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November 15, 2022

WHO updates recommendations to guide family planning decisions

PATTAYA, 15^th November 2022 — These days
the World Wellbeing Corporation (WHO) launched essential updates to its landmark Loved ones Preparing Handbook, which
offers well being workers and policy makers with the most recent info on contraceptive solutions.

Drawing on lessons from new outbreaks, this new version information tangible measures for frontline health workers to defend obtain to loved ones organizing companies during emergencies, these types of as wider access to self-administered contraceptives and the use of
electronic technologies by companies. It also expands assistance for ladies and young persons at large risk of HIV.

“Family preparing encourages self-actualisation, empowerment, as perfectly as health and fitness and wellbeing, and reduces maternal and toddler fatalities as a result of the avoidance of unintended being pregnant and unsafe abortion,” reported Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Wellness and Rights.
“This updated Loved ones Preparing Handbook is a important source, serving to health staff support contraceptive customers about the planet in earning educated selections about the suitable contraceptive solutions for them.”

Expertise from the latest outbreaks demonstrates that household preparing services can be seriously compromised through emergencies. For the duration of the preliminary phases of the COVID-19 pandemic in 2020, somewhere around 70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of international locations claimed disruptions to these critical solutions – intensifying risks of unintended pregnancies
and sexually transmitted bacterial infections.

To aid steer clear of such outcomes in the upcoming, the guide information practical measures that assist continuity of loved ones arranging providers through epidemics. These involve wider entry to self-administered contraceptives, and direct distribution of contraceptives
by pharmacies. Wellbeing practitioners can also choose methods to assistance ongoing contraceptive entry even exactly where actual physical mobility is decreased, this sort of as offering multi-thirty day period materials.

Self-administered contraceptives contain condoms, contraceptive products, some diaphragms, spermicides and most a short while ago, the solution of self-injection of DMPA (a progestin-only contraceptive) due to the fact this can now be securely administered just less than the pores and skin
fairly than into the muscle. Numerous women desire injectable contraceptives considering that they are personal and non-intrusive, demanding motion only at any time 2-3 months, with the solution of self-injection probably to further more raise uptake.

“The updated tips in this Handbook demonstrate that nearly any family scheduling strategy can be applied securely by all ladies, and that appropriately, all gals need to have entry to a range of alternatives that satisfy their exclusive needs and objectives in life,”
said
Dr Mary Gaffield, Scientist and direct writer of the Handbook. “Family preparing solutions can be provided properly and affordably so that no matter in which they are living, partners and people are ready to pick from risk-free and helpful
household preparing methods.”

For the first time, the 2022 edition of the Handbook incorporates a committed chapter to tutorial family organizing solutions for gals and adolescents at significant chance of HIV, which include folks living in configurations where there is superior HIV prevalence, these who have various
sexual associates, or whose common associate is dwelling with HIV.

Though only condoms guard in opposition to HIV and other sexually transmitted bacterial infections, all contraceptive solutions – with the sole exception of nonoxynol-9 spermicide – are now regarded as protected for gals and young persons at significant possibility of HIV, i.e. have not been observed to improve hazard of HIV
transmission or acquisition of an infection. For all those at significant risk of HIV, the handbook states that testing, counselling and very first-line medical care and referrals need to all be presented as component of household organizing solutions.

In addition, the Handbook incorporates the most recent WHO assistance on cervical most cancers and pre-cancer prevention, screening and remedy which can all be furnished through spouse and children setting up solutions management of sexually transmitted bacterial infections, and family preparing in postabortion treatment.

Now in its fourth version, WHO’s Spouse and children Setting up Handbook is the most greatly applied reference guideline on the subject globally, with more than a million copies distributed or downloaded to date. It is complemented by the healthcare eligibility standards software for
contraceptive use, also downloadable as a dedicated App.

The updated Handbook was unveiled at the Global Conference of Household Planning in Pattaya, Thailand. Assistance for its creation and dissemination has been furnished by way of the Johns Hopkins Bloomberg Faculty of General public Health and the United States Agency for Worldwide Enhancement (USAID).

Call

At ICFP: Sarah Kessler, [email protected]

July 3, 2022

Sleep duration essential for heart health, new AHA recommendations say

An analog clock resting against the wall on top of a dresser — Sleep duration and quality are essential for cardiovascular health. Photo editing by Steve Kelly; Artur Debat/Getty Images

A new advisory published by the American Health Association (AHA) now includes sleep quality as one of the essential factors for optimal cardiac health.
The previous AHA advisory published in 2010 consisted of seven factors for assessing cardiac health, including physical activity, smoking, blood glucose levels, cholesterol levels, body mass index, and blood pressure.
Four of the existing factors—diet, smoking, blood lipids and glucose—were updated to also include nicotine via e-cigarettes and vapes.
The advisory now also highlights the role of mental health and socioeconomic and cultural factors such as racial discrimination in influencing cardiac health.

