YOUR HEALTH is your greatest wealth and asset. Your healthy body gives you the strength and energy that help you to achieve better results in every aspect of your life. Being able to sleep at night, walk without pain, eat and enjoy food is the main...

The Carriacou workshop is part of a series of parish-level trainings to strengthen the multi-sectoral teams for gender-based violence

View the full post Gender-Based Violence workshop held in Carriacou on NOW Grenada.

But a research study the Centers for Medicare & Medicaid Services commissioned to identify the appropriate level of staffing made no specific recommendations and analyzed only staffing levels lower than what the previous major federal evaluation had considered best, according to a copy of the study reviewed Monday by KFF Health News. Instead, the new study said there was no single staffing level that would guarantee quality care, although the report estimated that higher staffing levels would lead to fewer hospitalizations and emergency room visits, faster care, and fewer failures to provide care.

Patient advocates said the report was the latest sign that the administration would fall short of its pledge to establish robust staffing levels to protect the 1.2 million Americans in skilled nursing facilities. Already, the administration is six months behind its self-imposed deadline of February to propose new rules. Those proposals, which have not been released, have been under evaluation since May by the Office of Management and Budget. The study, dated June 2023, has not been formally released either, but a copy was posted on the CMS website. It was taken down shortly after KFF Health News published this article.

“It’s honestly heartbreaking,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for nursing home patients in New York state. “I just don’t see how this doesn’t ultimately put more residents at risk of neglect and abuse. Putting the government’s imprimatur on a standard that is patently unsafe is going to make it much more difficult for surveyors to hold facilities accountable for the harm caused by understaffing nursing homes.”

For months, the nursing home industry has been lobbying strenuously against a uniform ratio of patients to nurses and aides. “What is clear as you look across the country is every nursing home is unique and a one-size-fits-all approach does not work,” said Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association, an industry trade group.

Nursing home groups have emphasized the widespread difficulty in finding workers willing to fill existing certified nursing assistant jobs, which are often grueling and pay less than what workers can make at retail stores. Homes say their licensed nurses are often drawn away by other jobs, such as better-paying hospital positions. “The workforce challenges are real,” said Katie Smith Sloan, president and CEO of LeadingAge, an association that represents nonprofit nursing homes.

The industry has also argued that if the government wants it to hire more workers it needs to increase the payments it makes through state Medicaid programs, which are the largest payor for nursing home care. Advocates and some researchers have argued that nursing homes, particularly for-profit ones, can afford to pay employees more and hire additional staff if they forsake some of the profits they give investors.

“Certainly, facilities haven’t put all the dollars back into direct care over the years,” said David Grabowski, a professor of health care policy at Harvard Medical School. “But for certain facilities, it’s going to be a big lift to pay for” higher staffing levels, he said in an interview last week.

In a written statement to KFF Health News, Jonathan Blum, CMS’ principal deputy administrator and chief operating officer, said the study had been posted in error. “CMS is committed to holding nursing homes accountable for protecting the health and safety of all residents, and adequate staffing is critical to this effort,” he said. “CMS’s proposal is being developed using a rigorous process that draws on a wide range of source information, including extensive input from residents and their families, workers, administrators, experts, and other stakeholders. Our focus is on advancing implementable solutions that promote safe, quality care for residents.” Blum’s statement called the study a “draft,” although nothing in the 478-page study indicated it was preliminary.

The study has been widely anticipated, both because of the central role the administration said it would play in its policy and because the last major CMS study, conducted in 2001, had concluded that nursing home care improves as staffing increases up to the level of about one worker for every six residents. The formal metric for that staffing level was 4.1 staff hours per resident per day, which is calculated by dividing the number of total hours worked by nurses and aides on duty daily by the number of residents present each day.

CMS never adopted that staffing ratio and instead gave each nursing home discretion to determine a reasonable staffing level. Regulators rarely cite nursing homes for insufficient staffing, even though independent researchers have concluded low staffing is the root of many nursing home injuries. Too few nurse aides, for instance, often means immobile residents are not repositioned in bed, causing bedsores that can lead to infection. Low staffing also is often responsible for indignities residents face, such as being left in soiled bedsheets for hours.

The new research was conducted by Abt Associates, a regular contractor for CMS that also performed the 2001 study. But the report, in an implicit disagreement with its predecessor, concluded there was “no obvious plateau at which quality and safety are maximized or ‘cliff’ below which quality and safety steeply decline.” Abt referred questions about the study to CMS.

The study evaluated four minimum staffing levels, all of which were below the 4.1 daily staff hours that the prior study had identified as ideal. The highest was 3.88 daily staff hours. At that level, the study estimated 0.6% of residents would get delayed care and 0.002% would not get needed care. It also said that staffing level would result in 12,100 fewer hospitalizations of Medicare residents and 14,800 fewer emergency room visits. The report said three-quarters of nursing homes would need to add staff to meet that level and that it would cost $5.3 billion extra each year.

The lowest staffing level the report analyzed was 3.3 daily staffing hours. At that level, the report said, 3.3% of residents would get delayed care and 0.04% would not get needed care. That level would reduce hospitalizations of Medicare residents by 5,800 and lead to 4,500 fewer emergency room visits. More than half of nursing homes would have to increase staff levels to meet that ratio, the report said, and it would cost $1.5 billion more each year.

