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Oregon health care workers will be required to get vaccinated or face frequent testing

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Oregon Governor Kate Brown speaks during the June 30, 2021 press conference announcing the end of the state mask mandate.

Kristyna Wentz-Graff

Oregon health workers will need to get vaccinated against COVID-19 or undergo weekly tests, which Governor Kate Brown usually plans to introduce in late September.

As an alarming surge in case numbers and hospital admissions threatens to overwhelm public health authorities and local hospitals, Brown announced Wednesday that it has directed the Oregon Health Authority to enact new rules designed to put pressure on health workers. You can either get vaccinated by September 30th or have frequent tests for the virus.

“The more contagious Delta variant changed everything,” Brown said in a press release. “This new security measure is necessary to prevent Delta from causing serious illness on our first line of defense: our doctors, nurses, medical students and health workers on the front lines.”

The new rule falls short of what the state’s largest hospital association had called for: a new rule or regulation that gives individual health systems the power to require Covid-19 vaccination if they so choose. That would have brought Oregon in line with most other states.

Brown feared that vaccination with no alternative could lead to staff shortages, her spokesman said.

The upcoming rules are similar to the testing requirements President Joe Biden and California Governor Gavin Newsom put in place for federal and state employees during the COVID-19 resurgence. But rather than addressing all state or federal employees, Brown limits her focus to health care workers “who have direct or indirect contact with patients or infectious materials.”

Brown’s office is still considering vaccination and testing requirements for government employees, the statement said. The governor, who in recent weeks has emphasized more localized decision-making over state mandates, urged private and public employers across the state to introduce masking requirements and “facilitate employee access to vaccines” with guidelines such as paid time off for vaccinations and others Incentives.

While vaccination assignments are acceptable as a condition of employment in most sectors, Oregon law prohibits health care providers from making them mandatory unless vaccinations are required by state or federal regulations. The governor’s office said Brown plans to “address” this ban when lawmakers meet early next year.

In the meantime, not all providers are waiting. Kaiser Permanente announced Monday that it will make vaccines mandatory for all employees. PeaceHealth’s medical system announced Tuesday that all of its caregivers must be vaccinated against COVID-19 or submit a qualified medical exemption. Those who do not can be removed from patient care.

Health systems across the state have said they support a change in the law, while the Oregon Nurses Association has warned that if nurses are not part of the contract negotiations, they could result in resignation when morale is low and hospitals and long-term care facilities last are already scarce.

The increased demands come as COVID-19 patients are being hospitalized at a worrying rate. As of Wednesday, 393 people with the virus had been hospitalized in the state, 95 more than last Friday and 14 more than the day before.

State health officials released modeling results last week that suggested that nearly 100 people a day could be hospitalized by mid-August if steps are not taken to contain the spread of the Delta variant. The same modeling suggested that the daily case numbers could rise to nearly 1,200 over the same period. The state reported 1,575 new cases on Tuesday.

The state had 393 available beds in a non-intensive care unit and 110 free beds in the intensive care unit as of Wednesday morning.

Despite worrying trends and calls from their own health advisors to get vaccinated as soon as possible, the new requirements for health workers won’t go into effect until September 30th. Brown’s office said an eight week delay will “give employers time” to prepare for implementation and will give currently unvaccinated health care workers time to fully vaccinate.

Vaccination rates for health care workers are higher than rates for the general population, but they vary widely by region, ranging from a low of 43% in Harney County to a high of 81% in Washington County.

Vaccinations for long-term care facilities are particularly critical, the residents of which were responsible for around half of the deaths in the first year of the pandemic.

Approximately 68% of Oregon long-term care workers have been vaccinated – about 10% more than the national average, according to the Oregon Health Care Association, which represents the industry.

In Oregon, by July 3, 70% of all health workers were vaccinated. The rates vary depending on the profession: 87% of vaccinated doctors, 74% of registered nurses and 57% of certified nursing assistants.

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‘Anomie in post-Covid world reason for more urban suicides’ | Nagpur News

