Tutkimus: elämäntaparemontti voi parantaa kakkostyypin diabeteksen jo vuodessa - 7 tapaa pysäyttää

Painonpudotus on tehokkain tapa torjua ja hoitaa kakkostyypin diabetesta. Tuoreen tutkimuksen mukaan elämäntaparemontti voi parantaa kakkostyypin diabeteksen jo vuodessa. Tutkimuksen tulokset vahvistavat käsitystä siitä, että elämäntapamuutokset ja laihduttaminen voivat parantaa tyypin 2 diabeteksen ainakin sellaisilta potilailta, joiden sairaus ei ole kestänyt pitkään.
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A member of the medical staff listens as Montefiore Medical Center nurses call for N95 masks and other critical PPE to handle the coronavirus pandemic on April 1, 2020, in New York. | Bryan R. Smith/AFP via Getty Images Five months into the pandemic, the Trump administration hasn’t taken charge of a supply chain that’s been stretched thin. In the early weeks of the pandemic, it was nearly impossible to buy N95 masks. These masks, unlike surgical masks or cloth masks, are tight-fitting and filter airborne particles that can carry the virus, making them a key source of protection for health care workers, some of whom have died after being exposed to Covid-19 at their medical facilities. Now, as the United States continues to reopen and the number cases and hospitalizations surge, that troubling shortage of personal protective equipment — and especially N95 masks — is once again a problem. A survey from the National Nurses Union found that 85 percent of nurses reported being asked to reuse personal protective equipment that’s meant to be single-use. At one private clinic in Arizona, medical workers are treating Covid-19 patients without being given any N95 masks, according to the New York Times. The shortage is so dire that the inventor of the powerful filtration material in these masks has come out of retirement to look for ways to decontaminate his invention and make them safer for reuse. But why is there still a shortage? Despite months of shutdown that were meant to reduce pressure on the health care system and give the US more time to prepare, production for personal protective equipment, which includes N95 masks, medical gowns, and medical gloves, never adjusted to meet the massive demand caused by the pandemic. At the same time, reopening in many states has meant that other businesses, like outpatient medical offices and construction firms, are now in search of N95 masks too. Meanwhile, the recent surge in Covid-19 cases that has followed reopening is almost certainly leading to a greater need for protective equipment in hospitals, especially in the places currently experiencing massive outbreaks, like Florida and Texas. In early April, Donald Trump invoked the Defense Production Act (DPA), which allows the federal government to order private companies to produce needed supplies, to obtain more masks produced by 3M, one of the major American mask manufacturers. Later that month, the Department of Defense announced several other contracts for N95 masks. But as it becomes increasingly evident that these measures weren’t enough, organizations like the National Nurses United, a nationwide nurses union, and the American Medical Association have in recent weeks called for the Trump administration to use the law more aggressively to address the PPE shortage. Earlier this week, presidential candidate Joe Biden released a supply chain plan for Covid-19 that calls for more broadly invoking the DPA, in part to deal with the ongoing shortage of N95 masks. “The Trump administration is still dragging its feet on using the DPA to produce urgently-needed supplies to combat the COVID-19 pandemic, and has fallen far short of the domestic mobilization we need,” the plan says. “There was sometime in May where I felt like it was getting to more of a steady state,” Anne Miller, the sourcing lead for Project N95, a protective equipment clearinghouse established during the pandemic, told Recode. “The whole tenor of everything seems to be ramping back up again, and we see lots of requests for N95 respirators, isolation gowns, and surgical masks.” A growing number of cases is increasing demand Since states across the country have moved toward full reopening, the coronavirus crisis has arguably gotten worse than it has ever been. On July 9, the US saw nearly 60,000 new Covid-19 cases. In a majority of US states, Covid-19 cases are increasing, according to the New York Times, and outbreaks risk overwhelming some rural hospitals and smaller cities that weren’t prepared for the pandemic. “It feels like right now we see more demand this week than we did last week, and I think we will continue to see that,” said Miller, who expects that reopening schools and universities will also cause another surge in cases, though she notes that heightened demand for N95 masks never really went away. But national coordination of a supply chain was never set up to effectively distribute personal protective equipment and other supplies, despite calls for the federal government to step in. The National Strategic Stockpile didn’t have a large amount of backup supplies to begin with, and it wasn’t set up to respond to the full needs of a pandemic. Without leadership