TIME Cancer

Many Breast Cancer Patients Don’t Understand Their Condition, Study Says

The disparity is particularly pronounced for minority women

Many breast cancer patients don’t understand the details of their disease, according to a new study. While many believed they understood the grade, stage and type of tumor, only 20% to 58% identified those characteristics correctly.

The study, published Monday in the journal Cancer, found that minority women fared particularly poorly in identifying their tumor characteristics, a finding that remained true even as researchers controlled for factors like education. The lack of understanding about their own disease makes it difficult for patients to make informed medical decisions and to follow prescribed treatments, said study author and Harvard Medical School professor Rachel Freedman.

“Our results illustrate the lack of understanding many patients have about their cancers and have identified a critical need for improved patient education and provider awareness of this issue,” Freedman said.

TIME ebola

WHO Chief Unveils Reforms After Ebola Response Criticized

WHO Director-General Margaret Chan addresses the media during a special meeting on Ebola at the WHO headquarters in Geneva
World Health Organization (WHO) Director-General Margaret Chan addresses the media during a special meeting on Ebola at the WHO headquarters in Geneva on Jan. 25, 2015. Pierre Albouy—Reuters

"The Ebola outbreak revealed some inadequacies and shortcomings"

The head of the UN’s global health agency has laid out a set of reforms to better and more quickly fight disease outbreaks, in a frank acknowledgement that the organization struggled to confront the scale of the 2014 Ebola outbreak that killed more than 8,600 people.

“This was West Africa’s first experience with the virus, and it delivered some horrific shocks and surprises,” said World Health Organization (WHO) director General Margaret Chan in a speech on Sunday. “The world, including WHO, was too slow to see what was unfolding before us.”

The needed changes, she said, include country-specific emergency workforces trained with “military precision”; a strengthened team of epidemiologists for detecting disease and a network of other providers to allow responders to reach “surge capacity.”

“The Ebola outbreak revealed some inadequacies and shortcomings in this organization’s administrative, managerial, and technical infrastructures,” she said, calling for a “dedicated contingency fund to support rapid responses to outbreaks and emergencies.”

The remarks came as the WHO’s executive board prepared to meet in Geneva to discuss reform proposals that many in the international community consider to be overdue. The response to Ebola by the UN’s health agency was seen by many as slow and ineffectual.

Indeed, Sunday’s speech did not mark the first time Chan acknowledged her organization’s shortcomings. In October, she told TIME that “the scale of the response did not match the scale of the outbreak.”

TIME Infectious Disease

Don’t Go to Disneyland’s California Parks If You Haven’t Been Vaccinated for Measles

DISNEY PARKS DISNEY SIDE
More than 1,000 fans gather for a photo at Disneyland in Anaheim, Calif. Newsire — AP

State health officials say 42 of California's 59 cases are linked to exposure at Disneyland

California state epidemiologist Gil Chavez is calling on anyone who hasn’t had the measles-mumps-rubella (MMR) vaccine to avoid visiting Disneyland’s two California theme parks “for the time being.”

State authorities say at least 59 people across California have been diagnosed with the highly infectious, airborne disease since December.

“Of the confirmed cases, 42 have been linked to an initial exposure in December at Disneyland or Disney California Adventure Park in Anaheim, California,” read a statement released by the California Department of Public Health on Wednesday.

Health officials have also called on any California resident who has not been vaccinated for the disease to consider getting inoculated immediately.

Read next: Disneyland: The Latest Victim of the Anti-Vaxxers

Listen to the most important stories of the day.

TIME Research

Here’s What Alcohol Advertising Does To Kids

alcohol
Getty Images

Booze ads reach kids far younger than the legal drinking age

Alcohol advertising that reaches children and young adults helps lead them to drink for the first time—or, if they’re experienced underage drinkers, to drink more, according to a study in the journal JAMA Pediatrics.