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 1 in 4 deaths each year. Notably, adopting healthier lifestyle practices can reduce the risk of CVD by around 80{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

A recent AHA presidential advisory published in the journal Circulationdescribes 8 lifestyle and health factors called Life’s Essential 8 that could help preserve optimal heart health and prevent CVD.

The AHA publishes advisories that highlight the current state of knowledge on cardiovascular health and key areas for future research. Such advisories can help inform decision-making by clinicians and the formulation of healthcare guidelines. However, such advisories only serve to inform and are not guidelines.

An AHA advisory published in 2010 outlined the construct or concept of cardiovascular health (CVH) to help promote the maintenance of optimal heart health throughout a person’s lifetime. This construct emphasizes the prevention of CVD and the improvement of cardiovascular health.

The initial formulation of CVH included seven health factors and behaviors called Life’s Simple 7. These seven components included diet, physical activity levels, cigarette smoke exposure, body mass index (BMI), blood cholesterol, blood glucose, and cholesterol levels.

According to threshold values defined by the AHA, an individual’s levels of each of these seven components were categorized as being poor, intermediate, or ideal. An individual with ideal CVH would have ideal levels of all seven components.

Numerous studies conducted since 2010 have shown that individuals with ideal CVH had a lower risk of cardiovascular disease. Moreover, studies suggest that optimal cardiovascular health is associated with a longer lifespan and better overall health, including a lower risk of dementia, cancer, and kidney disease.

While these studies emphasize the validity of the CVH construct, scientists and clinicians have encountered some limitations while using the original formulation of CVH.

For instance, some of the criteria used for assessing CVH were either too broad or lacked sensitivity to evaluate changes in CVH over time. Moreover, the original CVH construct did not include sleep and social factors.

This has led the American Health Association to revise the construct of CVH. The new CVH construct includes sleep as the eighth component and is now called Life’s Essential 8.

An important contribution of this new construct is the inclusion of criteria for assessing CVH in children and pregnant people. The new construct also incorporates evidence from studies showing that brain health and CVH are closely intertwined.

Described below are the changes included in the updated CVH construct.

The original CVH construct described the quantification of the seven health behaviors or factors using the categories of poor, intermediate, or ideal. However, the use of these categories rather than a continuous scoring system makes the construct less sensitive to changes in the health of an individual over time or differences amongst individuals.

For instance, the original construct categorizes individuals engaging in moderate to vigorous physical activity for 1 to 149 minutes as having intermediate physical activity levels. However, the original CVH construct would have categorized both individuals who engage in a few minutes of physical activity and those who engage in 149 minutes as having intermediate physical activity levels.

To remedy this, the AHA has developed a continuous scale from 0 to 100 to better quantify the levels of each health factor or behavior. The average score of the eight health components is then used to measure overall cardiovascular health on a scale from 0 to 100.

Diet

The 2010 construct of cardiovascular health was focused on the quantities of intake of five nutrients, which included whole grains, fish, fresh fruits and vegetables, sodium levels, and sugar-sweetened beverages. However, sodium or sugar intake can be hard to track.

Instead, the updated CVH construct focuses on the intake of whole foods and healthy eating patterns.

Moreover, there are cultural differences in eating patterns and the new CVH construct notes that there are multiple different strategies for achieving healthy eating patterns.

The new construct emphasizes the benefits of DASH– and Mediterranean-style eating patterns, which have been shown to reduce the risk of CVD.

Blood glucose

The new CVH construct now includes measures of glycated hemoglobin (HbA1c) along with blood glucose levels, which were included in the original formulation. Hemoglobin is a protein that allows red blood cells to transport oxygen to different parts of the body.

Glucose can also bind to hemoglobin to form glycated hemoglobin (HbA1c), and HbA1c levels reflect blood glucose levels over the previous 2 to 3 months.

Elevated HbA1C levels are observed in individuals with diabetes and are associated with an increased risk of CVD.

Thenclusion of HbA1C along with blood glucose levels thus provides a more comprehensive measure of cardiovascular health.

Cholesterol levels

The original construct recommended the use of total cholesterol levels to assess CVH. Cholesterol in the blood includes high-density lipoproteins (HDL), low-density lipoproteins (LDL),very-low-density lipoproteins (VLDL), and triglycerides.

