The HPV Vaccine Is Now FDA-Approved for People Over 26: What You Need to Know

For years, health officials have urged people under the age of 26 to get the vaccine that protects against human papilloma virus (HPV). If you happened to miss that deadline or were older than 26 when the vaccine came out, it wasn’t recommended for you. But now, adults over 26 may want to consider getting it if they haven’t already.

The Food and Drug Administration (FDA) recently approved expanding the use of one form of the HPV vaccine, Gardasil 9, to include people between the ages of 27 and 45. Gardasil 9 helps prevent certain cancers and diseases caused by the nine HPV types that are covered by the vaccine.

The approval “represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,” Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research, said in a statement. ”The Centers for Disease Control and Prevention has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90 percent of these cancers, or 31,200 cases every year, from ever developing.”

Gardasil was originally approved in 2006 to prevent cancers and diseases associated with four strains of HPV.

Then, in 2014, Gardasil 9 was approved, covering an additional five strains. But both were only approved for use in people through age 26. And, according to the Centers for Disease Control and Prevention (CDC), kids should ideally get the vaccine when they’re age 11 or 12. That’s because the vaccine is most effective when you get it before you’re exposed to HPV—the most common STI. So the goal is to get vaccinated before you become sexually active. But that doesn’t mean that getting it later in your life is pointless.

The original 26-year-old cutoff was also partly due to the ages of participants included in studies used for the vaccine’s approval. But new evidence suggests there may still be benefits to getting the vaccine at a later age. For instance, the FDA cites research (discussed in the prescribing information for Gardasil 9) in which about 3,253 women aged 27 through 45 were followed for an average of three and a half years and found that Gardasil was about 88 percent effective in preventing persistent HPV infection (which can lead to cancer), genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine. The FDA says it approved the extended use of Gardasil 9 based on this data, combined with new long-term follow-up data from the study.

The FDA deemed Gardasil 9 safe for men in the same age group based on that data, as well as data from Gardasil used in younger men and data from a clinical trial of 150 men between the ages of 27 and 45 who received the HPV vaccine.

The new recommendation means that you can get vaccinated even if you’ve already been sexually active (and have already potentially been exposed to some strains of HPV). That’s because “it is unlikely that they were exposed to all nine types of HPV that the vaccine protects against,” Susan Vadaparampil, Ph.D., M.P.H., vice chair of the Health Outcomes and Behavior Department at Moffitt Cancer Center, tells SELF. “Thus, there are continued opportunities for health benefit from receiving the vaccine after age 27.”

Almost everyone under age 46 who hasn’t already gotten the vaccine is eligible for it, but some people may benefit more than others.

People ages 27 and older who haven’t been vaccinated and are sexually active with any new partners may want to consider getting Gardasil 9, Vadaparampil says. That doesn’t mean you shouldn’t get it if you have had one long-term sexual partner, though. “It’s an important conversation to have with your doctor, who can help each person gauge the benefits for themselves,” she adds.

That said, doctors still don’t know when people are most likely to be exposed to the forms of HPV that cause cancer, Lois Ramondetta, M.D., a professor in the The University of Texas MD Anderson Cancer Center’s department of gynecologic oncology and reproductive medicine, tells SELF. Meaning, you might have been exposed to a strain of HPV in the past that was relatively harmless for you, but you could still be exposed to a future strain that could lead to cancer. “Really, everybody under the age of 45 is eligible for this,” Dr. Ramondetta says.

However, if you got the “regular” Gardasil shot before Gardasil 9 became available in 2014, there’s no current recommendation to be vaccinated again, G. Thomas Ruiz, M.D., lead ob/gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. He notes, “At this point, the original Gardasil still protects against most of the variants that cause cervical cancer.” Dr. Ramondetta agrees: “The original Gardasil still protects against the forms of HPV that are considered the most dangerous,” she says—HPV 16 and 18. Still, there doesn’t seem to be any harm in getting vaccinated again. “I know a lot of people who have done that,” Dr. Ramondetta says.

People who are pregnant or allergic to any component of the vaccine (including yeast) should not get the vaccine.

If you haven’t gotten the vaccine yet, talk to your doctor about your options and what you can expect.

Like all medications, there are some potential side effects of the HPV vaccine, including redness and/or pain and discomfort in the arm where you get the shot, dizziness, fainting, nausea, and headache, the CDC says. But the CDC also notes that the shot is “typically not associated with any serious side effects.”

“The HPV vaccine has been through the same rigorous process used for all vaccines to monitor safety on an ongoing basis,” Dr. Vadaparampil says. “Bottom line, the vaccine has been administered to millions worldwide and shown to be both safe and effective.” And not getting the vaccine makes it more likely that you’ll develop complications related to HPV, possibly including cancer.

