Archive for the ‘Hormone Clinic’ Category

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Michelle Janas (PhD) trained as an immunologist and worked in research and experimental medicine for 20 years. She recently embarked on a career change into social work.

On 1 December, a landmark judgment was delivered in the case of Bell & Anor v The Tavistock And Portman NHS Foundation Trust [2020] EWHC 3274. The High Court was asked to determine whether children experiencing gender dysphoria could give informed consent to receive puberty-suppressing drugs, by achieving Gillick competence.

The court found that competence to consent to such treatment is was highly unlikely for 13-year-olds and very doubtful for those aged 14 or 15. While consent can be presumed for young people aged 16 and 17, medical professionals may want to seek court approval before treatment if there are doubts as to whether it would be in the young persons long-term best interests.

The judgment will be implemented on 22 December. If the Tavistock or the two NHS trusts who administer the treatment appeal by then, and this is granted by the Court of Appeal, implementation will be deferred until the appeal is decided.

However, on the day of the judgment, NHS England, which commissions the Tavistocks Gender Identity Development Service (GIDS), ordered it to cease referring patients under 16 to paediatric endocrinology clinics for puberty blockers unless a best interests order for the child in favour of the treatment has been made.

It also ordered GIDS to review all current patients under 16 it had referred for puberty blockers, with lead clinicians either making a best interests application to the courts to determine what should happen or safely withdrawing treatment.

Although NHS England has commissioned a full review of services for children and young people experiencing issues with their gender identity, for the foreseeable future such medical treatment via the GIDS clinic will not be an option for children under 16 without a court order.

This is an important judgment for social work. GIDS provides social work support and also liaises with social workers already working with the children referred to it, while many practitioners work with children with gender identity issues.

There were two factors that combined to play key roles in this decision: that the treatment is experimental in nature and, because of this, there are unknown and potentially profound lifelong consequences that a child will struggle to comprehend for their adult self.

In this article I will refer directly to the judgment throughout and attempt to outline why the treatment was determined to be experimental, and how the experimental classification impacted on the ruling of competence. I draw upon my 20 years of experience in working in research medicine and early-stage clinical trials, as well as my interest in the ethics of social science research, which I have written about previously.

Puberty blockers (PBs) are formally known as gonadotropin-releasing hormone agonists (GnRHas). This is important as this medication was originally developed for a different use to how it was being prescribed at GIDS. These drugs act by supressing the release of the sex hormones and are typically used to treat prostate cancer and breast cancer, and to assist in fertility treatments in women. Controversially, GnRHas are sometimes used to chemically castrate male sex offenders in other countries.

In children, these drugs are used to treat a very rare condition called precocious puberty, in which puberty occurs early at around the age of six. GnRHas halt this premature puberty until the child has reached the appropriate developmental age of around 12 hence the name puberty blockers.

The diagnosis of gender dysphoria in itself is somewhat contested, but one which the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines as a difference between ones experienced gender and assigned gender, and significant distress or problems functioning.

GnRHas were being prescribed by GIDS as an off-label treatment meaning the medication is not being used for its licensed purpose to treat gender dysphoria in adolescent children after the commencement of normally timed puberty. Off-label use of medication is relatively common, particularly for paediatric populations. The caveat, however, is that there should be justifiable scientific evidence that the treatment is safe and beneficial for the patient. The safety data here is paramount, as it helps prevent catastrophic unintended consequences of untested medications, as seen in the thalidomide scandal of the 1950s.

The court found that for PBs, the evidence for safety and efficacy was lacking. Indeed, the judges found the absence of data on the age distribution of patients (until 2019-20), the proportion of children referred to it for the treatment with an ASD diagnosis and the percentage who move on to take cross-sex hormones surprising.

Also, an interim report from a GIDS Early Intervention Study (which commenced in 2011) concluded that for 44 young people who received pubertal suppression, there was no overall improvement in mood or psychological wellbeing using standardized psychological measures (para 73).

The judges also noted an incongruence between the GIDS claim that puberty blockers were fully reversible and other evidence, including the NHS websites section on the treatment of gender dysphoria, which states, little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria (para 67).

Therefore, due to the lack of both safety and efficacy data on the use on GnHRas for gender dysphoria, the court has considered the treatment to be experimental in nature.

For experimental medicines to become licensed, they need to progress through a strictly defined series of clinical trials, starting from small-scale safety studies and then increasing in size and complexity as the efficacy of the treatment is tested. The design of the studies is agreed in advance, including all the data to be collected, and the patients are carefully monitored. It is an issue which is currently writ large in the public imagination, as we watch the Covid vaccine make its way through these hurdles. To date, GIDS has been unable to produce data from the types of clinical trials that would set puberty blockers along the road to licensing for gender dysphoria. But it has also not produced sufficient scientific evidence to justify their use as off-label medication.

The court stated explicitly that it was not addressing whether the use of PBs for gender dysphoria was effective, but whether a child could consent to such experimental treatment. Two key issues were defined by the court: whether Gillick competence could be achieved and whether the information being given was adequate (to enable Gillick competence).

Gillick competence is the legal test, in which a minor can consent to surgical, medical or dental treatment in the absence of a parent or guardian. The child needs to show sufficient maturity to understand what is involved (Lord Scarman, 1986). Whilst case law has made clear that the child does not need to comprehend all the peripheral detail, they do need to be able to demonstrate sufficient understanding of the salient facts (Cobb J, 2019).

It is important to note that the demonstration of Gillick competence is crucial for these children, as GIDS guidelines state that although the parents or guardian must also be in agreement, they cannot give consent on behalf of the child.

The judges considered both evidence presented and case law, and as it is not within my expertise to cover them all, (Marina Wheeler QC gives a neat summary). I will instead restrict myself to medical aspects. One of the pertinent pieces of medical information given in evidence was that practically all children (although, as stated above, GIDS could not give exact data) who started on puberty blockers progress to cross-sex hormone (CSH) treatment (testosterone for females and estrogen for males). Therefore, it was considered relevant by the court that a child was able to understand both the consequences of PBs and CSHs for Gillick competence.

The issues of lifelong and life-changing implications were raised throughout the judgment. These included the possibilities presented in evidence by GIDS regarding uncertainty of apparent long-term physical consequences of puberty blocking on bone density, fertility, brain development and surgical options (para 62).

The judgment cites several pieces of evidence regarding the courts concerns on a childs ability to understand the impact on future fertility and sexual relationships. This includes the GIDS testimony that for children these implications will always involve some act of imagination (para 122) and a witness statement from a 13-year-old trans boy who wrote, I havent really thought about parenthoodI just have no idea what me in the future is going to think. Also, Kiera Bell, who brought the legal challenge, stated in evidence, It is only until recently that I have started to think about having children and if that is ever a possibility.

In determining competence, the judgment states that a child must not only have sufficient understanding of the factors relevant to the present, but also be able to objectively weigh information relevant to the future (para 124). Thus, although a child might understand the concept of fertility loss, it is not the same as understanding how this might affect their adult life (para 139).

Induced sterility is a principal ethical dilemma in paediatric cancer medicine, as the treatments given for advanced or complex tumours can render a child infertile. However, as the treatment is usually a final life-saving option, sterility, although distressing, is perhaps considered acceptable. The court also refers to this to emphasise the gravity of these types of decisions by stating that apart from life-saving treatment, there will be no more profound medical decisions for children than whether to start on this treatment pathway (para 149), a statement which gives context to the courts justification for the high bar it has set.

Therefore, although the court acknowledges that a lack of evidence in experimental medicine is not a barrier to competence per se, it is the combination of this with the potentially profound lifelong consequences that a child will struggle to comprehend that has led it to conclude that Gillick competence for a child under 16 is highly unlikely to be reached, no matter how much information and support is given.

This judgment also gives social work pause for thought. Social workers, by virtue of the profession, are interested in issues of social justice and welcome diversity and difference. However, just as for the medical profession, we do need to ensure that foremost, we do no harm.

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Puberty blockers and consent to treatment: an analysis of the High Court's ruling - Communitycare.co.uk

Robust pooled analysis demonstrating how CTC count may help to optimize treatment choices

BOLOGNA, Italy and HUNTINGDON VALLEY, Pa., Dec. 9, 2020 /PRNewswire/ -- Menarini Silicon Biosystems, a pioneer of liquid biopsy technology, today announced the results of a pooled analysis of 14 clinical trials on the relevance of circulating tumor cell (CTC) count to predict both disease prognosis and treatment efficacy in metastatic breast cancer (MBC). This global study, based on 4079 cases across all advanced breast cancer subtypes, is the largest pooled analysis to-date on the role of serial CTC count in the MBC setting. It included individual patient data and was selected for an oral presentation at the 2020 San Antonio Breast Cancer Symposium.

The analysis was led by Minetta C. Liu, MD, Professor and Research Chair for the Department of Oncology and Consultant in the Department of Laboratory Medicine & Pathology at Mayo Clinic in Rochester, Minnesota, USA and Prof. Prof, Dr med Wolfgang Janni, Professor of Obstetrics, Adult and Pediatric Gynecology of the University Hospital Ulm, Germany. According to Dr. Liu, "This pooled analysis represents an international collaboration including an unprecedented number of multi-institutional clinical trials conducted across Asia, Europe, and North America. Colleagues kindly provided de-identified, individual patient level data from prospective clinical studies published in the peer-reviewed literature to generate a dataset of over 4000 participants. This statistical power allowed us to achieve our main objective namely, to further define and validate the role of CTC enumeration for early monitoring of disease status in patients with metastatic breast cancer, irrespective of subtypes defined by hormone receptor and HER2 status."

Data from this pooled analysis were gathered at baseline and then at a median of 29 days after treatment initiation.Detection, capture, isolation and phenotyping of tumor cells circulating in the blood in all patients was carried out with Menarini Silicon Biosystems' CELLSEARCH CTC System. Results were determined by commonly used log rank and Cox regressions tests. The focus of these statistical analyses was on the association between serial CTC enumeration results and overall survival (OS) in the full patient cohort and defined subgroups. Subgroups included patients with hormone receptor positive, HER2 type and triple negative MBC as well patients whose breast cancer type was not specified. The conclusion across all groups is that patients whose CTC status is negative, both at baseline and follow-up, namely the reference group, have a median OS rate of 47.05 months compared to 17.87 months for those with a positive CTC status at both check points (p-value <0.0001). The importance of conducting follow-up analyses of patient CTCs is underlined by the data from all subgroups because they indicate that patients, whose CTC status went from positive to negative, had an OS of 32.2 months (HR 0.49, p-value <0.0001) an almost two-fold increase in the OS of patients whose CTC status remained positive.

"With the efficacy of novel therapies increasingly linked to the biological characteristics of a given tumor and the urgent need to continue to improve clinical interventions in the metastatic setting, this study strongly supports the potential of early CTC monitoring in all subtypes of MBC to optimize individual patient management along the treatment pathway and thereby improve patient outcomes," further commented Prof. Dr med Wolfgang Janni.

For Fabio Piazzalunga, President and CEO of Menarini Silicon Biosystems: "The results of this large and robust pooled analysis represent not only a major contribution to the expanding body of evidence aimed at validating the role of repeat CTC counts to optimize clinical interventions for the more difficult to treat MBC, they are also a testimony to the importance of developing more sophisticated prognostic/predictive approaches alongside new targeted therapies to reach the ultimate goal of improving both patient outcome and quality of life." As the pioneer in liquid biopsies, Menarini Silicon Biosystems is committed to developing its technology to help physicians identify appropriate treatment strategies in the challenging environment of heterogenous advanced breast cancers and growing number of therapeutic options from which to choose.

About CELLSEARCH

CELLSEARCH is the first and only clinically validated blood test cleared by the U.S. Food & Drug Administration (FDA) for detecting and counting CTCs to aid physicians in managing patients with metastatic breast, prostate, and colorectal cancers when used in conjunction with other clinical methods of monitoring. The test is also approved by the China National Medical Products Administration (NMPA) for use in monitoring patients with Metastatic Breast Cancer. The CELLSEARCH Systemis the most extensively studied CTC technology, with research published in more than 650 peer-reviewed publications.

For more information on the full intended use and limitations of the CELLSEARCH system, please refer to the Instructions for Use athttp://documents.cellsearchctc.com/.

About Menarini Silicon Biosystems

Menarini Silicon Biosystems offers unique rare cell technologies and solutions that provide clinical researchers with access to unparalleled resolution in the study of cells and their molecular characterization.

Menarini Silicon Biosystems, based in Bologna,Italy, andHuntingdon Valley, Pa., U.S., is a wholly owned subsidiary of the Menarini Group, a multinational pharmaceutical, biotechnology and diagnostics company headquartered inFlorence, Italy, with more than 17,000 employees in 140 countries.

Contact: Linda Pavy - [emailprotected]

Logo - https://mma.prnewswire.com/media/1362208/Menarini_Logo.jpg

SOURCE Menarini Silicon Biosystems

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New Global Pooled Analysis Supports Clinical Utility of Circulating Tumor Cell Count for Early Monitoring of Metastatic Breast Cancer - PRNewswire

Want to know the easiest one thing you can do to predict your risk of disease later in life? Take the jiggle test. This easy test can help you differentiate the type of fat on your body, and if your body is holding any of the fat that causes the risk of disease.

Biologically, there's an enormous difference between subcutaneous fatthe stuff that's right below your skin, the stuff that makes up love handles and the likeand visceral fat, which is inside your abdominal wall, wrapped around your internal organs. The easiest way to tell the differences might be this: subcutaneous fat jiggles, but visceral fat doesn't. Subcutaneous fat is fat you can pinch; visceral fat is the solid stuff that makes your gut stick out. And unlike subcutaneous fat, visceral fat isn't just hanging out, keeping us warm. It's a lot more dangerous to our bodies than you think.

Here's why, and for more helpful tips, be sure to check out our list of 15 Underrated Weight Loss Tips That Actually Work.

Visceral fat secretes more than 100 biochemicals, which are collectively known as adipokines. But they ought to be known as adipo-unkinds, because they include such nasty substances as:

Resistin, a hormone that undermines your body's ability to metabolize glucose ad leads to high blood sugar

Angiotensinogen, a compound that raises blood pressure

Interleukin-6, a chemical associated with arterial inflammation

Tumor necrosis factorwhich is as bad as it soundscauses inflammatory issues such as Crohn's disease and various forms of arthritis.

Now, this is a bit different for those that have "pear-shaped" bodies. Studies suggest that subcutaneous fat in your hips and thighs is associated with reduced insulin levels and increased insulin sensitivity (meaning that it actually protects against diabetes). People who are "pear-shaped" and store fat in their hips and thighs also tend to have higher HDL cholesterol (the good kind) and lower triglycerides.

According to the National Institutes of Health, people who carry excess fat around their waists are at a greater risk of dying early from cancer and heart disease. So, the jiggle or pinch test can clue you into the need to reduce your visceral belly fat. An even better test involves a tape measure. Just wrap it around your waist at your belly button so the tape is parallel with the floor. Read it and consider the findings of an analysis of waist circumference and mortality in 650,000 adults published in the Mayo Clinic Proceedings. The data determined that men with a waist circumference of 43 inches had more than a 50% greater risk of death than did men with a 37-inch waist. And women with a 37-inch waist had an 80% higher risk of death than women with a 27.5-inch waist.

For more information on the dangers of visceral fat and a practical guide to getting rid of it, check out my book Zero Belly Diet: Lose Up to 16 lbs. in 14 Days!.

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This One Thing Can Predict Your Risk of Disease, Says Science - Yahoo Lifestyle

Period poops are totally normal, but there are a few things you can do about them.

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Mood swings, cramps and food cravings are just a few surefire symptoms you can expect during your menstrual cycle. But that time of the month often also comes with unpleasant GI side effects like period poops.

