“I was good at telling people to exercise,” he says, “and they understood why it was important.” His patients knew the health benefits of a simple walking regimen; it would help them to prevent type 2 diabetes, obesity, heart disease, osteoporosis and depression, for starters. The problem was they still didn’t get out there and exercise.

So, Dr. Sabgir decided to be the “Pied Piper” of exercise for his practice in Columbus, Ohio and in April, 2005 he started the Walk with a Doc program. His strategy was simple: if he walked alongside his patients, perhaps they would be more open to regular exercise. Sabgir’s nurse designed a flier for the office and started talking up the idea of a group walk.

The next Saturday morning, Sabgir went to Sharon Woods Metro Park for his first 2.2-mile walk—and he found 101 people waiting for him. Since that first walk, patients showed up consistently, even during a downpour that first summer when Sabgir had planned to cancel the morning’s walk.

“We want people make it a daily habit—just half an hour of movement, five times a week,” he says. That 150 minutes of moderate activity, including brisk walking, is the amount recommended in the 2008 Physical Activity Guidelines for Americans. “It makes a dramatic, dramatic improvement in preventing diseases—but only 3 percent of Americans are doing it.”

Doctors in surrounding communities started hearing about Sabgir’s walks and asked for his help in organizing their patients. Anthem, the insurance company, called and offered to sponsor Walk with a Doc—a welcomed development, Sabgir says, “because I had been providing pedometers and other items out of my own pocket.” Anthem, which still sponsors the program, has since been joined by Pepsi and other corporations, enabling the group to maintain an office and small staff, and publish a newsletter.

They need the support, Sabgir says: after Walk with a Doc took a booth at the American College of Sports Medicine’s 2011 conference, he heard from doctors in more than 250 locales, including China, India, Portugal, South Africa and Jamaica, wanting to get their patients walking.

So far, Sabgir and his staff have helped establish Walk with a Doc in 36 communities, with more than 250 doctors participating. “They rotate,” he says. On average, between 30 and 80 people are likely to join in a walk; some groups get as many as 250 on one morning.

By the end of 2012, Sabgir expects 125 groups to be walking, with 250 groups by the end of 2013. “We’re fortunate to have found a lot of passionate leaders,” he says. “The docs want it, the people want it. It’s fun, easy exercise.”

CONNECT THE DOTS

Readers can find a Walk with a Doc program in their communities and read the group’s newsletter at the organization’s website. Doctors interested in starting their own Walk with a Doc group can enroll and get a banner, free pedometers and shirts, and help with web page development at the site. Find tips online for getting past personal barriers to exercise, including physical discomfort, boredom and exercising in bad weather. You also can rate your own neighborhood’s walkability using an online checklist.

Guest blogger Andrea Campbell is the author of Your Corner of the Universe: A Guide to Self-Therapy Through Journal Writing and other books. She is a member of American Society of Journalists and Authors.

Neurologist Richard Restak observed that dealing with the daily raw emotions of patients can be stressful and at times discouraging for him and other doctors involved in similar specialties. He believes that writing things down has helped him to make order out of life’s chaos, and that switching between two very different career activities, physician and author, has given his life stability.

Traumatic experiences such as the death of a loved one, fighting a recurring disease or surviving abuse create anxiety. When people suffer an illness or emotional upheaval they have an inherent need to discuss or confront the experience. Consistent journal writing can serve as stress relief. The act of converting emotions into words changes the way a person thinks—and this personal narrative helps them to summarize, store and cope with their feelings more efficiently. Here’s a look at other potential benefits:

* Better Health – Writing about their chronic conditions can help boost the health of patients who suffer from asthma and arthritis. “We looked at writing about the most stressful experience of one’s life in an emotional way,” says Arthur A. Stone, Ph.D. at Stony Brook University School of Medicine and co-author of this study. Over four months, one group wrote about their plans for the day, while the others wrote out feelings about a stressful event, all the while continuing their regular medical treatment. After being evaluated, researchers found that 47% of the patients who wrote about their feelings showed improvement after 4 months, while only 24% of the other group did. However, the study did not evaluate whether these health improvements would persist beyond 4 months.

