Monday, September 23, 2019

Power training provides special benefits for muscles and function

Quality preparing is a prevalent term for activities that construct muscle by outfitting obstruction against a contradicting power. Quality preparing is now and again called obstruction preparing, dynamic opposition preparing, or weight preparing. The opposition can emerge out of your body, or from free loads, elasticized groups, or concentrated machines. Regardless of what sort of opposition you use, putting more than the typical measure of burden on your muscles makes them more grounded. Since the muscles being practiced are appended to basic bone, these activities reinforce bones too.

Quality preparing isn't only for those looking for buff bodies or built up muscles. It likewise supports the quality required for day by day undertakings. Pretty much any action ends up simpler with more grounded muscles. So does any game you appreciate.

Another kind of preparing, known as power preparing, is demonstrating to be similarly as significant as quality preparing in keeping up or reestablishing capacity. As the name recommends, control preparing is planned for expanding power, which is the result of both quality and speed. Ideal power reflects how rapidly you can apply power to deliver the ideal development. Here's a model: Faced with a four-path convergence, you may have enough solidarity to stroll over the road. Be that as it may, it's capacity, not simply quality, that can get you over each of the four paths of traffic before the light changes. In like manner, power can counteract falls by helping you respond quickly on the off chance that you begin to trip or lose your equalization.

Some power moves are quality preparing activities done at a quicker speed. Others depend on the utilization of a weighted vest, which is worn while playing out specific activities that are ordinarily planned for improving capacities, for example, bowing, coming to, lifting, and ascending from a situated position.

As we age, muscle power ebbs much more quickly than quality does. So practices that can deliver gains in power become particularly significant further down the road. That is the reason a few examiners in the field of physical medication are presently consolidating the quick or high-speed moves of intensity preparing with increasingly purposeful and moderate quality preparing activities to receive the rewards of the two exercises.

Placing it into training:

Here are three of the three dozen activities exhibited in Strength and Power Training, a Special Health Report from Harvard Medical School, for which I was the staff manager. They should be possible at home or out and about, and require no exceptional gear.

Seat stand

Activities the muscles of the guts, hips, front thighs, and buttocksChair stand

Position a seat with the goal that its back is leaning against a divider. Spot a little cushion upstanding at the back of the seat. Sit at the front of the seat, knees twisted, feet level on the floor and somewhat separated. Recline on the pad in a half-leaning back situation with your arms crossed and your hands on your shoulders. Keeping your back and bears straight, raise your chest area forward until you are sitting upstanding. Stand up gradually, utilizing your hands as meager as could reasonably be expected. Gradually sit down. Go for eight to 12 redundancies. Rest for a moment or somewhere in the vicinity and rehash the set.

Power move: Change the move marginally for the last set by ascending from the seat rapidly. Plunk down again at an ordinary pace.


Activities the muscles of the back, back thighs, and rear end


Lie on your back on a towel or tangle with your knees twisted and your feet level on the floor. Put your hands by your hips with palms level on the floor. Keep your back straight as you lift your rear end as high as you can off the tangle, utilizing your hands for parity as it were. Respite. Lower your rear end without contacting the tangle, at that point lift once more. Do eight to 12 reiterations. Rest and rehash the set.

Triceps plunge

Activities the muscles of the back upper arms, chest, and shoulders

Triceps dipPut a seat with armrests in a bad position. Sit in the seat and set up your feet together level on the floor. Lean forward a piece while keeping your shoulders and back straight. Twist your elbows and spot your hands on the armrests of the seat, so they are in accordance with your middle. Squeezing descending on your hands, attempt to lift yourself up a couple of crawls by fixing your arms. Raise your chest area and thighs, however keep your feet in contact with the floor. Delay. Gradually discharge until you're sitting down once more. Go for eight to 12 reiterations. Rest and rehash the set. Variety: If you don't have a seat with armrests, sit on the stairs. Put your palms down on the stair over the one you are situated on. Press descending on the impact points of your hands, lifting your body a couple of crawls as you fix your arms. Interruption. Gradually discharge your body until you are sitting down once more. Go for eight to 12 reiterations. Rest and rehash the set. The bombs that detonated on Monday close to the end goal of the Boston Marathon killed three individuals, physically harmed almost 200 others, and damaged thousands more. Recuperation and mending are starting for the groups of the individuals who passed on, for the harmed and their families, and for others moved by this disaster. For a few, recuperating will be quick. For other people, it will be estimated in little strides over months, and conceivably years.

The Marathon blasts will leave a heritage of passionate scars alongside the physical ones, even among the individuals who weren't anyplace close to the impacts. Those near the blasts saw things people aren't intended to see—terribly harmed youngsters, broke bodies, cut off appendages. Others were damaged from a far distance, wiped out with stress over friends and family running in the Marathon or giving a shout out to sprinters close to the end goal. For a few, the blasts reignited the dread brought about by the September eleventh assaults.

The very idea of the Boston Marathon may likewise add to the passionate resonations of the assault. The Marathon has generally been a day of happiness and brotherhood. We commend the first class sprinters, and afterward root for a large number of common people attempting to accomplish something uncommon. The besieging transformed that into awfulness and anguish.

A few people who were at the area of the blasts will without a doubt create post-awful pressure issue (PTSD). In any case, PTSD isn't the main reaction to terrifying occasions. Truth be told, the vast majority presented to an injury don't build up this condition. They may build up an uneasiness issue, for instance, or become discouraged. A great many people do have some passionate reaction, yet the lion's share builds up no disease by any means.

PTSD can be activated by any horrendous experience that includes a noteworthy danger—or reality—of death, genuine damage, or harm to physical honesty. Or on the other hand by an occasion, similar to this one, that motivates exceptional dread, weakness, or loathsomeness. An individual may encounter the occasion legitimately, witness it, or be faced with it in some other manner.

For anybody moved by the Boston Marathon besieging, it's valuable to know a little about PTSD. Regardless of whether it is PTSD or not, the sooner manifestations are faced, the simpler it is to beaten them.

PTSD characterized

PTSD by and large causes three sorts of side effects:

Hyperarousal. People with PTSD become touchy, effectively alarmed, and continually on gatekeeper. They rest inadequately and experience issues concentrating.

Re-encountering or interruption. The horrendous mishap automatically springs up in the psyche as striking recollections, bad dreams, or flashbacks. An individual with PTSD may feel or go about as if the awful accident is going on once more. Any article, circumstance, or feeling that helps the individual to remember the injury can cause exceptional misery.

Shirking and enthusiastic desensitizing. People with PTSD attempt to maintain a strategic distance from emotions, considerations, people, spots, and circumstances that summon recollections of the injury. They lose enthusiasm for their standard exercises. They feel irritated from other individuals and even from their own emotions.

An emotional well-being proficient ought to have the option to audit side effects to help make a judgment whether PTSD is the focal issue. The determination is, much of the time, less significant than concentrating on indications that either undermine a feeling of prosperity or are hindrances to continuing ahead with life.

Adapting to PTSD

Treating PTSD can be testing. Some portion of the procedure includes standing up to the excruciating memory, which a great many people would want to maintain a strategic distance from. However, pushing endlessly the memory may just exacerbate the situation. It can develop when you are under pressure or let down your gatekeeper. The psychological and passionate vitality spent keeping away from the memory can hurt connections and the capacity to work.

No accord exists about how best to treat PTSD. Different types of talk treatment can help, and meds are in some cases utilized.

Subjective conduct treatment. This involves cautiously and continuously "uncovering" yourself, ordinarily with the assistance of an advisor, to contemplations, emotions, and circumstances that help you to remember the injury. The reason for the introduction is to help an individual working better. It is commonly not a smart thought to just fortify recollections, since that can strengthen the injury. Rather, psychological social treatment for PTSD includes distinguishing annoying musings about the awful mishap, particularly those that are contorted or unreasonable, and supplanting them with more quiet or increasingly sensible considerations.

Family treatment. The impacts of PTSD frequently overflow to relatives. Family treatment can help in a few different ways: it can give your friends and family a chance to comprehend what you are experiencing, it can improve correspondence, and it can chip away at relationship issues brought about by, or compounded by, PTSD.

Drug. Antidepressants, for example, fluoxetine (Prozac) or sertraline (Zoloft) can help with a portion of the indications of sorrow or tension on the off chance that they are available. In some cases different kinds of antianxiety prescriptions are advertised. It's critical to remember that while prescriptions can enable you to feel less discouraged or stressed, they don't effectively diminish the basic reason for PTSD—your recollections.


An interfaith administration held yesterday at the Cathedral of the Holy Cross in Boston intended to support the city and those exploited by the bombings start to mend. Speakers included Boston Mayor Thomas Menino, Massachusetts Governor Deval Patrick, President Barack Obama, and ministry from numerous Boston gatherings.

Meeting up, and discussing what we've encountered, is one approach to start the recuperating procedure. In the words Boston's Cardinal Sean O'Malley, we should be "joined in the determination not to be overwhelmed by abhorrence, yet to battle fiendish with great, cooperating to assemble an always simply, free and secure society for a long time into the future."
Read More »

Extra protein is a decent dietary choice, but don’t overdo it

It isn't each day that a powerful new treatment for some Parkinson's malady side effects tags along. Particularly one that is protected, causes no unfriendly symptoms, and may likewise profit the remainder of the body and the brain. That is the reason I perused with fervor and intrigue a report in the New England Journal of Medicine demonstrating that kendo may improve equalization and avoid falls among individuals with Parkinson's sickness.

