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iStock/Thinkstock(SAN FRANCISCO) -- Phil Powell was more than 163 miles from the massive blaze burning in Northern California and about 350 miles from one ravaging the southern part of the state, yet he and scores of other people walking around San Francisco this week were wearing masks to protect their lungs from smoky conditions.

"I can feel it in my throat and a lot of people have said they've had headaches," Powell told ABC station KGO-TV in San Francisco, adding that he had plenty of N95 industrial masks left over from the fires that ravaged Northern Californa's Wine County in Napa and Sonoma counties in October 2017.

Cities throughout California that are far from the flames of the Woolsey Fire in the south and the Camp Fire in the north, the deadliest and most destructive in state history, are feeling the effects of the smoke, officials said.

On Wednesday morning, Health and Human Services Secretary Alex Azar declared a public health emergency in California due to the wildfires.

"We are working closely with state health authorities and monitoring the needs of healthcare facilities to provide whatever they may need to save lives and protect health," Azar said in a statement. "This declaration will help ensure that Americans who are threatened by these dangerous wildfires and who rely on Medicare, Medicaid, and the Children's Health Insurance Program have continuous access to the care they need."

Azar noted that at least two hospitals and eight healthcare facilities close to the fire zones have been forced to evacuate. Azar also warned that smoke from the fires can present "a significant health threat" for people with asthma and other lung conditions.

Numerous school districts, some nearly 200 miles from the Camp Fire, including those in Santa Rosa, canceled classes for again on Wednesday due to bad air and smoke conditions.

The University of California Davis, which is about 100 miles from the Camp Fire, also called off classes on Tuesday "due to poor air quality as a result of the Butte County fires." University officials, according to a statement, decided to resume classes on Wednesday but canceled all outdoor activities after consulting with health and fire experts monitoring air quality.

The school was also handing out protective masks to students and staff.

"Unfortunately, smoke from the fire continues to blanket all nine counties of the Bay Area, which is why we have called the mandatory Winter Spare the Air Alert through Friday," Jack Broadbent, executive officer of the Bay Area Air District, said in a statement referring to the advisory for people not to use their fireplaces and to carpool or take public transportation to cut down on air pollution.

"Any additional smoke from Bay Area chimneys could push the region into an even higher unhealthy air quality level, which puts us all in jeopardy," Broadbent said.

The Woosley and Camp fires both started on Thursday and quickly spread, destroying more than 7,000 home and burning more than 345 square miles of land combined. The larger fire, Camp Fire, caused 42 deaths and is now ranked and the deadliest and most destructive in state history.

AirNow.gov, a state website that charts air quality throughout California, showed numerous cities far from the fires experiencing unhealthy air quality.

According to the AirNow chart, good air quality is anything under a reading of 50, meaning air pollution is causing little effect. Moderate air quality is a reading of 50 to 100, while bad air quality is any measurement of 100 to 200 and anything higher is considered very unhealthy or hazardous.

Oakland, which is more than 160 miles from the Camp Fire, had a reading of 164 on Tuesday, while San Francisco had a reading of 167.

Oxnard in Ventura County, which is about 30 miles of the epicenter of Woolsey Fire, had the worst air in the state outside the fire zone Tuesday with a hazardous reading of 392 while Gridley, about 30 miles from the Camp Fire, had a reading hazardous reading of 250.

"I've lived in the Bay Area for over 35 years and except for the Oakland Hills fires and Napa fires, I can't remember consistent smoke like this," Troy Blanchard of Oakland told KGO.

On Monday and Tuesday, the Golden Gate Bridge in San Franciso was clouded in smoke. Over Sunday, fans attending the Oakland Raiders football game not only sported the home team's silver and black colors, many also donned protective masks.

"It feels eerie and worrisome and the sun looks really funny and the moon as well," Beth Gorelick of San Francisco told KGO. "I feel really bad for the people in Paradise."

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iStock/Thinkstock(NEW YORK) -- Officials are now investigating 252 cases of possible acute flaccid myelitis (AFM), including 90 confirmed cases in 27 states, according to the Centers for Disease Control and Prevention.

The number of cases under investigation by the CDC is up 33 from last week, and the number of confirmed cases rose by 10, Dr. Nancy Messonnier, the director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters Tuesday.

Acute flaccid myelitis is a condition that has polio-like symptoms such as partial paralysis. The virus mostly affects children and young adults.

The CDC said it does not know why the condition is impacting these individuals, but many believe it is caused by viruses. The CDC emphasized it remains a rare condition and said there have been no reported deaths from AFM so far in 2018.

The typical symptoms of AFM are similar to those of a severe respiratory illness, along with a fever, but then progress into neurological symptoms. Some patients with AFM feel weakness in their arms or legs, a loss of muscle tone or slower reflexes. Some patients may also exhibit facial droop or weakness, difficulty moving their eyes and drooping eyelids or difficulty with swallowing or slurred speech. The most severe symptom is respiratory failure.

Messonnier said the CDC doesn't yet have enough information to definitively say what causes AFM and are casting a wide net for information. Part of that is studying the long-term health of AFM patients. Scientists are also looking for a pathogen in AFM patients' spinal fluid, but haven't yet found a pathogen that's a clear cause, she said.

The CDC said it sees an uptick in AFM cases every two years, and so far, the curve of the cases being investigated this year looks very similar to that of 2014 and 2016. Officials don't expect many more cases in 2018 compared to 2016 and 2014, Messonnier said.

The best advice available is to wash your hands regularly, which lowers the chances of getting sick or spreading germs from many of the viruses linked to AFM, and protect against mosquito bites by using repellent, in addition to staying indoors at dusk and dawn.

The CDC said the vaccines your pediatrician suggests are very effective and children should continue to receive them on schedule even though there is no vaccine for AFM.

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iStock/Thinkstock(EL PASO, Texas) -- A woman who traveled to Mexico to receive plastic surgery suffered brain damage from the anesthesia used in the procedure, her family told ABC's El Paso, Texas affiliate KVIA-TV.

Dallas resident Laura Avila, 36, was supposed to go into surgery for a rhinoplasty on the morning of Oct. 30 in Juarez, Mexico, her sister, Angie Avila, told KVIA. But the surgery was pushed to noon because surgeons flying in from Guadalajara were running late, Angie Avila said.

Laura Avila's fiance, Enrique Cruz, was not permitted to see her when he returned to the facility around 4 p.m., although he'd been told the surgery would only take four hours, he told the station.

Once Cruz finally spoke to doctors, they told him that the director of a nearby hospital came in and saw her, saying, "We need an ambulance right away."

Her family later learned that she had suffered complications from the injection of anesthesia, Angie Avila said.

Although the anesthetic was injected into Laura Avila's spine, it traveled to her brain, and she suffered severe brain damage, Angie Avila said doctors told her. In addition, she suffered from a heart attack and deprivation of oxygen, Angie Avila said.

