Archive for January, 2019

Genetic disorders can be detected early in pregnancy

A new test allows doctors to diagnose genetic disorders in fetuses early in pregnancy by sequencing small amounts of fetal DNA in the mother’s blood.

Non-invasive prenatal tests are already available for chromosome disorders such as Down’s syndrome. Two years ago, a similar test was developed for recessive single-gene diseases, which occur when someone has two copies of a faulty gene. That test is particularly useful when one or both parents are known to be carriers for inherited diseases such as sickle cell anaemia, haemophilia or cystic fibrosis.

Now there is a test that looks at 30 genes associated with dominant genetic diseases, which occur when someone has just one copy of a faulty gene. These usually occur because of a mutation in the sperm, egg or embryo, and are more common when one of the parents is relatively old. Around one in 600 babies is born with one of these conditions.

The test will likely be used after an ultrasound has shown that the fetus has a skeletal abnormality, or it may be offered to couples in which the father is relatively old.

If it gives a positive result for a genetic disorder, women can be offered a more invasive test to confirm the diagnosis. If that test is positive, couples would ideally be offered genetic counselling so they can make informed decisions about how to manage the pregnancy.

Jinglan Zhang at Baylor College of Medicine, Texas, and colleagues tested blood samples from 422 pregnant women, from nine weeks of gestation onwards, sent to them from clinics in the US, Europe and Asia. Some of them had abnormal results on ultrasound scans suggesting a skeletal disorder in the fetus. Thirty-two tested positive for mutations in one of the 30 genes in the test.

For 147 of the participants, the team were able to obtain results from more invasive tests or postnatal tests. Out of these, all of the follow-up tests confirmed that the initial test from the mother’s blood was correct.

“The data so far show that this test is promising and accurate to detect the mutations it’s supposed to see,” says Zhang. However, they will need results from a much larger group of women to demonstrate that the test is clinically useful.

The test uses genetic sequencing technologies that are widespread in developed countries. However, genetic counselling specialists are not available everywhere. “It’s not the technology that’s difficult to implement in different hospitals; it’s the service around this test that’s equally important,” says Zhang.

Source: https://www.newscientist.com/article/2192032-blood-test-can-diagnose-fetal-genetic-disorders-early-in-pregnancy/

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healthcare, vaccination and people concept – doctor with syringe making medicine injection to girl at hospital

HPV vaccination rates for younger American adolescents are alarmingly low, researchers say.

“While we have seen gains in HPV vaccination coverage, we are still falling behind at the younger ages,” said study lead author Robert Bednarczyk. He’sassistant professor of global health and epidemiology at Emory University in Atlanta.

Human papillomavirus (HPV) is a sexually transmitted virus that can cause cervical, vaginal and vulvar cancer in women; penile cancer in men; and mouth, throat and anal cancer in both sexes.

Two shots of the HPV vaccine, six to 12 months apart, are recommended for kids who are 11 or 12 years old.

For the study, researchers analyzed 2016 data from a nationwide U.S. Centers for Disease Control and Prevention survey of parents.

The findings showed that about 43 percent of kids aged 13 to 17 were fully vaccinated against HPV. But only about 16 percent of 13-year-olds and about 35 percent of 15-year-olds had received all recommended doses of the vaccine.

“In general, we need to do a better job of recommending the HPV vaccine at the routine, adolescent, and well-child visits, with a particular focus on 11 to 12 years of age,” Bednarczyk explained in a news release from the Infectious Diseases Society of America.

Nearly 80 million people in the United States are infected with HPV, which causes about 34,000 cancers a year. The latest version of the vaccine protects against seven of the most common types of HPV, the study authors noted.

The new report was recently published in the Journal of Infectious Diseases.

Advantages to completing vaccination by age 13 include a stronger immune response and better protection against HPV. The CDC recommends three shots instead of two for kids over 14 who have not been vaccinated.

More information

The U.S. Centers for Disease Control and Prevention has more on HPV vaccination.

SOURCE: Infectious Diseases Society of America, news release, Jan. 17, 2019

Source: https://consumer.healthday.com/sexual-health-information-32/human-papillomavirus-hpv-news-756/still-too-few-teens-getting-the-hpv-vaccine-741758.html

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When it comes to the workplace, many working moms still believe they’re overlooked and left behind.

Issues of gender equity have become top of mind in the wake of the #MeToo movement which focused a spotlight on sexual harassment at work. But 78 percent of working moms think they must prove their mettle more than their colleagues to climb the corporate ladder, according to a new study commissioned by Bright Horizons, a provider of child care and other employer-sponsored services.

Twenty-one percent say they would be worried to tell their boss they are expecting a child – nearly twice the number who were similarly concerned five years ago.

“I think we keep believing that these things have evolved,” says Maribeth Bearfield, chief human resources officer for Bright Horizons. But “there are still women in the workplace who feel they’re being disadvantaged on things like pay (and) career opportunities. …You hear ‘She’s got children; she may not be able to work on the project as much.’ ‘Do we want her traveling?’ Conversations that shouldn’t take place, but they do.’’

A sizable number of workers – 41 percent – believe working mothers are less dedicated to their jobs, and 38 percent frown on their needing more flexible hours, the report found.

Meanwhile, working dads get more latitude. Among those surveyed, 75 percent thought working fathers were more devoted to their professions than their female counterparts.

Support Makes All the Difference

But a company’s support is critical for mothers and fathers alike to do their best at work, parents say.

For Jackie P. Taylor, a mother of five who is a partner and principal with the firm Ernst & Young, flexibility is “a necessity.”

Her company allows her and other employees to often work remotely. And it provides back-up care services that enable staffers to call a toll-free number 24 hours a day to get a slot for a child at a local child care center or to arrange for a nanny to come to the home so that they can still work.

“There is no way as a mother of school-age children that I would be able to balance that without the appropriate supports in the workplace,” says Taylor, of Hillsborough New Jersey, whose children range in age from 9 to 16. “That has a huge impact on my career trajectory – whether I make a decision to stay in the workforce or not stay in the workforce and quite frankly at the end of the day the quality of life for my children and of our family.”

Beyond the benefits the company provides, her workplace’s culture has also been critical. Taylor recalls needing to take a short leave of absence when one of her children was diagnosed as being on the autism spectrum.

“The firm was super, super supportive,” she says, noting that she didn’t have to give up any of her client relationships despite taking time away. “So the culture of your organization, not only in their words but in their actions, is important.”

Nadine Fattaleh, a chemistry professor at a community college near Portland, Oregon, says that she’s not sure that some of her colleagues always understand the balancing act that comes with being a professional who is also the parent of a 7-year-old daughter.

“I do think that I have some co-workers who might not be able to understand some of the pressures that I have,” she says. “I have a supervisor who very kindly asks me how my family is doing whenever he sees me. But he doesn’t ask the same of many of my male counterparts, or at least I haven’t witnessed it. So I appreciate the nod and sort of the personal connection, but, at the same time, you can ask me how my classes are going, like you ask male professors.”

But Fattaleh says her job gives her the latitude that she needs. “I obviously have to be in class and be in labs and be here for my students,” she says. But when it comes to grading papers and returning emails, “I can do that after (my daughter’s) bedtime.”

The school also has a childcare facility run and staffed by students and instructors in its early childhood education program. Fattaleh’s daughter attended it until she went off to kindergarten.

“I didn’t look anywhere else for child care,” she says, noting that she tells colleagues who are expecting a baby or have young children how nice it was to have her daughter cared for five minutes away from her office.

Hila Roberts, a Home Depot merchant, is the primary caregiver for her children when her husband is on the road but it hasn’t hindered her ascent up the corporate ladder.
Home Depot

Hila Roberts, an Atlanta-based merchant for Home Depot, says that there’s always the tug and push of work and home life.

“I think any parent, you always have that struggle of you want to do a great job at work because work is really important, but at the end of the day your family comes first,” says Roberts, who is the primary caretaker for her 6-year-old daughter and 3-year-old son during the week while her husband is on the road.

Finding the balance between work and home can mean prioritizing and planning. “It’s very important for me to pick up the kids from school and take them home and have dinner with them,” she said, noting that, to make it work, she shifts her focus to home for a period. “I may not be as responsive between the hours of 5 to 8, but … once the kids go to bed, I can devote my time back to catching up on emails or completing some projects that are due.”

Money: Let’s all resolve to stop saying these things to pregnant women and new moms

Money: How the gender pay gap hurts women’s retirement and 401(k) plans

Money: Childcare costs and strict hours are crippling working parents, especially the single ones

Roberts’ obligations at home have not hindered her ability to attain more responsibility at work. “It’s really about the leadership here and them being supportive of having someone like me,” she says. The type of people who “want to have a life and also want to do a great job at work.”

Through Bright Horizons, Home Depot provides back-up care for staffers’ family members, a benefit Roberts tapped just last week when she sent her daughter to a day care center when school was closed for the Martin Luther King Jr. holiday.

“I know other people where … their company doesn’t have that benefit, and they are losing workdays,,” she says. “If every company had that, it would make every parent’s life so much easier. … That gives you a way to still be able to work but know that the people you love are still being taken care of.”

Despite the obstacles they may face climbing the corporate ladder, working mothers are believed to possess many of the qualities companies often value most in a leader. Eighty-four percent of those in the Bright Horizons survey said working moms in top roles will make a company more successful.

Among respondents, 65 percent said working moms are better listeners than working dads or people who aren’t parents, 51 percent said working mothers are calmer in emergencies, and 44 percent said they are better team players.

