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Overweight, obesity at midlife linked to greater morbidity, health care costs later in life


March 21, 2022

1 min read


Disclosures: Khan reports receiving grants from the American Heart Association and the NIH. Please see the study for all other authors’ relevant financial disclosures.

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Having overweight or obesity in midlife was associated with significantly higher cumulative morbidity and thousands of dollars in additional health care costs during older adulthood, data show.

The findings were published in JAMA Network Open.

Khan SS, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.2318.

“The greater proportion of life lived with morbidity translated to higher adjusted cumulative and mean annual health care expenditures during older adulthood, which will have substantial consequences for health care costs as the aging population intersects with the obesity epidemic,” Sadiya S. Khan, MD, MSc, an assistant professor of cardiology and epidemiology medicine at the Feinberg School of Medicine at Northwestern University, and colleagues wrote.

Khan and colleagues conducted a prospective cohort study of participants from the Chicago Heart Association Detection Project in Industry. The participants underwent baseline in-person examinations between November 1967 and January 1973. These data were linked to Medicare data that were collected between January 1985 and December 2015. The final analysis included 29,621 Medicare beneficiaries who were followed for more than 40 years; 57.1% were men, 9.1% were Black and the mean age was 40 years.

At baseline, 46% of participants had a normal BMI, 39.6% were overweight and 11.9% had classes I and II obesity. Khan and colleagues reported a higher cumulative morbidity burden in older adulthood among participants with overweight (7.22 morbidity-years) and classes I and II obesity (9.8 morbidity years) compared with those with a normal BMI (6.1 morbidity years) in midlife (P < .001). The mean age at death was similar between those who were overweight (82.1 years; 95% CI, 81.9-82.2) and those who had normal BMI (82.3 years; 95% CI, 82.1-82.5). However, participants with classes I and II obesity died at a younger age (80.8 years; 95% CI, 80.5-81.1), on average.

The cumulative median per-person health care costs in older adulthood were $12,390 (95% CI, 10,427-14,354) higher among participants with overweight and $23,396 (95% CI, 18,474-28,319) higher among those with classes I and II obesity compared with participants with a normal BMI (P < .001).

“Resources and strategies are urgently needed at the individual and population level to address the growing public health challenge of excess weight in the context of an aging population,” Khan and colleagues wrote.

Connection between tobacco use, mental health important to understand


According to the American Academy of Family Physicians, adults with a behavioral health disorder (ie, a mental health disorder and/or a substance use disorder) are more likely than others to be tobacco users and face additional problems because of that.

Purdue, along with the state of Indiana and nationwide agencies, provides support for tobacco cessation and behavioral health disorders. The need for such resources is confirmed by numerous agencies and organizations.

The American Lung Association, via its Behavioral Health & Tobacco Use webpage, shares a variety of statistics on tobacco and mental health, such as:

  • It is estimated that 35% of cigarette smokers have a behavioral health disorder and account for 38% of all US adult cigarette consumption.
  • Despite the national cigarette smoking rate being 14% overall among adults, it is 23% for individuals with a behavioral health disorder.
  • The nicotine dependency rate for individuals with behavioral health disorders is two to three times higher than the general population.
  • Lifetime smoking rates are higher in patients who are diagnosed with major depression disorder (59%), bipolar disorder (83%), or schizophrenia and other psychotic disorders (90%) compared with 32% among adults with no mental illness.
  • Among current smokers with a lifetime history of depression, anxiety, anxiety with depression or major depression, they smoke more cigarettes, smoke more frequently and have a higher level of dependence.
  • The presence or history of depression is associated with greater smoking severity and poorer smoking outcomes.

“The connection between nicotine use and mental health is a vicious cycle,” said Lindsay Bloom, health coach at Purdue Fort Wayne. “Statistics show the connection between those living with mental health issues and the use of tobacco (smoking, vaping, etc.). This increase can be linked to individuals wanting to self-medicate to help alleviate symptoms of their mental health issues; However, using tobacco doesn’t really alleviate the symptoms. In reality, it negatively impacts mental health. Over time, smoking can lead to lower levels of dopamine production by the brain, which then triggers a need to smoke more to increase the dopamine levels.”

Thus at the same time that individuals with mental health issues smoke and use tobacco at higher rates, effects of the usage can also bring about mental health concerns such as:

  • Addiction.
  • Stress.
  • Depression.
  • Schizophrenia.

A study, published in 2019 in Psychological Medicine, found that smokers had nearly double the risk of developing depression or schizophrenia that nonsmokers had. Its conclusions statement reads: “These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.”

Quitting tobacco

According to the Centers for Disease Control and Prevention, not only does quitting tobacco provide extensive physical health benefits but it also supports behavioral health treatment and could improve mental health. Additionally, Truth Initiative, America’s largest nonprofit public health organization committed to making tobacco use and nicotine addiction a thing of the past, reports that quitting smoking is linked with lower levels of anxiety, depression and stress. Truth Initiative’s Quitting nicotine can alleviate mental health symptoms webpage provides additional details.

Purdue provides tobacco cessation resources for benefits-eligible employees on all campuses and dependents covered on a Purdue health plan, including one-to-one counseling via the Center for Healthy Living (CHL) and Healthy Boiler tobacco cessation lifestyle programs. In addition, the Indiana Tobacco Quitline is provided by the state Department of Health to all residents of Indiana and is available seven days a week.

