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(a) Engage Visit Your URL the resources of the Federal Government to address the mental- and behavioral-health needs of vulnerable Americans, including online doctor ventolin by. (i) providing crisis-intervention services to treat those in immediate life-threatening situations. And (ii) increasing the availability of and access to quality continuing care following initial crisis resolution to improve behavioral-health outcomes.

(b) Permit and encourage safe in-person mentorship online doctor ventolin programs. Support-group participation. And attendance at communal facilities, including schools, civic centers, and houses of worship.

(c) Increase the availability online doctor ventolin of telehealth and online mental-health and substance-use tools and services. And (d) Marshal public and private resources to address deteriorating mental health, such as factors that contribute to prolonged unemployment and social isolation. Sec.

3. Establishment of a Coronavirus Mental Health Working Group. The Coronavirus Mental Health Working Group (Working Group) is hereby established to facilitate an “all-of-government” response to the mental-health conditions induced or exacerbated by the pandemic, including issues related to suicide prevention.

The Working Group will be co-chaired by the Secretary of Health and Human Services, or his designee, and the Assistant to the Start Printed Page 63978President for Domestic Policy, or her designee. The Working Group shall be composed of representatives from the Department of Defense, the Department of Justice, the Department of Agriculture, the Department of Labor, the Department of Housing and Urban Development, the Department of Education, the Department of Veterans Affairs, the Small Business Administration, the Office of National Drug Control Policy, the Office of Management and Budget (OMB), and such representatives of other executive departments, agencies, and offices as the Co-Chairs may, from time to time, designate with the concurrence of the head of the department, agency, or office concerned. All members of the Working Group shall be full-time, or permanent part-time, officers or employees of the Federal Government.

Sec. 4. Responsibilities of the Coronavirus Mental Health Working Group.

(a) As part of the Working Group's efforts, it shall consider the mental- and behavioral-health conditions of those vulnerable populations affected by the pandemic, including. Minorities, seniors, veterans, small business owners, children, and individuals potentially affected by domestic violence or physical abuse. Those living with disabilities.

And those with a substance use disorder. The Working Group shall examine existing protocols and evidence-based programs that may serve as models to better support these at-risk groups, including implementation and broader application of the PREVENTS, and the Department of Labor's Employer Assistance and Resource Network on Disability Inclusion's Mental Health Toolkit and Centralized Accommodation Programs. (b) Within 45 days of the date of this order, the Working Group shall develop and submit to the President a report that outlines a plan for improved service coordination between all relevant public and private stakeholders and executive departments and agencies (agencies) to assist individuals in crisis so that they receive effective treatment and recovery services.

Sec. 5. Grant Funding for States and Organizations that Permit In-Person Treatment and Recovery Support Activities for Mental and Behavioral Health.

The heads of agencies, in consultation with the Director of OMB, shall. (a) Examine their existing grant programs that fund mental-health, medical, or related services and, consistent with applicable law, take steps to encourage grantees to consider adopting policies, where appropriate, that have been shown to improve mental health and reduce suicide risk, including the following. (i) Safe in-person and telehealth participation in support groups for people in recovery from substance use disorders, mental-health issues, or other ailments that benefit from communal support.

And peer-to-peer services that support underserved communities. (ii) Safe face-to-face therapeutic services, including group therapy, to remediate poor behavioral health. And (iii) Safe participation in communal support—both faith-based and secular—including educational programs, civic activities, and in-person religious services.

(b) Maximize use of existing agency authorities to award contracts or grants to community organizations or other local entities to enhance mental-health and suicide-prevention services, such as outreach, education, and case management, to vulnerable Americans. Sec. 6.

General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect. (i) the authority granted by law to an executive department or agency, or the head thereof.

Or (ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals. (b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

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NCHS Data Brief where to get ventolin pills No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease where to get ventolin pills (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is where to get ventolin pills “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are where to get ventolin pills postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than where to get ventolin pills 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 where to get ventolin pills. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal where to get ventolin pills status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer where to get ventolin pills had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf where to get ventolin pills icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in where to get ventolin pills five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 where to get ventolin pills. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image where to get ventolin pills icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer where to get ventolin pills had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data where to get ventolin pills table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep where to get ventolin pills four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 where to get ventolin pills. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear where to get ventolin pills trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual where to get ventolin pills cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE where to get ventolin pills. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the where to get ventolin pills past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 where to get ventolin pills. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data online doctor ventolin Continue Reading Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes online doctor ventolin (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that online doctor ventolin occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of online doctor ventolin women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health online doctor ventolin Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 online doctor ventolin. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by online doctor ventolin menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if online doctor ventolin they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE online doctor ventolin.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or online doctor ventolin more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 online doctor ventolin.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p < online doctor ventolin. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or online doctor ventolin less.

Women were premenopausal if they still had a menstrual cycle. Access data online doctor ventolin table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more online doctor ventolin in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 online doctor ventolin. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, online doctor ventolin 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if online doctor ventolin they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE online doctor ventolin. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% online doctor ventolin among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 online doctor ventolin. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

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As medical cannabis gains more mainstream acceptance, and as physicians increasingly encounter patient questions about its use, doctors are developing more clinical resources to guide those who decide to prescribe it.At this year's PAINWeek in September, Alan Bell, MD, of ventolin hfa interactions the University of Toronto, and colleagues presented recommendations for using medical cannabis to treat chronic pain. The same month, two physicians published a book aimed at helping colleagues treat patients, and the previous month a pain medicine specialist published a similar book.Though evidence from gold-standard randomized controlled trials has been severely limited, authors of the publications told MedPage Today that it's important to start somewhere."We are trying to advocate for more physicians to provide better care," said Kevin Hill, MD, of Beth Israel ventolin hfa interactions Deaconess Medical Center in Boston, a co-author of one of the new clinical textbooks. "We wanted to present exactly where things stand now -- understanding we have a long way to go in some areas."Latest ResourcesThe "consensus recommendations" presented at PAINWeek were supported by Canopy Growth, described on its website as the "first cannabis company in North America ventolin hfa interactions to be publicly traded."The group met via video calls to develop the guidelines, setting the bar at 75% agreement to include any recommendations, and touting the use of a modified Delphi process.Ultimately their recommendations included. Stratifying patients into conservative, routine, or rapid treatment protocols based on level of need. Following a regimen heavy on cannabidiol (CBD), introducing tetrahydrocannabinol (THC) in small doses only when CBD alone cannot yield ventolin hfa interactions desired patient outcomes.

