Daily low-dose aspirin found to have no effect on healthy life span in older people

In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability). Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health, were published online on September 16, 2018 in three papers in The New England Journal of Medicine.

ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a physical disability and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.

“Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease,” said NIA Director Richard J. Hodes, M.D. “The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin’s benefits and risks among healthy older persons.”

The team of scientists was led by John J. McNeil, M.B.B.S., Ph.D., head of the Department of Epidemiology and Preventive Health at Monash University, Melbourne, Australia, and Anne M. Murray, M.D., director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis. The research was supported in part by the National Institute on Aging (NIA) and the National Cancer Institute (NCI), both parts of the NIH. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University. Aspirin and placebo were supplied by Bayer, which had no other involvement with the study.

In the total study population, treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.

The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance.

The researchers also analyzed the ASPREE results to determine whether cardiovascular events took place. They found that the rates for major cardiovascular events — including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke — were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.

Significant bleeding — a known risk of regular aspirin use — was also measured. The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding — hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization — occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.

As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

“The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes,” said Leslie Ford, M.D., associate director for clinical research, NCI Division of Cancer Prevention. “Analysis of all the cancer-related data from the trial is under way and until we have additional data, these findings should be interpreted with caution.”

“Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date,” said Evan Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology. “These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants.”

As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin’s effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE’s findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.

4 Things I Wish I Knew Before I Started Lifting Weights

I started lifting weights in my early 20s, fresh out of Army Basic Training and desperate to get stronger after realizing just how weak I was compared to my male counterparts. Trying to walk 12 miles with a 35-pound rucksack while wearing a suffocating weighted vest and carrying my rifle was more difficult than I had imagined. I knew I had to do something to improve my physical fitness before my first deployment to Iraq and doubling down on cardio was not the answer.

Everyone has their own reason for stepping outside their comfort zone and picking up a barbell for the first time. There’s always fear and awkwardness for a beginner. I personally had no idea where to start and I was convinced that I knew it all after reading a few “How to Lift Weights” articles online.

Since transitioning careers from soldier to personal trainer, it’s easy for me to look back and identify the things I was doing wrong back then and, in hindsight, what I wish I had known before I started. I also realize now that I probably should have invested in working with a personal trainer to build a strong foundation and a better plan.

To help you avoid some of the mistakes I made, here are the top things I wish I knew about lifting weights when I first started.

1. You don’t need to spend as much time lifting weights to see results as you think you do.

A two-hour weightlifting session six days per week may feel like a proper dedicated routine, but it’s just too much for most people. I used to log endless hours at the gym, thinking the sweat dripping from my body and mental exhaustion was an indication of my hard work. But tracking progress by time spent lifting rather than increases in the weights I used for each lift limited my progress. That’s because lifting too often for too long can actually be counterproductive to building muscle and strength.

The fact that you’re able to lift for so long probably means you’re not lifting heavy enough to challenge your muscles and efficiently build strength. To use resistance training effectively, you need to put a decent amount of stress on your muscles, causing fatigue and ultimately muscle growth. If you don’t challenge your muscles with enough weight, you won’t stimulate this process. (Over time, the weight that challenges you will progressively increase.) Using too-light weight may allow you to train for a longer time, but is more likely to improve muscular endurance than help you get stronger.

So, how can you tell how heavy is heavy enough? A good guideline is to lift heavy enough that the last 2-3 reps on each set feel challenging to complete but not so hard that you can’t do them with proper form. After the last rep, you should feel close to maxed out with enough energy left to do however many sets you have left. If you’re lifting heavy enough, you probably don’t need to lift for more than an hour. I’d suggest planning to do five to seven exercises, 2-4 sets of 6-12 reps of each. Once you feel your performance declining, you will know it’s time to wrap up your workout for the day. Don’t ignore that feeling!

When it comes to the question of how many days a week you should train, that really does depend on your goals. Anywhere from three to five days is a good number (as long as you are resting enough in between sessions—more on that later). I typically do two upper-body days and three lower-body days per week. If you are training less than four times per week, a full body split (meaning, sticking to total-body workouts most days instead of breaking it up) is probably a better approach.

Lifting for too long can also increase the chances you’ll overdo it. If you are lifting heavy weights and really challenging yourself, you’ll get pretty tired toward the end of your workout. Pushing past this state of fatigue for too long could lead to injury, and eventually overtraining, leaving you constantly exhausted and sore and even potentially messing with your sleep.

2. Being extra sore doesn’t necessarily mean you got a better workout.

If you have heard the phrase “no pain no gain” or “if it doesn’t hurt then you didn’t work hard enough” then you may have fallen into the same trap I did of using soreness as an indicator of a good workout. I used to look forward to the pain I would feel climbing the stairs after a strenuous leg day, but this also made it difficult to get through my next workout.

Delayed onset muscle soreness, or DOMS, is muscle damage caused by strenuous physical activity about 24 to 72 hours after training. On one hand, muscle soreness is normal and will happen occasionally, especially if you are new to a specific exercise or type of workout. However, chasing muscle soreness is more likely to lead to a decrease in the quality of your workout, hinder motivation, and even lead to injury. If you always have significant DOMS, it could be a sign you’re going too hard and need to dial it back.

