Category Archives: Men’s Health

Even as birth rates fall, teens say they are getting less sex education

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By Michelle Andrews
Kaiser Health News

Teenage girls are catching up to teenage boys in one way that does no one any good: lack of sex education, according to a recent report.

The proportion of teenage girls between the ages of 15 and 19 who were taught about birth control methods declined from 70 to 60 percent over two time periods, from 2006-2010 and 2011-2013, the analysis of federal data found.

Meanwhile, the percentage of teenage boys in the same age group who were taught about birth control also declined, from 61 to 55 percent.

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“Historically there’s been a disparity between men and women in the receipt of sex education,” said Isaac Maddow-Zimet, a coauthor of the study and a research associate at the Guttmacher Institute, a reproductive health research and advocacy group. “It’s now narrowing, but in the worst way.”

The study, which was published online in the Journal of Adolescent Health in March, analyzed responses during the two time periods from the Centers for Disease Control and Prevention’s National Survey for Family Growth, a continuous national household survey of women and men between the ages of 15 and 44.

In addition to questions about birth control methods, the study asked teens whether they had received formal instruction at their schools, churches, community centers or elsewhere about sexually transmitted diseases (STDs), how to say no to sex or how to prevent HIV/AIDS.

Overall, 43 percent of teenage girls and 57 percent of teenage boys said in the most recent time frame that they hadn’t received any information about birth control before they had sex for the first time. Continue reading

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Study Finds HPV Vaccine Has Lowered Number Of Women With Disease

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The HPV vaccine has lowered the number of women with HPV, a sexually transmitted disease that can lead to cancer, according to a study in the journal Pediatrics. NPR’s Audie Cornish talks to Dr. Joseph Bocchini from Louisiana State University to get his read on the results.

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Trying to conceive after a pregnancy loss — NIH

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Blue Pregnant BellyFrom the National Institutes of Health

A pregnancy loss, also called miscarriage or spontaneous abortion, is the unexpected loss of a fetus before the 20th week of pregnancy. After such a loss, many doctors recommend that couples wait at least 3 months before conceiving again.

The World Health Organization recommends waiting at least 6 months. However, there’s little evidence to support such delays.

At a Glance

  • Researchers found no evidence to support the idea that couples should wait for 3 months after an uncomplicated early pregnancy loss before trying to conceive.
  • For those who are emotionally ready, the common recommendation to wait at least 3 months after a loss may be too conservative.

A research team led by Dr. Enrique Schisterman at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) investigated the link between how long couples waited after an early pregnancy loss before trying to conceive again and their success in achieving live births.

The team analyzed data from a trial that took place from 2007 to 2011. The trial’s primary goal was to evaluate the effect of daily low-dose aspirin on reproductive outcomes in women, ages 18 to 40 years, with a history of pregnancy loss.

The participants were followed for up to 6 menstrual cycles and, if they became pregnant, until the outcome of their pregnancy was known. The investigators examined data from more than 1,000 of these women.

Their analysis excluded women with pregnancy complications known to require longer follow-up care. Results were published online on January 7, 2016, in Obstetrics & Gynecology.

The researchers found that more than 76% of the women began trying to conceive within 3 months after losing a pregnancy. Compared to those who waited longer, this group was more likely to become pregnant (69% vs. 51%) and to have a pregnancy leading to a live birth (53% vs. 36%).

The investigators didn’t find any difference in the risk of pregnancy complications between the groups.

“Couples often seek counseling on how long they should wait until attempting to conceive again,” Schisterman says. “Our data suggest that women who try for a new pregnancy within 3 months can conceive as quickly, if not quicker, than women who wait for 3 months or more.”

“While our data show no basis for delaying attempts at conception following a pregnancy loss, couples may need time to heal emotionally before they try again,” says first author Dr. Karen Schliep. “For those who are ready, our findings suggest that conventional recommendations for waiting at least 3 months after a loss may be unwarranted.”

