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Try not to let frosty or blustery climate give your children the indoor weariness soul. Here are 10 approaches to help them smolder off some vitality when stuck inside.
That is the point at which I break out my dependable traps for keeping my children dynamic inside. In the event that there's one thing I've adapted after six winters in the Northwest with children, its that it pays to have an arrangement. I've additionally discovered that "being dynamic" doesn't need to mean running and bouncing. Simply getting children up and moving goes far towards enhancing their manners.
Here are my main 10 courses for getting the kids' vitality out when they're stuck inside.
Yoga. There are such a variety of incredible approaches to get children included in yoga nowadays. From applications on your cell phone to child amicable cards showing essential stances, there are huge amounts of awesome items to help your kids get their Zen on. There are some incredible free alternatives, as well. One of our top picks is a YouTube show called Cosmic Yoga.
Twister. This is an oldie yet without a doubt a goodie in that its great, shabby fun and it doesn't take up an excess of room. This excellent amusement is ideal for keeping a few children dynamic in a little space.
Simon Says. Children dependably have a decent time playing this senseless diversion — and you can utilize it to blaze off vitality by joining loads of enormous developments including hopping, turning, creeping, adjusting and the sky is the limit from there.
Indoor Scavenger Hunt. Who says forager chases are only for the outside? Look at these 5 changed approaches to set up a forager chase — and after that go insane redoing it to your kids' advantage or what they're at present dealing with in school. (Sight word and math scrounger chases are a major hit around our home of late.)
Pandora Freeze Frame. This is a straight forward diversion I made up one blustery evening. Essentially turn on your most loved Pandora station and have your children move up a tempest. Stop the station now and again and have them solidify at whatever point the music stops. Once the curiosity of this wears off, you can give them a telephone and let them take photos of one another when solidified, or even transform the action into an out-dated round of a game of seat juggling.
Toys Made to Get the Wiggles Out. Consistently by and by web journal, I set up together a progression of occasion toy blessing aides. While looking into them a couple of years prior, I lurched onto an entire classification of indoor toys made to help children work off their vitality. Our top picks in this classification incorporate indoor trampolines, parity sheets and air bounce balls.
Tumbling. A couple of years back, I had the delight of co-facilitating a Facebook visit with Olympic Skier Jonny Moseley. When somebody asked him how he kept his children dynamic, he said he had an aerobatic mat that he conveyed out for his children to tumble and wrestle on at whatever point they were stuck inside. I thought the thought was ingenious to the point that I requested a mat for my children that night. It's one of the best buys I ever constructed!
Stronghold Building. There truly is nothing more fun than ripping off the bed sheets and sofa pads and working throughout the evening with your kin to make the most epic fortification ever.
Inflatable Play. Have you ever seen how unbelievably long your children can involve themselves basically by batting around a blow up they got at an eatery or specialist's office? I keep a stash of dollar-passageway blow ups in a drawer for when fretfulness strikes. Amplify the enjoyment by playing "inflatable badminton" with two or three paper plates taped to wooden spoons as rackets. Then again what about an inviting rivalry of blow up races?
Find the stowaway. As a last resort, a great session of find the stowaway will regularly get you through. You can make it additional diversion for greater children by giving them spotlights and making it as dull as could be expected under the circumstances ins
With the reckoning of "back to class" upon us, mothers all around are in planning mode. We're purchasing knapsacks, arranging snacks and are prepared to execute those back-to-class conventions that we hold dear. Here are 9 BTS customs that my family cherishes. We trust you do, as well!
Back-to-School Photo Traditions
Take the conventional BTS photograph conventions to another level with an itemized concentrate on what you plan to report. Here are three basic points of view when shooting your conventional back-to-class photographs.
1. Track your kid's development: Use an easel, rather than a handheld board, to archive your youngster's development — and take the photo before the easel. As you proceed with the custom over the long run, your tyke's stature will likewise be recorded. Regardless of the fact that you don't have an easel, shoot the picture alongside the same tree or other visual marker rather than a clear divider.
2. Compose an announcement: Actually, archive your youngster's announcement! Ask the same question prior and then afterward the school year and perceive how her reaction changes. Our inquiry is "The thing that makes you amped up for school?" — and her answers dependably fill my heart. Add the solutions for your BTS photograph customs.
3. Incorporate their top choices: We cherish books, so I keep our convention in light of my girl's most loved scholarly impact, yet capturing your tyke with his most loved book, toy or action is a basic BTS photograph custom that will further help record his improvem
Archive Educational Milestones
4. Lead quarterly meetings: Do you know what your kid knows? Take a quarterly evaluation of her developments in view of summed up inquiries that you can posture for quite a long time to come. Archive how her feeling of reason develops and her values structure.
5. Record your tyke perusing the same book: Record your minimal one perusing the same book over the course of the years and listen as you hear how he advances from prereader to abstract mate.
6. Make an existence and learning report: Whether composed or described by your minimal one, archive her point of view on life and learning with a report. What is she realizing in school? Does she feel the data is vital? What subjects are most intriguing to her? How would her kin, folks, companions affect her learning? Request that her compose definite stories or draw pictures. Include her school extends in there, as well. Listen for the subtle elements and report them. Over the course of the years, you'll have the capacity to see how the force of learning has transformed her life.
Conventions with Teachers
The instructors who touch our youngsters' lives merit celebrating. Here are a couple of conventions to begin to help archive the relationship your youngster has with his instructors.
7. Request that educators compose a glad birthday message: I adore the instructor engravings made in adolescence books, however why not center that message on your tyke's birthday? Birthdays inspire a characteristic marker of development and help archive points of reference. Give educators a characteristic approach to message a note on that development. On the off chance that your minimal one has a late spring birthday, request that his educator compose a note in their birthday book on the most recent day of school.
8. Give instructor gratefulness endowments: Kids love custom and schedules in light of the fact that it gives them a feeling of comprehension. Research an educator gratefulness blessing that feels special to your youngster and offer that as a blessing every year. Your tyke will love imparting the historical backdrop of this convention to her instructors.
9. Praise the "instructor" in them: Help your tyke discover and sharpen her own particular novel endowments by recognizing that we're all educators to somebody. Is your minimal one an incredible huge sister? A phenomenal companion? Esteem, grasp and record the instructor in your little understudy by provoking her to make a rundown of the considerable number of ways she can offer back to her surroundings by sharing her capacities.
Thinking about skipping the dentist? It could cost you in the long run.
The national debate over health insurance largely overlooked dental coverage. But many of the problems in the health care industry – lack of access, high costs and poor health outcomes – afflict dental coverage, too.
With far fewer Americans having dental than medical insurance, and being linked to adverse and potentially deadly consequences, those who forgo dental treatment could find themselves with considerable bills.
Around 40 percent of Americans lacked dental insurance at the end of 2012, according to the . That’s compared to 12.9 percent without health insurance, according to the latest figures from . Those lacking coverage are far less likely to see a dentist – both for regular preventive exams and treatment of acute pain and other problems.
Many Americans don’t see the dentist unless something is wrong, and 56 percent of those without dental insurance skip preventive treatment altogether. Their reasons for delaying or forgoing care: high costs and lack of price transparency, according to the . But like forgoing health care, neglecting oral health could be a costly exercise in denial.
Cost of Reactive Care
You could be the most dedicated brusher and flosser and still have dental problems if you go years without seeing a professional. These problems can build up over time and leave you with a dental emergency that will cost you in the long run, experts say.
“I’ve seen patients with excellent home dental care develop severe gum disease because their tartar had built up for years, causing gingivitis and gum disease,” says Dr. Marshall Young, a dentist in Newport Beach, California. “Also, patients that fail to come for regular checkups and cleanings can have decayed teeth that were at one time small, fixable issues.”
