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March 15, 2011
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A Guide to Women's Health: Fifty and forward
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Get your copy of A Guide to Women's Health: Fifty and forward

Midlife can be a woman’s halftime celebration. Not only can it be an opportunity to reflect on and rejoice in the life you’ve lived, but it is also a good time to plan your strategy for the future. This report will help you determine the conditions for which you are at greatest risk and do your best to avoid them. It will also help you to better manage chronic conditions that may erode your quality of life, and to deal with physical changes that are more bothersome than serious. It is designed to give you the information to make the choices today that will ensure you the best health possible tomorrow.

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Easing bedbug anxiety

It seems like there has been a recent lull in reports about bedbug infestations, which makes it tempting to assume that the problem itself is going away. Unfortunately, experts on these parasitic insects warn of a big resurgence coming in the summer of 2011. The good news is that there is plenty you can do to prevent them.

Bedbugs are showing up in residences of all kinds, including apartment buildings, dormitories, and hotels, as well as in offices, retail stores, schools, theaters, and public transportation. Explanations for the resurgence of Cimex lectularius include increased international travel, changing pest control practices, resistance to pesticides, and lack of knowledge about how to control them. “But these are just speculation,” says entomologist Dr. Richard Pollack. “The proper answer is, ‘We don’t know.’”

What we do know is that they’re back after a hiatus of nearly 50 years, and it’s putting people’s nerves on edge. No one likes the thought of bugs invading their homes and biting them (or their children) while they sleep. And the fear of getting or giving bedbugs can lead to problems with relationships, activities, and work. Worry over bedbugs also causes insomnia and may result in actions more harmful than the bugs themselves, including the misuse of pesticides and wasteful spending on dubious detection and eradication measures.

While it’s true that bedbug populations are on the rise, many reports of bedbugs are false, says Pollack, who runs a bug identification laboratory and consulting service called IdentifyUS. He says that fewer than half the specimens submitted to his laboratory as bedbugs turn out to be bedbugs. Most are common household bugs, such as carpet beetles, which are often found in bedrooms (and don’t bite). Still, we shouldn’t let our guard down, and the first step is to “know thy enemy.”

What are they?

Bedbugs are small, flightless insects (see photograph) that feed on the blood of (usually) sleeping people and animals. During the day, they hide in dark, protected places around beds, and their flat bodies allow them to squeeze into cracks and crevices in bed frames, headboards, and box springs and to tuck themselves along the seams of mattresses. They also hide behind baseboards, under wallpaper, beneath carpet edges, and amid clutter. Bedbugs tend to gather in cozy clusters of adults and nymphs, eggs, cast-off skin, and feces.

photo of adult bedbug

Photo courtesy Dr. Gary Alpert, Harold Arlan, and Richard Pollack

They feed for about five to 10 minutes, then return to their hiding places to digest the blood. When they excrete the remains of their blood meals, they leave dark reddish-black spots on sheets or the mattress. Bedbugs inject an anesthetic when they feed, so a bite is unlikely to be noticeable enough to wake you. When you detect bite marks, it’s hard to know if bedbugs are responsible, since their bites tend to resemble those of other insects, such as mosquitoes and fleas. (Sometimes the bites appear as a suspicious row of dots referred to as “breakfast, lunch, and dinner.”)

Not everyone reacts to bites (an allergic reaction to the bedbug’s saliva), but those who do may develop itchy, red welts that can become secondarily infected through scratching. Most bites don’t require treatment and will heal in a week. For severe reactions, treatments include antihistamines to suppress symptoms, topical steroid drugs such as hydrocortisone, and antibiotics (if a secondary infection develops).

While bedbugs are a nuisance and can be upsetting, they aren’t known to transmit disease (their biology is a little different from bloodsucking insects that do transmit disease).

Keeping them away

Bedbugs easily hitch rides in luggage, backpacks, briefcases, purses, clothing, and furniture. Here are some measures you can take to minimize the chance of bringing bedbugs into your home:

Travel precautions. When staying in a hotel, place your luggage on a table or luggage rack away from the bed and off the floor, or keep it in the bathroom. You may also want to bring along a large plastic trash bag to put your suitcase in. Don’t unpack your clothes into drawers. Check mattress seams for dots of bedbug feces; if possible, inspect the headboard, bed frame, and underside of the box springs for signs of infestation. If you find anything that concerns you, discuss it with the management. Keep bed linens off the floor. Upon returning home, unpack directly into the washing machine (placed on the “hot” setting), or run your clothes in a dryer for about 20 minutes. Dry cleaning also works. Inspect and vacuum your suitcase.

Protecting your home. Used furniture is one of the biggest sources of bedbugs. If you can’t resist a bargain, inspect it very carefully before bringing it home. When visiting others, hang your coat and purse on a hook or in a closet away from the bedroom. If you live in an apartment, plugging holes and cracks in walls and around pipes, baseboards, and moldings may stop bedbugs (and other pests) from invading from adjacent apartments. Place your mattress and box springs in protective mattress and box spring encasements, which eliminate bedbugs’ access to their favorite hiding places. Encasements are widely available in bedding stores and on the Internet.

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Lose Weight and Keep it Off
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Get your copy of Lose Weight and Keep it Off

Successful weight loss depends largely on becoming more aware of your behaviors and starting to change them. Rather than willpower, this process demands skill power, which is good news because you can learn new skills. This report offers a range of solutions that have worked for many people and can be tailored to your specific needs. Take this challenge seriously, though, because overweight and obesity can lead to serious medical problems.

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What do you know about the HCG diet?

Q. I’ve been trying to lose weight for a long time and nothing seems to work. What do you know about the HCG diet?

A. The HCG diet is a weight-loss plan that combines daily injections of human chorionic gonadotropin (HCG) with severe calorie restriction — only 500 calories per day. HCG is a hormone that’s released in large quantities during pregnancy and can be extracted from the urine of pregnant women. It was first promoted as a weight-loss aid in the 1950s by British physician Dr. Albert T. Simeons, who claimed that the HCG regimen caused the body to preferentially burn stored fat, especially fat from the stomach, hips, and thighs. He also said that HCG dieters would lose more fat than muscle and would not be as hungry or irritable as you might expect. In 1954, Simeons reported that he had treated 500 patients and found that those who followed the HCG weight-loss plan for 40 days lost 20 to 30 pounds without feeling weak or excessively hungry.

Since then, the HCG diet has been studied in randomized trials that have included control groups receiving a placebo (saline) injection instead of HCG. In almost every case, researchers found that any weight loss was entirely due to the low-calorie diet. A meta-analysis (combined analysis) of 24 studies published in 1995 concluded that there is no scientific evidence that HCG causes weight loss, redistributes fat, reduces hunger, or creates a feeling of well-being.

The FDA has stated that HCG is of no benefit in the treatment of obesity. Nevertheless, the HCG diet has been getting attention in the popular press and Internet blogs. In part, that’s because HCG is now available in a sublingual form, meaning that it can be taken as a lozenge placed under the tongue — far more convenient than an injection. The sublingual form has not been tested in clinical trials.

I do not recommend the HCG diet. The calorie intake is too low to provide adequate nutrition, and scientific studies have shown that HCG does nothing to enhance weight loss or improve the way you feel. There are also a few reports of adverse effects — at least from the HCG injections — including blood clots, headaches, restlessness, depression, and dizziness. Finally, this diet does nothing to change the habits that lead to weight gain, and there’s no evidence that it results in sustainable weight loss.

— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch