All posts by SRH Matters

Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe

Reproductive Health

Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe

2014-01-27

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The European Medicines Agency (EMA) — the European version of the U.S. Food and Drug Administration (FDA) — launched a broad review of whether body weight influences the ability of emergency contraceptives to prevent unintended pregnancies.

The agency recently required makers of the European version of Plan B, called Norlevo, to add an alert that the product may be less effective for overweight women. The move was spurred by a 2011 study that found that women with a body mass index (BMI) greater than 25 who used levonorgestrel, which prevents pregnancy by blocking the release of the egg from the ovary, inhibiting fertilization or changing the uterine lining to discourage pregnancy, were four times more likely to get pregnant than women with lower BMIs.

Now, based on that study and other data, the EMA is turning its attention to other emergency contraceptive measures that rely on hormones to prevent pregnancy. These include Norlevo, Levonelle/Postinor and Levodonna which all contain the hormone levonorgestrel. All the medications are available over the counter, and the agency is also studying one prescription-based medication called ellaOne that includes ulipristal acetate.

It’s unclear why emergency contraception could be less effective in overweight women, but the U.S. FDA is also reviewing existing data to determine if any changes in labeling or action is necessary. Calls to the FDA were not immediately returned.

Reproductive health experts say women who are concerned about whether their emergency contraceptive will prevent pregnancy should consider other birth control methods known to be more effective, like the IUD.

Why It’s Still a Big Deal If Your Teen Smokes Pot Read more: Pot Legalization: Why It’s Still a Big Deal If Your Teen Smokes POt

Behaviour

Why It’s Still a Big Deal If Your Teen Smokes Pot Read more: Pot Legalization: Why It’s Still a Big Deal If Your Teen Smokes POt

2014-01-24

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With each passing day, it seems, smoking pot becomes less and less stigmatized in our society.

In a much-buzzed-about piece in The New Yorker this week, President Obama suggested making pot legal in large part to correct the vast inequities that minorities face in terms of cannabis-related arrests and imprisonment. Besides, said the president, who was known to smoke his fair share of weed back in the day, “I don’t think it is more dangerous than alcohol” for the individual user.

Even the straight-laced Bill Gates recently announced his support of legalization. And this year’s Super Bowl has been dubbed the “Super Doobie Bowl,” a reference to the fact that the teams vying for the NFL championship, the Denver Broncos and Seattle Seahawks, hail from the two states that have legalized marijuana for recreational use. Mainstream websites are circulating marijuana-laced game-day snack recipes. It won’t be long before Martha Stewart comes up with her own pot-brownie concoction.

With all of this hanging in the air, it’s obvious we parents should be talking to our kids about smoking dope. But what are we supposed to tell them when it’s clear that “just say no,” isn’t going to cut it?

After consulting with two researchers from Northwestern University’s Feinberg School of Medicine, I now know what I’m going to tell my own 16-year-old: Not so fast, buddy. Your brain simply isn’t ready for you to start using pot.

“Adolescence is a sensitive time for brain development,” says Matthew J. Smith, a research assistant professor of psychiatry and behavioral sciences. “If a teen introduces the abuse of marijuana at that point in their life, it could have consequences for their ability to problem solve, for their memory and for critical thinking in general.”

Unfortunately, this crucial message is getting lost in the pro-legalization fervor. Use of pot among adolescents, which had declined from the late 1990s through the mid-to-late 2000s, is again on the rise, according to the National Institute on Drug Abuse. One likely reason: “The percentage of high-schoolers who see great risk from being regular marijuana users has dropped,” over time the agency points out.

That perception, however, is all wrong. In a study published last month, Smith and his colleagues found that teens who smoked a lot of pot had abnormal changes in their brain structures related to working memory—a predictor of weak academic performance and impaired everyday functioning—and that they did poorly on memory-related tasks.

While the study focused on heavy marijuana users—specifically, those who indulged daily for about three years—one of its most crucial findings related not to the amount of pot an adolescent smoked, but when he or she started: The earlier the drug was taken up, the worse the effects on the brain.

“Marijuana is the ideal compound to screw up everything for a kid,” says Hans Breiter, a professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine, and a senior author of the study. “If you’re an athlete, a chess player, a debater or an artist, you need working memory, and marijuana hurts the brain circuitry.”

Breiter, who himself has four children 11 to 21, adds: “The more I study marijuana, the more I wonder if we should have legislation banning the use of it for everyone under 30.”

The study, which appeared in the journal Schizophrenia Bulletin, sought to distinguish the effects of daily marijuana use on the adolescent brain from the effects of schizophrenia on the deep regions of the brain that are necessary for working memory.

Although the researchers were not equating pot smokers with those suffering from schizophrenia—a chronic, disabling brain disorder—they did find parallels in one respect. “Schizophrenia is a very disruptive illness on working memory, and using marijuana produced many similar effects to schizophrenia,” Breiter says.

The scientists noted that these effects were still apparent two years after their subjects had stopped using marijuana, but more research will be needed to determine whether the neurological abnormalities in heavy teen pot smokers are permanent.

In the end, you can’t blame kids if they’ve come to believe that smoking pot is not that big a deal. The cultural cues are very strong. President Obama said he tries to fight against this by telling his own two teenage daughters: “It’s a bad idea, a waste of time, not very healthy.”

But I think that parents have an opportunity—and an obligation—to be even more pointed with our children by saying to them: “If you’re tempted to smoke pot, please hold off as long as you possibly can. Your beautiful brain is still developing.”

@ranhoder

Randye Hoder writes about the intersection of family, politics and culture. Her articles have also appeared in the New York Times, the Los Angeles Times, the Wall Street Journal, and Slate. You can follow her on Twitter @ranhoder.

What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things) Read more: Understanding Why We Dream

Psycological Health

What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things) Read more: Understanding Why We Dream

2014-01-15

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Do they predict the future or simply rehash the past? By figuring out why we dream, researchers are hoping to nail down what the nightly cavalcade of images and events means.

Ever since Sigmund Freud published his controversial theories about the meaning of dreams in 1900, we have been fascinated with the jumble of experiences we seem to live through while we slumber. Freud was convinced that dreams represent some unfulfilled desires or hoped-for wishes, while later investigators saw a more pragmatic quality to them, as reflection of waking life. None of these theories, however, have had the benefit of much in the way of solid, objective data.

At least, until now. Two new developments in research — brain imaging and big data — may offer some stronger answers. More detailed and timely snapshots of the brain at work, combined with the information researchers amassed about dreams from experiments in sleep labs, is gradually peeling away the mystery of dreams, and revealing their meaning.

From a strictly biological standpoint, scientists have learned much about the physiological process of dreaming, which occurs primarily in REM sleep. “During dreaming,” says Patrick McNamara, a neurologist at Boston University School of Medicine and the graduate school of Northcentral University in Prescott Valley, Ariz., “the limbic part of the brain—the emotional part—gets highly activated while the dorsal lateral prefrontal cortex, the executive part of the brain, is under-activated. So the kind of cognitions we experience during dreams are highly emotional, visually vivid, but often illogical, disconnected and sometimes bizarre.” That suggests that our dreams may have some role in emotional stability.

That does not necessarily mean, most dream researchers believe, that dreams are random expressions of emotion or devoid of some intellectual meaning. While some scientists maintain that dream patterns are strictly the result of how different neurons in the brain are firing, Deirdre Barrett, a psychologist and dream researcher at Harvard Medical School, believes they represent something more.  “I think it’s a fallacy that knowing brain action negates a subjective, psychological meaning any more than it does for waking thought. I think dreams are thinking in a different biochemical state.”

Defining that state, not to mention understanding the rules under which that universe operates, however, is a challenge. It may represent a complex interplay between emotional and cognitive information, says McNamara, so that dreams serve to help our brains process emotional memories and integrate them into our long-term memories. And because traumatic events are associated with higher levels of the stress hormone cortisol, they can cause nightmares. Researchers believe that excessive amounts of cortisol can impair the interaction between the hippocampus and the amygdala, the two main brain systems that integrate memory. “The memories don’t get integrated,” he says, “but just sit around. In post traumatic stress disorder, they get re-experienced over and over.”

In fact, from sleep studies in which people were exposed to images, learning tasks or other experiences immediately before they dozed off and then examined when they awakened, many scientists believe that dreams can help us rehearse for challenges or threats we anticipate—emotionally, cognitively and even physiologically. In our dreams we may try out different scenarios to deal with what’s coming up. Although much of the evidence for this is anecdotal, McNamara says, someone practicing piano or playing video games in waking life may start to do the same while dreaming. People solving a puzzle or studying a foreign language, he adds, can have breakthroughs with dreams that go beyond the perceptions that simply taking a break from the problem can produce. 

And now, Barrett says, brain imaging holds the promise of being able to help scientists “see” what until now could only be reported by subjective, possibly inaccurately recalled, dream accounts. For example, in research with rats trained to run through mazes to get rewards, investigators were able to record neuron activity in sleeping rats and determined that the rats were running the same mazes in their dreams.

In other experiments with humans, scientists monitored volunteers who slept inside an fMRI scanner while hooked up to EEG electrodes that measured brain wave activity. When the EEG indicated they were dreaming, the participants were awakened and asked what images they had seen in their dreams. The investigators were later able to match certain patterns of brain activity to certain images for each person.  “There’s a crude correspondence between the brain scan and the image. “From the scan, you can guess it’s an animal with four legs,” says Barrett. Despite the primitive state of this dream decoding, the ability to actually glean content from a dream is getting closer.