The estimate that more than 27 percent of U.S. adults ages 20 to 44 have untreated cavities. Minor cavities can turn into major problems, and what would have required a filling can eventually require a root canal or extraction. Young says regular exams can uncover small problems before they grow in both size and cost.
Dr. Don C. Atkins, a dentist in Long Beach, California, also sees patients with serious conditions that could have been prevented with regular checkups.
“When a patient comes in reporting pain, since they just noticed it, they’re thinking it’s early on and probably no big deal,” Atkins says. “But when a dentist hears a patient complaining that they feel something, we already start to wonder if it’s a root canal or extraction type of problem.”
According to data from OkCopay, the is around $170 for a front tooth or $183 for a molar. Cavities identified early can be easily fixed with a filling. When a cavity goes undetected, it’s less likely that a filling will suffice.
The is far steeper: between $700 and $900. Likewise, a deep cleaning required in cases of periodontal disease, where tartar builds up beneath the gum line, can cost several times more than a regular dental cleaning, and involve charges for local anesthesia and antibiotics, too.
In addition to financial costs, there’s pain and, often, embarrassment that comes dental problems. Few pains are as brutal as a toothache, and few imperfections make you more self-conscious than missing teeth.
Links Between Poor Dental Care and Adverse Health Outcomes
Not taking care of your teeth impacts more than your oral health, however. Studies have linked bad dental care to a variety of poor, or even deadly, health outcomes.
“There are clear links between gum disease and other systemic issues, such as heart disease, diabetes and respiratory disease, to name a few,” Young says, adding that a dental exam can also identify digestive and bone health problems.
Living close to heavy traffic areas can place you at a higher risk for abnormal lung function and asthma.
Smoking is the culprit of chronic obstructive lung disease – everybody knows that. Except when it isn't. While smoking remains the – the combined term for emphysema, bronchitis and some forms of asthma – about one-quarter of people affected are nonsmokers. Some have a . And for others, environmental factors play a role.
"There's very strong evidence that if you're exposed to vapors, dust, gas and fumes at the workplace, then you have increased risk of COPD – independent of smoking," says Dr. John Balmes, a professor with the University of California–San Francisco medical school and at the UC–Berkeley School of Public Health.
Never Smoked – Have COPD
Vlady Rozenbaum, 74, founder of the advocacy group COPD-Alert, was raised in the harsh cold of a Siberian mining town. Retired Judge Valerie Chang, 57, grew up in balmy Honolulu. Chang and Rozenbaum are both nonsmokers. Yet both have COPD.
Rozenbaum's mother was a heavy smoker, and he's pretty sure she smoked during pregnancy. Chang's closest exposure to secondhand smoke was when she worked in the library as a law clerk one summer and people dropped in to smoke, sending her off to the cleaner air of the open atrium.
Both had lung conditions as children. Chang says she had "very mild, well-controlled asthma" as a girl. Rozenbaum's problems were more severe: He suffered from frequent respiratory infections, including pneumonia, and at one point was hospitalized and critically ill. He eventually developed bronchiectasis, a condition in which the airways are abnormally enlarged. Despite successful surgery, the condition later evolved into emphysema.
X-Factors
Chang's case is more mysterious. "I was diagnosed with COPD at 42, which is fairly young, and I had no risk factors," she says. So far, Chang has undergone genetic testing five times, to no avail. Experts still haven't figured out the cause, she says: "I'm one of those enigmas."
"Twenty-five percent of people in the United States who have evidence of COPD have never smoked," says Dr. David Mannino, a professor and chair of preventive medicine and environmental health at the University of Kentucky. "It's a big problem." A number of factors go into developing COPD, including early-life respiratory infections, exposure to occupational dusts and family history of emphysema, says Mannino, former chief science officer for the Centers for Disease Control and Prevention's Air Pollution and Respiratory Health Branch.
Many COPD patients have had asthma for years, he says. One challenge for doctors can be they have – or it might be both.
Urban and Rural Risks
Environment pollutants aren't usually the major and COPD, but they can make lung conditions worse, says Dr. Robert Wise, a professor of medicine at the Johns Hopkins University School of Medicine.
Urban areas have traditionally been thought of as particularly unhealthy, Wise says. For one thing, "the closer you live to traffic, the more likely you are to have abnormal lung function and a risk for asthma." But, he says, recent evidence suggests rural environments, where people are exposed to agricultural air particles, like hay mold, also have a significant effect on asthma.
In some parts of the United States, families who cook indoors with wood- or coal-burning stoves in poorly ventilated homes are at added risk for respiratory conditions.
"Outside of the United States, high levels of exposures to particulates, particularly from cooking what we call 'biomass fuels' – which includes things like grass and straw and animal dung – appears to be a major contributor to chronic lung disease," Wise says.
Workplace Connection
About 15 percent of COPD cases can be attributed to a person's occupation, according to the . Coal mine and silica dust are known risks. Rubber, plastics, leather manufacturing, construction utilities and textile manufacturing industries raise disease risk, according to NIOSH.
Smoke exposure is another work hazard, Balmes says. "Modern firefighters wear self-contained breathing apparatus equipment, and they're protected when they have that on," he says. But after a fire is "out," smoldering continues even as firefighters have removed protective gear. "They're actually inhaling potentially worse stuff than when you're actually fighting a fire," he says.
Diesel exhaust fumes are also a danger, Balmes says, whether you're working at a rail yard or as a truck driver. Over time, he says, continual irritation and inflammation from these types of hazards lead to airway scarring, obstructed air flow obstruction and reduced lung function – hallmarks of COPD.
Chemical Concerns
Industrial cleaning solutions are another problem, Mannino says. "Cleaning fluids are notorious for being irritants to the respiratory tract," he says. At least one study has found that people who work in cleaning jobs, like janitors, have higher levels of respiratory disease.
Manicurists in can be exposed to the same chemicals as factory workers, Mannino notes, but without similar monitoring or regulations. Surgical-type facial masks "are probably completely ineffective" protection, he says. Instead, effective prevention would likely involve some type of industrial hood. "You need to remove the exposure – those chemicals – from your breathing space," he says.
There are no recommendations for preventive screenings, such as pulmonary function tests or lung CT scans, for workers in high-risk occupations, Mannino says, although he thinks there should be.
Pollution Protection
Wise says it's "critical" to pay more attention to air pollution. For all the efforts made to control , he says, evidence suggests federal ozone standards "are still too high and need to come down." Meanwhile, he says, indoor air pollution has been made worse from efforts to increase energy efficiency by closing off houses and reducing ventilation.
What can you do on an individual level to protect yourself and your family? If feasible, Balmes suggests choosing to live in an area where the air quality is as clean as possible. You can check any U.S. location by plugging the ZIP code into the report card from the American Lung Association.
If you live in a problem area, Balmes says, pay attention to air quality alerts and avoid going outdoors on particularly bad days. You also can buy air filtration devices for your home to reduce particle exposure. If you work in a high-risk occupation, wear protective respiratory gear – which your employer should provide. And don't overlook the basics of lung health: not smoking and avoiding secondhand smoke.
COPD Frontlines
"I always thought of emphysema and COPD as something only smokers got," says Chang, the former judge. So when she learned of her diagnosis 15 years ago, "it was really hard to reconcile." Now, as founder and executive director of the Hawaii COPD Coalition, her advocacy skills come in handy for around the third-leading cause of death in the United States. "COPD is so misunderstood," Chang says. "It's not given the respect it deserves."
On Thursday, May 28, U.S. News and the National Heart, Lung, and Blood Institute will host a Twitter chat on . Experts will discuss everything from what causes asthma to how schools are helping students manage the condition, how to enjoy the outdoors with asthma and what you can do to prevent an attack.
Who: , , and .
What:A Twitter chat on coping with asthma. Join the conversation by using the hashtag #AsthmaChat.
Where:
When: Thursday, May 28 at 2 p.m. EST.
