In these top hospitals, socioeconomically vulnerable patients will find care | Second opinion

Many of America’s best hospitals are located in and serve communities of relative privilege. People who are not financially well-off, not well-insured, and not white have historically been underserved by the U.S. health care system and are less likely to receive care at these top medical centers. While about 38 percent of all U.S. hospitals are located in neighborhoods that are socially disadvantaged by one measure, those hospitals are less than a quarter more likely to pass the high-profile quality assessment than hospitals located in more advantaged neighborhoods.

Hospitals, sometimes called safety nets, that treat a substantial portion of poor, uninsured or otherwise vulnerable patients “struggle to achieve the same quality metrics” compared to other medical centers, says Dr. Clyde Yancy, chief of cardiology and professor at Northwestern. Feinberg University School of Medicine. “Safety net hospitals are plagued by very challenging patient populations, often due to the maldistribution of social determinants of health,” he says. The challenges these facilities face are “largely dependent on policy, resources and available investment capital. They typically don’t have as much investment capital and don’t make the same margins for the care they provide.”

The problem is twofold: patients with higher social needs may face barriers to accessing health services from certain providers and institutions due to factors such as insurance acceptance, geographic proximity, or lack of transportation. At the same time, hospitals that care for a greater proportion of more vulnerable patients are often under-equipped and face challenges such as lower reimbursement from some insurance companies, which reduces their revenue potential, limiting their ability to provide services to their communities. These hospitals may also be disadvantaged on performance measures that don’t properly account for each patient’s risk factors, experts say.

“A hospital can do everything it can to help patients, but it won’t reverse decades of inadequate care over the course of a patient’s life,” says Dr. Karen Joynt Maddox, a cardiologist, researcher and professor at Washington University School of Medicine in St. Louis many purchasing programs that reward hospitals with payments for the quality of care they provide do not take social risk into account when evaluating patient outcomes and potentially “penalize hospitals doing the hardest work” in caring for patients with greater social needs.

Yet some hospitals stand out by excelling in quality measures while caring for a range of patients from vulnerable communities. On Parkland Healthand the best hospital in dallas, for example, four out of every 10 patients are on Medicaid, the government insurance program for the poorest Americans. On Grady Memorial Hospital in Atlanta, six out of every 10 patients insured by another government Medicare program are black, exceeding the 28 percent proportion of Atlanta residents covered by Medicare who are black. In Tulsa, Oklahoma, more than a quarter of patients on both St. Francis Hospital and Hillcrest Medical Center they are on Medicaid. Both hospitals serve a large proportion of patients from disadvantaged communities, as well as a significant number of Native American patients. More than a quarter of patients treated for NYC Health and Hospitals-Elmhurst are on Medicaid, and two-thirds of her Medicare patients are non-white.

“Racial and ethnic minorities, as well as low-income patients, are typically segregated in a low percentage of hospitals,” says Dr. Sidra Bonner, a surgeon who has studied hospital-level segregation of Medicare patients. According to surgical research, he adds, “most racial and ethnic minorities are served in 20 percent of hospitals.”

AND recent studies in the American Journal of Surgery found that patients treated at top hospitals had fewer complications and a better chance of survival than similar patients treated elsewhere. In addition, the study authors wrote that “patients living in extreme (persistent poverty) experienced the greatest reductions in the likelihood of mortality and morbidity when they received care at a first-class hospital.” Author Chanza Shaikh and colleagues from The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center concluded: “Improving access to high-quality hospitals for socially disadvantaged patients can help reduce disparities in surgical care.”

Despite treating patients who face social and economic adversity, Parkland, Grady, Hillcrest, Saint Francis and Elmhurst have managed to achieve great results and have previously been recognized as US News Best Regional Hospitals.

We set out to identify multiple hospitals that treat a disproportionate share of patients from three different historically underserved communities: people living in more socioeconomically disadvantaged neighborhoods, Medicaid recipients, and racial and ethnic minorities. We found dozens of such hospitals in 26 states that also provide high quality overall care, ranking them among the best in their region.

The list of institutions below is by no means a definitive list of hospitals involved in providing access to socio-economically vulnerable populations. No doubt there are others that we can identify and recognize in the future. However, these 53 hospitals provide certain vulnerable populations with substantial access to high-quality care—an essential contribution to health equity. That’s why today we recognize them as the best regional hospitals for equitable access by US News & World Report.

A brief description of the criteria appears after this list.

