The findings, experts say, underscore that it’s racial disparities, not biology, driving the biggest differences in death rates between Black and white women. While Black women and white women are diagnosed with breast cancer at similar rates, Black women are 40% more likely to die from the disease. 

“Within health care there was this notion that an important contributor to disparities was that Black women have higher rates of triple-negative,” which is a particularly aggressive type of breast cancer, said lead author Erica Warner, a cancer epidemiologist at Massachusetts General Hospital. 

While that does play a role in the higher rates of death, Warner said, “based on these results it isn’t a significant or even a primary reason.” 

Warner and her colleagues conducted a meta-analysis that looked at 18 studies with nearly 230,000 patients with breast cancer in total, 34,000 of whom were Black, comparing the  mortality rates of Black women and white women with the same breast cancer molecular subtypes. 

A cancer’s subtype affects how the tumor behaves and responds to treatments, which largely influences mortality rates. 

For breast cancer, subtypes depend on what type of receptors are found on the surface of the tumor cell. Hormone receptor-positive (HR-positive) tumors have receptors for either estrogen or progesterone, two female hormones. HER2-positive tumors have a kind of receptor that allows the tumor to spread more quickly — or better respond to treatment. 

In all cases, the receptors can serve as clear targets for treatments. Tumors that have none of these receptors are referred to as triple-negative and are the most difficult to treat. 

For the most common subtype, HR-positive, HER2-negative, which accounts for 60% to 70% of all breast cancer diagnoses, Black women were 50% more likely to die from the disease than white women. For those with HR-positive, HER2-positive tumors, Black women were 34% more likely to die than white women. 

Black women were 17% more likely to die from triple-negative breast cancer than white women, a finding that surprised Warner. 

Although Black women are three times more likely to be diagnosed with triple-negative breast cancer than white women, given the high mortality rates for this type of cancer in everyone, the researchers did not expect to see a notable difference between races. 

“We thought that the hormone receptor-positive tumors is where we would see the biggest disparities and that we would not see a difference in the triple-negative tumors,” Warner said. “In reality we saw disparities of similar magnitudes across all breast cancer subtypes that we looked at.” 

‘If we can create them, we can eliminate them’

That the biggest disparities were seen among women diagnosed with hormone receptor-positive tumors highlights the role racial disparities play in the mortality rates, said Dr. Eric Winer, director of the Yale Cancer Center.

“In these cancers, people need to be on extended treatment with hormonal therapy for five years or more, which is often associated with out-of-pocket cost, so economics play a role,” Winer said. “People are falling through the cracks, whether that is because they are unable to afford hormone therapy, not as able to take it or not, or not able to pick up their medication.”

Doctors may also not be offering such extended treatments to Black or low-income patients as often, he added. Not all Black women are low-income or uninsured, but Centers for Disease Control and Prevention data shows that Black patients are more likely than white patients to be uninsured.

It’s one of many structural barriers Black women are more likely to face, said Dr. Wendy Wilcox, chief women’s health officer at New York City Health + Hospitals. 

“There are all these things we don’t tend to think about when we think about treating breast cancer, but they absolutely have an effect,” she said. 

So-called social determinants of health — including not just access to good health care, but child care, transportation to and from appointments, time off from work, access to healthy food, and living in an area with low levels of pollutants — all factor into who has better health outcomes across the board. 

“There has been a long-standing lack of Black women being represented in clinical trials,” Wilcox added. “From the very beginning, the breast cancer treatment research phase, Black women are not being represented.”

Black women are also more likely to have breast cancer at a younger age, but not be diagnosed until their cancer is at a more advanced stage. 

“Regardless of subtype it’s about early detection,” said Dr. Marissa Howard-McNatt, director of the Breast Care Center at Atrium Health Wake Forest Baptist in North Carolina. “Black women tend to get breast cancer at a younger age. Screening doesn’t start until age 40, but a lot of Black women can get breast cancer in their 30s.”

Anyone who has a history of breast cancer in their family should start screening with mammograms 10 years before a sibling or parent was diagnosed, Howard-McNatt said. 

“Women in all racial ethnicities, especially Black women, need to know their family history,” she said.

She added that helping Black women diagnosed with breast cancer access health care facilities that have patient navigators, which assist patients with everything from understanding their treatment options to arranging transportation, could help begin to shrink the disparities these women face. 

There weren’t always differences in the breast cancer death rates between Black and white women.

“If you look at breast cancer data from 40 years ago, there really weren’t differences in mortality for breast cancer between Black and white women. We weren’t very good at treating and diagnosing it. But as we’ve gotten better, the gap between white and Black women has grown,” Warner said. “That is problematic, but that also tells us we have our foot on the pedal for these differences. If we can create them, we can eliminate them.”

This story first appeared on NBCNews.com. More from NBC News:

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Earlier this year, experts warned that Joro spiders could start showing up in Pennsylvania, New Jersey and Delaware this summer, spreading up from the southeastern U.S., where they have been proliferating.

critter corner Jun 5

Giant, parachuting Joro spiders could arrive in Pa., NJ and Del. this summer

Nature Nov 9, 2023

These giant, parachuting spiders are spreading rapidly in the US, study shows

Joro spiders spotted in suburbs of Philadelphia

Now, there is a report of six of the creepy invasive crawlers in southeastern Pennsylvania on JoroWatch.com. (Yes, that’s a real website powered by the University of Georgia and other academic and environmental entities.)

Someone spotted the group of a half dozen or so colorful arachnids in the yard of a home in Warminster, Bucks County, on Sept. 5, 2024, JoroWatch said.

What is a Joro spider?

The yellow and black arachnids are native to East Asia, but the invasive arachnids have been around in Georgia for about a decade. A fall of 2023 peer-reviewed study conducted by David Coyle, a scientist and assistant professor in the Department of Forestry and Environmental Conservation at Clemson University, found that the species is “here to stay” in the U.S. as it spreads rapidly around the country.

As of October 2022, the species’ range spanned at least 120,000 square kilometers across Georgia, South Carolina, North Carolina and Tennessee, according to the study. There were also reports of Joro spiders in Alabama, Maryland, Oklahoma and West Virginia. And the spiders are expected to make more East Coast states their home in the future.

“(The data from the study shows) that this spider is going to be able to inhabit most of the eastern U.S.,” Coyle said. “It shows that their comfort area in their native range matches up very well with much of North America.

“Barring some unforeseen circumstance, we expect the range of these things to continue expanding, likely to the north, and we’ve already seen that with some populations in Maryland.”

Nature Mar 17, 2022

This College Student Has Held Hundreds of Joro Spiders. Here's What He Wants You To Know

Nature Nov 9, 2023

These giant, parachuting spiders are spreading rapidly in the US, study shows

Adding to nightmares, the spiders are light enough to travel through the air by a process called “ballooning,” making it even easier for them to spread. The “spiders move through the air by releasing gossamer threads to catch the wind and go airborne, at the mercy of air currents and electric fields, although human-mediated transport cannot be discounted,” Coyle wrote.

What does a Joro spider look like, how big is it?

Female Joro spiders, a.k.a. Trichonephila clavata, can have a body about 1 inch long and legs that span up to 4 inches, according to a 2022 Penn State Extension article. The females are brightly colored, whereas the males are brown.

But there is good news: Even though its palm of your hand size tends to freak people out, the species is relatively harmless to humans and pets.

Are Joro spiders dangerous?

While Joro spiders may appear frightening to some, they are relatively harmless to people and pets, a University of Georgia study from last year said. In fact, that study found that Joro spiders “may be the shyest spider ever documented.”

The spiders will only bite if they’re cornered and even then their fangs likely wouldn’t be large enough to pierce human skin, according to the University of Georgia study.

“Our paper shows that these spiders are really more afraid of you than the reverse,” said Andy Davis, lead author of the study and a research scientist in UGA’s Odum School of Ecology.

Another positive about the spiders: they don’t want to go inside homes, according to Coyle. They will instead spin webs on the outside of houses or other structures. If a Joro spider needs to be moved, Coyle suggests using a broom or stick to place it elsewhere.

Might Joro spiders spread further in the Delaware Valley soon?

The simple answer is maybe, but not to worry too much.

“In their native range, Jorō spiders can be found in relatively cold areas – the average January temperature of northern Honshu, Japan is 25–32 °F, similar to most of Pennsylvania,” the Penn State article said. “So it is likely that they will be able to spread throughout eastern North America at least as far north as Pennsylvania and possibly further in warmer, coastal areas.”

“Between 2014–22, Jorō spiders spread outward in all directions from the location they were initially found by 50–80 miles, or about 10 miles per year. At that rate, they may reach southeastern Pennsylvania in 35 years and northwestern Pennsylvania in 60 years. However, spiderlings are capable of moving tens to hundreds of miles via ballooning,” Penn State said. “Additionally, as they increase in numbers, the risk of human-mediated transport to new areas also increases. This means that the immediate risk of Jorō spiders appearing in Pennsylvania is relatively small but will increase year over year as they spread naturally, via high wind events, and through accidental human transport.”

University of Delaware’s Department of Entomology and Wildlife Ecology entomologist Dr. Doug Tallamy has been downplaying a potential Joro invasion.

“It’s possible but very low on the list of things we should be worried about,” he wrote earlier this year. Reached on Wednesday by NBC10, he wrote: “I think it’s a non issue that should not be blown out of proportion.”

How did Joro spiders get to the U.S. to begin with?

Joro spiders are native to East Asia. It’s believed the species likely made its way to the U.S. via a shipping container.

Are Joro spiders orb-weavers?

Joro spiders are in the family of orb-weavers, which spin large, orb-shaped webs. They look similar to garden spiders and banana spiders.

Do Joro spiders fly?

The pattern in which Joro spiders have spread “suggests it is primarily driven by natural dispersal mechanisms, such as ballooning,” according to Coyle’s study. Ballooning is when spiders move through the air like a parachute by releasing “sail-like trails of silk that lift them up and off into the wind,” per National Geographic. (Want to get a bit freaked out? Read the full Nat Geo story.)

The study said human-mediated transport can’t be discounted, either, in regard to the spread of the species.

What do Joro spiders eat?

Joro spiders aren’t exactly picky eaters. Coyle said they “don’t seem to care what gets in their web.” The spiders eat mosquitoes, yellowjackets, stink bugs and even spotted lanternflies — another invasive pest.

“They’re just as likely to eat brown marmorated stink bugs as they are to eat a Monarch butterfly,” he added. “To say they’re more beneficial than another spider is just simply wrong — they’re a spider — and if something gets caught in their web, it’s going to get eaten. And they don’t care if it’s a rare native pollinator and there are only a few of them left in the world or if it’s a brown marmorated stink bug.”

An interesting find from Coyle’s study is that Joro spiders are displacing native species, along with having other negative impacts. But it’s unclear exactly why other species are being negatively impacted by Joro spiders.

“These are not just benign spiders coming to catch and kill bad things; these are pushing out native species and catching and killing whatever happens to get in their webs,” Coyle said. “Are they bad or good? It’s very nuanced depending on your perspective.”

The variant has been largely spreading overseas with countries like Denmark, Germany, the UK and the Netherlands seeing the largest spikes, but the variant has also appeared to begin a climb in the U.S., according to researchers.

So what should you know about it?

Here’s an explainer:

What is the XEC variant?

According to Eric Topol, director of the Scripps Research Translational Institute in California, the XEC variant “appears to be the most likely one to get legs next.”

At this juncture, the XEC variant appears to be the most likely one to get legs next. Its current status nicely tracked by @Mike_Honey_ 's threadhttps://t.co/4AnLa3MXfz

— Eric Topol (@EricTopol) September 15, 2024

Topol reported the subvariant is a “recombinant of KS.1.1 and KP.3.3” variants and has been “showing up in many countries with a growth advantage.” He added, however, that it could take time to learn the variant’s full extent.

The variant’s rise comes from a recent mutation, Topol told the LA Times.

While KP.3, nicknamed the FLuQE variant, and its subvariant KP.3.1.1, or the deFLuQE variant, each had mutations of their own, XEC took the mutation even further, making it a “very pathogenic, very immune evasive variant.”

He noted that it could be behind a recent wave that is sickening people who otherwise may not have contracted COVID.

Where is it spreading?

The variant’s prominence remains largely abroad, with XEC still not widely detected enough to make it on the U.S. Centers for Disease Control and Prevention variant proportions data tracker.

According to the CDC estimates, the dominant variant in the U.S. is still KP.3.1.1, which represents more than half of COVID cases currently.

Data reported over the weekend showed the highest percentages of the variant seen in Denmark, the Netherlands, Germany and the UK.

Will vaccines prevent against the XEC variant?

Experts have long said the COVID virus will continue to mutate.

This fall’s vaccine recipe is tailored to a newer branch of omicron descendants. The Pfizer and Moderna shots target a subtype called KP.2 that was common earlier this year.

While additional offshoots, particularly KP.3.1.1, now are spreading, they’re closely enough related that the vaccines promise cross-protection. It is expected that the vaccines will provide some protection against XEC as well.

A Pfizer spokesman said the company submitted data to FDA showing its updated vaccine “generates a substantially improved response” against multiple virus subtypes compared to last fall’s vaccine.

This summer’s wave of COVID-19 isn’t over but winter surges tend to be worse. And while COVID-19 vaccines do a good job preventing severe disease, hospitalization and death, protection against mild infection lasts only a few months.

What are the symptoms?

It’s not clear if the new variant will bring with it a change in symptoms.

As of now, the symptoms for COVID remain the same:

• Cough
• Sore throat
• Runny nose
• Sneezing
• Fatigue
• Headache
• Muscle aches
• Altered sense of smell
• Congestion
• Fever or chills
• Shortness of breath or difficulty breathing
• Nausea or vomiting
• Diarrhea

Recent reports have centered on specific gastrointestinal symptoms related to the virus.

Dr. Katelyn Jetelina, a scientific consultant for the CDC and epidemiologist, said “gastrointestinal issues including nausea, vomiting, and diarrhea” have been previously identified as possible symptoms of COVID-19.

“We do not have specific data about the incidence of GI symptoms with the current strains of the virus, but COVID-19 symptoms can certainly differ based on the variant and the individual,” Jetelina told NBC Chicago in July.

Last fall, a Chicago-area doctor said she’s noticed shifts in the most common symptoms her patients reported as the JN.1 variant rose to dominance.

Dr. Chantel Tinfang, a family medicine physician with Sengstacke Health Center at Provident Hospital of Cook County, noted at the time that many of the cases she saw reported less of the fever, body aches and chills, and presented more with sore throat, fatigue and coughing.

“We still see some patients experiencing decreased appetite, a loss of taste or smell. So it kind of depends,” she said. “One patient was just very, very tired. Like she couldn’t really do much. And that’s when you know … it’s different. It’s not just coughing and shortness of breath. We still see that though.”

She suggested consulting with your doctor if your symptoms don’t begin to improve outside of the recommended isolation period.

How long does COVID last?

As for timing, symptoms can last for several days, but in some cases, even longer.

“Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as Long COVID or Post-COVID Conditions (PCC),” according to the CDC.

Such symptoms can last for weeks and possibly even years.

Previous timing guidelines centered around five to 10 days, however.

What to do if you test positive?

In March, the CDC updated its COVID guidelines to mirror guidance for other respiratory infections. Those who contracted COVID-19 no longer need to stay away from others for five days, the CDC said, effectively nixing the five-day isolation recommendation.

Jun 14

KP.3 COVID variant is dominant in the US: What are the symptoms?

People can return to work or regular activities if their symptoms are mild and improving and it’s been a day since they’ve had a fever, but the CDC still recommends those with symptoms stay home.

“The recommendations suggest returning to normal activities when, for at least 24 hours, symptoms are improving overall, and if a fever was present, it has been gone without use of a fever-reducing medication,” the guidance states.

Once activities are resumed, the CDC still recommends “additional prevention strategies” for an additional five days, including wearing a mask and keeping distance from others.

The agency is emphasizing that people should still try to prevent infections in the first place, by getting vaccinated, washing their hands, and taking steps to bring in more outdoor fresh air.

As part of the guidance, the CDC suggests:

• Staying up to date with vaccination to protect people against serious illness, hospitalization, and death. This includes flu, COVID-19, and RSV if eligible.
• Practicing good hygiene by covering coughs and sneezes, washing or sanitizing hands often, and cleaning frequently touched surfaces.
• Taking steps for cleaner air, such as bringing in more fresh outside air, purifying indoor air, or gathering outdoors. 

The change comes at a time when COVID-19 is no longer the public health menace it once was. It dropped from being the nation’s third leading cause of death early in the pandemic to 10th last year.

Most people have some degree of immunity to the coronavirus from past vaccinations or from infections. And many people are not following the five-day isolation guidance anyway, some experts say.

Where can you get free COVID tests?

On the heels of the summer wave of COVID-19 cases, Americans will be able to get free virus test kits mailed to their homes, starting in late September.

U.S. households will be able to order up to four COVID-19 nasal swab tests when the federal program reopens, according to the website, COVIDtests.gov. The U.S. Health and Human Services agency that oversees the testing has not announced an exact date for ordering to begin.

The tests will detect current virus strains and can be ordered ahead of the holiday season when family and friends gather for celebrations, an HHS spokesperson said in an emailed statement. Over-the-counter COVID-19 at-home tests typically cost around $11, as of last year.

More recently, Consumer Reports found a concerning amount of the toxic metal in a third of cinnamon powders purchased from more than a dozen grocery stores in the Northeast.

There is no safe limit of lead to consume. At the same time, completely eliminating the heavy metal in food isn’t feasible, because lead is a naturally occurring element in the Earth’s crust. Trace amounts can infiltrate the food supply in various ways, including in places where foods are grown, raised or processed, experts say.

However, the recent findings raise questions about why the Food and Drug Administration hasn’t already proposed limits on lead in foods meant for young children.

“This issue with the cinnamon and the lead and other issues with heavy metals in baby and children’s food is all emblematic of a larger problem that I think the FDA is trying to get a handle on,” said Laurie Beyranevand, director of the Center for Agriculture and Food Systems at Vermont Law and Graduate School. “I’m not sure if the FDA is doing it as quickly as people would feel comfortable with.”

After a major FDA investigation late last year into lead-contaminated apple cinnamon fruit puree, the FDA began screening cinnamon imports, followed by several warnings and recalls of some brands for elevated lead levels.

That prompted Consumer Reports to test brands across 17 mainstream and niche grocery stores.

It found high levels of lead in 12 products, with levels reaching 3.5 parts per million.

The United Nations’ Food and Agriculture Organization has a proposed international safety standard of 2.5 ppm for spices that include cinnamon.

Anything above 1 ppm would trigger a recall in New York — the only state in the U.S. that regulates heavy metals in spices — Consumer Reports noted.

“There are some products in here that are up to three times that, which is concerning,” said Dr. Adam Keating, a pediatrician with Cleveland Clinic Children’s.

Keating’s primary concern is with children and pregnant women who ingested the cinnamon on a regular basis as opposed to just a single instance.

“A single sprinkle of cinnamon in a dose in one dish would be different than if they were eating the product every day,” said Keating, who was not involved in the Consumer Reports testing. “Regular ingestion of lead is the main concern that we have, particularly with children and pregnant women, because the most profound effect of lead is developmental delays and learning problems.”

The FDA currently does not set limits for heavy metals in spices, including cinnamon, although it does set limits for certain foods, such as candy made with sugar.

Last year, the agency proposed limits on lead levels in processed baby food that it says could reduce exposure to the contaminant by as much as 27%. Those guidelines are not expected to be finalized until next year, however.

“I’m not totally sure why they have not done that yet,” Beyranevand said. “Maybe it’s difficult to do in a number of different products, but it feels like at least with cinnamon, given the prevalence of the findings and the fact that there’s been so much lead, it feels like it would move the agency to set some sort of action level.”

The FDA did not immediately respond to a request for comment.

Lead exposure can be harmful to people of all ages, Keating said, but it is particularly dangerous for children. High levels of lead can lead to serious health problems in kids, including learning and behavior issues, reduced IQ and damage to the brain and nervous system, according to the FDA and the Centers for Disease Control and Prevention. Additionally, lead exposure can cause hearing and speech problems.

Many children may not have any obvious symptoms, Keating said. He recommended that parents get their children in for routine lead screening at 1 and 2 years of age.

Consumer Reports advised people to check their homes for the products and throw them out.

The consumer product testing group also said that people might consider sticking with mainstream brands.

Of the 12 products that contained high levels of lead, 10 of them were from relatively unfamiliar brands sold mainly in small markets specializing in international foods, according to the report’s findings.

The FDA has wound down some of its response efforts to its cinnamon applesauce investigation but will continue to monitor other products in stores for high lead levels.

This story first appeared on NBCNews.com. More from NBC News:

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As chaplain for the men’s team for 30 years, she’s famous as the “basketball nun” — stealing the show and people’s hearts when the Loyola Ramblers made it to the Final Four at the 2018 NCAA basketball tournament.

Known simply as Sister Jean, she leads the team in a pre-game prayer before matches and serves as a good luck charm. Enthusiastic, uplifting and knowledgeable about basketball, “she’s like another coach,” one of the players told the Chicago Tribune. “She knows her stuff.”

Born on Aug. 21, 1919, the centenarian continues to work at least five days a week, commuting from her apartment to campus via shuttle bus, and offering advice, support and hugs to students in her office. She uses an iPad, a computer and is active on email, but it’s the personal connection with young people that matters most.