And starting with 2.5-mg doses of THC and 5-mg CBD doses and increasing dosages by 1-5 mg."Our main focus was to provide directions to clinicians ventolin hfa interactions to surmount the huge barrier that may exist because of the knowledge gap" about medical cannabis overall, Bell told MedPage Today. "There's a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen."Hill and Samoon Ahmad, MD, of New York University, authored Medical Marijuana. A Clinical Handbook, published by Wolters Kluwer Health ventolin hfa interactions in September. The 500-plus-page book features chapters on the endocannabinoid system, adverse effects, pharmacology, ventolin hfa interactions among other topics. It also contains 11 chapters on using cannabis within individual medical specialties.In August, Springer published a similar book edited by Kenneth Finn, MD, a longtime Colorado pain medicine specialist who has written about medical cannabis for KevinMD and MedPage Today.

Finn's 585-page book includes chapters on cannabinoids and pain, dermatology, and ventolin hfa interactions public health. Chapters are co-written by clinicians and professors, as well ventolin hfa interactions as advocates including Kevin Sabet and David Evans.Also this summer, Matthew Mintz, MD, who uses medical cannabis in his primary care practice in the suburbs of Washington, D.C., self-published a book for providers and patients based largely on his clinical experience. Bonni Goldstein, MD, a Los Angeles medical cannabis specialist, authored a similar book aimed at both audiences."There's a strong need for good education," said Leslie Mendoza Temple, MD, director of NorthShore Medical Group's Integrative Medicine program in Chicago and a board member of the advocacy group Doctors for Cannabis Regulation. "The more we add to the knowledge base, the better it is for everyone."Evidence ChallengesThe resources seek to provide guidance in a field that lacks a substantial evidence base, in large part because research has been limited by federal regulations and the Drug ventolin hfa interactions Enforcement Administration's Schedule 1 designation. Few randomized controlled trials have been completed, and the aging studies cited in a 2017 National Academies report still serve as prominent sources.Hill and Ahmad said they aimed to incorporate all the credible research they could find into their book, including new evidence beyond the ventolin hfa interactions NAS report, and at a more detailed level.

A website affiliated with the book will continuously update as new evidence emerges.Medical and scientific groups have called for better research into medical cannabis. In May, the Parkinson's Foundation issued a consensus statement calling for "well-designed studies that will address the question of whether cannabis-based medicines offer therapeutic benefit in the treatment of motor and non-motor symptoms of [Parkinson's disease]."The American Heart Association published a scientific statement on medical cannabis in September, highlighting a "pressing need for refined policy, education of clinicians and the public, and new research." All practitioners "need greater exposure to and education on the various cannabis products and their health implications during their initial training and continuing education," the statement said.Just this week, the American Society of Addiction Medicine published a policy statement calling for medical cannabis to be rescheduled "to promote more clinical research and FDA ventolin hfa interactions oversight typical of other medications.... Federal legislation and regulation ventolin hfa interactions should encourage scientific and clinical research on cannabis and its compounds, expand sources of research-grade cannabis, and facilitate the development of FDA-approved medications derived from cannabis such as CBD or other cannabis compounds."On the other hand, some experts have argued existing evidence is enough to work with. Writing in BMJ Open, David Nutt, DM, of Imperial College London, and colleagues criticized British physicians for using the lack of RCTs ventolin hfa interactions as a crutch, saying "it is utterly deceitful for people who need it not to be offered medical cannabis."Clinicians should evaluate other published evidence, including observational studies and patient-focused trials, he wrote.Yet the lack of randomized controlled trials has largely prevented British physicians from prescribing medical cannabis since it was legalized in 2018, the paper noted.Additional Resources NeededThe field still lacks other key resources, such as consensus medical guidelines from a leading medical association, Hill said.Physicians should scrutinize current resources, experts said. In the consensus guidelines, for example, the 2.5-mg doses and CBD-only treatments lack much evidence to support their use in chronic pain, and using the Delphi process does not make their recommendations science-based, Mintz said.Mintz took umbrage with extracting guidelines from a poster presentation "not based on true data." (The guideline task force plans to include more information when they submit for publication, Bell said.)"It's an interesting, good start, but calling these guidelines is an overshoot," Mintz said.

"At least there is a consensus group of clinicians ventolin hfa interactions. ... A lot of what we are using [now] is based on clinical experience."The next step would be for the group to develop guidelines based on data, said Jordan Tishler, MD, president of the Association of Cannabis Specialists.Mintz credited the other resources' authors for striving to add to the field's knowledge, regardless of how complete and controversial they may be."All physicians should be aware there is some evidence for cannabis and should be aware because it is a good option for some patients," he said. "The more we can get clinicians, physicians out there saying, 'yes this is something we can use and here's a couple ideas how to use it,' while waiting on federal regulations, that will help.""And hopefully we will see the laws change so we can get the data we need." Ryan Basen reports for MedPage’s enterprise &. Investigative team.

