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Tag: Hearing

  • An Arm and a Leg: The Medicare episode

    An Arm and a Leg: The Medicare episode

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    Medicare may sound like an escape from the expensive world of U.S. health insurance, but it’s more complicated, and expensive, than many realize. And decisions seniors make when they sign up for the federal health insurance program can have huge consequences down the road. 

    Host Dan Weissmann speaks with Sarah Jane Tribble, KFF Health News’ chief rural health correspondent, about one of the biggest choices seniors must make: whether to enroll in traditional Medicare or the privatized version, Medicare Advantage. 

    Then, Weissmann shares practical tips about how soon-to-be seniors can avoid penalties and pick the plan that’s right for them.

    Dan Weissmann @danweissmann Host and producer of “An Arm and a Leg.”

    Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

    Credits

    • Emily Pisacreta Producer

    • Adam Raymonda Audio wizard

    • Ellen Weiss Editor




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.



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  • New insights on the brain’s emotional processing center

    New insights on the brain’s emotional processing center

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    How much do our emotions depend on our senses? Does our brain and body react in the same way when we hear a fearful scream, see an eerie shadow, or smell a sinister odor? And does hearing an upbeat music or seeing a colorful landascape bring the same joy?

    In an innovative study published in Science Advances, researchers have unveiled new insights into the intricate relationship between emotion and perception.

    Led by a team of Italian neuroscientists from the IMT School for Advanced Studies Lucca, and conducted in collaboration with the University of Turin, the research project investigates whether the brain employs sensory-specific or abstract codes to construct emotional experiences.

    Emotion and perception are deeply intertwined, yet the exact mechanisms by which the brain represents emotional instances have remained elusive. Our research addresses this fundamental question, providing critical insights into how the brain organizes and represents emotional information across different sensory modalities and as a result of past sensory experience.”


    Giada Lettieri, Study Lead Author and Researcher, Psychology, IMT School for Advanced Studies Lucca

    To conduct the study, the researchers showed the movie 101 Dalmatians to a group of 50 volunteers, and tracked with functional magnetic resonance imaging the brain activity associated with the unfolding of the movie plot. The viewers of the movie in the scanner were both individuals with typical development and congenitally blind and congenitally deaf volunteers, who were presented with the audio play and the silent version of the movie, respectively. The researchers also asked a group of 124 independent participants to express and rate their emotions while watching the same movie outside the scanner, trying to predict the brain response of people with and without sensory deprivation during the experience of amusement, fear, and sadness, among other emotions.

    “Including in the experiment individuals with congenital sensory deprivation – blind and deaf people – is a way to dissect and decipher the contribution of sensory experience to neural mechanisms underlying emotions” explains Luca Cecchetti, researcher at the IMT School, and senior author and supervisor of the study. “Our results show that emotions categories are represented in the brain regardless of sensory experience and modalities. In particular, there is a distributed network encompassing sensory, prefrontal, and temporal areas of the brain, which collectively encode emotional instances. Of note, the ventromedial prefrontal cortex emerged as a key locus for storing an abstract representation of emotions, which does not depend on prior sensory experience or modality.”

    The existence of an abstract coding of emotions in the brain signifies that even though we are tempted to believe that our emotions directly depend on what happens in the surrounding world, it is our brain that is wired to generate emotional meaning regardless of whether we are able to see or hear.

    “In a world where sensory-deprived individuals are frequently overlooked, it is essential to understand how mental faculties and their corresponding neural representations can evolve and refine without sensory input, so to further advance the understanding of the emotion and the human brain,” says Lettieri.

    Source:

    IMT School for Advanced Studies Lucca

    Journal reference:

    Lettieri, G., et al. (2024) Dissecting abstract, modality-specific and experience-dependent coding of affect in the human brain. Science Advances. doi.org/10.1126/sciadv.adk6840.

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  • Association of volatile aromatic compounds in blood with hearing impairment

    Association of volatile aromatic compounds in blood with hearing impairment

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    In a recent study published in BMC Public Health, researchers evaluated the impact of benzene, ethylbenzene, and xylene (BEX) exposure on auditory health among United States (US) adults.

    Study: Association between blood volatile organic aromatic compound concentrations and hearing loss in US adults. Image Credit: Ground Picture/Shutterstock.comStudy: Association between blood volatile organic aromatic compound concentrations and hearing loss in US adults. Image Credit: Ground Picture/Shutterstock.com

    Background

    Hearing loss (HL) is associated with financial hardships, an increased risk of diseases such as Alzheimer’s disease and dementia, and communication difficulties.

    There are few effective hearing loss (HL) treatments, highlighting the need for developing prevention strategies. Ototoxic processes and trace heavy metals are HL risk factors. The link between environmental contaminants in human blood and HL is unclear.

    The concentration of polycyclic aromatic hydrocarbons (PAHs) in urine correlates with HL frequency across ages. However, using organic solvents in urine as HL biomarkers has limitations due to their short biological half-lives and varied metabolism.

    BEX chemicals, a significant component of volatile-type organic aromatic compounds (VOACs), are recognized as carcinogens by the International Agency for Research on Cancer, causing reproductive dysfunction, asthma, leukemia, benzene poisoning, immune suppression, splenic damage, and premature birth.

    About the study

    The present study researchers comprehensively explored the link between BEX concentration in blood and hearing impairment among US adults.

    The researchers analyzed the National Health and Nutrition Examination Survey (NHANES) data for 2003-2004, 2011-2012, and 2015-2016, including demographics, VOAC exposure, and audiometry measurements.

    They performed weighted multivariable logistic regression modeling to determine the odds ratios (ORs) for the relationship between BEX concentration in blood with high-frequency HL (HFHL) and speech-frequency HL (SFHL).

    Study covariates included age, sex, race, ethnicity, body mass index (BMI), marital status, education level, smoking habits, drinking status, diabetes, hypertension, and household income.

    The team used the Linden and Jerger classification to define peak middle ear pressures as type C (<99 daPa), type B (0.2 compliance value), and other pressures as type A.

    They analyzed participant blood samples at mobile examination centers (MECs) using mass spectrometry (MS), capillary gas chromatography (GC), selected ion monitoring (SIM), and isotope dilution methods.

    Trained examiners conducted audiometry examinations, defining hearing loss as pure-tone averages exceeding 25 dB in both ears.