“I love every bit of it. … It just makes me very joyful,” Sister Jean tells TODAY.com. “I don’t consider it really working. I just have so much fun. These students are a joy to work with. I learn so much from them, and I know they learn from me.”

She celebrated her 105th birthday with seven parties organized by the university, students and the assisted living community where she resides.

The nun is a member of the Sisters of Charity of the Blessed Virgin Mary. She’s spent her life working as a teacher, administrator and principal. She’s also coached basketball and other sports.

“I feel fine” at 105, Sister Jean says. “I eat well, I sleep well and hopefully I pray well.”

Here are some of the secrets of her longevity:

Be around young people

“I love being around young people. They keep me alive, healthy, and vibrant,” she writes in her memoir, “Wake Up With Purpose!: What I’ve Learned in My First Hundred Years.”

“My interactions with those students are why I’ve never regretted not having children of my own.”

Never retire

Sister Jean actually did try retirement in 1994 at age 75, but found she didn’t want to give up working — a sentiment common among people who live extraordinarily long lives.

That same year, she was asked to be the chaplain for the men’s basketball team, which became “the most transformational and transcendent position of my life,” she writes in her book.

Given the team’s schedule, she sometimes works until 9:30 at night and on the weekends. She’ll be attending every home game this year.

“There’s more work for me to do. I don’t like to sit around. I just like talking to people or doing something good for others,” she says as fall activities get underway at the university. “We’re going to be very busy, but that’s fun.”

It’s important to have a purpose in life, but since people spend so much time at work, they should make a change if they don’t like their job or career, she advises.

Keep moving forward

Sister Jean is comfortable with modern technology, stays on top of the news and calls adaptability her “superpower.”

“If you’re not moving forward, you’re going to get left behind real quick,” she writes in her book.

The nun calls herself the queen of the selfie since so many people want a photo with her. It makes them happy, so she’s happy to do it, she says.

Inherit great genes

The centenarian believes a lot of her longevity comes from her father’s side of the family. He lived to be 95, and several of his siblings made it to a similar age.

“When my 95 came along, I thought, ‘I’ve got to really get ready to go to God.’ But I’m still here,” she says.

Wake up and go to sleep joyfully

If you don’t take care of yourself, you can’t take care of anybody else, Sister Jean says. It’s important to set aside quiet time for prayer and reflection to take care of the mind, she adds in her book.

The nun wakes up at 5 a.m. and pauses for a 30-minute meditation.

Then at night, she takes time to think about all the good things she did that day.

“I still go to bed every night with a smile on my face, gratitude in my heart, and love in my soul,” she writes in her book.

Eat in moderation

Sister Jean says she eats pretty much everything, but not too much of anything.

Lunch is her heavier meal, and then she eats more lightly at dinner time, opting for soup and a salad or a sandwich.

She used to be very careful about her diet when she was younger, but has taken a more relaxed approach in recent years.

“Perhaps I don’t watch my diet so much at breakfast. Sometimes I have eggs and bacon and toast,” the centenarian notes.

“But I think to myself, I’m 105, what difference does it make?”

For her birthday, Sister Jean enjoyed chicken fricassee, homemade noodles, peas and pound cake — the meal she always asked her mom to make for her special day.

Stay positive and joyful

Sister Jean says she’s never been depressed and believes it takes too much energy to be stressed out.

She credits her good mental health to her parents, who created a happy home for her, and her two brothers even when times were tough during the Great Depression — a warmth that has always stayed with her. They also fostered her love of sports, which she calls the best teacher of teamwork.

“I learned a lot of that from my mom and dad. They were so positive all the time,” she says.

“They told us that we could really do things if we really tried, and I certainly believe that.”

Her parents and brothers have died, but she talks to them all the time. “I know they hear me in heaven,” she writes.

This article first appeared on TODAY.com. Read more from TODAY here:

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The research, published in the journal Endocrinology, is the first to look at how chemicals found in the environment may affect the brain, possibly leading to early puberty, Dr. Natalie Shaw, a pediatric endocrinologist at the National Institute of Environmental Health Sciences and co-senior author of the study, told NBC News.

However, it’s too early to say whether musk ambrette is definitely playing a role in the early puberty trend, experts stress — though there may be some small steps that parents can take to err on the side of caution.

Here’s what to know about the research, musk ambrette and the products that contain it.

Puberty starting earlier in girls and boys

Research from 2020 shows that the average age of starting puberty for girls has decreased by about three months each decade from 1977 to 2013. A study from 2012 found that boys were hitting puberty anywhere from six months to two years earlier than previous research had indicated.

And a large study in May 2024 published in JAMA, which looked at over 70,000 females born between 1950 and 2005, found that the average age at which girls had their first periods has decreased, and it’s taking longer on average for periods to become regular.

The reason behind the drop in age at which children are starting puberty has eluded experts for years. Some have pointed to the rise in obesity in children, less nutritious diets, and exposure to phthalates, a substance added to plastics, but nothing is proven.

Shaw believes that because the change in puberty onset has happened so quickly, it’s likely due to “environmental factors,” she told NBC News.

Starting puberty early has been linked to adverse health outcomes, such as increased risk of breast, endometrial and testicular cancers; diabetes; heart disease; obesity; and psychological issues.

Musk ambrette may play a role in rise in early puberty, new research finds

To conduct the study, the researchers looked at over 10,000 compounds using a library of licensed pharmaceuticals, environmental chemicals and dietary supplements.

They found that musk ambrette, which is a synthetic form of musk, may be able to attach to a receptor in the brain associated with puberty and prompt it to release a hormone called GnRH, which affects the sexual maturation of organs and production of sex hormones, like estrogen, testosterone and progesterone.

“The ability of these compounds to stimulate these brain receptors raises the possibility that they may prematurely activate the reproductive axis in children,” Shaw tells TODAY.com via email.

There were several types of chemicals that the researchers identified that could influence puberty, including cholinergic agonists, a type of medicine, and musk ambrette.

“Musk ambrette is of potential concern for children because it can be found in personal care products. A limited number of studies in rats also suggest that it can cross the blood-brain barrier. Children are less likely to encounter cholinergic agonists in their daily lives,” Shaw explains.

“It is important to conduct confirmatory studies in girls with early puberty, but these compounds deserve greater attention,” she adds.

What is musk ambrette?

Musk ambrette is a synthetic form of musk. It’s often used to add scent to personal care and household products or as a flavoring food additive, Michael Hansen, Ph.D., senior scientist at Consumer Reports, tells TODAY.com.

The Flavor and Extract Manufacturer Association (FEMA), a major flavor trade group in the U.S., does not give musk ambrette its “generally recognized as safe” designation. The European Union has prohibited the use of musk ambrette in cosmetics, and Canada has also restricted it.

“Exposure to (musk ambrette compounds) is also of concern because they can bioaccumulate in human tissues,” Shaw explains. “Studies have detected these compounds in maternal blood, umbilical cord blood, and breast milk, highlighting potential risks for children.”

What products contain musk ambrette?

A range of products in the U.S. may contain musk ambrette. According to Hansen and Shaw, these include:

• Detergents
• Soaps
• Air fresheners
• Cleaning products
• Perfumes, especially inexpensive or counterfeit fragrances
• Essential oils
• Cosmetics and other scented personal care products, like shampoos, deodorant and body wash
• Spices
• Some foods

“If I had to guess, I would suspect that the bulk of the exposure (to musk ambrette) is coming in through personal care products,” Hansen says. “Since it’s a fragrance, that means … you’re inhaling it. … That goes straight into the mucous membranes (in the nose), which are far easier for chemicals to get to the brain.”

What can parents do?

Some experts say it’s too early in the research to suggest that parents consider taking action to reduce their children’s exposure to musk ambrette, and it would also be premature to ban or restrict it, based on this research.

However, Shaw and Hansen both agree there’s no harm in trying to limit kids’ exposure to the chemical and its related compounds, such as musk xylene and musk ketone. And Hansen says the research ideally should lead to follow-up studies looking at musk ambrette exposure in communities more likely to experience early puberty.

In the mean time, Hansen suggests avoiding products that have musk ambrette on the ingredients label. However, know that some products that use musk ambrette may only list it as synthetic or natural fragrance or flavoring, Hansen adds.

So, you may want to consider just cutting back on scented products where the scent isn’t necessary, such as lotions, shampoos and body washes.

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The research is among the first to find a relationship between escalating doses of the drugs — amphetamines, in particular — and a greater likelihood of psychotic symptoms. 

The drugs include Adderall, Vyvanse and generic amphetamines, such as dextroamphetamine.

The link between amphetamines and psychosis isn’t new. Amphetamines increase levels of dopamine in the brain. The neurotransmitter plays a number of roles in the body, including in memory, motivation and mood, but it’s also implicated in psychosis.

The drugs “can flood the brain with dopamine, and when you flood the brain with dopamine you potentially can cause psychosis,” said Dr. Jacob Ballon, a psychiatrist and co-director of the INSPIRE Clinic at Stanford Medicine, a clinic specializing in patients with psychosis. 

What hadn’t been established was that the risk of psychosis rose with higher doses, a phenomenon known as a “dose-response relationship.”

“That’s what this study provides,” said Dr. Will Cronenwett, vice chair for clinical affairs in psychiatry at Northwestern Medicine.

“The United States is having sort of an amphetamine moment right now,” Cronenwett said. “The popularity and use of amphetamines is high and getting higher.” 

Stimulant use in the U.S. has skyrocketed in recent years, particularly among adults. A study published this year in JAMA Psychiatry found that prescription rates for amphetamines for attention-deficit hyperactivity disorder had risen 30% from 2018 to 2022 in people ages 20 to 39. Among people ages 40 to 59, rates rose 17%. 

In a statement to NBC News, a spokesperson for Takeda Pharmaceuticals, the maker of Vyvanse, said, “Takeda believes it is important for patients to take our medicines in accordance with U.S. Food and Drug Administration (FDA)-approved labeling guidance and in consultation with their prescribing health care provider.”

Teva Pharmaceuticals, the maker of Adderall, didn’t respond to a request for comment. 

High doses

The lead study author, Dr. Lauren Moran, a psychiatrist and researcher at McLean Hospital, a teaching hospital that is a part of Mass General Brigham in Boston, said it’s not uncommon for people to develop psychosis related to amphetamines.

“We’ve seen this a lot,” Moran said. “We are seeing college students coming in being prescribed stimulants who didn’t have much of a psychiatric history developing new onset psychosis.” 

In the new study, Moran and her colleagues reviewed electronic health records from Mass General Brigham from 2005 through 2019, focusing on teens and adults ages 16 to 35 — the typical age range for the onset of psychosis or schizophrenia. They identified 1,374 cases of patients who were hospitalized with first episodes of psychosis or mania, compared with 2,748 patients who were hospitalized for other psychiatric conditions, such as depression or anxiety. 

They also looked at whether the patients had been prescribed stimulants in the past month and, if so, at what dosages.

Patients taking the highest dosages — more than 40 milligrams of Adderall, 100 mg of Vyvanse or 30 mg of dextroamphetamine — were 5.3 times more likely to develop psychosis than patients taking no stimulants. 

The medium dosage — 20 mg to 40 mg of Adderall, 50 mg to 100 mg of Vyvanse or 15 mg to 30 mg of dextroamphetamine — was linked to a 3.5 times higher risk. It’s not clear whether taking less than 20 mg of Adderall, 50 mg of Vyvanse or 15 mg of dextroamphetamine is associated with an increased risk of psychosis, Moran said.

There was no increased risk of psychosis with another ADHD drug, Ritalin, which isn’t an amphetamine.

Moran said that, according to an analysis of national insurance claim data, about 6% of patients taking amphetamines are prescribed the highest dosages and about 22% are prescribed the medium dosages.

Cronenwett said the risk of developing psychosis from an amphetamine remains rare, around 1 in 1,000. Still, people taking high doses should be aware of the risks. 

“I would counsel patients who have a personal or family psychiatric history of serious mental illness, including things like bipolar disorder with mania or schizophrenia,” he said. “If these sorts of illnesses are in the family tree, then that’s somebody who might want to be very careful about how much of these medicines they use and in what doses.” 

Ballon agreed.

“There may be some folks out there who are receiving stimulants for whom they’re not necessarily that effective,” he said. “What ends up happening is the doses get escalated to seek that level of effectiveness and in so doing put people at this increased level of risk.”

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“Both have a lot of health benefits,” Julia Zumpano, a registered dietitian with the Cleveland Clinic Center for Human Nutrition, tells TODAY.com. For example, the two oils are both rich in “healthy fats that have been shown to reduce inflammation and protect against heart disease,” she says.

They also contain helpful vitamins and antioxidants, registered dietitian Grace Derocha, a spokesperson for the National Academy of Nutrition and Dietetics, tells TODAY.com.

But there are some big differences, especially when it comes to choosing how and when to cook with avocado oil versus olive oil, the experts say.

Fat content

Nutritionally, avocado oil and olive oil are very similar, Zumpano says, though there are some slight differences. When it comes to calories and fat content per serving, “they’re almost the same,” she adds.

In 1 tablespoon of avocado oil, you’ll get about 124 calories and 14 grams of fat, including around 2 grams of saturated fat, 2 grams of polyunsaturated fat and 10 grams of monounsaturated fat.

In 1 tablespoon of olive oil, you’ll get 119 calories and 13.5 grams of fat, including about 2 grams of saturated fat, 1.5 grams of polyunsaturated fat and 10 grams of monounsaturated fat.

Both are low in saturated fat, which has been linked to increases in cholesterol. Yet they’re “rich in monounsaturated fats,” Derocha says, which are especially helpful for heart health. In particular, they’re both good sources of oleic acid, an omega-9 fatty acid and monounsaturated fat, Zumpano says.

“Essentially, both are good overall as a heart-healthy oil to use,” Derocha says.

Other nutrients

In addition to those healthy fats, both avocado oil and olive oil contain a slew of other nutrients. However, they contain slightly different combinations of those vitamins, antioxidants and beneficial plant compounds.

Both contain vitamin E, which boasts benefits for skin health and has antioxidant properties. But, Zumpano says, olive oil comes with slightly more than avocado oil.

“Antioxidant-wise, both of them have very powerful antioxidants, but olive oil does contain slightly higher values,” she adds.

For example, lab research suggests that oleocanthol, an antioxidant compound unique to extra virgin olive oil, has pain-relieving properties similar to ibuprofen, Zumpano notes. Oleocanthol may also have benefits for brain health.

Meanwhile, avocado oil provides the antioxidant lutein, which is helpful for eye health, Derocha says.

Ultimately, either oil will provide a good dose of beneficial plant compounds and nutrients.

Smoke point

Perhaps the biggest difference between these two oils are their smoke points, meaning the temperatures at which they begin to burn and produce smoke.

Olive oil has a lower smoke point, Derocha says, which is in the range of 375 degrees Fahrenheit. If you’re using extra virgin olive oil, which is unrefined, Zumpano typically recommends keeping the temperature around 350 to 375 or below. That means most olive oil will be better suited to lower-heat cooking, like simmering in a pan, or used at room temperature and drizzled over salads or veggies.

(Note that refined olive oil can be heated to higher temperatures.)

On the other hand, avocado oil has a higher smoke point, up to about 520 degrees Fahrenheit, the experts say. Even at high heat, avocado oil “doesn’t have a burnt flavor, and it also retains all those nutrients,” Derocha says. “So when you’re thinking of high-heat cooking methods, like frying, roasting or grilling, you want to go (with) avocado oil.”

Zumpano agrees: “If I’m going to pan-fry or if I’m coating potatoes to roast at a higher temperature, I’ll use an avocado oil,” she explains. “If I’m using a lower-temperature cooking or room temperature, like seasoning or flavoring salads, I’ll use an olive oil.”

Flavor

Your mileage may vary here, but the experts agree that avocado oil generally has a more neutral taste than olive oil.

Avocado oil has a mild and slightly nutty or buttery taste. But, depending on the variety of olives used, your olive oil may have a distinctive sweet, fruity flavor or even some spicy, peppery notes, Derocha says.

That’s most evident in extra virgin olive oils, which are the result of the first cold-pressing of the olives, Zumpano explains. With more refined olive oils, you’ll get less of those flavors but also less of the nutrients, TODAY.com explained previously.

Olive oil also has a lower acidity level than avocado oil, which is why it’s often paired with a vinegar, Derocha notes.

If you’re making a salad dressing, sauce or olive oil cake, that profound olive flavor might be exactly what you’re going for. “Sometimes it’s very specific to certain foods,” Zumpano says. “It actually enhances the flavor of Mediterranean-style dishes,” she adds.

But, with its milder taste, avocado oil tends to be more versatile — especially in baked goods, the experts agree.

Should you use avocado oil or olive oil?

Both avocado oil and olive oil are plant-based oils that provide a good mixture of healthy fats, vitamins and antioxidants. One isn’t really healthier than the other, the experts say.

“They have slightly different compositions that are for slightly different purposes, but I think they’re equally as healthful,” Zumpano says.

So, which should you use? It depends on what you’re making.

Because it has a milder flavor and higher smoke point, avocado oil is better for high-heat cooking. You can easily roast vegetables, pan-fry meat and bake with avocado oil.

Olive oil has a more noticeable peppery and sweet flavor, and it also has a lower smoke point. That means it’s better to save olive oil for low-heat cooking, like stove-top simmering, or to use it as a topping or salad dressing ingredient.

Keep in mind that there’s a huge variety of olive oils out there — even among extra virgin olive oils. Some are better suited to cooking while other higher-quality olive oils have more intense flavors and are best saved for drizzling or dipping.

It’s important to be selective when purchasing your olive oil. First, check that it’s in an opaque container, Zumpano says, which helps preserve the oil by protecting it from exposure to light.

And check for the harvest date on the bottle, Derocha adds. “Olive oil is best consumed one to two years from the harvest date on the package,” she explains. “And if it doesn’t have a harvest date, that also tells you something.”

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Liraglutide lowered body mass, slowed weight gain and improved health markers in kids ages 6 through 11, according to research presented Tuesday at a medical conference and published in the New England Journal of Medicine.

Based on the results of the trial, drugmaker Novo Nordisk has asked U.S. regulators to expand use of the medication for kids in that age group, a company spokesperson said Tuesday. If approved, the drug would be the first authorized to treat the most common type of obesity that affects more than 20% of U.S. kids ages 6 through 11, according to the U.S. Centers for Disease Control and Prevention.

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“To date, children have had virtually no options for treating obesity,” said Dr. Claudia Fox, a pediatric obesity expert at the University of Minnesota who led the study. “They have been told to ‘try harder’ with diet and exercise.”

Side effects were common among those given the drug, particularly gastrointestinal effects such as nausea, vomiting and diarrhea. And experts said doctors and parents would need to carefully consider those risks and the lack of data about the long-term use of such drugs in young kids.

“Having a medication for that age group, if approved, would be a really nice tool to have, but we’re also going to have to be careful about how widely we start using it,” said Dr. Melissa Crocker, a pediatric obesity specialist at Boston Children’s Hospital who wasn’t involved in the study. “And I would answer that differently at 6 than I would at 11.”

Liraglutide is in a class of so-called GLP-1 drugs that include blockbuster medications like Wegovy and Mounjaro. The medications mimic hormones that affect appetite, feelings of fullness and digestion. It’s taken as a daily injection and is approved under the brand name Victoza to treat diabetes in adults and children ages 10 and older and as Saxenda to treat obesity in adults and children ages 12 to 17.

The new study, paid for by Novo Nordisk, included 82 children with a mean age of 10 and a baseline weight of about 155 pounds (70 kilograms). The average starting BMI was 31, above the threshold for childhood obesity. More than half the children had obesity-related health problems such as insulin resistance, asthma or early puberty. The results were presented at the annual meeting of the European Association for the Study of Diabetes in Madrid.

In the trial, 56 children received daily injections of up to 3 milligrams of liraglutide for nearly 13 months, while 26 got dummy medications. The kids were followed for six months afterward.

All the children received individual counseling to help them follow a plan that called for a healthy diet and 60 minutes a day of moderate to high-intensity exercise.

Researchers found that kids who took the drug for more than a year reduced their body mass index — a measure of height and weight that can account for a child’s natural growth – by 5.8%. Children who received the dummy medication saw their BMI increase by 1.6%.

At the same time, children who received the drug slowed weight gain to 1.6% of their body weight during that period, compared with a 10% gain for those who got sham drugs.

The study found that 46% of kids who got the drug lowered their BMI by at least 5%, an amount that has been linked to improvements in health problems tied to obesity. In kids who received placebo, 9% met that mark. Lower measures of blood pressure and blood sugar were detected in children who received the drug, researchers noted.

Side effects, mostly mild to moderate, were reported in nearly 90% of both groups of participants. Gastrointestinal side effects including nausea and vomiting were reported in 80% of kids who received the drug, compared with 54% who received sham medications. Serious side effects were reported in seven children using liraglutide and two who took placebo. Six participants taking the drug left the trial because of the side effects, while no one taking placebo stopped treatment.

In the six-month follow-up, children in both groups who stopped treatment increased BMI and gained weight, the study found. The trial has been extended to include more treatment and follow up, with results expected in 2027.

Fox receives research funding from Novo Nordisk and drugmaker Eli Lilly paid directly to her institution. Those companies are also conducting trials with more powerful weekly injections of Novo’s Wegovy and Lilly’s Zepbound in kids as young as 6.

