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HIV (the human immunodeficiency virus) weakens the human immune system and destroys the important cells that fight disease and infection. A person can get HIV when bodily fluids — including blood, semen, pre-seminal fluid, rectal fluids, or vaginal fluids of a person with the virus — come in contact with a mucous membrane or damaged tissue. HIV can be transmitted through breast milk, or when a contaminated needle or syringe comes into direct contact with the bloodstream.

There is no cure for HIV, but with proper medical care the virus and its effects can be controlled. HIV transmission can be reduced by consistent use of condoms and clean needles. However, another way to protect against getting HIV is pre-exposure prophylaxis, or PrEP.

PrEP is a pill that can help prevent HIV

PrEP is a combination of two antiretroviral medications, tenofovir and emtricitabine, that, if taken every day, can now prevent HIV. The pill (Truvada) is FDA approved. Truvada works by blocking an enzyme so that HIV cannot reproduce and establish infection in the body.

The pill is taken by mouth with or without food. It is best if taken at the same time every day, as this helps establish a routine. Skipping days isn’t recommended. If you forget a dose, take it as soon as you remember. If it is almost time to take the next dose, skip the missed dose and continue the regular dosing schedule. Truvada takes full effect seven to 20 days after starting the medication. It can be discontinued whenever the protection it offers is not necessary (for example, if your risk for HIV or preferences change). Do talk to your doctor when stopping or starting any medication.

Who should consider PrEP?

The following circumstances mean that PrEP may be a good choice and worth a conversation with your doctor:

  • if you have had anal or vaginal sex with more than one partner and prefer to use condoms only sometimes or not at all
  • if you are a sexually active adult male who prefers male partners, whose HIV status may not be known
  • if you are in a relationship with an HIV-positive partner
  • if you have recently had a sexually transmitted infection in your anus or vagina
  • if you have had sex with people who inject drugs, or if you inject drugs yourself
  • if you are trying to conceive with a known HIV-positive partner
  • if you have used stimulants, poppers, cocaine, meth, ecstasy, or speed in the last six months.
What about condoms?

Condoms do provide protection against HIV. Unlike PrEP, they also protect against other sexually transmitted infections, and prevent pregnancy when used correctly and consistently.

Does PrEP have side effects?

Overall PrEP is very well tolerated. As with starting any medication, some people will experience side effects such as nausea, gas, or headache. In general, these side effects are mild and tend to improve with time if the medication is stopped. Kidney problems can occur infrequently, and so your doctor will monitor your kidney function with regular blood tests. Some people may experience a mild reduction in bone mineral density. The significance of this is not known, but it tends to stabilize or go back to normal over time.

PrEP does not interfere with most medications including suboxone, methadone, or oral contraceptives, and does not affect sexual performance. While this medication has been used extensively in pregnant and breastfeeding women who have HIV infection, the risk/benefit of using it for HIV prevention during pregnancy or breastfeeding needs to be individualized. Talk to your doctor if you are taking NSAIDs like ibuprofen or naproxen, or antivirals like valacyclovir or acyclovir.

What are the next steps if you think PrEP is right for you?

Make an appointment with your doctor and talk about why you think you would like to take this medication. Your doctor will run tests to check for HIV and other sexually transmitted infections as well as hepatitis A, B, and C, and check your kidney function before starting PrEP. Usually your provider will need to get prior authorization for the medication. Most insurances cover the cost. If your provider is uncomfortable prescribing this medication, ask to be referred to an HIV specialist in your area.

You will need to see your doctor initially after one month and then every three months, when HIV and sexually transmitted infection testing will be repeated. Your kidney health will be monitored via a blood test once within six months, and PrEP must be stopped if the kidneys are adversely affected.

References

Centers for Disease Control and Prevention, HIV Basics: About HIV.

Centers for Disease Control and Prevention, HIV Basics: PrEP.

World Health Organization, Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV.