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Older men who exercise more have better erectile function | Reuters

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Road BikeMen who exercise more have better erectile and sexual function, suggests a small study of older overweight men.

The authors say their results support the idea that exercise might one day be prescribed as a treatment for erectile dysfunction.

via Older men who exercise more have better erectile function | Reuters.

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Men, minorities and the elderly not getting treated for depression

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And younger man's hand holds an elderly man's handBy Milly Dawson
HBNS Contributing Writer

A leading cause of disability, depression rates are increasing in the U.S. and under-treatment is widespread, especially among certain groups including men, the poor, the elderly and ethnic minorities, finds a new study in General Hospital PsychiatryContinue reading

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CorrectionalHealthcare_thumb

Aging inmates push up prison healthcare costs

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By Christine Vestal
Stateline Staff Writer

State spending on prisoner health care increased in 42 states between 2001 and 2008, with a median growth of 52 percent, according to a new report from The Pew Charitable Trusts. The primary driver of the cost spike is bigger and older prison populations.

“Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend,” said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation.

Pew analyzed inflation-adjusted correctional health care expenditures collected by the U.S. Department of Justice from 44 states that participated. Overall, these states spent $6.5 billion on inmate health care in 2008, up from $4.2 billion in 2001. Average per-inmate spending also grew in 35 of the states during the same period at a median rate of 32 percent.

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Of the states in the study, prisoner health care costs in Illinois and Texas decreased. Those not included in the study are Georgia, Kansas, Kentucky, New Mexico, Vermont, Wyoming and Washington, D.C.

Although sentencing changes have resulted in a recent decline in the prison population, the number of people held in state prisons ballooned over the last 30 years. During the study period, it grew by about 200,000, a 15 percent increase.

During the same period, the number of state and federal inmates age 55 and older grew from 40,200 to 77,800, a 94 percent increase. Since 2008, the number of elderly inmates has continued to grow to 121,800 in 2011. The aging of the prison population is the result of a large number of inmates living out longer sentences and an uptick in the number of older people who are sent to prison.

Like the the population on the outside, elderly prisoners are more likely to have chronic medical and mental conditions that require expensive treatments. The health care costs for inmates age 55 and older with a chronic illness is on average two to three times that of the cost for other inmates, according to the study.

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Cutting Costs

States have developed a number of strategies to mitigate the rising cost of caring for prisoners, including increased use of telemedicine and the outsourcing of medical services to state universities and other providers, according to the report.

In addition, a small number of states have made limited use of Medicaid to help finance rising prison health care costs. The potential benefits of Medicaid financing will increase substantially in 2014 when the Affordable Care Act takes effect, but only in states that expand their programs.

Currently, most state Medicaid programs cover very few childless adults, who make up the bulk of the prison population. In most cases, only pregnant women and disabled inmates are eligible for Medicaid.

By expanding Medicaid to all adults with incomes up to 138 percent of the federal poverty line ($11,490 for an individual), virtually everyone who is incarcerated will qualify for the federal-state program. The federal government will pay 100 percent of costs for newly eligible adults from 2014 through 2016 and gradually decrease its share to 90 percent by 2020.

For inmates, Medicaid pays only for health care services provided outside of prison walls. But those charges – for inmates admitted for 24 hours or more to a hospital, nursing home or psychiatric center – are often substantial.

In Ohio, where Republican Gov. John Kasich recently circumvented the GOP-led legislature to approve the expansion, the state estimates it will save $273 million in prison health care costs in the first eight years. Michigan expects to save about $250 million on inmate health expenses in the first 10 years, and California expects to save nearly $70 million each year.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Randy Dotinga

A freelance writer with a dodgy ticker tells of his hunt for insurance

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Randy Dotinga

Randy Dotinga

I’d like to start a long-term relationship with a health plan, but all I’ve had are flings — seven insurers in the last 13 years. Is it something I said? Nope, it’s something I am: a self-employed, 45-year-old single guy with a heart that beats funny.