    They conducted SFHL assessments at frequencies of 500, 1,000, 2,000, and 4,000 Hz and HFHL evaluations at 3,000, 4,000, 6,000, and 8,000 Hz.

    The team conducted sensitivity analyses to examine the relationship between BEX and hearing loss, reclassifying individuals into three levels based on average hearing threshold, excluding those aged >40 years, and extracting serum cotinine data from NHANES to quantify tobacco smoke exposure.

    The team excluded individuals below 20 or above 60 years with tympanometric type B or C in one or both ears.

    They also excluded individuals with missing data for VOACs such as benzene, ethylbenzene, o-xylene, m/p-xylene, family income-poverty ratio (PIR), and marital status.

    Further, they excluded individuals prescribed hydrocodone, acetaminophen, phenytoin, ciprofloxacin, rifampin, levofloxacin, aspirin, minocycline, bumetanide, nitroglycerin, or metronidazole from the study.

    Study participants did not suffer from cerumen or collapsing external ear canals, did not use hearing aids, or suffered from Parkinson’s disease.

    Results

    The study included 2,174 participants with a mean age of 39 years and weighted prevalences of HL, HFHL, and SFHL, being 47% (n=995), 46% (n=973), and 25% (n=513), respectively.

    Individuals with advanced age, male gender, married status, higher BMI, educational attainment, occupational noise exposure, smoking history, alcohol use, diabetes, and hypertension had higher hearing impairment prevalence than those with no impairment.

    However, the dose-response assessments indicated increased risk among older females with weight in the normal range.

    Benzene, ethylbenzene, ortho-xylene, and para/meta-xylene exposures and cumulative BEX concentrations elevated hearing impairment risk with ORs of 1.4, 1.2, 1.2, 1.4, and 1.3, respectively). 

    Concerning the SFHL endpoint, benzene, ethylbenzene, ortho-xylene, para/meta-xylene, and cumulative BEX concentrations elevated the risk with ORs of 1.2, 1.3, 1.3, 1.2, and 1.3, respectively.

    For HFHL, benzene, ethylbenzene, ortho-xylene, para/meta-xylene, and cumulative BEX exposures increased hearing impairment risk with ORs of 1.2, 1.4, 1.4, 1.2, and 1.3, respectively.

    Surprisingly, the correlation between HL severity and BEX concentration was positive for HL and HFHL, not SFHL. Sensitivity analyses yielded similar findings, indicating the robustness of the primary results.

    Low doses of benzene can activate cellular oxidative stress, contributing to hearing loss. Obesity may lower the risk of hearing impairment induced by BEX by altering insulin-like growth factor (IGF-1) levels.

    Prolonged progesterone and estrogen stimulation in females can elevate hearing thresholds and negatively impact hearing. The team hypothesizes that BEX may disrupt the female endocrine system, with compensatory increases in estrogen outweighing the protective benefits.

    Conclusions

    The study findings showed a positive association between BEX exposure and hearing impairment (HL, HFHL, and SFHL) risk among American adults.

    Future studies could elucidate the mechanisms underlying BEX-related hearing impairment and validate findings from longitudinal environmental research.

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  • Toxic gas that sterilizes medical devices prompts safety rule update

    Toxic gas that sterilizes medical devices prompts safety rule update

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    Over the past two years, Madeline Beal has heard frustration and even bewilderment during public meetings about ethylene oxide, a cancer-causing gas that is used to sterilize half of the medical devices in the U.S.

    Beal, senior risk communication adviser for the Environmental Protection Agency, has fielded questions about why the agency took so long to alert people who live near facilities that emit the chemical about unusually high amounts of the carcinogenic gas in their neighborhoods. Residents asked why the EPA couldn’t close those facilities, and they wanted to know how many people had developed cancer from their exposure.

    “If you’re upset by the information you’re hearing tonight, if you’re angry, if it scares you to think about risk to your family, those are totally reasonable responses,” Beal told an audience in Laredo, Texas, in September 2022. “We think the risk levels near this facility are too high.”

    There are about 90 sterilizing plants in the U.S. that use ethylene oxide, and for decades companies used the chemical to sterilize medical products without drawing much attention. Many medical device-makers send their products to the plants to be sterilized before they are shipped, typically to medical distribution companies.

    But people living around these facilities have been jolted in recent years by a succession of warnings about cancer risk from the federal government and media reports, an awareness that has also spawned protests and lawsuits alleging medical harm.

    The EPA is expected to meet a March 1 court-ordered deadline to finalize tighter safety rules around how the toxic gas is used. The proposed changes come in the wake of a 2016 agency report that found that long-term exposure to ethylene oxide is more dangerous than was previously thought.

    But the anticipated final rules — the agency’s first regulatory update on ethylene oxide emissions in more than a decade — are expected to face pushback. Medical device-makers worry stricter regulation will increase costs and may put patients at higher risk of infection from devices, ranging from surgical kits to catheters, due to deficient sterilization. The new rules are also not likely to satisfy the concerns of environmentalists or members of the public, who already have expressed frustration about how long it took the federal government to sound the alarm.

    “We have been breathing this air for 40 years,” said Connie Waller, 70, who lives with her husband, David, 75, within two miles of such a sterilizing plant in Covington, Georgia, east of Atlanta. “The only way to stop these chemicals is to hit them in their pocketbook, to get their attention.”

    The EPA says data shows that long-term exposure to ethylene oxide can increase the risk of breast cancer and cancers of the white blood cells, such as non-Hodgkin lymphoma, myeloma, and lymphocytic leukemia. It can irritate the eyes, nose, throat, and lungs, and has been linked to damage to the brain and nervous and reproductive systems. Children are potentially more vulnerable, as are workers routinely exposed to the chemical, EPA officials say. The agency calculates the risk based on how much of the gas is in the air or near the sterilizing facility, the distance a person is from the plant, and how long the person is exposed.

    Waller said she was diagnosed with breast cancer in 2004 and that her husband was found to have non-Hodgkin lymphoma eight years later.

    A 2022 study of communities living near a sterilization facility in Laredo found the rates of acute lymphocytic leukemia and breast cancer were statistically significant, greater than expected compared with statewide rates.

