Harvard Health Blog http://meeto.raminosk.savana-hosting.cz/?big=blog Harvard Health Blog: You’ll find posts from Harvard Medical School physicians and our editors on a variety of health news and issues. Wed, 20 Mar 2019 14:30:39 +0000 en-US hourly 1 http://meeto.raminosk.savana-hosting.cz/?big=images/misc/logo-HHP_shield.png Harvard Health Blog http://meeto.raminosk.savana-hosting.cz/?big=blog 102 120 Harvard Health Blog: You’ll find posts from Harvard Medical School physicians and our editors on a variety of health news and issues. Over-the-counter cold and flu medicines can affect your heart http://meeto.raminosk.savana-hosting.cz/?big=blog/over-the-counter-cold-and-flu-medicines-can-affect-your-heart-2019032016220 http://meeto.raminosk.savana-hosting.cz/?big=blog/over-the-counter-cold-and-flu-medicines-can-affect-your-heart-2019032016220#respond Wed, 20 Mar 2019 14:30:39 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16220 Some common over-the-counter medications typically taken for colds and the flu may increase the risk of a cardiovascular event. This increased risk is more likely to occur in people with existing heart disease, and in people who take the medications for an extended period of time.

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As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants.

NSAIDs and your heart

Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhibiting an enzyme called COX that produces molecules called prostaglandins. However, this enzyme also has additional important effects throughout the body, which may impact cardiovascular risk. For example, the inhibition of a form of COX called COX-2 in the lining of blood vessels may influence blood vessel injury repair, relaxation, and clotting. The inhibition of COX-2 in the kidney may influence fluid retention, which may in turn affect blood pressure and heart failure symptoms.

Large population studies have demonstrated that the use of NSAIDs similar to those in OTC cold and flu remedies is associated with about two additional cardiovascular events (such as a heart attack or stroke) per 1,000 people per year among individuals without a history of cardiovascular disease (CVD). Among individuals with a history of CVD, this association increases to an additional seven or eight cardiovascular events per 1,000 people per year.

Importantly, these studies were primarily conducted in individuals who were using NSAIDs for long periods of time (more than a month) due to chronic pain or inflammatory conditions. Cardiovascular risk associated with NSAIDs decreases by using these medicines for the shortest duration and lowest dose and frequency as possible — as is often the case during short bouts of a cold or the flu.

Thus, among individuals who do not have CVD, the use of NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually a reasonable option for short-term symptom relief. For individuals who do have CVD, it is worth discussing use of NSAIDs with a doctor.

For individuals with CVD, it is often fine to use NSAIDs for a short duration if a different medication, such as acetaminophen (Tylenol), is not an option. In this case, however, the choice of NSAID may be important. Some data suggest naproxen and the COX-2 selective NSAID celecoxib (Celebrex) may have slightly lower associations with CVD in high-risk patients.

Certain individuals should definitely speak with a doctor before considering NSAIDs, even for just a few days. These include individuals who have heart failure; who are on blood thinners such as warfarin, rivaroxaban (Xarelto), apixaban (Eliquis), or dabigatran (Pradaxa); who take antiplatelet medications such as aspirin (Bayer, Bufferin), clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta); or who have had a recent heart attack, stroke, angina (chest pain), or coronary artery bypass surgery.

Decongestants and your heart

Decongestants such as phenylephrine (Sudafed PE Congestion, Suphedrin PE) and pseudoephedrine (Sudafed Congestion, Suphedrin) also affect the cardiovascular system. These agents act on the “fight or flight” response to constrict, or narrow, blood vessels. This dries up runny noses and congestion, but may also lead to increases in blood pressure and changes in heart rate. The long-term effects of these drugs on outcomes such as heart attack and stroke have not been as well studied as they have for NSAIDs. However, clinical experience has demonstrated that in certain individuals who are especially sensitive to sudden changes in blood pressure or heart rate, these drugs can sometimes have harmful effects.

People without CVD can almost always safely tolerate the effects of these decongestants when used for short periods of time. As with NSAIDs, it is always best to use the lowest dose and frequency possible for the shortest amount of time.

For individuals with established CVD, however, it is likely best to avoid these medications. This is especially true in individuals with heart failure, difficult-to-control blood pressure, or coronary artery disease. In these cases, blood vessel constriction and abrupt changes in blood pressure and heart rate may not be as safely tolerated by the body.

Many OTC medicines for the cold and flu such as NSAIDs and decongestants can have negative effects on the cardiovascular system. These effects can have significant consequences — even during short-term use — for some people with established CVD. If you fall into this category, discuss your risk and alternative treatment options with your cardiologist.

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http://meeto.raminosk.savana-hosting.cz/?big=blog/over-the-counter-cold-and-flu-medicines-can-affect-your-heart-2019032016220/feed 0 16220 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fover-the-counter-cold-and-flu-medicines-can-affect-your-heart-2019032016220 ]]> Over-the-counter pain relievers and your heart http://meeto.raminosk.savana-hosting.cz/?big=blog/over-the-counter-pain-relievers-and-your-heart-2017051511617 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg 2019-03-20 10:30:39 2019-03-20 14:30:39 Gut reaction: How bacteria in your belly may affect your heart http://meeto.raminosk.savana-hosting.cz/?big=blog/gut-reaction-bacteria-belly-may-affect-heart-2016072210005 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg 2019-03-20 10:30:39 2019-03-20 14:30:39 Flu news: Now most people with egg allergies can get a flu shot http://meeto.raminosk.savana-hosting.cz/?big=blog/flu-news-now-most-people-with-egg-allergies-can-get-a-flu-shot-2016100610411 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg 2019-03-20 10:30:39 2019-03-20 14:30:39 Physician burnout can affect <i>your</i> health http://meeto.raminosk.savana-hosting.cz/?big=blog/physician-burnout-can-affect-your-health-2018062214093 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg 2019-03-20 10:30:39 2019-03-20 14:30:39 10 things you can do for your pet when it’s cold outside http://meeto.raminosk.savana-hosting.cz/?big=blog/pets-safety-cold-weather-2018012613137 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg 2019-03-20 10:30:39 2019-03-20 14:30:39 https://hhp-blog.s3.amazonaws.com/2018/01/iStock-618523968.jpg Mark Benson, MD, PhD
How to prevent poisonings in children — and what to do if they happen http://meeto.raminosk.savana-hosting.cz/?big=blog/how-to-prevent-poisonings-in-children-and-what-to-do-if-they-happen-2019031916230 http://meeto.raminosk.savana-hosting.cz/?big=blog/how-to-prevent-poisonings-in-children-and-what-to-do-if-they-happen-2019031916230#respond Tue, 19 Mar 2019 14:30:05 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16230 Safety precautions can prevent a child from accidentally ingesting or being exposed to poisonous or harmful items in your home, but knowing what to do if something happens can save a life.