Take Cigna. We seemed to click until the company wanted me to pay $11,000 a year in premiums. Another insurer came calling but turned out to be a scam, defrauding me and thousands of others. The high-risk plan in California — my home state — took me on, but I had to cough up $700-plus a month for paltry coverage.

Another couple of government-run plans were supposed to get me through this year with cheaper rates, but a bureaucratic snafu snuffed my coverage.

At least my misery has company. People with pre-existing medical conditions “face every kind of possible hassle,” said Nancy Metcalf, a senior program editor with Consumer Reports. Many can’t find coverage at all.

Now 2014 is fast approaching, and I suddenly have suitors. Six companies are offering me 34 plan options through my state’s marketplace, which was created under the federal health law. Insurance coverage, at last, is guaranteed. And, for now, so is confusion.

It’s A Long Story Involving A Scam, An $11,000 Annual Premium And Relief (Kinda)

My endless insurance drama began in 2001, when my COBRA coverage expired from my previous newspaper job. I needed to find new coverage on the individual market as a self-employed freelance writer who didn’t have access to a guaranteed group health plan. But insurer after insurer rejected me because I had a pre-existing condition: an irregular heartbeat I’d developed in my 20s.

The condition, known as atrial fibrillation, slightly raises my risk of stroke. It also requires occasional cardiologist checkups and costs about $260 in medication each year. That was enough to make me one of the millions of people on the individual market who can’t get coverage because insurers don’t want to risk paying extra for their health problems. (I like to imagine that insurance companies ran screaming into the night when they received my applications).

I needed to find the individual insurance market’s Holy Grail — an insurer who’d take all comers, pre-existing condition or no. I discovered it through a writers’ group that sold an Aetna insurance policy, no health questions asked. But then Aetna spiked its rates, and the group found replacement insurance through a company called Employers Mutual. This did not go well.

The company turned out to be unlicensed and a scam, leaving me and 29,000 other policyholders in the lurch. Employers Mutual reportedly left tens of millions of dollars in medical claims unpaid.

Dotinga Steps 300Coverage through Cigna came next via a firm that provides coverage to members of associations representing artists, performers and writers. But in 2006, when I was 38, I faced a prohibitive increase in my monthly premium from $509 to $928.

(The Cigna rates are even worse now. My annual premium for 2013 if I bought a Cigna point-of-service plan through the same company: $3,028 a month, or $36,336 for the year, plus a $24 service fee.)

A lack of options forced me to enroll in California’s high-risk pool, and it cost me big-time. My monthly premium grew over time and by 2008 it was more than $700 a month for coverage with an annual benefit limit of $75,000 and a lifetime limit of $750,000.

As Metcalf of Consumer Reports puts it, that level of coverage is “terrible.” Indeed, a serious car accident or bout with cancer could wipe that out quickly. I worried that an expensive medical catastrophe would mean bankruptcy for me.

So I paid.

Left In The Lurch Once Again

Fast forward to the Affordable Care Act. For me, it is shaping up to be a blessing — sort of — in my case.

The health law set up a new state insurance plan for high-risk people – the California Pre-Existing Condition Insurance Plan – that offered me the opportunity to get fantastic benefits at less than half the cost of my existing coverage. But I had to go without any insurance for six months to qualify.

So I did, and I survived. But this plan, at an exceptional price of $265 a month, expired in June of this year, forcing me and residents of 16 other states into a six-month transition plan.

That brought more trouble. I’ve been paying the $287 monthly premiums for the transition plan, but a visit to the doctor’s office this month for a flu shot revealed that the feds cancelled my coverage back in August. The system seems to believe I’m eligible for Medicare. Actually, I have another 20 years. Now, I’m working through a bureaucratic maze of phone calls and emails to restore my coverage for the remainder of this year.

That’s just one spot of bother for me to resolve. There’s another: Now I need to wade through 34 insurance options from Covered California, the state’s online health insurance marketplace, which was created as a result of the health law,  and figure out which one to purchase for 2014.

