Archive For: Wellness

Let It Go: The Ancient Art of Meditation

Finding Peace Through Mindfulness and Meditation

Mindful, compassionate, serene, happy: emotions that have been in short supply during the pandemic but can be beautifully restored to those who embrace the chance to learn the time- honored practice and art of meditation. For many, it is as easy as downloading the Headspace app on their smartphone, receiving a seamless introduction to a technique the company describes as “rooted both in ancient history and modern science.”

There’s an App For That

Meditation has been practiced for over 3,000 years, and its benefits, improving well-being, helping eliminate insomnia, enhancing focus, decreasing stress, and reducing blood pressure, among many others, have been studied for decades.

But the real democratization of meditation may have been ushered in by the proliferation of apps like Calm, Buddhify, Insight Timer and Simple Habit. Since its 2010 debut, global leader Headspace has been downloaded more than 65 million times, a number that has steadily risen during the coronavirus crisis.

Dr. Megan Jones Bell, the company’s chief science officer, reports a tenfold increase in those starting the “stressed” meditation and a twelvefold increase in “reframing anxiety at home” users from mid-March to mid-May of 2020.

Getting Started

First, choose a time to meditate, and consistently make it part of your daily routine. Find an uncluttered, quiet spot where you won’t be disturbed. Make yourself comfortable in a chair or on the floor with a pillow behind you, close your eyes and allow yourself to let go. It’s natural to wonder, “Am I doing this right?” The experts at Headspace offer some gentle guidance:

  • If your body is fidgeting or your mind keeps constantly chatting, you may want to walk away from the feeling. Instead of giving up, just write off the first few minutes and give your mind time to slow down. It’s not time wasted, but time spent training the mind.
  • Dozing off occasionally during the first few weeks of meditation is normal. If it keeps happening, try a different time of day, sit up a little straighter or splash a little cold water on your face before you meditate.
  • You may feel all sorts of unpleasant emotions, such as impatience, irritation and rage. Don’t suppress them, but give them the space to arise, unravel and ultimately fall away. Do the same if you’re fixated on a particular worrisome thought, or if you’re experiencing sadness. Acknowledge the feeling, even shed a few tears, and keep meditating.
  • If you find yourself planning incessantly in a way that is unproductive and unhealthy, let those thoughts go and come back to your focus – a breath, an image, a way that is unproductive and unhealthy, let those thoughts go and come back to your focus – a breath, an image, a sound.
  • Find the sweet spot between pushing yourself too hard and not applying enough focus. You may have a certain idea of what meditation should be, but it’s important to get out of your own way and give the experience room to breathe.

More Than One Way to Meditate

More than a dozen different types of meditation are taught, including:

  • Guided: Form mental images of places or situations you find relaxing.
  • Mantra: Silently repeat a calming word, thought or phrase to prevent distracting thoughts.
  • Mindfulness: An increased awareness and acceptance of living in the present moment; observe thoughts and emotions, but let them pass without judgement.
  • Calming: Cultivate a quieter, more peaceful state of mind and improved concentration.
  • Insight: Set an intention to develop qualities such as wisdom and compassion.
  • Body scan: Sync body and mind by performing a mental scan and paying attention to any discomfort or tensions.
  • Visualization: Focus on a mental image.
  • Loving kindness: Direct positive energy and goodwill to yourself and then to others.
  • Resting awareness: Let thoughts simply drift away.
  • Zen: Focus on following the breath to foster a sense of presence.
  • Chakra: Bring the body’s core centers of energy into balance.

The post Let It Go: The Ancient Art of Meditation appeared first on Specialdocs Consultants.

Navigating Uncertain Times with Hope and Optimism

How to Adjust, Adapt and Embrace the New Normal

As we emerge cautiously from the safety of home into a world that seems comfortingly familiar yet irrefutably altered, a swirl of conflicting emotions is certain to be triggered. Relief and thankfulness may mingle uneasily with fear, anxiety and uncertainty, making it difficult to cope at times. Concierge psychologist Dr. Rebecca Johnson Osei, MA, PsyD, ABPP, shares her thoughtful perspective on navigating uncertain times with hope and optimism.

Q: What are some of the short- and long-term effects of the COVID-19 crisis on our mental health?

Dr. Johnson Osei: We’re seeing increases in anxiety and depression. Loneliness has also been a concern, due to social distancing, especially for older populations who may be more isolated from family and friends. Some are feeling grief, particularly those who weren’t able to say goodbye to a loved one, and survivor’s guilt, a common reaction to traumatic events. And most of us keenly miss the sense of control over our daily lives.

