Experiences at first sexual encounter impact risk of HIV and violence for women in Kenya

Adolescent girls and young women in Mombasa, Kenya are more likely to experience higher risks of HIV and gender-based violence when they are involved with sex work venues or have sexual experiences at a young age, suggests a study co-led by St. Michael’s Hospital and the University of Manitoba in Canada.

Published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), the research suggests that the conditions of a first sexual encounter, such as a woman’s age, the man’s age, use of condoms, and whether or not the encounter is consensual can be indicators of future risk of HIV infection and gender-based violence.

The research team found that adolescent girls and young women in Mombasa, Kenya, who are forced or coerced in their first sexual experience, are four to five times more likely to face ongoing gender-based violence throughout their lifetime. This research also showed that one in four participants experience gender-based violence after their first sexual experience, with 37.5 per cent prevalence amongst those involved in sex work.

Dr. Sharmistha Mishra, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and one of the study’s lead authors, and her team found that women who experienced their first sexual encounter before the age of 15 were two times more likely to be at risk of HIV acquisition. This was especially prevalent for those in the sex work industry and those who frequented sex work venues.

“We wanted to understand early risk and vulnerabilities for HIV because many prevention programs for key populations reach young sex workers several years after they have already experienced high-risk encounters,” Dr. Mishra said. “There are vulnerabilities that appear in the first few years of becoming sexually active and entering sex work more formally.”

The study’s results were drawn from a cross-sectional biological and behavioural survey conducted among sexually active adolescent girls and young women in Mombasa, Kenya. Community organizations, including past and current female sex workers working with the International Centre for Reproductive Health Kenya, identified participants at local sex work hotspots who then participated in interviews and HIV testing. Participants were referred to HIV prevention and care programs in Mombasa.

“Global health partnerships are strongest when there is a generation of new knowledge that informs programs led on the ground,” said Dr. Mishra, speaking of this work’s partnership between St. Michael’s Hospital, the University of Toronto, the University of Manitoba, and the National AIDS and STI Control Programme in Kenya.

This research is part of a multi-component study designed to count how many young women are involved in sex work in Mombasa, Kenya; measure early HIV risks through a representative survey; and conduct mathematical modelling to understand the impact of not accounting for the early risk many young women face.

“We’ve identified a need to provide HIV prevention and treatment plans for adolescent girls and young women at an earlier age,” Dr. Marissa Becker, associate professor at the University of Manitoba and co-lead of the study. “We hope the findings of this research can assist HIV prevention programs to adapt their strategies to reach vulnerable young women and teenaged girls at a younger age and intervene on risks early on.”

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Genetic Testing for Cancer Lacking for Women on Medicare: Study

FRIDAY, Aug. 17, 2018 — Testing for gene mutations linked to breast and ovarian cancer is rare among some Medicare patients who have the cancers and qualify for such tests, a new study finds.

Researchers analyzed data from 12 southeastern states between 2000 and 2014. Only 8 percent of 92 women who met Medicare criteria for BRCA1 and BRCA2 gene testing received it within five years of their cancer diagnosis, the study found.

No patients in Arkansas, Louisiana, Tennessee, Virginia and West Virginia got the tests, according to the study published Aug. 14 in the Journal of the American Medical Association.

Breast cancer patients with BRCA mutations are more likely to develop cancer in a second breast and are also at increased risk for ovarian cancer. Ovarian cancer patients with the gene changes are more likely to get breast cancer.

Relatives who also have the mutations also face a higher cancer risk, the Vanderbilt University Medical Center researchers said.

“Women who carry one of these mutations but don’t know their mutation status are not able to take advantage of preventive or early detection interventions that we have available, so they miss out on the opportunity to reduce their risk for these cancers and potentially reduce their overall mortality,” study author Amy Gross said in a university news release.

“They are also not able to inform family members who might be affected,” Gross added. She is an epidemiologist at the Vanderbilt Institute for Clinical and Translational Research in Nashville.

The study covered a broad age range: More than half of the women were under age 65 and qualified for Medicare due to disabilities.

The researchers said lack of patient interest and physician recommendations might explain the low genetic testing rate. None of the patients had received a doctor referral for genetic counseling, they added.

More information

The U.S. National Cancer Institute has more on BRCA gene mutations.

Posted: August 2018

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Counseling needed for pediatric patients with impaired fertility

(HealthDay)—Counseling about impaired fertility and sexual function for at-risk pediatric populations in developmentally appropriate ways is essential, according to a clinical report published in the August issue of Pediatrics.

Leena Nahata, M.D., from The Ohio State University in Columbus, and colleagues reviewed evidence and considerations for providers related to information sharing about impaired fertility and sexual function in pediatric patients attributable to congenital and acquired conditions or treatments.

The American Academy of Pediatrics recommends that providers assess risk, use an interdisciplinary team approach, and assess what the family knows, as well as what interventions have already been performed. Clinicians should also consider cultural factors, ethical issues, and other special circumstances that may impact communication in planning initial talking points for both the parents and patient on the basis of age or developmental stage. Recommended counseling considerations include allowing sufficient time; normalizing the stress of ambiguity, and acknowledging family stressors.

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Period Panties for Tweens Exist Now Thanks to Thinx

On Wednesday, Thinx — the creators of one of the most revolutionary menstrual hygiene products of the 21st century — announced they would be releasing a new line of period-proof underwear, Thinx (Btwn). But unlike traditional Thinx, which are marketed to menstruators in their reproductive years, Thinx (Btwn) are designed specifically for teens, preteens and young adults.  

In an emailed press release, Thinx CEO Maria Molland Selby explained the reasoning behind Thinx (Btwn): “First periods can be a scary and challenging time for both the parents and children. Our customers have repeatedly requested a product designed for young people with periods, and we listened. With the launch of THINX (BTWN), parents have the opportunity to help ease their pre-teen or teen into their first period by providing an easy to use and environmentally friendly solution to what can be an anxiety-ridden time.”

Image: Courtesy Of Thinx.
(Btwn) will offer teens and tweens the same comfort and protection as regular Thinx — thanks to a patented four-layer technology system that absorbs menstrual flow — but they will also give young adults something greater: peace of mind, especially since the first few years of having a period are irregular and inconsistent.

At best.

“Anyone with a period can think back to their early years and probably recall at least one, if not multiple, cringe-worthy stories that involved getting their period,” added Siobhan Lonergan, chief brand officer at Thinx. “Imagine if period underwear were available at that time and the embarrassment it would have saved.”

Thinx (Btwn) will be available for young people ages 9 through 16 years old, and the line — which will have three styles (shorty, bikini and brief); two colors, Beet Juice and Tidal Wave; and one print, Let’s Polka! — will go on sale on Sept. 6.

One pair will retail for $23, while the three-pair starter pack will retail for $59.

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Amputation May Not Be Best Option for Severe Circulation Problems

WEDNESDAY, Aug. 15, 2018 — Trying to restore blood flow may be better than amputation for patients with a serious leg circulation problem called critical limb ischemia, a new study contends.

Critical limb ischemia is the most severe form of peripheral artery disease (PAD) and can lead to ulcers, gangrene and amputation, the researchers said.

“Many patients who are diagnosed with critical limb ischemia are told amputation is their only option,” explained study author Dr. Jihad Mustapha.

“But amputation is associated with many poor outcomes, including shorter survival, depression and loss of independence,” he added.

Mustapha is a cardiologist who specializes in critical limb ischemia at the Advanced Cardiac & Vascular Amputation Prevention Centers in Grand Rapids, Mich.

His team reviewed the medical records of more than 72,000 Medicare patients diagnosed with primary critical limb ischemia between 2010 and 2015. Medicare is the primary payer for about 75 percent of critical limb ischemia-related hospitalizations in the United States, the researchers said.

Over four years, survival rates were 23 percent among patients who had amputations; 38 percent among those whose blood flow was restored by angioplasty; and 40 percent among those who had vein grafts to bypass blocked blood vessels.

During follow-up, annual health care costs were $55,700 for amputation; $49,700 for angioplasty; and $49,200 for vein grafts.

