The opioid crisis may be far worse than thought, making the epidemic harder to fight

artisteer/iStockBY: Dr. Yalda Safai

(NEW YORK) -- There may be a gross underreporting of opioid-related death rates, leading to misrepresentation about the extent of the epidemic, according to a new study.

A substantial share of the documentation on fatal drug overdoses may be missing information on the specific drug that caused the overdose.

 The study, published in the journal "Addiction," looked at a total of 632,331 drug overdoses between 1999 and 2016. Of these deaths, 78.2% were drug overdoses with known drug classification and 21.8% were unclassified drug overdoses. Of the unclassified drug overdoses, further investigation revealed that 71.8% involved opioids, translating to 99,160 additional opioid-related deaths.

There were over 70,000 drug overdose deaths in 2017, according to an estimate from the Center for Disease Control and Prevention. Based on findings from the new study, over half of those deaths -- about 47,000 -- are suspected to have involved opioids.

An issue with documenting drug overdose deaths

"The number of deaths from opioid-related overdoses could be 28% higher than reported due to incomplete death records," said Elaine Hill, Ph.D., an economist and assistant professor at the University of Rochester Medical Center Department of Public Health Sciences and senior author of the study.

"Other work has already exposed the ways in which coroner versus medical examiner systems undermine accuracy in death records, but the opioid crisis and our research highlights the extent of the problem," Hill told ABC News.

Death certificates issued after fatal drug overdoses are often missing information on the specific drug involved -- something that is causing the underreporting of opioid-related deaths and downplaying the extent of the opioid epidemic, the authors of the new study concluded.

"The risk of underreporting these cases is to underscore the scope of the current crisis which could lead to a slower or less intensive response in coming up with a viable solution," says Dr. Shailinder Singh, an emergency room psychiatrist practicing in New York City.

Besides overdose deaths, there are other consequences of the opioid epidemic including increased risk of infectious disease among IV drug users, a greater number of newborns with neonatal abstinence syndrome and higher rates of emergency department visits for opioid involvement.

While the majority of overdose-related deaths in the past have involved an opioid, with illicit fentanyl as the primary driver of these deaths, however this data is likely underreported.

 The rate of non-fatal overdoses has also increased and is likely underestimated. "Unless these individuals are able to receive urgent medical care and the case is reported in that manner, there is little incentive for a person to report the overdose themselves due to fear of possible litigation or stigmatization," said Singh.

Three phases of the opioid epidemic

The opioid epidemic today progressed in three phases, according to the CDC. The first, involved deaths caused by prescription opioids, the second, an increase in heroin use, and the third, a surge in the use of synthetic opioids or fentanyl.

The United States is right in the middle of the third phase of the epidemic, due to the increasing availability of fentanyl and increasing rates of overdose deaths involving synthetic opioids.

 In 2017, West Virginia, Ohio, Pennsylvania and Washington D.C., had the highest overdose death rates in the country. However, accurate data is not being collected from rural areas and therefore these areas receive significantly less federal funding to combat the crisis.

"The rates of both lethal and non-lethal overdoses have undoubtedly increased due to the addition of synthetic opioids available as pills or mixed in with heroin," said Singh.

"Most notably, these include illegally manufactured fentanyl and carfentanil, which are 50 times and up to 5,000 times more potent than heroin, respectively." he added.

As the U.S. faces a rise in the number of overdose deaths involving heroin and fentanyl, the federal government has readjusted its strategy to combat the epidemic. This includes expanded access to treatment medications for opioid use and to the opioid overdose antidote, naloxone.

Also crucial among those efforts is collecting accurate data. Correct data regarding deaths from opioids is critical to know when implementing policies. Federal funding is also highly dependent on accurate statistics.

"Funding from federal agencies is often tagged to areas with the highest rates of opioid mortality. If these data are inaccurate, then areas in need may receive less funding than they need to address the crisis," said Hill.

Yalda Safai, MD, MPH, is a psychiatry resident in New York City. Melanie Graber, MD, is an internal medicine resident in Connecticut. Both are contributors to the ABC Medical News Unit.

Copyright © 2020, ABC Audio. All rights reserved.

Coronavirus could lead to drug shortages in US

busracavus/iStock(NEW YORK) -- As the novel coronavirus paralyzes large chunks of China's economy, another possible result from the outbreak could strike closer to home for many Americans: shortages of lifesaving medication.

The U.S. relies on China for electronics, clothes, toys and, increasingly, prescription drugs. About 90% of the active ingredients used by U.S. companies in drug manufacturing come from China, which has prompted politicians and public health experts to express concern over potential shortages of common generics.

To date, manufacturing disruptions caused by the novel coronavirus, or COVID-19, haven't led to reported shortages in the U.S., but the Food and Drug Administration said it's closely monitoring the situation.

The FDA said earlier this week it was tracking about 20 drugs that are manufactured primarily in China. Depending on the drug, stockpiles lasting weeks, perhaps months, have been warehoused, according to supply chain experts.

But "it's an issue now," said David Jacobson, a professor of practice at Southern Methodist University's business school. "If China isn't in a position to turn [drug manufacturing] around … then we don't have an alternative source from which to source them."

Michael Wessel, commissioner of the U.S.-China Economic and Security Review Commission, said generic antibiotics and blood pressure meds could be among those first affected.

"We don't know exactly which products are going to be short," said Erin Fox, senior policy director of drug information and support services at the University of Utah Health. But, she added, for many Americans, stockpiling a two-week supply, no different from preparing for a long vacation, may be a good idea.

"We don't want people to panic," Jacobson said, but "patients might try to position to have a couple months ahead just in case. We do have to recognize that if everybody tried to do that, it would exacerbate the problem, but that's what I would have my family do."

Wessel said although "hoarding is something we should avoid," with most providers, "it's pretty hard in this day and age to stock up when your insurance company will limit you to a 90-day supply."

The coronavirus outbreak has highlighted a "substantial and potentially threatening reliance on China with our drug supplies," Wessel added. "As production in China has been taken offline, the supplies of those products that go into 90% of the generics Americans take are at risk."

As China's government continues work to contain the epidemic, it's also possible drugs or related products previously earmarked for export will be used locally.

