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Christy Duan/ABC(KISORO, Uganda) -- Before the sun rises, psychiatric nurse Immaculate Owembabazi makes her way to a small district hospital in the rural village of Kisoro, Uganda.

Sister Immaculate, as everyone calls her, lives up to her namesake. Each morning, she greets patients in her uniform: a tailored dress, hair combed neatly into a tight bun, and a radiant smile.

Despite her cheerful demeanor, Sister Immaculate struggles with depression, the leading cause of disability worldwide, which affects one out of every six adults in the United States.

While caring for patients as a psychiatric nurse, she developed her first major depressive episode.

"I lost my husband when I was three months pregnant with my baby, [and my son] was still very young," she said. "I was down, totally down. I feel I hated myself."

Thirty-five percent of Ugandans are estimated to have some form of mental illness. Sister Immaculate is one of the few who received modern psychiatric treatment; 90 percent of Ugandans with mental illness never do, according to the World Health Organization.

In the United States, by contrast, 17 percent of adults have mental illness and 43 percent receive care, according to the National Institute of Mental Health.

Most Ugandans are treated by traditional healers, who often believe that mental illness is caused by a curse.

"Most of the people perceive [mental illness is] due to witchcraft. It’s due to spirits. It’s due to demons," Sister Immaculate said.

Traditional healers may tie patients up in ropes or chains while warding off spirits with methods such as prayer, herbal remedies or blood sacrifices.

As many as 80 percent of Ugandans in psychiatric hospitals have been to traditional healers. For one, they are easier to access and culturally more accepted. After all, there are only about 30 psychiatrists in Uganda -- that’s less than one psychiatrist per 1 million Ugandans.

For Ugandan health workers such as Sister Immaculate, building bridges between modern and traditional medicine is a massive undertaking.

"It’s very hard to convince somebody that this is a mental health problem that can be helped, can be managed in hospital," she said.

That evoked memories of Sister Immaculate's own psychiatric hospitalization nearly 10 years ago. Her husband had died, she lost her job, and she was plunged into a court battle when her in-laws sold her home.

Then, she gave birth.

Eighty-five percent of pregnant and postpartum women experience a mood disturbance, and up to 15 percent develop more severe depression and anxiety. In extreme psychological distress, some develop irrational thoughts to harm themselves or others.

In industrialized nations, many women receive help in the form of reassurance, medication and therapy.

Not so in Uganda.

"I’m looking at the world, seemingly nothing for me," Sister Immaculate recalled. "My mind goes, 'Kill these children. Kill yourself.'"

"I felt I would not leave them with my in-laws [or] my parents because [they] hated me," she added. "So I felt whoever hates me will not love my children."

Though Sister Immaculate did not harm anyone, it was only after she developed these severe symptoms that she was brought to the psychiatric hospital. She credits the four-month hospitalization for her recovery.

"Self-counseling" with psychological techniques and antidepressant treatment with Lexapro (escitalopram) and later Elavil (amitriptyline) has kept her depression at bay.

"I had never thought it would happen to me," she said. "But sharing experiences with other people -- it has kept me moving."

Sister Immaculate also shares medical experiences with local traditional healers, trying to lead them to greater acceptance of the modern medical approach.

Seth Muhire, a Busanza-based traditional healer, stands out in Uganda. He has been practicing for nearly 40 years and collaborates with modern medical providers.

While traditional healers are secretive, Muhire told ABC News about his work in his local language.

Muhire works only with herbs gathered from the forest -- and occasionally psychiatric medication. At times, he uses a padlock and loose chains to restrain patients who may run away or become violent. He said that he does not use ropes, which tend to cut through the skin and open up the possibility of infection.

Muhire learned herbal remedies from his father and grandfather. Meanwhile, he learned about the sky-blue tablets of Phenergan (promethazine), a weak antipsychotic, from modern mental health providers.

"I used to collaborate with people who had clinics, so I would learn from them and they would learn from me. In that integration, I got to learn more about using these Western medicines," Muhire said.

When herbal remedies are not working, he sends patients to the psychiatric hospital.

Phiadorah Kampire is one example of trying both methods. She had her first psychotic episode when she heard the deep voice of an old man calling out to her, but no one was there.

A university student majoring in tourism and hotel management at the time, Kampire believed that her schoolmates bewitched her, but her family took her to a psychiatric hospital. She was diagnosed with schizophrenia in 2008 and put on Haldol (haloperidol) -- but at 2500 Ugandan shillings ($0.70 per month), she lapsed in her treatment.

Since then, she occasionally seeks treatment from traditional healers as well.

"During the time I am sick, I have no insight of anything. I don’t even see the good of being on treatment during the time. I’m in attack," Kampire said. "I think I will never be well."

Each psychotic episode is longer, more intense and leads to further isolation. She left the university, cannot maintain a job because of her paranoia and was ostracized by her family.

When asked if she saw any hope in her situation, Kampire reached out for a single, immaculate blade of grass before fanning her fingers outwards and sweeping them across her view of the countryside. She said she can see meaning in the long grasses that sway on the steep hill across from her.

"I put myself in a simple kind of living," she said. "Working at my pace, at my own rate, and in peace. Peace of mind, peace of heart, hoping to achieve heaven."

Christy Duan is a psychiatry resident physician at Zucker Hillside Hospital in New York and a resident at the ABC News Medical Unit.