Charlene Harrington, a professor emeritus of nursing at the University of California-San Francisco, said CMS “sabotaged” the push for sufficiently high staffing through the instructions it gave its contractor. “Every threshold they looked at was below 4.1,” she said. “How can that possibly be a decent study? It’s just unacceptable.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Barbados has again proven itself to have the best triathletes in the region.

For the second year running, Barbados emerged as champions at the CARIFTA Triathlon, Aquathlon and Mixed Relay Championships, which climaxed over the weekend in the Bahamas.

The team captured 15 medals, including an impressive eight gold medals, to amass 180 points and lift the title. The Bahamas was a distant second on 130 points.

Barbados is scheduled to host the 2024 Championships and will be going after a three-peat on home soil. (RB/PR)

The post Barbados lift CARIFTA title appeared first on Barbados Today.

Every person who agreed to get the smallpox vaccination was a potential outbreak averted, so the team was determined to vaccinate as many people as possible. 

The duo leaned on each other, sometimes literally, as they traversed the country’s rugged and watery geography. Khan, whom Miner sometimes referred to as “little brother,” used his local knowledge to help the team navigate both the cultural and physical landscape. When crossing rickety bamboo bridges, he would hold Miner’s hand and help him across. “We didn’t let him fall,” chuckled Khan. 

Episode 4 of “Eradicating Smallpox” explores what it took to bring care directly to people where they were. 

To conclude the episode, host Céline Gounder speaks with public health advocate Joe Osmundson about his work to help coordinate a culturally appropriate response to mpox in New York City during the summer of 2022. “The model that we’re trying to build is a mobile unit that delivers all sorts of sexual and primary health care opportunities. They’re opportunities!” exclaimed Osmundson.

The Host:

Céline Gounder
Senior fellow & editor-at-large for public health, KFF Health News

@celinegounder

Read Céline's stories

Céline is senior fellow and editor-at-large for public health with KFF Health News. She is an infectious diseases physician and epidemiologist. She was an assistant commissioner of health in New York City. Between 1998 and 2012, she studied tuberculosis and HIV in South Africa, Lesotho, Malawi, Ethiopia, and Brazil. Gounder also served on the Biden-Harris Transition COVID-19 Advisory Board. 

In Conversation with Céline Gounder:

Joe Osmundson 
Public health advocate and clinical assistant professor of biology at New York University

@reluctantlyjoe

Voices from the Episode:

Tim Miner
Former World Health Organization smallpox eradication program worker in Bangladesh

Shahidul Haq Khan
Former World Health Organization smallpox eradication program worker in Bangladesh

Click to open the transcript

Transcript: Speedboat Epidemiology

Podcast Transcript 

Epidemic: “Eradicating Smallpox” 

Season 2, Episode 4: Speedboat Epidemiology 

Air date: Aug. 29, 2023 

Editor’s note: If you are able, we encourage you to listen to the audio of “Epidemic,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

TRANSCRIPT 

Céline Gounder: In the early 1970s, smallpox was still stalking parts of South Asia. India had launched its eradication program more than a decade before, but public health workers couldn’t keep up with the virus. 

Enter … the bifurcated needle. 

[Metallic ding sound] 

[Light instrumental music begins playing] 

Tim Miner: It was a marvelous invention in its simplicity. It looks like a little cocktail fork. 

Céline Gounder: You dip the prongs into a bit of vaccine … 

Tim Miner: And you would just prick the skin about 12 or 15 times until there was a little trace of blood and then you’d take another one. 

Céline Gounder: It barely took 30 seconds to vaccinate someone. 

And it didn’t hurt. 

Yogesh Parashar: No. 

Céline Gounder: Well … it didn’t hurt too much. 

Yogesh Parashar: It was just like a pinprick, rapidly done on your forearm. You had a huge supply with you and you just went about and — dot, dot, dot — vaccinated people, carry hundreds with you at one go. 

Tim Miner: And you could train somebody in a matter of minutes to do it. 

Céline Gounder: Easy to use. Easy to clean. And a big improvement over the twisting teeth of the vaccine instrument health workers had to use before. 

The bifurcated needle was maybe 2 and a half, 3 inches long. 

Small, but sturdy enough for rough-and-tumble fieldwork. 

Yogesh Parashar: It was made of steel. And it used to come in something that looked like a brick. It was just like one of those gold bricks that you see in the movies. 

Céline Gounder: And maybe worth its weight in gold. 

[Light instrumental music fades to silence] 

Céline Gounder: That “cocktail fork” was among the pioneering innovations that helped public health workers wipe out a centuries-old virus. 

Tim Miner: You had the bifurcated needle, you had the sterile water, and you had the freeze-dried vaccine, and you could mix them up and off you’d go. 

Céline Gounder: Ah, but getting there wasn’t always that easy. 

I’m Dr. Céline Gounder, and this is “Epidemic.” 

[Epidemic theme music plays] 

Céline Gounder: On this episode, we’re exploring what it took to deliver the smallpox vaccine to the people — and all the remaining places — that needed it most. 

