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America has always been made fun of by other nations for the obesity rate and all of the fast food restaurants. But the rate is has risen significantly.

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A Global Look at Rising Obesity Rates

Obesity has truly become a worldwide problem, affecting countries rich and poor. So just how many men, women, and children are overweight or obese? It's a natural question-and a surprisingly hard one for researchers to answer. The problem's vast. The data, from some regions, quite spotty. So projections from one group differ a bit from the estimates of another. But all point to tremendous increases in global obesity rates over the past three decades-and find that the epidemic shows no signs of abating without dedicated efforts to combat it. ( 1- 5)

Not that long ago, obesity was largely a problem of the rich, primarily in wealthy countries. Globalization, though, has made the world wealthier. And as poor countries move up the income scale, and people shift from subsisting on traditional diets to overeating on Western diets, obesity becomes a disease of the poor. The result: Over the past few decades, obesity has quietly become a "pandemic" in developing countries. ( 4)

One paradox of this so-called "nutrition transition" is that even as obesity rates rise, underweight persists, sometimes within the same household. ( 6) Low- and middle-income countries often face a dual burden-the infectious diseases that accompany malnutrition and, increasingly, the debilitating chronic diseases linked to obesity and Western lifestyles.

This article gives a brief overview of global obesity trends in adults. Overweight refers to a BMI of 25 to 29.9, obesity, a BMI of 30 or higher. The combined category of "overweight and obese" refers to a BMI of 25 or higher. Since Asians have a higher risk of weight-related diseases at lower BMI levels, some countries in Asia do use lower thresholds for overweight and obesity. But for the purposes of this article, assume that a study has used the standard international adult BMI cut points of 25 for overweight and 30 for obesity, unless otherwise specified.

A related article covers global obesity trends in children.
Quick links: North America | Central and South America | Europe and Central Asia | North Africa and the Middle East | Sub-Saharan Africa | Asia Pacific and Australasia
North America

Read the media coverage of the latest U.S. obesity numbers, and you might think the country had turned the corner on the epidemic: "American Obesity Rates Have Hit Plateau, CDC Data Suggest,"( 7) and "Good News: Obesity Rates Leveling Off."( 8) But those optimistic headlines tell only part of the story. While U.S. obesity rates have, overall, stayed steady since 2003, they have more than doubled since 1980. They remain worrisomely high-the highest among all of the high-income countries in the world. ( 1) And obesity takes a heavier toll on some U.S. ethnic and racial groups than others, with rates continuing to rise. ( 9) A closer look at the U.S. numbers in adults:

Roughly two out of three U.S. adults are overweight or obese (69 percent) and one out of three are obese (36 percent). (9)

Obesity rates are higher in non-Hispanic Black, Hispanic, and Mexican American adults than in non-Hispanic White adults. (9)

Non-Hispanic Black women have the highest rates of obesity in the U.S.-nearly 59 percent, compared to 44 percent in Mexican American women, 41 percent in Hispanic women, and 33 percent in Non-Hispanic White women. (9)

Though overall obesity rates in the U.S. have stayed steady since 2003, obesity rates have continued to climb in men, Non-Hispanic Black women, and Mexican American women. (9)

If U.S. trends continue unabated, by 2030, estimates predict that roughly half of all men and women will be obese. (10)

Obesity rates in Canada are not quite as high as they are in the U.S., but Canada has seen similarly-dramatic increases over the past three decades. In 1979, 14 percent of Canadian adults were obese. By 2008, 25 percent of adults were obese, and 62 percent were overweight or obese. ( 11) Obesity is also more common among Canada's Aboriginal population than it is among other groups: Surveys from 2007-2008 find obesity rates of 25 percent among Aboriginal groups who live outside of reservations, compared with 17 percent in non-Aboriginal groups. ( 11)
Central and South America
Theres a dearth of long-term data on obesity rates in Central and South America. Unlike the U.S., where multiple national surveys regularly assess BMI across all age groups, many Central and South American countries tend to field smaller surveyssay, of BMI patterns in city dwellers, or within specific age groupsthat may not give as accurate a picture of obesity trends overall. But taken together, these surveys show that Central and South America have seen steady BMI increases over the past three decades, as well as current obesity rates that rival those of the U.S. and Canada. ( 1) A closer look at data from the region:

Among women, between 1980 and 2008, Finucane and colleagues estimate that the average BMI in Central Latin America and Southern Latin America increased by 1.3 and 1.4 units per decade. (1) Men in these regions have seen similar increases in obesity, though not quite as steep as those in women. (1)

In 2008, more than 30 percent of women in Central and Southern Latin America were obese, according to Finucane's estimates, and about 25 percent of men in Southern Latin America and 20 percent of men in Central Latin America were obese. (1)

In Mexico, a recent report, based on 2006 data collected across Mexico, finds that roughly 30 percent of Mexican adults are obese and 70 percent are overweight or obese, a 12 percent increase since 2000. (12) Three out of four Mexican adults have abdominal obesity, and women have higher rates of obesity and abdominal obesity than men.

Europe and Central Asia

The European obesity epidemic is far from uniforma reflection, perhaps, of Europes diverse economic and cultural landscape. But its clear that obesity rates are rising across the continent, though not as rapidly or high as they are in the U.S. ( 1, 14)

One challenge to tracking weight trends across Europe is that some countries, especially those of the former Soviet bloc, have only sparse data. But the best available estimates find that over the past 30 years, average BMI in men has been rising a bit more rapidly in Western and Central Europe than in Eastern Europe and Central Asia (0.6, 0.4, 0.2, and 0.2 units per decade, respectively). ( 1) Average BMI in women stayed relatively stable in Eastern and Central Europe and Central Asia-some of the very few places on the globe to report such a trend-and increased by 0.4 units per decade in Western Europe. ( 1)

Within Western Europe, there are marked differences in obesity rates from country to country. In 2008, for example, average BMI in the U.K. was among the highest in Western Europe-27.4 in men and 26.9 in women. France and Switzerland, meanwhile, had mean BMIs that were far lower-25.9 and 26.2 in men, and 24.8 and 24.1 in women. ( 1) The U.K.'s obesity rates have risen by about a percentage point per year since the mid-1990s, and in 2009, about 25 percent of U.K. adults were obese and 57 percent were overweight. ( 14)

North Africa and the Middle East

Today, obesity rates in some of the Arab Gulf countries rival or exceed those of the U.S.: In Saudi Arabia, for example, recent surveys have found that 28 percent of men and 44 percent of women are obese, and 66 percent of men and 71 percent of women are overweight or obese. In Kuwait, 36 percent of men and 48 percent of women are obese, while 74 percent of men and 77 percent of women are overweight or obese. ( 16) Though obesity rates are higher among women in the region than men, they appear to be rising more quickly in men than in women.

Sub-Saharan Africa

Under-nutrition has historically received more public health attention in sub-Saharan Africa than over-nutrition. Yet today, obesity and the chronic diseases that accompany it have become a growing problem across this huge and diverse continent. Some have called it a "silent epidemic," ( 17) striking countries that are still struggling with the health and economic burdens of malnutrition, stunting, infectious disease, and high childhood mortality rates.

As in other developing regions, nationally-representative studies of obesity in sub-Saharan Africa are scarce. The studies that are available, though, suggest that obesity rates vary widely from country to country.

For example, in 2008, the average BMI among men in the Democratic Republic of the Congo was 19.9-the lowest in the world. ( 1) Yet in South Africa, men had an average BMI of 26.9-on par with the average BMIs in Canada (27.5) and the U.S. (28.5). ( 1)

Some studies in urban settings have found that obesity rates are rising more quickly in the poor than in the rich. ( 18) More research is needed to give a fuller picture of obesity trends across the continent.

Asia-Pacific Region

Some countries in South Asia, Southeast Asia, and East Asia have mean BMIs that are among the lowest in the world. In Bangladesh, for example, the estimated mean BMI in 2008 was less than 21, for both men (20.4) and women (20.5). But even Bangladesh and other countries where under-nutrition remains a significant threat-Cambodia, China, India, Nepal, and Vietnam-have seen the prevalence of overweight and obesity in women increase from the 1990s through the mid-2000a, by anywhere from 3.5 to 38.5 percent a year. ( 4)

Recent trends in China and India are of special concern. Although obesity rates are still fairly low overall, China and India are the most populous nations on the planet-with more than 2.5 billion people, combined-so even small percentage increases in obesity rates translate into millions more cases of chronic disease.

In China, from 1993 to 2009, obesity (defined as BMI of 27.5 or higher) increased from about 3 percent to 11 percent in men and from about 5 percent to 10 percent in women. Abdominal obesity (defined as a waist circumference of 90 centimeters or higher in men, and 80 centimeters or higher in women) also increased during this time period, from 8 percent to 28 percent in men and 28 percent of 46 percent in women. ( 19) That's worrisome, since abdominal obesity may carry more serious metabolic consequences than overall obesity.

In India, meanwhile, recent data finds that in 2005, nearly 14 percent of women ages 18 to 49 were overweight or obese, with higher rates among urban women (25 percent) than rural women (8 percent). The rate of overweight and obesity in women, overall, increased by 3.5 percent a year from 1998 to 2005. ( 4)

The Bottom Line: Turning Around the "Globesity" Epidemic

The worldwide increases in obesity over the past three decades have already led to increases in obesity-related chronic diseases, a trend that threatens healthcare systems, economies, and individual lives. Given the huge costs, both public and personal, of obesity-and how hugely difficult it is to lose weight once someone becomes obese-prevention is key. Slowing the increases in obesity and turning around the epidemic will take large-scale, multifaceted efforts, within individual countries and across the globe, to improve people's food choices and increase physical activity. These efforts cannot begin in earnest soon enough.

References
3. International Obesity Task Force. The Global Obesity Epidemic. 2010. Accessed February 29, 2011. 7. Belluck P. American Obesity Rates Have Hit Plateau, CDC Data Suggest. The New York Times. January 14, 2012. 8. Nestle M. Good news: obesity rates leveling off. But how come? In: Food Politics; January 22, 2012. 11. Public Health Agency of Canada. Obesity in Canada: A Joint Report from the Public Health Agency of Canada and the Canadian Institute for Health Information; 2011. In; 2011:12-6.

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Obesity has truly become a worldwide problem, affecting countries rich and poor. So just how many men, women, and children are overweight or obese? It's a natural question-and a surprisingly hard one for researchers to answer. The problem's vast. The data, from some regions, quite spotty.

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In sports it is common to get injured but there are many ways to prevent common injuries from happening.

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With the start of a new school year it's a good opportunity to remind anyone thinking about participating in sports of some simple things you can do to prevent some common injuries. Check back regularly, we will be adding new sports regularly!

Football (American) is one of the most watched and played sports played by athletes of all ages. According to the U.S. Consumer Product Safety Commission more than 920,000 under the age of 18 were treated in medical clinics for football related injuries, most of which could have been prevented.
Some of the most common football injuries include:
Overuse Injuries - Lower back or overall back pain is a common complaint in Football (American) players due to overuse. Often a leading cause is overtraining syndrome. This is when a player trains beyond the ability for the body to easily recover. Knee pain is another problem that football players complain of, this can usually be dealt with by a quadriceps-strengthening program.

Concussions - One of the most common injuries in Football (American). A concussion occurs due to a traumatic impact. Some signs of concussion are; headache, dizziness, nausea, drowsiness, loss of balance, numbness, burry vision, and difficulty concentrating. Concussions can be a very serious injury, if you think you may have suffered from one seek medical care immediately.

Heat Injuries - With the start of training camp this is a large concern. Most often occurs with the intense physical activities associated with long outdoor training sessions in the height of summer. Sweating depletes the body of salt and water. Some of the symptoms you may note are cramping, if not treated with simple body cooling and fluids you can suffer from heat stroke or heat exhaustion which can if untreated lead to death.

Traumatic Injuries - Knee injuries in football are the most common, especially those to the anterior or posterior cruciate ligament (ACL/PCL) and to the menisci (cartilage of the knee). These knee injuries can adversely affect a player's longterm involvement in the sport. Football players also have a higher chance of ankle sprains due to the surfaces played on and cutting motions. Shoulder injuries are also quite common and the labrum (cartilage bumper surrounding the socket part of the shoulder) is particularly susceptible to injury, especially in offensive and defensive linemen. In addition, injuries to the acromioclavicular joint (ACJ) or shoulder are seen in football players.
Football Injury Prevention Tips

Perform proper warm-up and cool-down routines

Consistently incorporate strength training and stretching

Hydrate adequately to maintain health and minimize cramps

Stay active during summer break to prepare for return to sports in the fall

Wear properly fitted protective equipment, such as a helmet, pads, and mouth guard

Tackle with the head up and do not lead with the helmet

Have a pre-season health and wellness evaluation

Speak with a sports medicine professional or athletic trainer if you have any concerns about football injuries or football injury prevention strategies

Gymnasts must consistently prepare for the rigorous physical and emotional toils that the sport requires. With the complexity of routines, the risk of potential injury increases. Injuries most commonly occur in the ankles, feet, lower back, knees, wrists, and hands, often from overuse or simple stress. Injuries are rarely severe, but if left untreated they can lead to chronic pain and bone fractures. Each year, more than 86,000 gymnastics-related injuries are treated in hospitals, doctors' offices, clinics, and ambulatory surgery centers.
Some of the most common gymnastics injuries include:
Often the upper body is used as a weight-bearing joint in gymnastics, injuries to the shoulder, elbow, and wrist are common and may include: Superior Labrum, Anterior-Posterior (SLAP) Lesions in the Shoulder, Elbow Dislocation and Wrist Sprains. The most common gymnastics injuries to the lower body involve the knee and ankle. Lower extremity injuries usually result from the landing and dismount activities and may include: Anterior Cruciate Ligament (ACL) Injury, Achilles Tendon Injury, and Lower Back Injuries.

Labral tears - (sometimes called SLAP tears) may occur during any gymnastic exercise, but ring and bar specialists seem particularly vulnerable. It is characterized by pain that initially resolves but tends to recur with return to sport. An MRI can be helpful in establishing a definitive diagnosis.

Wrist Injuries - The wrist is subjected to forces that can exceed twice the body weight. The first step in treating wrist pain is to reduce the training volume of the athlete, relieve symptoms, and to participate in only pain-free activities. After an injury, gymnasts should avoid extensive pressure on the wrist joint for six weeks. If the gymnast is experiencing pain with non-gymnastic activities of daily living, using a brace or cast to immobilize the wrist temporarily may be helpful.

ACL injuries - can result when a gymnast lands "short" or is over-rotated while tumbling, dismounting, or vaulting. A "pop" may be heard or felt followed by knee swelling with hours. MRI is often used to confirm ACL injury. As with other sports, ACL reconstruction is recommended for gymnasts who wish to return to full sports participation.

Achilies Tendons - Gymnasts can suffer from a variety of injuries to the Achilles tendon located just above the back of the heel, as a result of the repetitive stress of jumping and landing. Achilles tendinitis results in calf soreness that is aggravated with jumping and landing. Treatment should initially consist of ultrasound, stretching, activity modification, and calf exercises. Foot immobilization for seven to ten days may be beneficial for severe symptoms.

Foot & Ankle - Injuries to the foot and ankle are common in gymnastics. Acute injuries are usually sprains which can be minor or more serious. Swelling, bruising and tenderness directly over the bones are signs of a more serious injury. Minor injuries typically have tenderness limited to one side of the joint without significant swelling. Serious injuries require evaluation by a qualified professional while return to participation after a minor injury is often possible within a week if there is no pain (or limping) with weight bearing activity. Protection with taping or a brace can aid recovery and reduce the risk for re-injury. Chronic ankle pain or repeated injuries are worrisome and require evaluation before continuing with participation.

Muscle Strain - The cause of low-back pain can include muscle strain, ligament sprain, fracture, and/or disc disorders. Frequently, low-back pain will worsen with activity, especially with extension movements, such as arching the shoulders backwards. Low-back pain in gymnasts related to muscular strain or ligament sprain usually responds to rest and physical therapy exercises. Persistent back pain is uncommon and should not be ignored. An MRI or a bone scan are often helpful to rule out more significant injuries.
Gymnastics Injury Prevention Tips:

Insist on spotters when learning new skills

Warm up muscles with light aerobic exercise, such as jumping jacks or running in place, before beginning training or new activities

Inspect equipment to ensure that it is in good condition, including padded floors, secured mats under every apparatus, and safety harnesses for learning difficult moves

Wear all required safety gear whenever competing or training - special equipment may include wrist guards, hand grips, footwear, ankle or elbow braces, and pads

Do not "play through the pain" - if you are hurt, see your doctor and follow instructions for treatment and recovery fully

Make sure first aid is available at all competitions and practices

Cheerleading is considered an athletic activity that incorporates elements of dance and gymnastics along with stunts and pyramid formations. Cheerleading competitions at the high school and collegiate levels have created a whole new dynamic, including increased risk for injury.
Some of the most common cheerleading injuries include:
One study estimates that cheerleading led to 28,000 emergency room visits in 2009 (the latest year for data). While not as frequent as injuries in other sports, cheerleading injuries tend to be more severe, making up more than half of the catastrophic injuries in female athletes. Cheerleading injuries affect all areas of the body - most commonly the wrists, shoulders, ankles, head, and neck.
Cheerleading Injury Prevention Tips:
Stunt restrictions - In an attempt to curb the amount of catastrophic injuries in cheerleading, restrictions have been placed on stunts. They range from height restrictions in human pyramids, to the thrower-flyer ratio, to the number of spotters that must be present for each person lifted above shoulder level.

For example, the limit for pyramids is two body lengths for the high school level and 2.5 body lengths for the college level, with the base cheerleader in direct contact with the performing surface. Base supporters must remain stationary and the suspended person is not allowed to be inverted or rotate on dismount.

Basket toss stunts in which a cheerleader is thrown into the air (sometimes as high as 20 feet) are only allowed to have four throwers. The person being tossed (flyer) is not allowed to drop the head below a horizontal plane with the torso. One of the throwers must remain behind the flyer at all times during the toss.

Mats should be used during practice sessions and as much as possible during competitions. Cheerleaders should not attempt a stunt if they are tired, injured, or ill, as this may disrupt their focus and cause the stunt to be performed in an unsafe manner.

Training - The importance of a qualified coach is also critical. Coaching certification is encouraged. Precautions should always be taken during inclement weather for all stunts. Also, a stunt should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt. Supervision should be provided at all times during stunt routines.

As with any sport, proper conditioning and training are important to minimize injury, including:

Resistance exercises to gain strength in the lower back, stomach, and shoulders

Regular stretching, yoga, or pilates instruction to improve flexibility

Speaking with a sports medicine professional or athletic trainer if you have any concerns about injuries or cheerleading injury prevention strategies

Returning to play only when clearance is granted by a healthcare professional

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Common Sports Injuries and Sports Injury Prevention Tips

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With the start of a new school year it's a good opportunity to remind anyone thinking about participating in sports of some simple things you can do to prevent some common injuries. Check back regularly, we will be adding new sports regularly!

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Gender inequality is discrimination of the basis of sex or gender. This article talked about the examples of gender inequality in the workplace, in politics and in life.

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In this website, the leading reasons of crime in the US is due to an extreme mental illness. The sit states that more than 70% of people who have been in federal prison of jail have a mental illness, and the leading cause of death in prison is suicide, again due to a mental illness.

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Addressing Mental Health and the Criminal Justice System

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New approaches to mental health and criminal justice attempt to ensure fair treatment of mentally ill criminal defendants and reduce the overall crime rate.

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Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day-to-day life becomes impaired. The most severe SUDs are sometimes called addictions.

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Selective Mutism is caused by the inability or unwillingness to speak. Usually caused by extreme social anxiety. Most people with this will only speak in a comfortable setting or with people they are very close with. May only speak in a whisper.

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Selective Mutism Anxiety & Related Disorders Treatment Center | SMart Center

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Selective Mutism - A Comprehensive Overview

PH: (215) 887-5748 | E: SMartCenter@SelectiveMutismCenter.org

Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

More than 90% of children with Selective Mutism also have social phobia or social anxiety. This disorder is quite debilitating and painful to the child. Children and adolescents with Selective Mutism have an actual FEAR of speaking and of social interactions where there is an expectation to speak and communicate. Many children with Selective Mutism have great difficulty responding or initiating communication in a nonverbal manner; therefore, social engagement may be compromised in many children when confronted by others or in an overwhelming setting where they sense a feeling of expectation.

Not all children manifest their anxiety in the same way. Some may be completely mute and unable to speak or communicate to anyone in a social setting, others may be able to speak to a select few or perhaps whisper. Some children may stand motionless with fear as they are confronted with specific social settings. They may freeze, be expressionless, unemotional and may be socially isolated. Less severely affected children may look relaxed and carefree, and are able to socialize with one or a few children but are unable to speak and effectively communicate to teachers or most/all peers.

When compared to the typically shy and timid child, most children with Selective Mutism are at the extreme end of the spectrum for timidity and shyness.

Why does a child develop Selective Mutism?
The majority of children with Selective Mutism have a genetic predisposition to anxiety. In other words, they have inherited a tendency to be anxious from one or more family members. Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, and extreme shyness from infancy on.

Children with Selective Mutism often have severely inhibited temperaments. Studies show that individuals with inhibited temperaments are more prone to anxiety than those without shy temperaments. Most, if not all, of the distinctive behavioral characteristics that children with Selective Mutism portray can be explained by the studied hypothesis that children with inhibited temperaments have a decreased threshold of excitability in the almond-shaped area of the brain called the amygdala. When confronted with a fearful scenario, the amygdala receives signals of potential danger (from the sympathetic nervous system) and begins to set off a series of reactions that will help individuals protect themselves. In the case of children with Selective Mutism, the fearful scenarios are social settings such as birthday parties, school, family gatherings, routine errands, etc.

Some children with Selective Mutism have Sensory Processing Disorder (DSI) which means they have trouble processing specific sensory information. They may be sensitive to sounds, lights, touch, taste and smells. Some children have difficulty modulating sensory input which may affect their emotional responses. DSI may cause a child to misinterpret environmental and social cues. This can lead to inflexibility, frustration and anxiety. The anxiety experienced may cause a child to shut down, avoid and withdraw from a situation, or it may cause him/her to act out, have tantrums and manifest negative behaviors.

Some children (20-30%) with Selective Mutism have subtle speech and/or language abnormalities such as receptive and/or expressive language abnormalities and language delays. Others may have subtle learning disabilities including auditory processing disorder. In most of these cases, the children have inhibited temperaments (prone to shyness and anxiety). The added stress of the speech/language disorder, learning disability, or processing disorder may cause the child to feel that much more anxious and insecure or uncomfortable in situations where there is an expectation to speak.

More studies are necessary to fully assess speech/language abnormalities and Selective Mutism as well as processing disorders and Selective Mutism. It is important to note that there are many children with Selective Mutism who are early speakers without any speech delays/disorders or processing disorders.

Research at the Selective Mutism Anxiety Research and Treatment Center (SMart Center) indicates that there is a proportion of children with Selective Mutism who come from bilingual/multilingual families, have spent time in a foreign country, and/or have been exposed to another language during their formative language development (ages 2-4 years old). These children are usually temperamentally inhibited by nature, but the additional stress of speaking another language and being insecure with their skills is enough to cause an increased anxiety level and mutism.

A small percentage of children with Selective Mutism do not seem to be the least bit shy. Many of these children perform and do whatever they can to get others attention and are described as professional mimes! Reasons for mutism in these children are not proven, but preliminary research from the SMart Center indicates that these children may have other reasons for mutism. For example, years of living mute and therefore have ingrained mute behavior despite their lack of social anxiety symptoms or other developmental/speech problems. These children are literally stuck in the nonverbal stage of communication. Selective Mutism is therefore a symptom. Children are rarely "just mute." Emphasis needs to be on causes of the mutism and propagating factors of mutism.
Studies have shown no evidence that the cause of Selective Mutism is related to abuse, neglect or trauma.

What is the difference between Selective Mutism and traumatic mutism?
Children who suffer from Selective Mutism speak in at least one setting and are rarely mute in all settings. Most have inhibited temperaments and manifest social anxiety. For children with Selective Mutism, their mutism is a means of avoiding the anxious feelings elicited by expectations and social encounters.

Children with traumatic mutism usually develop mutism suddenly in all situations. An example would be a child who witnesses the death of a grandparent or other traumatic event, is unable to process the event, and becomes mute in all settings.

It is important for parents and teachers to understand that the physical and behavioral symptoms are due to anxiety and treatment needs to focus on helping the child learn the coping skills to combat anxious feelings.

It is common for many children with Selective Mutism to have a blank facial expression and never seem to smile. Many have stiff or awkward body language when in a social setting and seem very uncomfortable or unhappy. Some will turn their heads, chew or twirl their hair, avoid eye contact, or withdraw into a corner or away from the group seemingly more interested in playing alone.

Others are less avoidant and do not seem as uncomfortable. They may play with one or a few children and be very participatory in groups. These children will still be mute or barely communicate with most classmates and teachers.

As social relationships are built, and a child develops one or a few friendships, he/she may interact and even whisper or speak to a few children in school or other settings but seem to be disinterested or ignore other classroom peers. Over time, these children learn to cope and participate in certain social settings. They usually perform nonverbally or by talking quietly to a select few. Social relationships become very difficult as children with Selective Mutism grow older. As peers begin dating and socializing more, children with Selective Mutism may remain more aloof, isolated, and alone.

1. Temperamental Inhibition: Timid, cautious in new and unfamiliar situations, restrained, usually evident from infancy on. Separation anxiety as a young child.

2. Social Anxiety Symptoms: Over 90% of children with Selective Mutism have social anxiety. Uncomfortable being introduced to people, teased or criticized, being the center of attention, bringing attention to himself/herself, perfectionist (afraid to make a mistake), shy bladder syndrome (Paruresis), eating issues (embarrassed to eat in front of others).

3. Social Being: The majority of children/teens with SM have age appropriate social skills and are on target developmentally, although some do not. Most children on the autism spectrum struggle with speech/language skills, social skills and have developmental challenges.

4. Physical Symptoms: MUTISM, tummy ache, nausea, vomiting, joint pains, headaches, chest pain, shortness of breath, diarrhea, nervous feelings, scared feelings.

5. Appearance: Many children with Selective Mutism have a frozen-looking, blank, expressionless face and stiff, awkward body language with lack of eye contact when feeling anxious. This is especially true for younger children in the beginning of the school year or then suddenly approached by an unfamiliar person. They often appear like an animal in the wild when they stand motionless with fear! The older the child, the less likely he/she is to exhibit stiff, frozen body language. Also, the more comfortable a child is in a setting, the less likely a child will look anxious. For example, the young child who is comfortable and adjusted in school, yet is mute, may seem relaxed, but mutism is still present. One hypothesis is that heightened sympathetic response causes muscle tension and vocal cord paralysis.

6. Emotional: When the child is young, he/she may not seem upset about mutism since peers are more accepting. As children age, inner turmoil often develops and they may develop the negative ramifications of untreated anxiety (see below).

7. Developmental Delays: A proportion of children with Selective Mutism have developmental delays. Some have multiple delays and have the diagnosis of an autistic spectrum disorder, such as Pervasive Developmental Disorder, Aspergers, or Autism. Delays include motor, communication and/or social development.

8. Sensory Integration Dysfunction (DSI) symptoms, Processing Difficulties/Delays: For many children with SM, sensory processing difficulties are the underlying reason for being 'shut down' and their mutism. In larger, more crowded environments where multiple stimuli are present (such as the classroom setting), where the child feels an expectation, sensory modulation specifically, sensory defensiveness exists. Anxiety is created causing a 'freeze' mode to take place. The ultimate 'freeze mode' is MUTISM.

9. Common symptoms: Picky eater, bowel and bladder issues, sensitive to crowds, lights (hands over eyes, avoids bright lights), sounds (dislikes loud sounds, hands over ears, comments that it seems loud), touch (being bumped by others, hair brushing, tags, socks, etc), and heightened senses, i.e., perceptive, sensitive, Self-regulation difficulties (act outing, defiant, disobedient, easily frustrated, stubborn, inflexible, etc).

10. Common symptoms within a classroom environment: Withdrawal, playing alone or not playing at all, hesitation in responding (even nonverbally), distractibility, difficulty following a series of directions or staying on task, difficulty completing tasks. Experience at the Smart Center dictates that sensory processing difficulties may or may not cause learning or academic difficulties. Many children, especially, highly intelligent children can compensate academically and actually do quite well. MANY focus on their academic skills, often leaving behind 'the social interaction' within school. This tends to be more obvious as the child ages. What is crucial to understand is that many of these symptoms may NOT exist in a comfortable and predictable setting, such as at home. In some children, there are processing problems, such as auditory processing disorder, that cause learning issues as well as heightened stress.

11. Behavioral: Children with Selective Mutism are often inflexible and stubborn, moody, bossy, assertive and domineering at home. They may also exhibit dramatic mood swings, crying spells, withdrawal, avoidance, denial, and procrastination. These children have a need for inner control, order and structure, and may resist change or have difficulty with transitions. Some children may act silly or act out negatively in school, parties, in front of family and friends. WHY? These children have developed maladaptive coping mechanisms to combat their anxiety.

12. Co-Morbid Anxieties: Separation anxiety, Obsessive Compulsive Disorder (OCD), hoarding, Trichotillomania (hair pulling, skin picking), Generalized Anxiety Disorder, Specific phobias, Panic Disorder.

13. Communication Difficulties: Some children may have difficulty responding nonverbally to others, i.e., cannot point/nod in response to a teachers question, or indicate thank you by mouthing words. For many, waving hello/goodbye is extremely difficult. However, this is situational. This same child can not only respond nonverbally when comfortable, but can chatter nonstop! Some children may have difficulty initiating nonverbally when anxious, i.e., have difficulty or are unable to initiate play with peers or go up to a teacher to indicate need or want.

14. Social Engagement Difficulties: When one truly examines the characteristics of a child with Selective Mutism, it is obvious that many are unable to socially engage properly. When confronted by a stranger or less familiar individual, a child may withdraw, avoid eye contact, and 'shut down,' not only leaving a child speechless but preventing him/her from engaging with another individual. Greeting others, initiating needs and wants, etc., are often impossible for many children. Many shadow their parents in social environments often avoiding any social interaction at all. The common example given is; 'A child in grocery story can sing, laugh and talk loudly, but as soon as someone confronts him/her, the child freezes, avoids and withdraws from social interaction.' As the child ages, freezing and shutting down rarely exist, but the child remains either noncommunicative or will respond nonverbally after an indeterminate amount of warm up time.

MUTISM is just one of the many characteristics that children with Selective Mutism portray.

When are most children diagnosed as having Selective Mutism?
Most children are diagnosed between 3 and 8 years old. In retrospect, it is often noted that these children were temperamentally inhibited and severely anxious in social settings as infants and toddlers, but adults thought they were just very shy. Most children have a history of separation anxiety and being slow to warm up. Often it is not until children enter school and there is an expectation to perform, interact and speak, that Selective Mutism becomes more obvious. What often happens is teachers tell parents the child is not talking or interacting with the other children. In other situations, parents will notice, early on, that their child is not speaking to most individuals outside the home.
If mutism persists for more than a month, a parent should bring this to the attention of their child's physician.

Why do so few teachers, therapists and physicians understand Selective Mutism?
Studies of Selective Mutism are scarce. Most research results are based on subjective findings based on a limited number of children. In addition, textbook descriptions are often nonexistent, or information is limited, and in many situations, the information is inaccurate and misleading. As a result, few people truly understand Selective Mutism. Professionals and teachers will often tell a parent, the child is just shy, or they will outgrow their silence. Others interpret the mutism as a means of being oppositional and defiant, manipulative or controlling. Some professionals erroneously view Selective Mutism as a variant of autism or an indication of severe learning disabilities. For most children who are truly affected by Selective Mutism, this is completely wrong and inappropriate!

Research at the SMart Center indicates that children who seem oppositional in nature often have parents, teachers, and/or treating professionals who have pressured them to speak for months, perhaps years. Mutism not only persists in these children, but is negatively reinforced. These children may develop oppositional behaviors out of a combination of frustration, their own inability to make sense of their mutism, and others pressuring them to speak.

Because Selective Mutism is an anxiety disorder, if left untreated, it can have negative consequences throughout the child's life and, unfortunately, pave the way for an array of academic, social and emotional repercussions such as:

Worsening anxiety

Depression and manifestations of other anxiety disorders

Social isolation and withdrawal

Poor self-esteem and self-confidence

School refusal, poor academic performance, and the possibility of quitting school

Underachievement academically and in the work place

Self-medication with drugs and/or alcohol

Suicidal thoughts and possible suicide

Anxiety disorders are the most common mental illnesses among children and adolescents. Our main objective is to diagnose children early, so they can receive proper treatment at an early age, develop proper coping skills, and overcome their anxiety. According to the US Surgeon General, our country is in a state of emergency as far as children's mental health is concerned. 10% of children suffer from mental disorders, but less than 5% of these children are actually receiving treatment.

If parents suspect their child has Selective Mutism, what should they do?
Parents should initially remove all pressure and expectations for the child to speak, conveying to their child that they understand he/she is scared and it is hard to get the words out and that they will help their child through this difficult time. Praise the child's efforts and accomplishments, support and acknowledge the difficulties and frustrations.

Parents should speak with their family physician or pediatrician and/or seek out a psychiatrist or a therapist who has experience with Selective Mutism. However, please note that having experience with Selective Mutism does not guarantee that the treatment approach and understanding is correct. In fact, a clinician with less experience, yet who has an excellent understanding of Selective Mutism may be an ideal choice for your child.

What are the key questions to ask a potential therapist or physician?
Do your homework! You will have a much better idea what to look for if you understand Selective Mutism. Educate yourself as much as possible before seeing any professional. Parents should read as much information as they can about Selective Mutism. The Selective Mutism Association website has countless pages of information and it is updated on a regular basis.

Key questions to ask include:

What are your areas of expertise?

Have you ever treated a child with Selective Mutism? If so, how many and what are your success rates?

What are your views on Selective Mutism? In other words, what are some of the reasons a child manifests mutism?

What is your treatment approach to Selective Mutism?

What will be my role as a parent? What is the teacher's role?

What is your opinion on medication in treating Selective Mutism and when do you consider medication?

Can you supply me with references of families you have worked with?

How will you work with my child to help him/her progress communicatively?*

*Children do not progress communicatively without learning coping skills. Simply lowering anxiety is NOT enough to enable the child to begin engaging socially, learn to progress to verbal communication and feel comfortable in an environment. Skills must be taught.

Caution: When speaking to potential treating professionals, please be cautious of those who see Selective Mutism as a controlling/manipulative behavior. Treatment approaches based on discipline and forcing a child to speak are inappropriate and will only heighten anxiety and negatively reinforce mute behavior.

How is a child evaluated for Selective Mutism?
Social Communication Anxiety Treatment® or S-CAT® is an evidenced-based program created by Dr. Elisa Shipon-Blum and implemented at the Selective Mutism Anxiety Research and Treatment Center (SMart Center). Presently, the SMart Center is the ONLY Center in the world that implements S-CAT®.

Dr. Elisa Shipon-Blum's S-CAT® Program is based on the concept that Selective Mutism (SM) is a social communication anxiety disorder that is more than just not speaking. Families in the S-CAT® Program are provided with structured, individualized, step-by-step treatment.

Dr. Shipon-Blum has created the SM-Stages of Social Communication Comfort Scale© that describes the various stages of social communication possible for a child suffering from Selective Mutism. Children suffering from Selective Mutism (SM) change their level of social communication based on the setting as well as the expectations from others within a setting. As a result, social comfort and communication will change from setting to setting and person to person. The Social Communication Bridge® illustrates this concept in a visual form.

For example, a child may be "chatting up a storm" with their friend or family member in one setting, yet meet that same person in another setting (such as at school or perhaps at a family function) and the child may have difficulty socially engaging, communicating nonverbally and perhaps the child cannot communicate at all!

For some children, they appear very comfortable and mutism is the most noted symptom. This usually means they are able to engage nonverbally with others via astute nonverbal skills (professional mimes!) in most, if not all settings. These children are stuck in the nonverbal stage of communication (Stage 1) and suffer from a subtype of SM called Speech Phobia.

Although mutism is the most noted symptom of SM, the inability to speak merely touches on the surface of our children. A complete understanding of the child is necessary to develop an appropriate treatment plan for home and in the real world, as well as in school by developing accommodations and interventions, e.g. IEP or 504 Plan.

According to Dr. Shipon-Blum's work, after a complete evaluation consisting of parent and teacher assessment forms such as the Selective Mutism Comprehensive Diagnostic Questionnaire (SM-CDQ)© and the SM School Evaluation Form©, and parent and child interviews, treatment needs to address three key questions:

1. did this child develop (including influencing, precipitating and maintaining factors)?

2. does Selective Mutism persist despite past treatment and/or parent/teacher awareness?

3. can be done at home, in school, and in the real world to help the child build the coping skills needed to overcome his/her social communication challenges?

To help a child suffering in silence, an understanding of which stage the child is in during particular social encounters must be developed. The Social Communication Anxiety Inventory (SCAI©) can be used to determine the stage of social communication on the Social Communication Bridge®. Treatment is then developed via the whole child approach under the direction of the treatment professional, the child, parents, and school personnel working together.

Dr. Shipon-Blum emphasizes that although anxiety lowering is key, it is often not enough, especially as children age. Over time, many children with Selective Mutism no longer feel anxious, but their mutism and lack of proper social engagement continue to exist in select settings.

