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We are living in the time of quick improvement of innovation and a sparkling case of that are 3D printers. Under PC control, progressive layers of material are produced to make a three-dimensional protest. Every one of these procedures utilized as a part of the combination of a protest are represented by a gadget called a 3D printer. That is the essential thought of 3d printing. The business behind this idea has been enhancing at an amazing pace and it's at last prepared to be grasped by the majority.

These days this industry is extremely beginning to take off and these gadgets are winding up increasingly moderate that even essential buyers with a diversion around there can begin 3D printing. It's not any more an innovation saved for huge partnerships or production lines. A people group venture called RepRap started an open-source upheaval when it began advancing making unreservedly accessible 3D printers for the advantage of everybody. After an expansion in reasonableness, these items wound up feasible to be utilized by a wide range of experts, for example, engineers, originators, teachers and even individuals with an enthusiasm for the astounding capability of this innovation.

In the event that you feel like 3D printing would be an enticing undertaking for you then you can without much of a stretch end up in a tight spot due to the diverse choices and costs. You need to do some genuine research in light of the fact that in spite of the fact that it's valid that 3D printers are presently less expensive than any time in recent memory, that doesn't mean you don't need to treat it like a major speculation. Before you go chasing for awesome arrangements, the initial step is choosing what precisely do you require it for, what sort of printing do you expect to make. 3D printers are outlined in view of a specific client and can in some cases address some quite certain necessities so you must kick back and contemplate this perspective deliberately before settling on a choice.

This rundown has been intended to incorporate the best 3D printers with regards to an incentive for the cash. There are loads of good decisions out there yet finding the best can be intense. I like to use as a basic factor while deciding whether a printer merits purchasing, the best harmony between what you spend and what you really get. So in case you're hoping to purchase a 3D printer nowadays make a point to check these best printers in their individual classes.

Additionally, I composed two articles about CNC switches, drivers, and stepper engines and the best laser cutters and etchers, so you should need to look at those as well.

1. FlashForge 3d Printer Creator Pro

The following stage after the first section level FlashForge Creator, the Creator Pro is an exceptionally reasonable 3D printer with different abilities for assembling 3D objects. It's proposed for a further developed client, similar to a middle of the road level and it has some extraordinary general highlights that make this printer one you shouldn't miss in case you're in the market for one.

It's worked in a strong metal casing with an encased case. To help with adjustment and strength, it gives a z-pivot direct pole and it includes an overhauled stage leveling framework. FlashForge gained from past missteps on the past models thus the new metal body is more quiet, keeps vibrations to a base and to guarantee the best exactness of the print heads, it traps the warmth in. This is an extremely pleasant change that includes genuinely necessary firmness considering the old wooden body and the disturbing spilling of warmth and commotion. The printer likewise has a superior form plate configuration to allow higher print speeds and to constrain the quantity of mistakes and venture disappointments. For more immovability, the maker included little elastic feet to keep the printer stable and once more, to diminish however much as could reasonably be expected the odds of venture disappointments.

The all dark plan of the printer looks perfect and expert, easily wrapped up. In the front of the gadget there is an unmistakable and smooth acrylic board that fills it, and inside there is a blue LED light which shows signs of improvement perspective of your venture amid printing. An eyewitness would thus be able to watch the way toward transforming crude ABS or PLA plastic into a question specifically, influencing the procedure to appear to be more cool and intriguing. It's a really flawless little component that adds to the experience of 3D printing. The FlashForge Creator Pro has a control interface on a sparkly LCD board to have the capacity to see the condition of the present task. You can think that its fair underneath the acrylic board together with a group of catches for simple control. We'll discuss the product side for a bit however before that, we should take a gander at the genuine assembling capability of this 3D printer.

With a sensibly liberal size, the Creator Pro has enough space to fabricate anything from models to substitution segments. The manufacture conveyance instrument is good with the two most famous thermoplastics utilized as a part of the business: ABS short for Acrylonitrile butadiene styrene and PLA or Polylactic corrosive. The layering procedure is genuinely exact, the materials can be stacked on spools and after that coordinated through the double extruder at a conventional 30-160 mm for each second. The stores of 100-300 Micron thick are accomplished by a brilliant arrangement of aides and bars and because of a level aluminum plate. This plate alongside the steel undercarriage and double spool bolsters takes into account a brisk and proficient approach to evacuate any abundance warm which concedes the gadget the capacity to create great protests in a short measure of time.
The machine's product is exceptionally flexible and perfect with all the well known working frameworks including Linux so no issues there as the vast majority ought to be secured. The activities are acknowledged through the open source Replicator G or MakerWare programming. A portion of the information document composes upheld are STL and gcode. For availability, there is a SD card space and furthermore printing should be possible over a wired USB link.

With such a great amount of potential for imagination and such effective print chamber activities, the FlashForge Creator Pro has every one of the highlights to make the rundown of best 3D printers. With a more than reasonable value given its dependability and the superb norms for its development and usability, this is a strong champ on the off chance that you are searching for a productive 3D printer with a solid incentive for cash proportion.

Details list:

FDM Printer

ABS, PLA and different materials

100 microns least layer stature and 500 microns max

2 Heads

11 microns accuracy

40-100 mm/s speed

Open Source

Warmed Platform

1.75 Filament

USB SD card

Best 3D Printer for Beginners

2. LulzBot Mini Desktop 3D Printer

The LulzBot Mini is an extraordinary machine for clients who are simply beginning to get into 3D printers. It accompanies the considerable capacity of printing appropriate out of the container. You should simply introduce the product and you're essentially great to go. No repetitive, tedious tweaking required to have the capacity to deliver fantastic prints effectively. The cost of the gadget is more than sufficient considering all the stunning highlights of what I'd consider the most effortless to-utilize shopper level 3D printer as of now available.

In the first place, we should investigate the outline of this 3D printer. The LulzBot Mini has a dark steel outline which is open with no entryway, sides or best. The development is extremely solid and the general plan is basic and modern. Both the extruder gathering and the print bed are put on moving beds, an outline which appears to function admirably for this model as much taller things can be printed without issues. You can locate the red power switch on the front alongside the USB port. There are no physical controls or a SD Card opening and the Mini must be fastened to a PC always for it to have the capacity to print – this could be a slight detriment for a few people however it's not by any stretch of the imagination a dealbreaker.

The LulzBot Mini offers bolster for an amazing exhibit of printing materials past the commonplace ABS and PLA normally utilized as a part of 3D printing. You can utilize a group of different alternatives including the new, lightweight HIPS (high-affect polystyrene) fiber which Aleph Objects, the organization behind Lulzbot, really suggests particularly for this printer. On its site, you can discover downloadable programming settings for more extraordinary fibers bolstered.

A standout amongst the most imperative attributes is, obviously, the print quality and unwavering quality and in such manner, the Lulzbot Mini has some incredible highlights to demonstrate its value. It can hit a thickness of just 0.05 mm with the correct settings. The printed objects tell the truth with smooth sides and a rich level of detail. In spite of the fact that the layers of the print can be exceptionally discernible they are in truth less articulated than different printers in this value range and it's a genuinely ordinary thing to occur with most 3D printers. The printing speed is choice for a FDM write with top print paces of around 275 mm/sec at 0.18 layer stature. In case you're not the patient kind, the Mini will definitely fulfill you.

As to print region, this machine is well, not surprisingly from the name, more arranged towards printing little things which can be pleasant if that is what you're searching for. While the littler print region may demoralize a few, the Mini it's still particularly justified, despite all the trouble for its other extraordinary characteristics like the usability, the faultless print quality, and unwavering quality. Indeed, that is an exceptionally solid purpose of the Mini, as it can direct out quality prints for significant lots of time without any disappointments.

The Cura programming the Lulzbot utilizes is clear and natural and makes for a steady and straightforward printing process. Stacking 3D models is quite direct in its consistent interface and in addition altering or changing certain subtle elements in spite of the fact that Cura isn't a 3D demonstrating program. On the off chance that you need to utilize the full settings you will be required to set the z-hub home by adjusting the printer. The convenience of this product is an extraordinary quality of the Mini and one of the fundamental reason this printer is more adapted towards novices.

Taking everything into account, the LulzBot Mini is a very much outlined, passage level machine sufficiently great to coordinate more costly 3D printers with regards to print quality and speed. Combined with the way that it's so natural to setup, utilize and keep up and given its adaptability, its capacity to deal with such an extensive variety of materials and its astonishing simple way to deal with printing because of a develop programming, this 3D printer has the perfect characteristics you ought to expect in such a machine.
Determinations list:

FDM Printer

Extensive variety of materials

50 microns min layer stature and 500 microns max

1 Extruder Head

275mm/sec speed

Equipment and programming both open source

Associates with USB

Best Cheap 3D Printer

3. Streak Forge Finder 3D Printer

Considered the ideal starter 3D printer, The FlashForge Finder truly has a ton to offer for an extensively ease. Joined with the clear „plug and play" way to deal with printing, this is extremely the complete decision for novices, specialists and 3D printing fans who love to explore at home.

The body of this gadget is much the same as in the photo, square formed like a case yet with adjusted corners and edges. It is conservative with a moderate plan, nothing excessively ostentatious or convoluted. In spite of the general plastic feel of the casing, the printer is by all accounts sufficiently solid for all your printing tests. The print bed likewise goes about as a sliding plate which can be embedded and evacuated absent much exertion.

To make an instinctive UI, FlashForge introduced a brilliant LCD board where you can flip distinctive choices like stacking and emptying the fiber or on the off chance that you'd get a kick out of the chance to level the print bed naturally. This element works extraordinary to streamline the adjusting procedure of the printer quaint little inn the best resolutions for your printer by rectifying any twisting issues or flaws which can happen on the PLA parts.