"China is going to treat its own people first -- any country would do that," Wessel said. "We shouldn't blame them for that. But because we are so dependent on them for those, the question is going to be whether there is going to be treatments available for citizens across the globe."

As coronavirus diagnoses wane, and as more factories in China reopen, potential risks to supply chains also should decline, experts told ABC News.

"I think we'll have a much better idea in eight to 12 weeks," Fox said. "I think it's important not to panic, but I think it's a good idea to have a couple of weeks on hand of chronic medications. That's never a bad idea."

Copyright © 2020, ABC Audio. All rights reserved.

Social media exposure may exacerbate eating disorder

alexsl/iStock(NEW YORK) -- Katherine Ormerod remembers when she first signed up for Instagram.

Even more than that, she remembers how it made her feel.

"I was asked by my boss to set up a social media account -- it became part of my professional life -- but soon I realized it was having detrimental impact on my body," Ormerod told ABC News. "I never had big problems with anorexia, but I just never felt good about my body because of social media."

Ormerod, an influencer who authored Why Social Media is Ruining Your Life, said that she realized during a trip with friends what was she was seeing -- and what she was posting -- didn't tell the whole story, and "something inside me just snapped."

"We spent so much time talking through personal and professional struggles," she said, describing her trip, "but then I scrolled through the pictures and it was only margaritas, sunsets and this easy-looking life."

Similarly, other influencers and bloggers and public figures who post to social media raving about the latest diet trends or clean eating aren't always sharing the whole picture -- and in doing so, may be creating potentially harmful scenarios.

Some people are at risk of developing an unhealthy obsession with exercise or clean eating, according to some experts, who've dubbed such a condition Orthorexia Nervosa.

"Orthorexia is not an official Diagnostic and Statistical Manual diagnosis, however we are hearing about this more and more recently from clinicians," Claire Mysko, chief executive officer of the National Eating Disorders Association, told ABC News in an interview.

Orthorexia Nervosa was coined in 1997 by Dr. Steven Bratman, a physician practicing alternative medicine. Bratman noticed that while healthy diets had been adopted by some in lieu of medications, certain individuals became obsessed to an unhealthy degree.

Young adults, particularly women, are most at risk for eating disorders, "but it could really be anyone," said Shelley Kendra, R.D., L.D.N., the clinical nutrition manager at UPMC Magee-Women's Hospital. "There are also men out there with eating disorders -- so I don't think it singles out anyone -- but young adult women may be more predisposed."

Among environmental triggers that fuel restrictive eating, social media may be the most influential.

"We are being bombarded with messages about what is healthy," Mysko. "It is a more confusing landscape for people to navigate as more and more products and trends are being placed in the category of health and wellness by companies."

Orthorexia can create a significant amount of distress. Somewhat ironically, being overly dedicated to healthy eating can jeopardize one's health.

Even without an official diagnosis, orthorexia can cause permanent damage reminiscent of anorexia nervosa or bulimia -- increased risks of malnutrition and heart disease, negatively affected cognition and fertility, and a weaker immune system.

Orthorexia also may be tougher to spot in an individual because healthy eating is so frequently applauded.

An estimated 8.4% of women and 2.2% of men grapple with an eating disorder at some point of their lives. The earlier an intervention can happen, the better the chance for a speedy recovery.

"Ask yourself whether your attitude around food and body image is unhealthy -- whether it is difficult to engage with others and feel good about yourself," Mysko said.

Although it's important to be aware of how much time and energy are spent on food selection, "each patient's treatment is extremely individualized," said Kendra, adding that it's vital to "figure out the triggers and what their thoughts are to help overcome their barriers."

And it's important to understand how those triggers and barriers are influenced by, well, influencers.

"What people are seeing is not a reflection of a lived life -- it's a highly edited best 1%," Ormerod said. "When I'm shooting for my girlfriends, we can take 300 or 400 pictures, and of that we will choose one. If you put your very best next to your very worst, they can look unrecognizable from each other."

Parents have a key role to play in how online content seen by their children potentially affects their eating habits and how they view themselves.

"The problem," Ormerod continued, "is we are very harsh on ourselves, and when we look in the mirror we hone in on what is the 'worst' and compare that to what people post as their very best."

"You are what you eat. It's called a feed for a reason, and I think the way we feed our brain and the content we put in has a massive impact on our mental health. Look at 'diet' as part of what you're doing with social media," she said.

If you or someone you know is in crisis, please call the toll-free National Alliance on Mental Illness helpline at 800-950-NAMI. For more information on eating disorders, including warning signs and how to find support and help, visit the National Eating Disorders Association website.

Copyright © 2020, ABC Audio. All rights reserved.

Mom dances with 2-year-old son in case his wedding day never comes

Samantha Duran(NEW YORK) -- Call it a just-in-case dance.

Just in case 2-year-old Maddox Duran's wedding day doesn't come. Just in case the cyst the toddler has on his spine could herniate his brain stem and ultimately take his life.

Little Maddox was born with spina bifida and has had 17 surgeries in his short life. He has epilepsy and is tube-fed. But it's the cyst that currently has his mom, Samantha Duran, most fearful.

In a video she posted to Facebook, she wrote in part, "Last April, we got the worst news of our life and it's been nothing but a roller coaster of emotions since then. We were told that the cyst Maddox has on his spine could herniate his brain stem and ultimately take his life. I've updated recently that we are currently in limbo. However, a flood of emotions has taken over my mind and body since last April. One of the thoughts that I had was that I might never get to have my Mother-Son dance with my special guy at his wedding because we're not sure if that day will come. So I bought a dress. Maddox got a little suit - complete with vest and bow tie, of course - and we did it. We had our dance. I will remember these 2 minutes for the rest of my life. "

Duran told ABC News' Good Morning America that Maddox is "hard not to fall in love with." The Pennsylvania mother of three described him as nosy and sweet.

"He loves to cuddle and steal your sunglasses," she said. "He's the cutest thing."

The duo's video is touching many on social media. Duran said the family is all about "making memories" with Maddox and she's received messages that it's inspiring others to do the same.

Still, the family faces an uncertain future. After his last surgery, his doctor told Duran and her husband that the surgery -- one he's had multiple times -- would be more difficult going forward. The recovery is hard on the little boy. Duran said the next one would be the last. They have made his funeral arrangements already so they won't have to if the time comes.