US Public Health Service, Preexposure Prophylaxis for the Prevention of HIV Infection in the United States — 2014: A Clinical Practice Guideline (PDF).

Acknowledgements: Dr. Linda Shipton, MD, an internist and infectious disease specialist at Cambridge Health Alliance, for support during the preparation of this post.

The post PrEP: Protection against HIV in a pill? appeared first on Harvard Health Blog.

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Have you ever noticed that you tend to get a lot angrier on the road with other drivers than you do with people in the rest of your life? To a large degree, the experience of road rage is universal, and can be explained by the emotional distance that is created between drivers when there is both physical separation and a high potential for perceived slights and wrongdoing. The relative anonymity of driving leads to an exaggerated emotional response when feeling slighted or threatened, in part because all you may know of the other driver is that he or she just cut you off. It makes sense that you might react more angrily in that situation than if the same interaction occurred in another real-life setting.

Now if you accept the premise that separation and relative anonymity increase the potential for rage, imagine what the anonymity and dehumanization of the Internet does to virtual interactions. It is well documented that online comment sections too often become a hub for threats, heated arguments, and name calling.

Let’s explore why this might happen.

In 2016, FiveThirtyEight.com performed an extensive survey of 8,500 commenters to better understand the nature of their behavior. It found that commenters tended to be younger than 40 and predominantly male. Commenters also stated that they commented primarily in order to correct an error, add to the discussion, give their personal perspectives, and represent their views. Less often, they were trying to be funny, praise content, ask a question to learn, or share their own thoughts. So, we can acknowledge that there is a certain self-selection in the Internet commentary world that will lead to many comments being oppositional, even if most readers do not perceive the article this way.

But why do online commenters so often seem rageful in their opposition?

One explanation begins with the knowledge that the content most likely to elicit impassioned responses is on the very subjects that people feel affect them personally. The majority of Internet commenters know something about the topics being discussed, and often their personal experience does not align with the viewpoint of the author. Put another way, they may feel that this firsthand experience makes them more knowledgeable than the author, while the author may only have theoretical experience or none at all. Because commenters so often identify personally with the topic for this reason, the magnitude of their emotional response can be amplified, sometimes leading to stronger language than they would use in the real world. This is the case even when topics are written by so-called experts. This may be attributed to a principle in psychology known as the “backfire effect” — that is, people often become counterintuitively more entrenched in their position when presented with data that conflicts with their beliefs.

Even when commenters read entire articles, hostile comments are often formed out of defiance rather than ignorance of evidence presented by the author. The Dunning-Kruger effect may be at play here. This principle states that a person’s perception of what they have read and the content they’ve actually read often do not align well. In other words, a person may read an article whose focus is on one area, but become attentionally derailed by a strong emotional response provoked early in the piece. The provocative nature of Internet headlines are in fact designed to elicit such emotional responses in order to gain additional page views. One result is that many readers come away very quickly feeling attacked or misrepresented by information when that was not necessarily the article’s objective or focus. With the inherent anonymity and seclusion of Internet use, it is not hard to see how reasonable online decorum so often fails to hold under such circumstances.

There is little that you as an individual can do about the nature of the Internet, but you can choose how you interact with it. Good mental health around Internet use likely revolves around limiting your use to content arenas that promote your best self by allowing you to be productive and enjoy the time you spend on the web. If sites or posts seem to make you rageful, it may not be worth continuing to engage in this way. This is one aspect of online interactions where you have a lot of control.

The post The psychology of Internet rage appeared first on Harvard Health Blog.

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Naturally fermented foods are getting a lot of attention from health experts these days because they may help strengthen your gut microbiome—the 100 trillion or so bacteria and microorganisms that live in your digestive tract. Researchers are beginning to link these tiny creatures to all sorts of health conditions from obesity to neurodegenerative diseases.

Fermented foods are preserved using an age-old process that not only boosts the food’s shelf life and nutritional value, but can give your body a dose of healthy probiotics, which are live microorganisms crucial to healthy digestion, says Dr. David S. Ludwig, a professor of nutrition at the Harvard School of Public Health.