Choices, Choices And More Choices

Fortunately, I live in one of the 14 states that operate their own marketplaces and don’t rely on healthcare.gov, the trouble-prone federal website. Unfortunately, the Covered California website has had its own glitches, including a buggy doctor search feature and shutdowns of the enrollment section for repairs.

So far in my efforts to enroll, which began shortly after the Oct. 1 launch, I’ve faced numerous impediments — blackouts when the site was shut down for scheduled maintenance, a disappearing enrollment section and other technical hiccups, including broken links and HTML coding problems.

Still, I’ve found the website easy to use when it’s actually working. It says 34 plans are available to me ranging in price and particulars from $263 a month for “bronze” level coverage in an exclusive provider organization to $548 a month for a “platinum” level health maintenance organization.

The “metal” levels — bronze, silver, gold and platinum — refer to the level of coverage offered by a plan. They range from platinum plans that cover an average of 90 percent of health care costs to bronze plans, which have significantly cheaper premiums but cover only 60 percent of costs and have higher deductibles. (They pay for 100 percent of costs after a policyholder reaches a set out-of-pocket spending limit.)

The state standardized the four general types of coverage levels so they share the same deductibles and co-pays, said Anthony Wright, executive director of Health Access California, a non-profit advocacy group. “This is a huge benefit for consumers because it creates a situation where people can actually make apple-to-apple comparisons, and it removes the fear of the fine print.”

34 Different Of Apples

But I’ve still got to compare 34 different apples. And it’s not just Granny Smith versus Red Delicious, even with California’s user-friendly modifications.

There are many factors to consider just to choose the best metal level. Platinum plans cover a lot with no deductible and a low, $4,000 maximum out-of-pocket expense for an individual, but they’re mighty pricey and a bad deal if I don’t need much care.

Bronze plans could save me thousands of dollars a year in premiums versus platinum plans, but they don’t cover much and have a higher out-of-pocket maximum — $6,350.

(My income is too high for me to be eligible for subsidies to reduce my premium or costs like co-pays. The Covered California website says I’d get an $11 a month subsidy if I made $45,000 in “Modified Adjusted Gross Income” a year or a whopping $207 monthly subsidy if I made $25,000.)

The Covered California website had a handy feature that asked me how much I typically spend on medical costs annually and then estimated how much I’d spend each year, per plan, on premiums and out-of-pocket costs. But that feature seems to have disappeared for the moment, along with the enrollment section.

Then there are the other factors: HMO, PPO or EPO? If I’d like an HMO, I could go with Kaiser Permanente, which insures 7 million Californians and is well-respected, but would require me to dump my current doctors. HealthNet has by far the cheapest gold-level HMO plan at $347 a month, a savings of $552 a year over the next cheapest one.

But the website’s failure to provide a working database of the physicians covered by the various plans leaves me in the dark about whether HealthNet HMOs include the doctors I’ve seen for a decade or longer.

And I know HealthNet has tried to lower costs to policyholders by sharply limiting the number of doctors who are covered by its plans. So has Blue Shield of California, which will make about half of its doctors off limits to those who buy coverage through the marketplace, the LA Times reported.

Soon, though, I should have coverage set up for 2014 that will be thousands of dollars cheaper a year than what it once was — although more than I’m paying now — and cover much more.

Who knows, maybe an insurer and I will finally start going steady.

Randy Dotinga is a freelance writer based in San Diego.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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State gonorrhea cases up 34 percent

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Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Snohomish to offer free HIV tests for eligible gay & bisexual men, Oct. 1

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aids-ribbonIn support of National Gay Men’s HIV Awareness Day, the Snohomish Health District will host a free evening of information and testing from 4-7 p.m., Tuesday, Oct. 1 in Suite 108 at the Rucker Building, 3020 Rucker Ave., Everett, Wash.

