In individuals with metabolic syndrome, a 6-month lifestyle intervention based on exercise training with specialized telemonitoring-based supervisions can help improve liver inflammation and fibrosis, according to study results published in Clinical and Translational Gastroenterology.

Metabolic syndrome is a major global health concern and risk factor for metabolic-associated fatty liver disease. The increasing prevalence of metabolic syndrome and metabolic-associated fatty liver disease require technology-aided interventions to fortify long-term compliance with physical activity and lifestyle changes.

Previously, a team of investigators conducted a randomized controlled trial (ClinicalTrials.gov Identifier: NCT03293264) in employees with metabolic syndrome using a 6-month lifestyle intervention to monitor reduced disease severity.

In this current secondary analysis, the investigators assessed whether the intervention, which included exercise training with individualized telemonitoring-based supervision, could also improve liver parameters and reduce the risk for metabolic-associated fatty liver disease.

Volunteers who had metabolic syndrome were randomly assigned to either a 6-month lifestyle intervention or a waiting-list (control) group. Of the 314 employees who were included in the study, 274 completed the intervention: 132 patients in the intervention cohort and 142 in the control cohort.

During the 6-month intervention, exercise activity increased more for participants in the exercise group than in the control group. There were no differences reported between groups for energy intake, macronutrient intake, and alcohol consumption at baseline. Although the exercise group had a reduction in total energy intake, as well as fats and carbohydrates, no significant differences were noted between the 2 groups over time. Blood parameters and renal function were also similar between the 2 groups.

At baseline, both cohorts had slightly increased levels of alanine aminotransferase; however, alanine aminotransferase and aspartate aminotransferase levels significantly decreased after 6 months of physical activity intervention in the exercise group compared with the control group. In addition, alkaline phosphatase and gamma-glutamyl transferases significantly decreased in the exercise cohort. These levels did not decrease for the control cohort, thereby significantly increasing the differences between the cohorts over time.

Changes in body mass index were associated with changes in alanine aminotransferase (P <.01) and aspartate aminotransferase (P <.01) in the exercise group. Improved exercise capacity was also linked to improved aminotransferase levels for patients in the exercise cohort.

“We observed that the activity duration and intensity as well as applied telemonitoring systems were well accepted, with attrition rates in line with those commonly observed for exercise programs,” the researchers wrote. “As [metabolic syndrome] and [metabolic-associated fatty liver disease] also carry a large economic burden with rising prevalence, a telemonitoring-guided intervention might also be a cost-effective approach to support treatment of both diseases independent of residence or workplace,” the investigators concluded.

 

 

September is Prostate Cancer Awareness Month. According to the National Cancer Institute, prostate cancer is the second leading cause of cancer death among men in the US.

It occurs mainly in older men and more often in African American men.

Doctors encourage men to use this month to take better care of their health.

“Men in general tend to overlook their health in a lot of ways. So I think that it’s very important, especially during Prostate Cancer Awareness Month, that men’s health in general, for men to really take ownership of their own bodies and do their best to optimize them. And to live their best and healthiest life moving forward,” said Dr. Adit Shah from Crossroads Hospital.

The National Cancer Association says prevention helps lower the chance of cancer and suggests talking to your doctor about getting screened.

In Georgia, the CEO of Northeast Georgia Health Systems said it had 287 Covid patients Monday morning, which is more than the hospital has had since January.

“So, in essence, our hospitals are full,” Carol Burrell said. “We’re looking to add space in hallways and conference rooms in waiting areas. Our emergency rooms and our urgent care centers are seeing higher volume than they’ve seen throughout this pandemic,” she said.

And it’s not just the South now. On Tuesday, Idaho had just four ICU beds available out of the 400 beds total in the state, Gov. Brad Little said.

“Yesterday evening I toured a nearly full ICU wing in Boise. What I saw was heartbreaking. Among the Covid-positive patients all of them were unvaccinated,” Little said.

“Some were young, two were middle-aged, two patients were pregnant. I was told the average age of the patients was 43. All of them were struggling to breathe and most were only breathing with help from a machine,” the governor said in a televised address Tuesday.

Hospitals around the country have been stretched as cases have picked back up, but the South, where vaccinations have been lagging, has been particularly hit. Many hospitals have been reporting oxygen shortages.

