Monday, January 31, 2011

How to Use Pills to Prevent HIV

CDC: HIV Prevention Pills Only for Men Having Sex With Men

By Daniel J. DeNoon
WebMD Health News


Reviewed by Laura J. Martin, MD


Jan. 27, 2011 -- The CDC has issued early recommendations for the use of AIDS drugs to prevent HIV infection of men who have high-risk sex with men.


The preliminary guidelines follow last November's groundbreaking report that daily use of the AIDS drug Truvada lowers men's risk of HIV infection. This strategy, called pre-exposure prophylaxis or PrEP, can cut HIV risk by as much as 92% in men who take the pill every day.


But there's a catch. Several catches. For example:

Truvada has to be taken every day, not just prior to sex.Truvada, like all HIV drugs, has side effects.Drug-resistant virus develops in men who begin PrEP when already infected with HIV.PrEP does not prevent other dangerous sexually transmitted diseases.Truvada is expensive. Since PrEP is not an FDA-approved use of the drug, insurance may not cover the cost.

U.S. public health agencies are developing PrEP guidelines. But since the news is out -- and men already are asking their doctors whether PrEP is right for them -- the CDC today issued preliminary guidelines.


Since PrEP was tested only in men (and male-to-female transgendered women), PrEP should be given only to biological males. Men eligible for PrEP should be at high risk of HIV infection -- that is, they should frequently change sexual partners or have concurrent partners in a region with high HIV prevalence.


Here's the CDC's basic advice:

PrEP should be offered only to HIV-negative men at high risk of HIV infection.PrEP should be just one part of a comprehensive prevention plan.PrEP must include regular HIV testing.Providers offering PrEP must regularly monitor patient adherence, drug side effects, and HIV risk behaviors.The only PrEP drug regimen tested is once-daily Truvada; other anti-HIV drugs should not be substituted.

Before starting PrEP:

Test for HIV, including a sensitive test for recent infection if there are any symptoms of acute HIV infection.Check for normal kidney function.Test for hepatitis B infection.Test for sexually transmitted diseases.

When starting PrEP:

Take one Truvada tablet every day.Providers should prescribe no more than a 90-day supply, renewable only when HIV testing is negative.Providers should offer counseling on reducing HIV risk behavior and on Truvada adherence.Providers should offer condoms.

During PrEP:

HIV testing should be done every two to three months.Test regularly for sexually transmitted diseases.Providers should perform regular lab tests to evaluate Truvada side effects.

When PrEP is discontinued:

Test for HIV.If HIV test is positive, evaluate whether virus is drug-resistant.If HIV test is negative, men should be referred to appropriate HIV prevention services.

The CDC's full preliminary PrEP guidelines appear in the Jan. 28 issue of Morbidity and Mortality Weekly Report.

SOURCE: Morbidity and Mortality Weekly Report, Jan. 28, 2011; vol 60: pp 65-68.


©2011 WebMD, LLC. All Rights Reserved.



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Sunday, January 30, 2011

How to break bad habits

To stop yourself from gossiping, focus your conversations on sharing your experiences or rehashing current events.Plan short-and long-term goals and reward yourself when you reach themList the advantages and disadvantages of keeping -- or changing -- your habitDon't beat yourself up if you fall back into your old ways

(RealSimple.com) -- Middle-School flashback: You're slouched in your chair, biting your nails and yakking to Susan about Katie -- that is, until Mrs. Anderson yells, "Girls!"


Fast-forward to last night: You're slouched at your kitchen counter, frowning at your chewed cuticles and yakking on your cell phone to Susan about Katie. Where's Mrs. Anderson now?


Bad habits afflict us all. But whether your particular fixation is merely annoying, wastes time or could actually hurt someone (like poor, long-suffering Katie), there are tricks and techniques to nip it in the bud. Of course, serious habitual behaviors might require years -- and even some bona fide therapy sessions -- to break.


But psychiatrists, psychologists, and cognitive therapists agree that recognition is the first step. So you're already on the road to recovery and a lifetime of good posture, manicures and trusting friendships.


RealSimple.com: 5 things worth admitting to


The habit: fidgeting


Why you do it: You have excess energy, perhaps from the surge in adrenaline caused by consuming too much caffeine or sugar, and it has to come out somehow. Just ask that pen you keep clicking.


