Demand for doctors – whether in person or via a computer screen – is expected to surge as millions more Americans become insured under the Affordable Care Act. About 10 million people already rely on telemedicine, often from doctors who live in another state.
As a result, more physicians are applying for medical licenses in multiple states – a costly and time-consuming proposition for some. Without a license to practice medicine in the patient’s state of residence, both doctors and patients may be at legal risk.
Many states are embracing telemedicine by encouraging it in their Medicaid programs and requiring private insurers to pay for it. But they have made little progress in removing medical licensing barriers that proponents of the technology say have kept doctors and hospitals from expanding even more.
Telemedicine was once the purview of small town doctors who needed to consult with specialists available only in larger urban areas. Today, telemedicine technology is even being used to conduct surgeries using robotics, typically only in emergency situations such as during war.
Most telemedicine consists of video teleconferencing between a doctor and a patient. Doctors also routinely use telemedicine technology to transmit and discuss diagnostic images and to remotely monitor patients with chronic diseases so they don’t have to leave their homes or nursing facilities.
For some consumers, it is the primary way they receive medical care. Using Skype on a computer or FaceTime on an iPhone, patients discuss their symptoms and show their doctors any visible evidence of their conditions, such as a swollen eye or skin rash. Patients most often conduct these consultations from home or their workplace. In some cases, patients go to a medical facility and use high-end, secure equipment to teleconference with a doctor in another location.
Much of the growth in telemedicine is expected to be in remote monitoring of patients with heart and lung diseases and diabetes, who have recently been discharged from a hospital. The aim is to detect health problems early enough to prevent them from being sent back to the hospital.
States have argued that easing licensing requirements could jeopardize patient safety. If doctors practice in a state without obtaining a license there, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. Also, these doctors would not benefit from any legal protections the state may have against malpractice lawsuits.
Proponents of telemedicine argue that since doctors take standardized national exams and most requirements are set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. They say state medical boards are simply trying to shield doctors from out-of-state competition and preserve state revenues from licensing fees.
When the dust of debate settles, the new revision’s benefits should be clear: good science, better diagnoses, more individualized care.
Sometime this month, the DSM-5 will replace the DSM-IV as the coin of the realm for diagnosis of mental illnesses, including substance use disorders. Despite the unprecedented criticism that has accompanied the process, the final product’s changes are based on very solid epidemiological research, and they are likely to reduce ambiguity and confusion. But there may be some surprise, too, as received wisdom about the diagnosis and treatment of addiction is turned on its head. Let’s hope that this development will result in a more rational and nuanced approach to addiction.
When the DSM-IV was developed, it appeared that abuse and dependence were two distinct disorders. Substance abuse was defined according to four criteria; dependence, according to seven criteria. In practice, “abuse” was often used to denote a milder form of Substance Use Disorder (SUD); “dependence,” a more severe SUD.
In the case of opioids, “dependence” was confusing because almost anyone on opioid-based painkillers for any length of time develops physiological dependence (they will have withdrawal if they stop suddenly), whereas in the DSM-IV, “dependence” meant “addiction” (pathological, compulsive, harmful use). So pain patients prescribed opioids were mislabeled as opioid “dependent” even though they took their medication as prescribed.
Since then, a considerable body of research has shown that there are not two distinct types of substance misuse, but only one. More important, most DSM-IV “abuse” symptoms develop only in people with severe addiction, while “dependence” symptoms are among the earliest to develop. In the DSM-5, “abuse” and “dependence” are gone. In their place is the single “Substance Use Disorder.”
With alcohol, for example, the earliest and most common problems are “internal” problems, such as going over limits, persistent desire to quit or cut down, and use despite hangover or nausea. The only “abuse” criterion that develops early is drinking and driving, but without a DUI. In the largest study of its kind, the NIAAA Epidemiological Study of Alcohol and Related Conditions (NESARC), 90 percent of people who met criteria for DSM-IV alcohol abuse—but not dependence—did so because of admitting drinking and driving. All other abuse criteria only occurred in people with the most severe and chronic addiction, and then late in the game.
In fact, legal problems occur so infrequently that this criterion was dropped from theDSM-5. This may come as a surprise to people working in the treatment industry because legal problems are the most common reason people seek treatment in rehab. But only about 12 percent of people with DSM-IV alcohol dependence ever seek specialty treatment, which suggests that the rest—who are not in treatment—have less severe disorders. People in rehab or AA are to alcohol use disorder what asthmatics on a ventilator in the ICU are to people with asthma: the most severe, treatment-refractory disorders as well as the most co-morbid psychiatric and medical problems. We’ve made a large error by assuming that everyone in the community who meets the criteria for a substance disorder has exactly the same disease as people in rehab or AA.
