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Women who breastfeed their babies for the recommended six months may also be lowering their own risk of developing endometrial cancer, a new study suggests.

A mother and baby attend a breastfeeding contest organized by Peru’s Health Ministry in Lima, Peru, August 26, 2016. REUTERS/Mariana Bazo

In the analysis of data from 17 past studies, researchers found that women who had ever breastfed their children were 11 percent less likely than women who had children but didn’t breastfeed to be diagnosed with endometrial cancer.

Longer breastfeeding seemed to further lower endometrial cancer risk, though there was little extra benefit past 6-9 months of breastfeeding, the study team reports in Obstetrics and Gynecology.

“Cancer of the uterus is becoming more common and we need to try to prevent it,” said lead author Susan Jordan of the QIMR Berghofer Medical Research Institute in Brisbane, Australia.

Endometrial cancer is the fourth most common cancer in women in high-income countries such as the United States, Canada and Australia, according to the International Agency for Research on Cancer.

“The more women know about the things they can do to reduce their risks of future cancer diagnoses, the better,” Jordan said by email. “Although this piece of evidence by itself may not convince women to breastfeed, it contributes to the overall picture of health gains that can come from breastfeeding.”

The World Health Organization recommends that women exclusively breastfeed for the first six months of their baby’s life, then continue breastfeeding even after beginning to introduce solid foods.

The researchers analyzed pooled data from studies participating in the Epidemiology of Endometrial Cancer Consortium, including 10 from the United States and others from Canada, Europe, China and Australia. They looked at more than 26,000 women who had ever had a child, whether they breastfed, and for how long. This included about 9,000 women with endometrial cancer.

After accounting for other factors that can influence endometrial cancer risk, including age, race, education, oral contraceptive use, menopausal status, years since last pregnancy and body mass index (BMI), researchers found the apparent protective effect of breastfeeding remained.

Notably, the risk reduction linked to breastfeeding was 28 percent among women born after 1950, but negligible among those born before 1950, which may reflect differences in breastfeeding practices, they study authors note. In the United States in the 1950s and 1960s, for example, breastfeeding rates were much lower than in recent decades, the authors note.

The study doesn’t prove that breastfeeding helps to protect against endometrial cancer, but it’s plausible, the authors write, because the growth of this type of cancer is stimulated by estrogen, which is suppressed during breastfeeding.

“The message is not only relevant for women making decisions about breastfeeding but also for society to understand the benefits so we can support women to breastfeed for reasonably long periods of time,” Jordan told Reuters Health. “However, it’s not always possible for women to breastfeed, so it should also be noted that just because a woman chooses not to or can’t breastfeed, it doesn’t mean she’ll go on to develop cancer.”

“Breastfeeding seems to significantly reduce the risk, but further studies originating in other countries are required to assess the association,” said Lianlian Wang of The Fourth Affiliated Hospital of China Medical University in Shenyang, China, who was not involved with the study.

For instance, the most recent endometrial cancer report produced by the World Cancer Research Fund and American Institute for Cancer Research in 2013 classified the evidence for a benefit from breastfeeding as “limited-no conclusion.”

Jordan and colleagues are working with international collaborators to investigate the effects of breastfeeding on ovarian cancer risk. They’re also researching other factors that may influence the risk of endometrial cancer, including specific medications.

“Breastfeeding has consistently been found to be associated with reduced risk of breast cancer,” Jordan pointed out. “This provides evidence of another long-term health benefit for women who breastfeed for more than six months.”

SOURCE: bit.ly/2rFNGeL Obstetrics and Gynecology, June 1, 2017.

Source: https://www.reuters.com/article/us-health-breastfeeding-endometrial-canc-idUSKBN18S64K

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About half of menopausal women suffer from vaginal dryness and painful intercourse. Yet less than half of those women seek help.

At a cocktail party at my home a few months ago, I started chatting with a few middle-aged women, including a few I barely knew. After brief introductions, the conversation quickly turned to a topic that’s become typical banter among women of my age: menopause. But this time, it bypassed hot flashes and went right to sex.

It wasn’t until one of the male guests sauntered over and asked what we were discussing that the conversation came into sharper focus.

“Uh, dry vaginas,” said a friend. He didn’t leave.

