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Many of the things that make rural living appealing to some – the remoteness, the absence of crowds, the simplicity – can make health care more difficult. Choices for doctors may be limited and health care facilities can be miles away. For some care, you may need to plan days or more in advance.

So while it’s always a good idea to look ahead for your health care needs, it can be especially important in a rural community.

“It’s better to establish care before you need it,” says Kevin Bennett, director for the Center for Rural and Primary Healthcare, University of South Carolina School of Medicine.

It’s not just about the aggravation of having to rush to find a doctor and get an appointment when you suddenly find that you need one, Bennett says. It’s also that in remote areas, a lack of health care planning is far more likely to result in bad health outcomes.

“People delay care. They don’t get the necessary care – primary or preventive – and then it becomes an issue,” he says.

As a basic rule of thumb, Bennett says if your distance from basic necessities like groceries require you to plan in advance, you probably need a plan for health care issues as well.

What You Can Do

Start by educating yourself about what’s available in your own community, says Keith J. Mueller, director of The University of Iowa’s Rural Policy Research Institute.

Much of the information is available online. Or you can call up your local state or county health office for help. They will likely be able to guide you to the closest primary care resources and a path to specialist care if you need it. If you’re not already ill, Mueller says, start with primary care.

Even if your community is too small to support a medical doctor for primary care, many rural areas have primary care clinics staffed by a physician’s assistant (PA) or nurse practitioner who can do most of what a physician might do in that setting, Mueller says.

It’s a good idea to set up a checkup at one of these facilities closest to your home before you have an acute illness or health emergency, he says. This allows the clinic to get your health history in an electronic record early, so your medical team can have easy access to a list of medications you are taking, as well as past illnesses or surgeries. Then when you need fast treatment or referral to a specialist, the clinic will be able to move quickly, Mueller says.

In areas where hospitals and clinics are not available, state or local health authorities often will set up mobile health centers that pass through your community from time to time. Check for availability and schedules online or call your state or local health authority.

What Happens if You Need a Specialist?

Finding a specialist in a rural area can be hard. While there are some specialists who travel to rural communities, their availability is often sparse and if your condition requires regular appointments, you may need to travel.

Where transportation is an issue, many communities organize volunteers to help you get to needed appointments. But however you get there, remember that travel times to reach medical treatment can be affected by weather, like rain or snow, and by the terrain, such as winding roads or hills.

And again, good specialist care starts with your primary care provider. That’s why you should establish care early. They’ll know about specialists in the area and the best way to see them. Once you’re in their system, even a mobile office will be able to make referrals and can send records and lab reports to specialists when necessary.

What About Telehealth?

Telehealth may also be an option. In some states (where allowed by law), your primary care clinic may be able to set up a telehealth appointment with a specialist. Telehealth has become far more common since the beginning of the COVID-19 pandemic, but there are limitations. In general, telehealth doesn’t allow for checking temperature or vital signs and some remote areas don’t have broadband.

However, in some cases your primary care clinic can set up a more in-depth telehealth specialist exam with the help of a specialized mobile medical computer, called a COW (computer on wheels).

And some rural communities are working on other solutions like providing telehealth at local libraries.

The Bottom Line

Rural communities have their limitations, but they often have more health care options than it first seems, Bennett says.

“I think rural communities are really resilient and creative in how they approach these issues. How do we use what we’ve got? How do we ‘double-use’ what we’ve got?”

With few exceptions, Bennett says, there is little reason you shouldn’t be able to live a long, healthy, and vibrant life in a rural area. You simply have to put a few simple things in place.

If you’re new to an area, make sure you have enough medication for any prior conditions and you’re up to date on doctor visits. Meet your neighbors and find out about health care resources in your community (including transportation if you need it). And of course, make an appointment ASAP at the closest point of primary care.

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You may know that taking some antibiotics and acne medicine can trigger skin sensitivity to the sun, but common over-the-counter meds like aspirin and antihistamines can also spark sunburns and rashes.

Medications with a possible sun sensitivity side effect are prescribed for a wide range of conditions including allergies, arthritis, depression, diabetes, hypertension, and rosacea. You may have gone through this reaction, which doctors call “photosensitivity.”

What Is Photosensitivity?

Photosensitivity happens when a substance like medication makes your skin sensitive to sunlight. The drug combines with the sun’s ultraviolet light (both UVA and UVB) and creates toxic and inflammatory reactions that harm your skin cells. Drug-induced photosensitivity is widely felt and can even affect those taking certain heart and chemotherapy medications.

There are two types of photosensitivity:

Phototoxicity: A sunburn-like effect that appears only on the skin that has been exposed to the sun. It can show up hours later and it’s the most common type of sensitivity.

Photoallergy: An allergic reaction that can affect areas of the skin that have not been in the sun. It can look like redness, scaling, itching, blisters, or spots that resemble hives. The signs typically develop 24 to 72 hours after you’ve been in the sun and can remain even after you’ve stopped taking the medicine.

Who Is Sun Sensitive?

Your doctor may let you know about the possibility of sun sensitivity, but there is no way to predict which patients will feel it. People can take the same dose of the same medication, and some may be fine in the sun while others break out and burn.

“Drug-induced photosensitivity affects all individuals, regardless of skin color, though the skin findings may appear milder in darker-skinned individuals,” says Vicky Zhen Ren, MD, assistant professor of dermatology at Baylor College of Medicine in Houston. For example, if your skin is darker, the redness seen in lighter skin may show up more as purple.

