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jcrmhscasereports · 1 year ago

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Prevalence of Hepatitis b and c viral infections among human immunodeficiency virus (HIV) infected patients on highly active anti-retroviral therapy (haart) in the university of port harcourt teaching hospital By Abel Charles In Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Introduction: This study determined the prevalence of hepatitis B and C viral infections among human immunodeficiency virus (HIV) infected patients on highly active anti-retroviral therapy (HAART) in the University of Port Harcourt Teaching Hospital.

Methodology: It was a purposive, cross-sectional study that was conducted in the Anti-retroviral clinic of the facility and a sample size of 38.33 (increased to 100, due to perceived small size), using a prevalence of 2.56% from a previous study by Nnakenyi et al. (2019).

Results: There was more female participation, 77.0%, majority had secondary school education, 59.0%, mostly Civil servants, 43.0%, Christians, 87.0% and mainly of Ijaw ethnicity, 39.0%. Majority had heard of HBV and HCV, 84.0%, mainly in the hospital, 36.9%, with the least from friends/family members, 6.0%, 98.0% had not been infected by any of the hepatic viruses, all of them affirmed that the viruses can be treated, 100.0%, while 72.0% confirmed the efficacy of medical treatment for the viruses and 46.0% had been vaccinated against the viruses. Also, majority opined that sexual intercourse is the main route for transmission of the hepatic viruses, 51.0%, followed by blood transfusion, 37.0% and lifestyle is the most common risk factor to contract the viruses, 71.0%. The prevalence of HBV, HCV and VDRL among HIV-infected patients on HAART was 96.0%, 98.0% and 99.0% respectively. Similarly, we observed statistical significance of HBV (0.042) and HCV (0.021), as well as, venereal diseases (0.028).

Conclusion: There is low prevalence of the hepatic viruses among HIV infected persons in the study population, while the existence of a venereal disease is a risk factor to contracting the hepatic viruses, owing to similar pathways of transmission, thus, rigorous efforts at educating the populace about the risk factors and common routes of transmission of these viruses is required.

Keywords: Hepatitis, venereal disease, HIV, HAART, infection.

INTRODUCTION

Human immunodeficiency virus (HIV) is a retrovirus that infects humans and other mammals. Infection by the virus is a huge public health problem, with African being one of the most affected by the pandemic globally resulting in an estimated 25.7 million human infections worldwide (World Health Organization [WHO], 2019).

Viral hepatitis is also a global health challenge of public concern worldwide (Ndifontiayong, Ali, Sokoudjou, Ndimumeh & Tume, 2021). Some of the features associated with the micro-organisms are high prevalence, high mortality and morbidity, poor diagnostic tools, leading to sub-optimal diagnosis and poor management approaches, especially, in developing countries (Naghavi, Wang, Lozano, Davis, Liang, Zhou, Vollset, Ozgoren, Abdalla & Abd-Allah, 2015; Mokdad, Lopez, Shahraz, Lozano, Mokdad, Stanaway, Murray & Naghavi, 2014).

Hepatitis B virus (HBV) alters the liver architecture and may progress to chronic, life-threatening conditions, such as liver cirrhosis and hepatocellular carcinoma or otherwise mild case, known as hepatitis (Nnakenyi, Uchehukwu & Nto-ezimah, 2020). The global prevalence of HBV is estimated as 0.1%-20% (McMahon, 2005; Custer, Sullivan, Hazlet, Lloeje, Veenstra & Kowdley, 2004) and its diagnosis is made by detection from blood and body fluids, such as semen, saliva and nasopharyngeal secretion, while the main routes of transmission are sexual intercourse, mother to child transmission in pregnancy, delivery and breastfeeding, blood contact and sharing of infected materials (WHO, 2011).

In 2017, the World Health Organization (WHO) reported that the global prevalence of hepatitis B surface antigen (HBsAg) in the African region was 60 million, with an estimated prevalence of 6.1% (4.6% - 8.5%) and accounting for an estimated 87,890 annual deaths in sub-Saharan African region alone. Both HIV and HBV infections pose a reciprocal effect on the progression of both diseases in regards to the impact on the morbidity and mortality of the diseases, with co-infection being a serious challenge in resource-constrained settings (Xie, Han, Qiu, Li, Li, Song, Wang, Thio & Li, 2016; Milazzo & Antinori, 2014). In the western countries, complications arising from HBV and HCV and the infections itself are rare, but common in Asia and Africa, where the chronic infection is common and usually acquired through the parenteral route or in adulthood (Lavanchy, 2004).

Hepatitis C virus (HCV) is also a major cause of hepatitis, like HBV, with a chronic potential (Nnakenyi et al., 2020). The transmission of HCV is similar to HBV. There are scanty prevalence data for HCV, especially, in sub-Saharan African region, but approximately 30 million people are reported to be infected by the virus (Matthews, Geretti, Goulder & Klenerman, 2014). HCV also leads to chronic liver diseases like hepatocellular carcinoma, (Ndifontiayong et al., 2021). Both HBV and HCV are very prevalent in patients infected by HIV and those with the disease condition of HIV, AIDS, leading to an increased morbidity and mortality (Spearman, Afihene, Ally, Apica, Awuku & Cunha, 2017). The co-infection of HIV with either HBV, HCV is associated with poor survival, rapid progression to liver diseases and high potential for hepatotoxicity, arising from the anti-retroviral therapy administered (WHO, 2013; Highleyman, 2010).

Globally, an estimated 550 million people are infected by either HBV or HCV, about 9% of the world population, with the former estimated as 350-400 million, while the latter is estimated as 170-180 million (WHO, 2013; Lavanchy, 2011). Also, the three viruses; HIV, HBV and HCV dominant infections in sub-Saharan African, with 2.6 million HBV infections in HIV-infected people and approximately 2.3 million HCV in HIV-infected people (Kourtis, Bulterys, Hu & Jamieson, 2012).

Highly active anti-retroviral therapy, HAART, is a current, commonly implemented regimen for managing HIV infection. It is an innovation in HIV management and effectively reduces the viral load, as well as, increases the CD4 cell count.

Human Immunodeficiency Virus (HIV) infection, in itself, poses enormous burden on the health care system of many countries. However, the condition of infected individuals is worsened in the existence of co-infection, such as the hepatitis virus, causing poor prognosis and potentially shortens life span (Nnakenyi et al., 2020). It rapidly depletes the immune function of the host, as well as, other vital systems of the affected individual. Evidence suggests that HIV infection progresses faster, even to AIDS-defining illnesses, when there is a co-infection with hepatitis viruses (Greub, Ledergerber, Battegay, Grob, Perrin & Furrer, 2000).

Owing to this co-infection, it is advised that when treating HIV patients, their status of HBV and HCV is ascertained, if the patient is actually co-infected by any of the hepatitis viruses. This is important because a report by the WHO global hepatitis strategy for the elimination of viral hepatitis stipulates that by the year 2030, hepatitis disease will assume a huge public health propensity, thus, 80% of individuals eligible for HBV or HCV treatment should be availed the treatment (WHO, 2016). Despite this, in most developing countries, such as Nigeria, the screening for the hepatitis viruses is still a challenge, due to the cost of investigation or vaccination, unlike in HIV (Diwe, Okwara, Enwere, Azike & Nwaimo, 2013).

Prevalence studies abound in Nigeria regarding co-infection of HIV with either hepatitis B or C viruses, employing different settings and population sizes (Hamza et al., 2013; Idoko, Meloni, Muazu, Nimzing, Badung & Hawkins, 2009; Otegbayo, Taiwo, Akingbola, Odaibo, Adedapo & Penugonda, 2008; Ejele, Nwauche & Erhabor, 2004), with diverse but similar results.

In Nigeria, the national guideline for the prevention, treatment and care for HIV-infected patients does not recommend the screening for HBV, but hepatitis B surface antigen, HBsAg, and HCV commonly done as baseline test for the pre-treatment of HIV-infected patients (National Guidelines for HIV Prevention, Treatment and Care, 2016).

In a study conducted in Enugu state, Nigeria, among 1328 HIV-infected patients on HAART, Nnakenyi et al. (2020) reported that the prevalence of hepatitis B virus infection was 7.8%. Another study conducted among 1779 HIV-infected patients in a different geo-political region in Nigeria, reported HBV prevalence of 11.9% (Otegbayo et al., 2008), while other independent, but similar studies employing smaller sample sizes compared to the those earlier described, ranged from 9.7% to 25.0% (Idoko et al., 2009; Uneke, Ogbu, Inyama, Anyanwu, Njoku & Idoko, 2005; Ejele, Nwauche & Erhabor, 2004).

Regarding the co-infection of HIV and HCV, several studies documented distinct findings, majority of which suggest population size and diagnostic equipment and technique plays crucial roles in the prevalence. In some studies conducted in Nigeria, by Nnekanyi et al. (2020), Diwe et al. (2013) and Adewole, Anteyi, Ajuwon, Wada, Elegba and Ahmed (2013), prevalence values of 4.7%, 0.7% and 2.3% respectively were reported respectively.

Similarly, Nnekanyi et al. (2020) and Adewole et al. (2013) reported that HBV is more prevalent and the situation may be similar for other studies both within and outside Nigeria. Observations show that the varying sample sizes of the populations in the respective studies accounted for the differences reported in their prevalence, while positing that although, the three viruses are transmitted through similar routes, their rates of transmission could be dissimilar. For instance, HIV transmission, historically, is most common through the parenteral route, such as multiple blood transfusions and intravenous drug use, in addition to sexual transmission, but the sexual transmission route is less common for HCV (Tedaldi, Hullsiek, Malvestutto, Arduino, Fisher & Gaglio, 2003).

