“The University of Michigan recommends the following: there are very bicycle-friendly communities. It is, however, very important that bicyclists (and motorists) understand the rules of the road and how to stay safe while biking in the city. With an abundance of restaurants and shops downtown and various city parks to explore. Did you know that city ordinances require motorists to stop for pedestrians who are at or in crosswalks?  Walk with a friend, use designated sidewalks or paths, cross at designated crosswalks and don’t just look at signs but use your eyes looking both ways also.As we make the switch from warm to hot weather, it’s important to take the time to review tips for staying safe in the heat.  This means wear sunscreen for skin protection, drink plenty of water, limit alcoholic beverages, dress in loose-fitting, lightweight and light-colored clothing, and limit exercise outdoors in extreme heat.Summertime is often paired with grilling outdoors so this means place grills a minimum of 36″ away from your home, deck railings, and out from under eaves and overhanging branches, set up your grill on a flat, stable surface to prevent tipping, operate your grill safely by checking for leaks and opening the lid before lighting, maintain your grill by cleaning and inspecting it regularly and always have a fire extinguisher nearby.  Of course don’t forget the supervision of children and pets in also establishing a safe zone of at least three feet around the grill, where children and pets are not allowed.”

Division of Public Safety and Security University of Michigan –  DPSS (https://news.dpss.umich.edu/2024/06/1391)

“May sound so basic but not always followed so as a reminder to let the public know the best way to prevent HIV is to understand how the virus is transmitted and take steps to reduce your risk. If you’re living with HIV, understanding these practices can help prevent transmission to others.

HIV can’t be transmitted through saliva or skin-to-skin contact, such as hugging or shaking hands. The virus can only be transmitted by exchanging certain bodily fluids, including genital secretions and blood.

As a result, transmission most frequently occurs during condomless sex or shared use of syringes and other drug injection equipment.

Adopting certain harm reduction strategies, including safer sex and safer substance use or better yet no substance use, can help reduce the risk of contracting or transmitting the virus.

Although you have up to 72 hours to begin PEP, the medication is less likely to be effective over time. Additional medication must also be taken consistently and correctly for 28 days.

If you don’t have a primary care doctor or another healthcare professional to reach out to, you may be able to get a prescription for PEP at your local: health department, sexual health clinic, urgent care center or emergency room.

Know approximately 1.2 million people in the United States have HIV, according to HIV.gov. Of those people, 13% do not know they have it.  In 2021, there were 1,086,806 people living with HIV in the U.S. In 2021, 36,126 people were newly diagnosed with HIV.“

healthline (https://www.healthline.com/health/hiv-aids/hiv-prevention/hiv-prevention?utm_source=google&utm_medium=cpc&utm_cmpid=20958361886&utm_adgid=156321296365&utm_adid=688286705703&utm_network=g&utm_device=c&utm_keyword=&utm_adpos=&utm_gclid=EAIaIQobChMI8fKFhNj0hgMV-2BHAR2JDwgDEAMYASAAEgL8BPD_BwE&gad_source=1&gclid=EAIaIQobChMI8fKFhNj0hgMV-2BHAR2JDwgDEAMYASAAEgL8BPD_BwE#takeaway)

“National HIV Testing Day (NHTD) encourages HIV testing as a critical tool to help end the HIV epidemic in the United States. Observed annually on June 27, the 2024 NHTD theme is Level Up Your Self-Love: Check Your Status, emphasizing self-compassion, self-respect, and self-love in honoring health needs by getting an HIV test. When someone knows their HIV status, they can choose options to stay healthy.

According to the Centers for Disease Control and Prevention (CDC), in 2022, an estimated 1.2 million people in the United States had HIV, but 13 percent of people with HIV did not know their HIV status. HIV testing is the pathway to engage people in care and help them stay healthy, regardless of the test result. People who have a positive HIV test can start antiretroviral therapy (ART) to stay healthy. People who have a negative HIV test can learn how to access HIV prevention options like pre-exposure prophylaxis (PrEP). CDC recommends that everyone aged 13–64 get tested for HIV at least once as part of routine health care. People with certain risk factors—such as having sex with someone who has HIV, sharing needles or drug injection equipment, or being treated for another sexually transmitted infection (STI)—should be tested for HIV at least once per year.”

HIVinfo.NIH.gov (https://hivinfo.nih.gov/understanding-hiv/hiv-aids-awareness-days/national-hiv-testing-day)

”Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression.”

National Library of Medicine – NIH (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690315/)

The nervous system’s dials for communicating chronic pain to the body work differently in male and female mice, according to a study published today in Nature Neuroscience. If this difference is also found in humans, it could lead to chronic pain treatments that are better tailored to the patient. But the most immediate impact might be in basic research — the earliest stages of work — since right now, the mice being used are almost exclusively male.

