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Advocates in Mass. are pushing to keep masking in health care settings

Health

Massachusetts’s COVID-19 public health emergency runs out on May 11, ending state masking requirements in health care facilities.

Public health advocates are urging Massachusetts health officials to keep universal masking in place at health care facilities. John Tlumacki / The Boston Globe, File

A coalition of public health advocates is urging Massachusetts to keep masking requirements in place in health care settings, even after the state’s COVID-19 emergency declaration runs out in early May.

“Without universal masking precautions in healthcare, vulnerable people face substantial risk of being exposed in waiting rooms or clinical settings against their will, violating their autonomy, and deterring many from seeking much-needed care,” the Massachusetts Coalition for Health Equity wrote in an open letter last week.

Coalition co-founder Dr. Lara Jirmanus, a family physician and Harvard Medical School instructor, explained in a virtual press conference Wednesday that removing masking requirements from health care settings will be especially risky for babies and children who can’t mask.

“People can bring these infections home to their loved ones and hurt them,” Jirmanus said. “And I will say personally, as a parent of a 16-month-old baby, this is part of my calculation.”

In September, the Centers for Disease Control and Prevention revised its guidelines to relax masking requirements for health care facilities in parts of the country with lower levels of community transmission. (In Massachusetts, state masking requirements remained in health care settings even after the CDC change.)

Relying on community transmission data to dictate masking is flawed, Jirmanus asserted, citing underreported cases.

According to the coalition’s letter, “far fewer people are testing for COVID-19 as much required routine testing has ended, federal funding for COVID-19 testing has diminished, and most rapid tests are not reported. Further, most low-wage workers don’t have paid sick time, and many are incentivized or compelled to go to work with COVID-19, or to avoid testing.”

The group cited data from the Institute for Health Metrics and Evaluation, whose director estimated in September that only 4{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} to 5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of COVID-19 infections are actually reported.

Even when transmission rates are low, clinics and hospitals will still be an epicenter for COVID-19 patient care, creating opportunities for the virus to spread, according to the coalition’s letter. Removing masks from health care settings also puts providers at risk at a time when the health care system is overrun with staffing shortages, the group argued.

A spokesperson for the state’s Executive Office of Health and Human Services told The Boston Globe that the state health department will continue to track COVID-19 cases and make adjustments as circumstances change.

The spokesperson also told the Globe that infection control leaders at several of the largest hospital systems in Massachusetts have repeatedly asked state health officials to end the mask mandate.

The Massachusetts Coalition for Health Equity remains unconvinced.

“We are wondering, when we take a look at that Globe article, why have hospital administrators been lobbying to remove masks? Is this about the money?” Jirmanus asked. “It doesn’t make sense. Removing masks in health care … is going to cause health worker outbreaks and it’s going to exacerbate existing staffing shortages and thereby exacerbate the budget crisis.”

She added: “We all have a loved one in our lives who could be hurt by a COVID infection. … and we could all be harmed by long COVID. So let’s be safer together.”

World Health Day: 5 easy steps to get healthier

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Wouldn’t it be nice if there were some undiscovered ingredient, and one bite of it would cure all our health concerns?

There isn’t one, sadly.

But scientists do know the recipe to better health, and it is a long-term practice of good habits when it comes to sleep, eating, exercise, socialization and stress.

In honor of the 75th anniversary of the World Health Organization, here are the factors that add up to better health and what you can do today to improve in these areas.

Ask your doctor if you have specific concerns in any of these areas.

A bad night’s rest doesn’t just mess with your concentration during the day. So far this year, CNN has reported that not getting enough sleep can increase your risk of mood problems, asthma, stroke and longevity.

Sleep is kind of a big deal.

The US Centers for Disease Control and Prevention recommends that adults get at least seven hours of sleep a night — but quality is important as well.

To get more good sleep, research shows it’s important to set a schedule for going to bed and waking up, follow a nighttime routine to tell your brain it’s time to go to bed, keep your bedroom dark and cool, turn away from the screens early, and don’t lay in bed if you are having trouble sleeping.

