Kaiser Health News
Depressed? Anxious? Air Pollution May Be a Factor
by Jim Robbins
Tue, 25 Apr 2023 09:00:00 +0000
In the 1990s, residents of Mexico City noticed their dogs acting strangely — some didn't recognize their owners, and the animals' sleep patterns had changed.
At the time, the sprawling, mountain-ringed city of more than 15 million people was known as the most polluted in the world, with a thick, constant haze of fossil fuel pollution trapped by thermal inversions.
In 2002, toxicologist and neuropathologist Lilian Calderón-Garcidueñas, who is affiliated with both Universidad del Valle de México in Mexico City and the University of Montana, examined brain tissue from 40 dogs that had lived in the city and 40 others from a nearby rural area with cleaner air. She discovered the brains of the city dogs showed signs of neurodegeneration while the rural dogs had far healthier brains.
Calderón-Garcidueñas went on to study the brains of 203 human residents of Mexico City, only one of which did not show signs of neurodegeneration. That led to the conclusion that chronic exposure to air pollution can negatively affect people's olfactory systems at a young age and may make them more susceptible to neurodegenerative diseases such as Alzheimer's and Parkinson's.
The pollutant that plays the “big role” is particulate matter, said Calderón-Garcidueñas. “Not the big ones, but the tiny ones that can cross barriers. We can detect nanoparticles inside neurons, inside glial cells, inside epithelial cells. We also see things that shouldn't be there at all — titanium, iron, and copper.”
The work the Mexican scientist is doing is feeding a burgeoning body of evidence that shows breathing polluted air not only causes heart and lung damage but also neurodegeneration and mental health problems.
It's well established that air pollution takes a serious toll on the human body, affecting almost every organ. Asthma, cardiovascular disease, cancer, premature death, and stroke are among a long list of problems that can be caused by exposure to air pollution, which, according to the World Health Organization, sits atop the list of health threats globally, causing 7 million deaths a year. Children and infants are especially susceptible.
Sussing out the impact of air pollution on the brain has been more difficult than for other organs because of its inaccessibility, so it has not been researched as thoroughly, according to researchers. Whether air pollution may cause or contribute to Alzheimer's or Parkinson's is not settled science. But Calderón-Garcidueñas' work is at the leading edge of showing that air pollution goes directly into the brain through the air we breathe, and has serious impacts.
Some psychotherapists report seeing patients with symptoms stemming from air pollution. Not only does the pollution appear to cause symptoms or make them worse; it also takes away forms of relief.
“If we exercise and spend time in nature we become extra resilient,” said Kristen Greenwald, an environmental social worker and adjunct professor at the University of Denver. “A lot of folks do that outside. That's their coping mechanism; it's soothing to the nervous system.”
On polluted days a lot of her clients “can't go outside without feeling they are making themselves more sick or distressed.”
Megan Herting, who researches air pollution's impact on the brain at the University of Southern California, said environmental factors should be incorporated in doctors' assessments these days, especially in places like Southern California and Colorado's Front Range, where high levels of air pollution are a chronic problem.
“When I go into a medical clinic, they rarely ask me where I live and what is my home environment like,” she said. “Where are we living, what we are exposed to, is important in thinking about prevention and treatment.”
In the last two decades, with new technologies, research on air pollution and its impact on the human nervous system has grown by leaps and bounds.
Research shows tiny particles bypass the body's filtering systems as they are breathed in through the nose and mouth and travel directly into the brain. Fine and ultrafine particles, which come from diesel exhaust, soot, dust, and wildfire smoke, among other sources, often contain metals that hitchhike a ride, worsening their impact.
A changing climate is likely to exacerbate the effects of air pollution on the brain and mental health. Warmer temperatures react with tailpipe emissions from cars to create more ozone than is generated when it's cooler. And more and larger forest fires are expected to mean more days of smoky skies.
Ozone has been linked to neurodegeneration, decline in cerebral plasticity, the death of neurons, and learning and memory impairment. Ozone levels are extremely high in Los Angeles and the mountain valleys of the West, including the Front Range of Colorado, Phoenix, and Salt Lake City.
Air pollution also causes damage from chronic inflammation. As air pollution particles enter the brain, they are mistaken for germs and attacked by microglia, a component of the brain's immune system, and they stay activated.