Mining big data bases of reported dreams holds another kind of promise. Until now, researchers have been working on relatively small samples of dream accounts, usually fewer than 200 per study. But new dream websites and smartphone apps like DreamBoard and Dreamscloud are encouraging thousands of people to report their dreams into larger repositories so researchers can finally answer their most urgent questions.  McNamara, for example, is excited to study dreams from different countries to see whether there are cultural differences in what people’s brains do when they aren’t awake.

The data bases also provide an opportunity to investigate the intriguing but under-studied realm of sex dreams. Until recently, says McNamara, they represented only 10% of reported dreams, likely because people are not eager to share this type of content with researchers in white lab coats. But self-reporting via the apps and websites, despite its potential biases, may provide more information on these types of dreams. “This is a wide open area crying for investigation,” he says.

McNamara is also eager to study individuals’ dreams over time to observe differences and changes in emotional tone, colors, words and other significant patterns and connect these to events in their lives. That would bring him closer to answering whether dreams are, in fact, prophetic — it might be possible, for example, that certain kinds of dreams precede getting the flu, or that other other dreams are more associated with happier events.

Such investigations could also reveal more about less welcome dreams, such as nightmares, and potentially lead to ways to control or avoid them. Barrett plans to mine the new database to study how often nightmares occur, and how they relate to an individual’s trauma or a family history of anxiety disorder. One of her first projects will involve the dream data from DreamBoard.com, which has accumulated 165,000 dreams over the last two years. Because Dreamboard has coded the dreams by the gender, colors, emotions (joy, anxiety, anger) and the number and categories of people in a dream, Barrett says she can identify basic patterns.

We already know, she says, that women dream equally about men and women while men’s dreams are two-thirds populated by men. Research so far also shows that men’s dreams may show slightly more anger and physical aggression while women’s display a bit more sadness and verbal hostility. Interpreting what these differences mean, however, will require deeper studies.

What’s been discovered so far, however, suggests that such studies could reveal an enormous amount about what role dreams play in our lives, and how important they are for biological, psychological or social reasons. With this research, McNamara believes, scientists can find out if what shrinks have been saying for years is true — that reflecting on our dreams is useful and can give us insight into ourselves. Psychologists say so, and many people think so. But this research, he says, gives us the potential to know.
Read more: Understanding Why We Dream | TIME.com http://healthland.time.com/2014/01/14/what-dreams-are-made-of-understanding-why-we-dream-about-sex-and-other-things/#ixzz2qRNr8LsX

Diet Soda Doesn’t Help You Lose Weight

Behaviour

Diet Soda Doesn’t Help You Lose Weight

2013-12-10

Sales of diet soda beverages is the only number on the decline

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Diet soda is falling out of favor. According to new research from Wells Fargo, low-calorie and zero-calorie soda sales slipped about 7% over the past year. Regular soda has fallen just over 2%.

The reason remains a mystery, but perhaps folks are realizing that the benefits of drinking diet soda are just not there. At least, if you’re trying to shed pounds.

Several studies in the past couple of years have torn holes in the theory that zero-calorie sodas mean zero weight gain. Indeed, research presented at the American Diabetes Association’s (ADA) Scientific Sessions in 2011 showed the opposite is true—diet sodas can actually contribute to weight gain.

(MORE: Studies: Why Diet Sodas Are No Benefit to Dieters)

How? There are a few theories. First, scientists speculate that artificial sweeteners fool more than just your palate; they also fool your brain. When you taste something sweet, your body naturally expects a calorie-load that diet beverages don’t deliver. As a reaction, the metabolic system may start converting the sugar that’s already circulating in the blood into fat, on the assumption that more has just come in that can be used as energy. In the alternative, the body may go in the other direction, burning though the circulating sugar so that the incoming soda doesn’t leave you with too much. But since the soda has no sugar at all, you wind up with a net loss—which may lead to a craving for candy or some other high-sugar snack.

It’s also possible that the lack of calories causes diet-soda drinkers to overeat later for psychological reasons. They either feel unsatisfied and eat more to make up for it, or they think they saved on calories earlier by opting for diet soda—a handy justification for eating more.

The plunging sales numbers may suggest that consumers are catching wise to all of this. The solution: it’s better to kick the soda habit and stick to water.

(No) Condom Culture: Why Teens Aren’t Practicing Safe Sex

Sexual Health

(No) Condom Culture: Why Teens Aren’t Practicing Safe Sex

2013-12-04

By Katy Steinmetz

There were certain things that the 1990s just did better — including getting the word out about the dangers of unprotected sex.

According to the Centers for Disease Control and Prevention (CDC), the percentage of American students using condoms hit its peak at around 60% a decade ago, and has stalled since then, even declining among some demographics. A recent study released by the Sex Information and Education Council of Canada found that nearly 50% of sexually active college students aren’t using condoms. Other reports have found that while teenagers are likely to use a condom the first time they have sex, their behavior becomes inconsistent after that.

