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Showing posts with label Healthy Living - The Huffington Post. Show all posts
Showing posts with label Healthy Living - The Huffington Post. Show all posts

Friday, 23 June 2017

13:06

2 New Studies Differ Over Effects Of Marijuana On Drivers






Two U.S. studies on the effects of marijuana on drivers in states where it is allowed for recreational use came to different conclusions about whether it increases risks behind the wheel.


A study by the American Journal of Public Health published on Thursday looked at motor vehicle fatalities and found no significant increase in Colorado and Washington State, where recreational marijuana use is legal, compared with eight states where it is not legal that have similar populations, vehicle ownership, and traffic laws. Alabama, Kentucky and Texas were among the states in the comparison group.


“Our study focused on deaths and actually found what we expected going into this,” Jason Adedoyte, lead author of the study said in a telephone interview. Adedoyte is a trauma surgeon at Dell Seton Medical Center at the University of Texas at Austin.


“Back in 2012 some argued that people would ride around in their cars crash and die. Our study proved that isn’t true,” he said.


The American Journal of Public Health examined data from 2009 to 2015 taken from the U.S. Fatality Analysis Reporting System.


In another study published on Wednesday, the Highway Loss Data Institute analyzed the frequency of car insurance collision claims in Washington, Colorado and Oregon, where recreational marijuana is also permitted.


It found a 3 percent increase in collision claims in those states compared with Wyoming, Idaho and Nevada, where it is not legal.


“In states that passed legislation approving the recreational use of marijuana, the data showed that there was a strong indicator that marijuana was a factor in considering the rise of claims,” Matt Moore, senior vice president of The Highway Loss Data Institute, said in a telephone interview.


The Institute examined about 2.5 million insurance collision claims from January 2012 and October 2016.


Mason Tvert, communication director of the Washington, D.C.-based Marijuana Policy Project, a pro-legalization group, questioned the methodology of the Institute’s study.


“There’s no clear evidence that marijuana is a factor. It’s going to take several years and studies before we can determine that,” he said in a telephone interview.


The Institute’s Moore defended its approach, saying, “We looked at the correlation of states with similar insurance claim frequencies, and the states we chose had the highest correlation.”


Federal law prohibits recreational use of marijuana in the country, however, it has been approved by eight states including Maine, Massachusetts, Colorado, Washington, Alaska, Oregon, California, Nevada and the District of Columbia.


 


(Reporting by Taylor T. Harris in New York; Editing by Frank McGurty)

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12:21

What Not To Say To Someone With Cancer, In One Comic

As if having cancer isn’t awful enough, many of the things people say ― however well-meaning ― can really sting.


Most friends and family are likely coming from a good place when they offer their sympathy or advice to someone with the disease. But as artist Matthew Mewhorter, who dealt with cancer himself, points out, these platitudes often don’t have their intended effect.


“I don’t want them to feel pity or guilt, but just be better informed,” he told HuffPost. “There’s so much misinformation about the cancer experience in the media and Hollywood, which has a negative effect on the way cancer [patients] are treated in real life.”


Mewhorter summed up the emotionally taxing experience of dealing with people trying to cheer up cancer patients in the comic below:



Mewhorter, who has been in remission for two years following a stage II rectal cancer diagnosis, channeled his experiences with the illness into his artwork. He created a series of comics like the one above called Cancer Owl, which details the everyday realities of living with and fighting the condition. He draws both his own stories and the stories of others who reach out to him.


“My therapist originally proposed that I art journal my experience and share it with others as a form of self care,” Mewhorter said. “I started drawing an owl with cancer in my hospital bed after my first surgery, and it just felt right. Drawing cute animals with bright colors made talking about cancer easier somehow.”


It’s estimated that more than 1.5 million people were affected by cancer in 2016. Mewhorter hopes his artwork helps people dealing with the condition to find some relief and community through humor about their illness.


“I hope it helps cancer patients and survivors not feel so alone,” he said. “I hope they feel permission to laugh in the middle of their situation, and consider a perspective that has given me vitality and hope in the midst of suffering.”


Head over to Cancer Owl to see more of Mewhorter’s comics.

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10:36

Prince Harry Perfectly Explains What Panic Attacks Feel Like


Does this sound familiar?


In a recent interview with Forces TV, a U.K. Army channel, Prince Harry opened up about his experience with panic attacks, giving an honest description of what it’s like to deal with this mental health issue.


“In my case, every single time I was in any room with loads of people, which is quite often, I was just pouring with sweat, my heart beating ― boom, boom, boom, boom ― literally, just like a washing machine,” he said.


Harry also said that his fight or flight stress responses would kick into gear, but he couldn’t act on them.


“I was like, ‘Oh my God, get me out of here now. Oh, hang on, I can’t get out of here, I have got to just hide it,’” he explained.


The prince’s account will ring true to the millions of Americans who deal with anxiety and panic disorders. They’re debilitating and they often appear without warning.


Panic episodes cause immediate and increased stress in a person who experiences them. They can lead to shortness of breath, feeling intense fear, an accelerated heart rate, nausea and more. Sometimes they’re triggered by a certain event but others happen for no apparent reason.


Harry’s candor is in keeping with his longtime advocacy for mental health. Along with the Duke and Duchess of Cambridge, the prince created the anti-stigma initiative Heads Together. He is particularly close to military and veteran mental health, often speaking with armed forces about post-traumatic stress disorder ― an issue that affects 8 million adults in a given year. 


Earlier this year he also discussed how not processing his grief over his mother’s death affected his mental wellbeing over time. He admitted to the Telegraph’s Bryony Gordon that he saw a mental health professional at the age of 28 after multiple years of “total chaos.”


Experts overwhelmingly support this kind of move: Mental health treatment can help people manage their conditions. Not only that, research suggests talking to a therapist can positively rewire the brain.


In the Forces TV interview, Harry stressed how common mental health conditions are and encouraged other people struggling with them to seek support.


Rather than running around at 50 percent capacity, imagine if we could run around at 100 percent capacity,” he said. “Imagine what we could achieve.”







H/T The Daily Beast

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07:36

Bernie Sanders: Thousands Of Americans Will Die Because Of 'Barbaric' Trumpcare Plan




Sen. Bernie Sanders (I-Vt.) slammed Senate Republicans’ bill to repeal Obamacare as a “barbaric” plan that means thousands will die so the wealthy can get billions of dollars in tax breaks.


