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A Puerto Rican man died from complications of the Zika virus earlier this year, the first reported death attributed to the disease in the United States. The victim, a man in his 70s, died in February from internal bleeding as a result of a rare immune reaction to an earlier Zika infection, according to the Centers for Disease Control and Prevention. Puerto Rico now has 683 confirmed Zika infections in its outbreak, which began in December; 89 are in pregnant women, according to Dr. Ana Ríus, the territory’s health secretary. (McNeil and Victor, 4/29)

Officials said the unidentified man recovered from initial Zika symptoms, but then developed a condition in which antibodies that formed in reaction to the Zika infection started attacking blood platelet cells. He died after suffering internal bleeding. [Health Secretary Ana] Rius said the man died less than 24 hours after seeking help at a health center. She said three other cases of the condition known as severe thrombocytopenia have been reported in Puerto Rico, and that those patients recovered successfully. (4/29)

The agency said he developed severe thrombocytopenia, which is a low blood platelet count, but did not give more details. Deaths from Zika are rare, and health officials say symptoms tend to me mild. Many people develop no symptoms at all. The virus is mainly seen as a threat for pregnant women because it is linked to severe birth defects in babies. (Sullivan, 4/29)

Health officials on Friday confirmed the first U.S. death of a patient infected with the Zika virus in Puerto Rico. The man, who was in his 70s, died from severe thrombocytopenia, a bleeding disorder caused by abnormally low blood platelets, which are needed for blood clotting. (Steenhuysen, 4/29)

Congress accomplished relatively little in a short work period, missing deadlines on the budget and on helping Puerto Rico with its financial crisis as lawmakers began a weeklong break. They left behind few clues about how they would address must-do items such as finding money to counter the Zika virus and a second, even scarier July 1 deadline for averting a fiscal disaster in cash-strapped Puerto Rico. Democrats called upon House leaders to modify this spring's three-weeks on, one-week off legislative schedule to keep working, as Puerto Rico hurtles toward a half-billion-dollar default on Sunday. (4/30)

Southern mosquitoes could buzz into Iowa this summer, but state experts don't expect them to be a major carrier of the Zika virus. New maps from the Centers for Disease Control and Prevention show Iowa in the range of one of two mosquito species believed to carry the virus, which causes birth defects. The maps show the Aedes aegypti mosquito’s range petering out in Missouri, but they show the Aedes albopictus mosquito’s range extending through Iowa and into southern Minnesota. (Leys, 4/29)

The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare. But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates. ... In some ways, the turmoil is not surprising: Under the health law, plans are unable to choose who to insure, or how much to charge them based on their medical history. ... The timing, though, is bad news for Democrats. Proposed rate hikes are just starting to dribble out, setting up a battle over health insurance costs in a tumultuous presidential election year that will decide the fate of Obamacare. (Demko, 5/2)

House Speaker Paul Ryan’s recent proposal to shift sick people to their own health insurance could place a sizable financial burden on the government, but it also gets at a question that Obamacare supporters are contemplating: How to keep the cost of covering sick people from significantly increasing the cost of insurance for the healthy. Ryan’s plan, which he floated to a student audience at Georgetown University last week, would separate people with preexisting conditions from the regularly insured market. His remarks offer a glimpse into one way Republicans would “repeal and replace Obamacare” under a Republican administration. (Owens, 5/2)

Helmy Eltoukhy’s company is on a roll. The start-up is a leading contender in the crowded field of firms working on “liquid biopsy” tests that aim to be able to tell in a single blood draw whether a person has cancer. Venture investors are backing Guardant Health to the tune of nearly $200 million. Leading medical centers are testing its technology. And earlier this month, it presented promising data on how well its screening tool, which works by scanning for tiny DNA fragments shed by dying tumor cells, worked on an initial group of 10,000 patients with late-stage cancers. Just one thing is holding the company back: Guardant Health has yet to get approval from the Food and Drug Administration. (Cha, 4/28)

