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Some grain free foods have been confirmed linked to heart disease in dogs by the FDA. Help keep our pups healthy, read labels!
Medicare Advantage home healthcare may not be best quality
Medicare Advantage home healthcare may not be best quality
Reuters: Health
(Reuters Health) - Older Americans who get home healthcare through traditional Medicare plans may have access to better quality services than their counterparts who enroll in private plans known as Medicare Advantage, a U.S. study suggests.
Reuters: Health
(Reuters Health) - Older Americans who get home healthcare through traditional Medicare plans may have access to better quality services than their counterparts who enroll in private plans known as Medicare Advantage, a U.S. study suggests.
Bad viruses travel fast: Measles vaccine important for travelers
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The United States was declared free from ongoing measles transmission in 2000. But we may be at risk for joining the U.K, Greece, Albania, and the Czech Republic, four countries recently stripped of measles elimination status by the World Health Organization. Since the beginning of 2019, more than 1,234 measles cases have been reported in 31 states, with active outbreaks in upstate New York and El Paso, Texas. New York has just declared the end of its yearlong outbreak, which required a massive public health response to control. Minnesota had a major measles outbreak in 2017. In 2015, 125 cases of measles occurred in California, and in 2014, 383 people were infected with measles in an Amish community in Ohio. Beyond our borders, measles outbreaks have also been a big problem in Europe and elsewhere – a point to be aware of if you’re traveling.
How measles outbreaks happen
There are several reasons why we are still at risk for measles outbreaks. Travelers may get infected overseas, and bring the measles virus back into the country with them unawares. The 2015 measles outbreak in Ohio began when two infected members of the Amish community returned home from typhoon relief work on the Philippines. The California measles outbreak in 2014 started at two Disney theme parks, perhaps after the virus was brought there by a foreign tourist.
In measles, there is an unusually long delay between infection and the development of the rash and other symptoms, typically about two weeks. Measles virus is also highly contagious. Patients start to spread the virus to other people about four days beforethe rash develops. These features make it possible for measles to spread quickly through an unsuspecting population.
The final component to measles outbreaks is inadequate immunity. Many American adults have only received a single dose of the measles, mumps, and rubella (MMR) vaccine, which is only 93% effective at preventing measles. Since 1989, the recommendation has been to give two doses of MMR, which is 97% protective against measles. Vaccination rates among patients in recent US outbreaks have been low, probably due to the success of anti-vaccine activists in pushing a debunked connection between autism and the MMR vaccine.
Measles infection can still be lethal
So, what’s the big deal about measles? For most people, measles makes for a miserable week of high fever, cough, runny nose, watery eyes, and an impressive total body rash. But for others, it can be a life-threatening, even fatal, condition. One out of every 20 measles patients develops pneumonia, which may be severe. Infection of the brain, or encephalitis, occurs in one out of 1,000 cases. Brain damage, deafness, intellectual disability, or death may result. Before the measles vaccine was available, measles killed 500 people in the US every year, most of them children, and led to 1,000 cases of brain damage per year.
Measles has an especially horrifying late complication known as subacute sclerosing panencephalitis (SSPE). In SSPE, children recover from their initial measles infection, only to develop progressive brain infection with a mutated form of measles virus in their teenage years, leading to a persistent vegetative state.
Many outbreaks of measles could probably be prevented if more travelers received MMR prior to foreign travel. According to a study done in US travel clinics, 16% of pre-travel patients were eligible for measles vaccine, but only a minority of patients received it. The authors of the study cited many reasons that patients didn’t receive the vaccine, with patient refusal being the most common. Next time you plan to travel overseas, think about protecting your community by asking your doctor if you are a candidate for the MMR vaccine before you leave.
Follow me at @JohnRossMD
The post Bad viruses travel fast: Measles vaccine important for travelers appeared first on Harvard Health Blog.
Transgender people in U.S. still face conversion therapy attempts
Transgender people in U.S. still face conversion therapy attempts
Reuters: Health
(Reuters Health) - One in seven transgender people in the U.S. has experienced an attempt by a professional counselor to make them undergo pseudoscientific "therapy" with the goal of changing their gender identity, a recent study suggests. 
Reuters: Health
(Reuters Health) - One in seven transgender people in the U.S. has experienced an attempt by a professional counselor to make them undergo pseudoscientific "therapy" with the goal of changing their gender identity, a recent study suggests.
