Sunday, 9 June 2019

Online Education Offers Unparalleled Learning Freedom

As the information age rolls on we are finding more and more universities that are willing to invest in the education of students who may not necessarily be in a position to attend classes at that particular university. The offerings are still somewhat limited but there are opportunities to earn associates, bachelors, and even master’s degrees strictly though online course work. This is something that was virtually unheard of even a few years ago.

Today’s students truly do have more options available to them than ever before if they are willing to invest the time and effort into their studies, there are few limits to the level of education you can receive, even if it has been years since you last attended a university or community college. Even those colleges and universities that do not offer full fledged degree programs exclusively through online learning mediums are beginning to offer many courses online for students with busy schedules and lifestyles. This means that you now have the opportunity to combine distance or online learning with a few night or weekend courses in order to complete your degree even if you have a full time day job and family that needs to see you at home on occasion.

Even if a degree is not something you are necessarily seeking you might be amazed at the wide array of courses that are available for those interested in increasing their depth of knowledge on different issues from the comfort of their own homes. I know that the idea of self-directed online learning opportunities appeal to me on many levels. These opportunities however, are not necessarily a good idea for everyone. We all learn in different manners and some of us learn best by actually being in the classroom and hearing what has to be said or from hands on experience. This type of learning is not necessarily possible when it comes to distance learning in an email or bulletin board type of environment, which is how many Internet classrooms operate.

Online learning is also not a good idea for those who aren’t perfectly willing, able, and capable of holding themselves responsible for their learning. Face it, for some of us it is much easier to get up and go to a classroom than it is to force ourselves to log on and pay attention at home. We all have areas in which our discipline is well in hand and others where we seem to have no discipline whatsoever. If you can’t hold yourself on task or have difficulties not being distracted by the many other novel things there are to do online you might be best served through an actual classroom experience rather than a distance learning environment like those of online classes.

This is not meant to discourage you from distance learning or online classrooms. In fact, I think these are by far the best option for many working professionals who are seeking to advance their careers, knowledge, and/or earning potential. You will not need to feel as though you are choosing between the future needs of yourself and your family and the limited time you have with your family already. You can schedule around your family time and make the sacrifice when it comes to sleep.

With online classes it doesn’t matter if you are in your pajamas or in a suit and tie you can still do the work you need to do online and no one will be the wiser. You also might find that you can squeeze your education into your lunch hour, particularly if you can type and chew at the same time. The truth is that online classes offer superior flexibility to those hoping to further their education. Whether you are hoping to earn a degree or simply wish to broaden your horizons by taking a few online classes, you just might find that the possibilities are limitless once you begin taking these courses from home. 
A degree from a university means many thing to many different people. Only you can define the importance of a degree such as this to you and only you can determine whether or not now is the time for you to pursue a university degree. If you are unsure about how advantageous a university degree could be to your life let’s look at some of the advantages to a university education in relationship to a community college education.

Money. The first obvious advantage of a university education would be in future earning potential. A four-year degree trumps a two-year degree almost every time. There would have to be exceptional circumstances for someone with a two-year degree to earn more over the course of a lifetime than someone with a four-year degree in the same exact field. While a degree does not guarantee employability, it does improve the odds as well as the income potential that is associated with the field you are entering into. If you have a two-year degree the decision to continue your educational pursuits can be a tough one but it is well worth the effort in the end.

Housing. This is another distinct advantage that universities offer over community colleges. In fact, many universities are now offering housing opportunities to students with families in addition to those students who have no families. Colleges and universities are offering all kinds of value when it comes to housing and meal plans. A great deal of the college experience is missed when you do not live on campus. For this particular reason students wishing to enjoy the experience that dorm life provides often consider universities over community colleges.

Diversity. This is another key component that is often missing at the community college level. International students find no real price breaks between universities and community colleges so they tend to opt for the housing and cultural atmosphere that universities present rather than going with the limiting educational, residential, and cultural experience offered by many community colleges. You will find students of different races, religions, cultures, and nations on the university level-far more than will typically be seen in a community college unless you are attending community college in a very culturally diverse city such as New York.

Culture. This is something that is often lacking on the community college level, as they are largely commuter campuses. You will not see quite the opportunity to experience art, music, the theater, and other wonderful experiences that universities pride themselves in offering to their students. There is nothing quite like the cultural offerings of most large universities and if you get the opportunity I hope you will take the time to stop and experience some of the wonderful things that being in a university community present you with an opportunity to experience.

Research opportunities. On a university level you will have the opportunity to participate in research projects with certain professors if your prove yourself worthy and express an interest. This is something that isn’t as likely on the community college level as most professors in a community college are dedicated to teaching rather than research. You will find that the experience of working on a large-scale research project is unlike anything you are likely to experience again if you ever get the chance.

Confidence. There is nothing quite like a college degree from a university to help you become a more confident person both personally and professionally. This is something that really can’t be achieved on the community college level but can only be experienced by getting a degree from a university. If you lack confidence when dealing with others or in your career, I hope that you will find that your university education is just the thing to help you feel more confidence on all levels of your life. Countless women nowadays are striving to lose weight some restrict their food intake and engage in intense exercise routines. The long list may include athletes, super models, and ordinary women who believe that “thin is sexy.” These individuals tend to exercise too much and eat too little. Women who engage in such activities are at risk of many health problems like amenorrhea, a term that refers to the absence of menstrual periods. This is experienced by women because of extremely low body fat content. Missed menstrual is often linked to decreased estrogen (primary female sex hormone) levels. Several medical studies show that amenorrheic women and those who have below 10% body fat may have a hard time getting pregnant.

Amenorrhea may also lead to osteoporosis, an ailment which decreases bone density, making the bones vulnerable to fracture and other injuries. Bones usually become brittle when people are much older, but some young women, especially the ones who experience amenorrhea develop brittle bones at a very young age. A report released by the National Osteoporosis Foundation concluded that one in two women over 50 may encounter an osteoporosis related injury in their lifetime.
You must not only consider the possible health risks but also the potential legal consequences, before you buy steroids. It can be extremely dangerous to buy steroids. Anabolic steroids can lead you to jails, or strict federal penalties. So, you should be very careful while you go to buy steroids. You must know the potential legal consequences, before you buy steroids.

Anabolic steroids, you know, are classified as controlled substances under U.S. federal law and the laws of many states. It is a federal crime to use/possess/distribute/buy steroids without proper prescriptions from doctors. The Anabolic steroids Control Act of 1990 places anabolic steroids in the same legal class – Schedule III – as amphetamines, methamphetamines, opium, and morphine.

Simply the possession of any of Schedule III substances is a federal felony that could fetch you federal punishment up to one year in prison and/or a minimum fine of $1,000. If you are caught possessing anabolic steroids with a previous conviction for certain offenses, including any drug or narcotic crimes, you could get imprisonment of at least 15 days and up to two years, and a minimum fine of $2,500. With two or more such previous convictions, you could face imprisonment of not less than 90 days but not more than three years, and a minimum fine of $5,000, just for simply possessing any of Schedule III substances.

It’s not just about possessing Schedule III substances, but selling these substances is also a serious crime. Selling steroids or possessing them with intent to sell, is a federal crime. If you buy steroids, and possess them with intent to sell, you could get punishment up to five years in prison (with at least two additional years of supervised release) and/or a $250,000 fine. If you commit such a violation after a prior conviction for a drug offense, you could faces up to ten years imprisonment (with at least four additional years of special parole) and/or increased fines. Thus, you commit a federal crime when you buy steroids for non therapeutic use, without proper prescriptions from doctors.

