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Kaufman and colleagues have considered the relationship between minimum wage and suicide mortality in buy lasix pill the USA.1 Overall, they found that a dollar increase in the minimum wage was related to a meaningful 3.4% decrease in suicide mortality for those https://www.kraenzle.com/how-to-get-a-lasix-prescription-from-your-doctor/ of lower educational attainment. Interestingly, this is the third paper in recent buy lasix pill months to address the question of how minimum wage affects suicide. Across these papers, there is a remarkable overall consistency of findings, and important subissues are highlighted in each individual paper.The first of these papers, by Gertner and colleagues, found a 1.9% reduction in suicide associated with a dollar increase in the minimum wage across the total population.2 However, this research was unable to delve into the subgroup effects that would have allowed for a difference in differences approach, or placebo tests, due to their data source. First, Dow and colleagues,3 buy lasix pill and then Kaufman and colleagues1 built on this initial finding with analyses of data that facilitated examination of subgroups. Both of these papers considered the group with a high school education or â¦.

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Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely distressing dreams continued to be associated with heart problems, hypertension, and other heart trouble," Ulmer said in a https://www.wolf-garten.com/1000mg-zithromax-online/ presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society."Research on heart rate lasix alternative variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what lasix alternative role nightmares specifically might play in contributing to increased risk in this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is solely due to poor health behaviors among those with PTSD, our findings suggest an important role for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with lasix alternative an average age of 38 who served since Sept. 11, 2001 lasix alternative. The majority (73.5%) had one or two lasix alternative tours of duty and most (77.4%) were men.

Most (65.0%) lasix alternative had moderate-to-heavy combat exposure.The researchers assessed nightmare frequency and severity with the Davidson Trauma Scale. Nightmares were classified as frequent if they occurred two or more times per week and lasix alternative moderate-to-severe if they were at least moderately distressing. Self-reported medical issues lasix alternative were assessed using the National Vietnam Veterans Readjustment Study questionnaire and other measures. Diagnoses of PTSD and depression lasix alternative were established through structured clinical interviews.About a third of veterans in the study reported nightmares in the past week, and 41% had poor sleep quality scores as measured by the Pittsburgh Sleep Quality Index. In total, 31% of the veterans met criteria for current PTSD and 32.7% reported at least one cardiovascular condition.Diagnosed depression lasix alternative was more common in the PTSD group.

Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more severe distressing dreams.After controlling for depression, PTSD, and current smoking, risks for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent nightmares.The findings set the stage for future research lasix alternative examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimerâs, lasix alternative dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinsonâs, ALS, concussion, CTE, sleep, pain, and more. Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with lasix alternative type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with the ACE/ARB drugs versus placebo in patients with and without type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing end-stage renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as lasix alternative a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney disease trials are in parallel to chronic heart failure trials, because SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We lasix alternative are thinking as cardiologists probably too much into boxes, compartmentalization," he said.

"Maybe we lasix alternative need a more holistic view... They're certainly lasix alternative not just glucose-lowering drugs. They're not just only diuretics lasix alternative. Maybe we should just move to organ protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 to 75 lasix alternative mL/min/1.73 m2 and urine albumin to creatinine ratio of 200 to 5,000 mg/g), about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to 10 mg dapagliflozin once daily or lasix alternative matching placebo.

People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney transplantation, or renal death29% lower risk of CV lasix alternative death or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group. Serious adverse lasix alternative events were actually numerically less common with the drug, which Heerspink said was in keeping with dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population with and without diabetes. The drug lasix alternative has FDA fast track designation for an indication in that regard. The CREDENCE trial previously showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- it's going to lasix alternative be like nine or 10 large scale trials, which is extraordinary," Packer said. "For most classes lasix alternative of drugs, we don't have that kind of evidence base.

... Physicians have to start using SGLT2 inhibitors across the board for these patients. It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology. "The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable.

When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..

Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely buy lasix pill distressing dreams https://www.wolf-garten.com/1000mg-zithromax-online/ continued to be associated with heart problems, hypertension, and other heart trouble," Ulmer said in a presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society."Research on heart rate variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what role nightmares specifically might play in contributing to increased risk in this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is solely due to poor health behaviors among those with PTSD, buy lasix pill our findings suggest an important role for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with an average age of buy lasix pill 38 who served since Sept. 11, 2001 buy lasix pill.

The majority buy lasix pill (73.5%) had one or two tours of duty and most (77.4%) were men. Most (65.0%) had moderate-to-heavy combat exposure.The researchers assessed nightmare frequency and severity with the Davidson buy lasix pill Trauma Scale. Nightmares were classified as frequent if they occurred two or more times per week and moderate-to-severe if they were at buy lasix pill least moderately distressing. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study buy lasix pill questionnaire and other measures.

Diagnoses of PTSD and depression were established through structured clinical interviews.About a third buy lasix pill of veterans in the study reported nightmares in the past week, and 41% had poor sleep quality scores as measured by the Pittsburgh Sleep Quality Index. In total, 31% buy lasix pill of the veterans met criteria for current PTSD and 32.7% reported at least one cardiovascular condition.Diagnosed depression was more common in the PTSD group. Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more buy lasix pill severe distressing dreams.After controlling for depression, PTSD, and current smoking, risks for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent nightmares.The findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimerâs, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinsonâs, ALS, buy lasix pill concussion, CTE, sleep, pain, and more.

Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative buy lasix pill reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with the ACE/ARB drugs versus placebo in patients with and without type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing buy lasix pill end-stage renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney disease trials are in parallel to chronic heart failure trials, because buy lasix pill SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We are thinking as cardiologists probably too much into boxes, compartmentalization," he said. "Maybe we need a more holistic buy lasix pill view...

They're certainly buy lasix pill not just glucose-lowering drugs. They're not just buy lasix pill only diuretics. Maybe we should just move to organ protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 to 75 mL/min/1.73 buy lasix pill m2 and urine albumin to creatinine ratio of 200 to 5,000 mg/g), about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to 10 mg dapagliflozin once daily or buy lasix pill matching placebo.

People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney transplantation, or renal death29% lower risk of CV death buy lasix pill or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group. Serious adverse events were actually numerically less common buy lasix pill with the drug, which Heerspink said was in keeping with dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population with and without diabetes. The drug has buy lasix pill FDA fast track designation for an indication in that regard. The CREDENCE trial previously showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- it's going to be like nine or 10 large buy lasix pill scale trials, which is extraordinary," Packer said.

"For most classes of drugs, we don't have buy lasix pill that kind of evidence base. ... Physicians have to start using SGLT2 inhibitors across the board for these patients. It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology.

"The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable. When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..

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Dewsnap C, Sauer U, medication lasix 20mg Evans C https://www.sgrsports.com/buy-azithromycin-zithromax/. Sex Transm Infect 2020;96:79. Doi. 10.1136/sextrans-2019-054397This article was previously published with missing information. Please note the below:The authors would like to acknowledge their gratitude to Daniel Richardson, Zara Haider, Ceri Evans, Janet Michaelis and Elizabeth Foley for providing a helpful format for this piece.Richardson D, Haider Z, Evans C, et al.

The joint BASHH-FSRH conference. Sex Transm Infect 2017;93:380. Doi. 10.1136/sextrans-2017-053184Using cytokine expression to distinguish between active and treated syphilis. Promising but not yet ready for prime timeDistinguishing between previously treated and active syphilis can be challenging in the subset of treated patients with serofast status, defined as persistent non-treponemal seropositivity (<4-fold decline in rapid plasma reagin titre â¥6 months after treatment).

The study investigated whether serum cytokine expression levels, measured with a 62-cytokine multiplex bead-based ELISA, can help guide clinical management. Using samples from patients with active, treated and serofast syphilis, the authors developed a two-cytokine (brain-derived neurotrophic factor and tumour necrosis factor Î²) decision tree that showed good accuracy (82%) and sensitivity (100%) but moderate specificity (45%). While further studies will be needed to confirm and refine the diagnostic algorithm, there also remain important technical, operational and financial barriers to implementing such cytokine assays in routine care.Kojima N, Siebert JC, Maecker H, et al. The application of cytokine expression assays to differentiate active from previously treated syphilis. J Infect Dis.

2020 [published online ahead of print, 2020 Mar 19].Global and regional prevalence of herpes simplex lasix type 2 . Updated estimates for people aged 15â49 yearsEstimates of genital herpes simplex lasix (HSV) s across regions inform advocacy and resource planning and guide the development of improved control measures, including treatments. In 2016, HSV-2 affected 13% of the global population aged 15â49 years (high-risk groups excluded), totalling 491âmillion people. Of note, by excluding people aged >49 years, the analysis knowingly underestimated the true burden of HSV-2 .1 Prevalence showed a slight increase relative to 2012 and was highest in Africa and Americas and among women. Given the association between HSV-2 and subsequent HIV ,2 it is concerning that HSV-2 was estimated to affect ~50% of women aged 25â34 years in the African region.

The analysis also estimated the prevalence of genital HSV-1 (3%), but uncertainty intervals were wide.James C, Harfouche M, Welton NJ, et al. Herpes simplex lasix. Global prevalence and incidence estimates, 2016. Bull World Health Organ. 2020.

98. 315-329.Observed pregnancy and neonatal outcomes in women with HIV exposed to recommended antiretroviral regimensThis large Italian observational cohort study analysed data from 794 pregnant women who were exposed within 32 weeks of gestation to recommended antiretroviral regimens in the period 2008â2018. Treatment comprised three-drug combinations of an nucleoside reverse transcriptase inhibitor (NRTI) backbone plus a ritonavir-boosted protease inhibitor (78%, predominantly atazanavir), an non-NRTI (NNRTI) (15%, predominantly nevirapine) or an integrase strand transfer inhibitor (INSTI. 6%, predominantly raltegravir). No major differences were found for a wide range of pregnancy and neonatal outcomes, including major congenital defects.