    Beal, the EPA risk adviser, who regularly meets with community members, acknowledges the public’s concerns. “We don’t think it’s OK for you to be at increased risk from something that you have no control over, that’s near your house,” she said. “We are working as fast as we can to get that risk reduced with the powers that we have available to us.”

    In the meantime, local and state governments and industry groups have scrambled to defuse public outcry.

    Hundreds of personal injury cases have been filed in communities near sterilizing plants. In 2020, New Mexico’s then-attorney general filed a lawsuit against a plant in Santa Teresa, and that case is ongoing. In a case that settled last year in suburban Atlanta, a company agreed to pay $35 million to 79 people who alleged ethylene oxide used at the plant caused cancer and other injuries.

    In Cook County, Illinois, a jury in 2022 awarded $363 million to a woman who alleged exposure to ethylene oxide gas led to her breast cancer diagnosis. But, in another Illinois case, a jury ruled that the sterilizing company was not liable for a woman’s blood cancer claim.

    Greg Crist, chief advocacy officer for the Advanced Medical Technology Association, a medical device trade group that says ethylene oxide is an effective and reliable sterilant, attributes the spate of lawsuits to the litigious nature of trial attorneys.

    “If they smell blood in the water, they’ll go after it,” Crist said.

    Most states have at least one sterilizing plant. According to the EPA, a handful, like California and North Carolina, have gone further than the agency and the federal Clean Air Act to regulate ethylene oxide emissions. After a media and political firestorm raised awareness about the metro Atlanta facilities, Georgia started requiring sterilizing plants that use the gas to report all leaks.

    The proposed rules the EPA is set to finalize would set lower emissions limits for chemical plants and commercial sterilizers and increase some safety requirements for workers within these facilities. The agency is expected to set an 18-month deadline for commercial sterilizers to come into compliance with the emissions rules.

    That would help at facilities that “cut corners,” with lax pollution controls that allow emissions of the gas into nearby communities, said Richard Peltier, a professor of environmental health sciences at the University of Massachusetts-Amherst. Stronger regulation also prevents the plants from remaining under the radar. “One of the dirty secrets is that a lot of it is self-regulated or self-policed,” Peltier added.

    But the proposed rules did not include protections for workers at off-site warehouses that store sterilized products, which can continue to emit ethylene oxide. They also did not require air testing around the facilities, prompting debate about how effective they would be in protecting the health of nearby residents.

    Industry officials also don’t expect an alternative that is as broadly effective as ethylene oxide to be developed anytime soon, though they support researching other methods. Current alternatives include steam, radiation, and hydrogen peroxide vapor.

    Increasing the use of alternatives can reduce industry dependence on “the crutch of ethylene oxide,” said Darya Minovi, senior analyst with the Union of Concerned Scientists, an advocacy group.

    But meeting the new guidelines will be disruptive to the industry, Crist said. He estimates companies will spend upward of $500 million to comply with the new EPA rules and could struggle to meet the agency’s 18-month timetable. Sterilization companies will also have difficulty adjusting to new rules on how workers handle the gas without a dip in efficiency, Crist said.

    The Food and Drug Administration, which regulates drugs and medical devices, is also watching the regulatory moves closely and worries the updated emissions rule could “present some unique challenges” if implemented as proposed, said Audra Harrison, an FDA spokesperson. “The FDA is concerned about the rule’s effects on the availability of medical devices,” she added.

    Other groups, like the American Chemistry Council and the Texas Commission on Environmental Quality, the state’s environmental agency, assert that ethylene oxide use isn’t as dangerous as the EPA says. The EPA’s toxicity assessment has “severe flaws” and is “overly conservative,” the council said in an emailed statement. Texas, which has several sterilizing plants, has said ethylene oxide isn’t as high a cancer risk as the agency claims, an assessment that the EPA has rejected.

    Tracey Woodruff, a researcher at the University of California-San Francisco who previously worked at the EPA, said it can be hard for the agency to keep up with regulating chemicals like ethylene oxide because of constrained resources, the technical complications of rulemaking, and industry lobbying.

    But she’s hopeful the EPA can strike a balance between its desire to reduce exposure and the desire of the FDA not to disrupt medical device sterilization. And scrutiny can also help the device sterilization industry think outside the box.

    “We continue to discover these chemicals that we’ve already been exposed to were toxic, and we have high exposures,” she said. “Regulation is an innovation forcer.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Using hearing aids can be frustrating for older adults, but necessary

    Using hearing aids can be frustrating for older adults, but necessary

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    It was an every-other-day routine, full of frustration.

    Every time my husband called his father, who was 94 when he died in 2022, he’d wait for his dad to find his hearing aids and put them in before they started talking.

    Even then, my father-in-law could barely hear what my husband was saying. “What?” he’d ask over and over.

    Then, there were the problems my father-in-law had replacing the devices’ batteries. And the times he’d end up in the hospital, unable to understand what people were saying because his hearing aids didn’t seem to be functioning. And the times he’d drop one of the devices and be unable to find it.

    How many older adults have problems of this kind?

    There’s no good data about this topic, according to Nicholas Reed, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health who studies hearing loss. He did a literature search when I posed the question and came up empty.

    Reed co-authored the most definitive study to date of hearing issues in older Americans, published in JAMA Open Network last year. Previous studies excluded people 80 and older. But data became available when a 2021 survey by the National Health and Aging Trends Study included hearing assessments conducted at people’s homes.

    The results, based on a nationally representative sample of 2,803 people 71 and older, are eye-opening. Hearing problems become pervasive with advancing age, exceeding 90% in people 85 and older, compared with 53% of 71- to 74-year-olds. Also, hearing worsens over time, with more people experiencing moderate or severe deficits once they reach or exceed age 80, compared with people in their 70s.

    However, only 29% of those with hearing loss used hearing aids. Multiple studies have documented barriers that inhibit use. Such devices, which Medicare doesn’t cover, are pricey, from nearly $1,000 for a good over-the-counter set (OTC hearing aids became available in 2022) to more than $6,000 for some prescription models. In some communities, hearing evaluation services are difficult to find. Also, people often associate hearing aids with being old and feel self-conscious about wearing them. And they tend to underestimate hearing problems that develop gradually.

    Barbara Weinstein, a professor of audiology at the City University of New York Graduate Center and author of the textbook “Geriatric Audiology,” added another concern to this list when I reached out to her: usability.