How to stop: If you're a large-triple-mocha drinker, cut back. To control energy peaks and troughs, it's also important to get enough exercise and sleep. And try converting the movement of your hands and legs into isometric exercises: Put your hands in your lap and concentrate on gently pushing your palms together. For your legs, place both feet flat on the floor and then push down. Do these exercises until the need to fidget subsides.


The habit: smacking gum


Why you do it: It's another oral fixation that serves as a security blanket when you're nervous or anxious.


How to stop: The fastest and most effective solution? Switch to hard candy. But if you really don't want to give up gum, have a friend stop you every time she hears you doing it. Then keep smacking long enough to hear yourself and recognize what an irritating sound it is. You might be embarrassed enough to stop.


The habit: running late


Why you do it: The nice reason? You're a pleaser and an overdoer, packing too much in. Not so nice? Deep down, you may think your time is more important than the time of those waiting. Either way, you lack some essential time-management skills.


How to stop: When someone asks you to do something, don't accept right away. Say you'll get back to him, then decide whether you have the time. Also, figure out which tasks always seem to make you late. Maybe it's drying your hair in the morning: Time yourself to see how long it takes, then allot enough time in your routine.


Tricks: Set your watch five minutes fast and build in time for unexpected delays. And always call ahead if you're running late. Not only is it gracious but the shame of making repeated calls might also be the incentive you need to be punctual.


The habit: procrastination


Why you do it: It's a strategy for managing the anxiety of having to complete a task.


How to stop: Recognize that when you procrastinate, others may think you don't care about the job, and that's worse than completing something less than perfectly. One trick to get you started: Make a check out to an organization you despise and give it to a friend to hold. If you don't finish the self-assigned task by a certain date, have her mail the check. If you make yourself accountable for the consequences, it will motivate you to wrap up the task.


The habit: slouching


Why you do it: You may have slouched when growing up because you were self-conscious or taller than others or developed breasts before your peers, and the posture stuck. Or you might just be tired.


How to top: Take dance lessons, Pilates, or yoga to strengthen the abdominals and upper-back muscles. A simple shoulder-shrug exercise -- think of touching your shoulders to your earlobes -- is an even easier way to combat slouching. Do 10 rotations forward and 10 rotations back, says Phil Haberstro, executive director of the National Association for Health and Fitness, in Buffalo. "This will raise consciousness of posture and help remind you to stand and sit tall," he says. "Regular physical activity helps combat the mental and physical fatigue that can contribute to slouching."


RealSimple.com: How to bounce back from a bad first impression


The habit: disorganization


Why you do it: You may be a visual processor. You like to be surrounded by a mess because it's stimulating -- and it reminds you to do your work. But it backfires, since you waste time searching for things.


How to stop: Separate papers into a pile you need to do and a pile you can think about doing. Use folders or boxes in different colors. "One of my clients has 12 clipboards hung up in her office: six for current projects and six for those she may get to later," says Lynn Cutts, a Colorado-based certified life coach. "She's still being visually stimulated, but her stuff is organized." Set up a system that works for you, and start with basic steps, like putting your keys in the same place every day.


The habit: name-dropping


Why you do it: You feel insignificant and want to be perceived as more special than others around you. You think people will be impressed with you if you're associated with a particular person. In addition to that, name-dropping can serve as a form of intimidation. "It's a kind of one-upmanship," says life Cutts.


How to stop: Listen to yourself! Would you want to stick around and hear all this? Remind yourself that you don't need to resort to mentioning names as a way of increasing your value.


If you can't resist dropping a name or two, do so in a non-self-promoting way or with humor. Do it to share information, as opposed to putting someone down or making yourself look more important. And make sure to tell the full story, even if it's "Oh, I passed Harrison Ford on the street. He didn't actually speak to me, but he did glance in my direction."


The habit: nail biting


Why you do it: You use it to derive comfort and relieve stress. "Nail biting could be the adult version of thumb sucking," says Alan Strathman, associate professor of social psychology at the University of Missouri, Columbia.


How to stop: First, note when you bite your nails, and then substitute another action. Keep a stress ball on your desk, or even play with Silly Putty the next time your fingers start tickling your teeth. You can also try wearing synthetic nails or painting your natural nails with a polish that has a foul taste. Or get a manicure. You'll look good, and after paying for the service, you'll think twice about ruining the results.


The habit: whining


Why you do it: You don't feel confident that you have the power to request something. As a kid, you probably whined when you didn't get what you wanted, and it paid off -- then.


