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We all want our children to be able to go back to school. What we don’t want is for them — or their teachers — to get sick from COVID-19.

There is no easy, let alone perfect, solution, which is why, a year into the pandemic, there is no clear way forward. Recently the Centers for Disease Control and Prevention (CDC) released new guidelines to serve as a roadmap for navigating this difficult part of our pandemic journey.

According to these new guidelines, all schools offering in-person learning should prioritize universal, correct use of masks and physical distancing. The CDC also notes three more strategies are essential for safe in-person instruction: hand washing, cleaning school facilities, and contact tracing. Layering together these five strategies can help lessen the spread of COVID-19 in schools.

Below are key highlights from the CDC guidelines.

Children need to be in school

I think that all of us agree that remote school pales in comparison to in-person instruction for the vast majority of our children and teens. It’s not just about education, which is clearly better when one has the ability to interact in person with other students, but also about equity. So many families have struggled with access to the technology, learning space, and support that are necessary to make remote learning even vaguely successful; for so many children and communities, the pandemic has caused learning loss that will have long-reaching consequences.

There are also consequences in terms of mental health. Being isolated at home has led to a significant increase in depression and anxiety among children and teens — and a decline in the mental and economic well-being of families in general, given how many parents have had to leave their jobs to stay home with their children.

What the CDC guidelines urge is to prioritize opening schools over more economically- or socially-driven openings. The more a community opens, the higher the risk of transmission of COVID-19, which impacts schools, too. We can’t have everything; we need to choose what is most important to us.

Elementary school children don’t pose as high a risk as older students

While our understanding of COVID-19 is still evolving, it appears that younger children are less likely to get sick and less likely to transmit the virus than teens and adults. Because of this, the CDC argues that they should be getting in-person instruction, not remote.

The amount of community transmission matters in decisions to reopen schools

The CDC stratifies community spread of COVID-19 into four levels based on cases per 100,000 people and the percent of tests that are positive. The levels are

• low (0 to 9 cases per 100,000, less than 5% positive tests)
• moderate (10 to 49 cases per 100,000, 5% to 7.9% positive tests)
• substantial (50 to 99 cases per 100,000, 8% to 9.9% positive tests)
• high (more than 100 cases per 100,000, 10% or higher positive tests).

For communities with low or moderate spread, the CDC believes that K-12 should open for full in-person instruction for all grades, with precautions like masking and social distancing in place.

For communities with substantial or high spread, the CDC recommends a hybrid model in elementary schools. For middle schools and high schools, it recommends hybrid for communities with substantial spread and all-remote for high.

Masks, distancing, hand washing, ventilation, and cleaning are key

The CDC recommends that everyone wear masks that cover the mouth and nose, wash frequently, and set a goal for physical distancing of six feet.

In areas of low or moderate spread, they recommend distancing “to the greatest extent possible.” They also encourage ventilation (such as by opening windows and doors) and cleaning of shared surfaces.

This is an area where the devil is very much in the details. Getting elementary students back to full-in person instruction while also physical distancing is tough. So is getting adequate ventilation into old buildings, or figuring out exactly how to do effective cleaning while also managing all the other work of running a school.

Flexibility is needed

Some children need remote instruction because their health conditions, or the health conditions of family members, put them at higher risk of severe COVID-19 disease. Some schools are going to need more support than others. The realities of this pandemic and of our society defy simple recommendations, and we will need to realize and work with that.

Testing is needed, too

Ideally, schools should have access to testing for students and teachers with symptoms, as well as routine screening to identify asymptomatic cases. Additionally, they should work closely with local departments of health to isolate active cases, and do contact tracing and quarantining as needed.

This is another area where the devil is in the details. Testing costs money, and not all communities have ready access to testing and the ability to get results quickly.

Vaccination of teachers is important but not required

Teachers are essential workers and ideally all should be vaccinated against COVID-19. But the reality is that we are unlikely to get all teachers vaccinated before the end of the school year. The CDC argues that first, the overall risk to teachers is low (especially elementary school teachers); and second, that our children are losing too much education for us to wait.

Understandably, many teachers are worried about their health, and the health of their families, and don’t want to be forced to choose between that and the education of their students.

Even as vaccination offers a light at the end of the tunnel, we are still in the tunnel, and may be there for many months yet to come. We can’t just wait for everything to be over to address the needs of our children; we need to come together to take care of them. Our children are our future, after all.

Follow me on Twitter @drClaire

The post New school guidelines around COVID-19: What parents need to know appeared first on Harvard Health Blog.

As COVID-19 vaccines roll out across the US, many grandparents — including one co-author of this blog post — are thrilled to hold out their arms for a jab. In some parts of the country, these vaccinations began as early as mid-January. By mid-February, legions of energized and relieved seniors were trading selfie shots of their newly vaccinated arms.

Grandparents, like other seniors, wanted the vaccine to keep themselves safe. However, there was another compelling reason: the desire to hug grandchildren. Ellen Glazer, LICSW, asked fellow grandparents in different states — some of whom live minutes away from grandchildren and some who are separated by continents — what they look forward to once fully vaccinated.

Below, Amy Sherman, MD, an infectious disease specialist and instructor in medicine at Harvard Medical School, weighs in on a number of hopes and questions — some very specific, and some that can help everyone. Keep in mind that experts may disagree about what is or isn’t safe to do after vaccination. Also, advice is likely to change as we learn more about the vaccines and as a larger number of people get vaccinated, bringing herd immunity closer.

While the current messages — stay cautious, practice protective measures — may feel frustrating for grandparents relieved to have gotten the vaccine, they’re necessary. Reflecting on the past year, many realize that practices that seemed so difficult at the start of the pandemic, such as wearing masks and engaging in some degree of social distance, have become part of our lives. These new habits enable us to move forward with small, well-informed, and hopeful steps toward our new normal.

Can I make others sick? Is it safe to see (and hug) grandkids and family who haven’t had the vaccine?

Studies show both mRNA vaccines (Moderna and Pfizer/BioNTech) are about 95% effective in preventing symptomatic COVID-19. Both vaccines protect against moderate to severe disease and reduce hospitalizations and deaths due to COVID-19, which is fantastic! But we don’t know if these vaccines prevent asymptomatic infection — that is, being sick with the virus without symptoms like fever, cough, and shortness of breath. So it’s possible that you could have the virus without symptoms, and spread the virus to others.

Generally, the more closely people interact and the longer they spend with others, the higher the risk of getting or spreading the virus, according to the Centers for Disease Control and Prevention (CDC).

With those words of caution, I think it is reasonable to consider seeing and hugging your family and grandkids while taking protective measures to stay healthy:

• Wash hands often.
• Wear masks that fit well when in close contact, such as while in the same room with others and when hugging.
• Limit time spent with family members who are not yet vaccinated.
• Hold the visit outdoors if you can.

When possible, everyone gathering can lower risk further by avoiding contact with people outside their household for 14 days before a visit, and/or by getting tested for the virus one to three days before a visit.

Can I still get sick?

I like to think of these vaccines as being a water-resistant jacket, as opposed to a waterproof jacket. With the vaccine, you may still get wet, but not soaked. As explained above, it is still possible to develop asymptomatic or mild illness. A small proportion of people may get more severe illness despite vaccination. Further, it’s important to note that

• vaccines do not always provide robust immune responses in people ages 65 and older, because the immune system normally weakens with age. Therefore, even if vaccinated, you may not have the same high level of protection against moderate to severe disease described in the studies.
• we are still learning about variant strains now circulating. We do not yet know how the vaccines perform in the real world against these variants. Early indications suggest the mRNA vaccines may not be as effective against some variants, but still seem to help avoid hospitalizations and death.