Often, you feel that it’s pretty safe to buy steroids thru internet, but it’s not true. The Federal Postal inspectors also monitor the U.S. mails. Suspicious packages coming from overseas can be examined. The domestic parcels from California and the Southwest to sites on the East Coast are often monitored. If illegal drugs are found in your mail, the U.S. Postal inspectors will often arrange a “controlled delivery” of the package to you. If you accept the package, police agents with a search warrant can search out your place for additional drugs. So, it’s not risk free to buy steroids thru mail order. If you get arrested for possessing/buying anabolic steroids, you are advised to stay silent until you consult your lawyer. You should not answer any questions until you speak to your lawyer.
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Great Reasons To Complete Your Degree

Many people search and search for the University they will attend upon graduation from high school. Eager students look forward to their time at university while parents wring their hands hoping that their children choose to attend a university that is not only close to home but also within their budget limitations. Another worry that parents have when their children decide to attend college is whether or not that university they attend will have the specialized and individualized services that their children were accustomed to receiving in high school. Face it; larger universities tend to be rather impersonal when it comes to the education of their students.

One answer to all those worries and more is to transition your students from high school to a two-year college rather than throwing them to the university wolves so to speak. Many people find that two-year colleges can in fact provide superior educations to four-year universities for those first two years or foundation college level courses. You will not get the specialized or specific instruction in a two year college that is available to upper level students on a university level but most students find the first two years of their college educations focused on getting the requirement and pre-requisite courses rather than the specialized courses in their intended field of study.

Many people also find that those first two years at a community college-transitioning from a small pond to a larger lake-are much easier to handle than going straight from high school to a university-out of the pond and into the ocean. Universities often have lower level classes as auditorium classes. These classes offer little individual instruction and are often sink or swim sorts of classes. Those students who have special learning needs are often lost in the shuffle when entering a university. Community colleges offer smaller classes and ample opportunities for tutoring as well as classes on how to learn to study.

Two-year colleges are also much easier on the budget than most universities. Most people find that community college does not place nearly the financial burdens on families that universities place. Add to that the fact that most community colleges offer very flexible class scheduling and even some courses online and you will find that there are many reasons to consider community college that go well beyond mere budgeting requirements.

Another benefit to students who wish to enter the work force sooner rather than later is that you can actually get a degree or certification in certain programs from a two-year college. This means that you can actually graduate and begin earning much sooner than if you were to attend a four-year college in search of a degree. If you aren’t sure you want to invest the next four or five years of your life in pursuit of a degree or you simply aren’t ready to commit yourself to one line of work for the rest of your life it is a good idea to spend two years in a community college rather than making the leap straight into a university setting.

If you are considering whether or not a community college or two year education is the best course of action for your specific needs, I really recommend creating a list of pros and cons of each and balancing your budget to see where your needs are most likely to be fully met. Remember you can always transfer to a university once you’ve completed your two-year college education or at any time during that education as long as you meet the universities admission requirements. Good luck and remember that your college education is one of the largest indicators of your future earning potential so take it seriously.
When it comes to getting a college education, financing is one of the most important considerations that you will need to make. Unfortunately for far too many it is one the last considerations that is made when it comes to the educations of our children. If you are a parent you owe it your child and yourself to plan ahead and plan carefully in order to cover the cost of your child’s education. There are fortunately, a few great ways in which you can do this.

The most common is to begin by opening up an educational savings account for your child (under the age of 18). When you open up an educational savings account for your child, you can contribute up to $2,000 per year per child. This is a combined total contribution however and includes the contributions of grandparents, friends, and family in addition to your own personal contributions. The money from these funds can be withdrawn tax-free as long as they are used for educational purposes.

Educational expenses in this case include books, tuition, fees, supplies, and college room and board provided that your child is at least a part-time student. If you do not use all the funds for your child there are options as far as what to do with the remaining funds in the account. The first option would be to leave the funds in the account and allow the account beneficiary to withdraw them up until the age of 30. There is a penalty involved and the beneficiary will be required to pay income tax on those funds. You could also elect to roll those funds over to the next child under the age of 18 who will have educational expenses in the future.

The money you set aside in these accounts to cover the cost of the education of your child or children is not tax-deductible however, it is a great way to begin saving money and investing in the future of your child. If you begin investing the maximum amount $2,000 per year upon birth your child should have a nice nest egg to help cover educational expenses. If your child is fortunate enough to qualify for scholarships and other sources of financial aid you can turn the funds over as a graduation gift or save it for the next college student in your family that comes along. Either way you’ve saved yourself a good part of the worry that goes along with providing for your family by having this fund set up for your children.

You can sign up for programs like Upromise in order to subsidize your contributions with donations from corporate sponsors as their way of thanking you for buying their products or using their services on any credit cards that you, your friends, and your family members have registered to go into your child’s account. Every edge you give yourself when it comes to investing in the education of your children is an edge worth having. College tuition rates are rising at an alarming rate while corporate expectations of college degrees are rising at the same near lightening speed. This means that a college degree is more critical for our children than in any past generations.

Take the time now to check into securing the future of your children by establishing an educational savings account. Let friends and family know that any gifts they are planning to give your children that involve money would be appreciated if they instead invested in the future of your children rather than the now. You can also ask your friends and family to sign up their credit cards with Upromise in order to provide a little bump in donations to your child’s college savings account. These little steps add up to significant savings over the course of 18 years. You just might find that the investment you are making is adequate to cover the costs of your child’s tuition in full.
A university education is one of the best possible ways to insure your earning power upon graduation. There are all kinds of fields and all kinds of majors, some paying higher than others but as a rule, college graduates will earn more money over the course of their lifetimes than those who do not have a college education or degree.

We live in a world that increasingly demands more of its citizens. We need to have the ability to hold academic conversations on the corporate level that go well beyond the score in last nights basketball games. Companies’ want well-rounded employees that epitomize all the great things that a four-year degree has to offer. For this reason, even those who have labored in order to gain an associate’s degree are getting left behind in favor of those who have a more ‘complete’ education.

If you have already entered the work force there is still the time to increase your earning potential by seeking higher education. Colleges and universities today are offering more options for students wishing to return to college than ever before. In fact we are seeing an increasing number of college students that are classified as non-traditional students. We are seeing many more adults returning for the education they didn’t receive the first time around, which is good news. It also means that more and more options are becoming available at night and on the weekends for those adults.

Even better is the fact that more and more often we are seeing courses being offered online for those who are seeking to complete their education. This allows even more options for those students who are desperately trying to balance careers, family, and education. As more and more opportunities such as these arise we will also see a growing number of graduate studies opportunities being offered in a similar fashion.

If you are thinking of returning to school after years of absence or perhaps attending for the very first time while managing an existing career there is no time like the present in order to do so. Not only will a college education give you greater earning potential in your lifetime it can also qualify you for promotions within the company for which you currently are employed.

The truth of the matter is that you really can’t go wrong when it comes to going back to college and getting or finishing your degree. You can increase your earning potential, your promotion potential, and most importantly your self-image. There is something about having a degree that makes you feel better about yourself and your ability to provide for your family. Even if you never actually use your degree for anything other than a plaque on the wall, you will have the knowledge that you accomplished something that only a small percentage of the population ever gets around to completing.

If nothing else, your college education is worth every penny you will pay in order to have it for the wonderful sense of accomplishment that goes along with getting it. Your college degree won’t make you a better person; just give you a better opinion of yourself as a person in many instances. If you need a confidence booster in your professional and your personal life, getting your college degree is often just the bump of confidence you need in order to accomplish many great things.
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How to get award in High school

For any student hoping to attend college in the coming year, the first place you need to start is by filling out the Free Application for Federal Student Aid that is commonly referred to as FAFSA. The earlier you fill out this form the better as far as your chances of receiving the full amount of financial aid that is available to you as well as to clear up and fix any potential problems that may arise well ahead of the deadline for aid being awarded.

The final date for application changes from year to year and is generally somewhere near the beginning of summer. Earlier is much better than later as far too many students wait until closer to deadline in order to fill out their forms and if you have any questions you are likely to find yourself standing in or calling into longer lines for your answers.