By Rachael Rettner, MyHealthNewsDaily Staff Writer
Adriana Lara, a mother in Hutto, Texas, is not able to work because her 5-year old son Joshua has autism. Lara must stay home to give Joshua the care he needs, and to drive him to his therapy sessions five days a week.
“It’s just impossible for me to be able to hold a job and do all these things with Josh,” Lara, 31, said. The family depends on the salary of Lara’s husband, a psychologist at a Veteran’s Affairs hospital.
Joshua’s therapies, including speech, music and occupational therapy, cost about $5,000 a month. Eighty-five percent of the cost is currently covered by a government grant, but the grant will run out this summer, and the family’s insurance policy won’t cover Joshua’s therapies, Lara said.
“We don’t know how we’re going to afford it,” Lara said. While public schools offer autism therapies, Joshua’s school does not offer the type of intensive therapies he needs, Lara said. For instance, the therapies provided by Joshua’s school are not one-on-one, Lara said.
A new study highlights the unique financial burden faced by families of children with autism, like Lara’s. The burden is particularly significant for mothers, the study finds.
On average, mothers of autistic children earn $14,755 less per year than mothers of healthy children, and $7,189 less per year than mothers of children with other health conditions (such as asthma and ADHD) that limit their ability to engage in childhood activities, according to the study.
Despite the fact that they tend to have completed more years of education, mothers of autistic children are 6 percent less likely to be employed, and they work on average 7 hours less weekly than mothers of healthy children, the researchers say.
“We don’t think that autism creates more of a strain on the family per se than other chronic conditions of childhood,” said study researcher David Mandell, associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine. “I think the reason these mothers are leaving the workforce is because the service system for children with autism is so fragmented,” Mandell said.
Health care and workplace policies need to recognize the full impact of autism, and alleviate costs for the families with greatest needs, the researchers concluded, writing in the March 19 issue of the journal Pediatrics.
Higher Bills, Lower Salaries
About 1 in 110 children in the United States have an autism spectrum disorder, a developmental disability that can cause language delays, impaired communication skills and social challenges, according to the Centers for Disease Control and Prevention.
The new study results are based on yearly surveys of U.S. households conducted between 2002 and 2008. The study included 64,349 families with healthy children, 2,921 families of children with other health limitations and 261 families of children with autism.
While fathers’ salaries, by themselves, were not affected by having a child with autism, total family income was, the study showed. On average, families with autistic children earned $17,763 less than families with healthy children, and $10,416 less than families with children with other health limitations.
As Lara’s story shows, having a child with autism may limit the parents’ abilities to work because these children require more care. Finding quality, specialized childcare for autistic children may be difficult and costly, the researchers say.
“A traditional daycare setting really is really not conducive,” for children with autism to thrive, said Carolyn Price, whose 7-year old son has autism. Autistic children are very sensitive to sights and sounds, and may be overwhelmed at a day care, Price said.
When Price’s son was in daycare — before he was diagnosed with autism — he would bite other children because he couldn’t cope with the environment, Price said. In addition, autistic children need one-on-one interaction that is generally not feasible at day care, Price said.
When Price’s son, also named Joshua, was young and had to be at home, she and her husband felt uncomfortable having anyone beside themselves or close friends look after him.
“It’s really challenging when you have a child with special needs, to really turn that responsibility over to someone else and feel like they are getting the best care,” Price said. Price’s husband Joel still works only part time, so he can drive his son to therapy sessions.
Children with autism need to be immersed in their therapies in order to benefit, Price said. Providing therapy one day a week, when a child needs five sessions, won’t have the same impact, Price said.
In 2010, Price and her husband started a non-profit organization called Imagine a Way to provide financial assistance to families with autistic children. The organization focuses trying to provide funds to support for children for two years.
While other nonprofits and government subsidies offer support to families of children with autism, it’s often comes in the form of a little bit at a time, Price said.
“There’s a recognized need for it, I just don’t think there’s a consolidated organization like Autism Speaks, that’s able to do something on a major scale,” Price said. While any source of funding is valuable, “For the magnitude of what these kids need, a little bit is just not enough,” Price said.
Pass it on: Autism places a significant financial burden on families.