The darker your skin, the greater the amount of melanin (a substance that absorbs harmful ultraviolet rays) it has.

“Patients with darker skin aren’t as likely to experience the phototoxic side effects because the more melanin in their skin gives them a little more protection, but there is still a risk. Everyone should take the same precautions even if they have less risk,” says Elizabeth Messenger, MD, an assistant professor of clinical dermatology at the University of Pennsylvania’s Perelman School of Medicine.

When to Call Your Doctor

Pay attention to your body if something doesn’t look or feel right on your skin.

“If you have any questions or concerns, ask the doctor who prescribed the medication,” Messenger says. “Your doctor may know how to handle the side effect and would tell you if and how urgently you might need to see a dermatologist.”

Your sun reaction could be more than a rash and you could start feeling ill. If you get flu-like symptoms (fever with chills, nausea, headache, and weakness), or if your skin blisters, see your doctor.

Shield Your Skin

Staying out of the sun is your best bet. If you must spend time outdoors, scope out the shade whether from trees, umbrellas, or awnings. If you plan on being outside, skip the sun between 10 a.m. and 4 p.m., the peak hours for UVB radiation exposure.

Blocking the Sun

The sun’s rays can even reach your skin through windows in your home, workplace, or car.

“Traditionally we think of sunburn when we go outside, due to UVB radiation. But with a phototoxic reaction, a large cause is UVA radiation and it can penetrate through glass. Driving in a car, you normally wouldn’t experience any sun reaction, but it could be different if you are incredibly sensitive to the sun on your medication. Be diligent with your sun protection,” Messenger says.

Dermatologists recommend using SPF 30+ sunscreen that is broad-spectrum (protects against both UVA and UVB light), water-resistant, and contains at least 8% zinc oxide, as well as SPF 15+ lip balms.

“To cover your entire body, adults should apply 1-2 ounces (or 2-4 tablespoons) of sunscreen 15 minutes prior to sun exposure and every 2 hours after – more frequently if you are swimming or sweating excessively,” Ren says.

If you’re nowhere near doing that, you have a lot of company.

“We know that most patients only use 50% of the amount recommended for their body and people don’t reapply it as often as they should,” Messenger says. “You can extend protection with a wider brim hat and long sleeves shirts and pants with a tight weave because it is harder for the sun to go through.” You can also look for SPF 40+ clothing and UV-blocking sunglasses, Ren says.

Caring for Your Skin

If you need relief from irritated skin and minor sunburns, Ren suggests taking cool showers, using plain petroleum jelly or moisturizer containing aloe vera, and drinking plenty of water.

“There are many ingredients in over-the-counter skin care products that might further irritate the skin and cause sensitization that leads to an allergic reaction,” Ren says. “Try to avoid products containing fragrance additives, formaldehyde, lanolin, oxybenzone, or methylisothiazolinone. Sunscreens containing zinc oxide and titanium dioxide are less likely to cause skin irritation.”

Can you still use a retinol product or get facials?

That might not be a great idea.

“Retinols, retinoids, and facials may all cause skin irritation, which can lead to further photosensitivity,” Ren says.

Her advice: “It is best to consult with your board-certified dermatologist or licensed aesthetician regarding the pros and cons of using retinols or undergoing facials based on your skin type, medications, and underlying medical conditions.”

If you opt for such cosmetic treatments, it’s even more important to be strict about sun protection.

“Put on sunscreen to leave home every morning and make it part of your routine,” Messenger says. Everyone needs to do this, regardless of any medications they take. It’s just like brushing your teeth: a habit to keep.

“You don’t realize how much sunscreen does for you until you have a problem when you don’t use it,” Messenger says. “Build daily habits of safe sun practice and you’ll benefit in the long run.”

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Baby formula is recommended for moms living with HIV in the U.S. because of a slim chance that babies may contract HIV through breast milk.

Women living with HIV who take antiretroviral therapy and have undetectable viral loads may give birth to HIV-free babies. They may see “breast is best” posters in their doctors’ offices and wish to breastfeed their babies. But they may not think that it’s an option for them.

“Everyone knows there are numerous health benefits from breastfeeding, even compared to formula feeding,” says Patrick Jean-Philippe, MD. He’s the chief of the maternal, adolescent and pediatric research branch in the AIDS division of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases.

But for women living with HIV, Jean-Philippe says, ”this is where the benefits of breastfeeding versus the risk of transmission may become a little bit in the gray zone.”

What Is the Risk of HIV Transmission From Breastfeeding?

An NIH-funded study conducted in six African nations (South Africa, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe) and India tracked the risk of a baby getting HIV from breastfeeding. The researchers found that when women with HIV took antiretroviral therapy while breastfeeding, it nearly eliminated the risk of HIV transmission. Less than 1% of babies – specifically, 0.6% – who were breastfed for a year contracted HIV through breast milk.

But the transmission rate isn’t zero. So breastfeeding isn’t recommended in the U.S for women with HIV.

The CDC’s website states that this recommendation has been in place since 1985 and “remains consistent with the most up-to-date scientific literature and is considered best practices for preventing HIV transmission.”

In 2021, a panel of experts made a slightly more nuanced recommendation to the U.S. Department of Health and Human Services. The panel states that breastfeeding isn’t recommended for people with HIV – but that if someone with HIV decides to breastfeed, their doctor should provide patient-centered, evidence-based counseling on infant feeding options to help minimize the risk of HIV transmission.

