Rolfing Orlando by Robyn Martin

12/14/2024

07/09/2022

I should have been interviewed fir this article.

Drip so hard

04/20/2022

Long, but worth the read.

On Monday, a Florida judge voided the U.S. mandate for public transit, which includes planes, trains, and buses. Several airlines immediately announced they dropped masks. And, in true pandemic fashion, an intense debate about masks ensued. There are health equity

09/03/2021

This is not about COVID19, but another important public health issue: Abortion

***If you can’t tell from the title, this post isn’t about COVID-19. Epidemiologists don’t just study infectious diseases. As a field, we all focus on the health of populations. Some epidemiologists study cancer, others study violence (like me), others study women’s health. No matter what we’re studying, we find patterns to develop a healthier life for our community. This post focuses on another important public health topic in the United States. It isn’t COVID19 related, but it is data-driven and timely. If you’re not interested, feel free to stop reading at this point. I will be back to COVID-19 tomorrow.***

An abortion law was put into effect this week in my home state of Texas: banning all abortions after six weeks of pregnancy. Last night the Supreme Court decided not to block it, making it a reality for Texans. This means that about 85% of abortions in Texas are now illegal. This will likely lead to an overturned Roe vs. Wade decision in 2022, which will introduce a wave of strict abortions laws across the United States.

It’s important to review the science so you can equip yourself with the facts and, maybe one day, policymakers can make more evidence-based, data-driven decisions. Here’s the science on abortions.

***Epidemiology***
The CDC has an abortion surveillance program so we can easily understand the rate of abortions in the United States. Unfortunately this data isn’t perfect due to the voluntary reporting structure (i.e. all data is underreported), but it’s the best we have in real-ish time. The latest data published was from a 2018 study in the MMWR journal:

-In 2018, 611,376 people got an abortion. This equals 11.3 abortions per 1,000 women aged 15–44 years. This also equals 189 abortions per 1,000 live births. This is an underestimate; the true number of abortions in the United States is closer to 1.2 million a year.

-The abortion rate has decreased overtime. From 2009 to 2018, the total number of reported abortions decreased 22% (thank you Obamacare and access to birth control)

-In 2018, New York had the highest number of abortions (77,250) followed by Florida (70,082) and Texas (55,140).

***Who typically gets abortions and when?***
-Women in their 20s accounted for more than half of abortions (57.7%)

-3 out of 4 abortions were performed at ≤9 weeks’ gestation. Nearly all (92.2%) were performed in the first trimester

-Case Fatality Rate of legal abortions is rare: 0.44 deaths per 100,000 legal abortions. So, on average, 0.44 women die out of 100,000 abortions.

***Why do women get an abortion?***
The reasons are complex, as more than 60% of women report multiple reasons. More than 900 women in a U.S. study were asked why they got an abortion. The scientists categorized what they heard into 11 broad themes. They were:

1. Financial reasons (40%): “[It was] all financial, me not having a job, living off death benefits, dealing with my 14 year old son. I didn't have money to buy a baby spoon.”

2. Timing (36%): Like a 21 year old pointed out, “Mainly I didn't feel like I was ready yet - didn't feel financially, emotionally ready. Due date was at the same time as my externship at school. Entering the workforce with a newborn would be difficult - I just wasn't ready yet.”

3. Partner related reasons (31%): Like “being with the wrong guy” or “partner issues”

4. Need to focus on other children (29%): “I already had 2 kids and it would be really overwhelming. It's kind of hard to raise 2 kids by yourself,”

5. Interfere with future opportunities (20%):“I didn't think I'd be able to support a baby and go to college and have a job.”

6. Not emotionally or mentally prepared (19%)

7. Health-related reasons (12%)

8. Want a better life for the baby than she could provide (7%)

9. Lack of maturity or independence (7%)

10. Influences from friends and/or family (5%)

11. Don’t want a baby or place baby for adoption (4%)

***What’s the problem if women are denied an abortion?***
Safety and Death
Illegal abortions, for now, are incredibly rare in the United States. You can’t even see the rate of illegal abortions on histogram when compared to other regions of the world.