Why: May marks Asthma Awareness Month – a nod to the nearly 19 million people in the United States , which affects the lungs and causes wheezing, breathlessness, chest tightness and coughing. It's a genetic condition, and triggers include irritants such as dust mites, pollen, mold; cigarette smoke and strong odors; cold air and dry wind; and exercise. There's no cure, but children and adults with asthma can learn to effectively manage it – and during our #AsthmaChat, we'll explain how.
Cities were scored based on factors such as how many people smoke and are overweight, as well as the region's walkability and number of pools and tennis courts.
The District of Columbia is often criticized as a do-nothing town full of politicians who are all talk and no action. But for the residents of the city and its neighboring suburbs, it's just the opposite. The District is so active, in fact, that a out today from the American College of Sports Medicine names it the fittest metropolitan area in the nation.
"It's a city that is full of smart and driven people, who can tend to be tightly wound sometimes," says Lexie Bohnert, a 26-year-old communications professional-turned-yoga instructor in the District who cofounded the blog . "Fitness is an opportunity for them to let loose and release tension and stress from Metro rides, office politics, actual politics and general life."
In other words, the city is just as friendly to workoutaholics as .
The ASCM's American Fitness Index, released annually since 2008, scored 50 metropolitan areas on 31 indicators of personal fitness, such as , are overweight and eat at least two servings of fruit each day, as well as measures of community fitness, such as the region's walkability, school requirements for physical education and number of pools and tennis courts. A new indicator this year assesses how many residents live within a 10-minute walk to a park.
| Rank | Metropolitan Area | Score |
|---|---|---|
| 1 | Washington-Arlington-Alexandria, DC-VA-MD-WV | 79.6 |
| 2 | Minneapolis-St. Paul-Bloomington, MN-WI | 75.6* |
| 3 | San Diego-Carlsbad, CA | 75.6* |
| 4 | San Francisco-Oakland-Hayward, CA | 72.6 |
| 5 | Sacramento-Roseville-Arden-Arcade, CA | 71.4 |
| 6 | Denver-Aurora-Lakewood, CO | 71.1 |
| 7 | Portland-Vancouver-Hillsboro, OR-WA | 69.6 |
| 8 | Seattle-Tacoma-Bellevue, WA | 68.5 |
| 9 | Boston-Cambridge-Newton, MA-NH | 68.1 |
| 10 | San Jose-Sunnyvale-Santa Clara, CA | 65.9 |
| 11 | Hartford-West Hartford-East Hartford, CT | 64.8 |
| 12 | Salt Lake City, UT | 61.9 |
| 13 | Raleigh, NC | 60.1 |
| 14 | Atlanta-Sandy Springs-Roswell, GA | 57.5* |
| 15 | Virginia Beach-Norfolk-Newport News, VA-NC | 57.5* |
| 16 | Cincinnati, OH-KY-IN | 56.4 |
| 17 | Chicago-Naperville-Elgin, IL-IN-WI | 56.3 |
| 18 | Richmond, VA | 55.0 |
| 19 | Baltimore-Columbia-Towson, MD | 54.5 |
| 20 | Austin-Round Rock, TX | 54.2 |
| 21 | Pittsburgh, PA | 53.0 |
| 22 | Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 52.5 |
| 23 | Los Angeles-Long Beach-Anaheim, CA | 52.0 |
| 24 | New York-Newark-Jersey City, NY-NJ-PA | 50.9 |
| 25 | Cleveland-Elyria, OH | 50.5* |
| 26 | Kansas City, MO-KS | 50.5* |
| 27 | Tampa-St. Petersburg-Clearwater, FL | 50.2 |
| 28 | Providence-Warwick, RI-MA | 49.4 |
| 29 | Saint Louis, MO-IL | 48.1 |
| 30 | Miami-Fort Lauderdale-West Palm Beach, FL | 47.5 |
| 31 | Las Vegas-Henderson-Paradise, NV | 47.4 |
| 32 | Buffalo-Cheektowaga-Niagara Falls, NY | 47.3 |
| 33 | Milwaukee-Waukesha-West Allis, WI | 46.8 |
| 34 | Riverside-San Bernardino-Ontario, CA | 44.8 |
| 35 | Jacksonville, FL | 43.5 |
| 36 | Orlando-Kissimmee-Sanford, FL | 42.7 |
| 37 | Phoenix-Mesa-Scottsdale, AZ | 41.1 |
| 38 | Columbus, OH | 41.0 |
| 39 | Houston-The Woodlands-Sugar Land, TX | 39.8 |
| 40 | Detroit-Warren-Dearborn, MI | 39.0 |
| 41 | Dallas-Fort Worth-Arlington, TX | 38.8 |
| 42 | New Orleans-Metairie, LA | 38.6 |
| 43 | Charlotte-Concord-Gastonia, NC-SC | 37.4 |
| 44 | Birmingham-Hoover, AL | 34.5 |
| 45 | Nashville-Davidson-Murfreesboro-Franklin, TN | 33.0 |
| 46 | Louisville/Jefferson County, KY-IN | 32.1 |
| 47 | San Antonio-New Braunfels, TX | 32.0 |
| 48 | Oklahoma City, OK | 29.6 |
| 49 | Memphis, TN-MS-AR | 27.3 |
| 50 | Indianapolis-Carmel-Anderson, IN | 26.8 |
| Source: American College of Sports Medicine | *The scores shown have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full calculated score values that were not equal in those cases. |
"We wanted to find out two things: What is it about us who live in these big cities that guides our behaviors?" says Walter Thompson, a professor of kinesiology, health and nutrition at Georgia State University who chairs the Index's Advisory Board. "But beyond that, we wanted to … really answer the question: If I live in a city and I want to be physically active, does my community support that?"
For example, someone who wants to stay fit in the Minneapolis-St. Paul region, which the ACSM ranked the country's second fittest metropolitan area, won't have to look far, despite the Twin Cities' bitter weather. According to the ACSM index, residents there enjoy 2.6 recreational centers per 20,000 people – more than 2.5 times the ACSM's "target goal" of one center per 20,000 people.
People in the Minneapolis-St. Paul area "know that from October 1 to April 1, it's going to be cold. They know it – it happens every year," Thompson says. "They made this conscious decision that people who want to be physically active need to be provided that space and that time indoors."
Meanwhile, the Washington area achieved an even higher ranking due to measures such as the number of farmers markets (28.7 per 1,000,000 people), the percentage of people who (14.2 percent) and the percentage of residents who live within a 10-minute walk to a park (95 percent).
"If you want to go to nice restaurant, it's not that far away. If you want to go to a gym to work out in, it's not that far away. If you want fresh produce ... in almost every neighborhood, you can find all of these amenities within a mile of where you stand," says Brian McGee, a personal trainer and owner of FIT360DC, a gym in the District.
Residents of some other regions don't have that luxury. The Indianapolis area, for example, scored lowest on the ACSM index this year, thanks to factors such as its number of recreational centers (0.6 per 20,000 people), percentage of land that's parkland (5 percent) and percentage of residents who bike or walk to work (1.8 percent). Individual behaviors in that area are relatively poor, too: 20.5 percent of residents smoke, for example, and less than 13 percent eat at .
"What's happening in some of these cities is that they just haven't quite gotten out of the economic downturn," Thompson says. "So their resources that have been reduced during this time they haven't been able to recover yet to put money back into the infrastructure of the city's recreational facilities."
Still, some of the lowest ranking cities should be commended for their progress, Thompson says. Oklahoma City, for one, perpetually ranked last but held its No. 48 slot this year, thanks in part to changes spearheaded by its mayor, Mick Cornett, who launched a in 2011. "He's very dedicated to physical activity," Thompson says.
