TIME Research

90% of Americans Eat Too Much Salt

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A new report sheds light on Americans' sodium habits

Consuming too much sodium can be a risk factor for heart problems, and new federal data shows more than 90% of Americans eat too much.

The findings show that from 2011 to 2012, the average daily sodium intake among U.S. adults was 3,592 mg, which is well above the public health target set by the U.S. Department of Health and Human Services (HHS) of 2,300 mg. The data comes from the U.S. Centers for Disease Control and Prevention’s (CDC) 2013 survey of 180,000 American adults in 26 states, D.C. and Puerto Rico. The findings were published Thursday in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

Some Americans, however, are taking action to cut back, the report shows. About half of the U.S. adults surveyed said they were monitoring or reducing their sodium intake, and 20% said they had received medical advice to do so. People with high blood pressure were more likely to report they were doing something about their sodium consumption, and overall, people in Southern states were more likely to report such action or advice from medical providers.

Public health experts argue that people without high blood pressure could also benefit from cutting back. “Among adults without hypertension, most did not report taking action to reduce sodium intake, and an even smaller proportion reported receiving professional advice to reduced sodium,” the study authors write. “These findings suggest an opportunity for promoting strategies to reduce sodium consumption among all adults, with and without hypertension.”

Sodium intake recommendations have been the focus of controversy, with some researchers arguing that sodium levels are safe and that cutting back to very low recommended levels could be harmful. Others argue that high sodium consumption is related to serious health complications and contributes to millions of deaths every year. Some groups recommend limits that are even lower than the HHS; for instance, the American Heart Association recommends less than 1,500 mg a day.

In the new CDC report, researchers say that a high sodium habit doesn’t come cheap; medical costs for cardiovascular disease are predicted to triple from $273 billion to $818 billion between 2010 to 2030, and cutting back on sodium intake by 1,200 mg a day could save $18 billion in costs each year, they say.

TIME Research

Rising Birth Rates a Good Sign for the Economy

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First increase since the recession

The number of children born in the U.S. increased in 2014 for the first time since the Great Recession, a sign that some women may be feeling financially stable enough to start a family.

The National Center for Health Statistics released a study Wednesday showing that both the number of births and the fertility rate in the U.S. increased by 1% in 2014, the first rise since 2007, when both demographic markers began dropping.

Last year, the U.S. birth rate had fallen to a 15-year low, according to NCHS data, with the number of births decreasing from 4.3 million in 2007 to 3.9 million in 2013, a 9% drop. Based on 2007 birth rates, University of New Hampshire demographer Ken Johnson estimates that there were 2.3 million fewer babies born between 2008 and 2013 than there would have been if the birth rate remained stable.

The falling birth rate has been one of the indirect consequences of the recession and of particular concern for demographers. Low birth rates over the long term, barring an influx of immigrants, can mean a population decline that leads to a smaller tax base and fewer people to financially support programs like Social Security and Medicare as the population ages.

Demographers have been trying to determine whether the economy forced women to merely delay childbirth or forego starting a family altogether. The latest numbers, while preliminary, suggest that women may just have been delaying.

The birth rate for women aged 30-34, many of whom were graduating from college and looking for jobs when the recession hit, rose 3% in 2014 and has steadily increased since 2011. The rate for women aged 35-39 increased by 3% while the rate for those aged 40-44 rose 2%.

For women aged 20-24, however, the birth rate decreased by 2%, and it remained steady for those aged 25-29, suggesting that many millennials are still putting off starting a family.

“We won’t know how significant this is unless it continues for the next few years,” said William Frey, a demographer at the Brookings Institution, of the overall rise in birth rates. “But it’s a glimmer of hope that demographic responses are reacting to an improving economy.”

TIME Infectious Disease

Patient With Drug-Resistant Form of TB Treated in Maryland

The goverment is seeking people who may have come into contact with the patient

A patient diagnosed with a rare, drug-resistant form of tuberculosis has been taken to the National Institutes of Health (NIH) in Maryland for treatment, and the government is urgently trying to identify people whom the patient may have exposed to the illness.

The patient traveled from India to Chicago’s O’Hare Airport and spent time in Missouri and Tennessee before seeking treatment for “XDR-TB” and receiving a diagnosis seven weeks after arriving in the country, the CDC said. She was transferred to the NIH facility in Bethesda, Maryland via special air and ground ambulances.

“CDC will obtain the passenger manifest for [the India to Chicago] flight from the airline and will begin a contact investigation. Although the risk of getting a contagious disease on an airplane is low, public health officers sometimes need to find and alert travelers who may have been exposed to an ill passenger,” a spokesperson at the Centers for Disease Control and Prevention said in a statement.

Only about one third to half of XDR-TB cases have been cured and if the patient survives she may need months or even years of treatment. Cases of XDR-TB are very rare in the U.S. with only 63 cases reported between 1993 and 2011. People with H.I.V. infection or other infections that weaken the immune system are particularly vulnerable to this strain of TB.

TIME South Korea

Hundreds More Under Quarantine in South Korea as MERS Claims Seventh Victim

Eight new cases have been diagnosed, but officials are optimistic that the virus is being contained

South Korea authorities confirmed the death of another person diagnosed with Middle East Respiratory Syndrome (MERS) on Tuesday, raising the toll from the outbreak to seven.

The latest victim was a 68-year-old woman who had previously suffered from chronic heart conditions before contracting the respiratory virus, according to the state news agency Yonhap.

Public health officials have been working frantically to contain the virus’s spread since the outbreak began on May 20. On Tuesday morning, authorities said that eight new cases of the virus had been diagnosed, raising the number of infections across the country to 95.

Over 2,800 people have been quarantined — up from 2,300 reported Monday — and more than 1,800 schools closed in an effort to halt the spread of the contagion.

However, health officials say progress is being made against the outbreak because infections have only been recorded at hospitals where a MERS patient has been treated, or which has been visited by somebody with MERS. So far, the disease has not emerged in the community at large.

“This week may be very crucial to overcoming MERS,” Prime Minister Choi Kyung-hwan told a meeting of top officials this week, reports Yonhap.

Public-health experts appear to concur that the risk of a rapidly spreading pandemic is low.

“The chance of a massive outbreak in South Korea is not high,” Ho Pak-leung, a microbiology expert at the University of Hong Kong, told Agence France-Presse. “Rather I think there will be continued transmissions at a low level.”

Despite the official optimism, governments across the globe asked their fellow citizens to exercise caution when traveling to the country.

Hong Kong, which experienced its own battle with the Severe Acute Respiratory Syndrome outbreak in 2003 that claimed around 775 lives worldwide — 299 of them in Hong Kong — issued an official travel notice on Tuesday, advising its residents against “nonessential travel” to South Korea.

The city’s decree follows the issuing last week of a Level 1 travel advisory for South Korea made by the U.S. Centers for Disease Control and Prevention.

TIME opioids

FDA Warned Drugmaker About Pain Pill Injection

Endo Pharmaceuticals Opana Drug Pain Killer
Tripplaar Kristoffer—Sipa/AP A logo sign outside of a facility occupied by Endo Pharmaceuticals in Malvern, Penn. on May 30, 2015.

A new form of pain killer could be driving addicts to inject the drug, hastening the spread of HIV

As officials in Indiana scramble to contain a fast-spreading HIV outbreak, TIME has learned that government officials warned one company that the newest version of a drug it manufactured could be driving behavior that is contributing to the crisis.

In May 2013, federal regulators from the Food and Drug Administration told Endo Pharmaceuticals, the maker of the widely used prescription pain pill Opana, that a new form of the medication could be driving abusers to inject the drug intravenously instead of snorting it.

The HIV outbreak in southern Indiana, which has ballooned from 8 cases in January to 166 as of June, is the result of addicts dissolving and injecting Opana, according to the Centers for Disease Control and Prevention (CDC) and local officials in Scott County, where the outbreak is centered. 96% of those who tested positive for HIV and were interviewed by the CDC said they were injecting Opana, according to an April health alert by the agency.

In 2012, Endo introduced a new version of the drug that it said was designed to be abuse deterrent. Where a previous version of the drug could be easily crushed and snorted or dissolved and injected, the new version had a special coating that supposedly made doing so more difficult. Endo removed the previous version from the market and asked the FDA to rule that it had been unsafe. Such a ruling would have prevented other drug makers from introducing generic versions of the pill.

The FDA denied Endo’s request, rejecting the company’s claims about the new coating’s ability to deter abuse. While the new formulation made it harder to crush and snort the drug, the FDA found, “it may be easier to prepare OPR for injection.” That raised, the FDA said, “the troubling possibility that the reformulation may be shifting a non-trivial amount of Opana ER abuse from snorting to even more dangerous abuse by intravenous or subcutaneous injection.”