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Dr. Abhishek Somani, Professor, Department of Psychiatry, Indira Gandhi Government Medical College and Hospital, invokes the concept of “anomie” by French sociologist Emile Durkheim to explain the state of despair and hopelessness that many face after rounds of limitations and Go through isolation. An increasing sense of dejection is a very strong indicator of suicidal intent, adds a widespread sense of fear about the unpredictability of the disease, economic problems due to lockdown, an increase in alcohol and other substance use, resulting health problems, and verbal and physical violence added home. All of these are an important mix in leading a person to suicidal intent. In an interview with TOI, Dr. Somani, who is also the past president of the Psychiatric Society of Nagpur, elaborates on this burning issue.
Excerpts …
Q. What are your general observations on the upward trend in suicides?
A. The social fabric is getting weaker. The earlier concepts of shared families and extended families are now seen in fewer and fewer cases. That important safety net is now missing. With the world at your fingertips with the Internet, a Pandora’s box has been opened. So you are not only influenced by what is good, but also by things that are not so good. The Blue Whale game is a good example. The internet also draws attention to the lack of sophistication in one’s life. And since everyone publishes photos of the best time ever, a doubt creeps in: “Why am I not as happy as you are? Maybe I’m a failure. People got through the pandemic without any significant increase in suicide gestures in the immediate period. But the stress of the pandemic and its social, economic and personal effects will increase mental health problems in the long run, and we will see an increase unless urgent action is taken to alleviate these problems.
Q. Has the lockdown and Covid phase increased suicidality?
A. Surprisingly not. There was an immediate period of escalation in anxiety and depression as the pandemic level began to decline, but the incidence of self-harm and committed suicide was lower than expected. We can speculate that maybe everyone was in trouble together, so people drew strength from misery.
Q. Why are middle class people and even the financially secure people at the end of their lives?
A. Overall, the suicide rate tends towards cities. Large cities account for nearly 25% of suicide deaths in urban areas, according to NCRB 2019 data. The same data suggests that over 90% of suicides are committed by people from the lower social classes, but common sense suggests that it can be disgusting to have suicides reported by those who are better at hiding a shameful death .
Q. How do you justify this underreporting claim?
A. The French sociologist Emile Durkheim’s concept of “anomie” comes to mind. Anomie is a state of society in which generally accepted values ​​and meanings lose their acceptance, but new values ​​(with common consensus) have yet to be developed. People at risk develop a sense of senselessness and emotional emptiness. This feeling of helplessness and hopelessness is a strong indicator of suicidal intent. Financial stability is by no means a protection against psychological stress. Peace of mind emerges from feeling satisfied with everything one has. So money doesn’t do much to prevent suicide, but it definitely helps to hide it. Anomie can develop in the post-covid world where normal interactions and communication have become a risky activity. So putting on a mask and maintaining physical distance are not a natural part of our behavior.
Q. Are you suggesting that the mask and physical distancing need to go at some point?
A. We cannot maintain physical distance for life. You can see that people don’t put on their masks. Few of those who are very cautious or paranoid about Covid still adhere to the norms. Quiet, everyone has left. This is a kind of anomie that happens when normal social rules are given up or broken but nothing else could be picked up. This created a “I don’t know what to do” feeling. The normal structure of life is disturbed and there is no alternative. The mind cannot exist in an ambivalence. This ambivalence causes fear and fear has suicide as one of the results. You have to take sides, yes or no. There is a lot of indecision due to Covid. You don’t know when the pandemic will end, who will survive if you get infected.
Q. Is the pandemic the only cause of mental health problems?
A. All of the previous factors related to suicide have been accelerated by the stress caused by Covid and Lockdown. 33% of suicides are due to family problems, 17% to illness, 6% to addiction and 10% to money problems. Each of these factors increased during the lockdown. Some families have grown closer, but domestic violence has increased dramatically as any police officer will tell you. Alcohol consumption has risen sharply. Covid’s hospital stay has severely impacted the family’s savings. So overall, the pandemic has accelerated the fire of the mental health problems that people will face over the next few years. An increase in mental disorders would increase the number of episodes of self harm, unless we can make people aware of the importance of seeking help in a timely manner.
Q. What are the early signs and indicators of mental illness?
A. A noticeable change in a person’s behavior over a period of typically 2 weeks or more. He / she becomes more moody, loses interest in ordinary activities, appears withdrawn or aloof, sloppy looking, suddenly crying or flying in anger, talking about how better it would be if he / she wasn’t around, etc. But it requires a really keen eye to see that we often give a long rope to those who have recently suffered a traumatic event. We consider this part of normal sadness. Conversations about dying are not. The number of violent and homicidal offenses is increasing significantly, which can also be seen in the context of the lockdown-associated anomie, in which social rules and values ​​lose importance.
Q What are the solutions?
A. Prevention is easier said than done. It will take years of effort to create mental health professionals capable of meeting India’s tremendous needs. There are currently fewer than 10,000 psychiatrists in India, the overwhelming majority of whom serve urban areas. In the meantime, a sustained campaign in the media to highlight symptoms of mental illness, support and recognition from well-known personalities and simple things like a break from ambition, changes in a more balanced lifestyle, and sustainable life goals will help.

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She fought to save her child from an eating disorder. Now, she combats the misconceptions.

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Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette

Resources:

National Association for Eating Disorders – nationaleatingdisorders.org
Families supports and supports the treatment of eating disorders (FEAST): fest-ed.org
UC San Diego Center for Treatment and Research for Eating Disorders – eatdisorders.ucsd.edu
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit – rchsd.org
EQUIP virtual family-based treatment program – equip.health
Parent and patient coaching by JD Ouellette: jdouellette.com

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How insulin resistance can lead to depression

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Stanford Medicine scientists have found that insulin resistance can increase the risk of developing major depressive disorder. The results of the study were published in the American Journal of Psychiatry. “If you are insulin resistant, your risk of developing major depressive disorder is twice that of someone who is not insulin resistant, even if you’ve never experienced depression before,” said Natalie Rasgon, MD, PhD, Professor of Psychiatry and Behavioral Sciences.