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March 17–March 23, 2019 is National Poison Prevention Week

Every day in the United States, over 300 children under the age of 20 are seen in an emergency room because of poisoning, and two of them die. What is most heartbreaking is that poisonings are preventable — and quick action can save lives when they happen.

Poisoning prevention

Here are some tips from the Centers for Disease Control and Prevention and the American Academy of Pediatrics to prevent poisoning in children:

  • Keep medicines, cleaning and laundry products, paints and varnishes, as well as pesticides, out of sight and reach of children. If possible, lock these products away.
  • Always keep these products in their original containers, which makes it less likely that they will be ingested by accident.
  • While laundry and dishwasher detergent pods can be convenient, stick with the standard liquids and powders if there are young children in the house. The pods just look too much like candy.
  • Have safety caps for all medications, but don’t rely on them (meaning keep medications out of reach and sight).
  • Make sure you know the correct dose of any medication you give your child, and always use a medication syringe or spoon to measure it (ask your pharmacist for one if you don’t have one).
  • Get rid of any old or unused medicines or cleaning products. The less around, the better.
  • If you use e-cigarettes, only buy nicotine refills in safety containers and keep them out of sight and reach. Nicotine can be very dangerous.
  • If you have a gas, kerosene, coal, or wood-burning stove, make sure it is in good working order.
  • Have smoke and carbon monoxide detectors, and check them regularly to be sure they are working.
  • Know what devices in your home use button cell batteries, and keep them out of reach of children. Don’t buy children’s books or toys that have these batteries; it’s not worth the risk.
  • Make sure you know all the types of plants you have in your house or yard. If any are poisonous, either keep your child away from them, or better yet, get rid of them.

What do to should a poisoning happen, or if you think it might have

  • If the child is having any trouble breathing, is unconscious, or has what you think even might be a serious injury, call 911 right away.
  • For a swallowed poison, have the child spit out whatever isn’t swallowed. Do not use ipecac or anything else to make them vomit. If your child has any symptoms, call 911 or bring your child to a local emergency room. If your child doesn’t have symptoms, call 1-800-222-1222, the nationwide poison control center number. Have the container with you when you call, and be ready to tell the person you talk to how much your child swallowed (or your best guess).
  • For something that gets on the skin, take off any clothing and run water over the affected area for 15 minutes. While you are doing that, call the poison center.
  • If anything gets in the eyes, hold the eye open and run room-temperature water on the eyes (aim for the inner corner) for 15 minutes. Call the poison center while you do — or call 911 if a lot got into the eyes or the child is in a lot of pain — but don’t stop flushing the eyes.
  • If a child swallows a button cell battery, or puts it in his nose or ear, take him immediately and directly to an emergency room. They can do damage quickly.
  • If a child has inhaled a poison, or you think that she might have, get her out into fresh air. Call 911 if she is unconscious or having any trouble breathing.

Keep the Poison Center number in your phone and posted in your house so that it is always handy. You can and should also call the number — or your doctor — if you think your child might have gotten into something, but you aren’t sure. It’s always better to be safe than sorry.

Follow me on Twitter @drClaire

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http://meeto.raminosk.savana-hosting.cz/?big=blog/how-to-prevent-poisonings-in-children-and-what-to-do-if-they-happen-2019031916230/feed 0 16230 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fhow-to-prevent-poisonings-in-children-and-what-to-do-if-they-happen-2019031916230 ]]> Physical therapy after hip replacement: Can rehab happen at home? http://meeto.raminosk.savana-hosting.cz/?big=blog/physical-therapy-hip-replacement-can-rehab-happen-home-201605119563 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg 2019-03-19 10:30:05 2019-03-19 14:30:05 7 ways to prevent holiday stress — for your children http://meeto.raminosk.savana-hosting.cz/?big=blog/7-ways-prevent-holiday-stress-children-2017112812809 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg 2019-03-19 10:30:05 2019-03-19 14:30:05 The times, they are a-changin’ (and bringing new syndromes) http://meeto.raminosk.savana-hosting.cz/?big=blog/times-changin-bringing-new-syndromes-201607019844 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg 2019-03-19 10:30:05 2019-03-19 14:30:05 The most important health problems (and why they matter) http://meeto.raminosk.savana-hosting.cz/?big=blog/important-health-problems-matter-2016091510267 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg 2019-03-19 10:30:05 2019-03-19 14:30:05 Are fresh juice drinks as healthy as they seem? http://meeto.raminosk.savana-hosting.cz/?big=blog/fresh-juice-drinks-healthy-seem-2016072910044 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg 2019-03-19 10:30:05 2019-03-19 14:30:05 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-147665766.jpg Claire McCarthy, MD
How long does a joint replacement last? http://meeto.raminosk.savana-hosting.cz/?big=blog/how-long-does-a-joint-replacement-last-2019031816242 http://meeto.raminosk.savana-hosting.cz/?big=blog/how-long-does-a-joint-replacement-last-2019031816242#respond Mon, 18 Mar 2019 14:30:33 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16242 A person considering a knee or hip replacement needs to weigh how long the new joint will last as part of the decision-making process. Analyses of hundreds of thousands of hip and knee replacements show encouraging results for those facing this decision.

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Joint replacement surgery represents one of the biggest and most life-changing advances in modern medicine. It has meant the difference between disability from crippling arthritis and nearly normal mobility for millions of people in recent decades. The hip and knee are, by far, the most commonly replaced joints, and they have the most reliable results. In the US each year, more than 300,000 hips and 700,000 knees are replaced, and the results are generally good. But every time a joint is replaced, an important question looms: how long will it last?

It’s a fair question. After all, no one wants to go through the risk, discomfort, and recovery time required for a major operation only to need it again in a short time.