Plus, both Dr. Vadaparampil and Dr. Ramondetta anticipate the cost of the vaccine being covered by insurance for those through age 45, as it has often been in the past for those through age 26. Without insurance, the full series of three doses costs around $400, SELF reportedly previously.

Overall, doctors stress that it’s best to get the vaccine when you’re younger (if you can), but now anyone who missed out when they were younger still have the opportunity. “By using a prevention approach through vaccination while also remaining vigilant about screening, we have tremendous potential to eliminate cervical cancer in the U.S.,” Dr. Vadaparampil says.


How to Store Condiments the Right Way

Every time I walk into a new kitchen, I can’t help but notice the condiments. People keep them in the strangest places! At my friends’ various abodes, I’ve seen everything from opened bottles of ketchup and mayo in the pantry, to hot sauce and olive oil in the fridge, and vice versa. If there’s anything my kitchen snooping has taught me, it’s that where you keep your condiments is a deeply personal choice that may, or may not, be based on expert opinion.

Many times I’ve wondered if it’s even safe to leave things like ketchup, mayonnaise, jam, or nut butters at room temp. After all, they’re wet ingredients that seem like they’d be the perfect breeding ground for bacteria. On the other hand, I’ve also wondered if you can accidentally wreck an ingredient by storing it at the wrong temperature. For example, you’ll notice olive oil solidifies when stored in the fridge, and that can’t mean good things for its flavor—right?

To clear up any confusion, I asked Jennifer Berg, Ph.D., director of graduate food studies at New York University, exactly how to store condiments no matter what kind. Use what she told me to ensure you never put your ketchup in the wrong place again.

Anything with a lot of acidity, sugar, or salt does not need to be refrigerated.

So it turns out I was wrong about refrigerating certain wet ingredients, like ketchup, mustard, and jam. You totally don’t have to, says Berg, because the large amounts of salt and sugar they’re made with keep them preserved even after opening. The same goes for things like Sriracha, hoisin or barbecue sauce, both of which are made with enough vinegar and sugar to keep them safe to consume when stored at room temperature. (Plus: Sriracha has the added bonus of also being a bit fermented!) She says mustard’s flavor will keep better in the fridge, but it’ll still be safe to eat until its best by-date if you decide to store it in the pantry. The only instance in which you might need to refrigerate one of these ingredients is if you’ve purchased a reduced-sugar or low-salt version, says Berg. Because they have less than the normal amount of preservatives, they may not last as long open and kept at room temp, she explains. “I would err on the cautious side and refrigerate after opening,” she says.

As for salad dressings, the rule is that if there’s no dairy, eggs, or fresh vegetables (like herbs), it’ll be fine at room temp.

That means vinegar- and sugar-heavy dressings like Italian or balsamic are fair game, whereas you should definitely keep Caesar and ranch dressings in the fridge.

Fermented sauces, like soy sauce and fish sauce, can also be left at room temperature.

Berg says that because they’re fermented, fish and soy sauces can be kept at room temp and will be safe to eat for up to a year after opening.

Nut butters can stay in the pantry, unless they’re fresh.

If you buy your nut butters with nothing added, or you get them freshly ground, or you make them yourself, Berg says you’ll need to store them in the fridge. On the other hand, shelf-stable nut butters are typically made with preservatives, and will be safe to eat when kept in your pantry. If you’re not sure if the nut butter you bought should be refrigerated or not, check the bottle or the company website for storage instructions. Or take a look at the ingredients list—if you notice preservatives, or lots of sugar or salt, then it’ll be safe to leave at room temp after opening.

Butter you can refrigerate or leave at room temp, but you can’t keep it at room temp for a very long time.

According to the FDA, you can safely leave butter at room temperature for one to two days before it starts to go off. So if you’re a big butter on toast kinda person, leave just enough out to give you softened butter for two days at a time (just be sure to store it in an airtight container). Other dairy products—spreads like cream cheese—are generally a no-go because they aren’t aged and preserved like butter. Keep those in the fridge.

Mayonnaise should always be refrigerated.

Mayonnaise is one of the few wet condiments made without a bunch of sugar, salt, and vinegar. Mainly, it’s just eggs and oil, which is a combo that can go bad pretty quickly if kept in your pantry, says Berg. “I would always refrigerate mayonnaise once opened,” she says.

And never refrigerate olive oil or honey.

You run the risk of destroying these ingredients if you refrigerate them, says Berg. Honey can crystallize and dry out, and olive oil will solidify and lose its flavor. You can find all the nitty gritty details about storing olive oil here, but to sum it up, you should always keep it in a cool, dark place in your pantry to protect if from heat and light, without cooling it down too much like you would by refrigerating it.

Now that you know how to store condiments, use your knowledge to keep all your spreads and sauces fresh and safe to eat, so you always have a way to spice things up.