CNN’s Anderson Cooper asked Sanders about his statement Thursday that the Republican health care plan is the “most harmful piece of legislation” he’s seen in his lifetime.


“It is an extraordinary statement because this is an extraordinary piece of legislation,” Sanders replied. “If you throw 23 million people off of health insurance, if you cut Medicaid by over $800 billion dollars, there is no question but that thousands of Americans will die.”


Sanders added, “The purpose of this whole legislation — of raising premiums for older workers, of defunding Planned Parenthood ...  is to provide $500 billion in tax breaks for the top 2 percent, for the insurance companies, for the drug companies and other major corporations.”


“This is barbaric,” he said. “Frankly, this is what oligarchy is all about. It’s the wealthy and powerful saying, ‘We need even more tax breaks’ — despite the fact that they’re doing phenomenally well — and if it means people in America dying ... ‘Hey, that’s not our problem.’”


Sanders acknowledged that premiums, deductibles and copays are currently “too high” under the Affordable Care Act, also known as Obamacare. (The Senate’s Trumpcare proposal isn’t expected to lower deductibles.) But he added that prices are rising because the Trump administration is “sabotaging” Obamacare, and the system will not be improved by ejecting millions who rely on it, including children.


“I don’t care what your political view is,” Sanders said. “I don’t think there are many Americans who think that we give unbelievably large tax breaks to billionaires, and then tell disabled kids or people who are in nursing homes today ... that we’re going to punish them to give tax breaks to billionaires. Man, that is not what this country is supposed to be about.”


To hear more from Sanders, watch the video above.


type=type=RelatedArticlesblockTitle=Related Coverage + articlesList=59398ad3e4b0c5a35c9d4c9c,594c1f52e4b05c37bb753c04

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07:36

The Funniest Tweets From Parents This Week

Kids may say the darndest things, but parents tweet about them in the funniest ways. So each week, we round up the most hilarious 140-character quips from moms and dads to spread the joy. Scroll down to read the latest batch and follow @HuffPostParents on Twitter for more!

























































































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07:36

How Embracing Vulnerability Strengthens Our Relationships


Science has revealed a long list of complex reasons why social connections benefit our mental and physical health. Having relationships and support can lead to longer lives, healthier habits, reduced symptoms of stress, and a sense of meaning. Most of us have personally experienced these rewards and don’t need a study to tell us why our relationships matter. However, despite our bent toward connection, we all hold certain patterns and beliefs that can lead us to resist the intimacy and vulnerability that are essential to, not only sustaining these connections, but fully experiencing their many benefits.


Humans are naturally a social species.  While most of us think we want close connections, we resist vulnerability, the very trait that makes that connection possible. In a culture that often praises having a thick skin and staying strong and self-contained, we mistakenly brush off being vulnerable as weak. We believe it will unnecessarily expose us to hurts and humiliations we could easily avoid. Yet, what vulnerability is really about is the willingness to truly be ourselves – to expose a softer side of ourselves that is not hidden behind our defenses.  As researcher Brene Brown put it, “Vulnerability is about having the courage to show up and be seen.” 


Our reasons for avoiding being vulnerable are deeply personal and specific to our unique experience. They often tie back to very early in our lives. Children are keen observers. We learned how to relate from our earliest relationships. We absorbed how our parents saw and treated us, themselves, and others. Limitations in our environment or ruptures in our childhood relationships gave us a model for how we now see ourselves and the world around us. For example, if we had a rejecting or neglectful parent, we may see ourselves as a burden or intrusion. If we had a parent who was critical or flew off the handle, we may walk on eggshells and keep to ourselves. Whatever the circumstance, the message most of us internalize is that “it’s not okay to just be me.” We grew up believing, to varying degrees, that something about us is flawed or shameful. As a result, we expect that we won’t be accepted, and that others will fail us. We try to protect ourselves by keeping our guard up.


The patterns of relating that surround us at an early age not only serve as a model for how we expect the world to work, but they teach us to defend ourselves in ways that, although adaptive in childhood, hurt us in our adult life. Originally, we developed our defenses to protect ourselves when we were dependent and helpless and felt overwhelmed by the hurt of being rejected, ignored, or not getting our needs met. But ultimately, our defenses lead us astray, because as adults we can tolerate pain and frustration. Being defended and unwilling to be vulnerable hurts our connections to others.


My father, Dr. Robert Firestone, often refers to the inner dialogue that personifies these psychological defenses as our “critical inner voice.” The critical inner voice is a destructive thought process that acts like an internal parent and tends to assess, judge, undermine, and insult us as we move through our lives. “Don’t show her who you really are. She’d want nothing to do with you,” it warns.  “You’re going to make a fool of yourself. Don’t put yourself out there,” it beckons. This “voice” reinforces old, negative beliefs about ourselves and leaves us feeling anxious or afraid of being an imposition on others. It tells us in a variety of ways that we are not acceptable. It also warns us not to trust others.  “He only wants to take advantage of you.” “She will never really love you. Keep your distance.” Basically, it does everything in its power to prevent us from being vulnerable and forming intimate connections with others.


Yet, our willingness to be vulnerable and tolerate intimacy matters much more than we think. A few years ago, researcher Brene Brown conducted thousands of interviews, and came to the conclusion that the key to connection is vulnerability. “There can be no intimacy—emotional intimacy, spiritual intimacy, physical intimacy—without vulnerability,” said Brown. “One of the reasons there is such an intimacy deficit today is because we don’t know how to be vulnerable. It’s about being honest with how we feel, about our fears, about what we need, and, asking for what we need. Vulnerability is glue that holds intimate relationships together. “


When we resist vulnerability, we’re listening to a “voice” that’s telling us we shouldn’t be a open, but in truth, we’re actually denying the people close to us by not allowing them to fully know us. We fear we will be hurt or rejected, but vulnerability actually draws people in. We’re doing ourselves and the other person a favor by being open. 


Many of us struggle with vulnerability because of fear, but we also fail to fully realize all of the ways we protect and distance ourselves from others. It may feel like we’re doing the right thing by keeping our mouths shut, when in fact, we should be doing just the opposite. Being vulnerable involves the following actions:


1.    Ask for what you need. When we’re hurting, it’s easy to dismiss our pain or try to protect ourselves and the people around us by closing off. Achieving close connections means being willing to speak up when we’re in need. Admitting that we need someone to lean on or that we’re struggling and need help allows our loved ones to feel for us and respond to us in ways that bring us closer.


