r/MedForums

https://apple.news/AVaXSZa\_BTg-sdhacPMLleg

“WASHINGTON (AP) — The Trump administration is proposing a new rule on Thursday to keep hospitals from charging markups on discounted drugs for Medicare patients and says that could save consumers $1.1 billion next year, according to estimates obtained by The Associated Press.
The rule would apply to hospitals that serve low-income patients under what is known as the 340B program, which lets hospitals buy outpatient prescription drugs at discounted prices. But in many cases, hospitals can bill insurers at rates that exceed those costs, allowing hospitals to keep the difference and resulting in higher costs to patients.”

. “Under the proposed rule, the Centers for Medicare & Medicaid Services would change the formula for what hospitals participating in the program can get reimbursed, in an effort to cut costs for patients.
The Republican administration has sought to show during an election year that it is tackling the challenges of affordability for U.S. families at a time when rising healthcare costs are driving financial strains for households and the government alike. While the administration has taken several steps it says will save money on medical treatment, it is unclear how much savings might ultimately materialize based on the complexity of the country's healthcare system.
There is the risk that hospital systems could see their revenues decrease, which could have consequences in the communities they serve in terms of the services they offer and jobs they provide. The 340B program was initially designed as a way for healthcare providers to stretch scarce federal resources to better serve more patients. But it has long been at the center of a lobbying battle between hospitals and pharmaceutical companies, with each side attempting to enlist lawmakers in maintaining or changing the benefit.”

“The agency estimates that the average older adult with Medicare Part B coverage who is administered one of these drugs would save $800 a year in co-payments. That would work out to a total savings of $1.1 billion for everyone with that coverage.
The savings over 10 years could total about $20 billion, according to a White House official who requested anonymity to discuss the rule before the official announcement. The official said the proposed rule was not previewed for hospital groups before the release.
In a policy draft of the rule, the administration gave a specific example of how the current system works for the prostate cancer drug Lupron Depot. Hospitals under the 340B program can acquire a dose for roughly $700, but they can receive about $4,000 in Medicare reimbursement for administering it and an additional $1,000 from the patient co-payment.
The proposed rule would cut by roughly 40% that amount that hospitals in the discounted drug program could be paid through Medicare programs. If approved, the rule would go into effect at the start of next year.
In 2018 during President Donald Trump's first term, his administration tried to enact this same type of rule reduce Medicare payments to hospitals. But the Supreme Court ruled in 2022 that the government could not provide a separate reimbursement plan for 340B hospitals.

“The president signed an executive order in April 2025 to survey how much hospitals spend to buy drugs. The result of that survey led to the proposed rule, which would cap Medicare reimbursement for participating hospitals at the average sales prices, minus 33.4%. The reason why the average reimbursement rate would be cut is because the hospitals acquired the drugs at discounted prices.”

https://apple.news/AQ1DIhJCyRo2NQXMzJWa-1g

“CARACAS, Venezuela (AP) — A week after Venezuela’s devastating twin earthquakes , doctors on Wednesday said the biggest dangers now facing survivors are untreated injuries and infectious diseases.
Thousands of displaced Venezuelans are sleeping in crowded shelters or outside without access to clean water amid dismal sanitary conditions following the June 24 earthquakes which officials say killed at least 2,295 and left more than 11,000 injured.
Aid workers said the aftermath of the quakes has become a major medical crisis that, unless quickly controlled, would take more lives in the days and weeks ahead. The emergency has laid bare Venezuela's chronic shortage of doctors, the result of years of economic crisis, underfunding and emigration .
“The issue we foresee just around the corner is the infections that patients who have been exposed to the disaster for the longest time might bring,” said Eugenio Cova, the head of the trauma unit at Hospital del Oeste Dr. José Gregorio Hernández in Caracas, the capital. “We’ve already gone through the period of complex trauma — which will continue to occur — but now it’s complicated by infections."”

