7 Health Benefits of Holding Hands and Its Potential for Healing Society


There’s something special about holding hands with another human being. All of us are innately conscious of how this simple act can stir an instant intimacy, heighten our awareness and express a deep connection. This alchemy of two hands touching has so deeply captured our collective imagination, it’s been the subject of our highest artistic achievements, from the ceiling of the Sistine Chapel, to the poetry of Romeo and Juliet, to the lyrics of the Beatles.

But what is it about holding hands, exactly, that makes it so powerful? In partnership with Dignity Health, The Huffington Post explored what science can tell us about this ubiquitous, mysterious gesture and how it can affect our brains and physical well-being, as well as our relationships. Holding hands, we learn, has the power to impact the world.

Holding Patterns

Human beings are hardwired to seek out each other’s touch before we are even born. If you’ve ever touched the palm of a newborn baby, then you’ve likely witnessed (and been treated to) one of the earliest instinctual responses to manifest in humans: the “grasping reflex.” Known to science as the palmar grasp reflex, the instinct makes a baby grab your finger and squeeze it tight.

Humans share this trait with our primate ancestors; it can still be observed in species of monkeys, notably in the way newborns cling to their mothers, unsupported, so the mother can transport the two, hands-free.

Human fetuses have been observed displaying this behavior weeks before full-term delivery. They will clutch their umbilical cord, place their hand in their mouth, or suck their thumb. Twin fetuses are known to hold hands, as poignantly captured in a Kansas family’s moving sonogram image, in which one twin is healthy and the other is critically ill.

Babies may relinquish the grasping reflex over time, but the importance and vitality of touch remain essential.

Touch, A Necessity Of Life

Quantifying the power of touch can be challenging for researchers — measuring the outcome of, say, depriving a child from human contact is unethical. But an unsettling episode in Romania offered scientists some telling insights into what can happen when we are denied the nurturing that touch can provide.

Charles Nelson, professor of pediatrics at Harvard Medical School and author of the book Romania’s Abandoned Children: Deprivation, Brain Development, and the Struggle for Recovery, led a study that measured the developmental progress of hundreds of children raised in poorly run Romanian orphanages. They had endured years without being held, nuzzled or hugged, according to a Harvard Gazette report. Many of the children had physical problems and stunted growth, despite receiving proper nutrition.

The same appears to hold true through adulthood. Adults who don’t receive regular human touch — a condition called skin hunger or touch hunger — are more prone to suffer from mental and emotional maladies like depression and anxiety disorders.

As psychologists Alberto Gallace and Charles Spence point out in the journal Neuroscience and Biobehavioral Reviews, “touch is the first of our senses to develop” and “our most fundamental means of contact with the external world.” It’s more than just a comforting sensation; touch is vital to human development and life.

The ‘Love Hormone’ 

Clearly, we humans live to touch. But how does it sustain us? What’s happening in our bodies and minds when what we touch is another person’s hand?

Multiple studies — including one conducted at the University of California Los Angeles (UCLA) — show that human touch triggers the release of oxytocin, aka “the love hormone,” in our brain. Oxytocin is a neurotransmitter that increases feelings of trust, generosity and compassion, and decreases feelings of fear and anxiety.

Dr. Tiffany Field, director of the Touch Research Institute (TRI) at the University of Miami/Miller School of Medicine, says that holding hands is one of the most powerful forms of touch in part because the skin is a sense organ and needs stimulation, just as the ears and the eyes do.

Touch is our most fundamental means of contact with the external world.

Psychologists Alberto Gallace and Charles Spence

“When the fingers are interlaced and someone is holding your hand, they’re stimulating pressure receptors [that trigger] what’s called vagal activity,” Field says. “When there’s pressure in the touch, the heart rate goes down, the blood pressure goes down, and you’re put in a relaxed state. When people interlace their fingers, they get more pressure stimulation than the regular way of holding hands.”

Physical touch — and especially holding hands — is commonly associated with “feeling good.” Which raises the question, is there more hand-holding can do for us?

With Touch Comes Toleration

As we’ve seen, humans are not only creatures of habit, we’re also creatures of comfort. We gravitate toward situations and people who make us feel as content and secure as possible.

In the scientific study “Lending A Hand,” neuroscientists from the University of Virginia and the University of Wisconsin studied the effect the simple act of a human touch has on people in stressful situations. In this case, the participants underwent the threat of electric shock. The researchers came to the conclusion that a “loving touch reassures.”

On a physiological level, participants were able to better cope with pain and discomfort when they were holding hands because the act of holding hands decreased the levels of stress hormones like cortisol in their body. In other words, if stress is contagious, apparently a feeling of calm is contagious, too.

The Societal Imprint Of Human Touch 

Scientific research correlates physical touch with well being in  several important areas of life. Multiple studies at TRI concluded physical touch can affect pain management, lower blood pressure, decrease violence, increased trust, build a stronger immune system, create greater learning engagement and enhance overall well-being.

TRI is mining the potential of touch through a range of current studies, including how massage may help premature babies to grow, and if it can reduce depression in pregnant women such that they’re less likely to deliver prematurely.

“If every preemie was massaged in the U.S.,” Field suggests, “in one year that would save about $4.8 billion in hospital costs, because on average they get out of the hospital six days earlier.”

Field and her colleagues at TRI treat people with hip pain, typically from arthritis, and work to reduce depression and sleep problems in veterans who suffer from PTSD.  “Touch reduces pain because of the serotonin that’s released, and with the pressure on receptors during physical exercise, you get more deep sleep,” Field says.

Human Touch: More Important Now Than Ever

Science indicates that there’s a social argument to encourage hand-holding. What’s holding us back from embracing this? Today’s growing preoccupation with digital media over personal physical contact may unintentionally affect people negatively.

Though small in scope, another Touch Research Institute study suggests that American teenagers touch each other less than French teenagers do, and are more prone to aggressive verbal and physical behavior. Other data supports this claim that American youth is more violent and more prone to suicide than youth in other countries. Field’s hypothesis is that it has to do with ours being a “touch-phobic society.”

Oh please, say to me / You’ll let me be your man / And please, say to me / You’ll let me hold your hand

The Beatles, “I Wanna Hold Your Hand”

“With this taboo of touch in the school system, children are getting touched less,… less than when I was a kid, certainly,” Field says. “We’re so concerned about kids being touched the wrong way that we’ve basically banned it from the school system, and I think that’s really unfortunate.”

What can we do to shift this paradigm? It may be as simple as instilling in ourselves the mindfulness to outstretch a hand more often to those in our lives who matter most to us.

Here is a summary of seven documented benefits of holding hands:

  1. Holding hands is a great stress reliever

Holding hands with your significant other decreases the level of a stress hormone called cortisol. Even the touch of a friend or a teammate can make us feel more content, connected, or better about ourselves. When we are stressed out, a light touch on our hand can help ease the strain, both physically and mentally. Our skin also gets more sensitive when cortisol is rushing through our bloodstream, so the touch of a helping hand will have a significantly larger impact. The largest concentration of nerve endings is actually contained inside the hands and fingertips.

So, next time you’re having a really tough day, get together with your partner or a friend and ease the stressful day with them.

  1. Holding hands boosts love & bonding

Oxytocin is the hormone behind this benefit. Oxytocin strengthens empathy and communication between partners in a relationship, which is proven to be a contributing factor for long-lasting, happy relationships. Holding hands with your partner will improve your relationship and create a bond that will impact the quality of your relationship significantly.

Couples who have happy relationships hold hands automatically, sometimes without even noticing, because of a habit developed by their nervous systems. Holding hands produces the oxytocin, which makes us feel happier and more loved.

  1. Holding hands is great for your heart

Besides relieving stress, holding hands with your partner lowers your blood pressure, which is one of the major contributors to heart disease. When we’re clasping fingers with our loved ones, we’re not just easing stress and improving our relationships – we are providing a comfortable sensation that helps our heart. The power of a warm touch goes beyond the health benefits to the heart; a study from Behavioral Medicine backs up this claim.

  1. Holding hands relieves pain

While enduring pain, humans have the natural reflex to tighten their muscles. Think of childbirth – husbands are typically inside the delivery room holding their wife’s hand while she’s going through labor. The reflex to grasp our partner’s hand comes as second nature: It’s always easier to endure pain while holding hands with your soulmate.helping hand

  1. Holding hands fights fear

Remember that horrible scene in the last horror movie you saw that made you want to jump out of your chair? Luckily, your darling was with you to hold your hand and make you feel safe. The human brain responds to sudden stimulation using adrenaline; this stimulation gets our blood pumping and releases high levels of cortisol throughout our body.

During these moments, our natural reaction is to hold hands with someone we trust. It varies from person to person, but a large portion of women will instantly grab their partner’s hand. That’s the intuitive way to fight off nerve

  1. Holding hands provides a sense of security

Simple hand holding is a source of safety and comfort for young children. Remember when your parents taught you to how to cross the street or walked you down a crowded sidewalk? Or when you were learning to ride a bicycle? Insecurity disappears when we have a hand to hold and allows us to more easily conquer obstacles. The security that parents provide their children by holding hands shapes their children’s behavior and their way of thinking.

Additionally, the sensation of safety goes both ways; parents also feel safer when their children are within their grasp.

  1. Holding hands is just plain comfortable

Everybody loves comfort. The sensation of holding hands often provides a comfy feeling while talking a walk with your loved one. A great example is holding hands inside a jacket pocket to warm them up on those cold December nights when you decide to take a stroll in the snow with your partner. Even with gloves, we love to hold hands. It bonds us; it provides lovely sensations and gives us quality time with people we care about.

Conclusion

One thing is certain: our entire bodies, from our nerves to our brains, respond positively to touch and crave it from the time we’re born. Whether it’s due to instinct, comfort, intimacy or love, touch brings us closer to each other both physically and emotionally — and is a necessity for our overall well-being.

This tiny, commonplace behavior triggers chemical reactions in our minds that make us feel loved, happy, cared for, and respected.  Holding hands is one of the fundamental ways we can positively impact our lives and the lives of others.

When we hold hands, the nerves in our skin communicate with our core nervous system, producing hormones that make us feel pleasant and warm. There’s much more to it, of course, and new studies continue to explore the positive psychological effects of human touch today.



As AT&T used to say, “Reach out and Touch Someone”, but not through the phone.  Be present.  Put down the phone.  Hold hands.

Looking for a physician that understand the importance of compassionate care?  At HealthLynked, we are connecting patients and physicians in ways never before possible.  We have built a social ecosystem designed to bring you and your care givers closer than ever before to Improve HealthCare.

Ready to get Lynked?  Get connected today for free by going to HealthLynked.com.


Adapted from the following Sources:

By HuffPost Partner Studio.  The Science Behind The Profound Power Of Holding Hands |

A touching tribute. May 20, 2016

Kvrgic, Dejan.  Study Discovers 7 Surprising Benefits of Holding Hands.  LifeHack.com

 

 

 

21 Health Benefits and 6 Cool Facts About Zucchini

A staple at many markets and bountiful in backyard gardens during this time of year, zucchini can range in color from yellow to deep green. It has a tender texture with a slightly sweet flavor and, at just 21 calories per cup, it makes a welcome addition to a calorie-controlled diet.

Today, August 8th, is National Zuchinni Day and Sneak Some Zucchini on Your Neighbors’ Porch Day, so let’s take a look at all the potential benefits of this SuperFood.

What Is Zucchini?

Often known globally as courgette, zucchini is a summer squash native to the Americas. It belongs to the species Cucurbita pepo, along with a few other types of squashes and pumpkins. Zucchini boasts a rich nutritional profile, and it offers many health benefits thanks to its phytonutrients, mineral and vitamin content, including:

Vitamin C

Zucchini serves as a good source of vitamin C. A water-soluble antioxidant, vitamin C dissolves in your body fluids and protects your cells from free radicals, which are highly reactive compounds that oxidize your DNA, lipids and proteins, causing cellular damage. Getting enough vitamin C in your diet also aids in nerve cell communication, helps your body metabolize cholesterol and keeps your tissues strong. A cup of chopped zucchini contains 22 milligrams of vitamin C, which is 24 percent of the recommended daily intake for men and 29 percent for women, set by the Institute of Medicine.

Lutein and Zeaxanthin

Zucchini also provides you with lutein and zeaxanthin, two phytonutrients that belong to the carotenoid family, which is the same nutrient family that includes beta-carotene, a source of vitamin A. Lutein and zeaxanthin promote healthy eyesight. They filter light rays as they enter your eye, helping to ensure that harmful rays can’t damage your eye tissues. While, as of September 2013, the Institute of Medicine has not set a recommended daily intake for lutein and zeaxanthin, the American Optometric Association notes that intakes of at least 6 milligrams per day can reduce your risk for age-related macular degeneration, an eye disease that causes blindness. A cup of chopped zucchini provides 2.6 milligrams of lutein and zeaxanthin, or 43 percent of this intake goal.

 Manganese

Consuming zucchini also boosts your intake of manganese, an essential mineral. Like vitamin C, manganese protects your tissues from harmful free radicals. It supports the function of glycosyltransferases, a family of proteins that promote healthy bone tissue development. Manganese also helps your body produce collagen essential for efficient wound healing. Each cup of chopped zucchini boasts 0.22 milligram of manganese. This provides 12 and 10 percent of the Institute of Medicine’s recommended daily intake for women and men, respectively.

 Other Cool Zucchini Facts

  • One zucchini is called zucchina.
  • The world’s largest zucchini was 69 1/2 inches long and weighed close to 30 kilos.
  • Zucchini is the only fruit that starts with the letter Z.
  • The most flavorful of zucchinis are usually small and have darker skin.
  • Even the flower of the zucchini plant is edible. You can fry the zucchini blossoms into a delicacy.
  • And lastly, the word zucchini comes from ‘zucca’, which is the Italian word for squash.

Benefits Of Zucchini

  1. Zucchini Benefits For Weight Loss

It’s super low in calories, making it the perfect light side dish for a heavy meal; one cup of sliced zucchini has about 19 calories. That’s 40 to 50% lower than the same serving size for other low-cal green veggies like broccoli and Brussels sprouts. And because it’s so versatile, you can enjoy this low-calorie food in so many different recipes, from baked fries to pesto roll-ups. Of course, you can always grill zucchini with herbs for some savory flavor, too.

Zucchini is a low-starch fruit, low in carbohydrates and high in fiber. It will fill you up and discourage overeating.

The fruit also has a high water content which can keep you full for longer periods. It is one of those foods with a low glycemic index. Increased intake of fruits and vegetables and low-fat foods has been linked to healthy weight loss and weight maintenance.  Another benefit of high-fiber foods is they require more chewing – an individual, therefore, takes more time to eat and is typically unable to gorge on a large number of calories in a brief period.

  1. Improves Heart Health

Zucchini has a good amount of potassium: 295 milligrams per cup, or 8% of your recommended daily value. According to the American Heart Association, potassium can help control blood pressure because it lessens the harmful effects of salt on your body. Studies suggest boosting your potassium intake (while also curbing sodium) can slash your stroke risk and may also lower your odds of developing heart disease.