What if I live with someone who hasn’t had the vaccine?

It’s best to continue the safe behaviors you were doing pre-vaccination to help protect your spouse or others that you live with. The vaccine is another layer of protection for you, and also helps protect your spouse or others in your immediate household. However, transmission is still possible.

Can I visit with friends or family who have had the vaccine — for example, have a meal together indoors or have a grandchild stay with us?

If you and your family or friends have been vaccinated, you could consider spending time together. As with a COVID pod or bubble, talk to your family or friends before gathering, to ensure everyone is comfortable socializing in person and with the precautions others are taking.

A few factors to discuss include:

• How recently was the vaccine given? How many doses has each person received? We know that one dose of the mRNA vaccine provides some protection, but peak protection likely occurs about 10 to 14 days after the second dose.
• The potential for asymptomatic illness and spread, even if people are vaccinated: make sure everyone knows transmission is still possible, although the likelihood of severe disease due to COVID-19 is low if everyone has been vaccinated. Still, if someone has the virus, they may spread it to unvaccinated people.

Can I travel on a plane safely (and is first class any safer than coach)?

Start by checking CDC, state, and local guidelines before you fly. The CDC currently recommends postponing travel.

Your risk isn’t confined to the plane itself (or potential differences between first class and coach). How will you travel to and from the airport (public transportation, ride shares)? What about check-in lines at the airport, or sitting in the gate area with others in close quarters for an extended period of time? Will you need to use public restrooms, or eat in areas with lots of other travelers? These scenarios carry higher risks of virus transmission.

If it’s possible to drive, this may be a better option in order to limit exposures. In the car, you can limit stops, pack food and eat and drink in the car, and avoid large gatherings of people that occur in airports and public transit.

If you must fly, try to reduce risk and exposures as much as possible. Your vaccine is one layer of protection. Protect yourself in other ways to lower your chances of becoming infected with the virus that causes COVID-19:

• Get a viral test one to three days before you leave. If it’s positive or you develop symptoms, do not fly.
• Some airlines are limiting seating and keeping middle seats open. Try to book a flight that is abiding by these guidelines.
• Drive yourself or have family drive you to the airport.
• Keep your mask on and avoid crowded areas in the airport.
• Avoid eating or drinking in waiting areas.
• On the plane, continue to wear a mask throughout the flight.
• Bring extra hand sanitizer and masks.

What precautions do I still need to take outside my household, and why?

COVID-19 rates remain very high in the community, and variants will continue to circulate. If you are exposed to the virus, you are not 100% protected from illness even if you’ve had the vaccine.

Until a high proportion of the population is vaccinated, I recommend maintaining familiar precautions outside of the home: wash hands often, wear masks, practice physical distancing. We need herd immunity in the community before we can relax any of these protective measures. Even if you’ve been vaccinated, you do not want to contribute to community spread of COVID-19 that can make others very sick, or even die.

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In times like these, it can feel wrong to feel happy. There is so much suffering in the world that appreciating the goodness that still exists can seem unempathic, if not altogether futile. A landmark study on happiness often mentioned at dinner parties and social gatherings (when we had those things) considered how people react to intense, sudden changes to their circumstances. The researchers found that people who had recently won the lottery were no happier after some time had passed than people who had experienced severe trauma that paralyzed their lower bodies. It’s a testament to stubbornness as our common lot in life — and the resilience we also share.

The lottery winners seemed to lose their ability to find joy in mundane aspects of their lives, while the survivors of trauma had a different experience entirely: they focused more on idealized memories of their past, perhaps at the expense of channeling energy into appreciating whatever they could about their new life.

In this year of the pandemic, there are very few literal or proverbial lottery winners. Many of us have shared in various forms of emotional, behavioral, and physical trauma. How have we, as individuals, coped?

What happens when trauma continues to unfold?

In many, many cases, we have not coped — or rather, we’ve coped to our limit, but the trauma continues. Many people, particularly the privileged among us, have never experienced the intensity and duration of the emotional toll taken by this pandemic. We are in uncharted territory, and the early data are troubling.

Since the pandemic began, mental health symptoms related to depression, anxiety, suicide, and substance use are up dramatically. As many as 40% of US adults have reported struggling with mental health or substance abuse during this time. This number represents a serious and deadly corner of the pandemic that has not received enough attention.

Resilience, solace, and moments of joy

Yet I have also noticed striking glimmers of resilience from those with and without formal diagnoses of mental health disorders. In my own life, I discovered solace in the rituals and routines of everyday tasks. I did my work. I wrote. I spent time with family and time outside. The simple act of maintaining my routine helped me gain momentum, and kept me away from doomscrolling.

I thought back to the happiness study, and wondered if others were experiencing a similar phenomenon. When I posed the question to my friends online, the responses I got back were incredible. Like me, some described the privilege of finding comfort and purpose in basic, ritualized tasks. Others seemed to blossom by seeking out new adventures and skills. My friends wrote about becoming suburban caretakers to chickens, learning to garden, growing their own food, picking up or revisiting an instrument that had long been gathering dust. They became devoted to baking and cooking in new and interesting ways. One former colleague said she particularly enjoyed rollerblading to work instead of riding public transit; what began as a necessity at the start of the pandemic had become a passion, and perhaps the only time in each day that she felt at peace in the world. Still others turned their pandemic angst into good by making masks for those in need.

Finally, a large group of my informal survey respondents said that they simply found ways to appreciate the world around them. They began going for daily walks around the neighborhood, noticing details in plain sight yet unseen until this year. They became friendlier with their neighbors. They took moments to not only breathe, but to appreciate the air around them. They recognized their good fortune in the midst of challenge — not every day, and surely not always — and sometimes found ways to share it.

The problems we face today are uniquely challenging, but our resilience has never come in so many different forms. We’re bonded by our shared drive to keep moving forward. Someday, when our lives begin to resemble the before times, I hope we carry with us the lessons we’ve learned.

The post Seeking solace, finding resilience in a pandemic appeared first on Harvard Health Blog.

High or abnormal cholesterol levels, inflammation, and endothelial dysfunction play a key role in atherosclerosis and plaque buildup, the most common cause of heart attacks and strokes. (Endothelial dysfunction refers to impaired functioning of the inner lining of blood vessels on the heart’s surface. It results in these vessels inappropriately narrowing instead of widening, which limits blood flow.) There are many different types of cholesterol, including high density lipoprotein (HDL, or good, cholesterol); triglycerides (a byproduct of excess calories consumed, which are stored as fat); and low-density lipoprotein (LDL, or bad cholesterol).

It’s well established that lowering LDL cholesterol, sometimes regardless of whether or not you have high cholesterol, improves cardiovascular outcomes. But do older adults reap the same benefits from lowering cholesterol, and do they face additional risks?

Lowering LDL reduces cardiovascular risk

Studies have consistently shown that lowering LDL cholesterol reduces the risk of cardiovascular death, heart attacks, strokes, and the need for cardiac catheterizations or bypass surgeries. This has been shown in those with established coronary artery disease, as well as in high-risk patients without coronary artery disease.

Lifestyle changes can decrease cholesterol numbers by about 5% to 10%, while cholesterol-lowering medication can decrease LDL cholesterol by 50% or more. Therefore, while lifestyle modifications like a heart-healthy diet (the Mediterranean diet, for example), quitting smoking, regular exercise, and weight loss are critical to reducing cardiovascular risk, medications are often needed to provide additional cardiovascular protection.

