Tag: iab-healthy living

Decreasing rates of childhood immunization are a major concern. Our medical analyst explains why | CNN

Post By Health , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,



CNN
 — 

Vaccine rates for measles, polio, diphtheria and other diseases are decreasing among US children, according to a new study from the US Centers for Disease Control and Prevention.

The rate of immunizations for required vaccines among kindergarten students declined from 95% to approximately 94% during the 2020-21 school year. It dropped further — to 93% — in the 2021-22 school year.

That’s still a high number, so why is this drop in immunization significant? What accounts for the decline? What might be the consequences if these numbers drop further? If parents are unsure about vaccinating their kids, what should they do? And what can be done on a policy level to increase immunization numbers?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Why is it a problem that childhood immunization rates are declining?

Dr. Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories in the last 100 years.

The polio vaccine was introduced in the United States in 1955, for example. In the four years prior, there were an average of over 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the US. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disability among children each year.

The measles vaccine was licensed in the US in 1963. In the four years before that, there were an average of over 500,000 cases and over 430 measles-associated deaths each year. By 1998, there were just 89 cases recorded — and no measles-associated deaths.

These vaccines are very safe and extremely effective. The polio vaccine, for example, is over 99% effective at preventing paralytic polio. The measles vaccine is 97% effective at preventing infection.

We can do this same analysis for other diseases for which there are routine childhood immunizations.

It’s very concerning that rates of immunization are declining for vaccines that have long been used to prevent disease and reduce death. That means more children are at risk for severe illness — illness that could be averted if they were immunized. Moreover, if the proportion of unvaccinated individuals increases in a community, this also puts others at risk. That includes babies too young to be vaccinated or people for whom the vaccines don’t protect as well — for example, patients on chemotherapy for cancer.

CNN: What accounts for the decline in vaccination numbers?

Wen: There are probably many factors. First, there has been substantial disruption to the US health care system during the Covid-19 pandemic. Many children missed routine visits to the pediatrician during which they would have received vaccines due to pandemic restrictions. In addition, some community health services offered also became disrupted as local health departments focused on Covid-19 services.

Second, disruption to schooling has also played a role. Vaccination requirements are often checked prior to the start of the school year. When schools stopped in-person instruction, that led to some families falling behind on their immunizations.

Third, misinformation and disinformation around Covid-19 vaccines may have seeded doubt in other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the issues.

According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said vaccinating children against measles, mumps, and rubella shouldn’t be a requirement for them to attend public schools, even if that may create health risks for others. This was a substantial increase from 2019, when a similar poll from the Pew Research Center found only 23% of parents opposed school vaccine requirements.

CNN: What are some consequences if immunization rates drop further?

Wen: If immunization rates drop further, we could see more widespread outbreaks. Diseases that were virtually eliminated in the US could reemerge, and more people can become severely ill and suffer lasting consequences or even die.

We are already seeing some consequences: Last summer, there was a confirmed case of paralytic polio in an unvaccinated adult in New York. It’s devastating that a disease like polio has been identified again in the US, since we have an extremely effective vaccine to prevent it.

There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved unvaccinated children, and at least 34 have been hospitalized.

CNN: If parents are unsure of vaccinating their kids, what should they do?

Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our kids are diagnosed with asthma and diabetes, or if they have new worrisome symptoms of another illness. We should also consult our pediatricians about childhood immunizations; parents and caregivers with specific questions or concerns should address them.

The national association of pediatricians, the American Academy of Pediatrics, “strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.”

CNN: What can be done to increase immunization numbers?

Wen: There needs to be a concerted educational campaign to address why vaccination against measles, mumps, rubella, chickenpox, polio and so forth is so crucial. One of the reasons for vaccine hesitancy, in my experience, is that these diseases have been rarely seen in recent years. Many people who are parents now didn’t experience the devastation of these diseases growing up, so may not realize how terrible it would be for them to return.

Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination drives at schools, parks, shopping centers, and other places where families gather can help increase numbers. In other places, the low uptake may be because of vaccine hesitancy and misinformation. There will need to be different strategies implemented in that situation.

Overall, increasing immunization rates for vaccine-preventable childhood diseases needs to be a national imperative. I can’t underscore how tragic it would be for kids to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been routinely given for decades.