With this printer, you don't have numerous alternatives material-wise as this machine just acknowledges one kind of fiber, 1.75 mm PLA. This is consummately sheltered and incredible around kids too in light of the fact that it's totally non-lethal. The streamlining procedure goes encourage along these lines as the Finder does not require a warmed print bed for more lethal materials, for example, ABS. The speed of the printing is genuinely normal, swaying between 40 to 200 mm for each second. One extraordinary component of this 3D printer is the MK 10 metal spout joined with a warm obstruction direct tube which encourages hugely to influence a more productive expulsion to process. No huge issues with the commotion level were identified which was going as low as 50 dB.

Availability for this gadget is additionally conceivable through Wi-Fi other than USB and that is very helpful in the event that you plan to deal with the FlashForge Finder over your neighborhood organize. The installed memory is 4 GB, sufficiently open to exchange records utilizing a USB link and after that just untether the printer from the PC. Worth specifying the way that the extraordinary Flash Print the machine accompanies is anything but difficult to utilize, intended for most extreme openness.

The printing quality is keeping pace with the sensible evaluating of this model which ought not surpass any easygoing 3D printing fan's financial plan. It's certain that FlashForge endeavored to streamline the printing activities and generally speaking I'd state it was a fruitful endeavor. To close, essentially this printer makes them guarantee characteristics, an astounding an incentive for your cash and it's profoundly prescribed for any tasks.

Determinations list:

FDM Printer

PLA, ABS materials

50 min layer stature

1 Extruder

USB and WiFi

Quality: ☆ ☆☆

Best Expensive 3D Printer

4. MakerGear M2 Desktop 3D Printer

MakerGear M2 is the result of Ohio-based organization MakerGear and it was initially discharged in 2012. From that point forward, MakerGear made a few upgrades and this is at present the fifth amendment age of the M2 arrangement. What influences this 3D printer to remain above numerous others in the business can be most precisely summed up in single word: quality. Be that as it may, to a great degree top notch principles likewise accompany a cost, truly. It's somewhat costly for a more easygoing client, however for the individuals who look to upgrade their expert undertakings with the best the business brings to the table, ought not pass this strong arrangement.

When you choose to make a major venture, the one viewpoint you're presumably most worried about is unwavering quality. Would this be able to item stand the trial of time and convey a consistent level of value and accuracy for requesting ventures? In light of this current how about we see the M2's potential in such manner. The printer has a vigorous steel outline and a machined cast aluminum development to which it owes its accuracy print quality. This printer can print layers considerably more slender than a solitary sheet of paper. On account of its steady casing and high resistance parts, the machine can continue making quality prints without the dread of misalignment and the requirement for consistent tweaking. It includes a warmed stage fit for imprinting in both standard sorts of fibers ABS and PLA. Obviously, you're not just restricted to these materials. Moreover, you can actualize in your ventures from the more typical thermoplastics to Flexibles, Nylons, Polycarbonate and others. It has huge form envelope of 8″ x 10″ x 8″and because of its open body, you will see that this printer can get very uproarious now and again.

Intended to be as low upkeep as could be allowed, the M2's printer carriage contains circling metal balls used to make a solid and exact direct movement. The X and Y direct rails are solid and exact, the pivot mounts are made of dark anodized aluminum. Displaying a firm aluminum manufacture plate and cleaned hardened steel shafts, this 3D printer is certainly a case of wonderful current building. Regardless of what you toss at it, the M2 will continue stopping ceaselessly lovely prints without disappointment.

On account of its best mounted direct fiber drive and the expanded soundness of its thick metal edge, the printing speed is exceptionally amazing, effortlessly outperforming different printers. This, obviously, relies upon the multifaceted nature and nature of the task yet at the same time, a great outcome in any case. Speed is one angle however a 3D printer must be exact keeping in mind the end goal to precisely enliven an advanced outline. The client selectable Z layer exactness can get as low as 0.0025 mm in spite of the fact that the proposal is to keep it somewhere close to 0.1 and 0.25 mm. The spout size of 0.35 accomplishes that additional fresh detail.

Investigating the product side for this printer you can rest guaranteed that you're in great hands. There is a well ordered guide and instructional exercise video that, as per MakerGear, will take you through your first tasks. To give adaptability and adaptability the M2's product is open-source however some further developed clients may encounter a slight absence of ease of use now and again thus to achieve the most extreme capability of this printer you will presumably need to obtain a more expert programming, for example, Simplify3D.

At a marginally higher cost than different contenders, the MakerGear M2 legitimizes this cost through its exceptional development, dependable task, and general astounding printing. On the off chance that this appears as though what you're searching for, you won't be disillusioned with this venture as the measure of effectively printed tasks will unquestionably improve the cost in time. Produced to engage the two experts and specialists by offering prevalent unwavering quality and exactness, the M2 is with everything taken into account an extraordinary arrangement.

Particulars:

FDM Printer

Extensive variety of materials

25 microns min layer

1 Extruder

80-200 mm/s speed

Open Source

Warmed Platform

USB, Ethernet

5. LulzBot TAZ 6 3D Printer

Going for a regularly extending market, Aleph Objects, the organization behind LulzBot attempts to conquer any hindrance between machines expected for proficient clients and those situated towards a more easygoing fragment of specialists. Their TAZ line of items has now achieved the sixth era and is being produced definitely to encourage developing private companies and different experts.
Similarly adaptable and very profitable, the TAZ 6 from LulzBot will take care of business with supported exertion keeping pace with modern level undertaking requests. It's very clear there have been a couple of penances in regards to style however the gadget works on account of utilitarianism compensating for its looks with proficiency and quality printing. One thing the TAZ 6 enhances over the past renditions is the expansion of mechanized highlights that guarantee a much smoother pre-printing process. Coming now with a robotized bed leveling implies that setting up and adjusting the TAZ is presently simpler than at any other time. There's additionally a little felt cushion which deals with cleaning the extruder of any residual fiber bits before a print that can conceivably demolish a model. With an extensive form envelope of 280mm x 280mm x 250mm, you have a great deal of room for your tasks. The measure of room the TAZ offers is one of the greatest in its value extend for the buyer part which is a major in addition to. There is an extensive variety of materials accessible to be utilized with the TAZ 6 from the exemplary ABS and PLA to some more refined fibers, for example, conductive PLA and ABS, Nylon, Alloy 910 and Polycarbonates.

To convey awesome quality prints and a quick print speed, it's important to actualize a durable casing with sufficiently solid pivot and direct bearing and that is precisely what LulzBot went for when planning this machine. On the off chance that I were attempting to articulate this present printer's development as precisely as conceivable I could presumably say that it's constructed like a tank, with a stone strong metal body that will beyond any doubt inspire any tested client with its solidness. Does this really convert into quality printing abilities? As far as completed quality, the LulzBot makes exceptionally point by point prints for a FDM printer and you can be charmingly astounded to perceive how astonishing a few articles turn out. The speed is likewise keeping pace with contenders at around 200mm/s however this relies upon a few elements and for the most part, clients may lean toward quality over speed.

Where the TAZ 6 really surpasses all desires is unwavering quality, which eventually ought to be viewed as the most problem that needs to be addressed that cutting edge 3D printers confront nowadays. Two angles must be considered while assessing a printer's unwavering quality. One is the consistency, to have the capacity to print brilliant things continually and the second one is the disappointment rate for a print. As per LulzBot, they assert that the TAZ 6 is the most solid customer 3D printer available, an announcement sponsored by the way that they're running day in and day out their printers at their central command situated in Colorado. This claim is astonishingly precise as the machine can run for all intents and purposes relentless with no real inconvenience conveying consistent quality. This is certainly an item worked to last.

Being stacked with such a significant number of premium highlights, it wouldn't be a distortion to state that the TAZ 6 is as of now the best 3D printer cash can purchase. On the off chance that you have the monetary allowance required, this is surely more dependable and less demanding to use than its forerunners. All things considered, this is pass on the best venture you can make in a purchaser 3D printer.

Determinations list:

Rich measure of materials good with

50 microns min tallness and 500 microns max

200mm/sec speed

Open Source

Warmed Platform

No controls on printer

SD card

Best 3D Printer for the Money

6. Sindoh 3DWOX DP200 3D Printer

Having some expertise in 2D printers and copiers since 1960, the Korean based organization Sindoh has pulled in consideration in the 3D printing industry with a smooth, highlight rich printer called DP200 3DWOX. The gadget is worked considering openness, went for purchasers searching for that sort of fitting and-print encounter you would anticipate from 2D printers however with the cool elements of a 3D one.

At a first look, you can see that this printer appears as though it would fit well in a lounge room because of its dark advanced outline that establishes a rich connection and gives it a noble vibe. Its encased structure keeps up a predictable temperature and keeps all the moving parts inside for safe task while additionally diminishing the commotion level for a more lovely print involvement. The 3Dwox has a fairly unassuming form territory yet it compensates for it in different perspectives.

An invited include is the fiber autoloading. Changing the fiber physically can turn into a troublesome strategy however with the 3Dwox you should simply embed the cartridge and the printer takes every necessary step for you. It can utilize either ABS or PLA fibers and because of the mechanized leveling framework there is never again a requirement for manual alignment. Ensuring the print bed is superbly level can likewise demonstrate a test with a few printers however no issues with this one. Printing easily is additionally enhanced by ceaseless warming of the construct stage which makes for a fast startup. Regardless of utilizing a setting of rapid/low quality, the prints can turn out of the blue smooth and with promising moment points of interest. Enormous props for Sindoh, the print quality is extremely fulfilling.