There are a few things you need to know about the FAFSA. Most schools require this form to have been filled out before they will award any financial aid, not just federal financial aid. In other words you should check with your school but you may need to fill out this form even if you are only applying for departmental scholarships and not federal financial aid. It is a good idea to begin at the financial aid office of the institution you plan to attend at any rate to make sure they do not have additional forms that they require you fill out in order to apply with financial aid through the university or college as well as the federal government.

Another thing you need to be well aware of is that you will need to fill out one of these forms for each year that you hope to receive financial aid of any kind. This is not something that is automatically renewed or guaranteed. There are many changes that could affect the amount of money you are eligible to receive as well as whether or not you are eligible to receive federal funds at all on any given academic year. For this reason you must apply for aid for each year that you attend.

Another thing that you must remember is that while a subsidized student loan doesn’t been to accrue interest until you graduate or cease to be enrolled for the required hours, an unsubsidized student loan begin accruing interest from day one. This means that you will owe a substantial amount of money in interest upon graduation if you take out an unsubsidized student loan in order to pay for educational expenses.

Student loans make college educations possible for many people who would not otherwise have the opportunity to attend college. At the same time there are many people, who neglect to use these loans responsibly, which is the beginning of irresponsible spending habits that can plague people for the remainder of their lives. Take great caution that you use your student loans for their intended purpose and use them wisely.

The FAFSA also enables you to apply for Federal Pell Grants and Federal Work Study programs in addition to student loans. Of the three mentioned above, student loans should be a last resort rather than a first. The amount of money available can prove to be quite tempting so be very careful and read all the terms before signing up for any and all financial aid. Your high school, college financial aid office, and the Internet are all excellent sources for information on scholarships, grants, loans, and work study programs for which you may qualify.
Student loans are both a blessing and a curse to college students all across the country. On one hand, student loans allow you to have the money you need in many cases to attend college at all. On the other hand, most college students, particularly those entering college for the first time have inflated opinions of their starting salaries upon graduation and the bills they will face while living in the real world. In fact, most freshmen college students have no real concept of the limits of money in which to base their decisions as to whether or not they can realistically expect to repay those funds once they’ve graduated college.

The sad truth is that many college graduates find that for the first 10-15 years after they have graduated college, they are essentially indentured servants to their student loan debts. There are many reasons for this and different college graduates will find different things about their student loans when the appropriate time comes. First of all, those taking out student loans need to understand that a college degree does not guarantee a high starting salary. Beyond that, a college degree is no guarantee that there will be employers lining up to take your name and number upon graduation. The truth is that most college grads take anywhere from 6 months to a year to find a job in their fields and even then the starting salaries are often far less than anticipated.

Part of the blame for over-inflated expectations is the fault of universities attempting to validate their high tuition rates by displaying average starting salaries of only those that have successful offers in the field of study immediately upon graduation (which usually indicates a history of working with the company or another company as an intern prior to being hired) and not those students who have no prior work experience in their chosen fields. Part of the expectations is students reading job advertisements for experienced workers in a field and assuming that an education will provide the experience that employers require. Regardless of the reason, most starting salary expectations are not realistic in light of the current market.

The problem is that for many students a student loan is the difference in receiving a college education or not receiving one. For these students, there is no option. The price they will pay (with interest) for having student loans in order to get through the educational process will repay itself over the course of a lifetime if they are wise about making the necessary payments and stay on top of things such as consolidation loans and making payments on time.

Student loans are a great tool for those who have no other options when it comes to attending and affording to attend a university. On the other hand, for those who do not have an absolute need for the funds a student loan can provide they can prove to be problematic when trying to establish your career and your lifestyle upon graduation. This is a tool for education that should be used sparingly at best.

Whether or not you choose to take out student loans in order to fund your college education it is a good idea if you exhaust all other available resources first. Check out your options for grants, scholarships, and work-study programs before leaping into student loans to pay for your education.
There are all kinds of college programs that are available today for those seeking higher education and degrees in a wide variety of fields. The problem often lies in finding the type of education that is appropriate for your specific needs. We all learn best through different methods and identifying your learning method is a great way to understand what learning environment will work best for you.

The common learning environments for college level studies are the following: community colleges, universities, and online or distance learning opportunities. Community colleges tend to offer smaller classrooms with more discussion-oriented styles of learning and discourse. Universities tend to be more lecture oriented while distance and online learning opportunities are quite often self-directed learning opportunities that require a great deal of discipline in order to be successful.

When trying to identify the college that will work best for you, you should keep in mind your personal learning style. Beyond that you should also consider the type of environment you expect from your college education and the amount of time you wish to devote to the pursuit of your education and degree. Some people find that university life is far too distracting while others find that the solitude of online and distance learning is a distraction in and of itself.

You will find all kinds of cultural opportunities at a university that you will not find through home studies or on the community college level. For some students, these opportunities are icing on the cake and an important part of the learning experience as you delve into other cultures, art, music, and history. Others find these opportunities to be far too plentiful and far too distracting for their study needs. Whichever student you tend to be will make a huge difference in the best situation for your learning needs.

Another important consideration is housing. Most universities have ample on campus housing for their students while a few campuses experience on campus housing shortages and rely on housing that is located in and around the college area in order to fill in the gaps. Some universities will even offer limiting housing opportunities to students who have spouses and children. While housing on community college is seen, particularly in rural areas where there is limited housing available in and around the schools, these are more often the exception rather than the rule. Most community colleges are largely commuter campuses with very limited if any housing opportunities. Online and distance learning programs offer no housing to students.

Another concern that most also be considered carefully is the distance between classes and any special needs you may have. Universities tend to be large and spread out. It is quite possible to need to get from one end of campus to another (a mile or more in some cases) with a 10-minute window in which to get it done. For students with special needs or physical disabilities this can be quite problematic, especially on days of inclimate weather. Community colleges tend to have smaller campuses, which mean less real estate to cover in between classes. Online and distance learning classes go with you wherever you have access to a computer. This means that they are as portable as you need them to be if you have your own laptop and wireless Internet access.

You must consider all these things and so much more when narrowing down your college choices. Do you really want to take the personal responsibility required in order to succeed in online and distant learning courses? Do you want to be limited by the meager offerings of coursework available at the community college level? Is it worth it to you to pay the high price involved in a university education? These are all questions that you need to consider carefully before making the decision as to which college environment is the most desirable for you.
When it comes down to the importance of an education there is no denying that the longer you stay in school the better off you are when it comes to earning potential over the course of your lifetime. Recent estimates have presented some rather astonishing figures to support these claims however, and I for one think they are well worth mentioning.

Let’s discuss first things first however. A high school diploma will net the average citizen $200,000 additional dollars of lifetime income on average. This is one small baby step when it comes to the educational process however. Some college, even without a degree will even increase that figure an additional $150,000 for a total of $350,000. If this isn’t enough to convince you however try the facts and figures that are associated with the additional earning potential that a four-year degree introduces: $500,000. This addition makes a total of $850,000 more over the course of a lifetime in earning potential. I don’t know about you but I find those figures to be quite a nice motivator for going back and finishing a degree.

While a person’s education may not be an accurate indicator of his or her actual ability it is often used in the business world to narrow down a growing field of applicants for a sadly stagnate number of positions across the country. There are things you just can’t see on a piece of paper and ability and capabilities are among those things. Businesses need a defining factor by which they narrow down the field of potential employees and that defining characteristic is often a college degree in the field of business or a complimentary major course of study.

While this may not seem fair to many who have the practical skills companies are seeking employees that can fill multiple roles in order to eliminate positions that have been occupied in the past. For this reason they want business people who have technical skills and a college education provides a brief introduction to many skills that are useful in these situations. Unfortunately, the only way to know whether or not you have these specific skills is if you list them on your resume while those who have a four-year degree are believed to have them by the merit of their educations.

