- Obamacare Coverage Increases Despite Moves to Repeal It
- Why Blood Pressure Is Rising Worldwide
- Kids Are Eating Nearly 200% More Fake Sugar
- The One Supplement Pregnant Women Should Take
- Miscarriages May Be Prevented With Progesterone
- The Case for Annual Mammograms Is More Complicated Than Ever
- This Is Your Email Personality Type
Posted: 10 Jan 2017 09:37 AM PST
(WASHINGTON) — Congress may be moving to repeal “Obamacare,” but millions of people are still signing up. The administration said Tuesday that 11.5 million enrolled nationwide through Dec. 24, ahead of last year’s pace.
Administration officials said about 290,000 more people have signed up than at the same time last year, evidence that the Affordable Care Act is on sound footing despite rising premiums, dwindling choice and healthy people holding back from getting coverage.
While acknowledging what they call “headwinds,” administration officials said the latest numbers refute claims by GOP leaders that “Obamacare” is in a “death spiral” and about to collapse because of its own problems. Among the Republicans making such claims are President-elect Donald Trump, House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell.
“This market is not merely stable; it is on track for growth,” said Aviva Aron-Dine, a senior adviser at the Department of Health and Human Services. “Today we can officially pronounce these death spiral claims false.”
The administration has set a goal of 13.8 million people signed up for coverage in 2017 by the time open enrollment ends on Jan. 31. Officials believe a strong finish will bolster the case for preserving President Barack Obama’s signature domestic policy achievement, largely responsible for reducing the nation’s uninsured rate to a historic low of about 9 percent.
With the final deadline less than three weeks away, the administration is planning advertising and grassroots outreach to millions of people who qualify for subsidized coverage under the law, but remain uninsured. The health law expanded coverage through a combination of taxpayer-subsidized private insurance and a state option to expand Medicaid for low-income people.
Separately on Tuesday, the nonpartisan Kaiser Family Foundation released an analysis that suggests Republican lawmakers face political risks if their repeal drive destabilizes the insurance markets for individuals.
The study found that about 55 percent of “Obamacare” enrollees last year lived in Republican congressional districts. That’s roughly the same proportion as the share of seats held by Republicans in the House of Representatives.
Among states that expanded Medicaid, the Kaiser study found that 16 have Republican governors, 14 have Democratic governors, and one has an independent governor. However, the overwhelming majority of individuals who have benefited from the Medicaid expansion are in blue states, including high-population states like California and New York.
Posted: 10 Jan 2017 09:28 AM PST
One U.S. adult out of every three has high blood pressure, which increases the risk of heart disease and stroke. But the number of people with elevated blood pressure, not yet in the high range, is much higher.
According to a new analysis published in the Journal of the American Medical Association, based on more than 8 million people from 154 countries across 844 studies, the problem of elevated blood pressure is worldwide, and it has serious consequences.
The researchers were particularly interested in the top number of a blood pressure reading, called systolic pressure, which measures pressure in the blood vessels when the heart is beating. This number can escalate quickly in older adults. Elevated systolic blood pressure of at least 110-115 millimeters of mercury (mmHg) has been linked to heart disease, kidney and cerebrovascular disease and stroke.
Even though blood pressure medication isn’t typically used until a person reaches 140 mmHg, the researchers wanted to see the link between these lower levels and bad health outcomes. “We think it’s important to measure the lost health between 115 and 140 mmHg, even though we do not yet know whether giving all of those people blood pressure lowering medications would be beneficial,” says Dr. Gregory Roth, one of the study’s authors and assistant professor in the division of cardiology at the University of Washington.
The number of people with elevated systolic blood pressure has increased dramatically in the past 25 years, and so has the rate. “We found that 3.5 billion adults have blood pressure high enough to bring some risk, and 870 million people around the world are hypertensive,” says Roth.
Elevated systolic blood pressure was found to be a leading contributor to preventable death in 2015 and was linked to more than 10 million deaths—1.4 times the number in 1990.
Countries with very large populations—especially China, India, Russia, Indonesia and the U.S.—lost the most health due to heightened blood pressure. Yet “elevated systolic blood pressure is a risk in almost every population in the world,” Roth says. Part of the reason why is likely that blood pressure lowering medications, though effective, aren’t accessible or cheap enough to many people with hypertension who need them.