Q: How can we best manage these feelings?

Dr. Johnson Osei: Most importantly, allow yourself to experience all these emotions without guilt or judgment. They’re simply part of being human. While much of what we’re feeling may be remedied with time, be mindful and address your feelings now so they don’t become long-term issues. Also realize that you can regain control of your narrative by “reframing” your decisions. For example, instead of feeling forced to stay inside, frame it as a decision you made to protect your family. It changes your mindset when you realize that, ultimately, your behavior is your choice.

Q: Are there positive behaviors you’re seeing as a result of people learning to cope with unprecedented circumstances?

Dr. Johnson Osei: A number of really significant ones. People are gaining a renewed appreciation for the people and things they love. One-on-one time and simple human touch are valued so much more now. I imagine when friends and families reunite, there will be some really great long hugs! Being more aware of our mortality is also helping people cherish life, realizing it truly is a gift that can disappear in a second.

Being solitary and alone with our thoughts is a struggle for some, but it’s emotionally healthy to be able to entertain yourself and meet your own needs. For most Americans, coping with the discomfort of not being able to do what they want, when they want to do it, is a tough lesson, but it’s a good one to learn.

The need to connect has driven a much greater acceptance of technology than existed just a few months ago. There’s a growing willingness to think outside the box for new, ingenious ways to stay connected, and I believe this will carry on in our society well beyond the current crisis.

Q: What lessons learned from previous world crises can help guide us?

Dr. Johnson Osei: Think about how 9/11 fundamentally changed the way we travel. At first, it seemed untenable – the security lines were long and slow-moving, no one had the right size toiletries. It all feels completely normal now, and we know how to navigate the lines, pack our toiletries correctly, and wear shoes that slip on and off easily. Humans are incredibly resilient, and it’s why we’ve survived as a species. We don’t know what the new normal will look like, nor can we predict if this will go on for months or maybe years. But we do know we will adapt, and it will get easier.

Q: Any recommended strategies as we move to the next phase?

Dr. Johnson Osei: Go at the pace that’s right for you as an individual, even if it may not align with your city or state’s approach. Just because you can do something doesn’t mean you should. Be an outlier if wearing a mask or working from home makes you feel more comfortable.

Finally, it’s so important to remember: Life may be different, but this is not the end of the world we knew – it’s literally a new beginning.

The post Navigating Uncertain Times with Hope and Optimism appeared first on Specialdocs Consultants.

Pet Therapy: The Healing Power of Dogs

Unleashed: The Healing Power of Dogs

“Who rescued whom?”
They’re already considered best friends, trusty companions and beloved members of the family. Now add to the dog’s list of accomplishments, heart healer, exercise coach, and mood enhancer, and the answer to the question above, often used by rescue organizations, becomes even more meaningful. There is new a body of research that goes beyond the anecdotal charms of dog ownership to provide some increased evidence of its health benefits.

The impact on patients with cardiovascular disease (CVD) was initially noted by the American Heart Association in 2013 after an examination of studies reporting beneficial effects of dog ownership, including increased physical activity, favorable lipid profiles, lower systemic blood pressure and stress levels, and improved survival after a heart attack. The AHA’s measured conclusion then was that dog ownership “may be reasonable for reduction in CVD risk,” and further research was recommended.

Late in 2019, a meta-analysis of studies, including data from 3.8 million patients, further bolstered the concept that dog ownership can play a significant role in reducing CVD risk factors by alleviating social isolation, improving physical activity and lowering blood pressure. According to the study, compared to non-owners, dog owners experienced a 24% reduced risk in all-cause mortality, 31% reduction in mortality due to cardiovascular-related issues and 65% reduced risk of mortality after a heart attack.

The AHA noted that while the non-randomized studies can’t conclusively “prove” that owning a dog leads directly to reduced mortality among heart attack and stroke survivors, “the robust findings are certainly suggestive of this” and set the stage for additional exploration.
“The results were very positive,” affirmed researcher Caroline Kramer, MD. “The next step would be an interventional study to evaluate cardiovascular outcomes after adopting a dog and the social and psychological benefits of dog ownership.”

A dog owner herself, she added, “Adopting Romeo [her miniature Schnauzer] has increased my steps and physical activity each day, and filled my daily routine with joy and unconditional love.”