Higher HDL levels are associated with lower CVD risk, whereas non-HDL cholesterol, which includes LDL, VLDL, and lioprotein (a), is associated with an increased risk of CVD.

Life’s Essential 8 consists of non-HDL levels, instead of total cholesterol, as one of the 8 components to better reflect cardiovascular health.

Nicotine exposure, BMI, and blood pressure

The original construct only included cigarette use as an indicator of cardiovascular health. The nicotine exposure metric has now been expanded to include e-cigarettes, vaping, and exposure to second-hand smoke.

Life’s Essential 8 has retained the original definitions of ideal BMI and blood pressure described in Life’s Simple 7. The only change is that these metrics are now evaluated on a scale of 0 to 100.

The new addition: sleep

Studies have shown that inadequate or excessive sleep is associated with an increased risk of coronary heart disease. Although sleep duration is associated with the seven components included in the original construct, sleep quality can independently predict the risk of a cardiovascular event.

There is also some evidence to suggest that changing sleep duration can help modify the risk of cardiovascular disease.

The president of the AHA, Dr. Donald Lloyd-Jones, who led the advisory writing group, says:

“The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure, or risk for Type 2 diabetes more effectively.”

“In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home,” he adds.

In addition to these eight factors, the new construct also highlights the role of psychological health and social factors in achieving cardiovascular health.

Stress and depression are associated with poor cardiovascular health most likely due to increased difficulty achieving a high cardiovascular health score, though depression itself may impact directly on cardiac health. In contrast, positive mental health is linked to better cardiovascular health.

Moreover, social factors such as socioeconomic position, racial discrimination, education levels, employment status, social isolation, and access to healthcare can also impact cardiovascular health.

“We considered social determinants of health carefully in our update and determined more research is needed on these components to establish their measurement and inclusion in the future,” Dr. Lloyd-Jones says.

“[S]ocial and structural determinants, as well as psychological health and well-being, are critical, foundational factors in an individual’s or a community’s opportunity to preserve and improve cardiovascular health.”
— Dr. Donald Lloyd-Jones

Dr. Sonia Anand, a professor of medicine at McMaster University, noted that the advisory was comprehensive but certain topics should receive more emphasis.

“Diet is always controversial and is very contextual; they do rely on U.S. data and metrics but this also limits the application to the U.S. population. They also mention the importance of considering social factors including ethnicity and race, along with diverse settings, and add a call for more research in this area. This is very important and to some, urgent,” she said.

“[The key gaps described by the advisory included information] on diverse populations/health equity, [and] this should be emphasized to ensure that funders of research and health promotion engage these communities in order to work within them to close these gaps,” she added.

April 15, 2022

uses, dietary recommendations, and more

Molybdenum is a nutrient that people often forget about despite the point that it plays a important function in human overall health. This critical mineral is included in processing proteins and genetic material. It also assists the body crack down poisonous substances.

Molybdenum exists in the soil, and a particular person will commonly eat adequate via the plants and meat in their food plan. The richest sources include things like pulses, grains, and organ meats.

Deficiencies are rare, as the entire body wants only trace quantities. For that reason, it is not ordinarily necessary to supplement the diet regime until a health care qualified advises usually.

Read on to discover far more about the takes advantage of of molybdenum, its added benefits, and the roles it plays in the human body.

Numerous bodily processes depend on molybdenum. The entire body merchants some molybdenum in the sort of molybdopterin in the liver, kidneys, adrenal glands, and bones.

Molybdopterin is a cofactor that the system involves for the functionality of some enzymes. It is involved in 4 essential enzyme pathways:

Sulfite oxidase: This enzyme converts compounds identified as sulfites to sulfates. Sulfites arise naturally in food items, and suppliers may also add them as preservatives. A buildup of sulfites can prompt allergic reactions.
Aldehyde oxidase: This enzyme metabolizes aldehydes, which are organic and natural compounds that are toxic at specific levels. It can also assistance the liver break down alcohol and some medications.
Xanthine oxidase: This enzyme converts xanthine to uric acid, aiding crack down nucleotides, the parts of DNA, when the human body no more time needs them.
Mitochondrial amidoxime lessening element (mARC): It seems that this enzyme assists eliminate harmful byproducts of fat burning capacity.

At the moment, very little proof suggests that individuals require to health supplement this trace mineral. Nevertheless, some people today feel that supplementation has a position in addressing Candida infection signs and symptoms, while the exploration to assist this is lacking.