* Better Coping Skills – According to a recent Baylor University study, men with testicular cancer demonstrated improved mental health after five weeks of writing positive thoughts. “There’s a lot of research that takes this writing-based approach…but we applied this line of research to the testicular cancer context for the first time that we are aware of,” says Mark T. Morman, Ph.D. and director of graduate studies at Baylor University. “We think writing about the experience could add to the therapy and can help with recovery and quality of life issues after treatment, as the men try to get on with their lives.”

* Handling Grief – After a loved one dies, the emotional devastation for family and friends may be accompanied by an upset stomach, frequent headaches, shortness of breath or a tightening in the throat and many other physical symptoms. Much has been written about the various stages of grief, but an article in the Mayo Clinic Health Letter suggests that keeping a journal and writing a letter to the deceased may help to alleviate feelings of anxiety and the associated discomfort. Writing out words left unsaid, regrets, and thoughts about loss isn’t a cure for grief, but the process can help people cope with feelings that may be too painful to express verbally.

* Making Sense of Emotions – The world may feel unsafe or out of control but venting on paper is not enough. A study of the effects of journaling on students at the University of Iowa showed that if someone only writes about stressful emotions, doing so might actually make things worse. The study found the combination of writing down one’s feelings about traumatic events, and initiating efforts to understand and make sense of them offered greater benefits than simply writing down negative emotions.  In other words, a key to better health is to free-flow write about feelings, then try to make sense of your reactions to life events and learn from them. By journaling, you give yourself permission to be totally honest and review your experiences in a thoughtful manner in order to enhance feelings of control and mastery over the traumatic event.

CONNECT THE DOTS

For additional information on how to write about traumatic experiences download “Emotional Processing of Traumatic Events,” or pick up “Forming a Story: The Health Benefits of Narrative.” For tips on journal writing see “Writing and Health: Some Practical Advice.” For a look at how keeping a food diary may help with weight loss, check out our blog post, “Free Weight App Combines Calorie Counter and Food Diary.”

Eli Beer’s father collapsed in his arms. Two decades of paramedic training flew out the window. But Beer literally had a panic button on his mobile phone, and he managed to push it. Two volunteers who lived across the street rushed to the scene to revive Beer senior. Nine minutes after he regained his pulse, the ambulance pulled up.

Thanks to Beer and a 1,600-strong volunteer network called United Hatzalah of Israel (“hatzalah” is Hebrew for rescue or relief) that he created, such stories have become commonplace in Israel. Some 181,000 people received quick-fire medical attention last year – free of charge. Many calls are for life threatening conditions or traumas, with heart attacks and traffic accidents leading the way. The nonprofit emergency medical services organization cites scientific studies that point to higher survival rates and better recovery if medical attention is provided within five minutes of an incident. Given congested urban streets and distances in the countryside of Israel, ambulances usually take longer. Combining a network of geographically distributed volunteers with a dispatching system with ground-breaking technology, United Hatzalah boasts a response time of between two and four minutes.

Beer found his calling at the age of seven. Making his way home from school in Jerusalem on a Friday afternoon in June, he walked right into the scene of a terrorist bomb attack on a bus. Among the passengers were some of his classmates. “No one knew what to do,” he said. “People were yelling, ‘Ambulance! Ambulance’ – but it took a long time” for help to arrive.

At 16 he joined a volunteer ambulance corps, but became frustrated by delays that cost lives. “Why not have neighbors provide the first response?” he thought. In 1990, with a group of friends, Beer approached a local ambulance company to ask them to forward calls. At first the firm refused, so the budding volunteers bought a radio scanner to monitor emergency calls. Seeing how effective they were, ambulance companies started sharing information and similar groups began cropping up around the country.

The demands of the 2006 Lebanon War revealed the gaps in the hodge-podge system, so Beer engineered coordination under the United Hatzalah umbrella. That nationwide network represents one thing that sets United Hatzalah off from other community-based volunteer medical programs, including some run by Jewish organizations in the United States.