Providence Alaska Medical Center Berth AND
University of Alabama at Birmingham Hospital Birmingham AL
UAMS Medical Center A small rock AR
TMC Healthcare-Tucson Tucson THE
Banner-University Medical Center Phoenix Phoenix THE
Banner-University Medical Center Tucson Tucson THE
Mercy San Juan Medical Center Carmichael ca
Loma Linda University Medical Center Loma Linda ca
Providence St. Mary Medical Center Apple Valley ca
Sharp Chula Vista Medical Center Chula Vista ca
Kaiser Permanente Fontana and Ontario Medical Centers Fountain ca
Adventist Health-White Memorial Angels ca
Kaiser Permanente South Sacramento Medical Center Sacramento ca
UCHealth Memorial Hospital Colorado Springs WHAT
Hospital and Medical Center St. Francis Hartford CT
Yale-New Haven Hospital New heaven CT
UF Health Jacksonville Jacksonville FL
Grady Memorial Hospital Atlanta GA
Advocate Trinity Hospital Chicago IL
Carle Foundation Hospital Urban IL
Ochsner Lafayette General Medical Center Lafayette THE
UMass Memorial Medical Center Worcester MA
Johns Hopkins Bayview Medical Center Baltimore MD
Hospital of the Assumption of St. Agnes Baltimore MD
MedStar Southern Maryland Hospital Center Clinton MD
Corewell Health Hospital in Dearborn Dearborn ME
Henry Ford Hospital Detroit ME
St. John’s Assumption Hospital Detroit ME
Christian Hospital St. Louis MO
Barnes-Jewish Hospital St. Louis MO
Mercy Hospital Springfield Springfield MO
Moses H. Cone Memorial Hospital Greensboro NC
Cape Fear Valley Medical Center Fayetteville NC
UNC Hospital Chapel Hill NC
ECU Health Medical Center Greenville NC
Altru Health System-Grand Forks Grand Forks N.D
Sanford Medical Center Bismarck Bismarck N.D
Cooper University Health Care-Camden Camden NJ
Jefferson Health-Stratford, Cherry Hill and Washington Township Stratford NJ
NYC Health and Hospitals-Elmhurst Elmhurst NY
Hillcrest Medical Center Tulsa OK
Hospital of St. Francis-Tulsa Tulsa OK
Asante Rogue Regional Health Center Medford OR
Salem Hospital Salem OR
UPMC Presbyterian Shadyside Pittsburgh BYE
Geisinger Wyoming Valley Medical Center Wilkes Barre BYE
McLeod Regional Medical Center Florence SC
Grand Strand Regional Health Center Myrtle Beach SC
Lexington Medical Center Western Colombia SC
Memphis Methodist Hospital Memphis TN
Parkland Health-Dallas dallas TX
JPS Health Network – Fort Worth strength value TX
Inova Fairfax Hospital Falls Church VA

The hospitals recognized here previously met the criteria for inclusion in 2023-2024 The best regional hospitals. They also met at least two of the following three criteria:

  • At least 40% of Medicare inpatient visits involved patients living in more socioeconomically disadvantaged neighborhoods. Socio-economic deprivation of neighborhoods was assessed using area deprivation index data obtained from Neighborhood Atlas. Both national percentiles, which compare neighborhoods to others in the country, and state deciles, which compare neighborhoods only to others within the same state, were considered. A neighborhood with national ADI values ​​above 70 (on a scale where 100 indicates the greatest deprivation) or state ADI values ​​above 7 (on a scale of 1 to 10) was classified as more socio-economically deprived for this analysis. A hospital could meet this criterion if at least 40% of its Medicare patients lived in disadvantaged neighborhoods, according to the state or national ADI.
  • A substantial Medicaid population. A hospital met this requirement if at least 20% of its patients were insured by Medicaid or if it achieved the highest category (“Higher than other hospitals”) for the US News Health Equity measure “Representation of Low-Income Patients.”
  • A patient population that reflects the racial and ethnic diversity of the surrounding community. A hospital met this requirement if at least 20% of its Medicare inpatients receiving elective care were racial or ethnic minorities, or if it treated a non-trivial Medicare population from one or more of the five racial/ethnic minorities and achieved the highest category (“” Comparable to or higher than the community”) for the corresponding measure of race/ethnicity that US News publishes as part of its Health Equity measures.

Hospital evaluation will expand the use of objective data | Second opinion

Measuring patient outcomes forms the basis of the Best Hospital rankings. For years, US News has studied hospital outcomes for patients covered by the nation’s largest insurance plan — traditional Medicare. In recent years, a rapidly growing number of Medicare beneficiaries have opted for commercial alternatives to traditional Medicare, known as Medicare Advantage or Part C.

To address this nationwide trend in the use of commercial insurance plans, today we are announcing the largest-ever expansion of the data used in the Best Hospitals rankings. Beginning with the rankings, which will be released on July 16, 2024, hospitals in 11 adult specialties will be ranked not only by their outcomes for traditional Medicare beneficiaries, but also by their risk-adjusted mortality rates for patients covered by Medicare Advantage (MA) plans. .

In each specialty, the weight previously assigned to the mortality score for traditional Medicare patients (36% in most specialties) will be shifted to the new combined mortality score calculated from traditional Medicare and MA data. Each hospital’s combined score will be a weighted average of its traditional Medicare and MA risk-adjusted mortality scores, with more or less emphasis on each hospital’s MA scores depending on the proportion of its Medicare patients covered by an MA plan.

Next year, we expect to incorporate Medicare Advantage outcomes into the procedure and condition evaluation.

A fair approach

An upcoming new US News show will shine a light on some hospitals that exemplify both quality care and fair access. On June 5, 2024 at The State of Justice in America forum in Washington, DC, US News will reveal a list of the best regional hospitals that are distinguished by their degree of care for patients from certain socially vulnerable backgrounds, such as households and neighborhoods with lower resources and racial and ethnic minorities. While no list can capture all hospitals doing virtuous work, our goal in issuing this new recognition is to help identify some of the many organizations working to make high-quality health care available to populations in need.

Further changes for 2024-2025

Other changes to this year’s Best Hospitals adult specialty rankings and rankings include:

  • Interhospital transfers. Starting this year, patients transferred to the hospital from an outside emergency department will be excluded from the hospital’s risk scores in all specialties. Based on input we received from industry experts, this change will remove a potential barrier for hospitals to admit high-risk patients who may benefit from a switch, such as some stroke patients. In addition, patients transferred from the inpatient service of one hospital to another will continue to be excluded. Due to the wide variability of hospital coding practices, interhospital transfers will only be identified using consecutive requests from both participating hospitals; for some hospitals, this will reduce the number of cases identified as incoming transfers.
  • Evaluation of gynecological oncological surgery. The assessment of ovarian cancer surgery and uterine cancer surgery will be replaced by a single combined assessment. This change increases the sample size and improves the measurement of results. Surgical cases previously included in either assessment will be included in the new Gynecological Cancer Surgery assessment, and the anatomic location of the cancer will account for the risk adjustment.
  • Outpatient outcomes. Complication rates after ambulatory surgery will be incorporated into the Ear, Nose and Throat Assessment, Prostate Cancer Assessment and the New Gynecological Cancer Assessment. These outpatient outcome measures are similar to those introduced last year in the orthopedics and urology rankings.
  • Observation stays. This year, the days a patient spent in the observation unit will count as time away from home in the outcome measure labeled “Giving patients time at home,” which the researchers called “time at home” or “days alive and at home.” In addition, hospital-level data on observation status utilization and mortality among high-risk patients treated on observation units will be available in Hospital Data Insights. US News has received and is considering expert opinions on whether some high-risk observation stays should count toward mortality scores in future years to improve comparability among hospitals that use observation to varying degrees.
  • Rehabilitation. As previously announced, the weights will be adjusted for the four existing measures used only in the Rehabilitation rankings: Employee flu vaccination rates will be weighted at 2% (down from 5%), and each of the three volume measures that previously had a 2% weight will now receive 3% by weight. In addition, flu vaccination rates will be normalized so that hospitals with rates of 90% or higher will receive full credit for this measure.

The above list is not exhaustive, but we try to ensure transparency with regard to changes. Further refinements of the adult assessment methodology and assessment will be discussed in point a virtual event on June 12 and detailed in methodological reports made available to hospitals on 27 June.

Any changes to this year’s Best Children’s Hospital rankings will be announced at a later date.

As always, we welcome input from stakeholders—patients, physicians, nurses, healthcare leaders, and anyone else who may have useful insight into how to measure healthcare quality. Comments and suggestions can be sent to bhmethodology@usnews.comand each will be reviewed by our methodology team.

The 2024-2025 Best Hospitals methodology was developed and implemented with Zach Adams, Tavia Binger, Avonelle K. Davis, Ruoyu Ji, Daniel Lara Agudelo, Joshua H. Sandefur, Kaylan Ware, Chelsey Wen, Jennifer Winston, Xinyan Zhou and colleagues at RTI International .

US News Announces Simplified Survey of Maternity Services for 2024 | Second opinion

Every year, US News honors hospitals that meet high standards in the care of patients with uncomplicated pregnancies. Best hospital for maternity care. This recognition helps patients make informed decisions about where they receive their maternity care and gives hospitals greater visibility. In addition, starting in 2023, US News recognized hospitals providing quality birth care to communities that would not otherwise have access to these services. A hospital with access to maternity care.

US News identifies hospitals for these designations using objective data collected through the US News Maternity Services Survey. From June 3 to August 2, 2024, the survey will be open to all hospitals offering maternity care. Hospital representatives will have access to the survey within US News Healthcare Dashboard and must have “Editor” status to enter and submit data. (To create or update an account, please visit US News Healthcare Dashboard.) A draft survey will soon be available to hospitals to begin collecting information before the data submission period.

Participation in the survey is free, releaseand all participating hospitals will receive a birth care scorecard of the day

All hospitals that complete the survey will also earn a transparency credit of 3% of their overall score in 2025-2026. The best hospital for obstetrics and gynecology rankings and rankings. Hospitals that completed the survey last year will earn credit in the 2024-2025 rankings, which will be published in the summer of 2024.

In making changes to the birth rate survey, US News prioritized the goal of reducing the time burden on hospitals. US News considered input from hospital leaders, obstetrics quality experts and other stakeholders, as well as decisions made by the Centers for Medicare and Medicaid Services, The Joint Commission and other quality measurement organizations. Changes to this year’s survey include:

The 2025 Best Hospitals for Maternity Care will be announced on 10 December 2024. Embargoed ratings will be available on the Healthcare Dashboard from 14 November 2024.

6 Best Upper Body Exercises for Women in the Gym

If you’re new to resistance training, focus on movements that mimic what you do in your everyday life.

“This would involve pushing and pulling in both the horizontal and vertical planes,” says Siebert.

It’s also important to look for balance and symmetry, as this can promote full muscle development while helping you avoid injuries and imbalances. For example, pairing a chest press with a horizontal row develops both the front and back of your body to make you more stable and balanced in terms of muscle development.

If you’re worried about looking too “bulky”, don’t worry.

“”It becomes bulky“requires lifting weights that feel heavy, where maybe you can only do two more reps before you fail when you finish the set,” says Siebert.

If you want to get toned muscles, aim for three to four sets of eight to 12 repetitions of each lift. When trying to build strength, aim for three to five sets of four to six repetitions with extended rest.

Next:1. Lat pull-down machine

What are the most common questions for pharmacists about over-the-counter drugs?

If you’re like most Americans, you probably live within five miles of a local pharmacy and use it to pick up prescription drugs and over the counter drugs that you rely on for your health.

Whether you’re there because your doctor prescribed a short course of antibiotics, you’re filling a prescription for an ongoing chronic condition, or you just need to buy an aspirin relieve headache, pharmacies are the foundation of public health. In fact, according to US Department of Health and Human ServicesAn estimated 131 million Americans take prescription drugs that they get from pharmacies.

Despite how common and widely used pharmacies are, pharmacists—yes, the ones behind the counters—are often underutilized.

Pharmacists complete four years of education to earn a professional doctorate and typically one to two years of internship, making them uniquely qualified to do more than just dispense medication. They play an integral role in ensuring the health and safety of millions of people.

“Pharmacists can provide patients with a huge amount of drug information, advice and support to ensure they receive the safest treatment and experience the best response,” says Daniel Krinsky, pharmaceutical consultant and founder of EduCare4U.

Services that a pharmacist can provide

Services that a pharmacist can provide that you may not be aware of include:

It is important that people talk to their pharmacists, especially about questions about their medicines.

“We know that pharmacists are busy filling prescriptions and working with patients and don’t spend much time in the OTC aisles of pharmacies, but pharmacists are always available for questions about side effects, dosages, drug interactions and everything in between,” says Krinsky.

Pharmacist survey results

About 7 in 10 pharmacists (71%) wish consumers would ask them more often about which over-the-counter medications they would recommend for their medical conditions, according to a March 2023 US News & World Report survey conducted by The Harris Poll . More than 350 pharmacists nationwide from chain, independent and hospital pharmacies participated in the online survey.

“This research provides a unique pharmacist’s perspective on interactions with consumers and clearly shows that pharmacists do not feel consumers are taking advantage of the resources they offer,” said Rob Jekielek, executive director of The Harris Poll. “The main benefit is that patients have a great opportunity to consult pharmacists more frequently on a range of medication-related questions, particularly regarding the safe use of over-the-counter medications.”

Based on expert feedback, the most common questions pharmacists wish consumers would ask include:

Almost three-quarters of pharmacists surveyed (74%) want patients to ask them fatigue and other common side effects from over-the-counter drugs. The best way to learn about potential side effects is to read the drug information label on an over-the-counter product, but the information may not always be easy to understand.

“I always encourage patients to talk to their pharmacists,” says Krinsky. “It is especially important to ask about side effects when an individual is taking other prescription or over-the-counter medications because side effects can be magnified when combined with other medications.”

“Pregnant people are strongly advised to consult their health care provider before starting to use over-the-counter medications doctor or a pharmacist about potential side effects and precautions,” says Hanna Phan, clinical associate professor at the University of Michigan College of Pharmacy in Ann Arbor, Michigan.

Experts encourage people to ask what foods that should be avoided with some medications. green leafy vegetables, grapefruitcaffeinated beverages and other foods and beverages may interact with your medication and potentially change the effect or potency of the medication or lead to additional or more serious side effects.

Moreover, because vitamins, supplements and herbal medicines are not regulated by the FDA, there is only limited science and evidence to support their effectiveness, safety and quality.

“We know there are many quality supplement manufacturers out there, and those are the ones on the pharmacy shelves, but it is strongly recommended that people talk to their pharmacist and other providers about supplements, especially when they want to combine them with prescription drugs or over the counter drugs. Krinsky says.

The labels on over-the-counter medicines often include information on how long to take the medicine or give instructions on when to stop taking the medicine, but it is important to ask your pharmacist about long-term use and its effects.

“It’s one thing for people to use regularly melatonin on aid in falling asleep, but it’s another thing for them to take high doses of OTC acetaminophen every day for a year because of the potential liver toxicity issues that result from continued use,” explains Krinsky. “When in doubt, always talk to your pharmacist about how long it is safe to take over-the-counter medications.”

There are certain over-the-counter medications that should be taken with food and some on an empty stomach. OTC medications for heartburn relief are a good example of a drug that should be taken without food, but ibuprofen should be taken with food to avoid upset stomach.

Some people may think it’s okay to take more over-the-counter drugs than their prescription equivalents. However, sometimes a prescription version will be offered instead.

“There may be medical reasons why doctors prescribe pain medication to provide relief,” says Phan. “If you are uncomfortable taking prescription pain medications, let your provider know so you can both discuss possible options.”

When a person misses a dose of an over-the-counter drug, pharmacists often recommend waiting until the next dose.

“Definitely don’t take an OTC twice to make up for a missed dose,” says Krinsky. “We don’t want patients to get used to double dosing because that could potentially lead to dangerous situations.”

According to the survey, 72% of pharmacists are concerned that people think it’s OK for children to take over-the-counter medicines for adults, even if the dose is reduced.

