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        <title><![CDATA[Harvard Health Blog]]></title>
        <link>https://www.health.harvard.edu/blog</link>
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            <title><![CDATA[What does a birth doula do?]]></title>
            <description><![CDATA[<p>
          <img alt="A birth doula in blue top smiles at a pregnant woman seen from the side wearing a hospital gown" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14566/4363d72b-26d0-4308-8327-d9122eb1fe4d.jpg" style="height:400px; width:600px" class="ucr-content-image" data-cr-imageid="4363d72b-26d0-4308-8327-d9122eb1fe4d" referrerpolicy="no-referrer">
        </p>
        <p>Childbirth — painful, messy, unpredictable — has been part of humankind for time immemorial. And in the US, which has surprisingly high rates of avoidable complications and <a href="https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age" style="text-decoration:underline" target="_blank">maternal deaths</a>, more people seem to be seeking out doulas for additional care during pregnancy and birth, says Natalia Richey, interim chief midwife in the Department of Obstetrics and Gynecology at Massachusetts General Hospital.</p>
        <p>Some research suggests that doula care may benefit both mother and baby. But what does a birth doula do? While neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birthing process.</p>
        <p>Here's what to know if you're considering doula care.</p>
        <h2>What's the difference between doulas and midwives?</h2>
        <p>Midwives and doulas tend to have a few overlapping duties. But there's a key difference: midwives provide medical care and doulas don't.</p>
        <ul>
          <li><strong>Midwives:</strong> Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.</li>
          <li><strong>Doulas:</strong> Unlike midwives, doulas don't perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.</li>
        </ul>
        <p>"Many women hire doulas if they're trying to have an unmedicated birth," Richey says. "Doulas are really good at knowing what techniques — such as walking, showering, massage, or aromatherapy — can help a woman through the pain. It's like having a coach."</p>
        <h2>Are doulas trained or licensed?</h2>
        <p>Be aware that doula training varies widely. There are no formal rules requiring licensing or certification. Many doulas, however, seek certification from the more than 100 independent organizations that offer some type of doula training and credentials, according to the <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">National Health Law Program</a>.</p>
        <h2>Is doula care covered by insurance?</h2>
        <p>Private insurers often do not cover doula care, which can cost several thousand dollars when arranged for privately.</p>
        <p>However, some employers — including <a href="https://apnews.com/article/walmart-doulas-maternal-care-national-black-doulas-association-ad206d3a4fede48cf2605a0df34b8fcb" style="text-decoration:underline" target="_blank">Walmart</a> — will help pay for doula care. And <a href="https://www.bmc.org/obstetrics/birth-sisters" style="text-decoration:underline" target="_blank">some hospital systems</a>, particularly in low-income or medically underserved areas, have doula programs aimed at improving maternal care during and after pregnancy. Others <a href="https://www.massgeneral.org/obgyn/news/striving-equitable-birth-outcomes-doula-care" style="text-decoration:underline" target="_blank">may arrange doula support</a> for people with limited resources who might otherwise be alone during the later stages of pregnancy and birth.</p>
        <p>As of February 2023, 10 states and the District of Columbia <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">provided Medicaid coverage for doula services</a>. Other states are in the midst of implementing coverage. Most of the states that provide Medicaid coverage for doula care require doulas to be trained or certified by an approved organization.</p>
        <h2>Can working with a doula improve birth outcomes?</h2>
        <p>A 2023 analysis in the journal <em>Cureus</em> reviewed 16 individual studies done over 22 years. It found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/" style="text-decoration:underline" target="_blank">doula support was linked with better birth outcomes</a>, such as fewer C-sections and premature deliveries, and shorter length of labor.</p>
        <p>Additionally, the emotional support provided by doulas was associated with less anxiety and stress in birthing mothers. Among low-income women, doula support was shown to improve breastfeeding success.</p>
        <p>"It's impressive," Richey says. "I think those improved outcomes are due to having an expert in the labor process who isn't a medical person but is just there for you from moment to moment."</p>
        <h2>How do people collaborate with doulas?</h2>
        <p>Agreements about care vary. Typically, doulas meet with women every few months through their pregnancy to discuss their goals for birth (such as skipping pain medication, for example), and to build rapport with both the expectant person and their spouse or partner.</p>
        <p>Like obstetricians, doulas are on call 24/7 to support clients who have gone into labor or who have their labor induced. Doulas stay throughout the birth process.</p>
        <p>"Having someone there who's seen quite a few births, who can support and advocate for them, can be a huge comfort," says Richey.</p>
        <p>This may be especially important to women with limited resources, particularly those who might otherwise be alone during the later stages of pregnancy and birth. "Doulas remind women that they're okay and can get through this process — all the things many of us take for granted," Richey says.</p>
        <h2>How might a doula work with the OB/GYN team?</h2>
        <p>Usually, this is a seamless process, Richey says. If a hospital arranges for a woman's doula, OB/GYN team members may meet the doula a couple of times before childbirth. Meanwhile, a doula who's been hired privately will usually only meet the larger OB/GYN team when the woman arrives at the hospital to give birth.</p>
        <p>When everyone sticks to their assigned roles, all goes smoothly. For a doula, that may mean suggesting nonpharmacological ways to ease pain and help labor progress. Boundaries are important, though, when medical intervention is needed.</p>
        <p>"If the baby's heart rate is down, for instance, the expertise needs to be left to the midwife or doctor," Richey explains.</p>
        <h2>What questions should you ask if you're interested in working with a doula?</h2>
        <p>Richey suggests starting by asking yourself:</p>
        <ul>
          <li>What are my hopes and goals for the childbirth process? Might a doula enhance my ability to achieve them?</li>
          <li>How do I envision my support team during delivery? Do I have a partner, a mom, or a friend I want there? Would a doula add to any support I already have?</li>
          <li>Do I have friends or family members who have used doulas in the past? What were their impressions of the experience? Can they recommend a doula?</li>
        </ul>
        <p>If you contact a doula to explore your options, ask about:</p>
        <ul>
          <li>their training and certification</li>
          <li>how many births they've attended</li>
          <li>how they believe they can help you during your pregnancy and during labor</li>
          <li>how they will collaborate with your partner or spouse and the medical team</li>
          <li>whether they provide support after a birth — if so, what type of support and for how long?</li>
        </ul>
        <p>"Take the time to meet with any doula you're considering and make sure they're a good fit," Richey advises, "because this is someone who will be there during one of the most vulnerable times of your life. Having someone there who doesn't make you feel safe and comfortable can affect birth in a major way."</p>
    ]]></description>
            <pubDate>Wed, 22 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</guid>
            <link>https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</link>
        </item>
        <item>
            <title><![CDATA[Cellulitis: How long does it take to heal on legs?]]></title>
            <description><![CDATA[<p>
          <img alt="Illustration of round, bumpy, pink streptococcus bacteria, one cause of the skin infection cellulitis; dark purple background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14509/55ccb00e-2a59-4f8b-963b-09fcf5929752.jpg" style="height:337px; width:600px" class="ucr-content-image" data-cr-imageid="55ccb00e-2a59-4f8b-963b-09fcf5929752" referrerpolicy="no-referrer">
        </p>
        <p>Cellulitis is <a href="https://www.health.harvard.edu/a_to_z/cellulitis-a-to-z" style="text-decoration:underline" target="_blank">an infection of the deep layers of the skin</a>. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, <em>Staphylococcus</em> or <em>Streptococcus,</em> are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.</p>
        <p>Dr. Arash Mostaghimi, a dermatologist at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.</p>
        <h2>What are the symptoms of cellulitis?</h2>
        <p>The body's natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.</p>
        <h2>How is cellulitis treated?</h2>
        <p>The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.</p>
        <h2>How quickly can antibiotics help cellulitis resolve?</h2>
        <p>After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.</p>
        <p>Does that mean the antibiotic treatment was ineffective? Not necessarily, according to <a href="https://pubmed.ncbi.nlm.nih.gov/37849504/" style="text-decoration:underline" target="_blank">a recent study of people with cellulitis in the lower leg</a> that described the natural history of the healing stages following antibiotics.</p>
        <p>"The healing process has two parts, which is why a full recovery takes longer than you might think," says Dr. Mostaghimi.</p>
        <p>First, the antibiotics and your white blood cells work together to kill the bacteria. But your body's immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.</p>
        <h2>What did the study find?</h2>
        <p>The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:</p>
        <ul>
          <li>Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.</li>
          <li>A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.</li>
          <li>Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.</li>
        </ul>
        <p>This pattern of discomfort isn't unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they're often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)</p>
        <p>But after they feel better and start walking more, fluid shifts back down into the legs. So it's not surprising that the area might feel a little swollen and uncomfortable again once they're back on their feet, he says.</p>
        <h2>Who is at greatest risk for cellulitis?</h2>
        <p>Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.</p>
        <p>Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or <a href="https://www.health.harvard.edu/diseases-and-conditions/whats-causing-those-swollen-feet" style="text-decoration:underline" target="_blank">chronic edema</a> (swollen limbs).</p>
        <p>Additionally, skin conditions such as eczema and <a href="https://www.health.harvard.edu/blog/skin-in-the-game-two-common-skin-problems-and-solutions-for-men-202111222643" style="text-decoration:underline" target="_blank">athlete's foot</a> can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.</p>
        <h2>What happens if cellulitis goes untreated?</h2>
        <p>Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby <a href="https://www.health.harvard.edu/blog/wondering-what-your-lymph-nodes-have-done-for-you-lately-202310102980" style="text-decoration:underline" target="_blank">lymph nodes</a> may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.</p>
        <h2>The bottom line</h2>
        <p>"It's important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve," says Dr. Mostaghimi. You'll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you're done does not mean you need another course of antibiotics or a different antibiotic, he says.</p>
    ]]></description>
            <pubDate>Mon, 20 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</guid>
            <link>https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</link>
        </item>
        <item>
            <title><![CDATA[What to do when driving skills decline]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a square-topped gold car key and a gold car on a key ring against a deep yellow background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14502/bcb42e0d-03e3-4752-8f23-2286f283fb97.jpg" style="height:399px; width:600px" class="ucr-content-image" data-cr-imageid="bcb42e0d-03e3-4752-8f23-2286f283fb97" referrerpolicy="no-referrer">
        </p>
        <p>
          <em>Part 2 of a two-part series on making decisions about driving as we age. Read Part 1 <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">here</a>.&nbsp; </em>
        </p>
        <p>It's a simple but unfortunate fact: driving skills can wane over time.</p>
        <p>Eventually, <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">driving can become unsafe</a> for an older driver, their passengers, and others on the road. If you notice a decline in driving abilities in a loved one, or in yourself, what's the best way to handle this?</p>
        <h2>If you're an older driver: Create an action plan</h2>
        <p>If you're an older driver, don't wait for a near-miss or an accident to think about the next steps. Planning ahead can help you tackle fixable issues, make necessary transitions easier, and avoid harming yourself or someone else.</p>
        <p>Here are six measures you can take right now:</p>
        <p><strong>Have a frank conversation with a trusted friend or family member.</strong> After driving with them as a passenger, ask whether they are worried about your driving. <a href="https://www.health.harvard.edu/staying-healthy/what-to-do-when-your-kids-confront-you-about-your-health" style="text-decoration:underline" target="_blank">Don't disregard their comments</a>, even if they share things you don't want to hear.</p>
        <p><strong>See your doctor and talk about your driving.</strong> Is it harder to see at night? Are you finding you're slower to react? Ask your doctor about medical care that can help, such as cataract surgery, treatment for sleep apnea, or adjustments to medications that might affect driving.</p>
        <p><strong>Take a self-evaluation test or an on-road test.</strong><a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/evaluate-your-driving-ability/" style="text-decoration:underline" target="_blank">AAA has tools</a> to help with this, or you can check with your local <a href="https://www.usa.gov/state-motor-vehicle-services" style="text-decoration:underline" target="_blank">department of motor vehicles</a> for options. Even if you feel it's unnecessary, a driving test can be reassuring to your loved ones that you're still safe behind the wheel.</p>
        <p><strong>Take driving classes.</strong> In many places, there are general refresher courses, courses for defensive driving, and even simulators that don't require actual road tests. <a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/aaa-roadwise-driver/" style="text-decoration:underline" target="_blank">AAA</a> and <a href="https://www.aarpdriversafety.org/?_ga=2.62395948.1812440934.1661463375-2048398612.1661463373" style="text-decoration:underline" target="_blank">AARP</a> offer online courses that can help you improve your driving. (And by the way, these courses may also reduce the cost of your auto insurance!)</p>
        <p><strong>Consider alternatives to how you drive.</strong> Stick to roads that are close to home or to routes that have traffic lights (rather than having to decide when traffic is clear enough to turn). Consider giving up night driving if that is particularly difficult.</p>
        <p><strong>Make adjustments to your car that can help.</strong> Examples include using a steering wheel cover to improve your grip or changing the position of your seat to improve your view of the road. Check out the <a href="https://car-fit.org/" style="text-decoration:underline" target="_blank">CarFit program</a> that aims to optimize the "fit" of a driver in their car.</p>
        <p>In addition, explore options that don't require you to drive as often or at all:</p>
        <ul>
          <li>grocery delivery</li>
          <li>public or senior transportation (if offered or available where you live)</li>
          <li>carpooling with friends or family</li>
          <li><a href="https://www.aarp.org/home-family/personal-technology/info-2022/ride-hailing.html" style="text-decoration:underline" target="_blank">ride-hailing services</a> or taxis</li>
          <li>hiring a driver.</li>
        </ul>
        <p>Cost and availability may be barriers, but it's worth looking into these options.</p>
        <h2>If you're a concerned family member or friend: Start a conversation</h2>
        <p>With so much at stake, the language you use matters. So, it's a good idea to think ahead about <em>how</em> to talk about these challenges.</p>
        <p><strong>Put safety and solutions first. </strong>It's best not to lead by criticizing driving skills. Instead, talk about driving with safety and solutions in mind, such as the options described above.</p>
        <p><strong>Choose your words carefully.</strong> It helps to avoid threats or confrontational language: rather than saying "Your driving is terrible so I've taken away your keys," <a href="https://www.thehartford.com/resources/mature-market-excellence/publications-on-aging" style="text-decoration:underline" target="_blank">focus on safety and support</a>:</p>
        <ul>
          <li style="list-style-type:none">&nbsp;</li>
          <li>
            <em>Let's talk about how I can help so you don't have to drive. I can drive you to get your groceries on Sundays and we can make a day of it!</em>
          </li>
          <li>
            <em>How do you think those dents got on your car? Are you having trouble with your vision?</em>
          </li>
          <li><em>We'd all feel terrible if you had an accident and got hurt or hurt someone else</em>.</li>
        </ul>
        <p><strong>Offer to go for a ride together and then to talk about specific concerns</strong>, such as staying in the proper lane, changing lanes, making left-hand turns, speed, or sudden braking. Encourage consideration of a self-evaluation or on-road test, and driving classes to help polish skills.</p>
        <p><strong>Use examples from familiar experiences.</strong> It can be helpful to remind your loved one how his or her parents or grandparents had to cut back on their driving, or how an older neighbor was an unsafe driver.</p>
        <p><strong>Focus on the risks posed by <em>other</em> drivers.</strong> Aggressive or unpredictable drivers can pose more danger to older drivers with slower reaction times.</p>
        <h2>How else can families or friends of older drivers be helpful?</h2>