The earning potential alone should be enough to turn your head when it comes to the importance of earning a college degree though there are many more excellent reasons to pursue the completion of your degree. If you haven’t considered some of the other wonderful reasons for returning to college and getting your degree, perhaps the reasons below will provide a little additional motivation.

1) Challenge. There is very little in life that offers the challenge of returning to college after an absence. It is a frightening prospect for many and yet can be equally as exciting. You will find that the constant exposure to academic debate is a great way to feed your mind and open your eyes to new ideas. Challenge your preconceptions and challenge the limits of your own experiences by opening up your mind to the thoughts and ideas of others.

2) Learn New Skills. There is never a bad time to begin learning new skills no matter what they say about old dogs and new tricks. The truth is that as long as you open your mind to learning you are feeding it and that is a great thing.

3) Career advancement. Whether you realize it or not, a college degree is one of the quickest paths you can take to career advancement.

If the money wasn’t enough to convince you of the impact that a four-year degree can make in your life perhaps the reasons mentioned above were enough to do the trick. Whether or not you realize how much a degree can affect your life the truth of the matter is that it can improve so many things about your life and how you view yourself and the world around you. Now is the perfect time to go back to school and earn your degree.
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Wednesday, 17 April 2019

A mindful worker is a happier worker

When I gave a talk at Google a few months ago about using mindfulness to help relieve anxiety, depression, and other common forms of psychological distress, I was impressed by the company’s commitment to taking care of their employees. From the organic juice bars in every building to the gyms and meditation and yoga facilities scattered around the campus, it was clear that they’re thinking a healthy employee will be a productive employee (not to mention an employee who needs fewer expensive medical services). In fact, they had a whole team devoted just to teaching mindfulness meditation, and offered regular practice sessions that workers could attend either in person or online throughout the day.

But can mindfulness practice really help employees’ mental health? Is it something that more businesses should be investing in, or just another fad for ex-hippies in Silicon Valley? The results of the best-designed study to date that addresses this question are just in, and the answer is impressive: mindfulness really can help workers, even those far from California.
What the study found

The new study comes from Taiwan, where researchers surveyed 3,270 factory workers to identify those with high levels of psychological distress. They then invited these particularly unhappy workers to participate in the study. The 144 workers who ultimately agreed to participate were assigned to either an active intervention group, in which they completed an eight-week mindfulness training program consisting of two-hour classes each week at work and 45 minutes of daily meditation homework, or a control group, who reported regularly on their psychological well-being but didn’t receive any mindfulness training.

What did they find? Compared with the control group, the workers who took the mindfulness class reported feeling much better. They had less prolonged fatigue — that feeling of exhaustion that doesn’t go away even after having a chance to rest. They also felt less stressed, reported reduced anxiety and depression, and had fewer sleep difficulties, aches and pains, and problems getting along with others.

So what exactly was this mindfulness training that helped them? Mindfulness involves bringing our attention into the present moment and accepting whatever is happening here and now. That sounds very simple, but when we begin to try to actually practice mindfulness — by picking a sensory experience such as the breath, bringing our attention to it, and working to accept whatever arises in our awareness — most of us find not only that our minds quickly wander off into all sorts of thoughts about the past and the future, but they also generate all sorts of negative judgments about what’s happening.

The good news is that like any skill, mindfulness can be learned. It just requires a bit of instruction, and setting aside some time to practice. Numerous research studies have shown that by practicing mindfulness, we can actually change both the structure and the functioning of our brains in ways that are consistent with feeling happier and more engaged in our lives. These changes also help us to have an easier time dealing with both physical and emotional pain.
How you can reap the benefits of mindfulness

So how might you begin if you wanted to become more mindful? One way that doesn’t require any extra time is to simply pick a few activities, such as walking the dog, showering, or eating a meal alone, and decide to do them as mindfulness practices. That means instead of checking our smartphone, going over our to-do list, or listening to music, we try to bring our attention to the sights, sounds, and bodily sensations occurring during the activity. Since mindfulness practice is very dose-related, the more we try to do this throughout the day, the more mindful we become.

While these informal practices will indeed help you to develop some mindfulness, to develop more, it’s helpful to set aside time for meditation practice, like they do at Google. Most studies documenting the effectiveness of mindfulness involve people meditating regularly. It’s easiest to begin a regular meditation practice by following recorded instructions. While there are many sources for these, you can listen for free to some that I recorded It is abundantly clear that smoking damages the heart, the lungs, and virtually every other body system. According to the Centers for Disease Control and Prevention, smoking remains the leading cause of preventable death in the United States.

So why do people do it?

It’s the nicotine. This stimulant, found in all tobacco products, makes smokers feel calm and relaxed — and it can quickly lead to addiction. The more you smoke, the more you need to smoke to feel good. It’s the pull of nicotine that makes quitting so difficult.

But what if you could reduce the amount of nicotine available in cigarettes to begin with? Would it help people quit — or might it cause them to smoke more to compensate?

Recently, a team of researchers set out to answer this question by following more than 800 adults who smoked at least five cigarettes a day. These study volunteers had no desire to quit smoking. They were asked to either continue smoking their regular brand of cigarette or to smoke one of six types of investigational cigarettes that had varying amounts of nicotine, ranging from 15.8 milligrams (mg) of nicotine per gram of tobacco (the amount found in most commercial brands) all the way down to 0.4 mg per gram. The smokers were followed for six weeks. The results of the study were published in today’s New England Journal of Medicine.

These results were unexpected. The people given the lower-nicotine cigarettes smoked 23% to 30% fewer cigarettes per day than those who smoked the cigarettes with 15.8 mg of nicotine per gram. Perhaps even more surprising, the low-nicotine cigarette smokers also had reduced dependence on nicotine — and fewer cravings for cigarettes when they weren’t smoking.

This study lasted only six weeks, so we’ll need longer trials to help us really understand whether low-nicotine cigarettes are a “safer” option for people who are determined to smoke (as many as one in five Americans is a current smoker). However, these findings do suggest that if the nicotine content in commercial cigarettes could be lowered, users would smoke less and be less likely to get “hooked,” which could mitigate the health risks associated with smoking.

For those who do want to cut out nicotine, there are good options that can help them meet the challenge. They come in many forms, from nicotine patches and gums to lozenges and nasal sprays — not to mention e-cigarettes, which work by vaporizing nicotine. E-cigarettes have become wildly popular, but to date, we don’t know for sure that they are safer than regular cigarettes, or that they can actually help people quit. Prescription drugs like bupropion (Zyban) and varenicline (Chantix) can also help smokers quit. All of these methods work especially well when combined with behavioral supports, such as talk therapy. Of course, it often takes multiple attempts to quit before succeeding — but it can be done. Being an overweight child is no picnic — it can be hard to keep up with your friends on the playground, you can’t wear some of the same styles of clothing other kids do, and the teasing can be merciless. New research published in The New England Journal of Medicine shows that the damage goes beyond the social and emotional, too.

This study, entitled “Cardiometabolic Risks and Severity of Obesity in Children and Young Adults,” enrolled almost 9,000 children and adolescents ages 3–19 who were either overweight or obese (severely overweight). Doctors tested these young people for high blood pressure and cholesterol, diabetes, and other important risk factors for heart disease. On average, the most severely obese children and teens had higher blood pressures, worse cholesterol profiles, and higher blood sugar levels than those who were just overweight. This association was true even when taking into account race, ethnicity, gender, and age.

This was a cross-sectional study, meaning that it did not follow patients forward in time to see what happened to them. Rather, it examined each patient “in the moment” and identified factors that doctors believe affect the risk for future heart disease. So, based on the information in this study, we can’t tell which of these young people eventually went on to develop heart disease. However, we do know that, for adults, controlling blood pressure, cholesterol, and blood sugar are critical to preventing heart disease. It is reasonable to infer that this would also hold true for children.