He has worked as a journalist for more than a decade, earning national and state honors for his investigative work. He often writes about issues concerning the practice and business of medicine. FollowThe FDA expanded the indication for pitolisant (Wakix) to include the treatment of cataplexy in adults with narcolepsy, Harmony Biosciences announced.Hyperemesis gravidarum -- or severe morning sickness during pregnancy -- was closely tied to depression in mothers. (BMJ Open)Participating in sports could be a protective factor against attention deficit-hyperactivity disorder (ADHD) symptoms in girls, but not for boys. (Preventive Medicine)Pandemic-related loneliness in adults hasn't peaked as much as one would expect.

(NPR)And kids did surprisingly well during quarantines too, owing to more sleep and family time and less social media. (The Atlantic)Writing in the Lancet Psychiatry, researchers suggested re-conceptualizing "treatment-resistant" depression as "difficult-to-treat" depression instead, writing that most treatments have "only modest or moderate effectiveness."Having a secure attachment style can offset a genetic risk for post-traumatic stress disorder (PTSD), according to a genome-wide association study. (Yale Daily News)New research suggests human brains are hardwired to prioritize high-calorie foods. (Scientific Reports) Last Updated October 14, 2020 Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and dermatology news. Based out of the New York City office, she’s worked at the company for nearly five years..

As medical cannabis gains more mainstream acceptance, and as physicians increasingly encounter patient questions online doctor ventolin about its use, doctors are ventolin hfa 108 90 base mcg act aerosol developing more clinical resources to guide those who decide to prescribe it.At this year's PAINWeek in September, Alan Bell, MD, of the University of Toronto, and colleagues presented recommendations for using medical cannabis to treat chronic pain. The same month, two physicians published a book aimed at helping colleagues treat patients, and the previous month a pain medicine specialist published a similar online doctor ventolin book.Though evidence from gold-standard randomized controlled trials has been severely limited, authors of the publications told MedPage Today that it's important to start somewhere."We are trying to advocate for more physicians to provide better care," said Kevin Hill, MD, of Beth Israel Deaconess Medical Center in Boston, a co-author of one of the new clinical textbooks. "We wanted to present exactly where things stand now -- understanding we have a long way to go in some areas."Latest ResourcesThe "consensus online doctor ventolin recommendations" presented at PAINWeek were supported by Canopy Growth, described on its website as the "first cannabis company in North America to be publicly traded."The group met via video calls to develop the guidelines, setting the bar at 75% agreement to include any recommendations, and touting the use of a modified Delphi process.Ultimately their recommendations included. Stratifying patients into conservative, routine, or rapid treatment protocols based on level of need. Following a online doctor ventolin regimen heavy on cannabidiol (CBD), introducing tetrahydrocannabinol (THC) in small doses only when CBD alone cannot yield desired patient outcomes.

And starting with 2.5-mg doses of THC and 5-mg CBD doses and increasing dosages by 1-5 mg."Our main focus was to provide directions to clinicians to surmount online doctor ventolin the huge barrier that may exist because of the knowledge gap" about medical cannabis overall, Bell told MedPage Today. "There's a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen."Hill and Samoon Ahmad, MD, of New York University, authored Medical Marijuana. A Clinical online doctor ventolin Handbook, published by Wolters Kluwer Health in September. The 500-plus-page book features chapters online doctor ventolin on the endocannabinoid system, adverse effects, pharmacology, among other topics. It also contains 11 chapters on using cannabis within individual medical specialties.In August, Springer published a similar book edited by Kenneth Finn, MD, a longtime Colorado pain medicine specialist who has written about medical cannabis for KevinMD and MedPage Today.

Finn's 585-page book includes chapters on cannabinoids and pain, dermatology, and public online doctor ventolin health. Chapters are co-written by clinicians and professors, as well as advocates including Kevin Sabet and David Evans.Also this summer, online doctor ventolin Matthew Mintz, MD, who uses medical cannabis in his primary care practice in the suburbs of Washington, D.C., self-published a book for providers and patients based largely on his clinical experience. Bonni Goldstein, MD, a Los Angeles medical cannabis specialist, authored a similar book aimed at both audiences."There's a strong need for good education," said Leslie Mendoza Temple, MD, director of NorthShore Medical Group's Integrative Medicine program in Chicago and a board member of the advocacy group Doctors for Cannabis Regulation. "The more we add to the knowledge base, the better it is for everyone."Evidence ChallengesThe resources seek to provide guidance in a field that lacks a substantial evidence base, in large part because research online doctor ventolin has been limited by federal regulations and the Drug Enforcement Administration's Schedule 1 designation. Few randomized controlled trials have been completed, and the aging studies cited in a 2017 National Academies report still serve as prominent sources.Hill and Ahmad said they aimed to incorporate all online doctor ventolin the credible research they could find into their book, including new evidence beyond the NAS report, and at a more detailed level.