Children with SM need strategies and interventions to progress from nonverbal to spoken communication. This is the Transitional Stage of Communication, an aspect missing from most treatment plans. In other words, how do you help a child progress from nonverbal to verbal communication?

Strategies and interventions are developed based on where the child is on the Social Communication Bridge in a particular setting and are meant to be a desensitizing method as well as a vehicle to unlearn conditioned behavior. Time in the therapy office is simply not enough. The office setting is used to help prepare the child for the school and real world environments by developing strategies to help the child unlearn his or her conditioned behavior. Then, in the real world and within the school setting, the strategies and interventions are implemented.

The S-CAT® Program incorporates anxiety lowering techniques, methods to build self-esteem, and strategies and interventions to help with social comfort and communication progression. This may include bridging from shut down to nonverbal communication and then transitioning into spoken communication via the Verbal Intermediary®, Ritual Sound Approach®, and possibly the use of augmentative devices.

Children with SM need to understand, feel in control, and have choice in their treatment (age dependent). These are critical components of Social Communication Anxiety Treatment® strategies, which provide the child with choices and help to transfer the child's need for control into the strategies and interventions.

S-CAT® games and goals (based on age and where the child is on the Social Communication Bridge®) are used to help develop social comfort and ultimately progress into speech via the use of ritualistic and controlled methods. Strategy charts are used to help develop social comfort and progress into speech. Silent goals (environmental changes) and active goals (child directed goals based on choice and control) are some of the other tools used within the S-CAT® Program.

Every child is different and therefore an individualized treatment plan needs to be developed to incorporate home (parent education, environmental changes), the child's unique needs, and school modifications (teacher education, accommodations and interventions). By lowering anxiety, increasing self-esteem, and increasing communication and social confidence within a variety of real world settings, the child suffering in silence will develop necessary coping skills to enable for proper social, emotional, and academic functioning.

A trained professional familiar with Selective Mutism will have a parental interview. Emphasis will be on social interaction and developmental history, other manifestations of anxiety, behavioral characteristics (shy temperament), home life description (family stress, divorce, death, etc.) and medical history. From the results of the initial interview, the professional will often see the child. Children with Selective Mutism may or may not speak to the diagnosing professional. Whether or not a child speaks to the evaluating physician does not really matter. An astute professional should be able to assess interpersonal communication skills and build rapport quite easily and, if given at least one session and possibly viewing videotapes from home, can rule in or out Selective Mutism as a diagnosis.

1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.

2. The disturbance interferes with educational or occupational achievement or with social communication.

3. The duration of the disturbance is at least 1 month (not limited to the first month of school).

4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

5. The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning. Teasing or goading by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive- Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation. Intellectual disabilities, hospitalization or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings children with Selective Mutism are almost always given an additional diagnosis of Anxiety Disorder, especially Social Phobia is common. (DSM-V-TR) (APA, 2018)

Authors note: The above criteria are quite vague/nonspecific and should not be used alone to rule in or rule out the diagnosis of Selective Mutism. As mentioned earlier, children with Selective Mutism manifest many behavioral characteristics other than mutism. In addition, since children with Selective Mutism often have difficulty responding and/or initiating nonverbally, Selective Mutism can be viewed as a communication disorder. In addition, children with autism, PDD-NOS, Aspergers and other developmental disorders can manifest mutism that is selective in location.

How is Selective Mutism treated?
The main goals of treatment should be to lower anxiety, increase self-esteem and increase social confidence and communication. Emphasis should never be on getting a child to talk. All expectations for verbalization should be removed. With lowered anxiety, confidence, and the use of appropriate tactics/techniques, communication will increase as the child progresses from nonverbal to verbal communication. Treatment approaches should be individualized, but the majority of children are treated using a combination of:

1. Social Communication Anxiety Therapy® (S-CAT®): This is the philosophy of treatment implemented at the Selective Mutism, Anxiety, and Related Disorders Treatment Center (SMart Center). This treatment includes development of an individualized treatment plan that focuses on the whole child and incorporates a TEAM approach involving the child, parent, school personnel, and treating professional. Recommended therapeutic tactics and techniques are implemented to build social comfort and progression of communication comfort (nonverbal and verbal) in various social settings (in and out of school). Because anxiety levels change from situation to situation, and often from one person to the next, methods often change from one social situation to another. Therefore, by lowering anxiety, increasing self-esteem, as well as increasing communication and social confidence within a variety of REAL WORLD settings, the child suffering in silence will develop necessary coping skills to enable for proper social, emotional, developmental, and academic functioning.

2. Behavioral Therapy: Positive Reinforcement and Desensitization techniques are the primary behavior treatments for Selective Mutism, as well as removing all pressure to speak. Emphasis should be on understanding the child and acknowledging their anxiety. Introducing the child to social environments in subtle and non-threatening ways is an excellent way to help the child feel more comfortable, i.e., Parents can take the child into school when few people are around to get the child to practice speaking. Eventually, bring a friend or two to school and allow the children to play when other children are not present. Small groups with only a small number of children are helpful, as well as allowing parents to spend time with the child within the class. After the child is speaking quite normally, the teacher, and then the students are gradually introduced into the group setting. Positive reinforcement for verbalization should be introduced when, and only when, anxiety is lowered and the child feels comfortable and is obviously ready for some subtle encouragement.

3. Play Therapy, Psychotherapy, and other psychological approaches: These can be effective if all pressure for verbalization is removed and emphasis is on helping the child relax and open up. Confronting mutism in a non-threatening way is important. These children are SCARED, and the focus should be to help them identify their level of being scared' in a particular situation. Helping them to realize that you understand and are there to help them relieves tremendous pressure.

4. Cognitive Behavioral Therapy: CBT trained therapists help children modify their behavior by helping them redirect their fears and worries into positive thoughts. CBT needs to incorporate awareness and acknowledgement of anxiety and mutism. Most children with Selective Mutism worry about others hearing their voice, asking them questions about why they do not talk and trying to force them to speak. The focus should be on emphasizing the childs positive attributes, building confidence in social settings, and lowering overall anxiety and worries.

5. Medication: Studies indicate that the most effective approach to treatment is a combination of behavioral techniques and medication. Often behavioral techniques are used for an indeterminate amount of time prior to the addition of medication. If children are not making enough progress with behavioral therapy alone, medication may be recommended to reduce the anxiety level. Serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Celexa, Luvox, and Zoloft are very effective in the treatment of anxiety disorders. Similar to the SSRIs, there are other drugs that affect one or more neurotransmitters such as serotonin, norepinephrine, GABA, and dopamine, etc. which are also proving to be affective. Examples are Effexor XR and Buspar. Both classes of drugs work well in children who have a true biochemical imbalance. This seems to be the case in the majority of children with Selective Mutism. Very often, we have seen positive effects in as little as a week! Medication is used as a jump start with the hope that, as we lower anxiety via medication, we can implement behavioral techniques more easily and successfully! Goals for the duration of treatment with medication are usually 9-12 months.

6. Self-esteem boosters: Parents should emphasize their childs positive attributes. For example, if your child is artistic, then by all means show off the artwork! Have a special wall to display your childs masterpieces; perhaps you can even have a special exhibition! Have them explain their artwork to family members and close friends. This promotes more verbalization practice, as well as helps with confidence!

7. Frequent socialization: Encourage as much socialization as possible without pushing your child. Arrange frequent play dates with classmates or even small group interactions with individuals the child knows well. The goals is for your child to feel comfortable enough with the classmates so that verbalization will occur. Most children with Selective Mutism will talk to friends in their own home. As the child gets increasingly comfortable speaking to one child, invite another child over, and then have two or three children at a time! Transfer speaking into the school via set tactics/techniques. For some children, Social Skills therapy is necessary and often helpful in accomplishing increased communication.

8. School involvement: Parents need to educate teachers and school personnel about Selective Mutism! You must be an advocate for your child. The school needs to understand that children with Selective Mutism are not being defiant or stubborn by not speaking, that they truly CANNOT speak. Explain to the teacher that a child needs to feel that it is alright for them not to speak. Nonverbal communication is acceptable in the beginning. As the child progresses with treatment, the teacher should be involved in the treatment plan with verbalization being encouraged in subtle, non-threatening ways. An Individualized Educational Plan (IEP) or 504 Plan may be necessary to help accommodate your childs inability to communicate verbally and to help the child progress communicatively as well as build social comfort.

9. Family involvement and parental acceptance: Family members must be involved in the entire treatment process! Very often changes in parenting styles and expectations are necessary to accommodate the needs of the child. Remember, never pressure or force your child to speak this will only cause more anxiety. Convey to your child that you are there for them. Spend one on one time, especially at night, when all pressure is off and engage your child in discussions about their feelings. Allowing your child to open up helps relieve stress. A parents acceptance and understanding is crucial for the child!

It is important to realize that with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is excellent!

Author: Dr. Elisa Shipon-Blum is President and Director of the Selective Mutism, Anxiety, & Related Disorders Treatment Center (SMart Center). She created CommuniCamp™, an intensive group treatment program for Selective Mutism, and is also Founder and Director Emeritus of the Selective Mutism Association and a Clinical Assistant Professor of Psychology and Family Medicine PCOM. Dr. Shipon-Blum's initial interest in Selective Mutism was personal. Her experience trying to find help for her daughter made the need for research, development of appropriate/effective treatment strategies, and dissemination of information about this social-communication disorder abundantly clear. Many of these findings are based on research from treatment at the SMart Center of hundreds of children with Selective Mutism.

Contributors: Christine Stanley, Lori Dabney, Laurie Gorski

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WHAT IS SELECTIVE MUTISM? Selective Mutism - A Comprehensive Overview BY DR. ELISA SHIPON-BLUM PH: (215) 887-5748 | E: SMartCenter@SelectiveMutismCenter.org Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school.

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Cyber security is important because a cyber attack can result in identity theft or loos of important data. Cyber security can protect you from these things.

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Cybersecurity is the practice of protecting systems, networks, and programs from digital attacks. These cyberattacks are usually aimed at accessing, changing, or destroying sensitive information; extorting money from users via ransomware; or interrupting normal business processes.

Implementing effective cybersecurity measures is particularly challenging today because there are more devices than people, and attackers are becoming more innovative.

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Cybersecurity is the practice of protecting systems, networks, and programs from digital attacks. These cyberattacks are usually aimed at accessing, changing, or destroying sensitive information; extorting money from users via ransomware; or interrupting normal business processes. Implementing effective cybersecurity measures is particularly challenging today because there are more devices than people, and attackers are becoming more innovative.

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This article tells about Child Star
Syndrome, the effects people have had from acting, and the trauma gained from being in
Hollywood from a young age.

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Why Do So Many Child Stars Develop PTSD?

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For PTSD Awareness Month our experts explore the dangers of child-star syndrome and how you can overcome the mental health challenges it…

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Major League Baseball’s Expansion Paradox

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Major League Baseball’s Expansion Paradox

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The MLB is considering expansion, but it's not as easy as people think. With money issues, low fan attendance, it might not work!

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Portland has looked to expansion or relocation for a Major League Baseball team dating back to the ... [+]
Portland Diamond Project

If 2001 to 2005 taught us anything about Major League Baseball, it was that the league has considerable demand. At a time when then-commissioner Bud Selig and the owners floated the folly of "contracting" the league to 28 teams by shuttering the Montreal Expos, and possibly the Minnesota Twins, whether it was legal action to thwart it, or the idea that relocation was a more favorable option, markets around the U.S. suddenly jumped up and said they'd take a team.

In 2005 that culminated in the Expos moving to Washington, D.C. where they were rechristened the Washington Nationals. The rest, as they say, is history.

Since then, Rob Manfred took over as commissioner, and MLB - with reoccurring labor deals with the players the possible exception - settled into a steady groove. Revenue continued to climb. The one thing that has grown is the number of clubs in the league.

In October 2015, I interviewed Manfred where the topic of expansion surfaced. I had considerable interest in how MLB had approached relocation and possible expansion dating back to that time 2001-2005 timeframe given I had worked with baseball boosters and the city of Portland to try and make a pitch for a team.

Manfred has repeatedly said that he sees MLB as a growth industry. The idea of 32 clubs in the league is something that repeatedly surfaces. Whether it's been The Athletic, with a recent series on markets that have shown interest, or me back in 2012 for Baseball Prospectus, or 2019 for Baseball America, MLB expansion has more than its fair share of information as fodder for fans and those looking to lure clubs to their home markets.

Removing who would be a favorite. Removing what market is "the best". If one looks across the U.S., Canada, and Mexico several markets could support a club providing a decent market size to fill ballparks 81 dates a year. They all have varying levels of corporate entities for local and regional sponsorships. And there are more than enough boosters to fire up, "Hey! Look at us!" campaigns of varying maturity.

Baseball is healthy. The markets can support an expansion team. So, why is MLB stuck in a paradox that makes the idea of expansion at this point may be its most challenging?

To start, unlike relocation, where clubs have owners in place that has already been approved by the league, whether it's former MLB pitcher and player agent Dave Stewart in Nashville, former Nike executive Craig Cheek in Portland, or William Jegher and Stephen Bronfman in Montreal, the biggest wild card for baseball boosters looking to lure an expansion team is whether they ultimately wind up more than a minority owner. A modern MLB ballpark, with a retractable roof, could approach $2 billion to construct. And with the model for MLB owners to build "ballpark villages" like the Battery around Truist Park for the Braves becoming more the norm, the costs vault into more than double that. Throw in expansion fees of $2 billion-$2.5 billion, and pulling together the capital stack to make a project fly, is exceedingly difficult.

Even still, the money issues could be overcome. The return on investment for clubs in the major sports leagues is staggering, as the Forbes valuations show each and every year, along with revenues that grow and are seemingly impervious to recession factors. The issue is one of pulling it all together - the investment money, the public funding, and the support from local, regional, and state politicians based on, "It might happen."

None of the baseball boosters or political leaders, or for that matter, Rob Manfred and baseball's 30 owners, have an idea when the trigger will be pulled on expansion at this point. And even if Manfred and the league do decide to open markets to officially explore, no one during the process is picked before the funding for a ballpark site and facility are in place. The league will always encourage markets because the reality is, what each market learns; or what each booster group puts in place, does help. What the league isn't going to say is, "You're the one. If you keep going this way, the selection process is wired for you to win the day."

This isn't MLB being coy, although political leaders will tell you on background or on record, that that's what they believe. The reality is, there are 30 owners, and that means 30 different points of view. Whether there is 75% of them to approve a market - and remember, there would need to be two to balance out the league - is the question.

While there are absolutely markets in the U.S. that can support a club, the reality is all the big markets have been gobbled up. That means the possibility of an expansion club being part of revenue sharing. And even if it weren't, it's taking the centralized revenue pie that's consumed by 30 owners, and adding two additional mouths eating it.

But maybe the biggest issue is more recent.

Sinclair-owned Diamond Sports Group, which is branded the Bally Sports regional sports networks, is on the verge of bankruptcy. While the league would like to see contracts fully fulfilled, it's possible in Chapter 11 restructure, negotiating lower rights fees could be in play. But even if clubs take on equity of all or part of them. Or, if a direct-to-consumer model is put in place, regional sports network revenues are likely to decline, not just for Bally Sports, but as other RSN deals come up for renewal given the shedding of subscribers for traditional linear television as consumers move to streaming options.

Expansion markets in the U.S. would need to carve out media deals in which every bit of the country is already claimed by one or more MLB franchises. The idea of cannibalizing media rights for existing franchises at this precarious point in the media landscape is bound to push many owners away from the idea of expansion at this time.

And so, MLB has its paradox. It is a multi-billion dollar industry that sees it exceptionally healthy at the enterprise level. On the surface, expansion would be a no-brainer. But looking deeper, expansion - with its media rights challenges, and exceptional costs - seems a bridge too far right now. At some point, it happens. Now...? Almost assuredly not. In a decade... maybe.

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Major League Baseball's Expansion Paradox

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If 2001 to 2005 taught us anything about Major League Baseball, it was that the league has considerable demand. At a time when then-commissioner Bud Selig and the owners floated the folly of "contracting" the league to 28 teams by shuttering the Montreal Expos, and possibly the Minnesota Twins, whether it was legal action to thwart it, or the idea that relocation was a more favorable option, markets around the U.S.

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Exercise involves engaging in physical activity and increasing the heart rate beyond resting levels. Doing physical workouts benefit the body in multiple ways.

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Exercise involves engaging in physical activity and increasing the heart rate beyond resting levels. It is an important part of preserving physical and mental health.

Whether people engage in light exercise, such as going for a walk, or high intensity activities, for example, uphill cycling or weight training, regular exercise provides a huge range of benefits for the body and mind.

Taking part in exercise of any intensity every day is essential for preventing a range of diseases and other health issues.

In this article, we explain the different types of exercise and their benefits, as well as the considerations for designing a fitness regime.

People divide exercise into three broad categories:

We describe each of these categories below.

Aerobic exercise

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There are several types of exercise, and they provide a range of benefits for health and well-being.

Aerobic exercise aims to improve how the body uses oxygen. Most aerobic exercise takes place at average levels of intensity over longer periods.

An aerobic exercise session involves warming up, exercising for at least 20 minutes, and then cooling down. Aerobic exercise mostly uses large muscle groups.

Aerobic exercise provides the following benefits:

Anaerobic exercise

Anaerobic exercise does not use oxygen for energy. People use this type of exercise to build power, strength, and muscle mass.

These exercises are high-intensity activities that should last no longer than around 2 minutes. Anaerobic exercises include:

weightlifting

sprinting

intensive and fast skipping with a rope

interval training

isometrics

any rapid burst of intense activity

While all exercise benefits the heart and lungs, anaerobic exercise provides fewer benefits for cardiovascular health than aerobic exercise and uses fewer calories. However, it is more effective than aerobic exercise for building muscle and improving strength.

Increasing muscle mass causes the body to burn more fat, even when resting. Muscle is the most efficient tissue for burning fat in the body.

Agility training

Agility training aims to improve a person's ability to maintain control while speeding up, slowing down, and changing direction.

In tennis, for example, agility training helps a player maintain control over their court positioning through good recovery after each shot.

People who take part in sports that heavily rely on positioning, coordination, speed, and balance need to engage in agility training regularly.

The following sports are examples of ones that require agility:

Stretching and flexibility

Some exercises combine stretching, muscle conditioning, and balance training. A popular and effective example is yoga.

Yoga movements improve balance, flexibility, posture, and circulation.

The practice originated in India thousands of years ago and aims to unify the mind, body, and spirit. Modern yoga uses a combination of meditation, posture, and breathing exercises to achieve the same goals.

A yoga practitioner can tailor a course for individual needs.

A person looking to manage arthritis might need gentle stretches to improve mobility and function. Someone with depression, on the other hand, may need more emphasis on the relaxation and deep breathing elements of yoga.

