Biased research muddies the health harms of sugary drinks, researchers contend
From: http://www.webmd.com/diet/obesity/news/20161031/when-soda-makers-fund-studies-links-to-obesity-weaken?src=RSS_PUBLIC
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Have you noticed that when you go to a doctor’s office, the providers are on a computer or flipping through papers for much of the visit? Maybe they’re looking through your records, typing your history, filling out forms, or checking boxes from a questionnaire. Whatever it is, isn’t it kind of weird and awkward that you’re sitting there in person for an illness or an examination, and you are not the primary focus of attention?
In fact, you’re not imagining things, and it is weird and awkward. A recent study published in the Annals of Internal Medicine supports prior research in this area showing that a ridiculous amount of a doctor’s time is spent interfacing with a computer or on other administrative tasks, instead of with patients, even when the patient is right there in the room.
The researchers observed 57 physicians from four different specialties (family practice, internal medicine, cardiology, orthopedics) in four different states for a total of 430 hours. They were interested in learning precisely how doctors spend their time.
What they learned was that during office hours, half the time — a huge chunk — was allocated to desk work, like documentation in the electronic medical record (EMR), reviewing test results, handling medication requests, and filling out forms. What was remarkable was that even during office visits, doctors interacted with their patients for only half of the time; the rest was EMR and paperwork. As a matter of fact, for every hour of face-to-face patient time, another two hours were spent on desk work.
Notably, about 40% of the doctors observed in this study used documentation support, like voice recognition software or medical scribes, and they still got these results. Also notably, none of the primary care doctors had the luxury of documentation support. You can imagine that the family practice and internal medicine docs (like yours truly) spend even more time on desk work.
So, when you felt that your provider wasn’t paying attention to you for much of your recent visit, you were right. And you know what? We hate it, too.
It’s no revelation that physicians in all specialties are feeling increasingly bogged down with the desk work. But what does “desk work” mean? Well, let me tell you.
Let’s say you’re just in for a physical. During your 20 minutes, I have to catch up on anything that’s happened since your last visit, review and update your medications, listen to any current ailments that you’d like addressed, and answer your questions from the list you brought. I need to make sure I’m not missing anything you might be due for, like vaccinations, bone density, or cancer screening tests (Pap smears, mammograms, colonoscopies). We may need to discuss screening for sexually transmitted diseases, and birth control. I may also need to review your specialists’ notes and recommendations. I have to examine you, which can include paying special attention to your areas of complaints, like that rash, or a swollen knee. I need to note any previous abnormal test results, then discuss and order labs. For these and any other tests, I have to fuss with our high-tech electronic system to match an acceptable diagnosis with the order, or your insurance may not pay. Before you leave I need to make sure you understand any new prescriptions or treatment plans, and that you’re all set with your medication refills. Often, people also bring forms they need filled out, like those work health status checklists, family medical leave paperwork, or preoperative requirements.
After your visit, I need to follow up on your test results and report them to you. I know that if there is something abnormal you’d rather hear it from me, and personally, I’d rather be the one to call you. But I have to allocate things like high cholesterol and osteopenia (reduced bone density) to my nurse. I try to speak to patients directly about positive tests for sexually transmitted infections or other potentially unsettling results. Regardless, I type up the lab interpretation and plan and send it to you in writing.
If we referred you to a specialist and you’re having difficulty getting an appointment, I can sometimes intervene and try to speed up the process. I’ll write to the specialist and explain the issue, which involves reviewing your chart and summarizing the issue as concisely as possible. Or, more and more frequently, we’ll make it an “electronic consult,” where the specialist relies on my history, exam, and testing, reviews your case, and provides guidance on your issue to me directly, without seeing you. Then, I need to follow up on his or her recommendations and communicate everything to you.
Often insurance creates major tangles and snafus. For example, it can require an unbelievable amount of time and effort to have an MRI or a sleep study approved, never mind replace a broken CPAP machine (I have a good story on that!) And I haven’t even mentioned school physicals, letters of medical necessity, and disability forms. I could go on and on, and I have.
No, I’m not leaving primary care anytime soon. But I do want patients to understand that yes, we do spend an inordinate amount of time not paying direct attention to them, and yes, we hate it too.
The post Physicians, paperwork, and paying attention to patients appeared first on Harvard Health Blog.
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My Shih Tzu, Latte, is like a therapist, personal trainer, and primary care physician all wrapped up into 10 pounds of white fluffiness. When you are bedridden with a cold, she never leaves your side until you are well. When you have a bad day, she is there with a comforting look that says, “Everything is going to be okay.” At 5 p.m., she reminds you that you’ve sat for too long and need to take her for a walk.
It turns out that Latte is doing what most animals naturally do with humans: provide comfort and support.
This type of therapeutic interaction even has a scientific name — animal-assisted therapy (AAT) — and research has shown it helps with a variety of emotional issues like depression, anxiety, and grief.
“The great thing about animals is they don’t have a preconceived notion of people,” says Dr. Henry Feldman, of the Division of General Internal Medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. “They provide unconditional love, which encourages interaction and helps people feel more confident.”
Animal-assisted therapy involves interacting regularly with animals for a set time over weeks or months. The get-togethers usually involve dogs and cats in either individual or group settings, and consist of everything from petting to giving treats to just sitting together.
What happens when you interact with animals? Researchers speculate that levels of oxytocin, the “love hormone” that encourages bonding, often increase, as does the production of serotonin, the feel-good brain chemical.
Animal-assisted therapy is often used in retirement centers to help people with depression. A study in the June 2013 Anthrozoos found that patients with dementia living in residential care who received 11 weeks of dog-assisted therapy improved their depression scores compared with those who had human-only therapy.
Hospitals also use animal-assisted therapy for patients coping with stressful treatment and recovery. A study in the January 2015 Journal of Community and Supportive Oncology explored how AAT — in this case therapy dogs — affected the well-being of cancer patients who underwent radiation therapy and chemotherapy. The patients received daily 15- to 20-minute animal visits for six weeks, and afterward reported a noticeable increase in their emotional well-being.
AAT is especially helpful for people healing after traumatic events like an accident, the death of a loved one, or catastrophes like the recent Pulse club shootings in Orlando. In fact, Orlando’s Trinity Lutheran Church coordinated with Chicago-based Lutheran Church Charities’ K-9 Comfort Dogs program to bring in golden retrievers to help with grief counseling for survivors, first responders, and volunteers.
Physicians usually “prescribe” animal-assisted therapy, but you may need to be proactive and inquire about AAT and how it may complement your treatment and needs. But you don’t need a prescription to tap into AAT’s feel-good effects. Pet ownership is one way, but if you are not ready for that responsibility, check with your local senior center about public animal therapy programs, or volunteer with community partners of animal therapy organizations like Pet Partners, Therapy Dogs International, and the Good Dog Foundation.
Another option: advertise your services as a local pet sitter or dog walker, or lend a hand to a pet-owning neighbor, friend, or family member. Or you could hang out with Latte for awhile. She would love it.
Learn more about the health benefits of canine companionship in the Harvard Medical School Special Health Report, Get Healthy, Get a Dog.
The post Talk to the animals: Animal-assisted therapy offers emotional support appeared first on Harvard Health Blog.
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As mindfulness meditation and yoga have become mainstream and more extensively studied, growing evidence suggests multiple psychological and physical benefits of these mindfulness exercises, as well as for similar practices like tai chi and qi gong.
Systematic reviews and meta-analyses analyzing hundreds of research studies suggest that mindfulness-based interventions help decrease anxiety, depression, stress, and pain, and help improve general health, mental health, and quality of life. These practices also appear to reduce inflammation and increase immune response.
As much as this intuitively makes sense, I’ve often wondered if simple rest and relaxation could be just as good for you. The few studies conducted suggest that vacation does result in real, albeit temporary, positive effects on health and well-being.
So when the editors at Harvard Health Publications suggested I take a look at a recent study comparing a mindfulness meditation and yoga retreat to regular vacation in terms of mental health as well as physical health outcomes, I agreed. This is interesting stuff.
The study was conducted at a resort in Southern California with 91 female volunteers who had no major health problems, were not pregnant, nor taking hormones or antidepressants. The mindfulness intervention was an established meditation and yoga retreat consisting of 12 hours of meditation, nine hours of yoga, and self-reflective exercises over a week. The participants were divided into three groups of about 30 each: experienced meditators, women who had never meditated, and a group who simply “went on vacation.” The 30 “vacation participants” listened to health lectures and then did fun outdoor things for a week.
At the end, all three groups (vacation, novice, and regular meditators) showed statistically significant improvements in scores of stress and depression, which were measured using well-established and commonly used questionnaires. If we stop there, it seems that vacation is just as good as mindfulness exercises for stress reduction and mood lifting.
But what’s really striking are the result from 10 months later: the regular meditators still showed significant improvements on these scores, the novice meditators even more so. However, the vacationers were back to baseline. The researchers had ensured that all three groups were equal in average age, education level, employment status, and body mass index. This finding is in keeping with prior research showing that vacation has beneficial but very temporary effects, and that mindfulness therapies have sustained beneficial effects.
These researchers also took blood samples just before and after the weeklong study period. All three groups showed significant positive changes in the markers of immune function. However, regular meditators also showed additional, more interesting changes. I got in touch with study author Eric Schadt, Ph.D., director of the Icahn Institute at Mount Sinai, who offered this interpretation of the data:
“Regular meditators showed both the same types of ‘improvements’ at the molecular level as the others, but on top of that exhibited changes that were also associated with some aging/disease processes that also correlated with biomarkers of aging in a favorable direction. I think there is some suggestion there of improved healthy aging, so hopefully that motivates further study in this direction.”
He went on to explain that other factors that often go hand in hand with meditation (for example, exercise, diet, even exposure to incense) could help explain these improvements. “So that as well remains to be more fully resolved in future studies.”
The vacation study was fairly small and included only women, and the authors point out that more research in this area is needed. But the evidence that mindfulness exercises can result in long-lasting positive psychological effects, especially for people new to these experiences, is compelling. In addition, meditation and yoga can boost immunity, and regular practice seems to promote more complex genetic effects related to healthier aging.
The post Regular meditation more beneficial than vacation appeared first on Harvard Health Blog.
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