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Endometriosis can take years and requires surgery to diagnose. Researchers say they are close to a solution

Drs. Christine Metz and Peter Gregersen are studying endometriosis through the ROSE Study at Feinstein Institutes for Medical Research. -- Feinstein Institutes for Medical Research

(NEW YORK) -- Victoria Balducci, a 39-year-old teacher in New York, was diagnosed last year with endometriosis, a condition that can cause debilitating pain and infertility for women.

Before getting that diagnosis, Balducci said she spent nearly two decades of her life living with menstrual cycles so painful she'd have to miss work or school.

"I've been to the [emergency room] because the pain was so bad sometimes I thought, 'This can't just be cramps. This has to be my appendix bursting,'" Balducci told "Good Morning America." "I consistently was told that my [period] pain was normal. Nobody mentioned the word endometriosis once."

It was only last year, as Balducci was starting the process of freezing her eggs, that she said a fertility doctor told her she should see a specialist for her pain.

Once she saw a specialist who told her she likely had endometriosis, Balducci had to undergo laparoscopic surgery, as it is currently the only way to diagnose the disease.

"It's really invasive ... and the recovery is very intense," Balducci said of the surgery. "And the diagnosis and the surgery, for many, is a step because there is mystery around if the endometriosis is going to grow back, and if the pain is even going to go away."

Researchers believe that endometriosis -- a disease where the tissue forming the inner lining of the uterus is found outside of the uterus such as within the fallopian tubes, ovaries, bladder and intestines -- affects more than 6 million women in the U.S. and as many as 200 million women worldwide.

Though it is one of the most common gynecological diseases, according to the National Institutes of Health, getting a diagnosis is often similar to Balducci's experience: long and painful.

On average, women wait as long as seven to 10 years for a diagnosis, according to Christine Metz, Ph.D., head of the laboratory of medicinal biochemistry and a professor in the Institute of Molecular Medicine at the Feinstein Institutes for Medical Research in New York.

Metz said the delay can be due to everything from women being told their menstrual pain is normal, as in Balducci's case, to the symptoms of endometriosis -- painful menstrual cramps, chronic lower back and pelvis pain, pain during and after sex, bleeding or spotting between periods and digestive problems like diarrhea, constipation, bloating and nausea -- being misdiagnosed and treated as gastrointestinal issues.

In many cases, the delay happens, she said, because patients are either not referred for diagnostic surgery, or are hesitant to undergo such an invasive surgery in order to be diagnosed.

"Endometriosis can only be definitively diagnosed through laparoscopic surgery, and that means a small camera is inserted into the abdominal cavity to look for endometriosis lesions," Metz said. "The suspected lesions that they find during this scoping procedure are removed and then analyzed for the presence of endometrial-like cells."

Metz said that in her own experience, she has seen patients who have gone as long as 20 years without a diagnosis of endometriosis.

For the past six years, Metz has worked to find a way to diagnose endometriosis that does not require surgery.

She and her research partner, Dr. Peter Gregersen, a rheumatologist and genetics researcher, believe they have found the answer in something that comes monthly for menstruating women: menstrual blood.

"Scientifically, it makes a lot of sense because the lesions that are found in the pelvic cavity contain the same cells that are found in menstrual blood," Metz said. "And we believe that if you were healthy, most of that tissue and material would be removed."

Metz and Gregersen are the co-directors of the Research OutSmarts Endometriosis (ROSE) study at the Feinstein Institutes for Medical Research.

So far, more than 2,400 women around the world have taken part in the study.

The menstrual blood samples are collected through menstrual sponges that Metz and Gregersen created as a way to collect the sample without any type of insertion, a request that came from participants, according to Metz. The researchers have also worked, she said, to make the diagnostic test "reasonably priced" so it is not cost-prohibitive once it hits the market.

By collecting just a small amount of menstrual blood on the sponge and then analyzing it, Metz said they have been able to document differences in the menstrual blood of people with endometriosis.

Late last year, Metz and Gregersen began a new clinical trial focused on people who are preparing to undergo laparoscopic surgery. The goal of the trial is to see if menstrual blood analysis can be used as a way to screen people for endometriosis, which would help people know more definitively that they could benefit from surgery.

"We hope to finish the trial by the end of this year or the beginning of next year and submit materials to the [U.S. Food and Drug Administration], so that we could get an FDA approval for either a diagnostic for endometriosis or a screening tool," Metz said.

Endometriosis currently has no known cause, but Metz said by studying menstrual blood, she and Gregersen have been able to start unlocking some of the mysteries of how this common disease starts.

Endometriosis occurs in about 1 in 10 women of reproductive age but is more commonly diagnosed in women in their 30s and 40s, according to the American College of Obstetricians and Gynecologists.

There is no known cure for endometriosis, but treatment options include medications and/or surgery, including the medication Orilissa, which has been specifically studied and marketed for the treatment of endometriosis pain.

Metz said that due to a "frustrating" lack of research, doctors and researchers do not yet know what it would mean for women to be diagnosed with endometriosis soon after their first-ever menstrual cycle instead of years or decades later.

"We haven't even been able to study whether early diagnosis will impact anything, because it's never been studied in any organized way," Metz explained. "We don't know whether early diagnosis with the current therapies will even do anything."

Through their years of research on menstrual blood, Metz said she and Gregersen have discovered it may help with more than endometriosis, and instead be more of a window into a woman's overall uterine health.

"Nobody studied menstrual blood with respect to endometriosis, or any uterine condition, prior to our work," Metz said. "It was never used to understand women's health."

In the future, Metz said she hopes collecting a menstrual blood sample will be a routine part of a gynecological exam.

"We believe it was a completely neglected biological sample, perhaps related to the 'yuck factor' associated with it," Metz said of menstrual blood. "We have to dispel all of the negative discussion of being afraid to discuss periods and menstruation ... We're not afraid to talk about our leg pain or arm pain or our tooth pain, but somehow we've been quieted."

Copyright © 2023, ABC Audio. All rights reserved.

Amid shortage of generic Adderall, frustration builds as demand increases

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(NEW YORK) -- Months after the Food and Drug Administration first indicated that there was a shortage of ADHD drugs, suppliers are warning that those shortfalls could continue throughout the year -- a source of frustration amid increased demand and diagnoses.

Amphetamine mixed salts, commonly referred to by the brand name Adderall, is a stimulant medication that can treat ADHD. It requires a prescription and as a controlled substance, supply is strictly monitored, and distribution is limited.

According to the FDA, Adderall is no longer in shortage, but generic versions are still impacted.

The FDA told ABC News that the shortage started with a delay from a manufacturer, which has since resolved, and is now demand-driven.

A CDC report released Thursday estimates that prescription fills for stimulant drugs -- which are primarily used to treat ADHD -- grew by more than 11% among adults ages 25-44 during the first year of the COVID-19 pandemic. Notable increases were also seen for adolescent females, as prescriptions increased more than 8% for those ages 10-14, and over 15% for those ages 15-19.

Suppliers are echoing demand issues, with Sandoz Pharmaceuticals, a division of Novartis, telling ABC News they expect the product to remain in tight supply for the entirety of 2023.

“At this time we are meeting current customer orders but have not been able to fill increased demand due to the initial quota in 2023 given to us by the DEA… We submitted our requests to the DEA for an increase in volume in 2023, but have not been granted our full request,” Leslie Pott, vice president of corporate affairs at Sandoz told ABC News.

Each year, the DEA sets a limit for the amount of active ingredient in controlled substances that can be produced by manufacturers.

Teva, the largest manufacturer of generic and brand name Adderall in the U.S, told ABC News that while the company is not currently experiencing manufacturing issues or shortages, “they are still seeing unprecedented demand which may cause intermittent delays for some pharmacies or patients.”