Pilates is another stretching option that promotes flexibility and core strength. Tai chi is also an effective option for exercise that promotes calm stretching rather than intensity.
Here, learn more about yoga.
A sedentary lifestyle can increase the risk of the following health problems:

It can also contribute to an increased risk of premature death from all causes, including the complications of being overweight and obesity.

In many parts of the world, including the United States, the number of overweight and obese people continues to increase rapidly.

According to the most recent National Health and Nutrition Examination Survey, that researchers did in 2013-2014 across the U.S., more than 2 in 3 adults are overweight or obesity.

The same survey found that around 1 in 13 adults have extreme obesity and face an increased risk of severe health complications.
Discover how to prevent cardiovascular disease.
Taking the stairs instead of an elevator can be a great way for busy people to meet exercise guidelines.

Fitting exercise into a busy schedule can be a roadblock to a successful regime. However, people do not need to dedicate large amounts of extra time to exercise to see the benefits.

Here are some tips for fitting physical activity in a busy schedule:

See which car journeys you can replace with walking or cycling. Is driving to work necessary? If so, try parking half a mile away from the office and walking the final bit.

People who commute to work by public transport could try getting off their bus or train a few stops early and walking the rest of the way.

Consider walking up and down the stairs at your office instead of taking elevators or escalators.

Try to think about the amount of time spent watching television and avoid binge-watching TV shows. While watching television for extended periods, light exercises, such as stomach crunches or jumping jacks, can help a person include more physical activity in their day.

If a person enjoys video games, they could consider playing games that encourage physical activity, such as exercise routines on a Nintendo Wii.

Vigorous housework, gardening, and going up and down the stairs while doing chores also qualify as physical activity and can help people meet the guidelines productively.

People will likely gain the most benefit from exercises they enjoy that fit their lifestyle.

Some of the examples below are the easiest to fit into a daily routine:

Go for a brisk 30-minute walk five times every week.

Walk your dog more often or go for walks and jogs with friends.

Try to add swimming to your weekly routine, even if it is not every day.

Join some exercise classes that are fun, collaborative, and educational.

Become a member of a martial arts club. Beginner's sessions can be gentle and fun.

Exercise is sometimes a gradual learning curve. A person should spread sessions across the week and scale up the intensity slowly.

It is important for people to ensure they drink plenty of water during and after exercise. Checking with a doctor is a good precaution to take if someone has a health condition or injury that could impact exercise levels, or that exercise could make worse.

While a combination of aerobic and anaerobic exercise provides the most benefit, any exercise is better than none for people who currently have an inactive lifestyle.

Guidelines

Current U.S. guidelines recommend that people do one of the following:

at least 150-300 minutes of moderate-intensity exercise a week

a minimum of 75-150 minutes of vigorous-intensity, aerobic physical activity

a combination of the two types of exercise

Toward these goals, it is worth remembering that even 10-minute bursts of physical activity during the day provide health benefits.

Please note: Medical News Today does not imply a warranty of fitness for a particular purpose or endorse any of these applications. Nobody at MNT has evaluated them for medical accuracy. The Food and Drug Administration (FDA) has not approved them unless otherwise indicated.

Exercise may be difficult to maintain for some people. Consider the following tips to achieve long-term success:

Have a clear goal: Whether for health reasons or otherwise, try to always keep in mind the reason you started increasing your exercise levels.

Work at your own pace: Doing too much too quickly can increase the risk of injury and the chance to develop a stable routine. Set targets based on the goals you established at the start of the regimen and celebrate small wins to boost confidence.

Enjoy yourself: A regimen is more sustainable if a person enjoys the physical activities that it involves.

Join a club with a friend: If you join a fitness club with a friend, or exercise with a friend, you may enjoy the sessions more. Some people prefer not to have the stress of someone else around. This depends on you.

Trainers and teachers can be helpful: People just starting a regimen or looking to step up their routine may benefit from a personal trainer or teacher. They can provide motivation and guidance, helping people track their goals and stay dedicated.

Vary your exercises: Change your exercise program every few weeks. Mixing it up can help a person work on different muscle groups and increase the range of benefits. If you enjoy one particular exercise, such as running, try changing the speed and distance of a run, or follow a different route with more hills.

Make it a habit: After a few weeks of regularity, an exercise routine starts to become a habit, even if you find it difficult or boring at first.

The benefits of regular physical activity are wide-reaching and should form a part of every person's day to help them remain healthy.

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Exercise: Health benefits, types, and how it works

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Exercise involves physical activity, exerting the body with movement, and increasing the heart rate. Exercise is vital for looking after and improving our health, and supports physical and mental well-being. This article looks at different types of exercise, how to get involved, and the ways exercise helps.

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Since the 70's Men's T-Levels have been dropping consistently and there are many studies showing why.

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For decades, testosterone levels have been declining. Your grandad may not have been quite as swift with Excel, but he probably one-upped you where T levels are concerned.

It's normal for testosterone levels to decline as you get older, but for some reason, there's been a population-level drop with each generation, at least since the 70s [1-4]. This means, on average, Gen Zers and millennials have significantly lower testosterone levels compared to their predecessors.

But what is it about younger generations that has caused this trend?

In this article, we look at:

The generational decline in testosterone

The average testosterone level of a 60-year-old man in 1987 was around 17.5nmol/L, according to a 2007 study in Massachusetts [5]. Compare that to a 60-year-old man in 2002 - his testosterone level was closer to 15nmol/L.

Based on this, average testosterone levels in men are declining by 1% every year, give or take.

Research carried out on Finnish and Danish populations has shown the same trend [1,6]. And even more recently, a large-scale study of Israeli men has shown how average testosterone levels have dropped between 2006 and 2019 [7] - by over 10% across almost every age category.

Of course, we can't know for certain that 60-year-old millennials and Gen Zers will have lower testosterone levels, at least not for a few decades, but it's looking very likely.

What's concerning is testosterone levels aren't the only problem. Sperm counts are dropping significantly [8] and some reproductive disorders, like testicular cancer, are on the rise (9). Even men's grip strength has declined [10]. So, what's going on?

Why are testosterone levels falling?

This is a complicated question. The truth is, it's not entirely clear, and it likely comes down to a combination of factors.

1. Obesity and sedentary lifestyles

Rising rates of obesity almost certainly play a role in declining testosterone levels. Being overweight can push the body's hormone axis out of balance and affect how the body responds to insulin, both of which can lower testosterone levels [11]. One study found that an increase in BMI by four to five points was associated with a testosterone level of someone ten years older [2].

These days, most of us eat too much and don't move enough. Much of this has been sparked by the digital revolution; ecommerce, tech, and entertainment industries have boomed, which makes it easy to prioritise convenience over health. You can now order a Big Mac from your phone to be delivered to your house while you finish binge-watching your favourite Netflix series. It's something Baby Boomers wouldn't have dreamed of and something Gen Zers can't imagine a world without.

The digital age has transformed how we work too. We favour machinery and automation over manual labour, which likely explains the drop in men's grip strength over time. Many jobs are now office-based and some of us don't even need to leave the house to work. Modern-day careers tend to be much less active than our grandfathers', and people who lead sedentary lifestyles tend to have lower testosterone [12].

But even after taking obesity into account, most studies still show a downward trend in testosterone, which means it can't be the only culprit.

2. External toxins

The annual global production of plastics has grown from 50 million to 300 million tons since the 70s [13]. Science is now seeing the connection between this and changes to our hormone health.

Many plastics contain endocrine-disrupting chemicals (EDCs). EDCs, as their name suggests, are chemicals that interfere with the body's hormones and may be natural or man-made. Some EDCs are slow to break down and accumulate which makes them potentially hazardous over time, even in low doses.
EDCs are found in everyday products, including:

Plastic bottles

Food storage containers

Liners of metal food cans

Detergents

Research has found links between EDC exposure and effects on attention (ADHD), immunity, metabolism, puberty, and reproduction [14]. Several EDCs have been associated with lower semen quality and testosterone levels [15], so there's a possibility they may be partly to blame for this population-level decline.

3. Fewer smokers

This might surprise you, but some data shows that smoking marginally increases testosterone levels [16,17], though not all studies agree with this. Nicotine is metabolised by the body into cotinine; it's possible this may prevent testosterone breakdown [17].

In the 70s, half of men smoked [18], but since then there's been a significant decrease. Now in the UK, only around 15% of men smoke [18]. This may play a part in falling testosterone levels.

But that's not a good reason to light up. Smoking is extremely harmful to many systems in the body and its dangers massively outweigh any potential effect it may have on testosterone. There are safe and natural ways to boost your testosterone - and smoking isn't one of them.

4. Stress and mental health problems

Acute stress may cause testosterone levels to spike. But both physical and psychological long-term stress is likely to lead to reduced testosterone levels [19,20].

Some say that, as a society, we're more stressed than ever before. This one is up for debate. After all, a lot of modern-day problems are nothing new: recessions, political upheavals, and the demands of work and family.

One big difference is that we're now constantly plugged in. We have phones in our pockets that ping with newsflashes and notifications watches that buzz when a friend tries to make contact and headphones that silence the real world around us. Everything is immediate: we just need to press a button and we have access to any information we please. This constant stimulation can make it hard to switch off. And one of the biggest distractors is mobile phones.

Most children are phone owners by the age of seven, a report from Childwise showed [21], and it comes with implications.

Smartphone use has been linked to difficulties regulating emotions, impulsivity, addiction to social networking, shyness, low self-esteem, and FOMO (fear of missing out) [22]. From the physical aspect, it can also lead to sleep problems, reduced physical activity, and migraines [22]. Apps like TikTok and Instagram use algorithms to feed us content we like, which makes it even more difficult to separate ourselves.

There are, of course, upsides to smartphones and social media. Some argue that digital communication can improve friendships and connections [23], or that it may inspire, motivate, and give us new knowledge [24]. Might this just be a new normal that we're adjusting to? Gen Zers could represent the start of a new wave of how we connect with one another. They're the first generation to use smartphones, tablets, and social media from such a young age - and we're still not entirely sure what the lifelong effects of this might be.

5. Other causes

Above are just a few reasons that might explain declining testosterone levels.

Other more off-the-wall theories have been put forward too, like tighter-fitting underwear and warmer temperatures in homes and offices [25]. (There's a reason your crown jewels hang away from your body.)

Conditions like diabetes have also become much more common. People with diabetes tend to have lower testosterone, though it's not entirely clear which causes which (26).

But one thing we can be sure of - there's no single cause for these downward trends. It likely comes down to a combination of changes in our lifestyles, environment, and behaviours.

How important is testosterone for men?

Testosterone is a sex hormone produced mainly in the testes. It plays an essential role in developing and maintaining typical male characteristics, including:

Building muscle

Growing body and facial hair

Regulating sperm production

A lack of testosterone can lead to a variety of symptoms from fatigue to reduced sex drive.

Find out more about the role of testosterone.

Should I be worried?

Are we heading towards an impending Spermageddon?

While there's a downward trend in sperm counts and testosterone levels, averages haven't yet fallen to the point where they're considered low for the overall population. The decline is gradual, so it's not something you need to worry about specifically. But from an evolutionary and ecological perspective, it does raise interesting questions about the future of men's health and reproductivity.

Testosterone replacement therapy (TRT) prescriptions have rocketed in recent years (29). While this is mainly due to changes in our approaches to management and media influences, there has been a genuine increase in the number of men with testosterone deficiency (30).

Measuring your testosterone levels

There's no need to measure your testosterone levels routinely unless you have signs or symptoms of low testosterone. If this is the case, it's best to let a doctor know exactly what you're experiencing so they can interpret your results alongside your symptoms.

Alternatively, you can check your levels from home with our Testosterone Blood Test - it's a simple finger-prick test you can take yourself. You'll receive a report from one of our doctors with your result and you can then see how your testosterone levels compare to other men your age.

References

1. Andersson AM, Jensen TK, Juul A, Petersen JH, Jørgensen T, Skakkebaek NE. Secular decline in male testosterone and sex hormone binding globulin serum levels in Danish population surveys. J Clin Endocrinol Metab. 2007 Dec;92(12):4696-705.

2. Travison TG, Araujo AB, Kupelian V, O'Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007 Feb;92(2):549-55.

3. Nyante SJ, Graubard BI, Li Y, McQuillan GM, Platz EA, Rohrmann S, et al. Trends in sex hormone concentrations in US males: 1988-1991 to 1999-2004. Int J Androl. 2012 Jun;35(3):456-66.

4. Lokeshwar SD, Patel P, Fantus RJ, Halpern J, Chang C, Kargi AY, et al. Decline in Serum Testosterone Levels Among Adolescent and Young Adult Men in the USA. Eur Urol Focus. 2021 Jul;7(4):886-9.

5. Population-Level Decline in Serum Testosterone Levels in American Men | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic [Internet]. [cited 2022 Nov 21]. Available from: https://academic.oup.com/jcem/article/92/1/196/2598434?login=false

6. Perheentupa A, Mäkinen J, Laatikainen T, Vierula M, Skakkebaek NE, Andersson AM, et al. A cohort effect on serum testosterone levels in Finnish men. European Journal of Endocrinology. 2013 Feb 1;168(2):227-33.

7. Chodick G, Epstein S, Shalev V. Secular trends in testosterone- findings from a large state-mandate care provider. Reprod Biol Endocrinol. 2020 Mar 9;18:19.

8. Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Mindlis I, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. 2017 Nov;23(6):646-59.

9. Testicular cancer statistics [Internet]. Cancer Research UK. 2015 [cited 2022 Nov 21]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer

10. Fain E, Weatherford C. Comparative study of millennials' (age 20-34 years) grip and lateral pinch with the norms. Journal of Hand Therapy. 2016 Oct 1;29(4):483-8.

11. Lowered testosterone in male obesity: mechanisms, morbidity and management - PMC [Internet]. [cited 2022 Nov 21]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/

12. Hayes LD, Herbert P, Sculthorpe NF, Grace FM. Exercise training improves free testosterone in lifelong sedentary aging men. Endocrine Connections. 2017 Jul 1;6(5):306-10.

13. Impact of EDCs on Reproductive Systems [Internet]. [cited 2022 Nov 22]. Available from: https://www.endocrine.org/topics/edc/what-edcs-are/common-edcs/reproduction

14. Endocrine Disruptors [Internet]. National Institute of Environmental Health Sciences. [cited 2022 Nov 22]. Available from: https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm

15. Exposure to Endocrine Disrupting Chemicals and Male Reproductive Health - PMC [Internet]. [cited 2022 Nov 22]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046332/

16. Wang W, Yang X, Liang J, Liao M, Zhang H, Qin X, et al. Cigarette smoking has a positive and independent effect on testosterone levels. Hormones (Athens). 2013 Dec;12(4):567-77.

17. Zhao J, Leung JYY, Lin SL, Mary Schooling C. Cigarette smoking and testosterone in men and women: A systematic review and meta-analysis of observational studies. Preventive Medicine. 2016 Apr 1;85:1-10.

18. ASH. Smoking Statistics [Internet]. ASH. [cited 2022 Nov 22]. Available from: https://ash.org.uk/resources/view/smoking-statistics

19. Afrisham R, Sadegh-Nejadi S, SoliemaniFar O, Kooti W, Ashtary-Larky D, Alamiri F, et al. Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students. Psychiatry Investig. 2016 Nov;13(6):637-43.

20. Choi JC, Chung MI, Lee YD. Modulation of pain sensation by stress-related testosterone and cortisol. Anaesthesia. 2012 Oct;67(10):1146-51.

21. Media PA. Most children own mobile phone by age of seven, study finds. The Guardian [Internet]. 2020 Jan 30 [cited 2022 Nov 23]; Available from: https://www.theguardian.com/society/2020/jan/30/most-children-own-mobile-phone-by-age-of-seven-study-finds

22. Wacks Y, Weinstein AM. Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults. Frontiers in Psychiatry [Internet]. 2021 [cited 2022 Nov 23];12. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.669042

23. Lapierre MA, Zhao P. Smartphones and Social Support: Longitudinal Associations Between Smartphone Use and Types of Support. Social Science Computer Review. 2022 Jun 1;40(3):831-43.

24. Wilson C, Stock J. 'Social media comes with good and bad sides, doesn't it?' A balancing act of the benefits and risks of social media use by young adults with long-term conditions. Health (London). 2021 Sep;25(5):515-34.

25. Bhasin S. Secular Decline in Male Reproductive Function: Is Manliness Threatened? The Journal of Clinical Endocrinology & Metabolism. 2007 Jan 1;92(1):44-5.

26. Type 2 diabetes risk linked to low testosterone levels [Internet]. Diabetes UK. [cited 2022 Nov 23]. Available from: https://www.diabetes.org.uk/about_us/news_landing_page/type-2-diabetes-risk-linked-to-low-testosterone-levels

27. Gan EH, Pattman S, H S Pearce S, Quinton R. A UK epidemic of testosterone prescribing, 2001-2010. Clin Endocrinol (Oxf). 2013 Oct;79(4):564-70.

28. Carnegie C. Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests. Rev Urol. 2004;6(Suppl 6):S3-8.

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Why Are Men's Testosterone Levels Decreasing?

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For decades, testosterone levels have been declining. Your grandad may not have been quite as swift with Excel, but he probably one-upped you where T levels are concerned. It's normal for testosterone levels to decline as you get older, but for some reason, there's been a population-level drop with each generation, at least since the 70s [1-4].

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In summary, this article talks about the common types of sports injuries, how they are caused, and what you can do to prevent them.

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Good preventive steps: Warm up before you work out, alternate days for exercising certain muscle groups, and cool down when you’re done.

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There are some topics in school that are almost completly unnecesary, also studetns have barely any choice in what they learn so they are un engaged and don't learn anything.

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This article talks about how yourself and others can understand what its like to have anxiety and some ways to contain it.

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Anxiety disorders affect nearly 1 in 5 American adults each year, creating fear and uncertainty that interferes with everyday activities. The good news is that most anxiety disorders get better with treatment.

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The 7 Habits Of Highly Effective Teens7 habits of teens

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The 7 Habits Of Highly Effective Teens7 habits of teens

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the 7 habits of highly effective teens discusses the biggest problems teens today face, and what has been the root cause

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The effects of racism on physical and mental health

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Racism may be responsible for increasing physical and mental health disparities among Black, Indigenous, and people of color (BIPOC).

The COVID-19 pandemic has brought disparities in healthcare outcomes for different races and ethnic groups into greater focus.

The Centers for Disease Control and Prevention (CDC) revealed that BIPOC in the United States experienced higher rates of hospitalization and death than White populations.

This article looks at how racism can impact a person's body, how it affects physical and mental health, how a person can live healthfully while facing the burden of racism, and how socioeconomic factors that have associations with racism can continue to pose physical and mental health risks.

According to the , racial and ethnic minority populations experience higher levels of poor health and disease across various conditions when compared with their White counterparts.

These stark disparities have driven interest and research into how racism may affect people's physical and mental health.