 

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Oklahoma City Zoo(OKLAHOMA CITY) -- An 18-year-old lioness at the Oklahoma City Zoo is puzzling zoologists after she mysteriously sprouted a mane.

In late 2017, caretakers noticed that Bridget the African lion, a "beloved" longtime resident of the Oklahoma City Zoo, began to grow the extra hair around her neck and head, Gretchen Cole, an associate veterinarian at the zoo, told ABC News.

"After a while, it became obvious to everybody that Bridget was developing something a little different," Cole said.

Curious veterinarians do not yet know what the cause for the "exceptionally rare" growth is but were able to take a blood sample from Bridget's tail without placing her under anesthesia after her caretakers spent several days training her to position it to the side.

The blood sample will be compared to a sample taken from Bridget's sister, 18-year-old Tia, who was born in the same litter as her in 1999, Cole said.

Manes typically develop in males at about a year old after they experience an increase in testosterone.

"Changes when a female develops characteristics of a male are unusual," Cole said.

Other "unique" cases in which female lions have developed a mane include a 13-year-old lioness at the National Zoo in South Africa in 2013, who had an issue with her ovaries that caused an excess production of testosterone.

In 2014, a group of five lionesses in the Botswana wildness were observed with manes. In that case, researchers believe a genetic component played a role, since the lions came from the same pride and developed the manes at a young age, according to the Oklahoma City Zoo.

While Bridget's veterinarians suspect hormones may play a role, that would also be the first factor to be ruled out once they get the results of the blood work, Cole said. Another culprit could be a benign tumor located on her adrenal or pituitary glands, which regulate hormones, the zoo said.

Bridget's age places her in the "geriatric" category of lions, Cole aid. The median lifespan for lions is 16.9 years, according to the Association of Zoos and Aquariums.

Bridget doesn't seem to notice her new hairdo and is acting "completely normal," Cole aid. She's eating and grooming the same, and, more notably, her "strong attitude" is still present.

"It's only the outward appearance of the mane that has changed," she said. "... We are trying to solve the puzzle."

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ABC News(NEW YORK) -- A leading researcher at the National Institutes of Health (NIH) is declaring this year's severe flu season a "wake-up call" for the medical community.

The flu is widespread in 48 states, according to the Centers for Disease Control and Prevention, and has sent 19,398 people to the hospital. At least 84 children have died since Oct. 1.

"We need to do better," said. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

How?

Take, for example, Dr. Matt Memoli's team of researchers at NIH who are infecting healthy humans with the flu and quarantining them for days at a time.

The goal: a vaccine that lasts many years and covers an umbrella of viruses, scrapping the need for yearly injections that may miss the virus that is circulating most that season.

NIH is paying 94 people $3,500 each to infect them with the flu virus and then test the effectiveness of antibodies. Every year, the virus changes a bit, but some parts stay the same. The researchers want to find what is consistent year to year, aiming for that universal vaccine.

"What we have to do is target this idea of a universal vaccine," Memoli said. "Every step that we make forward in the vaccine is one step closer to that goal."

Doctors believe they are still many years away from that goal, but it's research like this that inches them closer to a breakthrough.

But why would a regular person raise her hand to get sick with the flu and spend more than a week in a room by themselves?

"For myself -- and then for young children as well, because those are the ones who get severely affected by it," said 24-year-old Emily Laltoo, a recent college graduate participating in the study while job searching.

"There’s no reason, in 2018, that people should be dying from the flu. That just doesn’t make sense to me,” said Marcus Williams, a 42-year-old who runs a nonprofit and is participating in the study with Laltoo at the NIH Clinical Center, where previous patients have been treated for diseases such as Ebola.

So what do they do while separated from other people and likely quite sick?

"I’ve brought my laptop, and I plan on watching some Netflix and movies on there. And I brought a book," said Laltoo.

"I’m also going to work on my resume and cover letter," she added with a laugh.

These two patients will spend at least 10 days in quarantine after receiving the H1N1 via a nasal spray, the same strain of the flu that caused a 2009 pandemic. Around this clinic, the vials of the virus are carried through the hallways on ice and hand-delivered to patients.

Some will get a drug containing an antibody, and doctors will observe them to see if their condition improves, piecing together the puzzle of a vaccine that will cover a multitude of flu types.

Researchers said they are making progress. New vaccines designed to attack four or five different types of flu could be just five years away. The universal vaccine -- the holy grail for the medical community -- is likely at least a decade away.

But when that day comes, Williams said he will be watching.

"The doctors and nurses, of course, get the most credit," said the Charlottesville native. "Scientists obviously get a lot more credit, but at least I can say I had something to do with it.”

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iStock/Thinkstock(NEW YORK) -- Depression is the leading cause of disability, with 350 million people affected worldwide.

While antidepressants have long been used, there’s been debate about how well they work.

In a new study published in The Lancet, researchers trying to settle the matter found that all 21 antidepressants that they looked at work better than placebo.

The researchers did a meta-analysis where they comprehensively reviewed past studies.

Among the 28,552 studies that they looked at, only 522 were rigorous enough to be included – that’s a total of 116,477 participants treated with 21 different antidepressants.

In addition to finding that all the antidepressants included were more effective than placebo, they compared antidepressants to see whether some worked better than others, and whether people could tolerate the side effects of some more than others.