The new study adds to recent evidence that blood pressure readings even lower than the guidelines recommend may be beneficial. The 2015 results of the clinical SPRINT—short for the systolic blood pressure intervention—trial found that people who kept their systolic blood pressure at 120, compared to those who kept their blood pressure at the recommended level of 140, had much lower rates of heart-related deaths and early deaths from any cause.
Not everyone needs to take a medication for elevated systolic blood pressure. It’s possible to lower your blood pressure naturally through changes in diet, exercise and weight, Roth says. The important thing is to start paying attention to blood pressure early. “Elevated blood pressure starts contributing to a very large amount of lost health at a relatively young age,” Roth says.
Posted: 10 Jan 2017 09:23 AM PST
The survey results, published in the Journal of the Academy of Nutrition and Dietetics, reveal that in 1999, less than 9% of kids consumed low-calorie sweeteners, which are common in diet sodas and low-calorie and low-fat processed foods. That number rose to about 25% in 2012, and even children as young as two are consuming them, the study finds.
The report looked at data from close to 17,000 men, women and children who participated in the National Health and Nutrition Evaluation Survey from 2009 to 2012. The researchers compared that data to other survey findings from 1999-2008.
Sugar substitutes are getting more popular among adults, too. Forty-four percent of adults and 20% of children in the survey reported consuming low-calorie sweeteners more than once a day; 17% of adults consumed an artificially sweetened food or beverage three times a day or more.
Artificial sweeteners remain a debated health topic, but growing evidence suggests that fake sugar isn’t a worry-free food. Sugar substitutes promise fewer calories, but they’ve recently been linked to obesity and diabetes. The new study found that the likelihood that a person consumed low-calorie sweeteners rose with body mass index; close to 20% of adults with obesity consumed these sweeteners three times a day or more, compared to 13% of normal-weight adults. A 2016 study also found that pregnant women who consumed more artificial sweeteners in beverages were twice as likely to have children that were overweight or obese at one year, compared to women who consumed less.
Some research even suggests that people tend to gain weight when they regularly use these sweeteners, and though the reason why isn’t yet clear, it’s possible that the sweeteners trigger a craving for more food, according to some experts. When people eat sweet food, the thinking goes, the brain’s receptors are activated and the body prepares for calories by releasing insulin, which breaks down sugar. But if there’s a lack of sugar or calories to metabolize, the body may stay in craving mode, potentially causing people to eat more.
More research is needed into the health effects of artificial sweeteners, and more is sure to come. For now, study author Allison Sylvetsky, assistant professor of exercise and nutrition sciences at the George Washington University Milken Institute School of Public Health, endorses an easy fix: to “drink water instead of soda” and to “sweeten a serving of plain yogurt with a little fruit.”
Posted: 10 Jan 2017 08:00 AM PST
A government task force has reaffirmed its stance that women who are pregnant, or planning to become pregnant, should take folic acid supplements as a way to prevent birth defects.
On Tuesday, the U.S. Preventive Services Task Force, an independent panel of national medical experts, released its final recommendation on folic acid supplements for the prevention of birth defects. The group looked at 24 studies on the benefits and potential harms of folic acid supplementation and concluded that they’re safe and effective. The task force regularly re-visits health issues in order to ensure that government guidelines for Americans are in line with the latest science.
Folic acid has repeatedly been shown to prevent improper brain and spinal chord development, called neural tube defects. Many birth defects happen in the first few weeks of pregnancy, which is why doctors recommend women start taking a daily supplement of 400 to 800 micrograms of folic acid.
The most important times for women to take the supplements are a month before becoming pregnant and throughout the first three months of pregnancy, the task force concludes.
Dr. Alex Kemper, a member of the task force and professor of pediatrics at Duke University Medical School, says that given how safe folate supplementation is, women could take the pills for longer if they desired. “Most [defects] seem to happen early in pregnancy, before a woman may even know she’s pregnant,” he says. “Given that only half of pregnancies are planned, it makes sense for any woman who might become pregnant to be taking the supplements.”
Women can get folate naturally from their diets, if they eat foods high in the nutrient, like dark green leafy vegetables, legumes and oranges. But around 75% of women do not get the recommended daily amount of folate from their diet alone, the new recommendation says.
“The recommendation is to make sure women get enough folic acid to prevent defects, and the one really sure way is by taking the supplement,” says Kemper.