“Aid workers also warn that the extensive damage to infrastructure is turning hard-hit communities into petri dishes for disease.
“It’s very hot and there’s a lot of concern about potential vector-borne diseases,” said Veronique Durroux, the U.N. humanitarian agency spokesperson for Latin America and the Caribbean. “Waste management is an issue. Debris management, when you see the scale of devastation, it’s very concerning.”
US military deploys 900 personnel to aid Venezuela
The United States had 900 military personnel currently on the ground to support relief and rescue operations as of Wednesday, Steven McLoud, a U.S. Southern Command spokesperson, told The Associated Press. ”

“The military has repaired an earthquake-damaged runway at the main international airport that serves Caracas to allow for the arrival of humanitarian assistance and stationed naval assets off the coast to receive airlifted survivors. An additional 100 people from the U.S. State Department have been sent to aid those efforts, McLoud said.”

“So far, the Trump administration has offered Venezuela $300 million in assistance channeled through aid groups and the United Nations. But that remains just a fraction of the post-earthquake aid the country needs: Material damage from the quakes is estimated at over $6.7 billion, according to satellite analysis by the U.N. Development Program.
Fifty other international teams have arrived in recent days to help with search-and-rescue operations, including from countries like Ecuador and Israel that don't have diplomatic relations with Venezuela. Against the odds — the time period for survival when trapped under rubble is typically 48 to 72 hours — rescuers are continuing to find a small number of survivors, including on Tuesday, a toddler who had been trapped for six days.
Underequipped hospitals face a surge
Long before the earthquakes, Venezuela's public hospitals were strained by shortages of water, energy, critical medical equipment and highly trained staff.
Among the 8 million people who fled the country's economic crisis in recent years are many specialized doctors and nurses.
“Doctors between the ages of 35 and 55 have left and taken with them a ton of experience,” said Jaime Lorenzo, director of United Doctors of Venezuela, a nonprofit network ”

“Those who remain now confront the overwhelming prospect of treating thousands of grievous injuries from crushed and caved-in concrete structures. The government on Wednesday raised the number of people injured in the quakes to 11,267.
Hospital del Oeste Dr. José Gregorio Hernández in Caracas lacks screws and plates needed for orthopedic surgery and medicated gauze to prevent infections, said Cova, who conducts surgery on crushed limbs in makeshift operating rooms because possible earthquake damage has made parts of the building inaccessible. According to the government, the earthquakes damaged or otherwise compromised 38 hospitals nationwide.
There's also a nationwide shortage of ambulances that forces most injured Venezuelans to arrive to hospitals in the backs of pickup trucks, said Lorenzo. That's just one of the ways that ordinary citizens, feeling abandoned by the government , say they've been forced to shoulder much of the rescue effort.
When the chaos and trauma of this first week after the quake starts to subside, Lorenzo said he fears a new wave of patients will hit hospitals: Venezuelans, who, rendered suddenly homeless after the earthquakes, have gone all week without medication for chronic diseases such as asthma, diabetes and high blood pressure.”

“The government of acting President Delcy Rodriguez — who served as deputy to President Nicolás Maduro until he was ousted by the United States in January and who became interim leader with the backing of the Trump administration — has faced growing criticism over its handling of the disaster.
Videos circulating on social media in recent days appear to show security officers picking through the rubble of fallen buildings and making off with U.S. dollars, appliances and other personal belongings and sparking widespread anger among Venezuelans. The videos could not be verified by the AP.
In response to the videos, the the Interior Ministry on Wednesday said it dismissed and detained four police officials for “deviating from their duties and taking advantage of the rescue and humanitarian aid efforts."
Rodríguez announced seven days of national mourning on Wednesday to honor victims.
Many thousands remain missing, adding ambiguity to the temblors' complete toll and leaving families in an agonizing limbo as they wait days by collapsed buildings, hoping for the bodies of their loved ones to surface.
One non-governmental digital database where families can register missing loved ones showed over 40,600 people still unaccounted for as of Wednesday.”