Mastercard is among the companies focused on providing support and opportunities for the mothers on its staff. It has also enlisted Bright Horizons to provide back-up care for its employees.  The company enables flexible work schedules, and it has instituted a policy worldwide that gives a minimum of 16 weeks for maternity leave and 8 weeks for paternity leave.

“The critical factor is ensuring you have executive leadership … that genuinely believes from a talent perspective that this is good for an organization,” says Michael Fraccaro, chief human resource officer for Mastercard. “We’re very transparent in progress we’ve made and areas we need to focus on, particularly in continuing to promote people from within into senior levels of management.”

The company also has an initiative, launched in 2017,  that helps mostly female talent that has left the workforce to reignite their careers.

The 12-week program, fittingly called “Relaunch Your Career,” gives the participants a job and mentors. The goal is that more than 75 percent of them will become full-time employees.

“Once given a chance,” Fraccaro says, “the level of commitment and engagement from these individuals, and their work ethic … is extremely high.”

Source: https://eu.usatoday.com/story/money/2019/01/28/working-mothers-often-not-given-chance-lead-new-report-finds/2604334002/

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An estimated 11 percent of the global population have IBS, making it the most common gut disorder in the world. And, according to some estimates, twice as many women suffer as men. What’s more, over a third of cases actually go undiagnosed, meaning that many people are dealing with debilitating symptoms like diarrheabloatingcramps, and constipation, while having no idea how to manage their painful condition.

Think your unpredictable bathroom habits could be IBS? Here, learn more about what causes and influences IBS, how to treat it naturally with dietary changes and mind-body practices, plus a few gut-soothing supplements that can boost your chances of success.

What exactly is irritable bowel syndrome, or IBS?

IBS is a chronic condition defined by discomfort surrounding one of our most basic acts, going to the bathroom. It’s characterized by regularly recurring bouts of constipation or diarrhea, sometimes alternating, which, according to the most recent classification, has lasted at least three months. Often bloating and gassiness are added to this unpleasant mix.

“It’s really very frustrating when your life is ruled by your bowels—you can’t go, or you need to go all the time,” says integrative nutritionist Kathie Madonna Swift, M.S., RDN, author of The Swift Diet: 4 Weeks to Mend the Belly, Lose the Weight, and Get Rid of the Bloat.


What causes IBS?

Even the term IBS is the tip-off that mainstream gastroenterology doesn’t have a handle on what causes it or how exactly to treat it. It’s not a “disease” but a “syndrome,” or a collection of symptoms under the catchall umbrella term of IBS.

The problem with IBS, Swift says, is that so many things can cause it, or at the least contribute to it—from food sensitivities to an overactive gut immune system to stress, be it the everyday variety or a history of physical or sexual abuse. And while a serious case of IBS can make a body miserable, it doesn’t create the obvious, visible physical damage inside the digestive system as potentially life-threatening conditions like inflammatory bowel disease or colon cancer. Additionally, the drugs that doctors have used to treat IBS have had only limited success.

How do you treat IBS?

If you suspect IBS, make an appointment with a gastroenterologist. This step is important so you can rule out the possibility that your symptoms are actually signs of a more severe disease. After you get the “all clear” from a specialist, perhaps after a sigmoidoscopy or colonoscopy, any knowledgeable health care provider should be able to guide you in the use of over-the-counter products to help manage obvious symptoms—for instance, psyllium fiber products for constipation.

But to get at the root causes of what’s ailing you, Swift says, you want a holistic approach and to experiment with a range of different therapies to address what’s causing your IBS. Increasingly, integrative nutritionists are at the forefront of treating patients with IBS because—despite whatever else may influencing the syndrome—food is central to getting symptoms under control.

In a study in the American Journal of Gastroenterology, for instance, the vast majority of IBS sufferers reported their symptoms were triggered or exacerbated by eating a meal. This is in sharp contrast to medical thinking only a generation ago, which regarded IBS as “all in your head,” or more technically, “a digestive system manifestation of chronic stress and nervous tension.” Today, the leading academic gastroenterologist William Chey from the University of Michigan regards food as “the main course to wellness and illness for IBS patients.”

Dietary therapies for IBS.

Eliminate common triggers.

Swift will start simple with a new patient, eliminating the “usual suspects” from the diet. Alcohol and caffeine are two excellent candidates to lose on a trial basis—they don’t cause IBS, but they can certainly exacerbate it. With food, she usually begins with eliminating wheat and dairy.

Patients with celiac disease have a severe gastrointestinal reaction to eating wheat and other foods that contain gluten—and if celiac is suspected, it should be tested for. But far more common, Swift says, are food sensitivities or intolerances to gluten or other wheat proteins that, while less dire than celiac, are still a major driver of IBS symptoms.