Alvogen and Teva have reported to the FDA that demand increases are behind the shortages, while Epic Pharma and US Pharma Windlas (a new manufacturer) have reported a shortage of the active ingredient.

Aurobindo Pharma and SpecGX are predicting supply issues through April 2023, according to the shortage database.

Dr. Anish Dube, chair of the American Psychiatric Association’s Council on Children, Adolescents and their Families told ABC News that there may be an increase in diagnoses due to increased awareness.

“I think there's been a lot more awareness and knowledge and folks are getting assessed more frequently for ADHD and this could be a cause for increased diagnosis and treatment,” says Dube.

While people of all ages are affected by the shortage, school-age children and families are especially feeling the constraints.

Millions of US children rely on the medication. The latest estimates suggest that roughly 10% of US children ages 3-17 have been diagnosed with ADHD, according to the Center for Disease Control and Protection, and these numbers may have increased since 2019.

“Especially for children who are in school, or that are still doing any kind of virtual options, having to be in front of the screen for extended stretches of time, it can be particularly challenging for them to be sitting still or to be stationary for extended periods,” says Dube.

The American Academy of Pediatrics recommends medication, in combination with parent training in behavior management and behavioral classroom interventions for those in a classroom setting for children and adolescents ages 6-18 with an ADHD diagnosis.

Parents who are struggling to obtain their child’s medication and feel they've exhausted all options, should call their pharmacist or doctor to discuss a plan.

“It's important that parents have a contingency plan with their prescribing physician… At least temporarily, you might be looking at other treatment options to help the young person to manage those symptoms,” says Dube.

The FDA says they recognize the potential impact that increased demand of certain products may have on health care providers and patients, and are working to alleviate constraints.

“The FDA is working closely with numerous manufacturers, agencies, and others in the supply chain to understand, mitigate and prevent or reduce the impact of intermittent or increased demand of certain products,” an agency spokesperson told ABC News.

Copyright © 2023, ABC Audio. All rights reserved.

FDA approves over-the-counter Narcan to reduce drug overdoses

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(NEW YORK) -- The U.S. Food and Drug Administration approved the overdose reversal drug Narcan for over-the-counter use on Wednesday-- a milestone decision that advocates said will make it easier to save lives amid the ongoing opioid epidemic.

Narcan, made by the company Emergent BioSolutions, is given as a nasal spray and the active ingredient in the medication -- naloxone -- can quickly restore breathing if someone is experiencing an opioid overdose.

Medical experts said it is safe for bystanders to administer the drug to anyone who appears to be experiencing an overdose and will not hurt users if it turns out they are not experiencing an overdose.

The FDA's approval means the medication can now be sold to Americans in places such as drug stores, grocery stores, convenience stores, gas stations and even online.

"Today's approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it's available and help reduce opioid overdose deaths throughout the country," FDA Commissioner Dr. Robert M. Califf said in a statement. "We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price."

The drug is already available in a prescription form -- although state laws made it possible for people to obtain it without a prescription through various workarounds.

In November, the FDA encouraged drug companies to submit applications for over-the-counter versions of naloxone.

An advisory committee for the FDA voted unanimously to recommend marketing for over-the-counter naloxone without a prescription in February.

The U.S. has been battling a drug overdose epidemic for years. According to provisional data from the Centers for Disease Control and Prevention, there were an estimated 107,622 drug overdose deaths in the U.S. in 2021 -- a record-high.

The majority of these deaths were due to opioids, particularly synthetic opioids such as fentanyl, which is between 50 and 100 times stronger than morphine.

Harm reduction groups and other experts have been pushing for easier access to naloxone as one strategy to help prevent some of the tens of thousands of overdose deaths that occur each year in the U.S.

These groups say everyone should carry naloxone and learn to administer it. Over-the-counter status means people won't have to speak to a pharmacist to purchase the drug, which lowers barriers to access and reduces stigma.

"Naloxone is a critical tool in addressing opioid overdoses and today's approval underscores the extensive efforts the agency has undertaken to combat the overdose crisis," Dr. Patrizia Cavazzoni, director of the FDA's Center for Drug Evaluation and Research, said in a statement. "The FDA is working with our federal partners to help ensure continued access to all forms of naloxone during the transition of this product from prescription status to nonprescription/OTC status."

The statement continued, "Further, we will work with any sponsor seeking to market a nonprescription naloxone product, including through a [prescription] to OTC switch, and encourage manufacturers to contact the agency as early as possible to initiate discussions."

According to the FDA, the approval of Narcan will require a change in labeling for generic naloxone nasal spray products, and manufacturers will be required to submit a supplement to their applications so they can receive over-the-counter status.

Other brand-name products will be made on a case-by-case basis, but these companies are already working on making their versions available.

Harm Reduction Therapeutics announced in December that the FDA granted a priority review to its new over-the-counter naloxone nasal spray RiVive. The nonprofit company said it expects a decision by the end of April.

Copyright © 2023, ABC Audio. All rights reserved.

Woman diagnosed with colorectal cancer at 35 on mission to raise awareness

ABC News

(NEW YORK) -- When Candace Henley, 55, was diagnosed with colorectal cancer 20 years ago, all she wanted was to see her youngest child turn 18.

“I wouldn’t ask [God] anything, but in return I would do what I needed to do to save someone else from going through the trauma that I and my family went through,” Henley told ABC News' Good Morning America.

Now a cancer survivor, Henley is making it her mission to educate others about the disease and save lives.

What is colorectal cancer?

Henley was 35 years old when she was diagnosed with the disease.

She told GMA that she recalled being in “so much pain.”

“I couldn’t stand up,” she said. “Finally, one of my cousins said we’re going to the emergency room.”

According to the Colorectal Cancer Alliance, colorectal cancer or CRC is a “disease of the colon or rectum.”

Signs include abnormal growths in the colon or rectum that can turn into cancer if not removed, according to the Centers for Disease Control and Prevention. However, someone could have polyps or colorectal cancer and not know it, according to the CDC.

The disease typically occurs in people ages 45 and older, but is on the rise among younger people, according to the CCA.

Earlier this month, the American Cancer Society reported that one in five cases of the disease in 2023 occurred in people under 55. Colon cancer is also the most common cancer and the second most common cancer death in the U.S., according to the ACS.

“Colorectal cancer is one of those things that people really don’t like to talk about,” Sophie Balzora, a gastroenterologist and clinical professor of medicine at New York University, told GMA. “And it does prevent people from going to the doctor to talk about their symptoms or even just talking about screening.”

Health experts like Balzora have stressed the importance of getting screened regularly for colorectal cancer as a way to reduce the risk of it. Screening for colorectal cancer should begin at age 45, according to the CDC, but if you have a family history of it, you should get screened earlier for the disease.

The Blue Hat Foundation

Henley is now using her story to raise awareness about the disease, especially among those in the Black community, where rates are the highest of any racial or ethnic group in the U.S., according to the ACS.

Henley founded The Blue Hat Foundation in 2015, with the goal of raising awareness about CRC. It began at her church and has since expanded into a thriving organization.

“We’re trying to make sure that we connect the patient to what they need,” Henley said.

“I don’t want anyone to go through what I did,” she added. “Communities of color will continue to be left behind in research if we don’t participate willingly this time. We have to do our part to help improve our community’s health outcomes and it’s not enough to complain and wait. We must be proactive, educate ourselves and make informed decisions about our health.”

For more information and resources on colorectal cancer, visit Colorectal Cancer Alliance online where you can take a screening quiz. Colorectal cancer patients and caregivers can also receive free support at CCA's BlueHQ website.

Copyright © 2023, ABC Audio. All rights reserved.