This degenerative condition can cause many vexing issues. These range from tremors and firmness to an easing back or solidifying of development, rest issues, uneasiness, and that's just the beginning. Parkinson's malady may likewise upset parity, which can prompt startling and harming falls.

A group from the Oregon Research Institute selected 195 people with gentle to direct Parkinson's sickness. They were haphazardly doled out to twice-week after week sessions of either yoga, quality structure activities, or extending. Following a half year, the individuals who did yoga were more grounded and had much preferable parity over those in the other two gatherings. Truth be told, their parity was around multiple times superior to those in the obstruction preparing gathering and multiple times superior to those in the extending gathering. The judo bunch additionally had fundamentally less falls, and more slow paces of decrease in by and large engine control. Likewise, judo was protected, with little danger of Parkinson's sickness patients coming to hurt.

Other littler investigations have detailed that jujitsu can improve personal satisfaction for the two individuals with Parkinson's infection and their help accomplices.

These examinations are noteworthy on the grounds that they recommend that judo can be utilized as an extra to flow non-intrusive treatments and drugs to facilitate a portion of the key issues looked by individuals with Parkinson's ailment.

Into the center

Parkinson's sickness influences more than one million Americans. This cerebrum issue meddles with muscle control, prompting trembling; solidness and firmness of the arms, legs, neck, and trunk; loss of outward appearance; inconvenience gulping; and an assortment of different side effects, incorporate changes in memory and thinking abilities. These progressions can extraordinarily diminish the capacity to complete ordinary exercises and lessen personal satisfaction. Meds can help, however they some of the time have undesirable reactions.

Since the presence of the New England Journal of Medicine study, jujitsu classes explicitly for Parkinson's malady patients have jumped up the nation over, and the advantages of yoga for Parkinson's infection have been supported by the National Parkinson's Foundation. (You can see a video of a kendo class at Brigham and Women's Hospital for individuals with Parkinson's ailment at the base of this post.)

A few partners and I have built up a kendo program for individuals with Parkinson's sickness. It unites Harvard Medical School specialists and different clinicians with yoga specialists. The 12-week program utilizes the conventional yoga rules that I depict in my recently discharged book, The Harvard Medical School Guide to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart and Sharp Mind. This program is together supported by the Parkinson's Disease and Movement Disorders Center at Beth Israel Deaconess Medical Center and the Osher Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School. Up until now, around 50 individuals have finished the program.

We have likewise started a little, starter study over different Harvard Medical School clinics concentrated on understanding the collaborations between psychological capacity, portability, and engine work in beginning period Parkinson's illness. The thought is to look at how the mind-body association of kendo eases back the loss of portability and intellectual capacity in people as of late determined to have Parkinson's ailment. The consequences of this pilot study will be utilized to guide randomized preliminaries to further test the effect of yoga.

I predict a developing number of medical clinics in the nation creating comparative jujitsu programs for people with Parkinson's sickness. Notwithstanding facilitating parity issues, and perhaps different indications, yoga can help straightforwardness stress and uneasiness and fortify all pieces of the body, with scarcely any destructive reactions. I anticipate the day when proof based kendo projects become broadly accessible and utilized by people with Parkinson's sickness around the world. Diet-wise, I was great yesterday. I had a fried egg with salsa for breakfast; spinach plate of mixed greens with barbecued chicken for lunch; a bunch of almonds for a bite; a little bit of salmon, broccoli, and darker rice for supper; and natural product for treat.

I state "great" since I like to restrict my starches to one feast a day—supper, for this situation. It makes me feel superior to having carbs for the duration of the day. I'm not following a specific eating routine, yet simply attempting to eat in what I believe is a solid way. That implies having more protein-based suppers than carb-based dinners. It turns out I'm not the only one.

The International Food Information Council Foundation reports that half of customers are keen on incorporating more protein in their eating regimens and 37% accept protein assists with weight reduction. An examination in the May/June 2013 issue of the Journal of Nutrition Education and Behavior found that 43% of ladies reviewed are utilizing the act of eating more protein to forestall weight addition, and this system was related with weight reduction.

Be that as it may, on the grounds that individuals are accomplishing something doesn't make it sound. I asked Dr. Michelle Hauser, a clinical individual in drug at Harvard Medical School and a confirmed gourmet specialist and sustenance instructor, if it's a smart thought to eat additional protein and cut back on carbs.

"In case you're eating more protein yet you have a decent blend of new natural products, vegetables and entire grains to make up its remainder, that is fine," Dr. Hauser let me know. One of the upsides of eating more protein-rich sustenances is that individuals who do it additionally will in general wipe out excessively prepared starches, for example, white breads and prepackaged nourishments like treats and wafers. Such sustenances are quickly processed and transformed into glucose, and will in general be low in empowering supplements.

Yet, it isn't important to dispense with all starches and spotlight just on protein. Such an eating system may have a momentary result for weight reduction, yet it might likewise accompany some long haul dangers.

Getting protein

Protein is a basic piece of our eating regimen. We need it to construct and fix cells, and make solid muscles, organs, organs, and skin. Everybody needs a base sum every day. The Institute of Medicine prescribes 0.8 grams of protein per kilogram of body weight. For somebody who gauges 150 pounds, that implies 54 grams of protein for every day. Another rule is to ensure in any event 15% of your every day calories originate from protein.

By what means may more protein and less carbs in the eating regimen have any kind of effect for weight reduction or weight control? "Protein takes more vitality for you to process than refined sugars, and furthermore gives your body a sentiment of satiety," says Dr. Hauser. Low-carb diets have been appeared to enable a few people to shed pounds.

However, over the long haul, a lot of protein and too few starches may not be the most beneficial arrangement. This sort of eating example has been connected to an expanded danger of creating osteoporosis. That is on the grounds that processing protein discharges acids into the circulation system. The body kills these acids with calcium—which can be pulled from bone if fundamental. Eating an excess of protein likewise makes the kidneys work more earnestly. In sound individuals, this generally doesn't represent an issue. Yet, those with kidney illness or diabetes (which is related with kidney ailment) need to watch their day by day protein admission so they don't over-burden their kidneys.

Denying yourself of sugars can likewise influence the cerebrum and muscles, which need glucose (the fuel that originates from processing carbs) to work productively. The fiber conveyed by some starch rich sustenances help insides move. Also, recall that solid wellsprings of starches, for example, organic products, vegetables, and entire grains, accompany a large group of nutrients, minerals, and different supplements.

Settling on shrewd protein decisions

It's alright to decrease carbs and eat more protein, yet ensure you're likewise getting some carbs in your every day diet. "In the event that you take any solid eating regimen, 40% to 60% of calories should originate from natural carbs," says Dr. Hauser. For somebody on a 2,000 calorie-a-day diet, 40% would be 800 calories or 200 grams of carbs. (Note to self: increment servings of sugars.)

Yet, there are great carbs and awful carbs, just as great proteins and terrible proteins. Sustenances that convey entire, grungy carbs, similar to entire wheat, oats, quinoa, and such, exaggerate those made of exceptionally prepared wheat or different grains. Lean meats, poultry, fish, and plant wellsprings of protein like beans and nuts are unquestionably more energizing than greasy meats and prepared meats like wiener or shop meats.

The great awful thing can be befuddling, so Dr. Hauser recommends a couple of basic standards.

Pick the empowering trio. At every feast, incorporate sustenances that convey some fat, fiber, and protein. The fiber makes you feel full immediately, the protein causes you remain full for more, and the fat works with the hormones in your body to guide you to quit eating. Adding nuts to your eating routine is a decent method to keep up weight since it has each of the three.

Keep away from exceptionally prepared nourishments. The closer a sustenance is to the manner in which it began, the more it will take to process, the gentler impact it will have on glucose, and the more supplements it will contain.

Pick the most refreshing wellsprings of protein. Great protein-rich nourishments incorporate fish, poultry, eggs, beans, vegetables, nuts, tofu, and low-fat or non-fat dairy items.

These three procedures fit in with the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) eats less. The DASH diet incorporates 2 or less servings of protein every day, for the most part poultry or fish. "The Mediterranean eating routine uses protein from fish as a focal point of a supper, and different meats as all the more a part of a dinner," says Dr. Hauser.

I needed to inquire as to whether it's essential to spread carbs for the duration of the day or if it's alright to confine them to one feast, the manner in which I do. "In the event that it makes you feel better to eat carbs at one feast a day as opposed to spreading them for the duration of the day, that is fine. You can dissipate the carbs as you see fit," says Dr. Hauser.
Read More »

Thursday, September 5, 2019

Safe injection sites and reducing the stigma of addiction

It’s the end of the school year, the time of graduation speeches, of looking back at accomplishments and making plans for new ones. It’s a time when many parents think about their hopes and dreams for their children, whether they are graduating or just learning to walk.

