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  • A Different Kind of Father’s Day: Nurturing Mindfulness and Care in the Garden

    A Different Kind of Father’s Day: Nurturing Mindfulness and Care in the Garden

    On Mother’s day, I found myself at my local garden center, where I like to spend the holiday. In fact, my only request each Mother’s Day is to spend some time picking out plants and then finding a home for them in my garden. On this particular Sunday, I overheard another mom talking with her children, beaming as she told them how the garden was her “happy place.” Her delight was contagious, and the children skipped off, eagerly pointing out their favorite blooms, asking if they too could take a plant home. 

    There are many ways that gardening mirrors care work.

    Variations of this scene played out all around me, moms both wanting to and getting to spend the holiday here amongst the teeming plant life. I wondered if the store would look the same in just a few weeks, when Father’s Day rolled around. I hoped that it would.

    Benefits of Gardening 

    There are many ways that gardening mirrors care work. Anyone who has spent an afternoon weeding knows that it can be a thankless task, and that nurturing a seed as it grows into its fullest expression requires patience, consistency, resilience, hope, and a bit of luck. 

    In nature, as in parenthood, awe and beauty proliferate in the process, rather than at any predetermined end point.

    There is an adage among parents that parenting often involves more of the joy-fun than the fun-fun, meaning it can be deeply rewarding and fulfilling, but doesn’t always provide immediate gratification. This is of course true in the garden, too. A fig tree seedling doesn’t immediately bear fruit. An asparagus plant requires three years to root and mature before it is ready for harvest. 

    In nature, as in parenthood, awe and beauty proliferate in the process, rather than at any predetermined end point. Practices that cultivate experiences of awe and an appreciation of beauty positively impact wellbeing. If you ask someone about their most recent experience of awe (which I suggest you do!), they might share a moment in nature: a shooting star in the otherwise inky black sky, the appearance of a rainbow shimmering overhead on an anniversary of a loved one’s passing, the discovery of a robin’s perfectly pale blue eggs. Or, chances are, they will share a moment with a child: a first step, a dimpled smile, a birth. Like any mental muscle, we can train ourselves to look for these moments. Often, all we have to do is step outside. 

    Gardening is an investment in something that needs nurturing. It requires taking seriously the commitment to care for a living thing.

    Studies have shown that gardening has a positive impact on health and wellbeing. Simply spending time in green spaces can measurably reduce stress levels. Time in nature gives our brain an opportunity to engage in what’s called “soft fascination,” a diffuse attentional state in which the brain, freed of an immediate task-demand, can experience relaxation, make new connections, and restore attention. Most of us have had the experience of going on a walk and suddenly coming up with a solution to a previously unsolvable problem or – less dramatically but equally important – returning to our desk feeling refreshed and in a better mood. Parenting is demanding of many resources, not the least of which is attention. As parental stress and the demands of modern parenting increase, it is more and more pressing to identify both sustainable and accessible practices of stress management. Gardens can offer a built-in salve. 

    Further, while gardening can be a quiet, restorative, individual activity, gardening communities abound in the form of CSAs, urban gardens, plant shares, and seed libraries, suggesting that gardening can also feed the social brain. Leisure activities that foster social connection have a particular impact on happiness (the fun-fun!). And, in parenting, having a strong social network is a protective factor for overall health

    There’s something else that differentiates gardening from other activities in nature, though. 

    In fact, fathers who act as primary caregivers experience many of the physiological brain changes previously associated with biological mothers, such as changes in grey matter and restructuring of emotional processing centers of the brain.

    Gardening is an investment in something that needs nurturing. It requires taking seriously the commitment to care for a living thing. It is what gardening represents—about who wants to, gets to, and needs to care for our environment and our fellow human beings, about who enjoys cultivating beauty, about who has the capacity to be patient, gentle, and tender—that makes it a particularly poignant activity for fathers. 

    Dads as Essential Caregivers

    There has been a historic gap in research on fathers’ experiences of parenthood. In her book, Dad Brain, Darcy Saxbe explains how new studies at the intersection of neuroscience and psychology reveal how all of us—not just moms—are predisposed for caretaking. This shows up in the form of neural circuitry that is activated by the act of caretaking, not simply, or even solely reliant upon, experiences of pregnancy and birth. 

    In fact, fathers who act as primary caregivers experience many of the physiological brain changes previously associated with biological mothers, such as changes in grey matter and restructuring of emotional processing centers of the brain. 

    Fathers have much to gain from their role as caregivers. The majority of fathers report deriving significant meaning and feelings of purpose from parenthood. Interestingly—and maybe unsurprisingly—dads who act as primary caregivers also seem to be more vulnerable to the mental health challenges associated with modern parenthood. They, like all parents, need support and access to tools and practices that promote wellbeing. Gardening, with its overall benefit to wellbeing, quality of life, and health, is one such example. In order to meaningfully encourage this we must first acknowledge—and even better, celebrate—fathers’ capacity to nurture, shepherd, and cultivate.

    When we take a father’s role as a caregiver seriously, we not only bolster support systems for children, we also more effectively honor the challenges and benefits of carework in general. 

    Father’s Day is only one day of the year. But holidays reinforce cultural norms and values. Father’s Day traditions can provide a mirror for cultural messaging about a father’s role, needs, and desires, as well as the activities and resources available to them. If we pause to really consider the values we’d like to cultivate as parents, perhaps we might see how an activity like gardening can offer fathers the associated psychological and health benefits, while also reinforcing their essential role within complex networks of care. 

    To be clear, there is no one right or wrong way to celebrate Father’s Day. In fact, there are infinite ways to have a meaningful celebration. Regardless of how we choose to spend the day itself, when we take a father’s role as a caregiver seriously, we not only bolster support systems for children, we also more effectively honor the challenges and benefits of carework in general. 

    And, perhaps by more intentionally including fathers in some of the rituals, communities, and activities that have historically been associated with moms—by inviting them into the garden, so to speak—we can also extend our understanding of who desires, deserves, and has a duty to care for living things. 

    Mindful Gardening Practices For Fathers And Families 

    1. Plant a seed with your child. A single seed is all you need. Plant it outside or on a window sill. Together, check on it daily. Each time you do, share your observations about the teeny, tiny changes you notice as it begins to sprout and grow. 
    2. Go for a senses walk in a garden. Look for all of the colors of the rainbow. Smell the flowers and gently rub edible herbs between your fingers, noticing the fragrance that lingers. Feel the sun, wind, or mist on your face. If there is a clean fruit or vegetable ready for harvesting, do a taste test together, savoring the flavors.
    3. Visit a garden center, join a CSA, volunteer with an urban gardening project, or visit a seed library. These are great activities to do as a family. Introduce yourselves. See what new facts you can discover about native flora, companion planting, dahlia tubers, even cucumber trellises.
    4. Find a sit-spot. Dedicate one place—a window, a tree, a bench—that you can return to weekly. Each time you do, set a timer for 3 minutes (or 30 seconds, if doing this with a small child). Sit silently, noticing the sights, sounds, smells, and your own emotions. Share, draw, or journal your observations.
    5. Invite a father-figure. Consider bringing a fellow father, partner, or a father-figure to a garden experience with you. Share what you love about the garden. Show them where you find beauty, meaning, and awe. While you’re at it, share what you appreciate about them as a caregiver, how they themselves have been a cultivator of growth. 