Woman diagnosed with MS at age 24 puts spotlight on underrepresentation of Hispanics

Angelina Cubero

(NEW YORK) -- Angelina Cubero said she spent nearly a decade of her life going to doctors, trying to find out why she experienced migraines, brain fog numbness and pain in her legs, and other unexplained symptoms.

"I would go to the doctor, I would go to the ER, I would go to urgent cares, I would go to my primary doctor, I'd go to a specialist, another specialist, and I wasn't really getting any answers," Cubero, 27, told ABC News' Good Morning America. "They would say, 'You look fine. You don't look sick. All your tests seemed normal to me.' ... The only reason they told me was anxiety."

Cubero, who lives in Jersey City, New Jersey, said it was only three years ago, in 2020, that she underwent a second brain magnetic resonance imaging scan, or MRI, where doctors discovered multiple lesions, or plaques, in her brain.

The discovery led to a diagnosis of a disease Cubero said she had never heard of, multiple sclerosis.

"I'd never heard of MS," Cubero said. "I had to do my own research to figure out what is MS, and that was scary."

Multiple sclerosis is a neurological disease in which the immune cells in the body body injure myelin, the tissue that surrounds nerves, including those in the brain and spinal cord, according to the National Institutes of Health. It is a chronic disease, with no known cause and no known cure.

It is also a disease that can be unpredictable, causing differing symptoms with variable timing and frequency, from fatigue, numbness or tingling, weakness, dizziness and vertigo to, in the most severe cases, rendering a person unable to write, speak or walk, according to the NIH. Even individually, MS symptoms can vary, ranging from mild to extreme pain during a flare-up of the disease.

Cubero said that as a Hispanic woman who was 24 years old when she was diagnosed with MS, she struggled to find anyone who looked like her talking about the disease.

"There were so many questions I had, and it was really hard to find those answers," Cubero said. "I didn't really find much information on how it affects the Hispanic community ... and I didn't know how it affected young people."

Cubero was a senior in college when she was diagnosed, and said she decided to write her senior thesis on either MS and young people or MS and Hispanics.

"I was like, 'I'll do one or the other,' and I couldn't find research for either," she said. "So that was the tricky part, not only for my project, but also for personal knowledge on how this new disease that I have affects me."

Why Hispanics have been overlooked in MS research

Though Cubero struggled to find representation after receiving her MS diagnosis, she is not alone.

Symptoms for people with MS usually first start between the ages of 20 to 40, and the disease is estimated to be three times more common in women than men, according to both the NIH and the National Multiple Sclerosis Society, a nonprofit organization focused on raising MS awareness and increasing research.

In addition, people of Hispanic or Latino descent are more likely to be diagnosed with MS at younger ages and have earlier onsets of symptoms, according to the National Multiple Sclerosis Society.

Julie Fiol, the organization's associate vice president of health care access, told GMA that Cubero's experience of struggling for years to get a diagnosis is not uncommon among MS patients, especially for people of color.

"It can be challenging for anyone to receive a diagnosis because there is no one, easy-to-access confirmatory test that says that you have MS," Fiol said. "There are several tests, like an MRI, that can be done that can help rule in and confirm a diagnosis of MS, but before even getting that, it requires someone to be connected with a physician who takes them seriously, acknowledges that their symptoms are real and can put together that the person who is sitting in front of me could potentially have MS."

She continued, "For far too long, MS was viewed as a disease that affected white people, so if you didn't fit that mold of what that clinician was expecting to see for MS, they may not have even considered MS as a possibility."

In Cubero's case, she said it was only when she found an MS specialist who is also a psychiatrist that she began to receive the treatment she needed.

"He understood what was anxiety and what was MS, and he heard me out and he said, 'No, you actually have relapsing-remitting MS. Those are MS symptoms,'" Cubero said. "That was when I finally felt validated and secure, like, OK, I can trust my doctor moving forward and we can come up with a plan that works best for me."

With relapsing-remitting MS, the most common type of the disease, symptoms occur in attacks, called a relapse or exacerbation, followed by a period of remission that may last for weeks, months or years. People with secondary-progressive MS have usually had a history of MS attacks and their symptoms and ability to function worsen over time. In the two more severe and rare forms of MS -- primary-progressive MS and progressive-relapsing MS -- people's symptoms progressively worsen from the beginning, with no remission, according to the NIH.

People of Hispanic and Latino descent often have more severe symptoms of MS, with a faster severity of disease, according to the National Multiple Sclerosis Society. In addition, optic neuritis, or swelling of the eye's optic nerve, which can impact vision, is twice more common in Hispanic people with MS.

Exactly why Hispanic patients are hit younger and more severely by MS remains to be seen because research has been so limited, according to Dr. Lilyana Amezcua, who is considered one of the pioneers in researching the impact of MS on the Hispanic and Latino communities.

"Is that all an issue of access to care and what we call social determinants of health, or are there other environmental factors and genetic predispositions that do not allow for better recovery of the disease? Those are all questions that are unanswered at this time," Amezcua said.

Amezcua, a neurologist and Multiple Sclerosis Fellowship Program Director at the University of Southern California's Keck School of Medicine, said she began studying the connection a decade ago as a practicing neurologist in Los Angeles. At the time, she said less than 1% of MS scientific literature focused on Hispanics or African-Americans.

"One of the things that I was observing was that with Hispanic patients, there was a delay of diagnosis," she said. "When I would compare them to what I would expect for white people, it was about one to three years delay of getting that diagnosis, so from there we started with our first initial studies to better understand this population."

As she began her research -- founding the Alliance for Research in Hispanic MS, a collaboration between multiple universities -- Amezcua said she and her colleagues discovered that Hispanics had been vastly underrepresented in clinical trials. When it comes to clinical trials on medications to treat MS, for example, just 7% of participants are Hispanic, according to Amezcua.

"We know probably that the drugs do work, but we don't know to the extent, particularly if the disease in [an Hispanic patient] is starting a bit more worse," she said. "What is the possibility that we're going to sort of calm [MS] down more effectively with one drug?"

Amezcua said the group is now leading a global study that is researching one specific drug targeted for Hispanic and African-American populations, which were both underrepresented in other clinical trials.

The group's research over the past decade has also shown that many of the genetic risk factors present in white people diagnosed with MS are also present in the Hispanic population, according to Amezcua.

"We're hoping to dig deeper to see if there's additional risk factors that are both genetic and environmental that could help us understand ... MS, and help not just Hispanics but everyone else," she said, adding that while there are barriers, more and more Hispanic people want to participate in MS research.

"We find that there's a high interest of wanting to participate because they're interested in understanding what does MS look like in them, what are the best treatments out there and what services are out there?" Amezcua said.

Both Fiol and Amezcua noted that in addition to scientific research, a large part of the work being undertaken by researchers and patient organizations like the National Multiple Sclerosis Society is to educate both medical professionals and the general public about all the populations MS may impact.

In the Hispanic community, that means working to increase access to MS specialty centers and educating people about MS as a "silent disease." The education includes sharing information about the signs and symptoms of MS both so that people can get medical care earlier, and so families and caregivers understand more about the disease.

"In MS you have those symptoms that are visible, like walking with a cane, but you also have the silent symptoms and the silent symptoms can culturally be an issue," Amezcua said, noting that fatigue, for example, may be perceived as laziness to people unfamiliar with MS. "MS is not as common as, let's say diabetes and hypertension is in this population, so many of [a patient's] family members may not have heard about MS."

Fiol said a large part of her work at the National Multiple Sclerosis Society is focused on recruiting MS specialists like Amezcua, who are Hispanic.

