Sexual health and gender-affirming care – Harvard Health Blog


LGBTQ+ people are often considered a cohesive group, but sexual orientation and gender identity are different. Sexual orientation describes who a person prefers to be sexually intimate with. Gender identity, on the other hand, describes their sense of themselves as male, female, or another gender. Transgender and other gender diverse (TGD) people, whose gender identity is not aligned with their recorded sex at birth, can have any sexual orientation. (The same is true, of course, with cisgender people, whose gender identity aligns with their recorded sex at birth.)

What is sexual health?

Sexual health is a concept that goes beyond pregnancy and sexually transmitted infection prevention. The World Health Organization describes it as “the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.” This is not assured for many people, particularly TGD people, who face higher risks for discrimination and interpersonal violence, including within their intimate relationships.

This blog post discusses two aspects of sexual health: how certain types of gender-affirming care may affect sexuality and fertility.

Can gender affirmation through medical or surgical means affect your sexuality?

The lived experience of every TGD person is unique, as are their approaches to gender affirmation. While some people may choose to affirm their gender only socially, or not at all, others use a variety of medical and surgical procedures to do so. Some research shows that gender-affirming care, when accessible and desired, may reduce distress and can make it easier to live in a sometimes hostile world.

People are more likely to enjoy intimacy with others when they are happier and feel comfortable in their own skin. Those who choose to pursue gender-affirming care may find it affects their sexuality in both positive and negative ways. The examples below speak to both possibilities, although it’s best to discuss the range of options available to you with a doctor who provides gender-affirming care, if you’re wondering about your own situation.

  • Gender-affirming hormone therapy (GAHT) that includes testosterone has been associated with an increase in sex drive. Yet testosterone therapy may cause vaginal atrophy, which has the potential to lead to sexual pain or discomfort. For transfeminine individuals, therapies designed to reduce testosterone may lower sex drive, and may also decrease or eliminate spontaneous erections. This may or may not be experienced as a positive change.
  • Gender-affirming surgical procedures also have various benefits and tradeoffs for sexual health. Transmasculine people who have chest surgeries may experience less or no nipple sensitivity, but find their overall sexual function increases — possibly through making a person more comfortable having partners see and touch their chests. Vaginoplasty restructures the head of the penis into a clitoris and creates a vaginal cavity. In one study of 119 vaginoplasty patients, 90% of transfeminine people who had the surgery reported that they were still able to have an orgasm, and 75% said their orgasms were either the same or more intense than before. However, their experience of arousal could be quite different.

Different techniques can be used to create a neophallus, a structure that resembles and serves as a penis. During a phalloplasty, the clitoris is embedded in the base of the penis, which allows for sexual sensation. Many surgeons also attach one of the clitoral nerves to the flap. With metoidioplasty, the hormonally enlarged clitoris used as the body of the penis maintains its sensitivity and natural erectile function, but most people do not have sufficient length to engage in sexual penetration. In both cases, research suggests most people are capable of orgasm after surgery, but metoidioplasty is not generally recommended for patients who desire the ability to engage in sexual penetration.

If you wish to have genital surgery, tell your surgeon about your sexual goals as well as your interest in other aspects of surgery (such as being able to stand to pee).

Gender-affirming hormones and your fertility

If you are interested in having children who are genetically linked to you, it’s best to discuss fertility with your doctors before starting treatment with gender-affirming hormones. GAHT generally reduces, but does not eliminate, fertility.

  • Transmasculine people have been shown to be able to produce viable eggs even after years on testosterone treatment, leading to planned or unplanned pregnancies. Small case studies have reported on transmasculine people who chose to stop testosterone treatment in order to become pregnant and give birth. How often ovulation occurs in people taking testosterone consistently isn’t well understood yet.
  • Transfeminine people may also still make viable sperm after long periods on estrogen. How often this happens is unclear.

However, if you transition after puberty and wish to preserve eggs or sperm, it is usually easiest to do this prior to starting hormone treatment, if such a delay is tolerable.

Also keep in mind that gender-affirming hormones should not be counted on as birth control, and everyone should be mindful of sexually transmitted infections. Additionally, doctors recommend that transmasculine individuals who still have their uterus and ovaries use a reliable method of birth control if they have sex in ways that could cause pregnancy, even if testosterone use has eliminated menstruation. Transfeminine individuals who can still ejaculate may be able to get someone pregnant, and should discuss that possibility with relevant partners. Talk to your medical team about what is best for you.



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COVID-19 and the heart: What have we learned? – Harvard Health Blog


Early in the pandemic, epidemiologists made a striking observation. Compared to the general population, people with cardiovascular disease (CVD) were more than twice as likely to contract severe forms of COVID-19. In the last six months, death rates from COVID-19 have dropped significantly, but CVD remains a major predictor of poor outcome. What have we learned about heart disease and COVID-19 in that time?