People’s individual bodies need different things, but is there a best way to guide your nutrition?

According to many scientific studies and U.S. News & World Report’s annual rankings, it’s the Mediterranean diet.

Don’t let the word diet fool you — this isn’t a restrictive philosophy to manipulate your body weight. The Mediterranean diet is a way of eating that features simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra-virgin olive oil. Fats other than olive oil, such as butter, are consumed rarely, if at all, and sugar and refined foods are reserved for special occasions.

Numerous studies have found the Mediterranean diet can reduce the risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer.

Scientists have long known that exercise is good for a healthy body, but research has shown it’s also important for a healthy mind.

The US Department of Health and Human Services recommends that people between the ages of 18 and 64 engage in at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity each week, as well as muscle-strengthening activities at least twice a week.

The good news is even if you can’t get there right now, adding even a little bit will help.

Research published earlier this year showed that even 11 minutes of exercise a day can lower your risk of cancer, cardiovascular disease or premature death.

Many people place a lot of importance on some of the health behaviors often thought of as more physical, but social and emotional factors deserve our attention as well.

And good, strong friendships are key to not just alleviating our stress and improving emotional well-being, but also boosting markers of our physical health, according to the latest research.

People should grow this area of health by investing more in a feeling of community, experts have suggested.

They also stressed the importance of making friendship a priority in your schedule: Text a friend that you haven’t talked to in a long time, commit to meeting one new person a month, host a dinner party or join a class.

Strong bonds won’t happen overnight, but starting small and prioritizing friendships as an important part of your life can bring more happiness, less stress and more support, workplace belonging expert Adam Smiley Poswolsky told CNN earlier this year.

“Even when — especially when — their friend is struggling or going through something hard,” said Poswolsky who is also author of “Friendship in the Age of Loneliness: An Optimist’s Guide to Connection.” “You know someone is a true friend when they have your back when you’re sick, when you lose your job, when you make a mistake, when you’re going through a break-up, when you’re stressed, when you’re sad.”

I know I’ve heard it every time I go to the doctor for any concern: Whatever it is, it gets worse with stress.

Sure enough, stress can send a body into fight or fligh, which raises cortisol. Higher levels of cortisol can exacerbate health conditions such as cardiovascular disease, diabetes and chronic gastrointestinal problems, according to the Cleveland Clinic.

Stress can also cause or contribute to anxiety, irritability, poor sleep, substance abuse, chronic distrust or worry, and more.

Fortunately, a balanced diet, good sleep, exercise and social support can help with stress reduction. It can also help to explore breathing and meditation techniques.

You may be thinking, I am already stretched thin in my day — adding in all these health behaviors will cause stress by itself.

The good news is that these habits are best added with small, manageable changes over a period of time.

Approach your goals one bite at a time and with a plan, flexibility, fun and support, and you may soon find you’ve made the changes you are looking for, said Katy Milkman, the James G. Dinan Professor at the Wharton School of the University of Pennsylvania, author of “How to Change: The Science of Getting From Where You Are to Where You Want to Be.”

Sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inform and inspire you to reduce stress while learning how to harness it.

Minnesota health systems are dropping masking requirements for patients, staff

Numerous Minnesota well being care methods are stress-free their masking demands in a further move away from procedures proven at the peak of the pandemic three several years in the past.

The most current to announce is Mayo Clinic, which declared in a assertion earlier this week that its program would no for a longer period need masks in “most individual care regions on Mayo Clinic and Mayo Clinic Health Program campuses” setting up April 10. Masking will as a substitute be voluntary, besides in large-chance affected individual configurations. In the assertion, Mayo officers stated they approach to notify higher-threat, immunocompromised patients to have on a mask though at their facilities.

Allina Wellbeing also plans to relieve their masking regulations at its amenities, starting April 18.

“These have been conversations that we have genuinely ongoing to have all through the pandemic,” claimed Mallory Koshiol, Allina Health’s VP of method security and good quality.