But for now, "we're letting him live his best life and making the memories we can," she said.

And even though Maddox doesn't speak, he and his mom communicate just fine.

"He says volumes," Duran said.

Copyright © 2020, ABC Audio. All rights reserved.

Stars wear masks amid coronavirus warnings -- but experts say most don't need them

XiFotos/iStock(NEW YORK) -- Famous stars are showing off the way they are protecting themselves while traveling amid warnings and public speculation regarding coronavirus.

A day after the Centers for Disease Control and Prevention warned Americans to prepare for a "significant disruption" from the virus, celebrities including Kate Hudson and Gwyneth Paltrow showed off on social media the face masks they sported while traveling.

Many similar images have circulated across the Internet lately, with public concern over coronavirus increasing daily.

At a news conference Tuesday, Dr. Nancy Messonnier, director of the U.S. Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said, "Ultimately, we expect we will see community spread in this country."

Many followers took to the comments on Hudson's post to question whether or not these masks are effective.

Paltrow used a somewhat less serious tone in her caption, referencing her role in 2011 movie, "Contagion" in the caption.

"En route to Paris. Paranoid? Prudent? Panicked? Placid? Pandemic? Propaganda? Paltrow's just going to go ahead and sleep with this thing on the plane. I've already been in this movie. Stay safe. Don't shake hands. Wash hands frequently. 😷" she wrote.

Experts told Dr. John Smith of the ABC News Medical Unit that wearing masks are not necessarily beneficial to many.

"There isn't a lot of data to support if there is any benefit to wearing a mask in the public setting. It is currently unclear," Dr. Jonathan Grein, a board-certified infectious disease physician and director of Hospital Epidemiology at Cedars-Sinai Medical Center in Los Angeles, told ABC News.

The masks might even bring about negative effects.

"The mask itself can become contaminated and serve as a source of infection, actually doing more harm than good," Dr. Jonathan Grein added. "If wearing a mask, I caution touching it."

The CDC also doesn't recommend to the general public using facemasks as a method of protection from coronavirus or other respiratory illnesses.

"You should only wear a mask if a healthcare professional recommends it," the CDC said. "A facemask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected."

Health care professionals treating and dealing regularly with those affected must wear protective masks, specifically N95 medical respirator masks.

Dr. Henry Wu, assistant professor of infectious disease at the Emory University School of Medicine and former medical epidemiologist at the CDC, told ABC News, "Masks are not recommended for general protection if you are not ill."

ABC News Chief Medical Correspondent Dr. Jennifer Ashton advised following "basic common sense precautions" for protection.

"Apply hand hygiene -- washing your hands regularly with soap and water. If that's not available, an alcohol based hand sanitizer, avoiding touching your mouth or face, avoiding contact with people who are known to be ill, staying home, if possible, if you're sick," she said. "And when you talk about infectious diseases for which we do have a vaccine, like influenza, it's not too late to get a flu vaccine."

Dr. Anne Schuchat, Principal Deputy Director of CDC, appeared on "Good Morning America" Wednesday to discuss the outbreak and ways in which to protect oneself.

"This is a respiratory virus and we think it's spread through respiratory droplets -- coughs and sneezes and so forth -- so those sensible measures we talk about every year with the flu are important steps that you can take."

"Cover your mouth and nose when you cough or sneeze," she shared. "Stay home when you're sick, and wash your hands. It's a great reminder that washing your hands is a good prevention step for respiratory viruses. "

Recommendations, information and more health guidelines surrounding coronarvius can be found here.

President Donald Trump is planning a news conference at the White House with Centers for Disease Control representatives at 6 p.m. Wednesday.

Copyright © 2020, ABC Audio. All rights reserved.

Scotland poised to become 1st country to provide free period products, including tampons and pads

iStock/NARONGRIT(EDINBURGH, U.K.) -- Scotland is on the verge of a historic first as it is poised to become the first country in the world to give period products to all women for free.

The Period Products (Free Provision) Scotland Bill received 112 votes in favor Tuesday in the Scottish Parliament. Members of Parliament can now propose amendments to the legislation, according to Reuters.

The bill would provide free period products to "anyone who needs them," according to the Scottish Parliament's website.

"Women and girls are too often left behind in the political process," the bill's sponsor, Monica Lennon, said Tuesday in Parliament. "This is a chance to put them first and to do something that is truly groundbreaking on gender equality."

"The bill will ensure free universal access to period products for anyone who needs them, and it will place a duty on schools, colleges and universities to make free period products available in toilets," she said. "Menstruation is normal, free universal access to tampons, pads and reusable options should be normal, too."

"Period dignity for all is not radical or extreme, but is simply the right thing to do," Lennon said.

Three years ago, in 2017, Scotland began offering sanitary products in schools, colleges and universities, becoming the first country in the world to do so, according to The Associated Press.

In the United Kingdom, 10% of girls are unable to afford menstrual supplies, according to a 2017 report by Plan International, a girls' rights organization.

In the U.S., where women make up more than half of the population, women are more likely than men to live in poverty, and they spend an average of 2,535 days in their lifetime, or almost seven years, on their periods, according to UNICEF.

A survey released last year of low-income women in St. Louis, Missouri, found nearly two-thirds couldn’t afford menstrual hygiene products in the past year, and more than one in five said they had the same problem every month. The women said they instead had to use cloth, rags, tissues, toilet paper and sometimes diapers or paper towels, according to the report published in Obstetrics & Gynecology.

Poor menstrual hygiene does pose health risks for women, including reproductive issues and urinary tract infections.

The taboo around menstruation and the lack of access to menstrual products also hurts women economically because it costs them money for products and may keep them from jobs and school, advocates say. It also sets women back mentally and in a society where something that happens to them naturally is demeaned or even not discussed.

"Most of us have been conditioned for all of our lives to not talk about menstruation," said Jennifer Weiss-Wolf, a lawyer and author of "Periods Gone Public," told "Good Morning America" last year. "And the things that keep us potentially from succeeding are often the things that happen to be what we don’t talk about in polite society."

New York Rep. Grace Meng, has two bills on menstrual equity currently pending in Congress.

Meng's "Menstrual Equity for All" bill also proposes changes like requiring corporations of 100 employees or more to provide free menstrual products to employees. Her "Menstrual Products Right to Know" bill would make tampons and pads just like most other products where manufacturers are required to list out their ingredients.