    “Hearing aids aren’t really designed for the population that most needs to use them,” she told me. “The move to make devices smaller and more sophisticated technologically isn’t right for many people who are older.”

    That’s problematic because hearing loss raises the risk of cognitive decline, dementia, falls, depression, and social isolation.

    What advice do specialists in hearing health have for older adults who have a hard time using their hearing aids? Here are some thoughts they shared.

    Consider larger, customized devices. Many older people, especially those with arthritis, poor fine motor skills, compromised vision, and some degree of cognitive impairment, have a hard time manipulating small hearing aids and using them properly.

    Lindsay Creed, associate director of audiology practices at the American Speech-Language-Hearing Association, said about half of her older clients have “some sort of dexterity issue, whether numbness or reduced movement or tremor or a lack of coordination.” Shekinah Mast, owner of Mast Audiology Services in Seaford, Delaware, estimates nearly half of her clients have vision issues.

    For clients with dexterity challenges, Creed often recommends “behind-the-ear hearing aids,” with a loop over the ear, and customized molds that fit snugly in the ear. Customized earpieces are larger than standardized models.

    “The more dexterity challenges you have, the better you’ll do with a larger device and with lots of practice picking it up, orienting it, and putting it in your ear,” said Marquitta Merkison, associate director of audiology practices at ASHA.

    For older people with vision issues, Mast sometimes orders hearing aids in different colors for different ears. Also, she’ll help clients set up stands at home for storing devices, chargers, and accessories so they can readily find them each time they need them.

    Opt for ease of use. Instead of buying devices that require replacing tiny batteries, select a device that can be charged overnight and operate for at least a day before being recharged, recommended Thomas Powers, a consultant to the Hearing Industries Association. These are now widely available.

    People who are comfortable using a smartphone should consider using a phone app to change volume and other device settings. Dave Fabry, chief hearing health officer at Starkey, a major hearing aid manufacturer, said he has patients in their 80s and 90s “who’ve found that being able to hold a phone and use larger visible controls is easier than manipulating the hearing aid.”

    If that’s too difficult, try a remote control. GN ReSound, another major manufacturer, has designed one with two large buttons that activate the volume control and programming for its hearing aids, said Megan Quilter, the company’s lead audiologist for research and development.

    Check out accessories. Say you’re having trouble hearing other people in restaurants. You can ask the person across the table to clip a microphone to his shirt or put the mike in the center of the table. (The hearing aids will need to be programmed to allow the sound to be streamed to your ears.)

    Another low-tech option: a hearing aid clip that connects to a piece of clothing to prevent a device from falling to the floor if it becomes dislodged from the ear.

    Wear your hearing aids all day. “The No. 1 thing I hear from older adults is they think they don’t need to put on their hearing aids when they’re at home in a quiet environment,” said Erika Shakespeare, who owns Audiology and Hearing Aid Associates in La Grande, Oregon.

    That’s based on a misunderstanding. Our brains need regular, not occasional, stimulation from our environments to optimize hearing, Shakespeare explained. This includes noises in seemingly quiet environments, such as the whoosh of a fan, the creak of a floor, or the wind’s wail outside a window.

    “If the only time you wear hearing aids is when you think you need them, your brain doesn’t know how to process all those sounds,” she told me. Her rule of thumb: “Wear hearing aids all your waking hours.”

    Consult a hearing professional. Everyone’s needs are different, so it’s a good idea to seek out an audiologist or hearing specialist who, for a fee, can provide guidance.

    “Most older people are not going to know what they need” and what options exist without professional assistance, said Virginia Ramachandran, the head of audiology at Oticon, a major hearing aid manufacturer, and a past president of the American Academy of Audiology.

    Her advice to older adults: Be “really open” about your challenges.

    If you can’t afford hearing aids, ask a hearing professional for an appointment to go over features you should look for in over-the-counter devices. Make it clear you want the appointment to be about your needs, not a sales pitch, Reed said. Audiology practices don’t routinely offer this kind of service, but there’s good reason to ask since Medicare started covering once-a-year audiologist consultations last year.

    We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • A government video would explain when abortion is legal in South Dakota

    A government video would explain when abortion is legal in South Dakota

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    South Dakota lawmakers want state officials to create an educational video to help doctors understand when they can end a pregnancy without risking prison time under the state’s near-total abortion ban.

    It’s an example of how states are responding to the national controversy over what exceptions to abortion bans actually mean. Critics point to reports of women developing dangerous complications after hospitals in states with strict abortion laws refused to terminate their pregnancies.

    South Dakota legislators are moving a bill that would direct the state Department of Health to work with the attorney general and health and legal experts to create educational material, including a video, and publish it on its website.

    The legislation is the first of its kind in the country, according to Susan B. Anthony Pro-Life America, an anti-abortion group.

    The bill says the video would explain how South Dakota law defines abortion. Republican Rep. Taylor Rehfeldt, who introduced the bill, said treatments for miscarriages or an ectopic pregnancy —when a fertilized egg implants outside the uterus — do not count as abortions, and therefore are allowed.

    The video would also discuss conditions that can threaten the life or health of a pregnant woman, and the criteria that providers might use to decide the best course of treatment. Rehfeldt said she expects the video to address when these medical conditions may need to be treated with an abortion, including how sick a patient needs to become.

    Rehfeldt, a nurse anesthetist with a personal history of high-risk pregnancies, said she introduced the bill after hearing from health care providers who want guidance about the state’s abortion law.

    “They said that they were confused and not sure when they can intervene,” Rehfeldt said. “I think it’s important that we provide that clarification because we all want moms to be taken care of.”

    South Dakota has one of the nation’s strictest laws, prohibiting abortions unless they’re needed to save the life of a woman. There are no exceptions for preventing serious injury to the mother or in cases of fatal fetal anomalies, rape, or incest. Providing an illegal abortion is a felony that can be punished with two years in prison.

    The state also has high rates of infant and maternal mortality, especially among Native Americans. Some South Dakota women have already been harmed because of the law after they were denied or received delayed abortions, according to Amy Kelley, an obstetrician and gynecologist in Sioux Falls.

    Rehfeldt is confident her bill will pass the Republican-controlled legislature because the proposal has support from the governor’s office, health department, one of the state’s largest hospital systems, and state and national anti-abortion groups.