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  • Genicular Artery Embolization Delivered 12 Months of Knee Arthritis Pain Relief without Surgery in Nearly 200 Patients

    Genicular Artery Embolization Delivered 12 Months of Knee Arthritis Pain Relief without Surgery in Nearly 200 Patients

    For millions of people living with knee osteoarthritis, the current treatment ladder has a frustrating middle step that is largely empty. Conservative measures — physical therapy, NSAIDs, corticosteroid injections — provide relief that wanes over months. Full joint replacement surgery is effective but invasive, carries surgical risks, requires weeks of rehabilitation, and comes with a prosthetic lifespan of 15 to 20 years, making it poorly suited for younger or less medically robust patients who face decades of living with arthritis.

    Between those two rungs is a gap that has driven years of research into minimally invasive interventional options. A study published June 16, 2026, in Radiology — the flagship journal of the Radiological Society of North America — now provides the strongest evidence yet that one of those options delivers a full year of meaningful pain relief and functional improvement for appropriately selected patients.

    “For many patients with knee osteoarthritis, there is a real treatment gap today,” said lead author Florian Nima Fleckenstein, M.D., deputy head of Interventional Radiology Campus Mitte at Charité — Universitätsmedizin Berlin. “Conservative measures such as intra-articular injections no longer provide sufficient relief, but joint replacement is not an option for medical or personal reasons.”

    What Genicular Artery Embolization Is — and How It Works

    Genicular artery embolization (GAE) is a minimally invasive procedure performed by interventional radiologists using fluoroscopy (real-time X-ray imaging) and catheter-based techniques. The procedure targets a specific feature of the arthritic knee joint that conventional treatments have largely ignored: abnormal blood vessel formation.

    According to ScienceDaily’s coverage, in a healthy knee, the synovial tissue and supporting structures maintain a normal, controlled blood supply. In osteoarthritis, the chronic inflammation process triggers the growth of abnormal new blood vessels — called neovascularization — in and around the joint. These pathological vessels contribute to sustained inflammation and pain. Standard treatments target the inflammation downstream; GAE targets the vascular supply driving it.

    During GAE, an interventional radiologist threads a thin catheter through a puncture in the femoral artery, navigates it to the genicular arteries supplying the knee, and injects tiny microspheres that block blood flow to the abnormal vessels. By shutting down these pathological vessels, the procedure aims to reduce the vascular contribution to joint inflammation — producing pain relief and functional improvement without cutting, implanting, or removing anything.

    The version studied in the June 2026 Radiology paper uses rapidly resorbable, gelatin-based microspheres — a key distinction from earlier GAE studies that used permanent microspheres. The resorbable particles dissolve in the body over time, potentially reducing risks associated with permanent vascular occlusion in the lower extremity.

    GAE Radiology Study Key Data (June 16, 2026) Detail
    Published in Radiology (RSNA), June 16, 2026
    DOI 10.1148/radiol.253312
    Lead author Florian Nima Fleckenstein, M.D., Charité – Universitätsmedizin Berlin
    Total patients included 333
    Patients analyzed at 12-month follow-up 272
    Microsphere type Rapidly resorbable gelatin-based microspheres
    Follow-up period 12 months
    Key finding Significant, lasting pain relief + improved functional outcomes + improved quality of life at 12 months
    Safety Established; described as “real confidence” by Dr. Fleckenstein
    Procedure type Minimally invasive; image-guided catheter-based; outpatient
    Comparison No randomized placebo control — observational cohort design
    Global OA knee prevalence (WHO) 365 million adults
    U.S. OA prevalence ~32.5 million adults

    What the Study Found — and Why Scale Matters

    According to the Radiology abstract, 333 patients were included in the study, with 272 analyzed at the 12-month follow-up point. “This lets us speak about safety and efficacy with real confidence,” Dr. Fleckenstein told ScienceDaily. The study used validated outcome measures, including patient-reported pain scores and functional assessments, to document improvement.

    The clinical finding was clear: in patients with symptomatic knee osteoarthritis, GAE using rapidly resorbable microspheres provided long-lasting pain relief, improved functional outcomes, and enhanced quality of life across the 12-month observation period.

    According to Applied Radiology’s analysis, Dr. Fleckenstein framed the study’s significance specifically: “This study addresses osteoarthritis, which is a significant public health issue and the leading cause of chronic pain and disability worldwide. With millions of people affected by knee osteoarthritis, particularly in aging populations, finding effective, minimally invasive treatments is critical.”

    “GAE has the potential to reduce the need for more invasive surgeries, lower healthcare costs and significantly improve the quality of life for countless individuals suffering from knee osteoarthritis,” Dr. Fleckenstein added.

    An important technical caveat: this is a prospective observational cohort study, not a randomized controlled trial with a placebo or sham procedure comparison group. The absence of a randomized control arm means the study cannot fully exclude the placebo effect and selection bias as contributors to the observed outcomes. The evidence base for GAE is growing — including prior trials with permanent microspheres that also showed benefit — but the gold-standard randomized trial with a sham control remains an important next step in confirming GAE’s efficacy.

    Who Is an Appropriate Candidate for GAE?

    The procedure is designed for patients who have osteoarthritis-related knee pain that is no longer adequately controlled by conservative measures (physical therapy, NSAIDs, injections) but who are not candidates for or do not wish to pursue joint replacement surgery. This includes:

    • Patients who are too young or too active for joint replacement (where prosthetic lifespan becomes a concern)
    • Patients with medical comorbidities that increase surgical risk
    • Patients on blood thinners or immunosuppressants that complicate surgery
    • Patients who have declined joint replacement for personal reasons
    • Patients for whom prior injections have provided diminishing returns

    GAE is not appropriate for patients with advanced, end-stage osteoarthritis where the joint has lost virtually all cartilage, nor for patients with inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis), local knee infection, significant peripheral arterial disease, or irreversible coagulopathy. Patient selection is performed by the interventional radiologist in consultation with an orthopedic specialist or rheumatologist.

    The procedure is typically performed in an outpatient or same-day surgery setting under conscious sedation. Recovery is significantly less demanding than joint replacement — most patients resume normal activities within days rather than weeks.

    The Road to Widespread Availability

    In the United States, GAE is currently performed primarily at academic medical centers and major hospital systems with active interventional radiology programs. It is not yet widely available at community hospitals. Insurance coverage is variable; Medicare and many private insurers have not universally adopted coverage policies for GAE, though this is an active and rapidly evolving area given the growing evidence base.

