Record $417M award in suit linking baby powder to cancer

A La jury on Monday purchased Manley & Manley to pay for an archive $417 million to some hospitalized lady who claimed inside a suit the talc within the company’s legendary baby powder causes ovarian cancer when applied regularly for feminine hygiene.

The decision within the suit introduced through the California lady, Avoi Echeverria, marks the biggest sum awarded in a number of talcum powder suit verdicts against Manley & Manley in courts round the U.S.

Echeverria alleged Manley & Manley unsuccessful to adequately warn consumers about talcum powder’s potential cancer risks. She used the business’s baby powder every day starting in the 1950s until 2016 and it was identified as having ovarian cancer in 2007, based on court papers.

Echeverria developed ovarian cancer like a “proximate consequence of the unreasonably harmful and defective nature of talcum powder,” she stated in her own suit.

Echeverria’s attorney, Mark Robinson, stated his client is undergoing cancer treatment while hospitalized and told him she wished the decision would lead Manley & Manley to place additional warnings on its products.

“Mrs. Echeverria is dying out of this ovarian cancer and she or he stated in my experience all she desired to do ended up being to assist the other women through the whole country who’ve ovarian cancer for implementing Manley & Manley for 25 and 3 decades,Inch Robinson stated.

“She really did not want sympathy,” he added. “She wanted to obtain a message to help other women.”

The jury’s award incorporated $68 million in compensatory damages and $340 million in punitive damages, Robinson stated. Evidence within the situation incorporated internal documents from the 3 decades that “demonstrated the jury that Manley & Manley understood concerning the perils of talc and ovarian cancer,” Robinson stated.

“Manley & Manley had many warning bells more than a thirty year period but unsuccessful to warn the ladies who have been buying its product,” he stated.

Manley & Manley spokeswoman Carol Goodrich stated inside a statement that the organization appeals the jury’s decision. She states while the organization sympathizes with females struggling with ovarian cancer that scientific evidence props up safety of Johnson’s baby powder.

The decision came following a St. Louis, Missouri jury in May awarded $110.5 million to some Virginia lady who had been identified as having ovarian cancer this year.

She’d blamed her illness on her behalf utilisation of the company’s talcum powder-that contains products in excess of 4 decades.

On top of that situation, three other trials in St. Louis had similar outcomes this past year — with juries awarding damages of $72 million, $70.a million and $55 million, for any combined total of $307.six million.

Another St. Louis jury in March rejected the claims of the Tennessee lady with ovarian and uterine cancer who blamed talcum powder on her cancers.

Two similar cases in Nj were tossed out with a judge who stated the plaintiffs’ lawyers didn’t presented reliable evidence linking talc to ovarian cancer.

Greater than 1,000 others have filed similar lawsuits. Some who won their lawsuits won reduced amounts, illustrating how juries have wide latitude in awarding financial damages.

Manley & Manley is getting ready to defend itself and it is baby powder at approaching trials within the U.S., Goodrich stated.

This story continues to be updated.

With contributions from Amanda Lee Myers

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Will transparency in drug prices pressure lower costs?

Because the condition legislature came back to operate in Sacramento Monday, lawmakers were thinking about numerous bills meant to restrain an upswing of healthcare prices, including one which will need drug makers to inform the general public before raising the cost of certain medications.

“We must be innovative of methods we are likely to control healthcare costs,” states Erectile dysfunction Hernandez, chair from the senate health committee and sponsor of Senate bill 17.

When the bill passes, the coming year the state’s insurance regulators could keep a yearly listing of the 25 mostly pricey drugs, the 25 most generally prescription drugs, and which 25 drugs’ prices increased probably the most. The report would likewise incorporate how individuals costs affected medical health insurance premiums.

Pharmaceutical companies would need to show the condition periodically why they’re raising prices, and they’d need to give two months notice to purchasers before raising prices by a specific amount.

Hernandez admits his measure alone wouldn’t pressure individuals companies to lessen their prices, but he believes imposing greater transparency would put more pressure in it to do this.

The pharmaceutical industry opposes the measure. The Biotechnology Innovation Organization has expressed concern it’s an effort to impose a kind of cost control that will discourage investors.  The French drug maker Sanofi has stated the measure wouldn’t help the consumer. The primary industry lobby, the Pharmaceutical Research and Manufacturers of the usa, stated the balance would distort the particular prices of medication since it ignores rebates and discounts that insurers and enormous provider groups can acquire from manufacturers.

The senator states he props up industry’s right to create a profit, but “they shouldn’t cover the cost of a lot money at the fee for the citizen or even the consumer.”

Hernandez states the us government could lead towards the effort to reduce drug costs whether it began negotiating the costs of prescriptions offered through Medicare.

“If we are likely to mandate that everyone purchase medical health insurance, government must try everything [it] can to make certain the consumer will get the very best cost they are able to for those their own health care, including drugs,” he states.

Senate bill 17 has transpired the Senate and today is incorporated in the Set up. This really is the next time around for that bill Hernandez pulled it this past year when confronted with suggested amendments he felt will make it too hard to attain his objective of “shedding light around the reasons precipitating skyrocketing drug prices.”

California’s legislature can also be thinking about the next:

  • AB 315 – An invoice that will bring pharmacy benefit managers, a try-between industry that negotiates prices between insurance providers and drug manufactures, underneath the state’s regulatory control.