We’ve all heard about the importance of getting a good night’s sleep, and now scientists offer more evidence to back that up.A new study found that people who get less sleep may be inclined to eat more, move less and gain weight.
Scientists at the Mayo Clinic in Rochester, Minn., studied a group of 17 healthy volunteers between the ages 18 and 40 for a week in their homes, monitoring how much each one typically slept and ate. Then, they brought the volunteers into the clinic’s research lab for eight days: Half of the volunteers were allowed to sleep according to their usual pattern, and the other half got only two-thirds of their usual shut-eye.
All the volunteers were allowed to eat as much food as they wanted from the hospital cafeteria or from outside the research center. The researchers also measured how much energy each volunteer expended each day.
The sleep-deprived participants wolfed down an average of 549 calories beyond their usual intake but burned no more calories than their well-rested peers.
“A lot of people have this idea that if they’re up late, working hard, they’re burning more energy. But we found no change in how much they moved when sleep deprived,” said Dr. Andrew Calvin, lead author of the study and an assistant professor of medicine at the Mayo Clinic. “They’re consuming an additional 549 calories per day, but not burning any of them off.”
Those excess of unburned calories is a surefire way to gain weight, which numerous studies have connected to a variety of chronic health problems.
The volunteers who got less sleep also had higher levels of leptin, a hormone that suppresses appetite, and lower levels of ghrelin, a hormone that stimulates appetite, in their blood. The findings seem counterintuitive to what researchers would expect in people who are hungrier, but Calvin said the hormones were most likely an outcome, rather than a cause of people eating more.
Scientists have previously studied the physical downsides of getting too little sleep.
In 2011, Australian researchers found that adolescents and teenagers were more likely to be slimmer if they went to bed earlier, while those who stayed up late were more likely to engage in sedentary activities.
Previous studies have also found that workers covering late and overnight shifts were more likely to be obese and have type 2 diabetes, which may be associated with unhealthy eating habits, according to an editorial published in December.
The connection between sleep and weight may be important for the more than one-quarter of Americans who get six hours of sleep or less every night. Calvin said the future research on how sleep affects eating habits may give scientists useful insights into two of America’s biggest health problems: sleep deprivation and obesity.
“This study, while small, suggests that these two may indeed be linked, and if the findings are confirmed, they may suggest that sleep is a powerful factor in how much we eat and our chances of gaining weight,” he said.
I often am asked questions regarding the ethical issues for counselors regarding social networking, specifically Facebook. At that point I usually hear about a situation that has caused professional and personal problems for an addictions professional. In each scenario that follows names have been changed and situations modified to protect the identity of those involved.
Danny is a substance abuse counselor who decided to join Facebook for a specific reason: he wanted to look up clients to see if they were posting information on Facebook that would indicate they were using.
What are the Ethical Concerns?
Client autonomy: Clients in treatment have a right to choose whether to use alcohol or other drugs. As a counselor would you drive by a client’s house to see if that client is sitting on the front porch smoking a joint? Clients have a right to their personal lives outside of treatment, whether or not it is what we would choose for them.
Counseling relationship: Trust is a major component of the counseling relationship. A client could consider it a violation of that trust to “spy” on him on Facebook. Before the advent of Facebook, a counselor asked clients if they were using and conducted drug screens. Should our methods be any different today?
Do no harm: Is there the possibility that such actions could harm a client? We must always consider the possible outcomes of our actions when it involves client care. A client could possibly feel betrayed by her counselor if such “investigation” is pursued by the counselor.
Professional boundaries: One of our responsibilities as counselors is to have healthy professional boundaries. These boundaries can easily become blurred if or when we begin to intrude on the personal lives of clients outside the professional relationship. Just as we need to set appropriate boundaries with clients regarding our personal Facebook pages, we too should respect their boundaries.
Situation 2 – The Personal/Private Divide
Mary Beth was a counselor at a large addictions treatment facility. She is not in recovery from drug or alcohol addiction. She had recently returned from a vacation at the beach. A client of one of Mary Beth’s colleagues at the same facility mentioned during an individual session that he had been searching people on Facebook and found Mary Beth’s page. He stated, “I really liked those pictures of her vacation.” After the client left, his counselor looked up Mary Beth on Facebook to see what the client was referring to. To her dismay she found that Mary Beth had no security on her page and all of her information was open to anyone who came across it. Additionally, she had posted pictures of herself in a bikini, holding a beer in her hand, with a male companion who appeared to be fondling her. Mary Beth was fired from her job. The agency maintained that she was not projecting a professional image and was negatively affecting the reputation of the agency.