Laura Avila spent four days in a Mexican hospital before she was transferred to the University Medical Center in El Paso. Her condition has not improved much, her family said.

"She's been in a bed. She hasn't moved," Angie Avila said. "She's opened her eyes, and there have been small movements, but she has a glazed look in her eyes. Doctors don't believe she can see us. You know, she's physically here, but not mentally here."

Investigators for the Mexican state of Chihuahua have searched the facility where Laura Avila received the surgery, KVIA reported. Authorities are looking into whether medical negligence played a role in the complications she suffered.

Laura Avila's family is now juggling the difficult decision on whether to remove her from life support, as doctors said "there's really nothing else they can do for her," Angie Avila said.

"We cry every single day and I think, right now, we're just shocked and don't want to believe it's true, you know," Angie Avila said. "She is the person I love the most on this earth, she's a second mom to me."

Cruz, who has been with Laura Avila for more than 10 years, said the pair were "married by God."

"No matter what happens I want her to know I have a special place my heart (for her)," he said.

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Community Hospital North(INDIANAPOLIS) -- A pay it forward chain that began with two nurses in an Indianapolis neo-natal intensive care unit has allowed a mother of three battling breast cancer to feed her 10-month-old daughter breast milk.

The chain started when Katie Hanover, 29, a NICU nurse at Community Hospital North, gave birth last November nearly five weeks early.

Hanover’s daughter, Maggie, spent six days in the same NICU where she works.

Hanover’s coworker, Abby Black, who had her daughter Vivian just one month earlier, volunteered to donate her breast milk to Hanover.

"Just working in the NICU I’ve been educated on the importance and value of human breast milk," Black said. "It was something I had more than enough of, so it was an easy decision to make."

Once Hanover was able to breastfeed Maggie herself, she had a big enough supply that she too started donating her breast milk.

When a lactation consultant at the hospital told Hanover about Kata Carter, a mother who was facing breast cancer, Hanover jumped at the chance to donate her breast milk to Carter.

"I knew that feeling and knew I wanted to pay it forward," she said. "I was like, 'Absolutely. In a heartbeat.'"

Carter, 34, also of Indianapolis, was diagnosed in March with stage 3B inflammatory breast cancer, a rare subtype of the disease. She noticed a lump in one breast while breastfeeding her youngest daughter, Rosie, then just 3 months old.

"It was pure shock," she said of the diagnosis. "I had run through what seemed like every scenario of what [the lump] could have been in my mind and cancer was not one of them."

Carter said she was breastfeeding Rosie in her doctor’s office when she received the cancer diagnosis. She had to stop breastfeeding almost immediately and began the first of six rounds of chemotherapy just a week later.

"I got all of the information at once, the cancer, the type and that I had to stop breastfeeding," she recalled. "The thing that struck me immediately was the breastfeeding. I was devastated."

Carter, a dietitian, received support from a group of graduate school friends who knew how much she wanted to breastfeed Rosie. One of them, who lives out of the country, connected her to Hanover.

“We met in person the very first time she donated to me and she brought probably 600 or 800 ounces,” Carter said of Hanover. “Katie knew the feeling of not being able to breast feed her daughter so I think that connects us a lot.”

In the months since that first donation, Hanover has donated hundreds of more ounces of breast milk to Carter, including some from Black, her fellow NICU nurse.

Carter said the donations have been a "huge relief" as she has faced a mastectomy and radiation in addition to the six rounds of chemotherapy.

"They took that off my plate," Carter said of her concerns about not being able to breastfeed Rosie. "To take that worry away was enormous."

Hanover’s and Black's donations also started another chain reaction of breast milk donations to Carter from friends and strangers alike.

Carter estimates she has received thousands of ounces of donated breast milk over the past seven months. One group of friends got together to purchase and install a deep freezer in Carter’s home to store all of the milk.

“It’s not really anything I can express in words,” Carter said of her gratitude. “I know that if I were able to I would return the favor in a heartbeat. It’s one of the most precious gifts I’ve ever received.”

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iStock/ThinkstockBY: DR. JOHANNA KREAFLE

A recent study from the Nationwide Children’s Hospital in Columbus, Ohio shows that participation in the Make-A-Wish program may give children better quality of life and reduce hospital visits and healthcare costs.

Patients who received a wish were 2.5 times more likely to have fewer unplanned hospital admissions and 1.9 times more likely to have fewer unplanned emergency department visits compared to patients of similar age, gender, disease category, and disease complexity who would also quality for a wish but did not receive one.

What is the Make-A-Wish Foundation?

The Make-A-Wish Foundation is a non-profit organization whose goal is to provide children aged three to 17-years-old who have progressive, life-limiting, or life-threatening medical conditions, with experiences known as “wishes.” These wishes include “I wish to…” “go,” “be (someone for a day),” “meet,” and “have” (i.e. receive gifts.) The foundation is funded by contributions from individual donors, corporations, and other organizations.

What are the goals and mission of the Make-A-Wish Foundation?

The Make-A-Wish Foundation “serves a unique, and vital, role in helping strengthen and empower children battling illnesses.” And, “wishes make life better for kids with critical illnesses.”

How many “wishes” does the foundation grant?

The Make-A-Wish Foundation was founded in November 1980 and the first wish was granted in the spring of 1981 to Frank “Bopsy” Salazar, a 7-year-old who had leukemia. Bopsy had three wishes: to be a fireman, go to Disneyland, and ride in a hot air balloon -- all of which were granted to him. Since then, more than 285,000 children in the United States and its territories have benefited from experiencing their wishes. The foundation granted 15,300 wishes last year alone; which means on average, a wish is granted every 34 minutes.

There is a long-held belief that receiving a wish improves a child’s quality of life and potentially improves their family’s quality of life, enhances family bonding, reduces stress, increases hope and serves as a distraction from illness.

But recent research done at Nationwide Children’s Hospital shows it may do a lot more than that. This study showed that patients who received a wish were 2.5 times more likely to have fewer unplanned hospital admissions and 1.9 times more likely to have fewer unplanned emergency department visits compared to patients of similar age, gender, disease category, and disease complexity who would also quality for a wish but did not receive one. (The study's author, Dr. Anup Patel, is a member of the Medical Advisory Council for the non-profit Make-A-Wish Foundation. A list of all board members can be found here.)

And, a higher percentage of "wish kids" achieved a decrease in healthcare costs after their wish was granted, compared to those children who did not receive a wish over the same period of time -- this savings was even after the cost of the wish was factored in.

Johanna Kreafle, M.D. is an emergency medicine physician at the Carolinas Medical Center in Charlotte, North Carolina, and a member of the ABC News Medical Unit.

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iStock/Thinkstock(NEW YORK) -- It's happened to every parent on the planet at least once and perhaps many more times: your kid is in a stage 3, Defcon 1, the-wheels-have-completely-come-off meltdown.

They're screaming. You're sweating. You're looking for every. possible. way. to distract, distract, distract so they will calm. down.

It's not working. But what if you just . . . did nothing?

The Train Analogy


Katie McLaughlin, a blogger and mom of two, wrote about the train analogy in 2017 on her site Pick Any Two.

"The moment I published the post, the response was overwhelming," she told Good Morning America.

"I couldn't keep up with all the comments and shares. It obviously resonated with other parents who were struggling to help their children manage their big emotions."

It goes like this, according to McLaughlin: "Difficult feelings are tunnels, and we are trains traveling through them. We have to move all the way through the darkness to get to the -- you knew this was coming! -- calm, peaceful light at the end of the tunnel."

Now apply this to your child. That's what McLaughlin did when her four-year-old had temporarily lost his beloved tiger lovey blanket named Glenn. A broken heart and a full meltdown ensued.

"So often when our kids are struggling with a difficult feeling -- sadness, anger, fear, embarrassment, loneliness, guilt -- we try to logic them out of it," she wrote in her post. "We explain why they’re overreacting, or how WE know it will turn out just fine in the end."

"We’re trying to help our children, of course, but if we peel back the layers a bit, I think we’ll find that what we’re really doing is trying to make OURSELVES feel better," she said. "Because our children’s pain hurts US so deeply, makes US so acutely uncomfortable."

So instead of telling her son he would be fine, McLaughlin simply sat beside him and did nothing.

"I just sat next to him as the ripples of anger melted into shaking and sobbing," she wrote. "When I thought it was OK to do so, I started rubbing his back -- still without speaking. He kept crying and crying and crying. He cried and he cried and he cried."


"Until he wasn’t crying anymore."

"Until, from his vantage point -- splayed out on the floor -- he caught a glimpse of a nearby book about world-record-holding dogs, pulled it over, and started paging through it. As if nothing had happened at all."

"I peeked at the clock," she said. "It had been eight minutes."

"I decided speaking would be OK now, so I asked my son if he wanted to make a plan," she said. "I told him I knew that bedtime tonight would be extra tough, but maybe we could think of some ideas together to help him through it."

"Had I suggested such a thing two minutes prior, he would have EXPLODED," she said. "But because I waited until his train was through this tunnel, it was fine."

"Without any additional prompting from me, my 4-year-old chose two different stuffed animals to sleep with that night, then asked if we could read two extra books before bed to help make the evening more special," she said.

"Later, as I kissed him goodnight and he turned onto his side to fall asleep, he said peacefully, 'I’m going to be OK tonight.'”

Andrew D. Wittman, Ph.D., author of the book Seven Secrets of Resilience for Parents, told GMA that "because of how much we care about our child, we are tempted to immediately look for ways to solve their problem and shield them from any perceived suffering.

"This actually shields the child from learning how to process and deal with the situation," Wittman said. "We tend to fix the problem instead of teaching and coaching the child through the cognitive steps of finding a workable solution and learning how to channel his or her emotions in a productive direction."

He said the train analogy can be useful as a one-off, stop-gap measure and only as a short-term tactic.

That said, "it should not be utilized in a more public setting."

"Allowing your child to have a 'going through the tunnel' experience in the middle of the candy aisle at the grocery store is enabling, encouraging and rewarding the child to be controlled by their emotional reactions," he said.

McLaughlin told GMA that she has used the train analogy at home several times since the Glenn incident with great success.

"I've used it when my son was bawling over losing a soccer game. I've used it when my daughter was hysterical because her jacket zipper got stuck. Yes, our children need to learn how to handle these small disappointments and frustrations, but we also need to remember that in their world, these aren't small at all."

"So instead of telling them their emotions aren't valid or trying to logic them out of their tears, I choose to support and comfort them through the emotional tunnel. Nine times out of ten, it's only a few minutes before they're back on their feet," she said.

Wittman suggested the "first responder" technique as a long-term strategy.

"Teach the child how to perceive any situation in a way similar to a First Responder instead of an emotional reactor," he said. "Imagine a firefighter showing up to a house that is on fire and having to go through the tunnel before taking any life-saving actions."

Since McLaughlin first published her "train analogy" post, it's been shared more than 300,000 times on Facebook and almost 50,000 times on Pinterest.

"My recommendation to parents is to remember what your job is -- and what it isn't," she said.

"Your job is not to get your child to stop crying and be happy again as quickly as possible. Rather, your job is to provide comfort, show empathy, and be there with your child as they travel through the tunnel of their emotions. They will make it to the other side!"

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iStock/Thinkstock(NEW YORK) -- A group of physicians at Johns Hopkins Medicine and the American Heart Association have released updated guidelines on managing cholesterol to minimize the risk of heart attack, stroke, and death.

The new guidelines advocate for more aggressive treatment with statin therapy and getting LDL cholesterol counts, commonly referred to as “bad cholesterol” to your target level –- in general, less than 100mg/dL; for those with risk factors, less than 70mg/dL.

What is cholesterol?

Cholesterol is a type of fat found in blood and cells. It travels in bundles called lipoproteins. Cholesterol itself isn’t bad -- the body needs it to make hormones, vitamin D and digestive fluids, and it helps organs function properly. But having too much cholesterol can be a problem.

There are two forms of cholesterol:

- LDL (low-density lipoprotein): “bad,” unhealthy cholesterol. It builds up in arteries forming plaques, which can block the flow of oxygen-carrying blood to major organs including the heart, and has been shown to be associated with cardiovascular events including heart attacks and stroke. LDL levels are influenced by the food you eat, genetics, liver function and other factors.

- HDL (high-density lipoprotein): “good,” healthy cholesterol. It takes extra cholesterol out of arteries and delivers it to the liver, removing it from the body.

How do I know if I need to lower my cholesterol?

There are three tests to talk about with your doctor:

- Non-fasting blood test to measure LDL cholesterol

- Coronary artery calcium score

- Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator -- an equation to calculate the 10-year future risk of a heart attack

Based on these tests, your doctor will decide if you should be on a statin.

What can I do to lower my cholesterol?

Lifestyle changes including exercise, a healthy diet, and quitting smoking can prevent 80 percent of heart disease, the leading cause of death in the U.S.

Diet has been shown to be vitally important and effective in preventing heart attacks and reducing the risk of subsequent cardiovascular events in those who have already had a heart attack. Plant-based and Mediterranean diets are effective but you must find a diet that works for you.

However, lifestyle changes may not be enough; you may need to take a statin to lower your LDL further.

What are statins?

Statins prevent heart attacks by lowering LDL and reducing inflammation, among other mechanisms. They can be used to prevent a heart attack or stroke before it occurs, or prevent a second heart attack or stroke.

What are the side effects of statins?

The risk of serious side effects range from one in 500 to one in 1,000, which is considered very low. Muscle aches are a possible side effect, but are not considered serious. An increase in the dose of statins is not associated with an increase in side effects.

What is the bottom line of the new recommendations?

Talk to your doctor about what LDL level is right for you, and use the highest dose of statin tolerated to get to that target LDL level. And, as always, continue with lifestyle modifications, including exercise, a healthy diet, and quitting smoking.

