By Gina Garippo

Some people with overactive bladder try treatment after treatment, but nothing seems to work. Others find certain treatments difficult to tolerate. Don't lose hope! A new treatment, called neurostimulation, may be worth considering.

Neurostimulation is a way of controlling urinary incontinence, frequency, and problems emptying the bladder. It works by sending mild electrical pulses to the sacral nerves—the nerves in the lower back that help control bladder function. The treatment requires only an outpatient procedure, and results can be seen quickly.

The Bladder "Pacemaker"The therapy, provided by FDA-approved Medtronic InterStim® Therapy for Urinary Control, works similarly to how a pacemaker helps regulate the heart. A small device is surgically implanted under the skin close to the tailbone. It's programmed to emit electrical pulses that interrupt poor communication between the brain and sacral nerves. Without clear communication, the body is unable to store and void urine correctly.

By regulating communication between the brain and bladder, neurostimulation can reduce urinary leaking and urgency feelings. In clinical trials, the therapy has been shown to eliminate or greatly decrease bladder-control symptoms in people who couldn't tolerate or failed to improve with other, more conservative treatments, such as lifestyle changes or medication.

Reversible TreatmentNeurostimulation isn't permanent. In fact, doctors can remove or simply turn off the system at any time. And it does not cause harm to the nerves. A hand-held programming device allows the patient to adjust the strength of stimulation. This device sends radio signals through the skin to the neurostimulator.

A Pre-Surgery TestWhat if you're interested in the device but leery of committing to surgery? You can test its effectiveness before having the surgical procedure. During this trial period, the doctor numbs your lower back and inserts a thin wire near the sacral nerves. The wire leads to a stimulator, which is worn on your waistband during the trial. The stimulator sends mild pulses through the wire to the sacral nerves.

The trial period lasts three to seven days. During this time, patients keep a diary of urinary symptoms. If there is a significant improvement, they may consider having the device implanted for ongoing use.

Talk with Your DoctorNeurostimulation isn't right for everyone. Some people with the device have experienced negative side effects. These include:

• Pain at the implant site
  
  
• Infection or skin irritation
  
  
• Wire movement
  
  
• Changes in bowel or urinary function
  
  
• Unpleasant feeling of stimulation
  
  

If you'd like to explore neurostimulation, discuss it with your doctor. 

By Sabrina Tavernise

MEMPHIS — When it came time to have the baby, Shirita Corley was alone. Her mother was at the casino, her sister was not answering her cellphone, her boyfriend had disappeared months earlier, and her father she had not seen in years.

So she got in her green Chevy TrailBlazer and drove herself to the hospital.

“I feel so down,” she texted from her hospital bed. “I’m sick of these deadbeats. I’m sick of having to be so strong.”

The message went not to a friend or family member, but to a nurse, Beth Pletz. Ms. Pletz has counseled Ms. Corley at her home through the Nurse-Family Partnership, which helps poor, first-time mothers learn to be parents.

Such home visiting programs, paid for through the Affordable Care Act, are at the heart of a sweeping federal effort aimed at one of the nation’s most entrenched social problems: the persistently high rates of infant mortality. The programs have spread to some 800 cities and towns in recent years, and are testing whether successful small-scale efforts to improve children’s health by educating mothers can work on a broad national canvas.

Ms. Pletz plays with Jamarley, 2. CreditAndrea Morales for The New York TimesHome visiting is an attempt to counter the damaging effects of poverty by changing habits and behaviors that have developed over generations. It gained popularity in the United States in the late 1800s when nurses like S. Josephine Baker and Lillian Wald helped poor mothers and their babies on the teeming, impoverished Lower East Side of Manhattan. At its best, the program gives poor women the confidence to take charge of their lives, a tall order that Ms. Pletz says can be achieved only if the visits are sustained. In her program, operated here by Le Bonheur Children’s Hospital, the visits continue for two years.

It is Ms. Pletz’s knack for listening and talking to women — about misbehaving men, broken cars, unreliable families — that forms the bones of her bond with them.

She zips around Memphis in her aging Toyota S.U.V. with a stethoscope dangling from the rearview mirror. Her cracked iPhone perpetually pings with texts from her 25 clients. Most of them are young, black, poor and single. Few had fathers in their lives as children, and their children are often repeating the same broken pattern.

“I was lost, going from house to house,” recalled Onie Hayslett, 22, who was homeless and pregnant when she first met Ms. Pletz two years ago. Her only shoes were slippers. “She brought me food. That’s not her job description, but she did it anyway. She really cares about what’s going on. I don’t have many people in my life like that.”

Infant mortality rates in the United States are about the same as those in Europe in the first month of life, a recent study found, but then become higher in the months after babies come home from the hospital — a period when abuse and neglect can set in. (The study adjusted for premature births, which are also higher in the United States partly because of poverty. They were kept out of the study, researchers said, because the policies to reduce them are different.)

