DiversityNursing Blog

By David McNamee

A new report finds that by 2100, there will be more people alive on the planet than has ever previously been predicted. We investigate what the consequences these extra bodies may have for maintaining public health.

The potentially catastrophic consequences of an exponentially growing global population is a favorite subject for writers of dystopian fiction.

The most recent example, Utopia - a forthcoming David Fincher-directed series for HBO - won critical acclaim in its original incarnation on UK television for its depiction of a conspiracy-laden modern world where the real threat to public health is not Ebola or other headline-friendly communicable viruses, but overpopulation.

Fears over the ever-expanding number of human bodies on our planet are not new and have been debated by researchers and policy makers for decades, if not centuries. However, recent research by University of Washington demographer Prof. Adrian Raftery - using modern statistical modeling and the latest data on population, fertility and mortality - has found that previous projections on population growth may have been conservative.

"Our new projections are probabilistic, and we find that there will probably be between 9.6 and 12.3 billion people in 2100," Prof. Raftery told Medical News Today. "This projection is based on a statistical model that uses all available past data on fertility and mortality from all countries in a systematic way, unlike previous projections that were based on expert assumptions."

Prof. Raftery's figure places up to an additional 5 billion people more on the Earth by 2100 than have been previously calculated.

A key finding of the study is that the fertility rate in Africa is declining much more slowly than has been previously estimated, which Prof. Raftery tells us "has major long-term implications for population."

Fertility rates declining more slowly in Africa than previously reported

A 2003 Centers for Disease Control and Prevention (CDC) report found that, in sub-Saharan Africa, both fertility and mortality rates were high, with the proportion of people aged over 65 expected to remain small, increasing from an estimated 2.9% in 2000 to 3.7% in 2030.

The CDC report notes that fertility rates declined in developing countries during the preceding 30 years, following a 20th century trend among developed countries. The pattern established by developed countries - and presumed to follow in developing countries - was that countries shift from high fertility and high mortality rates to low fertility and delayed mortality.

This transition starts with declining infant and childhood mortality as a result of improved public health measures. Improvements in infant and childhood mortality contribute to longer life expectancy and a younger population.

This trend of adults living longer, healthier lives is typically followed by a decline in fertility rates. The CDC report suggested that by 2030, there would be similar proportions of younger and older people in developing countries, by that point mirroring the age distribution in developed countries circa 1990.

Prof. Raftery's research, however, notes that in Nigeria - Africa's most populous country - each woman has an average of six children, and in the last 5 years, the child mortality rate has fallen from 136 per 1,000 live births to 117. This works out as a population increase of 20 people per square mile over the same timespan.

How will population growth affect developing countries?

But what does this mean for countries where the public health system is already stretched to breaking point - as has been demonstrated by the recent Ebola epidemic?

"Rapid population growth is likely to increase the burden on the public health service proportionally," answered Prof. Raftery.

"There are already big public health needs and challenges in high-fertility countries, and rapid population growth will make it even harder to meet them." However, if the fertility rate declines faster, Prof. Raftery suggests that high-fertility countries can reap "a demographic dividend."

He explained:

"This is a period of about a generation during which the number of dependents (children and old people) is small. This frees up resources for public health, education, infrastructure and environmental protection, and can make it easier for the economy to grow. This can happen even while the population is still increasing."

Does this suggest that an increasing population is not quite as much of a threat, but that it is more specifically the accelerations and decelerations in fertility rates that provide warning signs to future public health crises?

"Following a long run of an increasing human population growth rate, over the past half century the rate has been halved from about 2% to about 1%," Darryl Holman, professor of biological anthropology at the University of Washington, explained to MNT.

"The turnaround is quite remarkable," he said. "But as long as the growth rate remains positive, our species will eventually reach numbers and densities where technological solutions cannot ameliorate resource scarcity."

High population density leads to a much higher rate of contact between humans, which means that communicable diseases - ranging from the common cold to Dengue fever - can be much more easily transmitted.

And more people means greater efforts are needed to control waste management and provide clean water. If these needs cannot be adequately met, then diarrheal diseases become much more common, resulting in what Prof. Holman described to the University of Washington's news website The Daily UW as a "huge, huge, huge difference in mortality rates."

Taking a more general view, "the anticipated increase in the number of older persons will have dramatic consequences for public health, the health care financing and delivery systems, informal caregiving, and pension systems," wrote the authors of the CDC's 2003 report.

Overpopulation and the environment

"Can we assume that life on earth as we know it can continue no matter what the environmental conditions?," asked the authors of a 2001 Johns Hopkins School of Public Health report on the health consequences of population growth.

The Johns Hopkins report quoted figures demonstrating that unclean water and poor sanitation kill over 12 million people every year, while air pollution kills 3 million. In 64 of 105 developing countries, population has grown faster than food supplies.

By 2025, the report claimed, humankind could be using over 90% of all available freshwater, leaving just 10% for the world's plants and animals.

