John Cleese takes us on a tour of a laughter therapy practice in India.
Laughter promotes stress reduction, community bonding, stronger immune system... and joy. What a simple solution!
These new medical schools are seeking to address an imbalance in
American medicine that has been growing for a quarter century.
Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools.
In a weird aberration of "outsourcing", the medical field was outsourcing medical education to foreign countries, and then hiring foreign nationals to work in our American healthcare system, presumably at lower rates and longer hours.
During the 1980s and '90s only one new medical school was established.
"Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study," Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. "I think it was a kind of wake-up call."
The
proliferation of new schools is also a market response to a rare
convergence of forces:
Colleges serve a "Gatekeeping Function" as well as education of new practitioners. By carefully limiting the number of trained professionals, those with established careers have less competition -- and that can be important to personal care services that must maintain a full staff even when they have a light load of patients. Under-staffing also causes long delays in getting an appointment, and has healthcare consequences when care is delayed.
If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country.
Read more at the REFERENCE SOURCE: New York Times
This study, was published in the February 2, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.
People who experience memory loss or a decline in their thinking abilities may be at higher risk of stroke, regardless of whether they have been diagnosed with dementia...
"Stroke is a leading cause of disability and death among older people, making early identification of people at high risk of stroke extremely important, so preventative measures can be taken," said study author Bernice Wiberg, MD, with Uppsala University in Sweden.
For the
study, 930 men in Sweden around the age of 70 without a history of
stroke participated in three mental tests.
Trail Making Test B
The first test, called the
Trail Making Test A, measures attention and visual-motor abilities.
The
second, the Trail Making Test B, measures the ability to execute and
modify a plan.
The third, the Mini Mental State Examination, is commonly used by doctors to measure cognitive decline.
During a
13-year period, 166 men developed a stroke or transient ischemic
attack, or TIA.
Brain infarction is the most common cause of stroke. Hemorrhage is another kind of stroke.
Brain infarction happened to 105 patients.
It causes tissue damage when the proper
amount of blood does not reach the brain.
INDICATOR: Low Performers on Trail Making Test B
The study found that people who were among the bottom 25 percent of performers on the Trail Making Test B were three times more likely to have a stroke or a brain infarction compared to those who scored among the top 25 percent of performers on the test. The other two mental tests did not predict brain infarction or stroke.
Cognitive Decline May Predict Risk of Stroke
"Our
results support the idea that cognitive decline regardless of whether a
person has dementia may predict risk of stroke," said Wiberg. "The
Trial Making Test B is a simple and cost-effective test that, with more
research, could be used to identify those persons for whom stroke
prevention measures should be considered."
The study was
supported by the Medical Faculty at Uppsala University, the Swedish
Stroke Association, Swedish Research Council, the Swedish Heart Lung
Foundation, the Geriatric Fund and the Uppsala County Association
Against Heart and Lung Diseases.
The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer's disease, narcolepsy and stroke.
For more information about the American Academy of Neurology, visit http://www.aan.com.
VIDEO: http://www.youtube.com/AANChannelIn recent studies of married couple supportiveness issues in their first few years of marriage, researchers learned that too much support is harder on a marriage than not enough. When it comes to marital satisfaction, both partners are happier if husbands receive the right type of support, and if wives ask for support when they need it.
The married support findings
illustrate the need for couples to understand the various ways they can
be supportive, and the importance of communicating what they need and
when, said Erika Lawrence, associate professor of psychology
in the UI College of Liberal Arts and Sciences. Marriage issues are
solved with understanding and slightly changed support behaviors.
"The idea that simply being more supportive is better for your marriage is a myth," Lawrence said. "Often husbands and wives think, 'If my partner really knows me and loves me, he or she will know I'm upset and will know how to support me.' However, that's not the best way to approach a supportive marriage. Your partner shouldn't have to be a mind reader. Couples will be happier if they learn how to say, 'This is how I'm feeling, and this is how you can help me.'"
Too much of a good thing in marriage issues
In one study, Lawrence and colleagues discovered that receiving more support than desired is a greater risk factor for marital decline than not being there for a spouse.
"If you don't get enough support, you can make up for that with family and friends -- especially women, who tend to have multiple sources of support," she said. "When you receive too much support, there's no way to adjust for that."
The supportive marriage issues study involved 103 husbands and wives who completed surveys five times over their first five years of marriage. The questionnaires looked at how support was provided and measured marital satisfaction.
Types of supportive marriage
Four kinds of marriage issue support were identified in the study:
Worst! Too much unwanted advice!
Results showed that too much informational support -- usually in the form of unwanted advice-giving -- is the most detrimental.
Always Wanted in Marriage: Genuine Esteem Support!
In contrast, you can never go wrong providing esteem support, assuming it's genuine.
Too little marriage support was more common than too much.
Receiving less support than desired was a complaint of about two-thirds of men and at least 80 percent of women. Only about one-third of men and women reported receiving more support than they wanted.
The paper, published in the Journal of Family Psychology, was co-authored by Rebecca L. Brock, a UI graduate student in psychology.
Marriage Support isn't one-size-fits-all
A related supportive marriage study showed that for men, it's important that their wives provide the right kind of support, offering emotional, informational, tangible or esteem support as needed. For wives, it's more important that their husbands try to be supportive -- even if what they do doesn't quite hit the mark.
"Both parties are more satisfied if the husband gets the right kind of support, and if the wife feels like she's supported," Lawrence said. Marriage issues are shared by both genders. "Husbands shouldn't throw their hands up if they're not sure what to do. They need to stay in there and keep trying, because we found that women appreciate the effort to be supportive."
Dialog solves marriage issues
Lawrence said dialog is key to a supportive marriage. If you need support, request it; if you're providing support, ask how you can help -- don't assume you know what to do. Afterward, talk about what worked and what didn't, and adjust accordingly.
"The assumption is that men just want to be left alone and women want to be held and listened to," Lawrence said. "In reality, different men want different kinds of support, and different women want different kinds of support."
Marriage Issue Research
For this study of marriage support, 275 newlyweds completed questionnaires about supportive behaviors and marital satisfaction, the type of support they received, and whether it was sufficient. Twice during the study, 235 married couples visited the lab to discuss how they would approach a goal such as stress management, a career change, improving family relationships or being more assertive. Researchers shot video of the 10-minute conversations and observed how couples asked for, provided and accepted support.
The supportive marriage behaviors paper was published in the journal Personal Relationships. Lawrence was the lead author, with co-authors from the University of Iowa, CIGNA Health Solutions, Santa Clara University, the University of California, San Francisco, and the University of North Carolina at Chapel Hill.
Both marital support studies were supported by grants from the Centers for Disease Control and Prevention, the National Institute for Child and Human Development, and the UI.Approximately 75% of the U.S. housing stock built before 1978, or 64 million homes, contain some lead-based paint.
According to one of my favorite online health information sources, Mayo Clinic, physical activity is a "best practice" for everyone's health.
Regardless of age, weight or athletic ability, aerobic activity is good
for you. As your body adapts to regular aerobic exercise, you'll get
stronger and your body's organs get more efficient.
Consider these 10 ways that aerobic activity can help you feel better and enjoy life to the fullest.
Aerobic activity can help you:
Overall risk for women taking antidepressants is relatively small
Dr. Wassertheil-Smoller notes that the overall risk for women taking antidepressants is relatively small: a 0.43 percent risk of stroke annually versus a 0.3 percent annual risk of stroke for women not taking antidepressants. However, because antidepressants are among the most widely prescribed drugs in the U.S. - especially among postmenopausal women - small risk increases can have significant implications for large patient populations.
Dr. Wassertheil-Smoller cautioned that "it remains unclear" from the data whether antidepressants are solely responsible for the greater mortality rate among users. The link observed in this study between antidepressant use and increased stroke risk for older women might partially be due to the underlying depression, since several studies have found that depression itself is a risk factor for cardiovascular problems.The researchers also pointed out other limitations to their findings. This was an observational study, so the findings are not as conclusive of causality as would be the case for a randomized controlled trial; and since the WHI study is comprised primarily of older white women, the findings might not extend to other groups.
The group's paper, "Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Post-Menopausal Women in the Women's Health Initiative Study," appears in the December 14 online edition of Archives of Internal Medicine.
Depression often coexists with other long-term health problems,
presenting additional complexities. About 60 percent of depressed
outpatients have at least one other chronic medical condition as well,
such as a heart problem, high blood pressure, or diabetes.
The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality has funded
research to track effective care of depression.
Heart Attacks and Depression
Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.
Chronic Conditions and Depression in Older Persons
The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:
To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.
The organization of care can affect care delivery for depression.
One AHRQ-sponsored study showed that shifting patients away from mental
health specialists to general medical providers (as is the practice in
some managed care arrangements) may lead to fewer improvements in
patient functioning but costs two to three times less.
Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.
Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.
Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.
The National Guideline Clearinghouse™ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.
Of those treated with cognitive behavior therapy, only 7% had a recurrence compared to 36.7% of people treated with light therapy.
The recurrence rate for the combination group was 5.5 percent.
When Rohan looked at the
severity of the depression that did occur, however, CBT was associated
with less severe depression than those treated with either light
therapy or a combination of both.
A new report in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, by a panel of distinguished clinical scientists -- Timothy Baker (University of Wisconsin-Madison), Richard McFall (Indiana University), and Varda Shoham (University of Arizona) - calls for the reform of clinical psychology training programs and appeals for a new accreditation system to ensure that mental health clinicians are trained to use the most effective and current research to treat their patients.
There are multiple practices in clinical psychology that are grounded in science and proven to work, but in the absence of standardized science-based training, those treatments go unused.Cognitive-behavioral Therapy (CBT)
For example,
cognitive-behavioral therapy (CBT) has been shown to be the most
effective treatment for PTSD and has the fewest side-effects, yet many
psychologists do not use this method.
Baker and colleagues cite one
study in which only 30 percent of psychologists were trained to perform
CBT for PTSD and only half of those psychologists elected to use it.
That means that six of every seven sufferers were not getting the best
care available from their clinicians.
Furthermore, CBT shows both long-term and immediate benefits as a treatment for PTSD; whereas medications such as Paxil have shown 25 to 50 percent relapse rates.
Escalating cost of mental health care treatment
The
report suggests that the escalating cost of mental health care
treatment has reduced the use of psychological treatments and shifted
care to general health care facilities.
The authors also stress the importance of coupling psychosocial interventions with medicine because many behavioral therapies have been shown to reduce costs and provide longer term benefits for the client.
Baker and colleagues conclude that a new accreditation system is the key to reforming training in clinical psychology. This new system is already under development: the Psychological Clinical Science Accreditation System (PCSAS www.pcsas.org).
For more information, a copy of this report or to arrange an interview with the authors please contact Kevin Lyn Sisson at 202.293.9300 or ksisson@psychologicalscience.org.
Timothy Baker is Professor of Medicine in the University of Wisconsin School of Medicine and Public Health. Richard McFall is Professor Emeritus in the Department of Psychological and Brain Sciences at Indiana University-Bloomington. Varda Shoham is Professor of Psychology at the University of Arizona..
Psychological Science in the Public Interest provides definitive assessments of topics where psychological science has the potential to inform and improve the well-being of society.