2.    Be willing to expose your feelings.  Sometimes we are afraid to expose our feelings even to ourselves. But acknowledging and accepting our feelings is an important part of being in touch with ourselves and sharing ourselves with others. A big part of strengthening our connections involves being willing to communicate how we feel. 


3.    Say what you want. As a therapist, I’ve sat in a room with so many couples who are very good at stating exactly what they don’t like and don’t want from their partner. This leads to a lot of tit for tat and back and forth that gets them nowhere. Instead of blaming each other and complaining, I encourage couples to say what they want from their partner. It’s usually much harder for partners to do this. When they take a chance and try and get in touch with what they want and then say what they want, they often feel sadness from opening up and being vulnerable. Their voices and expressions soften. Much of the time, their partner no longer feels on the defense, and their body language changes, turning toward their partner and really feeling for the other person. It’s touching to see the connection people feel for each other when they’re strong enough to be vulnerable and say directly what they want.


4.    Express what you really think. In addition to expressing our wants and needs, it’s important to be honest about our point of view and showing our real selves. Our relationship should be a space in which we aren’t afraid to say what we truly think. This doesn’t mean being insensitive or unnecessarily hurtful, but it does mean offering an authentic exchange. We should be open to giving and receiving feedback without being overly defensive. Remembering that we are all human and flawed can help us have more self-compassion and interest as we engage in more honest exchanges. 


5.    Slow down and be present. Part of vulnerability is being willing to be in the moment with someone else. When we listen to our critical inner voice or spend a lot of time in our heads, we can miss out on intimacy. Looking our partner in the eye, listening to what they have to say, and being willing to give time and attention to the moment are acts of vulnerability that are often harder to do than we imagine. Yet, engaging in each of these behaviors keeps us closer to one another and to our own feelings.


It’s surprising just how anxious being vulnerable can make us. Many of us have deep, even unconscious fears of intimacy. There is real sadness and fear around allowing another person to really know us and to feel close to that person emotionally. Both intimacy and vulnerability challenge us to give up an old, familiar identity and form a new conception of ourselves in which we believe that we’ll be accepted for who we are. However, staying vulnerable helps us consistently recognize our value as a unique and independent human being, while giving us the courage to reveal ourselves in ways that will strengthen our connections.

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Thursday, 22 June 2017

19:41

The Medical Emergency Of Otto Warmbier

All that the doctors who treated Cincinnati, Ohio resident Otto Warmbier knew is what they had seen or maybe read in the news. They knew he had just been released on June 13 from imprisonment in North Korea where he had been held by for more than 17 months. He had been sentenced in March 2016 to 15 years of hard labor for allegedly removing a propaganda poster from a wall at a Pyongyang hotel where he had been staying. The University of Virginia honors student had been visiting the authoritarian state during a five-day trip with a group called Young Pioneer Tours, which is a group out of China – an important note.


Otto Warmbier’s ordeal began on Jan. 2, 2016 when he was removed from a flight that was about to leave Pyongyang, the capital of North Korea, by two North Korean officials who explained that he was very sick and needed to go to a hospital. He was not sick and did not need to go to a hospital. He had just been arrested for allegedly trying to steal that poster.



Most of us have seen the video by now of Otto Warmbier in captivity from March 2016 – just a couple months after he was removed from the flight – he was alert and made a confessional statement in front of media cameras, where he pleaded for leniency and then broke down crying. In another video clip, we see him paraded before cameras being roughly escorted by two North Korean soldiers who had tight grips on each of his arms, his head bowed, his feet shuffling.


Then came the news well over a year later that through various means of diplomacy, he was being released to go back home to Cincinnati, but that he was in a coma and had been for most of his time in captivity. The explanation from the North Koreans? He had contracted botulism and had taken a sleeping pill.


Medically, that was pretty much the extent of what we knew about Otto Warmbier. Now, imagine you’re the doctor receiving this patient. You have no medical records, no tests whatsoever, no way of knowing what really happened. Not even the family can help – they, too, have no way of knowing what really happened. Where do you begin? How do you play medical detective to determine the extent of the damage done to Otto Warmbier’s body and what exactly caused it? And can you find a way to help him recover?


You begin with the basics, just like anyone coming into any emergency department in America. You take vital signs – respiratory rate, pulse, blood pressure, temperature, pupil responsiveness, general responsiveness to physical and verbal stimulation. You establish an I.V. to support him with fluids and as a way to administer any medications he may need.


You begin testing. You take blood for a variety of reasons – a CBC (complete blood count) to be sure, which will give a great deal of information regarding the kinds and numbers of cells in the blood – red blood cells, white blood cells, platelets, leukocyte count, etc. – which give an indication of anemia, infection, blood disorders or diseases, and a host of other things. Something to look for immediately is blood sugar level.


Then you begin with scans. And in Otto Warmbier’s case, I would do a complete work up – from X-Rays to CT scans and eventually MRIs, a bone scan and thyroid scan. I would leave no stone unturned. Then there’s something that medical personnel refer to as A-E-I-O-U TIPS. It’s a mnemonic device we use to remember the protocol for examining someone who exhibits altered mental state, like Otto Warmbier’s. Let’s take a look at each letter individually to see what needs to be covered:



  • AAlcoholism, Abuse of substances, Acidosis. You never know what someone like Otto Warmbier might have been subject to while in captivity, especially in a place like North Korea. You check for alcohol or drug intoxication, diabetic ketoacidosis, hypoventilation due to COPD, asthmatic airway obstruction, or neuromuscular disease.

  • E – Environmental; was there an issue with hypothermia or hyperthermia or evidence of any other sort of environmental issue? Epilepsy; what about an epileptic seizure or a seizure of any kind for any reason? Electrolytes; what is Otto’s balance like – any hyponatremia or hypernatremia, hypocalcemia or hypercalcemia? I’d check for encephalopathy; either Wernicke’s (exhaustion of B vitamins, especially B1, which could lead to neurological symptoms) or Chronic Traumatic Encephalopathy (CTE – which is a degenerative condition found in those who have had repeated blows to the head). Also endocrine disease, where I’d look for adrenal insufficiency or thyroid disease.