Yet another finding on the co-infection between HIV and either HBV or HCV also reported gender bias against the transmission, especially, HBV. The study reported that HIV/HBV co-infection is more common among men that have sex with men, as against men that have sex with women or women that have sex with women, the transmission being almost inefficient in the latter category, while it is also commoner in heterosexual individuals with multiple sexual partners and contacts with commercial sex workers (Alter, 2006).

Triple infection of the three viruses; HIV, HBV and HCV have been observed in certain circumstances. In three individual groups of study conducted in the southeast, north-central and a sub-urban part of Nigeria by Nnakenyi et al. (2020), Adewole et al. (2009) and Diwe et al. (2013), they reported the prevalence of triple infection as 0.58%, 1.5% and 0% respectively. In response to the varying findings in the respective studies, Nnakenyi and colleagues posited that at this point, it will be difficult to discern if residing in the city poses more risk to contracting triple infection and whether social lifestyle in the urban regions is implicated in the observed prevalence, which is absent in the sub-urban region.

Opaleye, Oluremi, Ogbolu, Babalola, Shittu and Adesiyan (2014) also investigate the prevalence of HBV among HIV-infected patients HAART regimen and reported more male co-infection, while the age group of 30-49 years were more predominantly co-infected.

In a study in Burkina Faso among 11,592 blood donors, with sero-positive HIV blood, 1.13% prevalence of HBV co-morbidity with HIV was reported, while the prevalence of HCV among the HIV sero-positive patients was 0.14% (Tounkara, Sarro, Kristensen, Dao, Diallo & Diarra, 2009). This is a clear contrast from the studies documented from the different geo-political regions in Nigeria and may differ from what is tenable in other climes. A review of comparative studies on the prevalence of HBV among HIV-infected patients in four continents; Asia, Africa, America and Europe, reported higher prevalence of co-infection among patients in the developed continents of America and Europe, as against those in the developing continents of Africa and Asia (Askari, Hakimi, Nasiri, Hassanshahi & Kazemi, 2014). The higher prevalence in the patients of developed continents was attributed to better diagnostic equipment and lower sensitivities available in these continents, as against the developing continents.

The treatment of co-infection with HIV and any of HBV or HCV is another area of interest that have elicited several research discourses. At the moment, HAART is the mainstay for individuals with HIV infection and the combination of HAART regimen for the different co-infection varies. This regimen, HAART, comprises of five main drugs that include; tenofovir, Ribavirin, sofosbuvir and emtricitabine. Studies have reported that in cases of HIV/HBV co-infection, tenofovir and emtricitabine should be employed, since these drugs are effective for the two viruses and reduces the likelihood of HBV developing resistance for any of the drugs, while in co-infection of HIV/HCV, ribavirin and sofosbuvir should be used, just as HBV vaccine can be administered in situations of HIV/HBV co-infection (National Guidelines for Human Immunodeficiency Virus Prevention, Treatment and Care, 2016).

While several studies have been conducted both within and outside Nigeria to ascertain the prevalence of HBV or HCV co-infection among HIV patients on HAART, there is scanty data regarding this in the study area, thus necessitating this study, hoping that it will not only serve as reference, but also avail clinicians and scientists the required information for prompt decisions when attending to these category of patients.

METHODOLOGY

This purposive, cross-sectional study was conducted at the Anti-retroviral clinic and Pathology laboratory of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria, a tertiary healthcare facility located in the southern region of the country and caters for the training of medical students and other allied medical professions, medical and epidemiologic research, as well as, treatment and counseling of medical conditions. A minimum sample size of 38.33 was obtained for the study, using a prevalence of 2.56% (being the average for 4.7%, 0.7% and 2.3% reported for HIV, HBV and HCV respectively) as reported by Nnekanyi et al. (2020), Diwe et al. (2013) and Adewole et al. (2013). However, owing to the small nature of the calculated minimum sample size, it was increased to 100, to make it significant.

5ml venous blood sample was obtained from each participant in the study using an ethylene diamine tetra acetic acid (EDTA) bottle, after they consented to participate and this analyzed by the aid of an auto-analyzer and the result entered into statistical package for social sciences (SPSS) version 22, where both descriptive and inferential analysis were performed. The socio-demographic parameters of the respondents were obtained using a structured questionnaire and also analyzed. Ethical approval for this study was obtained from the Research Ethics Committee of the University of Port Harcourt Teaching Hospital.

RESULTS

This study had more females, 77.0%, they mostly had secondary school education, 59.0%, with the least having primary school education, 18.0%, and were mostly civil servants, 43.0%, while 27.0% were traders and 17.0% were schooling. Also, majority, 87.0% were Christians, but 6.0% were Muslims and they were mostly Ijaws by ethnicity, 39.0%, followed by Igbos, 35.0%, while the least were Hausas, 4.0%.

In table 2 above, it was observed that most of the respondents have heard about the HBV and HCV, 84.0%, with most of them hearing about it in the hospital, 36.9%, followed by school, 32.1%, while the least heard from friends/family members, 6.0%. However, 98.0% had not been infected by any of the hepatic viruses, with all of them affirming that the viruses can be treated, 100.0%, while 68.0% responded that it can affect anybody, while only 1.0% mentioned it can affect children. Similarly, 72.0% of the respondents agreed that the viruses can be treated medically, but 1.0% person mentioned its treatment by fasting/prayer, with less than half, 46.0% taken vaccination against the viruses and those that have not been vaccinated was mostly due to the cost, 88.9%, while the least was due to attitude of health personnel, 1.9%.

The factors that influence the transmission of hepatitis B and C viruses, according to the respondents in this study, is presented in table 3 above. It shows majority of them responding to sex, 51.0%, followed by blood transfusion or blood products, 37.0%, while lifestyle is the most reported risk factor for contracting the viruses, 71.0%, followed by smoking, 13.0%, and the least being canned foods, 1.0%.

DISCUSSIONS

This study recorded more female participation, 77.0%, majority had secondary school education, 59.0%, mostly Civil servants, 43.0%, mostly Christians, 87.0% and mostly Ijaw by ethnic inclination, 39.0%. The finding about more female participation in this study is not surprising, due to the known fact that the female reproductive tract is more receptive and bound to be more impact in infections contracted through sexual intercourse, such as HIV, HBV and HCV. Apart from this, females tend to be more pursuant to seek healthcare than their male counterparts, except the health condition has truly impacted the males, before they reluctantly seek health care. This is in confirmation by the WHO (2019) that women tend to seek help more for their health needs, as well as, being more infected with venereal diseases that are usually, long-standing, owing to the long duration associated with it before clinical symptoms begin to manifest, sometimes, years.

This study also observed that majority of the respondents have heard of HBV and HCV, 84.0%, with many hearing of it in the hospital, 36.9% and the least heard from friends/family members, 6.0%. HIV, like HBV (usually commonly known as hepatitis), are widespread disease conditions, especially, the former, and majority of the populace are aware of it, due to the fact the fact that information about them are ubiquitous. The findings of HIV and HBV in this study are in tandem with those of Ndifontiayong et al. (2021) and Naghavi et al. (2015) respectively. It was also observed in this study that 98.0% of the respondents had not been infected by any of the hepatic viruses, with all of them affirming that the viruses can be treated, 100.0%, with only 1.0% indicating infection in children, while 72.0% confirmed the efficacy of medical treatment for the viruses and 46.0% had been vaccinated against the viruses. This agrees with the report by Highleyman (2010) that although HBV and HCV are in existence and widespread, their prevalence is considerably low in the general population (McMahon, 2005).

We also observed that shows majority of our study participants responded to sexual intercourse being the main route for transmission of the hepatic viruses, 51.0%, followed by blood transfusion or blood products, 37.0% and lifestyle is the most common risk factor for contracting the viruses, 71.0%. The findings of this study disagrees with that of Liaw et al. (2010), which reported that the parenteral route is the most dominant route of transmission of HBV, HCV and HIV globally, especially, through mother to child transmission during delivery and breastfeeding, while other routes, like sexual intercourse, are also common. The prevalence of HBV, HCV and VDRL among HIV-infected patients on HAART in this study was 96.0%, 98.0% and 99.0%. This is an attestation of the finding by McMahon (2005) that the global prevalence of the hepatic viruses was low in the general population. Similarly, we observed statistical significance of HBV (0.042) and HCV (0.021) venereal diseases, such as HIV. This, we believe to be a common trend, since they mostly share common routes of transmission. However, it confirms the reports by Xie et al. (2016), Milazzo and Antinori (2014), and Lavanchy (2004).

CONCLUSIONS

There seems to be low prevalence of the hepatic viruses, even among HIV infected persons in the general population, while the existence of a venereal disease may encourage or serve as risk factor for contracting the hepatic viruses, since they share similar routes of transmission. This, calls for more concerted efforts at educating the populace about the risk factors and common routes of transmission of these viruses.

Conflict of Interest

None.