from the federal government — which insisted that supplies should be handled on the local and state level — governors and hospital systems have been arranging their own private purchases of personal protective equipment, often directly competing with one another. It’s an approach that Illinois Governor J. B. Pritzer recently likened to the Hunger Games. Opening up means more people need protective equipment When the pandemic first started, the country’s primary concern was getting protective equipment to hospital health care workers who were treating Covid-19 patients. But as the country opens back up, people working in medical and dental offices, as well as other industries like construction, are looking for N95 masks too. Michael Einhorn, the president of the medical supplier Dealmed, said there’s also an understandable incentive for medical facilities to buy more safety stock beyond what they need for present day-to-day operations. He points to efforts like New York Gov. Andrew Cuomo’s 90-Day Supply Goal as an example. That guidance urges health care facilities to have in stock enough protective equipment to last about three months. “There are biopsies that need to take place. People need to get screened and tested. There are people out there that need treatment outside of Covid,” Einhorn told Recode. “These facilities that treat these patients don’t have access to N95s, and it’s a very big problem.” At the end of June, the American Medical Association (AMA) sent a letter to the Federal Emergency Management Agency (FEMA) emphasizing that doctor’s offices and practices outside of hospital systems were struggling to get access to personal protective equipment. James Madara, the AMA’s CEO and executive vice president, raised the alarm about “growing concern” from doctors about shortages and said that despite pleas to Congress, “a remedy remains elusive.” In fact, the problem in outpatient medical facilities was bad enough that Madara also sent a letter to Vice President Mike Pence, asking the administration to invoke the Defense Production Act. “Without adequate PPE, physician practices may have to continue deferring care or remain closed, which will continue to have a dramatic impact on the health of their patients,” Madara wrote. One major challenge is that many of these medical facilities don’t typically buy in bulk the way large hospital systems do and aren’t used to buying protective equipment for their daily operations. One doctor told a local paper in Pennsylvania that if his surgery center and clinic were to reach full capacity, it would only have enough PPE to last a week or two and would then have to shut down. “If I’m a doctor, and I’m going to open my practice and … need a respirator every day, I only need a box of 20,” explains Miller, from the N95 Project. “But you can’t go out and buy a box of 20.” The supply chain is still riddled with problems On its own, the US simply isn’t producing enough N95 masks and other protective equipment to meet demand, despite major producers like 3M and Prestige Ameritech ramping up production. Even before the pandemic, the US relied significantly on imports, especially from China, and many point to a lack of leadership and coordination in the early months of the pandemic as a cause for the ongoing shortages. The federal government actually turned down an early offer from Prestige Ameritech to produce millions of masks early this year, according to the Washington Post. Leading companies in the medical equipment distribution industry also told members of Congress that between January and March, the administration gave them little effective guidance, and there’s still no national coordination of a supply chain. At the beginning of the pandemic, finding a steady and trustworthy supply of N95 masks was difficult. Hospitals ended up with counterfeit and otherwise unreliable products, while others placed orders for masks that would never arrive. There was also price gouging and hoarding, and a growing number of new, and often unreliable, suppliers attempting to take advantage of desperate buyers. The murkiness of the supply chain has improved somewhat, though issues remain. Miller, who has kept an eye on the gray markets for protective equipment, said that many “opportunistic players have been winnowed out of the market.” The ones that remain are more reliable, and payment terms for bulk purchases have begun to return to normal. Dealmed’s Einhorn said that hospitals and buyers have become more aware of unreliable orders and the risk of counterfeit or otherwise suspicious products. “Our government has basically said that we’re going to allow the free economy to fix the issues,” Val Griffeth, an Oregon-based doctor who co-founded a nonprofit PPE effort called Get Us PPE, told Vox last month. “Unfortunately, it takes time and capital to ramp up production, and because the government has not devoted capital to helping solve the situation, we’re seeing a delay in its resolution.” In fact, officials don’t seem to think shortages are as significant as some medical workers have said. Vice President Mike Pence on Wednesday said that the supply of PPE is “very strong” and encouraged medical workers to