Stopping smoking is associated with an improvement in mental health, researchers at the universities of Oxford and Birmingham have found.
The researchers say the size of the effect is equal to that seen in antidepressant treatment of mood and anxiety disorders.
They say their findings should give hope to many smokers who want to stop but continue smoking as they believe it can help with stress or anxiety.
And healthcare professionals can be encouraged to offer smoking cessation advice to people with mental health problems, where some might have previously been worried that quitting could make their conditions worse.
‘Patients often say to me, “Doctor, I’m too stressed to stop smoking now”,’ says Professor Paul Aveyard from the Nuffield Department of Primary Care Health Sciences at the University of Oxford. ‘I hope doctors will now reassure those patients that there’s a good chance that stopping smoking will make you less stressed.
‘In fact, for people with chronic mental health problems, stopping smoking might be an effective treatment.’
The researchers from the universities of Birmingham, Oxford and King’s College London analysed the results of 26 studies looking at mental health before stopping smoking and at least six weeks after stopping – in healthy adults and in patients with long-term physical and psychiatric conditions.
The team found consistent evidence that stopping smoking is associated with improvements in mental health compared with continuing to smoke, including measures of depression, anxiety, stress, psychological quality of life, and positivity. The effect was similar in all groups, including those with mental health disorders.
‘It is hugely encouraging to be able to demonstrate that smoking cessation leads to an improvement in mental health,’ says first author Gemma Taylor from the University of Birmingham. ‘Smoking rates in the general population have declined substantially over the last 40 years. However, the rates of smoking in people with mental health problems have barely changed. Part of this disparity is due to the myth that stopping smoking will worsen mental health. I believe this research debunks this myth and I hope that these findings motivate people with and without mental health problems to stop smoking.’
Nearly half of young Americans eligible to buy insurance on HealthCare.gov could pay $50 or less a month for coverage, the U.S. Department of Health and Human Services said in a reportreleased Monday. HHS is touting the affordability of insurance on the exchanges in part because young adults are crucial to making the health care reform law's finances work.
The conclusion was based on data from the 30-plus states where insurance is being sold through HealthCare.gov, for adults ages 18 to 34, who qualify for tax credits through the law. The analysis found that 46 percent could pay $50 or less for a bronze plan (which covers 60 percent of costs), and 66 percent could pay $100 or less.
“The health care law is making health insurance more affordable for young adults,” HHS Secretary Kathleen Sebelius said in a statement.
The administration has said it hopes to enroll 2.7 million age 18 to 34 (out of 7 million total) in the first year.
Mike Konczal says most of what needs to be said about the underlying sources of Obamacare’s complexity, which in turn set the stage for the current tech problems. Basically, Obamacare isn’t complicated because government social insurance programs have to be complicated: neither Social Security nor Medicare are complex in structure. It’s complicated because political constraints made a straightforward single-payer system unachievable.
It’s been clear all along that the Affordable Care Act sets up a sort of Rube Goldberg device, a complicated system that in the end is supposed to more or less simulate the results of single-payer, but keeping private insurance companies in the mix and holding down the headline amount of government outlays through means-testing. This doesn’t make it unworkable: state exchanges are working, and healthcare.gov will probably get fixed before the whole thing kicks in. But it did make a botched rollout much more likely.
So Konczal is right to say that the implementation problems aren’t revealing problems with the idea of social insurance; they’re revealing the price we pay for insisting on keeping insurance companies in the mix, when they serve little useful purpose.
So does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn’t going to happen — partly because of the insurance lobby’s power, partly because voters wouldn’t have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that’s what it took to cover the uninsured, so be it.
And although the botched rollout is infuriating — count me among those who believe that liberals best serve their own cause by admitting that, not trying to cover for the botch — the odds remain high that this will work, and make America a much better place.
The reorganization of the Greece's health system, under German direction, is advancing. "A final timetable is to be presented in the second half of this year," declared the German Health Ministry (BMG). The German government sees deficits also in the lack of an "effective cost management," but most of all in the lack of "competitive elements." In a "Memorandum of Understanding" (MoU), the BMG and the Task Force for Greece (TFGR) have reached an agreement with the Greek government on the introduction of the highly criticized German-modeled so-called case flat-rates. The criticisms stem from the fact that patients are not being treated in response to their medical needs but on the basis of economic efficiency. The massive consequences the austerity measures are having on the public health in Greece are becoming more evident. A growing number of Greek citizens are losing their health insurance, due to unemployment and therefore must pay medical costs themselves. The shortage of medical aid, for example, has caused an increase of 40 percent in the child mortality rate since 2009. Diseases such as malaria or AIDS are spreading more rapidly. The German government continues to insist on its austerity course in spite of these ramifications.