Instead, I suggest keeping a training log to track the weights you used and increases in strength, rather than judging progress by how hard it was to walk up the stairs the next day.

3. Compound exercises are some of the best ways to spend your time at the gym

One of the biggest fitness mistakes I made is underestimating the importance of compound exercises and spending too much time on exercises that isolate one muscle group at a time, like bicep curls and calf raises.

While there are hundreds of weight lifting exercises to choose from, you get the best bang for your buck by focusing most of your energy on compound movements that work multiple muscle groups at once, such as the squat, deadlift, hip thrust, shoulder press, back row, and bench press. It’s more efficient, and more functional, meaning you’re strengthening your body in the ways it moves in everyday life.

Exercises that focus just on one muscle group, such as leg extensions, bicep curls, and lateral raises, can and should be used to complement compound movements and enhance muscle growth and strength, but they shouldn’t take up the bulk of your workouts if your goal is to get stronger and fitter overall.

4. Recovery is just as important as actually lifting heavy weights.

Recovery and rest are critical components of strength training. Resting gives your body the time it needs to rebuild the muscle you have broken down—and yes, that’s how you actually get stronger.

It is easy to become obsessed with lifting weights and neglect self-care outside of gym time. I know, because I used to do that. But it does’t matter how hard you train in the gym if you don’t prioritize recovering from your workouts.

There is no specific one-size-fits-all method for proper recovery, because everyone responds to training differently. However, some general guidelines I give my clients are to get about 8 hours of sleep each night, and take a day off from lifting at least 1-2 days per week. Generally, it’s a good idea to take a rest day after a particularly intense or hard workout. But you should listen to your body to determine when it’s best to schedule your rest days—if you are tired or feel like your strength decreases the day after a certain workout, then that is an indication your body needs some time away from the weights to fully recover.

If you don’t want to completely rest, there are plenty of active recovery workouts you can try that’ll keep you moving while still giving your hardworking muscles the time they need to recoup. You’ll be glad you showed your body some TLC when you feel well-rested and strong on your next lifting day.

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9 Schizophrenia Facts to Know, Because It’s Way Too Misunderstood

If you aren’t super familiar with schizophrenia, you might associate the condition with movies like A Beautiful Mind or episodes of Law & Order. But schizophrenia is a complex, widely misunderstood condition, and pop culture references to the disorder don’t always (or even usually) get it right. Here’s what you actually need to know about schizophrenia.

1. Yes, schizophrenia is a mental health disorder that can cause symptoms such as delusions, but there’s more to it than that.

According to the National Institute of Mental Health (NIMH), you can think of the symptoms of schizophrenia in three major buckets: positive, negative, and cognitive.

Positive symptoms encompass psychotic behaviors you don’t typically see in people without disorders like schizophrenia. They include:

  • Hallucinations
  • Delusions
  • Unusual thought processes
  • Unusual body movements

Negative symptoms are ones that indicate a lack of feelings and behaviors you would see in many people without schizophrenia, such as:

  • “Flat affect,” which is basically when someone doesn’t express the level of emotions you’d expect
  • Taking less pleasure in life
  • Problems starting and sticking with activities
  • Diminished speaking

Cognitive symptoms have to do with memory and thinking. They include:

  • Problems understanding information and using it to make decisions
  • A hard time concentrating
  • Trouble with “working memory” (being able to use information right after learning it)

2. Experts aren’t totally sure what causes schizophrenia, but it’s thought to be a combination of factors such as genes and brain chemistry.

People often point solely to factors like family dynamics as the origin of schizophrenia, Ananda Pandurangi, Ph.D., director of the Schizophrenia and Electroconvulsive Therapy programs at Virginia Commonwealth University’s Department of Psychiatry, tells SELF. “This is totally inaccurate,” Pandurangi says.

According to the NIMH, the condition is largely genetic; multiple genes might increase a person’s risk of developing schizophrenia. An imbalance in neurotransmitters such as dopamine and glutamate might also make a person more susceptible to this mental health condition. In addition, people with schizophrenia experience brain changes such as reduced gray matter. (Gray matter is brain tissue that helps with processing information, according to the National Institute of Neurological Disorders and Stroke.) Experts are still investigating to what extent this decrease in gray matter is involved with schizophrenia’s onset and trajectory.

Finally, components like mind-altering drug use as a teenager or young adult, prenatal exposure to viruses that can affect brain development, prenatal malnutrition, and psychosocial factors (meaning psychological and social issues such as childhood trauma) can also play a role. The takeaway: No single environmental or behavioral factor leads to schizophrenia.

3. Men are more likely to develop schizophrenia than women.

Of the 23 million or so people worldwide who have schizophrenia, the World Health Organization estimates that 12 million are men and 9 million are women. Experts aren’t sure of exactly why this is, though they have some theories. One is that higher levels of hormones such as estrogen in women may help prevent imbalances in neurotransmitters like dopamine and glutamate that are implicated in schizophrenia. There’s also the idea that sex chromosomes may be a factor, though that’s still up for debate.

