Cancer

Cancer is one of our nation’s most feared diseases, with more than 1.6 million new cases diagnosed each year. But thanks to National Institute of Health (NIH) research, this number is now falling. Between 1991 and 2014, #cancer death rates went down 25 percent.

NIH research has transformed the way we think about cancer from affecting specific parts of the #body to a much more precise understanding of the molecular cause. For example, the drug pembrolizumab is one of a new class of cancer drugs that works by engaging a patient’s immune system to attack his or her tumors. Doctors already use this drug to treat some patients with several specific cancer types, including lung cancer and head and neck cancer. And, very recently, it became the first cancer therapy approved by the Food and Drug Administration (FDA) to treat any type of tumor, regardless of its location in the body, as long as the tumor has specific genetic features that make it much more likely to shrink after treatment with the drug. This is just one example of how genomics has revolutionized our understanding of cancer (see Precision Oncology, p.18).

Despite gains, there is much work to do. Many clinical trials are testing new targeted treatments, as well as combinations of different cancer therapies. With other federal agencies, NIH is participating in the Cancer MoonshotSM, a bold initiative to accelerate cancer research that aims to make more therapies available to more patients while also improving our ability to prevent cancer and detect it at an early stage.

Good Health for All

Many people in America are more likely to get certain #diseases and to die from them, compared to the general population. One of NIH’s greatest challenges is to understand and eliminate profound disparities in health outcomes for these individuals. We know the causes of health disparities are many. They include biological factors that affect disease risk; but most of the causes turn out to be non-biological factors such as socioeconomics, culture, and environment. Teasing apart health outcomes that differ among racial/ethnic groups is providing clues. For example, NIH research shows that among cigarette smokers, African Americans and Native Hawaiians are more susceptible to lung cancer than Whites, Japanese Americans, and Hispanics. Scientists are also intrigued by the “Hispanic paradox,” in which U.S. Hispanics often experience similar or better health outcomes across a range of diseases compared with non-Hispanic Whites. Understanding this advantage may help us identify contributing factors and effective interventions.

5 Public Health Crises Facing America

Public Health Crises: Five Big Ones Facing America Right Now

  • Obesity
  • Heart Disease
  • Addiction/Substance Abuse
  • Dementia
  • Food Safety

Obesity, dementia, and heart disease – these are among some of the most concerning public health crises faced by the US today. Why are we facing some of these issues, and what are the known facts at this point? Follow along for the scoop on five of today’s most pressing public health crises in the US.

1. Obesity

The advantages of living in a modernized society include more luxury and more ready access to consumables of all sorts. This becomes a problem when the end result is obesity in a significant portion of the population. According to most research, the 1980s marked the beginning of the obesity epidemic in America today.

So, what does this particular health crisis look like? U.S. News shares that around 40 percent of Americans over the age of 20 are said to be obese. These numbers and the numbers of obese children are steadily on the rise. At the end of the day, what makes this such a critical issue overall is the fact that obesity is directly linked to early death and the onset and even further complication of diabetes, heart disease, liver disease, cancer, and many other ailments.

2. Heart Disease

As discussed above, heart disease itself is often a derivative of obesity. In other cases, it can be brought on by unhealthy lifestyle choices, environmental factors, and sometimes, genetics. At the end of the day, this condition is a major problem plaguing Americans’ health at present.

Heart disease, often called by several other names, is essentially stress and damage taken on by the heart that can worsen and lead to heart attacks, strokes, and even fatal events, ultimately in some cases. Factors that help to remediate the various forms of heart disease include healthy dietary choices, regular exercise, and avoidance of illicit drug and alcohol use. These remediating factors are many of those very same ones that Americans struggle to healthily maintain so often in today’s times.

3. Addiction/Substance Abuse

Addiction and substance abuse represent some of the most notable public health crises happening right now in the US. The reasons for this current epidemic are many and complex, but the effects of it are crippling to the individual sufferer and entire communities alike. According to the National Institute on Drug Abuse, an average of more than 130 people die each day in the US from opioid overdose alone. The economic burden placed on the country as a whole, just from prescription opioid abuse itself, is estimated by officials to be around $78.5 billion each year. With these kinds of figures, it’s easy to begin to see how detrimental this particular crisis has become in recent times.

