Heat related illness: How to keep your cool

Originally Posted Here: https://www.health.harvard.edu/blog/heat-related-illness-how-to-keep-your-cool-2018081714590

The summer season is waning but we’re not done with the heat. Hot and humid weather can bring a host of heat-related problems: heat cramps, heat rash, heat exhaustion, heat stroke…. It’s helpful to be aware of these issues, especially as we experience changes in the climate with humidity or rising temperatures. There have been several studies which have documented an uptick in emergency department visits and hospital admissions for conditions like dehydration, electrolyte imbalances, and other types of heat related illness during times of high heat. Persons who are particularly at risk are the very young and old, those who do prolonged exertional work outdoors, and intense athletes.

Getting overheated: The cause of heat related illness

Our bodies are not well-equipped to withstand large increases in our core body temperature, which is usually around 98.6 ˚ F (37˚ C). With heat stroke, core body temperatures may rise dangerously to around 103˚ to 104˚ F (39.4˚ to 40˚ C). If you have a concern about overheating, be sure to check a rectal temperature, as other methods like oral, axillary, or tympanic measurements can be inaccurate in these situations.

Our bodies have a number of mechanisms to help us cool down. One of the most important is evaporation through sweat, but this mechanism becomes less efficient in high humidity. Also, when we are dehydrated or when we are not accustomed to exertion in the heat, cooling off through evaporation becomes more challenging.

Furthermore, there are a number of medications that impair our bodies’ mechanisms for cooling off, like antihistamines, anticholinergics, decongestants, diuretics, stimulants, and some blood pressure pills, to name a few.

Signs and symptoms of heat-related illness vary. Dehydration may cause feelings of thirst, dizziness, and fatigue. Heat stroke, which needs urgent medical attention, may include hot or flushed skin, a fast heart rate, headache, nausea, dizziness, confusion, or loss of consciousness.

3 key questions about hydration

1.   How much should you hydrate? If you know you are going to be exerting yourself in the heat, start your hydration beforehand, so you start with a “full tank.”

2.  Is it possible to “overhydrate”? Yes. Best to speak with your doctor if you have a medical condition that requires you to be on diuretics or a fluid restriction. Also, though not common, drinking too much water can cause hyponatremia, or a low sodium concentration in the blood. This can be quite serious when it does happen, leading to symptoms like nausea, vomiting, headache, muscle cramps, confusion, and seizures. Hyponatremia is more likely to happen with athletes who sweat a lot, losing salt and water, but then replace the sweat by drinking only water, causing a diluting effect. Sport electrolyte drinks (which can be high in sugar and calories) are an option, but usually not necessary if you hydrate with water while having regular meals or salt-containing snacks.

3.  How do you know if you are getting enough fluids? Well, if you feel thirsty, you may already be dehydrated. Another telltale sign of dehydration is making less and darker urine, as opposed to normal amounts of light yellow urine.

10 tips for avoiding heat related illness Plan to take it easy, especially if you are not used to exerting yourself in the heat and humidity. Seek shade or cool areas and avoid prolonged exposure to the heat. Protect yourself from sunburns. Wear light, loose, reflective clothing. Stay hydrated and avoid alcohol and caffeinated drinks. Cool down with a cold bath or shower. Dampen your clothes or apply wet towels while cooling off with an electric fan. Use ice packs, especially on the neck, underarms, or groin near the main blood vessels. If you feel ill and your symptoms are severe, seek prompt medical attention. And remember, check in on anyone you think is at risk and might be more vulnerable!

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Small study suggests benefits of computer-guided CBT for substance abuse

Originally Posted Here: https://www.health.harvard.edu/blog/small-study-suggests-benefits-of-computer-based-cbt-for-substance-abuse-2018082014434

There is no way to meet the need for substance abuse treatment through the current healthcare system. The number of people who need treatment for drug and alcohol abuse is far greater than the number of clinicians available to treat them. In more rural areas, patients might have to spend a lot of time traveling great distances to appointments, which can be difficult to do while working or taking care of a family. And, the cost and stigma of treatment can get in the way of getting help. Moreover, even if people do get to substance abuse treatment, they often do not receive the most effective ones. As illicit drug use increases in the United States, new ways to deliver treatment are urgently needed.

Computer-guided treatments are one way to overcome the hurdles of access to evidence-based treatments, including travel and scheduling, cost, and stigma. Additionally, using computers to treat one’s own substance abuse can be empowering, giving a sense of “I did it on my own.”

How well do computer-guided treatments work compared to live counseling?

Researchers from Yale University recently developed and studied the “Computer-based Training for Cognitive-behavioral Therapy” (or “CBT4CBT”) web-based substance abuse treatment as a fully standalone intervention. CBT4CBT provides cognitive behavioral therapy (CBT) — an evidence-based treatment for substance abuse. The treatment is completely computer-guided, and does not involve interacting with a counselor or other healthcare professional. It combines online games and video vignettes with actors to teach how to manage one’s own substance use. Specifically, CBT4CBT covers: how to understand and change patterns of substance use; dealing with cravings; refusing offers of alcohol and drugs; problem-solving; noticing thoughts about drugs and alcohol and how to change them; and strengthening decision-making abilities.

Earlier research has shown that CBT4CBT can be an excellent complement to make live treatment with a counselor more effective and efficient. Recently, the research team conducted the first comparison of any standalone web-based treatment for substance abuse to “treatment as usual” — and data suggest that it may be better.