Not only are men more likely than women to develop schizophrenia, the two groups might experience the condition differently. For example, symptoms of schizophrenia generally emerge between the ages of 16 and 30, but they typically begin in the early to mid-20s for men and the late-20s for women, according to the Mayo Clinic. (The later onset in women may be related to lower estrogen levels as women age.)

It also appears as though men and women can experience schizophrenia differently. For instance, men with schizophrenia tend to have more of those negative symptoms while women are more inclined to have mood-related symptoms, a 2010 paper in International Review of Psychiatry explains. This may be due in part to neurotransmitters acting differently in people of different sexes.

4. People with schizophrenia are not inherently violent or criminals, no matter what you’ve heard.

“Most people with schizophrenia are not violent,” Prakash Masand M.D., a psychiatrist and founder of the Centers of Psychiatric Excellence, tells SELF. It’s true that a person with untreated schizophrenia may be more likely than someone without schizophrenia to commit a violent crime, and people with schizophrenia are largely overrepresented in prison populations, Dr. Masand notes. But this is about correlation, not causation: Having schizophrenia doesn’t inherently make a person dangerous.

A 2014 study in Law and Human Behavior found that out of 429 violent and non-violent crimes committed by people with mental illnesses, only 4 percent were directly related to schizophrenia-induced psychosis. (Three percent were directly related to depression, and 10 percent to bipolar disorder.) Other elements—mainly general risk factors for crime, regardless of a person’s mental health status—tended to weigh much more heavily, such as poverty, substance abuse, homelessness, and unemployment. Another issue is that people with schizophrenia are often unable to access the mental health treatment they need, as explained in this 2015 paper in Crime Psychology Review, which is not so much about schizophrenia as it is barriers to health care.

Furthermore, a 2011 study in Schizophrenia Bulletin noted that people with schizophrenia may be up to 14 times more likely to be victims of violent crimes than to be arrested for committing them.

“This is for a few reasons,” Aimee Daramus, Psy.D., a licensed clinical psychologist at Behavioral Health Associates in Chicago, Illinois, tells SELF. “[People with schizophrenia] are often attacked by people who are afraid of their eccentric behavior, such as talking, singing, or shouting at their hallucinations. People with schizophrenia also have high rates of homelessness, which puts them at risk of violence. And because they’re often focused on their internal world of hallucinations and delusions, they often aren’t paying attention to their surroundings.”

5. Schizophrenia is not the same thing as bipolar disorder or dissociative identity disorder.

The word “schizophrenia” came from the Greek “skhizein,” meaning “to split,” and “phren,” which translates to “mind,” the Oxford English Dictionary explains. But this literal meaning can cause confusion, so people may conflate schizophrenia with bipolar disorder or dissociative identity disorder.

Bipolar disorder, which is sometimes called manic depression, is a mental health condition characterized by extreme mood swings between highs (mania) and lows (depression), according to the Mayo Clinic. People with bipolar disorder may experience psychosis—one of the main components of schizophrenia—but it’s not common. And while schizophrenia can cause mood swings, that’s not a primary symptom.

There are also differences between schizophrenia and dissociative identity disorder (previously referred to as multiple personality disorder). Per the Mayo Clinic, people with dissociative identity disorder (DID) alternate between multiple identities and may feel like there are many voices inside their head vying for control. While schizophrenia can also cause delusions and hallucinations, they don’t necessarily revolve around various personalities the way they do with DID.

Here’s another way to think about it, if it helps: The “split” in schizophrenia refers to a split from reality during times of psychosis, not a split in identities or the split between extremely high and low moods.

6. People who have schizophrenia may be at a higher risk of other health issues, including premature death.

Individuals with schizophrenia can be more vulnerable to issues such as cardiovascular disease, diabetes, and smoking-related lung disease, according to the NIMH, which notes that under-detection and under-treatment of these conditions in those with schizophrenia can lead to death. People with schizophrenia are also more likely to die by suicide. Due to these factors, people living with schizophrenia are unfortunately at a higher overall risk of premature mortality (dying at an early age) than the general population, according to the NIMH.

7. There’s no definitive diagnostic test for schizophrenia, so doctors will typically take a multi-pronged approach.

The fifth and most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which experts use as a blueprint for identifying different mental health conditions, lays out exactly what doctors should look for when it comes to schizophrenia. Diagnosis isn’t just about the symptoms, but also things like how long they last (a person must have at least two positive or negative symptoms for at least a month) and how they affect a person’s life, such as making it tough to maintain work, relationships, and self-care.

It’s also about ruling out other influences that can cause schizophrenia-esque symptoms, such as bipolar disorder and substance use. To do this, doctors might perform a physical exam, do drug and alcohol screenings, and conduct psychiatric evaluations to assess symptoms like delusions and hallucinations, the Mayo Clinic explains.

8. There’s not yet a cure for schizophrenia, but the available treatments make it possible to manage the condition.

The majority of people with schizophrenia can function well and have fulfilling lives if they undergo the recommended treatments to diminish or eliminate symptoms, Pandurangi says.

