How to Conceal Pimples the Right Way, According to Makeup Artists

Regardless of whether you’re having a great hair day or crushing it at work, one bad breakout can completely change everything. Not only are pimples incredibly inconvenient and totally unapologetic about it—as evidenced by the multitude of zits camping out on my right cheek—they can also be really hard to cover if you don’t understand the best practices to do so.

Although pimples come in all shapes in sizes, there are certain makeup techniques that can help to minimize their appearance on your face if that’s what you’re looking for. The right full-coverage foundation or finesse of a Beautyblender could be the difference between doing a little too much and a smoother, more natural-looking complexion. As someone who’s gone through lots of trial and error with zits and dark spots, I know that covering them up requires some skills—which is why I reached out for some expert tips.

To find out how to make breakouts vanish (at least for a few hours), I spoke with Kelli J. Bartlett, artistic director at Glamsquad; celebrity makeup artist Allan Avendaño; and Dominique Lerma, Moda Brush executive artist, to get the lowdown on common mistakes we make when it comes to hiding pesky pimples.

1. You’re not allowing your breakout to heal properly.

Piling on a ton of makeup over your zits will not only make them more obvious, but also slow down their healing process. It’s not enough to just cover them up and hope they’ll disappear—treating the skin under the makeup will actually help pimples go away sooner. “One common mistake that women make when concealing breakouts is not taking the time to heal the breakout before moving forward with concealing it,” Lerma explains. “I never recommend putting makeup on an open breakout/freshly popped pimple. It’s as unsanitary as it sounds and the breakout will not heal properly when makeup is packed on top.” Editor tip: Since breakouts can become even worse if they’re improperly treated—resulting in dark spots or even scabbing—it’s best to use a spot treatment like Mario Badescu Drying Lotion, $17, to help them dry out and heal before you conceal.

2. You’re using dirty makeup tools.

Not washing your brushes and sponges can cause them to collect bacteria, which tends to make acne worse. “Before even getting to makeup, you have to make sure that everything is clean, so no dirty brushes or sponges,” Avendaño tells SELF. Makeup guru Bobbi Brown has said that brushes that are used around the eyes should be cleaned at least twice a month while all others can be washed once a month.

3. You’re not moisturizing enough.

Even if you’re not suffering from a breakout, moisturizing should always be a first step before applying makeup, as it helps to provide a smooth base for foundation and concealer. It’ll also help avoid looking like you piled too much product on. “Skin-care is of utmost importance always but especially when dealing with a breakout,” Lerma says. “I recommend following your skin-care regimen, but applying a little extra moisturizer on the breakout area, and then priming the entire face.”

Avendaño agrees, explaining that applying a moisturizer before foundation makes a huge difference for acne-prone skin. “Whenever I’m working on someone with acne, I make sure to apply moisturizer first so any dry areas are fully hydrated, ensuring concealer and foundation don’t cling to dry spots around their breakouts,” he says. “I love using the Differin Oil Control Moisturizer SPF 30 before applying foundation because it’s a moisturizer with SPF, and due to its matte finish, also acts as a primer.”

4. You’re not using a color corrector.

Color correcting might seem intimidating, but once you understand how colors work for different issues, they can be your go-to secret weapon for disguising zits—especially if they’re more on the red side. Color correctors are “so helpful for really red pimples or dark acne scars,” Bartlett explains. “I typically use a green shade for red, inflamed blemishes, but yellow works, too. Peach shades tend to cover dark spots very well.”

As less is more when it comes to concealing breakouts, Lerma advises starting with a small amount of product and adding more if necessary, especially when working with color correctors. “If used properly, the color correctors will work like a charm,” she explains. “I always suggest starting with a small amount of product and then adding more if necessary, as it’s always easier to add more than to take off.”

5. You’re not choosing the right concealer color.

Just like choosing the correct foundation shade to match your skin color, using the right concealer shade is important when covering up breakouts. “One of the biggest mistakes people make is choosing a concealer that is the wrong color for their breakout,” says Bartlett. “If the color is too light and the pimple has a raised texture, it will not blend into the surrounding skin evenly. Choose an exact match to your skin tone—or even slightly deeper—so that you can easily camouflage the pimple.” Think of it this way: Using a concealer shade that is too light for your skin tone is like putting a spotlight on your zits.

6. You’re using the wrong type of makeup brush.

To seamlessly cover breakouts, using the right application tool is key. Avendaño swears by a buffing brush (one with dense bristles) to apply foundation on his clients who are dealing with breakouts. “With foundation, I tend to use a dry buffing brush to apply the product in a circular motion,” he explains. He says he doesn’t use blending sponges because he believes they actually pull product off blemishes—the opposite of what you want. Lerma agrees, explaining that brushes offer a more full range of motion for flawless makeup application.

However, not all makeup artists are in agreement about sponges. While Bartlett prefers to use a makeup brush on her clients with more acne-prone skin, she also uses a sponge to finish the look, which she called “a combination approach.” A small, firm brush can provide targeted concealing, she explains, adding that a fluffy brush will help to blend edges. “A sponge helps to melt makeup into the skin and make it look like it’s not [even] there,” she says. If you’re covering up an especially bad breakout, Bartlett advises using a dry sponge for more full coverage, as wetting a sponge tends to sheer out foundation.

7. You’re applying too much makeup.

One of the beauty lessons I learned the hard way was that overcompensating with more product to cover pimples will often make the situation look even worse. The top culprit? Too much powder, which “can give the pimple more texture, making it more visible,” Avendaño says. First, make sure any dry areas of the face are properly moisturized. If you choose to use a color corrector, apply that next, and then apply your foundation. Then lightly dab on concealer with a flat brush to the areas that need special attention. Build the product up in thin layers until the breakout is barely visible. Finish your look by lightly dusting the face with setting powder to help everything stay put.