Both of those bills are still pending in the House, while legislation she worked on in the last Congress that would allow people to use health savings accounts to buy menstrual products passed the House but was never taken up in the Senate.

"I don’t want to, as I [did when I] grew up, feel like I have to hide my product up my sleeve as I’m walking through the halls of school or the office toward the bathroom," Meng told "GMA" last year. "This is a natural part of being a human being and I don’t want people to be ashamed of it."

Copyright © 2020, ABC Audio. All rights reserved.

Video-game therapy may help treat ADHD, study finds

Rouzes/iStock(NEW YORK) -- A new video-game therapy has shown promise in treating attention-deficit hyperactivity disorder in children, according to a new study.

"This study is designed to assess whether the video-game therapy works -- specifically, to see if it improves attention -- and the video game did just that," said Dr. Scott Kollins, a professor in psychiatry and behavioral sciences at Duke University and co-author of the study, which was done in collaboration with 20 U.S. research institutions.

The video-game treatment is not yet "an alternative to good, existing treatment, but it is promising," Kollins added. "We still need to see the best way this would fit into the overall clinical picture. But the more tools we have, the better."

Symptoms of ADHD include difficulties in sustaining attention, impulsivity and restlessness that results in functional impairment.

About 4.4% of people in the U.S. and 3.4% globally have been diagnosed with ADHD, the most common childhood mental condition and one that often lasts into adulthood.

About 8% to 12% of school-aged children have ADHD, which also is more common in boys than in girls. Nearly three-quarters of those diagnosed see the condition last into adulthood.

ADHD typically is treated first with medications. Untreated ADHD, experts have said, often creates problems in familial, social and educational situations.

Successful ADHD treatments also tend to include therapeutic components, such as cognitive-behavioral therapy, which retrains people in how to think and how to act in particular situations.

While the combination of medication and behavioral therapy has proven effective, Kollins and his colleagues pointed out that not everyone has access to these treatments. Additionally, many parents are often reluctant to put children on medications.

The study focused on video-game therapy suggests that it can help lessen ADHD symptoms in children with minimal side effects.

Researchers developed a video game designed to improve attention in children by creating multitasking challenges adapted to their individual skillsets. In the study, 350 children ages 8 to 12 who had ADHD but hadn't yet been prescribed drugs were divided into two groups -- one that used the newly created video-game therapy, and another that played a regular video game.

The children in each group spent four weeks playing their assigned game for 25 minutes per day, five days per week. Data showed that the children who played the new video-game therapy had significant improvements in attention scores compared with the control group.

A similar study that examined children who still were taking medication showed similar results. Side effects of the video-game therapy included headaches and frustrations.

"The number of side effects in the trial was very low, especially compared to a pharmacologic trial," Kollins said. "Also the intervention is easy to access, as opposed to a qualified provider, which is difficult to access in many areas and communities. This video game is something that can be downloaded."

Dr. Neha Chaudhary, a child and adolescent psychiatrist at Massachusetts General Hospital and Harvard Medical School, and a co-founder of Brainstorm, Stanford's Lab for Mental Health Innovation, largely agreed with Kollins' assessment.

"This study shows promise for digital interventions," Chaudhary added. "While they may not be replacements for medications, they certainly might augment clinical care in a new way. With child psychiatrists in short supply, these tools might be helpful for kids to use in the interim while waiting to get plugged into mental health care."

Behavioral strategies can be particularly helpful for children with ADHD, "especially where medications cannot be used," Chaudhary explained. "While the gold standard of treatment for ADHD in childhood is still stimulants -- and the benefits of such treatments are clear -- it is exciting to see new, innovative interventions emerge."

Copyright © 2020, ABC Audio. All rights reserved.

US military dependent in South Korea diagnosed with coronavirus, triggering precautions

ABC News(DAEGU, South Korea) -- A family member of a U.S. service member has been diagnosed with coronavirus -- officially called COVID-19 -- in South Korea, as the number of cases in that country continues to explode and the U.S. military considers scaling back its exercises with South Korean forces due to the virus.

In a press release on Monday, U.S. Forces Korea announced that it had been informed by South Korea's Centers for Disease Control and Prevention that a military dependent living in Daegu had tested positive for COVID-19. It marks the first time a U.S. Forces Korea-related individual tested positive for the virus, the release said.

In a tweet on Monday, the commander of U.S. Forces Korea Gen. Robert Abrams identified the 61-year old female patient as the widow of a retired soldier.

"We are saddened to hear of her contracting the virus," Abrams tweeted. "We pray for her recovery."

According to the release, the woman visited the Camp Walker Post Exchange on Feb. 12 and 15. Korean and American military health professionals are now "actively conducting contact tracing to determine whether any others may have been exposed."

In response, U.S. Forces Korea has ordered personnel to limit non-mission essential in-person meetings, gatherings, and temporary duty travel and assignments. It's also warned personnel to "expect longer wait times, possible temperature checks and screening questionnaires at gates to access installations" and instructed personnel to limit off-installation travel. The overall risk of COVID-19 to U.S. military personnel on the Korean Peninsula is now characterized as "high."

Defense Secretary Mark Esper told reporters on Monday that the U.S. may scale back military exercises with South Korean forces due to the spread of the virus.

At a Pentagon press conference with the South Korean defense minister, Esper said that military commanders "are looking at scaling back the command post training due to concerns about the coronavirus," though no decision has been made.

Over the weekend, the U.S. State Department raised the travel advisory level for South Korea and Japan to level 2, citing the COVID-19 outbreak. The alerts say that "sustained community spread has been reported in South Korea," meaning people in both countries "have been infected with the virus, but how or where they became infected is not known, and the spread is ongoing."

The U.S. Centers for Disease Control and Prevention (CDC) also issued its highest travel warning for South Korea on Monday, telling Americans to avoid non-essential travel and citing limited access to medical care in areas affected by the virus.

As of Tuesday, more than 975 cases of COVID-19 had been confirmed in South Korea, many in the southeastern city of Daegu where the soldier's widow contracted the virus. The nation has also seen 11 COVID-19 related deaths.

Alex Johnson, an American living in Daegu with his family, told ABC News on Sunday that "daily life has changed for us."

