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How to address opposition in young children

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"No!"

It might have been endearing as your child’s first word, but dread often kicks in when that word starts to follow parental requests. Experiencing resistance to small or big asks? Stuck in arguments that seem to go in circles and leave you exasperated with unmet requests? The good news is that this pattern can be disrupted. First, you’ll need to identify reasons behind the opposition. Then you can apply relevant strategies to see more helpful behaviors instead.

Below are some examples of opposition drivers and tips to address them.

Difficulty with transitions

If you find that your child resists a request right after engaging in an activity, it might be that your child first needs time to transition. This can be a common experience when parents make requests while children are playing video games or another stimulating activity. One way to manage this is to give your child a five- or 10-minute heads-up (whichever they might need) that you will be asking for the game to stop. This gives your child time to find a place to pause if playing a video game and to transition.

Some families find it helpful to talk with their children before playtime begins to learn what game or activities will be taking place, and how much advance notice might be helpful before the activity would need to stop. This invites collaboration and shows that you respect that not all moments are ideal for stopping a game.

Independent streak

Children almost never are in control, and resistance can show up when that wears on them. Try to fold in elements of choice and control throughout the day for children (that are within a framework you determine) to create more of a balance with your requests. Perhaps you let a young child know that they will need to wear long sleeves and pants because of the weather, but they can pick which top and pair of pants to wear that day. Another idea is to invite your child to pick a side dish for a future dinner from a premade list of a few options.

It also helps to create opportunities for your child to practice being independent. This fosters mastery and offers experiences of feeling in control. This could look like your child preparing any parts of meals that are age-appropriate (for example, a three-year-old could pour cereal into a bowl; a five-year-old could measure ingredients for baking). The kitchen counter may be extra sticky as your child learns new skills. With time, your child will be more adept, and your counters will be cleaner.

Hunger and tiredness

We need both food and sleep to recharge our batteries. When we run low on either or both, it’s extra difficult to be our best selves. If you find that your child is crankier than usual, reflect on when your child last ate and how your child slept the night before (or napped if your child is of napping age). If it’s been a while since your child has eaten and/or your child did not sleep as much as usual, your child may need to recharge before being more receptive to requests. Have your child grab a healthy snack or meal if needed. If sleep is the issue, validate to yourself that this is frustrating that there is no quick fix. Acknowledge privately they are not their usual self at this moment and may be more receptive tomorrow.

Resistance also may crop up when children are coming down with a viral illness, so keep an eye out for any symptoms that may emerge.

Mental health challenges

Everyone has off days, but a persistent pattern of resistance to requests and distress following them may suggest that a child is experiencing mental health difficulties. For example, if a child appears oppositional every morning before school, it could be that they experience anxiety about going to school and are trying to avoid the distress they experience when there. In this case, it is important to ignore the "no" bait and focus on the emotion behind the refusal. Validate or acknowledge how your child is feeling to open the door to learn more. For example, you could say, "You seem really worried about going to school. What about school has been so tough lately?"

Use a similar approach for symptoms of depression, such as withdrawing from and refusing to engage in activities: validate your child’s feelings and invite your child to share more to help you understand their experiences. Discovering what is driving the resistance can allow you to develop a collaborative plan to support your child’s needs and get extra help if needed. Cognitive behavioral therapy is an evidence-based treatment for children experiencing anxiety and/or depression. Your pediatrician can be a helpful resource for mental health treatment referrals. The Anxiety & Depression Association of America also provides treatment resources.

Sometimes, oppositional behavior is pervasive. It can include a frequent loss of temper, irritability, difficulty following the rules, defiance of authority figures, spitefulness, and more. If these behaviors occur at home and also show up in other settings, such as at school, a child may be experiencing symptoms of oppositional defiant disorder. Parent training programs such as parent management training, along with problem-solving skills training, are evidence-based treatments, and pediatricians also may be able to provide relevant referrals.

Your patience understandably can wear thin if you find yourself facing repeated resistance. That experience, though, does not have to continue. You can help shift these patterns once you discover what is driving the "no."

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Anti-inflammatory food superstars for every season

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Berries and watermelon in the summer, kale and beets in the winter. The recipe for anti-inflammatory foods to enjoy can change with the seasons.

Your heart, your brain, and even your joints can benefit from a steady diet of these nutritious foods, and scientists think that their effects on inflammation may be one reason why.