Prof. Holman summarizes the writings of experts Joel Cohen, E.O. Wilson, Paul Ehrlich and Ronald Lee, who have argued that the consequences of long-term environmental degradation - "specifically rising sea levels, disruption of agriculture and the increased frequency of extreme weather events resulting from anthropogenic climate change, exacerbated by resource scarcity" - create social problems that lead to social unrest.

With more people living together than ever before, it seems inevitable that this compounded social unrest would lead to increased warfare and fighting for resources.

According to the Johns Hopkins researchers, about half of the world's population currently occupies a coastal strip 200 kilometers wide - which means that 50% of us are squeezed together on just 10% of the world's land surface.

The projected flooding of these coastal regions as a result of global warming and rising sea levels could displace millions of people, result in widespread droughts and disrupt agriculture.

The Johns Hopkins team identified two main courses of action to divert these potential disasters.

Firstly - sustainable development. The report authors argued this should include:

• More efficient use of energy
• Managing cities better
• Phasing out subsidies that encourage waste
• Managing water resources and protecting freshwater sources
• Harvesting forest products rather than destroying forests
• Preserving arable land and increasing food production
• Managing coastal zones and ocean fisheries
• Protecting biodiversity hotspots.

The second vital area of action is the stabilization of population through good-quality family planning, which "would buy time to protect natural resources."

How to reduce fertility in a morally acceptable way?

Commenting on Prof. Raftery's finding that we may be welcoming an additional 5 billion individuals onto the planet by 2100 than had previously been estimated - a potential global population of 12.3 billion people - Prof. Holman admits that "it is difficult to know what the public health effects will be."

He explains:

"By then, we may see severe petroleum and fresh water resource shortages, climate changes that affect agriculture patterns that, in turn, affect food supplies. Reducing fertility in socially and morally acceptable ways seems like one public health strategy to avoid - or at least postpone - testing some of these limits."

In Utopia, a sinister governmental organization proposes to sterilize a large percentage of the population by rolling out a secretly modified vaccine in response to a manufactured flu pandemic. Obviously, that is not a socially or morally acceptable strategy for reducing fertility - but what is?

Experts consider boosting the education of girls in developing countries to be a prime solution.

As well as acquiring more control over their reproductive life, an educated female workforce should have more opportunities of employment and of earning a living wage. Studies report that the children of educated women also have better chances of survival and will become educated themselves. This pattern continuing across generations is associated with a decline in fertility rates.

A 2011 article by the Earth Policy Institute (EPI), analyzing data from the United Nations (UN), states that "countries in which more children are enrolled in school - even at the primary level - tend to have strikingly lower fertility rates."

In particular:

"Female education is especially important. Research consistently shows that women who are empowered through education tend to have fewer children and have them later. If and when they do become mothers, they tend to be healthier and raise healthier children, who then also stay in school longer. They earn more money with which to support their families, and contribute more to their communities' economic growth. Indeed, educating girls can transform whole communities."

The relationship between education, fertility and national poverty is a direct one. As the EPI authors add: "When mortality rates decline quickly but fertility rates fail to follow, countries can find it harder to reduce poverty."

The UN's 2012 Revision of the world population prospects report suggested if we make rapid reductions in family size, then it may still be possible to constrain the global population to 8 billion by 2045.

No projections are set in stone - all are contingent on what extent fertility rates will sway over the next century. And, as Prof. Holman pointed out to us, the nature of the threat posed by overpopulation has "been vigorously debated for over 200 years" with experts still not in complete accord.

For instance, in the 1980s, said Prof. Holman, the economist Julian Simon and ecologist Paul Ehrlich went on tour together, with a series of debates about the consequences of population growth.

"Ehrlich argued that continued population growth would lead to disaster for humans. Simon argued that population growth provided more people to invent new solutions to the problems confronting humans," said Prof. Holman, adding:

"Given the trends to this point, Simon has been 'more right.' One simple measure of this is mortality rates, which have decreased for most human groups. The flaw in Simon's argument may well be that we have never hit the limits of our finite earth. Positive population growth guarantees that we will, someday, hit some hard limits."

"So that," Prof. Holman concluded, "is the long term."

Source: www.medicalnewstoday.com

By LINDSAY CROUSE

When Paula Radcliffe won the New York City Marathon in 2007, nine months after giving birth to a daughter, Isla, Radcliffe was considered an anomaly. Her intense training through her pregnancy, which included twice-a-day sessions and grueling hill workouts, was scrutinized and criticized.

Seven years later, maintaining a top running career and a family has become relatively common. About a third of the women in the professional field of 31 for the New York City Marathon next Sunday have children.

“I watched Paula win New York, basically leading from the starting gun to the finish tape, and afterward she picked up her baby,” said Kara Goucher, a top American marathoner. “I realized I can do both. And I want to do both.”

Goucher, 36, finished third in the 2008 New York City Marathon, and this year she will run the New York race for the first time with her 4-year-old son, Colt, cheering her on.