"Everybody's wearing masks and gloves," he said.

Video taken by Johnson showed empty streets and closed restaurants.

"And if you look at this coffee shop here, this says right here: Corona-19 Virus," Johnson said pointing to a sign on the coffee shop window. "They're closed because of the virus. They're not closed because they had a virus problem here, but they're closed because they had a safety. So basically, most people in our neighborhood are just staying indoors and they're not going out and doing anything."

Copyright © 2020, ABC Audio. All rights reserved.

Bebe Rexha opens up about her battle with bipolar disorder in new interview

Cindy Ord/Getty Images(NEW YORK) -- Fans of Bebe Rexha know that she’s an unapologetic rock star. She’s able to command an arena full of people with her confidence-filled, upbeat songs and she’s also not afraid to wear her heart on her sleeve.

And while many may shy away from talking about the challenges they face, Rexha, 30, is fearless when it comes to being real with her fans.

In a recent Self magazine interview, the singer unabashedly opened up once more and spoke about living with bipolar disorder.

“I was very fearful,” she told Self magazine. “I didn’t want to think there was something wrong with me.”

Rexha first revealed her battle with bipolar disorder last April to her 1.6 million followers on Twitter.

She wrote, “For the longest time, I didn’t understand why I felt so sick. Why I felt lows that made me not want to leave my house or be around people and why I felt highs that wouldn’t let me sleep, wouldn’t let me stop working or creating music. Now I know why.”

In her interview with Self, Rexha said that throughout her life, she had experienced symptoms like mood swings, anxiousness and overwhelming depression. And in the midst of it all, she was also diagnosed with premenstrual dysphoric disorder, a condition that occurs a week or two before a woman’s menstrual cycle, which can cause severe irritability, depression or anxiety.

“My mom would call it code red,” Rexha said. “A day before [my period started], I would feel like my world was ending ... I would get into these funks and be really depressed and not want to leave my house.”

Rexha said it wasn’t easy confronting her illness, especially as a child of Albanian immigrant parents.

“Growing up, when I had anxiety and depression, they’d be like, just get over it. It’s all in your head. Take a walk,” she said. “For my parents, it was hard because they felt like it was a sense of failure. But it’s not their failure at all; it’s just an illness.”

But the singer wanted to get better, and with the support of her friends and family, she found a therapist and eventually started taking medication under the guidance of a psychiatrist -- something she delayed after fearing that medication would change her as a person and as an artist.

“I waited a very long time until I took meds. I was really scared that it was going to flatten me out,” she said. “[Medication has] maybe helped me be a little bit more insightful and learn things about the world and also allowed me to be a little bit more centered so that I can actually write about my feelings.”

She said that it wasn’t until much later that she directly asked her therapist if she was bipolar, which prompted Rexha to share the news with her followers on Twitter.

Now, the singer is putting a spotlight on the illness and hoping to help destigmatize the way people think about the disorder by sharing her story and how she’s coped with it.

“I felt like me opening up to my fans was me finally saying, ‘I’m not going to be imprisoned by this,’” she said. “And maybe it’ll make somebody not feel imprisoned, in that moment, if they feel like they’re going through a rough time. That’s why I decided to really open up and to free myself from that.”

Copyright © 2020, ABC Audio. All rights reserved.

How the Harvey Weinstein verdict may impact sexual assault reporting

Andy445/iStock(NEW YORK) -- After hearing from 35 witnesses over more than two weeks of testimony, the jury in Harvey Weinstein’s rape and sexual assault case delivered a verdict Monday.

Weinstein was found guilty of criminal sexual assault and of rape in the third degree. He was found not guilty of the more serious charges of predatory sexual assault and rape in the first degree.

That verdict will very likely have ripple effects touching everyone from survivors of rape and sexual assault and their allies to defense attorneys and the criminal justice system, experts say.

"The fact that the jury deliberated and reached a verdict in the case is unusual and from my perspective is a marker of progress," Deborah Tuerkheimer, a law professor at Northwestern University, told ABC News' Good Morning America. "I think the verdict sends a powerful message about not only this new era we find ourselves in, but also a new era for sex crimes prosecution."

Weinstein, once one of the biggest power players in Hollywood, became the public face of the #MeToo movement in 2018 after both The New York Times and The New Yorker published explosive accounts of his alleged misconduct. The reporting featured accusations from actresses including Gwyneth Paltrow, Ashley Judd, Rose McGowan and more.

In the New York trial, Weinstein faced five felony counts of rape and sexual assault, based on the testimony of two accusers: former Project Runway production assistant Miriam 'Mimi' Haleyi -- who claims the Hollywood producer sexually assaulted her in 2006 -- and actress Jessica Mann who claimed Weinstein raped her in a Manhattan hotel suite in 2013. Mann is being named now because she has told the DA’s office that she does not object to being named publicly.

In addition to the two women behind those charges, four others, including actress Annabella Sciorra, testified in support of prosecutors' efforts to demonstrate a pattern of sexual predation.

Weinstein, who will be sentenced next month, was convicted of committing a criminal sex act on Haleyi and of third-degree rape of Mann. His defense attorneys said Monday they plan to appeal the verdict.

Weinstein also faces a second trial in Los Angeles. He was charged there in January with one felony count each of forcible rape, forcible oral copulation, sexual penetration by use of force and sexual battery by restraint.

"This is the new landscape for survivors of sexual assault in America," Manhattan District Attorney Cyrus R. Vance, Jr., said after the verdict. "This is a new day."

Why the Weinstein case stands out

The Weinstein case had circumstances that are common in cases of sexual violence but have traditionally made cases harder to prosecute, experts say.

Both Mann and Haleyi acknowledged in their testimony that they later had consensual sex with Weinstein and continued to see him after the alleged assaults. The charges on behalf of the two women were also brought to trial several years after the alleged assaults took place.

"The allegations are typical of what happens in the world, but the [trial] is not typical of what happens in criminal court," said Tuerkheimer, noting the most common incidents of sexual violence include no weapon, no physical injury and no prompt reporting of charges.

"With this kind of high-profile case that the world is watching, a conviction has meaning that will reverberate," she said of the Weinstein decision. "Survivors and prosecutors will see that these kinds of cases can be brought and we should expect to see more of these kinds of cases that have traditionally not been handled well by the criminal justice system."

