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    The items below are highlights from the free newsletter, “Smart, useful, science stuff about COVID-19.” To receive newsletter issues daily in your inbox, sign up here kamagra canada buy. Please consider a monthly contribution to support this newsletter. For some SARS-CoV-2 vaccine makers, a vaccine "could meet the companies' benchmarks for success if it lowered the risk of mild COVID-19, but was never shown to reduce moderate or severe" COVID-19, nor the kamagra canada buy risk of hospitalization, intensive care admission or death, according to an essay published 9/22/20 in The New York Times. This statement pertains to vaccines being developed by Moderna, by Pfizer, and by AstraZeneca, the essay states.

    The benchmarks should be higher, the authors contend. Evidence should instead show that a vaccine reduces the risk of moderate or kamagra canada buy severe cases, write Dr. Peter Doshi of the University of Maryland School of Pharmacy and Dr. Eric Topol at Scripps Research.

    The essay states that reducing the risk of mild COVID-19 does not kamagra canada buy guarantee a similar reduction for moderate or severe cases. In both the Moderna vaccine experiments and the Pfizer vaccine experiments, some people report feeling “side effects that are similar to the symptoms of mild COVID-19,” the essay states. London could be the site kamagra canada buy of the first experiments in which quarantined volunteers would be deliberately exposed to SARS-CoV-2 after being inoculated with a candidate vaccine to protect against the new coronavirus, according to various reports. Such experiments are called human challenge trials.

    The London experiments are expected to start in January, Reuters reported 9/23/20, picking up an initial report by The Financial Times (paywalled). So far, about 2,000 participants have volunteered with the group 1Day Sooner for coronavirus kamagra canada buy challenge trials, the Reuters story states. Tanya Lewis at Scientific American has reported a feature story on some of the more than 100 U.S. Universities and colleges that have contracted rapid, frequent SARS-CoV-2 testing for their campus to a program offered by the Broad Institute of the Massachusetts Institute of Technology and Harvard University (9/23/20).

    Institutions’ reports on the kamagra canada buy program so far are positive, and such an approach to testing “could be a model for reopening colleges and institutions nationwide,” Lewis writes. The program enables testing once or twice a week throughout the semester for students, faculty and staff, the story states. The story includes comments kamagra canada buy from users of the Broad program, including representatives from Tufts University, Bowdoin College, and University of Massachusetts Amherst, where the basketball arena reportedly has been converted into a SARS-CoV-2 testing center. Plans for early access to highly anticipated SARS-CoV-2 vaccines are “taking shape,” reports Nidhi Subbaraman at Nature (9/17/20).

    Organizations that have issued preliminary plans or guidance so far include an advisory group at the World Health Organization and a panel convened by the U.S. National Academies of Sciences, Engineering, and kamagra canada buy Medicine (NASEM), the story states. The NASEM panel gives top priority for vaccination to health-care workers and first responders, and then to “medically vulnerable groups,” such as people with preexisting conditions such as heart disease or diabetes as well as “older people living in crowded conditions,” Subbaraman reports. The NASEM panel's third priority group includes high-risk-of-exposure essential workers such as those working in public transit and schools, as well as people living in homeless shelters and prisons, the story states.

    Fourth priority goes to young adults, children and essential kamagra canada buy workers “at increased risk of exposure,” and the fifth priority is everyone remaining. NASEM is set to release a final plan in October, the story states. In a feature story for The kamagra canada buy Scientist, Katarina Zimmer explores the latest theories for why some people develop severe COVID-19 and others do not (9/16/20). More details are coming into focus on why the immune system “goes haywire” in some people infected with the virus.

    One study she mentions found that the blood of patients with severe COVID-19 showed an initial diminished response of interferons, which she defines as "cytokines [small signaling compounds/proteins] that, in general, act to curtail viral replication.” And that can lead to damage that leads to inflammation, the story states. €œThe higher the damage, the more the immune system is trying to get rid of the damage,” says the director of the Precision Medicine Institute kamagra canada buy at Mount Sinai. €œSo it gets activated and at some point…it goes completely crazy.” That leads to the phenomenon called a cytokine storm — the immune system over-reaction. The piece also details new insights into function problems and creation problems in various immune cells (e.g.

    Myeloid cells, T cells, kamagra canada buy and antibodies). Near the end of the piece, the same researcher is attributed as saying that the myeloid defects could be at the root of the runaway cytokine responses. But an immunologist at Emory University is quoted saying that it’s hard to tease apart the chicken and the egg. Parts of the kamagra canada buy U.S.