On Monday, data presented by a vaccine adviser from the US Centers for Disease Control and Prevention showed a hospitalization rate 16 times greater in the unvaccinated population than in those vaccinated.

“This to me seems to be a strong indication that the current epidemiologic curve that we’re seeing is really a reflection of failure to vaccinate, not vaccine failure,” said Dr. Matthew F. Daley at the CDC Advisory Committee on Immunization Practices meeting.

The effect of the low vaccination levels can be seen in Kentucky, where hospitals are overwhelmed with record numbers of Covid-19 patients and 58 of the 96 hospitals are reporting critical staffing shortages, Gov. Andy Beshear said Monday.

“We’re living in a reality where some Covid patients who are sick are being treated in their cars when there isn’t room for them inside the ER or inside the hospital,” Beshear said.

And Mississippi is also struggling, with only nine ICU beds available in the state, Mississippi Department of Health Senior Deputy and Director Jim Craig said Monday.

With increased hospitalizations, more deaths have followed. The Central Florida Disaster Medical Coalition has purchased a total of 14 portable morgues to help with the “unprecedented” number of Covid-19 deaths in the region, the organization told CNN.

And among children, cases “have increased exponentially” recently after a decline in early summer, the American Academy of Pediatrics reported Tuesday.

In the past week, about 204,000 children tested positive for Covid-19, a five-fold increase from a month earlier, the AAP said. That’s the second week that pediatric cases are at levels not seen since the surge last winter, the AAP said.

The rise in children’s infections is worrying experts as parents and students prepare for a new school year.

Thousands of students in quarantine

Health experts have been particularly concerned about how cases will trend as school gets underway; and with many regions early in their academic year, thousands of students are already back in quarantine.

In Florida’s 15 largest school districts, at least 21,869 students and 4,481 employees have tested positive for Covid-19 since the start of school, according to a CNN analysis.

At least an additional 45,024 students and staff members have been quarantined or put on “stay home” directives due to possible exposure to Covid-19. That’s an increase of 62% since CNN’s last update on Thursday afternoon.

In Texas, after just the first two weeks of school in the Fort Worth Independent School District, more than 3,000 students have been quarantined due to close contact with individuals who tested positive for Covid-19.

The district announced a mask mandate earlier this month for all students, employees and guests, despite ongoing legal battles in the state against Gov. Greg Abbott’s ban on such mandates.

While vaccines are currently the best defense against the spread of the virus, they have not yet been approved for those under the age of 12.

But not even those children who are eligible for the protection are not reaping the full benefits. Children ages 12 to 15 are eligible but less then half of that group is vaccinated with at least one dose, according to data published Monday by the CDC.

A Virginia county is requiring student-athletes to get vaccinated

Virginia’s largest school district is among the first to mandate vaccines for some of its students. Athletes in Fairfax County Public Schools will have to be vaccinated in order to compete in winter and spring sports, according to a letter from the superintendent.

“Proof of full COVID-19 vaccination will also be required for participation in any other activity that requires a physical,” Superintendent Scott S. Brabrand wrote in a letter to the community Monday. “This includes dance team and step team, as well as out-of-season practices and workouts.”

The requirement kicks on November 8.

Most pauses in education in the district’s high schools come from exposure to Covid-19 during athletic activities, the letter said.

Students returned to in-person learning at Fairfax County Schools on August 23. Since then, the district has reported at least 177 students and 31 employees have tested positive for Covid-19.

Fairfax’s decision comes several weeks after New York Mayor Bill de Blasio issued a vaccine mandate for “high-risk” public school sports.

The mandate applies to roughly 20,000 students and staff participating in football, basketball, wrestling, lacrosse, stunt, rugby, and bowling, according to a statement from the NYC Department of Education.

New York Gov. Kathy Hochul plans to require mandatory weekly Covid-19 testing for school staff in the state who are not vaccinated, she said Tuesday.

“School staff, anybody who enters that building will have to be vaccinated or undergo mandatory testing — mandatory testing, and we’re in the process of getting the legal clearance for that, as I speak,” Hochul said.

School infections could be cut in half by masking and testing, projections show

While the risk of unvaccinated students becoming infected when they go to school is of concern, a new study shows that masking and testing could help prevent infections in at least half of that population.