  • I – Infection. Sepsis, for sure, meningitis, and a host of other possible infections that could cause a comatose state.

  • OOverdose of any sort of drug – like more than one sleeping pill. Also, oxygen deficiency, which is what the doctors treating him suspect. That there was a period of time that his brain was deprived of oxygen, causing brain tissue to die and Otto’s lapse into an unresponsive conscious state.

  • UUnderdose; not enough prescription meds to control a condition. I’d also look for uremia, which is excess urea in the blood as a result of kidney failure or heart failure.

  • TTrauma; and it would just be my medical inclination, but I’d be very suspicious of this – is there any evidence of a concussion or traumatic brain injury, or increased cranial pressure? Tumor; unlikely in Otto’s case, but you never know. You have to rule it out.

  • IInsulin; what are the levels? Any issues with hyperglycemia or hypoglycemia?

  • PPoisonings; any evidence of any sort regarding this? Any evidence of nerve agents of any sort, like sarin, for example. People who receive a dose of sarin that doesn’t kill them can ultimately suffer permanent neurological damage. Is there a possibility of psychogenic issues? The emotional and mental stress of sudden captivity in harsh conditions could manifest in physical illnesses.

  • SShock; a spinal cord injury could cause neurogenic shock. Also, one could suffer cardiogenic shock caused by a heart attack in which there is insufficient circulation and therefore oxygenation of tissues, which could permanently affect the brain. And there’s always the possibility of a stroke, given the conditions of captivity.


The doctors who treated Otto Warmbier described him as having a “severe neurological injury” and that he was in a state of “unresponsive wakefulness.” They also said he had extensive loss of brain tissue. In a statement from his family, they said Otto was “unable to speak, unable to see and unable to react to verbal commands” when he returned to the U.S. He was in bad shape.


Sadly, just six days after his June 13 release from captivity in North Korea, he died. As you can see going through the A-E-I-O-U TIPS scenarios, there are so many paths to explore to get to the bottom of what happened to Otto Warmbier and what caused his death. Even after extensive testing, often nothing definitive emerges. Rest assured, his doctors did everything they possibly could to give him a chance to recover. But the sad truth is that it’s likely we may never know what caused his condition or his death.


_________________________________________________________________


To learn more about Dr. Sudip Bose, MD, please go to SudipBose.com and visit his nonprofit TheBattleContinues.org where 100% of donations go directly to injured veterans.

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17:16

For Seniors, Senate Health Care Bill Is Even Worse Than The House Version






The Senate health care bill released Thursday closely mirrors what the House narrowly approved in May. Some analysts called it a tempered version of the House bill  ― which President Donald Trump called “mean.” But it nevertheless puts vulnerable seniors smack in its crosshairs, according to advocates for elderly people.


“Actually, the Senate bill is even meaner” than the House bill, Howard Bedlin, vice president for public policy and advocacy for the National Council on Aging, said in a phone interview.


Bedlin cited the Medicaid cuts and per-capita caps that would harm elderly people who rely on the program to pay for their long-term care. The Senate didn’t stop the weakening of the Medicare Trust Fund that will result from the repeal of the payroll tax on wealthy Americans, nor did it change the so-called age tax that would dramatically increase out-of-pocket costs for older Americans in the form of higher premiums.


“Over time, the Senate bill imposes even deeper cuts and caps on Medicaid than the House proposal,” Bedlin said.


Here are a few reasons why the Senate measure is worse for seniors than what the House passed:


The Senate imposes deeper cuts to Medicaid, which pays for 65 percent of nursing home residents. 


Medicare, the health care system for people 65 and older, does not pay for long-term nursing home stays. Most people enter a nursing home as a private-pay patient until they exhaust enough of their assets to qualify for Medicaid. For every $1 Medicaid spends on a poor child, it spends $5 for an elderly person in a nursing home.


Medicaid is the primary support for 65 percent of nursing home residents. It is literally the last resort for affording nursing homes, which easily can cost upward of $80,000 a year. 



Under Obamacare, everyone who qualified for Medicaid ― of any age ― was guaranteed to get it. That would change under the GOP’s plan. The House bill would let states decide who gets their health care needs met by Medicaid, and shrinks the total pot by a draconian $880 billion by 2026.


The Senate bill follows that same course ― states would receive a lump sum per year, or a lump sum per enrollee, that would function as caps. But the Senate bill makes even deeper cuts to the program by tying federal spending to a slower growth index. The House measure tied it to medical inflation.


Under the House bill, the federal spending can increase only up to 4.7 percent each year (the Medical Consumer Price Index, plus 1 percent).  Under the Senate bill, it can rise up to this same rate until 2025, when the capped growth rate drops forever to 2.4 percent (the Consumer Price Index), explained Bedlin.


The Senate bill also slows the introduction of these Medicaid cuts, pushing the deepest wounds to the elderly into the future. The changes won’t fully kick in for seven years, which of course is long after the next Senate election. But make no mistake, said advocates for the elderly: When these changes to Medicaid fully kick in, they will pack a wallop.






 



The bipartisan Congressional Budget Office projected 14 million fewer people would receive Medicaid over the next 10 years under the House bill, and the Senate bill may mean an even higher number losing this coverage. The CBO isn’t expected to score the Senate bill until next week, but the number of people who would no longer get Medicaid help is an important one to watch. People aged 85 and over are the ones most likely to need expensive long-term care, and Baby Boomers will be turning 80 at right about the same time the full impact of the Medicaid cuts and caps kick in.


“Because the proposed caps do not adjust for an aging population, the nation’s oldest and most vulnerable seniors will be hit the hardest,” predicted Bedlin. 



If Medicaid were to stop paying for nursing homes, there is nothing ― and no one ― else that would. The likely outcome here is that the ranks of family caregivers would swell


Medicare’s troubles will worsen, despite promises.


The Senate bill repeals the payroll tax on wealthy Americans ― a tax cut for the rich that is expected to hasten the insolvency of the Medicare Trust Fund by about two years ― moving it from 2028 to 2026.


While the Senate version closely matches what the House measure did in this regard, GOP senators fell short of their promises to protect Medicare benefits for future generations.


“The Senate bill also cuts funding for Medicare which weakens the program’s ability to pay benefits and leaves the door wide open to benefit cuts and Medicare vouchers,” said AARP executive vice president Nancy LeaMond. 


The age tax remains, and subsidies will be weakened.



