(National Psoriasis Foundation) - You’ve seen the commercials. Psoriasis treatments are everywhere. So it would follow that people with psoriasis can also be found everywhere, right? In theory, yes. About 3 percent of all people will develop psoriasis – a chronic, inflammatory disease that can have severe consequences and comes with an unwelcome increased risk of several related diseases. But what the numbers don’t show is the impact that shame and stigma can have and the unintended consequences of those feelings.

More than 125 million people worldwide live with psoriasis. If you attend a National Football League game this fall or winter, you’ll be in a stadium with more than 2,000 people who have developed psoriasis. Or maybe music is more your thing. If you saw Taylor Swift at the average Eras Tour venue in the U.S., about 2,300 of your fellow Swifties in attendance were living with this lifelong disease.

When you frame it that way and think about all the psoriasis drug commercials filling up your screen, it may sound like the disease is well understood – even normalized. But the results of the new Psoriasis Health Indicator Report bring a dark reality to light: Misunderstandings about psoriasis and the people who live with this disease are rampant. Worse yet, stigma about the disease is a contributing factor to people living in isolation or not seeking care.

Misunderstandings Have Consequences

According to the report, more than half of the people in the U.S. who do not live with psoriasis say they would be uncomfortable dating someone with the disease, and more than 40 percent say they wouldn’t even be comfortable shaking hands with someone living with psoriasis.

How would you feel if 1 in 3 people were uncomfortable having you in their home? Yes, another sad reality laid out in the report. What about if 1 in 4 people were closed off to being your friend because of a disease you live with? Ouch.

With so much stigma – such a drastic level of misunderstanding and downright discrimination – would you be open about your life with psoriasis? Would you be willing to pursue treatment?

Psoriasis is not contagious, but it is a public health concern. People with this disease are at an elevated risk for heart disease, type 2 diabetes, psoriatic arthritis, and depression. All of those risks – as well as the threat of developing more severe psoriasis – increase when the disease is left untreated. Booking an appointment with a healthcare provider is hard enough. But carrying around all the stigma-driven shame that comes with having this visible disease makes the pursuit of proper disease management and treatment from a qualified specialist much more unlikely.

The Truth Heals

Tragically, all this stigma is a part of daily life for the 8 million people in the U.S. who live with psoriasis, but people are speaking out, and each time they do, the world gains a little more understanding. Take Takieyah Mathis of Fayetteville, North Carolina for example. She recently opened up in the National Psoriasis Foundation’s In Focus: #ThisIsPsoriasis video series about the challenges she faces each day with this disease and the lessons she’s learned. “Psoriasis put me in a big self-esteem hole,” she shares. “I started to worry about my hair, my skin.” Takieyah was constantly worried about who was looking at her because of the lesions on her skin.

Takieyah took some time to work up the resolve to face the stigma and the stares from onlookers, but as a model, mother, and community builder – psoriasis was not going to hold her back. With the support of her husband and community, she took back control of her self-belief. “You are not your diagnosis. Try to find ways that make you feel beautiful or feel good,” she says. “Finding that peace within yourself is really what’s going to carry you through every day.”

We all know someone with psoriasis. We owe it to them to promote encouragement and support in the face of judgement and misunderstanding. August is Psoriasis Action Month, and thanks to the increased attention, and stories like Takieyah’s who are combatting stigma head-on with the truth and their lived experience, the rest of the world is gaining a little added perspective and compassion.

To learn more about Takieyah or to hear from others who live with psoriasis, visit psoriasis.org/in-focus.

(NewsUSA) - Los niños están regresando a la escuela y el otoño se acerca rápidamente, lo que significa que la temporada de enfermedades respiratorias está a la vuelta de la esquina. Los expertos en salud instan a que ahora es el momento de pensar en cómo reducirás tu riesgo de enfermedades graves por COVID-19 y gripe en los próximos meses, incluyendo mantenerte al día con las últimas vacunas. Los funcionarios de salud también subrayan que el COVID-19 y la gripe son enfermedades graves que se encuentran entre las principales causas de muertes por enfermedades infecciosas en los Estados Unidos.