In Memphis, where close to half of children live in poverty, according to census data, the infant mortality rate has long been among the country’s highest. Sleep deaths — in which babies suffocate because of too much soft bedding or because an adult rolls over onto them — accounted for a fifth of infant deaths in the state, according to a 2013 analysis of death certificates by the Tennessee Department of Health.

Beth Pletz leaves Ms. Corley after a home visit. CreditAndrea Morales for The New York TimesWhen Ms. Pletz recently visited Darrisha Onry, 21, she saw Ms. Onry’s week-old child, Cedveon, lying beside her on a dark blue couch. The room was warm, small and crowded with a large living room set, a glass table, porcelain statues of dogs and an oversize cage holding two tiny, napping puppies.

“Where is he sleeping?” Ms. Pletz asked.

Cedveon started to cry, and Ms. Onry walked out of the room to make his bottle.

“The safest place for him is alone by himself on his back in his crib,” Ms. Pletz said, scooping up Cedveon, who had launched into a full-throated squall.

A little later, Ms. Pletz said, "You know never to shake the baby, right?”

Ms. Onry nodded.

Darrisha Onry holding her infant son, Cedveon. CreditAndrea Morales for The New York TimesMs. Pletz continued: “Nerves get shot and sometimes people lose their cool. If that happens, just put him on his back on a bed and close the door, and take a little rest away from him.”

The program is unusual because it is based on a series of clinical trialsmuch like those used to test drugs. In the 1970s, a child development expert, Dr. David Olds, began sending nurses into the homes of poor mothers in Elmira, N.Y., and later into Memphis and Denver. The nurses taught mothers not to fall asleep on the couch with their infants, not to give them Coca-Cola, to pick them up when they cried and to praise them when they behaved. The outcomes were compared with those from a similar group of women who did not get the help.

The results were startling. Death rates in the visited families dropped not just for children, but for mothers, too, when compared with families who did not get the services. Child abuse and neglect declined by half. Mothers stayed in the work force longer, and their use of welfare, food stamps andMedicaid declined. Children of the most vulnerable mothers had higher grade-point averages and were less likely to be arrested than their counterparts.

The program caught the attention of President Obama, who cited it in his first presidential campaign. His administration funded the program on a national scale in 2010. So far, the home visits have reached more than 115,000 mothers and children. States apply for grants and are required to collect data on how the families fare on measures of health, education and economic self-sufficiency. Early results are expected this year.

“The big question is, can the principle of evidence be implemented in a large federal program?” said Jon Baron, president of the Coalition for Evidence-Based Policy, a nonprofit group in Washington whose aim is to increase government effectiveness in areas including education, poverty reduction and crime prevention. “And if so, will it actually improve health?”

Experts say federal standards are too loose and have allowed some groups with weak home visiting programs to participate, even if they show effects on only trivial outcomes that have no practical importance for a child’s life. Congress should fix the problem, Mr. Baron said, warning that the program in its current state is “a leaky bucket.”

Beth Pletz catches up on email after her visit with Ms. Onry. CreditAndrea Morales for The New York Times“If left unchanged, essentially anyone will figure out how to qualify,” he said.

Its future is not assured. Funding for the home visiting initiative runs out as early as September for some states, and if Congress does not reauthorize it this month, programs may stop enrolling families and the $500 million the Obama administration has requested for 2016 will not be granted. Last week, its supporters urged Congress to extend it.

In Tennessee, where home visiting programs have bipartisan support, infant mortality is down by 14 percent since 2010, and sleep deaths dipped by 10 percent from 2012 to 2013. State officials credit a multitude of policies, including the home visits.

Ms. Pletz worries that she has helped only a handful of her clients truly improve their lives. But Ms. Corley, 28, the mother who drove herself to the hospital, said Ms. Pletz, who has been visiting her for two years, had made a difference. She “has been my counselor, my girlfriend, my nurse,” Ms. Corley said. Ms. Pletz helped her cope with the disappearances of her children’s fathers, taught her to recognize whooping cough and pushed her to set career goals, she said.

“She knows more about me than my own family does,” Ms. Corley said. “I feel like I’ve grown more wise. I feel stronger for sure.”

The morning after Ms. Corley gave birth, Ms. Pletz brought her breakfast: eggs, flapjacks and bacon. The new baby, Daniel, lay in a clear plastic crib next to Ms. Corley’s hospital bed, and the two women talked over his head like old friends.

“Can I pick him up?” Ms. Pletz asked.

Ms. Corley replied: “I think he’s waiting on it.”

Originally Found at: http://www.nytimes.com/2015/03/09/health/program-that-helps-new-mothers-learn-to-be-parents-faces-broader-test.html?ref=health&_r=0

Liberia’s last Ebola patient was discharged on Thursday after a ceremony in the capital, Monrovia, bringing to zero the number of known cases in the country and marking a milestone in West Africa’s battle against the disease.

