Closer Look
Opinion: From hospitals to the halls of Congress, advance directives have a role to play
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We're all familiar with advance directives, in which people state their wishes for their care when they can no longer speak for themselves. The law formalizing this process in hospitals arose after a Supreme Court decision about a young woman who was left in a permanent vegetative state after a car accident. Justice Sandra Day O'Connor's opinion lamented that Nancy Cruzan had not formally expressed her preferences for life-sustaining therapy in advance.
What if there were directives not just about the end of life but of political service? "As a physician I have seen medical care continue too long when burdens outweigh any hope of benefit," medical ethicist Joseph Fins writes in a STAT First Opinion. "And recently, as a citizen watching Sen. Mitch McConnell's 20-second freeze and Sen. Dianne Feinstein's alarming committee meeting, I have seen distinguished careers that may have gone on for too long." Read more on his solution.
health
Study documents brain damage in young athletes
In a brain bank study of athletes who played contact sports and died before their 30th birthdays, evidence of brain injury was found in 41.4% of them, a new paper in JAMA Neurology reports. Nearly all of the 63 out of 152 players had early stages of chronic traumatic encephalopathy, a condition Boston University researchers have linked in professional athletes to repetitive head impacts. The new work confirms that CTE can occur in young athletes, too, including the first woman diagnosed, a 28-year-old college soccer player. Other sports included American football, ice hockey, soccer, rugby, and wrestling.
Brain bank studies don't represent the wider population (donations are made because brain damage is suspected). The young people also had such issues as depression (70.0%), apathy (71.3%), difficulty controlling behavior (56.8%), and problems with-decision making (54.5%). Suicide was the leading cause of death, followed by drug overdose.
Infectious disease
CDC: Risk of malaria in the U.S. 'remains very low'
A week and a half ago, a single case of locally acquired malaria was reported in what's known as the National Capital Region of Maryland. That attracted attention because most cases arise another way: imported into the U.S. by people traveling from countries with malaria transmission, many in sub-Saharan Africa or South Asia. Before this year's Maryland example, locally acquired mosquito-borne malaria had not been detected since 2003.
Yesterday the CDC updated cases of local transmission in Florida and Texas unrelated to the Maryland one. Florida has identified seven cases and Texas has identified one case of locally acquired P. vivax malaria, but there have been no further reports of local transmission in Florida or Texas since mid-July. "The risk to the U.S. public for locally acquired mosquito-transmitted malaria remains very low," CDC said, but health care providers are advised to be alert for patients with high fevers, chills, headache, muscle pain, and fatigue.
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