Health officials from Oregon to Georgia are ringing alarm bells about rising rates of sexually transmitted diseases, worried that kids aren’t getting the message. Sex education is more robust than it was for previous generations, but a 2012 Guttmacher Institute report revealed that while nearly 90% of high schools are teaching students about abstinence and STDs, fewer than 60% are providing lessons about contraception methods.

The CDC estimates that half of new STD infections occur among young people. Americans ages 15 to 24 contract chlamydia and gonorrhea at four times the rate of the general population, and those in their early 20s have the highest reported cases of syphilis and HIV. Young men and women are more likely than older people to report having no sex in the past year, yet those who are having sex are more likely to have multiple partners, which increases the risk of STDs.

“We need to do better as a nation,” says Laura Kann, an expert in youth risk behaviors at the CDC. “Far too many kids in this country continue to be infected with HIV and continue to be at risk.”

When condom-usage rates were on the upswing in the ’90s, America was in the midst of an AIDS epidemic that was claiming young lives daily. The fear of the disease gave heft to safe-sex campaigns. Today, public-health officials are partly a victim of their own success; contemporary teenagers grew up after the terror had subsided, thanks to antiviral drugs and those messages that helped bring infection rates down. “The young people today know HIV as a manageable, chronic disease,” Kann says. “It’s not something that can kill you in their eyes. So that leads, most likely, to an attitude that it’s not something that they have to protect themselves from.”

In Oregon’s Lane County, senior health official Patrick Luedtke is in the midst of confronting an ongoing gonorrhea outbreak, with rates jumping as much as 40% in recent years. Like Kann, he believes complacency is a large part of the problem. “People don’t have the fear of death from sex like they had 15 years ago,” he says. “For the teenagers, that fear is gone, and people are not practicing safe sex as much as they used to.”

Other research collected by the CDC shows that some schools aren’t hammering away at the safe-sex lessons like they once did. In Alabama, Alaska and Florida, for instance, fewer public schools are teaching teenagers how to obtain condoms and why it’s important to use condoms. “Schools have competing health issues that they’re asked to deal with, things like tobacco use, bullying, the obesity epidemic. It’s been hard to keep attention focused on HIV and STD prevention,” Kann says. “This complacency issue [is not] unique to just youth themselves.” Last week, the American Academy of Pediatrics issued a policy statement supporting better access to condoms for teenagers, saying schools are still hesitant to provide them because of an enduring fear that access to condoms will make kids have more sex.

Public institutions beyond schools have had setbacks too. Budget cuts in Oregon meant that Luedtke’s county closed its STD clinic. “People don’t stop having sex because of the bad economy,” he says. “Where are the resources?”

Even in places where there’s money and free condoms to go around, health departments haven’t necessarily seen safe sex go viral. New York City health officials are reporting that only 1 in 3 adult residents uses protection, despite years of PSAs and prophylactic handouts under Mayor Michael Bloomberg. While condom use among young people in New York City is slightly up since 2009, that puts it on par with the stagnant nationwide average.

Kann says there are broader societal factors at work too, ones that disproportionately affect African-American youth. Compared with the population as a whole, their parents are less educated and have lower incomes, both factors that have been linked to sexually risky behaviors, including having unprotected sex. Adolescents who postpone sex have parents who are more educated. Lower incomes, meanwhile, are associated with factors like parents working multiple jobs, which can mean kids are left home alone without a watchful eye to factor into their decisionmaking.

Some research has suggested that sexually active Americans simply assume their partner is free of STDs, and an infected partner may be unaware, given that diseases like “silent” chlamydia often don’t have obvious symptoms. And there is a perception — if not a diehard belief — that using condoms makes sex less pleasurable. That’s why Bill Gates challenged designers earlier this year to create a better-feeling condom that sexually active people might be more likely to use.

While it’s hardly a sexy, revolutionary proposition like remaking the condom, Kann says the key to driving condom use higher is more education. Canada’s survey, for instance, was revealing about how relatively unimportant the students considered STDs. Those who used condoms were much more likely to cite pregnancy than STDs as their main concern; 54% said their single motivation for using protection was birth control, while just 6% cited STDs as their sole reason.

“It’s really critical for kids to know about their risk,” Kann says. “They need to know how to get tested. They need to know how to prevent infection. And we can’t do that alone here at CDC. We’re going to need action not only by this agency but also by parents, by schools and communities.”

You Can’t Be Fit and Fat

Behaviour

You Can’t Be Fit and Fat

2013-12-03

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It’s okay to be heavy, as long as you don’t have diabetes or hypertension–right? Not so fast, says the latest research.