A website affiliated with the book will continuously update as new evidence emerges.Medical and scientific groups have called for better research into medical cannabis. In May, the Parkinson's Foundation issued a consensus statement calling for "well-designed studies that will address the question of whether cannabis-based medicines offer therapeutic benefit in the treatment of motor and non-motor symptoms of [Parkinson's disease]."The American Heart Association published a scientific statement on medical cannabis in September, highlighting a "pressing need for refined policy, education of clinicians and the public, and new research." All online doctor ventolin practitioners "need greater exposure to and education on the various cannabis products and their health implications during their initial training and continuing education," the statement said.Just this week, the American Society of Addiction Medicine published a policy statement calling for medical cannabis to be rescheduled "to promote more clinical research and FDA oversight typical of other medications.... Federal legislation and regulation should encourage scientific and clinical research on cannabis and http://sw.keimfarben.de/where-to-buy-ventolin-pills/ its compounds, expand sources of research-grade cannabis, and facilitate the development of FDA-approved medications derived from cannabis such as CBD or other cannabis compounds."On the other hand, some experts have argued existing evidence is enough online doctor ventolin to work with. Writing in BMJ Open, David Nutt, DM, of Imperial College London, and colleagues criticized British physicians for using the lack of RCTs as a crutch, saying "it is utterly deceitful for people who need it not to be offered medical cannabis."Clinicians should evaluate other published evidence, including observational studies and patient-focused trials, he wrote.Yet the lack of randomized controlled trials has largely prevented British physicians from prescribing medical cannabis since it was legalized in 2018, the paper noted.Additional Resources NeededThe field still lacks online doctor ventolin other key resources, such as consensus medical guidelines from a leading medical association, Hill said.Physicians should scrutinize current resources, experts said. In the consensus guidelines, for example, the 2.5-mg doses and CBD-only treatments lack much evidence to support their use in chronic pain, and using the Delphi process does not make their recommendations science-based, Mintz said.Mintz took umbrage with extracting guidelines from a poster presentation "not based on true data." (The guideline task force plans to include more information when they submit for publication, Bell said.)"It's an interesting, good start, but calling these guidelines is an overshoot," Mintz said.

"At least online doctor ventolin there is a consensus group of clinicians. ... A lot of what we are using [now] is based on clinical experience."The next step would be for the group to develop guidelines based on data, said Jordan Tishler, MD, president of the Association of Cannabis Specialists.Mintz credited the other resources' authors for striving to add to the field's knowledge, regardless of how complete and controversial they may be."All physicians should be aware there is some evidence for cannabis and should be aware because it is a good option for some patients," he said. "The more we can get clinicians, physicians out there saying, 'yes this is something we can use and here's a couple ideas how to use it,' while waiting on federal regulations, that will help.""And hopefully we will see the laws change so we can get the data we need." Ryan Basen reports for MedPage’s enterprise &. Investigative team.

He has worked as a journalist for more than a decade, earning national and state honors for his investigative work. He often writes about issues concerning the practice and business of medicine. FollowThe FDA expanded the indication for pitolisant (Wakix) to include the treatment of cataplexy in adults with narcolepsy, Harmony Biosciences announced.Hyperemesis gravidarum -- or severe morning sickness during pregnancy -- was closely tied to depression in mothers. (BMJ Open)Participating in sports could be a protective factor against attention deficit-hyperactivity disorder (ADHD) symptoms in girls, but not for boys. (Preventive Medicine)Pandemic-related loneliness in adults hasn't peaked as much as one would expect.

(NPR)And kids did surprisingly well during quarantines too, owing to more sleep and family time and less social media. (The Atlantic)Writing in the Lancet Psychiatry, researchers suggested re-conceptualizing "treatment-resistant" depression as "difficult-to-treat" depression instead, writing that most treatments have "only modest or moderate effectiveness."Having a secure attachment style can offset a genetic risk for post-traumatic stress disorder (PTSD), according to a genome-wide association study. (Yale Daily News)New research suggests human brains are hardwired to prioritize high-calorie foods. (Scientific Reports) Last Updated October 14, 2020 Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and dermatology news. Based out of the New York City office, she’s worked at the company for nearly five years..

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For immediate release where can you buy ventolin over the counter. October 19, 2020Boston, MA – Air pollution was significantly associated with an increased risk of hospital admissions for several neurological disorders, including Parkinson’s disease, Alzheimer’s disease, and other dementias, in a long-term study of more than 63 where can you buy ventolin over the counter million older U.S. Adults, led by researchers at Harvard T.H. Chan School of Public Health.The study, conducted with colleagues at Emory University’s Rollins School of Public Health and where can you buy ventolin over the counter Columbia University’s Mailman School of Public Health, is the first nationwide analysis of the link between fine particulate (PM2.5) pollution and neurodegenerative diseases in the U.S.

The researchers leveraged an unparalleled amount of data compared to any previous study of air pollution and neurological disorders.The study was published online October 19, 2020 in The Lancet Planetary Health.“The 2020 report of the Lancet Commission on dementia prevention, intervention, and care has added air pollution as one of the modifiable risk factors for these outcomes,” said Xiao Wu, doctoral student in biostatistics at Harvard Chan School and co-lead author of the study. €œOur study where can you buy ventolin over the counter builds on the small but emerging evidence base indicating that long-term PM2.5 exposures are linked to an increased risk of neurological health deterioration, even at PM2.5 concentrations well below the current national standards.”Researchers looked at 17 years’ worth (2000–2016) of hospital admissions data from 63,038,019 Medicare recipients in the U.S. And linked these with estimated PM2.5 concentrations by where can you buy ventolin over the counter zip code. Taking into account potential confounding factors like socioeconomic status, they found that, for each 5 microgram per cubic meter of air (μg/m3) increase in annual PM2.5 concentrations, there was a 13% increased risk for first-time hospital admissions both for Parkinson’s disease and for Alzheimer’s disease and related dementias.