Acadia Pharmaceuticals Inc. has received U.S. Food and Drug Administration approval for Nuplazid, which the FDA said is the first drug it has approved to treat psychosis associated with Parkinson’s disease. Acadia said it plans to launch the drug in June. The biotech company’s shares surged in March after an advisory panel voted 12-2 in favor of approval. In after-hours trading Friday, the stock rose 10 cents to $32.40. (Beckerman, 4/29)

Federal health officials have approved an experimental drug to treat psychotic delusions and behaviors that often afflict patients with Parkinson’s disease, the debilitating movement disorder. The drug from Acadia Pharmaceuticals Inc. is the first drug for the condition, which affects approximately half of Parkinson’s patients. An estimated 50,000 Americans are diagnosed with Parkinson’s each year, making it the second-most common neurodegenerative disease in the U.S. (4/29)

As the Supreme Court debates a Texas law that has led to the closure of at least 20 clinics, providers and researchers are noticing a quieter trend: Abortion clinics are closing in blue states, too. Twelve clinics have closed in California since 2011, along with three in Washington and a number in New York, New Jersey and Connecticut, according to data compiled by Bloomberg — all states considered relatively favorable to abortion rights because of their legislative policies. According to Nikki Madsen, executive director of the Abortion Care Network, a national association for independent abortion care providers, for every three independent abortion clinics in her network that close in more conservative states, about two have closed in more liberal states over the past five years. (Schwartz, 5/2)

An Oklahoma bill that could revoke the license of any doctor who performs an abortion may soon head to the governor, with opponents saying the measure in unconstitutional and promising a legal battle against the cash-strapped state if it is approved. In the Republican-dominated legislature, the state's House of Representatives overwhelmingly approved a Senate bill late on Thursday. Governor Mary Fallin, a Republican, has not yet indicated whether she will sign it. (Brandes, 4/29)

Just hours after the American Civil Liberties Union filed a lawsuit against a new Indiana abortion law, Hillary Clinton stumped miles away from the state capitol and filed a sort of amicus brief. “I will defend a woman's right to make her own health-care decisions,” Clinton said to a few hundred supporters packed into a sweltering recreation center. “I’ll tell ya, I’ll defend Planned Parenthood against these attacks. And I commend the women of this state, young and old, for standing up against this governor and this legislature.” (Weigel, 5/1)

Heroin deaths are largely concentrated across New England and the Midwest, and heroin victims tend to be young men in their 20s and early 30s. By contrast, prescription opioids are killing people all across the country, especially people aged 45-54 and including a substantial number of women. (Horowitz, 5/2)

Until now, it’s been hard to see how, exactly, heroin and prescription opioids were interacting, since almost all available data lump them together under the heading of “opioids.” But a Globe examination of the information in death certificates from 1999 to 2014 reveals the increasingly toxic interplay between the drugs, both at the state level and in individual counties. (Horowitz, 5/2)

He was 40 years old, a father of three and an Orlando house painter, clean and sober for eight years. One night last summer, he climbed into his truck, stuck a needle in his arm and injected himself with what would be his final dose of heroin. "The paramedics worked on him for a long time. and when they declared him dead, he was still clutching his last bag of the drug in his fist," says Pastor Spence Pfleiderer. "That's the power of addiction." ... Despite decades of public-awareness ads to "Just Say No," the nation still has little to show in the battle to overcome addiction. In fact, the American Society of Addiction Medicine reports a "staggering rise" in the problem, particularly with heroin. (Santich, 4/24)

While addiction treatment providers are increasingly recommending that medication be used to help wean people off opioids, some doctors are concerned there is now too much of a focus on medication and not enough on the harder work of long-term recovery from substance use disorder. During the annual American Society of Addiction Medicine conference in Baltimore last month, a frequently heard statistic was that every 20 minutes someone in the U.S. dies from an opioid overdose. (Becker, 5/2)