As compelling as the statistics are, researchers emphasize that dog adoption should never be done for the primary purpose of reducing CVD risk. The long-term commitment and lifestyle changes involved in dog ownership must be fully understood and accepted.

Consider these questions:
• Do I have time to care for and clean up after the dog?
• What type of environment does the dog need to thrive?
• How large will the dog get and how much exercise will it need?
• What is the dog’s life span, and can I commit to caring for it throughout its life?
• How much will veterinary care cost?

Animal-assisted therapy
The healing power of dogs extends well beyond the home as their value in helping decrease pain, stress and anxiety and aid recovery in people coping with a range of health problems is increasingly recognized. Therapy dogs provide comfort to nursing home residents, hospice patients, prisoners, children coping with trauma, and veterans suffering from post-traumatic stress disorder (PTSD), among others. The field of animal-assisted therapy is growing rapidly, as seen in the success of Mayo Clinic’s Caring Canines program, now in its 10th year. More than a dozen registered therapy dogs make their daily “rounds” of hospital rooms and clinic waiting areas.

“If someone is struggling with something, dogs know how to sit there and be loving,” researcher Dr. Ann Berger explained in the National Institute of Health News. “Their attention is focused on the person all the time.”

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Alcohol: Not Gender-Neutral

The Female Factor: Alcohol is Not Gender-aNeutral

Given the growing popularity of the cocktail culture and wine time, it’s important to know that alcohol affects women very differently than men – physiologically, psychologically and socially. It’s worth asking: For women, is the wine glass half full or half empty when considering the risk-versus-benefit ratio?

First, there is the difference in women’s body composition. Women have more total body fat and less total body water than men. As a result, alcohol is less dispersed, resulting in a higher blood alcohol level, drink for drink, than in men. Metabolism also plays a role, as women produce less of the alcohol dehydrogenase (ADH) enzyme that controls the rate at which alcohol is broken down in the body. This means a blood alcohol level that rises more quickly in women and stays elevated longer. Women are more vulnerable than men to alcohol’s effects on other levels too: more likely to black out from drinking, to suffer from mood and behavioral changes and to more rapidly develop an addiction. Women may also experience higher rates of depression and anxiety, often drinking in response to negative emotions and problems with loved ones versus men’s tendency to drink for positive reinforcement and pleasure.

All these factors make the record high drinking rates for women a real cause for concern. Problem drinking rose by 83% among women from 2002 to 2013, rapidly closing – in a most unfortunate way – a gender gap that has existed for decades. Current statistics show that 5.4 million women over 18 may be considered as having alcohol use disorder (AUD) and need treatment. However, gender plays a role here too, as women who consistently seek treatment for almost every other physical and mental health problem at higher rates than men are far less likely to do so for alcohol-related problems. Less than 1 in 10 women get formal help, hindered by the stigma of addiction and feelings of guilt or shame in not being able to function as caregiver for their family.

Alcohol’s impact on other disease is mixed. There is evidence that one drink a day may reduce women’s risk of heart attack, cardiovascular disease and the most common type of stroke. The risk of breast cancer, however, increases by 5 – 9% and rises with each additional drink per day. It’s worth noting that taking a multivitamin fortified with 400 mcg of folic acid daily may lower some of women’s elevated risk from alcohol, according to recent studies.

The best advice, as with most of life’s issues, is moderation. Avoid alcohol if pregnant or if you have a personal or family history of breast cancer, liver disease or alcohol abuse. Otherwise, consuming one drink a day is generally healthy, so be knowledgeable about how to measure that (see below) and enjoy a glass with friends or at special events. Don’t try to match the pace of male celebrants, especially if they’re over-imbibing. In fact, gently steering them away from the bar and onto the dance floor may be the healthiest move for all.

Heavy drinking for women = more than one drink per day or seven-plus drinks per week

Did You Know?

Alcohol use disorder is characterized by symptoms such as:
· excessive time spent drinking
· needing to drink more to get the same effect
· wanting a drink so badly you can’t think of anything else
· inability to stop drinking despite the impact on work and family
*Source: National Institute on Alcohol Abuse and Alcoholism

The post Alcohol: Not Gender-Neutral appeared first on Specialdocs Consultants.

When Are the Best Years of Our Lives?

Happiness Continuum: When Are the Best Years of Our Lives?

Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways?

