On October 5, 2018 the FDA approved the use of the 9-valent HPV vaccine in women and men aged 27 through 45 years1. Although this approval opens the possibility for expanded protection against HPV disease in women and men, further review of the available data, including cost-effectiveness, is needed. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is reviewing the available data, and ACOG is working closely with the CDC to determine if changes in clinical guidance and recommendations are appropriate.

In the meantime, members are advised that Committee Opinion 704, Human Papillomavirus Vaccination, remains in effect2. As outlined in the guidance, obstetrician-gynecologists and other health care providers are encouraged to welcome conversations with women older than 26 years who are interested in receiving the HPV vaccine2. In patients aged 27 to 45 years, their decision to be vaccinated should be individually based using shared decision making and clinical judgment based on those patients’ circumstances, preferences, and concerns. The vaccine is safe and is effective in preventing new infections with HPV in women aged 27-45 years3.

This Practice Advisory was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group with Linda O’Neal Eckert, MD, and Kevin Ault, MD.


  1. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [press release]. Silver Spring (MD): FDA; 2018. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm. Retrieved October 18, 2018.
  2. Human Papillomavirus Vaccination. Committee Opinion No. 704. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e173-8. Available at: https://journals.lww.com/greenjournal/fulltext/2017/06000/Committee_Opinion_No__704___Human_Papillomavirus.52.aspx. Retrieved October 18, 2018.
  3. Luna J, Plata M, Gonzalez M, Correa A, Maldonado I, Nossa C, et al. Long-term follow-up observation of the safety, immunogenicity, and effectiveness of Gardasil in adult women. PLoS One 2013;8:e83431. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083431. Retrieved October 18, 2018.

    Source: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-FDA-Approval-of-9-valent-HPV-Vaccine-for-Use-in-Women-and-Men-Age-27-to-45

Premature birth, low birth weight and seizures are among the problems reported.

Babies of older fathers are at greater risk of premature birth, low birth weight and other neonatal problems, a new study reports.

Mothers may also be affected: Those with older partners were more likely to have gestational diabetes, probably because older paternity is associated with changes in the placenta.

The study, published in BMJ, used data gathered by the Centers for Disease Control and Prevention on more than 40 million live births between 2007 and 2016.

Compared with babies of fathers 25 to 34, those whose fathers were 45 to 54 had a 15 percent increased risk for premature birth, and an 18 percent increased risk for seizure. They were 14 percent more likely to be admitted to a neonatal intensive care unit, and 9 percent more likely to need antibiotics. Babies of fathers older than 55, although there were few in the study, were at even greater risk. The study controlled for maternal age and other factors.

The lead author, Dr. Michael L. Eisenberg, director of male reproductive medicine and surgery at Stanford, said that for the individual couple the effect is modest, and he would never tell a man he is too old to be a father.

Still, he said, “Men should no longer think their runway is unlimited. Now we know there are some risks that you should take into account when starting a family.”

A version of this article appears in print on , on Page D5 of the New York edition with the headline: Family: Woes for Babies of Older Fathers.
Source: https://www.nytimes.com/2018/11/07/well/family/older-fathers-more-likely-to-have-babies-with-health-problems.html

We spend a lot of time and energy trying to pinpoint the toxic people in our lives, but how often do we look inwards during our search? The truth is, there are times when even the best of us exhibit toxic behaviors or patterns without realizing it.

Of course, there’s a difference between being toxic and acting toxic. The first is when it’s ingrained into our personality, and we activelyenjoy hurting others; the second corresponds to aspects of our behaviors. Sometimes without knowing it, these toxic behaviors can take us over. Think about it as a muscle that you’re unknowingly pumping metaphorical steroids and iron, and soon it looks like The Hulk.

The good new is, with a little self-reflection and asking for feedback from others, we can become aware of these habits and eradicate them so we can become better people. Here are a few of the most common behaviors that even good people can develop that might actually be hurting those around them—as well as how to change course for the better.