The rate of HIV transmission ranged up to 2.4% in this study. This comprehensive evaluation will be useful for clinicians caring for women with HIV. More outcome data are needed for regimens comprising second-generation INSTIs.Floridia M, Dalzero S, Giacomet V, et al. Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors. An observational study.

2020;48:249â258.HIV status and sexual practice independently correlate with gut dysbiosis and unique microbiota signaturesGut dysbiosis may contribute to persistent inflammation in people with HIV (PWH) who receive antiretroviral therapy (ART). The study compared the gut microbiota of ART-treated PWH and HIV-negative controls matched for age, gender, country of birth, body mass index and sexual practice. Regardless of sex and sexual practice, the gut microbiota differed significantly in PWH vrsus controls, with expansion of proinflammatory gut bacteria and depletion of homeostasis-promoting microbiota members. The extent of dysbiosis correlated with serum inflammatory markers, nadir and pre-ART CD4 cell counts, and prevalence of non-infectious comorbidities. Further studies are warranted to elucidate causality and investigate microbiota-mediated strategies to alleviate HIV-associated inflammation.

Independent of HIV status, and in both men and women, receptive anal intercourse was associated with a unique microbiota signature.Vujkovic-Cvijin I, Sortino O, Verheij E, et al. HIV-associated gut dysbiosis is independent of sexual practice and correlates with non-communicable diseases. Nat Commun. 2020;11:2448.Reducing the cost of molecular STI screening in resource-limited settings. An optimised sample-pooling algorithms with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are frequently asymptomatic and, if untreated, may lead to severe reproductive complications in women.

Molecular testing is highly sensitive but costly, especially for resource-limited settings. This modelling study explored a sample pooling strategy for CT and NG testing among women in Zambia. Based on cross-sectional data, participants were stratified into high, intermediate and low prevalence groups, and the respective specimens were mathematically modelled to be tested individually, in pools of 3, or pools of 4, using the GeneXpert instrument. Overall, the pooling strategy was found to maintain acceptable sensitivity (ranging from 80% to 100%), while significantly lowering cost per sample. Investigation in additional cohorts will validate whether the approach may increase access to STI screening where resourced are constrained.Connolly S, Kilembe W, Inambao M, et al.

A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings. J Clin Microbiol. 2020 [published online ahead of print, 2020 Jun 10].Girl-only HPV vaccination can eliminate cervical cancer in most low and lower middle income countries by the end of the century, but must be supplemented by screening in high incidence countriesProgress towards the global elimination of cervical cancer must include effective interventions in lower-middle income countries (LMICs). The study modelled the effect over the next century of girls-only human papilloma lasix (HPV) vaccination with or without once-lifetime or twice-lifetime cervical screening in 78 LMICs, assuming 90% treatment coverage, 100% lifetime protection and screening uptake increasing from 45% (2023) to 90% (2045 onwards). Vaccination alone would substantially reduce cancer incidence (61âmillion cases averted) and achieve elimination (<5 cases per 100â000 women-years) in 60% of LMICs.

However, high-incidence countries, predominantly in Africa, might not reach elimination by vaccination alone. Adding twice-lifetime screening would achieve elimination of cervical cancer in 100% of LMICs. Results have informed the targets of 90% HPV vaccination coverage, 70% screening coverage and 90% of cervical lesions treated by 2030 recently announced by the WHO.Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination. A comparative modelling analysis in 78 low-income and lower-middle-income countries.

Dewsnap C, buy lasix pill Sauer U, Evans C Buy azithromycin zithromax. Sex Transm Infect 2020;96:79. Doi.

10.1136/sextrans-2019-054397This article was previously published with missing information. Please note the below:The authors would like to acknowledge their gratitude to Daniel Richardson, Zara Haider, Ceri Evans, Janet Michaelis and Elizabeth Foley for providing a helpful format for this piece.Richardson D, Haider Z, Evans C, et al. The joint BASHH-FSRH conference.

Sex Transm Infect 2017;93:380. Doi. 10.1136/sextrans-2017-053184Using cytokine expression to distinguish between active and treated syphilis.

Promising but not yet ready for prime timeDistinguishing between previously treated and active syphilis can be challenging in the subset of treated patients with serofast status, defined as persistent non-treponemal seropositivity (<4-fold decline in rapid plasma reagin titre â¥6 months after treatment). The study investigated whether serum cytokine expression levels, measured with a 62-cytokine multiplex bead-based ELISA, can help guide clinical management. Using samples from patients with active, treated and serofast syphilis, the authors developed a two-cytokine (brain-derived neurotrophic factor and tumour necrosis factor Î²) decision tree that showed good accuracy (82%) and sensitivity (100%) but moderate specificity (45%).

While further studies will be needed to confirm and refine the diagnostic algorithm, there also remain important technical, operational and financial barriers to implementing such cytokine assays in routine care.Kojima N, Siebert JC, Maecker H, et al. The application of cytokine expression assays to differentiate active from previously treated syphilis. J Infect Dis.

Of note, by excluding people aged >49 years, the analysis knowingly underestimated the true burden of HSV-2 .1 Prevalence showed a slight increase relative to 2012 and was highest in Africa and Americas and among women. Given the association between HSV-2 and subsequent HIV ,2 it is concerning that HSV-2 was estimated to affect ~50% of women aged 25â34 years in the African region. The analysis also estimated the prevalence of genital HSV-1 (3%), but uncertainty intervals were wide.James C, Harfouche M, Welton NJ, et al.

Herpes simplex lasix. Global prevalence and incidence estimates, 2016. Bull World Health Organ.

2020. 98. 315-329.Observed pregnancy and neonatal outcomes in women with HIV exposed to recommended antiretroviral regimensThis large Italian observational cohort study analysed data from 794 pregnant women who were exposed within 32 weeks of gestation to recommended antiretroviral regimens in the period 2008â2018.

Treatment comprised three-drug combinations of an nucleoside reverse transcriptase inhibitor (NRTI) backbone plus a ritonavir-boosted protease inhibitor (78%, predominantly atazanavir), an non-NRTI (NNRTI) (15%, predominantly nevirapine) or an integrase strand transfer inhibitor (INSTI. 6%, predominantly raltegravir). No major differences were found for a wide range of pregnancy and neonatal outcomes, including major congenital defects.

Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors. An observational study. 2020;48:249â258.HIV status and sexual practice independently correlate with gut dysbiosis and unique microbiota signaturesGut dysbiosis may contribute to persistent inflammation in people with HIV (PWH) who receive antiretroviral therapy (ART).

The study compared the gut microbiota of ART-treated PWH and HIV-negative controls matched for age, gender, country of birth, body mass index and sexual practice. Regardless of sex and sexual practice, the gut microbiota differed significantly in PWH vrsus controls, with expansion of proinflammatory gut bacteria and depletion of homeostasis-promoting microbiota members. The extent of dysbiosis correlated with serum inflammatory markers, nadir and pre-ART CD4 cell counts, and prevalence of non-infectious comorbidities.

Further studies are warranted to elucidate causality and investigate microbiota-mediated strategies to alleviate HIV-associated inflammation. Independent of HIV status, and in both men and women, receptive anal intercourse was associated with a unique microbiota signature.Vujkovic-Cvijin I, Sortino O, Verheij E, et al. HIV-associated gut dysbiosis is independent of sexual practice and correlates with non-communicable diseases.

Nat Commun. 2020;11:2448.Reducing the cost of molecular STI screening in resource-limited settings. An optimised sample-pooling algorithms with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are frequently asymptomatic and, if untreated, may lead to severe reproductive complications in women.

Overall, the pooling strategy was found to maintain acceptable sensitivity (ranging from 80% to 100%), while significantly lowering cost per sample. Investigation in additional cohorts will validate whether the approach may increase access to STI screening where resourced are constrained.Connolly S, Kilembe W, Inambao M, et al. A population-specific optimized GeneXpert pooling algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae to reduce cost of molecular STI screening in resource-limited settings.

J Clin Microbiol. 2020 [published online ahead of print, 2020 Jun 10].Girl-only HPV vaccination can eliminate cervical cancer in most low and lower middle income countries by the end of the century, but must be supplemented by screening in high incidence countriesProgress towards the global elimination of cervical cancer must include effective interventions in lower-middle income countries (LMICs). The study modelled the effect over the next century of girls-only human papilloma lasix (HPV) vaccination with or without once-lifetime or twice-lifetime cervical screening in 78 LMICs, assuming 90% treatment coverage, 100% lifetime protection and screening uptake increasing from 45% (2023) to 90% (2045 onwards).

Vaccination alone would substantially reduce cancer incidence (61âmillion cases averted) and achieve elimination (<5 cases per 100â000 women-years) in 60% of LMICs. However, high-incidence countries, predominantly in Africa, might not reach elimination by vaccination alone. Adding twice-lifetime screening would achieve elimination of cervical cancer in 100% of LMICs.

Results have informed the targets of 90% HPV vaccination coverage, 70% screening coverage and 90% of cervical lesions treated by 2030 recently announced by the WHO.Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination. A comparative modelling analysis in 78 low-income and lower-middle-income countries.

Best time to take lasix medication

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric best time to take lasix medication SocietyDoctors are community http://rabbitsunlimited.org/?page_id=133 leaders. This role has become even more important during the hypertension medications lasix. As patients navigate our new reality, they are looking to us to determine what is best time to take lasix medication safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that best time to take lasix medication each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has been best time to take lasix medication cut short one month and now closes Sept.

30.hypertension medications has only increased the importance of completing the census to help our local communities and economies recover. The novel hypertension has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been stretched best time to take lasix medication thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the lasixâs fallout. Therefore, it best time to take lasix medication is vital that all Texans be counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the stateâs program, which provides health coverage for two out of five Texas children, one best time to take lasix medication in three individuals with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texasâ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a communityâs social safety net:Health careThe Childrenâs Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make best time to take lasix medication too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and best time to take lasix medication respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the lasix continues. The Central Texas Food Bank saw best time to take lasix medication a 206% rise in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their best time to take lasix medication homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by hypertension, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress best time to take lasix medication highlights the desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov to take best time to take lasix medication it.