A lifelong regimen of antipsychotic medications is an essential part of managing schizophrenia, according to the Mayo Clinic. It seems as though the drugs, which come in pill or liquid form, might change the brain’s levels of dopamine in a way that lessens symptoms. It can take weeks to see a difference, though, and like drugs for many other mental health conditions, trial and error might be necessary to find the right course of treatment. Antipsychotics may also cause side effects such as tardive dyskinesia (a disorder that induces repetitive and involuntary movements), although newer ones generally come with fewer serious side reactions, the Mayo Clinic notes. Some people may also require antidepressants or anti-anxiety medication.

Therapy is another central component of schizophrenia treatment, along with other psychosocial methods. These methods can include training to help bolster people’s social skills so they can more fully participate in life, along with programs to help people with schizophrenia find and maintain employment. This type of lifestyle support is important for many people with the condition, the Mayo Clinic explains.

Research also suggests that electroconvulsive therapy (ECT) may be helpful for schizophrenia that isn’t responding well to other treatments. ECT has the potential to change a person’s brain chemistry by using an electric current to bring on short, painless seizures. A 2018 review of literature in Current Opinion in Psychiatry concluded that ECT is a promising potential treatment that warrants more research.

Beyond that, sometimes people with schizophrenia need short-term hospitalization to prevent them from harming themselves or others or allow professionals to assess how treatment is going.

9. Individuals with schizophrenia still face stigma surrounding their mental illness, and it’s on all of us not to add to it.

It’s normal to be nervous about things you don’t understand. But now that you do have a primer on schizophrenia, it’s hopefully a bit easier to recognize that people with this condition don’t deserve its often terrifying, violent portrayal. “Persons with schizophrenia are like anyone else,” Pandurangi says. “They are suffering an internal neurological chaos…and need an understanding and caring approach.”

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Here’s What Cardiologists Say About the Apple Watch’s New Heart Monitoring Features

On Wednesday, Apple unveiled the next generation of the Apple Watch—and it has some notable new features. Like many new tech roll-outs, the watch is thinner and faster than watches that came before it, but the updated version also has several unique options for tracking a person’s heart health.

Previous Apple Watches have always had a heart monitor, but the new version can perform an electrocardiogram (also known as EKG or ECG), a test that measures the electrical activity of your heartbeat. What’s more, the new Apple Watch’s ECG feature is FDA-cleared to detect atrial fibrillation (an irregular heart rate that increases your risk for stroke and heart failure) and to give users notifications that their heartbeat is irregular. The watch also notes when a person’s heart rate is too low.

Users will be required to go through education through an app before they can unlock the ECG feature. Additionally, the FDA says in the approvals that, although the ECG feature can “determine the presence” of an atrial fibrillation, neither feature should be used for the purposes of diagnosis or is intended to “replace traditional methods of diagnosis or treatment.” The features are also not intended to be used by people under age 22 or by people who have had previous atrial fibrillations or other arrhythmias.

There is another ECG-enabled device that’s received FDA clearance. It’s called AliveCor’s Kardiaband device, and it’s a watch band and app that works with the Apple Watch. (However, it’s not built into the watch itself like the new feature.) AliveCor also makes a personal ECG monitor called KardiaMobile that can be used with your phone.

The Apple Watch’s ECG and the ability to detect atrial fibrillation (an irregular heart rate that increases your risk for stroke and heart failure) will launch later this year, while the feature that detects a too-low heart rate will launch later this month with the Watch OS 5.

The Apple Watch’s ECG feature is different from an ECG you’d get at your doctor’s office in a few key ways.

Typically, your doctor will want you to have an ECG when you have irregularities in your heart (called arrhythmia), chest pain, structural problems with your heart’s chambers, a previous heart attack, or ongoing heart disease treatment like a pacemaker, the Mayo Clinic says. But your doctor will also likely want to run an ECG if you have heart palpitations, a rapid pulse, shortness of breath, have been dizzy or confused, or are having weakness, fatigue, or a drop in your ability to exercise.

But standard ECGs (which are done at your doctor’s office) can only tell your doctor what’s going on if you’re actually having symptoms while it’s being conducted. So, for instance, if you’ve been having heart palpitations but feel just fine when you’re undergoing the ECG, it’s probably not going to detect anything, Shephal Doshi, M.D., director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, Calif., tells SELF.

That’s why your doctor may want you to use a different type of heart monitoring device that you can wear more consistently—such as a Holter monitor that straps onto your chest—to try to figure out what’s going on, the Mayo Clinic says. This is where the Apple Watch’s ECG might be helpful, Dr. Doshi says: If it’s accurate, it can help your doctor pinpoint your heartbeat’s electrical activity at the time you report feeling symptoms.

This seems great in theory, but doctors are a little wary.

“It seems like a wonderful idea and I’m sure there are some potential upsides to it,” Micah Eimer, M.D., a cardiologist and medical director for the Northwestern Medicine Glenview and Deerfield Outpatient Centers, tells SELF. But Dr. Eimer worries “a lot” about the potential for false positives, or indications that something is wrong when it isn’t.