Upcoming ‘Tobacco Cessation’ Healthy Boiler lifestyle program

For those who are ready to quit smoking or who are thinking about quitting, the upcoming Healthy Boiler lifestyle program “Tobacco Cessation” is a great resource. The program, which will virtually meet from noon to 1 pm ET on Tuesdays from May 31 to June 28, teaches strategies to help individuals quit and stay quit. Bloom is the instructor.

Those interested in participating should register by April 28 via the Healthy Boiler Portal. The registration link can be found under the “Healthy Boiler Workshops” section on the portal’s homepage. Hover over the workshop’s square and hit “Submit” to register.

Participating in this program will count as an approved tobacco cessation program, resulting in a partial waiver of the 2022 tobacco-user additional premium, once completed program certificate is submitted.

Tobacco-user additional premium information

Aside from the health (physical and behavioral) benefits resulting from not smoking, there are also financial benefits, including a waiver of the tobacco-user additional premium on an employee’s premium benefits. As a reminder, employees, and their spouse if covered, who certify as tobacco users (a person who has used tobacco, including cigars, cigarettes, electronic cigarettes, chewing tobacco, pipe tobacco or any other tobacco product in the past 12 months) during Open enrollment each year will pay an additional $1,000 tobacco-user premium on their medical benefits. Premiums for term life, universal life and critical illness insurance also are based in part on whether an employee (and their spouse, if covered) have used tobacco in the last 12 months and those premiums may be affected as well.

Completed program certificates from an approved tobacco cessation program submitted after March 31 will waive the tobacco-user additional premium for the remainder of the 2022 plan year.

For more information about the additional premium, visit the Purdue Medical Plan Tobacco-User Additional Premium: Questions and Answers webpage.

More information on tobacco use and mental health


To assist faculty and staff

Review the Mental Health Resources webpage for a variety of available resources for faculty and staff, including EAP resources for all Purdue campuses, information on Purdue’s health plan coverage for mental health and substance abuse as well as behavioral health referral locations for the West Lafayette, Fort Wayne and Northwest campuses.

To assist students

Faculty and staff, who work with students or have a student at home, can direct students to the resources below for behavioral health assistance. Note: LiveHealth Online Psychology and LiveHealth Online Psychiatry services are also available to Purdue students who are covered on a Purdue health plan. Mental health visits through LiveHealth Online are fully covered on the Purdue student health plan.

Office of the Dean of Students

Counseling and Psychological Services (CAPS)

Natalie Mordovtseva’s Weight Loss Transformation Photos


90 Day Fiancé star Natalie Mordovtseva is known for her weight loss makeover. The Ukrainian actress has stunned fans with her weight loss secrets.

The 90 Day Fiancé franchise star Natalie Mordovtseva’s journey from being fat-shamed to impressing fans with her weight loss through her before and after pictures has been dramatic. 37-year-old Natalie became a known reality TV face after her 90 Day Fiancé season 7 debut, which featured her relationship with Mike Youngquist. The two were polar opposites and had several ups and downs in their storyline, from 90DF to 90 Day Fiancé: Happily Ever After? season 6. The couple did not go the distance.

Kyiv resident Natalie used to work as an actress, model, and journalist, and she met Mike via mutual friends. Natalie left her glam life behind to go stay in the woods with Mike. She looked forward to resuming her career as a TV personality after marriage, but was mocked by Mike’s mother, Trish Youngquist. However, Natalie didn’t let her dreams get crushed by her mother-in-law. Instead, after moving to Florida, Natalie ended up breaking up with Mike and starring in 90 Day: The Single Life season 2.


Related: 90 Day Fiancé: What Natalie Mordovtseva Is Up To Since Split With Mike

With no divorce from Mike in sight, Natalie dated a model called Johnny, whom she dumped, and later started dating Josh, the CEO of Johnny’s modeling company. In the finale, Mike revealed that he hasn’t filed for Natalie’s change of citizenship status, which could mean that she gets deported due to the divorce. However, Natalie is still in the US, and was recently seen posting behind-the-scenes videos from a modeling shoot. Natalie seems to have achieved her goals, and her new weight loss makeover appears to have given her confidence.

Natalie Deals With Pregnancy Rumors

Natalie Mordovtseva Instagram Weight Loss Before After In 90 Day Fiance

In January 2021, Natalie was a part of 90 Day Fiancé season 8, and her marriage plans with Mike were still up in the air. However, fans knew that Mike and Natalie had married in real life in April 2020, so a wedding was going to take place either way. It also meant that Natalie and Mike could have decided to have a baby after getting married. In the now-deleted photos that Natalie was posting on Instagram back then, fans claimed that they saw telltale signs of her being pregnant. Natalie was apparently Photoshopping her pics to give herself a smaller waist and bigger breasts. Fans noticed that none of Natalie’s Instagram photos showed her body below her waist. They speculated that this was because Natalie was pregnant and trying to hide her baby bump.

Natalie Confesses To Stress Eating

Natalie Mordovtseva Instagram Weight Loss Before After In 90 Day Fiance 2

Although having a baby with Mike in 90 Day Fiancé season 7 was all that Natalie wanted to do, she wasn’t pregnant after her wedding. Natalie had gained weight, and critics were crossing the line by body-shaming Natalie. In April 2021, Natalie told an Instagram follower the real reason behind the changes in her body. She mentioned that she’d gained 20 pounds. This was because she was stressed and kept on eating. Natalie admitted that she was trying to regain her fitness, which she soon did. She was seen asking fans for prayers on Instagram because she was going into a surgery that was a bit mysterious. Many people thought that Natalie was getting a nose job because she’d claimed that people often criticized her nose, which made her consider rhinoplasty.