What does that necessarily mean? The information, analysis and neighborhood conversation found listed here is funded by donations from individuals. Make a present of any amount of money today to guidance this source for all people.

In October 2022, the wellbeing care process announced that staff members could clear away their masks in non-individual treatment spots, like crack rooms and offices. Koshiol claimed this announcement is section of their “stepwise approach.”

“We do have metrics that we’ll keep on to watch ongoing and must [or] if we require to reinstate [the masking mandate] we undoubtedly will,” she claimed. “Safety is our prime priority. So we will proceed to keep track of and get the job done to function to maintain that. And we know our staff are seeking ahead to observing every single other smiling and resuming some degree of normalcy immediately after lots of, quite a few yrs of sporting masks all the time.”

Those people metrics contain occupational overall health between team and group transmission costs. Koshiol claimed team, individuals and visitors can pick out to mask, and clients and guests can ask for that staff members mask when offering care.

Officials at Hennepin Healthcare stated they also system to make improvements to their masking policies. Starting off April 11, masking by staff will go on in individual-struggling with regions, like exam rooms, remedy parts and front desks, but are no longer essential in other locations, like elevators, cafeterias and convention rooms.

Masking will be optional for individuals and visitors, besides in specified eventualities, the assertion said.

Though most people today have stopped putting on masks in community, it is frequently been demanded in well being treatment configurations because the pandemic commenced three many years ago.

Steering from the Facilities for Sickness Manage and Prevention, unveiled in September 2022, claims “[h]ealthcare amenities might choose to give well-fitting facemasks as a source management possibility for visitors but must enable the use of a mask or respirator with better-level security that is not visibly dirty by persons who chose that selection based mostly on their unique desire.”

But some providers say that wellness care is diverse and should really be looked at in another way.

“There’s a lot of people in hospitals that are not actually there by their personal alternative,” claimed Dr. Jill Foster, who specializes in pediatric infectious illnesses at the College of Minnesota Healthcare Faculty and Masonic Kid’s Medical center. She said they have a good deal of significant-risk people who may perhaps not be shielded from COVID the very same way that several in the normal inhabitants are.

“I believe it will make it tough for the reason that then we are creating the susceptible sufferers be the kinds who have to advocate for by themselves alternatively than institutions advocating in advance for them by environment pointers,” she claimed. “The gain is that folks can dress in a mask themselves and come to feel rather safeguarded. But of system, equally folks wearing a mask is certainly a lot much better.”

Other health and fitness care methods all around the condition have by now altered their masking regulations.

CentraCare, which has amenities across Minnesota, claimed their masking change also went into effect on April 2. The group stated that things associated to COVID-19 — such as employee an infection prices and the selection of clients they ended up dealing with with the virus — arrived into participate in in the final decision.

“While COVID-19 is not more than, it’s adjusted greatly because it initial started off. The health impacts are considerably less serious and mortality costs are much lower,” explained Dr. George Morris, who led CentraCare’s COVID response, in a assertion. “We even now have some protocols in location for personnel masking — and our clients need to go on to mask if they have any respiratory signs and symptoms. We will rely on carefully monitored metrics to information long run selections [sic] similar to masking if our atmosphere changes.”

Essentia Well being, which has facilities in central Minnesota and in the Duluth spot, eased masking limitations on April 3. In their announcement, officers mentioned this “does not apply to Essentia’s extensive-term care/nursing residence facilities or assisted residing facilities, which will proceed to examine masking protocols independently. Hospice workers will stick to the procedures of the amenities they enter.”

Officers at Fairview Wellness Solutions stated they’re talking about their masking policy, but did not have something to announce at this time.

4 food groups to focus on for gut health

Our knowledge of the great importance of intestine health and fitness is rising, from realizing how to check out in on our gut wellbeing to consuming a nutritious eating plan to support our intestine microbiome. But what precisely need to be involved in that diet program?