Dr. Alaina Vidmar, a pediatric obesity specialist at Children’s Hospital Los Angeles who wasn’t involved in the new study, said she has used liraglutide off-label to treat young kids and would welcome approval of the drug to increase flexibility and access.

The drug treats the underlying physiology of obesity, which is a complex, chronic disease that can occur at any age. Early use can prevent obesity and life-threatening health problems from extending into the teen years — and adulthood.

“We want these kids to have long, healthy lives,” Vidmar said. “The sooner that we can start, the more likely we can stop them from getting early onset diabetes, early onset heart disease, sleep apnea, all of those things. Doing nothing is not the right answer.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Scialfa shared the news in “Road Diary: Bruce Springsteen and the E Street Band,” which premiered at the Toronto Film Festival on Sunday, Sept. 8, according to Variety.

“This affects my immune system, so I have to be careful what I choose to do and where I choose to go,” the 71-year-old said in the film. “Every once in a while, I come to a show or two, and I can sing a few songs on stage, and that’s been a treat. That’s the new normal for me right now, and I’m OK with that.”

Variety reported Scialfa didn’t attend the premiere for the documentary. The current state of her health and whether she is receiving treatment for her myeloma is unclear.  

E Street Band was founded in 1972, nearly two decades before Springsteen and Scialfa married in 1991. In 2014, she, along with the rest of E Street Band, was inducted into the Rock & Roll Hall of Fame.

What is multiple myeloma?

The cancer Scialfa was diagnosed with, multiple myeloma, creates cancerous plasma cells in the bone marrow, which prevent the body from producing antibodies and reducing the ability to fight off infection, per Mayo Clinic. It’s not clear what causes it and there’s no cure.

Not everyone with multiple myeloma receives treatment. In some cases, if the cancer is not progressing and not causing symptoms, doctors may opt for a wait-and-see approach. It’s not clear if Scialfa needed or still needs treatment for her myeloma.

Symptoms of multiple myeloma include:

• Bone pain, especially in the hips, spine or chest
• Digestive issues, such as nausea, constipation and loss of appetite
• Mental issues, such as tiredness and brain fog
• Infections
• Weight loss
• Weakness
• Thirst and needing to pee more than usual

The cancer is more common in people in their late 60s, as well as men, Black people and those with a family history of multiple myeloma. Treatments, if needed, include immunotherapy, CAR-T cell therapy, chemotherapy, bone marrow transplant, radiation and more.

Between 42% and 82% of people diagnosed with multiple myeloma survive for four years or more, according to Cleveland Clinic.

Bruce Springsteen’s health issues

Scialfa isn’t the only band member who’s had to deal with illness. In 2023, Springsteen revealed health issues of his own. The “Born to Run” singer announced via X that he and the E Street Band would be postponing their shows because Springsteen had a peptic ulcer.

In 2024, he announced via Instagram that he’d be postponing additional concert dates until the following year on doctor’s orders due to “vocal issues,” TODAY.com reported at the time.

A few months later, Springsteen shared additional details about the ordeal with SiriusXM’s E Street Radio. “When I had the stomach problem, one of the big problems was that I couldn’t sing,” Springsteen said. “You sing with your diaphragm. My diaphragm was hurting so badly that when I went to make the effort to sing, it was killing me. So, I literally couldn’t sing at all.”

Springsteen’s also gotten candid about his mental and physical health. In 2012, Springsteen told The New Yorker that he’d dealt with “intervals of depression.” Scialfa added that therapy has helped him.

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But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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Levine, a 53-year-old executive assistant, tied the knot in 2014 and broke the union a little less than two years later.

For a slew of Lifetime movie-like reasons – infidelity, secret children, green cards, and her own general unhappiness – she knew she didn’t want to be married to her then-husband anymore. 

While the decision to leave was difficult, the action itself was liberating, she says. That’s why she wanted to throw a “divorce party.” 

“Filing for divorce is an act of freedom,” Levine says. “Why should I not celebrate one of the bravest choices I’ve ever made for myself?” 

Divorce party invites reached an all time high last year, according to data from Evite. 

The increase signals that more people are recognizing and even cherishing non-traditional milestones, says Olivia Pollock, Evite’s party data analyst. 

“The trend highlights a shift towards using celebrations to transform life transitions into positive experiences,” Pollock says.

It’s not just divorces. Americans are throwing parties for paying off debt, breast reductions, vasectomies, and other major life events. This is likely contributing to the 5% increase in all celebrations Evite has seen this year.

“Just like we celebrate weddings, birthdays, and anniversaries, it makes sense that divorce is being recognized and celebrated, too,” Pollock says.

It also helps that divorce holds less stigma than it once did. And why not have a little fun for a process that costs, on average, more than $11,000?

‘Divorce is more commonly accepted as a natural life event’

American views on both marriage and divorce have become less rigid. More than half, 55%, of adults say couples stay in bad marriages too long, according to data from Pew Research Center. 

Marriage itself has also lost some of its allure: 71% of adults say that having a job or career you enjoy is important to having a fulfilling life, according to data from Pew Research Center. Only 23% say the same of marriage. 

“Nowadays, divorce is more commonly accepted as a natural life event, and people are looking for positive ways to mark the end of a marriage,” Pollock says. 

It is mainly women who throw divorce parties, according to Evite data. 

Levine feels as though societal pressure corners women into unsuccessful marriages. 

“Women are more likely to stay in a situation that isn’t great for them,” she says. “They are so scared of a failed marriage. You leave jobs if you’re unhappy. You wouldn’t stay in a restaurant and eat rotten steak to make someone happy. It’s OK to walk away.” 

The societal assumption that ending a marriage is terrible often doesn’t resonate with the people actually doing it, says Lisa Marie Bobby, a relationship psychologist and founder of Growing Self Counseling & Coaching in Denver.

“There is a narrative in our culture that divorce is this shameful thing and the reality is that is not true,” Bobby says. “Many people experience it as a very, very positive thing that is associated with their freedom and ability to be empowered and have the life they want.”

Divorce parties can signal to others that this is a decision you take pride in.

“When you have a party to celebrate the fact that you are getting a divorce you are sending a powerful message to the world and yourself saying, ‘I am so excited about this,'” Bobby says.

‘It was incredibly therapeutic’

Because separations drum up a range of emotions, divorce parties can sour quickly. That’s why Levine set out a roster of rules to ensure she and her guests had a good time.

These included don’t bring up the ex, you can drink but don’t get too drunk, and pick a bar that you don’t associate with your former spouse. 

“I relied on my best friend to spread the vibe that I don’t want to talk about unpleasantries, and if you want to bring a gift that’s cool because I deserve some,” Levine says. 

She threw the party not only to commemorate the end of an unhealthy partnership, but to thank the community of people who helped her navigate a tough situation. 

“It was also to celebrate all my friends for still liking me after listening to all this crap for months,” she says. “They had a front row seat and were like, ‘Oh my god, please leave this person.’ It wasn’t just for me, it was for everyone around me.” 

While she doesn’t want to get married again, Levine says she would not hesitate to throw another divorce party: “It was incredibly therapeutic.” 

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“I realized I hadn’t properly supported my postpartum friends,” Rogers, now a mom of two, tells TODAY.com. “I gave them baby gifts, but what they needed was for me to show up for them. It’s one of those things that you don’t understand until you’re in it yourself. You have no idea what they’re going through.”

It’s a topic “Conversations With Cam” podcast host, 33, addressed in a recent Instagram video.

“I get asked a lot, what is the best gift you can give someone postpartum,” Rogers explained in the clip. “The number one thing is always food, but this is my number two.”

Moments later, a text message appears on the screen.

The message reads:

“Good morning love! I am yours from the hours of 12 to 3 tomorrow so please let me know how you would like to use me. Here are some options: 

1. I come while you hang with the baby and I do laundry, bottles, cooking, buy and put away groceries.

2. I come and take care of the baby while you sleep in your room alone or you go do something by yourself or you guys go out to lunch the two of you without the baby.

3. I come and take you out to lunch with or without the baby.

4. And we sit on the couch and just chat or watch a funny movie with the baby.

You can decide whenever you want just let me know!”

Rogers tells TODAY.com that her bleary-eyed friend chose option No. 2: sleep.

“She napped for four uninterrupted hours,” Rogers says. 

According to Rogers, the key is to give a variety of choices.

“When you’re in that newborn bubble and someone asks, ‘How can I help?’ You’re going to have analysis paralysis. It’s, like, where do I even begin?” Rogers explains.

The podcast host was inundated with comments. 

“As someone with no kids now, but with friends who have kids, and I’m sure more to come, THANK YOU,” one person wrote.

Other reactions included: 

• “Loooooove this. One other option that I would have loved postpartum is a friend to come over and watch the baby while I shower/get ready and then take cute pics of me and baby together.”
• “I also always wished someone would walk our German shepherd for us! I was healing so I couldn’t and my husband was busy helping take care of me and baby and toddler.”
• “YES!!!! Also I had someone reach out and say I’d love to make a meal, planning to bring over Monday if that works. Here’s a list of things I could make, tell me what sounds best… 1) roast chicken and potatoes, 2) salmon with dill and orzo, etc etc etc… it was so nice to say, ‘Yes Monday works and I’ll take option 3!’”
• THIS RIGHT HERE. Be specific in your offers of help and you will exponentially increase the likelihood they’ll take you up on it and that they’ll really feel the impact and benefit of it.
• “I’ve said, ‘Hey I’m making you dinner this week, Monday or Wednesday, soup or enchiladas?’ They’ll never answer if you say, “Let me know if you need anything.'”

This article first appeared on TODAY.com. Read more from TODAY here:

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Health officials said that botulism is a rare illness that can be spread through food or wounds.

Léelo en español aquí

“Botulism is rare, but it is a serious illness and is always considered an urgent medical matter,” said Camden County Health Officer Dr. Paschal Nwako. “It is important to note that botulism is not contagious and cannot spread from person to person, but the Health Department will continue to monitor the situation and investigate this case.” 

It is caused by a bacteria called “clostridium botulinum” and is related to a bacteria that can attack the body’s nerves, officials explained.

Symptoms of botulism:

• Difficulty swallowing
• Muscle weakness
• Double vision
• Drooping eyelids
• Blurry vision
• Slurred speech
• Difficulty breathing
• Difficulty moving the eyes

Symptoms of foodborne botulism include:

• Vomiting
• Nausea
• Stomach pain
• Diarrhea

Botulism symptoms in an infant:

• Constipation
• Poor feeding
• Drooping eyelids
• Pupils that are slow to react to light
• Face showing less expression than usual
• Weak cry that sounds different than usual

The CDC has more information on botulism on the website.

For more information on botulism from the New Jersey Department of Health, click here.

Black women are more than three times as likely to die from pregnancy or childbirth as white women in Oklahoma, which consistently ranks among the worst states in the nation for maternal mortality.

“Tulsa is suffering,” said Corrina Jackson, who heads up a local version of the federal Healthy Start program, coordinating needed care and helping women through their pregnancies. “We’re talking about lives here.”

Across the nation, programs at all levels of government — federal, state and local — have the same goals to reduce maternal mortality and erase the race gap. None has all the answers, but many are making headway in their communities and paving the way for other places.

Jackson’s project is one of more than 100 funded through Healthy Start, which gave out $105 million nationally in grants this year. Officials call Healthy Start an essential part of the Biden administration’s plan for addressing maternal health.

Other approaches to the crisis include California halving its maternal mortality rate through an organization that shares the best ways to treat common causes of maternal death and New York City expanding access to midwives and doulas two years ago. Several states passed laws this year aiming to improve maternal health, including a sweeping measure in Massachusetts. And last week, the U.S. Department of Health and Human Services announced more than $568 million in funding to improve maternal health through efforts such as home visiting services and better identifying and preventing pregnancy-related deaths.

Locally and nationally, “we need to really identify the birthing people who are at potentially the greatest risk,” New York City health commissioner Dr. Ashwin Vasan said, “and then wrap our arms around them throughout their pregnancies.”

A Healthy Start in Tulsa

Besides coordinating prenatal and postpartum care — which experts say is crucial for keeping moms alive — local Healthy Start projects provide pregnancy and parenting education and referrals to services for things like depression or domestic violence. The local efforts also involve women’s partners and kids up to 18 months. And they focus on issues that influence health, such as getting transportation to appointments.

“You try to get them in their first trimester and then work with them to delivery day, and then we also work with the babies to make sure that they reach their milestones,” Jackson said.

Jackson got help from the local Urban League as a single mom, and felt called to give back to her community. She’s been with Healthy Start for more than 25 years, first through Tulsa’s health department and recently through a nonprofit she started that received about $1 million in federal funds this fiscal year.

“I’m just like a mom to this program,” Jackson said.

Oklahoma overall has a maternal mortality rate of about 30 per 100,000 live births, significantly higher than the national average of about 23. But in Jackson’s quarter-century tenure, she said, there have been no maternal deaths among clients.

Pivotal to Healthy Start’s success are care coordinators like Krystal Keener, a social worker based at Oklahoma State University’s obstetrics and gynecology clinic, where clients get prenatal care. One of her responsibilities is to educate clients about health issues, like how to spot the signs of preeclampsia or how much bleeding is too much after delivery.

She also helps with practical matters: Many clients don’t have cars, so they call Keener when they need a ride to a prenatal visit, and she assists in scheduling one.

With doctors, Keener serves as a patient advocate. On a recent afternoon, Keener sat in on a prenatal appointment for Areana Coles. A single mom, Coles was joined by her 5-year-old daughter, who was born prematurely and spent time in intensive care.

Coles, 25, said Healthy Start is “probably the best thing that’s happened in this pregnancy.” She called Keener “an angel.”

Together they navigated several recent medical concerns, including dehydration and low potassium levels that put Coles in the hospital.

With Coles’ due date approaching, Keener talked about what to watch for around delivery and shortly after, like blood clots and postpartum depression. She advised Coles to take care of herself and “give yourself credit for small things you do.”

During an ultrasound a few minutes later, Coles watched Dr. Jacob Lenz point to her unborn baby’s eyes, mouth, hand and heart. He printed an image of the scan, which Coles immediately showed her daughter.

Keener said she’s gratified that Coles would not be giving birth prematurely this time.

“You made it to term – yay!” she told her client.

Coles smiled. “My body can do it!”

Improving medical care

While programs like Healthy Start focus on individual patient needs, other efforts manage the overall quality of medical care.

California has the lowest maternal mortality in the nation — 10.5 per 100,000 live births, less than half the national rate. But that wasn’t the case before it created a “maternal quality care collaborative” in 2006.

Founded at Stanford University’s medical school in partnership with the state, it brings together people from every hospital with a maternity unit to share best practices on how to deal with issues that could lead to maternal injury or death, like high blood pressure, cardiovascular disease and sepsis.

“When you look at the rate of maternal death in the United States compared to California, they basically ran neck-and-neck until it was established,” said Dr. Amanda Williams, clinical innovation adviser for the collaborative. “At that time they totally separated and California started going down. The rest of the country started going up.”

In the collaborative, hospitals get toolkits full of materials such as care guidelines in multiple formats, articles on best practices and slide sets that spell out what to do in medical emergencies, how to set up medical teams and what supplies to keep on the unit. The collaborative also tackles issues such as improving obstetric care by integrating midwives and doulas – whose services are covered by the state’s Medicaid program.

At first, some doctors resisted the effort, figuring they knew best, Williams said, but there’s much less pushback now that the collaborative has proven its value.

MemorialCare Miller Children’s & Women’s Hospital Long Beach started participating around 2010. The collaborative helps “vet through all the research that’s out there,” said Shari Kelly, executive director of perinatal services. “It’s just so important to really understand how we as health care providers can make a difference.”

For example, if a woman loses a certain amount of blood after a vaginal delivery, “we know to activate what we call here a ‘code crimson,’ which brings blood to the bedside,” Kelly said. “We can act fast and stop any potential hemorrhage.”

She said the collaborative has also helped reduce racial inequities — bringing down the rate of cesarean sections among Black moms, for example.

In July, U.S. Centers for Medicare & Medicaid Services proposed a similar initiative to California’s, focused on the quality of maternal care nationwide: the first baseline health and safety requirements for maternal emergency and obstetric services in hospitals.

A community perspective

Experts said getting maternal mortality under control at a national level requires tailoring solutions to individual communities, which is easier when programs are locally run.

New York City has a goal of reducing maternal mortality overall — and specifically achieving a 10% drop in Black maternal mortality by 2030. Statewide, Black residents are about four times more likely to die from pregnancy or childbirth than white residents.

The city is starting with, among others, low-income residents and those living in public housing. The New Family Home Visits Initiative gives pregnant people and those who’ve given birth visits from professionals such as nurses, midwives, doulas and lactation consultants. Vasan said more than 12,000 families have gotten visits since 2022.

Nurse Shinda Cover-Bowen works for the initiative’s Nurse Family Partnership, which has her visiting some families for 2 1/2 years, well beyond the pregnancy and birth. She said “that consistency of someone being there for you and listening to you and guiding you on your mother’s journey is priceless.”

Being grounded in the local community — and its history — is also crucial for Healthy Start projects. The lingering effects of racism are evident in Tulsa, where in 1921, white residents are estimated to have killed 100-300 Black people and destroyed homes, churches, schools and businesses in the Greenwood section. That’s where Jackson lives now, and where health disparities persist.

Being relatable is valuable for Black women, who may distrust the health care system, Jackson said. Plus, knowing the community makes it possible to work closely with other local agencies to meet people’s needs.

Denise Jones, who enrolled in Healthy Start in February, has struggled with anxiety, depression and drug addiction, but has been sober since April.

In mid-July, baby items filled her room — a crib, a bassinet, tiny clothes hanging neatly in a closet — in anticipation of her child’s arrival. Jones, 32, flipped through a baby book, pointing to a sonogram of her son Levi, who would be born within a couple of weeks.

She said she feels healthy and blessed by the help she’s gotten from Healthy Start and Madonna House, a transitional living program run by Catholic Charities of Eastern Oklahoma.

“I have professionals that are working with me and give me support. I didn’t have that with my other pregnancies,” she said. “I’m at one with my baby and I’m able to focus.”

___

Associated Press data journalist Nicky Forster in New York contributed to this report.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

It was the first time any living human had received a pig organ transplant.

“You never know what the news is, but my dad opened his eyes, and he was awake, and he was doing well. It was incredible,” Bennett Jr. said.

Bennett’s father, David Bennett Sr., had severe congestive heart failure and wasn’t a candidate for a human transplant. He knew he would likely die soon. There was nothing more to do — other than take a chance on a novel, cutting-edge surgery. Bennett Sr. and his son agreed it was worth the risk.  

The achievement made headlines around the world after the transplant surgery in January 2022. The results at first seemed promising, and some family members even began to entertain the idea that Bennett Sr. might eventually leave the hospital.

“There were definitely futuristic conversations, just about home setup and who was going to take care of him and how that would look,” Bennett Jr. said. “Everybody was very optimistic and hopeful.”

But two months later, Bennett Sr.’s body rejected the heart and he died at age 57. In a paper, his doctors at the University of Maryland Medical Center explained that his body had likely produced too many antibodies that fought off the new organ. A drug he’d been given may also have increased the odds of rejection, and a virus in the pig heart further complicated matters. 

Three other patients have followed in Bennett Sr.’s footsteps and received pig organs, most recently a pig kidney transplant in April. Together, they represent the pioneer patients of the burgeoning field of xenotransplantation. For their families, three of which spoke to NBC News about the experience, the journey came with a roller coaster of emotions, from uncertainty to blind hope — and, ultimately, admiration for their loved one’s decision. 

“I would love to still have my dad here, obviously, but I know that his sacrifice wasn’t for nothing,” Bennett Jr. said.

None of the patients survived more than three months. To the public, that might seem like failure. But to the families, the transplants accomplished their goals: to buy their loved ones more time and advance research that could potentially save lives one day.

“Larry approached it in this way: He was going to die. It was inevitable, and it was coming soon,” said Ann Faucette, whose husband of nearly 38 years, Lawrence Faucette, was the second person to receive a pig heart. “So why not offer up his body as a test subject for them to get as much data, do as much research as they could, so in the future there’s that other option for people who need those transplants?”

The promise of xenotransplants lies in the shortage of available human organs. An estimated 17 people die in the U.S. each day waiting for an organ transplant, according to the Health Resources and Services Administration. Because pig organs are more readily available, doctors envision a future in which these operations are as common as a hip replacement. 

But at this early stage, the Food and Drug Administration has only approved xenotransplants for patients on the verge of death with no other options. 

Like Bennett Sr., Lawrence Faucette qualified for a pig heart because he was dying of heart failure. Ann Faucette said that after the surgery, her husband was able to play cards and do physical therapy on an exercise bike. It was a contrast to the day before the surgery, when his heart had stopped and needed to be revived with an internal defibrillator. 

“We’re having full-on conversations. We’re watching football,” Ann said. “It’s like normal life, as normal as it can be in a hospital.”

She focused on the positives: “I was in denial. This was going to work. He was going to get better. He was going to come home,” Ann said.

Her two sons, now 29 and 31, “saw that the end could be at any point, so they made sure that they told Larry how they felt,” she added — that they loved him.

At her husband’s request, Ann bought a new chair for their house in Frederick, Maryland, in preparation for his return. The day it was delivered, she learned his condition had worsened.

“While I’m waiting for the chair, I get the call that they want to put Larry on ECMO,” she said, referring to a life-support device.