For instance, while having a low heart rate (below 60 beats per minute) can be a sign of a heart issue, thyroid disorder, sleep apnea, or a side effect of high blood pressure medications, in many cases, it’s totally harmless—especially if you’re a serious athlete.

Long-distance runners, for example, are prone to having lower heart rates (bradycardia), Dr. Doshi says. If you’re not an athlete, having a watch that detects bradycardia could tip you off that something isn’t right with your heart and prompt you to seek care, Dr. Doshi says. But it could also give you a false positive and freak you out for no reason.

Additionally, things that are normal and known to be normal to cardiologists could be alarming to an Apple Watch user, like the fact that your heart rate can drop down to 30 or 40 beats per minute when you’re sleeping (which would apparently trigger an alert). That, and other false positives, may lead to people rushing to the ER and flooding the medical system when they don’t need to, he says.

The ECG you’d get at your doctor’s office gathers information from 12 areas of your heart, the Mayo Clinic explains. But the Apple Watch only gives you one ECG reading, according to the FDA’s approval letter, similar to a Lead I ECG (essentially one part of the standard 12-part ECG). But it’s hard to say how accurate the watch heart data will be compared to medical-grade monitors that doctors use until more information (and research) about the Watch’s new capability is available.

“In theory, it will provide the ability to monitor patients in real time but we don’t yet understand how accurate this signal will be,” Dr. Doshi says. “In the past, devices like that have not been so accurate.”

There’s also the question of what to do with all the data. All of the data collected can be sent to your doctor in a PDF, Apple says in a press release. While that can be helpful in some situations, it can also be really tricky, Dr. Doshi says. “Who is going to be analyzing that data, and is there going to be proper follow-up?” he questions. “We use medical grade monitors all the time and they generate a lot of data. A lot of that is noise and can be very tricky even for trained users to figure out what’s real and what’s not.”

Some overzealous users may also overload their doctor with excess information (as Dr. Doshi is already seeing with AliveCor users). “There are some patients who start sending you EKGs every 30 minutes, which can become a challenge. That can cause a huge data dump,” Dr. Doshi says.

Finally, Dr. Eimer is concerned that a patient may have unusual symptoms, like chest pain, but write them off because their watch says they’re OK. “The doesn’t mean they’re actually OK,” he says. “Having chest pain may or may not cause an abnormal EKG. It’s a lot more complicated than it appears.”

Still, experts see some possible benefits to wearing a device like this.

If you have an irregular heart beat, a history of heart disease or heart attack, or a pacemaker, the Apple Watch’s ECG could potentially provide helpful information for your doctor—especially if you’re having symptoms outside of the doctor’s office. But any symptoms you experience would still require a visit to the doctor’s office to sort out, and would likely involve more traditional testing.

Dr. Elmer also says some people may see a doctor for abnormal readings who wouldn’t otherwise have sought care. He sees one or two patients a year who found that their heart rates were off thanks to a consumer heart monitoring device and ended up learning they had an atrial fibrillation or other issue. “That’s a big win, a big save,” he says. But that’s obviously not common.

Also, some patients require continuous heart rate monitoring, which is currently performed with a device implanted under a patient’s skin, Dr. Doshi explains. So, if the Apple Watch is accurate, it presents an opportunity for continuous heart rate monitoring that’s less invasive.

So, although doctors aren’t exactly recommending that patients go out and buy one of these, they say there’s potential—provided it works well and people use it correctly and with common sense. “If you’re having heart problems, go to your doctor,” Dr. Eimer says. “Watches may serve a very narrow purpose, but they certainly don’t tell the whole story when it comes to your heart.”

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10-Minute Butt and Core Pilates Workout You Can Do in Your Living Room

It’s hard to overstate how important a strong core and strong glutes are. As a fitness editor and certified trainer, I find myself harping on both of these things quite often—whether I’m talking about how a strong butt can help improve your running or how focusing on your core can be useful for relieving lower back pain. Both of these major muscle groups play a huge role in the majority of our movements, so the stronger they are, the more efficiently you can move.

When it comes to working both the glutes and core, Pilates is a great option. The low-intensity workout focuses on small, controlled movements that target specific muscles. “Focusing on that control helps isolate the muscles being targeted and lets you work them deeper, which is what makes Pilates so good and effective for working the core and butt,” Manuela Sanchez, certified Pilates instructor at Club Pilates in Brooklyn, tells SELF.

She adds that the mind-body focus of Pilates—it’s meant to be done in a precise, slow, focused manner—is beneficial. When you’re thinking about the muscles you’re working (what trainers often call “minding your muscle), it can help you better engage them.

Sanchez suggests doing the below circuit before a run or a high-intensity workout to get your core and glutes fired up and primed to work “before going into a more complex routine.” The workout below should take you 10 minutes max, and if you want to do it twice, that’s fine too. You can also just do it on its own a few times a week to do some extra core- and glute-strengthening work that will help keep you stable and strong for your other workouts.

Demoing the moves is Sonja Herbert, a New York–based writer, classically trained Pilates instructor, and founder of Black Girl Pilates.