“Your body doesn't like to be exposed to air pollution and it produces an inflammatory response,” said Patrick Ryan, a researcher at Cincinnati Children's Hospital, in an email. “Your brain doesn't like it either. There's more than 10 years of toxicological science and epidemiologic studies that show air pollution causes neuro-inflammation.”
Much of the current research focuses on how pollution causes mental health problems.
Damage to the brain is especially pernicious because it is the master control panel for the body, and pollution damage can cause a range of neuropsychiatric disorders. A primary focus of research these days is how pollution-caused damage affects areas of the brain that regulate emotions — such as the amygdala, prefrontal cortex, and hippocampus. The amygdala, for example, governs the processing of fearful experiences, and its impairment can cause anxiety and depression. In one recent review, 95% of studies looking at both physical and functional changes to areas of the brain that regulate emotion showed an impact from air pollution.
A very large study published in February in JAMA Psychiatry, by researchers from the universities of Oxford and Peking and Imperial College London, tracked the incidence of anxiety and depression in nearly 400,000 adults in the United Kingdom over a median length of 11 years and found that long-term exposure even to low levels of a combination of air pollutants — particulate matter, nitrogen dioxide, and nitric oxide — increased the occurrence of depression and anxiety.
Another recent study, by Erika Manczak at the University of Denver, found adolescents exposed to ozone predicted “for steeper increases in depressive symptoms across adolescent development.”
But the epidemiological research has shortcomings because of confounding factors that are difficult to account for. Some people may be genetically predisposed to susceptibility and others not. Some may experience chronic stress or be very young or very old, which can increase their susceptibility. People who reside near a lot of green space, which reduces anxiety, may be less susceptible.
“Folks living in areas where there is greater exposure to pollutants tend to be areas under-resourced in many ways and grappling with a lot of systemic problems. There are bigger reports of stress and depression and anxiety,” said Manczak. “Given that those areas have been marginalized for a lot of reasons, it's a little hard to say this is due to air pollution exposure.”
The best way to tell for sure would be to conduct clinical trials, but that comes with ethical problems. “We can't randomly expose kids to air pollution,” Ryan said.
By: Jim Robbins
Title: Depressed? Anxious? Air Pollution May Be a Factor
Sourced From: kffhealthnews.org/news/article/air-pollution-mental-health-impact-research-depression-anxiety/
Published Date: Tue, 25 Apr 2023 09:00:00 +0000
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Kaiser Health News
Journalists Delve Into Climate Change, Medicaid ‘Unwinding,’ and the Gap in Mortality Rates
Sat, 04 May 2024 09:00:00 +0000
KFF Health News senior correspondent Samantha Young discussed Medicaid and climate change on KCBS Radio's “On-Demand” podcast on April 29.
- Click here to hear Young on KCBS
- Read Young's “AC, Power Banks, Mini Fridges: Oregon Equips Medicaid Patients for Climate Change“
KFF Health News contributor Andy Miller discussed Medicaid unwinding on WUGA's “The Georgia Health Report” on April 26.
- Click here to hear Miller on “The Georgia Health Report”
- Read Phil Galewitz' “Millions Were Booted From Medicaid. The Insurers That Run It Gained Medicaid Revenue Anyway.“
KFF Health News Nevada correspondent Jazmin Orozco Rodriguez discussed mortality rates in rural America on The Daily Yonder's “The Yonder Report” on April 24.
- Click here to hear Rodriguez on “The Yonder Report”
- Read Rodriguez' “City-Country Mortality Gap Widens Amid Persistent Holes in Rural Health Care Access”
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Title: Journalists Delve Into Climate Change, Medicaid ‘Unwinding,' and the Gap in Mortality Rates
Sourced From: kffhealthnews.org/news/article/journalists-delve-into-climate-change-medicaid-unwinding-and-the-gap-in-mortality-rates/
Published Date: Sat, 04 May 2024 09:00:00 +0000
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Kaiser Health News
Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Darius Tahir
Fri, 03 May 2024 09:00:00 +0000
Since becoming a father a few months ago, I've been nursing a grudge against something tiny, seemingly inconsequential, and often discarded: instructional manuals. Parenthood requires a lot of gadgetry to maintain a kid's health and welfare. Those gadgets require puzzling over booklets, decoding inscrutable pictographs, and wondering whether warnings can be safely ignored or are actually disclosing a hazard.
To give an example, my daughter, typically a cooing little marsupial, quickly discovered babyhood's superpower: Infants emerge from the womb with talon-strength fingernails. She wasn't afraid to use them, against either her parents or herself. So we purchased a pistachio-green, hand-held mani-pedi device.