Some research has connected very low degrees of molybdenum to a better chance of esophageal most cancers, but experts do not know whether having dietary supplements decreases this danger.

Ordinary quantities of molybdenum in foodstuff and drinks do not cause any harm.

Nonetheless, miners, metalworkers, and other folks who come across substantial degrees of molybdenum in the environment may well often create gout-like signs and symptoms and superior uric acid ranges in the blood. The uric acid triggers very small crystals to form around the joints, which can guide to agony and swelling in that location.

The tolerable higher intake stage (UL) is the maximum day-to-day ingestion of a nutrient that is not likely to induce destructive wellbeing outcomes for most persons. Medical professionals suggest that folks do not exceed this level routinely. The UL for molybdenum in grownups is 2,000 micrograms (mcg) day-to-day.

From time to time, molybdenum dietary supplements can cause severe side consequences, even for doses down below the UL. In a single 1999 case, a man consumed 300–800 mcg of molybdenum day-to-day for 18 days. As a final result, he made acute psychosis, going through visual and auditory hallucinations, seizures, and brain harm.

On top of that, some research show that substantial intakes of molybdenum could affect bone growth and mineral density.

For case in point, 1 observational examine involving 1,496 adults observed that an increase in molybdenum ingestion amounts might lead to lumbar spine bone density to minimize in ladies aged 50 several years and older. Having said that, there are no controlled scientific tests in humans to ensure these consequences. Even more analysis is important to assist uncover the opportunity hyperlink concerning molybdenum use and bone density.

The recommended every day allowance (RDA) for molybdenum differs amid people based on their age and being pregnant status:

RDA:

1–3 several years: 17 mcg per day
4–8 a long time: 22 mcg for every working day
9–13 several years: 34 mcg per day
14–18 yrs: 43 mcg for every working day
19 years and in excess of: 45 mcg for each day

Anyone who is expecting or nursing really should purpose for 50 mcg per working day.

Dietary sources

Legumes consist of the maximum degrees of molybdenum. Other prosperous dietary sources incorporate:

total grains
nuts
beef liver
leafy greens
dairy solutions

The amount of money of molybdenum in a particular plant meals might count on the amount of money of molybdenum in the soil in which it grew and the drinking water that the farmers applied to irrigate the soil.

Individuals should be aware that there are restricted knowledge relating to the total of molybdenum in food stuff and h2o. Drinking water appears to comprise only trace quantities of molybdenum.

Molybdenum deficiency is scarce in human beings, but it is feasible. In a person acknowledged case from 1981, a gentleman with Crohn’s illness was obtaining complete parenteral nourishment, a technique of feeding that bypasses the digestive system. He was experiencing indications these kinds of as complications, evening blindness, and swift heart rate. The administration of ammonium molybdate, on the tips of the doctors handling this scenario, was significant to resolving all these signs.

In some people, a exceptional genetic dysfunction named molybdenum cofactor deficiency can result in deficiencies. This affliction stops the human body from synthesizing molybdopterin and sulfite oxidase. It can lead to extreme seizures and neurological hurt, which can be fatal in early childhood.

Most people do not want to use molybdenum supplements until a healthcare expert suggests them for a distinct healthcare cause.

Any one who thinks that they do not receive ample molybdenum as a result of their diet ought to explore this with a healthcare experienced.

As deficiencies are uncommon, individuals should not start out supplementation devoid of health-related assistance.

Molybdenum is an vital trace mineral that helps the human body rid alone of dangerous sulfites and helps prevent harmful toxins from building up in the tissues.

Deficiencies are unusual, and the mind-boggling majority of individuals get more than enough molybdenum in their eating plan from legumes, grains, dairy, and organ meats. For that reason, most people today do not demand molybdenum health supplements except a healthcare qualified advises using them.

February 26, 2022

New CDC Covid-19 metrics drop strong mask recommendations for most of the country

CNN
—

Most people in the United States live in areas where those who are healthy do not need to wear masks indoors, according to new US Centers for Disease Control and Prevention guidance – a sweeping change from what earlier Covid-19 metrics recommended.

New CDC metrics indicate that about 28{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people in the United States live in a county where they need to wear masks indoors. Previously, CDC pointed to levels of coronavirus transmission within communities as a key metric for restrictions and recommended that people in areas with high or substantial levels of transmission – about 99{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the population – should wear masks indoors.

Now, the CDC’s “Covid-19 community level” metrics are based on three pieces of data in a community: new Covid-19 hospitalizations, hospital capacity and new Covid-19 cases. The CDC’s website includes a list of US counties and their current Covid-19 levels.