It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the best time to take lasix medication same. If you are wondering who counts, the answer is everyone, whether itâs a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the lasix. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, best time to take lasix medication Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditorâs Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and best time to take lasix medication promoting the use of vaccinations.âCan the flu shot give you the flu?.

ÂâIs it dangerous for pregnant women to get a flu shot?. ÂâCan treatments best time to take lasix medication cause autism?. ÂThese were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan WealtherâNoâ is the answer to all the questions.

These were exactly best time to take lasix medication the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMAâs Be Wise â Immunizeâ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residentsâ best time to take lasix medication questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not best time to take lasix medication vaccinate despite having access to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residentsâ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions âI am concerned that vaccinations might not be safe,â and âHow likely are you best time to take lasix medication to receive a flu shot today?. Â We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan best time to take lasix medication WealtherWhy is this important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors best time to take lasix medication affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me âDr. Truthâ by the end of the evening.Second, our findings add to best time to take lasix medication our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their childrenâs vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly best time to take lasix medication influenza treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the hypertension medications lasix because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling up with hypertension patients, we could avoid adding dangerously ill flu patients to the best time to take lasix medication mix. Lastly, these findings are important because once a hypertension medications vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the best time to take lasix medication hypertension medications treatment is still in development, it is not immune to treatment hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a hypertension medications treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about best time to take lasix medication the hypertension medications treatment is circulating widely. (Someone recently asked me if the hypertension medications treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, best time to take lasix medication illustrates the need for health care professionals to answer patientsâ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the hypertension medications lasix best time to take lasix medication progresses, we need to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention.

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, weâre more than happy to answer your questions..

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) cheap lasix 40mg Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community buy lasix pill leaders. This role has become even more important during the hypertension medications lasix. As patients navigate our new reality, they are looking to us to determine what is safe, how to protect their families, and the buy lasix pill future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why buy lasix pill it is of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has buy lasix pill been cut short one month and now closes Sept.

30.hypertension medications has only increased the importance of completing the census to help our local communities and economies recover. The novel hypertension has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also buy lasix pill have been stretched thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the lasixâs fallout. Therefore, it is vital that buy lasix pill all Texans be counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the stateâs program, buy lasix pill which provides health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texasâ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of buy lasix pill a communityâs social safety net:Health careThe Childrenâs Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and buy lasix pill housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the lasix continues. The Central Texas Food Bank saw a 206% rise in clients buy lasix pill in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count buy lasix pill will help ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by hypertension, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress highlights the desperate need for affordable buy lasix pill childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov to take buy lasix pill it.

It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same buy lasix pill. If you are wondering who counts, the answer is everyone, whether itâs a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the lasix. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson buy lasix pill Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditorâs Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the buy lasix pill use of vaccinations.âCan the flu shot give you the flu?.

ÂâIs it dangerous for pregnant women to get a flu shot?. ÂâCan treatments buy lasix pill cause autism?. ÂThese were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan WealtherâNoâ is the answer to all the questions.

These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMAâs Be Wise â Immunizeâ program, buy lasix pill a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were buy lasix pill interested to see if our educational program could answer Alpha Home residentsâ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite buy lasix pill having access to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residentsâ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers buy lasix pill to the questions âI am concerned that vaccinations might not be safe,â and âHow likely are you to receive a flu shot today?. Â We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan WealtherWhy is this buy lasix pill important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an buy lasix pill influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me âDr. Truthâ by the end of buy lasix pill the evening.Second, our findings add to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their childrenâs vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly influenza buy lasix pill treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the hypertension medications lasix because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling up with hypertension patients, we could avoid adding dangerously ill flu patients to the buy lasix pill mix. Lastly, these findings are important because once a hypertension medications vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the hypertension medications treatment is still in development, it is not immune buy lasix pill to treatment hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a hypertension medications treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about the hypertension medications treatment is buy lasix pill circulating widely. (Someone recently asked me if the hypertension medications treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the need buy lasix pill for health care professionals to answer patientsâ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the hypertension medications lasix progresses, buy lasix pill we need to ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention.

Can lasix cause heart palpitations

By operation of the Public Governance, Performance and Accountability can lasix cause heart palpitations (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the http://www.cardozaartgallery.com/amoxil-cost-per-pill Australian Digital Health Agency. In this website, on can lasix cause heart palpitations and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth).

Website Accessibility Copyright Â©2015-2020 Australian Digital Health AgencyWhatâs happened? can lasix cause heart palpitations. We have received reports of fraudulent telephone calls from an individual or organisation claiming to be a representative of the Australian Digital Health Agency. It has been reported that the caller says they are calling from the can lasix cause heart palpitations âdigital health agencyâ to enrol people to get a âhealth recordâ.What do I need to do?.

If you receive a call from someone offering to enrol you for a âhealth recordâ, do not provide any personal information, hang up the call and report it to scamwatch.gov.au.The Australian Digital Health Agency will not telephone you with an offer to enrol you for a My Health Record. For more information on how to register for a My Health Record, visit myhealthrecord.gov.au.If you have shared your Medicare number with an unknown caller, report this to Services Australia who will place your details on a watch list to monitor can lasix cause heart palpitations for any compromise or misuse of your Medicare record. Email [email protected] or phone 1800 941 126 can lasix cause heart palpitations.

How could this affect me?. The caller is requesting personal information which could be used to steal your identity or can lasix cause heart palpitations commit financial fraud. Reports indicate that the caller is requesting the following personal information:â¢ Medicare numberâ¢ Date of birthâ¢ Email addressâ¢ Mobile telephone numberâ¢ Credit card detailsIdentity theft (also known as identity fraud) occurs when one person uses another individualâs personal information without their consent, usually for personal gain or to conduct further crimes.Where can I get more information?.

If you have shared personal information and believe you may be at risk, you can contact IDCARE, a not for profit organisation that provides assistance and support to victims of identity theft can lasix cause heart palpitations and other cybercrime. Visit idcare.org or telephone 1800 595 160.The Office of the Australian Information Commissioner provides information about identity fraud including what to do if your identity has been stolen.For additional information about scams, visit scamwatch.gov.au â you can also subscribe to a free alert service to receive updates about the latest scams.The Australian Cyber Security Centre also provides advice for individuals, a free alert service to help you understand the latest online threats and the ability to report online crimes via the ReportCyber page..

By operation of the Public moved here Governance, Performance and Accountability (Establishing the Australian buy lasix pill Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency. In this website, on and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to buy lasix pill be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth). Website Accessibility Copyright Â©2015-2020 Australian Digital buy lasix pill Health AgencyWhatâs happened?. We have received reports of fraudulent telephone calls from an individual or organisation claiming to be a representative of the Australian Digital Health Agency.

It has been reported that the caller says they are calling from the âdigital health agencyâ to enrol people to get a âhealth buy lasix pill recordâ.What do I need to do?. If you receive a call from someone offering to enrol you for a âhealth recordâ, do not provide any personal information, hang up the call and report it to scamwatch.gov.au.The Australian Digital Health Agency will not telephone you with an offer to enrol you for a My Health Record. For more buy lasix pill information on how to register for a My Health Record, visit myhealthrecord.gov.au.If you have shared your Medicare number with an unknown caller, report this to Services Australia who will place your details on a watch list to monitor for any compromise or misuse of your Medicare record. Email [email protected] or phone 1800 941 buy lasix pill 126. How could this affect me?.

The caller is requesting personal buy lasix pill information which could be used to steal your identity or commit financial fraud. Reports indicate that the caller is requesting the following personal information:â¢ Medicare numberâ¢ Date of birthâ¢ Email addressâ¢ Mobile telephone numberâ¢ Credit card detailsIdentity theft (also known as identity fraud) occurs when one person uses another individualâs personal information without their consent, usually for personal gain or to conduct further crimes.Where can I get more information?. If you have shared personal information and believe you may be at risk, you can contact IDCARE, a not for profit organisation that provides assistance and support to victims buy lasix pill of identity theft and other cybercrime. Visit idcare.org or telephone 1800 595 160.The Office of the Australian Information Commissioner provides information about identity fraud including what to do if your identity has been stolen.For additional information about scams, visit scamwatch.gov.au â you can also subscribe to a free alert service to receive updates about the latest scams.The Australian Cyber Security Centre also provides advice for individuals, a free alert service to help you understand the latest online threats and the ability to report online crimes via the ReportCyber page..

Iv lasix push time

The loss iv lasix push time of a husband article source. The death of a sister. Taking in an iv lasix push time elderly mother with dementia. This has been a year like none other for Dr. Rebecca Elon, who has dedicated her professional life to helping older adults.

Itâs taught her what families go through when caring for someone with serious iv lasix push time illness as nothing has before. ÂReading about caregiving of this kind was one thing. Experiencing it was entirely different,â she told me. Were it iv lasix push time not for the challenges sheâs faced during the hypertension lasix, Elon might not have learned firsthand how exhausting end-of-life care can be, physically and emotionally â something she understood only abstractly previously as a geriatrician. And she might not have been struck by what she called the deepest lesson of this lasix.

That caregiving is a manifestation of love and that love means being present with someone even when suffering seems overwhelming. All these experiences have been iv lasix push time âa gift, in a way. Theyâve truly changed me,â said Elon, 66, a part-time associate professor at Johns Hopkins University School of Medicine and an adjunct associate professor at the University of Maryland School of Medicine. Elonâs uniquely rich perspective on the lasix is informed by her multiple roles. Family caregiver, geriatrician and iv lasix push time policy expert specializing in long-term care.

