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Inflammation: if you follow health news, you probably hear about it often. When is inflammation helpful? How can it be harmful? What steps can you take to tone it down?
What is inflammation and how does it affect your body?
If you’re not familiar with the term, inflammation refers to an immune system reaction to an infection or injury. In those instances, inflammation is a beneficial sign that your body is fighting to repair itself by sending in an army of healing white blood cells. As the injury heals or the illness is brought under control, inflammation subsides. You’ve probably seen this happen with a minor ankle sprain: the initial swelling disappears within days as the injury heals.
But inflammation also occurs without serving any healthful purpose, such as when you experience chronic stress, have an autoimmune disorder, or obesity. And instead of solving a problem and receding, inflammation like this can last over a period of time, damaging the body and potentially leading to health problems like arthritis, heart disease, Alzheimer’s disease, depression, and cancer.
This is why inflammation has taken center stage in recent years, and why strategies aimed at reducing it are so popular. Many of these anti-inflammation recommendations relate to your diet.
Can changes in your diet reduce unhelpful inflammation in your body?
The truth is, there are still many unknowns regarding diet and its connection to inflammation and disease. What is clear is that having a healthy diet can help improve overall health and longevity. There is also some evidence to support the notion that eating a host of nutritious foods can reduce inflammation. For example, people who eat lots of fruits and vegetables tend to have lower levels of a substance called C-reactive protein, a marker of inflammation inside the body.
In addition, some research has found a link between diets heavy in foods that promote inflammation and a higher risk of certain health problems. For example, a study in Journal of the American College of Cardiology found that people who consumed pro-inflammatory foods, including red and processed meat, refined carbohydrates, and sugar-laden beverages, were more likely to develop cardiovascular disease than those who regularly reached for anti-inflammatory foods, such as leafy greens, beans, and tea.
It may be too soon to draw a direct line between the food you eat and levels of inflammation in your body. Fortunately, the foods that appear to reduce inflammation also tend to be good for you for other reasons. So, focusing on eating these foods can likely benefit your body in more than one way.
5 food swaps to help fight inflammation
A complete overhaul of your diet is challenging, so experts advise making smaller changes over time. Trying a series of simple swaps may add up to better health in the long term.
Below are five substitutions you can use to help reduce the number of inflammation-promoting foods in your diet.
Instead of a plain bagel with cream cheese, have a slice or two of whole-grain toast drizzled with olive oil. Whole grains contain substances that help promote the growth of healthy bacteria inside your body. That bacteria may then produce compounds that help to counteract inflammation. Regular consumption of olive oil also has benefits: along with anti-inflammatory effects, it may also help lower blood pressure and improve cholesterol levels.
Instead of a carbonated soda, try a cup of green tea. Green tea contains substances called catechins, a flavanol thought to combat inflammation. (Just be careful not to load your cup down with sugar.)
Instead of a corn muffin, substitute a handful of unsalted mixed nuts and an apple. Nuts bring a number of health benefits, including offering up a dose of healthy fats, protein, and (depending on the variety of nuts you are eating) phytochemicals. These phytochemicals contain antioxidants, which help clean up harmful substances called free radicals in the body. They are thought to have anti-inflammatory properties, as well. Fruit such as apples also contains fiber and phytochemicals.
Instead of a steak and baked potato, have a serving of salmon with a side of broccoli. The omega-3 fatty acids in salmon and other types of fish, such as tuna, sardines, and mackerel, have been linked with better heart health, possibly due to their anti-inflammatory properties. Broccoli is also a good source of fiber and is rich in vitamins C, E, K, and folate. It also contains carotenoids, a phytochemical.
Instead of a slice of cake, mix up a fruit salad using various types of berries. Fruits such as berries are rich in vitamins and inflammation-busting phytochemicals.
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As many people know, inflammatory bowel disease (IBD) is a complex condition affecting the intestine, which is the part of the digestive tract that helps digest food and remove water, salt, and waste.
But you might not know this: in recent years in the US, IBD is being diagnosed more often among people who are Black, Hispanic/Latinx, East and Southeast Asian, or from other minority groups than it was in past decades.
Is this a true rise in cases? Is IBD underrecognized in minority populations? While we don’t have all the answers yet, exploring health disparities in IBD and explaining its symptoms may encourage more people to get the health care they need.
What is IBD?
IBD is a chronic inflammatory condition in the intestine that may steadily progress, or repeatedly flare up (relapse) and calm down (remit).
The two main types of IBD are ulcerative colitis (UC) and Crohn’s disease (CD):
Ulcerative colitis affects the rectum and colon alone.
Crohn’s disease can affect any portion of the intestinal tract from the mouth to the anus, and can lead to complications such as abscesses, strictures, and fistulas.
Both conditions frequently involve organs outside of the gastrointestinal tract, such as the joints, skin, and eyes.
What do we know about IBD among minority groups?
Traditionally, IBD has been thought of as a disease that largely affects people who are white. For every 100,000 individuals, IBD occurs in about 10 Hispanic/Latinx individuals, 25 Black individuals, and 70 non-Hispanic white individuals, according to estimates published in 2014. However, more recently we’ve observed an increase in IBD among other racial and ethnic groups in the US and across the world.
Is inflammatory bowel disease underrecognized in minority groups?
Some experts believe that IBD might be underrecognized or underappreciated in minority populations, which might lead to delays in diagnoses. A delayed diagnosis could mean longer periods of untreated inflammation, which also increases risk for complications, such as
strictures (areas where the bowel narrows due to scarring)
fistulas (a passage between organs or nearby tissues that isn’t normally there)
abscesses (an infection that may result in a fistula if not treated)
surgery
cancer of the bowel.
One study looked at people receiving health care who had two symptoms suggestive of IBD: iron deficiency anemia (a low red blood count) and diarrhea. The researchers found that certain groups were less likely to receive an appropriate workup to find out why they had these particular symptoms. Those who were Black or publicly insured were less likely to receive the appropriate workup, compared with those who were white or privately insured. These findings further support the hypothesis that IBD might be underrecognized in minority populations.
What do we currently know about health disparities in IBD?
Preventable differences — called health disparities — in health and well-being are seen among people with inflammatory bowel disease. These disparities may be due to a range of factors affecting certain groups, including inequities in the social determinants of health, unconscious biases of medical providers, barriers to care, and differences in the complex genetic and environmental driving forces of IBD that haven’t been sufficiently studied.
Black patients who have IBD experience higher rates of emergency department use — and, in one study, higher rates of hospitalization, possibly because they are less likely to receive regular care from a gastroenterology specialist. Further, while the hospitalization rate in white patients with IBD has decreased, it remains unchanged for Black patients.
Additional research shows that Black patients with Crohn’s disease are less likely to be in remission, more likely to undergo surgery, and more likely to experience complications after surgery. Socioeconomic status matters, too: lower income is linked with a higher risk of severe disease, IBD-related hospitalizations, ICU stays, and death. Another study reports that approximately 14% of Americans with IBD are food insecure. Further, it links food insecurity with inability to take prescribed medications because of cost and difficulty paying medical bills.
What symptoms may be signs of inflammatory bowel disease?
A variety of symptoms may be signs of inflammatory bowel disease:
Blood in your stool, and urgency and increased frequency of bowel movements, may be signs of ulcerative colitis.
Abdominal pain, nausea, vomiting, blood in your stool, and diarrhea may be signs of Crohn’s disease.
If you have any of these symptoms — especially if you notice blood in your stool — talk to your healthcare provider. After a medical history and exam, the next steps may be further evaluation with a colonoscopy to look at the bowel, and/or an upper endoscopy to look at the upper part of the digestive system. Imaging studies may also be necessary. This evaluation will help your health provider diagnose IBD or another health problem causing similar symptoms.
