Challenge your mind and body to hone their thinking skills

Challenge your mind and body to hone their thinking skills - My friend Betty is one of the most impressive elders that I met him. At 88, her voice is strong and his heart is young, and it seems to have so much energy and enthusiasm as he did in 1982 when I met her. It exercises, friends, gardens, to pay their own bills, follow the news, and is constantly reading and ask questions. How do you stay so strong? "I guess I'm just a curious person, boy," he laughs.

But living there how Betty - always learn new things, and keep busy with friends and favorite activities - is exactly what experts say can help keep our skills sharp thinking. "Cognitive and social commitment demonstrated a protective effect against cognitive decline, while the loss, depression and social isolation of hearing is associated with cognitive impairment," says Dr. Kathryn Papp, a neuropsychologist and professor of neurology at Harvard Medical School.

How it works?
Dr. Papp said he does not know the exact reasons for the mental and social engagement, protecting our thinking abilities, but we have some ideas. "Until the 1990s, we thought that people are born with however many brain cells die with now know that new cell growth. - A process called neurogenesis - occurs throughout life, even in Does old age, "says.

It turns out that the human brain has great potential for something called neuroplasticity, or in other words, being very malleable. It seems to challenge our brain - for example, by learning a new skill - leading to real changes in the adult brain. "You can create new connections between brain cells by altering the balance of neurotransmitters available and change how to make connections," says Dr. Papp.

Being socially engaged can help repel social isolation and depression, both of which have been linked to decreased cognitive functioning in the future. Having good social support also reduces stress, another thing that we know that this has a negative impact on thinking skills.

Other factors 
A healthy lifestyle is also associated with neurogenesis, including getting enough sleep, avoid overeating, and the big boss of all: exercise. "The researchers found that physical exercise leads to the release of cellular growth factors that are important to neurogenesis," says Dr. Papp.And this combination of growth and new brain cells factors that come from a healthy, stimulating the brain, and stay connected socially in a meaningful way can actually help protect the brain and keep it more resistant to changes that cause dementia.

Start your engine 
What is the best way to speed up your thinking skills? Start with mini-challenges for the brain:

 *   Brush your teeth with the hand not commonly used.
 *   Take a different route or shop work.
 *   Eat a piece or two dinner with eyes closed.
 *   Listen to a new type of music.
 *   Do jumps 60 seconds (or any physical activity).
 *   Sit in a different place in your home or at a favorite restaurant."This requires the brain to do a job because it clashes with something you have not experienced before," says Dr. Papp.

You can also search for activities that integrate brain stimulation, physical activity, and social commitment, such as:

*   learn to play a sport or game (tennis, table tennis, golf)
*   learn to dance (try the cha-cha, rumba and merengue)
*   take a class by planting flowers or vegetables
*   learning tai chi, which has been shown to increase thinking skills.

If physical activity is not possible, consider taking a class in

*   painting (watercolors start, then switch to oils)
*   piano, flute, guitar or
*   write stories (or memories)
*   Computers
*   flower arrangement
*   hosiery (useful for Christmas presents!)
*   a new language.

Or you can participate in any new activities that you find interesting, such as:

 *   Volunteer at a local charity
 *    explore a new city
 *    join a book club
 *    try a new restaurant or new types of foods
 *    become a museum of education
 *    helping at a local school or daycare
 *    join a club collector (Dolls, stamps, souvenirs). 

"The best activities are those that are nice," says Dr. Papp. And just as it is important to stick to a diet medications or exercise, should take a model to always learn, as my friend Betty, to reap the benefits. "I like to ask questions and hear the stories of people," he said. "I never want to stop learning."

She would have made a great reporter, that one. But I'm glad I can be the one to share the news flash here, which is that staying mentally sharp decline in the use of your brain and your body, whatever your age.
By: Heidi Godman

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Sleep like a caveman?

Sleep like a caveman? - Are we sleep less than our ancestors did? Previous research that examined the primitive cultures geographically isolated, and further research where subjects lived without modern conveniences, suggest that sleep duration was reduced with the introduction of artificial lighting and other aspects of modern society.  

Public attention, however, a recent study has attracted called into question this belief.

The authors of this study analyzed the sleep duration and time in three geographically isolated tribes living in Africa and South America. They found that the average time for the members of each tribe has spent sleeping ranged from 5.7 to 7.1 hours per night, quite similar to reported sleep duration in most modern societies. In addition, the researchers suggest that these tribes, sleep and wakefulness are not related to the presence of environmental light and dark, but with changes in body temperature.

These claims are certainly controversial and contradicts previous research in this area. More studies are needed before we can confirm this theory. And other scientists have expressed reservations about the methods of research and design used in the study.

Whether or not these new results are correct will be a vigorous scientific debate. However, they should not be allowed to ignore the fact that 40% of US adults sleep less than seven hours per night self now recommended by the American Academy of Sleep Medicine and other professional organizations. Sixteen percent of us sleep less than six hours per night.  

Many studies show that the amount of sleep under 6 and possibly less than seven hours per night is associated with a decrease in physical and mental performance levels, increased rates of obesity, heart disease and diabetes, and premature death.

We sleep less than our ancestors is certainly interesting for anthropologists and scientists from sleep. However, it has little relevance to reverse the epidemic of sleep deprivation in the country. For much of the US population is not getting sleep is necessary for optimal health, we must continue to focus on why this is happening and find ways to reverse the trend.
By: Stuart Quan, MD

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Is ADHD or autism?

Is ADHD or autism? - The deficit disorder, attention deficit hyperactivity disorder (ADHD) and autism may look very similar. Children with one of them can be very active and impulsive, and can have concentration problems and interact with others. In fact, it can be difficult to differentiate between.

But the difference is very important.

In a recently published study in the journal Pediatrics, the researchers analyzed nearly 1,500 children between the ages of 2 and 17 who had a current diagnosis of autism (as reported by their parents). They found that those who received a diagnosis of ADHD before they had a diagnosis of autism were diagnosed with autism an average of 3 years later than those who received the diagnosis of autism first - and were 30 times more likely to get diagnosed with autism when they were 6 years of age or older.

Why is it important? Although there is much that we do not know about autism, one thing we know is that the earlier treatment begins, the better the child does in the long run. While autism can be diagnosed already at the age of 24 months, the median age at diagnosis is more than 4 years. Each year, the diagnosis is delayed is a year that the child does not receive assistance - which may have consequences for life. So to have the diagnosis delayed three years - and delays beyond these first crucial years - it is a real tragedy.

It is not always easy for general pediatricians to diagnose autism in young children. Special training is required, and it takes time, something that the average busy pediatrician did not. And since the social aspects of autism may not be apparent until the child begins school, parents do not realize that your child has problems with the other socializing - and can not say pediatrician. Given this, and given that most parents prefer to hear that their child has ADHD, he or she has autism, and therefore not push for more tests, it is understandable how this happens.

Autism is not the only diagnosis that can mimic ADHD. Children with learning problems, sleep disorders, hearing loss and other problems are often misdiagnosed with ADHD.

So before deciding on a diagnosis of ADHD, especially in young children, parents should talk to their doctor about whether to have more tests would be a good idea. These are difficult conversations to have, but most importantly, can make all the difference when it comes to getting a child the help he or she really needs.

For more information about autism and how to recognize it, check the Law on the starting page on the website of the Centers for Disease Control and Prevention of Diseases.
By: Claire McCarthy,MD 

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The problem with prescription painkillers

The problem with prescription painkillers - Pain. It is an almost inevitable part of human experience. Whether as a result of an injury or accident, surgery, or a health problem, such as a headache or infection, arthritis or fibromyalgia, pain can interfere with your ability to sleep , work and enjoy life.

There are many ways to treat pain. Opioids are a. Examples include hydrocodone (Vicodin used), oxycodone (Percocet used), methadone, codeine and morphine. These prescription drugs reduce pain recognition brain by binding to certain receptors in the body. In many situations, opioids are a reasonable choice for pain control - for example, severe pain caused by cancer.

Part of the problem is that a person can develop a tolerance to these drugs. Finally, increasing doses may be required to achieve the same level of pain relief. Overdose may prevent a person from breathing and cause death. In addition, the body can become physically dependent on these drugs, so that withdrawal symptoms if the drug is stopped.  

These factors are a recipe for dependence, which is the loss of control over the use of a drug, even if it harms the person. Furthermore, opioids may also cause a "high" pleasant and are often used for recreational purposes and not for its intended medical purpose, which further increases the risk of addiction. Opioid dependence is the greatest risk factor for addiction to heroin.

What is the opiate epidemic? 
The epidemic of opioid is the crisis currently facing our countries in terms of widespread abuse of opioid analgesics. Much of the problem comes from the increased availability of these drugs. Four times as many prescription painkillers are offered each year, compared to 1990 At the same time, we are seeing an increase in deaths from overdose of opiates.  

Thank you for the efforts to fight against this problem, the number of prescriptions for opioids and opioid-related deaths 44 people appears to have stabilized since 2012. However, on average, in the US a day die from overdose 'prescription opioid pain relievers. Double the number of deaths from heroin overdose.

What is being done about the epidemic of opiate?
Health authorities are working to educate health professionals on the safe prescribing and educate the public about the risks of opioid analgesics, especially when used for chronic noncancer pain. For example, state monitoring programs to track the number of prescriptions for these drugs are filled, to try to prevent drug abuse. They also make efforts to increase the availability of drug treatment, including detoxification (or "Detox") programs.

Specially licensed physician Treatment programs can provide methadone maintenance for people who have difficulty leaving opioids. These programs provide controlled dose of methadone given under careful monitoring, which reduces withdrawal symptoms, drug cravings, and the risk of overdose.

Trained doctors can prescribe other treatments such as buprenorphine / naloxone (Suboxone), which reduces withdrawal symptoms by partially mimicking the effects of opioid receptors in the body less than a "high" risk and fewer overdose.

Expanding access to naloxone (Narcan) - a drug "rescue" that blocks the effects of opioids on the body - can help prevent some overdose deaths. Naloxone Rescue Kits come in nasal spray and forms of self-injection, and are available without prescription in some states. However, as the application of naloxone has increased, therefore the cost of such kits.

How do people who use prescription painkillers can reduce the risk of abuse and overdose? 

People taking opioid analgesics should follow these steps:

 *  Store medicines safely and never share with anyone.
 *  Take the medication exactly as directed.
 *  Ask your doctor if a lower dose may be an option.
 *  Ask your doctor about other ways to manage pain - many non-pharmacological options can help.
 *  If the drug is not working properly, talk to your doctor.
 *  Do not take overlapping requirements of several suppliers.
 *  Do not take these drugs with other substances, such as alcohol or prescription sedatives for anxiety.
 *  Naloxone have a first aid kit available and train friends and family members how to use.
 *  If you think you may be developing an addiction, seek help as soon as possible.
By: Wynne Armand, MD

 

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A check to check: Do you really need an annual physical?

A check to check: Do you really need an annual physical? - In the US, annual physical exams are part of the structure of our health care system. 

For adults, even if they are perfectly healthy, visiting a doctor yearly long been regarded as the basis of good care.  

But recently, experts have begun to wonder if our collective belief in this ritual is reasonable. Do the benefits of annual care really as big as we think? Patients can get the benefits of the annual review by other means?

In a recent editorial in the New England Journal of Medicine, Drs. Allan Prochazka Ateev Mehrotra and explore the complex issues surrounding the annual medical examinations. In the name of improving the "value" in health care argue that these routine visits should not continue.

The evaluation of benefits and risks of the annual review 

As physicians and experts in health care policy, the authors understand that it will be difficult for us to change this practice.

Although a number of professional guidelines recommend that doctors should not follow the tradition of the annual review, the data show that the frequency of these tests has not diminished. Doctors and patients are very attached to the practice, and polls show that most believe it should continue.

But what are the real benefits of this practice? A careful review of several large studies have shown that these annual visits make no difference in health outcomes. In other words, you are seen by your doctor once a year does not necessarily prevent getting sick, or even help you live longer.

And some of the components of an annual visit can actually cause damage. For example, laboratory tests and tests that are controlled in healthy patients (unlike individuals exhibiting symptoms or diseases known) are statistically more likely to be "false positives" - that is, when the test results suggest there is no problem.

Although these inaccurate results reach only a small percentage of the 200 million adults who undergo these tests, monetary and emotional costs, practices are huge.

Drs. Mehrotra and Prochazka indicate that reducing the number of annual tests to save time and money. The time that primary care physicians currently spend on these visits could be used to address urgent needs and expand access to health care for the needy.

They recognize that this change will be a hard sell, in part because many physicians and patients perceive the annual visit as a critical opportunity to cement the doctor-patient relationship and a way to ensure that people receive appropriate examinations and care preventive.

Three steps to better care model 

To encourage this change, the authors propose three steps. First, they recommend a new type of business to concentrate solely on the doctor-patient relationship.

This would allow those who are new to a doctor to have a first visit to establish a relationship, and allow others to be seen in a routine range (perhaps every 3 years or less) to keep. The focus would be more on medical and social history, and less on laboratory testing or screening.

Secondly, they recognize that if the annual survey should be discarded, primary care doctors will have to find a way to proactively monitor the care of their patients in preventive care.

They suggest that the wait for patients to keep their annual visits to check this approach is too "passive" and encourage practices to move to "active participation" of their patients. Ways to do may include risk assessments online, waiting questionnaires, and a review of preventive care at each visit to the doctor. 

Finally, they suggest that doctors and patients to accept this change, taxpayers must make changes. The authors recommend that no health plans and government programs to pay for annual visits and regular checks used as a measure of quality of care.

The disappearance of the annual review will feel like a loss for many patients and their doctors. But the authors encouraged to think creatively to keep important values ​​of this visit new and more effective ways.

His "verify" suggests that the "health check" in need of major surgery. To push the metaphor, if we follow through their suggestions and like any procedure, you will be healthier in the end, but we will all probably feel a little pain we are going through it.

This discussion is not only theoretical for me. As primary care physician, I agree that the benefits of the annual review can and should be achieved by other means. At the same time, I know it will be difficult to make these changes with my patients.

The interruption of the annual physical is experienced as a loss, as a form of abandonment, for some. The most powerful way to treat this is to recognize and name the loss, and letting patients know that significant portions of the Annual suffer: attention to their needs, when they need care and attention to your Routine preventive care - just all without the annual visit.
By: Amy Ship, MD.

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Why many generic drugs become so expensive

The high cost of prescription drugs is great news. You hear on TV, in the doctor's office, and even in the election campaign. When you think of expensive drugs, you can think of new therapies for lung cancer or hepatitis C. But in fact, prices are also soaring for generic versions of some commonly prescribed drugs.

An article published last year in the New England Journal of Medicine reported that between 2012 and 2013, captopril - a generic drug used to treat hypertension and heart failure - increase in the price of 1 cent to 40 cents pill. During this same period, the cost of doxycycline, an older antibiotic, rose 6 cents to $ 3.36 per pill. 

Connecture, a company of information technology for health insurance, reports that while the price of most generic drugs remained constant between 2008 and 2015, nearly 400 increases over 1000% saw prices generic. At a time when 18% of the costs of prescription drugs are paid out of pocket and 8% of Americans do not take their medication reports to save money, these dramatic increases in generic prices placed a heavy burden on public health.

Why is your product going in the price? 
Most of us think of cheaper generic version of a brand name for a prescription alternative - and that is often the case. Pharmaceutical companies that manufacture generic drugs can sell at lower prices because they do not have to pay for research and development that brought the drug to market first.  

However, this advantage may take a backseat in situations like these, where competition is reduced or delayed, allowing generic manufacturers to increase their prices:

  * The marketing of certain generic drugs is so small it attracts several producers such as pyrimethamine (Daraprim), an ancient drug used to treat a parasitic infection called toxoplasmosis. GlaxoSmithKline has long been the only producer of pyrimethamine, but at a modest price. This August, however, Turing Pharmaceutical acquired the rights to the drug and operated its monopoly, the price increase of 5,000% (from $ 13.50 to $ 750 per pill).

  * In some cases, the number of producers of generic drug decreases due to a continuous wave of market consolidation within the pharmaceutical industry.

  * Unforeseen safety issues may limit the supply of a generic drug. Hikma Pharmaceuticals, for example, was forced to stop production of doxycycline in 2011 because of quality problems at its plant in New Jersey. The shortage led to an increase of 6,000% in the price of drugs.

  * It can be difficult and expensive for a manufacturer for a generic drug to market first. The average time to the Food and Drug Administration (FDA) for the treatment of an application for generic drugs was 42 months in 2014, compared to an average of eight months to apply for a new standard drugs.

  * A generic manufacturer must prove that his version of a drug product is equivalent to a "reference" existing on the market. When only one company produces a tightly controlled drug and distribution, it can be extremely difficult for other companies to provide reference samples for products.

What you can do 
While Congress, the FDA and other government agencies to explore possible solutions to prevent soaring prices of generic drugs, there are several steps you can take to limit the number of victims in your wallet.

First, when the doctor recommends a drug for you, ask about its cost. In some situations, another drug (cheaper) which has a similar mechanism of action could be safe and effective.

When this is not possible or desirable, you might be able to save money by purchasing generic drugs independent of their health insurance. Websites like GoodRx offer online tools to compare the real drug prices in your area. Discount drug programs or discounts can also help. Note that while these programs may provide some relief, which are often available only for a short period of time (most are not valid after one year), and which can undermine policies to reduce insurance costs - and therefore premiums - down.

Finally, use your voice to help keep this issue a political priority. If you experience a substantial increase in the price of generic drugs, tell your elected officials. 
By: Ameet Sarpatwari, JD, PhD

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Is it difficult to decide on the total knee replacement? Totally!

It is a very important decision: If knee surgery painful?

Many people say yes. In fact, each year about 700,000 people in the United States that the most common form of arthritis of the knee undergo knee replacement surgery.

But how does it work? This is a question which has been largely answered by asking people who have had the surgery if you are happy they did. Most say yes. But the search for high-quality surgical versus non-surgical has not been done so far ... treatments.

In the last New England Journal of Medicine issue, researchers in Denmark report the results of a study that randomly assigned 95 people considered eligible for surgery knee replacement surgery or continue with more conservative treatments such as Exercise and a diet to lose excess weight. Here's what they found:

* Those who have had the surgery had more pain relief and improved function one year later than those assigned to nonsurgical treatment.

* The function and quality of life were better in those who have undergone surgery.

Does this mean that surgery is good for most people with knee arthritis? Not necessarily. Here's why:

  * Those enrolled in this study were carefully selected - which included only 95 people of nearly 1,500 that were originally selected.

  * This study excluded those who had a sharp pain in the week prior to inclusion in the study.

  * Only people with osteoarthritis - the with age-related "wear and tear" arthritis - were included. People with other types, such as rheumatoid arthritis, are not eligible.

  * Although the improvement of those receiving surgery was greater than in the non-surgical group, both groups improved. And the difference between them was not great.

  * Severe side effects or complications were more frequent in the surgery group. For example, three of the 50 people who have had surgery (against none in the non-surgical group) developed blood clots that require treatment with anticoagulants. These clots can cause dangerous complications, potentially fatal.

  * This study only lasted a year, so he can not tell us what kind of treatment is best in the long run. This is important because osteoarthritis, and the impact of major surgery, can affect the pain and function for decades.

If you have osteoarthritis of the knee, talk to your doctor about your treatment options. Surgery may be a good choice if your symptoms are bothersome, other treatments have failed, and your overall health is good enough to support the operation. However, personal preferences are very important. For example:

 * How your arthritis affects you? An avid walker can take a different decision to undergo knee surgery that a person who is less active.

 * How do you feel about the risks? All surgery comes with a high potential for complications, such as infection or bleeding. Some people are more focused on the potential improvement provided by the operation, while others are more concerned about the risks.

 * Do you have other conditions or on medications that may make riskier than average surgery?

 * How do you feel about the necessary weeks of rehabilitation after surgery?

We still easy if the knee replacement surgery is best for people with osteoarthritis answer. This study helps. But preferences objectives, personal health and lifestyle are more important.
By: Robert Shmerling, MD

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