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#Hepatitis #venereal disease #HIV #HAART #infection #Shahraz #Mokdad #HBV #Akingbola #Odaibo #emtricitabine #socio-demographic #Abel Charles #jcrmhs

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phantomtutor · 2 years ago

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SOLUTION AT Academic Writers Bay Create an original posting with a minimum of 250-300 words. Back up your arguments with reliable evidence. Asking the Relevant Clinical Questions Evidence-based nursing is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. It is not about developing new knowledge or validating existing knowledge, but rather translating existing evidence so that it can be applied to clinical decision making. This process starts with formulating a sound PICO question. PICO is a format for developing a good clinical research question prior to starting a review or research. It is a mnemonic used to describe the four elements of a sound clinical foreground question. Scenarios: #1 A nurse in the PACU is interested in ways to decrease the use of pain medication in post-op patients. She’s wondering if classical music or guided imagery might be efficacious. #2 A 17-year-old African American woman, just diagnosed with hepatitis B, has been taking acetaminophen for headaches. Her mother has heard that acetaminophen can cause liver problems, and she asks you if her daughter should continue taking the drug for her headaches, considering her hep-b diagnosis. #3 You are on a hospital committee exploring best practices in inpatient oncology nursing. The first question to come before the committee is, “how can we improve patients’ sleep quality and quantity without resorting to sleep medication?” The committee decides to explore relaxation techniques (e.g., massage; music), noise reduction, bed/pillow comfort, and ambient temperature changes. Your assignment is to find the best practices to reduce noise levels on the unit. #4 A 53-year-old woman with rheumatoid arthritis wants to possibly change her medication to short-term low-dose corticosteroids instead of NSAIDS, which are upsetting her stomach. Will the corticosteroids be as effective? #5 Jeff, a smoker of more than 30 years, has tried to quit unsuccessfully in the past. A friend of his recently quit with acupuncture. He wonders if he should try it. Instructions: Choose one (1) clinical scenario above, and answer the following questions: What is evidence-based nursing practice and why is it important? What is the PICO process? Formulate a well defined clinical question that will yield the most relevant and best evidence. Describe the background of the question Present the question using PICOT format Indicate what will be the best study to answer the clinical question. “CUSTOM PAPER” CLICK HERE TO GET A PROFESSIONAL WRITER TO WORK ON THIS PAPER AND OTHER SIMILAR PAPERS CLICK THE BUTTON TO MAKE YOUR ORDER

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fionabasil · 4 years ago

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Who is behind Unlock Your Glutes and can we trust him?

How do women's bodies change as they age?

Yes, your 40s are your best decade. You will discover that you are wiser and more established; and if you are doing things right, you should discover that you are much happier as a woman, and / or as a man. In fact, you can look radiant and even younger than someone does at that age. But that does not mean that your body is not about to undergo interesting changes that, although it is not de rigueur that these changes appear to everyone just after the age of 40, yes to most and you should certainly know them because they commonly arrive without warning.

After age 40 your body changes in these ways

Now, if those changes are for better or for worse, it is really a matter of perspective. Plus, you are more than capable of lessening any adverse effects they may have on your life. So consider the following list a warning: that's what you should expect your body to do when it has crossed the threshold into middle age, and don't be caught off guard by the novelties of your four decades and beyond.

Your wrinkles become more pronounced

As we age, our skin becomes thinner, drier, less elastic, and less able to regenerate after damage. By the time we reach our forties, this aging plus wear and tear leads to wrinkles and lines on the skin.

All of that sounds like bad news until you consider the results of a Belgian study published in the Journal of Nonverbal Behavior, which found that when "crow's feet" were present, smiles were more authentic, intense, and spontaneous. If you are not influenced by this, you can anticipate wrinkles by using a moisturizer at night, staying properly hydrated and protecting your skin from UV rays with an SPF.

Hair begins to grow in strange places

To our knowledge, there is no study that has shown a connection between ear, nose, back, or chin hair and perceived attractiveness. However, it remains true that both men and women will be more likely to show off hair where there has been none before, often around the age of 40.

Keep in mind that many men's clippers come with ear and nose hair accessories, while a lot of new long-handled razors have recently hit the market. Tweezers are often the best option for wandering chin hair, although if there are more than a few, laser hair removal is something that women are turning to more and more.

Pains appear or more of them

Body wear and tear is, by definition, cumulative. Knowing your limits, maintaining a healthy weight, exercising, stretching, meditating, and consulting your doctor when something doesn't feel right are all part of a prescription to reduce some of the novelties of turning 40. You'll find that stress may be making aches and pains worse.

Your hangovers get more intense

All the effects of alcohol amplify with age. This is partly because the liver becomes less efficient as we age and also because people with a higher percentage of body fat and less body water tend to feel the effects of alcohol more strongly than those with greater muscle mass.

Limiting your alcohol intake and having a glass of water between each alcoholic drink are good ways to ensure that you don't find yourself in such a sorry state the day after a night out.

Your teeth become less sensitive

Some good news, if sensitive teeth have been a problem for you in your teens, 20s, or 30s. As you age, more dentin - the hard internal tissue - forms between the enamel and the nerves of your teeth. According to the International Dental Journal, this additional isolation results in a decreased response to pain.

The downside of this is that you are less likely to feel when something goes wrong with your teeth, which means that regular checkups become much more important when you reach 40.

It takes you longer to recover from an injury

Scientists are still not sure why at age 40 you recover more slowly from an injury than before. Some posit that it's something called cellular depletion, others argue that fewer hormonal changes make muscle repair last longer, while some argue that as we age, our body's inflammatory response to injury increases. Of course, it could be a cocktail of all three. When you are injured, anticipate spending more time on rest and recovery than in the past.

Catch fewer colds

By the time we reach 40 years of age, we have been exposed to more cold viruses and have developed immunities, and thus we get sick less often.

Hair loss becomes noticeable for men

According to research, the proportion of men with moderate to extensive hair loss skyrockets for men in their 40s. The study found that while significant hair loss affects 16 percent of men ages 18-29, more than half (53 percent) of men ages 40-49 will look frayed.

There are a growing number of interventions that men can do to slow or stop their hair loss, and some ways are quite effective. Before throwing money at your increasingly exposed dome, consider a study that found that bald men are more socially mature, intelligent, educated, and honest compared to men with a full head of hair.

Hair loss in women

Many women also experience noticeable hair loss in their 40s. An Australian study found that 64.4 percent of women who lived in the city of Maryborough had bitemporal hair loss. One (possible) silver lining is that age-related hair loss in women tends to occur everywhere on the body, which means less hair on the legs, armpit, and pubis.

You sleep less

In a study of 110 healthy adults who were allowed eight hours of sleep, the middle-aged (40 to 55) slept about 23 minutes less than the younger group (20 to 30 years). A simple explanation is that people need less sleep as they age, but the National Sleep Foundation denies this.

On their website they write: “It is a common misconception that sleep needs decrease with age. In fact, research shows that our sleep needs remain constant throughout adulthood. "

It's harder for you to lose weight

You may recall a time when getting back to your best shape required nothing more than cutting bread and sweets for 72 hours. For many of us, losing weight quickly has to be a much more difficult prospect by the time we hit 40, and you probably already know that it is caused by a slowing metabolism.

What many of us forget, however, is that a large part of having a slower metabolism is a direct consequence of decreased muscle mass. Muscles need fuel, which means the more muscle you have, the more calories you burn at rest. Put on a pound of muscle, and you'll re-fuel your oven and burn an additional 50 calories per day.

That math goes up, meaning that by gaining 10 pounds of muscle, with regular resistance training, and lots of high-quality protein, your body could burn an extra 3,500 extra calories per week.

You realize that you are shorter

People may start to shrink in height as early as their thirties, which means that, at 40, you may start to notice it. According to the University of Arkansas for Medical Sciences (UAMS), men can gradually lose an inch between the ages of 30 to 70, while women can lose about two inches.

Resistance training can help reduce shrinkage while eating foods rich in calcium and vitamin D can also help keep your bones strong.

A pilot study from UCLA showed that yoga could improve kyphosis, a forward curve of the spine that was originally believed to be an irreversible bone disorder. The researchers found that the study participants who did yoga had straighter spines and had increased height measurements.

Your hair starts to get grayer

As we age, the pigment cells in our hair follicles gradually die. What that means is that a hair follicle does not change color, but instead becomes transparent. Typically, Caucasians start to gray in their mid-30s, Asians in their 30s, and African-Americans in their 40s.

For men, there is a literal silver lining. According to a Match.com survey, 72% of women say they find men with gray, silver or "salt and pepper" hair attractive.

Your sense of smell and your taste change

When we are born, we have approximately 9,000 taste buds. But as we age, the number of taste buds decreases. What this means is that your sensitivity to the main flavors (sweet, sour, bitter, salty, and umami) gradually decreases.

Bad news ladies: this usually happens to women 10-20 years earlier than men. Loss of smell and taste is diagnosed by having a patient compare smells or tastes. From this, your doctor can determine the level of loss.

Dental cavities increase

As you get older, your mouth becomes drier. Saliva helps clean teeth and protects the mouth from cavities, which means that at age 40 the chances of cavities increase. Get it back by drinking more water, holding it in your mouth for a few seconds before swallowing. You can also suck on sugarless candy or chew sugarless gum to increase the amount of saliva in your mouth.

Your chances of developing breast cancer increase

In her 30s, a woman's chances of being diagnosed with breast cancer are 1 in 228. Between the ages of 40 and 49, however, that increases to 1 in 69. It is no wonder then that the American Cancer Society and The Mayo Clinic recommend it. Regular exercise has been shown to reduce the risk of breast cancer by 10-20%; A healthy diet with lots of fruits and vegetables, especially carotenoids, has also been shown to help, as well as reducing alcohol consumption.

Studies have shown that results show that women who drink 2-3 alcoholic beverages per day have a 20 percent higher risk of breast cancer than non-drinkers.

Your bone density decreases

As we age, we lose bone density, although women are more significantly affected by it. In part, this is due to the fact that women start out with lower bone density than their male counterparts and lose density at a faster rate, around 1% per year beyond the age of 35.

Resistance training can help prevent bone loss. A 1,500 mg daily calcium supplement and adequate vitamin D (think salmon, egg yolks, and sunlight).

Digestive problems are more constant

As we move into middle age, the possibility of indigestion, constipation, diverticulitis, and ulcers increases. A host of age-related factors, including the medications you take and a more sedentary lifestyle can wreak havoc on healthy digestion.

Your best bet to avoid digestive problems is to drink plenty of water, stay active, load up on fiber, enjoy probiotics, and eat a variety of different colored fruits and vegetables.

You see a decrease in muscle mass

This goes hand in hand with the decrease in testosterone mentioned above. As we age, the ratio of lean mass to fat in our bodies changes, which has all sorts of negative effects on the entire body.

However, you can still build muscle in your 40s and stop that trend and even reverse it. Eat plenty of high-quality protein from organic sources and add more resistance training to your exercise routine.