1. You’re always sarcastic.

The clever retort that’s accompanied by raucous laughter on a comedy—we’ve come to think that’s a good thing, and perhaps even aspire towards that. It’s gotten to the point that people who don’t know how to be “clever” believe they’re terrible, dull conversationalists. But the truth is, what’s funny on The Big Bang Theory isn’t necessarily funny in real life when you’re on the receiving end. It hurts.

It’s easy for this to be your default mode if you work in an industry that’s all about acting tough and masking emotions or if you grew up in a family where 99% of your conversations are sarcastic quips, “I told you so’s”, or remarks designed to one-up another person. Whilst I never advocate Pollyanna-esque naïveté, people who only look for the negative can be incredibly draining to be around in the long run; the teasing, even in good jest, will start to feel like carefully cloaked animosity.

The fix: We all know how terrible it feels to be the target of such remarks, especially when we’re in a vulnerable time. So before you open your mouth, ask yourself, “How would I feel if I were sharing something about my life or thoughts, and someone gave me such a response?”

2. You deal with conflict in a roundabout way.

Conflict is uncomfortable. We don’t like to deal with tricky situations directly, and so we devise ways of getting around them. But if you’re always beating around the bush and then secreting hostility via sullen behavior, stubbornness, and subtle insults, it just amplifies the problem and turns a single conflict into a larger issue. No matter how logical our arguments or how upset we might be over what’s happening, passive-aggressiveness is painful and not helpful to anyone. It’s a cancer in relationships.

The fix: Know that difficult conversations are scarier in our heads than in reality—we simply haven’t had enough practice. The more you have these conversations, the easier they become. The rule-of-thumb you can subscribe to is to ask yourself, “How can I say this in a way that is kind and useful?”

3. Everything is a competition.

Telling someone how you went through a similar experience as they did is different from trying to show how you’ve had it worse. The first is where you show you resonate with the other person and use that empathy to connect. The second is a competition. I get that we’ve been conditioned to have some sort of seemingly-objective metric of what’s worse—we prioritize physical health ailments over mental health difficulties, and for anyone who appears to be living comfortably, we dismiss it with the label “first world problems” over someone who is in abject conditions. Sometimes we’re filled with indignation if we’ve been through “worse” and think “How dare they?” Or sometimes, we genuinely believe someone is being weak and should just “suck it up,” because we have done so ourselves.

Importantly, we need to be aware of these biases and to realize that pain isn’t a competition. Regardless of a person’s diagnosable condition or lifestyle, pain is pain. When we try to convince them their situation isn’t so bad, we are effectively invalidating their experiences and alienating them.

The fix: Be aware of why you feel the need to “compete”—is it because this is the only way you’ll feel validated for or feel some respite from your experiences? Sometimes, honesty is the best gift we can give ourselves, no matter how scary it is. This way, we can truly have empathy for ourselves and others.

If you find it hard to express compassion for someone else, perhaps ask yourself, “What would I want someone to say to me in my position?”

4. You turn everything into a joke.

We’ve all met that person who ends every line with “haha” and has to make a joke out of everything—even the most serious and saddest stuff. Maybe it’s because we don’t know how to deal with the situation, or we feel uncomfortable as it rips open old emotional wounds. So we try to escape via lightheartedness.

The fix: It’s okay. You don’t need to have the answer to everything right now. Simply say, “I feel a little uncomfortable and uncertain because I’m not used to this.” This is a lot more respectful than laughing and can help your loved one and you deepen your relationship as you navigate the complications of being human.

5. You want to fix everyone and everything.

Some of us are innately rescuers and fixers—maybe you’ve been trained to preempt and solve problems, or we unconsciously get drawn to similar relationships to fix a dynamic we were helpless in when we were younger. Or maybe you simply love to provide solutions. But this is a form of emotional labor, and as the work piles up, so do our distress and resentments. Put simply, other people aren’t our projects, and just because we can solve a problem doesn’t mean we should—the responsibility is squarely in the hands of the issue-holder, who may not even see it as a problem.