    The June 2026 Radiology study’s scale — 333 patients, 272 analyzed at 12 months — represents the largest body of evidence assembled for GAE using rapidly resorbable microspheres, and it is likely to support additional insurance coverage petitions and professional society guidance updates in the coming months.

    Frequently Asked Questions

    What is genicular artery embolization (GAE)?

    GAE is a minimally invasive procedure where an interventional radiologist uses a thin catheter to navigate to the blood vessels supplying an arthritic knee joint and injects small particles that block abnormal (pathological) vessels. By reducing the vascular contribution to joint inflammation, the procedure aims to provide sustained pain relief without surgery.

    How long does the pain relief from GAE last?

    In the June 2026 Radiology study, significant pain relief and improved functional outcomes were sustained at 12-month follow-up in the 272 patients analyzed. Longer-term follow-up data is still being collected.

    Is this better than cortisone injections?

    Cortisone (corticosteroid) injections typically provide relief lasting weeks to a few months. GAE has demonstrated 12-month sustained benefit in this study and prior research, suggesting it offers more durable relief than repeat injections for appropriately selected patients. However, direct head-to-head randomized comparison with injections has not yet been published.

    What does the procedure involve?

    An interventional radiologist makes a small puncture in the femoral artery, threads a catheter to the genicular arteries of the knee, identifies abnormal blood vessels using imaging, and injects tiny resorbable microspheres that block them. The procedure is performed under fluoroscopy guidance, typically with conscious sedation, in an outpatient setting.

    Is GAE covered by insurance?

    Coverage in the U.S. varies by insurer and is still evolving. Medicare and private insurers are reviewing coverage policies as the evidence base grows. Patients should check with their insurer and the interventional radiology team about coverage and prior authorization requirements.

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  • Pest Control and Pesticide Safety for Consumers

    Pest Control and Pesticide Safety for Consumers

    Source: Environmental Protection Agency
    Related MedlinePlus Pages: Safety

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  • Why Healthy Fast-Food Menu Options Can Backfire

    Why Healthy Fast-Food Menu Options Can Backfire

    Adding a healthy option can actually drive people to make even worse choices, thanks to a mind-blowing glitch of human psychology.

    In 2017, and to much fanfare, menu labeling for calorie counts began to be mandated in national chain restaurants. Consumers should have the information needed to make healthy food choices outside the home, right? It makes sense that caloric information on menus will help people limit their food intake to stay within their daily energy needs. But it didn’t work. It turns out calorie labels are not effective, shaving off an average of eight insignificant calories per meal.

    You could have totally predicted that. Why? Just as one might divine the value of front-of-pack traffic light labeling from the ferocity of the industry response against it, one could probably gauge the futility of calorie labeling by the ease with which some regulations have been passed. McDonald’s voluntarily started publishing calorie information nationally back in 2012 after a labeling mandate in New York City was found to have no overall effect on consumer behavior. Studies suggest such labeling could boost “perceptions of the restaurant’s concern for consumers’ well-being” while carefully not undermining any Big Mac attacks.

    At the same time, McDonald’s announced plans to add seasonal produce to its menu. How cynical do you have to be not to at least recognize that as a good thing? Ironically, adding a healthy option can actually drive people to make even worse choices. Ready to have your mind blown?

    As I discuss in my video Do Healthy Fast-Food Options Lead to Healthier Choices?, if people are offered a choice of side dishes—something unhealthy like French fries or something more neutral like a baked potato—only about 10% of them will splurge for the fries. If an even healthier third option—like a side salad—is added, instead of choosing between an indulgent choice and the more neutral baked potato, people would have their pick of the indulgent choice, the neutral choice, or an even healthier choice. Even if everyone doesn’t choose the salad, more will go for the middle-ground baked potato over the fries, right? So, how much farther does French–fry–fancying fall by adding the salad option to the mix? It shoots up, tripling to 33%. Without the salad option, only 1 in 10 chose the fries, but that jumped to a third of people just at the sight of salad.

    The same thing happens when you offer people the choice between a bacon cheeseburger, a chicken sandwich, or a veggie burger. In a “No Healthy Option” scenario, where people were offered the cheeseburger, a chicken sandwich, or a fish sandwich, 17% chose the burger. Swap out the fish sandwich for a veggie burger, and the bacon cheeseburger preference doubled to 37%. How can just seeing a healthy option push people to make unhealthier choices?

    The paper describing this series of experiments was entitled “Vicarious Goal Fulfillment: When the Mere Presence of a Healthy Option Leads to an Ironically Indulgent Decision.” The thought is that seeing the salad or veggie burger, people make the mental note to choose that at some nebulous next time, thereby giving them the excuse to indulge now.

    There is this fascinating glitch of human psychology called self-licensing. This is when we unwittingly justify doing something that draws us away from our goals after we’ve just done something that brings us towards them, like justifying eating a donut because of last week’s weight loss. We reward ourselves with an indulgence that sets us back.

    If you give smokers “vitamin C” supplements, they subsequently smoke more cigarettes than if you give smokers what you explain are “placebo” pills (even though both groups were given identical sugar pills). The smokers who thought they were taking supplements smoked nearly twice as much, perhaps subconsciously thinking that since they had just done something good for their health, they could afford to “live a little,” which may have, in effect, caused them to live a little…less.

    You can see how this could translate into other lifestyle arenas. Those given placebo pills, which they believed to be dietary supplements, not only expressed less desire to subsequently engage in exercise, but they also followed through by walking about a third less. Compared to those who were told the pills were placebos, the misled participants were also more likely to choose a buffet over what was described as a “healthy, organic meal.” Would they eat more, too? A seminal study entitled “The Liberating Effect of Weight Loss Supplements on Dietary Control” put that to the test.

    Participants were randomized to take a known placebo or a purported weight-loss supplement (which was actually just the same placebo) and later covertly observed at a buffet. Not only did the “supplement” subjects eat more food, but they chose less healthy items. They also ate about 30% more candy in a bogus “taste test” and ordered more sugary drinks. “Hence,” the investigators concluded, “people who rely on dietary supplements for health protection may pay a hidden price: the curse of licensed self-indulgence.”

    Circling back, what the vicarious goal fulfillment studies discovered is that not only does making progress towards a goal rationalize decision-making that undermines us, but even just considering making progress can have a similar licensing effect. Note that the study participants were not only moved to make the unhealthier choice, but the unhealthiest choice. One might assume that even if people didn’t go for the salad or veggie option, the presence of a healthier alternative may have encouraged them to choose something in between—not the healthiest option, but at least not the unhealthiest choice. Instead, it moved people in the opposite direction.

    In another “No Healthy Option” scenario of chocolate-covered Oreos, regular Oreos, or golden Oreos, researchers found that adding a “lower-calorie” Oreo option doubled the likelihood that the study participants would go straight for the most indulgent chocolate-covered option. (See below and 6:10 in my video.)

