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Poor physician-patient communication impede STD screening in women

Young women who are sexually active often don’t talk to their clinicians about sex and STD risk, and many aren’t being tested for infection or disease as guidelines recommend, according to new research.

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Despite record high rates of new cases of sexually transmitted diseases (STDs), young women who are sexually active often don’t talk to their clinicians about sex and STD risk, and many aren’t being tested for infection or disease as guidelines recommend, according to new research from Quest Diagnostics, a provider of diagnostic information services.

The findings from a new survey -“Young Women and STDs: Are Physicians Doing Enough to Empower their Patients and Protect their Health?” – suggest that lack of direct communication between clinicians and patients – and false beliefs about STD risk held by both groups — may contribute to STD prevalence.

The survey examined the perceptions of young women 15-24 years of age, mothers of young women in this age group, and primary care, OB/GYN, and other specialty physicians regarding sexual activity, sexual health, and knowledge of and screening for STDs (also known as sexually transmitted infections or STIs). The results of the 2017 survey were also compared to those of previous research by Quest in 2015 involving similar populations.

Medical guidelines from the Centers for Disease Control and Prevention recommend annual laboratory testing for chlamydia and gonorrhea for all sexually active women under the age of 25. According to the Centers for Disease Control and Prevention (CDC), cases of sexually transmitted disease are at an all-time high, with more than two million cases of chlamydia, gonorrhea and syphilis reported in the United States in 2016. Young adults make up about half of STD cases.

“We know that people often think of STDs as something that happens ‘to others’ and, frequently, health care providers have similar beliefs and don’t view their patients as being at risk,” said Lynn Barclay, president and CEO, American Sexual Health Association. “Testing is crucial in young women because STDs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems including infertility.”

Among the key findings:

  • Young women may not understand their STD risk: A little more than half of young women (56%) say they are sexually active and of those who are, 56 percent say they have been tested for an STD. Young sexually active women cite “not feeling at risk” (62%) and “being asymptomatic” (55%) as reasons for not testing, although STDs often lack symptoms. Of women who are sexually active, 86 percent and 88 percent said they aren’t at risk for chlamydia or gonorrhea, respectively.
  • Many young women are uncomfortable talking to their clinician about sex and STDs: Fifty-one percent of young women say they don’t want to bring up for discussion the topics of sex or STDs with their clinicians.
  • Young women may fail to be truthful with their clinician: Twenty seven percent of sexually active young women admit they don’t always tell the truth about their sexual history to their clinician. For the youngest sexually active women (15-17 years of age), forty-three percent aren’t always truthful.
  • Women don’t recall having a clinician ask about STD screening: 49 percent of young women claim their clinician has never asked if they want STD testing, and less than one in four sexually active women has asked their healthcare professional for an STD test.

In addition, the survey responses of young women suggest rates of STD screening by clinicians have declined, particularly among those 15-17 years of age. Based on the comparison of responses of sexually active women 15-17 between 2015 and 2017, STD testing by clinicians for chlamydia and gonorrhea has decreased by 9 percent and 11 percent, respectively.

The survey also found gaps in care by some physicians.

Clinicians may also be uncomfortable discussing STDs, with one in four (24%) primary care physicians agreed with the statement, “I am very uncomfortable discussing STI risk with my female patients.”

One in three primary care physicians rely on symptoms to diagnose an STD: Twenty-seven percent reported that they could accurately diagnose STD patients “based on their symptoms,” even though CDC notes, “STDs do not always cause symptoms, so it is possible to have an infection and not know it.”

Also, one in four physicians will disregard screening guidelines if a patient is asymptomatic: Only seventy-four percent of primary care doctors said they would order chlamydia testing of an asymptomatic, sexually active female patient. Only seventy-two percent would order testing for gonorrhea for such an asymptomatic patient.

Annual screening for chlamydia and gonorrhea for men who do not have sex with other men is not currently guideline recommended, although, like women, they may not have symptoms and can unknowingly transmit infection to a partner. Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.