Indeed, a January 2014 study in BMC Women's Health found that nearly three-quarters of people with uteruses experienced at least one tummy-related issue during their period, with abdominal pain and diarrhea being most frequent.

We spoke to experts to learn how your period can mess with your poop habits, plus ways you can get your bowels back on track.

Loose poops may predominate when you have your period.

"Diarrhea has been associated with periods due to the increase in prostaglandins [hormone-like compounds] during the uterine shedding," Shweta Desai, MD, a urogynecologist and chief wellness advisor at Love Wellness, tells LIVESTRONG.com.

"While the prostaglandins cause your uterus to contract [and to shed its lining], they also cause the intestines to contract as well, thus leading to increased cramping and diarrhea in some cases," Dr. Desai explains.

2. But You Could Be Constipated

Conversely, your period may back up your bowel movements. Period-related hormones can cause constipation, but the exact mechanism is still unknown, Dr. Desai says.

"There are far more studies in pre-clinical models (i.e. mice, rats) than in humans, but studies have shown that estrogen can decrease gastrointestinal motility," says Lea Ann Chen, MD, a gastroenterologist and assistant professor at Rutgers Robert Wood Johnson School of Medicine.

Here's the thing: High estrogen levels appear to reduce colon transit time i.e., they slow down your poop's travel through your GI tract which can lead to being clogged up, Dr. Desai explains.

"Other studies have suggested that [the hormone] progesterone may play a bigger role in causing constipation," Dr. Desai says. "Regardless of which hormone is the culprit, constipation has been related to the menstrual cycle due to fluctuations in hormonal levels."

3. Food Cravings Dont Help

If you're jonesing for junk food during your period, shifts in your hormones are likely to blame. For example, the neurotransmitter serotonin fluctuates throughout your cycle, and when levels are low, you might experience food cravings, according to the Mayo Clinic.

The problem is, eating lots of sugary and fatty foods may affect your bowel movements.

"If you're experiencing period-related bowel changes, it's important to avoid foods that trigger diarrhea and continue to eat a high-fiber diet in order to avoid constipation," Dr. Desai says.

4. Certain Health Conditions Can Make Things Worse

Certain health conditions can exacerbate period-related bowel changes, Dr. Desai says.

Case in point: uterine fibroids, which are benign pelvic tumors that arise from the smooth muscle cells of the uterus.

"If the fibroid is located close to the rectum, there is a possibility that it can place pressure on the rectum, leading to constipation," Dr. Desai says.

"Also, if you suffer from irritable bowel disease or irritable bowel syndrome, symptoms can fluctuate during your cycle," she adds.

5. Stress and Anxiety Play a Role

The same BMC Women's Health study also found a link between period-related emotional symptoms and stomach complaints. People who had feelings of anxiety or depression during menstruation were more likely to report two or more GI issues. The researchers thought this had something to do with the gut-brain link.

Dr. Desai agrees that emotional factors like stress can affect bowel habits.

"Stress can cause the bowels to slow down, thus leading to increased time for the stool to pass through the digestive tract, which can lead to constipation," she explains.

How to Combat Period Poops

Daily exercise can help reduce stress and keep you regular.

Image Credit: fizkes/iStock/GettyImages

While you might not be able to fully prevent period poops, Dr. Desai offers strategies to help mitigate tummy problems during your menstrual cycle:

The best way to manage period-related bowel issues is to maintain a healthy diet (think: fruits, veggies and whole grains).

Avoid triggers for diarrhea, such as:

2. Add Certain Supplements

Follow a bowel-friendly regimen of probiotics and fiber supplementation to help keep you regular and your stool a good consistency.

If you're not sure where to start with these supplements, ask your doctor or pharmacist to point you in the right direction.

Reducing stress and staying active are also great ways to keep your bowels moving and healthy. Combine the two with stress-reducing exercises like yoga and stretching.

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Period Poops: Why They Happen and What You Can Do About Them - LIVESTRONG.COM

Following the harassment of Christian Cooper in Central Park in May 2020, Black birders created #BlackBirdersWeek to celebrate Black nature enthusiasts and highlight their belonging in outdoor spaces. Since then, dozens of campaigns have emerged to amplify and appreciate Black academics, scientists, and naturalists.

Next up is #BlackInMarineScienceWeek, running from November 29th to December 5th.Led by founder Dr. Tiara Moore and organizers Amani Webber-Schultz, Dr. Camille Gaynus, Carlee Jackson, Al Troutman, Jasmin Graham, Jeanette Davis, Kris Howard, Leslie Townsell, Kaylee Arnold, and Jaida Elcock, this week represents an opportunity for community building and improved representation.

There are few Black folks in ecology and even fewer in marine ecology, says Arnold, a science communicator and disease ecologist. The network that Ive gained through organizing this week is phenomenal. Meeting other Black marine scientists and showing that to the world, especially young Black folks, is a way to say we exist, were here. We have a full day dedicated to young kids, which is unique and exciting.

The organizers hope that the week will help normalize Black folks doing marine research, inspire younger generations, and remind everyone to check their preconceived notions.

"When I say I study sharks people seem concerned about my swimming or my hair, [and] sometimes respond with 'Oh, thats super interesting'... I dont know if that's because it's unusual for people to study sharks or because Im Black and I study sharks, recalls Elcock, an elasmobranch movement ecologist, science communicator, and co-founder of Minorities in Shark Science. Science is for everybody. People say there isn't diversity because [Black] people arent interested... thats clearly not true theres a whole week dedicated [to it]."

Discussion this week will address the fact that exclusion, not lack of interest, led to todays lack of representation. Centuries of segregation and underinvestment in Black neighborhood pools led to, and are perpetuated by, these incorrect and harmful ideas.

My grandparents and my mom said there were just no pools for her to go to... I had a very different experience. Despite people trying to push us out of the water and science, we persevered, and now we get to break down those stereotypes, notes Arnold.

Black in Marine Science Week is here to do just that, showcasing organizers and participants from every imaginable marine science niche, all shaping how society views the oceans and its inhabitants.

There's more Black folks than even we know and are showcasing. I hope that if the media picks up on the number of us as well, and has better representation. Seminar series are extremely white, and now you have a resource of people you can invite instead, emphasizes Arnold, pointing to the necessity of non-Black marine scientists to step up and ensure representation continues beyond this joyous and educational week.

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Dozens of bird and mammal species have been saved from extinction since 1993 - Massive Science

AACHEN, HENNIGSDORF and BERLIN, GERMANY / ACCESSWIRE / December 10, 2020 / The Uniklinik RWTH Aachen ("Uniklinik RWTH Aachen") has successfully translated the collaboration for research and biomarker validation with SphingoTec GmbH ("SphingoTec") into clinical routine. The routine measurements of the innovative biomarkers are providing organ-specific information for monitoring critical care conditions such as sepsis and acute kidney injury and support clinical decisions to improve patient outcomes.

Uniklinik RWTH Aachen is one of Germany's most modern hospitals due to the way it integrates diagnostics and therapy, research and teaching under the same roof. Following a patient-centric approach, Uniklinik RWTH Aachen has adopted innovative pathways in intensive medicine by introducing these new diagnostic tools for monitoring organ function of critically ill patients. The routine measurements of penKid(R) and bio-ADM(R) provide clinicians with more insights on the disease pathology and etiology of clinical symptoms and facilitate more efficient, timely, and adequate treatment.

Prof. Dr. Gernot Marx, the Director of the Clinic for Operative Intensive Care and Intermediate Care at Uniklinik RWTH Aachen explained: "Critically ill patients are highly dynamic with many complications interfering in the diagnostics process, thus a very challenging environment for introducing innovations. We have been looking for a long time for the right diagnostic tools to allow us a faster and better diagnosis, risk stratification, and monitoring of the disease progression so that we can provide the best available treatment immediately for acute cases. The first routine measurements do confirm the utility and value of these novel diagnostic biomarkers in clinical decision-making and ultimately in maximizing the patient's benefit. "

In intensive care units, 1 in 3 patients is developing acute kidney injury [1]. The existing diagnostic parameters for the determination of renal function or kidney damage, which are routinely used as standard procedure, have a considerable time delay or are influenced by inflammation or other diseases. These limitations are underlining the need for more precise tools to support clinical decisions. The biomarker penKid(R) offers real-time information about the kidney function with the first measurement and without being influenced by co-morbidities or the frequently occurring inflammation in critically ill patients [2,3,4]. Moreover, penKid(R) shows the best representation of the current kidney function, measured by the glomerular filtration rate (true GFR). [5]

World-wide, sepsis is accountable for 1 in 5 deaths [6]. Reduced organ perfusion in shock, which can be determined by existing laboratory values, is the culprit for the fatal course, but it can be induced by various factors. The loss of endothelial function is often a main cause for shock in sepsis, but it could not be detected by blood-based tests so far. The measurement of the bio-ADM(R) biomarker now allows for the first time the direct assessment of endothelial function in real time [7,8,9] independent of co-morbidities and inflammation, thus supporting precise and rapid treatment decisions.Dr. Andreas Bergmann, founder and CEO of SphingoTec added: "We are excited that the initial clinical evaluation ended in a successful translation of the biomarkers into clinical routine. The comprehensive amount of routine data on our biomarkers collected by Prof. Gernot Marx and his team will allow us to deepen our knowledge of the biomarkers and to explore further application areas. Encouraged by this implementation of our novel diagnostic tools at the frontlines of medical care, we intend to offer them in a near future on a larger scale in other European countries."

References [1] Ponce et. al. (2016), Acute kidney injury: risk factors and management challenges in developing countries Int. J. Nephrol. Renovasc. Dis., DOI: 10.2147/IJNRD.S104209[2] Hollinger et. al. (2018) Proenkephalin A 119-159 (Penkid) Is an Early Biomarker of Septic Acute Kidney Injury: The Kidney in Sepsis and Septic Shock (Kid-SSS) Study, Kidney Int Rep, DOI: 10.1016/j.ekir.2018.08.006[3] Siong Chan (2018) Proenkephalin in heart failure[4] Beunders et. al. (2017) Proenkephalin (PENK) as a novel biomarker for kidney function.[5] Beunders, R. et al. (2019), Proenkephalin compared to conventional methods to assess kidney function in critically ill sepsis patients, Shock,, doi:10.1097/SHK.0000000000001510(6) Rudd et al (2020), Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(19)32989-7(7) Geven (2018): Vascular Effects of Adrenomedullin and the anti-Adrenomedullin Antibody Adrecizumab in Sepsis. Shock. doi: 1097/SHK.0000000000001103(8) Mebazaa (2018): Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock (AdrenOSS-1) study. doi:10.1186/s13054-018-2243-2(9) Caironi (2017): Circulating biologically active adrenomedullin (bio-ADM) predicts hemodynamic support requirement and mortality During Sepsis. Chest. doi: 10.1016/j.chest.2017.03.035.

Uniklinik RWTH AachenThe Uniklinik RWTH Aachen is a supramaximal care provider that combines patient-oriented medicine and nursing, teaching and research at an international level. With 36 specialist clinics, 28 institutes and five interdisciplinary units, the University Hospital covers the entire medical spectrum. Excellently qualified teams of doctors, nurses and scientists are competently committed to the health of the patients. The bundling of patient care, research and teaching in one central building offers the best conditions for intensive interdisciplinary exchange and close clinical and scientific networking. Around 8.000 employees provide patient-oriented medicine and care according to recognised quality standards. With 1.400 beds, the University Hospital treats around 50.000 inpatient and 200.000 outpatient cases per year.

About SphingoTec SphingoTec GmbH ("SphingoTec"; Hennigsdorf near Berlin, Germany) develops and markets innovative in vitro diagnostic (IVD) tests for novel and proprietary biomarkers for the diagnosis, prediction and monitoring of acute medical conditions, such as sepsis, acute heart failure, circulatory shock, and acute kidney injury in order to support patient management and provide guidance for treatment strategies. SphingoTec's proprietary biomarker portfolio includes bioactive Adrenomedullin (bio-ADM(R)), a biomarker for real-time assessment of endothelial function in conditions like sepsis or congestive heart failure, Proenkephalin (penKid(R)), a biomarker for real-time assessment of kidney function, and Dipeptidyl Peptidase 3 (DPP3), a biomarker for cardiac depression. IVD tests for SphingoTec's proprietary biomarkers are made available as sphingotest(R) microtiter plate tests as well as point-of-care tests on the Nexus IB10 immunoassay platform by SphingoTec's subsidiary Nexus Dx Inc. (San Diego, CA, USA) alongside a broad menu of established and commonly used tests for acute and critical care.

About penKid(R)sphingotest(R) penKid(R) measures Proenkephalin (penKid(R)), a stable fragment of the kidney stimulating hormone Enkephalin. penKid(R) has been demonstrated to be a real-time surrogate biomarker for glomerular filtration rate, the gold standard to assess renal function. Measuring penKid(R) blood concentrations allows for timely information on kidney function in critically ill patients. Early assessment of worsening and improving of renal function on intensive care units and in emergency departments allows adjustment of nephrotoxic drug administration and the initiation of kidney-protective strategies to prevent acute kidney injury and thereby improve outcomes. Learn more about penKid(R) at https://www.youtube.com/watch?v=6SYhs7it4R4About bio-ADM(R)sphingotest(R) bio-ADM(R) measures bioactive Adrenomedullin (bio-ADM(R)), a hormone maintaining endothelial function. The endothelium contributes to blood pressure and separates blood from the surrounding tissue. Elevated blood levels of bio-ADM(R) predict blood pressure break down and leaky vessels resulting in oedema. Imbalanced endothelial function is the major cause of shock ultimately resulting in organ dysfunction and death. Early identification of an imbalance in endothelial function allows guidance of vasopressor and diuretic therapy in critically ill patients to improve outcomes. Learn more about bio-ADM(R) at https://www.youtube.com/watch?v=52lrrRNb0k4

Press contact Dr. Mathias BrandstdterLeitung UnternehmenskommunikationUniklinik RWTH AachenPauwelsstrae 3052074 AachenTelefon: 0241 80-89893mbrandstaedter@ukaachen.dewww.ukaachen.de

Ruxandra LenzSr. Manager Marketing and CommunicationsSphingoTec GmbHNeuendorfstr. 15 A16761 HennigsdorfTel. +49-3302-20565-0press@sphingotec.dewww.sphingotec.com

SOURCE: SphingoTec GmbH via EQS Newswire

View source version on accesswire.com:https://www.accesswire.com/620369/Uniklinik-RWTH-Aachen-is-the-First-Hospital-to-Implement-Sphingotecs-Innovative-Biomarkers-in-Clinical-Routine-with-the-Aim-of-Making-Intensive-Care-Diagnostics-More-Precise

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Winter is here, and this year feels different for a variety of reasons. The ongoing pandemic has many of us reconsidering the usual plans to travel home for the holidays, amplifying the feelings felt during the most stressful time of year. And thats on top of the dread of watching the sun peace out at around 4:30pm every day. While theres not much we can do about the darkness, there are a number of actions we can take to ease Seasonal Affective Disorder, also known as SAD. Here are the best foods for fighting the winter blues naturally.

In most cases, SAD emerges around late fall and early winter every year. According to the Mayo Clinic, symptoms include oversleeping, fatigue, change in appetite (especially cravings for food that are high in carbohydrates), and weight gain. Symptoms may start out mild and get worse as the season progresses.

The exact causes of SAD are unknown, but doctors have an idea of what might trigger it.

In the winter, theres a decrease in sunlight. And its thought that this could cause a drop in serotonin, a brain chemical that affects your mood, Amy Gorin, MS, RDN, a plant-based registered dietitian and owner of Plant-Based Eats in Stamford, CT, tells LIVEKINDLY.