With universal mask use, less than half of susceptible students — and perhaps as few as a quarter — may become infected with Covid-19 in the same timeframe, depending on the student body’s incoming level of protection from vaccinations or natural immunity, according to , projections modeled by researchers from North Carolina State University and published as a preprint earlier this month.

Adding randomized testing for half of the students biweekly, and assuming at least a 70% compliance with isolation requirements for those who test positive, would cut Covid-19 infections down to less than a quarter of all susceptible students in all scenarios, the researchers’ projections suggested.

The model assumes that in a class of 500, two or three students are infected at the start of the school year and that one additional case enters the school each week.

Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration told CBS’s Ed O’Keefe on Sunday that “we have to throw everything we can” at minimizing cases among school children.

“I don’t think that we should be going into the school year lifting the mitigation that may have worked and probably did work last year to control outbreaks in the school setting, until we have firm evidence on what works and what doesn’t,” he said, adding measures such as frequent testing and putting students in social pods “are probably the two most effective steps schools can be taking.”

 

The State of Michigan recently received a new $3.3 million federal grant to expand health insurance coverage and access to uninsured and underserved Michiganders. The grant will expand programs to increase qualified health insurance navigators to assist communities in obtaining health coverage. 

Health insurance navigators aim to facilitate the process of enrollment in health insurance for those who are uninsured in Michigan. This grant would give more funds to navigator organizations to expand their programs. Gov. Gretchen Whitmer said:

“For some Michiganders, having free, local help from qualified Navigators can be the difference between getting coverage and going without vital protection. I’m thankful that the Biden-Harris administration recognized this need, both in Michigan and nationwide, and has made this important funding available. These grants will have a direct and positive impact on the lives of Michigan residents.”

Three parent organizations of navigator groups will receive funding and how much they will receive: 

• Arab Community Center for Economic & Social Services (ACCESS) – $2,640,159
• Eastern Michigan University – $435,784
• Genesee Health Plan Corporation – $219,492

The target populations of these groups are underserved and minority populations, those eligible but not enrolled in Medicaid, pregnant women, and new mothers. 

Anita Fox, director of the Michigan Department of Insurance and Financial Services, said:

“The COVID-19 pandemic has underscored the importance of high quality, affordable health insurance, and we do not want anyone to avoid signing up because they worry that the enrollment process might be difficult. By logging on to LocalHelp.HealthCare.gov or by calling 800-318-2596, Michiganders can access free assistance to enroll in a 2022 Marketplace plan, Medicaid, or Michigan’s MIChild program.”

More than $80 million will be granted to over 60 Navigator organizations across the country as part of the nationwide 2021 Centers for Medicare & Medicaid Services (CMS) Navigator cooperative agreement. Organizations applied through CMS to receive this aid. Awardees of the grant include hospitals, community and consumer-focused non-profits, faith-based organizations, tribal organizations, and trade and professional organizations.

Samantha Boevers’s 4-year-old son, Porter, has made so much progress since being diagnosed with autism that he was assigned to a general preschool classroom this fall. So when Boevers dropped him off for his first day of school earlier this week, she wanted to feel all the emotions a parent should in that moment: excitement, pride, relief.

“The only thing I felt was heart-rending fear,” said Boevers, an instructional aide with a background in special education. “Because I didn’t know if he’d be safe.”

Porter’s disability puts him at heightened risk of getting sick from COVID-19. Mitigation strategies such as universal masking indoors, Boevers says, are critical to limiting that risk.

Yet Boevers and her family live in South Carolina – one of more than half a dozen states where schools are prohibited from requiring everyone on campus to mask up. Mask-wearing has been the exception rather than the rule in many of South Carolina’s school districts, and evidence suggests the trend has taken a toll. South Carolina has the third-highest rate of pediatric COVID-19 infections in the U.S., according to data collected by the American Academy of Pediatrics, with children accounting for roughly a fifth of the state’s positive cases.

With the help of the American Civil Liberties Union, Boevers and other parents and advocates recently filed suit in federal court challenging South Carolina’s ban on school mask mandates. The lawsuit, which names several state officials and local school boards as defendants, alleges South Carolina’s policy violates federal law by effectively excluding students with disabilities from participation in the public education system.

It’s one of at least seven lawsuits filed in recent weeks in states with similar restrictions – including Arizona, Florida and Texas – many saying the rules violate the rights of students with disabilities. In one of the Florida suits, a circuit court judge has already issued a ruling, concluding the state’s order banning school mask mandates is unlawful and districts have the right to set their own policies.