A 2019 research review found positive associations between reports of racial discrimination and many physical and mental health conditions, as well as preclinical indicators for disease.

These include:

Health inequality and racism

The above research review examined evidence linking mental and physical health outcomes to three key mechanisms of racism. It found that people can experience health inequality through:

Structural or institutional racism: The processes of racism embedded in policies, laws, and societal practices that give advantages to racial groups deemed superior, while racial groups deemed inferior are disadvantaged. For example, structural racism in the criminal justice system can lead to poorer health outcomes.

Cultural racism: The spread of the ideology that certain groups are inferior through language, values, media, and symbols. For example, racist stereotypes can influence the housing decisions of White property owners and lead to racial segregation in neighborhoods. This can create communities of concentrated poverty with worse housing and environmental conditions.

Individual-level discrimination: Where individuals or companies discriminate against racial groups, whether intentionally or without intent. This can result in worse access to employment, education, and medical care.

Learn more about structural racism in medicine here.
A 2015 systematic review collated the results of almost 300 studies to examine how racism affects the physical and mental health of Asian American, African American, and Latinx American people.

The sections below will detail the conclusions of this review, as well as those of other studies.

Physical health

The above review found that experiencing racism has associations with poor mental health and, to a lesser extent, poor physical health.

There is considerable research to suggest that the stress that comes with experiencing racism can have long-lasting physical effects.

Stress can elevate blood pressure and weaken the immune system, which, in turn, raises the risk of developing long-term health conditions.

Racism with higher rates of stress, increasing a person of color's risk of developing high blood pressure. The report that Black people are more likely to have hypertension than any other racial or ethnic group.

Also, a 2019 study found that racist experiences appear to increase inflammation in African American people, raising their risk of developing chronic conditions such as heart disease and kidney disease.

Another study found that unfair treatment of people of color significantly affects sleep and physiological functioning in midlife.

Many studies have cited structural racism within medical care as a key factor in poor physical health. For example, a 2016 study of racial bias and pain management found a link between undertreating pain in Black patients and false biological beliefs, such as, "Black people's skin is thicker than White people's skin."

A found that compared with other racial groups, Black children with severe pain from appendicitis are less likely to receive medication. This suggests that racial bias is causing medical professionals to use different pain thresholds for different racial groups, either inadvertently or purposefully, before administering care.

Mental health

The 2015 meta-analysis found that the association between racism and mental health is twice as strong as the link between racism and physical health. Of those the researchers sampled, BIPOC who reported experiences of racism also experienced the following mental health issues:

Hate crimes against Asian American people and Pacific Islanders surged during the COVID-19 pandemic, and a 2021 study found that COVID-19-related racial/ethnic discrimination had links with a greater risk of depression, anxiety, self-harm, binge drinking, and suicidal ideation among Asian American and Pacific Islander students.

A 2018 paper suggested that fear of racism itself is harmful and that it can undermine good mental health characteristics, such as resilience, hope, and motivation. The paper also underlined how verbal and physical assault can cause PTSD.
Learn more about the link between racism and mental health here.
The American Academy of Pediatrics (AAP) is so concerned about how racism affects the well-being of young people that it released a 2019 policy statement on it.

The statement says that failure to address racism in the United States "will continue to undermine health equity of all children, adolescents, emerging adults, and their families."

Physical health

Researchers have linked racism to poorer birth outcomes, such as infant mortality, for BIPOC. suggest that mothers who report experiences of racism are more likely to have babies with a low birth weight, which can cause further health problems for infants later in life.

Like older BIPOC, young people also experience the ongoing stress of living with and witnessing racism and discrimination. As young BIPOC get older, they risk developing chronic health conditions similar to their parents.
Learn more about maternal health outcomes in BIPOC here.
Mental health

The AAP recommends that young people who report experiences of racism should undergo routine assessment for mental health conditions, including:

The AAP also said that even if children do not directly experience racism themselves, they can be just as significantly affected by witnessing racism as those who experience it firsthand.

Intense and persistent stress can influence how the brain develops, intensifying negative emotions such as fear and impacting learning and memory.

BIPOC alone should not carry the burden of coping with racism. To reduce discrimination, everyone must address structural disadvantage, socioeconomic deprivation, and institutionalized racism.
Learn more about how to be an ally for the Black Lives Matter movement here.
However, there is evidence to suggest that certain factors can help people cope with the negative effects of racism, both physically and mentally.

The sections below will discuss these factors in more detail.

Talk about racist experiences with others

According to the American Psychological Association (APA), talking about racist experiences, instead of bottling them up, can help a person process feelings of distress in the aftermath of racial trauma and stress.

Similarly, engaging with - instead of ignoring - racism is likely beneficial.

A person may feel strong emotions such as anger, distress, or hopelessness when sharing these experiences. Some have suggested that talking about racism can even exacerbate distress and depression for some people.

There is nothing to be ashamed of about these feelings, but if talking about experiences of racism makes someone feel worse, then a counselor may be able to help a person process these emotions.
Learn more about types of therapy here.
Get involved in social activism

Many people find it helpful to channel feelings of anger and injustice into activism and campaigning for racial equality. Being involved in a movement that is working toward progressive change can help people connect with a network of like-minded people and find purpose.

A 2018 study found that political activism served as a protective factor to mitigate the negative effect of racial and ethnic discrimination on stress and depression among Latinx students at a predominantly White college in the U.S.

However, for Black students, higher levels of political activism had an association with more stress and anxiety compared with Black students who were less politically involved.

We need more research to understand the disparities in activism as a coping mechanism for different ethnic groups.

However, a history of law enforcement targeting Black activists, and police violence at more recent Black Lives Matter (BLM) protests, from reports by advocacy group Amnesty International, may explain these greater levels of stress and anxiety.

A 2022 study suggested that social activism might be an important method for coping with emotional distress from watching media coverage of police brutality and protests. But the authors said they need more research to understand how African Americans might engage in social activism without adversely impacting mental health.
Learn more about police violence and its physical and mental impacts on Black Americans here.
Foster a strong sense of racial identity

A study into racial identity and its effects on well-being found that African Americans who identified positively with their racial identity were more likely to have greater self-esteem and fewer depressive symptoms.

Participants who identified negatively with their racial identity, perhaps due to internalized racism, were more likely to have higher depressive symptoms.

Therefore, having a well-developed sense of ethnic or racial identity may help to blunt or buffer the effects of racism. However, research must continue in this area because findings are still limited.
Learn more about the role of family in multiracial identities and resilience here.
Lean on friends and family

A network of people to talk with for support, advice, and comfort can help a person cope with racial discrimination. It can encourage a sense of security and identity and reduce negative thoughts and feelings.

According to the American Psychological Association, socioeconomic status can directly affect physical and mental health. Researchers have linked low socioeconomic status and a lack of economic development to poor health and a shorter life expectancy.

Physical health

According to a 2017 analysis of 1.7 million people, having a low socioeconomic status is harmful to a person's health, alongside other key risk factors such as smoking, drinking a lot of alcohol, or eating an unhealthful diet.

People with low socioeconomic status are also more likely to have avoidable medical procedures, hospitalizations, and conditions that do not receive treatment.

Mental health

Reduced access to housing, employment, and mortgage lending due to low socioeconomic status can adversely affect mental health and increase feelings of depression, stress, and anxiety.

Although Hispanic and African American people seem to have a lower risk of mental health conditions than those in other racial or ethnic groups, those who develop such conditions tend to have more persistent psychological issues.

However, it is worth noting that this perceived lower risk may be due to racial inequities in the healthcare system.

Also, although there is an association between socioeconomic status and race, there is no perfect correspondence between race and low socioeconomic status. Among BIPOC of middle and upper socioeconomic status, the effects of racism on mental and physical health persist.

Racism can be a key factor in the onset of physical and mental health issues in BIPOC.

Research suggests that the stress that develops due to experiencing or witnessing racism can have long-lasting effects, increasing the risk of chronic disease and mental health conditions such as anxiety and depression in both children and adults.

Utilizing the support of peers and community, forging a strong sense of racial identity, and talking about racist experiences can all be effective ways of coping with the stress of racism.

Research suggests that low socioeconomic status has a significant harmful impact on physical health. Racial groups with higher levels of low socioeconomic status also tend to have more persistent mental health conditions.

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The effects of racism on health and mental health

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Racism, or discrimination based on race or ethnicity, is a key factor in the onset of disease and increasing disparities in the health of people of color. Learn more.

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It is ok to use your screen but too much of it is bery bad

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The best parental control app that empowers parents to balance children’s screen time, understand usage patterns and control the child’s mobile device. Try now!

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Over the past several years, the use of steroids in sports has increased. This is due to athletes wanting a competitive advantage over other people. They use steroids as a "one-up" to other athletes to try to be better. This is illegal in just about every sport but people still try to lie about it and still compete. Steroids are bad for people in a lot of ways. Some of these downsides include rapid mood swings, easily bruising skin, slower recovery, and tendon snapping due to the muscle being way more developed than the tendon.

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To excel in athletic competition is admirable. Most high school, college, amateur and professional athletes participate in sports for the opportunity to pit their abilities against those of their peers, and to experience the satisfaction that comes from playing to their potential.

Others do so to satisfy a desire for recognition and fame. Unfortunately, that creates some atheletes who are determined to win at any cost. And, they may use that determination to justify the use of anabolic steroids, despite evidence that these drugs can inflict irreversible physical harm and have significant side effects.

Anabolic steroids, commonly called "roids," juice, hype or pump, are powerful prescription drugs. They are controlled substances that people abuse in high doses to boost their athletic performance. Anabolic steroids are not the same as steroid medications, such as prednisone or hydrocortisone, that are legitimately used to treat asthma and inflammation of the skin or other parts of the body. Anabolic means body building tissue. Anabolic steroids help build muscle tissue and increase body mass by acting like the body's natural male hormone, testosterone. However, steroids cannot improve an athlete's agility or skill. Many factors determine athletic ability, including genetics, body size, age, sex, diet and how hard the athlete trains.

Anabolic steroids are a chemical derivative of testosterone, the "male sex hormone." Properly used, anabolic steroids can aid in the treatment of blood disorders, connective tissue disease, some cancers, intractable arthritis, some sexual dysfunctions and other serious illnesses. But, because of their potentially serious side effects, they must be prescribed and used only under close medical supervision. Under both federal and New York State Law, anabolic steroids may only be prescribed by an authorized prescriber after a face-to-face examination of a patient.

The number of athletes who abuse anabolic steroids is unknown. Many athletic associations ban their use, including the National Football League (NFL), Major League Baseball (MLB), National Collegiate Athletic Association (NCAA) and the Olympics, so few athletes are willing to admit that they use these drugs. The NFL tests its athletes for illicit use. Players who test positive face suspension and, upon testing positive a second time, are expelled from the League. MLB players are tested once a year, and if they test positive they can be suspended for up to ten days. If a player tests positive after the first test, they can be suspended without pay for up to one year. The American Academy of Pediatrics and the American College of Sports Medicine condemn the use of anabolic steroids for enhancement of sports performance or body building.

Why Some Athletes Abuse Anabolic Steroids

Believing that anabolic steroids can improve competitiveness and performance, uninformed or misguided athletes, sometimes encouraged by coaches or parents, abuse these drugs to build lean muscle mass, promote aggressiveness, and increase body weight.

Some athletes frequently take two or more anabolic steroids together, mixing oral and/or injectable types, and sometimes adding other drugs, such as stimulants, painkillers, or growth hormones. This is called "stacking." The athlete believes that different drugs will produce greater strength or muscle size than by using just one drug. What they don't know, or choose to ignore, is the damage to the body that abuse of these drugs can cause.

Supplements

Over the counter dietary supplements, such as creatine, should be used with caution. Manufacturers claim they can build muscles and improve strength without the side effects of steroids. Taken in small doses, nutritional supplements may not be harmful. Before taking any over-the-counter nutritional supplements or adding them to your regimen, talk with your doctor. When taken in large doses and combined with alcohol or aspirin, or when combined with stimulents such as caffeine or ephedrine, nutritional supplements may become dangerous.

Creatine can cause short-term cramping and diarrhea. While less is known about long-term use, creatine has been linked to muscle injury and kidney problems.

Creatine and other dietary supplements are gaining popularity. Manufacturers claim they can build muscles, and improve strength and stamina, without the side effects of steroids. Dietary supplements are not regulated by the Food and Drug Administration (FDA) and are not held to the same strict standards as drugs. If abused, they can have harmful effects. Creatine and certain other dietary supplements are banned by the NFL, NCAA and the Olympics. New York State law bans the sale of dietary supplements containing the stimulent ephedra.

The Dangers of Anabolic Steroid Abuse

When improperly used, anabolic steroids can cause serious health problems such as high blood pressure and heart disease; liver damage and cancers; and, stroke and blood clots. Other side effects of steroids include: nausea and vomiting, increased risk of ligament and tendon injuries, headaches, aching joints, muscle cramps, diarrhea, sleep problems and severe acne.

While the total impact of anabolic steroid abuse is not known, health care providers have observed the following problems:

Blood

Development of cholesterol patterns associated with coronary heart disease, obstructed blood vessels, or stroke

Heart

Increased cholesterol

Increased blood pressure

Liver

Impaired liver function

Peliosis hepatitis (blood-filled cysts that can rupture and cause liver failure)

Tumors

Skeleton

Stunted growth, caused by premature closing of cartilage-like growth plates in adolescents

Increased reate of muscle strains/ruptures

Skin

Appearance of, or increasing acne and other skin rashes or ailments

Male pattern baldness

Edema (water retention/swelling)

Striae (stretch marks)

Immune System

Hep B or Hep C, HIV infection (if needles are shared)

Psychological

Mood swings

Aggressive, even violent behavior

Depression

Psychotic episodes

Addiction

Because anabolic steroids are derived from testosterone, they can have profound effects on the hormone levels of both male and female abusers.

These effects can cause any or all of the following problems in men:

Temporary infertility or sterility (reversible)

Altered sex drive

Prostate enlargement, and increased prostate cancer risk

Irreversible breast enlargement

Painful erections

Shrinkage of the testicles

Reduced levels of testosterone

Abnormal sperm production

Increased levels of estrogen

Health care providers have reported the following problems in women:

Increased risk of cervical and endometrial cancer

Increased risk of osteoporosis

Temporary infertility or sterility (reversible)

Altered sex drive

Birth defects in future children

Changes in fat distribution

Growth of facial and body hair

Deepening of the voice

Shrinkage of the breasts and uterus

Clitoral enlargement

Menstrual irregularity

Changes in the male reproductive system are often reversible, if anabolic steroids have not been abused for a long period of time. Unfortunately, some of the changes in women are NOT reversible.

Prolonged abuse of anabolic steroids very often results in physical addiction. Abusers must undergo a strict, medically-supervised withdrawal program.

HIV/AIDS Risk

Sometimes, athletes who use anabolic steroids may share the needles, syringes or other equipment they use to inject these drugs. By sharing needles, syringes or other equipment, a person becomes a high risk for HIV transmission. HIV is the virus that causes AIDS.

If a person shares needles, syringes and other equipment to inject steroids into the vein (IV), in the muscles or under the skin, small amounts of blood from the person infected with HIV may be injected into the bloodstream of the next person to use the equipment.

HIV attacks the body's defense system, making the body less able to fight off infections and cancers. There's no vaccine or cure for HIV or AIDS. People who may have been exposed to HIV should be tested. If they find out they have the virus, they can start treatment early.

You can't tell just be looking at someone if he or she has HIV. And, since someone can be infected with HIV for many years without having any symptoms, some people may not know they have HIV. Anyone who has ever shared a needle to shoot any drugs -- even once -- could become infected with HIV and should be tested.

For more information about HIV/AIDS and HIV testing, call the New York State Health Department's AIDS hotline:

English 1-800-541-AIDS
Spanish 1-800-233-SIDA
TDD (deaf) 1-800-369-AIDS

To receive free copies of HIV/AIDS brochures and booklets, write to:

New York State Health Department
Box 2000
Albany, New York 12220

Ending the Abuse of Anabolic Steroids

There are many ways to increase your strength and improve your appearance. If you are serious about your sport and health, keep the following tips in mind:

Train safely, without using drugs.

Eat a healthy diet.

Get plenty of rest.

Set realistic goals and be proud of yourself when you reach them.

Seek out training supervision, coaching and advice from a reliable professional.

Avoid injuries by playing safely and using protective gear.

Talk to your health care provider about nutrition, your health, preventing injury and safe ways to gain strength.

The abuse of anabolic steroids by high school, college and other amateur athletes is a dangerous practice. Participants in amateur sports must be made aware of the physical and emotional dangers associated with steroid abuse. The "win at any cost " attitude embraced by some athletes must be redirected and replaced by personal dedication to the sport; a thorough knowledge of the sport's physical demands and requirements; maintenance of a healthy lifestyle; and, an appreciation of the satisfaction that comes from participation.
For more information, go to www.nyhealth.gov
1210 03/08

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Anabolic Steroids and Sports: Winning at any Cost

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To excel in athletic competition is admirable. Most high school, college, amateur and professional athletes participate in sports for the opportunity to pit their abilities against those of their peers, and to experience the satisfaction that comes from playing to their potential. Others do so to satisfy a desire for recognition and fame.

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This site talks about social media and it's drawbacks+benefits

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Columbia University Mailman School of Public Health

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Just How Harmful Is Social Media? Our Experts Weigh-In.

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As social media has proliferated worldwide, so too have concerns over how the platforms are affecting individual and collective wellbeing. Our experts weigh-in.

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Homework has been used for many reasons, but is not always good. Homework can help people retain information and develop good study habits, but it causes heavy stress and highlights inequalities among students

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Schools are getting rid of homework from Essex, Mass., to Los Angeles, Calif. Although the no-homework trend may sound alarming, especially to parents dreaming of their child's acceptance to Harvard, Stanford or Yale, there is mounting evidence that eliminating homework in grade school may actually have great benefits, especially with regard to educational equity.

In fact, while the push to eliminate homework may come as a surprise to many adults, the debate is not new. Parents and educators have been talking about this subject for the last century, so that the educational pendulum continues to swing back and forth between the need for homework and the need to eliminate homework.

The Problem with Homework: It Highlights Inequalities

One of the most pressing talking points around homework is how it disproportionately affects students from less affluent families. The American Psychological Association (APA) explained:

"Kids from wealthier homes are more likely to have resources such as computers, internet connections, dedicated areas to do schoolwork and parents who tend to be more educated and more available to help them with tricky assignments. Kids from disadvantaged homes are more likely to work at afterschool jobs, or to be home without supervision in the evenings while their parents work multiple jobs."
[RELATED] How to Advance Your Career: A Guide for Educators >>
While students growing up in more affluent areas are likely playing sports, participating in other recreational activities after school, or receiving additional tutoring, children in disadvantaged areas are more likely headed to work after school, taking care of siblings while their parents work or dealing with an unstable home life. Adding homework into the mix is one more thing to deal with - and if the student is struggling, the task of completing homework can be too much to consider at the end of an already long school day.