To supplement well the fastidious interior format of the machine, there is a 5" contact screen board intended to be exceptionally instinctive to control the printer. You can see a picture of your undertaking being printed and screen the advance of the print. There is likewise an intriguing element with respect to the observing of your print. Sindoh executed a camera and LED lighting for remote observing, so you're ready to see your thing getting imprinted on the screen of your tablet or cell phone. This is quite advantageous thinking about the long length of a few tasks. Other than the basic UI, you will be enchanted to discover a few choices for network. The 3Dwox can be associated specifically to a PC through the included USB link or utilizing Ethernet or Wi-Fi and a USB Flash Drive for ventures in a hurry.

The cost of this 3D printer is moderately low considering all these ground-breaking capacities and particularly in the event that you consider how simple is to utilize. No-nonsense, DIY unit building tinkerers may look somewhere else as this amazing printer fits best in the hands of more easygoing 3D printing devotees. The Sindoh DP200 3DWOX 3D Printer is an all around adjusted gadget with an interest to a specific section for the individuals who incline toward a more moderate, smooth plan and substantial help for effective and quality printing. In the event that you get it you can make sure you'll be awed.

Determinations list:

FFF technonlogy

Single Nozzle

PLA and ABS materials

Can associate with a wide cluster of gadgets and embellishments like Flash Drives

1.75mm diammeter for fiber

Contact Screen

Auto and manual leveling

Consequently stacks cartridge

Quality: ☆ ☆☆

Best 3D Printer Kit

7. DIY RepRap Guru Prusa I3 V2 3D Printer Kit

Outfitted towards innovative specialists, the Prusa I3 3D printer is seemingly the most prominent 3D printer on the planet. Furthermore, there are some extremely solid explanations behind that. The fundamental one would be the way that it's completely open source being created for the RepRap task and anybody learned and sufficiently decided can manufacture a printer at an exceptionally available cost. Most RepRap DIY units can be obtained for under $500 which is surely exceptionally moderate for a 3D printer.

Building a printer from zero can be a testing assignment as you have to accumulate heaps of parts exclusively and the cost can without much of a stretch include. Gratefully, the Prusa I3 unit exists unequivocally to disentangle this undertaking. The genuine work you need to do to gather the segments relies upon how much learning you have and regardless of the underlying impression, the aides are exceptionally far reaching and in a couple of days, you can have a printer that you fabricated yourself. It's useful for novices and in case you're on a financial plan, yet there are additionally different focal points to purchasing a DIY pack like the Prusa I3.

One angle you ought to consider is the way you pick up an extremely insinuate learning of how all parts connect and work together. On the off chance that you truly have an enthusiasm for the astonishing designing behind the workings of these machines is unquestionably justified regardless of an opportunity to get acquainted with the way toward breathing life into a 3D printer. In case you're new to 3D printing this is the approach in the event that you simply need to try out the innovation without burning through a huge number of dollars. There is additionally the likelihood of overhauling and changing the printer in spite of the fact that you can get OK prints without essentially doing that yet it's pleasant to realize that you have this choice.

On the off chance that you think you have what it takes to set out on the trip of collecting your own 3D printer then the RepRap Guru Prusa I3 is certainly extraordinary compared to other decisions available at this moment. The pack is faultlessly arranged for you, it doesn't require adjusting, penetrating or cutting anything. All the diligent work is done and they even incorporate all the fundamental wires and the 8″ x 8″ Borosilicate Heat Bed Glass Solder which is absent from different units. Likewise, in case you're stressed over the tinkering and setting it up ideal, there is a lot of data accessible on the Internet and an inviting network to kick you off.

There is not really whatever else to include, this is a moderate unit, somewhat troublesome now and again to collect yet after some learning, you will find that it's flawless, the parts are of high caliber and as a result of that it holds out extremely well and utilizing it can really be a fun affair. The odds of disappointment are low to print and the outcomes are typically incredible and even without the unbending nature of the more costly and industrially accessible machines, it doesn't baffle. To abridge, this unit offers a great deal at its cost and it has some huge innovative potential for the individuals who are simply beginning to get into 3D printers.

Determinations list:

ABS and PLA

50 microns min tallness for layer

Open Source

Warmed Platform

USB

Best Budget 3D Printer

8. QIDI TECHNOLOGY 3DP-QDA16-01 Dual Extruder Desktop 3D Printer

In view of the MakerBot Replicator 2X, Qidi Technology offers comparative highlights however at a much lower cost. Regardless of the coveted utilize, whether you're pretty much educated around 3D printers, this machine can fulfill your necessities.

The element that stands the most and which is in that spot in the title is the Dual Extruder capacity of this printer yet that is not all. This gadget comes joined in a full metal casing with shower paint innovation for additional adjustment amid the printing procedure on account of its additional quality. It gives a completely encased consistent temperature for the best outcomes particularly when printing with ABS fiber. The manufacture measure is more than satisfactory and the printer bed is warmed. What I enjoyed, specifically, was the way the plate is built utilizing flight review aluminum to keep twisting from high temperatures.

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The latest trend in mental health care

I’m heartened to see more public discourse about the pain of miscarriage. Recently, Mark Zuckerberg, the CEO of Facebook, went public on his Facebook page with the pregnancy losses that he and his partner suffered. Beyonce and Jay-Z wrote a song about their first pregnancy loss. Nicole Kidman, Mariah Carey, Celine Dion, Courteney Cox, and Brooke Shields have all publicly shared their miscarriage experiences. But all too often, I still find women and their partners suffering in silence and alone.

Recently, researchers at Albert Einstein College of Medicine in New York City surveyed over, 1,000 adults in the United States to determine what the general public knows about the causes of miscarriage and its emotional effects. Their results were published earlier this year in a paper called “A National Survey on Public Perceptions of Miscarriage.”

Fifteen percent of those surveyed said that they (or a partner) had experienced a miscarriage. Over half of the respondents believed that miscarriages were uncommon, even though studies show that approximately one in four pregnancies ends in miscarriage. Over three-quarters of respondents thought miscarriage resulted from stress, and over a quarter also thought that the most important causes were lifestyle choices made during pregnancy. But in fact, most miscarriages are the result of chromosomal abnormalities in the developing fetus, structural abnormalities of the uterus, or endocrine or autoimmune disorders in the mother.

To me, the most striking part of the survey was that many of those who had experienced a miscarriage reported feeling that they had done something wrong, and that they felt alone and ashamed. However, when their friends disclosed their own miscarriages to them, they felt less alone. They also felt less isolated when celebrities disclosed their miscarriages.

While it’s great that so many public figures have spoken up about their own miscarriages lately, the study results make clear that we still need to get discussion of miscarriage out of the closet. Here’s the advice I always give my patients who have experienced a miscarriage:

    Nothing you did caused this miscarriage, and nothing you could have done would have prevented it.
    Even if you had been perfectly still in bed, were totally relaxed, and ate nothing but healthy foods, you would still have had a miscarriage.
    You will be surprised at how many of your close friends and family members have experienced miscarriage. Share this experience with them.
You and a large number of others around the globe definitely know how it goes: in PlayerUnknown's Battlegrounds (AKA PUBG) up to 100 players skydive down to one of three unmistakable islands, rummage for apparatus, and race against a consistently shutting circle to murder one another (with no respawns) until there's only one remaining standing. PUBG is the amusement that commenced the fight royale furor with its incredible, semi-practical style of interactivity, and since the Xbox One form is conclusive and performs well, its fantastic parity truly radiates through.
PlayerUnknown’s Battlegrounds Xbox One camo
With the 1.0 update that arrived a week ago, PUBG on Xbox One shakes off its janky notoriety from the Xbox Game Preview form and is at long last a strong adaptation of the now second-most prominent fight royale shooter. Casing rate stammers a bit in the entryway region and amid hops, yet other than that it once in a while experiences difficulty holding 30 outlines for each second on a standard Xbox One, and association issues or disengages are uncommon. I've been playing on a standard Xbox One the visuals are a detectable minimization contrasted with the PC rendition, however I haven't had numerous issues other than certain structures setting aside additional effort to completely render.

PUBG on Xbox One additionally now has each component of the PC form. When jumping into a match you can do as such either in first-individual just or third-individual of course (with first-individual as an alternative) so you can quit individuals utilizing the improbable preferred standpoint of looking around corners in third-individual. You can likewise convey a performance soldier, with an accomplice in Duos, or with a full squad of four players. While gathering with irregular individuals is in fact conceivable, in my experience a great many people seldom utilize a mic, which is very baffling in an amusement that requires clear correspondence and cooperation. You'll truly need to discover a gathering of companions to play with in this one.

PUBG is an orderly and strategic experience.

Contrasted with other fight royale shooters – and explicitly Fortnite – PUBG is an efficient and strategic experience, one that is as much about keeping away from battle until you're certain you have the advantage all things considered about really scoring slaughters. That makes the highs considerably more elating yet additionally the lows can be horrendously exhausting. Digging in behind spread while enduring an onslaught by a foe squad, getting out bearings on the compass to colleagues to endeavor to arrange a flank, or insanely snickering when things turn out badly underscores what makes the fight royale sort so fun. Yet, given the measure of the three maps and moderate pacing, you may have amusements that extend for more than 20 minutes while never observing a solitary individual and after that get shot in the head by a peak expert sharpshooter – those runs are too disappointing.

Since PUBG has a considerably more sensible tone, there's no mysteriously assembling dividers out of nowhere, catching snares, rocket launchers, or Thanos hybrids to be found here. Rather, each bit of apparatus you find is set semi-coherently in structures around the dystopian scenes. You begin without any things by any stretch of the imagination, however everybody has a similar two essential weapon openings, sidearm space, throwable opening, and capacity/protection spaces. Rucksacks, body reinforcement, and head protectors are on the whole layered from Level 1 to Level 3, yet each weapon is made indistinguishably to different firearms of its sort. So there aren't diverse shading coded irregularity levels between various AKMs or M416 rifles; rather, you discover connections to improve your weapons through the span of the match. The incredible thing about this framework is that it boosts you to always plunder and discover better apparatus, up until you're close to the end – which is the point at which you're enticed to chance everything by presenting yourself to go for one of the air-dropped plunder boxes containing top of the line rigging and weapons. PUBG's increasingly genuine tone isn't as open, however its durable demeanor and solid center reason integrate everything astoundingly well without inclination unsavory.