The litigation comes amid a surge in pediatric COVID-19 cases largely due to the delta variant. And while the bans on mask mandates put all students at risk, parents and advocates argue they’re especially harmful to hundreds of thousands of students with disabilities, putting them at greater risk of severe COVID-related illness and death.

“Children with disabilities are entitled to learn and interact with all other children, to receive the same education as all other children, and to be returned home as safe and healthy as possible,” the ACLU lawsuit reads, echoing arguments being made by plaintiffs in the other states.

“We are left right now, as parents of a child with a disability, having to make the agonizing decision of choosing between his education … and his health,” Boevers said. “And that’s a decision no parent should ever have to make.”

‘A slap in the face’

Remote learning was tough for all kinds of students last year, but for Porter it wasn’t just challenging – it was “physically painful,” Boevers said. Porter, who struggles with communication, would get so frustrated with virtual speech and occupational therapy sessions that he’d screech and scream, sometimes hitting his parents.

Still, he worked hard and got better at using sentences, to the point that he can now learn alongside his neurotypical peers. He can continue making progress by being in that classroom, Boevers said. If he were to stick with virtual learning, he’d “revert back to a child who doesn’t have a future.”

She and her husband consulted with Porter’s pediatrician when deliberating whether to send him to in-person school this year. In 2019, Porter ended up being hospitalized for the flu because he hadn’t been able to communicate that he was in pain. Confused and scared by what was happening to him, he’d even stopped eating and drinking. Boevers held back tears as she reflected on the experience, on the memory of witnessing three grown men holding Porter down so they could get the IV tube in.

The doctor said the same thing could happen again if Porter was to contract the coronavirus, especially because he also struggles to comply with hygiene practices. Porter should attend school, the pediatrician concluded, only if anyone on campus who can wear a mask does so.

“I’ve seen people say the parents of children under 12 are living a different pandemic than everyone else because these children cannot be vaccinated,” Boevers said. “And I like to say, ‘The parents of special-needs children under 12 are living in hell during this pandemic,’ because every day we worry about the safety of our children when doing the basic things that every child has a right to do.”

South Carolina’s ban comes in the form of a budget provision passed earlier this summer that prohibits districts from using state money to require masks. The plaintiffs – which include parents of children with conditions including asthma and anxiety – allege that provision violates two federal laws: the Americans With Disabilities Act and the Rehabilitation Act.

Those laws prohibit public schools from excluding or segregating students with disabilities. They also require schools to make “reasonable accommodations” so students with disabilities have just as much of an opportunity as their peers to get a a good education.

South Carolina’s anti-mask law is excluding and segregating them, the plaintiffs allege, by forcing many of them to withdraw from public school. And in prohibiting schools from dictating their own mask rules, the complaint continues, the law also denies those children an equal education.

“It’s really a slap in the face to students with disabilities,” said Susan Mizner, director of the ACLU’s Disability Rights Program. “Because while there is a risk to everyone, … we know that the people who will get severely ill are almost always the students who have these underlying conditions or disabilities.”

Roughly 13% – more than 101,000 – of South Carolina’s public-school students receive special-education services, about 16,000 of whom are identified as “other health impaired.” Another 10,000 or so of the state’s special-ed students have autism, while some 6,000 have an intellectual disability.

Notably, a study of more than 65 million patients across 500 health-care systems found that people with intellectual disabilities are more likely to die from COVID-19 than people with conditions such as congestive heart failure and kidney disease.

In response to the lawsuit, Ryan Brown, a spokesperson for South Carolina’s Department of Education, said the state department has reminded school districts of their obligations under federal disability rights law. Schools should consider mandating masks for some people who are in contact with certain high-risk students, he said, citing guidance from both the Centers for Disease Control and Prevention and the state’s health department.

South Carolina’s schools superintendent, who’s named as a defendant in the suit, “has been clear in her support” of districts’ right to set their own mask rules, Brown said. And, he said, parents have the option of reverting to distance learning if they decide in-person instruction is too risky.

Families have little recourse

In some parts of the country, however, distance learning isn’t an option this school year. According to an analysis by the Center on Reinventing Public Education, a University of Washington research group, three of the states with restrictions on mask requirements have passed legislation or policies limiting access to virtual schooling.