    Anti-abortion advocates support the bill even though some groups, such as the Charlotte Lozier Institute, say exceptions to abortion bans are already clear. The group says state laws use language such as “reasonable medical judgment,” terms that hospitals should understand since such standards are often used in malpractice cases.

    “Abortion activists have spread the dangerous lie that pregnant women in states with pro-life laws cannot receive emergency care,” Kelsey Pritchard, a South Dakota-based official with Susan B. Anthony Pro-Life America — which is affiliated with the Lozier Institute — said in a news release. “This patently false allegation that is used to justify the abortion industry’s agenda for no limits on abortion is putting women’s lives in danger.”

    But abortion rights advocates say many doctors are afraid to provide critical care because of vaguely worded exceptions to abortion bans. Many say the only way to protect providers and their patients’ health is to repeal bans.

    Nisha Verma is an OB-GYN in Georgia, where abortion is generally banned once fetal cardiac activity can be detected, typically around six weeks. Verma, who has provided abortions, is also a spokesperson for the American College of Obstetricians and Gynecologists.

    “I understand the desire to grasp for anything that helps us provide care for our patients,” Verma said. But “there’s no way that you can create a video that talks about any type of inclusive list of conditions where you can and can’t provide care.”

    Several other states have tried to clarify exceptions to their bans, but the South Dakota bill is the most comprehensive, Pritchard said.

    In Oklahoma, the attorney general’s office sent a memo on the subject to prosecutors and police. It said doctors should have “substantial leeway” to provide lifesaving abortions, and don’t need to wait until a patient is “septic, bleeding profusely, or otherwise close to death.” The memo also says doctors should be prosecuted only if there’s evidence of criminal intent or a pattern of similar behavior.

    Kentucky’s attorney general wrote an advisory opinion on the topic; Louisiana’s health department published a rule listing “medically futile” fetal conditions that can legally justify an abortion. Texas lawmakers added protections for doctors who end ectopic pregnancies or pregnancies of patients whose water breaks too early for the fetus to survive. The legislation does not use the word “abortion,” and lawmakers eschewed publicity as they were passing it.

    Texas’ Supreme Court, lawmakers, and several pro- and anti-abortion rights advocates have all asked the state’s medical board for more guidance. The board must respond by mid-March as to whether it will do so, according to the health care publication Stat.

    Abortion rights supporters are divided about the value of supplying guidance on exceptions to the abortion law.

    “I wish we weren’t having this conversation,” said South Dakota Rep. Oren Lesmeister, a Democrat. “I wish we wouldn’t have had the trigger law” that banned most abortions.

    But given that the law does exist, Lesmeister decided to co-sponsor and vote for the bill in hopes it will help doctors and their patients.

    Critics of the legislation include the ACLU of South Dakota, the regional Planned Parenthood organization, and the Justice through Empowerment Network, a South Dakota abortion fund.

    Verma and Kelley, the obstetricians, said laws, videos, and other guidance can’t capture the complexity of when an abortion may be necessary.

    For example, conditions that aren’t fatal on their own can become deadly when combined with other complications, they said. Then there’s the question of when situations become life-threatening, which can happen quickly in obstetrics.

    “There’s not a line in the sand where someone goes from being totally fine to acutely dying,” Verma said.

    Verma and Kelley said doctors use their own expertise but also take their patients’ views into account when responding to life-threatening situations. That’s because one patient who learns they have a 25% risk of dying might decide against continuing their pregnancy, while another might view it as a risk worth taking, they said.

    Some patients are willing to die if it means their baby will live, Kelley said, and “we honor their choice even if we don’t always think that that’s the right choice.”

    Rehfeldt said she understands the concerns outlined by Verma and Kelley. But she said her bill would give doctors and hospital attorneys confidence to distinguish between legal and illegal procedures.

    “If you have an interpretation that’s coming from collaboration with the attorney general, as well as the pertinent medical professionals, as well as the current governor’s office, I don’t see how you would be worried about being charged with a crime,” Rehfeldt said.

    Kelley said it’s difficult to feel assured by any abortion-related guidance from South Dakota government officials when it feels as if they don’t trust doctors. For example, she said, lawmakers required abortion providers to share information with patients that can be opinionated and misleading.

    “So, it’s really hard for them to then say, ‘Oh, but trust us, you won’t get in trouble with this law, we’ll go with your judgment,’” Kelley said.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Zinc provides new clue for why loud noise causes hearing loss

    Zinc provides new clue for why loud noise causes hearing loss

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    Exposure to loud noises, such as at a music festival, can worsen our hearing

    SERGEI ILNITSKY/EPA-EFE/Shutterstock

    Exposure to loud noises may affect our hearing by disrupting levels of zinc in our inner ears, a study in mice suggests. Therapies that mitigate this could be used to treat or even prevent such damage, for example if taken before a rock concert.

    Loud noises can cause cells in the inner ear to die. This has long been known to affect hearing, but the mechanism behind it is less clear.

    Thanos Tzounopoulos at the University of Pittsburgh, Pennsylvania, suspected it might have something to do with free-moving zinc, which plays an important role in the neurological communication of our senses.

    Most of the body’s zinc is attached to proteins, but the rest works as a communication signal between organs, especially the brain, says Tzounopoulos. The highest concentration of free zinc in the body is in the cochlea, the snail-shaped structure in the inner ear that converts vibrations into electrical signals, which are then interpreted as sound.

    To learn more, Tzounopoulos and his colleagues tested free zinc levels in young mice that had been genetically modified to produce biological markers that flag the transportation of free zinc throughout the body.

    After hearing noises at 100 decibels – as loud as a bulldozer or motorcycle – for 2 hours straight, the mice had significant hearing loss within the next 24 hours, says Tzounopoulos.

    The researchers found that these mice had greater amounts of free zinc in between and around the cells in their cochlea after the sound blast compared with before, as well as in comparison to a group of control mice that hadn’t heard the loud sounds.

    “There is a very robust upregulation of zinc, in terms of quantity, but also in terms of spatial covering of the area,” he says. “It goes everywhere.”

    The zinc appears to have been released from certain cells in the cochlea after detaching from the proteins that normally bind it, says Tzounopoulos. The free zinc ultimately leads to cell damage and disrupts normal communication between cells, he says.