The study on CBT4CBT

The Yale team recruited 137 people seeking substance use treatment from the Connecticut Mental Health Center in New Haven; 49% African American, 34% Caucasian, and 8% Latino or Latina. Substances used were marijuana, cocaine, alcohol, opioids, and PCP. It was a real-world sample in that most participants used more than one illicit drug and most also used alcohol.

One-third of the participants were randomized to use CBT4CBT, with 10-minute in-person weekly checkups to evaluate their overall functioning, their safety, and their use of the online program. One-third of participants were enrolled in “treatment as usual,” which was either group or individual therapy, and covered topics including motivational interviewing, life skills, relapse prevention, harm reduction, mindfulness, and others. The other third were assigned to in-person CBT with a therapist who delivered the same type of content as the CBT4CBT online program.

The researchers found that drug use (measured by urine tests — which corresponded closely with self-reported use) in the CBT4CBT group was significantly less than treatment as usual, and remained lower over six months of follow-up. Persons who received live CBT had the same level of drug use as the treatment as usual group after six months. They also found that participants in the online treatment learned the CBT concepts the best, and had the highest level of satisfaction and lowest dropout rate of any of the three study conditions. Overall, after treatment the percentage of days abstinent from any drug use was 75% for the CBT4CBT group, vs. 67% of days abstinent for the treatment as usual group and 61% for the live CBT group. The study did not enroll a large enough number of participants to conduct a head-to-head comparison of CBT4CBT and live CBT. That may come later, and the results could inform how to conduct live CBT more effectively.

Getting access to computer-guided CBT

Computer-guided CBT for substance abuse should be studied further should be studied further, with different populations and in different settings, the next real challenge is to disseminate it widely across the US and beyond. According to its website, the CBT4CBT program is not yet available to the public, outside of clinical trials.

Building computer-guided treatment programs is often easier than building companies to deliver them. Barriers include acceptance by institutions, payment by insurance companies, liability, FDA approval, and resistance from healthcare providers — as well as coming up with viable business models. But if these obstacles can be overcome, the world could benefit from a highly effective and accessible treatment for drug and alcohol abuse.

References

Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes. American Journal of Psychiatry, May 2018.

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Home cooking: Healthy family meals

Originally Posted Here: https://www.health.harvard.edu/blog/home-cooking-healthy-family-meals-2018082114580

Family meals are beneficial for so many reasons. People who prepare meals at home tend to consume significantly more fruits and vegetables, and less sugar and fat. People who enjoy meals at home with others, sitting together and conversing, also have reduced stress and higher life satisfaction. The more frequently families with children have meals together, the more likely the children are to eat a high-quality diet, and the less likely to be overweight or obese. There are also other benefits: these children tend to have higher self-esteem and better academic performance, as well as lower risk of engaging in risky behaviors (like drug use) or developing an eating disorder.

Family meals without distraction

All those benefits go out the window if dinner is eaten in front of the television or other devices. This makes sense if we think about why the family meal has such powerful positive effects: it’s about closeness and connection. Sitting down to eat together is often the only time families can reconnect and communicate. Given our busy, technology-driven lives, the family meal is a rare (and critical) opportunity to unplug and check in. What’s even better is getting the kids involved in making dinner, which is also significantly associated with their eating a higher-quality diet.

One of my favorite family meals: Make-your-own soft tacos

The kids can get involved in preparing this simple and healthy meal, which is incredibly rich in protein and fiber, as well as calcium, iron, and potassium. Beans provide plenty of heart-healthy fiber, protein, and are associated with a lower risk of diabetes. Corn and masa (the tortilla flour made from corn) are considered whole grains and are loaded with vitamins and minerals. Avocados and olives provide heart-healthy fats, and the veggies are risk in fiber, vitamins, and antioxidants. All these easy-to-find ingredients, plus healthy veggies, the option of dairy, and protein from the pumpkin seeds, make this nutritious and fun to prepare with the family — and everyone will love that they can build their own taco!

Make-Your-Own Soft Tacos

This recipe will serve six people if some of those people are young children. For hungry teens and adults, expect it to feed three or four.

1 15-ounce can of unsalted black beans 1 can corn niblets, unsalted 2 avocados 1 red bell pepper sliced thin 1 tablespoons lemon juice 1 cup of salsa (fresh or jarred) 1 cup shredded cheddar or Monterey jack cheese 1/2 cup of plain Greek yogurt 1/2 cup pepitas (pumpkin seeds), unsalted (optional) 1/2 cup green olives (optional) 8-12 corn tortillas (made without lard)

Dice the avocado and gently mix with the lemon juice.

Heat the beans in the microwave or the stovetop; stir.

Heat the tortillas (I wrap them in a clean towel and zap them in the microwave on high for 30 seconds).

Set out all ingredients on the counter (or table) and let everyone put together their own healthy tacos.

Selected sources

Is cooking at home associated with better diet quality or weight-loss intention? Public Health Nutrition, June 2015.

Health and social determinants and outcomes of home cooking: A systematic review of observational studies. Appetite, April 1, 2017.

The relation between family meals and health of infants and toddlers: A review. Appetite, August 1, 2018.

Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. Canadian Family Physician, February 2015.

A Review of Associations Between Family or Shared Meal Frequency and Dietary and Weight Status Outcomes Across the Lifespan. Journal of Nutrition Education and Behavior, January 2014.

Involvement in Meal Preparation at Home Is Associated With Better Diet Quality Among Canadian Children. Journal of Nutrition Education and Behavior, July-August 2014.

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