“The remedy is very uncomplicated on a common level. … It truly is just a matter of estimate-unquote ‘being healthier’ and ingesting a quotation-unquote ‘healthy’ diet plan,” Dr. Aditya Sreenivasan, a gastroenterologist at Lenox Hill Clinic, recently explained to CBS News, pointing to a emphasis on complete plant foodstuff.

Sreenivasan normally advises ingesting additional fruits, vegetables and entire grains and less processed carbs like sugary drinks and processed and red meats.

To enable break issues down even more, Dr. Kenneth Brown, gastroenterologist and host of The Gut Verify podcast, shared four foods teams that are superior to integrate into your diet plan to guidance gut and all round health and fitness:

Significant-fiber meals

Taking in a diet loaded in fruits, veggies, entire grains, nuts and seeds can aid guidance intestine health by advertising “typical bowel actions and blocking constipation,” Brown says.

“Ingesting fiber-prosperous foodstuff can also help feed the effective micro organism in your gut, minimizing inflammation and increasing over-all digestive wellness,” he provides.

Fermented foods

Fermented meals like yogurt, kefir, kimchi and sauerkraut can support enhance digestion, Brown claims.

“Standard probiotics do not often endure right until they arrive at the colon but fermented meals act as a car or truck to produce pure probiotics to your microbiome wherever it is necessary most,” he points out. “Consuming fermented foodstuff routinely can support cut down swelling and increase digestive wellness.”

You can maximize your fermented food items alternatives with easy swaps much too, indicates Dr. Shilpa Ravella, transplant gastroenterologist and assistant professor of medication at Columbia College, pointing to sourdough as a great option in comparison to white breads, for example.

“These are technically each wheat, but they are two extremely different foods,” she clarifies.

Foods superior in polyphenols

Polyphenols are molecules uncovered in fruits and greens that give them their vivid coloration.

“Polyphenols work like prebiotics, which feed our microbiome. Our microbiome then breaks down polyphenols into lesser molecules that support our guts, mind and immune method,” Brown suggests.

Antioxidant-rich food items

Foods significant in anti-oxidants can help lower inflammation in the overall body and assist all round digestive overall health, Brown claims.

“This is because antioxidants neutralize free of charge radicals that cause cell destruction,” he points out. These foods alternatives include things like berries, leafy greens and dim chocolate.

But keep in mind, these tips may possibly not be for anyone. Folks who have particular problems this kind of as celiac sickness or SIBO (smaller intestinal bacterial overgrowth) could call for a distinctive, far more certain diet. If you are suffering from an rising sample, worsening or unexpected alter in gastrointestinal signs, it may possibly be time to talk to a physician as it could level to foodstuff-relevant sensitivities or other gut-associated difficulties.

Opinion | How health systems can fight climate change by not using desflurane

Physicians, nurses and other front-line providers know firsthand the health impacts of climate change. Air pollution exacerbates asthma and emphysema; extreme heat worsens heart and kidney conditions; and rising temperatures increase the occurrence of a wide range of illnesses, including mosquito-borne infections and depression.

That’s why it’s so shocking to learn that health care itself is a major contributor to climate change.

In the United States, the health sector is responsible for nearly 9 percent of the nation’s greenhouse gases. Researchers estimate that the environmental harm caused by medical care ultimately costs as many lives as preventable medical errors, which are responsible for as many as 98,000 deaths annually. This is in direct conflict with the mission of the healing professions.

Brian Chesebro, an Oregon-based anesthesiologist who serves as medical director of environmental stewardship at Providence, had this “aha” moment in 2016. At the time, he told me, he was going through a period of “eco-grief” about the state of the Earth.

“Instead of spiraling down, I realized that my greatest opportunity to advance environmental stewardship was through my job as a physician,” he said. “I could address it in my own practice, then, as a physician-leader in my hospital, inspire change in my colleagues.”

His work as an anesthesiologist turned out to be the right launchpad. That is because some anesthetic gases commonly used in operating rooms are extremely potent greenhouse gases.