The other is the LiveCompass Command Center, a central dispatch service that uses proprietary software that integrates the latest GPS tracking technology. Conceived of by United Hatzalah and developed by a company called NowForce, the software performs an algorithm in five seconds to identify the closest and most qualified volunteers and immediately alert them via a mobile telephone. Volunteers can also use it to communicate with each other, including by pressing that panic button. NowForce provides development free of charge and channels one-third of profits of the software’s commercial sales to United Hatzalah. As fire departments and other first response units take heed, these revenues may ultimately ensure the group’s financial viability in a way that the current donation-based model cannot.

Volunteers include physicians and paramedics, but also just regular folks. They must complete a rigorous training program to earn a license as an emergency medical technician. Then they are provided a kit similar to those used by professional paramedics. “Volunteers include journalists, lawyers, people in the fish market, millionaires who don’t need to work, poor people who have a hard time makings ends meet,” said Beer. “Anyone who wants to volunteer and has a good heart.”

Having earned recognition from the Geneva-based Schwab Foundation for Social Entrepreneurship and received the Presidential Award for Volunteerism from Shimon Peres, Beer hopes to take the model abroad. Most recently he met with a group of potential volunteers in France. “When you save someone’s life, nothing can match that feeling,” he said.

CONNECT THE DOTS

For more information, visit United Hatzalah’s website. A video of an United Hatzalah rescue operation after a traffic accident can be found on YouTube: The Geneva-based Schwab Foundation for Social Entrepreneurship offers a bio of Eli Beer and details on his organization. The Jerusalem-based company NowForce develops the software for the dispatch system.  For more news about technology that can be helpful in medical emergencies, check out our blog post, “In Case of Emergency Phone App.”

“The majority of people coming into my office for knee surgery are in their 50s,” says Steven Haas MD, Chief of Knee Surgery and Attending Orthopedic Surgeon at the Hospital for Special Surgery in New York City. This is a big shift in demand compared to 20 years ago, when fewer than 10% of knee replacement patients were in their 50s.

Innovative technologies in implant design and surgical techniques are meeting the growing demand for knee replacements among active Baby Boomers, providing both longer-lasting results and a faster recovery.

The FDA recently cleared a 30-year knee implant, based on simulated wear tests that showed an 81% reduction in wear, the leading cause of knee replacement failure. The implant uses VERILAST technology – a combination of oxidized zirconium (OXINIUM) for the femoral component and cross-linked polyethylene (XLPE) on the tibial side. As older knee implants made from chrome cobalt metal usually lasted only about 10-15 years, surgeons were reluctant to put them into people under 60 years old – they tried to match the implant survivor curve to the predicted lifespan of the patient.

Haas says that more recent knee implants are more functional than earlier versions, because the design has come a long way to fit the anatomy of the patient as closely as possible and provide a more natural articulation compared to the first knee implants that only hinged and were the same for both left and right sides.

Surgeons are also now using smaller instruments and minimally invasive surgical techniques to minimize trauma to the patient, leading to faster recovery. Dr. Hass developed the first minimally invasive surgical instruments in 2003. He says, “What we want to do is cut as little as possible to put the parts in, to do as little collateral damage to get access and minimize the trauma. With more anatomically shaped instruments, we are making the instruments fit the opening instead of the opening fit the instrument.”

Minimally invasive surgical techniques involve using smaller incisions to access the knee area after the patient receives a local anesthetic via epidural. The knee replacement operation is performed without needing to cut the quadriceps tendon or flip the kneecap upside down to gain access, as was required with older surgical techniques. Recoveries for patients who receive the minimally invasive surgical technique are significantly faster: most patients are able to resume their activities 6 weeks after surgery rather than 3 months.

Longer lasting implants and a quick recovery are appealing considerations for Baby Boomers, especially since the need for knee replacement is on the rise for that age group. Those in their 50s in general are more active than people in that group were a generation ago and they expect to maintain that active lifestyle for as long as possible. Expectations for the variety of activities have changed as well. Dr. Hass reports that Baby Boomers won’t settle for just walking around the block, “they want to be able to bike, hike, play tennis, ski, dance and play with their kids.”

All of this was good news for Jane Byron, age 51, a nurse who had both knees replaced in 2010 by Haas. An extremely active person who works on her feet and works out at the gym everyday, Jane tore her meniscus in a rollerblading accident. Subsequent arthroscopic surgery did not address her mobility issues. After minimally invasive surgery with new knee implants, she was pedaling a stationary bike for 45 minutes two days after surgery and pressing 75 pounds on the squat rack two months later.

