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Migrants Are Skipping Medical Care, Fearing ICE, Doctors Say

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Migrants Are Skipping Medical Care, Fearing ICE, Doctors Say

A man lay on a New York City sidewalk with a gun shot wound, clutching his side.

Emily Borghard, a social worker who hands out supplies to the homeless through her nonprofit, found him and pulled out her phone, preparing to dial 911. But the man begged her not to make the call, she said.

“No, no, no,” he said, telling her in Spanish that he would be deported.

Ms. Borghard tried to explain that federal law required hospitals to treat him, regardless of his immigration status, but he was terrified.

“He said, ‘If I go to the emergency department, that will put me on their radar,’” she recalled in an interview recounting the incident.

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Across the country, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, including injuries, chronic illnesses and high-risk pregnancies, are forgoing medical care out of fear of being apprehended by immigration officials. Since the Trump administration announced plans for mass deportations and rescinded a Biden-era policy that protected spaces like hospitals, medical clinics and churches from immigration enforcement, doctors said they have seen sharp increases in patient anxiety and appointment no-show rates.

If the trend continues, health care officials say, the list of consequences could be long: Infectious diseases circulating unnecessarily; worsening health care costs because of untreated chronic illnesses; and dangerous birth complications for women who wait too long to seek help, among others.

In a survey conducted by KFF, a health policy research organization, 31 percent of immigrants said that worries about immigration status — their own or that of a family member — was negatively affecting their health. About 20 percent of all immigrants surveyed said they were struggling with their eating and sleeping; 31 percent reported worsened stress and anxiety.

A White House spokesman did not respond to messages seeking comment. When the administration announced that it was ending protections at hospitals on Jan. 21, a statement from the Department of Homeland Security said the new policy was intended “to enforce our immigration laws and catch criminal aliens.”

Research has shown that immigration crackdowns are linked with poorer birth outcomes and mental health status, lapses in care, and fewer people accessing the types of public programs that reduce illness and poverty overall.

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“We’re really creating not just very serious health risks, but economic risks in the long run for our country,” said Julie Linton, a pediatrician and member of the committee on federal government affairs for the American Academy of Pediatrics. “These policies are creating very real fear and uncertainty for people and have a tremendous impact on their ability to function on a day-to-day level.”

Many immigrant communities suffer from high rates of chronic conditions such as high blood pressure and diabetes, which, if left untreated, can lead to heart attack, stroke and other grave complications.

That is why doctors worry about patients like Maria, a 47-year-old woman with pre-diabetes, who has been going to the same primary care clinic ever since she arrived in the United States from El Salvador 20 years ago. Even during the first Trump administration’s crackdown on immigration, she continued to seek medical care. But when the protections around hospitals and clinics were rescinded earlier this year, Maria canceled her appointment to have her blood sugar checked, a routine and crucial element of diabetes prevention in patients like her.

“We’re very scared of being in the clinic and having ICE arrive while waiting to be called,” she said in Spanish, referring to U.S. Immigration and Customs Enforcement.

Maria, who asked that her last name not be published, said that she is in a state of “constant anguish.” She said she avoids leaving the house and is working on a plan for the care of her children, who are American citizens, in case she and her husband are deported.

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One of their daughters, who is 15, is being treated for fatty liver disease and the other, 11, needs therapy for a developmental condition. Their older daughter has another doctor’s appointment in June. Maria and her husband don’t want to interrupt her care, but they are worried about taking her there themselves. “It’s very complicated,” Maria said. “I can put myself at risk for my children. But if it’s for my own health, I prefer to let it go.”

The consequences of abandoning regular medical care can turn serious quickly, however. Jim Mangia, president of St. John’s Community Health Network in Los Angeles described one patient with diabetes who stopped showing up for a weekly diabetes education class. When a clinic staff member called the woman, they discovered she was afraid to even go to the grocery store, and had been subsisting for days on tortillas and coffee, he said.

“Thank God we reached her and she came in,” said Mr. Mangia, whose network serves an estimated 25,000 undocumented patients across more than 20 locations. Tests at the clinic showed that her blood sugar had become dangerously high.

“That’s what we’re going to see more and more of,” Mr. Mangia said. “It kind of breaks my heart to talk about it.”

For doctors working in urgent care settings, a drop-off in immigrants has become apparent through some unusual metrics. For example, Dr. Amy Zeidan, an emergency room physician in Atlanta, said that requests for Spanish-language interpretation in her hospital’s emergency department had fallen more than 60 percent from January to February.