    €œmay be witnessing the first days of an autumn surge,” according a daily coronavirus data page updated 9/24/20 at National Geographic. Lower on the page, graphs indicate that SARS-CoV-2 case-counts have increased in the past week in kamagra canada buy Utah, Wisconsin, South Dakota, Montana, and Texas. And decreases appear to have taken place in the same period in Delaware, Louisiana, Indiana, Georgia, and Kentucky. Early evidence suggests that SARS-CoV-2 appears so far not to be spreading inside U.S.

    Schools, report Laura Meckler and Valerie Strauss at The Washington Post (9/23/20) kamagra canada buy. Thousands of teachers and students have been reported as infected, the story suggests, but these “rates of infection are far below what is found in the surrounding communities,” the reporters write. The evidence hints that re-opening schools “may not be as risky as many have feared,” the story states. The story notes that testing and reporting for SARS-CoV-2 is weak in many parts of the U.S., so it’s hard to say if this is an accurate picture of in-school kamagra canada buy transmission.

    The story also quotes epidemiologist Michael Osterholm of the Center for Infectious Disease Research and Policy at the University of Minnesota as saying. €œEveryone had kamagra canada buy a fear there would be explosive outbreaks of transmission in the schools. In colleges, there have been. We have to say that, to date, we have not seen those in the younger kids.” Several indoor-air quality researchers and other scientists have collaborated on a highly accessible 53-page google-document, “FAQs on protecting yourself from COVID-19 aerosol transmission,” designed to inform the general public (9/15/20).

    The information represents “our best kamagra canada buy understanding at this time and should always be similar or more stringent than information provided by [the U.S. Centers for Disease Control], [World Health Organization], and most regional &. Local health authorities.” The document’s authors include Linsey Marr of Virginia Tech. Shelly Miller and Jose-Luis Jimenez both of University of Colorado, Boulder kamagra canada buy.

    Kimberly Prather at University of California, San Diego. Charles Haas kamagra canada buy at Drexel University. And Richard Corsi of Portland State University. I haven’t read the whole document, but a primary point regarding reducing SARS-CoV-2 transmission is that “you should pay at least as much attention to the air you breathe as you do to sanitizing surfaces and your hands.” This 9/22/20 Bloomberg piece by opinion columnists Max Nisen and Elaine He features an easy-to-read graphic that illustrates the risks to long-term health posed by infection with SARS-CoV-2.

    The data came from a survey of more than 1,500 COVID-19 survivors who reported to an Indiana University Medical kamagra canada buy School researcher nearly 100 different long-term health problems. €œResearchers have yet to ascertain what share of people infected with COVID-19 suffer from long-term symptoms. But the potential for harm is vast,” based on the number of people infected with SARS-CoV-2, the story states. There’s also a powerful graphic lower on the page showing a kamagra canada buy data scientist's estimate of the actual number of U.S.

    Infections through November compared with the confirmed figures. You might enjoy, “Where the sidewalk ends, outdoor dining begins,” by Jeremy Hooper for McSweeney’s (9/23/20)..

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    Primary prevention (vaccination) remains a work in progress. Secondary prevention (prompt treatment) is largely dependent on diagnosis which depends on a kamagra canada buy positive throat swab or serological evidence in the form of the ASOT and ADB titres and this is where the complexities begin. Tertiary prevention, early diagnosis of heart disease by echo screening and prophylaxis has promise but is gestational. The range of population norms depends on exposure and threshold levels in one country might kamagra canada buy not be applicable elsewhere inevitably resulting in false positive and false negative results.

    Okello et al establishes a range of ASOT levels in urban Uganda and shows much higher mean titres than other comparable populations. Joshua Osowicki and Andrew Steer discuss the implications of these findings in the context of a multipronged approach to rheumatic fever during the wait for the long yearned-for group A streptococcal vaccine. See pages 825 and 813Febrile neutropaeniaOncological treatment is prolonged and draining for both a child kamagra canada buy and their family. A major contributor to the fatigue is the need for recurrent admissions for chemotherapy induced febrile neutropenia (FN).

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    Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of viagra kamagra cialis ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

    The age range selected viagra kamagra cialis for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords.

    Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

    Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <.