All metropolitan areas are encouraged to use their rankings as a way to identify "opportunities for change," says Thompson, whose hometown of Atlanta moved from 16 last year to 14 this year, in part thanks to the area's increasing number of bike lanes and construction of the BeltLine – a stretch of pedestrian-friendly rail transit and trails being built on a 22-mile historic rail corridor. "Those are the kinds of advancements we'd like to see in cities," Thompson says.
While policy and resources drive much of such advancements, residents too can no matter what city they live in by getting involved in grassroots movements and contacting their local leaders, Thompson says.
"Contact city leaders and tell them that 'We want to be fit, we want to exercise regularly, but our parks aren't safe, they aren't well-lit, there aren't enough bike lanes,'" he says. "Each one of these 31 indicators can change."
There's strong inconsistency surrounding when women should get mammograms.
Megan received a birthday card from her younger sister, reminding her she's turning 40 in few weeks. Megan’s sister always likes to rub in another birthday. A mother of three, Megan works for an advertising agency, exercises regularly and has been a strict for the past 10 years.
Always a planner, Megan made a checklist of things she needs to do once she turns 40. She wants to take that trip to Ireland she's been planning for many years – and take up yoga and meditation.
What about ?
Her aunt had breast cancer when she was in her 70s and was treated with surgery and radiation therapy. Because Megan was very close to her aunt, she always paid attention to breast cancer issues. And she's been keenly aware of the mammogram age and interval guidelines often discussed over the past four years.
Megan happened to run into her primary care doctor, Alison, at the gym. They've known each other for many years. Megan asked Alison when she should get a mammogram, but it seemed Alison didn't want to give a direct answer.
“Megan, let’s talk about that when you come to see me next time,” Alison suggested.
“That’s six months from now. Is that too late?” Megan was worried.
“No, you'll be fine,” Alison said, before she walked away.
Megan was well aware of the controversies around and the risk of procedures and over-diagnosis. But she still sought a clear answer. She asked her friend Janice, who works at a cancer center.
“I talked to our cancer doctors, and they strongly recommend a mammogram starting at age 40,” Janice said. Megan could always count on her for a direct answer.
Megan searched for more information online. She’s not the only one who's confused: Since the U.S. Task Force and Preventive Services came up with the mammogram recommendations, the debate has heated up. Just this past April 15, the guidelines .
According to the draft release, “The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years …. All women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive that would otherwise not have become a threat to her health, or even apparent, during her lifetime (known as “over diagnosis”). This risk is predicted to be increased when beginning regular mammography before age 50 years.”
After reading this, Megan was even more confused. She visited websites of a number of reputed physician organizations to see what she should do. What she found was much inconsistency:
| American Academy of Family Practice | Risk-based approach |
| American College of Physicians | Risk-based approach |
| American College of Radiology | Start mammogram |
| American Cancer Society | Start mammogram |
| National Cancer Institute | Start mammogram |
| U.S. Task Force for Preventive Services | Risk-based approach |
| U.K Health systems | Not recommended |
| Canadian | Risk-based approach |
| Affordable Care Act | Start mammogram |
After Megan shared her story with me, I reviewed her mammogram and biopsy report, discovering . Since it was found in its early stage, it's highly treatable and curable. She was happy to hear that, and extremely relieved she had a mammogram.
As a doctor, my view is skewed because I see only patients who have been given a breast cancer diagnosis. But I hear stories like Megan’s all the time, and it’s troubling to me. My personal view is that a mammogram is a low-cost, low-risk procedure that can save lives, regardless of what recommendations may say. I surmise many 40-something women with a breast cancer diagnosis would agree.
Aim for one tablespoon of olive oil a day.
As an interventional cardiologist who specializes in prevention, patients, friends and family ask me all the time which diet will best .
There's been much hype and fanfare surrounding various diets, but the diet that has consistently shown benefit in randomized control studies is the . It's been shown to reduce heart attack and stroke as well as . The Mediterranean diet is based on the traditional eating habits found in Southern Italy and Greece in the early 1960s. It's centered around plant-based foods – heavy on vegetables, fruits, legumes, fish, olive oil and some amount of nuts. But what does that really mean, and how much of these should we be eating? We can all agree that even too much of good thing is bad. So here's some helpful advice about how to follow the Mediterranean diet as studied in trials:
The first thing people notice about this diet is the limit on fish, nuts, meat and dairy to only 3 servings a week – not every day. Also, notice the . In this diet, meat is an accent, not a centerpiece of your meal.
Finally, eating is one of the greatest pleasures in life. Enjoy your food, eat what's good for you in moderation and remember the words of Hippocrates: “Let food be thy medicine, and medicine be thy food.”
Many believe stress and eating greasy foods can cause acne, but that's not the case.
Your skin is covered with many tiny holes, commonly referred to as hair follicles or pores, which contain oil glands that help keep skin and hair moisturized. During puberty, hormones can cause the skin to make too much oil, resulting in clogged pores, also . If the top of a pimple is dark, it's called a blackhead; if the top is white, it's called a whitehead.
Acne symptoms include redness around pimples and small red bumps. If a clogged pore breaks open, additional swelling and red bumps can occur; acne that is deep in the skin can be especially painful. Most pimples occur on the face, but can also appear on the neck, back, chest and shoulders. Acne and acne scars often result in and stress.
Several factors can trigger acne. As previously mentioned, hormonal changes in adolescence increase the skin's oil content. Likewise, high humidity, sweat and stress also aggravate acne. Certain medications can contribute. Additionally, some scientists believe genetics plays a role: if a parent had acne as a teenager, his or her children are likely to have acne. Table 1 lists common acne myths.
| Table 1: Acne Myths |
|---|
| The following are not true: |
| Adults don't get acne. |
| Wearing makeup causes acne. |
| Eating greasy foods causes acne. |
| Stress causes acne. |
| Scrubbing gets rid of acne. |
| Poor hygiene causes acne. |
People of all ages, including babies and elders, can develop acne. Even people in their 30s, 40s and 50s can develop acne. Up to 80 percent of people ages 11 to 30 have acne outbreaks, with 27 percent having severe acne, often leading to scaring. During adolescence, acne is more common in boys; in adults, acne is more common in women. At 40 years old, 5 percent of women and men still have acne.
Acne and Diet
Diet, as a , has been controversial. Chocolate, pizza and nuts don't appear to cause acne, while there is some evidence that high in refined sugars and dairy products may be related to acne. There is a stronger connection between skim milk and acne compared with other dairy products: People who drink two glasses of skim milk daily have a 44 percent greater chance of developing acne. White bread, rice, potatoes and pasta may likewise play a role.
Treatment
Treatments focus on four goals:
Most dermatologists use a combination of treatments that can be expensive and require multiple sessions before results are noticeable. Even with treatment, there is no guarantee that a person will be acne-free. Table 2 lists several medications used to treat acne. Table 3 lists tips for managing acne. If do not get the desired result, dermatologists can prescribe stronger medications. Most of these medications help break down blackheads and whiteheads by unclogging skin pores. All medicines have side effects, and your doctor or pharmacist will discuss these with you.