Because it is high in the antioxidant vitamin C, zucchini may help the lining of your blood cells function better, lowering blood pressure and protecting against clogged arteries. One cup of sliced zucchini has 20 milligrams, or about 33% of your daily value.

Ever heard of DASH diet? Also called the Dietary Approaches to Stop Hypertension, this diet is aimed at improving heart health by lowering hypertension. According to a report published by the National Heart, Lung, and Blood Institute, zucchini is a prominent part of the DASH diet.

Zucchini is low in cholesterol, sodium, and fat, and helps maintain a balance of carbohydrates – a requirement for optimum heart health.

Another reason zucchini works great for the heart is the presence of fiber. High intakes of fiber have been associated with significantly lower risks of developing stroke, hypertension, and heart disease.

Zucchini is also rich in folate, and as per a Chinese study, folate intake is inversely associated with heart disease risk.   The fact that it is rich in other nutrients like potassium and magnesium makes zucchini a superfood for the heart. Research has stated that deficiencies in the two nutrients can be directly linked to heart failure.

Another nutrient in zucchini that is worth your attention is riboflavin, which is a B-complex vitamin essential for energy production. In one study, children with cardiac disease were found to be shockingly deficient in riboflavin, emphasizing on the possible link between riboflavin and heart health.  Another Chinese study has linked riboflavin with alleviated cardiac failure in diabetics.

Riboflavin deficiency is also linked to certain birth defects in pregnant women, especially issues with the outflow tracts in the infant’s heart.

  1. Improves Eye Health

One doesn’t need to be reminded of the importance of vision. That said, zucchini seems to be more than food for your eyes. The fruit is rich in lutein and zeaxanthin, two antioxidants that were found to prevent age-related macular degeneration.

It is shocking to note that certain serious (and often irreversible) eye diseases like glaucoma and age-related macular degeneration have no warning signs.  So, what’s the best approach? Including zucchini in your diet. Zucchini is also a good source of vitamin A, shown to improve eye health.  It is important for eye development and maintenance.  As per a report published by Flaum Eye Institute of the University of Rochester Medical Center, a low-fat diet could be beneficial for the eyes – and zucchini can very well be a part of this diet.

The squash is also a wonderful source of beta-carotene that can improve eye health and offer protection against infections.

  1. Helps Control Diabetes

It is but unfortunate that a household without a diabetic is a rare scene. Well, that’s the sad part. So, is zucchini good for diabetics? Yes, the good part is, zucchini can help.

Non-starchy foods like zucchini can fill you up and aid diabetes treatment.  And the dietary fiber, which zucchini is replete with, can delay glucose absorption and help the patients with type 2 diabetes.  A German study states that insoluble fiber (which zucchini has a good amount of) can be very much effective in preventing type 2 diabetes.  Another study indicates the efficacy of insoluble dietary fiber that has shown to reduce diabetes risk.

Higher fiber intake is also associated with a lower risk of metabolic syndrome, which is one of the factors contributing to diabetes.  According to the University of Maryland Medical Center, soluble fiber can improve glucose tolerance in diabetics. Zucchini contains both soluble and insoluble fiber, by the way.

  1. Helps Lower Cholesterol

Zucchini is one of the few foods that are free of cholesterol, and hence you can include it in your cholesterol-lowering diet.  Soluble fiber has been found to interfere with cholesterol absorption. This helps lower the bad cholesterol or LDL in the blood.

  1. Helps Improve Asthma

In one Iranian study, the high levels of vitamin C in zucchini were thought to even cure asthma.  The anti-inflammatory properties of zucchini also contribute to asthma treatment.

Along with the vitamin C, zucchini also contains copper that is far more effective in treating asthma.

One Finnish study has found the benefits of vitamin C in treating not only asthma attacks, but also bronchial hypersensitivity — a characteristic of asthma.

  1. Protects Against Colon Cancer

The fiber in zucchini is the most important reason it can help in the treatment of colon cancer.  The fiber does multiple things – it absorbs the excess water in the colon, retains enough moisture in the fecal matter, and helps it to pass smoothly out of the body. Though precise knowledge about the subtypes of fiber (soluble or insoluble) in this aspect is important, dietary fiber as a whole has been linked to a reduced risk of colorectal cancer.

As per a Los Angeles study, dietary fiber plays a vital role in regulating the normal intestinal functioning and maintaining a healthy mucus membrane of the intestine. Though the exact amount of fiber and the type is still not clearly known, an expert panel from the study had recommended a fiber intake of 20 to 35 grams per day to prevent colon cancer.

The lutein in zucchini may also reduce the risk of colon cancer.

  1. Enhances Digestion

According to a report published by the University of Rhode Island, green fruits and vegetables, like zucchini, promote healthy digestion.  You can have zucchini as an after-meal snack – simply shred some carrots and zucchini on a quick bread or muffins and relish the taste and health benefits.

In fact, the late Henry Bieler (a prominent American physician who championed the idea of treating disease with foods alone) used to treat digestive issues in his patients with a pureed soup broth made from zucchini.   The dietary fiber in zucchini adds bulk to your diet and aids digestion. However, ensure you introduce fiber in your diet gradually. Increasing dietary fiber in your diet too quickly can lead to bloating, abdominal cramps, and even gas.

It has been found that dietary fiber forms the major components of foods that have low energy value, and hence are of particular importance, especially when it comes to dealing with abdominal issues.  If you are suffering from digestive issues, simply including zucchini in your meal might do the trick. It has been found that the addition of fiber in bread, cookies, breakfast cereals, and even meat products was found to have desirable results.

Zucchini contains both soluble as well as insoluble fiber. The insoluble fiber, also known as ‘the regulator’, accelerates the passage of water through the digestive tract. This reduces the time available for harmful substances to come in contact with the intestinal walls.

Seek out all-natural sources of fiber, and not just zucchini alone. If you are purchasing fiber-rich foods from the supermarket, there is but one ground rule – a good source of fiber is one that has at least 2.5 grams of fiber per serving. Foods having more than 5 grams of fiber per serving are excellent.  Anything lower than 2.5 grams could just be a waste of money.

  1. Lowers Blood Pressure

If you walk down a random street and pick any person you first see, chances are they might be (or is likely soon to be) suffering from high blood pressure.  We are so stressed about everything in life that blood pressure issues have become inevitable…almost.

With zucchini by our side, there is hope for natural relief.  Zucchini, being rich in potassium, is one of the preferred foods to combat hypertension.  Surprisingly enough, zucchini has more potassium than a banana.

Potassium is vasoactive, meaning it can affect the diameter of blood vessels. And hence, the blood pressure as well.  In a London study, potassium supplementation was linked to lowered blood pressure levels.  Though the study talks about certain conflicting results in pertinence to oral potassium supplementation, potassium was never shown to elevate the blood pressure levels.

As per another New Orleans study, potassium intake is mandatory to combat hypertension, especially when the individual is unable to reduce his/her sodium intake.  In addition to controlling blood pressure, potassium also lowers the heart rate and counters the harmful effects of sodium.

According to the National Academies Press, the adequate intake of potassium for adults is 4.7 grams per day.  Echoed by the World Health Organization, this dosage of potassium had the greatest impact on blood pressure levels.  However, dosing might vary depending on the overall health of an individual. Hence, consult your doctor for further details.

So, why is potassium so important with respect to lowering blood pressure? Because the nutrient is one of the principal electrolytes in the human body.  It is required in proper balance with sodium, in a ratio of 2:1. The junk foods we so very lovingly consume every other day have higher levels of sodium than potassium. Which is why they contribute to high blood pressure like no other. Zucchini is a good source of potassium. A medium-sized fruit offers 512 milligrams of the nutrient, which roughly equals 11% of your daily need.

  1. Slows Down Aging

Anti-aging is a big market today – a multi-billion dollar industry. You probably wouldn’t have to contribute much to that segment if you have zucchinis in your kitchen.

Zucchini is a good source of the antioxidants lutein and zeaxanthin. These two carotenoids exhibit powerful anti-aging properties.  They protect the cells of the body and the skin from free radical damage, which may otherwise lead to premature aging. Lutein and zeaxanthin have also been found to lighten the skin and improve its health.

In a study, lutein was found to prevent cell loss and membrane damage.  It also has photoprotective properties that protect the skin from UV damage. Zucchini is also rich in beta-carotene, the low levels of which were found to increase mortality risk in older men.

The riboflavin in zucchini maintains the health of the skin, hair, nails, and mucus membranes. It slows down aging by boosting athletic performance and preventing age-related memory loss and other related conditions like Alzheimer’s disease.  In one study, riboflavin was found to prolong the lifespan of fruit flies – indicating a similar possibility in human beings.

Zucchini, as we have seen, is rich in vitamin C. According to a South Korean study, the vitamin was found to decelerate aging in human heart cells.  Also, vitamin C is found in high levels in the skin layers, and the concentration shows a decline when we age.  Hence, intake of vitamin C appears to be a logical solution to slow down the signs of aging.

  1. Strengthens Bones And Teeth

Green vegetables and fruits, like zucchini, promote stronger bones and teeth,  The lutein and zeaxanthin in zucchini keep the bones and teeth strong. In addition, they also strengthen the blood cells.  Zucchini also contains vitamin K, which contributes to stronger bones.

Magnesium is another nutrient abundant in zucchini.  Most of the body’s magnesium resides in the bones, which helps build strong bones and teeth.  Magnesium also works along with calcium to improve muscle contraction.

The folate in zucchini also protects the bones, as does beta-carotene. Studies show that the body converts beta-carotene into vitamin A, which contributes to bone growth.

Zucchini contains phytochemicals such as indoles, which, according to Rutgers Cancer Institute of New Jersey, maintain strong bones and teeth.  Similar findings have been published by the California Department of Public Health.

  1. Helps Balance Thyroid And Adrenaline Function

Zucchini is rich in manganese, a mineral that promotes the optimal functioning of the thyroid gland.

  1. Helps During Pregnancy

Dark green vegetables are a must during pregnancy, and zucchini is one of them. In the nine months of pregnancy, consuming zucchini offers adequate B-complex vitamins that help maintain the energy levels and mood.

Zucchini is rich in folic acid that has shown to reduce the risk of certain birth defects,  like spina bifida – baby’s spinal chord doesn’t develop properly –  and anencephaly – the absence of a major portion of the brain.  As per a Canadian study, over 50 countries that have fortified their food staples with folic acid saw a dramatic decrease in neural tube defects in pregnant women.

One more reason folate is beneficial to pregnant women is its ability to aid in the production of red blood cells in the body.  This also helps lower the risk of developmental problems in the baby during pregnancy.

It is important to keep in mind that folic acid (or folate) works best when taken before getting pregnant and during the first trimester.  As women need additional folic acid during pregnancy, it is advisable to take a folic acid supplement as well.  Around 400 mcg of folic acid per day is recommended for women in this aspect.

Another reason zucchini is good for pregnancy is its magnesium content. As per an Italian study, magnesium is very important for women with an elevated risk of gestosis or premature labor.

  1. Good For Babies (And Kids)

Diarrhea is one common problem amongst most kids over one year of age. Oh yes, there are medications. But changes in the diet can also help. Bland foods work well in this case, and peeled zucchini can do wonders.

Mashed zucchini can also be a good addition to your baby’s diet.  Since it is soft and bland in taste (and since it comes replete with nutrients), your baby will be able to consume it easily.   NOTE: Never leave a baby alone when he/she is eating. Keep the portions small. And avoid those foods that he/she can easily choke on – these include everything that is hard to chew.

There is likely no need to emphasize the negative effects smoking can have on pregnant women. But, what if a woman has been a smoker for a long time before getting pregnant and just can’t give the habit up? In one Portland study, the intake of vitamin C has been found to prevent lung problems in babies born to pregnant smokers.  Zucchini, being rich in vitamin C, can help in this regard. By the way, this doesn’t mean it is okay to smoke during pregnancy. It simply isn’t.

In another Denmark study, the deficiency of vitamin C was found to impair brain development in infants.  In fact, the importance of vitamin C for infants was discovered way back in the early 1900s.

Studies conducted then stressed the significance of vitamin C in preventing scurvy in infants.  Dr. F.R. Klenner, between 1948-49, cured polio in children with vitamin C, and vitamin C only.  Of course, polio is nearly eradicated today. Both show how important vitamin C has been in the improvement  of population health.

  1. Helps Prevent Gout

Zucchini’s vitamin C grabs the spotlight, yet again. One study has linked vitamin C intake with a lower risk of gout in men.  It achieves this by lowering serum uric acid levels via a process called the uricosuric effect. The vitamin was also found to prevent not just gout, but numerous other urate-related diseases as well.

You can also intake zucchini to complement your gout treatment, especially if your treatment isn’t working well. As with every health concern, dosage is important, so talk to your doctor.

Though gout generally affects men over the age of 40 or anyone with a family history of the disease, it can occur anytime to anyone. It is caused by the excessive build-up of uric acid in the body, leading to its accumulation in tissues in the form of needle-shaped crystals. Apart from taking zucchini and other foods rich in vitamin C, something as simple as drinking 6 to 8 glasses of water daily can prevent gout.

  1. Promotes Prostate Health

When it comes to men’s health, zucchini is one of the vegetables that is often overlooked, but its phytonutrients greatly benefit the prostate.  The high carotenoid content of zucchini also associates it with a reduced risk of prostate cancer.

We have seen that zucchini is rich in beta-carotene and vitamin C. Both of these nutrients, as per a study, were found to be positively associated with prostate cancer.  Vitamin C reduces oxidative DNA damage and hampers the growth and ability of prostate cancer cells.

Lutein is also found in zucchini. As per a report published by the University of California San Francisco, lutein intake is inversely associated with prostate cancer.

Dietary fiber has been found to bind with carcinogens and eliminate them from the body. It also has the ability to prevent prostate cancer progression, and phytonutrients protect the cells from damage.  Both of these healthful compounds are abundant in zucchini, making it a powerful weapon to combat prostate cancer.

  1. Aids Collagen Formation

As we have seen, zucchini contains riboflavin, whose deficiency was found to affect the maturation of collagen.   The vitamin C in the squash plays a major part in the synthesis of collagen, which, as we know, is quite important to maintain the health of joints, cartilage, skin, and blood vessels.  The vitamin also protects the body from cellular damage.  In addition to collagen, vitamin C also helps in the production of elastin, both of which are essential for radiant and healthy skin.

A few other nutrients contribute to collagen formation, like potassium, zeaxanthin, and folate.  Zucchini is replete with these.

  1. Helps In Skin Hydration

Zucchini hydrates the body (and the skin) and helps it deal with the summer heat.

The lutein in zucchini encourages skin health by reducing inflammation responses. But how does that promote skin hydration? Well, here’s the science behind it. When the skin is exposed to sunlight, lutein reduces the inflammation response. This means the sunlight will cause less damage to the skin, and that means less damage to the moisture barrier of the skin as well.  And the result? Well hydrated skin.

Zucchini is 95% water.  This translates to hydrating the skin well. Keep in mind  only about 20% of our daily water intake is met through foods. Hence, it is also important we drink 8-10 glasses of water every day as skin cells need water to function at their best.

  1. Improves Brain Functioning And Memory

Green foods, especially zucchini, are rich in folate and are excellent for brain health.  Folate also helps in the production of DNA and RNA, the body’s genetic material. The nutrient, apart from improving mental health, also enhances emotional health.

The deficiency of folate is linked to megaloblastic anemia, which results in weakness and fatigue. Increased folate intake has been linked to reduced risk of dementia and Alzheimer’s disease in women.

Also, our brain is 75% water. When there is adequate water in your system, you will be more focused, think quick, and also display greater creativity. More importantly, sufficient water efficiently delivers nutrients to your brain and aids toxin removal. This results in enhanced concentration and mental alertness.  Zucchini, apart from being rich in water, also contains vitamin C, zinc, and omega-3 fatty acids – all of which largely contribute to brain health.

Though not very rich in iron, zucchini contains the nutrient in acceptable amounts. As per a study, early iron deficiency can lead to permanent neurobehavioral problems despite diagnosis and treatment.  Early iron deficiency can even affect the brain’s physical structure. Iron is also important for producing myelin, the fatty sheath that coats the brain’s nerves and accelerates brain communications.

  1. Promotes Hair Growth

Zucchini, being rich in zinc, promotes hair growth.  The vitamin C in zucchini can help heal dry and splitting hair.  It also makes your hair strands strong and supple.  Lack of vitamin C can result in the enlargement of hair follicles, which might eventually stall hair growth.

  1. Enhances Immunity

The vitamin C found in zucchini is an active form of ascorbic acid that boosts the immune system, and it does this in several ways. First, vitamin C helps develop the body’s T cells (a type of white blood cell) into functional T cells that defend against diseases. It also helps you produce more immune cells. The antioxidant properties of vitamin C also prevent cells from dying due to inflammation. The RDA of vitamin C is 90 mg in males and 74 mg in females.

Low levels of vitamin C are linked to increased risk of infection. In fact, high levels of vitamin C are frequently recommended for HIV-positive individuals to enhance their immunity.

In a Switzerland study, vitamin C and zinc were found to enhance immunity, so much that they had even improved the health of patients suffering from certain immune-deficient diseases like malaria and diarrhea.

Potential Side Effects Of Consuming Zucchini

  1. Digestive issues

Zucchini might cause digestive issues in people suffering from Irritable Bowel Syndrome (IBS). In such a case, consume it with caution, or avoid it altogether.  Bitter zucchini might also cause stomach cramps, diarrhea or both,

  1. Allergies

Zucchini might cause allergies in individuals who are sensitive to it. These include nausea, pruritus (severe skin itching), and certain kinds of oral allergies.

  1. Alzheimer’s

Yes, this can be contradictory to what was covered earlier in the article. Iron does help prevent brain ailments. But studies suggest that too much of it can cause neurological conditions like Alzheimer’s.  Though iron is not abundant in zucchini, it still is better to consider its effects.

  1. Excessive beta-carotene

Since zucchini is a very good source of beta-carotene, this could be a concern for certain individuals. Large doses of beta-carotene might be inadvisable for pregnant and lactating women, people who smoke, people who have been exposed to asbestos, and individuals who have undergone angioplasty.

Beta-carotene might also interact with medications – especially those used for lowering cholesterol and other medicines like niacin.

How much of zucchini is too much?

These side effects need not worry you unless you happen to take zucchini in excess. It sure is a super-food, yet there is conflicting information about just how much is too much, so please consult your doctor for more guidance.

 Zucchini – Tips For Selection And Storage

How to select zucchini

Zucchini is usually picked and sold even before it matures. Hence, the seeds and skin are tender, and you can cook it even without peeling. The zucchini must be clean and blemish-free. You must be able to pierce the skin easily with your fingernail.

Also, ensure the zucchini you select is small to medium in size – no more than 6 to 8 inches, and free of pricks and cuts. Some say it is better if it has one inch of stem attached.

How to store zucchini

Zucchini must be stored in a refrigerator. Remember to wrap it tightly.

If you want to freeze zucchini, choose the one with tender skin. Wash and slice it and scald for 3 minutes. Cool and drain and then pack it in a freezer container. You can also freeze shredded zucchini, provided you do it immediately.

If you are planning to grow zucchini in your backyard, you must remember that it grows best when surrounded by mulch, which keeps the soil moist. You also need to add two inches of water every week for the plant to thrive.

How To Prepare Zucchini

  1. As a healthy snack

Simply take raw zucchini sticks or slices and enjoy them with your favorite dip. You can also pack them in your lunchbox for a healthy afternoon snack.

  1. Mashed Zucchini

Wondering what to use as a side dish for your meal? Zucchini! Steam it and mash it. You can then puree this with other root vegetables and serve. Much better (and healthier) than mashed potatoes!

  1. Grilled Zucchini

Who said only meat can be thrown on the grill? Slice zucchini into 1/2-inch thick disks, or cut the zucchini lengthwise, and brush them with cooking oil.  Season as you desire, and grill right on the grate.

  1. Stuffed Zucchini

Pretty simple: Cut the zucchini lengthwise and scoop out the insides. Fill the empty zucchini cups with chopped vegetables, meat, and cheese. Bake for about 40 minutes at 375° F, or until they turn golden brown. Serve while hot.

  1. Use in salads

Make your salad healthier by slicing in zucchini.

Can you eat zucchini skin?

In fact, you should, as zucchini is 95% water. Most of this water is found in the flesh – which means most of the nutrients are found in the skin. Peeling the skin deprives you of vitamins C and K, fiber, potassium, antioxidants, and the other nutrients. Eating zucchini without the skin is almost like drinking plain water – only that you would be chewing in this case.

How To Make Zucchini For Baby

Zucchini can be wonderful for babies. It has a mild flavor. It is soft to chew, and it offers super nutrients.

But, remember this – zucchini, particularly because of its skin, can cause a bit of stomach upset in some individuals. Hence, you must wait till your baby is eating stage 2 foods, which would happen when (s)he is around 8 months old.

In case your child is prone to stomach upsets, peel the zucchini before cooking and observe how your child receives it. If things are alright, try with the skin the next time.

Here is how you can cook zucchini for your child:

  1. Select a zucchini with a firm and shiny skin. It must be free of bruises and any other visible damage. Keep it unwashed in a plastic bag and store it in the refrigerator (until you are ready to cook it, which would usually be up to 4-5 days).
  2. Divide the zucchini widthwise into half. Prepare the zucchini one half at a time. You can keep the second half back in the refrigerator until you want to use it next time.
  3. Slice the end of the zucchini. Wash it thoroughly under a stream of cold water.
  4. Cut it into thin slices.
  5. Fill a saucepan with cold water and bring it to a boil.
  6. Add the sliced zucchini to it. Once the water boils, decrease the heat to medium.
  7. Keep boiling the zucchini until it turns tender – this should take about 10 minutes.
  8. Drain the water and transfer the boiled zucchini into a food processor. Process it until it is completely pureed. You can add a little cold water if it appears too thick.
  9. Wait till the puree cools before you feed it to your little one. You can store the leftovers in a sealed container in the refrigerator for up to 2 days.
  10. You can prepare the other half of zucchini in a similar way.

As always, it is best to consult your baby’s pediatrician before introducing new foods in his/her diet.

Conclusion

Celebrate the  end-of-summer with the super food zucchini . Try grated zucchini in cookies and bread for added moisture, or, stuff between tortillas for a simple veggie quesadilla.  Packed with beneficial nutrients, including Vitamins C and A, potassium, folate, and fiber, zucchini contributes to a healthy heart by decreasing the risk of stroke, reducing high blood pressure, and lowering cholesterol. Get maximum benefits by eating either raw or cooked zucchini and feel free to eat the skin– it’s edible.

And, if you are looking for a physician in your area to advise you on how to take control of your nutritional health, go to HealthLynked.com to find a provider who fits the bill.  We connect providers to Patients and providers to providers to improve overall population health in a novel social ecosystem.

Ready to get Lynked?  Got to HealthLynked.com today to register for free and be entered into our “End of Summer” Contest.

Adapted from the Following Sources:

Tadimalla, Ravi Teja.  21 Amazing Benefits Of Zucchini For Skin, Hair, And Health. Stylecraze, February 20, 2018.

TREMBLAY, MSC, Steve.  The Health Benefits of Zucchini.  LiveStrong.com, OCT. 03, 2017.

 

 

 

 

 

 

 

Help Find the Missing Millions

Hepatitis is an inflammation of the liver. Viruses are the most common cause of hepatitis, but the condition can also be caused by other infections, heavy alcohol use, toxins, certain medications, and autoimmune disease. There are five main virus types that cause hepatitis—type A, B, C, D and E.

Hepatitis A and E are typically caused by ingesting contaminated food or water. Type B commonly occurs through contact with infected blood, semen or other bodily fluid through sex, sharing needles or other drug-injection equipment or from mother to baby at birth. Hepatitis type C is a blood-borne virus that is largely spread by sharing needles or other drug injection equipment. Hepatitis D, which is transmitted through contact with infectious blood, occurs only among people with hepatitis B infection.

Hepatitis B, C, and D afflict more than half a billion people worldwide and are responsible for more than a million deaths a year. Chronic infection with these viruses can lead to cirrhosis of the liver, end-stage liver disease, and liver cancer.

World Hepatitis Day is July 28th and is an opportunity to learn about the global burden of this disease and support efforts to combat viral hepatitis around the world. People can also find out if they should be tested or vaccinated for hepatitis A, B or C by taking CDC’s online Hepatitis Risk Assessment, which is based on CDC recommendations for the United States.

WORLD HEPATITIS DAY 2018 THEME: ELIMINATE HEPATITIS

In 2016, 194 governments adopted WHO’s Global Strategy on Viral Hepatitis, which includes a goal of eliminating hepatitis B and C by 2030, yet only a handful of countries are on track to meet these targets.

We are at a critical juncture. Unless we take action now, our chance to eliminate a cancer-causing illness will be missed. On WHD 2018, we are calling on all individuals and organizations to unite under the theme of “Eliminate Hepatitis” to drive action, build momentum and hold governments accountable. Because only together can we eliminate viral hepatitis by 2030.

WORLD HEPATITIS DAY 2018 CAMPAIGN: FIND THE MISSING MILLIONS

No one should have to live with viral hepatitis without knowing. Yet, globally more than 290 million men, women and children do. Unless there is a massive scale-up in screening, diagnosis and linkage to care, more people will become infected and lives will continue to be lost.

The World Hepatitis Alliance’s (WHA) global campaign – Find the Missing Millions – is a three-year global awareness-raising and advocacy campaign aimed at tackling the main barriers to diagnosis by putting civil society organizations and the affected community at the heart of the solution.

The Disease

The five hepatitis viruses – A, B, C, D and E – are distinct; they can have different modes of transmission, affect different populations, and result in different health outcomes.

  • Hepatitis A is primarily spread when someone ingests the virus from contact with food, drinks, or objects contaminated by feces from an infected person or has close personal contact with someone who is infected. Hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause serious symptoms. Hepatitis A can be prevented through improved sanitation, food safety, and vaccination.
  • Hepatitis B is often spread during birth from an infected mother to her baby. Infection can also occur through contact with blood and other body fluids through injection drug use, unsterile medical equipment, and sexual contact. The hepatitis B virus is common in sub-Saharan Africa, Asia and the Pacific Islands, but also has increased rates in the Amazon region of South America, the southern parts of eastern and central Europe, the Middle East and the Indian subcontinent. The hepatitis B virus can cause both acute and chronic infection, ranging in severity from a mild illness lasting a few weeks to a serious, chronic illness. If infected at birth or during early childhood, people are more likely to develop a chronic infection, which can lead to liver cirrhosis or even liver cancer. Getting the hepatitis B vaccine is the most effective way to prevent hepatitis B. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, followed by 2-3 additional doses. In many parts of the world, widespread infant vaccination programs have led to dramatic declines of new hepatitis B cases.
  • Hepatitis C is spread through contact with blood of an infected person. Infection can occur through injection drug use and unsafe medical injections and other medical procedures. Mother-to-child transmission of hepatitis C is also possible. Hepatitis C can cause both acute and chronic infections, but most people who get infected develop a chronic infection. A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer. With new treatments, over 90% of people with hepatitis C can be cured within 2-3 months, reducing the risk of death from liver cancer and cirrhosis. The first step for people living with hepatitis C to benefit from treatments is to get tested and linked to care. There is currently no vaccine for hepatitis C but research in this area is ongoing.
  • Hepatitis D is passed through contact with infected blood. Hepatitis D only occurs in people who are already infected with the hepatitis B virus. People who are not already infected with hepatitis B can prevent hepatitis D by getting vaccinated against hepatitis B.
  • Hepatitis E is spread mainly through contaminated drinking water. Hepatitis E usually clears in 4-6 weeks so there is no specific treatment. However, pregnant women infected with hepatitis E are at considerable risk of mortality from this infection.  Hepatitis E is found worldwide, but the number of infections is highest in East and South Asia. Improved sanitation and food safety can help prevent new cases of hepatitis E. A vaccine to prevent hepatitis E has been developed and is licensed in China, but is not yet available elsewhere.

Missing Millions

An estimated 290 million (89%) of the 325 million people living with viral hepatitis B and C are unaware that they are infected (WHO, 2017a), irrespective of gender, age, ethnicity or geography. This puts them at risk of unknowingly transmitting the virus to others and developing extrahepatic manifestations (e.g. autoimmune diseases, diabetes), liver complications, including fatal end-stage liver disease and liver cancer. Without a massive scale-up in awareness coupled with diagnostic services, to ensure that everyone infected gets tested, treatment rates will not increase and infection rates may rise (European Union HCV Collaborators, 2017).

Today, there is now a policy framework to combat and ultimately eliminate viral hepatitis. The United Nations’ Sustainable Development Goals (SDGs), adopted by all countries in 2015, call for combatting viral hepatitis (United Nations, 2015) and in 2016 the World Health Organization (WHO) adopted the Global health sector strategy on viral hepatitis, 2016–2021 (GHSS), which set the goal of eliminating viral hepatitis as a public health threat by 2030 and specifically for 30% of people infected to know their status by 2020 and 90% by 2030 (WHO, 2016). Thus, without  finding these “missing millions” and linking them to care, efforts to eliminate viral hepatitis will fail.

The “Find the Missing Millions” program, initiated by the World Hepatitis Alliance (WHA) in 2018, is a three-year effort intended to assist countries to reach the diagnosis targets they committed to when adopting the WHO viral hepatitis strategy. The program builds on the mission of WHA to “harness the power of people living with viral hepatitis to achieve its elimination” and this white paper highlights how involving civil society and the affected community can strengthen the response. While acknowledging the vast amount of work to date, including viral hepatitis testing guidance from clinical associations and technical agencies (AASLD, 2018; Chávez, 2013; EASL, 2018; Omata, 2016; WHO, 2017b), WHA, working with experts and key partners worldwide, developed a series of complementary recommendations, set out below, focusing on the role civil society and the affected community have in scaling up equitable diagnostic services to  nd the missing millions.