Pre-existing heart conditions and poor metabolic health increase risk of severe COVID-19

As I described in a blog post back in April, some health conditions, like diabetes, increase risk of severe COVID-19 by suppressing the immune system; others, like asthma, increase risk by weakening the lungs. However, in the early months of the pandemic it was not entirely clear how CVD increased the risk of severe COVID-19. We now have two explanations.

The first is that pre-existing heart conditions, such as damaged heart muscle or blocked heart arteries, weaken the body’s ability to survive the stress of the illness. A person with a vulnerable heart is more likely to succumb to the effects of fever, low oxygen levels, unstable blood pressures, and blood clotting disorders — all possible consequences of COVID-19 — than someone previously healthy.

A second explanation relates to poor underlying metabolic health, which is more common in those with heart disease. Poor metabolic health refers to diseases such as type 2 diabetes or prediabetes and obesity, which themselves cause inflammation and risk of blood clots, compounding the effects of COVID-19 and increasing the likelihood of devastating complications of COVID-19.

How does COVID-19 cause heart damage?

The SARS-CoV-2 virus can damage the heart in several ways. For example, the virus may directly invade or inflame the heart muscle, and it may indirectly harm the heart by disrupting the balance between oxygen supply and demand. Heart injury, which may be measured by elevated levels of the enzyme troponin in the bloodstream, has been detected in about one-quarter of patients hospitalized with severe COVID-19 illness. Of these patients, about one-third have pre-existing CVD.

Inflammation of the heart muscle

The majority of people with COVID-19 will have mild symptoms and recover fully. However, about 20% will develop pneumonia, and about 5% will develop severe disease. In the severe form of COVID-19, the body’s immune system overreacts to the infection, releasing inflammatory molecules called cytokines into the bloodstream. This so-called “cytokine storm” can damage multiple organs, including the heart.

Inflammation of the heart muscle, called myocarditis, typically occurs only in patients with advanced COVID-19 disease. Myocarditis can result from direct heart invasion by the virus itself, or more commonly by inflammation caused by cytokine storm. When this occurs, the heart may become enlarged and weakened, leading to low blood pressure and fluid in the lungs. While this severe form of myocarditis is rare, recent studies have suggested that a milder form of heart muscle inflammation may be much more common than previously recognized. A recent study showed that asymptomatic heart inflammation was seen on magnetic resonance imaging in up to three-quarters of patients who had recovered from severe COVID-19.

Increased oxygen demand and decreased oxygen supply lead to heart damage

Fever and infection cause the heart rate to speed up, increasing the work of the heart in COVID-19 patients who develop pneumonia. Blood pressure may drop or spike, causing further stress on the heart, and the resulting increase in oxygen demand can lead to heart damage, especially if the heart arteries or muscle were unhealthy to begin with.

Heart damage is most often caused by heart attacks, which result from the formation of a blood clot in a vulnerable heart artery, blocking delivery of oxygen to the heart muscle. COVID-19-related inflammation raises the risk of this type of heart attack by activating the body’s clotting system and disrupting the blood vessel lining. When inflamed, this lining loses its ability to resist clot formation. These blood clots in the large and small arteries of the heart cut off its supply of oxygen. The increased clotting tendency can also lead to blood clots in the lungs, which can cause a drop in blood oxygen levels. Severe pneumonia drops blood oxygen further. When the oxygen demand exceeds the supply, the heart muscle is damaged.

Finding a silver lining and lowering risk through healthy lifestyle

People with CVD who adopt healthy behaviors can strengthen their defenses against COVID-19 while also reducing the long-term risk from cardiovascular disease itself. This means plenty of physical activity and following a healthy diet like the Mediterranean diet. Cook at home when you can, and walk outdoors with friends if your gym is temporarily closed. Purchase an inexpensive and easy-to-use monitor to measure your blood pressure at home. And continue to follow the CDC’s safety guidelines to wear masks, physically distance, and avoid large gatherings.



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We’re supposed to make resolutions now? – Harvard Health Blog


After everything that’s happened in 2020, setting goals seems like a big ask. Resolutions inherently mean discomfort and require resolve, and most of us have had enough of the former and don’t have much left of the latter. The response to the annual tradition might involve a collective groan, eye roll, and require a censor.

The question is, is it okay to take this year off?

“It’s always okay,” says Dr. Inna Khazan, clinical psychologist and lecturer in psychiatry at Harvard Medical School.

Why do we make resolutions?

Resolutions have their use in pushing us out of our comfort zones, but they aren’t required. Some people stick to them and benefit, but others have a different relationship with resolutions: they make them without any intention of keeping them, and repeat this cycle year after year.

Khazan says that the result can be almost like doing less than nothing. “It provokes shame and guilt,” she says. “You’re not only not benefiting yourself, but you’re also kind of harming yourself.”

There’s no need for that. Resolutions should be based on two things: what you want to do and what you can do. You need to look at yourself, your schedule, your resources, and assess how full your plate is, and as Khazan says, for many people in 2020, “the plate is full.”

Not only that, but a person’s life could already include personal and professional loss, adds Dr. David H. Rosmarin, director of the Spirituality and Mental Health Program at McLean Hospital and assistant professor of psychology at Harvard Medical School. Resolutions just don’t rank on the priority list.