CONNECT THE DOTS

Learn more about the Hospital for Special Surgery in New York City, where more knee replacements and hip surgeries are performed than any other hospital in the U.S. Read stories about other patients who have had minimally invasive surgery for knee implants. Visit Smith & Nephew to learn about total knee replacement and VERILAST knee implant technology. You may also like our earlier post, Hip Resurfacing – Better Than Hip Replacement?

Conventional wisdom has long been that picturing a gooey cinnamon roll or a pizza oozing with cheese will rev up your appetite and set you up to binge on those goodies. But the lead author of the study, Carey Morewedge, Assistant Professor of Social and Decision Sciences, says that simply imagining the consumption of a food can have the opposite effect.

“The mental imagery of actually eating that food decreases our desire for it,” Morewedge explains. “These findings suggest that trying to suppress one’s thoughts of desired foods in order to curb cravings for those foods is a fundamentally flawed strategy.”

To conduct the study, Morewedge and his colleagues divided the participants into two groups and asked them to imagine eating either cheese cubes or M&Ms, one a time. The first group was asked to imagine eating just three of the morsels, while the second group imagined eating 30. Then, they were allowed to eat those foods for real.

“People who imagined eating 30 units of the food one at a time ate about between 40 and 50 percent less than people who imagined eating three units of the food,” said Morewedge.

The experiments showed that the reduction in actual consumption following imagined consumption was caused by a gradual reduction in motivation to eat more of the food. They also demonstrated that, in order to reduce the amount of food eaten, the mental imagery had to be about that particular food.

Morewedge believes that this research may have many valuable applications in the future. “We think these findings will help develop future interventions to reduce cravings for things such as unhealthy food, drugs and cigarettes, and hope they will help us learn how to help people make healthier food choices.”

In the meantime, I’ll try it to see if I can drop a few pounds. Do you think imaging yourself eating your favorite goodies would help you lose weight?

CONNECT THE DOTS

This healthy food diary mobile app can also help get your diet in check. Anti-obesity crusader, Barry Popkin, says we must address the root causes of obesity. Check out the self compassion diet and a free iPhone app can help you make better food choices.

28 million Americans suffer from debilitating migraines. And biofeedback can help put them in the driver’s seat by teaching them to control or modify their own body responses – responses that normally aren’t controlled voluntarily. Notably, it can aid in reducing muscle tension, a culprit in heightening migraine pain and, of course, in ubiquitous tension headaches. Biofeedback can also reduce stress, which is known to exacerbate migraine symptoms.

How does biofeedback work? Think of the way a thermometer can measure a physiological state externally. Well, biofeedback does the same thing – only more so. Various electronic or electromechanical instruments painlessly measure and process information about physiological functions like temperature, muscle tension, blood pressure, heart rate and brain waves. They then display the results in real-time in lines on a monitor or, perhaps, by emitting tones of varying pitch.

Essentially, biofeedback therapists train people to use their own thoughts to control what is happening in their bodies. First, they must become aware of subtle physiological signals, then learn to focus on them, and – generally while watching their progress on a screen – ultimately to manipulate them.

Reducing muscle tension helps because migraines generally have a muscle contraction component, says George von Bozzay Ph.D., founder and clinical director of the Biofeedback Institute of San Francisco. He trains patients to locate and isolate target muscles, then to contract and release them. “It’s sort of like learning how to wiggle your ears,” he says. In other words, it takes practice. He recommends eight to twelve treatment sessions and perhaps ten minutes of focused relaxation exercises twice daily.

For many, the commitment to changing thought processes or breathing patterns with techniques like guided imagery or abdominal breathing pays off by reducing pain.  A 2008 review of ninety-four separate studies of biofeedback and migraine and tension-type headaches, published in the journal Applied Psychophysiology and Biofeedback, concluded it is effective in reducing migraine and headache frequency and pain levels.