The most common food sensitivity of all is to the sugar in dairy products, lactose. Some IBS sufferers will need to say goodbye to dairy for good, while others can tamp down symptoms by limiting their dairy intake or taking a lactase supplement, which contains a digestive enzyme that helps break down lactose in the body.

Try a low-FODMAP diet.

“There is a tried-and-true way to treat IBS and other gut conditions without drugs or other invasive procedures: a low-FODMAP diet,” Vincent Pedre, M.D., gut health specialist and medical director of Pedre Integrative Health, told mbg.

FODMAPs are a family of carbohydrate sugars and fibers that may aggravate IBS:

The acronym stands for Fermentable(the process through which gut bacteria break down undigested carbohydrate to produce gases like hydrogen, methane, and carbon dioxide) Oligosaccharides (fructo-oligosaccarides found in wheat, rye, onions, and garlic) and Galacto-oligosaccharides (found in legumes/pulses), Disaccharides (a lactose found in milk, soft cheese, and yogurts), Monosaccharide (fructose in excess of glucose, found in honey and many fruits and vegetables), and Polyols (sugar polyols like sorbitol and mannitol, found in some fruits and vegetables and used as artificial sweeteners).

It’s a mouthful, but for difficult IBS cases, low-FODMAP diets can be a total game-changer. Basically, on a low-FODMAP diet you eliminate or aggressively reduce high-fiber vegetables, high-sugar fruits, legumes, dairy, and sugar alcohols for a period of time.

There’s also some compelling research to back it up: “One study found a low-FODMAP diet improved symptoms in about 68 to 76 percent of IBS patients—results I’ve seen in my own practice,” said Pedre. “IBS aside, a low-FODMAP diet helps a variety of gut conditions including Crohn’s disease, celiac disease, inflammatory bowel disease, and even small intestinal bacterial overgrowth (SIBO).”

Despite the success of the low-FODMAP diet, there are some important caveats. For one, it can be restrictive and difficult to follow correctly (unless you have a handy guide to a low-FODMAP diet). Plus, many people with IBS don’t need such a restrictive diet over the long term. For people who do benefit, Pedre emphasizes that the goal should be the gradual reintroduction of healthy FODMAP foods like vegetables, legumes, and fruits.

To up your chances of success, Pedre recommends keeping a food journal. “Tracking your food intake becomes an excellent way to pinpoint where high-FODMAP foods and other food intolerances might creep in, and [to help you] target major offenders.”

What does the microbiome have to do with IBS?

It all relates to fermentation. Much of the dietary fiber we consume is fermented, or broken down, by bacteria that live in the colon or large intestine—aka the gut microbiome. Too much fermentation results in the bloating, gas, and disordered bathroom habits that are the hallmark of IBS, and the low-FODMAP diet can help bring that under control.

But, researchers say, the right amount of fermentation helps protect a healthy gut—specifically, fermentation by-products help protect and repair the gut lining so that the microscopic contents of the gut don’t spill into the bloodstream and trigger systematic inflammation, or leaky gut.

That’s why nutritionists say most people need to eat more fiber, not less—the bacteria in our gut may actually be out of balance or “dysbiotic” because we eat too much low-fiber junk food. But people prone to IBS often have to go slowly, limiting high-fiber foods at first and slowly increasing over time, or trying different fiber options to find out what works and what doesn’t.

“It’s all about individual experimentation,” Swift says. “Maybe black beans will always overtax the digestive system, but chickpeas or lentils could be just right.”

How the gut-brain highway influences IBS.

The traditional view of IBS as “in your head” wasn’t all wrong, but the latest research has replaced this notion with a new understanding of gut function as part of a two-way conversation between the brain and the gut.

Yes, stress and anxiety can generate hormones and other chemical messengers that can upset the gut (we’ve all experienced butterflies in our stomach before a big event). But the gut’s nervous system, the enteric nervous system (or “second brain”), which produces the same neurochemicals as the brain—an estimated 90 percent of the body’s supply—can also influence our thoughts and emotions in ways researchers are only just beginning to understand (and it sheds some light on the association between depression and IBS).

The microbiome plays a kind of middleman here: A dysbiotic gut can throw off the production of the hormones generated in the enteric nervous system as well as signal the gut’s immune system to overreact to what would otherwise be harmless food components, like gluten—which then triggers inflammation that may produce symptoms like depression or brain fog.

Mind and body solutions for IBS.

We are a long way from decoding the exact gut-brain crosstalk that’s responsible for IBS in all of its various forms. But we can explore therapies that calm both mind and body and smooth out the conversation between them.

Swift recommends healing imagery exercises developed by Belleruth Naparstek that are specific to IBS. She also introduces many of her patients to the Asian movement discipline of qigong. Again, the idea is to find what works for you. For some that might be meditation, for others yoga.