Under the updated guidance, more than 70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the US population is in a location with low or medium Covid-19 community levels. For those areas, there is no recommendation for indoor masking unless you are at potential “increased risk” for Covid-19 and if so, the CDC recommends to talk to your health care provider about wearing a mask.

“We’re in a better place today than we were six months ago, six weeks ago, six days ago,” US Health and Human Services Secretary Xavier Becerra said in a statement to CNN. “Now it’s time to focus on severity, not just cases, of COVID. Because of all the hard work that’s been done and the many tools we’ve developed to tackle COVID, we can ease the guidance on mask use — not everyone in every place needs to wear a mask.”

At all levels, the CDC recommends people get vaccinated and boosted, and get tested if they have symptoms.

In areas with “high” levels, the CDC also advises wearing a mask in public indoor settings, including schools. In areas with “medium” levels, the CDC advises talking with your doctor about wearing a mask if you’re at increased risk for Covid-19. In areas with “low” Covid-19 community levels, there is no recommendation for mask wearing.

The CDC notes that anyone who wants to wear a mask should continue to do so.

The updated CDC recommendations reflect “a new approach” for monitoring Covid-19 in communities, Dr. Gerald Harmon, president of the American Medical Association, said in a statement Friday.

“But even as some jurisdictions lift masking requirements, we must grapple with the fact that millions of people in the U.S. are immunocompromised, more susceptible to severe COVID outcomes, or still too young to be eligible for the vaccine. In light of those facts, I personally will continue to wear a mask in most indoor public settings, and I urge all Americans to consider doing the same, especially in places like pharmacies, grocery stores, on public transportation – locations all of us, regardless of vaccination status or risk factors, must visit regularly,” Harmon said.

“Although masks may no longer be required indoors in many parts of the U.S., we know that wearing a well-fitted mask is an effective way to protect ourselves and our communities, including the most vulnerable, from COVID-19—particularly in indoor settings when physical distancing is not possible.”

Counties with fewer than 200 new Covid-19 cases per 100,000 people in the past week are considered to have “low” Covid-19 community levels if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Levels are “medium” if counties have 10 to nearly 20 new Covid-19 hospital admissions per 100,000 or between 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and 14.9{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Levels are considered “high” if counties have 20 or more new Covid-19 hospital admissions per 100,000 or at least 15{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.

Counties with 200 or more new Covid-19 cases per 100,000 people in the past week are not considered to have “low” levels of Covid-19. They are considered “medium” if they have fewer than 10 new Covid-19 hospital admissions per 100,000 or less than 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week. They are considered “high” if they have if they have 10 or more new Covid-19 hospital admissions per 100,000 or at least 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of staffed hospital beds occupied by Covid-19 patients on average in the past week.

“This new framework moves beyond just looking at cases and test positivity, to evaluate factors that reflect the severity of disease – including hospitalizations and hospital capacity – and helps to determine whether the level of Covid-19 and severe disease are low, medium or high in a community,” CDC Director Dr. Rochelle Walensky told reporters during a telebriefing call Friday.

“The Covid-19 community level we are releasing today will inform CDC recommendations on prevention measures, like masking, and CDC recommendations for layered prevention measures will depend on the Covid-19 level in the community,” Walensky said. “This updated approach focuses on directing our prevention efforts towards protecting people at high risk for severe illness and preventing hospitals and health care systems from being overwhelmed.”

The update to CDC guidance comes at a time when daily Covid-19 cases in the United States have fallen to a tenth of what they were at their peak last month, according to data from Johns Hopkins University. The 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} drop – from an average of more than 802,000 cases per day on January 15 to less than 75,000 currently – happened over the course of about six weeks.

In recent weeks, some states seem to have already made this shift in focus from community transmission to hospitalizations. Many states have made plans to lift indoor or school mask mandates based on their own metrics: declining hospitalization rates and having a larger share of fully vaccinated residents than the national average.

The CDC’s updated Covid-19 community metrics signal an important moment in the pandemic, Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, told CNN on Friday.

“I think that this is one of the long-awaited moments of the pandemic to hear of such a significant shift in how we view the data to identify the proper mitigation strategies,” Freeman said.

“An important moment during the pandemic in the sense that we’re able to now pivot to more of these community burden metrics that allow us to look at these mitigation strategies differently than we have perhaps before,” Freeman said, adding that, looking ahead, “I think we have to really watch the hospitalization data and identify ways to improve collection of data that allows us to account for individuals who come into the hospital with Covid versus for Covid.”