In its report, the panel made clear, in bold print, that this part of their recommendations “is not intended to be an endorsement of breastfeeding, nor to imply that breastfeeding is recommended for individuals with HIV in the United States.” HHS has not adopted the panel’s recommendations yet.

When a Mom With HIV Wants to Breastfeed

“Choosing to breast/chest feed is a reasonable choice and, in fact, the optimal choice for some families,” says Deborah Cohan, MD, MPH, professor of obstetrics, gynecology, and reproductive sciences at UCSF and medical director for HIVE at San Francisco General Hospital, which provides prenatal care to women living with HIV. “While we as providers may have our own bias and discomfort, we need to support our patients making choices for themselves.”

“There is this ongoing concern that … someone could face criminalization issues, and that’s really going to impact Black women and other women of color more than white women,” says Krista Martel, executive director of The Well Project, a nonprofit organization that supports women living with HIV who want to breastfeed.

Martel and Cohan say there are even anecdotal reports that some doctors may call Child Protective Services out of concern about the risk.

Some women with HIV look for doctors who support their choice to breastfeed – whether it’s something they want to do or if they’re having trouble finding formula feeding products during the current shortage.

New parents and their doctors can discuss the risks and benefits. “With shared decision-making, they can [ensure] that the woman is at the lowest risk,” Jean-Philippe says.

Meds Matter

People with HIV who breastfeed must continue taking antiretroviral therapy to treat their HIV. They should visit the doctor monthly to confirm that their viral load is still suppressed.

“This is optimal for their health too, not just related to preventing HIV transmission to their baby,” Cohan says. She says they try to engage pregnant patients about what will help with that so that they’re ready when the “sleepless nights and all the ups-and-downs of being postpartum” kick in.

Women should feel confident that taking antiretroviral medication is safe if they are breastfeeding. Some doctors also prescribe medication for babies, to lower the risk of transmission.

“Generally, we think antiretrovirals taken by the pregnant and lactating person is safe for the babies,” Cohan says. “Almost all antiretrovirals studied so far are associated with low levels in the infant blood when ingested via the milk. There are no antiretrovirals that appear to be specifically unsafe for babies via milk.”

One Mom’s Story

Ciarra “Ci Ci” Covin of Philadelphia, a woman living with HIV, became pregnant in 2010. She says that she was told that she couldn’t breastfeed her baby. So she used formula. When Covin became pregnant again in 2021, she took a different approach. Covin was on staff with the Well Project and says she had spoken with many doctors who supported breastfeeding among women living with HIV. That gave her confidence to find new doctors who would support her choice to breastfeed.

“The infectious disease [specialist], OB/GYN, and pediatrician — they were all on the same board that was allowing for shared, informed decision-making,” Covin says. “I was willing to take that [less than 1% transmission] risk.”

While Covin breastfed her daughter, the baby received medication to reduce the risk of transmission. Covin’s daughter is HIV-free, and Covin is thankful for the experience.

“I had to reframe my thinking” about doctors, Covin says. “I have goals and quality of life, [and] I just need you to support me.”

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If you’ve been diagnosed with cancer and are among the 1 in 5 Americans who live in a rural area, you may face challenges in getting the care you need because of where you live.

The first step is to work with your primary care doctor to find specialists with experience in treating your type of cancer at the stage at which it was diagnosed.

Once you know who could treat your cancer, then come other considerations:

  • How you will get to appointments
  • Where you will stay when you’re at a cancer facility for treatment
  • How you will ensure you get proper follow-up care and handle daily life while you’re recovering

Anytime travel is involved, there are a lot of costs. Assistance is available to help rural cancer patients overcome barriers to treatment. This includes lodging grants, help with airfare, and rides provided by volunteers to take you to oncology centers. These services, along with a helpline that operates 24 hours a day, are available through the American Cancer Society.

More options for at-home follow-up care are now available in some areas. This happened when the pandemic prompted state and federal agencies to lift restrictions on telehealth usage. The Centers for Medicare & Medicaid Services also allows hospitals more freedom to care for cancer patients at home following surgery, radiation, and chemotherapy treatment through video appointments and nurse visits.            

“It really was a silver lining of the health crisis,” says Kathi Mooney, PhD, RN, a co-leader in cancer control and population sciences at the Huntsman Cancer Institute at the University of Utah.

“Everybody agreed we don’t want more people in the hospital and cancer patients are more vulnerable,” Mooney says, “so it forced people who weren’t early adopters of hospital at home to try it.”

Bridging the Gap

The Institute started its Huntsman at Home program in 2018 for adults with cancer. They can’t get certain treatments at home. But the program can help cancer patients with symptoms such as nausea, vomiting, or dehydration at home – as well as providing supportive care, palliative care, and hospice to patients in their homes.

Mooney’s research shows that the program effort reduced hospitalizations for cancer patients by dispatching nurses to address issues such as dehydration and chronic pain early in the home. It began by serving people within a 20-mile radius of the Huntsman Cancer Institute and has since branched out to also include three rural counties in southeastern Utah.

The program is part of a push by hospitals and advocates to reduce disparities in treatment between urban and rural cancer patients as the nation’s population ages. (Many cancers become more common later in life.)

Lack of Oncologists in Rural Areas

Location makes a big difference in how available cancer care is.