Los expertos de Champions for Vaccine Education, Equity, and Progress (CVEEP), una coalición dedicada a promover la educación y el acceso a las vacunas, respaldan esta orientación, subrayando que la vacunación oportuna es la defensa más efectiva contra enfermedades graves y hospitalizaciones. “Recibir las últimas vacunas contra el COVID-19 y la gripe cuando estén disponibles este otoño es crucial”, señala Beth Battaglino, CEO de HealthyWomen y coordinadora de CVEEP. “Los virus como los que causan el COVID-19 y la gripe mutan con el tiempo y las vacunas se actualizan específicamente de manera regular para contrarrestar estas nuevas variantes en circulación”.

Este verano, la nación ha experimentado un aumento significativo en los casos de COVID-19, atribuido a un virus en evolución. Para sobrevivir, el virus del COVID-19 está cambiando constantemente, lo que lleva a la aparición de nuevas variantes. Estas nuevas variantes pueden escapar de nuestra respuesta inmune natural y de la protección proporcionada por las vacunas anteriores.

A medida que surgen nuevas variantes, la protección proporcionada por las vacunas puede disminuir. Por eso es crucial mantenerse al día con tus vacunas contra el COVID-19 y la gripe. Al igual que las vacunas contra la gripe, las vacunas contra el COVID-19 se actualizan regularmente para proteger contra las variantes que se prevé que circulen durante la próxima temporada de enfermedades respiratorias, que generalmente abarca de septiembre a marzo.

Mantenerse al día con las vacunas contra el COVID-19 y la gripe reduce significativamente el riesgo de enfermedades graves, hospitalizaciones y muertes. De hecho, estudios recientes han demostrado que las vacunas contra la gripe reducen el riesgo de enfermedad hasta en un 60% y las vacunas contra el COVID-19 reducen el riesgo de hospitalización en un 80% y de muerte en un 90%.

Se espera que las vacunas actualizadas contra el COVID-19 y la gripe estén disponibles en las próximas semanas. Los Centros para el Control y la Prevención de Enfermedades (CDC) recomiendan que todas las personas de 6 meses en adelante reciban estas vacunas. Consulta a tu proveedor de atención médica o farmacia local para obtener más información sobre la disponibilidad.

Visita CVEEP.org/stayupdated para obtener información adicional y recursos sobre vacunación.

(NewsUSA) - Children are returning to school and fall is fast approaching, which means respiratory illness season is right around the corner. Health experts urge that now is the time to think about how you will reduce your risk of severe illness from COVID-19 and flu in the months ahead, including staying up to date with the latest vaccines. Health officials also underscore that COVID-19 and flu are both serious illnesses that rank among the leading causes of infectious disease deaths in the United States.

Experts with Champions for Vaccine Education, Equity, and Progress (CVEEP), a coalition dedicated to promoting vaccine education and access, echo this guidance, underscoring that timely vaccination is the most effective defense against severe illness and hospitalization. "Receiving the latest COVID-19 and flu vaccines when they become available this fall is crucial," notes HealthyWomen CEO and CVEEP convener Beth Battaglino. "Viruses like those that cause COVID-19 and flu mutate over time and vaccines are specifically updated on a regular basis to counter these newly circulating variants.”  

This summer, the nation has experienced a significant surge in COVID-19 cases, attributed to an evolving virus. To survive, the COVID-19 virus is constantly changing, leading to the emergence of new variants. These new variants can escape our natural immune response, and the protection provided by previous vaccines.

As new variants arise, the protection provided by vaccines can wane.  That’s why staying up to date on your COVID-19 and flu vaccines is critical. Like flu vaccines, COVID-19 vaccines are regularly updated to protect against the variants predicted to circulate during the upcoming respiratory illness season, typically spanning from September to March.

Staying current with COVID-19 and flu vaccines significantly reduces the risk of severe illness, hospitalization, and death. In fact, recent studies have shown that flu shots reduce the risk of illness by up to 60% and COVID-19 vaccines lower the risk of hospitalization by 80% and death by 90%.

The updated COVID-19 and flu vaccines are expected to be available in the coming weeks. The Centers for Disease Control and Prevention (CDC) recommends that all individuals aged 6 months and older receive these vaccines. Consult your healthcare provider or local pharmacy to learn more about availability.

Visit CVEEP.org/stayupdated for additional information and vaccination resources.