There is also reliable research that suggests addressing IBS from the point of view of “mind” alone can be effective. In a 2015 meta-analysis, 75 percent of subjects who received some sort of psychological therapy—from cognitive therapy to hypnosis—saw greater improvement in gut symptoms than the people who did not, potentially due to a reduction in stress.

Plain old exercise may help, too, and it’s especially helpful in relieving constipation. But researchers have also found that intensive exercise can work in the opposite direction, promoting leaky gut, which drives inflammation and worsens IBS. As with everything else in the gut, balance is key.

Supplements for IBS.

Supplements can also complement all the healthful changes you’re making to your diet and lifestyle. On Swift’s personal list of got-to supplements for IBS:

  • enteric-coated peppermint oil, which has a relaxing effect on the smooth muscle of the gut
  • a probiotic such as Visibiome or Clinical GI Probiotic
  • Iberogast, an herbal blend that includes peppermint, caraway, lemon balm, licorice, and others to help relieve cramps, bloating, flatulence, and nausea
  • a melatonin supplement (3 mg at night) if sleep and an overactive enteric nervous system are problems

Because everyone (and everyone’s IBS) is different, no one menu of therapies fits all. “I can’t wave my magic wand and say, ‘IBS be gone!'” says Swift. “It’s very complex, but patients do get better.”

Source: https://www.mindbodygreen.com/articles/irritable-bowel-syndrome-ibs-symptoms-causes-and-treatment?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190127&otm_click_id=236e6c0710a8cde70a91efd12f5f6194&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

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Research shows cleaning is a powerful stress reliever—and I’ve experienced it myself.

Confession: I am 24, live in New York City, and more often than not, I rather spend my Friday nights cleaning my apartment than out at a bar with a cocktail in hand.

So I totally understand why people are suddenly obsessing over Tidying Up with Marie Kondo on Netflix. Keeping a clean home is weirdly therapeutic, and the simple act of getting rid of things you don’t need, folding clothes, organizing your pantry or closet, and even scrubbing a bathtub are powerful de-stressors.

But I didn’t always practice what I now preach. I have always considered myself a clean person, but just last year, I was living in an apartment in a different state that was triple the size of my current one-bedroom. I had five closets and a storage locker in the basement—which means I had plenty of space to store a lot of stuff: clothes that only saw the light of day once a year, boxes of extra curtains and bed sheets, multiple beach umbrellas (because obviously you need different sizes), and toiletries I bought in bulk because they were on sale.

After downsizing to a space that had just one small closet (for two people!), I realized just how unnecessary it all was. I bought things just to have them. Many items didn’t serve a purpose and I quickly became overwhelmed by it all.

That’s why the infatuation with Marie Kondo’s KonMari method makes sense to me: keep the items that truly make you happy and get rid of the ones that don’t.

But my love for tidying up goes beyond getting rid of things. I genuinely enjoy cleaning, especially when I feel stressed or anxious (a constant in my life). If I need to clear my head, I whip out the vacuum. After an argument, I walk away and do the dishes. And when I feel too tense to do anything else? You better believe the bathroom is getting a once-over.

Cleaning makes me feel lighter, more relaxed, and accomplished. It feels just as good as that post-workout high—you know, when that rush of endorphins validates that you do, indeed, have your life together. But why? I know I’m not the only one that feels this way, so I talked to a psychologist about it.

How clutter impacts your mental health

As it turns out, science shows that a messy home may actually dampen your mental well-being. In one 2010 study published in the journal Personality and Social Psychology Bulletin, researchers captured the life of 60 dual-income families. The participants were given a camera and were asked to do a tour of their homes, meaning they walked around their space, discussing their things and what they meant to them.

The researchers analyzed those narratives and looked for language specific to clutter, unfinished home projects, and things that needed to be done. The conclusion? Women who perceived their homes as cluttered had less healthy patterns of the stress hormone cortisol, explains lead study author Darby Saxbe, PhD, assistant professor of psychology at the University of Southern California, and they felt more stress as the day went on. People who didn’t feel this sense of clutter, on the other hand, actually experienced a drop in their cortisol levels.

“It is freeing. If you have fewer things, you have fewer decisions to make.”

It may boil down to the feeling of never-ending work and obligation, she explains, and your brain doesn’t like to deal with the weight of that responsibility.

That could be one reason why people are feeling connected to Kondo’s methods. “We’re living in this era of very affordable, disposable goods. People accumulate a lot of stuff, they lose track of it, and then they have to buy the same things,” says Saxbe. “That creates more of a cognitive demand for people, because they have to plan and decision-make about all of those things that are surrounding them.”

So when you finally rummage through your closet and set aside a pile of clothes to donate? Your brain actually relaxes at the sight of fewer options in the morning. “It is freeing. If you have fewer things, you have fewer decisions to make,” Saxbe says.

So why exactly does tidying up feel so therapeutic for some people?

We know that living with too much stuff can feel overwhelming, but I still wanted to understand why cleaning helped clear my head so much.

