Category: NATURAL

The first thing to know about ringworm is that there are no worms involved.

This generally harmless skin infection is caused by a fungus. The fungus causes a raised rash usually shaped like a ring, almost as if a worm was curled up under the skin (but again: no worms are involved).

The medical name for ringworm is tinea corporis.

Are there other types of tinea infections?

There are many different kinds of tinea skin infections, named in Latin for the part of the body they affect, such as the

• scalp (tinea capitis)
• groin (tinea cruris)
• feet (tinea pedis)
• body (tinea corporis).

Tinea infections can look a bit different depending on what part of the body they affect, but they are usually pink or red and scaly.

How do you get ringworm?

Tinea infections, particularly ringworm (tinea corporis), are very common. People catch them from other infected people and also from infected animals, particularly dogs and cats. They can also spread from one part of the body to another.

What does ringworm look like?

It usually starts as a pink scaly patch that then spreads out into a ring. The ring (which is not necessarily perfectly round) usually spreads wider with time. It can sometimes be itchy, but most of the time doesn’t cause any discomfort.

There are other rashes that can have a ringlike shape, so it’s always important to check in with your doctor, especially if the ring isn’t scaly. But most ringlike rashes are tinea.

How is ringworm treated?

Luckily, tinea corporis and the other kinds of tinea are very treatable. Most of the time, an antifungal cream does the trick.

When the rash is extensive (which is rare) or doesn’t respond to an antifungal cream (also rare), an antifungal medication can be taken by mouth.

As is the case with many other germs these days, there are some drug-resistant cases of tinea related to overuse of antifungal medications. But the vast majority of fungal infections go away with medication.

What should you do if you think a family member — or a pet — has ringworm?

If you think someone in your family has ringworm, call your doctor. The sooner you get started on treatment, the better.

If someone in the family has been diagnosed with ringworm, make sure that others don’t share clothing, towels, or sheets. Have everyone wash their hands frequently and well.

If your pet has a scaly rash, call the vet. Vacuum the areas your pet frequents, and have everyone wash their hands after touching the pet.

Can you prevent ringworm?

To prevent tinea corporis and other kinds of tinea:

• Keep skin clean and dry.
• Change clothes (particularly socks and underwear) regularly.
• Wash your hands regularly (this helps prevent all sorts of infections).
• If your child plays contact sports, make sure they shower after practice, keep their uniform and gear clean, and don’t share gear with other players.

To learn more about ringworm, visit the website of the Centers for Disease and Prevention.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Summer is an ideal time to take a hike, especially if you have the opportunity to explore one of our country’s many state and national parks. But if you venture far from home, it’s essential to make sure you’re prepared for the local climate and other conditions you may encounter on the trail, especially if you’re not an experienced hiker. Higher temperatures than you’re accustomed to or other extreme weather can be deadly.

“If you’re taking a hike in mid-July in the Arizona desert, there’s a very different list of considerations than if you’re in the mountains of Montana or the forests of North Carolina,” says Dr. N. Stuart Harris, chief of the Division of Wilderness Medicine at Harvard-affiliated Massachusetts General Hospital. Here’s a run-down of what to consider before you hit the trail.

Traveling companions, safety notifications, and orientation

First, it’s safer to travel in pairs or a group of people. But always tell someone not on your hike where you’re going, your anticipated route, and when you expect to return. National parks often require reservations or permits for overnight stays or treks to certain locales, and keep a record of day-hikers, so sign up as requested. If you end up getting injured or lost, the information can make a huge difference in locating you more quickly.

Remember to bring a map and know how to orient yourself. In many wilderness areas, cell service may be spotty or nonexistent, so don’t count on using your phone’s GPS.

In the desert, you may be able to see for 50 miles in the distance. But if you’re in a steep, wooded area, you might not be able to see 100 yards ahead and it’s much easier to become disoriented, says Dr. Harris.

Be ready for heat, humidity, and other weather hazards

Check forecasts first. Always check the forecast so you can be prepared for weather changes. Temperatures may drop and wind may increase as you climb higher. If you’re in an area prone to thunderstorms, lightning injury should definitely be on your radar, says Dr. Harris. Learn these lightning safety tips from the Centers for Disease Control and Prevention. Because these storms usually strike in the afternoon, you can minimize your risk by hiking in the earlier part of the day.