        <ul>
          <li><strong>Consider whether to contact their doctor.</strong> Ask their doctor if it's possible to talk with your loved one or friend about their driving. State regulations vary on <a href="https://pubmed.ncbi.nlm.nih.gov/29386271/" style="text-decoration:underline" target="_blank">mandatory reporting</a> of conditions that affect a patient's ability to drive. Be aware that some doctors may be reluctant to report their patients to their registry of motor vehicles, due to concerns about patient privacy or jeopardizing the patient-doctor relationship.</li>
          <li><strong>Look into </strong><a href="https://www.iihs.org/topics/older-drivers/license-renewal-laws-table" style="text-decoration:underline" target="_blank"><strong>rules and regulations around older drivers</strong></a><strong> where your loved one lives.</strong> Illinois is currently the only state that <a href="https://www.ilsos.gov/services/services_for_seniors/programs.html" style="text-decoration:underline" target="_blank">requires a road test for older drivers</a>. But many states require vision tests and in-person renewal with increasing frequency for older drivers.</li>
          <li><strong>Consider reporting an unsafe driver to traffic safety authorities.</strong> This may feel like a betrayal, but if other efforts have failed this option might be better than waiting until there's a serious accident.</li>
        </ul>
        <h2>The bottom line</h2>
        <p>In the future, safe, driverless cars may be a solution to the challenge of waning driving skills among older drivers. But we're not there yet.</p>
        <p>Right now, we should all acknowledge that it's not easy to address concerns about impaired older drivers. My best advice is that older drivers and their loved ones try to talk about ways to remain a safe driver and put a plan in place. Ideally, we all would start the conversation well before any driving problems are evident.</p>
        <p>And it may take more than one conversation. Many more. But let's face it: sooner or later, most drivers will have to stop driving. For some older drivers, that time may be now. For the rest of us, recognizing this eventuality could help when our time comes.</p>
    ]]></description>
            <pubDate>Wed, 15 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</guid>
            <link>https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</link>
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            <title><![CDATA[A tough question: When should an older driver stop driving?]]></title>
            <description><![CDATA[<p><img alt="Abstract of traffic on city highway at night with glaring headlights forming big, colored dots " class="ucr-content-image" data-cr-imageid="f6fd51a8-b6bf-4a40-9b61-0067cf611802" height="443" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14503/f6fd51a8-b6bf-4a40-9b61-0067cf611802.jpg" width="788" referrerpolicy="no-referrer"></p>
<p><em>Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">here</a>.&nbsp; </em></p>
<p>When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: "the sun was in my eyes" or "your grandfather distracted me." Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn't agree that her driving was a problem, and didn't appreciate our concerns.</p>
<p>Maybe there's a similar story unfolding in your family. Or maybe you're starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.</p>
<p>A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.</p>
<h2>How safe are older drivers on the road?</h2>
<p>Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:</p>
<ul>
<li>Fatalities occurring in crashes involving a driver ages 15 to 20 <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/teen-drivers/" style="text-decoration:underline" target="_blank">rose nearly 10% between 2020 and 2021</a>, accounting for 5,565 deaths.</li>
<li>Among drivers 65 or older, <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/older-drivers/" style="text-decoration:underline" target="_blank">fatalities rose 15% between 2020 and 2021</a>, accounting for more than 8,200 deaths.</li>
</ul>
<p>While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often <a href="https://pubmed.ncbi.nlm.nih.gov/32089137/" style="text-decoration:underline" target="_blank">overestimate their driving abilities</a>. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.</p>
<p>Per mile driven, the rate of motor vehicle accidents <a href="https://www.iihs.org/topics/older-drivers" style="text-decoration:underline" target="_blank">is higher for drivers ages 80 and older</a> than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of <em>fatal</em> motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.</p>
<p>These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.</p>
<p>Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it's important to recognize the problem and understand why it's happening. The following four steps are a good start.</p>
<h2>1. Seeing any red flags?</h2>
<p>As people get older, driving skills may decline so slowly that it's not obvious worrisome changes are happening. Even when mishaps and near-misses occur, there are so many possible contributors — especially other drivers — that it may not be clear that the older driver was at fault.</p>
<p>Red flags that might mean an older person is an unsafe driver include:</p>
<ul>
<li>concerned comments from family or friends</li>
<li>reluctance of others to ride with them</li>
<li>input from other drivers (<em>why is everyone honking at me?</em>) or traffic authorities (<em>why am I getting all these traffic tickets?</em>)</li>
<li>getting lost on familiar roads</li>
<li>consistently driving too slowly or too fast</li>
<li>unexplained dents or scratches appearing on the car</li>
<li>frequent accidents or near-misses.</li>
</ul>
<h2>2. Why do driving skills tend to wane with age?</h2>
<p>While people of advanced age <em>can</em> safely drive (and many do!), <a href="https://pubmed.ncbi.nlm.nih.gov/37656444/" style="text-decoration:underline" target="_blank">driving skills may wane</a> due to:</p>
<ul>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/34700248/" style="text-decoration:underline" target="_blank">medical conditions</a>, such as arthritis, neuropathy, or dementia</li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/37773496/" style="text-decoration:underline" target="_blank">medications</a>, such as sedatives or certain antidepressants</li>
<li>age-related changes in reaction time</li>
<li>trouble with vision or hearing</li>
<li>other physical changes related to aging, such as less flexibility or strength</li>
<li>difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.</li>
</ul>
<h2>3. What can — and can't — be reversed to improve driving?</h2>
<p>Some changes that impair driving can be reversed or a workaround can be found. For example, if driving is impaired due to cataracts, cataract surgery can restore vision and improve driving. If night driving is difficult, it's best to drive only during the day. If <a href="https://www.health.harvard.edu/blog/whats-the-relationship-between-memory-loss-and-driving-202210122829" style="text-decoration:underline" target="_blank">memory problems are starting to arise</a>, it may still be possible to drive safely in more limited circumstances.</p>
<p>Driving problems due to advanced dementia or a major stroke affecting judgment and physical skills are much less likely to improve.</p>
<h2>4. Accept that conversations about not driving are challenging</h2>
<p>If there is no simple way to reverse or work around declining driving skills, accept that there will be many challenges to navigate, whether you're the older driver or a family member.</p>
<p>Challenges facing the driver:</p>
<ul>
<li><strong>It's not easy to acknowledge declining function.</strong> Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.</li>
<li><strong>It can feel unnecessary and unreasonable.</strong> Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.</li>
<li><strong>Denial and defensiveness are common.</strong> Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).</li>
<li><strong>Not driving is a loss of independence.</strong> Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.</li>
</ul>
<p>Challenges facing the family:</p>
<ul>
<li><strong>Often, the older driver doesn't share their family's concerns about driving safety.</strong> This can lead to arguments, confrontation, and resentment.</li>
<li><strong>The safety of others is at stake.</strong> The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.</li>
<li><strong>It's hard to know when the time is right.</strong> Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.</li>
</ul>
<h2>Finding a path forward</h2>
<p>As for my grandmother, none of us knew what to say. Should we try to get her to agree to stop driving entirely or let her ease into the idea over time? Maybe she could stop driving at night or limit her driving to short distances. Should we bring it to the attention of her doctor and let them direct the next steps? Or should we take an even harder step and report her to the authorities?</p>
<p>If you're asking similar questions — or if you're starting to wonder about your own driving abilities — you may feel strongly that it's important to respect individual preferences, dignity, and independence. Yet you also want to protect everyone from harm.</p>
<p>What are the best ways to strike a balance? Can you test and improve how an older driver is doing behind the wheel? Can you navigate tough conversations in ways that allow room for both independence and safety? These are the subjects to be tackled in <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">Part 2</a>.</p>
    ]]></description>
            <pubDate>Mon, 13 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</guid>
            <link>https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</link>
        </item>
        <item>
            <title><![CDATA[Opill: Is this new birth control pill right for you?]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a silver blister pack of birth control pills with the four rows of days of the week" src="http://content.health.harvard.edu/wp-content/uploads/2023/11/ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd.jpg" style="height:339px; width:600px" imageid="ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd" referrerpolicy="no-referrer">
        </p>
        <p>Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. Just this past summer, the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter. This offers many more people access to a new nonprescription option for preventing pregnancy.</p>
        <p>Opill may be available early in 2024, although the exact date and cost are not yet known. Here's what anyone interested — adults, parents, and teens — should know.</p>
        <h2>What is in Opill and how does it work?</h2>
        <p>Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by</p>
        <ul>
          <li>affecting ovulation so that the ovaries do not release an egg every month</li>
          <li>thickening cervical mucus, which blocks sperm from reaching an egg</li>
          <li>changing the uterine lining in ways that keep a fertilized egg from implanting.</li>
        </ul>
        <h2>How effective is Opill at preventing pregnancy?</h2>
        <p>It depends on how consistent you are about taking Opill:</p>
        <ul>
          <li><strong>Perfect use</strong> means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.</li>
          <li><strong>Typical use</strong> averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don't take it perfectly, at least nine could become pregnant in a year.</li>
        </ul>
        <p>It's also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.</p>
        <h2>How do you take Opill?</h2>
        <ul>
          <li>Take it once a day at the same time each day until you finish the entire pack.</li>
          <li>Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.</li>
          <li>After you complete a 28-day pack, you should immediately start a new pack of pills the next day.</li>
        </ul>
        <h2>What happens if you forget to take a dose at the specific time or miss a dose?</h2>
        <ul>
          <li>If you take the pill more than three hours late it will not be as effective at preventing pregnancy.</li>
          <li>Take the missed pill as soon you remember.</li>
          <li>You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.</li>
        </ul>
        <h2>Is Opill safe for teenagers?</h2>
        <p>Opill is generally safe for most people who could get pregnant, including teenagers. There's no evidence to suggest that safety or side effects are different in teenagers compared with adults.</p>
        <p>Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.</p>
        <h2>When teens use birth control, what is the best choice for them?</h2>
        <p>There isn't a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.</p>
        <p>For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.</p>
        <p>Learn more about different contraception methods at the <a href="https://youngwomenshealth.org/guides/contraception/" style="text-decoration:underline" target="_blank">Center for Young Women's Health</a> website.</p>
        <h2>What side effects are common with Opill?</h2>
        <p>Progestin-only pills are usually associated with mild side effects. The most common side effects are:</p>
        <ul>
          <li>unexpected vaginal bleeding or spotting</li>
          <li>acne</li>
          <li>headache</li>
          <li>gastrointestinal symptoms such as nausea, abdominal pain, and bloating</li>
          <li>change in appetite.</li>
        </ul>
        <p>Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.</p>
        <h2>Will Opill cause any mood changes?</h2>
        <p>Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.</p>
        <p>Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.</p>
        <h2>Can it be used as emergency birth control?</h2>
        <p>No, it should not be used as <a href="https://youngwomenshealth.org/guides/emergency-contraception/" style="text-decoration:underline" target="_blank">emergency birth control</a>.</p>
        <h2>What should you know about STIs?</h2>
        <p>This type of birth control does not protect you from <a href="https://www.cdc.gov/std/default.htm" style="text-decoration:underline" target="_blank">sexually transmitted infections</a> (STIs) such as syphilis, gonorrhea, or chlamydia.</p>
        <p>You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.</p>
        <p>Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A <a href="https://www.cdc.gov/hiv/basics/prep.html" style="text-decoration:underline" target="_blank">medicine called PrEP</a> can help prevent HIV. Ask your medical team for more information about the right choices for you.</p>
        <h2>When will Opill be available and what will it cost?</h2>
        <p>The timeline for availability and the cost of medication is determined by the manufacturer. At time of FDA approval, it was expected to hit shelves in early 2024. No updates have been released for the exact date or estimated cost of the medication.</p>
    ]]></description>
            <pubDate>Wed, 08 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</guid>
            <link>https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</link>
        </item>
        <item>
            <title><![CDATA[Do children get migraine headaches? What parents need to know]]></title>
            <description><![CDATA[<p><img alt="Brown-haired boy lying on colorful spread, looks pained, one hand covering an eye, other eye shut &amp; other hand tucked behind head; concept is migraine headache" class="ucr-content-image" data-cr-imageid="cf914d00-e65a-4a1f-9d1d-146785bd94b1" height="400" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14489/cf914d00-e65a-4a1f-9d1d-146785bd94b1.jpg" width="600" referrerpolicy="no-referrer"></p>
<p>Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/" style="text-decoration:underline" target="_blank">one in 10 children and teens</a> overall. &nbsp;</p>
<p>What should you know — and do — if you think your child or teen may be having migraines?</p>
<h2>How early do migraines start to occur?</h2>
<p>We don't tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.</p>
<p>Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.</p>
<h2>Which migraine symptoms are most common in children?</h2>
<p>Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.</p>
<p>While it's not always easy to tell a migraine from another kind of headache, children</p>
<ul>
<li>often report throbbing pain</li>
<li>may experience nausea and sensitivity to light and noise.</li>
</ul>
<p>The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.</p>
<h2>What causes migraines in children?</h2>
<p>We don't know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.</p>
<p>Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.</p>
<h2>Can migraines be prevented?</h2>
<p>The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it's a good idea to keep a headache diary.</p>
<p>When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child's particular triggers.</p>
<p>It's a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!</p>
<h2>How can you help your child ease a migraine?</h2>
<p>When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it's not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.</p>
<p>It's important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!</p>
<h2>Are there prescription medicines that can help children with migraines?</h2>
<p>If those approaches aren't enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.</p>
<p>If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.</p>
<p>Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.</p>
<h2>When to contact your doctor</h2>
<p>If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.</p>
<p>You should always call your doctor, or go to an emergency room, if your child has a severe headache, <a href="https://www.health.harvard.edu/blog/8-things-to-watch-for-when-your-child-has-a-headache-2017051611761" target="_blank">a stiff neck</a>, trouble with coordination or movement, is abnormally sleepy, or isn't talking or behaving normally.</p>
<p>The American Academy of Pediatrics has additional <a href="https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx" style="text-decoration:underline" target="_blank">useful information</a> about migraines, and how to treat and prevent them, on their website.</p>
    ]]></description>
            <pubDate>Mon, 06 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</guid>
            <link>https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</link>
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            <title><![CDATA[Does running cause arthritis?]]></title>
            <description><![CDATA[<p>
          <img alt="A middle-aged man wearing a blue zip top and lighter blue track pants running alongside a blurred cityscape" src="http://content.health.harvard.edu/wp-content/uploads/2023/05/2434e7c0-3082-4e6a-9556-3e36e6f38b4c.jpg" style="height:410px; width:600px" imageid="2434e7c0-3082-4e6a-9556-3e36e6f38b4c" referrerpolicy="no-referrer">
        </p>
        <p>When I took up running in college, a friend of mine scoffed at the idea. He hated running and was convinced runners were "wearing out" their joints. He liked to say he was saving his knees for his old age.</p>