He died of transplant rejection roughly two weeks later, less than six weeks after the surgery. 

His doctors said Faucette’s recovery was complicated by the fact that his strength had declined shortly before the operation. 

The two xenotransplants after that followed a similar pattern: After surgery, the patients began to feel much better, then suddenly worsened after several weeks.

Brittany Harvill’s mother, Lisa Pisano, received a genetically modified pig kidney in April. Within a week, she had noticeably improved, Harvill said.

“She’s like, ‘I feel great.’ You could see the color in her face,” she said. “She looked like a whole new person.”

Before the surgery, Pisano could hardly walk due to shortness of breath and extreme fatigue. She had heart and kidney failure, so her surgery was more complicated than the others: Doctors implanted a mechanical heart pump eight days before the pig kidney. After the surgery, Pisano seemed more alert than ever, according to Harvill. She FaceTimed her grandchildren from the hospital, watched cooking shows and hung out with her daughter.

“I would bring pictures and then we would talk about what the kids were up to,” Harvill said.

But the demands of the transplant proved too much for Pisano’s other organs. Doctors prescribed blood-pressure medication, but it ultimately led to the rejection of the kidney. Pisano died in hospice care on July 7, around 12 weeks after the transplant.

Harvill said her mom was confident in her decision, but she still wishes Pisano had lived long enough to see her granddaughter, Olivia, go off to kindergarten.

“One thing that upsets me is that my mom would have loved to be there for that,” she said through tears.

Harvill believes the kidney transplant “100% would have worked” had it not been for her mom’s heart issues.

“Now I think the doctors definitely know, people that are as sick as my mom maybe aren’t the best people to do it,” she said.

Indeed, the surgeons who’ve done the xenotransplants and other experts in the field say these first four patients were not ideal candidates, since those on death’s door are likely to be too weak to support a new organ.

“If we could choose patients who are much more likely to do well, then we’d get a better idea about how successful it’s going to be,” said Dr. David Cooper, a physician investigator of transplant surgery at the Massachusetts General Research Institute, who did not perform any of the operations.

But for the FDA to approve such a transplant in a healthier patient, Cooper said, the agency wants to see more consistent one-year survival in studies done in animals. Privately, doctors had hoped that would be the case for the human patients. 

“We hoped for six months, and maybe a year. Out of ignorance, we felt our animal data supported that. We actually thought we’d do better in the humans,” said Dr. Bartley Griffith, clinical director of the cardiac xenotransplantation program at the University of Maryland School of Medicine, who operated on Faucette and Bennett Sr.

The only xenotransplant patient who recovered enough to return home was Rick Slayman, who received a pig kidney at Massachusetts General Hospital in March. He had terminal kidney disease, diabetes, high blood pressure and heart disease. 

Slayman’s family declined to be interviewed. According to his surgeon, Dr. Tatsuo Kawai, the dialysis Slayman had required before the transplant was no longer needed afterward, and his only struggle was climbing the three flights of stairs to his apartment.

Still, Slayman died less than eight weeks after his surgery, from what doctors suspect was a fatal arrhythmia. An autopsy showed that his heart disease was more advanced than his doctors had thought.

“The autopsy didn’t show any rejection or any abnormality in the kidneys, so in terms of transplant, we think this was successful,” said Kawai, who directs the Legorreta Center for Clinical Transplant Tolerance at Mass General.

The Bennett, Faucette and Harvill families do not regret their loved ones’ participation in the experimental transplants. Each saw any extra time as a gift, and they remain optimistic about xenotransplantation’s potential. Harvill compared the situation to the first human heart transplant in 1967. That patient died after 18 days, but thousands of such transplants are now performed in the U.S. each year.

The families are also aware of how much doctors learned from each surgery.

“The excitement in their voices and on their faces when they talk about the data that Larry was able to give them … it makes me grateful,” Faucette said.

On her wedding anniversary, she baked around 500 cookies for the hospital’s nursing staff.

Dr. Robert Montgomery, who did Pisano’s surgery and directs the NYU Langone Transplant Institute, said many people on the transplant waiting list are interested in a xenotransplant.

“I can’t tell you how many people call my office every week who want this. That’s what I think is underappreciated, is how desperate people are,” he said.

All of the researchers are eager to try another transplant as soon as they can find the right candidate and get FDA approval.

“We are at a place now where we feel 100% better informed,” Griffith said. “Whether that’ll translate to our next patient living a year, we’re not sure, but we moved from total ignorance to a really good idea of what our enemy is.”

This article first appeared on NBCNews.com. Read more from NBC News here:

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Wright, a Purple Heart recipient and a retired U.S. Army Staff Sergeant, received in-patient treatment in 2013 for post-traumatic stress disorder and anxiety.

“I wasn’t participating with them because I didn’t trust them,” Wright tells TODAY.com of his care team.

He eventually decided to start doodling during sessions to pass the time.

“Next thing you know, they were like the meeting is over. And I’m like, ‘OK, that’s crazy. It went by so fast.’ And they were like, ‘Today was a great day for you. You were talking. You were expressing yourself.’ I found out the whole time I was drawing, I was talking and engaging with the people,” Wright recalls.

After he completed his in-patient care, Wright says he went to get a tattoo. He had a good experience with the artist, who was also a friend who encouraged him to become a tattoo artist.

“Maybe I can do this,” Wright remembers thinking to himself. “I knew (that) I knew how to draw. I’ve been drawing since I was probably 2 years old. I bought a little kit. Never turned around.”

Wright has more than 100 tattoos himself and has given out thousands to people across the country to advance his mission of bringing mental wellness through tattoos.

His business, Marzmade Mobile Tattoo Studio, is based in New Jersey. He has a parlor in his home and a converted bus he uses to bring tattoos to people. He’s also on TV, with appearances in “Power Book III: Raising Kanan” and “Black Ink Crew: Chicago.”

Wright is among a cohort of veterans living with PTSD and anxiety. A 2024 study published in the Journal of Psychiatric Research estimated that 3 in 10 U.S. veterans report anxiety symptoms. According to the U.S. Department of Veterans Affairs, that 7% of veterans experience PTSD at some point in their lives.

For fellow veterans, Wright offers free tattoos so they can experience the lightbulb moment he did through art. He has given away more than 1,000 tattoos to them.

“I saw the correlation of tattooing and trauma, and I know about the trauma we have, especially when we get out,” Wright says. “I have tattoos over battle scars, and I’ve also tattooed over battle scars.”

Wright says most of the veterans he inks get tattoos in honor of their military service, and they trade war stories during the session.

“I can talk to you about the things you’re going through because I’ve been through it … as well as giving you a dope tattoo,” he adds.

Wright’s approach is clinically sound, experts say.

‘Reintegrate that painful memory’

Chase Cassine, a licensed clinical social worker in New Orleans who has worked with veterans, describes Wright’s work as “reintegration through tattoo therapy.”

“This is beneficial to both the tattoo artist and the person receiving the tattoo,” Cassine tells TODAY.com

“The tattoo is a symbol. The tattoo can also symbolize being a part of a group, being a part of a status, being able to commemorate a memory. But, also in that memory may be (another) painful memory. So you talk about what has happened and you can reintegrate that painful memory to a meaningful memory as a way to take back your power,” Cassine explains.

Tattoo therapy with Wright was particularly effective for Matt Davies, a Navy veteran who received a tattoo from Wright in 2020. Davies, who lives with PTSD, says he previously saw licensed therapists whom he did not find helpful.

“It felt more comfortable to talk with Daniel about the things that had happened to me than … with a licensed therapist because most therapists that you go to with the VA have no military background, so you’re speaking one language and they’re speaking another,” Davies says.

“It does get frustrating when you’re trying to convey what is happening, and you’re using terms that only a service member would use,” Davis adds. “This makes the ability to talk about it so much easier.”

‘Mimicking wartime adrenaline’

There’s also the physical side of getting a tattoo that helps, Wright and Cassine say.

“In the process of (getting) that tattoo, your adrenaline is so high that it’s mimicking wartime adrenaline,” Wright says. “When you were in wartime, you saw things. You smelled things. You heard things. Just think about it like this lid was opened and all of these smells and sensory things were put into your jar, and then it closed when you left wartime. And you’ve never had that much adrenaline to open it up again. I’m giving you that adrenaline to open a jar, and we’re talking about it to help release it.”

Davies says tattoo therapy helped him unlock “answers” he hadn’t previously known.

“When I went to meet with Daniel, we started talking about our time in the service, which led into a deeper conversation as to the things that we miss, the traumas that are associated with being in the service and also acclimating to life outside of the military,” Davies says.

“I believe my session was around five hours long, and we talked the entire time. It was very profound because I was able to finally feel like I got answers and not feel so alone or isolated with my feelings,” Davies adds.

Raising awareness of tattoo therapy

Wright mainly uses social media and digital platforms to advertise the free tattoos that he offers veterans. He has interested veterans enter a raffle and the winner gets the tattoo.

Davies says social media is how he heard about Wright. Davies won the raffle and they “hit if off” from there.

Cassine says tattoo therapy is a novel way to have impactful mental health conversations that actually land with the person.

“It may not be traditional, and sometimes we’ve got to get out of that framework, too. They have found therapeutic ways to help them cope with stress, with faith, with love, with trauma — tattoo therapy, speaking therapy, all these different things,” Cassine says.

There are other shops offering tattoo therapy, such as Tattoo Therapy BK and Therapy Ink NYC.

But Wright appears to be one of the only artists offering free tattoos for veterans.

“Everybody says the military is a band of brothers and sisters, and that is true,” Wright says. “But, when you get out or retire, it’s like you’re out of sight, out of mind. Everybody forgets about you. It’s not the same camaraderie you had every day. And that is one of the biggest traumas we deal with. I started bridging that gap.”

This story first appeared on TODAY.com. More from TODAY:

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The buzzing insects are more than annoying — they spread disease. When they bite and drink blood from a person or animal they can pick up viruses or germs, too. If they can go on to bite someone or something else, they deposit the germ right under the skin.

People in some areas of Massachusetts have been warned to stay indoors when mosquitoes are most active after a rare case of eastern equine encephalitis was discovered. And Dr. Anthony Fauci, the former top U.S. infectious disease expert, was recently hospitalized after he came down with West Nile virus.

Both are nasty diseases spread by mosquitoes — though thankfully they are relatively rare.

The best way to avoid getting sick is of course to avoid getting bitten, which means taking steps like using repellent, wearing clothing with long sleeves and long pants and staying indoors when the mosquitoes are out. Local health departments also work to reduce mosquito numbers, including spraying neighborhoods with insecticide. Authorities in Massachusetts are using trucks and planes this week to spray vulnerable areas.

Here’s a look at some common — and not so common — mosquito-borne diseases.

Health Jun 25

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Aug 24

A rare but deadly mosquito virus infection has Massachusetts towns urging vigilance

Eastern equine encephalitis

Most people infected with eastern equine encephalitis don’t develop symptoms, but some can come down with fever or swelling of the brain and about one third of people infected die.

There have been three cases of eastern equine encephalitis in the U.S. this year, according to the U.S. Centers for Disease Control and Prevention, one each in Massachusetts, New Jersey and Vermont.

The worst year for the disease was 2019, with 38 cases. It is caused by a virus and is not very common around the world. The virus typically spreads in certain swamps, including red maple and white cedar swamps in Massachusetts.

West Nile virus

About two in 10 people infected with West Nile virus develop symptoms, which can include fever and swelling of the brain. About one in 10 people who develop severe symptoms die.

There have been 216 West Nile cases so far this year. West Nile virus was first reported in the U.S. in 1999 in New York. It gradually spread across the country. In 2003, there were nearly 10,000 cases.

Malaria

Malaria infected nearly 250 million people globally in 2022 and killed more than 600,000, mostly children. Approximately 2,000 malaria cases are imported into the United States annually, mostly among U.S. residents with recent travel to areas with endemic malaria, according to the CDC. In 2023, the CDC identified nine cases of malaria that people contracted in Texas and Florida — the first documented cases of local infection in the U.S. in 20 years.

It is caused by a parasite carried by mosquitoes and mainly infects people in tropical regions, especially Africa. A vaccination campaign has been launched in recent months that health officials hope will help reduce cases and deaths.

Dengue

Also known as “break-bone fever” because it can be so painful, dengue is becoming more common. The World Health Organization says that about half the world’s population is at risk of getting the disease, and there are 100 million to 400 million infections every year. Not everyone gets symptoms, which can include fever, severe headaches and pain in the muscles and joints. Severe cases can involve cause serious bleeding, shock and death.

Most U.S. cases are in people who have traveled to other countries, though the CDC says there have been about 2,600 locally acquired cases so far this year.

There are four types of dengue virus, simply known as 1, 2, 3 and 4. When someone is first infected, their body builds antibodies against that type for life. If they get infected with another type of dengue, the antibodies from the first infection may fail to neutralize the second type — and actually can help the virus enter immune cells and replicate.

The state regulations that do exist are relatively new and the U.S. Environmental Protection Agency (EPA) recently released new standards. The NBC10 investigators went across the tri-state region looking at how towns and schools are handling the contamination of PFAS, or forever chemicals. We found residents trying to come up with their own ways to keep the pollution out of the water they drink– all while their towns and water operators struggle to meet their own state standards, plus the ticking clock of the new federal standards.

What are PFAS?

Per- and polyfluoroalkyl substances, referred to simply as PFAS or forever chemicals, are man-made chemicals that were used to create firefighter foam, non-stick cookware, and stain-resistant materials. They don’t easily break down in the environment, hence the term “forever.”

According to the EPA, PFAS exposure can lead to decreased fertility, reduced immunity, increased risk of cancer, and developmental delays in children.

The EPA announced earlier this year that all water systems across the country would have to test for PFAS by 2027. The agency is requiring that water operators meet the new standards set for five types of forever chemicals by 2029. The new limits are 4 part per trillion for PFOA and PFOS and 10 parts per trillion for PFNA, PFHxS, and HFPO-DA.

How much is a part per trillion?

One part per trillion is the equivalent of one drop in 20 Olympic-sized swimming pools. 

The following stories on “forever chemicals” will air on NBC10 this week:

‘Forever chemicals’ in Emmaus, Pennsylvania

The sleepy town of Emmaus, Pennsylvania, woke up one Fall day in 2021 to find out the levels of forever chemicals in its water was 10 times the federal health advisory limit at the time. Township officials jumped into action, shutting down the most polluted well. But they had to leave the second contaminated well open because of concerns over enough water to supply the town. A plan to purchase a filter to remove the contaminants came to halt when the state stepped in. Three years later, this town is still reeling with the forever chemical contaminant problem. A solution is still years away. We explain why– and how it may be a lesson for other cities about to confront this situation.

‘Forever chemicals’ in Pennsylvania schools

This is the first year Pennsylvania water systems, including schools with their own wells, have to test for PFAS. The first and second quarter results showed elevated levels at three school districts in our Southeast Pennsylvania region. The NBC10 Investigators found that some parents didn’t know about the elevated levels until we told them. And two of the districts only told parents once we started asking questions. School leaders deferred to the state Department of Environmental Protection about not having to tell parents and staff. But should they? We speak with a children’s health and PFAS expert about the risk for children consuming contaminated water. Plus, what are the districts doing? 

'Forever chemicals' in New Jersey

Following news of other South Jersey towns having forever chemical contamination in their water systems, Brooklawn managers tried to get ahead of their eventual pollution. They applied and received a $1 million grant to purchase a filtration system that would remove PFAS. By the time their PFAS level violated New Jersey’s standard in late 2022, Brooklawn officials assured residents everything was under control and the matter would be resolved by the start of 2023. However, that didn’t happen. Some Brooklawn residents are now trying to filter the forever chemical themselves with makeshift multi-level home filters. Meanwhile, the level of contamination grew and the township opened an untested well, which could have made the problem worse. But New Jersey officials say that’s how it’s supposed to work. 

'Forever chemicals' in Delaware

Water systems in New Castle County have known about PFAS contamination since 2014 when testing showed incredibly high levels. The two main water systems in the area installed filters to remove the PFAS in the water before it went into people’s homes. But the NBC10 Investigators found that the filters weren’t removing all of the forever chemicals. Some of the so-called “break-through” was at levels above what some states already regulate and well above the newly announced federal limits that will go into effect in 2029. When we raised questions about the levels to the state Office of Drinking Water, the test results were pulled off the website. We met with the water operator in charge of the water plants in question. He offered an explanation that may be beneficial for others about to embark on the filtering journey to hear.

The future of PFAS removal

Since Delaware has already been tackling the forever chemical contamination for a decade, a lot of work is being done there to study better ways of dealing with PFAS. The NBC10 Investigators toured one of the New Castle water plants with a filter to learn about lessons the operators there learned-- and why they are looking to switch to a hybrid filtration model. An engineer for one of the main carbon filtration manufacturers shows us the mini lab he is running to determine the best filtration systems. But the director of the University of Delaware's Water Resource Center points out how expensive it will be for townships to maintain the PFAS treatment. They are forever chemicals after all. He thinks he has a better solution. 

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Fauci, who also served as the chief medical adviser for the Biden administration, was sent home on Saturday and is now recovering, according to his spokesperson. He is expected to fully recover.

The virus first entered the U.S. in 1999, and it has become the leading cause of mosquito-borne disease in the country, per the CDC. 

According to the Department of Health and Human Services, the West Nile virus (WNV) is the most common mosquito-borne disease in the US, and around 2,205 cases are reported each year.

But what is the West Nile virus and what are its symptoms? Here’s what to know

What is the West Nile Virus?

The West Nile virus is a disease that most commonly spreads through mosquito bites, according to the Centers for Disease Control and Prevention.

The virus was first detected in the U.S. in 1999 after two men in New York City tested positive for the virus, which it is believed first arrived in the country through an infected mosquito or bird.

So far, over 200 cases of West Nile have been detected nationwide in 2024, according to CDC data.

What are the symptoms of West Nile virus?

Approximately 80% of the people infected with WNV will not develop any symptoms. 20% will experience mild flu-like symptoms such as fever and less than 1% will develop severe long-term effects which sometimes can be deadly, according to HHS.

The symptoms include:

• Body aches
• Diarrhea
• Fever
• Headache
• Vomiting

Among the most serious complications are meningitis, paralysis or death.

When do West Nile symptoms start to show?

Symptoms generally appear between two to 14 days after being bitten but sometimes it could be several weeks before symptoms show up in immunocompromised people, according to the CDC.

How to cure West Nile virus?

According to the CDC, there is no specific treatment for West Nile virus though doctors usually recommend pain medication for headaches and antiemetic therapy and rehydration to treat nausea and vomiting.

How to protect yourself from West Nile virus?

The best way to protect yourself from West Nile is to dress in loose-fitting clothing that covers arms and legs when outside. Using air conditioning and adding screens to open doors and windows is also recommended.

Most research about HPV’s potential impact on fertility has focused on women. But in recent years, researchers have increasingly expanded their focus to include the infection’s association with male fertility.

A new study from Argentinian researchers has found that the strains of HPV considered high risk because of their links to cancer were not only more common than low-risk strains in a small study population of men, they also appeared to pose a greater threat to sperm quality.

The study, published Friday in Frontiers in Cellular and Infection Microbiology, found that high-risk HPV appears to suppress key components of the immune system in the male genital tract. This could hamper the body’s ability to clear HPV, a process that typically takes about six months to a year after infection, while raising the risk of other infections that may also compromise male fertility.

“Individuals often have no symptoms or signs, yet still carry HPV in the male genital tract,” said the study’s senior author, Virginia Rivero, a professor of immunology at the National University of Córdoba in Argentina.

A 2020 systematic review of 50 studies found that 21% of infertile men had HPV-positive semen, compared with 8% in the general male population. Even after accounting for female infertility, men with HPV in their semen had three-fold greater odds of being infertile than those without the virus.

There are over 200 known strains of HPV. The riskiest handful can cause multiple cancers, including, in the U.S., about 26,000 diagnoses in women and 21,000 in men each year, according to the Centers for Disease Control and Prevention. The most common HPV-driven malignancy is cervical cancer, with about 13,800 invasive cases annually. Research suggests that most people are unaware that the virus can also cause vulval, anal, throat, vaginal and penile cancer.

A vaccine for HPV has been available since 2006, when it was initially recommended just for girls; the recommendation was expanded to boys in 2011. The current version, which is given in a two- or three-dose series, prevents nine of the riskiest HPV strains, including those that cause genital warts.

The CDC recommends routine HPV vaccination for all boys and girls at 11 or 12 years old — children can receive it at as young as age 9 — and for those through age 26 who were not previously fully vaccinated. Experts consider the vaccine exceptionally safe.

A CDC study published Thursday found that for adolescents born in 2007, about 65% were fully vaccinated for HPV by age 15, compared with 60% of those born in 2008. The CDC attributes this statistically significant difference to disruptions from the Covid pandemic, beginning when the younger group turned 12.

Vaccination at older ages typically provides less benefit, since so many people contract at least one strain of HPV after becoming sexually active. But the CDC suggests that people up to age 45 may still discuss potential vaccination with their doctors. 

High-risk HPV lowers immune cells

In her new study, Rivero and her colleagues studied the ejaculate samples of 205 men, none of whom were vaccinated for HPV. The men, who had a median age of 35, sought a fertility assessment or treatment for urinary-tract problems from 2018 to 2021 at a urology clinic in Argentina.