Hydrate well. During any type of exercise — especially hiking, which often demands a fair bit of exertion — be sure to drink extra water to replace the fluid you lose from sweating. On a warm day, you might not notice you’re sweating if it’s breezy. Pay attention to any signs or alerts advising hikers on how much water is best to carry.

Consider humidity. Temperature isn’t the only consideration, however. “If you’re in Arizona and the temperature is over 100° F, your body may be better able to release heat by sweating than if you’re in a very humid area,” says Dr. Harris. In the Great Smoky Mountains, for example, the temperature in July may be only in the high 80s. But humidity levels usually hover around 75% or higher. That means your sweat will evaporate more slowly, so your body’s natural cooling mechanism doesn’t work as efficiently. Be sure to rest and hydrate if you start feeling overheated.

What to wear and bring

Many park websites offer detailed safety tips specific to the terrain and weather you may encounter on a hike, so check before you go. Five basics to consider are as follows:

• If your hike involves rocky or uneven terrain, hiking boots will offer more support than tennis shoes.
• You’ll be more comfortable in lightweight, moisture-wicking clothing, but bring extra layers and rain gear, if the weather forecast suggests this is appropriate. Temperature drops can be surprising in some places when the sun wanes, so be prepared to layer up as needed if you’re out longer than expected.
• Wear a wide-brimmed hat and sunglasses to shield you from the sun’s glare — and don’t forget to apply sunscreen to all exposed skin before you set off.
• Along with plenty of fluids, bring high-energy snacks. If you get off course or encounter a problem, you’ll be glad you did.

Additionally, depending on where you’re hiking, you may need to dodge rash-inducing plants, including stinging nettles, poison oak, or poison ivy. Bring insect repellent to fend off biting insects and follow prevention strategies for ticks, which may harbor bacteria responsible for Lyme disease and other illnesses. Finally, carry a first aid kit with bandages for cuts and scrapes and moleskin for blisters.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Experiencing discrimination in the workplace — where many adults spend one-third of their time, on average — may be harmful to your heart health.

A 2023 study in the Journal of the American Heart Association found that people who reported high levels of discrimination on the job were more likely to develop high blood pressure than those who reported low levels of workplace discrimination.

Workplace discrimination refers to unfair conditions or unpleasant treatment because of personal characteristics — particularly race, sex, or age.

How can discrimination affect our health?

“The daily hassles and indignities people experience from discrimination are a specific type of stress that is not always included in traditional measures of stress and adversity,” says sociologist David R. Williams, professor of public health at the Harvard T.H. Chan School of Public Health.

Yet multiple studies have documented that experiencing discrimination increases risk for developing a broad range of factors linked to heart disease. Along with high blood pressure, this can also include chronic low-grade inflammation, obesity, and type 2 diabetes.

More than 25 years ago, Williams created the Everyday Discrimination Scale. This is the most widely used measure of discrimination’s effects on health.

Who participated in the study of workplace discrimination?

The study followed a nationwide sample of 1,246 adults across a broad range of occupations and education levels, with roughly equal numbers of men and women.

Most were middle-aged, white, and married. They were mostly nonsmokers, drank low to moderate amounts of alcohol, and did moderate to high levels of exercise. None had high blood pressure at the baseline measurements.

How was discrimination measured and what did the study find?

The study is the first to show that discrimination in the workplace can raise blood pressure.

To measure discrimination levels, researchers used a test that included these six questions:

• How often do you think you are unfairly given tasks that no one else wanted to do?
• How often are you watched more closely than other workers?
• How often does your supervisor or boss use ethnic, racial, or sexual slurs or jokes?
• How often do your coworkers use ethnic, racial, or sexual slurs or jokes?
• How often do you feel that you are ignored or not taken seriously by your boss?
• How often has a coworker with less experience and qualifications gotten promoted before you?

Based on the responses, researchers calculated discrimination scores and divided participants into groups with low, intermediate, and high scores.

• After a follow-up of roughly eight years, about 26% of all participants reported developing high blood pressure.
• Compared to people who scored low on workplace discrimination at the start of the study, those with intermediate or high scores were 22% and 54% more likely, respectively, to report high blood pressure during the follow-up.