Statins, including atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor), and pravastatin (Pravachol), are the mainstay therapy for lowering LDL. Statins work by reducing your own body’s production of cholesterol, which promotes uptake of LDL circulating in the blood by the liver. But not all of the benefit of statins can be explained by decreasing LDL alone. Studies show that statins have favorable effects on inflammation, endothelial dysfunction, and plaque stabilization (when plaque breaks apart, it can cause a heart attack or stroke). Statins have been around for about 40 years, so we have quite a bit of information on their short- and long-term safety and effectiveness.

Ezetimibe (Zetia) is a different type of LDL-lowering drug. Taken as a pill, it lowers cholesterol by inhibiting its absorption in the small intestines. Ezetimibe is mainly used as an add-on medication to statins to achieve further LDL lowering, or on its own in people who cannot tolerate statins. In older adults, ezetimibe alone was found to reduce cardiovascular events but not stroke.

PCSK9 inhibitors are a newer class of cholesterol-lowering drugs. They work by allowing more LDL receptors to remain in the liver, thus allowing the liver to sweep more LDL cholesterol out of the bloodstream. PCSK9 inhibitors have been shown to decrease LDL cholesterol by about 60%. There are two PCSK9 inhibitors on the market, evolocumab (Repatha) and alirocumab (Praluent), and both must be taken by injection every few weeks.

LDL lowering therapies: Are they safe for older adults?

The clinical benefit of lowering LDL cholesterol in older adults has been a point of contention, because people ages 75 and older are not usually included in large numbers in clinical trials. Some have even argued that the risks of LDL-lowering treatment may outweigh benefits for older adults compared to younger adults. But the evidence debunks this myth.

Meta-analyses and clinical trials indicate that statin use is not associated with increased risk of muscle injury, cognitive impairment, cancer, or hemorrhagic stroke compared with those not using statins, regardless of age. Likewise, in clinical trials, risk of liver or kidney injury is similar in people taking statins or a placebo, regardless of age. A prospective study evaluating liver safety in very elderly patients found statins to be safe overall in patients ages 80 and older.

The most common side effect of statins is muscle aches, which occur less than 1% of patients. Even if one type of statin causes side effects in a person, another statin may not. Statins can raise blood sugars, but this is unlikely to lead to type 2 diabetes in anyone not already at high risk for the condition. Similarly, ezetimibe use is largely safe, with diarrhea and upper respiratory infections being the most common side effects. Notably, the safety profile for ezetimibe plus statins is the same as for statins alone, even in older adults. And finally, PCSK9 inhibitors have not been found to increase risk of diabetes, neurocognitive disorders, liver injury, or muscle injury.

The evidence for LDL-lowering therapies in older adults

The question remains: do the benefits of cholesterol-lowering treatments outweigh the risks for older adults? In a systematic review and meta-analysis published in The Lancet, researchers evaluated the clinical benefit of statin and non-statin cholesterol-lowering therapy for older adults. They did this by extracting and re-analyzing data from previous studies that had evaluated statin and non-statin cholesterol-lowering treatments. The analysis included 21,492 patients ages 75 and older. Of these, 54.1% of patients had been enrolled in statin trials; 28.9% in ezetimibe trials; and 16.4% in PCSK9 inhibitor trials.

The investigators made these important observations:

• Older patients have a 40% higher risk of major cardiovascular events than younger patients (5.7% versus 4.1%).
• For every 38-mg/dL reduction in LDL cholesterol, older patients taking LDL-lowering therapies enjoyed a 26% reduction in risk of major cardiovascular events.
• LDL lowering prevented cardiovascular events to a similar degree in older and younger adults.
• In older adults, statin and non-statin LDL-lowering therapies were similarly effective for preventing most major cardiovascular events. The exception was stroke, for which non-statin therapy was slightly more effective; this is likely driven by the use of PCSK9 inhibitors.

The analysis above largely represented older patients with existing cardiovascular disease. There are ongoing trials that will help evaluate the utility of statins in older patients as a primary prevention for major cardiovascular events.

Follow me on Twitter @HannaGaggin. 

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A healthy, saucy version of your favorite takeout with antioxidant-rich eggplant, fresh bell peppers & summer squash.

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Hemorrhoids are painful, unpleasant, and, um, well, difficult to talk about. But they actually are quite common: about half of people over age 50 have had them. However, they’re easy to treat and manage.

“Hemorrhoids can be troublesome and embarrassing, but they often shrink on their own with simple self-help care and over-the-counter remedies,” says Dr. Howard LeWine, assistant professor of medicine at Harvard Medical School.

What are hemorrhoids?

Hemorrhoids are swollen veins near the anus. Common symptoms are rectal pain, itching, bleeding, and occasional protruding veins outside the anus.

There are two types of hemorrhoids: internal and external. You can have either type by itself, or both at the same time.

Internal hemorrhoids. These form inside the anal canal and usually are painless. However, they may cause intermittent bleeding with bowel movements, and sometimes discharge mucus. Internal hemorrhoids also can protrude outside the anus and look like small, grapelike masses.

External hemorrhoids. These form just outside the anal opening and can cause swelling, protrusions, and discomfort.

Why do hemorrhoids occur?

Sometimes hemorrhoids develop for no reason, but often they are associated with chronic constipation or diarrhea, straining during bowel movements, and prolonged sitting on the toilet. You can reduce your risk by following these three easy steps:

• Get enough fiber in your diet (guidelines suggest 14 grams for every 1,000 calories)
• Stay well hydrated (drink six to eight glass of water daily)
• Exercise regularly (aim for 150 minutes of moderate-intense activity per week).

Are there natural treatments for hemorrhoids?

First, some very good news: Neither type of hemorrhoid is dangerous, and severe complications that require medical care are rare. Symptoms often can be relieved by trying a few natural and self-care treatments.

• Draw a sitz bath. To relieve itching and irritation, fill a tub with three to four inches of warm (not hot) water and sit in it with your knees bent for about 10 to 15 minutes. Gently pat yourself dry with a towel, but don’t rub the area.
• Take fiber supplements. These draw water into your stool and make it easier to pass, helping to reduce hemorrhoid bleeding and inflammation. A psyllium husk fiber supplement, like Metamucil or a generic version, is a good choice. If psyllium causes gas or bloating, try a supplement with wheat dextrin (Benefiber) or methylcellulose (Citrucel).
• Ease discomfort. Apply over-the-counter products that shrink the inflamed tissue and relieve itching. Try pads infused with witch hazel (Tucks), or soothing creams that contain lidocaine, hydrocortisone, or phenylephrine (Preparation H).

You can also take steps to prevent flare-ups.

• Don’t delay. Putting off bowel movements can cause stool to back up, leading to increased pressure and straining, which aggravates your hemorrhoids.
• Sit right. Try not to sit on the toilet for long periods; this tends to make hemorrhoids push out and swell up. A way to speed up things is to elevate your feet with a step stool as you sit. This changes the position of your rectum to allow for easier passage of stools. Also, using a cushion beneath you when you sit on a chair or hard surface can ease swelling.
• Keep it clean. After every bowel movement, gently clean your anal area with a witch hazel pad, a soothing baby wipe, or a cotton cloth soaked in warm water. If you have any irritation afterward, apply petroleum jelly or aloe vera gel.

The post Natural remedies for hemorrhoids appeared first on Harvard Health Blog.