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Theresa Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center, said one of her residents had seen an immigrant patient who had suffered multiple facial fractures from an assault, but had not sought care for more than two weeks. “There is tremendous fear,” Dr. Cheng said.

In late January, Dr. Cheng said, she saw a patient who arrived with severely untreated diabetes. The patient, an undocumented woman, said she had waited to receive help because she was scared. She died that day.

Dr. Carolina Miranda, a family physician in the Bronx, spoke of a patient who had been granted asylum but, fearful of ICE, had failed to show up for a doctor’s appointment about a possible brain tumor.

Similar delays or cancellations are arising among pregnant women and new mothers, according to obstetrician-gynecologists around the country. Dr. Caitlin Bernard, an obstetrician in Indiana, said a patient had skipped her postpartum visit, explaining that she would no longer be leaving her house. On an obstetrics floor in a San Diego hospital, multiple staff members said they had seen an overnight drop-off following the inauguration in the number of immigrant women coming in with acute issues during their pregnancies.

“Obviously those women still exist,” said one doctor, who asked not to be identified because her employer forbade her from speaking publicly on the matter. “I fear it’s going to increase maternal mortality over time. ”

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Many of the children of immigrant parents who have skipped appointments or left medications unfilled are American citizens. But in mixed-status families, parents who are at risk of deportation are often unwilling to take the risk of going to the clinic or pharmacy.

A pediatrician at a health center that cares for underserved populations on the central coast of California reported a 30 percent increase in no-shows for pediatric appointments. Many of those who do bring their children, and are referred elsewhere for specialty care, such as speech therapy, or an autism evaluation, refuse, saying they are too frightened, said the pediatrician, who asked to be unidentified because he wasn’t authorized to speak publicly.

Dr. Tania Caballero, a pediatrician at Johns Hopkins who sees patients at a health center for underserved groups called Baltimore Medical System, said she had encountered parents who had not wanted to go with their babies to the emergency room out of fear, and parents of children with chronic conditions like cerebral palsy, asthma, and Type 1 diabetes who had told her they have stopped getting vital care.

“I tell patients, ‘I can’t control what happens outside of my space, and I can’t control if somebody comes into my space, But you know me. I have the tools, and I want to help you navigate this journey and do it together,’” she said.

Some parents of children in other dire situations — such as those receiving cancer treatment — are hoping that their child’s condition might actually protect them. Some have asked pediatricians for letters explaining their child’s medical requirements, in hopes that immigration officials who detain them might be convinced that the child needs to stay in the United States to survive.

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Dr. Lisa Gwynn, a pediatrician in South Florida who serves families from across the Caribbean and South America, said that her plummeting patient attendance rate is particularly worrisome because patients are missing out on childhood vaccines necessary for preventing diseases like measles, pneumonia and whooping cough.

Dr. Gwynn also worries that without coming to see her, children who have experienced severe trauma before coming to the United States aren’t being connected to social workers or psychologists who can help.

“Imagine your children living in a home where everyone’s scared, and they’ve come to this country to not feel scared anymore,” she said. “We know that stress does not fare well for health. Period. Kids don’t perform as well in school, they have mental health issues, depression, anxiety. ”

Some medical facilities have said they will comply with immigration officials. NYU Langone, in New York City, sent a memo to employees warning them not to try to protect illegal migrants. But many other health centers and organizations are finding ways to take a stand, telling staff to display “Know Your Rights” information on the walls and to never record their immigration status in a patient’s medical records. ”

Last week, the New England Journal of Medicine published an article by two doctors and a lawyer detailing how physicians can continue to provide health care and lawfully push back in the face of some ICE requests.

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The St. John’s clinic network in Los Angeles recently launched an ambitious home visitation program in which a doctor, nurse and medical assistant visit patients’ where they live to perform exams and deliver medications. They aim to inform all 25,000 of their undocumented patients of this option.

In the New York area, a hospital association suggested designating a “hospital liaison” who can be paged to quickly usher an agent into a private office, and then ask to see a signed warrant, which would then be reviewed by in-house counsel.

At the emergency room of University Hospital, a safety net facility in Newark, staff members hand out cards, in Spanish and other languages, reminding patients of their rights. “You have the right to refuse consent for immigration or the police to search yourself, your car or your home,” the cards state.