Getting effective treatment makes a difference
Fortunately, ulcerative colitis and Crohn’s disease are both treatable conditions. Our goal in treating IBD is stable remission to stop or ease symptoms and ensure a high quality of life. Everyone with IBD can attain this with good care. Treatment may include medicine taken by mouth or given as infusions, dietary changes, surgery, or a combination of these. It’s important to find the right treatment and monitoring plan for each person early in the course of their illness.
I assure my IBD patients that we will work together to find the best and safest treatment options for them. IBD care requires a team approach, which might include a primary care doctor, gastroenterologist, pharmacist, surgeon, dietitian, and other health providers. If you have IBD, you’re the central member and captain of the team; as providers we are just coaches. It is important that you feel heard, understood, and empowered as you navigate life with IBD.
Follow me on Twitter @AdjoaGIMD
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If you’ve learned that your newborn or young child has sickle cell disease, you — and other family members and friends — may have many questions.
These days, most cases of sickle cell disease in the US are diagnosed through newborn screening. It’s important to make the diagnosis early, so that babies can be started on penicillin (or another antibiotic) to prevent infection. Getting connected early to a pediatrician for primary care — and to specialists in blood disorders who can work closely with the child as they grow, and with their families — can help prevent complications of the disease.
The basics
Hemoglobin is the part of the red blood cell that carries oxygen. In sickle cell disease, the hemoglobin can change the rounded shape of red blood cells into a C-shape that is crooked, like the tool called a sickle. When that happens, the cells get sticky and can clog up small blood vessels. It also makes the red cells more fragile and likely to break apart, causing anemia.
Millions of people around the world have sickle cell disease, or SCD. In the US, the Centers for Disease Control and Prevention (CDC) estimate it affects about 100,000 people. It occurs in about one out of 365 Black or African American births, and one out of 16,300 Hispanic American births.
Is SCD a genetic disease?
Yes. All of us have two genes that decide what kind of hemoglobin we have, one from each parent. People with sickle cell disease have two copies of the sickle gene, inherited from both parents. If someone has one copy, they have “sickle cell trait,” meaning that they are a carrier of the gene.
Sickle cell trait is common, affecting one in 13 Black children. While there are some problems associated with sickle cell trait, people with sickle cell trait are generally healthy; in fact, they are thought to be less likely to develop severe cases of malaria, which is why the disease was thought to have evolved in people from areas around the equator where malaria is common.
There are other kinds of genetic hemoglobin diseases, such as thalassemia or hemoglobin C. Sometimes people are born with one sickle gene and one gene for a different hemoglobin problem. The severity of their condition depends on the particular hemoglobin combination.
Currently, there is no cure for sickle cell disease or the other genetic hemoglobin diseases, except for bone marrow transplant or stem cell transplant.
What health issues could SCD cause?
When sickle cells clog up blood vessels, it can lead to pain and damage to organs or tissues due to lack of blood flow. When coupled with the effects of anemia, this means that babies and children with sickle cell disease are more likely to have complications from infections, such as pneumonia; vision problems; blood clots; and breathing problems. Children with sickle cell disease can also get swelling of the spleen if sickled cells get stuck there.
How can you help your child live a healthy life as they grow?
Children with sickle cell disease and their families can work together to help prevent complications by taking these steps:
Stay well-hydrated, as dehydration can make cells more likely to sickle.
Avoid extremes of temperature, especially cold, as this also can trigger sickling of the cells.
Avoid areas of high altitude, where there is less oxygen.
Take care with very vigorous exercise, which may decrease the amount of oxygen available to the blood.
Wash hands regularly and avoid sick people to the extent possible.
Get all recommended vaccinations.
Learn all the signs and symptoms of blocked blood vessels, anemia, a swollen spleen, infection, blood clots, and lung problems, so that they know when to get medical care immediately. Ask your child’s doctor or medical team to help you understand key warning signs for each of these based on your child’s age.
Also, see this helpful toolkit created by the CDC and the American Society of Hematology. It explains common complications of sickle cell disease and steps to take for better health.
Being closely connected to medical care is crucial, because the sooner complications are diagnosed, the sooner and more successfully they are treated. There are also treatments such as hydroxyurea that can help prevent complications in the first place. Children with sickle cell disease should regularly see their primary care pediatrician and their specialist, whether they are having symptoms or not, so that they can work together to help live the healthiest life possible.
Follow me on Twitter @drClaire
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Vaccines have been heralded as a key measure to slow the COVID-19 pandemic and one day bring it to an end. Every day, millions of American adults are receiving one of the authorized vaccines proven highly effective at preventing severe illness that might otherwise lead to hospitalizations and deaths. In the US, most people over 65 have now been fully vaccinated, protecting the most vulnerable in our population.
As an infectious disease specialist, my responses to the questions below are based on what we know so far about infection and vaccines in children and teens. We’ll need to continue filling in gaps as research is done and our understanding evolves.
What do we know about how COVID-19 affects children and teens?
Most COVID-19 infections in children are mild or cause no obvious symptoms. However, a small percentage of infected children
develop a serious inflammatory condition called MIS-C in the two to six weeks following COVID-19 infection. This may happen even in children who have mild symptoms or no symptoms.
get very sick and need hospitalization or intensive care.
Over 400 children have died from COVID-19 infection. That’s greater than the number of childhood deaths during the deadliest flu season in the past two decades.
Vaccinating children to prevent these outcomes is one of the most important reasons driving vaccine studies in children. Further, vaccinating children will be critical to achieving a population-wide level of immunity — herd immunity — sufficient to slow the emergence of dangerous variants and bring an end to the pandemic.
What do we know so far about COVID-19 vaccines in teens?
The Pfizer/BioNTech vaccine is authorized for use in people ages 16 and older.
The Moderna and Johnson & Johnson vaccines are authorized for use in people ages 18 and older.
These authorizations were based on data from participants of these ages in randomized, placebo-controlled trials that demonstrated the safety and efficacy of these vaccines. Efficacy measures how well a vaccine works in the controlled circumstances of a study. Effectiveness is how well a vaccine works outside of a study, when people in the community receive it.
As states expand eligibility for COVID-19 vaccines, teens 16 and older can receive the appropriate vaccine through the same sources adults have had access to so far. Available vaccine sites may vary by state and where you receive health care. Check the searchable map on VaccineFinder, or your state board of health.
Vaccine research done so far, or now underway, includes the following:
Pfizer/BioNTech has completed a trial in 12-to 15-year-olds. This trial used the same dose and schedule of the vaccine as is used in adults: two doses given three weeks apart. The company announced in a press release that the vaccine was safe and well tolerated, elicited strong antibody responses, and had 100% efficacy in preventing mild to severe infection in this age group. The FDA is reviewing the data and will consider authorizing this vaccine for use in this age group. If all goes well, we might expect this vaccine to be available to 12-to 15-year-olds in the coming months.
Moderna completed enrolling 12-to 17-year-olds in a similar trial using the same dose and schedule as in adults: two doses given four weeks apart. Data from this trial are expected within the next few months.
Johnson & Johnson has started a trial of its vaccine for a small number of 16-to 17-year-olds. If the vaccine proves to be safe and effective in that age group, the trial will continue with 12-to 15-year-olds.
What about COVID-19 vaccine trials for younger children?
Pfizer/BioNTech and Moderna have both begun trials in children 6 months to 11 years old.
These trials will each begin by testing smaller doses than those given to older children, teens, and adults. This allows researchers to determine which dose is well tolerated and still elicits strong antibody results in younger children.
Once the dose is set, larger numbers of children in these age ranges will be enrolled in placebo-controlled trials to evaluate the efficacy of these vaccines.
All of these steps will take some time so that they can be done without cutting any corners on safety. The earliest vaccines will likely be available for younger children is late 2021, or perhaps early in 2022.
What is not yet known about COVID-19 vaccines in children and teens?
How long vaccine-induced immunity against COVID-19 infection lasts in children will need to be followed over time. Findings from such studies will help experts decide whether children will need boosters of COVID-19 vaccines in the future.
Researchers also need to study whether COVID-19 vaccines can be combined with other vaccines that children routinely receive. For now, the CDC recommends not giving any other vaccines within 14 days of a COVID-19 vaccine. This is true for people of any age.
Researchers will need to evaluate the impact of these vaccines on protecting children from infection with COVID-19 variants. But biologically, there would be no reason to expect differences in vaccine coverage of variants in adults versus children.
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While the COVID-19 pandemic is not over by any means, more people are getting vaccinated, and restrictions are gradually lifting. After too much time spent inactive and indoors, what better way to move your body and enjoy nature than by taking a hike? In many ways, hiking is the ideal antidote to a global pandemic, as it can heal both body and soul.
Enjoy the benefits of a hike
Like power walking, hiking offers a moderate-intensity cardio workout, provided your route includes some hills or inclines. Trekking on uneven surfaces engages your core muscles and improves your balance.
Hiking also is a mood booster. Research shows that spending time in green spaces, like nature trails and wooded areas, can reduce stress, anxiety, and depression. It doesn’t matter if you hike alone or with others.
The CDC still suggests people maintain social distancing during outdoor activities, including hiking, since it’s not possible to know who is fully vaccinated. You also should wear a mask around people who are not in your household or in your personal pod.
Many local, state, and national parks are still closed or have limited access, but some trails may be open in your area or will reopen soon. (Check out these sites to find the status of local trails near you: National Park Service, American Trails, and American Hiking Society.)
Ready to hike?
Before you lace up your hiking boots, make sure you’re well prepared. After all, it’s probably been a while since you’ve been out in the world. Here are some tips.
Work on your walking. If your walking endurance needs some work, begin a regular walking program in your neighborhood. Walk daily for 10 to 20 minutes, and wear a step counter to motivate you.
Safety first. If you can’t hike with someone, let a friend or family member know where you will hike and for how long. Bring your cell phone and a local map, if needed.
Apply sunscreen. Even if you mostly hike in the shade, you can still get sunburned. Always wear sunscreen with at least 30 SPF that blocks both types of ultraviolet rays — UVA and UVB —and a lip balm with sunscreen. Apply about 20 minutes before your hike, and then reapply every two hours.
Protect against ticks. Ticks are common in the US and can spread serious illnesses, such as Lyme disease and Rocky Mountain spotted fever. Ticks are often found in wooded, bushy, or grassy areas. Wear light-colored clothes with long sleeves and long pants, if possible. Use insect repellent that is effective against ticks on exposed skin, clothes, and hiking gear. Do a thorough tick check after hiking. Know what to do if you find a tick on your body — and what signs suggest you might have been bitten by one, such as a rash or flulike symptoms. Contact your health provider right away for advice and appropriate treatment.
Stay hydrated. Drink water before, during, and after your hike. Pay attention to your thirst (if you are thirsty, you are likely already dehydrated.) Set a timer on your phone or sports watch to remind you to drink at regular intervals.
Watch the weather. If you are not sure about the forecast, wear layers that you can add or take off depending on the temperature. Carry a rolled-up windbreaker, rain jacket, or poncho in a backpack.
Support yourself. Invest in hiking or trail shoes with good ankle support. Wear calf-length socks to protect your legs. Hiking with walking poles can help you navigate tricky terrain and support your knees.
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In a recent blog post I discussed how beneficial sleep is for memory function. But sleep isn’t just good for your memory; it can actually reduce your risk of dementia — and death. Although it has been known for some time that individuals with dementia frequently have poor, fragmented sleep, two new studies suggest that if you don’t get enough sleep, you are at increased risk for dementia.
Sleep six to eight hours each night
In the first study, researchers at Harvard Medical School studied more than 2,800 individuals ages 65 and older participating in the National Health and Aging Trends Study to examine the relationship between their self-report of sleep characteristics in 2013 or 2014, and their development of dementia and/or death five years later. Researchers found that individuals who slept fewer than five hours per night were twice as likely to develop dementia, and twice as likely to die, compared to those who slept six to eight hours per night. This study controlled for demographic characteristics including age, marital status, race, education, health conditions, and body weight.
In the second study, researchers in Europe (including France, the United Kingdom, the Netherlands, and Finland) examined data from almost 8,000 participants from a different study and found that consistently sleeping six hours or less at age 50, 60, and 70 was associated with a 30% increase in dementia risk compared to a normal sleep duration of seven hours. The mean age of dementia diagnosis was 77 years. This study controlled for sociodemographic, behavioral, cardiometabolic, and mental health factors, although most participants were white, better educated, and healthier than the general population. In addition, approximately half of the participants had their sleep duration measured objectively using a wearable accelerometer — a device that tracked their sleep using body movements — which confirmed the questionnaire data.
Inadequate sleep in midlife may lead to dementia
What’s new here is that inadequate sleep in midlife raises one’s risk of dementia. There are many reasons for poor sleep in middle age: shift work, insomnia, caretaking responsibilities, anxiety, and pressing deadlines, just to name a few. Although not all of these are controllable, some are. For example, if you’re currently only sleeping four to five hours because you’re up late working every night, you might want to change your habits, otherwise you risk developing dementia by the time you retire!
This relationship between sleep in midlife and dementia in late life is important not only from a clinical perspective, but also from a scientific one. It had always been a bit of a chicken-and-egg problem when trying to interpret the relationship between poor sleep and dementia. Was it really poor sleep that caused dementia, or just early dementia symptoms causing poor sleep? By looking at individuals who were initially studied in midlife — some as young as age 50 — we now have greater certainty that poor sleep can increase one’s risk of developing dementia 25 years or more in the future.
Flush your brain while you sleep
Although it is not totally understood why inadequate sleep increases your dementia risk, one possible reason relates to the deposition of the Alzheimer’s protein, beta amyloid. Beta amyloid is the protein that clusters and clumps together to form Alzheimer’s plaques. No one is completely certain what its normal function is, although there is increasing evidence it is involved in the brain’s defense against invading microorganisms.
During the day, we all make some of this beta amyloid protein in the brain. When we sleep, however, brain cells and their connections actually shrink. This shrinking allows more space between the brain cells, so that beta amyloid and other substances that accumulate during the day can be flushed away.
So the theory is, if you don’t get enough sleep, your brain won’t have enough time to drain away beta amyloid and other substances. These substances then continue to accumulate, day after day, until they cause dementia.
The good news
The good news is that you can reduce your risk of developing dementia by getting adequate sleep. One study from researchers in Toronto and Chicago examined people who were at increased genetic risk of developing Alzheimer’s. They found that better sleep not only reduced the likelihood of developing clinical Alzheimer’s disease, but it also reduced the development of tangle pathology in the brain — another substance that accumulates in Alzheimer’s disease.
The bottom line
Sleep isn’t merely an annoying interruption between the important aspects of our waking lives. Just like eating right and exercising, sleep is absolutely essential for good brain health. These two new studies show that the harmful effects of inadequate sleep can start at age 50 (if not earlier), and they can lead to early dementia and death. But the good news is that you can reduce your risk of dementia by simply giving yourself six to eight hours of sleep each night. Try to avoid sleeping pills, as they don’t give you the deep sleep you need. If you’re having trouble sleeping, nonpharmacological approaches are best.
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I have a confession: in late 2020, when the first COVID-19 vaccines were approved by the FDA, I was hesitant to get one myself. Despite working in public health and believing strongly in vaccines to keep our community healthy, I was anxious about putting something in my body that seemed so new. I thought: “What if the vaccine is dangerous?” “What about long-term side effects?”
I am part of the LGBTQ+ community. Our history may help explain why I hesitated.
Are LGBTQ+ people more hesitant to get the vaccine?
In March a New York Times article reported that LGBTQ+ people are more hesitant to get the COVID-19 vaccine. A research study from the Human Rights Campaign reported mixed findings: while LGBTQ+ people overall are more likely to get vaccinated, certain subgroups, such as LGBTQ+ people of color and bisexual women, are less likely to get vaccinated.