This implies there is a harder expectation to learn and adapt if this is your first fight royale shooter, particularly thinking about that every one of the three maps are definitely not the same as one another. The first guide, Erangel, is a cutting edge island loaded with communities, an army installation, staggered jail, emergency clinic, school, and more as its key tourist spots. Indeed, even now, with two different maps in revolution, Erangel is as yet my top choice. The speed at which the circles shuts, the parity of vehicle brings forth, separate between structures, trees, and other spread focuses, all vibe pretty much immaculate. Obviously, this guide has been out the longest and got the most love and consideration.

Indeed, even now, with two different maps in turn, Erangel is as yet my top choice

At that point there's the desert map, Miramar. While it's really a similar by and large size as Erangel, the forsaken scene, absence of vegetation, and general summary tasteful make it feel a lot bigger, which is at first great, yet it additionally appears to be substantially more unfilled, which sucks. Vehicles feel more diligently to drop by and, as a rule, you can spot foes running over the strict desert a mile away. That surely expands the strain and uneasiness since you generally feel uncovered, yet it regularly ends up turning into an instance of who finds the best haphazardly put extension as opposed to real ability in a firefight. Hence, Miramar is effectively my least top pick.

The direct inverse end of the range is the third and latest guide, Sanhok. It's a wilderness domain loaded with rich greenery and tropical lodges that is decisively a large portion of the span of the other two maps. Since a similar number of players are dropped in spite of the size distinction, that implies much more shots begin flying significantly more rapidly here. Close to landing you'll most likely observe somebody, regardless of how far expelled you think you are from the plane's flight way. The drawback to Sanhok is that the frantic dash to discover a firearm toward the begin and take out your neighbors can frequently abandon you feeling exposed in the event that you don't get fortunate with a plunder drop, yet on the off chance that you can make it past the underlying cleanse it's a perfectly structured guide that feels like a consolidated variant of Erangel. If that wasn't already enough, the new QBZ submachine weapon, which is selective to Sanhok, showers slugs like it's no one's matter of fact, and I adore it. Each guide has a portion of those select things, weapons, vehicles, and other minor changes, however the pacing and movement over each is commonly the equivalent.

When the circle gets additional little everybody begins playing all the more circumspectly, since you can expect those left alive have the same amount of if not more capability than you do. The pressure of a PUBG coordinate that just has 10 or 15 individuals left is substantial, making it addictive to watch and much more so to understanding.

PUBG likewise sports a Fortnite Battle Pass-enlivened discretionary Event Pass DLC. As you play, you gather XP and complete difficulties that add to your dimension close by the comparing occasion or regular period. On the off chance that you purchase the Event Pass whenever, at that point all already "opened" skins and things will be given to you, just as every future thing you increase through playing. Since you're as of now paying for PUBG itself, in which you acquire in-diversion money to buy cases loaded with customization choices as of now, the Event Pass doesn't feel like that extraordinary of an esteem. It's basically an instrument to get you to play more, for longer timeframes, with increasingly explicit objectives and goals that assistance keep things new. In any case, I'm attempting to locate a valid justification to purchase in since I as of now get such huge numbers of arbitrary corrective things with the standard rendition of PUBG.

The real contrast between PUBG's Event Pass and Fortnite's Battle Pass is that Fortnite's whole shake royale mode is generally totally allowed to play. Therefore, paying a little expense for additional opens and rewards doesn't feel like a major ordeal, and what you get is really a decent esteem. PUBG, then again, is a paid diversion that likewise offers a paid DLC go to gain additional in-amusement rewards. While it's absolutely discretionary and fundamentally only for beauty care products, the entire thing feels somewhat yucky by correlation.

THE VERDICT

PUBG v1.0 on Xbox One runs easily, highlights three inconceivably unique maps, and incorporates a huge amount of weapons, rigging, and things to use in the deadliest internet diversion. Its interesting image of tense, reasonable shooting blended with moderate paced strategic battle figures out how to remain new and energizing even after many matches. It makes returning for another endeavor at a "chicken supper" triumph hard to stand up to.

It's at last time. After many long periods of catching wind of the enchantment of PlayerUnknown's Battlegrounds, Xbox One players can encounter the marvel since a beta variant of the amusement has propelled on the Xbox One Game Preview program, Microsoft's response to Steam Early Access.

In the event that you aren't among the 20 million players who've gotten the diversion since it propelled on Steam Early Access in March, here's the speedy pitch. PlayerUnknown's Battlegrounds is a profoundly aggressive first-or third-individual shooter that centers solely around a solitary amusement mode, "Fight Royale." Each PUBG coordinate opens with 100 unarmed players hopping out of a plane onto a huge, open guide. When they land, it's dependent upon them to discover weapons and take every other person out. The last individual standing gets the success, or as the diversion likes to state, "Champ Winner Chicken Dinner!"

Allows simply get this off the beaten path. The Xbox One port of PlayerUnknown's Battlegrounds is a mediocre adaptation of the diversion. It doesn't have key highlights found in the PC form, and doesn't run well on any variant of Xbox equipment. Regardless of that, the center PUBG experience stays unblemished. Its still feels makes serious yet strategic, rushed yet fun. Win or lose, each experience will get your adrenaline siphoning.

Dull, soft Clouds

While the "completed" adaptation of PUBG dispatches on PC this week, the Xbox One form will probably remain in beta for years to come. On a specialized dimension, the Xbox One rendition of PUBG feels like an a lot prior, harsh cut variant of the diversion. System issues lead to periodic hitching and smashing. While a few impacts, similar to blasts, look superb, numerous fundamental components look muddied.

To top it all off, the diversion experiences difficulty stacking the amusement map rapidly, particularly directly toward the beginning of each match. In a match's opening minutes, you'll see land includes fly in as the plane flies in overhead. When you've hopped, you regularly land to find that the surfaces on the encompassing structures have not stacked yet. The world is, for a period, spotted with intuitive heaps of mush.

Each experience will get your adrenaline siphoning.

These issues can practically affect how you play. Chancing upon another player in the opening snapshots of a match ends up precarious in the event that you can't dash to the closest house (and probably the closest firearm). Clever players would be shrewd to change their methodologies to represent these potential hang-ups right off the bat.

In spite of the fact that the amusement is in "see" mode, and obviously set apart as incomplete, the specialized issues come as somewhat of a stun. Neither Microsoft nor the PUBG Corporation showed that the amusement would be not so great, and a bolted 30 outlines for every second should be conceivable. The diversion doesn't look sufficient to legitimize execution issues.

What does this catch do?

When you move beyond the specialized hang-ups, the greatest contrast between playing on PC and Xbox is the controller. In the same way as other recreations structured explicitly for PC, PUBG requires such a large number of contributions for a controller to deal with normally. To gather things into a controller-accommodating arrangement, the amusement depends on the full arrangement of data sources, including the D-Pad, and certain catches work diversely relying upon whether you tap or hold them. For instance, tapping the left trigger empowers point mode, which gives you a chance to glance through your extension, yet holding the trigger in third-individual mode changes to an over-the-bear see that steadies your point.

So also, a few parts of the first amusement were planned explicitly to work with a mouse. PUBG utilizes menus to oversee gear and utilize logical things, and players must do as such rapidly. There is no "time out" in multiplayer recreations, and players who wait in menus will in general get their heads brushed off.

A large portion of the progressions function admirably, when you become familiar with the ropes.

On Xbox One, PUBG streamlines the procedure of preparing and swapping connections. Instead of moving forward and backward between your gear and your stock with the LB and RB bear catches, you can just tap A to feature a thing you need to prepare, and the amusement consequently flips between the particular thing openings you can choose. Two fast taps, and you're ready. That is a trap we're certain PC players wouldn't see any problems with having.

A large portion of the progressions function admirably, when you get familiar with the ropes, yet getting to that point can be troublesome. The diversion has no presentation or instructional exercises, so it's on you to peruse up and make sense of things. On PC, leaving players to show themselves how to play is genuinely normal practice, yet it's a poor decision on reassure. PUBG's propelled controls are definitely not instinctive.

Silver Lining

While PlayerUnknown's Battlegrounds doesn't function admirably on Xbox One at the present time, there are signs the amusement's specialized issues are improving. Indeed, even following multi week, there's much less hitching, and less execution hiccups. Despite the fact that the surface fly in we portrayed before is as yet present toward the beginning of each match, the guide stacks more rapidly than at dispatch.

We additionally discovered that the additional power in the Xbox One X has a recognizable effect on execution in PUBG, at any rate for the present. Playing on a Xbox One X prompts you to pick between boosting framerate or goals. We found that organizing framerate keeps the amusement running easily. Despite your decision, the fly in issues at the beginning of each match appear to determine a quicker on One X, and are more averse to affect your diversion.

These are provisos, and don't pardon the diversion's execution issues, or propose you should purchase an amusement that isn't done. All things considered, we've delighted in investing energy with the Xbox One variant of PUBG, which is demonstration of the diversion itself.

PUBG has was never a visual exhibition or a specialized wonder on PC. Its prosperity lies in its capacity to suck you in with serious, exceptional ongoing interaction. Inasmuch as Microsoft and the PUBG designers invest the energy to streamline the amusement, there's no reason the Xbox One adaptation of PUBG can't be just as enrapturing as the first.

