Catelynn Lowell, Tyler Baltierra Would Consider Adoption for '1 More' Child

Keeping their options open. Catelynn Lowell and Tyler Baltierra wouldn’t be opposed to expanding their family through adoption.

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“We have discussed it,” the 16 and Pregnant alum, 28, exclusively told Us Weekly while promoting season 9 of Teen Mom OG. “Yeah, if we weren’t able to have one more, sure, [we’d adopt]. Most definitely. But who knows at this time?”

Lowell went on to tell Us that she and her husband, 29, “do want to have one more child and that will be [their] last child.” She added, “It’s just up to the universe right now. Whatever happens, will happen, I guess, in its own time. I don’t know when that will be.”

Catelynn Lowell, Tyler Baltierra’s Best Quotes About Expanding Their Family

The Michigan native first gave birth to daughter Carly, now 11, in 2009 and placed her for adoption. The preteen is still in touch with the MTV personalities and has met their daughters, Novalee, 6, and Vaeda, 23 months.

In December 2020, Lowell revealed that she had suffered a miscarriage. “I WAS Pregnant and excited to share it with all of you and I am heartbroken to reveal that I lost the baby,” she wrote via Instagram at the time. “I am sharing this to let you know you are not alone. We are all in this together and everyone experiences pain, loss, and the recovery from it. [I’m] still in the thick of dealing with this loss as it was recent and all the emotional trauma that follows such a loss in an already horrifically hard year.”

The Conquering Chaos author previously miscarried in 2017 and exclusively told Us that a pregnancy loss is “always going to be in the back of” her mind when she sees a positive test.

“It’s like, ‘Well, maybe I shouldn’t get so excited,’” she explained. “But I’m also not going to let it hold me back from what I know I want eventually. Having children and watching siblings together is one of the most amazing things we’re able to watch as a parent. It’s one of the most beautiful things in life to have children and raise them. So yeah … it’s sad and I feel those emotions, but I’m not going to let it hold me back from something really beautiful in the long run.”

Rainbow Babies: Stars Who Had Children After Miscarriages

She advised other moms in the same situation to “really have a support system,” from a therapist to a group of friends.

Season 9 of Teen Mom OG premieres on MTV Tuesday, January 26, at 8 p.m. ET.

With reporting by Christina Garibaldi

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Global demand for cancer surgery set to grow by almost 5 million procedures within 20 years

cancer

Demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next twenty years, requiring a huge increase in the workforce including nearly 200,000 additional surgeons and 87,000 anaesthetists globally. With access to post-operative care strongly linked to lower mortality, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications.

The findings of the two studies, published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle income countries, while also scaling-up their workforces in order to cope with increasing demand. Until now, a lack of data examining outcomes of cancer surgery in different income settings, and an absence of evidence-based estimates of future demand, had limited efforts to improve cancer care globally.

Cancer is a leading cause of death and disability globally, and exerts substantial economic impacts, with recent evidence suggesting a disproportionate burden of disease in LMICs. With more than half of cancer patients predicted to require surgery at some stage, it is a pivotal component of multidisciplinary care globally and plays a key role in preventing deaths. A 2015 study estimated that US$6.2 trillion in global GDP could be lost by 2030 if surgical cancer systems are not improved.

While the new studies did not assess impacts of COVID-19, the authors acknowledge that the delivery of high-quality post-operative care is more challenging during the pandemic.

Increasing future demand

The Article in The Lancet Oncology journal is a modelling study of global demand for cancer surgery and estimated surgical and anaesthesia workforce requirements between 2018 and 2040.

Using best-practice guidelines, patient characteristics and cancer stage data, the authors calculated the proportion of newly diagnosed cancer cases requiring surgery in 183 countries. To predict future surgery demand, they applied these rates to GLOBACAN cancer incidence predictions from 2018 to 2040.

The team’s analysis estimates that the number of cancer cases requiring surgery globally each year will rise from 9.1 million to 13.8 million (52%, an increase of 4.7 million) from 2018 to 2040. The greatest relative increase will occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, 107%).

Current and future surgical and anaesthesia workforces needed for the optimal delivery of cancer surgery services were also predicted using staffing estimates based on optimal surgical use in high-income countries as a benchmark for global requirements. To evaluate staffing gaps, the optimal estimated workforce (median workforce of 44 high-income countries) was compared with numbers of surgeons and anaesthetists in each country.