LGBTQ+ people have good reason to be hesitant about vaccines. Historically, this population has experienced — and continues to experience — discrimination in multiple settings, including in healthcare. At the same time, this population is more vulnerable to COVID-19 (see this study and an earlier blog post I wrote). LGBTQ+ people who are also people of color may be even more hesitant to get the COVID-19 vaccine, because of trauma and oppressions based on multiple intersecting marginalized identities that set the stage for mistrust in healthcare and medical research. We can include racism, transphobia, biphobia, and homophobia among such oppressions.
Weighing the risks and benefits of the COVID-19 vaccine
When I was trying to decide whether to get the vaccine, I began reading about the vaccine from trusted sources like the Centers for Disease Control and Prevention (CDC). I also talked to people I know and trust, like close friends, family members, and physician colleagues. I asked them: “Will you get the vaccine when it’s offered to you?” All of them gave me a resounding “yes!” Most shared this rationale: while we still don’t know about long-term side effects, this vaccine is similar to other vaccines that have been around for a while, and the benefits of getting vaccinated far outweigh the risks of getting seriously ill or even dying from COVID-19.
When the vaccine was offered to me earlier this year, I booked my appointment immediately, without hesitation, and I haven’t looked back. As soon as I got the first shot, and certainly when I was fully vaccinated two weeks after my second shot, I felt a profound sense of relief. I also felt empowered about taking an important step toward keeping myself, my family, and my community safe from COVID-19. I now feel safer and freer in my daily life. I go into stores (wearing a mask) without feeling anxious, and I have been able to visit in-person with other fully vaccinated people, like my mom, without masks.
If you are struggling to decide whether to get the COVID-19 vaccine, this decision-making grid may be helpful (note: auto-download). The grid walks you through the benefits and short-term and long-term risks of not getting the vaccine compared to getting the currently available vaccines.
Why the vaccine is critical for LGBTQ+ communities
Numerous “pandemics” have already wiped out large numbers of the LGBTQ+ community: HIV/AIDS, violence, suicide. In addition, the COVID-19 pandemic has already disproportionately harmed LGBTQ+ people (see this study and this report). LGBTQ+ seniors and people of color are at greatest risk for serious, possibly life-threatening illness from COVID-19. If each of us takes steps to get vaccinated, we can prevent more deaths and negative health outcomes in our communities.
How can you empower yourself to get the COVID-19 vaccine?
Educate yourself on what COVID-19 vaccines are, how they work, and why they are safe.
Talk to trusted experts and people in your life about your fears.
At this time, everyone in the US who is age 16 or older is eligible for the vaccine, so you can make an appointment where you live to get vaccinated.
Additional resources
More info on COVID-19 and vaccines:
Fenway Health COVID-19 resources
CDC COVID-19 information
Ways to avoid COVID-19 vaccine scams
What you can do after you are vaccinated
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Often, the skin can be a window to what is occurring inside your body. For women with polycystic ovarian syndrome, or PCOS, this this may mean acne, hair loss, excessive facial or body hair growth, dark patches on the skin, or any combination of these issues.
What is PCOS?
Skin and hair issues can be the most readily perceptible features of PCOS, and thus sometimes the reason for seeking medical care. However, features of PCOS also include menstrual irregularities, polycystic ovaries (when the ovaries develop multiple small follicles and do not regularly release eggs), obesity, and insulin resistance (when cells do not respond well to insulin).
The cause of PCOS is not entirely understood, but scientific evidence points to hormonal imbalances, specifically excess testosterone (also known as hyperandrogenism) and insulin resistance. PCOS is the most common cause of infertility in women. The hormonal imbalances in PCOS disrupt the process of ovulation, and without ovulation pregnancy is not possible. PCOS exists on a spectrum, meaning not every woman with PCOS has the same signs and symptoms. Because of the variation in characteristics of this syndrome, it can be difficult to diagnose.
How do I know if I have PCOS?
There is no one specific test that can be used to diagnose PCOS, so a thoughtful and thorough workup, including lab tests and imaging, is needed. Lab tests typically involve measuring levels of various hormones, such as androgens. Imaging tests may include ultrasound of the ovaries. Seeking care from an experienced team, including primary care physicians, gynecologists, endocrinologists, and dermatologists, can establish the diagnosis.
What are the skin manifestations of PCOS?
PCOS-related acne often flares on the lower face, including the jawline, chin, and upper neck. Although not a hard and fast rule, these areas are considered to be a hormonal pattern for acne. Women with PCOS may notice that acne lesions are deeper, larger, and slower to resolve. Acne in PCOS usually worsens around the time of menstrual periods. Dermatologists often recommend the use of oral contraceptive pills or a medication called spironolactone to treat this type of acne. These treatments, when used in the right patients who have no contraindications to them, can be very helpful in clearing acne.
Hirsutism, or excessive hair growth in places where hair is usually absent or minimal, is another dermatologic sign of PCOS. Common areas of hirsutism include the chin, neck, abdomen, chest, or back. On the scalp, however, balding or thinning of the hair can be seen. Both of these hair issues are driven by an excess of testosterone.
Occasionally, another skin condition appears called acanthosis nigricans, which are dark, velvety areas of skin, usually in skin creases such as around the neck and underarms. This type of skin condition is also associated with insulin resistance, and may be due to stimulation of skin cells by insulin, causing them to overgrow.
Treatment options and a tailored approach
Although there is no cure for PCOS, there are many treatment options for managing various symptoms of this syndrome. The types of treatments used depend on a woman’s priorities and symptoms. For example, being at a healthy weight can lead to improvement of symptoms, so lifestyle modifications to nutrition and exercise may help. Hirsutism can be treated with laser hair removal or electrolysis. Some patients may try birth control pills to improve menstrual regularity. Metformin, a commonly used medication for diabetes, can be used to help improve the body’s response to insulin.
Treatment planning is tailored to each person and depends on whether or not pregnancy is a short-term goal. Certain medications, including spironolactone and retinoids for acne, should be avoided if a woman is trying to become pregnant.
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Keeping your partner — or yourself — up at night with loud snoring? This might be more than a nuisance. About 25% of men and nearly 10% of women have obstructive sleep apnea (OSA), a serious sleep disorder characterized by explosive snores, grunts, and gasps. Tissue at the back of the throat temporarily obstructs the airway, leading to breathing pauses (apneas) throughout the night. Not only does OSA leave people tired and groggy, but it also puts them at risk for a host of health problems, including high blood pressure, depression, and heart disease.
The most effective and best-studied treatment is positive airway pressure (PAP), a small bedside machine that blows air through a mask to prevent your airway from collapsing. But people with mild or moderate OSA sometimes find PAP challenging to use, and often wonder about alternatives. Dental devices (also known as oral appliances) are an option for some people. But do your homework before going this route, cautions Sogol Javaheri, MD, MPH, MA, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital.
Who might benefit from a dental device for sleep apnea?
“These devices are supposed to reposition your jaw or tongue to open your upper airway. But they can be really uncomfortable and only work about half the time,” Dr. Javaheri says. It’s hard to predict who might benefit from using an oral device, and people with very mild OSA and few symptoms may not notice any difference. As a result, she generally doesn’t recommend them except for people with mild to moderate OSA or those with severe OSA who can’t tolerate PAP.
Three main categories of dental devices for OSA
Mandibular advancement devices. Made of molded hard plastic, these devices snap over your lower and upper teeth, and also feature metal hinges and screws that can be tightened to push your lower jaw forward. Some dentists make custom mandibular advancement devices, but before you consider buying a custom device, be sure to ask whether your dentist has experience in sleep-related breathing disorders and is certified by the American Academy of Sleep Medicine. Some non-certified dentists simply take a mold of your teeth, send it to a company that makes the device, then sell it to you at a large markup — sometimes totaling $4,000 or more. What’s more, it’s unlikely to be covered by your dental or medical insurance if it’s used for snoring.
