‘World’s heaviest woman’ dies

(CNN)Eman Abdul Atti, once believed to be the “world’s heaviest woman,” died on Monday due to complications from heart disease and kidney dysfunction, according to a statement from Burjeel Hospital in Abu Dhabi, the United Arab Emirates.

The 37-year old Egyptian woman weighed 1,102 pounds (500 kg), her family reported, prior to undergoing weight reduction surgery at Saifee Hospital in Mumbai in March.
All signs looked positive immediately following the surgery for Eman, who had lost more than 200 pounds prior to the operation.
    “She is very happy, she started dancing in her bed,” Dr. Muffazal Lakdawala, the surgeon who performed her laparoscopic sleeve gastrectomy operation, told CNN in March. “Her smile has come back.” The procedure involves removing part of the stomach so that only a “sleeve,” roughly the size and shape of a banana, is left behind, along with the muscle that controls emptying food into the intestine.
    On September 9, Eman celebrated her 37th birthday.

    Early difficulties

    Eman’s family said Eman had weighed 11 pounds (5 kg) at birth and suffered from thyroid problems since she was a child. The thyroid gland produces hormones that help regulate metabolism. By fifth grade, she’d stopped going to school because she’d begun to have difficulties moving and walking.
    For the past two decades, Eman has barely left her room, her family reported. She suffered a stroke and, unable to move or communicate, her weight increased to more than 1,000 pounds. Her health deteriorated rapidly.
    Her sister created a social media campaign last year and Lakdawala responded by offering to help. His proposed three-and-a-half year plan including two operations to help her reduce her weight to less than 220 pounds (100kg).
    Eman overcame a number of hurdles to reach what her family had hoped to be a life-saving surgery in Mumbai, including an initial refusal to grant her a visa because of her inability to get to the embassy in person. After surmounting that problem with the help of an Indian minister, she then faced the difficulty of boarding an airplane.
    Egypt Air specially adapted a cargo plane to transport her to India.
    Following the surgery, Lakdawala said her kidney function had improved.
    “She has done well post-surgery,” he told CNN in March. At that time, he intended for her to lose another 155 to 175 pounds (70 to 80 kg) within the next couple of months. The plan was to then send her home to Egypt and schedule a second surgery for next year.

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    Eman was later transferred to Burjeel Hospital in Abu Dhabi. There, her condition was managed by a medical team of more than 20 doctors in different specialties.
    However, her heart and kidneys could no longer function.
    Her family expressed appreciation for the care provided by Burjeel Hospital and the support of the people of the UAE, according to the hospital statement. “Our prayers and heartfelt condolences go out to her family,” Burjeel Hospital staff said in the statement.

    Read more: http://www.cnn.com/2017/09/25/health/heaviest-woman-dies-bn/index.html

    Hedonism is good for your health

    I think I might be a hedonist. Are you imagining me snorting cocaine through $100 notes, a glass of champagne in one hand, the other fondling a stranger’s firm thigh? Before you judge me harshly, I know hedonism has a bad reputation, but it might be time to reconsider.

    What if, instead of a guaranteed one-way road to ruin, hedonism is good for your health? If we think of hedonism as the intentional savouring of simple pleasures — like playing in fallen leaves, moments of connection with friends, or cuddling the dog — then it probably is. Seeking and maximising these kinds of pleasures can boost our health and well-being.
    So where do our ideas of hedonism come from and how can we harness hedonism to improve our health and quality of life?

      The popular view of hedonism

      In broad terms, a hedonist is someone who tries to maximise pleasure and minimise pain. Jordan Belfort (played by Leonardo DiCaprio) in The Wolf of Wall Street is probably the popular idea of the quintessential hedonist, where his extreme wealth allows him to indulge his insatiable hunger for all things pleasurable.
      Hedonism Bot from Futurama is another character exquisitely in touch with things that provide pleasure.
      We find these characters so compelling because they seem to reject the sensible, responsible way to live. They indulge their carnal appetites in ways we daren’t, with scant regard for consequences. We wait for their liver to rebel or their life to come crashing down around them, as of course it must.
      But this kind of behaviour is better termed debauchery — extreme indulgence in bodily pleasures and especially sexual pleasures — rather than hedonism.
      Hedonism has its philosophical roots as far back as Plato and Socrates, but ancient Greek philosopher Epicurus is often credited with articulating an early brand of hedonism based not on a life of untamed appetites, but on moderate pleasures and respect for others.
      Today there are multiple views on what hedonism is. This is largely due to some highly nuanced philosophical arguments about how we should conceptualise pleasure.

      What is pleasure?

      It might help to think of pleasure simply as a subjective state of enjoyment. This is a broad perspective, but one easily applied to our everyday lives. So, a lover’s caress gives me pleasure, but so can a piece of music, laughing with friends, or simply sitting still in a comfy chair after a frantic day.
      Just as different experiences can bring a similar shiver of pleasure, the same experience can conjure a range of responses — from extreme pleasure to definite displeasure — in different people.
      There is no single stimulus that elicits exactly the same response in everyone all the time: pleasure is an interaction between the stimulus and the perceiver.
      If you close your eyes and think about a time you experienced a tingle of pleasure, chances are you’re remembering a sexual experience, or something delicious you’ve eaten. Perhaps the memory is of a very good glass of wine, or those last 50 metres of a long, satisfying run.
      And these are good things, right? Sexual pleasure is linked with health and well-being. For example, women who say they are satisfied with their sex life score higher on measures of psychological well-being and vitality. A regular glass of wine is said to have a protective effect against dementia and heart disease, perhaps due to its antioxidant flavonoids. And everyone knows the advantages of physical fitness.
      Well, these activities are good … until they’re not. Many of the things that commonly give us pleasure can also be used in risky or harmful ways.

      When pleasure becomes a problem

      Dependence, addiction, bingeing and compulsive consumption can be thought of as risky or harmful uses of otherwise pleasurable experiences, like using alcohol and other drugs, doing exercise and having sex.
      It can be difficult to pin down the point at which a previously pleasurable behaviour becomes problematic. But, somewhere between enjoying an occasional beer and needing a drink before getting out of bed each morning, we’ve passed the tipping point.
      At this stage though, pleasure is no longer the motivation, nor the result, of the behaviour. The uncontrollable “hunger” has wiped the pleasure away and the best we can hope for is relief. Without pleasure, the behaviour is no longer a hedonic one.
      The single-minded pursuit of one intense pleasure at the expense of other aspects of life that bring meaning and pleasure is also counterproductive to living a rich and enjoyable life. This puts it well outside Epicurus’ idea of moderate pleasures and self-control.

      Let’s be rational about hedonism

      So, when we need to make the mortgage or rent and keep our complex lives on track, what might a modern hedonist’s life look like?
      A practical definition might be someone who tries to maximise the everyday pleasures while still balancing other concerns. I’ll call this a kind of “rational hedonism”. In fact, Epicurus emphasised a simple, harmonious life without the pursuit of riches or glory.
      Maximising pleasure, unlike with debauchery or addiction, need not take the form of more, bigger, better. Instead, we savour everyday pleasures. We relish them while they’re happening, using all our senses and attention, actively anticipate them, and reflect on them in an immersive way.
      So, if my morning coffee gives me pleasure, I might pause and relish it while I drink it: inhale the fragrance of it fully and focus on the nuanced warm, smoky, bitter deliciousness of it. I should fully attend to the warmth of it in my hands, to the feeling of it in my mouth, and to the cascade of sensations and flavours it delivers.
      Not only that, in the morning, before my coffee, I can anticipate it. I can think how lovely it will be. And later, as I go about my day, I can pause and think about that coffee, about just how warm and good it was, how it smelled and tasted.
      In other words, I can immerse myself in these moments, in the anticipation, in the drinking itself, and in the remembering, and bring all my attention to them. This kind of savouring results in a totally different, and richer, experience than if I absent-mindedly gulp down the coffee while dodging traffic and talking on the phone.
      The act of savouring intensifies the pleasure we extract from simple things and delivers greater satisfaction from them. One study found that spending a little time savouring the anticipation before eating chocolate led participants to eat less chocolate overall.
      And attention seems to be key to the link between pleasurable feelings and well-being.

      How do we benefit from hedonism?

      A state of pleasure is linked with reducing stress. So when we feel pleasure, our sympathetic nervous system — that fight or flight response we experience when we feel threatened — is calmed. First of all, the stimulus arouses us, then if we appraise the situation as safe, we have “stress-terminating responses“, which we experience as relaxation or stress relief.
      Studies show pleasurable emotions are associated with broader and more creative thinking, and a range of positive outcomes including better resilience, social connectedness, well-being, physical health, and longevity. So, pleasure might not only help us to live more enjoyably, but longer.

