New Normal In Age Of Hookup Apps? Rhode Island Rises In Syphilis, Gonorrhea, HIV

(Rhode Island Department of Health)

(Rhode Island Department of Health)

By Marina Renton
CommonHealth intern

The numbers are striking: Recent double-digit rises around the country in long-familiar sexually transmitted diseases — gonorrhea, HIV, even the old scourge of syphilis.

Perhaps even more striking is what Thomas Bertrand of the Rhode Island Department of Health said recently about the rising numbers on Here & Now: “I would not call it a crisis, I’d call it a new normal right now, and we need to push against it.”

Last month, the Rhode Island Department of Health put out a press release with its data from 2013 to 2014: Reported cases of infectious syphilis increased 79 percent, gonorrhea cases increased 30 percent, and newly diagnosed HIV cases increased 33 percent.

While these figures are dramatic, particularly the increase in syphilis, it’s important to remember that year-to-year changes aren’t always the best data to look at, said Bertrand, who is chief of the office of HIV, STDs, Viral Hepatitis, and Tuberculosis for the state Department of Health. It’s better to examine a period of five to 10 years, he says.

But those numbers don’t look good either: Since 2009, Rhode Island, along with the rest of the country, has seen increases in chlamydia, gonorrhea and syphilis, Bertrand said in a phone interview. “We mirror the national trends in general.”

“The acceleration or the increase may be a little bit steeper in Rhode Island than the rest of the country, but just a little bit,” he added.

Can swiping right lead to STDs?

The Rhode Island Department of Health’s statement mentions the use of hookup apps as a “high-risk behavior” that could be associated with the increase in STDs. However: “We don’t have data to say that the use of social media or the people who use it are more infectious or transmitting disease more than people who don’t,” Bertrand said.

But the apps do add to tracking problems: When people use social media such as Tinder and Grindr to arrange hookups, the encounter can be casual and brief, so people don’t share much information, Bertrand said. So, when someone is diagnosed with an STD, he or she might not be able to provide contact information for his or her sexual partners, making it harder to curb the spread of the disease.

Given the use of social media to arrange sexual encounters, there is opportunity for the health department to move online, Bertrand said. Continue reading

For Salem Dispensary, Mass. Issues One-Time Waiver From Marijuana Safety Tests

Massachusetts’ first medical marijuana dispensary will be allowed to open, but for limited sales, while the state reviews safety standards.

Marijuana grown so far tests for lead higher than allowed in Massachusetts, and the state says labs are not equipped to test for seven of 18 restricted pesticides. But the Baker administration will let Alternative Therapy Group, a proposed dispensary in Salem, open as long as it limits each patient to 4.23 ounces and instructs patients to consume no more than two grams a day.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

“Patients have waited to access marijuana for medical purposes for far too long,” Gov. Charlie Baker said in a statement. “This waiver will allow industry laboratories a little more time to reach full operation while providing safe amounts of medical marijuana for qualifying patients who need it.” Continue reading

Earlier:

When My Mother Died: A Story Of ‘Incomplete Mourning’

By Sarah Baker

I was 8 years old and the sky was black the day my mother died.

That morning, after a five-year struggle with a brain tumor, she’d passed away at Bethesda Naval Hospital, where she had been admitted a couple of days earlier. I hadn’t seen her since.

Grieving wasn’t an option in our house. We were a “chin up, shoulders back” group led by Dad, a rising star in the Navy. At my mother’s graveside in Arlington National Cemetery, my 10-year-old brother and I stood like little replicas of John F. Kennedy Jr. 12 years earlier when he saluted his father’s coffin. There were no tears, no signs of weakness. Long periods of mourning or sadness were not in our family culture — our grief was put on hold. There were bags to pack, and new ports of call. I was Soldiering On.

The Hardest Thing

According to the advocacy group SLAP’D (Surviving Life After a Parent Dies), 1 in 9 Americans loses a parent before age 20. Of those, nearly half said it was difficult to talk about their grief and only 7 percent said a guidance counselor helped. Six out of 10 adults interviewed, who lost a parent when they were children, said it’s the hardest thing they’ve had to deal with.