    This is attributed to another illogical quirk of human psychology, indelicately named the “what the hell effect.” This is when one forbidden cookie can lead dieters to eat the whole bag. Once you’ve already strayed from your goals, well, why not go all the way? So, once people decide they are going to get that salad next time and spoil themselves just this once, they might as well go for the most indulgent choice.

    The halo of healthy foods can even warp our perceptions. Show weight-conscious people a burger and nothing else, then ask them to estimate the calories, and the average answer is 734 calories. Okay, now show folks the exact same burger accompanied by three celery sticks, and they guess the total comes out to 619 calories. Did they think the celery had negative calories? No, most knew the celery had calories, too, but just the juxtaposition of the burger with the celery made the burger seem healthier. The same thing happens when you add an apple to a bacon-and-cheese waffle sandwich, a side salad to beef chili, or some carrots next to a cheesesteak—about a hundred calories appear to disappear, as shown here and at 7:27 in my video.

    Health halo effects may explain why people are more likely to order a dessert and more sugary drinks with a “healthier” sub at Subway versus a Big Mac at McDonald’s, even though the sub used in the study (filled with ham, salami, and pepperoni) had 50% more calories to begin with.

    Even just a reference to healthy foods can do it. Show people a picture of a Big Mac, and people estimate it has 646 calories. Just add the text “For your health, eat at least five fruits and vegetables per day,” and all of a sudden, the same burger in the same ad was thought to only have 503 calories. Merely offering and even promoting salads and fruit can bring McDonald’s accolades and bolster consumer loyalty without, ironically, helping their health.

    Doctor’s Note

    If you enjoyed this blog, you might also like a video I did on optimism bias: Why Don’t People Eat Healthier?

    For more on junk food, see How We Won the Fight to Ban Trans Fat and Ultra-Processed Junk Food Put to the Test.



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  • FDA Approves Xocova (Ensitrelvir): The First Oral COVID Pill You Take After Exposure — Before You Get Sick

    FDA Approves Xocova (Ensitrelvir): The First Oral COVID Pill You Take After Exposure — Before You Get Sick

    COVID-19 is still killing tens of thousands of Americans every year — and for the first time, there is now an FDA-approved oral medication that household contacts of infected individuals can take before symptoms develop to significantly reduce their risk of getting sick.

    On June 1, 2026, the U.S. Food and Drug Administration approved Xocova® (ensitrelvir), an oral antiviral developed by Japanese pharmaceutical company Shionogi, for post-exposure prophylaxis (PEP) of COVID-19 in adults and adolescents 12 years of age and older. It is the first and only oral option approved for preventing COVID-19 after exposure to an infected individual — a distinct and previously unaddressed clinical need.

    What Xocova Is — and How It Differs From Paxlovid

    The distinction between Xocova and Paxlovid (nirmatrelvir/ritonavir) is essential to understand, because they serve different purposes at different points in the COVID-19 timeline.

    Paxlovid is taken after a positive COVID test and symptom onset, to reduce the severity of illness in high-risk individuals who are already sick. It is a treatment for active disease.

    Xocova is taken after exposure to an infected individual, before the person becomes infected or symptomatic — a pre-symptomatic intervention window that previously had no oral pharmacological option in the United States. It is a prophylactic medication, not a treatment for existing infection.

    Mechanistically, both drugs target the same SARS-CoV-2 main protease (3CL protease) — a key enzyme the virus needs to replicate. By blocking this enzyme, Xocova prevents the virus from reproducing efficiently in newly exposed individuals, reducing the probability that a household exposure leads to established infection.

    According to the SCORPIO-PEP trial data published in the New England Journal of Medicine: in the primary endpoint analysis of 2,041 SARS-CoV-2-negative participants, only 2.9% of those in the ensitrelvir group developed symptomatic COVID-19 by day 10, compared with 9.0% in the placebo group — a 67% reduction in risk.

    Xocova (Ensitrelvir) Key Data Detail
    FDA approval date June 1, 2026
    Developer Shionogi (Japan)
    Indication Post-exposure prophylaxis (PEP) of COVID-19
    Age indication Adults and adolescents 12 years and older
    Phase 3 trial SCORPIO-PEP (NCT05897541)
    Primary endpoint result 67% lower risk of symptomatic COVID-19 (2.9% vs. 9.0%)
    Secondary analysis (all participants) 57% risk reduction
    Dosing regimen 375mg on Day 1 (3 tablets); then 125mg on Days 2–5 (1 tablet each)
    Duration 5 days
    Most common side effects Headache, diarrhea, cough (15.1% vs. 15.5% placebo)
    Prior approved COVID post-exposure option None (bamlanivimab withdrawn due to Omicron resistance)
    U.S. COVID cases Oct 2025 – May 2026 3.8–12.4 million (CDC estimate)
    U.S. COVID deaths Oct 2025 – May 2026 13,000–42,000 (CDC estimate)

    How the Trial Worked — and What the Results Mean

    The SCORPIO-PEP trial enrolled 2,387 individuals aged 12 and older who had tested negative for SARS-CoV-2 at enrollment and were living in a household with a confirmed COVID-19 case. Participants were randomized 1:1 to receive ensitrelvir or matching placebo for five days.

    According to AJMC, ensitrelvir was well tolerated — adverse event rates were nearly identical between the ensitrelvir group (15.1%) and placebo group (15.5%), with the most common events being headache, diarrhea, and cough. No serious safety signals were identified.

    A notable feature of the trial population: more than 99% of household contacts already had SARS-CoV-2 antibodies at baseline — meaning nearly the entire study population had pre-existing immunity from prior infection, vaccination, or both. TechTimes noted that the drug performed equally well in this highly immune population, confirming that Xocova’s benefit does not depend on immunological naivety. This is clinically significant: it means the medication is likely to work in 2026’s real-world population, nearly all of whom have some prior COVID immunity.

    Who Should Take Xocova — and When

    The critical timing parameter for Xocova is not yet formally defined by the FDA label as a specific hour cutoff, but the clinical logic — and the trial design — centers on initiating treatment as soon as possible after a confirmed household exposure, ideally within 24 to 72 hours.

    The populations with the most to gain include:

    • Adults 60 and older, who remain at highest risk of severe COVID outcomes
    • Immunocompromised individuals (transplant recipients, patients on chemotherapy, people with HIV, those on long-term immunosuppressive therapy)
    • Adults with significant comorbidities — heart disease, diabetes, chronic kidney disease, chronic lung disease, obesity
    • Residents and staff of long-term care facilities, where up to 47% of household-level contacts develop COVID following exposure to an infected person, according to Shionogi’s prescribing data
    • Adolescents 12 and older in high-risk households

    Anyone in one of these groups who has a confirmed household contact with COVID-19 should contact their healthcare provider immediately to discuss Xocova eligibility. The drug closes a therapeutic gap that has existed since bamlanivimab/etesevimab — the only prior authorized COVID post-exposure option — was withdrawn after proving ineffective against Omicron variants.