The Workout

Moves

  • The One Hundred — 5 reps
  • Articulated Bridging — 8 reps
  • Single-Leg Bridge — 8 reps each side
  • Criss-Cross — 30 reps, alternating sides
  • Leg Circles — 20 reps each side

Directions

Do all five exercises, for the set amount of reps. Try to rest as little as possible in between each one. If you want a longer workout, repeat the entire circuit a second time.

Here’s how to do each move:

J. Crew Has Lots of Cozy Fall Sweaters On Sale for Under $50

One of my favorite parts about the fall season is that its brisk temperatures give me an excuse to break out my favorite sweaters. While we’re still a little ways away from the full return of the turtleneck, a stylish sweater offers an easy and cozy wardrobe transition into cooler months. Right now, J. Crew is making fall dressing even easier with awesome markdowns on shoes, clothing, and accessories—some for up to 75 percent off their original prices.

I like to think of this sale as my fairy fashion godmother sprinkling my wallet with extra savings, plus some awesome outfit inspiration for the next couple of months. Who needs a jacket when you have a drawer full of sweaters just waiting to be worn? Ahead, check out all the chic and comfortable sweaters J. Crew has on deep discount just in time for the weather change.

Here’s Why You Are So Freaking Dry When You Get Off a Plane

Why is it that we always feel like we’ve spent a week in the desert after we get off a plane? We’re talking dry eyeballs, a parched mouth, alligator skin, the works. We talked to doctors about what the hell is up with this post-plane dryness, plus how to combat it before, during, and after your flight.

The low humidity in airplanes can cause skin dryness, along with discomfort in sensitive areas like your eyes, mouth, and nose.

Mini science lesson: Humidity is the amount of water vapor that’s in the air. The humidity you’re normally exposed to varies depending on where you live and the weather conditions, but the World Health Organization (WHO) points out that the humidity in most homes is typically over 30 percent. The humidity on airplanes is way lower than that, usually less than 20 percent.

Low humidity can mess with your skin’s ability to retain moisture, making it feel dried out after a while, Joshua Zeichner, M.D., a New York City–based board-certified dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Medical Center, tells SELF.

As for your eyes, they rely on a moisturizing tear film to function properly and keep you comfortable, the National Eye Institute (NEI) explains. When you’re in a low-humidity environment, you keep on making that tear film like normal, but the dry environment makes them evaporate more quickly than they otherwise would, Alex Nixon, O.D., assistant clinical professor of optometry at The Ohio State University, tells SELF. This can lead to symptoms like the obvious dryness, plus irritation, stinging, sensitivity to light, and more. Also, if you’re spending the flight watching that teeny TV on the seatback in front of you, working on your laptop, or reading, you’re probably blinking less than you typically would. This also saps your eyeballs of moisture because blinking spreads that important tear film across your eyes.

With your mouth and nose, it really comes down to the lack of humidity and dehydration, Omid Mehdizadeh, M.D., an otolaryngologist at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. Like your eyes, all the lovely moisture that’s naturally in your mouth and nose can evaporate more quickly in a low-humidity environment, he says. Couple that with the fact that you may not be drinking as much on the flight (either because you only drink when the beverage cart comes around or to avoid constant trips to the bathroom), and you’re just setting yourself up for a case of dry mouth and nose, Michael Zimring, M.D., director of the Center for Wilderness and Travel Medicine at Mercy Medical Center and co-author of the book Healthy Travel, tells SELF.

There are a few things you can do to avoid feeling like a living, breathing piece of beef jerky after every flight.

Obviously, everyone has different areas that tend to feel dried out after a flight, and you may not need to do all of these. Still, experts say they can really, really help.

1. Slather on a ton of thick moisturizer. Thick ointments and creams are more effective than thinner lotions at adding moisture to your skin, according to the American Academy of Dermatology (AAD). If you want to get even more specific, look for something that contains mineral, olive, or jojoba oil to lock in moisture, the AAD says. Lactic acid, urea, hyaluronic acid, dimethicone, glycerin, lanolin, and shea butter are also good options.

While you can start applying your cream mid-flight, it’s actually better to get started before that. “The more hydrated your skin is before boarding the plane, the better foundation you have to start off with when you are flying,” Dr. Zeichner says. Continue moisturizing as necessary post-flight until your skin feels normal again.

2. Swap your contacts for glasses. “It is best to avoid contact lens wear if possible on the airplane,” Dr. Nixon says. Even in a normal, perfectly humid environment, contact lenses can mess with your tear film and make your eyes feel dry, the Mayo Clinic says. (Contact lenses block the amount of nourishing oxygen your eyes can receive, plus they’re foreign objects, which can be irritating all on its own.) When you’re in a low-humidity zone like a plane, that drying effect can be even worse.

Also keep in mind that many people sleep on flights, and sleeping in your contacts is just going to dry out your eyeballs even more, Dr. Nixon says. (And potentially compromise your eye health by making you more vulnerable to infection.) “Glasses are the way to go for comfort and safety on board,” he says.