Not all fermented foods are created equal

The foods that give your body beneficial probiotics are those fermented using natural processes and containing probiotics. Live cultures are found in not only yogurt and a yogurt-like drink called kefir, but also in Korean pickled vegetables called kimchi, sauerkraut, and in some pickles. The jars of pickles you can buy off the shelf at the supermarket are sometimes pickled using vinegar and not the natural fermentation process using live organisms, which means they don’t contain probiotics. To ensure the fermented foods you choose do contain probiotics, look for the words “naturally fermented” on the label, and when you open the jar look for telltale bubbles in the liquid, which signal that live organisms are inside the jar, says Dr. Ludwig.

Try making your own naturally fermented foods

Below is a recipe from the book Always Delicious by Dr. Ludwig and Dawn Ludwig that can help get you started.

Spicy pickled vegetables (escabeche)

These spicy pickles are reminiscent of the Mediterranean and Latin American culinary technique known as escabeche. This recipe leaves out the sugar. Traditionally, the larger vegetables would be lightly cooked before pickling, but we prefer to use a quick fermentation method and leave the vegetables a bit crisp instead.

  • 2 cups filtered water
  • 1 to 1-1/4 tablespoons sea salt
  • 2 tablespoons apple cider vinegar
  • 1 jalapeño or a few small hot chiles (or to taste), sliced
  • 1 large carrot cut into 1/4-inch-thick rounds or diagonal slices
  • 1 to 2 cups chopped cauliflower or small cauliflower florets
  • 3 small stalks celery (use only small inner stalks from the heart), cut into 1-inch-long sticks
  • 1 bay leaf
  • 1 cabbage leaf, rinsed

Warm the water (no need to boil). Stir in the sea salt until it dissolves completely. Set aside to cool (use this time to cut the vegetables). Add the vinegar just before using. The brine can be made ahead of time and stored in a sealed glass jar on the counter to use when ready to pickle.

Set a quart-size canning jar in the sink and fill it with boiling water to sterilize. Empty the jar and tightly pack the vegetables and bay leaf inside to within 1 to 2 inches from the top of the jar. Pour the brine over the vegetables to fill the jar to within 1 inch from the top. Wedge the cabbage leaf over the top of the vegetables and tuck it around the edges to hold the vegetables beneath the liquid.

Set jar on the counter and cover with a fermentation lid. (Alternatively, use a standard lid and loosen it a bit each day for the first few days, then every other day, to allow gasses to escape.) Let pickle for three to five days, depending on the indoor temperature. Check the taste after a couple of days, using clean utensils. Vegetables will pickle faster in warmer climates. Make sure the vegetables stay packed beneath the level of the liquid and add salted water (2 teaspoons sea salt dissolved in 1 cup warm filtered water) as needed.

When the vegetables are pickled to your liking, seal the jar with a regular lid and refrigerate. Vegetables will continue to slowly pickle in the refrigerator. They will keep for about one month. Taste for saltiness before serving and, if desired, rinse gently to remove excess salt.

Calories: 1 (per 1 tablespoon)

Carbohydrate: 0 g

Protein: 0 g

Fat: 0 g

Excerpted from the book Always Delicious by David S. Ludwig, MD, PhD, and Dawn Ludwig. Copyright © 2018 by David S. Ludwig, MD, PhD, and Dawn Ludwig. Recipe reprinted with permission of Grand Central Life & Style. All rights reserved. 

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As the weather gets better and school vacations begin, along with sunburns and water safety there is something else parents need to think about: ticks and Lyme disease.

Lyme disease is spread by the bite of the blacklegged tick. While there are cases in various parts of the country, it’s most common in the Northeast and mid-Atlantic states, as well as around the Great Lakes. The early symptoms of Lyme include fever, body aches, and a bull’s-eye rash. It’s very treatable with antibiotics, but if not caught and left untreated, it can lead to serious health problems.