“Infants and young children often need smaller doses that are best measured using their appropriately designated liquid formulations,” explains Phan. “Substituting adult forms, which are often tablets or capsules, can be inaccurate and can increase the risk of medication errors such as overdose.”

In addition, young children are often unable to swallow tablets or capsules correctly. Since adult forms are often larger tablets or capsules, their use could pose a serious choking hazard.

Another issue that dominated the results, according to the survey, was the topic of drug affordability. About 7 in 10 (71%) pharmacists said patients should ask if they exist more affordable options for OTC drugs.

On pharmacy shelves, consumers have many options to choose from, including brand-name over-the-counter medications, generic forms, and store brands sold by CVS, Walgreens, and some grocery and supermarket chains.

“Sometimes there’s a misconception that brand-name drugs are better because of their household name and the advertising that consumers see all the time,” says Krinsky. “The bottom line is that the branded and generic versions are the same because they are both regulated by the FDA for quality and safety.”

Keeping a list of medicines

“A medication list should be maintained and regularly updated if new medications are taken or dosages are adjusted,” adds Krinsky.

“Keeping a list of your medications with you to share with your pharmacist or other healthcare provider can make the biggest difference in avoiding side effects and drug-drug interactions,” says Phan. “This list should include vitamins and supplements, including herbal products, as they can sometimes interact with other medications.”

Medication lists can easily be kept in a small notebook or electronic medical records using a healthcare system or smartphone apps to help manage medications, dosages, and provide reminders. Some phone apps allow patients to share their information with loved ones so they can easily access it, especially in an emergency.

  • Hello manga.
  • Medisafe.
  • MedManage.
  • MyMedSchedule Plus.

Bottom Line

Finally, it’s important to remember that pharmacists can help you with much more than just filling prescriptions.

The next time you shop the pharmacy aisles or pick up your next prescription at the window, take advantage of the wealth of knowledge and experience that pharmacists have to offer.

“If you have any questions about over-the-counter medications, take the time to talk to your pharmacist,” says Krinsky. “Our job is to make sure patients are using the safest product that will provide the best outcome.”

How to be more physically active

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If you’ve heard about the importance of physical activity but haven’t yet started a new routine, don’t worry—you may already be doing more than you realize.

There are plenty of things you do every day that qualify as physical activity, says Dr. Jay Shah, family physician and primary care sports medicine physician. Pomona Valley Hospital Medical Center in Pomona, California. These include:

  • Carrying food.
  • Climbing the stairs.
  • Gardening.
  • Car wash.
  • Playing with your children.
  • Walking the dog.
  • Doing housework.

These activities are functional movement training. In other words, by engaging in such activities over the long term, you build strength and endurance for everyday movements.

How to include more physical activity

To get into the rhythm of physical activity, you should start small and gradually increase. Shah recommends gradually increasing the frequency, intensity and duration of exercise build muscle growth.

She also suggests actively looking for ways to increase daily movement, such as:

  • Instead of the elevator, they decided on the stairs.
  • If possible, walk or cycle to work.
  • Walk during breaks in work.

You can also incorporate physical activity into your daily life by asking loved ones to join you.
“By doing it activities as a groupevery member of the family can encourage each other and give each other motivational support,” explains Shah. “This could be a great way to spend time with the family.”

Risks of Rincreasing physical activity

While being active is a critical part of overall health and fitness, it’s important not to overdo it. It takes time for your body to get used to a new training regimen, even if it’s based on routine tasks like gardening or cleaning your house.

“One of the biggest problems I see in my clinic is people who have either started exercising after a period of inactivity or have switched to a new and much more intense exercise program,” says Dr. Justin Mullner, sports medicine physician Hello Orlando Jewett Orthopedic Institute of Florida.

The problem, explains Mullner, who also serves as team physician for the Orlando City Soccer Club and the Orlando Pride, is that jumping into a new workout doesn’t allow your muscles, tendons and bones to properly adjust to the amount of force being applied. them. As a result, they become painful and inflamed, leading to muscle tensiontendinitis and stress fractures.

Instead, start small and build up slowly. As with any exercise protocol, it’s best to check with your healthcare provider before starting a new activity, especially if you have any underlying health conditions.

Include strength training

Also called resistance trainingstrength training refers to physical activity in which your muscles contract against an external force, such as dumbbells, hand weights, or exercise machines.

Strength training also adds variety health benefitsincluding:

  • Maintaining bone density, which can help stave off osteoporosis and reduce the risk of fractures.
  • Improving mobility, muscle strength and endurance.
  • Joint stabilization that can reduce your chances of injury and lead to fewer falls, especially as you get older.
  • Supporting good cognitive function and improve your mood and self-esteem.
  • Strengthening your metabolismor your basal metabolic rate to help you burn more calories and maintain or reach your ideal weight.
  • Decreasing blood pressure and promotes good heart health.

When you’re lifting at home — like carrying bulky groceries or picking up younger children — Shah says you should always be intentional about your movements.
“Tighten your core when doing housework,” she advises. “Use proper lifting technique when lifting heavy objects.”

Don’t forget to add cardio

In addition to strength training, you should focus on engaging regularly cardiovascular activity. For example, the American College of Sports Medicine recommends at least 150 minutes of cardiovascular activity per week, along with two days of strength training per week, Shah says.