While all students may groan at the mention of homework, it may be more than just a nuisance for poor and disadvantaged children, instead becoming another burden to carry and contend with.

Beyond the logistical issues, homework can negatively impact physical health and stress - and once again this may be a more significant problem among economically disadvantaged youth who typically already have a higher stress level than peers from more financially stable families.

Yet, today, it is not just the disadvantaged who suffer from the stressors that homework inflicts. A 2014 CNN article, "Is Homework Making Your Child Sick?", covered the issue of extreme pressure placed on children of the affluent. The article looked at the results of a study surveying more than 4,300 students from 10 high-performing public and private high schools in upper-middle-class California communities.

"Their findings were troubling: Research showed that excessive homework is associated with high stress levels, physical health problems and lack of balance in children's lives; 56% of the students in the study cited homework as a primary stressor in their lives," according to the CNN story. "That children growing up in poverty are at-risk for a number of ailments is both intuitive and well-supported by research. More difficult to believe is the growing consensus that children on the other end of the spectrum, children raised in affluence, may also be at risk."

When it comes to health and stress it is clear that excessive homework, for children at both ends of the spectrum, can be damaging. Which begs the question, how much homework is too much?

How Much Homework Is Too Much Homework?

The National Education Association and the National Parent Teacher Association recommend that students spend 10 minutes per grade level per night on homework. That means that first graders should spend 10 minutes on homework, second graders 20 minutes and so on. But a study published by The American Journal of Family Therapy found that students are getting much more than that.

While 10 minutes per day doesn't sound like much, that quickly adds up to an hour per night by sixth grade. The National Center for Education Statistics found that high school students get an average of 6.8 hours of homework per week, a figure that is much too high according to the Organization for Economic Cooperation and Development (OECD). It is also to be noted that this figure does not take into consideration the needs of underprivileged student populations.

In a study conducted by the OECD it was found that "after around four hours of homework per week, the additional time invested in homework has a negligible impact on performance." That means that by asking our children to put in an hour or more per day of dedicated homework time, we are not only not helping them, but - according to the aforementioned studies - we are hurting them, both physically and emotionally.

What's more is that homework is, as the name implies, to be completed at home, after a full day of learning that is typically six to seven hours long with breaks and lunch included. However, a study by the APA on how people develop expertise found that elite musicians, scientists and athletes do their most productive work for about only four hours per day. Similarly, companies like Tower Paddle Boards are experimenting with a five-hour workday, under the assumption that people are not able to be truly productive for much longer than that. CEO Stephan Aarstol told CNBC that he believes most Americans only get about two to three hours of work done in an eight-hour day.

When Does Homework Actually Help?

In the scope of world history, homework is a fairly new construct in the U.S. Students of all ages have been receiving work to complete at home for centuries, but it was educational reformer Horace Mann who first brought the concept to America from Prussia.

Since then, homework's popularity has ebbed and flowed in the court of public opinion. In the 1930s, it was considered child labor (as, ironically, it compromised children's ability to do chores at home). Then, in the 1950s, implementing mandatory homework was hailed as a way to ensure America's youth were always one step ahead of Soviet children during the Cold War. Homework was formally mandated as a tool for boosting educational quality in 1986 by the U.S. Department of Education, and has remained in common practice ever since.
Homework improves student achievement. Homework helps reinforce classroom learning. Homework helps students develop good study habits and life skills.
School work assigned and completed outside of school hours is not without its benefits. Numerous studies have shown that regular homework has a hand in improving student performance and connecting students to their learning. When reviewing these studies, take them with a grain of salt; there are strong arguments for both sides, and only you will know which solution is best for your students or school.
Homework allows parents to be involved with their children's learning.
Being responsible for completing at-home assignments helps students practice organization, time management, following directions, critical thinking and independent problem-solving.

Parents can see what their children are learning and working on in school every day.

Parents can participate in their children's learning by guiding them through homework assignments and reinforcing positive study and research habits.

Homework observation and participation can help parents understand their children's academic strengths and weaknesses, and even identify possible learning difficulties.

Negative Effects of Homework for Students
Students with too much homework have elevated stress levels. Students with too much homework may be tempted to cheat. Homework highlights digital inequity.
While some amount of homework may help students connect to their learning and enhance their in-class performance, too much homework can have damaging effects.

Today, homework often requires a computer and/or internet connection, which many students do not have access to outside of school.
Homework does not help younger students.
Students in low-income families are disproportionately affected by a lack of internet access, which further exacerbates the social and economic divide between them and their more affluent peers.

How Teachers Can Help

To help students find the right balance and succeed, teachers and educators must start the homework conversation, both internally at their school and with parents. But in order to successfully advocate on behalf of students, teachers must be well educated on the subject, fully understanding the research and the outcomes that can be achieved by eliminating or reducing the homework burden. There is a plethora of research and writing on the subject for those interested in self-study.
YOU'RE INVITED! Watch Free Webinar on USD's Online M.Ed. Program >>
For teachers looking for a more in-depth approach or for educators with a keen interest in educational equity, formal education may be the best route. If this latter option sounds appealing, there are now many reputable schools offering online master of education degree programs to help educators balance the demands of work and family life while furthering their education in the quest to help others.

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Is Homework Necessary? Education Inequity and Its Impact on Students

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Schools are getting rid of homework from Essex, Mass., to Los Angeles, Calif. Although the no-homework trend may sound alarming, especially to parents dreaming of their child's acceptance to Harvard, Stanford or Yale, there is mounting evidence that eliminating homework in grade school may actually have great benefits, especially with regard to educational equity.

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Injury is damage to your body which is resulted from harm or accidents. They can be minor or life threatening.

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Wounds and Injuries | Effective Health Care (EHC) Program

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An injury is damage to your body. It is a general term that refers to harm caused by accidents, falls, hits, weapons, and more. In the U.S., millions of people injure themselves every year. These injuries range from minor to life-threatening. Injuries can happen at work or play, indoors or outdoors,…

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Eating disorders are a huge problem in today's world. They cause a lot of problems for the human body and are a huge problem for your mental health as well.

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National Institute of Mental Health (NIMH)

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and symptoms

Risk factors

Treatments and therapies

Join a study

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Learn about eating disorders, including types (e.g., anorexia nervosa, bulimia nervosa), signs and symptoms, risk factors, and treatments and therapies.

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Schools should offer more common languages spoken around the world because it can cause a whole shift of learning experiances in the US.

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Recently, Katrina Griffin's students took on a hot-button topic: Should parents control how much video games their children play? They debated the question at great length, making fierce, fact-based arguments, aimed at swaying their peers.

And they did it-in German.

Consider what you've heard about the slow death of foreign languages in schools, and what you may already have heard or read: the number of language students enrolled has been declining for years, as has the number of language teachers.

Now, consider what Griffin heard in her own classroom: "A pretty heated debate! And it was in the target language," she says.

Griffin and other educators are showing how to reverse the decline of U.S. language instruction. They are making language interesting and relevant to students, while also teaching them the critical 21 st-century skills-collaboration, communication, presentation, and yes, proficiency in a second (or third) language-that will make them must-hire and give-them-a-raise employees someday.

The facts are these: Just 22 percent of elementary and secondary students in the U.S. take language classes or programs, according a new report from the American Academy of Arts and Sciences. According to "The State of Languages in the U.S.: A Statistical Portrait," among elementary schools, the percentage teaching language fell from 31 percent in 1997 to 25 percent in 2008, despite evidence that an early start provides an edge in acquiring language proficiency. Among middle schools, the percentage dropped from 75 to 58 percent.

In Connecticut, New Jersey, Pennsylvania, Maryland, Vermont, New Hampshire and Wisconsin, more than 30 percent of K-12 students were enrolled in language. In Kentucky, Arkansas, Oklahoma, Arizona, Colorado, Montana, and Oregon, it was fewer than 13 percent.

This lack of support at the K12 level has led to declining enrollments in college, and declining levels of proficiency among American adults. And yet, the report also found that employers actually want workers who can speak another language.

"While English continues to be the lingua franca for world trade and diplomacy, there is an emerging consensus among leaders in business and politics, teachers, scientists, and community members that proficiency in English is not sufficient to meet the nation's needs in a shrinking world," the report's authors write.

In Massachusetts a study found that online job ads seeking candidates who could speak a language other than English skyrocketed from 5,612 openings in 2010 to 14,561 in 2015. A similar study from New Jersey found that one in five job postings from some of the state's largest employers-Bank of America, H&R Block, etc.-sought bilingual employees.

Meanwhile, the federal government also designates some languages as representing "critical needs" for national security. These currently include Chinese, Russian, Arabic, Korean, and Japanese.
Hallo? Guten Morgen!
Bucking the national trends, at Griffin's school, North County High School in Anne Arundel County., Md., a diverse campus where about 42 percent of students are living below the federal poverty line and 43 percent are non-White, student enrollment in world languages continues to grow. Recently, additional teaching positions in the languages department have had to be added.

While English continues to be the lingua franca for world trade and diplomacy, there is an emerging consensus among leaders in business and politics, teachers, scientists, and community members that proficiency in English is not sufficient to meet the nation's needs in a shrinking world"

Students want to take these classes, and it's no mystery why. Griffin, chair of the language department and the American Council on the Teaching of Foreign Language's 2017 National Language Teacher of the Year, has tossed aside vocabulary memorization worksheets and verb-conjugation quizzes. Instead, with her leadership, language instruction has focused on actually using the language and practicing workplace skills.

Students read, write, and send emails in French, German, and Spanish. They also debate issues, like appropriate video game usage, write persuasive essays, work together on the Internet to research and write school-supply budgets and shopping lists, and discuss in groups meaningful, current questions like: Should new immigrants take on the culture of their new countries, or adhere to their cultural heritages? Their teachers don't have the answers-their students do.

"What's unique to our classroom is that it's the only place where students are taught to communicate. In other classes, students may learn a lot of content, but they may not be learning to look people in the eye, to effectively communicate in spoken and written language," says Griffin.

Her students rely on "authentic sources," not textbooks, but the kinds of things their peers might pick up in Austria or Germany. During assessments, they might have to have a real conversation that interprets and incorporates those sources. It's not like when Griffin started teaching, pre-home Internet, 16 years ago, and she was packing her vacation suitcases full of German magazines.

The students also are staying with languages longer, instead of the typical two to three years. Even though many of North County's students don't go to four-year colleges-many do go to two-year colleges, which don't require language study for admission-they like what they're learning. She and her colleagues teach every student "like they're going to be proficient someday, and we tell them, 'you just don't know how useful this may be to you.'"

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As Need for Foreign Languages in School Grows, Access Continues to Shrink | NEA

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Recently, Katrina Griffin's students took on a hot-button topic: Should parents control how much video games their children play? They debated the question at great length, making fierce, fact-based arguments, aimed at swaying their peers. And they did it-in German.

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This article tells about the effects Hollywood has had on society and the media. It tells us how values and perspectives has been changed from it, and how it effects people's health.

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Does Hollywood have a negative impact on the world?

All the Yes points:

1. Artistic. Hollywood films are poor, lowest-common denominator pulp, relying on special effects and ...

2. Moral. Hollywood films glorify sex and violence, attacking the moral values of all societies and le...

3. Cultural. Hollywood imposes American entertainment and its language on the world, at the expense of...

4. Political. Hollywood promotes a biased and peculiarly American view of the world. Hollywood portra...

5. Economic. The sheer size and financial power of Hollywood's major studios allows them to dominate f...

All the No points:

Artistic. Hollywood films are poor, lowest-common denominator pulp, relying on special effects and ...

Moral. Hollywood films glorify sex and violence, attacking the moral values of all societies and le...

Cultural. Hollywood imposes American entertainment and its language on the world, at the expense of...

Political. Hollywood promotes a biased and peculiarly American view of the world. Hollywood portra...

Economic. The sheer size and financial power of Hollywood's major studios allows them to dominate f...

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Does Hollywood have a negative impact on the world? Artistic. Hollywood films are poor, lowest-common denominator pulp, relying on special effects and ... Moral. Hollywood films glorify sex and violence, attacking the moral values of all societies and le... Cultural. Hollywood imposes American entertainment and its language on the world, at the expense of...

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The actor of spider-man suffered many major injuries from his role.

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NPR's Michele Norris talks with Chris Tierney, the actor and dancer whose 30-foot fall last month during Spider-Man: Turn off the Dark stunned and shocked preview audiences. Tierney's safety harness failed and he broke his skull, some ribs, and cracked three vertebrae. He is the fourth actor to be injured in the multimillion-dollar production.

MICHELE NORRIS, host:

Actor and dancer Christopher Tierney loves to make audiences scream. But last month, his performance on Broadway turned from thrilling to terrifying. Tierney flies onstage as Spider Man in the production "Spider-Man: Turn Off the Dark." On December 20th, something went terribly wrong. He fell 30 feet. Tierney is the fourth performer to be hurt on the $65 million production and his accident has prompted criticism about safety and a lot of finger pointing.

Tierney leaves the rehab hospital today and he's made time to join us to talk about his accident. Welcome to the program.

Mr. CHRISTOPHER TIERNEY (Actor, Dancer): Hello.

NORRIS: Could you describe for us the injuries that you sustained in a 30-foot fall?

Mr. TIERNEY: Yeah. I broke four ribs, three of my vertebras. I fractured my skull. I fractured my right scapula and a radial fracture on my elbow.

NORRIS: What do you remember about the accident? What do you remember about that night?

Mr. TIERNEY: I remember pretty much everything. I do this pretend jump off the bridge, but I'm stopped by the tether. But this night it wasn't tethered to the back of the stage. So when I went for it, I actually did jump off the bridge. I remember while I'm falling in that split second to make a turn fast just so I wouldn't fall on my head. And I fell on my back.

NORRIS: Did the cable snap or were you not properly hooked up?

Mr. TIERNEY: The cable that I'm attached with has 9,000 pounds of tension pressure. So the cable definitely didn't snap. So, I was not tethered to the back of the stage.

NORRIS: What happened there?

Mr. TIERNEY: Human error. They didn't attach me well enough.

NORRIS: Now, we should explain something, Christopher. Another actor actually plays Spider Man, sings the role onstage, but you're the Spider Man who flies through the air.

Mr. TIERNEY: Yeah. I'm the suited Spider Man.

NORRIS: So, you know, in addition to this jump off the Brooklyn Bridge, what other kinds of acrobatics are you performing?

Mr. TIERNEY: I'm flying through the theater at around 40 miles an hour. I have a big fight with the Green Goblin right above the orchestra seats and all throughout the theater. And it's very, very high flying adventure stuff. It's very fun.

NORRIS: You sound wistful when you describe this.

Mr. TIERNEY: Oh, it's so much fun. First of all, it's a dream come true. The four-year-old version of myself's dream come true.

NORRIS: We're talking to Christopher Tierney. He was injured in the Broadway production "Spider-Man: Turn Off the Dark."

Christopher, you've avoided blaming any one person. You've been very gracious about this, avoiding any kind of finger pointing, but you're not, as we said, the first person to be injured. Four performers have been hurt in this production.

Mr. TIERNEY: Yeah.

NORRIS: What's going on here? Why so many injuries?

Mr. TIERNEY: There's been a lot of injuries, but it is a very, very athletic show. It's funny, when you hear about all these injuries that happen, I've worked with dance companies all over the world where people tear their ACLs in performances. My ex-girlfriend had five concussions with a dance company, legs coming out of hip sockets - major, major injuries that happen all the time. But because we are so closely followed and scrutinized with "Spider-Man," you hear about every detail, about everything.

I feel completely safe on the show with the crew. They are watching every angle of everything. We never would've even thought to look at the tether in the back. It was just assumed that it was always there.

NORRIS: The union, the Actors' Equity, has faced criticism, the production has faced criticism, OSHA is actually monitoring the production very carefully. You're saying those criticisms are unwarranted?

Mr. TIERNEY: I mean, no, I mean, I'm all game for them to raise questions and check out the safety precautions in the show. You know, Department of Labor saw every single stunt that we did. We couldn't do a single performance of these stunts until they gave the go ahead. But they gave the go ahead.

NORRIS: The show's in previews and it's scheduled to open officially in early February. It's been delayed. Will you be healed by then?

Mr. TIERNEY: Yes, February.

NORRIS: Do you plan to be a part of the production?

Mr. TIERNEY: I don't think that Ill be healed by then, but I do believe I'll be close.

NORRIS: Christopher, we wish you all the best in your recovery.

Mr. TIERNEY: Thank you, Michele.

NORRIS: That's Christopher Tierney. He performs as the flying Spider Man in the Broadway musical, and he insists he will fly again.

Copyright © 2011 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR's programming is the audio record.

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'Spider-Man' Actor Reflects On His Injury

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NPR's Michele Norris talks with Chris Tierney, the actor and dancer whose 30-foot fall last month during Spider-Man: Turn off the Dark stunned and shocked preview audiences. Tierney's safety harness failed and he broke his skull, some ribs, and cracked three vertebrae. He is the fourth actor to be injured in the multimillion-dollar production.

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Issues with south west airline piolets going on a strike

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Issues with south west airline piolets going on a strike

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This website informs us about what has been going on with the Southwest airline piolets and how they started to go on strike because they believed the new labor agreement "fell short of the “industry-leading contract” they deserved. "

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Southwest Airlines Co. pilots will vote on whether to authorize their union to strike, frustrated by lack of progress in talks that started three years ago and scheduling issues that contributed to 16,700 flight cancellations late last month.

It will be the first time that Southwest aviators have voted on such a move, the Southwest Airlines Pilots Association said in a message to members Wednesday.

The vote, which starts May 1, won't allow pilots to walk off the job. It's one in a series of steps required under a federal law governing airline-labor relations that involves the National Mediation Board and eventually could lead to a strike.

"A contract is needed now more than ever to address our failing operation, mitigate the fatigue that is affecting the safety of our operation and to staunch the bleeding of pilots who are leaving Southwest for better working conditions in ever-increasing numbers," Casey Murray, president of the union, said in the message.

All four of the nation's largest airlines are working to reach new pilot labor agreements after the pandemic stalled negotiations, and the updated contracts are expected to be costly. Talks across the industry have been particularly tense as unions seek increases in compensation and more flexible work schedules, and pilots have frequently picketed outside of airports and sites of company investor meetings.

Southwest said Wednesday that the potential vote won't impact its operations and has no bearing on contract negotiations. The sides are scheduled to resume mediation on Jan. 24.

"We will continue to follow the process outlined in the Railway Labor Act and work, under the assistance of the National Mediation Board, toward reaching an agreement that rewards our pilots and places them competitively in the industry," Southwest said in a statement.

Costs Factored In

The Dallas-based carrier told investors last month that it has accounted for all open labor contracts, including pilots, in cost guidance it provided for 2023.