About 2 of every 3 counties in the U.S. have no oncology providers whose primary practice site is within that county, according to a 2019 analysis published in JCO Oncology Practice.

Limited access to providers in rural areas – along with low recruitment to clinical trials – means that people are more likely to be diagnosed at later stages, less likely to get adequate treatment and follow-up services, and have poor health outcomes afterward, a second report concluded.

But the research also shows that when people living in rural areas get similar care to those who live in or closer to urban areas, those gaps close.

Hospitals across the U.S. are working to fill gaps in treatment between those living in cities and their neighbors in the country. These include a network of 71 cancer centers designated by the National Cancer Institute (NCI) in 36 states. These NCI-designated cancer centers work on clinical trials involving thousands of people with cancer, as well as providing cancer treatment.

Momentum is building to expand such efforts, including those that focus on strategies to improve access to screening for all types of cancer, says Karen Knudsen, PhD, chief executive officer of the American Cancer Society and the American Cancer Society Cancer Action Network.

“Without question, we have made significant advances in cancer treatment,” Knudsen says. “We’ve seen a 32% reduction in mortality since 1991 because of breakthroughs in the way we manage some 200 diseases we call cancer.”

“It’s more important than ever to catch cancers early,” Knudsen says. “We need to determine what are disruptive models that can give earlier access to detection, prevention, and oncology care — a different model is needed.”

Medical professionals are working to advance screening methods that can detect cancer cells in someone’s bloodstream and to develop wearable devices that may also find the disease early, Knudsen says.

There are also oral chemotherapy medications that could mean less travel. For some cancers, these may be important in your treatment. But they are very strong medications that have special instructions and require monitoring, as they can have serious side effects. Oral chemotherapy can be expensive, so check with your insurance company to see what it covers and what you would pay.

Telehealth’s Challenges

Going to a doctor’s appointment can happen online. But access to telehealth may also be a challenge for rural residents who cannot afford a computer, cell phone, or WiFi connection, Knudsen says. Broadband service is often unavailable, or unreliable, in many rural areas. 

What’s more, some things are best done in person.

“There is nothing like visiting patients in their home to understand the context of what it means for them to have cancer and to have to seek cancer treatment,” Mooney says. “We have seen the need to more closely work with food banks to make sure the dietary needs of cancer patients receiving cancer therapy are met.”

After further evaluation of the Huntsman at Home program in southeastern Utah communities, Mooney hopes to expand it in Utah and to Nevada, Idaho, Wyoming, and Montana.

Besides technology, there are other issues.

Funding for innovative hospital at-home programs that expanded during the pandemic may not continue if the CMS waiver – which allowed for reimbursement of services provided to Medicare patients at home — is not extended, Mooney says. The CMS waiver is set to expire in July.

When it comes to private insurance, the current fee-for-service model doesn’t adequately address the cost of providing acute care in the home. And there are many regulations on how many nursing visits patients can have per “episode of illness.” These things must be addressed to help the hospital at home program expand in other states, Mooney says.

“The whole dialogue needs to be about, if this is a more value-based service, how do we pay for it?’” Mooney says. “We have to get families who have experienced it to say, ‘This is the kind of care we want,’ and employers to say, ‘This helped our employees recover and get back to work.’”

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June 8, 2022 — Take that, Omicron. Results of a trial looking at a combination COVID-19 vaccine booster reveals a “robust antibody response” against the Omicron variant, vaccine manufacturer Moderna announced Wednesday.

The neutralizing antibody response was eight times greater at 1 month following a 50-mcg dose with the booster containing both the original mRNA-1273 vaccine and a new vaccine in development that specifically targets the Omicron variant.

The bivalent vaccine, mRNA-1273.214, was compared to a 50-mcg dose of the original vaccine alone in 473 seronegative participants in the Phase 2/3 trial.

These results offer promise of greater protection against Omicron following earlier reports that showed that existing COVID-19 vaccines were not as effective against the Omicron variant.

Safety and tolerability of the new vaccine was consistent with a prior booster dose of the original vaccine, the company reported.

Moderna also has a bivalent vaccine booster in development that includes the original vaccine and a vaccine specific to the Beta variant of SARS-CoV-2, the virus that causes COVID-19.

Moderna plans to file this new data with the FDA as part of its application requesting authorization.

“We anticipate more durable protection against variants of concern with mRNA-1273.214, making it our lead candidate for a Fall 2022 booster,” Stephane Bancel, chief executive officer at Moderna, said in a company news release. “We are submitting our preliminary data and analysis to regulators with the hope that the Omicron-containing bivalent booster will be available in the late summer.”

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By Alan Mozes
HealthDay Reporter

WEDNESDAY, June 8, 2022 (HealthDay News) — Even after vaccination, living with HIV ups the odds for COVID infection, new research shows.

The study found that vaccinated people living with HIV have a 28% higher risk of developing a “breakthrough” COVID infection compared to those who don’t have the AIDS-causing virus.

That’s the bad news. But there’s good news, too: The overall risk for COVID infection among people vaccinated with at least the two primary doses remains low, regardless of their HIV status.

“We thought we might see an increase in the risk of breakthrough in people with HIV because of the impact of HIV on the immune system and the role of the immune system in responding to vaccination and infection from a virus like SARS-Cov-2,” reasoned study author Keri Althoff.

So, the researchers weren’t surprised to find “that about 4 in 100 people with HIV experience a breakthrough, compared to 3 in 100 people without HIV,” said Althoff, an associate professor in the Johns Hopkins School of Public Health epidemiology department.