    0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

    Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

    The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

    Figure 2. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

    0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

    Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

    The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

    Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

    0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

    Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

    The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

    Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

    0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

    Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

    SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

    In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

    Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

    A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

    2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

    €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

    Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

    €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

    Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying http://www.amisdepasteur.fr/where-to-buy-kamagra/ asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

    € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

    Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

    The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

    Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

    ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

    2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

    2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

    Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

    Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

    Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

    2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

    J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

    National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

    SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

    Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

    National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

    Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

    Blumberg, Ph.D., Associate Director for ScienceWelcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.Surprise COVID BillsAlthough the federal government has taken steps to prevent surprise billing for COVID-19 patients, the practice is still occurring, the New York Times reports.The Times collected 350 surprise bills from coronavirus patients, the majority of which come from out-of-network doctors, ambulances, and medical labs that patients didn't choose or didn't realize were involved in their care.Congressional efforts to prevent surprise bills fell through after private equity firms poured millions into advertising opposing the plan, the Times reports. Congress ultimately passed $175 billion in provider relief funds for hospitals and doctors who agreed not to send surprise medical bills when accepting the funds. Additionally, insurers promised to cover hospital stays in full for plan participants.Yet labs and ambulance services didn't get those funds, so they were free to bill coronavirus patients as they pleased.In one instance reported by the Times, an air ambulance owned by Conemaugh Medstar (owned by Air Methods, in turn owned by private equity firm American Securities) sent a Pennsylvania patient a bill for $52,112.

    The patient, who was intubated, needed to be airlifted from one Philadelphia hospital to another, both of which were in her insurance network.The plan initially said it would pay about $7,500 of the initial charges, but subsequently reversed its decision, leaving the patient on the hook for the full amount.The patient called her state's insurance commissioner, which doesn't regulate air ambulances, but it appears to have strong-armed the insurer into paying, according to the Times.In another instance, a California COVID patient was hit with two bills of $1,471 each for the Los Angeles Fire Department ambulances that took her and her husband to the hospital, which was only a mile from their house. While insurance covered most of the bill, she was stuck owing nearly $300.Another patient in Austin, Texas, was treated for COVID in an in-network hospital but seen by many out-of-network doctors. Her insurer denied about $4,000 of their charges."I think about the bills several times a day," the patient told the Times.

    "How am I going to pay this all off?. My parents were like, 'Don't worry about this right now, focus on getting better,' but that's easier said than done."Moderna CMO's $50M Rolling PaydayEach week, Moderna's chief medical officer Tal Zaks, MD, PhD, has been selling off his stock in the company through pre-scheduled trades, earning more than $50 million since the beginning of the pandemic, STAT Plus reports.The sales are completely legal, executed under a Securities and Exchange Commission rule called 10b5-1 that allows insider trades under certain circumstances -- in this case, because the trades were scheduled before Zaks had insider information that could work to his advantage.Zaks' first trade came on Feb. 21, three days before Moderna announced that its vaccine was ready for human trials.

    He sold 10,000 shares every week for the next 10 weeks, until his ownership stake was liquidated, bringing in $3.4 million, STAT reported.Zaks then moved on to his stock options, exercising them every Tuesday and then immediately selling those shares. He has thus far earned $48.9 million on nearly 1 million options.Moderna's stock price has nearly tripled since Zaks began selling his shares, and it's expected to rise even more if its coronavirus vaccine is approved, but Zaks isn't waiting for that, STAT reported.A Moderna spokesperson said the company is "aware of the questions that have been raised related to stock sales by members of its executive team."Nell Minow, of watchdog ValueEdge Advisors, said Zaks' actions are rare. "When I complain about stock sales by insiders, they always say, 'Oh, their kids are going to college.

    They have liquidity concerns.' Give me a break," Minow told STAT. "They've got plenty of cash, and you can always borrow against your stock holdings if it comes to that.... It's impossible for me to imagine any legitimate reason for this."24 States in COVID Red ZoneNearly half of U.S.

    States were in the federal government's "red zone" for new coronavirus cases, according to the latest White House coronavirus task force documents obtained by the Center for Public Integrity (CPI).Many of the 24 states in the red zone were in the middle of the country, including North Dakota, South Dakota, Wisconsin, Montana, and Utah, according to the Oct. 4 task force report, which urged masks and testing in hard-hit states.Red-zone Kansas, where most counties have opted out of a state mask mandate, was told that masks "must be worn indoors in all public settings and group gathering sizes should be limited."This was also the first time the task force recommended closing schools, noting that outbreaks in 10 Idaho counties may be related to school openings. "Recommend change to online K-12 classes in counties and metro areas with elevated test positivity and incidence among school-age children and increasing hospital utilization," the report stated.Vermont was the only state in the green zone.