The findings were published Aug. 15 in the Journal of the American Heart Association.

“It’s important that people know that amputation is not the only solution, so always get a second opinion,” Mustapha said in a journal news release.

Another vascular expert said the findings prove that amputation isn’t the only alternative.

“The study successfully points out that those initially treated with minor or major amputation are in fact more likely to require another major amputation over the course of the next four years,” said Dr. Maja Zaric, an interventional cardiologist at Lenox Hill Hospital in New York City.

“The primary major amputation appears to be associated with shorter survival time, higher risk of subsequent major amputation, and higher health care costs” than trying to restore blood flow to the damaged limb, Zaric added.

Dr. Stephen Waldo is an assistant professor of cardiology at the University of Colorado School of Medicine, and Dr. Javier Valle is an interventional cardiologist at Denver Veterans Affairs Hospitals. They wrote an editorial that accompanied the study.

The editorial said that the study shows the “significant clinical and financial burden that critical limb ischemia poses to our health care system. Considerable efforts are still needed to raise disease awareness and establish data that can guide further medical and procedural management, given the critical importance of limb ischemia.”

More information

Vascular Cures has more on critical limb ischemia.

Posted: August 2018

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The Makeup Debate: What’s the Right Age For Kids to Wear Makeup?

My almost-8-year-old daughter has never mentioned makeup to me. She’s seen me apply it; she’s seen false lashes and an array of rainbow colors on her 16-year-old cousin’s face, and she’s seen several of her classmates turn up to the school disco with glossy lips and painted nails. 

I’ve always secretly been relieved that she’s shown no interest in makeup, even when so many of her peers do. Not because I want her to stay a baby forever, but because I don’t want her to try to grow up too quickly. But I’m preparing myself for the day when she comes downstairs with her cheeks smeared with whatever she’s found in my makeup bag. 

Author Laurie Endicott Thomas, a medical researcher, editor and journalist, tells SheKnows that young girls "generally want to wear makeup for simple reasons… They want to bond with their friends by doing the same thing that their friends are doing… or they want to show that they are not babies anymore." 

Boys, on the other hand, generally have a very different reason for wearing makeup, says Endicott Thomas. "For boys, wearing makeup is generally a gesture of defiance against a society that is hostile to them. It can be a way of fitting in with a clique of misfits. Makeup and ‘weird’ clothes can even be an odd sort of protective coloration. If he wears makeup and unusual clothes, he can feel that he is being attacked because of something superficial rather than being rejected for who he is." 

Before you impose rules about makeup on your kids of any gender, consider the child’s actual age as well as their emotional and developmental age, Carrie Krawiec, licensed marriage and family therapist, tells SheKnows. And don’t worry about what is acceptable in other families, she says, as long as you set an expectation for what is appropriate in your own. "Because there are varieties of makeup, you may consider ranking them in order if how you see them from an age perspective, like perhaps lip gloss and blush may be seen as acceptable for younger kids, but eyeliner as [for] older [children]," says Krawiec. 

This is the approach taken by Lara, a mom of two from San Diego, California. "My daughter started wearing light makeup (lip gloss and mascara) in fourth grade," she tells SheKnows. "Initially, I thought she was too young, but when I realized most of her friends already wore makeup, I didn’t want her to feel excluded. I do have rules about what sort of makeup she can and can’t wear, though. I’m trying to teach her that ‘less is more.’" 

Sasha, a mom of three from Chicago, Illinois, has a very different approach. "My daughters know my stance on makeup, which is none at all until they are 16," she tells SheKnows. "I know that might seem strict to other parents, but I want them to grow up with confidence in their natural beauty and not feel that they have to hide behind or change their appearance with makeup." 

If you do let younger kids wear makeup, you might want to have some rules about when it’s acceptable and when it’s not. The ability to wear makeup could be a treat your child earns for showing maturity and responsible behavior. "Identify and explain to your child that wearing makeup is a privilege," suggests Krawiec. "If there are things you would like your child to improve upon, such as cleaning their room or completing homework, consider using makeup as a privilege that can be earned.