Weinstein's defense attorneys Donna Rotunno and Damon Cheronis highlighted in their statement after the verdict that Weinstein "was not convicted on the most serious charges" he faced and prepared the case for their appeal.

"There are issues in this trial that were extremely troubling, and they prejudiced Mr. Weinstein's ability to have his case fairly judged," they said in a statement. "These will be addressed to a higher court."

Time's Up, the organization started by Hollywood actresses in response to the #MeToo movement, described the Weinstein trial and verdict as marking "a new era of justice."

“The jury’s verdict sends a powerful message to the world of just how much progress has been made since the Weinstein Silence Breakers ignited an unstoppable movement," the organization said in a statement Monday, referring to the group of women who have accused Weinstein of sexual misconduct.

In the U.S., just 230 out of every 1,000 sexual assaults are reported to police and only about half of arrests made go to trial, according to RAINN, which describes itself as the nation's largest anti-sexual violence organization.

Perpetrators of sexual violence are also less likely to go to jail than other criminals, according to RAINN, which says out of every 1,000 sexual assaults, 995 perpetrators will walk free, a combination of assaults not being reported, cases not being brought to trial and the accused either not being convicted or not receiving jail time.

"There’s a feedback loop," explained Tuerkheimer. "When the criminal justice system fails survivors, survivors see that and are less likely to come forward."

"I think that's why a guilty verdict in the case resonates widely," she said, referring to the Weinstein case. "For survivors, for people who care about sexual assault prosecution this would be a signal that the criminal justice system can respond to the kinds of cases that historically it has not done well with."

The Weinstein case's impact on reporting

RAINN, which runs a national hotline, said it has seen a spike in interest around reporting incidents of sexual assault over the course of the Me Too movement, including the Weinstein trial.

From fall 2017 to today, the number of people helped by RAINN's victim services program has increased from 15,000 a month to 25,000 a month, according to Scott Berkowitz, the president of RAINN.

"It's been an overwhelming demand and that’s just the number of people we’ve been able to help," he said, noting that calls to RAINN's hotline also increase when a high-profile story like the Weinstein case is in the news.

Berkowitz said he believes the trend will continue with the two Weinstein guilty verdicts.

"One of the things many survivors struggle with is whether or not to report their assault to police," he said. "In the best of circumstances it’s a long, difficult process to pursue prosecution and live through an investigation."

"Reporting is a very personal decision so it’s not for us to tell people what to do, but we would like to create a society in which many more victims choose to report," Berkowitz said.

Laura Palumbo, communications director for the National Sexual Violence Resource Center (NSVRC), noted that the impact of the case on reporting incidents of sexual violence will have a lot to do with the public dialogue that emerges around the credibility of survivors.

"Most of the time the most significant thing in moving forward with a report are the sentiments [victims] hear from people in their inner most circle, people who are around them and in their community," she said. "We are all, in our day-to-day dialogue on this topic, on Me Too and the seriousness of sexual assault and harassment, sending messages to survivors on whether or not they’re believed and would be supported if they come forward."

The days and weeks after the verdict will be an important time for sexual violence survivors and their allies to make sure they have the support they need, according to Joan Cook, Ph.D., an associate professor of psychiatry at Yale University.

While some sexual assault victims and their allies may find relief in Weinstein's conviction on two counts, for others it may trigger memories of their own case or their own incident, according to Cook, whose expertise is working with trauma survivors.

She urges people to unplug from the news as needed, to take it easy on themselves and to reach out to their support systems, which may include seeking professional help.

"I know that you want to be informed of what’s happening in the news but you need to dial down and plug into self-care, maintain your routine, sleep well, eat well, do all of those things," said Cook. "It’s understandable to be grief stricken or upset or angry and allow those [feelings] to be but choose safe and healthy behaviors."

Cook said that her research has shown sexual trauma "packs a wallop like no other trauma" and can affect everything from a person's ability to trust, love, function on the job and have healthy sexual relationships. Considering that an American is sexually assaulted every 73 seconds, according to RAINN, the chance that you are a victim of sexual assault or know one is high.

"I hope people are compassionate to survivors," said Cook, who explained that one of the biggest predictors to recovery is social support. "They need to be listened to, to be able to ask for help and receive that help."

Ashley Judd, one of the "silence breakers" who accused Weinstein, took to Twitter after the verdict to publicly thank the women who testified in the trial, writing, "For the women who testified in this case, and walked through traumatic hell, you did a public service to girls and women everywhere, thank you."

What happens next

The experts GMA spoke with stressed the two guilty counts for Weinstein are neither the beginning nor the end for improving the criminal justice process for victims of sexual violence.

"A guilty verdict is a symbol but only one measure of progress," said Tuerkheimer. "For ordinary survivors and survivors who don’t have the strength in numbers that the accusers in this case had, the odds are still stacked against them."

Weinstein was acquitted on the most serious charges he faced, two counts of predatory sexual assault. The counts, which carried possible sentences of 10 years to life in prison, were related to the testimony of Sciorra, who said Weinstein violently raped her at her apartment nearly 30 years ago.

"We have to be cautious about generalizing from the verdict and drawing the conclusion that all is well and good for survivors who are seeking justice," said Tuerkheimer. "Improving the response that has for so long been lacking is a process that will take time."

The NSVRC also pointed out in a statement that it still remains the case that "most rape cases rarely make it to trial."

"The dynamics of this [Weinstein] case remind us that while the criminal justice system is an important avenue for some survivors to seek justice and healing, it cannot be, and is not, the only one," the organization said. "Only after there was an outpouring of allegations in the public eye did prosecutors act to investigate the reports of Weinstein’s pervasive sexual abuse. This trial demonstrated the widespread challenges encountered by victims of sexual assault across the country. Still we also know most victims never make a formal report to law enforcement, and most rape cases rarely make it to trial."

Organizations like NSVRC, Time's Up and RAINN say they will continue to work to hold people accountable and change the way society responds to victims of sexual violence.

“A single case cannot define a movement," NSVRC's Palumbo said, referring to the #MeToo movement. "The barriers that we as a society are creating for survivors coming forward and people accused not being held accountable are what allow this problem to continue to thrive."