Those states include Tennessee, whose policy, enacted in April, prohibits districts from offering systemwide remote or hybrid instruction unless there is a declared state of emergency.

Tennessee’s limitation – combined with the state’s executive order requiring schools to allow mask opt-outs – forces parents to choose between jeopardizing their children’s health or withdrawing them from public education altogether.

One of those parents is Suzanne Talleur, whose 16-year-old son, Max, has Down syndrome. Research shows that, compared with the general population, people with the condition are four times more likely to be hospitalized – and 10 times more likely to die – after contracting COVID-19.  That’s in part because they tend to have smaller airways and weaker muscle tone than average, which makes them more vulnerable to respiratory complications.

Talleur kept Max, who also has asthma and a heart condition, in remote-only instruction all last school year; he barely left the house. When she was asked in February whether he’d continue with online learning this school year, though, she decided it was time for him to return to the classroom.

“It was terrifying sending him back,” Talleur said, but she was optimistic about the power of COVID-19 vaccines, which her son received as soon as he was eligible. She was confident his school district would do what it could to mitigate the spread of COVID-19 by following CDC guidance.

Of course, Tennessee’s recent executive order prevents the state’s schools from practicing a critical piece of that guidance: universal mask-wearing indoors. And unlike the other states with restrictions on school mask mandates, Tennessee’s policy simply stipulates schools must allow parents to opt-out of any such requirements, which could make it hard to challenge on legal grounds.

“The Governor has said that parents should ultimately be able to decide what’s best for their children,” said Brian Blackney, a spokesperson for Tennessee’s education department.

Talleur now finds herself “in a pretty awful position,” especially because she couldn’t put Max in distance learning anytime soon, even if she wanted to. Like South Carolina, Tennessee has one of the highest rates of pediatric COVID-19 cases in the country.

Earlier this month, shortly after the school year began, a handful of students in Max’s special-needs classroom became infected with COVID-19. According to Talleur, few of the children had been wearing masks. Her son ended up having to stay home for three days. He did little more than a math worksheet and a five-line journal entry.

While he ultimately tested negative for the virus, Talleur  said the cluster – which she attributes to lax mask rules – effectively deprived her son of the education he was entitled to receive. If masks had been required of anyone able to wear one, Talleur said, her son wouldn’t have had to go into isolation and miss hours of class time.

“We’re not asking for perfection,” she said. “We’re asking for reasonable accommodations – and (mask requirements) are the definition of ‘reasonable accommodation.’”

Kim Hart, a Nashville-area epidemiologist whose 18-year-old son also has Down syndrome, says she’s in an awful position, too. Hart’s son is vaccinated against COVID-19. But his risk of contracting a breakthrough infection is high, Hart says, considering he got chicken pox when he was younger despite having gotten that vaccine.

“He wants to be at school and needs to be at school. He loves his friends – he’s a social 18-year-old,” Hart said. Plus, he’s now enrolled in a vocational-education program that necessitates hands-on learning. “We are taking a risk that he is going to become ill, and the consequences for him could be devastating.”

The need for accommodations

Many students with disabilities simply can’t mask up. They may have a breathing issue or physical abnormality. Perhaps they have a behavioral disorder and get agitated or anxious when wearing a face covering.

For that reason, the U.S. Department of Education issued guidance last September emphasizing schools should exempt such students from any universal mask requirements. Failing to offer such exemptions, the guidance suggested, could amount to discrimination on the basis of disability.

By the same token, schools should be able to require anyone who can wear a mask to do so, said Wendy Tucker, the senior director of policy at the Center for Learner Equity, which advocates for students with disabilities. That would allow those who can’t wear a mask to continue receiving an education, she said.

Legality aside, Tucker says the statewide bans are at the very least “bad policy.” The pandemic is playing out in different ways across the country – even within a given state, COVID-19 transmission and vaccination rates vary depending on the locale. To institute a blanket ban on mask mandates disregards the needs of individual school districts, Tucker said.

Back in South Carolina, Boevers says there’s a 50-50 chance she’ll end up pulling Porter out of in-person learning. And the prospect is tormenting her.

“Right now, his future is wide open – he is the absolute definition, as is every special education child in the state, of different not less,” she said. “When you take that classroom away, … he loses it all, and everything he loses will take him twice as long to gain back as another child.”