      Hedonism for health and well-being

      Maximising everyday pleasures can be used in therapy and shows promise as an intervention for depression.
      One study of school children showed focusing on pleasurable daily events, in this case recording them in a diary, reduced depressive symptoms, and the effect was maintained three months later.
      Focusing on the pleasurable aspects of healthy foods can also be a more effective way to eat more of them than focusing on how “healthy” they are. Similar approaches are likely to be effective with exercise and other behaviours associated with health benefits.
      What we know about the benefits of this kind of rational hedonism is likely to grow from here. We have only just begun to explore the therapeutic value of shifting focus to fully attend to and maximise pleasure.
      We do know that interventions encouraging individuals to focus on pleasurable experiences are associated with increased self-reported well-being.

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      Promoting well-being in older adults is a particularly promising area. Savouring pleasure is linked to resilience in older adults and positive emotions can help to offset the ill-effects of loneliness. Plus, regardless of physical health status, the ability to savour is associated with higher levels of satisfaction with life.
      And savouring can be taught. One study, looked at the effects of an eight week program promoting savouring for a group of community dwelling adults aged 60 and above. The program reduced depression scores, physical symptoms and sleep problems, and increased psychological well-being and satisfaction with life.
      In the meantime, we should defiantly shake off the idea that pleasure is slightly shameful or frivolous and become early adopters of this rational kind of hedonism. We can think of Epicurus, and intentionally savour the simple pleasures we have learned to overlook.

      Read more: http://www.cnn.com/2017/09/12/health/hedonism-partner/index.html

      Benefits of water: Are you getting enough fluids to stay healthy?

      (CNN)Water is known as the elixir of life, with good reason. Every system in your body needs it to survive.

      This feature is part of CNN Parallels, an interactive series exploring ways you can improve your health by making small changes to your daily habits.
      “Water regulates our body temperature, keeps our joints lubricated, helps prevent infections and delivers nutrients to our cells,” said registered US dietitian and CNN contributor Lisa Drayer. “Additionally, our kidneys and liver work hard to get rid of toxins in our bodies, and they depend on water to do their job.”
      Water makes up about 60% of your body’s weight, and although you can survive without food for weeks, dehydration can kill you within days or even hours, depending on the temperature and your environment.
        Dehydration means more water is moving out of your body’s cells than into them. And as this happens, it’s not just water that you lose. Small amounts of electrolytes critical to cell function and energy, such as sodium and potassium, are lost along with the water.
        You’re constantly losing water and electrolytes throughout the day via breath, sweat, urine and bowel movements, so even mild dehydration can exhaust you and affect many of your body’s daily functions.

        Hydration and your health

        You could quickly become constipated as your colon steals water from your stool to keep your digestive system moving. Urine will become darker; prolonged dehydration can also crystallize salts and minerals in urine, possibly leading to the formation of painful kidney stones.
        Because dehydration can often be mistaken for hunger, you might gain weight as you try to satisfy your body’s needs. Fortunately, the opposite is also true if you’re hydrated.
        “If you are looking to lose weight, water can help you shed pounds,” Drayer said. “Drinking a glass of water before a meal can fill you up a bit and help you eat fewer calories at a meal.”
        If you suffer from migraines, studies show that a lack of fluids might easily trigger an episode. Headaches are also likely to last longer if you’re low on fluids. In addition, dehydration can leave you unable to concentrate, cause short-term memory problems and leave you feeling moody and anxious.
        “When you’re well-hydrated, your sleep quality is better, your cognition is better, you function better, your mood is better, the list goes on,” said Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, which studies athletic performance — another area that benefits from drinking enough fluids.
        “We did a study on people who were mildly dehydrated, which can happen within just 30 minutes of exercise,” Casa said, “and we found mood was compromised in both men and women.”

        Signs of dehydration

        The signs of dehydration differ by age group. Infants and young children may not be able to recognize their need for fluids, so it’s critical to provide frequent fluid intake and keep an eye out for symptoms of dehydration: irritability or lethargy, no tears when crying, no wet diapers for as little as three hours, a dry mouth and tongue, sunken eyes and cheeks, and a shrinking of the soft spot on top of head.
        Adults show much different signs of dehydration, including fatigue, dizziness, confusion, less-frequent urination and extreme thirst, but the latter has one exception: the elderly. Older adults may not feel thirsty but can still be dehydrated.
        That’s why one of the best ways to tell whether you’re lacking fluids is by the color of your urine.
        “The morning is the best time to get a global sense of your hydration status,” Casa advised. “If your urine looks more like apple juice instead of lemonade, then you’re dehydrated. On the flip side, the need to urinate throughout the day is a sign that you’re well-hydrated.”

        Additional causes of dehydration

        A lack of fluids is not the only cause of dehydration. Certain blood pressure and diuretic medications can increase urination, as can diabetes that has not been diagnosed or isn’t well controlled.
        A sudden and extreme episode of diarrhea or vomiting can remove a large amount of fluids in a short amount of time. Add a high fever, and you could be in trouble quickly. Upping fluid intake, preferably fluids fortified with electrolytes, is critical.
        Sweating due to hot, humid conditions or extreme physical activity is another sure way to become quickly dehydrated. Athletes and those who work outside have to be especially careful to avoid heat injuries including muscle cramps, heat exhaustion and seizures.
        Hypovolemic shock, in which low blood volume causes a drop in oxygen and blood pressure, is the most serious form of dehydration and can be life threatening.

        The many sources of water

        What’s the best way to stay hydrated? Drinking plain water, of course, can’t be beat. It’s readily available and has zero calories.
        But what if, like many Americans, you don’t like the taste of water? Drayer suggests adding fruit or vegetables, such as lemons, berries and orange or cucumber slices, to enhance the flavor.
        The National Academies of Medicine recommends a little over 11 cups (2.7 liters) of fluids a day for the average woman and 15 1/2 cups (3.7 liters) for men. Though that may sound difficult to achieve, the fluids can come from many sources besides water, including food.
        “I often remind people that broth-based soup, as well as other beverages including tea, coffee and milk, count towards your daily fluid intake,” Drayer added. “Also vegetables including cucumbers, lettuce, celery and tomatoes and fruits including watermelon, cantaloupe and strawberries.”
        “Why don’t Americans like to drink water? Because we are conditioned to expect high levels of sweetness in everything,” said renowned nutritionist Dr. Walter Willett, professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health.
        “And that has led to a lot of problems,” he added. “High levels of sugar have adverse metabolic effects, and the amounts we get in beverages today is so huge that it is one of our major health issues.”
        Willett, who is also a professor of medicine at Harvard Medical School, has published over 1,700 research papers and reviews on lifestyle risk factors for chronic disease.
        “You might say we are malhydrated, because we drink so much soda and fruit juice and other sugar-sweetened beverages, and by that I mean we drink beverages that harm our health,” he said. “Even energy drinks and vitamin waters, most are loaded with sugar and not worth the use.”

        Calculate your fluids

        To help people make better choices about their fluid intake, the American Society for Clinical Nutrition’s Beverage Guidance Counsel created a “pitcher” of liquids to illustrate at a glance how much of each fluid is considered best for optimal health. Though it was created in 2006, Willett, who served on the council, said the guidance holds true today.

        The vast majority of your daily fluid intake should come from water. In this illustration, a person on a 2,200-calorie diet would drink about 50 fluid ounces of water a day, which is just over 6 cups (1.4 liters). Another 28 fluid ounces, which is 3½ cups or just over 700 milliliters, could come from coffee or tea.
        “There are health benefits to coffee. Studies show it can help with diabetes and has some modest cardiovascular benefits,” Willett said. “It’s a mild antidepressant. In fact, studies show about a 50% lower risk of suicide of with three to four cups of coffee a day.
        “Tea has about a third the amount of caffeine as coffee, so you’re much less likely to have sleep problems,” he added, “but we don’t see as many health benefits for tea as coffee.”
        The next choice in the fluid pyramid is skim milk, also sold as 1% milk, as well as soy or other unsweetened alternatives such as almond milk. For adults who wish to add that beverage to their diet, the maximum amount per day would be two cups (almost 500 milliliters).
        “Milk is really complicated area because it comes along with saturated fat,” Willett said, “and even low-fat milk is high in calories. Up to two servings a day is fine, but going beyond that is excessive.”
        Level four in the diagram includes diet sodas, teas and other beverages with non-calorie artificial or natural sweeteners such as aspartame, sucralose and stevia. Because there is growing evidence that these drinks might contribute to weight gain, Willett says they should be seen as an “occasional treat.” They are listed in the pitcher as no more than 16 ounces a day (2 cups or almost 500 milliliters); keep in mind that a typical can of soda is 12 ounces.
        Then come alcohol, whole fat milk, sports drinks, vitamin enhanced waters and fruit and vegetable juices. Yes, even fruit and veggie drinks are capped at 4 ounces a day.
        “Fruit juices are cautionary because they contain about the same amount of sugar as soda,” Willett said. “Orange juice has nutritional value, apple juice much less, so we recommend choosing orange over apple juice.”
        Alcoholic beverages are complicated, he added. “There are definite protective health benefits against heart disease for both sexes, but for women, even a half a drink a day can raise the risk of breast cancer. So if you’re not at risk for heart disease, there’s no benefit in preventing it, so there’s no reason to drink,” he said. That’s why alcohol is listed on Willet’s diagram as zero fluid ounces toward your daily amount.
        The last category is reserved for sugar- or high fructose corn syrup sweetened beverages such as regular soda, lemonade and fruit drinks. Willett says those get a ‘”thumbs down” because they provide no nutritional value and plenty of calories.