Do you ever wish that a certain person in your life would make the effort to truly understand where you’re coming from? That ability — being empathic — comes more easily to some people than to others. Empathy helps people get along with others, from loved ones to strangers. So it’s worth considering your own aptitude for empathy, which you can hone just like any other skill.

“While either genetic proclivity or our upbringing makes some people naturally empathic, empathy can be cultivated at any point in our lives,” says Dr. Ronald Siegal, PsyD, assistant professor of psychology at Harvard Medical School. Empathy helps us understand other people, so we feel more connected and able to help one another through difficult times, he adds.

What is empathy?

Empathy is a key aspect of emotional intelligence, which also includes the ability to identify and regulate one’s own emotions, and to use these abilities to communicate more effectively.

Psychologist Carl Rogers described empathy as “seeing the world through the eyes of the other, not seeing your world reflected in their eyes.” To be truly empathetic and understand another person’s perspective, feelings, and motivations, you have to be curious about that person.

“Empathy requires paying attention to others’ words and body language, noticing the feelings that arise within us when we interact with them, and asking them about their feelings. Doing this regularly refines our capacity to accurately sense other people’s emotional experience,” says Dr. Siegel.

Research suggests that empathy training can improve this skill. It can be part of counseling or formal programs that teach through experiences (such as games and role-play), lectures, demonstrations, and skills practice. A study that pooled findings from 18 diverse studies of empathy training found the techniques to be effective.

Try these three ways to practice empathy

You can practice these three measures on your own to cultivate greater empathy:

Acknowledge your biases. We all have biases or prejudices toward individuals or groups, whether we’re aware of them or not. So-called conscious bias refers to biases that people recognize. An example would be feeling threatened by another group and voicing opposition to that group’s beliefs or actions. But implicit or unconscious bias is more subtle, making it challenging to recognize. Common examples of these biases relate to differences in gender, race, class, age, weight, and culture. While it can be unnerving and bring up feelings of shame to have our implicit biases revealed, the more clearly we see them, the less they control our thoughts, feelings, and actions. One way to explore your implicit biases is through this test.

Ask questions sensitively. Even though biases may arise frequently in personal interactions, these perceptions certainly aren’t the only reason people fail to understand one another. You can misunderstand someone whose identity and background are very similar to your own. Assume you don’t know how the other person feels, because you probably don’t. Asking questions is the answer. Try something like, “I think my reactions may be different from yours. What’s your experience? How do you see it?” Expressing a willingness to hear another’s perspective will help that person feel respected.

Listen actively. Once you’ve asked a question, be sure to really listen to what the other person has to say. These three techniques can help:

• Make eye contact to enhance your concentration and connection with the other person.
• Don’t interrupt — allow the other person to finish speaking before you respond.
• If the person expresses negative emotions about a situation, avoid suggesting possible fixes unless he or she specifically requests your advice.

The post Want to feel more connected? Practice empathy appeared first on Harvard Health Blog.

In recent years, there’s been a veritable explosion in the number and type of health monitoring devices available in smartphones and fitness apps.

Your smartphone is likely tracking the number of steps you take, how far and fast you walk, and how many flights of stairs you climb each day. Some phones log sleep, heart rate, how much energy you’re burning, and even “gait health” (how often are both feet on the ground? how even are your steps?). And, of course, nonphone wearables and fitness gadgets are available, such as devices to measure your heart rhythm, blood pressure, or oxygen levels. The accuracy of these devices varies — and, in some instances, your skin tone may make a difference.

Generally, how accurate are health monitors?

I know from my experience with hospital monitoring devices that they aren’t always accurate. False alarms from EKG monitors often send medical staff scurrying into patient rooms, only to find the patient feeling fine and surprised about the commotion. A particularly common false alarm is a dangerous and unstable heart rhythm on a continuous heart monitor, which can be due to the motion from a patient brushing their teeth.

High-stakes devices with monitoring capability, such as defibrillators and pacemakers, are extensively tested by their makers and vetted by the FDA, so their accuracy and reliability are generally quite good.

But what about home health monitoring devices intended for consumer use that are not extensively tested by the FDA? Ever count your steps for a few minutes just to see if your phone’s tally agrees? Or climb a couple of flights of stairs to see if you are getting full credit for not taking the elevator?

The accuracy of consumer devices depends in part on what is being monitored. For example, one study assessed the accuracy of heart rate monitors and energy expenditure calculators in phones and health apps. Accuracy was quite high for heart rate (often in the range of 95%), but much less accurate for energy expenditure. Accuracy can also vary depending on who is being monitored.

Device bias: What it is and why it occurs

While no health gadget is perfect, some users get more reliable results than others. For example, if you’re wearing nail polish, a pulse oximeter — a device that clips onto the fingertip to measure blood oxygen through the skin — may not work well, because the polish interferes with proper function of the light sensor. In that situation, there’s a simple solution: remove the polish.

But in other cases, the solution isn’t simple. Increasingly, we’re recognizing that certain medical devices are less accurate depending on a person’s skin color, a phenomenon called device bias.

• Pulse oximeters. Although generally considered highly accurate and commonly relied upon in healthcare settings, their accuracy tends to be lower in people of color. That’s because the device relies on shining light through the skin to detect the color of blood, which varies by oxygen level. The amount of pigment in the skin may alter the way light behaves as it travels to blood vessels, leading to inaccurate results. The FDA has released an alert about this and other limitations of pulse oximeter use.
• Bilirubin measurement in newborns. Bilirubin is a breakdown product of red blood cells. Newborns are screened for high levels because this can cause permanent brain damage. When detected, phototherapy (light treatments) can help the baby get rid of the excess bilirubin, preventing brain damage. The screening involves examining a newborn’s skin and eyes for jaundice (a yellowing due to elevated bilirubin) and a light meter test to detect high bilirubin levels. But the accuracy of this test is lower in Black newborns. This is particularly important because jaundice is more difficult to detect in infants with darker skin, and dangerously high bilirubin levels are more common in this population.
• Heart rate monitors in smartphones. According to at least one study, smartphone apps may also be less accurate in people of color. Again, this is because the more skin pigment present, the more trouble light sensors have detecting pulsations in blood flow that reflect heartbeats.

Why device bias matters

Sometimes an error in measurement has no immediate health consequences. A 5% to 10% error rate when measuring heart rate may be of little consequence. (In fact, one could ask why anyone needs a device to monitor heart rate when you could just count your pulse for 15 seconds and multiply by 4!)

But pulse oximeter readings are used to help decide whether a person needs to be hospitalized, who requires admission to the intensive care unit, and who requires additional testing. If the oxygen level is consistently overestimated in people of color, they may be more likely to be undertreated compared with others whose readings are more accurate. And that may worsen previously existing healthcare disparities.

These examples add to the growing list of bias imbedded within healthcare, and other instances where failing to include diverse individuals has serious consequences. When you use a health device, it’s reasonable to wonder if it’s been tested on people like you. It’s also reasonable to expect people who develop medical and consumer health devices to widen the demographics of test subjects, to make sure results are reliable for all users before putting them on the market.

Sometimes a change in technology, such as using a different type of light sensor, can make health-related devices work more accurately for a wider range of people.

Or there may be no easy fix, and user characteristics will need to be incorporated into proper interpretation of the results. For example, a device could offer the user a choice of skin tones to match skin color. Then based on extensive data from prior testing of people with different skin colors, the device could adjust results appropriately.