Mouth guards. Similar to mandibular advancement devices, these devices also help reposition your lower jaw, although to a lesser degree. Some sleep physicians recommend SnoreRx, which you can purchase online for less than $100. Instead of starting with an impression of your teeth created by a dentist, you use what the company calls the “boil and bite” method. You place the device in a cup of boiling water for a minute and then bite down on the softened plastic so it molds to your teeth.
Tongue-retaining devices. These devices consist of a soft plastic splint placed around your tongue that holds it forward and out of your mouth throughout the night. They tend to make your mouth very dry and can be quite uncomfortable.
Most insurance plans at least partially cover these devices when used for OSA, but not if they’re used for simple snoring. Don’t be tempted to try one unless you’ve been formally diagnosed with OSA, says Dr. Javaheri. And even if you have OSA, be sure to call your insurance company so you understand how much is covered before you have a device made.
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No one likes getting stuck by a needle. Whether for a blood test, vaccination, or blood donation, needle sticks are something most people would prefer to avoid.
Yet, judging only by schedules for routine vaccinations and tests, the average healthy person can expect at least 165 needle sticks over a lifetime. Get hospitalized? That might add dozens or even hundreds more. And the number of needle sticks experienced by people with diabetes, HIV, and some other illnesses hovers in the “don’t ask” range.
For many, this may be more of an annoyance than a real problem. But if you have a strong fear of needles or aversion to the sight of blood, getting a vaccination or any other needle stick is a big deal. If this sounds like you, you may have trypanophobia.
What is trypanophobia?
Fittingly, the name combines the Greek term trypano — meaning puncturing or piercing — with phobia, meaning fear. This remarkably common condition is marked by irrational, extreme fear or aversion to blood or needles. It’s estimated that fear of needles affects up to 25% of adults, and may lead 16% of people in the US to skip vaccinations. Many people who strongly fear needle sticks may avoid doctors and medical care, so it’s likely that the magnitude of this problem is underestimated.
Just to be clear: this phobia is not limited to people who are overly sensitive to pain or aren’t “tough enough.” It can affect anyone. The cause is often unknown, but a particularly traumatic experience during childhood medical illness may set the stage for some people. And there may be a genetic component. Researchers have found genes linked to fainting after needle sticks, and trypanophobia sometimes runs in families.
What are the symptoms of this phobia?
People with trypanophobia who are contemplating a needle stick may experience
fear or anxiety
panic attacks, nausea, or sweats
palpitations
fainting (due to a reflex in which pain or the sight of blood triggers a drop in blood pressure)
insomnia in the days or weeks before an expected needle stick.
How does being afraid of needles affect you?
This fear can affect your
quality of life: It’s quite unpleasant to spend weeks dreading an upcoming doctor’s appointment.
health: Skipping recommended tests and treatment to avoid needle sticks can lead to missed diagnoses, poorly monitored medical conditions, and undertreatment. A timely example is foregoing a vaccination against COVID-19, which can have serious or even deadly consequences. Also, drug marketers sometimes play on fear of needles in their advertising, or might downplay the fact that a medication requires an injection.
longevity: Skipping routine medical care can contribute to avoidable suffering and death. For example, a cancerous breast lump that might have been detected during routine examination may go unnoticed until much later, when it’s no longer curable.
What can you do to cope with a fear of needles?
There’s not much high-quality research regarding how best to treat trypanophobia. Still, experts suggest a number of options to help people cope with it.
Bring support, if allowed. That’s routine for small children. But holding the hand or hearing the voice of a spouse, trusted friend, or family member can calm adults, too.
Harness the power of distraction (see this amazing video of a pediatrician distracting a young child before a vaccination). Focus on anything other than the needle stick: a spot on the floor, the positive effects of getting a COVID-19 vaccine (soon you can hug your family!), or your upcoming vacation.
Tell the person giving you a shot or drawing blood that you struggle with this, and let them know what works best for you. Some people prefer to hear about each step before it happens so there are no surprises. Ask if the healthcare provider has tricks of the trade to help you get through it.
Ask the person giving you’re a shot or drawing blood if they can use a numbing agent similar to novocaine, or a freezing spray to numb skin before a needle stick.
Don’t watch! It’s not helpful to watch all of the preparation for the needle stick or see the needle itself. Watching may make things worse.
Learn ways to relax. Try deep breathing or other relaxation techniques that you can practice before having the needle stick.
Relax the muscle receiving the injection, too. Some shots, such as vaccines that protect you against tetanus or COVID-19, are given in a muscle. Relaxing the muscle can lessen the pain of these shots.
Lie down before having the needle stick, if you’ve fainted or felt woozy in the past with needle sticks.
Can therapy help?
Seeing a mental health specialist may be helpful. He or she may recommend
cognitive behavioral therapy, or CBT, which teaches people ways to reframe unhelpful ways of thinking and build coping strategies.
exposure therapy, a gradual and supervised increase in your exposure to needles, which can lessen the panic they cause. For example, over a number of weeks you may be instructed to look at photographs of needles, then hold a syringe without a needle, then hold a syringe with a needle, and then imagine injection — all with guidance from a therapist — before actually having one.
medications, such as anti-anxiety or sedative medications, may be prescribed if other measures aren’t effective, and the anxiety around needle sticks is getting in the way of medical care (or just making you miserable).
The bottom line
It’s natural to have an aversion to pain, even when you know it’s coming and even though it’s for a good reason. So, if you’re one of the millions fretting about getting a COVID-19 vaccine or a blood test or any other needle stick, know that you’re not alone, and that there are things you can do to improve the situation. Talk to your doctor about your fear and get help if you need it. Your quality of life, health, and longevity could depend on it.
As for me, I’m going to do what I always do: avert my eyes and stare at that spot on the floor.
Follow me on Twitter @RobShmerling
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Not long ago, during pre-pandemic 2019, the reported life expectancy at birth for non-Hispanic Black, non-Hispanic White, and Hispanic populations was approximately 75, 79, and 82 years, respectively. The higher life expectancy of Hispanic people compared to others in the United States may come as a surprise to some.
This phenomenon, known as the “Hispanic paradox,” was first noted in the 1980s, and its legitimacy has been debated since. A host of explanations have been proposed, including hypotheses about the “healthy immigrant” (people who migrate to the US are healthier than those who stay in their native countries) and “salmon bias” (less healthy US immigrants are more likely to return to their countries of origin). Other experts note that Hispanic communities have lower rates of smoking and greater levels of social cohesion, which certainly may contribute to their presumed higher life expectancy. In the end, this difference remains poorly understood, and is further complicated by research noting US-born Hispanic individuals may have lower life expectancy compared to their foreign-born counterparts.
Now, recent estimates for life expectancy from the Centers for Disease Control and Prevention (CDC) show an alarming change that highlights the disproportionate impact COVID-19 has had on communities of color. Between 2019 and 2020, life expectancy dropped more sharply among Black and Hispanic populations compared to their White counterparts, by three years, two years, and one year, respectively. In fact, the gap in life expectancy between Black and White populations widened from four to six years, the largest gap since 1998. And the advantage in life expectancy previously held by Hispanic populations over Whites decreased from three to two years. In other words, the COVID-19 pandemic has led to a decrease in life expectancy among all individuals in the US, but this impact has been felt most by communities of color.
Many reasons for greater vulnerability to COVID-19
Many factors contributed to this uneven drop in life expectancy. But these remarkable numbers remind us of the vulnerability of Black, Indigenous, and People of Color (BIPOC) in the US, the result of longstanding unequal access to health care and resources needed to achieve upward economic mobility. Many BIPOC populations in the US live on the brink of collapse. With little health or financial reserves, these communities are increasingly vulnerable to sudden events, like the financial collapse of the early 2000s or a global pandemic.
Racism functions largely through structural barriers that advantage some groups and disadvantage others. Rather than causing new disparities, the COVID-19 pandemic simply unmasked chronic failings in our social policies and healthcare delivery for our BIPOC communities. Recently, the CDC acknowledged this and declared racism a public health threat that harms the health and well-being of BIPOC populations.