What are the Ethical Concerns?
Counseling relationship: What did the pictures portray to clients and colleagues who saw them on her Facebook page? We have a responsibility to safeguard the integrity of our relationship with clients. (NAADAC Code of Ethics, Principle I) Part of this safeguard is to always being aware of perceptions and how those perceptions may change the professional relationship with a client.
Professional responsibility: If Mary Beth had put the security blocks on her page which would allow only invited friends to see her page, she would have been acting more responsibly. The addiction professional recognizes that those who assume the role of assisting others to live a more responsible life take on the ethical accountability of living responsibly. The addiction professional recognizes that even in a life well-lived, harm might be done to others by works and actions. (NAADAC Code of Ethics, Principle IV)
Discretion: Mary Beth’s actions in regards to Facebook appear to be poor professional judgment. She certainly has a right to her personal life and to enjoy herself. On the other hand, professional judgment includes how we conduct ourselves in public, even in our leisure time which includes what we post on a Facebook page for all to view.
Do no harm: Although Mary Beth is not in recovery herself, the posting of the picture of her drinking may cause undue influence on clients to assume that if it is OK for a counselor to participate in these activities that it must be acceptable for them also. Or clients may believe that Mary Beth is not “practicing what she preaches”. Again, often we are talking about perceptions which may not always be reality.
Situation 3 – Information Sharing
Carla is in private practice working as a substance abuse professional. She recently joined Facebook and being a very social person, enjoys the interactions each evening with her Facebook friends. One of those friends is a counselor at a local substance abuse in-patient facility. For the past few evenings Carla has noticed that her friend has begun to post information about clients she has seen that day, funny things they have done or unusual crises they have experienced. Although her friend is not stating client names she has told others where she works.
What are the Ethical Concerns?
Confidentiality: We are to make every effort to protect the confidentiality of client information. (NAADAC Code of Ethics, Principle III) Carla’s friend has stated where she works and now she is talking about clients of that facility. She is not honoring confidentiality, even though she is not stating client identifying information. She may inadvertently be giving enough information that someone could deduce to whom she is referring. This is also a violation of client rights and their expectation that their information will be protected.
Due diligence: We are to be conscientious and careful in all of our actions when it concerns clients and our professional life. We, as professional counselors, should make every effort to avoid “gossiping” about clients. It is possible that, unbeknownst to this counselor, a client may be a “friend of a friend” on Facebook and actually can see what this counselor is posting and recognizes that the counselor is telling her story.
Legal concern: Carla is bound under 42 CFR Part 2 and HIPAA to make every reasonable effort to protect client information. This type of behavior could result in litigation.
Resolving Ethical Issues: Carla has a responsibility to go to her friend and discuss the ethical and legal concerns she has regarding her friend’s behavior. If her friend is unwilling to change that behavior, Carla next needs to seek supervision and consider her licensure reporting responsibility. (NAADAC Code of Ethics, principle VIII)
Situation 4 – Venting Frustrations
Martin has been having a difficult time at work lately. It is increasingly more stressful with an increased number of clients who are exhibiting more severe symptoms, fewer staff and fewer resources. He has recently been having disagreements with his supervisor. He has also begun to post his “venting” on his Facebook page.
What are the Ethical Concerns?
Discretion: As professionals we have an obligation to use utmost discretion in all of our professional life. Ethically, Martin would be well served to seek other supervision or peer support in his stressful situation rather than venting on his Facebook page.
Professional relationships: Martin is not building, supporting or treating his professional relationships respectfully. As professionals we are to respect other professionals by going to them when we have problems that are affecting us. I have heard many accounts of people losing their jobs as a result of airing their complaints about their jobs and employers on Facebook.
Situation 5 – Compromised Testimonials?
A 12 step focused residential treatment facility developed a Facebook page as a means of advertising. It is also a means for keeping a connection with former clients. These former clients may also write comments on their experience with the treatment program. Recently the administrator contacted former clients requesting that they post testimonials on Facebook. A counselor conducting patient aftercare was made aware of the request and was concerned about confidentiality.
What are the Ethical Concerns?
Informed consent and Confidentiality: In this situation clients need to be fully informed about the risks of posting testimonials on Facebook. If they do post voluntarily, they should be informed of the risk of confidentiality being compromised.
Due Diligence: This treatment facility, as well as the counselor who was made aware of the request, have an obligation to be diligent in the care of clients and sensitive client information.