What You Need to Know About Interpersonal and Social Rhythm Therapy

If you’ve never heard of interpersonal and social rhythm therapy (IPSRT), it may just sound like a bunch of vaguely psychological words strung together. In reality, IPSRT can be incredibly helpful for some people with bipolar disorder. Here are the ins and outs of how IPSRT can ease bipolar disorder symptoms.

Bipolar disorder causes extreme shifts in mood and energy that can disrupt a person’s life.

There are two major subcategories of the disorder: bipolar I and bipolar II, according to the National Institute of Mental Health (NIMH).

Bipolar I involves prolonged and possibly dangerous manic episodes, which is when a person experiences an extremely elevated mood and energized behavior, the NIMH explains. Symptoms can include increased activity, trouble sleeping, being agitated or irritable, talking very quickly (or feeling like their thoughts are moving very quickly), thinking they can accomplish anything, and engaging in risky behavior like unprotected sex or impulsive spending. Someone with bipolar I can also experience episodes of hypomania that involve the heightened mood and energy of mania but on a less severe scale, depressive episodes lasting at least two weeks, or episodes combining symptoms of mania and depression. Bipolar II only involves episodes of hypomania and depression, the NIMH explains.

There are also some related conditions that describe having symptoms of hypomania and depression to a lesser extent (cyclothymia) or having symptoms that don’t neatly fit into any of the previous categories (Other Specified and Unspecified Bipolar and Related Disorders).

IPSRT is designed to teach someone with bipolar disorder how to prevent or better manage these shifts in mood and behavior.

This form of therapy focuses on stabilizing a person’s daily rhythms, like sleeping, waking up, and eating meals, according to the Mayo Clinic. If you take a look at its pretty jargon-y name, you can better understand why it does this.

The “interpersonal” aspect of IPSRT stresses the link between how a person’s mood affects their life, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). “It is about how one relates to others in the world,” Nassir Ghaemi, M.D., M.P.H., professor of psychiatry at Tufts University School of Medicine, tells SELF. For instance, your therapist might ask you about recent or significant times your bipolar disorder has affected your friendships, love life, work relationships, and more. This can help a person with bipolar disorder examine how their condition influences their experiences so they’re more committed to living with it in the healthiest way possible. Your therapist may also ask you questions to identify how your routine (like when you sleep) affects your symptoms on a day-to-day basis, because committing to a lifestyle routine is an essential part of this therapy.

The “social rhythm” part of IPSRT centers around creating a daily routine a person can stick to long-term. “People with bipolar disorder tend to live less regimented lives,” Michael Thase, M.D., professor of psychiatry and director of the Mood and Anxiety Program at the University of Pennsylvania Perelman School of Medicine, tells SELF. “They may not go to bed at a good time, they may eat irregularly…adding normal times and a schedule to these things can help them take control of the irregularity.”

This type of set routine impacts your circadian rhythm (the collection of physiological processes timed to light and darkness that you go through over the course of 24 hours). This interplay is important because your circadian rhythm influences so many aspects of how your mind and body function, including the release of hormones that can influence your mood. (Research shows people’s circadian rhythms can affect their mood disorders.)

This is also why getting regular sleep is an especially crucial part of IPSRT, Dr. Ghaemi says. Since your circadian rhythm and sleep habits are inextricably intertwined, it’s no surprise that poor sleep can trigger manic and depressive episodes in some people with bipolar disorder.

If you’re going to get IPSRT, there are four phases of treatment to expect.

Here they are, per the SAMHSA:

  • The initial phase is all about you and the therapist exploring how disruptions in your routine have led to bipolar episodes in the past.
  • The intermediate phase involves laying out a new structure for your social rhythms (like when you wake up and go to sleep). You’ll typically start charting things like your mood, sleeping, eating, and exercise habits to pick up on how they’re connected, Dr. Ghaemi says.
  • The maintenance phase is meant to help you reinforce these social rhythms so you trust that you can stick to them.
  • The final phase is about reducing how often you need IPSRT.

As the SAMHSA explains, IPSRT treatment is meant to be weekly at first, then become monthly, then, ideally, you’d no longer need regular therapy sessions centered around this technique. Most people will undergo about 16 weeks of IPSRT, Dr. Ghaemi says. However, you can discuss continuing the sessions for as long as you find them valuable, Dr. Thase says.

Not every therapist is trained in IPSRT, so you’ll want to do your research before finding a practitioner.

When you’re searching for a therapist, you can use free consultations to ask how much practice your potential provider has in treating bipolar disorder, especially with this method. (Or you can ask the administrative office to find out for you if the therapist doesn’t offer free consultations.)

Even if they don’t have a ton of practice with IPSRT, a dedicated therapist may still be able to help. “The interpersonal component of this therapy is based on the traditional [psychotherapy] approach,” Dr. Ghaemi says. There are also free training tools available to experts looking to get a better handle on the social rhythm portion.

What if you’re interested in IPSRT but you’re already doing another form of therapy, like the cognitive behavioral variety? Ideally, you wrap that up before starting IPSRT, Dr. Ghaemi says, so you don’t interrupt your progress. “One could follow another,” he adds. However, that’s a decision you can make with your therapist. If they determine IPSRT would be more beneficial to you in the short-term than another form of therapy, it might make sense to dive right in.

Finally, let’s talk money, since therapy can be wildly expensive. IPSRT is typically covered by insurance at the same rate as any psychotherapy, Dr. Ghaemi says. If you have insurance, you can try using services like Psychology Today to find therapists who accept your plan and specialize in treating bipolar disorder. If you don’t have insurance, see whether any of the therapists who look promising to you accept patients on sliding scales based on income.