(NewsUSA) - Say hello to the uninvited guest: toenail fungus, the ultimate party crasher for your confidence! It’s not just about feeling uneasy; it’s like a fashion police for your feet, dictating a strict ‘no’ to those fabulous sandals and making you think twice before exposing your toes. And let’s talk about those doctor discussions - brace yourself for some seriously cringeworthy moments!

Identifying signs of toenail fungus, or onychomycosis, is essential. Look out for discolored or yellowed nails, nails that are brittle, cracked, or broken, thickened nails, or nails that have separated from the nail bed.

Did you know that toenail fungus affects around 10%-12% of the general population? It's even more prevalent among older adults and diabetics, with a whopping 20% in those over 60 and 50% in those over 70, according to Dr. Neil Sadick, a world-renowned dermatologist and Chief Medical Officer of STRIDETM, available at getmystride.com. While toenail fungus often targets the big toenail, any nail can fall victim to it.

"In general, clinical data strongly supports a combination of prescription antifungal medications as the most effective way to eliminate toenail fungal infections," advises Dr. Sadick. Dr. Peter Bregman, a board-certified podiatrist, has been treating toenail fungus for 25 years and echoes Dr. Sadick’s sentiment. He states, “The most effective treatment of toenail fungus is a combination of topical and oral medications in addition to treating your shoes with an antifungal spray to avoid recurrence. There are so many over-the-counter products that just do not work and patients are wasting their time and money with the vast majority of them.”

Dr. Sadick frequently recommends this combination approach for optimal results. The STRIDE DUOTM toenail fungus treatment boasts an impressive 89% clinical effectiveness rate, with noticeable improvements in appearance in just days. Thanks to STRIDETM, backed by Dr. Sadick, patients can now manage their condition entirely online, from the comfort of their home and on their own schedule. After creating a profile, a licensed clinician reviews the condition and provides a personalized diagnosis. Safe and effective FDA-approved prescription medications are then delivered to your door. Healthcare can be stressful, but STRIDETM takes the stress out of toenail fungus treatment.

For more information, visit getmystride.com. Say goodbye to toenail fungus without leaving your home!

(Amy Pisani) - The summer heat still lingers, but parents and caregivers have embarked on the annual ritual of preparing children for the school year ahead. Store shelves overflow with school supplies, and dorm décor, a clear sign of this busy season. Amidst the hustle, one crucial task often gets overlooked: ensuring children are up to date on their recommended immunizations. This is especially vital for students heading to college or living in group settings, where reminders or school-entry vaccination requirements may be lacking.

Meningococcal meningitis is a serious bacterial infection that can cause inflammation of the brain and spinal cord. While many parents have heard of this disease, they may not fully understand the risks.  It spreads easily through respiratory droplets, like those produced when coughing or sneezing, and close contact, such as kissing or sharing drinks, e-cigs, vapes and utensils.

One alarming aspect of meningitis is its similarity to the flu in its early stages, often delaying diagnosis. By the time the disease is identified, it may be too late for effective treatment. Meningitis can progress rapidly, leading to severe consequences within hours, including brain damage, organ failure, limb loss, and even death.

There are five serogroups of meningococcal disease: A, B, C, W, and Y. Each year, hundreds of people in the United States contract this vaccine-preventable disease and since 2021, cases of meningococcal disease have increased sharply, now exceeding pre-pandemic levels. While rare, the statistics are sobering: 10-15 percent of those infected will die, and 20 percent of survivors will suffer permanent disabilities such as brain damage, hearing loss, kidney dysfunction, or limb amputations. As our family advocates attest, their children’s illnesses progressed like wildfire, too often resulting in death. 

While anyone can contract meningococcal disease, it is most prevalent among infants under one year old (who are too young to be vaccinated), individuals aged 16-23, and adults over 85 years of age. Meningitis B accounts for about 60 percent of cases in individuals under 24 years of age.  

For years, vaccines have been available to protect against four of the five serogroups: A, C, W, and Y. In 2014, new vaccines covering the meningitis B strain were approved. While about 89 percent of teens have been vaccinated for meningitis ACWY, rates for meningitis B vaccination are far lower at about 30 percent. This is particularly concerning since meningitis B has been responsible for every college outbreak since 2011.

Fortunately, late last year, a new vaccine combining all five serogroups was approved by the FDA. This fall will be the first back-to-school season with this simplified option, which should reduce confusion about the vaccines and increase the likelihood that older teens are fully protected against this disease. But a flag for parents—to please make a proactive ask of your provider about the vaccines to protect against meningitis B, as many young adults are not up to date.