Sarah Baker at age 6, two years before her mother died (Courtesy)

Sarah Baker at age 6, two years before her mother died (Courtesy)

For us, the coping mechanism of Soldiering On worked splendidly for years, even decades. I survived all of the moves due to Dad’s deployments, even thrived, people might say. I went to college, graduate school, found great jobs, married a wonderful man, and had two beautiful children. All seemed well, at least on the surface.

But years of anxiety and disassociation gripped me. Recently, though, I felt all that emotional baggage was not sustainable. My external world appeared blissful (and it was!) but my internal world reeled. I had periods of blankness, inability to focus, sleeplessness, feelings of isolation when I was surrounded by loving people; despair, longing for something else, numbness, repeating negative loops in my mind, and sensations of being half dead. These feelings came in waves — days of it followed by lightness and connection. The longest darkness lasted three months — the world drained of its colors and none of my usual “reset,” or coping, tools seemed to work.

Necessary Grief

Importantly, coping is not grieving. “There is a kind of sanity to grief,” says Kay Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine and author of “An Unquiet Mind.” “It provides a path — albeit a broken one — by which those who grieve can find their way. Grief is not a disease; it is a necessity.”

Funerals and other rituals bring people together and defend against loneliness. But if the grief lingers too long, is too severe, or unprocessed, it might begin to resemble depression. It’s a fine line indeed.

I now know I had never fully experienced the pain and sorrow of my grief. Continue reading

Calling All Gene Detectives: Solve Diagnosis Mysteries To Win Contest, Play Role In Film

 

What in the world is wrong with Dr. Katia Moritz?

When she was 43, Moritz felt like she had life all figured out. Always a high-energy extrovert, she would begin her workdays as a clinical psychologist treating severely ill patients at 7:15 a.m., and get home in time to be with her three young children after school.

There was no time for slacking in a life so full, so when she was scheduled for a minor diagnostic procedure that involved inserting a tube down her throat to look into her stomach, she figured she’d recover from the sedation and come right back to work that afternoon.

But afterward, she felt so sick she went to bed and slept for three days. “I felt like I was poisoned,” she recalls. “It felt like the worst flu ever. I had a low grade fever, my body hurt, everything hurt. After a few days, I improved, but I never felt well. And then it became an episodic illness — a few days later I’d get it again, and a few weeks later I’d get it again.”

Moritz, now 48, has never been the same. For the last five years, she has seen dozens of doctors, trekked to leading medical centers around the country in search of a diagnosis and cure, to no avail. Her fevers come and go, and other symptoms; sometimes it’s hard to swallow, even walk.

Dr. Katia Moritz shares a happy post-interview moment with 5-year-old Jeremy, who is also undiagnosed. (Courtesy "Undiagnosed")

Dr. Katia Moritz shares a happy post-interview moment with 5-year-old Jeremy, who is also undiagnosed. (Courtesy “Undiagnosed”)

If this were the television show “House,” or the popular New York Times column “Think Like A Doctor,” her story would have a neat ending, a solution to her mystery. But as Moritz has learned in her exhaustive travels, in real life, a great many people — millions of them, she estimates — are clearly very sick but never get the answer that could help them get well. Call them “the undiagnosed.”

Now, she’s working on a documentary on their plight (see the trailer above) and — in a lucky convergence — she’s combining forces with the bright minds at the cutting edge of genomic research to seek answers.

Five undiagnosed patients from the documentary are the focus of a new contest run by Boston Children’s Hospital, titled “CLARITY Undiagnosed.” Aiming to advance the field of genomic medicine — using a patient’s gene information in the clinic — it offers a $25,000 prize to the research team that best solves the patients’ diagnostic mysteries.