IPSRT can be excellent, but it’s not supposed to replace medication for bipolar disorder.

IPSRT should be used with certain medications to help treat this condition. “It does not work by itself,” Dr. Ghaemi says.

Medications to treat bipolar disorder can include mood stabilizers (to control manic or hypomanic episodes), antipsychotics (to help with symptoms of depression or mania that persist despite treatment with other medications), antidepressants (to treat the downcast mood), an antidepressant-antipsychotic (which works as a depression treatment and mood stabilizer), and anti-anxiety medications (to help with agitation and improve sleep), according to the Mayo Clinic.

You may need to take a variety of medications for your bipolar disorder symptoms, but combined with therapy like IPSRT, they can give you a good chance of feeling more in control of your life.

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Types of Ovarian Cancer: The Three Types You Should Know

Hearing that you or a loved one has a diagnosis of ovarian cancer is terrifying. Once the initial shock wears off, you’ll likely have a lot of questions and do some research on your own to answer them. One thing you’ll probably discover: There are actually three overarching types of ovarian cancer. While every person’s experience with cancer will vary, understanding the similarities and differences between these three types might be helpful.

Ovaries are reproductive glands that produce eggs along with the hormones estrogen and progesterone.

The reason there are three types of ovarian cancer lies in the fact that your ovaries contain three main types of cells that can each create tumors, according to the American Cancer Society (ACS). Epithelial cells coat the surface of the ovaries, germ cells create eggs, and stromal cells keep the ovaries together and produce the hormones estrogen and progesterone.

(However, emerging science suggests that some ovarian cancers actually start in the fallopian tubes, which are the structures that connect the ovaries to the uterus. Scientists are continuing to study how exactly this happens.)

Let’s walk through the three types of ovarian cancer in detail.

1. Epithelial ovarian cancer: This begins in that thin layer of tissue that blankets the outside of the ovaries. According to the Mayo Clinic, about 90 percent of ovarian cancers fall into this category.
There are a lot of different subtypes of epithelial ovarian cancer, which is a pattern you’ll see with the other kinds of ovarian cancer, too. Serous carcinomas are the most common kind, according to the ACS. Serous refers to serum, the clear liquid portion of blood, the National Cancer Institute explains.

2. Germ cell ovarian cancer: This starts in the egg-producing cells, and it makes up less than 2 percent of ovarian cancers, according to the ACS. However, these cases tend to affect girls and young women. For instance, dysgerminoma, the most common ovarian germ cell cancer, typically develops in women in their teens and 20s. Another kind of ovarian germ cell cancer called immature teratoma usually happens in girls younger than 18.

“We don’t really know why [these cancers mainly affect young women and girls]” Stephen Rubin, M.D., chief of the Division of Gynecologic Oncology at Fox Chase Cancer Center, tells SELF. “They do arise from the germ cells in the ovaries which give rise to the eggs. It may be that these cells are more numerous and active in younger women, but that’s speculation.”

3. Stromal ovarian cancer: Official numbers vary, but this seems to make up about 1 percent of ovarian cancers. It starts in the ovarian tissue that contains hormone-generating cells and is usually diagnosed at an earlier stage than other ovarian cancers, the Mayo Clinic says. “[These tumors] tend to sit in the ovary and grow for a long period of time without spreading,” Dr. Rubin says. “It gives us more time to find them.”

Cancerous stromal growths, which include granulosa cell tumors (the most common type), granulosa-theca tumors, and Sertoli-Leydig cell tumors, can all secrete the reproductive hormone estrogen. This is important because it can translate into some of the more noticeable symptoms of ovarian cancer, which is often able to fly under the radar.

Before we delve into ovarian cancer symptoms, it’s important to be really clear about this: Not all ovarian growths (or growths in general) are cancerous.

Although epithelial, germ cell, and stromal tumors can lead to three distinct and eponymous types of ovarian cancer, they can also all cause tumors that aren’t cancerous. For instance, epithelial cystadenomas are benign growths that can be filled with a watery or mucous-based liquid, according to the Mayo Clinic. And germ cell growths are usually benign tumors called mature teratomas, the ACS explains. These can contain a bunch of different types of tissue including—gulp—hair, skin, and teeth.

There are some typical symptoms of ovarian cancer, but the frustrating thing is that they’re so vague.

“In general, ovarian cancers don’t hurt and don’t produce enough noticeable symptoms unless [they’ve grown to a] large size,” Dr. Rubin says. With that in mind, these are the usual symptoms of ovarian cancer, according to the Mayo Clinic. As you’ll see, they can all be due to a wide range of things that often have nothing to do with cancer:

  • Abdominal bloating or swelling
  • Feeling full quickly when you eat
  • Unexplained weight loss
  • Pelvic discomfort
  • Changes in your bowel habits, like constipation
  • Needing to pee a lot

Epithelial ovarian cancers (the ones that make up 90 percent of all ovarian cancers) are most likely to have these standard but nebulous symptoms, Robert Wenham, M.D., chair of gynecologic oncology at Moffitt Cancer Center, tells SELF. The other two less common forms are at least more likely to cause more attention-grabbing symptoms.

Some germ cell cancers, specifically dysgerminomas, can grow to a large size before being diagnosed, which can leave a person with abdominal pain, Dr. Rubin says. They can also cause irregular bleeding. “These tumors are highly vascular and may rupture and bleed,” he says.

Abnormal vaginal bleeding is actually the most common symptom of stromal ovarian cancer, the ACS says. This is due to the aforementioned excess estrogen this cancer can create. On the flip side, stromal tumors can also make hormones like testosterone, the ACS says. That can cause a person’s periods to stop and lead them to grow facial and body hair. Either way, if the tumor starts to bleed, it can cause severe abdominal pain seemingly out of nowhere, the ACS explains.