Officials in Scott County say abusers discovered they could cook down the abuse deterrent version of the pill, dissolving it and preparing it for injection. Officials say addicts prefer the drug to heroin, even though it is more expensive, and the high doesn’t last as long. Addicts in Scott County have transmitted HIV to each other by sharing needles as they shoot up, sometimes as often as 20 times a day.

Endo, a Pennsylvania-based company that specializes in pain medications, earned $1.16 billion in revenue from Opana from 2008-2012. The company has denied Opana is at the heart of the outbreak and has suggested generic versions of its drug that didn’t have the “abuse deterrent” coating might be at fault, as discussed in the current cover story of TIME on opioid abuse in America:

In April, Endo held a conference call with public-health officials in Scott County. The Endo officials “thought it was a mistake,” says [Scott County public health nurse, Brittany] Combs, who was on the call. Around the same time, [Scott County Sheriff Dan] McClain says an Endo security official called him and offered to help investigate the source of the pills. The Endo official told him the drug being abused couldn’t be Opana because it had been reformulated to be “abuse deterrent.” McClain was skeptical. “I’ve got an evidence room full of Opana over there right now, and I don’t have any generic forms of that pill that are being purchased off the street,” McClain says.

Endo officials declined repeated requests to be interviewed for this article. In response to questions emailed to the company regarding its marketing of Opana and its response to the crisis in Scott County, Keri Mattox, senior vice president for investor relations, said, “Patient safety is a top priority for Endo,” and the company has “an ongoing, active and productive dialogue” with the FDA regarding Opana’s “technology designed to deter abuse.” Mattox says the company supports “a broad range of programs that provide awareness and education around the appropriate use of pain medications” and has reached out to the CDC, Indiana state officials and Scott County health and law enforcement officials, among others.

 

 

 

TIME public health

Here’s the Difference Between MERS and Ebola

Another disease without treatment or vaccine is spreading

The news sounds familiar: a virus with no treatment or cure is spreading abroad. But while Ebola dominated the infectious disease news over the last year, the latest infection making headlines is the Middle East respiratory syndrome (MERS), which has most recently hit South Korea, infecting 87 there and killing 6.

Could the two viruses cause similar damage?

Currently, MERS doesn’t appear to be able to spread like Ebola can. Though it’s in the same family of viruses as SARS and the common cold—both highly contagious—MERS appears to be less transmittable. While Ebola spreads through direct contact with the bodily fluids of an infected person, MERS doesn’t spread easily from person to person, and though it spreads through the respiratory tract, very close contact is needed, which is why the risk is higher for health care workers.

Both diseases have high fatality rates (around 3 to 4 of every 10 patients reported with MERS have died) and like Ebola, there is no vaccine or cure for MERS. But right now, MERS is more of a mystery to the medical community.

“Ebola has been around for 40 years so we have a pretty good sense of how it functions and its genome has been pretty stable,” says Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). “MERS emerged in 2012 and we are still learning about it, and it may still be learning about us and evolving. It’s believed that when SARS spent more time circulating among humans, it evolved and became more transmissible.” Frieden says they haven’t yet seen that in MERS, but they’re watching: the CDC is currently sequencing the genome of the virus to understand how it might be changing, and to track its course.

The chance that MERS could change to become more transmittable worries experts. “Personally, I am more concerned about MERS following the course of SARS than I ever will be regarding Ebola becoming widespread outside of certain regions of Africa,” says Dr. Amesh Adalja, a senior associate at the Center for Health Security at the University of Pittsburgh.

MORE What Is MERS? Here’s What You Need To Know

MERS has yet to take that course, Frieden says, but hospitals can be hotbeds for the infection. Through intensive investigations in affected countries, the CDC has determined that more than 90% of the cases could be traced health care exposures. So far there hasn’t been evidence of sustained community spreading. “Hospitals can become amplification points,” says Frieden. “It’s the case in measles, it’s the case for drug-resistant tuberculosis, it’s the case for MERS and SARS and Ebola. That’s where sick people go and that’s where vulnerable people are. It really emphasizes the importance of good infection control in the health care system.”

In May of 2014, the U.S. experienced two cases of MERS. In both instances, the patients were health care providers who lived and worked in the Middle East. Health departments around the U.S. have the ability to test for the virus, and the U.S. has already tested around 550 people in 45 states as a precaution since the disease first emerged in 2012.

MERS and Ebola share an important similarity: a lack of treatments or vaccinations. There’s currently no vaccine. “If there were a vaccine, it’s the kind of thing that might be useful in the camel population, but that’s very theoretical for the future,” Frieden says.