  • AB 265 – An invoice that will stop drug companies from offering discounts on prescriptions that may discourage consumers from buying less expensive generic medications.

  • Senate bill 790 – An invoice that will ban drug makers from gift ideas to medical service providers.

  • AB 587 – An invoice that will produce a condition board to coordinate bulk prescription medication purchases.

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Many breast, ovarian cancer survivors must take this genetic test

Greater than a million American women who’ve had breast or ovarian cancer aren’t obtaining a simple genetic test that will settle if they have a mutation that puts them at greater chance of a recurrence, based on a UCLA study printed Friday.

As much as 10 % of ladies who’ve, and have had, cancer of the breast, and as much as 15 % of individuals with past ovarian cancer, carry inheritable mutations that place them at greater chance of cancer coming back, states the research, that was printed Friday within the Journal of Clinical Oncology. 

The exam to identify the mutations involves taking bloodstream or saliva, however the study discovered that 70 % of qualified cancer of the breast patients and 80 % of patients with ovarian cancer haven’t taken step one of discussing testing using their doctor.

“You want to determine who’re the ladies within this country which have individuals genetic changes,” states lead author Dr. Christopher Childers, a homeowner physician at UCLA’s David Geffen Med school. That information, he states, can inform decisions regarding their treatment and surgery. It may also help family people identify cancer early making changes in lifestyle to try and avoid the disease.

National Cancer Center Network guidelines recommend dna testing for ladies during these groups:

  • All ladies who’ve had ovarian cancer
  • Women who’ve had cancer of the breast when they were diagnosed at 45 or more youthful
  • Ladies who were identified as having cancer of the breast at 50 or more youthful and also have a mother, sister or daughter that has had cancer of the breast
  • Ladies who possess a mother, sister or daughter who’d cancer of the breast once they were 50 or more youthful
  • Ladies who possess a mother, sister or daughter that has had ovarian cancer.

The research, according to surveys in excess of 47,000 women nationwide, requested whether women were discussing the exam or had it. It didn’t assess why patients aren’t discussing or undergoing testing, but Childers states both providers and patients must lead to closing the space. He states all providers should ask women regarding their cancer history, question prior dna testing and be familiar with the most recent testing guidelines.

“Dna testing isn’t just something which is underneath the proper care of an oncologist, it is something that medical service providers, from surgeons to primary care doctors to cardiologists, should be considering whenever we see patients with past cancer,” he states.

Patients with past breast or ovarian cancer should see their doctors and question dna testing, even when these were diagnosed a long time earlier, states Childers. The mutations detected through the test can impact the BRCA1 and BRCA2 genes. Tests for that mutations have been in existence because the mid-1990s, but science, testing guidelines and test availability have evolved since that time.

“It isn’t something you can simply assume was taken proper care of whenever you had diagnosing five or ten years ago,” he states. “This really is something which is really as important ten years, twenty years, 3 decades after your cancer, because it cannot only affect your personal health, but also affects the healthiness of your loved ones people.”

From her experience like a genetic counselor at Providence Health & Services Los Angeles, study co-author Kimberly Childers states some patients need to know the hazards for their and themselves family to allow them to do something to avoid future cancers, while some say ignorance is bliss.

Individuals patients typically say, “I’d rather just see what goes on and never be worried about it, and when tips over, I’ll cope with it if this happens,” states Childers, who’s married towards the study’s lead author. She notes that testing won’t always be right of these people.

Around the switch side, Kimberly Childers also sees ladies who have cancer of the breast within their history, but learn through testing they didn’t inherit the gene mutation.

“While our focus is on identifying individuals in danger who can usually benefit from early prevention and recognition, additionally, it might help give people reassurance who may be coping with a cancer cloud,” she states.

The genetic test is included by Medicare, Medi-Cal and many private insurance coverage, states Kimberly Childers.

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Many nurses lack understanding of health problems to moms after giving birth

In recent several weeks, moms who nearly died within the hrs and days following childbirth have frequently told ProPublica and NPR their nurses and doctors were frequently slow to acknowledge the indicators their physiques were not healing correctly.

Research printed Tuesday in “MCN: The American Journal of Maternal/Child Nursing” substantiates a number of individuals concerns. Researchers surveyed 372 postpartum nurses nationwide and located that lots of them were ill-accustomed to the risks moms face following childbirth.

Requiring more education themselves, these were not able to satisfy their critical role of training moms about signs and symptoms like painful swelling, headaches, heavy bleeding and difficulty in breathing that may indicate potentially existence-threatening complications.

By neglecting to alert moms to such risks, the research found, nurses might be missing an chance in lowering the maternal mortality rate within the U.S., the greatest among affluent nations. An believed 700 to 900 women die within the U.S. each year from pregnancy- and giving birth-related causes. Another 65,000 nearly die, based on the Cdc and Prevention. The minute rates are greatest among black moms and ladies in rural areas. A current CDC Foundation analysis of information from four states discovered that near to 60 % of maternal deaths were avoidable.

Up to 50 % from the nurses who taken care of immediately laptop computer were not aware that maternal mortality has risen within the U.S. recently, and 19 percent thought maternal deaths had really declined. “If [nurses] are not aware that there are been a boost in maternal mortality, it causes it to be less urgent to describe to women exactly what the indicators are,” states study co-author Debra Bingham, who heads the Institute for Perinatal Quality Improvement and teaches in the College of Maryland School of Nursing.