The added estrogen from stromal ovarian cancer can also cause breast tenderness, Shannon Westin, M.D., an associate professor in the department of gynecologic oncology and reproductive medicine at M.D. Anderson Cancer Center, tells SELF, along with breast development before puberty.

Treatment for ovarian cancer varies based on the stage, grade, and type a person is at when they’re diagnosed.

You’re probably already familiar with staging, which is essentially figuring out how much a cancer has spread. So, let’s talk about grades of ovarian cancer. Depending on how much the tissue in a cancerous tumor looks like regular tissue, it will receive a grade, the ACS explains. The higher the grade, the less the tumor has in common with normal tissue. The tumor will also get a type (beyond the general types of ovarian cancer discussed above) based on how quickly the cells grow and how well they might respond to chemotherapy. Type 1 tumors grow more slowly and cause fewer symptoms, the ACS says, while type II do the opposite.

Doctors can have their suspicions that someone has ovarian cancer, they really won’t know all of these details until they get a pathology report, which typically comes after surgery, Dr. Wenham says, hence why surgery is a mainstay of ovarian cancer treatment.

The extent of the surgery depends on how much the cancer has spread, the Mayo Clinic explains. Remember, malignant and borderline malignant tumors all have the capacity to metastasize.

If the cancer is limited to one ovary, surgery may only require removing that gland and its accompanying fallopian tube, according to the Mayo Clinic. This can be a good fit if the patient still hopes to physically carry a pregnancy in the future. If the cancer has spread to both ovaries, those will need to be removed, as will the fallopian tubes. But leaving the uterus behind means a person could still theoretically carry a pregnancy via frozen embryos, frozen eggs, or donor eggs. However, if the cancer is also affecting the uterus (or if the person with cancer would rather preemptively have their uterus removed than preserve the chance to physically carry a pregnancy), that organ may also be taken out along with the ovaries and fallopian tubes, the Mayo Clinic explains. Nearby lymph nodes and a piece of fatty abdominal tissue called the omentum can also contain cancerous cells at this point, so they will likely come out as well.

Beyond that, doctors may recommend chemotherapy to kill cancer cells that remain after surgery. “Rarely, radiation may be used,” Dr. Wenham says. Radiation relies upon strong rays or particles of energy to target those cancer cells, but chemotherapy tends to be more effective for ovarian cancer.

Again, since everyone’s cancer experience can be so different, this is only meant to be an informative primer. If you or a loved one is diagnosed with ovarian cancer, Dr. Westin stresses the importance of being treated by a specialist if at all possible, particularly one at a major cancer center that deals with ovarian cancer often. They should be able to explain the specifics of the situation and, hopefully, determine which treatment has the best chance of success.

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Kristen Bell Fainted While Trying to Remove a Menstrual Cup

We may not all welcome our periods with open arms, but at least we have our choice of ways to deal with it. Still, what works for one person may not be ideal for another. For instance, for Kristen Bell, menstrual cups are not the top choice anymore.

While appearing on Busy Philipps‘s new show, Busy Tonight, Bell explained that she may be done with menstrual cups after a particularly trying experience with one. No, we don’t mean spillage—Bell actually passed out while trying to remove her cup. Here’s what happened, plus a gynecologist’s take on why this might occur.

“I tried the DivaCup but I had a very weird experience with it,” Bell told Philipps on the show.

“A menstrual cup is tricky and takes some trial and error and you have to be willing…” Philipps started.

“To figure it out,” Bell finished. “To finger it out, really.”

Bell went on to describe a time in which her DivaCup got, well, stuck. “I went to grab it and there was something that was suctioned to the wrong part of me,” she said, explaining the very odd feeling of something pulling on your insides, which caused her to pass out on the toilet.

“I fully passed out and came to and I still hadn’t had it out, so I then had to remember, like, ‘OK, you gotta brace yourself, you gotta grab hard, you gotta grab strong,'” she said. “I ripped it out, but after that I was like, ‘Maybe I should take a break. Maybe it’s not for me.'”

It’s not uncommon for people to get things like menstrual cups stuck, but most of us don’t faint when that happens.

Getting something like a tampon, vaginal ring, or menstrual cup stuck inside of you is an unfortunately common issue, Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF.

We obviously don’t know exactly what happened in Bell’s case, but she blamed her fainting on a nerve issue, such as vasovagal syncope. According to the Mayo Clinic, this is a condition in which your vagus nerve overreacts to certain triggers, like seeing blood or “extreme emotional distress,” causing a sudden drop in blood pressure that leads to fainting.

Interestingly, though, the vagus nerve branches out all over the body and passes directly by the cervix, Dr. Streicher says. So, some people find that “cervical manipulation” of any kind, like during a Pap test, causes a vasovagal reaction. So it’s possible that if a menstrual cup was far enough inside of you that it was putting pressure or suction on your cervix, that could also cause a reaction. “It’s not a common thing, but it’s not that strange,” Dr. Streicher says.

If you happen to find yourself in a similar situation, Dr. Streicher suggests, first, doing your best to stay calm. Then, try to squat and bear down at the time as you pull the cup (or other item), that way you have gravity and some extra pressure on your side. If you can, try to get two fingers inside rather than just one, which might make it possible for you to actually grab whatever’s inside of you. Or, if you have a partner or friend and you’re comfortable with it, you can ask them to help grab it.

“But the main thing is to stay calm and remember that nothing terrible will happen,” she says. And know that if all else fails, your ob/gyn will be happy to help.