Like trying to define why some people are born to be joyful and others to play the role of curmudgeon, this issue has long intrigued psychological and social science researchers. While no singular conclusion has been reached, there are a number of compelling hypotheses…and you may be pleasantly surprised to learn that a number of studies suggest a U-shaped happiness curve with peaks for young and old, giving us not one but two stages of life to savor. Mid-life can be stressful, full of the challenges and demands of raising a family and sustaining a career, but according to some experts, there is indeed a light at the end of the tunnel.

The Economist’s international survey of happiness gathered data from America’s General Social Survey, Eurobarometer and Gallup finding an upward trajectory of happiness until age 30, a downward trend into midlife, with the lowest point reached at age 46, and up to higher levels again after the 50’s. Jonathan Rauch, a senior fellow at the Brookings Institution and author of the 2018 book, The Happiness Curve, says although its effects vary between individuals, there appears to be a subtle but insistent tug that makes happiness more difficult to achieve in midlife and then reverses direction when we least expect it. Other research supports this finding, including a University of Chicago retrospective study of 28,000 Americans over a 32-year period which showed older age groups were consistently the happiest. Interestingly, Dr. Dilip Jeste, director of the UC San Diego Center for Healthy Aging, describes it not as a curve, but more of a linear improvement in mental health that occurs even as physical and cognitive function declines. In particular, today’s women may find some of their sweetest times between ages 50 and 70, according to an in-depth lifestyle study spanning three decades conducted by the TrendSight Group. The take-away for younger generations: “Aging isn’t a dirty word, with it can come incredible confidence, strength and freedom,” says study author Marti Barletta. Even better, a full 59% of women ages 50 to 70 felt their greatest achievements were still ahead of them.
Experts theorize a number of reasons that happiness may increase with age, including increased wisdom or psychological intelligence in handling challenges, fewer aspirations and expectations of self, greater appreciation for life, living in the moment with less worry about the future, greater ability to regulate emotions and less worry about pleasing everyone all the time. Stanford psychologist Laura Carstensen’s Socioemotional Selectivity Theory, which is grounded in the unique human ability to monitor time, suggests that relative to younger people, older adults focus more on positive than negative information and prioritize emotionally meaningful activities – notably, deepening close relationships – over those related to individual achievement and exploration.

Recent findings from the Harvard Study of Adult Development, one of the world’s longest studies of adult life, begun in 1938, also point to the vital role of relationships in happiness at older ages. According to the research, these ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ or genes. Dr. Robert Waldinger, study director and psychiatrist at Massachusetts General Hospital, acknowledges that the research shows correlation, not necessarily causation. However, after following the subjects (including both Harvard graduates and inner-city residents) for many decades and comparing the state of their health and their relationships early on, he is confident that strong social bonds play a causal role in long-term well-being.

Perhaps 19th century journalist David Grayson had the best advice of all: “The other day a man asked me what I thought was the best time of life. ‘Why,’ I answered without a thought, ‘now.’”

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Fight Fatigue

Wake-up Call: Fight Fatigue at Its Roots

Are these ordinary signs of aging? Exhausted throughout the day, joy in life slowly diminishing, active lifestyle becoming a distant memory. No, no and no. Feeling tired all the time is not a normal part of the aging process. Instead, it can point to the need for a better night’s sleep, stress or an underlying illness, or be the result of a mix of common medications. Or it may be a combination of all these things. Identifying the possible sources of your fatigue is the most important step in reenergizing your lifestyle.

Medical: Visit your physician to rule out these frequently seen causes of tiredness.

Emotional health: Low-grade depression, anxiety or chronic stress can sap energy.

Anemia: This condition occurs when your blood has too few red blood cells or those cells have too little hemoglobin, a protein that transports oxygen through the bloodstream. If untreated, anemia results in a drop in energy levels.

Heart disease: When the heart pumps blood less efficiently, it can lead to fluid in the lungs, causing shortness of breath and reducing the oxygen supply to heart and lungs.

Hypothyroidism : An underactive thyroid gland can cause fatigue – along with other symptoms, such as weight gain, weakness, dry skin, feeling cold and constipation.

Medications : Many medicines can cause fatigue, including blood pressure drugs, antidepressants, anti-anxiety drugs and antihistamines.