When she contemplated having a child, Goucher engaged in the careful strategizing common to elite female athletes, who consider precisely when to become pregnant so as not to risk missing out on an Olympic medal or sacrificing a corporate sponsorship.

Elite female distance runners now run competitive times well into their late 30s. The average age of a top female marathoner is 30, and 19 women in next Sunday’s professional field are that age or older.

As athletic peaks for these top runners have overtaken fertility peaks, the decision to combine motherhood and training has become increasingly unavoidable. Competitive careers are stretching: The American Deena Kastor, expected to be another top finisher next Sunday, is 41.

“I always wanted to have a child,” Goucher said, “and I didn’t want to wait until I was done, because I don’t really see an end date on my career. I wanted more in my life than just running. But the details of how you do that can get incredibly complicated.”

Elite runners often try to squeeze in a pregnancy and recovery in the 16-month window between world track championships in years with no Summer Olympics. This is one such year, and pregnancies abound.

Maternity leave in professional running is rare. A pregnancy is still frequently treated as if it were an injury, and women can experience a pay cut or not be paid at all if they do not compete for six months. During that period, they often remain bound to sponsors in exclusive contracts that can last upward of six years. Because the athletes are independent contractors, they are not covered by laws that protect employed women in pregnancy.

Lauren Fleshman, an N.C.A.A. 5,000-meter champion and a professional runner, switched to a women’s-oriented sponsor, the running apparel company Oiselle, before having a son in June 2013.

Referring to Goucher and Radcliffe, Fleshman said: “Kara and Paula showed that pregnancy doesn’t necessarily need to be an impediment to the athletic part of our careers, and blew up the vestiges of the myth of the ‘fragile woman’ who can’t be both a top athlete and a mother. But in terms of your career, there’s still the feeling that if you say you want to have a kid, you’re saying you don’t want to be an athlete.”

It does not help that so many people seem to have an opinion on the matter. After Alysia Montaño, a 2012 Olympian, ran an 800-meter race in June during her eighth month of pregnancy, her decision became the subject of intense public scrutiny.

“I wanted to help clear up the stigma around women exercising during pregnancy, which baffled me,” Montaño said. “People sometimes act like being pregnant is a nine-month death sentence, like you should lie in bed all day. I wanted to be an example for women starting a family while continuing a career, whatever that might be. I was still surprised by how many people paid attention.”

Montaño’s daughter was born in August.

“Giving birth is a very athletic activity, like going through intervals on the track,” Montaño said. “Like contractions, intervals can start out easy and progress as they get harder. There’s sometimes a point where you wonder, ‘Can I do one more set?’ But you know you’re going to make it. And then you kick to the finish.”

Other women have chosen different paths.

Clara Horowitz Peterson, a former top runner at Duke, focused on starting a family in her mid-20s, aiming for a racing peak afterward. Now 30, she is pregnant with her fourth child.

“I think if I’d chosen to train at altitude and log 120-mile weeks, I could have made it to the Olympics,” said Peterson, who typically runs 80 to 90 miles a week when not pregnant. “But that comes with sacrifices; you put your career first, and before you know it, you’re 28, maybe confronting fertility issues. I always felt like having children was more important to me than a running career.”

Still, Peterson ran right up until the births of her first three children. She qualified for the 2012 United States Olympic marathon trials just four months after delivering her second child, and she logged a 2-hour-35-minute time at the race four months later.

“I trained hard through that pregnancy,” Peterson said. “You can tell when you’re pushing it. You get twingy, or feel tendons pulling, so I backed off when that happened.”

To bounce back for the trials, Peterson said, she breast-fed her second child for only five weeks — finding that the hormones related to breast-feeding made her feel sluggish — and dropped the 20 pounds she typically gained during pregnancy in eight weeks without dieting. (She breast-fed her third child for six months.)

The understanding of women’s physical resilience during and after pregnancy has also developed in recent years.

“We still don’t have good science to guide us,” said Dr. Aaron Baggish, associate director of the cardiovascular performance program at Massachusetts General Hospital in Boston, which counsels elite athletes through pregnancy. “But unequivocally I think women should exercise through pregnancy, both for their baby and their own health. The body has evolved that way. Your baseline fitness level is the best guideline: Elite athletes start out with a higher threshold, so they can do more.”

After athletes give birth, efforts to get back into shape are consuming, coupled with the usual adjustments to caring for an infant. Breast-feeding interrupts the sleep that heals spent muscles and restores energy to a tired body. Babies are often kept out of group day care to prevent them from bringing home illnesses that could compromise rigid training plans.

Pregnancy can be hard to combine with any job. As in other fields, partners are generally a key component of elite athletes’ ability to continue their careers after having children.

Edna Kiplagat, a 35-year-old Kenyan who is among the favorites in next Sunday’s race, had two children before becoming a two-time marathon world champion and the 2010 winner in New York.

Her husband and coach, Gilbert Koech, gave up his running career to focus on hers and manage their family, making breakfast for their five children, three of whom are adopted, and taking them to school while Kiplagat trains.