As Emily Mediate from the nonprofit organization Health Care Without Harm told me, the elimination of one specific gas, desflurane, could make a profound impact. “Desflurane has the global warming potential of over 3,700 equivalents of carbon dioxide,” she told me. “It lasts for 14 years in the atmosphere.” Her organization is among those that have been urging health-care systems to move away from desflurane and switch to sevoflurane and isoflurane, anesthetics that are clinically equivalent but have a small fraction of the environmental consequence of desflurane.

Chesebro took on this challenge. He began by educating fellow clinicians. “We weren’t taught to think in terms of environmental impact in residency,” he said, noting that the response from other physicians was primarily “surprise, interest and curiosity.”

He also measured and documented each anesthesiologist’s desflurane use. When Chesebro informed a colleague that his use of desflurane was equivalent to driving a fleet of 12 Hummers, the colleague sputtered in defense, “But I drive a Prius!”

“He was trying so hard to make wise stewardship choices, but he didn’t realize that his environmental impact as an anesthesiologist far outstripped any other facet of his life,” Chesebro said. “He changed his practice that day and has never used desflurane since.”

Over time, Chesebro redesigned systems so that desflurane was less easily accessible than other inhaled gases. “We still keep one or two desflurane vaporizers so someone could use it if they really need it, but it is no longer at arm’s reach in every operating room,” he said. He believes this was more effective than banning the gas. “Instead creating adversaries, we created an army of advocates who are eager to partner with us” on other efforts.

Before this intervention, the Providence system’s eight Oregon hospitals used desflurane 42 percent of the time, according to Chesebro. Now, he says, the rate is 0.07 percent. “We’ve cut emissions related to anesthetic use by 95 percent, and, because desflurane is a more expensive option, we’ve also cut the financial cost by 80 percent.”

Providence is not alone. Mediate shared success stories from around the country. Virginia Mason Medical Center eliminated desflurane use, thanks to the advocacy of an anesthesiologist and an anesthesia tech there. This resulted in an estimated 60 percent decrease annually in its operating room greenhouse emissions and saved the hospital more than $30,000 each year. Advocate Aurora Health, in a nurse-led effort, also cut its use of desflurane. Since 2017, the health system has reduced its anesthetic gas emissions by 75 percent and saved $1.6 million.

There is still a lot more work to be done. While the U.S. health system accounts for about a quarter of all global health sector-related emissions, it is far behind many peer countries in tackling this problem. In fact, many political leaders are actively trying to block sustainability initiatives.

I was heartened to learn that Health Care Without Harm’s Climate Council includes 21 health systems representing more than 600 hospitals across 43 states. In addition to health sector-specific reforms, they are encouraging others to join them in addressing building emissions, switching to renewable energy and limiting single-use plastics, among other efforts to reduce their carbon footprint.

“Health-system leaders understand that the climate crisis is a health crisis,” Mediate said. “Better care is low-carbon care.”

That’s a perspective on medical care that I wasn’t aware of before. Now, I’m convinced that clinicians’ obligation to “first do no harm” should extend to our responsibility to reduce the effects of climate change caused by the health-care sector itself.

Opinions on climate & the environment

Walking 8,000 steps 1-2 days a week linked to major health benefits

Current research suggests that walking 8,000 brisk steps or more per day may be the sweet spot for receiving the health benefits walking provides.
People who have trouble finding time to walk each day of the week will be encouraged by a new study that demonstrates walking just one to two days is still associated with a significant reduction in all-cause and cardiovascular mortality.
The study’s authors found that each additional day walked confers greater benefits.

Briskly walking 8,000 or more steps each day of the week is associated with a significant decrease in all-cause and cardiovascular mortality. A new study finds, however, that people taking just 8,000 steps one or two days a week are also less likely to die over a 10-year follow-up period.

The study published in JAMA Network Open found that over a decade of follow-up, people 20 years or older who took 8,000 or more steps on one or two days a week were 14.9{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} less likely to die compared to people who were sedentary.