Inflammation: How it helps and harms the body

Inflammation is part of your body’s healing mechanism — the reason why your knee swelled and turned red when you injured it. But this inflammatory repair process can sometimes go awry, lasting too long and harming instead of helping. When inflammation is caused by an ongoing problem, it can contribute to health problems. Over time, inflammation stemming from chronic stress, obesity, or an autoimmune disorder may potentially trigger conditions such as arthritis, heart disease, or cancer. It may also harm the brain. Researchers have found a link between higher levels of inflammation inside the brain and an elevated risk for cognitive decline and impairment. Regularly adding anti-inflammatory foods to your diet may help to switch off this process.

Three diets that emphasize anti-inflammatory patterns

Research hasn’t looked specifically at the anti-inflammatory benefits of eating foods that are in season. “But it’s generally accepted that eating what’s in season is likely to be fresher and obviously there are other benefits, including those for the environment,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School. Eating foods that are in season may also help your grocery bill.

When it comes to anti-inflammatory foods, the goal should be to incorporate as many as you can into your overall diet. “Our emphasis now is on eating patterns, because it seems that interactions between foods and their combinations have a greater effect than individual foods,” says McCormick.

Three diets in particular, she says, contain the right mix of elements: The Mediterranean diet, the DASH diet, and the Alternative Healthy Eating Index. These diets are similar in that they put the emphasis on foods that are also known to be anti-inflammatory, such as colorful fruits and vegetables, whole grains, legumes, and healthy fats such as olive oil and nut butters. But just as importantly, these diets also eliminate foods — such as highly processed snacks, red meat, and sugary drinks — that can increase levels of inflammatory markers inside the body, including a substance called C-reactive protein.

Mixing and matching different foods from these diets can help you tailor an anti-inflammatory approach that fits your personal tastes, as can choosing the freshest in-season offerings. Whole grains, legumes, and heart-healthy oils can be year-round staples, but mix and match your fruits and vegetables for more variety. Below are some great options by season.

Winter anti-inflammatory superstars

In the cold winter months, think green. Many green leafy vegetables star during this season, including kale, collard greens, and swiss chard. Root vegetables like beets are another great and hardy winter option. Reach for sweet potatoes and turnips. Other options to try are kiwi fruit, brussels sprouts, lemons, oranges, and pineapple.

Spring anti-inflammatory superstars

When the spring months arrive, look for asparagus, apricots, avocados, rhubarb, carrots, mushrooms, and celery, as well as fresh herbs.

Summer anti-inflammatory superstars

Summer is prime time for many types of produce, and you’ll have lots of choices. Berries are a great anti-inflammatory option. Try different varieties of blueberries, blackberries, and strawberries. Go local with marionberries, huckleberries, gooseberries, and cloud berries, which grow in different parts of the US. Also reach for cherries, eggplant, zucchini, watermelon, green beans, honeydew melon, okra, peaches, and plums.

Fall anti-inflammatory superstars

Nothing says fall like a crisp, crunchy apple. But there are a host of other anti-inflammatory foods to try as well, such as cabbage, cauliflower, garlic, winter squash, parsnips, peas, ginger, and all types of lettuce.

Whenever possible, when you choose an anti-inflammatory food try to substitute it for a less healthy option. For example, trade a muffin for a fresh-berry fruit salad, or a plate of French fries for a baked sweet potato. Making small trades in your diet can add up to big health benefits over time.

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Skin in the game: Two common skin problems and solutions for men

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When I was on the junior varsity basketball team in high school, I wasn't surprised when I developed a case of itchy, flaky athlete's foot. After all, I was an "athlete," so I assumed it was a sign of dedication and hard work.

I was shocked when my mother told me the truth: it was due to poor foot hygiene, not my dribbling skills.

Fast-forward almost four decades, and I’m much more diligent about skin care. Still, some skin issues plague me at times, like they do many men. Here is a look at two common problems and solutions.

Dry skin

Symptoms of dry skin include scaly patches (with or without redness), itching, and overall dryness. You can get dry skin year-round — from the heavy heat of summer to the bitter cold of winter. Sun exposure damages skin, leaving it thinner and less likely to hold in moisture over time. Also, aging skin produces less of the natural oils that keep skin lubricated.

Treatment. The first line of defense is a moisturizer that softens and smooths skin with water and lipids (fats). Some moisturizers attract water to the skin and seal it in. Others prevent moisture loss by coating skin with a thick, impermeable layer.

  • Petroleum jelly. This waxy, greasy substance stops water loss without clogging pores. It can be used by itself but is also an ingredient in many moisturizers and ointments. Because petroleum jelly doesn’t contain water, it’s best used while the skin is still damp after bathing to seal in moisture.
  • Mineral oil. Mineral oil has the same effect but without a greasy feeling. It also should be used while skin is damp.
  • Moisturizing lotions and creams. These products contain both water and oils. They’re less greasy and more cosmetically appealing than petroleum jelly or oils. Look for moisturizers with at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts, or alpha hydroxy acids.