A recent report commissioned by a state-appointed overseer largely blames long wait times on low productivity among the network’s doctors, and argues wait times also contribute to unnecessarily high prices.

“The state’s largest healthcare provider is trying to get patients seen faster as it embarks on a wide range of reforms intended to shore up its finances and get the cost of care in Vermont under control.
Wait times are long at University of Vermont Health, as they have been for years. A recent report commissioned by a state-appointed overseer largely blames the problem on low productivity among the network’s doctors, and argues wait times also contribute to unnecessarily high prices.
In the wake of that report, UVM Health leaders have announced a raft of new mandates for its Medical Group, which includes over 150 outpatient clinics and more than 1,000 physicians.
Specialists must give up some time once set aside for administrative work and instead see more patients. Providers will have less control over scheduling, and health system officials are more strictly enforcing a policy that requires clinicians to request time off three months in advance.
Many clinicians are chafing at the reforms.
Teresa Fama, a rheumatologist at Central Vermont Medical Center, said she understands that “tough times call for tough measures.” But she blames administrative bloat for the system’s inefficiencies, and worries that demanding more from clinicians ”

“To meet the new benchmarks, Fama said she's going to have to cut her follow-up appointments to 20 minutes, down from 30. She said that’ll make it a lot harder for her to have the kinds of in-depth conversations many of her patients have come to expect from her.
“I've followed some of them for close to, you know, 20 years. I know their stories, I know their families, I have really good relationships with them,” she said.
Tim Schad, a family nurse practitioner speaking on behalf of AFT-Vermont, the hospital system’s nurses union, said the reforms may get patients seen faster. But visits will be more rushed, he said, and providers, who are already struggling to keep up with paperwork, may take longer to get back to patients.
“The sentiment I hear most is, you know, we're just being asked to do more with less,” he said.
But hospital officials say these changes are urgently needed — and, alongside layoffs that were announced earlier this month, only the beginning.
UVM Health includes three hospitals in Vermont and three in northern New York along with outpatient clinics, skilled nursing facilities and a home health hospice agency.”

“It faces mounting financial pressures from rising costs and stagnant reimbursements, which are expected to get worse with changes to Medicaid in 2027. The same report that underscored the hospital system’s wait times also recommended that UVM Health find $300 million in expense reductions over the next three years.
“Given that reality and the short timeframe, many aspects of the organization will need to transform,” Annie Mackin, a spokesperson for UVM Health, wrote in an email.
The consultants found that new patients had to wait, on average, over 100 days for an appointment at the University of Vermont Medical Center in Burlington, and three months to see a doctor at CVMC in Berlin.
Patients who don't get seen can't be billed, and those wait times contributed to significant financial shortfalls for the system. UVM Health’s Medical Group lost almost $280 million in the 2025 fiscal year.
Consultants hired for the state said that the hospital system has offset those losses in part by charging more for outpatient care and ancillary services. Clinical productivity at UVM Health, meanwhile, is below the 50% percentile for the nation.”

The network hopes productivity reforms will get wait times to the national median, Mackin said, and to cut the medical group’s losses by up to $55 million.

https://apple.news/AAINL3tWRQ\_2hijrtYqXbpA

Mass deportations would be felt across hospitals and emergency rooms, which already face persistent staffing shortfalls. The long-term healthcare sector will suffer the greatest disruptions, experts say.

Amid the flurry of consequential Supreme Court decisions that have come down recently, it's the one about temporary protected status that has America's healthcare sector the most worried.