Natalie Reveals Diet & Plastic Surgery Secrets

Natalie Mordovtseva Instagram Plastic Surgery Weight Loss In 90 Day Fiance 2

However, what Natalie did get was liposuction on her stomach, belly, waist, and chin. Natalie had met a trainer called Jeyran Dursunova on an intermittent fasting Facebook group, who helped her perfect her look within three months, with diet and exercise. After following a customized plan featuring a keto diet and 16:8 intermittent fasting, Natalie was able to go from 165 pounds to 136 pounds. Fans did accuse Natalie of scamming them since she’d already admitted that she did get a liposuction procedure, which also helped her to look slimmer. 90 Day Fiancé star Natalie wanted to reduce the fat on her tummy and keep her chest size intact.

Related: 90 Day Fiancé: Mike’s New Look After Natalie Split Surprises Fans

Earlier this year, in January, Natalie told 90 Day Fiancé fans that he was getting back into shape, and reported that her fitness journey was very difficult for her. She credited her diet and exercise routine for the changes, but also suggested that people who want to lose weight could also do cryotherapy, which she has tried.

Next: 90 Day Fiancé: Why Natalie Kept Her Two Ex-Husbands Before Mike A Secret

Recasting star trek voyager in 2022

Recasting Star Trek: Voyager In 2022

About The Author

Should children still wear face masks on planes and trains?


Q: Now that airlines have dropped mask mandates, is it OK to let my kids travel without masks?

A: The judge’s ruling striking down the federal mask mandate on public transportation and in transit hubs and the subsequent appeal by the Justice Department have created confusion about whether flying or riding the train is safe without a mask.

I realize that some families may find it difficult to decide what’s best for them. But, for some children, including those too young to be immunized and those with special health care needs, masking is still an important layer of protection.

Face masks can be safely worn by all children 2 years and older, including the vast majority of children with underlying health conditions, with a rare exception. In addition to protecting the child, the use of face masks significantly reduces the spread of SARS-CoV-2 and other respiratory infections in schools and other community settings.

Parents of children who are over 2 years of age should strongly consider having them wear a mask in crowded public spaces, on trains and on planes. Masks are especially important for those who interact with children under age 5, because young children are not yet eligible for the vaccine, and for those who are in close contact with elderly people or those who are immunocompromised or at higher risk for serious disease.

Masks also are a good idea in areas where COVID cases are rising. It’s important to remember that high-risk children and adults are still vulnerable to severe infection.

Studies have shown that a well-fitting mask helps reduce the spread of the COVID-19 virus. Masks form a barrier that can stop airborne virus particles from being inhaled by an uninfected person.

In addition, everyone ages 5 and older should be vaccinated against COVID-19 and those who are eligible should be boosted. Consider getting a second booster, if you or your child are eligible for one. The vaccine is very effective in helping to prevent hospitalization and death, and a booster reminds the body’s immune system about the virus it needs to defend against. This gives the immune system a vital boost.

With the continued dropping of COVID mandates across the country, there will be times when your family is around groups of people who aren’t wearing masks. Having a family plan about masks will help your child or teen know what to expect.

Parents can help their kids understand that there are many reasons why adults and children may continue wearing face masks when they are around others. For example, flight attendants, teachers, grocery store workers or ride-share drivers may choose to continue wearing face masks, even if they are not required to do so. Children with special health care needs may rely on masks for important protection so they do not have to miss school or other activities — especially if others around them do not wear masks.

Masking also helps cocoon children who are too young to be vaccinated. Masks can also protect kids who have weakened immune systems that put them at higher risk of serious illness from COVID-19. That’s why preschools and childcare centers may have different guidelines about mask wearing indoors. Be sure to check the rules in those places.

Family members who live in the same household do not need to wear masks when they are alone together. But if you are vaccinated and your children are not, you can choose to model mask-wearing behavior in support of your children when you are all out together. For example, everyone in the family can wear masks to the grocery store or when riding the train.

The pandemic continues to impact families in many different ways. As a parent, model empathy toward others. Strongly discourage the mocking of children who choose to wear a mask to protect themselves and their family.

Without the added layer of protection from the COVID vaccine for kids under age 5 just yet, masks are still an important way to protect our loved ones.

Dr. ​Yvonne A. Maldonado is a professor and the chief of the Division of Infectious Diseases in the Department of Pediatrics at Stanford University School of Medicine. She also is the chair of the AAP Committee on Infectious Diseases.

Biologics and Allergic Asthma


If allergic asthma symptoms are constantly disrupting your daily life, even though you use control medications like inhalers, it may be time to add on a biologic.

Biologics are medications you take as a shot or IV infusion. They’re monoclonal antibodies, which are human-made blood proteins. Scientists make them using cells from living organisms. Biologics bind to parts of your immune system that are responsible for asthmatic inflammation and turn it down.

“Biologics suppress this specific targeted immune response so that the asthma can be controlled without needing a broader immunosuppressant like prednisone, which comes with many side effects,” says Purvi Parikh, MD, allergist and immunologist with Allergy & Asthma Network.

Biologics are meant to be an add-on to other types of allergic treatments, not a standalone medication.

These may include:

Immunotherapy. This therapy involves seeing an allergist for allergy shots. The shots contain very small doses of the allergen that triggers a reaction in you. Over time, your body may become less reactive to the allergen.

Allergy medications. Although they aren’t treatments for asthma itself, oral and nasal antihistamines and decongestants, as well as corticosteroid and cromolyn nasal sprays, they can help ease the allergic reaction causing your asthma symptoms.

Who Should Take Biologics?

Doctors may consider you allergic a candidate for biologic treatment for asthma if you:

  • Wake up at night with symptoms
  • Use your quick-relief inhaler more than two times a week
  • Need oral or injection steroids two times a year or more
  • Visit the doctor, urgent care, or ER for asthma symptoms more than two times a year

Before prescribing a biologic, your doctor will first check to be sure you’re using your current medications correctly. They’ll ask if you’ve identified any triggers and are successfully controlling them, too. They may check to make sure another condition or medication isn’t causing your symptoms.

Biologic Options

There are currently five FDA-approved biologics for treating allergic asthma, but only one — omalizumab (Xolair) — is specific to allergic asthma. The other four — benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), and reslizumab (Cinqair) — treat eosinophilic asthma, a type of asthma where certain white blood cells (eosinophils) build up in your lungs and cause inflammation.

Omalizumab treats asthma caused by airborne allergens such as dust mites, cockroach debris, and pollen. You get it as an injection every 2 weeks or every 4 weeks, depending on dose. Kids as young as 6 can use omalizumab.

Benefits and Risks

Parikh says the use of biologics is becoming more common, both because more people are getting asthma and more cases are severe. The pros of taking biologics typically outweigh the cons.

When you take a biologic, you may see benefits such as:

  • Fewer urgent care or emergency room visits
  • Less need for oral steroids
  • A lower dosage of controller medications
  • Fewer missed days of work or school
  • Better lung function

Because biologics target specific asthma responses instead of whole-body systems, they tend to cause fewer side effects than oral corticosteroids.

“Overall risks are very low, but since they do suppress parts of your immune system, some may increase your risk of parasitic infections,” Parikh says. “Any injection also carries risk of an allergic reaction but that is also very rare.”

Other side effects may include:

  • So throat
  • Muscle or joint aches
  • Headache
  • Fatigue
  • Weakness
  • Back pain
  • Redness at the injection site

You’ll get your biologic injection in a doctor’s office. Your doctor may want you to stay for up to 2 hours after to make sure you don’t have a bad reaction.


Twin babies branded ‘lazy’ by experts found to have deadly cruel muscle condition



Parents Steve and Jenna Whyman, from Benfleet in Essex, were alarmed when sons Raffa and Sibby showed no sign of being able to lift their heads or roll over in their early months

Identical twins Raffy and Siddy Whyman have been diagnosed with Spinal Muscular Atrophy type 1

A mum whose twin sons have been diagnosed with a cruel muscle condition which means they were unlikely to live past two-years-old without treatment has described her family’s “living nightmare”.

Jenna Whyman and husband Steve realised something was wrong when they spotted babies Raffa and Sibby were not able to lift their heads and seemed to have limited movement.

But Jenna, 36, told The Mirror that healthcare workers suggested that the infants were “lazy” and that they would eventually catch up.

After months of raising fears about the twins’ development, the couple were eventually told something was seriously wrong.

The day before their first birthday Jenna and Steve were told the boys had Spinal Muscular Atrophy (SMA) type 1 – which if left untreated meant they were unlikely to live past the age of two.

Jenna said she first became worried when the boys showed no signs of being able to lift their heads or roll over, but was repeatedly told not to worry.

Parents Steve and Jenna became alarmed when the twins were unable to lift their heads or roll over


Jenna Whyman

As a result Raffa and Sibby lost vital time in their battle against the progressive condition, which causes muscle wasting and loss of movement.

She told The Mirror: “They had a rattly chest from birth, which we now know is a sign of SMA.

“Each time I’d raise that they’re not attempting to lift their head or roll over I was told ‘don’t worry, they’re twins, they’ll catch up in their own time.

“‘They’re boys, they’re probably just lazy.’

“Now they’re unable to sit up and hold their heads up, while other children their age are starting to get on their feet and take their first steps.”

As time passed and the boys showed no sign of improvement, swimming instructor Jenna and warehouse manager Steve, from Benfleet in Essex, pushed for answers.

The twins have undergone groundbreaking gene treatment, but face an uncertain future


Jenna Whyman

On one occasion, Jenna said, she was branded “neurotic” as she questioned why her sons were developing at a slower rate than other children their age.

After a health visitor finally agreed that something was wrong, the twins were rushed for urgent tests – leading to the heartbreaking news they both had SMA1.

“I was googling and it kept coming up with cerebral palsy, up to that point I’d never heard of SMA,” Jenna said.

“We were given a leaflet which said that babies with SMA type one don’t usually live beyond their second birthday. It was a complete shock, we were so emotional.

“I’m normally a positive person but I’m only human.”

The twins were diagnosed with the cruel condition just before their first birthday


Jenna Whyman

Steve and Jenna have launched a fundraising appeal to help their sons’ treatment


Jenna Whyman

They were referred to Great Ormond Street Hospital in London, where they learned of revolutionary treatments which could make a difference.

“Historically you’d be told to take them home and love them, and they wouldn’t be here after two years,” Jenna said.

“Even now with the treatment they’re on, there’s no data beyond the age of six, everything in their future is unknown.”

The boys have undergone gene therapy using a new drug named Zolgensma, branded the world’s most expensive drug because of its £1.7 million list price per dose.

The twins require specialist cough assist equipment to help them clear their lungs – something children with SMA1 are otherwise unable to do.