Leaders of Delta Air Lines Inc.'s pilots union are meeting this week to decide whether to approve a tentative contract and send it out for a membership vote. That agreement would provide at least 34% in cumulative pay raises for aviators over four years. The Air Lines Pilots Association unit at Delta has said it will schedule briefings for members on terms of the accord before any final vote occurs.

Pilot union leaders at American Airlines Group Inc. in November rejected a proposed contract that would have raised pay 19% over two years and United Airlines Holdings Inc. pilots overwhelmingly voted down a new labor agreement, saying it fell short of the "industry-leading contract" they deserved.

Southwest shares fell 2.2% at 11:58 a.m. in New York.

Learn how to navigate and strengthen trust in your business with The Trust Factor, a weekly newsletter examining what leaders need to succeed. Sign up here.

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Southwest Airlines pilots are taking a historic vote on authorizing a strike after the holiday flight meltdown that grounded more than 16,000 planes

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Southwest Airlines Co. pilots will vote on whether to authorize their union to strike, frustrated by lack of progress in talks that started three years ago and scheduling issues that contributed to 16,700 flight cancellations late last month.

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Pollution is a known wide problem and it can occur in several ways. No matter what way pollution is created, It will always be extremely bad for the environment.

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From smog hanging over cities to smoke inside the home, air pollution poses a major threat to health and climate.

Ambient (outdoor) air pollution in both cities and rural areas is causing fine particulate matter which result in strokes, heart diseases, lung cancer, acute and chronic respiratory diseases.

Additionally, around 2.4 billion people are exposed to dangerous levels of household air pollution, while using polluting open fires or simple stoves for cooking fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal.

The combined effects of ambient air pollution and household air pollution is associated with 7 million premature deaths annually.

Sources of air pollution are multiple and context specific. The major outdoor pollution sources include residential energy for cooking and heating, vehicles, power generation, agriculture/waste incineration, and industry. Policies and investments that support sustainable land use, cleaner household energy and transport, energy-efficient housing, power generation, industry, and better municipal waste management can effectively reduce key sources of ambient air pollution.

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Air pollution kills an estimated seven million people worldwide every year. WHO data shows that 9 out of 10 people breathe air containing high levels of pollutants. WHO is working with countries to monitor air pollution and improve air quality.

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Of all the books in the 21st century, one of the most banned books.

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Toledo Lucas County Public Library - TLCPL

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The Wizarding World of Harry PotterIf you asked most people in 1997 if they thought this new, magic-themed children's novel just published in the UK would become an entire universe, complete with eight movies, a London studio tour experience, a massive amusement park, and more, they probably would have said no. In fact, when Harry Potter and the Sorcerer's Stone was first published, many parents and teachers did not want this book in their schools, homes, or libraries. At. All. The book promoted "witchcraft, the occult, and anti-family themes" just to name a few. It was successfully banned from thousands of places. How could this so familiar, childhood staple, much loved book series, go from ban after ban to world-renowned family favorite?

The first Harry Potter book was published in the United States in 1998 and was immediately challenged. Challenging a book means that someone raised the idea that the book should not be readily available for the public audience. After a challenge is voiced at a school, library or bookstore, that entity may choose to ban the book or dismiss the challenge.

Even though it was published at the end of the decade, Harry Potter and the Sorcerer's Stone made the list of top 100 challenged books of the decade (1990-1999), ranking at number 48. Of course, the series continued to be challenged into the new millennium where it topped the most frequently challenged list for 2000-2009. Reasons for challenging the book included: glorifying witchcraft, promoting the occult, tones of death, hate, lack of respect and sheer evil, leading children to hatred and rebellion, confusing children, and leading them astray. Some were also concerned about the increasing dark tone in the later books but overall, most of the challengers' reasons based on religious beliefs. Luckily for us fans, libraries and intellectual freedom fighters fought censorship attempts and eventually overcame them. According to the American Library Association, Harry Potter books are now the most challenged books of the entire 21 st century. The books continue to be challenged and banned across the United States, the most recent occurrence in a Nashville Catholic school in 2019. Take a look at Harry Potter and the Bible: The Menace Behind the Magick for more in-depth reasoning about censoring this series.

Since its initial publication, the Harry Potter series has been translated into over 79 different languages, the most recent translation being into Scots in 2017. TLCPL has most of the series in French, Spanish, and German. If you want a different language, just ask your local librarian - they can probably get it for you.

Over 500 million copies of the Harry Potter books have sold worldwide, with more than 180 million in the United States. This makes Harry Potter the bestselling book series of all time.

Today, the Harry Potter universe can be found in almost all aspects of life and entertainment. Besides Rowling's seven-novel series, there are screenplays, guides, and spin-off books. Authors have gone wild writing about Harry Potter's world in many facets. There are cookbooks, knitting books, craft books, guides, quiz books, indexes, and much more published all regarding the Harry Potter universe. Video game companies have created action, adventure, and puzzle video games for all ages. LEGO has a whole line of Harry Potter universe buildable toys. Companies have created collectible (and edible) merchandise, toys, clothes, costumes, candies, foods and more.

One of the biggest, most stand out creations of this universe is the Wizarding World of Harry Potter at Universal Orlando Resort (Florida). At this massive theme park, you can shop for your wand at Ollivanders', enjoy butterbeer with your lunch at the Leaky Cauldron, ride the Hogwarts Express, see a fire breathing dragon on top of Gringotts Bank, buy a prank at Weasley Wizard Wheezes, and much, much more. It brings Diagon Ally, Knockturn Ally, and Harry's world to life.

Discover the magic of filmmaking at the Warner Brother's Studio Tour: The Making of Harry Potter (London, UK). Props, costumes, and entire scenes fill your eyes as you walk through the studio where the magic happened. The Great Hall is ready for a feast, see the robotic Dobby the Elf, a Miniature of Hogwarts Castle that magically lights, and of course, enjoy some butterbeer as you sit outside Number 4 Privet Lane, the night bus, and the flying car.

Wizarding World (previous known as: Pottermore), is the website where all things Harry Potter (& Fantastic Beasts) reside. JK Rowling herself communicates with fans via this website, answering questions, sharing unpublished writing, and offering up news and events. The site is also famous for its Sorting Hat Quiz which will leave no doubt as to which Hogwarts House you belong (I'm a Ravenclaw, if you were curious).

As we consider book censorship and celebrate our freedom to read, why not read or re-read the most challenged and best-selling series of all time?

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Banned Books Week 2021: Harry Potter: The Most Challenged Book of the 21st Century

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The Wizarding World of Harry PotterIf you asked most people in 1997 if they thought this new, magic-themed children's novel just published in the UK would become an entire universe, complete with eight movies, a London studio tour experience, a massive amusement park, and more, they probably would have said no.

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MLB Attendance Figures Continue to Trend Downward

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MLB Attendance Figures Continue to Trend Downward

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Since the year 2019 (Pre-Pandemic), the MLB has been faced a decline of attendance. If the trend continues to grow, this would make it the 8th year in a row with a decline of fans in the seats.

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The All-Star Break is typically a time for MLB teams to take stock of their situations, and the league is doing the same, starting with one glaring issue: declining attendance.

The league averaged 26,409 tickets sold per game in the first half of the season, down 5% compared to the same period in 2019.

Should the trend hold, this year would be the eighth in a row in which MLB attendance dropped, not counting 2020 and 2021, in which attendance was severely limited due to pandemic-related restrictions.

A 5% decline in attendance would be the largest since the 6.9% dip in 2009.

Compared to last season, when many teams restricted ticket sales, attendance is up 113%.

Manfred Speaks

No team's attendance has tumbled more since 2019 than that of the Oakland A's, who drew an average of 20,521 that year and have so far averaged an MLB-low 8,637 this season.

"The condition of the Coliseum is a really serious problem for us," Manfred said Tuesday, referring to the A's RingCentral Coliseum. "It is not a major league-quality facility at this point."

He noted that A's owner John Fisher must either make a deal with the city of Oakland on a new $12 billion ballpark and surrounding development - or relocate.

Manfred also said that he believes the Tampa Bay Rays may be best suited for Tampa, as opposed to their current home in neighboring St. Petersburg, but there are a number of factors at play.

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MLB Attendance Figures Continue to Trend Downward

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The All-Star Break is typically a time for MLB teams to take stock of their situations, and the league is doing the same, starting with one glaring issue: declining attendance. The league averaged 26,409 tickets sold per game in the first half of the season, down 5% compared to the same period in 2019.

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All over the world there has been many new advancements of theater.

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Theatre: Theatre, in architecture, a building or space in which a performance may be given before an audience. The word is from the Greek theatron, "a place of seeing." A theatre usually has a stage area where the performance itself takes place.

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This website talks about a lot of the risks that come with traveling like theft, heath risks, border controls, and visa issues.

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Traveling is riskier than staying at home and watching TV (for the short term only). Yet, traveling will give you unparalleled moments of joy and the risks can be managed with some preparation and the right mindset. We will now go over the major risks you can encounter while traveling and some of the ways you can mitigate those risks.
Theft and Losing your belongings
Travelling involves carrying all your belongings with you while moving from one place to another, or staying in random accommodation options. This greatly increases the chances of theft and losing your belongings. The best advice to mitigate risk is to be minimalist, and take only what you need with you. Every valuable you carry that is not needed brings pressure and attachment - you'll always be thinking of how to secure it instead of just going to the beach and taking a swim. Not to mention that travelling light is also fun. Granted, digital nomads need some valuables they can't do without (laptop, camera, passport, etc.) and safeguarding those things is necessary. Find the right balance between not being paranoid and not being careless and over-trusting.This balance also depends on where you are since the level of risk changes in each country. Try gaining information on the level of risk and most common theft/scam methods where you are, prepare yourself accordingly.

Violent crime. This is more severe and rarer than theft, and happens more in developing countries (developed countries are more prone to petty theft). The best advice if you are unlucky enough to be in a situation of violent crime is to understand that your life is worth a lot more than what you carry with you, so don't resist unless it's your only way out. Reduce risk by avoiding problematic locations (gain info beforehand on where is safe). Also, don't look clueless - signal that know where you're going, tourists (especially drunk ones) are considered easy and lucrative targets. It is also important not to flaunt your valuables, and use them only when necessary in safe locations. The most important advice here would be to trust your intuition. If a place doesn't feel good, spend money on taxi or new environment and get out. As the saying goes, "if you're looking for trouble, trouble will find you".

Health risk. Usually we're only aware of our health when it deteriorates, and health issues away from home are more challenging since you are alone out of your comfort zone. Firstly, before traveling (especially if you're going to developing countries) visit your doctor, ask about your destination's specific health risks and get some emergency medicine for common scenarios. Developing countries often lack quality medications or circulate counterfeited medicine you don't want to use. Also, getting travel insurance (We recommend WorldNomads for as a reliable global company for this service) will cover your treatment financially until you get to your country. It's inexpensive and worth the trouble, but be sure to read the small print to see that it covers most scenarios. When problems start, and if your health deteriorates, get some info about the best hospitals and clinics where you are. Some hospitals countries can be of poor quality, so if you are covered with travel insurance, it's always worth choosing the best place.

Transportation. Using transportation exposes us to the risk of accidents, especially in developing countries. If you're in a place with heightened risk (Peru, for an example, is known to have many deadly bus accidents), I recommend spending a bit more on a good bus company or airline. When the ride is long and risky, I try to sit in the middle of the bus on an aisle seat in the right side since those seats are proven to be the safest in case of an accident. Additionally, using motorcycles is a notorious risk; try to avoid them in places that have a lot of traffic.

Border controls and visa issues. First,an aside about problematic possessions and drugs. If you ever have them, don't carry them while crossing a border. But even if you stay clear of problems, some border control can prove to be quite frustrating (I have had two incidents in Hungary and Bolivia that ended with deportation and long delay). If incidents happen, keep cool and don't lose your temper since this will only make things worse. It is important to check the visa laws applicable to your country before traveling, so invest time in research to avoid problems. Keep your passport safe and in good shape since neglected passport screams fake and a lost passport is truly a hassle that you want to avoid.

Problems at home. There can be problems with family's health, bureaucracy and so on that are difficult to deal with when you are far away. Mitigate those risks by creating open channels of communication with home to make sure that if something happens, you'll get the news as soon as possible. It is also recommended to jump back to your homebase every now and then to sort your stuff out, before moving to the next destination.

Losing your sanity. There are cases of people traveling for a long time that get disconnected from themselves and society. This usually happens when you change places not for the right reasons, killing time instead of exploring new places, or running away from something (or from yourself, which doesn't really work). Older travelers are more prone to this since they find it harder to meet and connect with other travelers and locals. My advice would be, don't disconnect. Investing time in meeting and interacting with people in addition to having clear goals to accomplish while travelling keeps you happy and sane.

Now, hit the road!

An audio version of this post is available below:

/nomad/wp-content/uploads/risks-of-traveling.mp3

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Traveling is riskier than staying at home and watching TV (for the short term only). Yet, traveling will give you unparalleled moments of joy and the risks can be managed with some preparation and the right mindset. We will now go over the major risks you can encounter while traveling and some of the ways you can mitigate those risks.

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This site talks about the life for animals in labs and about all the different parts of animal testing. It talks about how you can help animals in labs and about what happens to the animal after the testing.

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Animals are used in many different kinds of experiments. These are just a few examples and alternatives to using animals in experiments.

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Music can positively affect your mind, mood, and body. Music can help you experience desired emotions and motivate you. It can also help you relieve stress, retain information and develop higher pain tolerance.

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Do you find yourself tapping your foot while shopping? Or having all the feels while watching movies? No matter your race, ethnicity, age or gender, music is a common phenomenon that impacts everyone. Music can be a powerful tool with its ability to evoke strong emotional responses.

For example, music may lead to the release of dopamine, a feel-good neurotransmitter. Music is present in everyday life for most people. Here, we answer questions about how music can affect your brain and body.

Does Music Alter Moods and Relieve Stress?

The short answer is, yes! The Iso-principle is a tool that matches a music listening experience to a current mood or emotion and then gradually shifts to music that represents a desired mood or emotion. If you want to listen to a song that you pair with anger or sadness, go ahead, but don't let it repeat too many times. Move on to music of the mood you desire. A music playlist that gradually moves from uncomfortable emotions to comfortable ones can be a healthy coping strategy and facilitate a positive mood change.

What Emotions Can Music Make You Feel?

Music can validate your current emotional state and influence your emotional destination. Again, the Iso-principle can help us experience desired emotions. It works most effectively when we first find a song that matches our current feeling or mood. In music therapy, emotional regulation is frequently addressed. Music can elicit many, if not every, emotion. Knowing yourself and which music you pair with your emotions will improve self-regulation, or "feeling your feelings."

While culture, memories and associations influence music and emotions, Berkley found an overlap across cultures and compiled an interactive music map based on people's responses with 13 emotional dimensions that people in China and the United States self-reported. You can check Berkley's Interactive Music Map to find out what music makes you feel.

What Impact Does Music Have on Memory?

Music can help retain essential information despite memory loss. Music memory is stored in the hippocampus, centrally located in the brain. Therefore, music memories are less likely to be negatively impacted by age or disease.

A musical mnemonic device is a natural way to memorize and recall information. As children, we learn various academic and social concepts through songs. Similarly, these memory strategies are highly effective for adults. In fact, our brains automatically " fill in the gaps " when a song suddenly stops.

Music therapists often incorporate these techniques with individuals to improve memory retention or developmental learning goals. Music may activate memories and remind us of places, events or people. A familiar tune may elicit the emotions associated with those memories.

What Changes Does Music Have on Your Body?

Singing, playing instruments and even dancing can improve pain tolerance. Researchers found that the physical movement used to create music provides a synchronized activity that significantly heightens the pain threshold. Music therapists are specifically trained clinicians that use music to address goals such as pain reduction.

Because music is often an enjoyable activity, it can activate the release of endorphins, which creates a general feeling of well-being. Music therapy can successfully reduce post-operative pain, physical tension and influence heart and breathing rates. Fast music tends to increase pulse rate and blood pressure. Slow music tends to decrease pulse rate and blood pressure, as well as breathing rate.

How Does Music Affect Behavior?

Music can affect behavior by being a motivator, a timer for completing tasks or a mood enhancer. It may also impact our shopping habits.

Music is used in advertising to encourage brand recognition and create familiarity and positive association with various products.

Younger shoppers spend more time shopping when stores play instrumental music. Older shoppers spend more time shopping when there's music playing with lyrics. Baby boomers are likely to spend more money if classic rock is playing in a store. Generations older than baby boomers are less likely to spend money if any music is playing.

If you are buying wine for the holidays, be aware that classical music may make you feel comfortable spending a little more money than those top 40 hits.

Why Do We Enjoy Holiday Music?

Holiday music is a vehicle that communicates sacred and secular stories of the season. People may enjoy holiday music because pivotal cultural and traditional events are often intertwined. Music fosters community, remembrance and celebrations.

While many people have fond memories and traditions with holiday music, it is important to be mindful. Some people have equally painful memories associated with holiday music or songs.

Music Therapy

Music Therapists are trained clinical professionals that use music to accomplish physical, emotional, cognitive and social goals. There are music therapists at Tallahassee Memorial Healthcare in a variety of clinical settings and through classes. You can also search the Certification Board for Music Therapists' website to find a music therapist in your area.

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How Music Affects Your Mind, Mood and Body

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Do you find yourself tapping your foot while shopping? Or having all the feels while watching movies? No matter your race, ethnicity, age or gender, music is a common phenomenon that impacts everyone. Music can be a powerful tool with its ability to evoke strong emotional responses.

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Stress is normal and happens when the body goes through changes. The body's nervous system controls heart rate, breathing, vision and more, and this is what controls stress.

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What is stress?

Stress is a normal human reaction that happens to everyone. In fact, the human body is designed to experience stress and react to it. When you experience changes or challenges (stressors), your body produces physical and mental responses. That's stress.

Stress responses help your body adjust to new situations. Stress can be positive, keeping us alert, motivated and ready to avoid danger. For example, if you have an important test coming up, a stress response might help your body work harder and stay awake longer. But stress becomes a problem when stressors continue without relief or periods of relaxation.

What happens to the body during stress?

The body's autonomic nervous system controls your heart rate, breathing, vision changes and more. Its built-in stress response, the "fight-or-flight response," helps the body face stressful situations.

When a person has long-term (chronic) stress, continued activation of the stress response causes wear and tear on the body. Physical, emotional and behavioral symptoms develop.

Physical symptoms of stress include:

Aches and pains.

Chest pain or a feeling like your heart is racing.

Exhaustion or trouble sleeping.

Headaches, dizziness or shaking.

High blood pressure.

Muscle tension or jaw clenching.

Stomach or digestive problems.

Trouble having sex.

Weak immune system.