The majority of the study volunteers were ages 12–19. So it also seems reasonable to conclude that the more severely obese a teenager is, the greater the likelihood that he or she will go on to develop heart disease. The study also found that the boys and young men tended to have more concerning test results, raising the concern that childhood obesity might be particularly hazardous for them.

This study is incredibly important because it supports what pediatricians have feared for many years now, ever since we noticed rising rates of obesity among our younger patients: if we don’t find ways to help our kids achieve and maintain a healthy weight, we are going to see them become adults who suffer from heart disease at higher rates and at younger ages than ever before.
Helping children achieve a healthy weight

The great news is that we can do something about this! Weight loss interventions do work for younger patients, and are becoming more accessible.  Most importantly, we should realize that even a little bit of weight loss can go a long way to living a healthy life, and this is important at every age.

If your child is overweight, I hope that learning about this study encourages you to talk to your pediatrician about helping him or her (or yourself!) lose weight. Ideally, make a plan as a family. Make it a goal for Mom, Dad, and all the kids to get lots of exercise and eat a healthy, well-balanced diet.

Before placing your child on a diet, or enrolling him or her in a weight-loss program, talk it over with your pediatrician. Don’t be embarrassed to do so! I can guarantee you that your doctor has seen many kids struggle with weight and has some expertise on the subject. Together you can create a plan of action that is right for your family and your child.
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Friday, 12 April 2019

Reversing the effects of the new anti-clotting drugs

Pediatricians and child behavior specialists who work with teens know that adolescence is an incredibly important time for social growth. Yet these years can be fraught with anxiety for the parents of teens. How will you know if your moody teen is hanging out with the right people? Which friends might be a bad influence? How can you help your son or daughter develop healthy relationships?

Recent research has addressed some aspects of these questions. One study entitled “Spreading of healthy mood in adolescent social networks,” published this year in the Proceedings of the Royal Society of London, investigated whether a teen whose friends have a healthy mood is less likely to be depressed. It also looked at how emotionally healthy friends affected a teen’s recovery from depression. Basically, the researchers wanted to find out: is a good mood contagious?

The study involved roughly 3,000 teens. Each study volunteer completed two surveys, six months apart, in which he or she listed up to five male and five female friends. Each teen was then followed over time, to see how his or her mood changed.

One of the interesting things about this study is that these researchers defined depression as a behavior, not necessarily as a disease that someone could get. This allowed them to do their statistical analysis a little differently from previous studies looking at the same subject matter, and it uncovered the potential power of positively minded friends.

The investigators found that having a social network made up of friends with a healthy mood cut a teenager’s probability of developing depression in half over a 6- to 12-month period. It also significantly improved the chances of recovering from depression for teens who already suffered from it. While the data don’t show a direct cause and effect, this study does suggest that having friends with a healthy mood may reduce the risk of depression and make it a little easier to recover from depression should it occur.
Surprising findings on from social networking research

This study is a nice example of a recent trend in epidemiology — using data about an individual’s social network to learn things about that person. This type of research has led to numerous interesting findings, and has really shaped an entire new area of inquiry. A study published in 2007 in The New England Journal of Medicine was one of the first of this kind. It showed that people who had obese friends and family were themselves more likely to be obese. Since then, additional research has looked at how social networks influence an individual’s risk of developing (or sidestepping) specific health conditions, such as obesity, smoking, and depression.

Results of these studies have been, at times, surprising, thus giving the medical community valuable new information. For example, I myself led a study in 2011 called “The influence of social networks on patients’ attitudes toward type II diabetes.” When I started this research, I supposed that patients would be less concerned about having diabetes if more of their friends and family members had diabetes. I had guessed that these patients might have become so used to the idea of diabetes that the disease would seem common and almost normal. But in fact, my team found the opposite! Patients with a higher prevalence of diabetes within their social networks expressed greater concern about their illness. This unexpected result gave me information that helped me to better take care of my patients.
Using social network data to improve your teen’s mental health

This type of research is not only helpful to doctors, but it also provides important information for anyone trying to improve his or her own health, or the health of one’s family. The study on positive mood in teens’ social networks suggests that parents may be able to reduce their teen’s chances of developing depression — or improve her or his mood if she does have depression — simply by promoting and supporting friendships with emotionally healthy peers. With much controversy about using antidepressants in teens, results such as these can give parents a simple way to promote emotional health and well-being in their adolescent children — with no medications involved. The oral anticoagulant warfarin (Coumadin) became available for prescription in 1954. This anti-clotting drug commanded national attention when President Dwight Eisenhower received the drug as part of his treatment following a heart attack. No other oral anticoagulant was successfully developed and marketed in the United States until 2010.

Warfarin is a dangerous drug. Along with insulin, it is responsible for the most emergency hospitalizations due to adverse drug reactions. Whereas insulin causes low blood sugar, warfarin is notorious for the complication of major bleeding. Warfarin is plagued by hundreds of drug-drug and drug-food interactions. The optimal dose is determined by monitoring the level of anticoagulant in the blood. Standard-intensity anticoagulation with warfarin is usually targeted to achieve prothrombin blood test results, expressed as international normalized ratio (INR), within a range of 2.0 to 3.0. If the INR is greater than 3.0, the warfarin dose is decreased to prevent excessive bleeding. If the INR is lower than 2.0, the warfarin dose is increased to prevent excessive blood clotting. This approach is slow, cumbersome, and frustrating. Even when the INR tests within the desired range, catastrophic bleeding complications, such as bleeding into the brain, can still occur.

Patients and health care providers complain about the difficulties and inconveniences of trying to use warfarin properly. Multiple algorithms and even genetic testing have been undertaken with the hope of deriving an easy-to-follow dosing scheme, but these efforts were disappointing overall.
Enter the new anticoagulants

In a remarkable five years spanning 2010 through 2014, four novel oral anticoagulants underwent pivotal trials for stroke prevention in atrial fibrillation, as well as treatment of pulmonary embolism and deep vein thrombosis. The four new drugs have better safety profiles than warfarin, and some are more effective than warfarin for stroke prevention in people with atrial fibrillation. All four were rapidly approved by the Food and Drug Administration to treat these thrombotic conditions. One, dabigatran (Pradaxa), is a direct thrombin inhibitor — that is, it inactivates clotting factor II (thrombin). The other three — rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa) — inactivate clotting factor X. None of these target-specific novel anticoagulants requires regular laboratory monitoring. They are administered in fixed doses. There are virtually no restrictions on foods such as green leafy vegetables, as there are with warfarin. And there are only about a dozen important drug-drug interactions.

As this wave of new oral anticoagulants came to market, there were predictions (which turned out to be false) that warfarin would rapidly become an infrequently used anticoagulant. At Harvard-affiliated Brigham and Women’s Hospital, we have about 3,500 patients in our Anticoagulation Management Service who still receive warfarin. So, why were the initial predictions wrong? And why does warfarin continue to command more of the “market share” than these target-specific designer-drug anticoagulants?

The biggest concern is that the novel oral anticoagulants have not, until now, had specific antidotes to counteract major bleeding. Warfarin is a vitamin K antagonist, so a dose of vitamin K is an antidote to warfarin — though one that works slowly and unreliably. But the fear with the novel oral anticoagulants has been that the rare episode of major bleeding might not be controllable or rapidly reversed.
New antidotes pave the way for greater use of the new anticoagulants

The landscape changed drastically in October 2015, when the FDA approved a dabigatran antibody as an antidote to dabigatran. After a rapid intravenous injection of the antidote, dabigatran is attracted to its own antibody at least 300 times more strongly than to thrombin (clotting factor II). When dabigatran and its antibody bond, thrombin is liberated from dabigatran and can do what clotting factors do best—stop the bleeding. In an ongoing clinical trial, laboratory evidence of anticoagulation from dabigatran was reversed within minutes of injecting the dabigatran antibody antidote. Hospitals across the United States now have the dabigatran antibody available for emergency use.