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        Taken as a whole, Willett said, the pitcher recommendations should come as a wake up call for anyone looking to quench their thirst.
        “The most important message is the source of the hydration,” he said. “Beverages can cause real harm. People are not dying of dehydration in America, so choosing beverages other than water and other healthy sources has major health implications.”

        Read more: http://www.cnn.com/2017/09/27/health/benefits-of-water-and-fluids/index.html

        People are living longer, but violent deaths are on the rise

        (CNN)Conflict, terrorism and gun violence are claiming more lives around the world now than a decade ago, according to a new study published Thursday in the health journal The Lancet.

        Deaths caused by war and terrorism spiked after 2006, with 150,500 reported in 2016 — a 143% increase from 10 years earlier. These fatalities occurred largely as a result of conflicts in North Africa and the Middle East, the researchers noted.
        Worldwide, gun deaths also climbed during the same period: In 2016, firearm suicide fatalities reached 67,500 and firearm assault casualties rose to 161,000, increases of 4.3% and 5.7%, respectively, from 2006.
          Guns may be the direct cause of more deaths, but the there was an overall 3% decrease in fatalities caused by self-harm during the decade ending in 2016, the study indicated.
          The Global Burden of Disease study, an annual assessment of health trends, provides worldwide and national estimates on more than 330 diseases, causes of death and injuries in 195 countries and territories. The study, coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, requires assistance from more than 2,500 researchers around the globe.
          One of several sunny spots in the report: Worldwide, people are living longer.

          Life expectancy on the rise

          Generally, male life expectancy was lower than female from 1970 through 2016. Currently, the average global life expectancy for women is 75.3 years, while men can expect to see 69.8 years on the planet. Life expectancy for both sexes combined is 72.5 years.
          By contrast, global life expectancy combined was 58.4 years in 1970 and 65.1 in 1990. In 2000, the combined expectancy was 66.8 years, and in 2005, it was 68.4 years.
          Of all the nations, Japan boasts the highest life expectancy at 83.9 years (a combined figure for both sexes), while people living in the Central African Republic can expect only 50.2 years, a global low.
          Several countries have seen recent large increases in life expectancy, far beyond expectations for their levels of development.
          These countries include Ethiopia, where life expectancy in 2016 was 64.7 years for men and 66.5 for women; the Maldives (77.6 years for men and 81.3 years for women); Nepal (69.7 years for men and 71.9 years for women); Niger (60.6 years for men and 62.8 years for women); Portugal (77.8 years for men and 84.0 years for women); and Peru (77.8 years for men and 81.6 years for women).
          These “exemplar” nations may offer insight into which policies are most successful for accelerating health progress, the study authors noted.

          Children reach a milestone

          “In 2016, for the first time in modern history, fewer than 5 million children under age 5 died in one year, as compared to 1990 when 11 million died,” Christopher Murray, a co-author of the report and director of the Institute for Health Metrics and Evaluation, wrote in an email. In 1970, 16.4 million deaths were recorded for this age group.
          Last year, lower respiratory infections, neonatal preterm birth complications and neonatal encephalopathy due to birth asphyxia and trauma were the most common causes of fatality for children under 5. Combined, these three causes resulted in 1.80 million deaths in 2016.
          Overall, there was what researchers described as a “profound” shift toward deaths at older ages: a 178% increase in deaths among people 90 to 94 and a 210% increase among those older than 95.
          In 2016, there were 1.7 million stillbirths worldwide. The rates decreased substantially between 1970 and 2016, from 41.5 stillbirths per 1,000 live births to just 13.1 per 1,000.
          This decrease occurred against a backdrop of increasing live births around the globe; in 2016, 128.8 million livebabies were born, compared with 114.1 million in 1970.
          Finland had the lowest rate of stillbirths at 1.1 per 1,000 live births, while South Sudan had the highest rate, at 43.4 per 1,000. Central sub-Saharan Africa’s stillbirths, which exceeded 23 per 1,000 live births in 2016, rank as the highest regional rates on the globe.

          Taking aim at early death

          A key measure of health is mortality — particularly at younger ages — and so avoiding early death from any cause is a key goal of health systems worldwide, noted the researchers.
          Early death is most often caused by diseases of various stripes.
          In 2016, noncommunicable diseases contributed 72.3% to the total number of deaths around the globe — 54.7 million — with 19.3% of deaths caused by communicable, maternal, neonatal and nutritional diseases. Injuries, including those incurred by violence, accounted for 8.4% of all deaths.
          “Population growth does not inherently mean there will be more deaths — it depends on a number of factors,” Mohsen Naghavi, a study co-author and a professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
          “We provide total counts of death, death rates by age, and age-standardized rates of death to tease out what component of change in deaths comes from a population increasing in size over time, the ageing of populations, and true change at each age,” Naghavi wrote.
          Ischemic heart disease — a condition that restricts blood flow throughout the body — caused 9.48 million deaths in 2016, an increase of 19% since 2006. It ranked as the leading cause of early mortality in all regions of the globe, apart from low-income countries.
          In the poorest nations, the leading cause of early death was lower respiratory infections, including pneumonia and other bronchial conditions. Combined, these resulted in 2.38 million deaths, a decrease of 8.2% since 2006. Diabetes caused 1.43 million deaths globally last year, an increase of 31.1% since 2006.
          Deaths from infectious diseases have decreased since 2006, but HIV/AIDS claimed 1.03 million lives in 2016 (a 45.8% decrease since 2006), while 719,500 people died from malaria (a 25.9% decrease) and 1.21 million died from tuberculosis (a 20.9% decrease) last year.
          Dengue, a mosquito-borne infection that can lead to a fatal hemorrhagic fever, increased sharply over the decade — by 81.8% — and caused 37,800 deaths in 2016. Extensively drug-resistant tuberculosis, which caused 10,900 deaths in 2016, also showed increasing rates throughout the past decade, rising by 67.6% since 2006.

          ‘Triad of troubles’

          Nearly one in every five deaths is linked to a poor diet, the report revealed. Diets lacking in whole grains, fruit, nuts and seeds and fish oils while providing too much salt were the most common dietary risk factors, the authors noted.
          As a result, high blood glucose, high blood pressure, high body mass index and high total cholesterol were among the top 10 leading risk factors for death for men and women globally.
          Nations and people are likely to tackle — or at least attempt to tackle — those diseases that kill at high rates, Murray noted, since death is a powerful motivator. “But, we’ve been much less motivated to address issues leading to illnesses,” he said
          Tobacco, which caused 7.1 million deaths across the globe in 2016, is another issue leading to illness.
          Another factor that sometimes lacks attention from policy-makers is mental illness, which in many cases contributes to disability.
          “Mental illnesses tend not to discriminate based on income,” Theo Vos, a study co-author and professor of global health at the Institute for Health Metrics and Evaluation, wrote in an email.
          “In 2016, 1.1 billion people were living with mental health and substance use disorders,” he noted. “Major depressive disorders ranked in the top 10 causes of years lived with disability in all but four countries worldwide.”
          Those four nations are American Samoa, Philippines, Myanmar and Indonesia.
          “There is considerable overlap between mental health disorders and substance use disorders,” Vos wrote. “People suffering from both types of disorders present considerable extra challenges to health services as one problem can interfere with the successful treatment of the other.”

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          Overall, the National Institutes of Health-funded study reveals a portrait of a globe precariously balanced between health successes and health failures — with some of the latter being intractable yet avoidable.
          “A ‘triad of troubles’ — obesity, conflict, and mental illness, including substance use disorders — poses a stubborn and persistent barrier to active and vigorous lifestyles,” Murray wrote.

          Read more: http://www.cnn.com/2017/09/14/health/global-gun-deaths-rise-study/index.html

          F1: How crashing out helps win races

          (CNN)Formula One drivers are famed for their jet-set lifestyles, but all that traveling around can catch up with them if they’re not careful.