How could discrimination affect blood pressure?

Discrimination can cause emotional stress, which activates the body’s fight-or-flight response. The resulting surge of hormones makes the heart beat faster and blood vessels narrow, which causes blood pressure to rise temporarily. But if the stress response is triggered repeatedly, blood pressure may remain consistently high.

Discrimination may arise from unfair treatment based on a range of factors, including race, gender, religious affiliation, or sexual orientation. The specific attribution doesn’t seem to matter, says Williams. “Broadly speaking, the effects of discrimination on health are similar, regardless of the attribution,” he says, noting that the Everyday Discrimination Scale was specifically designed to capture a range of different forms of discrimination.

What are the limitations of this study?

One limitation of this recent study is that only 6% of the participants were nonwhite, and these individuals were less likely to take part in the follow-up session of the study. As a result, the study may not have fully or accurately captured workplace discrimination among people from different racial groups. In addition, blood pressure was self-reported, which may be less reliable than measurements directly documented by medical professionals.

What may limit the health impact of workplace discrimination?

At the organizational level, no studies have directly addressed this issue. Preliminary evidence suggests that improving working conditions, such as decreasing job demands and increasing job control, may help lower blood pressure, according to the study authors. In addition, the American Heart Association recently released a report, Driving Health Equity in the Workplace, that aims to address drivers of health inequities in the workplace.

Encouraging greater awareness of implicit bias may be one way to help reduce discrimination in the workplace. Implicit bias refers to the unconscious assumptions and prejudgments people have about groups of people that may underlie some discriminatory behaviors. You can explore implicit biases with these tests, which were developed at Harvard and other universities.

On an individual level, stress management training can reduce blood pressure. A range of stress-relieving strategies may offer similar benefits. Regularly practicing relaxation techniques or brief mindfulness reflections, learning ways to cope with negative thoughts, and getting sufficient exercise can help.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Prostate cancer is generally viewed as a disease of older men. Yet about 10% of new diagnoses occur in men age 55 or younger, and these early-onset cancers often have a worse prognosis. Biological differences partially explain the discrepancy. For instance, early-onset prostate cancers contain certain genetic abnormalities that don’t appear as often in older men with the disease.

But socioeconomic factors also play an important role, according to new research by investigators at Jacksonville College of Medicine (JCM) in Florida. The fact that poverty, educational status, and other factors governing socioeconomic status (SES) influence cancer survival is well established.

This is the first study to investigate how SES affects survival in early-onset prostate cancer specifically. The findings show that men with lower SES don’t live as long as the higher-SES patients do. “They’re more likely to be diagnosed at advanced stages,” says Dr. Carlos Riveros, a physician and research associate at JCM and the paper’s first author.

What the research found

During the investigation, Dr. Riveros and his colleagues evaluated data from the National Cancer Database (NCD), which is sponsored by the American College of Surgeons and the National Cancer Institute. The NCD captures data from over 1,500 hospitals in the United States. Dr. Riveros’s team focused specifically on long-term outcome data for 112,563 men diagnosed with early-onset prostate cancer between 2004 and 2018.

The researchers were able to determine the zip codes where each of these patients lived. Then they looked at per-capita income for those zip codes, as well as the percentage of people living within them who had not yet earned a high school diploma. Taken together, the income and educational data served as a composite SES measure for each zip code’s population. In a final step, the team looked at how the survival of early-onset prostate cancer patients across the zip codes compares.

The results were remarkable: Compared to high-SES patients, the low-SES men were far more likely to be African American, and less likely to have health insurance. More of the low-SES men lived in rural neighborhoods and had stage IV prostate cancer at diagnosis. Fewer low-SES patients were treated at state-of-the-art cancer centers, and less of them had surgical treatment.

After adjusting for age, race, ethnicity, cancer stage, treatment, and other variables, the lower-SES men were 1.5 times more likely than the higher SES men to have died over a median follow-up of 79 months.

Observations and comments

According to Dr. Riveros, the findings are consistent with evidence showing that social determinants of health — the conditions in places where people work and spend their lives — have broad impacts on cancer risk. “Many people in lower-SES areas have had poor diets since birth,” he says.