4. Dementia

Dementia, the detrimental mental degradation associated with many cognitive diseases, is yet another looming and major public health crisis faced by the US right now. According to a group of top U.S. Surgeons General in a pivotal op-ed featured in the Orlando Sentinel recently, the public was made aware of the impending weight of the crisis at hand. It was therein estimated by experts that dementia numbers in the public double every five years and the numbers of those affected are unequivocally unprecedented and a potentially system-overwhelming problem.

5. Food Safety

Food safety is rated by a number of government and research organizations as another, top crisis concern for the US right now. This is because of the mass number of food producers, production associations, and even weak points in the continuum of the food markets. Food-born illness spread en-mass can quickly affect thousands of people, while cases of intentional endangerment to the food supply, such as through tampering or deceitful production practices, also can have major implications. For these many, compounding reasons, food safety in the US is a major concern today.

Public health crises can certainly be a great cause for concern. However, with the application of science and subsequent public awareness, many “worst-case scenarios” can be avoided altogether. As of now, the five above-mentioned public health crises are widely regarded as being among the most important and foreshadowing to address.

Men’s Mental Health: Warning Signs & Where to Go for Help

Men typically don’t want to discuss mental health issues, much less get treatment for one.

That’s a problem, given how many males struggle with mental health problems: Six million American men suffer from depression every year, while 3 million struggle with anxiety disorder, according to Mental Health America. Beyond that, 90% of those diagnosed with schizophrenia by age 30 are men, and 25% of those with binge eating disorder are males. Unfortunately, men are less likely to seek professional help for their problems.

When it comes to suicide, the picture is also troubling. While women are more likely to attempt suicide, it is the 7th leading cause of death among males, and white men over the age of 85 are the most likely to die by suicide.

Here, experts describe the most common mental health conditions men experience, the symptoms that may differ in men versus women, and what resources are available for those seeking help and treatment options.

Common mental health conditions in men

According to Mental Health America, the most common men’s mental health conditions are:

  • Depression
  • Suicide
  • Anxiety
  • Bipolar disorder
  • Eating disorders
  • Schizophrenia
  • Substance abuse

“It’s a sign of strength to talk about these issues with your health care provider, counselor or a supportive family member or friend,” Piedmont Healthcare family medicine physician Dr. Siraj Abdullah said in a recent article. “As men, we tend to let stress build up until it affects our mental and physical health. Talking about your mental health is a way to take care of your body.”

How men’s mental health symptoms may show up differently than in women

The reasons that mental health symptoms can be different for men and women are complex, according to McLean Hospital chief of psychology Kathryn McHugh.

She noted in a hospital article that “biology is not the only piece of the puzzle. There are also many social and cultural factors that play a role in mental health and wellness, such as social role expectations, discrimination and violence.”

The Anxiety and Depression Association of America states that the main mental health symptoms in men that may be different from those found in women are:

  • Abuse or misuse of drugs or alcohol
  • Noticeable changes in mood, appetite or energy levels
  • Violent, controlling or abusive behavior
  • Digestive issues, headaches and pain
  • Escaping into work, sports or other distracting behavior
  • Risk-taking

Men with depression are also more likely than women to report symptoms of fatigue and loss of interest in work or hobbies, according to Mental Health America.

Men are particularly susceptible to suicide. According to the U.S. Centers for Disease Control and Prevention, men are four times more likely to die by suicide than women, and gay and bisexual men under the age of 25 are at a higher risk for attempting suicide than the general male population, according to Mental Health America.