    To see if reducing free zinc levels could protect hearing, Tzounopoulos and his team treated another group of mice with a zinc-trapping compound, either by injecting it in their abdomens or by placing a slow-release implant in their inner ears. The mice then heard the same loud noise for 2 hours. Both groups experienced much less hearing loss.

    With further research, zinc-trapping pills, drops or slow-release implants might one day help prevent or treat inner ear damage from noise trauma, says Tzounopoulos.

    “You could go to a concert or to combat and you could take a pill,” he says. “Or you might have an accident, and they could have these compounds in the ER [emergency room] to give you to help mitigate the damage.”

    Future studies should also determine how long after noise exposure people could benefit from such a zinc-trapping therapy, says team member Amantha Thathiah, also at the University of Pittsburgh.

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  • Air Force cadets’ nutrition knowledge linked to success in gravitational acceleration test, study finds

    Air Force cadets’ nutrition knowledge linked to success in gravitational acceleration test, study finds

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    In a recent study published in Scientific Reports, researchers explored how nutrition knowledge, physical strength and activity, and body composition are related to whether Air Force cadets lose consciousness during the Gravitational Acceleration Test (G-test).

    The findings indicate that cadets who remained conscious and passed the test had better nutrition knowledge and were more physically active; these learnings have applications in improving training and test outcomes for cadets in the coming years.

    Study: Physical strength, body composition, and G-test results of air force cadets based on nutrition knowledge differences. Image Credit: John Hoffman/Shutterstock.comStudy: Physical strength, body composition, and G-test results of air force cadets based on nutrition knowledge differences. Image Credit: John Hoffman/Shutterstock.com

    Background

    Research in sports nutrition and training has applications in military training and nutritional management to maintain optimal physical and mental functioning while preventing disease. This requires an interdisciplinary approach that includes exercise, rest, recovery, and diet.

    Soldiers in the Air Force work under extreme physiological stress in aerial environments, where they may suffer from hypoxia, hearing loss, flight illusion, cognitive dissonance, and gravity-induced loss of consciousness (G-LOC).

    Enduring G-tests requires adequate nutrition and physical strength, but further understanding is required of how physical activity and strength can be improved among Air Force cadets.

    About the study

    Participants in the study were male senior cadets at the Air Force Academy in the Republic of Korea who took the G-test in 2022.

    Those who were injured or unwilling to participate were excluded from the study. All sampled participants followed the same training, sleep, meal, and work schedules.

    The G-test involved participants sitting in a cockpit-style seat of a high-speed centrifugal motion gondola for 30 seconds at an acceleration of 5 G.

    Losing consciousness before 30 seconds meant failing the test. Based on their test results, participants were divided into those who passed the 30 s G-test (GP) and those who failed (GF).

    Body strength was measured three months before the G-test, while body composition was assessed five days prior on an empty stomach. The strength test included a three-kilometer run, sit-ups, and push-ups.

    Participants were asked to avoid high-intensity activities and sleep sufficiently on the previous day. Measures taken included skeletal muscle mass, body fat percentage, body fat mass, body mass index, height, and weight.

    Participants also completed questionnaires assessing their physical activity levels and knowledge of nutrition-related topics. The data were analyzed using independent sample t-tests and logistic regressions at a significance level of 5%.

    Findings

    Of the 105 male cadets who participated in the study, those who passed the G-test weighed, on average, 3.5 kg more than those who failed and had a slightly higher BMI (24.05 compared to 23.08 on average).

    Skeletal muscle mass, though higher in the GP group, was not significantly different. Similarly, GP cadets had lower body fat mass and body fat ratio, but the difference was not significant.

    Cadets who passed were more physically active, working out for 22.2 minutes daily and 1.1 more reps each week on average. However, they did not perform significantly better in the physical strength evaluation.

    Cadets in the GP group performed significantly better in the general nutrition knowledge questionnaire, with an overall score of 6.6 points higher on average.

    The logistic regression showed significantly higher results for two sections (daily recommendation and food group) out of the four in the test questionnaire.

    There were no significant differences for the sections on healthy food choices and diet, disease, and weight associations.

    Conclusions

    Cadets who passed the G-test were significantly different in terms of their weight and BMI, with indications that higher skeletal muscle mass and lower body fat mass may be beneficial during the test.

    Specifically, higher muscle mass may facilitate better blood supply to the brain and prevent cadets from losing consciousness during the G-test. This indicates the need for a program design that balances aerobic and muscle training.

    The GP cadets were also more physically active and more knowledgeable on nutrition-related topics.

    While their food intake, energy metabolic rate, and activity were not measured, and how this knowledge translates into practice could not be observed, previous research indicates that people who understand nutrition benefits make more informed health decisions in terms of dietary intake. The authors recommend the introduction of a nutrition education program at the academy to address this.

    The findings indicate that nutritional knowledge and overall physical condition promote better performance at an acceleration equivalent to five times that of the Earth’s gravitational pull.

    In addition to continuous technological research, systematic nutrition management and education can improve and maintain optimal body composition, improving health outcomes under extreme physiological stress in aerial environments.

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  • First gene therapy trial aims to restore hearing in children

    First gene therapy trial aims to restore hearing in children

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    The aim of this clinical trial, which has just received approval in France, is to assess the safety and efficacy of a new gene therapy drug in children aged between 6 and 31 months with profound hearing loss. Audiogene was developed by a French consortium composed of teams from the Hearing Institute, an Institut Pasteur research center; the ENT Department and Pediatric Audiology Research Center at Necker-Enfants Malades Hospital (AP-HP); Sensorion and Fondation Pour l’Audition. The trial has also been submitted to other European countries and is currently undergoing assessment.

    Audiogene is the first clinical trial in France to test a gene therapy drug, SENS-501, developed by the biotech company Sensorion, to treat children with DFNB9, a form of hereditary deafness caused by mutations in the OTOF gene, which encodes a protein called otoferlin. The usual treatment for this form of hearing loss is a bilateral cochlear implant.

    The aim of this treatment is to restore hearing. It works by injecting a copy of the normal otoferlin gene into the child’s impaired inner ear. The SENS-501 drug is designed to correct the genetic abnormality in the inner ear cells of children with hearing loss and restore inner ear cell function and hearing in these children.

    The first step in the clinical trial will be to test two doses of SENS-501 so that the optimal dose can be selected for the rest of the trial.