Here is information from the Centers for Disease Control and Prevention on four things that everyone should know and do:

1.  Prevention is key

As is true with all health problems, preventing them in the first place is always best. Be mindful of where your children play, as brush and tall grasses are where the ticks hang out. As much as possible, try to keep to the center of paths. Use a repellent with DEET (at least 20%), picaridin, or IR3535 on exposed skin (the Environmental Protection Agency has a great online tool that can help you choose the best insect repellent), and spray clothing (including socks and shoes) and gear like backpacks with permethrin.

2. Do tick checks at the end of every day

Even if your kids were just playing outside in the yard, get in the habit of looking them over. Ticks like warm, moist areas like the armpits, groin, and scalp, so you should particularly check there. Be sure to look carefully, because the blacklegged tick often transmits when it’s in the nymph stage, and nymphs are really tiny.

If you find an attached tick, grab it at the base with a tweezer and pull it upward with steady pressure. You can get rid of a live tick by wrapping it tightly in something or flushing it down the toilet.

Along with checking your human family members, be sure to check pets that have been outside, as they can carry ticks inside with them. You should also check clothing. Anything that isn’t going into the wash can be thrown into the dryer for 10 minutes or so (when washing clothes, be aware that if they aren’t washed in hot water, they may need extra time in the dryer to kill any ticks on them).

3. Be on the lookout for symptoms

If you do tick checks at the end of every day you should be fine, because it takes at least 24 hours — more often 36 to 48 hours — for an infected tick to transmit Lyme. This is a really important point that many people don’t know.

The classic rash of Lyme is an expanding bull’s-eye rash at the site of the bite. The rash is present in 70% to 80% of cases. Of course, that means it isn’t present in 20% to 30% of cases, so if someone in your family had a tick on them for more than 24 hours, or if you live in an area where there are many cases of Lyme and there may have been a tick bite, you should call your doctor if the person has a fever, chills, aches and pains for no clear reason, along with swollen lymph nodes or swelling of one or more joints. While having these symptoms doesn’t mean for sure that a person has Lyme, it’s worth getting checked out, as early treatment generally leads to a complete cure.

4. Be a cautious consumer of information when it comes to testing and treatment of Lyme

As with many conditions, there is a lot of misinformation out there about Lyme testing and treatment. It’s important to use laboratories that use evidence-based norms and processes. There are many advertised tests for Lyme disease, but some of them are simply not reliable — and it’s really important to have reliable information when making a diagnosis. It’s also not recommended to do testing for Lyme in someone who does not have clear symptoms of Lyme disease.

Most people recover completely after treatment of Lyme, but there are some people who have chronic symptoms such as fatigue, pain, or joint swelling after Lyme disease. This is called post-treatment Lyme disease syndrome or post-Lyme disease syndrome. The cause of these syndromes is unknown. Prolonged use of antibiotics is not recommended. Studies have shown that it doesn’t help, and there can be serious health problems when antibiotics are taken for prolonged periods of time.

To learn more about Lyme and its treatment and prevention, visit the Lyme disease page on the Centers for Disease Control and Prevention website.

Follow me on Twitter @drClaire

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Follow me on Twitter @RobShmerling

Knuckle cracking is a common behavior enjoyed by many. It can become a habit or a way to deal with nervous energy; some describe it as a way to “release tension.” For some, it’s simply an annoying thing that other people do.

If you’ve ever wondered why stretching the fingers in certain ways causes that familiar noise or whether knuckle cracking is harmful in some way, read on. Despite how common it is, there has been considerable debate regarding where the noise comes from. Fortunately — at least for those of us who are curious about it — knuckle cracking has been the subject of a fair amount of research.