And, hey, if menstrual cups are really not for you, you’ve got plenty of options, such as tampons, pads, liners, and menstrual discs. Or you can even try one of Bell’s (and Philipps’s) favorites: Thinx period underwear.

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Hot brew coffee has higher levels of antioxidants than cold brew

In a new study, Jefferson (Philadelphia University + Thomas Jefferson University) researchers found chemical differences between hot and cold brew coffee that may have health impacts. In particular, the researchers found that hot-brewed coffee has higher levels of antioxidants, which are believed to be responsible for some of the health benefits of coffee.

The study, published Oct. 30 in Scientific Reports, also found that the pH levels of both hot and cold coffee were similar, ranging from 4.85 to 5.13 for all coffee samples tested. Coffee companies and lifestyle blogs have tended to tout cold brew coffee as being less acidic than hot coffee and thus less likely to cause heartburn or gastrointestinal problems.

The study was done by Niny Rao, PhD, associate professor of chemistry, and Megan Fuller, PhD, assistant professor of chemistry, both of them coffee drinkers who wondered whether the chemical make-up of cold brew differed from that of hot coffee.

While the popularity of cold brew coffee has soared in recent years — the U.S. market grew 580 percent from 2011 to 2016 — they found almost no studies on cold brew, which is a no-heat, long-steeping method of preparation. At the same time, there is well-documented research that hot-brewed coffee has some measurable health benefits, including lower risk of some cancers, diabetes and depression.

While the overall pH levels were similar, Fuller and Rao found that the hot-brewed coffee method had more total titratable acids, which may be responsible for the hot cup’s higher antioxidant levels.

“Coffee has a lot of antioxidants, if you drink it in moderation, research shows it can be pretty good for you,” Fuller said. “We found the hot brew has more antioxidant capacity.”

And considering hot and cold brews have comparable pH levels, Rao said, coffee drinkers should not consider cold brew a “silver bullet” for avoiding gastrointestinal distress.

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

Buckling down on child car seat use in ride-share vehicles

Traveling with young children can be a challenge. As ride-share apps continue to surge in popularity, transporting children safely via these services has become a growing concern.

The average Uber or Lyft vehicle does not generally come equipped with a car seat, and only in certain cities is it an option to request one. Although parents can provide their own, many infant and convertible car seats are bulky, heavy, and require a separate base, making this an unwieldy option for vacations or extended travel.

With the goal of increasing child safety, researchers at the Virginia Tech Transportation Institute (VTTI) and Texas A&M Transportation Institute (TTI) have released a new study about child ridership and child safety seat use in ride-share vehicles. They have also published a corresponding website to help educate the public on various child restraint guidelines across the country.

“It can be a challenge to figure out what the rules are for transporting kids in a ride-share vehicle, as the laws vary from state to state. We hope this website will serve as a valuable reference that parents, ride-share drivers, and others can use to identify the child passenger regulations in their area and other states they may visit,” said Justin Owens, a research scientist at VTTI and principal investigator on the project.

Owens and his colleagues analyzed child restraint laws nationwide in the initial phase of the study. According to their findings, 34 states, including Virginia, exempt taxis and for-hire vehicles from child restraint requirements. Whether these exemptions also apply to ride-share vehicles is often less clear, however. Currently, Georgia is the only state that distinguishes between ride-sharing and other for-hire vehicles in its legislation: for-hire vehicles are exempt, but ride-share drivers in Georgia are required to provide car seats if needed.

How are parents and ride-share drivers navigating this uncertain territory? To gauge this, the project team conducted both a series of focus groups in Texas with parents and ride-share drivers and a nationwide internet survey of parents of young children. The goal was to reveal the safety attitudes and practices of parents who use ride-share vehicles with their children, as well as any barriers that exist to appropriate child seat use.

While some findings diverged between the two methodologies, consistent trends emerged. These include:

  • More than a third of parents in the study utilized ride-share services with their children.
  • Up to half of parents reported not providing appropriate child safety seats while riding in an Uber, Lyft, or other ride-share vehicle with their families.
  • Three quarters of drivers in the focus groups had given rides to young children. Among these drivers, only half of them recounted car seat usage.
  • Overall, parents were interested in using child seats in ride-shares, but often felt deterred by the lack of car seat options and uncertainty surrounding the rules.

“These findings suggest that parents would like to be able to transport their children more safely when using ride-share vehicles, but there is a real need for user-friendly information about rules, regulations, and resources surrounding travel with children,” said Owens. “For that reason, we have created a website, https://kidsridesafe.org/, that aims to provide caregivers and ride-share drivers with this information in an easy-to-access manner.”

The project was funded by the Safety through Disruption (Safe-D) University Transportation Center, a research collaboration between VTTI, TTI, and San Diego State University. Safe-D was established via a $28 million grant from the U.S. Department of Transportation in order to study and maximize the safety potential of modern advancements in transportation.

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Materials provided by Virginia Tech. Note: Content may be edited for style and length.

Can wearable technology identify irregular heart rhythms?

A clinical trial to determine whether a smartwatch app that analyzes pulse-rate data can screen for a heart-rhythm disorder has enrolled more than 400,000 participants.

Researchers at Stanford Medicine, in collaboration with Apple, launched the Apple Heart Study last November to determine whether a mobile app that uses the optical sensor on the Apple Watch to analyze pulse rate data can identify atrial fibrillation. The condition, which is characterized by an irregular heartbeat, often remains hidden because many people don’t experience symptoms. Atrial fibrillation can increase the risk of stroke and heart failure.

A paper to be published online Nov. 1 in the American Heart Journal describes the design of this unique clinical trial, the largest screening study on atrial fibrillation ever done. Enrollment, which was conducted through an iPhone app, is now closed.