The authors estimate there is currently a global shortage of 199,000 (56%) surgeons and 87,000 (51%) anaesthetists (current workforce of 766,000 surgeons and 372,000 anaesthetists, compared with 965,000 and 459,000 optimal workforce, respectively, estimated by the team’s model). The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model estimated optimal number of 28,000 surgeons. The current number of anaesthetists in low-income countries falls 11,000 below the model estimated demand of 13,000 anaesthetists.

In recognition of the rising global demand for cancer surgery, estimates were calculated for the optimal surgical and anaesthesia workforces needed in 2040. Extrapolating 2018 data, taking account of predicted future cancer incidence burden in each country, revealed that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.

The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anaesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).

However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (increase from 6,000 to 28,000), and anaesthetists by nearly 550% (increase from 2,000 to 13,000), of their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.

Dr. Sathira Perera, from the University of New South Wales, Australia, said: “Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.”

Estimates in the study relied on several assumptions. Predictions of future cancer rates were based on 2018 estimates, however, country-level changes—such as economic developments or altered capacity to screen for early diagnosis—could alter cancer incidence and therefore surgical demand and workforce requirements. Observed gaps in the workforce could also be narrower than the actual gaps in practice, as predictions were conservative because they only considered initial surgical encounters and did not account for any follow-up interactions.

Cancer surgery outcomes

The Article in The Lancet is an observational study exploring global variation in post-operative complications and deaths following surgery for three common cancers.

Deaths among gastric cancer patients were nearly four times higher in low/lower middle-income countries (33 deaths among 326 patients, 3.72 odds of death) than high-income countries (27 deaths among 702 patients).

Patients with colorectal cancer in low/lower middle-income countries were also more than four times more likely to die (63 deaths among 905 patients, 4.59 odds of death), compared with those in high-income countries (94 deaths among 4,142 patients). Those in upper middle-income countries were two times as likely to die (47 deaths among 1,102 patients, 2.06 odds of death) as patients in high-income countries.

No difference in 30-day mortality was seen following breast cancer surgery.

Similar rates of complications were observed in patients across all income groups, however those in low/lower middle-income countries were six times more likely to die within 30 days of a major complication (96 deaths among 133 patients, 6.15 odds of death), compared with patients in high-income countries (121 deaths among 693 patients). Patients in upper middle-countries were almost four times as likely to die (58 deaths among 151 patients, 3.89 odds of death) as those in high-income countries.

Patients in upper middle-income and low/lower middle-income countries tended to present with more advanced disease compared with those in high-income countries, however researchers found that cancer stage alone explained little of the variation in mortality or post-operative complications.

Between April 2018 and January 2019, researchers enrolled 15,958 patients from 428 hospitals in 82 countries undergoing surgery for breast, colorectal or gastric cancer. 57% of patients were from high-income countries (9,106 patients), with 17% from upper middle-income countries (2,721 patients), and 26% from low/lower middle-income countries (4,131 patients). 53% (8,406) of patients underwent surgery for breast cancer, 39% (6,215) for colorectal cancer, and 8% (1,337) for gastric cancer.

Assessing hospital facilities and practices across the different income groups revealed that hospitals in upper middle-income and low/lower middle-income countries were less likely to have post-operative care infrastructure (such as designated post-operative recovery areas and consistently available critical care facilities) and cancer care pathways (such as oncology services). Further analysis revealed that the absence of post-operative care infrastructure was associated with more deaths in low/lower middle-income countries (7 to 10 more deaths per 100 major complications) and upper middle-income countries (5 to 8 more deaths per 100 major complications).

Professor Ewen Harrison, of the University of Edinburgh, UK, said: “Our study is the first to provide in-depth data globally on complications and deaths in patients within 30 days of cancer surgery. The association between having post-operative care and lower mortality rates following major complications indicates a need to improve care systems to detect and intervene when complications occur. Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries.

“High quality all-round surgical care requires appropriate recovery and ward space, a sufficient number of well-trained staff, the use of early warning systems, and ready access to imaging, operating theatre space, and critical care facilities. While in this study it wasn’t possible to assess cancer patients’ full healthcare journey, we did identify several parts of the surgical health system, as well as patient-level risk factors, which could warrant further study and intervention.”

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Moderna vaccine batch that caused 10 allergic reactions cleared for use

COVID-19 vaccination delays ‘could have been helped by Amazon’ if they intervened sooner: Dr. Siegel

Dr. Marc Siegel calls the company’s delay in getting involved until Biden became president a ‘disgrace’ that appears to be politically motivated.