Menopause, Part II: Psychological Well-being
In our previous menopause post, I mused on some perspectives of menopause that are positive and affirming for women. However, I don’t want to downplay the fact that many women experience menopause as a difficult, frustrating, and even disempowering time. (Again, I am using “menopause” to include the perimenopausal period.)
As I mentioned in the last post, some researchers estimate as many as 75% of women experience some type of “menopausal distress,” and we don’t talk about it enough. Today I want to examine some of the psychological and emotional facets of menopause. In the final post of this series, we’ll look at self-care techniques and non-hormonal therapies that seem to be the most beneficial.
What Research Suggests About Emotional Well-being During Menopause
Obviously menopause is a major life transition—significant biological changes wrapped up in a complex web of personal and sociocultural beliefs, fears, stressors, and stories. It can be a time of great apprehension, confusion, even despair for some women. Others pass right through menopause with hardly a bat of an eye. Still, others welcome and embrace it.
It’s extremely understandable why this would be a challenging time for women. Menopause can be a perfect storm of physical discomfort and cognitive symptoms (brain fog, forgetfulness), sleep deprivation (thanks to those night sweats and hot flashes), and emotional fluctuations. Besides how they feel, these symptoms can affect women’s personal relationships, ability to perform their jobs, and sense of self-worth and self-confidence.
For many women, menopause also coincides with the dual stressors of aging parents and raising teenagers or having a newly empty nest. Plus, menopause is an unmistakable marker of aging, which can evoke complicated feelings as well.
Overall, stress, depression, and anxiety seem to be fairly common during menopause. Recent Guidelines for the Evaluation and Treatment of Perimenopausal Depression commissioned by the Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers describe perimenopause as a “window of vulnerability for the development of both depressive symptoms and a diagnosis of major depressive disorder.”
It’s difficult to know exactly how many women are affected. Studies of depression and anxiety are usually conducted on women whose symptoms are severe enough to seek help from their doctors. Researchers estimate that up to 40% of women will experience depression at some point during menopause; it’s unclear how prevalent anxiety might be.
It’s easy to assume that some women become depressed and anxious during menopause because their symptoms are so gnarly. To some degree, that narrative is probably true. Studies do find that women who experience more severe symptoms such as frequent hot flashes also exhibit more depression and anxiety. This makes sense—being physically uncomfortable and unable to get a good night’s sleep can certainly set the stage for poor psychological outcomes.
On the other hand, it’s likely that for some women, depression and anxiety exacerbate the physical and emotional symptoms. That is, depression and anxiety might be a lens that magnifies how bad menopausal symptoms feel, so these women report having more severe symptoms.
In any case, there’s more to it than “menopause is rough, and it makes women depressed and anxious.” One of the biggest risk factors for depression and anxiety during menopause is prior episodes of depression and anxiety. Women who are also experiencing other life stressors, including relationship stress and socioeconomic stress, are also more likely to become depressed.
In other words, women who are otherwise vulnerable are more likely to experience poor psychological well-being when hit with the additional stress of the menopausal transition.
Along these lines, one study compared depressed and non-depressed perimenopausal women on a variety of quality of life measures, including life enjoyment and satisfaction; ability to function in work, social situations, and relationships; and perceived social support. The researchers also assessed the severity of the women’s hot flashes. The depressed women scored lower than the non-depressed women on all quality of life measures. Severity of hot flashes had no effect for either group.
The authors concluded that future studies “need to distinguish between those women with [perimenstrual depression] and non-depressed women to avoid attribution of decreased [quality of life] to the menopause transition alone.” In other words, don’t blame the hot flashes for what the depression wrought.
This is an important point: We assume that menopause interferes with women’s well-being and quality of life because the symptoms stink (and they definitely do for a lot of women). However, the degree to which menopause actually impacts a woman’s quality of life might depend, at least in part, on whether she experiences concurrent depression or anxiety.
This is not to say that if you’re having a hard time dealing with your symptoms, you’re definitely also depressed. Rather, consider whether depression and anxiety are contributing so that you can address them directly.
Likewise, don’t assume that depression and anxiety will resolve on their own once the physical symptoms subside. Treating the physical symptoms is important, but for many women it might not be enough.
What We Need to Be Saying (To Each Other) About It
At the risk of stating the obvious, a lot of distress is surely rooted in the fact that women don’t feel like they can talk openly and honestly about their experience of menopause, perhaps especially the mental and emotional aspects.