Sydney Warpness, a strength and conditioning coach and certified CrossFit trainer based in St. Augustine, Florida, says that virtually any activity that makes it a little harder to breathe can qualify as cardio. This may include household chores such as mowing the lawn or carrying the laundry upstairs. It can also include fun activities like going for a walk or a simple dance in your living room.

“The key to all of this is basically getting your heart rate up,” says Warpness.

And that key can unlock some serious fitness benefits.

“Cardio is great for your cardiovascular system because it helps strengthen your heart and lungs,” says Warpness. “A healthy cardiovascular system will improve overall health and longevity.”

The more cardio you do – i.e. the longer you’ll last increased heart rate – the more benefit you get.

“Cardio helps you build stamina and endurance, which allows you to push harder for longer periods of time without getting tired,” explains Warpness.

Make fitness a lifelong habit

The bottom line is, no matter how you exercise, just do it. Whether you’re weeding the garden or walking up and down the stairs, there are plenty of ways to add movement to your daily routine.

You should too make exercise a lifelong habit to reap the full benefits of physical and mental health, says Mullner. To make fitness a little easier, she suggests finding activities you enjoy.

“If you don’t enjoy the exercise you’re doing, or worse, you really dread it, then you’ll be less likely to continue doing the activity and therefore miss out on many of the great benefits it brings,” he explains.

Once you find an exercise you like, commit to it.

“Consistency is key,” says Warpness. “You have to teach your body that (being) fit and healthy is the new normal and the only way to keep it is to stick with it. Once you find something that works for you, stick with it.”

11 proven methods for better sleep

According to National Institute of HealthBetween 50 and 70 million Americans have sleep disorders, and one in three adults lack sleep for their health and well-being.

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A bad or disturbed sleep pattern is not a minor inconvenience; it is a serious health risk. Lack of quality sleep can disrupt your natural circadian rhythms (or sleep-wake cycle), which negatively affects several hormones and increases your risk of accidents, type 2 diabetes, heart disease, high blood pressure, obesity, Alzheimer’s disease, learning disabilities, and much more.

How much sleep is enough?

According to the National Institutes of Health, somewhere between 7 and 9 p.m. at night is a good rule of thumb for most adults. When healthy adults have unlimited sleep, they will sleep 8 to 8.5 hours per night. However, sleep scientists advise that optimal amount of sleep varies from person to person, but when individuals consistently get less than 7 hours per night, health risks increase.

11 tips for better sleep

To help you get the necessary rest your body needs, here are 11 proven methods to get better sleep.

Maintain a regular waking and sleeping pattern

One of the best things you can do is stick to a regular bedtime. Since most adults need about seven to eight hours of sleep, allow yourself enough time before you have to be awake the next day to reach this goal. Anything less is considered insufficient and has potential health consequences.

Establishing and maintaining a consistent schedule is the most important factor in improving your sleep health, as the body’s internal clock relies on consistency. Setting a regular sleep-wake schedule can help you fall asleep faster—and stay asleep—until it’s time to wake up and start your day.

Create a relaxing bedtime routine

To create a non-stimulating evening ritual, you might think of what your parents did when you were young to get you into sleep mode: take a warm bath or drink a cup of chamomile tea; it will either increase your body temperature, which makes you feel drowsy when you cool down

It takes time for the body to go into sleep mode. To get things moving in the right direction, spend the last hour before bed doing a calming activity, such as reading a book, listening to soothing music, or taking a warm bath. Avoid exercising and eating too close to bedtime as they can make it harder to fall asleep.

Avoid using electronic devices such as laptops, smartphones, or tablets before bed, as the brain-activating blue light emitted from the screens of these devices is associated with reduced sleep duration, sleep quality, and natural melatonin levels. Even small electronic devices can emit enough high-energy blue light instead of much-needed shut-eye to disrupt the brain, lower melatonin levels, and promote alertness.

Create a sleep-friendly environment in the bedroom

Make sure the bedroom is a dark, cool and quiet place. Ideally, computers and televisions—as well as restless pets—should be kept out of the sleep environment.

Try blue light filtering lenses before bed

Blue wavelengths, which are at the higher end of the light spectrum, are beneficial during daytime hours as they increase alertness and mood. The problem is getting all that high energy blue light at night.

Blue light blocking glasses worn in the evening can help reduce eye strain associated with excessive screen and LED light and help restore your natural circadian rhythms. Preliminary research suggests that wearing blue light-blocking glasses for three hours before bed may help improve sleep quality, particularly for those with insomnia.

Several brands of blue light blocking glasses are available from companies such as Pixel, Felix Gray, Gunnar, and Spektrum.

Adapt the mattress to your sleeping position

Mattresses have come a long way, so there’s no excuse not to have a good mattress that’s designed for your sleeping position. If your mattress is too soft, too hard, or simply uncomfortable, consider a new one. And there’s good news: US News mattress reviews you will discover that the most expensive mattress is not necessarily your best choice. Mattresses like Saatva, Avocado, Leesa and Purple make it easy to shop for a new mattress with online tools to find your perfect mattress based on your weight, sleeping position and personal preferences.