A batch of 330,000 doses of the Moderna COVID-19 vaccine that caused allergic reactions in at least 10 people has been cleared for continued use after health officials say they found “no scientific basis to continue the pause.” 

California’s Department of Public Health told providers to pause the distribution of the vaccine on Sunday evening, after some patients in San Diego reported after-effects of the vaccine including throat tightening and high blood pressure, indicative of a rare allergic reaction. 

COVID-19 VACCINES WON’T BE ‘IN EVERY PHARMACY’ BY LATE FEB., CDC DIRECTOR PREDICTS

“These findings should continue to give Californians confidence that vaccines are safe and effective, and that the systems put in place to ensure vaccine safety are rigorous and science-based,” California State Epidemiologist Dr. Erica Pan said.

Health officials said Wednesday that providers that halted the vaccinations could “immediately resume.” 

“These findings should continue to give Californians confidence that vaccines are safe and effective, and that the systems put in place to ensure vaccine safety are rigorous and science-based,” Pan said.

Doses from the lot originally on hold were dispersed among Tulare, Mariposa, Merced, and Kings counties. In Merced, 150 vaccines have already been administered, while 200 people in Kings County had already administered shots before the pause went into effect. 

WOMAN WILL GET MODERNA COVID-19 VACCINE SECOND DOSE DESPITE ALLERGIC REACTION TO FIRST

The release of the Moderna doses comes as California officials struggle to meet the challenge of vaccinating all those awaiting them, including millions of people 65 and older who recently were made eligible to receive the shot, after health care workers and people in nursing care homes.

At its peak, California receives about 400,000 to 500,000 doses a week but the rollout to administer the vaccine to patients has been slow and could take about four to five months for those 65 and older, Pan said during a state vaccine advisory committee meeting, according to the Sacramento Bee.

Large counties have been opening up more mass vaccination sites as they struggle with unprecedented demand. Officials are pinning hopes on President Biden’s promise to ramp up vaccination resources to get as many people vaccinated as soon as possible. 

With the all-clear for Moderna’s vaccine, San Francisco will be able to use 8,000 doses it had put on hold and no longer expects to run out of vaccine on Thursday as previously feared, the San Francisco Chronicle reported. Health officials had received fewer than 2,000 additional doses this week for city hospitals and community clinics.

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The Associated Press contributed to this report. 

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New trial finds arthritis drug tocilizumab no better than standard care for severe COVID-19

COVID-19, coronavirus

Adding the arthritis drug tocilizumab to standard care for patients in hospital with severe or critical COVID-19 is no better than standard care alone in improving clinical outcomes at 15 days, finds a new trial published by The BMJ today.

There was an increased number of deaths at 15 days in patients receiving tocilizumab, resulting in the trial being stopped early.

Today’s results contradict earlier observational studies suggesting a benefit of tocilizumab. However, observational effects are limited by a high risk that they may be due to other unknown (confounding) factors—and some studies have not yet been peer reviewed or published in a medical journal.

A randomised trial assessing tocilizumab in critically ill patients with COVID-19 (REMAP-CAP) published as a preprint earlier this month, found a beneficial effect of the drug on days free from organ support within 21 days and mortality. Reasons for these apparently contradictory effects, for example differences between patients’ characteristics, need to be assessed in future analysis, say the researchers.

Tocilizumab blocks a specific part of the immune system (interleukin 6) that can go into overdrive in some patients with COVID-19. Doctors think this might help lessen the body’s inflammatory response to the virus and avert some of the more dire consequences of the disease, but its effects are not well defined.

To test this theory, researchers based in Brazil conducted a randomised controlled trial comparing tocilizumab plus standard care with standard care alone in patients admitted to hospital with severe or critical COVID-19.

Their findings are based on 129 relatively young adults (average age 57 years) with confirmed COVID-19 at nine hospitals in Brazil between 8 May and 17 July 2020.

Patients were receiving supplemental oxygen or mechanical ventilation and had abnormal levels of at least two chemicals linked to inflammation in their blood.

Patients were randomly divided into two groups: 65 received tocilizumab plus standard care and 64 received standard care alone.

Other potentially important factors, such as underlying conditions and use of other medication, were taken into account and all patients were monitored for 15 days.

By day 15, 18 (28%) patients in the tocilizumab group and 13 (20%) in the standard care group were receiving mechanical ventilation or died.