While there are no hard-and-fast rules, remember that if you are overly restrictive of your child’s self-expression, they may rebel. Before you pick a fight with your child about makeup (or anything else), ask yourself a few simple questions: Will this affect my child’s health? Will this affect my child’s grades? Will this cause my child to hurt other people? 

"If you answer no to all three questions, that’s a good indication that you probably shouldn’t pick that fight," she says. Doing so can cause you to risk aligning yourself with people who might judge (or, especially with boys, even bully) your child over their decision to wear makeup. "So even if you ‘win’ the battle, you lose, because you have harmed your relationship with your child for no good reason," warns Endicott Thomas. 

If you’re concerned about negative responses from other people — particularly if your son is wearing makeup — Krawiec recommends having some standard responses up your sleeve, such as "This was a decision we made as a family based on our child’s interests and our guidance as parents." 

Ultimately, you don’t have to answer to other people. Being supportive of your child — with certain reasonable boundaries in place — is far more important than whether someone thinks your daughter or son is too young to wear a little lip gloss.  

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Clinical trial suggests new direction for heavy-smoking head and neck cancer patients

Patients with a greater than 10 pack/year history of smoking tend to develop an especially dangerous form of head and neck squamous cell cancer (HNSCC) for which prognosis remains poor and treatments have changed little during the past two decades. However, recent phase 1 clinical trial results by the Head and Neck Cancer Group at University of Colorado Cancer Center suggest a possible new direction for these patients. The first-in-human trial of the oral PARP inhibitor olaparib, with the anti-EGFR drug cetuximab and radiation, led to 72 percent 2-year survival in 16 patients on trial, compared with an expected 2-year survival rate of about 55 percent for standard-of-care treatment.

“Colorado promotes innovation, and this trial was certainly innovative when it was designed by our group,” says David Raben, MD, CU Cancer Center investigator and professor in the CU School of Medicine Department of Radiation Oncology. “Much credit goes to Antonio Jimeno, MD, Ph.D. who was very supportive of this idea and helped move this forward along with Dr. Sana Karam and Dr. Daniel Bowles.”

The drug cetuximab targets EGF receptor signaling (EGFR) and while it earned FDA approval in 2006 for use against head and neck cancers over-expressing EGFR, Raben stated there is significant room for improvement.

“That’s where olaparib and radiation come in,” he says. “Ten years ago, I was on a sabbatical from CU, working for AstraZeneca in England. And I remember taking the train from Manchester to Cambridge to learn about this new drug from a small biotech company called Kudos Pharmaceuticals. It was a PARP-inhibitor, meant to keep cells from repairing damaged DNA. That’s the drug we now call olaparib.”

Early in development, the drug had shown remarkable activity in woman with BRCA mutations, “but we wanted to know if it worked in other diseases where BRCA wasn’t the story,” Raben says.

Olaparib inhibits the action of an enzyme known as PARP, which is important for DNA repair. HNSCC in heavy smokers already tends to carry a heavy load of DNA damage. And radiation creates additional DNA damage. When olaparib nixes the ability of these cancers’ to repair DNA, it can push cancer cells past the tipping point of damage and into cell death. In this way, PARP inhibition and radiation may be synthetically lethal, meaning that together they exploit deficiencies in gene defects that leads to enhanced cell death.

In fact, lab work by Raben and CU Cancer Center colleagues including Xiao-Jing Wang MD, Ph.D., Barb Frederick, Ph.D., and Ariel Hernandez, among others, shows that PARP inhibitors like olaparib may also amplify the effects of anti-EGFR drugs like cetuximab.

“The traditional approach against this kind of cancer uses cisplatin chemotherapy along with radiation. I had seen data suggesting that the combination of cisplatin and olaparib might be too toxic on patients’ blood counts. So our team explored this alternative approach that we hoped would offer a more targeted treatment in this poor prognosis group,” Raben says.

In addition to promising survival results, the trial reinforces earlier work showing that cancer patients who continue to smoke while receiving treatment tend to fare worse than those who quit.