Here’s some of what we know about knuckle cracking
  • The “cracking” of knuckle cracking seems to be produced by increasing the space between finger joints. This causes gas bubbles in the joint fluid to collapse or burst. It’s a bit like blowing up a balloon and then stretching the walls of the balloon outward until it pops.
  • The reason you can’t crack the same knuckle or joint twice right away is that it takes some time for the gas bubbles to accumulate again in the joint.
  • Cracking the knuckles is probably harmless. Although there have been occasional reports of dislocations or tendon injuries from overly vigorous knuckle cracking, such problems seem very much to be the exception and not the rule.
How do we know that knuckle cracking is harmless?

One of the most convincing bits of evidence suggesting that knuckle cracking is harmless comes from a California physician who reported on an experiment he conducted on himself. Over his lifetime, he regularly cracked the knuckles of only one hand. He checked x-rays on himself after decades of this behavior and found no difference in arthritis between his hands. A larger study came to a similar conclusion.

There are rare medical reports of problems associated with this behavior that may relate to how much force is applied and one’s particular technique. For example, joint dislocations and tendon injuries have been described after attempts to crack knuckles. One study published in 1990 found that among 74 people who regularly cracked their knuckles, their average grip strength was lower and there were more instances of hand swelling than among 226 people who did not crack their knuckles. However, the incidence of arthritis was the same in both groups.

And a new study created a mathematical model of a knuckle that helped confirm that the noise comes from collapsing gas bubbles.

What about other sounds coming from the joints?

The origin of most joint noises, such as popping sounds or cracking of the knees when squatting, is uncertain. They may come from the kneecap rubbing on the bones below, or a tendon sliding across an irregular surface. However, in the absence of pain, swelling, or other joint symptoms, these sounds are probably nothing to be concerned about, and there is no reliable way to silence them.

The bottom line on knuckle cracking

If you want to crack your knuckles, it’s unlikely to cause you harm. But if you want someone else to stop cracking their knuckles, you’ll need a better reason than telling them they’re ruining their joints.

The post Knuckle cracking: Annoying and harmful, or just annoying? appeared first on Harvard Health Blog.

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Follow me on Twitter @JohnRossMD

If you’re the kind of person who avoids public bathrooms at all costs, you may feel validated, as well as disturbed, by a new study from researchers at the University of Connecticut and Quinnipiac University. They suspected that hot-air hand dryers in public restrooms might be sucking up bacteria from the air, and dumping them on the newly washed hands of unsuspecting patrons.

To test this theory, scientists exposed petri dishes to bathroom air under different conditions and took them back to the microbiology laboratory to look for bacterial growth. Petri dishes exposed to bathroom air for two minutes with the hand dryers off only grew one colony of bacteria, or none at all. However, petri dishes exposed to hot air from a bathroom hand dryer for 30 seconds grew up to 254 colonies of bacteria (though most had from 18 to 60 colonies of bacteria).

Were the bacteria multiplying inside the hand dryers, or were they being pulled into the hand dryers from the air inside the bathroom? To answer this question, the researchers attached high-efficiency particulate air (HEPA) filters to the dryers, which would eliminate most of the bacteria from the air passing through the dryer. When they exposed petri dishes to air from the hand dryers again, the quantity of bacteria in the dishes had fallen by 75%. As well, the researchers found minimal amounts of bacteria on the nozzles of the hand dryers. They concluded that most of the bacterial splatter from the hand dryers had come from the washroom air.

How did the bacteria get into the air in the first place? Unfortunately, every time a lidless toilet is flushed, it aerosolizes a fine mist of microbes. This fecal cloud may disperse over an area as large as six square meters (65 square feet). Aerosols from flushed toilets may be especially harmful in the hospital setting as a means of spreading Clostridium difficile.

Is there any good news from this study? Well, the vast majority of the microbes that were detected do not cause disease in healthy people, with the exception of Staphylococcus aureus. Some of the bathroom bacteria, such as Acinetobacter, only cause infections in people in the hospital, or in those with weak immune systems. The others that were found are relatively harmless. In addition, air from real-world bathrooms may contain fewer bacteria than the bathrooms in the study. The sampled restrooms were located in a university health sciences building, and at least some of the bacteria came from experiments going on in laboratories within the building.