But Rosmarin says that before completely dismissing the idea, think about just some of the challenges that have happened: Kobe Bryant dying in January, then COVID-19, school from home, racial unrest and protests, wildfires, “murder hornets,” the election. It’s been a full year. “Consider how resilient we’ve been,” he says. It can shift your mindset and make taking on a resolution not such a weighty thing.

Or your conclusion still might be, “Nope, I got nothing.”

“That’s totally valid. It’s not healthy to push yourself too hard, and you can take it off,” he says.

But to do that also means not feeling guilty over what you should be doing. It’s one of the eternal traps, since we hold ourselves to impossible standards and are our own worst critics, Khazan and Rosmarin both say. One solution that they offer is to imagine a friend laying out the same scenario: feeling drained, needing a break, not wanting another to-do item at this moment.

When hearing those words, your reaction would probably be compassion and something like, “Of course, take a pass. You deserve it.” Then, try saying that to yourself. And repeat it if necessary.

A different take

But Rosmarin says that while resolutions aren’t mandatory, the answer might not be in skipping them altogether, but in just making a tweak. One is to defer doing anything until the spring. “Give yourself a season to recover,” he says.

There’s also taking a new perspective. The point of any resolution is to better your life in some way, so here’s one: just be kinder to yourself. If you’ve been able to let go of the guilt or shame over foregoing resolutions for the year, guess what? You’ve already succeeded. It’s the non-resolution resolution, Khazan says.

But Rosmarin suggests a couple more ideas. Take vacation time, or just an occasional afternoon off, to restore your energy and allow other things into your head rather than worry. Write down one accomplishment a day to see more positives than negatives, or just enjoy one piece of food a day for the joy of it.

These “resolutions” have upsides. They don’t take much time. They don’t require equipment or a membership. They can always be done, regardless of shutdowns or restrictions. And “you’re creating a better relationship with yourself, which helps us to relate to others and the world,” Rosmarin says.

And he has one more. When someone gives you a compliment or a gift, say “thank you,” and that’s all. You don’t say “stop it” or “you shouldn’t have,” the natural inclination, which fails to acknowledge ourselves and dismisses what the other person just shared. “Saying ‘thank you’ means accepting that maybe, just maybe, you’re worthy of attention and value,” he says. “Also, it creates more connection. What’s wrong with that?”



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3 easy ways to eat a healthier diet – Harvard Health Blog


While many people might be taking a pass on formal New Year’s resolutions this year, others may mark a fresh start this month by resolving to make up for poor eating habits of the past. But this motivation is often focused on a diet that’s too ambitious, or too restrictive. Without a solid plan, you may fail quickly. So consider a compromise: start with these three easy ways to eat a healthier diet.

Aim for real food only

Look at your plate and note what’s processed and what isn’t. Maybe it’s the whole thing (like a frozen dinner), or maybe it’s just part of your meal (like the bottled dressing on your salad). Think of where you can swap processed foods for healthier versions. Ideas include

  • eating whole-grain pasta instead of enriched white-flour spaghetti
  • having quinoa instead of white rice
  • making your own snacks like baked chickpeas, instead of opening a bag of potato chips.

Processed foods are linked with chronic inflammation and other health conditions such as heart disease, diabetes, and cancer. One of the healthiest diets you can eat is a Mediterranean-style eating plan rich in vegetables, legumes, fruits, whole grains, nuts and seeds, fish, poultry, and low-fat dairy products (milk, yogurt, small amounts of cheese).

Schedule your meals and snacks

Set timers on your phone for three different meals and two snacks (if you need them), and don’t eat in between these scheduled times. This might curb your cravings, reduce stress about when you’ll eat next, and cut down on the extra calories of unnecessary snacking — a real challenge if you’re close to a refrigerator all day while at home or work.

Avoid scheduling late-night meals or snacks, when your body’s internal clock (circadian rhythm) senses that you’re supposed to be sleeping. “During the circadian sleep period our metabolism slows, our digestive system turns down, and brain temperature drops, part of the process of clearing toxins during sleep. Eating at different times than our typical circadian awake phase leads to weight gain,” says Dr. Lawrence Epstein, associate physician with the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women’s Hospital.

Reduce your portion sizes

If you’re like most Americans, you’re eating too much food. An easy way to implement portion control: load your plate as you normally would, then put back a third or half of the food. Other ideas:

  • Use a salad plate instead of a dinner plate, to fool yourself into taking less food.
  • Keep serving bowls off the table, so you won’t be tempted to eat extra helpings.
  • Don’t linger at the table and keep eating when you’re already full.

It will also help to know how many calories you should consume in a day. For example, if you’re supposed to eat 2,000 calories per day but you’re scarfing down 3,000, it’s probably time to cut all of your usual portions by a third. How can you figure out your calorie needs? For healthy people who exercise 30 minutes per day, multiply your weight (in pounds) by 15 for an estimate.