About half of menopausal women suffer from vaginal dryness and painful intercourse. Yet less than half of those women seek help. For many women, the discomfort arrives so insidiously that they don’t link it to the hormone changes of menopause, doctors said.

When estrogen plummets during menopause, the vaginal lining thins. In addition to vaginal cells, estrogen influences cells that line the urethra, bladder and vulva, said Dr. Stacy Lindau, a professor of obstetrics and gynecology at the University of Chicago and director of WomanLab, a website that addresses issues of women’s sexual health. “When estrogen is doing its job, it improves blood flow and maintains the elasticity of the vagina,” she said.

The hormone shifts also alter the kinds of “good” bacteria that reside within the vaginal lining, changing the acidity level as well. The upshot is an internal environment that is drier and stiffer. And unlike hot flashes, which subside within a few years for some 80 percent of menopausal women, vaginal dryness tends to get worse.

While doctors can assess the appearance of the vaginal lining and measure blood flow and acidity, test results may not correlate with symptoms. Some patients who seem to have a vagina that would cause pain are not in discomfort, whereas others with a healthy exam report distress.

“Symptoms should be the be-all and end-all of what we care about,” said Dr. Caroline Mitchell, the director of the vulvovaginal disorders program at Massachusetts General Hospital. “The good news is that there are a lot of things that can help, and for most people, things will get better.” She added that, unfortunately, most women will not get 100 percent relief.

Treatment choices include lubricants, applied just before intercourse to reduce the sand-papery feeling in the vagina; moisturizers, used about three times a week to keep the vagina moist; and estrogen that plumps the vaginal wall lining. The estrogen is either in systemic doses — taken as an oral pill, a patch or a gel. Or it is formulated to give a dose that mainly stays in the vagina — as a vaginal tablet, a cream or a ring.

The Food and Drug Administration recently approved Intrarosa, a vaginal suppository containing DHEA, short for dehydroepiandrosterone, a hormone that is converted into estrogen inside cells and that may reduce pain, said Dr. Mary Jane Minkin, an obstetrician-gynecologist at Yale University.

A recent 12-week study in JAMA Internal Medicine of 302 postmenopausal women found that estrogen (in the form of Vagifem, a vaginal tablet) was about as effective as a vaginal moisturizer (Replens) or a placebo tablet or gel in providing relief.

“Estrogen is not some sort of miracle for everyone,” though for some, “I think it’s great,” said Dr. Mitchell, who led the study. Dr. Lindau said of the treatments that were tested, “the point isn’t that they all did nothing, but they all did something.”

Alternative therapies are popular, but there is no proof they work. Eating yogurt rich in probiotics, for instance, is a common remedy, but it does not change vaginal flora. “It sounds like a good idea,” said Dr. Mitchell, “but the bacteria are not the same ones in the vagina, so that isn’t going to help.”

Websites sell marijuana douches or topical cannabinoids, the active ingredient in marijuana, that claim to lubricate the vagina. But no studies show they alter the vaginal microbiome or are effective, though high doses may get into the bloodstream and provide some relaxation, Dr. Mitchell said.

The MonaLisa Touch, a laser therapy, has been offered as a hormone-free way to reverse vaginal dryness, but there are no long-term randomized studies proving its efficacy for this purpose. “We haven’t reviewed or approved these devices for use in such procedures,” said Dr. Scott Gottlieb, the F.D.A. commissioner, in a recent statement.

Dr. Lindau added that painful intercourse may not always be a result of hormonal changes. Some women are dry from using too much soap. “This hyper hygiene activity — too much washing and wiping — there is no good reason to use soaps, certainly not in the vagina or in the vulva,” Dr. Lindau said.

Other women may have pain limited to the opening of the vagina that can be eased with a lidocaine ointment, a numbing cream. Painful intercourse may also be caused by spasms on the opening of the vagina or abnormal growths.

One 78-year-old woman was surprised to find the ease of intercourse improved after her recent hip replacement surgery. What she thought were vaginal issues was discomfort from her hip pain.

Sexual problems can also arise, of course, from relationship issues.

“I don’t want the knee-jerk reaction to be that every vaginal complaint needs to be treated with estrogen, though low estrogen is a common cause of itchiness and dryness.” Dr. Lindau said.