There are always exceptions to the rule, and that’s true of health issues too. While the bulk of studies warn about the dangers — to the heart, liver, kidneys and other body systems — of gaining weight, a small number of trials suggested that some overweight or obese individuals may be as healthy as their normal weight counterparts, since they had normal blood pressure, no diabetes and relatively stable cholesterol levels. In fact, one study found that overweight individuals (but not obese people) tended to live longer than those of normal weight.

But in a comprehensive review of studies dating back to the 1950s, scientists contradict that idea, with evidence that it’s not possible to be both overweight and healthy.

The researchers, from Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto, Canada, found that people who tipped the scales at above their recommended body mass index (BMI) but did not have abnormal cholesterol or blood pressure, for example, still had a higher risk of dying from heart disease over an average of about 10 years compared to metabolically healthy individuals within normal weight ranges. In their analysis, published in Annals of Internal Medicine, the researchers separated individuals in the previous studies into six groups: normal weight and healthy, normal weight and unhealthy, overweight and healthy, overweight and unhealthy, obese and healthy, and obese and unhealthy. Their results showed that regardless of the person’s BMI, an unhealthy metabolic state — such as having hypertension, diabetes or high cholesterol levels — was consistently linked to an increased risk of dying during the study period or having a heart event. And contrary to previous studies that suggested that heavier people with normal metabolic readings could have “benign obesity” or “metabolically healthy obesity,” the team also reported that metabolically healthy obese participants had a higher risk of dying earlier or having heart-related problems than those who were normal weight and also metabolically healthy.

Why did previous studies suggest that people could be fit and fat? According to the current study’s lead author, Dr. Caroline Kramer, the discrepancy likely has to do with how the various studies were set up. For instance, some large studies only compared weight and the risk of adverse events instead of looking closely at people’s metabolic health. So some of the apparently healthy but overweight or obese individuals might have had signs of diabetes or hypertension or high cholesterol that simply weren’t recorded in the study. Other trials compared healthy obese people to unhealthy obese people, instead of comparing them to people of normal or healthy weights, and other studies relied on small groups of participants who were only studied over short time periods.

“This concept of healthy obesity came in the last 10 years, and it compares people who are obese but metabolically healthy to only metabolically unhealthy overweight people,” says Dr. Kramer. ”Some studies report that if you are obese but metabolically healthy, you are protected in a way. We don’t think that that is true. And I don’t think it will come as much of a surprise.”

But since obesity has different effects on the body for different people, researchers are still investigating how weight gain and its health effects may vary among people whose obesity is due primarily to things such as genetics and environmental exposures as opposed to unhealthy diets and lack of physical activity. Even the studies in the current meta-analysis, for example, did not all include follow-up with the participants, so the final mortality and heart disease rates may be slightly higher or lower than they should be. But for now, the advice about maintaining a healthy weight in order to avoid premature death and disease seems sound — there may not be a way to heavy and healthy at the same time.

Want More Tolerant Kids? Keep Them Away from the TV Read more: TV makes kids less tolerant

Behaviour

Want More Tolerant Kids? Keep Them Away from the TV Read more: TV makes kids less tolerant

2013-11-26

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tv-300x200

Too much time in front of the television can blunt young children’s ability to accept and understand others, says the latest research.

Theory of mind is something that children typically develop during the preschool years — it’s the ability to start teasing apart individual mental states, like beliefs, intents  desires, and pretending, and understand that others may not have the same views. Child development experts say that this ability is critical for social development and that without it, it’s difficult for children to understand morality and recognize deception. If it’s not fully developed, for example, a child may think that everyone prefers a cookie over a carrot because that’s his personal preference.

How does television, with its depictions of fantasy worlds and reality, influence such development? To find out, researchers from the Ohio State University School of Communication studied the relationship between preschoolers’ TV viewing and their grasp on mental states.

The team interviewed the parents of 107 children between ages three years to six years old about how many hours a television was left on in the house, regardless of whether anyone was watching it, during three time periods on an average weekday and during an average weekend. The parents were also asked about whether the kids had TVs in their bedroom — 20% did.

The children were then given a variety of tasks that tested theory of mind, such as showing them a photo of a woman they named Mrs. Jones. The researchers told the children it was snack time, and that when given a choice between cookies and carrots, Mrs. Jones preferred whichever option the child did not. The researchers would then ask the child what snack Mrs. Jones would choose, to see if the child understood differing desires.

Even after accounting for differences based on the children’s age and socioeconomic status, the researchers found that kids in homes with more background TV and who had TVs in their bedrooms had lower understanding of differing mental states. According to the study authors, previous studies showed that television did not help kids to develop an appreciation for how people might have different views and beliefs. Books, on the other hand, could nurture such distinctions, since they often include explanations of how a person is feeling. Viewing a television scene, however, may not be as useful for gleaning what a person is thinking or feeling. Kids can learn and understand mental perspectives from a face-to-face conversation, but it’s harder for them to comprehend them when observing a two-dimensional scene.