The event is directed to gay and bisexual men who are at risk for HIV infection and other sexually transmitted diseases. No appointment needed. The event includes door prizes and light refreshments, and every man screened will receive a financial incentive.

Snohomish County currently ranks third in the state for new HIV cases, following King and Pierce counties. Recent data show that 58 percent of all new HIV cases in Washington State are among men who have sex with other men (MSM). Gay and bisexual men make up less than 10 percent of the population, but account for almost 60 percent of the burden of HIV disease.

The Health District also will offer free testing to qualified men for Hepatitis C and syphilis, and vaccine for Hepatitis A and B. Both the Hepatitis C and HIV tests are “rapid” antibody tests, requiring only a drop of blood pricked from a finger.

Test results will be available within 30 minutes. The tests are anonymous and confidential.

New prevention tool: Pre-exposure prophylaxis –PrEP

Information about a new HIV prevention tool will be shared by Michael Louella, outreach coordinator for the AIDS Clinical Trial Unit in Seattle.

Pre-exposure prophylaxis, or PrEP, is when HIV-negative individuals take a pill to prevent HIV infection.

The medicine currently is used to treat HIV, and has now been approved for this treatment by the Centers for Disease Control and Prevention, and the Food and Drug Administration.

Research studies show that PrEP can lower the risk of HIV transmission when used with other prevention measures, such as condoms.

For more information about HIV testing and risk, please call David Bayless, 425.339.5238.

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This Father’s Day, give your heart a checkup — CDC

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From the Centers for Disease Control and Prevention

HeartHeart disease does not discriminate. It is the leading cause of death for men of most racial and ethnic groups in the United States, including African Americans, American Indians and Alaska Natives, Hispanics, and whites.

For Asian American men, heart disease is second only to cancer among the leading causes of death.

A man’s risk for heart disease begins to rise greatly starting at 45 years of age.

Half of the men who die suddenly of coronary heart disease—the most common kind of heart disease—have no previous symptoms.

Even men who have no symptoms may be at risk.

The good news is that heart disease deaths have been falling steadily over the past few decades. With Father’s Day around the corner, it is a great time for all men to consider what they can do to lower their own risk for heart disease, for themselves and for their loved ones. What better time to start than now?

What are the symptoms of a heart attack?

The five major symptoms of a heart attack are—

  • Pain or discomfort in the jaw, neck, or back.
  • Feeling weak, light-headed, or faint.
  • Chest pain or discomfort.
  • Pain or discomfort in arms or shoulder.
  • Shortness of breath.

A person’s chances of surviving a heart attack increase greatly if the victim receives treatment quickly. Recognizing the signs of a heart attack will help you act fast and call 9–1–1 during a real emergency

Who’s at risk for heart disease?

Anyone—male and female, young and old, of any race/ethnicity—can develop heart disease. Several medical conditions and lifestyle choices can put people at a higher risk, including—

  • Diabetes.
  • Overweight and obesity.
  • Unhealthy diet.
  • Physical inactivity.
  • Alcohol overuse.

You can help prevent heart disease by making healthy choices and managing any medical conditions you may have.

Start reducing your risk today

There are many good reasons to lower your risk of heart disease. Following these steps will put you well on your way to leading a longer, healthier life and enjoying the benefits of heart health for years to come.

Eat a healthy diet. Fresh fruits and vegetables are especially abundant during the summer. Be sure to eat plenty of them—adults should have at least 5 servings each day.

Eating foods low in saturated fat, trans fat, and cholesterol and high in fiber can help prevent high cholesterol. When grilling, remember healthy meat alternatives, such as fish.

Limiting salt or sodium in your diet also can lower your blood pressure. For more information on healthy diet and nutrition, visit CDC’s Division of Nutrition, Physical Activity, and Obesity Web site or ChooseMyPlate.gov.