Death at 15 days occurred in 11 (17%) patients in the tocilizumab group compared with 2 (3%) in the standard care group.

The increased number of deaths in the tocilizumab group raised safety concerns and the trial was stopped early. In both groups, deaths were attributed to COVID-19 related acute respiratory failure or multiple organ dysfunction.

The researchers point to some limitations including the small sample size, which affects the chances of detecting a true effect. However, results were consistent after adjusting for levels of respiratory support needed by patients at the start of the trial, suggesting that the findings withstand scrutiny.

As such, the researchers conclude that in patients with severe or critical COVID-19, “tocilizumab plus standard care was not superior to standard care alone in improving clinical status at 15 days and might increase mortality.”

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USPSTF affirms evidence-based methods for smoking cessation

USPSTF affirms evidence-based methods for smoking cessation

The U.S. Preventive Services Task Force (USPSTF) concludes that there is substantial net benefit for behavioral and pharmacological therapies for smoking cessation, alone or combined. These findings form the basis of a final recommendation statement published in the Jan. 19 issue of the Journal of the American Medical Association.

Carrie D. Patnode, Ph.D., M.P.H., from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a systematic review of tobacco cessation interventions for adults. The researchers found that compared with minimal support or placebo, combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83), nicotine replacement therapy (NRT; RR, 1.55), bupropion (RR, 1.64), varenicline (RR, 2.24), and behavioral interventions, including clinicians’ advice (RR, 1.76), were associated with increased quit rates at six months or longer. No serious adverse events were seen with any of the drugs. Inconsistent findings were seen for the effectiveness of electronic cigarettes on smoking cessation at six or 12 months compared with placebo or NRT. Behavioral interventions were associated with greater smoking cessation during late pregnancy compared with no intervention (RR, 1.35).

Based on these findings, the USPSTF concludes that behavioral interventions and pharmacotherapy have net benefit for tobacco smoking cessation—alone or in combination—for nonpregnant adults who smoke. The net benefit of behavioral interventions for tobacco smoking cessation in pregnant persons is substantial. The current evidence on use of e-cigarettes for tobacco smoking cessation is inadequate for assessing the balance of benefits and harms.

“The good news is there are multiple safe and proven ways to help adults quit tobacco, including counseling, medications, or a combination of both,” USPSTF member Michael Silverstein, M.D., M.P.H., said in a statement.

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Broadening horizons for people with quadriplegia

Broadening horizons for people with quadriplegia

A system that uses flexible, breathable magnetic skin allows people with severe quadriplegia to move around and choose their surroundings. Developed by KAUST researchers, the high-tech system relies on the user’s facial expressions to accomplish a wide variety of tasks, from moving down the street to using an elevator.

There are a wide variety of assistive technologies for people with quadriplegia, but most systems are not suitable for patients with severe quadriplegia as they often rely on head or neck movements to work. For these patients, the options are limited to camera, tongue control, voice-assistant and neural detector systems. But these either offer a limited range of gestures or are not compatible with outdoor applications. Some also require invasive attachments or continuous attention while using the system.

“Most existing technologies don’t give people a lot of freedom,” says Abdullah Almansouri, a Ph.D. student in KAUST. “We wanted to develop a solution that works inside the house as well as outdoors, allowing them to move around independently.”

The new integrated system includes magnetic skins, smart glasses, a smart wheelchair and smart gadgets that rely on wireless Bluetooth and infrared communication.

The three magnetic skins are placed between the eyebrows and on each side of the nose to track facial movements, such as moving the eyebrows up and down and the nose left and right. These movements are detected by magnetic field sensors in the smart glasses and are converted into electrical signals that are transmitted to the head unit of the wheelchair.

This unit processes these signals into wheelchair or smart gadget commands, such as turning the lights on or clicking the mouse on a computer. The system currently supports 13 distinct facial gestures.

“We were aiming for something easy and accessible but also that couldn’t be easily triggered by accident,” says Almansouri. “The system itself handles the complexity, so the user is only wearing the glasses and magnetic skin to control their surroundings.”

With his team, Almansouri tested the system on three able-bodied users with a high success rate. The participants took less than 15 minutes to learn how to use the system without assistance, with a worst-case success rate of 93 percent.

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Metformin use reduces risk of death for patients with COVID-19 and diabetes

metformin

Use of the diabetes drug metformin—before a diagnosis of COVID-19—is associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes, according to a racially diverse study at the University of Alabama at Birmingham. Diabetes is a significant comorbidity for COVID-19.