It wasn’t simply the medium of television that blunted this ability. The preschoolers whose parents who watched TV with their them and talked about what they saw performed better on theory of mind assessments than those whose parents didn’t discuss the content.”Other research has found that parent-child communication in general is related to more advanced theory of mind, so that might be one explanation for our finding,” says lead study author Amy I. Nathanson, an associate professor at Ohio State, in an email response to TIME. “When parents talk with their children, they might discuss people’s thoughts, beliefs, intentions, goals — and they might use the terms “know,” “think,” etc. Exposure to these kinds of conversations helps children understand that other people have unique mental states that drive their behaviors.”

The findings suggest that watching television with young children may help them to understand and become more tolerant of views and beliefs that are different from their own, says Nathanson, and that could have implications for how they interact with friends, peers and colleagues as they get older.

Morning-After Pill May Not Work For Women Over 176 Pounds Read more:

Reproductive Health

Morning-After Pill May Not Work For Women Over 176 Pounds Read more:

Widespread implications if true

A European company that makes an emergency contraceptive identical to the morning-after Plan B pill is set to warn consumers that the drug is completely ineffective for women over 176 pounds, and begins to lose effectiveness after 165 pounds, Mother Jones reports.

The European drug, Norlevo, will be repackaged to reflect the weight limits, according to the report, which could carry significant implications for American women if true and if also applicable to morning-after pills in the U.S. Norlevo is chemically identical to many of the most popular emergency contraceptive brands used in the U.S., including Plan B One-Step, Next Choice One-Dose, and My Way. American manufacturer of emergency contraceptives didn’t comment to Mother Jones, and the FDA has yet to weigh in on the matter.

According to weight data from the Centers for Disease Control and Prevention, the average American woman weighs 166 pounds, and the average non-Hispanic black woman between 20 and 39 weighs about 186 lbs. If the European manufacturer is correct, morning-after pills could be ineffective for many American women.

Plan B One-Step is the only emergency contraceptive available over-the-counter to women of all ages. Norlevo packages will include a pamphlet summarizing the new discovery.

Is Your Teen a Night Owl? That Could Explain His Poor Grades Read more: Is Your Teen a Night Owl? That Could Explain His Poor Grades

Behaviour

Is Your Teen a Night Owl? That Could Explain His Poor Grades Read more: Is Your Teen a Night Owl? That Could Explain His Poor Grades

2013-11-19

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Staying up late is almost a rite of passage for teens, but night owl students could be paying the price with lower grades years after high school.

There’s plenty of research showing that the sleep-wake cycle of adolescents is about two hours behind that of pre-pubescent children, which means they are more likely to wake up later in the morning and go to bed later at night. And that also means they’re not well-timed with the school clock, either. But newly published research reveals that this mismatch may have lasting implications that dog high schoolers into their college years.

The study by University of California Berkeley researchers, published in the Journal of Adolescent Health, compared how the different sleep habits of 2700 teenagers, aged 13 to 18, affected their academic and emotional development. They found that teens who stayed up later than 11:30 pm on school nights — which included 30% of the study subjects — fared worse than early-to-bed kids, and that these consequences lingered six to eight years later, even into college.

Younger students, aged 14-16, suffered both academically and emotionally, says the study’s lead author, Lauren Asarnow, a doctoral student in clinical psychology at UC Berkeley. They had worse cumulative GPA’s at graduation and more emotional distress, as measured by questionnaires post-graduation. The GPAs of the 16-18-year-olds didn’t suffer as much, possibly because they were more used to being sleep-deprived. However, they were more emotionally troubled than their early rising counterparts in college and beyond. They were more likely to report they were “sad,” “down, or “blue,” and said they cried frequently, or showed other symptoms of depression. “It is really important,” Asarnow says, “to get our teens to bed earlier and to start young.”

Why do some teens stay up so late, even when they could go to sleep earlier? Their internal clocks certainly play a role in setting their sleep and wake cycles. But adolescents may also fail to realize how sleep deprivation affects them, physically and emotionally. And factors like parental monitoring, their dependence on technology, and academic and social pressures, which tend to escalate during middle school and high school also contribute.

But, says Asarnow, “The good news is that sleep behavior is highly modifiable with the right support.”

One controversial strategy is to stop fighting sleepy teens in the classroom and simply adjust their school schedules to start later in the morning. While a few pioneering school districts have tried this approach, and others are studying it, it’s still primarily up to parents to come up with better ways of bringing bedtimes in line with current school realities. Shelby Harris, director of the Behavioral Sleep Medicine Program at Montefiore Medical Center in New York, says, “This study highlights in even more depth the necessity to screen for school year bed time preferences in adolescents.” In order to make the right intervention, she says, it’s important understand why teens stay up so late. While nearly 70% of those in the study went to bed by 11:30pm, about 30% simply couldn’t get to sleep at that hour. Some, says Asarnow, may be the victims of their circadian clocks, while others just more seduced by their smartphones and late night activities, or not instructed enough by their parents to put their computers and phones away when it’s time for bed.