The Task Force has given the guideline an “A” recommendation, which means there is a high certainty of a substantial benefit.
Kemper says women who want to take daily folate supplementation can either get it through folate-specific pills or in a multi-vitamin, as long as it has the recommended 400 to 800 microgram dosage.
Posted: 09 Jan 2017 02:09 PM PST
For women who have had multiple miscarriages, a safe and inexpensive progesterone treatment may increase their chances of completing a pregnancy. In a new study published in the journal Fertility and Sterility, two-thirds of women who used the hormonal supplement before pregnancy successfully delivered babies, despite having had at least two previous pregnancy losses.
Progesterone has been shown to help stabilize the inner lining of the uterus called the endometrium, an important factor for healthy embryo development. Progesterone supplements (also known as micronized progesterone) have been recommended for more than 50 years for women struggling with infertility, but there’s been less research on how it might benefit women who get pregnant but then miscarry.
Researchers from the University of Illinois at Chicago and Yale University recruited 116 women who had lost at least two early pregnancies, and tested their levels of nCyclinE, a molecular marker for endometrial health. Those with abnormal levels were then prescribed progesterone supplementation, to be inserted vaginally, twice a day during the second half of their menstrual cycles.
The intervention seemed to help. In the progesterone group, 68% of the women had subsequent successful pregnancies, compared to 51% of those who did not receive the hormone.
The researchers believe that the progesterone caused the endometrium to secrete more nutrients, which serve as food for an embryo in its first weeks of development. (Women who became pregnant continued taking progesterone until the 10-week mark.)
Lead author Dr. Mary Stephenson, director of the recurrent pregnancy loss program at the University of Illinois Hospital and Health Sciences, says that women who have suffered multiple pregnancy losses should talk to their doctors about progesterone supplementation.
“We now know that, for some women, the use of progesterone in the second half of the menstrual cycle is associated with a higher likelihood of taking home a baby, and that is really good news,” says Dr. Stephenson. “We also know that progesterone is safe in early pregnancy, easy to use and inexpensive.”
Progesterone can be prescribed in several forms, including creams, capsules and pills that are inserted vaginally with an applicator. Women can self-administer these treatments, and they are usually covered by insurance, says Dr. Stephenson.
However, there are many possible causes of recurrent pregnancy loss, a condition that affects up to one in 20 women. Before deciding on a treatment option, she cautions, patients should undergo a thorough evaluation to determine what strategies might work for them.
In fact, the new research suggests that testing women for nCyclinE and other biomarkers may help doctors determine which patients would benefit from progesterone supplementation.
Co-author Dr. Harvey J. Kliman, director of the reproductive and placental research unit in the department of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, invented the patented test for nCyclinE levels used in the study.
“We initially created the Endometrial Function Test to identify women with infertility,” Dr. Kliman said in a press release. “This study has shown that the EFT can also be an important tool for patients with recurrent pregnancy loss.”
The study was published today in the journal Fertility and Sterility. Dr. Stephenson says she is in the early stages of developing a randomized clinical trial, which is needed to validate her early findings and influence any official recommendations for women who have had multiple miscarriages.
In the meantime, those women should talk with their doctors, says Dr. Stephenson. “We’ve been using vaginal progesterone for some time for recurrent pregnancy loss,” she says. “We know that it’s a reasonable strategy—one that should be discussed, risks and benefits, between patient and physician.”
Posted: 09 Jan 2017 02:00 PM PST
It seems like heresy but some cancer experts are starting to question the way we screen for breast cancer. In recent years, the American Cancer Society and other breast cancer groups have changed their recommendations about when women should get screened, and how often. The shift was prompted by a large scale review of the data showing that mammograms led to considerable over-diagnosis—meaning screening is catching cancers that never would have required treatment in the first place.
Similar reports in Europe have prompted the French National Cancer Institute to launch a year-long inquiry into how to improve screening, and the Swiss Medical Board now advises against routine mammogram screening for most women. Still, many earlier studies found that screening for breast cancer does prevent death from the disease in some people—making the topic controversial to discuss and confusing for women.
In the latest study on the subject published in the Annals of Internal Medicine, adds some clarity. Taken together, the findings of the new paper support growing data from other groups that breast cancer is over-diagnosed, with small growths that likely aren’t going to progress into cancer being detected—and treated—more than they need to be. Meanwhile, the truly dangerous tumors, which develop into advanced cancer that spreads to other parts of the body, are being missed.