        <p>So, was he onto something? Does running really ruin your joints, as many people believe?</p>
        <h2>Runners can get arthritis, but is running the cause?</h2>
        <p>You may think the answer is obvious. Surely, years of running (pounding pavements, or even softer surfaces) could wear out your joints, much like tires wear out after you put enough miles on them. And <a href="https://www.health.harvard.edu/a_to_z/osteoarthritis-a-to-z" target="_blank">osteoarthritis</a>, the most common type of arthritis, usually affects older adults. In fact, it's often described as age-related and degenerative. That sounds like a wear-and-tear sort of situation, right?</p>
        <p>Maybe not. Sure, it's easy to blame running when a person who runs regularly develops arthritis. But that blame may be misguided. The questions to ask are:</p>
        <ul>
          <li>Does running damage the joints and lead to arthritis?</li>
          <li>Does arthritis develop first and become more noticeable while running?</li>
          <li>Is the connection more complicated? Perhaps there's no connection between running and arthritis for most people. But maybe those destined to develop arthritis (due to their genes, for example) get it sooner if they take up running.</li>
        </ul>
        <p>Extensive research over the last several decades has investigated these questions. While the answers are still not entirely clear, we're moving closer.</p>
        <h2>What is the relationship between running and arthritis?</h2>
        <p>Mounting evidence suggests that that running does <em>not</em> cause osteoarthritis, or any other joint disease.</p>
        <ul>
          <li>A study published in 2017 found that <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/" target="_blank">recreational runners had lower rates of hip and knee osteoarthritis</a> (3.5%) compared with competitive runners (13.3%) and nonrunners (10.2%).</li>
          <li>According to a 2018 study, the rate of hip or knee arthritis among 675 marathon runners was <a href="https://www.oarsijournal.com/article/S1063-4584(22)00923-2/fulltext" target="_blank">half the rate expected</a> within the US population.</li>
          <li>A 2022 analysis of 24 studies found <a href="https://www.oarsijournal.com/article/S1063-4584(22)00923-2/fulltext" target="_blank">no evidence of significant harm to the cartilage lining the knee joints</a> on MRIs taken just after running.</li>
        </ul>
        <p>These are just a few of the published medical studies on the subject. Overall, research suggests that running is an unlikely cause of arthritis — and might even be protective.</p>
        <h2>Why is it hard to study running and arthritis?</h2>
        <ul>
          <li><strong>Osteoarthritis takes many years to develop.</strong> Convincing research would require a long time, perhaps a decade or more.</li>
          <li><strong>It's impossible to perform an ideal study.</strong> The most powerful type of research study is a double-blind, randomized, controlled trial. Participants in these studies are assigned to a treatment group (perhaps taking a new drug) or a control group (often taking a placebo). Double-blind means neither researchers nor participants know which people are in the treatment group and which people are getting a placebo. When the treatment being studied is running, there's no way to conduct this kind of trial.</li>
          <li><strong>Beware the confounders.</strong> A confounder is a factor or variable you can't account for in a study. There may be important differences between people who run and those who don't that have nothing to do with running. For example, runners may follow a healthier diet, maintain a healthier weight, or smoke less than nonrunners. They may differ with respect to how their joints are aligned, the strength of their ligaments, or genes that direct development of the musculoskeletal system. These factors could affect the risk of arthritis and make study results hard to interpret clearly. In fact, they may explain why some studies find that running is protective.</li>
          <li><strong>The effect of running may vary between people.</strong> For example, it's possible, though not proven, that people with obesity who run regularly are at increased risk of arthritis due to the stress of excess weight on the joints.</li>
        </ul>
        <h2>The bottom line</h2>
        <p>Trends in recent research suggest that running does not wear out your joints. That should be reassuring for those of us who enjoy running. And if you don't like to run, that's fine: try to find forms of exercise that you enjoy more. Just don't base your decision — or excuse — for not running on the idea that it will ruin your joints.</p>
    ]]></description>
            <pubDate>Wed, 26 Apr 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/does-running-cause-arthritis-202304262930</guid>
            <link>https://www.health.harvard.edu/blog/does-running-cause-arthritis-202304262930</link>
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        <item>
            <title><![CDATA[3 ways to create community and counter loneliness]]></title>
            <description><![CDATA[<p>
          <img alt="A high, overhead view looking down on a large crowd of tiny people and one tiny person standing alone in an empty, white, heart-shaped space " src="http://content.health.harvard.edu/wp-content/uploads/2023/04/24b364ff-eead-4160-9c1a-13890a2a4ad2.jpg" style="height:375px; width:600px" imageid="24b364ff-eead-4160-9c1a-13890a2a4ad2" referrerpolicy="no-referrer">
        </p>
        <p>Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you're surrounded by people — even friends and family.</p>
        <p>Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, <a href="https://www.health.harvard.edu/mind-and-mood/protecting-against-cognitive-decline">declining thinking skills</a>, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.</p>
        <h2>Taking the first steps</h2>
        <p>Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.</p>
        <p>Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. "That's a challenge as we get older, because people are often established in their social groups and aren't as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did," says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.</p>
        <p>Trying these strategies can help.</p>
        <h2>1. Seek like-minded souls</h2>
        <p>Being around people who share your interests gives you a head start on making friends: you already have something in common.</p>
        <p>Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you'd like to try.</p>
        <p>Once you join a group, you'll need to take part in it regularly to build bonds. If you can gather in person, it's even better. "The part of our brain involved in social connection is stimulated by all five senses. When you're with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen," Dr. Olds says.</p>
        <h2>2. Create opportunities</h2>
        <p>If joining someone else's group is unappealing, start your own. Host gatherings at your place or elsewhere. "All it takes is three people. You can say, 'Let's read books or talk about a TV show or have a dinner group on a regular basis,'" Dr. Olds says.</p>
        <p>Other ideas for gatherings — either weekly or monthly — include:</p>
        <ul>
          <li>game nights</li>
          <li>trivia nights</li>
          <li>hikes in interesting parks</li>
          <li>beach walks</li>
          <li>bird-watching expeditions</li>
          <li>running or cycling</li>
          <li>
            <a href="https://www.health.harvard.edu/blog/easily-distracted-try-meditation-202109232600">meditation</a>
          </li>
          <li>museum visits</li>
          <li>cooking</li>
          <li>knitting, sewing, or crafting</li>
          <li>shopping</li>
          <li>day trips to nearby towns</li>
          <li>jewelry making</li>
          <li>collector show-and-tell (comic books, antique dolls, baseball cards).</li>
        </ul>
        <p>The people you invite don't have to be dear friends; they can just be people you'd like to get to know better — perhaps neighbors or work acquaintances.</p>
        <p>If they're interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. "Don't be timid. Say, 'Let's get our calendars out and get this scheduled,'" Dr. Olds says.</p>
        <h2>3. Brush up your social skills</h2>
        <p>Sometimes we're rusty in surface social graces that help build deeper connections. "It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are," Dr. Olds says.</p>
        <p>Tips to practice:</p>
        <ul>
          <li><strong>Smile more.</strong> Smiling is welcoming, inviting, and hospitable to others.</li>
          <li><strong>Be engaging.</strong> Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you've gathered (if it's a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. "Maybe the person is wearing a pretty brooch. Ask if there's a story behind it," Dr. Olds suggests.</li>
          <li><strong>Be a good listener.</strong> "Listen in a way that someone realizes you're paying attention. Hold their gaze, nod your head or say 'Mm hmm' as they're talking so you give feedback. Assume everyone in the world is just yearning for your feedback," Dr. Olds says.</li>
          <li><strong>Ask follow-up questions.</strong> Don't ignore signals that someone has interesting stories to tell. "If they allude to something, your job is to look fascinated and ask if they can tell you more. They're dropping crumbs on a path to a deeper exchange," Dr. Olds notes.</li>
        </ul>
        <p>Even chats that don't lead to friendships can be enriching. A 2022 study found that people who had the most <a href="https://www.pnas.org/doi/10.1073/pnas.2120668119">diverse portfolios of social interactions</a> — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.</p>
        <p>Ultimately, a wide variety of interactions contributes to well-being, whether you're talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.</p>
    ]]></description>
            <pubDate>Wed, 08 Mar 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/3-ways-to-create-community-and-counter-loneliness-202303082900</guid>
            <link>https://www.health.harvard.edu/blog/3-ways-to-create-community-and-counter-loneliness-202303082900</link>
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        <item>
            <title><![CDATA[Holiday arguments brewing? Here's how to defuse them]]></title>
            <description><![CDATA[<p>
          <img alt="A round black time bomb with an illustrated brown striped, curvy fuse and yellow and orange paper flames at the end showing that it's been lit" src="http://content.health.harvard.edu/wp-content/uploads/2023/04/1380ed22-af68-4a71-88d7-57be377b5d5e.jpg" style="height:337px; width:600px" imageid="1380ed22-af68-4a71-88d7-57be377b5d5e" referrerpolicy="no-referrer">
        </p>
        <p>The holidays, as painted by idealists, are hardly the time for disagreements. They're supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don't have to get drawn into arguments if you plan ahead and stay alert for potential triggers.</p>
        <h2>Why do we fight at the holidays?</h2>
        <p>In many ways, we are primed for holiday arguments. "It's a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We're trying to juggle work and get time off," says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. "The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support."</p>
        <p>As a result, we are often emotionally vulnerable during the holidays, Gillis says. It's hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.</p>
        <p>"When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict," Gillis says.</p>
        <p>Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.</p>
        <h2>Plan ahead to help defuse emotions and arguments</h2>
        <p>It's challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if a

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            <title><![CDATA[What does a birth doula do?]]></title>
            <description><![CDATA[<p>
          <img alt="A birth doula in blue top smiles at a pregnant woman seen from the side wearing a hospital gown" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14566/4363d72b-26d0-4308-8327-d9122eb1fe4d.jpg" style="height:400px; width:600px" class="ucr-content-image" data-cr-imageid="4363d72b-26d0-4308-8327-d9122eb1fe4d" referrerpolicy="no-referrer">
        </p>
        <p>Childbirth — painful, messy, unpredictable — has been part of humankind for time immemorial. And in the US, which has surprisingly high rates of avoidable complications and <a href="https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age" style="text-decoration:underline" target="_blank">maternal deaths</a>, more people seem to be seeking out doulas for additional care during pregnancy and birth, says Natalia Richey, interim chief midwife in the Department of Obstetrics and Gynecology at Massachusetts General Hospital.</p>
        <p>Some research suggests that doula care may benefit both mother and baby. But what does a birth doula do? While neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birthing process.</p>
        <p>Here's what to know if you're considering doula care.</p>
        <h2>What's the difference between doulas and midwives?</h2>
        <p>Midwives and doulas tend to have a few overlapping duties. But there's a key difference: midwives provide medical care and doulas don't.</p>
        <ul>
          <li><strong>Midwives:</strong> Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.</li>
          <li><strong>Doulas:</strong> Unlike midwives, doulas don't perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.</li>
        </ul>
        <p>"Many women hire doulas if they're trying to have an unmedicated birth," Richey says. "Doulas are really good at knowing what techniques — such as walking, showering, massage, or aromatherapy — can help a woman through the pain. It's like having a coach."</p>
        <h2>Are doulas trained or licensed?</h2>
        <p>Be aware that doula training varies widely. There are no formal rules requiring licensing or certification. Many doulas, however, seek certification from the more than 100 independent organizations that offer some type of doula training and credentials, according to the <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">National Health Law Program</a>.</p>
        <h2>Is doula care covered by insurance?</h2>
        <p>Private insurers often do not cover doula care, which can cost several thousand dollars when arranged for privately.</p>
        <p>However, some employers — including <a href="https://apnews.com/article/walmart-doulas-maternal-care-national-black-doulas-association-ad206d3a4fede48cf2605a0df34b8fcb" style="text-decoration:underline" target="_blank">Walmart</a> — will help pay for doula care. And <a href="https://www.bmc.org/obstetrics/birth-sisters" style="text-decoration:underline" target="_blank">some hospital systems</a>, particularly in low-income or medically underserved areas, have doula programs aimed at improving maternal care during and after pregnancy. Others <a href="https://www.massgeneral.org/obgyn/news/striving-equitable-birth-outcomes-doula-care" style="text-decoration:underline" target="_blank">may arrange doula support</a> for people with limited resources who might otherwise be alone during the later stages of pregnancy and birth.</p>
        <p>As of February 2023, 10 states and the District of Columbia <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">provided Medicaid coverage for doula services</a>. Other states are in the midst of implementing coverage. Most of the states that provide Medicaid coverage for doula care require doulas to be trained or certified by an approved organization.</p>
        <h2>Can working with a doula improve birth outcomes?</h2>
        <p>A 2023 analysis in the journal <em>Cureus</em> reviewed 16 individual studies done over 22 years. It found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/" style="text-decoration:underline" target="_blank">doula support was linked with better birth outcomes</a>, such as fewer C-sections and premature deliveries, and shorter length of labor.</p>
        <p>Additionally, the emotional support provided by doulas was associated with less anxiety and stress in birthing mothers. Among low-income women, doula support was shown to improve breastfeeding success.</p>
        <p>"It's impressive," Richey says. "I think those improved outcomes are due to having an expert in the labor process who isn't a medical person but is just there for you from moment to moment."</p>
        <h2>How do people collaborate with doulas?</h2>
        <p>Agreements about care vary. Typically, doulas meet with women every few months through their pregnancy to discuss their goals for birth (such as skipping pain medication, for example), and to build rapport with both the expectant person and their spouse or partner.</p>
        <p>Like obstetricians, doulas are on call 24/7 to support clients who have gone into labor or who have their labor induced. Doulas stay throughout the birth process.</p>
        <p>"Having someone there who's seen quite a few births, who can support and advocate for them, can be a huge comfort," says Richey.</p>
        <p>This may be especially important to women with limited resources, particularly those who might otherwise be alone during the later stages of pregnancy and birth. "Doulas remind women that they're okay and can get through this process — all the things many of us take for granted," Richey says.</p>
        <h2>How might a doula work with the OB/GYN team?</h2>
        <p>Usually, this is a seamless process, Richey says. If a hospital arranges for a woman's doula, OB/GYN team members may meet the doula a couple of times before childbirth. Meanwhile, a doula who's been hired privately will usually only meet the larger OB/GYN team when the woman arrives at the hospital to give birth.</p>
        <p>When everyone sticks to their assigned roles, all goes smoothly. For a doula, that may mean suggesting nonpharmacological ways to ease pain and help labor progress. Boundaries are important, though, when medical intervention is needed.</p>
        <p>"If the baby's heart rate is down, for instance, the expertise needs to be left to the midwife or doctor," Richey explains.</p>
        <h2>What questions should you ask if you're interested in working with a doula?</h2>
        <p>Richey suggests starting by asking yourself:</p>
        <ul>
          <li>What are my hopes and goals for the childbirth process? Might a doula enhance my ability to achieve them?</li>
          <li>How do I envision my support team during delivery? Do I have a partner, a mom, or a friend I want there? Would a doula add to any support I already have?</li>
          <li>Do I have friends or family members who have used doulas in the past? What were their impressions of the experience? Can they recommend a doula?</li>
        </ul>
        <p>If you contact a doula to explore your options, ask about:</p>
        <ul>
          <li>their training and certification</li>
          <li>how many births they've attended</li>