The Suicide Prevention Resource Center notes that one of the reasons for higher male suicide rates is that men are less likely to get mental health care than women. The center suggests getting help before a mental health crisis occurs. This can include:

  • Seeking behavioral health care, such as seeing a therapist
  • Connecting to family, friends, community and social organizations
  • Learning life skills like problem-solving and strategies for adapting to change
  • Engaging with spiritual, religious or other belief practices that discourage suicide

If you’d like to begin or continue a behavioral health care plan, you can reach out to the SAMHSA National Helpline for a treatment referral.

Men’s mental health resources: How to get help

APA Psychologist Locator Tool

The American Psychological Association offers a database of thousands of therapists. Just put in your ZIP code, provider name or practice area. Once the results show up, you can sort the psychologists by a variety of categories, such as gender and treatment methods.

If you’re looking for a men’s mental health hotline to discuss your issues confidentially at no charge, the Mental Health Hotline provides a toll-free number with counselors on stand-by 24/7. The organization also lists several condition-specific hotlines for health issues like anxiety, depression, PTSD (post-traumatic stress disorder) and more — plus links to helpful resources on these conditions.

Fictional Dr. Rich Mahogany “runs” this site, which is actually administered by multiple agencies, including the Colorado Department of Public Health. It combines helpful mental health techniques and quizzes with humor and a uniquely human touch. There’s an online peer chat, 20-point head inspection and a worried-about-someone page to help loved ones of men who may be experiencing mental health issues.

Multicultural care meets mutual aid at Therapy for Black Men, where the coaches and counselors strive to offer free or discounted services to Black men with mental health issues. You can meet in person or online for a session, and there’s also a host of articles and social resources, including community organizations aimed at helping your mental health thrive.

Mental health medications

Several medications may be prescribed by your doctor to help you improve your mental health. According to the U.S. National Institute of Mental Health, these include:

  • Antidepressants
  • Anti-anxiety medications
  • Antipsychotics
  • Stimulants
  • Mood stabilizers

If you’re experiencing a mental health crisis or suicidal ideation and need to talk to someone, call 988, the Suicide & Crisis Lifeline. The Lifeline offers free, confidential emotional support across the United States, 24 hours a day, 7 days a week.

US Mayors Cite ‘Unprecedented’ Mental Health Crisis as Top Concern

Substance abuse, homelessness and access to health services are among the issues that city officials say demand more resources in a new US Conference of Mayors survey.

An “unprecedented” mental health crisis is overwhelming US cities, which lack adequate resources to address growing challenges, according to a new report released today by the US Conference of Mayors. In recent years, the Covid-19 pandemic exacerbated mental health issues, particularly involving substance abuse, said a survey of mayors of 117 cities in 39 states.

“Addressing this surging mental health crisis is one of the most pressing issues facing America’s cities,” said Tom Cochran, executive director of the US Conference of Mayors, a nonpartisan organization of cities with populations of 30,000 or more. The report also cited “staggering increases in stress, depression, isolation, loneliness, and accompanying mental health hurdles faced by Americans of all ages.”

In a survey conducted this spring, 97% of mayors said requests for mental health services increased in their city in the past two years, but 88% lack resources to address the crisis. Participating cities spanned the US, and included Chicago; Seattle; Montgomery, Alabama; and Atlanta.

Substance abuse was the main cause for increasing mental health problems, 85% of cities reported. That was followed by Covid-19, homelessness and economic concerns.

Substance use disorders topped the list of mental and behavioral health problems in 65% of cities, followed by homelessness stemming from mental illness in 56%. Other challenges included shortages of mental and behavioral health workers, including school counselors, as well as a lack of access to behavioral health services.

Among youth, depression is the leading primary mental health problem, according to 89% of cities. More than 43% said teen suicide is a significant problem. 

Nineteen cities called for more funding for services, but several noted that most funding goes to county — not city — governments. 

Although the vast majority of cities reported inadequate mental health resources, 82% have developed new initiatives and/or increased funding to mental health programs. Ninety-three percent reported they have improved their emergency response to behavioral health crises. Meanwhile, 94% of cities said their police department provides mental health programs to officers. 