Lower-SES individuals may be limited in their ability to find, understand, or use health-related information, and therefore “might not know what advanced prostate cancer feels like, or when it’s time to go to a doctor,” Dr. Riveros says. He and his co-authors concluded that SES should be considered when implementing programs to improve the management of patients with early-onset prostate cancer.

“This paper underscores the importance of addressing issues related to diversity, equity, and inclusion when it comes to optimizing outcomes for men with prostate cancer,” says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

Dr. Heidi Rayala, a urologist affiliated with Beth Israel Deaconess Medical Center in Boston, and a member of the Harvard Medical School Annual Report on Prostate Diseases editorial board, agrees, but adds that evaluating individual sociodemographic factors is challenging because many of them are coupled with disparities in insurance coverage. “What remains to be answered is whether there are unique underlying SES factors that would benefit from targeted cancer prevention strategies, or whether this all boils down to the 10% of the US population that remains uninsured,” she says.

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

The notion that hurting yourself can make you feel better seems like a contradiction. But that’s exactly what drives skin cutting and similar forms of self-harm among adolescents, says Matthew Nock, chair of the department of psychology at Harvard University.

If you’re a parent, you may have heard about cutting or be wondering about red flags. Here are the basics on what to know, and how you can respond if you’re concerned about this form of self-harm.

What is self-harm?

“Self-harm is the intentional destruction of body tissue in the absence of any intent to die,” explains Nock, who specializes in treating self-injury behaviors in childhood to young adulthood. “Most often it happens on the arms and takes the form of cutting with some type of sharp object, such as a razor blade, pencil, or pocket knife. It might also include burning the skin or inserting objects under the skin, such as paper clips.”

How many teens engage in self-harm?

About 17% of teenagers engage in self-harm at least once, according to the American Psychological Association.

Many who do so begin between ages 12 and 14, when adolescence can deliver a one-two punch: combining a new mental health disorder with greater risk-taking behaviors, explains Nock.

What leads some teens to engage in cutting?

Cutting appears to affect all genders of adolescents equally, Nock notes. But what factors make teens more likely to do it? In addition to experiencing depression, anxiety, or other mental health issues, teens who cut themselves may be more apt to use drugs or alcohol.

A 2022 study in Child and Adolescent Mental Health suggests additional contributing factors, including family problems, school or job challenges, and struggling relationships with friends. Ultimately, cutting appears to have three contributing components, Nock says: psychological, biological, and social.

“Kids who engage in self-injury have difficulty tolerating emotional distress and are more likely to try to escape from those feelings,” he says. “It might be that their pain demands attention, and when they’re really upset, cutting themselves focuses on their physical pain and reduces their psychological pain.”

The sense of relief or release after cutting reinforces the behavior, leading teens to cut themselves again and again. “An adult who’s feeling upset may have a drink, go for a run, or engage in yoga to decrease their distress. When they feel better afterward, that behavior gets reinforced,” Nock says. “We think the same is true with self-injury: if you feel really bad and cut yourself, the feeling goes away.”

Will asking about cutting put ideas in a teenager’s head?

Parents often worry about this. But it’s safe to assume kids in middle school and high school are well aware of what self-harm involves, from social media and interactions with peers and others. “Asking kids about it isn’t going to give them the idea to do it — all of the data we have suggests that’s not the case,” Nock says.

What are key signs of cutting in teenagers?

Be alert for

• fresh cuts on a teen’s skin, or evidence that skin has been cut, burned, or had objects placed under it
• covering body areas — whether arms or legs — they didn’t tend to cover before.

Is there a connection between cutting and suicide?

While teens who engage in cutting don’t intend to end their lives that way, their willingness to hurt themselves might indicate a greater risk that they may attempt suicide. More than 50% of children and adolescents who die by suicide have previously self-harmed, according to the 2022 study described above.

“The more you intentionally hurt your body — which takes some amount of courage to do — the more likely you’ll target yourself in the future,” Nock says. “We also think there’s a self-hatred component to this — you’ll hurt your body when in distress rather than do something productive like go for a run. There’s a sort of self-criticism that leads people to hurt themselves and ultimately try to kill themselves.”