The risk of death dropped as the number of days involved increased. For example, exercising from three to seven days a week was associated with a 16.5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} reduction in all-cause and cardiovascular deaths.

The same pattern held true for people meeting step goals of 6,000 to 10,000 steps.

Previous research found that mortality risk decreases up to 10,000 steps per day for people younger than 60 and 8,000 for people older than 60.

The study’s findings pertain to both “weekend warriors,” people who confine their exercise to non-work days, and to people who steal a few hours to walk during the week.

The study cites recent data showing the average American takes just 4,800 steps a day, too few to provide much of a health benefit.

“Brisk walking” is defined as walking three miles an hour. If you can speak song lyrics but not sing them, you are walking briskly.

The current study compared data from the U.S. 2005 and 2006 National Health and Nutrition Examination Survey with the National Death Index up to the year 2019. It incorporated accelerometer data from 3,101 participants 20 years or older and was a nationally representative sample. It included a similar number of women and men, and 50.9{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} were White, 21.5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} Black, 23.7{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} Hispanic, and 3.9{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} other race and ethnicity.

The participants most likely to walk 8,000 or more steps every day were more likely to be young, male, Hispanic, insured, and married. They were also typically never-smokers and were less likely to be obese or have comorbidities.

For many people, walking 8,000 steps each day requires a significant commitment of time. 8,000 steps are about four miles, which, walking at three miles per hour, comes to a total of about an hour and 20 minutes every day. Steps can be taken simultaneously or in shorter periods of brisk walking.

The study was led by Dr. Kosuke Inoue of Kyoto University in Japan, collaborating with researchers from UCLA in California. Dr. Inoue explained why the study was undertaken:

“We started this study to answer the question one of my patients asked during an outpatient clinic: ‘It is hard for me to keep sufficient steps every day. Is it okay to focus on walking only during the weekend?’”

Steps studies often consider the value of a week’s worth of various step goals, and Dr. Inoue saw a lack of evidence regarding the possible benefits of walking just a few days a week.

“Given that a lack of time is one of the major barriers to exercise in modern society,” said Dr. Inoue, “our findings provide useful information to recommend walking even for a couple of days per week to reduce mortality risk.”

“This is one of the first studies to use direct measures of daily steps using a wearable accelerometer over a 10-year followup period,” said Dr. Paul Arciero, a professor in the Health and Human Physiological Sciences Department at Skidmore College, who was not involved in the study.

Walking is viewed as a simple, low impact means of making a person’s life less sedentary. A sedentary lifestyle has been linked to an increased risk of all-cause and cardiovascular mortality.

“Further, a sedentary lifestyle drastically increases the risk of cardiometabolic disease such as abdominal obesity, hypertension (high blood pressure), type 2 diabetes, stroke, heart disease, and certain inflammatory conditions and cancers,” said Dr. Arciero.

According to Harvard Medical School, taking one’s steps has additional, less-obvious benefits. Walking offsets the effect of weight-promoting genes, reduces breast cancer risk, and boosts one’s immune system. It can also lessen arthritis-based joint pain, and even a 15-minute walk can curb a craving for chocolate, both generally and in response to stress.

The study’s findings should provide valuable information for clinicians and health professionals, said Dr. Inoue. He suggested a reader’s takeaway should be that for people who have difficulties engaging in regular exercise, “achieving recommended daily steps only a couple of days per week can have meaningful health benefits.”

Describing the study’s conclusions as “encouraging,” Dr. Arciero suggested the study may help people who don’t have enough time to walk 8,000 steps a day overcome feelings that walking less is pointless.

“We now have scientific evidence that proves this mindset is not true, and even a couple of days is beneficial!” said Dr. Arciero.

He said the study underscores the value of increasing one’s daily step count:

“Always a good reminder that any amount of walking, even one to two days per week, is still better than no walking.”

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Significant-fiber meals

Fermented foods

Foods superior in polyphenols

Antioxidant-rich food items