Only 12 % from the respondents understood that almost all maternal deaths occur dads and moms and days after delivery. Only 24 percent properly identified heart-related problems because the leading reason for maternal dying within the U.S.

Actually, coronary disease and heart failure — which, based on recent data, account for over a quarter of maternal deaths within this country — were “the region the nurses felt minimal positive about teaching about,” states Patricia Suplee, an affiliate professor in the Rutgers College School of Nursing in Camden, N.J., and also the lead investigator around the study.

Nurses also stated they spent almost no time — usually ten minutes or fewer — instructing new moms about symptoms of potential complications. Most of the nurses stated these were only prone to discuss such existence-threatening conditions as pre-eclampsia (pregnancy-related high bloodstream pressure), thrombus within the lung area or heart disease “if relevant,” although it was unclear what that meant. Because the study noted, “it’s impossible to precisely predict which women are affected from the publish-birth complication.”

The publish-delivery education supplied by nurses is especially important because when a mother leaves a healthcare facility, she typically does not see her very own physician for 4 to 6 days. As much as 40 % of recent moms, overwhelmed with taking care of a baby and frequently missing in maternity leave, day care, transportation and other sorts of support, never return for his or her follow-up appointments.

Working out the easiest method to instruct new moms is even more crucial, laptop computer noted, since the first days following childbirth are “exhausting, emotionally billed and physiologically draining” — hardly a perfect learning atmosphere. But like a lot of other main reasons of maternal healthcare, postpartum education continues to be poorly studied, Bingham states.

The respondents, who nearly one-third had master’s or doctorate levels, were people from the Association of Women’s Health, Obstetric and Neonatal Nurses, the key professional organization for nurses focusing on maternal and infant care. The association started searching in the education issue in 2014, when Bingham was the association’s v . p . of nursing research and education. “We’d to begin really in the ground-up, because we did not know precisely what women appeared to be trained,” she states.

In focus groups conducted in Nj and Georgia, two states with especially high rates of maternal mortality, researchers learned that postpartum nurses spent many of their time educating moms on how to take care of their new babies, not themselves. The data moms did receive about their risks was extremely sporadic and often incorrect, Bingham states. The written materials women required home frequently were not far better.

Some nurses were uncomfortable discussing the chance that complications might be existence-threatening. “We’d some nurses emerge and say, ‘Well guess what happens, I’d rather not scare the lady. This should be a contented time. I’d rather not appear like several I wish to discuss is dying,’ ” Bingham states.

However the researchers also discovered that nurses might be rapidly educated with short, targeted information. Using insights in the focus groups, a specialist panel developed two standardized tools: a listing and script that nurses could follow when instructing new moms along with a one-page handout of publish-birth indicators that moms could make reference to once they came back home, with obvious-cut instructions when ever to determine a physician or call 911.

Individuals tools were tested in four hospitals in 2015. “Very rapidly, we began talking with the nurses that ladies were returning to a healthcare facility using the handout, saying, ‘I have this symptom,’ ” Bingham states.

One of these would be a Georgia mother named Sarah Duckett, who’d just created her second child. Not much later, she recognized the symptoms of what switched out to become a bloodstream clot in her own lung, a postpartum complication that may be fatal. “Individuals were anecdotes, however they were very effective anecdotes,” Bingham states. “I have brought multiple projects through the years, and barely will i get such immediate feedback that something is working.”

The shortcomings documented through the national survey could promote wider utilization of these power tools, suggests Mary-Ann Etiebet, executive director of Merck for Moms, which funded the research included in a ten-year, $500 million initiative to enhance maternal health all over the world. “Simple things like creating educational and training programs for nurses … may have a real impact,” she states.

Copyright 2017 ProPublica. To determine more, visit ProPublica.

Orange County’s wealthiest metropolitan areas have greatest opioid problem

Opioid abuse and overdoses have caused er visits in Oc to greater than double during the last decade, based on a current report in the county healthcare agency. 

The metropolitan areas using the greatest rates of opioid-related er visits have been in generally wealthy south Oc and across the coast, with Dana Point towards the top of their email list.  

Opioid-related er visits in Oc

Top 12 metropolitan areas Ave. annual visits per 100,000 residents (2011 – 2015)
Dana Point 120
Costa Mesa 99
San Clemente 92
Laguna Beach 90
Laguna Forest 88
Laguna Niguel 74
Huntington Beach 73
San Juan Capistrano 73
Laguna Hillsides 65
Mission Viejo 56
Fountain Valley 56
Newport Beach 51

Source: Oc Healthcare Agency.

“More affluent communities have, maybe, more spare time, more use of prescription drugs,Inches report author Curtis Condon stated within an interview. 

Overdoses associated with prescription opioids, like Vicodin, Oxycontin and morphine, appear to become more concentrated in individuals affluent areas of the county using one of seniors, he stated. Meanwhile, heroin overdoses tend to be more common in central and north Oc, in addition to among more youthful people. 

Orange County’s number of er visits because of heroin overdoses was just slightly greater compared to percentage because of prescription opioid overdoses, based on the report. 