This in turn can trigger depression. Shorter days may also disrupt your circadian rhythm (your bodys internal clock) as well as the bodys level of melatonin, which affects your sleep patterns and mood.

| iStock.

Everyone has days where they feel down, but its important to monitor your symptoms. The Mayo Clinic notes that you should see a doctor when you feel unmotivated to partake in activities that you normally enjoy, especially if youre experiencing the above symptoms or thinking about suicide or self-harm.

Gorin notes that some foods can help lift your mood. but again, seeking professional help is best as the first course of action. Left untreated, symptoms of SAD may worsen.

A reduction in serotonin caused by the winter blues could lead to cravings for carbs, as consuming carbohydrates can increase your bodys release of serotonin, says Gorin. When reaching for carbs, choose fiber-rich options such as oats, quinoa, fruits, and vegetables.

Whole grain rice, pasta, and bread are also choice options. Oh, and potatoes just keep the skin on, as thats where approximately half of the dietary fiber and the majority of nutrients (like potassium and vitamin C) are found. Choosing carb-rich, high-fiber foods has an extra boon: dietary fiber helps maintain bowel health, lowers cholesterol levels, and helps reduce the risk of cardiovascular disease.

Eating protein-rich foods releases dopamine, a neurotransmitter associated with feelings of pleasure as part of the reward system and feelings of motivation. Eating low-fat, protein-rich foods can also give you more energy a huge plus for anyone who struggles with sluggishness in winter. Choose foods that are rich in plant protein and low in fat (i.e., tofu, tempeh, beans, and legumes) and combine them with whole grain carbs like brown rice, whole wheat pasta, and wheat berries, for a filling, energizing meal. (See here for the top vegan sources of protein.)

Blueberries, strawberries, cranberries, and raspberries are rich in vitamin C and antioxidants. That helps control cortisol, your bodys primary stress hormone that puts a stopper on functions that are not essential to the fight-or-flight response to stressful situations. With the exception of cranberries, fresh berries can get pricey in winter, but frozen is just as good (and much less expensive). Add berries to your morning oatmeal and sprinkle it with omega-rich nuts or seeds for a hearty, filling, and mood-balancing meal.

| Natalia Khimich / iStock.

The field of nutritional psychiatry is uncovering the connection not only between what you eat and your overall mental well-being, but also what kind of bacteria lives in your gut, according to Harvard Health. About 95 percent of your serotonin is produced in the gastrointestinal tract. This means that your gut does much more than just digest your meals; it also plays a significant role in how you feel. Studies have shown that following a traditional diet, such as the Mediterranean or Japanese diets, is associated with a 25 to 30 percent lower risk of depression. This is partly because these diets tend to be high in vegetables, fruits, and whole grains and low in meat, dairy, and processed and refined foods.

In addition, many of the foods in those diets are fermented, which helps promote gut health. A healthy gut is home to billions of good bacteria, which protect the intestinal lining from bad bacteria, reduce inflammation, improve your bodys ability to absorb nutrients, and activate neural pathways between your gut and your brain.

Add fermented foods to your diet like sauerkraut (make your own with this jar), kimchi, tempeh, and miso. For tips on making fermented foods at home, see here.

Some research suggests that eating dark chocolate may lower symptoms of depression. Theres also that old anecdote that people with periods crave chocolate during that-time-of-the-month because of its mood-boosting abilities. According to Harvard Health, you should choose 70 percent dark chocolate or higher in order to obtain the most flavanols, an antioxidant found in cocoa, red wine, and blueberries.

Dark chocolate also has anti-inflammatory benefits and may help improve mood and lower stress levels, says Gorin.

Although theres no definitive proof, a big mug of dairy-free hot chocolate certainly cant hurt on a dreary, chilly day.

On a final note: In addition to food, Gorin notes to get moving. Exercise does wonders for lifting your mood. Find what kind of movement brings you joy whether thats yoga, running, or bike riding.

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How to Reduce the Winter Blues With Plant-Based Food - LIVEKINDLY

Gambling addiction is a clinically recognized problem that requires special therapy and medical intervention in most cases to achieve full recovery. The premise of gambling is simple you risk something you have in the hopes of adding to the value of your original stake.

However, by repeatedly engaging with products recognized as gambling, many people are prone to developing gambling addiction or showing symptoms of compulsive gambling without realizing it. If you find yourself addicted to gambling, this article is your path to recovery and understanding pathological gambling better.

The official gambling addiction definitionstates that an individual must experience an uncontrollable urge to gamblewith increasing amounts despite the high risk involvedand possibly serious consequences for ones own well-being or the well-being of family members, friends, and loved ones. Gambling can be addictive because it targets the brains reward system and leads to the release of dopamine, the hormone connected with happiness.

However, not all people are at risk of developing compulsive or pathological gambling. In fact, most people are able to resist, but a good number of people are experiencing problem gamblingor are at risk of becoming compulsive gamblers themselves.

Today, gambling addiction or compulsive gambling is a mental health issue, and the addiction at its core is equated to abuseof substancessuch as alcoholand drugs. Gambling affects more men than women, but it is a genderless disorder with a high incidence across the human population. Different countries around the world recognize gambling addiction as a serious mental problem that needs specialist intervention.

The term compulsion used to describe an independent aberration but today compulsive gambling is equated to or synonymous with gambling addiction.

Problem gambling begins discreetly and privately. In most cases, an individual is unaware that they are developing an addiction to compulsive gambling right to the point where the condition starts interfering with day-to-day chores and responsibilities. Anxietyor depressionis another concomitant symptom of burgeoning or pathological gambling addiction. Similar to other addictions, as in the case of substance addicts who overuse drugs or alcohol, problem gambling is driven on by a chemical component in the brain.

Compulsive gamblers feel rewarded for pursuing an activity that feels good, but this feeling of elation or high, is connected to a chemical response from the brain which floods the frontal cortex with dopamine. Addictive substances may trick the brain into releasing these hormones that are ten levels above normal levels.

Studies have established that gambling products can elicit the same chemical response from peoples brains, leading to high-dopamine production and spiraling into problem gambling without the knowledge of the individual.

Impulsivity and reward-seeking behavior become norms without explanation and perfectly ordinary individuals begin to behave as problem gamblers, showing symptoms and signs of gambling addiction that appear almost without a warning. Today gambling addiction is also referred to as gambling disorderand it encompasses an effort by the scientific community, including the American Psychiatric Association, to establish the reasons behind addictive behavior, in gambling and beyond.

By now, research has shown that addicts, regardless of their chosen form of addiction, whether that is substance abuse problems or gambling products, have a genetic predisposition that gives insight into how these problems develop, evolve, and how they can be eventually treated to the benefit of problem gamblers. Gambling is officially recognized as an impulse control disorderand this is good news because treatment professionals are tasked with making feel better. But first, they need to know how to read the symptoms.

Gambling addiction in patients tends to be approached differently. To start helping, though, experts must first identify gambling addictionsignsand symptoms, which is essential to getting an early start in treatment. These symptoms will vary between individuals in terms of intensity and some may remain hidden until very late in the addiction.

From the standpoint of most problem gamblers, gambling addiction is described as a complete loss of controlover the individuals ability to control spending habits, even though the potentially ruinous consequences are well-understood by the majority of pathological gamblers.

Therefore, problem gambling will always pivot around core behavioral aberrations that can be predicted, studied, and counterweightedin therapy or by the individual themselves depending on how advanced the compulsion is.

To spot a symptom, you may use our manual, which will help you help determine if you are currently showing compulsive gambling symptoms to a point where they need professional help.

Even if you are not a problem gambler, it is always important to monitor your condition, especially if you have a history of substance abuse in your family or recognize addictive patterns in your own behavior. Here are several points that constitute symptoms and signs of gambling addiction.

Thanks to clinical experience and government-funded research, we understand the downsides of gambling a little better. Moreover, studying gambling has allowed health expertsto come with a very detailed breakdown and create accessible help materials that will assist you in identifying a problem if there is one. More importantly, remember to answer truthfully to the following questions for accurate results:

The National Healthcare System (NHS) in the United Kingdom recommends using a four-answer system where you will score differently based on your answers. Your answers should be never, sometimes, most of the time, almost always and you should score 0, 1, 2, and 3 for each respectively. If your score is higher than 8, the NHS suggests that you may be a problem gambler or you may have a gambling addiction.

Pathological gamblingis not an easy thing to deal with, and this is why governments continue to spend money on research and to fund specialist clinic centers. While some individuals may find it easier to distance themselves from compulsive gambling, for others fighting addiction is a life-long struggle.

Compulsion has a powerful pull and most health experts try to find a way that individuals can stay away from temptation, and resist your craving to gamble. With this said, stopping gambling is easy, but replacing it with a positive, constructive emotion can take time, effort, and grit.

The good news is that despite the difficulties, maintaining recovery is very possible, although it may require lifestyle changes and constant effort of will on your part. Certain pathologies, such as mental disorders, can be channeled into something positive. Start small and remember that exerting control over behavior is essential to long-lasting effects. Self-help is a good place to start, but you may seek professional help over time.

When you are a diagnosed gambling addict, the best thing you can do is to stop gambling. To do so, you must put some distance between gambling products and yourself. However, this is difficult at a time when the Internet makes it very easy for gambling firms to have targeted outreach through data use. Because of this, gambling companies know exactly who wishes to gamble based on social media and browser history.

Thankfully, there is a solution. You can put considerable distance between yourself and temptations. Avoid searching for gambling, and channel addiction elsewhere. Flag every ad you get on social media or Google that targets you, explaining that you are a recovering gambling addict and such content must not be displayed to you.

Avoid visiting casinos, whether in person or online and ask your friends and family members to respect your wishes in not bringing topics that are associative with your gambling addiction or that may trigger a strong urge to gamble.

Gambling addiction can be controlled by a system of checks and balances whereby you create a social circle that will help you keep yourself in check. Networking and joining groups with other people experiencing the same issues as you are, or better yet, who have recovered completely, is a good way to begin your recovery.

In addiction vernacular, individuals who take care of struggling addicts are known as mentors. Peer groups can have a strong and positive influence on your life, creating a sort of achievement system which you want to unlock, and that influences your life for the better.

When the desire to gamble becomes too strong, make sure to reach out to family, friends, or your designated mentor. Relapses are common, so do not beat yourself up if you do happen to give in on occasion, but know that your recovery depends on unwavering determination.

Because addiction takes time to tackle, and then effort and consistency to maintain recovery, many people create if-scenarios where they agree to complete a certain part of their treatment if they are allowed to experience the subject of their addiction.

Such if-statements are dangerous and they do not address the issue at hand, but rather postpone the urge to gamble and lead to pent-up desire to play. The best way to deal with any compulsive or pathological gambling is to be aware of your situation and not predicate your recovery on future rewards.

In todays world, avoiding exposure to gambling productscan be difficult. Clever algorithms target you to the point where you almost cannot avoid running into a piece of advertisement, regardless of the medium that is used to deliver the message. However, this is where smart and powerful self-help tools come in handy.

Online gambling may seem all-pervasive, but advanced gambling markets have rolled out solutions that will literally block your access from every licensed operator in the country that is part of the exclusion program. Such programs exist in all European regulated markets, the United Kingdom, the United States, and Australia.

They are admittedly developed better in some regions than others, but ultimately they are used to treat pathological gambling. Governments still have to put more effort into helping gambling addicts, but the good news is that considerable efforts have already been made.

Gambling addicts have many ways out of this difficult position. The main challenge addicts face has to do with the fact that they are reluctant to admit they have a problem. Forcing therapy or treatment options on individuals rarely work, as an addict much more likely to resist help unless they have opted into it.

To this end, all recovery and treatment processes are predicated on the willingness of participants. An individual who acknowledges that they have a gambling problem can start experimenting with ways that allow him or her to control their failings.

Cognitive-behavioral therapy is a good approach to mental health. The therapy is predicated on finding the underlying reason for your behavior and why certain things trigger you. Most commonly, the conclusion is that certain experiences elicit a stronger response in your brain that sends a dopamine rush.

By teaching yourself to study, analyze, and understand these individual bursts of hormones, you can master and model your behavior in a way that is positive and healthy. There are many private and government treatment centers that offer this type of therapy.

Sometimes, an individual may experience a range of mental health problems that relate to and tie into gambling addiction. In fact, conditions such as OCDand ADHDmay be the originator of negative emotions that make you seek validation or quick thrill by engaging in reckless gambling behavior. Therefore some mood stabilizers and anti-depressants can go a long way in helping you deal with your gambling problem. Remember to not resort to medication on your own and seek professional help.

Self-help for gambling addiction is becoming very popular. Some people prefer to try and deal with the issue on their own. This is a perfectly valid approach and individuals who are strong-willed and in the habit of addressing their behavior analytically stand to benefit. Joining peer groups is a way to have a natural self-check and

Relapses are a problem gamblers bigger fear. Unfortunately, they also happen quite often, which is not in itself something to be worried about. Mental health and achieving a healthy mindset towards your gambling problem are important, and a relapse is not an end of your road to recovery.

Just the opposite, you need to develop the right attitude towards this momentary setback. Instead of hiding it, fearing stigma the same way you probably first hid your gambling addiction, its best to open up to a loved one, your support group, or a health specialist.

Dont let the cravings simmer and fester. Talk out your issue or urge to gamble with someone whom you trust and who has proven a moral bulwark for your recovery. The support of people whom you have come to trust and appreciate is essential to genuinely pushing past your addiction.

If you do relapse, dont spend too much time agonizing over this. It happens, and the fact you feel guilty means that you are advancing in your recovery. Talk out what you have achieved by relapsing and whether it was worth it.

Compare how you felt during recovery with how you felt when you satisfied your urge. More often than not, you will establish that your addiction is now physically and mentally unpleasant and your desire to gamble is much lesser than before you started treatment.

Relapses arent too bad when they happen, and if anything, they are a quick reality-check if your treatment is working.

Addiction simply means that you have enough energy and determination, notwithstanding the chemical factor involved. You can channel your determination to pursue an activity into something that has a far more beneficial effect on you.

Of course, moderation will be essential, as the goal is to master addictive behavior, not encourage it in one form or another. You can take up any hobby that has to do with sports, music, art, books or anything you wish, really.

Even 15 minutes of exercise a day can help you achieve much better mental health. Exercise releases dopamine and boosts your cognitive and mental abilities, leading to a healthier lifestyle free of cravings to achieve momentary satisfaction.

Remind yourself that your pursuit of the almighty dollar is illusionary and that gambling is rigged and statistically stacked against you. You cannot realistically expect the win simply because the odds are against you, and this is always the case.

Who is at a risk to develop a gambling addiction? Gambling problems come in many forms, but understanding the type of personality that it would take to go over the tipping point is important to understand impulse control disorders in the first place.

Common risk factors are now identified, but they are by no means final or a blueprint. However, gambling studies have proven with a fair degree of accuracy that there are several ways to understand who is the most at risk from pathological gambling.

Maybe you have been told that you ought to hide your gambling problems for the sake of decency. Perhaps that used to be right, but support and reaching out to others is the best way to tackle gambling addictions.

Today, treatment professionals encourage their patients to share stories so that people who are only beginning to deal with their issues may know they are not alone. While your suffering may seem personal and exclusive, your emotions are universal and human, and by sharing, you can cope and move on with your life.

No problem gambling story should be buried or covered up. By opening up, you will be helping others to see a way out as well as assist researchers and professionals who are genuinely concerned to study and understand problem gambling and a gamblers mind closer. All this health information can be put to good use.

