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Telehealth might be best as a supplement to office visits, not a replacement

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.

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With the pandemic, there has been a rise in the use of virtual appointments for patients seeking health care. A new study by Tufts researchers, however, suggests that for many older and chronically ill patients, telehealth appointments may be most effective when they augment in-person health-care visits rather than fully replace them.

The findings suggest that while patients 70 and older may well be capable of navigating the technical aspects of virtual doctor visits and are interested in communicating online with health-care professionals, their opinions on the effectiveness of the care they receive varied widely.

The study, which focused on older patients with serious and chronic kidney disease, found that not all patients were satisfied with telehealth. People of color, including patients who identified as Black, Native American, or Hispanic, or required additional accessibility features such as interpreters, were largely dissatisfied with telehealth.

Patients of color disproportionately suffer from chronic kidney disease and may more often contend with challenges associated with at-home care, such as inadequate space for home-dialysis and limited broadband access to support video-telehealth visits, said Keren Ladin, associate professor of occupational therapy and community health, who led the study.

Owing to historical and experienced discrimination, “we found that patients of color were less comfortable with telehealth and had more concerns about the quality of the care and being deprived of care in a telehealth setting than white patients did,” said Ladin.

Ladin said she was surprised by these findings, given that the study, which was recently published in JAMA Network Open, was conducted during the height of the COVID-19 pandemic.

“I thought people of color who were at higher risk would prefer to stay out of the health system for longer, but that was not what we found,” she said. Black patients also reported that telehealth appointments prevented them from connecting meaningfully with their doctors, contributing to feelings of mistrust.

“It was really striking,” said Ladin. “One woman told us, ‘I need to see the physician’s eyes to know that they were understanding me,’ underscoring that the persistent impacts of structural racism on health-care experiences of patients of color.”

The patients did appreciate that telehealth facilitated the ability of care partners such as family members to join them for appointments, something that has been limited during the pandemic. Beyond the comfort of accompanying patients, care partner participation can help improve treatment and adherence and patient education for older patients managing complex, chronic illnesses such as kidney disease, Ladin said.

Downsides from the Clinical Perspective

For clinicians, the low regard for telehealth appointments was more pronounced. A majority of the physicians interviewed remotely from Boston, Chicago, Portland (Maine), and San Diego equated telehealth with lower-quality care.

They could not, for example, conduct physical examinations and lab tests virtually, nor could they naturally build and maintain a personal rapport with chronic-disease patients. Patients, too, were worried about this.

“We heard loud and clear from clinicians that they felt that the human aspects of their job that they love so much—the communication with patients and those relationships—were fraught and damaged by this flat interaction style,” Ladin said. She conceded that although clinicians were generally dissatisfied with telehealth in its current form, most agreed that it did provide critical insight into a patient’s home, which was previously unavailable.

“Up until now, the patient’s home environment was really a black box,” Ladin said, “Whatever the patient said when they came into the office was accepted as truth.” During video visits, however, doctors are able to see patient’s homes, the exact medications they are taking, and interact directly with care partners. “That was a positive feature of these types of visits—more holistic care.”

To address the range of obstacles perceived by both patients and clinicians in the study, the researchers recommend doctors share detailed post-visit summaries with patients and care partners, leave time during virtual visits for patients to absorb difficult news, and inquire specifically after patients’ emotions in the absence of nonverbal cues. Structural inequalities require a longer-term but equally important investment beyond simple communication strategies.

“I wish I could say we are doing it perfectly in person, and that telehealth is the only challenge we’re facing,” said Ladin. “We’re not. We need to work on this both in person and for telehealth.”

She stressed the importance of increasing the availability of interpreters during virtual visits and a more diverse workforce throughout the medical training pipeline, including nurses and physician assistants.

“The type of community-building and relationship repair that need to happen in health care will go a long way in improving this aspect,” said Ladin. “Diversifying the health-care workforce is crucial.”

Many telehealth services will stay covered by Medicare through 2023, under current law. After that, the future of remote health care for older Americans remains uncertain. Much of it will depend on whether perceptions among these patients, and in particular those with chronic illness, are positive. For Ladin, the benefits are as clear as the drawbacks.