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Can the weather really worsen arthritis pain

Pediatricians and child behavior specialists who work with teens know that adolescence is an incredibly important time for social growth. Yet these years can be fraught with anxiety for the parents of teens. How will you know if your moody teen is hanging out with the right people? Which friends might be a bad influence? How can you help your son or daughter develop healthy relationships?

Recent research has addressed some aspects of these questions. One study entitled “Spreading of healthy mood in adolescent social networks,” published this year in the Proceedings of the Royal Society of London, investigated whether a teen whose friends have a healthy mood is less likely to be depressed. It also looked at how emotionally healthy friends affected a teen’s recovery from depression. Basically, the researchers wanted to find out: is a good mood contagious?

The study involved roughly 3,000 teens. Each study volunteer completed two surveys, six months apart, in which he or she listed up to five male and five female friends. Each teen was then followed over time, to see how his or her mood changed.

One of the interesting things about this study is that these researchers defined depression as a behavior, not necessarily as a disease that someone could get. This allowed them to do their statistical analysis a little differently from previous studies looking at the same subject matter, and it uncovered the potential power of positively minded friends.

The investigators found that having a social network made up of friends with a healthy mood cut a teenager’s probability of developing depression in half over a 6- to 12-month period. It also significantly improved the chances of recovering from depression for teens who already suffered from it. While the data don’t show a direct cause and effect, this study does suggest that having friends with a healthy mood may reduce the risk of depression and make it a little easier to recover from depression should it occur.
Surprising findings on from social networking research

This study is a nice example of a recent trend in epidemiology — using data about an individual’s social network to learn things about that person. This type of research has led to numerous interesting findings, and has really shaped an entire new area of inquiry. A study published in 2007 in The New England Journal of Medicine was one of the first of this kind. It showed that people who had obese friends and family were themselves more likely to be obese. Since then, additional research has looked at how social networks influence an individual’s risk of developing (or sidestepping) specific health conditions, such as obesity, smoking, and depression.

Results of these studies have been, at times, surprising, thus giving the medical community valuable new information. For example, I myself led a study in 2011 called “The influence of social networks on patients’ attitudes toward type II diabetes.” When I started this research, I supposed that patients would be less concerned about having diabetes if more of their friends and family members had diabetes. I had guessed that these patients might have become so used to the idea of diabetes that the disease would seem common and almost normal. But in fact, my team found the opposite! Patients with a higher prevalence of diabetes within their social networks expressed greater concern about their illness. This unexpected result gave me information that helped me to better take care of my patients.
Using social network data to improve your teen’s mental health

This type of research is not only helpful to doctors, but it also provides important information for anyone trying to improve his or her own health, or the health of one’s family. The study on positive mood in teens’ social networks suggests that parents may be able to reduce their teen’s chances of developing depression — or improve her or his mood if she does have depression — simply by promoting and supporting friendships with emotionally healthy peers. With much controversy about using antidepressants in teens, results such as these can give parents a simple way to promote emotional health and well-being in their adolescent children — with no medications involved. Soon after his shootout with police in 2013, one of the suspected Boston Marathon bombers was taken to an area hospital with serious injuries. A reporter covering the story described how, despite the heinous crimes of which he’d been accused, doctors would work hard to save his life because they’d taken an oath to do so. I knew she was referring to the Hippocratic Oath. But I also knew she was wrong.

There was a good chance that these doctors had never taken the Hippocratic Oath, but even if they had, there’s nothing in the oath that specifically obligates them to provide care for suspected criminals.

Perhaps it should, but it doesn’t.

In fact, the modern-day Hippocratic Oath covers only a few issues relevant to the ethical practice of medicine. It does cover some important stuff. Some of that stuff is controversial, and has been liberally revised. But plenty is simply left out from the original.
What is the Hippocratic Oath?

The Hippocratic Oath is named after the ancient Greek physician Hippocrates. He is widely considered to be its author, although its true origins are uncertain; it may have been written by one of his students or by more than one person. It represents a time-honored guideline for physicians and other healthcare professionals as they begin or end their training. By swearing to follow the principles spelled out in the oath, healthcare professionals promise to behave honestly and ethically.

Those taking the “original” Hippocratic Oath promise to:

    respect and support their teachers
    share medical knowledge with others who are interested
    use their knowledge of medicine and diet to help patients
    avoid harming patients, including providing no “deadly medicine” even if requested to do so
    not provide a “remedy” that causes an abortion
    seek help from other physicians (such as a surgeon) when necessary
    avoid “mischief,” “injustice,” and “sexual relations” during visits to patients’ homes
    keep patient information confidential.

More modern revisions have avoided any mention of abortion and, as in a popular 1964 revision (by Dr. Louis Lasagna, a physician at Johns Hopkins University), treated euthanasia with more nuance:

“…it may…be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”

In addition, Dr. Lasagna encouraged a holistic and preventive approach to care:

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure.”
What’s missing?

Today’s doctors face a number of important ethical issues that are not included in the Hippocratic Oath. For example, it makes no mention of:

    honoring patients’ preferences
    sharing medical information with patients
    avoiding conflicts of interest, such as profiting by ordering unnecessary tests or treatments
    protecting patients who enroll in research studies
    treating all patients equally, regardless of ability to pay, social class, education, race, or suspicion of criminality
    avoiding the practice of medicine while impaired (due to physical or psychological disease).

Who takes the oath?

According to a 1989 survey, barely half of U.S. medical schools used any form of the Hippocratic Oath and only 2% used the original. In a 2011 study published in the Archives of Internal Medicine, about 80% of practicing physicians reported participating in an oath ceremony, but only a quarter felt that the oath significantly affected how they practiced.
Beyond the Hippocratic Oath

In the United States, when newly matriculating medical students are draped in their freshly starched white coats, an oath of some kind is often read as part of the ceremony. But there is far more for these new trainees to learn and understand than a passage as brief or as ancient as the Hippocratic Oath could capture. Today, health professionals routinely encounter ethical challenges in modern clinical practice. Rather than rely on well-intentioned but outdated principles, they must call upon their experience and training, widely-accepted modern guidelines, the advice of mentors, and their personal sense of right and wrong to figure out what to do. Fortunately, there are many useful resources beyond the Hippocratic Oath to help guide them in the right direction. In the 1890s, a Shakespearean actor named Frederick Matthias Alexander set out to discover why he often lost his voice when he performed. (Imagine yourself as a Shakespearean actor, completely dependent on your voice to pay your bills, finding yourself without a voice just when you needed to perform!) Needless to say, Alexander had to figure out why this was happening.

He began by observing himself in multiple mirrors while he prepared to perform. Indeed, he did discover that something changed prior to his speaking: He was contracting the muscles in his upper body, especially his neck, so strongly that his entire posture changed. He theorized that his voice loss could be a result of his disrupted posture.

Fortunately, his guess turned out to be correct. When he was able to release the tension in his muscles with a variety of movements, not only did his voice loss resolve, but he was able to change the habit he had developed of contracting his neck. As he continued to refine and improve his methods, Alexander realized they could help others improve their health and well-being. His discoveries, which have since been codified into the Alexander Technique (AT), are still in use today.
How is the Alexander Technique used today?

Today, AT is considered a mental discipline that teaches individuals how to let go of tension in the body and how to enable the body to move with ease and minimal effort. AT is used to treat a variety of conditions, from musculoskeletal pain and repetitive strain injuries to breathing problems, voice loss, and sleep disorders. Many artists, musicians, dancers, singers, and actors use AT to help enhance their performance. The purpose of AT, ultimately, is to enable individuals to methodically unlearn maladaptive (negative) habits — which can show up in the way we stand, sit, eat, walk, or talk — and instead learn how to return the body to a relaxed, balanced state of alignment and poise.
Is AT for you?

But you don’t have to be a musician or dancer to benefit from AT. Here’s just one example: You, like most of us living in today’s world, spend much of your time on a computer or checking your smartphone for emails and texts. This means you spend much of your time looking down, rather than straight ahead, the way your vertebrae were designed to support your head. Keeping your head bent down for long periods puts continual strain on the large neck muscles, which are meant to normally be lax. In contrast, the small neck muscles (which are meant to hold up your neck vertebrae) are not being used and are therefore lax. The result is that your vertebrae lose their support, so that you end up not only with neck stiffness or pain, but possibly some degeneration in your cervical spine, too.

AT can address this habitual contraction of the neck and teach you how hold your phone, how to position your head, and ultimately, how to re-establish better posture and ease in your body.
Is there science to support AT?

A recent randomized controlled study published in the Annals of Internal Medicine found that Alexander Technique lessons led to significant reductions in neck pain over 12 months, compared with usual care. (Interestingly, the study also found that acupuncture reduced pain as well, compared with usual care.)

Another interesting study published in the medical journal BMJ in 2008 tested a variety of treatments for back pain. A total of 579 patients with chronic or recurrent low back pain were randomly divided into four groups. The first group were given “normal care” (that is, they were the control group). The second group received massages. The third took six Alexander Technique lessons. The fourth group took 24 Alexander Technique lessons. Half of each group also received a prescription for exercise (primarily walking) from a doctor, plus behavioral counseling from a nurse. The results showed that the patients who had AT lessons along with an exercise plan improved the most. In addition, this combined intervention was also the most cost-effective (in particular, taking six lessons combined with an exercise plan).
What does this mean for you?

Proponents of the Alexander Technique would tell you to start paying attention. Pay attention to your posture — the way you walk, talk, sit, stand, or generally do anything, even lifting a forkful of food to your mouth. If you are like most people, your body is likely stuck in tense muscle patterns that may be causing you myriad problems, from back pain to headaches to possibly even anxiety. It may behoove you to unlearn these stuck patterns so you can move through your life with more ease — and much, much less pain.