In South Asia, Bangladesh was a major battleground in the campaign to stop smallpox. 

We spoke with a man who helped lead an eradication team there. 

Shahidul Haq Khan: My name is MD Shahidul Haq Khan. 

Céline Gounder: For our interview, Shahidul Haq Khan invited me to his home in Barishal. That’s in south-central Bangladesh. We sat at a table in the courtyard, and his granddaughter, Kashfia, who looked like she was around 10 years old, stood close by … 

Céline Gounder: Kashfia. So nice to meet you, Kashfia. I’m Céline. 

Kashfia: Hello. 

Céline Gounder: Hello. [Céline chuckles.] Are you going to listen to us? 

Céline Gounder: Kashfia wanted to hear her granddad’s stories, and I got the impression that was also important to Shahidul. 

As the two of us did our best to communicate through a translator — with neighbors, chickens, and street noise all around — Shahidul wanted me to understand why he was speaking with me and the significance of the smallpox campaign. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: The purpose of saying these things is that we needed all this effort. We put a lot of hard work and effort behind smallpox eradication. 

Céline Gounder: Very hard work. You must be very proud of what you helped accomplish. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: Yes, of course. Of course, I can say that we’re proud to say that we’ve eliminated smallpox from this country. 

Céline Gounder: The job was to hunt down smallpox — and stop it — in a country packed with people, crisscrossed by rivers, edged with mangrove forests, and dotted with remote lowland river islands. 

[Rain sounds fade in] 

Céline Gounder: And there were the monsoons. It rained A LOT. 

[Bouncy, upbeat music begins playing softly in the background] 

[Rain sounds fades out] 

Tim Miner: Uh, well, we got wet. [Tim chuckles.] To state the obvious. 

Céline Gounder: That’s Tim Miner. He was an officer with the World Health Organization in Bangladesh. 

Tim Miner: My legal name is Howard Miner, but I was the third Howard, so I got nicknamed Tim. 

Céline Gounder: Shahidul and Tim worked together for several months in 1974. 

The public health strategy was called “search and containment,” and a big part of that meant figuring out how to get the vaccine from one community to the next. 

Tim Miner: And occasionally you have to park your motorcycle, take your shoes and socks off, and walk across a leech-infested paddy field to get to the next case. 

Céline Gounder: The work depended on local knowledge, and Shahidul was the local knowledge. 

He was the lead Bangladeshi member on the eradication team, and when they arrived at a village that had a suspected case of smallpox, often Shahidul went in first, with Tim a few steps behind …  

Tim Miner: Someone would bring out some chairs. And sometimes we would have tea and biscuits. Or, if they didn’t have tea and biscuits, then somebody would climb up and get a coconut and chop off the top and watch me drink it and dribble the coconut milk all over myself, and everybody had a good time.  

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: Dr. Miner called me “little brother.” I was younger then. How old was I? 21 or 22 years old. 

Tim Miner: He referred to me as “Dr. Miner,” even though I’m not a … a physician. That’s how he referred to me. 

Céline Gounder: Shahidul had been working in public health before he joined the smallpox effort. He offered guidance on culture — and occasionally gave Tim a hand on rickety bamboo bridges. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: Most of the time, I escorted him across the bamboo bridge. I took his bag and held his hand and helped him across. 

Tim Miner: You learn to walk and not look down and just, uh, you know, hang onto the poles. And, fortunately, I never fell in. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: We didn’t let him fall. 

[Bouncy, upbeat music fades out] 

Céline Gounder: The team was based on a hospital ship, called the Niramoy. It had all the basics: a couple of cabins, a space to perform surgery, plus a few comforts, like a generator they’d turn on in the morning for showers, a cook who picked up fresh fish at the market every day. 

Tim Miner: I would have a doodh cha, a tea with milk, and a kacha morich pyaz — scrambled eggs with, uh, chiles. 

Céline Gounder: The hospital ship hauled supplies from port to port. And everywhere they went, they towed a speedboat along with them. 

Tim Miner: We would receive reports of cases and we would get down from the ship in our speedboat, and the speedboat driver would take us as far as the boat could go. And we would walk, do the investigation, and find out who the contacts were and vaccinate the village and surrounding areas. 

Céline Gounder: Tim calls it “speedboat epidemiology.” The work required a willingness to go wherever and everywhere the virus took up residence. By and large, people welcomed them and were glad to get the vaccine. 

Tim Miner: They know about smallpox. They’ve been dealing with it, you know, all of their lives. And they have lost family members to the disease. 

Céline Gounder: Still, the task was huge: to find and vaccinate every person with smallpox — and all the people that person had come in contact with. 

[Subtle music begins playing] 

Céline Gounder: In modern-day public health, the work gets done with cellphones and spreadsheets, maybe social media. In Bangladesh in 1974, they had none of that. 

Shahidul and Tim had the speedboat, motorbikes, and their feet to cover a territory that took them all the way down to the coast. 

Tim Miner: First there’s Barishal … 

Shahidul Haq Khan: Latachapli … 

Tim Miner: … then there’s Faridpur … 

Shahidul Haq Khan: … Dankupara … 

Tim Miner: … then there’s Patuakhali. 