How can parents respond if they notice signs of cutting?

If they confide in anyone at all, teens who self-harm tend to tell their friends, not their parents or other adults. But parents can break through the secrecy and offer support with a calm, steadfast approach.

“Encourage them to talk to you about what they’re experiencing, knowing that you’re an open ear and will be as nonjudgmental as possible,” Nock says. “It’s not realistic that we’re going to root out all risky behaviors that kids engage in. But when death is a potential outcome, encourage friends and family not to honor that secrecy and to try to intervene to keep the person safe.”

Seeking appropriate resources can help:

• Take your child to a primary care doctor who can refer to a mental health professional, or go directly to a psychiatrist, psychologist, or social worker for evaluation.
• Ask your doctor or a mental health professional about local or telehealth options for cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). Both approaches can help teens learn healthier strategies to cope with emotional distress.
• If your child’s self-injury seems severe or you’re concerned about the possibility of suicide, go to a hospital emergency room. “If our kids fall and suffer a break or accidental injury that needs medical attention, we go to the ER — and the same should happen for injuries that are self-inflicted,” Nock says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Health guidelines recommend adults get at least 150 minutes per week of moderate-intensity aerobic exercise, or at least 75 minutes of vigorous exercise. Which activities you choose don’t matter as long as they get you moving.

But what if an injury, illness, health condition, disability, or even normal aging makes being active hard for you? In those cases, adaptive sports could lend a much-needed hand.

What are adaptive sports?

Adaptive sports are competitive or recreational sports or activities for people with disabilities or physical limitations. They often run parallel to traditional endeavors, but are modified to support people’s specific physical abilities.

“Eventually, almost everyone will experience some kind of disability that impedes regular exercise, whether it’s mild arthritis, requiring a knee or hip replacement, limited vision, or a more significant physical disability,” says Dr. Cheri Blauwet, an associate professor in physical medicine and rehabilitation at Harvard Medical School, and a former wheelchair racer who is a seven-time Paralympic medalist and two-time winner of both the Boston and New York City Marathons. “But today, because of advanced technology and supportive infrastructure, people can find almost any kind of sport or activity that takes into account their abilities and helps them stay active.”

Why is it important to stay active?

Not getting sufficient regular exercise increases the risk of heart disease, stroke, obesity, diabetes, and cancer. It also affects mood. And people with disabilities are especially vulnerable because of the challenges of staying active, says Dr. Blauwet. “Adaptive sports are a way for us to continue to exercise regularly and support our health and well-being going forward.”

Research backs this up. According to one study, people participating in adaptive sports and activities report better overall health, quality of life, and social life.

How can you learn about options for adaptive activities near you?

You can find state and local adaptive sports programs and accessible activities through the websites of the National Center on Health, Physical Activity and Disability and the Challenged Athletes Foundation. “These programs also can help you find mentors, coaches, and the support system that you need to be successful,” says Dr. Blauwet.

What kind of sport or activity you choose ultimately depends on your interests and level of function, but many options are available.

Build on strengths and consider new activities

Dr. Blauwet shares other strategies that can help you transition to adaptive activities.

Look at your current form of exercise. “Almost any kind of sport or activity can be adjusted to accommodate people with disabilities, so there is a good chance you can continue with a favorite endeavor,” says Dr. Blauwet.

For instance, as part of her ongoing therapy, former Arizona representative Gabby Giffords, an avid cyclist who lives with a brain injury after an assassination attempt, now rides a recumbent bike because of paralysis on her right side and balance issues. (A recumbent bike is a three-wheel bicycle that places the rider in a seated or laid-back reclining position.)

Other sports and activities can be altered similarly. For example, specialized golf carts can help you stand and stabilize your body while swinging the club. Sledge hockey uses sleds to skate across the ice.

Focus on your strengths. Don’t dwell on what you can’t do, but focus on what you can. Running no longer an option? How about power walking using walking poles for support? Can’t use your legs? Focus on upper body activities like swimming or kayaking. Low vision? Guides are available to help you walk, run, and cycle.

Join a team. Many adaptive sports have organized team leagues with adjusted rules and formats, like wheelchair basketball and tennis, and “beep” baseball and kickball for individuals with low vision. “These are a great way to build more awareness about your new endeavor and build a community with other peers with similar disabilities,” says Dr. Blauwet. “Plus, a little competition provides extra motivation.”

Try something new. Use your new functional status as an opportunity to attempt a different sport or activity. “Test the waters and try something that has always interested you,” says Dr. Blauwet. “Now might be the ideal time to explore waterskiing, windsurfing, horseback riding, or rock wall climbing.”

It may be mentally and emotionally tough to embrace adaptive sports and activities, as it can feel like your disability has become magnified. But don’t let that dissuade you, adds Dr. Blauwet. “Staying committed to being active and investing in your health can help reduce and eliminate any negative stigma you feel. Participation in adaptive sports is not a lesser way of living, but a way to live better.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

Busy days make it hard to put heart health on the front burner. It just feels like you don't have time for habits that keep the ticker in top shape — like exercising regularly, getting enough sleep, and eating a healthy diet. So maybe you take the stairs when you can, or you park farther away from a store to rack up a few extra steps each day. But what else can you do? Here are three things that might fit in your schedule.

Swap electronic communication for an in-person meeting

It's fine if texting, emailing, social media, or Zoom calls are your primary means of communicating with others. But it's not okay if those methods leave you feeling lonely or isolated — two problems linked to higher risks for heart disease, heart attack, or stroke, according to a scientific statement from the American Heart Association in the Journal of the American Heart Association.

To combat loneliness and isolation, try to replace some of your electronic back-and-forth with people with in-person meetings. Maybe you can find room in your schedule for a quick walk, cup of coffee, or brief lunch with a friend or colleague.

"Time spent face-to-face helps connect you to others and may make you feel less isolated," explains Matthew Lee, a sociologist and research associate at Harvard University's Human Flourishing Program. "Being physically co-present can help you feel more engaged with others, more valued, and more likely to feel a sense of shared identity — all things that may help ease loneliness. This is why some doctors are starting to engage in 'social prescribing,' including suggesting that people get involved in volunteering and other activities that build in-person social relationships."

A recent study published in the International Journal of Public Health by Lee and a team of Harvard-led researchers suggests that better social connectedness may reduce the risk of being diagnosed with depression or anxiety. Both are associated with heart disease or making existing heart conditions worse.

Swap an unhealthy breakfast for a healthier one

Is your typical breakfast something quick and full of refined (not whole) grains, processed meat, saturated fat, or added sugar? Eating that kind of food regularly may drive up calories, weight, blood sugar, or cholesterol levels — and that's not good for your heart.

Instead, choose breakfast foods rich in fiber, a type of carbohydrate that either passes through the body undigested (insoluble fiber) or dissolves into a gel (soluble fiber) that coats the gut.

Not only does fiber help digestion, it also

• traps, mops up, and lowers bad [LDL] cholesterol that can lead to clogged arteries
• controls blood sugar and lowers the risk for diabetes, which is strongly associated with heart attacks and strokes
• may help fight chronic inflammation, which plays a role in clogging arteries and causing heart attacks.

Fruits, nuts, seeds, whole grains (oats, barley, quinoa) and many other foods are rich in fiber. Try these fiber-rich breakfast ideas:

• microwaved oatmeal (heat a 1/2 cup of oatmeal with almost a cup of low-fat milk for about two minutes)
• a serving of cooked quinoa (cold, if you have it in your fridge) with a dollop of nonfat Greek yogurt, berries, and granola
• whole-grain cereal with milk (go for cereals with the highest amounts of whole grains and lowest amounts of added sugars)
• a slice of whole-grain toast with two tablespoons of nut butter (like almond or peanut butter)
• one or two handfuls of homemade trail mix (use your favorite unsalted nuts, sunflower seeds, and dried fruit such as raisins or apricots).

Swap a few minutes of scroll time for meditation time

If you ever take a break from your busy day to scroll through news on your phone or computer, chances are you can also find a little time to meditate, which is important for heart health. Research indicates that people who meditate have lower rates of high cholesterol, diabetes, high blood pressure, stroke, and coronary artery disease compared with people who don't meditate.