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iStock/Thinkstock(NEW YORK) -- The U.S. government has issued the first new guidelines on physical fitness since 2008 with the message that Americans need to move more, especially kids.

Just one in five teens meet the recommendation of at least 60 minutes of activity each day, according to the Department of Health and Human Services.

For the first time, the new Physical Activity Guidelines included recommendations for kids ages 3 to 5. Preschool-aged children should be "active throughout the day to enhance growth and development," the guidelines say.

More specifically, children this age should be engaged in active play for at least 3 hours per day.

Kids between ages 6 and 17 saw no changes in the new guidelines. They continue to need at least 60 minutes of moderate-to-vigorous activity each day.

Three days a week, activity for kids and teenagers should include muscle-strengthening activity like climbing or swinging on monkey bars. Another three days should include bone-strengthening activity like running and jumping, according to the guidelines.

Adults continue to need at least 150 minutes per week of moderate-intensity aerobic activity and two days a week of muscle-strengthening activity like pushups, yoga and lifting weights, according to the guidelines.

Just 26 percent of men and 19 percent of women currently meet those requirements, according to HHS.

One key change is that aerobic activity no longer has to be done in blocks of at least 10 minutes to count towards meeting the guideline. Shorter bursts of activity are now promoted in the guidelines as a good way to get benefits like reduced anxiety and blood pressure, improved quality of sleep and improved insulin sensitivity.

Another key guideline for adults is to move more and sit less, according to HHS. Try yoga moves like these at your desk or get an energy boost by incorporating relaxation into your work day.

How to get active as a family

Since both kids and adults need to move more, according to the government's findings, families can find ways to be active together.

The Powells appeared on “Good Morning America” earlier this year to share how they found success in making exercise fun for the whole family.

Here are their four tips to try.

1. Start early

The Powells said they let their kids play around them, as infants, while they were working out. Between sets, the couple would play with the kids to make the connection between exercise and fun.

The result, they say, is that seeing mom and dad workout every day has become the kids' normal.

"It's so important to teach kids the importance of keeping their bodies moving," Chris Powell said. "And if they see it from when they're young, it will become their norm."

2. Turn it into a game

A deck of cards can turn into a family workout, an exercise game the Powell family has played for years.

An exercise is assigned to each suit in the deck of cards. The number on the cards dictates the number of reps of that exercise to be done.

Royal cards, aces, and jokers equal 10 repetitions of the exercise.

Here are five kid-friendly exercises to try for this game, as described by Chris Powell.

Bear walk: Bend your knees and crawl like a bear. Do this by simply moving your left paw (hand) and right foot forward at the same time and then switch sides. My kids love this, and it’s great for their shoulder and posterior chain.

Froggy squat: Squat down, fingertips on the ground between your legs for support. Leap up high in the air and tell your kids to try touching the clouds.

Dive bomber: Start in downward dog yoga pose. In a single motion, bend your elbows while lowering your chest, then stomach, to the ground... then push them forward and up while arching your back—like Ariel sitting on her rock. Return to downward dog.

Star jack: This one is fun, because who doesn’t want to be a star?! It’s like a jumping jack, only instead of hopping feet out to the side, jump straight up while spreading apart legs and arms in midair.

Superman: Help your little ones find their inner superhero with this one. Lie on your belly with your arms stretched out in front. Arch your back, lifting your chest, arms and legs off of the ground as though you’re wearing a cape and flying. Hold briefly and return to starting position

3. Create an obstacle course

The Powells' 7-year-old son, Cash, loves ninjas, so they created obstacle courses that they call ninja courses.

"It's great because the kids can race against each other and you can find a lot of the stuff [in the course] doesn't require any new equipment or can be done using stuff around the house," said Heidi Powell.

Some examples of stops on an obstacle course can include fast feet through an agility ladder or tape placed on the ground and a ball toss, just throwing a tennis ball into a bucket from 10-feet away.

"We mix and match balance, agility, accuracy and coordination movements with strength and endurance moves to keep it fun and get them comfortable with the feeling of exercise," explained Chris Powell. "[The kids are] totally distracted by racing against the clock."

4. Control screen time

If your child is a fan of video games, try having them mimic the movements in the video game so they are active while they're playing.

The Powells encourage their kids, for example, to do the dances in Fortnite, a popular video game, while they play.

They always reward their kids' activity with screen time.

"We have them do things like squats, push ups and sit ups and reward them with 30 minutes of screen time when they're done," Chris Powell said.

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iStock/Thinkstock(ATLANTA) -- The vast majority of violent crimes in sampled areas of metro Atlanta go unreported to police, according to a new study by Grady Memorial Hospital and the Centers for Disease Control (CDC) that was published in the peer-reviewed journal, JAMA Internal Medicine.

Unlike most medical research, this study has origins in the local police department. Years ago, DeKalb County Police Sergeant David Fraser’s department was on the hunt for a cat burglar prowling neighborhoods in the county. With about eight burglaries, the case became a priority, so the department set up a community meeting. "When we walked away from that meeting, we had 15 more incidents we were never aware of," Fraser recalled.

It’s a fact of life in law enforcement: for a wide array of reasons, an estimated 52.6 percent of violent crime-related injuries go unreported, according to the Department of Justice.

"You’re talking about a burglar that breaks into your house while you’re at home asleep!" Fraser added. "Some people think 'well I just don’t want to bother the police.' I don’t know what they think."

Fraser said such episodes are indelible in the minds of his police colleagues. Police departments can only hold so many community meetings, and even then departments can’t expect some of the people most vulnerable to crime, or most wary of police, to show up and speak out. When Fraser learned about an innovative new policing technique in the United Kingdom approaching the problem of unreported crime from an entirely new angle, he reached out to the federal agency headquartered in his own county, the CDC, to see if he could bring it here.

Emergency Rooms are a window into violent altercations in communities that law enforcement never learn about. Medical professionals treating the wounded have a duty to keep identifiable personal information private; unless the incident is legally mandated as reportable (involving firearms, or domestic violence) that rich trove of data is lost. Cardiff, Wales based surgeon Jonathan Shepherd realized hospital staff could ask patients about where and when incidents occurred, helping create anonymized spatiotemporal crime maps.

Finding far more crimes than Cardiff police knew about, they say these hospital-generated maps of violent incidents richly enhanced police and community understanding of crime by making trends much clearer. Cardiff's community board quickly realized how frequently intoxicated men threw or swung glass containers, so they asked bars to swap glass out for plastic. When they found many men were ending up in fights after bumping into each other on packed sidewalks, Cardiff opened up more streets to foot traffic.

After four years working with hospital-augmented crime maps this way, Cardiff reduced violent altercations causing wounds by 42 percent compared to similar U.K. cities.