The bottom line

The push to monitor our bodies, our health, and our life experiences continues to gain momentum. So we need to test and validate health-related devices to be sure they work for diverse individuals before declaring them fit for the general public. Even then, device bias won’t disappear: bodies vary, and technology has its limits. The key is to know it exists, fix what can be fixed, and interpret the results accordingly.

Follow me on Twitter @RobShmerling

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Body mass index, or BMI, has long been the standard tool for assessing weight status and health risk. A calculation of your size that takes into account your height and weight, BMI is frequently used because it’s a quick, easy, and inexpensive measurement tool. Yet, it lacks any assessment of how much fat a person has or how it’s distributed throughout the body, both of which are key indicators of metabolic health. A recent study published in The BMJ analyzed different measures of body shape — more specifically, of central or abdominal fat — to determine which measures were most predictive of premature death.

Abdominal fat associated with higher risk of death

Researchers in this study analyzed the following measurements of central fatness: waist, hip, and thigh circumference; waist-to-hip ratio; waist-to-height ratio; waist-to-thigh ratio; body adiposity index (which incorporates hip circumference and height); and a body shape index (calculated from waist circumference, BMI, and height).

They found that a larger hip and thigh circumference (sometimes referred to as a pear shape) were associated with lower risk of death from all causes. All other measures, which indicated centrally located fat (sometimes called an apple shape), were associated with a higher risk of death. That is, the more abdominal fat a person has, the higher their risk of dying from any cause.

What do these results mean?

These findings tell us that not only does the total amount of body fat determine health risk, but also the location of that fat on a person’s body. Prior research has shown that abdominal obesity is more strongly associated than overall obesity with cardiovascular risk factors such as increased blood pressure, elevated blood triglyceride levels, and type 2 diabetes. Studies have shown it’s even linked to dementia, asthma, and some cancers.

Fat located around the abdomen, particularly visceral fat surrounding the liver and internal organs, is highly inflammatory and metabolically disruptive: it releases inflammatory molecules that contribute to insulin resistance, type 2 diabetes, and ultimately cardiovascular disease. In contrast, fat located at the hips and thighs is protective. These protective effects include an association with lower total cholesterol, LDL (or bad) cholesterol, triglycerides, arterial calcification, blood pressure, blood glucose and insulin levels, and higher sensitivity to insulin.

Taken together, these findings demonstrate the importance of using BMI along with measurements of abdominal fat to fully assess health risk.

What was missing from this analysis?

Researchers in the BMJ study looked at the data from multiple angles, breaking down the results by different categories such as sex, geographical location, smoking status, BMI, physical activity, and presence of disease such as diabetes and high blood pressure.

Notably, they did not analyze the relationship between abdominal obesity and mortality among different races or ethnicities. A 2005 study demonstrated that waist circumference was a better indicator of cardiovascular disease risk than BMI, and proposed different waist circumference cutoffs varying by race/ethnicity and gender for more accurately assessing that risk.

More recently, a 2015 statement from the American Heart Association warned about the misclassification of obesity (and cardiovascular risk) in different racial and ethnic groups. Specifically, current thresholds can lead to underestimating risk in Asian populations and overestimating risk in Black populations. As a result, people in these groups may inaccurately perceive their weight status, and doctors may fail to offer appropriate treatment options.

What can you do to reduce your risk?

The question everyone wants to know the answer to is: how can you decrease abdominal fat? Well, there’s bad news and good news. An older study looking at fat distribution among identical and fraternal twins revealed the bad news, which is that how your body stores fat is largely determined by genetics.

The good news is that abdominal fat responds to the same behavioral habits and strategies recommended for overall health and total body fat loss. Those strategies include the following:

• Eat a healthy diet incorporating lean protein, fruits, vegetables, and whole grains.
• Limit processed carbohydrates, and especially added sugars, which are sugars not occurring naturally in food.
• Get adequate physical activity, at least 150 minutes per week of moderate-to-vigorous physical activity.
• Get adequate restful sleep: for most adults that means seven to eight hours per night.
• Limit stress, as it is correlated with the release of the hormone cortisol, which is linked to abdominal weight gain.

Racism and socioeconomic factors make fat loss harder for some

Although individuals have some control over the above lifestyle factors, we must acknowledge that there are systems-level factors that affect a person’s ability to access healthy foods, engage in regular physical activity, get adequate sleep, and reduce stress levels. These imbalances in access have long been linked with healthcare disparities.

This is particularly relevant as we enter 2021 — in the midst of the coronavirus pandemic, and exacerbated by social and political unrest in the United States. As a nation, we must confront these challenges and find systemwide solutions for reducing socioeconomic barriers and eliminating racism, in order to improve individual agency and ability to lead healthier lives.

The post The link between abdominal fat and death: What is the shape of health? appeared first on Harvard Health Blog.

Many Americans cannot wait to get the COVID-19 vaccine. They call hotline numbers. They search online for vaccine clinics. They wait for hours in line. Yet, others with ready access to the vaccine have declined it in large numbers. Staff in long-term care facilities were prioritized to receive the vaccine, but many are choosing not to get vaccinated. Why?

Nobody is more familiar with the impact of COVID-19 than staff at nursing homes and assisted living facilities that have been ground zero for the pandemic. Large numbers of residents and staff have contracted the virus. Nearly 40% of the COVID deaths in the US have occurred among residents of these facilities. Over 1,500 nursing home staff have also died from COVID, making nursing home caregiver the most dangerous job in America.

Nonetheless, many long-term care staff continue to refuse the COVID-19 vaccine. In a recent CDC report, nursing homes had a median vaccination rate of 37.5% for staff during the first month of the federal vaccination effort; by comparison, a median of 77.8% of nursing home residents received the vaccine. This has surprised some policymakers. Recently, Maryland’s acting health secretary told state lawmakers that about one-third to one-half of staff offered the vaccine chose to have it –– nowhere near an expectation of 80% to 90%. In a bit of positive news earlier this month, a large national nursing home chain reported 61% of staff and 84% of residents had been vaccinated as of early February, still far short of many policymakers’ expectations.

An information problem or a trust problem?

Many experts attribute low vaccination rates among staff to an information problem. Indeed, a recent survey of nursing home caregivers suggests many staff worry about vaccine safety and side effects. Yet, major information campaigns including well-crafted toolkits and fact sheets have not been sufficient. The problem isn’t just a lack of information, but also who delivers this information. Direct caregivers in long-term care may lack information about the vaccine, but they also lack trust in facility leadership.

We have historically undervalued the work of caregivers in long-term care facilities. They perform a difficult job for pay at or near minimum wage, with few benefits like health insurance or paid sick leave. They often work at multiple facilities in order to earn a living wage. Many facilities are understaffed with high turnover. The vast majority of caregivers are women, and many are people of color and recent immigrants. They may be treated poorly while being asked to work long hours at low pay.

Since the start of the pandemic, this workforce has been further exploited. They have often had to work in facilities that were severely short-staffed, without adequate personal protective equipment or rapid COVID testing. Many staff did not receive hazard or hero pay despite working in the most dangerous of conditions. Not surprisingly, many staff do not trust management at the facilities where they work.

The role of trust, vaccine mandates, and cash incentives

Given the lack of trust among caregivers, staff don’t just need more information about the safety of the vaccine; they need to hear this message from a trusted source. Some facilities with better employer-employee relationships have been able to have these discussions, as a recent New Yorker article notes.

This trust between facility leadership and staff is not built overnight. Facilities lacking this culture will need to turn to a trusted source either in or around the facility. In some instances, that might be respected clinicians and staff who work in the facility. In other instances, that might be a professional organization.