Freeloaders beware: Incentives to foster cooperation are just around the corner

In our society, there are always a certain percentage of people who adopt a freeloader attitude. They let other members of society do all the work and do not do their part. By not contributing their share of effort, to the detriment of the rest of society, freeloaders pose a serious social threat, and can even lead to social collapse. In a new study published in EPJ B, Chunpeng Du from Yunnan University of Finance and Economics, Kunming, China, and colleagues show that it is possible to incentivise members of society to cooperate by providing them fixed bonuses and, thus, prevent freeloader behaviour from becoming prevalent.

Darwinian evolutionary theory shows that reason alone does not encourage individuals to help potential competitors. Since cooperation is widespread in both biological and social systems, especially in human societies, many scientists have been working to explain why rational participants nonetheless cooperate extensively. In the real world, however, if mutual cooperation can maximise the collective interest, it is endangered when freeloaders put their personal interests before the common good.

In the study, the authors attempt to solve this problem by working with a model called the public goods game to study the cooperative behaviour of members of society. To incentivise cooperation, the model features a system of rewards. In this case, the authors study a neutral reward system in which a few individuals reward most of the others. No matter whether a given individual is a cooperator or defector, as long as the number of that particular kind of individual is not dominant, they bear the cost of the reward. This is a mechanism in which prosocial and antisocial behaviour coexist, making it suitable for exploring the evolution of cooperation.

Based on numerical simulations, Du and colleagues show that increasing the bonus directly promotes cooperation and resolves the social dilemma. Indeed, the system is such that players pursuing majority strategies in a group will be rewarded by other players pursuing minority strategies. And the dominant players will receive a fixed bonus provided by other vulnerable players. When the reward factor is large enough, it makes the income gap between cooperators and defectors become more noticeable. This means that such rules encourage the spread of those who cooperate, and cooperators will eventually take over the entire system. Therefore, they conclude, rewards for the majority of individuals can in fact promote cooperation.

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World’s largest sleep study shows too much shut-eye can be bad for your brain

Preliminary results from the world’s largest sleep study have shown that people who sleep on average between 7 to 8 hours per night performed better cognitively than those who slept less, or more, than this amount.

Neuroscientists from Western University’s Brain and Mind Institute released their findings today in the high-impact journal, SLEEP.

The world’s largest sleep study was launched in June 2017 and within days more than 40,000 people from around the world participated in the online scientific investigation, which includes an in-depth questionnaire and a series of cognitive performance activities.

“We really wanted to capture the sleeping habits of people around the entire globe. Obviously, there have been many smaller sleep studies of people in laboratories but we wanted to find out what sleep is like in the real world,” says Adrian Owen, Western’s superstar researcher in Cognitive Neuroscience and Imaging. “People who logged in gave us a lot of information about themselves. We had a fairly extensive questionnaire and they told us things like which medications they were on, how old they were, where they were in the world and what kind of education they’d received because these are all factors that might have contributed to some of the results.”

Approximately half of all participants reported typically sleeping less than 6.3 hours per night, about an hour less than the study’s recommended amount. One startling revelation was that most participants who slept four hours or less performed as if they were almost nine years older.

Another surprising discovery was that sleep affected all adults equally. The amount of sleep associated with highly functional cognitive behaviour was the same for everyone (7 to 8 hours), regardless of age. Also, the impairment associated with too little, or too much, sleep did not depend on the age of the participants.

“We found that the optimum amount of sleep to keep your brain performing its best is 7 to 8 hours every night and that corresponds to what the doctors will tell you need to keep your body in tip-top shape, as well. We also found that people that slept more than that amount were equally impaired as those who slept too little,” says Conor Wild, Owen Lab Research Associate and the study’s lead author.

Participants’ reasoning and verbal abilities were two of the actions most strongly affected by sleep while short-term memory performance was relatively unaffected. This is different than findings in most scientific studies of complete sleep deprivation and suggests that not getting enough sleep for an extended period affects your brain differently than staying up all night.

On the positive side, there was some evidence that even a single night’s sleep can affect a person’s ability to think. Participants who slept more than usual the night before participating in the study performed better than those who slept their usual amount or less.

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Materials provided by University of Western Ontario. Note: Content may be edited for style and length.

‘Boy Meets World’ Star Will Friedle Says Anxiety Stopped Him From Acting On Camera

Will Friedle has finally revealed why he hasn’t appeared on television since the finale of Boy Meets World. Friedle joined his former costars Ben Savage and Danielle Fishel for a panel at New York Comic Con, celebrating the 25th anniversary of their breakout show. There, he explained why he’s chosen to focus on voice work since leaving the show, rather than appear in front of the camera.

“What brought me to voice-over was anxiety,” he said, per Entertainment Weekly.