The study has entered the final phase of data collection and will be completed early next year, the researchers said. The Stanford team is led by principal investigators Mintu Turakhia, MD, associate professor of cardiovascular medicine, and Marco Perez, MD, assistant professor of cardiovascular medicine, and by study chair Kenneth Mahaffey, MD, professor of cardiovascular medicine.

“We hope this study will help us better understand how wearable technologies can inform precision health,” said Lloyd Minor, MD, dean of the School of Medicine. “These new tools, which have the potential to predict, prevent and manage disease, are finally within our reach.”

The Food and Drug Administration announced Sept. 11 that it had cleared two mobile medical apps designed by Apple to work on the Apple Watch. One app uses data from new hardware on the Apple Watch Series 4 to take an electrocardiogram by touching the button on the side of the device. The other app uses data from an optical sensor available on the Apple Watch Series 1 and later to analyze pulse data to identify irregular heart rhythms suggestive of atrial fibrillation and notify the user. The Apple Heart Study involves only this second app.

“The advantage of the app that uses the optical sensor is that it can check for an irregular pulse multiple times throughout the day in the background, without needing the user to actively engage the application,” Perez said.

Goals of the study

Each year in the United States, atrial fibrillation results in 130,000 deaths and 750,000 hospitalizations, according to the Centers for Disease Control and Prevention. The CDC estimates that the condition affects between 2.7 million and 6.1 million people. In addition, another 700,000 people may have undiagnosed atrial fibrillation.

Each participant in the study is required to have an Apple Watch (series 1, 2 or 3) and an iPhone. An app on the phone intermittently checks the heart-rate pulse sensor for measurements of an irregular pulse. If sufficient episodes of an irregular pulse are detected, then the participant receives a notification and is asked to schedule a visit with a doctor involved in the study. Participants are then sent electrocardiography patches, which record the electrical rhythm of their hearts for up to a week.

The goals of the study are threefold: to determine how many among those who receive irregular pulse notifications are found to have atrial fibrillation on ECG patch monitoring; to determine how many among those who received an irregular pulse notification go on to get medical attention; and to determine the accuracy of irregular-pulse detection by the watch by comparing it with the simultaneous ECG patch recordings.

“We now have access to high-quality sensors that can measure and detect changes in our bodies in entirely new and insightful ways without even needing to go to the doctor, but we need to rigorously evaluate them,” Turakhia said. “There’s never really been a study like this done before.”

A subset of the study data was used by Apple as part of its regulatory submission for FDA clearance of the smartwatch app that analyzes pulse-rate data. Apple Heart Study investigators were aware of the submission, but have not seen the submission data.

“We are inspired by the overwhelming response to the Apple Heart Study,” said Sumbul Desai, MD, vice president of Apple. “Through the combined power of our participants, Apple Watch and Stanford Medicine, it’s one of the largest and most novel atrial fibrillation studies to date.”

Researchers from the Lankenau Heart Institute, Jefferson Medical College, the University of Colorado School of Medicine, Cooper Medical School of Rowan University, StopAfib.org, the American Foundation for Women’s Health and Duke University also contributed to the paper.

The Apple Heart Study is funded by Apple Inc.

Half of women over 50 experience incontinence, but most haven’t talked to a doctor, poll finds

Nearly half of women over 50 say they sometimes leak urine — a problem that can range from a minor nuisance to a major issue — according to a new national poll.

Of more than 1,000 women between the ages of 50 and 80 who answered the poll, 43 percent of women in their 50s and early 60s said they had had experienced urinary incontinence, as had 51 percent of those age 65 and over.

Yet two-thirds of these women hadn’t talked to a doctor about the sometimes embarrassing, little-discussed issue. And only 38 percent said they do exercises that can strengthen the muscles that can help keep urine in.

The poll shows they’re finding ways of coping on their own — from using pads or special underwear to wearing dark clothing and limiting fluid intake.

The new findings from the National Poll on Healthy Aging suggest that more physicians should routinely ask their older female patients about incontinence issues they might be experiencing. The poll of 1,027 women between the ages of 50 and 80 was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M’s academic medical center.

“Urinary incontinence is a common condition that may not be routinely screened for in primary care, yet it can impact a woman’s quality of life and health, and is usually treatable,” says Carolyn Swenson, M.D., a urogynecologist at Michigan Medicine and IHPI member who helped develop the poll questions and analyze the findings. “It’s not an inevitable part of aging and shouldn’t be over-looked.”

Swenson studies delivery of women’s health care, especially related to the pelvic floor — the structures and muscles that support the bladder and reproductive organs. She notes that there are non-surgical and surgical options for treating incontinence.

Of the women who said they’d experienced at least some urine leakage, 41 percent described it as a major problem or somewhat of a problem. One-third of those with leakage experienced an episode almost every day. Nearly half worried that it would get worse as they got older.

The most common triggers were coughing or sneezing — experienced by 79 percent — and trying to get to a bathroom in time, experienced by 64 percent. But 49 percent said they’d leaked when laughing, and 37 percent said it had happened when they exercised.

“The last thing that older women should be doing is avoiding exercise or not being able to enjoy other activities that make life worthwhile,” says Preeti Malani, M.D., director of the poll and a professor of internal medicine at the U-M Medical School who has special training in geriatric medicine. “We hope these findings will help spur conversations between women and their health care providers, so that activities aren’t limited.”

Coping strategies

Women reported doing many things to cope with incontinence, including 59 percent who said they’d bought special pads or undergarments. Sixteen percent had cut down on the amount of fluid they drink, and 15 percent said they’d changed what they wore to hide accidents in case they occurred.

But only 38 percent had done Kegel exercises, which involve squeezing and releasing the muscles of the pelvic floor. Such pelvic floor muscle exercises can be an effective treatment when done correctly and consistently, especially as part of pelvic floor physical therapy with a specialized physical therapist.