Thirty-nine, or 19%, of the men tested positive for HPV. Researchers were able to identify 20 men among them who had high-risk strains and seven men with low-risk HPV.  

On the surface, the investigators didn’t find any notable differences in the semen quality between the men with either type of HPV and a group of 43 men who tested negative for the virus. When they examined the semen more closely with highly sensitive tools, they found clues suggesting how high-risk HPV strains might be influencing male infertility.

The men with high-risk HPV had a lower level of certain immune cells in their semen, suggesting the virus had hampered the body’s ability to fight it off. This suppression of immune cells might also have raised the men’s risk of other infections that could further compromise their ability to conceive.

There was also evidence that the sperm of the men with high-risk HPV were sustaining damage from what’s known as oxidative stress. This could explain why these men had a higher level of dead sperm compared with those who didn’t have the virus.

Dr. Eugenio Ventimiglia, an oncologist in the unit of urology at the Università Vita-Salute San Raffaele in Milan, Italy, said the new study, which he was not involved in, “provides insight into the biological mechanisms potentially linking HPV to male reproductive health issues.” 

Nevertheless, he said its findings should be “interpreted cautiously.”

“Instead of conclusively proving a cause-effect relationship between HPV and male factor infertility, the study’s findings are more appropriately seen as generating hypotheses for further research,” Ventimiglia said.

Can vaccination protect men’s fertility?

Men’s HPV might also affect fertility in part by transmitting the virus into the woman’s reproductive tract; the virus might then harm the pregnancy at various stages, including before the fertilized egg implants in the womb. Couples receiving assisted reproductive technology have a greater chance of miscarriage if the man has HPV in his semen, researchers have found.

Research indicates that providing the HPV vaccine to men who are having trouble conceiving and who have an active HPV infection might help them clear the virus faster and potentially improve their chances of conceiving.

“Whatever other changes are thought to be associated with HPV, it should be noted that HPV infection is usually brief, as is the sperm lifespan,” said Dr. Marie-Hélène Mayrand, an epidemiologist and the chair of the obstetrics and gynecology department of University of Montreal. “This is reassuring that any effect, if found, would be brief and self-limited.” Mayrand was not involved in the new research.

Rivero advises that men struggling with fertility receive testing for HPV and other sexually transmitted infections that could affect their fertility. If positive for HPV, additional testing may be needed to identify specific strains. 

The test results, Rivero said, could help men identify a potential driver of their infertility. 

HPV vaccination rates among adolescent boys and men have been rising over the last decade. Recent research suggested that the HPV vaccine was linked to a drastically lower rate of head and neck cancers in men and adolescent boys. 

It’s not yet known if the vaccine could protect men’s fertility. 

“When a critical mass of boys and girls are vaccinated, it is likely that the transmission of the HPV genotypes covered by the vaccines will decrease.” Rivero said. “But the broader impact on fertility remains uncertain.”

Rivero said she hoped to see a larger study in the future that could lend more statistical heft to her findings. Her own lab plans to further study how simultaneous infections with HPV and other STIs might influence male fertility.

This story first appeared on NBCNews.com. More from NBC News:

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School absences surged during the pandemic and have yet to recover. Nearly 1 in 4 students remains chronically absent, defined as missing 10% or more of the academic year, according to the latest data analyzed by The Associated Press.

One reason for continued high absences: After years of COVID-19 quarantines, parents are more cautious about sending children to school when they might be contagious with an illness.

When a child misses school, even for an excused absence like a sick day, it’s harder for them to stay on track academically. So schools and health experts are trying to change the culture around sick days.

Here’s what they want parents to know.

COVID guidelines have changed

During the pandemic, the Centers for Disease Control and Prevention urged people who tested positive for COVID-19 to isolate at home for a set number of days and to quarantine after exposure to the coronavirus. In some settings, people with any mild illness were urged to remain home until symptoms were clear.

Those standards, and the caution behind them, remained for years after schools reopened to in-person instruction. That meant children often missed large portions of school after contracting or being exposed to COVID-19 or other illnesses.

This spring, COVID-19 guidance officially changed. Now, the CDC suggests people treat COVID-19 like other respiratory illnesses, such as the flu and RSV.

Fever-free for 24 hours

If a child has a fever, they should stay home, no matter the illness.

A child can return to school when their fever has been gone for 24 hours without fever-reducing medication. Other symptoms should be improving.

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What about other symptoms?

If a child doesn’t have a fever, it’s OK to send them to class with some signs of illness, including a runny nose, headache or cough, according to schools and the American Academy of Pediatrics. If those symptoms aren’t improving or are severe, such as a hacking cough, call your child’s doctor.

The guidance around vomiting and diarrhea varies across school districts. Generally, students should remain home until symptoms stop, according to American Academy of Pediatrics guidelines. Older children may be able to manage mild diarrhea at school.

“Unless your student has a fever or threw up in the last 24 hours, you are coming to school. That’s what we want,” said Abigail Arii, director of student support services in Oakland, California.

Guidance from the Los Angeles Unified School District says students can attend school with mild symptoms such as a runny nose or cold, but should stay home if they have vomiting, diarrhea, severe pain or a fever of 100 degrees Fahrenheit (37 degrees Celsius) or higher.

School districts across the U.S. have similar guidance, including in Texas, Illinois and New York.

When to wear a mask

The CDC says people should take additional precautions for five days after returning to school or other normal activities.

Masks and social distancing are no longer mandated but are encouraged to prevent disease spread. Experts also recommend plenty of handwashing and taking steps for cleaner air, such as opening a window or running an air purifier.

School districts say parents should keep up-to-date on all health examinations and immunizations for students so they don’t miss additional days of school.

___

AP Education Writer Jocelyn Gecker in San Francisco contributed.

In the second episode of Watko’s Workouts, Philly Live’s Sheila Watko shows us two yoga classes that are making a splash, cat yoga at a special café, a sweat-inducing fitness class that will have your muscles screaming, a local pole academy, a boxing-inspired workout, a world champion knife and axe thrower, a school of circus arts and a senior dance group.

Watko's Workouts

Philadelphia Jan 5

Watko's Workouts: Archery, dance, boxing, bouncing, cycling, Padel and more!

Philadelphia Jan 5

Watko's Workouts: Episode 1

Philly live Jan 10

Watko's Workouts: Take your fitness journey to the next level at this Center City gym

Click on the images below for more information on the businesses featured in this episode:

Aqua Vida

Le Cat Café

Arena Fitness & Performance

Pennsylvania Pole Academy

Rumble Boxing Philly

Philadelphia School of Circus Arts

In January, Elmo had asked X users a seemingly innocent question: “Elmo is just checking in! How is everybody doing?” — only to be met with declarations of “existential dread,” mental burnout and general disenchantment with daily life.

The dreary responses inspired Sesame Workshop, the nonprofit behind “Sesame Street,” to undertake a survey project focusing on the “state of well-being in America.”

Conducted in partnership with consulting and market research firm The Harris Poll, “The State of Well-Being Report” interviewed 2,012 members of the U.S. population ages 16 and older in May. The survey was published Tuesday.

When asked about what they prioritize when it comes to the future of well-being, the majority of the participants found mental health nearly as important as economic stability, according to the findings.

“We could not have predicted the overwhelming response that followed Elmo’s post,” Samantha Maltin, chief marketing and brand officer of Sesame Workshop, said in a news release, adding that the Muppet’s post drew millions of responses. “As Elmo’s viral moment and this new study indicate, the most pressing issue facing American families right now is mental health and emotional well-being.”

0 seconds of 1 minute, 28 secondsVolume 89%

A third of parents and half of teens also said mental health issues significantly affect their well-being, with many parents citing lack of access to high-quality education and consequences of the Covid-19 pandemic as sources of negative impact.

Other common stressors on well-being reported in the survey include physical health, the effects of climate change, lack of a strong network of friends or family, and racism or discrimination.

When Elmo’s innocent question went viral in January, the official X account for “Sesame Street” shared a link to mental health resources.

Aaron Bisman, the vice president of audience development at Sesame Workshop, told NBC News at the time that “leveraging the interest in Elmo’s tweet” to share resources for emotional well-being is “exactly what Sesame Workshop was created to do.”

Despite all the apparent doom and gloom online, the survey also reported a glimmer of hope for the next generation of Americans: 67% of those interviewed said they wish their parents had been more honest about their own mental health struggles, including 79% of parents.

A majority of Gen Z and millennials — as well as 71% of educators surveyed — also said that they believe schools “should focus on social and emotional skills just as much as academics.”

While there appears to be a significant gap between the percentage of participants who believe they themselves practice kindness (93%) and those who believe the average American is kind (55%), a vast majority of people surveyed said it’s important to promote kindness in society.

In an appearance in February on NBC’s “TODAY” show, Elmo shared a message of empathy and urged people to check in on their friends.

“It’s important to remember that we all have a lot of feelings, and that’s OK,” the furry red Muppet said. “It’s good to know what feeling you’re having, and if you’re feeling sad or worried or confused, then you have to talk to someone that you love and trust, and it’s good to talk about it.”

This story first appeared on NBCNews.com. More from NBC News:

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You will be able to find these dispensers in courthouses, health and human services buildings, historic sites and county parks.

County officials said this initiative will widen access to menstrual products and alleviate so-called “period poverty,” when people are unable to afford or get access to tampons and pads.

“For those who have to make tough decisions about paying bills, buying food, or looking after their health, period products often end up at the bottom of the list, even though they are essential items,” Chair of the Montgomery County Board of Commissioners Jamila H. Winder said in a news release. “Stocking bathrooms in county buildings helps alleviate period poverty and ensures that our most vulnerable residents, including those with limited incomes and unstable housing, feel cared for.”

Montgomery County Jul 25

Preserving the past for children of all ages at Montgomery County mall's merry-go-round

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This Montgomery County community has been named 2nd-best place for families to live

Officials add that some Montgomery County buildings already provided menstrual products free of charge but they will ensure that all county-owned properties are regularly stocked.

For a complete list of county-owned and operated buildings, visit montgomerycountypa.gov/Facilities.

Drugmaker Lykos Therapeutics said the FDA notified the company that its drug “could not be approved based on data submitted to date,” and requested an additional late-stage study. Such studies generally takes several years and millions of dollars to conduct. The company said it plans to ask the agency to reconsider.

Lykos and other psychedelic companies had hoped that MDMA would be approved and pave the way for other hallucinogenic drugs to enter the medical mainstream. If the FDA had granted the request, MDMA, also known as ecstasy or molly, would have become the first illegal psychedelic to become a federally approved medicine.

The FDA’s decision was expected after a panel of government advisors voted overwhelmingly against the drug’s use for post-traumatic stress disorder in May. The negative vote came after an all-day meeting in which experts scrutinized Lykos’ study data, research methods and possible risks of the drug, including heart problems, injury and abuse.

FDA said Friday the MDMA application had “significant limitations” that “prevent the agency from concluding that the drug is safe and effective for the proposed indication.” The agency said it will continue encouraging “innovation for psychedelic treatments and other therapies to address these medical needs.”

Lykos said the issues FDA raised in what’s called a complete response letter echoed the concerns during the May meeting.

“The FDA request for another study is deeply disappointing,” Lykos CEO Amy Emerson said Friday in a statement. “Our heart breaks for the millions of military veterans, first responders, victims of sexual and domestic abuse and countless others suffering from PTSD who may now face more years without access to new treatment options.”

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Lykos is essentially a corporate spinoff of the nation’s leading psychedelic advocacy group, the Multidisciplinary Association for Psychedelic Studies, or MAPS, which funded the initial studies of MDMA by raising millions of dollars from wealthy backers.

The group has been a pioneer in researching the medical use of psychedelics, which major pharmaceutical companies have been unwilling to fund. Two small studies submitted to the FDA suggested combining MDMA with talk therapy led to significant easing of PTSD symptoms.

Antidepressants are now the only FDA-approved drugs for PTSD, which is closely linked to depression, anxiety and suicidal thinking and is more prevalent among women and veterans.

In recent years, MDMA research has been widely publicized by combat veterans, who say the lack of treatments options for the condition has contributed to higher rates of suicide among military personnel. Last month, veterans supporting psychedelic therapy rallied on Capitol Hill in support of the drug. And more than 80 House and Senate lawmakers have signed letters to the FDA in recent weeks urging MDMA’s approval.

But FDA’s review brought new scrutiny to the research. The vast majority of patients in Lykos’ studies correctly guessed whether they had received MDMA or a dummy pill, making it “nearly impossible” to maintain the “blinding” which is considered essential for medical research, according to FDA internal staffers.

In recent months, separate allegations of misconduct have emerged, including that some researchers involved in the studies coached patients to suppress negative results or inflate positive ones.

Despite the setback, many experts say other psychedelics may fare better before the agency.

MDMA is the first in a series of psychedelics that are expected to be reviewed by the FDA in coming years as part of a resurgence of interesting into their therapeutic potential.

The idea of using psychedelics to enhance psychotherapy is not new. A handful of therapists in California used MDMA during the 1970s and 1980s — when it was still legal — to facilitate couples therapy sessions. MAPS was founded in 1986 to oppose a federal decision placing MDMA in the same ultra-restrictive drug category as heroin, LSD and other illegal psychedelics.

MAPS’ studies of MDMA began more than a decade ago. Since then, dozens of small, startup drugmakers have entered the field, studying other substances like psilocybin and LSD for conditions including depression, addiction and anxiety. Those studies are generally larger and more rigorous than the MDMA studies submitted to the FDA.

Two drug developers, Compass Pathways and Usona Institute, are conducting late-stage studies of psilocybin — the active ingredient in magic mushrooms — for severe depression.

The Food and Drug Administration said it approved the spray from drugmaker ARS Pharmaceuticals Inc. as an emergency treatment for adults and older children experiencing life-threatening allergic reactions known as anaphylaxis.

Anaphylaxis occurs when the body’s immune system develops a sudden, unexpected reaction to a foreign substance, such as food, insect stings or medications. Common symptoms include hives, swelling, itching, vomiting and difficulty breathing.

The device, marketed as Neffy, could upend treatment for the 33 million to 45 million Americans with severe allergies to food and other triggers. Anaphylaxis sends more than 30,000 people to emergency rooms and results in more than 2,000 hospitalizations and more than 230 deaths in the U.S. each year.

Of the 6 million prescriptions written for auto-injectors each year, more than 40% are never filled, Dr. Thomas Casale, an allergist at the University of South Florida, told an FDA advisory panel last year. Even when they are available to caregivers, many auto-injectors are used incorrectly, he said.

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“There’s a real unmet medical need for a large portion of the population,” he said.

Neffy is intended for people who weigh at least 66 pounds. It is given in a single dose sprayed into one nostril. A second dose can be given if the person’s symptoms don’t improve.

The new treatment could be life-changing for people with severe food allergies, said Dr. Kelly Cleary, a pediatrician and director with the Food Allergy Research & Education, a nonprofit advocacy group.

“I have seen the look of worry or fear,” said Cleary, whose 11-year-old son has multiple food allergies. “I worry about what happens if someone hesitates.”

Requiring an injection in an emergency is as scary to some children as the allergic reaction itself. Some parents have had to restrain thrashing children to inject them, sometimes causing cuts that require stitches. About 3,500 caregivers a year are injured when they accidentally inject themselves in the hands, ARS said.

Priscilla Hernandez, of Pasadena, California said her 12-year-old son, Zacky, who is allergic to sesame, peanuts, tree nuts, avocado and other foods, was traumatized when he had a reaction at school about six years ago and a nurse treated him with an auto-injector.

“Having to do a shot creates this whole different level of anxiety,” she said.

She said, “we are over the moon” about the FDA’s approval of the spray, which Zacky will start carrying when it becomes available.

First marketed in 1901, epinephrine predates the FDA itself. Products like the EpiPen auto-injector, approved in 1987, were authorized based on chemistry and manufacturing data and were not required to prove safety and efficacy.

Clinical trials of people experiencing potentially deadly reactions are difficult for ethical and pragmatic reasons. Instead, ARS officials compared the effect of the nasal spray on biological markers to existing epinephrine treatments.

Results showed Neffy worked about as well as injected epinephrine to boost heart rate and blood pressure, which counter severe reactions. The drug is combined with a patented agent that allows it to be easily absorbed through nasal membranes.

Other needle-free epinephrine devices are being developed to treat allergic reactions. In the pipeline are nasal sprays from Bryn Pharma, of North Carolina, and Nausus Pharma, of Israel; a needle-free auto-injector from Crossject of France; and an epinephrine film that is administered under the tongue from Aquestive Therapeutics, of New Jersey.

Neffy is designed to be easy to carry and easy to use, especially for children, said Richard Lowenthal, president and chief executive of San Diego-based ARS.

“We don’t want fear. There’s no needle, there’s no pain with this product,” he said. “It’s basically like spraying saline into your nose.”

Neffy will come in packs of two and is expected to cost about the same as a two-pack of auto-injectors, around $300 to $700. Lowenthal said he hoped insurance companies would cover the cost to patients for a low co-pay amount.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Although the study was small, it’s the first head-to-head look at people’s blood levels after they consume products with erythritol or sugar (glucose). 

“We compared the results, and glucose caused none of the problems,” said Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic and the lead author of the study, published Thursday morning in the journal Arteriosclerosis, Thrombosis, and Vascular Biology. 

Erythritol is one ingredient on a growing list of nonsugar sweeteners found in low-calorie and sugar-free foods. Erythritol and xylitol are sugar alcohols that are sweet like sugar but with far fewer calories. Erythritol is often mixed with another sweetener, stevia, and xylitol is often found in gum, mouthwash and toothpaste. 

Earlier studies from Hazen’s lab — one published last year and the other in June — found potential links between the sugar alcohols and an increased risk of heart attacks and strokes. The research suggested both sugar alcohols might make blood platelets stickier and therefore more susceptible to clotting and blocking veins or arteries, in turn contributing to heart attacks and strokes.

For the new research, Hazen’s team analyzed the heart effects of erythritol and regular sugar — in this case, simple glucose — by enrolling two groups of healthy middle-aged male and female volunteers: 10 who consumed the erythritol and 10 who consumed sugar.

Both groups fasted overnight. In the morning, their blood was drawn to measure platelet activity. Then, half the volunteers drank glasses of water with 30 grams of glucose mixed in, and half drank glasses of water with 30 grams of erythritol. Hazen said 30 grams of erythritol is an amount typical of erythritol-sweetened foods. 

Around 30 minutes after each group consumed the sweetened drinks, their blood was drawn and retested. Researchers found the people who consumed erythritol had increased platelet aggregation — meaning the blood was more likely to clot. Adults who drank the normal sugar drink had no changes in platelet aggregation. 

The researchers measured a 1,000-fold increase in blood erythritol levels in the group given the erythritol drink. Those who drank glucose water didn’t have any changes in blood erythritol levels, and their blood glucose levels were only slightly increased. The finding stood out to Hazen, because it far exceeded the trace levels of erythritol that occur naturally in the blood. 

“The amount in sugar substitutes is thousands of folds higher than what is made in our bodies, so to call it ‘natural,’ it’s not,” he said. “Your best recommendation is to avoid the sugar substitutes, and sugar alcohols in particular, because there’s an acute increase in the likelihood of clotting events once you ingest them.”

The Food and Drug Administration considers artificial sweeteners, including erythritol and xylitol, as GRAS, or generally recognized as safe. Hazen hopes mounting evidence about the sugar alcohols might trigger the FDA to look more closely at the data. 

Outside the U.S., the concerns have drawn interest among food regulators. Last year, for instance, the European Food Safety Authority recommended that the European Commission request data about how much erythritol is in food, which could help clarify the risks. 

Do the findings indicate that erythritol is worse overall than high-calorie sugar? Valisa Hedrick, a registered dietitian at Virginia Tech, said a diet high in sugary foods can lead to elevated blood glucose levels that are also linked to stroke and clotting risks. Hedrick wasn’t involved in the Cleveland Clinic study.

The study has several important limitations. Beyond the small number of participants, it measured the effects of erythritol and glucose at only one point in time, as opposed to over months or years of consistent consumption, Hedrick noted.

And the amount of glucose in the sugar water — about 30 grams — is the equivalent of about 120 calories of sugar. Sugary beverages, especially juices and sodas, often contain more sugar. 

For example, a 12-ounce can of Coca-Cola contains 39 grams of sugar, and 12 ounces of Mountain Dew contains 46 grams. 

Michael Goran, a professor of pediatrics at the University of Southern California’s Keck School of Medicine, said it might also be worth comparing erythritol to both fructose and glucose. The combination of fructose and glucose is more typical of sugary juices and sodas than glucose alone, he said. Goran wasn’t part of the new study.

Hazen’s study looked at glucose alone. 

Although the Cleveland Clinic study didn’t find negative effects from consuming sugar, the researchers agreed the data doesn’t mean sugar is in the clear. Higher amounts of sugar may cause similar platelet effects, especially in people with diabetes, who can’t effectively regulate high blood glucose.

Hazen’s study focused specifically on healthy people, not people with diabetes.

It could also be important to analyze whether heart effects differ when people consume food with erythritol compared with water with erythritol, said Dr. Michelle Pearlman, a gastroenterologist who is CEO and a co-founder of the Prime Institute in Miami.

“Factors such as protein, fat, fiber and other nutrients might influence this response,” she said. 

Ultimately, said Hedrick of Virginia Tech, the new study underscores the need for more research comparing the health effects of sweeteners versus sugar.