So what’s a person to do to avoid picking up bacteria in a bathroom? You should still dry your hands, as not drying them after washing them helps bacteria to survive on them. Paper towels are the most hygienic way to dry your hands. For this reason, use of paper towels is already routine in health care settings. You may also wish to avoid jet air dryers, which have also been associated with the spread of germs in bathrooms. And remember that your chances of picking up a serious pathogen in a restroom are small. Direct contact with other people is much more likely as a means of acquiring infection.

The post The bacterial horror of hot-air hand dryers appeared first on Harvard Health Blog.

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For 30 years, I have talked to people about their memories and, as a neuropsychologist interested in amnesia, I am very interested in brain areas that mediate learning and forgetting.

How memories work

A core brain structure for memory is the hippocampus. The hippocampus (the Greek word for seahorse) is shaped like its namesake. It plays a key role in the consolidation of new memories and in associating a new event with its context (e.g., where it took place, when it happened). For example, you might hear the name Princess Diana. The hippocampus may activate verbal associations (e.g., she was part of the Royal Family), as well as memories of particular images or experiences. When I hear the name Princess Diana, I recall my brother telling me of her death as I descended the stairs of his home on Cape Cod. I can picture that moment in my “mind’s eye.” Despite my age, my (relatively) intact hippocampus allows me to retrieve a complex set of images and ideas that remind me where I was and who I was with when I heard the sad news of Princess Di’s death.

Memories that last

Some memories seem to age well. Recall of specific “flashbulb” events, such as the death of John F. Kennedy, or where you were on September 11th, 2001, seems unblemished and unchanged over time. However, in reality all memories, even flashbulb events, are malleable; they change as a result of the passage of time. They shift each time you call a memory to mind, as they are affected by other memories that have overlapping elements. As a student of memory, I am just as interested in long-term forgetting as I am in remembering. I am particularly intrigued by changes that take place with regard to autobiographical memory. Autobiographical memory is the foundation on which we derive a sense of who we are, what we find rewarding, and how we define our world. It is integral to how we construct meaning and purpose in our lives.

Autobiographical memory as we grow older

As we age our personal memories become fragile. They become less accurate and lose context. People with neurodegenerative conditions such as Alzheimer’s disease are particularly vulnerable to the loss of personal memories, due to the combined effects of their neurological condition and the aging process. They no longer have the same access to important milestones that helped define them. The importance of autobiographical memory is often overlooked. People come to me to ask for assistance with memory skills. I teach them all I know about mnemonic techniques to enhance face–name associations. I review cognitive strategies for new learning. I rarely talk about old memories… their first day of school, their first kiss, music from teenage years.

Tending to autobiographical memory

More recently I shifted my focus in conversations with people who want to talk about memory. Together with a therapist colleague, I started the “memoir project.” Why? I want to help highlight the important role of personal memories in maintaining a strong sense of self. People, even those with mild dementia, are encouraged to review important life events by using personal timelines to identify, for example, key events, food, music, and people who contributed to their sense of self. They may contact childhood friends, college roommates, and family members to remind them of shared experiences and to augment past memories. They often receive memory “gifts” as a result of these conversations — filling in the gaps in a memory that was beginning to fade. And of course, documentation and journaling are critical strategies. The stories people have shared with me have been fascinating. More important is the joy of reminiscence they experience.

The post Memories: Learning, remembering, (not) forgetting appeared first on Harvard Health Blog.

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Follow me on Twitter @RobShmerling

Chondroitin sulfate is among the most popular supplements in the world. It’s often taken in combination with glucosamine for joint disease — some take it for prevention, others to treat pain.