To convince you that you are not in this alone, we have put together the stories of people whom you may know, but to whom you will feel a unique connection after hearing about their own experience with gambling. Read the personal gambling stories of people who have been through the crucible of problem gambling:

Pathological gamblers need help to address a gambling problem. This can be a loved one or trained medical professionals, a helpline, or a peer group. Whatever your choice and approach to tackling gambling addictions, you can rest assured that help is readily available.

Pathological gambling is a condition that should be taken seriously and deserves the attention of health experts. Thankfully, attitudes towards problem gamblers have evolved and your struggle is recognized as a valid medical concern.

With the help of your family, friends, peer groups, a helpline, or treatment facility, you can make sure that you deal with your impulses and control your cravings.

By following your healthcare professional advice and building a safe environment for yourself, you can not only learn to live with gambling addiction but outlive it. You can do better, and your friends, family, and people you love believe in you.

Problem gambling, also known as compulsive gambling, pathological gambling, or gambling addiction in laymens terms, is a mental health issue that affects close to 0.5% of the population. Its characterized by the compulsive need to spend money on gambling and gambling without a stop.

Yes, gambling addiction is a type of impulse control disorder and is a recognized mental health problem. Sufferers cannot control themselves from making potentially perilous decisions that impact their livelihoods, mental, and physical well-being.

Find a therapist, use self-exclusion tools, and join a support group. Fighting gambling addiction and avoiding relapsing is a lifetime battle. With proper nurturing and guidance, you can avoid returning to pathological gambling, though.

Healthcare facilities, free clinics, non-for-profit organizations all offer help in dealing with problem gambling. Pathological gamblers can find numerous organizations willing to help, including GamblersAnonymous, GamCare, GamStop, and more.

Cognitive-behavioral therapy, peer groups, gambling addiction treatment programs are among the most popular choices. Self-help is another viable option with free clinics offering pro-bono help to problem gamblers.

Gambling addiction begins with anxiety, overspending, and constant preoccupation about gambling games. Individuals experiencing gambling addiction may lie to, borrow, or steal money from friends, family, and employers to fuel their habit.

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What Is Gambling Addiction and Problem Gambling? - GamblingNews.com

NHS England has now ordered a full clinical review of each GIDS patient offered puberty blockers under the age of 16. I was told privately by some the case was hopeless, that the bar had been captured by transgender activists, that institutions had been captured by ideologically driven charities, says Evans. Certain trans groups have really cultivated an atmosphere of fear among children and their families. But Im just very relieved and obviously pleased with the ruling.

Evans has worked for the NHS her entire life, and met her husband, Marcus, who was also in the field of psychoanalytic practice, when training in Springfield Hospital in Tooting Bec, south-west London. What drew me to therapeutic practice was trying to understand the internal emotional worlds of other people, she says, because with understanding comes an improved experience of life. I had an instinct that drugs and physical treatments were never going to provide an answer for people in emotional distress.

When Evans started at the Tavistock in 2003, she was proud to be working in a tiny team at a pioneering organisation. But on hearing a colleague describe how, after only a few assessments, they had referred a distressed 16-year-old boy who thought of himself as female for hormone treatment, her jaw dropped. She recalls feeling something was very, very wrong with the GIDS approach.

In her early years as a psychiatric nurse, she had witnessed treatments, such as electroconvulsive therapy, that are now widely condemned: I know enough of the history of psychiatry to always be cautious about intervention.

Evans had assumed she would be able to use her psychotherapeutic skills to support the scores of children referred each year. When she raised the possibility of alternatives to medication, Evans was advised the service would not have any patients without the offer of puberty blockers. Last year, GIDS had 2,590 children referred for them, compared with 77 patients a decade ago.

Evans began to become concerned by the influence of transgender organisations on clinical practice at the Tavistock. It was becoming increasingly difficult to discuss the needs of the patients who displayed clinical curiosity. The beginnings of the more affirmative model of care [whereby the cross-sex identity of a child with gender dysphoria is affirmed by referring to the child as if it were the opposite sex]were taking root.

To this day, Evans believes this practice has not been proven to alleviate mental distress, and that its use within the GIDS is based on political pressures and fears of litigation, rather than what would be clinically, professionally appropriate.

Back in January, Evans launched a crowdfunding campaign with Mrs A to cover legal costs for the judicial review. Immediately, she received letters from distressed parents who had been told that they were at fault when their children had harmed themselves.

Due to personal circumstance, Evans withdrew, passing on her role as claimant to Keira Bell, who was prescribed puberty blockers by GIDS when she was 16. She had a double mastectomy aged 20, and now regrets transitioning, which has left her with no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered. She may well be infertile as a side effect of the drugs.

More than a decade after she had walked out of the Tavistock, Evanss husband convinced her to push for a judicial review about some of the practices both had witnessed there.

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As the latest wave of coronavirus disease 2019 (COVID-19) rises, the first day of the San Antonio Breast Cancer Symposium 2020 opened up with a session that examined how the pandemic is disproportionately affecting care for minority patients.

Deborah Doroshow, MD, PhD, assistant professor of Medicine, Hematology, and Medical Oncology at the Tisch Cancer Institute, opened the session with an anecdote from April when she was doing rounds at the institute and met a Black woman in her 60s who was hospitalized for COVID-19. Three years prior, the woman had undergone a lumpectomy and radiation for hormone-positive breast cancer; she was currently on hormonal therapy with an aromatase inhibitor.

While in the hospital, the patient was growing short of breath and showing signs of being tachypneic and hypoxic; this led Doroshow to ask a rapid response team for high-flow nasal cannula. However, Doroshow was met with a response of, She was a cancer patientwhy be so aggressive?

The response, said Doroshow, rasied a larger question: What role might gender and race also be playing here?

Its well documented that race and ethnicity carries weight when it comes to outcomes across a myriad of conditions, and COVID-19 is no exception. Doroshow gave the example of a 3600-patient cohort from Louisiana, of which Blacks accounted for 70.4% of the COVID-19 infections despite representing less than one-third of the population.1 Similarly, among 28,000 tested patients in New York, 6000 tested positive for COVID-19, with Blacks accounting for nearly 1 in 4 infections and Hispanics accounting for 29% of infections while representing 19.2% and 12.8% of the population, respectively.2

Data from the CDC show that American Indians/Alaskan natives, Blacks, and Hispanic/Latinos are at higher risk of developing COVID-19, being hospitalized for the virus, and dying from COVID-19 infection.3 However, the agency does note that race/ethnicity are risk markers for other underlying conditions that impact health, such as socioeconomic status and access to healthcare.

Now, enter cancer. Having cancer or a history of cancer alone leaves a patient is at significantly higher risk of dying if they are infected with the virus. Data from nearly 4000 patients included in the COVID-19 and Cancer Consortium showed that 30-day all-cause mortality hit 14% overall and 23% among those hospitalized with the virus.4

So, both race/ethnicity and cancer on their own are associated with poorer COVID-19 outcomes, but what happens when you combine the 2?

Doroshow is an investigator in the COVID-19 and Cancer Outcomes Study, a multicenter, prospective study looking at the impact of the pandemic on cancer care delivery and outcomes among patients with active cancer or a history of cancer. The study includes 2300 patients who visited Mount Sinai Hospital or Dana-Farber Cancer Institute between March 2 and March 6, 2020. The team of researchers performed a 3-month retrospective analysis going back to December 2019 (baseline period), as well as a 3-month prospective analysis going through early June (pandemic period).

What they found was Black and Hispanic patients were less likely to have telehealth visits and were far more likely to be diagnosed with COVID-19, with an odds ratio of 1.86 and 3.19, respectively. When looking at pandemic-related delays in cancer care, Hispanic patients were far more likely to delay care, while Black patients had a trend toward this.

Why these disparities? questioned Doroshow. One can certainly point to a variety of factors. One might say that increased vulnerability to COVID could be related to the fact that minority patients are more likely to be frontline workers or perhaps to live in multigenerational homes. Could the possibility of poorer outcomes be related to poorer baseline health or disparities in health literacy or insurance, leading patients to seek care later on?

With a focus on the continuity of care, Doroshow outlined several focus points for closing these disparities. She argues providers should not assume all patients:

We must be persistent in not losing out most vulnerable patients to follow up, urged Doroshow. Ask about living and social situations; educate and support safe public health practices to the extent they are possible; provide nonjudgmental, supportive education; help our patients get to the clinic and stress the importance of not delaying urgent care; ensure telehealth is provided to patients who are able to participate fully and who are open to this mode of care; and ask of patients what they need from us.

References

1. Price-Haywood E, Burton J, Fort D, Seoane L. Hospitalization and mortality among Black patients and White patients with COVID-19. New Engl J Med. 2020; 382:2534-2543.

2. Wang Z, Zheutlin A, Kao Y, et al. Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records. BMJ Open. 2020;10(10):e040441.

3. COVID-19 Hospitalization and Death by Race/Ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Updated November 30, 2020. Accessed December 8, 2020.

4. Assessment of clinical and laboratory prognostic factors in patients with cancer and SARS-CoV-2 infection: The COVID-19 and Cancer Consortium (CCC19). Presented at: ESMO 2020; September 19-21, 2020. Abstract LBA72. doi: 10.1016/annonc/annonc325

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By Rich Larson, News Director

The Northfield Public School District has announced that they have terminated an employee of the Early Venture Childcare Center for administering melatonin to at least one infant without consent of that childs family.

Northfield Public Schools Superintendent, Dr. Matt Hillmann said that, once alerted, the district moved swiftly to investigate.

We know that she placed at least one tablet into the bottle of an infant, and possibly others. And so, we consulted with the Northfield Police Department on Wednesday, who suspect that its a child size dose of Melatonin. And of course, we made the appropriate reports to the Minnesota Department of Human Services as well as Northfield Police Department. And [on Wednesday] we did terminate that employee based on the investigation results. We have no evidence that anyone else was involved.

Hillmann also said that the district will offer help and resources to the families of the victim,as well as the other children enrolled with EarlyVentures.

Were going to be providing support for those families. Thats the sense of urgency we have right now, to make sure we are supporting those families in that classroom. Theyre going to have access to parent educators and medical personnel to help provide them with education and support.

We just cant emphasize how angry and appalled we are as a district that an employee would violate the trust that parents put in us every day to care for their children.

According to the Mayo Clinic, Melatonin is a hormone that plays a role in sleep and is commonly used to treat sleep disorders such as insomnia and jet lag.

Dr. Hillmann acknowledged the breach of faith that this incident may have caused and said that the district will work very hard to meet the communitys expectations.

We understand that an incident like this diminishes trust with our families, specifically the families involved. And we will work as hard as we can to rebuild that trust with those families and our community.

Early Ventures is achildcarecenter for infants, toddlers and preschoolers that is licensed by the Minnesota Department of Human Services and operated by the Northfield Public Schools. Dr. Hillmann said Ms. Woodcock had been employed there for four years.

Rice County break up theft ring

Rice County law enforcement has announcedthat they have broken up a theft ring that was involved in more than 20 different burglaries across the state.

Authorities said Troy Thomas Cook and Angela Michele Degrood, both of Faribault have been taken into custody after stolen property was discovered at their home. Both areCHARGEdwith receiving stolen property, additionally, Cook is charged with Ineligible Possession of a Firearm and 5thDegree Possession of a Controlled Substance.

On November 25th, members of theRice County Sheriffs Office, the Faribault Police Department and the Cannon River Drug and Violent Offender Task Force executed search warrants at 1016 Division Street West in Faribault and discovered a stolen residential water heater, a stolen arc welder, and an oxygen and acetylene torch. Further investigation led the authorities to property that they say was involved in more than 20 different burglaries across the state. Rice County Sheriff Troy Dunn said much of the property recovered was high quality equipment.

Everything from hand tools theamountof tools they recovered was unbelievable. There were very expensive tampers that you would use prior to putting down concrete. There were auto levelers, the things that landscapers and construction companies use to make sure that the grade is level, which are GPS equipped.

Dunn also commented on the work done by the detectives, investigators and agents involved in the case, calling them tenacious, and explaining why stopping an operation like this one is so important.

Some calls come into my office sometimes, say Sheriff I need to report a theft or a burglary. And we talk to these people. Our investigators share this with [thieves and burglars] when theyre arrested: youre not only stealing peoples items,youretaking away their feeling of security. Kids cant sleep. They run into theirparents room at night because theyre afraid somebodys going to break into their house and steal something. When you think of it that way, youre doing more than just stealing someone elses property. You are taking away someones sense of security and affectingthirquality of life.

If found guilty, Degrood is facing 5 years in prison and a $10,000 fine.

With the additional charges and his prior history, Cook is facing a fine of as much as $50,000 and 25 years in prison.

Big Woods park closed for special deer hunt

And the Big Woods State Park will be closed this weekend due to a special deer hunt that will take place in the park.

The DNR announced last month the park would close on December 5th& 6thin order to facilitate a special hunt designed to manage the parks deer herd and protect its natural resources.

Too many of one animal or plant species in an area can start to throw off the balance of other species in that area, said Tavis Westbrook, natural resource program coordinator for the Minnesota DNR. When there are too many deer in a park, they feed too much on certain trees and native plants, so occasionally we allow deer hunts as a way to thin the herd.

The hunt is open to firearms, muzzle loaders and archery, however the deadline to apply for a permit for a special hunt like this one has long since passed.

Big Woods State Park will resume regular hours of operation at 8am on Monday.

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Northfield school district employee terminated for unauthorized treatment of infant; Rice County law-enforcement breaks theft ring; Big Woods State...

PCOS is "a hormonal disorder common among women of reproductive age," the Mayo Clinic notes. "Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs."

In Keke Palmer's December 2020 Instagram share, in which she revealed she's been suffering from the disorder her "entire life," she also explained how she finally found out what she's been dealing with after numerous acne treatments failed.

" ... It took ME taking a personal look into my family that has a history of diabetes and obesity, to understand what was ACTUALLY happening with me," she divulged, explaining that she "did the research" and took her findings to a doctor, which led to "a proper diagnosis" of PCOS.

"I'm not saying trust web md for everything haha," Palmer joked, "but what I am saying is no one can help us like we can help ourselves." There's nothing like being your own advocate, and in Palmer's case, her deep dive into her medical history led to an important discovery about herself.

Read more from the original source:
How Keke Palmer found out the truth about her PCOS - Nicki Swift

This article was originally published here

J Turk Ger Gynecol Assoc. 2020 Dec 4;21(4):272-278. doi: 10.4274/jtgga.galenos.2020.2020.0119.

ABSTRACT

Coronavirus disease-2019 (COVID-19) has reduced the availability of health resources which will affect treatment of gynecological cancers. The present study aimed to provide a treatment protocol for patients with gynecological cancers during the global COVID-19 pandemic. International databases with keywords of COVID-19; Severe Acute Respiratory Syndrome; Middle East Respiratory Syndrome; gynecologic cancer; cervical cancer; and vaginal cancer, vulvar cancer, ovarian cancer, endometrial cancer, tumor, elective surgery, chemotherapy, radiotherapy, cancer, guideline, guidance, women, management, outpatient clinic visits, and triage were comprehensively searched. All the obtained guidelines were studied and the contents were summarized. During the COVID-19 pandemic, early stage endometrial cancer was preferably treated with hormone therapy while radiotherapy was given in preference in later stages. Cervical intraepithelial neoplasia 3 and high-grade squamous intraepithelial lesions should be treated immediately after diagnosis using at least a loop electrosurgical excision procedure while any major surgery should be postponed by 10-12 weeks. In the early stage of cervical cancer, surgery may be delayed by 2-4 weeks, and radiotherapy prescribed for the intervening period. In cases of an ovarian mass with negative tumor markers, no sign of cancer on imaging investigations, no ascites, a low serum CA-125 level, and no papillary projection or vegetation in the base of the cyst, the patient may be given hormone therapy for 2-3 months. In cases of newly diagnosed confirmed ovarian cancers, surgery should be performed as early as possible (maximum: 2-3 weeks). Vulvar and vaginal cancers can be treated within 10-12 weeks of diagnosis, but radiotherapy should be given in preference in this situation. A molar pregnancy is an oncological emergency for which a suction curettage is mandatory; the patient must be monitored for metastases. Information concerning the choice between open or laparoscopic surgery is limited. Given that any patient may be an asymptomatic carrier of the coronavirus, major surgery should be preceded by chest computerized tomography, with and without contrast medium, in order to detect lung lesions. Evidence concerning these recommendations is limited because of the novel and unknown nature of the COVID-19 pandemic. Furthermore, data pertaining to ethical debates about delayed treatment and treatment approaches deviating from current guidelines are also limited.