The fix: Here’s the deal. Sometimes people aren’t asking for solutions or even for a listening ear, but we unwittingly create trauma from nonexistent wounds by probing. What we can do instead is ask, “Do you want to talk about it?” If they say no, offer to be here if they change their minds. And if a person did not ask for advice, simply say, “I have a suggestion. Would you like to hear it?”

Additionally, recognize that you don’t need to fix everyone. Learn to accept people’s flaws, help them when asked, and if necessary, withdraw from those relationships where the person’s behaviors are seriously impacting you in a negative way. There’s no need for you to shoulder every single person’s problems and accompany them them all on their development journeys.

6. You secretly crave disaster because of the care you receive from it.

When we want to make a change, there are usually two sides of us in conflict. One side desires transformation, but the other doesn’t—because it has something to gain from the status quo. Much as we hate to admit it, a part of us may enjoy the attention from the drama and the subsequent pity parties we throw. Tough times happen, and we get stuck in a Groundhog Day rut.

A sign that we love the attention from pity parties is that we ask for solutions only to shoot them down. It’s a way of opening a conversation with someone else, bathing in their attention and care, and convincing ourselves we’re seeking help—but things never shift. While this might feel good for ourselves, it puts a lot of strain on our friends who need to continue picking up after us. We should of course feel free to lean on our network when we need help, but constantly injecting negativity into their lives just because we enjoy feeling the extent of their love is not fair to them.

The fix: If you feel a part of your life has become a consistently deteriorating train wreck, where the majority of your interactions are centered around getting this attention, it’s time to get it together. Commit to stop managing the problem and its symptoms and to instead start actually mastering the situation by mastering yourself. Think about a time when things were good, when you were in control, and when you liked who you were—your integrity and your energy. Tap into how that feels, and use that energy to propel your momentum and strategy towards finding that person again.

7. You think pointing out someone’s flaws will help them to change.

One of the most mortifying situations is when someone well-intentioned gathers others to shame you for a flaw, thinking this will whip you into action. We hear of such stories in families, where the flaw may be a mental health difficulty, weight gain, or bad skin. If you do this, know that it’s hurtful and alienating. Most of us are aware when we’re a shadow of our old selves, and if it is sliding in the wrong direction, we are busy trying to adjust or even mourn the loss of our old selves. Adding salt to the wound only triggers more shame and anxiety.

The fix: What you could say instead would be something like, “I’ve noticed this change in you, and I’m here for you if you ever want to talk.” Then leave the ball in their court.

8. You tell everyone to “just change their mindset.”

Someone told my friend Karla to “just be more proactive” when her professor had forgotten the deadline for her scholarship application, even though Karla had repeatedly reminded the professor for months. Karla was frantic and sad, and then furious with said friend. We often tell each other to just “cheer up,” “stop thinking that,” or “be logical’’—effectively applying cognitive photoshop on our “negative” emotions because these feelings are uncomfortable or socially unpalatable. But it is irrational to put a rational filter over everything.

The fix: The only way to master your emotions and difficult situations is to feel them. We must wholly acknowledge their part in our lives as signals and sources of wisdom, rather than to “just suck it up.” Unfortunate situations happen, and they don’t just get reset by the push of a mental button or a mindset transplanted into our heads. Instead of telling someone to simply change the way they’re thinking, just sit down with them and be a source of emotional comfort. Let them earnestly convey their emotions out loud to you without judgment. Sometimes this is all that’s needed for them to regain some semblance of emotional equilibrium so they can set out to tackle their problems.

9. You push your truth on others.

When we discover a solution, especially after feeling stuck for a long time, we want to shout it from the mountaintops. Whether it’s the secret to weight loss or finding spiritual salvation, we hope our loved ones will reap those benefits. And then there’s also another deeper subconscious drive that spiritual author Paulo Coelho writes about: We believe that an extra person subscribing to our truth makes it more valid.