“It’s very strong evidence that underage drinkers are not only exposed to the television advertising, but they also assimilate the messages,” says James D. Sargent, MD, study author and professor of pediatrics at Dartmouth’s Geisel School of Medicine. “That process moves them forward in their drinking behavior.”

The study found that young people were only slightly less likely than their older counterparts to have seen an alcohol ad. While 26% of young adults between the ages of 21 and 23 had seen a given alcohol advertisement, 23% of 15 to 17 year olds said they’d seen the same one. Researchers also found that young people who could accurately identify alcoholic products and who said they liked the ads were more likely to try drinking or to drink more.

Based on the findings, Sargent says that alcohol manufacturers should self-regulate more to limit the number of children they reach. The tobacco industry, which has volunteered not to buy television ads or billboards, could serve as model for alcohol manufacturers, he says.

“Alcohol is responsible for deaths of people during adolescence and during young adulthood,” says Sargent. “It seems to me that the industry should be at least as restrictive as the tobacco industry.”

“The spirits industry is committed to responsible advertising directed to adults and adheres to a rigorous advertising and marketing code,” said Lisa Hawkins, vice president of Public affairs at the Distilled Spirits Council, in a statement. The Distilled Spirits Council is a trade association that represents alcoholic beverage companies.
TIME Mental Health/Psychology

The More Hours You Work, the More You Drink, Study Says

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People across the socioeconomic spectrum use alcohol to unwind

People who work more than 48 hours a week are more likely to drink at dangerous levels than their counterparts who work fewer hours, according to new research. The link between alcohol misuse and long work hours suggests that employers have a role to play in stemming alcohol abuse, according to the study in the BMJ.

The study, which reviewed data from more than 300,000 participants, defined risky drinking as the consumption of more than 14 drinks per week for women and 21 drinks for men.

“If people are [engaging in] risky drinking, they don’t sleep well, they’re not as socially engaged,” says Cassandra Okechukwu, an assistant professor at the Harvard School of Public Health who wrote an editorial to accompany the study. “It’s really important for work places to pay attention to the productivity of their workers and work environment.”

MORE Alcohol Kills 1 Person Every 10 Seconds, Report Says

The study found the connection between long hours and increased alcohol consumption to be consistent across socioeconomic groups, so a fast food worker who works 60 hours at two jobs is just as likely to consume more alcohol as a banker who works the same hours. People across the spectrum use alcohol to unwind, says Okechukwu.

While the study identifies public health issues associated with working long hours, it offers little policy guidance on how to solve the problem. In Europe, the European Union Working Time Directive encourages employers to limit their workers’ weeks to 48 hours on the job, but many people still work longer. Enacting labor laws would be even more difficult in the United States, where few policies regulate working hours.

“I don’t want to make policy recommendations,” Okechukwu says. “In the U.S., we’re not even there yet.”

TIME Business

Now There’s a Female-Friendly Condom You Won’t Be Embarrassed to Buy

Photo courtesy of Lovability

A new brand of female-friendly condoms hopes to make contraception cute

Condoms present the ultimate catch-22: we all need them in order to stay STD-free, but buying them, carrying them, and presenting them can feel dirty.

Tiffany Gaines, 24, is out to change that. She’s in the process of raising money to expand the inventory of her new line of condoms, Lovability. They’re condoms specifically designed for female comfort, and not just in bed. “Lovability condoms were inspired by my realization that I didn’t feel comfortable acquiring condoms, and I didn’t even feel comfortable carrying them, and I didn’t feel comfortable producing them in the moment,” Gaines says. “For years, condoms have been marketed as a masculine, dominant, hyper-sexual product.”

And that’s a problem, since male condoms are approximately 82% effective at preventing pregnancy with average use, and (along with female condoms) they’re the only contraceptive that also prevents STDs. State and municipal health authorities are so sure that condoms are good for public health that they even distribute them for free in some places (like NYC and Philadelphia). Yet only 19% of single women say they regularly use condoms every time. Gaines found that most women she spoke to hated the experience of buying condoms, felt ashamed to carry them, and were anxious about using them, even though 6.2 million women rely on male condoms to prevent pregnancy.