Examples of initiatives cited in the surveyinclude Mesa, Arizona, where its police department is coordinating with a nonprofit crisis line and system. Since 2018, the cityhas increased the types of emergency calls transferred, including children with behavioral issues, second-hand suicide reports, as well as dementia, psychosis, anxiety, PTSD, and basic problem-solving help. In 2022 alone, more than 3,500 911 calls were sent directly to its crisis hotline, away from Mesa’s police and fire departments, according to the city’s survey response. 

In Las Vegas, an outreach team provides services to unhoused people to divert them from emergency rooms and into appropriate treatment. A crisis response team also works with the fire department to deescalate non-emergency mental health issues.

Long Beach, California, has established mobile homeless and behavioral health services, and teams of mental health clinicians to do homeless outreach. In 2022, Hartford, Connecticut, launched a non-law enforcement crisis intervention program in response to emergency 911 calls for people in mental health crises.

City leaders from Orlando, Florida, expressed their support for the “Housing First” model as a means of addressing homelessness, and said mental health challenges are easier to address when people are housed. But respondents from the city of Fontana, California commented, “Hiding someone away in an apartment or hotel room does not cure them from mental illness. Housing first without mental health support DOES NOT WORK.” [SIC]

Officials from Issaquah, Washington, observed: “Stable housing must be coupled with other intensive support services. Housing alone does not improve mental health outcomes.” Theyadded that for chronically unhoused people, “adjusting to living indoors is often underestimated and if housing is not accompanied by extra supports to help with the transition, people are more likely to fall back into homelessness.”

Cardiovascular Disease Is Primed to Kill More Older Adults, Especially Blacks and Hispanics

Cardiovascular disease — the No. 1 cause of death among people 65 and older — is poised to become more prevalent in the years ahead, disproportionately affecting Black and Hispanic communities and exacting an enormous toll on the health and quality of life of older Americans.

The estimates are sobering: By 2060, the prevalence of ischemic heart disease (a condition caused by blocked arteries and also known as coronary artery disease) is projected to rise 31% compared with 2025; heart failure will increase 33%; heart attacks will grow by 30%; and strokes will increase by 34%, according to a team of researchers from Harvard and other institutions. The greatest increase will come between 2025 and 2030, they predicted.

The dramatic expansion of the U.S. aging population (cardiovascular disease is far more common in older adults than in younger people) and rising numbers of people with conditions that put them at risk of heart disease and stroke — high blood pressure, diabetes, and obesity foremost among them — are expected to contribute to this alarming scenario.

Because the risk factors are more common among Black and Hispanic populations, cardiovascular illness and death will become even more common for these groups, the researchers predicted. (Hispanic people can be of any race or combination of races.)

“Disparities in the burden of cardiovascular disease are only going to be exacerbated” unless targeted efforts are made to strengthen health education, expand prevention, and improve access to effective therapies, wrote the authors of an accompanying editorial, from Stony Brook University in New York and Baylor University Medical Center in Texas.

“Whatever focus we’ve had before on managing [cardiovascular] disease risk in Black and Hispanic Americans, we need to redouble our efforts,” said Clyde Yancy, chief of cardiology and vice dean for diversity and inclusion at Northwestern University’s Feinberg School of Medicine in Chicago, who was not involved with the research.

Of course, medical advances, public health policies, and other developments could alter the outlook for cardiovascular disease over the next several decades.

More than 80% of cardiovascular deaths occur among adults 65 or older. For about a dozen years, the total number of cardiovascular deaths in this age group has steadily ticked upward, as the ranks of older adults have expanded and previous progress in curbing fatalities from heart disease and strokes has been undermined by Americans’ expanding waistlines, poor diets, and physical inactivity.

Among people 65 and older, cardiovascular deaths plunged 22% between 1999 and 2010, according to data from the National Heart, Lung, and Blood Institute — a testament to new medical and surgical therapies and treatments and a sharp decline in smoking, among other public health initiatives. Then between 2011 and 2019, deaths climbed 13%.