They noted that some drugs, like Remeron (mirtazapine) and Lexapro (escitalopram), appear to be more effective and tolerable for the average patient.

However, researchers warn that what works well for one patient doesn’t always work well for another – and that antidepressants take a few weeks to begin working in most patients.

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iStock/Thinkstock(NEW YORK) --  If they don’t have to think about cost or availability, women may be more likely to choose long-lasting birth control, according to a new study published in the American Journal of Public Health.

Intrauterine devices, or IUDs, and implants -- tiny, thin rods smaller than a match stick coated with hormones and placed under the skin in the arm -- are considered to be highly-effective, reversible contraceptive methods.

But they’re also expensive forms of birth control for women without appropriate insurance coverage. In addition to physician fees for placement of the device, the price of an intrauterine device or implant hovers just short of $1,000, according to Goodrx.com, a prescription comparison site.

"When you remove cost as a factor, people are more likely to select more effective contraception methods that are often the most expensive up front," Jessica Sanders, Ph.D., MSPH, first author and research assistant professor in Obstetrics and Gynecology at University of Utah Health, said in a press release.

Sanders and her colleagues at the University of Utah enrolled more than 4,400 women in the study, which spanned three years.

The study was separated into three six-month periods. For the first six months, they observed patterns of contraceptive choices without altering them. For the second six months, they offered women any type of birth control for free, and guaranteed that the contraceptive was available and could be given that same day. During the final six months, they added a local media campaign in Utah's Salt Lake County to provide education about long-lasting contraceptives, as well as advertise the availability of no-cost contraception; this included posts to Facebook and Instagram.

"When we added education and outreach to the picture, we saw an increase in the demand for these methods," Sanders said. The study results showed the odds of getting an implant or IUD increased 1.6 times with the first intervention and 2.5 times after they added the media campaign.

The researchers plan to follow the participants in this study to determine the impact of universal access to family planning services over the next years.

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iStock/Thinkstock(NEW YORK) -- Paying attention to the quality of the food is more effective for weight loss than religiously counting calories, according to a new study.

Researchers at Stanford University found there is no significant difference in weight change between a healthy low-fat diet versus a healthy low-carbohydrate diet.

The 12-month weight loss study of 609 individuals found the tactic of choosing whole, unprocessed foods and not worrying about calories resulted in similar weight loss for people following both diets.

The study also found there is no specific insulin levels associated with the dietary effects of weight loss and no specific gene pattern that affected which diet made an individual lose weight.

"I was very happy when I read it," Maya Feller, a New York-based dietitian, said of the study, published Tuesday in the Journal of the American Medical Association.

“The takeaway is that the quality of what you eat is incredibly important,” she said. “You may or may not need to eat an 1,800-calorie diet, but what you need is a diet that is based on whole and minimally processed foods without an excess of added sugars, salts and saturated fats.”

Feller said staying within calorie limits doesn't necessarily mean making good nutrition choices. For example, choosing to eat a 100-calorie pack of cookies would make it easy to count the calories consumed, but it won't contribute to better health.

"Yes, it’s 100 calories and if you’re on a calorie-counting diet it probably fits within your plan, however a 100-calorie pack of [cookies] is not really going to give you as much nutrition as having a piece of fish and some vegetables," she said.

Participants in the Stanford study were given nutrition information in 22 diet-specific small group sessions led by health educators, over the 12-month period. The study said the sessions focused on "ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality."

Making the switch from focusing on the number of calories consumed to eating whole, unprocessed foods is a “deep paradigm shift,” according to Feller.

“I do think that consumers may be confused because for some people who don’t have a healthy relationship with food, counting calories gives them guidelines,” she said. “It’s like really relearning a relationship to food.”

That relearning process requires both mindfulness and focus, but Feller believes it can be done.

"It means you’ve shifted from buying the box that lists out the serving size to actually purchasing a head of collard greens and saying, ‘I’m going to pair it with quinoa and grilled fish,'" she explained.

Feller recommends setting a goal to eat two to three servings of fruit per day and consuming a minimum of two servings of non-starchy vegetables at both lunch and dinner.

People concerned about portion size can focus on dividing their plates, Feller suggested. Half of the plate should have vegetables, one-fourth should have lean protein and one-fourth should have grains or starchy vegetables.

Whole, unprocessed foods are also naturally more filling and satiating, she added.

When shopping for food, Feller recommended buying the food in its most minimally processed state.

“If you want broccoli, then you should be eating a head of broccoli,” she said. “And you can buy fresh produce in bulk and freeze it for later use, so you become your own manufacturer.”

Advance preparation can also be key to eating whole foods daily, instead of running to the vending machine.

“Meal prep can be a lifesaver,” said Feller. She shared these four tips for meal prep success.

1. Use Saturday to plan ahead:
Sit down Saturday and look at your week. Ask yourself, 'What am I prepping for? Is there a refrigerator? Do I need to bring it in a cooler?'

2. Be creative: One size doesn’t fit all. You have to be creative and find out what’s going to work. The best eating plan is the one that you can actually stick to and maintain.

3. Pack balanced meals:
This is not a time to starve yourself. Take time to pack balanced meals that will nourish you.

4. Use the freezer:
Prep for the entire week and put it in the freezer and take it out the night before so it’s ready to go.