“The pain will be felt across hospitals and emergency rooms, which already operate under persistent staffing shortfalls, but it’s the long-term care sector, including senior care facilities and home care, that will suffer the greatest disruptions, said Steffie Woolhandler, a distinguished professor of health policy at City University of New York at Hunter College and a faculty member at Harvard Medical School.
“It’s going to be a disaster in the Boston area, where a lot of our nursing home and home care aides are Haitian,” Woolhandler told NPR. But beyond that, she added, “If the United States becomes inhospitable to noncitizens, which I think Trump is doing, we're going to have a lot of problems staffing our entire healthcare system.”
Massachusetts has the third largest population of Haitians with TPS (19,000), behind Florida (158,000) and New York (40,000), respectively.
Woolhandler is one of three authors of a 2025 report analyzing the impact of Trump’s mass deportation plans, including the potential effects of stripping TPS protections from people from the 17 countries that the federal government deemed eligible. The status is meant to protect individuals from those countries who are living in the U.S. from having to return to places ”

“FWD.us breaks down the numbers even further, estimating that 21,000 Haitian TPS holders are in hard-to-fill jobs as nursing assistants and caregivers.
The dearth of qualified healthcare workers is already putting existing institutions under tremendous strain. Woolhandler said two-thirds of hospitals report they’ve had to close beds because they don't have enough staff, and about half of nursing homes similarly say that they can't take new admissions because they don't have enough personnel.
“The thing that has to be said is that the healthcare of everybody is going to be compromised by this. If you start throwing out workers that play a key role in the whole continuum of care … it tends to create a bottleneck or a backup,” she said.
If a family can’t find a bed in a nursing home or home aid caregiver, then those people may end up stuck in a hospital or in emergency rooms, Woolhandler said.
Katie Smith Sloan, president and CEO of LeadingAge, which represents more than 5,300 aging service providers nationwide, called the ruling a direct threat to the delivery of much-needed care and services.”

“The legal limbo has communities wracked with worry, particularly in Springfield, Ohio, where 1 in 4 residents is of Haitian descent. Hours after the ruling, dozens of panicked TPS holders were calling Viles Dorsainvil asking for advice. The 40-year-old is the co-founder and executive director of Haitian Support Center, a nonprofit that provides a range of services to Haitian nationals and refugees, including legal assistance.
“They’re wondering if they can still keep their assets or money at the bank, if they can still go to work because TPS came with the work permit, and with the driver's license privilege,” Dorsainvil told NPR. “The community is devastated.”
The Trump administration has released little information about how it will withdraw protections under the program for more than 330,000 Haitian and 4,000 Syrian TPS holders affected by the high court’s ruling last week. On Wednesday, the Department of Homeland Security announced that existing Employment Authorization Documents, which permit TPS recipients to legally work in the country, will expire on July 10.”

“Dorsainvil said he’s advising people that the most important step they can take is to sign a power of attorney to someone they trust. Parents with American-born children should also plan to sign over guardianship of their kids, in case DHS pursues family separations, he said.
For now, he said, he’s got little else to share with the people calling, but he shares their anxiety.
Dorsainvil is also a TPS recipient, but unlike those who fled the destruction of the 2010 earthquake, he came to the U.S. in 2020 on a visitor visa. At the time, he did not intend to stay more than six months. But during his stay, Haiti’s already fragile political system devolved into unrest and violence that led to the assassination of President Jovenel Moïse, and continues to today.
“There was no way I could go home,” Dorsainvil said, adding that it was the Biden administration’s extension of the TPS program for Haitians that allowed him and his brother to stay in the country. It wasn’t until 2024, when Trump first set his eyes on ending the TPS program for Haitians, that Dorsainvil and his sibling, a former doctor in Haiti who now works as as a nurse in Chicago, both applied for asylum. Those applications have still not been resolved.
”

.