| Table 2: Acne Medications |
|---|
| Oral antibiotics. |
| Topical antibiotics applied to the skin. |
| Medications called spironolactone and isotretinoin. |
| Retinoic acid cream or gel. |
| Azelaic acid applied to the skin. |
| Other agents, such as sulfur and benzoyl peroxide. |
| Table 3: Tips for Managing Acne |
|---|
| Wash your face twice daily after sweating. Perspiration worsens acne. |
| Use your fingers to apply gentle, nonabrasive face cleaners. Using a washcloth or sponge may irritate the skin. |
| Avoid scrubbing acne. |
| Shave carefully. |
| Shampoo regularly. If you have oily hair, shampoo daily. Also, keep hair away from your face. |
| Avoid wearing hats, headbands and baseball caps. |
| Avoid touching your face, which may cause flare-ups. |
| Choose makeup carefully. Select oil-free products, and never leave makeup on overnight. |
| Avoid sun and tanning beds. Some acne medications result in the skin being very sensitive to sunlight and tanning devices. |
| Find the right OTC product for your skin type. These creams, washes and soaps work in different ways to reduce oil production in the pores. |
| Consult a dermatologist if OTC products are ineffective. |
| If acne depresses you, talk to your doctor. |
| Don't squeeze or pop pimples, blackheads and whiteheads. This can lead to scarring. |
Acne Scars
ranges from mild to severe, the latter being associated with deep tissue scars. Laser skin resurfacing, dermabrasion, chemical peels and the use of fillers are four procedures used to treat acne scars. Laser skin resurfacing removes skin layer by layer, with precision, so that skin cells formed during healing give the skin a tighter, younger-looking surface. Dermabrasion, also called sanding, removes layers of skin, as well. Chemical peels involve applying a chemical solution to the skin to make it "blister" and eventually peel off; the new skin revealed is usually smoother than the old skin. Fillers, which are injected, "plump" up scars and bring them closer to the surface, thereby making them less noticeable. The effects of fillers last between six and 18 months. Acne surgery is another treatment option. The surgery involves lifting the scar to make it less noticeable. Over time, some acne scars fade. Your doctor may use medications to prevent scarring. Bellafill was recently approved to treat acne scars. Isotretinoin is also very effective in treating and preventing scars; however, because isotretinoin can cause birth defects, it's not used in pregnant women.
Acne, left untreated, can lead to scars, depression and . Early treatment is critical to obtain the best results and minimize or prevent scarring.
Note: This article was originally published on April 17, 2015 on PharmacyTimes.com. It has been edited and republished by U.S. News. The original version, with references, can be seen .
More than 150,000 people have been notified that they were potentially exposed to unsafe injection practices.
Far from a , some injections carry more than medicine into the veins and bodies of patients.
To date, more than 150,000 people have received letters after going to outpatient centers and other health care providers notifying them they were potentially exposed to unsafe injection practices, and, as a result, diseases , an infection of the liver that commonly becomes chronic, as well as bacterial infections. That’s according to the latest figures from the Centers for Disease Control and Prevention, which began keeping statistics on the problem in 2001.
Through 2011, the most recent year for which data are available, dangerously negligent practices such as reusing single-use syringes or drawing from single-use medication vials to administer injections to multiple individuals have led to more than 40 outbreaks nationwide.
Health officials say the findings punctuate a need to raise awareness and improve safety education among providers and patients in the U.S.
“I think it was realizing that this was not just a developing world problem,” says CDC health care epidemiologist Dr. Joseph Perz. “CDC was supporting the World Health Organization, and its Safe Injection Global Network activities – that’s something that CDC helped found in the late 1990s – and what we realized by the early 2000s is that we had a lot more outbreak activity here in the U.S. than we’d anticipated.”
Perz and his CDC colleagues say problems persist today.
Earlier this month, Tonya Rushing, the former chief operating officer of a Las Vegas medical clinic involved in a 2007 hepatitis C outbreak tied to unsafe injection practices, pleaded guilty to conspiracy to commit health care fraud for inflated billing practices and received a sentence of one year and one day in federal prison. Rushing had served under the physician owner of the Endoscopy Center of Southern Nevada, Dr. Dipak Kantila Desai.
For his part, Dr. Desai is serving a life sentence for second-degree murder, related to the death of a 77-year-old patient infected with hepatitis C.
“What made this outbreak different is that this wasn’t just a bad day. It was the routine practice in the clinic,” Perz says. Nurse anesthetists, who also faced prosecution in the case, were found to have routinely reused syringes, against proper single-use protocol, repeatedly dipping into vials containing the sedative propofol, which were apparently contaminated with hepatitis C. Perz called the outbreak a “tipping point” for stepped-up efforts to raise public awareness about unsafe infection practices.
While the CDC says most providers follow safe injection practices, he and others at the agency stress that recent outbreaks highlight the need for patients to remain vigilant. That includes an ongoing investigation into a Santa Barbara, California, doctor’s office where unsafe injection practices were implicated in at least five patients testing positive for hepatitis C.
“There’s been a lot of real patient harm – life-threatening diseases, not limited to but including hepatitis C, multiple-drug resistant staph aureus, a long list of fairly serious infections,” Perz says. Among them: and spinal meningitis.
One unsafe injection practice that gets less recognition, he says, involves a health provider’s failure to wear a face mask – as they should – while administering a spinal injection.
“That is a way of spreading bacteria to one of your protected, sterile immune sites, anatomically. You can imagine that if bacteria are inadvertently introduced into your spine that the outcome could be very bad,” he says. “There’s a number of outbreaks involving spinal meningitis that have occurred from, most likely, the simple failure to wear a face mask as recommended in that situation.”
Injecting patients safely also requires keeping up with the times and .
Insulin pens created for convenient use by one individual have been misused in health care settings. “We’ve had a number of situations – not outbreaks, per se, but situations – where somebody in a hospital, a nurse, uses that insulin pen for more than one patient,” Perz says. “We’ve had thousands of patients who’ve had to get letters and go through the anxiety of testing. We’ve not documented an outbreak, thank goodness.” But, he says, it raises concern as pre-filled, self-injection pens are becoming more prevalent.
“The technology is moving. That’s good for patients who are managing their own disease process, but we have to be very careful when that technology is introduced into a health care setting and we don’t have all the safeguards and training in place,” Perz adds. “So that’s something the [CDC] campaign has tried to bring attention to as well.”
Outspoken patient advocate Evelyn McKnight, the victim of unsafe injection practices, encourages patients to talk openly with providers about injection safety.
“Certainly when you’re going to be given an injection, ask, ‘Is this going to be one needle, one syringe, only for me, only used one time?’ You might ask to see them open the needle in front of you,” she says.
That’s central to the CDC’s “One & Only” public awareness campaign, which aims to educate providers and patients, and facilitate dialogue on safe injection practices.
“It’s a little bit technical for a patient to start to ask providers questions about if they’re using a single-dose vial versus a multiple-dose vial, and how much of which, and which equipment that they’re using,” says campaign director Jennifer Mitchell. “So we try on our website to provide introductory level questions so that patients feel empowered in being able to have this type of conversation if they’re concerned about their safety and their environment.”
The CDC recommends patients the following questions before receiving an injection:
• Will a new needle, new syringe and a new vial be used for this procedure or injection?
• Can you tell me how you prevent the spread of infections in your facility?
• What steps are you taking to keep me safe?
Mitchell and others want patients to realize are far from an extraneous add-on to health care conversations; rather they fit into broader discussion about infection control that CDC recommends patients routinely have with providers. The agency insists, for example, that patients not be bashful about asking doctors or other providers to wash their hands – an infection-control measure as powerful as it is simple, and one that studies show frequently gets skipped.
For backup – and to guide the safe-injection-practices discussion – Mitchell recommends patients download and print out a health care provider brochure and separate pocket card with injection safety information from the and take it with them to share with health care providers.
McKnight says providers should, in turn, be open to having injection safety conversations. She knows all too well the stakes for patients.
In 2001, McKnight contracted hepatitis C while being treated for a recurrence of at a clinic in Fremont, Nebraska, where she lives. Under her oncologist’s direction, nurses had reused syringes to draw contaminated saline from a vial used for multiple patients, infecting McKnight and 98 patients with hepatitis C in what remains one of the largest health care outbreaks in U.S. history.
“It was such suffering for all of our community,” McKnight says. “I mean 99 people. There was such sorrow and grief and difficulty. Lives were lost. Six people died from hepatitis C, not from cancer. It’s also completely preventable.”