And yet, evidence that it actually works at all is limited at best. One review of the evidence suggested that of the few studies of chondroitin that were positive, nearly all were funded by makers of the supplement. Despite this, millions of people take it, many of my patients swear by it, and the lack of evidence doesn’t seem to be much of a concern to them. A frequent comment I hear is: “Well, I’m not sure if it’s doing much but it can’t hurt, right?” A new study suggests that maybe it can.

Can chondroitin increase melanoma risk?

Researchers publishing in the medical journal Molecular Cell are raising concerns that chondroitin sulfate may encourage the development or recurrence of melanoma, a potentially deadly form of skin cancer. Here’s what they found:

  • The growth of human melanoma cells with a particular mutation (called V600E) that had been grafted onto the skin of mice was promoted when the mice consumed chondroitin sulfate. About half of human melanomas contain this mutation.
  • Among mice fed chondroitin sulfate, these melanoma tumors were more resistant to an antitumor drug, vemurafenib, than those without the mutation.

Although this research did not actually study people with melanoma, the study authors speculate that for people with precancerous skin growths containing the V600E mutation, taking chondroitin might be a bad idea because it could speed up tumor growth. And if a person had melanoma in the past, taking chondroitin might make recurrence more likely.

The research linking chondroitin and melanoma is preliminary

It’s important to point out that this is preliminary research. Although the tumor cells studied came from humans, a link between chondroitin sulfate use and melanoma in humans has not yet been established. It’s possible that these results aren’t relevant to actual people — for example, the doses or metabolism of chondroitin sulfate may be so different in humans (vs. mice) that these results do not apply to humans. It is not rare that studies in animals do not translate directly to people.

Why does this matter?

Melanoma is not the most common type of skin cancer, but unlike many other skin cancers (such as basal cell cancers), simply removing the cancer doesn’t always cure it. It can spread quickly even years after apparent “cure.” Estimates are that more than 90,000 people learn they have melanoma each year, and more than 9,000 people die of the disease annually.

Here’s my take: this research is quite preliminary, and might turn out to have little relevance to human disease. But if chondroitin sulfate may promote melanoma growth — and it’s not clear that this supplement is particularly helpful anyway — I’d advise against its use, at least until we know more.

The post Chondroitin and melanoma: How worried should you be? appeared first on Harvard Health Blog.

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Follow me on Twitter @drClaire

As we learn more about the frequency and effects of concussions in football, we are increasingly being forced to face the question: do we need to take the tackling out of youth football?

A study published in the Annals of Neurology definitely begs that question. Researchers from Boston University examined the brains of 246 deceased football players, 211 of whom were diagnosed with chronic traumatic encephalopathy, or CTE. They found that the younger the players started playing tackle football, the earlier they started showing symptoms of CTE such as neurological and behavioral problems. In fact, for every year before age 12 that the players started playing, they showed symptoms 2.5 years earlier.

That’s really sobering. That means that a child who starts Pop Warner football in kindergarten at 6 could have real problems 15 years earlier than someone who started in middle or high school.

Now, there are obvious limitations to this study. They didn’t have a control group, and it’s certainly possible that families of players with more serious symptoms were more likely to donate the players’ brains for study. But given what we know about the effects of repeated head injury, it makes sense. Given what we know about any repeated injury, it makes sense: when you injure a part of the body it can become weakened, and less able to heal completely from future injuries. When that part of the body is the brain, the ramifications are particularly worrisome.

It’s hard to imagine football without tackling — but you could argue that the real athleticism of football isn’t the part where people get knocked down. You could argue that it’s in the speed and agility, the ability to throw and catch with precision. You could argue that the successful teams aren’t so much the ones who are good at slamming into people, but the ones who are good at strategy and teamwork. If we took out the tackling, we’d still be teaching young athletes skills that are important not just for sports but also for life.

Of course, concussions happen in other sports besides football. Youth who play soccer, volleyball, lacrosse, and many other sports are at risk for concussion too. My daughter actually got two concussions in high school swimming from colliding with other swimmers. It’s important that parents and coaches of athletes in all sports be aware of the risks and do everything they can to lessen them.