ÂI donât think we, as a nation, are going to make needed improvements [in long-term care] until we take responsibility for our aging mothers and fathers â and do so with love and respect,â she told me. Elon has been acutely aware of prejudice against older adults â and determined to overcome it â since she first expressed interest in geriatrics in the late 1970s. ÂWhy in the iv lasix push time world would you want to do that?. Â she recalled being asked by a department chair at Baylor College of Medicine, where she was a medical student. ÂWhat can you possibly do for those [old] people?.

Â Elon iv lasix push time ignored the scorn and became the first geriatrics fellow at Baylor, in Houston, in 1984. She cherished the elderly aunts and uncles she had visited every year during her childhood and was eager to focus on this new specialty, which was just being established in the U.S. ÂSheâs an extraordinary advocate for elders and families,â said Dr. Kris Kuhn, iv lasix push time a retired geriatrician and longtime friend. In 2007, Elon was named geriatrician of the year by the American Geriatrics Society.

Her life took an unexpected turn in 2013 when she iv lasix push time started noticing personality changes and judgment lapses in her husband, Dr. William Henry Adler III, former chief of clinical immunology research at the National Institute on Aging, part of the federal National Institutes of Health. Proud and stubborn, he refused to seek medical attention for several years. Eventually, however, Adlerâs decline accelerated and in 2017 a neurologist iv lasix push time diagnosed frontotemporal dementia with motor neuron disease, an immobilizing condition. Two years later, Adler could barely swallow or speak and had lost the ability to climb down the stairs in their Severna Park, Maryland, house.

ÂHe became a prisoner in our upstairs bedroom,â Elon said. By then, Elon had cut back on work significantly and hired a home health aide to come in iv lasix push time several days a week. In January 2020, Elon enrolled Adler in hospice and began arranging to move him to a nearby assisted living center. Then, the lasix hit. Hospice staffers stopped coming iv lasix push time.

The home health aide quit. The assisted living center went on lockdown. Not visiting Adler wasnât imaginable, so Elon kept him at home, remaining iv lasix push time responsible for his care. ÂI lost 20 pounds in four months,â she told me. ÂIt was incredibly demanding work, caring for him.â Meanwhile, another crisis was brewing.

In Kankakee, Illinois, Elonâs sister, Melissa Davis, was dying of esophageal cancer and no longer able to care for their mother, iv lasix push time Betty Davis, 96. The two had lived together for more than a decade and Davis, who has dementia, required significant assistance. Dr. Rebecca Elonâs sister Melissa Davis (right) was the primary caretaker for their iv lasix push time mother, Betty Davis, for the past 10 years. But new living arrangements had to be made for their mother when Melissa Davis died of esophageal cancer in May 2020.

(Dr. Rebecca Elon) Elon sprang iv lasix push time into action. She and two other sisters moved their mother to an assisted living facility in Kankakee while Elon decided to relocate a few hours away, at a continuing care retirement community in Milwaukee, where sheâd spent her childhood. ÂIt was time to leave the East Coast behind and be closer to family,â she said. By the end of May, Elon and her husband were settled in a two-bedroom apartment in iv lasix push time Milwaukee with a balcony looking out over Lake Michigan.

The facility has a restaurant downstairs that delivered meals, a concierge service, a helpful hospice agency in the area and other amenities that relieved Elonâs isolation. ÂI finally had help,â she told me iv lasix push time. ÂIt was like night and day.â Previously bedbound, Adler would transfer to a chair with the help of a lift (one couldnât be installed in their Maryland home) and look contentedly out the window at paragliders and boats sailing by. ÂIn medicine, we often look at people who are profoundly impaired and ask, âWhat kind of quality of life is that?. Ââ Elon iv lasix push time said.

ÂBut even though Bill was so profoundly impaired, he still had a strong will to live and retained the capacity for joy and interaction.â If she hadnât been by his side day and night, Elon said, she might not have appreciated this. Meanwhile, her mother moved to an assisted living center outside Milwaukee to be nearer to Elon and other family members. But things didnât go iv lasix push time well. The facility was on lockdown most of the time and staff members werenât especially attentive. Concerned about her motherâs well-being, Elon took her out of the facility and brought her to her apartment in late December.

For two months, iv lasix push time she tended to her husbandâs and motherâs needs. In mid-February, Adler, then 81, took a sharp turn for the worse. Unable to speak, his face set in a grimace, he pounded the bed with his hands, breathing heavily. With hospice workersâ help, Elon began administering morphine to ease iv lasix push time his pain and agitation. ÂI thought, âOh, my God, is this what we ask families to deal with?.

Ââ she said. Though she had been a hospice medical director, âthat didnât prepare me for the emotional exhaustion and the ambivalence of giving morphine to my husband.â Elonâs mother was distraught when Adler died 10 days later, asking repeatedly what had happened to him and weeping when she iv lasix push time was told. At some point, Elon realized her mother was also grieving all the losses she had endured over the past year. The loss of her home and friends in Kankakee. The loss iv lasix push time of Melissa, whoâd died in May.

And the loss of her independence. Dr. Rebecca Elon and her mother, iv lasix push time Betty Davis, mask up during the lasix. (Dr. Rebecca Elon) Betty Davis plays with Peanut at Dr.

Rebecca Elonâs apartment in Milwaukee over iv lasix push time the Christmas 2020 holidays. (Dr. Rebecca Elon) That, too, was a revelation made possible by being with iv lasix push time her every day. ÂThe dogma with people with dementia is you just stop talking about death because they canât process it,â Elon said. ÂBut I think that if you repeat whatâs happened over and over and you put it in context and you give them time, they can grieve and start to recover.â âMom is doing so much better with Rebecca,â said Deborah Bliss, 69, Elonâs older sister, who lives in Plano, Texas, and who believes there are benefits for her sister as well.

ÂI think having [Mom] there iv lasix push time after Bill died, having someone else to care for, has been a good distraction.â And so, for Elon, as for so many families across the country, a new chapter has begun, born out of harsh necessities. The days pass relatively calmly, as Elon works and she and her mother spend time together. ÂMom will look out at the lake and say, âOh, my goodness, these colors are so beautiful,ââ Elon said. ÂWhen I cook, sheâll tell me, âItâs so nice to have a meal with you.â When iv lasix push time she goes to bed at night, sheâll say, âOh, this bed feels so wonderful.â Sheâs happy on a moment-to-moment basis. And Iâm very thankful sheâs with me.â Weâre eager to hear from readers about questions youâd like answered, problems youâve been having with your care and advice you need in dealing with the health care system.

Visit khn.org/columnists to submit your requests or tips. Judith Graham iv lasix push time. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story TipLast summer, Anna Ramsey suffered a flare-up of juvenile dermatomyositis, a rare autoimmune condition, posing a terrifying prospect for the Los Angeles resident. She might have to undergo chemotherapy, further compromising her immune system during a lasix. After an agonizing three-day iv lasix push time wait, the results of a blood test came back in her online patient portal â but she didnât understand them.

As hours passed, Ramsey bit her nails and paced. The next day, she gave in and emailed her doctor, who responded with an explanation and a plan. For Ramsey, now 24, instant iv lasix push time access to her test results had been a mixed blessing. ÂIf thereâs something Iâm really nervous about,â she said, âthen I want interpretations and answers with the result. Even if it takes a few days longer.â On April 5, a federal rule went into effect that requires health care providers to give patients like Ramsey electronic access to their health information without delay upon request, at no cost.

Many patients may now find their doctorsâ clinical notes, test results and other medical data iv lasix push time posted to their electronic portal as soon as they are available. Advocates herald the rule as a long-awaited opportunity for patients to control their data and health. ÂThis levels the playing field,â said Jan Walker, co-founder of OpenNotes, a group that has pushed for providers to share notes with patients. ÂA decade ago, the medical iv lasix push time record belonged to the physician.â Jan Walker and Dr. Tom Delbanco co-founded OpenNotes, a group that has pushed for providers to share notes with patients.

(Edward Brown/AcademyHealth) But the rollout of the rule has hit bumps, as doctors learn that iv lasix push time patients might see information before they do. Like Ramsey, some patients have felt distressed when seeing test results dropped into their portal without a physicianâs explanation. And doctorsâ groups say they are confused and concerned about whether the notes of adolescent patients who donât want their parents to see sensitive information can be exempt â or if they will have to breach their patientsâ trust. Patients have long had a iv lasix push time legal right to their medical records but often have had to pay fees, wait weeks or sift through reams of paper to see them. The rule aims not only to remove these barriers, but also to enable patients to access their health records through smartphone apps, and prevent health care providers from withholding information from other providers and health IT companies when a patient wants it to be shared.

Privacy rules under the Health Insurance Portability and Accountability Act, which limit sharing of personal health information outside a clinic, remain in place, although privacy advocates have warned that patients who choose to share their data with consumer apps will put their data at risk. Studies have shown numerous benefits of note sharing iv lasix push time. Patients who read their notes understand more about their health, better remember their treatment plan and are more likely to stick to their medication regimen. Non-white, older or less educated patients report even greater benefits than others. For Sarah Ford, 34, of Pittsburgh, who has iv lasix push time multiple sclerosis, reading her doctorâs notes helps her make the most of each visit and feel informed.

ÂI donât like going into the office and feeling like I donât know whatâs going to happen,â she said. If she wants to try a new medication or treatment, reading previous notes helps her prepare to discuss it with her doctor, she said. The new iv lasix push time rule will have less impact on Ford and the more than 50 million patients in the U.S. Whose doctors had already made their notes available to patients before the rule kicked in. However, only about a third of patients with access to secure online health portals were using them.

While most doctors who have shared notes with patients think itâs a good idea, the policy has iv lasix push time drawbacks. One recent study found that half of doctors reported writing their notes less candidly after they were opened to patients. Another study, published in February, found that 1 in 10 patients had ever felt offended or judged after reading a note. The studyâs iv lasix push time lead author, Dr. Leonor Fernandez, of Beth Israel Deaconess Medical Center, said there is a âlegacy of certain ways of expressing things in medicine that didnât really take into account how it reads when youâre a patient.â âMaybe we can rethink some of these,â she said, citing the phrase âpatient admits to drinking two glasses of wine a dayâ as an example.