Prevention. Try a few changes to help prevent dry skin:

  • Add moisture to the air with a humidifier or a pan of water set atop the radiator.
  • In the shower or bath, use lukewarm water (hot water can dry the skin by stripping it of natural oils).
  • Choose nondrying soaps with no abrasives or irritants. Super-fatted soaps or cleansing bars are less drying than regular, liquid, or antibacterial soaps.
  • To retain the water your skin absorbs while showering or bathing, apply jelly, oil, or moisturizer immediately afterward.

Athlete’s foot

Athlete’s foot is caused by dermatophytes, a group of fungi on the surface of the skin. Tell-tale signs include intense itching; cracked, blistered, or peeling areas of skin, especially between the toes; and redness and scaling on the soles. Dermatophytes thrive in warm, moist environments like pools, showers, and locker rooms where people walk with bare feet. The warm, moist environment of sweaty socks and shoes encourages them to grow.

Treatment. First, try an over-the-counter antifungal ointment, cream, or powder, such as clotrimazole (Lotrimin AF, Mycelex, generic), terbinafine (Lamisil AT, Silka,), or miconazole (Lotrimin AF spray, Micatin). It can take weeks for an infection to improve, and recurrences are common. If symptoms don't improve after several weeks, consult a doctor, who may prescribe antifungal pills.

Prevention. Keeping feet clean and dry is the best way to ward off athlete’s foot. Also, do the following:

  • Wash your feet well every day, and wear a clean pair of socks after your bath or shower.
  • Take time to dry your feet thoroughly (including each toe and especially the web space between the toes) after you bathe, shower, or swim.
  • Wear flip-flops or sandals around public pools and in gym locker rooms and showers.
  • Wear moisture-wicking socks that absorb sweat.
  • Don’t wear the same shoes two days in a row. Give shoes a 24-hour break between wearings to air out and dry.

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If you have knee pain, telehealth may help

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Just about everyone experiences knee pain at some point in their lives. Most of the time, it follows an injury or strenuous exercise and resolves in a few days, but knee pain can last months or even years, depending on the cause. A new study suggests telehealth programs designed for people with knee osteoarthritis may help ease pain, improve ability to function, and possibly even lead to weight loss.

What is osteoarthritis of the knee?

Osteoarthritis (OA) — the age-related, “wear-and-tear” degeneration of the knee joint — is the number one cause of chronic knee pain, affecting nearly a quarter of people age 40 or older. It’s responsible for most of the 600,000 knee replacements in the US each year, and more than $27 billion in annual healthcare spending.

How is it treated?

No treatment for knee OA is ideal or works in every case. Standard approaches to treatment include pain management, exercise, and loss of excess weight.

For pain, people with knee OA may consider

  • anti-inflammatory drugs that are rubbed on the skin, such as diclofenac gel
  • anti-inflammatory medicines, such as ibuprofen
  • pain relievers, such as acetaminophen
  • injections of corticosteroids.

Opiates, arthroscopic surgery, and other injected treatments are not routinely recommended due to risks, lack of proven benefit, or both. Knee replacement surgery has a high success rate for knee OA, but is generally considered a last resort because it’s major surgery that requires significant recovery time.

Virtual visits can help

Before the COVID-19 pandemic, many people with knee OA regularly saw their healthcare providers to

  • monitor their pain and ability to function
  • consider changes in treatment
  • check for treatment side effects
  • determine if other problems are contributing to symptoms.

It turns out, much of this can be done virtually. The pandemic made it a necessity. And a new study suggests it works.

What did the study on knee osteoarthritis find?

The study demonstrated that telehealth visits are a good way to provide care to people with knee OA. The researchers enrolled nearly 400 participants who had knee OA and were overweight or obese. They were divided into three groups:

  • Group 1 was given access to a website that provided information about OA, including pain medications, exercise, weight loss, and pain management.
  • Group 2 received the same information as group 1, and also engaged in six exercise sessions with a physical therapist by videoconference. These sessions lasted 20 to 45 minutes and included advice about self-management, behavioral counseling, and education about choosing exercise equipment.
  • Group 3 followed the same format as group 2, and also had six consults by videoconference with a dietitian about weight loss, nutrition, and behavioral resources. These sessions also lasted 20 to 45 minutes.

After six months, participants in groups 2 and 3 reported pain relief compared to Group 1. On a pain scale of 1 to 10:

  • group 3 improved more than group 1 by 1.5 points
  • group 2 improved more than group 1 by about 1 point.