"Efficiency and Effectiveness"
Within the framework of the EU austerity dictates, Germany took the lead in the reorganization of the Greek health system back in March 2010. "The German Ministry of Health is in support of the Greek government's measures to increase the efficiency and effectiveness of long-term health care, by substantial and effective transformations in the organization of its health system," declared the State Secretary in the Ministry of Health, Stefan Kapferer in February 2011, on the occasion of the signing of the corresponding "Declaration of Intent." The concrete measures had been specified by the German Ministry of Health and the Task Force for Greece (TFGR) in the April 2012 "Memorandum of Understanding" (MoU) with the Greek government. These measures include the introduction of case flat-rates, a change in hospital management structures, the reorganization of the National Organization for Healthcare Provision insurance (EOPYY) and new pricing models for medicine. The German GIZ development aid agency was given the responsibility of the final elaboration of these plans, which thereby opens "new markets in industrialized countries." The German government bought supplementary expertise at the "KSB Clinic Consulting Group" and the "B and K Informatik and Consulting" company.
According to the German government the Greek health sector is lacking an "effective cost management," but above all it lacks "elements of competitiveness." The introduction of German-modeled case flat-rates is considered a fundamental instrument for overcoming these alleged deficits. By using a remuneration system oriented on the type of illness rather than on the length of hospital stay, the government coalition expects "major advantages" - even though criticisms of this model have been growing for a long time. Doctors have been criticizing that the false incentives, on the one hand, could lead to unnecessary, but lucrative treatments, and, on the other, to premature discontinuation of treatments in less profitable therapies. In addition, no studies have proven that costs are reduced through a reorientation on "Diagnosis Related Groups" DRGs. The German government is not promising overnight effects through DRGs. These would presuppose the implementation of modern, efficiency-oriented hospital management structures, which would be time consuming. "In this situation, short-term, tangible successes are not to be expected," according to a government answer to a parliamentary interpellation in the German Bundestag.
Cut the Health Budget by One-Third
These proposed transformations are being implemented within the framework of the austerity measures being enforced by Berlin. According to the stipulations handed down by the Troika, Greece's health expenditures should not surpass six percent of the country's gross national product - in Germany these expenditures were at 11.3 percent in 2011. Since, as a result of the austerity policy imposed on that country, the Greek GNP has been on the decline for years, the expenditures for the health system are sinking drastically. By 2012, these expenditures were reduced to around 9.5 billion Euros, from 14 billion Euros in 2009. The Greek government has already shut down 46 of its 130 hospitals and cut the budget by 40 percent for those remaining. This has added thousands more to the unemployed created by the devastation of the health sector. The newly founded EOPYY health insurance organization has had its finances cut. This has created billions in debts and is unable to pay the costs of medicine and treatments. Therefore patients must themselves pay, along with approx. 30 percent of their fellow citizens, who had lost their health insurance due to unemployment.
In 2012, Greece's Minister of Health, at the time, Andreas Lykourentzos, characterized the negotiations with the Troika as the most difficult period of his incumbency. "The public health system can't be amputated," he warned following the talks. In fact, the imposed austerity measures had a devastating effect on his country's health situation. Sick leaves have already a tendency to increase in times of economic crisis; the austerity policy, therefore, makes the situation even worse. Dr. Giorgos Vichas, speaks of a "humanitarian crisis." Since 2008, the child mortality rate has risen by 40 percent. The number of HIV positive drug users has risen from 10 - 15 in 2007 to 314 in the first eight months of 2012 alone - mainly due to the drastic cutbacks in preventive programs. Malaria and tuberculosis, the West Nile and dengue fevers are continuing to spread. Doctors' initiatives, appealing for donations of medicine and treating patients free of charge are attempting to mitigate the most serious emergencies, but they cannot substantially better the medical situation.