The majority of the patients were white-colored males. The greatest rate of er visits undoubtedly was among 18- to 24-year-olds. 

Still, seniors aged 45 to 64 are dying of opioid overdoses in the greatest rates in Oc. Seniors are prescribed more opiates than their more youthful peers, Condon stated.

“You know, pains and aches. Or you have surgery, lots of occasions you will be prescribed lots of opioids,” Condon stated.

Orange County’s opioid-related dying rates are much greater compared to condition average — and nearly three occasions greater than neighboring La County, based on the California Department of Public Health’s Opioid Overdose Surveillance Dashboard.

Still, the speed of deaths in OC brought on by opiates is a small fraction of that observed in the California counties using the worst problem, including Plumas, Lake and Tuolumne counties. California ranks low nationwide for opioid abuse.

The California Department of Public Health intends to give Oc 6,200 doses of Naloxone, which could reverse an opioid overdose, included in a statewide intend to combat addiction. A nearby nonprofit will distribute the drug to at-risk individuals.  

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LA officials demand overhaul of system that takes care of seriously psychologically ill

La County officials are attempting to tackle an issue they are saying is hampering the region’s capability to serve its most seriously psychologically ill people: the company given the job of becoming their protector is chronically understaffed and it has trouble retaining employees. 

The L.A. County Board of Supervisors Tuesday dicated to pursue a change from the Office from the Public Protector by searching for methods to create lower caseloads, improve the caliber of services, and be sure individuals who be eligible for a public guardianship are becoming sufficient care.

The move may come as the county starts an enormous effort to deal with being homeless and cut the amount of people selecting jail due to untreated mental illness. 

“It is really an issue that should be addressed,” stated Supervisor Kathryn Barger. “Whenever you consider the quantity of destitute psychologically ill in the pub, we have to arrive at the real cause.Inch

That, she stated, means not just treating people when they are put on emergency mental health holds, but additionally ensuring they receive ongoing mental healthcare. 

“This really is one vehicle to achieve that,Inch she stated.

The kind of conservatorship at concern is restricted to individuals who’re “seriously disabled” because of mental illness and can’t, within the eyes of the court, take care of themselves. When such people have no willing family people for everyone his or her protector, the county’s Office from the Public Protector stages in to handle their matters, including their mental health treatment. 

Right now, work works as a conservator for just two,700 people. Because of staffing issues, deputies at work have 70-110 cases, based on the office of Supervisor Sheila Kuehl, who authored the overhaul motion.

“The caseloads are extremely, high,Inch stated Dr. Jonathan Sherin, director of mental health for L.A. County.

Area of the concern is that regardless of the complexity from the position, the task is recognized as entry-level, with relatively low pay. Staffers frequently proceed to greater level positions in other county departments rapidly, sometimes only lasting within the project for a couple of several weeks. 

While staffing is really a serious problem, Kuehl stated challenges exist at each stage from the conservator process, from ensuring the right individuals are known and approved for conservatorships, as to whether they are exiting this program too rapidly. 

Underneath the motion, which received unanimous support, mental medical officials, advocacy groups, and court officials will appear at just how the county can reform the conservatorship process, begin to track and measure outcomes in the program, and address staffing issues. 

A lot of conservatorship is controlled by condition law, however the county continues to have significant leeway in the way the program works, Kuehl stated. 

“It has been a fairly hidden issue,” Kuehl stated. “Hopefully this can shine a better light.”

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Covered California will alow insurers recoup 2018 losses later on years

The board that oversees Covered California will think about a plan Thursday to lure medical health insurance companies to help keep selling individual policies around the condition exchange even when they generate losses the coming year. 

Covered California is proposing that insurers who generate losses in 2018 around the exchange could be permitted to create bigger profits each one of the following 3 years to recuperate their losses.

The exchange suggests ongoing market uncertainty as the reason behind the net income proposal. Health insurers are waiting to find out if the Trump administration continuously fund subsidies which cover certain lower-earnings consumers’ out-of-pocket costs.

“It’s usually a hard process even just in a far more stable policy atmosphere where we are able to predict more readily what federal and condition healthcare policies will be,Inch says Zachary Courser, research director of the Dreier Roundtable at Claremont McKenna College.

The California Association of Health Plans didn’t immediately react to a request comment.

Medical health insurance companies set their rates according to the things they calculate it’ll cost you these to cover the price of their customers’ healthcare. Precisely what markets may be like can be difficult to calculate.

“Healthcare, obviously, is a sector which has were built with a greater inflation rate than all of those other economy,” states Courser.

Covered California is finalizing plans for 2018 now. The condition exchange announced a typical 12.five percent premium rate hike over the condition, presuming Obamacare remains unchanged in next season.

Because they get ready for the coming year, Courser states all condition exchanges finish up in a “difficult place.”

“They’ve to find away out to draw in enough insurers to make these exchanges work with consumers. And i believe to achieve that, they’re attempting to offer some path toward attract insurance firms to carry on to function underneath the exchanges,” he states.

Underneath the Covered California proposal, the condition would make reference to each insurer’s historic profit to find out whether it must raise rates that recoup 2018 losses and “maintain sufficient reserves.”

Underneath the plan, if the insurer comes with an unpredicted profit the coming year, the exchange would seek through negotiations “to subtract the unanticipated profits for that 2018 plan year from Contractor’s incomeInch within the subsequent 1 to 3 years. 