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iStock/Thinkstock(NEW YORK) -- Being a trailblazer is familiar territory for Sen. Tammy Duckworth, D-Ill. She was the first disabled vet to serve in Congress, the first Asian American representative to be elected from Illinois and come spring she'll chalk up another milestone -- the first Senator to give birth while serving in the chamber.

Duckworth is expected to deliver her second child a few weeks after she turns 50, a time when many woman expect the end of fertility and the beginning of menopause to be around the corner.

The Senator said she delayed having children to pursue her career and, by the time she was ready, she had to overcome infertility.

"The early part of my career, which was also, [like] for most women, your twenties and early thirties, your prime fertility years," she told ABC station WLS in Chicago, "were also my career-building years."

She is not alone. Duckworth is among a growing number of women, including celebrities like Janet Jackson and Sophie B. Hawkins, tackling motherhood in their fifties.

Overall birthrates in the United States have been declining for years, reaching a record low in 2016, according to National Bureau of Health Statistics, and provisional data suggests a new low for 2017.

But, among women over 40, the birthrate has increased. Women ages 40 to 44 had a 4 percent increase in birthrate and there was also a slight birthrate increase in of .1 percent among women between 45 and 49 years old.

Some doctors are seeing the trend in their practices. Dr. Norbert Gleicher, the medical director and chief scientist at the Center for Human Reproduction, which specializes in treatments of last resort for women who are either older or have had complications in trying to get pregnant, said more than half of his patients are 43 or older.

"This would have been unimaginable 10 years ago," Gleicher told ABC News. "The trend toward having children at older ages is growing year by year. And we are learning better ways to treat older women."

He said he was turning clients over 40 away, a decade ago, because their chances for a viable pregnancy were so small. But many advances in the past several years have changed the landscape: Higher life expectancy, advances in technology and increased rates of egg donations are helping to raise the odds that women in their fifties, and even in their sixties, can have successful pregnancies.

"They need to be screened carefully, but with proper screening the outcome stats are surprisingly good," Gleicher said. "All the published data suggest that with the appropriate screening having babies in the fifties is perfectly manageable."

"In general a healthy woman will have a completely normal pregnancy," he added, "although [older women] do have a higher Cesarean rate due to the higher risk of complications."

Although some women in their later 40s and beyond can have success getting pregnant with their own eggs, the New York City-based fertility specialist said, it's still more common that they conceive with donor eggs.

IVF treatments later in life

Dr. Leona Ashmore, 53, is hoping to become pregnant again this year. The child psychologist has two children -- ages 19 and 17 -- and is divorced, but she has been eager for a bigger family.

"I always thought I had all this time," she said.

But after she turned 52, Ashmore realized time was running out and thought, "I've got to do this now."

Ashmore spent a year researching fertility clinics before settling on CHR.

"It’s so beautiful they have this technology that could help you with that," she added.

Although she was in good health, she went through a battery of required tests, including psychological screening, a cardiac stress test and a lung x-ray, before she was accepted as a candidate for IVF.

Gleicher said older women do face higher health risks for pregnancy, like diabetes, hypertension, preeclampsia, and congestive heart failure. Women over the age of 45 at his clinic undergo expanded pre-testing for physical and mental fitness.

"Pregnancy is a stress test on every organ of the body," said Gleicher. "The testing is not necessarily to exclude patients, but careful pre-screening can help our obstetrics colleagues be ready for any pregnancy complications by detecting the risks and problems before pregnancy."

Having to pass a physical never crossed Ashmore's mind when she first became pregnant at 30.

"Life went on as if I wasn’t pregnant," she said. "With age you become more cautious, watching what I eat, and making sure I get enough rest. It’s a big change how I was at 30 and how I am now."

Sometimes the commitment required for IVF can seem overwhelming, but women trying to get pregnant after 40 are often grateful for the opportunity that it represents, according to Dr. Jane Miller, medical director of North Hudson IVF in Englewood Cliffs, New Jersey.

"What I find with older patients is that they’re not concerned by things that younger patients are concerned about, such as weight gain and stretch marks," she told ABC News. "They have a whole other way of thinking."

Raising kids from a different perspective

Having children after 40 can also mean a different way of parenting, as was the case for Judy Lederman. At 59 years old, she is raising the twin boys she delivered at the age of 53. She and her husband have six children between them from previous marriages, ranging in age from 21 to 33.

"We’re the Brady Bunch on steroids," she said with a laugh.

In 2010, Lederman was 49 years old, divorced and already a grandmother when she met the man who would later become her husband. Three years later the couple got married. At 52, she had become pregnant with twin boys after receiving IVF assistance.

Her pregnancy was considered high risk due to her age and the fact that she was carrying twins. But other than morning sickness for a few months, Lederman said she had a problem-free pregnancy.

"At 37.5 weeks, the doctors were shocked that I was still not ready to deliver," she said. On her doctor’s advice, she agreed to be induced and her twins were delivered by C-section.

Her sons, now 5, have made her a calmer and more intuitive parent, she said.

"I feel like I’ve learned how to tailor my parenting to the child," Lederman told ABC News. "Back then it was one size fits all, it was all about getting to work, getting it all done and getting pulled constantly."

As a retiree with an active partner to help her, she said she is much more focused on the individual needs of her sons. She is also grateful for the help of technology she didn’t have while raising children in the 80s, such as virtual assistants that can cue up bath music and other entertainment.