Longstanding systemic failings lead to poor overall health
Abnormally high and sustained exposure to stress during pregnancy and early childhood leads to sustained release of inflammatory and stress-related hormones such as cortisol, which results in toxic levels of chronic stress. Racism causes chronic stress, which detrimentally affects the development and well-being of BIPOC children. Moreover, many BIPOC children have less overall opportunity to thrive. They live in neighborhoods plagued by pervasive poverty caused by longstanding discriminatory policies such as redlining and residential segregation. These factors compound, ultimately resulting in higher levels of cardiovascular disease, mental illness, and health-risk behaviors. Known as weathering, this contributes to both decreased lifespan and healthspan (the period of a life during which a person is in good health).
Further, BIPOC individuals in the US persistently face barriers in access to quality health care. Examples include higher rates of no insurance and underinsurance, and lower health care literacy. Pervasive bias and discriminatory policies are deeply embedded into our healthcare delivery infrastructure. So, the results of the CDC report should come as no surprise: a population chronically deprived of accessible preventive services would be expected to fare poorly during a pandemic.
Moving forward: What changes could help?
We can all raise our voices to persuade and support the efforts of government officials at every level, and healthcare leaders, to address immediate disparities related to the ongoing pandemic and the chronic flaws that leave BIPOC communities increasingly vulnerable. Below are several measures that could get our system moving in the right direction.
Regular citizens can
Vote in all elections — especially local elections. Local elected officials, such as a city mayor, town manager, city council members, and county sheriff, can affect the lives of citizens even more personally than state or federal officials. Local news media and websites may have information on policy views and track records to help you choose candidates.
Be wary of fake news promoted on social media. Social media places a wealth of information at our fingertips, yet also offers ways to spread false information that can greatly affect our decisions. Try to maintain a healthy level of skepticism. Check information with trusted sources. These common-sense tips can help keep you from falling victim to fake news.
Support local organizations. Local nonprofits and community organizations play a major role in helping to address COVID-19 disparities affecting BIPOC communities and fighting for testing and vaccine equity. If you’re financially able, consider donating to local nonprofits, food banks, and community organizations so that they can keep helping in times of need.
Policy makers and government leaders can
Fix unemployment insurance. Inject federal funds into refurbishing crumbling state unemployment insurance infrastructures, and pass legislation mandating that standard minimum benefits be provided by all states.
Make universal healthcare happen. Ensure universal health insurance is achieved, whether via a public option, single payer, or a host of other alternatives. Americans deserve equitable access to quality healthcare, especially preventive care.
Eliminate historically racist and discriminatory policies. Eliminate discriminatory practices like gerrymandering that contribute to ongoing disempowerment of voters, residential segregation, and pervasive poverty, leaving communities of color in destitute circumstances without a voice.
Editor’s note: At the request of Dr. Perez, terms used to describe all races and/or ethnicities are capitalized in this post, to reflect his view of identity and racial equity.
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If a 3-year-old finds a cookie on the table, chances are they are going to eat it.
Even if it is made with marijuana or THC, CBD, or other components of cannabis.
As more states have legalized the use of marijuana and an ever-widening range of derivative products, it’s not surprising that more children are being exposed — including by eating marijuana edibles. A research brief published in the journal Pediatrics found that between 2017 and 2019, there were 4,172 calls to regional poison control centers about exposures to cannabis in babies and children through age 9. About half of the calls were related to edibles.
The frequency of these calls, and the percentage related to edibles, went up over the two-year period. Not surprisingly, the exposures were about twice as common in states where marijuana use is legal as in those where it is not.
More calls about edibles involving younger children
The most common age group involved was 3- to 5-year-olds, which makes sense: this is the age where they are old enough for parents to take their eyes off them for a minute or two, but not old enough to understand why they shouldn’t eat that brownie, gummy bear, or piece of chocolate.
Thankfully, the effects of these exposures were mostly minor — but in 15% they were moderate, and in 1.4% they were severe. In rare cases, significant ingestion can lead to trouble breathing or even coma. That’s the problem with edibles: it’s hard to know how much cannabis is in each one, it’s easy to ingest a lot, and the effects can last a long time.
It’s important to remember, too, that this was just a study of calls to poison centers. It’s impossible to know how many exposures there have been that were never reported — including how many went completely unnoticed by parents or caregivers.
Safety first: Children and cannabis
Clearly, there will need to be some regulation around labeling and child-safe packaging. But as an immediate step, parents and others shouldn’t buy marijuana edibles that might appeal to children (just like it’s best not to buy detergent pods that look like candy). If you do buy marijuana edibles that a child might want to eat, they need to be stored securely, out of reach, always.
When parents bring their children to visit friends, it may be a good idea to add marijuana edibles to the list of safety issues to ask about. Think of something along the lines of, “Hey, our daughter is still little and curious, so we like to ask about things like matches, guns, medications, marijuana edibles, or other things that might be dangerous for her if she gets into them. Is there anything that might be in her reach?”
It might be a bit awkward, but if you make it quick and routine, you can decrease the awkwardness. And ultimately, it’s worth a bit of awkwardness to keep your child safe.
Follow me on Twitter @drClaire
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Most people might not guess that pills (or creams, patches, and inhalers, for that matter) have a big impact on the environment — but they do.
Climate change is leading to noticeable effects on the environment, as well as to consequences for our health, such as rising rates of asthma and new patterns of infectious diseases. The key driver of climate change is greenhouse gas emissions. Our health care system plays a large role, contributing close to 10% of our nation’s greenhouse gases. The US is also responsible for more than 25% of the world’s total health care emissions.
Within our health care system, pharmaceutical drugs and chemicals are the largest line-item contributor to greenhouse gas emissions. In addition, pharmaceutical waste throughout the global supply chain can lead to environmental and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance (aka “superbugs”). In 2018, 5.8 billion prescriptions were filled in the US. Meanwhile, consumers spent $34 billion on over-the counter medications.
Many of these drugs are lifesaving, offering us enormous benefits and healthier lives when taken correctly. But with some thought, there may be a few things you can do to make your medicine cabinet more environmentally friendly, while still keeping your health front and center.
Minimize waste when buying medicines
Less is more. Filling 90-day supplies of medications can reduce the overall cost per pill, offer more convenience, and require less packaging. But in some situations, it makes sense to request smaller quantities, such as when you are trying a new medicine, or buying over-the-counter medications that you use infrequently and do not expect to finish before the expiration date.
Do the math. If your doctor is recommending a dose change and the math works out, consider halving or doubling your current pills first. If this is working, you can then request a prescription for the new dose strength for your next refill.
Fill it when you use it. Don’t pick up a prescription unless you are going to use it, except for an emergency medicine you should have on hand. If you are given the option of getting a medication to take if your symptoms get worse or don’t improve, ask your doctor to send the prescription to the pharmacy, and notify the pharmacy that you will let them know if you want it filled.
Downsizing your medicine cabinet
Review the benefits versus harms. Bring all your prescription and over-the-counter medications to your appointments, and periodically review them with your primary care doctor. Make sure your drug regimen offers more benefits than harms for your situation. This is especially helpful if you see a lot of different doctors who prescribe medications for you. Sometimes, people stumble into a cascade, where one drug is added to treat symptoms that are side effects of another. But be sure to discuss with your doctor before making any changes; it may be harmful to stop some medications, and others may need to be tapered slowly.
Incorporate lifestyle medicine. Talk to your doctor about lifestyle medicine, which focuses on healthy habits like regular exercise and healthful foods to prevent disease and promote longevity. Often, these lifestyle changes can help reduce or eliminate the need for medications.
Inhalers: Know your options
Explore options. If you have asthma or chronic obstructive pulmonary disease (COPD), ask your doctor what your options are for inhalers. Metered dose inhalers (MDIs) use hydrofloroalkane propellants, which are greenhouse gases, to deliver the medication. Check if there is an equivalent dry powder inhaler (DPI) option for you. However, not everyone can use DPIs, which rely on patients to take quick deep breaths to draw the medication into the lungs. (For this reason, rescue inhalers used during an asthma attack are usually MDIs.) Your inhaler choices will also depend on cost and coverage from your insurer. In the end, the important thing is to use the inhaler device that works best for you in controlling your condition.