People in groups 2 and 3 also had better scores for function compared to group 1. All of these improvements were considered meaningful and held up for at least 12 months.

In addition, those assigned to group 3 lost about 20 pounds over the course of the study, while the other groups’ weights were nearly unchanged. That’s an important finding, because excess weight can worsen osteoarthritis of the knee. Losing excess weight can improve symptoms and help prevent the arthritis from getting worse.

Since there was no comparison with in-person care, it’s impossible to say whether these virtual visits were better, worse, or similar to an office visit. In addition, this study did not report the costs of these virtual sessions, the long-term impact of virtual visits, or whether repeated virtual visits could maintain the improvements people reported.

The bottom line

The pandemic is giving researchers an opportunity to seriously study the potential value and limitations of virtual care on a large scale. If these visits are as good as or better than in-person visits for certain conditions and the costs are no greater, that’s a big deal. A virtual visit can eliminate time spent in travel and the waiting room, and possible parking fees that can make a brief doctor’s visit an expensive undertaking that takes half the day. Virtual care also has the potential to reach patients who otherwise cannot get to their doctor’s office.

Of course, telehealth isn’t equally available to everyone due to language barriers, technical abilities, health insurance plans, or simply not having access to smartphones, computers, or data plans. Some states are letting emergency measures supporting telehealth services expire. And some insurers may resort to pre-pandemic rules about coverage or physician licensing that create uncertainty about the future of telehealth.

This study and others suggest that it may be a mistake to curb telehealth just when it’s catching on. More studies like the one described here may make the case to insurers, regulatory agencies, healthcare providers, and patients that the future of medical care should rely on more, not less, virtual healthcare, and encourage approaches that overcome barriers to its use.

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Naps: Make the most of them and know when to stop them

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant.

But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes.

Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore.

Making naps work for your baby

Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the naps, most commonly the morning nap.

Every child is different when it comes to napping. Some need long naps, some do fine with catnaps, some will give up naps earlier than others. Even within the same family, children can be different. A big part of making naps work is listening to and learning about your child’s temperament and needs. Otherwise, you can end up fighting losing battles.

The needs of a parent or caregiver are also important: everyone needs a break. Sometimes those breaks are particularly useful at specific times of the day (like meal prep time). While you can’t always make a child be sleepy at the most convenient time for you, it’s worth a try — which leads me to the first tip:

Schedule the naps. Instead of waiting for a child to literally drop and fall asleep, have a regular naptime. We all do better when our sleep routines are regular, even adults. If you can, put the child down awake (or partially awake). Learning to fall asleep without a bottle or a breast, or without being held, is a helpful skill for children to learn and can lead to better sleep habits as they grow.

A couple of scheduling notes:

  • If you need a child to fall asleep earlier or later than they seem to do naturally, try to adjust the previous sleep time. For example, if you need an earlier morning nap, wake the child up earlier in the morning. It may not work, but it’s worth a try.
  • Naps later in the afternoon often mean that a child won’t be sleepy until later in the evening. That may not be a problem, but for parents who get tired early or need to get up early, it can be. Try to move the nap earlier, or wake the child earlier. If the problematic afternoon nap is in daycare, talk to the daycare provider about moving or shortening it.

Create a space that’s conducive to sleep. Some children can sleep anywhere and through anything, but most do best with a space that is quiet and dark. A white noise machine (or even just a fan) can also be helpful.

Don’t use screens before naptime or bedtime. The blue light emitted by computers, tablets, and phones can wake up the brain and make it harder for children to fall asleep.

When is it time to give up naps?

Most children give up naps between the ages of 3 and 5. If a child can stay up and be pleasant and engaged throughout the afternoon, they are likely ready to stop. Some crankiness in the late afternoon and early evening is okay; you can always just get them to bed earlier.

One way to figure it out, and ease the transition, is to keep having “quiet time” in the afternoon. Have the child go to bed, but don’t insist on sleep; let them look at books or play quietly. If they stay awake, that’s a sign that they are ready to stop. If they fall asleep but then end up staying up very late, that’s another sign that the afternoon nap needs to go.

Whether or not your child naps, having some quiet time without screens every afternoon is a good habit to get into. It gives your child and everyone else a chance to relax and unwind, and sets a placeholder not just for homework but also for general downtime as children grow — and just like naps for babies, downtime for big kids is crucial.

Follow me on Twitter @drClaire

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Minimizing successes and magnifying failures? Change your distorted thinking

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Some things are not debatable. Rain falls from the sky. Elevators go up and down. Orange traffic cones are orange. But because we interpret the world through our experiences, a lot isn’t so definitive.

