Fast Exercise – by Dr. Michael Mosley & Peta Bee
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We’ve written before about the benefits of High-Intensity Interval Training (HIIT), but there’s more to say than we can fit in a short article!
Dr. Michael Mosley, who hates exercise but knows his stuff when it comes to the benefits, teamed up with Peta Bee, who loves exercise and is a science journalist with degrees in sports science and nutrition, to bring us this book.
In it, we learn a lot about:
- the science of HIIT
- what makes it so different from most kinds of exercise
- exactly what benefits one can expect
…in a very detailed clinical fashion (while still remaining very readable).
By “very detailed clinical fashion”, here we mean “one minute of this kind of exercise this many times per week over this period of time will give this many extra healthy life-years”, for example, along with lots of research to back numbers, and explanations of the mechanisms of action (e.g. reducing inflammatory biomarkers of aging, increasing cellular apoptosis, improving cardiometabolic stats for reduced CVD risk, and many things)
There’s also time/space given over to exactly what to do and how to do it, giving enough options to suit personal tastes/circumstances.
Bottom line: if you’d like to make your exercise work a lot harder for you while you spend a lot less time working out, then this book will help you do just that!
Click here to check out Fast Exercise, and enjoy the benefits!
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The Doctor’s Kitchen – by Dr. Rupy Aujla
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We’ve featured Dr. Aujla before as an expert-of-the-week, and now it’s time to review a book by him. What’s his deal, and what should you expect?
Dr. Aujla first outlines the case for food as medicine. Not just “eat nutritionally balanced meals”, but literally, “here are the medicinal properties of these plants”. Think of some of the herbs and spices we’ve featured in our Monday Research Reviews, and add in medicinal properties of cancer-fighting cruciferous vegetables, bananas with dopamine and dopamine precursors, berries full of polyphenols, hemp seeds that fight cognitive decline, and so forth.
Most of the book is given over to recipes. They’re plant-centric, but mostly not vegan. They’re consistent with the Mediterranean diet, but mostly Indian. They’re economically mindful (favoring cheap ingredients where reasonable) while giving a nod to where an extra dollar will elevate the meal. They don’t give calorie values etc—this is a feature not a bug, as Dr. Aujla is of the “positive dieting” camp that advocates for us to “count colors, not calories”. Which, we have to admit, makes for very stress-free cooking, too.
Dr. Aujla is himself an Indian Brit, by the way, which gives him two intersecting factors for having a taste for spices. If you don’t share that taste, just go easier on the pepper etc.
As for the medicinal properties we mentioned up top? Four pages of references at the back, for any who are curious to look up the science of them. We at 10almonds do love references!
Bottom line: if you like tasty food and you’re looking for a one-stop, well-rounded, food-as-medicine cookbook, this one is a top-tier choice.
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To Medicate or Not? That is the Question! – by Dr. Asha Bohannon
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Medications are, of course, a necessity of life (literally!) for many, especially as we get older. Nevertheless, overmedication is also a big problem that can cause a lot of harm too, and guess what, it comes with the exact same “especially as we get older” tag too.
So, what does Dr. Bohannon (a doctor of pharmacy, diabetes educator, and personal trainer too) recommend?
Simply put: she recommends starting with a comprehensive health history assessment and analysing one’s medication/supplement profile, before getting lab work done, tweaking all the things that can be tweaked along the way, and—of course—not neglecting lifestyle medicine either.
The book is prefaced and ended with pep talks that probably a person who has already bought the book does not need, but they don’t detract from the practical content either. Nevertheless, it feels a little odd that it takes until chapter 4 to reach “step 1” of her 7-step method!
The style throughout is conversational and energetic, but not overly padded with hype; it’s just a very casual style. Nevertheless, she brings to bear her professional knowledge and understanding as a doctor of pharmacy, to include her insights into the industry that one might not observe from outside of it.
Bottom line: if you’d like to do your own personal meds review and want to “know enough to ask the right questions” before bringing it up with your doctor, this book is a fine choice for that.
Click here to check out To Medicate Or Not, and make informed choices!
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Keeping Your Kidneys Healthy (Especially After 60)
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Keeping your kidneys happy: it’s more than just hydration!
Your kidneys are very busy organs. They filter waste products, balance hydration, pH, salt, and potassium. They also make some of our hormones, and are responsible for regulating red blood cell production too. They also handle vitamin D in a way our bodies would not work without, making them essential for calcium absorption and the health of our bones, and even muscular function.
So, how to keep them in good working order?
Yes, hydrate
This is obvious and may go without saying, but we try to not leave important things without saying. So yes, get plenty of water, spread out over the day (you can only usefully absorb so much at once!). If you feel thirsty, you’re probably already dehydrated, so have a little (hydrating!) drink.
Don’t smoke
It’s bad for everything, including your kidneys.
Look after your blood
Not just “try to keep it inside your body”, but also:
- Keep your blood sugar levels healthy (hyperglycemia can cause kidney damage)
- Keep your blood pressure healthy (hypertension can cause kidney damage)
Basically, your kidneys’ primary job of filtering blood will go much more smoothly if that blood is less problematic on the way in.