Especially if we’re watching our friends’ lives deteriorate or worried about the afterlives of our loved one, we feel compelled to proselytize. But this backfires in the end: forcing our truths down someone else’s throat feels just as uncomfortable and invasive as the metaphor suggests. Moreover, just because something’s worked for you doesn’t mean it’ll work for someone else— solutions must be tailored to someone’s personality, experience, and situation for maximum success.

The fix: Remember that you’re their loved one, not their doctor or coach—your role isn’t to heal or save them. Simply be the best example for them—live your life the way you’d like someone else to have been your role model. When they are ready and start asking you, you can gently open the conversation.

As you start to detox, take pride in your growth.

We’re fundamentally copycats—we learn behaviors by modelling others, and sometimes we have the wrong role models. At other times, we run into a bad spate in life, get jaded, and see the world through a pessimistic lens. And so our toxic behaviors grow.

But having them in one chapter of our lives doesn’t mean we’re condemned to them forever. Instead, pinpointing the root and committing to personal growth can help us to find our old selves again or create a new self that is stronger, having integrated the wisdom of a difficult chapter in our lives.

Just because we’ve had some bad behaviors isn’t cause for shame. Rather, knowing that we’ve transcended them is actually cause for pride. Understanding our own toxic behavior develops empathy for why we do the things we do, hones our self-awareness, and helps us to become better people. Acknowledgment is the first step down that journey.

Source: https://www.mindbodygreen.com/articles/toxic-relationships-are-you-the-toxic-person-in-your-life

The true culprit is actually a lot easier to fix.

It’s easy to say that neck and back pain is due to our slouching, hunching-over culture—too easy, says Eric Robertson, associate professor of clinical physical therapy at the University of Southern California. “Actually, if you hunch a while, that’s fine,” he says. “You can see people who have all sorts of funky postures and positions and they don’t experience pain. I think it’s convenient, when somebody does have pain, to point at their posture and say, ‘oh look, that’s why.’” Robertson also points out that there aren’t studies that show a link between pain and posture.

So why are you in such pain? It’s simple: you probably aren’t moving enough.

That’s because most pain comes from weak or stiff muscles. “Imagine if you woke up one day and you never turned your head. Well, at the end of the day you wouldn’t be very good at turning your head left or right. It would feel stiff and uncomfortable,” Robertson says. That’s what happens when we sit in a car or at a desk. It’s not the hunching or leaning forward itself—it’s that that’s all we’re doing.

The solution: Take your joints through their full range of motion every day. “All joints have a built-in range that they can go through, and they like to visit those ranges often,” he says. “Think of something like yoga that’s been around for eons. One of the things it does is take people through a very wide range of motions.”

Next time you’re starting to feel a twinge in your back or neck, give your head, shoulders, and back a good twist and turn, and you’ll stave off increasing pain. Better yet, start a regular stretching routine. The benefits of stretching are well-known; try these stretches for your lower backhipsgroin, and neck.

For pain that lingers, Robertson suggests seeing a physical therapist. “The care is individualized, so the intensity of the solution matches the intensity of the problem,” he says. “Working with providers that empower you as a partner—rather than give you passive interventions—is a really important factor in your success.”

Source: https://www.prevention.com/health/a24791641/bad-posture-back-pain/

Researchers announced last month that thanks to a compulsory vaccine program, Australia is on track to eradicate cervical cancer. This is due to almost universal vaccination against human papillomavirus (HPV), a virus which is responsible for 90 percent of cervical cancers. The vaccine itself is a medical breakthrough and has only been available for use since 2006. In just 12 short years, cervical cancer is becoming a rarity in Australia and will eventually be eliminated, saving thousands of Australians’ lives.

According to the Center for Disease Control and Prevention (CDC), each year HPV causes cancer in 33,700 men and women in the U.S. alone. Cervical cancer is not the only cancer caused by HPV; 70 percent of oropharynx cancers, for example, which were previously attributed only to alcohol and tobacco use, are caused by HPV.