If you’re interested in Alexander Technique lessons, the American Society for the Alexander Technique can help you find an instructor. If you have arthritis, you may have noticed that the weather affects your symptoms. I hear it from my patients all the time.

If it’s true that the weather can worsen arthritis pain, how does that work? Is there any scientific evidence to explain it? People have been asking these questions for many years without finding good answers. But that’s not keeping researchers from trying to understand it better.
What we (think we) know

Past studies examining the effect of rain, humidity, and other weather-related factors on symptoms of arthritis have been inconclusive, and in some cases, contradictory. Some suggest that the key variable is rising barometric pressure. Other studies found just the opposite — that falling pressure could provoke joint pain or stiffness. There have even been attempts to artificially vary environmental conditions to mimic weather changes, such as placing arthritis sufferers in barometric chambers and varying the pressure up and down.

Despite this, we still don’t know whether it is one particular feature of the weather or a combination of features that matters. There are many potential factors — humidity, temperature, precipitation, and barometric pressure among them. Even if we could precisely identify what about weather affects arthritis pain and stiffness, we’re still not sure why — biologically speaking — weather should have any impact on joint symptoms.

Having reviewed the studies, I find myself not knowing how to answer my patients who ask me why their symptoms reliably worsen when the weather is damp or rain is coming, or when some other weather event happens. I usually tell them that, first, I believe there is a connection between weather and joint symptoms, and second, researchers have been unable to figure out just what matters most about the weather and arthritis symptoms or why there should be a connection.
The newest studies

In just the past year or so, two new studies have weighed in on the question of whether weather has an impact on arthritis symptoms. And both found that yes, indeed, weather matters!

In the first study, Dutch researchers enrolled 222 people with osteoarthritis of the hip — the most common, “wear-and-tear” type of arthritis — and compared their reported symptoms with a variety of weather variables. They found that over a two-year period, pain and stiffness were slightly worse with rising barometric pressure and humidity, although the overall average impact was small. The second study included more than 800 adults living in one of six European countries and who had osteoarthritis of the hip, knee, or hands. Although changes in weather did not seem to affect symptoms, higher humidity was linked with increasing pain and stiffness, especially in colder weather. So, while these studies varied in the specifics, we now have a bit more evidence linking weather to joint symptoms.
So what?

It’s a fair question. After all, even if we could prove a clear and powerful impact of weather on symptoms of arthritis, how is that helpful to know? It’s not as if doctors are likely to suggest that a patient move to a more arthritis-friendly climate. It’s even less likely that patients would follow such a recommendation. Until we can control the weather or our internal environments with precision, these new studies probably have little impact for the individual arthritis sufferer.

However, identifying a link between a particular type of weather and joint symptoms might help us understand the causes and mechanisms of arthritis symptoms. And that might lead to better treatments or even preventive strategies. In addition, figuring out why some people seem to feel worse in certain circumstances while others notice no change (or even feel better) in those same environments could help us understand subtle differences between types of arthritis or the ways individuals respond to them.
“Everyone keeps talking about the weather…

…but no one is doing anything about it.” That’s an old line but, of course, there’s truth to it. But even if weather does affect the symptoms of arthritis and there’s nothing that can be done about the weather, that doesn’t mean there’s nothing to be done about the arthritis! There are more treatment options than ever before, with and without the use of medications. If you have significant and persistent joint pain, stiffness, or swelling, see your doctor — rain or shine.

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Dangers of body Pain oin your health

When you think of clinical depression, you probably think of feeling sad and down for long periods of time; losing your energy and your interest in things you used to enjoy; sleeping too much or too little, or eating too much or too little. But besides these, depression can actually change your ability to think. It can impair your attention and memory, as well as your information processing and decision-making skills. It can also lower your cognitive flexibility (the ability to adapt your goals and strategies to changing situations) and executive functioning (the ability to take all the steps to get something done).

For people with severe depression, medications can provide some relief of low mood and energy, bolster the motivation to engage in enjoyable and important activities, and help people return to normal sleeping and eating patterns. (Notably, antidepressants are less helpful in general for mild and moderate depression.)

But we don’t know whether antidepressant medications treat cognitive impairment related to depression. Recently, an international research team attempted to answer this question as part of a larger study on depression treatment. Their results were published in The Lancet last month.

To study the effect of three common antidepressant medications on depression-related cognitive impairment, the researchers asked over 1,000 people with depression who were taking either escitalopram (Lexapro), sertraline (Zoloft), or venlafaxine-XR (Effexor-XR) to go through extensive cognitive testing. In short, none of the medications helped. Of these patients, 95% showed no improvement on any of the cognitive impairments mentioned above, and none of the three drugs was better than the others at improving cognitive symptoms.

This result is not completely surprising — antidepressant medications are mainly meant to help improve mood and increase the ability to participate in beneficial and enjoyable activities, two key aspects of depression treatment. It’s also worth noting that different parts and processes of the brain are responsible for cognitive (versus emotional) functioning; this may explain why the three drugs tested didn’t seem to help improve cognitive symptoms. New drugs for depression may be able to address these symptoms as well.

Beyond medications, problem-solving treatment can train people how to improve their problem-solving skills, and cognitive behavioral therapy can teach people to recognize and challenge distorted thinking patterns. Another approach, cognitive remediation therapy, uses practice drills to improve memory and executive functioning. Combining these behavioral interventions with antidepressants may yield better results for improving depression-related cognitive impairments.

There are some limitations to this study: it’s not known if the participants had cognitive impairments before they developed depression, and the length of drug treatment and follow-up was short — eight weeks in total. However, this study is important because the cognitive impairment symptoms of depression have received little attention — and haven’t necessarily been the target of medications for depression. It shows that we have a long way to go in helping people with depression return to a normal level of full mental functioning.  When I was in training, one of my beloved mentors declared, “I never use a drug until it’s been on the market for 20 years.” I was young enough then that I couldn’t fathom being a doctor for 20 years, let alone waiting two decades to use a new drug. As my career has progressed, I’ve seen many new drugs released to the market. Some of them are truly miraculous, bringing people longer, healthier, and more productive lives. Many of them have not withstood the test of time. More than a few have even been taken off the market. Even though the Food and Drug Administration diligently reviews each new medicine before it’s approved for use, we often learn much more about a drug after its release into the general population.

I reflected on that memory when I read a recent editorial in The New England Journal of Medicine (NEJM) about insulin resistance. In his editorial, the author tells us of the “long, strange trip” of a class of medications called thiazolidinediones, which help people who have type 2 diabetes or pre-diabetes to be more sensitive to the insulin that they make in their bodies. (Many diabetes medications work by helping the body lower its resistance to insulin in different ways.)

When they were first released, these medicines were widely accepted and adopted. We do, after all, have an epidemic of obesity and diabetes in the United States, and they seemed to work very well for people. They seemed a great alternative to insulin, which has to be injected. Then, after about 6 years on the market, these drugs began to be linked to liver disease and congestive heart failure — and maybe even cancer. Even though longer-term studies did not show that there was a definite risk of heart attack or cancer, these drugs became unpopular and fell into disuse. We were not willing to take a chance with our patients when we had other good options.

And yet, some researchers continued to wonder if there was any safe role for these very potent medications with their many positive effects, despite the concerns. The same NEJM issue as the editorial referenced above also contains a study that showed that certain carefully selected patients might, in fact, have fewer strokes if they took a medication called pioglitazone, which is in the thiazolidinedione class of medicines. Interestingly, the patients in this trial were already on extremely comprehensive stroke prevention regimens — and still they decreased their risk of a future stroke by 24%. These patients, all of whom were at risk of developing diabetes, had a slower rate of progression to diabetes as well.

What grabbed me about this story? First, it would seem that the drugs in question are neither panacea nor pariah. Pioglitazone, in fact, might a very good drug to prevent stroke in a very select population.

But, can we define that select population? That might be the most interesting tale of the past decades. Twenty years ago, we could only guess, based on certain characteristics of a patient, whether a medication would be effective. Today, we know certain people’s genetics make them better candidates for certain medications than other people. We are close to being able to tailor a medication to the patient at the level of his or her genes. When we are able to do this in an effective, safe, and efficient way, we will be able to deliver truly personalized medicine. As a clinician, I find this truly exciting. It would be wonderful to say to a patient, “This drug might have the following side effects — but I know they won’t affect you!”

My mentor may well have been right that it takes 20 years to know how a drug works and for whom it will work. He would not be surprised by the strange story of thiazolidinediones. He would undoubtedly be overjoyed by the idea that the past  20 years of laboratory and clinical research has brought us that much closer to truly personalized care. y often caused by our thoughts, feelings, and resulting behaviors. And an exciting new study now demonstrates that treatments aimed at our beliefs and attitudes can really help.

When our back hurts, it’s only natural to assume that we’ve suffered an injury or have a disease. After all, most pain works this way. When we cut our finger, we see blood and feel pain. When our throat hurts, it’s usually because of an infection.

But back pain is different. There simply isn’t a close connection between the condition of the spine and whether or not people experience pain. Research has shown that a majority of people who have never had any significant back pain have the very same “abnormalities” (such as bulging or herniated spinal discs) that are frequently blamed for chronic back conditions. And then there are the millions of people with severe chronic back pain who show no structural abnormalities in their back at all.

On top of this, it turns out that people in developing countries, who do back-breaking labor and don’t have easy access to medical treatment, have much fewer incidents of chronic back pain than people in the developed world who sit in ergonomically designed chairs, sleep on fancy mattresses, and have ready access to spinal imaging, surgery, and medications.