Though catastrophic bleeding from the novel oral anticoagulants is extremely rare, the availability of antidotes reassures health care providers, patients, and their families. It changes the psychology of prescribing and tilts the balance more strongly toward the novel agents.

As for rivaroxaban, apixaban, and edoxaban, a universal antidote is in late and successful stages of clinical development. This antidote is not an antibody, but it is an attractive “decoy” for these three anticoagulants, all of which target clotting factor X. The antidote is more attractive to the anticoagulants than factor X is, even though it is only slightly modified from the structure of factor X. The decoy, which is inert, “fools” these three anticoagulants. They then detach from clotting factor X and bind to the decoy instead, liberating the unbound clotting factor X to stop the bleeding.

In summary, these two antidotes are important “backups” to our arsenal of novel anticoagulants. They permit us to prescribe the new agents with increased confidence. Regular exercise is one of the cornerstones for maintaining good health. Regular physical activity helps to prevent heart and blood vessel disease, diabetes, dementia, and even some types of cancer. But while the health benefits of exercise are indisputable, there is still a question about exactly how much exercise is needed to promote optimal health.

According to a recent article in The Journal of the American Medical Association by Thijs Eijsvogels and Paul Thompson, the answer may be “not as much as you might think.”
Every little bit of exercise counts

Drs. Eijsvogels and Thompson reviewed several published studies and concluded that as little as 15 minutes a day of moderate-intensity exercise — and only 8 minutes a day of vigorous-intensity exercise — reduced the risk of death. They referred to this as the “lowest effective dose.” This means that even a small amount of exercise may have substantial health benefits compared with being sedentary, and even people who are “too busy to exercise” can find this amount of time.

Exercising beyond the lowest effective dose had further health benefits. For every additional 15 minutes of moderate-intensity exercise, there was a further 4% reduction in the risk of death. The greatest benefit was seen in people who exercised for an average of 63 to 88 minutes a day, and vigorous-intensity exercise was better than moderate-intensity exercise.

Another new study, published in JAMA Internal Medicine, found that young adults who were physically fit (as measured by endurance testing on a treadmill) had a lower risk of developing heart and blood vessel disease over the next three decades. For each additional minute a person was able to stay on the treadmill, there was a 15% reduction in the risk of death and a 12% reduction in the risk of heart and blood vessel disease.
Putting the “lowest effective dose” of exercise to work for you

Taken together, these two new studies further underscore a single conclusion: you don’t have to be a triathlete to achieve health benefits from physical activity. Even small amounts of exercise and modest increases in fitness can make a clear difference, and some exercise is always better than no exercise.

If you need to increase your level of physical activity, it may be a good idea to start by counting your daily steps using a Fitbit or similar device (there are also free apps for your phone or tablet that can count your steps). Gradually increase your daily goal, and before you know it, you will be on track towards having a longer and healthier life.
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Myths about using Suboxone to treat opiate addiction

It used to be that prostate cancer screening was routine for men over the age of 50. Positive results on the prostate-specific antigen (PSA) test would trigger a biopsy, and findings of cancer would lead almost inevitably to treatment.

But recently, the rate of PSA screening in the United States has fallen sharply — and the number of new cases of prostate cancer has dropped, too. That’s according to a pair of studies published together this past November in The Journal of the American Medical Association. The studies couldn’t prove that these two trends are causally related; however, the authors speculate that they are. That is, the drop in the number of new cases likely reflects declines in screening, rather than a drop in the number of men who actually have prostate cancer.

Like some other cancer screening tests, such as mammography for breast cancer, the PSA test has come under growing scrutiny. Experts say that it flags too many low-risk tumors that might never become harmful during a man’s lifetime. Treating those cancers can expose men to a needless risk of impotence, incontinence, and other side effects.
Why the numbers are dropping

In 2008, the United States Preventative Services Task Force (USPSTF), an influential volunteer panel of medical experts, came out against PSA screening in men older than 75. Then in 2012, they issued an updated recommendation against screening for all men, regardless of age, race, or family history. These recommendations are controversial. Even though many experts acknowledge the PSA test’s limitations, they worry that abandoning the PSA test altogether will boost diagnoses of late-stage tumors that may no longer be curable.

One of the newly published studies reviewed national PSA screening data collected between 2000 and 2013. Results showed that screening rates started falling in 2010, but only among men younger than 75, and especially within the 50-54 and 60-64 year age groups. The overall screening rate (for all men combined) fell from 36% to 31%.

The second study detected a similar drop in PSA screening rates — from 37.8% to 30.8% — as well as a 22% drop in new prostate cancer diagnoses. The authors of this study reviewed data maintained by the National Cancer Institute and found the number of diagnoses per 100,000 men ages 50 and older had fallen from 540.8 cases in 2008 to 416.2 cases in 2012. The biggest declines came after the USPSTF released a preliminary draft of its updated screening recommendations in October 2011.

“These are the first national, population-based data showing what appears to be an effect on prostate screening and diagnoses from the Task Force recommendations,” said Ahmedin Jemal, DVM, Ph.D., vice president of surveillance and health services research at the American Cancer Society, and a key author of the first study.
Don’t write off PSA screening just yet

In an accompanying editorial, Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, cautioned that the “pendulum” of popular opinion might be swinging too far away from screening. But rather than stopping screening altogether, Penson called for smarter, more targeted screening approaches directed mainly at men considered at high risk of developing prostate cancer.

“These new findings are an expected consequence of the Task Force’s conclusion that PSA testing probably causes more harm than good,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. However, Dr. Garnick also called for better screening tests, acknowledging that the number of men presenting with more advanced prostate cancer is now likely to rise. “We also need studies that offer focused screening to those at potentially high risk of more aggressive forms of prostate cancer,” he said. “The research should test whether early treatment saves lives or decreases the rates of prostate cancer mortality. Until we have those data, the true effect of decreasing screening rates will remain unknown, and the debates about PSA testing will continue, with no clear answers in sight.” Traveling with your children can be a great way to explore new places, spend time together as a family, and visit with those friends and family members who don’t live nearby. To have the safest and healthiest trip possible, keep in mind these travel tips.
Bring the important things from your medicine cabinet

    Pack any prescription medicines your child takes. Check to be sure you have enough for the whole trip.
    Bring commonly used over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), antibiotic ointment, cold medications (as recommended by your doctor), and diphenhydramine (Benadryl).
    Carry a thermometer and a few Band-Aids on every trip; they can come in very handy. Consider a pair of tweezers, too, if your child gets splinters often.

Kids need car seats

    Make sure you have the proper seat for your child’s age and weight, and that it’s correctly installed in the vehicle you are traveling in. The website of the American Academy of Pediatrics offers tips on choosing and installing car safety seats.
    If you are traveling by plane, the Federal Aviation Administration strongly recommends bringing car seats for infants and toddlers and fastening them to an airplane seat. Remember that you will have to purchase a separate ticket for the child in order to use the seat. Check with the airline to see if discounts are available. The car seat must be less than 16 inches wide to fit; be sure to measure before you go! Booster seats are not allowed on planes.

Be aware of common travel health problems

    If your child easily gets carsick, make sure she is high enough in the car to see out the window, as this can help. Keep a window cracked open for a breeze, and have some light snacks such as pretzels available; both can help nausea go away. If your child has particularly bad carsickness (for example, she vomits every trip), talk to your doctor about medications she might take.
    Ear pain can be a problem when people fly. Having an infant nurse or take a bottle during take-off and landing is a good idea, as swallowing helps combat ear pain. For older children, try having them drink, chew gum (sugarless, of course!), or play a yawning game to prevent their ears from blocking up.
    Since schedules and what you eat when traveling are often different than when you’re home, constipation (not having a bowel movement as often as usual) may happen. Give your child plenty of fluids, and make sure there is fiber (fruits, vegetables, whole grains) in his diet.
    Germs can be anywhere when you travel. Carry hand sanitizer with you at all times, to help you bring fewer of them along with you!