Sgt. Fraser and his DeKalb colleagues met with London police and learned about how these hospital-police-community partnerships, termed the "Cardiff Model," became standard nationwide. With funding from the Robert Wood Johnson Foundation, a partnership was formed between the CDC, Grady Hospital and DeKalb County police to pilot a version here, called the United States Injury Prevention Partnership. While also underway in Philadelphia, Atlanta is the first to publish data, and the numbers are eye-opening.

The data revealed that 83.2 percent of injury-causing crimes went unreported to police in one Atlanta jurisdiction, and 93.1 percent in another, numbers far higher than the Department of Justice’s official estimates.

DeKalb County police consider this new data source a win-win scenario.

"We're getting this extra data, but because it's anonymized and there are no identifiers, it doesn't count against us for Uniform Crime Reporting and it doesn't add to our workload significantly... this is like icing on top of the cake," Fraser said.

"The secret sauce of this is not the hospital, it’s not the police department, it’s the community," said Grady ER physician Dr. Daniel Wu, who co-authored the study and noted that it gives the community invaluable insight about where to direct its attention.

The partnership hopes to see similar initiatives expand nationwide.

 

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iStock/Thinkstock(NEW YORK) -- Nearly every piece of advice these days for finding happiness includes something about gratitude, including everything from saying three things you're thankful for each day to keeping a gratitude journal.

The advice is sound -- research shows gratitude makes us happier, healthier people -- but actually practicing gratitude is the bigger hurdle.

The good news, experts say, is there are easy ways to improve.

"We used to think you inherit optimism and pessimism, so some people will be better than others at gratitude," explained Shawn Achor, author of The Happiness Advantage and a positive psychology expert. "But we now know you can train your brain to see more positives in the same way you train your body to swing a golf club."

With Thanksgiving quickly approaching, there is no better time than now to make gratitude a part of your daily life.

Starting to train your gratitude muscle now means that at Thanksgiving, you'll be able to look past the burned turkey or the negative family member to see the moments that bring you joy, Achor explained.

Here are the why's and how's of practicing gratitude, just in time for the holidays.

How can gratitude help me?

Gratitude is the brain’s ability to find meaning in whatever environment you find yourself, Achor said.

To make gratitude a habit, it helps to understand what a positive impact it can have on your well-being.

"Your life is what you focus on, so focusing on gratitude means living with a grateful heart," said Rachel Hollis, author of the New York Times best-seller Girl, Wash Your Face. "It's about being intentional with your time and your thoughts so you can focus in on the blessings in your life."

Practicing gratitude can reduce stress, reduce depression, reduce symptoms of physical illness and just make you an all-around happier person, research shows.

"Gratitude deepens your connection to others and strengthens your relationships," said Gabrielle Bernstein, bestselling author of The Universe Has Your Back. "When you embrace an energy of gratitude, people will want to spend more time with you and support you."

Does it matter what I'm grateful for?

The short answer, according to experts, is yes.

"Most people believe that they are very grateful, but then can only think of the obvious things, like, 'I’m grateful for this family member or my job,'" Achor said. "But what really makes someone grateful, in my research, is the ability to scan for multiple, varied and non-obvious things, even in the midst of stress or change."

In other words, practicing real gratitude takes digging a bit below the surface.

Instead of saying you are grateful for your job or your son, think of why you are grateful for your job and why you are grateful for your son.

"It's not what you're grateful for that matters, it's why," Achor said.

So how do I practice gratitude?

Be intentional about noticing what you are grateful for all around you as you move through the day, experts say.

To make it even more powerful, take time each day to write down the things for which you are grateful.

Write your list in the morning or the evening, or both. Both have benefits, according to experts, but the more important thing is that you write it.

If you struggle to find what you're grateful for, try these tips:


Focus on little moments: "I tell people to look for little moments: a great cup of coffee, your 5-year-old telling you a joke, someone letting you into rush hour traffic on the freeway," said Hollis. "It helps you to appreciate today."

Think of gratitude like you think of a noun: "Focus on a person you’re really appreciative of today, like your partner or your parent," recommends Hollis. "Then focus on a place -- your favorite chair or your cozy bed. Imagine yourself there. See it in detail. Lastly, focus on a thing, like your favorite sweater."

Send a note to a family member, friend or colleague: Bernstein recommends using the Thanksgiving season to write a letter to a family member or a friend to let them know why you're grateful for them. On a daily basis, sending just a quick email of thanks and appreciation each day to someone will have a positive impact on you, not to mention the recipient.
How do I include my family?

Including friends and family members in your gratitude practice not only makes it more fun, but more effective, Achor said.

Here are his three tips, in his own words:


1. Create a gratitude jar that you have everyone in your family add one or two things that they are grateful for from over the past year. Then read them as a family, and remind them again of them at New Year's.

2. Create a digital photo album of the past year showing all the things you have to be grateful for. Then watch it as a family.

3. Do something collaborative with family, even putting together a puzzle or a game of touch football or your own Macy's parade with your kids with balloon blimps.

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iStock/Thinkstock(NEW YORK) -- For many people, Thanksgiving is a holiday full of mashed potatoes, cheesy casseroles and decadent desserts. But while these foods may seem like a hard pass for followers of the popular Whole30 and ketogenic diets, they don't have to be.

"Thanksgiving is very much a traditional holiday, so it's about creating a keto or Whole30 version of a traditional recipe," said London Brazil, who shares recipes on her blog, Evolving Table. "It's putting new twists on the old favorites."

The ketogenic diet, aka keto diet, promotes a low-carb, high-fat regimen. The Whole30 diet, based on a bestselling book, strips food groups like sugar, grains, dairy and legumes from participants' diets for a full 30 days.

To meet those requirements, keto and Whole30 followers can look to Pinterest, where delicious, compliant Thanksgiving recipes abound.

(MORE: Whole30 Challenge Confessions: Why I decided to give up all my favorite foods and hop on the trend)

Brazil, whose recipes are featured on Pinterest, said the key to making Whole30 and keto-friendly dishes that you and your guests will want back on the Thanksgiving table next year is the use of spices and herbs.

"A lot of times, and with Whole30 in particular, you think you need sugar or some kind of artificial sweetener, but really you need spices or just the right balance of fat, salt and acidity," she said. "And a little bit of fresh rosemary, thyme or sage adds so much flavor to a dish."

(MORE: Inspiring grocery store coworkers lose over 200 pounds on keto diet)

Searches on Pinterest for “keto thanksgiving recipes” are up 175 percent and 120 percent for “Whole30 thanksgiving recipes” compared to last year, the company told “Good Morning America.”

Here are the keto Thanksgiving recipes trending on Pinterest right now:


Roasted garlic mashed cauliflower


Bacon-and-butter-wrapped asparagus


Low-carb biscuits with almond flour

Creamed spinach

Pumpkin spice fat bombs

And here are the Whole30 Thanksgiving recipes trending on Pinterest right now:


Sweet potato unstuffing

Sausage-and-cranberry-stuffed mushrooms


Dairy-free mashed potatoes

Whole30 sausage gravy

Pumpkin pie chia pudding


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Angelica Caye Kuhn(NEW YORK) -- Angelica Caye Kuhn was on the road to becoming a nurse.