The Importance of Involving Civil Society and the Affected Community in the Response

People living with viral hepatitis and the affected community should be at the heart of every effort to eliminate viral hepatitis. Aside from fulfilling the need for trusted entities that consistently disseminate reliable information, civil society organizations bring fundamentally important perspectives and experiences which greatly enhance the effectiveness of strategies and programs.

In the context of addressing the barriers to diagnosis, a meaningful partnership with the affected community and civil society organizations can, amongst other things, contribute to the delivery of stronger awareness campaigns; strengthen innovative approaches to finding the undiagnosed through peer support services; help identify gaps within action plans which would otherwise be missed; and o er a platform to address stigma and discrimination, ensuring an equitable response so that the most vulnerable and marginalized are not left behind in the effort to eliminate viral hepatitis. As such, policy-makers should harness the voices of those affected by viral hepatitis, recognising them as vital partners in the elimination e ort.

Further, as more people living with viral hepatitis are aware of their diagnosis, they and those in their social environment can be part of the drive to prevent the disease by ensuring access to services, from prevention to testing to treatment and follow-up care, and by encouraging innovation, such as health systems reforms that facilitate new, more people-centered health services.

Methodology

Available research on the barriers to diagnosis of viral hepatitis and strategies to overcome them is limited to a small number of mainly high-income countries, or speci c regions and populations (Ishizaki, 2017). These studies are also limited with regard to the number and category of respondents. To address these data gaps, WHA conducted a global survey on the barriers to diagnosis of hepatitis B and hepatitis C.

WHA commissioned DJS Research, an independent research agency, to undertake a global consultation, in the form of an online survey that ran from 22 February to 21 March 2018. DJS Research sent approximately 3000 emails in English, French or Spanish to WHA member organizations, people living with viral hepatitis, medical professionals, policy-makers and other stakeholders. An open link to the survey was also provided on websites worldwide, which could be accessed by the wider hepatitis community.  Five hundred and sixty-one surveys were completed.

Following the online survey, telephone interviews were conducted with 17 respondents from Argentina, Australia, Brazil, Canada, Cyprus, Germany, Guatemala, Mali, Portugal, Spain, Switzerland, the United Kingdom and the United States of America. The interviews were designed to gather more detailed views on the barriers that were identified as major within the online survey.

The implications of the overall small sample size are that the data from individual regions can best be regarded as indicative and do not permit comparison or robust conclusions. Further, it is important to note that geographic representation in the survey is not proportionate to the prevalence and incidence of viral hepatitis in the different regions. Nonetheless, the  findings  provide useful avenues for exploration which then need to be adapted to the needs of each individual region. Details on barriers to the diagnosis of viral hepatitis B and C can be found in Find the Missing Millions: Barriers to Diagnosis Global Report (World Hepatitis Alliance, 2018).

The focus of the two-day global stakeholder consultation, held in London on 17–18 May 2018, was to further explore the role that civil society and the affected community can play in overcoming the identified barriers to diagnosis BOX 1 . Participants discussed the barriers to diagnosis identified by the survey and developed a set of recommendations; highlighting the unique role that civil society and the affected community have to play in a sustainable response.

Recommendations

 These recommendations should be considered complementary to WHO guidelines for viral hepatitis testing (WHO, 2017b) and the WHO Global health sector strategy on viral hepatitis, 2016-2021 (WHO, 2016) in that they set out to enhance the role of civil society and the affected community in overcoming the barriers to diagnosing viral hepatitis.

It is important to note that implementing these recommendations requires a multi-stakeholder response and this may mean policy-makers and other stakeholders will need to look beyond current partners. The response will be enhanced by involving not just those already engaged but also anyone who has contact with affected populations or populations at risk. This will vary depending on the setting but potential allies to consider include addiction specialists, nephrologists and hematologists, pharmacists, refugee and migrant support organizations, religious/cultural leaders who have played a role in developing and fostering health services, patient groups representing affected communities such as those with kidney disease, hemophilia or thalassemia and peers in general. Target groups may be different for e orts to combat hepatitis B versus hepatitis C and will likely differ by country or locality.

Overcoming the main barriers to diagnosis requires all stakeholders to engage in three main activities:

1.  Raising Awareness

Lack of public knowledge of the diseases, lack of knowledge among healthcare professionals and stigma and discrimination are all underpinned, in part, by a lack of awareness and so it is recommended that these three barriers should be collectively addressed.

When raising awareness, improving education and combatting stigma and discrimination, different strategies are required for different populations and, as WHO suggests, they will be dependent on the country context and may include promotion through the mass media (WHO, 2017b). In the GHSS it is stated that “Concerted advocacy e orts, particularly by political and community leaders, and a sound communication strategy are required to increase public and political awareness of the public health importance of viral hepatitis… and to mobilize action” (WHO, 2016).

Civil society and the affected community can enhance the response that WHO calls for by:

Partnering with stake holders to advocate for:

  • Health authorities to ensure continuous medical and professional education on viral hepatitis is provided from the early stages of training
  • Enabling frameworks such as anti-discrimination laws and their enforcement and redress of discriminatory acts
  • Decriminalization of drug use and homosexuality as punitive laws hamper public health efforts National governments to join all countries in upholding the commitment made at the 63rd World Health Assembly (2010) to use World Hepatitis Day to improve education and understanding of viral hepatitis

Partnering with stakeholders to take action to:

Promote the use of  findings  from national and/or WHO monitoring and evaluation frameworks to:

  • develop focused awareness strategies which target populations that are being left behind
  •  develop focused awareness strategies which target populations that are being left behind
  • create civil society-led shadow reports highlighting the experiences and expertise of civil society and the affected community to add further weight to national or WHO findings
  • Highlight in campaign materials that viral hepatitis is potentially a cancer-causing disease
  • Highlight that hepatitis can cause severe extrahepatic manifestations
  • Find influencers beyond the usual stakeholders that can help raise awareness (e.g celebrities and political leaders)
  • Create enabling environments where people living with viral hepatitis are able to share their stories in order to humanize the experience of living with viral hepatitis and reduce the stigma around it
  • Contribute to communication and awareness-raising campaigns by helping to formulate culturally speci c messaging to debunk myths, convey a sense of urgency, and reduce stigma
  • To ensure testing for hepatitis B and C is carried out alongside education on viral hepatitis so that awareness is increased in all people tested, not just those with viral hepatitis
  • Use the Find the Missing Millions campaign or other awareness-raising initiatives like World Hepatitis Day and NOhep to promote testing and improve understanding of viral hepatitis

2.  Making Testing More Accessible

The promotion of human rights and equity are core to both the SDGs (United Nations, 2015) and WHO initiatives to eliminate viral hepatitis. In particular these principles are evident within the guidance on access to testing, with WHO calling for testing services to be “accessible to the populations most affected” (WHO, 2017b). WHO further elaborates that: “Rapid expansion of programs to improve coverage should not compromise the quality of services, nor contribute to inequities in access to services and health outcomes” and “Actively engaging affected populations in developing strategies and programs should result in better targeted and acceptable services” (WHO, 2016).

Building on the foundation provided by WHO, civil society and the affected community can help national governments, national health institutions and other stakeholders to make testing more readily available by:

Partnering with stakeholders to advocate for:

  •  Development of a partnership response to viral hepatitis, where people living with the infections are included in ministerial and other global and national advisory structures
  • Better data to shape testing strategies so that they are targeted and client-centered
  • Available and effective testing, integrating both simple and appropriate testing technologies, while incentivizing testing at the primary care level
  • Provision of testing services through new models of care that allow for a “one-stop shop” experience where chronic infection can be confirmed and appropriate linkage to care implemented
  • Gaps in services to be addressed, specifically at sites where testing is not available or where it is underutilized
  • Broad availability of quality-assured rapid tests to screen for viral hepatitis

Partnering with stakeholders to take action to:

  •  Participate in the design of testing policies and strategies at the national level to ensure appropriate considerations that can enhance implementation are accounted for
  • Build the capacity of non-governmental organizations and community-based organizations, including patient groups, to test for viral hepatitis
  • Stimulate political will at all levels of government for increased access to testing
  • Help to ensure an equitable response by setting targets, especially for vulnerable populations, as they are frequently under-represented in testing efforts
  • Recruit peers from the affected communities to conduct testing, act as case managers, provide pre- and post-test counselling, provide reliable information to support those newly diagnosed and address transmission fallacies
Spotlight on peers:

Peer networks span multiple and intersecting groupings and have been successful in community mobilization. For example, peer involvement by community leaders or family members has been shown to promote access and subsequent participation in services for migrant populations, who are often cut o  from services, particularly where language and a fear of using services are barriers (Seedat, 2014; Sweeney, 2015).

The role of peers could extend beyond the current focus on testing and diagnosis to also serve to provide education on viral hepatitis, including how infection/reinfection occurs (Batchelder, 2017). For example, peer-driven testing campaigns for speci c populations such as people living with HIV (PLHIV), men who have sex with men (MSM), and people who inject drugs (PWID) can enable the scale up of diagnosis and treatment, as well as disseminate information on the distinct, available resources for those with a positive diagnosis to prevent stigmatization (Crawforth & Bath, 2013; Meyer, 2015; Scott, 2014; Sharma, 2015).

 3.  Removing Cost Barriers for Viral Hepatitis Testing

The WHA global survey found that out-of-pocket costs to patients were one of the principal barriers to diagnosis. To date, viral hepatitis testing costs have mainly been approached from a provider rather than user perspective in WHO initiatives (WHO, 2017b). However, the 4th strategic direction of the GHSS is: “Financing for sustainability: proposing strategies to reduce costs, improve efficiencies and minimize the risk of  financial hardship for those requiring the services” and the proposed priority actions for countries include reducing  financial barriers to patients by phasing out direct, out-of-pocket payments (WHO, 2016).

A coordinated and decided approach to curb this barrier is needed and civil society and the affected community can contribute by:

Partnering with stakeholders to advocate for:

  •  No, or limited and easily affordable, out-of-pocket costs for patients through inclusion of viral hepatitis services in health insurance schemes
  • Hepatitis testing and treatment to be included in universal health coverage packages, as set out by the Universal Health Coverage Forum in the Tokyo Declaration (2017)
  • The use of central procurement of quality-assured and affordable tests in order to obtain price-volume agreements
  • Leveraging of existing services in order to decrease investment costs for testing infrastructure and personnel, e.g. within HIV or other settings

 

Partnering with stakeholders to take action to:

  • Be a part of multi-stakeholder initiatives at the national level to inform the negotiation of pricing for diagnostic technologies and services
  • Assist in collecting and monitoring pricing data

Get Connected

Need a good doctor to take a peak inside or help you get closer to your microbiome?  Find one fast on HealthLynked.com, where you can build your own personal, portable health record and Connect and collaborate with your care team using our novel ecosystem.

Get Lynked today!  Go to HealthLynked to sign up for Free and start taking control of your medical care.

Sources:  Adapted from

WHA.org

CDC.org

WHO.org

 

References from WHA Whitepaper

American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society  of America (2018). HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis. Last Updated: May 24, 2018. Available from https://www. hcvguidelines.org/sites/default/ les/ full-guidance-pdf/HCVGuidance_ May_24_2018a.pdf, accessed 19 June 2018.

Batchelder AW, Cockerham-Colas L, Peyser D, Reynoso SP, Soloway I, Litwin AH (2017). Perceived benefits of the hepatitis C peer educators: a qualitative investigation. Harm Reduct J;14(1):67.

Chávez-Tapia NC, Ridruejo E, Alves de Mattos A, Bessone F, Daruich J, Sánchez-Ávila JF, et al (2013). An update on the management of hepatitis C: guidelines for protease inhibitor-based triple therapy from the Latin American Association for the Study of the Liver. Ann Hepatol;12 Suppl 2:s3-35.

Crawford S, Bath N (2013). Peer support models for people with a history of injecting drug use undertaking assessment and treatment for hepatitis C virus infection. Clin Infect Dis;57:S75–S79.

European Association for the Study of the Liver (2018). EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. pii: S0168-8278(18)31968-8.

European Union HCV Collaborators (2017). Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol;2(5):325-336.

Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, et al (2017). Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis.;17(Suppl 1):696.

Meyer JP, Moghimi Y, Marcus R, Lim JK, Litwin AH, Altice FL (2015). Evidence-based interventions to enhance assessment, treatment, and adherence in the chronic Hepatitis C care continuum. Int J Drug Policy;26(10):922-35.

Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, et al (2016). APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int;10(5):681-701

Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM (2014). Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav.;18(5):913–20.

Seedat F, Hargreaves S, Friedland JS (2014). Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads. PLoS One; 9(10):e108261.

Sharma M, Ying R, Tarr G, Barnabas R (2015). Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature;528(7580):S77–85.

Sweeney L, Owiti JA, Beharry A, Bhui K, Gomes J, Foster GR, Greenhalgh T (2015). Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals. BMC Health Serv Res;15:97.

United Nations (2015). Sustainable Development Goals. https:// sustainabledevelopment. un.org/?menu=1300 Universal Health Coverage Forum (2017). Tokyo Declaration on Universal Health Coverage: All Together to Accelerate Progress towards UHC. http://www.who.int/universal_health_coverage/tokyo- decleration-uhc.pdf?ua=1 World Health Organization (2016).

Global health sector strategy on viral hepatitis, 2016-2021. WHO: Geneva. http://www.who.int/ hepatitis/strategy2016-2021/ghss- hep/en/World Health Organization (2017a). Global hepatitis report, 2017. WHO: Geneva http://apps. who.int/iris/bitstream/handle/10665/255016/9789241565455- eng.pdf?sequence=1

World Health Organization (2017b).  Guidelines on hepatitis B and C testing. WHO: Geneva http:// apps.who.int/iris/bitstream/handle/10665/254621/9789241549981- eng.pdf?sequence=1

World Health Assembly (2010). 63rd World Health Assembly. Viral hepatitis. 21 May 2010. http://apps. who.int/gb/ebwha/pdf_ les/WHA63/ A63_R18-en.pdf

World Health Assembly (2014). 73th World Health Assembly. Hepatitis. 24 May 2014. http://www.wpro.who. int/hepatitis/wha67_r6-en.pdf

World Hepatitis Alliance (2018). Find the Missing Millions: Barriers to Diagnosis Global Report, http:// www.worldhepatitisalliance.org/ missing-millions/wp-content/ uploads/2018/06/Find-the-Missing- Millions-Survey-Report-FINAL.pdf

 

 

 

Are We Infertile? Finding Help When Trying to Get Pregnant

Infertility happens when a couple cannot conceive after having regular unprotected sex.  It may be that one partner cannot contribute to conception, or that a woman is unable to carry a pregnancy to full term. It is often defined as not conceiving after 12 months of regular sexual intercourse without the use of birth control.

In the United States, around 10 percent of women aged 15 to 44 years are estimated to have difficulty conceiving or staying pregnant. Worldwide, 8 to 12 percent of couples experience fertility problems. Between 45 and 50 percent of cases are thought to stem from factors that affect the man.

Treatment is often available.