ÂWhy not just write âtwo glasses of wine a dayâ?. Â UC San Diego Health started phasing in open notes to patients in 2018 and removed a delay in iv lasix push time the release of lab results last year. Overall, said Dr. Brian Clay, chief medical information officer, both have been uneventful. ÂMost patients are agnostic, some are super-jazzed, and a few are distressed iv lasix push time or have lots of questions and are communicating with us a lot,â he said.

There are exceptions to the requirement to release patient data, such as psychotherapy notes and notes that could harm a patient or someone else if released. Dr. David Bell, president of the Society for Adolescent Health and Medicine, believes itâs unclear exactly what qualifies as âsubstantial harmâ to a patient â the standard that must be met for doctors to withhold an adolescent patientâs notes from a parent. Clarity, he said, is especially important to protect teenagers living in states with less restrictive laws on parental access to medical records. Most electronic medical records are not equipped to segregate sensitive pieces from other information that might be useful for a parent in managing their childâs health, he added.

Some doctors say receiving devastating test results without counseling can traumatize patients. Dr. James Kenealy, an ear, nose and throat doctor in central Massachusetts, said a positive cancer biopsy result for one of his patients was automatically pushed to his portal over the weekend, blindsiding both. ÂYou can give bad news, but if you have a plan and explain, theyâre much better off,â he said. Such incidents arenât affecting the majority of patients, but theyâre not rare, said Dr.

Jack Resneck Jr., an American Medical Association board trustee. The AMA is advocating for âtweaksâ to the rule, he said, like allowing brief delays in releasing results for a few of the highest-stakes tests, like those diagnosing cancer, and more clarity on whether the harm exception applies to adolescent patients who might face emotional distress if their doctor breached their trust by sharing sensitive information with their parents. The Office of the National Coordinator for Health Information Technology, the federal agency overseeing the rule, responded in an email that it has heard these concerns, but has also heard from clinicians that patients value receiving this information in a timely fashion, and that patients can decide whether they want to look at results once they receive them or wait until they can review them with their doctor. It added that the rule does not require giving parents access to protected health information if they did not already have that right under HIPAA. Patient advocate Cynthia Fisher believes there should be no exceptions to immediately releasing results, noting that many patients want and need test results as soon as possible, and that delays can lead to worse health outcomes.

Instead of facing long wait times to discuss diagnoses with their doctors, she said, patients can now take their results elsewhere. ÂWe canât assume the consumer is ignorant and unresourceful,â she said. In the meantime, hospitals and doctors are finding ways to adapt, and their tactics could have lasting implications for patient knowledge and physician workload. At Massachusetts General Hospital, a guide for patients on how to interpret medical terminology in radiology reports is being developed, said Dr. William Mehan, a neuroradiologist.

An internal survey run after radiology results became immediately available to patients found that some doctors were monitoring their inbox after hours in case results arrived. ÂBurnout has come up in this conversation,â Mehan said. Some electronic health records enable doctors to withhold test results at the time they are ordered, said Jodi Daniel, a partner at the law firm Crowell &. Moring. Doctors who can do this could ask patients whether they want their results released immediately or if they want their doctor to communicate the result, assuming they meet certain criteria for exceptions under the rule, she said.

Chantal Worzala, a health technology policy consultant, said more is to come. ÂThere will be a lot more conversation about the tools that individuals want and need in order to access and understand their health information,â she said. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Sarah Kwon. @skwonjournalist Related Topics Contact Us Submit a Story TipFor cancer patients, the road from diagnosis to survivorship feels like a never-ending parade of medical appointments.

Surgeries, bloodwork, chemotherapy, radiation treatments, scans. The routine is time-consuming and costly. So, when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized. Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after he had been treated at another hospital for a brain tumor. The medical news was good.

His stage 2 tumor was stable. The financial news was not. When he sat down at the receptionistâs desk to check out, Leon was confronted by a bold, red-lettered sign on the back of her computer that read. ÂWE DO NOT VALIDATE PARKING.â Below that all-caps statement was a list of parking rates, starting with $2 for a 30-minute visit and maxing out at $28 a day. Lose your ticket?.

Then you could pay $27 for an hour. ÂTo this day, I remember that sign,â Leon, 40, said of the 2017 appointment, which he posted about on Facebook. ÂThese patients were people who were coming in for various types of cancer treatment. These were people who were keenly aware of their own mortality, and yet the sign was screaming at them, âWe do not validate parking.ââ (Hospital officials did not respond to requests for comment about their parking policy.) JulieAnn Villa, who was diagnosed in March with her third bout of cancer, estimates she has spent âthousands of dollarsâ on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she commutes 6 miles to Chicagoâs Northwestern Memorial Hospital from her apartment.

Should she take public transit?. Call a lasix surge-rate Uber?. Ask a friend to drive her?. Or pay $12 to $26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?. She was hospitalized for multiple days in April after spending 23 hours alone in an overburdened ER, because she didnât want friends to pay to wait with her.

ÂI almost drove myself, and Iâm so glad I didnât,â Villa said. ÂThat would have been expensive.â Long a source of frustration for patients, the cost of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators. ÂIf you want to rile up patients or caregivers or family members, just bring up parking costs,â said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies the âfinancial toxicityâ of cancer treatment, including costs not covered by insurance, such as parking fees. Chino, who enrolled in medical school after her husband died of a rare neuroendocrine cancer in 2007, added, âFor people who have to pay $15 to $18 every single time, which is what I remember paying, it really feels like the last straw, frankly â like kicking you when youâre down.â Public transit is possible for some cancer patients in larger cities, but not for those too ill or immunocompromised.

Others have accessibility issues. Many must travel to get care, making driving the best option. Parking fees can have implications for more than just the patient. ÂSome patients say, âThis is the reason I didnât participate in a clinical trial, because I couldnât afford the parking,ââ Chino said. At a time when hospitals and drug companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said.

There are some pilot programs to improve access to drug trials, and some charities, such as the Leukemia &. Lymphoma Society, offer travel grants, but accessibility remains a substantial barrier to cancer care, said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which offers financial aid to patients and advocates in Washington, D.C., for âpatient-centeredâ health policies. ÂThe true definition of a patient-centered health care system,â Franklin said, is one that allows patients to choose the best means of transportation. ÂItâs not making them go into debt because theyâve had to pay a ton of money for parking each time they go to the clinic or the hospital.â Chino and colleagues published a short study in July showing that some cancer patients pay $1,680 over the course of treatment. According to readership statistics released in late March, the study was the most read and downloaded article in JAMA Oncology last year, and it continues to prompt a lively social media response.

A thread on Reddit has logged more than 1,100 comments, including many from patients in other countries voicing surprise at U.S. Parking policies. The researchers calculated the cost to park at 63 National Cancer Institute-designated cancer centers while receiving the standard number of treatments for each of three types of cancers. Node-positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate costs for follow-up appointments, blood draws, routine scans and immune-boosting injections.

They found that, while 20 of the hospitals provided free parking for all cancer patients, the other 43 had widely varying fees. ÂThe range was $0 to $800 for breast cancer,â Chino said. ÂThatâs huge, and itâs not like the person whoâs paying $800 is necessarily getting any better treatment.â The maximum charges for a standard course of therapy for head and neck cancer were $665 and for AML, $1,680. Practices should change, Chino said, âto alleviate this strain for our patients.â Of the 63 hospitals, including those where parking is free for cancer patients, 54% offered free parking for chemotherapy and 68% for radiation treatment. The top daily parking rate, according to the researchers, is $40 at New Yorkâs Mount Sinai Hospital.

(A spokesperson for Mount Sinai declined to comment.) Chinoâs own institution, Memorial Sloan Kettering, is not far behind. Parking at one of its main garages begins at $12 an hour and maxes out at $36 a day. A spokesperson for the hospital said some locations do offer free parking, and all patients can apply for aid to cover parking costs. A few colleagues scoffed when Chino said she was researching parking charges, she said, but a growing number of mostly younger oncologists are concerned about indirect costs that contribute to the financial toxicity of cancer. ÂIt seems ethically incorrect to nickel-and-dime patients for parking charges,â a trio of doctors wrote last year in an editorial published by the American Society of Clinical Oncologists.

They acknowledge that most top cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate the garages. ÂNevertheless, in 2020, with our multibillion-dollar cancer center budgets, we as health care systems should do everything we can to help patients and caregivers,â the editorial said. City of Hope National Medical Center in Los Angeles is one of the 20 NCI-designated hospitals that do not charge patients for parking. Dr. Vijay Trisal, a surgical oncologist who serves as City of Hopeâs chief medical officer, takes pride in that distinction.

ÂCharging cancer patients for parking is like a knife in the back,â he said. ÂWe canât control copays, but we can control what patients pay for parking.â While Trisal would never want a patient to choose City of Hope for the free parking alone, he acknowledges the policy gives his hospital a competitive advantage. ÂYou would not believe how many patients have said to me, âThank you for not charging for parking,ââ he said. Related Topics Contact Us Submit a Story TipAmid a lasix that left law enforcement agencies stretched thin and forced shutdowns that left young men with little to do, California registered a devastating surge in homicides in 2020 that hit especially hard in Black and Latino communities. The number of homicide victims in California jumped 27% from 2019 to 2020, to about 2,300, marking the largest year-over-year increase in three decades, according to preliminary death certificate data from the California Department of Public Health.

There were 5.8 homicides per 100,000 residents in 2020, the highest rate in California since 2008. Similar increases were seen nationwide. The number of homicides in a sampling of large cities grew 32% from 2019 to 2020, according to preliminary FBI data. The data encompasses over 200 cities with more than 100,000 people but does not include some big cities, like New York, Chicago and Philadelphia, that did not report. The California death certificate data reveals striking disparities in who fell victim to homicide in 2020.