“Our findings suggest that discomfort with frank conversations about sexual activity and false beliefs about risk are key barriers to STD testing, and could be driving some of the increase in STD cases of young women,” said Damian P. Alagia, III, MD, FACOG, FACS, medical director of woman’s health, Quest Diagnostics. “Half of all new STD cases are acquired by young people between the ages of 15-24, and one in four sexually active adolescents has a sexually transmitted disease. Our hope in sharing this survey’s findings with clinicians and the general public is that it prompts open dialogue about reproductive health and STD risk, which is absolutely critical to reversing the trajectory of high STD rates in the US.”

The research was conducted by Aurora Research & Consulting on behalf of Quest Diagnostics in December, 2017. A total of 4,742 study respondents, comprised of 3,414 young women between the ages of 15-24, of whom 1,500 self-identified as sexually active; 1,016 mothers of young women in that age group; and 312 primary care, OB/GYN and specialty physicians were surveyed. Most clinician survey data presented in this report was of responses of 100 primary care physicians. Each respondent completed 15-30 minute online surveys regarding perceptions and knowledge of STDs and chlamydia and gonorrhea testing. Strengths of the research include the large number of respondents and the research’s national scale, while limitations include self-reported data and a lack of direct comparability between study populations. The 2017 research was complemented by results of a survey of similar cohort of patients and healthcare practitioners performed in 2015.

Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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Fitness

Stair climbing offers significant cardiovascular, muscular benefits for heart patients

While it is widely known that exercise and lifestyle changes reduce the risk of secondary cardiovascular disease, statistics suggest less than a quarter of all cardiac patients adhere to fitness programs.

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A team of McMaster University researchers who studied heart patients found that stair-climbing routines, whether vigorous or moderate, provide significant cardiovascular and muscular benefits.

The findings, published in closely related studies in the journals Medicine & Science in Sports & Exercise and Frontiers, address the most frequently cited barriers to exercise: time, equipment and access to gym facilities.

“Brief, vigorous stair-climbing and traditional moderate intensity exercise both changed fitness, which is a key predictor of mortality after a cardiac event,” says Maureen MacDonald, one of the lead researchers on both studies and a professor in McMaster’s Department of Kinesiology.

“We’ve shown stair-climbing is a safe, efficient and feasible option for cardiac rehabilitation, which is particularly relevant during the pandemic when many people don’t have the option to exercise in a gym,” she says.

While it is widely known that exercise and lifestyle changes reduce the risk of secondary cardiovascular disease, statistics suggest less than a quarter of all cardiac patients adhere to fitness programs.

Researchers worked closely with the Cardiac Health and Rehabilitation Centre at the Hamilton General Hospital to develop an exercise protocol that did not require specialized equipment or monitoring and could be easily performed outside a laboratory.

Participants with coronary artery disease who had undergone a cardiac procedure were randomly assigned either to traditional moderate-intensity exercise or vigorous stair climbing: three rounds of six flights of 12 stairs, separated by recovery periods of walking, with participants selecting their own stepping pace.

Researchers compared the results and found that individuals who had done traditional exercise and those who had done stair-climbing both increased their cardiorespiratory fitness after four weeks of supervised training and maintained those levels for an additional eight weeks of unsupervised training.

They also reported substantial muscular improvement.

“These patients who had undergone a coronary bypass or stent procedure had muscle that was compromised, compared to age-matched healthy controls,” explained Stuart Phillips, a co-author of the studies and a professor in the Department of Kinesiology at McMaster who oversaw the analysis of muscle tissue taken during the study.

Previously, there had been very few studies of the impact of exercise on cardiac patients’ muscle specifically. This analysis shows heart patients can still repair and build lost muscle.

“Even in just a short period, whether it was moderate intensity, continuous training or high-intensity stair climbing, there were beneficial adaptations in muscles after a cardiac procedure,” Phillips says. “The improvements were clear.”

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Fitness

Returning to sports or exercise after recovering from COVID-19

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As COVID-19 affects everyone differently and the long-term effects are hard to predict, returning to exercise once recovered should be undertaken with great care, especially in the case of moderate to severe cases of COVID-19, says an expert from a top American hospital, Cleveland Clinic.