Hazen and his colleagues concluded the research by urging further studies focusing on erythritol’s heart risks, particularly in people already at higher risk of strokes and clotting.

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The Beijing Third Intermediate People’s Court upheld the ruling Tuesday that a hospital did not violate Teresa Xu’s rights when it denied her access to egg freezing services.

The 36-year-old Xu announced the judgement Wednesday. “This isn’t outside of my expectations,” she said to viewers of her livestream. “All these years, we finally have an end, and an answer.”

Xu first went to the hospital as a 30-year-old in 2018, asking if she could freeze her eggs. She had an initial consult but was told she could not have the procedure after the doctor found out she was not married.

In China, hospital regulations require that a woman be married to freeze her eggs.

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“The doctor kept on trying to persuade me, ‘You should have a child now,’” Xu said in 2019. “She said, ‘Your career can develop at any time, but it’s harder to have a child later on.’”

The doctor was kind, she said, but the experience left her angry. “I was looking for a professional service, but got this life advice instead.”

Xu had looked into alternative routes, such as egg freezing abroad, but found the cost too high. Meanwhile, it took multiple attempts to get the court to accept her case in 2019. The process was delayed during the pandemic.

The Chaoyang Intermediate People’s Court said in a 2022 judgment that the hospital did not violate her rights in denying her access to freeze her eggs. Xu decided to appeal.

Xu said she knew she had a low chance of success but wanted to pursue it because of the potential societal impact.

She noted that the judgement had positive language despite its verdict: “As our country’s policy on births is adjusted, relevant medical and health laws, regulations, diagnosis and treatment standards and medical ethics standards may also change accordingly.”

_

The alert came Friday after the PAHO, which is the main international health agency for the Americas, reported the first deaths associated with the virus — including fetal deaths associated with “possible instances of vertical transmission,” in which a virus is transmitted mother-to-child during pregnancy.

At least 8,078 confirmed Oropouche cases, including two fatal cases, have been reported in the Americas. The cases are concentrated in Bolivia, Colombia, Cuba, Peru and Brazil — the country with the most confirmed cases and where the two deaths were reported.

Two young women in Brazil, ages 21 and 24, are believed to have died because of the virus. According to PAHO, they both died a few days after having first experienced sudden symptoms such as fever, muscle aches, pain behind the eye sockets, headaches and vomiting, among other symptoms. A third case is being investigated in Brazil as a possible third death from Oropouche.

At least 7,284 cases have been confirmed in Brazil, according to PAHO. That’s 90% of all confirmed Oropouche cases in the Americas and a significant jump from the 832 cases Brazil reported last year.

Among other fatal cases still under investigation in Brazil are one case of fetal death, one miscarriage and four cases of newborns with microcephaly, a birth defect in which a baby’s head is smaller than expected. Microcephaly is also associated with the Zika virus, another mosquito-borne disease.

A mother in Brazil who experienced symptoms consistent with Oropouche sought medical attention on June 6 after she noticed lack of fetal mobility, PAHO said. Oropouche genetic material in umbilical cord blood and organ tissue was detected after the fetal death was confirmed. A similar case was reported soon after, involving a mother who miscarried after having experienced bleeding symptoms related to the virus. Brazilian health officials who were conducting a study on four newborns with microcephaly found the babies already had antibodies against Oropouche virus.

Based on those cases, PAHO had issued a previous alert on July 17 “about possible cases of pregnant mother-to-child transmission of Oropouche virus,” according to the U.S. Centers for Disease Control and Prevention, which emphasized that it is still “not clear if infection with Oropouche virus was the cause of negative health outcomes for the fetuses.”

The CDC said it’s working with PAHO and other international partners to learn more about the potential risks of Oropouche during pregnancy.

There are no to vaccines or specific antiviral drugs to prevent or treat Oropouche infections. Treatment is focused on relieving patients’ symptoms, according to PAHO.

Oropouche virus symptoms are similar to those of dengue, according to the CDC. They include headaches, fever, muscle aches, stiff joints, nausea, vomiting, chills and sensitivity to light. In severe cases, the virus can also cause the tissues surrounding the brain and the spinal cord to swell.

In certain patients, symptoms may also include rash, vomiting and bleeding — typically in the form of nosebleeds, bleeding gums or blood speckles under the skin, according to PAHO.

Symptoms typically start four to eight days after a person is bitten. Even though symptoms tend to last three to six days, the infection can last up to three weeks.

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Hospitals have identified at least 30 newborns with what has been identified as “fetal fentanyl syndrome,” NBC News has learned. The babies were born to mothers who said they’d used street drugs, particularly fentanyl, while pregnant.

“I have identified 20 patients,” said Dr. Miguel Del Campo, a medical geneticist at Rady Children’s Hospital in San Diego who specializes in children exposed to drugs and alcohol in utero. “I fear that this is not rare, and I fear kids are going unrecognized.”

The syndrome was first identified in 10 babies last fall by geneticists at Nemours Children’s Health in Wilmington, Delaware. The infants had specific physical birth defects: cleft palate, unusually small heads, drooping eyelids, webbed toes and joints that weren’t fully developed. Some had trouble feeding.

Published research about the babies caught Del Campo’s attention. He’d previously diagnosed some children with similar abnormalities with fetal alcohol syndrome, even though their mothers denied drinking while pregnant.

“After reading the paper and thinking about things,” he said, “I have recognized the potential for exposure to fentanyl.”

Dr. Karen Gripp, a geneticist at Nemours, and her team were the first to identify the 10 babies with fetal fentanyl syndrome last fall. “This is another huge piece of the puzzle” explaining the defects, she said.

The birth defects in the babies closely resemble a rare genetic condition called Smith-Lemli-Opitz. It’s a condition that affects how fetuses make cholesterol, which is critical for the brain to develop properly. But none of the babies had Smith-Lemli-Optiz.

The mothers’ reported drug use was a strong clue as to what was causing the defects, but there was no scientific evidence that fentanyl stopped cholesterol production in developing fetuses.

When Gripp and a team of researchers at the University of Nebraska Medical Center exposed human and mouse cells to fentanyl, they discovered that the drug directly disrupted their ability to make cholesterol.

“This is not something that people had known before, that fentanyl interferes so significantly with cholesterol metabolism,” Gripp said. “This is so important because cholesterol needs to be synthesized as the embryo develops.”

Their paper explaining the connection was published in Molecular Psychiatry in June.

Who is at risk

Illicit fentanyl use during pregnancy is a known risk factor for preterm birth and stillbirth. Babies born after significant fentanyl exposure in utero may have seizures, vomiting, diarrhea and be irritable, fatigued and have trouble feeding.

But despite a rise in fentanyl misuse, even during pregnancy, there is no indication of a concurrent rise in birth defects. And most babies exposed to fentanyl in utero aren’t born with the defects that are hallmarks of the fetal fentanyl syndrome.

The new research helps to explain that.

While two copies of the gene that causes Smith-Lemli-Optiz result in the syndrome, cells with just one copy of that gene were more likely to be affected by fentanyl exposure.

That is, a single copy of the gene may make some babies more vulnerable.

“Not everyone is equally susceptible,” Dr. Karoly Mirnics, one of the study authors and director of the University of Nebraska Medical Center’s Munroe-Meyer Institute, said in a press release announcing the results. “The potentially adverse effects of any medication or chemical compound might depend on your genes, lifestyle and environmental factors. One drug might not cause problems for me and might be catastrophic for you.”

Gripp expects the number of documented fetal fentanyl cases will rise with awareness and continued research.

“The group is growing,” she said. “We anticipate that there will be many more patients.” 

Del Campo, also an associate professor at the University of California San Diego, said it’s critical to diagnose babies appropriately with fetal fentanyl syndrome so doctors can follow them long term.

“We need to know how these kids are doing. I have some 2 year-olds that are very concerning,” he said. “They’re just not growing or developing.”

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The findings, shared exclusively with NBC News, are the result of a monthslong investigation by Democrats on the House Committee on Energy and Commerce. They’re based on conversations with leaders and educators from 20 OB-GYN residency programs conducted from February to June. Half of those programs are in states that restrict abortion access.

The report highlights several worrisome effects of abortion restrictions instituted after Roe v. Wade was overturned, including fewer applicants to OB-GYN residency programs in states that restrict abortion, practicing OB-GYNs moving out of these states and new doctors being left unprepared to treat pregnant patients in life-threatening scenarios.

“I don’t think people realize how dire the situation has become so quickly,” said Rep. Frank Pallone Jr., of New Jersey, the committee’s ranking Democrat.

Several residency program directors interviewed for the report recalled dangerous, sometimes tragic, situations in states with abortion bans.

One director described a patient who died from sepsis after she wasn’t able to get an abortion. Another said their hospital had to hold off on providing an abortion for a patient whose amniotic sac had ruptured at 20 weeks, which creates a risk of infection.

The report also reinforces the conclusions of other prior research: that pregnant patients have to travel longer distances to obtain abortions or wind up visiting multiple hospitals before they can find one that will treat them for complex medical issues. The share of patients traveling to other states for abortions doubled from 2020 to 2023, according to the Guttmacher Institute, a research organization that supports abortion access.

“Those delays in care really can lead to downstream complications and preventable morbidity,” said Dr. Justin Lappen, chair of the Society for Maternal-Fetal Medicine’s Reproductive Health Committee, who wasn’t involved in the new report. 

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The report also highlights how little education some OB-GYN residents are receiving in how to provide an abortion. 

“It’s already happened in the restricted states that women who needed an emergency abortion were not able to get it because [doctors] were afraid to perform it. Now, on top of that, you layer the fact that even if the doctors wanted to do it, they don’t have the knowledge to do it,” Pallone said.

In the past, residency programs often partnered with abortion clinics to provide that training, but in states with abortion bans, those clinics have shut down. Some programs pay for residents to get such training out-of-state, but that often requires additional medical licenses and liability insurance and means residents must spend multiple weeks away from home. 

In states that restrict abortion, some OB-GYN residents have to rely on textbooks in lieu of observing an abortion firsthand or simulate the procedure using a piece of fruit. 

“You can tell who has done it and who has learned it from a book,” one residency director said in the report. “There is a gap in how they’d manage patients.”

Lappen said residents who don’t receive sufficient training might not develop expertise about how to manage situations like miscarriages or ectopic pregnancies, or lack the skills to quickly intervene in life-threatening emergencies, when an abortion is medically necessary. 

“Abortion care can be the fastest way to save someone’s life, and the easiest way to save someone’s life” in certain cases, he said. “That skill set is really, incredibly important and there are parts of the country where it currently is in significant shortage or may not exist.”

Applications to OB-GYN residency programs in states with abortion restrictions have declined since Dobbs, according to the report. Other research has found the same trend: The number of medical school graduates who applied to residencies in states with abortion bans fell 3% in the 2022-2023 application cycle compared to the previous year, then another 4% in the 2023-2024 cycle. 

Some states with strict abortion laws have also seen OB-GYNs move away, making it harder for residents to access reproductive care. Idaho, for instance, lost 22% of its practicing obstetricians from August 2022 to November 2023, according to one report.

Like many doctors and nurses in states that restrict abortion, OB-GYN residents fear being fined or held criminally liable for providing an abortion in an emergency, the new report says. They also lack clarity as to when the procedure is legally allowed to save a patient’s life. 

Some patients, doctors and advocates have begun to seek that clarity in court. In May, the Texas Supreme Court rejected a challenge to the state’s abortion ban from 20 women and two doctors who sought more information about what’s considered a “medical emergency” under state law. In June, the U.S. Supreme Court dismissed an appeal in a case about whether doctors in Idaho can perform abortions in emergencies. The decision allowed emergency abortions to continue in the state.

The problems outlined in the new report existed before Dobbs, several OB-GYNs said, since some states already had restrictions that made abortions difficult to obtain — but they said the issues have gotten worse in the last two years. 

The report suggests that reinstating a federal right to abortion is the way to keep these problems from escalating, and it calls on Congress to pass the Women’s Health Protection Act, a bill that would safeguard abortion access nationwide. 

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Two residents – one over the age of 70 and the other under 18 years old – tested positive for West Nile virus neuroinvasive disease in Union and Middlesex counties with symptoms reported the first week of July, health officials said.

Léelo en español aquí.

Health officials said both individuals were hospitalized but have since been discharged. An additional report of an asymptomatic WNV-positive blood donor was reported in a Somerset County resident.

According to health officials, WNV cases with symptom onset in early July are earlier than what is typically seen in New Jersey. Most cases occur between mid-August and mid-September.

“This year, New Jersey is seeing higher than average West Nile virus activity earlier than expected. As mosquito season can last into October, bite prevention will be essential in protecting yourself and your family against mosquito-borne diseases like West Nile virus in the remaining summer months and into the fall,” said New Jersey Health Commissioner Kaitlan Baston, M.D. “This means avoiding mosquito bites through tried-and-true methods, like using insect repellants, wearing long sleeves and pants, and limiting outdoor activity during peak times for mosquito activity.”

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What is West Nile Virus?

Health officials said that in most cases, WNV causes asymptomatic infection or a mild to moderate illness, typically with a fever. However, people over the age of 50 with a weak immune system are at greater risk for developing severe illness.

Those who develop a more severe form of the disease could experience severe headaches, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. West Nile virus can even lead to death.

Symptoms of West Nile virus can often be confused with COVID-19 or other common illnesses. Health officials said specific laboratory tests are needed to confirm West Nile Virus, but there is no specific treatment for it.

Health officials said to protect against mosquito-borne diseases, residents should:

• Wear EPA-registered insect repellant.
• Avoid being outdoors during dawn and dusk when mosquitos are most active.
• Wear long sleeves and long pants and covering exposed skin.
• Cover cribs, strollers, and baby carriers with mosquito netting.
• Repair holes in screens to keep mosquitoes outside and use air conditioning when possible or ensure you have well-fitted screens.

For more helpful information visit nj.gov/health/cd/topics/westnile.shtml.

The American Academy of Pediatrics is the latest, and largest, medical society to sound an alarm about the increasing use of scissors or lasers to cut away some infants’ tongue tissue when breastfeeding is difficult.

“It’s almost an epidemic,” said Dr. Maya Bunik, a Colorado-based co-author of the report.

Experts say there isn’t a good count of how many infants each year are being treated for tongue-tie with surgery, though Bunik believes the annual tally may exceed 100,000. Research suggests many of those treatments are not necessary, she added.

The academy’s new report encourages pediatricians and other medical professionals to consider nonsurgical options to address breastfeeding problems. The report cites a study that suggests less than half of the kids with the characteristics of tongue-tie actually have difficulty breastfeeding.

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Ankyloglossia, or “tongue-tie,” occurs when an infant is born with a tight or short band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth. The condition can make it hard for the infant to extend and lift their tongue to grasp a nipple and draw milk — which in turn can be painful for the mother.

Doctors say it’s critical to get breastfeeding on track in the first three to four weeks, and surveys indicate most parents want to breastfeed, so it’s natural that they want a quick solution to a problem, Bunik said.

Ankyloglossia diagnoses have been increasing worldwide, though there is no uniform diagnostic criteria for this condition and no consensus on how to treat it. One common approach is to cut the tissue with scissors, but dentists increasingly are using lasers to vaporize the tissue — some charging $800 or more.

But the procedures can cause pain and sore mouths, potentially deterring babies from trying to breastfeed, Bunik said.

“The practice (of treating tongue-tie) got to be very common without a lot of good data,” said Wisconsin pediatrician Dr. Jennifer Thomas, who also co-authored the report.

The report also recommends lactation experts, pediatricians and surgeons and other medical professionals work with parents to evaluate possible reasons for breastfeeding challenges and make the best treatment decision.

The American Academy of Pediatrics, which has 67,000 members who specialize in treating children, started working on the report in 2015 after some pediatricians began to notice that an increasing number of patients were going to dentists to get treatment for tongue-tie, Thomas said. Pediatricians were finding out after the surgeries.

At least two other medical groups have issued statements about tongue-tie. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus statement in which member physicians said they believe tongue-tie is being overdiagnosed in some places and that there isn’t sufficient evidence to support claims that using lasers is superior to other techniques.

A year later, the Academy of Breastfeeding Medicine, an international group, issued a position called formore research into tongue-tie treatment and stressed that decisions “require a high level of clinical skill, judgment, and discernment.”

The American Dental Association didn’t directly respond to The Associated Press’ questions about the new report. It sent a statement saying the organization agrees with a 2022 policy statement by the American Academy of Pediatric Dentistry, which noted not all children with ankyloglossia need surgical intervention and that a team-based approach with other specialists can aid in treatment planning.

Haley Brown saw a lactation consultant two years ago after her son Shiloh, who was born prematurely, had trouble nursing. But as months passed and the situation didn’t improve, Brown turned to a Denver dentist she heard about on social media The dentist diagnosed Shiloh with tongue-tie and also lip-tie, in which the tissue inside the upper lip is too tight. Shiloh underwent a short laser procedure that cost $750.

Breastfeeding improved immediately. “Things just seemed a little easier for him,” said Brown, 33, of Englewood, Colorado.

Brown later had another baby, and another lactation consultant told her that a scissors snip could have been less involved and just as effective. Brown said the laser treatment worked for Shiloh, but added: “I probably should have consulted with my pediatrician before I went straight to the dentist.”

It turns out, both those things can be true, but the differing advice has created some confusion.

Stretching can help make you more flexible, improve range of motion in your joints — and feel good. David Behm, who researches human kinetics at Memorial University of Newfoundland in St. John’s, Canada, offers this advice on when to stretch and how to do it safely:

It’s almost always good to stretch, but it’s better if you warm up first, said Behm, author of “The Science and Physiology of Flexibility and Stretching.” He recommends a light aerobic activity such as jogging, walking or cycling for five or 10 minutes.

Follow that with some static stretching, the traditional way of reaching and holding a position (think back to that gym class). You can then do activity-specific dynamic stretching, in which you warm up the muscles with repetitive movements like leg lifts.

Behm says one minute is “the magic number” for how long to do static stretching per muscle group without fatigue.

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Should you always stretch before exercising? If it’s traditional stretching, not necessarily.

The better question, Behm says, is, “Should people increase their range of motion? Should people have better flexibility? And that is yes, because it helps prevent injuries. It helps with health. But you don’t have to stretch to achieve that.”

Resistance training, for instance, can be an effective form of stretching, he said. Doing a chest press increases range of motion in your deltoids and pecs, whether with barbells, dumbbells or machines, so there is no need to stretch beforehand. Just make sure to start with a small amount of weight to warm up and then add more to train.

“You probably don’t have to do extra stretching unless you’re a gymnast, a figure skater, or even a golfer who needs a great range of motion through that swing,” Behm said.

Nor do you need to stretch first if you’re going for a leisurely run. Simply start with a slow jog to warm up and then increase the pace.

After exercise, “light stretching is OK, as long as you don’t reach a point where you’re feeling pain,” Behm said. Since your muscles will be warm by that point, overdoing it makes you more likely to injure yourself.

Foam rollers can help with muscle recovery and have been shown to increase range of motion as well as stretching.

If you’re playing a sport, Behm said, static stretching beforehand helps reduce muscle and tendon injury.

“If you’re going to do an explosive movement, change of direction, agility, sprint, any of these explosive activities that involve your muscles and tendons,” he said, “you’re going to be stronger if you do static stretching.”

People can especially get in trouble when they go back to a sport they used to play, whether it’s tennis, surfing or any sort of team activity.

Also, stretch both sides equally. Lacking flexibility on one side also can lead to injury.

Different studies over the years have either encouraged or discouraged stretching before exercise. Behm says that partly because some studies didn’t reflect real-life conditions, or were designed with elite athletes in mind, not regular people.

“If you’re Usain Bolt, it makes a difference,” said Behm. Not so much for the rest of us.

NBC10’s Matt DeLucia tackles a variety of sports from the Paris Summer Games, learning from the best in 2024.

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Was Matt able to ride a wave at the Jersey Shore?

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Breaking down the Olympic medals won in Paris

Hitting the open seas ⛵

Matt DeLucia sails on the Delaware.

How’s the jump shot? 🏀

A teenage basketball player gave Matt a lesson on dribbling and shooting on North Philadelphia courts near where Olympian Kahleah Copper grew up.

Matt gets in the ring 🥊

Does Matt have fight in him as he puts on the boxing gloves?

Matt tries to spin with the best in gymnastics

These youngster put in the practice to do the moves that Matt can only hope to complete.

Matt picks up ping pong paddle 🏓

We all might be able to pick up a ping pong paddle, but what does it take to play table tennis like an Olympian?

Matt takes a stab at fencing 🤺

Matt gets the perfect coach as he dons fencing gear, Mark Masters who has coached Olympic gold medalist Maia Weintraub.

Matt channels inner B-Boy while breaking

Does Matt have the stamina and the attitude to break with the best of them?

Matt jumps on the track 👟

Some Montgomery County high schoolers tried to help Matt clear this challenge with mixed results.

Matt flips for artistic swimming

Jump into the pool for artistic swimming. Was Matt in sync?

Matt tries to get an archery bull’s eye 🏹🎯

First up? Archery! How was Matt’s aim?

Keep checking back on this page throughout the games to see Matt’s latest attempts to earn the gold (or just tries not to fall).

The student at George Mason University in Northern Virginia was a daddy’s girl who was treated like a princess by her parents and three older brothers.

It never crossed his mind that his daughter would die at 20 after melanoma spread to her brain, neck and spine. Her grieving parents now warn other families to be aware of melanoma, as doctors see a disturbing trend among teens and young adults.