    In practice, the SENS-501 gene therapy drug will be directly injected into the inner ear of the child with DFNB9 deafness. The drug is injected into the round window in the inner ear, in a similar way to cochlear implantation surgery. The procedure will be performed under general anesthetic by a lead ENT surgeon. The drug will be administered using an injection system developed in partnership with the company EVEON, so that the injected dose can be measured precisely and the inner ear structures can be preserved.

    This gene therapy for hearing loss patients with an otoferlin deficiency was developed as part of the RHU AUDINNOVE project, involving a consortium composed of scientists from the Hearing Institute, an Institut Pasteur research center; physicians from the ENT Department and Pediatric Audiology Research Center at Necker-Enfants Malades Hospital (AP-HP); and teams from Sensorion and Fondation Pour l’Audition.

    A collective effort that thrills the AUDINNOVE stakeholders

    The launch of the Audiogene clinical trial is a major step forward for deaf children with otoferlin defects and their parents but also brings hope to people with genetic deafness. We are very proud that our long-time support to French innovation and to the teams of Prof. Petit at the Hearing Institute, an Institut Pasteur research center, and Prof. Loundon, at the Clinical Center for Research in Pediatric Audiology at AP-HP Necker hospital, translates now into a trial.”


    Denis Le Squer, Executive Director of Fondation Pour l’Audition

    Alain Chédotal, Chair of the Scientific Committee at Fondation Pour l’Audition: “The launch of the first gene therapy clinical trial for a deafness in France is a major milestone for Fondation Pour l’Audition, which supported the project from its beginning. It embodies our high-level scientific and medical actions and positions France as a key player in this field at an international level. It also embraces our strong ambition to speed up the development of therapies for individuals with hearing disorders.”

    Nawal Ouzren, Chief Executive Officer of Sensorion, said: “The launch of the Audiogene clinical trial is a significant milestone in the development program of SENS-501, a pioneering drug candidate in the field of gene therapies for genetic hearing loss. We are delighted to be continuing our collaboration with the team at the Fondation Pour l’Audition, the research teams at the Hearing Institute and the clinical team at the Pediatric Audiology Research Center at Necker-Enfants Malades Hospital (AP-HP), as part of the AUDINNOVE consortium. This consortium, composed of leading stakeholders, is currently one of the few players worldwide capable of bringing about a technological and medical revolution that offers real hope for all children with congenital hearing loss.”

    Natalie Loundon, Director of the Pediatric Audiology Research Center and a Pediatric Otolaryngologist and Head and Neck Surgeon at Necker-Enfants Malades Hospital (AP-HP), who is the Audiogene clinical trial coordinator investigator, comments: “This project is incredibly innovative and represents a first in the field, raising high hopes for patients with hearing loss. The project heralds the advent of a revolution in the future treatment of hearing loss patients. For this study, DFNB9 patients will be offered an alternative to cochlear implantation. We are already working on widening the indications to include other causes of hearing loss.”

    Christine Petit, Professor at the Institut Pasteur and Professor Emeritus at the Collège de France, added: “This clinical trial, which aims to correct the deficiency in a gene responsible for congenital hearing loss to restore hearing, is based on the pioneering research carried out at the Institut Pasteur in our Genetics and Physiology of Hearing Unit, which involved identifying the genes responsible, elucidating the defective mechanisms and demonstrating the possible reversal of hearing loss in the laboratory. We have been performing research on DFNB9 deafness for around 20 years now. Audiogene assembles a wide range of expertise so that these discoveries can be applied for the benefit of people with hearing loss. There is currently no treatment for hearing loss. The success of this clinical trial should serve as a catalyst in the search for much-needed therapeutic solutions for a whole series of hearing impairments and vestibular disorders.”

    Anne-Lise Giraud, Director of the Hearing Institute, an Institut Pasteur center, concluded: “The Hearing Institute is delighted with this major first, to which its teams, especially those led by Christine Petit and Saaid Safieddine, have made a huge contribution by paving the way for the translation of basic research into therapeutic applications.”

    Multiple technological innovations

    A gene can only enter inner ear cells if it is transported by a viral vector that is capable of crossing the cell membrane. In this case the adeno-associated virus (AAV) is used to deliver the gene. As the OTOF gene is so big, it is divided into two DNA fragments, each transported by an AAV, which are then assembled inside the inner ear cells. This is referred to as a dual AAV vector technology. AAV vectors are harmless and non-pathogenic; they are reliable, well known and do not cause diseases. They are produced using the highest applicable industry standards and approved by health authorities for use in humans. Some are already in use and have been marketed as treatments.

    This work was supported by the French National Research Agency which is funding the France 2030 program entitled RHU AUDINNOVE, ANR-18-RHUS-0007.

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  • Colorado legal settlement would up care and housing standards for trans women inmates

    Colorado legal settlement would up care and housing standards for trans women inmates

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    Taliyah Murphy received a letter in early 2018 about a soon-to-be-filed class-action lawsuit brought on behalf of transgender women like her who were housed in men’s prisons in Colorado. It gave her hope.

    Murphy and other trans women in Colorado had faced years of sexual harassment and often violence from staff members and fellow incarcerated people. They were denied requests for safer housing options and medical treatment, including surgery, for gender dysphoria, the psychological distress that some trans people experience because of the incongruence between their sex assigned at birth and their gender identity, according to the lawsuit.

    “We were targets for victimizing, whether it was sexual assault, extortion, you name it,” said Murphy, who was released from prison in 2020. Most of the time, she added, “The guards just looked the other way.”

    A historic legal settlement called a consent decree, expected to be finalized by early March, would establish two new voluntary housing units for incarcerated trans women, making Colorado the first state to offer a separate unit, according to attorneys in the case. A federal law states such units are prohibited unless court-ordered. The plan outlined in the agreement, which received preliminary approval last fall, would mandate the Colorado Department of Corrections pay a $2.15 million settlement to affected trans women; update its protocols and staff training; improve medical and mental health care; limit cross-gender searches from correctional officers; and require corrections staff to use correct names and pronouns for trans women inmates.

    A state judge held a hearing on the consent decree on Jan. 4 and is expected to finalize it by early March, after she granted an extension to allow more incarcerated women to be notified of the settlement. Approximately 400 currently or formerly incarcerated trans women are eligible to be beneficiaries.