Deadly Shock Therapy
"The interaction between austerity policy, economic shock treatments and deficient social protective measures seems to ultimately lead to an escalation of the health and social crises in Europe," concluded a study by several scholars published in the renowned "The Lancet" medical journal, Epidemiologists, David Stuckler and Sanjay Basu drew the same conclusion in their book "The Body Economic - Why Austerity Kills." This is why the "European Health Alliance" has appealed for a political about face in an open letter to the European Commission. Associations in Germany, for example "Medico International" and the "Association of Democratic Doctors" are protesting against the austerity dictate and its catastrophic consequences.
Expenditures Still too High
The German government does not seem to be impressed by these initiatives. For example, activities to insure a better health insurance protection, surpassing the program set with the TFGR in the "Memorandum of Understanding," are not being planned. "The German government is concentrating its active support on the focal themes set out in the MoU with the Greek government and the TFGR," explains the Chancellery. In the meantime, the Troika has imposed even more drastic cut backs. Following its last "inspection," at the beginning of this month, it has forced the Greek government to agree to take concrete steps - not, for example, to mitigate the dramatic consequences of austerity on the country's health situation - but rather to bring under "control" the still "too high expenditures in the areas of health."
With lifespans lengthening, researchers found that where Americans live says a lot about how healthy they will be in later years.
Hawaiians are lucky in more than their idyllic weather and gorgeous scenery. Seniors there can expect a little more than 16 years of healthy life after 65. Women in Hawaii can expect more than 17 years.
At the other extreme, Mississippi’s seniors have less than 11 years of healthy life. Older black Mississippians have only eight years, lower than anywhere except, oddly, African-Americans in Iowa, with seven years.
The national average is 14 years. That is, the average 65-year-old American can expect good health until age 79 – a little more for women, a little less for men.
In general the Northeast, Upper Plains and West foster good health while the Midwest and, especially, the South (except Florida) are less healthy places. Some of this may owe to environmental factors as well as the usual factors of healthy behavior and access to good preventative care.
In related news a study published this month in the Journal of the American Medical Association found that, as NPR puts it:
The U.S. rank declined on every measure of longevity and good health between 1990 and 2010. On “healthy life expectancy,” the US went from 14th place to 26th over those two decades – while its already disproportionately high health care spending spiraled ever higher.
Commenting on the JAMA study in an accompanying editorial, Dr. Harvey Fineberg, president of the National Institute of Medicine, quoted from an influential 1970s book called “Doing Better and Feeling Worse: Health in the United States.”
“Despite a massive increase in health expenditures,” wrote Dr. John Knowles, editor of that volume, “the nation’s health has improved less than was promised or expected. The benefits have not appeared to justify the costs.”
The appendix may not be useless after all. The worm-shaped structure found near the junction of the small and large intestines evolved 32 times among mammals, according to a new study. The finding adds weight to the idea that the appendix helps protect our beneficial gut bacteria when a serious infection strikes.
Charles Darwin was one of the first scientists to theorize on the function of the appendix, which in his day had been identified only in humans and other great apes. He hypothesized that the distant ancestors of these animals survived on a diet of leaves, and so they required a large cecum, a portion of the gut that houses bacteria that can break down stubborn plant tissue. Later, he speculated, these ancestors shifted to a largely fruit-based diet that was easier to digest. A large cecum was no longer necessary, and it began to shrink; today our cecum is tiny. Darwin thought the appendix, which juts off of the cecum, is one of its former folds that shriveled up as the cecum shrank. Consequently, he thought it carried no function.
But some scientists have challenged the idea that the appendix serves no purpose. It's been clear for about a century that the structure contains a particular type of tissue belonging to the lymphatic system. This system carries the white blood cells that help fight infections. Within the last decade, research has shown that this lymphatic tissue encourages the growth of some kinds of beneficial gut bacteria. What's more, careful anatomical study of other mammals has revealed that species as diverse as beavers, koalas, and porcupines also have a structure jutting off of their guts in exactly the same place as our appendix—in other words, the feature is much more common among mammals than once thought.
Now, an international team of researchers that includes Heather F. Smith, an evolutionary biologist at Midwestern University in Glendale, Arizona, and William Parker, a surgeon who studies the immune system at Duke University Medical Center in Durham, North Carolina, says it has the strongest evidence yet that the appendix serves a purpose. In a new study, published online this month in Comptes Rendus Palevol, the researchers compiled information on the diets of 361 living mammals, including 50 species now considered to have an appendix, and plotted the data on a mammalian evolutionary tree. They found that the 50 species are scattered so widely across the tree that the structure must have evolved independently at least 32 times, and perhaps as many as 38 times.