The usual estimate: 10 to 15 years

When I was in medical school, the commonly quoted estimate was that a replaced knee or hip should last about 10 to 15 years, but hopefully much longer. That was an average, of course. Rare complications requiring re-operation can occur soon after surgery; for others, a replaced joint can last two decades or more. And since it takes many years to know whether improved surgical techniques and materials have led to longer joint life, it’s hard to know at any given time how long a replaced joint might last.

Why is this so important? Estimates of joint replacement longevity are helpful to the person who is uncertain about whether joint replacement is worth pursuing. But in addition to whether to have surgery, these numbers can help people decide when to have it done. For example, a person in their 30s might be looking at two or more revisions (the surgeon’s term for replacing a previously replaced joint). Some younger joint replacement surgery candidates have been advised to wait until symptoms are more severe in the hopes of reducing the need for multiple revisions in the future.

A new study provides new estimates

In February 2019, two large analyses were published in the medical journal Lancet regarding the longevity of replaced hips and knees, that included nearly 300,000 total knee replacements and more than 200,000 total hip replacements. They found encouraging results:

  • Nearly 60% of hip replacements lasted 25 years, 70% lasted 20 years, and almost 90% lasted 15 years.
  • Total knee replacements lasted even longer: 82% lasted 25 years, 90% lasted 20 years, and 93% lasted 15 years.

These estimates are quite a bit higher than prior ones and may reflect improvements in surgical technique and materials, general medical care around the time of surgery, or more aggressive mobilization and physical therapy that starts right after surgery. The study authors also suggest that these numbers reflect “real life” patients (including all patients in multiple medical centers who were having their knees or hips replaced), rather than a small number from a single medical center.

Some caveats are worth noting:

  • These surgeries were performed in New Zealand, Australia, Denmark, Finland, Norway, and Sweden. The results might be different in the US or other countries.
  • Detailed information was not available regarding which patients were considered eligible for total joint replacement and which were denied surgery because they were considered at high risk for failure or complications. These factors can affect the success of joint replacement surgery.

Surgery is usually the last (and sometimes best) option

When a hip or knee has worn out and no longer functions as it should, medications, physical therapy, various injections, and other nonsurgical treatments can only do so much — often they can’t do much at all. For those who are healthy enough to have major surgery (and willing to go through with it), total joint replacement is often the only option that offers a good chance at significant pain relief and improved function. Joint replacement surgery for arthritis is considered a treatment of last resort. But even though replaced joints may not last forever, they may last longer than we’d thought.

Follow me on Twitter @RobShmerling

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http://meeto.raminosk.savana-hosting.cz/?big=blog/how-long-does-a-joint-replacement-last-2019031816242/feed 0 16242 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fhow-long-does-a-joint-replacement-last-2019031816242 ]]> How long will my hip or knee replacement last? http://meeto.raminosk.savana-hosting.cz/?big=blog/how-long-will-my-hip-or-knee-replacement-last-2018071914272 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg 2019-03-18 10:30:33 2019-03-18 14:30:33 Does addiction last a lifetime? http://meeto.raminosk.savana-hosting.cz/?big=blog/does-addiction-last-a-lifetime-2018100814962 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg 2019-03-18 10:30:33 2019-03-18 14:30:33 Unlocking the lock jaw: Temporomandibular Joint (TMJ) dysfunction http://meeto.raminosk.savana-hosting.cz/?big=blog/unlocking-the-lock-jaw-temporomandibular-joint-tmj-dysfunction-2017022211146 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg 2019-03-18 10:30:33 2019-03-18 14:30:33 Physical therapy after hip replacement: Can rehab happen at home? http://meeto.raminosk.savana-hosting.cz/?big=blog/physical-therapy-hip-replacement-can-rehab-happen-home-201605119563 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg 2019-03-18 10:30:33 2019-03-18 14:30:33 Knee replacement: Life changing or a disappointment? http://meeto.raminosk.savana-hosting.cz/?big=blog/knee-replacement-life-changing-disappointment-2016082410095 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg 2019-03-18 10:30:33 2019-03-18 14:30:33 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-914140918.jpg Robert H. Shmerling, MD
Something else to avoid in pregnancy: Phthalates http://meeto.raminosk.savana-hosting.cz/?big=blog/something-else-to-avoid-in-pregnancy-phthalates-2019031516224 http://meeto.raminosk.savana-hosting.cz/?big=blog/something-else-to-avoid-in-pregnancy-phthalates-2019031516224#comments Fri, 15 Mar 2019 10:30:10 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16224 Chemicals called phthalates are in all kinds of products we use every day, making them nearly inescapable. But research has found that children whose mothers were exposed to phthalates during pregnancy were more likely to have problems with motor skills or language development, so pregnant women should try to avoid them.

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Most pregnant women know that they should avoid things like alcohol and tobacco while they are pregnant, as well as certain foods like sushi and soft cheeses. But not many pregnant women think about avoiding lipstick, perfume, or lotions — and it turns out that they probably should.

The problem is a type of chemical called phthalates. It’s nearly impossible to avoid phthalates entirely, as they are quite literally everywhere. They are in plastic products including packaging, in toys and garden hoses, as well as in cosmetics and other personal care products. They can act like hormones and interfere with male genital development, as well as increase the risk of cardiovascular disease and diabetes.

The risks of phthalates, though, begin before birth. A study showed that children whose mothers were exposed to phthalates during pregnancy were more likely to have problems with motor skills, the skills that we use not just in sports but also in everyday activities, and another showed that the children of mothers exposed during pregnancy had problems with language development.

Even if it’s impossible to avoid phthalates entirely, there are ways women can decrease their exposure:

  • Limit exposure to plastics, especially anything with the number 3 or 7 on them. Use glass, ceramic, or metal containers for food and drink.
  • Try to buy foods that don’t come in plastic packaging.
  • If you have to use plastic, don’t microwave it, and wash it by hand rather than in the dishwasher to limit the leaching out of chemicals.
  • Avoid anything with fragrance in it, as phthalates are commonly used in making fragrances.
  • Look into handmade cosmetic and personal products that don’t use any chemicals (and skip the products entirely when you can). The Environmental Working Group has a database you can use to learn more about commercial products.
  • Go DIY. Things like honey, coconut oil, baking soda, vinegar, and salt can be used in place of many commercial beauty products. Do a little research — you may find that it’s easier than you think to make a moisturizer, a shampoo, or a perfume.
  • Wash your hands often with soap and water.