Goucher’s husband, Adam, retired from professional racing a year after their son’s birth and started a running-related business. He tries to balance supporting her racing career with managing his new one, saying that he and Kara work to share equally in caring for Colt.

“Kara’s putting her body through a lot right now,” her husband said, “and we need to do everything possible to alleviate the stress of training. When she needs to go out and run, or needs to rest and recover, that’s my first priority.”

Goucher said she was taking the trade-offs in stride.

“It’s scary because the fact is for all women when you have a child, you do need to drop out for a long time, and you don’t know how you’ll come back,” she said. “It’s a huge risk. Of course, I’m serious about my job, but in life I needed to be more than that. So I think it was worth it.”

Source: www.nytimes.com

By Elizabeth Baier

Anyone who has spent much time in Minnesota's "Med City" can't help but notice that wheelchairs are everywhere.

From city parking ramps and downtown sidewalks to park trails and the local mall, the chairs have an inescapable presence.

More than likely that has do to with the fact that Rochester is home to Mayo Clinic, visited by thousands of patients every day. Many of them use wheelchairs to get around. So it's not surprising that they exist in big numbers.

The big curiosity is how they end up all over the city with their users nowhere in sight — a fact that some local residents can be oblivious to.

Denny and Carol Scanlan say empty wheelchairs are just part of the Rochester landscape.

"I never even thought of it until just now," Denny Scanlan says over a drink at American Legion Post 92, where he is a member. "Well, I see them kind of everywhere we go, I guess — where you least expect them."

"Yes," says his wife, with a laugh. "At the mall. In a restaurant. " She adds, "We're so used to it that I don't even notice it."

But some people do notice the big blue chairs.

At the Blue Water Salon on the skyway level of the Doubletree Hotel, owner Shelly Joseph often sees them just outside her door, in a public stairwell largely used by hotel staff.

"I don't know why they're in here, but randomly they're in this stairwell," she says. "It's a fire exit, basically."

At the Starbucks across the hall, manager Dawn Lee-Britt sees wheelchairs outside the employee entrance at the back of the coffee shop at least a couple of times a week.

"Sometimes we can't get out," she says. "I'm getting used to it because we see them so often." She adds: "It's like they don't need it anymore or it's time to go.

Mayo Clinic has 1,180 wheelchairs in its Rochester fleet, largely for patient transport. It loses up to 150 chairs each year, says general services manager Ralph Marquez, who oversees patient equipment.

At $550 each, that could be as much as $82,500 a year.

"Yes, it's a financial burden to us from that standpoint, but it's also a service we provide," Marquez says. "And if the patient, you know, truly comes first, sometimes that's the expense of the business."

Because the clinic does not want to keep patients from leaving the campus, the clinic's courier service rounds up wheelchairs weekly, mostly from hotels and other places that alert them.

But the chairs can travel much farther than that.

"We've gotten calls from Orlando Airport. Goodwill up in Duluth had one of our chairs and luckily we were able to retrieve that one. We've had them in Denver, out east in a few airports," Marquez says. "They get back to us dirty and needing to be cleaned. People may take them home for a while. They wind up everywhere."

That includes the Rochester Public Library, where communications manager John Hunziker considers wheelchairs normal.

"I'm sure if you aren't used to Rochester, seeing somebody going down the skyway, you know, pushing an IV on a rolling stand looks kind of weird," he says. "But it's just part of living in Rochester."

And on some days, part of Hunziker's job is to let the Mayo Clinic know there's a blue chair to pick up in the lobby.

Source: www.npr.org

By Robert Preidt

Cesarean delivery was the most common inpatient surgery in the United States in 2011 and was used in nearly one-third of all deliveries, research shows.

The new study found that 1.3 million babies were delivered by cesarean section in 2011. The findings also revealed wide variations in C-section rates at hospitals across the United States, but the reasons for such differences are unclear.

"We found that the variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity. This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions," lead author Katy Kozhimannil, an assistant professor in the School of Public Health at the University of Minnesota, said in a university news release.

The researchers analyzed data from more than 1,300 hospitals in 46 states. They found that the overall rate of C-section was about 33 percent. Between hospitals, however, that rate ranged between 19 and 48 percent, according to the study.

For women who'd never previously had a C-section, the overall C-section rate was 22 percent. Depending on the hospital, that rate ranged between 11 percent and 36 percent, the researchers said.

C-section rates ranged from 8 percent to 32 percent among lower-risk women and from 56 percent to 92 percent among higher-risk women, according to the study published Oct. 21 in the journal PLoS Medicine.

The findings highlight the roles that hospitals' policies, practices and culture may have in influencing C-section rates, the study authors concluded.

"Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth, and these results indicate that we have a long way to go toward reaching this goal in the U.S.," Kozhimannil said in the news release.

Source: www.nlm.nih.gov

BY ISSIE LAPOWSKY

When you’re deaf, finding a job isn’t easy.