The covid-19 pandemic has also added to the death toll, with coronavirus infections causing serious complications such as blood clots and millions of seniors avoiding seeking medical care out of fear of becoming infected. Most affected have been low-income individuals, and older non-Hispanic Black and Hispanic people, who have died from the virus at disproportionately higher rates than non-Hispanic white people.

“The pandemic laid bare ongoing health inequities,” and that has fueled a new wave of research into disparities across various medical conditions and their causes, said Nakela Cook, a cardiologist and executive director of the Patient-Centered Outcomes Research Institute, an independent organization authorized by Congress.

One of the most detailed examinations yet, published in JAMA Cardiology in March, examined mortality rates in Hispanic, non-Hispanic Black, and non-Hispanic white populations from 1990 to 2019 in all 50 states and the District of Columbia. It showed that Black men remain at the highest risk of dying from cardiovascular disease, especially in Southern states along the Mississippi River and in the northern Midwest. (The age-adjusted mortality rate from cardiovascular disease for Black men in 2019 was 245 per 100,000, compared with 191 per 100,000 for white men and 135 per 100,000 for Hispanic men. Results for women within each demographic were lower.)

Progress stemming deaths from cardiovascular disease in Black men slowed considerably between 2010 and 2019. Across the country, cardiovascular deaths for that group dropped 13%, far less than the 28% decline from 2000 to 2010 and 19% decline from 1990 to 2000. In the regions where Black men were most at risk, the picture was even worse: In Mississippi, for instance, deaths of Black men fell only 1% from 2010 to 2019, while in Michigan they dropped 4%. In the District of Columbia, they actually rose, by nearly 5%.

While individual lifestyles are partly responsible for the unequal burden of cardiovascular disease, the American Heart Association’s 2017 scientific statement on the cardiovascular health of African Americans notes that “perceived racial discrimination” and related stress are associated with hypertension, obesity, persistent inflammation, and other clinical processes that raise the risk of cardiovascular disease.

Though Black people are deeply affected, so are other racial and ethnic minorities who experience adversity in their day-to-day lives, several experts noted. However, recent studies of cardiovascular deaths don’t feature some of these groups, including Asian Americans and Native Americans.

What are the implications for the future? Noting significant variations in cardiovascular health outcomes by geographic location, Alain Bertoni, an internist and professor of epidemiology and prevention at Wake Forest University School of Medicine, said, “We may need different solutions in different parts of the country.”

Gregory Roth, a co-author of the JAMA Cardiology paper and an associate professor of cardiology at the University of Washington School of Medicine, called for a renewed effort to educate people in at-risk communities about “modifiable risk factors” — high blood pressure, high cholesterol, obesity, diabetes, smoking, inadequate physical activity, unhealthy diet, and insufficient sleep. The American Heart Association has suggestions on its website for promoting cardiovascular health in each of these areas.

Michelle Albert, a cardiologist and the current president of the American Heart Association, said more attention needs to be paid in medical education to “social determinants of health” — including income, education, housing, neighborhood environments, and community characteristics — so the health care workforce is better prepared to address unmet health needs in vulnerable populations.

Natalie Bello, a cardiologist and the director of hypertension research at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles, said, “We really need to be going into vulnerable communities and reaching people where they’re at to increase their knowledge of risk factors and how to reduce them.” This could mean deploying community health workers more broadly or expanding innovative programs like ones that bring pharmacists into Black-owned barbershops to educate Black men about high blood pressure, she suggested.

“Now, more than ever, we have the medical therapies and technologies in place to treat cardiovascular conditions,” said Rishi Wadhera, a cardiologist and section head of health policy and equity research at the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center in Boston. What’s needed, he said, are more vigorous efforts to ensure all older patients, including those from disadvantaged communities, are connected with primary care physicians and receive appropriate screening and treatment for cardiovascular risk factors, and high-quality, evidence-based care in the event of heart failure, a heart attack, or a stroke.

What is high blood pressure in pregnancy?

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:

  • Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don’t have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
  • Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women may have had it long before becoming pregnant but didn’t know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
  • Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.