          The F1 paddock cover around 100,000 miles over the course of the season and how a driver prepares for all that time on the road can play an crucial role in the outcome of races on the track.
          This weekend’s Singapore Grand Prix signals the start of a particularly grueling period for the teams with five grands prix in six weeks — three in Asia followed by two races in North America with the US Grand Prix taking place on October 22 before the F1 circus travels to Mexico a week later.
            In a bid to help their drivers crash out in bed rather than in a race teams turn to sleep scientists like Steven Lockley who ensure their stars are at their mental peak of their powers when the lights go out.
            “If you are healthy you can’t really get too much sleep and the more you get the better you perform — it’s been pretty well proven,” Lockley, an associate professor of medicine at Harvard Medical School, told CNN’s The Circuit.
            “F1 drivers are looking for every edge, every advantage and sleep is one of the tools they can use to make sure they are at optimal performance.”

            Circadian clock

            In Singapore, keeping jet lag at bay isn’t too problematic — the evening race allows drivers to stick to European time.
            “They end up going to bed at 3-4 a.m. Singapore time and get up about noon there,” Lockley says.
            But for the races that follow in Malaysia and Japan, longer, more complex plans are required.
            “We start shifting them to the new time zone before they leave, so they get a head start and then managing their light/dark cycles which is a key synchronizer of circadian clocks.
            “So when to see light but also when to avoid light — wearing sunglasses becomes an important component,” Lockley added.
            “We also use melatonin which is good at helping you shift your clock and we manage caffeine use so it’s being used optimally to help alertness, but minimizing the negative impacts on sleep.”
            Lockley provides his expertise to F1 through Hintsa Performance, a consultancy that work with several drivers on the grid, tending to all aspects of their health, from mental and physical well being to nutrition and recovery.
            Their team of coaches apply the philosophy of its late founder, and former McLaren team doctor, Aki Hintsa, who was a highly respected and much-loved figure in the F1 paddock.
            Lewis Hamilton, who worked with Hintsa at McLaren, has spoken glowingly about the Finn’s positive influence. Reigning world champion Nico Rosberg also credits Lockley’s guidance with helping him clinch the 2016 title.
            “I always struggled so much in all the years with sleeping when I got to different time zones … it took so much energy from me,” Rosberg explained earlier this year.
            But by following Lockley’s advice of making small adjustments ahead of races, the German’s fortunes were transformed.
            “I just had that little bit extra capacity and brain power, you know, and energy left for the crucial moments. Anything extra you can bring to the table is going to help you in that moment and that’s part of why I won the world championship.”

            Speedsters and spacemen

            Lockley has spent almost 25 years studying sleep and along with F1’s elite counts astronauts among his clients.
            “Through our work, NASA are putting new multi LED lights on the International Space Station so they can change the intensity and the color of the light to help with alertness when we want them to be performing well or to calm the brain before sleep.”
            Other more down-to-earth professions are also beginning to benefit from his expertise — notably police, firefighters, doctors and nurses whose body clocks are routinely under siege from night shifts and long working hours.
            Scientists already know a lot about these “all-nighters,” as Lockley calls them, but the effects of chronic sleep loss are only just starting to be better understood.
            “We didn’t realize until recently that this chronic sleep loss builds up pretty quickly and that’s a problem for most of us — that, and the impacts on long-term health, increasing the risk of heart disease, diabetes and cancer, is key,” Lockley said.
            “You can build up quite quickly what’s termed as a chronic sleep debt. Even within a couple of weeks if you’re only sleeping six hours a night you can be as bad as someone who has been awake for 24 hours straight.
            “We know that even eight hours a night isn’t enough to maintain performance day-to-day … there is no one walking around that does well after five or six hours of sleep, even though they might claim to. When you measure them objectively you find that they are still performing poorly.”

            Fast asleep

            With Lockley’s sleep plans to hand, few drivers will have any problem getting their eight hours in this weekend. Some spend even longer in bed — Force India’s rising star Esteban Ocon says he sleeps for 12 hours!
            “What I have noticed, even before I was involved, is that sleep is being prioritized — the drivers sleep a long time,” Lockley said.
            “They know that they need to sleep well … the drivers are wanting to sleep eight, nine, 10 hours a night because they know it makes such a big difference. They are, if you like, good advocates for sleep. They realize its importance and prioritize it in their planning.”
            Planning is the key word here, whether you’re an F1 driver, an astronaut or even a holidaymaker heading off on a long-haul flight.
            “The direction of travel — and how well you adapt — depends on your internal clock. Three quarters of us have a clock longer than 24 hours which means we find it easier traveling west, whereas a quarter of people actually find it easier to travel east,” says Lockley, whose jet lag advice will shortly be available on an app called Timeshifter.
            “Knowing whether you are a morning type of an evening type is a good start. Think about your direction of travel and plan your trip accordingly. Start to shift before you go. If you’re going west, go to bed a bit later for a couple of days before. If you’re going east go to bed earlier.”
            But what about Lockley? Does he ever suffer from jet lag?
            “The jet-lag guy can’t have jet lag so I plan and follow the program when I travel. My wife and I traveled to Australia for the first time about 10 years ago and that was the first time she really believed I knew what I was talking about!” he says.
            “That was the proof of the pudding.”
            The 2017 Singapore Grand Prix takes place on Sunday September 17

            Read more: http://www.cnn.com/2017/09/14/motorsport/f1-singapore-malaysia-japan-jet-lag-sleep-rosberg-hintsa/index.html

            Here’s what would happen to Jimmy Kimmel’s son if Graham-Cassidy passes

            (CNN)It was frightening news that every parent dreads: Hours after the birth of their son, Jimmy Kimmel and his wife were informed by doctors that Billy had a complex heart condition and would need immediate surgery.

            That life-altering moment for the late-night comic has spurred a heated national debate about the ongoing Republican campaign to repeal the Affordable Care Act. On his show Tuesday night, Kimmel blasted one Republican senator in particular — Louisiana’s Bill Cassidy — for having “lied right to my face.”
            Kimmel was referring to Cassidy’s vow earlier this year to only support a health care legislation if it passed a “Jimmy Kimmel test” — that a child born with a congenital heart disease like Billy Kimmel would “be able to get everything she or he would need in that first year of life,” the senator said on CNN in May.
              But the Graham-Cassidy Obamacare repeal bill, Kimmel argued this week, doesn’t even come close to fulfilling that promise of protecting people with pre-existing conditions.
              “Not only did Bill Cassidy fail the Jimmy Kimmel test, he failed the Bill Cassidy test,” Kimmel said in a lengthy monologue Tuesday night. “He failed his own test.”
              Both Cassidy and Sen. Lindsey Graham, the bill’s co-sponsor, have forcefully pushed back. “I am sorry he does not understand,” Cassidy said on CNN Wednesday morning. He insisted that under his bill, “more people will have coverage and we protect those with pre-existing conditions.” 
              Here’s what would be at stake for Billy Kimmel and others with serious health conditions if Graham-Cassidy became law:
              Billy Kimmel’s heart condition 
              Tetralogy of Fallot with pulmonary atresia, the condition that Billy Kimmel has, is a congenital heart defect in which there is a hole in the wall between the heart’s left and right chambers. Without a valve connecting the right ventricle to the lungs, not enough blood reaches the lungs. 
              Those born with the condition are usually diagnosed as infants or young children, according to the American Heart Association, with visible symptoms that include skin that is bluish in color. (Kimmel said a nurse happened to notice that Billy’s skin appeared to have a purple tint).  
              How is it treated and how much does it cost?
              The life-long condition typically requires multiple procedures, including open-heart surgeries to reconstruct the connection between the heart and lungs and catheterization to help enlarge arteries. Even after the children get older, they will need constant monitoring and sometimes follow-up operations as adults.
              Needless to say, it is an expensive condition to treat.  
              According to Dr. Roger Breitbart, the chief of Boston Children’s Hospital’s inpatient cardiology division, open heart surgery and hospitalization can easily cost upwards of hundreds of thousands of dollars, while catheterization procedures can be multiple tens of thousand of dollars each. The total lifetime cost could easily surpass $1 million, he said.
              Breitbart has treated many children with the condition and said some of his patients who are now teenagers “wouldn’t be alive if they had not had the series of treatments. They may have had three or four open heart operations and as many as a dozen heart catheterization procedures in the first six to eight years of life.”
              How does someone like Billy Kimmel fare under Obamacare?
              Prior to Obamacare, Billy Kimmel could have found himself branded uninsurable for life. 
              Insurance companies routinely turned people with pre-existing conditions away or charged them sky-high premiums if they applied for coverage on the individual market. More than a quarter of non-elderly adults have health conditions that would have made them ineligible for coverage in this market, according to the Kaiser Family Foundation. 
              Plus, they often limited how much they’d be willing to cover annually or over one’s life. Kids like Billy Kimmel would likely blow through the cap pretty quickly. 
              Those with employer policies fared better, but even there, it was possible to get hit. Health care bills were one of the leading causes of bankruptcy. 
              The Affordable Care Act changed all that. Insurers are no longer allowed to turn people away, nor charge them more, because of pre-existing conditions. And they must offer comprehensive policies that cover a wide array of treatments and medication. Plus, insurers cannot impose annual or lifetime limits on coverage of those essential health benefits.