Lifestyle Habits

Sleep: Quality, quantity and environment matter greatly in ensuring a healthy sleep, but these factors are surprisingly misconstrued. According to NYU School of Medicine, dispelling these widely held beliefs is key:

  • Myth: “Alcohol before bed is good for sleeping.” A nightcap before bed may help you fall asleep but will dramatically reduce the quality of sleep by disrupting the REM (rapid eye movement) stage all night, and you’ll wake unrefreshed.
  • Myth: “Many adults need only five hours of sleep or less, especially as they get older.” The reality is everyone needs to get enough sleep to wake up feeling refreshed. The average is seven to eight hours nightly to allow the body to progress through four phases of restorative sleep, including deep sleep cycles of REM and delta waves sleep, which are important for generating neurons, repairing muscle and restoring the immune system.
  • Myth: “Watching TV in bed before sleep is a good way to relax.” Actually, turning off the TV and putting away electronic devices at least two hours before bedtime is recommended, as the blue light produced affects the release of melatonin, the sleep hormone, and will delay slumber.
  • Myth: “If I wake up in the middle of the night, it is best to lie in bed until I fall back asleep.” Tossing and turning for more than 20 minutes is not helpful; instead, change rooms and engage in something mindless, like folding socks. Do not watch TV or look at electronic devices, as this wakes up your brain.
  • Myth: “Snoring is a common, harmless problem.” Snoring can be a sign of sleep apnea, a disorder characterized by decreased or complete lack of airflow throughout the night. Over time, this can increase the risk of cardiovascular disease if untreated.
  • Myth: “Falling asleep anywhere, anytime is the sign of a good sleeper.” It’s just the opposite, indicating a sleep “debt” from insufficient rest or a sleep disorder such as narcolepsy or sleep apnea.

Under- or over-activity: Sedentary days and nights can cause loss of muscle mass and flexibility and make even moderately intense activities seem exhausting. However, exercising at a very high intensity can also cause fatigue.

An Infusion of Energy for Chronic Fatigue Research

Far beyond ordinary tiredness is the profound fatigue known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), which has puzzled and frustrated medical professionals for decades. No cure or approved treatment is available to its 2.5 million sufferers, only a management of symptoms worsened by any type of physical, cognitive or emotional effort. But a sea change is underway. It began in 2015 with a new name recommendation by the Institute of Medicine (IOM): Systemic Exertion Intolerance Disease (SEID). Noting that the term chronic fatigue syndrome can trivialize the seriousness of the condition and that “ME” is inappropriate because neither muscle pain nor brain inflammation has proven to be a symptom, the IOM panel stated: “SEID captures a central characteristic of this disease – that exertion of any sort can adversely affect patients in many organ systems and in many aspects of their lives.”

Even more promising is the significant investment in research announced by the National Institutes of Health (NIH). Up to $36 million over five years has been granted to shine a brighter light on the origins and progression of chronic fatigue and ultimately to help develop diagnostic markers and effective treatments.

Did You Know?

58% of older adults sleep less than seven hours a night.

80% of people age 55 and over report unintentionally falling asleep at least once during the day within the last month.

Source: Centers for Disease Control and Prevention

The post Fight Fatigue appeared first on Specialdocs Consultants.

Fight Fatigue

Wake-up Call: Fight Fatigue at Its Roots

Are these ordinary signs of aging? Exhausted throughout the day, joy in life slowly diminishing, active lifestyle becoming a distant memory. No, no and no. Feeling tired all the time is not a normal part of the aging process. Instead, it can point to the need for a better night’s sleep, stress or an underlying illness, or be the result of a mix of common medications. Or it may be a combination of all these things. Identifying the possible sources of your fatigue is the most important step in reenergizing your lifestyle.

Medical: Visit your physician to rule out these frequently seen causes of tiredness.

Emotional health: Low-grade depression, anxiety or chronic stress can sap energy.

Anemia: This condition occurs when your blood has too few red blood cells or those cells have too little hemoglobin, a protein that transports oxygen through the bloodstream. If untreated, anemia results in a drop in energy levels.

Heart disease: When the heart pumps blood less efficiently, it can lead to fluid in the lungs, causing shortness of breath and reducing the oxygen supply to heart and lungs.

Hypothyroidism : An underactive thyroid gland can cause fatigue – along with other symptoms, such as weight gain, weakness, dry skin, feeling cold and constipation.

Medications : Many medicines can cause fatigue, including blood pressure drugs, antidepressants, anti-anxiety drugs and antihistamines.