Jenna said she had to push for a diagnosis for the baby twins


Jenna Whyman

It is likely both Raffa and Sibby, who turned one in April, will require wheelchairs for life.

Jenna and Steve say that although the NHS care they have received since diagnosis has been “incredible”, they are struggling to meet the costs of physiotherapy and hydrotherapy and specialist equipment.

Their home also requires extensive modification to make it accessible for the twins, and they have launched a fundraising appeal – which has already collected more than £13,500.

“It’s so overwhelming, as a family we’re so incredibly touched.”

She said she hopes that by sharing her story, others in a similar situation will push for a diagnosis when they know something is wrong.

In the US all children are screened for SMA, but Jenna said other parents of children with the condition have had to battle to find out what is wrong.

“I just hope that one person reads my story whose child is facing an SMA diagnosis and they push the doctors to take them seriously,” she said.

“If it saves just one child it’ll be worth it.”

To support the family’s fundraising appeal, click here

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Young Physicians Don’t Bear the Scars From Infectious Diseases of Yore


I am a member of the Boomer generation — born between 1946 and 1964. We were the last generation in the US to deal with measles, mumps, rubella, chickenpox, and polio on a large scale.

My mother wears she almost went crazy one winter when my two siblings and I (my youngest sibling wasn’t born until a decade later) took turns with measles, mumps, and chickenpox. In those days, the house would be quarantined, with only my father allowed to leave for work. Luckily, we never got polio or smallpox. I still remember going to our high school after Sunday church for 3 weeks to receive our polio sugar cubes in 1960. Everyone around my age also has the vaccine scar to protect us from smallpox (eradicated in 1980).

Thankfully, my sisters and I survived these illnesses with no residual problems. Others were less fortunate. An elementary school friend’s sister developed post-measles encephalopathy, leaving her intellectually disabled. This occurs in one child in every 1,000. My cousin’s husband was in an iron lung for several months due to polio and continues to have mobility issues. I had a medical instructor who experienced polio with residual walking issues during my residency.

I also saw the devastation of these diseases in my patients. During medical school, residency, and early in my pediatric practice, I remember the devastation of H influenza meningitis. During the winters of my training, we would routinely have three to five patients with H influenza meningitis each week in the intensive care unit. We had an occasional death, but most would live. A number had residual seizures, hearing impairments, and learning problems. I treated some patients with pneumococcal and meningococcal meningitis. During this time, I also cared for a 3-week-old baby with Group B streptococcus sepsis. He lost all four of his limbs to gangrene.

Later on, I was pregnant with my first child when I had to care for a 5-year-old boy with meningococcal meningitis. He had large necrotic areas on his legs, arms, and chest. I was fearful that I would get it and pass it on to my unborn child. Two of my children had to take rifampin after another child in their daycare was hospitalized with H influenza meningitis. A respiratory syncytial virus infection hospitalized my youngest child for 4 days. This illness still has no vaccine.

I am very pro-vaccination, in part due to my numerous experiences with infectious diseases. I know that children benefit from vaccinations to prevent illness and morbidity or mortality. But unfortunately, not all physicians feel the same way. For the last few decades, there has been increased talk of physician vaccine hesitancy, perhaps in part among the young doctors who had never dealt with any of these diseases. Some studies demonstrate that physician specialty and conservative versus liberal stance also affect the rate of vaccine hesitancy.

Vaccine Hesitancy Among Providers

Several studies report increased vaccine hesitancy among many levels of healthcare providers, from hospital employees to direct care providers, such as nurses, PAs, NPs, and physicians.

A study looking at acceptance of the COVID-19 vaccines and vaccines in general among medical students and dental students (who are approved in many states to administer COVID-19 vaccines) shows that confidence is not as high as many might suspect. Overall, 6.1% of medical student respondents and 18% of dental student respondents felt that people get more vaccines than are good for them, while 67.9% and 40.3%, respectively, felt that the COVID-19 vaccine should be mandatory for the general public . Looking at mandatory vaccination of healthcare providers, 85.9% of the medical students agreed, while only 53.9% of the dental students did. These numbers are concerning in terms of how they will respond to patient vaccine hesitancy in their practices.

Another study, published in the American Journal of Infection Control In October 2021, looked at COVID-19 vaccine hesitancy related to various issues, including the type of healthcare worker, political leaning, and family members at risk for COVID-19. In the survey of 1,974 healthcare workers from the greater Chicago area, 15% noted that they declined or anticipated declining vaccination. Candidates were more likely to have declined or anticipated declining if they were Republicans, of Black race, and nurses or other healthcare workers (rather than physicians or PAs/NPs). The recipients were more likely to have received a vaccine or plan to if they felt people close to them thought it was important to do so.

What’s Driving Vaccine Hesitancy?

Several factors are likely at play here, but I suspect one component among medical students and younger physicians is that they have not had the firsthand experiences that would help them understand the value of vaccines. Many spend little time in hospitals anymore due to the specializations of emergency medicine, hospitalists, and intensive care medicine. Most didn’t grow up surrounded by death and illness from the endemic diseases of my time. While many may now be working within the context of the COVID-19 pandemic, dealing with this type of crisis is relatively new for most younger physicians. Less experience may lead to feeling less confident in discussing the benefits of vaccines.

In terms of the place-based and ideology-based divisions, other factors may also be at play. More conservative providers and those in rural settings often feel greater distrust of the CDC and other federal agencies, which may fuel hesitancy.

How Do We Address Physician Vaccine Hesitancy?