By plotting the dietary information onto the evolutionary tree, the researchers could work out whether the appendix appears when a particular group of mammals changes its diet. In most cases, there was no sign of a dietary shift, suggesting appendix evolution doesn't necessarily proceed as Darwin thought. He may have correctly identified the origin of the ape appendix, though, which the analysis confirms did appear when our ancestors switched diets.
Randolph Nesse, an evolutionary biologist at the University of Michigan, Ann Arbor, is impressed by the new study. "I salute the authors for creating an extraordinary database," he says. "The conclusion that the appendix has appeared 32 times is amazing. I do find their argument for the positive correlation of appendix and cecum sizes to be a convincing refutation of Darwin's hypothesis."
"I agree with the general assertion that the appendix evolved numerous times in mammals, but I think the exact count is still up for debate," adds Olaf Bininda-Emonds, an evolutionary biologist at the University of Oldenburg in Germany. There is some uncertainty over whether all 50 species considered to have an appendix really do possess one. When just the clear-cut cases are included, the appendix evolved 18 times, he says.
Researchers found that easy mood-boosters -- like giving people a small bag of candy -- helped seniors do significantly better on tests of decision-making and working memory.
This is the first study to show the power of positive moods in helping older people with these brain tasks.
"There has been lots of research showing that younger adults are more creative and cognitively flexible when they are in a good mood. But because of the cognitive declines that come with aging, we weren't sure that a good mood would be able to help older adults," said Ellen Peters, co-author of the study and professor of psychology at Ohio State University.
"So these results are good news. There are ways for older adults to overcome some of the cognitive declines that come with aging."
The study was done with Stephanie Carpenter of the University of Michigan; David Västfjäll of Linköping University in Sweden; and the late Alice Isen, of Cornell University. It appears in the current issue of the journal Cognition and Emotion.
The study involved 46 adults aged 63 to 85. Half of them were put into a good mood by receiving a thank-you card and two small bags of candy, tied with a red ribbon, when they arrived at the lab for the experiment. The other "neutral mood" participants did not receive a card or candy.
The participants completed the study on a computer. Those who were induced into the positive mood had a background screen that was designed to help keep them feeling positive -- it featured smiling suns on a sky-blue background. The neutral-mood participants had a similar background, but with neutral round images with no face.
In the decision-making task, the participants were given $3 in quarters and presented with eight virtual decks of cards over the course of experiment. Each of the decks had a different pattern on its back so that participants could identify them. Four of the decks were "gain" decks, meaning that the participants won a quarter 75 percent of the time if they chose a card from that deck, while the other 25 percent they did not win or lose. The other four decks were "loss" decks, meaning they lost a quarter 75 percent of the time that they chose a card from the deck.
Participants could choose to accept or reject the top card of each deck that was offered to them. They were told the goal of the experiment was to win as much money as possible.
The researchers wanted to see how quickly and accurately the participants would learn which decks generally won them money, and which decks lost them money.
The findings were clear: older adults who were put into a good mood chose significantly better than those who were in the neutral mood.
These results are significant because this decision-making task was experiential, meaning that the participants knew nothing about the card values at the beginning of the experiment and had to learn through trial and error.
"We used an experiential task because real life is experiential," Peters said.
"For example, you meet a new person and she is like one of these decks of cards. You don't know anything about her and you have to learn if she is someone you can trust. What this study suggests is that people who are in a good mood are going to learn faster and make better decisions."
Later in the experiment, the researchers tested working memory -- how much information people can hold in their mind at any one time. Researchers read aloud a group of intermixed letters and numbers (such as T9A3) and participants were to repeat the group back in numeric and then alphabetic order (in this case, 39AT). The participants received groups with increasingly more letters and numbers.
Results showed that the older adults who were induced into a good mood scored better on this test of working memory.
"Working memory is important in decision making," Peters said.
"If you're working your way through different options, how much you can remember of each option -- and can therefore compare and contrast in your head -- has a big impact on how well you can make a decision."
A positive mood did not help these older adults on some cognitive measures, such as speed of processing or vocabulary.
Still, Peters said the results provide some good news for a fast-growing population segment in the United States.
"Given the current concern about cognitive declines in the aged, our findings are important for showing how simple methods to improve mood can help improve cognitive functioning and decision performance in older adults, just like they do in younger people."