But even there, the fear is palpable. Annalee M. Baker, an emergency physician, said she had seen a young woman who said her partner had beaten her until she was unconscious. Covered in welts and bruises, she had waited hours to come in. The reason given: she was terrified that her partner would be deported.

Dr. Baker also treated a minor who had been stabbed; she had needed his parents’ consent to treat him, but the boy had been skittish about providing any details about them, out of fear they might be caught in the immigration dragnet.

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Still, it is the people who never come in at all that haunt Dr. Baker the most.

“The tragic message to these people is: Be a shadow and hope that you do not die.”

Sarah Kliffcontributed reporting.

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Just 5 minutes a day of these exercises can sharpen your brain as you age

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Just 5 minutes a day of these exercises can sharpen your brain as you age

Exercise has long been linked with stronger brains and reduced risk of dementia and other cognitive diseases. But new research suggests that older adults can significantly improve brain health with only a few minutes of daily movement.

Researchers from the University of South Australia and the U.S.-based AdventHealth Research Institute found that as few as five minutes of moderate-to-vigorous exercise a day correlated to significantly better cognitive performance. The study, published in the British journal Age & Ageing in early April, examined data from hundreds of people 65 to 80 years old.

Researchers found that “huff-and-puff” movements, like running or lap swimming, were associated with better brain functions including information processing, focusing and multitasking and short-term memory. They also found that even a few minutes of moderate exercise like walking improves brain functions.

“Our key finding was that moving from doing zero minutes or very little moderate-to-vigorous physical activity to doing just five minutes a day — that’s where the biggest gain in cognitive function was seen,” said the study’s lead author, Maddison Mellow, a research associate at the University of South Australia.

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The researchers distinguished between moderate and vigorous exercise by applying a simple test: whether subjects could still manage to speak full sentences after moving around. Vigorous exercise makes that impossible, said Audrey Collins, a postdoctoral research scientist at AdventHealth Research Institute and the paper’s co-lead author.

The study observed 585 people, all in good health. Their physical activity was measured using accelerometers they wore on their wrists; the researchers tested cognitive functions using online and paper-based tests.

Worth noting: This study also found a “strong relationship” between spending little to no time doing moderate to vigorous activity and poorer cognitive performance, Mellow said. One slightly surprising finding, she added, was that the cognitive performance gains from exercise don’t extend to longer-term memory and visual-spatial functions like judging distances or sizes.

The study was novel in that it categorized how people divided their days into three behaviors: sleep, sedentary and active. And though getting enough quality sleep is important to brain health in midlife and beyond, the researchers said that when forced to choose between minutes spent sleeping and minutes spent exercising, reducing sleep time to spend more time moving resulted in better brain function.

“It didn’t really matter, in this sample, where time was coming from, whether from sleep, sedentary behavior or light intensity physical activity,” Mellow said. “So long as time was being increased in moderate vigorous activity, that’s where the benefits were being shown for cognitive outcomes.”

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With that in mind, what are some moderate or vigorous bursts of exercise for older adults to do every day? We consulted experts to give you five accessible options.

1. Walking

Two experts I spoke with each said the easiest way to clock those five daily minutes for brain health is by walking.

“Walking is No. 1, because that’s the easiest,” said E. Todd Schroeder, professor of clinical physical therapy and the director of the Clinical Exercise Research Center at USC. Very sedentary older adults may want to start with simple flat-ground walking at their normal pace, Schroeder says.

If you’re already a steady, regular walker, kick up the pace to elevate your heart rate into that all-important moderate category.

“A brisk walk is considered to be moderate activity,” said Rob Musci, an assistant professor of health and human sciences at Loyola Marymount University. On a scale of 1 to 10, moderate exercise is what you would consider being in the 4 to 6 range, Musci said.

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To achieve a real huff-and-puff workout, walking or hiking briskly uphill is excellent, Schroeder said, because it also necessarily requires walking back down hill.

“That interval-type training is good,” he said, “where your heart rate goes up for a time then comes back down.”

2. Swimming

Swimming is a terrific way to get a full-body workout and raise your heart rate.

“It’s easy on the joints,” Shroeder said. “Even if you struggle with the technique of swimming, you can put on fins and get some at least moderate exercise.”

3. Cycling

Cycling can be on a stationary bike or an outdoor bike, many of which are now battery-assisted, making pedaling up hills almost too easy. One reason I like old-fashioned outdoor bikes, sans batteries, is that they also train balance and require your brain to keep you safe.