In an unusual twist for such an exercise in competitive crowd-sourcing, the teams may also appear in the documentary that Moritz is creating. Titled simply “Undiagnosed,” It is still filming and thus far chronicles the patients’ struggles but has no happy endings. (The medical detectives can also opt out if they’re camera-shy.)

“The probability that we’re going to find something in any of these individuals is about 50 percent.”

– Dr. Isaac Kohane

Up to 30 competing teams in the CLARITY contest will be given each patient’s full medical record — no small file, given the medical odysseys they have endured. The contestants will also be given extensive data on the patients’ genes.

Teams have until June 25 to apply, says Dr. Isaac Kohane, chair of Harvard Medical School’s Department of Biomedical Informatics, and they will then have two months to work. Results will be announced in November.

“I would say that, based on the performance from the Undiagnosed Disease Program at the National Institutes of Health, the probability that we’re going to find something in any of these individuals is about 50 percent,” Kohane says. Continue reading

OB Talks About Home Birth, Midwives And Re-Engineering U.S. Maternity Care

Dr. Neel Shah (Courtesy)

Dr. Neel Shah (Courtesy)

Just mention the phrase “home birth,” and controversy will surely follow.

One example: a recent opinion piece in the New England Journal of Medicine by Dr. Neel Shah, an obstetrician at Beth Israel Deaconess Medical Center in Boston. In the piece, Shah suggests that for many pregnant women, giving birth in the U.K. — with its streamlined system of midwives and greater acceptance of births in the home — may be better than the high-intervention childbirth system that dominate U.S. labor wards.

Shah wrote the piece in response to the release of new guidelines from the U.K.’s National Institute for Health and Care Excellence (NICE), recommending healthy women with low-risk pregnancies opt for home or midwife-led births. Shah’s conclusion? “The majority of women with straightforward pregnancies may truly be better off in the United Kingdom.” In other words, the intense treatment U.S. obstetricians are trained to provide is unnecessary in many cases.

Dr. Shah continued the conversation on Radio Boston earlier this week. Highlights from the segment include his analysis of why the U.S. and U.K. have such different approaches to childbirth and discussion of the possible movement towards a model more like the U.K. Listen to the segment or read an excerpt below:

Host Meghna Chakrabarti: You also point out in your piece — and we spoke with people in preparing for this conversation — that these are relatively new recommendations, and the vast majority of women in the U.K. as of today still have their babies in hospitals there.

Dr. Neel Shah: They do. So about 90 percent of babies in the UK are born in hospitals, although I’ll say that the model even for babies born in hospitals is that midwives provide the first level of care and the obstetricians are there for complexity, even if you’re in the hospital. But here it’s more like 99 out of 100, so there’s still a big difference.

MC: But how do we change that, though? If in the U.K., from what you’re describing, it seems that obstetricians are viewed upon as highly trained specialists who should be called on in the event of specialty care when it’s needed, and midwives provide more of the primary care. It feels like we don’t have that framework here in the United States. When a woman gets pregnant, her first thought is “I need to go see an obstetrician to provide what’s essentially primary care during a pregnancy.”

NS: That’s exactly right. I think there’s a few different things that we could do to move forward. There are a lot of strategies and, like I said in the piece, I think there are lessons in the U.K., but I think our model will obviously need to look different from the U.K. One of the things I think we should start to think about is health care systems in 2015 in the United States are starting to take responsibility for populations and trying to think about not just the surgery but your health care overall. And 25 percent of all hospitalizations are childbirth related; it’s the number one reason to come into the hospital. So it seems like this should be a big piece of the pie, and I think as big health systems start to take ownership over the health of people that they serve there’s an opportunity to reinvent and re-engineer the way we approach it.

MC: Let’s take a couple more calls. Emily is calling from Westford; you’re on the air, Emily.