Lifestyle Habits

Sleep: Quality, quantity and environment matter greatly in ensuring a healthy sleep, but these factors are surprisingly misconstrued. According to NYU School of Medicine, dispelling these widely held beliefs is key:

  • Myth: “Alcohol before bed is good for sleeping.” A nightcap before bed may help you fall asleep but will dramatically reduce the quality of sleep by disrupting the REM (rapid eye movement) stage all night, and you’ll wake unrefreshed.
  • Myth: “Many adults need only five hours of sleep or less, especially as they get older.” The reality is everyone needs to get enough sleep to wake up feeling refreshed. The average is seven to eight hours nightly to allow the body to progress through four phases of restorative sleep, including deep sleep cycles of REM and delta waves sleep, which are important for generating neurons, repairing muscle and restoring the immune system.
  • Myth: “Watching TV in bed before sleep is a good way to relax.” Actually, turning off the TV and putting away electronic devices at least two hours before bedtime is recommended, as the blue light produced affects the release of melatonin, the sleep hormone, and will delay slumber.
  • Myth: “If I wake up in the middle of the night, it is best to lie in bed until I fall back asleep.” Tossing and turning for more than 20 minutes is not helpful; instead, change rooms and engage in something mindless, like folding socks. Do not watch TV or look at electronic devices, as this wakes up your brain.
  • Myth: “Snoring is a common, harmless problem.” Snoring can be a sign of sleep apnea, a disorder characterized by decreased or complete lack of airflow throughout the night. Over time, this can increase the risk of cardiovascular disease if untreated.
  • Myth: “Falling asleep anywhere, anytime is the sign of a good sleeper.” It’s just the opposite, indicating a sleep “debt” from insufficient rest or a sleep disorder such as narcolepsy or sleep apnea.

Under- or over-activity: Sedentary days and nights can cause loss of muscle mass and flexibility and make even moderately intense activities seem exhausting. However, exercising at a very high intensity can also cause fatigue.

An Infusion of Energy for Chronic Fatigue Research

Far beyond ordinary tiredness is the profound fatigue known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), which has puzzled and frustrated medical professionals for decades. No cure or approved treatment is available to its 2.5 million sufferers, only a management of symptoms worsened by any type of physical, cognitive or emotional effort. But a sea change is underway. It began in 2015 with a new name recommendation by the Institute of Medicine (IOM): Systemic Exertion Intolerance Disease (SEID). Noting that the term chronic fatigue syndrome can trivialize the seriousness of the condition and that “ME” is inappropriate because neither muscle pain nor brain inflammation has proven to be a symptom, the IOM panel stated: “SEID captures a central characteristic of this disease – that exertion of any sort can adversely affect patients in many organ systems and in many aspects of their lives.”

Even more promising is the significant investment in research announced by the National Institutes of Health (NIH). Up to $36 million over five years has been granted to shine a brighter light on the origins and progression of chronic fatigue and ultimately to help develop diagnostic markers and effective treatments.

Did You Know?

58% of older adults sleep less than seven hours a night.

80% of people age 55 and over report unintentionally falling asleep at least once during the day within the last month.

Source: Centers for Disease Control and Prevention

The post Fight Fatigue appeared first on Specialdocs Consultants.

An Update on the Measles Outbreak in the US

What are the newest guidelines for measles vaccinations?

  • Adults with no evidence of immunity should get 1 dose of MMR. Immunity is defined as documented receipt of 1 dose, or 2 doses, 4 weeks apart if high risk, of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birthdate before 1957.
  • High-risk people, including healthcare personnel, international travelers and students at post-high school educational institutions, should receive 2 doses.
  • Persons who previously received a dose of MMR vaccine in 1963–1967 and are unsure which type of vaccine it was, or if it was an inactivated measles vaccine, should be revaccinated with either 1 (if low-risk) or 2 (if high-risk) doses of MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered complete for their age or risk status.

Why does a birthdate prior to 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Between 2% and 5% of people do not develop measles immunity after the first dose of vaccine for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose.

Are there any situations in which more than 2 doses of MMR are recommended?

There are two circumstances when a third dose of MMR is recommended, according to ACIP.

  1. Women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. NOTE: MMR should not be administered to a pregnant woman.
  2. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection. More information is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf

Many people age 60 years and older do not have records indicating what type of measles vaccine they received as children in the early 1960s. What measles vaccine was most frequently given in that time period? That guidance would assist many older people who would prefer not to be revaccinated.

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received.

