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Even Without Warren Buffett, IUDs Have Some Upside

CommonHealth (WBUR) - Thu, 08/06/2015 - 7:54am


Don’t miss this fantastic bit of reporting by Bloomberg’s Karen Weise that uncovered the juicy news that through a charitable foundation, Warren Buffett “has become the most influential supporter of research on IUDs.”

It turns out the Buffett-funded foundation paid for myriad studies of the once-shunned type of contraception that is now undergoing a renaissance of sorts. (Shunned, of course, due to the infamous Dalkon Shield, a type of intrauterine device eventually linked to complications, including infertility, infections, even death.)

Here & Now covered the story this week and posted these details:

First, an anonymous donor funded a multi-year study in St. Louis, finding that when given the choice, 75 percent of women chose IUDs or IUDs and hormonal implants. Further, the study revealed that IUDs had over a 99 percent effectiveness rate — in addition to being extremely safe. That study was written up in 50 medical journals, and was also used to promote extensive initiatives in Colorado and Iowa, where an anonymous donor funded low cost IUDs, as well as training programs for medical professionals on IUD use and counseling. In Colorado, the results showed the teen birth rate dropping by 40 percent. Finally, with the evidence of the IUD’s safety and effectiveness indisputable, the anonymous donor funded the development of a new, low-cost IUD known as Liletta.

Well, it turns out that the anonymous donor, in every case, was the Susan Thompson Buffett Foundation — a philanthropic organization funded by its founder billionaire Warren Buffett.

OK, so Buffett has long been a supporter of expanding access to contraception. Does that mean the IUD should not be given a second look? We’ve written a fair amount on this topic: Carey wrote about her own IUD here, and also offered a thoughtful, news-you-can-use post, “10 Reasons To Get An IUD, And 5 Downsides.”

Here’s her list:

The upsides:

1. “Just one act“: It takes a doctor’s visit to have an IUD implanted, but then your birth control is likely set for years.

2. Effective: Once that “one act” is done, the device is close to 100% effective.

3. Cost: The IUD is also considered one of the most cost-effective forms of birth control; though it costs several hundreds dollars up front, that cost is spread out over years, and…

4. New coverage rules: Under new federal rules that take effect starting next summer, insurance companies must cover FDA-approved contraception, which includes the IUD, with no co-pays or additional fees.

5. Periods diminish or disappear with the Mirena — considered a plus by many women.

6. The Paragard offers effective long-term birth control without hormones.

7. Though IUDs work long-term, their birth control effect is reversible: once they’re out, it ends.

8. They’re private: As this fact sheet points out, an IUD cannot be seen or felt.

9. Recent research suggests IUDs are safe enough to be implanted at what I’d call a “never again” moment, right after a birth or an abortion.

10. Other countries have much higher rates than America does, with good success, while we have a shocking accidental pregnancy rate of nearly 50%.

Some downsides:

1. IUDs don’t protect against sexually transmitted infections. A reader who’s happy with her own IUD points out: “An IUD is an effective form of birth control NOT a way to practice safe sex.”

2. Though current IUDs have caused nothing like the 1970s fiasco of the dangerous Dalkon Shield, complications still do arise. As Judy Norsigian of Our Bodies, Ourselves noted: ““Like every method, it has its downsides. There’s a remote risk of embedding and perforation, but it’s small. And some women have a lot of pain, others don’t. Some women expel the IUD, others don’t.”

Two IUDs are in use these days: The copper Paragard and the hormone-emitting Mirena. Each has some minuses:

3. The copper Paragard can lead to heavier periods.

4. The Mirena makes periods diminish or disappear, which some women don’t like.

5. Also, though their levels are very low, the hormones that the Mirena emits can affect some women. A friend of mine just had her Mirena pulled because of nasty, depressive symptoms. It’s a well-trodden path for women to replace the hormonal Mirena with the copper Paragard.

Categories: Health Care

Want Happiness At 50? Be A Social Butterfly At 20, Keep Friends Close At 30

CommonHealth (WBUR) - Wed, 08/05/2015 - 8:33pm

Seranya Photography/flickr

By Marina Renton
CommonHealth Intern

What’s the key to happiness in middle age? Be a social butterfly when you’re 20 and keep your friends close at 30. That’s according to a new study looking at the health impacts of social networks over decades.

Researchers at the University of Rochester found that because our social goals change over time, a high quantity of social interactions at age 20 and a high quality of interactions at age 30 was associated with better social and psychological outcomes around age 50. The study appears in the journal Psychology and Aging.

A Pleasant Interaction? 

The study was 30 years in the making and began in the ’70s when college students were asked to keep a kind of diary where they logged all their social interactions over a two-week period. They recorded the length of their interactions, the level of intimacy and pleasantness, among other things. The diary method, officially called the Rochester Interaction Record, was designed to capture spontaneous social activity (think pre-Twitter). It was also an attempt to minimize “recall bias.”