The California Department of Managed Healthcare and also the condition Department of Insurance possess the final say over contracts with medical health insurance firms.

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You can order STD tests online. Should you?

America is losing the battle against sexually transmitted infections. Cases of chlamydia, gonorrhea and syphilis all hit record-high numbers in 2015. Tens of thousands contract HIV every year in the U.S., and oral cancers caused by human papillomavirus are increasing.

So startups are popping up online to help serve what they see as unmet demand for STD testing. One advertises that you can “get a sexy deal” by ordering.

The question is whether those companies can survive — at least one left the market before its product even launched — and whether the services they offer get the right tests to the right people.

Although encouraging people to get tested is a simple enough public health message, that doesn’t mean it’s simple to carry out, says Kevin Ault, a professor of obstetrics and gynecology at the University of Kansas Medical Center in Kansas City, Kan.

“You have to make the appointment at the doctor’s office, drive to the doctor’s office, give the sample to the doctor, the doctor sends it to the lab, you wait for the results to come back, and then you wait for the doctor to call you,” Ault says. And the Centers for Disease Control and Prevention recommend that people in some at-risk groups do all that several times a year.

“The biggest advantage of home tests in general is if you catch HIV or chlamydia early on, you can change the natural course of the disease,” Ault says.

Few options exist to make the process easier. So far, there is just one test approved that gives rapid results in the home, and it’s for HIV. The startups are hoping that being able to collect samples at home will be enough to encourage people to get tested.

“The concept of providing the possibility of a self-sampling approach to test for STDs is really going to be our future in terms of diagnostic testing,” says Jennifer Smith, an associate professor of epidemiology at the University of North Carolina Gillings School of Global Public Health in Chapel Hill. Hill also consults for myLAB Box, one of companies offering these services. “Getting the actual test to the patient is going to be a way of not only increasing access and improving acceptability, but also cutting down on unnecessary medical visits,” Smith says.

Big increases in people infected with STDs

A sobering report from the CDC last October revealed just how much new approaches are needed to combat increasing infection rates. More than 1.5 million people contracted chlamydia in 2015, an increase of 5.9 percent from the year before. Similarly, gonorrhea cases jumped 12.8 percent to almost 400,000 cases. The nearly 24,000 new cases of primary and secondary syphilis (the two most infectious disease stages) represented a 19 percent increase.

Aside from early symptoms that several STDs can cause — such as painful urination, discharge, bleeding, swelling or pain — long-term symptoms in people who don’t receive treatment can be serious. Untreated gonorrhea, for example, can cause infertility and long-term pelvic or abdominal pain in men and women as well as ectopic pregnancies, which can be fatal. If syphilis is not treated, it can damage the brain, eyes and nervous system, potentially resulting in severe headaches, poor muscle coordination, paralysis, numbness, dementia or blindness. In rare cases, syphilis can cause death 10 to 30 years after infection.

STDs also have downstream consequences for the next generation. Cases of congenital syphilis, which can cause severe illness and stillbirth, has increased in newborns 38 percent from 2012 to 2014, according to the CDC, even though women don’t even represent 10 percent of new infections overall.

New HIV infections have been steadily dropping, but 2015 still saw more than 39,500 new cases. And although HPV, the most commonly transmitted STD, resolves on its own in most people, it still causes about 31,500 new cancers annually.

“When something affects millions of people, even a low rate of serious outcomes translates to a lot of people,” says H. Hunter Handsfield, a professor emeritus at the University of Washington who consults for the CDC on STDs and spent a quarter of a century directing the STD control program for Seattle’s public health department. “We have an ongoing and important public health problem of people getting HIV and getting cervical and other HPV-related cancers. The numbers of those actual cancers are small, but that’s a big deal for each of those people.”

Startups See An Opportunity

The idea of online STD testing isn’t new, but most services so far have been localized, limited in test options or still require visiting a lab or pharmacy.

For example, residents of Maryland, Washington, D.C., and Alaska can request kits to be mailed to them with self-collection instructions and materials for genital and/or rectal swabs, but only for gonorrhea, chlamydia and trichomoniasis. Planned Parenthood has begun offering similar services but only for gonorrhea and chlamydia and only in Idaho, Minnesota and Washington. More than a dozen commercial companies nationally let consumers order STD testing kits online for other infections, but buyers still have to visit a local lab for sample collection.

The online businesses aim to offer many more tests without customers needing to go anywhere except the mailbox. The two business models are subscription-based or one-off orders: Consumers order the test, receive it in the mail, collect their own blood, urine, genital and/or rectal samples, mail samples back in a prepaid envelope and then wait until results are available to check online.

One company, GetTested, still has a live website but has ceased operation, according to a spokesperson. Another, Mately, doesn’t appear operational and did not respond to multiple attempts to request an interview. That leaves myLAB box, which has been tweaking its services and procedures since its launch in December 2013 as executives learn what does and doesn’t work.

The CDC generally supports the idea of at-home STD testing, according to John Papp, a microbiologist in the CDC’s Division of STD Prevention and author of CDC’s lab testing recommendations for gonorrhea and chlamydia.