In Australia in 2016, 78.6 percent of females and 72.9 percent of males had completed the HPV vaccine series. By comparison, the CDC reports only 49 percent of U.S. adolescents completed the series in 2017. So why is Australia so much closer to eradicating cervical cancer than the United States?

Anti-vaxxers and conservative attitudes on sex

One reason is the anti-vaccine movement, pushed into the mainstream by the former physician and con man Andrew Wakefield, who falsified research results linking autism to vaccines and planned to make millions of dollars selling a scam diagnostic test, and promoted by the likes of Jenny McCarthy, the celebrity anti-vaxxer who wrongly claimed vaccines caused her son to develop autism. McCarthy was denounced by medical scientists, but that didn’t keep her from spreading her erroneous views to millions of Americans thanks to regular television appearances on “Oprah” and “The View.”

Conservative attitudes about sex, especially as it relates to young people, have also kept many American parents from having their children vaccinated against HPV.  But we need to talk about healthy sexual behaviors, as current movements like #MeToo have shown us. We need to discuss with our children ways they can remain healthy when choosing to participate in sexual activity.

This includes removing the stigma surrounding sex that causes unintended pregnancies and sexually-transmitted infections to spread because adolescents and young adults are too embarrassed to seek out contraception. Religious leaders have suggested the HPV vaccine encourages promiscuity, a claim that has been exhaustively disproven in medical research.Suggesting that protecting oneself against cancer is something to be ashamed of is an irresponsible and nefarious assertion.

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As a nurse, I am still amazed that we have the ability to prevent cancer from occurring and save tens of thousands of people’s lives, just through a vaccine. Yet so many of my patients still wrongly believe that vaccines are dangerous, despite my assurances. Anti-vaccine groups have gone so far as to spread false claims regarding the safety of the vaccine. The World Health Organization, the Food and Drug Administration and the CDC have all determined the HPV vaccine is safe. And the only common side effects that have been proven are ones that can occur with any vaccine, like dizziness and a reaction at the injection site.

It strikes me that my patients accept my recommendations with almost every other health decision they have to make. Why do my patients trust me when I prescribe antibiotics or anti-hypertensives, but not when I recommend the HPV vaccine? Why is Jenny McCarthy’s medical opinion valued over mine?

HPV vaccine should be required for school

For the Unites States to eradicate cervical cancer as Australia is on pace to do, we must include the HPV vaccine in the regular childhood vaccine schedule, and it should be required for enrollment in school.

The HPV vaccine is recommended in childhood for two reasons.  First, the vaccine works best at the beginning of adolescence when one’s body can make stronger antibodies that are required to prevent infection. Second, a child must be vaccinated before he or she has been exposed to the virus itself.

Making the choice to protect your children against cancer is the same as making them wear a seat belt or a helmet. You hope they will never need it, you hope they won’t be exposed to the virus, but if they are, they will be covered. No one should die because of myths and misconceptions. We have the power to stop this virus in its tracks and protect generations of Americans from an early death. Don’t American children deserve to have lives as long and healthy as those in Australia?

Source: https://eu.usatoday.com/story/opinion/2018/11/12/eradicate-cervical-cancer-require-hpv-vaccine-like-australia-column/1850760002/

Older women who lose weight may have a lower risk of developing invasive breast cancer than those who maintain or gain weight, a large U.S. study suggests.

While obesity has long been linked to an increased risk of breast cancer, previous research has offered a mixed picture of the potential for weight loss to help reduce that risk. For the current study, researchers assessed weight and height to calculate body mass index (BMI) for more than 61,000 women twice, three years apart.

Then, researchers followed women for an average of 11.4 more years. During this time 3,061 women developed invasive breast cancer.

Compared with women who had stable weight during the initial three years of the study, women who lost at least 5 percent of their body weight during those first three years were 12 percent less likely to develop breast cancer over the next decade or so.