“Picking up cancers in the early stages should lead to fewer late-stage cancers, that’s the whole point of screening,” says Dr. Karsten Jorgensen, chief of the Nordic Cochrane Center and professor at Rigs Hospitalet. “But the frequency of invasive [late stage] cancers keep increasing. So the screening doesn’t seem to be working in the way we thought it would. The screening isn’t picking up the cancer it’s supposed to pick up.”
In Denmark, there was a 17-year period during which women living around the capital city of Copenhagen were getting screened, while nearly 80% of women in the rest of the country were not. Those who didn’t get screened served as a natural control population, so the scientists could get a true sense of how much benefit, or not, mammography screening had on the type of cancer detected. Based on the types of cancers that were diagnosed — smaller lesions v more advanced cancers — they could also determine whether screening was having its intended effect. If screening was working, and picking up cancers that were then treated, the number of advanced breast cancers should decline, since more women would have their tumors found and treated.
Jorgensen and his colleagues found, however, that wasn’t the case. Instead, they learned that the number of advanced breast cancer cases was not much lower among the screened women than among the non-screened women over time. Instead, more smaller lesions were being detected.
Jorgensen suspects that the tumors that cause advanced disease tend to grow grow so quickly — in between the yearly mammograms — that they are already advanced by the time the screening occurs. “Screening isn’t picking up the cancer it’s supposed to pick up,” he says. “If you screen every year or once every second year, the really aggressive cancers are so fast growing that they go through the screen-detectable stages too fast for screening to pick up. They pop up between screening rounds.”
Does that mean screening should occur more frequently, or that it’s not useful at all? Not exactly, and that’s what is controversial about the emerging data. The data does not suggest that screening should be abandoned, but instead reflects the fact that screening, as it exists today in much of the world, is outdated.
“I am for screening, but also for realizing that current screening is not as good as what we need,” says Dr. Otis Brawley, chief medical and scientific officer of the American Cancer Society, who wrote an editorial accompanying the study. Screening can clearly be helpful in detecting and treating disease before it becomes advanced and untreatable — some of the drop in breast cancer deaths can be attributed to screening. But mammography may not be best way to do that. In fact, some researchers argue that much of the decline in breast cancer deaths should be traced to better treatments rather than primarily to screening with mammography.
They say that breast cancer deaths should be going down further, given the widespread education and implementation of screening and treatments in most parts of the world. But in order to accomplish that, additional screening tests, such as a blood test or genetic evaluations, may be needed. Brawley points to colon cancer screening as a model. It is lowering death rates and leading to a drop in the number of advanced disease. That’s been accomplished with colonoscopy, an invasive procedure that can both scan and remove suspicious polyps at the same time. There isn’t such an effective screening tool for breast cancer — yet.
The breast cancer findings also point to another flaw in existing screening strategies. They are built on centuries-old definitions of cancer and equally unchanged views on how best to treat them. Back then all tumorous growths were assumed to be fast-growing and potentially lethal, and therefore needed to be removed. But, says Jorgensen, “we shouldn’t treat all cancers the same way because they are not the same. Our knowledge of cancer biology tells us that breast cancer represents a spectrum of really different cases of cancer that behave in very different ways. And sadly screening is not good at picking up those cancers that we really want to pick up.”
Brawley agrees, but points out that we are not yet ready to accept that some breast cancers may not need treatment. In other cancers, such as prostate and thyroid, doctors have begun to tell some patients that they don’t need to take immediate action to treat their cancers. Some can be monitored and treated only if they start to grow or change. “What this study, and others like it tell me, is that if we look into 2025 and 2030, some women are going to be screened and diagnosed with cancer and told that their cancers are ones they can watch as opposed to treat,” he says. “So instead of treating it aggressively, we are going to watch it. We are not there yet with this type of treatment for breast cancer — but we are going to be there in the next 10 years.”
In fact, a couple of important studies examining different ways of screening and monitoring early breast cancer are underway; one will compare women who are treated in the existing way and another will adopt a more personalized screening regimen for women based on their history and risk factors. Their results will provide critically needed information on what role screening can play in addressing breast cancer.