The number of homicides that took the lives of Black Californians rose 36% from 2019 to 2020, while homicides that took Hispanic lives rose 30%. By comparison, the number of white homicide victims rose 15% and the number of Asian victims rose 10%. Most victims of homicide in 2020 were young, between 15 and 34 years old. The number of homicide victims in this age group rose from about 900 in 2019 to 1,175 in 2020, a 31% rise. Firearms were the most common instrument of death, and the number of homicides involving guns rose 35% last year, the state data shows.

Extending another long-standing trend. Males were five times as likely to be the victims of homicide as females. The number of male victims rose 30% in 2020, compared with a 14% rise in female victims. The increase in deadly violence played out across large swaths of the state, urban and rural, and was keenly felt in the San Francisco Bay Area. Among Californiaâs 10 most populous counties, the sharpest increases were reported in Alameda County, where homicides rose 57%, followed by Fresno (44%), Sacramento (36%) and Los Angeles (32%).

Only one of the 10 most populous counties â Contra Costa â saw a decline in homicides last year. Law enforcement officials and criminologists said an increase in conflict among young adults, particularly those in street gangs, was a significant factor in the violence. They noted that schools and sports programs shut down as hypertension medications surged, as did large numbers of community and nonprofit programs that provide support, recreational outlets and intervention services for at-risk youth. ÂThey were bored,â said Reynaldo Reaser, executive director of Reclaiming America's Communities Through Empowerment (R.A.C.E.), which offers sports leagues, gang mediation and youth development in impoverished neighborhoods of South Los Angeles. ÂAnd so, having nothing to do â no programs, no sports, no facilities open â the only thing they could focus on is each other.â Reaser runs a dynamic youth softball league that typically would draw more than 600 players and spectators during Sunday play, he said, many of them young gang members.

But those games and other programs were curtailed during the hypertension medications lasix. Terrell Williams, an 18-year-old who lives in the West Athens area of South Los Angeles, said he spent many nights doing âdelinquent stuffâ before Reaserâs program changed his life. He said many of his peers felt cooped up and restless during the lasix lockdowns, which contributed to an increase in violence. Âhypertension medications tended to, I guess, make people not want to stay inside the house, and drove them outside more towards each other,â he said. Jorja Leap, a UCLA anthropologist and expert in gangs, violence and trauma, echoed that theme, saying the restrictions on youth intervention programs and other healthy activities played âa huge roleâ in the rise in violence.

ÂThe sports after school â football, basketball, whatever it might be â all that is stopped,â said Leap, a faculty member at UCLAâs Luskin School of Public Affairs. ÂSo, frankly, you got a lot of adolescent and young adult energies out there.â Leap said young adults were particularly vulnerable to the mental toll of the lasix. ÂThey finally get programs. They have people interested in them. And then, it's all of a sudden withdrawn,â she said.

lasix-fueled anxiety and isolation corresponded with a huge increase in gun sales, which Leap said may also explain some of the increase in homicides. ÂI am worried about how easy it has been to get a gun during such a crisis time in America,â she said. ÂItâs not âPick one factor,ââ she added. ÂAll of these factors reinforce each other.â David Robinson is the sheriff in Kings County, a largely rural county in Southern California that registered 15 homicides in 2020, up from four in 2019. He is also president of the California State Sheriffsâ Association, giving him a wide lens on a difficult year.

Robinson agreed that an increase in gang activity and the âmental impactâ of telling young adults they had to stay indoors likely contributed to the violence. But separately, he cited the toll the lasix took on police agencies. Many officers fell ill with hypertension medications, forcing their agencies to reduce patrols and other crime prevention efforts. The mass protests that followed George Floydâs murder by a Minneapolis police officer last May also diverted resources, said Robinson. And the anger directed at police made it tougher for some officers to do their jobs.

ÂWhen there's this call to defund police, it has an impact on the mentality of the men and women doing the job,â he said, adding that constant criticism can cause officers to âbecome more reactive than proactive.â Robinson echoed other law enforcement officers in noting that thousands of inmates were released early from state prisons and county jails during the lasix to stem hypertension medications outbreaks. He said he thinks research eventually will show a correlation with the surge in homicides. Leap disagreed. ÂIf you get two shoplifting charges, it's a felony,â she said. ÂThat's who they're releasing.

They're not releasing people from death row.â With mass vaccinations taking place across the state and nation, more places are reopening and young adults have more options to engage in something positive. But Leap said it will take a broad effort to bolster jobs and education, along with short-term intervention aimed at those still hurting from the lasix, to improve the social conditions that contributed to the increase in homicides. ÂAs much as we've never dealt with a global lasix in modern times, we've never dealt with the aftermath of a global lasix,â she said. Reaser, in Los Angeles, is nonetheless optimistic. After a year of shutdowns, his youth softball league is starting up again.

Finally, instead of trying to work out conflicts over the phone or online, Reaser can get young adult rivals to talk, face to face, and bond in a positive way. ÂI really think that a lot of programs will open up,â he said. ÂA lot of violence will slow down.â MethodologyThis story draws on data from three sources. The data from these sources matches closely, but not precisely. Cause of death and population figures for 1979 through 2018 come from the federal Centers for Disease Control and Prevention.

Cause of death figures for 2019 and 2020 come primarily from the California Department of Public Health and are based on death certificates. The exception is 2019 data for eight largely rural counties with few homicides. CDPH did not publish specific 2019 homicide figures for those counties due to data privacy rules. For those counties, 2019 homicide data comes from the California Department of Justice. Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Related Topics Contact Us Submit a Story Tip.

The loss of a husband buy lasix pill http://www.ec-paul-langevin-strasbourg.ac-strasbourg.fr/wp/?p=2531. The death of a sister. Taking in an elderly mother with buy lasix pill dementia. This has been a year like none other for Dr.

Rebecca Elon, who has dedicated her professional life to helping older adults. Itâs taught her buy lasix pill what families go through when caring for someone with serious illness as nothing has before. ÂReading about caregiving of this kind was one thing. Experiencing it was entirely different,â she told me.

Were it not for the challenges sheâs faced during the hypertension lasix, Elon might not have learned firsthand how buy lasix pill exhausting end-of-life care can be, physically and emotionally â something she understood only abstractly previously as a geriatrician. And she might not have been struck by what she called the deepest lesson of this lasix. That caregiving is a manifestation of love and that love means being present with someone even when suffering seems overwhelming. All these experiences have been buy lasix pill âa gift, in a way.

Theyâve truly changed me,â said Elon, 66, a part-time associate professor at Johns Hopkins University School of Medicine and an adjunct associate professor at the University of Maryland School of Medicine. Elonâs uniquely rich perspective on the lasix is informed by her multiple roles. Family caregiver, buy lasix pill geriatrician and policy expert specializing in long-term care. ÂI donât think we, as a nation, are going to make needed improvements [in long-term care] until we take responsibility for our aging mothers and fathers â and do so with love and respect,â she told me.

Elon has been acutely aware of prejudice against older adults â and determined to overcome it â since she first expressed interest in geriatrics in the late 1970s. ÂWhy in the world buy lasix pill would you want to do that?. Â she recalled being asked by a department chair at Baylor College of Medicine, where she was a medical student. ÂWhat can you possibly do for those [old] people?.

Â Elon ignored the scorn and became the first buy lasix pill geriatrics fellow at Baylor, in Houston, in 1984. She cherished the elderly aunts and uncles she had visited every year during her childhood and was eager to focus on this new specialty, which was just being established in the U.S. ÂSheâs an extraordinary advocate for elders and families,â said Dr. Kris Kuhn, a retired geriatrician and buy lasix pill longtime friend.

In 2007, Elon was named geriatrician of the year by the American Geriatrics Society. Her life took an buy lasix pill unexpected turn in 2013 when she started noticing personality changes and judgment lapses in her husband, Dr. William Henry Adler III, former chief of clinical immunology research at the National Institute on Aging, part of the federal National Institutes of Health. Proud and stubborn, he refused to seek medical attention for several years.

Eventually, however, Adlerâs decline accelerated and in 2017 a neurologist diagnosed frontotemporal dementia with buy lasix pill motor neuron disease, an immobilizing condition. Two years later, Adler could barely swallow or speak and had lost the ability to climb down the stairs in their Severna Park, Maryland, house. ÂHe became a prisoner in our upstairs bedroom,â Elon said. By then, Elon had cut back on work significantly and hired a home health buy lasix pill aide to come in several days a week.

In January 2020, Elon enrolled Adler in hospice and began arranging to move him to a nearby assisted living center. Then, the lasix hit. Hospice staffers buy lasix pill stopped coming. The home health aide quit.

The assisted living center went on lockdown. Not visiting Adler wasnât imaginable, so Elon kept him at home, remaining responsible for his care buy lasix pill. ÂI lost 20 pounds in four months,â she told me. ÂIt was incredibly demanding work, caring for him.â Meanwhile, another crisis was brewing.

In Kankakee, Illinois, Elonâs sister, Melissa Davis, was dying of esophageal cancer and no longer able to care for their mother, Betty Davis, 96 buy lasix pill. The two had lived together for more than a decade and Davis, who has dementia, required significant assistance. Dr. Rebecca Elonâs sister Melissa Davis buy lasix pill (right) was the primary caretaker for their mother, Betty Davis, for the past 10 years.

But new living arrangements had to be made for their mother when Melissa Davis died of esophageal cancer in May 2020. (Dr. Rebecca Elon) Elon sprang into buy lasix pill action. She and two other sisters moved their mother to an assisted living facility in Kankakee while Elon decided to relocate a few hours away, at a continuing care retirement community in Milwaukee, where sheâd spent her childhood.