The boss might say, “Good job,” and we wonder why they didn’t say, “Great job.” We see someone looking in our direction and they seem angry, so we believe that they’re mad at us, and no other explanation makes sense.

What’s happening is that we’re distorting our experience, jumping to conclusions, mind reading, and going to the worst-case scenario. When we do this, we shrink our successes and maximize our “failures,” and because it can be an automatic process, it’s hard to tell when it’s happening. “You don’t know you’re wearing magnifying glasses,” says Dr. Luana Marques, associate professor of psychology at Harvard Medical School.

So what can you do to see things more clearly and with a more balanced perspective? It takes practice and a willingness to tolerate discomfort, but as with addressing any problem, it starts with awareness.

What’s happening when we magnify failures and jump to negative conclusions?

We like to process information quickly, and we use filters to help do that. If we believe, “I’m no good,” all words and behaviors that support that contention just make everything easier.

“The brain doesn’t want to spend energy trying to fight that,” Marques says. And the brain responds depending on the distortion. If something causes anxiety, say from a curious look or comment, the limbic system is activated and we’re in fight-or-flight mode, hyper-focused on the threat, not thinking creatively or considering alternative, less threatening options.

But sometimes, there’s no threat in play. We’re just thinking, probably overthinking, when we question our abilities and minimize our accomplishments.

So what can you do about it?

Label the type of thinking distortion

It helps to define our distortions, the common ones being:

  • Catastrophizing: Taking a small incident and going to the worst-case scenario.
  • Black-and-white thinking: Seeing only all-or-nothing possibilities.
  • Jumping to conclusions: Assuming what will happen rather than waiting to see what will actually happen.
  • Mind reading: Assuming what someone is thinking without much evidence.

When you label it, you can better understand and recognize what your go-to distortion is, because “we tend to do one more than another,” Marques says.

After that, it helps to take your emotional temperature by asking: Am I stressed? Am I sweating? Is my heart pounding or my breathing shallow? It brings you more into the moment and it allows you to think about what you were doing that brought on the response, such as, “I was trying to guess the outcome.” It’s another way to pinpoint the distortion you tend to favor, she says.

Challenge the distortion

Whichever distortion it is, you want to examine your assumption by looking for other evidence. If you question your boss’s reaction to you, ask yourself: What does my boss really say? What does this person say about other people? Have I received raises and promotions? Am I given good projects?

An easy trap with distortions is that they’re plausible. A person who is mad at me would give me a look. A person who hated me wouldn’t text me back. Maybe so, but think of five other possible explanations, Marques says. This exercise engages the prefrontal cortex, which takes you out of the fight-or-flight mode and expands your thinking. You’re then problem-solving and not solely keyed on one option.

You also want to ask an essential question: is this thinking helpful? You might realize that all your thinking/wondering/worrying does is make you anxious. Gaining that presence might be enough to get you off the path of distorted thinking. “Asking and answering the question about your thinking pauses the brain, and you potentially see the world differently,” she says.

Being balanced and kind to ourselves

As you examine and attempt to control your distortions, be mindful of how you treat yourself. Self-criticism is a really easy trap to fall into, but try talking to yourself as you would a friend. Better yet, imagine you’re speaking to a child. Your language would be considerate, supportive, and you wouldn’t use words such as “stupid” or “dumb.” This approach also shifts you into the detached, third person. “You get out of your head,” Marques says. “We’re cleaning our magnifying glasses a little bit.”

Lastly, realize that you’re not looking to switch your attitude from “I’m unworthy” to “I’m super-great.” That’s just trading one extreme for another. All you want is to counterbalance your distortion, then let it go. Countering thinking distortions is a lot like meditation, where you practice acknowledging your thoughts without getting hooked onto them.  “You don’t have to magnify or minimize.” Marques says.

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Making holiday shopping decisions quicker and with less stress

When faced with buying shoes, some people will be done in five minutes and be totally satisfied. For others, it’ll be a multiday process of reading reviews, comparing prices, consideration, and more consideration before making a decision.

Or not.

People can want to make a choice, but fear of making a bad one or of missing a better deal that might come gets in the way. The upcoming holiday gift-buying only ups the pressure.

“Making decisions is a taxing task,” says Dr. Soo Jeong Youn, clinical psychologist at Massachusetts General Hospital and assistant professor in the department of psychiatry at Harvard Medical School.

We’re doing it constantly, with what to wear and eat. It can also feel agonizing, even paralyzing, because sometimes we don’t know all the information, and so the brain fills in the gaps with worst-case scenarios, which does nothing to lower the stress.