As parents, we tend to think about getting good grades, excelling at athletics, being popular, getting into good schools, and getting good jobs. All of this is great, of course. But there is something that children need if they are going to truly succeed in life, and that’s resilience.

Resilience is the ability to overcome hardship and be okay. It’s the ability to navigate life’s inevitable bumps and still be happy and healthy and stay on track. What worries me sometimes is that our current parenting culture of achievement and obsessing over safety — and the way that electronic devices have become so ubiquitous — may get in the way of learning resilience.

According to Harvard University’s Center on the Developing Child, there are four factors that help children develop resilience. They are:

    Supportive adult-child relationships. This is crucial. All it really takes is one supportive, nurturing relationship to make all the difference. This gives children a buffer, and helps them know that they aren’t alone and that they matter to someone. While all parents want to have a good relationship with their child, the demands of daily life can get in the way. Try to spend regular time with your child when they have your undivided attention. Ask about their day, get involved in activities they enjoy, spend time doing things together. Make sure your child knows that no matter what, you have their back — and you will love them.
    A sense of self-efficacy and perceived control. Basically, you want to help a child learn that they can manage, and that even if things go wrong, they can figure a way through. You can’t do this just by telling your child that he is smart and capable; he needs to learn it himself. Bit by bit, giving independence, letting children make decisions and take risks helps them learn to weather life’s storms. It’s not always easy to let children take risks —we never want them to be hurt, emotionally or physically — but with you at their back, and in a gradual way, most children can and do manage just fine. Learning this also involves shutting off the screens and being active. Learning to be physically capable is important. In being active, in running and climbing and other such activities, children learn not just their strengths and limitations but how to plan and troubleshoot.
    Strong adaptive skills and self-regulatory capacities. This is what we call “executive function.” It’s like the air traffic controller functions of life: the ability to prioritize, not get distracted, make a plan, negotiate, get along with others, and manage emotions. These are not easy tasks, and there is no way to learn them without practice. One of the best ways for children to practice is through unstructured playtime, either alone (so they can find ways to entertain themselves) or with others (so they can learn how to work with others). Consistent discipline, not giving in to tantrums, and helping children manage sadness or frustration rather than just fixing things for them, can also help. The Center on the Developing child also has suggestions on activities to support executive function at different ages.
    Being able to mobilize sources of faith, hope, and cultural traditions. It helps to be part of something bigger, to have community, to have traditions that help you through difficult times. This doesn’t mean that you need to join a faith if you don’t belong to one. But if you do, maybe you could go to services a bit more often. If you don’t, spending time with extended family, joining a community group, taking part in service opportunities together… these activities can help give your child a perspective on life, as well as strategies for handling challenges. Because ultimately, the ability to keep perspective and handle challenges is what gets us through and helps us succeed.
When I was a kid, my summer sport of choice was baseball. Every day I played in marathon neighborhood games until it was too dark to see the ball. It was about fun and not fitness. But now that I’m older, and my Louisville Slugger has been officially retired, I need a summertime sport that recaptures the playfulness of my youth, but also works to keep my physical and mental skills sharp.

So, I picked up a racket.

It turns out that racket sports are not only fun, but they may help me live longer. A study published online by the British Journal of Sports Medicine examined the link between six different types of exercise and the risk of early death. Researched looked at racket sports, swimming, aerobics, cycling, running, and soccer. Study volunteers included 80,306 people, who ranged in age from 30 to 98. Over the course of the study’s nine years, those who regularly played racket sports were 47% less likely to die of any cause and 56% less likely to die of cardiovascular disease.

“In many ways, racket sports like tennis, squash, badminton, racquetball, Ping-Pong, and other variations are the ideal exercise for many older adults,” says Vijay A. Daryanani, a physical therapist and personal trainer with Harvard-affiliated Spaulding Outpatient Center. “Besides offering a good cardiovascular workout, they can help with both upper- and lower-body strength at one time. They can be played at any age, can be modified to fit most fitness levels, and do not involve a lot of equipment.”
Body and mind games

Racket sports offer something other fitness sports do not — lateral movement. “Most of our lives are spent moving forward, and that includes our exercise,” says Daryanani. “Racket sports force you to move both back and forth and side to side. This helps improve balance and weight shifting, which can lower your risk of falls.”

This kind of activity also exercises your mind. From a cognitive standpoint, it sharpens your planning and decision-making skills, as you must constantly anticipate and execute your next shot.

Racket sports also serve up a strong social component. You play against other people — either as a single or part of a doubles team — while other exercises like running, swimming, and cycling are more isolated activities. Frequent social contact is essential for a long and healthy life. In fact, a 2012 study in the Archives of Internal Medicine found that loneliness was associated with functional decline and an increased risk of death among adults older than age 60.
Pick up pickleball

While there are many types of racket sports to try, one of the fastest-growing among older adults is “pickleball.” It’s a hybrid sport that blends tennis, table tennis, and the backyard childhood game of Wiffle ball.

The paddle is between a table tennis paddle and a tennis racket in size and made of lightweight composite material, such as aluminum or graphite, which cuts down on fatigue. The plastic pickleball resembles a larger Wiffle ball and travels about one-third the speed of a tennis ball, so it is easier to see and hit.

Pickleball is played both indoors and outdoors. The court is 20 by 44 feet, or about the size of a double badminton court. The net is shorter than a tennis net, which makes it easier to hit over. Here are the basic rules:

    The ball is served underhanded and must land in the opposite diagonal court just beyond a 10-foot area by the net called the “kitchen.”
    The ball must bounce once before being returned, and again before being returned by the serving team.
    Once the ball has bounced and been returned by each team, volleying may continue with or without bounces, only if participants are outside of the kitchen.
    Games are played to 11 points, with points scored only by the serving team.
    A two-point spread wins the game.
The United States was declared free from ongoing measles transmission in 2000. So why are we still having measles attacks? An outbreak of measles is currently raging in Minnesota. In 2015, 125 cases of measles occurred in California, and in 2014, 383 people were infected with measles in an Amish community in Ohio.
How measles outbreaks happen

There are several reasons why we are still at risk for measles outbreaks. Travelers may get infected overseas, and bring the measles virus back into the country with them unawares. The 2015 measles outbreak in Ohio began when two infected members of the Amish community returned home from typhoon relief work on the Philippines. The California measles outbreak in 2014 started at two Disney theme parks, perhaps after the virus was brought there by a foreign tourist.

In measles, there is an unusually long delay between infection and the development of the rash and other symptoms, typically about two weeks. Measles virus is also highly contagious; patients start to spread the virus to other people about four days before the rash develops. These features make it possible for measles to spread quickly through an unsuspecting population.

The final component to measles outbreaks is inadequate immunity. Many American adults have only received a single dose of the measles, mumps, and rubella (MMR) vaccine, which is only 93% effective at preventing measles. Since 1989, the recommendation has been to give two doses of MMR, which is 97% protective against measles. Vaccination rates have been low among patients in recent US outbreaks. In the current outbreak in Minnesota, most measles cases have occurred in unvaccinated Somali-American children, probably due to the success of anti-vaccine activists in pushing a debunked connection between autism and the MMR vaccine.
Measles infection can still be lethal

So, what’s the big deal about measles? For most people, measles makes for a miserable week of high fever, cough, runny nose, watery eyes, and an impressive total body rash. But for others, it can be a life-threatening, even fatal, condition. One out of every 20 measles patients develops pneumonia, which may be severe. Infection of the brain, or encephalitis, occurs in one out of 1,000 cases. Brain damage, deafness, intellectual disability, or death may result. Before the measles vaccine was available, measles killed 500 people in the US every year, most of them children, and led to 1,000 cases of brain damage per year.

Measles has an especially horrifying late complication known as subacute sclerosing panencephalitis (SSPE). In SSPE, children recover from their initial measles infection, only to develop progressive brain infection with a mutated form of measles virus in their teenage years, leading to a persistent vegetative state.

Many outbreaks of measles could probably be prevented if more travelers received MMR prior to foreign travel. According to a study done in US travel clinics, 16% of pre-travel patients were eligible for measles vaccine, but only a minority of patients received it. The authors of the study cited many reasons that patients didn’t receive the vaccine, with patient refusal being the most common. Next time you plan to travel overseas, think about protecting your community by asking your doctor if you are a candidate for the MMR vaccine before you leave. Imagine a chronic medical condition in which the treatment itself has serious side effects. Examples of this are plentiful in medicine. For example, in diabetes, giving too much insulin can cause hypoglycemia (low blood sugar), a dangerous and potentially life-threatening condition. That doesn’t happen very often, but imagine that it was a common complication of treating diabetes because doctors couldn’t really tell how powerful a given dose of insulin actually was. And suppose that doctors and patient safety experts advocated for places where patients with diabetes could be carefully monitored when taking their insulin. Would you be opposed to this idea? Would you blame the patient for developing diabetes, or for needing this carefully supervised medical treatment in order to live? I suspect that the answer is “of course not!”