PMID:33274617 | DOI:10.4274/jtgga.galenos.2020.2020.0119

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Gynecological cancers and the global COVID-19 pandemic - DocWire News

Being sleep deprived is hard for parents of a new baby, but very young kids typically dont sleep long stretches at night. iStock / Special to On the Minds of Moms

Other than warming our hearts, infants and very young children spend more time sleeping than doing anything else. The American Academy of Sleep Medicine recommends children 4 months to 12 months get between 12 and 16 hours in each 24-hour period more than half the day. Before 4 months, there's a wide range of normal so the general advice is to let them do what it seems like their little bodies want to do, since sleep is integral to all the work of growing their bodies and developing brains.

Very young children aren't supposed to sleep through the night, or even for more than a few hours at a time for the first several months of life. Waking is usually a sign of another biological need, such as food or a diaper change. During the night, the simplest way to get them back to sleep is simply to take care of their needs quickly and quietly without turning on the light if possible and get them back to bed.

Studies show that having a nightly bedtime routine is associated with better sleep in children of all ages. For babies, that routine can be as simple as a few minutes of rocking and sharing a favorite lullaby.

Tots who are learning more about boundaries and control can start taking a more active role in their bedtime routine at this age. iStock / Special to On the Minds of Moms

When your baby gets a little bigger, routines are still very important, but they'll want to have more power over things in their life. At this age they're starting to test boundaries, so giving them control over small choices around sleep like what book to read, which side of the bed to put their head on or which stuffed animal to to snuggle. This helps them feel like they have some authority while avoiding power struggles which we all learn eventually that no one really wins.

At this age, kids should be sleeping between 11 and 14 hours a day, including two naps a day at the start of this period, dropping to one nap a day as they turn 2.

Night terrors start appearing in some children around this age. Kids may wake up screaming, unable to properly communicate. Experts recommend doing your best to quietly soothe your child, keep them in bed and help them get back to sleep. Usually children don't wake up fully during night terrors or remember them in the morning. They can be frightening for parent and child, but are generally normal. If they're frequent or are causing daytime sleepiness, talk to your pediatrician.

Preschoolers tend to stall the bedtime process, but there are ways to make things go smoothly. iStock / Special to On the Minds of Moms

We all know it when we see it tantrums, emotions running high and hyperactivity. Its what a lack of sleep looks like in a preschooler. When they dont get the recommended 10 to 13 hours of sleep in a 24-hour period, thats when these fun times can rear their ugly heads. While we make our best attempts at getting those squirrly littles safe and sound asleep at a decent time, there are often many hurdles to jump through: the bathroom breaks, the unquenchable Im- going-to-die-if-I-dont-get-a-drink thirst, and the just one more thing pleas.

We get it. Were all tired from a full days worth of adulting, but throwing in the towel here may have some drawbacks because its not only about preventing a bad day. A lot of functions important to growth, health, memory and cognitive development happen during sleep. Nerve cells are rewired, muscles are restored and human growth hormone is released.

Basically, kids need their sleep so they can grow and learn at an optimal rate. If your kid is dealing with some serious FOMO during bedtime that keeps them springing out a bed for just one more thing here are a few things to try:

Prep the brain by turning off screens about one hour before bedtime.

Create a calm environment. As bedtime nears, dim the lights and choose relaxing activities, such as reading or talking.

Stick to a consistent sleep schedule throughout the entire week. Yes, even on weekends, as much as possible.

Involve them in planning their bedtime routine. Whatever relaxing activities you choose to make part of their bedtime ritual, be sure to explain the rules, e.g. number of books, time limits, etc.

Kids age 6 to 9 still need a good amount of sleep, which may require some experimentation before you find the right amount for your child. iStock / Special to On the Minds of Moms

These are some big years for big kids. Theyre becoming more immersed in the large world around them, which means theyre also experiencing more learning, social and emotional challenges than ever before. All the more reason getting the American Academy of Sleep Medicines recommended nine to 12 hours of sleep a day is important.

According to AASM when kids are able to regularly get this amount of good quality sleep their attention, behavior, learning and memory operate at optimal levels. And like everyone else, their quality of life as well as overall mental and physical health are enhanced. Good, ample sleep is like setting the stage for their success.

So how do you know when your kids arent hitting their sleep sweet spot? Here are some signs to look out for from the Cleveland Clinic:

You need to awaken your child three to four times before they actually get out of bed.

Your child tells you they're tired during the day.

They need catch-up sleep on weekends.

They fall asleep during the day.

If these sound familiar, work toward getting back on track. Start bedtime earlier by about 15 minutes per day until you hit the right amount of sleep per night for your child. Also, be sure to stick to a similar schedule on the weekends, staying within the same wakeup and bedtime by 30 to 45 minutes. If you havent already, this may be a good time to start using an alarm clock. And finally, consider a relaxing bedtime routine, which can be helpful for anyone at any age really.

It may sound crazy, but tucking in your tweeners is still a great habit to set the stage for quality sleep. iStock / Special to On the Minds of Moms

This can be a busy time for kids this age, as school activities pick up and homework gets to be more of an actual thing. But parents should not let up on insisting on nice, early bedtimes because while they might seem a little bit old to do the traditional tuck-in, their growing bodies and brains still desperately need that good, quality sleep.

According to the sleepfoundation.org, tweeners require 9-11 hours of sleep per night. And while grumpiness and grogginess will certainly follow a night of inadequate sleep, thats the least of the worries. According to experts, children who do not get enough sleep on a regular basis are at a much higher risk of developing anxiety and depression. And what are kids this age often doing later at night anyway when they should be in bed? They might be sitting on their phones, which can not only contribute to depression and anxiety due to excessive social media, but the screens emit a blue light that stimulates the brain, making it even more difficult for children to fall asleep. Having them put the phones up in the kitchen and tucking them in like theyre little can do wonders for kiddos this age.

Inadequate sleep can also hit children physically in terms of weight gain. Studies show that when kids dont get enough sleep, it disrupts their hormone levels, which regulates appetite and food intake. This can lead to overeating and a craving for sugar and bad carbs. Moral of the story? Tuck them in. You read that right.

Its a common stereotype assigned to teenagers in movies and TV shows. They emerge from a messy bedroom, yawning and running fingers through disheveled hair oblivious to whats going on in the world. Hilarity ensues when mom or dad crack wise about the teen sleeping all day.

The truth is teenagers do need more sleep than the average adult. But despite what Hollywood implies, most teenagers are not getting enough of it.

The American Academy of Sleep Medicine has recommended that teenagers aged 13 to 18 years should sleep 8 to 10 hours per 24 hours. However, in a 2015 survey, the Centers for Disease Control found seven out of 10 teenagers were not getting the minimum eight hours of sleep a night.

If the lack of sleep only meant a few extra yawns at the breakfast table, it would be no big deal. However, doctors say teens who dont get enough sleep have a higher risk of obesity, diabetes, injuries, poor mental health, and problems with attention and behavior.

Parents can do their part to help their teen sleep better, including setting up a media curfew. Require your teen to get off SnapChat, TikTok and all social media and electronics no later than 9 p.m. The brain needs time to unwind and settle into a good nights sleep. And while teens are more likely than other age groups to have active social lives outside the family, encourage your teen to get the same amount of sleep every night. While it might feel good to catch up on your sleep on the weekends, in the long run, getting a solid eight to 10 hours a night is better for your teens mental and physical health.

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Here's how much sleep your kids need to stay healthy - INFORUM

Simply known as birth control pills, these pills are made out of hormones higher than a woman's normal body levels. These pills have to be taken daily to be effective. The constant intake of hormones will prevent ovulation (the release of the ovum) throughout the menstrual cycle and thus prevent pregnancy.

There are two types of pills - the combined (estrogen and progesterone) and the progesterone-only pills.

Both types can be bought over-the-counter from a pharmacist without a prescription. Ideally though, you should seek medical advice on both the hormones before using it as everyone has different contraindications, e.g. people with high blood pressure cannot take pills with estrogen in it.

OCPs are often advised for women who not only need birth control, but also if they have heavy and painful periods because these pills can make periods become more regular, shorter, less heavy, and less painful.

These pills can be used to treat acne too. However, it may also worsen the condition in some people, which is exactly why you should seek medical advice.

Drawbacks: Users have to take the pill at almost the same time every single day. It doesn't protect against STIs. It can cause weight gain and blood clotting issues (venous thromboembolism).

Effectiveness: 91% if used correctly

Cost: RM30 to RM60 for a box for one month

Common brands in Malaysia: Diane, Mirogynon, Regulon, Rigevidon, Yasmin, Yaz

Original post:
Here Are The Types Of Birth Control Available In Malaysia And How Much They Cost - SAYS

Image Credit: Pixabay

Some people are lucky. They binge on pizzas, burgers, ice creams, fries and chocolates, but dont seem to add an inch to their waistlines. And we wonder why they never put on weight. Its genetics, they say. True, their genes gives them high metabolism.

Thats only partly the truth. The other part is perception. We only see them wolf down high-calorie food, but we dont know what they do during the rest of the day. Maybe they have only one or two meals a day so that the calorie intake evens out. They could have an active lifestyle to burn the calories: they may be playing a sport regularly or at least going for long walks.

People with certain health conditions like hyperthyroidism and diabetes dont pile on the pounds. Eating disorders such as bulimia and anorexia too can prevent people from gaining weight. So weight management is more than just genetics and portion control.

Weight gain and weight loss: What science says

Genetics: Does it decide your body weight?

Genetics plays a major role in managing body weight since it influences metabolic rate and hormone sensitivity, allowing some people to burn calories faster than others. It also may make them less sensitive to food cues, making it easy for them to resist cravings. But genetics is not the only reason why some people stay slim no matter what they eat.

There's no evidence that some people are born to burn more calories than others, Dr Ines Barroso, a researcher at the University of Cambridge in England, says, although researchers have identified over 250 different regions of DNA associated with obesity. In a 2019 study published in PLOS Genetics, thin participants were found to have fewer genes associated with obesity. But Barroso, a co-author on the study, says genes alone don't determine your weight. "We didn't find genes that were exclusively either protecting from obesity or predisposing someone to obesity.

Kathleen Melanson, a professor of nutrition and food sciences at the University of Rhode Island, US, concurs. Our tendency to gain weight or maintain our weight isn't pre-determined, but it's also not entirely under our control. There's genetic, nutritional, and even behavioral factors involved," she told Live Science.

Starvation hormone: How does it work?

Leptin is a hormone that helps in regulating appetite. People with higher leptin sensitivity tend to control cravings better. An absence of leptin or leptin resistance [when the body doesnt respond to the brain signals.] can lead to uncontrolled feeding and weight gain. So people with leptin deficiency can be obese.

Known as starvation hormone, leptin is a protein that tells the brain if theres enough energy stored in fat cells to carry out normal metabolic processes required to maintain the body. When leptin levels are above a certain threshold [higher sensitivity], the body burns energy at a normal rate, but when it dips, the body conserves energy and stimulates hunger pangs.

The thinness gene

Researchers at the University of British Columbia have identified a gene called Anaplastic Lymphoma Kinase (ALK) which they say plays a role in resisting weight gain. Dr. Josef Penninger and his team reported the discovery of a mutation in the ALK gene in a thin group of people in a study published in the journal Cell.

The gene is known to mutate frequently in several types of cancer, driving the development of tumours. ALK acts in the brain, where it regulates metabolism by integrating and controlling energy expenditure, says Michael Orthofer, the studys lead author and a post-doctoral fellow at the Institute of Molecular Biology in Vienna.

Digestive enzyme: How it regulates body fat

MGAT2 (monoacylglycerol acyltransferase-2) is a digestive enzyme that regulates fat in the body. So if the enzyme is absent and the body will be unable to use fat, helping them to stay thin. Scientists at the University of California in San Francisco found that mice without the gene for MGAT2 can eat whatever they want without getting fat. The results suggest that the enzyme has a pivotal role in lipid metabolism in the small intestine, and curbing MGAT2 can help in the treatment of obesity-related metabolic disorders, according to a journal published by the US National Institutes of Health's National Library of Medicine.

Basal metabolic rate: How it influences calorie spend

Basal metabolic rate is the minimal rate of energy burned per unit time by the body when its at rest. This energy is spent on normal metabolic processes like breathing, pumping of the heart, and functioning of brain. So people with high basal metabolic rate expend more calories at rest and they dont gain weight easily. The rate decreases as a person grows older and it increases when theres a spike in muscle mass.

Food choices: How it affects body weight

Weight gain is intrinsically linked to the quantity and quality of food consumed. If people eat large quantities of food thats less nutritious and low in calories, they wont gain weight. High sugar and highly processed food will have alarming levels of calories that will increase a persons weight. So the right amount of nutritious food is the key.

Physical activity: Why its important

An active lifestyle makes a huge difference. You dont have to hit the gym regularly, moving around a lot is good enough. Some people are predisposed to moving more and that extra movement can burn a lot of calories even though its not a workout. Even non-conventional exercises results in calorie burn over an extended period.

Non- conventional exercises: What are they?

Non-exercise activity thermogenesis (NEAT) is an efficient way to manage body weight. NEAT constitutes body movements that do not qualify as exercise but can help expend calories. Walking around while talking over the phone, any kind of physical labour like cooking or cleaning, walking a dog, using a standing desk, climbing stairs, and fidgeting are some of them. It's also called non-exercise physical activity (NEPA). NEAT increases the metabolic rate, leading to a substantial energy loss over a long period.

Appetite regulatory system: How food intake is regulated

The nervous system and hormones in the blood interact to signal when a person is hungry or full. This is called the appetite regulatory system. When energy stores in the body are depleted, a stimulus for appetite will trigger the start of feeding, and its counterbalanced by satiety, the opposite stimulus to stop eating.

Sleep: Why its very important

The hormone cortisol plays a vital role in regulating hunger. So sleep deprivation sleep leads to stimulation of cortisol resulting in weight gain.

Skinny fat: The dangers that lie beneath

Skinny fat is medically known as metabolically obese but within a normal weight range for the height. Its a phrase used to describe people who look fit and healthy, but suffer from a range of health problems due to a lack of exercise or poor diet. These people can have the same diagnostic markers of diabetic patients like high blood sugar, low good cholesterol, high triglycerides, inflammation, and high blood pressure. They can also have vitamin deficiencies, resulting in fatigue and poor levels of concentration.

Underweight: Its as dangerous as obesity

If a persons BMI is below 18.5, he or she is said to be underweight. That body mass is not enough to sustain optimal health. According to studies quoted by Healthline, being underweight can raise the risk of early death in men by 140 per cent in men, and by 100 per cent in women. It can also decrease immunity, increase chances of infections, osteoporosis and fractures, besides causing fertility problems.