What causes preeclampsia?

The cause of preeclampsia is unknown.

Who is at risk for preeclampsia?

You are at higher risk of preeclampsia if you:

  • Had chronic high blood pressure or chronic kidney disease before pregnancy
  • Had high blood pressure or preeclampsia in a previous pregnancy
  • Have obesity
  • Are over age 40
  • Are pregnant with more than one baby
  • Are African American
  • Have a family history of preeclampsia
  • Have certain health conditions, such as diabeteslupus, or thrombophilia (a disorder which raises your risk of blood clots)
  • Used in vitro fertilization, egg donation, or donor insemination

What problems can preeclampsia cause?

Preeclampsia can cause:

  • Placental abruption, where the placenta separates from the uterus
  • Poor fetal growth, caused by a lack of nutrients and oxygen
  • Preterm birth
  • low birth weight baby
  • Stillbirth
  • Damage to your kidneys, liver, brain, and other organ and blood systems
  • A higher risk of heart disease for you
  • Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
  • HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.

What are the symptoms of preeclampsia?

Possible symptoms of preeclampsia include:

  • High blood pressure
  • Too much protein in your urine (called proteinuria)
  • Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
  • Headache that does not go away
  • Vision problems, including blurred vision or seeing spots
  • Pain in your upper right abdomen
  • Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

How is preeclampsia diagnosed?

Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

What are the treatments for preeclampsia?

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

  • If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
  • If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby’s growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby’s lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

Diabetes and Pregnancy Also called: Gestational diabetes 

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, high blood sugar levels are not good for your baby.

About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk for developing type 2 diabetes later on. Your child is also at risk for obesity and type 2 diabetes.

Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier.

If you already have diabetes, the best time to control your blood sugar is before you get pregnant. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy – even before you know you are pregnant. To keep you and your baby healthy, it is important to keep your blood sugar as close to normal as possible before and during pregnancy.

Either type of diabetes during pregnancy increases the chances of problems for you and your baby. To help lower the chances talk to your health care team about:

  • A meal plan for your pregnancy
  • A safe exercise plan
  • How often to test your blood sugar
  • Taking your medicine as prescribed. Your medicine plan may need to change during pregnancy.

If you have diabetes and plan to have a baby, you should try to get your blood glucose levels close to your target range before you get pregnant.

Staying in your target range during pregnancy, which may be different than when you aren’t pregnant, is also important. High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant. If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.

If you develop diabetes for the first time while you are pregnant, you have gestational diabetes.

How can diabetes affect my baby?

A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.

High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.

High blood glucose also can increase the chance that you will have a miscarriage NIH external link or a stillborn baby.1 Stillborn means the baby dies in the womb during the second half of pregnancy.

How can my diabetes affect me during pregnancy?

Hormonal and other changes in your body during pregnancy affect your blood glucose levels, so you might need to change how you manage your diabetes. Even if you’ve had diabetes for years, you may need to change your meal plan, physical activity routine, and medicines. If you have been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to your due date, your management plan might change again.

What health problems could I develop during pregnancy because of my diabetes?

Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney disease, especially if your blood glucose levels are too high.

You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy. Preeclampsia NIH external link can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born.

How can I prepare for pregnancy if I have diabetes?

If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.

Work with your health care team

Regular visits with members of a health care team who are experts in diabetes and pregnancy will ensure that you and your baby get the best care. Your health care team may include

  • a medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist
  • an obstetrician with experience treating women with diabetes
  • a diabetes educator who can help you manage your diabetes
  • a nurse practitioner NIH external link who provides prenatal care NIH external link during your pregnancy
  • a registered dietitian to help with meal planning
  • specialists who diagnose and treat diabetes-related problems, such as vision problems, kidney disease, and heart disease
  • a social worker or psychologist to help you cope with stress, worry, and the extra demands of pregnancy

You are the most important member of the team. Your health care team can give you expert advice, but you are the one who must manage your diabetes every day.