You sweat less

As we age, our sweat (eccrine) glands shrink and become less sensitive. A study in the Journal of Applied Physiology found that women approaching middle age sweated less than their younger counterparts.

They attributed it to "a diminished response of the sweat glands to central and / or peripheral stimuli" and "an age-related structural alteration in the eccrine glands or surrounding skin cells."

Urinary tract infections become more common for women

Estrogen appears to play a protective role against the bacteria that lead to UTIs, and by 40, your body produces less. A low dose of topical estrogen cream can help, but recurring UTIs are definitely worth discussing with your doctor.

You experience a hearing loss

When we reach 40, our eardrum and inner ear change. Unsurprisingly, this affects your hearing, and since your inner ear controls its balance, it can also be a bit less coordinated.

You start to struggle a bit with holding your urine

Perimenopause means a reduction in the amount of estrogen you produce. With less estrogen in your system, the muscles that support the urethra weaken and make it more vulnerable to leakage. There are several things you can do to avoid unexpected jingle.

These include: avoiding foods and drinks that tend to cause leakage, losing some weight to reduce pressure on the bladder, and doing Kegel exercises. If none of these strategies help, your doctor can suggest what to do.

You experience sleep disruption more often

You may have slept like a log in your 20s and 30s, but in your 40s, men and women are more likely to experience interruptions in their sleep.

Studies have shown that increases in the time it takes to fall asleep (sleep latency), an overall decrease in REM sleep, and an increase in sleep fragmentation (waking up during the night) occur more frequently when we are past forty. To combat the less-than-stellar sleep spectrum, check out 10 tips for your best sleep.

You become more distracted

As a person ages, their ability to ignore distractions worsens, according to research by psychologists at the University of Toronto.

But your libido can increase

In a study of 827 women, psychologist David Buss found that people in their 40s are more interested in being intimate. Buss is an evolutionary psychologist and believes that this increase in female libido could be a biological tactic to increase the chances of childbearing.

He proposes that as women produce fewer eggs, their bodies are wired to become more aroused to increase the likelihood that an egg will be fertilized.

Your brain changes

Another consequence of the female body producing less estrogen during perimenopause is brain chemistry and function. It can lead to being more forgetful because the brain has a harder time organizing its thoughts in a way that is easy to remember. The good news is that, over time, the brain adapts to lower levels of estrogen and compensates for it.

You become lactose intolerant

One of the myriad great things the body does is help your small intestine digest lactose, a disaccharide sugar made up of galactose and glucose found in milk, by producing an enzyme called lactase.

As we age, lactase levels drop, and the lactose we ingest can affect the colon in a less digested state, and the results, well, not as pleasant.

If you think you are developing an intolerance to dairy products, try taking probiotics and experimenting with other sources of milk such as almond, rice, coconut, or cashew milk. You can also take digestive enzymes to help.

Scaly patches of skin may appear

An actinic keratosis (also known as solar keratosis) is a scaly area in areas exposed to the sun, such as the head and face. It is the most common skin condition caused by sun damage - the result of skin damaged by the sun over many years.

They are more common in men, mainly because men are more likely to have outdoor occupations, but are generally not dangerous and only pose a small risk of developing into cancer.

You experience changes in vision

In your 40s, your eyes may need a little help reading fine print and deciphering menus in restaurants by candlelight. Now that you are the age when all of this and more can happen, it's more important than ever to get regular eye exams. Protect your eyes from sun damage with UV protection sunglasses and a healthy diet.

Research suggests that lycopene, the pigment that gives tomatoes their red color, may reduce your risk of macular degeneration and cataracts later in life.

Your risk of bad things increases

After age 40, regular checkups and exams are crucial to preventing heart disease, stroke, high blood pressure, cancer, and a host of other illnesses that begin to pose a higher risk.

Yes, we will tell you to eat better, sleep well, reduce stress and exercise more, but we will also tell you to see your doctor more often and seek preventive care.

Unlock Your Glutes is an effective fitness program by Brian Klepacki focused on the people who need to accomplish a rounder, firmer, more grounded butt. This workout program will clarify how squats, jumps, and deadlifts aren’t actuating your glutes in the manner you think they are, and why simply zeroing in on these activities will leave you with powerless glute muscles, subsequently making you more inclined to injury.s Unlock Your Glutes

#Unlock Your Glutes

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makeetelich92 · 4 years ago

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Vitamin D: Why you're in all probability NOT obtaining Enough and the way that produces You Sick

What aliment might we'd like in amounts up to twenty five times over the govt recommends for U.S. to be healthy?

What vitamin deficiency affects 70-80 p.c of the population, is nearly ne'er diagnosed and has been coupled to many cancers, high blood pressure, heart disease, diabetes, depression,(i) fibromyalgia, chronic muscle pain, bone loss and autoimmune diseases like multiple sclerosis?(ii)

What vitamin is almost wholly absent from our food supply?

What vitamin is that the hidden explanation for a lot of suffering that's simple to treat? national vitamin company products

The answer to any or all of those queries is vitamin D.

Over the last fifteen years of my practice, my focus has been to discover what the body needs to function optimally. Vitamin D, a nutrient (more of a hormone and gene modulator) is a critical, essential ingredient for health and optimal function. The problem is that most of us don't have enough of it because we work and live indoors, use sun block and can't get enough from our diet--even in fortified foods.

Two recent studies in the journal Pediatrics found that 70 percent of American kids aren't getting enough vitamin D, and this puts them at higher risk of obesity, diabetes, high blood pressure and lower levels of good cholesterol. (iii) Low vitamin D levels also may increase a child's risk of developing heart disease later in life.

Overall, 7.6 million, or nine percent, of US children were vitamin-D deficient, and another 50.8 million, or 61 percent, had insufficient levels of this important vitamin in their blood.

The average blood level of vitamin D was 25 ng/dl for Caucasians and 16 ng/dl for African Americans. The optimal level is 45 ng/dl and requires about 3000-4000 IU a day of vitamin D3 -- 10 times current recommendations. If our whole population achieved a minimum level of 45 ng/dl, we would have 400,000 fewer premature deaths per year. There would be a reduction of cancer by 35 percent, type 2 diabetes by 33 percent and all causes of mortality by seven percent. (iv)

The economic burden due to vitamin D insufficiency in the United States is $40-$53 billion per year. This can be corrected for pennies a person per day.

Over the last five years, I have tested almost every patient in my practice for vitamin D deficiency, and I have been shocked by the results. What's even more amazing is what happens when my patients' vitamin D status reaches optimal levels. Having witnessed these changes, there's no doubt in my mind: vitamin D is an incredible asset to your health.

That is why in today's blog I want to explain the importance of this essential vitamin and give you six tips on how to get optimize your vitamin D levels.

Let's start by looking at the massive impact vitamin D has on the health and function of every cell and gene in your body.

How Vitamin D Regulates Your Cells and Genes

Vitamin D has a dramatic impact on the health and function of your cells. It reduces cellular growth (which promotes cancer) and improves cell differentiation (which puts cells into an anti-cancer state). That makes vitamin D one of the most potent cancer inhibitors--and explains why vitamin D deficiency has been linked to colon, prostate, breast and ovarian cancer.

But what's even more fascinating is how vitamin D regulates and controls genes.

It acts on a cellular docking station called a receptor that then sends messages to our genes. That's how vitamin D controls so many different functions--like preventing cancer, reducing inflammation, boosting mood, easing muscle aches and fibromyalgia and building bones.

Vitamin D also helps prevent the flu and colds and infections. In an observational study of Finnish soldiers, those with 25-hydroxyvitamin D levels higher than 16 ng/mL (40 nmol/L) had fewer respiratory infections than those with lower levels.(v) More recently, in a double-blind randomized controlled trial involving school girls, supplementation with 1200 IU/d of vitamin D3 during the wintertime significantly reduced influenza A infections.(vi)

These are just a few examples of the power of vitamin D. When we don't get enough it impacts every area of our biology, because it affects the way our cells and genes function. And many of us are deficient for one simple reason ...

Your body makes vitamin D when it's exposed to sunlight. In fact, 80 to 100 percent of the vitamin D we need comes from the sun. The sun exposure that makes our skin a bit red (called 1 minimum erythemal dose) produces the equivalent of 10,000 to 25,000 international units (IU) of vitamin D in our bodies.

The problem is that most of us aren't exposed to enough sunlight.

Overuse of sunscreen is one reason. While these product help protect against skin cancer--they also block a whopping 97 percent of your body's vitamin D production.

If you live in a northern climate, you're not getting enough sun (and therefore vitamin D), especially during winter. And you're probably not eating enough of the few natural dietary sources of vitamin D: fatty wild fish like mackerel, herring and cod liver oil or porcini mushrooms.

In addition, aging skin produces less vitamin D--the average 70-year-old person creates only 25 percent of the vitamin D that a 20 year-old does. Skin color makes a difference, too. People with dark skin also produce less vitamin D. And I've seen very severe deficiencies in Orthodox Jews and Muslims who keep themselves covered all the time.

With all these causes of vitamin D deficiency, you can see why supplementing with enough of this vitamin is so important. Unfortunately, you aren't really being told the right amount of vitamin D to take.

The government recommends 200 to 600 IU of vitamin a day. This is the amount you need to prevent rickets, a disease caused by vitamin D deficiency. But the real question is: How much vitamin D do we need for OPTIMAL health? How much do we need to prevent autoimmune diseases, high blood pressure, fibromyalgia, chronic muscle pain,(vii) depression, osteoporosis and even cancer?

The answer is: Much more than you think.

Recent research by vitamin D pioneer Dr. Michael Holick, Professor of Medicine, Physiology, and Dermatology at Boston University School of Medicine, recommends intakes of up to 2,000 IU a day -- or enough to keep blood levels of 25 hydroxy vitamin D at between 75 to 125 nmol/L (nanomoles per liter).(viii) That may sound high, but it's still safe: Lifeguards have levels of 250 nmol/L without toxicity.