Eating disorders prevent weight gain and impact health

Eating disorders are medical conditions that adversely impact health. An excessive focus on body weight results in dangerous eating behaviours that deprive body of nutrition. This can affect the heart, digestive system and other organs, and trigger major diseases. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

Anorexia nervosa

People suffering from anorexia nervosa have an excessive fear of gaining weight, even if they are severely underweight. So they may restrict their food intake or compensate it through various purging behaviours like forced vomiting or use of laxatives. Some others exercise obsessively to shed weight. Over time, the body may go into starvation and they could slip into depression.

Bulimia nervosa

This binge-eating disorder can go unnoticed as the patients may not be thin. These people eat frequently, gorging a huge amount of food high in calories without even tasting it. They feel out of control. Stomach pains and the fear of weight gain force them to vomit, use laxatives or exercise excessively. The frequency of such bouts are alarming.

Binge-eating disorder

Its similar to bulimia as patients consume huge amounts of high-calorie food in a short period. The crucial difference is that people with binge eating disorder do not employ purging behaviours to compensate for their binges.

Restrictive food intake

Avoidant/restrictive food intake disorder (ARFID) causes people to eat very less due to a lack of interest in food or an intense distaste for certain foods. This can lead insufficient calorie intake and the lack of nutrition could result in poor development of the body in youngsters.

How some health conditions affect body weight?

Weight loss can be a sign of illness. Some health conditions like hyperthyroidism and diabetes can cause unintentional weight loss. It could also be triggered by cancer, depression, certain infections, bowel diseases among many other ailments.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid gland produces excessive thyroxine (a hormone). Mostly seen in women, an overactive thyroid accelerates body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat, according to Mayo Clinic.

Diabetes

In people with diabetes, the body fails to produce enough insulin to process the sugar in the bloodstream. So, the body starts burning fat and muscle for energy, causing a reduction in overall body weight.

Real life stories: How some people continue to remain thin

Samir Salama: Food and lifestyle have helped me stay slim

I have always had a body mass index (BMI) of less than 20. [BMI is weight in kilograms divided by the square of height in metres. A BMI of 18.5 24.9 is considered normal or healthy]. I am in good health, and have no medical conditions or eating disorders. My lifestyle plays a major role [in maintaining my weight], Samir Salama, Gulf News Associate Editor based in Abu Dhabi, says.

Genetics does play an important role in determining the body weight. My parents and siblings too are like me. They too dont gain weight easily.

- Samir Salama

Besides genetics, there are other things too. To stay in shape, one has to exercise. It doesnt have to be strenuous activity. When I was young, I used to walk to and from school 15kms a day, and enjoyed working in the field with my grandfather in Egypt. I have been eating a lot of herbs, which we grew ourselves, and many meals are eaten outdoors, or in the fields.

So when I moved to the UAE, I increased the fibre in my diet, which helps make me feel full and is beneficial to the microbiome in the gut. It has an impact on body weight too. In the UAE, my outdoor activities are not the same [as in Egypt]. I dont have the luxury of a garden, but I always get outside and move quite a bit (non-conventional exercise), which is very important. My daily fluid intake has been increased to at least three litres. I also ensure that I get enough sleep, which can impact appetite and metabolism.

I believe sustainable weight loss is a marathon not a sprint. It doesnt do any good if you lose 20kg, then gain it six months later. A good food regimen should be for life, and parents should recommend it to their children.

Mohammad Al Jashi: I tried to put on weight, and failed

People have always been in awe of my metabolism. No matter how much I eat, I can never gain weight, Mohammad Al Jashi, a freelance writer based in Toronto, Canada, says.

I was always fascinated by how quickly my friends put on weight. They end up adopting a stringent dietary regime of salads and no carbohydrates, something I could never wrap my head around since potatoes (crisps) and rice are a daily staples of my nourishment.

- Mohammad Al Jashi

At 57kg, Im very conscious about my lanky physique. I have tried to put on weight. There is one attempt that sticks out in particular: My skinny cousin suggested an appetite stimulant that worked wonders. I became hungry always and my portions grew even larger in size. I still remember how famished I used to be in the morning, to the extent that I would prepare my breakfast before even considering washing my face. It felt like my appetite could never be sated.

I would eat around five to six meals a day for over three months, resulting in the addition of 5.5kg. It was infuriating, because eating became a chore, and meals were no longer enjoyable as it became a means to tamp down the painful rumblings of my tummy.

Then Ramadan rolled along. Once it was over, I hopped onto the scale to find out that I lost my record gain of 5.5kgs. I realised that this is something beyond my control.

To me, gaining weight is difficult, but for my friends weight loss is a commitment that requires plenty of self-control and discipline.

Staying healthy: What the experts say

Suchitra Bajpai Chaudhary, Senior Reporter

While most of us are huffing and puffing on the treadmill, counting calories and resisting our favourite foods, we have some people seem to have their cake and eat it too. In other words, these people not only eat well, but they also dont need to watch the scales. How do they achieve this impossible feat?

Gulf News spoke to a nutritionist, a gastrointestinal specialist and weight loss expert to learn what revs our metabolism. They pin it down to three main factors: behavioural patterns, sound nutrition and genetics.

Dr Fiona Cowie, Weight loss expert

Dr Fiona Cowie, an aesthetician with a certification in advanced weight loss management at the Dermalase Clinic, Jumeirah, Dubai, said weight loss and super-charged metabolism in many people could be due to NEAT. This is Non-Exercise Activity Related Thermogenesis. Some people may not be going to the gym but have an active lifestyle. From cooking, cleaning, looking after the kids, pacing in the office to even fidgeting with a pen, their activity levels can be high, leading to a constant calorie burn. It is estimated that NEAT can boost metabolism up to 50 per cent. Many people might go to the gym but overall follow a sedentary lifestyle.

Two other significant factors are sleep and eating pattern. Our nervous system and our hormones together work in tandem to create an appetite regulatory system. When people dont have good eight hours of sleep at night, it triggers cortisol release because of the stress. This activates the hunger hormone leptin, and they tend to snack a lot and put on weight. Others just have a huge appetite and tend to eat even when they are not hungry. Those with great metabolism are those who sleep well and eat only when hungry, Dr Cowie added.

Mitun De Sarkar, Clinical dietician

Mitun De Sarkar, a clinical dietician with Simply Healthy, Dubai, attributed to the slender physique of some people to mindful eating. While we might see many people eating heavy food, we are not privy to their total eating pattern. These people are likely to balance out their calories for the day. Therefore, even if you saw them eating and drinking at one particular time, they might be eating a light dinner or completely cutting out on snacking. This is behavioural. They are mindful of this behaviour and know how to compensate off the excess calories later.

According to Dr Rajesh Nambiar, specialist gastrointestinal (GI) surgeon from the International Modern Hospital, Dubai, some people are blessed with a good Basal Metabolism Rate (BMR), which helps them burn calories at a faster rate without activity. Of course, BMR can change according to ones lifestyle. However, it is a proven fact that a higher BMR can boost metabolism by up to 15 per cent.

Dr Rajesh Nambiar, Specialist gastrointestinal surgeon

The length of the gut matters a lot. The small intestine is the site where nutrition from food gets assimilated. The small intestine length can vary from 120-180 cm and in taller people; it is usually longer compared to those who are shorter. Taller people tend to have more lean muscle mass and better BMR that allows them to eat and also burn calories faster, Dr Nambiar added.

Other factors that can provide a robust metabolism is regular physical exercise and an active lifestyle. Physical activity, in general, can make a big difference. People who are up and about, always on the move, not necessarily gym freaks but with an active job or new mums chasing their toddlers and busy with household chores, are able to keep their weight off even while snacking around. All these movements rev up the metabolism, increasing the number and activity of mitochondria in the cells. More the mitochondria in your muscles higher the basal metabolic rate of your body, De Sarkar said.

But big eaters who are skinny must check their body composition. If the analysis reveals a higher body fat percentage, high cholesterol and triglyceride levels, it is advisable to cut back on incessant eating and watch what they eat to avoid serious health repercussions, De Sarkar added.

10 tips to manage your weight

Dona Cherian, Assistant Online Editor

Farah Hillou, Integrative and functional nutritionist

Farah Hillou (MS, RD, IFNCP), Integrative and Functional Nutritionist at Chiron Clinic in Dubai gave Gulf News her top ten tips to prevent unhealthy weight gain.

1. Restrict the eating window

Practise time-restricted feeding for at least 14 hours a day. Research has shown that practising time restricted feeding and intermittent fasting can help reduce inflammation, control blood cholesterol and insulin levels, promote autophagy, boost brain health, and help maintain a healthy weight. For instance, dinner can be at 7pm while breakfast the next day is around 9am.

2. Limit snacking

Not only does this prevent grazing and taking in more foods than necessary, but it supports the MMC (migrating motor complex) which optimises digestion.

3. What you eat is crucial

Fill up half of your plates with nutrient-dense, high fibre, colourful vegetables. Include greens like spinach, kale and arugula, as well as cruciferous vegetables like cabbage, broccoli and cauliflower. Add vegetables to your smoothies, soups, and stews.

4. Satiety with proteins and fats

Include protein and/or healthy fats at every meal. This can help with satiety (feeling full) and promotes blood sugar balance. Protein foods include meat, fish, beans, lentils and quinoa while healthy fats include nuts, seeds and avocado.

Avoid foods high in sugar such as cakes, cookies and pastries. Excess sugar can be stored as excess body fat.

5. Support your gut

Studies have shown that an imbalance in gut microbes can stimulate weight gain over time. Add 1 tablespoon of probiotic-rich fermented vegetables such as sauerkraut and kimchi to your meals every day. Moreover, eat prebiotic foods such as garlic and onions to boost healthy gut microbes.

6. Mindful eating

Practise mindful eating by starting with three deep breaths before eating, chewing slowly, and placing your fork down between every few bites. Apply the Japanese proverb Hara Hachi Bu: eat until you are 80 per cent full.

7. Read the labels

Refer to the nutrition facts table and the ingredient list whenever your purchase any packaged foods. Ingredients are listed in order of weight, let go of anything with ingredients you cannot pronounce, and those that have sugar listed in the top few ingredients.

8. Meal planning to deal with cravings

Plan your meals ahead of time and batch cook on weekends. Sudden hunger pangs can have you reach out for anything in sight.

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Why some people never gain weight | Health Gulf News - Gulf News

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Hormone Logics specializes in anti-aging and hormone replacement for men and women in Hudson County, New Jersey. This includes Human Growth Hormone-HGH Therapy, Testosterone Therapy, Hormone Deficiency Education, Therapy for Testosterone Deficiency, Therapy for Erectile Dysfunction, Andropause Therapy, Menopause Therapy, Growth Hormone Deficiency, Peptides for Men & Women, Sermorelin Therapy, Ipamorelin Acetate Therapy, GHRP-6 & GHRP-2 Therapy, CJC-1295 Therapy, BPC-157 Therapy, PT-141 Therapy, Adrenal Imbalances, Insulin Imbalance, Thyroid Functional Imbalance, Medical Weight Loss With HCG, Lipotropic Weight Loss Injections, Fitness & Nutrition Programs, Nutraceuticals & Blood Tests. Hudson, NJ

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Hudson Hormone Replacement Therapy and Anti-Aging in ...

Getting some education on Bio-Identical Hormone Replacement Therapy (BHRT) is important! The question is: How much do you know about your hormones?

The fact remains that most medical professionals do not understand nor do they specifically treat hormone deficiency. Why? Thats a good question to ask. The good news is we are experts in the field of hormone deficiency. Specifically in using Bio-Identical Hormone Replacement Therapy to treat our patients. LoveJoy Hormone Clinic providers (combined) have treated THOUSANDS of patients and performed over 10,000 procedures. That is a lot!

More importantly, we only treat through the combination of scientific (blood analysis) and anicdodal (patient symptoms). Not to mention, we listen to our patients and only provide therapy if they need it.

Sodo a little homework and request our FREE BHRT E-book above. Then, you will be empowered to make the decision to call us for your FREE consultation.

At LoveJoy Hormone Clinic, we get it! We have the solution using bio-identical hormone replacement that lasts months. There are no creams, pills, or shots to take every day or week. We use only the best pellets individually customized for all of our hormone therapy patients. Best yet, our clinic is managed by Joy Melby, NP-C who has performed thousands of hormone replacement procedures. She is classified as an expert in the field of Bioidentical Hormone Replacement.

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LoveJoy Home | LOVEJOY Hormone Clinic

ByThe Associated Press

December 1, 2020, 5:17 PM

2 min read

LONDON -- Britains High Court ruled Tuesday that children under 16 years old who are considering gender reassignment are unlikely to be able to give informed consent to medical treatment involving drugs that delay puberty.

The ruling said that because of the experimental nature of the drugs, clinics should seek court authorization before starting such treatment, even in cases of teens aged 16 or over.

The case was brought by two claimants against a National Health Service trust that runs the U.K.s main gender identity development service for children. One of the claimants, who was prescribed hormone blockers at 16, argued that the clinic should have challenged her more over her decision to transition to a male.

Tuesdays ruling will protect vulnerable young people, said Keira Bell, who is now 23 and has stopped taking cross-sex hormones. She added that she was delighted to see that common sense has prevailed.

I wish (the judgement) had been made before I embarked on the devastating experiment of puberty blockers. My life would be very different today, she said outside the court.

Hormone blockers are drugs that can pause the development of puberty, and are sometimes prescribed to help children with gender dysphoria by giving them more time to consider their options.

Lawyers for Bell and the other claimant the mother of a 15-year-old autistic girl on the waiting list for treatment said that children going through puberty are not capable of properly understanding the nature and effects of hormone blockers.

They argued that children who start taking hormone blockers are highly likely to later take cross-sex hormones, which they say cause irreversible changes.

Health officials involved in the case argued that taking hormone blockers and later cross-sex hormones were entirely separate stages of treatment.

But on Tuesday, three judges ruled that children under 16 are unlikely to understand and weigh both the immediate and long-term consequences of the treatment to be able to consent to the use of puberty blockers. They said that puberty blocking drugs are a pathway to much greater medical interventions because a vast majority of patients taking the drugs go on to take cross-sex hormones.

The Tavistock and Portman NHS Trust, which runs the gender clinic, said it would seek permission to appeal against the ruling.

The trans childrens charity Mermaids said the ruling was devastating for trans young people in the country.

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UK court rules against clinic in puberty blocking drugs case - ABC News

Approximately one in 11 persons in the United States has been affected by kidney stones; among those who have experienced a kidney stone, the likelihood of recurrence is high, with up to 50% developing a recurrent stone within 10 years of the first episode. Hyperparathyroidism (PHPT) is evident in approximately 3% to 5% of patients with kidney stones and screening for PHPT is a strategy aimed at reducing the recurrence rate. Patients with kidney stones and PHPT present with hypercalcemia and hypercalciuria, raising the risk for stones by increasing urine supersaturation for calcium oxalate or phosphate.

Guidelines from the American Urological Association and the European Association of Urology call for measurement of serum calcium in patients with kidney stones, followed by the serum parathyroid level (PTH) if there is clinical suspicion for PHPT. It is unknown whether patients with kidney stones receive those recommended screenings in clinical practice. Results of a previous study suggested that fewer than one in four veterans with persistent hypercalcemia treated in the Veterans Health Administration (VHA) were screened for PHPT.

Calyani Ganesan, MD, MS, and colleagues conducted a cohort study to examine the prevalence of PTH testing in veterans with kidney stones and hypercalcemia. The researchers also sought to identify the demographic, geographic, and clinical characteristics of veterans who were more or less likely to receive PTH testing. The study was designed to test the hypothesis that the frequency of PTH testing remains low despite current clinical practice guidelines and that a wide variation in screening practices is not adequately explained by patient-specific or facility-level factors. Results of the study were reported online in JAMA Surgery [doi:10.1001/jamasurg.2020.2423].