Two companies are on the cusp of taking a new treatment for opioid addiction to the U.S. market at a time when lawmakers are seeking ways to arrest an epidemic of heroin and painkiller abuse that kills 78 Americans every day. Titan Pharmaceuticals Inc and privately owned Braeburn Pharmaceuticals have together developed a matchstick-sized implant that analysts expect will be approved next month, despite mixed reviews. (Grover, 4/29)

The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents. The review comes as regulators disclosed that the number of doctors who completed voluntary training programs is less than half that targeted by the agency. (Perrone, 4/29)

William Logan Kennedy, a chronic drug abuser who cycled in and out of Miami jails, died last year slumped over his bed in an Overtown home. Next to him: a syringe and a bag of what was suspected to be heroin. It wasn't. Instead, toxicologists determined this year, the 49-year-old handyman succumbed to a more dangerous and potent painkiller called fentantyl -- a synthetic narcotic often peddled to unknowing users as heroin. (Ovalle and Weaver, 4/29)

The Ohio Bureau of Workers' Compensation continues to move forward in its battle against opioid addiction among injured workers, announcing proposed guidelines that address how doctors treat patients in pain, as well as those who become reliant on the drugs. (Kurtzman, 4/30)

It began with what she saw in the bathroom mirror. On a dull morning, Geri Taylor padded into the shiny bathroom of her Manhattan apartment. She casually checked her reflection in the mirror, doing her daily inventory. Immediately, she stiffened with fright. Huh? What? She didn’t recognize herself. ... But to not recognize her own face! To Ms. Taylor, this was the “drop-dead moment” when she had to accept a terrible truth. She wasn’t just seeing the twitches of aging but the early fumes of the disease. (N. R. Kleinfield, 5/1)

Hoping to keep your mental edge as you get older? Look after your heart, a recent analysis suggests, and your brain will benefit, too. A research team led by Hannah Gardener, an epidemiologist at the University of Miami, analyzed a subset of data from the Northern Manhattan Study, a large, ongoing study of risk factors for stroke among whites, blacks and Hispanics living in the Washington Heights neighborhood of New York City. (Neighmond, 5/2)

On a recent Thursday, the staff at Sunny Vista Living Center in Colorado Springs bustled in the kitchen. The phone rang with a last minute order as Chris Willard tended to a large pot of Thai-style soup with fresh ginger, vegetables and thin-sliced beef. It was a special meal for a woman of Asian descent who didn't like any of the dozen choices on the menu. ... Sunny Vista is part of a slow but growing trend among the nation's 15,600 nursing homes to abandon rigid menus and strict meal times in favor of a more individualized approach toward food. Advocates pushing for the change say it has taken more than three decades to get to this point. (5/2)

Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels. Her daughter traced the source to the medicine bottles in Oyler’s home in St. Joseph, Missouri. One drug that keeps heart patients like Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily. ... Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show. (Rau, 5/2)

Motor vehicle crashes are the leading causes of death for teenagers in the United States, and alcohol is involved in 1 out of 4 of those crashes. The stronger a state's restrictions on alcohol overall, the lower the teen death toll, a study finds. Policies aimed at the general population were more effective than those targeting teens, the study found. They included regulations that limit the hours alcohol can be sold and the density of alcohol outlets in a particular area, as well as taxes on alcohol sales. (Du, 4/30)

Her heart beats thump, squish, thump, squish. Depending on the angle, the muscle appears to squeeze and release or wobble side to side. Blood flows toward the skin, then away. The valves flutter as they open and shut. (Rhodes, 5/1)

Health care workers are scrambling to help the people here cope with what many fear will be chronic consequences of the city’s water contamination crisis: profound stress, worry, depression and guilt. Uncertainty about their own health and the health of their children, the open-ended nature of the crisis, and raw anger over government’s role in both causing the lead contamination and trying to remedy it, are all taking their toll on Flint’s residents. (Goodnough and Atkinson, 4/30)