Medicare kicks in at age 65. Those who are in their 50s and early 60s are too young to be eligible for Medicare and too old to be considered young and healthy, which makes them less attractive to private insurers. Older people are more prone to illness and require more medical care than younger age groups.




Under the current Affordable Care Act, the most an insurance company can charge an older person for premiums is three times whatever younger people are being charged. Under the GOP House bill, that ceiling jumps from three times to five times, and significantly reduces tax credits that help lower- and modest-income adults pay for coverage. The House bill includes a tax credit that maxes out at $4,000 ― far less than it does under the current law. 




The Senate bill closely mirrors the Obamacare subsidies, which are currently available to those who earn between 100 percent and 400 percent of the federal poverty level. Under the Senate bill, starting in 2020 this assistance would be capped for those earning up to 350 percent of poverty level, with adults aged 59 to 64 paying up to 16.2 percent of their income. 


The CBO has predicted that older people with lower incomes will likely opt out of buying coverage for themselves because the legislation allows insurers to charge them higher rates than they do now ― and the financial assistance provided doesn’t sufficiently offset that.


Advocates for elderly people commended the Senate for not allowing states to opt out of key protections for patients with preexisting conditions. But they said the devil lives in the details.


Josie Kalipeni, policy director for Caring Across Generations, noted that the Senate measure ”allows states to deny coverage for essential services like ambulance rides or prescription drugs” at the same time it raises costs.





Senate leadership has said it wants to vote on the bill by July 4. 



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15:01

What The Senate GOP Health Bill Will Mean For Opioid Treatment






After weeks of closed door meetings lead by Senate Majority Leader Mitch McConnell, Republicans unveiled a discussion draft of the Senate’s health care replacement bill on Thursday.


Although the draft was billed as a fresh overhaul of health care, it’s not much different than the House bill that passed last month, which the Congressional Budget Office reported would leave 23 million Americans without insurance by 2026. The CBO tweeted that it plans to release its evaluation for the Senate health care plan early next week.


The draft proposed eliminating most of the taxes the Affordable Care Act imposed on businesses and wealthy Americans, limiting tax credits for middle-income individuals who buy insurance and defunding Planned Parenthood for at least one year. It also called for phasing out the ACA’s Medicaid expansion, which has allowed millions of uninsured people to get coverage. The new bill would also nix the open-ended guarantee of federal funding to states and instead give states pre-determined lump sums per state or per person enrolled. The Republican proposal also makes it easier for states to waive essential benefit requirements for health care services such as mental health and addiction coverage.


Should the bill pass in its current form, funding for opioid and addiction treatment would plummet.


Dramatic Medicaid cuts could spell trouble for opioid treatment options, given that around 1.3 million Americans are currently receiving Medicaid-funded mental health and addiction treatment, according to Harvard and New York University researchers.


Repealing Medicaid expansion would deplete behavioral health coverage, which includes opioid addiction coverage, by $4.5 billion, the researchers report.


The Senate draft did include $2 billion for grants “to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders” in 2018.


But it’s not clear exactly what kind of treatment would fall into those categories. 


Moreover, the $2 billion is far short of the $4.5 billion expected to be lost by repealing Medicaid expansion.


 






A one time fund of $2 billion for addiction and mental health treatment “is pocket change” Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University told HuffPost.


“Medicaid spends more than twice that every single year so this is a massive cut to services and will likely lead to more opioid overdose deaths,” Humphreys said.


As it stands, overdoses are the leading cause of death for Americans under the age of 50.


And since addiction is a multifaceted disease, treatment and recovery are often more complicated than getting an individual to simply stop using opioids. 


“One of the things we’ve seen over and over again is that when you give people supplemental services around addiction treatment — you take care of their pain, you take care of their depression, you take care of their unmanaged hepatitis C, they’re more likely to recover,” Humphreys told Stat News.


“It’s sort of like saying we’re going to treat somebody’s pancreas but not touch the rest of them. It’s really hard to do that with people,” he added. “Things tend to be interconnected.”



Congress debates the fate of funding for opioid treatment


Still, as Russell Berman noted in the Atlantic, since Senate budget rules include a “vote-a-rama” session in which both parties can offer amendments, it’s possible that the low-level opioid grants in McConnell’s draft are meant to change. Giving senators like Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.), who previously advocated for $45 billion over 10 years to fight the opioid epidemic, ownership over opioid-related amendments. The additions could make them more likely to vote for the ultimate bill because they’d get credit for those improvements. 


Republicans argued their health care legislation would directly address the opioid crisis with $2 billion in grants for substance abuse treatment. But when asked whether that money would adequately offset their bill’s deep cuts to Medicaid, GOP senators said the $2 billion was merely an opening salvo. 



I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.
Rob Portman (R-Ohio)


“It starts a segregated fund of $2 billion that can be renewed annually and likely will be increased over time,” Sen. Tim Scott (R-S.C.) told HuffPost on Thursday. “I think it starts the conversation in that direction.” 


“There’s more that we’ll be doing about opioids,” added Sen. Pat Toomey (R-Pa.). 


Sen. John McCain (R-Ariz.) suggested that the crisis needed to be addressed separately.


“That problem is very deep-seated obviously,” he said. “Opioids is a big enough issue that by itself it needs to be addressed.”


Portman on Thursday said that he was still reviewing the bill. But he specifically cited its effect on opioid treatment as a key concern about the legislation.


“I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic,” he said in a statement.


On the other side of the aisle, Democrats assailed Republicans for including a fraction of the needed funding meant to address the crisis. 


“Lives will be put at risk because of this heartless, cruel measure,” Sen. Richard Blumenthal (D-Conn.) said in a speech on the floor of the Senate.


There’s no end in sight for the nation’s growing opioid crisis


According to a New York Times Upshot analysis published earlier this month, the opioid epidemic continues to worsen: Drug overdose deaths are projected to exceed 59,000 for 2016, a 19 percent increase from the previous year ― the largest such increase in recorded U.S. history.


Overdoses aren’t the only negative health outcome linked to opioids, either. Complications can include mental health problems, respiratory suppression and infection from intravenous drug use, all of which drive up opioid-related hospitalizations.


Between 2005 and 2014, emergency room visits linked to opioid use rose 99 percent and inpatient stays increased 64 percent, a report published this week by the Agency for Healthcare Research and Quality found.