This risk remained elevated even below supposedly safe levels of PM2.5 exposure, which, where can you buy ventolin over the counter according to current U.S. Environmental Protection Agency standards, is an annual average of 12 μg/m3 or less.Women, white people, and urban populations were particularly susceptible, the study found. The highest risk for first-time Parkinson’s disease where can you buy ventolin over the counter hospital admissions was among older adults in the northeastern U.S. For first-time Alzheimer’s disease and related dementias hospital admissions, older adults in the Midwest faced the highest risk.“Our U.S.-wide study shows that the current standards are not protecting the aging American population enough, highlighting the need for stricter standards and policies that help further reduce PM2.5 concentrations and improve air quality overall,” said Antonella Zanobetti, principal research scientist in Harvard Chan School’s Department of Environmental Health and co-senior author of the study.Liuhua Shi, research assistant professor at Emory’s Rollins School of Public Health, was a co-lead author and Marianthi-Anna Kioumourtzoglou, assistant professor in environmental health sciences at Columbia’s Mailman School of Public Health, was a co-senior author.Other Harvard Chan School authors included Mahdieh Danesh Yazdi, Danielle Braun, Yaguang Wei, Yun Wang, Joel Schwartz, and Francesca Dominici.This study was supported by the Health Effects Institute (4953-RFA14-3/16-4), the National Institute of Environmental Health Sciences (NIEHS R01 ES024332, R01 ES028805, R21 ES028472, P30 ES009089, P30 ES000002), the National Institute on Aging (NIA/NIH R01 AG066793-01, P50 AG025688), and the HERCULES Center (P30ES019776).

Research described in this where can you buy ventolin over the counter article was done under contract to the Health Effects Institute, an organization jointly funded by the U.S. Environmental Protection Agency (assistance award number R-83467701) and some motor vehicle and engine manufacturers.“Long-term effects where can you buy ventolin over the counter of PM2.5 on neurological disorders in the American Medicare population. A longitudinal cohort study,” Liuhua Shi, Xiao Wu, Mahdieh Danesh Yazdi, Danielle Braun, Yara Abu Awad, Yaguang Wei, Pengfei Liu, Qian Di, Yun Wang, Joel Schwartz, Francesca Dominici, Marianthi-Anna Kioumourtzoglou, Antonella Zanobetti, The Lancet Planetary Health, online October 19, 2020, doi. Https://doi.org/10.1016/S2542-5196(20)30227-8Photo.

IStock/hapabapaVisit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.Nicole Rura617.221.4241nrura@hsph.harvard.edu###Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses.

Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.CORVALLIS, Ore. €“ Oregon State University scientists have developed a method that could potentially predict the cancer-causing potential of chemicals released into the air during wildfires and fossil fuel combustion. The research, which was recently published in the journal Toxicology in Vitro, was conducted as a part of the OSU Superfund Research Program. The findings are important for agencies that regulate air pollution caused by these chemicals, known as polycyclic aromatic hydrocarbons (PAHs).

It also could help medical researchers who study patients with conditions such as asthma. PAHs are a class of chemicals that occur naturally in coal, crude oil and gasoline. They also are produced when coal, oil, gas, wood, garbage and tobacco are burned. At high levels, as was the case during recent wildfires in the western United States, when PAHs are inhaled they can be harmful to human health.

Despite PAHs being the first class of chemicals identified as cancer-causing, little is known about the carcinogenic potential of the more than 1,500 PAHs. Part of the challenge is that PAHs usually occur as a mixture of chemicals, making it difficult to tease apart roles of individual chemicals in the mixture. The OSU researchers, led by Susan Tilton, an associate professor in the Department of Environmental and Molecular Toxicology in the College of Agricultural Sciences, have been studying PAHs for over six years. They previously developed a system to predict whether tumors formed in mice exposed to certain PAHs.

The current research translates that approach using human bronchial cells. The researchers treated the cells with individual PAHs and then used computational analysis to look at changes across thousands of genes simultaneously to identify gene signatures. They then looked for gene signatures consistent across the different chemicals with similar carcinogenic potential. €œThose with similar carcinogenic potential are the ones we can focus on,” Tilton said.

€œPotentially, in the future we wouldn’t need to look at thousands and thousands of genes. Once we tested enough chemicals and felt very confident about this we could drill down and look at a select handful of genes in order to make these types of predictions.” In the future, the researchers plan to expand the number of chemicals that they test, particularly chemicals whose carcinogenic potential is not well understood. They also want to study lung cells from people with pre-existing conditions, such as asthma and chronic obstructive pulmonary disease, to see if they are particularly sensitive to certain chemicals. Co-authors of the paper were Yvonne Chang, Celine Thanh Thu Huynh, Kelley M.

Bastin, Brianna N. Rivera, Lisbeth K. Siddens, all of Oregon State..

For immediate online doctor ventolin http://sw.keimfarben.de/where-to-buy-ventolin-pills/ release. October 19, 2020Boston, online doctor ventolin MA – Air pollution was significantly associated with an increased risk of hospital admissions for several neurological disorders, including Parkinson’s disease, Alzheimer’s disease, and other dementias, in a long-term study of more than 63 million older U.S. Adults, led by researchers at Harvard T.H. Chan School of Public Health.The study, conducted with colleagues at Emory University’s Rollins School of Public Health and Columbia University’s Mailman School of Public Health, is online doctor ventolin the first nationwide analysis of the link between fine particulate (PM2.5) pollution and neurodegenerative diseases in the U.S. The researchers leveraged an unparalleled amount of data compared to any previous study of air pollution and neurological disorders.The study was published online October 19, 2020 in The Lancet Planetary Health.“The 2020 report of the Lancet Commission on dementia prevention, intervention, and care has added air pollution as one of the modifiable risk factors for these outcomes,” said Xiao Wu, doctoral student in biostatistics at Harvard Chan School and co-lead author of the study.

€œOur study builds on the small but emerging evidence base indicating that long-term PM2.5 exposures are linked to an increased risk of neurological health deterioration, even at PM2.5 concentrations well below the current national standards.”Researchers looked at 17 years’ worth (2000–2016) of hospital admissions data from 63,038,019 online doctor ventolin Medicare recipients in the U.S. And linked these with estimated PM2.5 concentrations by zip online doctor ventolin code. Taking into account potential confounding factors like socioeconomic status, they found that, for each 5 microgram per cubic meter of air (μg/m3) increase in annual PM2.5 concentrations, there was a 13% increased risk for first-time hospital admissions both for Parkinson’s disease and for Alzheimer’s disease and related dementias. This risk remained elevated even below supposedly safe levels of PM2.5 exposure, which, according to current online doctor ventolin U.S. Environmental Protection Agency standards, is an annual average of 12 μg/m3 or less.Women, white people, and urban populations were particularly susceptible, the study found.