What's the connection? Meditating triggers the body's relaxation response, a well-studied physiological change that appears to help lower your blood pressure, heart rate, breathing rate, oxygen consumption, adrenaline levels, and levels of the stress hormone cortisol.

The great news: it doesn't take much time to reap the heart-healthy benefits of meditating — just about 10 to 20 minutes per day.

Ideas for quick ways to meditate in a busy day include sitting quietly, closing your eyes, and

• focusing on your breathing, without judging sounds you hear or thoughts that pop into your head
• listening to a guided meditation, which uses mental images to help you relax
• listening to a recording of calming sounds such as waves, a bubbling brook, or gentle rain.

Just try to calm your brain for a few minutes a day. Soon, you may find you've become better at meditating and better at practicing other heart-healthy habits, no matter how busy you are.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

In this increasingly digital world, it’s not surprising that children are spending more and more of their time on some sort of device. And while there is certainly much to be learned, explored, and created using devices, there are skills that devices can’t always teach — and that children need to learn.

Play bolsters executive function and mood regulation skills

Executive function, emotional regulation, and general physical skills are important for children to learn — and practice — as they grow. The best way for children to learn these skills is through play; that’s why we say that play is the work of a child. As devices become more pervasive, and as many children become more scheduled with lessons and organized activities, making time for device-free play can become forgotten.

I think that also, parents and children are literally forgetting how to play. Parents used to bring toys to entertain their children while they waited to see me; now they just hand their child their phone. Devices are so ubiquitous and easy, it can take real effort to put them aside and find something else to do.

Play is essential to healthy development

Harvard’s Center on the Developing Child has developed excellent handouts for parents (note: automatic download) on different age-based games and activities to help support their child’s development. I particularly like those that involve the parent too — because that not only helps your child, it helps your relationship.

Great games to play with younger children: Ages 4 to 7

In the first three years of life, play is about literally building brain connections and basic skills. As kids grow, play builds on those skills and gives them opportunities to think, be creative, cooperate with one another, and use their bodies.

Here are some ideas for 4-to 7-year-olds (note: automatic download):

• Freeze Dance, Red Light Green Light, Simon Says, or Duck Duck Goose are all games that get kids active while reinforcing self-regulation and cooperation.
• I Spy, Bingo (or Opposites Bingo, where families make their own picture boards and kids have to match the opposite to what is said), and other matching games are great for building memory and cognitive skills.
• Try starting a story and having others add to it to see what plot twists emerge! It’s a great way to encourage creativity. You can do something similar with a drawing: start with something simple, like a house or a boat, and take turns embellishing this, narrating as you do.

Great games to play with older children: Ages 8 to 12

The 8-to 12-year-olds (note: automatic download) are capable of more complicated activities, like:

• Doing jigsaw puzzles, or solving crosswords or other puzzles together.
• Playing games like chess, Battleship, Go, or Clue that involve memory and planning.
• Playing a sport — play basketball together, go skating, practice yoga, or go for a run together. Being active together is not only healthy for both of you, it sets a good lifelong example.
• Learning an instrument — learn together!
• Making things. Teach them to cook, build, sew, crochet, grow a garden. This, too, can be play.

Opportunities to play help teens, as well

As kids grow into teens (automatic download), they naturally seek more independence and time with their peers. Opportunities for play take different forms depending on personal interests. Sports, cooking, music, theater, and even (within moderation) video games can encourage creativity, life skills, and fun.

For more information about how parents can build and encourage important life skills in their children, visit the Harvard Center on the Developing Child website.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Everyone who lives with inflammatory bowel disease (IBD) knows their illness has a major impact on daily life. Many people are diagnosed in their 20s or 30s, a time when we might hope for few health challenges.

Medications, and sometimes surgery, may be used to treat IBD. If you identify as LGBTQ+, you might wonder how all of this may affect you — your physical health, of course, but also your sexual health and pleasure. Below are a few things to understand and consider.

What is inflammatory bowel disease?

IBD is a condition that causes inflammation along the gastrointestinal (GI) tract. The two main types are Crohn's disease and ulcerative colitis:

• Crohn's disease: inflammation can occur anywhere along the GI tract (from the mouth to the anus)
• Ulcerative colitis: typically affects the large intestine (colon) only.