That was the easy part. The difficulty came when we consulted the manual, a palm-sized, two-page document.
The wandlike tool is topped with a whirring disc. One can apparently adjust the speed of its rotation using a sliding toggle on the wand. But the product manual offered confusing advice: “Please do not use round center position grinding,” it said. Instead, “Please use the outer circle position to grinding.” It also proclaimed, “Stay away from children.” In finer print, the manual revealed the potential combination of kids and the device's smaller parts was the reason for concern.
One would hope for more clarity about a doodad that could inadvertently cause pain.
Later, I noticed another warning: “If you do not use this product for a long time, please remove the battery.” Was it dangerous? Or simply an unclear and unhelpful yet innocuous heads-up? We didn't know what to do with this information.
We now notice shoddy instructions everywhere.
One baby carrier insert told us to use the product for infants with “adequate” head, neck, and torso control — a vague phrase. (The manufacturer declined to comment.)
Another manual, this one online and for a car seat — a device that's supposed to protect your kid — informed readers with words and images that a model baby was “properly positioned” relative to the top of the headrest “structure” when more than one inch from the top. Just pixels away, the same model, slumped further down, was deemed improperly positioned: “The headrest should not be more than 1” from the top of her head,” it said, in tension with its earlier instructions. Which was it, more than one inch or not? So we fiddle and hope for the best.
I acknowledge this sounds like new-parent paranoia. But we're not entirely crazy: Manuals are important, and ones for baby products “are notoriously difficult to write,” Paul Ballard, the managing director of 3di Information Solutions, a technical writing firm, told me.
Deborah Girasek, a professor of social and behavior sciences at the Uniformed Services University of the Health Sciences, told me that for decades, for the young and middle-aged alike, unintentional injury has been the leading cause of death. That's drownings, fires, suffocation, car crashes. The USU is a federal service academy training medical students destined for the armed services or other parts of the government.
Some of these deaths are caused by lack of effective communication — that is, the failure of instruction about how to avoid injury.
And these problems stretch from cheap devices to the most sophisticated products of research and development.
It's a shortcoming that's prompted several regulatory agencies charged with keeping Americans healthy, including the Consumer Product Safety Commission, the Food and Drug Administration, and the National Highway Traffic Safety Administration, to prod companies into providing more helpful instructions.
By some lights, they've had success. NHTSA, for example, has employees who actually read manuals. The agency says about three-quarters of car seats' manuals rate four or five stars out of five, up from 38% in 2008. Then again, our car seat's has a five-star rating. But it turns out the agency doesn't evaluate online material.
Medical product manuals sometimes don't fare too well either. Raj Ratwani, director of MedStar Health's Human Factors program, told me that, for a class he teaches to nurses and doctors, he prompted students to evaluate the instructions for covid-19 tests. The results were poor. One time, instructions detailed two swabs. The kit had only one.
Technical writers I spoke with identified this kind of mistake as a symptom of cost cutting. Maybe a company creates one manual meant to cover a range of products. Maybe it puts together the manual at the last moment. Maybe it farms out the task to marketers, who don't necessarily think about how manuals need to evolve as the products do.
For some of these cost-cutting tactics, “the motivation for doing it can be cynical,” Ballard said.
Who knows.
Some corners of the technical writing world are gloomy. People worry their jobs aren't secure, that they're going to be replaced by someone overseas or artificial intelligence. Indeed, multiple people I spoke with said they'd heard about generative AI experiments in this area.
Even before AI has had its effect, the job market has weighed in. According to the federal government, the number of technical writers fell by a third from 2001, its recent peak, to 2023.
One solution for people like us — frustrated by inscrutable instructions — is to turn to another uncharted world: social media. YouTube, for instance, has helped us figure out a lot of the baby gadgets we have acquired. But those videos also are part of a wild West, where creators offer helpful tips on baby products then refer us to their other productions (read: ads) touting things like weight loss services. Everyone's got to make a living, of course; but I'd rather they not make a buck off viewers' postpartum anxiety.
It reminds me of an old insight that became a digital-age cliché: Information wants to be free. Everyone forgets the second half: Information also wants to be expensive. It's cheap to share information once produced, but producing that information is costly — and a process that can't easily or cheaply be replaced. Someone must pay. Instruction manuals are just another example.
——————————
By: Darius Tahir
Title: Oh, Dear! Baby Gear! Why Are the Manuals So Unclear?