The highest risk for first-time Parkinson’s online doctor ventolin disease hospital admissions was among older adults in the northeastern U.S. For first-time Alzheimer’s disease and related dementias hospital admissions, older adults in the Midwest faced the highest risk.“Our U.S.-wide study shows that the current standards are not protecting the aging American population enough, highlighting the need for stricter standards and policies that help further reduce PM2.5 concentrations and improve air quality overall,” said Antonella Zanobetti, principal research scientist in Harvard Chan School’s Department of Environmental Health and co-senior author of the study.Liuhua Shi, research assistant professor at Emory’s Rollins School of Public Health, was a co-lead author and Marianthi-Anna Kioumourtzoglou, assistant professor in environmental health sciences at Columbia’s Mailman School of Public Health, was a co-senior author.Other Harvard Chan School authors included Mahdieh Danesh Yazdi, Danielle Braun, Yaguang Wei, Yun Wang, Joel Schwartz, and Francesca Dominici.This study was supported by the Health Effects Institute (4953-RFA14-3/16-4), the National Institute of Environmental Health Sciences (NIEHS R01 ES024332, R01 ES028805, R21 ES028472, P30 ES009089, P30 ES000002), the National Institute on Aging (NIA/NIH R01 AG066793-01, P50 AG025688), and the HERCULES Center (P30ES019776). Research described in this article was online doctor ventolin done under contract to the Health Effects Institute, an organization jointly funded by the U.S. Environmental Protection Agency (assistance award number R-83467701) and some motor vehicle and engine manufacturers.“Long-term effects of PM2.5 on neurological disorders in the American Medicare population online doctor ventolin. A longitudinal cohort study,” Liuhua Shi, Xiao Wu, Mahdieh Danesh Yazdi, Danielle Braun, Yara Abu Awad, Yaguang Wei, Pengfei Liu, Qian Di, Yun Wang, Joel Schwartz, Francesca Dominici, Marianthi-Anna Kioumourtzoglou, Antonella Zanobetti, The Lancet Planetary Health, online October 19, 2020, doi.

Https://doi.org/10.1016/S2542-5196(20)30227-8Photo. IStock/hapabapaVisit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.Nicole Rura617.221.4241nrura@hsph.harvard.edu###Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses.

Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.CORVALLIS, Ore. €“ Oregon State University scientists have developed a method that could potentially predict the cancer-causing potential of chemicals released into the air during wildfires and fossil fuel combustion. The research, which was recently published in the journal Toxicology in Vitro, was conducted as a part of the OSU Superfund Research Program. The findings are important for agencies that regulate air pollution caused by these chemicals, known as polycyclic aromatic hydrocarbons (PAHs). It also could help medical researchers who study patients with conditions such as asthma.

PAHs are a class of chemicals that occur naturally in coal, crude oil and gasoline. They also are produced when coal, oil, gas, wood, garbage and tobacco are burned. At high levels, as was the case during recent wildfires in the western United States, when PAHs are inhaled they can be harmful to human health. Despite PAHs being the first class of chemicals identified as cancer-causing, little is known about the carcinogenic potential of the more than 1,500 PAHs. Part of the challenge is that PAHs usually occur as a mixture of chemicals, making it difficult to tease apart roles of individual chemicals in the mixture.

The OSU researchers, led by Susan Tilton, an associate professor in the Department of Environmental and Molecular Toxicology in the College of Agricultural Sciences, have been studying PAHs for over six years. They previously developed a system to predict whether tumors formed in mice exposed to certain PAHs. The current research translates that approach using human bronchial cells. The researchers treated the cells with individual PAHs and then used computational analysis to look at changes across thousands of genes simultaneously to identify gene signatures. They then looked for gene signatures consistent across the different chemicals with similar carcinogenic potential.

€œThose with similar carcinogenic potential are the ones we can focus on,” Tilton said. €œPotentially, in the future we wouldn’t need to look at thousands and thousands of genes. Once we tested enough chemicals and felt very confident about this we could drill down and look at a select handful of genes in order to make these types of predictions.” In the future, the researchers plan to expand the number of chemicals that they test, particularly chemicals whose carcinogenic potential is not well understood. They also want to study lung cells from people with pre-existing conditions, such as asthma and chronic obstructive pulmonary disease, to see if they are particularly sensitive to certain chemicals. Co-authors of the paper were Yvonne Chang, Celine Thanh Thu Huynh, Kelley M.

Bastin, Brianna N. Rivera, Lisbeth K. Siddens, all of Oregon State..

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Convalescent plasma from a recovered coronavirus disease (COVID-19) patient is seen at the Central Seattle Donor Center of Bloodworks Northwest during the outbreak in Seattle, Washington, April 17, 2020.Lindsey Wasson | ReutersA panel of experts convened by the National Institutes of Health said Tuesday cost of ventolin in usa there is "insufficient data" to show convalescent plasma works against the coronavirus, refuting claims made by President http://sw.keimfarben.de/where-to-buy-ventolin-pills/ Donald Trump and the head of the Food and Drug Administration.The panel said it reviewed available data on the treatment and found no data from "well-controlled, adequately powered randomized clinical trials that demonstrate the efficacy and safety of convalescent plasma" for the treatment of Covid-19. It also said "there cost of ventolin in usa was no difference in 7-day survival" for patients, contradicting FDA Commissioner Dr. Stephen Hahn, who said the treatment resulted in a 35% improvement in survival.