“We didn’t cherry pick our patients for this trial. All were heavy smokers, many were heavy drinkers, advanced T-stages, and some continued to smoke during the treatment. People who continued smoking were the ones who did the worst,” Raben says.

However, the trial’s survival benefit came with additional side effects, some of which appeared relatively late in the course of the trial (demonstrating the importance of long-term follow-up for patients in radiation Phase I studies).

“We did see an increase in skin toxicity, which wasn’t unexpected, and we learned that when you combine olaparib with radiation, you need perhaps one tenth the dose that you would when using olaparib alone,” Raben says. Most common side effects included dermatitis (39 percent) and mucositis (69 percent). Several patients experienced increased long-term fibrosis and one showed carotid stenosis, though Raben points out that some side effects could be due to the continued influence of smoking, as well.

“The question now is whether we should move this combination into a randomized phase II trial or use what we’ve learned to design new combinations,” Raben says. For example, “There is tremendous enthusiasm in the oncology community to combine DNA damage repair inhibitors like olaparib with immune enabling drugs, and this may reduce overall toxicity further when combined with or used after radiation,” he says.

Or, Raben suggests that targeted therapies and immunotherapies could be used earlier in the course of treatment, pointing to a forthcoming clinical trial by collaborator Sana Karam, MD, Ph.D., that will test the ability of radiation and immunotherapy to shrink head and neck cancer tumors before surgery.

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Research shows surprising scale of health benefits for biggest losers

When it comes to shedding pounds, it pays to think big, according to new research by The University of Texas Health Science Center at Houston (UTHealth).

The study, in collaboration with the American Cancer Society, focused on Americans looking to slim down and found those who lost more than a fifth of their body weight more than doubled their likelihood of good metabolic health, compared to those who only lost a relatively small amount.

“If you’re overweight or obese, even losing just a little is better than none. But the rewards appear to be greater for those who manage to lose more. The evidence to date suggests that a 5 to 10 percent weight loss for those with excess weight is beneficial to one’s health. A higher level could potentially lead to lower cardiometabolic risk,” said Greg Knell, Ph.D., the study’s lead author and a postdoctoral research fellow at UTHealth School of Public Health.

Its findings, published today in Mayo Clinic Proceedings, are representative of people in the U.S. who are trying to lose weight, where more than two-thirds of adults are overweight or obese.

Using data of 7,670 adult participants of the National Health and Nutrition Examination Survey, the study examined their weight history and results from physical examinations, including waist size, blood sugar and cholesterol levels to determine metabolic health.

Those who lost between five and 10 percent were 22 percent less likely to have metabolic syndrome, a combination of conditions which increases risk of heart disease, stroke and diabetes—three of the country’s most lethal health problems. By contrast, those who lost more than 20 percent lowered their odds by 53 percent.

But the study, among the first at such a large nationally representative level, also revealed how hard Americans find it to lose any weight at all. Despite trying, nearly two-thirds (62 percent) of participants, with an average age of 44, were unable to lose between 5 and 10 percent—the recommended target for adults with excess weight, according to the American Heart Association. While almost one in five (19 percent) achieved this, only 1 in 20 (5 percent) succeeded in losing greater than or equal to 20 percent.

“Since weight loss is so difficult, a 5 to 10 percent weight loss for those with excess weight should be the target. This should be done gradually through following a healthy lifestyle with guidance from experts, such as your primary care provider,” said Knell.

As the study analyzed data at a specific point in time, further research is required to monitor the same individuals at multiple points to see if these findings still hold true.

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What To Look For In A Great Pet Sitter Or Dog Walker – Fetch! Pet Care

For many families in the United States, a pet – be it a dog, cat, rabbit, reptile, fish or ferret – is an adored part of the family. As such, many families work hard to find a reliable and caring person to care for their pets when the family is away. This can be a daunting task, but can be made much easier if you know what to look for.

Here are some traits and requirements that any professional pet sitter should possess:

Genuine Animal Lover: This is the most basic trait you should look for in a quality pet sitter or dog walker. Have a potential sitter meet with you and your pets, ensure that the sitter gets along with your pets, and that your pets reciprocate in kind.