  • Maintain a healthy weight. Being overweight or obese can increase your risk for heart disease. To determine whether your weight is in a healthy range, doctors often calculate a number called thebody mass index (BMI). If you know your weight and height, you can calculate your BMI at CDC’s Assessing Your Weight Web page.
  • Exercise regularly. The summer is a good time to get active with family and friends. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. The Surgeon General recommends that adults should engage in moderate exercise for 2 hours and 30 minutes every week. Walk, go for a hike or a bike ride, or head to the local pool for a swim. For more information, seeCDC’s Division of Nutrition, Physical Activity, and Obesity Web site.
  • Monitor your blood pressure. High blood pressure often has no symptoms, so be sure to check it on a regular basis. You can check your blood pressure at home, at a local pharmacy, or at a doctor’s office. Find more information at CDC’s High Blood Pressure Web site.
  • Don’t smoke. Cigarette smoking greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quit as soon as possible. Your doctor can suggest ways to help you quit. For more information about tobacco use and quitting, visit CDC’s Smoking & Tobacco Use Web site and Smokefree.gov.
  • Limit alcohol use. Avoid drinking too much alcohol, which can increase your blood pressure. Men should have no more than two drinks per day (and one per day for women). For more information, visit CDC’s Alcohol and Public Health Web site.
  • Have your cholesterol checked. Your health care provider should test your cholesterol levels at least once every 5 years. Talk with your doctor about this simple blood test. You can find out more from CDC’s Cholesterol Web site.
  • Manage your diabetes. If you have diabetes, monitor your blood sugar levels closely, and talk with your health care team about treatment options. Visit CDC’s Diabetes Public Health Resource for more information.
  • Take your medicine. If you’re taking medication to treat high blood pressure, high cholesterol, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something. Your pharmacist can help if you have questions about taking your medication or about side effects.

More Information

References

  1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009.  [PDF – 3.12MB] National Vital Statistics Reports. 2011;60(3).
  2. Heron M. Deaths: leading causes for 2009  [PDF – 2.56MB]. National Vital Statistics Reports. 2012;61(7).
  3. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation.2013;127:e6–245.
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Microscopic view of prostate cancer

New PSA screening guidelines urge weighing harms, benefits

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By Rita Rubin

This KHN story was produced in collaboration with 

Microscopic view of prostate cancer

Prostate Cancer

For nearly a quarter century, doctors have ordered annual PSA tests for men of a certain age to screen for prostate cancer, despite a lack of evidence that the benefits outweighed the risks — especially when tiny, slow-growing tumors were detected.

But the landscape appears to be changing. While questions about PSA screening remain, physicians increasingly recognize the need to discuss both the harms and benefits with patients.

The U.S. Preventive Services Task Force shook up the status quo last July when it advised against using the simple blood test, which measures levels of a protein called prostate specific antigen, with average-risk men of any age who had no prostate cancer symptoms.

That recommendation prompted a backlash from urologists, who argued that screening saves lives, but gave pause to primary care doctors.

In recent weeks, though, urology and internal medicine groups have published surprisingly similar directives.

“I would say it’s a shift toward a more targeted screening approach rather than a one-size-fits-all screening approach,” said Dr. H. Ballentine Carter, a Johns Hopkins urologist, of the American Urological Association guidelines released May 3 and developed by a committee he chaired. The international association has more than 19,000 members worldwide.

Carter’s committee noted that the greatest benefit appears to be for those 55 to 69 but urged that men in that age group discuss the pros and cons with their doctor before deciding whether to proceed.

For those who opt for screening, waiting at least two years between tests could minimize potential harms — namely false-positives and the detection of slow-growing tumors that wouldn’t have caused any symptoms — while preserving most benefits.

Similarly, the American College of Physicians, representing internists, released guidelines April 9 advising members to discuss the test’s “limited benefits and substantial harms” with patients 50 to 69 years old and let them decide.

Both groups agreed that doctors should not screen men younger or older than their guidelines’ age ranges or those expected to live less than 10 to 15 years because of other health conditions.