The specialty of infectious disease, from my viewpoint, has historically been regarded as a less important part of medicine. It was not a mandatory rotation during my medical school or residency years, and while in medical school professors discussed different infectious diseases, the symptoms, the treatments, and possible adverse outcomes, these lectures simply felt like living history that highlighted vaccines’ benefits for our childhood illnesses.

Since then, infectious disease education doesn’t appear to have risen in state. Reviewing medical school curricula from Boston University and St. Louis University, for example, reveals no apparent modules dedicated to vaccines and public health. Instructors may have integrated vaccine discussions into other modules such as virology, microbiology, and continuity clinics. Other medical schools, such as the University of Wisconsin (ForWard Curriculum), have revamped their programs to incorporate more patient-centered and community-based modules. This includes modules focused on infectious diseases and vaccines, and public health.

All medical students and residents (of all specialties) should have at least a one-month infectious disease rotation, which should include vaccine development and monitoring. Ideally, there could be programs where medical students (and primary care residents) would serve in a developing nation for a couple of months to witness the heartbreaking impact of disease on unvaccinated children and adults.

Medical students and residents during the COVID-19 pandemic have had a unique opportunity to experience how devastating infections can be and have firsthand the impact of effective vaccines and treatments. But they may be the last physicians with a frontline experience like this for a while. We need our medical schools and residency programs to gear up their efforts to provide simulated experiences like this and increased exposure to infectious disease knowledge and ways to treat and prevent (including through vaccines) further pandemics.

Patricia McGuire, MD, is a developmental and behavioral pediatrician, medical writer, author, and speaker. She has a podcast, Helping Challenging Children, where she focuses on issues that affect the development, behavior, learning, and mental health of children and adolescents.

Symptoms, Causes, Relief, and More


Constipation is one of the most common digestive problems in the United States. Around 16 out of 100 US adults have constipation. This figure doubles for adults over age 60.

It’s defined as having hard, dry bowel movements or passing stool fewer than three times a week.

Each person’s bowel habits are different. Some people go three times a day, while others go three times a week.

However, you may be constipated if you experience the following symptoms:

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends seeking medical advice if symptoms don’t go away or if you notice the following:

  • bleeding from the rectum
  • blood in your stool
  • persistent abdominal pain
  • pain in the lower back
  • a feeling that gas is trapped
  • vomiting
  • fever
  • unexplained weight loss
  • a sudden change in bowel movements

A healthcare professional may carry out tests to rule out a more serious condition, such as colorectal cancer or irritable bowel syndrome (IBS).

Your colon’s main job is to absorb water from residual food as it’s passing through your digestive system. It then creates stool (waste).

The colon’s muscles eventually propel the waste out through the rectum to be eliminated. If stool remains in the colon too long, it can become hard and difficult to pass.

Poor diet frequently causes constipation. Dietary fiber and adequate water intake are necessary to help keep stools soft.

Fiber-rich foods are usually plant-based. Fiber comes in soluble and insoluble forms. Soluble fiber can dissolve in water and create a soft, gel-like material as it passes through the digestive system.

Insoluble fiber retains most of its structure as it goes through the digestive system. Both forms of fiber join with stool, increasing its weight and size while also softening it. This makes it easier to pass through the rectum.

Stress, changes in routine, and conditions that slow muscle contractions of the colon or delay your urge to go may also lead to constipation.

Common causes of constipation include:

  • Low fiber diet, particularly diets high in meat, milk, or cheese
  • dehydration
  • low exercise levels
  • delaying the impulse to have a bowel movement
  • travel or other changes in routine
  • Medications, including certain antacids, pain medications, diuretics, and some treatments for Parkinson’s disease
  • pregnancy
  • older age (constipation affects around one-third of people ages 60 and over)

Underlying health issues

The following underlying health conditions can bring on constipation:

Changing your diet and increasing your physical activity level are the easiest and fastest ways to treat and prevent constipation.

You can try the following techniques as well:

  • Every day, drink 1.5 to 2 quarts of unsweetened fluids, like water, to hydrate the body.
  • Limit consumption of alcohol and caffeinated drinks, which cause dehydration.
  • Add fiber-rich foods to your diet, such as raw fruits and vegetables, whole grains, beans, prunes, or bran cereal. Your daily intake of fiber should be between 20 and 35 grams.
  • Cut down on low fiber foods, such as meat, milk, cheese, and processed foods.
  • Aim for about 150 minutes of moderate exercise every week, with a goal of 30 minutes per day at least five times per week. Try walking, swimming, or biking.
  • If you feel the urge to have a bowel movement, don’t delay. The longer you wait, the harder your stool can become.
  • Ask your doctor about bowel training to get your body used to passing stool 15 to 45 minutes after breakfast each day.
  • Raise your knees by putting your feet on a footstool when having a bowel movement.
  • When using the bathroom, allow yourself plenty of time, and try to relax your muscles.
  • Use laxatives sparingly. A healthcare professional may prescribe laxatives or enemas for a short period of time to help soften your stools. Never use laxatives for more than 2 weeks without talking with a healthcare professional. Your body can develop a dependence on them.
  • Ask a healthcare professional if any of your medications might be causing constipation.

Over-the-counter medications

If home remedies do not work, a healthcare professional may recommend an over-the-counter laxative, such as:

  • fiber supplements
  • osmotic agents, such as Milk of Magnesia
  • stool softeners
  • lubricants, such as mineral oil
  • stimulants

Prescription drugs

If you still have trouble with constipation, a healthcare professional may prescribe medications to help, such as:

  • lubiprostone, which increases fluid levels in the intestine
  • linaclotide or plecanatide, which can help make bowel movements more regular for people with long-term constipation or IBS
  • prucalopride, which can help the colon move the stool along

A healthcare professional may also advise that you stop taking certain medications that may cause constipation.