Can we get better at making decisions? The short answer is yes. It takes some organization, but also a mindset shift in which we accept that there is no ideal choice. But before that, it helps to look a little more at why decision-making can be so difficult.

Knowing what to expect

Not all decisions cause the same stress. Big ones, like changing jobs or buying a house, take consideration, which we expect. Everyday choices, like our morning coffee order or groceries, are often automatic. And usually, the prefrontal cortex is in control. That’s the part of the brain behind the forehead, handling executive functioning skills — a term, Youn says, which tries to capture the complexity behind thinking. The prefrontal cortex processes information from the entire brain and puts it together to make a choice.

It’s the midlevel decisions — the new bike, winter jacket, toaster, or shoes — that become troublesome. They’re not huge purchases, but since we don’t make them regularly, we can spend more time weighing cost versus benefit. “We haven’t engaged in the thinking process,” Youn says.

Instead of the prefrontal cortex, the limbic system takes over. It’s the fight-or-flight response part of the brain, and there’s no careful weighing of factors. The goal is simple: survival, and it can cause us to make a less-than-optimal choice just to end the decision-making process — or to avoid the situation altogether by doing nothing, she says.

That’s not necessarily our goal. We want to make a good choice, but often there’s more in play, namely expectations. It’s tied into how we get viewed and what our worth is. If it’s a present, we worry about whether it expresses our feelings appropriately. As Youn says, “That decision is not just about that decision.”

And underlying it all is the fear and regret that you picked the wrong thing.

But to that, Youn poses a question: Wrong for what?

Get your focus

Often, people go into a purchase without being clear on what they need. Is the item for warmth, durability, exercise, style? Does it have to have special features? Do you need it quickly? Establishing a scope gives us something to refer back to and ask, “Does this fit with my purpose?” Conversely, with no parameters, we spend more time and angst making decisions, and sometimes keep looking under the belief that the “perfect” thing exists.

“We want this to check off all the boxes, even though we haven’t defined what all the boxes are,” she says.

For some people, the difficulty is in making the decision, but once done, the stress is over. But for others, the worry continues: the limbic system is still activated, and that’s when regret or buyer’s remorse comes in. Youn says to treat it like that song in your head that won’t go away, and give it some attention.

Examine the worry and name it. If you’re wondering about missing out on something, ask, “Why is that important?” And then with every assumption ask, “And then what would happen?” The process might reduce the magnitude of how much something actually matters. If that doesn’t work and you’re worried that you missed out on a better deal, then do some research. Whatever the result, even if it wasn’t in your favor, take it as a lesson that you can use for the next decision.

Lean on routines

New decisions take energy. That’s why routines are helpful — they remove the uncertainty of what to do in the morning or how to get to work. When possible, Youn says, use previous knowledge instead of constantly reinventing the wheel. If you like a pair of sneakers, there’s no problem with rebuying them if your needs haven’t changed.

If they have, just re-examine the new components, not the stuff you already know. And if you feel like you’re getting stuck in the evaluation process, ask yourself, “Is this worth my time?” The question creates a pause, brings you back into the moment, and allows you to decide how you want to proceed.

More research won’t help with decision-making or decision regret

It helps to realize that when we do our research, there comes a point where we’ve seen everything. In fact, more information becomes overload. What helps is to shrink down options as soon as possible. Maybe start with 10, but quickly get to five, then three, and finally two to compare before picking the winner. What can also help is setting the timer on your phone and giving yourself a certain number of minutes to make a choice. Sometimes that self-imposed deadline can keep us on track, and we can move on to the next decision.

But there can always be a nagging feeling that there’s more to know. In reality there isn’t, and actually we can’t know everything and don’t have to know everything — and that’s all right. As Youn says, “It’s an illusion.”

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How to stay strong and coordinated as you age

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So many physical abilities decline with normal aging, including strength, swiftness, and stamina. In addition to these muscle-related declines, there are also changes that occur in coordinating the movements of the body. Together, these changes mean that as you age, you may not be able to perform activities such as running to catch a bus, walking around the garden, carrying groceries into the house, keeping your balance on a slippery surface, or playing catch with your grandchildren as well as you used to. But do these activities have to deteriorate? Let’s look at why these declines happen — and what you can do to actually improve your strength and coordination.

Changes in strength

Changes in strength, swiftness, and stamina with age are all associated with decreasing muscle mass. Although there is not much decline in your muscles between ages 20 and 40, after age 40 there can be a decline of 1% to 2% per year in lean body mass and 1.5% to 5% per year in strength.