A final thought: Take just one step a week

You don’t need to incorporate all of these steps at one time; try one step per week. Write down what you’re eating and any thoughts or questions you have about the process. After a week, assess what worked and what didn’t. Before long, you’ll have the confidence to attempt new steps.



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Do pro-inflammatory diets harm our health? And can anti-inflammatory diets help? – Harvard Health Blog


Our emerging understanding of the role of inflammation in major chronic diseases has brought much attention to the effect of diet on the inflammatory process. Understanding the link may help us identify specific dietary patterns and foods than can diminish chronic inflammation and improve health.

Inflammation: Helpful, harmful, or both?

There are two types of inflammation: acute and chronic. Acute inflammation is the body’s protective response to an injury or infection. For example, acute inflammation occurs when you cut your finger. Your body dispatches white blood cells to protect the area. You may see some swelling and redness and feel pain, but this process is critical to preventing infection.

Chronic inflammation may be triggered when the body tries to rid itself of harmful substances such as toxins from smoking. Increased levels of chronic inflammation are also associated with excess fat, especially around the abdomen.

Low-grade chronic inflammation may damage blood vessels, arteries, nerves, and the intestines. It can eventually lead to chronic diseases including heart disease, diabetes, certain cancers, and some diseases of the bowel.

Can diet impact chronic inflammation?

Looking at markers of inflammation such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF- α), researchers have found that diet can influence inflammation. There is also a great deal of evidence showing that diet impacts the risk of chronic disease, including heart disease and diabetes. Is inflammation the means by which diet influences disease risk?

Pro-inflammatory diets may increase risk of cardiovascular disease

A recent study published in the Journal of the American College of Cardiology (JACC) examined whether pro-inflammatory diets are associated with increased risk of cardiovascular disease (CVD). (CVD includes non-fatal and fatal heart attack, and fatal and non-fatal stroke.) The researchers assessed the diets of more than 200,000 women and men enrolled in the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study. The study participants had filled out food frequency questionnaires every four years for up to 32 years.

Results showed that those consuming the most pro-inflammatory diets had a 38% higher risk of developing CVD compared to those consuming the most anti-inflammatory diets. The associations were consistent in men and women, and remained significant even when other lifestyle factors and other potential contributors to inflammation such as obesity, diabetes, high blood pressure, and high cholesterol were taken into consideration.

This study also showed that pro-inflammatory diets were associated with a poor cholesterol profile. This finding was also seen in other another study, also published in JACC, which found that pro-inflammatory foods had a harmful effect on cholesterol levels while some anti-inflammatory foods had favorable effects.

What foods are pro-inflammatory and anti-inflammatory?

Foods with a higher pro-inflammatory potential are red meat, processed meat, and organ meat; refined carbohydrates such as white bread, white rice, and many desserts; and sweetened beverages including colas and sports drinks.

Foods that have a higher anti-inflammatory potential are green leafy vegetables like kale, collard greens, and spinach; dark yellow vegetables such as winter and summer squash and yellow peppers; whole grains such as wheat berries, quinoa, whole-grain bread, and oatmeal; and fruits, tea, coffee, and wine. These foods contain specific anti-inflammatory compounds such as carotenoids, flavonoids, vitamins, and fiber.

The recent JACC study findings are consistent with other research that identifies certain dietary patterns that are associated with lower inflammation and reduced risk of CVD. These include the Mediterranean diet, which emphasizes many anti-inflammatory foods and limits pro-inflammatory foods such as red meat and refined carbohydrates.

The bottom line: limit pro-inflammatory foods and eat more anti-inflammatory foods

The data suggest a prudent approach of both limiting pro-inflammatory foods and adopting an anti-inflammatory diet may provide an effective strategy for CVD prevention.

Below are some practical ways to get more anti-inflammatory foods in your diet.

Anti-inflammatory foods
Category Foods Tips to get more in your diet
Fiber ·       Fruits and vegetables

·       Beans, nuts, and seeds

·       Packaged foods containing more than 5 grams of fiber per serving

·       Replace refined grains with whole-grain options like brown rice and whole wheat

·       Eat high-fiber snacks like berries, apples, or carrots with hummus

·       Fill half your dinner plate with veggies

Phytonutrients ·       Red, orange, and yellow vegetables and fruit

·       Dark green leafy veggies like kale

·       Spices: turmeric, curcumin, peppers, cinnamon, garlic, ginger, onions, etc.

·       Green tea and black coffee

·       Fruits and veggies rich in flavor (especially bitter flavors), aroma, or color often have more phytonutrients

·       Try not to peel your fruits and veggies

·       Use many different spices when preparing meals

·       Shorten length of cooking time and limit pre-soaking of fruits and veggies

Healthy fats ·       Mono-unsaturated fatty acids (olive oil, canola oil, sesame oil

·       Omega-3 fatty acids (fatty fish like salmon and mackerel)

·       Flaxseeds and walnuts

·       Eat walnuts for a mid-morning or afternoon snack

·       Use olive oil as salad dressing and when sautéing vegetables

·       Sprinkle whole flaxseed or flax powder in oatmeal, cereal, or smoothies

Source: Department of Nutrition, Brigham and Women’s Hospital



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Making the most of physical activity apps – Harvard Health Blog


One of the best moves you can make for your health is to get moving. “Walking is man’s best medicine” is a well-known quote from Hippocrates. Centuries later, we have multiple research studies that reveal the power of exercise as medicine. One study specifically compared exercise to common medications for heart disease, stroke, and prediabetes, demonstrating that exercise can have comparable outcomes with regard to lowering risk of death. Recent research also highlights the impact that even short doses of exercise can have on your mood and increased creativity. However, as when you stop taking a medicine, if you stop exercising, the benefits stop as well.