Source link

#Decreasing #rates #childhood #immunization #major #concern #medical #analyst #explains #CNN

What older Americans need to know before undergoing major surgery | CNN

Post By Health , , , , , , , , , , , , , , , , , , , , , , ,



KHN
 — 

Larry McMahon is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants, and injections aren’t offering relief.

“It’s a pain that leaves me hardly able to do anything,” he said.

Should McMahon, an 80-year-old retired Virginia state trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a lumbar laminectomy, another arduous back surgery.)

“Will I recover in six months — or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?” McMahon asked, relaying some of his concerns to me in a phone conversation.

Older adults contemplating major surgery often aren’t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior’s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the loss of independence.

I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here’s some of what they suggested.

Ask your surgeon, “How is this surgery going to make things better for me?” said Dr. Margaret “Gretchen” Schwarze, an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?

If your surgeon says, “We need to remove this growth or clear this blockage,” ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn’t mean it has to be addressed, especially if you don’t have bothersome symptoms and the procedure comes with complications, said Drs. Robert Becher and Thomas Gill of Yale University, authors of that recent paper on major surgery in older adults.

Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.

Here’s how she describes a “best case” surgical scenario for that condition: “Surgery will be about four to five hours. When it’s over, you’ll be in the ICU with a breathing tube overnight for a day or two. Then, you’ll be in the hospital for another week or so. Afterwards, you’ll probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it’ll probably take you two to three months to feel like you did before surgery.”

Among other things people might ask their surgeon, according to a patient brochure Schwarze’s team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?

A “worst case” scenario might look like this, according to Schwarze: “You have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you’re still in the ICU with a breathing tube, and you’ve lost most of your strength, and there’s no chance of ever getting home again. Or, the surgery didn’t work, and still you’ve gone through all this.”

“People often think I’ll just die on the operating table if things go wrong,” said Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults in San Francisco. “But we’re very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don’t go the way we hope.”

Once your surgeon has walked you through various scenarios, ask, “Do I really need to have this surgery, in your opinion?” and “What outcomes do you think are most likely for me?” Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment, or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.

“It’s important to have family or friends in the room for these conversations with high-risk patients,” Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.

Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider “watchful waiting” — ongoing monitoring of their symptoms — rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.

Because of McMahon’s age and underlying medical issues (a 2021 knee replacement that hasn’t healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. “He told me, ‘I make my money from surgery, but that’s a last resort,” McMahon said.

“Preparing for surgery is really vital for older adults: If patients do a few things that doctors recommend — stop smoking, lose weight, walk more, eat better — they can decrease the likelihood of complications and the number of days spent in the hospital,” said Dr. Sandhya Lagoo-Deenadayalan, a codirector in Duke University Medical Center’s Perioperative Optimization of Senior Health (POSH) program.

When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home. They leave with a “to-do” list of recommended actions, usually starting several weeks before surgery.

If your hospital doesn’t have a program of this kind, ask your physician, “How can I get my body and mind ready” before having surgery, Finlayson said. Also ask: “How can I prepare my home in advance to anticipate what I’ll need during recovery?”

There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?

Ask how long you’re likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you’ll want to know what kind of therapy you’ll need and whether you can expect to return to your baseline level of functioning.

During the Covid-19 pandemic, “a lot of older adults have opted to go home instead of to rehab, and it’s really important to make sure they have appropriate support,” said Dr. Rachelle Bernacki, director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.

For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.

Source link

#older #Americans #undergoing #major #surgery #CNN

Experts say the ‘cycle syncing’ workout trend may not be all it’s cracked up to be | CNN

Post By Health , , , , , , , , ,

Editor’s Note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.



The Conversation
 — 

If you’re someone who has to deal with a period regularly, you’re probably all too familiar with just how much your energy levels can change throughout your cycle thanks to hormonal fluctuations. Not only can this sometimes make even the simplest daily tasks challenging, it can make it even harder to stay motivated to keep fit and stick to your regular workout routine, especially when noticing a decline in your performance.

But, according to some popular information on social media, a technique called “cycle syncing” may help you avoid feeling this way.

READ MORE: From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms

The premise of cycle syncing is relatively simple. Instead of doing the same type of workouts throughout the month, you instead tailor your workouts according to the current phase of your menstrual cycle. Some women also go a step further and tailor their diet to each phase as well. The claim is that, by doing so, it can help “balance” your hormones — which in turn may lead to a range of health benefits, including improved energy levels, fewer PMS symptoms and better health overall.