The mother of two was working as a patient care technician nearly two decades ago when one day she heard a pop in her back.

She was in pain for days and, after several tests, she was diagnosed with Spina Bifida, a spinal cord defect common in children of male Vietnam veterans who were exposed to Agent Orange. The daughter of a combat Vietnam veteran who served in 1969 until 1970 in areas that were the most heavily sprayed with Agent Orange, Kuhn said most of her life she struggled with neurogenic stomach and bowel issues that were often misdiagnosed.

Her father years later would later be diagnosed with several heart conditions and diabetes all related to Agent Orange exposure.

Kuhn eventually received her nursing license and went back to work, but her career was short-lived. Since then, she has had 28 different surgeries and is now legally disabled.

"I am a hostage and a prisoner," she wrote in an email to ABC News. "Imprisoned by my handicap. All because of a KNOWN toxic chemical that was dumped on my unsuspecting father and millions of other unsuspecting members of our military, who have/are paying with their lives and the lives of their children!!!"

More than 40 years after the end of the Vietnam War, children of the men and women who served say they are battling a new war for benefits as they grapple with the impact of toxic exposure which has wreaked havoc on their lives.

Agent Orange is a term that is used to describe a series of odorless herbicides that were used by the military to defoliate hiding places, fields and rice paddies that were used by the Viet Cong for survival.

Almost 20 million gallons of Agent Orange was sprayed in Vietnam, according to the Department of Veterans Affairs.

The chemical was also used at several U.S. military posts in America, Southeast Asia, and Canada, according to the agency.

Earlier this year, the agency recognized publicly for the first time that some service members were exposed to dioxin because C-123’s that were used to spray the Agent Orange was still being used by the Air Force and Air Force reserves in the U.S. until 1986.

Five years after the C-123’s were taken out of service, "The Agent Orange Act" passed in Congress allowing returning men and women to receive medical compensation for their illnesses.

The VA declared specific conditions ranging from diabetes to cancer, directly tied to presumptive exposure to Agent Orange and dioxin.

The VA recognized over a dozen medical conditions for children of women who served in of Vietnam. However, for the children of the men who served in Vietnam, only Spina Bifida is recognized as being directly connected to Agent Orange exposure.

The VA did not respond to ABC News' multiple requests for comment.

In 2017, Rep. Barbara Lee, D-Calif., introduced legislation in Congress to allow the VA to recognize more medical conditions from children and grandchildren of male veterans. The bill is still being considered but hasn’t gone to a vote.

 The Vietnam Veterans of America, a nonprofit, has been advocating for decades for the government to assist veterans with issues as it relates to Agent Orange and has held over 300 town halls on the issue.

Their project Faces of Agent Orange focuses on children and grandchildren of both male and female veterans with filing claims with the VA.

The group says they are attempting to help the government have an accurate database on the long-term effects of the chemical exposure.

“You can't review science that doesn't exist and nobody was funding the science on the children the grandchildren,” said Mokie Porter, the communications director for the Vietnam Veterans of America.

On Wednesday, the U.S. announced that it had completed a clean up the dioxin saturated soil the area surrounding Da Nang Airport, an area heavily sprayed with Agent Orange according to Vietnamese and American officials.

And in October, Secretary of Defense Jim Mattis traveled to Vietnam to visit Bien Hoa Air Base a spot that is undergoing a $390 million soil restoration project headed by U.S. Agency for International Development.

The Vietnamese claim that 4 million people were exposed to Agent Orange and 3 million of its people suffer from medical conditions that were caused by the exposure from the Vietnam War.

Despite the efforts to decontaminate the soil, the U.S. vehemently denies that the number of Agent Orange illnesses are that high, which according to the Vietnamese includes children of men and women who were exposed to the dioxin following the war.

Betty Mekdeci, the executive director of Birth Defect Research for Children, a Florida-based non-profit says she’s collected data since 1986 on birth defects from toxic exposure. Because more men served in Vietnam, Mekdeci says she has received more data specifically showing birth defects in the descendants of male veterans.

Her organization has collected data from nearly 10,000 veterans, 2,000 children of Vietnam veterans and 300 grandchildren of veterans. Many of the medical conditions she’s seen in grandchildren of veterans aren’t physical.

Mekdeci says she’s seen issues with ovaries, endocrine, learning and attention deficit disorders and cancer.

“We don't have ten years to look at these things. These kids are having problems right now and we need to get on it right now not ten years from now.” She says that the scientific community should focus on assisting children of veterans instead of studying them.

Kuhn, who is an administrator of a Facebook group for second and third generation children with Agent Orange exposure, says many of her fellow members are suffering from rare medical conditions “it’s happening to us in droves.”

“It’s always things that aren’t normal," she said. With my condition, the doctor will tell you that it is something so rare that you hardly see it.”

Kuhn said she applied for VA benefits in 2000 and was granted only partial benefits. She appealed the VA’s decision saying that she met the criteria and was legally disabled.

Kuhn says after a call to the Denver VA office of Spina Bifida, a VA employee asked if she was able to feed herself. Kuhn says after replied, yes, she says the VA employee said since she could feed herself, she didn’t need any additional help from them.

Kuhn says she has appealed the VA’s ruling and has successfully won twice but has been denied seven years of back pay.

Kuhn said she often relies on wheelchairs and canes to move around and because her husband works to support her family she is often alone at home.

She says the VA has denied her request pay for a stair lift so she can be mobile in their two-story home and has denied her request for hand controls so she can drive her car. Kuhn says that although she is entitled to VA social worker due to her condition, she has yet to receive one and currently doesn’t have a home health aid despite numerous requests.

Kuhn’s family members say they have also suffered medical problems.

Her mother developed a rare blood condition and was diagnosed with a toxic liver. And Kuhn's daughter suffers from a connective tissue disorder.

Under the VA guidelines, Kuhn’s daughter would not be covered for VA benefits because her grandfather was a male veteran who served in Vietnam.

Dr. Kenneth Ramos, the chairman of 2014 Congressionally mandated report by the National Academies of Sciences, Engineering, and Medicine on Veterans and Agent Orange, says that the majority of the studies done by the scientific community regarding agent orange has been focused on women and not men.

Ramos says that changes in technology will help answer questions on transgenerational inheritance. But it won’t answer all of the questions right away.

“The biggest challenge that you face with current generational inheritance is the length of time that it takes for you to see the facts,” he said in order to fully study the impact on future generations research would have to be started from scratch.

Dr. Michael Skinner, with Washington State University’s Center for Reproductive biology, has studied the transgenerational health effects of dioxin exposure using animals and says women who served in Vietnam and was exposed to Agent Orange could have passed the dioxin to children for at least 15 to 20 years after they returned home.

“The problem with dioxin or Agent Orange is that it stays in the system for a very long period of time.”