In Becoming a Menopause Goddess, author Lynette Sheppard asserts that all of her friends experienced sadness, if not full-blown depression, during menopause. All of them. More than anything, she says, they needed to hear that it was normal, that there was nothing inherently wrong with them.
Instead, the stigma surrounding mental health struggles and the taboo nature of talking about menopause keep many women suffering in silence. Of course, it’s not like we talk freely about the physical symptoms, either. Sure, we can kvetch about hot flashes with our friends. How many women feel free to discuss brain fog and sleep deprivation with their bosses, even if they have very real consequences in the workplace?
I understand that “just talk about it” is neither easy nor sufficient—I’m not trying to be trite. It’s not like posting your hot flashes on social media will do anything to stop them. Nor can I promise that your boss will be super understanding if you march into his/her office and announce that you can’t finish your project on time because you simply can’t focus.
However, let’s think about what we can do to open up the channels of communication with our friends and partners at least to start. It’s no secret that social support can be an important factor in warding off depression during times of stress.
We Need A Multi-Pronged Approach
Besides talking about it, what else can women do to cope with physical, psychological, and emotional symptoms during menopause? Hormone therapy (HT) is the predominant approach that doctors prescribe (of course). I won’t cover the pros and cons, nor the safety questions, since Mark did so recently. Definitely check out that post if you are considering HT for yourself. Mark’s wife, Carrie, has also written about her experience with menopause symptoms in previous posts (1, 2).
I will point out that most symptoms aren’t clearly caused by the hormonal changes that characterize menopause. Vasomotor symptoms (hot flashes, night sweats) are the most strongly linked to hormonal changes, but other symptoms seem to be more related to psychosocial factors. Even vasomotor symptoms don’t map perfectly onto hormone fluctuations. Women with the biggest drops in estrogen won’t necessarily experience the most hot flushes, for example.
That doesn’t mean you shouldn’t try HT if you and your doctor decide it’s right for you. It clearly has benefits, including that it seems to help some women with depressive symptoms and anxiety. It’s not clear whether this is because it alleviates physical symptoms or because the depression and anxiety are directly caused, at least for some women, by hormone fluctuations.
However, it’s a mistake to assume that if we “fix” the hormones, or get rid of the hot flashes for example, the rest will fall into place.
Thinking about the quality of life study I mentioned above, it’s important not to get wrapped up in the story that hormones plummet, hot flashes and night sweats ensue, and then women become grouchy and depressed as a result.
In reality, the hormone stuff, the physical stuff, the emotional stuff, the sleep stuff, the relationship stuff, and more stuff all get thrown into the mix, each potentially feeding into and off of the others.
What we need is a multi-pronged approach. (I feel like there’s a pun here about protecting the flanks—I’ll keep working on that one.) Besides treating underlying hormone fluctuations with HT or herbal remedies, women and their doctors should also separately address specific physical and cognitive symptoms, general health, and psychological and emotional well-being.
The aforementioned Guidelines for the Evaluation and Treatment of Perimenopausal Depression, for example, offer this recommendation, “Proven therapeutic options for depression (antidepressants, cognitive behavioral therapy and other psychotherapies) should remain as front-line antidepressive treatments for major depressive episodes during perimenopause.” In other words, take care of the depression on its own.
For women who want to be holistic in their approach, and who perhaps want to avoid or minimize HT, there are a number of non-hormonal, complementary practices that have been shown to help. In the next post in this series, I’ll highlight some of the ones that show the most promise for relieving menopausal symptoms specifically, as well as for stress reduction, emotion regulation, and coping more generally.
Now I want to hear from you. Do you feel free to talk about your experience of menopause with the people in your life? Have you had positive or negative experiences when you have talked about it in the past?
Resources:
Deeks AA. Psychological aspects of menopause management. Best Pract Res Clin Endocrinol Metab. 2003 Mar;17(1):17-31.
Schneider M, Brotherton P. Physiological, psychological and situational stresses in depression during the climacteric. Maturitas. 1979 Feb;1(3):153-8.
Zhou B, Sun X, Zhang M, Deng Y, Hu J. The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder. Arch Gynecol Obstet. 2012;285(5):1345–1352.
The post Menopause, Part II: Psychological Well-being appeared first on Mark's Daily Apple.
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