“From our perspective in public health, we want people to have access,” Papp says. “The concept of greater access, however that looks, if it’s by a website or a van down by the river, is always a good thing. But the regulatory piece needs to be adhered to.”

But little regulation exists for online, at-home STD testing. The labs where tests are performed should meet the standards of the Clinical Laboratory Improvement Amendments, and the tests themselves should be FDA-approved when available. The tests offered by myLAB Box meet both those requirements.

“There’s no FDA indication for at-home collection and sending it into a laboratory,” Papp says. “Having said that, if the specimen is collected properly, regardless of the setting, the test is probably being performed adequately.”

Most of the tests detect some piece of the organism itself. Three others, for hepatitis C, syphilis and herpes simplex type II, test for the body’s antibodies made in response to the infection. The HIV test looks for both the virus and antibodies. The tests have been shown to work even with samples exposed to extreme temperatures, so having a blood spot and urine sample sitting in a Florida mailbox in August shouldn’t affect results, Handsfield says.

Reaching the right people

But Handsfield says online tests don’t reach the people who need testing and treatment the most.

“It’s a good idea, with a giant caveat that it reaches the wrong people,” Handsfield says about online services. “The highest infection rates are in people with lesser education or lower income, in inner cities or the rural kid in a red state immersed in a methamphetamine world.”

He would like to see public health departments partner with online sites and subsidize the cost to promote home self-testing for a broader population of high-risk, lower-income people. The CDC’s October report, for example, showed that 15- to 24-year-olds make up half of gonorrhea cases and almost two-thirds of all chlamydia ones. “These are not the same people who are paying money to buy tests online,” Handsfield says.

MyLAB Box offers three pricing tiers: the “Safe Box” for $189 (HIV, chlamydia, gonorrhea and trichomoniasis); the “Uber Box” for $269 (adds hepatitis C, herpes simplex type II and syphilis); and the “Total Box” for $399 (adds HPV, Mycoplasma genitalium and ureaplasma plus rectal and throat testing for chlamydia and gonorrhea). Each test can also be purchased individually for $79.

But Gary Richwald, myLAB Box’s medical director and chief scientific officer, says the company is reaching the right people. He says their rates of positive tests are on par with or higher than what he saw when he ran STD clinics for Los Angeles County, the largest such program in the U.S., from 1989 to 2000. For example, 7.3 percent of myLAB Box clients’ tests for chlamydia were positive in February. Community rates at L.A. clinics two decades ago, where the population would presumably have been high risk, ranged from 4 percent to 5 percent, Richwald says, with family planning clinic rates lagging just behind that.

“The data show in every study that people who voluntarily go somewhere to be tested have higher rates than the general population who might be tested door to door,” Richwald says. And yet “the vast majority of people with STDs never get tested, and they are the principal source of new infections.”

Richwald describes the company’s customer base as people mostly in their mid- to late 20s, with many in their 30s and 40s as well, and often at a transitional stage in their life, such as having recently ended a relationship or gotten divorced. Economically, they seem to hover between lower middle class and middle upper class, he says. Customers include residents of areas with doctor shortages, where getting tested requires going to urgent care or the ER; single mothers without time to get to a clinic or doctor’s office; and individuals with previous unsatisfactory health care experiences.

They also tend to have three other characteristics: comfort and familiarity with using the Internet, a desire for convenience — “I can’t tell you how many people said they collected their specimen after midnight,” Richwald says — and concerns about privacy.

“With this election and general concerns about privacy in this country, people are afraid that even their request for a test, much less their positive, would end up in some place that collects health-related information,” Richwald says. A number of customers include those in the health care field themselves, he says, such as physicians, dentists and nurse practitioners.

Choosing the right tests

One big question is what to test for.

Public health clinics generally offer free testing of gonorrhea, chlamydia, syphilis and HIV, with some offering various additional tests, such as trichomoniasis, HPV or herpes type II. Few public health clinics test for ureaplasma, hepatitis C or Mycoplasma genitalium.

A person’s first instinct may be to test for “everything,” especially if they have a sexual history or recent sexual experience that could be a concern. But not everybody should be tested for every infection.

Hepatitis C, for example, is currently among the tests offered by myLAB Box, but it’s not considered a sexually transmitted disease for anyone other than men with HIV who have sex with men, Handsfield says. (All individuals born between 1945 and ’65 are recommended to be tested once for hepatitis C, however.) And men are not typically tested for HPV because no treatment exists for the infection, and it’s unclear what to do with a positive result.

MyLAB Box company co-founder Lora Ivanova says the company trusts the consumer to do the homework on what tests to order.

“Our role is to make it as easy as possible for the person who has decided to get tested to get the test they want,” Ivanova says. “For a long time, consumers have been limited to the tests they can take based on the medial debate. We’re taking the position that the consumers ultimately have the right to know. We don’t see why we as providers should limit their access to care.”

But if doctors and public health policymakers cannot agree on who should be tested for infections like Mycoplasma genitalium and ureaplasma, Handsfield says, then how would a consumer make that decision?

“The issue of who to test and what tests to do continues to be a question that’s very important but does not have an exact answer,” Richwald acknowledges. That’s partly why he was brought on, and Ivanova did say the company’s system “is in constant flux” based on “recommendations and available data.” The company doesn’t offer testing for herpes simplex type I, for example, because 60 percent to 70 percent of individuals already have antibodies, acquired non-sexually in childhood.

