Younger Americans are homeless

Now, with what he calls "lowered the standards" and a new position inconsistent with a Jack in the Box restaurant, Mr Taylor, 24, doesn't do enough to rent an apartment or share one. Sleeps on a mat in a homeless shelter, except when his sister let him crash on her couch.

"Anytime I could lose my job, my safety," said Mr. Taylor, explaining how it has always been the last hired and first fired. "I'd like to be able to support myself. This is my only goal. "

Across the country, tens of thousands of people unemployed and underemployed youth with college credits or work stories, many are struggling to house themselves following the recession, which has left workers between 18 and 24 with the highest unemployment rate of all adults.

Who can move back home with their parents — the so-called boomerang set — are the most fortunate. But that is not an option for those whose families have been affected badly the economy, including Mr. Taylor, whose mother is barely scraping while working at a laundromat. Without a permanent residence, they are an elusive group which mostly SURFs sofa or sleeping hidden away in your car or other private places, hoping to avoid the stigma of homelessness lasting public during what I hope will be a temporary situation.

These young adults are the new face of a national population of homeless, poverty experts and workers say cases is growing. But the problem is largely invisible. Most cities and States, focusing on homeless families, they did not make special efforts to identify young adults, who tend to shy away from ordinary admissions for fear of being victimized by a chronically homeless people, seniors. The unemployment rate and the number of young adults who can't afford college "point to the fact that there is a dramatic increase in homelessness" in that age group, said Barbara Poppe, Executive Director of the United States Interagency Council on homelessness.

The Obama administration has launched an initiative with nine communities, most of them large cities, to try and those between 18 and 24 who are without a consistent home address. New York, Houston, Los Angeles, Cleveland and Boston are among the cities included in the effort.

"One of our first approaches you get an estimate more confident," said MS. Poppe, whose Agency is coordinating the initiative.

Those who provide services to the poor in many cities say that economic recovery has not alleviated the problem. "Years ago, you haven't seen what looked like college age sitting and waiting to talk to a worker of the crisis because they are homeless on the street," said Andrae Bailey, the Executive Director of the Community food and Outreach Center, one of the largest charitable organizations in Florida. "Now that is a normal thing."

Los Angeles first attempted a count of young adults who live on the street in 2011. Found 3,600, but the city had the capacity to shelter only 17 percent of them.

"The rest are left to their own devices," said Michael Arnold, Executive Director of the homeless services authority in Los Angeles. "And when you start adding in those who are couch surfing and staying with friends, that number increases exponentially.

Boston also tried to contend in 2010 and 2011. Seeking shelter homeless young adult population has grown by 3 percentage points to 12 percent of homeless people 6,000 served during that time.

"It is a step significant enough to know that it is just the tip of the iceberg," said Jim Greene, Director of emergency shelters for the Commission of public health in Boston.

In Washington, Lance Fuller, a 26-year-old with a degree in journalism, he spent the end of last month packing a one-bedroom apartment that he can no longer afford after being fired. Mr Fuller said he had been unable to keep a job for more than eight months after graduating from the University of Florida in 2010.

"Luckily, I have a girlfriend who is willing to let me stay with you until I get back on my feet again," said Mr Fuller, who writes a blog, rumors of a lost generation. "It's really hard for people of my generation do not feel completely defeated by this economy."

Mr. Taylor, the fast-food worker in Seattle, said that he felt lucky when he could find a coveted space to roots, a shelter for young adults in a church basement. These shelters are rare.

For generations, services for the homeless were directed at two groups: children and the elderly. There has been little attention focused on what today we call the experts «transitional age youth ' — young adults whose needs are distinct.

"I see them coming back day after day, more defeated, tired out, asking, ' when will it be my turn? ' "said Kristine Cunningham, Executive Director of roots".Is heartbreaking. This is the age when you want to show the world that have the value ".

Need more than just clean clothes and shelter to move into adulthood, experts say. "They want a way out," said MS. Poppe, whose Agency is also gathering evidence on what types of programs and awareness campaigns work best. "They want the opportunity to develop skills so they are long-term marketable".

"A more individualized approach seems to be working," he added.

View the original article here

Analysis of two Annals papers on benefits of mammography in younger women

Results of two studies published in the Annals of Internal Medicine point to benefits of biennial mammography screening starting age 40 for women at increased risk.

One evaluated data from 66 published articles and from the Breast Cancer Surveillance Consortium.  The authors’ conclusion:

The second study tried to assess “tipping the balance of benefits and harms to favor screening mammography starting at age 40.”  The lead author concluded:

“The evidence suggests that for women at twice the average risk for breast cancer, biennial screening beginning at age 40 has more benefits than harms,” said study lead author Nicolien T. van Ravesteyn, MSc, of the Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. “These results provide important information toward developing more individualized, risk-based screening guidelines.”