But if we do change the laws, it will not result in lower abortion rates. The abortion rate is 37 per 1000 in countries that prohibit abortion and the abortion rate is 34 per 1000 in countries that allow abortion. What does shift is the number of illegal abortions. Our histogram will go up. Before Roe vs. Wade (1950’s and 1960’s), the number of illegal abortions in the United States ranged from 200,000 to 1.2 million per year.

And illegal abortions are incredibly dangerous for women. Women with illegal abortions are at higher risk for serious medical problems including:
-Incomplete abortions
-Heavy bleeding (hemorrhaging)
-Infection
-Uterine perforation (or the uterus pieced by a sharp object)
-Damage to the ge***al tract and internal organs (due to inserting dangerous objects like sticks, knitting needles, broken glass)
-Each year, 7 million women worldwide are admitted to hospitals for unsafe abortions. 4.7-13% of those women typically die.

Mental Health Issues
Women who are denied an abortion also have more mental illness problems. A major JAMA study followed 956 women who had abortions or women who tried to get abortions but were turned away from the offices where they first sought care. The scientists surveyed these women two times a year for 5 years. Scientists were particularly interested in the mental health differences immediately seeking care and mental health thereafter. What did they find?
-Women denied an abortion reported more anxiety, lower self-esteem, and lower life satisfaction. Depression among the two groups were the same.

-Women who were denied an abortion, in particular those who later miscarried or had an abortion elsewhere, had the most elevated levels of anxiety and lowest self-esteem and life satisfaction

-The mental health between groups by 1 year were about the same

This rejects the common misconception that abortion increases women’s risk of mental illness. In fact the inability to get an abortion does this.

***The most vulnerable of populations will suffer***
In an older study on pregnant r**e victims, 1 in 3 of these victims did not discover they were pregnant until they had already entered the second trimester (long after 6 week mark from the Texas law). Of pregnant r**e victims, 50% underwent abortion. Victims of r**e or domestic abuse are not an exception to the new Texas law. Victimization, alone, causes long-term mental and physical health problems. Adding the inability to get an abortion only exacerbates health problems for years and years to come.

Women in Texas will also now have to travel to other states to get an abortion. Or, if they don’t have the means, they may have to preform an unsafe abortion in their home state. Poor and minority women experience both greater need for and reduced access to abortion services.
-Women with incomes less than 100% of the federal poverty level (FPL) have an abortion rate of 52 abortions per 1000 women, compared to 9 per 1000 among women with incomes greater than 200% FPL
-The abortion rate for non-Hispanic White women was 12 abortions per 1000 reproductive-age women, compared with 29 per 1000 for Hispanic women, and 40 per 1000 for non-Hispanic Black women.
Health inequity in the United States will only be exacerbated with these laws.

***A Better Picture***
As a mixed methods scientist, I’ve found that numbers are important but when numbers are married with stories we get a more comprehensive picture of the public health problem. I’m not nearly strong enough to talk about my story, but many, many women are. I suggest you read this one. Here is an excerpt:

“Most people talk about abortion as if something is ending. Even the language that pro-choicers use—saying that we ‘ended’ a pregnancy or using the word ‘termination’—reflects that mindset. It’s not that those words aren’t accurate, exactly—but they’re also not complete. Because for me, and for so many others, abortion was the start of something.

The truth is that all abortions create something. Paths forward, lives lived, connections made. Some are hard, some are beautiful—but all are chosen.”

***Bottom Line:***
Access to safe and legal abortion is vital to the physical and mental health of women in the United States. The science says this. The women on the ground say this. If only policy-makers would come to the same conclusion.