    Nine others were in the yellow zone, followed by 17 in the orange zone.The White House coronavirus task force distributes the reports to governors every week but doesn't publish them. CPI began obtaining the reports in July.More Calls to Release Warp Speed ContractsFollowing an NPR investigation, Democrats in Congress are calling on the Trump administration to release Operation Warp Speed vaccine contracts.Rep. Lloyd Doggett (D-Texas), who has been working on a bipartisan bill to create a central database to track COVID-19 spending, said the White House hasn't responded to requests for information on coronavirus spending and "really just seems to be playing a game of hide-and-seek."Sen.

    Patty Murray (D-Wash.) and Rep. Jan Schakowsky (D-Ill.) also objected to the lack of transparency and called for the contracts' release.Last month, NPR reported that the Trump administration awarded more than $6 billion in contracts tied to Operation Warp Speed through a third party company, Advanced Technology International, bypassing normal processes. Contracts awarded this way don't have to include taxpayer protections, NPR reported.Rick Bright, PhD, who was fired from the Biomedical Advanced Research and Development Authority (BARDA) after clashing with the administration, filed a whistleblower complaint in May alleging that some federal coronavirus-related contracts were awarded based on "political connections and cronyism."Bright told NPR that administering contracts through third parties could hide certain terms.

    "We don't know the rewards or the incentives that the companies are getting, which might drive some companies to take additional risk or maybe do things inappropriately." Kristina Fiore leads MedPage’s enterprise &. Investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett &.

    Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow.

    NCHS Data my sources Brief kamagra canada buy No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic kamagra canada buy conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the kamagra canada buy loss of ovarian activity” (3).

    This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this kamagra canada buy analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

    Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <.

    0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE.

    NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2.

    Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

    Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

    Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

    Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

    The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

    United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

    Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

    In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

    DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

    €. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

    Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

    €Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying official website asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

    NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

    The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

    The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

    Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

    Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

    2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

    Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

    National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

    Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

    2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

    Blumberg, Ph.D., Associate Director for ScienceWelcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.Surprise COVID BillsAlthough the federal government has taken steps to prevent surprise billing for COVID-19 patients, the practice is still occurring, the New York Times reports.The Times collected 350 surprise bills from coronavirus patients, the majority of which come from out-of-network doctors, ambulances, and medical labs that patients didn't choose or didn't realize were involved in their care.Congressional efforts to prevent surprise bills fell through after private equity firms poured millions into advertising opposing the plan, the Times reports. Congress ultimately passed $175 billion in provider relief funds for hospitals and doctors who agreed not to send surprise medical bills when accepting the funds. Additionally, insurers promised to cover hospital stays in full for plan participants.Yet labs and ambulance services didn't get those funds, so they were free to bill coronavirus patients as they pleased.In one instance reported by the Times, an air ambulance owned by Conemaugh Medstar (owned by Air Methods, in turn owned by private equity firm American Securities) sent a Pennsylvania patient a bill for $52,112. The patient, who was intubated, needed to be airlifted from one Philadelphia hospital to another, both of which were in her insurance network.The plan initially said it would pay about $7,500 of the initial charges, but subsequently reversed its decision, leaving the patient on the hook for the full amount.The patient called her state's insurance commissioner, which doesn't regulate air ambulances, but it appears to have strong-armed the insurer into paying, according to the Times.In another instance, a California COVID patient was hit with two bills of $1,471 each for the Los Angeles Fire Department ambulances that took her and her husband to the hospital, which was only a mile from their house. While insurance covered most of the bill, she was stuck owing nearly $300.Another patient in Austin, Texas, was treated for COVID in an in-network hospital but seen by many out-of-network doctors.