There is also a sobering downside to being an older mother, Lederman said. She sorely misses the caregiving support her mother and father were able to provide when she was raising her older children. A weekend getaway was possible with just a phone call, for example. But now, her elderly mother suffers from Alzheimer’s and her father has passed away.

It's advice she wanted to share with other women thinking about becoming mothers later in life.

"They have got to have their support systems mapped out," she said. "If you don’t have a significant other, then best have some good friends you can rely on."

While Lederman sheepishly admitted she misses her afternoon naps, she’s quick to say she has no regrets. She said coffee has been a good energy booster when she’s flagging.

Ashmore isn’t worried about her energy reserves, confident she has plenty of vigor left for another baby. She’s looking forward to enjoying every moment with a new child if she is able to have one. But her dream of having one does have a time limit.

"I will not be trying by 60," she said. "If it doesn’t happen by then, it's just not happening."

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iStock/Thinkstock(NEW YORK) -- Among parents who own guns, only one in three store their guns the way pediatricians recommend, a new study found: locked, unloaded and separate from ammunition.

This was the case whether or not the children in the home had any history of mental health issues, according to the study in the journal Pediatrics.

Guns that are accessible and loaded may be more dangerous to the children than to anyone else, including those who might harm themselves.

"One of the most incontrovertible pieces of evidence is that when a gun is in the home it increases risk of suicide," Dr. Matthew Miller, a study author and professor of health sciences and epidemiology at Northwestern University, told ABC News, "especially when it is stored loaded."

The Centers for Disease Control and Prevention said in their mortality data report that, among children age 10 to 17, firearms accounted for more than 40 percent of all suicides.

Mental health conditions increase the likelihood of suicidal behavior, so Miller, who has researched gun violence for the past 20 years, and his team decided to study guns and homes with children who have a history of mental health challenges.

Attention deficit hyperactivity disorder (ADHD) or attention-deficit disorder (ADD), depression and mental health conditions other than depression were categorized as "self-harm risk factors" in this study.

The research team asked two crucial questions for the study:

Are parents whose children are at risk of self-harm any less, or more, likely to live in homes with guns? Do parents with firearms store their household guns more, or less, safely?

Researchers conducted an online survey of almost 4,000 adults across the United States in 2015. The results were self-reported and the authors admit that this could increase the chance of bias, but said they do not believe it played a dominant role in their findings.

Among the group who responded, approximately one in three households contained firearms.

Of those, having a child with self-harm risk factors did not affect how parents stored their guns. This came as "no surprise" to Miller.

Despite what appears to be a recent upswing in gun violence, and extensive media coverage of school shootings, public health recommendations regarding homes with both guns and children have not wavered.

The American Academy of Pediatrics recognized the need to reduce firearm injury to children over a quarter of a century ago. They say the safest home for a child is one without guns. But if guns are in the home, their recommendation is that risk can be substantially reduced by storing all household firearms locked, unloaded, and separate from ammunition.

"The best thing to do is to not have a gun in the home, especially if you have a child with a mental health issue," Miller advises parents. "But even if your child does not have a mental health issue, children can be impulsive and having a gun in the home in that instance is likely to prove fatal."

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Pima County Sheriff's Office (TUCSON, Ariz.) -- An Arizona couple was arrested for child abuse after allegedly locking their adopted children in rooms without food, water or a bathroom, officials said.

The investigation began Saturday when a boy in "disheveled condition" asked to use the phone at a Family Dollar store in Tucson, and the store clerk called 911 to report the suspicious activity, the Pima County Sheriff's Office said in a news release Tuesday.

When deputies responded to the boy's home, they found four children -- ages 6 to 12 -- and learned they were kept in separate bedrooms that were locked from the outside, the sheriff's office said.

The sheriff's office said the children were regularly kept in their locked rooms for up to 12 hours at a time without access to food, water, a bathroom or lights.

One bedroom had a bucket as a toilet, the sheriff's office said.

The child who asked to use the Family Dollar store phone had escaped through a window at the home, according to the sheriff's office.

The other four children were removed from the home while the adoptive parents, Benito Gutierrez, 69, and Carol Gutierrez, 64, were arrested and each charged with three counts of child abuse, the sheriff's office said.

They made their first court appearance Wednesday morning and were held on $25,000 bond, reported ABC affiliate KGUN-TV in Tucson. They return to court March 5.

Last month, two Southern California parents were arrested for allegedly holding their 13 children captive in their home.

David and Louise Turpin allegedly forced the children to shower only once a year, shackled them and beat them routinely, prosecutors said. The victims weren't released from their chains even to go to the bathroom, according to prosecutors.

They were arrested after the couple’s 17-year-old daughter escaped and alerted authorities.

David and Louise Turpin have each been charged with 12 counts of torture, 12 counts of false imprisonment, seven counts of abuse of a dependent adult and six counts of child abuse. David Turpin was also charged with one count of a lewd act on a child under the age of 14 by force, fear or duress. They have pleaded not guilty.

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iStock/Thinkstock(PARKLAND, Fla.) -- The handlers behind the comfort dogs making their way through the Florida community where 17 students and teachers were killed in a school shooting last week have a saying.

"We like to say, 'Comfort walks in on four paws,'" Brenda Burden told ABC News today.