Our government currently recommends 2,000 IU as the upper limit for vitamin D -- but even that may not be high enough for our sun-deprived population! In countries where sun exposure provides the equivalent of 10,000 IU a day and people have vitamin D blood levels of 105 to 163 nmol/L, autoimmune diseases (like multiple sclerosis, type 1 diabetes, inflammatory bowel disease, rheumatoid arthritis and lupus) are uncommon.

Don't be scared that amounts that high are toxic: One study of healthy young men receiving 10,000 IU of vitamin D for 20 weeks showed no toxicity.(ix)

You might have seen a recent study in the Journal of the American Medical Association that shows that a single high dose of 500,000 Units of vitamin D3 (one year's worth of vitamin D) increased the risk of falls and fractures in elderly woman.(x) Does this mean that vitamin D doesn't prevent fractures or falls? Absolutely not!

The design and logic of the study were completely wrong. As a friend once said, "The well meaning are often ill doing."

Imagine a study that gave people a year's worth of vitamin A, or iron (both are nutrients that are stored in the body like vitamin D) in one dose. The vitamin A would cause immediate liver failure and death. In fact, the way the Inuit used to kill explorers in the Arctic was to feed them polar bear liver, which gave them toxic doses of vitamin A. A year's worth of iron in one dose would cause severe intestinal problems and iron poisoning.

Biologically we understand why a single high dose of vitamin D may cause problems. A single high dose induces protective mechanisms that reduce the available vitamin D by increasing the activity of enzymes that cause the vitamin D to be broken down by the body. (xi) The body requires a balance of the right nutrients at the right dose at the right time. No one would eat a year's worth of anything in one day and expect it to be healthy.

The question that remains is: How can you get the right amounts of vitamin D for you?

6 Tips for Getting the Right Amount of Vitamin D

Unless you're spending all your time at the beach, eating 30 ounces of wild salmon a day, or downing 10 tablespoons of cod liver oil a day, supplementing with vitamin D is essential. The exact amount needed to get your blood levels to the optimal range (100 to160 nmol/L) will vary depending on your age, how far north you live, how much time you spend in the sun and even the time of the year. But once you reach optimal levels, you'll be amazed at the results.

For example, one study found that vitamin D supplementation could reduce the risk of getting type 1 diabetes by 80 percent.(xii) In the Nurses' Health Study (a study of more than 130,000 nurses over 3 decades), vitamin D supplementation reduced the risk of multiple sclerosis by 40 percent.(xiii),(xiv)

I've seen many patients with chronic muscle aches and pains and fibromyalgia who are vitamin D deficient--a phenomenon that's been documented in studies. Their symptoms improve when they are treated with vitamin D. A Danish study of Arabic women with fibromyalgia found significant vitamin D deficiency and recovery with replacement of vitamin D.(xv)

Finally, vitamin D has been shown to help prevent and treat osteoporosis. In fact, it's even more important than calcium. That's because your body needs vitamin D to be able to properly absorb calcium. Without adequate levels of vitamin D, the intestine absorbs only 10 to 15 percent of dietary calcium. Research shows that the bone-protective benefits of vitamin D keep increasing with the dose.

So here is my advice for getting optimal levels of vitamin D:

1. Get tested for 25 OH vitamin D. The current ranges for "normal" are 25 to 137 nmol/L or 10 to 55 ng/ml. These are fine if you want to prevent rickets -- but NOT for optimal health. In that case, the range should be 100 to 160 nmol/L or 40 to 65 ng/ml. In the future, we may raise this "optimal" level even higher.

2. Take the right type of vitamin D. The only active form of vitamin D is vitamin D3 (cholecalciferol). Look for this type. Many vitamins and prescriptions of vitamin D have vitamin D2 -- which is not biologically active.

3. Take the right amount of vitamin D. If you have a deficiency, you should correct it with 5,000 to 10,000 IU of vitamin D3 a day for three months--but only under a doctor's supervision. For maintenance, take 2,000 to 4,000 IU a day of vitamin D3. Some people may need higher doses over the long run to maintain optimal levels because of differences in vitamin D receptors, living in northern latitudes, indoor living, or skin color.

4. Monitor your vitamin D status until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous and parathyroid hormone levels every three months.

5. Remember that it takes up to 6 to 10 months to "fill up the tank" for vitamin D if you're deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 to four,000 Units a day.

6. attempt to eat dietary thereforeurces of aliment D. These include:

• Fish liver oils, love cod liver oil. one TBSP (15 ml) = 1,360 IU of vitamin D• sauteed wild salmon. 3.5 oz = 360 IU of vitamin D• sauteed mackerel. 3.5 oz = 345 IU of vitamin D• Sardines, willned in oil, drained. 1.75 oz = 250 IU of vitamin D• One whole egg = twenty IU of vitamin D• Porcini mushrooms 4 ounces = four hundred IU of vitamin D

You can see currently why I feel so turbulently regarding vitamin D. This vitamin is crucial for good health. therefore begin aiming for optimum levels--and watch however your health improves.

#health #exercise #diet #healthy living #health and wellness #healthy lifestyle

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sciencebehindchocolate-blog · 4 years ago

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an (un)helpful guide to malaria

I’ve been advised by quite the many people around me, to start my articles with something eye catching, surprising, even breath-taking. I’ve never really known what that something should be and so, this is my little experiment.

MALARIA

I believe that a word written in caps-lock is enough of an eye catch so I’m going to start with the serious business. To actually catch the attention, let’s begin with the facts that make diseases so interesting – death rate:

Even with the development of vaccinations and the undoubtable progressive course of pharmacy, malaria is still proved to kill almost half a million people yearly (just to compare, the current number of deaths caused by SARS-CoV-2 = the new coronavirus is approximately 450 thousands). With this rather astonishing number of dead people yearly, it shouldn’t be surprising that World Malaria Day exists, with the date 25/4 and the focus on its devastating effects and the progress in “curing the world”. And to make the impact and importance of this illness really remarkable for the 3rd time in these 7 lines – the CDC (centres for disease control and prevention) was originally formed in 1946 to fight malaria, because of it being widely spread during war conflicts.

Even though it seems as if malaria was a problem of less economically developed countries – mainly African republics, the truth is that malaria might affect every single one of us. “Airport Malaria” occurs when a malaria infected Anopheles mosquito travels by aircraft to a country for which malaria is uncommon and bites/infect person at the airport. In such cases, the patient might be in serious health risk for an obvious reason – no one suspects malaria. Often, the discovery of the true causative agent in patients in countries where malaria is not widespread is just a lucky coincidence when a staff member/the patient himself notices a mosquito bite present on the body.

Of course, not every mosquito should be taken as a danger now, no matter how unpleasant even those uninfected are :). Malaria is a serious relapsing infection caused by five related protozoans – Plasmodium falciparum (the deadliest), Plasmodium vivax (most common one), Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi and spread by the bite of infected female Anopheles mosquitoes. Just for the effect – there are approximately 3000 species of mosquitoes worldwide.

How can one mosquito bite transfer a deadly infection into your organism?

With the bite of the mosquito – immature form of the parasite called sporozoites are injected into the bloodstream and to the liver, where they mature into schizonts. Over the course of 7-14 days, these schizonts develop into thousands of merozoites which leave liver and reenter the bloodstream with intent to invade and destroy red blood cells. These merozoites then continue to reproduce, mainly asexually.

The trouble with malaria is, that typically a patient does not experience any symptoms until 10 to 28 days after infection. The first signs are usually chills, fevers, headaches, muscle aches, nausea, diarrhea and abdominal cramps occurring in periodic attacks, which usually coincide with the release of new reproduced generation of merozoites into the bloodstream – 48 hours for P. falciparum, vivax and ovale, 72 hours for P.malariae and 24 hours for P.knowlesi. Specific case might be P.falciparum which may deteriorate very rapidly from almost no symptoms to coma, because of the infection of a large portion of the red blood cells and the adhesion of capillaries affecting the brain. Some of the sporozoites of P.vivax and P.ovale tend to remain dormant in the liver for a certain time period before realising their attack causing a relapse of the disease.

Prevention is currently considered to be the best treatment, especially thanks to the rather large selection of vaccines. Many of interesting approaches are being looked into these days, and rather successful seems to be PfSPZ vaccine made of attenuated P. falciparum sporozoites, which we use to protect healthy volunteers against malaria. None of antimalarial drugs is completely effective against the parasites, still drugs such as chloroquine, mefloquine, primaquine and artemisinin that are proved to destroy the parasites in red blood cells should be taken prophylactically.

“Everyone says I suck” – said the mosquito.

M.S.

#malaria #medicine #diseases #epidemics #lame jokes #science #scientific jokes #medical article

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dukuzumurenyiphd · 5 years ago

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Posted @withrepost • @sunpeople_1 Nutrient deficiencies and toxicity from a poor diet are linked to nearly all modern health conditions. John Hopkins University reports that some 80 percent of cancer patients are believed to be malnourished, and that treatments used to battle cancer (like chemotherapy) only increase the body’s need for nutrients and very high-quality foods even more. You probably already know that diabetes and heart disease (currently the No. 1 killer in the U.S. and most industrialized nations) are also illnesses that are highly influenced by one’s diet — and the same can be said for allergies, autoimmune disorders like arthritis, thyroid disorders and many more. _ Some of the ways that medicinal foods specifically act like natural protectors against disease: Decreasing & Controlling Inflammation – Inflammation is a response from the immune system when the body perceives it’s being threatened, and it can affect nearly every tissue, hormone and cell in the body. _ Balancing Hormones −Abnormal hormonal changes contribute to accelerated aging, diabetes, obesity, fatigue, depression, low mental capacity, reproductive problems and an array of autoimmune diseases. _ Alkalizing the Body – Processed, low-quality foods make the body more acidic and allow diseases to thrive more easily. An alkaline diet (high in plant foods that are detoxifying) helps with cellular renewal and might promote longevity. _ Balancing Blood Glucose (Sugar) –Poorly managed blood sugar levels due to consuming high amounts of sugar and processed carbohydrates can lead to cravings, fatigue, neurological damage, mood disorders, hormonal balances and more. _ Detoxifying & Eliminating Toxins –Toxicity is tied to poor digestive health, hormonal changes and decreasing liver functioning. _ Improving Absorption of Nutrients –The majority of processed convenience foods are stripped of their natural nutrients or at least partly manmade, packed with synthetic ingredients and preservatives but very low in vitamins, minerals, antioxidants, fiber and enzymes. _ Click Link In Bio or visit blackveganhealth.com _ #buyblack #african #blackhealth #health #blackexcellence https://www.instagram.com/p/B0wborXH31i/?igshid=p5l60tiu0vd

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delphinidin4 · 6 years ago

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Forty-five percent of adults say they’re preoccupied with their weight some or all of the time—an 11-point rise since 1990. Nearly half of 3- to 6- year old girls say they worry about being fat.

...

I have never written a story where so many of my sources cried during interviews, where they shook with anger describing their interactions with doctors and strangers and their own families.

Chances of a woman classified as obese achieving a “normal” weight:.008%

SOURCE: AMERICAN JOURNAL OF PUBLIC HEALTH, 2015

Diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism

“As a kid, I thought that fat people were just lonely and sad—almost like these pathetic lost causes. So I want to show that we get to experience love, too. I’m not some 'fat friend' or some dude's chubby chasing dream. I'm genuinely happy. I just wish I'd known how possible that was when I was a kiddo.”— CORISSA ENNEKING

“If you looked at anything other than my weight,” Enneking says now, “I had an eating disorder. And my doctor was congratulating me.”

...

This phenomenon is not merely anecdotal. Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. ... In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

...

When Joy Cox, an academic in New Jersey, was 16, she went to the hospital with stomach pains. The doctor didn’t diagnose her dangerously inflamed bile duct, but he did, out of nowhere, suggest that she’d get better if she stopped eating so much fried chicken. “He managed to denigrate my fatness and my blackness in the same sentence,” she says.

“There is so much agency taken from marginalized groups to mute their voices and mask their existence. Being depicted as a female CEO—one who is also black and fat—means so much to me. It is a representation of the reclamation of power in the boardroom, classroom and living room of my body. I own all of this.”— JOY COX

Physicians are often required, in writing, to prove to hospital administrators and insurance providers that they have brought up their patient’s weight and formulated a plan to bring it down—regardless of whether that patient came in with arthritis or a broken arm or a bad sunburn. Failing to do that could result in poor performance reviews, low ratings from insurance companies or being denied reimbursement if they refer patients to specialized care.

...

Three separate studies have found that fat women are more likely to die from breast and cervical cancers than non-fat women, a result partially attributed to their reluctance to see doctors and get screenings. Erin Harrop, a researcher at the University of Washington, studies higher-weight women with anorexia, who, contrary to the size-zero stereotype of most media depictions, are twice as likely to report vomiting, using laxatives and abusing diet pills. Thin women, Harrop discovered, take around three years to get into treatment, while her participants spent an average of 13 and a half years waiting for their disorders to be addressed.

...

If Sonya ever forgets that she is fat, the world will remind her. She has stopped taking the bus, she tells me, because she can sense the aggravation of the passengers squeezing past her. Sarah, the tech CEO, tenses up when anyone brings bagels to a work meeting. If she reaches for one, are her employees thinking, “There goes the fat boss”? If she doesn’t, are they silently congratulating her for showing some restraint?

Emily says it’s the do-gooders who get to her, the women who stop her on the street and tell her how brave she is for wearing a sleeveless dress on a 95-degree day.

Ratio of soda and candy ads seen by black children compared to white children: 2:1

SOURCE: UCONN RUDD CENTER FOR FOOD POLICY AND OBESITY, 2015

This is how fat-shaming works: It is visible and invisible, public and private, hidden and everywhere at the same time. Research consistently finds that larger Americans (especially larger women) earn lower salaries and are less likely to be hired and promoted.... What’s worse, only a few cities and one state (nice work, Michigan) officially prohibit workplace discrimination on the basis of weight.

...Paradoxically, as the number of larger Americans has risen, the biases against them have become more severe. More than 40 percent of Americans classified as obese now say they experience stigma on a daily basis, a rate far higher than any other minority group. And this does terrible things to their bodies. According to a 2015 study, fat people who feel discriminated against have shorter life expectancies than fat people who don't. “These findings suggest the possibility that the stigma associated with being overweight,” the study concluded, “is more harmful than actually being overweight.”

...

Kids as young as 3 describe their larger classmates with words like “mean,” “stupid” and “lazy.”

And yet, despite weight being the number one reason children are bullied at school, America’s institutions of public health continue to pursue policies perfectly designed to inflame the cruelty. TV and billboard campaigns still use slogans like “Too much screen time, too much kid” and “Being fat takes the fun out of being a kid.” Cat Pausé, a researcher at Massey University in New Zealand, spent months looking for a single public health campaign, worldwide, that attempted to reduce stigma against fat people and came up empty. In an incendiary case of good intentions gone bad, about a dozen states now send children home with “BMI report cards,” an intervention unlikely to have any effect on their weight but almost certain to increase bullying from the people closest to them. [I have a friend who had to take a paper home in high school telling her family she was obese. Now, in her late twenties, she’s still dealing with the emotional scars.]

...

The effects of weight bias get worse when they’re layered on top of other types of discrimination. A 2012 study found that African-American women are more likely to become depressed after internalizing weight stigma than white women. Hispanic and black teenagers also have significantly higher rates of bulimia. And, in a remarkable finding, rich people of color have higher rates of cardiovascular disease than poor people of color—the opposite of what happens with white people. One explanation is that navigating increasingly white spaces, and increasingly higher stakes, exerts stress on racial minorities that, over time, makes them more susceptible to heart problems.

...

But perhaps the most unique aspect of weight stigma is how it isolates its victims from one another. For most minority groups, discrimination contributes to a sense of belongingness, a community in opposition to a majority. Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them. In a 2005 study, the words obese participants used to classify other obese people included gluttonous, unclean and sluggish.

...

Fat people, though, never get a moment of declaring their identity, of marking themselves as part of a distinct group. They still live in a society that believes weight is temporary, that losing it is urgent and achievable, that being comfortable in their bodies is merely “glorifying obesity.” This limbo, this lie, is why it’s so hard for fat people to discover one another or even themselves. “No one believes our It Gets Better story,” says Tigress Osborn, the director of community outreach for the National Association to Advance Fat Acceptance. “You can’t claim an identity if everyone around you is saying it doesn’t or shouldn’t exist.”

“I think some folks are genuinely surprised that a man who looks like him is with a woman like me. As a fat person, I'm very aware of when I'm being stared at—and I have never been looked at this much before. So I thought that taking the photo in public would be a good idea. It feels subversive to show my fat body doing regular stuff the world believes I don't or can't do.”— EMILY

Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.

...

The problem is that in America, like everywhere else, our institutions of public health have become so obsessed with body weight that they have overlooked what is really killing us: our food supply. Diet is the leading cause of death in the United States, responsible for more than five times the fatalities of gun violence and car accidents combined. But it’s not how much we’re eating—Americans actually consume fewer calories now than we did in 2003. It’s what we’re eating.

For more than a decade now, researchers have found that the quality of our food affects disease risk independently of its effect on weight. Fructose, for example, appears to damage insulin sensitivity and liver function more than other sweeteners with the same number of calories. People who eat nuts four times a week have 12 percent lower diabetes incidence and a 13 percent lower mortality rate regardless of their weight. All of our biological systems for regulating energy, hunger and satiety get thrown off by eating foods that are high in sugar, low in fiber and injected with additives. And which now, shockingly, make up 60 percent of the calories we eat.

4% of all agricultural subsidies go to fruits and vegetables.

SOURCE: ENVIRONMENTAL WORKING GROUP, 2014-16

But that’s still no reason to despair. There’s a lot we can do right now to improve fat people’s lives—to shift our focus for the first time from weight to health and from shame to support.

...

In 2017, the U.S. Preventive Services Task Force, the expert panel that decides which treatments should be offered for free under Obamacare, found that the decisive factor in obesity care was not the diet patients went on, but how much attention and support they received while they were on it. Participants who got more than 12 sessions with a dietician saw significant reductions in their rates of prediabetes and cardiovascular risk. Those who got less personalized care showed almost no improvement at all.

“My son and I both like to play the hero. There wasn't necessarily any intentional symbolism in the costumes we chose, but I am definitely a member of the rebellion, and I see my role as an eating disorders researcher as trying to fight for justice and a better world. Also, I like that I'm sweaty, dirty and messy, not done up with makeup or with my hair down in this picture. I like that I'm not hiding my stomach, thighs or arms. Not because I'm comfortable being photographed like that, but because I want to be—and I want others to feel free to be like that, too.”— ERIN HARROP

A review of 44 international studies found that school-based activity programs didn’t affect kids’ weight, but improved their athletic ability, tripled the amount of time they spent exercising and reduced their daily TV consumption by up to an hour. Another survey showed that two years of getting kids to exercise and eat better didn’t noticeably affect their size but did improve their math scores—an effect that was greater for black kids than white kids.

You see this in so much of the research: The most effective health interventions aren't actually health interventions—they are policies that ease the hardship of poverty and free up time for movement and play and parenting. Developing countries with higher wages for women have lower obesity rates, and lives are transformed when healthy food is made cheaper. A pilot program in Massachusetts that gave food stamp recipients an extra 30 cents for every $1 they spent on healthy food increased fruit and vegetable consumption by 26 percent. Policies like this are unlikely to affect our weight. They are almost certain, however, to significantly improve our health.