                Cassidy: Health bill should pass Kimmel test

               
              What about the Graham-Cassidy bill?
              It would depend on where Billy Kimmel lives. The bill would allow states to set up their own rules for coverage, an idea that Republicans generally favor because they say it lets each address its unique needs. For example, one state might keep many of Obamacare’s protections, while another could loosen the rules considerably.
              Graham-Cassidy would not let insurers turn away those with pre-existing conditions anywhere. But states could opt to once again allow carriers to raise premiums because of people’s medical histories and to sell skimpier policies that don’t cover Obamacare’s 10 essential health benefits. 
              Also, insurers would be able to cap the amount they would pay for treatment outside what their states deems an essential health benefit. 
              “Families with young children with conditions such as this are likely worried most immediately about the pre-existing condition issue,” Breitbart said about the Republican proposal. As for the lifetime cap, “one has to wonder what are such families going to do after we have saved their lives quite literally as children and then can’t provide ongoing care.”
              All these changes are particularly troubling for those in the individual market since employers generally offer better coverage. And they are among the reasons why multiple patient advocacy groups, including the American Heart Foundation, have come out against the bill.
               
              Kimmel: Not everyone is as fortunate as he is
              The ABC late night host has made one thing clear as he has spoken about his son’s diagnosis: His family is incredibly fortunate.
              He has health insurance and the means to pay for his son’s care. As much as he has used his son’s diagnosis to draw public attention to the impact of various GOP proposals to gut Obamacare, Kimmel can at least rest easy knowing that his family can afford to pay for Billy’s treatments. 
              It’s a luxury that many other families don’t have. 
              “If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make,” Kimmel said in May. “No parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.”

              Read more: http://www.cnn.com/2017/09/20/politics/jimmy-kimmel-son-graham-cassidy/index.html

              Need motivation to keep exercising? 25 tips from trainers

              If it were easy to stay motivated to work out, then we’d all have rock-hard abs. Alas, the drive to get out of bed for an early morning sweat session is elusive, except for those infectiously positive and perky fitness trainers and instructorsor so you thought. Even they need some encouragement once in a while. We asked four inspiring exercise experts to share what motivates them both in and out of the gym and studio. Their advice could be the extra nudge you need.

              Take a new class

              Your favorite instructors are great teachers, but they’re still students, too. “Just like my clients, I oftentimes need to be told what to do when it comes to my exercise routine,” says Annie Mulgrew, program director at CityRow in New York City. “I’ll take a class at my studio or another studio with an instructor friend,” she says. “I always feel better afterward!”
                Mulgrew says group fitness is more than just a workout, but an opportunity to see what other instructors are doing and get new ideas. “We’re still consumers of group fitness.”

                Treat yourself every day

                To stay on track with a healthy, balanced diet, Mulgrew says she gives in to temptation one time every day. “If I allow myself a treat, I’m way less likely to overindulge or binge,” she says. “One glass of wine is perfect, but a whole bottle? Derailing.”
                This smart eating strategy is the reason many authorities say trendy or restrictive diets simply don’t work. You end up craving the self-banned food even more, increasing your odds of binge eating or falling off the wagon completely.

                Pump up the jams

                Music can be an incredibly powerful mood booster. In fact, research has shown that listening to happy or sad music can actually directly alter the way you perceive the world—powerful stuff!
                Los Angeles-based personal trainer Astrid Swan harnesses the power of music to get her ready to take on the world. “No matter what the situation is—an early wake-up call, sprints on the treadmill, or just having a life moment, music brings me back to me,” says Swan. Need a quick jolt? She says to turn up the dial “on the volume and on your workout.” One song that always works for this fitness pro: “Stronger” by Britney Spears.

                Give yourself a pep talk

                Whether it’s a family member’s words of encouragement that have stuck with you, or lyrics from a familiar song, keeping a mantra, catchphrase or motto handy when you need a boost of confidence or determination can work wonders.
                For Swan it’s simply “Let’s go! I’ve got this.” “If I’m going into a meeting, or totally dying during a workout session, I’ll say it [to myself],” she says. “I say it to my clients, too! ‘You’ve got this. You just have to believe’.”

                Plan a post-workout meal

                Having a food in mind for your post-workout nosh will motivate you to crush your sweat session. Erin Bulvanoski, trainer at KORE New York, says it helps her really work for that snack she’s craving. “I love finding a great smoothie shop after class,” she says. “It’s something I get excited about.” That said, don’t overdo it—remember these tips for avoiding a post-workout binge.

                Connect with friends

                A workout buddy holds you accountable for the time and effort you put into your workouts—research proves it. Plus, socializing as you sweat can make exercise more fun.
                Bulvanoksi says she enjoys staying connected to and touching base with her favorite clients. “I love inviting my friends to join me in class, too,” she says. “The more people I have to look forward to see, the more I feel motivated to be at the top of my game.”

                Practice being mindful

                The art of being in the moment, blocking out all the external day-to-day stressors that can get in the way is sometimes easier said than done, but this kind of mindfulness is something Daniela Iannone, personal trainer and instructor at Prime Cycle in Hoboken, New Jersey truly believes in and follows.
                “For many people in my class, the 45 minutes they spend with me is the only time during their day that they have to themselves,” Iannone says. “I tell them to give that to themselves and focus on the task at hand. Where your mind goes, your energy goes with it.”

                Surround yourself with positive people

                Mulgrew says spending time with positive, hard-working co-workers and friends makes her want to follow their lead. “If I’m having a rough day, my team keeps me focused on the good, and helps me power through,” she says.
                It’s nice to surround yourself with friends who have similar interests, but Mulgrew says it’s just as important to be with people who are doing things you want to be doing. If you see other people living healthfully, those actions could become habits for you, too. “If you have someone helping you to stay consistent, it’s a game-changer,” says Mulgrew.

                Listen to your body

                Your body could be telling you things you may not want to hear. Mulgrew says that sometimes her body wants to push her out of her comfort zone. “So I look around at other people at the gym or in class and tell myself if they can do it, so can I.”
                Other times though, your body might be warning you to stop. “There’s nothing wrong with taking a break, and there’s nothing less motivating than an injury,” says Mulgrew. “If my body feels too fatigued or I feel discomfort in my muscles or joints, I back off. Staying safe and healthy allows for longevity, and that’s really what it’s all about.”

                Get in those steps for the day

                You signed up for spin class only to realize it was at the location across town. Instead of dreading the commute, make good use of that time! “Sometimes to get motivated for class, I force myself to run, walk, or bike there instead of taking the subway as a way to get my blood flowing and endorphins up,” says Bulvanoski.
                Studies have shown that exercising outdoors (or in this case, taking the scenic route to class) offers bonus benefits like improved mood and, weather permitting, an extra dose of vitamin D.

                Think about what you can accomplish right now

                You might have a larger goal in mind—dropping pounds, training for a marathon—but it’s crucial to remember all the baby steps it takes to get there.
                During her high-intensity classes, Bulvanoski asks clients to set goals for themselves that they aim to complete during the hour-long class, and she sets one for herself, too. “Tangible things to achieve are always a stronger motivator to be at your best,” she says.

                Watch yourself

                The floor-to-ceiling mirrors surrounding most studios are not there to torture you. Sure, you may feel a little awkward while you’re getting the hang of a particularly challenging move, but looking in the mirror can help perfect your form over time.
                The mirror helps show Bulvanoski just how hard she’s working. “Seeing my muscles work is a huge motivator,” she says. “The more fun and fitted I can get my workout clothes, the more I can clearly see the goals I’m trying to achieve—and look good [while] doing it!”

                Drink more matcha

                A caffeine jolt before the gym may enhance exercise results. In anInternational Journal of Sport Nutrition and Exercise Metabolismstudy, trained athletes who took in caffeine pre-exercise burned about 15% more calories for three hours post-exercise, compared to those who ingested a placebo. If you’re not much of a coffee drinker but still want a quick caffeine fix, try matcha, a powdered form of green tea. “A matcha green tea latte with almond milk is my go-to,” says Swan. “It’s my only caffeine intake, so I get a surge of energy!”
                The spotlight on matcha has grown brighter recently, and for good reason. Because you are drinking the whole tea leaves (instead of only steeping them) matcha drinks are a more potent source of nutrients than traditional teas. Matcha is rich in antioxidants that may protect against heart disease and cancer, as well as help regulate blood sugar and blood pressure.

                Scroll through your news feed

                “Sometimes I check in on fitness hashtags on Instagram to see what other people are doing,” says Iannone. “Seeing bodies in motion and images of strength motivates me.”
                Remember the point is not to compare yourself to others (everyone’s health journey and physique is different). Instead think about what or who inspires you to get moving and believe in yourself, and then follow instructors, trainers, or studios on social media for some fitspiration. It’s not a bad idea to follow your favorite magazines either (cough, @healthmagazine).