How to stop: As an adult, you're in for a big surprise if you think you'll get the same results. If your husband or friends say you're a whiner, take note. Simply state what you want by making a direct request. For example, instead of ruining an evening out by complaining that you got stuck at a table next to the kitchen, politely ask the waiter to reseat you.


Remember: Most people will develop a resistance to whiners. "We rebel against the behavior because we recognize that giving in will only reinforce it," says Strathman.


RealSimple.com: Weird symptoms, explained


The habit: gossiping


Why you do it: You try to take the focus off your flaws by exposing those of others. But a person who gossips by habit doesn't truly believe she's good enough on her own.


How to stop: Focus your conversation on sharing your experiences, such as discovering a new restaurant or your latest vacation. Brush up on current events, music, or sports. This will give you something else to discuss besides other people.


Plus, you never know who is listening in on your conversation. If you're complaining about your coworker, be aware that her best friend might be the woman directly behind you on the train. Keep in mind that gossiping makes you seem untrustworthy. You may even lose friends and professional contacts when people realize you're a gossip.


The habit: perfectionism


Why you do it: Mom and Dad, who were probably perfectionists, had high expectations. ("Only a B, Mary?") You define yourself by what you do, yet nothing gets done.


How to stop: Train yourself to care less. Deliberately do a poor job when performing a small chore -- one that has no professional or personal impact, like doing the dishes or making the bed. "You'll see the consequences aren't so dire," says Cutts. Set time limits for tasks, and use an alarm. There will be no room in the schedule for that "one more thing" to make it perfect.


Finally, just for fun, do something at which you don't excel. If you're a shower diva (but know you're no Streisand), try singing lessons. Or play a weekend sport with a team that judiciously ignores the score.


Five steps for changing any bad habit


These tips come courtesy of Cherry Pedrick, coauthor of "The Habit Change Workbook" ($16, amazon.com).


• Know when your habit shows up. Identify habit-prone situations. Record how often and where it presents itself.


• Know the consequences. List the advantages and disadvantages of keeping -- or changing -- your habit.


• Know an alternative behavior. Develop a competing response that you can employ instead of falling back on your habit.


• Know your goals. Make a plan with short-and long-term goals, and reward yourself when you reach them.

• Know you're human. Don't beat yourself up if you fall back into your old ways. This is a natural part of change.

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Copyright © 2010 Time Inc. All rights reserved.


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How to crack Asian business culture

Learn the local rules of business first and more practical advice on expanding your company's footprint in China, Japan and South Korea.


By Katherine Ryder, contributor


The future may well lie with the United States, as President Obama reiterated during his State of the Union speech earlier this week, but that doesn't change the fact that many U.S. executives are still grappling with how to do business with an empowered Asia.


Maxims about how to succeed in Asia are everywhere -- but judging by the high failure rate of U.S. companies in Asia, there is clearly more to the game than delivering your business card with two hands. Now U.S. and European business schools are seizing on the demand for good information about Asia, putting greater emphasis on educating future executives about Asian business culture.


Michael Witt, a professor of Asian business and comparative management at the Singapore campus of INSEAD business school, and an Associate in Research at Harvard's Reischauer Institute, is at the forefront of an emerging field called "Comparative Business Systems." Witt doesn't focus solely on macroeconomic trends, but rather teaches MBA and EMBA students how to capitalize on opportunities by understanding the differences between workforces in different Asian markets.


And the differences, he says, are stark. "Everyone is playing ball," Witt says, "but they're playing very different games."


It all comes down to understanding how people think. "Culture is not how you pick up the chopsticks," says Witt. "It's how you make sense of the world." In other words, the ways in which people interpret facts have a huge impact on how decisions are made and how businesses are run. One way to evaluate culture is to consider how business leaders view the role of the firm in their economy.


In Witt's latest research, he asked senior executives in both the U.S. and Asian countries why their firms exist. Most Americans answered quickly that firms exist to "create shareholder value" -- a mantra in the U.S. business world at least since the early 1980s. But across Asian countries, Witt found, the answer to this simple question varies widely. How top management in China understand their world, for instance, differs starkly from the views of their counterparts in Japan. "When firms partner with each other, they are thinking about what the other side wants," says Witt. "We're adding a key piece of information: it depends on the country."


China

Private firms in China exist to provide shareholder value -- like their U.S. counterparts -- but only for people at the very top. The function of the firm in the private sector in China is mainly about generating family wealth. Most of China's new class of millionaires comes from profitable family-owned businesses. Thus, the idea of most of these businesses is to squeeze as much as possible out of the workers for the benefit of the owner, which is why many large Chinese companies are governed more hierarchically than their Western counterparts.