Now, let’s shift gears and discuss opioid addiction, specifically people who use illicit drugs like heroin and black-market fentanyl. Heroin is the strong opioid substance derived from the poppy seed that has been used for thousands of years. Fentanyl is a synthetic opioid that can be hundreds of times more powerful than morphine or heroin. Increasingly, illicit heroin is adulterated with fentanyl and similar chemicals, which public health experts believe is the reason for the continued rise in opioid-related deaths despite aggressive measures to decrease opioid prescriptions, increase substance use disorder treatment facilities, and widely distribute naloxone, the antidote to opioid overdose.
Saving lives in the face of increased risk for dying of a heroin overdose

People who use heroin are now at significant risk for overdose death, mainly because the opioid content can vary considerably from dose to dose. Previously, a little too much could have caused a decrease in respiratory rate and a high dose could lead to overdose. Now, with the variability of potency from the synthetic opioids, the strength of each dose can be markedly different. Furthermore, the uptake of fentanyl in the brain is so rapid that a fatal overdose can occur much more quickly than with heroin alone.

If we, as a society, are truly serious about saving lives, we have no choice but to allow people who use injectable opioids to do so in safe, monitored locations without fear of negative repercussions (e.g., being arrested). If you had asked me about this several years ago, I never would have believed that I could write the preceding sentence. I would have said, “Why empower junkies to abuse illegal drugs? Why make it easier on them instead of harder? Why should society condone this activity?”

However, I was wrong — dead wrong.
Good reasons for a change of heart

It turns out that addiction (called substance use disorder or, more specifically here, opioid use disorder in medical jargon) is a disease that can affect any one of us, just like diabetes or high blood pressure. It does not discriminate and does not represent a moral failure on the part of the individual who develops it. It is a condition that no one chooses, but when it attacks, it changes the brain of those with the disease. We can actually visualize those changes with tests like functional MRIs. It leads people to make choices that destroy their lives and the lives of others, such as loss of job, isolation and loss of relationships, incarceration, and even death. We also now know that this is a treatable disease, but the window for successful treatment depends on the psychological state of the person. We must be ready to engage them in treatment at that moment when they are ready.

My opinions changed drastically after a visit to a local needle exchange facility. By current law, individuals can’t inject inside the building. They have to take their chances outside and then they can come inside to be monitored after injecting. I initially envisioned the facility to be sterile, dirty, and depressing. Instead, I was surprised to see that it looked like a living room. There were sofas and a television. There was a warm light, and it appeared to be a welcoming place. Across from the sofas were two desks where staff members sat. Their job is to watch for any signs of overdose (a person who is too sleepy or who is breathing too slowly) and then rapidly respond by providing a nasal dose of naloxone to reverse the overdose. More importantly, they are there to help people right when they are open to treatment for substance use disorder. The staff will help connect them to treatment resources, whether it is group therapy or medical treatment like buprenorphine (Suboxone) or methadone.

If that moment of opportunity in which the individual is receptive to treatment passes, the consequences can be deadly.

Furthermore, the facility is all about harm reduction. There are boxes of free supplies: needle kits so that people do not share needles, condoms for safe sex, kits to help treat small skin infections, even little clean cups to freebase injectable drugs. Naloxone kits are also provided free of charge. There is no judgment there. It is only about reducing a person’s risk of serious, life-threatening infections like HIV and hepatitis C, or the risk of death. And it makes sense. If we are going to agree that opioid use disorder is just another medical condition that needs to be treated, then the compassionate thing to do is to remove the stigma associated with it and reduce associated harms while a person is suffering with substance use disorder. Plain and simple: people with this disease are going to use drugs. Is it better for them to use in the shadows, risking transmission of serious infectious diseases, or monitor them when they are using and be there for them to get them treatment at the moment they are ready?

Currently it’s still illegal in the US to allow people to inject in these supervised environments, but the tide is turning. The city of Ithaca, NY is contemplating a safe injection space, as is Seattle. Multiple studies have confirmed that they work. In Vancouver, Canada, where such facilities were implemented in 2003, they concluded: “Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts.” Massachusetts is also contemplating a similar pilot supervised injection facility program. With the crises of the opioid epidemic now claiming more than 30,000 lives every year in the US, it’s time to change our biases and old ways of thinking — people’s lives depend on it.
Read More »

Mistakes First Year Med Students Make

hi friends welcome back to my cannot afford it I’m very good and one yes very good really good I knew there had to back to school then Tony will be will be configured as Mina Mina karma upon the Llama Llama Llama Scala then you go to school year she did you being on time I have a supportive husband on skincare and hairstyle you go find you can do some low Mia

Mama mia Mia Mia here we have homo to scan and we can study tips work back the school video calling me during my afternoon evening Miss America tema hormone in Scala then Elijah okay but i’m i’m not opening moment but get an alien guy of legitimacy masking tape on the beta beta call. or to schedule a call a good omen did I see as opposed to the Marines Amelia are now after the classic classic at the pineapple and I can cancel at any idea yet somebody at the colon and with legendary and then some European lagi the material chop call Aggie class but just entering guru Dan Dan and getting up in the data can appear do my thing and we’ll be happy to rose calm all romantically Rachel I need a karma then based on yeah we can be smart about how we did it into movie star or a court of law Last then I think a lot more one on one with the ending earlier in like the recording a new law is anti money and he told me container indeed Yes What color are they Angela same topic Macedonia Carmela be there for my sophomore year then opposed to the Jericho some bill by Chuck D 10 o’clock oh by the end ammonium Ed McMahon Michelle I’m happy

Related Post: How to Study Maths Easily

Sherry study group Yamaha Dan and looking after your mo makan pleasure and my in my in Ghana study group me effective topic and a final comment ammonia can distract Denmark and mine cannibalize your mind to boy a puppy I have no foul odor cherry

pick sign up for a good practice empathy I just represent us Ito Magnus I know De De De De De De abstract

Among society and fit and I think but the idea is kept guru percent nine yeah Belinda boots I am in that 5% I think

that’s comics ledger Mira Loma Prieta Massey up in the room with me as a mom Why did he call it with them well I decided to do my job like Jeremy and other people like a Rama Rama saca de de ma ma journey the journey of karma podcast formatting or by then keep our data quality can be manipulated any major Columbia calendar abandoning and more six a pilot be focused pass Malaysia talent show by check playlist nice Lago de de de society disclaimer on the combo and what Nigeria

What I did real simple simple dialogue Jenny we assign any Appomattox Coca Cola coca Coca Cola God throws up America chapter near you do chapter chapter

by chapter and you doing our partners point point the ball about the underlying it to a park yes injury Kira Kira but he bought a chapter equal picking up I didn’t

change karma power pose central overwhelmed by burner topic near and lm chapter chapter on daily mouse through and supplying a band before mosquito lock them up I you see a housekeeper have Mindy chapter any color you review the batch of Boko Haram happens to be your last penny Tom and Jerry caliber champion thing is an awesome day and so I and we are and until I began my journey the P and you can tell me for some reason

Limited put muscle they’ve signed your theology or jam we have fall it is there a setting moment? The only know what I’m going to go on? Kellyanne, could you tell me do you have five being the end then chatter on my calendar Cameroon current show by the last topic he told me he said my device in public opinion by science nearly got my next book but the current topic here

for otter ketone esters new hires have fall but boxes why or external gamma gamma gamma can be strikes on my hand on getting Jojo Hidden Hand for Derek Charlie Popeye and formula by Jeremy Santa Clara Santa Pancho can be found at our public ledger, not collecting any pocket. Raise your hand for me to do here Airplane Mode column salsify and go with challah difficulty. Not difficult to welcome Mr. Kalyan my

America can you put your focus the match match and then promos topic area yellow be effective it okay Petro Canada in Toronto at our calendar invite

you into look Thank you Patricia Kim JD better and also nickel game plan you can see coffee or tea and coffee very adept

Kalyan Barbara popular Cassie

Malaysia I guess yeah Miss Apple shares Mongo Mongo vile suka Joe Papp like like that subscription our post playing a video Pennsylvania so you can make up calm and subscribe Captain idea makeup my other JD automatic channel me then yeah my shareable among law social media Facebook Twitter Don’t be greedy share your knowledge with everyone and I’ll see you guys next tips byeWhat’s up friends welcome to another video to MD journey where my job is to teach you how to succeed in med school, but less time and this video we’re going to talk to all the first year medical students as well as soon to be med students on a what not to do when you first start med school.

And if you want to these medical students that are making these mistakes, like stop like yesterday, please for your sake, but I’m going to talk to you and the most common mistakes that students make six in particular that med students including myself made and it kind of ruins your medical experience because you carry these bad habits throughout. So yeah. Q intro

so six mistakes that first year medical students make now honestly, there’s more than six, but these are the most common, honestly, the most detrimental. So Mistake number one students come in with our predetermine mindset. Now this won’t be every single student but you’ll know who the students are because day one

See: The Biggest Teaching Mistake

They’ll start saying that they want to become a dermatologist, orthopedic surgeon slashed astronauts slash radiologists. Now if you can manage to make those work all power to you, but it’s not about choosing competitive specialties are having high goals. The problem is, is when you have high goals, but then you use it as a crutch throughout your for you experience a why you can’t enjoy the rest of med school.