                Think about how you’ll feel after

                “I work out for my sanity, not vanity,” says Swan. “Workouts are my therapy. I know if I don’t get to release those endorphins, I’m not as carefree.”
                Exercise has long been shown to have lasting mental health benefits well after you complete a workout. Activity (even just a walk around the block) is said to reduce stress, boost your mood, and improve self-esteem. Those awesome psychological effects should be motivation enough to get you up and out.

                Be thankful

                It’s all too easy to get caught up in your own problems, frustrations, or never-ending to-do list, but Iannone finds it helpful to back away from complaints and consider what she has to be thankful for. She reminds herself and her clients that they each have the basic ability to move. “Be grateful that you have two legs that work,” she says. “Don’t take that for granted.”
                It’s this gratitude that keeps Iannone moving forward each day. “I think about people who can’t move, and it puts everything in perspective for me.”

                Set the mood

                What wakes Iannone up in the morning? Techno. Admittedly not a morning person, she says she prefers energetic music in the early hours to pump her up. “Music is fuel for your body,” she says. “Feed the excitement and passion to keep going forward.”
                Although the beat gets her moving in the morning, lyrics help maintain her drive. In one of Iannone’s favorite songs, “The Fire” by The Roots, she loves the lyrics “I am the definition of tragedy turned triumph,” which she says remind her of overcoming adversity and not giving up.

                Go shopping

                They say when you look good, you feel good. Sounds like an excuse to go shopping! And Swan is definitely on board, “I’m not going to lie, a new gym outfit gives me motivation,” she says. “Brand new spandex or a killer sports bra is just like buying the perfect little black dress.”
                More than just retail therapy, stepping into fun new workout wear could be just the boost of self-love you need in order to stick to a weight loss goal or rigorous training schedule. And new research suggests that dressing for an activity can actually boost your performance of a task. So hopefully if you dress like a tennis pro, you’ll play like one, too.

                Take a breather

                Sundays are typically rest days for Swan, but if you happen to find her in the gym that day, it’s not because she’s working out seven days a week. “I give my body a full day’s rest no matter what,” she says. “Physically, it’s the best time for your muscles to recover, and it’s so important for your muscles to be able to grow, but a full day’s rest is going to rest your mind, too. Allow yourself to decompress.”
                Schedule rest days just as you would workouts to avoid overuse injuries and ample time for muscle repair. And remember, a good rest mentally and physically prepares you to bring your A game to the next workout.

                Change your mind

                There is no such thing as a quick-fix solution for your health and fitness goals, reminds Iannone, and she believe the first step starts inside you. “It’s not just about working out,” she says. “It’s about working within.”
                The fitness philosophy by which she lives and teaches encompasses this theory: “Change your mindset to change your life!” you’ll often hear her screaming to a packed spin studio. “You have to approach fitness and life from a strong, positive, persistent place. Be brave in all that you do.”

                Eat Often

                You hate being hangry just as much as your friends hate to be around someone who’s irritable from a rumbling stomach and low blood sugar. Avoid that feeling and make sure you have the energy needed to take on your next workout by eating throughout the day. The key is to think small, satisfying snacks, not full, heavy meals.
                Swan says she eats every three hours, which means she prepares for her day and any possible delays the night before. She chops fresh fruit and veggies, and grabs to-go almond butter, Greek yogurt, and raw nuts to put in a cooler she takes in the car.

                Set attainable goals

                Setting an extremely lofty, unrealistic, or unhealthy goal is just setting yourself up for failure or exhaustion, says Mulgrew. “If you don’t make the progress you want to see in the short-term, you could say ‘oh this doesn’t work, so I just won’t do it’,” she warns.
                The key thing for her to remember and what she tells clients is that consistency and longevity are more important than a looming right-now goal. “My goal is to live a healthy lifestyle, and to be an active human,” she says. “Resting for a day or going for a walk, in the long run, doesn’t matter. There’s so much room for breaks.”

                Grab a pen

                A journal is a place for Iannone to hold her sudden inspirations. “I come up with phrases or mantras that pop into my mind, and write them down or create a [digital] poster to share with my followers online,” she says. Feeling unmotivated? Look back all those positive vibes you wrote before.
                You might know that food journaling, or recording your food intake throughout the day can help you lose weight. But did you know regularly jotting down your feelings could have positive effects on your mind as well? Journaling has been shown to help manage anxiety, reduce stress, and prioritize your feelings by acting as a healthy outlet to express emotions.

                Fight boredom

                You’ve probably heard an instructor tell you that if a move or class doesn’t challenge you, it doesn’t change you. Not only are they referring to the physiological effects from exercise, but they’re also warning you against complacency.
                Mix things up to avoid the same old routine or you’ll quickly become bored and unmotivated. “If I start to get bored, I know something needs to be adjusted,” says Iannone. “I take it back to the books, the images, and the music because that’s what works best for me.”

                Do what you love

                Although Iannone stopped formally practicing dance by the time she entered adulthood, that passion for movement and activity is what ultimately led her to pursue a career in fitness. “It was health-related and kept my mobile,” she says. “I get to see different people every day and stay moving. This work makes me better.”
                Think about some of your favorite hobbies or activities. Even if you don’t turn that passion into a career like Iannone, it’s important to maintain your connection to what makes the best healthy, happy version of you.
                This article originally appeared on Health.com.

                Read more: http://www.cnn.com/2015/11/13/health/fitness-trainer-tips-stay-motivated-exercise/index.html

                Resilience, suffering and silver linings after a disaster

                (CNN)The torrential rains may have ended, yet many people in Texas, Florida and the Caribbean continue to feel the impact of hurricanes Harvey and Irma in unseen, dramatic ways.

                “Unlike the physical damage which is all too obvious, the psychological toll will have effects that cascade over time,” Dr. Octavio N. Martinez Jr., executive director of the Hogg Foundation for Mental Health at the University of Texas at Austin, wrote in an email.
                Most of those affected by these intense storms are functioning as normal, with symptoms that may not seem very serious: anxiety, difficulty sleeping, sadness. Most notice their symptoms, yet accept them as part of the impact of the disaster.
                  “It is when these symptoms affect the person’s ability to function when it becomes crucial to reach out for assistance,” wrote Martinez. After all, distress behaviors — such as feelings of marginalization, increased smoking and alcohol use, and chronic irritability — have a tendency to slip under the radar, he said.
                  The mental health impact of Hurricane Katrina offer a hint of what’s to come for some survivors of the current storms, added Martinez. Some mental health conditions became more prevalent over time for survivors of the hurricane that struck the Gulf Coast during in 2005, according to a study published in the journal Nature.

                  Katrina and Sandy

                  For example, the prevalence of post-traumatic stress disorder (PTSD) in Alabama, Louisiana and Mississippi rose from 15% a few months after Katrina to 21% a year later, Martinez noted, based on the study. PTSD is a mental health disorder that develops in some people who have experienced a shocking or dangerous event.
                  “And the percentage of people experiencing suicidal thoughts more than doubled from 2.8 percent to 6.4 percent,” wrote Martinez.
                  Meanwhile, other studies have indicated that traumatic events during childhood can have a lasting life impact by increasing a child’s future risk of smoking, using alcohol and substances, obesity, depression, heart disease, cancer and even early death.
                  “This will be especially relevant to children and youth who endured Hurricanes Harvey and Irma,” said Martinez.
                  Rebecca M. Schwartz, an associate investigator at the Feinstein Institute for Medical Research in Manhasset, New York, looked at the mental health impact of Hurricane Sandy among adults living in some areas of Queens, Staten Island and Long Island. The study included a simple 30-item survey with participants checking off whether they’d experienced damage to their homes, damage to their cars and displacement. They also answered whether they felt their lives had been endangered or if a family member went missing.
                  “Basically, increased exposure to the hurricane — the more events or the more things that happened to you during Hurricane Sandy — the more likely you were to experience higher levels of depression symptoms, anxiety symptoms, perceived stress, and PTSD symptoms,” said Schwartz.
                  Displacement, in particular, was linked to developing symptoms of PTSD, she said. People who stayed at a temporary shelter, for example, were more at risk for PTSD than those who boarded with friends or family.
                  Sarah Lowe, an assistant professor of psychology at Montclair State University in New Jersey, has also investigated the psychological aftermath of natural disasters. For one study of resilience, she and her colleagues interviewed survivors of Hurricane Katrina about their mental health, their social relationships, and how the hurricane contributed to changes in their lives one year, three years and 12 years later.
                  “The punch line is that most people are very resilient to disasters,” said Lowe.