The study utilized VHA health records to identify patients with kidney stones and hypercalcemia who received care in one of the 130 VHA facilities across the United States from January 1, 2008, through December 31, 2013. Patients with kidney stones were those with one or more inpatient International Classification of Diseases, Ninth Revision (ICD-9) codes for kidney or ureteral stones, two or more outpatient ICD-9 codes for kidney or ureteral stones, or one or more Current Procedural Terminology codes for kidney or ureteral stone procedures within 1 year. Exclusion criteria included previous screening for PHPT, defined as those with a PTH level measurement between 6 and 30 months prior to the index stone diagnosis.

Data collection occurred from January 1, 2006, to December 31, 2014. Data analysis occurred from June 1, 2009, to January 31, 2020. The primary outcomes of interest were the proportion of patients with a serum PTH level measurement and the proportion of patients with biochemical evidence of PHPT who underwent parathyroidectomy.

A total of 157,539 unique veterans were diagnosed with kidney stones during the study period. Of those, 139,115 had a serum calcium determination within 6 months of their index stone diagnosis, and 7381 had been previously screened with a serum PTH level measurement and were excluded. Following application of exclusion criteria, the final cohort comprised 7561 patients with kidney stones and measured hypercalcemia (n=3938) or albumin-corrected hypercalcemia (n=3623). Mean age of the final cohort was 64.3 years, 94.4% (n=7139) were men, 5.6% (n=422) were women, and 75.0% (n=5673) were white. Patients with hypercalcemia compared with those with normocalcemia (n=124,173) were more likely to have diabetes (39.8% vs 29.5%), impaired kidney function, defined as estimated glomerular filtration rate <45 mL/min/1.73 m2 (36.1% vs 15.1%), osteoporosis (4.4% vs 2.1%), and fractures (7.1% vs 4.2%).

Of the 7561 patients with kidney stones and hypercalcemia, 24.8% (n=1873) completed a serum PTH level measurement around the time of the initial stone diagnosis. In the 3938 patients with measured hypercalcemia, 34.8% (n=1369) completed a serum PHT level measurement; only 13.09% (n=504/3623) of the patients with albumin-corrected hypercalcemia did so. Of the 1873 veterans with PTH testing, 38.3% (n=717) had an elevated PTH level consistent with biochemical PHPT.

Results of multivariable logistic regression models demonstrated that the odds of PTH testing in patients with kidney stones and hypercalcemia were lower with older age (odds ratio [OR], 0.95 per decade; 95% confidence interval [CI], 0.90-1.00) and among patients with a history of metastatic cancer (OR, 0.63; 95% CI, 0.49-0.81). Patients with albumin-corrected hypercalcemia were less likely to complete PTH testing compared with patients with measured hypercalcemia (OR, 0.32; 95% CI, 0.28-0.37).

The odds of PTH testing were higher for patients who visited either a nephrologist or a urologist (OR, 1.56; 95% CI, 1.35-1.81), and much higher for those who visited both a nephrologist and a urologist (OR, 6.57; 95% CI, 5.33-8.10) compared with patients who did not visit a stone specialty clinic during the observation period.

Across the 130 VHA facilities in the United States, the prevalence of PHT testing among the veterans with kidney stones varied between 4.0% and 57.0%. The study researchers examined the composite complexity score assigned to each facility and found no association with PTH testing rate for each facility. None of the individual facility-level variables of the complexity score were associated with PTH testing across the 130 facilities. In a comparison of facilities in the top quartile versus the bottom quartile of the PTH testing, there was an association between PTH testing and the presence of stone specialty care at each facility. There was no association between PTH testing and the mean number of parathyroidectomies performed at each facility.

Study limitations cited by the authors included the high proportion of male participants, using a single definition of PHPT, and the inability to capture medical care for veterans with kidney stones who received care outside the VHA system.

In conclusion, the researchers said, In this cohort study, a generally low rate of PTH testing was found in veterans with kidney stones and hypercalcemia, and extensive variation in PTH testing rates was found across VHA facilities in the United States. More awareness of the level or frequency of elevated serum calcium concentration may be associated with higher rates of PTH testing in patients with kidney stones. Improved screening for PHPT could increase the rates of detection and treatment of PHPT and decrease stone recurrence associated with missed or untreated PHPT.

Takeaway Points

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Parathyroid Hormone Testing in Veterans with Kidney Stones and Hypercalcemia - DocWire News

Roughly one in four women will have one. You probably know one of them, whether shes told you about it or not. As of 2017, theyre at a record low rate in America, thanks in part to the Affordable Care Acts requirement that birth control is covered by private insurance as out-of-pocket costs. Sixty-one percent of Americans say it should be legal in all cases, but a considerable subsection of them, especially in the South, dont have reliable access to it. Thats right: were talking about abortion and the musicians who are working to preserve access to it.

If youve seen some of your faves posting about the issue on Instagram (Kim Gordon and Karen O doing it caught my eye), youve probably been seeing the work of a New Mexico-based initiative called Noise For Now. They play matchmaker between musicians who want to support reproductive rights, including abortion and local funds. They aim to destigmatize the conversation around abortion. Hence, part of their plan is to ask artists to post about the organization and why access to healthcare for women is essential. Co-founder and President Amelia Bauer moved to the Southwest from New York after the 2016 election and, while trying to find a way to get involved with local reproductive rights organizations, ended up organizing a concert to benefit the National Organization For Women. It outraised all the big donor dinners and galas they had been putting on.

The idea to work as a connector between those with a large audience your favorite musician and small, local abortion funds hits at a targeted play to provide access to reproductive health care that includes abortion to women who are systematically cut off from it. Since 2011, Texas has lost 25 clinics. In the Midwest, 33 clinics have shut down. In the South, its 50. Even after the TRAP (targeted regulation of abortion providers) laws that closed them were largely overturned by the courts, most of those clinics have not reopened. Theres no doubt that in specific regions of America, the right to choose is under attack. Meanwhile, 59 new womens health clinics opened in the Northeast. More and more, having access to reproductive care and abortion is a matter of how much money you have and where you live.

When you have state legislators working against the will of the people, they create barriers to abortion for people without means, Bauer explains. Anyone with means can travel to another state to access abortion if they cant reach it near their home. That means people who work multiple jobs, who cant get time off, who cant afford a plane or bus ticket, who cant afford childcare are left out of access to safe abortion. She notes that in the U.S., where most abortions are performed in clinics, the procedure is extremely safe, while in countries where it has been outlawed and criminalized, it becomes dangerous for women. Thats why Noise For Now focuses on working with funds that support and are run by Black, brown, indigenous, and undocumented people.

For Bauer, her work in New Mexico started with an eye on preserving the access that women in nearby states traveled to get and in making that travel and all the things that go with it, from the time off work to childcare, possible. The current Supreme Court, which leans more conservative than it has in generations, has caused many to worry about stripping away the landmark Roe vs. Wade ruling. It is what guarantees women the right to have an abortion under the Fourteenth Amendment right to privacy, as explained in the majority opinion by Justice Harry Blackmun a lifelong Republican. With the current slate of justices, Bauer predicts the worst, saying, I dont have a crystal ball, but I dont think its very likely it will survive this court.

Amanda Shires is all too aware of the restrictions placed on womens access to reproductive rights. In Tennessee, 96% of the counties have no facilities that provide abortions. The issue is also bleak for women in neighboring Alabama, Kentucky, and Mississippi the latter has only one clinic and three facilities in total where women can obtain an abortion.

Part of the problem is if people are out protesting [clinics], theyre protesting contraceptive services, HIV testing, hormone therapy, treatment for erectile dysfunction, and all kinds of stuff they dont even think about. And cancer screenings. And LGBTQA+ hormone therapy, Shires points out. She later continues, saying, What I try to do is say, to the best I can, is that Im on your side, whatever side of this you choose, in hopes people dont have to walk around feeling alone.

For Shires, who performed at Noise For Nows Voices For Choice event and the Pro Roe Tee Campaign for Planned Parenthood, talking about things is the most effective way to destigmatize them and affect change. It sometimes feels hard to make a change on your own because you cant. If you can align and affiliate and help and take action, then I dont know about you, but it makes me feel like I can sleep a tiny bit better at night, Shires says.

Shires released The Problem near the end of 2020. This song imagines a conversation between a couple discussing abortion, with proceeds benefitting the Yellowhammer Fund. This Alabama-based fund offers financial and logistic support to those in need of abortion in the state. Yellowhammer is also a fund that Noise For Now has supported. Its Executive Director Laurie Bertram Roberts points out that having these conversations in spaces where its typically verboten, namely among the conservative audiences of country music, is part of removing the stigma.

We need to be talking about how we make sure were having these conversions in spaces we may not think are welcoming, but are maybe more welcoming than we think they are, Roberts says and notes that some of the most significant legacies in country music have been all about womens issues.

Amandas song is one is a long legacy of country women artists giving social critique. It goes back to the first women in country music. It goes to Kitty Wells. It goes to Loretta Lynn and The Pill. Even Tammy Wynette singing D-I-V-O-R-C-E. All those things were controversial at the time, but it tells womens stories. Even Martina McBride talking about Independence Day. Those are women telling their stories in a way that made it accessible and acceptable to talk about those subjects.

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Noise For Now Connects The Indie Scene To Support Women's Health Care - UPROXX

Medicine is ever-evolving on a daily basis. Keeping track of the changes can be an almost-full-time job.Stacker looked at a number of medical journals and media sources to discover the biggest breakthroughs the year you were born, from 1921 to the current day.

From diseases that have been around for decades, such as diabetes and the flu, to cutting-edge tools like artificial intelligence and 3D printing, explore how medical and scientific professionals continually conduct research and clinical trials to improve the lives of patients. Sometimes advances arent immediately adopted, as with the Pap smearthat wasnt integrated into womens health care for 16 years after it was invented. But other times the path from laboratory to everyday use is much more abbreviated, like with insulin, which was used to treat diabetes only a year after it was discovered.

Another recurring theme in medical history is the repurposing of medicines that have worked for one disease in the past, to see how theyll work with another. A number of drugs and vaccines are being re-explored to manage COVID-19. Not all the heroes of medical research come from a traditional backgroundone was an electric engineer who worked for a major record label. Some were recognized with the highest honors, but others still have little visibility decades after their death. Funding for the research behind the breakthroughs is always a considerationsometimes it comes from foundations and government entities, but other times via donations from individuals and enterprises.

The dark side of medical history shown here includes unethical behavior by researchers in the past, which explains why some in the Black community arent exactly early adopters when it comes to clinical trials and new treatment options.

Advances noted here focus not only on the body, but also the mind. Explore this slideshow to see all the ways that health care has changed over the past century.

You may also like: Countries with the best life expectancy

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Medical history from the year you were born - Bryan-College Station Eagle

DARE-BV1 met the primary endpoint of the study and all pre-specified secondary efficacy endpoints; demonstrated significantly greater clinical cure rates compared to placebo

DARE-BV1 has Fast Track and QIDP designations from FDA

New drug application (NDA) submission planned 1H of 2021

SAN DIEGO, Dec. 07, 2020 (GLOBE NEWSWIRE) -- Dar Bioscience, Inc. (NASDAQ: DARE), a leader in womens health innovation, today announced positive topline results from the DARE-BVFREE Phase 3 randomized, double-blinded, placebo-controlled clinical trial evaluating DARE-BV1 in 307 women diagnosed with bacterial vaginosis, a serious condition estimated to affect approximately 21 million women in the United States. DARE-BV1 is an investigational thermosetting bioadhesive hydrogel containing clindamycin phosphate 2% designed as a convenient, one-time vaginally-administered treatment for bacterial vaginosis. The trial met its primary endpoint demonstrating that a single administration of DARE-BV1 was superior to placebo as a primary therapeutic intervention for women diagnosed with bacterial vaginosis.

Based on these topline results, DARE-BV1 delivered clinical cure rate values greater than those of currently marketed FDA-approved products for the treatment of bacterial vaginosis. This successful Phase 3 clinical trial marks another important achievement for Dar. We began 2020 with the announcement of a commercial partnership for Ovaprene with Bayer, marketer of one of the most successful contraceptive products in womens health, and were concluding the year with another exciting milestone, the successful completion of our Phase 3 clinical trial of DARE-BV1 to support an NDA for the treatment of bacterial vaginosis, said Sabrina Martucci Johnson, President and CEO of Dar Bioscience. We believe there is a large unmet need for a more efficacious and convenient, single-dose vaginally-administered product to treat bacterial vaginosis, and we believe DARE-BV1 could become a new front-line treatment option. DARE-BV1 received Fast Track designation from the FDA earlier this year and, based on the topline results of this trial, we plan to file our NDA in the first half of 2021.

Topline Results of the Phase 3 Randomized Clinical TrialDARE-BVFREE randomized 307 women at 32 centers across the United States in a 2:1 ratio to receive a single vaginal dose of DARE-BV1 (N=204) or a single vaginal dose of placebo gel (N=103) to be applied intravaginally within one day of randomization.

The primary endpoint for the study was clinical cure of bacterial vaginosis determined at the final study visit which occurred 21 to 30 days after study drug administration, also referred to as the test-of-cure (TOC) visit, in the modified intent-to-treat (mITT) study population (N=180). In accordance with U.S. Food and Drug Administration (FDA) guidance, the mITT population excludes subjects from the intent-to-treat (ITT) population (N=307) who subsequently demonstrated a positive test result for other concomitant vaginal or cervical infections at baseline.

A single vaginal dose of DARE-BV1 proved statistically superior to placebo at p-value < 0.001 at the TOC visit that occurred 21 to 30 days after study drug administration (primary efficacy endpoint) and also at the assessment visit that occurred 7 to 14 days after study drug administration. DARE-BV1 also demonstrated statistically significant efficacy in all four additional pre-specified secondary efficacy assessments. The clinical cure endpoint results are shown in the following table:

Summary of Clinical Cure Results (mITT Population), p-value < 0.001:

The clinical cure rate at the Day 21-30 visit for the ITT population was similar to that for the mITT population (70.1% for the DARE-BV1 group (N=204) and 36.9% for the placebo group (N=103), p-value < 0.001), demonstrating effectiveness of DARE-BV1 in treating bacterial vaginosis even when other concomitant vaginal or cervical infections were present.

The DARE-BVFREE studys two treatment arms were well balanced in terms of age, race, ethnicity, bacterial vaginosis history, and body mass index (BMI). The ITT population comprised primarily patients aged 15 to 51 years, with a mean age of 34.8 (standard deviation 8.84) and median age of 35. Over 53% of the ITT population qualified as obese (BMI 30.0), with a mean BMI of 31.50 (standard deviation 8.499). In the ITT population, 56.0% of women identified as Black or African American, 41% identified as white and 25.5% identified as of Hispanic or Latino origin (compared to 74.5% as not of Hispanic or Latino origin). In addition, more than 75% of the women in the ITT population reported one or more episodes of bacterial vaginosis diagnosed in the 12 months before they were randomized into the study (76.9% in the DARE-BV1 group and 73.8% in the placebo group).

DARE-BV1 was well-tolerated in the study. There were no early discontinuations due to adverse events (AEs), and the only serious AE occurred in a woman in the placebo group. In the DARE-BV1 group, 15.3% of patients reported AEs that were considered to be possibly, probably or definitely related to study treatment compared to 9.7% of patients in the placebo group.

Only two AEs were reported by more than 2% of patients in the DARE-BV1 arm and at a rate higher than in patients in the placebo arm vulvovaginal candidiasis, commonly called a vaginal yeast infection (17.2% in the DARE-BV1 group and 3.9% in the placebo group), and vulvovaginal pruritus, commonly referred to as vaginal itching (4.4% in the DARE-BV1 group and 1.9% in the placebo group). Over half of the vaginal yeast infections reported in the DARE-BV1 group and exactly half of those reported in the placebo group occurred in patients who exhibited a positive yeast culture prior to dosing.