Causes in men

The following are common causes of infertility in men.

Semen and sperm

Semen is the milky fluid that a man’s penis releases during orgasm. Semen consists of fluid and sperm. The fluid comes from the prostate gland, the seminal vesicle, and other sex glands.

The sperm is produced in the testicles.

When a man ejaculates and releases semen through the penis, the seminal fluid, or semen, helps transport the sperm toward the egg.

The following problems are possible:

  • Low sperm count: The man ejaculates a low number of sperm. A sperm count of under 15 million is considered low. Around one third of couples have difficulty conceiving due to a low sperm count.
  • Low sperm mobility (motility): The sperm cannot “swim” as well as they should to reach the egg.
  • Abnormal sperm: The sperm may have an unusual shape, making it harder to move and fertilize an egg.

If the sperm do not have the right shape, or they cannot travel rapidly and accurately towards the egg, conception may be difficult. Up to 2 percent of men are thought to have suboptimal sperm.

Abnormal semen may not be able to carry the sperm effectively.

This can result from:

  • A medical condition: This could be a testicular infection, cancer, or surgery.
  • Overheated testicles: Causes include an undescended testicle, a varicocele, or varicose vein in the scrotum, the use of saunas or hot tubs, wearing tight clothes, and working in hot environments.
  • Ejaculation disorders: If the ejaculatory ducts are blocked, semen may be ejaculated into the bladder
  • Hormonal imbalance: Hypogonadism, for example, can lead to a testosterone deficiency.

Other causes may include:

  • Genetic factors: A man should have an X and Y chromosome. If he has two X chromosomes and one Y chromosome, as in Klinefelter’s syndrome, the testicles will develop abnormally and there will be low testosterone and a low sperm count or no sperm.
  • Mumps: If this occurs after puberty, inflammation of the testicles may affect sperm production.
  • Hypospadias: The urethral opening is under the penis, instead of its tip. This abnormality is usually surgically corrected in infancy. If the correction is not done, it may be harder for the sperm to get to the female’s cervix. Hypospadias affects about 1 in every 500 newborn boys.
  • Cystic fibrosis: This is a chronic disease that results in the creation of a sticky mucus. This mucus mainly affects the lungs, but males may also have a missing or obstructed vas deferens. The vas deferens carries sperm from the epididymis to the ejaculatory duct and the urethra.
  • Radiation therapy: This can impair sperm production. The severity usually depends on how near to the testicles the radiation was aimed.
  • Some diseases: Conditions that are sometimes linked to lower fertility in males are anemia, Cushing’s syndrome, diabetes, and thyroid disease.

Some medications increase the risk of fertility problems in men.

  • Sulfasalazine: This anti-inflammatory drug can significantly lower a man’s sperm count. It is often prescribed for Crohn’s disease or rheumatoid arthritis. Sperm count often returns to normal after stopping the medication.
  • Anabolic steroids: Popular with bodybuilders and athletes, long-term use can seriously reduce sperm count and mobility.
  • Chemotherapy: Some types may significantly reduce sperm count.
  • Illegal drugs: Consumption of marijuana and cocaine can lower the sperm count.
  • Age: Male fertility starts to fall after 40 years.
  • Exposure to chemicals: Pesticides, for example, may increase the risk.
  • Excess alcohol consumption: This may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but it may affect those who already have a low sperm count.
  • Overweight or obesity: This may reduce the chance of conceiving.
  • Mental stress: Stress can be a factor, especially if it leads to reduced sexual activity.

Laboratory studies have suggested that long-term acetaminophen use during pregnancy may affect fertility in males by lowering testosterone production. Women are advised not to use the drug for more than one day.

Causes in women

Infertility in women can also have a range of causes.

Risk factors

Risk factors that increase the risk include:

  • Age: The ability to conceive starts to fall around the age of 32 years.
  • Smoking: Smoking significantly increases the risk of infertility in both men and women, and it may undermine the effects of fertility treatment. Smoking during pregnancy increases the chance of pregnancy loss. Passive smoking has also been linked to lower fertility.
  • Alcohol: Any amount of alcohol consumption can affect the chances of conceiving.
  • Being obese or overweight: This can increase the risk of infertility in women as well as men.
  • Eating disorders: If an eating disorder leads to serious weight loss, fertility problems may arise.
  • Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. Women who are at risk, including those on a vegan diet, should ask the doctor about supplements.
  • Exercise: Both too much and too little exercise can lead to fertility problems.
  • Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a woman and cause inflammation in a man’s scrotum. Some other STIs may also cause infertility.
  • Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and solvents have been linked to fertility problems in both men and women. A mouse study has suggested that ingredients in some household detergents may reduce fertility.
  • Mental stress: This may affect female ovulation and male sperm production and can lead to reduced sexual activity.

Medical conditions

Some medical conditions can affect fertility.

Ovulation disorders appear to be the most common cause of infertility in women.

Ovulation is the monthly release of an egg. The eggs may never be released, or they may only be released in some cycles.

Ovulation disorders can be due to:

  • Premature ovarian failure: The ovaries stop working before the age of 40 years.
  • Polycystic ovary syndrome (PCOS): The ovaries function abnormally and ovulation may not occur.
  • Hyperprolactinemia: If prolactin levels are high, and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
  • Poor egg quality: Eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is, the higher the risk.
  • Thyroid problems: An overactive or underactive thyroid gland can lead to a hormonal imbalance.
  • Chronic conditions: These include AIDS or cancer.

Problems in the uterus or fallopian tubes can prevent the egg from traveling from the ovary to the uterus, or womb.

If the egg does not travel, it can be harder to conceive naturally.

Causes include:

  • Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
  • Submucosal fibroids: Benign or non-cancerous tumors occur in the muscular wall of the uterus. They can interfere with implantation or block the fallopian tube, preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may make the uterus’ cavity bigger, increasing the distance the sperm has to travel.
  • Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body.
  • Previous sterilization treatment: In women who have chosen to have their fallopian tubes blocked, the process can be reversed, but the chances of becoming fertile again are not high.

Medications, treatments, and drugs

Some drugs can affect fertility in a woman.

  • Non-steroidal anti-inflammatory drugs (NSAIDs): Long-term use of aspirin or ibuprofen may make it harder to conceive.
  • Chemotherapy: Some chemotherapy drugs can result in ovarian failure. In some cases, this may be permanent.
  • Radiation therapy: If this is aimed near the reproductive organs, it can increase the risk of fertility problems.
  • Illegal drugs: Some women who use marijuana or cocaine may have fertility problems.

Cholesterol

One study has found that high cholesterol levels may have an impact on fertility in women.

Treatment

Treatment will depend on many factors, including the age of the person who wishes to conceive, how long the infertility has lasted, personal preferences, and their general state of health.

Frequency of intercourse

The couple may be advised to have sexual intercourse more often around the time of ovulation. Sperm can survive inside the female for up to 5 days, while an egg can be fertilized for up to 1 day after ovulation. In theory, it is possible to conceive on any of these 6 days that occur before and during ovulation.

However, a survey has suggested that the 3 days most likely to offer a fertile window are the 2 days before ovulation plus the 1 day of ovulation.

Some suggest that the number of times a couple has intercourse should be reduced to increase sperm supply, but this is unlikely to make a difference.

Fertility treatments for men

Treatment will depend on the underlying cause of the infertility.

  • Erectile dysfunction or premature ejaculation: Medication, behavioral approaches, or both may help improve fertility.
  • Varicocele: Surgically removing a varicose vein in the scrotum may help.
  • Blockage of the ejaculatory duct: Sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
  • Retrograde ejaculation: Sperm can be taken directly from the bladder and injected into an egg in the laboratory.
  • Surgery for epididymal blockage: A blocked epididymis can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked, sperm may not be ejaculated properly.

Fertility treatments for women

Fertility drugs might be prescribed to regulate or induce ovulation.

They include:

  • Clomiphene (Clomid, Serophene): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. It makes the pituitary gland release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
  • Metformin (Glucophage): If Clomiphene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance.
  • Human menopausal gonadotropin, or hMG (Repronex): This contains both FSH and LH. Patients who do not ovulate because of a fault in the pituitary gland may receive this drug as an injection.
  • Follicle-stimulating hormone (Gonal-F, Bravelle): This hormone is produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
  • Human chorionic gonadotropin (Ovidrel, Pregnyl): Used together with clomiphene, hMG, and FSH, this can stimulate the follicle to ovulate.
  • Gonadotropin-releasing hormone (Gn-RH) analogs: These can help women who ovulate too early—before the lead follicle is mature—during hmG treatment. It delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
  • Bromocriptine (Parlodel): This drug inhibits prolactin production. Prolactin stimulates milk production during breastfeeding. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems.

Reducing the risk of multiple pregnancies

Injectable fertility drugs can sometimes result in multiple births, for example, twins or triplets. The chance of a multiple birth is lower with an oral fertility drug.

Careful monitoring during treatment and pregnancy can help reduce the risk of complications. The more fetuses there are, the higher the risk of premature labor.

If a woman needs an HCG injection to activate ovulation and scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless if the desire to become pregnant is very strong.

If too many embryos develop, one or more can be removed. Couples will have to consider the ethical and emotional aspects of this procedure.

Surgical procedures for women

If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through.

Endometriosis may be treated through laparoscopic surgery. A small incision is made in the abdomen, and a thin, flexible microscope with a light at the end, called a laparoscope, is inserted through it. The surgeon can remove implants and scar tissue, and this may reduce pain and aid fertility.

Assisted conception

The following methods are currently available for assisted conception.

Intrauterine insemination (IUI): At the time of ovulation, a fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected.

The woman may be given a low dose of ovary stimulating hormones.

IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. It can also help if a man has severe erectile dysfunction.

In-vitro fertilization (IVF): Sperm are placed with unfertilized eggs in a petri dish, where fertilization can take place. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use.

Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.

Sperm or egg donation: If necessary, sperm or eggs can be received from a donor. Fertility treatment with donor eggs is usually done using IVF.

Assisted hatching: The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to implant into the uterine lining. This improves the chances that the embryo will implant at, or attach to, the wall of the uterus.

This may be used if IVF has not been effective, if there has been poor embryo growth rate, and if the woman is older. In some women, and especially with age, the membrane becomes harder. This can make it difficult for the embryo to implant.

Electric or vibratory stimulation to achieve ejaculation: Ejaculation is achieved with electric or vibratory stimulation. This can help a man who cannot ejaculate normally, for example, because of a spinal cord injury.

Surgical sperm aspiration: The sperm is removed from part of the male reproductive tract, such as the vas deferens, testicle, or epididymis.

Types

Infertility can be primary or secondary.

Primary infertility is when a couple has not conceived after trying for at least 12 months without using birth control

Secondary infertility is when they have previously conceived but are no longer able to.

Diagnosis

Most people will visit a physician if there is no pregnancy after 12 months of trying.

If the woman is aged over 35 years, the couple may wish to see a doctor earlier, because fertility testing can take time, and female fertility starts to drop when a woman is in her 30s.

A doctor can give advice and carry out some preliminary assessments. It is better for a couple to see the doctor together.

The doctor may ask about the couple’s sexual habits and make recommendations regarding these. Tests and trials are available, but testing does not always reveal a specific cause.

Infertility tests for men

The doctor will ask the man about his medical history, medications, and sexual habits and carry out a physical examination. The testicles will be checked for lumps or deformities, and the shape and structure of the penis will be examined for abnormalities.

  • Semen analysis: A sample may be taken to test for sperm concentration, motility, color, quality, any infections, and whether any blood is present. Sperm counts can fluctuate, so that several samples may be necessary.
  • Blood test: The lab will test for levels of testosterone and other hormones.
  • Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation.
  • Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it.

Infertility tests for women

A woman will undergo a general physical examination, and the doctor will ask about her medical history, medications, menstruation cycle, and sexual habits.

She will also undergo a gynecologic examination and a number of tests:

  • Blood test: This can assess hormone levels and whether a woman is ovulating.
  • Hysterosalpingography: Fluid is injected into the woman’s uterus and X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If a blockage is present, surgery may be necessary.
  • Laparoscopy: A thin, flexible tube with a camera at the end is inserted into the abdomen and pelvis, allowing a doctor to look at the fallopian tubes, uterus, and ovaries. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.

Other tests include:

  • ovarian reserve testing, to find out how effective the eggs are after ovulation
  • genetic testing, to see if a genetic abnormality is interfering with fertility
  • pelvic ultrasound, to produce an image of the uterus, fallopian tubes, and ovaries
  • Chlamydia test, which may indicate the need for antibiotic treatment
  • thyroid function test, as this may affect the hormonal balance

Complications

Some complications can result from infertility and its treatment. If conception does not occur after many months or years of trying, it can lead to stress and possibly depression.

Some physical effects may also result from treatment.

Ovarian hyperstimulation syndrome

The ovaries can swell, leak excess fluid into the body, and produce too many follicles, the small fluid sacs in which an egg develops.

Ovarian hyperstimulation syndrome (OHSS) usually results from taking medications to stimulate the ovaries, such as clomiphene and gonadotrophins. It can also develop after IVF.

Symptoms include:

  • bloating
  • constipation
  • dark urine
  • diarrhea
  • nausea
  • abdominal pain
  • vomiting

They are usually mild and easy to treat.

Rarely, a blood clot may develop in an artery or vein, liver or kidney problems can arise, and respiratory distress may develop. In severe cases, OHSS can be fatal.

Ectopic pregnancy

This is when a fertilized egg implants outside the womb, usually in a fallopian tube. If it stays in there, complications can develop, such as the rupture of the fallopian tube. This pregnancy has no chance of continuing.

Immediate surgery is needed and, sadly, the tube on that side will be lost. However, future pregnancy is possible with the other ovary and tube.

Women receiving fertility treatment have a slightly higher risk of an ectopic pregnancy. An ultrasound scan can detect an ectopic pregnancy.

Coping mentally

It is impossible to know how long treatment will go on for and how successful it will be. Coping and persevering can be stressful. The emotional toll on both partners can affect their relationship.

Some people find that joining a support group helps, as it offers the chance to talk to others in a similar situation.

It is important to tell a doctor if excessive mental and emotional stress develop. They can often recommend a counselor and others who can offer appropriate support. Online support from organizations such as Resolve can be helpful.

Outlook

For couples who experience fertility problems and those who wish to have children at an older age, there are more options available than ever before.

In 1978, the first baby was born as a result of IVF. By 2014, over 5 million people had been born after being conceived through IVF.

As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time.

Financing fertility treatment can also be costly, but there are programs that can help with this.

Finding Help

HealthLynked is a great platform for connecting and communicating with medical professionals who can guide and counsel you through the issues of infertility.  Create a free profile today and LYNK with physicians in your area immediately.

Ready to get Lynked?  Go to HealthLynked.com to get started for free…right away!