“I was planning to do more on-camera work, but then I got hit with these anxiety attacks that prevented me from doing that. I was so thankful I had voice-over because I could still perform and act,” he added.

Friedle later revealed that the anxiety began when he was around 22 or 23 years old. “My career was going in one direction, I thought I was going to be an on-camera actor my entire life,” he told the crowd. “It got to the point where my anxiety was so bad that I couldn’t audition for on-camera stuff anymore. So, it was like, I was so thankful that I had voice-over. I could still perform, I could still act.”

Friedle finally ended his self-imposed hiatus when he reprised the role of Eric for the Boy Meets World spin-off, Girl Meets World. “Lately I’ve pulled out of that because of Girl Meets World,” the actor explained. “[Creator] Michael [Jacobs] was like, ‘Come back if you want to come back.’ So I’ve been slowly starting that again, and it’s been fun.”

At one point, Fishel also chimed in and revealed that Friedle’s castmates were concerned about him. “There were years there when we were really worried about Will. He wasn’t leaving his house,” she said, according to Fox News. “We’re really happy you’re back out there.”

As SELF explained previously, anxiety attacks aren’t the same thing as panic attacks, but they can still be distressing.

Panic attacks are intense episodes of fear or anxiety that come with physical symptoms, including an increased heart rate, shortness of breath, sweating, or dizziness. Anxiety disorders can also cause things like extreme fear or worry, a feeling that you’re out of breath, and trembling.

So an anxiety attack might refer to an exacerbation of those symptoms or, sometimes, what people refer to as “anxiety attacks” are actually panic attacks. Either way, if you notice that your anxiety is interfering with your relationships or ability to work, that’s a sign that you could use the help of a mental health professional.


The Breathing Trick Amandla Stenberg Uses to Ground Herself When Triggered by Sexual Assault News

Like so many Americans, actor Amandla Stenberg tuned in to witness the powerful testimony of Christine Blasey Ford, Ph.D., before the Senate Judiciary Committee last week.

She watched as Ford recounted in detail how Supreme Court nominee Brett Kavanaugh (now confirmed) allegedly sexually assaulted her when they were in high school. And, like a lot of women watching, hearing Ford’s story brought back the trauma of Stenberg’s own experience with sexual assault, the actor revealed in an op-ed for Teen Vogue.

In her essay, Stenberg wrote about the difficult emotions, like shame and self-blame, that she and millions of survivors deal with—and how those feelings can be brought to the surface by hearing other women’s stories.

“Watching Dr. Ford’s testimony pushed me and so many others to move through discomfort that we’d buried,” she wrote. “We have been riding waves of upheaval that have actuated processing and release,” Stenberg said, referring to the ongoing revelations of sexual assault in the news. “Although these tipping points are chaotic, disorienting, infuriating, and often heartbreaking, I like to believe that real change begins with the eruption of truth.” She added, “I am in awe of all survivors who have had no choice but to confront their trauma during this period, whether personally or publicly.”

Stenberg talked about the indispensable grounding technique that she turned to while watching the hearing last week.

Her mother taught her how to use her breath in difficult situations throughout her life, and the strategy proved useful once again in this scenario. “As I live-streamed Dr. Christine Blasey Ford’s testimony in a hotel room, a humid drizzle painted the windows an opaque gray, and I found myself relying heavily on the tool of my breath,” Stenberg wrote. “The grounding practice of breathing was gifted to me by my mama when I was a child and has been invaluable whenever I step into circumstances that challenge me to process and move through discomfort. Breathing practice is what I turn to when I’m scared or lonely; when I feel I am not enough or way too much.”

She explained, “My breath reminds me that I was brought into the world with all that I could need already within me. When I set the intention to honor my body by giving myself time to breathe, to treat myself like a friend, my body actually listens, and my brain and nervous system naturally conspire together for my highest good.”

Stenberg also turned to breathing as a coping mechanism in the immediate aftermath of a sexual assault.

“My breath was the tool I relied on when I ended up in a foreign country on a three-hour train ride to find an emergency contraceptive,” she said. “The night before, what started as a consensual experience had turned forceful. Painful things had been done to my body that made me feel broken and disposable. I was unable to consent to them, and was silenced verbally and physically when I protested.”

This was the second time Stenberg was sexually assaulted, she noted. The first time, she did not initially recognize what had happened to her as assault, because although she had not consented, she did not say “no” either. “I figured it was just an inherent part of sexual exploration as a teenage girl; the conundrum of compliance,” she wrote. “In both instances, I excused the behavior because I had been taught to, and it was easier than facing the full weight of my pain. Afterward, I clung to the tool of my breath that had been given to me by my mama, but I didn’t call her to tell her what had happened.”

Intentional breathing techniques are one way for sexual assault survivors to de-escalate their anxiety in the moment when difficult memories are triggered.