Chronic pain affects more than 100 million people in the US, which is more than heart disease, cancer, and diabetes combined. And many pain conditions occur more often in women than in men, according to the FDA. That’s why figuring out how male and female mice deal with pain — and whether they do so differently than humans — is so important. After all, most medical research — including pain research — starts with mice.

In the study, researchers focused on microglia, a type of immune cell that can be found in the brain and the spinal cord. These cells are known to play a role in the “volume knob” for pain, explains Jeffrey Mogil, a pain researcher at McGill University and a co-author of the study. The knob turns way up after an injury. A genetic study done in Mogil’s lab a few years ago had indicated that microglia weren’t as important in the pain circuit of female mice. So, the scientists decided to find out if interfering with the microglia would have the same effect in male and female mice.

Male mice had no pain, whereas female mice did

The researchers used mice that were suffering from a hypersensitivity to pain. The scientists gave them drugs that target the microglial cells in the spinal cord, in the hopes that this would prevent the animals from feeling pain. But only male mice responded to the drugs — the female mice still had an increased sensitivity to pain.

When the researchers repeated these experiments in mice under varying conditions, they saw the same results: male mice had no pain, whereas female mice did. “Whatever the manipulation is, in every case, blocking microglia or some part of the microglial system brings the pain sensitivity back to normal in male mice, and doesn’t do anything in female mice,” Mogil says.

Now looking at the human we see this: There is a growing body of literature that indicates women are more likely than men to be undertreated for their pain.

It appears that gender affects not only pain perception, pain coping, and pain reporting, but also pain-related behaviors, including use of healthcare and the social welfare system. It is also probable that men and women differ systematically in their responses to pain treatments, although further research is needed in this area.

For many common pain conditions, including migraine and tension-type headache, facial pain, and abdominal pain, population-based studies indicate higher prevalence rates in adult women than in adult men.

Despite the difficulties with human laboratory experiments on pain sensitivity, many investigators are willing to draw the inference from these studies that women are, in general, more sensitive to painful stimuli than men, and that this difference is biologically based.

Whatever the pain prevalence differences for men and women, most studies show that women seek healthcare for pain at a higher rate than men:

• • One study indicated that women are more likely to be given sedatives for their pain, while men are more likely to be given pain medication.

  • Faherty and Grier studied the administration of pain medication after abdominal surgery and found (after controlling for weight) that physicians prescribed less pain medication for women than for men ages 55 or older, and that nurses administered less pain medication to women than to men ages 25-54 years.

  • Beyer et al examined pain medication given to children and found that, after surgery, boys received significantly more codeine than girls, and girls were more likely than boys to be given acetaminophen.

  • In a 1994 study of 1,308 outpatients, Cleeland and colleagues found that women with metastatic cancer were significantly more likely than men with the same diagnosis to receive inadequate pain medications.

  • In a study of several hundred AIDS patients, Breitbart and colleagues found that, based on the WHO analgesic ladder guideline, women were significantly more likely than men to receive inadequate analgesic therapy.

  • A study by Weir and colleagues found that women are less likely than men to be referred to a specialty pain clinic, at least upon initial encounters with their physicians.

  • A study reviewing cancer care at seven outpatient clinics in California found that female cancer patients were prescribed half the pain medication as male patients with the same pain intensity scores.

  • Males outnumber females two to one in the burn population. This is related to male household and job roles, which increase the risk for burn injury. Furthermore, males more commonly engage in risk-taking behaviors involving chemicals, flammable materials, or electricity.So what do we see so for at this point:

• We feel pain more intensely than men, according to a new study of 11,000 men and women who were patients at the Stanford Hospital and Clinics.

• Researchers analyzed electronic medical records of patients’ reports of pain across a range of different diseases, and found a distinct gender-driven difference in how much discomfort patients say they felt. The study included 47 disorders — from cancer to back conditions and infectious diseases — and more than 161,000 patient-reported pain scores. The patients were all asked by nurses or other health personnel to rate their pain on an 11-point scale, with 0 representing “no pain” and 11 signifying the “worst pain imaginable”.

• Not surprisingly, most responses clustered around either the two extremes of very little pain or extreme pain or the middle score of 5. But overall, women were more likely to indicate higher pain levels than men, says lead author Dr. Atul Butte, chief of systems medicine in the department of pediatrics at Stanford University School of Medicine. And that was true across almost all of the different diseases. “That was the most surprising finding,” says Butte. “We completely wouldn’t have expected such a difference across almost all disorders, where women were reporting a whole pain point higher on the 0-to-10 scale than men.”

