain online vendors and specialty tobacco shops as part of an effort to prevent children from getting hooked on nicotine. “I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” said FDA Commissioner Scott Gottlieb in a statement. “We’ll take whatever action is necessary to stop these trends from continuing.” (Fortune)

Time off for organ donors. Children’s Mercy hospital of Kansas has a novel idea—maybe people who decide to donate their organs should, well, get some extra time off for their efforts. “Children’s Mercy employees who agree to serve as a bone marrow or solid organ donor may use up to 40 hours of additional Extended Illness Time when they qualify for a leave of absence due to their inability to work during and immediately following the donation,” according to a spokesperson.

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National Rural Health Day observed in Alabama

“Many communities that just don’t have routine access to health care, very difficult for rural hospitals to stay open, it is very difficult for rural communities to have providers who want to move, live and practice in those communities,” said Harris. “The hospital or nursing home may well be the largest employer in the county. We want to put the spotlight on these communities and particularly illustrate what it means to have good health care.”

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‘We’re All Kind of Feeling It.’ Wildfires Prompt Concern Over Major Health Consequences

Smoke masks. Eye drops. No outdoor exercise. This is how Californians are trying to cope with wildfires choking the state, but experts say an increase in serious health problems may be almost inevitable for vulnerable residents as the disasters become more commonplace.

Research suggests children, the elderly and those with existing health problems are most at risk.

Short-term exposure to wildfire smoke can worsen existing asthma and lung disease, leading to emergency room treatment or hospitalization, studies have shown.

Increases in doctor visits or hospital treatment for respiratory infections, bronchitis and pneumonia in otherwise healthy people also have been found during and after wildfires.

Some studies also have found increases in ER visits for heart attacks and strokes in people with existing heart disease on heavy smoke days during previous California wildfires, echoing research on potential risks from urban air pollution.

For most healthy people, exposure to wildfire smoke is just an annoyance, causing burning eyes, scratchy throats or chest discomfort that all disappear when the smoke clears.

But doctors, scientists and public health officials are concerned that the changing face of wildfires will pose a much broader health hazard.

“Wildfire season used to be June to late September. Now it seems to be happening all year round. We need to be adapting to that,” Dr. Wayne Cascio, a U.S. Environmental Protection Agency cardiologist, said this week.

In an overview published earlier this year, Cascio wrote that the increasing frequency of large wildland fires, urban expansion into wooded areas and an aging population are all increasing the number of people at risk for health problems from fires.

Wood smoke contains some of the same toxic chemicals as urban air pollution, along with tiny particles of vapor and soot 30 times thinner than a human hair. These can infiltrate the bloodstream, potentially causing inflammation and blood vessel damage even in healthy people, research on urban air pollution has shown. Studies have linked heart attacks and cancer with long-term exposure to air pollution.

Whether exposure to wildfire smoke carries the same risks is uncertain, and determining harm from smog versus wildfire smoke can be tricky, especially with wind-swept California wildfires spreading thick smoke hundreds of miles away into smoggy big cities.

“That is the big question,” said Dr. John Balmes, a University of California, San Francisco, professor of medicine who studies air pollution.

“Very little is known about the long-term effects of wildfire smoke because it’s hard to study populations years after a wildfire,” Balmes said.

Decreased lung function has been found in healthy firefighters during fire season. They tend to recover but federal legislation signed this year will establish a U.S. registry tracking firefighters and potential risks for various cancers, including lung cancer. Some previous studies suggested a risk.

Balmes noted that increased lung cancer rates have been found in women in developing countries who spend every day cooking over wood fires.

That kind of extreme exposure doesn’t typically happen with wildfires, but experts worry about the kinds of health damage that may emerge for firefighters and residents with these blazes occurring so often.

Whether that includes more cancer is unknown. “We’re concerned about that,” Balmes said.

Regular folks breathing in all that smoke worry about the risks too.

Smoke from the fire that decimated the Northern California city of Paradise darkened skies this week in San Francisco, nearly 200 miles southwest, and the air smelled “like you were camping,” said Michael Northover, a contractor.

He and his 14-year-old son have first-time sinus infections that Northover blames on the smoke.

“We’re all kind of feeling it,” Northover said.

Most schools in San Francisco, Sacramento, Oakland and Folsom said they would be closed Friday because of poor air quality.

An Environmental Protection Agency website said that air quality in Sacramento was “hazardous” on Thursday afternoon and San Francisco’s was “very unhealthy.” Many people walking around the cities wore face masks.

Classes were canceled Thursday in at least six universities in Northern California as smoke from the fire continued to blanket all nine counties of the Bay Area. Some were closing all buildings but others, including Cal State East Bay said libraries, health centers and dining halls would stay open.

At Chico State University, 11 miles from Paradise, ash was falling this week and classes were canceled until after Thanksgiving.

“It’s kind of freaky to see your whole town wearing air masks and trying to get out of smoke,” said freshman Mason West, 18. “You can see the particles. Obviously it’s probably not good to be breathing that stuff in.”

West returned home this week to Santa Rosa, hard hit by last year’s wine country fire, only to find it shrouded in smoke from the Paradise fire 100 miles away. West’s family had to evacuate last year for a week but their home was spared.

“It’s as bad here as it was in Chico,” West said. “It almost feels like you just can’t get away from it.”

Smoke has been so thick in Santa Rosa that researchers postponed a door-to-door survey there for a study of health effects of last year’s fire.

“We didn’t feel we could justify our volunteer interns going knocking on doors when all the air quality alerts were saying stay indoors,” said Irva Hertz-Picciotto, a public health researcher at the University of California, Davis. The study includes an online survey of households affected by last year’s fire, with responses from about 6,000 people so far.

Preliminary data show widespread respiratory problems, eye irritations, anxiety, depression and sleep problems around the time of the fire and months later.

“Conventional thinking is that these effects related to fires are transient. It’s not entirely clear that’s the case,” Hertz-Picciotto said.

Researchers also will be analyzing cord blood and placentas collected from a few dozen women who were pregnant during the fire, seeking evidence of stress markers or exposure to smoke chemicals.

They hope to continue the study for years, seeking evidence of long-term physical and emotional harms to fire evacuees and their children.

Other studies have linked emotional stress in pregnant women to developmental problems in their children and “this was quite a stress,” Hertz-Picciotto said.

It’s a kind of stress that many people need to prepare for as the climate warms and wildfires proliferate, she said.

“Any of us could wake up tomorrow and lose everything we own,” she said. “It’s pretty scary.”

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What are the top health IT priorities in Europe? Not so different from the US

Hospital IT executives in Europe share many of the same priorities and face many similar challenges as CIOs in other regions of the globe, including the United States, according to the HIMSS Analytics Annual European eHealth Survey 2018 released on Wednesday.

Among them: empowering patients, sharing health information, protecting sensitive data and managing the growing need for a deeper talent pool.


Healthcare entities around the globe are all facing what is essentially the same set of opportunities and challenges in digital transformation.  

Whether you call it patient experience, engagement or empowerment, HIMSS Analytics found that consumers owning and managing their own data, whether in apps or wearables, is a high priority among the 571 health information and technology professionals who participated in the survey.

“The level of achievement varies,” said Jorg Studzinki, director of research and advisory services at HIMSS Analytics. “While countries like Germany and Switzerland need better and more electronic patient records, other ones, especially the Nordics and the Netherlands, can already change their focus toward more innovative ways to provide care, create networks of collaboration and let the patient actively participate in managing more aspects of self-care and prevention.”

To that end, HIMSS Analytics listed EMR-maturity as a factor for advancing eHealth projects, as is the ability to share health data.

“In the second wave of digitization, healthcare has to move toward a shared care model,” said Jordi Piera, chief information and RD officer at Badalona Serveis Assistencials, member of the Global Conference Education Committee at HIMSS and secretary of the strategic IT board at the Catalonian Healthcare Department. “Patients should be able to receive all types of care in their prefered location,” he added. “This will, in turn, increase the efficiency and sustainability of our organizations.”

Enabling that shared care model will also require strong cybersecurity in the age of consumerism. HIMSS Analytics research found that operating with insufficient budget for infosec will continue to be a large challenge for hospitals and healthcare entities in the years ahead – and that is true even though attacks grow increasingly sophisticated.

“Public healthcare institutions are regularly attacked by hackers and often they lose valuable information,” Piera said. “We need to put a greater emphasis on protecting our systems; the number of cyberattacks is on the rise and our IT infrastructures and staff are not ready for them. Furthermore the number of patient devices connected to the systems is growing and this poses even greater risks.”


Empowering patients, achieving interoperability and securing health information fueling the need for new skill sets and, as such, giving rise to emerging career roles.

“While a few years ago it was often sufficient to put digital transformation into the hands of a CIO or an IT director, this is not enough anymore,” Studzinki said. “Chief digital officers and chief innovation officers appear in more organizations, especially in larger ones. And it is likely that we will see even more of this differentiation of job roles in the future.” 


Focus on Artificial Intelligence

In November, we take a deep dive into AI and machine learning.

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Brainstorm Health: Virta Health Diabetes Program, J&J Talc Suit, Precision Medicine

Moving precision medicine beyond cancer. Guest authors Kathy Giusti and Richard Hamermesh of the Kraft Precision Medicine Accelerator have a piece up on Fortune today on the how we might be able to nudge the project of precision medicine, which appears to focus lengthily on cancer drug development at this point, into other areas. And much of the effort will depend on better utilization of data. “Today, vast amounts of data exist, however most of the time that data is siloed, fractured, and rarely in a standardized format. Data needs to be clean and harmonized in order to make sense of it. That means building large, digestible clinical datasets that are connected to equally large molecular datasets, then following them over time. It also means applying machine learning to help physicians make better decisions about patient diagnoses and treatment options, while understanding the possible outcomes for each treatment path,” they write.  (Fortune)

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