Dr. Otis Brawley, chief medical and scientific officer of the American Cancer Society, wrote an accompanying editorial.  Excerpts:

“I worry that the public perceives mammography as a better technology than it actually is. Mammography screening is often promoted for its benefit. Unfortunately, many do not appreciate its limitations. Truth be told, it cannot avert all or even most breast cancer deaths. There are also tradeoffs. Mammography, like every screening test, has a potential for harm, and one must carefully weigh the harm–benefit ratio for a specific woman or a specific population of women (such as those aged 40 to 49 years) before advising use of the test. The harms associated with mammographic screening include false-positive results, false-positive biopsy results, radiation exposure, false-negative results and false reassurance, pain related to the procedure, overdiagnosis (that is, diagnosis of tumors that are of no threat), and overtreatment. False-positive results are the most common and easily quantifiable harm. On the basis of statistics specific to U.S. practice patterns, about half of women getting an annual mammogram for 10 years starting at age 40 years will have at least 1 false-positive result that requires additional testing. More than 5% will get a biopsy during that time.

…These studies also demonstrate that questions about annual versus biennial screening are legitimate but unsettled. The Cancer Intervention and Surveillance Modeling Network consistently shows that annual screening of women in their 40s marginally increases the number of lives saved while substantially increasing harms. This means that patients and their physicians need to make value judgments regarding the harms and benefits.
In the future, more emphasis will be placed on riskbased screening guidelines tailored to the individual. There may be recommendations that some women at very high risk get annual testing, some at intermediate risk get biennial testing, and some at normal risk start screening at a later age. This will be challenging because many health care providers and members of the lay community do not understand screening and the concept of risk. Specific tools designed to educate them need to be developed and rigorously assessed. Ultimately, the preferences of individual women, recognizing the potential for harm and benefit, should be respected.”

For more perspective, I asked Russell Harris, MD, MPH of the University of North Carolina, to analyze the new studies.  He wrote:

“These are well-conducted studies that try to move us toward more efficient screening for breast cancer.  Certainly we are all in favor of that.  At present, our screening is based on the fact that the risk of breast cancer and breast cancer mortality increases with age; thus, we base starting screening on age.  This is the famous “start at age 40 vs start at age 50” debate we have been having for many years.  These investigators suggest that perhaps there are risk factors beyond age that could allow us to better target the women who could benefit from screening.  It is a good idea.

Unfortunately, the first paper (Nelson et al) shows that we just don’t know enough about the factors that increase or decrease the risk of breast cancer to be able to use this proposed strategy.  This causes the second paper (van Ravesteyn) to make some statements that may be misunderstood and confusing.

Nelson (the first paper) systematically reviews studies of the risk of breast cancer, finding that, other than age, extremely dense breasts on mammogram and presence of first-degree family history of breast cancer are the most important risk factors.  It is important to know that dense breasts on mammography may well reduce the ability of mammography to detect breast cancer, and that very few women will have 2 or more first degree relatives who have been diagnosed with breast cancer (which is the group that has a really substantial increased risk).  The problem is that neither of these factors increase risk more than about two-fold.  These factors would be much more useful if they increased risk by 15 or 20-fold.

Van Ravesteyn et al (the second paper) then use their models to find that if we could identify women in their 40s whose risk is more than 3 times usual risk, then the number of lives extended by screening those women in their 40s would be about the same as the number in their 50s whose lives are extended by screening.  (In neither case is this a large number of women.)  Unfortunately, they do not adequately address the issue of the harms of screening, especially including overdiagnosis, a problem that many people far underestimate. Because the models do not adequately address harms, and because we don’t know how much benefit there would be (if any) from screening women in their 40s with dense breasts, and because there are so few women in their 40s with 2 or more first degree relatives, this strategy really doesn’t get us very far toward making screening more efficient.  The best strategy is still what the USPSTF recommended: individual discussions between patient and medical team to develop an individual approach.

Some people who have wanted to start screening mammography at age 40 will read these papers and find a justification for starting early.  A better interpretation of these studies is that we still need better risk tools that help us become more efficient with breast cancer screening – and this means not only finding women whose risk is high enough that screening makes good sense AND also finding women in their 50s and 60s whose risk is low enough that screening doesn’t make sense.  Then we can truly say we are more efficient – screening women more likely to benefit and NOT screening women more likely to be harmed.”

View the original article here

Analysis of two Annals papers on benefits of mammography in younger women

Results of two studies published in the Annals of Internal Medicine point to benefits of biennial mammography screening starting age 40 for women at increased risk.

One evaluated data from 66 published articles and from the Breast Cancer Surveillance Consortium.  The authors’ conclusion:

The second study tried to assess “tipping the balance of benefits and harms to favor screening mammography starting at age 40.”  The lead author concluded:

“The evidence suggests that for women at twice the average risk for breast cancer, biennial screening beginning at age 40 has more benefits than harms,” said study lead author Nicolien T. van Ravesteyn, MSc, of the Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. “These results provide important information toward developing more individualized, risk-based screening guidelines.”