But it was a relief, she said, to see that nine months after vaccination, “the rate and risk of breakthrough is low among vaccinated people with and without HIV” — around 4% in each group.

Her team analyzed data on nearly 114,000 COVID-vaccinated men and women, of whom 33,000 had HIV. Most were 55 years and up, 70% were white, and more than 9 in 10 were men.

The authors focused on COVID risk during the latter half of 2021, when the more contagious Omicron variant emerged. Althoff noted that breakthrough infections were higher across the board — regardless of HIV status — in December, when Omicron became the dominant strain.

Beyond identifying the 28% higher risk for a breakthrough infection among those with HIV, the researchers noted that certain individuals with HIV faced a higher infection risk than others. They included people under age 45, compared with those between 45 and 54. Risk was also higher among those who had not received a third (or booster) dose, and those with a prior infection.

Risk of breakthrough infection in folks with HIV also increased as their T-cell counts dropped. According to the U.S. National Library of Medicine, T-cells are critical infection-fighting white blood cells which are typically attacked by HIV. (When an HIV patient’s T-cell count falls to an extremely low level, it is often a sign of transition to full-blown AIDS.)

Althoff said she and her colleagues “hypothesize that HIV-induced immune dysfunction may be playing a role in vulnerability to breakthrough COVID-19 illness.”

For that reason, boosters may be critical for such patients, she said.

Currently, Althoff pointed out, third-dose boosters are recommended for those whose HIV is either untreated or advanced.

“To increase protection against breakthrough infections, all people with HIV may need an additional dose in their primary series,” she noted.

That thought was echoed by Dr. Joel Blankson, a professor of medicine at Johns Hopkins Medicine, who was not part of the study.

Because the study showed a decrease in breakthrough infections in patients who had received a third vaccine dose, “it is important that people living with HIV get a booster dose when they are eligible,” Blankson said. The U.S. Centers for Disease Control and Prevention has COVID vaccine guidelines here.

Additional research by Althoff’s team suggests that hospitalization risk for breakthrough cases is higher among HIV-positive people compared to those without HIV. (Those findings are still under peer review and are not yet published.)

Her advice to those with HIV: “Get vaccinated. Get boosted. Keep living your life and scale up and down your mitigation strategies — mask-wearing, attending indoor gatherings, etc. — based on the amount of COVID-19 transmitting in your community, and your personal health status.”

Dr. Thomas Gut is associate chair of medicine at the Zucker School of Medicine at Hofstra/Northwell in New York City.

“The HIV-linked risk of reinfection is somewhat expected,” said Gut, who had no role in the study. “In many other infectious diseases besides COVID, it’s been known that patients with HIV do tend to have higher risk of both getting sick and having poorer outcomes.”

But patients with HIV “that have strong immune cell counts have traditionally been known to be better protected from infections compared to those with low immune system counts,” he added. “It appears that COVID reinfection risk follows this same pattern.”

Therefore, Gut said, it is important to keep HIV infection under control as best as possible.

The findings are in the June 7 issue of JAMA Network Open.

More information

There’s more on HIV status and COVID-19 at HIV.gov.

SOURCES: Keri N. Althoff, PhD, MPH, associate professor, epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Joel N. Blankson, MD, PhD, professor, medicine, Johns Hopkins Medicine, Baltimore; Thomas Gut, DO, associate chair, medicine, and director, ambulatory care services, Zucker School of Medicine at Hofstra/Northwell, Staten Island, N.Y.; JAMA Network Open, June 7, 2022

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By Dennis Thompson
HealthDay Reporter

WEDNESDAY, June 8, 2022 (HealthDay News) — Dropping a load of pounds through weight-loss surgery can significantly decrease your risk of developing or dying from cancer, according to three new studies.

Obese folks who underwent bariatric surgery were at least two times less likely to develop certain types of cancer and more than three times less likely to die of cancer than heavy people who didn’t get the procedure, according to a study presented Tuesday at the American Society for Metabolic and Bariatric Surgery’s (ASMBS) annual meeting, in Dallas.

Another much larger study by the Cleveland Clinic found similar, if smaller, benefits from weight-loss surgery — a 32% lower risk of developing cancer and a 48% lower risk of cancer-related death, according to results published June 3 in the Journal of the American Medical Association.

People need to lose at least 20% of their body weight to gain this protection against cancer, a goal that’s far beyond the reach of people trying to shed pounds through diet and exercise, said lead researcher Dr. Ali Aminian, director of the Cleveland Clinic’s Bariatric and Metabolic Institute.

“Most patients with lifestyle change only cannot reach that threshold,” Aminian said. “I think this study suggests that instead of just focusing on lifestyle modification to reduce the risk of cancer, we need to use effective treatments for obesity.”

The new studies’ findings make sense, said ASMBS President Dr. Shanu Kothari said.

“We’ve known that people who undergo weight-loss surgery live longer compared to folks who qualify for the surgery but don’t have it,” Kothari said. “The main reason is they have fewer heart attacks, but now we’re seeing they’re also having fewer cancers. That’s why they live longer.”

Obesity tied to 13 cancers

More than 42% of Americans are obese, according to the U.S. Centers for Disease Control and Prevention. Their excess weight increases the risk of developing 13 types of cancer that account for two out of five cancers diagnosed every year in the United States.