As the school year approaches, parents and caregivers must prioritize their children’s health by ensuring they are fully vaccinated, including the meningococcal vaccines. Colleges and group living situations are breeding grounds for diseases, making immunization essential.

To learn more about meningitis and other back-to-school vaccine resources visit https://vaccinateyourfamily.org/firstdayvax/. 

Amy Pisani, MS, is the CEO of Vaccinate Your Family, an organization whose mission is to ensure the timely immunization of people of all ages.

(NewsUSA) - Newly diagnosed college student Trevor Dixon shows that managing diabetes doesn’t get in the way of an active life at the transition to adulthood

Trevor was in his second semester of his senior year in high school, when he found himself feeling abnormally thirsty and needing to use the bathroom excessively. He first dismissed it as a symptom of all the exercise he was doing. However, after his mother encouraged him to pay a visit to the family doctor, it was clear all was not well.

Trevor commented; “Born in Arizona, you would think I would drink a lot of water, as it’s usually hot most of the year. But I never really did drink a ton of water or need the bathroom so frequently, so this was strange for me.”

The doctor ran some tests and Trevor’s blood glucose levels were far too high. After being rushed to the ER, Trevor was shocked to learn that he had type 1 diabetes.

The time after the diagnosis was a frightening and confusing period for Trevor and his mother, especially since he was preparing to attend college out-of-state in a matter of weeks. Suddenly, passing finals, enjoying summer and setting up a new life in Southern California seemed more daunting than ever.

Trevor would have to adapt to managing a condition that he knew little about, quickly. Thankfully, there is diabetes education available to people who need support.

One of the big changes Trevor had to make was to his diet and nutrition. He was always partial to sweet things and sodas, but all that had to change; “the biggest thing for me, was I had a sweet tooth, like my mom. After my diagnosis, sweets became a rare treat on occasion,” Trevor said.

Trevor and his mom spoke to their doctor to learn about all the options available to help reduce the burden of managing diabetes effectively. He tried a range of traditional short-term continuous glucose monitors (CGMs), but found them bulky and felt they didn’t work for his lifestyle. He had trouble with the accuracy of some CGMs and felt frustrated that others would be easily knocked off.

Trevor wanted to manage his diabetes and not the limitations of his CGM. He wanted to live his life without worry and pursue his passion of swimming. He wanted to feel comfortable managing his diabetes as he left home for college.

After returning to the doctor for more answers, Trevor’s mom spotted a poster for Eversense and they decided to give it a try. Eversense is the world’s first and only fully implantable long-term CGM and the latest version, Eversense E3, lasts for 180 days vs. just a week or two for other available CGMs.

Trevor acquired his Eversense E3 and began studies at a University in Southern California.

The unique design of the Eversense E3 CGM simplified Trevor’s diabetes management, allowing his life as a college student to be less interrupted by diabetes. The implantable sensor, paired with the removable smart transmitter, is an especially useful feature for Trevor, as it makes swimming for the college team easier.

Trevor also appreciates several other features of Eversense that make his life easier and reduces the burden on him day-to-day, including the discrete on-body vibrations, which don’t draw attention during his college classes.

“Eversense has on-body vibration alerts, which means I can choose to have cell phone notifications either on or off and still manage my diabetes. This is nice because my phone isn't going off all the time in situations like classes where that would be embarrassing to me personally.” Trevor said.

Eversense makes it easy for Trevor to check his real-time glucose readings, glucose trends, as well as receive alerts that predict hypoglycemia and hyperglycemia, all while maintaining his active, busy life. This has been particularly reassuring for Trevor’s mom, who worried about him looking after himself away from home for the first time – and that was before he was diagnosed with diabetes!

Trevor is now a college sophomore, majoring in business and finance. He is on his fourth 180-day Eversense sensor, and doesn’t let diabetes slow him down from swimming, studying and spending time at the beach with friends.

“Make sure some of your friends know about your condition, so they can offer support if you need it,” says Trevor. But overall, Trevor says he has been able to incorporate diabetes management into his life without much fuss, thanks to Eversense.

The Eversense E3 is broadly covered for people living with diabetes across the United States. For more information about successfully managing diabetes, visit EversenseDiabetes.com/get-started-today.