If wearing glasses is just not an option, definitely pack some rewetting drops in your bag and use them liberally during the flight, Dr. Nixon says. Make sure to get drops that don’t promise to relieve redness, since those can cause an aggravating rebound effect that just makes your eyes redder.

3. Use a salt spray in your nose. Saline nasal sprays can help add moisture to your nasal passages when you’re in a low-humidity place like an airplane cabin, Dr. Mehdizadeh says. Just use a few squirts in each nostril to keep your nose feeling OK, and keep on doing it if you start drying out.

4. Hydrate before your flight, and keep it up when you’re on board. In a perfect world, you’d consume about 11.5 cups of fluid a day, per the Mayo Clinic. (That includes liquids you get from drinks like coffee and foods you eat.) But life happens, and sometimes it’s hard to meet that goal. Still, it’s especially important to make sure you’re well-hydrated before you get on a plane, Dr. Zimring says. One easy way to tell? When you’re hydrated, your pee is clear or pale yellow.

The work doesn’t stop once you board: Dr. Zimring recommends trying to have a small bottle of water every hour or two during your flight, depending on what you (and your bladder) can handle.

5. Drink mainly water instead of caffeinated or alcoholic beverages. The plane’s low humidity itself won’t dehydrate you, but what you drink can certainly contribute. That’s why the WHO recommends that you don’t go overboard with caffeine and alcohol when you fly (especially on long hauls). These substances have a diuretic effect (meaning they make you pee more), and that can eventually make you dehydrated if you’re not replacing those fluids.

That doesn’t mean you have to completely shun the good stuff on the beverage cart. If you want to have a cocktail, that’s OK. “Just follow it with plenty of water,” Dr. Zimring says.

6. Whip out a sheet mask midflight. OK, sure, this may look a little silly, but…sheet masks can be really hydrating for your skin, Dr. Zeichner says. “A sheet mask is a great option for the airplane because it is at the same time effective, easy to use, and portable,” he points out. Every sheet mask is different, but you can simply clean your face in the bathroom, follow the mask’s directions, and then chuck it in the trash when you’re done. Voilà.

Related:

How to Give Oral Sex to Someone With a Vagina: 7 Things You Need to Do

Are you a bit confused on how exactly to make your partner get off with oral sex? No worries. You’re not the only one with questions on how to properly go down on a vulva. There simply isn’t enough accurate information out there. You’ll find everything from bad fingering advice to untested ideas about using your tongue like a helicopter blade or spelling out the alphabet.

How do you know if they’re into it? How do you know what they like? What do you even do down there? As a certified sex coach and educator, I’ve heard all of these questions. The answers (and more) ahead.

1. Talk. Encouragement will get you everywhere.

Let your partner know how much you like being between their legs. They need to hear it come out of your mouth (see what I did there?).

Unfortunately, most of what we hear about oral sex has to do with penises, so it’s not surprising that those of us with vaginas often have trouble allowing ourselves to be serviced and giving into pleasure. It is not something we’ve been taught to expect. As a result, we often have trouble orgasming during oral sex if we feel we are taking too long, that you don’t want to be down there, that we’re asking for too much, etc.

Tell your partner you love going down on them. Encourage them to relax and breathe into it. Let them know you’re going to be down there all night if need be and you couldn’t be more delighted. The more chill they feel, the more likely they are to get where they want to be: in Orgasmland.

While you’re down there, make some noise. This isn’t the library. They want to know you’re enjoying yourself, too.

2. Keep it consistent (and choose a steady rhythm).

When in doubt, stay consistent and stay on the clitoris. The clitoris has over 8,000 nerve endings and the majority of those nerves are clustered in the exposed bud-like glans (the part you can see at the tippy top of the vulva).

If you’re with a new partner or aren’t feeling totally confident in your skills, pick a move and stick to it. You can try running your tongue back and forth over the clitoris, up and down, in clockwise circles, or in a figure eight motion. Whatever it is, do it until they come.

If they’re not responding positively (E.G. “Yes! Just like that!”), try a different pattern.

3. Pay attention to their body.

If you’re wondering if your partner is enjoying themselves, pay attention to their body. Are they moving their hips into your face? Are they moaning? Keep these things in mind. If your partner is lying on the bed like a limp starfish, perhaps you should reassess what you’re doing.

Their body will tell you much of what you need to know. If you’re still not sure if they’re liking your moves…

4. Ask for direction.

Inquiring about their needs is not unsexy. It’s hot to want to please your partner. If you want to know what they like, ask. They’ll be more than happy to tell you which moves they like best. After all, we’re all here to come, right?

If they’re not sure what they like, take time to explore their body and encourage them to inform you if something feels particularly good. Remember, every single vulva-owning human is different. We don’t all want the same things.

5. Try adding penetration.

Penetration of a finger or toy can be awesome during oral sex, but it isn’t for everyone. What I’ve found works best of all is to ask! Some people love penetration, some prefer external stimulation only, others want a combination. Don’t be afraid to try all three types of stimulation to find what works.

If your partner isn’t sure whether they like penetration, give it a go—with their permission. Start with one finger, hooking it in a rocking horse or “come hither” motion. This will give you access to the G-spot area, behind the pubic bone.