“At its best, maybe we are getting back to a more patient-centered approach,” she said. “But I would be cautious to use it as a replacement device. For older, complex patients, we want to strive for a balance between seeing somebody in person in the clinic most times and then occasionally seeing them onscreen.”

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5 Tips to upgrade your sleep

Sleep contributes to better brain function, memory, concentration and lower stress. According to the National Institutes of Health, most adults need 7-9 hours of sleep every night to achieve maximum health benefits.

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Good sleep isn’t just about waking up feeling rested and ready for the day. Quality sleep, and plenty of it, is important for your overall health. While you sleep, your body naturally recharges itself, which puts you at lower risk for cardiovascular problems and chronic conditions like diabetes, as well as improving your immune system.

Sleep also contributes to better brain function, memory, concentration and lower stress. According to the National Institutes of Health, most adults need 7-9 hours of sleep every night to achieve maximum health benefits.

If you’re falling short of the recommended amount of sleep, you may be able to make some adjustments that help you reap the health benefits of better rest. Learn what you can do to improve your sleep with these tips from the experts in safer, healthier sleep at Naturepedic.

Reduce Light Exposure
Your body’s natural circadian rhythms are closely aligned with light and dark. When your body senses light, it sends signals to your brain that it’s time to be awake. Light also suppresses your body’s production of melatonin, a hormone linked to sleep. Cutting back on bright lights and avoiding devices at least an hour before bed can tell your body it’s time to wind down, and sleeping in a dark room promotes better rest.

Invest in the Right Mattress
Your mattress plays a major role in your comfort through the night, so making sure it fits your needs is an important step toward getting better rest. Take control of your comfort with a quality mattress such as Naturepedic’s EOS (Ergonomic Organic Sleep) mattress, which is handcrafted and made without polyurethane foam, formaldehyde, flame retardants or fiberglass. The breathable layers of certified organic cotton, wool and GOTS-approved latex ensure better temperature regulation while naturally contouring the body. An added feature is the ability to customize each side of the bed by opening the zippers and adjusting the layered components for the perfect comfort combination.

Find the Right Sheets
Sheets that are too stiff, scratchy or otherwise unpleasant make it nearly impossible to settle in for a good night’s rest. Higher thread counts tend to be softer, higher quality sheets. However, you may need to experiment to find which material suits you best.

Set a Comfortable Temperature
When you’re too hot or cold, your mind tends to focus on those sensations rather than allowing you to slip into a slumber. Set your thermostat at a comfortable temperature, adding fans or adjusting the layers of bedding as necessary to achieve the perfect level of cozy comfort.

Use a Sound Machine
If you’re a light sleeper, noise can wreak havoc on your rest. Many people find sound machines offer two key benefits: They provide a soothing sound, such as rain or ocean waves, that allows you to relax and ease into slumber and constant background noise, so additional sounds are less disruptive.

Find more solutions for achieving better sleep at Naturepedic.com.

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What you should know about IBD

Two common conditions are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). They’re often confused for one another, but these are actually two different GI disorders.

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It may not be something you like to talk about, but if you have gastrointestinal (GI) problems, your symptoms may be far more common than you think. According to data from the American Gastroenterological Association, 60-70 million people living in the United States have gut health concerns.

Two common conditions are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). They’re often confused for one another, but these are actually two different GI disorders.

IBS is a syndrome; it is defined by a group of symptoms, does not cause inflammation and rarely requires hospitalization or surgery. IBD, on the other hand, is an umbrella term used to describe disorders that cause chronic inflammation of your GI tract.

The disease is more common than you may realize; a study led by the Crohn’s & Colitis Foundation found nearly 1 in 100 people living in the U.S. have IBD. The two most common forms of IBD are Crohn’s disease and ulcerative colitis.

Understanding IBD Symptoms
Because it poses serious health risks and can cause permanent damage to your intestines, it’s important to be aware of what IBD is and recognize the symptoms. Your primary care doctor or gastroenterologist can help if you have concerns about these symptoms:

  • Intense, crampy pain that doesn’t go away in a day or two or has been present on and off for weeks or longer
  • A notable change in bowel movement frequency, whether more or less often
  • Frequent diarrhea over several weeks, or loose stools multiple times a day
  • Frequent constipation, or constipation alternating with diarrhea
  • Urgency on a regular basis or inability to hold back the bowel movement before reaching the bathroom
  • Blood with bowel movements
  • Mucus in your stool regularly or paired with pain or other symptoms
  • Always feeling as though you aren’t fully emptying your bowels

Other symptoms that may have a variety of causes but need extra attention especially if you notice them along with any of the symptoms above include pain outside of the gut, fatigue, loss of appetite and weight loss. In addition, children with IBD may have delays in growth and the onset of puberty.