          <li>how they believe they can help you during your pregnancy and during labor</li>
          <li>how they will collaborate with your partner or spouse and the medical team</li>
          <li>whether they provide support after a birth — if so, what type of support and for how long?</li>
        </ul>
        <p>"Take the time to meet with any doula you're considering and make sure they're a good fit," Richey advises, "because this is someone who will be there during one of the most vulnerable times of your life. Having someone there who doesn't make you feel safe and comfortable can affect birth in a major way."</p>
    ]]></description>
            <pubDate>Wed, 22 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</guid>
            <link>https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</link>
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            <title><![CDATA[Cellulitis: How long does it take to heal on legs?]]></title>
            <description><![CDATA[<p>
          <img alt="Illustration of round, bumpy, pink streptococcus bacteria, one cause of the skin infection cellulitis; dark purple background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14509/55ccb00e-2a59-4f8b-963b-09fcf5929752.jpg" style="height:337px; width:600px" class="ucr-content-image" data-cr-imageid="55ccb00e-2a59-4f8b-963b-09fcf5929752" referrerpolicy="no-referrer">
        </p>
        <p>Cellulitis is <a href="https://www.health.harvard.edu/a_to_z/cellulitis-a-to-z" style="text-decoration:underline" target="_blank">an infection of the deep layers of the skin</a>. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, <em>Staphylococcus</em> or <em>Streptococcus,</em> are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.</p>
        <p>Dr. Arash Mostaghimi, a dermatologist at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.</p>
        <h2>What are the symptoms of cellulitis?</h2>
        <p>The body's natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.</p>
        <h2>How is cellulitis treated?</h2>
        <p>The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.</p>
        <h2>How quickly can antibiotics help cellulitis resolve?</h2>
        <p>After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.</p>
        <p>Does that mean the antibiotic treatment was ineffective? Not necessarily, according to <a href="https://pubmed.ncbi.nlm.nih.gov/37849504/" style="text-decoration:underline" target="_blank">a recent study of people with cellulitis in the lower leg</a> that described the natural history of the healing stages following antibiotics.</p>
        <p>"The healing process has two parts, which is why a full recovery takes longer than you might think," says Dr. Mostaghimi.</p>
        <p>First, the antibiotics and your white blood cells work together to kill the bacteria. But your body's immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.</p>
        <h2>What did the study find?</h2>
        <p>The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:</p>
        <ul>
          <li>Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.</li>
          <li>A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.</li>
          <li>Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.</li>
        </ul>
        <p>This pattern of discomfort isn't unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they're often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)</p>
        <p>But after they feel better and start walking more, fluid shifts back down into the legs. So it's not surprising that the area might feel a little swollen and uncomfortable again once they're back on their feet, he says.</p>
        <h2>Who is at greatest risk for cellulitis?</h2>
        <p>Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.</p>
        <p>Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or <a href="https://www.health.harvard.edu/diseases-and-conditions/whats-causing-those-swollen-feet" style="text-decoration:underline" target="_blank">chronic edema</a> (swollen limbs).</p>
        <p>Additionally, skin conditions such as eczema and <a href="https://www.health.harvard.edu/blog/skin-in-the-game-two-common-skin-problems-and-solutions-for-men-202111222643" style="text-decoration:underline" target="_blank">athlete's foot</a> can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.</p>
        <h2>What happens if cellulitis goes untreated?</h2>
        <p>Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby <a href="https://www.health.harvard.edu/blog/wondering-what-your-lymph-nodes-have-done-for-you-lately-202310102980" style="text-decoration:underline" target="_blank">lymph nodes</a> may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.</p>
        <h2>The bottom line</h2>
        <p>"It's important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve," says Dr. Mostaghimi. You'll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you're done does not mean you need another course of antibiotics or a different antibiotic, he says.</p>
    ]]></description>
            <pubDate>Mon, 20 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</guid>
            <link>https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</link>
        </item>
        <item>
            <title><![CDATA[What to do when driving skills decline]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a square-topped gold car key and a gold car on a key ring against a deep yellow background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14502/bcb42e0d-03e3-4752-8f23-2286f283fb97.jpg" style="height:399px; width:600px" class="ucr-content-image" data-cr-imageid="bcb42e0d-03e3-4752-8f23-2286f283fb97" referrerpolicy="no-referrer">
        </p>
        <p>
          <em>Part 2 of a two-part series on making decisions about driving as we age. Read Part 1 <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">here</a>.&nbsp; </em>
        </p>
        <p>It's a simple but unfortunate fact: driving skills can wane over time.</p>
        <p>Eventually, <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">driving can become unsafe</a> for an older driver, their passengers, and others on the road. If you notice a decline in driving abilities in a loved one, or in yourself, what's the best way to handle this?</p>
        <h2>If you're an older driver: Create an action plan</h2>
        <p>If you're an older driver, don't wait for a near-miss or an accident to think about the next steps. Planning ahead can help you tackle fixable issues, make necessary transitions easier, and avoid harming yourself or someone else.</p>
        <p>Here are six measures you can take right now:</p>
        <p><strong>Have a frank conversation with a trusted friend or family member.</strong> After driving with them as a passenger, ask whether they are worried about your driving. <a href="https://www.health.harvard.edu/staying-healthy/what-to-do-when-your-kids-confront-you-about-your-health" style="text-decoration:underline" target="_blank">Don't disregard their comments</a>, even if they share things you don't want to hear.</p>
        <p><strong>See your doctor and talk about your driving.</strong> Is it harder to see at night? Are you finding you're slower to react? Ask your doctor about medical care that can help, such as cataract surgery, treatment for sleep apnea, or adjustments to medications that might affect driving.</p>
        <p><strong>Take a self-evaluation test or an on-road test.</strong><a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/evaluate-your-driving-ability/" style="text-decoration:underline" target="_blank">AAA has tools</a> to help with this, or you can check with your local <a href="https://www.usa.gov/state-motor-vehicle-services" style="text-decoration:underline" target="_blank">department of motor vehicles</a> for options. Even if you feel it's unnecessary, a driving test can be reassuring to your loved ones that you're still safe behind the wheel.</p>
        <p><strong>Take driving classes.</strong> In many places, there are general refresher courses, courses for defensive driving, and even simulators that don't require actual road tests. <a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/aaa-roadwise-driver/" style="text-decoration:underline" target="_blank">AAA</a> and <a href="https://www.aarpdriversafety.org/?_ga=2.62395948.1812440934.1661463375-2048398612.1661463373" style="text-decoration:underline" target="_blank">AARP</a> offer online courses that can help you improve your driving. (And by the way, these courses may also reduce the cost of your auto insurance!)</p>
        <p><strong>Consider alternatives to how you drive.</strong> Stick to roads that are close to home or to routes that have traffic lights (rather than having to decide when traffic is clear enough to turn). Consider giving up night driving if that is particularly difficult.</p>
        <p><strong>Make adjustments to your car that can help.</strong> Examples include using a steering wheel cover to improve your grip or changing the position of your seat to improve your view of the road. Check out the <a href="https://car-fit.org/" style="text-decoration:underline" target="_blank">CarFit program</a> that aims to optimize the "fit" of a driver in their car.</p>
        <p>In addition, explore options that don't require you to drive as often or at all:</p>
        <ul>
          <li>grocery delivery</li>
          <li>public or senior transportation (if offered or available where you live)</li>
          <li>carpooling with friends or family</li>
          <li><a href="https://www.aarp.org/home-family/personal-technology/info-2022/ride-hailing.html" style="text-decoration:underline" target="_blank">ride-hailing services</a> or taxis</li>
          <li>hiring a driver.</li>
        </ul>
        <p>Cost and availability may be barriers, but it's worth looking into these options.</p>
        <h2>If you're a concerned family member or friend: Start a conversation</h2>
        <p>With so much at stake, the language you use matters. So, it's a good idea to think ahead about <em>how</em> to talk about these challenges.</p>
        <p><strong>Put safety and solutions first. </strong>It's best not to lead by criticizing driving skills. Instead, talk about driving with safety and solutions in mind, such as the options described above.</p>
        <p><strong>Choose your words carefully.</strong> It helps to avoid threats or confrontational language: rather than saying "Your driving is terrible so I've taken away your keys," <a href="https://www.thehartford.com/resources/mature-market-excellence/publications-on-aging" style="text-decoration:underline" target="_blank">focus on safety and support</a>:</p>
        <ul>
          <li style="list-style-type:none">&nbsp;</li>
          <li>
            <em>Let's talk about how I can help so you don't have to drive. I can drive you to get your groceries on Sundays and we can make a day of it!</em>
          </li>
          <li>
            <em>How do you think those dents got on your car? Are you having trouble with your vision?</em>
          </li>
          <li><em>We'd all feel terrible if you had an accident and got hurt or hurt someone else</em>.</li>
        </ul>
        <p><strong>Offer to go for a ride together and then to talk about specific concerns</strong>, such as staying in the proper lane, changing lanes, making left-hand turns, speed, or sudden braking. Encourage consideration of a self-evaluation or on-road test, and driving classes to help polish skills.</p>
        <p><strong>Use examples from familiar experiences.</strong> It can be helpful to remind your loved one how his or her parents or grandparents had to cut back on their driving, or how an older neighbor was an unsafe driver.</p>
        <p><strong>Focus on the risks posed by <em>other</em> drivers.</strong> Aggressive or unpredictable drivers can pose more danger to older drivers with slower reaction times.</p>
        <h2>How else can families or friends of older drivers be helpful?</h2>
        <ul>
          <li><strong>Consider whether to contact their doctor.</strong> Ask their doctor if it's possible to talk with your loved one or friend about their driving. State regulations vary on <a href="https://pubmed.ncbi.nlm.nih.gov/29386271/" style="text-decoration:underline" target="_blank">mandatory reporting</a> of conditions that affect a patient's ability to drive. Be aware that some doctors may be reluctant to report their patients to their registry of motor vehicles, due to concerns about patient privacy or jeopardizing the patient-doctor relationship.</li>
          <li><strong>Look into </strong><a href="https://www.iihs.org/topics/older-drivers/license-renewal-laws-table" style="text-decoration:underline" target="_blank"><strong>rules and regulations around older drivers</strong></a><strong> where your loved one lives.</strong> Illinois is currently the only state that <a href="https://www.ilsos.gov/services/services_for_seniors/programs.html" style="text-decoration:underline" target="_blank">requires a road test for older drivers</a>. But many states require vision tests and in-person renewal with increasing frequency for older drivers.</li>
          <li><strong>Consider reporting an unsafe driver to traffic safety authorities.</strong> This may feel like a betrayal, but if other efforts have failed this option might be better than waiting until there's a serious accident.</li>
        </ul>
        <h2>The bottom line</h2>
        <p>In the future, safe, driverless cars may be a solution to the challenge of waning driving skills among older drivers. But we're not there yet.</p>
        <p>Right now, we should all acknowledge that it's not easy to address concerns about impaired older drivers. My best advice is that older drivers and their loved ones try to talk about ways to remain a safe driver and put a plan in place. Ideally, we all would start the conversation well before any driving problems are evident.</p>
        <p>And it may take more than one conversation. Many more. But let's face it: sooner or later, most drivers will have to stop driving. For some older drivers, that time may be now. For the rest of us, recognizing this eventuality could help when our time comes.</p>
    ]]></description>
            <pubDate>Wed, 15 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</guid>
            <link>https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</link>
        </item>
        <item>
            <title><![CDATA[A tough question: When should an older driver stop driving?]]></title>
            <description><![CDATA[<p><img alt="Abstract of traffic on city highway at night with glaring headlights forming big, colored dots " class="ucr-content-image" data-cr-imageid="f6fd51a8-b6bf-4a40-9b61-0067cf611802" height="443" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14503/f6fd51a8-b6bf-4a40-9b61-0067cf611802.jpg" width="788" referrerpolicy="no-referrer"></p>
<p><em>Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">here</a>.&nbsp; </em></p>
<p>When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: "the sun was in my eyes" or "your grandfather distracted me." Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn't agree that her driving was a problem, and didn't appreciate our concerns.</p>
<p>Maybe there's a similar story unfolding in your family. Or maybe you're starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.</p>
<p>A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.</p>
<h2>How safe are older drivers on the road?</h2>
<p>Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:</p>
<ul>
<li>Fatalities occurring in crashes involving a driver ages 15 to 20 <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/teen-drivers/" style="text-decoration:underline" target="_blank">rose nearly 10% between 2020 and 2021</a>, accounting for 5,565 deaths.</li>
<li>Among drivers 65 or older, <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/older-drivers/" style="text-decoration:underline" target="_blank">fatalities rose 15% between 2020 and 2021</a>, accounting for more than 8,200 deaths.</li>
</ul>
<p>While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often <a href="https://pubmed.ncbi.nlm.nih.gov/32089137/" style="text-decoration:underline" target="_blank">overestimate their driving abilities</a>. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.</p>
<p>Per mile driven, the rate of motor vehicle accidents <a href="https://www.iihs.org/topics/older-drivers" style="text-decoration:underline" target="_blank">is higher for drivers ages 80 and older</a> than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of <em>fatal</em> motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.</p>
<p>These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.</p>
<p>Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it's important to recognize the problem and understand why it's happening. The following four steps are a good start.</p>
<h2>1. Seeing any red flags?</h2>
<p>As people get older, driving skills may decline so slowly that it's not obvious worrisome changes are happening. Even when mishaps and near-misses occur, there are so many possible contributors — especially other drivers — that it may not be clear that the older driver was at fault.</p>
<p>Red flags that might mean an older person is an unsafe driver include:</p>
<ul>
<li>concerned comments from family or friends</li>
<li>reluctance of others to ride with them</li>
<li>input from other drivers (<em>why is everyone honking at me?</em>) or traffic authorities (<em>why am I getting all these traffic tickets?</em>)</li>
<li>getting lost on familiar roads</li>
<li>consistently driving too slowly or too fast</li>
<li>unexplained dents or scratches appearing on the car</li>
<li>frequent accidents or near-misses.</li>
</ul>
<h2>2. Why do driving skills tend to wane with age?</h2>
<p>While people of advanced age <em>can</em> safely drive (and many do!), <a href="https://pubmed.ncbi.nlm.nih.gov/37656444/" style="text-decoration:underline" target="_blank">driving skills may wane</a> due to:</p>
<ul>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/34700248/" style="text-decoration:underline" target="_blank">medical conditions</a>, such as arthritis, neuropathy, or dementia</li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/37773496/" style="text-decoration:underline" target="_blank">medications</a>, such as sedatives or certain antidepressants</li>
<li>age-related changes in reaction time</li>
<li>trouble with vision or hearing</li>
<li>other physical changes related to aging, such as less flexibility or strength</li>
<li>difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.</li>
</ul>
<h2>3. What can — and can't — be reversed to improve driving?</h2>
<p>Some changes that impair driving can be reversed or a workaround can be found. For example, if driving is impaired due to cataracts, cataract surgery can restore vision and improve driving. If night driving is difficult, it's best to drive only during the day. If <a href="https://www.health.harvard.edu/blog/whats-the-relationship-between-memory-loss-and-driving-202210122829" style="text-decoration:underline" target="_blank">memory problems are starting to arise</a>, it may still be possible to drive safely in more limited circumstances.</p>
<p>Driving problems due to advanced dementia or a major stroke affecting judgment and physical skills are much less likely to improve.</p>