Only 20% of countries are currently able to rapidly detect, respond to or prevent global health threats from emerging infections, like MERS and Ebola, according to CDC data. Countries around the world and official health emergency responders like the World Health Organization have vowed to increase their ability to act during outbreaks that public health experts say are undeniably in our future. Frieden says the CDC in partnership with other countries is accelerating its Global Health Security program, which will increase preparedness worldwide. The CDC is making visits to eight countries in the next six weeks to move the program forward.

“Bottom line, both Ebola and MERS are emerging infections that show us why it’s so important for every country in the world to be prepared to find and stop health threats when and where they emerge,” Frieden says. “We do think the South Korea outbreak will well grow, but there’s no reason to think it can’t be controlled as other outbreaks have been controlled.”

Read next: 6 Dead, 87 Infected, 2,300 Quarantined: South Korea’s MERS Crisis

Listen to the most important stories of the day.

TIME Research

More Than a Quarter of American Adults Have Untreated Tooth Decay

American oral health could use a brush-up

New data on tooth decay and cavities among American adults reveal the sad state of our pearly whites. More than 25% of American adults ages 20 to 64 have untreated tooth decay, and 91% have one tooth — or more — that has been treated for tooth decay or needs to be.

The latest findings published Wednesday from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics show that while tooth decay and complete tooth loss have dropped among Americans since the 1960s, disparities still remain, and there’s room for improvement in our oral health.

MORE: The Sugar Industry Shaped Government Advice on Cavities, Report Finds

The data span 2011–2012 and reveal that Hispanic and black adults had more untreated cavities compared with white and Asian adults ages 20 to 64. Black adults had the highest rate at 42%.

About 1 in 5 adults age 65 and older had untreated tooth decay; American adults ages 20 to 39 were twice as likely to have all their teeth, compared with adults ages 40 to 64.

Though the current report only looks at adults, cavities are common among young people too. Even though cavities are preventable, tooth decay is four times more common than asthma in teens ages 14 to 17. It’s the most common chronic disease among kids and adolescents ages 6 to 19.

TIME Aging

Why More Older Americans Are Suffering From Fatal Falls

55% of unintentional injury deaths among seniors come from falling

One of the fastest growing killers of older Americans isn’t a disease or a disability. It’s the accidental fall.

A new CDC report finds the rate of Americans aged 65 or over who die as a result of unintentional falls has nearly doubled since 2000; 55% of older citizens who die of unintentional injuries do so from falls, up from 33% in 2000. The death rate from falls increased from 29.6 per 100,000 in 2000 to 56.7 per 100,000 in 2013.

There’s no single reason for the steep increase in deaths from falls, and it’s far from clear what may be behind the rise, says the National Center for Health Statistics’ Ellen Kramarow, the report’s co-author. She notes the report is based on death certificate data, and there may be better reporting on underlying causes of death than in the past. But one factor some researchers point to is the continuing increase in overall life expectancy.

“People are living longer and living longer with conditions that make them frail and vulnerable to fall,” Kramarow says.

Before the growth in end-of-life care, assisted living facilities, medications, and hospital procedures designed to extend our lives, many people died from diseases or ailments that previously couldn’t be cured or treated in a way that made them manageable. Today, older Americans can often stave off death from something like heart disease or diabetes with medication that can prolong life longer than ever before. U.S. life expectancy is now at a record high of 78.8.

But as we live longer, often with diseases that once might have killed us, we get more frail — and consequently, researchers say, more likely to suffer fatal injuries from a fall.

Rates for other fatal accidental injuries like car crashes, suffocation, poisoning and fire-related deaths have remained steady over the last decade, according to the CDC. The death rate among seniors due to vehicle accidents actually went down in 2013 to about 15 per 100,000 people from 20 per 100,000 in 2000.

Overall, unintentional injuries resulted in almost 46,000 deaths for those 65 and older, making it the eighth leading cause of death. Unintentional injuries comprised 85% of all fatal injuries in 2012-2013 with suicide and homicide accounting for 15%.

TIME Research

Here’s What Time of Day Babies Are Born

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Just in time for Mother's Day, a new report shows when babies are most likely to be born

According to new data, American mothers-to-be aren’t having too many late night surprises. A new report shows the highest percentage of U.S. births in 2013 (the most recent data available) happened during morning and midday hours.