Especially for Millennials, there are many life stressors that can feel completely unpredictable, says Saxbe—say, like your job security, dealing with a mental health issue, or even the state of our planet. All of these things can weigh down your thoughts, and even make you feel helpless.

As silly as it sounds, tidying up can help you feel a bit more in control over your own world. “You’re putting things in order. Cleaning can be an escape and give people a sense of mastery and control that might be hard to find in other places,” says Saxbe.

Plus, there’s a reason the physical act of cleaning can feel just as good as going for a walk outside. “A lot of what we do these days is on screens. We’re typing, thinking, and living in a pretty abstract world. The idea of doing something really physical that uses your body, I think it does put your mind in a different space—just like exercise or going outside. It can give you some reframing,” says Saxbe.

That’s not to say that cleaning replaces the health benefits of your daily workout. But if you find that a tidy home seems to help you think more clearly, breathe more deeply, and let go of tension, you may be doing your mind a favor. It may not be “life-changing,” as Kondo’s book claims, but it certainly might make life easier to deal with.

Source: https://www.prevention.com/health/mental-health/a26010541/marie-kondo-tidying-up-health-benefits/

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Data visualization reveals how much hospitals across the nation charge for some of the most common procedures

In this month’s Science Agenda column Scientific American’s editors make the case for widespread adoption of midwifery care in the U.S. One major advantage of such a shift would be a reduction in the cost of childbirth. Midwives boast lower rates of cesarean section and other pricey interventions compared with those of obstetricians. Moreover, women in midwifery care might choose to give birth at home or in a birth center, the costs of which are typically a fraction of those associated with hospital delivery.

So, just how expensive is it? Despite the fact childbirth is one of the most common reasons for hospital admissions in the U.S., it can be difficult for an individual to estimate how much she might end up paying to deliver a baby. Part of the problem is charges vary based on factors such as hospital location, type of delivery and the payer. Depending on a person’s income and insurance status, this can be quite an anxiety-inducing question.

As a curious data visualizer who, as it happens, will soon be giving birth in a New York City hospital, I decided to investigate. Perhaps the best source for this type of information is the Healthcare Cost and Utilization Project(HCUP), which aggregates health care data from all over the country and makes it available for anyone to search. Using this resource, I created an interactive visualization that lets users explore hospital-charge data for all HCUP-participating states.


Credit: Amanda Montañez; Source: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

The amount a hospital charges typically exceeds what ultimately shows up on a medical bill, so unfortunately these data do not reveal how much an individual or even an insurer actually pays. I have yet to find a source yielding that level of granularity. But the visualization at least provides a starting point and lets users see how their state compares with the rest of the country. It also provides powerful visual support for the idea that a move toward cheaper, midwife-led care would be a step in the right direction.

Source: https://blogs.scientificamerican.com/sa-visual/the-cost-of-giving-birth-in-the-u-s/

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For years, the Pap smear was the standard when it came to detecting cervical cancer. Now doctors are shifting to the HPV test, which is thought to be more accurate.

Researchers at Moffitt Cancer Center in Tampa have developed a new test that can help guide cervical cancer screenings for women who test positive for HPV.

At one time, cervical cancer was the leading cause of cancer death for women the United States.

And while that rate has fallen significantly over the last 40 years, detection methods have mostly stayed the same. Until now.

Gynecologists have been screening for cervical cancer for years through routine Pap smear exams by testing for potentially precancerous and cancerous cells in the cervix.

But clinicians are shifting to screening specifically for the human papillomavirus, or HPV, an infection that causes nearly all cervical cancers, to improve accuracy as they work to prevent the disease.

More than 79 million Americans are currently infected with a strain of HPV, according to the Cleveland Clinic. And roughly 14 million people are newly infected every year.

About 80 percent of sexually active people, both men and women, are infected with HPV at some point in their lives, but most rarely ever know it or are affected in any way. Still, there are 12 strains of HPV that are known to cause cervical cancer in women. The HPV vaccine aims to protect women and men from those strains.

Because of the dramatic rise of HPV, screenings for the infection are becoming more popular. That has prompted the birth control delivery company, Nurx, to launch an at-home HPV screening test this month. Women receive the test in the mail and can perform it at home. It requires a vaginal swab, and the collection is sent in the mail to be tested, said Jessica Horwitz, the company’s clinician director.

“If the results are positive, we recommend the patient follow up with a provider in person,” she said. “But the standard guidelines are if the test is negative, you don’t need to repeat the test for the next three to five years.”

Nurx is an app-based service where users can already sign up to have birth control or the HIV-prevention medication, PrEP, sent to them in the mail. The company charges a $15 shipping fee and bills insurers for pharmacy services, though patients can pay out of pocket.