Once the baby is born, continue to be mindful about chemicals that can cause harm. Look for fragrance-free products that are as all-natural as possible, keep up with DIY including for cleaning products, and limit plastics in the house, especially baby bottles and toys. We can’t escape all the harmful chemicals around us, but by getting back to basics, we can make things safer for our children.

Follow me on Twitter @drClaire

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Aspirin for primary prevention of cardiovascular disease, part 2 http://meeto.raminosk.savana-hosting.cz/?big=blog/aspirin-for-primary-prevention-of-cardiovascular-disease-part-2-2019031414890 Thu, 14 Mar 2019 14:30:56 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=14890 The results of another clinical trial add to the evidence that healthy people without a history of cardiovascular disease should not take a daily aspirin for the prevention of a heart attack or stroke.

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Update

In March 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines that suggest that most adults without a history of heart disease should not take low-dose daily aspirin to prevent a first heart attack or stroke. Based on the ASPREE, ARRIVE, and ASCEND trials, the ACC/AHA guidelines concluded that the risk of side effects from aspirin, particularly bleeding, outweighed the potential benefit.

The new guidelines do not pertain to people with established cardiovascular disease, in whom the benefits of daily aspirin have been found to outweigh the risks.

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Well, it seems as though not even a week can go by without more data on aspirin! I recently reviewed the ARRIVE trial and the implications for primary prevention — that is, trying to prevent heart attacks and strokes in otherwise healthy people. Since then, yet another large clinical trial — the ASPREE study — has come out questioning the use of aspirin in primary prevention. Three articles pertaining to this trial were published in the prestigious New England Journal of Medicine, which is an unusual degree of coverage for one trial and highlights its immediate relevance to clinical practice.

Aspirin still strongly indicated for secondary prevention

Nothing about any of the new aspirin data, including ASPREE, pertains to secondary prevention, which refers to use of aspirin in patients with established cardiovascular disease. Examples include a prior heart attack or certain types of stroke, previous stents or bypass surgery, and symptomatic angina or peripheral artery disease. In general, in patients with a history of these conditions, the benefits of aspirin in reducing cardiovascular problems outweigh the risks. Chief among these is a very small risk of bleeding in the brain, and a small risk of life-threatening bleeding from the stomach.

ASPREE study suggests no benefit from aspirin in primary prevention

ASPREE randomized 19,114 healthy people 70 or over (65 or over for African Americans and Hispanics) to receive either 100 milligrams of enteric-coated aspirin or placebo. After an average of almost five years, there was no significant difference in the rate of fatal coronary heart disease, heart attack, stroke, or hospitalization for heart failure. There was a significant 38% increase in major bleeding with aspirin, though the actual rates were low. The serious bleeding included bleeding into the head, which can lead to death or disability. Again, the actual rates were very low, but they are still a concern when thinking of the millions of patients to whom the ASPREE results apply.

Rates of dementia were also examined, and again, there was no benefit of aspirin. Quite unexpectedly, there was a significantly higher rate of death in the patients taking aspirin. This had not been seen in prior primary prevention trials of aspirin, so this isolated finding needs to be viewed cautiously. Still, with no benefits, increased bleeding, and higher mortality, at least in this population of older healthy people, aspirin should no longer be routinely recommended.

Another unexpected finding in ASPREE was a significantly higher rate of cancer-related death in the people randomized to aspirin. The prior thinking had been that aspirin might actually prevent colon cancer, though generally after many more years of being on aspirin. The ASPREE trial was terminated early due to lack of any apparent benefits. And even though five years is a relatively long period of follow-up, it may not have been long enough to find a benefit on cancer. Thus, the increase in cancer deaths may be a false finding. Nevertheless, the overall picture from this trial is not a compelling one for aspirin use for prevention of either cardiac or cancer deaths.

Should healthy people take a daily aspirin?

In general, the answer seems to be no — at least not without first consulting your physician. Despite being available over the counter and very inexpensive, aspirin can cause serious side effects, including bleeding. This risk goes up with age. So, even though it seems like a trivial decision, if you are healthy with no history of cardiovascular problems, don’t just start taking aspirin on your own.

However, there are likely select healthy patients who have a very high risk of heart attack based on current smoking, family history of premature heart attacks, or very elevated cholesterol with intolerance to statins, for example, who might benefit. Therefore, the decision to start aspirin should involve a detailed discussion with your physician as part of an overall strategy to reduce cardiovascular risk. If you are already taking aspirin for primary prevention, it would be a good idea to meet with your physician and see if you might be better off stopping.

Follow me on Twitter @DLBHATTMD

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14890 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Faspirin-for-primary-prevention-of-cardiovascular-disease-part-2-2019031414890 ]]> Aspirin for primary prevention of cardiovascular disease? http://meeto.raminosk.savana-hosting.cz/?big=blog/aspirin-for-primary-prevention-of-cardiovascular-disease-2018092014858 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg 2019-03-14 10:30:56 2019-03-14 14:30:56 Anti-inflammatory medications and the risk for cardiovascular disease: A new study, a new perspective http://meeto.raminosk.savana-hosting.cz/?big=blog/anti-inflammatory-medications-and-the-risk-for-cardiovascular-disease-a-new-study-a-new-perspective-2016112310725 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg 2019-03-14 10:30:56 2019-03-14 14:30:56 Can aspirin protect against cancer? http://meeto.raminosk.savana-hosting.cz/?big=blog/can-aspirin-protect-cancer-201605209647 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg 2019-03-14 10:30:56 2019-03-14 14:30:56 Is aspirin a wonder drug? http://meeto.raminosk.savana-hosting.cz/?big=blog/aspirin-wonder-drug-2016122210916 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg 2019-03-14 10:30:56 2019-03-14 14:30:56 Understanding suicide in children and early adolescents may lead to more effective prevention http://meeto.raminosk.savana-hosting.cz/?big=blog/understanding-suicide-in-children-and-early-adolescents-may-lead-to-more-effective-prevention-2016120910715 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg 2019-03-14 10:30:56 2019-03-14 14:30:56 https://hhp-blog.s3.amazonaws.com/2016/12/aspirin-tablets-Warrenrandalcarr-iStock-622908048.jpg Deepak Bhatt, MD, MPH
Banishing dry winter skin http://meeto.raminosk.savana-hosting.cz/?big=blog/banishing-dry-winter-skin-2019031416142 http://meeto.raminosk.savana-hosting.cz/?big=blog/banishing-dry-winter-skin-2019031416142#comments Thu, 14 Mar 2019 14:30:35 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16142 Using a moisturizer is good for your skin year-round, but a dermatologist explains that during the cold and dry months there's more you can do to prevent or relieve dry skin.

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Do you have dry, itchy winter skin? You’re not alone. During the winter months, many of my patients come into clinic asking about the right cream to use to cure their dry skin. But dry skin care is about so much more than just moisturizers.

Here are some dermatologist-recommended tips for preventing and relieving dry skin:

  • Harsh soaps are not your friend. Many people love the feeling of being “squeaky-clean” after using harsh soaps in the shower. But these soaps strip your skin of essential lipids (fats) that keep the skin moisturized. Instead, try a gentle, fragrance-free cleanser and limit its use to cleaning the underarms and groin, or skin that is visibly soiled.
  • Warm showers, not hot. I look forward to a steaming-hot shower at the end of a cold winter day as much as the next person. But hot water and long showers can irritate and dry out the skin. So can saunas, hot tubs, and Jacuzzis. Especially when your skin is dry, try turning the temperature knob down slightly so that the water is warm rather than hot, and limit showering to once a day for no more than 10 minutes.
  • When you moisturize matters. The best time to moisturize is when your skin is still damp, such as right after a shower. Pat your skin dry gently, then slather up with a good moisturizer from head to toe. Not only is it more effective, it may also feel less greasy on your skin as the moisturizer traps existing moisture on your skin.
  • The thicker the better. Ointments or creams are much more effective at moisturizing than lotions. Ointments are typically petroleum or lanolin based, and creams tend to be thicker than lotions. Additional moisturizing ingredients to look for include shea butter, olive oil, and jojoba oil. If your skin is flaky, look for exfoliating ingredients such as lactic acid or urea, but be careful using these ingredients if you have sensitive skin.
  • Go gentle all around. Use skincare products that are gentle and unscented, including deodorants and hypoallergenic laundry detergent. Gentle or hypoallergenic products minimize the chance of skin irritation; avoiding irritation can help maintain the healthy skin barrier needed to retain water from the inside.
  • Consider a humidifier. During the dry winter months, using a humidifier to keep the humidity above 30% can make a big difference for your skin.
  • Nature versus nurture. Some people have a genetic mutation in the fillagrin gene. This gene is very important in the formation of the outer layer of the skin, which forms a barrier that helps the skin retain moisture. This mutation predisposes the affected individuals to eczema and persistently dry skin. It is especially important for people with this mutation to follow all the tips above to prevent and manage dry skin.

If your skin does not improve after making these changes, you may need to see a dermatologist. Sometimes, severe dry skin can be relieved by a prescription ointment or cream. Dry skin can also indicate a more serious skin condition; a dermatologist can evaluate your skin and decide on the regimen that can help you the most.

Follow me on Twitter @KristinaLiuMD

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http://meeto.raminosk.savana-hosting.cz/?big=blog/banishing-dry-winter-skin-2019031416142/feed 1 16142 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fbanishing-dry-winter-skin-2019031416142 ]]> A doctor answers 5 questions about dry skin http://meeto.raminosk.savana-hosting.cz/?big=blog/5-answers-about-dry-skin-2018020913227 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg 2019-03-14 10:30:35 2019-03-14 14:30:35 The fix for dry eyes http://meeto.raminosk.savana-hosting.cz/?big=blog/the-fix-for-dry-eyes-2017021011090 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg 2019-03-14 10:30:35 2019-03-14 14:30:35 Let the sun shine: Mind your mental health this winter http://meeto.raminosk.savana-hosting.cz/?big=blog/let-the-sun-shine-mind-your-mental-health-this-winter-2017012311058 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg 2019-03-14 10:30:35 2019-03-14 14:30:35 Is there a link between alcohol and skin cancer? http://meeto.raminosk.savana-hosting.cz/?big=blog/loose-link-alcohol-skin-cancer-2017120812861 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg 2019-03-14 10:30:35 2019-03-14 14:30:35 4 ways to protect against skin cancer (other than sunscreen) http://meeto.raminosk.savana-hosting.cz/?big=blog/4-ways-to-protect-against-skin-cancer-other-than-sunscreen-2018042713722 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg 2019-03-14 10:30:35 2019-03-14 14:30:35 https://hhp-blog.s3.amazonaws.com/2018/02/dry-skin-lotion-winter-iStock-522307570.jpg Kristina Liu, MD, MHS
Can exercise extend your life? http://meeto.raminosk.savana-hosting.cz/?big=blog/can-exercise-extend-your-life-2019031316207 http://meeto.raminosk.savana-hosting.cz/?big=blog/can-exercise-extend-your-life-2019031316207#comments Wed, 13 Mar 2019 14:30:14 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16207 Better health and more time: a long-term study of people who took a treadmill test suggests better fitness lengthens lives at every age.

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Exercise provides a remarkable variety of health benefits, which range from strengthening bones to positive effects on mood and helping to prevent chronic illnesses such as diabetes and heart disease. Research dating back to the late 1980s has consistently shown that aerobic fitness may help extend lives. Yet a few studies on athletes examining whether habitual vigorous exercise might harm the heart made some experts wonder how hard people ought to push when exercising (see here and here).

Do cardiorespiratory fitness levels affect longevity?

A retrospective study in JAMA attempts to answer this question. The study explores the association between long-term mortality and various levels of cardiorespiratory fitness (CRF). CRF is a measure of how well your heart and lungs pump blood and oxygen throughout the body during prolonged bouts of exercise. The more fit you are, the higher your level of CRF. Regular exercise, and vigorous exercise, can both boost CRF.

The researchers looked at over 122,000 patients at a large academic medical center who underwent exercise testing on a treadmill, an objective measure of CRF. While the average age was 53, participants ranged in age from 18 to over 80. Similar to findings of previous studies, being fit was associated with living longer. This held true at any age. The researchers also saw a relationship between CRF and survival rates: the higher the level of fitness, the higher the survival rate. This was especially notable in older people and people with high blood pressure. And the survival benefit continued to climb with no upper limit.

What does this mean for all of us?