    “The approval for COVID-19 PEP was based on data from the SCORPIO-PEP trial, which demonstrated favorable safety and efficacy in uninfected pediatric and adult patients who had been exposed to an infected individual, reducing the risk of symptomatic COVID-19 by 67%,” AJMC reported.

    COVID-19 in 2026 — Why This Still Matters

    The approval arrives at a moment when COVID-19 has become background noise for many Americans but remains a significant cause of illness, hospitalization, and death. The CDC estimates that between October 1, 2025, and May 23, 2026, there were 3.8 to 12.4 million new COVID cases in the United States, resulting in 800,000 to 2.3 million outpatient visits, 120,000 to 240,000 hospitalizations, and 13,000 to 42,000 deaths. Long COVID — which produces lasting neurological, cardiovascular, and respiratory complications — adds a further layer of risk that prevention reduces. Preventing even a percentage of those infections among the highest-risk population represents a meaningful public health gain.

    Frequently Asked Questions

    What is Xocova (ensitrelvir) and what was it approved for?

    Xocova (ensitrelvir) was FDA-approved June 1, 2026, by Shionogi, as the first and only oral medication for post-exposure prophylaxis (PEP) of COVID-19. It is approved for adults and adolescents 12 and older who have had contact with a confirmed COVID-19 case.

    How is Xocova different from Paxlovid?

    Paxlovid is taken after a positive COVID test and symptom onset to reduce disease severity. Xocova is taken after exposure but before infection or symptom onset, to prevent the exposed person from developing COVID at all. They target the same viral enzyme but are used at different clinical moments.

    How effective is Xocova?

    In the Phase 3 SCORPIO-PEP trial, Xocova reduced the risk of symptomatic COVID-19 by 67% compared to placebo in household contacts who were initially SARS-CoV-2-negative, with a secondary analysis showing 57% risk reduction across all participants.

    How do you take Xocova?

    Xocova is a 5-day oral regimen: 3 tablets taken as a single dose on Day 1, then 1 tablet per day on Days 2 through 5. It should be started as soon as possible after a confirmed household exposure. Contact your healthcare provider immediately if you have been exposed.

    Who qualifies for Xocova?

    The FDA approval covers adults and adolescents 12 and older following contact with a confirmed COVID-19 case. People most likely to benefit include adults 60 and older, the immunocompromised, those with significant comorbidities, and long-term care residents and staff. A healthcare provider should assess individual eligibility.

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  • Free Meditation Apps Worthy of Your Attention

    Free Meditation Apps Worthy of Your Attention

    There’s no shortage of mindfulness and meditation apps these days, promising to help you combat anxiety, sleep better, hone your focus, and more. In fact, the Wall Street Journal reports that more than 2,000 new meditation apps launched between 2015 and 2018, and offerings have only increased as a result of higher demand during the pandemic—according to the New York Times, mindfulness apps surged in 2020. We took the overwhelm out of finding the most valuable and easy-to-use meditation apps that are available free and narrowed it down to these five apps.

    Summary

    Mindfulness.com

    • Platforms: iOS, Android, web
    • Highlights: Over 2,000 guided meditations with a customizable “For You” experience, quick mini exercises,sleep aids, and calming soundscapes.
    • Paid Upgrade: Offers Mindfulness Plus+ for enhanced features like daily coaching.

    Insight Timer

    • Platforms: iOS, Android, web
    • Highlights: Massive library of 80,000+ free meditations from 10,000+ teachers, live events, and a global community showing real-time meditation stats.
    • Paid Upgrade: Annual subscription unlocks courses, offline downloads, and advanced player controls.

    Smiling Mind

    • Platforms: iOS, Android, web
    • Highlights: Not-for-profit with structured programs for different age groups and needs, including quick sessions and family-friendly content.
    • Cost: Entirely free with no premium options.

    UCLA Mindful

    • Platforms: iOS, Android
    • Highlights: Developed by UCLA’s Mindful Awareness Research Center, featuring bilingual guided meditations and research-based practices, plus longer “podcast” sessions.
    • Cost: Free.

    Healthy Minds Program

    • Platforms: iOS, Android
    • Highlights: Merges neuroscience with meditation training using a four-pillar approach (Awareness, Connection, Insight, Purpose) and offers micro practices for on-the-go mindfulness.
    • Cost: Free.

    5 Free Meditation Apps We’re Happy We Downloaded

    1) Mindfulness.com

    Available for iOS, Android, and web

    Entry price: Free

    With over 2,000 guided meditations from world-leading teachers, this app caters to both beginners and seasoned practitioners.

    The interface includes five tabs: Mini, where you can find quick and easy mindfulness exercises you can do anytime throughout the day; Meditate, where you’ll find all of the app’s 2,000+ guided meditations; Sleep, which houses restful and relaxing meditations for deep sleep; Radio, where you can find mindfulness music and sound scapes for focus and calm; and finally the For You tab, which is really what makes this app stand out.

    Throughout your use of this app, you’ll be prompted to provide information about your preferences, goals, and the type of support you’re looking for. The app will then offer personalized daily coaching videos paired with guided meditations on the For You tab. You can choose what length you’d like your daily meditations to be—from five to 30 minutes—depending on your schedule and level of practice. Opportunities to dive deeper include meditation courses, expert Q&As, breath work, journaling prompts, and more.

    Whether you’re looking to reduce stress and anxiety or seeking support for overall mental health, the Mindfulness.com app is a solid resource. The multitude of functionalities offered by this app puts your mindfulness journey in your hands and enables you to grow in the direction of your choosing at your own pace.

    Paid option: For $84.99 per year (with a 14-day free trial) or $169 for a lifetime membership, both with a 30-Day money-back guarantee, Mindfulness Plus+ includes: daily mindfulness video coaching and meditations; courses and tools to help manage anxiety, sleep, and stress; over 2,000 meditations, calm music, nature soundscapes, and more.

    Insight Timer - Free Meditation Apps

    Available for iOS, Android, and web

    Entry price: Free

    Insight Timer has a huge library of content: over 80,000 free guided meditations from over 10,000 teachers on topics like stress, relationships, healing, sleep, creativity, and more.

    Right from the beginning, the app feels like a global community—the world map on the home screen shows a collective of 18 million meditators, and announces, “741k today, 7k now.” After you finish a meditation, you’ll learn exactly how many people were meditating “with you” during that time—and by setting your location, you can even see meditators nearby and what tracks they’re listening to.

    Once you find a teacher you enjoy—like Jack Kornfield, Tara Brach, Sharon Salzberg, or Rhonda Magee—you can follow them to make sure you don’t miss any new content. You can also tune in to free talks for life advice and inspiration. For those craving real-time interactions, Insight Timer offers live events every hour of the day to join on a whim or plan into your schedule. 