Trevor Dixon is an Eversense brand ambassador and this article was sponsored by Ascensia Diabetes Care

(NewsUSA) - Buying over-the-counter (OTC) medicines or dietary supplements online can be easy and convenient, but how can you be sure that you know and trust the seller? As the number of counterfeit OTC products sold online has grown in recent years, along with scammers’ abilities to mimic legitimate products, experts at the Health In Hand Foundation, a non-profit with 20 years of helping consumers safely choose and use consumer healthcare products, are here to help you navigate the ever-changing landscape of counterfeit and resold OTC products.  

Honest consumer healthcare companies ensure the safety and quality of their products in many ways, including using regulated factories that follow strict safety standards and verified manufacturing practices. However, some individuals produce counterfeit versions of these same medicines in facilities with little or no regulation, quality control, or safety standards. 

When you purchase products online, the options can seem endless. One option is buying directly from a manufacturer’s website ([BRAND].com), where products are sold and shipped directly to you from the manufacturer. 

Alternatively, you may purchase products from an online retailer that sells multiple brands and products (e.g. Amazon, Walmart, Costco, or a pharmacy retailer). But make sure to look carefully because well-known e-commerce websites can have different sellers offering what seems to be the same product on the same results page. So. how can you be sure you’re purchasing from a legitimate seller? Keep these tips and red flags in mind the next time you plan on buying an OTC product online: 

• Prices that are too good to be true. Sellers of fake OTC medicines will often offer them at prices much lower than businesses selling the genuine product. Although the products may be fake, these sellers can still appear at the top of search results.  

• Photos that do not match the product. A low-quality image or an image that differs from the advertised item is another sign of a fake product. Some sellers will alter a photo by blurring or blocking the brand to avoid counterfeit detection. 

• Wording that doesn’t describe the product. If the brand name is missing from the listings, be cautious. Some sellers don’t mention the brand name in the listing to avoid counterfeit detection, and they may have an image of a branded product with a nonspecific description. 

• Unclear or confusing reviews. Reviews that don't match the product listed or comments that are confusing or inauthentic are red flags alerting you to a possible fake. 

• No contact information. If the seller doesn't have a physical address or telephone number listed within the United States, the business could be fake. 

• Poor or non-existent customer service policies.* Beware of companies with no return and/or refund policy. Also, avoid sellers who don’t have secure payment protocols in place to protect your financial information when you purchase from them online.  
   

*Important note: Genuine sellers often do not allow returns on OTC medications, so please review all factors mentioned before buying. 

If you have already placed an online order for an OTC product, inspect it closely when it arrives to ensure it has not been damaged or disturbed. Trust your instincts. If the packaging or labeling looks off or if the product itself does not look right, return it and report it. Becoming an informed shopper helps you find the legitimate and trustworthy products you need to help you feel your best. 

Visit healthinhand.org  for more tips and advice about choosing and using consumer healthcare products safely.  

(NewsUSA) - President Biden, First Lady Jill Biden, Hugh Jackman, Diane Keaton, Melanie Griffith, Richard Simmons and Caitlyn Jenner have all had nonmelanoma skin cancer, the most common type of cancer in the United States. More than 3.3 million Americans are diagnosed with this disease every year, and most undergo Mohs surgery, which can be painful and disfiguring. Seattle-area resident Cheryl Cayford was happy to find an FDA-cleared device providing a nonsurgical cure.

“I’ve been diagnosed with skin cancer twice before and treated successfully with Mohs surgery, so I am certainly familiar with that procedure,” she says. “When my doctor subsequently told me a sore on my nose was malignant, thoughts of those surgeries with the accompanying discomfort and scarring came flooding back. There was a real bit of panic as well. Surgery on my nose with plastic surgery to follow seemed way more daunting than the previous surgeries on my shoulder and arm.”

But this time, her dermatologist told her there was a noninvasive option that delivers the same 99%-plus cure rate as Mohs surgery, with no pain, surgical scarring or need for reconstructive surgery. Cheryl chose that alternative, called image-guided SRT or the GentleCure Experience. It involves the use of low-level x-rays precisely targeted with the aid of high-resolution ultrasound imaging. Cheryl sat for a series of 15-minute treatment sessions in her dermatologist’s office over the course of six weeks. 