Finding ways to make exercise fun and engaging is key

Most people know exercise is good for their health, yet only about half of Americans meet the physical activity guidelines to accumulate 150 minutes of moderate-intensity physical activity each week.

These days, making exercise more fun can include using apps on your phone or a fitness tracker, as well as using social media sites. Research has demonstrated that there is a relationship between using commercial physical activity apps and increased engagement in exercise.

Do certain people respond more favorably to using exercise apps?

A recent study explored the psychological mechanisms that come into play when people use apps to increase their levels of exercise. Researchers surveyed 1,274 male and female adults between the ages of 18 and 83, asking them questions online at one specific point in time (also known as a cross-sectional study).

The results showed that feelings of social support, self-efficacy (the feeling that a person is competent at an activity and can be successful), identified regulation (the personal value one places on the outcomes of physical activity), and intrinsic motivation (internal feelings that are rewarding after exercise), as well as being a highly competitive person, were all attributes associated with the use of physical activity apps. The research also showed that connecting to existing social media networks, sharing posts, and receiving encouragement may add to the app users’ feeling of social support, and in turn increase their feelings of confidence and competence in their ability to be successful with exercise. All of these attributes are associated with physical activity engagement.

We need to learn more about apps and exercise for different groups

This study was interesting (and very positive), but because was a cross-sectional study, we can’t draw conclusions about causality. This means we can’t say for sure if using an app will increase the amount of activity you do or your attitudes about exercise. We need more well-designed, randomized controlled trials to evaluate how effective physical activity apps are at increasing engagement and sustaining regular exercise in many different types of people. However, the current research can help guide us to use apps and social networks to our advantage and increase activity.

Here are some tips to move more (with or without apps) and to support others with the same goal:

  • Research various app options and determine which one is best suited for the activity you enjoy. Consider inviting a friend to join you in using the same app.
  • If you are competitive, a physical activity app might be an especially effective strategy to get you moving and staying on track. Many apps use gamification, which keeps you invested and interested in moving forward, reaching goals, and winning awards.
  • Social support can have a markedly positive impact on physical activity levels. Use apps with communities or those that can connect to your existing social medial platforms to be able to share posts and receive feedback.
  • Self-efficacy, also known as the belief that you can be successful with an activity or exercise, is associated with increased app use and physical activity engagement. Setting small goals that are SMART (specific, measurable, action-oriented, realistic, and time-sensitive) will help to increase self-efficacy. Start with a concrete, small goal. Achieving that goal will activate the reward system in the brain and release dopamine. Success breeds success.
  • Consider why being physically active is important to you at this point in your life. Make a list of ways your life would be different if you were physically active, and how it would be improved.
  • After exercising, think about what benefits you notice: are you more creative, do you feel a “runner’s high,” do you feel less stressed, are you more energized? List the things that you feel. These are intrinsic rewards, and when you recognize them as being a result of physical activity, you connect the reward with the exercise. This will help you want to repeat it over and over again.
  • Consider posting about your physical activity on your social media sites, and when you see others post about theirs, make an effort to like, retweet, or reply with words of encouragement. Social media can be a powerful force for good, if we choose to use it that way. Helping each other be more physically active is one good deed we can do in a day, and it’s only a click away.



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The health effects of too much gaming – Harvard Health Blog


It is estimated that 164 million Americans — half of our population — play video games, also known as gaming. Contrary to popular belief, it isn’t just teens who play games. According to a recent survey, only 21% of gamers were under 18 years old. While gaming can be a fun distraction or hobby (and is even becoming a competitive sport on many college campuses), there are health risks that come from too much gaming. What are these harms, and what can be done about them?

Is there anything good about gaming?

Before discussing the harms of gaming, it is only fair to mention the benefits. Aside from being entertaining and a fun pastime, gaming can provide a way for people to interact with each other — a virtual community — as they work together toward completing common tasks. Our society suffers from an epidemic of loneliness, and gaming can be a vehicle to connect with others, including otherwise difficult-to-connect-with people in your life, such as kids, grandkids, or (I’ve seen this be quite helpful) with autistic children, who can have challenges with traditional modes of communication.

There is mixed research that there are some cognitive benefits to gaming, such as better control of one’s attention and improved spatial reasoning, though it isn’t entirely clear how much these benefits extend outside of the video game sphere into the real world. Finally, video games have medical applications, such as training people with degenerative diseases to improve their balance, helping adolescents with ADHD improve their thinking skills, or training surgeons on how to do technically complicated operations.