Richwald also says the company isn’t testing for ureaplasma anymore, but the test still appears on the company website. Mycoplasma genitalium presents a conundrum as well.

First, no FDA-approved diagnostic test for the bacteria exists. Experts disagree on how to interpret positive results, Handsfield says. It’s a common bacteria found in about 1 percent of the population, but most people don’t have symptoms. Treatment is challenging and not recommended for infections without symptoms. But for those with symptoms — vaginal pain or itching, discharge from the urethra, painful urination and painful or swelling joints — treatment can prevent pelvic inflammatory disease or worsening symptoms, Richwald says.

Another consideration people must weigh is when to test, because incubation periods vary by disease. If someone has been regularly sexually active, especially without using a condom, and has not been tested in the six months, timing is less relevant. But if someone is testing after a specific encounter, some infections, such as HIV, cannot be detected immediately.

“Often people get tested too soon, such as a week after exposure,” Handsfield says. Chlamydia and gonorrhea can usually be detected after several days (a week on the conservative side), but herpes and one HIV test require up to three months of delay before testing.

A chart on the myLAB Box site provides time frames for testing and, when necessary, retesting. It recommends that people wait until the end of the time frames listed before testing unless the person plans to retest. The ideal testing window for Mycoplasma genitalium, however, is unknown, Handsfield says.

“For the panel as a whole, I would say wait three months if you have no symptoms,” Handsfield says. “If you have symptoms — if you’re having urethral discharge, unexplained vaginal discharge, abdominal pain — online testing is not for you. You need to see a doctor.”

Handling positive tests, whether true or false positives, also requires careful consideration. The newest syphilis tests, for example, are known for giving a lot of false positives, Handsfield says, and that can lead to increased anxiety between a first test and a retest, although the same concern would exist at a community clinic. At myLAB Box, Richwald personally calls all customers with a positive HIV result and ensures they get an appointment with an HIV specialist group. Immediate treatment can dramatically reduce their infectiousness while improving their health, he says. A positive result for syphilis requires confirmation at a clinic in person, and someone with chlamydia and symptoms of pelvic pain, for example, would be told to go to a clinic or urgent care.

MyLAB Box regularly reviews new research to inform their decisions, but it remains a tricky line to walk: making tests widely available to the public while trying to guide them toward the best tests for their situation without driving them away.

“There’s a lot of fear, hesitation and confusion, and I think what it has ultimately done is turn people to the point where they’re sweeping it under the rug,” Ivanova says. “At the end of the day, it’s about getting the person to get tested. If we lose that one single time in a year or in two or five years that they have mustered the courage to get online and get the tests, they might spend the next five years infecting every partner they have.”


Tara Haelle is the co-author of The Informed Parent: A Science-Based Resource for Your Child’s First Four Years. She’s on Twitter: @tarahaelle

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

Did yogis learn about ‘mummy tummy’ exercise centuries ago?

“There’s not new on the planet except a brief history you don’t know.”

— Harry S. Truman

The 2009 week, NPR printed a tale about how exactly women can deal with their “mother pooch” — you realize, that soft belly many moms retain after getting an infant.

The story garnered countless comments and emails. Many readers wanted to understand more about the brand new exercise. And something sharp readers noticed that the exercise may not be as new once we think.

“Jogs my memory of Kapalabhati breathing exercises in yoga,” Hemakshi Adke, of Portland, Ore., authored within an email. “After I do them regularly, it will help.”

I was intrigued: Did yogis contain the answer to mother pooch centuries ago?

Yoga used to be a men's only club. But did it inspire an exercise that is helpful for women trying to combat Yoga was once a men’s only club. But made it happen inspire a workout that’s useful for ladies attempting to combat “mummy tummy”? Science & Society Picture Library/Getty Images

Let us begin with just a little yoga history.

Kapalabhati is really a technique described within the classic 15th-century yoga text Hatha Yoga Pradīpikā, says James Birch, a historian of the Haṭha Yoga project at SOAS London College. The word originates from two words in Sanskrit: kapala, meaning “skull,” and bhati, meaning “light.”

In those days, Kapalabhati had one major purpose: to obvious out congestion in the sinuses, lung area and throat, Birch states.

“It’ll reduce and sometimes alleviate excessive kapha dosha,” Birch states, “that is most likely phlegm.”

Reducing phlegm is not prone to assist with postpartum abdominal issues. However when you look carefully in the two exercises, they are doing possess some surprising similarities.

Let us perform a side-by-side comparison.

Within the mother pooch exercise — that is sometimes known as a drawing-in exercise — you breathe deeply after which suck your belly into the spine around the exhale. Then you definitely hold it. After that, you are taking small breaths, as well as on the exhale, you push the belly back further in to the spine. Then you definitely simply do this again and again, rhythmically.

In Kapalabhati, Birch states, the traditional text states the process is performed such as the bellows of blacksmith, with very rapid inhalation and exhalation.

Childcare provider Yecenia Rivas plays with children during a yoga session at at Rivas Family Child Care in Reseda. Childcare provider Yecenia Rivas plays with children throughout a yoga session at at Rivas Family Day Care in Reseda. Maya Sugarman/KPCC

Nowadays, there are many methods to perform the yoga breathing exercise. However in general, you normally inhale using your nose after which around the exhale, also using your nose, push your belly back to your spine.