What foreign firms need to think about carefully when buying or partnering with a private Chinese firm is whether highly valued products are being created. "If you're thinking about taking over a Chinese company," says Witt, "you need to think about what you're really acquiring once the family is out of there."


Executives in state-owned enterprises, which are ubiquitous in China, have their own set of rules and incentives. These firms are considered the strategic tools of the state, and managers often view their positions as steps in their career within the communist party. The overriding objective for many of these managers, Witt says, is to supply resources and compete in global markets in order to propel the country's economic reemergence.


International competitors operating in China should know that they won't be operating on a level playing field, says Witt. Additionally, the dynamics for starting a business in China are completely different from what Western business people might expect. A company might not make quality products, but state assistance helps them in all sorts of ways.


One risk of partnering with Chinese firms, Witt says, is that they might attempt "to find out how you do it and take your business from you in the long-term." Danone's (GDPNF) foray into China ended in 2009 after its partnership with the multi-billion dollar beverage company Wahaha dissolved into an ongoing public brawl, with Danone accusing Wahaha of operating parallel businesses selling virtually identical products.


General Motors (GM), by contrast, has fared quite well in China. The firm is the first carmaker to sell more than two million cars in China and its success is due largely to local partnerships. The company just signed another deal with its Chinese partner, SAIC, to work together to crack India's market. As the once-struggling carmaker knows very well, despite the rocky experiences of some Western firms, the most dangerous thing about dealing with China can be refusing to deal with it at all.


Japan

Like in China, the purpose of the Japanese firm is not solely to maximize shareholder value -- but Japanese firms commonly assume a more family-like focus and strive first and foremost to take care of their employees. This is often a major constraint for foreign firms considering operations in Japan -- given the labor practices often don't mesh well with those of Western counterparts. Many Japanese firms entering a merger insist on retaining their entire workforce as a condition of sale. Companies think of themselves as serving society. "I interviewed someone who said, 'The first thing we need to wonder about is why does society permit our company to exist?'" says Witt.


This focus often translates to weak shareholder rights. Japanese firms provide benefits to employees like stable employment and a good livelihood, but this practice can be a major deterrent for foreign firms. "If you acquire a Japanese firm," says Witt, "you'll find it to be extremely resilient to any changes you would introduce." Firms will make decisions in order to avoid mass layoffs, he says, since questions about staffing levels are built around the assumption that employees will stay with a company for life.


This distinct corporate culture stems from the fact that many of Japan's firms, like Mitsui, trace their existence back hundreds of years. "For a manager, the most important thing is not to improve the business during one's time," remarked one of the executives Witt interviewed in his research. "Rather, I think it is extremely important that when one passes things on to the next manager, to what extent the firm is one whose shape is accepted by society and that one can ensure the permanence of the firm."


Although Japanese firms may enjoy an acceptable return on sales -- and some, like Honda (HMC), Canon (CAJ), and Toyota (TM), may rise to global prominence -- Western business people commonly find themselves surprised by the assumptions of Japanese executives.


South Korea

South Korea, according to a number of corporate executives, resembles Europe more closely than it resembles either Japan or China. The South Korean executive's primary rationale for the existence of corporations is the generation of profit, says Witt. Yet very much like China, the East Asian country boasts its own graveyard of Western companies who have tried to enter the market and failed.


Any Western executive considering work in South Korea should know first and foremost that South Korean labor unions are some of the fiercest in Asia. "When the unions are on strike, it's basically war," says Witt. In 2009, the World Economic Forum cited the difficulty of hiring and firing employees as the reason that Korea dropped so dramatically in its business competitiveness rankings.


Both Carrefour and Wal-Mart (WMT) were unable to strike a balance with union demands and left South Korea in 2006. The top management of both firms hailed either from France or the U.S., and industry-watchers say neither company successfully built a trusting relationship with Korea's unions.


The main thing to understand about a South Korean firm, Witt says, is that it has an eye towards its three major stakeholders -- employees, shareholders, and society. (Samsung's former motto, for instance, is: "We do business for the sake of nation building.") If a foreign firm isn't able to strike a balance and please all three stakeholders, then doing business in South Korea can be extremely difficult.


Also on Fortune.com:


Japan downgrade: The beginning of the end?


A harsh light on Apple's supply chain


The strong case for global optimism


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