“I was in and out in minutes,” she says, “and during each visit my provider showed me ultrasound images of the cancer cells shrinking away. Today, I’m cancer-free with no visible signs of having had any medical procedure at all.”

For Cheryl, GentleCure had additional meaning. “I have two daughters and I think their noses are adorable,” Cheryl notes with a laugh. “Thanks to my dermatologist, mine still is as well.”

Jacob Scott, MD, president and chairman of Dermatology Association of Radiation Therapy, noted, “The sun’s harmful ultraviolet rays are a leading cause of nonmelanoma skin cancer, and the cellular damage is cumulative over time. That explains why we see more of this type of cancer in seniors. In fact, one in five Americans will develop skin cancer by the age of 70, but there are other factors that put some of us at higher risk, such as having fair skin, red or blond hair, or green, blue or gray eyes. For those who fear surgery or who are, due to medical conditions, poor candidates for Mohs surgery, image-guided SRT can be a life-changing alternative.”

Image-guided SRT, the essence of the GentleCure Experience, is covered by Medicare and most insurance plans. It is available in select dermatology practices around the country. Information about the treatment is available at www.gentlecure.com. 

(Information provided by the U.S. Department of Health and Human Services) - Due to a new law, more people qualify for more prescription drug savings with Medicare’s Extra Help program, so it could pay to apply even if you don’t think you qualify or if you were denied before. Many people qualify for Extra Help and don’t know it. 

You may be able to save money on your Part D prescription drug costs through Medicare’s Extra Help program, including $0 drug plan premiums, $0 deductibles, and lower out-of-pocket costs. With Medicare’s Extra Help, you’ll pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs. The savings can really add up.

Apply for Extra Help if you have income below these limits:

• Individuals—Your yearly income is less than $22,590.
• Married and living with your spouse—Your yearly income is less than $30,660.

Apply through the Social Security Administration by visiting ssa.gov/extrahelp where you can complete and submit your application.

Need help applying? Access personalized health insurance counseling in your community at no cost, available from your State Health Insurance Assistance Program (SHIP). Visit shiphelp.org or call 1-800-MEDICARE for locations near you.

Even if you don’t qualify for Extra Help now, you can reapply for Extra Help any time if your income and resources change.

To learn more about Medicare’s Extra Help program, visit Medicare.gov or call 1-800-MEDICARE.

Information provided by the U.S. Department of Health & Human Services.

Debido a una nueva ley, más personas califican para ahorrar más en medicamentos recetados con el programa Ayuda Adicional de Medicare, por lo que podría valer la pena solicitarlo incluso si cree que no califica o si se le negó antes. Muchas personas califican para Ayuda Adicional y no lo saben.

Usted podría ahorrar dinero en los costos de sus medicamentos recetados de la Parte D a través del programa Ayuda Adicional de Medicare, que incluye primas del plan de medicamentos de $0, deducibles de $0 y costos de bolsillo más bajos. Con la Ayuda Adicional de Medicare, no pagará más de $4.50 por medicamentos genéricos y $11.20 por medicamentos de marca. Los ahorros realmente pueden sumar.

Solicite el programa de Ayuda Adicional si sus ingresos están por debajo de estos límites:

• Individuos: Sus ingresos anuales son menores de $22,590.
• Está casado y vive con su cónyuge: Sus ingresos anuales son menores de $30,660.

Solicite a través de la Administración del Seguro Social (Social Security Administration) visitando ssa.gov/extrahelp donde puede completar y enviar su solicitud.

¿Necesita ayuda para presentar su solicitud? Acceda a un asesoramiento personalizado sobre seguro médico en su comunidad sin costo, disponible a través de su Programa Estatal de Asistencia sobre Seguros de Salud (State Health Insurance Assistance Program, SHIP). Visite shiphelp.org o llame al 1-800-MEDICARE para conocer las ubicaciones más cercanas a usted.

Incluso si no califica para la Ayuda Adicional ahora, puede volver a solicitarla en cualquier momento si cambian sus ingresos y recursos.

Para obtener más información sobre el programa Ayuda Adicional de Medicare, visite es.Medicare.gov o llame al 1-800-MEDICARE.

Información proporcionada por el Departamento de Salud y Servicios Humanos de los EE. UU.

(U. S. Department of Health and Human Services).