Study co-author Cheryl Carmichael, an assistant professor of psychology at Brooklyn College and the Graduate Center of the City University of New York, explained why the “diaries” were important: “If I asked somebody, ‘Hey, how’s your social life going these days?’ it could very easily be colored by whatever their morning or afternoon was like,” she said. For instance, your social life might seem bleak if you’ve just argued with your best friend, but if you’ve have it all written down, you can get a more accurate sense of a person’s true social life.

Study participants were asked to complete the “diaries” again at around age 30.

Carmichael then followed up with participants when they were around 50 years old. Why? “There are all these theories out there that talk about how our early adulthood is sort of the prime time for focusing on our social relationships,” she said. “It’s this pivotal, critical period for intimacy development and social connections and focusing on forming relationships.”

Of the 222 adults who were college students when they began the first round of the study, Carmichael was able to reach 133 to conduct the follow-up research. The participants were asked about their social network and the various roles they filled, for instance, parent, co-worker, community member, etc., as well as how many social connections they had. They were also asked about the quality of their friendships and their psychological well-being as measured by their sense of autonomy, purpose, control, loneliness and presence of depressive symptoms, among other things, she said.

Quantity vs. Quality

“What we find is that at age 20, having more frequent activity was associated with better outcomes at midlife, at age 50,” Carmichael said. “People who had more frequent social experiences at age 20 were more socially connected, more socially integrated, had better quality friendships, and were better psychologically adjusted in that they were less depressed, less lonely, and had more of these positive psychological outcomes at age 50.”

Interestingly, frequent social activity didn’t seem to produce the same benefits at age 30, the study found.

Why the difference?

It might have to do with social goals changing over time, Carmichael said: “[Y]ou have certain goals at certain times in life, and there are certain things you need to do to fulfill those goals.”

Twenty-year-olds tend to be “really focused on learning about the world, social information-seeking and knowledge acquisition,” Carmichael said. A greater range of social experiences will build up those skills. For instance: dealing with an annoying roommate may be, well, annoying, but it can also provide valuable life lessons.

As time passes, social information-seeking gives way to a desire for “emotional closeness,” and with that comes the desire for higher-quality social interactions, according to the study.

“At age 30, people who had higher-quality social experiences, experiences that were more intimate and more satisfying, were better-off at age 50 in terms of their friendship quality and in terms of their psychological well-being,” Carmichael said. “Having intimate and high-quality social experiences at that point fulfills that goal for emotional closeness, so it’s satisfying and contributes to this long-term well-being.”

But having many social interactions at age 30 didn’t benefit well-being at 50, perhaps because frequent socializing may distract from the the pursuit of higher quality, more fulfilling social experiences, she said.

The study results were the same for men and women.

Further Exploration

One looming question involves the changing definition of social activity. In the ’70s and ’80s, when the participants were first logging their interactions, they were only face-to-face. How texting and social media use affect the building of quality relationships has yet to be studied, Carmichael said.

“Typically, intimacy is generated when one person discloses something, and the other person responds in a way that lets you know, ‘I understand where you’re coming from, I validate you, I care about you,’ ” she said. “In a face-to-face interaction, you have a lot of nonverbal cues…is an Emoji of a happy face the same?”

Categories: Health Care

Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds

Kaiser Health News - Wed, 08/05/2015 - 4:49pm

Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.

The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.

“Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.

The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.

The participants had up to 11 phone sessions between January 2011 and October, 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques. The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.

The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms.

Yet many seniors could face barriers getting that therapy because Medicare has stringent requirements for eligibility for these kinds of phone therapies, according to Lenze, who wrote an editorial accompanying the study. Lenze argued that phone therapy is a good alternative to drugs that are often prescribed for anxiety and depression but can make seniors sleepy and disoriented and lead to injuries.

“This demonstrates that [therapy] is just as effective as in-person psychotherapy and reimbursing for it would be a way to increase the reach of mental health care that in a concrete way would allow someone to get treatment for actual problems, not just medicating and ending up in the emergency room with a hip fracture,” Lenze said.

He said he treats some geriatric patients who drive from 100 miles away and doesn’t offer phone sessions because of the payment issue.

Medicare only pays for telehealth services done in rural areas with provider shortages; patients cannot do a phone call in their home, but must drive to a physician’s office or hospital to connect with the mental health professional at another site, he said.

“The reason it isn’t evolving is because it’s trapped in the law that isn’t evolving with modern medicine,” said Joel White, executive director of the Health IT Now Coalition, which is urging Medicare to loosen its strict limits on telemedicine.

Many states have also implemented some roadblocks for telephone therapy with laws requiring that anyone giving medical care must be licensed in the state where the patient resides. Reps. Frank Pallone, D-N.J., and Devin Nunes, R-Calif., offered a bill in July that would allow providers licensed in one state to provide care in another state electronically.

The Association of State and Provincial Psychology Boards is working on model legislation to recommend to states next year that would allow psychologists to practice by phone across state lines without having to pay a hefty licensing fee.

Categories: Health Care


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