IBD can cause diarrhea, bloody stool, weight loss, and abdominal pain, and is typically diagnosed with blood and stool tests, imaging, and colonoscopy. A diagnosis of IBD may increase the risk of developing anxiety or depression, and can also have an impact on sexual health. People with IBD may require long-term medical treatment or surgery for their condition.

The starting point: Talking to your doctor

Talking to your medical team about IBD and sexual health may not be easy. This may depend on how comfortable you feel disclosing your LGBTQ+ identity with your health care providers. Ideally, you should feel comfortable discussing sexuality with your medical team, including what types of sexual partners and activities you participate in and how IBD may affect this part of your life.

Be aware that health care providers may not be able to address all LGBTQ+-specific concerns. Optimal care for people with IBD who identify as LGBTQ+ is not fully understood. However, this is an active area of research.

How might medicines for IBD affect sexual health?

Many effective IBD medications subdue the immune system to decrease inflammation. These immunosuppressive medicines may raise your risk for sexually transmitted infections (STIs) such as HIV, chlamydia, syphilis, and gonorrhea.

What you can do: Discuss these concerns with your doctor so you can take appropriate protective measures. This might include:

• ensuring that your vaccinations, such as hepatitis B and HPV, are up to date.
• engaging in sex using barrier protection to prevent STI transmission.
• taking pre-exposure prophylaxis (PrEP). This safe and effective medicine helps prevent the spread of HIV. Ask your primary care doctor or gastroenterologist if PrEP is appropriate for you.

How might surgery for IBD affect sexual health?

For some people with IBD, gut inflammation is severe enough to require surgery to remove part of the intestine. For example:

• Abscesses or fistulas (abnormal connections between two body parts) sometimes form when someone has Crohn's disease around the anus. This may require surgical treatment.
• Active inflammation in the rectum or anus may make sex painful, particularly for people who engage in anal receptive sex.
• We don't yet know whether anal receptive sex is safe for people who have had surgery to remove the colon and create a J-pouch, which is formed from small intestine to create an internal pouch that enables normal bowel movements.

What you can do: Discuss your concerns with your gastroenterologist and colorectal surgeon.

If you engage in anal sex, you may be confused about whether it is safe to do so. While you may feel uncomfortable discussing this concern and others with your doctor, try to be as honest and open as you can. That way, you'll receive the best information on how to engage in safe and enjoyable sex after an IBD diagnosis or surgery.

What else to consider if you are transgender

People with IBD who are transgender may have additional concerns to address.

For example, there may be a risk for sexual side effects from gender-affirming surgery. These procedures may include vaginoplasty (surgical creation of a vagina) for transgender females, or phalloplasty (surgical creation of a penis) for transgender males. The safety of these procedures in people with IBD is not currently well understood.

What you can do: If you identify as transgender, ask your doctor if any gender-affirming surgeries you've had or medicines you take, such as hormones, might affect your IBD, recommended treatments, or sexual health.

If you're considering gender-affirming surgery, discuss your options with your medical team. Be aware that gender-affirming surgery may be more challenging, or may not be advisable, for people with complex or active IBD. It's important to discuss your specific risks with your doctor when pursuing gender-affirming care. Having access to a team of physicians, including a surgeon and a gastroenterologist, may improve outcomes.

The bottom line

Try to talk to your gastroenterologist about how your sexual practices and gender identity may affect — and be affected by — your IBD. A conversation like this may feel uncomfortable, but being candid about your symptoms and concerns will help you receive the best possible care.

Often, a multidisciplinary approach to care is helpful. Your health care providers, including your gastroenterologist and surgeon, may suggest seeing additional specialists.

Much remains unknown about sexual health and practices in LGBTQ+ people with IBD. While more research is needed, open communication on the impact of medications, surgery, and other aspects of living with IBD can do a lot to improve your quality of life.

About the Authors

Andrew Eidelberg, MD, Contributor

Dr. Andrew Eidelberg is a third-year internal medicine resident at Beth Israel Deaconess Medical Center. After graduating from the University of Miami and Weill Cornell Medical College, he decided to pursue a career in gastroenterology, specifically … See Full Bio View all posts by Andrew Eidelberg, MD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD