Category: Health

Researchers get to the roots of chronic stress and depression

A study in mice provides clues about the common molecular origins of chronic stress and depression. The discovery could inform new treatments for mood disorders.

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Image credit: PhotoAlto/Frederic Cirou/Getty Images

Millions of years ago, our ancestors evolved the physiological responses needed to survive in the face of sudden threats from rivals and predators.

The release of hormones, including epinephrine (adrenaline), noradrenaline (norepinephrine), and the steroid hormone cortisol, trigger these “fight-or-flight” stress responses.

However, sustained or chronic stress that does not resolve when the immediate threat passes is a major risk factor for the development of mood disorders such as anxiety and depression.

Traumatic experiences, for example, in military combat, can also damage the body’s ability to regulate its stress responses, causing post-traumatic stress disorder.

People with these mood disorders have abnormally high and sustained stress hormone levels, which puts them at an increased risk of developing cardiovascular disease.

Researchers at the Karolinska Institutet in Stockholm, Sweden, suspected that a protein called p11 plays a pivotal role in damping down stress responses in healthy brains after an acute threat has passed.

Serotonin signal boost

Their previous research found that p11 enhances the effect of the hormone serotonin, which regulates mood and has a calming effect.

Unusually low levels of p11 have been found in the brains of people with depression and in individuals who died by suicide.

Mice with reduced p11 levels also show depression and anxiety-like behaviors. In addition, three different classes of antidepressants that are effective in humans increase levels of this protein in the animals’ brains.

Now the Karolinska researchers have discovered that reduced p11 levels in the brains of mice make the animals more sensitive to stressful experiences.

The scientists also demonstrated that the protein controls activity in two distinct stress signaling pathways in the brain. It reduces not only the release of cortisol via one pathway but also adrenaline and noradrenaline via the other.

“We know that an abnormal stress response can precipitate or worsen depression and cause anxiety disorder and cardiovascular disease,” says first author Vasco Sousa. “Therefore, it is important to find out whether the link between p11 deficiency and stress response that we see in mice can also be seen in patients.”

The study, which appears in the journal Molecular Psychiatry, was a collaboration between the Karolinska Institutet and researchers at VU University in Amsterdam, The Netherlands.

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Knockout mice

To investigate the role of p11 in stress responses, the scientists bred “knockout” mice that lack the gene that makes this protein.

They compared their behavior with normal mice using a variety of standard tests. These suggested that those without p11 experienced heightened stress and anxiety.

For example, in one test, mice pups were separated from their mothers for 3 hours a day. The researchers found that pups lacking p11 produced more high-pitched distress calls, known as ultrasonic vocalizations, compared with normal pups.

In another test of anxiety-like behavior, the team gave the adult mice a choice of spending time in a brightly lit area or a dark space. Mice that were deficient in p11 chose to spend less time in the brightly lit area compared with normal mice.

In addition, their heart rates took longer to return to normal after a stress-provoking stimulus.

The scientists also monitored stress hormone levels in the animals, revealing hyperactivity in two distinct stress pathways in the mice that lacked p11.

One such pathway, called the sympathetic-adrenal-medullary (SAM) axis, is responsible for the immediate surge in adrenaline and noradrenaline that occurs in frightening situations, triggering physiological changes such as increased heart rate.

The other pathway, known as the hypothalamus-pituitary-adrenocortical (HPA) axis, responds slightly less quickly and leads to the release of cortisol. This stress hormone raises blood sugar levels, among other metabolic changes, and suppresses functions that the body does not need for the fight-or-flight response.

CULLED FROM MEDICALNEWSTODAY.COM

Through my eyes: Surviving cancer twice

“Helen, I’m so sorry to tell you that you have stage 4 ovarian cancer.” I will never forget hearing those words.

through my eyes surviving cancer
Cancer treatment was pretty grueling in the 1980s, and outcomes were a lot gloomier than they are today.

Nothing could ever prepare you for hearing your doctor say you have cancer. My life flashed before my eyes. I was in disbelief. How could I have cancer for the second time in my life?

I was only 48 years old at the time of my second cancer diagnosis, and I was already a survivor of a radical mastectomy due to breast cancer at the age of 32, just 2 years after I had given birth to my daughter, Julianne.

I received my diagnosis of breast cancer in 1972, and in those days, treatment was limited. The surgeon believed that a radical mastectomy of my right breast would give me the best outcome.

The doctor would prove to be correct, but I was no less devastated in the interim. I was the mother of three children, and instead of tending to my active children, I now needed to focus on my health and well-being.

However, I continued to live a blessed life. I was the wife of an Orthodox priest, a secretary, and a preschool Sunday school teacher. I was like any other mother, trying to prioritize my life. The difference being, if I got my priorities wrong, it could cost me my life.

Second cancer diagnosis

The second episode began almost 2 decades later when I woke up feeling very bloated and fatigued.

I didn’t think much of it at first and thought I would feel better the next day. Yet the bloating continued, especially after eating, and I began feeling pressure in my lower abdomen. I decided it was time to contact the family physician.

The doctor ordered tests, but various X-rays, an ultrasound, and an MRI showed nothing. My doctor thought it was a case of gastritis and that I needed to rest and relax. However, 2 years later, my belly was now protruding, and I felt horrible pressure, so I asked my doctor for another test. This time they ordered a CT scan.

The CT scan showed something was not right, and I would need exploratory surgery to get more information. They found ovarian cancer tangled and webbed intricately through a large part of my lower anatomy.

The surgery lasted many hours, and my surgeon believed he had debulked 90% of the cancer. He also told me that I needed to undergo chemotherapy.

Cancer treatment was pretty grueling in the 1980s, and outcomes were a lot gloomier than they are today. I had already beaten cancer once, and the chance of surviving a second round seemed bleak.

I was offered a cocktail of Cisplatin, anthramycin, and Cytoxan as my best defense. Chemotherapy lasted 7 hours a day, and my side effects lasted even longer.

I was unable to complete my final round of chemo as my white blood count dropped too low. My oncologist thought the last round of chemo might have done more harm than good, so he discontinued the therapy one month short of 6 months.

The surgeon didn’t mention a survival time frame to me, of course. He knew I had enough on my mind and didn’t need to tell me that the consensus was that I had 6 months to live.

I guess God had a different plan.

Road to recovery

I was sitting at the dinner table, having no appetite, looking frail and gaunt, with numbness and tingling in both my hands and feet. I was so tired and thinking that I can’t go on.

I didn’t realize that I had said that out loud until I was snapped out of my daze by my daughter telling me: “You can’t give up, you already lived longer than the doctor said you would.”

I was shocked. I expected to be gone already but felt emboldened by the fact that I wasn’t.

Like a boxer in the late rounds of a fight, I summoned energy I didn’t know I had. I vowed to not only go another round but to win this fight. I did it once, and I’ll do it again.

I got a second wind, but I needed something more, so I began exploring other avenues to find my cure. This wasn’t an easy task in the days before internet searches, and it would take considerable effort.

In retrospect, I feel there were three things I did that helped in my healing and recovery. The surgery and chemotherapy were a big part of my treatment plan, but I knew I couldn’t sit back and relax and let the doctors do all the work.

I went to church many nights, sometimes by myself. With my head bowed and body low, I asked God for forgiveness and strength, and to help rid me of any anger or resentment I had. As the wife of a priest, I received a lot of support, and people began praying for me all over the United States.

I also began juicing (long before the juicing craze began). I juiced mainly carrots, and once in a while, I would add garlic or an apple. I actually developed carotenosis, a condition that turns your skin orange — I drank so much carrot juice that I looked like a carrot!

The juice gave me valuable nutrition, and I found it easy to digest. The juicing seemed to provide me with energy, so I could continue to take care of my daily needs and responsibilities.

The third and possibly the most interesting approach that I discovered through a dear friend was a technique called “hands on therapy” by Janet Ziegler.

I met Janet through a friend, and during the introduction, I told her my name is Helen, and I have cancer. She turned towards me with a gentle, compassionate touch and told me, “You are Helen, and you had cancer.”

She taught me a process called visualization. It was as if she retrained my mind into thinking the opposite of what I knew as fact.

Before falling asleep that night, I remember asking God to give me a sign of a rainbow that things would be alright. It was that evening I clearly saw a rainbow full of vibrant color. I woke up the following morning feeling refreshed and thankful. Shortly after that experience, I no longer believed I had cancer.

 

 

CULLED FROM MEDICALNEWSTODAY

People with eating disorders negatively affected by lockdown

New research shows that people with a history of eating disorders experienced significant negative effects during the COVID-19 lockdown.

An image of dishes drying in the dish rack to accompany the article, "People with eating disorders negatively affected by lockdown"
A new study finds that during lockdown, eating disorder symptoms worsened in people with a history of eating disorders.

The research, which appears in the Journal of Eating Disorders, raises awareness of the pandemic’s detrimental effects on people’s mental health, and could be valuable for the future development of health services.

COVID-19, the disease caused by SARS-CoV-2, has hospitalized hundreds of thousands of people worldwide and resulted in a significant number of deaths.

However, the pandemic and the emergency measures responding to it, have also had a significant effect on people’s mental health.

To slow the spread of COVID-19, governments across the world introduced various emergency measures that typically involved some degree of physical distancing or lockdown.

While these lockdowns have been crucial in reducing the disease’s spread and saving lives, they have also been profoundly disruptive to individuals and society.

Everyday routines changed overnight as people worked from home, became furloughed from their jobs, or were made unemployed.

People living with friends or family were able to maintain some face-to-face socializing. However, people living on their own or with strangers could only see these friends and family virtually — and only if they had access to the necessary technology.

As with physical health, it has become clear that while the virus can affect anybody’s mental health, it does not do so equally.

Understandably, the pandemic has negatively affected people’s general mental health. For example, an article in The Lancet found that, in the United Kingdom, people’s mental health was generally worse during the pandemic than before. The authors also discovered young people, women, and those living with young children were particularly affected.

However, experts know less about the effects of the pandemic on people with pre-existing mental health diagnoses.

Eating disorders

In the present study, the researchers wanted to explore the pandemic’s effects on people who had experienced an eating disorder.

According to the National Institute of Mental Health, common eating disorders include:

  • anorexia, where people see themselves as overweight when they are underweight
  • bulimia, where people uncontrollably eat significant amounts of food and then compensate for this through behavior that can damage their health
  • binge-eating, where people lose control over the ability to stop eating food, often resulting in overweight or obesity

In early April, 2 weeks after a lockdown was enforced in the U.K., the researchers recruited 153 people through social media to take part in a questionnaire. These participants had to be U.K residents over 16 years of age, with experience of an eating disorder, including being in recovery.

After excluding people who didn’t meet these criteria, there were 129 suitable participants between the ages of 16 and 65. Of these, 93.8% were female.

In total, 62% described themselves as currently having an eating disorder. 6.2% had been in recovery for less than 3 months, 6.2% had been in recovery for between 3 months and 1 year, and 25.6% had been in recovery for more than 1 year.

The questionnaire included closed and open-ended questions about the social effect of the lockdown, the respondent’s internet usage, their exercise and food behavior, and the pandemic’s general impact on their eating disorder.

Worsened symptoms

The researchers found that 87% of the respondents said their eating disorder symptoms had worsened, while over 30% reported their symptoms were much worse.

The respondents said the pandemic had a significant negative effect on their psychological wellbeing. They reported feeling less in control and more socially isolated. They also experienced more rumination about their eating disorder and felt less socially supported.

The researchers believe that key triggers for these feelings include:

  • changes to everyday routine
  • their living situation
  • the amount of time they spent with family and friends
  • their ability to access treatment
  • how much physical activity they were doing
  • their relationship with food
  • how much they were using technology

CULLED FROM MEDICALNEWSTODAY.COM

How does weather affect COVID-19?

Research shows there are more COVID-19 cases as temperature and humidity fall. A recent study points to more severe cases in cold and dry weather. Do these findings suggest COVID-19 is seasonal? Experts disagree.

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Some research suggests COVID-19 may be more prominent in cooler temperatures.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. 

Why are these findings so controversial, and why has the United States seen most cases during its hot and humid summer? In this special feature, we investigate which weather conditions are most associated with COVID-19 cases.

We look at what factors might confound these studies and make them hard to interpret. And we describe how one international study tries to get around these problems.

There are good reasons to expect a respiratory virus to show seasonal variation. Infections from influenza and respiratory syncytial virus are more common during winter in temperate areas of the world.

“But the fact is that respiratory viruses are generally seasonal, probably as viruses that transmit on water droplets do so less well if the droplet dries up faster, and temperature, humidity, and UV may be part of the lull in transmission we are now seeing. The flip side, alas, is that the opposite will be true in the autumn and beyond.”

– Prof Ian Jones, Professor of Virology, University of Reading, United Kingdom

Studies of the first SARS-CoV in 2003 suggest weather might be important for coronavirus spread. While this virus did not circulate long enough to establish any potential seasonal pattern, daily weather was associated with the number of cases. In Hong Kong, new cases were 18 times higher in lower temperatures — under 24.6°C, 76°F — than more elevated temperatures.

The epidemic died out during a warm, dry July in 2003, but tight public health control measures were also in place. A recent review of the seasonality of respiratory infections describes how cold, dry winter weather makes us more susceptible to viruses in general.

In these conditions, the mucous lining in our noses dries up, which in turn impairs the function of cilia, the tiny hairs that line the nasal passage. These beat less often, meaning they may fail to clear viruses from the nose. The review concludes that a relative humidity of 40–60% might be ideal for respiratory health.

Americans spend 87% of their time indoors, so how does the outside weather affect them so much? When cold, dry air meets warm air from indoors, it reduces the air’s humidity inside by up to 20%. During winter, indoor humidity levels are 10–40%, compared to 40–60% in fall and spring. The lower humidity aids the spread of virus aerosols and could make the virus more stable.

 

Humidity and rainfall

Laboratory and observational studies of cases of COVID-19 patients show an impact of humidity on the SARS-CoV-2 virus.

A laboratory-generated aerosol of SARS-CoV-2 was stable at a relative humidity of 53% at room temperature, 23°C, 73°F. The virus had not degenerated much even after 16 hours and was more robust than MERS and SARS-CoV. This helps explain its higher levels of airborne infectivity.

Laboratory studies do not necessarily predict how a virus will behave in the real world. However, a study of 17 cities in China with more than 50 cases of COVID-19 found a link between rises in humidity and reductions in COVID-19 cases.

The team measured humidity as absolute humidity, or the total amount of water in the air. For every gram per cubic meter (1 g/m3) increase in absolute humidity, there was a 67% reduction in COVID-19 cases after a lag of 14 days between the humidity increase and the number of cases.

Experts report similar associations between the number of cases and humidity in Australia, Spain, and for both cases and deaths in the Middle East.

The way temperature and humidity interact provides different weather patterns, which are determined by latitude.

A comparison of climate data looked at eight cities with high levels of COVID-19 spread:

  • Wuhan, China
  • Tokyo, Japan
  • Daegu, South Korea
  • Qom, Iran
  • Milan, Italy
  • Paris, France
  • Seattle, U.S.
  • Madrid, Spain

These cities were compared with 42 other cities worldwide with a low COVID-19 spread. All of the first eight cities lay in a narrow band between 30°N and 50°N latitudes.

Between January and March 2020, the affected cities had low mean temperatures of 5–11°C, 41–52°F, and low absolute humidity of 4–7 g/m3. The authors conclude these findings are:

“consistent with the behavior of a seasonal respiratory virus.”

Studies of influenza show tropical areas where rainfall drives humidity have a higher transmission in humid-rainy conditions.

American researchers established a threshold of 18–21°C (64–70°F) and specific humidity below 11–12 g/kg, approximately equivalent to 13–14 g/m3, for increased winter transmission. Tropical countries with temperature and humidity levels above these had higher influenza transmission when rainfall was high, defined as greater than 150 mm per month.

Brazilian researchers looked at rainfall worldwide, and confirm COVID-19 cases also increase with greater precipitation. For each average inch per day of rain, there was an increase of 56 COVID-19 cases per day. No association was found between rainfall and COVID-19 deaths.

 

Temperature

Links between COVID-19 cases and temperature are less certain. Studies from China have both found and not found an association with environmental temperature.

Similarly, researchers report no effect of temperature and COVID-19 transmission or deaths in Australia, Spain, and Iran.

However, higher temperatures are associated with a lower number of cases in Turkey, Mexico, Brazil, and the U.S., but it appears there is a threshold. Higher temperatures do not cause a further decline in COVID-19 transmission, which could account for some of the disparities.

This is consistent with laboratory studies that show the SARS-CoV-2 virus is highly stable outside the body at 39.2°F (4°C) but increasingly unstable at temperatures above 98.6°F (37°C).

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Hours of sunshine and UV light

A study in Spain found after 5 days of lockdown, the longer the hours of sunshine, the more cases there were of COVID-19. This positive association held true with a lag — between sunshine hours and cases — of 8 and 11 days. There was no link between the hours of sunshine before lockdown and during the first 5 days.

This contradicts findings from influenza research, which suggests lower transmission with longer hours of sunshine. The authors say:

“The positive sign of sunshine may well be another instance of behavioral adaptations, whereby compliance with lockdown orders weakens on sunny days.”

In contrast, there appears to be no effect of solar UV light, as the wavelength required to kill viruses and bacteria is under 280 nanometers (nm).

This type of UV light (UVC) does not reach Earth as it is absorbed in the ozone layer. If it did reach Earth, humans would suffer severe burns to their skins and eyes within minutes.

Some minor effects of UVB light, defined as 280–320 nm, have been proposed to explain the contradictory findings of lower transmission of COVID-19 in cold and dry conditions at a higher altitude. However, other factors, such as higher vitamin D levels within people in these regions, might be more important.

“This virus demonstrates no seasonal pattern as such so far. What it clearly demonstrates is that if you take the pressure off the virus —the virus bounces back. That’s the reality, that’s the fact.”

– Dr. Michael Ryan, WHO press briefing 8/10/2020 @ 20:51 mins

Researchers in Oxford, United Kingdom list reasons why people should not use observational studies on the number of COVID-19 cases and associated weather conditions to establish the seasonality of COVID-19 transmission.

They argue that testing capacity has been a major problem in most countries, which means there are many more cases than are reported.

Therefore, any factor linked to the weather and increased chances of testing could make it seem like the number of cases was due to weather, while increased testing is simply driving the numbers.

For example, other respiratory illnesses are common in winter months and could prompt people to have a test for COVID-19. Milder cases will be identified, which would not have come to light without another virus’s respiratory symptoms.

Furthermore, other conditions, such as cardiovascular diseases, are more common in cold weather. Patients who present at the hospital are more likely to be tested, which leads to further identification of cases. However, these would be related to other conditions linked to the weather and not necessarily COVID-19.

Nevertheless, COVID-19 deaths are less likely to be confounded by testing capacity since those with severe symptoms are expected to attend the hospital independently of the weather. Some studies above report an association between deaths and changes in the weather.

During a pandemic, a new virus will spread rapidly through a population where no one has immunity. The National Academies of Sciences, Engineering, and Medicine state in their consensus report on COVID-19 transmission there have been:

“[Ten] influenza pandemics in the past 250-plus years—two started in the northern hemisphere winter, three in the spring, two in the summer and three in the fall. All had a peak second wave approximately 6 months after the emergence of the virus in the human population, regardless of when the initial introduction occurred.”

Researchers at Princeton University and the National Institutes of Health, Bethesda, have modeled the spread of SARS-CoV-2 in relation to the weather using data on two beta coronaviruses, similar to SARS-CoV-2, which usually cause the common cold.

They found pandemic transmission in the community was likely to be so strong it would negate the minor effects of weather changes, such as higher temperatures and humidity.

The model explains why some countries with weak public health control measures, such as avoiding close contact, closed spaces, and crowds, and where this is not possible, wearing masks, are showing high transmission rates in the hot and humid summer conditions.

“As Rachel [Baker] argues in the paper, there is likely a seasonal impact on transmission, but given the high rate of susceptible people, it was unable to suppress transmission. The current outbreak in the US would likely be worse if we didn’t have the weather on our side, and is likely to get worse going into the fall and winter, assuming everything else stays the same. Once we have enough people who are vaccinated or recovered, we will probably see small, seasonal outbreaks of COVID-19 returning every winter, similar to colds and the flu.”

– Marta Shocket, PhD, Postdoctoral Fellow, UCLA, personal communication 8/12/2020

 

A new study explores COVID-19 severity and weather

To overcome the problem of non-weather factors that confuse the picture of seasonality and COVID-19, an international group of researchers has analyzed the severity of COVID-19 instead of the number of cases.

Using data from admissions to six European hospitals and 13 hospitals in the Zhejiang province in China, they found decreases in deaths, the average length of stay, and admission to intensive care units for COVID-19 with each additional day of the pandemic.

This was found in most of the European hospitals, but not the Chinese hospitals. China’s pandemic rise took place entirely during winter, while in Europe, COVID-19 spread throughout the winter and spring months.

Deaths decreased in the European hospitals with each unit of temperature increase but not in the Chinese hospitals. The authors disregarded improvements in treatment during February and July, citing only a small impact from the use of dexamethasone.

They hypothesize the decrease in severity is related to humidity-driven changes in nasal mucous and viral clearance by nasal cilia.

The findings of decreasing severity were corroborated in their U.S. and UK data set of four million citizens self-reporting symptoms associated with COVID-19. Over 37,000 people had a symptom cluster with a close correlation to positive COVID-19 testing. There was a similar decrease in symptom duration across the course of the study.

What this study means

This research is a preprint and observational study. Therefore, it cannot establish causal links, but it does go some way to overcome the potential confounding factors in earlier weather and COVID-19 case studies.

If COVID-19 is seasonal, experts will likely establish this in 2021 or 2022 after the main pandemic waves.

In the meantime, the authors suggest the importance of considering hydration for patients and the public, including the ancient practice of nasal irrigation.

“… providing humidified air to patients in the early stages of the disease may be beneficial. [and] … in the situation of rapidly progressing COVID-19 pandemics it would be essential to actively promote universal humidification of dry air in all public and private heated spaces, as well as active nasal hygiene and hydration.”

Lack of sleep predisposes us to negative thinking

Researchers in Italy found that a continued lack of sleep for 5 consecutive nights predisposes people to see pleasant and neutral images adversely, indicating that poor sleep may generate a negative emotional bias.

 

The feeling of having a sleepless night is a familiar one to many people. Lack of sleep can affect a person’s performance at work, as well as their emotional state.

People are more likely to be irritable and frustrated when they have not slept properly the night before.

The influence of limited sleep on emotional well-being is of growing interest as a lack of sleep is widespread in modern society. The Centers for Disease Control and Prevention (CDC) report that about 35% of adults in the United States sleep less than 7 hours per night.

Although several reports suggest that lack of sleep influences our emotional state, a new study published in the Journal of Sleep Research has formalized this.

In the study, participants looked at “pleasant and neutral images” after 5 nights of normal sleep and 5 nights of restricted sleep. The results showed that the participants were more likely to have negative responses to these images after the periods of disturbed sleep than after normal sleep.

The authors conclude that lack of sleep imposes a negative emotional bias on people and has important implications for daily life, as well as in clinic settings.

Continued sleep restriction

Numerous studies have investigated the behavioral effects of lack of sleep. However, most have looked at the impact of a total lack of sleep, rather than slightly reduced sleep over a more extended period.

To test the impact of partial sleep deprivation on emotional reactions, the researchers behind this study asked 42 people to change their sleep patterns for 2 weeks.

During the 2-weeks, participants had 5 consecutive nights of normal sleep followed by 5 consecutive nights of restricted sleep in which they could sleep no more than 5 hours per night. In the sleep-restricted phase, participants went to bed at approximately 2 am and woke up at about 7 am.

The researchers switched the order of the sleep patterns between the participants, with a two-day ‘wash out’ period in-between to allow people to reset before the next period.

The morning after each 5-day period, the researchers asked the participants to rate images on a nine-item scale of emotions.

The researchers took the images from the International Affective Picture System (IAPS), a database of pictures that psychologists use to study emotion and attention. The database contains a vast, wide-ranging selection of images that depict pleasant, neutral, and unpleasant events.

The researchers randomized the order of the pictures and assessed the emotion the image evoked, as well as the intensity of the emotion.

Impact on emotional outlook

The researchers found that participants rated pleasant and neutral images more negatively after having 5 nights of restricted sleep than when they had slept normally.

Even when the researchers took account of mood changes, they continued to find that people viewed images more negatively under restricted sleep conditions.

“Insufficient sleep may impose a negative emotional bias, leading to an increased tendency to evaluate emotional stimuli as negative.”

– Daniela Tempesta, Ph.D., of the University of L’Aquila in Italy

This suggests that sleep-deprived people are likely to perceive emotional stimuli — such as events or personal interactions in their daily life — as worse than they really are.

The researchers did not find any significant difference in how people rated the unpleasant pictures under different sleep conditions.

Culled from Medicalnewstoday

The close relationship between sleep and mental health

Not getting enough sleep skews our ability to regulate our emotions. In the long run, this can increase our risk of developing a mental health condition. In turn, conditions such as anxiety and depression may cause further sleep disruption.
Fortunately, there are proven ways to improve sleep quality and break out of this vicious cycle. In this Special Feature, we discuss sleep and its deep relationship with mental health.

More than 400 years ago, William Shakespeare described the gift of sleep and the distress of insomnia:
O sleep! O gentle sleep!
Nature’s soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids down
And steep my senses in forgetfulness?

– Henry IV, Part 2

Shakespeare’s description of sleep as “nature’s soft nurse” was closer to the truth than he could have known.

According to the Centers for Disease Control and Prevention (CDC), insufficient sleep increases the risk of type 2 diabetes, cardiovascular disease, and obesity.

Sleep is essential for the physical upkeep of the body, but it also helps maintain cognitive skills, such as attention, learning, memory, and emotional regulation.

Getting a good night’s rest even underpins our ability to perceive the world accurately. Research suggests that going completely without sleep for 3 or more nights in a row results in perceptual distortions, hallucinations, and delusions.

The latest discoveries about the importance of sleep for physical and mental well-being come at a time when technology is putting pressure on sleep time as never before. Social media, the internet, TV on demand, and video games are increasingly keeping us from our beds in the evenings.

The CDC advise that adults get between 7 and 9 hours of sleep a day, with the specific recommendation varying by age.

However, according to the 2012 National Health Interview Survey, almost one-third (29%) of adults in the United States sleep for less than 6 hours each night.

Two-way link to mental health
Poor sleep is a recognized risk factor for the development of a range of mental health issues.

A study that followed 979 young adults in Michigan, for example, found that insomnia was associated with a four-fold higher risk of depression 3 years later.

A review of research found evidence that insomnia preceded the development of not only depression but also bipolar disorder and anxiety disorders. The researchers also found a link between insomnia and an increased risk of suicide.

In 2020, a study published in JAMA Psychiatry identified an association between sleep problems in early childhood and the development of psychosis and borderline personality disorder in adolescence.

As well as increasing the risk of developing mental health problems, sleep disturbances are also a common feature of most mental illnesses, including anxiety, depression, bipolar disorder, and schizophrenia.

Prof. Daniel Freeman, a psychiatrist, and his colleagues at the University of Oxford in the United Kingdom believe that the two-way relationship between sleep problems and poor mental health can result in a downward spiral.

Writing in The Lancet Psychiatry, they say that doctors can be slow to address these issues in people with mental health problems:

“The traditional view is that disrupted sleep is a symptom, consequence, or nonspecific epiphenomenon of [mental ill health]; the clinical result is that the treatment of sleep problems is given a low priority. An alternative perspective is that disturbed sleep is a contributory causal factor in the occurrence of many mental health disorders. An escalating cycle then emerges between the distress of the mental health symptoms, effect on daytime functioning, and struggles in gaining restorative sleep.”

A form of cognitive behavioral therapy for treating insomnia (CBT-I) has proven its worth as a way to tackle this cycle of sleep problems and mental health conditions.

When Prof. Freeman and his colleagues randomly assigned 3,755 students with insomnia from 26 universities in the U.K. to receive either CBT-I or usual care, they found that the treatment was associated with significant improvements.

Students who received CBT-I not only slept better, but they also experienced less paranoia and had fewer hallucinations.

According to a 2015 meta-analysis, CBT-I may also be an effective treatment for anxiety and depression in people with insomnia.

How does CBT for insomnia work?
The treatment involves educating people about sleep and aims to change their sleep-related behaviors and thought processes.

People learn about good sleep hygiene, which involves practices such as limiting daytime naps, avoiding alcohol, nicotine, and caffeine in the evening, and refraining from using digital devices at bedtime.

The behavioral techniques include:

Sleep restriction: Reducing the time the person spends in bed to match more closely the amount of sleep they need.
Stimulus control: For example, using the bedroom only for sex and sleeping, going to bed only when sleepy, and getting out of bed after 15–20 minutes of wakefulness.
Relaxation: For example, tensing and relaxing the muscles while in bed, or focusing on the breath.
The cognitive techniques include:

putting the day to rest, which involves setting aside time before bed to reflect on the day
paradoxical intention, or trying to stay awake
belief restructuring, which means addressing unrealistic expectations about sleep
mindfulness, in which the person acknowledges their thoughts and feelings before letting them go
imagery, which requires a person to generate positive mental images
A trio of biological causes
Psychiatrists have proposed three interrelated factors to explain the close two-way relationship between sleep and mental illness:

emotional dysregulation
genetics, in particular relating to the circadian “clock” that regulates the sleep-wake cycle
disruption of rapid eye movement (REM) sleep
Most of us have intuited from personal experience that a night of disturbed sleep can make us feel a little down and grumpy the next day.

Research backs up our intuition. A 2005 study of medical residents in Israel, for example, found that poor sleep increased negative emotional responses when the going got tough at work the following day. It also decreased positive emotional responses when things went well.

More recently, a study in Norway found that delaying going to bed for 2 hours, but still getting up at the normal time, stifled positive emotions, such as joy, enthusiasm, and a sense of fulfillment. This effect increased with every consecutive day of delayed sleep.

Relatively mild, temporary emotional disturbances of this sort can set in place a vicious cycle. Ruminating about the past day’s events, for example, or anxieties about tomorrow may prevent a person from falling asleep once again.

Individuals with a predisposition to a particular mental health condition and those who already have the condition may be particularly prone to this mutually reinforcing effect.

Someone with bipolar disorder, for example, might feel too “wired” to sleep during a manic episode. A person with an anxiety disorder, on the other hand, might feel too anxious.

Faulty clocks
Research has linked genes that regulate the daily cycle of wakefulness and sleepiness — known as circadian clock genes — to particular psychiatric disorders, including bipolar disorder, seasonal affective disorder, and schizophrenia.

Continual misalignments between a person’s internal “clock” and their actual sleeping pattern may contribute to their vulnerability to these conditions.

Interestingly, scientists have yet to find any association between circadian clock genes and major depression. However, several lines of evidence implicate a sleep stage known as REM sleep.

After you fall asleep, your brain enters three progressively deeper stages of non-REM sleep, which is mostly dreamless. After about 90 minutes, it enters REM sleep, which is when most dreaming occurs.

Normally, the brain will cycle through these stages several times in the course of a night’s sleep, with the REM stages getting progressively longer.

However, people with major depression tend to enter their first REM sleep stage more quickly than usual after falling asleep, and it lasts longer.
Emotional memories
Research suggests that we process emotional memories during healthy REM sleep, helping us “unlearn” frightening or painful experiences.

Els van der Helm and Matthew Walker, sleep scientists at the University of California, Berkeley, have speculated that the normal pattern of emotional processing that occurs during REM sleep breaks down in people with depression.

So rather than helping them unlearn negative associations, these memories somehow become consolidated during their REM sleep. Over time, this contributes to an increasingly bleak mindset.

In support of their hypothesis, the researchers note that many antidepressants suppress REM sleep, which may steadily improve mood by preventing this consolidation of negative emotional memories from happening.

Interestingly, in some people, total sleep deprivation can rapidly lift depression, though only temporarily. Van der Helm and Walker believe that this may work in much the same way as the antidepressants — by depriving the brain of this dysfunctional type of REM sleep.

Recurrent nightmares
Problems with REM sleep also appear to play a role in post-traumatic stress disorder (PTSD).

In the recurrent nightmares that people with PTSD typically experience, it is as though the brain is repeatedly trying and failing to remove the emotional label associated with the memory of a traumatic event.

A review of research suggests that the drug prazosin, which doctors usually prescribe for high blood pressure, can relieve the nightmares of military combat veterans with PTSD.

The drug seems to do this by lowering levels of noradrenaline, which is one of several brain hormones that determine our progression through the different stages of sleep as their levels change.

Noradrenaline suppresses REM sleep. By reducing the hormone’s concentration in the brains of veterans with PTSD, prazosin may promote more effective REM sleep, which then erases the emotional label that is causing their recurrent nightmares.

Breaking out of the cycle
This year, psychiatrists in the Netherlands have launched a major investigation of sleep problems in people with newly diagnosed mental health conditions, including bipolar disorder, depression, anxiety, PTSD, and schizophrenia.

As well as assessing the incidence and nature of sleep difficulties in people with these conditions, the researchers will randomly assign participants with sleep problems to receive either their usual care or treatment at a sleep clinic.

Describing their forthcoming study in the journal BMC Psychiatry, the psychiatrists write:

“Despite a high occurrence of sleep disorders and established negative effects on mental health, little attention is paid to sleep problems in mental health care. Sleep disorders are frequently diagnosed years after onset; years in which poor sleep already exerted detrimental effects on physical and mental health, daytime functioning, and quality of life.”

If successful, their clinical trial will provide hope that there is a way to slow down or even prevent the vicious cycle of poor sleep quality and worsening mental health.

CULLED FROM MEDICALNEWSTODAY.COM

Stroke risk higher for COVID-19 patients who smoke or vape

A review suggests smoking and vaping could increase the severity of COVID-19 due to blood vessel damage and a higher risk of stroke.

 

There is a growing body of evidence to suggest that, as well as the respiratory symptoms of COVID-19, the disease can also cause, among others, neurological effects.”

A recent report from a neurological hospital in the United Kingdom identifies cases of delirium, brain inflammation, nerve damage, and stroke in COVID-19 patients.

Reports of stroke in COVID-19 are particularly prevalent. Some reports estimate that 30% of critically ill COVID-19 patients experience blood clots. And if they occur in the brain, they may trigger a stroke.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Researchers from Texas Tech University Health Sciences Center previously found that smoking and vaping increases the risk of viral infection. They have now published a review on how these activities might affect the risk of neurological dysfunction in COVID-19, particularly from damage to blood vessels in the brain.

They found that both smoking and vaping could increase the risk of stroke in COVID-19 due to damage to the blood-brain barrier and a higher risk of blood clots.

The details are published in the International Journal of Molecular Sciences.

Higher risk of blood clots

Smoking causes well-known damage to the lungs and respiratory system.Previous researchhas shown that it also makes a person more vulnerable to influenza.

Smoking can also affect the vascular system in the brain, prompting the researchers to review the evidence on how this activity might influence the neurological symptoms of people who contract COVID-19.

They first looked at the evidence on SARS-CoV-2 and neurological disorders, including stroke. They found onestudywhich showed that 36.4% of COVID-19 patients had neurological symptoms. Anotherpaperfound five cases of sudden stroke in COVID-19 patients aged 30–40 years due to abnormal blood clotting in their large arteries.

But how does this relate to smoking? The researchers explain that when the body is deprived of oxygen, which occurs with smoking, the amount of clotting factors in the blood increase.

In combination with COVID-19, which also increases blood-clotting proteins, the risk of stroke rises.

 

“COVID-19 seems to have this ability to increase the risk for blood coagulation, as does smoke. This may ultimately translate in higher risk for stroke.”

– Luca Cucullo, Ph.D., Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center

culled from Medicalnewstoday

10 TIPS TO LOWER YOUR HEALTHCARE COSTS IN 2020

 

Healthcare costs in the United States are currently so high that patients have to become more knowledgeable and creative about how to reduce their costs. In this article, we highlight ten very important tips to significantly lower your healthcare costs in 2020.

 

  1. Use prescription discount cards
  2. Research about medical practice fees before becoming their patient
  3. Ask about self-pay options before buying a drug with high deductible
  4. Always go for annual checkup
  5. Always ask your doctor and pharmacy about generic option
  6. Take your prescription drugs regularly
  7. Eat well
  8. Shop around for your DMEs
  9. Consider alternative medicine
  10. Try telehealth and stay updated

 

  1. Use prescription discount cards

If you live in states where the percentage of people without health insurance is high or where many people have high deductible costs for medication, this is the most important tip to save significant healthcare costs. You can consider using the #1 prescription discount card in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MO if you live in any of these states to save up to 80% on high prescription deductibles.

People across the country are saving a lot. You can ask from your pharmacy anytime you are about to fill a prescription. Most of them have available cards but they will not offer it to you unless you ask. You can also seek advice from your doctors as some of them may have good suggestions for you. Alternatively, you can use the prescription discount card here.

If you are own a group medical practice, recently started a small solo practice, or you are about to start a new podiatry office, you can create an incentive for your prospective customers by offering them advice on prescription discount cards and other ways to save healthcare expense. Your patients will be happy and will stick with you.

I mentioned podiatry office as an example because it is a specialization that remains common among the independent medical practices in the United States. Many top podiatry billing companies in SD, ND, WY, IN, MN, IA, AL, AR, AK, MS, MA and RI help podiatrists in those states to focus on their core businesses by taking care of credentialing, medical billing service, as well as rejection and denial management. Some of these practices are making good progress by hiring digital marketing providers who can provide affordable Medical SEO for medical practices in TX, MN, SD, ND, IN, WI, MA, RI, MS, AR, AL, AK, IA, ID, WY, CT services to them.

 

  1. Research about medical practice fees before becoming their patient

Several patients complain about surprise medical billing from their doctor’s offices, which they receive several weeks or months after consultation. Surprise billing is basically the left-over payment required from the patients after the primary insurance or payer had already paid. It is often part of the patients’ deductibles or denied claims.

One thing that determines price range is whether the doctor is in-network with your insurance provider or not. This is something you can easily find out by making call to the insurance company ahead and double-checking with the doctor’s office just before you book an appointment.

If you have Medicaid as secondary insurance, you should call the medical practices and find out if they accept Medicaid or not. And if you are using Medicare as primary insurance, you should call the medical practices ahead to confirm.

When some doctors and I recently discussed the subject – how to grow your medical practice in 2020, we agreed it was important for those of them that had not been accepting Medicaid and Medicare or those of them who are not in-network with some private payers to consider getting credentialed with medicare, medicaid and more private payers. Because Medicare and Medicaid billing can sometimes be tricky, some medical practices tend to decline them. The lesson for patients here is that the credentialing status of medical practices change from time to time. So you should call the practices to find out about the insurance they accept and not rely on the information you get on the internet. This information can certainly help you save healthcare cost.

Finally, while coming up with the list of practices to consult, ask friends and family for recommendation and do not rely only on the practices that show up in your google search. For example, there are many doctors in the state of Massachusetts but many of the ones that show up in your google search are doctors who get top SEO service in Massachusetts.

 

  1. Ask about self-pay options before buying a drug with high deductible

Anytime you visit a local pharmacy and your deductible amount works out to be very high, you should immediately ask the pharmacy to give you the price for self-pay option. This might sound incredible, but the truth is that sometimes the self-pay price option works out cheaper than such high deductible especially when used with a prescription discount coupon described earlier.

I cannot explain how this happens but that is exactly what happens a lot nowadays. Before now, many pharmacies encourage their staff to offer prescription discount card options to patients but that has changed. Many pharmacists and support staff are no longer allowed to suggest the cards to customers. Patients or customers are now expected to bring their own prescription discount cards to the pharmacy or make the self-pay suggestion by themselves.

 

  1. Always go for annual checkup

Many insurance payers offer zero deductible for annual checkups. So take advantage of this service and don’t wait for your doctor to remind you about annual checkup. Regular annual checkup helps to keep us healthy because it helps doctors to pick up whatever may be wrong with us early enough. And like we all know, early detection of most diseases can save our lives. But aside the health benefits in doing regular annual checkups, it can also save us deductible expense and the expense of future high medical bills when a sickness is not detected early.

According to the #1 medical billing company in SD, ND, IA, AL, MS, AR, IA, ID, WI, AK, WY, IN, more than 60% patients that are eligible for free-deductible annual checkup are not aware of this service because they are not well informed by their insurance companies.

 

  1. Always ask your doctor and pharmacy about generic option

Doctors sometimes prescribe specific brand name drugs that can be pretty expensive. Patients often do not know until they get to the pharmacy. If you get to your pharmacy and the price is high, call your doctor to ask if you can get the generic option of same drug in place of the brand name. If your doctor agrees, let him or her send the revised prescription. Sometimes you may need to ask your pharmacist’s advice first so that you are proposing specific options to your doctor when calling her. If you tell your doctor that you spoke with your pharmacy and they offered you three alternative generic options X, Y, Z and you would like to know which of the options the doctor is most comfortable with, he or she will most likely agree.

 

  1. Take your prescription drugs regularly

When your doctors give you a prescription drug, be diligent to use them regularly as prescribed. This helps you stay healthy and ultimately helps to keep your healthcare expense low.

According to a medical billing service linkedin publication from a healthcare service company that provides mental health billing services in MA, TX, SD, ND, MS, AR, AL, AK, IA, ID, WY, MN, IN, WI, RI, CT, many mental health patients have a great tendency to stop using their medication as soon as they start feeling better. But the chances of relapsing is high when they doses are not complete or when the patient stops using a medication that is supposed to be perpetual. A relapse due to early stoppage of medication can lead to significantly health challenge that will ultimately cost more money to take care of.

 

  1. Eat well

Eating well seems perhaps too simple to include on this list, but food is like medicine. When you eat very well, you will stay healthier and this will help you keep healthcare costs down. Many people today give their tough jobs schedule as excuses for eating junk foods, but when we think about your health and costs of healthcare, we should be motivated to eat healthy.

The recent work-from-home and social distancing culture due to COVID-19 may encourage more people to eat healthy and benefit many people.

 

  1. Shop around for your DMEs

Durable medical equipment (DME) are costing patients, especially older people a lot of money in recent times. Some DMEs are reimbursable by government and private insurance, while some are always self-pay. Medical practices that are up-to-date with their DME credentialing are able to charge insurance payers on behalf of their patients but there are several DME providers that focus only on self-pay patients. Some of the ones that accepts insurance payments also depend on 3rd party companies offering DME billing services in MA, TX, GA, FL, OK, AK, ID, IA, WY, SD.

If you are a patient that requires DMEs that do not get reimbursed by insurance, you should always shop around at local and online stores to get the best deals. Setting up a DME store online is much cheaper than local setup, so the online stores tend to offer cheaper products than the brick-and-mortal stores. But you have to be careful with online stores. Check their customer reviews, ask about specific brands, and be sure the merchant accept returns.

In some other countries where patients usually buy DMEs only through self-pay methods, they can easily buy from popular local and foreign e-commerce websites, classified ads websites or  online stores – Delon Market, Craigslist, etc. But in the United States, it is greatly advisable that patients buy from local online stores in the US to guarantee quality and returns.

The DME industry continues to grow in the United States due to increasing number of people that are living beyond 80 and 90 years, and many manufacturers have to strike a balance between manufacturing locally or outsourcing manufacturing to foreign countries in order to reduce cost. The disadvantage of manufacturing abroad is that we will be creating more jobs in Mexico, China, India, and other parts of Asia, or jobs in Nigeria.

 

  1. Consider alternative medicine

It is also a good idea to consider alternative medicine to stay healthy. Food is part of what I mean by alternative medicine, but this also includes supplements, acupuncture, etc. Many insurance payers have recently started paying for acupuncture services in the United States. Acupuncturists in several states are able to focus on their business as acupuncture billing in MA, IL, CA, NY, WA, TX, GA and FL is available through many third-party providers in those locations.

 

  1. Try telehealth and stay updated

Because of the coronavirus crisis, telehealth services have become a lot more common in recent months. Before now, insurance payers and government have only granted limited approvals for telehealth practice across the country. But there have been substantial approvals in recent months because of social distancing requirements. Therefore, many doctors in many states have been seeking reliable telehealth solutions in MA, TX, MS, RI, CT, MN, SD, ND, IN, WI, IA, AR, AL, AK, ID, IA, TX, and the industry has experienced tremendous growth in the last few months.

Finally, you should continue to read and stay updated with changes in healthcare policies in the United States. Our laws keep changing every year and new information becomes available on the internet daily. In order to save healthcare expense, we all have to continue to regularly learn the required tips. According to the #1 medical billing company in Massachusetts, healthcare costs in the United States will continue to fluctuate based on issues and imminent changes to the Affordable Care Act.

Medical myths: Does sugar make children hyperactive?

When children indulge in sugary foods, they turn feral and bounce off every available surface. This is, as most parents can attest, a fact. In this Special Feature, we ask whether this common knowledge holds up to scientific scrutiny.

 

You are at a party, and there are around 20 children, aged 3–6. The noise is deafening and the candy bowls are empty. Screams of joy fill the air as parents marvel at their offspring’s sugar-induced bedlam.

But what does the science say? Does sugar increase the risk of hyperactivity in children? Perhaps surprisingly, the data says “probably not.”

This will come as a surprise to anyone who has attended a gathering of children where sweet treats are available, so let’s dive into the evidence, or lack thereof.

 

ugar and hyperactivity in children

The question of whether sugar influences children’s behavior started to generate interest in the 1990s, and a flurry of studies ensued. In 1995, JAMA published a meta-analysis that combed through the findings of 23 experiments across 16 scientific papers.

The authors only included studies that had used a placebo and were blinded, which means that the children, parents, and teachers involved did not know who had received the sugar and who had been given the placebo.

After analyzing the data, the authors concluded: “This meta-analysis of the reported studies to date found that sugar (mainly sucrose) does not affect the behavior or cognitive performance of children.”

However, the authors note that they cannot eliminate the possibility of a “small effect.” As ever, they explain that more studies on a large scale are needed.

There is also the possibility that a certain subsection of children might respond differently to sugar. Overall, though, the scientists demonstrate that there certainly isn’t an effect as large as many parents report.

Are some children more sensitive to sugar?

Some parents believe that their child is particularly sensitive to sugar. To test whether this might be the case, one group of researchers compared two groups of children:

  • 25 “normal” children aged 3–5
  • 23 children, aged 6–10, whose parents described them as being sensitive to sugar

Each family followed three experimental diets in turn and each for 3 weeks. The diets were:

  1. high in sucrose, with no artificial sweeteners
  2. low in sucrose, but with aspartame as a sweetener
  3. low in sucrose, but with saccharin — a placebo — as a sweetener

The study included aspartame, as the authors explain, because it, too, has been “considered a possible cause of hyperactivity and other behavior problems in children.”

All three diets were free from artificial food colorings, additives, and preservatives. Each week, the scientists assessed the children’s behavior and cognitive performance. After analysis, the authors concluded:

“For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed.”

In 2017, a related study appeared in the International Journal of Food Sciences and Nutrition. The researchers investigated the impact of sugar consumption on the sleep and behavior of 287 children aged 8–12.

The scientists collected information from food frequency questionnaires and demographic, sleep, and behavior questionnaires. A surprising 81% of the children consumed more than the recommended daily sugar intake.

Still, the researchers concluded that “Total sugar consumption was not related to behavioral or sleep problems, nor affected the relationship between these variables.”

Taking the findings together, it seems clear that if sugar does impact hyperactivity, the effect is not huge and does not extend to the majority of children.

Why does the idea persist?

At this point, some readers might be asking, “If there is no scientific evidence that sugar induces hyperactivity in children, why does it induce hyperactivity in my children?” Some of the blame, it is sad to say, may fall on parental expectations.

A study that underlines this point appeared in the Journal of Abnormal Child Psychology in 1994. The researchers recruited 35 boys aged 5–7 whose mothers described them as being behaviorally “sugar sensitive.”

The children were split into two groups. They all received a placebo, which was aspartame. Half of the mothers were told that their children had each received a placebo, and the others were told that theirs had each received a large dose of sugar.

The scientists filmed the mothers and sons as they interacted and were asked questions about the interaction. The authors explain what they saw:

“Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers.”

Also, the media plays a part in perpetuating the myth. From cartoons to movies, the term “sugar rush” has entered common parlance.

Another factor is the setting in which a child might be given excess sugar. The classic scenario is a room full of children at a birthday party. In this environment, they are having fun and are likely to be excitable, regardless of the candy consumed.

Similarly, if candy is a special treat, the simple fact of receiving a delicious reward might be enough to generate a boisterous outburst of high-octane activity.

Where did this idea begin?

The health effects of sugar have been discussed widely over the last century. Even today, much research is dedicated to understanding the full details of this sweet chemical’s power over human health.

In 1947, Dr. Theron G. Randolph published a paper discussing the role of food allergies in fatigue, irritability, and behavioral problems in children. Among other factors, he described sensitivity to corn sugars, or corn syrup, as the cause of “tension-fatigue syndrome” in children, symptoms of which include tiredness and irritability.

In the 1970s, sugar was blamed for reactive or functional hypoglycemia — in other words, a dip in blood sugar following a meal — which can cause symptoms such as anxiety, confusion, and irritability.

These were the two prominent theories that underpinned the belief that children’s behavior is negatively impacted by consuming sugar: It is either an allergic reaction or a response to hypoglycemia. However, neither theory is now backed by the data.

Another lay explanation is that sugary snacks cause a brief spike in blood glucose, an effect called hyperglycemia. However, the symptoms of hyperglycemia include thirst, frequent urination, fatigue, irritability, and nausea. They do not include hyperactivity.

In the late 1970s and early 1980s, there was a fresh surge of interest in the sugar–hyperactivity theory. A number of studies appeared to show that children who were the most hyperactive consumed more sugar.

However, these studies were cross-sectional, meaning that they studied one population of children at one point in time. As the authors of the meta-analysis cited above explain, from these findings, it is impossible to know whether sugar causes hyperactivity or whether hyperactivity drives increased sugar intake.

10 WAYS TO GROW YOUR MEDICAL PRACTICE IN 2020

  1. Devout quality time to learning business
  2. Hire the right staff
  3. Consider hiring an efficient medical billing company
  4. Identify and focus on your unique selling proposition or strategy
  5. Be updated on latest medical technology and treatments
  6. Regularly train your staff
  7. Send out satisfaction surveys to patients
  8. Consider digital marketing
  9. Provide patients with sources of helpful information
  10. Consider providing additional services

Many independent or private medical practices today are struggling to survive because of changing government regulations. But several of them are actually failing because the healthcare provider owners have not learnt the important business side of running or growing a medical practice. Medical practitioners are often very brilliant and hard-working people who have undergone many years of education and training, with virtually no training about owning, running, or growing business.

Because they are often smart, they usually think they have all it takes to run a successful medical practice business. This is usually not the case. Healthcare providers that own medical practices have to learn a lot outside their medical training in order to run or grow their business. This objective e of this article is to provide some advice to healthcare providers on how they can grow their medical practice. So, whether you’re a doctor seeking to grow your existing business, or a pedorthist starting her pedorthic credentialing in order to set up a DME store, you need to deliberately learn business to grow your business.

 

 Devout quality time to learning business:

Business is the activity of earning money by producing or selling products or services to customers. Doctors and healthcare providers should devout a lot of time to learn business. Many small medical practices hire practice managers and think that is the solution to their business challenge. Practice managers are like operation managers. They are skilled at keeping operations running, but you need more than this to succeed and grow your medical practice. Ideally, every business needs a head of sales, whose core duty is to bring in new customers to the company. Since small medical practices will typically not hire a head of sales or sales director, the practice owner and all other staff should learn and acquire good knowledge of sales, marketing, and finance.

Many decisions that can grow or destroy a medical practice have to be considered based on quality business analysis, and that makes it expedient for the key staff to understand business. For practices that accept only private insurance, decisions like credentialing with Medicare or Medicaid in order to start accepting government insurance payments cannot be taken lightly without good business thoughts.

Because doctors and healthcare providers will not typically advertise their services like traditional businesses, you would need to be very creative about your sales efforts. For example, you can have your staff participate in fundraising events or community service projects in order to promote your business reputation within your city or state.

 

 Hire the right staff

From the healthcare provider to the nurses, to the secretary, to the medical assistants, all the way to the receptionist, a medical practice must do its best to hire the right staff that will provide polite, caring and excellent service to all patients. Keeping your existing customers is the most fundamental way to grow your business, so hiring the right staff that can help to achieve this is very critical.

If the doctor or healthcare provider is not great at hiring, he or she should be humble enough to outsource this service. Just as some companies outsource their software developer recruitment, medical practices should not hesitate to hire small recruitment companies to help them to find the right kind of staff for their practices. It is very important to get staffing right. If you can do the hiring by yourself, that is very great, but you must painstakingly get it right.

After hiring the right staff, you should do your best to create an excellent working environment that makes your employees feel like you are family. Pay them well, show that you value them, communicate well with them, and do your best to know them and their families.

 

 Consider hiring an efficient medical billing company

The practice of medicine is being devalued as the federal government is pushing doctors to practice more business than medicine. Many solo and small independent or private medical practices struggle a lot with their cashflow because of several payment delays from Medicare, Medicaid and private insurance payers. This is often based on the fact that the person handling medical billing for the practice is either overwhelmed with other support jobs within the practice that does not give him or her adequate time to squarely focus on the billing or he or she may not be adequately skilled in billing.

In some cases, solo providers even handle their billing by themselves, thereby reducing their available time for seeing patients and growing their business. Outsourcing medical billing helps the medical providers focus more on what they had set out to do – practice medicine, while the billing company handles the practice management needs with ultimate efficiency.

Some medical billing companies provide service to healthcare providers at zero startup fees and only get paid after the provider has got paid. So there is enormous value in outsourcing, as it helps most medical practices boost their profits, improve their cash flow and increase their collections.

Most of the time, the cost of medical billing outsourcing is usually significantly less than the cost of hiring a full-time efficient medical biller. When you hire a reliable medical billing company to work for you, you will have more time to see more patients, practice medicine, and focus on different ways of growing your business. The time spent on billing and the huge amount of account receivables can be saved and turned into fresh earnings if you work with an efficient billing company.

For medical billing services in IA, AL, MS, AR, IN, SD, ND, RI, CT, WY, WI, IN, MN, AK and TX, you may consider a top medical billing company in Massachusetts – Delon Health that provides specialized cost-saving medical services across those states. Delon Health is part of a 25-year old franchise and though they are based out of Massachusetts, they provide high quality services across several states in the United States.

 

 Identify, promote, and focus on your unique selling point

Every company should have a unique selling point (USP) that drives their strategy. You will need to first identify your special skills, interests, or talents that you can modify into a key business USP. For example, if you a doctor that also helps people with weight loss (in addition to your primary work), you can choose that as something you wish to highlight. That will require you training all your staff to full adapt to the USP. It will require consistent messaging, and it will influence the way you attend to patients and the way you talk about your practice within and outside your office.

You must be able to describe this in a way that makes you stand out from other people talking about weight loss reduction. For example, you might decide to offer it as a free or discounted program available to all customers.

When creating your USP, you must think about it from a customer perspective and this should influence the way you describe it. Don’t expect to get it right at the early stages. Even if you decide to hire a marketing company to help you create the messaging strategies, you will still make mistakes at the early stages. But you must continue to refine it until you and your team get it right. Once you get it right, you must master the messaging, paste it around your office, and include in all your online and paper publications.

But beyond reading, writing, and saying the USP, it must be acted upon. The USP should be a driving force at your office as it does not make sense to keep talking about something you do not practice. Ultimately, people will know you for this uniqueness and it will win you customers.

To give an example outside medical practice, a top pain management billing company in South Dakota with a USP that relates to their laser focus on pain management billing has to demonstrate a reasonable knowledge of pain management billing to prospective customers. And the owner and staff must show this by providing high quality specialized service to their customers. This applies to podiatry billing company in Arkansas, or another healthcare provider in Texas.

 

 

 Be current and fully updated on latest medical technology and treatments

As is common in many industries, there is constant technological advancement in the medical field. This includes knowledge, technology, and systems of operation. You have to work hard to keep yourself abreast of all these, in order to grow your medical practice.

It might require you taking a few days off occasionally to attend conferences or seminars. It might also mean you staying up late occasionally to read journals and do internet research to update your knowledge. Do your best to acquire the most up-to-date machines, portals, and healthcare apps that can enhance your services.

 

 Consider digital marketing

In today’s world, no matter how conservative the industry is, every business has to have good internet presence. A quality website is the starting point of a good digital marketing strategy. So you should try to get a decent website setup for your medical practice. In addition to this, you should consider hiring a competent company that provides top SEO for medical practices services. When you do a basic google search for SEO companies, several foreign companies will show up. My strong advice is to consider affordable local SEO companies in the United States that understand the medical practice business quite well rather than patronize foreign SEO companies. For example, if your medical practice is in Massachusetts, you should ask around for whichever company provides the #1 Medical SEO for medical practices in Massachusetts.

 

  1. Regularly train your staff

Apart from training your staff to align fully with your USP, you need to provide adequate and regular training to your staff about their core job roles, customer service on the phone and at the medical office, politeness, communication best practices, and technology.

It is easy to retain and acquire more customers when your staff display excellent customer services to current and prospective customers. Encourage your staff by giving them great feedback when they do well. Let them know they are highly appreciated as vital parts of your team.

If you are about starting a completely new practice, you should even do more training related to learning a lot about the community, prospective referral partners and customers. For example, before opening a pedorthic office, you should learn about the community, competitors and likely referral partners in the area.

Some practice types just recently got approved by insurance payers, and they need to do a lot of job training their staff to become ready. For example, acupuncture billing in MA is a new area, and so acupuncture credentialing needs to be learnt so that the practice is able to start seeing patients with insurance payers as quickly as possible.

 

 Send out satisfaction surveys to patients and customers

In order to grow your medical practice, you need to know those things that you are doing very well, the ones you are doing averagely well in, and the ones that represent your weaknesses. Though your staff can provide quality feedbacks among one another, the best way to get quality feedbacks that properly educate you about your performance is through patients and customers.

So it will be a good idea to use patient satisfaction surveys to learn about what you are doing right, what you are not doing write, and different ways you can improve. Many of your patients will be happy to provide feedback, because they want to get better service from you. And when you respond with improvement, you will be able to keep them.

This should not be a once in a while practice. Endeavour to send out surveys once or twice a year. And follow up on the patients to complete and return. You can use an online form to make it easier for everyone. After receiving the reports, create good time to analyze and act on them.

 

 Provide patients with sources of helpful information

During the COVID-19 crisis, many people got scared and relied only on news coming from the television and the internet. But simple information like types of food to eat, doing exercises, and so on are quality information that medical practices at this time should remind their patients through emails, texts, or phone calls. They will help patients improve their immunity and potentially save lives. I gave this example because this is something that the medical and government officials rarely talked on television. They focused only on strategies like social distancing and later wearing of masks. A good medical practice should regularly provide helpful information to its patients. Don’t just tell them eat good food, research and give them suggestions. Send them good articles to read.

Apart from health advice, many patients also like to know how to reduce their healthcare costs. Tell your patients about prescription discount cards. In fact, do some research on their behalf and recommend cards to them. There are many such cards available in hard copies or the internet, including the #1 prescription discount card in TX, GA, FL, OK, AK, ID, IA, WY, SD. MA

Some of your patients will benefit from new-to-market devices. By sharing relevant information with your patients and helping to improve the quality of their lives on a regular basis, many of them will remain your customers for long and tell more people about your medical practice. Word of mouth recommendations from your existing patients is the best way to get more patients.

 

 

 Consider providing additional services

This advice is applicable to all types of businesses. Whenever you have the opportunity, it is always good to add some side products and services to augment income. As a medical practice owner, you should consider additional services that can potentially make you extra income. And in order to do this, you should become conversant with your community by constantly identifying changing demographics and needs.

For example, if you find out there is an increasing number of old people in your community, then you may consider setting up a DME office within your practice. You will need to go through the DME credentialing process and perhaps work with a billing company, but first you need to do your research to be sure the business will succeed. For top DME billing in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MO, or Pedorthist billing,  you can contact Delon Health.

Some medical practices may also choose to sell supplements, snacks, water, or food at their office. As long as it does not negatively impact your primary business, you should always consider adding extra services to earn you more income.