Exploitation: Is the facility using client testimonials to help others who are suffering with addictions or are they using this to further their business and bring in revenue? The concern here is whether or not it is exploiting clients to ask them to help in marketing a program by posting personal testimonials about their treatment experience. Clients may not understand the far-reaching outcomes of this course of action. Treatment programs need to consider all aspects of their decisions to use media such as Facebook to market their programs.
Often I hear professionals say that they hesitate to report unethical behavioral because they are friends with the person or they don’t want to hurt the other person’s career. As licensed or certified professionals, we have an ethical and legal obligation to report unethical behavior that cannot be resolved or that is such an egregious violation that it is beyond being resolved.
As technology grows and becomes more and more available, we as professionals must always consider the ramifications of our actions when using any technology, including social network sites such as Facebook. When ethics are violated, we have an obligation to address the issue and report to licensure boards when necessary.
Be true to yourself, your profession and your colleagues.
It’s almost time for that annual ritual of turning the clocks forward, which means we will soon be enjoying an extra hour of daylight at the end of the day. But along with the hour of daylight we gain this Sunday, the quarter of the world’s population who observe daylight saving time will also be losing an hour of sleep.
One hour might seem like a small change, but it has proven to have a larger effect on us than just being a little groggy come Monday morning.
Today, the original purpose of daylight saving time — maximizing the amount of light during waking hours —still holds true. But more studiesare popping up suggesting that people who are already susceptible to certain health problems, such as high blood pressure and depression, will feel the effects even more when the clocks move forward.
A Swedish study published in the New England Journal of Medicine in 2008 found the risk of a heart attack increases in the days right after the daylight saving time change.
“The most likely explanation to our findings are disturbed sleep and disruption of biological rhythms,” the lead author of the study, Imre Janszky, told National Geographic in an interview last year.
Researchers and sleep specialists have in recent years warned that the pace of modern working life, especially in the West, has left the majority of people sleep deprived. In 2007, Till Roenneberg of Ludwig-Maximilians University in Munich tracked the sleeping patternsof Europeans to explore the effects of moving from daylight time to standard time.
The study found that while both late and early risers adjusted to the time switch in the fall, night owls had a particularly difficult time adjusting to the time shift in the spring.
Australian researcher Greg Roach of the University of South Australia’s Centre for Sleep Research, who studies the body’s internal clock, said the study was commendable, even if it did confirm what many of us already knew.
“Until now, most of the impact of daylight saving time has been anecdotal,” Roach told the Australian Broadcasting Corporation. “One of science’s aims is to find evidence for things that seem common sense.”
Shyam Subramanian, a pulmonologist at Baylor College of Medicine and medical director of the sleep lab at Ben Taub General Hospital in Houston, spoke to the Houston Chronicle in 2010 about the effect of daylight savings on sleep patterns. Like Roenneberg, Subramanian’s research led him to conclude that most people in the West are already sleep deprived and are more affected than they realize by the time change.
“Losing an hour of sleep contributes to sleep debt,” he told the Chronicle. “If you don’t make up the debt, it manifests in waking up tired, needing a lot of caffeine to get going, nodding off during the day.”
The underlying lack of sleep and the adjustments people have to make to their schedules during daylight savings can also cause more accidents, Subramanian said.
“There is a higher incidence of workplace and occupational accidents, particularly in industries like mining and transportation, for about two to three weeks right around this time,” he told the paper.
Necessity or Nuisance
Scientists aren’t the only ones warning about the effects of daylight saving on health and behaviour. The Insurance Bureau of Canada doesn’t keep data on the number of accidents associated with the time change but uses the clock adjustment to remind people to be more cautious and pay greater attention to safety.
“From a property and casualty standpoint, [daylight saving is] a reminder for people to be awake, be aware and be safe on the roads,” said bureau spokesperson Steve Kee.
The bureau suggests people use the ritual of adjusting their clocks to remind themselves to also check around their home for possible safety risks, Kee said people can take that time to replace batteries in smoke and carbon monoxide detectors, put together an emergency supply kit and check homes for hazardous materials.
There are those who believe that the health and public safety risks associated with daylight time changes are significant enough to make changing the clocks twice a year more trouble than it’s worth.
Groups around the world have been lobbying governments to get rid of seasonal time changes altogether.
In Canada, areas of Quebec east of 63 degrees west longitude do not change to daylight time and remain on Atlantic standard time year round. Pockets of Ontario and British Columbia do not use daylight time.