Injuries are part of sports. We can’t prevent them all without stopping kids from playing sports completely, which we don’t want to do. But if we know that there is a particular aspect of a sport that puts kids at real risk, and that aspect of the sport isn’t necessarily crucial, then maybe we should think about making changes while players are young. When they are adults, or even teens, they can make their own choices. But when they are young kids, keeping them safe and getting them to adulthood in the best shape possible is, well, our job.

That’s really the crux of it. Knowing what we do about tackling, can we in good conscience let our kids keep doing it?

The post Do we need to take tackling out of youth football? appeared first on Harvard Health Blog.

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Autonomy means being in control of your own decisions without outside influence — in other words, that you are in charge of yourself. It is considered an essential development step toward maturity. We all make decisions about how to live our lives, although sometimes we have less choice than we might like.

When it comes to your health care, how much autonomy is the right amount?

There’s lots of interest in what the term means. Here’s a definition from MedicineNet:

Patient autonomy: The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.

This can be a hard line to navigate. In the past, physicians made all the decisions for their patients. They would plan the care, prescribe the treatment, and the patient would either comply or not. The word “comply” is itself pejorative. We have moved into a much more enlightened era of care, and many physicians seek to involve patients, to help them understand treatment options, and to work collaboratively to achieve goals of wellness.

When you and your doctor don’t see eye to eye on the best health care for you

But what if you and your physician don’t agree on the best course of care for you? What if your doctor insists that she knows best, and that your health will be at risk if you don’t follow her advice? Maybe your physician has discouraged you from researching your medical condition yourself. From the physician’s angle, most of us want our patients to understand their illness, be educated on goals of wellness, and be active participants in their own healthcare. But here’s where it gets tricky: physicians study for years to become doctors and bring their scientific knowledge and clinical acumen to the office and the bedside. Patients may not have those skills, but they know their own bodies, tolerance for treatment, and the manner in which they are comfortable receiving care.

Finding the right doctor

It’s sometimes hard to find a doctor you’re comfortable with, whether it’s for you or your child. Making a list of what’s important to you — whether you have a physician you like now, are uncomfortable in your current treating situation, or are in the process of looking for a new provider — can really help. Ask yourself these questions:

  • What is my style about health care? Do I want my doctor to tell me what to do, list the options but give me the final choice, or let me describe the medication and plan that I have researched first?
  • Would I like someone who is more relational or more boundaried? Do I want a physician who has the style of sharing his own life with me, asks about my life and tries to incorporate who I am as a person as well as a patient, or would I prefer a more businesslike approach? Do I want my physician to tell me if she has the same illness I do, and what it’s like for her, or would I prefer my doctor keep this to herself?
  • How much do I want my doctor to know about me as a person? Is that important in the way I want to receive my health care?
  • What might happen if I disagree with my doctor? Would that end the treating relationship right there, or could we work through a difference?
The right doctor will naturally support your patient autonomy

Figuring out how you want your physician to work with you lets you maintain your patient autonomy, whatever that autonomy might be. Receiving the kind of care that is comfortable for you is exercising your autonomy. There will always be blips along the way. One woman told me about a primary care doctor she had worked with for years who became enraged with her at a visit, seemingly out of the blue. She felt he was attacking her health care behavior without asking appropriate questions. She offered him several opportunities during the visit to re-evaluate his comments. When he couldn’t do so, she used her autonomy to fire him. Another patient described being told that if he did not take a specific medication, the outcome could be devastating for his health. This may have been true, but perhaps a more collaborative discussion would have allowed this patient to feel less bullied into a treatment. Feeling comfortable with your right to get the answers you need to understand your treatment reflects your patient autonomy. Make sure your doctor’s style matches your own. How the treating relationship works is an essential part of the treatment. If it works, everything is enhanced. If your autonomy is not respected, your health care will suffer.

The post Take control of your health care (exert your patient autonomy) appeared first on Harvard Health Blog.

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