 

Source:

Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT, Infertility in men and women, Medical News Today, 4 January 2018

 

#ivfjourney,#ivf,#fertilitytreatment,#fertility,#infertility,#friends,#ivfbaby,#ivfsuccess,#infertilitysucks

7 Ways to Beat the Heat and the Signs of Heat Distress

Extreme Heat often results in the highest number of annual deaths among all weather-related hazards in the US. On average, it has killed more people in the last 30 years than any other weather phenomena.  EXTREME HEAT is generally defined as an extended period (2 to 3 days) of high heat and humidity with temperatures above 90 degrees.  In such conditions, evaporation is slowed, and the body must work extra hard to maintain a normal temperature. This can lead to death by overworking the human body. Remember that:

  • Extreme heat can occur quickly and without warning.
  • Older adults, children, and sick or overweight individuals are at greater risk from extreme heat.
  • Humidity increases the feeling of heat as measured by a heat index.

While every year, thousands of people suffer from heat-related illnesses and even death, many of these tragedies can be prevented. Keep everyone safe this summer by following these seven simple tips:

  1. Ensure you get acclimated to the temperature and humidity! Especially children, the elderly, and athletes need time to adjust to activity and exercising in hot, humid weather. Planning early morning or late afternoon/evening activities and gradually increasing exercise and sports-related activities over the first two weeks of warmer weather will ensure they are adequately acclimatized to their environment.
  2. Properly dress before activity and exercise outdoors! Clothing should be light-colored, lightweight and limited to one layer of absorbent material to facilitate the evaporation of sweat. Sweat-saturated garments should be replaced by dry garments, and rubberized sweat suits should never be used for weight loss.
  3. Protect your largest organ from the sun! In addition to staying in the shade, limit skin’s exposure to the sun during the peak intensity hours and dress in lightweight clothing and hats. Everyone over 6 months should frequently apply (and reapply) sunscreen with at least 15 SPF to their skin. Little ones under six months should mostly avoid the sun. Sunscreen should be reapplied every two hours, or after swimming or sweating. Maximize the fun, not the sun.
  4. Be sure you are drinking plenty of fluids. Before and during any type of physical activity, everyone should be encouraged to drink plenty of fluids, such as cool water or flavored sports drinks. Due to their high-sugar and caffeine content, fruit juices, sodas and energy drinks (i.e., Red Bull) are not recommended. Alcohol “es no bueno”, as it dehydrates.
  5. Avoid equipment and surfaces directly exposed to the sun! In direct sunlight, playground equipment can heat up to temperatures well into the triple digits. Severe burns can result from young children unknowingly exposing their skin to extremely hot playground equipment. Same is true on pool deck equipment and surfaces. Avoid being outdoors midday and frequenting playgrounds that are not shaded by trees or canopies.   Cool surfaces with copious amounts of water.
  6. Never leave children, the elderly or even pets in a car or other closed motor vehicle! The inside of a car can quickly reach dangerous and life-threatening temperature levels! Since 1998, over 600 children in the U.S. have died of heat stroke when left unattended in a vehicle.  On average, 37 kids perish in hot vehicle each year.  The hottest months inevitably bring the highest numbers of hypothermia incidents, so summer, late spring and early fall are the most treacherous times.

As of July 20, 26 children have lost their lives this year in hot car death incidents. To prevent heat stress tragedies, parents and caregivers should never leave others alone in or around a vehicle, always lock the car and ensure children do not have access to keys or remote entry devices, create visual reminders to look in the back seat before you leave, and plan to have daycare providers or other family members call home if the child hasn’t arrived on schedule to verify there’s been a change from the daily routine.

Know the signs and symptoms of heat illness and watch for them among your family and friends! Heat-related illnesses, such as heat cramps, heat exhaustion and heat stroke, cause a wide-spectrum of signs and symptoms.

  • Muscle cramps usually occur in the larger muscle groups, such as the hamstrings and buttocks. If someone develops painful muscular cramping, they should stop exercising and start drinking fluids. Additionally, by encouraging the person to lie down in a cool area while massaging and stretching the affected muscles, their symptoms may improve at a quicker pace.
  • Heat exhaustion is the most common form of heat-related illness and will usually occur in those who participate in activities that lead to profuse sweat loss! Symptoms of heat exhaustion include temperature elevation, headache, dizziness, lightheadedness, nausea, vomiting and muscle weakness. If someone develops these symptoms, they should be moved away from direct sunlight and into a shaded or air-conditioned area. By fanning and rehydrating and placing ice bags around the neck, underarms and groin area, the core body temperature will start to lower. However, if the person is unable to keep fluids down (due to nausea/vomiting) and appears dehydrated, they should be seen by a physician.
  • Heat stroke is a medical emergency, with a mortality rate as high as 50 to 70 percent! With severe dehydration, the normal sweating response can become impaired! Symptoms of heat stroke are similar to those seen with heat exhaustion, but are typically accompanied by abnormal behavior or responsiveness, seizures, and core body temperatures greater than 104°F. In addition to moving and cooling the victim, 911 should be called immediately! Bystander CPR and the use of an AED (or automated external defibrillator) may be necessary if the person stops breathing and/or no longer has a pulse.

Remember, heat-induced illness and death are preventable! Be sure to take the necessary precautions to ensure everyone’s safety and a fun-filled summer, especially as we enter the hottest parts of our year in the northern hemisphere.

If you are experiencing any of the signs and symptoms of heat injury, seek medical attention Fast.  You might use HealthLynked.com to do so, and if you are already maintaining your medical information in our easy to use, secure portable, personal health record system, it will be so much easier to get the right care today.

Ready to get Lynked? Go to HealthLynked.comto learn more and sign up for free!

Sources:

Fema.gov

Ready.gov

Hashtags

#HeatSafety,#BeatTheHeat,#SummerSafety,#HeatstrokeKills,#PrepareAthon

 

Could Your Kid’s Growing Pains Be Something More?

When you think about arthritis and its associated swelling and joint pain, you likely relate the problem primarily with the elderly. However, statistics are clear it is not just the oldest (and wisest) among us who suffer from arthritis; there’s a whole range of problems under the Juvenile Arthritis (JA) umbrella negatively impacting the lives of kids, according to the Arthritis Foundation.

July is Juvenile Arthritis Awareness Month, a month dedicated to increase awareness about the early signs and symptoms of juvenile arthritis and to increase the focus and expand resources for the fight against JA. The campaign was initiated by the Arthritis Foundation and targets a condition that currently affects 300 000 children nationwide, making it one of the most common childhood diseases in the US.

What is Juvenile Arthritis?

The word “arthritis” means joint inflammation in Latin, but juvenile arthritis can impact eyes, skin and the gastrointestinal tract. The disorder takes on a large variety of forms, and researchers and doctors alike are working to better understand the key differences and how varying approaches can help.
Juvenile arthritis (JA) is not a disease in itself. Also known as pediatric rheumatic disease, JA is an umbrella term used to describe the many autoimmune and inflammatory conditions or pediatric rheumatic diseases that can develop in children under the age of 16.
Although the various types of juvenile arthritis share many common symptoms, like pain, joint swelling, redness and warmth, each type of JA is distinct and has its own special concerns and symptoms. Some types of juvenile arthritis affect the musculoskeletal system, but joint symptoms may be minor or nonexistent.

Three classifications of juvenile arthritis exist: juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis (JCA), and juvenile idiopathic arthritis (JIA), of which, juvenile rheumatoid arthritis is the most common. The classification is made based on symptoms, number of joints involved and the presence of antibodies in the blood

Facts About Juvenile Arthritis

1. Juvenile Arthritis Affects more than Joints

According to the Arthritis Foundation, JA can do more than cause joint discomfort in young people. While many types of JA share commonalities like swelling, “each type of JA is distinct and has its own special concerns and symptoms”, it notes.

For example, some versions of JA don’t fall under the classic definition of arthritis at all; the problem can affect the eyes, skin (Juvenile dermatomyositis) and digestive system as well, according to the foundation.

2. One of the Early Signs of JA is Limping

While some children may not express any pain from the disease, their actions can speak for themselves. The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that JA often targets the knees and feet, creating a telltale limp in junior’s walk.

The source also notes that the problem is usually worse first thing in the morning or after a nap, when the joints have a chance to stiffen. Keep an eye out for any strange walking patterns of your child, especially if you can’t recall any recent accidents that would contribute to the limping.

3. It’s Difficult to Say It’s a Genetic Problem

While many diseases are passed down from one parent or both, The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that it’s “very rare” for more than one family member to have JA.

That being said, children who have another family member who has JA are at “slightly increased” risk of developing the problem. Since JA is largely an autoimmune disease (when you immune system mistakenly attacks healthy cells), families with a history of autoimmune diseases such as Multiple Sclerosis or Thyroid inflammation may be at higher risk.

4. Girls are More at Risk

According to HealthCentral.com, Juvenile Arthritis affects more girls than boys, and is likely to develop from ages 2 to 4 or during the adolescent/teen years (but under the age of 16).

While there doesn’t seem to be any solid statistics for girls versus boys when it comes to JA cases, KidsGetArthritisToo.org notes that the most common form of JA is mild oligoarthritis (affecting fewer than five joints) that is usually found in girls aged 8-or younger.

5. Juvenile Arthritis Can be Fatal

Apparently arthritis and other rheumatic conditions (collectively known as AORC) in youth has accounted for deaths in the U.S., according to statistics from the Centers for Disease Control and Prevention (CDC). The source notes that between 1979 and 1998, there were roughly 50 deaths per year (of children younger than 15) attributed to the diseases.

The slightly better news is that during this roughly 20-year period, the death rate related to AORC diseases fell 25-percent from 1.2 deaths per million to 0.9 deaths per million, according to the CDC. These deaths are more common among females than males, according to HealthLine.com, which paints a somewhat bleaker picture regarding JA mortality rates.

6. Juvenile Arthritis is Treatable

At this moment, there is no cure for juvenile arthritis. The custom approach to the disorder is to control pain levels, reduce inflammation and maintain mobility, while in more extreme cases surgery is the only possible solution to prevent further joint damage. Many treatment plans are based on proper medication, therapeutically physical activities, eye care and healthy eating.

The treatments used for Juvenile Arthritis focus on improving quality of life for young people. In some cases, pain medication is the solution, but in some cases anti-inflammatory drugs (NSAIDS) are used. Doctors may also prescribe DMARDs, a family of drugs that are designed to slow the progression of the juvenile arthritis. Chemotherapy drugs have also been used to battle JA, although in lower doses than when treating cancer patients.

Physical therapy may also be part of the treatment plan to help maintain your child’s flexibility and maintain muscle tone. Probably the most important component of any plan is the way in which all measures are customized for a child’s daily schedule in order to affect the quality of life as little as possible.

Types of Juvenile Arthritis

  • Juvenile idiopathic arthritis (JIA). Considered the most common form of arthritis, JIA includes six subtypes: oligoarthritis, polyarthritis, systemic, enthesitis-related, juvenile psoriatic arthritis or undifferentiated.
  • Juvenile dermatomyositis. An inflammatory disease, juvenile dermatomyositis causes muscle weakness and a skin rash on the eyelids and knuckles.
  • Juvenile lupus. Lupus is an autoimmune disease. The most common form is systemic lupus erythematosus, or SLE. Lupus can affect the joints, skin, kidneys, blood and other areas of the body.
  • Juvenile scleroderma.Scleroderma, which literally means “hard skin,” describes a group of conditions that causes the skin to tighten and harden.
  • Kawasaki disease.This disease causes blood-vessel inflammation that can lead to heart complications.
  • Mixed connective tissue disease. This disease may include features of arthritis, lupus dermatomyositis and scleroderma, and is associated with very high levels of a particular antinuclear antibody called anti-RNP.
  • FibromyalgiaThis chronic pain syndrome is an arthritis-related condition, which can cause stiffness and aching, along with fatigue, disrupted sleep and other symptoms. More common in girls, fibromyalgia is seldom diagnosed before puberty.

Juvenile Arthritis Causes

No known cause has been pinpointed for most forms of juvenile arthritis, nor is there evidence to suggest that toxins, foods or allergies cause children to develop JA. Some research points toward a genetic predisposition to juvenile arthritis, which means the combination of genes a child receives from his or her parents may cause the onset of JA when triggered by other factors.

Juvenile Arthritis Symptoms

Each of the different types of JA have their own set of signs and symptoms. You can read more specifics about the diseases by following the links above, and by visiting the Arthritis Foundation’s website dedicated to pediatric rheumatic diseases, KidsGetArthritisToo.

Juvenile Arthritis Diagnosis

The most important step in properly treating juvenile arthritis is getting an accurate diagnosis. The diagnostic process can be long and detailed. There is no single blood test that confirms any type of JA. In children, the key to diagnosis is a careful physical exam, along with a thorough medical history. Any specific tests a doctor may perform will depend upon the type of JA suspected.

Juvenile Arthritis Self Care

An important part of JA treatment is teaching chidlren the importance of following the treatment prescribed by their healthcare team. Self care also involves helping the child address the emotional and social effects of the disease. Self management encompasses the choices made each day to live well and stay healthy and happy.

Finding the Right Physician

You’ll probably first bring your symptoms to the attention of your family doctor, who may refer you to a rheumatologist — a doctor specializing in the treatment of arthritis and other diseases of the joints, muscles and bone. Because JA can affect many organ systems, you may need to see a variety of medical specialists.

To get the right help, find a rheumatologist or other physician who knows how hard it is to endure a disease so few understand and can truly help.  Go to HealthLynked.com today to build a Free patient profile and begin communicating there with those who will collaborate on your wellness.

Sources:

Arthritis.org

ActiveBeat.com

 

DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of HealthLynked Corp and are intended to spark discussion about issues pertaining to health and wellness.

 

 

#ArthritisAwareness#ArthritisFoundation#JuvenileArthritis#StrongerThanJA#KidsGetArthritisToo#Arthritis

Will At Home Testing Improve Screening and Lower Cancer Rates?

Mailing colorectal cancer screening tests to patients insured by Medicaid increased screening rates for this population, report researchers at the University of North Carolina Comprehensive Cancer Center.

In collaboration with the Mecklenburg County Health Department in Charlotte, researchers with UNC Lineberger’s Carolina Cancer Screening Initiative examined the impact of targeted outreach to more than 2,100 people insured by Medicaid who were not up-to-date with colorectal cancer screening. The project resulted in a nearly 9 percentage point percent increase in screening rates for patients who received a screening kit in the mail compared with patients who just received a reminder, and it demonstrated that their method could serve as a model to improve screening on a larger scale. The findings were published in the journal Cancer.

The American Cancer Society estimates that more than 97,000 people will be diagnosed with colorectal cancer in the United States this year, and it will result in approximately 50,600 deaths. It is third most common type of cancer in the United States, and the second leading cause of cancer death.  Cancer, overall, is the second killer in the US, behind heart disease.

While colorectal cancer screening has proven effective in reducing cancer deaths, researchers report too few people are getting screened. Current guidelines from ACS recommend regular screening with either a high-sensitivity stool-based test or a structural (visual) exam for average-risk people aged 45 years and older, and that all positive results should be followed with colonoscopy.

Despite these recommendation, studies have identified notable gaps in screening rates, including by race, geographic region and other socioeconomic factors. Among patients who are insured, people with Medicaid have the lowest rates of colorectal cancer testing.