Sexual assault survivors who have strong reactions to news stories about assault—such as a panic attack or emotional distress—may benefit from having tools on hand to ground themselves in the present moment, Simon Rego, Psy.D., chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine, previously told SELF. “It’s good to remind yourself that you’re in a safe place and that the memories, although they’re scary, aren’t dangerous,” Rego said.

Breathing exercises are one way to do this, Laura Palumbo, a sexual assault counselor and communications director at the National Sexual Violence Resource Center (NSVRC), previously told SELF. Although there are different techniques, they usually involve a few minutes of slow, focused inhales and exhales, psychologist Paul Coleman, Psy.D., previously told SELF, which tells your parasympathetic nervous system that everything is OK. “If your mind is telling you fearful thoughts but your breathing is relaxed, it informs your brain that the situation is not all that threatening,” Coleman said.

Of course, while these can be helpful coping mechanisms in the moment for some people, in general, clinical anxiety and post-traumatic stress disorder (PTSD) are treated long term with therapy and sometimes medication. As Stenberg put it in her essay, “It is not your responsibility to figure this out by yourself… You are not weak for needing help. You are not defined by this. You are not alone. You are loved. Cry if you need to. Breathe. Your breath and your body belong wholly to you.”

If you need to talk to someone or find a nearby rape crisis center, you can reach a trained staff member at RAINN by calling 800-656-HOPE. You can also text a crisis counselor right now using the Crisis Text Line. And if you’re looking for mental health resources in your area, try the NAMI help line at 800-950-NAMI (6264).


Sexes differ when it comes to comfort during and after exercise, study finds

New research from the University at Buffalo has, for the first time, identified differences between men and women in their preferences for maintaining comfort both while exercising and in recovery. The results could one day inform the development of new athletic apparel.

The human body has a variety of automatic mechanisms in place to respond to being too warm, including sweating and increased skin blood flow. But people also have voluntary ways of cooling themselves down. If you’re in a stuffy room, for example, you can remove your jacket.

Scientists refer to these voluntary actions as “thermal behavior.”

“This study is the first to highlight sex differences in thermal behavior,” said Nicole Vargas, a postdoctoral fellow in exercise and nutrition sciences in UB’s School of Public Health and Health Professions.

Vargas is the lead author on the study, published online in August ahead of a scheduled December print date in Medicine & Science in Sports & Exercise, the official journal of the American College of Sports Medicine.

The study took place in UB’s Center for Research and Education in Special Environments. Researchers had 10 men and 10 women in their early 20s exercise at low intensity — about 65 revolutions per minute — on a stationary bicycle for one hour while watching a nature documentary. Each participant was equipped with a custom-made device: a dual tubing system that was in direct contact with the back of their neck.

The basic model for this study harkened back to similar studies in thermal behavior done in the 1970s. Those, however, used the hand for cooling purposes. “The neck makes more sense, however, because it’s more sensitive perceptually, so it gave us a more sensitive measure of thermal behavior,” explained Zachary Schlader, the study’s senior author and an assistant professor of exercise and nutrition sciences at UB.

One set of tubing was perfused with 93.2 degrees Fahrenheit water. The other series of tubes contained -4 degree liquid, but the flow of this liquid was controlled by a valve. Participants were instructed to “thermally behave” — or open the valve, thereby releasing the flow of extremely cold liquid — any time they felt that their neck was uncomfortably warm while exercising.

“As soon as they felt thermally comfortable again, they would turn the valve off and the 93 degree water would come through again, which effectively warmed their neck to thermoneutral range. If they felt they were getting too warm again, they could turn that valve back on,” Vargas said.

Participants were monitored for one hour after exercising and were instructed during the recovery phase to maintain their neck temperature at a comfortable level.

Researchers found that the female participants wanted more cooling than the males — despite similar overall changes in body temperature — as evidenced by the females’ more frequent use of the antifreeze liquid while exercising. Vargas says there are several potential explanations: Women have more subcutaneous fat than men, and women tend to have greater perceptual responses to temperature changes.

“The really interesting thing we found was during recovery,” Vargas said. “The dynamic of how skin temperature recovers versus core temperature in females compared to males was a lot different.”

Whereas skin temperature in males gradually fell following exercise, returning to normal levels within 60 minutes, skin temperature fell more rapidly in females, returning to normal levels within 10 minutes following exercise.

This rapid fall in skin temperature should theoretically decrease the desire for neck cooling in females. However, the women in the study continued to thermally behave by releasing the flow of the extremely cold liquid, likely because their core temperature remained elevated. This highlighted the importance of core temperature as a major contributor to thermal behavior following exercise, which was more apparent in females.

While the research team isn’t involved on the product side, the results of this study may help inform the development of new athletic apparel in the years to come.