In fact, obesity is expected to soon outstrip smoking as the world’s top risk factor for developing cancer, given the global obesity epidemic, Aminian said.

For the first study, a Wisconsin team of researchers compared more than 2,100 bariatric surgery patients to more than 5,500 obese people who qualify for the procedure but didn’t get it, according to a report at the ASMBS meeting.

Weight-loss surgery resulted in large reductions in the incidence of breast cancer (1.4% vs. 2.7%), gynecologic cancer (0.4% vs. 2.6%), kidney cancer (0.10% vs. 0.80%), brain cancer (0.20% vs. 0.90%), lung cancer (0.20% vs, 0.60%) and thyroid cancer (0.10% vs. 0.70%), researchers found.

During a decade-long follow-up, the weight-loss surgery group also had a much lower incidence of any new cancer (about 5.2% vs. just over 12%) and a higher survival rate (93% vs. 79%).

“We knew bariatric surgery would reduce cancer risk based on previous studies, but what surprised us was the extent of that reduction in certain cancers,” said researcher Dr. Jared Miller, a general and bariatric surgeon at Gundersen Lutheran Health System in La Crosse, Wis.

The Cleveland Clinic study involved even more patients, more than 5,000 who underwent weight-loss surgery versus more than 25,000 who didn’t, according to the report in the Journal of the American Medical Association.

After 10 years, 3% of patients in the bariatric surgery group and 5% of the non-surgery group developed an obesity-related cancer, researchers found. About 0.8% of surgery patients and 1.4% of non-surgery people died from cancer.

Analysis showed that weight loss has a dose-dependent relationship to cancer risk — the more weight you lose, the lower your cancer risk, Aminian said.

Another study presented on Tuesday at the ASMBS meeting also found that bariatric surgery reduced the risk of colon cancer by 37%.

This study combined data from 13 previous studies on weight-loss surgery that followed more than 3.2 million patients for as long as 10 years, said researcher Dr. Michal Janik, a general and bariatric surgeon at the Military Institution of Aviation Medicine in Warsaw, Poland.

Previous studies had suggested that bariatric surgery might increase the risk of colon cancer, but this large-scale analysis found the opposite was true, Janik said.

“We found something that was contrary to those earlier studies, because we performed a very detailed analysis of all studies,” Janik said.

Bariatric surgery is currently the only way to achieve the sort of weight loss needed to prevent cancer, Aminian and his colleagues argue.

Clinical trials have shown that intensive diet and exercise can lead to an average weight loss of nearly 9% within a year, they said in background notes.

Pounds need to stay off

The researchers agreed that the weight needs to stay off for the cancer protection to keep steady, and argued that at this point weight-loss surgery provides the most durable benefits.

However, Aminian noted that new drugs under development might soon help people drop enough pounds to provide similar protection against cancer.

“There are new medications in the pipeline that can help patients get to that 20% to 25% weight loss,” Aminian said. “And if those medications become available to patients and accessible to the public, then we should see the same results.”

Fat cells promote many risk factors for different types of cancer, Miller said, including systemic inflammation and elevated levels of the hormones insulin and estrogen.

“We believe that bariatric surgery through weight loss is indirectly affecting all these different mechanisms, thus decreasing the incidence of cancer and reducing the risk of cancer, Miller said.

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more on obesity and cancer.

SOURCES: Ali Aminian, MD, director, Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio; Shanu Kothari, MD, president, American Society for Metabolic and Bariatric Surgery; Jared Miller, MD, general and bariatric surgeon, Gundersen Lutheran Health System, La Crosse, Wis.; Michal Janik, MD, general and bariatric surgeon, Military Institution of Aviation Medicine, Warsaw, Poland; Journal of the American Medical Association, June 3, 2022

Source


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SOURCES:

Addiction: “Rate of Detoxification Service Use and its Impact Among a Cohort of Supervised Injecting Facility Users.”

American Addiction Centers: “Suboxone Withdrawal: Symptoms, Timeline & Detox Treatment.”

Caleb Blaschke, Sioux Falls, SD.

Canadian Mental Health Association: “Harm Reduction.”

City of New York: “Overdose Prevention Centers Averted 59 Overdoses in First Three Weeks of Operation.”

Cleveland Clinic: “Is Naloxone (Narcan) Sold Over-the-Counter?”

Consumer Federation of America: “Traditional Savings Accounts: Are They Still Popular?”

Drug and Alcohol Dependence: “Socioeconomic Marginalization and Opioid-Related Overdose: A Systematic Review,” “Supervised Injection Services: What Has Been Demonstrated? A Systematic Literature Review.”

Eric R., Find Addiction Rehabs, Boca Raton, FL.

Federal Deposit Insurance Corporation: “How America Banks: Household Use of Banking and Financial Services.”

FXB Center for Health & Human Rights at Harvard University: “From the War on Drugs to Harm Reduction: Imagining a Just Overdose Crisis Response.”

Harm Reduction Journal: “Harm Reduction in the USA: The Research Perspective and an Archive to David Purchase.”

Health & Justice: “Pre-Arrest Diversion to Addiction Treatment by Law Enforcement: Protocol for the Community-Level Policing Initiative to Reduce Addiction-Related Harm, Including Crime.”

Hopkins Bloomberg Public Health: “5 Things to Know About Overdose Prevention Sites.”

International Journal of Drug Policy: “Barriers to Naloxone Use and Acceptance among Opioid Users, First Responders, and Emergency Department Providers in New Hampshire, USA.”