McKnight went on to co-found HONOReform, a public policy organization, along with the nonprofit HONOReform Foundation, focused on developing programs to prevent future outbreaks, like promoting safe injection practices, and she has encouraged the CDC’s public awareness efforts.
“I am fortunate: I cleared the virus,” says McKnight, who is also cancer free. “I think when you go through a crisis, a trauma like this, the only solace you can take is [that] what happened to us can be used to prevent it from happening to anybody else.”
On Thursday, May 28, U.S. News and the National Heart, Lung, and Blood Institute will host a Twitter chat on . Experts will discuss everything from what causes asthma to how schools are helping students manage the condition, how to enjoy the outdoors with asthma and what you can do to prevent an attack.
Who: , , and .
What:A Twitter chat on coping with asthma. Join the conversation by using the hashtag #AsthmaChat.
Where:
When: Thursday, May 28 at 2 p.m. EST.
Why: May marks Asthma Awareness Month – a nod to the nearly 19 million people in the United States , which affects the lungs and causes wheezing, breathlessness, chest tightness and coughing. It's a genetic condition, and triggers include irritants such as dust mites, pollen, mold; cigarette smoke and strong odors; cold air and dry wind; and exercise. There's no cure, but children and adults with asthma can learn to effectively manage it – and during our #AsthmaChat, we'll explain how.
For survivors to remain in remission, the Cleveland Clinic is dedicated to providing a clear roadmap – a survivor’s guide – to living an anti-inflammatory lifestyle.
In August 2010, I received news that no one wants to hear: My sister’s mammogram identified a tumor. Cancer was the likely cause. After undergoing a biopsy, the pathology supported the initial dread – she had and would face an uphill battle for survival. In fact, when she had surgery to remove the tumor in its entirety, it was found that she had two tumors (one on top of the other) that were classified as different primary cancers – how incredibly unlucky for her.
Most of us can identify a family member, friend, co-worker or neighbor who has been impacted by a . Frustration continues to mount as we race to find the silver bullet that will eradicate this devastating disease. I was intrigued by a recent report that could illustrate a major breakthrough in cancer treatment.
This spring, the HBO documentary series “Vice” aired an eye-opening account of current clinical trials in the U.S. that use old adversaries to augment the immune system’s fight against cancer cells. “Killing Cancer” centered on the work of Dr. Jon Bell, a Canadian researcher who looked back 100 years to find a treatment program to test.
The documentary follows several who all failed standard treatments and faced certain death, until they met Dr. Bell. Inspired by a century-old study, he administered genetically modified viruses that he hoped would attack the cancer cells.
For many of the patients, the aggressive treatment worked. Two people with glioblastoma are in full remission. At the very least, the science is encouraging, and the medical community is hopeful that this will help eradicate the world’s cancer epidemic.
After watching the show, a question popped into my head: “How can the Cleveland Clinic Wellness Institute assist cancer survivors?” We have wellness programs for weight loss, disease reversal, and brain health, but nothing that relates to current and future cancer survivors.
Dr. Mladen Golubic, section head of Lifestyle Medicine at Cleveland Clinic, and I are meeting with specialists who treat prostate and breast cancer to collaborate on wellness initiatives for cancer survivors. We believe that for survivors to remain in remission, we must provide a clear roadmap – a survivor’s guide – to living an .
Lowering inflammation goes a long way toward living a long, healthy life. And cancer survivors need to focus on more than their cancer diagnosis. The rest of the body needs TLC in order to reduce the risk of developing another chronic disease. This starts with food choices and portion size, proper supplementation, stress reduction, avoiding all tobacco products and exercise.
So much of what we offer cancer survivors is about watching for signs of recurrence. The Cleveland Clinic Wellness Institute will partner with experts to develop forward-thinking approaches for cancer survivors. We want our patients focusing on healthy living. Running scared? Never again! The only running cancer survivors should be doing is for daily exercise.
My sister continues to receive the best care possible at Cleveland Clinic’s Tausig Cancer Center. I am grateful for her team of doctors and am so thankful to report that she continues to live a full life in remission. Though she is five years removed from her breast cancer diagnosis, it is time for her – as well as the millions of cancer survivors – to have a discussion on living “well.”
This forward-thinking approach to wellness will assist many patients in truly leaving their cancer . I will keep you updated on our newly created shared medical appointments as they emerge. Until next time, be well.
Cities were scored based on factors such as how many people smoke and are overweight, as well as the region's walkability and number of pools and tennis courts.
The District of Columbia is often criticized as a do-nothing town full of politicians who are all talk and no action. But for the residents of the city and its neighboring suburbs, it's just the opposite. The District is so active, in fact, that a out today from the American College of Sports Medicine names it the fittest metropolitan area in the nation.
"It's a city that is full of smart and driven people, who can tend to be tightly wound sometimes," says Lexie Bohnert, a 26-year-old communications professional-turned-yoga instructor in the District who cofounded the blog . "Fitness is an opportunity for them to let loose and release tension and stress from Metro rides, office politics, actual politics and general life."
In other words, the city is just as friendly to workoutaholics as .
The ASCM's American Fitness Index, released annually since 2008, scored 50 metropolitan areas on 31 indicators of personal fitness, such as , are overweight and eat at least two servings of fruit each day, as well as measures of community fitness, such as the region's walkability, school requirements for physical education and number of pools and tennis courts. A new indicator this year assesses how many residents live within a 10-minute walk to a park.
| Rank | Metropolitan Area | Score |
|---|---|---|
| 1 | Washington-Arlington-Alexandria, DC-VA-MD-WV | 79.6 |
| 2 | Minneapolis-St. Paul-Bloomington, MN-WI | 75.6* |
| 3 | San Diego-Carlsbad, CA | 75.6* |
| 4 | San Francisco-Oakland-Hayward, CA | 72.6 |
| 5 | Sacramento-Roseville-Arden-Arcade, CA | 71.4 |
| 6 | Denver-Aurora-Lakewood, CO | 71.1 |
| 7 | Portland-Vancouver-Hillsboro, OR-WA | 69.6 |
| 8 | Seattle-Tacoma-Bellevue, WA | 68.5 |
| 9 | Boston-Cambridge-Newton, MA-NH | 68.1 |
| 10 | San Jose-Sunnyvale-Santa Clara, CA | 65.9 |
| 11 | Hartford-West Hartford-East Hartford, CT | 64.8 |
| 12 | Salt Lake City, UT | 61.9 |
| 13 | Raleigh, NC | 60.1 |
| 14 | Atlanta-Sandy Springs-Roswell, GA | 57.5* |
| 15 | Virginia Beach-Norfolk-Newport News, VA-NC | 57.5* |
| 16 | Cincinnati, OH-KY-IN | 56.4 |
| 17 | Chicago-Naperville-Elgin, IL-IN-WI | 56.3 |
| 18 | Richmond, VA | 55.0 |
| 19 | Baltimore-Columbia-Towson, MD | 54.5 |
| 20 | Austin-Round Rock, TX | 54.2 |
| 21 | Pittsburgh, PA | 53.0 |
| 22 | Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 52.5 |
| 23 | Los Angeles-Long Beach-Anaheim, CA | 52.0 |
| 24 | New York-Newark-Jersey City, NY-NJ-PA | 50.9 |
| 25 | Cleveland-Elyria, OH | 50.5* |
| 26 | Kansas City, MO-KS | 50.5* |
| 27 | Tampa-St. Petersburg-Clearwater, FL | 50.2 |
| 28 | Providence-Warwick, RI-MA | 49.4 |
| 29 | Saint Louis, MO-IL | 48.1 |
| 30 | Miami-Fort Lauderdale-West Palm Beach, FL | 47.5 |
| 31 | Las Vegas-Henderson-Paradise, NV | 47.4 |
| 32 | Buffalo-Cheektowaga-Niagara Falls, NY | 47.3 |
| 33 | Milwaukee-Waukesha-West Allis, WI | 46.8 |
| 34 | Riverside-San Bernardino-Ontario, CA | 44.8 |
| 35 | Jacksonville, FL | 43.5 |
| 36 | Orlando-Kissimmee-Sanford, FL | 42.7 |
| 37 | Phoenix-Mesa-Scottsdale, AZ | 41.1 |
| 38 | Columbus, OH | 41.0 |
| 39 | Houston-The Woodlands-Sugar Land, TX | 39.8 |
| 40 | Detroit-Warren-Dearborn, MI | 39.0 |
| 41 | Dallas-Fort Worth-Arlington, TX | 38.8 |
| 42 | New Orleans-Metairie, LA | 38.6 |
| 43 | Charlotte-Concord-Gastonia, NC-SC | 37.4 |
| 44 | Birmingham-Hoover, AL | 34.5 |
| 45 | Nashville-Davidson-Murfreesboro-Franklin, TN | 33.0 |
| 46 | Louisville/Jefferson County, KY-IN | 32.1 |
| 47 | San Antonio-New Braunfels, TX | 32.0 |
| 48 | Oklahoma City, OK | 29.6 |
| 49 | Memphis, TN-MS-AR | 27.3 |
| 50 | Indianapolis-Carmel-Anderson, IN | 26.8 |
| Source: American College of Sports Medicine | *The scores shown have been rounded to the nearest tenth of a point resulting in some apparent ties; however, the rankings are based on the full calculated score values that were not equal in those cases. |
"We wanted to find out two things: What is it about us who live in these big cities that guides our behaviors?" says Walter Thompson, a professor of kinesiology, health and nutrition at Georgia State University who chairs the Index's Advisory Board. "But beyond that, we wanted to … really answer the question: If I live in a city and I want to be physically active, does my community support that?"