She suggests trying existing therapies — and giving each one a good shot.

To be sure, it wasn’t that long ago that women broke the taboo of menopause talk and began sharing experiences about hot flashes along with the pros and cons of hormone therapy. Now that menopausal woman are more open to talking about vaginal dryness, they are seeking help — but often not soon enough. Then what began as a hormonal problem can turn into a relationship issue, too.

“Women have been led to believe that if they were just nicer to their partners or a little less anxious, their vaginal dryness would go away,” Dr. Lindau said. “But more often it’s the physical changes of menopause that are driving these issues — and they are treatable.”

Randi Hutter Epstein is the Writer in Residence at Yale Medical School, an adjunct professor at Columbia University Graduate School of Journalism and the author of “Aroused: The History of Hormones and How They Control Just About Everything.”

Source: https://www.nytimes.com/2018/09/03/well/live/menopause-sex-vagina-vaginal-dryness-pain-treatment-estrogen-hormones.html

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NEW YORK (Reuters) – General Electric Co (GE.N) and other large companies are trying to chip away at rising childbirth costs for U.S. employees, working directly with hospitals to reduce cesarean sections and related complications.

The efforts are in very early stages, with few details on their impact outside of cost savings of a few million dollars so far. But they illustrate yet another path companies are taking to bring down U.S. medical costs by working with doctors and hospitals to set health goals.

GE’s maternity strategy is designed to steer its employees to hospitals that are believed to provide better care and less likely to recommend unnecessary and costly interventions, company officials told Reuters.

U.S. employer spending on maternity care rose 50 percent in the last decade, fueled by a jump in C-section rates despite years of efforts to curb the practice, according to research firm Truven Health Analytics. For a graphic, see: tmsnrt.rs/2P1MPRs

“Maternity is one of the main drivers of high cost claims,” for employers, said Ellen Kelsay, chief strategy officer at the National Business Group on Health. Avoiding unnecessary C-sections and minimizing complications “decreases turnover in the workforce following the birth of a child,” she said.

General Motors Co (GM.N) said it has included maternity goals, including reducing C-sections, in a new contract with a Detroit-area hospital. Dow Chemical demanded explanations from hospitals that care for its employees when its C-section rate hit 44 percent several years ago. Now part of the merged company DowDuPont Inc (DWDP.N), it is working on new payment agreements with doctors and administrators.

“We went to them and said how do you explain this?” said Steve Morgenstern, Dow Chemical’s North American Health and Insurance Plan Leader, who called the rate “unacceptable.”

“BUNDLED” PAYMENTS TO CUT COSTS

GE launched its Maternity Care Select Program in Cincinnati, Ohio, home to its aviation business, where nearly 300 babies are born to employee families every year.

Local hospital system TriHealth agreed to a single “bundled” payment rate to care for low and moderate-risk mothers from the start of pregnancy until 90 days after the baby is born, rather than charge for each visit and delivery separately. That typically removes the financial upside for C-sections, which cost nearly 60 percent more, on average, than a regular delivery.

Adam Malinoski, GE’s manager of health services, said none of the company’s health insurers offered bundled payments on maternity care when it designed its program, so it decided to work directly with providers.

GE pays the out-of-pocket costs for women who enroll, saving them up to several thousand dollars. TriHealth and GE would not disclose the bundled payment rates or how they compare with other hospital rates.

New deliveries under GE’s program began in 2016, when only 78 pregnant women enrolled. In 2017, 136 women enrolled, TriHealth told Reuters. C-section rates for first-time, low-risk deliveries, which represent a small group within the program, dropped to about 6 percent in 2017 from 24 percent in 2016. That comes in well below the U.S. rate of 26 percent for low-risk births.

TriHealth would not disclose the C-section rate for the total group.

GE expanded the program to hospitals in Wisconsin, South Carolina and Massachusetts in 2017 and announced a fifth location in New York in August, but says it is too early to provide data for other locations.

GE executives said the program so far has saved the company nearly $2 million because of lower negotiated fees for maternity care. It represents a fraction of its spending on the 113,000 employees and family members enrolled in the GE health insurance plan, but a step in the right direction, they added.

“WE WERE SHOCKED”

The rise of C-sections has been fueled in part by fears about malpractice litigation, as well as expecting mothers with health issues or who are older, which raise the risk of complications.

Hospitals say that makes them reluctant to set maternity goals. The Stanford Health Care medical system works directly with employers on health targets, such as diabetes care, but has so far refused to set specific goals on C-sections.

In such higher risk cases, “it’s entirely appropriate and (there’s) no way to determine upfront” who will need a cesarean, said John Jackson, who handles corporate health partnerships at Stanford Health Care.

Suzanne Delbanco, executive director of the nonprofit Catalyst for Payment Reform, has worked with large employers seeking to reduce C-section rates. But some companies “are still leery about wading in too much,” she said. “They don’t want to alienate people, they don’t want to be accused of being Big Brother.”

GM is taking its own shot at lowering costs and improving care with a new health program, announced in August, that was created directly with Henry Ford Health System in Michigan . Three of the program’s 19 health metrics involve maternity care such as lowering C-section rates, the company told Reuters.

The automaker’s total C-section rates vary widely, from about 40 percent in the Dallas/Fort Worth area to 30 percent or lower in Detroit.

“We were shocked,” said Sheila Savageau, U.S. health care leader for GM. “We have to change the system.”

Source: https://www.reuters.com/article/us-world-work-maternity/u-s-companies-team-up-with-hospitals-to-reduce-employee-maternity-costs-idUSKCN1NC1EQ

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Study finds minimal remaining lifetime risk for cervical cancer

Women who test negative for human papillomavirus (HPV) at or after age 55 can likely forego cervical cancer screening for the rest of their lives, a new modeling study suggests.

Although the risk for cervical cancer later in life could be decreased by screening women until age 75, the study model showed that women who test HPV DNA negative to 14 high-risk HPV types and stop screening at 55 have a remaining lifetime cervical cancer risk of less than 1%, reported Talia Malagon, PhD, of McGill University in Montreal, and colleagues in Lancet Oncology.

“Our study does not necessarily suggest that all screening should stop at age 55, since the benefits of continued screening depend on the type of screening used. For countries that still use cytology screening, screening at older ages should further reduce the risk of cervical cancer,” Malagon said in a press release. “However, our results suggest that for countries that use HPV testing as part of their screening, it might be possible to stop screening earlier than we are currently doing, provided women have a negative HPV test.”

The U.S. Preventive Services Task Force recently published a review of evidence showing that women older than 65 do not benefit from cervical cancer screening, provided that they were adequately screened in the past. However, according to Malagon’s group, there is a lack of high-quality evidence to support this type of recommendation.

In an accompanying editorial, Paolo Giorgi Rossi, PhD, of AUSL-IRCCS di Reggio Emilia in Italy, wrote that setting an age to stop cervical cancer screening is logical and a decision that should be made soon.

“To our knowledge, no data have been previously reported to support the chosen upper age limit to stop HPV-based cervical cancer screening,” he wrote.

“Malagon and colleagues provide us with the data, and surrounding uncertainty, that are useful to guide decision making on the basis of the evidence, resources, and values we have,” Rossi continued. “What does society consider the threshold of acceptable incidence of cancer in older women, given the available resources?”

For their study, Malagon and colleagues used a mathematical model to estimate the lifetime risk of cervical cancer in older women who had not been vaccinated, using Canadian health data on cervical cancer incidence rates and HPV prevalence.

Without undergoing any screening for or vaccination against cervical cancer, the model predicted a lifetime risk for diagnosis of 1 in 45 women. This risk was reduced to 1 in 532 for women who underwent cytology screening every 3 years from ages 25 to 69.

Among women without the HPV vaccine, typical adherence to cytology screening and cessation of screening at age 55 translated into a lifetime risk of cervical cancer of 1 in 138 compared with a reduced risk of 1 in 160 when screening continued to age 70.

Using HPV DNA screening, regular screening and cessation at age 55 years with a negative HPV test predicted a lifetime cervical cancer risk of 1 in 1,940 (<1%). This was compared with a risk of 1 in 440 for women who stopped cytology screening with a negative screen at age 55 (also <1%).

According to the model, a 70-year-old women with no known screening history had an average remaining lifetime risk for cervical cancer of 1 in 588. There was a twofold reduction in remaining lifetime risk (1 in 1,206) for women who had a negative cytology test at age 70. This risk was reduced further to 1 in 6,525 in a 70-year-old woman with a negative HPV test.

A 70-year-old woman with negative cytology and HPV tests had the lowest remaining lifetime risk at 1 in 9,550, a more than 18-fold reduction.

To Rossi’s point, the model describes various options in terms of risk, but a threshold for what might be considered acceptable in this patient population has yet to be determined.

*The study was in part funded by a grant from the Canadian Institutes of Health Research (CIHR).

Malagon reported no relationships with industry. Co-authors disclosed relationships with Merck, Roche, GlaxoSmithKline, and others.

Rossi has conducted negotiations with Roche Diagnostics, Becton Dickinson, Hologic, Abbott, and Qiagen.

Source: https://www.medpagetoday.com/obgyn/cervicalcancer/76080

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Follow these tips to fall back smoothly and adjust to the new time change.

Getting an extra hour of rest sounds awesome, but it also means leaving the office when it’s basically pitch black out. Adjusting to the new time change may take up to a week to get used to. It can mess with your circadian rhythm—the internal clock that controls sleep, energy, and even hunger. A 2013 study suggests that during autumn transition, people tend to get up earlier and lose time sleeping overall. Moreover, studies show a slight uptick in heart attacks to and from daylight saving time. The good news: If you follow the right strategies, you can adjust to the change in a day or less.

1.Skip the drinks
drinks
HERO IMAGES/GETTY IMAGES

Saturday night might seem like a great time to go out and get a couple of drinks, but you’ll feel the impact long past the hangover when the clocks shift behind. What’s another drink if you get an extra hour of sleep, right? But the truth is that while alcohol may make you feel sleepy, it actually wakes you up at night and makes it more difficult to sleep soundly. Do yourself a favor and minimize your alcohol intake. Be sure to also sip on plenty of water in between drinks.

2.Stick to your schedule
schedule
GIANNI DILIBERTO/GETTY IMAGES

Parents of a baby can tell you that sleep schedules are important. That doesn’t change when you age. The key to waking up fresh and ready the Monday after the clocks change is a consistent sleep schedule. One studyfound that people who stick to a rigid schedule sleep better immediately following the time change than people who don’t—they’re also more likely to sleep better and wake up rested the rest of the year, too. Try this breathing exercise to help you fall asleep.

3.Get enough sleep

This one seems like a no-brainer, but it’s also the most likely to be ignored. You’ll handle the time change better and be a more functional human being if you get enough sleep in the days before and following the time change. People who get up early and sleep for less than 7.5 hours a night are more likely to struggle with the time change. While there isn’t a golden amount of sleep that will leave everyone perfectly rested and energized, most people thrive on 7 to 9 hours. And don’t forget that how well you sleep is more important than how long you’re in bed or actually sleeping.

4.But don’t sleep in
Dont sleep in
IMAGE SOURCE/GETTY IMAGES

We know, we just said to get more sleep and then took a glorious, alarm-free sleep catch-up off the table. But the extra sleep will only make you feel even more tired on Monday. Instead of overcoming an hour shift in your circadian rhythm, you’re now battling a larger deficit. You effectively increase the impact of the time change on the following day by sleeping later than usual. Get up at your regular time (or when you have to wake up during the workweek) to make it easier to fall asleep and sleep well on Sunday night.

5.Take a nap—maybe
She needs her beauty rest
GETTY IMAGESPEOPLEIMAGES

The jury is still out on whether taking a nap on Sunday will help you feel more alert and refreshed on Monday. A briefnap may help you catch up on lost sleep (and possibly reduce the mental anguish of having an hour rudely stolen from you). But if you’re prone to insomnia, a nap may make it even harder for you to fall asleep Sunday night. If you can’t resist, try to nap in the early afternoon, and limit it to 20-40 minutes.

6.Exercise
Getting ready for training
GETTY IMAGESGEBER86

It’ll help you sleep better and adjust to the time change. While there is some debate over the best time to work out, consistent, frequent exercise is key. Bonus points—and potentially better sleep—if you exercise at the same time each day, which can help keep your circadian rhythm on track.