<h2>4. Accept that conversations about not driving are challenging</h2>
<p>If there is no simple way to reverse or work around declining driving skills, accept that there will be many challenges to navigate, whether you're the older driver or a family member.</p>
<p>Challenges facing the driver:</p>
<ul>
<li><strong>It's not easy to acknowledge declining function.</strong> Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.</li>
<li><strong>It can feel unnecessary and unreasonable.</strong> Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.</li>
<li><strong>Denial and defensiveness are common.</strong> Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).</li>
<li><strong>Not driving is a loss of independence.</strong> Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.</li>
</ul>
<p>Challenges facing the family:</p>
<ul>
<li><strong>Often, the older driver doesn't share their family's concerns about driving safety.</strong> This can lead to arguments, confrontation, and resentment.</li>
<li><strong>The safety of others is at stake.</strong> The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.</li>
<li><strong>It's hard to know when the time is right.</strong> Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.</li>
</ul>
<h2>Finding a path forward</h2>
<p>As for my grandmother, none of us knew what to say. Should we try to get her to agree to stop driving entirely or let her ease into the idea over time? Maybe she could stop driving at night or limit her driving to short distances. Should we bring it to the attention of her doctor and let them direct the next steps? Or should we take an even harder step and report her to the authorities?</p>
<p>If you're asking similar questions — or if you're starting to wonder about your own driving abilities — you may feel strongly that it's important to respect individual preferences, dignity, and independence. Yet you also want to protect everyone from harm.</p>
<p>What are the best ways to strike a balance? Can you test and improve how an older driver is doing behind the wheel? Can you navigate tough conversations in ways that allow room for both independence and safety? These are the subjects to be tackled in <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">Part 2</a>.</p>
    ]]></description>
            <pubDate>Mon, 13 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</guid>
            <link>https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</link>
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            <title><![CDATA[Opill: Is this new birth control pill right for you?]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a silver blister pack of birth control pills with the four rows of days of the week" src="http://content.health.harvard.edu/wp-content/uploads/2023/11/ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd.jpg" style="height:339px; width:600px" imageid="ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd" referrerpolicy="no-referrer">
        </p>
        <p>Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. Just this past summer, the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter. This offers many more people access to a new nonprescription option for preventing pregnancy.</p>
        <p>Opill may be available early in 2024, although the exact date and cost are not yet known. Here's what anyone interested — adults, parents, and teens — should know.</p>
        <h2>What is in Opill and how does it work?</h2>
        <p>Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by</p>
        <ul>
          <li>affecting ovulation so that the ovaries do not release an egg every month</li>
          <li>thickening cervical mucus, which blocks sperm from reaching an egg</li>
          <li>changing the uterine lining in ways that keep a fertilized egg from implanting.</li>
        </ul>
        <h2>How effective is Opill at preventing pregnancy?</h2>
        <p>It depends on how consistent you are about taking Opill:</p>
        <ul>
          <li><strong>Perfect use</strong> means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.</li>
          <li><strong>Typical use</strong> averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don't take it perfectly, at least nine could become pregnant in a year.</li>
        </ul>
        <p>It's also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.</p>
        <h2>How do you take Opill?</h2>
        <ul>
          <li>Take it once a day at the same time each day until you finish the entire pack.</li>
          <li>Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.</li>
          <li>After you complete a 28-day pack, you should immediately start a new pack of pills the next day.</li>
        </ul>
        <h2>What happens if you forget to take a dose at the specific time or miss a dose?</h2>
        <ul>
          <li>If you take the pill more than three hours late it will not be as effective at preventing pregnancy.</li>
          <li>Take the missed pill as soon you remember.</li>
          <li>You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.</li>
        </ul>
        <h2>Is Opill safe for teenagers?</h2>
        <p>Opill is generally safe for most people who could get pregnant, including teenagers. There's no evidence to suggest that safety or side effects are different in teenagers compared with adults.</p>
        <p>Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.</p>
        <h2>When teens use birth control, what is the best choice for them?</h2>
        <p>There isn't a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.</p>
        <p>For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.</p>
        <p>Learn more about different contraception methods at the <a href="https://youngwomenshealth.org/guides/contraception/" style="text-decoration:underline" target="_blank">Center for Young Women's Health</a> website.</p>
        <h2>What side effects are common with Opill?</h2>
        <p>Progestin-only pills are usually associated with mild side effects. The most common side effects are:</p>
        <ul>
          <li>unexpected vaginal bleeding or spotting</li>
          <li>acne</li>
          <li>headache</li>
          <li>gastrointestinal symptoms such as nausea, abdominal pain, and bloating</li>
          <li>change in appetite.</li>
        </ul>
        <p>Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.</p>
        <h2>Will Opill cause any mood changes?</h2>
        <p>Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.</p>
        <p>Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.</p>
        <h2>Can it be used as emergency birth control?</h2>
        <p>No, it should not be used as <a href="https://youngwomenshealth.org/guides/emergency-contraception/" style="text-decoration:underline" target="_blank">emergency birth control</a>.</p>
        <h2>What should you know about STIs?</h2>
        <p>This type of birth control does not protect you from <a href="https://www.cdc.gov/std/default.htm" style="text-decoration:underline" target="_blank">sexually transmitted infections</a> (STIs) such as syphilis, gonorrhea, or chlamydia.</p>
        <p>You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.</p>
        <p>Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A <a href="https://www.cdc.gov/hiv/basics/prep.html" style="text-decoration:underline" target="_blank">medicine called PrEP</a> can help prevent HIV. Ask your medical team for more information about the right choices for you.</p>
        <h2>When will Opill be available and what will it cost?</h2>
        <p>The timeline for availability and the cost of medication is determined by the manufacturer. At time of FDA approval, it was expected to hit shelves in early 2024. No updates have been released for the exact date or estimated cost of the medication.</p>
    ]]></description>
            <pubDate>Wed, 08 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</guid>
            <link>https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</link>
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        <item>
            <title><![CDATA[Do children get migraine headaches? What parents need to know]]></title>
            <description><![CDATA[<p><img alt="Brown-haired boy lying on colorful spread, looks pained, one hand covering an eye, other eye shut &amp; other hand tucked behind head; concept is migraine headache" class="ucr-content-image" data-cr-imageid="cf914d00-e65a-4a1f-9d1d-146785bd94b1" height="400" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14489/cf914d00-e65a-4a1f-9d1d-146785bd94b1.jpg" width="600" referrerpolicy="no-referrer"></p>
<p>Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/" style="text-decoration:underline" target="_blank">one in 10 children and teens</a> overall. &nbsp;</p>
<p>What should you know — and do — if you think your child or teen may be having migraines?</p>
<h2>How early do migraines start to occur?</h2>
<p>We don't tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.</p>
<p>Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.</p>
<h2>Which migraine symptoms are most common in children?</h2>
<p>Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.</p>
<p>While it's not always easy to tell a migraine from another kind of headache, children</p>
<ul>
<li>often report throbbing pain</li>
<li>may experience nausea and sensitivity to light and noise.</li>
</ul>
<p>The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.</p>
<h2>What causes migraines in children?</h2>
<p>We don't know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.</p>
<p>Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.</p>
<h2>Can migraines be prevented?</h2>
<p>The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it's a good idea to keep a headache diary.</p>
<p>When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child's particular triggers.</p>
<p>It's a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!</p>
<h2>How can you help your child ease a migraine?</h2>
<p>When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it's not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.</p>
<p>It's important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!</p>
<h2>Are there prescription medicines that can help children with migraines?</h2>
<p>If those approaches aren't enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.</p>
<p>If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.</p>
<p>Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.</p>
<h2>When to contact your doctor</h2>
<p>If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.</p>
<p>You should always call your doctor, or go to an emergency room, if your child has a severe headache, <a href="https://www.health.harvard.edu/blog/8-things-to-watch-for-when-your-child-has-a-headache-2017051611761" target="_blank">a stiff neck</a>, trouble with coordination or movement, is abnormally sleepy, or isn't talking or behaving normally.</p>
<p>The American Academy of Pediatrics has additional <a href="https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx" style="text-decoration:underline" target="_blank">useful information</a> about migraines, and how to treat and prevent them, on their website.</p>
    ]]></description>
            <pubDate>Mon, 06 Nov 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</guid>
            <link>https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</link>
        </item>
        <item>
            <title><![CDATA[Does running cause arthritis?]]></title>
            <description><![CDATA[<p>
          <img alt="A middle-aged man wearing a blue zip top and lighter blue track pants running alongside a blurred cityscape" src="http://content.health.harvard.edu/wp-content/uploads/2023/05/2434e7c0-3082-4e6a-9556-3e36e6f38b4c.jpg" style="height:410px; width:600px" imageid="2434e7c0-3082-4e6a-9556-3e36e6f38b4c" referrerpolicy="no-referrer">
        </p>
        <p>When I took up running in college, a friend of mine scoffed at the idea. He hated running and was convinced runners were "wearing out" their joints. He liked to say he was saving his knees for his old age.</p>
        <p>So, was he onto something? Does running really ruin your joints, as many people believe?</p>
        <h2>Runners can get arthritis, but is running the cause?</h2>
        <p>You may think the answer is obvious. Surely, years of running (pounding pavements, or even softer surfaces) could wear out your joints, much like tires wear out after you put enough miles on them. And <a href="https://www.health.harvard.edu/a_to_z/osteoarthritis-a-to-z" target="_blank">osteoarthritis</a>, the most common type of arthritis, usually affects older adults. In fact, it's often described as age-related and degenerative. That sounds like a wear-and-tear sort of situation, right?</p>
        <p>Maybe not. Sure, it's easy to blame running when a person who runs regularly develops arthritis. But that blame may be misguided. The questions to ask are:</p>
        <ul>
          <li>Does running damage the joints and lead to arthritis?</li>
          <li>Does arthritis develop first and become more noticeable while running?</li>
          <li>Is the connection more complicated? Perhaps there's no connection between running and arthritis for most people. But maybe those destined to develop arthritis (due to their genes, for example) get it sooner if they take up running.</li>
        </ul>
        <p>Extensive research over the last several decades has investigated these questions. While the answers are still not entirely clear, we're moving closer.</p>
        <h2>What is the relationship between running and arthritis?</h2>
        <p>Mounting evidence suggests that that running does <em>not</em> cause osteoarthritis, or any other joint disease.</p>
        <ul>
          <li>A study published in 2017 found that <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/" target="_blank">recreational runners had lower rates of hip and knee osteoarthritis</a> (3.5%) compared with competitive runners (13.3%) and nonrunners (10.2%).</li>
          <li>According to a 2018 study, the rate of hip or knee arthritis among 675 marathon runners was <a href="https://www.oarsijournal.com/article/S1063-4584(22)00923-2/fulltext" target="_blank">half the rate expected</a> within the US population.</li>
          <li>A 2022 analysis of 24 studies found <a href="https://www.oarsijournal.com/article/S1063-4584(22)00923-2/fulltext" target="_blank">no evidence of significant harm to the cartilage lining the knee joints</a> on MRIs taken just after running.</li>
        </ul>
        <p>These are just a few of the published medical studies on the subject. Overall, research suggests that running is an unlikely cause of arthritis — and might even be protective.</p>
        <h2>Why is it hard to study running and arthritis?</h2>
        <ul>
          <li><strong>Osteoarthritis takes many years to develop.</strong> Convincing research would require a long time, perhaps a decade or more.</li>
          <li><strong>It's impossible to perform an ideal study.</strong> The most powerful type of research study is a double-blind, randomized, controlled trial. Participants in these studies are assigned to a treatment group (perhaps taking a new drug) or a control group (often taking a placebo). Double-blind means neither researchers nor participants know which people are in the treatment group and which people are getting a placebo. When the treatment being studied is running, there's no way to conduct this kind of trial.</li>
          <li><strong>Beware the confounders.</strong> A confounder is a factor or variable you can't account for in a study. There may be important differences between people who run and those who don't that have nothing to do with running. For example, runners may follow a healthier diet, maintain a healthier weight, or smoke less than nonrunners. They may differ with respect to how their joints are aligned, the strength of their ligaments, or genes that direct development of the musculoskeletal system. These factors could affect the risk of arthritis and make study results hard to interpret clearly. In fact, they may explain why some studies find that running is protective.</li>
          <li><strong>The effect of running may vary between people.</strong> For example, it's possible, though not proven, that people with obesity who run regularly are at increased risk of arthritis due to the stress of excess weight on the joints.</li>
        </ul>
        <h2>The bottom line</h2>
        <p>Trends in recent research suggest that running does not wear out your joints. That should be reassuring for those of us who enjoy running. And if you don't like to run, that's fine: try to find forms of exercise that you enjoy more. Just don't base your decision — or excuse — for not running on the idea that it will ruin your joints.</p>
    ]]></description>
            <pubDate>Wed, 26 Apr 2023 00:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/does-running-cause-arthritis-202304262930</guid>
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            <title><![CDATA[3 ways to create community and counter loneliness]]></title>
            <description><![CDATA[<p>
          <img alt="A high, overhead view looking down on a large crowd of tiny people and one tiny person standing alone in an empty, white, heart-shaped space " src="http://content.health.harvard.edu/wp-content/uploads/2023/04/24b364ff-eead-4160-9c1a-13890a2a4ad2.jpg" style="height:375px; width:600px" imageid="24b364ff-eead-4160-9c1a-13890a2a4ad2" referrerpolicy="no-referrer">
        </p>
        <p>Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you're surrounded by people — even friends and family.</p>
        <p>Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, <a href="https://www.health.harvard.edu/mind-and-mood/protecting-against-cognitive-decline">declining thinking skills</a>, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.</p>
        <h2>Taking the first steps</h2>
        <p>Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.</p>
        <p>Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. "That's a challenge as we get older, because people are often established in their social groups and aren't as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did," says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.</p>
        <p>Trying these strategies can help.</p>
        <h2>1. Seek like-minded souls</h2>
        <p>Being around people who share your interests gives you a head start on making friends: you already have something in common.</p>
        <p>Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you'd like to try.</p>
        <p>Once you join a group, you'll need to take part in it regularly to build bonds. If you can gather in person, it's even better. "The part of our brain involved in social connection is stimulated by all five senses. When you're with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen," Dr. Olds says.</p>
        <h2>2. Create opportunities</h2>
        <p>If joining someone else's group is unappealing, start your own. Host gatherings at your place or elsewhere. "All it takes is three people. You can say, 'Let's read books or talk about a TV show or have a dinner group on a regular basis,'" Dr. Olds says.</p>
        <p>Other ideas for gatherings — either weekly or monthly — include:</p>
        <ul>
          <li>game nights</li>
          <li>trivia nights</li>