Unless there is a clear medical contraindication, we should all strive to achieve and maintain high levels of fitness. Current guidelines recommend 150 to 300 minutes per week of moderate aerobic activity (walking, running, swimming, biking), or 75 minutes of vigorous activity, or a mix of both. Twice-weekly resistance training to strengthen muscles is also recommended. Unfortunately, only about one in five adults and teens gets enough exercise to maintain good health.

Wondering where to start?

There’s a place to start for everyone regardless of age or current fitness level.

  • First, think safety. Walking and other low levels of exercise are generally safe for most people. But check with your doctor before starting or making changes to an exercise routine if you have a history of heart disease, or any other medical condition that might impact your exercise tolerance.
  • Start small. You’ll be more successful if you set the bar low. For example, start with a simple routine of walking 10 to 20 minutes three times per week. Every week or two, add five minutes per walk until you reach a goal of 30 minutes. Then, every week or two, add a day until you reach at least 150 minutes per week. Over time you can try to increase intensity. Remember, small goals are more achievable, and these little victories will continue to fuel your motivation.
  • Don’t be afraid of exercise or the gym. Any movement is good and is a step in the right direction. The gym intimidates many folks — perhaps you’re overweight or inexperienced, and worry that others might stare or judge you. Everyone was new to exercise at one point in time. Focus on your purpose and avoid wasting energy on things that do not matter.
  • Plan ahead. To maximize your success in adopting a long-term lifestyle change, plan ahead. Every week, look at your calendar ahead of time and commit to when you will exercise that week. Think of your opportunity to exercise as an appointment, rather than “I’ll get to it if I have time.”
  • Expect to lose some battles. Keep in mind that realistically, most people will get derailed at some point as they work on a behavioral change. Do not let this crush your motivation. Instead, identify obstacles that may have interfered, strategize a solution moving forward, and try again.

Trying to get back into physical activity after a hiatus?

Take the first week to ease back into exercising. Avoid building up to your previous level of fitness too quickly to avoid injuring yourself.

Already active and wondering how to reap more benefits?

  • Many people fall short on resistance training and are mostly focusing on cardio. Resistance training helps you build strength, thereby improving your overall cardiovascular fitness and performance.
  • If you’re short on time, consider a high-intensity interval workout. This will get you more bang for your buck.
  • Vary your exercise routine to keep yourself challenged physically.

Too often, our health takes a back seat in the midst of busy careers and the multitude of responsibilities we take on in our lives. Optimizing your health through highly nutritious food choices and by getting enough sleep and exercise takes time and dedicated effort. But it is certainly worth it, and only gets easier over time as these new habits become ingrained.

Follow me on Twitter @MarwaAhmedMD

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http://meeto.raminosk.savana-hosting.cz/?big=blog/can-exercise-extend-your-life-2019031316207/feed 2 16207 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fcan-exercise-extend-your-life-2019031316207 ]]> A mix of treatments may extend life for men with aggressive prostate cancer http://meeto.raminosk.savana-hosting.cz/?big=blog/mix-treatments-may-extend-life-men-aggressive-prostate-cancer-2018033113521 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg 2019-03-13 10:30:14 2019-03-13 14:30:14 Sharpen your cooking skills and improve your diet (and even your social life) http://meeto.raminosk.savana-hosting.cz/?big=blog/sharpen-cooking-skills-improve-diet-even-social-life-2017030311204 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg 2019-03-13 10:30:14 2019-03-13 14:30:14 Now hear this, men: Hearing aids can be a life changer http://meeto.raminosk.savana-hosting.cz/?big=blog/now-hear-men-hearing-aids-can-life-changer-2016112510674 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg 2019-03-13 10:30:14 2019-03-13 14:30:14 How to rediscover meaning in your life http://meeto.raminosk.savana-hosting.cz/?big=blog/how-to-rediscover-meaning-in-your-life-2017030811265 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg 2019-03-13 10:30:14 2019-03-13 14:30:14 Run for your (long) life http://meeto.raminosk.savana-hosting.cz/?big=blog/run-long-life-2017052411722 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg 2019-03-13 10:30:14 2019-03-13 14:30:14 https://hhp-blog.s3.amazonaws.com/2019/03/iStock-1086882540.jpg Marwa A. Ahmed, MD, MS
Just do it… yourself: At-home colorectal cancer screening http://meeto.raminosk.savana-hosting.cz/?big=blog/just-do-it-yourself-at-home-colorectal-cancer-screening-2019031216183 http://meeto.raminosk.savana-hosting.cz/?big=blog/just-do-it-yourself-at-home-colorectal-cancer-screening-2019031216183#comments Tue, 12 Mar 2019 14:30:21 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16183 Colonoscopy remains the best way to detect colorectal cancer, but there are at-home screening tests that do not involve the pre-test bowel clearing that many find uncomfortable.

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Colorectal cancer (CRC) is the fourth leading cause of death worldwide. Yet despite the ability of CRC screening to detect colon cancer early, and to find and remove potentially precancerous growths called polyps, screening rates remain low, below 60%. Experts generally agree that people should be screened for CRC at regular intervals beginning by age 50.

Colonoscopy is considered the gold standard for CRC screening. In this procedure, a doctor examines your entire colon through a colonoscope, a flexible tube outfitted with a small video camera and a light.

But concern around pre-colonoscopy bowel cleaning, which can be uncomfortable and unpleasant, may contribute to low screening rates. Your bowel needs to be completely empty during colonoscopy to give your doctor a clear view of your intestinal wall; preparing for the test involves drinking a liquid that triggers bowel-clearing diarrhea.

CRC screening tests: Other options

So, while colonoscopy remains the gold standard, the best test is the one that gets done or gets the process started. A recent meta-analysis found that fecal blood tests, which are available by prescription and can be done at home, are associated with increased screening rates. (Patients still need a colonoscopy if there is an abnormal result, to diagnose cancer or remove polyps to prevent cancer.)

In 2016, the United States Preventive Services Task Force updated its CRC screening recommendations to state that patients and physicians can choose among available screening tests.

Currently, three types of at-home CRC screening tests are approved by the Food and Drug Administration (FDA):

  • Guaiac FOBT (gFOBT) uses a chemical to detect a component of hemoglobin, a blood protein in the stool.
  • Fecal immunochemical test (FIT or iFOBT) uses antibodies to detect hemoglobin shed by polyps or colorectal cancer.
  • Multitarget stool DNA test (FIT-DNA) detects trace amounts of blood and DNA from cancer cells in the stool.