Journal of Addictive Disease: “Stigma from the Viewpoint of the Patient.”

Journal of Behavioral Health Services & Research: “Provider Views of Harm Reduction Versus Abstinence Policies Within Homeless Services for Dually Diagnosed Adults.”

Journal of Healthcare for the Poor and Underserved: “The Data Dilemma in Family Homelessness.”

The Lancet: “Reduction in Overdose Mortality after the Opening of North America’s First Medically Supervised Safer Injecting Facility: A Retrospective Population-Based Study.”

Letter signed by 14 U.S. Senators opposing supervised injections sites, sent to President Joseph R. Biden, Feb. 15, 2022.

NBC New York: “I-Team: Father Faults Judge for Son’s Heroin Overdose.”

The New York Times: “Nation’s First Supervised Drug-Injection Sites Open in New York.”

Social Science & Medicine: “Association between Homelessness and Opioid Overdose and Opioid-related Hospital Admissions/Emergency Department Visits.”

Substance Abuse and Mental Health Services Administration (SAMHSA): “Harm Reduction,” “Medication-Assisted Treatment (MAT),” “Naloxone.”

Washington State Department of Health: “Fentanyl Test Strip Project.”

The White House: “White House Releases Model Law to Help States Ensure Access to “Safe, Effective, and Cost-Saving” Syringe Services Programs.”

University of Southern California Department of Nursing: “Supervised Injection Sites are Coming to the United States: Here’s What You Should Know.”

U.S. Department of Health and Human Services: “Medication-Assisted Treatment for Opioid Addiction.”

U.S. Department of Housing and Urban Development: “Homelessness Increasing Even Prior to COVID-19 Pandemic.”

U.S. Government Accountability Office: “Drug Misuse: Most States Have Good Samaritan Laws and Research Indicates They May Have Positive Effects.”

Source


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Fun in the sun should always start with sunscreen, especially if you have lupus. Since the sun can cause lupus to flare up, either right away or days later, it’s extra important to protect your skin.

“The best thing with lupus is to kind of go into vampire mode. Never let the sun touch your skin, even for a second,” says Steven Daveluy, MD, FAAD, associate professor and program director of dermatology at Wayne State University.

Sunscreen can go a long way in protecting your skin. Here’s what to consider so you can choose the right sunscreen and enjoy your time outdoors.

There are two main types of sunscreen: physical and chemical.

Physical Sunscreen

Physical sunscreens, which have titanium dioxide or zinc oxide as an active ingredient, block the sun’s harmful ultraviolet radiation from hitting your skin. These sunscreens will block the most amount of light from the skin, including UVA (which causes signs of aging), UVB (which causes skin cancer), and visible light.

“UVA tends to be the one that’s more of a problem for people with lupus,” Daveluy says.

Any sunscreen labeled “broad spectrum” will protect you from both UVA and UVB, but physical sunscreens, or sunblock, do this really well.

“The downside to them is that sometimes they can be more difficult to apply, so some of those physical sunscreens can be thicker or some can leave more of a white color on the skin,” says Lindsay Strowd, MD, FAAD, associate professor of dermatology at Wake Forest School of Medicine.

To avoid the ghostly look, you could try a tinted physical sunscreen, especially if you have darker skin. As a bonus, the iron used to create the tint actually adds sun protection.

Chemical Sunscreen

Chemical sunscreens work not by blocking the sun’s light, but by absorbing it. This type of sunscreen protects you from some UVA and most UVB, but not from visible light.

“The upside to chemical sunscreens is they can be much easier to apply,” Strowd says. “So sometimes they are a much thinner type of sunscreen and feel cosmetically nicer on the skin.”

Some sunscreens have a combination of physical and chemical sunscreen ingredients.

“The most important thing is finding a sunscreen that you are comfortable using every day. This often means trying out different sunscreens to see how they feel on your skin,” Daveluy says.

What SPF Is Best?

Shoot for sunscreen with an SPF of at least 45, but higher is better.

“We used to say SPF 30 was good. That was based on testing done in the lab,” Daveluy says. “But now we know that no one puts their sunscreen on as thick as they do when testing, so we’re not getting the same level of protection that they see in testing.”

Strowd usually recommends that her patients “shoot for a higher SPF sunscreen because that way if you don’t put it on quite as thick as they do when they test it, you’re still going to get a higher SPF rating than if you use a lower SPF sunscreen.”

Lotion, Stick, or Spray?

The method of applying sunscreen — lotion, stick, spray — doesn’t matter, but if you use a spray sunscreen be sure to rub it in. Strowd even suggests spraying your skin twice. This is because the spray doesn’t cover your skin evenly and it can be hard to tell where you’re covered. The bottom line for any method is to put it on, and put it on thick.

The bottom line, Strowd says: “Whichever one you feel like you’re going to be most consistent with applying is the one that I would prefer.”

Don’t forget your lips. You can wear lip balm with SPF or just put regular sunscreen on your lips. Daveluy advises avoiding lip balm without SPF because it can magnify the sun’s rays.

Make It a Habit

You should wear your sunscreen every day, regardless of the weather or the season.

Strowd says to put it on 10 or 15 minutes before you head outdoors. That gives your skin time to absorb it so you’ll be protected from the minute you step outside.

Even 5 or 10 minutes in the sun without protection can cause a lupus flare up. Think of it like brushing your teeth, Strowd says, something you do automatically.