“It’s both surprising and disheartening to see that so many women seem to believe that incontinence is just a normal part of aging because it’s not,” says Alison Bryant, Ph.D., senior vice president of research for AARP. “A lot of women are unnecessarily limiting their daily activities and not enjoying life fully because of a condition that can often be remedied.”

Consulting with providers

Women older than 65 were more likely to have talked with a medical provider about their incontinence than younger women. So were women who reported being embarrassed by their urine leakage or said it was a problem for them.

Among women who didn’t talk with their doctor about their urinary incontinence, 22 percent said they didn’t think of urine leakage as a health problem, so they didn’t discuss it with their doctor. But Swenson notes that many treatment options now exist for urinary incontinence, and that Medicare and private insurers routinely cover both medical and surgical treatments.

Swenson is part of the Pelvic Floor Disorders treatment team at Michigan Medicine’s Von Voigtlander Women’s Hospital, which offers a full range of treatments for urinary incontinence and other pelvic floor issues. Such treatments range from physical therapy and pessary devices to nerve stimulation, injections done in the office to prevent exercise-related incontinence, and minimally invasive surgery.

The poll results are based on responses from a nationally representative sample of 1,027 women ages 50 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.

A full report of the findings and methodology is available at http://www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.

Genetic Testing for Breast Cancer: Psychological and Social Impact

Thinking about getting a genetic test to find out if you have a mutation in one of the breast cancer susceptibility genes—BRCA1 or BRCA2? First, consider whether you’re in the small minority of women for whom the test may be helpful.

The psychological, emotional, and social implications of genetic testing also are worth considering, both for yourself and for members of your family.

Positive test results

If genetic testing reveals a BRCA gene mutation, you might experience a range of responses to learning your test results, including:

  • Anxiety about developing cancer. Having an altered BRCA gene doesn’t mean you’ll definitely get breast or ovarian cancer. Test results can’t determine your exact level of risk, at what age you may develop cancer, how aggressively the disease might progress or how your risk of death from cancer compares with other women’s risks.
  • Relief of knowing your risk status. You may view your test results in a positive light: Now you know what you’re up against. You can step up cancer surveillance efforts or take risk-reducing steps, such as preventive surgery or medications. You also have the potential to inform and educate family members who may be affected.
  • Strained family relationships. Some of your relatives may not want to know there’s been a gene mutation detected within the family. But it may be hard to keep the truth from close family members if you’re planning proactive measures, such as preventive surgery. Give thought beforehand to how—or even if—you’ll share your test results with family members.
  • Guilt about passing a gene mutation on to your child. Learning your genetic status may prompt fears that your child or children also have inherited the gene mutation. If you learn that you are a carrier of the breast cancer gene, this can lead to more questions and anxiety about when is the best time to discuss the results with your children.
  • Stress over major medical decisions. Receiving a positive test result means you’ll want to consider cancer prevention and early detection strategies that are best for you. Discussing options with a genetic counselor, breast specialist, or oncologist can help guide you.
  • Concerns over health insurance discrimination. In the United States, the federal Genetic Information Nondiscrimination Act of 2008 protects individuals who undergo genetic testing. It prohibits insurers from denying health insurance or raising premium or contribution rates on the basis of genetic information. The law also covers protection from employment discrimination.

Talk about these—or any other—concerns with your genetic counselor, doctor or other health care provider.

Negative test results

Learning that genetic testing found no alteration in the BRCA genes might produce feelings of:

  • Relief that you don’t have an increased cancer risk. If your test result is negative and there’s a known mutation in your family, you may feel like a huge weight has been lifted off your shoulders. However, given your family history, you’ll want to develop a screening plan with your doctor that is right for you based on your family history.
    It would be a mistake to let your negative test results lull you into a false sense of security. You still face the same level of cancer risk as the general population—or maybe slightly higher because of your family history—and that makes your odds about 1 in 8 for developing breast cancer during your lifetime.
  • “Survivor” guilt. Testing negative for a BRCA mutation may bring on feelings of guilt—especially if other family members do carry the mutation and face an increased cancer risk.
  • Uncertainty about your cancer risk. Test results aren’t always clear-cut. Receiving a negative test result might not allow your doctor to draw a definite conclusion about your risk status. Also, testing negative doesn’t mean that you won’t one day develop cancer, just as testing positive doesn’t mean that you eventually will develop cancer.

Variant or unknown test results

In some instances, testing identifies a gene alteration that hasn’t been seen in prior families, and there isn’t enough information about the alteration to know whether it causes an increased risk of breast or ovarian cancer. This is known as a variant of uncertain significance.

Learning that you have a genetic variant of unknown significance may lead to:

  • Confusion and anxiety about your cancer risk
  • Frustration over the lack of accurate individualized cancer risk information
  • Challenges with making cancer screening, treatment, and prevention decisions

Living with test results

Most people would be anxious if given the chance to find out whether their risk of a serious disease was higher than average. In fact, you may decide that you’d rather not know, and just forgo testing altogether. That’s a valid choice.

It’s also normal to experience sadness, anxiety, or even anger if your test results are positive. You might be more likely to experience a more profoundly negative reaction if you didn’t expect your results to be positive—for instance, if your family history isn’t that significant.

However, research shows that, in the long run, most people cope well with the knowledge of an increased cancer risk and don’t experience significant distress over the test results.

The decision to have preventive (prophylactic) surgery if you test positive for the BRCA gene isn’t urgent. You have time to research and understand all your options before making a decision. Sometimes it’s helpful to seek a second opinion or meet with a breast specialist who can help you weigh the risks and benefits of the available options based on your individual situation.