    Her insurer denied about $4,000 of their charges."I think about the bills several times a day," the patient told the Times. "How am I going to pay this all off?. My parents were like, 'Don't worry about this right now, focus on getting better,' but that's easier said than done."Moderna CMO's $50M Rolling PaydayEach week, Moderna's chief medical officer Tal Zaks, MD, PhD, has been selling off his stock in the company through pre-scheduled trades, earning more than $50 million since the beginning of the pandemic, STAT Plus reports.The sales are completely legal, executed under a Securities and Exchange Commission rule called 10b5-1 that allows insider trades under certain circumstances -- in this case, because the trades were scheduled before Zaks had insider information that could work to his advantage.Zaks' first trade came on Feb. 21, three days before Moderna announced that its vaccine was ready for human trials. He sold 10,000 shares every week for the next 10 weeks, until his ownership stake was liquidated, bringing in $3.4 million, STAT reported.Zaks then moved on to his stock options, exercising them every Tuesday and then immediately selling those shares.

    He has thus far earned $48.9 million on nearly 1 million options.Moderna's stock price has nearly tripled since Zaks began selling his shares, and it's expected to rise even more if its coronavirus vaccine is approved, but Zaks isn't waiting for that, STAT reported.A Moderna spokesperson said the company is "aware of the questions that have been raised related to stock sales by members of its executive team."Nell Minow, of watchdog ValueEdge Advisors, said Zaks' actions are rare. "When I complain about stock sales by insiders, they always say, 'Oh, their kids are going to college. They have liquidity concerns.' Give me a break," Minow told STAT. "They've got plenty of cash, and you can always borrow against your stock holdings if it comes to that.... It's impossible for me to imagine any legitimate reason for this."24 States in COVID Red ZoneNearly half of U.S.

    States were in the federal government's "red zone" for new coronavirus cases, according to the latest White House coronavirus task force documents obtained by the Center for Public Integrity (CPI).Many of the 24 states in the red zone were in the middle of the country, including North Dakota, South Dakota, Wisconsin, Montana, and Utah, according to the Oct. 4 task force report, which urged masks and testing in hard-hit states.Red-zone Kansas, where most counties have opted out of a state mask mandate, was told that masks "must be worn indoors in all public settings and group gathering sizes should be limited."This was also the first time the task force recommended closing schools, noting that outbreaks in 10 Idaho counties may be related to school openings. "Recommend change to online K-12 classes in counties and metro areas with elevated test positivity and incidence among school-age children and increasing hospital utilization," the report stated.Vermont was the only state in the green zone. Nine others were in the yellow zone, followed by 17 in the orange zone.The White House coronavirus task force distributes the reports to governors every week but doesn't publish them. CPI began obtaining the reports in July.More Calls to Release Warp Speed ContractsFollowing an NPR investigation, Democrats in Congress are calling on the Trump administration to release Operation Warp Speed vaccine contracts.Rep.

    Lloyd Doggett (D-Texas), who has been working on a bipartisan bill to create a central database to track COVID-19 spending, said the White House hasn't responded to requests for information on coronavirus spending and "really just seems to be playing a game of hide-and-seek."Sen. Patty Murray (D-Wash.) and Rep. Jan Schakowsky (D-Ill.) also objected to the lack of transparency and called for the contracts' release.Last month, NPR reported that the Trump administration awarded more than $6 billion in contracts tied to Operation Warp Speed through a third party company, Advanced Technology International, bypassing normal processes. Contracts awarded this way don't have to include taxpayer protections, NPR reported.Rick Bright, PhD, who was fired from the Biomedical Advanced Research and Development Authority (BARDA) after clashing with the administration, filed a whistleblower complaint in May alleging that some federal coronavirus-related contracts were awarded based on "political connections and cronyism."Bright told NPR that administering contracts through third parties could hide certain terms. "We don't know the rewards or the incentives that the companies are getting, which might drive some companies to take additional risk or maybe do things inappropriately." Kristina Fiore leads MedPage’s enterprise &.

    Investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett &. Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow.

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    The role of personality in health has ajanta kamagra oral jelly uk been under speculation for decades. The rise of coherent theories of personality and the inclusion of modern personality trait measures in large-scale ajanta kamagra oral jelly uk epidemiological studies has only rather recently enabled to examine this question profoundly. Numerous studies have shown that from the five major personality traits, conscientiousness—describing individual differences, for example, in self-regulation, orderliness and carefulness—has emerged as maybe the most important personality factor in lifespan health with low consciousness being associated with a wide range of measures of health and well-being,1 including reduced life expectancy.2 This has sparked several calls highlighting the policy relevance of personality traits.3 4 However, personality traits are typically not included in health guidelines, and the potential causality between personality traits and health outcomes has remained inconclusive.The study by Singh-Manoux et al5 makes an important contribution ….

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