"We know that people feel more comfortable seeking care from doctors that they feel they can trust and can relate to, and sometimes that has to do with just finding someone that looks like them," Fiol said. "And only 7% of the neurology workforce in the U.S. is Hispanic, so we have a lot of ground to cover and a lot of work to do."

Becoming a voice for Hispanic people with MS

Nearly two years after she was diagnosed with MS, Cubero said she began sharing her journey publicly on social media in hopes of raising awareness of the disease and how it can impact Hispanic people as well as young women.

"Having a diagnosis leads to treatments, which leads to a better experience," Cubero said of the importance of people knowing the signs and symptoms of MS. "I'm just grateful to have a diagnosis because it led me to an MS center, which has a lot of resources for me to improve."

Cubero also began to use her voice literally to help raise awareness, singing about her journey in order to help educate people and make others with MS feel less alone.

"I wish I had that when I was searching for answers," said Cubero, who performs under the stage name Lina Light. "It's bittersweet for me, but I'm really happy to help others because I feel like I'm going through this for a bigger purpose. It wasn't just my story, it was to help others to get through their diagnosis too and to support each other."

Cubero said she has met other "MS warriors" through the National Multiple Sclerosis Society, which last year hosted its first-ever Hispanic LatinX Experience Summit that brought people together to connect virtually with each other.

The National Multiple Sclerosis Society is now also establishing an Hispanic-Latinx Collaborative, an initiative designed to increase outreach and engagement with those communities, according to Fiol.

Throughout her years-long health journey, Cubero said she has learned to advocate for herself. It's one of the lessons she said she hopes other people take away from her story.

"I really want people to be their best advocate, to speak up," she said. "I know that it can be intimidating. I know that it can be hard, but you have to speak up. You deserve the best care."

Copyright © 2023, ABC Audio. All rights reserved.

One in 12 kids lose a parent or sibling before turning 18: Report

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(NEW YORK) -- Patricia Royalty’s world turned upside down last June when her 34-year-old husband Dakota Royalty died from cirrhosis. The 36-year-old mother was left caring for the couple's five children.

"He meant a lot to the kids. He was always a really good father," Patricia said in an interview with ABC News. "When my 5-year-old went to school in January, they asked her what her new year’s resolution was. She asked for her dad back."

Royalty's children are among a growing group of children who have lost a parent or sibling. A new report from Judi’s House – an organization that advocates for grieving kids and families – found that one in 12 kids will lose a parent or sibling by age 18. Since the pandemic, the rate has continued to increase.

Micki Burns, a co-author of the report, said that on top of the grief, children who have lost a parent can feel isolated because it’s difficult for other kids to understand grief and loss.

"Recognizing that [losing a parent or sibling] is prevalent is important," Burns said in an interview with ABC News. "It's something that we need to start to talk about more openly and more easily so that the children don't feel so isolated."

Losing a parent during childhood is an important risk factor for adult mental health problems and the issue is often overlooked, according to M. Katherine Shear, a grief expert at Columbia University.

While grief affects everyone in different ways, Shear said children are oftentimes not the focus of support from community members. She said this most likely happens because people think children are more resilient than their grieving parent.

"[Kids are then] in a situation of great emotional need with a parent who is less able to provide it due to their own intense grief," Shear said in an email to ABC News. "It's very important that clinicians learn about childhood grief, how to recognize and treat it."

The researchers behind the new report also found higher rates of childhood grief in some southern and Appalachian states. West Virginia had the highest rate, with approximately 13.3% of children experiencing grief, while Minnesota had the lowest rate. Arizona, Royalty's home state, had a rate of 8.8%.

It’s unclear why certain states had lower rates, but Burns suggested the differences may depend on resource availability and state laws. She said states like West Virginia may have reduced access to health care and other resources.

Burns also emphasized that the causes of death have changed over the years. According to this year's report, the leading causes of death for parents are accidents, heart disease and cancer. Birth conditions, accidents and birth defects top the list for siblings who die.

Suicide and homicide are also among the leading causes of death. Royalty's sister, who had one child, died earlier this year from a fentanyl overdose.

Burns said she noticed a large uptick in suicide and drug overdose deaths during her career.

"That's where we really see kids coming in questioning, 'Was this because of something I did? Was this because I wasn't a good enough son or good enough sibling?'" Burns said. "I think it's alarming and it's saddening."

Shear pointed to research suggesting that negative outcomes in children, such as depression, continue to affect them for as long as seven years on average after a relative’s death.

While Royalty's children are still learning to grieve their father’s death, they receive emotional and social support at school. They are also finding ways to honor her late husband.

"I feel bad for kids who experience this at a young age. It’s difficult for them to show emotions and open up," Royalty said. "Always remain strong. Know that your parents will be watching you regardless. Do anything and everything to make them proud of you."

Michal Ruprecht is a medical student at Wayne State University School of Medicine and a member of ABC News Medical Unit.

Copyright © 2023, ABC Audio. All rights reserved.

How to talk to children about school shootings after six people killed at Nashville school Images

(NEW YORK) -- Just as the school week began across the country Monday, news broke that another school shooting was unfolding in the United States.

On Monday morning, according to officials, three children and three staff members were shot and killed at the Covenant School, a private Christian school for students in preschool through sixth grade, in Nashville, Tennessee.

The suspect was shot and killed by authorities inside the school. No one who was shot survived, officials said.

The deadly shooting is one of the nearly 130 mass shootings that have taken place so far this year in the U.S., according to the Gun Violence Archive, which defines a mass shooting as one in which four or more victims are shot or killed, not including the shooter.

The Nashville school shooting is now also on the long list of school shootings that have taken place in the past decade, since the Dec. 14, 2012, shooting at Sandy Hook Elementary School that claimed the lives of 20 students and six educators.

With each school shooting, the number of people affected by school shootings grows, as do the conversations parents and caregivers must have with kids about the reality of gun violence in the U.S.

Read on to see five tips from experts on how to discuss school shootings with kids:

1. Be proactive in talking with kids.

ABC News chief medical correspondent Dr. Jennifer Ashton said last July -- shortly after 19 students and two teachers were killed at Robb Elementary School in Uvalde, Texas -- that topics like school shootings should be discussed with kids in a proactive way.

"The first step is to make an age-appropriate dialogue, open lines of communication with your child," Ashton said, later adding, "We shouldn't sit back and wait for them to come up and say, 'Mom, Dad, I'd like to talk about gun violence.'"

She continued, "We're going to need to take the first step and come to them early and often and say, 'What are you thinking about? What are you afraid of? What questions do you have?'"

Ashton also encouraged parents and caregivers to lead with honesty and transparency and to not be afraid to say "I don't have an answer" or to share their feelings.

If an adult doesn't have an answer, Ashton recommended they use dialogue like, "I don't have an answer to that but I'll help you find it."

And if an adult has fear after a school shooting as children often do, Ashton said they can reassure a child by saying, "I know you're scared, so am I, but let me tell you what your teachers and what your parents and community are trying to do to help you stay safe."

2. Be truthful about what happened.

Dr. Melissa Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress, said parents and caregivers should be truthful with kids about school shootings that happen, but in an age-appropriate way.

"As hard as it is, we need to be truthful about what happened," Brymer told ABC News last year. "And make sure we answer kids questions truthfully."

She continued, "For our young kids, they don't need to have all the details. Many times they're going to be worried about their safety, your safety as a parent or caregiver or their family members' safety, so we want to reiterate what's being done to help them right now."

Brymer said parents should be prepared for teenagers to want a "much more in-depth conversation."

"How do we talk about what this event has meant that might have impacted our value system?" Brymer said of a potential conversation starter with a teen. "Can you encourage your kids to think about is there a club or some type of activity that they can do within their schools to show and create change? In these times, many of us start to feel lonely. How do we reach out to those that might not have someone in their life?"