“Our results are consistent with a woman being able to lower their cancer risk, even if they remain overweight or obese after losing some weight, since almost none of the women in our current cohort analysis lost sufficient weight to achieve normal weight,” said lead study author Dr. Rowan Chlebowski of the City of Hope National Medical Center in Duarte, California.

“That should be an encouraging result for women since modest sustained weight loss can be achievable by many, while weight loss sufficient to return to a non-obese or overweight category is quite difficult,” Chlebowski said by email.

All of the women in the study had gone through menopause, when menstruation stops and production of the hormone estrogen drops. After menopause, women’s main source of estrogen is fat tissue; being overweight or obese can increase the risk of cancer because estrogen can help tumors grow.

“Women who are overweight or obese likely have an increased risk of postmenopausal breast cancer due to increased hormone levels associated with fat cells,” said Dr. Daniel Schauer of the University of Cincinnati College of Medicine, who wasn’t involved in the study.

“These hormones, especially estrogen, can promote the development of postmenopausal breast cancer,” Schauer told Reuters Health by email. “Losing weight decreases the levels of circulating hormones.”

Among the roughly 41,000 women in the study who had a stable weight during the initial three years, participants had an average BMI of 26.7, which is considered overweight.

The 12,000 women who gained weight during the study also started out with an average BMI of 26.7.

Women who lost weight started out heavier.

The roughly 3,300 women who lost weight unintentionally started out with a BMI of 27.9 and half of them lost more than 17 pounds. Women who lost weight intentionally began with an average BMI of 29.9, just shy of the cutoff BMI of 30 to be considered obese, and half of them lost more than 20 pounds.

Weight gain of 5 percent or more was not associated with an increased risk of breast cancer overall, the researchers report in the journal Cancer. But this amount of weight gain was associated with a 54 percent higher risk of developing “triple negative” breast cancer, an aggressive and difficult to treat type of cancer.

The study wasn’t a controlled experiment designed to prove whether or how weight changes over time might directly impact women’s risk of developing or dying from breast cancer.

Researchers only measured women’s weight twice, at the start of the study and again three years later, and any changes in weight women reported after that were not verified by medical exams.

For most people, weight creeps up over time, said Dr. Graham Colditz of the Washington University School of Medicine in St. Louis, who wasn’t involved in the study.

“So, the first realistic goals is to work to stop gaining. There are health benefits to that, even if you’re overweight,” Colditz said by email.

“After that, sensibly and slowly losing weight is a good goal,” Colditz added. “Five to 10 pounds is a great start that’s more easily maintained over time.”

SOURCE: bit.ly/2AreUsz Cancer, online October 8, 2018.

Source: https://www.reuters.com/article/us-health-breastcancer-weightloss/weight-loss-after-menopause-tied-to-lower-breast-cancer-risk-idUSKCN1NF01B

Women fed soy-based formula as babies were more likely to have severe menstrual pain as adults.

Consuming soy-based formula during infancy may be linked to severe menstrual pain in adulthood, researchers report.

study published in Human Reproduction included 1,553 African-American women ages 23 to 35 with information on soy formula feeding gathered by questionnaires. To determine menstrual pain, they asked women whether they had ever taken prescription or over-the-counter medication to prevent menstrual cramps or pelvic pain.

About 13 percent of the women reported being fed soy formula as babies. They were significantly more likely than those who had not been fed soy formulas to have used hormonal contraception for menstrual pain, especially in the first five years after menarche.

The precise mechanism is unknown, but soy contains phytoestrogens that have been shown in animal studies to affect uterine development and adult uterine function.

The study relied on the subjects’ recall, and there was no data on the reasons for formula feeding or on the feeding of solid foods during infancy. The lead author, Kristen Upson, a researcher at the National Institutes of Health, said the observational study shows an association, not cause and effect.

Still, she said, menstrual pain is common, and “our findings point to the need for a greater understanding of exposure, even those that occur earlier in life.”

Source: https://www.nytimes.com/2018/11/09/well/family/soy-baby-formulas-tied-to-menstrual-pain.html