Most of Saskatchewan has not observed daylight time since 1966 and stays on central standard time all year-round, with the exception of some border towns that follow the same time as their neighbours in Manitoba or Alberta.
Daylight time is observed in most of the United States. Just two states, Arizona and Hawaii, and three territories, American Samoa, Puerto Rico and the U.S. Virgin Islands, do not participate.
Some groups are pushing for daylight saving to be implemented all year long. A campaign called Lighter Later in the U.K., for example, has suggested that clocks be put forward an hour permanently. That way, come springtime, clocks will essentially be put ahead two hours, resulting in two extra hours of daylight in the evening.
The extra two hours of light for half of the year would mean a significant reduction in electricity use and approximately 300 more hours of daylight a year, according to Mayer Hillman, a Lighter Later advocate.
The campaign has strong support from road safety groups, the tourism industry and certain special interest groups representing children and teens, women, pensioners and people living in rural communities, Hillman said.
The group’s proposal was brought forward in the British Parliament earlier this year as the Daylight Saving Bill but has since been tabled.
The growing debate on the relevance of daylight saving will no doubt continue, but for now, most of us will turn our clocks forward this Sunday at 2 a.m.
DSM-IV-TR vs. Proposed DSM-5: Comparison, Implications and Impact
Join NAADAC on February 29, 2012 from 3-4 p.m. EST and earn one continuing education credit. A revised edition of the Diagnostic and Statistical Manual of Mental Disorders will be released in May 2013. This webinar will examine the proposal and let professionals know what to prepare for.
Every February 14, across the United States and in other places around the world, candy, flowers and gifts are exchanged between loved ones, all in the name of St. Valentine. But who is this mysterious saint, and where did these traditions come from?
The Legend of St. Valentine
The history of Valentine’s Day–and the story of its patron saint–is shrouded in mystery. We do know that February has long been celebrated as a month of romance, and that St. Valentine’s Day, as we know it today, contains vestiges of both Christian and ancient Roman tradition. But who was Saint Valentine, and how did he become associated with this ancient rite?
The Catholic Church recognizes at least three different saints named Valentine or Valentinus, all of whom were martyred. One legend contends that Valentine was a priest who served during the third century in Rome. When Emperor Claudius II decided that single men made better soldiers than those with wives and families, he outlawed marriage for young men. Valentine, realizing the injustice of the decree, defied Claudius and continued to perform marriages for young lovers in secret. When Valentine’s actions were discovered, Claudius ordered that he be put to death.
Other stories suggest that Valentine may have been killed for attempting to help Christians escape harsh Roman prisons, where they were often beaten and tortured. According to one legend, an imprisoned Valentine actually sent the first “valentine” greeting himself after he fell in love with a young girl–possibly his jailor’s daughter–who visited him during his confinement. Before his death, it is alleged that he wrote her a letter signed “From your Valentine,” an expression that is still in use today. Although the truth behind the Valentine legends is murky, the stories all emphasize his appeal as a sympathetic, heroic and–most importantly–romantic figure. By the Middle Ages, perhaps thanks to this reputation, Valentine would become one of the most popular saints in England and France.
Origins of Valentine’s Day: A Pagan Festival in February
While some believe that Valentine’s Day is celebrated in the middle of February to commemorate the anniversary of Valentine’s death or burial–which probably occurred around A.D. 270–others claim that the Christian church may have decided to place St. Valentine’s feast day in the middle of February in an effort to “Christianize” the pagan celebration of Lupercalia. Celebrated at the ides of February, or February 15, Lupercalia was a fertility festival dedicated to Faunus, the Roman god of agriculture, as well as to the Roman founders Romulus and Remus.
To begin the festival, members of the Luperci, an order of Roman priests, would gather at a sacred cave where the infants Romulus and Remus, the founders of Rome, were believed to have been cared for by a she-wolf or lupa. The priests would sacrifice a goat, for fertility, and a dog, for purification. They would then strip the goat’s hide into strips, dip them into the sacrificial blood and take to the streets, gently slapping both women and crop fields with the goat hide. Far from being fearful, Roman women welcomed the touch of the hides because it was believed to make them more fertile in the coming year. Later in the day, according to legend, all the young women in the city would place their names in a big urn. The city’s bachelors would each choose a name and become paired for the year with his chosen woman. These matches often ended in marriage.