For all of these tests, you collect a stool sample at home using a kit, then mail the sample to a doctor or to a laboratory for testing. None require the bowel-clearing prep required for colonoscopy. Amazon sells screening tests: FOBT for $10 and FIT for $25. These are available without a prescription but are not as well studied or standardized as those available through your physician.

Pros and cons of at-home CRC screening tests

A review published in JAMA concludes that all three home tests may be an efficient first-step for low-risk patients. However, all the kits, as well as colonoscopy, can miss polyps, which can and should be removed at the time of the colonoscopy.

The FIT screening test has been in use for about 10 years. It should be repeated annually in case the cancer or polyp isn’t bleeding at the time of the test. (Colonoscopy is recommended once every 10 years for low-risk patients.) The FIT test detects cancer with 79% accuracy, with about 5% false positive results (suggesting cancer where none exists), which warrant a colonoscopy for further testing.

Studies have shown that the multitarget stool DNA test (Cologuard is currently the only FDA-approved brand) detects cancer with 92% accuracy. However, 14% of tests deliver a false positive result, which is higher than the FIT test. Health experts recommend repeating the test every one or three years.

For years we have used the gFOBT to detect microscopic amounts of blood in the stool that is not visible to the naked eye. It is less accurate than either the FIT or the DNA stool test, identifying only 20% to 50% of cancers. This test has a limited role today.

Cost considerations

An additional barrier to CRC screening is the out-of-pocket cost to patients. The Affordable Care Act mandated that insurance plans cover CRC screening tests, including colonoscopy, in full, with no out-of-pocket cost to patients. However, coverage does not apply to colonoscopies that convert from screening to diagnostic when a polyp is detected and removed during the procedure. And coverage does not apply to diagnostic colonoscopies after a positive CRC FIT or DNA screening test result.

This coverage failure means that patients may have to pay thousands of dollars to complete recommended CRC testing.

How can you decide which CRC screening test is right for you?

Ask your doctor and have a frank discussion about your risks and concerns. Most people find colonoscopy less miserable than they anticipate, and it is still the best option overall. Higher-risk people really do need a colonoscopy, usually until age 80. For others, get tested or get the screening process started, and the only wrong answer is ignoring the possibility of colon cancer.

The post Just do it… yourself: At-home colorectal cancer screening appeared first on Harvard Health Blog.

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http://meeto.raminosk.savana-hosting.cz/?big=blog/just-do-it-yourself-at-home-colorectal-cancer-screening-2019031216183/feed 1 16183 https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fjust-do-it-yourself-at-home-colorectal-cancer-screening-2019031216183 ]]> New blood test for colon cancer screening: Questions remain http://meeto.raminosk.savana-hosting.cz/?big=blog/questions-remain-new-blood-test-colon-cancer-screening-201607189994 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg 2019-03-12 10:30:21 2019-03-12 14:30:21 Colon cancer screening: Is there an easier, effective way? http://meeto.raminosk.savana-hosting.cz/?big=blog/colon-cancer-screening-is-there-an-easier-effective-way-2016120510751 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg 2019-03-12 10:30:21 2019-03-12 14:30:21 Cervical cancer screening update: Not your mother’s Pap smear http://meeto.raminosk.savana-hosting.cz/?big=blog/cervical-cancer-screening-update-not-mothers-pap-smear-2016120810824 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg 2019-03-12 10:30:21 2019-03-12 14:30:21 How to feel better about yourself if you are depressed http://meeto.raminosk.savana-hosting.cz/?big=blog/how-to-feel-better-about-yourself-if-you-are-depressed-2018101115022 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg 2019-03-12 10:30:21 2019-03-12 14:30:21 Give yourself an annual health self-assessment http://meeto.raminosk.savana-hosting.cz/?big=blog/give-yourself-an-annual-health-self-assessment-2018122815662 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg 2019-03-12 10:30:21 2019-03-12 14:30:21 https://hhp-blog.s3.amazonaws.com/2019/03/Colon-Cancer-tumor-Colorectal-canc-59883752.jpg James Richter, MD
Aging and sleep: Making changes for brain health http://meeto.raminosk.savana-hosting.cz/?big=blog/aging-and-sleep-making-changes-for-brain-health-2019031116147 http://meeto.raminosk.savana-hosting.cz/?big=blog/aging-and-sleep-making-changes-for-brain-health-2019031116147#comments Mon, 11 Mar 2019 14:30:37 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16147 Sleep is a necessity for everyone, but it’s especially important for older people to be aware of the changes in sleep patterns that accompany aging, and the effect that poor sleep can have on brain health.

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As a neuropsychologist, my research interests have focused on the link between sleep and cognitive health. As I have gotten older, I have personally come to appreciate the restorative power of a good night’s sleep for thinking, memory, and functioning at my best.

Sleep affects our overall health, including our hormones and immune system. Neurobiological processes that occur during sleep have a profound impact on brain health, and as a result, they influence mood, energy level, and cognitive fitness. Numerous studies have shown that structural and physiological changes that occur in the brain during sleep affect capacity for new learning, as well as the strength of memories formed during the day. Sleep promotes the consolidation of experiences and ideas; it plays a pivotal role in memory, and has been shown to enhance attention, problem solving, and creativity.

Specific sleep stages are associated with different types of learning

Over the course of each night sleep unfolds in five different cycles which alternate throughout the night. These include rapid eye movement (REM) and non-REM stages. REM is the stage when dreaming occurs. This stage of sleep is associated with active eye movements and body paralysis, which assures that a sleeping person is protected from acting out the dream. During REM there is increased activity in limbic structures involved in memory and emotional regulation, whereas there is less activity in frontal brain systems involved in analytic thinking. Fragments of events and memories experienced during the day may be combined in novel and often bizarre ways during REM-based dreaming. REM plays a pivotal role in memory and other cognitive functions. Other sleep stages are also associated with memory. For instance, stage 2 (slow wave) sleep promotes motor skill learning needed for activities such as playing an instrument or keyboarding.