Emily: Hi. Thank you for taking my call, and I’m thrilled that Dr. Shah is young and freshly out of medical school and doing what he’s doing. My experience was very different. I was 30 and 34 when I had my two children, and I worked with midwives both times in the Boston area. The first was Beth Israel’s Ambulatory Care Unit, and the two midwives there were ex-nuns, and they were both at the birth, and the obstetrician actually took pictures; he had nothing to do with the birth, which was great. And then the next one, four years later, was in Beverly, at the North Shore Birth Center, which was a house setting across the driveway from the hospital. So both of them were under the umbrellas of the hospital. Now I have to say this was in 1979 and 1983, but I was starting at an OB/GYN practice, and a friend of mine said, “You know, the OBs look for the abnormal. When you go to a midwife, they’re looking for the normal.” And I felt that was so true because all my appointments with my husband with me were an hour and a half at the midwife. Continue reading

Researchers Say They Can Lift Depression In Mice By Activating Happy Memories

(katiebordner/Flickr)

(katiebordner/Flickr)

You know when you’re feeling really down, or worse, in the throes of depression, and there’s always that chirpy person who earnestly says: “Just try to focus on happy thoughts; think positive!” Well, it turns out, that unshakeable optimist may have a point.

MIT scientists report that they are able to “cure” the symptoms of depression — in mice — by artificially activating happy memories that were formed before the depression took hold.

The findings, published in the journal Nature, hint at a future in which depression might be treated by manipulating brain cells where memories are stored.

MIT graduate student Steve Ramirez, the lead author on the paper, explains that while the work is tantalizing, it’s a long way from any real-world application in people:

“We’re doing basic science that aims to figure out how the brain works and how it can produce memory,” Ramirez said in an email. “The more we know about how the brain works, the better equipped we are to figure out what happens when brain pieces break down to give rise to broken thoughts. In my opinion, we’re a technological revolution away from being able to do this in humans; everything that exists currently is too invasive and not targeted enough. That said, the underlying proof-of-principles are there, as we can do these kinds of manipulations in animals. The question is how we can do this in humans in an ethically responsible and clinically-relevant manner.”

Still, he says, researchers did not expect such clear results:

“The finding that stimulating positive memories over and over actually forces the brain to make new brain cells was surprising,” he wrote. “We did not expect to have such a clean result demonstrating that artificially activated positive memories correlates with an increase in the number of new brain cells that are made.” Continue reading

State Launches Opioid Addiction Awareness Campaign Aimed At Parents

A screenshot from a new state public service announcement about addiction. (YouTube)

A screenshot from a new public service announcement, created by the state, about opioid addiction. (YouTube)

Calling education an “essential part of the cure for this epidemic,” Gov. Charlie Baker on Wednesday announced the launch of an opioid addiction awareness campaign aimed at parents.

The “Stop Addiction In Its Tracks” campaign is a recommendation of Gov. Baker’s opioid abuse task force, which was charged with developing a statewide strategy for combating addiction. The group is set to announce its full slate of recommendations next week.

The campaign includes TV and digital ads that will run through the end of July, pointing people to a new state website — mass.gov/StopAddiction. The website offers information on warning signs of opioid addiction; a list of commonly misused prescription medications; a guide for how guardians can talk to kids of different ages about the dangers of opioid misuse; information on Narcan, a medication that can reverse the effects of an overdose; as well as how to get help.

“With this messaging, we are impressing on parents that the road to heroin could start with what is left in our own homes and medicine cabinets,” Health and Human Services Secretary Marylou Sudders said in a statement. Continue reading

Related:

When A Burst Appendix Doesn’t Kill You: Big New Study Adds Data

An urgent laparoscopic appendectomy is performed aboard the nuclear-powered aircraft carrier USS Enterprise, in this undated photo. (U.S. Navy via Wikimedia Commons)

An urgent laparoscopic appendectomy is performed aboard the nuclear-powered aircraft carrier USS Enterprise, in this undated photo. (U.S. Navy via Wikimedia Commons)

If you’re a regular reader, you may have noticed that certain posts tend to dominate our most-popular list: on birth control and sex, on diet and exercise. Pretty predictable crowd-pleasers.