re-use products. “I’m not going to tell you we’re able to meet all demand, but there’s significantly less unfulfilled orders today than in April,” the navy official who is overseeing medical supplies distributed by the federal government, John Polowczyk, told the Washington Post in early July. “I don’t have the sense of there being severe shortages.” It’s difficult to estimate exactly how bad the national shortage is at scale, but direct reports from medical facilities are alarming. Doctors at a medical center in Houston told the New York Times they’ve been instructed to reuse N95s for up to two weeks. A family physician in Virginia, who is on the state’s testing task force, told local news that surgical masks continue to be used unless they become dirty, and disposable gowns are also reused. In Bradenton, Florida, nurses have protested because, they say, they’re not given enough proper protective gear and aren’t updated about patients’ Covid-19 statuses. If cases continue to surge, there’s no doubt that concerning reports like these almost certainly will, too. Open Sourced is made possible by Omidyar Network. All Open Sourced content is editorially independent and produced by our journalists. Support Vox’s explanatory journalism Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Vox’s work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn. 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Australia’s management of the pandemic has been a huge success — the country not only flattened its curve but “crushed” it, as University of South Australia biostatistics professor Adrian Esterman told me. But epidemiologists told me that worldwide, even places with low numbers of new cases will still be susceptible to resurgences until a vaccine is available — so new case numbers, in Australia and elsewhere, will continue to fluctuate. “You’ll have surges where everyone has to go into lockdown and then cases will go down. Then you can start doing normal things again, then the cases will go up, then you’ll have to go into lockdown again,” Raina MacIntyre, head of the Biosecurity Research Program at the Kirby Institute at the University of New South Wales, told me. “It’ll be intermittent periods of epidemic and inter-epidemic periods and intermittent lockdowns to manage the situation until we have a vaccine,” MacIntyre said. How Australia managed to control the pandemic Australia has done a great job controlling the pandemic, experts told me. But you really don’t need experts to tell you that — just look at the country’s total number of cases. Only slightly more than 9,300 people in Australia have been diagnosed with Covid-19 to date, and about 100 people have died as of July 10, according to Johns Hopkins University’s Coronavirus Resource Center. To put that in perspective, Peru and Chile have comparable population sizes to Australia’s — but each has reported over 300,000 coronavirus cases, with thousands of deathsas of the same date. The Australian government took the pandemic seriously from the beginning and, unlike in the United States, government officials listened to the advice of public health experts, Esterman told me. Esterman also said the vast majority of the public complied with social distancing and mask-wearing guidelines — again, unlike in the US, where masks are seen by some as an attack on individual liberty. Australia first tackled the virus with a ban on travelers from high-risk areas in February. MacIntyre told me that most cases from the first outbreak were travelers returning to Australia. That, and Australia’s lack of land borders with other countries, made it easier to identify who was infected or at risk. Australia’s borders were closed to non-citizens on March 19, and later that month public gathering places like movie theaters, bars, and schools were closed and social distancing rules were imposed. Testing has also been widely available — more than 2.6 million people of Australia’s population of 25 million have been tested as of last week. The country’s biggest misstep, Esterman told me, was the docking of a cruise ship in March with infected passengers on board. Hundreds of cases could be traced back to the Ruby Princess cruise ship, where passengers that were clearly sick left the ship without being tested, dispersing around the country. Reopening began in May, with the intent of safely reopening the economy fully by July. In the US, the coronavirus is disproportionately impacting Black, Latinx, and Native American communities. But in Australia, although institutional racism against Indigenous populations in health care is pervasive, Esterman said there were not significant racial disparities in Covid-19 infection rates during the initial outbreak because not many people were infected in the first place. “There were basically too few cases for there to be any differentiation,” Esterman said. But the new Melbourne-area outbreak is largely affecting immigrant communities. This outbreak began because of failures at quarantine hotels, where people who fly into Australia must stay for two weeks under mandatory quarantine. The BBC reports that improperly trained private security forces are facing the blame, including allegations of rule-breaking — like sharing cigarette lighters and having sex with quarantined travelers. From the hotels, the virus spread to low-income communities with large immigrant populations in Melbourne, Esterman told me. He said the government also didn’t spend enough time communicating with these non-English-speaking communities about the importance of mask-wearing and social distancing, leaving them vulnerable. Victoria logged a record-high 288 new cases on Friday. That’s the state’s highest number since the 212 new cases reported on March 28, during the peak of the first outbreak. 