If you or someone you know experienced sexual assault and is seeking resources, call the National Sexual Assault Hotline at 1-800-656-HOPE (4673).

Copyright © 2020, ABC Audio. All rights reserved.

Dad hears late son's heartbeat in teddy bear sent from donor recipient

John Reid(NEW YORK) -- Video of a father listening to his son's heartbeat inside a teddy bear is capturing the hearts of over 100,000 people on Facebook.

Stephanie Reid shared the footage earlier this month of her husband, John Reid, opening the gift from his late teenager's heart recipient. Dakota Reid, 16, died Jan. 25, 2019, days after being pronounced brain dead as a result of injuries he suffered in a car accident, the Reid family told ABC News' Good Morning America.

"He was full of life and there was not a person he did not love with all his heart," Stephanie Reid of McKenney, Virginia, told GMA. "He aspired to be a rapper, and he was pretty good at it. Dakota didn't have enemies. He always wanted peace."

"We loved to hear him laugh and see him smile," she added. "And he loved to play jokes on his dad. He [did] a great imitation of his dad."

After Dakota died, dad John Reid decided to donate Dakota's organs. A 69-year-old man named Bob O'Connor from Massachusetts received the child's heart.

"I am a Christian and I believe God called on my heart that this is what I was supposed to do," John Reid told I. "I knew it would bring life to others -- therefore, giving me closure that he lives on."

On Feb. 5, John Reid received a package from O'Connor containing a teddy bear that held the recording of Dakota's heartbeat.

A tearful Reid can be seen in a video with his ear held up to the stuffed animal.

"My heart was filled with joy, that he was able to give a piece of Dakota back to me," he said. "When Dakota was in the hospital, every night I would lay my head on his chest and listen to his heartbeat. Even up to that last night. Thanks to Bob O'Connor, I will continue to listen to his heartbeat."

The Reids hope the video raises awareness on organ donation, they said. They hope to meet O'Connor in person someday soon.

Copyright © 2020, ABC Audio. All rights reserved.

Feds backtrack on transfer of quarantined coronavirus patients to Alabama

jarun011/iStock(NEW YORK) -- Plans to move American coronavirus patients to an Alabama facility were canceled Sunday after local officials and residents expressed concerns.

Hours after Anniston County's City Council voted Sunday to pursue legal action against the federal government over its proposal to transfer patients from the Diamond Princess cruise ship to the town's FEMA facility for quarantine, U.S. Sen. Richard Shelby and Gov. Kay Ivey announced on Twitter that plans had changed.

Ivey said President Donald Trump called her and assured her that the patients who were aboard the Diamond Princess wouldn't be transferred to Alabama.

"I thanked him for his support of AL! We always want to help our fellow Americans, but this wasn't fully vetted," Ivey tweeted.

Representatives from the U.S. Department of Health didn't immediately return messages asking for comment Sunday.

Although the federal government assured the Calhoun County Emergency Management Agency that the coronavirus patients would be isolated in the Anniston FEMA facility and that they would pose no threat to residents, local officials said they were concerned and upset they weren't given more notice.

The Anniston City Council approved a resolution during an emergency meeting Sunday morning asking the city attorney to explore blocking any patient transfer with an injunction.

"What's primary is the health of this community," Councilmember Millie Harris said at the meeting. "This is not easy. We have to weigh everything."

Later in the day, the Calhoun County Commission also approved a resolution to pursue legal action against the federal government.

The Diamond Princess docked at the Japanese port of Yokohama on Feb. 3 and was placed under quarantine after passengers and crew showed coronavirus symptoms.

As of Sunday, there were 634 confirmed coronavirus cases aboard Diamond Princess, with two deaths. The U.S. government evacuated 300 American passengers to the U.S. last week, 14 of whom tested positive for the virus.

The Anniston facility was only being considered as a "back up" location in case patients couldn't be transported to other quarantine locations, according to Ivey.

During the Anniston City Council meeting, some councilmembers had mixed feelings about the situation.

Councilmember Jay Jenkins acknowledged that the town should receive more information from the federal government about the transfer, but reiterated that the patients are helpless Americans who need immediate care.

"Put yourself in those people's shoes," he said.

Some residents blasted the councilmembers for not going far enough to block the patient transfer. Yvonne Gomez said she was angry the federal government didn't consult the community or provide more information on how the transfer would work.

"We've got families … We have children too. We don't want to lose our children," she said.

Anniston wasn't the only American town fighting against plans to house quarantined patients. On Friday, Judge Josephine Staton issued a temporary restraining order against the federal government to block it from sending coronavirus patients to a quarantine site in Costa Mesa, California.

Officials from the Southern California city said they were not properly informed about the federal government's plans.

Copyright © 2020, ABC Audio. All rights reserved.

Photos of black women raises awareness about disparity in birth outcomes

PeopleImages/iStock(NEW YORK) -- It was about five years ago when Dallas-Fort Worth photographer Elaine Baca photographed her first birth. Until then, she had been primarily working weddings.

"I realized that my best images all along had been the ones that told a deeper story," Baca told ABC News' Good Morning America. "From that point on I changed paths and began doing documentary photography, exclusively focusing on families through birth and 'Day in the Life' sessions."

Her work took on even more meaning as of late when she began photographing alongside midwives Teree Fruga and Kennasha Jones of My Sister's Keeper Birth and Midwifery as they worked.

"They informed me about the huge difference in birth outcomes for black women along with the fact that at the time they were the only two black midwives in our area to hold their specific license," Baca said.

According to the Centers for Disease Control and Prevention, the risk of pregnancy-related deaths for black women is 3 to 4 times higher than those of white women.

"It's important for people to see and understand that black women and babies who are dying in childbirth are not just statistics put out by the CDC," Baca told GMA. "They are real families with real lives who are being changed forever. If we don't make big changes and hold people and our health system accountable, the disparities in birth outcomes for black women and their babies will only continue to grow."

Aside from the shocking disparity in birth outcomes for black women, Baca said it's important for black women to see birth stories of "people who look like them."

"Few birth stories depict black families," she said. When Fruga and Jones brought so many of these issues to her attention, "I knew immediately that I wanted to use my background in storytelling to photograph the work they were doing and help bring awareness to this growing issue."