In the meantime, both Brawley and Jorgensen stress that breast cancer screening is an important part of preventive care for any woman. They aren’t advocating eliminating the screening; they simply want to make sure that the screening put in place works to protect women from developing advanced disease. “We need to continue asking questions,” says Brawley. “Women should know the benefits as well as the potential harms associated with screening.
Posted: 09 Jan 2017 10:59 AM PST
Email is often cited as one of the most stressful things about the modern workplace, especially for people who feel pressure to stay logged on 24/7. Now, researchers say that different personality types respond in different ways to certain email habits and behaviors—and that knowing your “type” may help you reduce email-related dread or anxiety.
The new research, which was presented recently at the British Psychological Society’s annual conference for occupational psychology in Liverpool, is based on an online survey of 368 people who had also completed Myers-Briggs questionnaires to determine their personality type. This simple test prompts users to select traits for themselves in four categories: Introverted or Extroverted; Sensing or Intuitive; Thinking or Feeling; and Judging or Perceiving. The result is a four-letter combination of these traits: ISFJ or ENTP, for example.
When psychologists from OPP—a research branch of the Myers-Briggs company—compared survey data with respondents’ personality types, they found some interesting differences in how people used email, and in what they considered the most stressful aspects.
Read more: How to Recover From Emotional Exhaustion
“Our research shows that while there are some general guidelines for using email, everyone is different,” said study author and OPP researcher John Hackston, in a press release. “Knowing your personality type can help you to avoid stress and communicate better with others.”
For example, those whose types included an “I” for intuitive—whom the researchers described as having a “big-picture focus”—were more likely to check their emails on vacation, over the weekends, and before and after work than their more “matter-of-fact” (or “S” for sensing) peers.
That’s unfortunate for them, says Hackston, since emailing outside of work hours has been associated with emotional exhaustion and work-life imbalance. (This issue has become so pervasive around the world that France recently instituted a “Right to Disconnect” law, requiring companies to negotiate off-hours communication boundaries.)
That’s not all the survey found. Based on the full results, OPP developed personalized email management tips for eight unique personality types.
Read more: The Case for Taking a 7-Day Facebook Detox
For example, “activists” (people who are extroverted and sensing) should remember to make sure they send all of the emails they start in a day. “Conservers” (introverted and sensing) should turn off email notifications when they need to focus and concentrate, and are encouraged to follow up with people when they don’t respond to initial emails.
“Explorers” (extroverted and intuitive) should not worry about creating subfolders if they never use them, while “Visionaries” (introverted and intuitive) should consider sending a short “holding” email if they aren’t able respond right away.
“Directors” (extroverted and sensing) should avoid being too direct when stressed, and “Nurturers” (extroverted and feeling) shouldn’t be offended if people omit pleasantries in their emails.
Some advice was more broad: Extroverts are reminded that not everyone wants to meet face-to-face all the time, while introverts are reminded the opposite—that some things really are best hashed out in person, rather than online. The entire collection of email tips, as well as tips for sending emails to different personality types, is available on the OPP website.
The researchers also provide suggestions that all personality types can use to improve their relationship with work email. These include responding more quickly; taking care with chain emails and when cc’ing large groups; being clear, concise, and polite; and thinking about your audience.
They also recommend sending fewer emails overall, and sticking to the workday whenever possible. “This may be difficult, but try and have at least some time email free to reduce your stress levels,” they write.
Psychologist Ben Dattner, PhD, a New York City-based executive coach who was not involved in the new research, agrees that there are very few set-in-stone rules when it comes to managing emails.
Read more: Optimism Could Help You Live Longer
“Some people might find it more relaxing to totally unplug on vacation, while other people might find that stressful because they don’t have their finger on the pulse of what’s going on,” Dattner told RealSimple.com. “You might have to experiment a little, and be strategic about what you put in your out-of-office reply, to see what works best for you.”
He does think, however, that everyone can benefit from setting some time-and-place limits on email. He even cites an amusing 2005 study that revealed how email and phone distractions could affect workers’ IQ scores even more than smoking marijuana could.
“You need some sort of delineation between when you’re trying to be productive, like reading or writing, and when you’re doing email,” he says. “Close your browser or put your smartphone on mute, and tell yourself you’re only going to check once an hour or once every half hour. You may not be responding to as much all at once, but you’ll be responding better and more efficiently, and that’s what’s important.”
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