Whatever the reason, Asarnow offers these tips from Berkley’s sleep coaches to help night owl teens get more shut-eye:

1) Develop a wind-down routine that includes things like meditation or yoga

2) Start dimming the lights one to two hours before bedtime

3) Make the bedroom a technology-free zone, from 30 minutes to an hour before sleep time

4) Create weekend curfews that are an hour or less later than weekday bedtimes to avoid  “social jetlag,” which Asarnow likens to flying from New York to San Francisco every week.

“Even though kids may squawk about these rules,” says Carole Lieberman, a psychiatrist and author of Coping with Terrorism: Dreams Interrupted, “they are really comforted by knowing that their parents care enough to monitor them.”

Getting them to comply with better sleep habits may require some negotiation, says Asarnow. One method that works involves asking teens to pay attention to—and to write down—how they feel on a week when they are sleep-deprived and what consequences they suffer. Referring back to that may help them see the value of getting enough sleep — and going to bed on time. “You really don’t want to feel that way even for a week,” Asarnow says. “So, as you become aware, you start to value sleep more and more.” And that, as her findings show, could have lasting benefits.

Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa Read more: Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa

Reproductive Health

Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa Read more: Why It Takes Teens Equipped With Condoms to Encourage Family Planning in Africa

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Ethiopia has over 77 million inhabitants, and is considered one of the poorer countries in Africa. But this year, it’s playing host to the annual International Family Planning Conference in its capital, Addis Ababa.

The conference showcases the fact that despite Ethiopia’s high poverty rate and political intrusions on free speech, it has one of the most progressive family planning policies in Africa. And that success is serving as a model, not only for other developing nations such as Rwanda and Malawi, but for developed ones as well.

Economically, family planning is critical for a country’s stability — by protecting women from unwanted pregnancies that can contribute to high maternal and child mortality rates, these programs also allow mothers to enter the work force, and empower them to contribute to their local economy. Family planning is a public health term for essentially means controlling the number of births a woman has, and spacing those births. The Bill and Melinda Gates Foundation estimate that 1 in 4 women’s lives could be saved if there were global access to contraception, for example. And family planning isn’t just focused on mothers. The Foundation found that about 3.2 million children die each year from preventable diseases, many of which could be avoided if families had access to proper medical care, such as immunizations and antibiotics.

Such efforts have translated into measurable changes already. In Ethiopia, public health facilities offer all available contraceptive methods for free, and that has contributed to a rise in contraceptive use among women. The percentage of women of reproductive age using family planning has jumped from 8% in 2000, to 15% in 2005, to 29% in 2011.

For men, the Ethiopian government sends male mentors directly to people’s homes, to educate those who are skeptical or against the idea of their wives planning their births. Family planning is also introduced to boys in primary school. Despite these attempts, however, male involvement in family planning is still considered a challenge for countries in the developing world.

What has worked to improve the way couples start their families and enhance childhood health? Here’s what Ethiopia, Rwanda and Malawi are doing right to strengthen family planning.

Recognizing that young people are sexually active: While it seems obvious, acknowledging that teens are having sex is a challenge for some administrations, especially conservative ones. A typical 18-year-old Ethiopian woman is already married and likely expecting her first child, and most women have around five. However, community health centers in that country now include youth services and private offices to not only educate teens, but provide them with the protection they need to practice safe sex or delay sexual activity.

Appreciating that most teens may not feel comfortable talking about sex with adults, some NGOs and organizations have taken more unconventional approaches to getting contraceptives to young people. Planned Parenthood Federation of America, for instance, partners with Mary Joy Aid Through Development to train Ethiopian teens to become peer health promoters. As promoters, they talk to other teens about sexual health issues and distribute contraceptives like pills and condoms.

“I’ve been surprised by young men asking what methods of contraceptives they should use,” says Josephat Nyamwaya, a program officer for the Planned Parenthood Federation of America’s Africa office, where he trains youth in many African communities like his roots in Nairobi. “I tell them at their age, condoms, but that they also need to support their girlfriends in their contraceptive decisions.”

Making family planning the law: In Ethiopia’s constitution, access to family planning is cited as a woman’s right. Similarly, Rwanda’s government has legislated strong policies for family planning, and saw uptake of contraceptives jump by 10-fold. In 2000, only 4% of married women of reproductive age were using modern contraceptive methods, but the rate spiked to 45% by 2010, thanks to the country’s National Family Planning Program, which revamped access to contraceptives by stocking up all public health clinics, trained more providers in family planning education, and encouraged more women to give birth in their health facilities rather than at home.