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4. Resistance training

Lifting weights is one of the best ways to maintain muscle strength as we age, Musci said. Try these simple exercises you can easily do at home in fewer than three minutes. They include:

  • Tossing a weighted ball from one hand to another (try it standing on one leg)
  • Squats holding a kettlebell, dumbbell, a bag of oranges or nothing at all
  • Weighted chest presses in boat pose

5. Gardening and housework

Gardening can be a great way to engage core muscles, encourage flexibility and practice fine motor skills. Even basic house cleaning, like scrubbing a bathtub or mopping a floor, can qualify as moderate exercise.

“Anything that gets your heart going is what we’re looking for,” Musci said. “You hear about all these high-end interventions, fitness programs and boot camps, but in reality, it’s just movement.”

The most important thing, he said, is “just getting off the couch.”

Von Zielbauer is the creator of Aging With Strength on Substack.

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Biden is diagnosed with 'aggressive' form of prostate cancer

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Biden is diagnosed with 'aggressive' form of prostate cancer

Former President Biden has been diagnosed with an “aggressive form” of prostate cancer, his office said Sunday, a devastating development after having dropped his bid for reelection last summer over widespread concerns over his age and health.

Biden’s personal office said he was examined last week after the president reported a series of concerning symptoms.

“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday, he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” the office said in a statement.

“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management. The President and his family are reviewing treatment options with his physicians,” the statement added.

The former president, 82, had been making his first public appearances since leaving office in recent weeks, including a public address and a lengthy sit-down on ABC’s “The View,” and also hired a communications strategist to help burnish his legacy amid the publication of a series of books critically examining his time at the White House.

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Biden has a tragic personal history with cancer, losing his son, Beau Biden, to glioblastoma in 2015, when he was serving as vice president. At that time, he launched the “cancer moonshot,” a government-wide push for improved cancer treatments that he relaunched during his presidency.

The spread of cancer to the bones will make Biden’s cancer difficult to cure. But its receptiveness to hormone treatments could help his medical team inhibit the cancer’s growth, at least temporarily.

Biden dropped out of the 2024 race in July under immense pressure from leadership in the Democratic Party after a disastrous debate with the Republican presidential nominee, Donald Trump, laid bare concerns over his age and acuity.

Within hours of dropping out of the race, Biden endorsed his vice president, Kamala Harris, to run in his place. She quickly coalesced the party around her nomination and avoided a primary battle, but lost to Trump in November.

In a post on X, Harris said she and her husband, Doug Emhoff, were saddened to learn of Biden’s diagnosis. “We are keeping him, Dr. Biden, and their entire family in our hearts and prayers during this time,” she wrote. “Joe is a fighter — and I know he will face this challenge with the same strength, resilience, and optimism that have always defined his life and leadership. We are hopeful for a full and speedy recovery.”

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Last week on “The View,” Biden said he took responsibility for Trump’s return to power, because he was in office at the time. “I do, because, look, I was in charge and he won. So, you know, I take responsibility,” he said.

But he continued to reject criticisms that he and his team worked to conceal the effects of his age on his performance as president, saying he was not surprised by Harris’ loss and suggesting he still believes he could have beaten Trump had he stayed in the race.

“It wasn’t a slam dunk,” he said, referring to President Trump’s victory. “Let me put it this way. He’s had the worst 100 days any president’s ever had. And I would not say honesty has been his strong point.”

Trump expressed concern about Biden’s condition in a Truth Social post Sunday. “Melania and I are saddened to hear about Joe Biden’s recent medical diagnosis. We extend our warmest and best wishes to Jill and the family, and we wish Joe a fast and successful recovery,” he wrote.

California Gov. Gavin Newsom was among the many politicians from both parties who posted their warm wishes and prayers for the former president. “Our hearts are with President Biden and his entire family right now. A man of dignity, strength, and compassion like his deserves to live a long and beautiful life. Sending strength, healing and prayers his way,” Newsom wrote on X.

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House Speaker Mike Johnson (R-La.) wrote on X: “This is certainly sad news, and the Johnson family will be joining the countless others who are praying for the former President in the wake of his diagnosis.”

Biden was spending the weekend in Delaware with family, an aide said.