So these are the students who won’t come out on a Friday night or hang out with their friends and family on a weekend because they need to study or catch up. As I mentioned, they have high achieving goals, which is great and all of you should have those if you aspire to do one of these competitive specialties.

But as soon as you start making every little excuse you can find because all you want to get out of med school is becoming a dermatologist and orthopedic surgeon, a vascular surgeon, whatever you can think of.

That’s when medical school becomes more of a burden, then it becomes an experience. It’s great to have these high achieving goals but make sure you’re not using these goals and excuse of not enjoying other experiences with your classmates, your hobbies, your families and friends.

And one of the worst things that can happen is a third or fourth year. If you decide you don’t want to do that specific specialty, or you don’t want that goal anymore, you realize that you kind of wasted your first and second year on casing and being very narrow minded on this one goal and you use it as a crutch. So have high goals, I’m totally about that. But make sure that you’re also enjoying the experience. So the second mistake that most first year med students make is they don’t know how to study and this is because college creates very bad habits. All of you that are watching this video are very smart individuals. If you’re considering going into medicine, you have the grades you have the intellect, but sometimes we lean too much on our intelligence that we rely on cramming and passive methods. And when a new med student first starts to study in medical school, they’re split between active and passive learning is usually anywhere from 60 to 80% to 42 20%.

See also: How To Start A Digital Marketing Business In 2019

So that means that they’re spending a majority of their time reading, watching lectures, rewriting their notes, but these are not really methods

that are going to help them a long term retention. And just because of the mass volume that you have to learn in that school, they’re often not going to do well in their first couple exams, because they’re relying on the same techniques that they use in college, which helped them as an exam the next day when they started studying the night before, it doesn’t work in med school.

So instead, you have to flip that formula, and you have to spend the majority of your time doing active message. So I personally have already created two videos on how to study effectively in that school. The first one goes over a bunch of active techniques that you can use.

The second one is my personal method that I use to study very efficiently would not very many hours and I give you a very step by step method.

I’ll link both of those below in the description if you’re interested. So just remember that when you start setting in medical schools, spend the majority of your time doing active techniques.

So quizzing yourself, taking practice exams, flashcards, whatever that may be for you. That way you can retain as much info you’re focusing on your weak points as much as your strong points. You’re not doing passive technique assessed. It’s not going to work and that’s cool. So Mistake number three, and this is something

That I see my classmates still make today. And it’s a quote that I’ll give to you that I’ve kind of come through creating them the journey which is try to schedule med school into your life and not your life into med school. Unfortunately, the mistake that a lot of new med students make is that they’ll schedule their life into med school. Now, it’s a common notion that med school is kind of like having a full time job. It’s like an eight to five job. Unfortunately, a lot of new med students will try to work overtime. And so they’ll add additional hours to the end of the day, add additional hours to the beginning of their day. And eventually the whole life becomes just being a med student.

But then they have no time for their hobbies and times for their friends and families. And they really did lose a part of themselves. So something that I really recommend to do to avoid burnout to enjoy your for your experience and still progress and become a great med student is make sure that medicine is only a part of your life. So one thing that I plead people to do is making sure that their priorities before med school are still a big priority while they are meant to do

And a great way that I like to do this is that actually like to schedule my fun first. Now that’s usually opposite of what most med students will think they want to schedule their study time first, then find time for leisure. But if I can schedule a workout in and I can schedule and my TV shows, my video games, my lunch or dinner with families and friends, if I already know when I’m going to enjoy myself, then whatever time I’m not scheduled to do, those are times for me to study and study effectively.

So just make sure that just because you’re a med student, that you don’t lose that old part of your life that made you you afford the mistake that new MIT students make is they listen way too much to their classmates. Now, I love my classmates. But when it comes time for an exam or an important deadline, they’re often the last people I want to be around and I’m probably the last person they want to be around as well because we just stress each other out med students just feed off of each other stress and not in a good way.

So make sure that you take everything your classmates say with a grain of salt. Use your classmates as motivation they’re going to be the smart

Individuals that you’ll probably meet in your life thus far, they’re going to inspire you. They’re going to motivate you to work harder. But once they start shifting to their stress mode, you want to kind of step away and avoid contact at all costs. So for example, if you have your anatomy final coming up, your classmates really stressed and is this talking over and over about how stressed and behind they are on studying for that exam. You know, obviously, listen to them, give them support, but don’t let that stress freak you out.

So just make sure you take your classmates with a grain of salt, especially around stressful events, stressful deadlines. Now, the fifth mistake that new med students make is kind of similar to the last tip, but they were their stress on their sleeves.

So just the same way that we don’t want to be around stressful classmates all the time. Our classmates don’t want to be around a stressful version of us.

So also be very vigilant and be very cognizant of how we come across. It’s fine to use our friends and our classmates to cope with the stresses of med school because

A lot of people on the outside world you could say don’t really understand what the stresses of med school or like. So yes, you can use your classmates as a way to vent and cope. But don’t overdo it. You may think that first year is going to be the hardest thing you ever have to do in your life. But then you’re going to reach the second year med school and you’re going to reach the third year in the fourth year, and it’s going to continually get harder and more challenging. So use your classmates as your support but for their sake, and for your own health. Try not to wear your stress on your sleeve. And the last tip and mistake that new med students make and honestly even old veteran med students like myself make is that you talk about med school and medicine all the time. Going back to the third tip. Don’t forget your old life. So for med school,

you didn’t talk about med school with all your peers and your friends and your family hopefully did it so that same way you’re going to be around your classmates and your colleagues all the time. That’s gonna be very easy for med school to be the topic 99% of time, but when you can avoid it, try your best because then it makes it much easier to picture your life.

Being more than just being a med student, and if you can do that you can meet the challenges of med school head on. But as soon as your test your studying is over, you can go and enjoy the other aspects of your life. But if medicine is a part of your whole day, all of your conversations it can be very easy to reach burnout when you find a series of days and weeks that are much more stressful than the rest so try to have a good balance on your conversations people you hang out with and they’ll help you immensely and having a very stress minimal I’m not going to say stress free first year med school so those are my top tips for new med students on what things to avoid but if you have any questions at all about med school on how to study manager time stress a particular class just let me know comment below. You can also email me at the MD journey. com at gmail. com. I’ll also put that link in the description new videos coming out on a weekly basis. So go ahead and give this video like first and then
Read More »

The inconvenient truth of vaccine refusal of Health

There’s been a lot of back-and-forth recently about how much sleep we really need, with recent studies suggesting that some long-held notions about this may be outdated. For example, a recently published study challenged the widely held belief that adults need an average of eight hours of sleep a night to function well. The researchers found that members of pre-industrial societies, free of the technological distractions that often keep us up at night, tend to get an average of 5.7 to 7.1 hours of sleep per night (more on that in a bit).

However, while the actual amount of sleep required to function optimally may vary from person to person, it is still very clear that not getting enough sleep — whatever that “magic number” is for any specific individual — can have serious consequences. This is especially true in children and adolescents, whose developing brains are very sensitive to insufficient sleep.
Studying the effects of sleep deprivation in teens

This was borne out in a new study published in this month’s issue of Sleep. Researchers from Singapore compared two groups of high school students before, during, and after a week in which half were allotted nine hours sleep per night and the other half only five hours per night. Not only did the sleep-deprived kids exhibit impaired cognitive function, alertness, and mood during their week of five-hour nights as compared with their peers, but it took them more than two nights of “recovery sleep” to catch back up again.

One way of looking at this is that not only do you suffer the day after not getting enough sleep, but that the idea of skimping on sleep during the week with the plan to somehow “catch up” on the weekend isn’t a good one: it simply doesn’t work. Even after getting lots of sleep on the weekend, you’ll still be far away from where you could — and probably should — be as far as sharpness and mood go.
Setting up a great night’s sleep for your child

One way of helping kids get the sleep they need is by eliminating some of those things that tempt them into staying awake. There is a lot of evidence that kids with televisions in their bedrooms, for example, not only sleep less but also have poorer-quality sleep. (Increased screen time is also associated with higher rates of obesity and with less time spent reading, but that’s a topic for another post.) The same is probably true for computers, tablets, and smartphones as well. Removing electronic media devices from the bedroom will make it more likely that your child will fall asleep sooner — and sleep better — than she will with the world at her fingertips.

Another way of helping kids fall asleep sooner and with greater ease is by removing stressors from their bedroom and encouraging them to relax before bedtime. This means, for example, not doing homework in the bedroom (and never in bed!), but at the dining room table instead. This creates a distinct boundary between the pressures of the day and the comforting space of the bedroom, which is so important for falling asleep. It may also have the added benefit of keeping them focused on the task at hand instead of the distractions of YouTube, Snapchat, and texting that can turn one hour of homework into a three-hour ordeal. Likewise, ending the day with 20-30 minutes of mindfulness practice, yoga, or quiet reading can help your teen redirect himself to a different plane as he gets ready to sleep.

Finally, keeping to a regular sleep schedule, seven days a week, with fixed wake-up and bed times will help keep your teen’s internal clock synchronized with the external one, preventing the development of a circadian phase delay between the two that may interfere with his or her being able to fall asleep at their appointed bed time on week nights. Do you know your BMI? Increasingly, people know theirs, just as they know their cholesterol.