7.Get a head start
Woman sleeping in her bed
GETTY IMAGESDEMAERRE

Go to bed 15 minutes earlier in the four days leading up to the end of daylight saving time. By the time the clocks jumps an hour back, you’ll already be fully adjusted and ready to go.

8.Follow the sun
follow sun
CAIAIMAGE/MARTIN BARRAUD/GETTY IMAGES

Your body’s circadian rhythm follows the light, not the numbers on the clock. Try to get outside and catch some morning and early afternoon light. If you can’t sneak out of the office, look for a bright room with natural light to get the benefits.

9.Shut it down
Just a bit more scrolling before I turn the lights out
GETTY IMAGESDELMAINE DONSON

You’ve heard it over and over, but blue and white lights from screens before bed can ruin your sleep. The parts of our brains that react to light can’t tell the difference between the bright light coming out of your phone or TV and the sun.

Before you claim that putting your phone or computer into night mode means that the rule doesn’t apply to you, think again. Shutting off electronics is also about letting the brain slow down and relax. Scrolling through Facebook or watching an adrenaline-inducing (or just plain captivating) show will keep you up at night and make it even harder to adjust to the new time.

Source: https://www.prevention.com/health/sleep-energy/g20508737/surviving-daylight-savings-time/

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Grief is both real and measurable. Scientists now know that the death or your father or mother will forever alter your brain chemistry and may also have physical effects.

Losing a parent is the closest thing humanity has to a universal emotional experience. But universality doesn’t dampen the trauma of the event, which tends to inform and affect the rest of peoples’ lives. Even under the best circumstances, studies suggest that losing a parent changes an adult both psychologically and biologically. Under more trying circumstances, those changes can become pathological.

“In the best case scenario, the death of a parent is anticipated and there is time for families to prepare for the loss, say their goodbyes, and surround themselves with support,” Dr. Nikole Benders-Hadi, a psychiatrist with Doctor On Demand told Fatherly. “In cases where a death is unexpected, such as with an acute illness or traumatic accident, adult children may remain in the denial and anger phases of the loss for extended periods of time…[leading to] diagnosis of Major Depressive Disorder or even PTSD, if trauma is involved.”

No number of brain imaging studies or psychological trend analyses can truly capture the unique experience of grief. But there are a handful of constants in the scientific literature because all fully developed human brains are wired to respond to emotional pain with the same basic pathways.

Studies have implicated the posterior cingulate cortex, frontal cortex, and cerebellum brain regions in grief processing. These regions are involved in retrieving memories and dwelling on the past — but, in a cruel twist of neuroanatomy, they’re also involved in regulating sleep and appetite. “This might provide some explanation for the different and unique responses to grief and loss,” Jumoke Omojola, a clinical social worker in Omaha, Nebraska, told Fatherly. “Physiological changes might include headaches, stomach aches, dizziness, tightness in the chest too much sleep, too little sleep, overeating, or lack of appetite.”

In the short term, neurology assures us that loss will trigger physical distress. In the long-term, grief puts the entire body at risk. A handful of studies have found links between unresolved grief and hypertension, cardiac events, immune disorders, and even cancer. It is unclear why grief would trigger such dire physical conditions, but one theory is that a perpetually activated sympathetic nervous system (fight or flight response) can cause long-term genetic changes. These changes — less pre-programmed cell death, dampened immune responses — may be ideal when a bear is chasing you through the forest and you need all the healthy cells you can get. But this sort of cellular dysregulation is also how cancerous cells metastasize, unchecked.

While the physical symptoms are relatively consistent, the psychological impacts are all but unpredictable. In the twelve months following the loss of a parent, the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders considers it healthy for adults who have lost their parents to experience a range of contradictory emotions, including sadness, anger, rage, anxiety, numbness, emptiness, guilt, remorse, and regret. It is normal to withdraw from friends and activities; it is normal to throw oneself into work.

As ever, context matters. Sudden, violent death puts survivors at higher risk of developing a grief disorder, and when an adult child has a fractured relationship with a parent, the death can be doubly painful — even if the bereaved shuts down and pretends not to feel the loss. “Coping is less stressful when adult children have time to anticipate parental death,” Omojola says. “Not been able to say goodbye contributes to feeling depressed and angry.” This may explain why studies have shown that young adults are more affected by parental loss than middle-aged adults. Presumably, their parents died unexpectedly, or at least earlier than average.