3. Reach out to others for support.

Brymer also suggested parents and caregivers take a "pause" to think about how an event like a school shooting affects their own emotions so they can be ready to talk to their kids.

"Sometimes we don't have the words right away," Brymer said. "We might need to reach out to our own support systems and have those conversations, and then we can have them with our kids."

If a child's stress levels or response to a mass shooting are hard to manage, experts say parents and caregivers shouldn't hesitate to seek guidance from their pediatrician, a school counselor, social worker or other mental health experts. Parents should also seek out professional mental health help if they are struggling.

4. Keep an eye out for changes in kids' behaviors.

Psychiatrist and author Dr. Janet Taylor said children may respond to disturbing news about mass shootings in different ways, and parents and caregivers should pay attention to see if their child's behaviors change.

Children may experience problems focusing, have difficulty sleeping or become more irritable, according to Taylor.

"If you have younger children and they suddenly get more clingy or want to sleep in bed with you, pay attention to that and cuddle them as they need it," Taylor told ABC's Good Morning America in 2022. "Older kids may become more isolated or feel that they have to solve things by themselves."

5. Remember to check-in with kids.

Instead of discussing a school shooting only once, Robin Gurwitch, a licensed clinical psychologist and Duke University professor, said it's crucial to continue the conversation over time.

"A one-and-done conversation is not sufficient," Gurwitch told ABC News in 2018, after 17 students and teachers were killed at Marjory Stoneman Douglas High School in Parkland, Florida. "Let your child or teenager know that 'I really do care about you and I am open to having this discussion.'"

She continued, "It is really important to check back in tomorrow, to check back in the next day, to find out, 'What are your friends talking about related to this school shooting?'"

The National Child Traumatic Stress Network offers comprehensive resource guides for parents, caregivers and educators to support students. Click here for resources related to school shootings.

If you or someone you know is struggling with thoughts of suicide, free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988. Even if you feel like it, you are not alone.

Copyright © 2023, ABC Audio. All rights reserved.

What’s in your travel bag? Doctors share tips on what to pack for medical issues

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(NEW YORK) -- You added your destination on your weather app. Your out-of-office notification is on. Chargers -- check.

But one thing you didn't prepare for on your trip? An unexpected medical issue, possibly brought on by a red-eye flight that worked too well or the friends you’re visiting forgetting to tell you they have a new puppy -- and you're allergic!

ABC News asked doctors about must-have medications and products for travel that can relieve some of the pain and stress. Here's what they had to say.

For your eyes

To look your best on vacation, you may need eye drops that get the red out from that overnight flight and lack of sleep. Dr. Alison Watson, an oculoplastic surgeon in Philadelphia at Wills Eye Hospital, recommends redness relief eye drops that contain low-dose brimonidine as the active ingredient. She says over-the-counter redness relief drops that don’t have brimonidine are not safe for regular use and can “make your eyes more dry over time or actually cause rebound redness.” Anyone having side-effects like burning or itching or having to use redness relief drops for long periods of time should check with a health care provider.

Also, petroleum jelly, commonly referred to as Vaseline, is “the perfect thing to throw in” and "can be safely used around the eyes as a moisturizer,” Watson said.

Watson said petroleum jelly can even double as a makeup remover, even for waterproof makeup. “Just put a thin layer [of Vaseline] right over top. It works especially well for mascara … and you can then wipe it off if you have a cotton wipe or tissue and your makeup will come right off.”

Another product to pack is an eye cream that contains vitamin C and caffeine. “Vitamin C is really brightening and then caffeine works to reduce puffiness," Watson said. Caffeine constricts small blood vessels to help with redness and vitamin C is an antioxidant that can protect the skin from damage. "So if you're having later nights than usual or diet changes, it can sort of help keep you looking your best in a pinch on vacation when you're changing your typical routine," she said.

Watson’s final travel tip is to “have fun out there,” but not without sun protection for your eyelids, including sunglasses. She says to look for “shimmer eyeshadows that have SPF built in so you can use it as your makeup and also to protect your eyelids from the sun.”

For your allergies

Environmental allergens can trigger your body to release a chemical called histamine, which when overproduced causes congestion, cough and a runny nose.

“Symptoms you weren't experiencing in New York in February might be in full bloom in sunny Florida,” said Dr. Manav Segal, an allergist and immunologist at Chestnut Hill Allergy and Asthma Associates in Philadelphia.

If a stuffy nose is your main symptom, Segal said over-the-counter nasal steroids such as fluticasone, triamcinolone or mometasone “can be dosed when you need them.”

If you have asthma and it's aggravated while on a trip, albuterol is not an over-the-counter medication, but is a rescue inhaler that you should talk to your doctor about having with you when you travel.

If your allergies have “nothing to do with the season and everything to do with … cats and dogs,” Segal said safe, effective allergy medications such as loratadine, cetirizine and fexofenadine are available over-the-counter.

The FDA allows for certain medications to be sold without a prescription. but still warns, “You should never misuse OTC medicines by taking them longer or in higher doses than the label recommends. Symptoms that persist are a clear signal it's time to see a doctor."

Consider an EpiPen …

With new foods and a new environment, allergic reactions are possible so doctors recommend packing an antihistamine like oral benadryl.

A general rule of thumb is if you have just one symptom, then you can try an antihistamine for relief. But if the reaction involves two symptoms or body systems, using an EpiPen is safest.

“So there's hives, plus vomiting, or swelling, or any difficulty breathing like wheezing, coughing, then I start to worry that this is a reaction that's going throughout the whole body and is a little bit more severe," said Dr. Katie Lockwood, a pediatrician at Children’s Hospital of Philadelphia.

If you experience swelling that compromises your breathing or shortness of breath, administer an EpiPen immediately and call 911.

Getting an EpiPen requires first getting a prescription from your doctor.

Lockwood also said if you or your child has “a risk of a food allergy, or a venom allergy, like a bee sting allergy, and or have had anaphylaxis in the past, you should always travel with your EpiPen, because there might not be one available when you need it and they can be lifesaving.” Allergists recommend carrying two doses, as the reaction may reoccur.

Doctors say it's always safer to err on the side of caution and give an EpiPen if you're worried about an allergic reaction than to not give it. But if you end up using the EpiPen, you need to seek medical attention promptly afterward.

… and Insect Repellent

Insect repellant is also important to pack -- and to apply after you've put on SPF 30+ sunscreen -- when headed to locations where bugs and mosquitos are active. The most commonly available insect repellents contain the active ingredient DEET. The higher the concentration, the longer it will last. In infants at least 2 months old and children, DEET concentrations should not exceed 30%. Concentrations over 50% may last longer but provided no added benefit and those higher concentrations can be irritating to your skin. Other safe insect repellents are ones that contain picaridin and oil of lemon eucalyptus.

Inevitably, bugs seem to find a way to evade clothing and even bug spray barriers. When that happens, you want to have a topical steroid on hand to apply directly on the bug bites if they are causing itching or swelling.

A good over-the-counter, anti-itch cream to pack is hydrocortisone 1%. However, if you are prone to exaggerated reactions after bug bites or have a history of eczema, you may want to talk to your dermatologist doctor about having stronger topical steroids on hand and make sure you know how to safely use them.

Be Prepared

Doctors suggest bringing a three- to five-day extra supply of all your prescription medicines.

If you're traveling, if you just pack enough for the vacation days and your return flight gets delayed, or there's a terrible snowstorm and you can't leave, you don't want to be left without your medication,” said Dr. Nathalie May, associate professor of medicine at Drexel University.

Hopefully, your medication travel bag is untouched and it’s ready for your next trip, but don’t forget to check expiration dates before your next getaway.