For example, someone who wants to stay fit in the Minneapolis-St. Paul region, which the ACSM ranked the country's second fittest metropolitan area, won't have to look far, despite the Twin Cities' bitter weather. According to the ACSM index, residents there enjoy 2.6 recreational centers per 20,000 people – more than 2.5 times the ACSM's "target goal" of one center per 20,000 people.
People in the Minneapolis-St. Paul area "know that from October 1 to April 1, it's going to be cold. They know it – it happens every year," Thompson says. "They made this conscious decision that people who want to be physically active need to be provided that space and that time indoors."
Meanwhile, the Washington area achieved an even higher ranking due to measures such as the number of farmers markets (28.7 per 1,000,000 people), the percentage of people who (14.2 percent) and the percentage of residents who live within a 10-minute walk to a park (95 percent).
"If you want to go to nice restaurant, it's not that far away. If you want to go to a gym to work out in, it's not that far away. If you want fresh produce ... in almost every neighborhood, you can find all of these amenities within a mile of where you stand," says Brian McGee, a personal trainer and owner of FIT360DC, a gym in the District.
Residents of some other regions don't have that luxury. The Indianapolis area, for example, scored lowest on the ACSM index this year, thanks to factors such as its number of recreational centers (0.6 per 20,000 people), percentage of land that's parkland (5 percent) and percentage of residents who bike or walk to work (1.8 percent). Individual behaviors in that area are relatively poor, too: 20.5 percent of residents smoke, for example, and less than 13 percent eat at .
"What's happening in some of these cities is that they just haven't quite gotten out of the economic downturn," Thompson says. "So their resources that have been reduced during this time they haven't been able to recover yet to put money back into the infrastructure of the city's recreational facilities."
Still, some of the lowest ranking cities should be commended for their progress, Thompson says. Oklahoma City, for one, perpetually ranked last but held its No. 48 slot this year, thanks in part to changes spearheaded by its mayor, Mick Cornett, who launched a in 2011. "He's very dedicated to physical activity," Thompson says.
All metropolitan areas are encouraged to use their rankings as a way to identify "opportunities for change," says Thompson, whose hometown of Atlanta moved from 16 last year to 14 this year, in part thanks to the area's increasing number of bike lanes and construction of the BeltLine – a stretch of pedestrian-friendly rail transit and trails being built on a 22-mile historic rail corridor. "Those are the kinds of advancements we'd like to see in cities," Thompson says.
While policy and resources drive much of such advancements, residents too can no matter what city they live in by getting involved in grassroots movements and contacting their local leaders, Thompson says.
"Contact city leaders and tell them that 'We want to be fit, we want to exercise regularly, but our parks aren't safe, they aren't well-lit, there aren't enough bike lanes,'" he says. "Each one of these 31 indicators can change."
There's strong inconsistency surrounding when women should get mammograms.
Megan received a birthday card from her younger sister, reminding her she's turning 40 in few weeks. Megan’s sister always likes to rub in another birthday. A mother of three, Megan works for an advertising agency, exercises regularly and has been a strict for the past 10 years.
Always a planner, Megan made a checklist of things she needs to do once she turns 40. She wants to take that trip to Ireland she's been planning for many years – and take up yoga and meditation.
What about ?
Her aunt had breast cancer when she was in her 70s and was treated with surgery and radiation therapy. Because Megan was very close to her aunt, she always paid attention to breast cancer issues. And she's been keenly aware of the mammogram age and interval guidelines often discussed over the past four years.
Megan happened to run into her primary care doctor, Alison, at the gym. They've known each other for many years. Megan asked Alison when she should get a mammogram, but it seemed Alison didn't want to give a direct answer.
“Megan, let’s talk about that when you come to see me next time,” Alison suggested.
“That’s six months from now. Is that too late?” Megan was worried.
“No, you'll be fine,” Alison said, before she walked away.
Megan was well aware of the controversies around and the risk of procedures and over-diagnosis. But she still sought a clear answer. She asked her friend Janice, who works at a cancer center.
“I talked to our cancer doctors, and they strongly recommend a mammogram starting at age 40,” Janice said. Megan could always count on her for a direct answer.
Megan searched for more information online. She’s not the only one who's confused: Since the U.S. Task Force and Preventive Services came up with the mammogram recommendations, the debate has heated up. Just this past April 15, the guidelines .
According to the draft release, “The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years …. All women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive that would otherwise not have become a threat to her health, or even apparent, during her lifetime (known as “over diagnosis”). This risk is predicted to be increased when beginning regular mammography before age 50 years.”
After reading this, Megan was even more confused. She visited websites of a number of reputed physician organizations to see what she should do. What she found was much inconsistency:
| American Academy of Family Practice | Risk-based approach |
| American College of Physicians | Risk-based approach |
| American College of Radiology | Start mammogram |
| American Cancer Society | Start mammogram |
| National Cancer Institute | Start mammogram |
| U.S. Task Force for Preventive Services | Risk-based approach |
| U.K Health systems | Not recommended |
| Canadian | Risk-based approach |
| Affordable Care Act | Start mammogram |
After Megan shared her story with me, I reviewed her mammogram and biopsy report, discovering . Since it was found in its early stage, it's highly treatable and curable. She was happy to hear that, and extremely relieved she had a mammogram.
As a doctor, my view is skewed because I see only patients who have been given a breast cancer diagnosis. But I hear stories like Megan’s all the time, and it’s troubling to me. My personal view is that a mammogram is a low-cost, low-risk procedure that can save lives, regardless of what recommendations may say. I surmise many 40-something women with a breast cancer diagnosis would agree.
Experts say people who switch to the paleo diet should still find ways to mix vegetables into their meals.
Lindsay Tupper used to subscribe to the belief that low fat was good, and no fat was even better. Once, as a college student trying to reverse the , she bought a giant tub of red licorice. It was fat-free, after all.
"I thought, 'If I don't eat fat, I won't get fat,'" says Tupper, a 33-year-old mom and photographer in Houston. "That did not work at all."