Shahidul Haq Khan: … and Kuakata. 

Céline Gounder: People were constantly on the move — maybe for seasonal work or better opportunities. That made contact tracing tricky. During one investigation, Tim identified a man who’d been exposed to the virus, but he’d left the region for Dhaka. 

The capital was densely populated — a city of 2 million in 1974. And smallpox was highly contagious. So Tim called a colleague — on the shortwave radio — to see if he could track down the man in Dhaka. 

[Ambient Dhaka street noises play in the background] 

Tim Miner: Well, it’s not just a street address or a ZIP code or anything like that, as you can well imagine. He lived in a basti, or a slum. And I described it as best I could. You know, ‘You enter by the big tree and turn left at the tea stall and walk the path and then start calling out for the family name.’ 

Céline Gounder: They found the guy! And vaccinated him. Tim says the man had smallpox, but the virus hadn’t quite erupted yet, so it was a pretty mild case. 

Tim Miner: Because of his immunization. It is somewhat miraculous, the needle in the haystack. 

[Music fades out] 

Céline Gounder: In Bangladesh, people weren’t likely to just show up to a local clinic to get the vaccine, so the team took the vaccine to the people. 

At its best, public health follows and bends to the rhythm of the culture. For example, after Ramadan, as Muslims began to break the fast for Eid … 

Tim Miner: Where people go back to their villages and visit and bring presents and gifts and food. 

[Ambient sounds of the water from a port in Bangladesh play] 

Céline Gounder: The team went to ports where steamer ships departed, asking in Bengali if travelers had come in contact with anyone with the disease’s distinctive pustules. 

Tim Miner: Guṭibasanta, uh, basanta rōgī. 

Céline Gounder: Which means “smallpox patient.” 

Tim Miner: Have you seen any guṭibasanta and basanta rōgī? 

Céline Gounder: Tim says he relied on his team to figure out how best to make the person in front of them comfortable. 

Tim Miner: ‘What would you do? What do you think should be done in this case?’ And I don’t think this is done often enough. It was a real partnership. It was real working together. 

Céline Gounder: Well, a partnership, yes. But Shahidul Haq Khan says the search-and-containment program was pretty strict. His work was meticulously checked and checked again. 

Remember, he was maybe 21 or 22 years old, with a big responsibility on his shoulders, and Tim Miner was a tough boss. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: At any cost, we had to vaccinate all. There was no other way. 

Céline Gounder: Sometimes Shahidul had to return to the same home over and over — or hang out, if the man of the house was still in the fields working. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: We had to wait until they returned. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: Otherwise, Dr. Miner would again take us back there, no matter how late. [Shahidul laughs] 

Céline Gounder: One evening, Shahidul returned to the hospital ship after a day of door-to-door canvassing, and had to give a not-so-great report to Tim. 

[Tense music begins playing] 

Shahidul Haq Khan: [Shahidul speaking in Bengali] … a pregnant, uh, … 

English translation: I couldn’t vaccinate a pregnant woman in Dankupara. This was the first time that I couldn’t vaccinate someone. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: I couldn’t convince her at all. He immediately told us to pack up. He stopped the work and said, “Let’s go.” 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: Immediately. At that very moment. 

Tim Miner: We were working basically 24/7, if need be. 

Céline Gounder: The team headed to the speedboat. It was late. And it was freezing. Shahidul remembers the bite of the cold air as they blasted across the water toward the woman’s village. 

Tim Miner: I fully understand, understood why this woman hesitated to be vaccinated. She was expecting a child and she didn’t want to do anything to jeopardize her life or the life of the unborn child. So, we were very gentle in talking with her and answering her questions. It was time well spent. 

Céline Gounder: The woman agreed to take the vaccine. 

Shahidul Haq Khan: [Shahidul speaking in Bengali] 

English translation: That day was one of the most memorable of my life. 

[Music fades to silence] 

Céline Gounder: Many on the team considered their outreach to women fundamental to success in South Asia, because … women talk. 

What they say, what they believe, echoes. 

Tim Miner: They get together, they do the laundry, they do the cooking, they share good times and bad times. This woman who was vaccinated probably showed her vaccination either in her family or in the village. And that’s the importance of getting one person, especially a pregnant woman who will tell others about immunization. 

Céline Gounder: Public health workers trying to end smallpox across South Asia mostly had the same tools — the vaccine, that bifurcated needle, and a strategy — on paper. But squashing the virus required tactics specific to each community: its needs, its culture, its worries … and its terrain. 

[Staccato music begins playing] 

Céline Gounder: Smallpox eradication workers went to great lengths to meet people where they were. 

But Joe Osmundson, who’s a public health advocate in New York City, told me that’s not an approach we see nearly enough in public health today. 

Joe Osmundson: Céline, it’s not your first time at the rodeo. [Celine laughs] Um, it’s like, we’ve all been through this again and again and again. 

We know what the problems are and yet we seem reluctant to actually do the right thing, which is to build processes that meet people where they’re at. 

Céline Gounder: After the break, more on what it looks like to bring public health directly to those who need it most. 