Amid renewed questions about lead in local drinking water, Washington health officials say 365 young children in the state posted blood-lead levels last year high enough to potentially cause harm. But they caution that’s just a fraction of the 20,000 tests of kids ages 6 and younger submitted to the state Department of Health in 2015. The majority showed no sign of trouble. (Aleccia, 4/30)

Two government-run hospitals on Native American reservations in South Dakota will keep receiving crucial federal funding after agreeing to undertake significant measures to improve the quality of care provided to patients. The Indian Health Service, which administers the hospitals on the Pine Ridge and Rosebud Indian Reservations, announced Sunday that it reached last-chance remediation agreements with the Centers for Medicare and Medicaid Services on Saturday. (5/1)

Minnesota's second-largest psychiatric hospital is no longer at risk of losing federal funding after it reached a deal to correct safety and patient care issues. The Anoka-Metro Regional Treatment Center and the Centers for Medicare and Medicaid signed an agreement earlier this week that requires an outside consultant to conduct a review of the hospital. (Feshir, 4/29)

Horizon Blue Cross Blue Shield of New Jersey sees its newest coverage plan as a potentially transformative product, just what the health-care system needs to reward successful medical treatment and keep costs down by moving away from the traditional fee-for-service model. But the Omnia Health Plan, along with its payment model, has triggered three lawsuits, five hearings in Trenton, a dozen bills proposed by legislators and a costly public-relations war. (Haddon, 5/1)

State officials are negotiating with the federal government on a plan to keep Western State Hospital from losing $64 million a year in federal money. If approved, the agreement would give the troubled hospital, managed by the state Department of Social and Health Services (DSHS), more time to confront a range of issues. (O'Sullivan, 4/30)

The Colorado House passed a change to the state's hospital provider fee Friday that could keep $700 million a year in the state budget, instead of going to taxpayer refunds. Though the shift drew five Republican votes in the Democrat-controlled House, it appears a long shot to pass the Senate. In the upper chamber, Republicans have been entrenched since the beginning of the session to defend the refunds due under the state's Taxpayer's Bill of Rights. (Bunch, 4/29)

Federal authorities have determined that an investigation by the U.S. Department of Veterans Affairs into the manipulation of wait times for Texas veterans seeking care was "deficient and unreasonable." The U.S. Office of Special Counsel released a statement this week saying the investigation of scheduling manipulation at several Texas VA hospitals and clinics by the VA's Office of Inspector General "failed to appropriately address" whistleblower allegations. It found, for instance, that the VA substantiated that improper scheduling occurred at facilities in Austin and San Antonio but didn't address whether that may have endangered public health and safety. (4/29)

No prior healthcare experience required. Track record of turning around troubled institutions preferred. The job description for rescuing Miami-Dade’s century-old public hospital network, Jackson Health System, from the brink of financial ruin five years ago did not call for a seasoned healthcare executive. Instead, as sometimes happens in a crisis, the job fell to an unorthodox candidate: Carlos Migoya, a retired banker and erstwhile auto dealer who frankly didn’t need the salary or the headache of turning around a $1.7 billion-a-year public enterprise in an industry he hardly knew. (Chang, 4/30)

Saying he wants to make way for upcoming changes, Wesley Lo will step down as head of Maui County's three hospitals and its parent regional organization on July 1. (Tanji, 5/1)

Gov. Maggie Hassan has created a commission to study New Hampshire's shortage of health care workers. The Democrat says the shortage "increasingly threatens" the state's ability to care for its citizens and limits health care choices. Her office says the state is facing a shortage of doctors, nurses, mental health workers, substance abuse counselors, psychiatrists and home-care providers. An executive order creating the commission doesn't offer details on the shortages in each profession. (4/30)

Senior citizens already paying heavy premiums on their long-term care insurance plans strongly urged state regulators on Thursday to oppose any additional rate hikes wanted by insurance carriers. The seniors, who complained about the financial pressures placed on them by past rate increases, filled a Baltimore County auditorium where a public hearing called by Maryland Insurance Commissioner Al Redmer Jr. was held to consider if insurers should be allowed to impose even higher premiums. (McDaniels, 4/29)