Stress can lead to emotional and mental symptoms like:

Often, people with chronic stress try to manage it with unhealthy behaviors, including:

Drinking alcohol too much or too often.

Gambling.

Overeating or developing an eating disorder.

Participating compulsively in sex, shopping or internet browsing.

Smoking.

Using drugs.

How is stress diagnosed?

Stress is subjective - not measurable with tests. Only the person experiencing it can determine whether it's present and how severe it feels. A healthcare provider may use questionnaires to understand your stress and how it affects your life.

If you have chronic stress, your healthcare provider can evaluate symptoms that result from stress. For example, high blood pressure can be diagnosed and treated.

What are some strategies for stress relief?

You can't avoid stress, but you can stop it from becoming overwhelming by practicing some daily strategies:

Exercise when you feel symptoms of stress coming on. Even a short walk can boost your mood.

At the end of each day, take a moment to think about what you've accomplished - not what you didn't get done.

Set goals for your day, week and month. Narrowing your view will help you feel more in control of the moment and long-term tasks.

Consider talking to a therapist or your healthcare provider about your worries.

What are some ways to prevent stress?

Many daily strategies can help you keep stress at bay:

Try relaxation activities, such as meditation, yoga, tai chi, breathing exercises and muscle relaxation. Programs are available online, in smartphone apps, and at many gyms and community centers.

Take good care of your body each day. Eating right, exercising and getting enough sleep help your body handle stress much better.

Stay positive and practice gratitude, acknowledging the good parts of your day or life.

Accept that you can't control everything. Find ways to let go of worry about situations you cannot change.

Learn to say "no" to additional responsibilities when you are too busy or stressed.

Stay connected with people who keep you calm, make you happy, provide emotional support and help you with practical things. A friend, family member or neighbor can become a good listener or share responsibilities so that stress doesn't become overwhelming.

How long does stress last?

Stress can be a short-term issue or a long-term problem, depending on what changes in your life. Regularly using stress management techniques can help you avoid most physical, emotional and behavioral symptoms of stress.

When should I talk to a doctor about stress?

You should seek medical attention if you feel overwhelmed, if you are using drugs or alcohol to cope, or if you have thoughts about hurting yourself. Your primary care provider can help by offering advice, prescribing medicine or referring you to a therapist.
A note from Cleveland Clinic
It's natural and normal to be stressed sometimes. But long-term stress can cause physical symptoms, emotional symptoms and unhealthy behaviors. Try relieving and managing stress using a few simple strategies. But if you feel overwhelmed, talk to your doctor.

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Stress: Signs, Symptoms, Management & Prevention

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Stress is your body's reaction to changes. When you don't handle stress well, you can damage your body and your mind.

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Tatooist of Auschwitz is a bad book and not very pg and we were forced to read the whole thing and we were not very happy.

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The Tattooist of Auschwitz #1 Free Download Free Download

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This website tells us about the pros and cons of social media. While it does have its benefits social media can have a lot of risks on your mental health

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Social Media and Mental Health: Social Media Addiction

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Excessive use of social media can fuel anxiety, depression, and other mental health issues. Here’s how to change your habits and improve your mood.

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Short summary of the article.

Attach the link to a relatively reliable article providing more information about your topic.

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There are a lot of different injuries that can occur. Some require medical attention and others don't but it is important to always check them all to make sure you're ok.

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Wounds and Injuries | Effective Health Care (EHC) Program

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An injury is damage to your body. It is a general term that refers to harm caused by accidents, falls, hits, weapons, and more. In the U.S., millions of people injure themselves every year. These injuries range from minor to life-threatening. Injuries can happen at work or play, indoors or outdoors, driving a car, or walking across the street.

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This article tells about the parasocial relationships with celebrities and fans. It goes into the mental health of both sides and the studies shown.

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How does a celebrity make fans happy? Interaction between celebrities and fans in the social media context

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This research investigates how structural and situational factors related to a celebrity's activities on social media influence fans' self-congruity, ...

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Political inequality includes different levels of participation in democratic, electoral politics by social class, race, gender and more.

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by Joshua K. Dubrow, Institute of Philosophy and Sociology, Polish Academy of Sciences
We Know a lot about Economic Inequality

When the Occupy Wall Street movement reached its heyday in the Autumn of 2011, spreading to cities all over the world, the protesters' rallying cry was, "We are the 99 percent." They hoped for political change, among other things, but "99" was mainly understood as a statement about economic inequality.

If you want to know how much economic inequality there is in your country, and whether this inequality been rising, falling, or staying the same, you can turn to the terabytes worth of publicly available economic data and grind them through the many inequality equations to derive a multitude of statistics. With decades of innovations in the study of economics and inequality, led by the disciplines of sociology and economics, we can, at least, have a debate over economic inequality and its dynamics over time.
We Need More Eyes on the Problem
Political inequality is a distinct form of inequality but has yet to attract sustained, systematic scholarly attention in the same way as its sibling inequalities. Although political equality is a foundation of modern democracy, we do not know how far from equality we are. Even the news media rarely addresses political inequality. We need more eyes on the problem.
Popular Definitions
The work of social scientists, philosophers and other scholars offer many definitions of political inequality. Political inequality's conceptual roots are temporally deep and spread-out in many disciplines. Read together, they point to the idea that political inequality is at once a dimension of democracy and a dimension of stratification.

Built on the classics, modern definitions of political inequality depend on whether one is concerned about equality of opportunities or equality of outcomes. In short, equality of opportunities is about access to the political decision. Equality of outcomes refers to the law, symbols, policy or other output that is the result of the political process. Most definitions are based on the idea of equality of opportunities, but they could be modified to include outcomes, too.

Let's look at some popular definitions from my book on political inequality:

Political inequality is structured differences in the distribution of political resources. According to this definition, one group has greater or lesser access to, or acquisition of, political resources than another group

Political equality is when everybody's preferences are equally weighted in political decisions. The definition of "everybody" matters, of course: Everybody could mean all citizens, or it could mean all who are potentially impacted by the decision.

Political inequality is the existence of authority divisions. Here, we speak of political inequality when groups have unequal political input into the decisions that affect them. The more layers of authority between the citizen and the decision, the greater the political inequality.

We can usefully combine these approaches with a definition that both simple and flexible: Political inequality is unequal influence over decisions made by political bodies and the unequal outcomes of those decisions.
How Much Political Inequality Is There?
Short answer: nobody knows.

Why? Because there are no cross-national comprehensive measures of it. Nobody's ever done it. And that's because we need to ask, "for whom" and "of what." Who is unequal? And are they unequal in terms of voice or government response? Those questions are hard to quantify.
Political Inequality Is the Shadow of Democracy
Democratic institutions set the rules of the political process and guarantee formal rights of political participation to a wide variety of citizens, but not to all of them. Many discussions of political inequality are debates about whether and how equality in democratic governance can be achieved. The coexistence of democracy with political inequality leads to the question of how realistic the idea is that all interested participants can enjoy equal influence on the governance decision or in its outcomes. A common thought is that we should seriously consider acceptable limits in who should be unequal and how to manage this inequality while still raising high the banner of democracy. This leads to a conclusion that political inequality is the shadow of democracy.

A recent article on inequality and policy outcomes by Gilens and Page (2014) highlights the promise and the difficulties in measuring political inequality. Their unique data consists of 1779 policies taken up by the U.S. Congress from the 1980s to the early 2000s. Each policy is matched to a public opinion survey research question asked during the time the policy was introduced ("this policy says X, to what extent do you agree with it?") and to a set of interest groups who have taken a position on the policy. With these data, they gauged the extent to which the policy outcome reflects (a) the will of the median voter - identified within the surveys and (b) types of interest groups, such as economic elites, business interests, and mass public interest groups. They found that policy outcomes tend to favor the will of economic elites, not the median voter.

Their study provides solid, further evidence of the paucity of pluralism in American democracy, but their measure of political inequality has shortcomings. First, they chose policies based on whether they were asked in public opinion surveys, and that means the many, not-so-famous policy debates that also shape key economic distribution policies were excluded. Nor can it account for the policies that are off the Congressional agenda, the type of power that Bacharach and Baratz (1967) warned that is most pernicious: the power to compel voters to not even ask for the policy in the first place. It is also specific to the American experience; though it can be replicated elsewhere, so far there is no cross-national equivalent to these data. Gilens and Page (2014) conducted what is likely one of the most unique studies on American political inequality, and it's just a start.
What Now?
Political inequality is an important topic for our times. We must be aware that the objective and subjective realities of political inequality rouses people to action. That political inequality lives in democracies across the world is a troubling fact of life, and if we want to move closer to political equality, we can do better to understand it.

First, let's study it more. While doing that, let's see if we can measure it comprehensively across nations. And then, let's see what can be done about it.

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What Is Political Inequality and How Unequal Are We?

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by Joshua K. Dubrow, Institute of Philosophy and Sociology, Polish Academy of Sciences We Know a lot about Economic Inequality When the Occupy Wall Street movement reached its heyday in the Autumn of 2011, spreading to cities all over the world, the protesters' rallying cry was, "We are the 99 percent."

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Suicide rates have increased by about 36% in the past 22 years. Suicide was responsible for 48,000 in 2021 and 1.7 million people attempted it. The CDC has created suicide prevention resources for anyone who needs help.

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Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions. ¹

Many factors can increase the risk for suicide or protect against it. Suicide is connected to other forms of injury and violence. For example, people who have experienced violence, including child abuse, bullying, or sexual violence have a higher suicide risk. Being connected to family and community support and having easy access to healthcare can decrease suicidal thoughts and behaviors. ²

Suicide rates increased approximately 36% between 2000-2021. Suicide was responsible for 48,183 deaths in 2021, which is about one death every 11 minutes. ³ The number of people who think about or attempt suicide is even higher. In 2021, an estimated 12.3 million American adults seriously thought about suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicide. ⁴

Suicide affects people of all ages. In 2021, suicide was among the top 9 leading causes of death for people ages 10-64. Suicide was the second leading cause of death for people ages 10-14 and 20-34. ³

Some groups have higher suicide rates than others. Suicide rates vary by race/ethnicity, age, and other factors, such as where someone lives. By race/ethnicity, the groups with the highest rates are non-Hispanic American Indian/Alaska Native people followed by non-Hispanic White people. ³ Other Americans with higher-than-average rates of suicide are veterans, people who live in rural areas, and workers in certain industries and occupations like mining and construction. 5,6 Young people who identify as lesbian, gay, or bisexual have higher prevalence of suicidal thoughts and behavior compared to their peers who identify as heterosexual. 7 Read more about these suicide disparities and why they exist on this page.

Suicide and suicide attempts cause serious emotional, physical, and economic impacts. People who attempt suicide and survive may experience serious injuries that can have long-term effects on their health. They may also experience depression and other mental health concerns. ⁸

Suicide and suicide attempts affect the health and well-being of friends, loved ones, co-workers, and the community. When people die by suicide, their surviving family and friends may experience prolonged grief, shock, anger, guilt, symptoms of depression or anxiety, and even thoughts of suicide themselves. 8,9

The financial toll of suicide on society is also costly. In 2020, suicide and nonfatal self-harm cost the nation over $500 billion in medical costs, work loss costs, value of statistical life, and quality of life costs.

Suicidal behavior also has far-reaching impact:
There were 46,412 suicides among adults in 2021. But suicides are just the tip of the iceberg. For every suicide death*, there were about:

3 hospitalizations for self-harm**

8 emergency department visits related to suicide***

38 self-reported suicide attempts in the past year****

265 people who seriously considered suicide in the past year****

*Based on the latest year of available data for adults ages 18 and older.

**Source: HCUP National Inpatient Sample (2020)

***Source: CDC WISQARS (2020)

****Source: SAMHSA National Survey on Drug Use and Health (2021)

Suicide is preventable and everyone has a role to play to save lives and create healthy and strong individuals, families, and communities. Suicide prevention requires a comprehensive public health approach. CDC developed the Suicide Prevention Resource for Action (Prevention Resource), which provides information on the best available evidence for suicide prevention. States and communities can use the Prevention Resource to help make decisions about suicide prevention activities. Strategies range from those designed to support people at increased risk to a focus on the whole population, regardless of risk.

Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.

Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365.

Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org .

1. Crosby A, Ortega L, Melanson C. Self-directed violence surveillance: Uniform definitions and recommended data elements, version 1.0 [PDF - 1 MB] . (2011) Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

2. CDC. Preventing multiple forms of violence: A strategic vision for connecting the dots [PDF - 775 KB] . (2016) Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

3. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Jan 11, 2023

4. Substance Abuse and Mental Health Services Administration (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report

5. Centers for Disease Control and Prevention. (2022). Suicide Prevention Resource for Action: A Compilation of the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

6. Peterson C, Sussell A, Li J, Schumacher P, Yeoman K, Stone D. (2020) Suicide Rates by Industry and Occupation - National Violent Death Reporting System, 32 States, 2016. MMWR Morb Mortal Wkly Rep; 69: 57-62. DOI: http://dx.doi.org/10.15585/mmwr.mm6903a1.

7. Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Survey Data Summary and Trends Report: 2011-2021. Available at https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf.

8. Hamdan, S., Berkman, N., Lavi, N., Levy, S., Brent, D. (2020). The effect of sudden death bereavement on the risk for suicide. Crisis; 41(3):214-224. DOI: https://doi.org/10.1027/0227-5910/a000635.

9. Wagner, B., Hofmann, L., Grafiadeli, R. (2021). The relationship between guilt, depression, prolonged grief, and posttraumatic stress symptoms after suicide bereavement. J Clin Psychol; 77:2545-2558. DOI: https://doi.org/10.1002/jclp.23192.

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suicide is a leading cause of death in the u.s.

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Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions. 1 Many factors can increase the risk for suicide or protect against it.

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Vocal Chord Paralysis is usually caused by something happening to the RLN, making it hard to speak, cough, and/or breathe.

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What Is Vocal Cord (Fold) Paresis and Paralysis?

Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse, resulting in no movement; paresis is the partial interruption of nerve impulse, resulting in weak or abnormal motion of laryngeal muscles. Paresis/paralysis can happen at any age, from birth to advanced age, in males and females, from a variety of causes. The effect on patients may vary greatly, depending on the patient's use of his or her voice: A mild vocal fold paresis can be the end to a singer's career, but have only a marginal effect on a computer programmer. If you notice any change in your voice quality, immediately contact an otolaryngologist-head and neck surgeon.

What Nerves in the Vocal Cord are Involved?

Vocal fold movements are a result of the coordinated contraction of various muscles that are controlled by the brain through a specific set of nerves.

The superior laryngeal nerve (SLN) carries signals to the cricothyroid muscle. Since this muscle adjusts the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in abnormalities in voice pitch and the inability to sing with smooth change to each higher note. Sometimes patients with SLN paresis/paralysis may have a normal speaking voice but an abnormal singing voice.

The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing the folds for vibration during voice use, and closing them during swallowing. The RLN goes into the chest cavity and curves back into the neck until it reaches the larynx. Because the nerve is relatively long and takes a "detour" to the voice box, it is at greater risk for injury from different causes infections and tumors of the brain, neck, chest, or voice box. It can also be damaged by complications during surgery in the head, neck, or chest, that directly injure, stretch, or compress the nerve. Consequently, the RLN is involved in the majority of cases of vocal fold paresis/paralysis.

What Are the Causes?

The cause of vocal fold paralysis or paresis can indicate whether the disorder will resolve over time or whether it may be permanent. When a reversible cause is present, surgical treatment is not usually recommended, given the likelihood of spontaneous resolution of the problem. Despite advances in diagnostic technology, physicians are unable to detect the cause in about half of all vocal fold paralyses, referred to as idiopathic (due to unknown origins). In these cases, paralysis or paresis might be due to a viral infection affecting the voice box nerves (RLN or SLN), or the vagus nerve, but this cannot be proven in most cases. Known reasons can include:

Inadvertent injury during surgery: Surgery in the neck (thyroid gland, carotid artery) or in the chest (lungs, esophagus, heart, or large blood vessels) may inadvertently result in RLN paresis or paralysis. The SLN may also be injured during head and neck surgery.

Complication from endotracheal intubation: Injury to the RLN may occur when breathing tubes are used for general anesthesia or assisted breathing. However, this type of injury is rare, given the large number of operations done under general anesthesia.

Blunt neck or chest trauma: Any type of penetrating, hard impact on the neck or chest region may injure the RLN; impact to the neck may injure the SLN.

Tumors of the skull base, neck, and chest: Tumors (both cancerous and non-cancerous) can grow around nerves and squeeze them, resulting in varying degrees of paresis or paralysis.

Viral infections: Inflammation from infections may directly involve and injure the vagus nerve or its nerve branches to the voice box (RLN and SLN). Systemic illnesses affecting nerves in the body may also affect the nerves to the voice box.

What Are the Symptoms?

Both paresis and paralysis of voice box muscles result in voice changes and may also result in airway problems and swallowing difficulties.

Voice changes: Hoarseness; breathy voice; extra effort on speaking; excessive air pressure required to produce usual conversational voice; and diplophonia (voice sounds like a gargle).

Airway problems: Shortness of breath with exertion, noisy breathing, and ineffective cough.

Swallowing problems: Choking or coughing when swallowing food, drink, or even saliva, and food sticking in throat.

How Is Vocal Fold Paralysis/Paresis Diagnosed?

An otolaryngologist-head and neck surgeon conducts a general examination and then questions you about your symptoms and lifestyle (voice use, alcohol/tobacco use). Examining the voice box will determine whether one or both vocal folds are abnormal, and will help determine the treatment plan.

Laryngeal electromyography (LEMG) measures electrical currents in the voice box muscles that are the result of nerve inputs. Looking at the pattern of the electric currents will indicate whether there is recovery or repair of nerve inputs and the degree of the nerve input problem. During the LEMG test, patients perform a number of tasks that would normally elicit characteristic actions in the tested muscles. Because a wide list of diseases may cause nerve injury, further tests (blood tests, x-rays, CT scans, etc.) are usually required to identify the cause.

What Is the Treatment?

The two treatment strategies to improve vocal function are voice therapy (like physical therapy for large muscle paralysis), and phonosurgery, an operation that repositions and/or reshapes the vocal folds to improve voice function. Voice therapy is normally the first treatment option. After voice therapy, the decision for surgery depends on the severity of the symptoms, vocal needs of the patient, position of paralyzed vocal folds, prognosis for recovery, and the cause of paresis/paralysis, if known.

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Vocal Cord Paralysis | Boston Medical Center

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Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse, resulting in no movement; paresis is the partial interruption of nerve impulse, resulting in weak or abnormal motion of laryngeal muscles.

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This article talks about what the universe is, how old it is, and what it's made of. The universe contains a bunch of matter and energy that we can’t see or directly observe. All the stars, planets, comets, sea otters, black holes and dung beetles together represent less than 5 percent of the stuff in the universe.

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The universe is everything. It includes all of space, and all the matter and energy that space contains. It even includes time itself and, of course, it includes you.