[Music fades to silence] 

Céline Gounder: Mpox, formerly known as monkeypox, is a highly contagious virus. Last summer, mpox cases spiked around the world, spreading quickly, predominantly among men who have sex with men. Mpox spreads through physical contact. It causes a painful blistering rash and, in extreme cases, it can be deadly. 

My colleague Joe Osmundson acted as a community liaison for the New York City Department of Health to help coordinate a culturally appropriate response to mpox. 

Joe Osmundson: I’m a microbiologist by training, but I also just do tons of advocacy and activism as a queer person who believes in equal access to the best biomedicine available. 

Céline Gounder: As mpox cases were increasing, we knew we needed to vaccinate those at highest risk as quickly as possible. Joe’s plan? Mobile vans to quickly bring mpox vaccines to places where high-risk people already were. 

Joe Osmundson: Our idea was to go to commercial sex venues, because commercial sex venues self-select for people with a large number of sexual partners. And if you give them the best possible immunity, that protects not just the people at the party but all the other people in the larger sexual network that they connect with. 

Céline Gounder: What is a commercial sex venue? 

Joe Osmundson: It’s basically a nonhousehold space where people gather for sex. 

When you have public venues where people gather, you have the opportunity to meet them where they’re at, to provide education, to provide condoms, to provide access to HIV testing and access to health care. 

So many queer people don’t have affirming doctors, don’t feel comfortable asking about sexual health with their physicians. So, you can put a van outside with affirming physicians and actually provide that preventative care that actually stops the infection. 

Céline Gounder: Did you run into any obstacles in doing this outreach? Setting up the mobile vans …? 

Joe Osmundson: So, there is a huge amount of mistrust in this community for city officials, for good reason. For many decades there was a group inside the New York City Department of Health that had undercover people who would go to these parties and find violations and close them down. So really it was only me and a couple other people doing outreach on-site. 

Céline Gounder: How did it work, what was the scene like, and what was your role in that? 

Joe Osmundson: Yeah, so, when I was there, I would go inside the club and, you know, there’s a little line, an area where people get dressed or undressed, and I would just hang out there and people would have a lot of questions. 

So, because, again, they perceived me as being, like, a part of their community, it was very easy to talk to people and just ask, you know, “Hey, have you had your vaccine yet? Have you had both doses?” If not, you know, it’ll take 15 minutes. I can walk you down to the van and get you that dose tonight. 

Céline Gounder: Were these mobile vaccination vans successful? 

Joe Osmundson: We find them to be massively successful. Once the city was able to get the vans there, people were so grateful to be able to get a shot on-site. 

We were giving 60, 80 doses per event — when the event might only have 140 people — so we were vaccinating 60% of these parties. 

That’s the other magic of the mobile units, was that you had people queer people talking to queer people, and even queer people of color talking to queer people of color and offering the care in terms that that community knows how to respond to and also just has more inherent trust with. 

Céline Gounder: But, at the same time, in New York City, mpox vaccination rates have been disproportionately low in Black communities. 

Joe Osmundson: Mm-hmm. 

Céline Gounder: As well as Hispanic communities. 

What could public health leaders have done from the start to ensure more equitable vaccine distribution, and what should they be doing now? 

Joe Osmundson: Yeah. It was a remarkable sort of mistake that, not just New York, but many cities made where they said we’ll build the foundation and then worry about equity later, because this is an emergency. 

So we’ll open up a brick-and-mortar in Chelsea, and then we’ll get the vaccine vans up at, you know, Brooklyn Pride, a Bronx health clinic. You know, we’ll do that later. 

We know that if you don’t do equity as the foundation, you will be chasing disparities. 

Céline Gounder: What can we say about who’s been vaccinated and who remains unvaccinated? 

Joe Osmundson: Black people are undervaccinated. They also have a higher rate of advanced HIV infection, and mpox plus advanced HIV means really severe disease and even death. Ninety percent of mpox deaths have been in Black people, Black queer people with advanced HIV. 

And we need something brand-new because we’ve been failing these folks for years. They have so many horrific experiences with their health care providers, or they don’t have insurance, or they’re underemployed, or they live super far from the nearest health care clinic. 

When people have difficulties accessing care, it spreads to every disease state, from HIV to mpox to primary care, etc. 

Céline Gounder: How can we apply this model of health outreach beyond mpox? 

Joe Osmundson: The model that we’re trying to build is a mobile unit that delivers all sorts of sexual and primary health care opportunities. They are opportunities! You know? If someone’s getting a covid vaccine, give them a flu vaccine at the same time. The literature shows that these interventions work. 

Céline Gounder: What else is there beyond vans? Are there other strategies when it comes to reaching people where they are that we haven’t employed that we should be thinking about? 

Joe Osmundson: We have affirming clinicians, affirming Black queer clinicians all over this city. Their expertise should be fostered. 

For years there’s been this model of health officials talking to community. And that’s outreach. And we aren’t done with that. 

We have experts, we have clinicians, we have epidemiologists, we have scientists who are in the community who know the science just as well as health officials. And communication needs to go two ways. 

Céline Gounder: That was Joe Osmundson, a microbiologist at New York University and the author of the book “Virology.” 