“There has been a national push to increase colorectal cancer screening rates since colorectal cancer is a preventable disease, but screening rates are only about 63 percent, and low-income, and otherwise vulnerable populations, tend to be screened at even lower rates,” said the study’s first author UNC Lineberger’s Alison Brenner, Ph.D., MPH, research assistant professor in the UNC School of Medicine Department of Internal Medicine.

For the project, researchers either mailed reminders about colorectal cancer screening and instructions on how to arrange one with the health department, or reminders plus a fecal immunochemical test, or FIT kit, which can detect blood in the stool—a symptom of colon cancer. The patient completes the test at home and returns it to a provider for analysis. Patients who have a positive FIT kit result will be scheduled for a colonoscopy.

The UNC Lineberger researchers worked with the Mecklenburg County Health Department staff, who coordinated the reminders and mailings and ran the test analyses. They also partnered with Medicaid care coordinators to provide patient navigation support to patients who had abnormal test results and required a colonoscopy.

Twenty-one percent of patients who received FIT kits in the mail completed the screening test, compared with 12 percent of patients who just received a reminder. Eighteen people who completed FIT tests had abnormal results, and 15 of those people were eligible for a colonoscopy. Of the 10 who completed the colonoscopy, one patient had an abnormal result.

“Preventive care amongst vulnerable populations rarely rises to the top of the mental queue of things that need to get done,” Brenner said. “In North Carolina, many Medicaid recipients are on disability. Making something like colorectal cancer screening as simple and seamless as possible is really important. If it’s right in front of someone, it’s more likely to get done, even if there are simple barriers in place.”

Brenner said the study shows the potential to harness resources like the county health department for health prevention services.

“This collaborative and pragmatic quality improvement effort demonstrates the feasibility, acceptability, and efficiency of using existing health services resources and infrastructure, including Medicaid-based navigation to colonoscopy to deliver timely cancer screening services to low income populations,” said UNC Lineberger’s Stephanie Wheeler, Ph.D., MPH, associate professor in the UNC Gillings School of Global Public Health and the study’s senior author.

She said researchers plan to move forward to study whether they can implement their approach on a larger scale, and to understand all of the cost implications.

“This is looking at expanding the medical neighborhood—to harness community resources to target patients and in this case, insured patients, who are maybe not getting this from a primary health care organization, and how to increase screening rates in these types of vulnerable populations,” Brenner said.


If you are looking for a doctor to discuss the need for colon cancer screening or your results, you can find a physician at HealthLynked.com.  We are the first ever healthcare social ecosystem designed to Improve HealthCare.

Connect and collaborate with physicians in your area specializing in gastrointestinal disorders, or any other assorted medical malaise.  Even find testing right in the platform you can have delivered to your door.

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Source:  originally printed, “By sending tests in the mail, researchers boost colorectal cancer screening.”  July 14, 2018 , UNC Lineberger Comprehensive Cancer Center

More information: Alison T. Brenner et al, Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial, Cancer (2018).  DOI: 10.1002/cncr.31566

Provided by: UNC Lineberger Comprehensive Cancer Center

 

 

July is Sarcoma Awareness Month – Raise Awareness for this “Forgotten Cancer”

If you see yellow ribbons around your community during the month of July, it may mean something different than the usual “Support Our Troops” many think of when first sighted. Instead, they could be displayed in honor of Sarcoma Awareness Month, observed each July.

Sarcoma is a soft-tissue cancer that may occur in a variety of the body’s soft tissues, including the nerves, muscles, joints, blood vessels, fat and more. Sarcoma may also occur in the bones.  Although rare in adults, making up just ONE percent of adult cancers, sarcoma is relatively common in children, accounting for fifteen percent of childhood cancer cases.  Bone and joint cancer is most frequently diagnosed among teenagers, while soft tissue cancers typically affect those 55 years or older.

Sarcoma is most often found in the arms and legs, where the majority of connective tissues are located, but it can occur virtually anywhere. Because the disease often starts deep in the body, it may not be noticeable until a large lump or bump appears — and at this point the cancer may be difficult to treat.

The Sarcoma Foundation of America (SFA) estimates that about 20 percent of sarcoma cases are curable by surgery while another 30 percent may be effectively treated with surgery, chemotherapy and/or radiation. However, in about half of cases, the disease is resistant to all form of treatments, highlighting an urgent need for new therapies.

Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat; rhabdomyosarcomas form in muscle; and Ewing sarcomas form in bone and soft tissue.

In 2018, over 13,000 cases of soft tissue sarcoma and 3,400 cases of bone sarcomas are expected to be diagnosed in the United States, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER). Approximately 5,100 and 1,590 people are expected to die from soft tissue and bone sarcomas, respectively. The five-year survival rate for soft tissue sarcomas is 50 percent, while the survival rate is 66 percent for bone sarcomas.

Because sarcomas are difficult to distinguish from other cancers when they are found within organs, their incidence is probably underestimated, according to the National Cancer Institute.

 Fast facts on sarcoma

  • There are over 50 types of soft tissue sarcoma.
  • Symptoms may not be apparent; often, the only sign of sarcoma is a lump.
  • Pain may occur depending on where the tumor is located, or if it presses on nearby nerves.
  • Treatment, as for other forms of cancer, can include surgery, radiation therapy, and chemotherapy.

Symptoms of soft tissue sarcoma

People with soft tissue sarcomas often have no symptoms. There may be no signs until the lump grows to a large size and can be felt; however, even this may go unnoticed. The main symptoms are:

  • Pain – the most obvious symptom. Once the tumor affects local tissues, nerves, or muscles, it can be felt as pain in the general area.
  • Inflammation – the tumor grows and eventually affects the area with inflammation and swelling.
  • Location specific symptoms – inability to move limbs properly (if the sarcoma is on the arms or legs for example) and other impairments depending on the location.

Specific symptoms may reflect the particular type of sarcoma. For instance, tumors in the gastrointestinal system may bleed, so these sarcomas might produce symptoms like blood in the stool, or a stool that has a black, tarry appearance.

Types of sarcoma

Types of soft tissue sarcoma are defined by the specific tissue or location affected; they include:

  • Undifferentiated pleomorphic sarcoma – previously known as malignant fibrous histiocytoma – this tumor is most often found in the arms or legs but sometimes at the back of the abdomen.
  • Gastrointestinal stromal tumor (GIST) – this affects specialized neuromuscular cells of the gut.
  • Liposarcoma – sarcoma of fat tissue.
  • Leiomyosarcoma – affects smooth muscle in organ walls.
  • Synovial sarcomas – these are usually found around a joint in the arms or legs.
  • Malignant peripheral nerve sheath tumor – also known as neurofibrosarcoma, it affects the protective lining of the nerves.
  • Rhabdomyosarcoma – this forms in muscle and is a childhood cancer. While rare overall, it is a relatively common tumor in children.
  • Angiosarcomas – these develop in the cells of the blood or lymph vessels.
  • Fibrosarcomas – sarcomas that usually form in the limbs or on the trunk, forming from fibroblasts, the most common cell type in connective tissue.
  • Kaposi’s sarcoma – a sarcoma that affects the skin and is caused by a virus. The most common form of Kaposi’s sarcoma is related to AIDS.  Kaposi’s tumors often produce distinctive skin lesions but also affect other soft tissues.  Kaposi’s sarcoma is caused by the human herpesvirus 8.
  • Further examples – these include dermatofibrosarcoma protuberans, a skin lesion; epithelioid sarcoma, which often affects young adults’ hands or feet; myxoma, which affects older adults, usually in the arms and legs; mesenchymomas, which are rare and combine elements of other sarcomas and can be found in any part of the body; vascular sarcomas, containing many blood vessels; and malignant neurilemmoma (also known as schwannoma).  Sarcoma of the bone includes osteosarcoma, Ewing sarcoma, and chondrosarcoma.

Causes of sarcoma

The causes behind sarcoma are unknown, but there are some known risk factors. In adults, for instance, exposure to phenoxy acetic acid in herbicides or chlorophenols in wood preservatives may increase the risk. High doses of radiation are also known to cause sarcomas in some people, as are certain rare genetic alterations. The following inherited diseases are also associated with an increase sarcoma risk, according to SFA:

  • Li-Fraumeni syndrome, which is associated with alterations in the p53 gene
  • Von Recklinghausen’s disease (neurofibromatosis), which is associated with alterations in the NF1 gene

Having certain inherited disorders can increase the risk for other soft tissue sarcomas, including retinoblastoma, tuberous sclerosis, Werner syndrome, and nevoid basal cell carcinoma syndrome. Other risk factors for soft tissue sarcoma include past treatment with radiation therapy for certain cancers; exposure to certain chemicals, such as thorium dioxide, vinyl chloride, or arsenic; and long-term lymphedema in the arms or legs.

Past treatment with radiation can increase the risk of osteosarcoma and other types of bone cancers. Other risk factors for osteosarcoma include treatment with anticancer drugs called alkylating agents, having a certain change in the retinoblastoma gene, and having certain conditions including Paget disease, Diamond-Blackfan anemia, and Werner syndrome.

Tests and diagnosis of sarcoma

After understanding a patient’s medical history and completing a medical examination, medical imaging scans will help to inform a diagnosis, which will need to be confirmed through laboratory analysis of a tumor sample.

The following physical features should prompt a doctor to investigate:

  1. larger than 2 inches in diameter or growing in size
  2. fixed, immovable, or deep
  3. painful
  4. return of tumor previously removed

Medical imaging helps to locate, characterize, and give further information about a tumor to guide diagnosis. It may also be used to gauge the success of treatment or to look for spread of cancer.

Imaging techniques include X-rays, CT scan (computed tomography), MRI(magnetic resonance imaging), ultrasound, and PET (positron emission tomography).

Treatments for soft tissue sarcoma

The following treatment options can be used for sarcomas:

  • Surgery – the most common sarcoma treatment. It aims to remove the tumor and even some of the normal surrounding tissue. A biopsy sample is often taken at the same time to confirm the exact type of tumor.
  • Radiation therapy – this destroys cancer cells and may be done in addition to surgery, before or after the operation.
  • Chemotherapy – this could also be used in addition to surgery, though less often than radiation therapy.

Some soft tissue sarcomas have other available treatments, such as specific drug treatments, gene-targeted therapies, or biological therapies such as immunotherapy.

Treatment choice and intensity are also guided by the stage and grade of cancer, by the size of the tumor, and extent of any spread.

Prevention of sarcoma

Sarcoma is not typically preventable. Radiation therapy is a risk factor, so reducing exposure to it may be preventive, although a need for radiation therapy usually outweighs any subsequent sarcoma risk.

Observing Sarcoma Awareness Month

Sarcoma is still considered to be the “forgotten cancer.”  Efforts to encourage research and drug development are made more challenging due to a lack of awareness and understanding.  How as a community do we raise funds for vital research if people don’t know that this cancer exists?

Though the Sarcoma Foundation of America works tirelessly every day to raise awareness, during Sarcoma Awareness Month, they aim to further highlight the extraordinary challenges sarcoma patients face and the need for more sarcoma research and better sarcoma therapies.  Please join in efforts and pledge to bring awareness to your community.  Here are a few ways you can help highlight the need for ongoing research on sarcoma:

  • This July, take a moment to share a message via social media or speak with your friends and family about this relatively unknown condition.
  • Join sarcoma patients, survivors and their loved ones for the Steps to Cure Sarcoma.  Every dollar raised will be used to fund research, patient advocacy and education.
  • Take a moment to listen to a Sarcoma Awareness Month Public Service Announcement campaign. Share it online to raise awareness.
  • Get together with others in the sarcoma community and donate today!

Getting Help

Since sarcoma is a rare cancer, many people are unfamiliar with the disease and have not been affected personally. However, many children’s lives have been altered because of this disease, and advances in early detection and treatment could help save lives.

A number of clinical trails are underway for people with sarcoma. If you’ve been recently diagnosed, ask your doctor if a clinical trial, which could give you access to novel treatment options, is right for you.

Trying to find the right doctor to determine if that lump or new pain is something more than just a little annoying is made easy at HealthLynked.  We are the first ever social ecosystem designed to connect physicians and patients in a truly collaborative platform to Improve HealthCare.

Ready to get Lynked?  Sign up for free today and take control of your wellness!

 

Sources:

Han, MD, Seunggu.  “Sarcoma: Symptoms, types, treatments, and causes.” Medical News Today.  23 May 2017.

https://www.curesarcoma.org/sarcoma-awareness-month/

https://www.aacrfoundation.org/Pages/sarcoma_awareness_month.aspx

https://www.gatewaycr.org/gateway-blog/posts/2017/july/july-is-sarcoma-awareness-month-what-is-sarcoma/

 

 

 

How is Excess Body Fat Priming Our Brains for Mental Decline?

As today marks the 81st birthday of Krispy Kreme – an American doughnut company and coffeehouse chain based in Winston-Salem, North Carolina built off an ancient, secret cajun recipe – it seems a fitting day to talk about obesity, fat, and its effect on the brain.  Let’s start with “skinny fat”.

Sarcopenia, which is the loss of muscle mass, tends to happen naturally with age. So, in older people with sarcopenia, excess body fat may not be readily visible. But hidden fat, paired with muscle mass loss later in life, could predict Alzheimer’s risk, researchers warn, and Sarcopenic obesity may exacerbate the risk of other cognitive decline later in life.

A recent study — the results of which have been published in the journal Clinical Interventions in Aging — has found that sarcopenia and obesity (independently, but especially when occurring together) can heighten the risk of cognitive function impairments later in life.

The research was conducted by scientists at the Comprehensive Center for Brain Health at the Charles E. Schmidt College of Medicine of Florida Atlantic University in Boca Raton.

“Sarcopenia,” explains senior study author Dr. James Galvin, “has been linked to global cognitive impairment and dysfunction in specific cognitive skills including memory, speed, and executive functions.”

“Understanding the mechanisms through which this syndrome may affect cognition is important as it may inform efforts to prevent cognitive decline in later life by targeting at-risk groups with an imbalance between lean and fat mass.”

Dr. James Galvin

“They may benefit from programs addressing loss of cognitive function by maintaining and improving strength and preventing obesity,” he adds.

Beware sarcopenic obesity

The scientists analyzed health-related data collected from 353 participants — aged 69, on average — all of whom registered to take part in community-based studies on aging and memory.

To establish whether or not there was a link between sarcopenic obesity — that is, the presence of excess body fat in conjunction with muscle mass loss — and cognitive decline, the team assessed participants’ performance on tests evaluating cognitive function, including the Montreal Cognitive Assessment and animal-naming exercises.

Also, the participants’ muscle strength and mass were evaluated through grip strength tests and chair stands, and they also underwent body compositions assessments, which looked at muscle mass, body mass index (BMI), and the amount of body fat.

The researchers discovered that the participants with sarcopenic obesity had the poorest performance on cognition-related tests.  The next poorest performance on cognition tests was seen in people with sarcopenia alone, followed by participants who only had obesity.

Both when occurring independently and when occurring in concert, obesity and loss of muscle mass were linked with impaired working memory — which is the type of memory we use when making spontaneous decisions on a daily basis — as well as less mental flexibility, poorer orientation, and worse self-control.