The photos of Jones and Fruga's work have been shared almost 50,000 times since Baca posted them to Facebook.

"The photos and message shine a light on an issue that people either had no idea about or they knew and were excited to see people joining the fight," said Baca of why she thinks the photos are being shared so widely.

With the growing awareness, the photographer said she's received many requests from people who want to support the midwives.

"We need more black birth workers," she told GMA. "[People] can help by financially supporting organizations who are making a difference: My Sister's Keeper Birth and Midwifery, 4Kira4Moms, or individuals who are interested in obtaining a license as a doula or midwife. Then continue the work by speaking out about this growing issue and advocating for families."

Copyright © 2020, ABC Audio. All rights reserved.

Kelly Ripa on health: 'It's not just about living longer, it's about living better'

ABC News(NEW YORK) -- Kelly Ripa is known to her fans as a health and fitness fanatic.

The Live With Kelly and Ryan host is open about her support of the Alkaline Diet, has showed off clips of her workouts on her Instagram account and constantly promotes an active lifestyle.

She described where her love of nutrition and wellness stems from during a recent interview with Good Morning America.

"Well, you know, it's funny, I have three, now three young adult, children, and I have four aging parents, between my parents and my in laws," she said. "And we as humans are living longer and longer, but it's not just about living longer. It's about living better."

"I just see things that aren't addressed as young people [that] will have to be addressed as older people, and I don't want to live my later years in life being on a bunch of different medications," she added. "And anything I can do proactively to live optimally, that's what I'm going to do."

She said that she's encouraged her children to follow suit.

"We sort of lead by example in our lives. We've always made healthy offerings in terms of food and snacks in our house, and we always sort of lived in an active household," she said on she and her husband, Mark Consuelos' parenting.

"Our kids have always had various -- they've always participated in team sports and had extracurricular activities," she continued. "Having said that, they still want to eat as much sugar as I will possibly allow them, but they're adults now. And like I said, I think that those foundation things that we did for them help them make healthy choices now that they're adults."

Because of Ripa's desire to "live optimally," she recently partnered with Persona Nutrition, a health company that gives customers customized vitamins and supplement plans based on their needs. She says the company has offered her a "way to live my healthiest life possible."

"For many years, I've sort of devoted my life to fitness and I take it really seriously and I have a clean diet, all of that," she shared while promoting her new role as brand ambassador. "But the one aspect of my life that I found was sort of lacking was nutritional supplements. I find the whole world kind of overwhelming always."

She said she always had trouble pinning down exactly which nutritional supplements would be beneficial to her health.

"When you have kids -- when you have young kids -- your pediatrician tells you exactly what your kids need in terms of supplements," she said. "But then you grow up and you're an adult and no doctor has ever been able to me what I needed definitively to round out my life nutritionally, in forms of supplements."

"There's always like a sweeping generality -- take a multivitamin," she added. "Okay, fine. Well, you walk into a drugstore, a health food store, and there's 9000 different programs that you could be on, should be on, but you don't really know."

Ripa, who turns 50 in October, says she's taken her health more seriously as she's grown older.

"I definitely think that when I turned, I would say like 45, I noticed that things I did mattered more -- whatever I did, the recovery time was longer," she said.

"If I exercise the recovery time was longer, if I went out dancing with my friends and I stayed out till three in the morning, the recovery time from that was significantly longer," she continued.

She said those details along with other factors she'd "never noticed before" made her make some changes.

"I started saying, 'Ah, I need to drink more water...I have to be more mindful about what I put in my body, in terms of food, and certainly now with supplements,' like these are all things that keep you healthy," she added.

Copyright © 2020, ABC Audio. All rights reserved.

One-third of parents are delaying giving vaccines to their children: Study

iStock(NEW YORK) -- One-third of children between the ages of 19-35 months don't receive vaccines on time, leaving them vulnerable to preventable infectious diseases, and their complications, a new study finds.

The study revealed that 63% of children received vaccines on time before the age of three, as per Centers for Disease Control and Prevention guidelines, while 23% limited the number of shots per visit or skipped at least one vaccine. Another 14% were not compliant with guideline recommendations, according to data used from surveys at Emory University from 15,059 children nationwide showed.

The CDC recommends children be vaccinated against 14 illnesses in their first three years of life; Chickenpox (Varicella) Diphtheria, tetanus, and whooping cough (pertussis) (DTaP) (4th dose), Haemophilus influenzae type b disease (Hib) (4th dose), Measles, mumps, and rubella (MMR) (1st dose), Polio (IPV) (3rd dose), Pneumococcal disease (PCV13) (4th dose), Hepatitis A (HepA) (1st dose).

Vaccine delays were more common in children who moved across state lines, were not first-born, lived in the Northeast, were black or multi-race, and below the poverty level, according to the study.

"Some families work with their pediatrician to come up with a modified immunization schedule (vs. CDC schedule) or they will split up the combination vaccines, which ultimately ends up being more of a disservice to your newborn because of more overall injections given. Delaying vaccines, delays the body's ability to develop an immune response, relying on immunity from rest of community" Dr. Shaliz Pourkaviani, who is a bicoastal neonatologist, said.

Vaccination has been named an effective public health intervention yet, parents are still choosing to delay or forgo vaccination for their children. Uncertainty about safety and necessity of vaccines, along with general mistrust of the pharmaceutical industry, has led to this recent trend, the study said.

"There is a general trend in vigilant families to delay or refuse vaccinations due to concerns about preservatives used in vaccines," Pourkaviani said.

The study also confirms that misinformation about vaccines in recent years and reservations about giving too many vaccines at one time may be leading to these delays.

Authors of the study highlight a need for interventions to minimize vaccine delays that put children's health, and public health, at risk.

"It is important to speak with moms and try to dissect each individual family's concerns regarding vaccines. Often time's parents don't have a good understanding of why they are refusing, and seem to want to be a part of the anti-vaccine movement promoted by social media influencers/blogs and concepts that are not backed by reliable data" Pourkaviani said.

"As a nation we need to push for pharmaceutical industry to be more transparent regarding ingredients used," Pourkaviani added.

Interventions should target both providers and parents, the authors of the study said.

For more information on vaccination schedules, safety and side effects, refer to the CDC's website.

Copyright © 2020, ABC Audio. All rights reserved.

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