3,379 cases have been reported in Victoria to date. “These are unsustainably high numbers of new cases,” Victoria state premier Daniel Andrews told reporters on Tuesday. “It’s clear we are on the cusp of our second wave — and we cannot let this virus cut through our communities.” Lockdowns are being reimposedto contain the new outbreaks Now, metropolitan Melbourne residents are in a six-week lockdown, which began Wednesday, with limited exceptions for leaving home or traveling outside the metropolitan area. The Victoria-New South Wales border was closed Tuesday for the first time in 101 years — the last closure was an attempt to contain the Spanish flu in 1919, which killed 15,000 Australians. People who cross the border, which is guarded by New South Wales police and military personnel, will face large fines; 14-day permits are available for a few exceptions, and emergency service and law enforcement workers as well as people seeking medical care are free to cross. People in the metropolitan Melbourne area aren’t eligible for permits except in extreme circumstances, the Guardian reported. MacIntyre told me that the decision to close the border was made once daily new cases hit triple digits. Previously, affected suburbs and apartment buildings were locked down, but case numbers continued to rise, MacIntyre said. The border closure is meant to prevent people from bringing Covid-19 from areas with a high number of cases into unaffected areas, Krutika Kuppalli, an infectious disease physician and emerging leader in biosecurity fellow at Johns Hopkins Center for Health Security, told me. Kuppalli compared the Australian border closure to stay-at-home orders and quarantine mandates in the US, which are also intended to limit travel. More than 50,000 people crossed the border into New South Wales on Wednesday but were forced to wait for hours due to delays with the online permit system. One person has already been arrested for attempting to cross the border without a valid permit or exemption, the Guardian reported. Esterman said the fact that people can get a permit and cross the border at all could be dangerous. “If you live in Victoria and work in South Australia, they will let you through,” he said. “How is that helpful in trying to stop it from spreading from other states?” Areas that controlled the spread of the virus will continue to see outbreaks Australia’s new outbreak and the reimplementation of strict prevention measures show that areas that have limited the spread of the virus aren’t immune to spikes in Covid-19 cases once economies reopen and lockdown policies are lifted. “I think there’s always going to be a risk of resurgence until there is a vaccine, and the decision of when to initially reopen the economy and initially reopen society can be guided by best practices and evidence,” Gregory Tasian, an associate professor of urology and epidemiology at the University of Pennsylvania Perelman School of Medicine, told me. South Korea also contained its virus outbreak well but then faced spikes in new cases, including one linked to nightclub reopenings. Officials declared in June that the greater Seoul area is facing a second wave. Tasian said areas that meet criteria for reopening should effectively communicate universal masking and implement social-distancing guidelines in the workplace to decrease the overall transmission. But the United States is in a completely different situation than countries like Australia and South Korea, which have both managed to flatten their country’s curve of Covid-19 cases, Tasian said. The Northeast, which was once the US’s epicenter, has been able to control the pandemic, but cases in the South and West are on the rise. “The US never got out of the first wave,” MacIntyre told me. “So opening up is going to be extremely dangerous. It is guaranteed it’s going to result in another big surge of cases.” Tasian said that to ideally manage the pandemic, the US should implement nationwide policies, like masking and social distancing, and policies targeted to areas seeing spikes in cases — but that widespread testing is necessary to know which areas are facing larger outbreaks. Even if the US manages toslow the spread of the coronavirus nationwide — which doesn’t seem to be happening any time soon, as cases have just topped 3 million and a record-breaking nearly 60,000 cases were reported Thursday — it’s clear that we’ll be seeing outbreaks until we finally have a vaccine. Support Vox’s explanatory journalism Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. 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