Keep changes in body composition in check

The scientists explain that obesity could exacerbate the risk of cognitive decline through biological mechanisms that influence vascular health, metabolism, and inflammation.

Moreover, they warn that in people who already face impaired executive functioning, obesity might also impact energy resources through poor self-control that affects nutrition.

As for sarcopenia, the researchers note that it could influence brain mechanisms related to conflict resolution skills and selective attention.

Based on the study’s findings, Dr. Galvin and his colleagues are particularly concerned that a mix of sarcopenia and excess body fat in older adults could become a serious public health issue, so they believe that any significant changes in body mass composition should be closely monitored to prevent negative health outcomes.

“Sarcopenia either alone or in the presence of obesity, can be used in clinical practice to estimate potential risk of cognitive impairment,” notes study co-author Magdalena Tolea.

But such health issues can be kept under control, and the risks associated with them averted, she suggests.

“Testing grip strength by dynamometry can be easily administered within the time constraints of a clinic visit, and body mass index is usually collected as part of annual wellness visits,” concludes Tolea.

How Aging and Obesity Prime the Brain for Alzheimer’s

According to another new study, the effects of natural aging processes, combined with those of obesity and a poor diet, affect certain brain mechanisms, thereby boosting the risk of Alzheimer’s. The new study, conducted on mice, uncovered how a high-fat, high-sugar diet renders the aging brain more vulnerable to Alzheimer’s.

Alzheimer’s disease is a neurodegenerative condition that is characterized primarily by memory loss and impaired cognition.  Some risk factors for the development of this disease are aging and metabolic conditions such as obesity and diabetes.  However, many of the biological mechanisms underlying the onset and progression of this disease remain unknown.

This is despite the fact that our understanding of the predisposing risk factors is growing all the time.  Now, Rebecca MacPherson, Bradley Baranowski, and Kirsten Bott — of Brock University in Ontario, Canada — have conducted a study that has allowed them to uncover some more of the mechanics at play in the development of this type of dementia.

The team worked with aging mice to investigate how a high-fat, high-sugar (HFS) diet that fueled obesity might also prime the brain for neurodegeneration in this sample.  Their findings are described in a paper now published in the journal Physiological Reports.

How unhealthful diets impact the brain

Specifically, the researchers examined how an HFS diet, in conjunction with the effects of normal biological aging, would affect insulin signaling, which helps to regulate the amount of glucose (simple sugar) absorbed by muscles and different organs.

They also looked at how this obesity-inducing diet might alter biomarkers relating to inflammation and cellular stress.

To understand the impact of an HFS diet on aging mice, the research team put some mice on a regular type diet, while others were given food that had a high fat and sugar content.

After the mice had been fed their respective diets for a period of 13 weeks, the team looked for signs of inflammation and measured cellular stress levels in two brain areas associated with memory and cognitive behavior: the hippocampus and the prefrontal cortex.

The researchers also compared the effects of an HFS diet on the brains of aging rodents’ baseline measurements effected on the brains of younger mice.

They found older mice on an obesity-inducing diet had high levels of brain inflammation and cellular stress, as well as insulin resistance in parts of the hippocampus linked to the development of Alzheimer’s disease.

Although more markers of insulin resistance were observed in the prefrontal cortices of mice that had been on an HFS diet, inflammation status and cellular stress markers remained the same.

The study authors hypothesize that “region-specific differences between the prefrontal cortex and hippocampus in response to aging with an HFS diet [suggest] that the disease pathology is not uniform throughout the brain.”

Obesity boosts aging’s negative effect

Notably, the researchers also found that brain inflammation levels had also increased in the mice that had been on a regular diet, compared with baseline measurements.

The researchers note that this could be taken as evidence of aging’s role as an independent risk factor in Alzheimer’s. Obesity, they add, boosts the risk by affecting key mechanisms in the brain.

“This study,” they claim, “provides novel information in relation to the mechanistic link between obesity and the transition from adulthood to middle age and signaling cascades that may be related to [Alzheimer’s] pathology later in life.”

“These results add to our basic understanding of the pathways involved in the early progression of [Alzheimer’s] pathogenesis and demonstrate the negative effects of an HFS diet on both the prefrontal cortex and hippocampal regions.”

Every day, there are physicians in the HealthLynked system ready to help those combating obesity and care for Alzheimer and dementia patients  to help them live the best lives possible.  If someone you love is showing signs of memory loss beyond what might be considered normal for their age, or if too many donuts have made their way into your system, go to HealthLynked.com to connect and collaborate with any number of specialists at the ready.

 

Ready to get Lynked and get help?  Go to HealthLynked.com today to register for free!

 

Adapted from:

Cohut, Maria. ”Skinny fat’ linked to cognitive decline, study warns.” Medical News Today, Friday 6 July 2018

Cohut, Maria. ”Aging, obesity may prime the brain for Alzheimer’s.” Medical News Today, Monday 2 July 2018

 

Will We Soon Reverse Diabetes and Obesity with Gene Therapy?

New research shows that gene therapy can completely reverse markers of Type 2 diabetes and obesity in rodents.  If the theory holds, small alterations to our genes could soon repair metabolic disorders such as obesity and Type 2 diabetes in humans.

The prevalence of diabetes, or the total number of existing cases, is on the rise in the United States and globally.  According to recent estimates, over 30 million U.S. adults had diabetes in 2015.

Although the number has been relatively steady in the past few years, rates of newly diagnosed cases among children and teenagers have increased sharply.  And, worldwide, the situation is even more alarming; the number of people with diabetes almost quadrupled between 1980 and 2014, according to the World Health Organization (WHO).

Now, new research brings much-needed hope of curing this metabolic disorder.  Scientists led by Fatima Bosch, a professor at the Universitat Autònoma de Barcelona (UAB) in Catalunya, Spain, have successfully reversed the disorder in rodents.  Prof. Bosch and her colleagues achieved this using gene therapy, a technique that introduces new genetic material into cells to create beneficial proteins or to offset the effects of malfunctioning genes.  The findings were published in the journal EMBO Molecular Medicine.

Using the FGF21 gene to reverse diabetes

Prof. Bosch and team designed two mouse models of obesity and type 2 diabetes. One was diet-induced, and the other one was genetically modified.  Using an adeno-associated viral vector as “transport,” the team delivered the fibroblast growth factor 21 (FGF21) gene.

This gene is responsible for encoding the FGF21 protein, which is seen as a “major metabolic regulator” that stimulates the absorption of blood sugar in adipose tissue.  By delivering this gene, the researchers stimulated the production of the protein, which caused the rodents to lose weight and lowered their insulin resistance — a major risk factor for type 2 diabetes. Additionally, the mice lost weight and the treatment reduced the fat and inflammation in their adipose tissue.

The fat content, inflammation, and fibrosis of the rodents’ livers were completely reversed, with no side effects. In turn, these improvements increased insulin sensitivity.  These beneficial effects were noted in both murine models. Also, the team found that administering FGF21 to healthy mice prevented age-related weight gain and led to healthy aging.

Gene therapy was used to alter three tissue types: liver tissue, adipose tissue, and skeletal muscle.  “This gives a great flexibility to the therapy,” explains Prof. Bosch, “since it allows [us] to select each time the most appropriate tissue, and in case some complication prevents manipulating any of the tissues, it can be applied to any of the others.”

“When a tissue produces FGF21 protein and secretes it into the bloodstream, it will be distributed throughout the body,” adds Prof. Bosch.

First reversion of obesity, insulin resistance

Study co-author and UAB researcher Claudia Jambrina explains that their findings are particularly significant given that “the prevalence of type 2 diabetes and obesity is growing at alarming rates around the world.”

The team also says that delivering FGF21 as a conventional drug would not yield the same benefits as gene therapy; firstly, the drug would have to be administered periodically for long-term benefits, and secondly, its toxicity would be high.  Using gene therapy, however, is free of side effects, and a single administration is enough to make the mice produce the protein naturally for several years.

“This is the first time that long-term reversion of obesity and insulin resistance have been achieved upon a one-time administration of a gene therapy, in an animal model that resembles obesity and type 2 diabetes in humans.”

First study author Veronica Jimenez, a UAB researcher

“The results demonstrate that it is a safe and effective therapy,” she adds. The next steps will be to “test this therapy in larger animals before moving to clinical trials with patients,” notes Prof. Bosch.  “[The] therapy described in this study,” she concludes, “constitutes the basis for the future clinical translation of FGF21 gene transfer to treat type 2 diabetes, obesity, and related comorbidities.”

Statistics and facts about type 2 diabetes

Diabetes mellitus, or diabetes, is a disease that causes high blood sugar. It occurs when there is a problem with insulin.

Insulin is a hormone that takes sugar from foods and moves it to the body’s cells. If the body does not make enough insulin or does not use insulin well, the sugar from food stays in the blood, resulting in high blood sugar.

Diabetes is a key health concern worldwide. In the United States, the rate of new cases rose sharply from the 1990s, but it fell between 2008 and 2015, and it continues to fall, according to the Centers for Disease Control and Prevention’s (CDC) National Diabetes Report, 2017. Meanwhile, the number of adults living with diabetes continues to rise.

The most common of diabetes is type 2. According to the CDC, 90 to 95 percent of people with diabetes in the United States have type 2. Just 5 percent of people have type 1.

Key facts

Diabetes is at an all-time high in the U.S. The CDC’s Division of Diabetes Translation states that 1 percent of the population, which is about a half of a million people, had diagnosed diabetes in 1958.

In 2015, around 9.4 percent of the population in the U.S. had diabetes, including 30.2 million adults aged 18 years and over. Nearly a quarter of those with the condition do not know they have it.

Between 1990 and 2010, the number of people living with diabetes more than tripled, and the number of new cases doubled every year.

Figures suggest that the incidence is levelling off and may even be falling, but it remains unclear whether this will continue as other factors come into play, such as the aging population.

The risk of developing diabetes increases with age.

The CDC report that 4.0 percent of people aged 18 to 44 years are living with diabetes, 17 percent of those aged 45 to 64 years, and 25.2 percent of those aged over 65 years.

Causes

Type 2 diabetes is thought to result from a combination of genetic and lifestyle factors.

The exact cause is unknown, but risk factors appear to include:

  • excess body fat
  • high blood pressure or cholesterol
  • having a close family member with the condition
  • a history of gestational diabetes
  • higher age

As obesity has become more prevalent over the past few decades, so too has the rate of type 2 diabetes. In 2013, more than 1 in 3 people in the U.S. were considered to have obesity, and over 2 in 3 were either overweight or had obesity.

In 1995, obesity affected 15.3 percent of Americans, and in 2008, the figure was 25.6 percent. From 1998 to 2008, the incidence of diabetes increased by 90 percent.

Although the link between obesity and diabetes is well known, the reasons they are connected remain unclear. A report in the Journal of Clinical Endocrinology and Metabolism asks why obesity does not always lead to diabetes, given the established link between the two conditions.

The same report notes that the location of body fat appears to play a role. People with more fat in the upper body area and around the waist are more likely to get diabetes than those who carry their body fat around the hips and lower body.

Diabetes and ethnicity

Rates of diabetes vary between ethnic groups.

There may be a combination of factors, including:

  • genetics
  • health conditions
  • lifestyle
  • finances
  • environment
  • access to healthcare

The CDC’s National Diabetes Statistics Report, 2017, found that, among people aged 20 years and over, diabetes affects:

  • 7.4 percent of Non-Hispanic whites
  • 8.0 percent of Asian Americans
  • 12.1 percent of Hispanics
  • 12.7 percent of Non-Hispanic Blacks
  • 15.1 percent of American Indians and Alaska Natives

Why diabetes is serious

Diabetes can have serious health consequences.

The ADA report that more Americans die from diabetes every year than from AIDS and breast cancer combined.

According to the CDC, 79,535 deaths occur each year due to diabetes. The number of fatalities related to diabetes may be underreported.

Why and how does diabetes damage the body and cause complications?

The ADA says:

  • Adults with diabetes are significantly more likely to die from a heart attack or stroke.
  • More than a quarter of all Americans with diabetes have diabetic retinopathy, which can cause vision loss and blindness.
  • Each year, nearly 50,000 Americans begin treatment for kidney failure due to diabetes. Diabetes accounts for 44 percent of all new cases of kidney failure.
  • Each year, diabetes causes about 73,000 lower limb amputations, which accounts for 60 percent of all lower limb amputations (not including amputations due to trauma).

Costs

Because of its high prevalence and link to numerous health problems, diabetes has a significant impact on healthcare costs.

The productivity loss for reduced performance at work due to diabetes in 2012 was 113 million days, or $20.8 billion, according to the ADA.

Diabetes cost the U.S. $327 billion in 2017, including $237 billion in medical costs and $90 billion in reduced productivity.

However, this number does not include:

  • the millions of people who have diabetes but are undiagnosed
  • the cost of prevention programs for people with diabetes, which are not counted under standard medical costs
  • over-the-counter medications for eye and dental problems, which are more common in people with diabetes.
  • administrative costs for insurance claims
  • the cost of reduced quality of life, lost productivity of family members, and other factors that cannot be measured directly

Because diabetes affects various parts of the body, the medical costs span different areas of specialty. The ADA report that:

  • 30 percent of medical costs associated with diabetes are for circulation problems that reduce blood flow to the limbs
  • 29 percent of medical costs associated with diabetes are for kidney conditions
  • 28 percent of medical costs associated with diabetes are for nervous system conditions

Despite its complications, people can manage their diabetes with a comprehensive plan that includes lifestyle changes and proper medical care. If they control their blood sugar levels well, many people with diabetes can lead full, active lives.

Difference between types 1 and 2

In type 1 diabetes, the immune system attacks the cells in the pancreas that make insulin. As a result, the body does not produce insulin, and people with this condition must take insulin by injection or pump every day.

Type 1 diabetes usually develops in children or young adults, but it can occur at any age. There is no known way to prevent type 1 diabetes, and there is no cure.

In 2011-2012, around 17,900 children under the age of 18 years received a diagnosis of type 1 diabetes in the U.S., or around 49 children each day. Type 1 diabetes affects around 1.25 million American adults and children.

People with type 2 diabetes may still have insulin in their bodies, but not enough for proper blood sugar control. Or, the body may not be able to use the insulin it has properly. As a result, blood sugar levels can become too high.

Typically, adults are diagnosed with type 2 diabetes, but children can get it too. Certain factors increase a person’s risk of getting type 2 diabetes, including:

  • obesity
  • older age
  • a family history of diabetes
  • lack of exercise
  • problems with glucose metabolism

The annual relative increase for type 1 diabetes in 2002-2012 in the U.S. was 1.8 percent, but the annual increase for type 2 diabetes was 4.8 percent.

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Adapted from:

[1]  Murrell MD, Daniel.  “Statistics and facts about type 2 diabetes.” Medical News Today. 12 June 2018

[2]  Sandoiu, Ana. “Type 2 diabetes, obesity may soon be reversed with gene therapy.”  Medical News Today, 12 July 2018