    You can even sign up to Circle for Teams, one of their newer offerings, which allows you to create circles (read: groups) to meditate in real-time with friends or colleagues.

    If you prefer a quieter meditation, however, you can simply set a timer and meditate to intermittent bells, calming ambient noise, or soothing music.

    Depending on your preferences, Insight Timer’s extensive collection can be either a blessing or a curse—an endless list of choices that leave you overwhelmed or a buffet of tempting options to sink your teeth into.

    Paid option: For $60 per year (with a 30-day free trial), you get access to courses with well-known teachers, the ability to download meditations and listen offline, and advanced player functions like repeat mode and fast forward and rewind.

    3) Smiling Mind

    Free Meditation Apps - Smiling Mind app screenshot

    Available for iOS, Android, and web

    Entry price: Free

    Smiling Mind hits the sweet spot for a free mindfulness app in so many ways. 

    The not-for-profit app features hundreds of meditations, enough to keep you engaged without overwhelming you with choice. They are organized into structured programs like Mindful Foundations (35 sessions), Sleep (6 sessions), Digital Detox (8 sessions), and Stress Management (10 sessions), but you have the flexibility to choose where to start and to easily jump between programs. Most meditations are in the five- to fifteen-minute range, with a few practices up to 45 minutes for advanced meditators. Smiling Mind also offers bite-sized meditations between 2 to 5 minutes for moments when you’re in need of a quick, mindful pause in the day.

    Downloaded by over 5.5 million people, the app also has a variety of specialized programs for families, children and teens of various ages, healthcare workers, and educators (including curricula they can use in the classroom); all developed with the help of psychologists and health professionals.

    While you could use a meditation app as a temporary break from your hectic life, Smiling Mind wants you to take your mindfulness practice off the cushion and into the rest of your day. Interspersed with some of the meditation programs are instructions for “activities” like Journaling Exercise, Go Offline, Where Did My Food Come From, and Count Your Senses. In the Count Your Senses activity, for example, the audio prompts you to bring your attention to your senses by counting things that can be seen, felt, heard, smelled and tasted. 

    Smiling Mind was originally created for kids, so they offer a robust selection of kid- and youth-appropriate mindfulness sessions. 

    Created by a nonprofit by the same name, Smiling Mind is entirely free—so you don’t have the distraction of paid content that’s inaccessible to you as a free user. The app wants to put a “smile on your mind”—and it might just succeed. 

    Paid option: None

    4) UCLA Mindful

    Free Meditation App—UCLA Mindful

    Available for iOS and Android

    Entry price: Free

    If all the research on mindfulness has persuaded you that you need to meditate, the UCLA Mindful app could be a good place to start. 

    Developed by the Mindful Awareness Research Center at the University of California, Los Angeles (UCLA), the app features about a dozen meditations of different types in English and Spanish. You can learn to focus on your breath, your body, or sounds; work with difficult emotions; and cultivate loving-kindness in sessions ranging from 3 to 19 minutes long.

    If you’re new to mindfulness, you might choose to take advantage of their Getting Started section, which offers information on what mindfulness is, how to choose a meditation, which posture is best for your practice, and what research-backed benefits you might expect from it.

    As a bonus, the app also offers longer meditations that it calls “podcasts.” These are half-hour audio recordings of meditations that include talks, typically by UCLA Director of Mindfulness Education Diana Winston, before and after the meditation, as well as plenty of silent practice time. 

    If you’re looking for an app that is heavily grounded in the science of mindfulness, you can put your trust in UCLA Mindful.

    Paid option: None

    5) Healthy Minds Program

    Available for iOS and Android

    Entry price: Free

    Healthy Minds Program Free Mindfulness App

    The Healthy Minds Program app wants to help you develop the skills for a healthy mind—by strengthening mental focus, decreasing stress, and growing resilience, compassion, and better immune health.

    Founded by neuroscientist Dr. Richard Davidson (who also founded the research institute Center for Healthy Minds at the University of Wisconsin-Madison), the app integrates neuroscience and research-based techniques with meditation training to increase overall well-being.

    The framework of the app’s mindfulness and well-being training is organized into four pillars: Awareness, Connection, Insight, and Purpose. Each pillar consists of three to five parts, and each part contains three series and multiple sessions within. For the Connection pillar, for example, the Innate Self-Worth series includes five sessions packaged to foster self-worth (think sessions like Practice Seeing the Good In Ourselves, and Learn Negativity Bias). You have a choice of either a Sitting or Active type of practice—“active” practices include guidance for being mindful while you exercise, or during your commute—and you can customize the length of time (five minutes to 30 minutes).

    The app offers a collection of 27 meditations outside their four-pillar wellness framework, including one-minute Micro Practices for when you’re in need of a brief respite. 

    At times the podcast-style app may encourage more thinking compared to typical guided meditations, but for the listener who is seeking guided meditations with the greater goal to increase awareness, cognition, and well-being, Healthy Minds Program app may be just the ticket.

    Paid option: None 



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  • GLP-1 Drugs Like Ozempic Are Showing a 47 Percent Reduction in Breast Cancer Risk in a Major New Study — and Weight Loss May Not Explain It

    GLP-1 Drugs Like Ozempic Are Showing a 47 Percent Reduction in Breast Cancer Risk in a Major New Study — and Weight Loss May Not Explain It

    The list of conditions that GLP-1 receptor agonists appear to protect against keeps getting longer. These drugs — which include semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), and the newly approved orforglipron (Foundayo) — were originally developed for type 2 diabetes before emerging as transformative obesity medications. Then cardiovascular outcome trials showed they reduce heart attacks and strokes. Then the sleep apnea approval added obstructive sleep apnea to the indication list. Then studies suggested reductions in kidney disease progression, non-alcoholic fatty liver disease, and alcohol dependence.

    And now, a major study presented at the American Society of Clinical Oncology Annual Meeting in Chicago in early June 2026 and reported widely on June 10, 2026 has added breast cancer to the rapidly expanding list of conditions that GLP-1 drugs appear to protect against — with an effect magnitude that has stunned the oncology community.

    The study, which analyzed real-world data from a large cohort of women with type 2 diabetes or obesity who were treated with GLP-1 receptor agonists, found that GLP-1 drug use was associated with a 30 to 47 percent lower risk of developing breast cancer compared to women who did not use these medications. The lower end of that range (30 percent) emerged from analyses adjusted for body mass index and weight change — meaning even when researchers accounted for the weight loss that GLP-1 drugs produce, a significant protective signal remained. This finding strongly suggests that GLP-1 drugs may be protecting against breast cancer through mechanisms that go beyond simply reducing body fat — mechanisms that may include direct anti-tumor effects, reduced insulin resistance and associated growth factor signaling, or anti-inflammatory pathways.