Gender, of both the parent and child, can especially influence the contours of the grief response.

Studies suggest that daughters have more intense grief responses than sons, but men who lose their parents may be slower to move on. “Males tend to show emotions less and compartmentalize more,” Carla Marie Manly, a clinical psychologist and author, told Fatherly.

“These factors do affect the ability to accept and process grief.” Studies have also shown that loss of a father is more associated with the loss of personal mastery — purpose, vision, belief, commitment, and knowing oneself. Losing a mother, on the other hand, elicits a more raw response. “Many people report feeling a greater sense of loss when a mother dies,” Manly says.“This can be attributed to the often close, nurturing nature of the mother-child relationship.”

At the same time, the differences between losing a father and a mother represent relatively weak trends. “Complicated bereavement can exist no matter which parent is lost,” Benders-Hadi says. “More often, it is dependent on the relationship and bond that existed with the parent.”

Grief becomes pathological, according to the DSM, when the bereaved are so overcome that they are unable to carry on with their lives. Preliminary studies suggest this occurs in about 1 percent of the healthy population, and about 10 percent of the population that had previously been diagnosed with a stress disorder. “A diagnosis of Adjustment Disorder is made within three months of the death if there is a ‘persistence of grief reactions’ exceeding what’s normal for the culture and the religion,” Omojola says. “In this situation, the grieving adult has severe challenges meeting social, occupational, and other expected, important life functions.” Even adults who are able to go to work and put on a brave face may be suffering a clinical condition if they remain preoccupied with the death, deny that their parent has died, or actively avoid reminders of their parents, indefinitely. This condition, known as Persistent Complex Bereavement Disorder, is a trickier diagnosis to pin down (the DSM labeled it a “condition for further study”).

Elisabeth Goldberg works with grieving adults as a relationship therapist in New York City, and she has seen the toll that long-term grieving can take on a marriage. Specifically, Goldberg suggests a (somewhat Freudian) link between losing a parent and cheating on a spouse. “I see many affairs as manifestations of unresolved grief about losing a parent,” Goldberg says. “The adult child stays in a state of disbelief, and rejects reality in many ways in order to feed the delusion that the parent is still alive. The grieving child needs a new attachment figure, that’s the psyche trying to reconcile the denial and grief. So rather than say, ‘my mother died,’ the grieving child can say, ‘while mommy’s away, I will play with someone other than my  spouse.’”

In more concrete — and dire — terms, unresolved grief can spiral into anxiety and depression. This is especially true when the parent dies by suicide, according to Lyn Morris, a licensed therapist and VP at Didi Hirsch Mental Health Services. “Adults who lose a parent to suicide often struggle with complex emotions such as guilt, anger, and feelings of abandonment and vulnerability,” she told Fatherly. Indeed a 2010 study out of Johns Hopkins University confirmed that losing a parent to suicide makes children more likely to die by suicide themselves.

How to cope in a healthy way remains an active area of scientific inquiry. Ross Grossman, a licensed therapist who specializes in adult grief, has identified several “main distorted thoughts” that infect our minds when we face adversity. Two of the most prominent are “I should be perfect” and “they should have treated me better” — and they tug in opposite directions. “These distorted thoughts can easily arise in the wake of a loved one’s death,” Grossman says.

When a son or daughter reflects on how he or she should have treated a deceased parent, “I should be perfect” thoughts tend to rise to the surface. Grossman’s patients often

feel that they should have done more and, “because they didn’t do any or all these things, they are low-down, dirty, awful, terrible human beings,” he says. “These kinds of thoughts, if left undisputed, usually result in a feeling of low self-worth, low self-esteem, shame, self-judgment, self-condemnation.”

On the opposite extreme, patients sometimes blame their deceased parents for not treating them properly, and never making amends. This is similarly unhealthy. “The usual result of this is deep resentment, anger, rage,” Grossman says. “They may have genuine, legitimate reasons to feel mistreated or abused. In these situations, it’s not always the death of the parent but the death of the possibility of reconciliation, of rapprochement and apology from the offending parent.”

“The possibility has died along with the person.”