Patients don’t necessarily need to have a doctor’s prescription to use the service. Horwitz said Nrux is a kind of “telemedicine” service that aims to provide greater access to care to people who may not be able to see a doctor.

Access has become a concern as numbers reveal that too many women have been slow to get screenings.

A study published this month in the Journal of Women’s Health shows a decline in screenings for women in the 21 to 29 age range for cervical cancer and HPV. Just over half of the women in that group were current on their screenings in 2016, a number the study’s author found “acceptably low.”

“The traditional medical system is slow to catch on,” said Horwitz, the Nurx executive. “It’s a bit polarizing. But the rate of women coming in for routine exams is lower and lower.”

In another recent twist, researchers at Moffitt Cancer Center in Tampa have developed a new test that can help guide cervical cancer screenings for women who test positive for HPV. According to a National Cancer Institute study, this new HPV test can more accurately predict whether an HPV-positive woman would develop cervical cancer within five years compared to a Pap test, where the results can vary.

The test uses a dual-stain method to measure the presence of two proteins that in combination have shown to be an accurate and dependable way to detect pre-cancerous cells. In the study, HPV-positive women who had a negative result on the dual-stain test had a low risk of developing cervical cancer over the next five years. Therefore, researchers concluded these women could wait three years before being screened again.

This screening method is still too new to be put into everyday practice among gynecologists, but it’s a step in the right direction to earlier detection and prevention, said Dr. Robert Wenham, the chair and director of research in the department of gynecologic oncology at the Moffitt.

“Testing methods have stayed stagnant for a very long time,” Wenham said. “A lot of times results from a Pap smear can come back a little funny, and we just don’t know how quickly pre-cancerous cells can change.”

Source: https://www.tampabay.com/health/medical-news/hpv-test-emerging-as-an-alternative-to-the-pap-smear-20190122/

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Antibiotic resistance associated with overprescribing of the drugs is a known threat to public health and has been the subject of educational campaigns throughout the world. However, an analysis of recent US insurance claims data, using a novel classification scheme, calls into question how well those messages are translating into clinical practice.

Published in BMJ, the findings show that in 2016, 1 in 7 enrollees in employer-provided insurance plans filled at least one prescription for an antibiotic on an outpatient basis that was inappropriate. The data reflect claims experience for more than 19 million individuals, including adults aged 18 to 64 and children aged 0 to 17 years.

For the study, the authors developed a classification scheme to determine whether each of 91,738 ICD-10-CM diagnosis codes “always,” “sometimes,” or “never” justified antibiotics. For each antibiotic prescription filled in 2016, the scheme was used to classify all diagnosis codes in claims during a look-back period that began 3 days before antibiotic prescription fills and ended on the day fills occurred. The main outcome was the proportion of fills in each of four mutually exclusive categories: “appropriate” (associated with at least one “always” code during the look-back period, “potentially appropriate” (associated with at least one “sometimes” but no “always” codes), “inappropriate” (associated only with “never” codes), and “not associated with a recent diagnosis code” (no codes during the look-back period.

The claims data analyzed were from the 2016 Truven MarketScan Commercial Claims and Encounters database, which contains claims for people aged 0 to 64 years who receive employer-sponsored health insurance. The authors said they “erred on the side of assuming appropriate antibiotic use” by, for example, classifying several diagnosis codes as “sometimes” even when oral antibiotics are rarely necessary.

Overall, the researchers found that 23.2% of the outpatient antibiotics prescriptions written were inappropriate, 35.5% were potentially appropriate, and 28.5% were not associated with a recent diagnosis code. During the study period, 14.1% of the individuals in the claims database filled at least one inappropriate antibiotic prescription, including 10.6% of the children and 15.2% of the adults. Of the inappropriate prescriptions, 70.7% were written in an office-based setting, 6.2% in urgent care centers, and 4.7% in emergency departments.

In subgroup analyses, 31.4% of antibiotics prescriptions to adults were appropriate, compared with 48.7% of those written for children. The most commonly prescribed antibiotics were azithromycin (19.0%), B lactam derivatives (18.2%), and clavulanate (11.6%). The most common diagnoses associated with the appropriate fills were urinary tract infection, streptococcal pharyngitis/tonsillitis, and bacterial pneumonia. Acute bronchitis, acute upper respiratory tract infection, and respiratory symptoms such as cough were the diagnoses most frequently associated with inappropriate prescribing.

Limitations of the study noted by the authors included reliance on diagnosis codes assigned by clinicians, use of a classification scheme developed on the basis of consensus, in ability to capture fills or visits paid for out of pocket or prescriber specialty, and assessment of antibiotic appropriateness solely based on indication and not choice of agent or duration of therapy. Nevertheless, the researchers said, their data “highlight the importance of conducting future studies to assess the 64.0% of outpatient antibiotic prescription fills that are either only potentially appropriate or not associated with a recent diagnosis code.” They also believe that their classification scheme “could be a valuable tool for policymakers and researchers interested in measuring and improving the appropriateness of outpatient antibiotic prescribing.”