Proper disposal of medicines
Know when to flush. Do not put medications down the toilet or sink (unless they’re on the FDA flush list), as this may contaminate lakes, rivers, agriculture, and drinking water. Read the packages for any drug disposal instructions. Many pharmacies or local public safety agencies like the police will accept unused medications and dispose of them safely. National Prescription Drug Take Back Day is April 24, 2021 so check for safe collection sites near you.
Some medicines can be discarded in trash. Remove personal identifying labels first, and then mix the medication in a container with coffee grounds, cat litter, or soil. (This is not recommended for controlled substances like opioids and other addictive medicines.) Visit this FDA web page for more information about drug disposal.
Health care is a partnership, and with thought and care, we can work together to have the best of both worlds — a healthier you, and a healthier planet.
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There is growing interest in the human body’s microbiome and its connection to chronic disease. A new study examines that connection, along with how the foods we eat influence the composition of our microbiome.
Microbiome protects host and plays role in disease risk
The microbiome consists of the genes of tiny organisms (bacteria, viruses, and other microbes) found in the gastrointestinal tract, primarily in the small and large intestine. The normal gut flora — another term for the microbiome — protects its human host. For the microbiome to flourish, the right balance must exist, with the healthy species dominating the less healthy.
Scientists do not fully understand how the microbiome factors into the risk of developing chronic diseases, such as heart disease, obesity, and type 2 diabetes. Many factors, including differences between individuals and individual diets, have made this a difficult area to investigate.
Study investigates relationships between diet, microbiome, and disease risk
But a new study, published in Nature Medicine, accounts for these factors and sheds light on how our diets shape our microbiome and how our microbiome, in turn, influences our disease risk.
The researchers studied more than 1,100 individuals enrolled in PREDICT 1, a large trial looking at individual responses to food. They used a technique called metagenomic sequencing to identify, classify, measure, and analyze genetic material from the study participants’ microbiomes. They also collected detailed, long-term dietary intake information from all of these individuals, so they could analyze their dietary patterns, including their intake of different food groups, foods, and nutrients. In addition, they collected information from the study participants on a variety of factors that are known to influence metabolism and disease risk, including pre- and post-meal measures of blood sugar (glucose), cholesterol, and inflammation. Finally, they measured personal health attributes of the study participants, including age, weight, body mass index (BMI), body fat, and blood pressure.
Diet influences microbiome and microbiome influences disease risk
The study found that the health of the microbiome is influenced by diet, and that the composition of the microbiome influences the risk of health outcomes. The results showed that specific gut microbes were associated with specific nutrients, foods, food groups, and overall diet composition. Health conditions such as heart disease, type 2 diabetes, obesity, and general inflammation appeared to be most impacted by diet-influenced changes to the microbiome.
For example, less healthy dietary patterns (dairy desserts, unhealthy meats, processed foods) supported gut species that were associated with measures of blood sugar, cholesterol, and inflammation that are significantly associated with higher risk of cardiac events, strokes, and type 2 diabetes.
In contrast, a more diverse gut microbiome was tied to healthy dietary patterns (high-fiber vegetables like spinach and broccoli, nuts, and, heathy animal foods such as fish and eggs) and was linked to measurements tied to lower risk of certain chronic diseases. In addition, the study found that polyunsaturated fats (found in fish, walnuts, pumpkin, flax and chia seeds, sunflower, safflower, and unhydrogenated soybean oils) produce healthy gut species linked to a reduced risk of chronic disease.
Minimally processed, plant-based diet is good for the microbiome and for reducing disease risk
So what do these findings mean for us? First, the study showed that eating more unprocessed plant foods — fruits, vegetables, nuts, seeds, and whole grains — allows the gut microbiome to thrive. Some animal foods, such as fish and eggs, are also favorable. Avoiding certain animal foods, such as red meat and bacon, dairy foods, and highly processed foods (even processed plant foods such as sauces, baked beans, juices, or sugar-sweetened drinks and desserts) prevents less-healthy gut species from colonizing the gut.
It is important to note that food quality matters; processed or ultra-processed plant-based foods were not associated with heathy clusters of gut microbes. When choosing foods, consider whether they are processed or unprocessed, in addition to whether they are a plant or animal food.
It can also be helpful to think in terms of dietary patterns, rather than individual foods or food groups. Meal patterns that emphasize foods beneficial to the microbiome are the whole-food, plant-based dietary patterns. These include vegan (no animal products) and ovo-vegetarian (vegetarian plus eggs) diets. The pescatarian eating pattern, in which oily and white fish are the meats of choice, is also good for the microbiome.
Emphasizing minimally processed plant foods allows the gut microbiome to thrive, providing protection against, or decreasing the risk of, chronic diseases such as heart disease, diabetes, metabolic disease, and obesity.
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Did the print on that label suddenly shrink? If you’re in your 40s or beyond, you may have asked yourself that question as you struggled to read something that you used to be able to see clearly with no problem.
Blame your aging eyes. Much like our joints, our eyes undergo age-related changes. While eye problems can affect people of any age, some conditions become more common after age 40.
Getting older? Three common eye conditions
Presbyopia. The lens of the eye gets stiffer with age, which makes it harder to focus on objects nearby — hence your label-reading struggles. Many people find satisfaction with inexpensive reading glasses, but once you need them, it’s time for a midlife vision check-up.
Cataracts. Another common condition that can crop up as you age is cataracts, a clouding of the lens of your eye that can impair vision. Cataracts affect about half of people ages 65 to 74. Treatment typically involves an outpatient surgical procedure to replaces the clouded lens.
Dry eye syndrome. This condition affects more than 15 million adults in the United States, and occurs due to a reduction in tear production. With less natural lubrication your eyes can become irritated, sticky, or you may feel a burning or scratchy sensation in the eye. Depending on severity, symptoms can be treated using eye drops that simulate your natural tears, a topical prescription drug, or a device to increase tear production.
Additional eye conditions that may occur with age or illness
Posterior vitreous detachment (PVD). Signs of this condition include visual disruptions, such as seeing light streaks, floaters, or a cobweb-like haze. These occur because the jelly-like substance called vitreous in the eye starts to liquefy and shrink, causing it tug on the retina.
Call your medical team right away if you notice these signs. While most people experiencing PVD won’t need treatment, in some cases the vitreous can completely detach from or tear the retina. A tear or detachment can cause vision loss, and requires a laser procedure or surgery to repair the problem, according to the American Society of Retina Specialists.
Glaucoma. Another condition that becomes more common after age 40 is glaucoma. This painless, often symptomless condition damages the optic nerve that transmits information from your eyes to your brain. When not treated, glaucoma can lead to peripheral or central vision loss. Most often, glaucoma is treated with prescription eye drops designed to reduce the pressure in your eye. Less commonly, your doctor may recommend a laser procedure or surgery.
Age-related macular degeneration (AMD). This condition causes degeneration of the retina, a thin layer of tissue at the back of the eye. Light-sensitive cells of the retina capture images and transmit them to the brain through the optic nerve. AMD affects a central part of the retina called the macula. It can lead to blurred or distorted vision, and possibly a blind spot in a person’s field of vision. Treatment, which may include medication or laser therapy, can often help prevent or at least delay vision loss.
Diabetic retinopathy. This condition also causes damage to the retina. For people with diabetes, keeping blood sugar and blood pressure under control helps prevent diabetic retinopathy. If it is detected, your eye specialist will recommend treatment, usually eye injections or laser therapy.
Easy ways to maintain eye health
Many eye conditions can be effectively treated to protect your vision if they are caught early. That’s why it’s wise to get regular eye exams, to spot potential problems and address them before they affect your eyesight.