Love, YLE

There’s a lot you can do. For immediate help, please consider donating to the Lilith Fund so Texans can be financially supported to leave the state for abortions needed now. Donate to the ACLU who is representing the plaintiffs in the case to fight for abortion access in Texas. For more options, here is an amazing list. You can find abortion funds to help and people to follow on this thread too.

For the hyperlinks, graphs, and data sources go here: https://yourlocalepidemiologist.substack.com/p/this-is-not-about-covid19-but-another

08/24/2021

A very good read.

Health insurers may be charging higher rates to the unvaccinated. One more reason to get vaccinated.

Full FDA approval: What will this change?

Today the FDA granted full approval to Pfizer/BioNTech’s COVID19 vaccine for people 16 and older. The FDA press release highlighted the rigor this entails:
“The public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product.”

The vaccine also continues to be available under emergency use authorization (EUA) for 12-15 year olds and for the third dose among immunocompromised individuals.

This only confirms what we’ve known for months: the vaccine is safe and effective.

***Nonetheless, this. is. worth. celebrating.***
This is the first mRNA vaccine to be fully approved. And it’s been a long scientific road to get here. The work began in 1961, when mRNA was first identified as an integral part of our human body.

Then, in the 1990’s, Dr. Katalin Karikó, a Hungarian-born scientist, discovered that mRNA could possibly be used for vaccines. For decades she had convince people to fund her research, which was more than difficult. But her perseverance, leadership, and collaborative spirit prevailed and research resulted in the COVID19 Pfizer/BioNTech vaccine we are using today. (Read more about this story here; it’s fascinating. I hope she’s celebrating with a glass or five of wine).

Before the pandemic, there were (and currently are) many clinical trials testing the applicability of new class of treatments for cystic fibrosis, heart disease, genetic conditions, cancers, diabetes, the flu, and even seasonal allergies. It’s not an understatement to say that mRNA biotechnology will be a game changer for the human race.

Once the pandemic hit, scientists quickly leveraged this groundwork and adapted it for a COVID-19 vaccine. Speed did not mean rushed. It meant leveraging a whole lot of smart people (scientists and clinical trial volunteers), money, and decades of previous work to get us a vaccine. And we did it in 9 months.

Pfizer was granted Emergency Use Authorization (EUA) by the FDA in December 2020 after accumulating the required 2 months of Phase III data. It was under the assumption that they would apply for a full licensure once they had 6 months of follow-up data (showing vaccine longevity, continued safety) and necessary documents (like manufacturing processes).

On May 7, 2021 Pfizer submitted their application for full approval. Today, the FDA fully approved the vaccine for those aged 16+ years old.

***So, what does full approval change?***
We should see a cascade of events.

First, we should expect an uptick in vaccinations. According to the Kaiser Family Foundation, 3 out of 10 (32%) unvaccinated adults said they were more likely to get the vaccine if the FDA granted full approval. After crunching the numbers (209,128,094 18+ year olds in the United States and 70.8% vaccinated), we should see 6.2 million adults in line to get a vaccine.

Second, clinicians now have the autonomy to prescribe off-label. Clinicians now have the decision-making power to recommend the vaccine to children aged 11 and younger. I’m sure pediatricians were inundated with phone calls today. Thankfully the American Academy of Pediatrics was quick to react and released a statement today discouraging this practice:
“The clinical trials for the COVID-19 vaccine in children ages 11 years old and younger are underway, and we need to see the data from those studies before we give this vaccine to younger children. The dose may be different for younger ages. The AAP recommends against giving the vaccine to children under 12 until authorized by the FDA”.