  • The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine.
  • Persons born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease, should receive at least 1 dose of MMR.
  • Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Do people who received MMR in the 1960s need to have their dose repeated?

Not necessarily.

  • People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated.
  • People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective (see above).
  • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as persons who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

Please explain the Advisory Committee on Immunization Practices (ACIP)’s revised definition of evidence of immunity to measles, rubella, and mumps.

In the 2013 revision of its MMR vaccine recommendations, ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis was previously not accepted as evidence of immunity for rubella. The decrease in measles and mumps cases over the last 30 years has made the validity of physician-diagnosed disease questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

What can be done for unvaccinated people who have already been exposed to measles, mumps, or rubella?

The measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Post-exposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

Why Today’s Health News Often Becomes Tomorrow’s Retractions

Handle with Care: Why Today’s Health News Often Becomes Tomorrow’s Retractions

We’ve all seen it played out hundreds of times, as a drug, food or habit is trumpeted as the way to lower the risk of cancer or heart disease only to be walked back the next month in another study. The reasons can be diverse, including a flawed hypothesis, bad data or misleading conclusions, but at the center is the study design itself. A longitudinal trial may yield very different findings from an observational one, while the gold standard – a randomized controlled trial (RCT) – can be extremely costly and difficult to design. The resulting patchwork of research requires professional analysis and a wait-and-see approach until confirmation is received via follow-up studies. We share some expert insights to help you view new studies with both a healthy skepticism and the realization that some of the most important medical breakthroughs of recent years have been discovered in just this way.

Did You Know?

1,400

Number of scientific papers retracted each year
Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

50%

Percentage of scientific studies confirmed in follow-up studies
Source: Healthy Aging Project, University of Colorado, Boulder

Researchers agree that a randomized, controlled trial is the best way to learn about the world. In a drug study, for instance, a population is randomly divided into groups who receive the drug and those who don’t. If properly controlled and designed, any difference in outcomes between the groups can be measured and credibly attributed to the effects of the treatment. The methodology is highly valued in evidence-based medicine, proving that associations are causal, and not just by chance. The approach has powerful real-world applications, as seen in the Women’s Health Initiative (WHI), one of the nation’s largest-ever health projects.

Begun in 1993, with more than 161,000 women enrolled, the randomized, controlled clinical trial was designed to test the efficacy of long-term hormone therapy in preventing heart disease, hip fractures and other diseases in post-menopausal women over 60 years old on average. Previous observational studies had strongly suggested the preventive benefits of hormone therapy, and it was routinely recommended for women years after menopause. What happened next was stunning.

In 2002, the trial was halted three years earlier than planned as evidence mounted that the estrogen plus progestin therapy significantly raised a woman’s chances of developing cardiovascular disease, stroke and breast cancer. Millions of women stopped taking hormone therapy, and the trial has since been credited with reducing the incidence of breast cancer by 15,000-20,000 cases each year since the results were made public. Numerous follow-up studies were conducted to dig deeper into the surprising data, and while they showed that hormone therapy may still be reasonable short-term to manage menopausal symptoms in younger women, it is no longer routinely recommended years after menopause to prevent chronic disease in women.

Similarly, Vitamin E supplements, once thought to reduce risk of heart disease, were found to not have beneficial properties and actually may increase the risk of heart disease in higher doses. Consequently, the American Heart Association now advises that the best source of Vitamin E is foods, not supplements.

The biggest takeaway from both initiatives: the critical need for randomized, controlled trials to prove that associations between an intervention and a disease are causally related.

Nutrition studies have also come under increased scrutiny, especially with the recent revelation of erroneous data published by high-profile researcher Dr. Brian Wansink, founder of the Food and Brand Lab at Cornell University. Numerous papers have been retracted as the lab’s propensity for data dredging – running exhaustive analyses on data sets to cherry pick interesting and media-friendly findings – came to light. This practice, seen somewhat frequently in food and nutrition research, may be part of why contradictory headlines seem to be the norm.

As the adage goes, data can be tortured until it says what the researcher wants to hear. That’s why your physician will always be the best source for making sense of the tremendous amount of health data released each day…so please ask!


Testing by Design

The most commonly used research models include:

Randomized controlled trial (RCT): carefully planned experiments like the WHI that introduce a treatment or exposure to study its effect on real patients; includes methodologies that reduce the potential for bias and allow for comparison between intervention groups and control groups.