And it’s no wonder, because the condom experience is totally creepy. First, you have to find the condoms in the drugstore next to the pregnancy tests and the yeast-infection treatments (not sexy), and in some stores you have to slide open the noisy plastic theft guards (which make you feel like a criminal), then you have to wait in line to purchase them so everybody sees what you’re buying (and gives you side-eye).

Carrying condoms is equally embarrassing– just look how Reese Witherspoon’s character in Wild was judged when fellow hikers found her stash. And after all that, Gaines says that many women worry that tearing open the slippery packages can cause condoms to rip, or that condoms get put on inside-out in the heat of the moment.

Lovability isn’t the only condom company that’s pushing to appeal to female consumers. Sustain makes eco-friendly condoms marketed to women with tasteful cardboard packaging decorated with shells or bamboo. L Condoms also has female-focused branding, plus they donate a condom to Africa for each condom sold (and offer one-hour delivery in some places). But Lovability condoms are unique in that they don’t look like condoms: they come in a cute little tin that looks more like lip balm or mints than anything else. “You’re first drawn to it in the store because of the way it looks,” Gaines said. “It’s absolutely discrete. It looks like a cosmetic product.”

The tins are designed so women can carry them in their purses without being embarrassed if they’re found, which means spontaneous encounters don’t have to be unprotected ones. The design also eliminates the anxiety that the condom might rip when the package is opened; Lovability condoms come in a special buttercup packaging, so there’s no confusion about which side of the condom is the top. “In a regular foil wrapper, you have no idea, you’re just tearing it and hoping for the best,” Gaines says. “It was really important for us to not only create a condom that was more accessible and more beautiful, but also more functional in the bedroom.” (And each individual condom package comes with a motivational quote inside.)

Lovability is a very young startup: the two-person company started out with less than $10,000 in funding, and even though she’s the president of the company, Gaines spends hours assembling the tins herself. But the condoms were so popular that they sold out in NYC lingerie stores, which is why Gaines and Claire Courtney, Lovability’s outreach director, are raising money to make more. They’ve got their eye on big outlets like Sephora, Anthropologie, and Urban Outfitters, but also want to sell condoms in other places women feel comfortable, like salons, gyms, or spas. Basically, they only want to sell their condoms where no other condoms are sold. Or, as Gaines puts it, “Why shouldn’t you discover your favorite condom brand while enjoying a spa day with the girls?

Gaines says Lovability’s aesthetic appeal is all in the service of public health and sexual empowerment– she wants more women to have condoms with them at all times to prevent the spread of STDs. “You can be safer if it’s a shared responsibility. And a lot of time guys aren’t prepared,” Gaines says. “This is a great opportunity to capitalize on the judgement of women. ” Plus, Gaines adds, some women like to provide the condoms, since “they know it hasn’t been in the guy’s wallet for the last three years.

But the startup hopes to do more than keep women safe. Gaines also wants the condoms to spark discussions about contraception. “Our mission is to bring condoms out of the back room and into the spotlight, and get conversations going about it,” she says. “Modern women are ready to take control of their sexual health, and be proud of it.”

 

TIME Healthcare

Why Some Experts Want Mandatory Flu Shots For School Kids

Flu Outbreak Continues In Bay Area
A syringe filled with influenza vaccination is seen at a Walgreens Pharmacy on January 14, 2014 in Concord, California. Justin Sullivan—Getty Images

'This is just part of being a good citizen and not hurting your neighbor'

How do you prevent elderly people from dying from the flu? Immunize preschoolers, infectious disease experts say.

A new policy mandating that preschool children receive flu vaccination went into effect in New York City earlier this month with exactly that goal in mind.

Young children respond particularly well to the flu vaccine, and giving it to preschoolers creates a ripple effect that diminishes the flu in the population as a whole. Even though preschoolers are just a fraction of the population, immunizing a critical percentage of the population from the flu could significantly diminish the chance of a widespread outbreak, a phenomenon known as herd immunity.