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What does work, Corrigan says, is for fat people to make it clear to everyone they interact with that their size is nothing to apologize for. “When you pity someone, you think they’re less effective, less competent, more hurt,” he says. “You don’t see them as capable. The only way to get rid of stigma is from power.”

...

This has always been the great hope of the fat-acceptance movement. (“We’re here, we’re spheres, get used to it” was one of the slogans in the 1990s.) But this radical message has long since been co-opted by clothing brands, diet companies and soap corporations. Weight Watchers has rebranded as a “lifestyle program,” but still promises that its members can shrink their way to happiness. Mainstream apparel companies market themselves as “body positive” but refuse to make clothes that fit the plus-size models on their own billboards.

...

“Fat activism isn’t about making people feel better about themselves,” Pausé says. “It’s about not being denied your civil rights and not dying because a doctor misdiagnoses you.”

...

There is no magical cure. There is no time machine. There is only the revolutionary act of being fat and happy in a world that tells you that’s impossible.

“We all have to do our best with the body that we have,” [Ginette Lenham] says. “And leave everyone else’s alone.”

#fat pride

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mymedtrips · 6 months ago

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Best Neurosurgery Hospitals in India

Neuro diseases are very bad diseases. Many people are caught by Neuro diseases nowadays. It is related to brain diseases. Many people in India are caught by Neuro Diseases. It happens in Adults as well as children.

A person of any age can be affected by this. Before this time very bad disease Named EPILEPSY affected adults as well as children. It causes FITS in a person who is affected by this disease. It is a nerve problem in the Brain.

When this disease increases it can become BRAIN TUMOR in a person who is affected by this disease which can be the cause of death. It is not good for a person and their family members.

When a person is affected by BRAIN TUMOR then firstly doctors recommend to treatment of a person by medication. The person affected by the starting phase of BRAIN TUMOR of many diseases like EPILEPSY and the person has to take many medicines in a day for many years, Medicine Neuro diseases are very costly. But if a person doesn't want to do surgery on the brain, a person is afraid of death. So a person is ready to take medicines daily.

otherwise, in BRAIN tumors doctors recommend doing Neurosurgery of the Brain. Doctors check that person who has been taking medicines for many years and then suggest him to Neurosurgery or take medicines his whole life.

Neuromedicines and neurosurgery a very costly processes in India and it is very tough to take treatment of NEUROSURGERY for a Normal middle-class person. A person doesn't want to prefer surgery so he recommends taking medicine and the person's family members don't agree to Neurosurgery.

NEUROSURGERY COST in India

When a Patient's Condition is very critical then doctors suggest Neurosurgery. There are many tests of the brain recommended by doctors i.e. MRI, CT-Scan, EEG, etc. Which are very costly. MRI confirms that this part of the brain caused of Brain Tumor. It is a very technical surgery and many gadgets are used in this surgery. Most doctors do laser neurosurgery which is very costly and difficult to do by a middle-class person. It starts from 2 lacs to 5 lacs. But for some patients, its amount goes high.

BEST HOSPITAL FOR NEUROSURGERY IN INDIA:

Now in every city, there is a one special hospital named Neurosurgery like Bhatia Neurosurgery Hospital which is in Patiala district in Punjab. Also, many hospitals especially do treatment of this disease and other diseases as well like Knee Surgery. Other hospitals are popular for the treatment of Neurosurgery like Indraprastha Apollo Hospital in New Delhi. Fortis Healthcare is situated in almost every state of India. Apollo is the best neurosurgery hospital in India.

BEST DOCTORS FOR NEUROSURGERY IN INDIA

There are many doctors of Neurosurgery in India. In every government hospital, there are many special neurosurgeons do treatment of Neuro patients. Some Doctor's name I am mentioning below.

1. Dr. Sudheer Kumar Tyagi

2. Dr. Vinit Suri

3. Dr. V.P. Singh

4. Dr. Sanjeev Dua

5. Dr. Anita

My Med Trip is one of the best medical tourism companies. We provide complete medical and healthcare services with consulting in India for patients from all over the world including South African countries like Kenya, Ethiopia, South Africa, etc. We help you in finding the best hospitals, doctors, and good accommodations at affordable costs in India. We offer Kidney, liver, lung, heart, and bone marrow transplants and treatment; shoulder replacement surgery cost , knee replacement surgeries, breast cancer surgery cost, skin cancer treatment, kidney transplant cost, heart transplant and so on.

Source: https://mymedtrips.blogspot.com/2023/09/best-neurosurgery-hospitals-in-india.html

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ayurvedarishikesh-blog · 6 years ago

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Health: First of all Liberties

In this age when health awareness is increasing, we must be more careful about on-going adverts of so-called healthy food and other catered health products.

We are at the junction of the change in climates all over the world. In southern hemisphere winter is going and spring is ahead. The birds are making nests; spring is in the air - a time of rebirthing. Trees are budding and welcoming the spring and ready to blossom new leaves and flowers.

But are we? Are we ready to cooperate with the change of weather just around the corner?

Our rhythms are directly connected to the seasons because our metabolic nature is derived from the penetration of five elements.

Now Sun is changing its directions to earth. When we take our food in harmony with the season, we strengthen our rhythms and we can achieve our optimal state of health. By observing the seasonal influence on our food we remain in harmony with nature. This is the easiest way to keep our body and mind in a state of balance.

The Ayurvedic texts say:-

Kapha is accumulated as toxins during cold weather and during spring this increased accumulated Kapha, liquefied by the heat of the sun, causes diminished Agni (digestive activity) thus blocking our energy channels and causing diseases. During the junctions between the seasons, when all nature is in flux, the disease can also take root in the body. Due to the upheavals dominating these junctions, the body’s natural immunity becomes virtually defenseless against impending disease.

I have already spent 15 years working in this rainbow nation. I advocate an integrated approach to health and work closely with my patients to find unique solutions to questions by combining the ancient wisdom of Ayurveda and Therapeutic Yoga with current practices, and by drawing on a variety of techniques. I am grateful to thousands of South Africans for their trust in this oldest art of healing. I am also thankful to some of my friends for whom I was unable to provide a cure through a lack of understanding of each other. One always learns from these experiences.

I am writing this article on the basis of my experience and expertise. My intention is not to offend the work of conventional approaches to medicine, but having said that, it is clear to me that we are conditioned to believe certain issues about health that have no relationship to the truth.

There are two ideas that have become more embedded in the health and wellness sector than any other. The first is that certain foods are bad for us and the second is that we need some vitamin supplements to keep us well. We have been taught to believe these myths which are deeply entrenched and are promoted by everyone from gym trainers to doctors to public health authorities. For more info, you can read more about Ayurveda Courses.

Here is a short story that I have translated from Hindi. I think it demonstrates nicely how the issue of supplements, food, and medication can be imposed on us unnecessarily, and how situations in our lives are actually quite simple and easy to fix without these complicated and unhealthy solutions.

“A boy was born into a privileged family”

The lovely boy entered kindergarten and mama and papa watched him grow. They were very proud, but one afternoon when mama and papa went to fetch their child, the teacher took them aside for a moment. She was concerned, she explained, because the lovely boy had started to paint his drawings in black paint. This was very sudden and she was sure it was not good.

The teacher explained that the precious boy had painted a sun in black. In his beautiful picture, the background was all white, but the sun and its glorious waving rays were black. And then again he painted, on a starkly striking white background, a perfect tree with a sturdy black trunk, and the strong black boughs that reached for the sky were adorned with tiny black leaves. And in the third picture, the clever boy had painted a gorgeous summer’s day; again against a pristine white background, he’d painted lush grass, verdant tall flowers waving in a gentle breeze with a butterfly suspended delicately above – all in black.

The teacher and doting parents were very concerned. They discussed many possibilities and eventually, mama and papa disclosed that at times there was discord between them. They hadn’t thought it was serious, but they resolved then and there to hide it better from their fragile boy, and discussed what was necessary to fix the damage. Teacher reflected for a moment and then recommended a special psychologist for children.

Therapy began immediately. Mama and Papa and teacher watched the beautiful boy closely for any changes or signs of improvement, but while he still laughed and played with the other children and continued to produce pretty pictures, they were all in black. Mama grew more alarmed, and in speaking to her sisters and cousins daily decorated the drama with tears and anguish.

Eventually, the special psychologist for children asked for help. She suggested a special psychiatrist that she knew, and a meeting was arranged between the boy and the new expert. After many hours spent assessing the young child the new expert prescribed medicine for him, that should make him happier and perhaps even make him more compliant. She also said he was missing vitamins and strongly urged mama and papa to procure for him supplements that would fill the gaps. A new diet was drawn up and only those foods that would aid in his recovery were allowed from now on.

Mama and Papa, teacher and new expert continued to watch the boy. And then one day while they were busily engaged in discussing the problem, the boy went outside and began to play in the school grounds. There he was found by a trusted old gardener who had watched over the children for many a long year. Having noted all the meetings and discussions and therapy, the gardener asked the child if all was well.

“All is fine.” Came the cheerful response.

“There are so many people who gather together to discuss you.” Said the old man.

“Yes, I know.” said the boy, “I don’t know what they want, but I’ve been to play in a hospital and that was fun. I have to take some pills and eat special food, and that’s not much fun, but the lady who gives me the pills is very beautiful. She has soft shinning hair, and she wears clothes with threads that shimmer like silverfish in water. She’s very kind and I like her very much. She also gives me sweets each time when I leave.”

“But are you feeling sad?” gently pressed the old man.

“No, not all!” replied the child. “Why do you ask?”

