Study: Whooping Cough Immunization Wanes Substantially Over Time
Unfortunately, the vaccine for whooping cough becomes less effective over time, according to a study published yesterday in the New England Journal of Medicine. Children typically receive a series of about five shots for the vaccine, but after the last one is administered, the study suggests those children become 42 percent more likely each year to get the disease. This news comes at a time when whooping cough, or pertussis, is a major concern. More than 26,000 cases of the contagious respiratory infection disease have been reported this year alone, and a decreasingly effective vaccine may help explain the resurgence. Although news about the vaccine—called DTaP for diphtheria, tetanus, and acellular pertussis—is disappointing, it doesn't mean children should forgo the shots. The study didn't show that the vaccine is useless, said Nicola Klein, who worked on the study and is co-director of the Kaiser Permanente Vaccine Study Center. "We also found … that some protection is better than no protection," Klein told TIME. "The existing DTaP is safe and effective, but protection just doesn't last as long as we'd like."
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No Wait at the ER
When Ethel Salzberg, 87, was wheeled into the emergency room in Boston after a recent fall, she'd steeled herself for a long haul in a crowded waiting room. So she was startled to be seen immediately by a nurse who took her vital signs and whisked her into a private room where companions, once banned, were welcome. "My mother-in-law is very nervous," says Dena Salzberg, who brought Ethel in. "For her to have me with her is huge." Salzberg was registered at her bedside and visited by a doctor within 10 minutes.
At Brigham and Women's Hospital, where Salzberg was treated for a dislocated shoulder, the ER patient is now a VIP. Over the past three years, the hospital has totally re-engineered its emergency department to streamline operations. Today median "door to doctor" time is just 12 minutes and patient satisfaction surveys show the score for emergency care has soared from 35 percent to 99 percent. It's a target more hospitals are working toward, in the wake of a 2006 Institute of Medicine critique of emergency care as overwhelmed and fragmented from the rest of the hospital, and as institutions scramble to bring in more business and come to grips with Medicare reimbursement rates now partially tied to patient satisfaction. Most have a fair way to go. The median wait time to be seen in U.S. emergency departments is now 33 minutes, according to the Centers for Disease Control and Prevention. But that means a good many comers still sit and sit and sit.
1. Online booking: One visible sign of the times is the hospital billboard, strategically placed to announce current ER waits. Inova Health System offers a free app in the iTunes store that provides updates at its 10 emergency centers in Northern Virginia. ER Texting, a Miami company, sells a service that lets consumers send a text to 4ER411, punch in their ZIP code, and find out what to expect at some 235 participating ERs. For $9.99, about half of Tenet Healthcare's 50 hospitals allow patients to view and book available appointments online, waiving the charge if they're not seen within 15 minutes of the time. [Read more: No Wait at the ER]
Forget BMI. Do You Know Your 'Best Weight'?
When it comes to weight, we physicians seem to be woefully bad at addressing the individual sitting in front of us, writes U.S. News blogger Yoni Freedhoff. A typical scenario goes something like this: Overweight patient comes in; doctor consults either an "ideal weight" table or the body mass index (BMI) chart, which reports weight as a function of height and suggests there's only a narrow "healthy range." Doctor comes up with a ridiculously low number for that patient to "aim" for, and infers—or explicitly states—that if the patient doesn't reach that goal, his or her weight will remain unhealthy.
Unfortunately, that practice flies in the face of two incredibly important things—the first being medical evidence. There is no shortage of papers reporting that healthy living—through regular exercise and nutritious eating—provides truly dramatic protection against the risks most commonly associated with weight, even for folks whose BMIs put them well into the realm of medical obesity. Getting just 30 minutes of daily exercise most days of the week, and eating a plant-inclusive, minimally processed diet will confer more benefit to folks at any weight than any medication ever could.
The second is the idea that you need to be at (or very near to) some specific, ideal weight to be considered healthy, which is what those favored charts imply. Consider the analogy of school. While it's true that getting good grades likely does somewhat correlate with future success, does that mean that if you're not in the top of your class you're doomed? Other factors—like your work ethic, your ability to work with others, your persistence, your having tried your best—are as important, if not more important, to future success than grades. [Read more: Forget BMI. Do You Know Your 'Best Weight'?]