Is there a role for policy in increasing staff vaccination rates? Maybe. One idea is to mandate that staff take the vaccine. The federal government has been reluctant to do that, especially because the vaccine was approved through an emergency use authorization. Although a few assisted living chains have mandated the vaccine, most companies have not chosen this route. Everyone acknowledges that mandates will have the intended effect of increasing vaccination rates among staff. However, mandates are also likely to have the unintended effect of causing some staff to leave their positions rather than get vaccinated. It all comes back to trust. Given severe staffing shortages and the challenge of recruiting new workers to these jobs, facilities can ill afford to lose more workers.

Another approach is to pay staff to take the vaccine. Some facilities have offered a free breakfast or gift cards. These rewards are nice but fairly nominal, and unlikely to move the needle much. Larger cash amounts like $500 for the first shot and $1,000 for the second shot would likely motivate more staff to get vaccinated. However, there are ethical considerations around paying staff, and funding for these payments would require government support.

At the end of the day, no matter the approach, trust and relationships will figure centrally into resolving this situation. In getting long-term care facility staff vaccinated, the messages we share matter, but so does the messenger who delivers this information.

Follow me on Twitter @DavidCGrabowski

The post Why won’t some health care workers get vaccinated? appeared first on Harvard Health Blog.

Toasted chickpeas and refreshing veggies atop lemony salted Greek yogurt. A perfectly balanced, protein and fiber-filled lunch!

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Do all kids spy? Just me? When I was a child, I spent hours snooping in my parents’ nightstands, Granny’s pocketbook, my older brothers’ dresser drawers. I’m not sure what I was looking for, exactly, other than validation of my suspicion that the teenagers and adults in my life were keeping secrets from me.

And no opportunity for sleuthing seemed richer than the twin mirrored medicine cabinets hanging from my parents’ bathroom wall. My mother’s was kind of boring, its glass shelves lined with bottles of aspirin and antacids, plus a dusty jar of jewel-toned bath oil beads. My father’s was a treasure trove — to me, at least. An orthopedic surgeon, he had access to all sorts of paraphernalia with which he stocked his medicine cabinet: syringes, alcohol, sterile gauze, tincture of opium, ACE bandages, gentian violet, and even butazolidin, an injectable anti-inflammatory long off the market for humans, though still used by veterinarians.

Appealingly, these items seemed mysterious and vaguely dangerous. Indeed, they likely inspired in me a desire to become a doctor one day myself, to join the exclusive club whose members knew how to use such things. What I realize in retrospect, though, is that my father’s medicine chest offered a window into his attitude toward health. While often indisposed with one ailment or another, he never relinquished his doctor’s identity, never fully adopted the patient role. The contents of his medicine chest declared that no matter how sick he became, he could take care of himself.

Family culture of illness: Are you a maximalist or a minimalist?

Along with our family medical histories — the ones our physicians record when they ask which of our relatives had cancer, diabetes, or heart disease — each of us has a parallel history, what I like to think of as our family’s culture of illness. A decade ago, in Your Medical Mind: How to Decide What is Right for You, Harvard doctors Jerome Groopman and Pamela Hartzband broadly divided people into medical “maximalists” and “minimalists.” Maximalists are more likely to go to the doctor, willingly take medication, and undergo invasive testing. Minimalists take more of a wait-and-see approach; they prefer to seek cures in diet and exercise. Groopman and Hartzband, who are married, detail how such attitudes are formed early in life, deeply embedded in a family’s approach to health and illness.

In my own family’s case, I now see that my father’s medicine chest reflected maximalism — with a twist: Dad would go for aggressive treatment, but he wanted to maintain some control, perhaps even by administering the treatment himself. My mother, in contrast, was a minimalist through and through. What a hot bath couldn’t cure, a couple of TUMS and a long talk on the phone would.

A look at our own approach to health

So, having grown up with this mixed culture of illness, what’s in my own medicine cabinet? When our kids were young, my doctor-husband and I were pretty minimalist. We kept on hand a thermometer of dubious accuracy, outdated calamine lotion, and a crusty bottle of liquid Tylenol. We weren’t irresponsible parents, but maintaining a well-equipped dispensary at home was never a priority for us. I admired a friend who was ready for anything — she always had antihistamine combined with Tylenol, Advil, and plain — but never felt moved to emulate her.

Now that our kids are grown, I see a continuation of our minimalism. But there’s also a new element: a touch of hoarding, which the substitution of spacious bathroom drawers for wall cabinets seems to encourage. We’ve accumulated from hotel stays dozens of little bottles of shampoo, conditioner, and lotion, in addition to regular-sized ones; we’re never without at least one mammoth Costco bottle of ibuprofen; and we own a hot water bottle, a heating pad, and a microwavable hot pack — none of which we’ve ever used. For what, exactly, are we preparing? The sudden onslaught of old age, which we fear might take us unaware?

Take a look at your medicine cabinet now. What does it say about you?

Follow me on Twitter @SuzanneKovenMD

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March 11th, 2020 — or was it March 12th, or a few days before or beyond that? Each of us has a date and time etched in our minds when we knew that the COVID-19 pandemic was upon us. Now, the anniversary of that date is fast approaching. What, if anything, do we do to mark it? And how do we convey our thoughts and feelings about this milestone to our grandchildren?

Anyone who has reached grandparenthood has collected anniversaries along the way. There are anniversaries of joyful occasions, and ones that serve as painful reminders of loss. There are the personal anniversaries — the births and deaths of loved ones — and public ones, including 9/11, the moon landing, and (for those of us in our mid-60s and older) the deaths of JFK, RFK, and MLK. For many of us, the upcoming anniversary of the pandemic has elements of loss and triumph that feel both deeply personal and assuredly communal.

How has the pandemic affected your relationship as a grandparent?

Many grandparents have been unable to see their grandchildren up close and personal. Others have been more fortunate, spending time with grandchildren from the start, but even so this time has been punctuated by COVID fear and COVID scares. No one has been without challenges. Nonetheless, many grandparents find themselves looking back not only on loss, stress, and frustration, but on creativity, resourcefulness, discovery. Who would have imagined last March 11th — the very day the World Health Organization recognized the pandemic — that we’d be having car parade birthday parties, Thanksgiving dinner in our garages, and playing board games and more over Zoom?

Why — and how — you might like to mark this anniversary with your grandchildren

I’ve been thinking a lot about why and how grandparents might want to mark March 11th with their grandchildren. Marking this time with our grandchildren can help them make sense of what they have been through. Years from now when they look back on the pandemic, they may cherish memories of the ways in which their grandparents were their fellow travelers.

Ask simple questions to help capture these thoughts. What disappointed? What felt sad? Were there unexpected gifts and moments of joy? Was there anything you really wished you could do, but couldn’t — and anything you successfully did, though perhaps differently than in the Before Times? As we approach the anniversary of the day when so much changed for all of us, consider these questions and additional ideas to help you reflect back on this year with your grandchildren.

Young children, ages 3 to 7

Young children may not grasp the extent of loss that the pandemic has brought, nor what it means to create rituals. But they do understand birthdays and holidays. It may be best to keep it light, approaching March 11th not from a perspective of loss and pain, but using it as a time to celebrate what they — and you — have accomplished. They may have learned to wear masks, study online, and live with the loss of activities they really enjoy and value. Something as simple as a cake with a mask made of frosting, or a “pandemic birthday” dinner in which you have pizza or another favorite food delivered, can communicate to young children that this strange time had a beginning and will — at some point — have an end.