He also says through his research he’s seen dioxin passed through sperm to the offspring in animals. His concern is not with the veterans who returned home or their children, but with their grandchildren.

“We have examples where there is no disease in the first generation but there's huge numbers of disease and the third generation,” he said.

On Thursday, the National Academies of Sciences, Engineering, and Medicine will release their report as a part of the congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War.

The report will address “possible generational health effects that may be the result of herbicide exposure among male Vietnam veterans” according to the organization. The Vietnam Veterans of America, however, says regardless of the outcome of the report they will continue to educate and advocate for its members and their descendants.

In the meantime, Kuhn said she'll continue to push for awareness.

"It's been a nightmare," Kuhn said and vowed to continue fighting for awareness. "You have to fight them because if you don't they will run over you big time and a lot of people you know they just give up and walk away and you can't do that."

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iStock/ThinkstockTIFFANY YEH, M.D.

(NEW YORK) -- Diabetes is one of the most common chronic conditions in the U.S. today, with almost 30.3 million of people suffering from difficulties in managing their blood sugar.

It is the seventh leading cause of death, and the No. 1 leading cause of kidney failure, adult-onset blindness, and lower limb amputation.

Most people with diabetes have Type 2 diabetes, which is often associated with lifestyle choices and genetics. It is the type of diabetes that is caused because the body has trouble using insulin properly or can't make enough.

About 1.25 million suffer from Type 1 diabetes, which is an autoimmune disorder. It's the type of diabetes that is a result of the pancreases not making any insulin.

Both conditions result in difficulty regulating a body’s glucose -- or sugar -- levels, but due to very different reasons.

Since November is Diabetes Awareness Month, it is a good time to answer frequently asked questions about the disease.

What is diabetes?

So let’s start with what happens in a normal person without diabetes. When you eat a meal, your body begins to digest it into protein, sugar and fat.

An organ called the pancreas senses the absorbed sugar and produces a hormone called insulin, which then pulls the sugar -- or glucose -- from the food you just ate and into different parts of your body so that it can be used for energy.

In diabetes, your body either doesn’t make enough insulin or can’t use it as well as it should. If you don’t have enough insulin, too much glucose stays in the bloodstream, which can cause serious health problems over time, such as heart disease, kidney disease or vision loss.

What is the difference between Type 1 and Type 2 diabetes?

Type 1 Diabetes

In patients with Type 1 diabetes (T1DM), their pancreas is unable to produce insulin at all, due to an autoimmune condition whereby the body attacks itself. People are more frequently diagnosed when they are children or young adults, and symptoms often develop quickly. They may report feeling very thirsty, going to the bathroom very often, losing weight even though they eat normally, and feeling very exhausting.

People with T1DM need to take insulin every day to survive, and currently, there is no known way to prevent or cure T1DM. They need to check their blood glucose levels several times a day and at night, and give themselves insulin multiple times a day based on their body makeup, blood sugar and what they eat.

Can I get T1DM?

T1DM was previously thought to be only in children and was previously referred to as “juvenile diabetes,” but we now know that young adults and even older adults can develop T1DM. It is not something contagious, or related to your lifestyle. Rather, it is an autoimmune condition, whereby your body develops antibodies against your own pancreas and gradually destroys the pancreas’ ability to produce insulin.

Type 2 Diabetes

In patients with Type 2 diabetes (T2DM), either the body has become resistant and needs more insulin or their pancreas is not making enough insulin. Their body has a hard time keeping the blood glucose at normal levels.

T2DM is not caused by eating sugar itself, but by a variety of lifestyle factors and genetics.

Can I get T2DM?

This is the more common adult form of diabetes, and unfortunately, the numbers of affected people, including children, in the U.S., continues to rise. This type of diabetes is associated with obesity, high blood pressure, high cholesterol, or a family history of T2DM.

If you have any of those conditions, it is important to see your primary care doctor regularly to be tested for diabetes.

Can I tell if I have diabetes? How is it diagnosed?

Most commonly, it is diagnosed with a blood test - either a high glucose level before you eat or something called a hemoglobin A1c, which is an average of your blood sugar over three months.

If your glucose level is high, you may feel symptoms like feeling thirsty all the time, urinating more than usual, weight loss, blurry vision or fatigue. Sometimes, people with Type 1 diabetes present very sick, with something called diabetic ketoacidosis, due to not having enough insulin in their body.

This can be a deadly condition that requires hospitalization to help correct the condition.

If you are on medications that can make your blood sugar go low, such as insulin, low blood sugar can result in sweating, shaking, uncharacteristic behavior, or disorientation. If it goes very low, it can even result in coma and death if not rapidly treated with glucose or a medication called glucagon.

If you notice any of these symptoms, you should notify your doctor.

How do I treat diabetes? Is there a cure?

Unfortunately, diabetes is a chronic illness with no cure. For people with Type 1 diabetes, the only treatment so far is insulin. For people with Type 2 diabetes, in addition to dietary changes, there are many medication options that vary from pills to injections.

Some types of bariatric surgery may be helpful in decreasing the amount of medications people with T2DM need to take. There are many novel technologies being developed to help improve the daily lives of people with diabetes.

Although Type 1 and Type 2 diabetes are invisible to people who don’t have it, having a blood sugar that is too high or too low can be very dangerous. But with good control and continual improvement in medication and technology, many people with diabetes are able to lead happy, fulfilling lives.

Tiffany Yeh, M.D., is an endocrinology fellow at New York-Presbyterian Weill Cornell Medical Center and a member of the ABC News Medical Unit.

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iStock/Thinkstock(NEW YORK) -- The current Ebola outbreak in the Democratic Republic of the Congo is now the most severe in the country's recorded history and ranks the third worst on the African continent.

At least 319 people have reported symptoms of hemorrhagic fever in the Central African nation's eastern provinces of North Kivu and Ituri, which share borders with Uganda and Rwanda. Among those cases, 284 have tested positive for Ebola virus disease, according to the country's health ministry.

There have been 198 deaths thus far, including 163 people who died from confirmed cases of Ebola. The other deaths are from probable cases of Ebola.

"No other epidemic in the world has been as complex as the one we are currently experiencing," the country's health minister, Dr. Oly Ilunga Kalenga, said in a statement late on Friday.

The total number of cases exceed that of the country's first Ebola outbreak, which was recorded in 1976 in the small northern village of Yambuku in what was then Zaire. The ongoing outbreak is also the third most severe in the recorded history of the African continent, following 28,652 cases in the 2013-2016 outbreak in multiple West African nations and 425 cases in the 2000 outbreak in Uganda, according to data from the U.S. Centers for Disease Control and Prevention.

The development comes just a month after the World Health Organization (WHO) concluded the current outbreak does not yet meet the criteria for an international public health emergency -- a proclamation that would have mobilized more resources and garnered global attention.

Here is what you need to know about the deadly virus.

What is Ebola?