“The correct answer is rapid and mild,Inch Birch states. “The inhalation is simply natural, and so the emphasis is around the exhalation. There is however no real tensing from the stomach muscles, a minimum of to not the level that you simply describe for that other exercise.”

So would Kapalabhati be useful for brand new moms?

This will depend how your body has retrieved following childbirth, says Catherine Allen,that has been training yoga teachers for 18 years.

“Kapalabhati pushes downward and puts pressure around the pelvic floor muscles,” Allen states. During sex are under lots of stress while pregnant and delivery. To allow them to be weakened and broken immediately following childbirth.

KPCC's Rebecca Plevin performs acro-yoga. KPCC’s Rebecca Plevin performs acro-yoga.

You need to make certain your pelvic floor is strengthened and retrieved prior to doing Kapalbhati, Allen states. “Otherwise, it might worsen.Inch

And So I guess ancient yogis did not be aware of secret to postpartum health in the end — that is really not very surprising since ancient yoga texts were compiled by men for males.

“They don’t ever point out that women were excluded from yoga,” Birch states. “But in those days, a lady would certainly need her husband’s or father’s support to rehearse yoga.”

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Teen pregnancy prevention enter in LAUSD and Compton fighting for survival after federal cuts

Recently, over 80 teen pregnancy prevention programs about the nation got word they’re facing a monetary high cliff. The government Office of Adolescent Health, supervised through the Trump Administration’s Department of Health insurance and Human Services, informed researchers and educators their grant funding is going to be cut short. For many, which means ending curriculum and knowledge gathering 2 yrs early.

Among the programs left reeling in the news serves students and fogeys in La and Compton Unified School Districts. It’s known as “Ensure That Is Stays Real Together.”

A co-director from the program became a member of A Martinez on Tuesday to go over.

Dr. Kristin Meyer may be the Director of Youth Prevention Programs using the L.A. County Department of Public Health division of Aids & STD programs.

Let me know about Ensure that is stays Real Together. You are dealing with USC to reduce the teenage pregnancy rate–That do you achieve? What is actually the curriculum like?

This is actually the second grant we have caused by work of Adolescent Health. The very first was an effectiveness based program where we required a junior high school program known as, “It’s My Game, Ensure That It Stays Real,” so we tested it among middle schoolers in L.A. County, across 24 middle schools. It had been discovered to be good at encouraging positive attitudes about delaying sex, abstinence, and condom use once they do become if perhaps you are. And since it was this type of effective grant, work of Adolescent Health awarded us another grant, referred to as a scale-up grant, that is what we should have at this time. We are likely to be in 45 middle schools this season, and 11 high schools. And we are wishing to achieve over 800 parents with this parent curriculum. 

Regrettably due to the funding atmosphere, this is the this past year from the program, it’s anticipated, though we’re working carefully with this partners at LAUSD and Compton USD along with other community partners to find away out toward sustain the progress that we have made in your area.

I am thinking about these workshops for moms and dads. I believe lots of parents available need to know, what is the best span of advice regarding how to speak with a child about reproductive health?

This is a type of question. Many parents aren’t comfortable speaking for their kids about these sensitive issues. But they’re one of the most influential individuals inside a child’s existence. We all know scientifically, when parents share their set goals for his or her kids, and share they wish these to have healthy adult lives, kids are more inclined to delay sex in order to safeguard their own health.

So our program is really a 2-3 hour workshop…in both Spanish and British, also it will get parents more acquainted with adolescence and human development but additionally starts the conversation together. What is a healthy relationship? Connecting using their kids. How to begin that conversation and the way to express their wants their children that they’ll safeguard their own health making smart decisions continuing to move forward.

Let me know concerning the letter you received recently? What made it happen say and who had been it from?

We yearly obtain a ‘Notice of Grant Award,’ usually at the beginning of the grant year, the start of This summer. It states the funding that i will be getting for your year. This information came around the fifth of This summer. It had been only a simple 2-3 sentence paragraph at the end from the first page stating our funding stating that this program could be ending by June 30th, 2018.

Have you have warning relating to this? 

There wasn’t any warning, it required us unexpectedly. We understood policies may be altering in Washington, but we didn’t look forward to finding this out with the Notice of Grant Award.

Does this sort of factor occur to grant programs a great deal whenever a new administration begins?

In my opinion it is really an unparalleled change. The us government continues to be funding 81 grantees across the nation, and a number of these are testing the effectiveness of curriculum in delaying [intercourse], but additionally scaling up what we should know to become evidence-based programs. And collecting data to exhibit the outcome of those programs. Our nation has invested huge amount of money during these initiatives, and also to cut them short by 2 yrs means we will not possess the data continuing to move forward. It truly cuts our nose off and away to spite our face.

What is the future seem like to keep it Real Together? And its these programs?

One benefit of employed in this profession is you are encircled by those who are very committed–very dedicated to the youth, towards the issues. Therefore we will work very difficult with this community partners and partners across the nation to check out sustainable routes forward.

We simply were built with a very promising ending up in our teacher advisory board a week ago, teachers from Compton Unified and from LAUSD, preparing methods to help the work move ahead. It is a challenging period but we are inside it for that lengthy haul. 

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