That rise resulted in more than 1.27 million hospitalizations due to opioid-related complications in 2014.


McConnell wants senators to vote on the bill next week.


“McConnell is rushing a healthcare bill to the Senate floor that will threaten millions of lives by heartlessly cutting life-saving opioid treatment,” Grant Smith, deputy director of national affairs with the Drug Policy Alliance said in a statement on Thursday.


“We know that yanking away health care from people who struggle with addiction dramatically increases relapse and overdose rates,” he added. “We know that any rollback of the Medicaid expansion will profoundly exacerbate the opioid crisis.”

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14:06

A Heroin Addict’s Appeal To President Trump


I didn’t vote for you. You see, I was born with a brain injury. Doctors at Children’s Hospital in Boston told my parents I would never be able to walk normally.


Young children are mean. As a young boy, insults, and laughs became a daily ritual. When I walked into a classroom, a restaurant, or down a street, people didn’t look into my eyes. They always looked down as I limped awkwardly along.


But I overcame and became a varsity athlete at a prep school outside of Boston. As a teenager, I grew strong, and anybody that made fun of my limp or my awkward gate became irrelevant.


Frankly, Mr. President, the day you mocked a disabled reporter should have been the end of your presidential candidacy.


That said, I for one am all for giving you a chance to “Make America Great Again.” Mr. President, I implore you to focus more of your efforts on the heroin epidemic that is crushing the American dream in every state in the Union.


I understand that the stigma and moral issues of heroin addiction run deep. Today’s heroin epidemic parallels the AIDS epidemic of the 1980s. The old school philosophy back then was, “Men having sex with men. It’s not natural. That’s God’s punishment.”


Although the diction has changed, the sentiment remains constant today. “I didn’t force them to stick a needle of heroin into their arm. Why should I be forced to pay for their rehabilitation?”


But you see, we are not just junkies, Mr. President. I am three decades clean, have won the prestigious du-Pont-Columbia as a journalist, written a Bestseller, became a WGA screenwriter and worked on The Fighter, a feature film that won two Academy Awards.


I have spoken to organizations and recovery centers all across America. And what amazed me the most were the rooms were filled with middle-class kids whose fathers were chief’s of police, firefighters, teachers, lawyers, and doctors.


Heroin addiction is insidious: in several states across this country, young women are selling themselves as sex-slaves to maintain their daily heroin habit.


Just recently, NPR did a radio program about heroin addicts that are purposely committing crimes, so they’ll be arrested and locked up to get the treatment they need.


Treatment is just not available on the streets because there aren’t any beds available in recovery centers. The medical community could never have prepared for the onslaught of heroin in their neighborhoods.


Mr. President, this epidemic was given birth by Purdue Pharma and their owners, the Sackler family. In fact, the Sacklers became known as the Godfathers of OxyContin and rang in at number 19 on last year’s Forbes annual list of America’s richest families.


Through Purdue Pharma, the Sackler family acquired a fortune with the blood of young Americans. Although, a judge convicted Purdue Pharma’s top executives in Federal Court of knowingly and willfully misleading consumers, unfortunately, your old friend Rudy Giuliani’s law firm got them off with a sweetheart deal.


As President of the United States, you have an opportunity to save countless lives. Please consider creating a “sin tax” similar to the cigarette and alcohol tax levied by several states. If big Pharma wants to do business on the backs of the American consumers suffering from chronic pain, force them to pay a “recovery tax.”


Please consider creating a work program for heroin addicts that want help. A simple, we’ll pay for your thirty-day recovery hospital and continued care, and you’ll work cleaning up roads or run down areas of your community to pay for it.


Finally, why not designate a line on the IRS tax forms for people to donate a dollar or more to help put an end to the suffering brought on by the countless deaths of promising young men and woman.


Mr. President, you have a daunting task in front of you. But you can’t “Make America Great Again” by sitting back and watching 4,380 Americans die every month from an accidental overdose of heroin. That’s right, 144 people a day die from an accidental overdose of opioids.


I have an 11-year-old son that is on the brink of growing up in a society that will be the most dangerous environment in America’s history. You see, Mr. Trump, not since your predecessor, Lyndon Johnson, has the youth of America been more in jeopardy.


Think about it; not since the Vietnam War has a generation been at greater risk to die between the ages of 18 to 25. Please help them. An entire generation is on the verge of being wiped out.


Ritchie Farrell is the author of I AM A HEROIN ADDICT.


Follow Ritchie Farrell on Twitter: http://www.twitter.com/ritchiefarrell1


Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.


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13:51

The Challenge I Face Being A Parent To Children Both On Earth And In Heaven


It’s a busy morning as I race around the house, stashing piles of laundry and picking up week old cheerios that are scattered about. My daughter’s fourth birthday is approaching and company will soon be arriving, ready to celebrate our miracle child. As I search the couch crevices for lingering crumbs, my daughter grabs my attention from the other room. Next to her play kitchen, she quietly sits, assembling her pretend cake. I walk towards her and squat down, inquiring about her colorful wooden cake. “I’m practicing for my birthday! Let’s sing Mommy,” she exclaims. Right at that moment, a familiar feeling sweeps over me; one of pure joy, mixed with pain and heartache. As the tears quickly form, I jump to my feet, not wanting my daughter to see my sadness. I rush to the kitchen with the promise that we’ll sing together in a few minutes. It’s at that moment I am reminded of the challenge I face being a parent to children both on earth and in heaven.


When I was pregnant, I never imagined that I would be confronted with such a dilemma, bad things didn’t happen to me. But on June 23, 2013, my world came crashing down. Our first triplet passed away within hours of birth; our second baby died 55 days later. For months, I pushed the grief aside, staying strong for our lone survivor fighting for her life in the neonatal intensive care unit. It wasn’t until our daughter arrived home when the deep sorrow enveloped me, leaving me in a foggy state between reality and what could have been.


As the months passed by, the grief slowly changed. I found myself concentrating on the positive moments my micro-preemie was achieving, her milestones even shocking the doctors and nurses who cared for her. But, as I watched my daughter accomplish the unthinkable, my mind kept wandering to my two children in heaven. The questions of “what if” were peppered with “woe is me”. I was conflicted; feelings of sheer happiness were blurred by self-pitty.



For those of us in the club no parent ever wants to be part of, there is life pre-loss and life post-loss. Grief explodes at the most random times and tears are often considered the “new normal”. The first few years post-loss, I found myself living life, wondering when the knot in my stomach would reappear. Typical milestones like Christmas and anniversaries would leave me choking back the tears, the uncontrollable sobs eventually grabbing hold of my body and soul. Then months would then pass by before I had another spell of heartbreak. Sure, the tears well up most days as a simple thought can trigger grief, but that’s part of being a parent to children in heaven–you wear your heart on your sleeve.


Over the years, I have found life after loss. Most days with my daughter are filled with sweet moments of love and tenderness. Her witty and over-the-top personality are a reminder of the strong child who fought for her life since day one. I often stare at her in awe, amazed by the miracle she has become. I make sure she feels loved and understands how special she truly is. There isn’t a day that goes by when I don’t think of her brother and sister, but the tears are fewer and further between the more days that pass by.



As my daughter keeps herself entertained with her imagination and her pretend food, I begin wiping away the tears. I take a few deep breaths to compose myself and blot my puffy eyes with a tissue. For some reason, this week leading up to their birthday has been much more difficult than in years past. I have found myself fighting back tears at work, the grocery store, even at the gas station. I’m tired and emotionally drained, but life doesn’t stop when you have a child eager to play.


As I walk towards my toddler, I glance at our bookshelf in the distance. A sense of peace sweeps over me as I spot Parker and Abby; their two pictures staring at me, keeping a close eye on our family from heaven. I glance over at my daughter, Peyton, just as she pretends to blow out her birthday candle. “Did you make a wish?” I ask her. “What’s a wish?” she replies. At that moment I feel genuine happiness. While I’d give anything to have Parker and Abby here playing with Peyton, I try to be grateful for all that life has given me. As I explain to her what a wish means, I realize my wish has come true. I have a happy and healthy child and two beautiful angels guiding our way. It may not be what I envisioned, but I am finally learning how to balance life between heaven and earth.


A version of this originally appeared on Perfectly Peyton


Follow Stacey’s journey through Facebook, Instagram and Twitter


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13:16

Inside The Coffee Shop Providing Jobs To 40 People With Disabilities






A coffee shop in North Carolina is helping its employees with disabilities ― all 40 of them ― show the world what they can do.


Bitty and Beau’s Coffee opened in January 2016. Its 40 employees have a variety of intellectual and developmental disabilities including Down syndrome, autism and cerebral palsy. Some don’t have a formal diagnosis. The shop, located in Wilmington, North Carolina, also has two typically-abled managers.



Amy Wright, who co-founded the shop with her husband, Ben Wright, had always wanted to participate in something impactful for people with disabilities, especially for her two children with Down syndrome, 7-year-old Bitty and 12-year-old Beau, who are the namesakes of the coffee shop. Amy described having two kids with Down syndrome as a “rare occurrence” that she and her husband are “so blessed” to experience.


“We say we’ve won the lottery twice,” she told HuffPost. “That’s what we like to say.”


After several fundraisers, walks and concerts, Amy decided to raise more awareness about people with disabilities with Bitty and Beau’s Coffee and show the community what its coffee shop family could do.


“The whole experience revolves around people with intellectual and developmental disabilities doing their jobs and being the front of the business, not being tucked into some warehouse,” Amy told HuffPost. “It’s kind of a phenomenon. I can’t think of anything else that does it this way.”



The community has also been extremely responsive. The first version of Bitty and Beau’s Coffee was a 500-square-foot shop. The team quickly learned they couldn’t accommodate the business they were getting and moved to a larger location.


“Our community embraced us from day one,” Amy told HuffPost.


The atmosphere at Bitty and Beau’s is filled with positivity and acceptance. Most importantly, everyone is “respected and valued.”


“When you walk in you know that you’re loved for who you are and how you are, and that’s because that’s how we feel about our employees and then they share that with everyone else that walks in,” Amy said. 



The Bitty and Beau’s team plan to expand their mission to Charleston, South Carolina, with another location. Amy has no plans on slowing down when it comes to changing the way society views people with disabilities. 


“What I think we can do is continue to tell our stories and have people think about people with disabilities differently.”


For more information, head to the Bitty and Beau’s Coffee site or Facebook page.


H/T Today

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10:58

Sheryl Sandberg On What So Many People Get Wrong About Expressing Sympathy






Reading about grief and actually experiencing it are two very different things, as Facebook COO Sheryl Sandberg has learned over the last few years. After the sudden death of her beloved husband, Dave Goldberg, in 2015, Sandberg understandably struggled with her immense grief. Now, she’s sharing the truths and lessons she learned from her bereavement in her new book, Option B, and in a “SuperSoul Sunday” interview with Oprah Winfrey.


Speaking with Oprah, Sandberg admits that, before experiencing this personal tragedy, she would express her sympathy to others in a very common way: by saying very little, as to not remind an individual of their pain.


“If someone in my life were going through something hard, usually the first time I saw them, I would say, ‘I’m so sorry,’” she says. “And then I would never bring it up again because I didn’t want to remind them.”  


Though well-intentioned, Sandberg now says she realizes the flaw in this logic.


“You can’t remind me I lost Dave,” she says. “You also can’t remind someone that she has cancer, or that his father just went to jail, or that she lost a job. It’s not possible. Big hardships, these challenges ― they’re always with us.”


In the above clip, Sandberg also addresses the trouble with asking, “How are you?” to someone grieving a loss. The rest of her conversation with Oprah airs this weekend on “SuperSoul Sunday” at 11 a.m. ET on OWN.

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10:58

What The Senate Health Care Bill Could Mean For People With Mental Illness


The draft of the Senate health care reform bill, called the Better Care Reconciliation Act, released Thursday prompted new anxiety over what the eventual bill could mean for those living with mental illness.


The short answer: Less coverage for more money.


The bill is largely similar to the one passed by House Republicans in May. Nearly 23 million Americans were estimated to lose health coverage under the House bill, known as the American Health Care Act, according to the Congressional Budget Office. Lawmakers hope to have the CBO’s analysis for the Senate’s version by early next week.


The Senate’s bill most striking measure would slash Medicaid by almost a trillion dollars through cutting back on federal funding over a decade. That will affect all aspects of health coverage (for example, Medicaid covers 40 percent of all children’s basic health care). But it will also have a major impact on mental health: Medicaid is the single largest payer of mental health services in the country.