Source: http://www.contemporaryobgyn.net/antibiotic-resistance/study-1-7-antibiotic-scripts-may-be-unnecessary

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The S.T.D. has gained ground among all women in the U.S., including those who are expecting.

The Treponema pallidum bacterium, which causes syphilis. It can be passed from mother to child during pregnancy or birth.CreditCreditSusan Lindsley/CDC, via Associated Press

Syphilis continues to make a dismaying comeback in the United States.

Between 2012 and 2016, the rate of primary and secondary syphilis among women increased 111 percent. Over the same period, the rate of congenital syphilis increased by 87 percent.

The sexually transmitted disease is caused by infection with the bacterium Treponema pallidum. The bacterium also can be passed from mother to child during pregnancy or birth.

Up to 40 percent of infants with syphilis are stillborn. The rest appear normal at birth; if left untreated, however, they may develop a number of serious symptoms, from bone pain to deafness and blindness.

Infected babies are treated with penicillin. Infants who picked up the bacterium while passing through the birth canal generally fare better than those infected during pregnancy.

The number of reported syphilis cases in women — including primary and secondary stages, and latent stage, when infection is much less easily transmitted — rose to 14,838 in 2016 from 9,551 in 2012, an increase of 55 percent, according to a study published in the journal Obstetrics and Gynecology.

Over the same period, the number of cases in pregnant women increased 61 percent, to 2,508 from 1,561.

The increases occurred in all age groups, among all racial and ethnic groups, and in every region of the country. The greatest increases were among women in their twenties, non-Hispanic black women, and women who live in the South.

Only half of pregnant women reported any of the known risk factors, among them drug use, a history of sexually transmitted disease, or more than one sex partner in the past year.

“All women must be tested,” said the study’s senior author, Dr. Sarah Kidd, a medical officer at the Centers for Disease Control and Prevention. “If you’re only trying to weed out women with typical risk factors, you’re going to miss a lot of women.”

The C.D.C. recommends screening at the first prenatal visit. Because some women become infected after the initial test, women should be screened again during the third trimester and again at delivery, especially those women living where prevalence is high.

Treatment of pregnant women with penicillin is up to 98 percent effective in preventing congenital syphilis.

“The incidence of syphilis has been at an all-time low over the past 20 years,” Dr. Kidd said. “Some recently trained physicians have never seen it. But it’s making a comeback, and physicians should be aware of it.”

Source: https://www.nytimes.com/2019/01/21/health/syphilis-women-pregnancy.html

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When I rounded up the best health books of 2018, I noticed a common theme emerging: Most of them were either directly about mental health or had a strong mental health or brain health component. There’s no doubt about it, this facet of wellness is becoming more and more of a top priority for people all over the world.

When you think about this rise in popularity, it makes sense; our lifestyle changes drastically affect the health of our minds, and in exchange, our mental health greatly affects our ability to make healthy lifestyle choices. Essentially, we need both to be truly healthy.

Knowing this, it doesn’t come as a huge surprise that sales of books about mental health are soaring. What might surprise you, however, is that this year they surpassed sales of books about diet and exercise.

At first this is hard to believe; diet and exercise books have long dominated the health and wellness scene. I mean, who doesn’t want to learn how to burn more fat or get the body of an Olympian? But according to new data released by Barnes & Noble, mental health officially became priority No. 1 for American readers interested in bettering their health. The data was collected from retail store sales and online book sales that occurred between December 16 and January 5—typically prime time for book sales on self-improvement and weight loss.

You might be wondering what this all means. As Liz Harwell, Barnes & Noble’s senior director of merchandising, told the Los Angeles Times: “When it comes to preparing for New Year’s resolutions and goals, the data shows that across the chain more people are buying books about mental and emotional well-being as opposed to what were previously the more popular areas of exercise and dieting.” In other words, it points to the idea that people are more interested in reducing stress and increasing their confidence than losing weight this year. Mark Manson’s book The Subtle Art of Not Giving a F*#k: A Counterintuitive Approach to Living a Good Life was No. 1 with more than 3 million copies sold over the last two years. No. 2 was You Are a Badass: How to Stop Doubting Your Greatness and Start Living an Awesome Life by Jen Sincero.

There are many contributing factors to this shift in thinking, but one could definitely be the increase in mental-health-related illnesses in America and all around the world. According to the Anxiety & Depression Association of America, anxiety disorders are the most common mental illness in the United States—affecting 18.1 percent of the population every year—and 322 million people worldwide live with depression. People want to be happier, more confident, and have greater self-esteem—and they’re willing to do the work to get there.

Source: https://www.mindbodygreen.com/articles/mental-health-books-outsell-weight-loss-diet-exercise-books

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