Other options

Other strategies that may help are:

  • biofeedback therapy, which can help a person retrain their muscles
  • an enema
  • a procedure to manually remove feces to provide relief
  • surgery to remove a blockage
  • long-term treatment for a chronic condition, such as IBS

Tips for preventing constipation are similar to those for relieving it.

Try the following:

  • Eat plenty of fruits, vegetables, and whole grains.
  • Eat high fiber foods and ask a healthcare professional about using fiber supplements.
  • Include prunes or bran cereal in your diet.
  • Drink plenty of water.
  • Avoid alcohol and caffeine, as they can lead to dehydration.
  • Get regular exercise.
  • Consider adding probiotics to your diet, like those found in yogurt and kefir with live active cultures.
  • Train your muscles to have a bowel movement at the same time each day.

Some studies have shown that adding probiotics can be helpful for people with chronic constipation. If you add fiber supplements, remember to drink plenty of fluids. Fluids help fiber work more efficiently.

If constipation persists, or if you have concerns about your symptoms, it may be time to see a healthcare professional.

A healthcare professional:

  • will ask questions about your symptoms, medical history, and any medications or underlying conditions
  • may carry out a physical examination, including a rectal exam
  • may do some blood tests to check your blood count, electrolytes, and thyroid function

They may recommend additional tests to identify the cause of your symptoms. Tests may include the following:

Marker study

A marker study, also called a colorectal transit study, is used to test how food is moving through your colon. For this test, you’ll swallow a pill that contains tiny markers that will show up on an X-ray.

Numerous abdominal X-rays will be taken over the next few days so the healthcare professional can visualize how the food is moving through your colon and how well your intestinal muscles are working.

You may also be asked to eat a diet high in fiber during the test.

Anorectal manometry

An anorectal manometry is a test used to evaluate anal sphincter muscle function. For this test, a healthcare professional will insert a thin tube with a balloon tip into your anus.

When the tube is inside, they will inflate the balloon and slowly pull it out. This test allows them to measure your anal sphincter’s muscle strength and see whether your muscles are contracting properly.

Barium enema X-ray

A barium enema X-ray is a type of test used to examine the colon. For this test, you’ll drink a special liquid the night before the test to clean out the bowel.

The actual test involves the insertion of a dye called barium into your rectum, using a lubricated tube. The barium highlights the rectum and colon area. This allows the healthcare professional to better view these areas on an X-ray.


A colonoscopy is another type of test healthcare professionals use to examine the colon. In this test, a healthcare professional will examine your colon using a colonoscope. This is a tube fitted with a camera and light source.

A sedative and pain medication is often given, so you’ll likely not even remember the examination and should feel no pain.

To prepare for this test, you’ll be on a liquid-only diet for 1 to 3 days. You may have to take a laxative or enema the night before the test to clean out the bowel.

Constipation is a common problem that affects people as they get older, when they use certain medications, or if they don’t have much fiber in their diet.

Most cases of constipation are mild and easily treated with changes in diet and exercise.

If you’re experiencing chronic constipation or constipation along with other bowel changes, it’s important that you talk with a healthcare professional.


Ontario’s 2022 budget proposes reducing car insurance costs. What could that mean for you?


There’s no logical reason you’d expect a leader who goes by the name of Ford to have a soft spot for motorists.

Yet Ontario Premier Doug Ford has shown drivers a lot of love lately. Among other things, he’s canceled and rebated license-plate renewal fees, removed some road tolls and promised to build new highways.

The high cost of automobile insurance has been on the government’s mind, as well. When COVID-19 shuttered schools and workplaces two years ago, Queen’s Park directed some financial relief for drivers, resulting in more than $1.3 billion in insurance savings dispersed to motorists who were driving a lot less during the lockdown.

In its recently unveiled 2022 budget, the Ontario government proposed new measures to reduce the cost of auto insurance, including changes that would provide consumers with more flexible coverage, a pledge to crack down on fraud, as well as enhance insurance fairness – including re- examining the use of postal code information to determine premiums.

Ontario drivers may soon be able to tweak their insurance coverage further, such as by making not-at-fault damage coverage, also known as direct compensation property damage (DCPD), an optional add-on. It’s an idea that could yield some savings for drivers on a tight budget. Those who own older cars that are worth less than the cost to insure them would be able to opt out of DCPD coverage, which is currently mandatory in Ontario.

If another driver is at fault in an accident, DCPD covers damage to your vehicle and its contents, and for the loss of use of your vehicle when damaged. But if you drive an older, inexpensive vehicle, you may wish to drop the coverage and welcome the lower payments (this is separate from collision coverage, which pays for repairs to your car when you’re at fault).

“There’s significant savings for the driver who accepts the risk,” says Matt Hands, insurance director at Ratehub.ca. “However, the cost of replacing or repairing the vehicle will be fully incurred by the motorist.”

The government wants to see more innovations adopted, chiefly usage-based insurance (UBI) programs that give drivers more control over their insurance costs. Sometimes referred to as pay-as-you-drive insurance, UBI has been around for nearly a decade in Canada. It relies on a telematic device that plugs into the OBD-II data port and collects information about the vehicle’s speed and driving characteristics, such as hard acceleration and braking (newer programs no longer use a plug-in and only require the driver’s smartphone).