Burden and her husband, Phil, of Hilton Head Island, South Carolina, have been in Parkland, Florida, this week with their dog Sasha and others with Lutheran Church Charities' K-9 Comfort Dog Ministry.

The ministry was started in August 2008 and dispatches golden retrievers around the U.S. to help those grieving after tragedy. One dog named Jacob had traveled to Las Vegas and Orlando after the deadly mass shootings in those cities last year and the year before.

The ministry has more than 130 comfort dogs in more than 20 states has training sites in Illinois and Nebraska. The dogs are trained to remain calm and soothe people who are grieving or distressed.

According to the organization, the dogs had been dispatched to comfort residents and survivors after the Sandy Hook school massacre as well as after Hurricane Harvey.

According to Dana Yocum of Lutheran Church Charities, the ministry relies solely on donations for funding.

Burden said that 3-year-old Sasha and the other dogs were doing visits all week.

"We have been visiting the community at the Parkland amphitheater. We have been visiting first responders to thank them for their services," she said. "Today, we started visiting elementary schools."

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iStock/Thinkstock(NEW YORK) -- Flu season isn’t over yet, but the U.S. Food and Drug Administration (FDA) recently announced that in less than two weeks they will be putting together a panel of experts to help select strains for next season’s flu vaccine.

The influenza virus changes or mutates every year, which makes it very difficult to create a vaccine. It also takes several months to produce the influenza vaccine, which is why health officials are getting started even before this season ends.

While the flu vaccine remains the best method to prevent illness and death during the flu season, a new study published in Clinical Infectious Diseases investigates why “vaccine effectiveness continues to be modest.”

Dr. Scott Gottlieb, FDA commissioner, in his statement on the efficacy of the 2017-2018 influenza vaccine states, “This year much of the illness has been caused by one strain of influenza A called H3N2, with another strain of influenza A called H1N1 and strains of influenza B contributing to lesser extents.”

The effectiveness of the flu vaccine for H3N2 is estimated to be around 25 percent this season, according to an interim report by the Centers for Disease Control and Prevention (CDC). Overall, this season’s vaccine is 36 percent effective. That means that over one-third of the people who get the shot won’t get the flu. In children, it’s even more effective -- 59 percent.

With vaccines against common childhood diseases effective in more than 90 percent of people, why is targeting the flu so difficult?

Researchers have found that poor immune response, based on past encounters with flu strains, is the culprit. When people get the flu virus or vaccine, their immune system makes antibodies that recognize and attack those strains. Antibodies made earlier in life have a stronger response, and affect how the immune system makes future antibodies. A person’s immune response could be worse at making effective antibodies, even if the vaccine protects against the right strains.

"We see that both vaccinated and unvaccinated people were infected with similar flu viruses and that the vaccine didn’t elicit a strong immune response from most people,” Dr. Yonatan Grad, Ph.D., assistant professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health and co-author of the study, said in reference to his study analyzing 2012-2013 H3N2 data in a press release.

The CDC admits that vaccine effectiveness estimates against influenza A (H3N2) viruses have been lower than estimates against influenza A (H1N1) and influenza B viruses for several years. They cite factors such as age, baseline health status and that year’s vaccine “match” -- the similarity between the viruses used to make the vaccine and the ones that are prevalent in a certain year. They also acknowledge that more research is needed to determine if vaccine effectiveness changes between egg-based and non–egg-based vaccines. It is thought that non-egg-based vaccines are less likely to have mutations that lead to less protective effects.

However, the study authors conclude that egg-based vaccines did not explain the low H3N2 vaccine efficacy rate, at least not in 2012-2013.

The leading health officials insist that even with current vaccine effectiveness estimates, vaccination will still help prevent influenza illness, including thousands of hospitalizations and deaths.

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iStock/Thinkstock(NASHUA, N.H.) -- First responders in Nashua, New Hampshire, completed the final phase of a yearlong project last Tuesday, equipping their vehicles with active shooter kits.

The idea, Chris Stawasz, the regional director for American Medical Response in New Hampshire, told ABC affiliate WMUR, is for EMT, fire and police units to be able to deploy the necessary tools as quickly as possible in the event of a mass casualty shooting incident.

"The most important piece of these active shooter events, which are generally over very quickly, is to get inside and rescue anybody who still has an opportunity to be saved," Stawasz said.

Shooting injuries are always serious; however, in mass casualty incidents like the one in Parkland, Florida, last week that killed 17, injuries tend to be much more dangerous. School shooting suspect Nikolas Cruz used an AR-15-style rifle, the bullets of which travel at around 3,200 feet per second, depending on their weight, or about three times as fast as the bullets in a 9mm handgun, according to Time.

"Typical gunfire from a .22 or something is a very small hole. Some of these things are just massive destruction to the human body," Stawasz said.

The high-caliber weapons usually used in mass shooting events can cause a tremendous amount of damage and bleeding. With that in mind, the active shooter kits in Nashua all come equipped with tourniquets, bandages and specialized clotting material that help blood clot more quickly than it normally would.

“This is a kit that where we can deploy it really quickly, throw it into a scene and, if there's multiple casualties, you can use that kit as your primary source of equipment to go out and save these people,” Stawasz told WMUR.