“Well,” said the man, “You paint all your lovely pictures in black paint, and they want to know why a happy boy would paint in black.”

“But,” exclaimed the boy, “if you look inside, you will see that all the other colors in my paint box are finished!”

It must be made clear that there is no standard diet that is ideal for every individual. Furthermore, how we eat is as important as what we eat; how we cook is as important as what we cook; what kitchen equipment is used and what feelings accompany the preparation of food, all affect us as human beings.

What is a negative feedback mechanism?

Our food is digested, assimilated in the liver and then sent to different parts of our body according to the need. Blood vessels work as the transport system and nerve endings as messengers. In a healthy situation, if we eat lots of sweets and our blood glucose is high, a message will be conveyed to the pancreas to secrete more insulin. If we feel hot, our skin starts sweating to keep our temperature normal.

On the other hand, if we are taking synthetic or unnecessary hormones or vitamins, our body prevents our intestine from absorbing the same vitamin from food. It also prevents the natural production of hormones.

If we have been taking vitamins or supplements for a long time, then every so often we should stop doing so for a while. Such pauses provide a chance for the body to assimilate all medicines. We must be very careful not to take unnecessary supplements, and we must not become victims of multinational pharmaceutical companies. Also, one can read about Nutritional Ayurveda Course

There’s no doubt that what we eat can have a massive impact on our health, performance, and body composition. However, there’s no evidence showing that we can’t achieve all of these things while still enjoying any of the food we like. The biggest problem with the idea of “clean eating” is that clean has no unique definition. Everyone believes different foods are “unclean.”

#ayurveda courses #ayurveda #yoga #ayurveda treatment

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rapeculturerealities · 6 years ago

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We stopped keeping statistics on the number of Native moms and babies that are lost in our region; it was just too upsetting,” said Millicent Simenson, co-founder of Mewinzha Ondaadiziike Wiigaming.

In light of growing awareness of the negative impact of institutional racism on health for women of color, especially Black women, a new analysis argues the experience of Native American women closely parallels that of African American women. An emerging community-centered and culturally relevant response is offering families hope amid staggering rates of maternal and infant mortality.

Mewinzha is a Native American holistic care center for pregnant, birthing moms and their families in Bemidji, Minnesota. Simenson, of the Mandan Hidatsa and Arikara tribes, and her partner at Mewinzha, Roberta Decker of the Leech Lake Ojibwe tribe—both licensed nurses with extensive experience working in mainstream health care—offer childbirth, breastfeeding education, and doula training for both Native and non-Native people. They also serve as volunteer doulas as time permits.

“Even though we don’t get any referrals from mainstream health care, we continue to do the work because Native people are asking for it, and we think it helps,” Simenson said.

Released today, the analysis from the Center for American Progress, shared pre-publication exclusively with Rewire.News, includes data supporting Simenson’s observations. The analysis, titled “American Indian and Alaska Native Maternal and Infant Mortality: Challenges and Opportunities,” finds that official and ad hoc practices, including traditional Native concepts of community support, are playing a critical role in improving access to health-care services.

Although health and birth and death records notoriously underreport racial classifications for Native Americans, the available data is startling.

In 2015, mortality rates for American Indians and Alaska Native babies under the age of 1 was 8.3 per 1,000 births versus white non-Hispanic babies at 4.9 deaths per one thousand births, according to the Centers for Disease Control and Prevention (CDC). Mortality rates declined for infants of all races except for American Indians.

Native American infants are twice as likely as non-Hispanic white infants to die from Sudden Infant Death Syndrome (SIDS), and are 70 percent more likely than non-Hispanic white infants to die from accidental deaths before the age of 1. Data from the Urban Health Institute collected from the organizations’ 33 nationwide health-care locations found that maternal mortality rates for Native women was 4.5 times greater than non-Hispanic white women.

Since Native Americans constitute approximately 2 percent of the U.S. population, they are frequently overlooked in public health data, according to the authors of the analysis, Lucy Truschel and Cristina Novoa. Physicians often misreport racial identity for Native Americans in medical documents. Birth and death racial data may also be inaccurate. The mother usually indicates racial identity, but some tribes may only recognize members whose fathers are Native. Also, since physicians or coroners often report racial identity for death certificates, the possibility for misidentification increases. The CDC, for instance, uses information from public health and birth and death records for its data reporting.

The CAP authors maintain that the actual rate of Native American maternal and infant death is much higher than shown by available data.

In the series “Lost Mothers,” ProPublica and National Public Radio journalists collected over 200 stories from African American mothers who overwhelmingly reported feeling devalued and disrespected by medical providers. Journalists also cited a 2010 study by Arline Geronimus, professor at the University of Michigan, who describes the cumulative physical impact of enduring stress, such as living with racism, as “weathering.” Geronimus links weathering to a broad range of health disparities, including high maternal and infant mortality rates.

Native women also bear the burdens of negative health impacts from historical trauma borne out of past federal policies supporting genocide, forced migration, and cultural erasure. Examples include forced placement on reservations, attendance at boarding schools, relocation programs moving Native peoples from home communities to cities. This premise is supported by research such as the Adverse Childhood Experiences Study connecting stress and the risk of developing health problems such as addiction, depression, intimate partner violence, suicide, diabetes, liver disease, and poor fetal health.

Native women may be reluctant to seek services from mainstream medical professionals; they are 2.5 times more likely to receive late or no prenatal care compared to non-Hispanic white mothers. Barriers to getting health care include lack of money and transportation to travel to facilities far from home, lack of health insurance, and fear of discrimination.

According to a study by the Robert Wood Johnson Foundation and the Harvard School of Public Health, 23 percent of Native American respondents reported being discriminated against when visiting the doctor or clinic. Fifteen percent reported avoiding visiting the doctor altogether due to fear of discrimination.

“I’ve seen a lot of racism when it comes to how our women are treated by health-care professionals,” said Rebekah Dunlap, a public health-care nurse on the Fond du Lac Reservation in Minnesota. “Native people get so judged by mainstream health care professionals who don’t understand our communities or know where we’re coming from. So many of our people are living in survival mode, but doctors simply see us as non-compliant in terms of our health status,” she said. Dunlap is a member of the Fond du Lac Band of Ojibwe.

Simenson described her experience supporting a client during a prenatal visit at a local clinic. “She was dreading going to the clinic because of a bad previous experience. The receptionist ignored her and skipped to the next person as she waited at the desk to get her next appointment,” Simenson recalled.

The client got angry and began to storm away. “I’m not going to do this anymore; I’m not going back there,” she said.

Simenson acknowledged the client’s feelings, but reminded her it was important to set up the next appointment. With Simenson’s support, the client went back and scheduled her next visit. Simenson also called the receptionist’s attention to the client’s experience.

“I’m not sure I would describe the receptionist’s behavior as racially motivated, but it really doesn’t matter because the client sincerely felt that it was and wouldn’t have scheduled her next appointment because of it,” Simonsen said.

Pregnant people who use drugs may also fear going to the doctor. Use of opioids among Native Americans has skyrocketed. Native American Minnesotans were five times more likely to die of drug overdose than white Minnesotans in 2015, according to the Minnesota Department of Health, while comprising only 1.1 percent of the population in that state. In Wisconsin, Native American infants were disproportionately affected by neonatal abstinence syndrome (NAS) compared to other ethnicities.

NAS is a set of symptoms—such as tremors, excessive crying, and diarrhea—that newborns can present with at birth if they were exposed to opioids in utero. NAS can occur if a person uses illicit drugs, prescribed medication, or even methadone or buprenorphine, medication-assisted treatments used to treat opioid-use disorder recommended for pregnant people.

A common medical practice for infants born with NAS includes separating baby and mother for 72 hours while baby is placed in a neonatal intensive care unit (NICU) where they are treated for withdrawal symptoms. In some instances, mothers may be charged with child abuse or other crimes and/or have their babies removed from their care by government social service agencies.

Pregnant patients “seem to know which hospitals won’t separate them from their babies,” said Birdie Lyons, Family Spirit program supervisor for the Leech Lake Ojibwe tribe in Minnesota.

Indian Health Service (IHS) facilities—those providing health-care services to American Indian and Alaska Native families in the United States—in the Bemidji area refer pregnant clients to Sanford Hospital in Bemidji for birthing. According to Lyons, Sanford Hospital separates babies with withdrawal symptoms from their mothers for 72 hours. In response to Rewire.News’ emails about this practice, Katie Johnson, vice president of marketing and communications for Lake Region Healthcare, wrote, “our Director in that department and our [chief nursing officer] … determined we would elect to decline to provide comments for this article.” Sanford Hospital is part of Lake Region Healthcare.

The bonding benefits of skin-to-skin touch between mothers and babies, as well as breastfeeding newborns, outweigh the risks, according to Lyons.

Mainstream medicine’s attitudes about allowing babies with NAS to remain with mothers are changing. The Canadian Paediatric Society recommends babies and moms stay together. Leading experts on the issue in the United States have noted that automatic entry into the NICU is not always the best care and, instead, practices like keeping mother and baby together and breastfeeding often result in the best treatment.

“We don’t judge them at Family Spirit,” Lyons said. “Although we’re mandated reporters, we take our clients at their word about their drug use. Our overriding concern is keeping track of the baby and mother.”

“Some of our moms won’t seek government assistance because they’re afraid of having [their] baby taken away,” Lyons said. “But they’ll come and see us at Family Spirit because they know they can talk to us. I don’t care how addicted they are, moms don’t want to hurt their babies,” she added.

Family Spirit is a home visiting program of the John Hopkins Center for American Indian Health designed to promote health and well-being for parents and children. Family Spirit has programs in over 100 tribal communities in both urban and rural areas across the United States. In its evidence-based model, tribal communities determine the cultural aspects of the service and integrate their understanding of health. Community paraprofessionals regularly visit pregnant women and families in their homes, providing support during and after pregnancy.