Valentine’s Day: A Day of Romance
Lupercalia survived the initial rise of Christianity and but was outlawed—as it was deemed “un-Christian”–at the end of the 5th century, when Pope Gelasius declared February 14 St. Valentine’s Day. It was not until much later, however, that the day became definitively associated with love. During the Middle Ages, it was commonly believed in France and England that February 14 was the beginning of birds’ mating season, which added to the idea that the middle of Valentine’s Day should be a day for romance.
Valentine greetings were popular as far back as the Middle Ages, though written Valentine’s didn’t begin to appear until after 1400. The oldest known valentine still in existence today was a poem written in 1415 by Charles, Duke of Orleans, to his wife while he was imprisoned in the Tower of London following his capture at the Battle of Agincourt. (The greeting is now part of the manuscript collection of the British Library in London, England.) Several years later, it is believed that King Henry V hired a writer named John Lydgate to compose a valentine note to Catherine of Valois.
Typical Valentine’s Day Greetings
In addition to the United States, Valentine’s Day is celebrated in Canada, Mexico, the United Kingdom, France and Australia. In Great Britain, Valentine’s Day began to be popularly celebrated around the 17th century. By the middle of the 18th, it was common for friends and lovers of all social classes to exchange small tokens of affection or handwritten notes, and by 1900 printed cards began to replace written letters due to improvements in printing technology. Ready-made cards were an easy way for people to express their emotions in a time when direct expression of one’s feelings was discouraged. Cheaper postage rates also contributed to an increase in the popularity of sending Valentine’s Day greetings.
Americans probably began exchanging hand-made valentines in the early 1700s. In the 1840s, Esther A. Howland began selling the first mass-produced valentines in America. Howland, known as the “Mother of the Valentine,” made elaborate creations with real lace, ribbons and colorful pictures known as “scrap.” Today, according to the Greeting Card Association, an estimated 1 billion Valentine’s Day cards are sent each year, making Valentine’s Day the second largest card-sending holiday of the year. (An estimated 2.6 billion cards are sent for Christmas.) Women purchase approximately 85 percent of all valentines.
Distracted Dining, by Jon Vredenburg, MBA, CSSD, RD, LD/N
Quick – What did you have for dinner last night?
If you are like most people, uncovering that answer in your brain probably took some time. Multi-tasking has gone main stream and has blunted the overall awareness of our most fundamental activities. If you are looking to get a handle on the distractions in your life, then your nutritional health will stand to benefit.
‘Distracted Dining’ can be simply defined as diverting focus from your dietary intake. The source of distraction can take many forms. It is a challenge for an individual to eat healthfully if they are not focused on the task at hand. After all, if a person is not fully aware of what they are doing – then how can they be sure if they are doing it right?
The end result for most distracted diners is an unsatisfying calorie surplus. “When our brain is distracted during eating we are unable to fully register what we are eating and how much we are eating,” states Sally Clifton, a Registered Dietitian with Shands Jacksonville’s Employee Wellness Program. “It is like multi-tasking – even though we think we can do it, we are never really able to fully devote attention to one task.”
Recent research has measured how food intake is impacted when the brain is concentrating on something else besides a fork and spoon. Researchers in Great Britain looked at how playing a computer card game during a meal influenced a person’s eating behavior. The test subjects were given a prepared lunch and then 30 minutes later were questioned about the meal and were also offered a “taste test” snack. The study showed that the distracted eaters ate twice as much during the subsequent taste test in comparison to those without the diversion. The individuals who were playing the computer card game also reported being less satisfied with their lunch meals and also had difficulty remembering what they just ate.
It is clear that overconsumption is the primary problem when multi-tasking becomes part of meal time. Clifton suggests using smaller plates and portioning food in single-serve containers or sandwich bags to help cap calorie intake if your attention has to be diverted. Establishing ground rules is the key. “No eating in front of the television, no eating on the couch and no eating in the car,” advises Clifton. “You can lose focus on your senses since [attention] goes to your eyes and ears and that can lead to overeating.”
Another common trap for distracted diners is the tendency to eat food at a rapid rate. By doing so, the enjoyment of the meal is lessened while caloric intake is heightened. “It takes a while for our brain to actually compute satiety. When we are shoveling the food in we tend to take in more calories than we would have if we slowed down and were mindful about our eating. Let your body respond to the food and increase satiety,” states Jill McCann, a Registered Dietitian with Preferred Nutrition Services. It takes about 20 minutes for food to be digested enough to influence hormones and impact blood sugar so savoring the meal and enjoying each bite helps on multiple levels.