“It’s a very helpful technique,” says Seymour Diamond, M.D., founder of the Diamond Headache Clinic and of the National Headache Foundation. His clinic uses temperature training, progressive relaxation and diaphragmatic breathing, all to provoke the body’s natural relaxation response.

Sensors or electrodes are generally applied to the head and fingers, then connected to the equipment. The therapist takes a baseline reading, then demonstrates how to evoke a quantifiably different physiological response by changing thinking or breathing. Slowing breathing and synchronizing it to the heart rhythm with progressive relaxation or visualization techniques, for example, can work well.

There are various types of biofeedback equipment. Electromyography (EMG) measures muscle tension. And von Bozzey believes tackling that with biofeedback can derail an approaching migraine, “because it doesn’t get triggered, it doesn’t have the muscle contraction precursor.”

Many experts like von Bozzey believe blood vessel constriction is involved in migraines. Frequently, migraines are preceded by a drop in hand temperature because “there’s less blood flow, there’s less heat flow,” he says. Temperature training with guided imagery or slow abdominal breath helps patients warm their own hands. “We’re trying to get them to redirect the blood flow to their arms or hands and away from the head,” Dr. Diamond adds.

Biofeedback’s end goal is to completely eliminate the need for instruments by having patients internalize the techniques. The external loop – electrode to machine to patient – is replaced, he says, “with an internal loop that the person is aware of inside their body.” But biofeedback is no substitute for medical care. Always discuss symptoms and treatment with a physician.

Heart rate variability machines can work well for training respiration, says von Bozzay. He suggests a few training sessions with a healthcare provider or therapist before going it alone. Some devices are portable, others connect to a Mac or PC. See the Resperate, the StressEraser, and the emWave.

CONNECT THE DOTS

Find a certified practitioner through the Biofeedback Certification International Alliance. More information is available through the American Migraine Foundation, the University of Maryland Medical Center, and the Association for Applied Psychophysiology and Biofeedback.

In Nicaguara, access to quality health care is a luxury that many cannot afford. Injured patients often must choose between delaying care to wait for transportation to a distant hospital, or tolerating local treatment with partially sterilized instruments. Such a decision could prove fatal, as dangerous infections can result from the improperly or insufficiently sterilized medical equipment. But there is hope. A solar-powered autoclave, the Solarclave, uses the sun to sterilize medical equipment, making it possible to bring low-cost, sustainable care to destitute villages of Nicaguara.

Development of the Solarclave began in 2008 when a group of students entered a business plan competition at the University of Dayton, winning a $10,000 prize for their proposal to develop solar-powered sterilizers. An earlier design of the autoclave, created by Lori McLlvaine Hanna, was recognized by The Carter Center for her design, which included a solar box cooker and pressure vessel. Since winning the competition, the students went through a number of designs, before finally settling on the current model.

The Solarclave consists of three components: a modified satellite dish, a wine bottle, and a pressure cooker. The satellite dish is used to heat water through the wine bottle and constrict steam through a pressure cooker using the sun’s rays. Anna Young, R&D Officer for International Laboratories of Innovations in International Health at MIT, explained that in order to reach proper sterilization, the instruments are sterilized by steam into a pressure cooker at a temperature of 250ºF for 20 minutes, although the full sterilization cycle of heating, sterilizing and cooling the equipment takes approximately one hour.

At the back end of the model, a modular sterilization indicator measures temperature and beeps when the cycle has completed the sterilization process. Even though the design is still in development, the Solarclave could radically change the lives of the patients who currently lack access to safe medical care. Furthermore, unlike other autoclaves which are large and costly, the Solarclave will use local, sustainable materials to keep costs low for health care providers.

“The device empowers nurses at their job and provides equipment they can use without having to travel to a hospital,” said Young. “A number of patients come in with emergency births or roadside accidents, and sterilized instruments can help to prevent infection and provide services to save lives.” The solar autoclave is an example of frugal innovation that is helping advance medical care in developing countries.

How do you think it might improve care in other nations?

CONNECT THE DOTS

To learn more about the solar powered autoclave, visit the Massachusetts Institute of Technology website here. To learn more about the non-profit organization which has partnered with the research team and MIT, visit the Salud Del Sol website here. Also, a video presentation of the solar powered autoclave can be viewed on YouTube here. For more news on low-cost innovations that are helping save lives in developing countries, read our blog posts, “Indonesia’s New Health Regime,” “Embrace: A Sleeping Bag That Helps Babies Survive in India,” and “HIV Prevention: One Penny Saves One Life.”