Limit caffeine, nicotine and alcohol

Although it may be tempting to relax with a glass of wine, a cocktail, or a “night cap” after a stressful day, the sedative effects of alcohol may help you fall asleep more quickly, but it inhibits deep, restorative REM sleep. People who drink alcohol often wake up in the middle of the night when the effect of ethanol wears off, which can affect breathing at night. This is why many drinkers report feeling tired and groggy the next day.

And while caffeine it may help you stay awake longer when your body is telling you it wants to sleep, but it will only make it harder for you to fall asleep. Caffeine blocks receptors for the hormone adenosine, which tells your body it’s time to sleep. A good rule of thumb is to include caffeine in your day only in the morning and then skip it in the afternoon and evening.

Like caffeine, nicotine is a stimulant that keeps you awake, and its use results in poor sleep quality.

Set the correct temperature

For most adults, a cooler temperature is between 60 and 67 degrees Fahrenheit National Sleep Foundation. A cooler room can promote better sleep because it works in tandem with the body’s natural circadian rhythms, which cause your core temperature to drop during sleep. If you like to sleep, use high-quality, breathable sheets made of cotton or other moisture-wicking fabrics to make you feel more comfortable.

Avoid large meals within four hours of bedtime

Certain foods take longer to digest, so you don’t want to eat them within 3-4 hours of hitting the sack. Foods rich in fat and protein leave the stomach more slowly, so eating a meal rich in fat or protein before bed can make you feel full when you’re trying to go to sleep. The size of your last meal should also be smaller to help you sleep as well. Eating too much food and lying down shortly afterwards can lead to gastroesophageal reflux disease (GERD), making it difficult to get comfortable enough to even fall asleep.

Avoid drinking too much water before bed

Staying well hydrated is important during the day, but not ideal at night. If you drink a lot of fluids the night before bed, you will wake up at least once a night to go to the bathroom. As a general rule, if you feel like you need to drink before bed, take a few small sips of water, but don’t drink too much.

Consider natural sleep aids

Seek medical help from a sleep specialist

Lack of sleep is serious. If you’ve tried these tips and still aren’t sleeping well, seek medical advice from your GP or, if you have access to a doctor, sleep specialist. You can have a sleep disorder or there may be an underlying medical condition that is disrupting your sleep. There are sleep centers with accreditation American Academy of Sleep Medicine.

What to do when you can’t sleep

Cognitive Behavioral Therapy (CBT-I)

According to Mayo Clinic, if your thoughts or behaviors keep you up at night, it can be helpful to practice better sleep habits, sometimes with the help of a therapist.

“If you can’t sleep, get out of bed for 10 to 15 minutes,” says Dr. Alcibiades J. Rodriguez, medical director of the New York University Langone Health Comprehensive Epilepsy Center – Sleep Center in New York. “Go to the chair and read something boring.”

When you start to feel drowsy, you can go back to bed.


Some studies suggest mindfulness meditation can help reduce worry and anxiety. The easiest way to practice mindfulness is to pay attention to your thoughts without labeling them as “good” or “bad” while remaining in the present moment as much as possible. It also means letting go of thoughts about what has happened or what might happen.

4-7-8 Breathing

If practicing mindfulness meditation doesn’t work for you, you can try deep meditation breathing techniquesas 4-7-8 breathing, which have been shown to reduce stress. To begin 4-7-8 breathing, take a deep breath for four seconds. Hold your breath for seven seconds, then slowly release your breath and exhale, counting from one to eight. Repeat these steps a few times and then stop and notice if you feel more relaxed.

Keeping a diary

If you tend to do a lot of planning in bed, it may help to journal or write down your thoughts before bed. It can help to make a to-do list or jot down your thoughts in another room before you go to bed in the bedroom, says Dr. Alon Y. Avidan, professor of neurology at the University of California, Los Angeles and director of the UCLA Sleep Disorders Center. If you don’t get out of bed to record your thoughts, “then the bed becomes a place for planning and thinking. It’s a place for hypervigilance.”

Bottom Line

Although you can try a whole range of them strategies for falling asleep at night it is still important to review your daily routine and assess whether improvements need to be made. “Whatever you do during the day will affect your sleep,” says Rodriguez. “A healthy life will give you the best sleep.”

Related 360 reviews

These hospitals provide what too many communities lack: Access to maternity care | Second opinion

Regional Health Center St. Joseph serves Idaho’s most rural health district. No other medical center within 40 miles delivers babies. Each year, about 640 pregnant women travel an hour or more to a Lewiston hospital to give birth. To minimize how often patients have to commute to Lewiston, obstetricians at St. Joseph often collaborates with midwives and obstetrician colleagues in communities in Northwest Idaho and Eastern Washington.

One of those patients is Jamie Laird, 43, of Kamiah, Idaho. A midwife and mother of eight, she has given birth to three children of her own at home and cares for other women who want to do the same. Sometimes, she knows, it’s not safe to give birth at home. “I send a lot of my patients to St. Joe’s,” she said. “He always has our back. When Laird’s eighth pregnancy required specialized care for placenta previa, she turned to a doctor in Lewiston, even though it meant driving an hour and a half when the day of her scheduled C-section arrived. If for her St. Joseph was out of the question, she would have to go to Spokane, Washington, three hours from her home.