An elevated PSA level doesn’t necessarily signify prostate cancer, but it can trigger a cascade of tests and treatments that could be riskier than the disease itself, potentially causing impotence, incontinence or even death from prostate cancer surgery.

Even before the latest sets of guidelines were released, Dr. Michael Albert, a Hopkins internist, said he began to change his approach, spurred by the Preventive Services Task Force recommendations and a 2009 U.S. study that concluded PSA screening didn’t save lives.

“It used to be much easier for me to click on the PSA button and order it,” said Albert, medical director of the East Baltimore Medical Center, part of Johns Hopkins Community Physicians.

Dr. Gene Green, a board-certified family practice doctor and internist who is president of the Hopkins-affiliated Suburban Hospital in Bethesda, said he’s been screening a smaller percentage of patients and referring fewer of them with a PSA level of 4 — traditionally the point at which prostate cancer concerns are raised in older men — to urologists.

Carter, head of adult urology at Hopkins, said the AUA guidelines “had absolutely nothing to do with the task force,” and though the two groups’ guidelines were based on similar scientific evidence, they viewed the evidence differently.

“We interpreted the evidence from an individual’s perspective vs. a public health perspective,” he said. Prostate cancer might not represent a threat to the public health the way diabetes or heart disease does, but it’s a “major risk to an individual who’s in your office and who may be very concerned about the possibility,” Carter said.

Dr. Kenny Lin, a family physician, called the informed-consent approach a “cop-out.” Simply by raising the subject of screening, doctors push patients toward it, said Lin, who as a medical officer at the Agency for Healthcare Research and Quality wrote the evidence review on which the Preventive Services Task Force based its recommendation. So, said Lin, now on the faculty at the Georgetown University School of Medicine, “I don’t bring it up necessarily.”

Meanwhile, the American Association of Clinical Urologists, whose website said its membership includes 45 percent of U.S. urologists, warns in a statement that these recent sets of guidelines could leave the impression that early detection of prostate cancer is no longer needed.

The Preventive Services Task Force and the AUA committee agree that one life is saved for every 1,000 men screened.

“There’s really no doubt [it] saves lives,” said Dr. William Nelson, a medical oncologist and urologist who directs Hopkins’ Sidney Kimmel Comprehensive Cancer Center.

The death rate from the disease has been declining since it peaked 20 years ago, although it isn’t clear how much is due to PSA screening and how much to improved treatment.

Still, Nelson acknowledged, “a lot more men die with prostate cancer than will ever die of it. The greatest threat to their health and happiness is attempts to treat them.”

ProstateSince the 1990s, screening has led to a diagnosis of early-stage prostate cancer in more than a million U.S. men who probably never would have developed symptoms. More than nine out of 10 of them chose aggressive treatment.

Mark Humphrey, now 71, a retired General Electric executive, lived in western Massachusetts when a 2006 test showed his PSA had nearly doubled to 3.5. Although still in the normal range below 4, the rapid increase spurred his doctor to refer him to a urologist for a biopsy, which revealed abnormal cells.

But his cancer appeared unlikely to be aggressive. That information, coupled with memories of his late brother-in-law’s experience with incontinence and impotence after surgery, led Humphrey to take a pass on the aggressive approach.

So Humphrey, who now lives in Baltimore, enrolled in the world’s first prostate cancer “active surveillance program,” which Carter directs at Hopkins. Instead of treating Humphrey’s disease, Carter is keeping an eye on it, with PSA testing and a rectal exam every six months.

Approximately 1,000 men have opted for active surveillance since the program launched more than 16 years ago. By following the participants, Carter said, he and his colleagues hope to learn more about what distinguishes slow-growing from aggressive cancers. Their goal: to build a better screening test.

“And then we want to learn more about the personal preferences of patients,” Carter said. For example, are they comfortable living with cancer?

Albert remembers seeing one patient, an otherwise healthy man in his early 60s with a PSA-detected tumor. After six months in the program, the man chose surgery. “He couldn’t fathom the idea that you’d sit on a cancer that could metastasize.”