Most mass trauma survivors will suffer an immediate distress reaction, characterized by feelings of horror, shock and nervousness. These symptoms will usually decrease with time as basic needs are reestablished for food, safe shelter, water, medical attention and finding loved ones.

Charles Raison, MD, an associate professor and clinical director of the Mind-Body Program and director of the Behavioral Immunology Program in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine,  advises: “if there is also an element of dissociation to the immediate reaction, a feeling of unreality, that’s a strong sign that people could go on to develop PTSD. We know for sure that how people respond immediately to a stressor is very powerfully predictive of how much long-term trouble they are going to have. An acute response seems to set pathways in the brain or body and set the stage for later trouble.”

Psychological First Aid (PFA) is now widely considered by mental health experts to be the intervention of choice to help disaster victims manage post-disaster distress and to identify those who may need additional treatment. It is designed for delivery by mental health specialists who may be embedded in a variety of response units, including first responder teams, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, and other disaster relief organizations.

The primary objectives of PFA are to:

* Establish a human connection in an unobtrusive, culturally sensitive manner

* Make survivors feel safe and secure both physically and emotionally

* Help survivors specify their immediate needs

* Connect people to social support networks

* Provide information that can help victims reduce stress reactions

* Support and encourage adaptive coping behaviors

Experts concur that “debriefing” survivors or forcing them to recount their experiences in the first week or two after a traumatic event is not recommended as that approach has been shown to make things worse. Further, it is important not to impose a particular method of treatment or a timeline for recovery.

Additional risk factors for developing PTSD after a traumatic event are: how much worse the stressor was compared to expectations, the history of past trauma, and the victim’s mental health before the event occurred. Sadly, the March 11, 2011, earthquake and tsunami that devastated parts of Japan has led to continuing stress for the survivors due to the massive destruction and the ongoing nuclear facility crisis.

Raison takes Japan’s history into account when he considers the potential prevalence of psychological distress among the survivors and says, “given the history of Japan as the only country to have ever been attacked by a nuclear weapon, the specter of this latest nuclear threat so soon after the initial destruction of the earthquake and tsunami means there will unfortunately be a great number of people in psychological distress for years to come.”

CONNECT THE DOTS

The PFA Field Operations Guide for first responders, primary and emergency health care providers and disaster relief organizations is available from the National Child Traumatic Stress Network or the National Centre for PTSD, in English and in Japanese. Visit the National Institute of Mental Health site to learn more about PTSD and anxiety disorders.  For more news about PTSD, check out our blog post, “Virtual Reality Therapy for Veterans with PTSD.” The American Red Cross or Doctors Without Borders are also inspiring disaster relief organizations.

A study in the August, 2010 issue of the New England Journal of Medicine found that, among patients with metastatic non–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. When compared to patients who received standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. The findings may seen counter-intuitive but this study validates the work Diane Meier has been doing for more than 15 years.

Meier was working as a geriatric physician when she realized that, when it came to treating the chronically and terminally ill, there was no middle ground between hospice and disease care. That recognition led Meier to establish the Hertzberg Palliative Care Institute at Mount Sinai in New York City. The model program assists patients and families in navigating the complexities of illness and devises strategies for managing pain and other symptoms.

“The culture of medicine has gone from one of trying to relieve and comfort to trying to cure all the time,” says Meier. “Even when people are clearly dying, our job is to figure out how to defeat that process instead of figuring out how to make that process as tolerable as possible for the patient and their families.”

Too often, the terms “palliative care” and “hospice care” are used interchangeably. Meier points out that, while all hospice care is palliative, not all palliative care is hospice care. Palliative care tries to maximize quality of life for patients living with a disease and is not dependant on their prognosis. It is delivered at the same time as treatments intended to cure or prolong life. Conversely, hospice is specifically for the dying. Two physicians must certify that the patient’s prognosis is less than six months and the patient must waive insurance coverage for treatment intended to prolong his/her life.