But while evidence does show that certain phases of your menstrual cycle may be optimal for different types of exercise, there’s currently no evidence showing cycle syncing has any benefits beyond making it easier to keep fit. Not to mention that actually managing to execute cycle syncing properly may be easier said than done.

The menstrual cycle can be split into four phases: menses, follicular, luteal and pre-menses. The concentration of the sex hormones estrogen and progesterone change in each phase.

During the menses phase (your period), estrogen and progesterone are at their lowest levels. But as you move into the follicular phase, estrogen begins to increase. In the luteal phase, which immediately follows, progesterone concentrations also begins to increase. Both hormones reach their peak near the end of the luteal phase, before dropping dramatically during the pre-menstrual phase (days 25-28 of the average cycle).

READ MORE: The US lacks adequate education around puberty and menstruation for young people

Research shows that thanks to these hormones, certain phases of your menstrual cycle are optimized for different types of exercise.

For instance, the luteal phase may be the perfect time for strength training thanks to the boost in both estrogen and progesterone. Research shows there are noticeable increases in strength and endurance during this phase. Energy expenditure (calories burned) and energy intake are also greater during the luteal phase, alongside a slight decrease in body mass. You may also find you feel more energetic and capable of exercise during this phase. The hormone concentrations in the luteal phase may also promote the greatest degree of muscle change.

The folicular phase also shows some increases in strength, energy expenditure and energy intake — albeit smaller.

But when progesterone and estrogen are at their lowest levels during your period (menses phase), you’re likely to see fewer changes when it comes to building muscle. There’s also a greater chance that you will feel fatigued due to low hormone levels, alongside the loss of menstrual blood. This may be a good time to consider adjusting your training, focusing on lower-intensity exercises (such as yoga) and prioritizing your recovery.

READ MORE: Exercising during pregnancy: what to consider

So based on the way hormones change during each phase of the menstrual cycle, if you’re looking to improve strength and fitness you may well want to plan your most intense workouts for the follicular and luteal phases to achieve the greatest gains.

This all seems fantastic, and you may well be wondering why more women are not following this trend. But the answer is that it may all be too good to be true.

While the responses reported do take place, actually putting this all into practice is easier said than done. First, most research on the menstrual cycle’s impact on fitness assume the cycle has a regular pattern of 28 days. But 46% of women have cycle lengths that fluctuate by around seven days — with a further 20% exhibiting fluctuations of up to 14 days. This means a regular cycle varies for each person.

READ MORE: Going home for the holidays? How to navigate conflict and deal with difficult people

The second key assumption is that the responses of progesterone and estrogen, which drive the changes in fitness are constant. But this is often not the case, as both estrogen and progesterone exhibit large variations both between cycles and each person. Some women may also lack estrogen and progesterone due to certain health conditions. These responses make it difficult to track the phases of the cycle precisely through monitoring of hormones alone — and make syncing accurately also very difficult.

So while the idea of syncing your menstrual cycle with your workouts seems logical, the outcomes each person sees are likely to vary. But if you do want to give it a try, menstrual tracking apps — alongside the use of ovulation test strips and temperature monitoring — can help give you a good idea of what stage in your menstrual cycle you’re at.

This article is part of Quarter Life, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.

Source link

#Experts #cycle #syncing #workout #trend #cracked #CNN

Making the case for an underappreciated but full-of-flavor ingredient | CNN

Post By Health , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Editor’s Note: Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Among foods that spark a strong reaction, anchovies are at the top of the food chain.

Whether they’re adored or abhorred, it’s difficult to find someone who doesn’t have a strong opinion about these small silvery swimmers.

Food writer Alison Roman wants the haters to think differently. Anchovies are more versatile than most people think and deserve to be approached with an open mind, according to Roman.

She might be biased — anchovies are one of her all-time favorite foods — but she has a strategy to change cooks’ minds.

“They’re more of a condiment than an ingredient,” Roman said. “To cook with them, you don’t need to eat them whole.” She incorporates anchovies into many of her dishes in the same way that she would add garlic, herbs or other flavorful aromatics. “Most of the time when I’m eating (anchovies), I can’t even see them.”

Even if you think your taste buds will rebel if you try an anchovy, your brain and heart will be happier if you do. “Anchovies are a small but mighty fish,” said Michelle Dudash, registered dietitian, nutritionist and author of “The Low-Carb Mediterranean Cookbook.”