Older kids, ages 7 to 12

Your elementary and middle school grandchildren are old enough to remember March 11, 2020, and the changes that came to their lives in the days, weeks, and months that followed. They can recall the sense that many adults had in the beginning — that the disruptions in our lives would last a few months, and then we would return to normal. Instead, a new normal of mask wearing and more social distancing unfolded. These children bore witness to these changes and participated in them. For this age group, March 11th has real significance: life as they knew it changed. Depending on how creative they — and you — are, you may want to engage them in making a collage of the year. Assuming you are not able to do this together in person, the very act of creating a collage via FaceTime or Zoom will help make this project a fitting memorial to the year.

Teens

Teenagers get it. The pandemic has upended their lives in so many ways. Touchstones of adolescence have been dramatically altered or temporarily put on hold: proms, college tours, graduations. School plays and concerts have been pushed to the side. Religious observances and celebrations, such as bar and bat mitzvahs, have moved to Zoom. For many, classroom learning has been interrupted at a time when they were most fully engaged. They have surely experienced loss during the pandemic. Creating a ceremony or ritual with your teen grandchildren may help them make a place for the pandemic in the history of their lives. In so doing, it may offer reassurance that this time will pass. Let them take the lead on what this ritual or ceremony will look like. Perhaps you can assist them by sharing your memories of some of the complex times you lived through, including the Vietnam war and the aftermath of 9/11.

As March 11, 2021 approaches, the pandemic is far from over. However, vaccines offer all of us hope that life will look very different by March 11, 2022. This knowledge holds promise and an opportunity to approach the anniversary of the pandemic with curiosity and creativity, seeing it not only as a painful reminder of all that we’ve lost, but also as a time of resourcefulness and resilience.

The post Grandparenting: Anticipating March 11 appeared first on Harvard Health Blog.

While endometriosis is a common condition, affecting as many as one in every 10 American women, it is complex and often misunderstood. Endometriosis occurs when tissue much like the tissue that normally lines the uterus — called the endometrium — starts to grow elsewhere in the body. These growths may cause pain, scarring, and, in some instances, infertility.

One study shows it can take up to seven years for a woman to get a diagnosis of endometriosis because symptoms may mimic other common conditions, such as irritable bowel syndrome or pelvic inflammatory disease. And misconceptions about the disease, including the five myths below, may keep some women from seeking help. Talk to your health care team if you’re concerned about painful periods or other possible symptoms of endometriosis, such as long-lasting pain in your lower back or pelvis.

5 myths — and the facts — about endometriosis

Myth 1: The symptoms are just a heavy period. Women with endometriosis sometimes assume that their symptoms are a normal part of menstruation, and when they do seek help they are sometimes dismissed as overreacting to normal menstrual symptoms. But in fact, something much more serious is going on than period cramps. One theory is that the pain occurs because even when endometrium-like tissue is outside the uterus, it continues to respond to hormonal signals and produce chemicals that cause inflammation and pain.

During the course of the menstrual cycle, this endometrium-like tissue thickens and eventually bleeds. But unlike endometrial tissue in the uterus, which is able to drain through the vagina each month, blood from displaced tissue has nowhere to go. Instead, it pools near the affected organs and tissues, irritating and inflaming them. The result is pain, and sometimes the development of scar tissue that can form a web, fusing organs together. This may lead to pain with movement or sexual activity.

Myth 2: Endometriosis only affects the pelvic region. The most common locations for endometriosis growths to occur are within the pelvis, such as on the outer surface of the uterus, the bladder, and the fallopian tubes. But endometriosis may occur anywhere in the body. Rarely, endometrium-like tissue has been found in the lungs, for example.

Myth 3: Endometriosis is always painful. Not everyone with endometriosis experiences pain. It’s not uncommon for a woman to learn she has endometriosis only after she begins investigating why she is having difficulty getting pregnant. Endometriosis is the leading cause of infertility in the United States. Having the condition also increases the likelihood of miscarriage and other problems in pregnancy. However, the good news is that the vast majority of women with endometriosis are ultimately able to have a child.

Myth 4: Endometriosis can be prevented. There’s no clearly understood cause for endometriosis, so at this point there is no known way to prevent it. Certain steps to help lower estrogen levels in the body can reduce your risk, according to the US Office of Women’s Health. Estrogen can fuel the growth of endometriosis and magnify symptoms. You can reduce your estrogen levels by choosing a lower-estrogen birth control method, losing weight if you are overweight, and getting regular exercise.

Myth 5: Endometriosis always improves after menopause. Although endometriosis symptoms occur most often during menstruation, for some women they last well after monthly cycles end. Even after a woman goes through menopause, the ovaries continue to produce small amounts of estrogen. Endometriosis growths may continue to respond to the hormone, causing pain. So, while symptoms of endometriosis improve in many women, menopause doesn’t bring relief to all. Some women who have gone through menopause may opt for surgical procedures to remove endometriosis implants or adhesions, or even hysterectomy and oophorectomy (removing the ovaries). However, these procedures are not always successful in controlling pain. Hormonal therapies, too, appear to be less effective in women after menopause.

For information about treating endometriosis pain, see this post from the Harvard Health Blog.

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Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give this year could be truly life-changing? A gift that could save someone’s life, or free them from dialysis?

You can do this. For people in need of organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. That’s why February 14th is not only Valentine’s Day — it’s also National Donor Day, a time when health organizations nationwide sponsor blood drives and sign-ups for organ and tissue donation. Read on if you’ve ever wondered what can be donated, had reservations about donating your organs or tissues after death, or had concerns about the risks of becoming a live donor.

The enormous impact of organ, tissue, or cell donation

It’s hard to overstate the impact donors can make in the lives of people whose organs are giving out. Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, improved quality of life, or both. And yet, the number of people who need organ donation far exceeds the number of compatible donors: about 90% of people in the US support organ donation, but only 60% sign up. An estimated 109,000 women, men, and children are awaiting an organ transplant in the US. About 6,000 die each year, still waiting.

What can be donated?

The list of ways a donor can help someone in need has grown dramatically in recent years. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help up to 75 people!

Here is a list of the most commonly donated organs, tissues, and cells.

After death, people can donate

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• intestine
• pancreas
• skin
• veins.

Live donations may include

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Misconceptions about becoming an organ donor are common, and they limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor, or, worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open casket funeral is an option for organ donors.

The experience of being a live donor

If you’re donating blood, there is little or no risk involved. Other donations do come with real risk. Surgery to donate a kidney comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Because bone marrow is removed through needles inserted into the back of the pelvis bones on each side, back or hip pain is common. This can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.

Stem cells are found in bone marrow. They also appear in small numbers in the blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects, such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can be an organ, tissue, or blood cell donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2019, about a third of organ donors were over age 50. People in their 90s have donated organs upon their deaths and saved the lives of others. However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, may be made worse by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

As National Donor Day approaches, think about the impact you can make by becoming a donor, whether during your life or after death. In the US, you must opt in to be a donor, unlike some countries in which everyone is considered an organ donor unless they specifically choose to opt out. Research suggests an opt-out approach could significantly increase rates of organ donation in this country, but currently there seems to be no movement in that direction.

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor. Let me know what you choose — and why.

Follow me on Twitter @RobShmerling

The post Flowers, chocolates, organ donation — are you in? appeared first on Harvard Health Blog.

It’s something people don’t like to think about, but it’s a fact that dust mites are all around us. These mites are microscopic relatives of spiders and ticks who live off of skin cells that we shed. It is almost impossible to eradicate them, and even the cleanest home has dust mites. Though dust mites do not bite us or cause rashes, they are a common cause of year-round allergy symptoms such as runny nose, itchy eyes, and sneezing. People with dust mite allergy have a persistently itchy nose even when not physically around dusty objects.

A recent study has shown that a new way of treating dust mite allergy is effective and safe. What do you need to know about this treatment, called sublingual immunotherapy?

Dust mite allergy and management

The first-line management of dust mite allergy is always to manage the environment. Beyond cleaning (wiping surfaces, washing linens), encasing any upholstery that cannot be washed will reduce the impact of dust mites, which like to burrow into soft cushions and mattresses. Zippered, allergen-resistant encasements for pillows, mattresses, and box springs can be purchased and are an effective measure in the fight against these microscopic mites. Over-the-counter allergy medications such as steroid nasal sprays and antihistamines can also be helpful.

For decades, when these measures have failed, we have used allergy shots, also called subcutaneous immunotherapy (SCIT), to treat dust mite allergy. This is an effective but burdensome treatment, which involves weekly shots for approximately six to eight months, and then monthly shots for approximately three to five years. The shots must be given in a doctor’s office, where a physician is present, because of the risk of allergic reactions. This is an inconvenience during normal times, but even more so during the pandemic.

SLIT: The convenient new way to treat dust mite allergy

Sublingual immunotherapy (SLIT), which was approved by the FDA in 2017, is the newest treatment option for treatment of dust mite allergy. It is sold under the brand name Odactra in the United States. Just like SCIT, SLIT trains the immune system to no longer recognize dust mites as an allergen. The biggest benefit compared to SCIT is the convenience: this is an oral medication that is taken at home.

The daily medication is placed under the tongue, and many patients complain of a bit of tingling in the mouth or an odd taste. And because there is a risk of an allergic reaction, you must carry an EpiPen at all times so that you can treat yourself if necessary. I teach all of my patients on SLIT to recognize and treat anaphylaxis. Your doctor may not prescribe SLIT if you cannot use epinephrine for any reason, such as severe heart disease. SLIT is expensive, and insurance approval has been a major barrier for my patients, despite my best efforts.

Study finds SLIT is safe and effective

A recent study, published in the Journal of Allergy and Clinical Immunology, showed the safety and efficacy of dust mite SLIT compared to placebo. This was an international study, with about 800 patients in the placebo group and 800 patients in the treatment group. At the end of one year, patients who had received dust mite SLIT had fewer nose and eye symptoms and had used fewer medications to control allergy symptoms, compared to those in the placebo group. The study also demonstrated safety, with no one having anaphylaxis and only four uses of epinephrine in the SLIT group. Although the study only extended out one year, SLIT would likely be used for three to five years, the same duration as SCIT.

SLIT for ragweed and grass is also FDA-approved, but we don’t combine SLIT treatments, so the best candidate for dust mite SLIT is someone who is allergic only to dust mites. A person with many allergies is better served by SCIT, which can address several allergies at once.

I’m excited about this new method of treating my patients, and I’m hopeful that similar drugs for other allergens will be on the horizon.

The post Can dust mite allergy be treated with a pill? appeared first on Harvard Health Blog.

Learn how to adjust key app settings so your diary and dashboards reflect your personal health and fitness goals.

The post How to Customize the App for Your Goals appeared first on Under Armour.

Canned cannellini and frozen broccoli are the star staples in this simple, high-fiber, vegetarian dish. No stove needed!

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Just about every single one of us is spending too much time in front of a screen these days. Many, if not most, of us are spending most of our days on one — including, unfortunately, our children.

Hindsight is 20/20, of course. When the pandemic began a year ago, we had no way of knowing it would last so long. Suddenly, school became remote, daycare ended. Many parents started working remotely, and those who remained in the workplace had less oversight at home. At the same time sports, playdates, and other non-screen activities literally disappeared. We naturally went into survival mode and turned on the screens. We let our kids spend hours more than they used to on entertainment media, figuring that it wouldn’t be for long. We turned a blind eye to the violent online games, figuring that at least our children were interacting with their friends.

But a year later we are still stuck in our homes — and our kids are increasingly stuck to their screens.

Life on screen: Changes in behavior and learning

This isn’t good for them. Besides the simple fact that screen time is sedentary time, too much time in front of a screen has effects on behavior and learning that can change our children. The rapid-fire stimulation of much of what children engage with on entertainment media makes slower-paced activities like playing with toys, painting a picture, or looking at a book less appealing. Not only that, but it can interfere with how children learn and practice executive function skills, like delayed gratification, troubleshooting, collaborating, and otherwise navigating life’s challenges. It also gives them fewer chances to use their imagination and be creative. It can affect their mood, making them anxious or depressed.

There is the additional problem that it’s hard to know what children are doing on screens; many young children are exploring violent games or social media platforms meant for adults, and their parents don’t even realize it.

Steps parents can take around screen time

We have at least a few months left of the pandemic — too long to pretend that this screen time problem is temporary. We also have to face the reality that the habits our children are learning might not stop once the pandemic fades. It’s time to make some changes — and build some new habits.

So what can we do?

Take stock of the problem. Take an honest look at what your children — and you — are doing. Actually count up the hours, and do some research into what exactly your children are doing online (have them show you). What you find out may surprise you; we all like to think that things are better than they are. We’re human. But you can’t make changes until you know what you are dealing with.

Draw some lines in the sand. The screens do not always have to be on, and some activities just aren’t okay. It’s time for some house rules if you don’t have them already. For example:

• Children should not be engaged in online activities or games that aren’t age-appropriate. This may include violent video games. Think long and hard about what you want your child to do. Talk to your pediatrician if you have questions.
• Screen time should not be getting in the way of sleep. Devices should be charged somewhere besides the bedroom (or on do not disturb mode for teens).
• Screen time shouldn’t be getting in the way of social interaction. Have screen-free zones, like family meals or other family time. (Yes, that means parents too.)
• Screen time shouldn’t get in the way of homework. This is complicated by homework involving screens, but many kids are getting distracted by social media and online gaming.

Think as a family about alternatives to screens. At the beginning of the pandemic, when we thought it would be quick, we all cut corners and were a bit lazy about coming up with alternatives. Now that we know it’s not quick, we need to reassess.

Talk about it as a family. Be clear that screen time has to get cut, that’s not the discussion — the discussion is about what you might do instead. For example:

• Board games and toys: get them out, make a space to play. We forget how fun it can be.
• Make things! Build with blocks, make a city out of boxes. Boxes that held bottles of wine or liquor can make great apartment buildings if put on their side — you can cut doors and windows and decorate each compartment. Draw, paint, or build with clay. Knitting and crocheting can be fun, and are easy to learn with online tutorials.
• Read books with actual pages. Graphic novels and comic books count.
• Play instruments. Virtual lessons — and free online tutorials — are available.
• Cook and bake. Try out new recipes, make old favorites. It doesn’t have to be fancy.

Some of this does involve adult time too, depending on the age of your child — and that’s not always easy these days. Try to come up with some activities that don’t require an adult to be actively involved. As for activities that do need adults, think of it as an investment in your child’s well-being — and a chance for you to unplug and relax too.

Make a family media plan. The American Academy of Pediatrics (AAP) has a great tool that you can use. You may have to go through a few versions as you work on disengaging your family from screens. But that’s fine; the point is to begin, to lean into healthy habits that will serve your children well for their rest of their lives.

Follow me on Twitter @drClaire

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