Diagnosing IBD
No single test can confirm a Crohn’s or ulcerative colitis diagnosis. Your medical history and information obtained from diagnostic testing can exclude other potential causes of your symptoms, since gastrointestinal symptoms are common and can have a variety of causes.

Your first tests will likely include blood and stool laboratory tests. Further testing could include imaging studies of your gastrointestinal tract or a look inside your GI tract through an endoscope.

Identifying Treatment Options
Once an IBD diagnosis is confirmed, you can partner with your doctor to manage your disease. Treatment plans are highly personalized, as what works for one person may not for another. Medication and managing your diet and nutrition are two common treatment recommendations. In some cases, surgery can help improve your quality of life.

Clinical trials may also be an option for treating your IBD. Through clinical trials, researchers find new ways to improve treatments and quality of life. In fact, clinical trials represent the final stages of a long and careful research process to make new and improved treatment options for patients available.

However, an important part of clinical trials for IBD is patient participation. Without the enrollment of patients in clinical trials, new treatment options for IBD can be delayed or never become available.

Equally important to this process is having a diverse representation of patients that considers race, age or other categories. This helps researchers develop treatments that meet the needs of a vast IBD patient community.

If you’re interested in participating in a clinical trial, ask your doctor to help you find a trial that is right for you, and visit crohnscolitisfoundation.org to learn more about IBD and treatment options, including clinical trials.

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Unlocking the science of sleep: How rest enhances language learning

Getting eight hours of sleep every night helps the brain to store and learn a new language.

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Sleep is critical for all sorts of reasons, but a team of international scientists has discovered a new incentive for getting eight hours of sleep every night: it helps the brain to store and learn a new language.

A study led by the University of South Australia (UniSA) and published in the Journal of Neuroscience has revealed that the coordination of two electrical events in the sleeping brain significantly improves our ability to remember new words and complex grammatical rules.

In an experiment with 35 native English-speaking adults, researchers tracked the brain activity of participants learning a miniature language called Mini Pinyin that is based on Mandarin but with similar grammatical rules to English.

Half of the participants learned Mini Pinyin in the morning and then returned in the evening to have their memory tested. The other half learned Mini Pinyin in the evening and then slept in the laboratory overnight while their brain activity was recorded. Researchers tested their progress in the morning.

Those who slept performed significantly better compared to those who remained awake.

Lead researcher  Dr Zachariah Cross, who did his PhD at UniSA but is now based at Northwestern University in Chicago, says sleep-based improvements were linked to the coupling of slow oscillations and sleep spindles – brainwave patterns that synchronise during NREM sleep.

“This coupling likely reflects the transfer of learned information from the hippocampus to the cortex, enhancing long-term memory storage,” Dr Cross says.

“Post-sleep neural activity showed unique patterns of theta oscillations associated with cognitive control and memory consolidation, suggesting a strong link between sleep-induced brainwave co-ordination and learning outcomes.”

UniSA researcher Dr Scott Coussens says the study underscores the importance of sleep in learning complex linguistic rules.

“By demonstrating how specific neural processes during sleep support memory consolidation, we provide a new perspective on how sleep disruption impacts language learning,” Dr Coussens says. “Sleep is not just restful; it’s an active, transformative state for the brain.”

The findings could also potentially inform treatments for individuals with language-related impairments, including autism spectrum disorder (ASD) and aphasia, who experience greater sleep disturbances than other adults.

Research on both animals and humans shows that slow oscillations improve neural plasticity – the brain’s ability to change and adapt in response to experiences and injury.

“From this perspective, slow oscillations could be increased via methods such as transcranial magnetic stimulation to accelerate aphasia-based speech and language therapy,” Dr Cross says.

In future, the researchers plan to explore how sleep and wake dynamics influence the learning of other complex cognitive tasks.

“Understanding how the brain works during sleep has implications beyond language learning. It could revolutionize how we approach education, rehabilitation, and cognitive training.”

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