Dr. Otis Brawley, chief medical and scientific officer of the American Cancer Society, wrote an accompanying editorial.  Excerpts:

“I worry that the public perceives mammography as a better technology than it actually is. Mammography screening is often promoted for its benefit. Unfortunately, many do not appreciate its limitations. Truth be told, it cannot avert all or even most breast cancer deaths. There are also tradeoffs. Mammography, like every screening test, has a potential for harm, and one must carefully weigh the harm–benefit ratio for a specific woman or a specific population of women (such as those aged 40 to 49 years) before advising use of the test. The harms associated with mammographic screening include false-positive results, false-positive biopsy results, radiation exposure, false-negative results and false reassurance, pain related to the procedure, overdiagnosis (that is, diagnosis of tumors that are of no threat), and overtreatment. False-positive results are the most common and easily quantifiable harm. On the basis of statistics specific to U.S. practice patterns, about half of women getting an annual mammogram for 10 years starting at age 40 years will have at least 1 false-positive result that requires additional testing. More than 5% will get a biopsy during that time.

…These studies also demonstrate that questions about annual versus biennial screening are legitimate but unsettled. The Cancer Intervention and Surveillance Modeling Network consistently shows that annual screening of women in their 40s marginally increases the number of lives saved while substantially increasing harms. This means that patients and their physicians need to make value judgments regarding the harms and benefits.
In the future, more emphasis will be placed on riskbased screening guidelines tailored to the individual. There may be recommendations that some women at very high risk get annual testing, some at intermediate risk get biennial testing, and some at normal risk start screening at a later age. This will be challenging because many health care providers and members of the lay community do not understand screening and the concept of risk. Specific tools designed to educate them need to be developed and rigorously assessed. Ultimately, the preferences of individual women, recognizing the potential for harm and benefit, should be respected.”

For more perspective, I asked Russell Harris, MD, MPH of the University of North Carolina, to analyze the new studies.  He wrote:

“These are well-conducted studies that try to move us toward more efficient screening for breast cancer.  Certainly we are all in favor of that.  At present, our screening is based on the fact that the risk of breast cancer and breast cancer mortality increases with age; thus, we base starting screening on age.  This is the famous “start at age 40 vs start at age 50” debate we have been having for many years.  These investigators suggest that perhaps there are risk factors beyond age that could allow us to better target the women who could benefit from screening.  It is a good idea.

Unfortunately, the first paper (Nelson et al) shows that we just don’t know enough about the factors that increase or decrease the risk of breast cancer to be able to use this proposed strategy.  This causes the second paper (van Ravesteyn) to make some statements that may be misunderstood and confusing.

Nelson (the first paper) systematically reviews studies of the risk of breast cancer, finding that, other than age, extremely dense breasts on mammogram and presence of first-degree family history of breast cancer are the most important risk factors.  It is important to know that dense breasts on mammography may well reduce the ability of mammography to detect breast cancer, and that very few women will have 2 or more first degree relatives who have been diagnosed with breast cancer (which is the group that has a really substantial increased risk).  The problem is that neither of these factors increase risk more than about two-fold.  These factors would be much more useful if they increased risk by 15 or 20-fold.

Van Ravesteyn et al (the second paper) then use their models to find that if we could identify women in their 40s whose risk is more than 3 times usual risk, then the number of lives extended by screening those women in their 40s would be about the same as the number in their 50s whose lives are extended by screening.  (In neither case is this a large number of women.)  Unfortunately, they do not adequately address the issue of the harms of screening, especially including overdiagnosis, a problem that many people far underestimate. Because the models do not adequately address harms, and because we don’t know how much benefit there would be (if any) from screening women in their 40s with dense breasts, and because there are so few women in their 40s with 2 or more first degree relatives, this strategy really doesn’t get us very far toward making screening more efficient.  The best strategy is still what the USPSTF recommended: individual discussions between patient and medical team to develop an individual approach.

Some people who have wanted to start screening mammography at age 40 will read these papers and find a justification for starting early.  A better interpretation of these studies is that we still need better risk tools that help us become more efficient with breast cancer screening – and this means not only finding women whose risk is high enough that screening makes good sense AND also finding women in their 50s and 60s whose risk is low enough that screening doesn’t make sense.  Then we can truly say we are more efficient – screening women more likely to benefit and NOT screening women more likely to be harmed.”

View the original article here

Analysis of two Annals papers on benefits of mammography in younger women

Results of two studies published in the Annals of Internal Medicine point to benefits of biennial mammography screening starting age 40 for women at increased risk.