The loss of muscle mass is related to both a reduced number of muscle fibers and a reduction in fiber size. If the fibers become too small, they die. Fast-twitch muscle fibers shrink and die more rapidly than others, leading to a loss of muscle speed. In addition, the capacity for muscles to undergo repair also diminishes with age. One cause of these changes is decline in muscle-building hormones and growth factors including testosterone, estrogen, dehydroepiandrosterone (better known as DHEA), growth hormone, and insulin-like growth factor.

Changes in coordination

Changes in coordination are less related to muscles and more related to the brain and nervous system. Multiple brain centers need to be, well, coordinated to allow you to do everything from hitting a golf ball to keeping a coffee cup steady as you walk across a room. This means that the wiring of the brain, the so-called white matter that connects the different brain regions, is crucial.

Unfortunately, most people in our society over age 60 who eat a western diet and don’t get enough exercise have some tiny "ministrokes" (also called microvascular or small vessel disease) in their white matter. Although the strokes are so small that they are not noticeable when they occur, they can disrupt the connections between important brain coordination centers such as the frontal lobe (which directs movements) and the cerebellum (which provides on-the-fly corrections to those movements as needed).

In addition, losing dopamine-producing cells is common as you get older, which can slow down your movements and reduce your coordination, so even if you don’t develop Parkinson’s disease, many people develop some of the abnormalities in movement seen in Parkinson's.

Lastly, changes in vision — the "eye" side of hand-eye coordination — are also important. Eye diseases are much more common in older adults, including cataracts, glaucoma, and macular degeneration. In addition, mild difficulty seeing can be the first sign of cognitive disorders of aging, including Lewy body disease and Alzheimer’s.

How to improve your strength and coordination

It turns out that one of the most important causes of reduced strength and coordination with aging is simply reduced levels of physical activity. There is a myth in our society that it is fine to do progressively less exercise the older you get. The truth is just the opposite! As you age, it becomes more important to exercise regularly — perhaps even increasing the amount of time you spend exercising to compensate for bodily changes in hormones and other factors that you cannot control. The good news is that participating in exercises to improve strength and coordination can help people of any age. (Note, however, that you may need to be more careful with your exercise activities as you age to prevent injuries. If you’re not sure what the best types of exercises are for you, ask your doctor or a physical therapist.)

Here are some things you can do to improve your strength and coordination, whether you are 18 or 88 years old:

  • Participate in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
  • Participate in exercise that helps with strength, balance, and flexibility at least two hours per week, such as yoga, tai chi, Pilates, and isometric weightlifting.
  • Practice sports that you want to improve at, such as golf, tennis, and basketball.
  • Take advantage of lessons from teachers and advice from coaches and trainers to improve your exercise skills.
  • Work with your doctor to treat diseases that can interfere with your ability to exercise, including orthopedic injuries, cataracts and other eye problems, and Parkinson’s and other movement disorders.
  • Fuel your brain and muscles with a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
  • Sleep well — you can actually improve your skills overnight while you are sleeping.

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Period equity: What is it, why does it matter?

It’s happened to so many people who menstruate: you’re going about your life until you realize that you just got your period. The ungainly scramble to find a restroom and the fervent prayer that you packed a menstrual product leaves you feeling anxious, vulnerable, and exposed. This is compounded by the fact that our society stigmatizes menstruation — or really, anything to do with a uterus — and a taboo hangs over these discussions.

This scenario is far worse if you are one of the nearly 22 million women living in poverty in the US who cannot afford menstrual hygiene products, a problem known as period poverty. One study in Obstetrics & Gynecology demonstrated that 64% of women reported ever having difficulty affording menstrual products, such as pads, tampons, or reusable products like menstrual cups. And 21% reported that they were unable to afford these products every month. People who are homeless or incarcerated are at particularly high risk of not having access to adequate menstrual hygiene products.

Why are period products a luxury?

Menstruating is a basic fact of human existence. Menstrual hygiene products are necessities, not luxuries, and should be treated as such. Unfortunately, food stamps and subsidies under the WIC (women, infants, and children) program that help with groceries do not cover menstrual products.

I have had patients tell me that they use toilet paper or paper towels instead of pads or tampons because they cannot afford menstrual products. People with heavy periods requiring frequent changes of these products particularly face financial challenges, as they must buy even more pads or tampons than the average menstruating person. If they try to extend the life of products by using them for multiple hours at a time, they can wind up with vulvar irritation and vaginal discomfort. They may also be at greater risk for toxic shock syndrome, a life-threatening infection.

Why is it important to talk about stigma around periods?