                  Personal resilience

                  “If you look a year out, there’s only going to be a small percentage of survivors who meet criteria for mental disorders, such as PTSD and major depressive disorder,” said Lowe.
                  Jeff Temple, an associate professor at University of Texas Medical Branch, said that in the immediate aftermath of a disaster, many people will experience symptoms yet their ranks dwindle as time passes.
                  “Right away, the first month, if the symptoms are to a high degree or worrisome, that’s when we would diagnose acute stress disorder,” he said. And, if the symptoms persist longer than a month, that’s when PTSD might be diagnosed.
                  Jesse Cougle, associate professor of psychology at Florida State University, said that Hurricane Irma did little damage to Tallahassee, where he teaches, compared to Miami and the Keys, and widespread evacuations in Florida served as a protective buffer.
                  The people who stayed and witnessed the destruction will likely experience worse mental health than those who evacuated, he said. Still, it’s possible, said Cougle, that even those who evacuated will experience symptoms in the days to come. Finding a place to flee to in heavy traffic was highly stressful and “negative life events can trigger these types of reactions,” said Cougle.
                  “Of course, what makes hurricanes different than a lot of other traumatic events, too, is if your property is damaged,” he said. “A lot of people can become homeless, a lot of people can be thrown off from normal healthy routines they have and there’s just all this stress associated with repairing their house, repairing their property, and just kind of adapting to all the problems.”
                  Capt. Maryann Robinson, chief of emergency mental health and traumatic stress services branch at Substance Abuse and Mental Health Services Administration, said “when you go home and now you are actually faced with what has happened — the devastation that has occurred in your home — it really does re-traumatize the individual.”
                  Still, said Robinson, “not everyone is going to need treatment. Most people do pretty well on their own.”
                  Some even find an unexpected silver lining in the storm clouds.

                  Post-traumatic growth

                  Lowe of Montclair State University and her colleagues looked at patterns of distress one year pre-Katrina and then again at both one year and three years afterthe storm in a separate study of the hurricane’s effects.
                  “For about 5% of participants, their mental health actually improved,” said Lowe. “They had severe distress prior to the storm and then afterward were indistinguishable from people we would call resilient — who maintain low levels of distress.” Another group also had severe distress prior to Katrina yet, one and three years after the storm, they had lower levels than before the storm, but only slightly elevated above average.
                  The trauma of a natural disaster, then, actually improved the mental health of some people — a phenomenon Lowe calls “post-traumatic growth.”
                  The reasons why are unclear.
                  “So maybe before the storm they had experienced many stressful and traumatic life events — such as childhood abuse, sexual abuse, intimate partner violence — and the hurricane was the first time where they came in contact with mental health services where they could deal with pre-existing vulnerabilities,” said Lowe.
                  For others, the displacement and subsequent relocation to new areas allowed them to “seize upon new opportunities, whether it be educational opportunities, employment, or new opportunities for relationships,” said Lowe. Some said they were able to get away from problematic relationships by being in a new community, while for others, the displacement allowed their children to enroll in new, better quality and more diverse schools.
                  Post-traumatic growth is “an intuitive phenomenon,” said Lowe, where some people find they’ve grown as a person “whether it be that they feel stronger, or they feel they can see new possibilities in their lives, or their relationships got better, or they have a stronger connection with God or spirituality.”
                  Post-traumatic growth often walks hand-in-hand with symptoms of PTSD — the adults who grew most had some of the worst psychiatric responses, said Lowe.
                  Still, not all PTSD sufferers experienced growth.

                  Who is at risk?

                  Women are more vulnerable to PTSD than men after disasters, said Lowe.
                  “In general, people who have fewer resources — so lower levels of social support, lower income — tend to be more vulnerable,” said Lowe. “As well as racial and ethnic minorities.”
                  Robinson added that children and the elderly are also more vulnerable.
                  “Cumulative exposure also serves as a precursor” to PTSD, said Robinson, so people who have had past traumatic experiences will be more susceptible to stress.
                  Even first responders, who help others in dire circumstances, can succumb to symptoms of anxiety and depression following a natural disaster, said Robinson: “If you are not processing the things that you see in a very healthy way, you are at more risk for a long-term consequence.”
                  Temple said that a lot of the mental health issues following a natural disaster stem from “direct exposure” to being in danger and seeing other people imperiled.
                  “So some of those at the epicenter of the disaster are certainly going to be the most vulnerable to mental health problems,” said Temple. Yet, people throughout the Houston area and even nationally felt distress just by seeing images from the 24/7 news cycle, he said. Whether images of a disaster are viewed on social media or television, said Temple, it is usually those who have already experienced previous traumas who will succumb to distress.
                  As Martinez of the Hogg Foundation for Mental Health noted, “It’s been said that time heals all wounds, but there’s reason to doubt that truism.”

                  What to do?

                  “There are resources for mental health support that we’re encouraging people to use, and our organization has compiled a modest list of them,” Martinez noted. “There is no silver bullet, but these are excellent places to start.”
                  “Everybody feels sad at times and that’s normal but when you’ve been through a trauma, it’s OK to seek help,” said Schwartz. After Sandy, people who normally did not experience mental health difficulties were very quick to dismiss their symptoms, she said. With a house needing repair, insurance papers to file, “they pushed their health and mental health to the back burner,” she said.
                  “If you’re feeling stressed, if you’re feeling overwhelmed, the best thing you can do is to seek help — if you do not, all the other things that need to be dealt with … become impossible to do if you’re depressed and anxious and suffering from PTSD symptoms,” said Schwartz. Even four years later, time had not dispelled the symptoms of some.
                  “We did see someamazing… community work being done, where people were meeting in groups and sharing their experiences,” said Schwartz. Still, she advised professional help and said that mental health should be prioritized “just like you would any other aspect of recovering from these hurricanes.”
                  Cougle said there are important things to do — and not do — to help the natural adaptive process or resilience possessed by most people.
                  “One is realize that anxiety is just a normal response to the hurricane and having to evacuate and all the stress and uncertainty associated with that,” said Cougle. “It’s the survival instinct, it’s not dangerous to feel anxious in that way.”
                  Still, he added, people should “resist the urge to cope with or avoid anxiety with things like substance use.
                  “Social support is a pretty-well established buffer against the development of PTSD following a trauma,” Cougle said.
                  Temple suggested “getting back to a normal routine. Your brain is rewired, basically, when you experience this sort of traumatic event, so give yourself some semblance of what it used to be like and have some of that normal routine.”
                  Following a disaster, a rare few feel no anxiety, and then worry about this reaction.
                  “It’s OK to not have a reaction at all,” said Temple, but it also “doesn’t mean you’re immune to later effects. You can be perfectly fine and then a month later develop PTSD.” (Usually, PTSD develops within six months of a trauma. With longer delays, doctors suspect the sufferer did not notice their symptoms.)
                  “So being continually on guard for changes — changes in behavior, changes in mood — both in yourself and friends and family members is good,” said Temple.

                  Sleep and exercise

                  Robinson said, “We tell people to pay attention to your physical self — so make sure you’re getting enough sleep and you’re resting.”
                  It’s important for survivors to guard their health by eating nutritious meals, exercising and avoiding “caffeine, tobacco, drugs and alcohol,” said Robinson.
                  “We tell people to move,” said Robinson. “It just may be walking around and taking deep breaths. Taking deep breaths really does serve as a purging — it helps to move stress out of the body.”
                  Relaxing music can also help, said Robinson.
                  Many people have mental health skills they developed in the past when, say, a parent passed or illness made an appearance, said Robinson: In the aftermath of a natural disaster, you must bring to bear all the coping skills that helped you in the past.
                  She also suggests you call SAMHSA’s Disaster Distress Helpline — 800-985-5990.

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                  “We have crisis counselors that are manning the phone 24/7, seven days a week, 365 days a year, for those individuals who are experiencing stress, distress, emotional, anxiety and depression,” said Robinson.
                  With responses translated into over 100 languages, anyone and everyone can call or text the disaster helpline. A waiting counselor will offer tips for managing your mental health symptoms and also steer you to your available community resources, said Robinson.
                  “Most of which people are not aware of,” Robinson said, “because before a disaster occurs, they don’t need them.”

                  Read more: http://www.cnn.com/2017/09/19/health/psychological-aftermath-hurricanes-harvey-irma/index.html

                  Doctor: Graham-Cassidy health ‘reform’ is a wolf in sheep’s clothing

                  (CNN)There’s perhaps no clearer snapshot of the disconnect in D.C. than a week in which a small group of Democratic senators comes out swinging for a single-payer healthcare system, only to be blindsided by the news that a far larger pool of Republican senators are coalescing around yet another effort — the disastrous Graham-Cassidy bill — to repeal and replace the Affordable Care Act.

                  It’s as if everyone in Washington has given up on the idea of practical governance in favor of posturing for the benefit of their core political base.
                  A hurricane’s projected landfall is an example of a true deadline, one that really means do or die. September 30th, the date after which the Republican Senate can no longer use the budget reconciliation process to push through health care legislation by a simple majority, is an example of an artificial deadline — one that is about politics, not about improving anyone’s health care.
                    It’s easy to see where Republicans’ urgency about making that deadline comes from. They are looking across the aisle at Bernie Sanders, who is drawing “Amens” for the concept that Medicare-for-all is the only way to achieve universal coverage, and pondering how they might negotiate anything with these Democrats.
                    The GOP’s fear is palpable. Republicans in Congress are getting an earful from constituents who’ve swallowed endless lies from them about Obamacare since before its passage, folks who are hooked into a media echo chamber that can easily spawn GOP primary opponents to better conform to the party’s “repeal and replace” promise.