Professionalism: Any service provider should present and represent themselves in a professional manner, all that much more when they’re being considered for taking care of a member of your family.

Licensed, Bonded and Insured: Any worthwhile individual doing pet sitting should at a minimum be properly trained on how to care for pets. They should also be bonded and insured, this will give you peace of mind where your home and personal belongings are concerned.

Reliability: A proven and traceable track record for reliability is a must. When you’re leaving your pet in somebody else’s care, you want to know for certain that they will show up on time to get the job done. A network of reliable backup sitters should also be available in the event your selected sitter cannot perform their duties.

Communicative: A great pet sitter will have a means of keeping in touch with you while you’re away, and will find pleasure in providing you with updates on how your pet is doing. They should also provide you with details as to how they will be caring for your pet, and ask you lots of questions concerning your pet, such as needs, behavior, likes, dislikes, quirks, etc. They should also provide you with a final report on how the care went while you were away.

By following these guidelines, you and your pet will likely have a great experience. For more information about our top rated professional pet sitting and dog walking services, visit us on the web at www.fetchpetcare.com.

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Best Holiday Gifts For Your Pet – Fetch! Pet Care

The holidays are here and it feels like “the most wonderful time of the year”! This is a great opportunity to remember what is truly important, and our pets certainly make that list.  In honor of the pets we’ve put together a list of the best pet gifts, so you can show your pet just how grateful you are for them!  We’ve created a list for both dog and cat lovers.

Dog Holiday Wish List

Our doggie wish list starts with the essential soggy doggy door matt. This magical door matt can tackle even the biggest wet messes! They offer assorted colors and patterns to blend in with any home décor.

Click here for Soggy Doggy door matt

Next on our list is another basic essential: the Flik-it ball launcher. This isn’t your average ball launcher, the Flik-it arm pivots to increase power, accuracy and range, all while reducing your joint and muscle strain.

Click here for Flik-it ball launcher

If you’re not able to make it to the park, keep your dog busy with the Bionic Bone. Your dog will be busy for hours!  Bionic Bone is built with super sturdy rubber, and designed to fit the curvature of your canine’s mouth – this will keep even the most aggressive chewer occupied!

Click here for Bionic Bone

Now for a little fun, we’ve included The Illuminated Leash on our list. This fun light-up leash will brighten any evening or early morning walk.  The light is visible for one quarter mile away, helping you keep safe and look cool all at the same time!

Click here for The Illuminated Leash

Last but not least, if you’re having any formal events at your home this bow tie collar will make sure your pooch is dressed to impress! For fun outings you may choose the skull and bones design, or for a formal get together pinstripes may fit the bill! In any case this bow tie collar is a must!

Click here for Bow Tie collar

Cat Holiday Wish List:

Now for our favorite cat gifts! We think the holidays should have the perfect balance of play and rest. That’s why we’ve chosen this cat trapeze. The suspended design challenges cats to climb to the top—then provides a comfortable place to rest! We think every cat will love this cat trapeze.

Click here for Cat Trapeze

Next on our list is fun, yet practical. Every cat needs a place to scratch, why not make it enjoyable at the same time? This Cat Scratch DJ Deck lets your cat scratch records on a turn table for hours of fun and laughs.

Click here for Cat Scratch DJ Deck

If you’re cat is more of a lounging kitty, this is the perfect gift for them! This bamboo hammock is made with eco-friendly materials, offers a unique sleeping surface, is stain resistant and has a reversible cover.

Click here for Bambu Hammock

While you’re out holiday shopping, this great DVD will keep your kitty company. This DVD is designed to keep your cat’s attention without being too repetitive. They may not even know you’re gone!

Click here for DVD for Cats: While you’re away

Last but not least is the Senses Play Circuit. This toy incorporates your cat’s sound, touch and sight senses for a dynamic playing experience!  By engaging with your cat’s natural hunting instincts your cat will be busy playing for hours!

Click here for Senses Play Circuit

Whichever gift you decide to give your pet we know it will be a special time of year. Here at Fetch! Pet Care, we wish you and your family a happy and safe holiday!

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