The new study from the U.S. Centers for Disease Control and Prevention (CDC)’s National Center for Health Statistics looked at 2013 birth certificate data from the National Vital Statistics System (NVSS), and found that the highest percentage of births took place occurred during the hours of 8:00 a.m. and noon. Less than 3% of babies were born during each hour from midnight to 6:59 a.m.

Though most births happen during the day, the latest findings report that when babies are born on a Saturday or Sunday, they are more likely to happen in the late evening or overnight—11:00 p.m. through 5:59 a.m.—compared to births that happen between Monday to Friday.

When it comes to how women gave birth, there were also some distinct patterns in timing. The researchers reported that compared to with induced and non-induced vaginal deliveries, cesarean deliveries were the least likely to occur during evening and early morning. Non-induced vaginal births were more likely to happen in the early morning compared to cesarean and induced vaginal births. Births in out-of-hospital settings were most likely to happen in the early morning hours starting at 1:00 a.m.

“As the use of medical interventions for childbirth (i.e., induction of labor and cesarean delivery) has increased during the last few decades, an increasing proportion of deliveries occur during regular daytime hours,” the study authors write. Understanding when women are most likely giving birth and what types of births are occurring when, can help hospitals better prepare to ensure mother and child are healthy.

TIME Addiction

Health Officials Worry as HIV Cases in Indiana Grow

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Elizabeth Renstrom for TIME

Health officials say families are using drugs together

The number of new HIV infections in Scott County, Indiana, has risen to 142, prompting local and state officials to call it a public-health emergency.

A new report released by the federal and state health officials on Friday reveals disturbing trends in injection drug use in a county of only 4,200 people. Scott County has historically reported less than five new cases of HIV each year, making the new tally of 142 all the more alarming. Health experts say the recent outbreak is reflective of a growing drug epidemic nationwide.

“There are children, and parents and grandparents who live in the same house who are injecting drugs together sort of as a community activity,” said Dr. Joan Duwve, the chief medical consultant for the Indiana State Department of Health, at a press briefing. “This community, like many rural communities, especially those along the Ohio River and Kentucky and West Virginia, has really seen a lot of prescription opioids flooding the market. With few resources [and] not a lot to do, the use and abuse has been occurring for at least a decade and probably longer.”

Health officials note that like many other rural counties in the U.S., Scott County has high unemployment, high rates of adults who have not completed high school and a large proportion of residents living in poverty with limited health care access. The report underlines the fact that the county consistently ranks among the lowest in Indiana for health and life expectancy.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction,” said Duwve.

The ages of the men and women diagnosed with HIV in Scott County range between ages 18 and 57. The health officials report that no infants have tested positive, though a small number of pregnant women have. Ten women in the cluster were identified to be sex workers. Around 84% of the patients have also been infected with hepatitis C. Eighty percent of the patients with HIV have reported injection drug use and among those people, all of them have reported dissolving and injecting tablets of oxymorphone. Some also reported using methamphetamine and heroin.

Dr. Jonathan Mermin, who runs the CDC’s National Center for HIV/AIDS, reminded reporters that the United States is facing an epidemic of prescription opioid abuse. “An estimated two million people are dependent on or abuse prescription opioids nationally. So while opioid pain relievers can play an important role in the management of some types of pain, the overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose,” he said.

The CDC estimates that nationwide about 3,900 new HIV infections each year are attributable to injection-drug use, which is down nearly 90% from a peak of about 35,000 in the late 1980s, says Mermin. He adds that opioid poisoning deaths in the United States have nearly quadrupled from 1999 to 2011. This epidemic has already played a major role in a growing epidemic of viral hepatitis among people who inject drugs with a 150% increase in reports of acute hepatitis C nationwide between 2010 and 2013.

State health officials and the CDC are working together to control the outbreaks of HIV and hepatitis C. The state has launched a public health campaign to notify residents of the support available to them: lab testing and treatment, referrals to addiction services and employment, and help with insurance registration. The state initially declared a 30-day public health emergency for Scott County on March 26, but expanded the executive order another 30 days. “I want to assure everyone [that] the state of Indiana will not abandon this community once the executive order is over,” said Dr. Jerome M. Adams, the Indiana State Health Commissioner.

The CDC also released a health advisory on Friday, and is asking states to look closely at their most recent data on HIV and hepatitis C diagnoses, overdose deaths, admissions for drug treatments, and drug arrests in order to help identify communities that could be at high risk for unrecognized clusters of the infections.

“We must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” said Mermin.

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