"There are insufficient data to recommend either for or against the use of convalescent plasma for the treatment of COVID-19," the panel cost of ventolin in usa said in a statement. "Convalescent plasma should not be considered standard of care for the treatment of patients with COVID-19."The FDA granted the treatment emergency authorization on Aug 23., cost of ventolin in usa allowing U.S. Health-care providers to use the plasma to treat suspected or confirmed infections in hospitalized patients.Results of a study by the Mayo Clinic that the FDA cited in its authorization of the plasma treatment indicates that patients below age 80 who were not on a respirator and received plasma with a high level of antibodies within three days of diagnosis fared better than patients who received plasma with a low level of antibodies.

A weakness of the Mayo study was that it did not include a controlled group of patients receiving a placebo.The FDA's decision to authorize emergency use came a day after Trump accused cost of ventolin in usa the FDA of delaying enrollment in clinical trials for Covid-19 vaccines or therapeutics. The criticism from cost of ventolin in usa Trump and action from the FDA led some scientists to say the emergency use was politically motivated, especially since it was announced on the eve of the Republican National Convention.Hahn, under intense criticism, later walked back comments he made on the benefits of convalescent plasma, saying he could have done a better job of explaining the data on its effectiveness.He also said he wasn't bowing to pressure from Trump. "The decision was made by FDA career scientists based on data submitted a few weeks ago," Hahn tweeted last week.

This is a developing cost of ventolin in usa story. Please check back for updates..

Convalescent plasma from a recovered coronavirus disease (COVID-19) patient is seen at the Central Seattle Donor Center of Bloodworks Northwest during the outbreak in Seattle, Washington, April 17, 2020.Lindsey Wasson | ReutersA panel of experts convened by the National Institutes of my ventolin is not working Health said Tuesday there is "insufficient data" to show convalescent plasma works against the coronavirus, refuting claims made by President Donald Trump and the head of the Food and Drug Administration.The panel said it reviewed available data on the treatment and found no data from "well-controlled, adequately powered online doctor ventolin randomized clinical trials that demonstrate the efficacy and safety of convalescent plasma" for the treatment of Covid-19. It also said "there was no difference in 7-day survival" for online doctor ventolin patients, contradicting FDA Commissioner Dr. Stephen Hahn, who said the treatment resulted in a 35% improvement in survival.

"There are insufficient data to online doctor ventolin recommend either for or against the use of convalescent plasma for the treatment of COVID-19," the panel said in a statement. "Convalescent plasma should not be considered standard of care for the treatment of patients with COVID-19."The FDA granted the online doctor ventolin treatment emergency authorization on Aug 23., allowing U.S. Health-care providers to use the plasma to treat suspected or confirmed infections in hospitalized patients.Results of a study by the Mayo Clinic that the FDA cited in its authorization of the plasma treatment indicates that patients below age 80 who were not on a respirator and received plasma with a high level of antibodies within three days of diagnosis fared better than patients who received plasma with a low level of antibodies.

A weakness of the Mayo study was that it did not include a controlled group of patients receiving a placebo.The FDA's decision to authorize emergency use came a day after Trump accused the FDA of delaying enrollment in clinical trials for Covid-19 vaccines or online doctor ventolin therapeutics. The criticism from Trump and action from the FDA led some scientists to say the emergency use was politically motivated, especially since it was announced on the eve of the Republican National Convention.Hahn, under intense criticism, later walked back comments he made on the benefits of convalescent plasma, saying he could have done a better job of explaining the data on its effectiveness.He also said he wasn't bowing to pressure online doctor ventolin from Trump. "The decision was made by FDA career scientists based on data submitted a few weeks ago," Hahn tweeted last week.

This is online doctor ventolin a developing story. Please check back for updates..

Proventil ventolin difference

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The Ministry has revised the guidance to the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Act), http://sw.keimfarben.de/where-to-buy-ventolin-pills/ outlining the rights of compulsory mental health consumers and the obligations of proventil ventolin difference mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular proventil ventolin difference. the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act.

The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..

The Ministry has revised the guidance to the Mental Health (Compulsory Assessment and Treatment) online doctor ventolin Act 1992 (the Act), outlining the rights of compulsory mental health http://sw.keimfarben.de/where-to-buy-ventolin-pills/ consumers and the obligations of mental health clinicians. This guidance is intended to promote the protection of compulsory mental health consumers’ rights by clarifying the responsibilities of mental health services and clinicians and offering guidance on how sections of the Act can be administered. A number of key changes and emerging issues have been signalled in the revision of these Guidelines. In particular online doctor ventolin.

the growing influence of rights-based approaches and how these can be better promoted within the parameters of the current Mental Health Act. The need to give greater emphasis to our obligations under Te Tiriti o Waitangi the impact of He Ara Oranga and, in particular, the feedback from people with lived experience and families and whānau on how they experience the current administration of the Mental Health Act. Please also read the companion document to these guidelines, Human Rights and the Mental Health (Compulsory Assessment and Treatment) Act 1992, which offers guidance to thinking about and applying a human rights approach and supported decision-making when implementing the Act..

Can you take ventolin when pregnant

NONE

Etchells E, can you take ventolin when pregnant http://sw.keimfarben.de/where-to-buy-ventolin-pills/ Ho M, Shojania KG. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Safe 2016;25:202–6.The article has been corrected since it was published can you take ventolin when pregnant online. The authors want to alert readers to the following error identified in the published version. The error is in the last paragraph of the section “Small samples can make ‘rapid improvement’ Rapid”, wherein the minimum sample size has been considered as six instead of can you take ventolin when pregnant eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions.