In some parts of the US, pregnant women don’t have reasonable access to the care Laird needed. According to March of Dimes2.2 million women live in so-called maternity deserts, which the non-profit organization defines as regions where no hospital or birthing center offers maternity care and no obstetricians work. Adverse financial factors, rather than a lack of community need, may make providing maternity care in these communities unsustainable for hospitals, said Elizabeth Cherot, president and CEO of the March of Dimes.

Inadequate access to maternal care can be particularly acute for historically marginalized populations. In Montana, for example, Native American women travel another 24 minuteson average than white women. “If you’re considered high risk, you have to drive 60 miles one way for a 15-minute appointment,” said Janelle Palacios, a nurse-midwife at Kaiser Permanente Oakland Medical Center in California.

The problem of desert in the maternity hospital is getting worse. According to American Hospital AssociationBetween 2015 and 2019, at least 89 maternity units were closed in rural hospitals, and by 2020 only half of hospitals in rural communities offered maternity services. Declining reimbursement rates, low birth rates and difficulty retaining doctors in rural areas are putting pressure on rural obstetricians, says Katherine Glaser, an obstetrician and spokeswoman for the American College of Obstetricians and Gynecologists. These economic constraints have forced many hospitals to close their labor and delivery departments, and once a hospital loses that staff and infrastructure, it is very difficult to reopen.

(US News)

A hospital with access to maternity care

To identify hospitals that keep birth deserts at bay, we first identified communities that would become deserts if the only maternity hospital serving them stopped providing this essential service. We then reviewed obstetrics data that many of these centers provided to US News in this year’s survey and found 73 hospitals with acceptable performance on each of the quality measures used to determine Best hospital for maternity care. (See this methodological report for details.)

Today, we recognize these 73 hospitals—listed alphabetically by state below—as hospitals with access to maternity care. Some, including St. Joseph Regional Medical Center, are also recognized as the best hospital for maternity care. Others may not be among the best hospitals in the country—but each is a vital resource for the community that depends on it.

“Our providers are very committed to the community,” said Lindsay Kern, an obstetrician who cares for patients giving birth at St. Joseph.

Hospitals with maternity access are, on average, 15 miles further from the nearest hospital providing delivery services than hospitals that do not receive this designation, and are located in counties that have less than half the number of obstetricians per 10,000 births than other hospitals.

To overcome these challenges, these hospitals must be resourceful. To facilitate access for patients with long travel times, such as providers in St. Joseph in Idaho advises some patients to have routine prenatal visits with an obstetrician or midwife located closer to the patient’s home, after an initial evaluation at the hospital during the early period. pregnancy. In Kern’s eyes, the trusted relationships her team has established with community providers are essential tools for ensuring the best possible outcomes for their shared patients.

Indeed, hospitals with access to maternity care provide high-quality care to the communities they serve. On average, they have significantly lower cesarean rates in low-risk pregnancies (23.1% vs. 25.4%) and unexpected neonatal complications (27.3 vs. 31.8 complications per 1,000 deliveries, respectively) than hospitals that did not receive the designation.

11 Best Low Carb Breakfast Ideas

This diabetes friendly recipe makes 2 servings.

  • Calories per serving: 290.
  • Protein: 16 grams.
  • Total Carbohydrate: 15 grams.
  • Total fat: 16 grams.


  • 2 eggs.
  • 1 teaspoon of cooking oil.
  • 1 cup spinach, roughly chopped.
  • ¼ cup boiled black bean.
  • 1 medium whole wheat tortilla.
  • ½ cup shredded cheese (the kind that melts well, like cheddar or Monterey Jack), divided.
  • Hot sauce (such as Cholula).
  • Sea salt to taste.


1. To cook the eggs, heat 1 teaspoon oil in a medium-sized skillet (either well-seasoned cast iron or nonstick) over medium heat until shimmering. Add the chopped spinach and cook, stirring often, until wilted, about 1 to 2 minutes. Add the black beans to the pan. Pour in the scrambled eggs and cook, stirring frequently, until the eggs are set, about 1 to 3 minutes. Transfer the mixture to a bowl to pause the cooking process (eggs will cook in the quesadilla).

2. To cook the quesadilla, heat a tortilla over medium heat, turning occasionally. Once the pan and tortilla are warm, sprinkle one half of the quesadilla with ¼ cup cheese. Top the cheese with the scrambled eggs, then stir in the scrambled eggs with almost ¼ cup of the cheese, reserving about 1 tablespoon of the cheese for later. Press half of the empty tortilla onto the topping.

3. Let the underside of the quesadilla cook for a minute, then carefully flip the quesadilla with a spatula. Immediately sprinkle the remaining tablespoon of cheese on the hot side of the quesadilla and let it melt for a few minutes while the other side cooks. Flip the quesadilla again and let the cheese cook in the quesadilla for about 2 minutes. Use a spatula to get under the side of the melted cheese and flip again. Cook this side for a few more minutes, if necessary, until both sides are nicely crispy, golden brown.

4. Transfer the quesadilla to a cutting board to cool for a few minutes, then cut each quesadilla into 2 slices using a pizza cutter or very sharp knife.

Stauffer notes that you need to check the nutrition label of your tortilla, as the total carb count can vary greatly depending on the brand. Choose one that has less than 20 grams of total carbs to keep this food safe low carb.