Since this study was completed, researchers have begun applying the basic study model and technique to more clinical applications. For example, Vargas received a grant through the American College of Sports Medicine to examine thermal behavior in people with multiple sclerosis. The symptoms of MS can be exacerbated during exercise.

“We’re interested in determining whether people with MS use thermal behavior appropriately and if that can help mitigate some of the symptoms they feel while exercising,” Vargas explains. “This whole line of thermal behavior research has opened up a lot of doors for us.”

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Materials provided by University at Buffalo. Original written by David J. Hill. Note: Content may be edited for style and length.

In childbirth, when to begin pushing during labor does not affect C-section rates

More than 3 million women in the United States give birth each year. But obstetricians have differing opinions about when women should begin pushing during labor and whether the timing of pushing increases the likelihood of a cesarean section, which carries a higher risk of complications compared with a vaginal delivery.

Many obstetricians recommend that a woman begin pushing as soon the cervix is fully dilated, while others advise waiting until she feels the urge to push. Until now, doctors have not had conclusive evidence about which approach is better for mothers and their babies.

Now, a multicenter study led by Washington University School of Medicine in St. Louis and involving more than 2,400 first-time pregnant women, shows that the timing of pushing has no effect on whether women deliver vaginally or by C-section.

However, women who delayed pushing experienced longer labors and higher risks of severe postpartum bleeding and infections. Their babies also were more likely to develop sepsis — a serious complication related to infection.

The study, funded by the National Institutes of Health (NIH), is published Oct. 9 in the Journal of the American Medical Association.

“Obstetricians tend to favor one approach over the other, but no solid evidence has existed to favor either one,” said the study’s first author, Alison G. Cahill, MD, a Washington University associate professor of obstetrics and gynecology and director of the Division of Maternal-Fetal Medicine. “We think our findings are likely to change how many obstetric providers manage labor. Previous studies comparing the immediate versus pushing approaches involved small numbers of patients, and results were often contradictory and inconclusive.”

The current study enrolled 2,414 first-time pregnant women at one of six U.S. hospitals between May 2014 and November 2017. The women were at least 37 weeks pregnant with a single pregnancy, and all had received epidural anesthesia to reduce labor pain. Once the cervix was fully dilated at 10 centimeters, indicating the beginning of the second stage of labor, the women were randomly assigned to either begin pushing immediately or to delay pushing for 60 minutes.

Of those in the immediate-pushing group, 1,031 (85.9 percent) delivered vaginally compared with 1,041 (86.5 percent) in the delayed-pushing group — a difference that is not statistically significant.

“The findings provide strong evidence that for first-time pregnant women receiving epidurals, immediate versus delayed pushing during the second stage of labor did not affect vaginal delivery rates,” said Menachem Miodovnik, MD, a medical officer at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

However, women in the immediate-pushing group experienced significantly lower rates of infections and fewer episodes of excessive bleeding following delivery. Specifically, 80 (6.7 percent) of the women who began pushing immediately developed an infection compared with 110 women (9.1 percent) who delayed pushing. In addition, 27 (2.3 percent) in the immediate-pushing group suffered severe postpartum bleeding, compared with 48 (4 percent) in the delayed-pushing group.

Additionally, women who pushed immediately experienced a shorter second-stage of labor by an average of 30 minutes, compared with those who delayed pushing — 102.4 versus 134.2 minutes.

Although the numbers were small, infants delivered to mothers in the immediate-pushing group experienced significantly lower rates of suspected sepsis compared with those in the delayed-pushing group: 38 (3.2 percent) and 53 (4.4 percent), respectively.

“Pushing during labor is physically demanding and intense,” said Cahill, who delivers babies at Barnes-Jewish Hospital. “Women look to their obstetric providers for guidance and what’s best for them and their babies. Our findings can guide providers to better manage the second stage of labor for optimal health for moms and their babies. This means avoiding delayed pushing for the sake of increasing the chance of vaginal delivery since it is associated with longer labor time and higher health risks to mothers and babies.”

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Materials provided by Washington University in St. Louis. Original written by Kristina Sauerwein. Note: Content may be edited for style and length.

Even when presented with facts, supported by evidence, many choose not to believe them

In an era of fact-checking and “alternative facts,” many people simply choose not to believe research findings and other established facts, according to a new paper co-authored by a professor at Indiana University’s Kelley School of Business.

“A growing body of evidence suggests that even when individuals are aware of research findings supported by a vast majority of studies, they often choose not to believe them,” wrote Ernest O’Boyle, associate professor of management and entrepreneurship, and two co-authors in the Journal of Management.

“There are reasons for growing alarm about the disbelief of scientific findings across a wide range of professional domains because it seems to reflect a much broader drop in the credibility of academics and scientists.”

In an editorial commentary, O’Boyle and two professors at the University of Iowa — Sara Rynes and Amy Colbert — explain why people often don’t believe research findings.