Joe Osmundson: The sexiest public health outreach worker of all time! [Laughter] A face made for radio. [Laughter] 

[“Epidemic” theme music begins playing] 

Céline Gounder: Next time on “Epidemic” … 

Larry Brilliant: Your company is sending death all over the world. You’re the greatest exporter of smallpox in history … You’ve got to stop this. 

Céline Gounder: “Eradicating Smallpox,” our latest season of “Epidemic,” is a co-production of KFF Health News and Just Human Productions. 

Additional support provided by the Sloan Foundation. 

This episode was produced by Taylor Cook, Zach Dyer, and me. 

Redwan Ahmed was our translator and local reporting partner in Bangladesh. 

Managing editor Taunya English was scriptwriter for the episode — with help from Stephanie O’Neill. 

Oona Tempest is our graphics and photo editor. 

The show was engineered by Justin Gerrish. 

Voice acting by Pinaki Kar. 

We had extra editing help from Simone Popperl. 

Music in this episode is from the Blue Dot Sessions and Soundstripe. 

We’re powered and distributed by Simplecast. 

If you enjoyed the show, please tell a friend. And leave us a review on Apple Podcasts. It helps more people find the show. 

Follow KFF Health News on Twitter, Instagram, and TikTok. 

And find me on Twitter @celinegounder. On our socials, there’s more about the ideas we’re exploring on the podcasts. And subscribe to our newsletters at kffhealthnews.org so you’ll never miss what’s new and important in American health care, health policy, and public health news. 

I’m Dr. Céline Gounder. Thanks for listening to “Epidemic.” 

[“Epidemic” theme fades out] 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is senior editor for broadcast innovation with KFF Health News, where she leads enterprise audio projects.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is associate audio producer for Season 2 of Epidemic. She researches, writes, and fact-checks scripts for the podcast.

Oona Tempest
Photo editing, design, logo art

@oonatempest

Oona is a digital producer and illustrator with KFF Health News. She researched, sourced, and curated the images for the season.

Additional Newsroom Support

Lydia Zuraw, digital producer Tarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Simone Popperl, broadcast editor Chaseedaw Giles, social media manager Mary Agnes Carey, partnerships editor Damon Darlin, executive editor Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chiefChris Lee, senior communications officer 

Additional Reporting Support

Swagata Yadavar, translator and local reporting partner in IndiaRedwan Ahmed, translator and local reporting partner in Bangladesh

Epidemic is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here. Subscribe to Epidemic on Apple Podcasts, Spotify, Google, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

day in European Heart Journal.

“Infective endocarditis is an uncommon but very serious disease that can present with many different symptoms, and thus may be challenging to diagnose,” said Guidelines task force chairperson Professor Michael Borger of Leipzig Heart Centre, Germany. “Patient education is therefore paramount to early diagnosis and treatment. Those with valvular heart disease or previous heart valve surgery should be particularly diligent with regards to prevention and recognising symptoms.”

Infective endocarditis refers to an infection of the heart’s inner lining, most frequently the heart valves. It occurs when bacteria or fungi enter the bloodstream, for example through skin infections, dental procedures and surgery. Symptoms include fever, night sweats, unexplained weight loss, cough, dizziness and fainting. The infection can lead to destruction of the valve, abscesses and clusters of microbes and cells, which can break into smaller parts that travel to other areas of the body (called embolisation). Heart failure, septic shock and stroke can also occur.

Worldwide each year there are nearly 14 new cases of infective endocarditis for every 100,000 individuals and more than 66,000 patients die. “The mortality rate is extremely high and therefore preventive strategies in patients at high risk are pivotal,” said Guidelines task force chairperson Dr. Victoria Delgado of the Germans Trias i Pujol University Hospital, Badalona, Spain.

Those at highest risk include survivors of previous episodes of infective endocarditis and patients with prosthetic heart valves, congenital heart disease (not including isolated congenital heart valve abnormalities) or a left ventricular assist device. In these patients, prophylactic antibiotics are recommended before oral or dental procedures. Patients at intermediate risk are those with pacemakers, severe valvular heart disease, congenital heart valve abnormalities (including bicuspid aortic valve) and hypertrophic cardiomyopathy, a disease where the heart muscle is thickened. In these patients, the need for antibiotic prophylaxis prior to dental procedures should be evaluated on an individual basis. Antibiotic prophylaxis is not needed in those at low risk.

The main targets for antibiotic prophylaxis are oral streptococci. The document states that “the emerging and increasing antibiotic resistance among oral streptococci is of concern”. Dr. Delgado said: “Streptococci are naturally present in the mouth but can enter the bloodstream when oral hygiene is suboptimal and during dental procedures. Rises in antibiotic use for infectious diseases have led to resistance, meaning that antibiotics become ineffective. Caution in the use of antibiotics is therefore needed and self-medication should be avoided.”

The Guidelines recommend other preventive measures for patients at intermediate and high risk including twice daily tooth cleaning, professional dental cleaning (twice yearly for high risk and yearly for intermediate risk patients), consulting a general practitioner for fever with no obvious

reason, strict skin hygiene, treatment of chronic skin conditions, and disinfection of wounds. Piercings and tattoos are discouraged.