“This is just part of being a good citizen and not hurting your neighbor,” says Jon C. Tilburt, a medical professor at the Mayo Clinic. “It’s good for your neighbor’s kids and it’s good for grandma.”

Jane Zucker, an assistant commissioner at New York City’s Department of Health, says herd immunity “absolutely” shaped her department’s new policy, which mirrors similar rules that have been followed in Connecticut and New Jersey followed for years.

“There’s a good evidence base about the importance of vaccinating young children on community transmission, and [herd immunity] was really a strong influence on the decision to move forward,” she says.

Mandatory vaccination is nothing new in the United States. School children across the country have been required receive immunization for diseases like measles and mumps for years. But mandatory influenza vaccination hasn’t caught on as fast, even though vaccination for young children is strongly recommended by the Centers for Disease Control and Prevention.

The constantly evolving nature of the flu and its less-than-perfect effectiveness are among the reasons why the requirement hasn’t taken root, says University of California San Francisco medical professor Barbara Koenig. The warnings of dangerous side effects propagated by the attention-grabbing anti-vaccination movement do nothing to further the cause of mandatory vaccines.

MORE: Why the Anti-Vaccine Crowd Won’t Fade Away

Health officials have begun to latch onto the idea, says Zucker. She says she’s been in touch with policy makers from other jurisdictions who say they are considering a similar measure, and the National Foundation for Infectious Diseases sponsored a webinar on the topic last year, Zucker says.

Health experts say there is little risk of side effects, and they stress that in New York parents can obtain a religious or medical exemption. But parents should want to protect their own children with immunization, experts say. In Connecticut, the number of hospitalizations in the impacted age group fell by 12% following the implementation of a mandatory vaccination.

“There needs to be some individual direct benefit to the individual,” says Richard Malley, a doctor at Boston Children’s Hospital. “What we have here are vaccines that are recommended for children. They are disease sparing and, in some cases, they are life saving. They have a phenomenal effect on individual.”

TIME Research

Longer Rest After Concussions Might Not Be Good, Study Says

Research calls into question the five-day waiting period

Concussion patients who wait several days to resume physical activity after receiving a hit may be more likely to suffer symptoms of the condition, a new study suggests. The research calls into question the five-day waiting period for concussion patients recommended by some doctors.

The study, published Monday in the journal Pediatrics, compared patients who waited five days to resume physical activity with those who waited one or two days. Patients who waited longer were more likely to report suffering from headaches and nausea in the first few days after the concussion and emotional symptoms in the 10 days following the blow.

The study looked at almost 100 concussion patients between the ages of 11 and 22 who had been admitted to the emergency room with a concussion. The findings do not necessarily apply to patients with more severe concussions.

None of the patients in the study were hospitalized.

TIME public health

NYC Hit a 100-Year Low on Pedestrian Deaths

The NYPD increased the number of summonses for failure to yield to a pedestrian by 126%

About 130 pedestrians died in New York City traffic accidents last year, the lowest number since the city began keeping such records 100 years ago. Overall, traffic fatalities in the city fell to about 250, down from 300 in 2013.

The news comes less than a year after Mayor Bill DeBlasio declared traffic deaths unacceptable and announced that he would put the “full weight of city government” behind an effort to stem the deaths. Since then, the mayor has pushed through a slew of new laws designed to make the streets safer, including a reduction in the default speed limit from 30 to 25 miles per hour. The New York Police Department (NYPD) has also stepped up enforcement of existing traffic laws. The number of speeding summonses increased by 42% and the number for failure to yield to a pedestrian increased by 126%.

“There is no question we are moving this city in the right direction, thanks to stepped up enforcement by the NYPD, strong traffic safety measures by the Department of Transportation, new laws passed by our legislators and the work of New Yorkers fighting for change,” DeBlasio said in a statement.