Because there’s so little correlation between the condition of the spine and any given person’s experience with back pain, clinicians and researchers have begun looking instead at treatments that address the psychological and behavioral patterns that can lock people into years of suffering. And they’ve just demonstrated that two of these treatments work much better than traditional medical interventions alone.
What actually helps back pain

Last week, researchers at the University of Washington published a landmark study in The Journal of the American Medical Association that showed training people with chronic low back pain in either mindfulness or cognitive behavioral therapy (CBT) works significantly better than medical care alone to reduce both their disability and pain-related suffering. The researchers randomly assigned 320 adults, ages 20 to 70, to either an eight-week class in one of these methods, or to “usual care.” The subjects who attended the classes saw significantly more improvement in their pain and disability than those receiving usual care — and this greater improvement was still evident a full year later, when the study ended.

Mindfulness training teaches us to be aware of, and accept, moment-to-moment physical sensations of discomfort, while letting go of our usual negative reactions. So instead of spending hours each day thinking about how much we hate our back pain, worrying about our prognosis, and seeking relief, we learn how to be with the pain — paying attention to how it actually feels at each moment and relaxing our tendency to tense up against it, while observing our worried or distressed thoughts and feelings coming and going.

CBT takes a somewhat different approach. It helps us learn to observe and identify our negative thoughts about our condition, and replace them with more realistic ones.

Both methods help us see the functioning of our minds more clearly, and the role that anxious, angry, and frustrated thoughts and feelings about our condition play in increasing our fear and stress.

And as it turns out, it is precisely this fear and stress that maintains most chronic back pain. This explains why events such as childhood physical and sexual abuse, painful losses, and job dissatisfaction have all been shown to be risk factors for the condition.
Take action for back pain relief

The excellent news is that for most of us, chronic back pain needn’t derail our lives. CBT is available at many pain clinics, as is mindfulness training.

You might also try on your own. You could explore CBT using the book on which the University of Washington class was based: The Pain Survival Guide: How to Reclaim Your Life. Alternatively, you can try mindfulness practice by following recorded instructions. While there are many resources for these, you can listen for free to some that I recorded at mindfulness-solution.com.

Additionally, for a comprehensive guide to using mindfulness along with rehabilitation to work through chronic back pain, you can consult a book I co-authored on the subject: Back Sense: A Revolutionary Guide to Halting the Cycle of Chronic Back Pain.

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Risks of active surveillance for men with intermediate-risk prostate cancers

Chances are good that at some point you or someone you know will have hip replacement surgery.

I can say that with some confidence because it’s a common operation that’s becoming more common all the time. An estimated 300,000 total hip replacements are performed each year in this country, and that number is expected to nearly double by 2030. The most common reason is osteoarthritis, the age-related “wear-and-tear” type of arthritis that can be difficult to treat with medications or other non-surgical approaches.

If you’ve had a hip replacement yourself, you may have experienced some things that surprised you. For example:

    Despite having major surgery on the largest joint in the body, you probably stood up and started walking on it within a day or two.
    You probably were only in the hospital for a few days.
    The improvement in the arthritic pain is usually noticeable right away.
    Despite all that, after discharge from the hospital, the physical therapy visits seemed to go on forever.

In fact, it’s routine after hip replacement surgery to have extensive physical therapy — also called rehabilitation therapy, or “rehab.” This usually consists of a series of outpatient appointments with a physical therapist. These visits usually take place two or three times a week for a month or more to help you work on strengthening, stamina, and balance.
Is home rehab just as good?

A new study calls into question the way people receive rehab after hip replacement surgery.

The researchers presented their findings at a recent meeting of the American Academy of Orthopaedic Surgeons. They described how, among 77 people having hip replacement surgery, half were randomly assigned to meet with a physical therapist 2 or 3 times a week for 2 months. The rest were instructed on particular exercises to be performed on their own at home for two months.

Here’s what they found:

    One month after surgery, there were no major differences in the individuals’ ability to function as assessed by their ability to sit, walk, and use stairs, or other measures of daily activities.
    Six months after the surgery, there was still no difference in results.
    Changing the routine physical therapy from supervised appointments to exercising at home could be accompanied by a significant reduction in the cost of care. And the convenience is an extra bonus.

Of course, this may not work for everyone. Many people who have hip replacement surgery cannot return home right away, especially if they live alone and have to climb a number of stairs right away. For them, surgery is followed by a stay at a rehabilitation facility, where they receive supervised physical therapy on a daily basis until they’re strong and steady enough to get around safely at home.

Another consideration in how post-op rehab is provided is the notion of “pre-hab” — that is, when surgery can be planned in advance (such as a hip replacement for arthritis), an exercise program prior to surgery may be useful. Those willing and able to exercise before surgery may have an easier time with home rehab.
So, now what?

This new research should be considered preliminary because it included only a small number of study subjects and the results were presented at a medical conference; they have not yet been published in a peer-reviewed medical journal. Additional research will likely be needed to confirm the findings and to identify those who are most likely to do well with self-directed rehab.

But, if the findings of this new study are confirmed, it’ll be welcome news for the thousands of people having hip replacement surgery who may no longer be asked to trudge back and forth to physical therapy appointments. For parents of teens, “addiction” is a scary word. It brings to mind all sorts of things we never want to have happen to our children, from overdoses to arrests — and so we talk to our kids about drugs and alcohol. But is there another addiction we should be worrying about, too?

The Merriam-Webster definition of addiction is “a strong and harmful need to regularly have something (such as a drug) or do something (such as gamble).” Using that definition, you could make a real argument that many teens are becoming addicted to their mobile devices.

You could make the same argument about their parents — and plenty of other people, too.

Common Sense Media recently published a report on a survey they did on 1,240 parents and teens (620 parent-child pairs). The findings are not a big surprise to anyone who, well, looks up from their phone. They found that:

    50% of teens feel that they are addicted to their mobile devices (and 28% think that their parents are too)
    27% of parents feel that they are addicted to their mobile devices (and 59% think that their teens are too)
    66% of parents feel that their teens spend too much time on their mobile devices — and 52% of the teens agree with them
    48% of parents and 72% of teens feel the need to respond immediately to text messages and other notifications
    69% of parents and 78% of teens check their devices at least hourly
    half of parents and a third of teens at least occasionally try to cut down the time they spend on their devices.

This is pretty powerful. Parents and teens are in agreement that their devices have a hold on them.

Now, I don’t want to seem to say that constantly checking Instagram is the same as shooting heroin. Clearly, it’s not. I also want to be careful to point out that clinicians are not quite ready to use the word “addiction” when it comes to technology. And there is also very limited research on the long-term effects of having our faces stuck to our phones. But there is real cause for concern.

Devices displace. It’s that simple. We only have so much bandwidth when it comes to awareness, interaction, and memory; multitasking is, ultimately, simply paying less attention to more things. And when you pay less attention, there can be consequences.

For teens, there are consequences when it comes to learning (it’s hard to lay down new memories and learn new material when you are distracted), social relationships (it’s hard to build or maintain them, and to hone social skills, when you are on your phone), sleep (which can have tremendous impacts on both mental and physical health), safety (like using the device while driving or crossing the street) and the general and important ability to sustain attention.

For parents, besides all the consequences above (which apply to adults, too), there are concerns about how devices literally get in the way of parenting. Researchers at Boston University have done some very interesting observational studies of parents and children, and found (here’s a shocker) that when parents are on their phones, they interact less with their children. Given that so much of relationship-building and cognitive development depends on interaction, the implications — which may not be fully seen for years — could be significant, even profound.

We need more research to understand all those implications. But in the meantime, the message is clear: devices need to be used thoughtfully, and with care.

Every person and every family is different — and so every approach to a healthy balance is going to be different. But there are three times when device use should be as close to zero as possible:

    When it impacts safety, like when driving or walking. This is where the zero comes in.
    When attention is important for learning or performance, like at school, doing homework, or in the workplace.
    During social gatherings, like meals or parties — or simply hanging out or having a conversation. It’s one thing to use devices to connect with people who are somewhere else; it’s entirely another to use devices when those people are sitting next to you. Our connections with other people are crucial for our health and well-being; we cannot let our devices undermine those connections.

Check out the Common Sense Media report. Talk about it as a family. Do some soul-searching. Make some ground rules. Make sure that every day, you spend time paying full attention to the world around you — and to the people you love.

Watch the short video below. It’s powerful — and brings the point Men diagnosed with slow-growing prostate tumors that likely won’t be harmful during their lifetimes can often avoid immediate treatment. Instead, they can have their tumor monitored using a strategy called active surveillance. With this approach, doctors perform periodic checks for tumor progression and start treatment only if the cancer begins to metastasize, or spread. Active surveillance has become popular worldwide, but doctors still debate which groups of men can safely use this strategy. Some doctors offer it only to men with the lowest risk of cancer progression. Others say that men with intermediate-risk prostate cancer can also make good candidates.

A new study now shows that intermediate-risk tumors are more likely to metastasize on active surveillance than initially expected. “Most men do fine on surveillance, but we have detected a higher risk of metastasis among intermediate-risk patients over the long term,” said Dr. Laurence Klotz, director of the active surveillance program at the University of Toronto’s Sunnybrook Health Sciences Centre, where the study was based.
Taking a look at intermediate-risk prostate cancer

Sunnybrook’s active surveillance program dates back to 1995, so it allows for remarkably long-term follow-up. Nearly 1,000 men have enrolled in the program so far. The majority have low-risk prostate cancer, which means their prostate-specific antigen (PSA) levels don’t exceed 10 nanograms per milliliter (ng/mL) and their Gleason scores are no higher than 6. (Gleason scores describe how aggressive a tumor sample looks under the microscope.) About 200 men in the study have intermediate-risk prostate cancer. Usually, intermediate-risk cancer is determined by a Gleason score of 7 or a PSA level higher than 10 ng/mL. However, these intermediate cancers can also be divided into lower- and higher-risk categories, depending mostly on how much higher-grade cancer shows up in the biopsy.