If you don’t know your BMI, you can use a BMI calculator available online, including this one at Harvard Health Publishing. All you need is your height and weight. Or, you can calculate it yourself, using this formula:

BMI = (Weight in Pounds x 703) / (Height in inches x Height in inches).

So, now that you know your BMI, is it worth knowing? What are you going to do with it?
What your BMI means

To understand what your BMI means, it’s useful to take a step back and understand what it’s measuring and why it’s measured.

BMI is a calculation of your size that takes into account your height and weight. A number of years ago, I remember using charts that asked you to find your height along the left side and then slide your finger to the right to see your “ideal weight” from choices listed under small, medium, or large “frame” sizes.

These charts came from “actuarial” statistics, calculations that life insurance companies use to determine your likelihood of reaching an advanced age based on data from thousands of people. These charts were cumbersome to use, and it was never clear how one was to decide a person’s “frame size.”

BMI does something similar — it expresses the relationship between your height and weight as a single number that is not dependent on “frame size.” Although the origin of the BMI is over 200 years old, it is fairly new as a measure of health.
What’s a normal BMI?

A normal BMI is between18.5 and 25; a person with a BMI between 25 and 30 is considered overweight; and a person with a BMI over 30 is considered obese. A person is considered underweight if the BMI is less than 18.5.

As with most measures of health, BMI is not a perfect test. For example, results can be thrown off by pregnancy or high muscle mass, and it may not be a good measure of health for children or the elderly.
So then, why does BMI matter?

In general, the higher your BMI, the higher the risk of developing a range of conditions linked with excess weight, including:

    liver disease
    several types of cancer (such as those of the breast, colon, and prostate)
    high blood pressure (hypertension)
    high cholesterol
    sleep apnea.

Current estimates suggest that up to 365,000 excess deaths due to obesity occur each year in the U.S. In addition, independent of any particular disease, people with high BMIs often report feeling better, both physically and psychologically, once they lose excess weight.
And here’s why BMI may not matter

It’s important to recognize that BMI itself is not measuring “health” or a physiological state (such as resting blood pressure) that indicates the presence (or absence) of disease. It is simply a measure of your size. Plenty of people have a high or low BMI and are healthy and, conversely, plenty of folks with a normal BMI are unhealthy. In fact, a person with a normal BMI who smokes and has a strong family history of cardiovascular disease may have a higher riskof early cardiovascular death than someone who has a high BMI but is a physically fit non-smoker.

And then there is the “obesity paradox.” Some studies have found that despite the fact that the risk of certain diseases increases with rising BMI, people actually tend to live longer, on average, if their BMI is a bit on the higher side.
Should we stop giving so much “weight” to BMI?

That’s exactly what’s being asked in the discussion generated by a new study. For this study, researchers looked at how good the BMI was as a single measure of cardiovascular health and found that it wasn’t very good at all:

    Nearly half of those considered overweight by BMI had a healthy “cardiometabolic profile,” including a normal blood pressure, cholesterol, and blood sugar.
    About a third of people with normal BMI measures had an unhealthy cardiometabolic profile.

The authors bemoaned the “inaccuracy” of the BMI. They claim it translates into mislabeling millions of people as unhealthy and also overlooking millions of others who are actually unhealthy, but are considered “healthy” by BMI alone.

Actually, this should come as no surprise. BMI, as a single measure, would not be expected to identify cardiovascular health or illness; the same is true for cholesterol, blood sugar, or blood pressure as a single measure. And while cardiovascular health is important, it’s not the only measure of health! For example, this study did not consider conditions that might also be relevant to an individual with an elevated BMI, such as liver disease or arthritis.
Bottom line

As a single measure, BMI is clearly not a perfect measure of health. But it’s still a useful starting point for important conditions that become more likely when a person is overweight or obese. In my view, it’s a good idea to know your BMI. But it’s also important to recognize its limitations. In the United States, the national drinking age is 21. States can make it younger, but if they do they lose federal highway funding. The idea is that youth less than 21 are more likely to run into trouble if they drink, and that having them wait until they are older is better. You can argue about whether this actually works, but the idea is a good one.

And yet when it comes to tobacco, as far as the federal government is concerned, you just have to be 18. Which, for anyone who knows anything about what happens when youth smoke, makes no sense at all.

It was really Mothers Against Drunk Driving (MADD) that drove the national drinking age legislation. It’s true that smoking doesn’t cause immediate impairment in the way alcohol does; one can smoke a couple of cigarettes and drive. But the longer-term impacts of tobacco use are staggering. Cigarette smoking is the leading preventable cause of death in the United States, causing more deaths each year than HIV, illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents combined. Even if it doesn’t kill you, smoking markedly increases your risk of heart disease, cancer, lung disease, rheumatoid arthritis, and diabetes, among other health problems. When pregnant women smoke, their babies are at higher risk of being born small, prematurely, or having birth defects. When parents smoke, it’s more likely that their baby will die of sudden infant death syndrome, or SIDS.

Here’s why it’s so crucial to stop youth from smoking: 90% of all smokers tried their first cigarette by 18, and 99% started by age 26. Three-quarters of teen smokers end up smoking into adulthood, even if they intend to quit. And here’s another important fact: most youth under the age of 18 get cigarettes from someone under 21.

If we make it so that nobody under 21 can buy tobacco, the impact could be enormous. And, according to an editorial just published in the New England Journal of Medicine, the time for Tobacco 21 laws may have come.

The editorial quotes a study from the Institute of Medicine that says that if we were to increase the national smoking age to 21, it would lead to, among other benefits:

    20-30% less smoking among 15 to 17-year-olds
    12% fewer smokers overall
    249,000 fewer premature deaths, with 4.2 million fewer lost life years
    286,000 fewer preterm births
    4000 fewer cases of SIDS

That’s pretty astounding. Many states have already made this change — and yet some, like New Jersey, have balked. Which is interesting, as according to the editorial most people support the idea — especially current and former smokers (66.5% and 73%, respectively). It is also indisputable that raising the smoking age to 21 would lead to huge health care savings. The biggest obstacle? Special interest groups. The tobacco industry has deep pockets and clearly doesn’t want to lose its future smokers, so it has lobbied hard.

It’s pretty difficult to come up with arguments against federal Tobacco 21 legislation. You could say that it infringes on personal rights. But unlike other rights, the right to an addiction that can kill you and those around you, well, that’s a bit hard to justify — especially among our youth. We have a responsibility to set them on the path to the healthiest life possible.

You could say — and those who fight this legislation do — that it will hurt businesses that sell tobacco products, especially small stores that rely on cigarette sales for income. That’s certainly true. But who are we as a country if we value the health of small businesses over the health of our people?

There is abundant evidence that cigarettes are bad for you — so much evidence that nobody disputes it. If we can’t come together to stop youth from smoking, and in doing so prevent so much disease and death, we should be ashamed. While it is obvious that your feelings can influence your movement, it is not as obvious that your movement can impact your feelings too. For example, when you feel tired and sad, you may move more slowly. When you feel anxious, you may either rush around or become completely paralyzed. But recent studies show that the connection between your brain and your body is a “two-way street” and that means movement can change your brain, too!
How exercise can improve mood disorders

Regular aerobic exercise can reduce anxiety by making your brain’s “fight or flight” system less reactive. When anxious people are exposed to physiological changes they fear, such as a rapid heartbeat, through regular aerobic exercise, they can develop a tolerance for such symptoms.

Regular exercise such as cycling or gym-based aerobic, resistance, flexibility, and balance exercises can also reduce depressive symptoms. Exercise can be as effective as medication and psychotherapies. Regular exercise may boost mood by increasing a brain protein called BDNF that helps nerve fibers grow.

For people with attention-deficit disorder (ADHD), another study showed that a single 20-minute bout of moderate-intensity cycling briefly improved their symptoms. It enhanced the participants’ motivation for tasks requiring focused thought, increased their energy, and reduced their feelings of confusion, fatigue, and depression. However, in this study, exercise had no effect on attention or hyperactivity per se.

Meditative movement has been shown to alleviate depressive symptoms. This is a type of movement in which you pay close attention to your bodily sensations, position in space, and gut feelings (such as subtle changes in heart rate or breathing) as you move. Qigong, tai chi, and some forms of yoga are all helpful for this. For example, frequent yoga practice can reduce the severity of symptoms in post-traumatic stress disorder to the point that some people no longer meet the criteria for this diagnosis. Changing your posture, breathing, and rhythm can all change your brain, thereby reducing stress, depression, and anxiety, and leading to a feeling of well-being.
The surprising benefits of synchronizing your movements

Both physical exercise and meditative movement are activities that you can do by yourself. On their own, they can improve the way you feel. But a recent study found that when you try to move in synchrony with someone else, it also improves your self-esteem.

In 2014, psychologist Joanne Lumsden and her colleagues conducted a study that required participants to interact with another person via a video link. The person performed a standard exercise — arm curls — while the participants watched, and then performed the same movement.