Gaming injuries

Repetitive stress injuries, or overuse injuries, are injuries that come from activities that involve repeated use of muscles and tendons, to the point that pain and inflammation develop. If these injuries are allowed to progress, numbness and weakness can develop, and permanent injury can result. Overuse injuries of the hands and arms are rampant among gamers.

One common example is carpel tunnel syndrome, which many gamers develop. Carpal tunnel syndrome, often seen in office workers, involves inflammation of a nerve in the wrist, which causes pain and numbness.

“Gamer’s thumb,” which was previously called “PlayStation thumb” (or “nintendinitis” or “nintendonitis” when Nintendo was popular), occurs when the tendons that move the thumb become inflamed. The medical term for this is de Quervain’s tenosynovitis, and it can lead to swelling and limited movement. Gamers are also at risk for trigger finger, or stenosing tenosynovitis, which is when a finger gets stuck in the bent position due to chronic inflammation. Gamers can also get tennis elbow, a painful inflammation of the place where the tendon inserts into the bone on the outside of the elbow.

Gaming is also associated with obesity in teens and, plausibly, the same would be shown in adults, if studied. This is due to the obvious phenomenon that if a teen is sitting in front of a screen for hours every day, he or she isn’t getting much exercise. The obesity is also thought to be due to increased food intake while playing video games. According to a study in the Journal of Clinical Nutrition, “a single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.” The proposed mechanisms are that either the signals that indicate satiety (fullness) get impaired, or that the mental stress involved with playing video games activates the reward centers, which leads to increased food intake.

Vision problems are common complaints of gamers. The most common vision problem is eye strain, which can lead to headaches and poor concentration. Gaming has been reported to result in seizures, leading to warnings on the packaging.

Gaming addiction

Gaming has also been associated with psychological problems. It is still an open question whether video game addiction, or internet gaming disorder (IGD), is a unique syndrome. According to the American Psychological Association, IGD is defined as experiencing at least five of the following nine criteria over a 12-month period:

  • gaming preoccupation
  • withdrawal
  • tolerance
  • loss of interest in other activities
  • downplaying use
  • loss of relationship, educational, or career opportunities
  • gaming to escape or relieve anxiety, guilt, or other negative mood states
  • failure to control
  • continued gaming despite psychosocial problems.

According to one study from the American Journal of Psychiatry, between 0.3% and 1.0% of Americans might have an internet gaming disorder. Treatments for this problem are a work in progress, as the disorder isn’t fully understood or agreed upon, but can include public health approaches such as education and harm reduction, stricter labeling on the packaging, as well as cognitive behavioral therapy. There are even support groups, such as Computer Gaming Addicts Anonymous, which leverage the power of group support — also helpful in the treatment of other addictions — to the realm of gaming addiction.

Gaming has also been associated with sleep deprivation, insomnia and circadian rhythm disorders, depression, aggression, and anxiety, though more studies are needed to establish the validity and the strength of these connections. There has also been concern that exposure to the extreme violence that is commonly found in video games can desensitize teens and young adults to such violence, causing emotional problems and even leading to young people committing acts of violence.

Gaming in moderation

As with many other activities that have potential benefits and harms, moderation is the key. Most of the harms that come from gaming can be improved, if not avoided altogether, by limiting the number of hours spent in front of the screen, and by engaging in healthy activities like exercising, or socializing in the real world instead of the virtual game world.

Education is an essential key to injury prevention. Gamers need to be educated on how to protect their thumbs, wrists, and elbows, their waistlines, their emotional state, their sleep, and their eyes. Simple education around taking breaks, stretching, eating healthy snacks, and resting and icing your thumb, wrist, or elbow when it starts hurting can address injuries early, before they become significant. For the eyes, gamers can try the 20-20-20 rule: every 20 minutes, try to look at something 20 feet away for 20 seconds.

In short, playing video games can be fun and a social activity when integrated into a healthy lifestyle that includes plenty of sleep, exercise, and good nutrition, rather than letting the game become your life.



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Good news: Deaths due to HIV are way down – Harvard Health Blog


World news this month appropriately focuses on containing the COVID-19 pandemic, as the first vaccines become available. Yet we can also celebrate major success in the fight against a different global viral scourge: HIV.

During my medical training in the 1980s, hospital wards were often filled with people dying of HIV. Since then, antiviral treatments have dramatically transformed the diagnosis of HIV infection or AIDS from a death sentence to a chronic illness. A normal lifespan is no longer unusual among people living with HIV. And preventive measures described below have reduced the number of people becoming infected in the first place. Since the 1980s peak of new HIV infections, the number of people with newly diagnosed HIV in the US has fallen by more than two-thirds.