‘Sort of small, like a strawberry’

It all started with a tiny birthmark on Tisera’s toe. When she was a freshman in college, the birthmark changed.

“It started growing, sort of small, like a strawberry,” her father recalled.

A biopsy later confirmed the birthmark was melanoma. The cancer was deep, and her toe needed to be amputated.

The family thought the worst was over, but it wasn’t. As Tisera tried to continue with life as a college student, her cancer spread. Doctors tried to surgically remove what they could, but it was too late.

Tisera died in June 2023 surrounded by family and friends.

‘It was a total shock’

Her parents, who live in Front Royal, Virginia, said they still consider what they could have done differently.

“I’m thinking about what we did wrong but I – you cannot believe how organized we were. We have calendars with all her appointments. We never missed any appointment,” her mother, Viviana Tisera, said as she fought tears.

One appointment the family never thought to make early on was to a dermatologist for a skin check.

“It was a total shock,” Mari Tisera’s father said about the moment they learned she had melanoma.

They had no family history of skin cancer, and her parents had believed melanoma primarily affected older adults, people with lighter skin and sun worshippers, which their daughter was not.

Doctors seeing melanoma among young people

Melanoma is the second most common type of cancer diagnosed in 15- to 19-year-olds and the most common form of cancer affecting young adults age 25 to 29, according to the Skin Cancer Foundation.

While sun exposure is the main risk factor, people who have certain types of birthmarks also can be at risk.

Look out for large birthmarks in particular, said Dr. Geoffrey Gibney, an oncologist at Medstar Georgetown University Hospital. Melanoma can develop within birthmarks or moles, and even in parts of the body not exposed to the sun.

Potential red flags for skin cancer include:

• a new mole
• a mole that has grown
• a mole that has changed in size or color
• a mole that has started itching or bleeding

One in five adults will develop skin cancer in their lifetime.

“A mole that’s changing really does warrant more urgent evaluation,” Gibney said.

The earlier you get something checked out, the better.

“When we do see an abnormal skin lesion, seeing a dermatologist is key, and you should not delay it,” he said. “We want to catch skin cancers earlier in the development, not later, when there’s a higher risk for the patient.”

Tisera’s parents said they hope sharing their late daughter’s story will help others. Time with her is what they wish they could have back.

“Coming in the door every weekend and saying, ‘I’m here! The princess is here!’” her mother said. “That is what I miss the most.”

The Health Department said this month alone they discovered and treated four pools of standing water containing mosquitos infected with the virus.

The first discovery was made in Concord Township, followed by positive test results in Yeadon, Haverford Township and Brookhaven.

West Nile virus is a mosquito-borne sickness that may cause encephalitis, a brain infection. Officials said cases occur primary in the summer to late fall.

Those who are infected by the virus can experience symptoms such as severe headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis.

However, officials said most people infected with West Nile virus do not develop any symptoms.

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Delaware County health officials said finding infected mosquitos is something that is expected every summer and no human cases have been reported.

“Preventing the spread of West Nile virus is up to everyone in Delaware County,” Delaware County Health Department Director Melissa Lyon said in a news release. “Routinely checking for standing water sources and discarding potential breeding areas on your property can help reduce the chance for your family and neighbors of getting sick.”

Officials said the most effective way to prevent the spread of West Nile virus is to keep mosquitoes from breeding on your property.

If you would like to report mosquito problem you can call the Delaware County Health Department Wellness Line at 484-276-2100.

It can be easy for parents and caregivers to leave a child in a car just for a “quick run” into the store. Still, these senseless tragedies are essential for everyone to understand that even though they can happen, moments like these are preventable.

Here are the facts

• A child’s body temperature rises three to five times faster than the average adult’s. When a child is left in a vehicle, the child’s body temperature can rise even faster, making the situation very dangerous.
• Heatstroke begins when the core body temperature reaches 104 degrees.
• A child can die when their body temperature reaches 107 degrees.
• In 2023, 29 children died of heatstroke in vehicles.
• In 2018 and 2019, there was a record number of hot car deaths – 53 children died both years – the most in 25 years, according to NoHeatstroke.org.

Everyone can help to prevent hot car deaths for children. NHTSA has created safety tips for parents and caregivers to practice safety before leaving their children.

Tips for parents and caregivers

• Never leave a child in a vehicle unattended for any length of time. Rolling windows down or parking in the shade does little to change the vehicle’s interior temperature.
• Make it a habit to check your entire vehicle—especially the back seat—before locking the doors and walking away.
• Ask your childcare provider to call if your child doesn’t show up for care as expected.
• Place a personal item like a purse or briefcase in the back seat; this is another reminder to look before you lock. Write a note or place a stuffed animal in the passenger’s seat to remind you that a child is in the back seat.
• Store car keys out of a child’s reach and teach children that a vehicle is not a play area.
• Always lock your car, even when you are not using it. Even if you do not have a child, someone in the neighborhood could get into the unlocked vehicle.

If you see a child seated alone in a locked car, act immediately and call 911. A distressed child should be removed from the vehicle as quickly as possible and rapidly cooled.

That’s the pitch from a new cluster of companies selling high-tech scans to healthy people interested in learning more about their wellness.

These whole-body MRI scans aren’t cheap. Startup companies like Prenuvo charge between $1,000 to $2,500 for various scanning options, none of which are currently covered by insurance.

Proponents say consumer-driven medical scans are the next logical step in preventive medicine. The industry has received a big publicity push from celebrities and influencers like Kim Kardashian, who posted about her Prenuvo scan last year.

But many medical experts say the companies are selling expensive, unproven technology that may cause extra worries and unnecessary treatment, while driving up costs for the U.S. health system.

Here’s what to know before considering a scan:

What is an MRI?

MRI stands for magnetic resonance imaging. It’s a type of medical scan that uses magnetic fields to produce detailed images of organs, bones and other structures inside the body. Unlike many other types of scans, MRIs don’t use radiation.

Doctors will order an MRI to help diagnose cancer, brain injuries, damaged blood vessels and other medical conditions. Full-body scans can take an hour or more, with patients lying motionless inside a cylindrical tube.

Medical societies only recommend routine, full-body scans for certain high-risk groups, such as people who have a heightened genetic risk of cancer.

“MRIs are great for what they’re typically used for,” said Dr. Ernest Hawk, a vice president at the University of Texas MD Anderson Cancer Center. “But now you’re moving them much earlier into an average risk population and that’s where you can run into these questions that haven’t been answered.”

Why are people paying for them now?

Companies like Prenuvo say their scans can help identify more than 500 medical conditions that can go undetected at a typical doctor’s visit.

The company charges $999 to scan the torso, $1,799 for the head and torso or $2,499 for the entire body. Several other companies offer similar services and pricing.

Prenuvo’s chief medical officer, Dr. Daniel Durand, says customers can decide for themselves if the price is worth it.

“We’re trying to give people the opportunity to be more proactive about their health,” Durand said.

Along with the scans and a reader-friendly summary of the results, customers can consult with a nurse or physician employed by Prenuvo to talk about next steps.

The company says it doesn’t pay for endorsements but will sometimes “provide a complimentary scan for an unbiased review.”

What are the potential downsides of MRI screening services?

Many radiologists say the likelihood of finding a serious problem, such as a cancerous tumor or brain aneurysm, in someone with no symptoms is very low. Instead, scans are likely to flag growths that are usually harmless. Definitively ruling out a problem could require additional tests, appointments and even surgeries.

“You’re going to end up finding a lot of incidental things,” said Dr. Mina Makary, a radiologist at Ohio State Wexner Medical Center. “That’s going to create more psychological stress or trauma for the patient, including additional costs for tests and procedures that may have risks.”

Experts also worry that people who undergo MRI scans may start skipping other routine exams, such as mammograms.

“You’ve gone through a scan and it didn’t find anything so you say ‘Gee, I don’t need to do the other routine things my doctor recommends that have been proven to extend life,” said Hawk.

What do medical authorities say?

The American College of Radiology does not recommend MRI screening in people without symptoms, stating that there is “no documented evidence” the technique is “cost-efficient or effective in prolonging life.”

The Food and Drug Administration has not approved any MRI machines for preventive screening, but doctors are free to use the devices however they choose.

There are examples of imaging practices that were once considered experimental but have subsequently become standard practice. Prenuvo executives say their approach could follow a similar path.

“The evidence will evolve over time but patients don’t necessarily want to wait 30 years to be in a position to benefit from it,” said Prenuvo’s Durand.

When will we know if MRI screening helps people live longer?

The studies needed to show such a benefit would have to be very large and long, tracking a diverse population for years, according to experts.

Prenuvo recently announced plans to screen 100,000 people and study their health over time. The study isn’t expected to wrap up until 2034 or later.

Most people enrolling in Prenuvo’s study are expected to pay a $2,200 fee. But eventually academic or government studies could offer individuals a chance to participate in such research without paying out-of-pocket.

“This is a great area in which to participate in a research study that might provide the information you’re seeking, while also helping answer whether this is beneficial or not,” Hawk said. “But doing so outside of a study makes no sense.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The new cases bring the U.S. total to nine since the first human case of the current outbreak was detected in 2022, also in a Colorado poultry worker. Eight of the nine were reported this year.

Their illnesses were relatively mild — reddened and irritated eyes and common respiratory infection symptoms like fever, chills, coughing, sore throat and runny nose. None were hospitalized, officials said. The other U.S. cases have also been mild.

A fifth person with symptoms is undergoing testing, but those results are not back yet, officials said. The workers were culling poultry at a farm in northeast Colorado, according to state health officials. All had direct contact with infected birds.

A bird flu virus has been spreading since 2020 among mammals — including dogs, cats, skunks, bears and even seals and porpoises — in scores of countries. Earlier this year the virus, known as H5N1, was detected in U.S. livestock, and is now circulating in cattle in several states.

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Health officials continue to characterize the threat to the general public as low and the virus has not spread between people. But officials are keeping careful watch, because earlier versions of the same virus have been deadly to people.

The Centers for Disease Control and Prevention has sent a nine-person team to Colorado to help in the investigation, at the state’s request, CDC officials said.

This cases earlier this year were among dairy farm workers in Michigan, Texas and Colorado.

The virus detected in the four latest cases is least partly identical to the type found in the earlier U.S. cases, but further genetic analysis is underway to make sure it’s exactly the same, officials said.

As of Friday, the H5N1 virus has been confirmed in 152 dairy herds in 12 states, according to the U.S. Agriculture Department. Hundreds of commercial poultry flocks in more than 30 states have reported H5N1 or other types of bird flu.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Every day, about 9,500 people are diagnosed with skin cancer in the United States, adding up to nearly 3.5 million people every year, according to the American Academy of Dermatology Association. The AADA also says skin cancer is the most commonly diagnosed cancer in the country.

So how much sunscreen should you really use? And how often should you reapply it? Here’s what to know.

What does a sunscreen’s SPF rating mean?

According to Hopkins Medicine, a sunscreen’s sun protection factor or SPF is a measure that tells you how many harmful ultraviolet rays the cream absorbs or reflects away from your skin.

Contrary to popular belief, an SPF rating is not an indicator of how long you can stay out in the sun before protection wears off, rather it indicates how much longer it takes skin with sunscreen to start to redden compared to without it, the FDA notes.

For day-to-day use, Hopkins Medicine recommends using sunscreen with an SPF of 30 or higher. However, if you spend time outdoors, such as at the beach, an SPF of 60 or greater might be better for you.

What is the difference between UVA and UVB rays?

According to the FDA, UVA rays are one of the strongest types of ultraviolet radiation coming from the sun. UVA rays go deeper into the skin than UVB, and cause skin aging, age spots and wrinkles.

UVB rays meanwhile are the ones that produce sunburns. Most of these rays are absorbed by Earth’s atmosphere.

UVA rays have the longest wavelengths, followed by UVB, and UVC rays which have the shortest wavelengths. While UVA and UVB rays are transmitted through the atmosphere, all UVC and some UVB rays are absorbed by the Earth’s ozone layer. So, most of the UV rays you come in contact with are UVA with a small amount of UVB.

Who needs to wear sunscreen?

The FDA recommends anyone over the age of six months use sunscreen with an SPF of 30 or higher.

Due to the greater risk of developing rashes and side effects, the agency does not recommend children under 6 months old to use sunscreen. Instead, it recommends limiting their sunlight exposure between 10 a.m. and 2 p.m and using protective clothing in case of direct sun exposure.

How much sunscreen should I apply?

Probably more than what you’re currently applying.

According to Hopkins Medicine, about 1 ounce of sunscreen covering your palm is enough to protect your face, neck, arms and legs. To protect your face and neck, meanwhile, HM recommends about a half teaspoon.

How often should I reapply sunscreen?

According to the FDA, how often you should reapply boils down to the SPF rating of your sunscreen.

Since an SPF rating indicates how much longer it takes skin to begin to burn with sunscreen applied compared to how long it takes to start reddening without it, the lower the SPF is, the more often it’s recommended to reapply.

In general, the FDA recommends reapplying sunscreen every two hours or more often if you’re sweating or swimming.

Should I use sunscreen indoors?

Yes. Even if you are inside, dermatologists recommend applying sunscreen.

Because UVA rays do not get absorbed by glass, it is recommended to apply sunscreen if you’re next to a window, use a digital screen or are inside your car. However, you may not need to reapply sunscreen as frequently until you step outside, Hopkins Medicine writes.

Should I use sunscreen at night?

No. While sunscreen is effective at blocking UV light from the sun, its SPF molecules could create larger pores in your skin if worn at night so it is important you wash it off before bedtime and use night cream instead.

Researchers at Northwestern Medicine and Brigham and Women’s Hospital say they’ve discovered a root cause of lupus, a disease that affects hundreds of thousands of people in the U.S. 

Scientists have long suspected that a person’s genetics or hormones may predispose them to lupus, and that the disease may be triggered by environmental factors like a previous viral infection or exposure to certain chemicals.

Now, a study published Wednesday in the journal Nature outlines a clear pathway for how the disease likely develops, pointing to abnormalities in the immune systems of people with lupus.

“What we found was this fundamental imbalance in the types of T cells that patients with lupus make,” said Dr. Deepak Rao, one of the study authors and a rheumatologist at Brigham and Women’s Hospital in Massachusetts. T-cells are white blood cells that play a key role in the body’s immune response. 

The study arrived at its findings by comparing blood samples from 19 people with lupus to blood samples from healthy individuals. The comparison showed that people with lupus have too much of a particular T cell associated with damage in healthy cells and too little of another T cell associated with repair.

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At the heart of this imbalance is a protein called interferon, which helps defend the body against pathogens. Scientists have known for many years that people with lupus have excess amounts of type I interferon — but the new study links this issue to several negative effects.

First, too much type I interferon can block a protein called the aryl hydrocarbon receptor, which helps regulate the body’s response to bacteria or environmental pollutants. 

Blocking this receptor hinders the production of T cells that can help heal wounds on the barrier of the skin, lungs and gut. It also stimulates the production of T cells involved in creating autoantibodies, which attack healthy cells and are a hallmark of lupus.

Rao said the theory could explain the vast majority of lupus cases.  

“I think this is going to apply to essentially all patients with lupus,” he said.

But other experts questioned the idea that there’s a singular explanation for all instances of lupus.

“It’s very exciting research and very hopeful, but I think that it might be too early to say that it’s the root cause of the disease,” said Mara Lennard Richard, scientific program officer for the Lupus Research Alliance. The alliance is a private funder of lupus research and contributed grant funding to Rao’s study.

Because lupus symptoms are so varied and the contributing factors are manifold, “it’s been very hard to find one singular root cause for the disease,” Lennard Richard said. “Obviously, if this turns out to be the cause of lupus, that would be amazing and really fantastic for people living with lupus.”

Dr. Jill Buyon, director of the division of rheumatology and the Lupus Center at NYU Langone Health, said the theory would need to be tested in a larger sample of people.

“Until they study 100 patients prospectively, how are we going to know?” said Buyon, who was not involved in the study.

The Centers for Disease Control and Prevention estimates that more than 200,000 people in the U.S. have lupus, though the Lupus Foundation of America puts the total much higher: roughly 1.5 million people. Around 90% of people with lupus are women.

Common symptoms include extreme fatigue, joint pain or skin rashes. In rare cases, the disease may lead to kidney or heart damage, or weaken the immune system so the body can’t fight off infections. These issues can be fatal or life-threatening.

Lupus has historically been difficult to treat. Many of the current options broadly suppress the immune system, including beneficial T cells that fight infection. And for some people with the disease, standard treatments aren’t effective. 

The new study hints at the possibility of better treatments in the future, which could take the forms of infusions or pills, said Dr. Jaehyuk Choi, one of the study authors and a dermatologist at Northwestern Medicine.

The study found that giving people with lupus anifrolumab, a drug that blocks interferon, prevented the T-cell imbalance that likely leads to the disease. 

“We followed patients who received this as part of their clinical care and showed that in patients who got the drug, this cell imbalance was fixed or was on the way to getting fixed,” Choi said.

In blood samples of people with lupus, the researchers also tested the effects of adding a small molecule that activates the aryl hydrocarbon receptor. They found that it limited the accumulation of disease-promoting T cells. 

The major challenge to developing a new treatment, according to Choi, is finding ways to administer it without activating aryl hydrocarbon receptors throughout the whole body, which may result in more side effects.

Even if such a treatment becomes available, Buyon said, it’s unlikely to work for everyone with lupus.

“We have come to the profound understanding that one drug will not do it all,” she said.

This story first appeared on NBCNews.com. More from NBC News:

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The case was first reported Friday and preliminary test results indicated the bacteria’s presence.

Although the plague is best known for “The Black Death,” an outbreak that killed millions in Europe, the Middle East and northern Africa during the Middle Ages, the bacteria circulates naturally among wild rodents and in rare cases infects humans and their pets, according to the U.S. Centers for Disease Control and Prevention.

The last urban plague epidemic in the United States occurred in Los Angeles from 1924 through 1925. Since that time, plague has occurred as scattered cases in rural areas. Most human cases in the United States have occurred in outbreaks in California, New Mexico, Oregon, Idaho, Nevada, Utah, Arizona, Colorado, Texas, and Oklahoma.

People get plague from bites of infected fleas, by touching or skinning infected animals, or inhaling droplets from the cough of an infected person or animal.

Here’s what to know about the bubonic plague:

What is plague?

Plague is an infectious disease that can affect mammals. It’s caused by the bacterium Yersinia pestis, which is carried by rodents and fleas. Sunlight and drying can kill plague bacteria on surfaces, according to the  CDC. Humans and pets suspected to be sick with plague are typically treated with antibiotics, and sometimes with other medical measures.

Plague symptoms can manifest in a few ways. Bubonic plague — the kind contracted by the Colorado resident — happens when the plague bacteria gets into the lymph nodes. It can cause fever, headache, weakness and painful, swollen lymph nodes. It usually happens from the bite of an infected flea, according to the CDC.

Septicemic plague symptoms happen if the bacteria gets into the bloodstream. It can occur initially or after bubonic plague goes untreated. This form of plague causes the same fever, chills and weakness, as well as abdominal pain, shock and sometimes other symptoms like bleeding into the skin and blackened fingers, toes or the nose. The CDC says this form comes from flea bites or from handling an infected animal.

Pneumonic plague is the most serious form of the disease, and it occurs when the bacteria gets into the lungs. Pneumonic plague adds rapidly developing pneumonia to the list of plague symptoms. It is the only form of plague that can be spread from person to person by inhaling infectious droplets.

All forms of plague are treatable with common antibiotics, and people who seek treatment early have a better chance of a full recovery, according to the CDC.

Am I at risk of plague?

In the U.S., an average of 7 cases of human plague is reported each year, according to the CDC, and about 80% of them are the bubonic form of the disease. Most of those cases were in the rural western and southwestern U.S.

A welder in central Oregon contracted it in 2012 when he pulled a rodent out of his choking cat’s mouth in 2012 — he survived but lost his fingertips and toes to the disease. A Colorado teen contracted a fatal case while hunting in 2015, and Colorado officials confirmed at least two cases last year — one of them fatal.

Worldwide, most human cases of plague in recent decades have occurred in people living in rural towns and villages in Africa, particularly in Madagascar and Congo, according to the Cleveland Clinic.

People can reduce the risk of plague by keeping their homes and outdoor living areas less inviting for rodents by clearing brush and junk piles and keeping pet food inaccessible. Ground squirrels, chipmunks and wood rats can carry plague as well as other rodents, and so people with bird and squirrel feeders may want to consider the risks if they live in areas with a plague outbreak.

The CDC says repellent with DEET can also help protect people from rodent fleas when camping or working outdoors.

Flea control products can help keep fleas from infecting household pets. If a pet gets sick, they should be taken to a vet as soon as possible, according to the CDC.

Isn’t plague from the Middle Ages?

The Black Death in the 14th century was perhaps the most infamous plague epidemic, killing up to half of the population as it spread through Europe, the Middle East and northern Africa. It began devastating communities in the Middle East and Europe between 1347 and 1351, and significant outbreaks continued for roughly the next 400 years.

An earlier major plague pandemic, dubbed the Justinian plague, started in Rome around 541 and continued to erupt for the next couple hundred years.

The third major plague pandemic started in the Yunnan region of China in the mid-1800s and spread along trade routes, arriving in Hong Kong and Bombay about 40 years later. It eventually reached every continent except Antarctica, according to the Cleveland Clinic, and is estimated to have killed roughly 12 million people in China and India alone.