Kansas legislators approved a health and public welfare bill Monday that would reduce prescription drug costs within the state's Medicaid program and make changes to eligibility for public assistance. Senators voted 27-13 in favor of the measure early Monday after the House approved it in a 79-43 vote. The measure will now go to Gov. Sam Brownback, who has touted welfare reform in the past. (Hellmann, 5/2)

When doctors get in trouble in Ohio, it's usually for one of two reasons: impairment or prescribing issues. Figures from the State Medical Board of Ohio show that last year, those troubles were the primary basis for nearly 60 percent of the 134 disciplinary actions taken against some of the state's more than 50,000 physicians and doctors-in-training. (Kurtzman, 4/30)

Despite an infusion of funding from lawmakers for the state’s mental health care system, Texas struggles to provide psychiatric care for all patients who need it. Crumbling, century-old state hospitals today have around 400 people on waiting lists, and the number of beds the state pays for in private facilities has not kept up with the state’s rapid population growth. At the same time, publicly funded options for people who need mental health care but are not yet in crisis are even harder to come by, experts say. (Walters, 5/1)

Massachusetts lawmakers have advanced a proposal that would require insurance companies to provide coverage for doctor-prescribed Lyme disease treatments. The measure was tacked on to the nearly $40 billion state budget that was approved last Wednesday by the House of Representatives. It now goes to the Senate. (5/1)

A strain of Elizabethkingia bacteria has been found in an infant being treated in the neonatal intensive care unit at Children's Hospital of Wisconsin, the hospital confirmed, but there is no indication it is the same strain that has infected 65 people in Wisconsin in recent months. (4/29)

In June 2014, Epic Systems Corp. in Verona received an email that no software company can ignore: Employees of a company working for one of its customers had gained unauthorized access to a restricted website and may have stolen documents that contained trade secrets. (Boulton, 5/1)

The brains of premature infants fed a primary diet of breast milk grow faster than those who are fed formula, according to a small study at St. Louis Children's Hospital. Babies whose diets included at least 50 percent breast milk from their own mothers or donors had more brain tissue by their expected due dates, brain scans showed. The 77 premature infants in the study had stayed in the hospital's neonatal intensive care unit. They had all been born at least 10 weeks early. (Bernhard, 4/30)

State health officials want to hire someone to keep an eye on marijuana legalization — at potentially one of the highest salaries in state government. The Colorado Department of Public Health and Environment is advertising a position for a "marijuana health effects and research manager." The job will involve monitoring the health consequences of legalization; gathering data from hospitals, emergency rooms and poison control centers; and helping to lead an advisory committee that produces a report on legalization's outcomes. (Ingold and Baca, 4/29)

The Kansas Legislature passed a bill Saturday banning tanning salons from serving minors, a measure advocates say will reduce cancer. Free-market advocates had pushed for an amendment allowing tanning for customers under 18 with parental permission. But the House and Senate ultimately voted to join a dozen other states and Washington, D.C., in banning it completely. (Marso, 4/30)

The Colorado Medical Society is sounding alarms that a pair of proposed insurance company mergers could threaten doctors' independence and harm patient care. The mergers would turn four giant health insurers into two. Anthem Inc., which is affiliated with Blue Cross Blue Shield, wants to acquire all outstanding shares of Cigna for $54 billion. Aetna is offering to buy out Humana for $37 billion. (Olinger, 4/29)

A transportation company that serves people with disabilities can expand its operations in Lincoln despite objections raised by taxi services, the Nebraska Supreme Court said Thursday. Complaints against Golden Plains Services include instances where a van arrived late and the customer missed a medical appointment, and a person who said a wheelchair wasn't properly secured and tipped, injuring the client's arm. (Schulte, 4/29)