Don’t forget about childproofing

    Bring along a childproofing kit with outlet covers, cabinet locks, and whatever else you use at home.
    If staying at someone’s house, you may not be able to childproof the entire place. Ask if there is one room you can completely childproof, so you can relax better while your child is there. Think about the biggest dangers, such as medications, cleaning fluids, knives, and potential choking hazards. Ask if those and any other particularly dangerous things can be moved and/or locked out of reach during your stay.
    For infants and toddlers, a portable crib can serve as both a bed and a safe place to play.
    Consider bringing safety gates with you to block stairs or to help keep your child in a safe room. Your host may appreciate it if you use the kind that open out, as opposed to ones that need to be climbed over.

Do your homework

    Write down your child’s medical information, especially medication allergies (if you forget the name of the antibiotic that gave him the rash, find out before you go!), health problems, and prescription medications. Keep it with you at all times. If your child needs to see a doctor while you are traveling, she’ll need to know these things.
    Bring the names and phone numbers of all doctors your child sees, including specialists, in case you or a doctor you see needs to contact them.
    Ask your doctor about the best hospitals in the area where you are traveling, so you’ll know where to go if necessary.
    Make sure you bring your health insurance cards, and check with your insurance company about coverage out of your area. Most companies will cover emergency care if your child needs it, but you may need to call for approval or go to a particular hospital.

If traveling outside of the country…

    For travel to certain countries, your child may need special vaccines. To find out the latest recommendations, visit the Traveler’s Health section at the U.S. Centers for Disease Control and Prevention (CDC) website. Do this at least six to eight weeks before traveling, as many of the vaccines need to be given at least a month before travel and you may need an appointment at a special travel clinic to get certain vaccines.
    Find out about the particular health risks, such as malaria or dengue, in the country where you will be traveling so that you can talk to your doctor before you go about how to prevent them. The CDC’s website can help with this. It also has lots of useful, practical information about topics such as safe food and water and traveler’s diarrhea.

It sounds like a lot, but mostly it’s just a matter of planning. And it can make a big difference when it comes to making your trip memorable for all the right reasons. In the United States, depression is the top cause of disability, but only 21% of patients diagnosed with major depression get treatment that meets the guidelines of the American Psychiatric Association. Of people seeking depression treatment, those who’d like to be treated with live psychotherapy outnumber those who’d like to be treated with medication three to one, but those who want live therapy often don’t receive it. Access to psychotherapy is limited by the number of professionals in one’s region, cost, and logistics — not to mention stigma. And when people do get therapy, therapists may not provide care that is evidence-based.

One way to get high-quality psychotherapy to people who need it is to automate and computerize the treatment process and deliver it through websites and apps. This could potentially offer guidelines-based treatment to anyone, anywhere, anytime, at a modest cost. Stand-alone computerized cognitive behavioral therapy (CCBT) has been found to be effective for the treatment of depression, and is already available from a few entities. But it’s still not known how much, if at all, CCBT would improve treatment of depression in primary care, so a group of researchers in the United Kingdom recently tested the advantages of adding CCBT to standard treatment. They randomly assigned 691 people with depression into three different groups. One group received standard care, and the others received standard care plus one of two online CCBT programs.
Comparing CCBT with standard care for depression

As it turns out, standard depression treatment in UK primary care centers is quite good. Citizens are routinely offered antidepressant medications, psychotherapy, and access to community mental health teams, psychologists, psychiatrists, and counselors — a range of resources seldom available in US primary care practices.

There was a lot of crossover between the study groups. In the “standard care” group, 19% ended up using CCBT even though they weren’t specifically assigned to that treatment. Between 77% and 84% of all three groups used medication to treat their depression, and “live” mental health specialists were seen by 17% of one and 24% of the other CCBT group.

Against this backdrop — with many participants in the CCBT groups also receiving mental health specialty treatment and 19% of the standard-practice group receiving CCBT — no significant difference in depression treatment results was found. However, in the US, the findings may have been very different, considering the limited array of mental health resources in most primary care clinics.

It would be most interesting, and more important, to know the benefit of using CCBT for patients who receive nothing else — no medication and no access to mental health specialists. It’s for these patients that CCBT might be the most beneficial.
Challenges in getting people to use CCBT for depression treatment

Both of the CCBT websites had been tested in previous clinical trials and both had been found to be effective treatments — but they’re only helpful if people use them. Even though the two stand-alone CCBT websites were designed to be used over either 6 or 8 “sessions,” most people only used them once or twice, even though the study provided reminder calls to the participants. People with depression can experience fatigue, impaired concentration, and feelings of hopelessness. Getting them to consistently use CCBT websites on their own schedule is a challenge — even if these programs might be helpful in the end. More structure may be needed to keep people using CCBT.

What’s the take-home? The biggest challenge isn’t building a CCBT program that works; it’s building one that people will use. Just as you need to entertain before you can educate, any CCBT program needs to be extremely engaging to users — and to provide immediate value from the first session. And, although the treatment-anywhere-anytime concept is alluring, relying on people to schedule CCBT themselves on their own time, in their own homes, may lead to high levels of drop-off; after all, you can always get around to it later. When I was growing up, my doctor still made house calls when we were too sick to get to his office. But he stopped visiting people at home long before he retired. Both he and his patients realized they were perhaps better served by going to his clean, well-equipped office for whatever care they needed.

So I was more than a little surprised when a woman representing my health insurance plan called to schedule me for a home visit from either a nurse practitioner or physician. I have a Medicare Advantage plan, and I thought I was being offered this visit because the caller assumed I was frail and house-bound. I assured her I could easily get to my doctor’s office if I needed to. I’d also just had my annual physical, my immunizations and screenings were up to date, and I felt great. Why would I need a home visit?

The only reason she could give was that the clinician would have more time to spend with me than my own doctor did. The home visit would last 45 minutes to an hour and would include a health history, a physical exam, screenings, and health advice. Since I work full-time, I could schedule the visit for a weekend. And she’d even throw in a $25 Walmart gift card if I completed the exam.

I declined, feeling a little creeped out — especially after checking with my doctor and learning that she knew nothing about this. So I did a little research.

I learned that these visits are legitimate — in fact, over a million patients have signed up for them so far. And I learned that the extra exam had reduced hospitalizations, primarily for patients with diabetes, heart failure, or chronic obstructive pulmonary disease. But what still puzzled me was why my insurer would want to incur the extra expense of duplicating the exam and tests I had just gotten from my doctor. I don’t have any serious conditions and my doctor consistently receives top grades from all the ratings systems.
A method to the supposed madness

Dr. Michael McWilliams suggested an answer. As an associate professor of health policy at Harvard Medical School, he understands the arcane regulations that cover how Medicare reimburses my Medicare Advantage plan for the care I get. He told me that each of us covered by these plans is assigned a risk score. As we develop more health problems, our risk score increases. “The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare.  Generally speaking, the more diagnoses recorded, the higher the payment,” Dr. Williams says.

He explains that the risk adjustment system was created to ensure that plans don’t enroll only the healthiest patients, who are less likely to run up charges for expensive procedures and hospital stays. To provide an incentive for insurers to cover sicker patients, the plans are paid commensurately more for their care.