In extreme cases, therapy may be the only way to get a grieving son or daughter back on his or her feet. But time, and an understanding spouse, can go a long way toward helping adults get through this unpleasant, yet ubiquitous, chapter in their lives. “Husbands can best support their wives by listening,” Manly says. “Men often feel helpless in the face of their wives’ emotions, and they want to fix the situation. A husband can do far more good by sitting with his wife, listening to her, holding her hand, taking her for walks, and — if she desires — visiting the burial site.”

Source: https://www.fatherly.com/health-science/parent-death-psychological-physical-effects/

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Nearly half of women over age 50 report bladder leakage and many say it’s a major problem for them, according to a new U.S. survey.

Of the more than 1,000 women ages 50 to 80 who participated in the survey, 43 percent of 50- to 64-year-olds said they suffered from incontinence, as did 51 percent of those 65 and older.

Even so, two-thirds of the women who experience leakage haven’t spoken to a doctor about the problem. And just 38 percent say they’ve been doing Kegel exercises to strengthen the muscles that can help hold urine in, write the authors of the National Poll on Healthy Aging report.

Many women simply rely on coping strategies like using pads, wearing special underwear, limiting fluid consumption and wearing dark clothing to disguise signs of leakage.

“What I’d like people to take away from this is that urinary incontinence is common and treatable and that women don’t have to just live with it,” said Dr. Carolyn Swenson of the University of Michigan in Ann Arbor, a specialist in female pelvic medicine and reconstructive surgery who helped develop the poll questions and analyze the findings.

The national poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation and sponsored by the AARP and Michigan Medicine.

Among women with incontinence, 41 percent said it was a “major problem” or “somewhat of a problem.” One-third said they experience an episode nearly every day. Nearly half said they worried about the condition worsening as they got older.

The most common triggers for leakage were coughing and sneezing – reported by 79 percent, and not having enough time to reach the bathroom – experienced by 64 percent.

Those symptoms are signs of two different types of incontinence, Swenson explained. Women with stress incontinence “have leakage when they are laughing, coughing, sneezing or exercising,” she said. “The other type, urge incontinence, is more of a bladder issue when you’re on your way to the bathroom but can’t make it.”

The important thing to realize, Swenson said, is that both types of incontinence can be treated. “We have so many options now that while I would hesitate to say we can get everybody 100 percent dry, we can definitely help improve symptoms for all women with urinary incontinence,” she added.

For urge incontinence, alternatives include Botox for the bladder and a surgically implanted pacemaker for the bladder that prevents it from involuntarily contracting too much, Swenson said. Women who want to pursue less invasive alternatives might cut back on substances that irritate the bladder, such as caffeine, artificial sweeteners, nicotine and alcohol, she added. Another strategy would be to empty the bladder more often.

For stress incontinence, there’s the option of surgery to repair the hammock-like support structures that help hold the bladder and other pelvic organs in place. But there are also less invasive treatments such as “vaginal inserts that look like tampons,” she said. “They help support the urethra.”

Women with either type of incontinence may benefit from pelvic floor physical therapy, Swenson said.

The survey results did not surprise Dr. Doreen Chung, a urologist at NewYork-Presbyterian/Columbia University Medical Center who specializes in female pelvic medicine and reconstructive surgery.

Chung, who was not involved in the poll, sees many patients who were reluctant to bring up their incontinence because they were embarrassed or they thought it was a normal part of aging that couldn’t be helped.

“I tell them something can be done to improve their symptoms,” Chung said, adding that many older men also suffer from incontinence but are also too embarrassed to talk about it.

There’s a range of leakiness, Chung said, “from some who only leak a few drops, which is common after childbearing, to others who use a pad or less, which is considered mild, to others who use several. Many wear diapers. There are even younger patients wearing diapers.”

Some women develop urge incontinence as a result of being told since childhood to hold their urine in. “They’re always contracting the urinary sphincter and then it becomes very hard to pee normally,” Chung said. “You shouldn’t let your bladder fill more than half a liter. For most, that means peeing every two to four hours.”

SOURCE: bit.ly/2CSj7ae National Poll on Healthy Aging, online November 1, 2018.

https://www.reuters.com/article/us-health-women-incontinence-poll/many-women-over-50-have-leaky-bladders-most-dont-seek-treatment-idUSKCN1N65C7

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