The decline in traffic fatalities was not consistent across all methods of transportation; the number of bicyclists who died in traffic accidents in 2014 increased to 20 from 12 the previous year.

DeBlasio’s traffic safety push, called Vision Zero, follows principles developed by a Swedish campaign of the same name. The Scandinavian country’s investment in infrastructure, technology and enforcement has cut traffic deaths in half since the beginning of the initiative.

While the movement has spread around the globe, New York has been among the most enthusiastic adopters in the United States and transportation advocates say they’re hopeful that the city’s success will lead the movement to spread.

Paul Steely White, Executive Director of New York-based Transportation Alternatives, told TIME late last year that he was pleasantly surprised by the speed of change in New York

“We’re having this very special moment in New York City public policy,” he said. “All eyes are on New York right now to see if we can tame our infamously mean streets.”

TIME health

New Global Study Calls Violence Against Women ‘Epidemic’

A Pokot woman holds a razor blade after performing a circumcision on four girls in a village about 80 kilometres from the town of Marigat in Baringo County, Kenya, Oct. 16, 2014.
A Pokot woman holds a razor blade after performing a circumcision on four girls in a village about 80 kilometres from the town of Marigat in Baringo County, Kenya, Oct. 16, 2014. Siegfried Modola—Reuters

Governments need to step up their game to protect women, says extensive new research

When it comes to stopping violence against women, actions speak louder than words. So even though there’s increased worldwide awareness about violence against women, the problem won’t be solved unless countries make significant policy and financial changes to support victims, according to a five-part series of studies in The Lancet, one of the world’s premier medical journals.

The series, entitled “Violence Against Women and Girls,” calls the violence a “global public health and clinical problem of epidemic proportions,” and the statistics are bleak. 100-140 million women have undergone female genital mutilation worldwide, and 3 million African girls per year are at risk. 7% of women will be sexually assaulted by someone besides their partner in their lifetimes. Almost 70 million girls worldwide have been married before they turned 18. According to WHO estimates, 30% of women worldwide have experienced partner violence. The researchers said that these problems could only be solved with political action and increased funding, since the violence has continued “despite increased global attention,” implying awareness is not enough.

“No magic wand will eliminate violence against women and girls,” series co-lead Charlotte Watts, founding Director of the Gender Violence and Health Centre at the London School of Hygiene & Tropical Medicine, said in a statement. “But evidence tells us that changes in attitudes and behavior are possible, and can be achieved within less than a generation.”

One of the major problems highlighted in the Lancet series is that much of the current research on violence against women has been conducted in high-income countries, and it’s mostly been focused on response instead of prevention. The study found that the key driver of violence in most middle-and-low income countries is gender inequality, and that it would be near impossible to prevent abuse without addressing the underlying political, economic, and educational marginalization of women.

The study also found that health workers are often uniquely positioned to help victims, since they’re often the first to know about the abuse.

“Health-care providers are often the first point of contact for women and girls experiencing violence,” says another series co-lead, Dr. Claudia Garcia-Moreno, a physician at the WHO, in a statement. “The health community is missing important opportunities to integrate violence programming meaningfully into public health initiatives on HIV/AIDS, adolescent health, maternal health, and mental health.”

The series makes five concrete recommendations to curb the violence against women. The authors urge nations to allocate resources to prioritize protecting victims, change structures and policies that discriminate against women, promote support for survivors, strengthen health and education sectors to prevent and respond to violence, and invest in more research into ways to address the problem. In other words: money, education, and political action are key to protecting the world’s most vulnerable women. Hashtag activism, celebrity songs, and stern PSAs are helpful, but this problem is too complicated to be solved by awareness alone.

“We now have some promising findings to show what works to prevent violence,” said Dr. Cathy Zimmerman from the London School of Hygiene & Tropical Medicine. “We urgently need to turn this evidence into genuine action so that women and girls can live violence-free lives.”

The study comes just in time for the UN’s International Day for the Elimination of Violence Against Women, on Nov. 25.

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