Nashua police were the first to get the kits, then the fire departments and finally the primary ambulances. The EMT go-bags even have quick roll-out stretchers, like reinforced sheets with handles, so that victims who are unable to walk can be dragged away from the scene.

"Unfortunately, these events are becoming far too common, and we want to be prepared in the city and respond to them if they do happen here," Stawasz said.

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ABC News(PESARO, Italy) -- Having grown up in a tiny room in his family’s home in Pesaro, Italy, 27-year-old architect Leonardo Di Chiara is used to living a minimalist lifestyle.

His latest project, the aVOID tiny house, currently on display -- and inhabited -- by the architect in Berlin, takes the concept of reductionist living to the next level.

Measuring just 96 square feet and equipped with all one needs to live, the home seeks to challenge the concept of traditional housing.

“It’s a tiny house and it’s on wheels, so you can move it wherever you want. You can live wherever you want,” the architect told ABC News.

aVOID is part of the tiny-house social and architectural movement started in the U.S. in the 1980s and has seen a resurgence in the past several years. The concept centers around downsizing one’s home to live a more sustainable and minimalistic lifestyle, using few resources.

Since 1973, the typical size of a U.S. home has doubled -- peaking at just over 2,600 square feet, according to U.S. census data. Tiny houses, meanwhile, are typically 100 to 150 square feet, on wheels, and come in a variety of shapes and sizes.

With furniture such as tables, chairs, a bed and a sofa folding out of the walls of the structure, Di Chiara’s home has been likened to a Swiss Army knife. Yet the project is no novelty -- Di Chiara hopes it will be a model for those who want to live with less, without the burden of paying high rents increasingly plaguing many large cities, including Berlin.

Di Chiara intends for its user to live in unoccupied spaces in the city.

He said he hopes aVOID will be part of what he calls migratory neighborhoods -- clusters of tiny homes on wheels integrated within city centers.

For now, it's a work in progress. "Living in the tiny home is a challenge," Di Chiara admitted, largely because it is still a work in progress. He is constantly discovering problems and finding ways to resolve them, often with the help of products provided by sponsors who believe in his vision, he said.

"I realized that the air inside gets too stuffy, especially during the night," Di Chiara said. To resolve the problem, he partnered with a company that provided a prototype ventilation system.

Despite the challenges, Di Chiara said he plans to live in the house for an entire year, but aims to call it home for life once it is perfected. He said he also allows others to try out living in the house for a night or two, provided they give him feedback.

Di Chiara’s aVOID house is one of over a dozen small structures on the Bauhaus Museum campus in Berlin. It is part of the "Tinyhouse University," a nonprofit founded in 2016 by German architect Van Bo Le-Mentzel that brought together architects, designers and refugees to explore different housing typologies.

“We want to create solutions for living in an innovative way that allow people to be very active in the process of living, including designing, building and living in the house,” said Di Chiara. Some of the tiny buildings are cafes, while others are living spaces and workspaces.

aVOID is a prototype for a single working professional and takes inspiration from the Bauhaus design movement, which combined art with the industrialization process.

Di Chiara is working on lowering the production costs to make aVOID available to anyone who would like to own it, regardless of their income level. The materials for the home cost €45,000 (about $56,000), and it was built and customized by the architect himself. Di Chiara said he hopes to eventually be able to lower total production costs to €30,000 (roughly $37,000) through mass production.

First, though, he'll need to get others onboard. It's currently illegal in Berlin to have a migratory neighborhood along the lines of Di Chiara's vision, so his goal is to first raise awareness of tiny-house living before holding serious discussions with city officials. He said he plans to set his sights on Milan, where rents are higher and there is less empty urban space than in Berlin.

In March, Di Chiara will take the home on a seven-city tour, ending in Rome.

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IMDB(NEW YORK) -- Black Panther signals a revolutionary moment –- not only in its implications for Black culture, but also for Black mental health.

“At a very basic level, representation affects people's identity,” said Dr. Ruth Shim, Director of Cultural Psychiatry and Associate Professor of Psychiatry and Behavioral Sciences at University of California, Davis. “Having positive representations and people reflecting the diversity of what they can be and experience can be protective against depression and anxiety stemming from negative images.”

Indeed, Black representation in pop culture has expanded in recent years. Television shows such as "Insecure," "Empire" and "Black-ish" feature predominantly Black casts. Films like the comedy-horror "Get Out" satirize racial disparities, while "Hidden Figures" and "Moonlight" portray different Black realities. But "Black Panther" forms a category all its own: Black superheroes and superheroines in a sci-fi world.

Take Wakanda, the fictional nation in which "Black Panther" is based. Wakanda is particularly evocative because it re-envisions reality. It asks not what is, but what could be. Imagine if racism, poverty, and chronic illness –- all risk factors for depression and anxiety disorders among Black Americans –- simply did not exist. They don’t in Wakanda.

The world depicted in "Black Panther" brings with it an unstated question" “Would the rates of depression and anxiety among Black Americans change if reality were different?”

Depression is the leading cause of disability worldwide, and a serious medical illness that can cause specific mood, mental and physical symptoms. It is also associated with higher rates of chronic disease, increased need for health care, and difficulty functioning at work, at home and in social settings.

A 2009-2012 survey by the Centers for Disease Control (CDC) showed that Black people are significantly more likely to have depressive symptoms than whites – and those symptoms are more likely to be severe.