Soon after, when she returned to her hometown to care for her mom who had suffered a brain aneurysm, Tupper became more health-savvy. "Trying to get her better and healthier, I found nutrition to be very important," says Tupper, who was also dealing with and skin problems.
After reading "The China Study," a book that links animal products to chronic diseases, she became a . But after a couple years, she wasn't seeing results. Plus, the more she read, the more she learned she should be supplementing with vitamins.
"I was like, 'That doesn't make any sense to me. If it's so healthy, why can't you get everything your body needs?" Tupper remembers. "I started eating meat again." Today, she follows a "primal" diet, which, like , emphasizes meat and plants and snubs grains. "I definitely feel like it's improved my health a lot." says Tupper, now a nutrition consultant who launched the blog .
Vegetarians-turned-paleo eaters like Tupper are everywhere, despite the diets' apparent contradictions. Anne Hathaway and Bill Clinton made the shift, while nutrition experts (and U.S. News bloggers) and are also former vegetarians who now enjoy meat regularly. Even David Soto Jr., author of "The Complete Guide to Primitive Eating" and blogger at , is a former vegetarian. "A lot of people don't know that about me," he says.
That's not to say vegetarianism is going anywhere – nor should it, experts stress. After all, the latest iteration of the , expected to be released later this year by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, touts fruits, vegetables and grains, and looks down on meats – especially red and processed kinds.
"There's lots of research showing that people who do vegetarian diets well have a much lower risk for just about everything," says Elizabeth Somer, a registered dietitian in Salem, Oregon. Here's what she and other experts say you should know before trading a meat-free diet for a meat-laden one – or vice versa:
1. Ask yourself why.
When someone goes from one diet to another, it's usually for one of two reasons, says Brian Wansink, a marketing professor at Cornell University, where he directs the Cornell Food and Brand Lab. Either the person subscribes to a "food as medicine" way of thinking and the first diet isn't treating what ails them, or the person went on the first diet to achieve some goal like – and met it.
"Either it doesn't work and you say, 'The heck with it!' Or, it does work and you say, 'I don't need it any longer,'" says Wansink, one of 22 expert panelists who help U.S. News produce its annual rankings.
But jumping from one diet to the next in search of a quick fix for, say, an expanding waistline or , is likely to do more harm than good, Somer says. "In the long run, as you get either bored with [the diet] or lazy … typically, the weight comes right back," she says. "Take a really hard look at why you're making the change in the first place."
2. Take it slow.
When Soto decided to add meat back into his diet after four years of abstinence, he did it the only way he knew how: "I went out and said let's get the biggest steak I can find," he says. "I just got a steak and I ate the whole thing – and I never went back."
While Soto says his go-big-or-go-home approach didn't cause any problems, that method is risky since longtime vegetarians' bodies stop making as many enzymes to break down meat, Somer says. "So you start chowing down on a 12-ounce T-bone, and you're either going to have some serious GI-tract diarrhea or constipation for a while until your body catches up and starts making the enzymes it needs."
On the other hand, if someone who skimped on fiber on a meat-heavy diet begins suddenly eating a fiber-rich or vegetarian diet, "the tsunami of fiber … could present a bit of a problem with gas and GI tract discomfort for a few weeks," Somer says.
That's one reason why it's helpful to to your diet rather than making a drastic shift overnight. Another reason to take it slowly? To boost your odds of long-term success, Somer says. "You're much more likely to stick to a diet if you gradually tweak the one you're already on rather than leaping from one tight barge to the next."
3. Do it right.
Cutting meat from your diet may make you a vegetarian, but that alone won't make you healthy, Somer says. "I seldom see someone do vegetarian right," she says. "They're still eating white bread, they're still eating Pop-Tarts. There's a whole lot of crap in those grocery store shelves that is vegetarian, but we would be far better off if they had never been developed in the first place."
Likewise, people who switch to the paleo diet aren't going to experience health benefits if they forgo vegetables in favor of bacon three times a day, says Nancy Kennedy, a fitness and nutrition expert in Los Angeles who wrote "The Hollywood Wrap." Kennedy used to be vegetarian but now eats paleo about 85 percent of the time. She recommends taking a similarly moderate approach to any diet. "Life is short," she says. "We just can’t do this every day, all day."
There's also lots of room for error when it comes to the balance of nutrients in a new diet. Vegans, for example, often lack vitamins D, B12, B6 and , while paleo dieters often don't get enough vitamins D and E, Somer says. "The more you limit your food choices, the higher your risk of being deficient," she says.
That's why it's key to call in a nutrition professional, say a registered dietitian, who can help identify gaps in your diet if you're planning to make a significant change, Somer says. "Unless you've done the research and [got] it form a credible source, it's very likely, in our toxic food environment, to end up eating poorly," she says.
Seeing someone with formal training, she adds, will better ensure you're "not doing more harm than good."
Growing up with a painful chronic disease – ulcerative colitis – helped Sneha Dave, 17, emerge stronger.
Everyone has struggles. Mine came in the form of a life-changing medical diagnosis at age 6: – a type of inflammatory bowel disease (IBD for short) that has given me both pain and perspective in the past decade. As people around the globe recognize World IBD Day today, I’d like to share some of the lessons I’ve learned while navigating my childhood – and presently teens – with .
1. There will always be light at the end of the tunnel; just keep walking until you find it.
At my sickest, I would wake up each day wondering if today would be the day I’d be magically cured. I wondered if the 20 medicines I swallowed seven days a week would disappear, and if I would ever find a way to be a “normal” kid who did “normal” things instead of worrying about finishing the nutritional drink I sipped for hours.
Deep down, I sensed that someday things would improve. They had to. Right?
Imagining myself as a normal, healthy teenager kept me going. Even though it was difficult to , I tried my best do anything and everything I could to keep myself from lying in bed all day, in pain. Day after day, I treaded along until my family and I made a difficult decision we thought would get me as close to normal as possible: getting my colon removed.
2. Look at what you have instead of what you don’t.
However, things weren’t normal, I realized, shortly after my procedure, as I looked down at the stoma (piece of small intestine) sticking out of my belly, designed to help me eliminate waste through a bag. I felt defeated because my colon was gone, taking with it the hope that my body would ever heal itself on its own. I would still need numerous procedures and would continue to endure moments of immense pain.
But after having my colon removed, I also gained a new view on my not-so-normal life. I thought about my best friend who passed away after battling bone cancer and , another type of IBD. I thought about kids who would be grateful for the treatment I was fortunate to get. I thought about how lucky I was to be here.
That’s how, as I entered my freshman year so undernourished from the disease that I resembled a 10-year-old, I found strength I didn’t know I had. I can’t think of a classmate who didn’t look at me in disbelief as I walked down the halls in jeans two sizes too large because of my grotesque skinniness. I felt people judging me not only on my appearance but on the way my body behaved, which was painfully apparent every time I had to abruptly leave the classroom to use the restroom or sit in the nurse’s office as I rode out painful spasms. I knew I was under a magnifying glass, but there was nothing I could do in the face of those whispers and awkward glances except trudge on, still too sick to worry about minutiae.
People did not know my story. And I didn’t know theirs. Everyone is dealing with something, I realized – be it IBD, family trouble or other issues. So in that sense, I was normal.
I also came to learn that you will lose, but that loss will eventually be compensated. In any sickness people lose things they previously had. For me it was my colon. Although I will never have another colon, losing mine gave me an immense amount of “normalcy” I would have otherwise never experienced. I have been able to get back to things I enjoyed before I was plagued by major flare-ups. The loss of my colon brought me a life I would not have thought possible a few years ago.
But the steps I’ve taken forward have not just been physical. Helping brings healing. Coming out of a physically disabling situation always brings the . Speaking out about my illness and creating support for myself and others through various activities has brought me healing. I believe that by helping others, you are really helping yourself.
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