Mark Abdelmalek, M.D., is an ABC News investigative reporter and medical contributor, and a Mohs Surgeon in Philadelphia at Dermatology of Philadelphia.

Copyright © 2023, ABC Audio. All rights reserved.

CVS acquires at-home health care company: How it could impact medical services

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(NEW YORK) -- CVS Health Corp announced Monday it would be closing its acquisition of home health care services company Signify Health.

The deal, which was originally agreed upon in September 2022, allows retail pharmacy chain to acquire Signify for $30.50 per share for a total value of approximately $8 billion.

"We have nothing additional to share at this time; we'll of course have more to say upon expected closure of the deal," a spokesperson for CVS told ABC News.

By buying Signify, CVS will be among the first pharmacy chains in the U.S. to enter the at-home health care space after building its successful Minute Clinics.

Signify Health has thousands of employees including physicians, nurse practitioners and other clinicians which provide a "holistic suite of clinical, social, and behavioral services to address an individual's healthcare needs and prevent adverse events that drive excess cost, all while shifting services towards the home," the company said in a press release.

Here's how the deal may affect services including COVID testing and abortion care.

COVID tests performed at home

While every American has been able to either buy at rapid at-home antigen tests at their local store or get them delivered to their doors, polymerase chain reaction (PCR) tests have been reserved for doctors' offices, clinics and pharmacies.

PCR tests, which look for genetic material from the virus, are considered the "gold standard" when it comes to COVID-19 testing.

While less accurate than PCR tests, antigen tests are still considered quite accurate when used in people with symptoms of infection. The tests look for proteins on the surface of the virus and can deliver results in 15 minutes or less.

CVS has been offering PCR testing at its stores but, with Signify already having a system in place providing on-site COVID screening, clinicians may be able to perform such testing in people's homes.

Abortion services

It's not clear how the CVS acquisition will affect abortion pills, but at-home care could be provided.

In January, after a change in rules from the U.S. Food and Drug Administration, both CVS and Walgreens announced plans to seek certification to distribute abortion pills where legally allowed.

Despite Walgreens saying it would not distribute mifepristone in 21 states after conservative attorneys general threatened legal action, CVS has not said it will be doing the same.

Even if CVS does follow in Walgreens' footsteps, licensed physicians may be able to prescribe pills directly in a woman's home in states where procedure is legal,.

Signify Health declined to comment to ABC News.

Expanding health care into rural areas

According to the American Hospital Association, there are just 1,805 rural hospitals in the U.S., the latest date for which data is available. It also represents a 59% decrease since 2019.

What's more, a January report from the Center for Healthcare Quality and Payment Reform found that 631 rural hospitals -- or roughly 30% -- are at immediate risk or high risk of closing due to low financial reserves or being too dependent on certain forms of revenue such as state subsidies.

By comparison, CVS has more than 9,000 stores across the country.

The acquisition may allow the company to be able to reach traditionally underserved communities that live far away from metropolitan areas.

Copyright © 2023, ABC Audio. All rights reserved.

Hayden Panettiere shares what she wished she knew about postpartum depression

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(NEW YORK) -- Hayden Panettiere, who hasn't shied away from talking about postpartum depression, is sharing what she wishes she knew beforehand.

The Scream 6 star welcomed her daughter Kaya back in 2014, but said she wasn't aware that postpartum depression could affect her.

"I wish somebody told me that that was a possibility, told me it's OK if you birth your child and you're not immediately like, 'Oh my god, I love you more than anything in the entire world!'" Panettiere told E News' The Rundown.

"I just thought there was something seriously wrong with me, so I thought, 'Fireball will fix this -- duh!'" the 33-year-old continued, referencing a brand of cinnamon whisky. "And it didn't. It does for a moment, but then it makes everything worse."

About 20% of women are not asked about depression during a prenatal visit and over half of pregnant women with depression are not treated, according to the Centers for Disease Control and Prevention.

Panettiere has spoken out about postpartum depression in the past and said it led in part to her struggles with alcoholism as well. Last July, the actor told ABC News' Good Morning America and People magazine in an exclusive joint interview that she "didn't know where the alcoholism was ending and the postpartum was beginning."

"I didn't have any negative feelings towards my child," she said at the time. "I just knew I was deeply depressed."

About 1 in 8 women report symptoms of depression after giving birth, according to the CDC.

Usually, the condition starts about one to three weeks after a child's birth, but can occur up to a year after birth.

"When we think of postpartum depression, there are many signs that come immediately after delivery and that can include worthlessness and guilt, not feeling an immediate emotional or physical bond with your baby, decreased sleep, decreased appetite and possible feelings of suicide," Dr. Jessica Shepherd, a board-certified OB-GYN and the chief medical officer for Verywell Health, who did not treat Panettiere, told GMA.

Unlike the "baby blues," which can appear within a couple of days after a child's birth and resolve within two weeks, the CDC notes postpartum depression, and the intense feelings of sadness, anxiety and hopelessness that accompany it, usually requires medical treatment.

Other symptoms of postpartum depression, according to the CDC, include withdrawing from loved ones, crying more than usual, feeling worried or overly anxious, feeling anger, doubting your ability to take care of your baby and thinking about harming yourself or your baby.

Today, Panettiere said she's doing better and said her daughter has "more love than anybody I've ever met." Although Panettiere didn't say what type of treatment she sought, current treatment options for postpartum depression usually include therapy or medications or a combination of both, according to the National Institute of Mental Health.

Panettiere has been just one of many celebrities, including Serena Williams, Alanis Morissette and Kylie Jenner, who have spoken publicly about postpartum depression in recent years, helping to destigmatize the health issue.

If you are experiencing suicidal, substance use or other mental health crises please call or text 988. Trained crisis counselors are available for free, 24 hours a day, seven days a week. You can also go to or dial the current toll free number 800-273-8255 [TALK].

Copyright © 2023, ABC Audio. All rights reserved.

Public health departments across US concerned about spread of potentially deadly fungus

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(NEW YORK) -- Public health departments across the United States have expressed concern about the spread of a potentially deadly fungus after the Centers for Disease Control and Prevention reported cases have spiked.

Candida auris, or C. aurisis, is increasing at an "alarming" rate with cases doubling in 2021, the CDC said.

Now, with infections reported around the country, health officials are working to prevent the drug-resistant yeast from spreading further.

Two cases were recently reported to the Colorado Department of Public Health and Environment. The agency told local ABC affiliate Denver 7 that the patients had been receiving care in facilities out of state and were transferred to Colorado for additional care.

On its website, CPDPHE said it was concerned about C. auris because it is often multi-drug resistant, can be difficult to identify and can cause outbreaks in health care settings.

Additionally, the Indiana State Department of Health said it is monitoring 87 cases of C. auris, according to local affiliate WRTV.

The fungus "presents a serious global health threat," the department said on its website. "Outbreaks of this organism have occurred in healthcare settings, so early identification and communication about cases are essential to awareness and prevention."

What's more, Austin Public Health recently told KXAN that the spread was "very concerning" and that it is a "top threat" to the agency.

While most healthy people are not at risk, vulnerable populations -- including those with weakened immune systems -- are prone to drug-resistant infections.

In addition, nursing home patients or hospital patients who have or have had lines and tubes in their body -- such as a catheter or a breathing tube -- are also at high risk.

Doctors previously told ABC News they are concerned because C. auris can spread either from person to person or by coming into contact with contaminated surfaces.

Although several strains of C. auris are multi-drug resistant, there is a class of antifungal drugs called echinocandins that can be used and are given intravenously.

According to the National Institutes of Health, echinocandins prevent a key enzyme needed to maintain the cell wall of the fungus.

In some cases, when the infection is resistant to all three main classes of drugs, multiple high doses may be required, the CDC said.