Becoming fully engaged in what you are doing sounds more like a life lesson, than nutritional advice, but it is important nonetheless. The concept of ‘mindless eating’ is fairly new, but it has become part of America’s nutritional lexicon. McCann coaches clients on techniques to fight mindless eating. “Distracted dining is one of the biggest driving forces against anyone seeking weight management or overall wellness,” states McCann.
McCann uses the acronym H.A.L.T. to help her clients curtail their tendencies towards mindless eating. “H.A.L.T. stands for Hungry, Angry, Lonely or Tired,” states McCann. “Before taking that first bite, you should HALT and ask yourself if you are actually hungry or if you responding to other emotions.” It is quite normal for feelings of hunger to be present anywhere from 4 to 5 hours after eating. Anything inside of that window would require taking an emotional inventory.
Stressful situations, like those that trigger feelings of anger, can lead many people towards food. “I see emotional hunger a lot of times in the afternoon or nighttime as people are stressed out when they get home from work,” states McCann. “Food becomes a comfort for them.” In those circumstances McCann suggests simple deep breathing techniques before even opening the kitchen pantry.
Loneliness is another emotion that can influence a person’s attraction towards food. The act of eating increases serotonin levels in the brain which can elevate mood and provide a distraction from feelings such as isolation. Visiting with friends or family is the more healthful way to address this emotion. The consensus among nutritional therapists is that the emotions we may experience are controlled by outside forces, but how a person responds to that emotion is completely under their control. “Being healthy involves standing up for yourself and having confidence in the choices you are making,” states Clifton.
Fatigue is the last feeling in the H.A.L.T. tool and it is a common foe in weight loss efforts. The relationship between weariness and weight gain are driven by the two hormones that regulate hunger: gherlin and leptin. Gherlin is a hormone made in the stomach that tells the brain when it is time to eat. Conversely, leptin is the hormone that sends a signal to the brain that you are full. Leptin is released by the fat cells in our body. Researchers have found that people who regularly get less than seven hours of sleep have higher levels of gherlin and lower levels of leptin. It is easy to see why this hormonal one-two punch can lead to weight gain.
One common technique for battling the struggles of mindless eaters is food journaling. Clifton uses it as a tool with many of the clients in her wellness programs. “The journaling allows them to know where they stand with every single thing that they eat,” states Clifton. The method used to journal, whether online or hand-written, depends on the needs of the individual but either method creates much needed awareness. The cell phone, which is a weapon of mass distraction in most cases, can actually be a valuable ally for tracking intake. Clifton recommends fitday.com and myfitnesspal.com since they have meal tracking applications that are compatible with most smart phones. These websites help the user identify specific calorie goals and have a wealth of food items stored in their databases. “Sparkpeople.com is another good resource since it has a social media component which can be a source of additional motivation by being part of a community,” states Clifton. Best of all, they are free. Your bank account will appreciate that mindfulness.
At the end of the day Disturbances during meals are sometimes inevitable. The fact that your senses may be pulled in different directions while you eat does not mean it is unhealthy. However, if the television, desk or steering wheel is frequently at arm’s length during meals it may be time for a change of scenery. Maybe by this time tomorrow you will remember what you had for dinner.
Acupuncture and Oriental Medicine Day is observed annually on October 24. It is part of an effort designed to increase public awareness of the progress, promise, and benefits of acupuncture and Oriental medicine.
An estimated 36% of U.S. adults use some form of complementary and alternative medicine (CAM), according to a survey by the National Center for Complementary and Alternative Medicine, a component of the National Institutes of Health. When megavitamin therapy and prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62%. Among the common CAM practices identified by the survey were acupuncture, acupressure, herbal medicine, tai chi and qi gong.
A survey by the National Certification Commission for Acupuncture and Oriental Medicine found that approximately one in ten adults had received acupuncture at least one time and 60% said they would readily consider acupuncture as a potential treatment option. Nearly half (48%) of the individuals surveyed who had received acupuncture reported that they were extremely satisfied or very satisfied with their treatment. In addition, one in five (21%) of the total NCCAOM survey respondents reported that they had utilized some other form of Oriental medicine besides acupuncture, such as herbs or bodywork (e.g., shiatsu).
These studies and others like them clearly demonstrate that CAM therapies such as acupuncture and Oriental medicine are common practice in today’s health care system. They also support the need for consumers to be provided accurate and reliable information regarding their treatment options. Source: http://www.aomday.org/