You can also take other steps to ensure that your eyes stay healthy, such as exercising, eating a healthy diet, quitting smoking, and protecting your eyes from ultraviolet rays by wearing sunglasses outside.
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Doctors told you that your COVID-19 virus infection cleared months ago. However, even though you no longer struggle to breathe, and your oxygen levels have returned to normal, something doesn’t feel right. In addition to constant headaches, you find yourself struggling with seemingly easy tasks. The fatigue you experience makes moving from the bed to the kitchen feel like an accomplishment. But most troubling for you is a feeling of dread, a nervousness so severe you can feel your heart pounding. Constant worries now keep you from sleeping at night.
What are the mental health effects of COVID-19?
We are still learning about the long-term effects of COVID-19 on the brain. Data from Wuhan suggest that the virus may invade the brain, with more than one-third of infected patients developing neurologic symptoms. In addition to brain infection, we know that the pandemic has resulted in worsening mental health outcomes due to the psychological toll of isolation, loneliness, unemployment, financial stressors, and the loss of loved ones. The prescription of antidepressants has spiked, intimate partner violence has increased, and suicidal thoughts are on the rise, especially in young adults.
Does COVID-19 infection increase the risk of psychiatric disorders?
Until recently, mental health outcomes as a result of COVID-19 infection were not known. A new study of electronic health records of 69 million people found that COVID-19 infection increased the risk of developing a psychiatric disorder, dementia, or insomnia. Furthermore, people with psychiatric disorders were 65% more likely to be diagnosed with COVID-19, which may be related to behavioral factors, lifestyle factors (such as smoking), inflammation, or psychiatric medication. This is the first large study to show that infection with COVID-19 indeed increases the risk of developing psychiatric disorders.
The long-term mental health effects of COVID-19 infection remain to be seen. Following the influenza pandemic of 1918–19, offspring of mothers infected during pregnancy were found to have higher rates of schizophrenia. It is thought that virus infection during pregnancy may be one risk factor for the development of mental illness related to the body’s immune response. If COVID-19 infection even slightly increases the risk of mental illness in offspring, this could have a large effect at the population level, given the high numbers of infections worldwide.
Do you have a psychiatric disorder as a result of COVID-19?
You may feel fatigued, stressed, or sad due to the effects of COVID-19 on your body, or due to life circumstances. However, even if you screen positive for depression or anxiety at your doctor’s visit, remember that screening tools are not diagnostic. People with physical symptoms of COVID-19 infection often screen positive for depression, as symptoms of infection often overlap with symptoms of depression. For example, poor sleep, impaired concentration, and reduced appetite may be due to a medical illness rather than depression.
For a doctor to make an accurate diagnosis, you may need to wait a period of time to monitor symptom development. Although antidepressants are often prescribed for mood and anxiety disorders, keep in mind that mild to moderate symptoms often go away on their own when life circumstances improve. If this is your first episode of depression or your first experience of anxiety, you may not require specialist treatment if your symptoms are mild. If you do start a medication, make sure to regularly review your treatment with your doctor and make changes as needed.
What steps can you take to minimize the mental health consequences of COVID-19 infection?
Get vaccinated. This is especially important for people with psychiatric disorders, which are independent risk factors for COVID-19 infection.
Continue to wear a mask and physically distance. However, aim to maintain social connections.
Make use of resources. Online therapies, workbooks, and mobile applications (COVID coach, CBT-I coach) can provide benefits without risking exposure during treatment.
Advocate for others. COVID-19 long haulers may not be in the position to advocate for workplace modifications, life insurance, or mental health coverage, especially if suffering from fatigue and brain fog.
Perform physical activity. in addition to being as effective as medications on mood and anxiety, physical activity also helps with memory and heart health.
Make use of relaxing rituals. When the world seems out of control, try establishing a ritual. Having control over even one part of your day can help you feel grounded.
Use caution with sleep aids and as-needed medications. Short-term use can quickly become long-term use, leading to medication tolerance, dependence, and rebound anxiety.
Limit alcohol and cannabis use. Prolonged stress from caring for sick loved ones, unemployment, increased time at home, and relationship stressors can result in increased and problematic substance use.
Be mindful of caffeine. If post-COVID fatigue is severe, discuss other options with your doctor, as excess caffeine can exacerbate anxiety and sleep problems.
Check in and ask how you can help your loved ones, friends, colleagues, and neighbors. It is often much easier to turn down help than to ask for help. If someone is privately struggling with thoughts of suicide, a simple check-in call or kind gesture can be lifesaving. The National Suicide Prevention Lifeline (800-273-8255) is available to anyone in severe distress.
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Did you know that antidepressant medications are often prescribed for people without depression?
It’s true. Antidepressants are frequently prescribed for chronic pain, especially pain related to nerve disease (called neuropathic pain), chronic low back or neck pain, and certain types of arthritis.
In fact, some guidelines for the treatment of chronic low back pain and osteoarthritis (the most common type of arthritis) include antidepressants. One antidepressant in particular, duloxetine (Cymbalta), is FDA-approved for these conditions.
Just how antidepressants reduce pain is not well understood. One possibility is they affect chemicals in the brain involved in pain perception, a mechanism that differs from how they fight depression.
Not usually the first choice for pain relief
For people with chronic low back or neck pain or osteoarthritis of the hip or knee, an antidepressant medication is not usually the first treatment recommended. Other approaches, such as physical therapy, exercise, losing excess weight, nonsteroidal anti-inflammatory drugs (NSAIDs), or cortisone injections are usually tried first. But if these aren’t helpful, antidepressants such as duloxetine or amitriptyline might be a reasonable next step.
When prescribed for pain, the initial dose is typically low (often lower than the starting dose for depression). It’s gradually increased if necessary. Ideally, people notice a benefit within weeks of starting the drug, and the medication can be continued at the lowest effective dose. Switching to a different antidepressant may be recommended if pain is not well controlled, side effects develop, or there is an interaction with another medication.
A new study suggests antidepressants don’t work well for common types of pain
Past research on antidepressants for chronic pain, such as duloxetine for osteoarthritis of the knee, amitriptyline or duloxetine for chronic low back pain, and amitriptyline for chronic neck pain, demonstrated modest, short-term benefit. But the studies were limited: most trials were small and lasted only a few months or less. Notably, medication side effects, such as nausea, constipation, and erectile dysfunction, were common in these trials.
Now a 2021 study has combined the data from past research to get a better sense of just how safe and effective antidepressants are for these conditions. The news isn’t good:
On average, treatment with antidepressants minimally reduced pain and disability compared with placebo. The improvement in pain — about 4 points on a scale of 0 to 100 — was considered too small to be noticeable.
People treated with certain antidepressants for chronic pain often stopped taking the medication because it didn’t work, caused unacceptable side effects, or both.
People with both chronic pain and depression did not experience more improvement than people with chronic pain alone.
Sciatica may be an exception: antidepressants may have reduced pain for up to a year. However, the quality of the prior research was poor, so the study authors were not confident about these conclusions.
These findings cast doubt on the usefulness of antidepressant treatment for these common causes of chronic pain. However, they don’t rule out the possibility that some individuals may get more relief from these medications than others.
The bottom line
The available evidence suggests that, on average, the benefit of antidepressants for osteoarthritis or chronic low back pain and neck pain is modest at best, and tends to be temporary. That’s disappointing because, for many pain sufferers, there are no reliably effective treatments (short of joint replacement for osteoarthritis).
So, if you’re on an antidepressant for pain and you aren’t sure if it’s working, talk to your doctor about whether you should consider stopping it. But don’t stop it on your own. There may be other reasons your doctor is recommending this medication, and many antidepressants should be gradually reduced, not stopped all at once, to avoid discontinuation symptoms.
If you’re taking an antidepressant for pain, it’s worth revisiting whether it’s really doing anything for you and whether it might be time to shorten your medication list. Not only might you simplify your medical regimen, you may also reduce the cost of your medicines and the risk of medication-related side effects.
Follow me on Twitter @RobShmerling
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