“Sometimes we think of ourselves as weak, hopeless, that we don’t have that light. There’s a dark cloud that’s there,” said Stephanie Grimes, a depression and anxiety survivor who founded the Detroit-based mental health organization Hope360. “But with these superheroes, it shines a light and lets people know that we struggle with some things, but we can feel accomplished and have hope too,” she said. “Things can change. Things can get better.”

Psychologists Kenneth and Mamie Clark affirmed the negative impact of racism on self-esteem in the 1940s through “The Doll Tests.” These series of experiments demonstrated that, regardless of race, children as early as 3 years old preferred the white doll to a Black one, and attributed positive characteristics to it, while attributing negative characteristics to the Black doll.

“I feel like I just went through the largest therapy session in cinematic form,” said Dr. Italo Brown, a Jacobi and Montefiore Medical Center emergency medicine resident physician who wrote about why he wants to move to Wakanda to practice medicine. “It was group therapy with 100 people – everything from dressing the part, showing up with people you’re comfortable with, and being vulnerable. You saw a representation of what you’re capable of,” he said.

While depression is most effectively treated with a combination of medication and therapy, only 33.6 percent of Black people with severe depression were in contact with a mental health professional within a year. Younger men of color who report daily feelings of depression or anxiety are also less likely to take medication or talk to a mental health professional compared to their white peers, according to the CDC.

That could be because they can’t afford it, because of mental health stigma, or mistrust of a medical system that has a history darkened by racist experimentation, said Dr. Karinn Glover, Assistant Professor of Psychiatry at the Albert Einstein College of Medicine.

“You're treating a society-wide phenomenon of depression and anxiety wrapped up in racial trauma and oppression. There are so many microaggressions and inequalities embedded in American culture,” Glover said. “That has a subconscious toll on the psyche.”

While there’s more work needed to create communities where people care for each other and distribute the “wealth of the kingdom,” Brown said, Black celebrities, like hip-hop mogul and entrepreneur Jay-Z, are reducing stigma by opening up about their own experiences with therapy.

“Mental health is a path to freedom,” Glover said, noting that as a Black female psychiatrist, “what inspires me is justice, leveling the playing field and restoring the balance of power.”

Immediately after watching "Black Panther," Glover said, “I’m glowing on the inside. I was just thrilled to see such gorgeous and real representations – that spirit and tenderness and bravery.”

This article was written by Christy Duan and Jay-Sheree Allen for ABC News. Duan is a psychiatry resident physician at Zucker Hillside Hospital in New York and a resident at the ABC News Medical Unit. Read more of her work at www.christyduan.com. Allen is a family medicine resident physician at the Mayo Clinic in Minnesota and a resident at the ABC News Medical Unit.

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Courtesy Brittany Deane(NEW YORK) -- Two sets of identical twins are now planning a joint wedding after twin brothers proposed to twin sisters on February 2, or 2-2.

Brittany and Briana Deane met Josh and Jeremy Salyers last August at The Twins Days Festival in Twinsburg, Ohio, which bills itself as the "largest annual gathering of twins (and other multiples) in the world," according to its website.

Although the 31-year-old Deane twins have been trekking to the festival from their home in Virginia since 2011, for the 34-year-old Salyers' twins, it was their first time.

"When we got there it turned out better than we ever expected," Josh Salyers told ABC News, referring to his recent engagement.

Brittany Deane recalled that she and her sister spotted the Salyers twins at one of the festival's welcoming events.

"We were sitting on the bleachers and I saw just these two amazingly handsome young men that looked to be about our age," she recalled to ABC News, "and they were walking across the gym floor below."

Her sister Briana Deane recalls that her sister grabbed her by the wrist, "which we always do when we get excited about something," she said. And after a few moments, she too had spotted the brothers.

"They were stunning," Briana Deane said of her now-fiance and his twin brother.

Sadly, the twin siblings didn't cross paths until the last day of the festival for it's closing night party. "They were there at the end of the hall," Briana Deane said. "They smiled at us and we all started talking."

The Salyers twins sent the Deane twins a message via Facebook saying they couldn't wait to bump into them next year at the festival. But instead, the sisters asked, "Why wait?" The brothers then made a road trip out of it -- driving from their previous home in Clinton, Tennessee to visit the sisters in Virginia. After an amazing trip, the brothers said they knew immediately they'd propose one day.

"You know when you know," Jeremy Salyers said. "We’ve always known our whole life if we were going to be married that it was going to be with twins."

The brothers, who now live in Hagerstown, Maryland, planned a proposal at the same location as their first date -- Twin Lakes State Park in Virginia. They told the sisters the wedding venue on-site wanted to feature the four in a commercial, so they all arrived in matching blue gowns and matching blue ties.

What the Deane sisters didn't expect was for the Salyers brothers to drop down on one knee at the same time. It made it even more special for all of the pairs.

"We have done so much in life together. We’ve gone through ... having twin loves of our lives and to accept their marriage proposal at the same time made it that much more special," Brittany Deane said.

Josh Salyers added, "We’ve always felt blessed to have each other and now we have two other twins who are just like us...but they also add their own contributions that we couldn’t have. Together we can accomplish anything."

The couples now plan to have a double wedding this August at the Twins Days Festival in Ohio. And yes, if you're wondering, the brides will be in identical wedding dresses.

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