You can give this a try first, and then add back in your mouth. Gently sliding a finger or two (or a toy—read on) in an out of the vagina while running circles over the clitoris can be highly stimulating. This does take some multitasking! If you want to try internal stimulation on its own, but aren’t sure what to do with your mouth, try talking dirty or kissing your partner’s chest and breasts.

Always remember to pay attention to your partner’s body. If you’re unsure about how it’s going, again, just ask. If they’re feeling it, you can move to two or three fingers.

6. Maybe get a toy in on the action.

There are two main ways I suggest clients and readers incorporate toys into oral sex: penetration with a G-spot wand or a vibrator on the clitoris.

When using a wand for penetration, focus on the G-spot. These toys are specifically designed for this purpose, curving upward for the perfect reach. Massage the G-spot while using your tongue on the clitoris.

With a vibrator on the external glans clitoris (the part you can see!), massage in the same consistent motion you use with your tongue. You can use your mouth as well! Try penetration with the tongue or gently stimulate the very bottom of the vaginal opening. This area contains many pleasurable nerve endings.

7. Check in after sex.

Once playtime is over, check in. Aftercare is an important part of any sexual experience. We have many raw emotions after sex. Talking, cuddling, and discussing everything that transpired will help get you both in the right headspace. No matter the nature of your relationship, whether casual or long-term, your partner deserves respect and to have their needs met. Everyone needs emotional care.

Ask what was working for them and what they enjoyed most. This will help you improve your skills for next time. Sexual play always includes learning and growing.

Gigi Engle is a certified sex coach, educator, and writer living in Chicago. Follow her on Twitter and Instagram @GigiEngle.

Repeat vaccination is safe for most kids with mild to moderate reactions

Children who experience some type of adverse event following initial immunization have a low rate of recurrent reactions to subsequent vaccinations, reports a study in The Pediatric Infectious Disease Journal, the official journal of The European Society for Paediatric Infectious Diseases.

“Most patients with a history of mild or moderate adverse events following immunization [AEFI] can be safely reimmunized,” write Gaston De Serres, MD, of Laval University, Quebec, and colleagues. Although recurrent AEFIs can sometimes occur after repeat doses of vaccine, this study suggests that the risk of recurrent AEFIs after re-vaccination is relatively low, especially when the previous reaction was mild or moderate.

Safety of Repeat Vaccination after Initial Reactions — ‘Passive Surveillance’ Data

In Quebec, healthcare professionals are legally required to report any “unusual or severe” AEFI related to a “passive surveillance” system similar to the Vaccine Adverse Event Reporting System (VAERS) used in the United States. The analysis included 5,600 patients with AEFIs reported to Quebec’s passive surveillance database from 1998 through 2016, all of whom required further doses of the vaccine to which they reacted. (The analysis excluded seasonal influenza vaccine, which changes from year to year.)

Of 1,731 patients with available follow-up data, 1,350 patients were re-vaccinated: a rate of 78 percent. Most of the re-vaccinated children were under two years old; about one-half of the AEFIs were allergic-like reactions.

Sixteen percent of patients experienced some type of recurrent AEFI after re-vaccination. In more than 80 percent of cases, the recurrent reaction was no more severe than the initial reaction. The researchers analyzed potential risk factors for recurrent reactions, including:

  • Patient Characteristics. Children under age 2 were more likely to be re-vaccinated and less likely to have recurrent reactions, compared to older patients. Recurrence risk was similar for males and females.
  • Type of AEFI. Recurrence rate was similar for patients with most types of initial AEFIs. The risk was highest (67 percent) for patients with large local reactions with “extensive limb swelling.” For patients who had allergic-type reactions, the recurrence rate was 12 percent. Severe allergic events (anaphylaxis) were very rare after re-vaccination.
  • Severity of AEFI. Patients with more severe initial AEFIs were less likely to be re-vaccinated: only 60 percent of children with severe reactions were re-vaccinated, compared to 80 percent of those with less-severe reactions. Within this selected group, patients with severe AEFIs were less likely to have recurrences: eight versus 17 percent.
  • Type of Vaccine. The recurrence rate did not differ significantly for different types of vaccines. The re-vaccination rate was highest (90 percent) for children with AEFIs to diphtheria-tetanus-pertussis vaccines.

Prior to this study, there have been limited data on the safety of reimmunizing patients who had a prior AEFI. The study is one of the largest to estimate the rate of recurrent AEFIs by type of reaction and type of vaccine — key information for healthcare providers and parents/caregivers making decisions about further immunization. The results support the safety of continued vaccination especially when the previous reaction was mild or moderate.

The study provides helpful information on the risk of recurrent reactions to specific vaccines and in patients with different types of initial reactions. Dr. De Serres and coauthors suggest that vaccine adverse event passive surveillance systems could be adapted to include “systematic and standardized follow-up” to provide more complete information on recurrence risk and other outcomes for children with AEFIs .

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Materials provided by Wolters Kluwer Health. Note: Content may be edited for style and length.