• Of course, self-reports can’t account for the fact that people may define tolerable and intolerable pain in vastly different ways, says Butte, but the fact that a gender difference emerged from such a large number of patients suggests that the effect is real.

• What accounts for the gender gap? Hormones may explain some of the difference — studies have shown that estrogen in women can help dampen the activity of pain receptors, helping them to tolerate higher levels of pain. That means, however, that they may become more sensitive to pain during low-estrogen parts of the menstrual cycle.

• There may also be explanations that have nothing to do with biology. Men, for example, may feel compelled by cultural stereotypes to be tough, and therefore report feeling less pain than they really do —especially when asked by the mostly female nursing staff.

Still, even if non-biological factors are influencing how much pain men and women report, Butte says the difference is worth noting. “The reasons may be biological or they may not be, but we should still be aware of the bias that patients have in reporting pain,” he says. He is hoping to continue the research by following up these results with surveys of patients’ ratings after they were treated for pain. That may help doctors to better address the real pain patients may be feeling.

Through the National Library of Medicine in 2022 (https://pubmed.ncbi.nlm.nih.gov/36038207/) They state; “Chronic pain affects 20% of adults and is one of the leading causes of disability worldwide. Women and girls are disproportionally affected by chronic pain. About half of chronic pain conditions are more common in women, with only 20% having a higher prevalence in men. There are also sex and gender differences in acute pain sensitivity. Pain is a subjective experience made up of sensory, cognitive, and emotional components. Consequently, there are multiple dimensions through which sex and gender can influence the pain experience. Historically, most preclinical pain research was conducted exclusively in male animals. However, recent studies that included females have revealed significant sex differences in the physiological mechanisms underlying pain, including sex specific involvement of different genes and proteins as well as distinct interactions between hormones and the immune system that influence the transmission of pain signals. Human neuroimaging has revealed sex and gender differences in the neural circuitry associated with pain, including sex specific brain alterations in chronic pain conditions. Clinical pain research suggests that gender can affect how an individual contextualizes and copes with pain. Gender may also influence the susceptibility to develop chronic pain. Sex and gender biases can impact how pain is perceived and treated clinically. Furthermore, the efficacy and side effects associated with different pain treatments can vary according to sex and gender. Therefore, preclinical and clinical research must include sex and gender analyses to understand basic mechanisms of pain and its relief, and to develop personalized pain treatment.”.

“CDC states the following:

• Sickle cell disease (SCD) is a group of inherited blood disorders. Abnormal hemoglobin is produced.
• Red blood cells become hard and sticky and get stuck in small blood vessels, resulting in pain and other serious complications.
• There are several types of SCD, some more severe than others.
• In the United States, SCD is often found at birth through routine newborn screening.

Sickle cell disease (SCD) affects about 100,000 people in the United States; more than 90% are non-Hispanic Black or African American, and an estimated 3%–9% are Hispanic or Latino.

The estimated life expectancy of those with SCD in the United States is more than 20 years shorter than the average expected.

Many people with SCD unfortunately do not receive the recommended healthcare screenings and treatments.”

Center for Disease Control and Prevention – CDC (https://www.cdc.gov/sickle-cell/data/index.html)

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September is National Sickle Cell Awareness Month, a time to recognize the perseverance of patients living with sickle cell disease (SCD) and to recommit ourselves to improving the quality of life and health outcomes for all individuals living with SCD.

Mount Sinai Health System is reminding the community of the importance of newborn screening performed soon after birth with a blood test, education for families with this inherited condition and comprehensive care for children and adults including regular visits with a specialist can reduce complications of this illness.

SCD is the most commonly inherited blood disorder in the United States, affecting 100,000 people, and millions more worldwide. The disease primarily affects people of African, Hispanic, Mediterranean, Middle Eastern and South Asian ancestry.

What is sickle cell disease (SCD) actually?

The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in their red blood cells.

Hemoglobin is a protein in red blood cells that carries oxygen throughout the body.

“Inherited” means that the disease is passed by genes from parents to their children. SCD is not contagious. A person cannot catch it, like a cold or infection, from someone else.

People who have SCD inherit two abnormal hemoglobin genes, one from each parent. In all forms of SCD, at least one of the two abnormal genes causes a person’s body to make hemoglobin S. When a person has two hemoglobin S genes, Hemoglobin SS, the disease is called sickle cell anemia. This is the most common and often most severe kind of SCD.

Hemoglobin SC disease and hemoglobin Sβ thalassemia (thal-uh-SEE-me-uh) are two other common forms of SCD.

Cells in tissues need a steady supply of oxygen to work well. Normally, hemoglobin in red blood cells takes up oxygen in the lungs and carries it to all the tissues of the body.