We need to address stigma around menstruation in order to understand and fix the challenges people face around access to menstrual hygiene products. Period poverty is real. Period equity should be real, too. Embarrassment or taboos may prevent people from advocating for themselves, but if that stigma is removed — or even eased by talking through these issues — we as a society can move forward to address the needs of half of our population. There is no equity when half the population bears the financial and physical distress as a consequence of the reproductive cycle needed to ensure human survival.

How can we address period poverty?

There are simple solutions to period poverty. The first is to eliminate the tax on menstrual products. Think about it: just as food, a necessity for all of us, is not taxed, menstrual products should not be taxed. Products that are reusable, such as menstrual cups or underwear, should be subsidized, and their use encouraged, to eliminate excess waste from individually wrapped pads and tampons. If these products are publicized, promoted, and affordable, more women may opt for them. Pads and tampons should be available free of charge in schools and federal buildings (note: automatic download).

Finally, you can take action: write to or call your legislators! There is a fantastic bill, Menstrual Equity For All Act of 2019, sponsored by Representative Grace Meng, that was introduced on March 26, 2019, but never received a vote. There is no good reason why this bill, which would allow homeless people, incarcerated people, students, and federal employees free access to menstrual hygiene products, was never even brought forward for a vote. We live in one of the world’s wealthiest countries, and lack of menstrual hygiene products should never impact someone’s ability to work or go to school. It’s time to stop treating people with a uterus as second-class citizens.

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New study investigates treatment-associated regrets in prostate cancer

Men who are newly diagnosed with prostate cancer have difficult choices to make about medical therapy, and the last thing any of them want is to regret their treatment decisions later. But unfortunately, treatment-related regrets are quite common, according to a new study.

After looking into the experiences of 2,072 men diagnosed with prostate cancer between 2011 and 2012, the investigators found that more than one in 10 were unhappy with their chosen treatment.

The men were all younger than 80, with an average age of 64. Nearly half of them had slow-growing cancers with a low risk of recurrence or spread after treatment. The rest were in intermediate- or higher-risk categories.

All the men were treated in one of three different ways: surgery to remove the prostate (a procedure called radical prostatectomy); radiation therapy; or active surveillance, which entails monitoring prostate tumors with routine PSA checks and imaging, and treating only when, or if, the cancer progresses. More than half the men chose surgery regardless of their cancer risk at the time of diagnosis. Most of the others chose radiation, and about 13% of the men — the majority of them in low- or intermediate-risk categories — chose active surveillance. Then, at periodic intervals afterwards, the men filled out questionnaires asking if they felt they might have been better off with a different approach, or if the treatment they had chosen was the wrong one.

What the results showed

Results showed that after five years, 279 of the men (13% of the entire group) had regrets about what they had chosen. The surgically-treated men were most likely to voice unhappiness with their decision; 183 of them (13%) felt they would have been better off with a different approach. By contrast, regrets were expressed by 76 (11%) of the radiation-treated men and 20 (7%) of men who chose active surveillance. Men in the low-to intermediate-risk categories were more likely to regret having chosen immediate treatment with surgery or radiation instead of active surveillance. The men with high-risk cancer, however, did not regret being treated immediately.

The study was led by Dr. Christopher Wallis, a urologic oncologist at Mount Sinai Hospital in Toronto, Canada. Wallis and his team didn’t explore which specific disease outcomes or complications led to the regrets associated with particular treatments. However, the study did find that sexual dysfunction was significantly associated with treatment regrets in general. “And patients on active surveillance may develop regret if their disease progresses and they then come to believe that they may have been better suited by getting treatment earlier,” Wallis wrote in an email.

The study’s key finding, according to the investigators, is that regrets arise from discrepancies between what men expect from a particular approach and their actual experiences over time. “That’s the important take-away,” Wallis said.

In an accompanying editorial, Randy Jones, PhD., RN, a professor at the University of Virginia School of Nursing, emphasized that improved treatment counseling at the time of diagnosis can help to minimize the likelihood of regret later. This communication, he wrote, should consider the patient’s personal values, stress shared decision-making between patients and doctors, and aim for an “understanding of realistic expectations and adverse effects that are possible during treatment.”

“This study underscores the importance of not rushing into a decision, and fully understanding the time course of side effects and what can be expected from them,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Only when these consequences of treatment(s) or surveillance are fully understood is the patient able to make a truly informed decision.” All too often, newly diagnosed patients respond by “wanting to take care of this as soon as emergently possible.” But with prostate cancer, patients have the time to fully understand what is at stake. “I urge my patients to speak with members of prostate support groups and other prostate cancer patients about the issues they are likely to face, not necessarily in the immediate future, but years later. The fact that this study evaluated individuals 10+ years following their decision is an important feature in helping us better understand the time course during which regrets may be experienced.”