The Ebola virus is described as a group of viruses that cause a deadly kind of hemorrhagic fever. The term "hemorrhagic fever" means it causes bleeding inside and outside the body.

The virus has a long incubation period of approximately eight to 21 days. Early symptoms include fever, muscle weakness, sore throat and headaches.

As the disease progresses, the virus can impair kidney and liver function and lead to external and internal bleeding. It’s one of the most deadly viruses on Earth with a fatality rate that can reach between approximately 50 to 90 percent. There is no cure.

The WHO has received approval to administer an experimental Ebola vaccine, using a "ring vaccination" approach, around the epicenter of the current outbreak in the Democratic Republic of the Congo. Nearly 28,000 people, including children as well as health and frontline workers, have been vaccinated in the outbreak zone since Aug. 8, according to the WHO.

The vaccine, which was developed by American pharmaceutical company Merck, has proved effective against the country's previous outbreak in the western province of Equateur.

How is it transmitted?

The virus is transmitted through contact with blood or secretions from an infected person, either directly or through contaminated surfaces, needles or medical equipment. A patient is not contagious until he or she starts showing signs of the disease.

Thankfully, the virus is not airborne, which means a person cannot get the disease simply by breathing the same air as an infected patient.

Where have people been infected?

In this current outbreak, people have been infected in North Kivu and Ituri, which are among the most populous provinces in the Democratic Republic of the Congo and share borders with Uganda and Rwanda.

Those two provinces are awash with conflict and insecurity, particularly in the mineral-rich borderlands where militia activity has surged in the past year, all of which complicates the response to the outbreak. There is also community mistrust, partly due to the security situation, and some residents delay seeking care or avoid follow-up.

Ebola is endemic to the region. This outbreak is the 10th in the Democratic Republic of the Congo since 1976, the year that scientists first identified the deadly virus in Yambuku near the eponymous Ebola River.

This outbreak in the country's eastern region was announced Aug. 1, just days after another outbreak in the western part of the country that killed 33 people (including 17 who had confirmed cases of Ebola) was declared over.

Where did the virus come from?

The dangerous virus gets its name from the Ebola River in northern Democratic Republic of the Congo, which was near the site of one of the first outbreaks. The virus was first reported in 1976 in two almost simultaneous outbreaks in the Sudan and the Democratic Republic of the Congo. The outbreaks killed 151 and 280 people, respectively.

Certain bats living in tropical African forests are thought to be the natural hosts of the disease. The initial transmission of an outbreak usually results from a wild animal infecting a human, according to the WHO. Once the disease infects a person, it is easily transmissible between people in close contact.

An outbreak that began in the West African nation of Guinea in March 2014, and soon spread to neighboring Liberia and Sierra Leone, was the largest in history, infecting 28,646 people and causing 11,308 deaths. The outbreak, which the WHO deemed a public health emergency of international concern, was declared over in June 2016.

Who is at risk?

The virus is not airborne, which means those in close contact can be infected and are most at risk. A person sitting next to an infected person, even if they are contagious, is not extremely likely to be infected.

However, health workers and caregivers of the sick are particularly at risk because they work in close contact with infected patients during the final stages of the disease, when the virus can cause internal and external bleeding.

In the current outbreak alone, 28 health workers have been infected so far and at least three of them have died, according to the WHO.

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iStock/Thinkstock(NEW YORK) -- The current Ebola outbreak in the eastern part of the Democratic Republic of the Congo is the worst in the country's recorded history, with 319 confirmed and probable cases, resulting in 198 deaths, the country's health ministry said.

Ebola virus disease, which causes an often-fatal type of hemorrhagic fever, is endemic to the region. It's the 10th outbreak the Democratic Republic of the Congo has seen since 1976, the year that scientists first identified the deadly virus near the eponymous Ebola River.

"No other epidemic in the world has been as complex as the one we are currently experiencing," the country's health minister, Dr. Oly Ilunga Kalenga, said in a statement late on Friday.

The outbreak is also the third most severe in the recorded history of the African continent, following 28,652 cases in the 2013-2016 outbreak in multiple West African nations and 425 cases in the 2000 outbreak in Uganda, according to data from the U.S. Centers for Disease Control and Prevention.

Among the total amount of people who have reported symptoms of hemorrhagic fever since the country's latest outbreak began Aug. 1, 284 of them have tested positive for Ebola virus disease. Nearly 28,000 people have been vaccinated in the outbreak zone since Aug. 8, according to the health ministry.

The outbreak has been heavily concentrated in the northeastern province of North Kivu, where about half of all cases have been recorded in the conflict-torn city of Beni, which is home to 800,000 people. People have also been infected in neighboring Ituri province.

North Kivu and Ituri are among the most populous provinces in the Democratic Republic of the Congo and share borders with Uganda and Rwanda. They are also awash with violence and insecurity, particularly in the mineral-rich borderlands where militia activity has surged in the past year, all of which complicates the response to the outbreak.

There is also misinformation and mistrust from the community, partly due to the security situation, and there's a reluctance among some residents to seek care or allow health workers to vaccinate, conduct contact tracing and perform safe burials, according to the health ministry.

"Since their arrival in the region, the response teams have faced threats, physical assaults, repeated destruction of their equipment and kidnapping. Two of our colleagues in the Rapid Response Medical Unit even lost their lives in an attack," the health minister said in his statement Friday night.

Although the outbreak remains "dangerous and unpredictable," new measures to overcome these challenges are having a "positive impact," the United Nations Department of Peacekeeping Operations and the World Health Organization (WHO) said in a statement Thursday after a joint mission to assess the situation.

"The fact that we have so far prevented Ebola from spreading into neighboring countries is a testament to the hard work and determination of staff from all partners," WHO director-general Tedros Adhanom Ghebreyesus said in the statement.

The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) has recently adopted an "active approach" to the armed groups operating in North Kivu, providing a "period of calm" in and around Beni, although some attacks have persisted in surrounding villages.

"We are facing numerous complex challenges, but it’s encouraging and inspiring to see that our efforts to deliver as one UN have been extremely successful in many hotspots and will help to end the outbreak and save lives," United Nations under-secretary-general for peacekeeping operations Jean-Pierre Lacroix said in the statement.

Last month, the WHO heeded the recommendation of an expert advisory committee to not declare the outbreak a public health emergency of international concern -- a proclamation that would have mobilized more resources and garnered global attention.

The committee chairman, Robert Steffen, said they came to the decision by looking at three main criteria.

"Is it extraordinary? Is there a risk of cross-border spread? Is there potential for requiring international response?" Steffen told reporters in a teleconference Oct. 17.

Despite its conclusion, the committee emphasized in a statement that the Congolese government, WHO and partners "must intensify the current response" to the ongoing outbreak and this "should be supported by the entire international community," otherwise "the situation is likely to deteriorate significantly."

"I’ve accepted the recommendation of the committee but this does not mean that we are not taking the outbreak seriously," World Health Organization's director-general, Tedros told reporters. "We will not rest until this outbreak is finished."

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