“This beneficial effect remained, even after correcting for age, sex, race, obesity, and hypertension or chronic kidney disease and heart failure,” said Anath Shalev, M.D., director of UAB’s Comprehensive Diabetes Center and leader of the study.

“Since similar results have now been obtained in different populations from around the world—including China, France and a UnitedHealthcare analysis—this suggests that the observed reduction in mortality risk associated with metformin use in subjects with Type 2 diabetes and COVID-19 might be generalizable,” Shalev said.

How metformin improves prognosis in the context of COVID-19 is not known, Shalev says. The UAB findings suggest that the mechanisms may go beyond any expected improvement in glycemic control or obesity, since neither body mass index, blood glucose nor hemoglobin A1C were lower in the metformin users who survived as compared to those who died.

“The mechanisms may involve metformin’s previously described anti-inflammatory and anti-thrombotic effects,” Shalev said.

The study—first made available in MedRxiv and now published in the peer-reviewed journal Frontiers in Endocrinology—included 25,326 patients tested for COVID-19 at the tertiary care UAB Hospital between Feb. 25 and June 22 of last year. Of the 604 patients found to be COVID-19-positive, 311 were African Americans.

The primary outcome in the study was mortality in COVID-19-positive subjects, and the potential association with subject characteristics or comorbidities was analyzed.

Researchers found that Blacks, who are only 26 percent of Alabama’s population, were 52 percent of those who tested positive for COVID-19, and only 30 percent of those who tested negative. In contrast, only 36 percent of the COVID-19-positive subjects were white, while whites made up 56 percent of those who tested negative, further underlining the racial disparity. Once COVID-19-positive though, no significant racial difference in mortality was observed.

“In our cohort,” Shalev said, “being African American appeared to be primarily a risk factor for contracting COVID-19, rather than for mortality. This suggests that any racial disparity observed is likely due to exposure risk and external socioeconomic factors, including access to proper health care.”

Overall mortality for COVID-19-positive patients was 11 percent. The study found that 93 percent of deaths occurred in subjects over the age of 50, and being male or having high blood pressure was associated with a significantly elevated risk of death. Diabetes was associated with a dramatic increase in mortality, with an odds ratio of 3.62. Overall, 67 percent of deaths in the study occurred in subjects with diabetes.

The researchers looked at the effects of diabetes treatment on adverse COVID-19 outcomes, focusing on insulin and metformin as the two most common medications for Type 2 diabetes. They found that prior insulin use did not affect mortality risk.

However, prior metformin use was a different matter. Metformin use significantly reduced the odds of dying, and the 11 percent mortality for metformin users was not only comparable to that of the general COVID-19-positive population, it was dramatically lower than the 23 percent mortality for diabetes patients not on metformin.

After controlling for other covariates, age, sex and metformin use emerged as independent factors affecting COVID-19-related mortality. Interestingly, even after controlling for all these other covariates, death was significantly less likely—with an odds ratio of 0.33—for Type 2 diabetes subjects taking metformin, compared with those who did not take metformin.

“These results suggest that, while diabetes is an independent risk factor for COVID-19-related mortality,” Shalev said, “this risk is dramatically reduced in subjects taking metformin—raising the possibility that metformin may provide a protective approach in this high-risk population.”

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New dietary guidelines for Americans

food

The Dietary Guidelines for Americans have been updated to include, for the first time, recommendations across the lifespan.

Dr. Donald Hensrud, director of the Mayo Clinic Healthy Living Program, says the dietary guidelines, which are updated every five years, are designed to give the best recommendations on what to eat and drink to promote health and prevent disease.

One of the changes for this edition of the guidelines is focused on a lifespan approach from infancy to older adulthood. “We’ve known for quite some time that for the first six months of an infant’s life, they should be fed exclusively human breast milk,” says Dr. Hensrud.

“Another addition that people may not be aware of is that when foods are introduced to an infant around the age of 4 to 6 months, peanut-containing foods can be added to the diet after checking with the infant’s health care provider. The evidence shows that by adding peanuts early in the diet, it may prevent allergies later on. Also, under the age of 2 years, no added sugars should be included in the diet of children. Added sugars do not provide any health benefit

Key recommendations from the guidelines include:

  • For about the first 6 months of life, exclusively feed infants human milk.
  • At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially allergenic foods along with other complementary foods.
  • From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight and reduce the risk of chronic disease.
  • Limit foods and beverages higher in added sugars, saturated fat and sodium, and limit alcoholic beverages.