“They’re packed with the omega-3 fatty acids DHA and EPA, which are important for brain, cardiovascular and skin health,” she added. Anchovies are on par with salmon and tuna as one of the fish with the highest amounts of omega-3s per serving, and are a good source of protein, niacin and vitamin B12.

Following Roman’s lead of using anchovies as one of many elements in a dish instead of as the spotlight ingredient, cooks who want to incorporate anchovies into meals “can start small,” Roman suggested. “They don’t have to dump a whole jar into their salad.”

Here are three ways Roman likes to introduce anchovies to the wary but curious. Ready to change your “anchoview”? Read on.

Move over, ranch dressing — there’s another dip in town. Bagna cauda, the Italian dipping sauce made from anchovies, garlic, butter and olive oil, is traditionally served with crudités as an appetizer.

Roman loves using bagna cauda as a vehicle to introduce unsuspecting dinner guests to anchovies because it hits the taste trifecta of “salty, buttery, garlicky” flavors. “It’s mostly about garlic and vegetables,” Roman said. In addition to the traditional accompaniment of raw, crunchy vegetables, she likes to include steamed artichoke hearts and tender cooked potato slices.

Bagna cauda is also an answer to the ever-present question about anchovies: What about the bones? “They are so tiny, they mostly all melt” and dissolve into the dish when heat is applied, Roman said. “They’re not going to choke you.”

“High-quality anchovies shouldn’t have many bones,” she added, and they should not be noticeable like they would be in larger fish, such as a salmon fillet. If you happen to see many bones in your anchovies, “spring for a more expensive tin,” Roman said.

If the presence of whole anchovies resting atop a bed of romaine in a Caesar salad has been historically too much to handle, Roman’s Caesar-adjacent salad will be a refreshing revelation.

Roman likes to pair bitter greens from the chicory family, such as radicchio, with a dressing that can stand up to their strong flavors. “I put anchovies in my salads all the time,” she said, but when hidden in the dressing, they add body and nuance without overpowering any of the other ingredients with which they’re paired.

Anchovies in a dressing can add body and nuance to a salad without overpowering other ingredients.

Her preferred dressing blends finely chopped anchovies and capers with lemon, whole grain or Dijon mustard, and good quality olive oil. “It’s anchovy-heavy but more about the mustard and the garlic,” Roman explained, which she finds “meatier and saltier and more interesting” than the usual Caesar dressing.

Finally, the same strategy of dissolving the umami flavors of anchovies in a sauce comes into play when making a rich and comforting pasta. Based on the Venetian dish bigoli in salsa, in which long strands of thick bigoli pasta are tossed with slow-simmered onions and anchovies, Roman’s version can be used with any long, thin pasta.

Pasta alla puttanesca features garlic, olives, capers, tomatoes and anchovies.

Roman adds whole anchovies and chopped dried chili pepper to a skillet of sliced onions, garlic and fennel caramelized in olive oil. The whole fillets might look intimidating, but as with the bagna cauda, the anchovies melt and dissolve as the sauce simmers, leaving only a rich and meaty undertone. Finishing the dish with freshly squeezed lemon juice and parsley brightens up the intense sauce.

A free-form pasta sauce such as this lets you adjust the flavor balance based on what you like best. If you love lemon, squeeze more on. If fennel isn’t your favorite, use more onions instead. If you like it spicy? Amp it up with more chili pepper. “Gauge your own personal preferences,” Roman recommended.

When choosing a tin or jar of anchovies, Roman said to make sure the anchovies are oil-packed, salt-cured anchovy fillets, not brined, pickled or whole anchovies. The former is the most common style of jarred or canned anchovies on the market, but it always pays to double-check the label.

Second, “always try a bunch of brands. They really are all different,” Roman said. Though the ingredients in each container should be the same — anchovies, salt and olive oil — the fillets will vary in saltiness, taste and texture. “Ortiz and Cento are available nationally,” she said, and many other brands are available in brick-and-mortar and online specialty food stores.

One note on the salt-curing: “The only downside of anchovies is the sodium,” Dudash noted, since they are packed in salt during the curing process. “If you are concerned about your sodium intake or if you simply prefer less salty food, briefly rinse the anchovies and pat dry with a paper towel” before using them.

Source link

#Making #case #underappreciated #fullofflavor #ingredient #CNN