The WHO estimates that almost 5% of adults suffer from depression. Symptoms include incessant sadness, despair, sluggishness, trouble sleeping, and loss of appetite.

Also read: How I recognized OCD and what impact it had on my life

Some factors that contribute to this deeply debilitating disease – such as childhood trauma, the loss of a loved one, or the stress of the COVID-19 pandemic – we cannot prevent. But insulin resistance is preventable: it can be reduced or eliminated through diet, exercise and, if necessary, medication.

Rasgon shares lead authorship of the study with Brenda Penninx, MD, PhD, Professor of Psychiatric Epidemiology at the Medical Center of the University of Amsterdam. The study’s lead author is Kathleen Watson, PhD, a postdoctoral fellow in Rasgon’s group.

Studies have confirmed that at least 1 in 3 of us walk around with insulin resistance – often without knowing it. The condition is not caused by an inadequate ability of the pancreas to secrete insulin into the bloodstream, as is the case with type 1 diabetes, but rather by the decreased ability of cells throughout the body to obey this hormone’s command.

The job of insulin is to tell our cells that it is time for them to process the glucose that floods our blood from our food intake, its production in our liver, or both. Every cell in the body uses glucose as fuel, and each of these cells has receptors on their surface that, when bound to insulin, signal the cell to take in the precious source of energy.

But an increasing proportion of the world’s population is insulin resistant for a variety of reasons, including their insulin receptors that don’t bind properly to insulin, excessive caloric intake, sedentary lifestyle, stress, and lack of sleep. Eventually, their blood sugar levels become chronically high.

Once these levels stay above a certain threshold, the diagnosis is type 2 diabetes, a treatable but incurable disease that can lead to cardiovascular and cerebrovascular disease, neuropathy, kidney disease, limb amputation, and other unhealthy outcomes.

Associations between insulin resistance and several mental disorders have already been established. For example, about 40 percent of patients who suffer from mood disorders have been shown to be insulin resistant, Rasgon said. But these assessments are based on cross-sectional studies – snapshots of populations at a single point in time.

The question of whether one event was the cause or the result of the other – or whether both were the results of a different causal factor – is best clarified by longitudinal studies that people can typically track over years or even decades to determine which event occurred first.

Also Read: How Reflection Can Accelerate Growth

As part of a cross-institutional collaboration within the Rasgon research network, founded in 2015, the scientists received data from an ongoing longitudinal study in which more than 3,000 participants were closely observed in order to get to know the causes and consequences of depression: the Dutch study on depression and anxiety.

Rasgon is Stanford’s lead investigator and Penninx is the lead investigator. “The Dutch study, with its meticulous monitoring of a large test population for nine years and still growing, presented us with a great opportunity,” said Watson.

The Stanford team analyzed data from 601 men and women who served as controls for the Dutch study. At the time of their enrollment, they had never suffered from depression or anxiety. Their median age was 41 years. The team measured three proxies of insulin resistance: fasting blood sugar levels, waist circumference, and the ratio of circulating triglyceride levels to that of circulating high-density lipoprotein – or HDL, known as “good” cholesterol.

They examined the data to see if those who were diagnosed with insulin resistance were at an increased nine-year risk of developing major depressive disorder. The answer to all three measures was yes: they found that a moderate increase in insulin resistance, as measured by the triglyceride-to-HDL ratio, was associated with an 89 percent increase in new cases of major depressive disorders.

Similarly, every two-inch increase in belly fat was associated with an 11 percent higher rate of depression, and an increase in fasting plasma glucose of 18 milligrams per deciliter of blood was associated with a 37 percent higher rate of depression. “Some subjects were already insulin resistant at the start of the study – there was no way of knowing when they first became insulin resistant,” said Watson. “We wanted to be more specific about how quickly the connection started,” added Watson.

The researchers therefore limited the next phase of their analysis to the approximately 400 test subjects who not only had never experienced significant depression, but also showed no signs of insulin resistance at the start of the study. However, within the first two years of the study, nearly 100 of these participants became insulin resistant. The researchers compared the likelihood of this group of developing major depressive disorder within the next seven years with that of participants who had not become insulin resistant after two years.

Also read: Pressure is a privilege, believes soccer player Ashutosh Mehta

While the number of participants was too small to determine statistical significance for waist circumference and triglyceride-to-HDL ratio, the fasting glucose results were not only statistically significant – meaning they were not incidental – but Also clinically meaningful – that is, important enough to worry: Those who developed prediabetes within the first two years of the study were at 2.66 times the risk of major depression after the nine-year follow-up up compared to those who received normal fasting glucose test results. had the two year point.

Bottom line: Insulin resistance is a strong risk factor for serious problems, including not only type 2 diabetes but also depression. “It is time providers took into account the metabolic status of patients with mood disorders and vice versa by assessing mood in patients with metabolic disorders such as obesity and high blood pressure,” said Rasgon. “To prevent depression, doctors should check their patients’ insulin sensitivity. These tests are readily available in laboratories around the world and they are inexpensive. In the end, we can curb the development of lifelong debilitating diseases, ”concluded Rasgon.

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