Dr. Hensrud says that before the guidelines are released, a scientific report on dietary guidelines is published. The dietary guidelines are then derived from this scientific report.

“What many people who work in nutrition would have liked to have seen is a lower limit for added sugars and alcohol. This was included in the scientific report, but did not end up in the Dietary Guidelines,” says Dr. Hensrud.

“For example, the dietary guidelines recommend no more than 10% of calories as added sugars. But the scientific report recommended no more than 6%,” he says. “Similarly, previous guidelines recommended up to no more than an average of two drinks per day for men. The scientific report recommended lowering this to one drink a day on average for both men and women. The Dietary Guidelines still recommend up to two drinks a day for men.”

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U.S. tops 4,000 daily deaths from coronavirus for 1st time

coronavirus

The U.S. has topped 4,000 daily deaths from the coronavirus for the first time, breaking a record set just one day earlier, with the surge being driven in several Sun Belt states that experienced spikes over the summer.

The tally from Johns Hopkins University shows the U.S. had 4,085 deaths Thursday. The U.S. had nearly 275,000 new coronavirus cases on the same day.

The numbers are another reminder of the worsening situation following travel for holidays and family gatherings, along with more time indoors during the winter months.

Cases and deaths are soaring in California, Arizona, Texas and Florida. Those four states had a combined nearly 1,500 deaths and 80,000 cases on Thursday—figures that were comparable to nationwide totals in October.

Many hospitals in Los Angeles and other hard-hit areas are struggling to keep up and warned they may need to ration care as intensive care beds dwindle. Many nurses already stretched thin are now caring for more patients than typically allowed under state law after the state began issuing waivers that allow hospitals to temporarily bypass a strict nurse-to-patient ratio law.

The biggest fear is that hospitals will be tipped into rationing care in a few weeks when people who ignored social distancing rules to gather with friends and relatives for Christmas and New Year’s Eve start showing up for medical care.

In Los Angeles County at the Henry Mayo New Hall in Valencia, nurse Nerissa Black says her hospital is overwhelmed with patients, comparing the situation to New York at the beginning of the pandemic.

She has worked there for seven years and staffs the telemetry unit where she is assigned six patients. She essentially can spend 10 minutes with each of them per hour, which includes the time it takes for her to change her personal protective equipment and document and coordinate their care.

“It’s very hard to decide which one should I go see first: the patient who has chest pain or the patient whose oxygen level is dropping,” she said, speaking on a day when she where she wasn’t working after getting the second shot of the Pfizer vaccine.

At St. Joseph Hospital south of Los Angeles, nurses in the COVID-19 ward describe being overwhelmed as the death toll mounts.

“Just today we had two deaths on this unit. And that’s pretty much the norm,” said Caroline Brandenburger. “I usually see one to two every shift. Super sad.”

“They fight every day, and they struggle to breathe every day even with tons of oxygen. And then you just see them die,” Brandenburger said. “They just die.”

The outbreak has taken another turn for the worse in Arizona, with the state now leading the nation with the highest COVID-19 diagnosis rate over the past week. From Dec. 30 to Jan. 6, one in every 115 people was diagnosed with the virus.

More than 132,000 people nationwide are hospitalized with the virus.

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Teen vaping doubles risk for subsequent tobacco use

Teen vaping doubles risk for subsequent tobacco use

(HealthDay)—Adolescent boys who use electronic cigarettes have an increased risk for subsequently initiating traditional tobacco products, according to a study published online Dec. 8 in Addictive Behaviors.

Brittney Keller-Hamilton, M.P.H., from the Comprehensive Cancer Center at The Ohio State University in Columbus, and colleagues used a causal inference framework to identify whether male adolescent e-cigarette users were at increased risk for initiating cigarette smoking and smokeless tobacco (SLT) use compared with similar boys who had never used e-cigarettes. The analysis included 1,220 boys (aged 11 to 16 years at enrollment) followed every six months for two years.

The researchers found that compared with nonusers, e-cigarette users were more than twice as likely to later initiate both cigarette smoking (relative risk [RR], 2.71) and SLT (RR, 2.42). E-cigarette users were also more likely to become current (past 30 days) cigarette smokers (RR, 2.20) and SLT users (RR, 1.64).

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