          <li>hikes in interesting parks</li>
          <li>beach walks</li>
          <li>bird-watching expeditions</li>
          <li>running or cycling</li>
          <li>
            <a href="https://www.health.harvard.edu/blog/easily-distracted-try-meditation-202109232600">meditation</a>
          </li>
          <li>museum visits</li>
          <li>cooking</li>
          <li>knitting, sewing, or crafting</li>
          <li>shopping</li>
          <li>day trips to nearby towns</li>
          <li>jewelry making</li>
          <li>collector show-and-tell (comic books, antique dolls, baseball cards).</li>
        </ul>
        <p>The people you invite don't have to be dear friends; they can just be people you'd like to get to know better — perhaps neighbors or work acquaintances.</p>
        <p>If they're interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. "Don't be timid. Say, 'Let's get our calendars out and get this scheduled,'" Dr. Olds says.</p>
        <h2>3. Brush up your social skills</h2>
        <p>Sometimes we're rusty in surface social graces that help build deeper connections. "It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are," Dr. Olds says.</p>
        <p>Tips to practice:</p>
        <ul>
          <li><strong>Smile more.</strong> Smiling is welcoming, inviting, and hospitable to others.</li>
          <li><strong>Be engaging.</strong> Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you've gathered (if it's a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. "Maybe the person is wearing a pretty brooch. Ask if there's a story behind it," Dr. Olds suggests.</li>
          <li><strong>Be a good listener.</strong> "Listen in a way that someone realizes you're paying attention. Hold their gaze, nod your head or say 'Mm hmm' as they're talking so you give feedback. Assume everyone in the world is just yearning for your feedback," Dr. Olds says.</li>
          <li><strong>Ask follow-up questions.</strong> Don't ignore signals that someone has interesting stories to tell. "If they allude to something, your job is to look fascinated and ask if they can tell you more. They're dropping crumbs on a path to a deeper exchange," Dr. Olds notes.</li>
        </ul>
        <p>Even chats that don't lead to friendships can be enriching. A 2022 study found that people who had the most <a href="https://www.pnas.org/doi/10.1073/pnas.2120668119">diverse portfolios of social interactions</a> — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.</p>
        <p>Ultimately, a wide variety of interactions contributes to well-being, whether you're talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.</p>
    ]]></description>
            <pubDate>Wed, 08 Mar 2023 00:00:00 GMT</pubDate>
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            <link>https://www.health.harvard.edu/blog/3-ways-to-create-community-and-counter-loneliness-202303082900</link>
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            <title><![CDATA[Holiday arguments brewing? Here's how to defuse them]]></title>
            <description><![CDATA[<p>
          <img alt="A round black time bomb with an illustrated brown striped, curvy fuse and yellow and orange paper flames at the end showing that it's been lit" src="http://content.health.harvard.edu/wp-content/uploads/2023/04/1380ed22-af68-4a71-88d7-57be377b5d5e.jpg" style="height:337px; width:600px" imageid="1380ed22-af68-4a71-88d7-57be377b5d5e" referrerpolicy="no-referrer">
        </p>
        <p>The holidays, as painted by idealists, are hardly the time for disagreements. They're supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don't have to get drawn into arguments if you plan ahead and stay alert for potential triggers.</p>
        <h2>Why do we fight at the holidays?</h2>
        <p>In many ways, we are primed for holiday arguments. "It's a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We're trying to juggle work and get time off," says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. "The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support."</p>
        <p>As a result, we are often emotionally vulnerable during the holidays, Gillis says. It's hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.</p>
        <p>"When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict," Gillis says.</p>
        <p>Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.</p>
        <h2>Plan ahead to help defuse emotions and arguments</h2>
        <p>It's challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if a

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            <title><![CDATA[What does a birth doula do?]]></title>
            <description><![CDATA[<p>
          <img alt="A birth doula in blue top smiles at a pregnant woman seen from the side wearing a hospital gown" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14566/4363d72b-26d0-4308-8327-d9122eb1fe4d.jpg" style="height:400px; width:600px" class="ucr-content-image" data-cr-imageid="4363d72b-26d0-4308-8327-d9122eb1fe4d" referrerpolicy="no-referrer">
        </p>
        <p>Childbirth — painful, messy, unpredictable — has been part of humankind for time immemorial. And in the US, which has surprisingly high rates of avoidable complications and <a href="https://www.commonwealthfund.org/publications/issue-briefs/2022/apr/health-and-health-care-women-reproductive-age" style="text-decoration:underline" target="_blank">maternal deaths</a>, more people seem to be seeking out doulas for additional care during pregnancy and birth, says Natalia Richey, interim chief midwife in the Department of Obstetrics and Gynecology at Massachusetts General Hospital.</p>
        <p>Some research suggests that doula care may benefit both mother and baby. But what does a birth doula do? While neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birthing process.</p>
        <p>Here's what to know if you're considering doula care.</p>
        <h2>What's the difference between doulas and midwives?</h2>
        <p>Midwives and doulas tend to have a few overlapping duties. But there's a key difference: midwives provide medical care and doulas don't.</p>
        <ul>
          <li><strong>Midwives:</strong> Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.</li>
          <li><strong>Doulas:</strong> Unlike midwives, doulas don't perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.</li>
        </ul>
        <p>"Many women hire doulas if they're trying to have an unmedicated birth," Richey says. "Doulas are really good at knowing what techniques — such as walking, showering, massage, or aromatherapy — can help a woman through the pain. It's like having a coach."</p>
        <h2>Are doulas trained or licensed?</h2>
        <p>Be aware that doula training varies widely. There are no formal rules requiring licensing or certification. Many doulas, however, seek certification from the more than 100 independent organizations that offer some type of doula training and credentials, according to the <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">National Health Law Program</a>.</p>
        <h2>Is doula care covered by insurance?</h2>
        <p>Private insurers often do not cover doula care, which can cost several thousand dollars when arranged for privately.</p>
        <p>However, some employers — including <a href="https://apnews.com/article/walmart-doulas-maternal-care-national-black-doulas-association-ad206d3a4fede48cf2605a0df34b8fcb" style="text-decoration:underline" target="_blank">Walmart</a> — will help pay for doula care. And <a href="https://www.bmc.org/obstetrics/birth-sisters" style="text-decoration:underline" target="_blank">some hospital systems</a>, particularly in low-income or medically underserved areas, have doula programs aimed at improving maternal care during and after pregnancy. Others <a href="https://www.massgeneral.org/obgyn/news/striving-equitable-birth-outcomes-doula-care" style="text-decoration:underline" target="_blank">may arrange doula support</a> for people with limited resources who might otherwise be alone during the later stages of pregnancy and birth.</p>
        <p>As of February 2023, 10 states and the District of Columbia <a href="https://healthlaw.org/doula-medicaid-training-and-certification-requirements-summary-of-current-state-approaches-and-recommendations-for-improvement/" style="text-decoration:underline" target="_blank">provided Medicaid coverage for doula services</a>. Other states are in the midst of implementing coverage. Most of the states that provide Medicaid coverage for doula care require doulas to be trained or certified by an approved organization.</p>
        <h2>Can working with a doula improve birth outcomes?</h2>
        <p>A 2023 analysis in the journal <em>Cureus</em> reviewed 16 individual studies done over 22 years. It found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/" style="text-decoration:underline" target="_blank">doula support was linked with better birth outcomes</a>, such as fewer C-sections and premature deliveries, and shorter length of labor.</p>
        <p>Additionally, the emotional support provided by doulas was associated with less anxiety and stress in birthing mothers. Among low-income women, doula support was shown to improve breastfeeding success.</p>
        <p>"It's impressive," Richey says. "I think those improved outcomes are due to having an expert in the labor process who isn't a medical person but is just there for you from moment to moment."</p>
        <h2>How do people collaborate with doulas?</h2>
        <p>Agreements about care vary. Typically, doulas meet with women every few months through their pregnancy to discuss their goals for birth (such as skipping pain medication, for example), and to build rapport with both the expectant person and their spouse or partner.</p>
        <p>Like obstetricians, doulas are on call 24/7 to support clients who have gone into labor or who have their labor induced. Doulas stay throughout the birth process.</p>
        <p>"Having someone there who's seen quite a few births, who can support and advocate for them, can be a huge comfort," says Richey.</p>
        <p>This may be especially important to women with limited resources, particularly those who might otherwise be alone during the later stages of pregnancy and birth. "Doulas remind women that they're okay and can get through this process — all the things many of us take for granted," Richey says.</p>
        <h2>How might a doula work with the OB/GYN team?</h2>
        <p>Usually, this is a seamless process, Richey says. If a hospital arranges for a woman's doula, OB/GYN team members may meet the doula a couple of times before childbirth. Meanwhile, a doula who's been hired privately will usually only meet the larger OB/GYN team when the woman arrives at the hospital to give birth.</p>
        <p>When everyone sticks to their assigned roles, all goes smoothly. For a doula, that may mean suggesting nonpharmacological ways to ease pain and help labor progress. Boundaries are important, though, when medical intervention is needed.</p>
        <p>"If the baby's heart rate is down, for instance, the expertise needs to be left to the midwife or doctor," Richey explains.</p>
        <h2>What questions should you ask if you're interested in working with a doula?</h2>
        <p>Richey suggests starting by asking yourself:</p>
        <ul>
          <li>What are my hopes and goals for the childbirth process? Might a doula enhance my ability to achieve them?</li>
          <li>How do I envision my support team during delivery? Do I have a partner, a mom, or a friend I want there? Would a doula add to any support I already have?</li>
          <li>Do I have friends or family members who have used doulas in the past? What were their impressions of the experience? Can they recommend a doula?</li>
        </ul>
        <p>If you contact a doula to explore your options, ask about:</p>
        <ul>
          <li>their training and certification</li>
          <li>how many births they've attended</li>
          <li>how they believe they can help you during your pregnancy and during labor</li>
          <li>how they will collaborate with your partner or spouse and the medical team</li>
          <li>whether they provide support after a birth — if so, what type of support and for how long?</li>
        </ul>
        <p>"Take the time to meet with any doula you're considering and make sure they're a good fit," Richey advises, "because this is someone who will be there during one of the most vulnerable times of your life. Having someone there who doesn't make you feel safe and comfortable can affect birth in a major way."</p>
    ]]></description>
            <pubDate>Wed, 22 Nov 2023 15:30:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</guid>
            <link>https://www.health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995</link>
            <author><![CDATA[Maureen Salamon]]></author>
        </item>
        <item>
            <title><![CDATA[Cellulitis: How long does it take to heal on legs?]]></title>
            <description><![CDATA[<p>
          <img alt="Illustration of round, bumpy, pink streptococcus bacteria, one cause of the skin infection cellulitis; dark purple background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14509/55ccb00e-2a59-4f8b-963b-09fcf5929752.jpg" style="height:337px; width:600px" class="ucr-content-image" data-cr-imageid="55ccb00e-2a59-4f8b-963b-09fcf5929752" referrerpolicy="no-referrer">
        </p>
        <p>Cellulitis is <a href="https://www.health.harvard.edu/a_to_z/cellulitis-a-to-z" style="text-decoration:underline" target="_blank">an infection of the deep layers of the skin</a>. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, <em>Staphylococcus</em> or <em>Streptococcus,</em> are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.</p>
        <p>Dr. Arash Mostaghimi, a dermatologist at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.</p>
        <h2>What are the symptoms of cellulitis?</h2>
        <p>The body's natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.</p>
        <h2>How is cellulitis treated?</h2>
        <p>The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.</p>
        <h2>How quickly can antibiotics help cellulitis resolve?</h2>
        <p>After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.</p>
        <p>Does that mean the antibiotic treatment was ineffective? Not necessarily, according to <a href="https://pubmed.ncbi.nlm.nih.gov/37849504/" style="text-decoration:underline" target="_blank">a recent study of people with cellulitis in the lower leg</a> that described the natural history of the healing stages following antibiotics.</p>
        <p>"The healing process has two parts, which is why a full recovery takes longer than you might think," says Dr. Mostaghimi.</p>
        <p>First, the antibiotics and your white blood cells work together to kill the bacteria. But your body's immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.</p>
        <h2>What did the study find?</h2>
        <p>The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:</p>
        <ul>
          <li>Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.</li>
          <li>A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.</li>
          <li>Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.</li>
        </ul>
        <p>This pattern of discomfort isn't unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they're often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)</p>
        <p>But after they feel better and start walking more, fluid shifts back down into the legs. So it's not surprising that the area might feel a little swollen and uncomfortable again once they're back on their feet, he says.</p>
        <h2>Who is at greatest risk for cellulitis?</h2>
        <p>Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.</p>
        <p>Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or <a href="https://www.health.harvard.edu/diseases-and-conditions/whats-causing-those-swollen-feet" style="text-decoration:underline" target="_blank">chronic edema</a> (swollen limbs).</p>
        <p>Additionally, skin conditions such as eczema and <a href="https://www.health.harvard.edu/blog/skin-in-the-game-two-common-skin-problems-and-solutions-for-men-202111222643" style="text-decoration:underline" target="_blank">athlete's foot</a> can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.</p>
        <h2>What happens if cellulitis goes untreated?</h2>
        <p>Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby <a href="https://www.health.harvard.edu/blog/wondering-what-your-lymph-nodes-have-done-for-you-lately-202310102980" style="text-decoration:underline" target="_blank">lymph nodes</a> may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.</p>
        <h2>The bottom line</h2>
        <p>"It's important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve," says Dr. Mostaghimi. You'll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you're done does not mean you need another course of antibiotics or a different antibiotic, he says.</p>
    ]]></description>
            <pubDate>Mon, 20 Nov 2023 15:30:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</guid>
            <link>https://www.health.harvard.edu/blog/cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994</link>
            <author><![CDATA[Julie Corliss]]></author>
        </item>
        <item>
            <title><![CDATA[What to do when driving skills decline]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a square-topped gold car key and a gold car on a key ring against a deep yellow background" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14502/bcb42e0d-03e3-4752-8f23-2286f283fb97.jpg" style="height:399px; width:600px" class="ucr-content-image" data-cr-imageid="bcb42e0d-03e3-4752-8f23-2286f283fb97" referrerpolicy="no-referrer">
        </p>
        <p>
          <em>Part 2 of a two-part series on making decisions about driving as we age. Read Part 1 <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">here</a>.&nbsp; </em>
        </p>
        <p>It's a simple but unfortunate fact: driving skills can wane over time.</p>
        <p>Eventually, <a href="https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132990" target="_blank">driving can become unsafe</a> for an older driver, their passengers, and others on the road. If you notice a decline in driving abilities in a loved one, or in yourself, what's the best way to handle this?</p>
        <h2>If you're an older driver: Create an action plan</h2>
        <p>If you're an older driver, don't wait for a near-miss or an accident to think about the next steps. Planning ahead can help you tackle fixable issues, make necessary transitions easier, and avoid harming yourself or someone else.</p>
        <p>Here are six measures you can take right now:</p>
        <p><strong>Have a frank conversation with a trusted friend or family member.</strong> After driving with them as a passenger, ask whether they are worried about your driving. <a href="https://www.health.harvard.edu/staying-healthy/what-to-do-when-your-kids-confront-you-about-your-health" style="text-decoration:underline" target="_blank">Don't disregard their comments</a>, even if they share things you don't want to hear.</p>