This could potentially leave millions of Americans without coverage that could help them get the care they need, like therapy, for mental health issues.


The Senate bill does protect those with pre-existing conditions, including mental illness, more than the House version. It does this by keeping a provision, known as the community rating, that prevents health insurers from charging those with pre-existing conditions more.


However, the Senate’s plan may still propose giving states the power to waive what’s known as essential health benefits. This would allow insurance companies in those areas to exclude certain benefits from their coverage, like mental health or substance use disorder services.


An analysis published Tuesday, before the draft was released, by the Center for American Progress said prices could go up for mental health and substance use disorder treatment because of these waivers.


Less comprehensive insurance plans could drive up costs of treatments for conditions like mental illness by essentially forcing people to buy added coverage for treatment for their behavioral health condition. Or, it may push them to select a more expensive plan with broader coverage in the first place. As CAP points out, expenses people could incur by the year 2026 are not small:



In states that waived requirements for substance use disorder and mental health benefits, coverage for drug dependence treatment would cost an extra $20,450, and coverage for depression would cost an extra $8,490.



The Senate’s draft legislation could be changed before there’s a vote on it. Still, the chamber’s GOP leaders are pushing to bring it to the floor as early as next week.


What all of this means


The proposed plan by the Senate Republicans threatens the coverage that now exists for those with mental illness, including children and veterans.


Mental health protection is something the country supports: A recent poll found that the majority of Americans ― regardless of political party ― think mental health care should be covered by insurance.


Mental health organizations have been expressing concern about how the Republican effort to repeal and replace Obamacare could affect people living with mental illness. American Psychiatric Association officials noted that they were not consulted on the House version or the Senate’s draft legislation.


Dr. Saul Levin, the association’s CEO and medical director, on Thursday blasted the Senate proposal as “represents a significant move in the wrong direction, resulting in fewer people having access to insurance, fewer patient protections, and less coverage for essential behavioral health care.”


He urged the Senate “to reject this harmful legislation and start again on a health care bill that puts patients first.”


About one in five American adults will be affected by a mental illness annually. Not having access to proper treatment for those disorders can be catastrophic: Data shows untreated mental health issues is one of the most frequent causes of suicide ― major public health problem that’s been steadily on the rise over the last 15 years.


Research shows medical care, through therapy, medication or both, is effective in helping to curb mental health issues, but that access to such care is slowly dwindling. That’s thanks in part to issues with insurance. A study published in April by NYU’s Langone Medical Center found that 10.5 percent of people in 2014 experienced delays in getting treatment due to insufficient mental health coverage, a small rise from the last time data was gathered in 2006.


Mental health advocates have vowed to fight against any legislation that threatens those living with mental illness. This includes pushing for other laws that help those individuals and promoting programs that help them get treated, said Linda Rosenberg, president and CEO of the National Council for Behavioral Health.


Mental illness is an illness like any other,” Rosenberg previously told HuffPost. “People recover and they can live full and productive lives with effective treatment. We just have to be sure that treatment is still available in every community, just like we do for cancer and heart disease.”

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10:18

This Is Your Brain On Warm Weather

There’s just something about summer.


People’s attitudes seem noticeably different with the sunshine. And that isn’t a coincidence: Research shows warmer weather can have a small influence, positively and even occasionally negatively, on your mindset. 


We’ve rounded up just a few ways the toastier temperatures of summer can affect your mood. Check them out below:


Spending time outdoors when it’s sunny is linked with a mood boost...



The gold standard on this subject is a 2004 University of Michigan study that found people who spent at least 30 minutes outside in pleasant weather — either by taking a trip to warmer climates in the winter months or by taking advantage of a newly warm spring day in the park — had happier moods. And in corroborating research, a 2014 UM study found that being outside could lead to a better mindset and reduced stress.


But if you’re still stuck in the tundra, don’t worry too much. Kelly Rohan, a professor of psychiatric science at the University of Vermont, points out that weather pales in comparison to other stress mitigators, such as the lessening of relationship or work pressures. While warmer weather doesn’t make a sizable difference in outlook, research supports the idea that nice weather has a positive psychological impact on the overall population, she told HuffPost.


...But don’t expect the same effect on the dog days of August.


The weather-mood connection is a positive one, up to a point. The original University of Michigan researchers also noted that positive attitudes seemed to wilt in particularly sweltering weather — an idea that’s also supported by other research conducted on climate and mood change.


Despite the fact that summer brings sunnier days and brighter colors, people are at a greater risk for heatstroke and dehydration during the warmer months, Dr. Brent Solvason, a Stanford University clinical associate professor of psychiatry and behavioral sciences, told HuffPost.


“There’s clearly a sense of discomfort because of the oppressiveness of the heat,” he said.


Both dehydration and heatstroke can have an influence on mood or behavior and, at their worst, can also damage the brain.


We’re generally happier when the days are longer...



More light = More happiness.


“People simply feel better on longer days and when there’s more available sunshine,” Rohan said. “The winter variety of seasonal affective disorder (SAD) is mostly tied to how long the day is. So even though spring was a little slow coming this year... the days are still long. Those extra hours of sunlight make a really big difference.”


...But some people are more susceptible to depression during warmer months. 


While it’s much less prevalent than the winter variety of SAD, some people do suffer from spring and summer SAD. Diagnosing and treating the disorder can be complicated, Solvason notes, mainly because conducting research on this specific type of depression is more challenging.


Experts theorize that warmer-weather SAD is aggravated by excessive heat and humidity, Rohan said.


“Those triggers are really different than wintertime, which is brought on usually by lack of light and shorter days,” she explained. “It’s really a few people that we’re talking about as opposed to the wintertime SAD people can relate to on some level, but it does happen.”


On the plus side, warm weather may make you more inventive.



The University of Michigan study also found that being outdoors in enjoyable climates can improve memory and broaden cognitive style, which is linked to more creative thoughts.


Being outside in pleasant weather really offers a way to reset your mindset,” said Matthew Keller, one of the study’s authors, when the research was released. “Everyone thinks weather affects mood, but the biggest tests of this theory ... found no relationship, so we went back and found there are two important variables: how much time you spend outside and what the season is. If you go from winter to spring and spend enough time outside, there’s a noticeable change.”


So go on, celebrate that sweet, sweet summertime.


A previous version of this article appeared in April 2015.

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