Sourced From: kffhealthnews.org/news/article/baby-product-instruction-manuals-confusing-technical-writing/
Published Date: Fri, 03 May 2024 09:00:00 +0000
Kaiser Health News
California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Jasmine Aguilera, El Tímpano
Fri, 03 May 2024 09:00:00 +0000
Marisol Pantoja Toribio found a lump in her breast in early January. Uninsured and living in California without legal status and without her family, the usually happy-go-lucky 43-year-old quickly realized how limited her options were.
“I said, ‘What am I going to do?'” she said in Spanish, quickly getting emotional. She immediately worried she might have cancer. “I went back and forth — I have [cancer], I don't have it, I have it, I don't have it.” And if she was sick, she added, she wouldn't be able to work or pay her rent. Without health insurance, Pantoja Toribio couldn't afford to find out if she had a serious condition.
Beginning this year, Medi-Cal, California's Medicaid program, expanded to include immigrants lacking legal residency, timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years. But her application for Medi-Cal was quickly rejected: As a farmworker earning $16 an hour, her annual income of roughly $24,000 was too high to qualify for the program.
California is the first state to expand Medicaid to all qualifying adults regardless of immigration status, a move celebrated by health advocates and political leaders across the state. But many immigrants without permanent legal status, especially those who live in parts of California where the cost of living is highest, earn slightly too much money to qualify for Medi-Cal.
The state is footing the bill for the Medi-Cal expansion, but federal law bars those it calls “undocumented” from receiving insurance subsidies or other benefits from the Affordable Care Act, leaving many employed but without viable health insurance options.
Now, the same health advocates who fought for the Medi-Cal expansion say the next step in achieving health equity is expanding Covered California, the state's ACA marketplace, to all immigrant adults by passing AB 4.
“There are people in this state who work and are the backbone of so many sectors of our economy and contribute their labor and even taxes … but they are locked out of our social safety net,” said Sarah Dar, policy director at the California Immigrant Policy Center, one of two organizations sponsoring the bill, dubbed #Health4All.
To qualify for Medi-Cal, an individual cannot earn more than 138% of the federal poverty level, which currently amounts to nearly $21,000 a year for a single person. A family of three would need to earn less than $35,632 a year.
For people above those thresholds, the Covered California marketplace offers various health plans, often with federal and state subsidies, yielding premiums as low as $10 a month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website so that immigrants regardless of status can be offered the same health plans that would be subsidized only by the state.
Despite a Democratic supermajority in the legislature, the bill might struggle to pass, with the state facing a projected budget deficit for next year of anywhere from $38 billion to $73 billion. Gov. Gavin Newsom and legislative leaders announced a $17 billion package to start reducing the gap, but significant spending cuts appear inevitable.
It's not clear how much it would cost to extend Covered California to all immigrants, according to Assembly member Joaquin Arambula, the Fresno Democrat who introduced the bill.
The immigrant policy center estimates that setting up the marketplace would cost at least $15 million. If the bill passes, sponsors would then need to secure funding for the subsidies, which could run into the billions of dollars annually.
“It is a tough time to be asking for new expenditures,” Dar said. “The mirror marketplace startup cost is a relatively very low number. So we're hopeful that it's still within the realm of possibility.”
Arambula said he's optimistic the state will continue to lead in improving access to health care for immigrants who lack legal residency.
“I believe we will continue to stand up, as we are working to make this a California for all,” he said.
The bill passed the Assembly last July on a 64-9 vote and now awaits action by the Senate Appropriations Committee, Arambula's office said.
An estimated 520,000 people in California would qualify for a Covered California plan if not for their lack of legal status, according to the labor research center at the University of California-Berkeley. Pantoja Toribio, who emigrated alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health care options when she made her weekly visit to a food pantry at Hijas del Campo, a Contra Costa County farmworker advocacy organization, where they told her she might qualify for a plan for low-income people through Kaiser Permanente.
Pantoja Toribio applied just before open enrollment closed at the end of January. Through the plan, she learned that the lump in her breast was not cancerous.
“God heard me,” she said. “Thank God.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
——————————
By: Jasmine Aguilera, El Tímpano
Title: California Floats Extending Health Insurance Subsidies to All Adult Immigrants
Sourced From: kffhealthnews.org/news/article/california-legislation-medicaid-subsidies-all-adult-immigrants/
Published Date: Fri, 03 May 2024 09:00:00 +0000
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