For many, simply knowing their risk status eases psychological and emotional distress. They can be proactive and establish a personalized plan to deal with their increased risk.

Updated: 2016-08-25

Publication Date: 2006-11-20

7 Things I Wish More People Understood About My Arranged Marriage

As a first generation Iraqi-American born and raised in the U.S., I have been asked if my marriage was arranged more times than I can count. In my early 20s, it was the first thing out of people’s mouths when they found out I was Muslim and newly married. I heard it from coworkers, hairdressers, and acquaintances, and it always gave me pause. I didn’t want to be associated with the stereotypes arranged marriages conjure up—the prodding parents, the exchange of dowries, the unwilling bride, and the pitiable loveless life.

My story was nothing like that. Even though I never dated my husband before we got engaged, we met when we were children. We’d grown up together, and my husband told me he had feelings for me before his family officially proposed. But that backstory was too much to share in casual conversation, and I always walked away from these exchanges feeling as if my very existence had fulfilled the stereotypes of the person in front of me.

I’ve now been happily married for over 20 years, but the myths surrounding arranged marriages persist. I don’t want another generation of people, choosing to uphold their families’ or their cultures’ traditions, to feel as if their relationships are in any way inferior to couples who have had more typical love stories.

Here are seven things I wish more people understood about match-made marriages like mine.

1. An arranged marriage is not the same thing as a forced marriage.

My father actually thought I was too young to get married. Over the course of my engagement, he repeatedly asked me if I wanted to call things off, but he never pushed me to change my mind either. He knew that who I married was ultimately my decision.
The most pervasive and damaging misconception about arranged marriage is that the couple, and more commonly, the woman, is coerced. While I would never deny the occurrence of forced marriages in different communities across the world, this practice is very different from arranged marriage. The far more common scenario is for a couple to be introduced through family or friends—or a growing number of Muslim dating apps and online matchmaking services—and then for both parties to agree to a courtship.

2. Listening to your parents’ advice about who to pick as a partner is not necessarily a bad thing.

Television and movies repeatedly offer the message that having your parents involved in the choice of your partner is preposterous and backwards. During the rare circumstances when we do see a character from an immigrant background from a culture where matchmaking is the norm, it is almost always in the context of standing up to their parents to marry the person they love.

Truthfully, the most difficult thing about my mother’s role in choosing in my partner was explaining it to my American friends.

During my engagement, I complained to my mother that my fiancé wasn’t as goal-oriented and driven as I was. My mom told me that I should be grateful. There wasn’t room for two big egos in one household. Over the years, I have come to see the wisdom of her words. One of the things I appreciate most about my spouse is that he is not motivated by a never-ending to-do list. I turn to my husband when I need a dose of perspective and someone to calm me down.

3. There’s an upside to knowing a prospective partners’ intentions are for marriage from the outset.

When I was a teenager, I longed for the element of surprise in romantic relationships, much like what I saw in romantic comedies. But I’ve since come to see the benefit of knowing a partner’s intentions from the outset.

My husband and I may have been young when we got engaged, but we also skipped the surface level, getting-to-know-you stage, where everyone is worried about showing that they care too early in the relationship. Clear intentions are a fast track to intimate and deep conversation, and right away, we were able to talk openly about the issues that really matter in a relationship—compatibility, values, and goals.

Courtesy of the writer

4. Sharing the same background, traditions, and values as your partner means one less thing to navigate as couple.

My husband and I never had to discuss whether or not we’d pick Arabic names for our children, teach our children to say their daily prayers, or spend our religious holidays at the masjid. All these were a given in our household.

Not only were we raised with the same religion and traditions, but we both embraced them and wanted to carry them on. As the first generation in my family to be born in the United States, this means a lot to me. I have already lost so many of my family’s culture and traditions, and I appreciate having a spouse that can help me pass down as much of my heritage to my children as possible.

5. You don’t have to have previous relationships to know what you want in a partner.

I had several close non-Muslim girlfriends in college who were under constant pressure from well-meaning family and friends to date other people before settling down with their first serious boyfriend. They were repeatedly asked how they could know if their boyfriend was the one if they hadn’t dated anyone else. I reassured these friends that seeing other people was not a universal prerequisite for marriage, and that there were so many parts of the world where their relationship would have never been questioned.

I do not doubt that the life experience gained from past relationships can teach us something about ourselves, but that does not mean that there is less opportunity for self-discovery and growth from within a committed relationship. Being with one partner your entire life is not a deterrent to self-knowledge. It’s just a different path.

6. It shouldn’t be taboo to get married for pragmatic reasons.

When I married my husband, there were several things I was certain of—his character, how much I trusted him, how safe I felt with him, how much he respected me. But I didn’t know if I was “in love” because the language for love in American culture was all about butterflies, sparks, and chemistry.

Now I question why we are encouraged to research and get input on every decision—from the cars we buy, the colleges we choose, to where we live—but who we spend our lives with and have children with is, at least at first, based on such ambiguous feelings. While I have no doubt that those feelings can point us in the direction of wonderful people, I don’t think it’s the only way to find them.

7. There is not one kind of love story.

For years, I wondered if I’d been “in love” with my spouse because my relationship was so different from any of the love stories I’d encountered in books and movies. I never stopped to question why these stories were so incredibly narrow. I’d known my husband since childhood, and the kind of attraction that is based on novelty and “the chase” was not going to happen for me. But, I now see what a unique privilege it is to have shared so much of my life with my spouse. And even though it’s not your typical love story, I’m so glad it’s mine.

Related: What 12 Women Wish They’d Known Before Getting Married

Huda Al-Marashi is the author of the memoir First Comes Marriage: My Not-So-Typical American Love Story (November 13, 2018).