        <p><strong>See your doctor and talk about your driving.</strong> Is it harder to see at night? Are you finding you're slower to react? Ask your doctor about medical care that can help, such as cataract surgery, treatment for sleep apnea, or adjustments to medications that might affect driving.</p>
        <p><strong>Take a self-evaluation test or an on-road test.</strong><a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/evaluate-your-driving-ability/" style="text-decoration:underline" target="_blank">AAA has tools</a> to help with this, or you can check with your local <a href="https://www.usa.gov/state-motor-vehicle-services" style="text-decoration:underline" target="_blank">department of motor vehicles</a> for options. Even if you feel it's unnecessary, a driving test can be reassuring to your loved ones that you're still safe behind the wheel.</p>
        <p><strong>Take driving classes.</strong> In many places, there are general refresher courses, courses for defensive driving, and even simulators that don't require actual road tests. <a href="https://exchange.aaa.com/safety/senior-driver-safety-mobility/aaa-roadwise-driver/" style="text-decoration:underline" target="_blank">AAA</a> and <a href="https://www.aarpdriversafety.org/?_ga=2.62395948.1812440934.1661463375-2048398612.1661463373" style="text-decoration:underline" target="_blank">AARP</a> offer online courses that can help you improve your driving. (And by the way, these courses may also reduce the cost of your auto insurance!)</p>
        <p><strong>Consider alternatives to how you drive.</strong> Stick to roads that are close to home or to routes that have traffic lights (rather than having to decide when traffic is clear enough to turn). Consider giving up night driving if that is particularly difficult.</p>
        <p><strong>Make adjustments to your car that can help.</strong> Examples include using a steering wheel cover to improve your grip or changing the position of your seat to improve your view of the road. Check out the <a href="https://car-fit.org/" style="text-decoration:underline" target="_blank">CarFit program</a> that aims to optimize the "fit" of a driver in their car.</p>
        <p>In addition, explore options that don't require you to drive as often or at all:</p>
        <ul>
          <li>grocery delivery</li>
          <li>public or senior transportation (if offered or available where you live)</li>
          <li>carpooling with friends or family</li>
          <li><a href="https://www.aarp.org/home-family/personal-technology/info-2022/ride-hailing.html" style="text-decoration:underline" target="_blank">ride-hailing services</a> or taxis</li>
          <li>hiring a driver.</li>
        </ul>
        <p>Cost and availability may be barriers, but it's worth looking into these options.</p>
        <h2>If you're a concerned family member or friend: Start a conversation</h2>
        <p>With so much at stake, the language you use matters. So, it's a good idea to think ahead about <em>how</em> to talk about these challenges.</p>
        <p><strong>Put safety and solutions first. </strong>It's best not to lead by criticizing driving skills. Instead, talk about driving with safety and solutions in mind, such as the options described above.</p>
        <p><strong>Choose your words carefully.</strong> It helps to avoid threats or confrontational language: rather than saying "Your driving is terrible so I've taken away your keys," <a href="https://www.thehartford.com/resources/mature-market-excellence/publications-on-aging" style="text-decoration:underline" target="_blank">focus on safety and support</a>:</p>
        <ul>
          <li style="list-style-type:none">&nbsp;</li>
          <li>
            <em>Let's talk about how I can help so you don't have to drive. I can drive you to get your groceries on Sundays and we can make a day of it!</em>
          </li>
          <li>
            <em>How do you think those dents got on your car? Are you having trouble with your vision?</em>
          </li>
          <li><em>We'd all feel terrible if you had an accident and got hurt or hurt someone else</em>.</li>
        </ul>
        <p><strong>Offer to go for a ride together and then to talk about specific concerns</strong>, such as staying in the proper lane, changing lanes, making left-hand turns, speed, or sudden braking. Encourage consideration of a self-evaluation or on-road test, and driving classes to help polish skills.</p>
        <p><strong>Use examples from familiar experiences.</strong> It can be helpful to remind your loved one how his or her parents or grandparents had to cut back on their driving, or how an older neighbor was an unsafe driver.</p>
        <p><strong>Focus on the risks posed by <em>other</em> drivers.</strong> Aggressive or unpredictable drivers can pose more danger to older drivers with slower reaction times.</p>
        <h2>How else can families or friends of older drivers be helpful?</h2>
        <ul>
          <li><strong>Consider whether to contact their doctor.</strong> Ask their doctor if it's possible to talk with your loved one or friend about their driving. State regulations vary on <a href="https://pubmed.ncbi.nlm.nih.gov/29386271/" style="text-decoration:underline" target="_blank">mandatory reporting</a> of conditions that affect a patient's ability to drive. Be aware that some doctors may be reluctant to report their patients to their registry of motor vehicles, due to concerns about patient privacy or jeopardizing the patient-doctor relationship.</li>
          <li><strong>Look into </strong><a href="https://www.iihs.org/topics/older-drivers/license-renewal-laws-table" style="text-decoration:underline" target="_blank"><strong>rules and regulations around older drivers</strong></a><strong> where your loved one lives.</strong> Illinois is currently the only state that <a href="https://www.ilsos.gov/services/services_for_seniors/programs.html" style="text-decoration:underline" target="_blank">requires a road test for older drivers</a>. But many states require vision tests and in-person renewal with increasing frequency for older drivers.</li>
          <li><strong>Consider reporting an unsafe driver to traffic safety authorities.</strong> This may feel like a betrayal, but if other efforts have failed this option might be better than waiting until there's a serious accident.</li>
        </ul>
        <h2>The bottom line</h2>
        <p>In the future, safe, driverless cars may be a solution to the challenge of waning driving skills among older drivers. But we're not there yet.</p>
        <p>Right now, we should all acknowledge that it's not easy to address concerns about impaired older drivers. My best advice is that older drivers and their loved ones try to talk about ways to remain a safe driver and put a plan in place. Ideally, we all would start the conversation well before any driving problems are evident.</p>
        <p>And it may take more than one conversation. Many more. But let's face it: sooner or later, most drivers will have to stop driving. For some older drivers, that time may be now. For the rest of us, recognizing this eventuality could help when our time comes.</p>
    ]]></description>
            <pubDate>Wed, 15 Nov 2023 15:30:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</guid>
            <link>https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991</link>
            <author><![CDATA[Robert H. Shmerling, MD]]></author>
        </item>
        <item>
            <title><![CDATA[A tough question: When should an older driver stop driving?]]></title>
            <description><![CDATA[<p><img alt="Abstract of traffic on city highway at night with glaring headlights forming big, colored dots " class="ucr-content-image" data-cr-imageid="f6fd51a8-b6bf-4a40-9b61-0067cf611802" height="443" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14503/f6fd51a8-b6bf-4a40-9b61-0067cf611802.jpg" width="788" referrerpolicy="no-referrer"></p>
<p><em>Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">here</a>.&nbsp; </em></p>
<p>When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: "the sun was in my eyes" or "your grandfather distracted me." Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn't agree that her driving was a problem, and didn't appreciate our concerns.</p>
<p>Maybe there's a similar story unfolding in your family. Or maybe you're starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.</p>
<p>A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.</p>
<h2>How safe are older drivers on the road?</h2>
<p>Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:</p>
<ul>
<li>Fatalities occurring in crashes involving a driver ages 15 to 20 <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/teen-drivers/" style="text-decoration:underline" target="_blank">rose nearly 10% between 2020 and 2021</a>, accounting for 5,565 deaths.</li>
<li>Among drivers 65 or older, <a href="https://injuryfacts.nsc.org/motor-vehicle/road-users/older-drivers/" style="text-decoration:underline" target="_blank">fatalities rose 15% between 2020 and 2021</a>, accounting for more than 8,200 deaths.</li>
</ul>
<p>While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often <a href="https://pubmed.ncbi.nlm.nih.gov/32089137/" style="text-decoration:underline" target="_blank">overestimate their driving abilities</a>. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.</p>
<p>Per mile driven, the rate of motor vehicle accidents <a href="https://www.iihs.org/topics/older-drivers" style="text-decoration:underline" target="_blank">is higher for drivers ages 80 and older</a> than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of <em>fatal</em> motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.</p>
<p>These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.</p>
<p>Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it's important to recognize the problem and understand why it's happening. The following four steps are a good start.</p>
<h2>1. Seeing any red flags?</h2>
<p>As people get older, driving skills may decline so slowly that it's not obvious worrisome changes are happening. Even when mishaps and near-misses occur, there are so many possible contributors — especially other drivers — that it may not be clear that the older driver was at fault.</p>
<p>Red flags that might mean an older person is an unsafe driver include:</p>
<ul>
<li>concerned comments from family or friends</li>
<li>reluctance of others to ride with them</li>
<li>input from other drivers (<em>why is everyone honking at me?</em>) or traffic authorities (<em>why am I getting all these traffic tickets?</em>)</li>
<li>getting lost on familiar roads</li>
<li>consistently driving too slowly or too fast</li>
<li>unexplained dents or scratches appearing on the car</li>
<li>frequent accidents or near-misses.</li>
</ul>
<h2>2. Why do driving skills tend to wane with age?</h2>
<p>While people of advanced age <em>can</em> safely drive (and many do!), <a href="https://pubmed.ncbi.nlm.nih.gov/37656444/" style="text-decoration:underline" target="_blank">driving skills may wane</a> due to:</p>
<ul>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/34700248/" style="text-decoration:underline" target="_blank">medical conditions</a>, such as arthritis, neuropathy, or dementia</li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/37773496/" style="text-decoration:underline" target="_blank">medications</a>, such as sedatives or certain antidepressants</li>
<li>age-related changes in reaction time</li>
<li>trouble with vision or hearing</li>
<li>other physical changes related to aging, such as less flexibility or strength</li>
<li>difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.</li>
</ul>
<h2>3. What can — and can't — be reversed to improve driving?</h2>
<p>Some changes that impair driving can be reversed or a workaround can be found. For example, if driving is impaired due to cataracts, cataract surgery can restore vision and improve driving. If night driving is difficult, it's best to drive only during the day. If <a href="https://www.health.harvard.edu/blog/whats-the-relationship-between-memory-loss-and-driving-202210122829" style="text-decoration:underline" target="_blank">memory problems are starting to arise</a>, it may still be possible to drive safely in more limited circumstances.</p>
<p>Driving problems due to advanced dementia or a major stroke affecting judgment and physical skills are much less likely to improve.</p>
<h2>4. Accept that conversations about not driving are challenging</h2>
<p>If there is no simple way to reverse or work around declining driving skills, accept that there will be many challenges to navigate, whether you're the older driver or a family member.</p>
<p>Challenges facing the driver:</p>
<ul>
<li><strong>It's not easy to acknowledge declining function.</strong> Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.</li>
<li><strong>It can feel unnecessary and unreasonable.</strong> Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.</li>
<li><strong>Denial and defensiveness are common.</strong> Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).</li>
<li><strong>Not driving is a loss of independence.</strong> Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.</li>
</ul>
<p>Challenges facing the family:</p>
<ul>
<li><strong>Often, the older driver doesn't share their family's concerns about driving safety.</strong> This can lead to arguments, confrontation, and resentment.</li>
<li><strong>The safety of others is at stake.</strong> The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.</li>
<li><strong>It's hard to know when the time is right.</strong> Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.</li>
</ul>
<h2>Finding a path forward</h2>
<p>As for my grandmother, none of us knew what to say. Should we try to get her to agree to stop driving entirely or let her ease into the idea over time? Maybe she could stop driving at night or limit her driving to short distances. Should we bring it to the attention of her doctor and let them direct the next steps? Or should we take an even harder step and report her to the authorities?</p>
<p>If you're asking similar questions — or if you're starting to wonder about your own driving abilities — you may feel strongly that it's important to respect individual preferences, dignity, and independence. Yet you also want to protect everyone from harm.</p>
<p>What are the best ways to strike a balance? Can you test and improve how an older driver is doing behind the wheel? Can you navigate tough conversations in ways that allow room for both independence and safety? These are the subjects to be tackled in <a href="https://www.health.harvard.edu/blog/what-to-do-when-driving-skills-decline-202311152991" target="_blank">Part 2</a>.</p>
    ]]></description>
            <pubDate>Mon, 13 Nov 2023 05:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</guid>
            <link>https://www.health.harvard.edu/blog/a-tough-question-when-should-an-older-driver-stop-driving-202311132992</link>
            <author><![CDATA[Robert H. Shmerling, MD]]></author>
        </item>
        <item>
            <title><![CDATA[Opill: Is this new birth control pill right for you?]]></title>
            <description><![CDATA[<p>
          <img alt="photo of a silver blister pack of birth control pills with the four rows of days of the week" src="http://content.health.harvard.edu/wp-content/uploads/2023/11/ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd.jpg" style="height:339px; width:600px" imageid="ec54ca7d-b745-4ffb-8cf1-2b5ea1d438dd" referrerpolicy="no-referrer">
        </p>
        <p>Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. Just this past summer, the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter. This offers many more people access to a new nonprescription option for preventing pregnancy.</p>
        <p>Opill may be available early in 2024, although the exact date and cost are not yet known. Here's what anyone interested — adults, parents, and teens — should know.</p>
        <h2>What is in Opill and how does it work?</h2>
        <p>Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by</p>
        <ul>
          <li>affecting ovulation so that the ovaries do not release an egg every month</li>
          <li>thickening cervical mucus, which blocks sperm from reaching an egg</li>
          <li>changing the uterine lining in ways that keep a fertilized egg from implanting.</li>
        </ul>
        <h2>How effective is Opill at preventing pregnancy?</h2>
        <p>It depends on how consistent you are about taking Opill:</p>
        <ul>
          <li><strong>Perfect use</strong> means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.</li>
          <li><strong>Typical use</strong> averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don't take it perfectly, at least nine could become pregnant in a year.</li>
        </ul>
        <p>It's also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.</p>
        <h2>How do you take Opill?</h2>
        <ul>
          <li>Take it once a day at the same time each day until you finish the entire pack.</li>
          <li>Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.</li>
          <li>After you complete a 28-day pack, you should immediately start a new pack of pills the next day.</li>
        </ul>
        <h2>What happens if you forget to take a dose at the specific time or miss a dose?</h2>
        <ul>
          <li>If you take the pill more than three hours late it will not be as effective at preventing pregnancy.</li>
          <li>Take the missed pill as soon you remember.</li>
          <li>You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.</li>
        </ul>
        <h2>Is Opill safe for teenagers?</h2>
        <p>Opill is generally safe for most people who could get pregnant, including teenagers. There's no evidence to suggest that safety or side effects are different in teenagers compared with adults.</p>
        <p>Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.</p>
        <h2>When teens use birth control, what is the best choice for them?</h2>
        <p>There isn't a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.</p>
        <p>For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.</p>
        <p>Learn more about different contraception methods at the <a href="https://youngwomenshealth.org/guides/contraception/" style="text-decoration:underline" target="_blank">Center for Young Women's Health</a> website.</p>
        <h2>What side effects are common with Opill?</h2>
        <p>Progestin-only pills are usually associated with mild side effects. The most common side effects are:</p>
        <ul>
          <li>unexpected vaginal bleeding or spotting</li>
          <li>acne</li>
          <li>headache</li>
          <li>gastrointestinal symptoms such as nausea, abdominal pain, and bloating</li>
          <li>change in appetite.</li>
        </ul>
        <p>Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.</p>
        <h2>Will Opill cause any mood changes?</h2>
        <p>Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.</p>
        <p>Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.</p>
        <h2>Can it be used as emergency birth control?</h2>
        <p>No, it should not be used as <a href="https://youngwomenshealth.org/guides/emergency-contraception/" style="text-decoration:underline" target="_blank">emergency birth control</a>.</p>
        <h2>What should you know about STIs?</h2>