Watch your over-the-counter pill intake
A lot of PRN OTC NSAIDs (PRN = pro re nata, i.e. you take them as and when symptoms arise) (NSAIDs = Non-Steroidal Anti-Inflammatory Drugs, such as ibuprofen for example) can cause kidney damage if taken regularly.
Many people take ibuprofen (for example) constantly for chronic pain, especially the kind cause by chronic inflammation, including many autoimmune diseases.
It is recommended to not take them for more than 10 days, nor more than 8 per day. Taking more than that, or taking them for longer, could damage your kidneys temporarily or permanently.
Read more: National Kidney Foundation: Advice About Pain Medicines
See also: Which Drugs Are Harmful To Your Kidneys?
Get a regular kidney function checkup if you’re in a high risk group
Who’s in a high risk group?
- If you’re over 60
- If you have diabetes
- If you have cardiovascular disease
- If you have high blood pressure
- If you believe, or know, you have existing kidney damage
The tests are very noninvasive, and will be a urine and/or blood test.
For more information, see:
Kidney Testing: Everything You Need to Know
Take care!
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In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.
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Series: Culture of Cruelty:Inside Illinois’ Mental Health System
State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.
Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.
Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.
With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.
The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.
Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.
The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.
Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.
Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.
Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”
But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.
Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.
But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.
U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.
For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”
“Living Inside a Box”
Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.
In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”
For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.
Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.
That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.
Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.
“Right now, all she’s doing is living inside a box,” Stacey Rogers said.
Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.
Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.
“If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.
Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”
Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.
In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.
In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.
The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.
In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”
Lawyers for the state argued that those improvements are enough to end court oversight.
“The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.
Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.
Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.
While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.
At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.
“I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.
While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.
Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.
For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.
“I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”
This article is republished from ProPublica under a Creative Commons license. Read the original article.
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What is a virtual emergency department? And when should you ‘visit’ one?
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For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.
But health-care services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The ED is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.
All Australian states and the Northern Territory have some form of virtual ED at least in development, although not all of these services are available to the general public at this stage.
So what is a virtual ED, and when is it appropriate to consider using one?
How does a virtual ED work?
A virtual ED is set up to mirror the way you would enter the physical ED front door. First you provide some basic information to administration staff, then you are triaged by a nurse (this means they categorise the level of urgency of your case), then you see the ED doctor. Generally, this all takes place in a single video call.
In some instances, virtual ED clinicians may consult with other specialists such as neurologists, cardiologists or trauma experts to make clinical decisions.
A virtual ED is not suitable for managing medical emergencies which would require immediate resuscitation, or potentially serious chest pains, difficulty breathing or severe injuries.
A virtual ED is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care or treatment.
When attending the ED, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to respond to emergencies. The virtual ED will not hesitate in directing callers to come into the physical ED if staff believe it is an emergency.
The doctor in the virtual ED may also direct the patient to a GP or other health professional, for example if their condition can’t be assessed visually, or if they need physical treatment.
The results so far
Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now starting to slowly see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases could be managed effectively by the virtual ED.
Preliminary data from a Victorian virtual ED indicates it curbed a similar rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of another Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.
Only 1.2% of people assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission within 48 hours of being “discharged” from the virtual ED. None of these cases were life-threatening. This indicates the virtual ED is very safe.
The service experienced an average growth rate of 65% each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual ED positively.
What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual EDs, and how these measures compare to the physical ED across different triage categories.
There are also challenges associated with virtual EDs, including around technology (connection and skills among patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.
Nonetheless, these services have the potential to reduce congestion in physical EDs, and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual ED, you may need to check you are eligible in your jurisdiction. Most virtual EDs can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How to Fall Asleep Faster: CBT-Insomnia Treatment
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Insomnia affects a lot of people, and is even more common as we get older. Happily, therapist Emma McAdam is here with a drug-free solution that will work for most people most of the time.
Cognitive Behavioral Therapy for Insomnia (CBTI)
While people think of causes of insomnia as being things such as stress, anxiety, overthinking, disturbances, and so forth, these things affect sleep in the short term, but don’t directly cause chronic insomnia.
We say “directly”, because chronic insomnia is usually the result of the brain becoming accustomed to the above, and thus accidentally training itself to not sleep.
The remedy: cut the bad habit of staying in bed while awake. Lying in bed awake trains the brain to associate lying in bed with wakefulness (and any associated worrying, etc). In essence, we lie down, and the brain thinks “Aha, we know this one; this is the time and place for worrying, ok, let’s get to work”.
So instead: if you’re in bed and not asleep within 15 minutes, get up and do something non-stimulating until you feel sleepy, then return to bed. This may cause some short term tiredness, but it will usually correct the chronic insomnia within a week.
For more details, tips, and troubleshooting with regard to the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How to Fall Back Asleep After Waking Up in the Middle of the Night
Take care!
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