“Modern medicine focuses on curing disease and prolonging life but fails to treat the physical and psychological distress of patients in both early and advanced stages of serious illness,” says Meier.  “As an attending physician, we were supposed to keep doing things for people without really talking to them about what they wanted and helping them make an informed decision based on the facts. I felt at a visceral level that what we were doing was wrong.”

As director of the Center to Advance Palliative Care at Mount Sinai, Meier’s mission is to provide technical guidance to hospital staff and help advance new palliative care programs throughout the country. In the last decade, her work has helped make palliative medicine a formal sub-specialty with a board certifying exam for doctors in the field. It also earned her a 2008 MacArthur Fellowship, a five-year grant to individuals who show exceptional creativity in their work and the prospect for still more in the future.

Realizing that a supportive policy was critical to sustain all the advances that have been made, Meier has spent the last year as a Health & Aging Policy fellow in Washington, DC trying to hone the political skills necessary to influence policy makers.

“Over the next ten years, I see palliative care becoming not just a nice-to-have but a have-to-have for hospitals and nursing homes. I hope it becomes a condition of participation for Medicare and Medicaid and for private insurance as well.”

CONNECT THE DOTS

Want to know more about palliative care? The Center to Advance Palliative Care and the Hertzberg Palliative Care Institute can help.

Couch potatoes beware: Too much TV can actually be deadly. A new study found that people who spend four or more hours daily in front of a screen during their leisure time—primarily watching the tube—have more than double the risk of heart attack and other major cardiovascular events over a four-year period, compared to people who devoted fewer than two hours a day to screen-based entertainment. Those who spent the most time watching TV, surfing the Web, or playing video games after work were also 50 percent more likely to die prematurely of any cause—regardless of how much they exercised. Here’s a look at healthy habits that could extend your life.

*Get more sleep. More than one-third of US adults routinely sleep fewer than seven hours a night, magnifying their risk for chronic diseases, injuries and car crashes, the CDC reported in March. Dimming the lights and turning off the TV and other electronics one hour before bedtime are excellent ways to improve both sleep and health.

*Take a brisk walk. Almost 38 percent of adults, and about 20 to 30 percent of teens, don’t participate in any vigorous physical activity. All movement counts—and a number of studies show that 30 minutes of brisk walking five or more days a week trims risk for CVD, diabetes and many other diseases. Wearing a pedometer causes people to take about 2,000 extra steps a day (one extra mile), a study at Stanford University School of Medicine found.

*Eat more fruits and vegetables. For each additional serving of fruits and vegetables people eat per day, the risk of fatal cardiovascular disease drops by 4 percent, a European study involving more than 313,000 men and women reported in January. Those who ate at least eight servings of 80 grams (2.8 ounces) apiece daily had a 25 percent lower risk than those who consumed fewer than three portions a day. A diet rich in fruits and vegetables also helps people slim down, because these foods are filling.

*Defuse tension. Chronic stress takes a toll on every organ in the body, including the heart, by repeatedly activating the well-known “fight-or-flight” system. Listening to joyful music is both relaxing and beneficial to blood vessel function, a study at University of Maryland School of Medicine reports, while an earlier study by the same researchers also found similar benefits to laughter. Try laughter yoga, a popular exercise program that combines self-triggered mirth with deep yogic breathing to draw oxygen deep into the body.

*Snuff out the tobacco habit. Smoking even one cigarette a day increases the threat of heart attack by 63 percent and smoking 20 or more cigarettes a day more than quadruples it. Need more motivation to quit? Tobacco use also boosts risk for diabetes, chronic obstructive pulmonary disease, and many types of cancer. A 2010 study reports that using a nicotine patch for six months makes it easier for smokers to kick the habit.

CONNECT THE DOTS

For more news on cardiovascular disease prevention and healthy lifestyle, read our blog posts, “Women’s Heart Health: New Guidelines from the American Heart Association” and “Top 10 Fitness Trends for 2011.” For additional information on smoking cessation, check out “Another Reason to Quit Smoking in 2011: Bladder Cancer” and “Cigarette Smoking: A Global Health Challenge. Learn to quit smoking without gaining weight.