Some public distrust comes from a rapid rise in studies suggesting that current research findings aren’t as robust as previously thought. Reasons range from innocent causes, such as undetected analytical errors, to occasional questionable research practices. But the authors also point to “well-funded, concerted efforts to discredit solid scientific research for self-interested political, ideological or economic ends.”

This trend affects American business and the workplace because managers are less likely to look to academic research for advice or apply empirically validated best practices. For example, they may fail to embrace the view that intelligence is the single best predictor of job performance, which has been widely proven through research.

“Research suggesting the benefits of diversifying the labor force or promoting women or minorities into leadership positions is likely to threaten the vested interests of members of currently overrepresented groups while raising the hopes and aspirations of others,” they said. “Many people are also likely to use motivated reasoning when evaluating research-based claims about the causes and consequences of pay inequity.”

To address these challenges, O’Boyle and his colleagues said business researchers should broaden the range of research to focus on bigger, more important problems and consider more emphasis on needs of customers, employees, local communities, the environment and society as a whole. They need to find opportunities to co-create research with practitioners, beyond their simply providing data and other information.

They also need to improve how they report and communicate about their research.

“To outsiders, the current publishing model of academic research is likely to appear strange, counterintuitive and wasteful,” they said. “Experts have long recommended publishing findings in outlets that are more accessible.

“Many practitioners, students and members of the general population now get much of their information from sources that were barely in use little more than a decade ago, such as blogs, online videos and various forms of social media. The best opportunities to … get research evidence to the public may lie in these alternative forums.”

These forums may include TED talks, online forums and massive open online courses, known as MOOCs. O’Boyle and his co-authors also suggest that scholars need to better anticipate and address resistance to specific findings in their research.

“A lot of what we’re doing to bridge the academic-practice gap, like publishing in more accessible outlets and doing more executive training, doesn’t work unless we are able to overcome some of these natural barriers to persuasion,” O’Boyle said.

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Materials provided by Indiana University. Note: Content may be edited for style and length.

How To Pick the Right Skin-Care Acid For Your Concerns

The thought of using skin-care acids used to scare me for the longest time. (Now, I’ll gladly take one of each.) In reality, incorporating the right acids into your beauty routine could actually be beneficial for addressing a number of skin-care concerns that may be bothersome to you.

Also a reality: the fact that store shelves are spilling over with all kinds of cleverly packaged serums, moisturizers and oils that promise to brighten, tighten, and exfoliate your skin. All of that is great—in theory—but who wants to turn themselves into a science experiment in the name of skin-care? (Okay, I know some of you do, but not me!) That’s why I reached out to two dermatologists to help me put together a cheat sheet on everything you need to know about the most popular skin-care acids they recommend to their clients, and what they can and can’t do for you.

1. Hyaluronic Acid

Good for: Dullness, aging skin

If you’ve ever seen people rave on Instagram or Reddit about products that give them dewy skin, it’s probably because of hyaluronic acid. Hyaluronic acid is a humectant, meaning it helps skin attract and retain moisture. Jacqueline Schaffer, M.D., founder of Shique Beauty, tells SELF that hyaluronic acid is naturally produced in the body, and is what helps gives our skin a youthful glow.

As we age, the amount of hyaluronic acid our body produces decreases, which can leave us with duller-looking skin. Products containing hyaluronic acid can improve the skin’s ability to absorb and hold water to keep it looking plump and hydrated, Dr. Schaffer says, which is why she recommends incorporating hyaluronic acid serums into your nighttime skin-care routine, about three or four times a week. It’s generally well-tolerated by most skin types.

Dr. Schaffer suggests using Skinceuticals’ Hyaluronic Acid Intensifier, $98, but there are other more affordable options too, like Neutrogena’s Hydro Boost Gel-Cream, $16, or cult-favorite The Ordinary’s Hyaluronic Acid 2% + B5, $13, both of which are top sellers on Amazon.

2. Alpha hydroxy acid (AHA)

Good for: Exfoliating, improving mild textural issues, skin brightening

Alpha hydroxy acids are acids derived from food and plant sources like sugar, milk, and fruits. There are several different types of alpha hydroxy acids used for skin-care, like citric (derived from citrus fruits) , mandelic (derived from plants), or lactic acid (derived from milk), but the most common one is glycolic acid (derived from sugar). Sejal Shah, M.D., a board-certified dermatologist and founder of SmarterSkin Dermatology, tells SELF that because of their exfoliating properties, AHAs are a great option for skin brightening and improving mild textural issues like hyperpigmentation from sun exposure. Note that since AHAs are water soluble they don’t penetrate the pores as deeply, so they’re best for addressing surface skin issues. Generally, AHAs are pretty well-tolerated by most skin types, but experts say that people with sensitive skin should use AHAs carefully since they can be potentially irritating.