Sports medicine physician Marie Schaefer, MD, says: “The truth is, the disease can affect everyone differently. Anyone, including young athletes, could experience a severe case or have long-term damage, which is why it is so important to take this seriously.”

While experts know that in some people the virus can lead to damage of the heart, brain, lungs and kidneys, she says there is no way to pinpoint or predict who exactly these individuals will be. Some might also experience lingering symptoms, including shortness of breath, muscle aches, loss of stamina and exhaustion.

For many athletes and active people, Dr. Schaefer says, returning to activity will likely be a slow process and will require patience. Individuals should work with a physician to make sure they are progressing appropriately and to monitor their symptoms.

Timelines determined by severity of COVID-19

When an athlete or active individual is sick with COVID-19, they should not engage in any physical activity. During this time, they should focus on rest, good hydration, proper nutrition and following the advice of their physician or healthcare provider.

After this, the timeline of return to exercise or sport will be determined by how mild, moderate or severe the case was.

If an active individual or athlete only has a mild illness or tests positive without experiencing any symptoms, he or she can consider returning to activity after a 10-day isolation period. Once that window has passed, the athlete may consider a gradual return to physical activity, but must not have symptoms.

If an active individual or athlete had a moderate or a severe illness, or had to be hospitalized, he or she should be evaluated by a physician prior to restarting any type of exercise. Dr. Schaefer says these people may need to have additional tests, including ECGs, heart imaging or blood work before they are cleared to start a progression back into activity.

Myocarditis in athletes and active people

Dr. Schaefer points to the possibility of myocarditis, which is an inflammatory response of the heart due to a viral infection, such as COVID-19. It can cause swelling in the heart muscle making rigorous activity more difficult and sometimes, even deadly.

“Myocarditis is more likely to be found in people who had a moderate or severe case of the virus, but it can happen to anyone who was infected,” says Dr. Schaefer.

Given this increased potential risk for myocarditis, athletes or active people returning after COVID-19 infections need to be cleared by a healthcare provider who will determine if any additional testing is needed. Because of the risk of myocarditis, athletes and anyone who exercises should follow a graduated return to physical activity over the course of a week to monitor for signs and symptoms of this serious complication.

Advice for easing back into fitness

While serious athletes should follow a Return to Play (RTP) schedule supervised by a professional trainer or physician, Dr. Schaefer has three pieces of advice for anyone planning to reintroduce exercise into their routine.

1. Listen to your body. If someone is experiencing symptoms like chest pain or heart palpitations, they should stop exercising immediately and consult with a doctor. Exercise and movement are important for overall health, but for COVID-19, things can change overnight as we learn more about the virus, she says. People should keep monitoring themselves and if something feels more serious than just a consequence of being out of shape, they need to stop exercising and talk to a physician.

If individuals experience any of the follow red flag symptoms, they stop exercising immediately:

  • chest pain or heart palpitations
  • nausea
  • headache
  • high heart rate not proportional to exertion level or prolonged heart rate recovery.
  • feeling lightheaded or dizzy
  • shortness of breath, difficulty catching breath or abnormal, rapid breathing
  • excessive level of fatigue
  • swelling in the extremities
  • syncope (passing out)
  • experiencing tunnel vision or loss of vision.

2. Take it easy. Recovered patients should not try to “power through” as they did in the past. Athletes of all ages should follow a gradual progression to get back into exercise. They will need to build up the time and intensity of their workouts. Dr. Schaefer advises starting with a slow walk and if that feels alright, trying a brisk walk the next day. They will need to gradually increase the time they spend walking, building this up for about one to two weeks before returning to HIIT training or CrossFit, for example.

3. Be patient. Dr. Schaefer points out that even if someone the recovered patients were training for a marathon prior to becoming infected, they will likely discover that their body has changed a bit, which warrants extra caution. “Do not push too hard on a body that is still trying to recover,” she concludes.

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