The “video link” was in fact a pre-recorded video of a 25-year-old female in a similar room, also performing arm curls. As part of the experiment, participants had to either coordinate their movement or deliberately not coordinate their movement with the other person’s arm curls. They filled out a mood report before and after each phase of synchronizing or falling out of synchrony. They also reported on how close they felt to the other person.

The results were interesting. When subjects intentionally synchronized their movement with the recording, they had higher self-esteem than when they did not. Prior studies had shown that synchronizing your movement with others makes you like them more. You also cooperate more with them and feel more charitable toward them. In fact, movement synchrony can make it easier to remember what people say and to recall what they look like. This was the first study to show that it makes you feel better about yourself, too. That’s probably why dance movement therapy can help depressed patients feel better.
Putting it all together

Your mind and body are intimately connected. And while your brain is the master control system for your body’s movement, the way you move can also affect the way you think and feel.

Movement therapies are often used as adjunctive treatments for depression and anxiety when mental effort, psychotherapy, or medication is not enough. When you are too exhausted to use thought control strategies such as focusing on the positive, or looking at the situation from another angle, movement can come to the rescue. By working out, going on a meditative walk by yourself, or going for a synchronized walk with someone, you may gain access to a “back door” to the mental changes that you desire without having to “psych yourself” into feeling better. Alzheimer’s disease often strikes fear in people’s hearts because it gradually erodes a person’s ability to remember, think, and learn. There is no cure, and available treatments alleviate symptoms only temporarily. An estimated 5.3 million Americans currently have Alzheimer’s disease, yet this brain disorder is far less common than heart disease. More than 85 million people in the United States are living with some form of cardiovascular disease or the after-effects of stroke, which also affects brain function.

Many people don’t realize that Alzheimer’s and heart disease share a genetic link: the apolipoprotein E gene, also known as ApoE. Genetic testing for ApoE — which is done mainly in research settings and isn’t yet widely available — cannot predict whether a person will develop Alzheimer’s disease, only whether they may be more likely than others to do so. The results of ApoE testing can be distressing for people who discover they carry a potentially a worrisome variant of the gene, but a recent Harvard study revealed a surprising silver lining.
Understanding the ApoE gene

The ApoE gene provides instructions for making a protein that transports cholesterol in the bloodstream. It comes in three different forms: e2, e3, and e4. Everyone inherits two variants, one from each parent. More than half of people in the general population have two copies of the most common variant, e3, which doesn’t appear to affect the risk of either heart disease or Alzheimer’s disease. The potentially problematic variant is e4. Having at least one copy of the e4 variant increases blood levels of both harmful LDL cholesterol and triglycerides by about 10 points. This translates to a slightly higher risk of cardiovascular disease.

“It’s a well-proven association. But the effect of the e4 variant on Alzheimer’s disease risk is stronger,” notes Dr. Kurt Christensen, instructor of medicine at Harvard Medical School. Exactly how the e4 variant is related to Alzheimer’s disease remains a mystery. But the variant seems to hamper the clearance of amyloid plaque, the clumps of protein found in the brains of people with Alzheimer’s. Amyloid plaque is thought to destroy brain cells, causing the disease’s devastating symptoms, says Dr. Christensen.

People who inherit one copy of e4 face a two-fold higher risk of developing Alzheimer’s than those without the e4 form. Those who inherit two copies of the e4 form have up to a four-fold higher risk. But it’s important to understand that these people won’t necessarily develop Alzheimer’s disease, and that people without the e4 variant can still get the disease. In fact, up to 60% of people with Alzheimer’s disease don’t have an e4 variant.
What the new study found

Dr. Christensen and colleagues recently published a study in the Annals of Internal Medicine that included 257 people who were interested in knowing their genetic risk of Alzheimer’s disease. Nearly 70% had a parent or sibling with the disease. All received information about their genetic risk of Alzheimer’s. But half were randomly assigned to get additional information about ApoE’s connection to heart disease, along with suggested strategies to lower their risk, including quitting smoking, eating a healthy diet, losing weight, treating high cholesterol, and exercising (with a doctor’s permission).

Among the people who had a higher risk based on their ApoE status, learning about the additional risk to their hearts actually reduced their distress, says Dr. Christensen. And over the following year, something even more unexpected happened: They made a number of healthy behavior changes, such as improving their diets, reducing their stress levels, and being more physically active. And while these habits haven’t been proven to help stave off Alzheimer’s disease, doctors generally agree that what’s good for the heart is good for the brain.

The findings offer reassurance that disclosing genetic information about possible health risks can be helpful — particularly when the knowledge comes with action-oriented suggestions about ways to lessen the impact of that risk. Parents of teenagers, here is another post that I hope will be helpful to you.

Moms and dads of teens — and the doctors who care for these children — know how difficult it can be to identify depression in adolescents. When is your teen simply feeling down or irritable, and when is it something more?

Doctors are receiving better and better training in diagnosing teenage depression, but perhaps the greatest challenge is finding time to make sure it happens. During a typical well-child visit, parents are usually busy trying to address the concerns they have about their child, while at the same time trying to understand what vaccines they need and making sure school forms are filled out. Pediatricians are busy trying to address physical and emotional concerns and anticipate problems that may come up for your child regarding friends, schoolwork, academic work, safe sex, and other risky behaviors.

Where does screening for depression fit in?

Several medical organizations that provide up-to-date, evidence-based guidelines to physicians recommend that we do screen our teens for depression. Among them is the United States Preventative Services Task Force (USPSTF), an agency charged with providing recommendations to the Primary Care community about preventing chronic or difficult-to-detect illnesses. To help us keep our teens as healthy as possible, the USPSTF recently published an updated guideline about screening for Major Depressive Disorder in adolescents.
What is screening?

Screening is the act of checking for a condition that is common in a community but not obvious to doctors unless some sort of testing is done. For example, doctors screen for high blood pressure by checking blood pressure measurements at most visits. Doctors can’t tell, just by looking at a patient, if his blood pressure is high. The same goes for depression. Sometimes it is very difficult to tell if a person is suffering from depression, until it is quite serious. The point of screening is to catch dangerous problems early, before they become severe problems. When doctors elect to screen patients for a condition, typically the following guidelines are met:

    The condition is common, but silent, in the community; lots of people have it.
    The condition is important to a person’s future health.
    Detecting the condition early improves outcomes.
    The condition is something we can treat!
    The testing required is good, easy to administer, and not overly painful or inconvenient.

Can we screen for depression in teens?

Yes, we can, and doctors have been doing so for years, although not necessarily in an organized or systematic way. The USPSTF recommendation is important because it emphasizes this need to test all teens — because depression is common in teenagers, and potentially dangerous.

A few facts about screening for teenage depression:

    Depression is prevalent, but often silent, in adolescents. We don’t have reliable numbers for children 11 or younger, but for children 12-18, rates of depression in the U.S. have been estimated to be around 8%. That means that about one out of every 12 teens will experience an episode of major depression in his or her teenage years!
    The condition is important! Depression in adolescence is associated with depression later in life. It can also lead to poor school performance, substance abuse, early pregnancy, and even suicide.
    Early detection may help prevent long-term, serious problems by allowing your teen to get good treatment in a more timely manner.
    Effective treatment is available. Readers of my last blog post may recall that I discussed how some antidepressant medications have been associated with higher risk of teen suicide. But this is not the case for all medications or all treatments. Psychotherapy, in particular, has been associated with much improved outcomes and little to no risk to a teen’s health.
    The screening test is painless and easy to do. Several simple, short questionnaires exist which have been vetted by experts and proven to be reliable, even when administered to teenagers.

What will screening look like for my teen?

When your adolescent comes to the pediatrician or family doctor’s office for a physical, he or she will be given a short questionnaire, such as the Beck Depression Inventory or the PHQ-A. These questionnaires typically have about nine questions and can be completed in 1-2 minutes. It is important to let your teen complete this questionnaire on his own. Your pediatrician may discuss the answers with your teen privately, but rest assured that if the concern of depression is raised, the pediatrician will never hide from you the fact that your teen is at risk.
A final word…

As parents, you spend much more time with your adolescents than we doctors can during brief office visits. If you notice that your teen has simply not been acting like himself, or if you are worried, please let your pediatrician know! He or she is always ready to help. My elderly dad is sporting a cool new mobile device these days, complete with a sleek design and an aluminum cover. It’s not a smartphone or a laptop or a tablet; it’s a medical alert system, a one-button gadget that can summon emergency help. “Many older people who live alone embrace the devices, because they worry how they would get help if they fell and couldn’t get to a phone. And it’s reassuring for their kids to know there’s a backup system in place,” says geriatrician Dr. Suzanne Salamon, assistant professor at Harvard Medical School.

The devices weren’t always so popular. Once the target of comedians (an issue that kept some seniors from using them), medical alert systems are now in big demand, perhaps due to an aging population, advances in technology, and the reality that one in three adults ages 65 and older might fall one day. Throw in a higher comfort level with mobile gadgets, and it’s not a big surprise that sales of the systems are rising steadily, expected to reach $21.6 billion by 2020, according to some marketing research estimates.
Lots of choices

The popularity of alert systems has resulted in a flood of choices. There are dozens of brands, and each company has several systems available.
Basic models

These typically consist of a pendant or wristband with a large electronic button, and a base unit (similar to a speaker phone) that you plug into your house phone jack. If you get into trouble, you simply press your button, which signals the base unit to call the alert system operators. The operators then talk to you through the speaker in the base unit, and send paramedics if you need help. Most gadgets are waterproof, and have built-in batteries that don’t need recharging; most batteries last for years, and will be replaced free of charge if they run out. Just like a wireless house phone, these buttons can signal the base unit only within a limited range, such as 400 feet. But the buttons don’t provide two-way communication with operators; only the base unit does that.