Carter, Nelson and Green are among a group of Hopkins urologists and primary care doctors working on an app to help doctors discuss the risks and benefits of PSA screening with patients.

The app, to be tested later this year, takes into account such factors as life expectancy and prior PSA levels. It will be integrated into patients’ electronic medical records.

Notes Green: “Very few times in our lives can we say ‘always’ or ‘never.'”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teen Pregnancy, Part 5: Teens Raising Children

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By Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

It’s hard to write a brief post on something as complicated on teens having and raising children! Your story will be different than anyone else’s, and your experience unique. However, I think the following 8 points are good ones to consider when your teen tells you they are thinking about becoming a parent.

1. Your teen needs to make this decision. Let your teen know what you think about them having and raising the child, and why. Make a pro-con list. Discuss your experience in parenting and give them a realistic view of what to expect. But even if you disagree with their decision, it’s important to respect it. This isn’t a decision you can make for them without the possibility of major repercussions down the road.

2. This is going to be a hard adjustment. Many parents of teens are looking forward to a time when the house will be theirs again, when they can retire and take trips and generally relax. Now there is the prospect of a new infant in the home. It’s completely normal to feel disappointed or angry, even while you know you’ll love your grandchild. If the feelings persist or are interfering with your ability to cope, seek help from a counselor. Likewise, if you feel like your teen is having trouble adjusting, have them see a counselor as well.

3. Your teen needs your help. Remember how lost you felt, the first time you were caring for a newborn? Hopefully, you had wise friends and family to help you with taking on the role of a new parent. Your teen needs that wise advice, and your experience is invaluable. Any teen can learn to feed, change, and clothe a baby. But they will need your ongoing support to interact with their baby, learn to play with them, differentiate normal behavior from worrisome signs, and adjust to their rhythms.

4. Make a plan. Any teen will appreciate help with babysitting, diaper changes, and driving to the doctor’s appointments, but some teens simply expect their parents to raise the baby. Even young teenagers can and should take on parenting responsibilities. Sit down with your teen before the baby is born and work through what your expectations are, including their responsibilities in getting prenatal care now and planning for the birth. Make sure they know that as they get older, more parental responsibility will shift to them. Conversely, some teens may expect to be able to take on all care immediately, with little to no parental help. Let them know that you are happy to assist, and they will usually take you up on it once the baby is born.

5. Don’t abandon educational and career goals. Your teen needs to attend school full-time after their time off to have the baby, making use of day care as needed. If your teen gets any pushback at school, this may be illegal; the ACLU has information about ways to respond effectively. If your teen was planning on college, having a child shouldn’t change that. Many campuses have family housing, day care facilities, and support for student parents. Further education or career training leads to better financial stability in the future, which will help both your teen and their child.

6. Let your teen have a life. Part of teen development is spending time with peers, and your teen is no different. They need to be able to go out with their friends, date, and have an active social life. While they should expect some nights in, it’s important that they spend time having fun outside the house. By offering to babysit and let your teen go be a typical teen for a while, you’re helping them mature into a socially healthy adult. In addition, find community programs (this one is a good example) where your teen can meet other teen parents.

7. Expect rough patches. Babies are adorable. Toddlers are adorable, too, but at around age 2 they become much less pliable. Your teen may have a lot of trouble with the “terrible twos”, when their baby is discovering its identity, being contradictory, and fighting parental authority. For a teen whose developmental tasks are discovering their identity, being contradictary, and fighting parental authority, this can be a lot to take. Know that there are times in the development of both your teen and your grandchild when a cooler head and more experienced hands may be called for.

8. You’re going to love your grandchild. Even if this wasn’t exactly when you planned on having a grandchild, you’ll still love this baby like crazy. Your family is growing, perhaps unexpectedly, but you will have a new love in your life along with all the chaos this situation brings!

What advice would you give to parents whose teens are planning to have and raise a child? What advice would you give to teens?

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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