Changing circadian rhythms and sleep disturbances are common

When we get older, we tend to feel sleepy earlier in the evening. This may result in waking up early in the morning as our sleeping hours shift. Older people have less REM and less slow wave sleep. Less slow wave sleep may impede memory consolidation in older adults. In addition to changes in sleep cycles, older people are increasingly vulnerable to sleep disturbances that cause poor sleep and low brain oxygen such as sleep apnea, a medical condition characterized by loud snoring, breathing pauses during sleep, and daytime fatigue. Research has shown that sleep apnea increases amyloid, a protein associated with Alzheimer’s disease. Poor sleep increases amyloid deposition and in turn, amyloid deposition compromises the quality of sleep. In fact, people with Alzheimer’s disease are prone to sleep problems, including insomnia at night and excessive sleeping during the day.

Aging well means prioritizing sleep

We know that a good night’s sleep is good for our brain, especially as we get older. But how do we do this? As a first step you should use a sleep diary to keep track of your sleep schedule for at least two weeks. This will provide objective information regarding the consistency of your sleep routine as well as the association between sleep and your level of alertness during the day.

Recommendations from sleep experts such as Dr. Suzanne Bertisch provide a road map for improving sleep hygiene. The following tips are highlighted:

Consistency matters. Train your body to sleep well by going to bed and getting up around the same time each day (even on weekends).

Only sleep when you are sleepy. Do not spend too much time awake in bed.

Pay attention to your sleep environment. Your bed should be comfortable. The room should be sufficiently dark and quiet. Some people use eye masks to block light. Some use white noise filters or ear plugs when there is noise in or near the bedroom. The temperature of your bedroom should be cool. A cool room with warm blankets is optimal for a good night’s sleep.

Reserve your bed for sleep (and sex). Avoid television, reading, or work activities while in bed.

Avoid (or limit) naps. You need to be tired at bedtime. If you need a daytime nap, do this before 3 PM and for less than one hour.

Avoid stimulants (coffee, cola, chocolate, and cigarettes) for four to six hours before going to bed.

Limit alcohol intake for four to six hours before going to bed. Alcohol disrupts REM and slow wave sleep, which are important for memory.

Avoid electronic devices with LED screens for at least an hour prior to bedtime. The blue light that comes from these screens interferes with the brain’s natural sleep rhythms, and may trick your brain into thinking that it is daytime.

Use rituals. Some people enjoy a hot bath one to two hours before sleep. Others use stretching or mindfulness practices in preparation for sleep.

If you do wake during the night, don’t remain in bed struggling to fall back to sleep. Get up and do something that may increase sleepiness (like reading) for about 20 minutes, and then return to bed and try to initiate sleep.

Sleep is an important aspect of cognitive health, but it is not whole story. Further information regarding brain fitness can be obtained by reading our Special Health Report A Guide to Cognitive Fitness.

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Stretching: Less pain, other gains http://meeto.raminosk.savana-hosting.cz/?big=blog/stretching-less-pain-other-gains-2019030816168 http://meeto.raminosk.savana-hosting.cz/?big=blog/stretching-less-pain-other-gains-2019030816168#comments Fri, 08 Mar 2019 11:30:03 +0000 http://meeto.raminosk.savana-hosting.cz/?big=blog/?p=16168 Stay flexible by adding simple stretches to your day and fitness routine. Stretching aids balance and posture, and helps prevent pain and injury.

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As you get older, your toes may seem farther away. Stretching to reach them can take a lot more effort than it once did. But while it may be tempting to shrug and assume that losing flexibility is just a cost of aging, it’s nothing to take in stride. It can affect your balance and your posture. It can even make you more prone to chronic pain.

For example, tight hamstrings behind your knees can cause a pelvic misalignment that makes your lower back hurt. A lack of flexibility might also make you more prone to injury.

“In general, a lot of us have bad posture and poor range of motion,” says Dr. Lauren Elson, an instructor in physical medicine and rehabilitation at Harvard Medical School.

How can you improve flexibility?

The solution? Whether you’re an avid exerciser or spend most of your time sitting in front of a computer, stretching should be part of your weekly routine. While this may conjure images of complicated twists and contortions, the type of stretching you need may be as simple as taking periodic work breaks to lift your arms above your head and to perform some other easy movements.

“Stretching doesn’t have to be a particular program. It’s just getting out of the posture you spend a lot of time in, taking some deep breaths, and moving your joints through their full range,” says Dr. Elson.

Try the three main types of stretches described below to help improve flexibility. All are easy to incorporate into your day or week.

Stretches to combat a lack of movement

If you sit at a desk all day, you may be doing your posture a disservice. Many sedentary days can lead to neck and shoulder problems and tight muscles in the hips.

“Get out of your chair and move around for a few minutes every hour,” says Dr. Elson. Focus on stretches that move the neck, shoulders, and hips, in particular. Even simple movements — such as putting your arms above your head or squeezing your shoulders back while sitting at your desk — are helpful.

Also, pay attention to other potential trouble spots. For example, many women wear high heels every day, which can reduce the flexibility of their calves. Stretching the calves daily can help ensure that this does not become a problem.

Dynamic stretches before you exercise

In the past, experts recommended that people stretch thoroughly before exercise to limber up their joints. But this is no longer the case. Research has found that holding stretches for 30 seconds or more can actually reduce the power in your muscles, hindering your performance in the workout that follows.

Instead, try what experts refer to as dynamic stretches. These are movements that will warm you up without sapping your muscle strength. Dynamic stretches are simple movements that put your muscles and joints through a normal range of motion. Examples include rolling your shoulders, circling your arms up and around, or doing lunges from side to side. If you’re going to be running or playing tennis, you might want to focus on dynamic stretches that use movements similar to those you will be performing during your workout.

Static stretches after you exercise

“The best time to stretch for lengthening, for example if you’re trying to increase hamstring flexibility, is after a workout,” says Dr. Elson. This is the time to try your static stretches — those that hold your body in various stretching positions for a few seconds or more. Stretches should be held without bouncing, because bouncing can lead to injuries.

Choose the right level of challenge

How you stretch depends a lot on your basic level of mobility. Stretches can be done at varying degrees of intensity based on your fitness level. There are easier and more challenging versions of various stretches. Select the one that is appropriate for you.

Take cues from your body to determine the right level of challenge. When you stretch, you should feel the sensation in your muscle and not at the joint. “You shouldn’t feel joint pain when stretching. Rather, it should feel like lengthening of the muscle,” says Dr. Elson.

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