Observational studies: researchers observe the effect of a risk factor, diagnostic test, treatment or other intervention without trying to change who is or isn’t exposed to it. Includes cohort studies, which compare any group of people linked in some way (e.g. by birth year); and longitudinal studies in which data is gathered for the same subjects repeatedly over years or even decades. An example is the Framingham Heart Study, now in its third generation, which has provided most of our current consensus regarding the effects of diet, exercise and medications on heart disease.

Case control study: compares exposure of people with an existing health problem to a control group without the issue, seeking to identify factors or exposures associated with the illness. This is less reliable than RCTs or observational studies because causality is not proven by a statistical relationship.

Meta-analysis:  a thorough examination of numerous valid studies on a topic, which uses statistical methodology to combine and report the results of multiple studies as one large study. This is cost-effective but not as accurate as RCTs as the individual studies were not designed identically.

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A Flu-Free Winter: Your Best Shot

Take Your Best Shot for a Flu-Free Winter

Last year’s flu season was severe in most parts of the country and left many wondering why the flu vaccine hadn’t performed more effectively. However, it remains our best line of defense for averting and lessening the severity of this common but potentially deadly illness. Below we clear up some of the most common misconceptions about the flu vaccine…and continue to strongly recommend that you make sure to get your shot of prevention this fall.

Myth: I can get the flu from a flu shot.

A flu shot will not give you the flu. The viral strains in injectable influenza vaccine are inactive and biologically unable to cause illness. The one exception is the vaccine administered in nose spray form.

Myth: The vaccine didn’t work last year, so it must be losing potency.

The amount of protection provided by flu vaccines varies by influenza virus type, and how well matched vaccine viruses are to the circulating flu viruses. Last year’s results, while lower than average, still meant that the risk of getting sick from flu was reduced by a third. This year, both types of vaccines, trivalent (protection against influenza A H1N1 and H3N2 viruses and one type of influenza B virus) and quadrivalent (four component protection to protect against two types of B viruses), have been modified to better anticipate the season’s circulating flu viruses.

Myth: The flu vaccine will also prevent other viruses.

Flu vaccines do not protect against infection and illness caused by other viruses, such as rhinovirus (one cause of the common cold) and respiratory syncytial virus (RSV), despite their flu-like symptoms.

Myth: Flu vaccines are not appropriate for people over 65, who have weaker immune systems than younger people.

Although immune responses may be lower in the elderly, flu vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults. It’s also important to remember that people 65 and older are at increased risk of serious illness, hospitalization and death from the flu, making the flu vaccination especially important for this age group.

Myth: There are no flu vaccines just for people over 65.

There are two vaccines designed specifically to help enhance the effectiveness in adults older than 65. A high dose vaccine, containing four times the amount of antigen as the regular flu shot, and the adjuvanted flu vaccine, which creates a stronger immune response in the elderly.

Myth: The vaccine is less effective if received every year.

Multiple studies have shown that while immune responses to vaccination may be higher among people not previously vaccinated, those who are repeatedly vaccinated still have increased immune responses and are provided protection against the flu.

Myth: I should wait as late as possible to get immunized so it lasts throughout the season.

The CDC and Advisory Committee on Immunization Practices (ACIP) recommends that you get a flu vaccination in early fall to ensure you’re protected before flu season begins. However, as long as flu viruses are circulating, it’s not too late. Receiving a vaccination in December or January can still protect you because flu season often peaks after January and can last as late as May.

Myth: Getting sick with the flu is not all that serious.

In the U.S., 36,000 people die and more than 200,000 are hospitalized each year because of the flu. Children, the elderly and people with certain chronic conditions (heart disease, lung disease, asthma or diabetes) are at higher risk for complications such as pneumonia. For everyone, flu symptoms, including fever, headaches, cough, sore throat, nasal congestion, extreme tiredness and body aches, can disrupt work and social life for up to two weeks. The flu vaccine has proven effective in both preventing flu and in lessening the severity of symptoms if flu should occur, thereby reducing the risk of hospitalization and admission to the intensive care unit.

Did You Know?

Up to 60% – Decrease in the risk of flu during seasons when most circulating flu viruses are well matched to the flu vaccine. Put another way, in 2016-17, the vaccine prevented an estimated 5.29 million illnesses, 2.64 million medical visits and 84,700 hospitalizations associated with flu.

79% / 52% – Reduction in hospitalization for people with diabetes (79%) or chronic lung disease (52%) as a result of receiving the flu vaccine.

Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

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