ÂIt was time to leave the East Coast behind and be closer to family,â she said. By the end of buy lasix pill May, Elon and her husband were settled in a two-bedroom apartment in Milwaukee with a balcony looking out over Lake Michigan. The facility has a restaurant downstairs that delivered meals, a concierge service, a helpful hospice agency in the area and other amenities that relieved Elonâs isolation. ÂI finally had help,â she told me buy lasix pill.

ÂIt was like night and day.â Previously bedbound, Adler would transfer to a chair with the help of a lift (one couldnât be installed in their Maryland home) and look contentedly out the window at paragliders and boats sailing by. ÂIn medicine, we often look at people who are profoundly impaired and ask, âWhat kind of quality of life is that?. Ââ Elon buy lasix pill said. ÂBut even though Bill was so profoundly impaired, he still had a strong will to live and retained the capacity for joy and interaction.â If she hadnât been by his side day and night, Elon said, she might not have appreciated this.

Meanwhile, her mother moved to an assisted living center outside Milwaukee to be nearer to Elon and other family members. But things didnât go well buy lasix pill. The facility was on lockdown most of the time and staff members werenât especially attentive. Concerned about her motherâs well-being, Elon took her out of the facility and brought her to her apartment in late December.

For two months, she tended buy lasix pill to her husbandâs and motherâs needs. In mid-February, Adler, then 81, took a sharp turn for the worse. Unable to speak, his face set in a grimace, he pounded the bed with his hands, breathing heavily. With hospice buy lasix pill workersâ help, Elon began administering morphine to ease his pain and agitation.

ÂI thought, âOh, my God, is this what we ask families to deal with?. Ââ she said. Though she had been a hospice medical director, âthat didnât prepare me for the emotional exhaustion and the ambivalence of giving morphine to my husband.â Elonâs mother was distraught when Adler died 10 days later, asking repeatedly what had happened to buy lasix pill him and weeping when she was told. At some point, Elon realized her mother was also grieving all the losses she had endured over the past year.

The loss of her home and friends in Kankakee. The loss of Melissa, whoâd died in buy lasix pill May. And the loss of her independence. Dr.

Rebecca Elon buy lasix pill and her mother, Betty Davis, mask up during the lasix. (Dr. Rebecca Elon) Betty Davis plays with Peanut at Dr. Rebecca Elonâs buy lasix pill apartment in Milwaukee over the Christmas 2020 holidays.

(Dr. Rebecca Elon) buy lasix pill That, too, was a revelation made possible by being with her every day. ÂThe dogma with people with dementia is you just stop talking about death because they canât process it,â Elon said. ÂBut I think that if you repeat whatâs happened over and over and you put it in context and you give them time, they can grieve and start to recover.â âMom is doing so much better with Rebecca,â said Deborah Bliss, 69, Elonâs older sister, who lives in Plano, Texas, and who believes there are benefits for her sister as well.

ÂI think having [Mom] there after Bill died, having someone else to care buy lasix pill for, has been a good distraction.â And so, for Elon, as for so many families across the country, a new chapter has begun, born out of harsh necessities. The days pass relatively calmly, as Elon works and she and her mother spend time together. ÂMom will look out at the lake and say, âOh, my goodness, these colors are so beautiful,ââ Elon said. ÂWhen I cook, sheâll tell me, âItâs so nice to have a meal with you.â When she goes to bed at night, sheâll say, âOh, this bed feels so wonderful.â Sheâs happy on buy lasix pill a moment-to-moment basis.

And Iâm very thankful sheâs with me.â Weâre eager to hear from readers about questions youâd like answered, problems youâve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips. Judith buy lasix pill Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story TipLast summer, Anna Ramsey suffered a flare-up of juvenile dermatomyositis, a rare autoimmune condition, posing a terrifying prospect for the Los Angeles resident.

She might have to undergo chemotherapy, further compromising her immune system during a lasix. After an agonizing three-day wait, the results of a blood buy lasix pill test came back in her online patient portal â but she didnât understand them. As hours passed, Ramsey bit her nails and paced. The next day, she gave in and emailed her doctor, who responded with an explanation and a plan.

For Ramsey, now 24, instant buy lasix pill access to her test results had been a mixed blessing. ÂIf thereâs something Iâm really nervous about,â she said, âthen I want interpretations and answers with the result. Even if it takes a few days longer.â On April 5, a federal rule went into effect that requires health care providers to give patients like Ramsey electronic access to their health information without delay upon request, at no cost. Many patients may now find their doctorsâ clinical notes, test results and other medical data posted to their electronic portal as soon as they are available buy lasix pill.

Advocates herald the rule as a long-awaited opportunity for patients to control their data and health. ÂThis levels the playing field,â said Jan Walker, co-founder of OpenNotes, a group that has pushed for providers to share notes with patients. ÂA decade ago, the medical buy lasix pill record belonged to the physician.â Jan Walker and Dr. Tom Delbanco co-founded OpenNotes, a group that has pushed for providers to share notes with patients.

(Edward Brown/AcademyHealth) But the rollout of the rule has hit bumps, as doctors learn that patients might see buy lasix pill information before they do. Like Ramsey, some patients have felt distressed when seeing test results dropped into their portal without a physicianâs explanation. And doctorsâ groups say they are confused and concerned about whether the notes of adolescent patients who donât want their parents to see sensitive information can be exempt â or if they will have to breach their patientsâ trust. Patients have long had a legal right to their medical records but often have had to pay fees, wait weeks or sift through reams of paper to buy lasix pill see them.

The rule aims not only to remove these barriers, but also to enable patients to access their health records through smartphone apps, and prevent health care providers from withholding information from other providers and health IT companies when a patient wants it to be shared. Privacy rules under the Health Insurance Portability and Accountability Act, which limit sharing of personal health information outside a clinic, remain in place, although privacy advocates have warned that patients who choose to share their data with consumer apps will put their data at risk. Studies have shown numerous benefits of buy lasix pill note sharing. Patients who read their notes understand more about their health, better remember their treatment plan and are more likely to stick to their medication regimen.

Non-white, older or less educated patients report even greater benefits than others. For Sarah Ford, 34, of Pittsburgh, who has multiple sclerosis, reading her doctorâs notes helps her make the most of buy lasix pill each visit and feel informed. ÂI donât like going into the office and feeling like I donât know whatâs going to happen,â she said. If she wants to try a new medication or treatment, reading previous notes helps her prepare to discuss it with her doctor, she said.

The new rule will have less impact on Ford and the more than 50 million patients in the U.S buy lasix pill. Whose doctors had already made their notes available to patients before the rule kicked in. However, only about a third of patients with access to secure online health portals were using them. While most buy lasix pill doctors who have shared notes with patients think itâs a good idea, the policy has drawbacks.

One recent study found that half of doctors reported writing their notes less candidly after they were opened to patients. Another study, published in February, found that 1 in 10 patients had ever felt offended or judged after reading a note. The studyâs lead author, buy lasix pill Dr. Leonor Fernandez, of Beth Israel Deaconess Medical Center, said there is a âlegacy of certain ways of expressing things in medicine that didnât really take into account how it reads when youâre a patient.â âMaybe we can rethink some of these,â she said, citing the phrase âpatient admits to drinking two glasses of wine a dayâ as an example.

ÂWhy not just write âtwo glasses of wine a dayâ?. Â UC San Diego buy lasix pill Health started phasing in open notes to patients in 2018 and removed a delay in the release of lab results last year. Overall, said Dr. Brian Clay, chief medical information officer, both have been uneventful.

ÂMost patients are agnostic, some are super-jazzed, and a few are distressed or have lots of questions buy lasix pill and are communicating with us a lot,â he said. There are exceptions to the requirement to release patient data, such as psychotherapy notes and notes that could harm a patient or someone else if released. Dr. David Bell, president of the Society for Adolescent Health and Medicine, believes itâs unclear exactly what qualifies as âsubstantial harmâ to a patient â the standard that must be met for doctors to withhold an adolescent patientâs notes from a parent.

Clarity, he said, is especially important to protect teenagers living in states with less restrictive laws on parental access to medical records. Most electronic medical records are not equipped to segregate sensitive pieces from other information that might be useful for a parent in managing their childâs health, he added. Some doctors say receiving devastating test results without counseling can traumatize patients. Dr.

James Kenealy, an ear, nose and throat doctor in central Massachusetts, said a positive cancer biopsy result for one of his patients was automatically pushed to his portal over the weekend, blindsiding both. ÂYou can give bad news, but if you have a plan and explain, theyâre much better off,â he said. Such incidents arenât affecting the majority of patients, but theyâre not rare, said Dr. Jack Resneck Jr., an American Medical Association board trustee.

The AMA is advocating for âtweaksâ to the rule, he said, like allowing brief delays in releasing results for a few of the highest-stakes tests, like those diagnosing cancer, and more clarity on whether the harm exception applies to adolescent patients who might face emotional distress if their doctor breached their trust by sharing sensitive information with their parents. The Office of the National Coordinator for Health Information Technology, the federal agency overseeing the rule, responded in an email that it has heard these concerns, but has also heard from clinicians that patients value receiving this information in a timely fashion, and that patients can decide whether they want to look at results once they receive them or wait until they can review them with their doctor. It added that the rule does not require giving parents access to protected health information if they did not already have that right under HIPAA. Patient advocate Cynthia Fisher believes there should be no exceptions to immediately releasing results, noting that many patients want and need test results as soon as possible, and that delays can lead to worse health outcomes.

William Mehan, a neuroradiologist. An internal survey run after radiology results became immediately available to patients found that some doctors were monitoring their inbox after hours in case results arrived. ÂBurnout has come up in this conversation,â Mehan said. Some electronic health records enable doctors to withhold test results at the time they are ordered, said Jodi Daniel, a partner at the law firm Crowell &.