Officials in Monrovia, the city where the raging epidemic littered the streets with bodies only five months ago, celebrated even as they warned that Liberia was at least weeks away from being officially declared free ofEbola. They also noted that the disease had flared up recently in neighboring Sierra Leone and Guinea, the two other countries hardest hit by it.

“It was touching, it was pleasing,” Tolbert Nyenswah, the deputy health minister in charge of Liberia’s fight against Ebola, said in a telephone interview about the ceremony. “There was a lot of excitement because we feel that this is a victory.”

“But it’s not over yet,” he added. “We are still cautioning people. We told them they must still protect their villages, their towns. They should report any suspicion of Ebola to the health teams. We still have a response that is tight. Yeah, we made that point.”

Continue reading the main story

Graphic: Ending the Ebola Outbreak“But,” Mr. Nyenswah said, “it’s exciting, man.”

The authorities are still tracking more than 100 people for possible exposure to the virus. As of Thursday, no new cases of Ebola had been confirmed inside Liberia for the past 13 days, Mr. Nyenswah said.

If no new cases emerge, the epidemic in Liberia will be considered over officially on April 4, or 42 days after the last known infection. The 42-day marker is twice the longest incubation period for Ebola, 21 days.

Liberia has suffered the highest number of deaths during the epidemic, with 4,117 recorded victims, according to the World Health Organization. More than 9,800 people have died in total.

The health organization reported Wednesday that new cases had increased sharply — to 132 from 99 — in Sierra Leone and Guinea in the week before March 1. Transmission remains widespread in Sierra Leone, and Conakry, the capital of Guinea, suffered a marked increase, according to the organization.

On Thursday, the last patient being treated in Liberia, Beatrice Yardolo, 58, an English teacher, was released from a treatment center in Monrovia built by the Chinese government. Ms. Yardolo, who lost two sons and a daughter to the disease, was treated for Ebola at the center and tested negative on Tuesday.

Continue reading the main storyVideoPLAY VIDEO|6:50Inside the Ebola Ward
Inside the Ebola WardWorkers at the International Medical Corps treatment center in Suakoko, Liberia, use faith, hard work and caution as they face a stream of sick people in this remote hilltop east of Monrovia.

 Video by Ben C. Solomon on Publish DateOctober 23, 2014. Photo by Daniel Berehulak for The New York Times.
“I feel fine to be back home with my family after being away for almost three weeks — I feel very proud,” Ms. Yardolo said in a telephone interview. “I’m very grateful to God because he does everything.”

Music could be heard from inside her family home in Monrovia, the sound of the festivities amplified by a loud rooster.

Her husband, Steve Yardolo, said: “I think you hear the music. We are happy. The family is sitting around here, and we continue to celebrate.”

Ms. Yardolo’s case was part of a recent outbreak in a community called St. Paul’s Bridge, located in what was one of the biggest Ebola hot spots in Monrovia, New Kru Town. The outbreak was unusually violent and far-reaching, in part because it involved criminal gangs that did not cooperate with the authorities and fears that it could be spread through a knife fight with one member nicknamed Time Bomb.

The recent outbreak in St. Paul’s Bridge also exposed the continuing weakness in Liberia’s health care system, as patients with Ebola were admitted to health clinics that had failed to carry out proper triage. Hundreds of health care workers at a half-dozen health clinics were placed under quarantine for possible exposure, though none of them became infected.

In Ms. Yardolo’s case, her infection was traced to her oldest son, Steve, 32, who worked as a hygienist at an Ebola treatment center. He was infected while performing his duties or interacting with a sick neighbor, Dr. Mosoka Fallah, Liberia’s chief epidemiologist, said by telephone.
“Steve was a popular member of the community and a member of a local group of intellectuals,” Dr. Fallah said. “It’s a big loss.”

The virus was transmitted to other members of his family, including a brother, Elijah, 30, and a sister, Amanda, 20, both of whom died. Believing that Amanda was suffering from appendicitis, her family took her to a clinic, where she was treated.

Dr. Fallah said the transmission inside this family was typical of how the disease had spread during the epidemic as a whole.

“It started from somebody getting it from outside the family and bringing it to the family, a caregiver who gives it to the rest,” he said.

Ms. Yardolo, who was taking care of Amanda, was eventually also infected. But unlike her family members, she reacted quickly and survived.

“The moment I started getting the signs and the symptoms, the next day I said they should send an ambulance to carry me to the center,” Ms. Yardolo said. “So because of going early, I felt that God will take care of things, and he did.”

Though her family, including three other children, could still be heard celebrating, Ms. Yardolo grew silent for several seconds at the thought of the three who had died.

“It’s so heartbreaking,” she said. “However, we have to let go somehow and celebrate my life with the rest of the children.”