Top 10 Most Common Health Issues

  1. Physical Activity and Nutrition
  2. Overweight and Obesity
  3. Tobacco
  4. Substance Abuse
  5. HIV/AIDS
  6. Mental Health
  7. Injury and Violence
  8. Environmental Quality
  9. Immunization
  10. Access to Health Care

Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases, including some cancers, heart disease and diabetes, and also relieve depression and improve mood. Inactivity often accompanies advancing age, but it doesn’t have to. Check with your local churches or synagogues, senior centers, and shopping malls for exercise and walking programs. Like exercise, your eating habits are often not good if you live and eat alone. It’s important for successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.

Overweight and Obesity

Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, dyslipidemia and endometrial, breast, prostate, and colon cancers. In-depth guides and practical advice about obesity are available from the National Heart Lung and Blood Institute of the National Institutes of Health.

Tobacco

Tobacco is the single greatest preventable cause of illness and premature death in the U.S. Tobacco use is now called “Tobacco dependence disease.” The Centers for Disease Control and Prevention (CDC) says that smokers who try to quit are more successful when they have the support of their physician.

Substance Abuse

Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and alcohol, which can lead to serious health consequences. In addition, seniors may deliberately or unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens, many medical people fail to ask seniors about possible substance abuse.

HIV/AIDS

Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between 1991 and 1996, AIDS in adults over 50 rose more than twice as fast as in younger adults. Seniors are unlikely to use condoms, have immune systems that naturally weaken with age, and HIV symptoms (fatigue, weight loss, dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can accompany old age. Again, stereotypes about aging in terms of sexual activity and drug use keep this problem largely unrecognized. That’s why seniors are not well represented in research, clinical drug trials, prevention programs and efforts at intervention.

Mental Health

Dementia is not part of aging. Dementia can be caused by disease, reactions to medications, vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There are many forms of dementia (including Alzheimer’s Disease) and some can be temporary. With accurate diagnosis comes management and help. The most common late-in-life mental health condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a surprising fact: The rate of suicide is higher for elderly white men than for any other age group, including adolescents.

Injury and Violence

Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to reduce injury include exercises to improve balance and strength and medication review. Home modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based fire prevention devices should be in place and easy to use. People aged 65 and older are twice as likely to die in a home fire as the general population.

Environmental Quality

Even though pollution affects all of us, government studies have indicated that low-income, racial and ethnic minorities are more likely to live in areas where they face environmental risks. Compared to the general population, a higher proportion of elderly are living just over the poverty threshold.

Immunization

Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious infections, especially among women and the very old.

Access to Health Care

Seniors frequently don’t monitor their health as seriously as they should. While a shortage of geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and geriatric specialists of any medical community in the country. Your access to health care is as close as URMC, offering a menu of services at several hospital settings, including the VA Hospital in Canandaigua, in senior housing, and in your community.

What is Stress?

Stress is a normal psychological and physical reaction to the demands of life. A small amount of stress can be good, motivating you to perform well. But many challenges daily, such as sitting in traffic, meeting deadlines and paying bills, can push you beyond your ability to cope.

Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones that increase your heart rate and raise your blood pressure. This “fight-or-flight” response fuels you to deal with the threat.

Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life and its demands and expectations mean that some people’s alarm systems rarely shut off.

Stress management gives you a range of tools to reset and to recalibrate your alarm system. It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems.

Don’t wait until stress damages your health, relationships or quality of life. Start practicing stress management techniques today.

Stress symptoms: Effects on your body and behavior

Stress symptoms may be affecting your health, even though you might not realize it. You may think illness is to blame for that irritating headache, your frequent insomnia or your decreased productivity at work. But stress may actually be the cause.

Common effects of stress

Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can help you manage them. Stress that’s left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity and diabetes.