Public-health officials settled their case against a Seattle hookah lounge Friday, clearing the way for Mayor Ed Murray to end his clash with owners of other similar businesses. Last August, Murray said he would move to shutter all 11 of the city’s hookah lounges for violating a state ban on indoor smoking in public places and places of employment. He linked the businesses to violent crime, including the fatal shooting of Chinatown International District community leader Donnie Chin near one such lounge. (Beekman, 4/30)

Late one night, while riding along with a police officer on patrol, the mayor of Fishers, Ind., asked the officer what kinds of calls most concerned him. He got an unexpected answer: mental health situations. They were occurring almost once a shift. Mental illness isn’t readily visible in a place like Fishers, an affluent suburb of Indianapolis with just under 90,000 residents. “In our community,” Mayor Scott Fadness says, “there are a lot of people living in quiet despair and suffering from mental health issues, but they’re not being addressed in a systemic way.” (Mike Maciag, 5/2016)

Is home birth safe? That depends on where you ask the question. In much of the developed world, home birth is a fringe practice, at about 2 percent of births or less, for obvious reasons: Childbirth is inherently dangerous, and if an emergency occurs, the baby or even the mother may die. Indeed, in the United States, the switch from home birth to hospital birth over the 20th century was accompanied by a more than 90 percent decrease in neonatal mortality and nearly 99 percent decrease in maternal mortality. Antibiotics, blood banking, safe C-sections and neonatology have combined to change death in childbirth from common to rare. (Amy Tuteur, 4/30)

Among the most hotly debated of the issues Hillary Clinton and Bernie Sanders have taken on in the Democratic primary contest is how best to get to universal health insurance coverage. The former secretary of state favors incremental steps, and the senator calls for a single-payer system. That debate, and their focus on universal coverage as their goal, appears to have had a modest and perhaps surprising effect on attitudes toward the Affordable Care Act. The health-care law is issue about which public attitudes seldom shift, yet the share of Democrats who want to expand the Affordable Care Act rose over the past year. (Drew Altman, 5/1)

On April 1, Iowa officially adopted a new framework to manage and deliver the state’s Medicaid benefits. The new program, IA Health Link, serves more than 560,000 low-income and disabled Iowans through three managed care organizations. (Kimberly Foltz, 4/29)

Sunday marks a bright day in the struggle to provide health insurance for every child in California. It's the day all children, regardless of immigration status, will have access to checkups and other basic preventive care as part of the state's Medi-Cal expansion signed into law last year by Gov. Jerry Brown. The dark cloud looming on the horizon is the state's failure to offer adequate compensation for doctors treating millions of low-income patients. It's meaningless to give insurance to the needy if there aren't enough doctors willing to accept them as patients. Even before this, many Medi-Cal patients have had to resort to the emergency room because they couldn't find a doctor to see them. (5/30)

The number of irresponsible parents in the Des Moines area increased this school year. In Polk County, they sought and obtained religious exemptions allowing 821 students to escape mandatory school vaccinations, an increase of 33 percent from the previous year. (5/1)

A thistle to some elected officials in Iowa who have an unhealthy obsession with the reproduction of their female constituents. Their fixation doesn’t end with the desire to outlaw abortion and force every pregnant woman to bear a child. They also want to prevent young women from obtaining information about how to avoid getting pregnant in the first place. Lawmakers relentlessly pushed this legislative session for a change in state law to ban Planned Parenthood from receiving public dollars for family planning services. (5/1)

Imagine, for a moment, that another country attacked the United States and killed 40,000 Americans. Now imagine that such an attack struck the U.S. every single year. That's the crisis we face right now — except it's not another country that's responsible for this death toll. It's suicide. More than 40,000 Americans take their own lives each year. That's roughly one every 13 minutes. (Andrew Romanoff, 4/30)

Here’s some news we never tire of reporting: The teen pregnancy rate continues to decline across the country, including in North Carolina. New numbers last week from the Centers for Disease Control and Prevention show that birth rates for females ages 15-19 have declined 38.5 percent nationwide from 2006-07 to 2013-14. The drop is even more stark for black teens (40.3 percent) and Hispanic teens (47.8 percent.) (5/1)