                      Trump to Senate: Vote again on Obamacare

                    Another fabricated sense of urgency surrounds the idea that Obamacare’s markets are rapidly crumbling. In fact the Congressional Budget Office makes it clear in a report last week that it’s Trump himself who is destabilizing the ACA marketplaces.
                    Trump’s Department of Health and Human Services is cutting 90% of the budget from its enrollment campaign for 2018 (I’ll advise you that open enrollment is November 1st through December 15th).
                    Such efforts to cut down the customer base of ACA insurance plans are a key reason premiums will go up in 2018, and the other key factor — cited in an analysis of proposed insurance prices by the Kaiser Family Foundation — is all of the President’s talk about not fulfilling the law’s requirement to distribute subsidies to insurers, part of the law’s careful balancing of risk that keeps insurers willing to play along.
                    Yet despite the administration’s best efforts, as of today every single county in the United States has an insurer offering plans on the ACA marketplace. That’s the single most powerful crystallization of the law’s careful balancing of capitalism and public utility. All of these companies have a choice, and they ultimately choose to sell insurance on the marketplaces because they prefer to make money.
                    Of course, this situation can only hold so long under the weight of a four-year, post-truth presidency enabled by a Republican Congress.

                      Sanders: Trump wants to sabotage health care

                    Which brings us to the post-truth Graham-Cassidy repeal bill currently on offer.
                    If it collects 50 Republican senators who are irresponsible enough to sign on without a CBO score, it would surely get a tie-breaking vote from the Vice President, a rubber stamp in the House and an instant signature by the President.
                    “If a politician controls the dollar, the system lines up to serve the politician,” Sen. Bill Cassidy (R-LA) stated at his September 13 press conference discussing the bill. “If the patient controls the dollar, the system lines up to serve her. The theme of what we are trying to do is to give the patient the power.”
                    I’m not aware of any politicians who’ve lined their pockets thanks to Obamacare. As an informed citizen, I don’t know what Senator Cassidy is talking about.
                    But as doctor, I can tell you this: Cassidy’s bill fails his own “Jimmy Kimmel Test,” the promise he made to the late-night host whose son was born with a congenital heart defect, receiving very expensive care at Cedars Sinai.
                    Cassidy said he’d only support legislation if a “child born with a congenital heart disease (would) be able to get everything she or he would need in that first year of life” even if costs exceed “a certain amount.”
                    The patient is in fact powerless under the Cassidy-Graham bill, which gives the states block grants to administer healthcare for the poor and disabled, under whatever mechanisms they wish, and near complete freedom to enact their own rules with regards to the quality of private insurance plans sold in their states.

                      Pence: Health care ‘ain’t over by a long shot’

                    Most importantly, states can let insurers charge what they like to cover sicker individuals. Kimmel’s son, despite his heart condition, won the birth lottery in that his future access to healthcare isn’t in question — his father is rich.
                    But the Jimmy Kimmel test is supposed to apply to everyone. Most Americans with congenital heart defects can easily find themselves priced out of insurance plans that weigh medical risk factors.
                    To people with health conditions to manage, the United States would no longer be a place of free movement and opportunity. They would become a second tier of the citizenry, constrained by the limitations of a very different, balkanized land.
                    President Trump, too, promised Americans he’d replace Obamacare with a system that still guaranteed people with pre-existing conditions access to good coverage. “I am going to take care of everybody. I don’t care if it costs me votes or not,” Trump told “60 Minutes” while campaigning for the office.
                    After the election, he told the Washington Post, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
                    But President Trump’s and Senator Cassidy’s sunny promises bear no relation to the Graham-Cassidy disaster that’s bearing down on the United States.

                      Trump: I’ll turn to Dems if I need to

                    For the President, his behavior surrounding an ACA repeal is no different than his unreal stance on many other critical policy debates. On DACA, he also promises something better than the rules now in place, but similarly he’s ginned up urgency by issuing a deadline by which he’ll revoke the current presidential policy.
                    Just like with Obamacare, he’s trying to save the nation from a disaster he’s creating, a feat of propaganda that only works on those trapped in his echo chamber.
                    As for congressional Republicans like Bill Cassidy, they need to serve the needs of the people in their states, not their personal ideologies. Cassidy could start by listening to Louisiana’s Department of Health Secretary, Dr. Rebekah Gee, who wrote the Senator (himself a physician) about his bill’s impact on their shared state.
                    She points to Louisiana’s “high burden of extreme poverty,” that necessitates a strong Medicaid program and how the bill allows insurers “to charge individuals more based on age and health status (which) would inevitably increase the cost of care for those who need it the most — likely driving these individuals out of the workforce and into the increasingly tattered safety net of public assistance.”
                    Gee’s letter talks about the real people Obamacare is helping right now. Republicans and Democrats would do well to work on improving this law together, which is well made enough that it keeps ticking along, doing its core job. Such real work of governance gets fewer retweets than declarations of ideological purity, but a bit less fervor from the fan base is a small price to pay for the greater good of the country.

                    Read more: http://www.cnn.com/2017/09/19/opinions/graham-cassidy-bill-a-wolf-in-sheeps-clothing-vox/index.html

                    Opioid overdoses shorten US life expectancy by 2.5 months

                    (CNN)Opioid drugs — including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl — are not only killing Americans, but also shortening their overall life spans. Opioids take about 2.5 months off our lives, according to a new analysis published in the medical journal JAMA.

                    In 2015, American life expectancy dropped for the first time since 1993. Public health officials have hypothesized that opioids reduced life expectancy for non-Hispanic white people in the United States from 2000 to 2014. Researchers have now quantified how much opioids are shortening US life spans.
                    The researchers noted that the number of opioid overdose deaths are likely underestimated because of gaps in how death certificates are completed.
                      From 2000 to 2015, death rates due to heart disease, diabetes and other key causes declined, adding 2.25 years to US life expectancy. But increases in deaths from Alzheimer’s disease, suicide and other causes offset some of those gains. On average, Americans can now expect to live 78.8 years, according to data from 2015, the most recent data available. That’s a statistically significant drop of 0.1 year, about a month, from the previous year.

                      Women can still expect to live longer than men — 81.2 years vs. 76.3 years — but both of those estimates were lower in 2015 than they were in 2014.
                      Life expectancy at age 65 remained the same in 2015. Once you’ve reached that age, you can expect to live another 19.4 years. Again, women fare slightly better: 20.6 years vs. 18 years for men.

                      Drug overdose deaths reach new highs

                      Drug overdose deaths are expected to continue to reach new record highs. The CDC expects drug overdose deaths to top 64,000 in 2016 when the numbers are finalized — that’s more than the number of American troops lost during the Vietnam War. Most of these overdoses involved an opioid. Since 1999, the number of opioid-related drug deaths has more than quadrupled.
                      While prescription opioids like oxycodone or hydrocodone were considered to be driving factors in the increasing rates of overdose in the early part of the 2000s, heroin and illicit fentanyl have become the drivers for opioid overdose deaths in recent years. In fact, the number of overdose deaths related to fentanyl is expected to more than double, from an estimated 9,945 in 2016 to 20,145 in 2017, the CDC says. For the first time, fentanyl will be the leading cause of opioid overdose.

                      ‘It’s a national emergency’

                      On the heels of the release of a draft report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, over the summer, President Donald Trump said “The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It’s a national emergency.
                      “We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” he added. “It is a serious problem the likes of which we have never had.”
                      Yet, five weeks have passed since Trump’s statement, and the White House has yet to make any sort of formal announcement of a national emergency.
                      In addition, this week, New Jersey Gov. Chris Christie, a Republican who chairs the drug addiction commission, posted a letter on the White House’s website requesting an additional four weeks for the commission to complete its final report. “In the interest of submitting … sound recommendations, our research and policy development are still in progress,” wrote Christie. “Accordingly, and pursuant to the Executive Order establishing the Commission, we are seeking an additional four weeks to finalize our work.”

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                      Many public health officials point to the over-prescribing of narcotic painkillers as one of the roots of the opioid overdose epidemic. Last year, the CDC issued new prescribing guidelines for using opioids to treat chronic pain. According to a recent government report, the No. 1 reason that people misuse prescription drugs is to manage pain. In an attempt to help deal with the pain issue, the Trump administration is partnering with private pharmaceutical companies to help fast-track non-opioid, non-addictive pain relief alternatives.

                      Read more: http://www.cnn.com/2017/09/19/health/opioids-life-expectancy-study/index.html