"We believe these data demonstrate that DARE-BV1 is significantly effective in a representative patient population, including a large proportion of patients who have been previously treated for this infection. Today, about half of the patients treated for bacterial vaginosis experience recurrence of the infection within 12 months of their treatment, and currently marketed FDA-approved products for the treatment of bacterial vaginosis have clinical cure rates in the mid-30% to the high-60% range, said David Friend, PhD, Chief Scientific Officer of Dar Bioscience. If approved, we believe DARE-BV1 will be an important new and convenient one-time vaginally-administered treatment option with the potential to improve clinical outcomes and overall quality of life for women suffering with bacterial vaginosis.

Based on the topline results from the study, Dar expects to have a pre-NDA meeting with the FDA in early 2021 and to submit an NDA during the first half of 2021. DARE-BV1 received both Fast Track and Qualified Infectious Disease Product (QIDP) designations from the FDA for the treatment of bacterial vaginosis. Given these designations, the NDA could be eligible for priority review, which, if granted, could allow for a 2021 PDUFA date, and, assuming approval, an early 2022 commercial launch in the U.S.

About the Phase 3 Study

DARE-BVFREE was a randomized, multicenter, double-blind, placebo-controlled study of a single administration of DARE-BV1 (clindamycin phosphate vaginal gel, 2%) compared to a single administration of placebo vaginal gel (HEC Universal Placebo Gel) for the treatment of bacterial vaginosis. Patients were evaluated during three clinic visits: Day 1 (screening and randomization visit), Day 7-14 (assessment visit), and Day 21-30 (TOC visit). Clinical cure was defined as resolution of the specific clinical signs that comprise the Amsel criteria; specifically, resolution of abnormal vaginal discharge associated with bacterial vaginosis, clue cells less than 20% of total epithelial cells on microscopy, and a negative 10% KOH whiff test. The total study duration was approximately one month for each individual patient.

About Bacterial Vaginosis

Bacterial vaginosis is the most common cause of vaginitis worldwide and is estimated to affect approximately 21 million women in the United States.1,2 Prevalence of bacterial vaginosis among non-white women in the U.S. is higher than among white women (African American 51%, Mexican American 32%, white 23%).2 While there are several therapeutic options for women in the U.S. diagnosed with bacterial vaginosis, currently approved options have relatively insufficient clinical cure rates, require sequential daily administrations or can be otherwise inconvenient for women to use. It is estimated that as many as 50% of women treated for bacterial vaginosis will experience a recurrence within 12 months of their treatment.3

About DARE-BV1

DARE-BV1 is an investigational thermosetting bioadhesive hydrogel containing clindamycin phosphate 2% being evaluated as a one-time, vaginally-administered treatment for bacterial vaginosis.

About Dar Bioscience

Dar Bioscience is a clinical-stage biopharmaceutical company committed to the advancement of innovative products for womens health. The companys mission is to identify, develop and bring to market a diverse portfolio of differentiated therapies that expand treatment options, improve outcomes and facilitate convenience for women, primarily in the areas of contraception, vaginal health, sexual health, and fertility.

Dars product portfolio includes potential first-in-category candidates in clinical development: Ovaprene, a hormone-free, monthly contraceptive intravaginal ring whose U.S. commercial rights are under a license agreement with Bayer; Sildenafil Cream, 3.6%, a novel cream formulation of sildenafil to treat female sexual arousal disorder utilizing the active ingredient in Viagra; DARE-BV1, a unique hydrogel formulation of clindamycin phosphate 2% to treat bacterial vaginosis via a single application; and DARE-HRT1, a combination bio-identical estradiol and progesterone intravaginal ring for hormone replacement therapy following menopause. To learn more about Dars full portfolio of womens health product candidates, and mission to deliver differentiated therapies for women, please visit http://www.darebioscience.com.

Dar may announce material information about its finances, product candidates, clinical trials and other matters using the Investors section of its website (http://ir.darebioscience.com), SEC filings, press releases, public conference calls and webcasts. Dar will use these channels to distribute material information about the company, and may also use social media to communicate important information about the company, its finances, product candidates, clinical trials and other matters. The information Dar posts on its investor relations website or through social media channels may be deemed to be material information. Dar encourages investors, the media, and others interested in the company to review the information Dar posts in the Investors section of its website and to follow these Twitter accounts: @SabrinaDareCEO and @DareBioscience. Any updates to the list of social media channels the company may use to communicate information will be posted on the investor relations page of Dars website mentioned above.

Forward-Looking Statements

Dar cautions you that all statements, other than statements of historical facts, contained in this press release, are forward-looking statements. Forward-looking statements, in some cases, can be identified by terms such as believe, may, will, estimate, continue, anticipate, design, intend, expect, could, plan, potential, predict, seek, should, would, contemplate, project, target, tend to, or the negative version of these words and similar expressions. In this press release, forward-looking statements include, but are not limited to, statements regarding Dars plans and strategies for regulatory approval and commercialization of DARE-BV1, including expected timing of Dars engagement with the FDA regarding an NDA for DARE-BV1, submission of an NDA for DARE-BV1, FDA review and approval of the NDA, and commercial launch of DARE-BV1 in the U.S. if approved; DARE-BV1s potential importance to and utilization by women with bacterial vaginosis, including its potential ability to improve clinical outcomes and overall quality of life compared to currently available therapeutic options for bacterial vaginosis if approved; and DARE-BV1s commercial potential. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause Dars actual results, performance or achievements to be materially different from future results, performance or achievements expressed or implied by the forward-looking statements in this press release, including, without limitation, risk and uncertainties related to: the risk that topline results from a clinical trial, including the DARE-BVFREE study, are based on Dars preliminary analysis of key efficacy and safety data and, following a comprehensive review of study data, such results may change and topline results may not accurately reflect the complete results from the clinical trial; the risk that the FDA, other regulatory authorities or members of the scientific or medical communities may not accept or agree with Dars interpretation of or conclusions regarding the study data; Dars ability to raise additional capital when and as needed to advance its product candidates and continue as a going concern; the effects of the COVID-19 pandemic on Dars operations, financial results and condition, and ability to achieve current plans and objectives, including the potential impact of the pandemic on the ability of third parties on which Dar relies to assist in the conduct of its business, including its clinical trials, to fulfill their contractual obligations to Dar; Dars ability to develop, obtain regulatory approval for, and commercialize its product candidates; the failure or delay in starting, conducting and completing clinical trials or obtaining FDA or foreign regulatory approval for Dars product candidates in a timely manner; Dars ability to conduct and design successful clinical trials, to enroll a sufficient number of patients, to meet established clinical endpoints, to avoid undesirable side effects and other safety concerns, and to demonstrate sufficient safety and efficacy of its product candidates; the risk that positive findings in early clinical and/or nonclinical studies of a product candidate may not be predictive of success in subsequent clinical and/or nonclinical studies of that candidate; Dars ability to retain its licensed rights to develop and commercialize a product candidate; Dars ability to satisfy the monetary obligations and other requirements in connection with its exclusive, in-license agreements covering the critical patents and related intellectual property related to its product candidates; the risks that the license agreement with Bayer may not become effective and, if it becomes effective, that future payments to Dar under the agreement may be significantly less than anticipated or potential amounts; developments by Dars competitors that make its product candidates less competitive or obsolete; Dars dependence on third parties to conduct clinical trials and manufacture clinical trial material; Dars ability to adequately protect or enforce its, or its licensors, intellectual property rights; the lack of patent protection for the active ingredients in certain of Dars product candidates which could expose its products to competition from other formulations using the same active ingredients; the risk of failure associated with product candidates in preclinical stages of development that may lead investors to assign them little to no value and make these assets difficult to fund; cyber attacks, security breaches or similar events that compromise Dars technology systems or those of third parties on which it relies and/or significantly disrupt Dars business; and disputes or other developments concerning Dars intellectual property rights. Dars forward-looking statements are based upon its current expectations and involve assumptions that may never materialize or may prove to be incorrect. All forward-looking statements are expressly qualified in their entirety by these cautionary statements. For a detailed description of Dars risks and uncertainties, you are encouraged to review its documents filed with the SEC including Dars recent filings on Form 8-K, Form 10-K and Form 10-Q. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Dar undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

Investors on behalf of Dar Bioscience, Inc.:Lee RothBurns McClellanEmail: lroth@burnsmc.com+1 212-213-0006

Source: Dar Bioscience, Inc.

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Dar Bioscience Announces Positive Topline Results From DARE-BVFREE, a Phase 3 Trial of DARE-BV1 in Patients Diagnosed with Bacterial Vaginosis -...

Dublin, Nov. 24, 2020 (GLOBE NEWSWIRE) -- The "Acromegaly and Gigantism - Epidemiology Forecast to 2029" report has been added to ResearchAndMarkets.com's offering.

Acromegaly and gigantism are rare disorders of the pituitary gland, characterized by the hypersecretion of growth hormone (GH). In 98% of the cases of acromegaly and gigantism, the hypersecretion of GH results from a benign GH- secreting pituitary adenoma (Sesmilo, 2013). A common sign of acromegaly is enlarged hands and feet, and the disease can also cause gradual changes in the shape of the face, such as a protruding lower jaw and brow, an enlarged nose, thickened lips, and wider spacing between the teeth. Progression of acromegaly can result in major health problems such as diabetes mellitus, cardiovascular disease, hypertension, sleep apnea, carpal tunnel syndrome, and spinal cord compression (Mayo Clinic, 2019). While both acromegaly and gigantism are complications of uncontrolled GH levels, the presentations of the two hormonal diseases are very different; most notably, acromegaly occurs in adulthood and gigantism occurs during childhood (Eugster and Pescovitz, 1999). In 2019, the 7MM combined had 43,220 diagnosed prevalent cases of acromegaly in both sexes for ages 15 years and older.

The US accounted for the majority of these cases with 26,549 diagnosed prevalent cases, while Spain accounted for the fewest cases with 1,775 cases in 2019. The publisher epidemiologists forecast an increase in the diagnosed prevalent cases of acromegaly to 47,340 cases in 2029 in the 7MM at an Annual Growth Rate (AGR) of 0.95% during the forecast period. In 2019, the 7MM combined had 643 diagnosed prevalent cases of gigantism in both sexes for all ages. The publisher epidemiologists forecast an increase in the diagnosed prevalent cases of gigantism to 675 cases in 2029 in the 7MM at an AGR of 0.50% during the forecast period. Any change in the diagnosed prevalent cases of acromegaly and gigantism in the 7MM is attributable to changing population demographics and changing diagnosed prevalence rates in the respective markets.

Scope

Reasons to Buy

Key Topics Covered:

1 Table of Contents1.1 List of Tables1.2 List of Figures

2 Acromegaly and Gigantism: Executive Summary2.1 Catalyst2.2 Related Reports2.3 Upcoming Reports

3 Epidemiology3.1 Disease Background3.2 Risk Factors and Comorbidities3.3 Global and Historical Trends3.4 Forecast Methodology3.4.1 Sources3.4.2 Forecast Assumptions and Methods3.4.3 Diagnosed Prevalent Cases of Acromegaly and Gigantism3.4.4 Diagnosed Prevalent Cases of Acromegaly and Gigantism with Macroadenoma3.4.5 Diagnosed Prevalent Cases of Acromegaly and Gigantism with Diabetes3.4.6 Diagnosed Prevalent Cases of Acromegaly and Gigantism with Cardiovascular Disease3.4.7 Diagnosed Prevalent Cases of Acromegaly and Gigantism with Hypertension3.5 Epidemiological Forecast for Acromegaly, 2019-20293.5.1 Diagnosed Prevalent Cases of Acromegaly3.5.2 Sex-Specific Diagnosed Prevalent Cases of Acromegaly3.5.3 Age-Specific Diagnosed Prevalent Cases of Acromegaly3.5.4 Diagnosed Prevalent Cases of Acromegaly with Macroadenoma3.5.5 Diagnosed Prevalent Cases of Acromegaly with Comorbidities3.5.6 Diagnosed Prevalent Cases of Gigantism3.5.7 Sex-Specific Diagnosed Prevalent Cases of Gigantism3.5.8 Age-Specific Diagnosed Prevalent Cases of Gigantism3.5.9 Diagnosed Prevalent Cases of Gigantism with Macroadenoma3.5.10 Diagnosed Prevalent Cases of Gigantism with Comorbidities3.6 Discussion3.6.1 Epidemiological Forecast Insight3.6.2 Limitations of the Analysis3.6.3 Strengths of the Analysis

4 Appendix4.1 Bibliography4.2 About the Authors4.2.1 Epidemiologist4.2.2 Reviewers4.2.3 Global Director of Therapy Analysis and Epidemiology4.2.4 Global Head and EVP of Healthcare Operations and Strategy4.3 About the Publisher4.4 Contact4.5 Disclaimer

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Epidemiology Forecast on Acromegaly and Gigantism to 2029 - - GlobeNewswire

Rachel Scanlon's lucky toilet came through for her not once, but twice.What you dont have a lucky toilet? Maybe Rachels story will convince you to reconsider.

On TuesdaysRyan Tubridy Show, Rachelwhos beenthrough IVF an extraordinary thirteen times started by telling Ryanthat before deciding on going down the road of IVF, she and her partner Kevin had experienced a lot ofdisappointment:

"We had a lot of miscarriages. And a lot of early miscarriages and a lot of later miscarriages. But, yes, we had a lot and so, we sought treatment."

Ryan asked Rachel to give an outline of what the IVF process involves and she madesomethings clear at the start: its a long process and different womenhave different experiences.

Different clinicstreat people differently and every womans body is different. So, no two women will have the exact same IVF experience.There are different protocols involved and Rachel found herself, more than once,on a protocol where she downregulated.

"Your body is kind ofsupressedinto a menopause-like state.And I suppose its to allow the clinic to take over and to take over the regulation of your body and so you stopproducingeggs so that the drugs can takeover andproduce the eggs for you."

The menopause-like stateprobablylasts for a couple of weeks, Rachelcontinued,beforehormone injections begin. The injections are intended to produce follicles which will eventually produce eggs. She was injecting herself every evening and sometimes more than once a dayand she was scanned regularly to ensure that the hormones are overor under-stimulating follicle production.

Pumping your body full of hormones has other effects besides follicle production, though:"Your moods are up and down, youre all over the placeI mean, youre hard to live with. Its difficult. And youre bloated as well.Your stomach is bloated. You actually look like youre pregnant because your ovaries are just bulging. Youre just a hot mess, really."

Thats one way of putting it.Of course, the long, gruelling, expensiveprocess is worth it when you get a baby at the end of it. But when you dont,when the process doesnt work at all, it can be extremely disheartening.

"Looking back, one of the hardest periods for me was when that first IVF didnt work."

Rachel reckons she was naive in the beginning because she had so much hopeinvested in that first attempt, only for it to fail:

"You eventually get to a pointwhere youre taking a test. My first time, I didnt even get to take the test, my period just arrived, like nothing had happened. Like we hadnt spent all this money, like I hadnt taken all these injections. I was absolutely heartbroken the first time it didnt work."

That first time wasjust the start of a six-year IVFjourney, that took in thirteen proceduresin four clinicsacrossthreecountriesand eventually resulted in two joyouspositivetests in that lucky toilet,in a cafcalled Wilde and Green in Milltown, Dublin,two years apart.

Little Eve and hersisterErin are thetwo happy endings toRachel and Kevinsjourney.

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IVF: "I was absolutely heartbroken the first time it didn't work" - RTE.ie