    Why This Finding Is Biologically Plausible

    The biological connection between metabolic dysfunction, obesity, insulin resistance, and breast cancer risk is well established. Adipose tissue (fat) produces estrogen through a process called aromatization, making obesity a direct driver of estrogen-dependent breast cancers. Hyperinsulinemia — the elevated insulin levels that accompany insulin resistance in type 2 diabetes and obesity — activates the insulin-like growth factor (IGF-1) pathway, which promotes cancer cell proliferation and survival. Chronic inflammation from adipose tissue dysfunction activates oncogenic pathways that promote tumor growth.

    GLP-1 receptor agonists address multiple of these pathways simultaneously. They reduce body fat (reducing aromatization and adipose inflammation), improve insulin sensitivity (reducing hyperinsulinemia and IGF-1 signaling), and have direct anti-inflammatory effects. Preclinical studies have also documented direct GLP-1 receptor agonist activity on cancer cell lines, suggesting GLP-1 receptors may be expressed in breast cancer tissue and may mediate direct anti-proliferative effects when activated.

    The study’s finding that the protective signal persists even after adjustment for weight and BMI is the most provocative result, because it suggests the drug’s biological effects — beyond simple caloric restriction and fat mass reduction — are contributing to cancer protection.

    What This Means for the 15 Million Americans on GLP-1 Drugs

    Approximately 15 million Americans are currently prescribed GLP-1 receptor agonists. The vast majority are taking them for type 2 diabetes or weight management. If the breast cancer protective signal seen in this study is confirmed in larger prospective trials and in controlled analyses, it would represent an additional major health benefit of these medications — one that could influence prescribing decisions, insurance coverage arguments, and cancer prevention discussions.

    The researchers caution that this is observational data from a real-world cohort, not a randomized controlled trial. Confounding variables — the possibility that GLP-1 drug users differ from non-users in ways that independently affect breast cancer risk — must be accounted for before these findings can be considered definitive. Prospective studies and potential randomized trials with cancer outcomes as endpoints are now being planned. The Phase 3 ORCA trial of semaglutide in high-risk cancer prevention populations is one ongoing effort that will provide higher-quality evidence.

    For women currently taking GLP-1 drugs for any indication, this study is not a recommendation to take them as cancer prevention without diabetes or obesity indication — rather, it is an important signal that the health benefits of these medications may be broader than previously understood.

    Frequently Asked Questions

    Q: What did the new GLP-1 and breast cancer study find?

    A: A real-world cohort study presented at ASCO 2026 found that women with type 2 diabetes or obesity who used GLP-1 receptor agonists had a 30–47% lower breast cancer risk compared to non-users. The effect persisted after adjustment for weight loss.

    Q: Does this mean women should take GLP-1 drugs specifically to prevent breast cancer?

    A: No. This is observational data, not a randomized trial. The finding is a promising signal that warrants further research, not a clinical recommendation for GLP-1 drugs as cancer prevention outside of established indications.

    Q: Why might GLP-1 drugs protect against breast cancer beyond weight loss?

    A: By reducing hyperinsulinemia, improving insulin sensitivity (lowering IGF-1 signaling), reducing adipose-tissue inflammation, and potentially through direct GLP-1 receptor activity on breast tissue — all mechanisms independent of weight loss.

    Q: Which GLP-1 drugs were included in the study?

    A: The study analyzed GLP-1 receptor agonist use broadly, including semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) among the most commonly used agents. Results were not limited to a specific drug within the class.

    Q: How does this new finding fit with the other cancer data on GLP-1 drugs?

    A: A 2024 Nature Medicine study documented lower incidence of multiple obesity-associated cancers in GLP-1 users. The 2026 ASCO breast cancer study adds specifically to that growing body of evidence suggesting GLP-1 drugs may have broad anti-cancer properties.

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  • GLP-1 agonists: MedlinePlus Medical Encyclopedia

    GLP-1 agonists: MedlinePlus Medical Encyclopedia

    Ahmann AJ, Riddle MC. Therapeutics of type 2 diabetes mellitus. In: Melmed S, Auchus, RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 34.

    Dhatariyan KK, Umpierrez GE, Crandall JP. Diabetes mellitus. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 210.

    Jensen MD, Bessesen DH. Obesity. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 201.

    Moiz A, Filion KB, Tsoukas MA, Yu OH, Peters TM, Eisenberg MJ. Mechanisms of GLP-1 receptor agonist-induced weight loss: a review of central and peripheral pathways in appetite and energy regulation. Am J Med. 2025 Jun;138(6):934-940. Epub 2025 Jan 31. PMID: 39892489.  pubmed.ncbi.nlm.nih.gov/39892489/.

    Moiz A, Filion KB, Tsoukas MA, Yu OHY, Peters TM, Eisenberg MJ. The expanding role of GLP-1 receptor agonists: a narrative review of current evidence and future directions. EClinicalMedicine. 2025 Jul 17;86:103363. PMID: 40727007; PMCID: PMC12303005. pubmed.ncbi.nlm.nih.gov/40727007/.

    Orandi BJ, Aronne LJ. Obesity. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 8.

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  • Chikungunya Outbreaks Are Now Active in Three Different Countries and Territories Simultaneously — and Summer Travelers Are at Risk from the Caribbean to the Indian Ocean

    Chikungunya Outbreaks Are Now Active in Three Different Countries and Territories Simultaneously — and Summer Travelers Are at Risk from the Caribbean to the Indian Ocean

    Summer 2026 has produced an unusual public health picture on the CDC Travel Health Notices page: three simultaneous active travel notices for chikungunya — the mosquito-borne virus known for causing weeks of debilitating joint pain — across three different geographic regions. Suriname, a country on the northeastern coast of South America, has had an active chikungunya outbreak since February 2026. Mayotte, a French territory in the Indian Ocean off the coast of Mozambique, has been under a CDC chikungunya notice since March 10, 2026. And French Guiana, the French overseas territory on the northern coast of South America adjacent to Brazil, received a new CDC travel notice for chikungunya on June 4, 2026 — just 10 days ago.

    Three simultaneous active outbreaks across two continents and the Indian Ocean, all in destinations that receive American travelers during peak summer season, all involving the same virus, and all preventable by a vaccine that most American travelers have never heard of.

    Chikungunya is caused by the chikungunya alphavirus, transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes — the same species responsible for dengue fever and Zika virus transmission. It cannot spread person to person. It requires a mosquito bite for transmission, which means travelers who effectively prevent mosquito bites can protect themselves. But unlike dengue — for which no reliably effective, widely available vaccine existed in the U.S. until recently — chikungunya now has an FDA-approved single-dose vaccine that provides broad, durable protection.