Ultraviolet rays shine right through clouds. So you still need sunscreen on overcast days, and even when you’re in the car or indoors by a window.

“Glass filters some (ultraviolet rays) but it doesn’t filter all of it,” Strowd says. “So you have to be careful and make sure you’re protected even if you’re inside.”

Be sure to reapply sunscreen at least every 2 hours when you’re out in the sun. If you’re swimming, moving, or sweating you’ll need to reapply more often. But even if you’re not, the sun breaks down the sunscreen within 2 hours of being outside.

More tips from Strowd and Daveluy:

  • Keep a small bottle of sunscreen in your purse or backpack so you always have some on hand.
  • Don’t stash sunscreen in your car. If your car heats up, your sunscreen’s ingredients can break down and stop working.
  • Also use other ways of protecting your skin from the sun. Wear a wide-brimmed hat, look for shade or carry an umbrella for instant shade, and avoid outdoor activities between 10 a.m. and 4 p.m., when the sun is most intense.

“You can use the shadow rule if you aren’t sure,” Daveluy says. “If your shadow on the ground is longer than your height, the sun is low and less intense. But if your shadow is short, the sun is overhead and intense.”

Clothing with UPF protection is also another way to layer on protection. Strowd says, “It’s quite easy now to find high-neck, long-sleeve shirts that provide relatively high protection against the sun, but they’re still made in a way that makes them fairly breathable and relatively easy to wear even in the hot, sunny, summer weather.”

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Toasters and bathtubs, we are all warned as children, don’t mix. Yet in the late 19th century, if you were diagnosed with rheumatoid arthritis, there is a good chance you would have been led to a special hospital room and placed in an electrified tub connected to large batteries. Then the doctors would have flipped the power on.

These tubs were called galvanic baths. A little over a century ago, they were “pretty common in general hospitals,” says Iwan Morus, PhD, editor of The Oxford Illustrated History of Science and a history professor at Aberystwyth University in Wales.

Though there were skeptics, many saw the galvanic bath as a promising tool to treat nervous disorders and skin conditions caused by lupus. It was particularly used for joint problems like rheumatoid arthritis, a debilitating autoimmune disease first identified in 1800. An 1896 article on rheumatoid arthritis in The British Medical Journal claimed that “excellent results” had been achieved from the treatments, without “the slightest pain, shock or discomfort.”

At the time, advances in battery technology were making electricity widely accessible for the first time. Electricity was still thought of as an invisible fluid, and, to most people, it seemed almost miraculous, and the belief that it had healing properties became widespread. In Great Britain, thousands purchased batteries advertised as having healing properties. Even Charles Dickens owned an electrified water basin that he used to treat his knee pain. In the United States and Canada, fancy galvanic bath spas catered to a wealthy clientele.

A typical galvanic bath consisted of a single porcelain bathtub with electrodes placed near the patient’s head and feet, both connected by wires to external batteries. A variation called the Schnee four-cell bath had four smaller electrified basins, one to submerge each limb. The Schnee’s popularity stemmed from the fact that the patient could remain fully clothed during the treatment.

From our modern vantage point, an electrified bath sounds alarming, but their low voltages – and their lack of modern metal drains, which could provide grounding for electricity – meant that galvanic baths were relatively harmless. Patients would feel a twinge. At worst, they might faint.

The tubs took their name from the Italian scientist Luigi Galvani, an inspiration for Mary Shelly’s novel Frankenstein. Galvani discovered electricity’s role in the body by inadvertently shocking severed frog legs, causing them to move as if alive.

Galvani’s twitching frog legs led to a rudimentary understanding of the role of what was called “animal electricity” as the body’s messenger, passing commands from the brain to the limbs and vital organs. “There was a relatively common belief that the nerves were like telegraph wires, communicating information back and forth between body and brain,” says Morus. That is why electricity was seen as particularly useful in treating mental afflictions or joint problems like rheumatoid arthritis.

Another reason doctors turned to galvanic baths in the case of rheumatoid arthritis was that there were no effective treatments. Like so many autoimmune diseases, rheumatoid arthritis has never been well-understood. Its cause is still a mystery, and while there are effective treatments, there is still no known cure. Yet it is relatively common, affecting about 1 out of every 100 people. The symptoms can include severe chronic joint pain, bone erosion, and deformity, and it can even affect vital organs.

The lack of an effective cure has led to a long history of unorthodox treatments; so many that the former research chief of Britain’s Arthritis and Rheumatism Council, F. Dudley Hart, once wrote an “encyclopedia” of what he called “quack cures,” including wearing red flannel underwear and ingesting bee venom. Hart attributed the faith in such treatments to the fact that rheumatoid arthritis will sometimes go away on its own, leading patients to swear by the last method they tried.

Like many other rheumatoid arthritis treatments, the galvanic bath was eventually labeled as quackery and was abandoned by the medical community by the early 20th century.

But the electric bath may not have been as crazy as we once thought. A small, relatively recent study has shown that electricity may indeed be an effective treatment for rheumatoid arthritis, via implantable batteries about the size of a pill. The remote-controlled batteries emit electrical impulses that stimulate nerves. Researchers hope the stimulation will curtail the release of inflammation-causing proteins called cytokines, which they believe cause the most severe symptoms of the disease. Similar treatments have been used successfully for combating epilepsy, and a larger study of the electrical implants for rheumatoid arthritis is currently underway at the University of Washington.

Source


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