        <p>This type of birth control does not protect you from <a href="https://www.cdc.gov/std/default.htm" style="text-decoration:underline" target="_blank">sexually transmitted infections</a> (STIs) such as syphilis, gonorrhea, or chlamydia.</p>
        <p>You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.</p>
        <p>Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A <a href="https://www.cdc.gov/hiv/basics/prep.html" style="text-decoration:underline" target="_blank">medicine called PrEP</a> can help prevent HIV. Ask your medical team for more information about the right choices for you.</p>
        <h2>When will Opill be available and what will it cost?</h2>
        <p>The timeline for availability and the cost of medication is determined by the manufacturer. At time of FDA approval, it was expected to hit shelves in early 2024. No updates have been released for the exact date or estimated cost of the medication.</p>
    ]]></description>
            <pubDate>Wed, 08 Nov 2023 15:30:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</guid>
            <link>https://www.health.harvard.edu/blog/opill-is-this-new-birth-control-pill-right-for-you-202311082989</link>
            <author><![CDATA[Candice Mazon, MD]]></author>
        </item>
        <item>
            <title><![CDATA[Do children get migraine headaches? What parents need to know]]></title>
            <description><![CDATA[<p><img alt="Brown-haired boy lying on colorful spread, looks pained, one hand covering an eye, other eye shut &amp; other hand tucked behind head; concept is migraine headache" class="ucr-content-image" data-cr-imageid="cf914d00-e65a-4a1f-9d1d-146785bd94b1" height="400" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14489/cf914d00-e65a-4a1f-9d1d-146785bd94b1.jpg" width="600" referrerpolicy="no-referrer"></p>
<p>Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/" style="text-decoration:underline" target="_blank">one in 10 children and teens</a> overall. &nbsp;</p>
<p>What should you know — and do — if you think your child or teen may be having migraines?</p>
<h2>How early do migraines start to occur?</h2>
<p>We don't tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.</p>
<p>Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.</p>
<h2>Which migraine symptoms are most common in children?</h2>
<p>Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.</p>
<p>While it's not always easy to tell a migraine from another kind of headache, children</p>
<ul>
<li>often report throbbing pain</li>
<li>may experience nausea and sensitivity to light and noise.</li>
</ul>
<p>The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.</p>
<h2>What causes migraines in children?</h2>
<p>We don't know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.</p>
<p>Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.</p>
<h2>Can migraines be prevented?</h2>
<p>The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it's a good idea to keep a headache diary.</p>
<p>When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child's particular triggers.</p>
<p>It's a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!</p>
<h2>How can you help your child ease a migraine?</h2>
<p>When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it's not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.</p>
<p>It's important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!</p>
<h2>Are there prescription medicines that can help children with migraines?</h2>
<p>If those approaches aren't enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.</p>
<p>If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.</p>
<p>Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.</p>
<h2>When to contact your doctor</h2>
<p>If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.</p>
<p>You should always call your doctor, or go to an emergency room, if your child has a severe headache, <a href="https://www.health.harvard.edu/blog/8-things-to-watch-for-when-your-child-has-a-headache-2017051611761" target="_blank">a stiff neck</a>, trouble with coordination or movement, is abnormally sleepy, or isn't talking or behaving normally.</p>
<p>The American Academy of Pediatrics has additional <a href="https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx" style="text-decoration:underline" target="_blank">useful information</a> about migraines, and how to treat and prevent them, on their website.</p>
    ]]></description>
            <pubDate>Mon, 06 Nov 2023 05:00:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</guid>
            <link>https://www.health.harvard.edu/blog/do-children-get-migraine-headaches-what-parents-need-to-know-202311062988</link>
            <author><![CDATA[Claire McCarthy, MD]]></author>
        </item>
        <item>
            <title><![CDATA[Long-lasting C. diff infections: A threat to the gut]]></title>
            <description><![CDATA[<p>
          <img alt="Gloved fingers holding lab dish with red scratches and dots of bacteria on clear growing media; concept is testing for C. diff " src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14485/39724b9a-bb07-43dc-9f0d-ad6badb52175.jpg" style="height:399px; width:600px" class="ucr-content-image" data-cr-imageid="39724b9a-bb07-43dc-9f0d-ad6badb52175" referrerpolicy="no-referrer">
        </p>
        <p>If you've ever dealt with diarrhea, you know how quickly it leaves you feeling depleted. Now imagine a case that rages on and on — or comes back again and again.</p>
        <p>This is the reality for nearly 500,000 Americans each year who have the bacterial infection known as <em>Clostridioides difficile</em>, or C. diff. Virulent diarrhea and inflammation of the colon can even turn life-threatening.</p>
        <p>This primer will help you understand how C. diff spreads and releases toxins, what the common symptoms are, and who is most vulnerable. Dr. Jessica Allegretti, director of the fecal microbiota program at Harvard-affiliated Brigham and Women's Hospital, also touches on promising preventive strategies and treatments.</p>
        <h2>How does C. diff spread?</h2>
        <p>Like many bacteria, C. diff is present in our stool. It's carried by virtually everyone — on our skin and even on the soles of our shoes. When C. diff bacteria are outside the body, they are inactive spores. They only have a chance to become active when they're swallowed and reach the intestines.</p>
        <p>Even then, many people who swallow C. diff spores never become ill. The spores only sicken people whose gut microbiome — the trillions of organisms living in their intestines — becomes imbalanced for one of the various reasons described below. When an imbalance occurs, the spores start to multiply and create toxins that lead to a C. diff infection.</p>
        <p>"Many of us are colonized with C. diff bacteria without any consequences," says Dr. Allegretti. "We're swallowing C. diff spores all the time. Only under the right circumstances will the spores germinate and release a toxin. It's the toxin that makes you sick."</p>
        <h2>What are the symptoms of a C. diff infection?</h2>
        <p>The symptoms mimic those of many other types of gastrointestinal ailments. Initially, this may make it difficult to tell the infection apart from milder illnesses.</p>
        <p>Symptoms to watch for include</p>
        <ul>
          <li>persistent diarrhea lasting three or more days</li>
          <li>nausea</li>
          <li>fever</li>
          <li>stomach pain or tenderness</li>
          <li>appetite loss.</li>
        </ul>
        <p>"C. diff isn't something that people in the general population should be walking around scared of," Dr. Allegretti says. "But if you need to take an antibiotic, be on the lookout for diarrheal symptoms after finishing the course of antibiotics. Diarrhea that's associated with antibiotics alone should resolve once you finish taking the medication."</p>
        <h2>Who is most vulnerable?</h2>
        <p>A <a href="https://www.cdc.gov/cdiff/what-is.html" style="text-decoration:underline" target="_blank">few sobering facts</a> from the Centers for Disease Control (CDC):</p>
        <ul>
          <li>C. diff is the top cause of health care-associated infections in the US.</li>
          <li>It disproportionately strikes people in hospitals and nursing homes.</li>
          <li>Among people over 65, one in 11 of those diagnosed with a health care-associated case of C. diff dies within a month.</li>
        </ul>
        <p>However, other groups are also susceptible to the infection. Health care-associated C. diff infections are plateauing, Dr. Allegretti notes, while so-called community-based infections that occur among the general population are increasing.</p>
        <p>People most likely to experience such infections:</p>
        <ul>
          <li>Are taking antibiotics or have just finished a course of antibiotic therapy. People are <a href="https://www.cdc.gov/cdiff/risk.html" style="text-decoration:underline" target="_blank">up to 10 times more likely to get C. diff</a> while on antibiotics or during the month afterward, according to the CDC. "Not everyone who takes an antibiotic gets C. diff, and not everyone who gets C. diff gets recurrent C. diff," says Dr. Allegretti. "It has a lot to do with your host response, your gut microbiome, and your individual risk factors, such as immunosuppression or inflammatory bowel disease."</li>
          <li>Have a weakened immune system due to cancer, organ transplant, or treatment with immunosuppressive drugs (such as people with inflammatory bowel disease or autoimmune conditions).</li>
          <li>Have close contact with someone who has been diagnosed with C. diff.</li>
        </ul>
        <h2>What prevention strategies help block the spread of C. diff?</h2>
        <p>Hospitals try to prevent C diff. among patients in several ways. They impose scrupulous hand-washing requirements among staff members. Patients who develop new diarrhea are tested for C. diff infection. Those who have it are isolated in their own rooms to help prevent further spread.</p>
        <p>Outside of a hospital, you can help prevent this gut infection through a few commonsense measures.</p>
        <ul>
          <li><strong>Wash your hands thoroughly</strong> with soap and water every time you use the bathroom and always before eating. Clean hands are especially important if you've had C. diff or know you've been exposed to someone with it. By the way, alcohol-based hand sanitizer <em>isn't</em> effective against C. diff because its organisms can form resistant spores.</li>
          <li><strong>Take antibiotics only when strictly necessary</strong> and for the shortest period possible. "The biggest thing we can do is advocate for ourselves," Dr. Allegretti says. "During cold and flu season, we know a lot of unnecessary antibiotic prescriptions are written for infections that are most likely viral, not bacterial. Antibiotics do not kill viruses — and unnecessary antibiotics may upset the bacterial balance in your gut. Ask your doctor: Do I need this prescription? Is there an alternative?"</li>
          <li><strong>When you do need antibiotics,</strong> ask if a narrow-spectrum antibiotic would be effective for your type of infection. Why? Broad-spectrum antibiotics kill a wider array of bacteria. This may be overkill, depleting your gut microbiome unnecessarily and enabling C. diff bacteria to germinate. "The caveat is, we don't want patients to not take antibiotics they need for an actual infection," she says. "But have a conversation with your health care team."</li>
        </ul>
        <p>The type of antibiotic prescribed also matters, according to a 2023 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444966/" style="text-decoration:underline" target="_blank">study</a> in the journal <em>Open Forum Infectious Diseases. </em>Researchers compared more than 159,000 people who had C. diff infection with 797,000 healthy controls. Study findings suggest that using clindamycin and later-generation cephalosporin antibiotics pose the greatest risk for C. diff infection. Meanwhile, the antibiotics minocycline and doxycycline were associated with the lowest risk.</p>
        <p>"But there are very few safe antibiotics with regard to C. diff risk," Dr. Allegretti says.</p>
        <h2>Can probiotics help prevent or treat C. diff infection?</h2>
        <p><a href="https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know" style="text-decoration:underline" target="_blank">Probiotics</a> are live microorganisms that can help keep the gut healthy and are found in supplements, yogurt, and <a href="https://www.health.harvard.edu/blog/want-probiotics-but-dislike-yogurt-try-these-foods-202107142918" style="text-decoration:underline" target="_blank">other fermented foods</a>. Two familiar examples are various strains of <em>Lactobacillus</em> and <em>Bifidobacterium.</em></p>
        <p>However, probiotics haven't been found to prevent C. diff or its recurrence. Research performed in mice and humans suggests that giving probiotics after a course of antibiotics <a href="https://www.cell.com/cell/fulltext/S0092-8674(18)31108-5?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867418311085%3Fshowall%3Dtrue" style="text-decoration:underline" target="_blank">may slow the pace of microbiome recovery</a>. "You're potentially delaying the recovery of your microbiome with probiotics," she says.</p>
        <h2>How is C. diff infection treated?</h2>
        <p>Ironically, C. diff therapy typically starts with antibiotics, despite the infection's proliferation due to antibiotic use. The antibiotics of choice include fidaxomicin or oral vancomycin.</p>
        <p>However, about one in five people will suffer one or more recurrences –– and with each one, yet another recurrence becomes far likelier, Dr. Allegretti says. A repeat episode may happen because people haven't disinfected their homes effectively. That leaves them open to reinfection with the same strain of C. diff while still vulnerable.</p>
        <p>When C. diff recurs, <a href="https://gi.org/topics/fecal-microbiota-transplantation-fmt-bacteriotherapy/" style="text-decoration:underline" target="_blank">fecal microbial transplants</a> (FMT) are considered the gold standard treatment. FMT transplants fecal matter from a healthy donor into a patient's gut, placing it there using an endoscope, enema, or within an oral capsule. This year, the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-orally-administered-fecal-microbiota-product-prevention-recurrence-clostridioides" style="text-decoration:underline" target="_blank">FDA</a> approved two live fecal microbiota products aimed at preventing recurrent C. diff infections.</p>
        <p>"We haven't gotten away from antibiotics yet to treat this disease," says Dr. Allegretti. "But we have a lot of preventative strategies now. It's certainly very exciting for people struggling with C. diff infections."</p>
    ]]></description>
            <pubDate>Wed, 01 Nov 2023 14:30:00 GMT</pubDate>
            <guid isPermaLink="false">https://www.health.harvard.edu/blog/long-lasting-c-diff-infections-a-threat-to-the-gut-202311012987</guid>
            <link>https://www.health.harvard.edu/blog/long-lasting-c-diff-infections-a-threat-to-the-gut-202311012987</link>
            <author><![CDATA[Maureen Salamon]]></author>
        </item>
        <item>
            <title><![CDATA[How much sleep do you actually need?]]></title>
            <description><![CDATA[<p>
          <img alt="Happy white and black-faced sheep clustered around a big gray alarm clock; crescent moon and clouds against lilac background, concept sleep" src="https://domf5oio6qrcr.cloudfront.net/medialibrary/14476/266d658e-36d0-4ae5-b500-b20c187947cc.jpg" style="height:407px; width:600px" class="ucr-content-image" data-cr-imageid="266d658e-36d0-4ae5-b500-b20c187947cc" referrerpolicy="no-referrer">
        </p>
        <p>On average, how many hours do you sleep each night? For most healthy adults, guidelines suggest <a href="https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html" style="text-decoration:underline" target="_blank">at least seven hours</a> of slumber.</p>
        <p>But these are general recommendations and not strict rules. "Some people need less than seven hours, while others might need more," says Eric Zhou with the Division of Sleep Medicine at Harvard Medical School.</p>
        <h2>Do you need more or less sleep time?</h2>
        <p>We get it: you know people who swear they only need five hours of sleep per night, yet you feel foggy unless you log in eight to nine hours. The major reason for individual differences is that we often look at sleep the wrong way.</p>
        <p>"Instead of focusing exclusively on the number of hours we sleep per night, we should also consider our sleep <em>quality</em>," says Zhou.</p>
        <p>Sleep quality means how well you sleep during the night. Did you sleep straight through? Or did you have periods where you woke up? If so, did it take you a long time to fall asleep? How did you feel when you woke up?</p>
        <p>"If you awaken refreshed and feel like you have the energy to get through your day, then I would worry less about the exact number of hours you're sleeping," says Zhou.</p>
        <h2>How does sleep quality affect your health?</h2>
        <p>Sleep quality is vital for our overall health. Research has shown that people with poor sleep quality are at a higher risk for diabetes, <a href="https://www.health.harvard.edu/heart-health/too-little-sleep-may-be-hard-on-your-heart" style="text-decoration:underline" target="_blank">heart disease</a>, stroke, and <a href="https://www.sciencedirect.com/science/article/pii/S1087079221001416" style="text-decoration:underline" target="_blank">mental health</a> issues like anxiety and depression.</p>
        <p>And that's not all. "Poor sleep also can increase daytime fatigue and make it more difficult to enjoy life," says Zhou.</p>
        <p>Yet it's normal for people's sleep patterns to change over time. "Many people are not going to sleep in their 50s and 60s exactly like they did in their 20s," says Zhou.</p>
        <p>Many of these changes are age-related. For instance, your <a href="https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx" style="text-decoration:underline" target="_blank">circadian rhythm</a> — which regulates many bodily functions, including our sleep-wake cycle — can naturally get disrupted over time. This means people spend less time each night in restorative slow-wave sleep.</p>
        <p>Production of melatonin, the sleep hormone, also gradually declines with age. "As a result of these changes, when we get older we may start to wake up earlier than we did when we were younger, or wake up more frequently during the night," says Zhou.</p>
        <h2>How can you track sleep quality?</h2>
        <p>How can you better understand the factors likely contributing to your sleep quality? One way is to keep a sleep diary where you track and record your sleep.</p>
        <p>Every day, record the time you went to bed, how long it took you to fall asleep, whether you had any nighttime awakenings (and if so, how long you were awake), and at what time you woke up. Also, keep track of how you feel upon awakening and at the end of the day.</p>
        <p>"After a week or two, review the information to see if you can identify certain patterns that may be affecting your sleep quality, then make adjustments," says Zhou.</p>