“For a few nights in October, Lynn Callaway went to sleep not knowing if she’d wake up in the morning. 
Callaway was actively miscarrying at her home in Austin, Texas, after being turned away by two hospital emergency rooms in a 72-hour period, according to a federal complaint filed last week. She spent her days curled up in bed in agonizing pain, experiencing chills, fever and an overwhelming amount of blood loss. ”

“The treatment plan for early pregnancy loss in Texas, a state with one of the most extreme abortion bans in the country, is to send patients home and let the miscarriage run its course. Two of the hospitals Callaway visited discharged her using this “wait and see” method — an approach now used in many states with abortion bans in order to avoid offering a combination of certain abortion medications, the standard of care for early miscarriage. 
But, like so many women denied miscarriage care since the fall of Roe v. Wade, Callaway developed an infection — leaving her at death’s door with no one to turn to for help. 
Her husband wanted to drive to New Mexico or fly to Colorado — anywhere other than their home state that was seemingly letting his wife die in front of his eyes. But by that point, Callaway was too weak. 
“I was like, ‘I don’t know, I might bleed out,’” Callaway told HuffPost. “I was thinking: If it’s going to happen, I’d rather it happen here and not in a car or on a plane trying to get somewhere.” 
“I’m, in that moment, trying to plan for my death,” she said. 
Callaway and her ”

“Six days, multiple emergency room visits and repeated calls to her OB-GYN’s office later, Callaway was finally offered care to fully expel her pregnancy. Her OB-GYN prescribed her antibiotics for the infection and abortion medication to complete the miscarriage. When Callaway asked her OB why the ER doctors had not offered her the same medication, her OB responded that the ER would “have to be damned sure that it’s an actual miscarriage to be offering the pill,” the complaint states.
In her lawsuit, Callaway alleges that two hospitals violated the Emergency Medical Treatment and Active Labor Act, also known as EMTALA. The federal law requires hospitals to offer abortion care if it’s necessary to stabilize the health of a pregnant patient while they’re experiencing a medical emergency.
“There is a myth that miscarriage care, ectopic pregnancy care, care for severe cases of obstetrical complications, that that [care] is still happening and it’s just not,” said Molly Duane, Callaway’s attorney and the litigation director of Amplify Legal, a nonprofit legal organization. 
“If a patient like Lynn can’t get care in an urban center like Austin, then who knows what’s happening in places like Corpus Christi and the Rio Grande ”
.

“LA GUAIRA, Venezuela (AP) — Aid groups warned Tuesday that Venezuela's fragile healthcare system is being pushed to its limits nearly a week after two powerful earthquakes , with damaged and understaffed hospitals overwhelmed by the injured and deteriorating conditions in the disaster zone causing infectious diseases to spread.
The scores of international and domestic teams across Venezuela remain focused on the search for survivors , with the government death toll surpassing 1,700 and new bodies still being hauled out from the rubble.
But a humanitarian crisis is already unfolding among the living. United Nations agencies expressed concern about the health effects of thousands of displaced people sleeping for days in the open or in crowded, unsanitary shelters.
Venezuelan officials say that more than 15,800 people have been affected by the earthquakes — a figure that reflects the official number of displaced people, U.N. refugee agency spokesperson Carlotta Wolf said on Tuesday. Suddenly homeless Venezuelans are sleeping in cars, parks and elsewhere without adequate emergency shelter available.”

“Wolf said that number would continue to rise. Many of those displaced in the hardest-hit state of La Guaira are suffering from widespread food shortages, she said.
At a media briefing in Geneva on Tuesday, World Health Organization spokesperson Christian Lindmeier said that displaced Venezuelans have become increasingly vulnerable to the outbreak of preventable diseases like measles, given the population's low vaccination rates, as well as waterborne illnesses like dengue, yellow fever and malaria now flaring the disaster's wake.
The Venezuelan healthcare system, strained by decades of underinvestment and years of economic crisis is “under extreme pressure now, with facilities operating beyond the capacity of the surge of the trauma cases,” Lindmeier said.”

“According to the government, last week's earthquakes damaged or otherwise compromised 38 hospitals nationwide. WHO said it so far has evaluated 21 of those facilities, three of which are no longer operating. Another six have sustained damage and the rest are now buckling under a surge of trauma cases.
Many specialist doctors are missing in the ruins, including officials in charge of maternity care in La Guaira, WHO said, adding to the strain.
“Findings reveal chaotic service delivery and patient flow, marked by overcrowding, growing surgical backlogs ... and a breakdown in biosafety measures,” Lindmeier said, adding that the mayhem has caused “the collapse of forensic and morgue services and inadequate casualty registration.””