The information is shown on the driver’s phone app and relayed back to the insurance company, which determines how safely the client is driving and assigns a numeric score that’s constantly changing. Drivers who opt for the surveillance system are promised at least a 10 per cent discount for signing up.

Despite the promise of instant insurance savings, a mere 15 per cent of Canadian drivers say they have tried UBI, and some of them went back to conventional insurance.

“Telematics is a tricky feature,” says Hands. “For the longest time it could not affect your rates going up, and only represented a benefit to the motorist.” But some insurers have changed the rules of engagement, introducing the prospect of higher rates for bad drivers.

Ratehub’s own survey of drivers, conducted in 2021, tapped into consumers’ trepidation regarding usage-based auto insurance:

  • 77 per cent say they are concerned about potential rate hikes
  • 67 per cent express concern about the accuracy of the programs
  • 56 per cent have privacy concerns
  • 51 per cent are hesitant in case it negatively impacts their rates

“If I have to pass someone on a two-lane highway and briefly accelerate to 125 km/h in an 80 km/h zone, am I going to be penalized?” Hands poses, echoing a common question. The reality is it depends on the insurance provider and their UBI program. If you consistently demonstrate poor driving behaviours, you could see your rates increase.

Hands says that insurers are listening to motorists’ concerns and are making changes. Some programs allow the driver to edit their driving record on the app to remove instances when another family member was driving the vehicle, or made an evasive maneuver to avoid a collision.

“It’s a great feature, but just know that if you edit too frequently, you will be put on notice by your insurer,” warns Hands. He’d like to see companies offering consumers a trial period with the software, so that they can experience the potential benefits and savings – something that a few insurers have instituted.

Hands would like to see more options for “pay as you go” insurance aimed at downtown city dwellers. Intended for low-mileage drivers whose vehicles sit at home while they commute to work by transit, the plan offers lower premiums because vehicles are mostly driven on weekends and not during accident-prone rush hours.

As for the much-despised territorial rating that assigns risk according to residential postal code, Hands says the government could choose to remove geography from the criteria, making communities like Brampton, Ontario, less expensive to insure a car. But the risk would be pooled across the rest of the province, raising everyone else’s insurance premiums, he says.

“Postal codes are a crude way of assigning risk,” Hands points out. “The province of Alberta has tried tying insurance risk to drivers’ credit score, which seems to have some validity.”

As Ontario moves ahead with auto insurance reforms through its Financial Services Regulatory Authority, Hands cautions that change comes slowly in this sector and that nothing is going to happen overnight.

“The industry has been slow to adopt digitization and other technology in Canada,” he says, while other jurisdictions have embraced innovation much quicker. “The United Kingdom is ahead of its time, as is much of Europe.”

Just don’t look to the Ontario government to offer public auto insurance schemes of its own. Hands insists that government-run plans are costlier, since there’s no competition. Instead, he says Ontario is doing the right thing by working with the industry and weighing regulatory changes to eke out savings for consume

“It’s all about fostering a better relationship with the private insurers and providing regulatory transparency, which is in the best interest of everyone.”

SEO Firm Highlights Why They Are the Best SEO Company in Los Angeles


In a recent announcement of public interest, SEO Company Santa Monica spoke about digital marketing services companies can get. The group listed the top reasons that companies should get various SEO services.

Los Angeles, CA – SEO Company Santa Monica, a digital marketing company based in Los Angeles, CA, recently spoke about digital marketing and how equity can be achieved in the digital marketplace. The company wanted people to know about SEO services and how they can help any business propel and rank better. The team said they understand digital marketing can be tough to do alone. The group wanted to urge people to get the marketing services to get the best results.

SEO Company Santa Monica said that people can work with an SEO company to increase their competition levels. The group said SEO services are vital as the digital marketplace has many people, making it easy to sell to people worldwide if the business operates on that scale. The team said a team that doesn’t use digital marketing techniques could fall behind in terms of competition and miss out on many potential clients. To get equity in the digital market space, many companies must use digital marketing to boost their business.

SEO Company Santa Monica said that SEO companies Los Angeles have a wide range of services that people can benefit from. The group said that a business could use all the forms of digital marketing or work with a few to help their company. SEO Company Santa Monica mentioned some of the services, including SEO, link building, and web design & development. All the services are vital, and each plays a unique role in ensuring the digital marketing campaign is a success. Many companies’ use of these services is crucial in increasing equity in the digital marketplace.

SEO Company Santa Monica said that all forms of businesses could grow by working with SEO companies in Los Angeles. The team noted that SEO would benefit a person with an individual, local, or family business. Digital marketing can empower such companies, and SEO Company Santa Monica wanted to urge people into this practice. The team’s primary goal is to help companies of all sizes grow to realize their potential. With digital marketing, companies can get the online traffic that they deserve. With online traffic, a company can get more clients and thus more revenue. An increase in equity in the digital marketplace will benefit all businesses, and that can only happen if more companies migrate to digital marketing.

About SEO Company Santa Monica

SEO Company Santa Monica is an SEO company based in Los Angeles, CA. The group knows all about digital marketing and how it can help companies grow and get more online traffic. This can be done by having digital marketing campaigns with more companies, whether local, individual or family businesses. The company has a wide range of services that people can benefit from.

Media Contact
Company Name: Seo Company Santa Monica
Contact Person: Joshua River
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Phone: 1-866-237-0547
Address:202 Bicknell Ave #10
City: Santa Monica
State: CA 90405
Country: United States
Website: https://seocompanysantamonica.com