The other five became frustrated and gave up. Table 1 tells you that, with an observed success rate of 50% and a desired target of 90%, any audit with a sample of six or more allows you to confidently reject the null hypothesis that your form is working at a 90% success rate.For decades, those working in can you take ventolin when pregnant hospitals normalised the incessant alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention. Fortunately, times can you take ventolin when pregnant are changing and managing alarm fatigue is now a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now beginning to understand how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety. Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit.

The primary project goal was to reduce alarm notifications from continuous bedside can you take ventolin when pregnant monitoring. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons. First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention bundle encompassed a wide variety of can you take ventolin when pregnant changes including adoption of a smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued.

Implementation of an alarm notification escalation algorithm after a certain amount of can you take ventolin when pregnant time in alarm threshold violation. Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of can you take ventolin when pregnant electrode lead replacement every 24 hours. And discussion of alarm parameters on daily rounds. Third, the authors introduced a novel strategy for reducing the stress that alarms may can you take ventolin when pregnant cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to this component of the intervention.This project constitutes an important contribution to the published literature.

However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management. (1) Identification of meaningful can you take ventolin when pregnant outcome measures and (2) Lack of high-quality evidence for most interventions. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the intervention, these notifications accounted for only about half of all alarm notifications. The other half included second and third notifications can you take ventolin when pregnant for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the primary nurse and to ‘buddy’ nurses, potentially increasing alarm burden.

On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is can you take ventolin when pregnant the most commonly used outcome measure in alarm research and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a highly functional alarm management system. Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms. Unfortunately, most studies have not been powered can you take ventolin when pregnant to statistically evaluate improvements in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation).

To assess change in can you take ventolin when pregnant nurses’ perceptions of alarm frequency, Pater et al conducted a prepost survey, which despite the small sample size (n=38 preintervention and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue. In fact, we currently have no widely accepted, validated can you take ventolin when pregnant tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the focus needs to shift away from simply reducing the frequency of alarms to more meaningful outcome metrics. In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions.

Most alarm reduction interventions have can you take ventolin when pregnant not been systematically evaluated at all or only in small studies without a control group.10 11 As a result, alarm management projects tend to involve complex and costly bundles of interventions of uncertain benefit. The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also made massive investments in personnel, such as monitor ‘watchers’ can you take ventolin when pregnant to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will benefit from a higher quality evidence base for the growing list of potential alarm management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted. In addition, we need to evaluate interventions that address can you take ventolin when pregnant the full spectrum of the alarm management system.

Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the notification is available to respond can you take ventolin when pregnant to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not always respond quickly for a variety of reasons.7 15–17 Factors like insufficient staffing, high severity of illness on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response. In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.The robust QI initiative carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm management interventions can you take ventolin when pregnant for a particular unit, demonstrating a generalisable process for others to emulate. Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities).

This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..

Etchells E, http://sw.keimfarben.de/where-to-buy-ventolin-pills/ Ho M, Shojania KG online doctor ventolin. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Safe 2016;25:202–6.The article has been corrected since it was published online online doctor ventolin.

The authors want to alert readers to the following error identified in the published version. The error is in the last paragraph of the section “Small samples can make ‘rapid online doctor ventolin improvement’ Rapid”, wherein the minimum sample size has been considered as six instead of eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions. The other five became frustrated and gave up.

Table 1 tells you that, with an observed success rate of 50% and a desired target of 90%, any audit with a sample of six or more allows you to confidently reject the null hypothesis that your form is online doctor ventolin working at a 90% success rate.For decades, those working in hospitals normalised the incessant alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention. Fortunately, times are changing online doctor ventolin and managing alarm fatigue is now a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now beginning to understand how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety.

Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit. The primary online doctor ventolin project goal was to reduce alarm notifications from continuous bedside monitoring. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons.

First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention bundle encompassed online doctor ventolin a wide variety of changes including adoption of a smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued.

Implementation of online doctor ventolin an alarm notification escalation algorithm after a certain amount of time in alarm threshold violation. Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of electrode lead replacement every 24 hours online doctor ventolin.

And discussion of alarm parameters on daily rounds. Third, the authors introduced a novel strategy for reducing the stress that alarms may cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to this component of the intervention.This project constitutes an important contribution to the online doctor ventolin published literature. However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management.

(1) Identification of meaningful outcome measures and online doctor ventolin (2) Lack of high-quality evidence for most interventions. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the intervention, these notifications accounted for only about half of all how to use ventolin evohaler alarm notifications.

The other half included second and third notifications for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the primary nurse online doctor ventolin and to ‘buddy’ nurses, potentially increasing alarm burden. On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is the most commonly used outcome measure in alarm research and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a online doctor ventolin highly functional alarm management system.

Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms. Unfortunately, most studies have not been powered to statistically evaluate improvements online doctor ventolin in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation).

To assess change in online doctor ventolin nurses’ perceptions of alarm frequency, Pater et al conducted a prepost survey, which despite the small sample size (n=38 preintervention and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue. In fact, we currently have no widely accepted, validated tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the focus needs to shift away from simply reducing the frequency of alarms to more meaningful online doctor ventolin outcome metrics.

In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions. Most alarm online doctor ventolin reduction interventions have not been systematically evaluated at all or only in small studies without a control group.10 11 As a result, alarm management projects tend to involve complex and costly bundles of interventions of uncertain benefit.

The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also made massive online doctor ventolin investments in personnel, such as monitor ‘watchers’ to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will benefit from a higher quality evidence base for the growing list of potential alarm management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted.

In addition, we need to evaluate interventions that address the full spectrum of the online doctor ventolin alarm management system. Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the notification is available online doctor ventolin to respond to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not always respond quickly for a variety of reasons.7 15–17 Factors like insufficient staffing, high severity of illness on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response.

In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.The robust QI online doctor ventolin initiative carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm management interventions for a particular unit, demonstrating a generalisable process for others to emulate. Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities).

This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..