    The Pattern of These Three Simultaneous Outbreaks

    The geographic distribution of the three current CDC chikungunya notices reflects distinct but parallel epidemiological situations. In Suriname, chikungunya has been circulating since at least February 2026, consistent with the country’s tropical climate that supports year-round Aedes mosquito activity. Suriname borders Guyana to the west, Brazil to the south, and French Guiana to the east — meaning outbreak activity in Suriname creates risk for cross-border spread to adjacent territories, and the French Guiana notice issued June 4 is likely connected to regional transmission dynamics that began in Suriname and Brazil.

    Mayotte’s chikungunya outbreak is separate in origin — the island’s subtropical Indian Ocean climate creates independent conditions for Aedes activity, and chikungunya has a well-documented history of large outbreak cycles in Indian Ocean territories, including the catastrophic 2005–2006 outbreak in La Réunion that infected nearly one-third of the island’s population.

    What these three outbreaks share is the presence of Aedes aegypti or Aedes albopictus at epidemic transmission levels, a population of susceptible individuals without prior immunity, and the current arrival of the summer travel season, which increases the probability of importation to the United States via returning travelers.

    What Chikungunya Does to the Human Body

    The word chikungunya comes from the Makonde language of Tanzania, meaning “that which bends up” — a reference to the stooped posture that patients adopt in response to severe joint pain. The description is medically accurate and experientially unforgettable. After an incubation period of 2 to 12 days following a mosquito bite, patients develop sudden high fever — often above 103°F — accompanied by polyarthralgia, the simultaneous severe painful inflammation of multiple joints. The hands, wrists, ankles, and feet are most commonly affected, and the pain is frequently described by patients as worse than anything they have experienced. Many cannot walk, dress, or grip a cup.

    The acute phase typically lasts 7 to 10 days. Most patients recover. But approximately 25 to 50 percent of people infected with chikungunya develop chronic post-chikungunya arthritis — persistent joint pain that continues for months to years after the initial infection has resolved. This is the longest-lasting and most debilitating consequence of chikungunya, and it disproportionately affects older adults and those with pre-existing joint disease.

    The Vaccine That Travelers Are Not Getting

    The FDA approved Ixchiq (chikungunya vaccine) in November 2023 for adults 18 and older at increased risk of chikungunya exposure. Ixchiq is a live-attenuated, single-dose vaccine that requires no booster and has demonstrated strong immunogenicity and an acceptable safety profile in clinical trials. It is available through travel medicine clinics and many primary care providers.

    Despite its approval, Ixchiq remains significantly underutilized among American travelers to chikungunya-endemic and outbreak-affected regions. Awareness of the vaccine’s existence is low among both patients and some general practitioners who do not specialize in travel medicine. Travelers heading to Suriname, French Guiana, Mayotte, or any of the many Caribbean and South American destinations currently experiencing elevated chikungunya activity should specifically ask about Ixchiq at their travel medicine consultation.

    The vaccine requires at least 28 days to induce full protection, so travelers should plan accordingly — those departing within 28 days should be advised to rely on intensive mosquito bite prevention while the vaccine becomes effective, or may not benefit from vaccination for their current trip. As with all mosquito-borne disease prevention, repellent use, protective clothing, air conditioning, and bed nets remain essential complements to vaccination.

    Frequently Asked Questions

    Q: Where are the current chikungunya outbreaks with CDC travel notices?

    A: As of June 2026, active CDC chikungunya travel notices cover Suriname (February 2026), Mayotte, a French Indian Ocean territory (March 10, 2026), and French Guiana (June 4, 2026).

    Q: What are the symptoms of chikungunya?

    A: Sudden high fever and severe polyarthralgia — simultaneous joint pain in multiple joints, especially the hands, wrists, ankles, and feet — beginning 2 to 12 days after a mosquito bite. The pain is frequently described as the worst the patient has ever experienced. Most cases resolve within 7 to 10 days, but 25–50% develop chronic joint pain lasting months to years.

    Q: Is there a vaccine for chikungunya?

    A: Yes. Ixchiq is an FDA-approved single-dose live-attenuated vaccine for adults 18 and older. It was approved November 2023 and is available at travel medicine clinics. It requires approximately 28 days to become fully effective.

    Q: Who should get vaccinated against chikungunya before travel?

    A: Adults 18 and older traveling to areas with active chikungunya transmission who will have outdoor exposure to mosquitoes. This currently includes travelers to Suriname, French Guiana, Mayotte, and other active outbreak areas.

    Q: How is chikungunya different from dengue fever?

    A: Both are transmitted by Aedes mosquitoes and cause fever. Chikungunya is distinguished by the severe arthralgia (joint pain) that dominates its clinical picture and can persist for months to years. Dengue more commonly causes a characteristic rash, severe headache, and potentially hemorrhagic complications.

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  • Vagus nerve stimulation: MedlinePlus Medical Encyclopedia

    Vagus nerve stimulation: MedlinePlus Medical Encyclopedia

    After the surgery, you may stay overnight or go home on the same day. You will have two wound dressings, on your chest and on the left side of your neck.

    You may have pain for a few days and feel a slight bump where the device was placed. Your provider may prescribe pain medicines. If you have been given antibiotics, take them as instructed.

    Do not take baths, swim, or use a hot tub until your provider approves. You may be allowed to have sponge baths with your incision covered.

    Avoid wearing tight clothes that could rub on your incision. Change your dressing as advised. Wash your hands with soap for at least 20 seconds before and after changing your dressings.

    Check your incision for any signs of infection, such as redness, swelling, increased pain, warmness, or pus.

    Your stitches will be absorbed on their own.

    Ask your surgeon if you need to avoid driving or using any machinery.

    You will have a follow-up visit to program the device in 2 to 4 weeks. The device is set to deliver stimulation at a certain frequency for a specific time at regular intervals. The device is usually set at low levels at first to see how your symptoms respond.

    You will be given a handheld magnet to use at home:

    • Sweeping the magnet over the device delivers extra stimulation.
    • Removing the magnet makes the device resume the programmed stimulation cycle.
    • This allows you to control the device as needed.

    For example, if you have epilepsy, and a seizure is about to happen, you can swipe the magnet to send an extra burst of stimulation.

    You will need regular checkups so your device can be monitored. Your provider will check:

    • That the device is in the correct position and working properly
    • The number of stimulations delivered
    • If the programming needs to be adjusted
    • How much power is left in the batteries

    Check with your provider before having any imaging, such as an MRI, as it may interfere with the device.

    Be sure to go to all of your follow-up visits as long as you have the device.

    Side effects can occur due to nerve stimulation and are temporary. When you first start using VNS, you may notice:

    • Hoarseness or a change in your voice
    • Mild coughing
    • A tickling sensation in your throat
    • Shortness of breath
    • Pain in your neck or throat
    • Nausea, vomiting
    • Difficulty swallowing or speaking
    • Tingling or prickling sensation in the skin
    • Headaches
    • Difficulty sleeping or worsening of sleep apnea

    These side effects usually improve with time.

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