The new analysis shows that 30 of the 980 men evaluated in the study eventually developed metastases (or areas of spread). Of those men, two had low-risk prostate cancer, while the other 28 had either been diagnosed initially with intermediate-risk tumors, or were upgraded to that category while they were on active surveillance. The risk of metastases was therefore 3% overall for all the men evaluated, but roughly four times that for the intermediate-risk men, specifically. The median time to metastasis was 8.9 years, meaning that for all the men whose cancer spread, half experienced it within 8.9 years of diagnosis and half experienced it later than that.

According to Dr. Klotz, the likelihood of metastases was mainly dependent on the amounts of Gleason 7 cancer in the prostate, and whether a man’s PSA levels doubled quickly. He expects that a few more men in the study will develop metastatic cancer with age and longer-term follow-up.
Is active surveillance right for some intermediate-risk men?

Though metastasis is a major problem when it occurs, Dr. Klotz emphasizes that roughly 80% of the intermediate-risk men in the study have so far avoided that outcome. And these men, he said, are also avoiding cancer treatments that would otherwise have a significant effect on their quality of life. Still, Dr. Klotz urges caution when selecting intermediate-risk men for active surveillance. “Based on these findings, I would strongly encourage that these men be further evaluated with magnetic resonance imaging and/or genetic biomarkers,” he said.

“These longer-term data shed new light on the ultimate outcomes of men considered for active surveillance who had components of higher-grade cancer when they were initially diagnosed, or who were found to have it on subsequent biopsies while on active surveillance,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “Many variables factor into whether active surveillance should be considered for intermediate-risk men. Dr. Klotz highlights MRI and biomarkers, but medical diagnoses, family history, and the patient’s emotional capacity to address a higher likelihood of metastases should all be considered.”

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Lung disease in smokers who don’t have COPD

A few years ago, I saw a lovely patient who had gained a surprising amount of weight between visits. Surprised, because usually she takes great care of herself, I said, “Wow. You’ve gained 10 pounds since I saw you last. What’s going on?” She looked at me and told me that her finances were in dire straits. She explained that she gained weight because her budget did not allow her to buy healthy food. In fact, she told me that the bagged cookies she purchased at a local dollar store were the least costly way to keep her from feeling hungry.

My heart was heavy that day, as it always is when I hear that my patients are having trouble getting their basic needs met. I am fortunate to work in a practice that has social workers, so I was able to get some urgent help for her food insecurity. And yet I knew that it was going to be hard work to take off those 10 extra pounds, and that those pounds were going to make her knees sore and mess with her blood sugars and blood pressure.

I wish this were an uncommon event, but it’s not. According to a NEJM Catalyst blog post, social, environmental, and behavioral factors account for up to 60% of people’s health needs. The things we focus on so often in medicine account for just 10%.
One organization’s story: Stepping forward and making a change

Kaiser Permanente, a health care organization based in California, recognized that nations that focus on social needs — housing, food, transportation — often spend less on health care. So they decided to act on behalf of their patients and tackled the idea of meeting a patient’s social needs to help provide better health care. They didn’t build houses or grocery stores, but they did develop a system that engaged with existing community resources to help reach their neediest patients. By partnering with an exciting social enterprise organization called Health Leads, Kaiser developed a call center to help reach out to people who use a lot of health care resources. They found three out of every four patients they reached had at least one unmet social need. The most common were food insecurity, transportation problems, and difficulty paying utility bills. Kaiser’s program then connected these people with established community organizations who could help.
Putting “health” in a broader perspective

Perhaps few of you taking the time to read this blog have the kind of dire unmet social needs I mention above. But, I bet that every one of you has had a social need or a life challenge that has impacted your ability to take care of yourself. I see it all the time in parents of young children, caregivers of seniors — and, really, almost everyone I meet.

Our ability to be healthy depends on our ability to meet our own basic social, emotional, and physical needs. Articles like this one help us think about health a little bit more broadly. As the World Health Organization says, health is not just the absence of disease, but the presence of physical, mental, and social well-being. Doctors, nurses, and all health care providers need to engage with patients around their unmet needs — big and small — to help engage their patients to enhance their health and feel able to make important physical and behavioral changes. On television, heart attacks are portrayed in rather dramatic fashion — typically, an older man clutching his chest with agonizing pain. This mental image is embedded in our culture, but it actually represents only a small fraction of heart attacks. As it turns out, a variety of different symptoms may develop with a heart attack. In addition to chest pain, some of the other symptoms that can occur with a heart attack include chest pressure, chest heaviness, arm pain, neck pain, jaw pain, shortness of breath, sweating, extreme fatigue, dizziness, and nausea. That is, in part, why it is not always so easy to diagnose a heart attack. And of course, women are also at risk for heart attacks. Whether women are more likely than men to have these symptoms other than chest pain remains a controversial point.

Now, research from the Atherosclerosis Risk in Communities (ARIC) Study has found that almost half (45%) of heart attacks appear to be clinically silent — that is, not associated with any symptoms at all, at least that the patient can recall. These sorts of silent heart attacks were picked up by use of a routine electrocardiogram (ECG). And these silent heart attacks weren’t just a meaningless abnormality picked up on a test. The silent heart attacks were associated with a similar risk of subsequent death as clinically detected heart attacks.

Older studies had more or less come up with similar findings. The present study extended these observations into a much more diverse population. The excess risk associated with silent heart attacks was found to be present in both men and women. Of note, rates of both types of heart attack were higher in men than in women. There was also an excess risk of future death associated with both clinical heart attacks and silent heart attacks in both white and African American patients. Other races were not examined in this study, and more work needs to be done in this regard, though likely the results would be similar.

What does this mean for people who are worried about heart attacks? Guidelines for physicians from professional medical societies in general no longer recommend routine ECGs in healthy people, though this used to be a common practice. Certainly, if you should have an ECG for some purpose, such as before certain types of surgery, and a silent heart attack is detected, that needs to be taken seriously — really, as though you had had a clinically apparent heart attack. Any medications and lifestyle changes prescribed as a result of detecting a silent heart attack should also be relatively similar.

Future studies will have to determine if certain populations might benefit from routine screening for silent heart attacks. Beyond any studies done within the world of conventional medical research, the increasing availability of various apps will allow people to get ECGs on themselves, so detection of silent heart attacks will probably increase. The risk of this sort of indiscriminate screening is that one test abnormality might lead to another set of more expensive and risky tests. So, hopefully we can sort our relatively quickly (i.e., in the next few years) who might be best served with routine screening with ECGs, or perhaps even more sophisticated tests to detect silent heart attacks or people at risk for them. Smoking cigarettes damages your health in a number of ways. The top three smoking-related causes of death are cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD). In addition to these “top three,” smoking is also linked to a number of other cancers, getting more colds and infections, diabetes, osteoporosis and hip fractures, problems in pregnancy, difficulty with erections, stomach ulcers, gum disease, and the list goes on.
What exactly is COPD?

Emphysema occurs when the tiny air sacs of the lungs become damaged. Chronic bronchitis occurs when the lining of the airways becomes damaged. Many people have a combination of both, so the umbrella term COPD is more accurate. Having COPD makes it harder to get air in and out. Breathing tests, known as pulmonary function tests or “spirometry,” help determine how the lungs are working and are used to make a diagnosis of COPD.

So, if you smoke, or you used to smoke, but you don’t have COPD, does that mean your lungs haven’t been affected by smoking? Not necessarily.
Smoking may damage the lungs — even if you don’t have COPD

The May 12, 2016 issue of The New England Journal of Medicine included a study of smokers or past smokers (with at least 20 pack-years) who had some respiratory symptoms but didn’t quite meet the criteria for COPD. The well-recognized COPD Assessment Test (CAT) was used to measure the presence and severity of these symptoms, such as cough, mucus, shortness of breath, and activity and energy limitations. This group with symptoms (using a cutoff CAT score ≥10) was compared with non-smokers, as well as with smokers and past smokers with no respiratory symptoms.

The results showed that, when compared to those without symptoms, the group of smokers and past-smokers with symptoms had the following:

    more episodes of respiratory illness that required antibiotics, steroids, or doctor’s office and emergency room visits
    a shorter average walking distance on a 6-minute walking test
    more bronchial airway disease (bronchiolitis) as seen on lung CT scans.

This group was also often prescribed medications typically used for COPD, such as inhalers, even though they did not meet the criteria for COPD.

Though it is hard to draw firm conclusions from this study because the participants were volunteers and not randomly selected, it is notable that in this study, a full 50% of smokers and past smokers had some degree of respiratory symptoms, even though they did not have COPD.
What does this all mean?

Many smokers may not reach the cutoff criteria on spirometry for the diagnosis of COPD, but still have symptoms related to smoking — maybe a cough, mucus production, or shortness of breath with minimal exercise and activity. This study affirms that these people can experience serious health consequences, even without COPD. This finding also brings into question how we should classify chronic respiratory disease. So far, we haven’t determined a way of classifying those who have symptoms but don’t quite meet the usual criteria for COPD, and we also don’t have much data or guidance on how best to treat them.

In the meantime, quitting smoking remains the best way to lower your chances of getting COPD — and the best way to lessen any respiratory symptoms you’re having. Most smokers who stop will feel better, with less cough and mucus, within 12 months. They will also lower their risk of getting (and dying from) smoking-related illnesses. Though the benefits of stopping smoking are greater at younger ages, there is always a benefit from stopping, even at the age of 80! If you are a smoker and you want to stop, talk to your doctor. Quitting is a challenge, but there are a number of tools and treatments available to help you through it.

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