Typical price: $25-30/month.

This type of model usually come with a base unit and a wearable button, and they also upgrade the technology to include fall detection, an innovation that automatically contacts emergency operators if it detects a fall (handy if you’re unable to push your button).

Original versions of automatic fall detection weren’t the most reliable at discerning if you’d fallen or just leaned over. Newer versions claim to have worked out the kinks, promising much higher accuracy, as much as 95%.

Typical price: $30-40/month
Premium models

These products upgrade the button to top-of-the-line devices that use cellular technology to contact emergency help. The improved communication allows you to use the alert system wherever you go, whether it’s the grocery store or the great outdoors. Unlike the other options, this device has a built-in speaker, so you can talk to an operator through the button. It also features global positioning system technology (GPS), which gives alert system operators the ability to send help to your exact location. This button is thicker and larger than the type worn only at home, so you probably won’t be able to wear it comfortably on your wrist—you’ll have to put it in your pocket or wear it around your neck. Also, it must be charged every few days, just like a cell phone. If you’re not faithful about that, the button won’t work. Typical price: $40-50/month
The fine print

It’s not enough to find the latest and greatest alert system. Make sure that the company you choose has no long-term contracts, low activation fees, no cancellation fees, discounts for add-ons to your service, free replacement for equipment that’s not working, and most important: operators available 24 hours a day. Many alert system companies meet those standards, so it may help to get a recommendation from a friend, your doctor, or even a local hospital.

And remember: no matter what kind of device or deal you get, the alert system will be useless if you don’t wear it. “Not everyone remembers to wear the device, or they’re stubborn about them, or they take them off to take a shower, which is a place people often fall,” says Dr. Salamon.

In my dad’s case, the medical alert system is always around his neck. He has a premium model that looks a lot like a mini-cellphone. But believe me, the peace of mind the device brings to all of us is absolutely super-sized.
Read More »

What is addiction?

Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.
A revised view of addiction

It might seem strange to group gambling problems in the same category as a problem with drugs or alcohol. But addiction experts are beginning to move away from the notion that there are multiple addictions, each tied to a specific substance or activity. Rather, the Syndrome Model of Addiction suggests that there is one addiction that is associated with multiple expressions. An object of addiction can be almost anything — a drug or drug-free activity. For addiction to develop, the drug or activity must shift a person’s subjective experience in a desirable direction — feeling good or feeling better.

Several scientific advances have shaped our contemporary understanding of this common and complex problem. For example, brain-imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from ingesting psychoactive substances, such as alcohol and other drugs, or engaging in behaviors, such as gambling, shopping, and sex. Genetic research has revealed that some people are predisposed to addiction, but not to a specific type of addiction.

These findings suggest that the object of addiction (that is, the specific substance or behavior) is less important than previously believed. Rather, the new thinking reflects the belief that addiction is functional: it serves while it destroys. Addiction is a relationship between a person and an object or activity. With addiction, the object or activity becomes increasingly more important while previously important activities become less important. Ultimately, addiction is about the complex struggle between acting on impulse and resisting that impulse. When this struggle is causing suffering related to health, family, work, and other activities of everyday life, addiction might be involved.
There are many routes for recovery, and the road may take time

Addiction is a chronic and often relapsing disorder. It is often preceded by other emotional problems. Nevertheless, people can and do recover from addiction, often on their own. If not on their own, people can recover with the help of their social network or a treatment provider. Usually, recovery from addiction requires many attempts. This can lead to feelings of frustration and helplessness. Smoking is often considered one of the most difficult expressions of addiction to change. Yet, the vast majority of smokers who stopped quit on their own! Others stopped smoking with the help of professional treatment. It is important to remember that the process of overcoming an addiction often requires many attempts. Each attempt provides an important learning opportunity that changes experience and, despite the difficulties, moves recovering people closer to their objectives. There are many pathways into addiction and many routes to recovery. Think about recovery from addiction as a five-year process that will have its ups and downs; after about five years, life can and will be very different. As life becomes more worth living, addiction loses its influence.
Going out for dinner can be a nice way to unwind with family or friends. But if you’re watching your salt intake, restaurants aren’t always so relaxing. Much of their fare is loaded with sodium, a main component of salt. In fact, some entrees at popular chains contain far more than 2,300 milligrams (mg) of sodium — the recommended limit for an entire day’s worth of food.

Limiting sodium is especially important for people with high blood pressure, because excess salt worsens this common condition, leaving you more prone to heart attack and stroke. If you eat out only once a month, you probably needn’t worry too much. But Americans tend to eat out far more frequently — about five times a week, on average.
For starters, do your prep work

But there are plenty of strategies for staying within your salt budget when eating out, starting before you even leave home, says Debbie Krivitsky, director of clinical nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital. When possible, check the restaurant’s website to look up the nutrition information (including sodium) for different menu items beforehand. You can also search for your favorite dishes at CalorieKing, which includes nutrient data for foods from hundreds of popular nationwide chains. Federal law now requires all restaurants with more than 20 locations to provide this information.

Not surprisingly, the highly processed fare at fast-food restaurants is quite salty (for example, a Big Mac has 950 mg of sodium). Beware of unexpected sources: a Dunkin’ Donuts reduced-fat blueberry muffin contains 540 mg of sodium. But sit-down restaurants aren’t all that much better. “The typical meal at a chain sit-down restaurant contains about 2,100 mg of sodium for every 1,000 calories,” says Krivitsky.

Certain cuisines tend to have higher sodium levels than others. Asian restaurants use a lot of sodium-rich soy and fish sauces, and Italian food (especially pizza) has high-sodium sauces, cheeses, and cured meats, such as pepperoni and prosciutto.
Fresher options and menu tweaks

A better option (if available) is a “farm-to-table” restaurant. These newly fashionable eateries focus on fresh and often locally grown or raised foods. While they may not provide nutritional information, these establishments — as well as other neighborhood and smaller “mom-and-pop” places — may be willing to work with you to prepare a lower-sodium meal. These days, with more people following gluten-free and vegan diets, they’re used to making adjustments. And it’s in their best interest to make their customers happy.

If you’re comfortable doing so, tell your server you have a medical condition or are taking medication and need to limit your salt. They may be more inclined to take you seriously, says Krivitsky. Then say, “Please tell the chef to grill, broil, or steam my food with no added seasonings or sauces.” If you’re ordering a piece of meat, chicken, or fish, find out the weight of the serving size. Have the server bring you a plate with only the amount you want to eat and bag the rest to take home.

If you’ve got your heart set on a special entree that’s over your sodium budget, ask the server to box up half of the dish to save for the next day before bringing it to your table. That way, you can enjoy the portion without being tempted to pick at the rest just because it’s in front of you.
Harvard Medical School (HMS) has a bicycle-friendly campus. Faculty, staff, and students who commute by bike can park their wheels in secured cages, wash off road grime in showers, buy new helmets at a discount, and receive a monthly reimbursement for bike maintenance costs. HMS encourages bicycle commuting not just to relieve parking congestion and foster cleaner air, but also because observational studies have suggested that cycling, like other forms of exercise, is good for us.

A recent study suggests that bicycle commuting, like recreational cycling, is not only associated with a lower risk of serious disease, but with a longer life as well. For that study, researchers from the University of Glasgow followed more than 263,450 commuters in England, Scotland, and Wales for an average of five years. The group was composed of 52% women and 48% men ages 40 through 69.

The researchers divided the participants into five groups based on how they got to and from work on a typical day — walking, cycling, riding in a car or on public transportation, mixed walking (a combination of walking and riding), and mixed cycling (cycling and riding). They found that compared with riding to work, bike commuting was associated with a lower risk of being diagnosed with cardiovascular disease or cancer, or dying of any cause during the five-year period. Walking was associated with a lower risk of developing cardiovascular disease.
The benefits of biking outweigh the risks

“The benefits of regular physical activity are well documented, but there have been concerns that traffic crashes may negate the benefits from commuting by bicycle,” says Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, and a bicycle commuter himself. “This study is important because it confirms, with a much larger sample size, previous findings from other countries. Moreover, it shows that the benefits strongly outweigh the risks.”

The study also provides some assurance to cyclists in the US, where biking conditions are similar to those in the United Kingdom and less friendly than in many European countries. For example, in the Netherlands the bicycle is the major mode of transportation for more than a third of the population, who have access to separated cycle tracks, networks of bicycle paths, and ample dedicated bike parking, and where traffic laws give them the right of way over cars, trucks, and buses. A 2015 analysis conducted by researchers at the University of Utrecht determined that cycling prevents about 6,500 deaths each year in the Netherlands and is responsible for adding six months to the life expectancy of the average Dutch person.
Read More »