According to the CDC, studies on mortality related to C. auris are limited but anywhere between 30% and 60% of people with C. auris infections have died.

The federal health agency, however, noted many of these patients also had other serious illnesses that increased their risk of death.

Copyright © 2023, ABC Audio. All rights reserved.

Mom shares warning after son's legs amputated following strep, influenza A infections

Courtesy of Michele Stevenson

(NEW YORK) -- A Michigan mom is warning other parents to pay attention to their kids and take action if they seem unwell after her son developed strep A and influenza A infections in late December and had to get a double amputation earlier this month.

Michele Stevenson of Grand Blanc, Michigan, told ABC News' Good Morning America her son Kaden, 7, started to get sick right before Christmas but she didn't think it was anything serious. She said he told her he felt tired and she thought he possibly had a stomach bug or a cold and let him rest. But after about four days, Kaden didn't seem to be getting any better -- instead, he seemed to be getting progressively worse.

"I'm thinking maybe he might have the flu just because of the pain he kept talking about. So I'm thinking it might be just body aches or something like that. But by the time I got to him, I couldn't put his shoes on, I couldn't put his coat on, he was in that much pain," Stevenson recalled.

"Something just felt off," the mom of one said. "So I looked him over. His right leg was swollen. He had a rash all over his body. His eyes look puffy to me and it seemed like that all happened within a short period of time."

Stevenson said she took Kaden to Hurley Children's Hospital in Flint, but shortly thereafter, doctors told her they needed to transfer Kaden for higher-level care.

"The ER doctor sat down in front of me and gave me the most serious look I've ever seen a doctor give me and said, 'Your son is really sick,'" Stevenson recounted. "By the next day, they were telling us that they were about to transfer us to another hospital that Kaden needed a pediatric orthopedic surgeon … but I knew it was really serious the moment they said, 'It's going to be in a matter of minutes.' They were just waiting on the helicopter to arrive."

Officials with the Centers for Disease Control and Prevention renewed their December warning about invasive strep A Wednesday, noting that at least five children in Illinois have reportedly died following infections this year. The season for invasive strep A tends to run between December through April and this type of bacterial infection can be more dangerous because it can impact multiple parts of the body, such as a person's blood, bones or lungs.

In addition, although the number of influenza cases have been relatively low across the U.S., multiple strains of the influenza A virus have been in circulation, according to data from the CDC.

With her son's flu and strep infections, Stevenson said she didn't initially realize how bad it could've been.

"I didn't hear about [strep] really until we got in the hospital and I heard about other kids at the same time had the same thing my son had," Stevenson said. "One little boy didn't make it. I'm hearing this family sad and crying and saying goodbye to their son, and my son's here still fighting for his life. My heart goes out to that family."

Although Stevenson said it has been an "extremely scary" three months for her and her son, she said she feels grateful for the doctors, nurses and medical professionals who "saved his life" and cared for the young boy.

"[Kaden] said the other little boy that died, he was sad that he died, but he was going to live for him. He was going to be strong for the little boy," Stevenson said.

"As a mother, as a parent, as a person in general, I don't want anybody else to have to go through this. This has been horrifying," she added.

According to Stevenson, Kaden underwent amputations for both of his legs on March 3 and is now looking forward to receiving what he calls his "robot legs" or prosthetic legs.

"He always talks about [how] he misses the old times and he misses when he could walk and how things used to be but he said he's kind of happy. He likes his new legs," Stevenson said.

As Kaden starts a new chapter on the road to recovery, Stevenson said she hopes to raise awareness for other parents.

"If your kid has any of those signs of fever, they complain of pain, you see any rashes, just take them to the emergency." Stevenson said. "Catch it early. That's the biggest thing. And listen to your kids. They tell you they don't feel good? Don't just sweep it under the rug, assuming that it's a little cold. Get it checked out."

Copyright © 2023, ABC Audio. All rights reserved.

Does the TikTok trend of face taping to stop wrinkles work? A doctor weighs in


(NEW YORK) -- Simply search the hashtag #facetaping on social media and you'll get tens of thousands of posts about this beauty trend that promises to help prevent wrinkles and smooth fine lines.

Face taping, as the trend is known, involves placing tape on the areas of the face where a person wants to reduce the appearance of wrinkles and fine lines, like the forehead and cheeks.

The type of tape people use includes everything from regular clear, sticky tape to the kinesiology tape normally used to treat injuries to newer brands of tape marketed just for face taping.

To see whether this viral trend is one that is safe to try at home, ABC News' Good Morning America spoke with Dr. Jennifer Ashton, a board-certified OB-GYN and ABC News' chief medical correspondent.

Here are her answers on whether face taping is safe and, importantly, whether it actually works:

1. Does face taping have any real, physical benefits?

Possibly, according to Ashton, but any benefit would be temporary.

"Very superficially and very temporarily, it can smooth out those superficial wrinkles," Ashton said. "It depends on the age of the person, how much sun damage there is, how much elasticity or collagen there is in their skin, how much volume they've lost with age. All of those things can contribute to the appearance of wrinkles."

Ashton emphasized that a person's wrinkles could return within "minutes" of face taping.

"It's possible that when you remove the tape, those wrinkles can re-form in minutes to hours," she said. "So it's going to be a very transient effect."

2. Does face taping help deep wrinkles?

No, said Ashton.

"You have to ask yourself whether you're dealing with fine wrinkles and lines or deep wrinkles," Ashton said. "Taping your face at night for several hours is very unlikely to do anything significant for deeper wrinkles."

According to the Cleveland Clinic, fine lines are the first stage of wrinkles. They look like small creases on the skin and are closer to the skin's surface.

Fine lines are most likely to be in places where you make repetitive movements, like around your eyes and mouth. As a person ages, those fine lines become wrinkles.

Wrinkles, according to the Cleveland Clinic, are "deeper creases" within the skin and can form anywhere on the body, not just the face.

3. Is there a risk to trying face taping?

Ashton said the main risks associated with face typing would be a reaction to the type of tape that is used, which would vary person to person.

A person could be allergic to a specific type of tape, according to Ashton, who recommends trying a small patch of skin first.

"We see all the time allergic reactions to tape on the skin in surgery," Ashton said. "I would suggest if you're going to try this, try it on a part of your body that the whole world doesn't see in case you have an allergic reaction."

Ashton said caution also needs to be taken when a person removes tape so that it doesn't cause a burn.

"In some cases there can be tape burns," Ashton said. "You can actually remove the superficial level of the epidermis, and obviously that would be a big problem."

4. What are other options for reducing fine lines and wrinkles?

Ashton said injections like Botox and fillers performed by a certified professional are the "gold standard" when it comes to the prevention or improvement of wrinkles.

"Obviously there's cost involved and that result is also temporary," she said of injections, which can cost hundreds of dollars per session. "It's just that instead of lasting a few hours, [injections] last a couple of months -- three to four months in some cases, even six months."

The American Academy of Dermatology notes that lifestyle changes can make a difference when it comes to wrinkles and fine lines.

Among the group's recommendations are to wear sunscreen every day, moisturize the skin, avoid getting a tan from the sun or a tanning bed, testing facial products before using and using products as directed.

Copyright © 2023, ABC Audio. All rights reserved.

Suicide can be contagious for teens, research shows. Here’s how parents can help

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(NEW YORK) -- Rates of mental health emergencies are increasing among teenagers around the world, according to a new study from the University of Calgary. It found an increase in pediatric emergency room visits for suicide attempts, suicidal ideation, and self-harm during the first year of the pandemic.

It’s a particular concern because for teenagers, suicide can be contagious.

Teenagers with a friend or family member who died of suicide were at significantly higher risk of suicide than those without, according to a 2016 review published by the American Association of Suicidology.

"[Teenagers'] emotional development means that they experience trauma and tragedy in slightly different ways," said Seth Abrutyn, Ph.D., and associate professor of sociology at University of British Columbia who has studied youth suicide contagion, in an email to ABC News. "Youth rarely are ready to make sense of a death – let alone something as confusing as a suicide."

A growing crisis: 'Perfect recipe for declining mental health'

Suicide rates were growing even before the COVID-19 pandemic. According to data from the Centers from the Disease Control (CDC), suicide rates in U.S. preteens increased by over 40% from 2009 to 2019.

"[This] crisis has been growing for many, many years," Dr. Neha Chaudhary, a child and adolescent psychiatrist at Massachusetts General Hospital and Chief Medical Officer at BeMe Health, told ABC News in an email. "Add to the social isolation, grief, and lack of structure an overwhelming sense of uncertainty and you have a perfect recipe for declining mental health."

Per the CDC’s 2021 Youth Behavior Risk Survey, there are high levels of hopelessness across all ages and demographics. The data shows that one in three teenage girls and one in seven teenage boys "seriously" considered suicide.

Teens are particularly vulnerable to contagion because of constant exposure to their peers through school and social media, Abrutyn said. They see their peers as role models and are highly susceptible to their influence. In the case of a suicide, this can be extremely jarring to their developing sense of identity.

Having a friend or person in their peer group die by suicide or attempt suicide can also normalize something that drastic, according to a study from the Journal of Health and Social Behavior. Girls are more vulnerable to this contagion than boys, according to a review by the American Sociological Association. That review also found that friends’ suicide attempts can have more of an impact than family members’ if they were perceived as a role model.

"If adults do not step in to help make sense of the trauma in health and appropriate ways…the wrong sorts of stories about suicide may spread; stories that kids can identify with easily to make sense of their own problems," Abrutyn said.

How parents can help

Hearing or talking about suicide isn’t inherently dangerous, experts say.

"The idea that talking about suicide causes suicide is unfortunately rampant among adults and not based in any evidence-based research" Abrutyn said. "It fosters a culture of stigma and repressed help seeking."

But the discussion should be framed in a thoughtful way — like that it’s a disease that can be treated, Chaudhary said.

"Parents can explain that someone was struggling with a disease and died because of it, and that it is a very sad thing that happened," she said. "It's also important to let kids know that if they or someone they know has thoughts of suicide, that there are several ways to get help right away."

An important way for parents to protect their kids from suicidality is to ask about it, Chaudhary said.

"If you've never talked about it before, it's OK to say to an older kid, 'Hey, I know this might seem out of nowhere, but I wanted to ask you— have you ever had thoughts of suicide before?,'" Chaudhary said.

With younger kids, you can phrase the conversation differently. "You might say something like: ‘Sometimes when kids are feeling sad or really upset they feel like they don't want to be alive anymore. Have you ever had that feeling before? It's OK if you have, I just want to know so we can figure out how to help you not feel like that again, or to know what to do if the feeling comes back.’"

The Huntsman Mental Health Institute at the University of Utah has guides available for talking to children about suicide at various ages.

Parents can also encourage kids to stay physically active and exercise. Exercise can help protect against suicide, research shows. One study found that at least 5 hours of physical exercise per week was associated with less risk of suicidal ideation in college students.

Suicide prevention programs in middle and high schools can also be effective. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a free toolkit available with information sheets, training tools, and screening protocols for high schools. The American Foundation for Suicide Prevention (AFSP) has a list of recommended community programs for both students and teachers.

One program, Sources of Strength, has been implemented in thousands of schools across the U.S. and Canada. Research published in the American Journal of Public Health showed its approach improved help-seeking, connectedness with adults, and school engagement. These factors are protective against suicide, as well as school dropout, depression, and substance use problems.

"If we're going to move the needle in a high school, we have to have high school students involved," Sources of Strength CEO Scott LoMurray told ABC News. "We showed that you could use peer leaders to change population level health norms"

Resilience can also be contagious, he said.

"Positive things can spread through networks in really remarkably similar ways to [negative things]," LoMurray said. "We're training students to… become patient zero in an epidemic of health."

If you or someone you know is struggling with thoughts of suicide — free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988. Even if you feel like it, you are not alone.

Nisarg Bakshi, DO is a pediatrics resident at University of Chicago Comer Children's Hospital and a contributor to the ABC News Medical Unit.

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COVID-19 death rates varied dramatically across US, major analysis finds

Stefan Cristian Cioata/Getty Images

(NEW YORK) -- Death rates from COVID-19 varied dramatically across the United States, a major new analysis finds.

The report, published Thursday in medical journal The Lancet, looked at the rate of deaths throughout the country between January 2020 and July 2022.

COVID death rates in states like Arizona and New Mexico were roughly four times higher than in states like Hawaii, New Hampshire and Maine, researchers found.

The highest COVID-19 death rates were seen in Arizona with 581 deaths per 100,000 and Washington D.C. with 526 deaths per 100,000.

By comparison, the lowest rates of death were seen in Hawaii with 147 deaths per 100,000, New Hampshire with 215 deaths per 100,000 and Maine with 218 deaths per 100,000.

The authors of the study noted that Arizona's high death rate from COVID-19 deaths may be due to "inequality, some poverty...ultimately [low] vaccination rates and behaviors didn't line up to have good outcomes."

States that did well, like Hawaii, New Hampshire and Washington state, are states -- in most cases -- "[that] have done a good job restricting travel, and in some cases have less poverty, less inequality, and relatively high vaccination rates."

Additionally, states with larger proportions of people who identified as Black or Hispanic witnessed higher death rates.

Lower rates of infection and death from COVID-19 were seen in states with higher education levels, lower poverty levels and higher rates of self-reported trust in the federal government and in the scientific community.

"Nearly every state, from the 26 worst performing states in the pandemic, fall into one of the three...[either] disproportionately high population of people identifying as Hispanic...higher than the national average identifying as black...or high levels of support for the 2020 republican presidential candidate," said lead author Tom Bollyky, a senior fellow for global health, economics, and development at the Council on Foreign Relations and professor of law at Georgetown University, in a video commentary.

The authors further discussed parts of the study highlighting racial, economic and social inequities in the U.S. that led to differences in rates of infection and death rates between states.

States with higher poverty rates of poverty had higher death rates. For every 2.6% increase in poverty rates above the national average within a state, there was a 23.3% increase in the cumulative death rate, reflecting a significant economic healthcare disparity.

"The COVID-19 pandemic clearly exacerbated fundamental social and economic inequities, but science-based interventions and policy changes provided clear impact on mortality rates at the state level," said Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children's Hospital and an ABC News contributor.

Policies adopted by states during the pandemic, including mask mandates, social distancing and vaccine mandates, were associated with lower COVID-19 infection rates and higher vaccination rates were associated with lower death rates.

"We can invest in programs that protect the communities that we see disproportionately affected by the pandemic," said co-lead author Emma Castro, a researcher at the Institute of Health Metrics and Evaluation at the University of Washington, in the video commentary. "We can invest in programs such as paid family and sick leaves, expanded health insurance and expanded Medicaid."

She continued, "These sorts of programs will protect individuals in the lower income bracket, and hopefully help void some of the unnecessary loss that we experienced in the pandemic."

Alaa Diab, MD, an internal medicine resident at Greater Baltimore Medical Center and MPH candidate at Johns Hopkins Bloomberg School of Public Health, is a contributor to the ABC News Medical Unit.

Keerthana Kumar, MD, MPH, a preventive medicine resident at the University of Kentucky, is a contributor to the ABC News Medical Unit.

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