And to persuade couples to space children apart, or use contraceptives, the government of Malawi has focused on improving child health services. Ironically, the more dire their circumstances, the more children parents are likely to have, because they know that many won’t survive their first years. “You cannot tell people not to have [more] children if they don’t feel secure that they will survive,’ says Malawi Minister of Health, Catherine Gotani Hara.

Giving family planning prominence in the country’s constitution is an important step toward acknowledging the critical role that reproductive health plays in a country’s economic stability. “These countries that are having success have really come out front with the recognition that if they were to solve this problem, they would solve so many others in their country. When you don’t have that leadership, it’s really difficult to move forward,” says Beth Fredrick, director of advance family planning for the Bill & Melinda Gates Institute at Johns Hopkins School of Public Health.

Bringing family planning services to the people: In both Ethiopia and Malawi, health extension workers are the key to reaching community members and getting them to clinics, as well as providing them with access to family planning programs. In Ethiopia, every community is allocated a hospital, a smaller health center, and a health post—which is staffed by two health extension workers. To supplement their efforts, the governments of these countries, using funds from the U.S. Agency for International Development (USAID), developed the Women’s Development Army. Members of the army, which include local community mothers who are trained by extension workers, go door to door, educating women about family planning, and hosting small gatherings of five community members to discuss reproductive health and answer questions in an informal setting.

‘I had my first [of five children] when I was just 15 and didn’t know about family planning,’ says Yenenesh Deresa, a member of the Women’s Development Army of Burayu, Ethiopia. “Now we sit around coffee and I talk to women about family planning. They’re empowered to make their own decisions and have safer pregnancies.”

Realizing the value of educating girls: If countries like Ethiopia, Rwanda and Malawi can lower their fertility rate, there’s a possibility that they could experience a bump in the economy, known as reaching the demographic dividend. That’s when younger generations join the workforce, and the greater proportion of this cohort that can find employment and live independently, the fewer dependents a country has. The first step toward achieving this condition is to lower fertility rates, but the younger generation needs to be educated to succeed in the workforce and there needs to be jobs available as well. While educating both genders is critical for such success, making sure that girls receive their degrees is especially important, since about a quarter of girls in low-resource countries drop out of school once they get pregnant.

“Empowerment [of women without education] is complicated. If girls need to be educated and attend schools, they need to be protected from unplanned pregnancies,” says First Lady of Ethiopia, Roman Tesfaye. “If we do not address these issues for women, it will be too challenging to become a middle income country.”

The push to protect women through health measures that will keep her in schools is slowly playing out even in rural communities. “You can see that things are changing now for women. I am a woman, and I am a leader here,” says Zewdtu Areda, head of health zone near Muka Turi, Ethiopia where she oversees health services offered for the area.

Offering all forms of birth control: Even in the U.S., research shows that when all methods of contraception are offered at low cost, women tend to pick long-acting reversible contraceptives (like implants and IUDs) over condoms and pills. Ethiopia, Rwanda and Malawi all provide contraceptives at no cost in public health clinics, and in line with prior research, women tend to choose the longer-acting, more discreet methods. However, clinics continue to offer the less popular methods in order to give women a full spectrum of choices, so women can decide for themselves which methods are best for them.

Changing cultural acceptance of family planning: Health clinic workers often hear the same requests from women — they want birth control, but don’t want their husbands to know they are using a contraceptive. Even with progressive policies, in countries like Ethiopia cultural stigmas against limiting reproduction remain. Health workers often meet young women in public, outside of the clinic, to give women birth control so her husband won’t know she visited a family planning program.

Changing cultural norms remains a challenge, but officials in Rwanda rely on community health workers to talk to men about why they should support family planning and about how planning their children can mean having healthier children and potentially fewer children to support. They even encourage male family planning methods such as vasectomies. When men come in with their wives to discuss family planning measures, health workers cite the surgery as an option, and encourage it alongside circumcision to prevent diseases like HIV although it’s still not a popular choice.

In Malawi, public health officials are enlisting the help of respected elders. A campaign headed by community chiefs that promotes family planning for couples, for example, includes the voice and perspective of men. “In the villages, we try to include as many men as possible. Men are very affected. In rural settings in Malawi, the breadwinner is usually the man. So if they cannot control their family, they’re the ones in trouble,” says Gotani Hara.

Public health officials are hopeful that the success of these initiatives in the developing world could spill over to industrialized nations as well — including the U.S. — that still struggle to reduce rates of sexually transmitted diseases, unplanned pregnancies and infant mortality. If there is one lesson to learn from these programs, it’s that the most successful strategies don’t come from doctors or government officials, but from peers — mothers, friends or respected elders –  who, it turns out, have the strongest voice when it comes to talking about sex and families.