Red blood cells that contain normal hemoglobin are disc shaped (like a doughnut without a hole). This shape allows the cells to be flexible so that they can move through large and small blood vessels to deliver oxygen.

Sickle hemoglobin is not like normal hemoglobin. It can form stiff rods within the red cell, changing it into a crescent, or sickle shape.

Sickle-shaped cells are not flexible and can stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can’t reach nearby tissues.

The lack of tissue oxygen can cause attacks of sudden, severe pain, called pain crisis. These pain attacks can occur without warning, and a person often needs to go to the hospital for effective treatment.

Most children with SCD are pain free between painful crises, but adolescents and adults may also suffer with chronic ongoing pain.

The red cell sickling and poor oxygen delivery can also cause organ damage. Over a lifetime, SCD can harm a person’s spleen, brain, eyes, lungs, liver, heart, kidneys, penis, joints, bones, or skin.

Sickle cells can’t change shape easily, so they tend to burst apart or hemolyze. Normal red blood cells live about 90 to 120 days, but sickle cells last only 10 to 20 days.

The body is always making new red blood cells to replace the old cells; however, in SCD the body may have trouble keeping up with how fast the cells are being destroyed. Because of this, the number of red blood cells is usually lower than normal. This condition, called anemia, can make a person have less energy.  Anemia ending line is lack of oxygen to the tissue body parts all over.

“Sickle cell disease is devastating for patients and their families,” said Jeffrey Glassberg, MD, MA, Assistant Professor of Emergency Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai. “It’s a chronic disorder causing pain in the extremities and back, infections, organ failure and other tissue damage, skin infections, loss of eyesight, severe blood clots and strokes. Patients learn to function in a constant state of pain and when that pain becomes debilitating, they often end up in the emergency room,” said Dr. Glassberg, also Associate Director of the Comprehensive Sickle Cell Program at The Mount Sinai Hospital.

“Patients with SCD are more likely to live full lives if they undergo regular checkups, prevent infections and develop healthy habits,” said Jena Simon, MS, FNP-BC, RN, also of the Comprehensive Sickle Cell Program.

Tips to Staying Healthy for SCD patients:

• Get regular checkups. Regular health checkups can help prevent some serious problems.
• Prevent infections. Common illnesses, like influenza quickly can become dangerous for both children and adults with SCD. The best defense is to get a flu shot every fall and to stay up-to-date on other immunizations.
• People with SCD should drink 8 to 10 glasses of water every day and eat healthy food. They also should try not to get too hot, too cold, or too tired.
• Look for clinical studies. New clinical research studies are beginning all the time at Mount Sinai and elsewhere, with the goal of finding better treatments for SCD. Study participants gain early access to experimental medicines and treatments.
• Get support. People with SCD should find a patient support group or other organization in the community that can provide information, assistance, and support.

Sickle Cell Disease Facts & Figures:

• SCD is an inherited blood disorder that can cause severe pain and permanent damage to the brain, heart, lungs, kidneys, liver, bones and spleen.
• SCD is most common in Africans and African-Americans. It is also found in other ethnic and racial groups, including people from South and Central America, the Caribbean, Mediterranean countries, and India.
• More than 2 million people carry the sickle cell gene that allows them potentially to pass the disease on to their children. People of African, Hispanic, Mediterranean, Middle Eastern, and Indian descent may want to be tested for the gene before having children. You can carry the gene and not have any signs or symptoms of SCD. Both parents have to have the gene to have a child with SCD.

DIAGNOSIS & TREATMENT for SCD:

Minnesota Department of Health states the following about treatment:

“Sickle cell disease is usually diagnosed at birth through a blood spot test, which is part of the Newborn Screening Program. A blood test can also be performed at any time for those not screened at birth.

Treatment can help relieve symptoms and complications of SCD, which vary and can range from mild to severe. Treatment will be different for each person based on what symptoms they have. The goals of treating SCD are to prevent and relieve SCD complications, including pain, infections, organ damage, and strokes. Treatments can include:

• Receiving blood transfusions
• Drinking lots of water (8 to 10 glasses of water each day)
• Receiving IV (intravenous) therapy (fluids given into a vein)
• Taking pain relievers
• Taking an FDA-approved medication, such as hydroxyurea, crizalizumah, L-glutamine, or voxeletor

Currently, the only known cure for SCD is a blood or marrow transplant (BMT). A blood or marrow transplant is a procedure that takes healthy stem cells from a donor and puts them into someone else. These healthy stem cells cause the bone marrow to make new cells that are not in the sickle shape. Many people do well after a BMT and experience significant improvement in their quality of life. However, there are risks associated with transplants. Discuss eligibility for transplant and associated risks and benefits with a transplant doctor.”.