Deaths due to HIV infection continue to fall

A study published in the November 2020 Mortality and Morbidity Weekly Report noted remarkable progress:

  • Between 2010 and 2018, overall deaths among those diagnosed with HIV fell by more than a third, from 19.4 to 12.3 per 1,000 people.
  • From 2010 through 2017, deaths related to HIV fell by nearly half, dropping from 9.1 to 4.7 per 1,000 people).
  • The highest rates of HIV-related death were noted among people who were Black, people who identified themselves as mixed-race, and people living in the South.
  • Men with HIV had slightly lower death rates than women.

The study authors attribute the falling death rates to early diagnosis and improved treatment.

There’s still plenty of room for improvement

While the number of new cases of HIV infection in the US has fallen dramatically over the last decade, the latest data from 2014 to 2018 suggest this may be slowing. And not everyone has access to HIV testing or the most effective treatments. This is especially true for persons without health insurance, good nutrition, or other resources.

As with so many conditions, there are significant healthcare disparities among persons with HIV. Throughout the world, gender, race, and geography matter in who becomes ill and who receives timely, effective treatment. The burden of suffering and death is borne by some groups much more than others.

While advances in prevention and treatment of HIV are worth celebrating, we have a long way to go before declaring victory.

What you can do now

If you don’t have HIV: Take measures to keep it that way.

  • limit your sexual activity to one partner who is similarly committed to only having sex with you
  • always use a condom
  • never share needles
  • if you have a high-risk exposure (such as through sexual contact or a needle stick), contact your healthcare provider or go to an urgent care clinic to consider taking a medication to prevent HIV infection.
  • HIV spreads through high-risk activities, such as sharing needles or having unprotected sex with a partner who has HIV or whose HIV status is unclear. Medicine known as PrEP (pre-exposure prophylaxis) can prevent infection if taken regularly. Talk to your doctor about this.

If you already have HIV: See your doctor for monitoring and treatment. A number of highly effective drugs are available to lower the amount of virus in your body. This can prevent complications of HIV infection and reduce the risk of infecting others.

If you aren’t sure about your HIV status but have had possible exposure: Get tested. Estimates suggest that one out of every seven people infected with HIV doesn’t know it.

The bottom line

Since the HIV epidemic began, we have witnessed enormous progress: researchers identified the cause and understood how it spread; highly accurate testing became available; public health measures were undertaken to prevent spread; and effective medications were developed. However, this progress took many years. And we still have no vaccine to prevent HIV infection. New infections and related deaths remain far too common, and healthcare disparities persist in the fight against HIV.

The experience with HIV has demonstrated how dangerous a new and contagious infectious disease can be, even in places with highly sophisticated medical care — a truth highlighted more recently by the COVID-19 pandemic. There are undoubtedly many lessons to be learned from past infectious diseases, including HIV, SARS, MERS, and Ebola, as we grapple with COVID-19. But the lessons could go both ways. Perhaps the ways we combat COVID-19 — including the creation of new vaccines — can be applied to HIV.

Hopefully, the progress in fighting HIV/AIDS will continue, perhaps even to its elimination. And what we have learned from HIV infection over several decades, and from COVID-19 during the past year, should make us better equipped to fight the next pandemic.

Follow me on Twitter @RobShmerling



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New high-resolution imaging scans approved for use in prostate cancer – Harvard Health Blog


Imagine trying to find a single match from a book of matches in a large room. Not an easy task, right? But if the lights were dimmed and the match was lit, then its location would be immediately apparent.

This is the basic idea behind PSMA imaging, a newly approved method for detecting prostate cancer that is spreading, or metastasizing. The method relies on a minimally radioactive tracer called gallium-68 PSMA-11. Delivered in tiny amounts by injection, the tracer travels throughout the body and gloms onto a protein called PSMA that is found at high levels on prostate cancer cell surfaces. The labeled cells will then light up on whole-body imaging with a positron-emission tomography (PET) scan.

Per the FDA’s new approval, doctors can give a PSMA-PET scan to hunt for metastases in men with rising PSA levels after prostate cancer treatment, or if they suspect cancer is metastasizing in a newly diagnosed patient. The scans have unparalleled resolution: able to detect tumors only a few millimeters in size anywhere in the body, they allow doctors to find and treat metastases before they become more dangerous.

The pivotal study leading to PSMA’s approval was published in 2019 by collaborators at the University of California, Los Angeles and the University of California, San Francisco. The investigators enrolled 635 men with rising PSA levels after surgery or radiation for prostate cancer. All the men got a whole-body PSMA-PET scan, and suspicious findings were recorded for the prostate bed (the local anatomy in the vicinity of the prostate), lymph nodes, skeletal structures, and other organs. Teams of independent experts reviewed the PSMA-PET data, and their interpretations were in turn validated by pathologists who looked at the actual tissue samples under a microscope. When tissue samples were not available for the pathologist’s review (which is called histopathology), PSMA-PET findings were confirmed or ruled out using additional imaging tools, or with PSA measures taken after cancer treatment.

Results showed that PSMA-PET scan correctly flagged metastases confirmed by histopathology 84% of the time. The accuracy was better for scans that were further confirmed with other imaging tools and PSA readings; in these cases, PSMA-PET identified metastatic tumors 92% of the time. Importantly, the higher a man’s PSA, the more likely the scans were to find metastatic cancer.