In the late 1800s, an effective treatment with an antiserum was developed. That treatment was later replaced by even more effective antibiotics a few decades later.

Though plague remains a serious illness, antibiotic and supportive therapy is effective for even the most dangerous pneumonic form when patients are treated in time, according to the World Health Organization.

In the comments sections of such videos, many viewers have shared their alarm at the claims, even saying that they’ll no longer buy shredded cheese. But what do dietitians think?

“These kinds of videos stir up fear in viewers who are already skeptical about our food system and aren’t sure who to trust,” registered dietitian Kristina Cooke tells TODAY.com. “When information is not coming from a scientifically sound and credible source, it’s almost like playing a game of telephone that gets out of hand.”

The most important thing to know about the claims is that both preshredded and block cheeses are healthy and safe to eat, experts say. Read on to learn more about the substance found on shredded cheese, known as powdered cellulose, and its uses.

What is the powdered substance on shredded cheese?

The powdery or finely grained substance that coats pieces of packaged, shredded cheese is an organic structural compound called cellulose (sometimes labeled as cellulose gum, carboxymethyl cellulose, or microcrystalline cellulose). As a food additive, it prevents the cheese from clumping together in packaging.

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“It’s also used in some products as a calorie reducer, an anti-caking agent, a thickener, and to add texture,” Caroline Susie, a registered dietician and national spokesperson for the Academy of Nutrition and Dietetics, tells TODAY.com. And because the compound absorbs excess moisture, it also helps prevent mold growth, thereby extending the shelf life of some products.

The cellulose used as a food additive is usually made from wood pulp or cotton lint, according to the Center for Science in the Public Interest, an independent food and health watchdog group.

“The edible cellulose … used in food is extracted and removed from the non-edible portion,” explains Cooke. “(It) is molecularly the same cellulose that exists in virtually all plant matter.”

In fact, cellulose has the important function of giving plant cells the rigidity they need to maintain their shape, so varying amounts of it are found naturally in all plants and plant-based foods.

The CSPI rates cellulose as safe to consume.

What foods contain cellulose?

In addition to shredded cheese, cellulose is sometimes added to:

• Bread
• Ice cream and other frozen desserts
• Pancake syrup, condiments and sauces
• Granola bars
• Yogurt
• Dried spices
• Processed meat
• Meal replacement shakes
• Fiber supplements

Cellulose is naturally found in fruits, vegetables, grains, beans, lentils, nuts and seeds.

“Celery is especially high in cellulose,” Amy Goodson, a nutritionist and registered dietitian at The Sports Nutrition Playbook, tells TODAY.com. “If you’ve ever had stringy pieces from celery stuck between your teeth, you’ve experienced cellulose firsthand.” 

Is cellulose dangerous to consume?

In either natural or additive form, cellulose is “generally recognized as safe (GRAS) by the Food and Drug Administration,” says Jen Messer, a registered dietitian and president of the New Hampshire Academy of Nutrition and Dietetics. If it wasn’t, she says it wouldn’t be approved by the agency nor be allowed in literally thousands of products sold in grocery stores across the country. 

She says humans lack the enzymes to break cellulose down, so it passes through the digestive system without being absorbed. Cellulose also counts as dietary fiber, though Messer says the amount added to shredded cheese “is so negligible it doesn’t contribute significantly to your daily fiber intake.”

In larger quantities though, naturally occurring cellulose plays a vital role in digestive health and helps promote regular bowel movements. It can also help improve cholesterol and blood sugar levels and aid in feelings of fullness, called satiety, which is why it’s often added to meal replacement shakes. 

So, is buying block or shredded cheese better?

There are no differences between the health benefits of either cheese type, the experts say.

“Both options contain the same nutrient-rich goodness that cheese provides, including calcium, protein, vitamin B12, selenium, niacin, riboflavin and iodine,” says Goodson.  

The other experts agree, telling TODAY.com the only differences one needs to consider between block and shredded cheese are related to cost, convenience and taste. 

For instance, the additives and preservatives used in shredded cheese “can slightly affect the flavor, making it less fresh tasting than freshly grated cheese to some people,” says Goodson.

It’s also usually more expensive per ounce compared to block cheese, and Messer notes that freshly grated cheese “may melt more smoothly” than preshredded cheese. 

On the other hand, the upsides of packaged shredded cheese include less moisture overall — so it is less likely to mold and generally lasts longer in the refrigerator than block cheese. It also usually takes up less space and doesn’t require clunky kitchen tools, such as a cheese grater.

“Purchasing pre-shredded cheese is also convenient because it saves time and effort in both food preparation and cleanup,” says Messer. 

Cooke agrees: “If time, capacity, effort and extra dishes are barriers to your eating a food that might benefit you, make it easier on yourself and purchase shredded cheese. But if you enjoy the satisfaction of preparing more of your meal, opt to purchase block cheese instead.”

This article first appeared on TODAY.com. Read more from TODAY here:

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Pennsylvania’s Senate on Wednesday approved a bill to encourage school districts to start a pilot program that effectively bans students’ use of cellphones during the school day in an effort to improve their mental health and academic performance.

The bill, which passed 45-5, would authorize grants to school districts to buy locking bags after the district creates a policy requiring students to leave their phones in such bags for the whole school day. It now goes to the state House for consideration.

The bill’s sponsor, Republican state Sen. Ryan Aument of Lancaster, said he hopes that limits on phone use will result in improvements in students’ mental health and academic performance.

“Kids spend so much time on social media and using their smartphones that it’s taking a toll on them mentally, emotionally and academically. Smartphone restrictions have proved successful in reversing these trends,” Aument said.

Under the bill, the policy must provide exemptions for students who have a documented medical condition that requires them to use a cellphone. Participating school districts must track changes over two school years in student mental health, bullying, violence and academic performance.

Grants would be awarded by the Pennsylvania Commission on Crime and Delinquency, and separate legislation would be required to set grant amounts and devote money to the purpose.

Most schools already have rules regulating student phone use. But a growing number of state officials have begun endorsing school cellphone bans, and such legislation is emerging in other states.

Last year, Florida became the first state to crack down, passing a law requiring public schools to ban student cellphone use during class time and block access to social media on district Wi-Fi networks. Some districts went further and banned phones for the entire school day.

California allows school districts to limit or ban the use of smartphones by students while at school, and the Los Angeles Unified School District board voted last month for the district to develop such a policy.

The Pennsylvania bill’s passage in the state Senate comes two weeks after U.S. Surgeon General Vivek Murthy called on Congress to require warning labels on social media platforms and their effects on young people.

The Food and Drug Administration approved Eli Lilly’s Kisunla on Tuesday for mild or early cases of dementia caused by Alzheimer’s. It’s only the second drug that’s been convincingly shown to delay cognitive decline in patients, following last year’s approval of a similar drug from Japanese drugmaker Eisai.

The delay seen with both drugs amounts to a matter of months — about seven months, in the case of Lilly’s drug. Patients and their families will have to weigh that benefit against the downsides, including regular IV infusions and potentially dangerous side effects like brain swelling.

Physicians who treat Alzheimer’s say the approval is an important step after decades of failed experimental treatments.

“I’m thrilled to have different options to help my patients,” said Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis. “It’s been difficult as a dementia specialist — I diagnose my patients with Alzheimer’s and then every year I see them get worse and they progress until they die.”

Both Kisunla and the Japanese drug, Leqembi, are laboratory-made antibodies, administered by IV, that target one contributor to Alzheimer’s — sticky amyloid plaque buildup in the brain. Questions remain about which patients should get the drugs and how long they might benefit.

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The new drug’s approval was expected after an outside panel of FDA advisors unanimously voted in favor of its benefits at a public meeting last month. That endorsement came despite several questions from FDA reviewers about how Lilly studied the drug, including allowing patients to discontinue treatment after their plaque reached very low levels.

Costs will vary by patient, based on how long they take the drug, Lilly said. The company also said a year’s worth of therapy would cost $32,000 — higher than the $26,500 price of a year’s worth of Leqembi.

The FDA’s prescribing information tells doctors they can consider stopping the drug after confirming via brain scans that patients have minimal plaque.

More than 6 million Americans have Alzheimer’s. Only those with early or mild disease will be eligible for the new drug, and an even smaller subset are likely to undergo the multi-step process needed to get a prescription.

The FDA approved Kisunla, known chemically as donanemab, based on results from an 18-month study in which patients given getting the treatment declined about 22% more slowly in terms of memory and cognitive ability than those who received a dummy infusion.

The main safety issue was brain swelling and bleeding, a problem common to all plaque-targeting drugs. The rates reported in Lilly’s study — including 20% of patients with microbleeds — were slightly higher than those reported with competitor Leqembi. However, the two drugs were tested in slightly different types of patients, which experts say makes it difficult to compare the drugs’ safety.

Kisunla is infused once a month compared to Leqembi’s twice-a-month regimen, which could make things easier for caregivers who bring their loved ones to a hospital or clinic for treatment.

“Certainly getting an infusion once a month is more appealing than getting it every two weeks,” Schindler said.

Lilly’s drug has another potential advantage: Patients can stop taking it if they respond well.

In the company’s study, patients were taken off Kisunla once their brain plaque reached nearly undetectable levels. Almost half of patients reached that point within a year. Discontinuing the drug could reduce the costs and safety risks of long-term use. It’s not yet clear how soon patients might need to resume infusions.

Logistical hurdles, spotty insurance coverage and financial concerns have all slowed the rollout of competitor Leqembi, which Eisai co-markets with U.S. partner Biogen. Many smaller hospitals and health systems aren’t yet setup to prescribe the new plaque-targeting Alzheimer’s drugs.

First, doctors need to confirm that patients with dementia have the brain plaque targeted by the new drugs. Then they need to find a drug infusion center where patients can receive therapy. Meanwhile, nurses and other staff must be trained to perform repeated scans to check for brain swelling or bleeding.

“Those are all things a physician has to have set up,” said Dr. Mark Mintun, who heads Lilly’s neuroscience division. “Until they get used to them, a patient who comes into their office will not be offered this therapy.”

In a place with a long history of people living — and sometimes dying — under the Boardwalk, Atlantic City has launched an effort to address homelessness by preventing people from sleeping on public property and connecting them with shelter and services.

The effort comes only days after the U.S. Supreme Court ruled that municipalities can ban homeless encampments, something the city said would support its efforts to address homelessness.

It follows an April 19 fire that killed a man in a homeless encampment under the Boardwalk, months after another fire suspected of being started by homeless people burned a section of the boardwalk in front of Resorts casino. The damage has since been repaired.

“We cannot claim to be this world-class resort (if) we don’t handle the problems that the resort sometimes encounters,” said Mayor Marty Small, a Democrat.

The city is implementing plans by its Boardwalk Improvement Group, which includes using state funds to pay for workers, training and equipment to seek out homeless people and offer them help, including transportation back to where they came from.

But that offer is often rejected. Out of about 200 homeless people that city officials encountered since September, only five have accepted an offer to go back home, officials said.

Many others refuse help of any kind, said Jarrod Barnes, Atlantic City’s director of health and human services.

“When that happens, there is nothing we can do,” he said. “We can’t force them to accept help.”

A tour by city officials of places known to be where homeless people stay was only minutes old when they encountered a disoriented man sprawled across a sidewalk in the midday sun. An ambulance was called and he was taken to a nearby hospital for evaluation.

Not far away, in a vacant lot strewn with empty liquor bottles, two young women, who both described themselves as homeless, acknowledged having been assisted multiple times by city outreach teams.

Essence, who would not give her last name, said she was given a free stay at a motel by the city, but returned to the streets. At one point, she said, she lived in a homeless encampment under the Boardwalk, until police broke it up.

Tanisha, who also would not give her last name, said she had no idea where she would spend the night on Monday.

“We’re just trying to make a way, find a way,” she said.

But she acknowledged she and others living outdoors are not always ready to accept help.

“It’s really up to us to do what we got to do first,” she said. “The struggle is real.”

In the wake of the Supreme Court ruling, Atlantic City plans to introduce an ordinance in the coming weeks that would prohibit sleeping in public places. It could be adopted and put into place by September.

The outreach effort includes 10 full-time workers assigned to find and interact with people who are homeless, offering social services, a pathway into drug or alcohol rehab if needed, and a place to stay. Police assign officers to regularly patrol spots known as homeless gathering points, and police, fire department and public works officers have been trained on interacting with homeless people.

Small noted that some of the homeless encampments have shown signs of real ingenuity. Refrigerators and microwave ovens have been patched into jerry-rigged electrical connections.

And, he added, inhabitants at one encampment managed to tap into the hose of a line under the Boardwalk providing beer to a casino’s beachfront bar.

Backward walking — also called retro-walking — is exactly what it sounds like: the act of walking in reverse. It involves walking backward while maintaining proper posture and balance. The movement engages different muscles than forward walking, activating the glutes, hamstrings and calves and stretching the quads and hips.

Walking backward has benefits beyong toning, too. It can help improve coordination and is a great way to switch up your workout routine and challenge your mind and body in a new way. Here are even more reasons to add it to your routine.

Backward walking challenges your brain

Backward walking offers a nice change of pace to your regular walking routine, keeping things interesting and preventing boredom. By challenging your body to move in an unfamiliar way, you are training your brain and muscles to adapt quickly.

“Walking backwards is not a ‘secret’ or ‘miracle’ exercise, but, it definitely provides some benefits,” Dr. Rand McClain, sports medicine physician and owner of the Regenerative & Sports Medicine clinic in Santa Monica, California, tells TODAY.com. “The most obvious difference between walking backwards versus walking forward is that walking backwards requires more focus and coordination, challenging the body and brain.”

“Different muscles are used to walk backwards and some of the same are used, but in a different sequence and balance,” McClain adds. ”That not only affects the muscles — typically getting them to work harder than they are used to — but affects the brain and the nervous system in new ways that help activate direct pathways involved in the movement itself as well as indirect pathways that help the brain grow and develop new neurons and synapses (a concept often referred to as neuronal or simply brain ’plasticity’).”

Backward walking benefits

The primary muscles used to propel you forward are the quads, hamstrings and calf muscles. Walking backward, on the other hand, engages the glutes, hamstrings and even the shins, which help to maintain balance. When you walk backward, you also naturally engage your core muscles to maintain stability and balance. This can contribute to better posture and spinal alignment over time.

As you walk in reverse, you are challenging your joints and muscles to move in a different range of motion. The increased mobility gained from walking backward can make everyday movements more comfortable and effortless, whether it is reaching for something on a high shelf or bending down to tie your shoes.

According to one study, people who walked backward improved their balance, length of their steps and speed of their steps. The same study showed that backward walking can actually put less strain on the joints compared to walking forward. So, if your knees, ankles or feet are feeling store or stiff, try walking backward to loosen things up.

Another study found that walking backward on a treadmill helped stoke patients improve their cardiopulmonary fitness, increased their walking speed and improved their balance.

Walking backward can help in developing coordination, strength, flexibility, cardiovascular fitness and “extra” calorie burning (due to it being more difficult), says McClain. “Also, it can often provide an alternate source of exercise for someone with injury or degeneration (arthritis) because walking backwards can often avoid using those injured or degenerated muscles or joint components (ligaments, arthritic areas and menisci) that walking forward aggravate,” he adds.

3 easy ways to add backward walking to your routine

•  Start small: Ease into it by simply walking backward throughout your day. You can walk backward down a hallway in your house, from the kitchen to the family room, or down the driveway to get your mail.
• Try intervals: During your daily walk, walk forward for 5 minutes and then walk backward for 1 minute. Repeat this routine a few times. If you want to incorporate even more backward motion, make the interval lengths equal by walking for one block or one minute forward, and then one block or 1 minute backward, alternating every minute.
• Use the treadmill: If you walk indoors on a treadmill, it’s a great opportunity to incorporate some backward walking with assistance. Since treadmills have handrails, they provide more stability and will help with balance as you get used to the new movement. Step on the treadmill backward, start the belt at a low speed (slower than you typically walk forward), and rest your hands lightly on the handrails before stepping on the belt.

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That was the case for Marilyn Espitia, a 31-year-old freelance photo editor and photographer in California who first ventured into online dating in college, when she met her former partner and now father of her child on OkCupid.

Today she is single, and has been for about three years. While she’s still a “hopeless romantic” who plans to keep using these platforms — primarily Hinge — Espitia says she’ll get off an app or pause her profile when it becomes a little too much.

“It starts getting overwhelming,” Espitia said.

Licensed clinical psychologist Yasmine Saad says that about 3 out of every 4 people she works with use dating apps, and anywhere between 80 to 90% have expressed feeling similar fatigue or burnout as Espitia at some point.

That’s due in part because success is never promised with online dating, regardless of whether you’re looking for a lifelong partner or casual fling.

“It’s a very difficult process for people because you invest a lot, then you receive little,” said Saad, founder and CEO of Madison Park Psychological Services in New York. “It triggers a lot of hopelessness and a lot of self-esteem issues.”

Kathryn Coduto, an assistant professor of media science at Boston University who has been studying online dating since 2016, says dating app burnout is probably as old as the apps themselves, noting that people had experienced fatigue with earlier desktop-dominant platforms like eHarmony or Match.com as well.

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But these days, burnout may be intensified by the fact there’s an app for just about every part of our daily lives, and that constant connectivity can be too much. Pandemic-era “Zoom fatigue” has spilled over into other areas of tech consumption, Coduto said, and online dating isn’t immune.

That doesn’t mean dating apps are going away anytime soon. Research shows usage has remained relatively stable over recent years.

Pew Research Center said that 3 out of 10 U.S. adults reported ever using an online dating site or app as of July 2022 — identical to the share found in October 2019, months before COVID-19 impacted much of daily life, including dating habits.

While there was some uptick in new user downloads at the start of the pandemic, Coduto’s research found more of a spike in usage from those who already had dating apps and were spending more time on them during lockdowns. But those same lockdowns also limited in-person interactions, and the ripple effects are still being felt today.

“The pandemic increased loneliness,” Saad said. “But it also boosted the hopelessness … because even the apps were not meeting the needs of people for socialization.”

For Jennifer Stavros, a freelance journalist in Los Angeles, her time in the online dating world has “been a mixed bag.” While she’s still giving platforms like Tinder, Hinge and OkCupid a try, Stavros notes she’s experienced a recent cycle of matches that don’t go far.

“I have a conversation … and it’ll go okay. (But) then it will just drop, or it’ll just hit a wall somewhere,” Stavros, 42, said. “It’s not making me feel super hopeful.”

Others add that it can also become easy to forget there are people on the other side of those swipes and likes, making them feel dismissed while looking for connections.

“I think that sense of swiping endlessly absolutely plays into burnout,” Coduto said. “You’re treating people like a card deck because that’s what you’re looking at.”

Yumei He, an assistant professor of management science at Tulane University’s A. B. Freeman School of Business who has also been studying online dating, said that hurtful experiences — such as being ghosted — can cause users to not trust a platform, or assume all future interactions there will end up the same way, leading them to log off and decide that “dating is important, but my security, my self (worth) is more important.”

And of course, burnout doesn’t look the same for everyone. Experiences can range widely depending on gender, sexuality, race and ethnicity. Researchers have found that women and genderqueer individuals, for example, are more likely to face harassment than men, while racial and ethnic minorities are often fetishized in online dating spaces, or experience other discrimination resulting from sexual racism.

The trauma of experiencing discrimination and other abuse on a dating app can make it very difficult to stay on a platform or trust it again, Coduto said.

Companies are increasingly navigating ways to address all of this. Hinge, for example, in April launched “Hidden Words,” which allows its users to filter out words, phrases and emojis in their incoming likes and comments. A Hinge spokesperson says this feature is aimed at helping vulnerable groups — particularly women, people of color and LGBTQ+ individuals — avoid unwanted interactions based on personal preferences.

Gay dating and social networking app Grindr alerts users of potential safety threats in their area, which has been particularly critical for LGBTQ+ people in countries who may face police raids and other dangers, CEO George Arison said in an interview. Users are also able to “surf the grid” on incognito mode, which is typically a paid feature, for free in some locations, he added.

“All Grindr users are under some form of challenges in their lives,” Arison said. “Our job has always been to create a safe environment for people to be who they are.”

When asked about dating app burnout overall, Arison said “we’ve not seen any fatigue of Grindr users” but he noted there’s growing hunger for innovation.

That’s evidenced by the scores of updates that have recently emerged across various dating apps — from a new prompts option on Bumble, which shifts how the platform historically facilitated its “first move,” to Tinder’s “Matchmaker” feature allowing friends to recommend profiles for each other and Hinge’s tests of “your turn limits” to help fend off ghosting.

A handful of popular platforms, including Grindr and Tinder, say they’ve started integrating artificial intelligence to help identify potential harmful messages and other safety precautions. Some are also looking at AI possibilities such as using the technology to strengthen matching algorithms or offer users’ message prompts and date ideas.

“We are just scratching the tip of the iceberg,” said Anindya Ghose, Heinz Riehl Chair Professor of technology and marketing at New York University’s Stern School of Business, who believes AI could help alleviate burnout but transparency will be key.

Such innovations may be a way to keep people hooked on dating apps. Espitia is among those who say she’d be open to seeing platforms implement further updates — including the use of AI — if it helps improve connections with people around her.

“We’re in this new age of finding love,” she said. “People really are like starved for love — and I think if that (technology) can help, why not?”