Recommendations are provided for diagnosis, treatment, and management of complications. Diagnosis is based on clinical suspicion, blood cultures, and imaging. Echocardiography is the first line imaging technique, and new diagnostic criteria include findings on other imaging techniques. There are new recommendations on the use of computed tomography, nuclear imaging and magnetic resonance imaging plus novel diagnostic algorithms when the infection involves native heart valves, prosthetic heart valves, and implanted cardiac devices such as pacemakers and defibrillators.

Treatment aims to cure the infection and preserve heart valve function. The Guidelines recommend appropriate antibiotics, determined from blood cultures, as the mainstay of therapy, with duration depending on the severity of infection. Surgery to remove infected material and drain abscesses is indicated for patients with heart failure or uncontrolled infection, and to prevent embolisation. Surgery should generally occur earlier than previously recommended because of improved survival.

One of the worst complications of endocarditis is stroke. Decisions about the timing of surgery in patients who have suffered a stroke must balance the risk of neurological deterioration during the procedure against that of delaying surgical therapy. Novel recommendations are to proceed with urgent heart valve surgery in patients with ischaemic stroke due to embolism but delay surgery in patients with haemorrhagic stroke. In addition, thrombectomy (removal of the embolus through a catheter) may be considered in very select patients with stroke.

A new section in the Guidelines is devoted to patient-centred care and shared decision-making. Professor Borger said: “Infective endocarditis is a life-threatening condition with lengthy treatment and can be emotionally distressing for patients and families. Patients must be at the centre of care to achieve the best physical and mental outcomes.”

(CMC) – Suriname has been named among eight countries that are adopting measures in line with the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) to protect the health of their populations from novel tobacco products.

The WHO said Friday that with the recent ban on the use and marketing of electronic cigarettes in Venezuela, currently, 21 countries in the Americas regulate electronic nicotine delivery systems (ENDS), such as e-cigarettes and vapes.

“The resolution that regulates new and emerging nicotine and tobacco products in Venezuela is an important step forward for the country and for the region,” said Dr Anselm Hennis, Director of Non-Communicable Diseases Mental Health at the Pan American Health Organization (PAHO/WHO).

“We hope that this measure motivates other countries to take action on these products, which are addictive, harmful and aggressively advertised towards the youngest,” he added.

The eight new countries to join the initiative are Argentina, Brazil, Mexico, Nicaragua, Panama, Suriname, Uruguay and Venezuela and PAHO said these countries prohibit their sale altogether, and the other 13 countries have partially or totally adopted one or more regulatory measures.

It said 14 countries in the Americas, including the Caribbean, lack any regulation of these products.

Last June, a previous resolution of the Venezuelan Ministry of Popular Power for Health banned the sale of vapes to minors.

Now, the August 1 resolution prohibits “the manufacture, storage, distribution, circulation, commercialization, importation, exportation, use, consumption, advertising, promotion and sponsorship of ENDS and electronic non-nicotine delivery systems (ENNDS)”, as well as their “consumables”, “accessories”, and “heated tobacco products”.

PAHO said e-cigarettes are the most common form of electronic nicotine delivery systems. When used, they heat a liquid to create aerosols that are inhaled by the user.

It said these “e-liquids” contain nicotine, a highly addictive substance found in tobacco, and other additives, flavorings and chemicals, some of which are toxic to the health of both the user and those exposed to them.

PAHO/WHO recommends that governments implement regulations in line with the provisions of the FCTC and its decisions, such as prohibiting the marketing of ENDS, including their importation, distribution or sale, as well as regulations on their use in public places, prohibiting their advertising and promotion, taxing them, and other regulations similar to those applied to tobacco products.

Tobacco kills one million people in the region of the Americas annually and while measures taken since the FCTC came into force in 2005 ha per cent in 2020, these achievements are threatened by novel tobacco and nicotine products.

Currently, 11.3 per cent of adolescents between 13 and 15 years of age in the region use tobacco, compared to the world average of 10.3 per cent.

The post Suriname bans the sale of electronic cigarettes appeared first on Barbados Today.

SUMMER is almost over. Summer camps are done, children are returning home from vacation at grandma's or cousin's house — free paper bun, and it's time to get ready for back-to-school!

Whether your child is about to start a new school or a new grade, it's important to instil healthy habits. In the words of my very good friend, "Germs still keeping".

Germs are everywhere. There are germs on every single surface we come in contact with, including our skin. And yes, the COVID-19 virus is still going around. If we teach our children about germs and how we can prevent the spread of germs, we can avoid many infections and trips to the doctor and hospital.

Here are some tips for you and your child as they head back-to-school.

*Get a check-up before school to identify any potential health concerns early

*If your child has a chronic illness like asthma, sickle cell or a heart condition, make sure you have all the necessary medications he/she needs

*Inform your child's (new) teacher about any health conditions and how to manage them; for example, what to do in situation like an asthma attack or seizure

*If your child needs to carry medications to school (for example, asthma pumps), teach them where to find the medications in their school bag and how to use them (of course, this is age appropriate).

*Inform the school if your child has any food allergies and teach your child about food allergies, and why they should NOT eat from other students. A peanut butter sandwich from an unknowing schoolmate could be very dangerous to a child with peanut allergies.

*Especially for preschool age group (two to five years), remember it is quite normal for children to get sick every three to four weeks

*Teach and encourage good hand hygiene. Wash hands frequently, use hand sanitisers, and wash hands especially if they are visibly dirty.

*Teach and encourage children how to cough into their elbow and not their hands, how to blow their nose or sneeze into a tissue which should be disposed right away followed by immediate hand washing. If you sneeze or cough into a rag, anything that touches that rag (hands, books, contents of their bag) are contaminated with germs.

*Keep kids out of school if sick especially if the illness is contagious — fever, coughing, runny nose, vomiting or diarrhoea. Think bodily fluids that can disseminate/spread easily

*If your child has a fever, keep out of school until fever-free for at least 24 hours

*Make sure children are up to date with their vaccines. Remember, the COVID vaccine is available for children 12 and older. If your child is immunocompromised (very prone to getting sick easily based on an underlying health condition), consider getting vaccines like the pneumoccal vaccine, chicken pox and rotavirus vaccine. Ask your doctor about these non-government issued vaccines.

*Keep in mind seasonal illnesses like hand foot and mouth disease, chicken pox, running belly. Know what symptoms to look for, and how to prevent these illnesses. Right now, dengue fever is on the rise, so protect your little ones with mosquito repellents at home and school.

*Consider a "worm out". Deworming is safe, easy and inexpensive. "Worm medicine" gets rid of possible parasites in the intestines that may potentially cause serious health issues like anaemia and blockage in the intestines. Deworming is usually done one to two times a year.

In addition, schools usually require a "medical" to be done before the start of a new school year. The school usually provides a medical form for you to carry to your doctor to have completed. If you haven't already done this, here is what to expect.

There may be a section for you, the parent, to fill out — name, address, date of birth, etc. There is also a section to fill out child's immunisations.

Your child's weight, height, vitals and blood pressure will be done. The doctor will examine your child from head to toe, including vision test, hearing evaluation, checking the skin, ears, listening to the chest (heart and lungs) and tummy with a stethoscope and checking all limbs (arms and legs). Some medicals require a urine test to look for blood, sugar and protein. There is also a section to document how much physical activity your child can tolerate (normal, as tolerated or limited).

Based on the information provided and the examination findings, the doctor will establish if your child is well, if he/she needs any further tests to be done (and will write requests for those), write a prescription if needed, or refer your child to see a specialist if they see fit.

Happy back-to-school!

Dr Tal's Tidbits

Before heading back-to-school, make sure your child gets a medical/check up that may pick up any health concerns to ensure a healthy, safe school term.

Dr Taleya Girvan has over a decade's experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal's Tidbits is a series in which she speaks to patients and caregivers, providing practical advice that will improve health care for the general population. E-mail: dr.talstidbits@gmail.com IG @dr.tals_tidbits.

WASHINGTON, DC (PAHO) - With the recent ban on the use and mar
keting of electronic cigarettes in Venezuela, more countries in the Americas are adopting measures in line with the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) to protect the health of their populations from novel tobacco products.

"The resolution that regulates new and emerging nicotine and tobacco products in Venezuela is an important step forward for the country and for the region," said Dr Anselm Hennis, director of non-communicable diseases mental health at the Pan American Health Organization (PAHO). "We hope that this measure motivates other countries to take action on these products, which are addictive, harmful and aggressively advertised towards the youngest," he added.

Currently, 21 countries in the Americas regulate electronic nicotine delivery systems (ENDS), such as e-cigarettes and vapes, in some way. Eight of them (Argentina, Brazil, Mexico, Nicaragua, Panama, Suriname, Uruguay, and Venezuela) prohibit their sale altogether, and the other 13 have partially or totally adopted one or more regulatory measures. Meanwhile, 14 countries lack any regulation of these products.

Last June, a previous resolution of the Venezuelan Ministry of Popular Power for Health banned the sale of vapes to minors. Now, the August 1 resolution prohibits "the manufacture, storage, distribution, circulation, commercialisation, importation, exportation, use, consumption, advertising, promotion and sponsorship of ENDS and electronic non-nicotine delivery systems [ENNDS]", as well as their "consumables", "accessories", and "heated tobacco products".

E-cigarettes are the most common form of ENDS. When used, they heat a liquid to create aerosols that are inhaled by the user. These "e-liquids" contain nicotine, a highly addictive substance found in tobacco, and other additives, flavourings and chemicals, some of which are toxic to the health of both the user and those exposed to them.

PAHO/WHO recommends that governments implement regulations in line with the provisions of the FCTC and its decisions, such as prohibiting the marketing of ENDS, including their importation, distribution or sale, as well as regulations on their use in public places, prohibiting their advertising and promotion, taxing them, and other regulations similar to those applied to tobacco products.

Tobacco kills one million people in the region of the Americas per year. While measures taken since the FCTC came into force in 2005 have reduced the percentage of smokers from 28 per cent of the total population in 2000 to 16.3 per cent in 2020, these achievements are threatened by novel tobacco and nicotine products.

Currently, 11.3 per cent of adolescents between 13 and 15 years of age in the region use tobacco, compared to the world average of 10.3 per cent.