But one sleeper’s appearance on the list has repeatedly surprised us: “When A Burst Appendix Doesn’t Kill You.” Turns out, appendicitis is no lightning strike: It hits 300,000 Americans a year, one-tenth of adults over their lifetimes.

That 2012 post shared the story of Martha Little, who was then WBUR’s news director and who kept toiling away in the newsroom even though her appendix had burst — not because she was a hopeless workaholic, but because she was undergoing antibiotic treatment.

The post prompted dozens of edifying appendicitis stories in the comments section, and now a new study adds some helpful data. But first, the necessary background in the post, from Dr. Douglas Smink of Brigham and Women’s Hospital:

Twenty years ago, Dr. Smink said, surgeons would go in and operate on virtually all cases of appendicitis, whatever the level of inflammation. But research found that for a certain group of patients, it was better to wait. Now, even the “interval appendectomy” is becoming controversial; a newer school of thought holds that some patients may do best with antibiotics alone, no operation at all.

The problem right now, he said, is that there’s some data on the antibiotics-only strategy, but not enough to make clear which patients really need an appendectomy and which can get along without one. Patients who have a stone in the appendix, called an appendicolith, definitely need the organ removed, for example, but many other cases are not so clear cut. More research is needed, he said, to explore the effects of age, severity of illness and other factors on whether antibiotics-only treatment will work for a given patient.

Meanwhile, some studies also suggest that for many patients with uncomplicated appendicitis — the appendix still intact — antibiotic treatment alone may be enough as well.

Continue reading

Just Sip It: More Than Half Of U.S. Kids Not Properly Hydrated

(sara_girl22/Flickr)

(sara_girl22/Flickr)

One statistic jumped out at me from this study by researchers at the Harvard School of Public Health about whether U.S. kids are drinking enough water: “Nearly a quarter of the children and adolescents in the study reported drinking no plain water at all.”

When you think about the kinds of serious health problems your kids might have, not drinking quite enough water may not top your list.

But it’s serious: beyond the physical problems related to insufficient water-drinking, there are cognitive implications as well, researchers report:

Inadequate hydration has implications for children’s health and school performance. Drinking water can improve children’s performance on cognitive tests. Two studies have found that children’s cognitive performance improved as their urine osmolality [a measure of urine concentration] decreased. Increasing drinking water access in schools may be a key strategy for reducing inadequate hydration and improving student health, because schools reach so many children and adolescents and that they typically provide free drinking water to students.

The study was published online in the American Journal of Public Health.

I asked Erica Kenney, a postdoctoral researcher and one of the study authors, a few questions about the work. Here, lightly edited, is what she said, via email.

RZ: What’s the takeaway here?

EK: We often take for granted that kids will keep themselves hydrated automatically and will drink when they’re thirsty, or that their schools, summer camps, afterschool programs, child care centers, etc. will be providing them with enough opportunities to drink water during the day. But our study indicates that this may not be the case — over half of all children and adolescents in the U.S. are estimated to be inadequately hydrated. We need to do a better job of getting safe, clean, appealing drinking water to kids (and by “we” I don’t just mean parents and families — I also mean the places where kids learn and play during the day) and keeping them hydrated so that they have the opportunity to be at their best in terms of well-being, cognitive functioning, and mood.

Where do we go from here? Continue reading

MassHealth Squandered More Than $500 Million, Audit Finds

The state Medicaid program squandered more than $500 million through unnecessary payments or missed savings opportunities in its managed care program, according to an audit released Tuesday.

The review by State Auditor Suzanne Bump found MassHealth, the state Medicaid program, made $233 million in unnecessary payments for medical services that should have been covered by managed care organizations between October 2009 and September 2014. The audit also says the state could have saved $288 million more through more detailed structuring of managed care contracts.

Bump said that during the five years covered by the audit, MassHealth paid managed care organizations about $12 billion to provide health services to 1.6 million members. Managed care organizations are private health care insurers that agree to fixed, per-member rates to administer and pay for specific categories of health care claims on behalf of MassHealth.

Continue reading