Because of my dry skin, I’m a huge fan of this gentle Tata Harper Resurfacing Serum, $88, which contains seven types of AHAs (along with BHAs—more on those below). You can also try Aveeno Positively Radiant 60 Second In-Shower Facial Cleanser, $20, which is formulated with glycolic acid.

3. Salicylic or beta hydroxy acid (BHA)

Good for: Unclogging pores for oily and acne-prone skin

Unlike AHAs, beta hydroxy acids bind to oil, not water. The most common BHA for skin-care is salicylic acid, which works as a deep exfoliator in your skin. “Because it’s oil-soluble, salicylic acid is able to break through the buildup of bacteria, oil, and dead skin cells in the pore lining and dissolve it, which unclogs pores and can help prevent breakouts from happening,” Dr. Schaffer explains. BHAs tend to penetrate deeper than AHAs, so they are good for oily or acne-prone skin. For an effective treatment, Dr. Schaffer recommends Tata Harper’s Resurfacing Mask, $62, or Paula’s Choice Skin Perfecting Exfoliant 2% BHA Liquid, $28.

Dr. Shah says that salicylic acid is best for people with oily and acne-prone skin, but people with sensitive skin should it use with caution since it can be drying. She recommends using salicylic acid in the evening, unless you are using a retinoid at night (more on the benefits of retinoic acid below). Experts don’t advise applying retinoids and salicylic acid together to reduce the possibility of irritation and dryness. If you use salicylic acid in the daytime, be sure to apply a sunscreen over it.

4. Vitamin C or ascorbic acid

Good for: Brightening skin, antioxidant protection, stimulating collagen

Vitamin C (or ascorbic acid) is a powerful antioxidant found in serums, exfoliants, and moisturizers. Like other antioxidants, vitamin C helps protect the skin from free radical damage from environmental factors like pollution or the sun. “It can also prevent signs of aging by boosting collagen synthesis and brighten and even skin tone,” Dr. Shah says. She recommends using it in serum form in the morning before applying moisturizer and sunscreen (remember to always apply products from thinnest to thickest). Vitamin C is generally well-tolerated by all skin types, and works well if you’re looking to address hyperpigmentation concerns.

Our experts recommend keeping an eye out for a specific type of vitamin C, tetrahexyldecyl (THD) ascorbate, which is a stable form of ascorbic acid. Some experts consider it the most effective form of vitamin C for skin-care since it’s fat-soluble and can penetrate more deeply than water-soluble forms in order to stimulate collagen, but more research is needed to confirm this theory. Also, some experts say that since THD ascorbate is stable, the formulation may last longer than vitamin C that is in active form. In any case, many companies that use ascorbic acid (the active form of vitamin C) have stabilized it in their formulations, although you should still be careful when storing and handling the product by limiting its exposure to air and light so it doesn’t oxidize quickly.

Dr. Shah likes Drunk Elephant C-Firma,, $80, which contains ascorbic acid along with other antioxidants. Another option is Sunday Riley C.E.O. Rapid Flash Brightening Serum, $85, which contains THD ascorbate, or our SELF Healthy Beauty Award winner, Vichy LiftActiv 15% Pure Vitamin C Serum Brightening Skin Corrector, $29, which contains ascorbic acid.

5. Retinoic acid

Good for: Stimulating collagen and cell turnover, exfoliation

Retinoic acid, also called retinol or retinoid, is a vitamin A derivative that directly helps increase collagen production to stimulate cell turnover. After sunscreen, many dermatologists say that retinoic acid or retinol is one of the best products for aging skin. “It’s so effective in keeping your skin looking youthful and goes directly to stimulate collagen,” Dr. Schaffer says. Retinol can be found either as an over-the-counter version, like the CeraVe Skin Renewing Cream Serum, $10, or prescribed through your dermatologist. Retinol can irritate the skin, so it’s best to take baby steps to get to a full-strength product. Experts always recommend applying the product at night and starting with a lower concentration—OTC retinols come in different strengths, ranging from 0.1 to 1.0 percent—and increasing slowly. For more tips check out this post on how to use retinol safely and effectively.

No matter what acid you use, remember that patience and realistic expectations are key.

Before you get started on your skin-care acid routine, make sure you understand how it can affect your skin, and avoid combining products that might lead to more irritation. For example, Dr. Schaffer recommends using any acid treatment at night when your skin cells are repairing and it’s not exposed to sunlight and environmental pollutants (and if you are wearing acids in the day, make sure you have sunscreen on).

The bottom line: while acids can be really effective, there’s no one size fits all when it comes to addressing skin-care concerns. Some acids may not be recommended for people with sensitive skin or for people with skin conditions like rosacea, eczema or psoriasis. Be sure to talk to a dermatologist if you have any questions before you take the (acid) plunge.