“The government has offered daily casualty updates, reporting on Monday that the death toll stood at 1,719 people killed and 5,000 injured. But experts say that's likely a significant undercount, as many more people remain missing and hopes for finding survivors diminish with each passing day.
Authorities have not offered any official count of missing people, and the earthquake's damage to phone networks and other infrastructure has complicated even informal efforts to gauge the toll of those still buried under the rubble.
More than 50,000 people were reported missing on one non-governmental digital database, though it's unclear how many of them have been found.”

“Physicians are working harder for more pay with compensation driven by patient demand and a shortage of doctors while reimbursement rates are stagnant and expected to worsen, a new report shows.
The American Medical Group Association’s AMGA 2026 Medical Group Compensation and Productivity Survey shows total clinic compensation is up 4.3% this year. Total clinic compensation includes pay of primary care physicians, medical specialties, surgeons and advanced practice nurses and physician assistants.
“Overall total clinical compensation rose 4.3% in 2025, a sustained increase that reflects both growing patient demand and the intensifying competition for clinical talent,” AMGA said in its analysis. Data for the AMGA 2026 Medical Group Compensation and Productivity Survey comes from more than 450 medical groups and health systems and more than 190 medical specialties representing nearly 190,000 providers of medical care. ”

“For example, primary care doctor pay rose 3.7% on average with median compensation of family physicians up 3.7% to $342,411 compared to $330,216 in 2025. Meanwhile, compensation of internal medicine doctors was up 3.9% to $361,426 and pay of pediatricians was up 3.5% to $305,435.
But AMGA analysts say about half of compensation growth is being funded by “increased provider output, not by gains in reimbursement.” Work relative value units (wRVUs) increased 2.4% overall in 2025, and patient visit volume grew 2.0%, which AMGA analysts say are “signs of genuine demand expansion.””

“Meanwhile, there’s still a physician shortage. The Association of American Medical Colleges says the United States will face a physician shortage of up to 86,000 physicians by 2036.
“Over the past several years, provider compensation has increased, but approximately half of the increases have been supported by ongoing growth in wRVU production,” said Fred Horton, AMGA Consulting president. “In a marketplace with stagnant reimbursement, this is necessary to afford the increases in total cash compensation, but it is not sustainable. At some point productivity will top out, and providers are already adjusting their (full-time equivalent employees) and seeking alternative work arrangements in response to increased workloads.”
The report comes amid a “difficult policy backdrop,” AMGA analysts said with a coming wave of federal spending cuts to the Medicaid health insurance program for poor Americans and the loss of enhanced subsidies for Americans to buy individual coverage under the Affordable Care Act also known as Obamacare.
The One Big Beautiful Bill Act that President Trump signed into law last year is projected to reduce federal spending on Medicaid by about $1 trillion over a decade.
“The Medicaid piece going to be very problematic going forward,” Horton said. ”

E

Shingles, a condition triggered by the reactivation of the varicella-zoster virus in the body, can cause a “war zone” of inflammation in the brain

“The shingles vaccine may significantly help protect older adults against dementia, a growing body of evidence shows.
Exactly how is unclear. The nervous system, however, likely holds clues.
Shingles, a condition triggered by the reactivation of the varicella-zoster virus in the body, can cause a “war zone” of inflammation in the brain, said Dr. Jennifer Pauldurai, the medical director of the Inova Brain Health and Memory Disorders Program in Northern Virginia.”

““That’s huge,” said Kaley Hayes, the lead study author and associate director of pharmacoepidemiology in the Center for Gerontology and Healthcare Research at the Brown University School of Public Health, who was surprised by the robust protection.
International research has yielded comparable results. A study of more than 282,000 older adults in Wales, published in Nature last year, found shingles vaccination was associated with a 3.5% reduced dementia risk over seven years.
According to a study of more than 101,000 older adults in Australia, published last year in the Journal of the American Medical Association, vaccine eligibility corresponded to a 1.8% reduced dementia risk over 7.4 years. A similar study of more than 232,000 older adults in Canada, published in February in the Lancet Neurology, linked vaccine eligibility to a 2% reduced dementia risk over 5.5 years.
The varicella-zoster virus causes both chickenpox and shingles. More than 99% of Americans born in 1980 or earlier have had chickenpox, according to the Centers for Disease Control and Prevention. The first chickenpox vaccine was approved in 1995. About 1 million people in the U.S. develop shingles annually.”

. “Previous research has established a link between shingles infection and increased dementia risk. For example, a study published last year in the Journal of Prevention of Alzheimer’s Disease found that older adults in Italy hospitalized with severe shingles had a 13% higher risk of dementia compared to the general population.
Shingles can cause buildup of Alzheimer’s proteins
A person’s risk for shingles increases with age, largely because the immune system naturally weakens over time.
When the shingles virus is reactivated, it may trigger the accumulation of amyloid and tau in the brain, “those bad proteins related to Alzheimer’s disease,” said Dr. Timothy Chang, an assistant professor of neurology at the Mary S. Easton Center for Alzheimer’s Research and Care at the University of California, Los Angeles.”

“Less than half of eligible Americans have gotten shingles vaccine
For Philbrick, the vaccine’s apparent protection against dementia wasn’t the most surprising thing about Hayes’ study. It was the “unfortunate” finding that less than 2% of the nursing facility patients eligible for Shingrix — whose health was already vulnerable — had received even one dose.
Only about a third of U.S. adults 50 and older and 43.8% of those 60 and older had gotten at least one dose of either shingles vaccine as of 2022, CDC records show. The rates were lower for Black and Hispanic adults compared to white adults.
Because Shingrix is typically covered by Medicare Part D, Medicaid and commercial insurance providers, cost is less of a barrier than access, Philbrick said.
“It takes an extra step, going to the pharmacy and making that appointment,” she said. “Making the follow-up appointment, too, because it is a two-dose series.”
Pauldurai, of Inova, said her patients often ask how they can prevent dementia. Though it’s not a substitute for healthy habits, getting the shingles vaccine may be one way to protect the brain.
“Much like if you were riding a bike and you know that you can’t see very ”

“Summary
At least 100 aftershocks reported
Beach town of La Guaira the worst hit city
Spain, US, Mexico sending aid
Nearly 24 hours after devastating twin earthquakes in Venezuela, people in the coastal city of La Guaira were still using their hands to dig through ​rubble, trying to rescue their neighbors.
"We are trying to help with what we can, but there is a lack of equipment," said ‌Carlos Borges, who said he was frustrated by the shortage of machinery like backhoes to move the piles of concrete slabs that were once high-rise apartment buildings.”

“His team pulled three people from one building, as other anxious family members, including the single mother of a missing teenage boy, waited at the site on Thursday morning.
U.S. Geological Survey models suggested deaths could exceed ​10,000 after two powerful earthquakes wreaked havoc in and around the capital Caracas on Wednesday. The government of acting President Delcy Rodriguez has confirmed nearly 200 ​dead and 1,520 injured.
Residents of La Guaira, a popular spot for beachgoers and the worst-hit city in the country, ⁠and Moron, near the quakes' epicenter, were scrambling amid limited official help.
“Is it not possible to call in the military? Everyone come, come and pitch in. ​Put them in an armored vehicle and come help the people. Find tractors wherever you can,” said Argenis Martinez, a resident of La Guaira's Los Corales neighborhood, ​who was looking for a relative among the rubble.
Some rubble caught fire overnight, despite a cut to domestic gas service. Terrified residents, many with nowhere else to go, huddled in the streets or peered into destroyed buildings, looking for survivors.”