    Housing assignments in U.S. prisons are nearly exclusively based on a person’s anatomy, despite a federal law outlining that the safety concerns of trans people should be taken into consideration when determining placement. That’s because they are significantly more likely than inmates who are not trans to be sexually or physically assaulted while incarcerated.

    “It’s like putting targets on their back,” said Paula Greisen, the civil rights lawyer who filed the class-action lawsuit in 2019 alongside the California-based Transgender Law Center.

    The U.S. Department of Justice found in 2014 that incarcerated trans people are much more likely to experience sexual violence behind bars from staff members and other incarcerated people, with 35% of trans inmates surveyed reporting having been assaulted in the previous 12 months. A 2007 study of trans women in California prisons found that 59% reported having been sexually assaulted during their incarceration, a rate 13 times higher than for others housed in prisons.

    Colorado’s case comes amid a growing number of lawsuits across the country aimed at improving access to gender-affirming care and safety for incarcerated trans people. In a landmark 1994 case, the U.S. Supreme Court ruled that prison officials’ “deliberate indifference” to a prisoner’s safety concerns violates the Eighth Amendment’s “cruel and unusual punishments” clause. Since then, incarcerated trans people have won legal cases against prison administrators in Washington, Georgia, California, and Idaho.

    And while a handful of states, including Colorado, have written policies regarding gender-affirming care and surgery, the barriers to accessing care are often insurmountable — an issue the consent decree hopes to address. California became the first state to establish policies on gender-affirming medical care in prisons, providing gender-affirming surgery starting in 2017. In 2019, a three-judge panel ruled that the state of Idaho was required to perform a surgery officials had previously denied. One incarcerated person in Colorado has had gender-affirming surgery, according to a Department of Corrections spokesperson.

    The Constitution requires jails and prisons to provide the same standard of care available in the community, said Matthew Murphy, an assistant professor of medicine and behavioral sciences at Brown University and a physician who oversees gender-affirming clinical care for the Rhode Island Department of Corrections. (Matthew and Taliyah are not related.)

    “With Medicaid and private insurance increasingly covering gender-affirming care,” he said, “there’s a growing precedent.”

    There were 148 trans women housed in Colorado prisons as of December, according to a Department of Corrections spokesperson, with nine trans women residing in women’s facilities. Before 2018, trans women were housed exclusively with men. The class-action lawsuit relates only to trans women and does not include trans men, nonbinary people, or intersex people.

    The lawsuit was filed after a young trans woman who had previously been housed with girls in a juvenile facility was transferred to an adult men’s prison, where she was brutally raped. Her numerous requests to be housed with other women, citing safety concerns, had been denied. After taking on the woman’s case, Greisen quickly stumbled upon many more trans women who had experienced similar violence. She contacted the Colorado attorney general’s office and governor’s office, but little changed, prompting her to file the class action.

    “The Department of Corrections in every state — it’s like trying to turn around the Titanic. There’s so much bureaucracy,” Greisen said. “You often have to sue to get their attention.”

    The World Professional Association for Transgender Health, the leading professional organization that sets standards for the medical treatment of people with gender dysphoria, recommends an “informed consent model” that allows patients to pursue gender-affirming care, including surgery, without having to undergo extensive psychological counseling.

    But Colorado’s prison system, like many across the country, doesn’t adhere to those standards. Current corrections department policies require trans women to receive multiple recommendation letters from medical and mental health providers to be considered for transition-related surgery. Often, prisons offer gender-affirming care “on paper” but lack qualified providers, making the care impossible to get, according to Matthew Murphy.

    That was the case for Taliyah Murphy, who pursued gender-affirming surgery twice during her incarceration. Murphy went to prison in 2009, after a conviction resulting from an altercation with her abusive boyfriend, according to the lawsuit. Her sentence was reduced in 2013, she said.

    In 2019, she finally received a recommendation for surgery to treat her gender dysphoria from a corrections department psychiatrist. But she was told that her other medical providers didn’t have the necessary training to evaluate her, according to the lawsuit, which halted the process. She received surgical treatment only after her release from prison in 2020, she said.

    Gender dysphoria, left untreated, can result in depression, anxiety, thoughts of self-harm, and suicidality — all of which already affect trans people disproportionately because of the discrimination, stigma, and other social stressors they face. “Those things are generally resolved, or improved at least, by undergoing gender-affirming clinical care — whether that’s medical, procedural, or surgical,” Matthew Murphy said.

    But prison systems are dragging their feet in providing treatment, he said, and a national shortage of gender-affirming care providers and surgeons makes matters worse.

    “And so, people are then forced to go to the courts,” he said.

    The consent decree will create two new voluntary housing options for trans women incarcerated in Colorado to better meet their specific needs and improve their safety.

    A voluntary 100-bed transgender unit, whose development is already underway, will be on the grounds of the men’s Sterling Correctional Facility. For those approved to move to the women’s prison, they will spend a few months in the 44-bed integration unit outlined in the consent decree.

    That adjustment time will be critical for both the cisgender women already housed in the women’s prison and the trans women who are likely leaving traumatic situations in the men’s prisons, said Shawn Meerkamper, senior staff attorney for the Transgender Law Center, who worked on the case.

    “We have seen in other places when folks are just dropped in a really new environment, it can be a sink-or-swim situation,” Meerkamper added.

    Eligibility for the units would be decided on a case-by-case basis by a committee, including medical and psychiatric experts trained in gender-affirming care as well as prison officials, according to the settlement. But regardless of placement, Colorado’s corrections department would still be legally required to provide trans women adequate mental and physical health care.

    “Trans women should not be forced to go to the trans unit or to a women’s prison if that’s not what they want,” Meerkamper said. “And they cannot be punished or retaliated against for refusing to go.”

    In response to the lawsuit, the Department of Corrections has hired an independent medical expert from Denver Health, as well as a gender-affirming care specialist, to help oversee requests for housing assignments and surgical consults.

    Taliyah Murphy hopes the new housing units and improved access to gender-affirming care will allow incarcerated trans women to focus less on safety and survival and more on rehabilitation and planning their lives outside prison walls.

    “We want them to leave better off than they came in and get the care they need,” said Murphy, who is now a small-business owner in Colorado Springs and is pursuing her bachelor’s degree in finance and accounting. “That’s what this is all about.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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