The trickiest part, explains Ryan Hait Campbell, is the interview. “You’re not required to tell an employer you’re deaf until the interview, but sometimes, they’re a little shocked,” says Campbell, who has been deaf since birth. “They don’t know how to handle it.”

Because of things like this, he says, unemployment rates are staggeringly high among the deaf. Hard numbers are tough to come by, but some figures estimate that around half of people with hearing disabilities are unemployed.

But Campbell wants to change this. He’s the co-founder and CEO of MotionSavvy, an Alameda, California-based startup that’s developing a case for tablet computers that can serve as a virtual interpreter for the deaf. Known as UNI, the case uses gesture recognition technology developed by Leap Motion to translate sign language into audible speech. It then merges this with voice recognition technology to convert spoken word to text. Because there are a variety of signs for any given word, users can upload new signs using a feature called Sign Builder. The system learns how individual users sign, while also distributing each new sign to every UNI device.

On Tuesday, MotionSavvy launched an IndieGoGo campaign for UNI to raise money and recruit beta testers to help build its dictionary of signs. For $499, a discounted rate, 200 selected backers will get a tablet and UNI case to try at home. “This could really give deaf people the power to live the lifestyle they want to live,” Campbell says, “and we think that is very powerful.”

Such technology would have seemed a distant dream not long ago. But the past decade has brought a wave of investment and interest in both gesture recognition technology and voice recognition technology, driven by companies like Apple and Microsoft, as well as smaller players like Nuance and Leap Motion. That hasn’t gone unnoticed by those who want to improve the lives of the deaf community. MotionSavvy is one of several players trying to capitalize on the convergence of these trends.

Just last week, Transcense, launched an IndieGoGo campaign for an app that provides real-time voice recognition so deaf people can follow a conversation. But unlike UNI, it doesn’t give deaf people who haven’t mastered speech a clear way to talk back. For MotionSavvy, that is the final—and most important—puzzle piece.

“It’s kind of like solving a quadratic equation at this point. It’s figuring out the right variables and stacking things together in such a way that they’ll all perform efficiently,” says Stephen Jacobs, associate director of Rochester Institute of Technology’s Center for Media Arts, Games Interaction, and Creativity.

Jacobs introduced Campbell to MotionSavvy CTO Alexandr Opalka when both were studying at RIT. Opalka, who also is deaf, had been working on similar technology as a student in RIT’s National Technical Institute for the Deaf. They teamed up with four other deaf students, and in 2012, launched MotionSavvy.

The technology is in its earliest stages. UNI recognizes only 300 signs, and its voice recognition component remains unreliable, though Opalka says UNI will come equipped with new and improved voice recognition for beta testers. And yet, during a demo of UNI at WIRED’s New York City office, it wasn’t hard to see just how transformative a technology like this could be. Campbell used it to sign a few common phrases to Opalka, such as “What’s your name?” and “Where are you from?” Yes, it was wonky, but still it struck me as sort of magical.

Campbell says that reaction’s not entirely unique. “I brought this to a table of older deaf people, and they all freaked out,” he says.

But it’s not just the deaf and hard of hearing who are excited about UNI. Campbell says the FCC has gotten in touch. For many low-income deaf people, translators, video relay services, and other communication tools are prohibitively expensive. So the National Deaf-Blind Equipment Distribution Program picks up the tab. When the commercial version of UNI launches in 2015, it’ll cost $799, plus a $20 monthly subscription for Sign Builder. It’s not cheap, but it’s better than the alternative.

Campbell acknowledges the product is a “moonshot,” and admits it may never replace human interpreters. In fact, he and Opalka hope that it does the opposite. If UNI can achieve its intended purpose—facilitating one-on-one communication— then it could become easier for deaf people to get decent jobs. And who typically pays for interpreters? Employers. “If you can’t communicate during an interview, you’re not getting the job,” Opalka says. “With UNI, we predict more people who are deaf will be able to get jobs and stay working, and that’s how we’ll get more people to hire interpreters. There will be more people in the workforce.”

Source: www.wired.com

A Department of Veterans Affairs initiative targeting staph infections in hospitalized patients has produced positive results, according to data released by the VA. 

Among VA patients in ICUs between 2007 and 2012, healthcare-associated MRSA infection rates dropped 72% — from 1.64 to 0.46 per 1,000 patient days. Infection rates dropped 66% — from 0.47 to 0.16 per 1,000 patient days — for patients treated in non-ICU hospital units.

“These results are striking,” Carolyn Clancy, MD, VA’s interim under secretary for health, said in a news release. “Healthcare-associated infections are a major challenge throughout the healthcare industry, but we have found in VA that consistently applying some simple preventive strategies can make a very big difference, and that difference is being recognized.”

VA’s prevention practices consist of patient screening programs for MRSA, contact precautions for hospitalized patients found to have MRSA, and hand hygiene reminders with hand sanitizer stations placed in common areas, patient wards and specialty clinics throughout medical centers, according to the release. Practices are reinforced via computerized reminders, training, measurement and continual feedback.

MRSA infections are a serious global healthcare issue and are difficult to treat because the bacterium is resistant to many antibiotics. In a Centers for Disease Control and Prevention 2012 MRSA surveillance report from its Active Bacterial Core surveillance, the CDC cites 75,309 cases of invasive MRSA infections and 9,670 deaths due to invasive MRSA in 2012, according to the release.

“The VA healthcare system is able to implement and assess these prevention strategies,” Martin Evans, MD, director of VA’s MRSA control program, said in the release. “What we’ve learned translates into better healthcare for the veterans we serve.”

Source: www.va.gov

By Eun Kyung Kim

James Wathen had stopped eating. Frail and barely able to speak, the 73-year-old whispered to a health care worker that he missed his dog, a one-eyed Chihuahua he hadn't seen since paramedics whisked him away to a Kentucky hospital weeks earlier. 

So a team of nurses hustled to learn the fate of Wathen's beloved pet, Bubba, hoping a reunion might provide some peace and comfort to their heartbroken and deteriorating patient — even if arranging one meant bending ahospital rule against pets.

A series of phone calls eventually led the nurses to the Knox-Whitley Animal Shelter, where Bubba was taken and placed with a foster family, said Mary-Ann Smyth, president of the non-profit facility.

Coincidentally, Bubba had also recently fallen ill.

"The dog quit eating a week ago, which is very strange," Smyth told TODAY.com. "The dog didn’t know where James was and James didn't know where the dog was and believe it or not, they both stopped eating at about the same time."

Plans were made to bring the little pooch, who lacked his bottom row of teeth along with his right eye, to the hospital over the weekend.

“He was so sad at first. We had him wrapped in a baby blanket and he was shivering,” Smyth said. “The minute we got about 20 steps from this guy’s room — I kid you not — his little head went up. His eyes got real bright and he was like a different dog.”

She says a similar transformation took place in Wathen during his roughly 30-minute hospital reunion Saturday with Bubba. 

"They didn’t think James was going to make it," she recalled being told during her initial visit to the hospital. “I was 10 feet from his bed and you could barely understand him because he was so hard to hear. The nurse had to lean up right against his face to hear what he was saying."

But he slowly perked up as his dog snuggled with him on his bed. By the time Bubba returned for a second visit Tuesday, visible changes were noticeable in both man and his best friend.

"He’s done a complete turnaround. He's speaking, he's sitting up, he’s eating. He doesn't look like the same guy," said Smyth, who didn't attend the second visit but saw Wathen in footage recorded by the shelter's director. "And the dog is eating and doing better now, too."

Baptist Health Corbin, the hospital treating Wathen, did not return repeated messages left by TODAY.com seeking comment.  

But nurse Kimberly Probus told WKYT-TV a team of nurses went looking for Bubba after "one of our social workers realized it was mourning the loss of the dog that was making our patient even worse and emotionally unhealthy."  

Smyth said she's not surprised at the healing power pets provide their owners.

"I hope this story will show to people the tremendous difference that animals can make in people’s lives," she said. She also hopes it will encourage people to think about rescuing pets from shelters like hers, which is rebuilding its facility after its previous home burned down in a fire last November.

“One of the biggest problems we face is the way some people think of animals. People just don’t see animals as creatures and beings, they see them as property,” she said. “I hope people understand they’re not 'its,' they’re 'beings.'”

Source: www.today.com

By JESSICA FIRGER

When Donna Tookes learned she had breast cancer last winter, the 59-year-old thought she had no choice but to accept one of the most dreaded side-effects of chemotherapy: losing her mane of silver hair, a feature that strangers young and old frequently stopped to admire.

"I had resigned myself," Tookes told CBS News. "I had purchased an array of scarves, about 10. And I actually practiced tying them."

Tookes was diagnosed with breast cancer in January after her annual mammogram, when her doctors detected some mild calcifications in her right breast. These clusters of white flecks visible on her scan indicated there might be something seriously wrong. After a few subsequent tests, Tookes learned she had HER2 breast cancer, an especially aggressive form that can be difficult to treat. Though her doctors caught the cancer early, they wanted to be certain it would never return, which meant a unilateral mastectomy followed by 12 rounds of punishing chemotherapy.

"You have a consultation before you start chemotherapy," said Tookes, who lives with her husband and children in Stamford, Connecticut, and has worked for more than three decades as a flight attendant. "I was told I would lose my hair. And then the nurse assured me, she told me 'you're beautiful,' and that I was one of the only ones who could carry the bald look because I have that bone structure."

But her family could see that losing her hair would take a serious toll on her psyche. Tookes had heard about some treatment in Europe that helps prevent chemo-related hair loss, though she didn't know many details. Secretly, her husband began to conduct research. He wrote to friends in Sweden, who were able to obtain information about a new and innovative therapy called a scalp cooling cap. He soon found out that Mount Sinai Beth Israel in New York City was involved in a clinical trial on the device, known as the DigniCap System, which is worn by a patient during chemotherapy transfusions.

The snug cap is secured onto a patient's head each time she undergoes chemotherapy. It chills the scalp down to 5 degrees Celsius so that the blood vessels surrounding the hair roots contract, meaning that less of the toxins from chemo enter the hair follicle. This minimizes -- and in some cases completely stops -- a patient's hair from falling out.

At first, Tookes was slightly skeptical, but her family finally convinced her to move her cancer treatment from her hospital in Connecticut to Mount Sinai Beth Israel in New York City.

Dr. Paula Klein, assistant professor of medicine, hematology and medical oncology at the Icahn School of Medicine at Mount Sinai and principal investigator for the clinical trial, told CBS News the device has been effective at limiting hair loss in nearly all of her patients enrolled.

"Unfortunately, in breast cancer the two most active agents are associated with significant hair loss," said Klein. "For many women with early stage breast cancer, they are getting chemotherapy for prevention of recurrence."

Klein said overall, women who use the cap lose just 25 percent of their hair. There are some patients who lose more and a lucky handful who lost no hair at all.

The clinical trial is now in its final phase. The company behind the cap, Dignitana, will be submitting results to the U.S. Food and Drug Administration by the end of November, and hope to win FDA approval for the cap in 2015.

For women struggling through a difficult medical ordeal, the benefit is significant. Research published in 2008 in the journal Psycho-Oncology looked at 38 existing studies on breast cancer treatment and quality of life issues, and found hair loss consistently ranked the most troubling side effect of treatment for women. "Significant alopecia [hair loss] is problematic," said Klein. "Every time you look in the mirror, you remember you're getting cancer treatment."

Many breast cancer survivors report that even when their hair finally grows back after chemotherapy it is often different in color or texture than the hair they had before, due to the period of time it takes the hair follicles to recover from the damage caused by the drugs.

Moreover, the feelings associated with hair loss impact nearly every aspect of a breast cancer patient's life -- from her self-image and sexuality to whether or not she is comfortable at work or even walking into the supermarket to buy a quart of milk.

When she first prepared for treatment, Tookes worried how people would react to her appearance if she lost all of her hair. But it didn't happen. Seven weeks into chemo, she finally felt confident enough to return the unused wardrobe of scarves. She still had a full head of hair. Because the cooling therapy was used only on her scalp, Tookes did still lose her eyebrows and "everything south of there."

Tookes is now cancer-free and says the therapy helped her stay optimistic about her prognosis. "My mother used to say, you just comb your hair and get yourself together and you'll get through hard times," she said.

Source: www.cbsnews.com

By MIKE STOBBE

For more than two months, health officials have been struggling to understand the size of a national wave of severe respiratory illnesses caused by an unusual virus. This week, they expect the wave to start looking a whole lot bigger.

But that's because a new test will be speeding through a backlog of cases. Starting Tuesday, the Centers for Disease Control and Prevention is using a new test to help the agency process four or five times more specimens per day that it has been.

The test is a yes/no check for enterovirus 68, which since August has been fingered as the cause of hundreds of asthma-like respiratory illnesses in children — some so severe the patients needed a breathing machine. The virus is being investigated as a cause of at least 6 deaths.

It will largely replace a test which can distinguish a number of viruses, but has a much longer turnaround.

The result? Instead of national case counts growing by around 30 a day, they're expected to jump to 90 or more.

But for at least a week or two, the anticipated flood of new numbers will reflect what was seen in the backlog of about 1,000 specimens from September. The numbers will not show what's been happening more recently, noted Mark Pallansch, director of the CDC's division of viral diseases.

Enterovirus 68 is one of a pack of viruses that spread around the country every year around the start of school, generally causing cold-like illnesses. Those viruses tend to wane after September, and some experts think that's what's been happening.

One of the places hardest hit by the enterovirus 68 wave was Children's Mercy Hospital in Kansas City, Missouri. The specialized pediatric hospital was flooded with cases of wheezing, very sick children in August, hitting a peak of nearly 300 in the last week of the month.

But that kind of patient traffic has steadily declined since mid-September, said Dr. Jason Newland, a pediatric infectious diseases physician there.

"Now it's settled down" to near-normal levels, Newland said. Given the seasonality of the virus, "it makes sense it would kind of be going away," he added.

The germ was first identified in the U.S. in 1962, and small numbers of cases have been regularly reported since 1987. Because it's not routinely tested for, it may have spread widely in previous years without being identified in people who just seemed to have a cold, health officials have said.

But some viruses seem to surge in multi-year cycles, and it's possible that enterovirus surged this year for the first time in quite a while. If that's true, it may have had an unusually harsh impact because there were a large number of children who had never been infected with it before and never acquired immunity, Newland said.

Whatever the reason, the virus gained national attention in August when hospitals in Kansas City and Chicago saw severe breathing illnesses in kids in numbers they never see at that time of year.

Health officials began finding enterovirus 68. The CDC, in Atlanta, has been receiving specimens from severely ill children all over the country and doing about 80 percent of the testing for the virus. The test has been used for disease surveillance, but not treatment. Doctors give over-the-counter medicines for milder cases, and provide oxygen or other supportive care for more severe ones.

The CDC has been diagnosing enterovirus 68 in roughly half of the specimens sent in, Pallansch said. Others have been diagnosed with an assortment of other respiratory germs.

As of Friday, lab tests by the CDC have confirmed illness caused by the germ in 691 people in 46 states and the District of Columbia. The CDC is expected to post new numbers Tuesday and Wednesday.

Aside from the CDC, labs in California, Indiana, Minnesota and New York also have been doing enterovirus testing and contributing to the national count. It hasn't been determined if or when the states will begin using the new test, which was developed by a CDC team led by Allan Nix.

Meanwhile, the virus also is being eyed as possible factor in muscle weakness and paralysis in at least 27 children and adults in a dozen states. That includes at least 10 in the Denver area, and a cluster of three seen at Children's Mercy, Newland said.

Source: http://news.yahoo.com

By Debra Wood

One out of every six newly licensed nurses (more than 17 percent) leave their first nursing job within the first year and one out of every three (33.5 percent) leave within two years. But not all nurse turnover is bad, according to a new study from the RN Work Project, funded by the Robert Wood Johnson Foundation.

“It seemed high,” said Carol S. Brewer, PhD, RN, FAAN, professor at the University at Buffalo School of Nursing and co-director of the RN Work Project, the only longitudinal study of registered nurses conducted in the United States. “Most of them take a new job in a hospital. We’ve emphasized who left their first job, but it doesn’t mean they have left hospital work necessarily.”

While many nursing leaders have voiced concern that high turnover among new nurses may result in a loss of those nurses to the profession, that’s not what the RN Work Project team has found. Most of those leaving move on to another job in health care.

“Not only are they staying in health care, they are staying in health care as nurses,” said Christine T. Kovner, PhD, RN, FAAN, professor at the New York University College of Nursing and co-director of the RN Work Project. “Very few leave. A tiny percent become a case manager or work for an insurance company, verifying people had the right treatment.”

Such outside jobs tend to offer better hours, with no nights or weekends. The nurses are still using their knowledge and skills but they are not providing hands-on care.

The RN Work Project looks at nurse turnover from the first job, and the majority of first jobs are in the hospital setting, Brewer explained. However, in the sample, nurses working in other settings had higher turnover rates than those working in acute care.

Kovner hypothesized that since new nurses are having a harder time finding first jobs in hospitals, they may begin their careers in a nursing home and leave when a hospital position opens up. On the other hand, those who succeed in landing a hospital job may feel the need to stay at least a year, because that’s what many nursing professors recommend. Hospitals also tend to offer better benefits, such as tuition reimbursement and child care, and hold an attraction for new nurses.

“Our students, if they could get a job in an ICU, they’d be happy, and the other place they want to work is the emergency room,” Kovner said. “They want to save lives, every day.”

The RN Work Project data excludes nurses who have left their first position at a hospital for another in the same facility, which is disruptive to the unit but may be a positive for the organization overall, since the nurse knows the culture and policies. The nurse may change to come off the night shift or to obtain a position in a specialty unit, such as pediatrics.

“That’s an example of the type of turnover an organization likes,” Kovner said. “You have an experienced nurse going to the ICU [or another unit].”

While nurse turnover represents a high cost for health care employers, as much as $6.4 million for a large acute care hospital, some departures of RNs is good for the workplace. Brewer, Kovner and colleagues describe the difference between dysfunctional and functional turnover in the paper, published in the journal Policy, Politics & Nursing Practice.

“Dysfunctional is when the good people leave,” Brewer said.

The RN Work Project has not differentiated between voluntary and involuntary departures, the latter of which may be due to poor performance or downsizing. And some nurse turnover is beneficial.

“If you never had turnover, the organization would become stagnant,” Kovner added. “It’s useful to have some people leave, particularly the people you want to leave. It offers the opportunity to have new blood come in.”

New nursing graduates might bring with them the latest knowledge, and more seasoned nurses may bring ideas proven successful at other organizations.

Once again, Brewer and Kovner report managers or direct supervisors play a big role in nurses leaving their jobs. Organizations hoping to reduce turnover could consider more management training for people in those roles.

“Leadership seems a big issue,” Brewer said. “The supervisor support piece has been consistent.”

Both nurse researchers cited the challenge of measuring nurse turnover accurately. Organizations and researchers often describe it differently, Brewer said. And hospitals often do not want to release information about their turnover rates, since nurses would most likely apply to those with lower rates, Kovner added. When assessing nurse turnover data, she advises looking at the response rate and the methodology used.

“There are huge inconsistencies in reports about turnover,” Kovner said. “It’s extremely important managers and policy makers understand where the data came from.”

Source: www.nursezone.com