The new approval applies only to gallium-68 PSMA-11 manufactured at UCLA and UCSF, and to PSMA-PET scans given at those two institutions. However, other PET imaging agents that bind to PSMA proteins are under accelerated review at the FDA, and should be approved in 2021, according to Dr. Jeremie Calais, a UCLA physician who helped lead the research.

“When this new PSMA scan becomes more widely available, it will again add to the diagnostic capabilities of physicians caring for men with prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Importantly, the scans enable a more precise evaluation of whether cancer deposits are present outside the area of the prostate gland that are not normally detected by currently available diagnostic studies. This in turn will help inform more specific treatments and enable a more accurate assessment of the effectiveness of our treatments.”



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Choosing joy during difficult times – Harvard Health Blog


Feeling good may be in short supply these days. The pandemic is on the upswing again, and many of us anticipate spending the colder months ahead cooped up in our homes with computer screens as our only windows into the world. Meanwhile, climate-related natural disasters are driving thousands of people out of their homes. Millions of jobs are being lost. I won’t even mention politics. It is as if the whole universe has conspired to take the joy out of life.

Then, in the midst of it all, I lost my sense of smell and taste after a bout of COVID. I was very distraught. I couldn’t taste the delicious chocolate cake my wife made for my birthday, nor smell the lilacs that burst into bloom in our garden. Suddenly, my world had gotten smaller, grayer. No one else I knew had this disease. I began to ask myself, “Why me?” — forgetting for the moment so many other people who were faring much worse than I was.

Our attitudes and actions partially influence our happiness

Looking for a way to feel better, I turned to literature about resilience and overcoming adversity. I read books by spiritual teachers, psychologists, and wellness coaches. They all mentioned our inherent potential to become whole again and experience joy in life despite painful adversities. I delved into this research. One study, quoted in the Dalai Lama’s Book of Joy, particularly impressed me, as it noted that lottery winners were not significantly happier than those who had been paralyzed in an accident! Another study cited in the book concluded that each of us has a “happiness set point,” a sort of happiness quotient, or HQ, which is only partially determined by immutable factors such as genes and temperament, or by circumstances beyond our control, be it a pandemic, a bad economy, or any unplanned life disruption.

The rest of a person’s HQ — almost half of it, in fact — has to do with our own attitudes and actions. These include the ability to acknowledge difficult feelings; to reframe a situation more positively; to experience gratitude for the good things we still have; to be kind and generous to others; and, last but not least, to cultivate a sense of humor. Makes sense, I thought. But how do you practice all these wonderful things when you’re down in the dumps?

Lessons from my patients in finding joy

In the end, it was my patients who helped me gain a perspective on my own predicament. As a clinical social worker, I witness various forms of human distress firsthand every day. I’m both humbled and inspired by my patients’ ability to find a measure of contentment, if not happiness — and sometimes, even joy — amidst their suffering.

For example, take Jane (all patients’ names and identifying details have been changed to protect their privacy), a 75-year-old woman whose husband has dementia. Because of the pandemic, Jane’s husband could no longer attend his day program. Now that she needed to look after him full-time, she worried about having no life left for herself. On the insistence of a friend, she joined a support group for caregivers. She got the energy to ask her son and daughter to pitch in whenever possible, and discovered that during the day her husband would happily watch TV. In the evening, Jane puts on the ballroom music that her husband still responds to, and they dance together. And they watch a lot of black-and-white comedies and laugh. It helped, of course, that Jane and her husband had always had a pretty good relationship. But she admitted that there were times when she needed to have a good cry to release stored-up tension and sadness. Then she’d be able to laugh again.

There is also Marsha, a woman in her 40s with atrophied limbs due to a congenital disease. When I first met Marsha, I was taken aback at the extent of her physical challenges, and wondered how she managed. I learned that Marsha felt that she was doing just fine, and that she finds contentment in simple things, like reading a good book, talking to a loved one on the phone, or taking care of her cats. It’s not that Marsha didn’t have her own dark night of the soul. For years, she struggled with depression, medications, and hospital visits. A day arrived, however, when she realized that she had a choice: She could continue to be miserable, or accept reality and find a way to move on.

And then there’s Jim, a young man in a wheelchair whose career as a promising athlete was cut short by disease. He is now homebound, barely able to make it from his bed to the bathroom under his own steam. Jim knows that he will probably never marry or have a family of his own, and that his years on this planet are likely to be short. COVID added its own blows, interfering with the delivery of special equipment he needs and keeping at bay family members who are willing to live with him. Yet each time I see Jim and ask him how he is, he replies, “I’m doing okay,” often with a genuine smile. In spite of the pain and discomfort, he keeps busy with workbench projects and hobbies. Once Jim said something that really blew me away: “I don’t ask myself, ‘Why me’? I mean, Why not me?”

In the words of the Dalai Lama, choosing joy at a time like ours is a revolutionary act. As my patients have shown, we can make such a choice even when things seem to be falling apart.



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