Moring. Doctors who can do this could ask patients whether they want their results released immediately or if they want their doctor to communicate the result, assuming they meet certain criteria for exceptions under the rule, she said. Chantal Worzala, a health technology policy consultant, said more is to come. ÂThere will be a lot more conversation about the tools that individuals want and need in order to access and understand their health information,â she said.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Sarah Kwon. @skwonjournalist Related Topics Contact Us Submit a Story TipFor cancer patients, the road from diagnosis to survivorship feels like a never-ending parade of medical appointments. Surgeries, bloodwork, chemotherapy, radiation treatments, scans.

The routine is time-consuming and costly. So, when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized. Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after he had been treated at another hospital for a brain tumor. The medical news was good.

Lose your ticket?. Then you could pay $27 for an hour. ÂTo this day, I remember that sign,â Leon, 40, said of the 2017 appointment, which he posted about on Facebook. ÂThese patients were people who were coming in for various types of cancer treatment.

These were people who were keenly aware of their own mortality, and yet the sign was screaming at them, âWe do not validate parking.ââ (Hospital officials did not respond to requests for comment about their parking policy.) JulieAnn Villa, who was diagnosed in March with her third bout of cancer, estimates she has spent âthousands of dollarsâ on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she commutes 6 miles to Chicagoâs Northwestern Memorial Hospital from her apartment. Should she take public transit?. Call a lasix surge-rate Uber?.

Ask a friend to drive her?. Or pay $12 to $26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?. She was hospitalized for multiple days in April after spending 23 hours alone in an overburdened ER, because she didnât want friends to pay to wait with her. ÂI almost drove myself, and Iâm so glad I didnât,â Villa said.

ÂThat would have been expensive.â Long a source of frustration for patients, the cost of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators. ÂIf you want to rile up patients or caregivers or family members, just bring up parking costs,â said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies the âfinancial toxicityâ of cancer treatment, including costs not covered by insurance, such as parking fees. Chino, who enrolled in medical school after her husband died of a rare neuroendocrine cancer in 2007, added, âFor people who have to pay $15 to $18 every single time, which is what I remember paying, it really feels like the last straw, frankly â like kicking you when youâre down.â Public transit is possible for some cancer patients in larger cities, but not for those too ill or immunocompromised.

At a time when hospitals and drug companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said. There are some pilot programs to improve access to drug trials, and some charities, such as the Leukemia &. Lymphoma Society, offer travel grants, but accessibility remains a substantial barrier to cancer care, said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which offers financial aid to patients and advocates in Washington, D.C., for âpatient-centeredâ health policies. ÂThe true definition of a patient-centered health care system,â Franklin said, is one that allows patients to choose the best means of transportation.

ÂItâs not making them go into debt because theyâve had to pay a ton of money for parking each time they go to the clinic or the hospital.â Chino and colleagues published a short study in July showing that some cancer patients pay $1,680 over the course of treatment. According to readership statistics released in late March, the study was the most read and downloaded article in JAMA Oncology last year, and it continues to prompt a lively social media response. A thread on Reddit has logged more than 1,100 comments, including many from patients in other countries voicing surprise at U.S. Parking policies.

The researchers calculated the cost to park at 63 National Cancer Institute-designated cancer centers while receiving the standard number of treatments for each of three types of cancers. Node-positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate costs for follow-up appointments, blood draws, routine scans and immune-boosting injections. They found that, while 20 of the hospitals provided free parking for all cancer patients, the other 43 had widely varying fees.

ÂThe range was $0 to $800 for breast cancer,â Chino said. ÂThatâs huge, and itâs not like the person whoâs paying $800 is necessarily getting any better treatment.â The maximum charges for a standard course of therapy for head and neck cancer were $665 and for AML, $1,680. Practices should change, Chino said, âto alleviate this strain for our patients.â Of the 63 hospitals, including those where parking is free for cancer patients, 54% offered free parking for chemotherapy and 68% for radiation treatment. The top daily parking rate, according to the researchers, is $40 at New Yorkâs Mount Sinai Hospital.

ÂIt seems ethically incorrect to nickel-and-dime patients for parking charges,â a trio of doctors wrote last year in an editorial published by the American Society of Clinical Oncologists. They acknowledge that most top cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate the garages. ÂNevertheless, in 2020, with our multibillion-dollar cancer center budgets, we as health care systems should do everything we can to help patients and caregivers,â the editorial said. City of Hope National Medical Center in Los Angeles is one of the 20 NCI-designated hospitals that do not charge patients for parking.

Dr. Vijay Trisal, a surgical oncologist who serves as City of Hopeâs chief medical officer, takes pride in that distinction. ÂCharging cancer patients for parking is like a knife in the back,â he said. ÂWe canât control copays, but we can control what patients pay for parking.â While Trisal would never want a patient to choose City of Hope for the free parking alone, he acknowledges the policy gives his hospital a competitive advantage.

ÂYou would not believe how many patients have said to me, âThank you for not charging for parking,ââ he said. Related Topics Contact Us Submit a Story TipAmid a lasix that left law enforcement agencies stretched thin and forced shutdowns that left young men with little to do, California registered a devastating surge in homicides in 2020 that hit especially hard in Black and Latino communities. The number of homicide victims in California jumped 27% from 2019 to 2020, to about 2,300, marking the largest year-over-year increase in three decades, according to preliminary death certificate data from the California Department of Public Health. There were 5.8 homicides per 100,000 residents in 2020, the highest rate in California since 2008.

Similar increases were seen nationwide. The number of homicides in a sampling of large cities grew 32% from 2019 to 2020, according to preliminary FBI data. The data encompasses over 200 cities with more than 100,000 people but does not include some big cities, like New York, Chicago and Philadelphia, that did not report. The California death certificate data reveals striking disparities in who fell victim to homicide in 2020.

Firearms were the most common instrument of death, and the number of homicides involving guns rose 35% last year, the state data shows. Extending another long-standing trend. Males were five times as likely to be the victims of homicide as females. The number of male victims rose 30% in 2020, compared with a 14% rise in female victims.

The increase in deadly violence played out across large swaths of the state, urban and rural, and was keenly felt in the San Francisco Bay Area. Among Californiaâs 10 most populous counties, the sharpest increases were reported in Alameda County, where homicides rose 57%, followed by Fresno (44%), Sacramento (36%) and Los Angeles (32%). Only one of the 10 most populous counties â Contra Costa â saw a decline in homicides last year. Law enforcement officials and criminologists said an increase in conflict among young adults, particularly those in street gangs, was a significant factor in the violence.

They noted that schools and sports programs shut down as hypertension medications surged, as did large numbers of community and nonprofit programs that provide support, recreational outlets and intervention services for at-risk youth. ÂThey were bored,â said Reynaldo Reaser, executive director of Reclaiming America's Communities Through Empowerment (R.A.C.E.), which offers sports leagues, gang mediation and youth development in impoverished neighborhoods of South Los Angeles. ÂAnd so, having nothing to do â no programs, no sports, no facilities open â the only thing they could focus on is each other.â Reaser runs a dynamic youth softball league that typically would draw more than 600 players and spectators during Sunday play, he said, many of them young gang members. But those games and other programs were curtailed during the hypertension medications lasix.

Terrell Williams, an 18-year-old who lives in the West Athens area of South Los Angeles, said he spent many nights doing âdelinquent stuffâ before Reaserâs program changed his life. He said many of his peers felt cooped up and restless during the lasix lockdowns, which contributed to an increase in violence. Âhypertension medications tended to, I guess, make people not want to stay inside the house, and drove them outside more towards each other,â he said. Jorja Leap, a UCLA anthropologist and expert in gangs, violence and trauma, echoed that theme, saying the restrictions on youth intervention programs and other healthy activities played âa huge roleâ in the rise in violence.

And then, it's all of a sudden withdrawn,â she said. lasix-fueled anxiety and isolation corresponded with a huge increase in gun sales, which Leap said may also explain some of the increase in homicides. ÂI am worried about how easy it has been to get a gun during such a crisis time in America,â she said. ÂItâs not âPick one factor,ââ she added.

ÂAll of these factors reinforce each other.â David Robinson is the sheriff in Kings County, a largely rural county in Southern California that registered 15 homicides in 2020, up from four in 2019. He is also president of the California State Sheriffsâ Association, giving him a wide lens on a difficult year. Robinson agreed that an increase in gang activity and the âmental impactâ of telling young adults they had to stay indoors likely contributed to the violence. But separately, he cited the toll the lasix took on police agencies.

Many officers fell ill with hypertension medications, forcing their agencies to reduce patrols and other crime prevention efforts. The mass protests that followed George Floydâs murder by a Minneapolis police officer last May also diverted resources, said Robinson. And the anger directed at police made it tougher for some officers to do their jobs. ÂWhen there's this call to defund police, it has an impact on the mentality of the men and women doing the job,â he said, adding that constant criticism can cause officers to âbecome more reactive than proactive.â Robinson echoed other law enforcement officers in noting that thousands of inmates were released early from state prisons and county jails during the lasix to stem hypertension medications outbreaks.

He said he thinks research eventually will show a correlation with the surge in homicides. Leap disagreed. ÂIf you get two shoplifting charges, it's a felony,â she said. ÂThat's who they're releasing.

After a year of shutdowns, his youth softball league is starting up again. Finally, instead of trying to work out conflicts over the phone or online, Reaser can get young adult rivals to talk, face to face, and bond in a positive way. ÂI really think that a lot of programs will open up,â he said. ÂA lot of violence will slow down.â MethodologyThis story draws on data from three sources.

The data from these sources matches closely, but not precisely. Cause of death and population figures for 1979 through 2018 come from the federal Centers for Disease Control and Prevention. Cause of death figures for 2019 and 2020 come primarily from the California Department of Public Health and are based on death certificates. The exception is 2019 data for eight largely rural counties with few homicides.

CDPH did not publish specific 2019 homicide figures for those counties due to data privacy rules. For those counties, 2019 homicide data comes from the California Department of Justice. Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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