One evaluated data from 66 published articles and from the Breast Cancer Surveillance Consortium.  The authors’ conclusion:

The second study tried to assess “tipping the balance of benefits and harms to favor screening mammography starting at age 40.”  The lead author concluded:

“The evidence suggests that for women at twice the average risk for breast cancer, biennial screening beginning at age 40 has more benefits than harms,” said study lead author Nicolien T. van Ravesteyn, MSc, of the Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. “These results provide important information toward developing more individualized, risk-based screening guidelines.”

Dr. Otis Brawley, chief medical and scientific officer of the American Cancer Society, wrote an accompanying editorial.  Excerpts:

“I worry that the public perceives mammography as a better technology than it actually is. Mammography screening is often promoted for its benefit. Unfortunately, many do not appreciate its limitations. Truth be told, it cannot avert all or even most breast cancer deaths. There are also tradeoffs. Mammography, like every screening test, has a potential for harm, and one must carefully weigh the harm–benefit ratio for a specific woman or a specific population of women (such as those aged 40 to 49 years) before advising use of the test. The harms associated with mammographic screening include false-positive results, false-positive biopsy results, radiation exposure, false-negative results and false reassurance, pain related to the procedure, overdiagnosis (that is, diagnosis of tumors that are of no threat), and overtreatment. False-positive results are the most common and easily quantifiable harm. On the basis of statistics specific to U.S. practice patterns, about half of women getting an annual mammogram for 10 years starting at age 40 years will have at least 1 false-positive result that requires additional testing. More than 5% will get a biopsy during that time.

…These studies also demonstrate that questions about annual versus biennial screening are legitimate but unsettled. The Cancer Intervention and Surveillance Modeling Network consistently shows that annual screening of women in their 40s marginally increases the number of lives saved while substantially increasing harms. This means that patients and their physicians need to make value judgments regarding the harms and benefits.
In the future, more emphasis will be placed on riskbased screening guidelines tailored to the individual. There may be recommendations that some women at very high risk get annual testing, some at intermediate risk get biennial testing, and some at normal risk start screening at a later age. This will be challenging because many health care providers and members of the lay community do not understand screening and the concept of risk. Specific tools designed to educate them need to be developed and rigorously assessed. Ultimately, the preferences of individual women, recognizing the potential for harm and benefit, should be respected.”

For more perspective, I asked Russell Harris, MD, MPH of the University of North Carolina, to analyze the new studies.  He wrote:

“These are well-conducted studies that try to move us toward more efficient screening for breast cancer.  Certainly we are all in favor of that.  At present, our screening is based on the fact that the risk of breast cancer and breast cancer mortality increases with age; thus, we base starting screening on age.  This is the famous “start at age 40 vs start at age 50” debate we have been having for many years.  These investigators suggest that perhaps there are risk factors beyond age that could allow us to better target the women who could benefit from screening.  It is a good idea.

Unfortunately, the first paper (Nelson et al) shows that we just don’t know enough about the factors that increase or decrease the risk of breast cancer to be able to use this proposed strategy.  This causes the second paper (van Ravesteyn) to make some statements that may be misunderstood and confusing.

Nelson (the first paper) systematically reviews studies of the risk of breast cancer, finding that, other than age, extremely dense breasts on mammogram and presence of first-degree family history of breast cancer are the most important risk factors.  It is important to know that dense breasts on mammography may well reduce the ability of mammography to detect breast cancer, and that very few women will have 2 or more first degree relatives who have been diagnosed with breast cancer (which is the group that has a really substantial increased risk).  The problem is that neither of these factors increase risk more than about two-fold.  These factors would be much more useful if they increased risk by 15 or 20-fold.

Van Ravesteyn et al (the second paper) then use their models to find that if we could identify women in their 40s whose risk is more than 3 times usual risk, then the number of lives extended by screening those women in their 40s would be about the same as the number in their 50s whose lives are extended by screening.  (In neither case is this a large number of women.)  Unfortunately, they do not adequately address the issue of the harms of screening, especially including overdiagnosis, a problem that many people far underestimate. Because the models do not adequately address harms, and because we don’t know how much benefit there would be (if any) from screening women in their 40s with dense breasts, and because there are so few women in their 40s with 2 or more first degree relatives, this strategy really doesn’t get us very far toward making screening more efficient.  The best strategy is still what the USPSTF recommended: individual discussions between patient and medical team to develop an individual approach.

Some people who have wanted to start screening mammography at age 40 will read these papers and find a justification for starting early.  A better interpretation of these studies is that we still need better risk tools that help us become more efficient with breast cancer screening – and this means not only finding women whose risk is high enough that screening makes good sense AND also finding women in their 50s and 60s whose risk is low enough that screening doesn’t make sense.  Then we can truly say we are more efficient – screening women more likely to benefit and NOT screening women more likely to be harmed.”

View the original article here