Common effects of stress

On your bodyOn your moodOn your behavior
HeadacheAnxietyOvereating or undereating
Muscle tension or painRestlessnessAngry outbursts
Chest painLack of motivation or focusDrug or alcohol misuse
FatigueFeeling overwhelmedTobacco use
Change in sex driveIrritability or angerSocial withdrawal
Stomach upsetSadness or depressionExercising less often
Sleep problems

Act to manage stress

If you have stress symptoms, taking steps to manage your stress can have many health benefits. Explore stress management strategies, such as:

  • Getting regular physical activity
  • Practicing relaxation techniques, such as deep breathing, meditation, yoga, tai chi or massage
  • Keeping a sense of humor
  • Spending time with family and friends
  • Setting aside time for hobbies, such as reading a book or listening to music

Aim to find active ways to manage your stress. Inactive ways to manage stress — such as watching television, surfing the internet or playing video games — may seem relaxing, but they may increase your stress over the long term.

And be sure to get plenty of sleep and eat a healthy, balanced diet. Avoid tobacco use, excess caffeine and alcohol, and the use of illegal substances.

When to seek help

If you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your healthcare provider may want to check for other potential causes. Or consider seeing a professional counselor or therapist, who can help you identify sources of your stress and learn new coping tools.

Also, get emergency help immediately if you have chest pain, especially if you also have shortness of breath, jaw or back pain, pain radiating into your shoulder and arm, sweating, dizziness, or nausea. These may be warning signs of a heart attack and not simply stress symptoms.

What is the immune system?

Your immune system is a complex network of cells, tissues, and organs. Together they help the body fight infections and other diseases.

When germs such as bacteria or viruses invade your body, they attack and multiply. This is called an infection. The infection causes the disease that makes you sick. Your immune system protects you from the disease by fighting off the germs.

What are the parts of the immune system?

The immune system has many different parts, including:

  • Your skin, which can help prevent germs from getting into the body
  • Mucous membranes, which are the moist, inner linings of some organs and body cavities. They make mucus and other substances which can trap and fight germs.
  • White blood cells, which fight germs
  • Organs and tissues of the lymph system, such as the thymus, spleen, tonsils, lymph nodes, lymph vessels, and bone marrow. They produce, store, and carry white blood cells.

How does the immune system work?

Your immune system defends your body against substances it sees as harmful or foreign. These substances are called antigens. They may be germs such as bacteria and viruses. They might be chemicals or toxins. They could also be cells that are damaged from things like cancer or sunburn.

When your immune system recognizes an antigen, it attacks it. This is called an immune response. Part of this response is to make antibodies. Antibodies are proteins that work to attack, weaken, and destroy antigens. Your body also makes other cells to fight the antigen.

Afterwards, your immune system remembers the antigen. If it sees the antigen again, it can recognize it. It will quickly send out the right antibodies, so in most cases, you don’t get sick. This protection against a certain disease is called immunity.

What are the types of immunity?

There are three different types of immunity:

  • Innate immunity is the protection that you are born with. It is your body’s first line of defense. It includes barriers such as the skin and mucous membranes. They keep harmful substances from entering the body. It also includes some cells and chemicals which can attack foreign substances.
  • Active immunity, also called adaptive immunity, develops when you are infected with or vaccinated against a foreign substance. Active immunity is usually long-lasting. For many diseases, it can last your entire life.
  • Passive immunity happens when you receive antibodies to a disease instead of making them through your own immune system. For example, newborn babies have antibodies from their mothers. People can also get passive immunity through blood products that contain antibodies. This kind of immunity gives you protection right away. But it only lasts a few weeks or months.

What can go wrong with the immune system?

Sometimes a person may have an immune response even though there is no real threat. This can lead to problems such as allergies, asthma, and autoimmune diseases. If you have an autoimmune disease, your immune system attacks healthy cells in your body by mistake.

Other immune system problems happen when your immune system does not work correctly. These problems include immunodeficiency diseases. If you have an immunodeficiency disease, you get sick more often. Your infections may last longer and can be more serious and harder to treat. They are often genetic disorders.

There are other diseases that can affect your immune system. For example, HIV is a virus that harms your immune system by destroying your white blood cells. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). People with AIDS have badly damaged immune systems. They get an increasing number of severe illnesses.