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Nearly half of Pasadena Unified schools have contaminated soil, district finds

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Nearly half of Pasadena Unified schools have contaminated soil, district finds

Eleven of the 23 Pasadena Unified School District schools, where students have been back on campus since January, have contaminated soil after the Eaton fire, the district found.

More than 40% of the schools had lead at levels exceeding the state’s health-based limits for residential soil, and more than 20% had arsenic levels beyond what L.A. County considers acceptable, according to the results released Wednesday.

The district found lead at more than three times the state’s allowable limit of 80 milligrams per kilogram of soil next to Blair High School’s tennis courts and more than double the limit at four elementary schools. Lead, when inhaled through dust or ingested from dirt-covered hands, can cause permanent brain and nerve damage in children, resulting in slowed development and behavioral issues.

Arsenic, a known carcinogen, was found at a concentration of 92 mg/kg at San Rafael Elementary School. The county has used 12 mg/kg as a reference level, based on an estimate of the highest naturally occurring arsenic levels in all of Southern California. The naturally occurring background level of arsenic in Altadena and Pasadena ranges from 4 to 10 mg/kg, according to a 2019 study by the U.S. Geological Survey.

There is no safe exposure level for arsenic or lead.

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“I’m worried about her safety,” said Nicole Maccalla of her daughter, a sixth-grader at Octavia E. Butler Magnet, which is located less than a mile from the Eaton fire burn area. “I would really like to have assurances that she’s physically safe while she’s at school.”

Instead, what she got was a map of the school posted by the district showing lead levels 40% and 70% above the allowable limit in soil samples taken next to the school entrance and near the outdoor lunch tables, respectively.

“If, literally, you’ve got to walk by lead to walk up the steps to school, then how many kids are walking through that with their shoes and then walking into the classroom?” Maccalla said. “It’s not like these are inaccessible areas that are gated off.”

Maccalla made the hard decision to let her daughter return to school in January despite early fears — worrying that the trauma of changing schools directly after the fire would be too much.

Along with other concerned parents, Maccalla has been pushing for both soil and indoor testing for months at school board meetings. It was only after the L.A. County Department of Public Health announced in April that it had found 80% of properties had lead levels exceeding the state’s standards in some areas downwind that the district hired the environmental firm Verdantas to conduct testing at schools.

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“The school board has been very resistant to any request for testing from parents,” she said. “The superintendent kept saying it’s safe.” The parents’ response: “Prove it.”

The district released test results for 33 properties it owns — some with district schools and children’s centers, others with charter and private schools, some rented to nonprofits — that were all largely unscathed by the fires. On the 22 properties with public schools, students have been back in the classroom since late January. The full results with maps for each school can be seen on the school district’s website.

The district stated on its website there was “no indication that students or staff were exposed to hazardous levels of fire-related substances in the soil,” noting that any contamination found was highly localized. (For example, although seven samples at Blair High School identified elevated lead levels, 21 samples did not.)

Health agencies also advised the district that soil covered with grass or cement was unlikely to pose a health risk.

In response to the results, the district stated it would restrict access to contaminated areas, complete follow-up sampling and work on remediation over the summer. No classroom instruction would be affected.

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“We want to be abundantly clear: Safety is not negotiable,” Pasadena Unified School District Supt. Elizabeth Blanco said in a press release. “That’s why we’re moving forward with both urgency and care.”

For Maccalla, it’s too little too late. “I would like to know what their plan is for monitoring the health of the children, given you’ve got kids that have already been playing outside in that soil for four months straight,” she said. “So what’s their health crisis mitigation plan?”

The test results also found high levels of chromium — which, in some chemical configurations, is a carcinogen — on one campus. Another had high levels of a class of contaminants called polycyclic aromatic hydrocarbons, which can cause headaches, coughing, skin irritation and, over long periods of exposure, can come with an increased risk of cancer.

Three of the five properties with the district’s children’s centers also had elevated levels of heavy metals — two with lead, one with arsenic.

When Maccalla — who has spent much of her time after the fire volunteering with the community advocacy group Eaton Fire Residents United — first saw the map of her daughter’s school, she began to formulate a plan to rally volunteers to cover the contaminated areas with mulch and compost before school buses arrive again Monday morning. (That is an expert-approved remediation technique for fire-stricken soil.)

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“If the district is not going to do it, the state’s not going to do it, our county’s not going to do it, our city’s not going to do it,” she said, “well, the citizens will. We absolutely will.”

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