I’ve received two more calls since I first declined the home visit, each more persistent than the last. Now I understand why. If the clinician could diagnose me with a serious health condition, the company could raise my risk score and get a higher Medicare reimbursement each time I visit the doctor.
What to consider if you’re offered a home visit

If you or someone you know is offered a home visit from a Medicare Advantage plan, keep the following in mind:

    If you have a serious health condition, the extra care might help you avoid a hospital stay.
    The care they provide isn’t ongoing. This is the only time you will see the clinician who examines you. The results of the exam and tests will be forwarded to your regular clinician for follow-up.
    If you are healthy and the visit results in an increased risk score, you won’t have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation’s rising health care costs.
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Tuesday, 9 April 2019

How to maintain your health living status

My mother was lucid and alert when she was hospitalized for pneumonia. But by the middle of the first night, she was wondering how she had ended up at a “hotel” that allowed strangers to enter her room at all hours. The second night, she wandered into the corridor, slipped, and fractured a hip. She didn’t leave the hospital alive.
What is up guys it is I cannot hear and we got a very special episode because they I am back with

today’s Tips is why is French So Dan sexy because me personally as an American as someone who learn French I learned it you know little little bit because it has such a reputation for being so

happy. So and it’s funny because a lot of French people are Belgian people like French is not last section. But for us Americans. It really is like a language of this language of love. It’s a language of just just pure unadulterated sexiness heard that so many times when people are telling me all this sounds so sexy.

I mean it’s normal for me is true is cheating because you got a nice voice to you know, maybe to basically how this video is going to work is I’m going to have five sentences that I’m going to say well she’s going to say them in first and French and I’m going to say the English version and you guys can tell me what sounds sexier in the comments below. And then after that we have a little bonus.

So the other five senses is I’m going to be speaking in my other languages and where to be comparing those languages to French. So for example, like Japanese versus or Russian versus French etc. Alright, are you ready for this?

Yeah.

Alright, so the first one the sound sound as sexy as possible, you know, look into the camera do what you gotta do

now in English, your feet need to buy some so

I think French would add like a French sexiness. You know,

we will definitely video editor put that in A Meeting if you fall down 1000 times get back up 1000. I don’t know. I don’t know. What would you feel about that guys? Yeah, yeah, you guys have to tell us like best for every sentence you can put in the comments below. Like, for example, I was sentence number two. You just put like, you know, 1-234-567-8910 and you can say like, either friend or sexier or English or another language that the sexier right so got it done in English. That dude is

can’t even see this anymore. I don’t I don’t know what to do. I feel trapped.

Okay, that dude is so dirty he never wash. I would have to get that to French in French. I don’t know it sounded like you were just talking about it kind of felt like I was giving you some company yeah

Related Post: Best Way to Learn French at Home for Free

yeah was like it was like you know anyone anyone that was speaking English the walks by would be like

instead of you’re like, really? Like it was actually nice to know many languages because you never know if someone is talking shit behind your back. Yeah, happened to me so many times when I was traveling in so many fights, just because people were like talking shit behind me. But they didn’t know it’s being friends. They love to do it to do it. Unfortunately, for me, even though there’s like six languages that I understand. I haven’t actually had the experience. I don’t know why. I don’t think people will really talk shit about why

Next one

is we can Play play play. Oh please. Alright so it’s Can I have some eggs with bacon and cheese and do some little bit better French? I don’t know this is a big no

no, no. Sometimes people like my mom always says like sometimes at soccer like people are like yeah there’s like a recipe recipe boys and I like this and normal Yeah, but in some ways like this normal so you know, it’s

all right. Next one. Let me wait. Was that sexy? way too much. That was that was like I’m fine. The translation was follow me on Instagram I can I take the best photos that’s what’s up and you should her influence Mana Mana mine is I can obey and now we’re getting to the bonus round all right but obviously be sure don’t forget to comment what you thought one every single sentence little battle every single sentence and now we’re going on to sentence number six I am pretty sure I’m going to see some comments from American people home saying own lead different oh don’t do that to her no come on come on okay so it’s going to be Dutch and since it’s a different language I’m gonna say it first so first let me say the English translation you are unbelievable I’m very impressed to indulge it is a bet on hopefully you’ve been air under the intro Wow tell us what you think is in the next one is Chinese

New sure pretty good

not bad phrase I put in Chinese The next one is you know next one is Japanese

I’m really gonna try with this one

Facilitate Why are you taking

up the sexy we’re gonna crank up let’s crank up the the sexiness level that mean that means like from this point on forget about me

that’s become I don’t speak Spanish is my next language. So I got to put a little bit of spice in the Japanese for now. You know will be more. Okay, sure it is. We wait. I gotta be more.

Yeah. Oh

actually I wanted to do another Chinese one. Just

throw it in there again, iTunes, Joshua. Ciao. Ciao.

Basically what I said was love and french fries are basically the same thing.

Give it to give it some some prison one as far

Alright guys so we have come to the final one I hope it has been interesting so far but now it’s time to get serious and sexy to want to go with Russian and

yeah

because when you have to push it really sounds like you know what I said was I wanted tickle your belly but never know you never know when that phrase might you know might come up because like this the way you said it was very late so I will freak out freak out.



That was not bad. Not bad. I’m not sure which one sounds sexy though but obviously

I had to include at least one funny phrase in there otherwise

well yeah that was a little sexiness competition and I think for the most part French came out on top for a lot of different things but maybe one or two of the other languages or maybe even you find English to be sexy but you gotta let us know so definitely let us know in the comments again this is Brendan monitor Instagram right here definitely go follow her you know she’s on the quest to hit that 50 k myself I’m on the quest to hit that 10 k I’m getting close to I think I like 7000 something followers now so it would be dealt if you guys uh. You know show your support and give us a follow that’s my music to me and and she has a music coming soon. So definitely, you know, show your support give us some love and hate that follow one as well as of course subscribe And yeah, guys, thank you so much.

Her story, though extreme, is sadly typical. According to several major studies, about half of people over 65 have episodes of delirium — a sudden change in mental status — during hospital stays, and those who do are at increased risk for falling, requiring nursing home care, and developing cognitive impairment and dementia.

It’s easy to understand why hospitalization can be disorienting. Your daily routine is overturned, you are introduced to a stream of new caregivers, and it’s hard to sleep through the night. Anesthetics or sedative medications can also affect your mental state. But decades ago, Dr. Sharon Inouye, professor of medicine at Harvard Medical School, recognized that delirium in older patients isn’t an inevitable consequence of hospitalization.
HELP during hospitalization

Dr. Inouye and colleagues developed the Hospital Elder Life Program (HELP). Available at 200 hospitals in the United States, HELP involves identifying patients at risk for delirium when they enter the hospital and assigning them to receive special care to minimize six major risk factors associated with delirium — cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Studies have found that HELP is associated with significant reductions in the percentage of patients who develop delirium. It is also linked to fewer falls while in the hospital, shorter hospital stays, fewer nursing home admissions, and a lower rate of cognitive and physical decline.
What you can do to avoid delirium

If you or a loved one is scheduled for a hospital stay, ask whether your hospital has HELP or another program for preventing delirium. If not, there are several things you can do as a patient or caregiver.

If you’re going into the hospital:

    Gather your records. Prepare a “medical information sheet” listing all your allergies, the names and phone numbers of your physicians and your usual pharmacy, all your medical conditions, and all the medications — both prescription and nonprescription — you’re currently taking. Have your medical records forwarded to the doctors who will be caring for you.
    Bring the essentials. You’ll need your glasses, hearing aids and fresh batteries, and dentures. Ask if you can bring a few familiar things like family photos, a good book, or an MP3 player with your favorite music or relaxation exercises.
    Set up a support team. Let family and friends know you’re being hospitalized and ask them to visit.

If you’re a caregiver:

    Arrange companionship. Schedule family and friends to visit in shifts — and stay overnight, if possible.
    Work with the nurses. See if they’d like your help in encouraging the person to eat, stay hydrated, and to participate in rehabilitation therapy.
    Be vigilant. If you notice signs of confusion, memory problems, or personality changes, let the nurses or physicians know immediately.
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