Third, the private and public sectors will likely ditch the carrot approach and move to the stick. A full approval means that employers, insurance companies, businesses, and maybe even hospitals may start getting braver with requirements:

-Many employers were hesitant to require vaccination under EUA. The legality of was in bit of uncharted waters. In June 2021, the Equal Employment Opportunity Commission issued guidance stating that employers can mandate COVID-19 vaccinations for employees who physically enter the workplace without running in anti-discrimination laws. But they also said “it’s beyond the EEOC's jurisdiction to discuss the legal implications of EUA or the FDA approach” and employers needed to consider religious and disability-related objections and explore reasonable accommodations. Employers did succeed in vaccine mandates under EUA, though. Houston Methodist hospital was one of the first in the nation to mandate COVID19 vaccines for their employees. This prompted 117 employees (out of 26,000) to file a lawsuit. But, a federal judge said the employees' claim was “false” and “irrelevant” and that it “will make it safer for their workers and the patients in Methodist's care.”

-Health insurers may start thinking about higher premiums for unvaccinated people. In June and July 2021, there were 113,000 preventable COVID-19 hospitalizations among the unvaccinated. In two months, this cost the US healthcare system $2.3 billion. That’s not a small bill.

-Full FDA approval will surely bring an interesting debate among other businesses too:
—-Businesses may start requiring proof of vaccination for customers. San Francisco is already requiring proof of vaccination to enter bars.
—-What about triage-making decisions? This debate came to the limelight last week when Dallas clinicians were discussing a tough scenario: If there is only one ICU bed left, does it belong to the person in a car accident? Or does it belong to the unvaccinated person who needs to be intubated because they didn’t take an effective and safe preventative measure? I doubt it will ever come to this, but an interesting debate to bring back to the classroom.

Bottom Line: The first full approval of mRNA biotechnology is a game changer. Both for scientific discovery and for getting us one step closer to ending this pandemic.

Cheers, YLE

For all the graphs, pictures and data sources, see my newsletter here: https://yourlocalepidemiologist.substack.com/p/full-fda-approval-what-will-this?justPublished=true

06/16/2021

Yesterday from the CDC:

"If you’re fully vaccinated, you no longer need to wear a mask in MOST settings.

The C.D.C. still recommends wearing a mask in settings where Covid-19 may spread more easily, including HEALTHCARE FACILITIES, correctional facilities, homeless shelters, transportation hubs and on all forms of public transportation. This helps protect people who may be particularly vulnerable to the virus and also to prevent spread."

This is why, even though I've been fully vaccinated since mid February, I am still requiring masks of everyone who comes in my office. I work with high-risk people every week.

Even though I'm vaccinated, it is still possible that I could get Covid, although it would most likely be a mild case. I would be OK, but this could devastate a high-risk individual. I'm not willing to take that risk.

Many of my clients are not getting vaccinated. So my choices are 1) To only work on vaccinated people, or 2) To require masks of everyone, or 3) To close my business. For now I am choosing 2.

So, PLEASE, if you choose to patronize a business, please follow their Covid requirements.

07/07/2020

Masks are required of both client and practitioner by the Florida Department of Health and Orange County.

04/01/2020

My clients know that I'm a big fan of the Alexander Technique and their Constructive Rest. It's a great way to relieve aches and pains and reduce anxiety. Try it out, you've probably got plenty of time right now.

https://m.youtube.com/watch?v=4V4DPqv0_lw

This 10-minute guided meditation uses principles of the Alexander Technique and embodied anatomy to help you release unnecessary tension and provide support ...

07/04/2018

It's office update time again. I moved two buildings east of my old space. 1850 Lee Road, #108, Lee World Center, Winter Park, FL, 32792

12/08/2015

Great article about the myth of core strength in relation to back pain.

https://www.facebook.com/missy.barnes.73/posts/10153990358706777

The Core Stability Myth Tue 01 Dec 2015 Myths, by their very nature, are very hard to dispel once they've taken hold. Despite the core stability myth being exposed nearly ten years ago, from conversations I have with people I'd say its hold is as strong ever. There's an elephant in the room regardin…

07/16/2015

"Take rest; a field that has rested gives a bountiful crop."
- Ovid

I recommend this to my clients all the time.

05/29/2015

A beautiful gift from one of my beautiful clients! Have a great weekend, everyone.