United Health Care Insurance

Background  During August 2003, Europe sustained a severe heat wave that resulted in 14 800 heat-related deaths in France. Most of these excess deaths occurred in urban areas, where maximal temperatures broke all records. Heatstroke is the most severe form of heat-related illness. The clinical course of heatstroke in urban areas of temperate countries is poorly documented.

Methods  During the French heat wave (August 1-20, 2003), we conducted a prospective study in a university hospital located in Lyon, one of the largest metropolitan areas in France. We evaluated survival and functional outcome for 2 years and looked for factors influencing the prognosis.

Results  A total of 83 patients presented with heatstroke. The 28-day and 2-year mortality rates were 58% and 71%, respectively. Mortality was influenced as early as admission by the level of fever and the number of organ dysfunctions. Multivariate analysis revealed an independent contribution to mortality if patients came from an institution (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.05-3.71), used long-term antihypertensive medication (HR, 2.17; 95% CI, 1.17-4.05), or presented at admission with anuria (HR, 5.24; 95% CI, 2.29-12.03), coma (HR, 2.95; 95% CI, 1.26-6.91), or cardiovascular failure (HR, 2.43; 95% CI, 1.14-5.17). Most surviving patients exhibited a dramatic alteration of their functional status at 1 and 2 years.

Conclusions  Heatstroke is associated with poor outcomes in temperate urban areas. This could be explained at least in part by our lack of experience. Western temperate countries need to be more prepared for future heat waves.

Published online August 13, 2007 (doi:10.1001/archinte.167.20.ioi70147).

Background  Although identifying individuals who are at increased risk of dying during heat waves and instituting protective measures represent an established strategy, the evidence supporting the components of this strategy and their strengths has yet to be evaluated. We conducted a meta-analysis of observational studies on risk and protective factors in heat wave–related deaths.

Methods  Using the OVID interface, we searched Medline (1966-2006) and CINHAL (1982-2006) databases. The Web sites of the World Health Organization, Institut National de Veille Sanitaire, and Centers for Disease Control and Prevention were also visited. The search terms included heat wave, heat stroke, heatstroke, sunstroke, and heat stress disorders. Eligible studies were case-control or cohort studies. Odds ratios (ORs) and information on study quality were abstracted by 2 investigators independently. Six case-control studies involving 1065 heat wave–related deaths were identified.

Results  Being confined to bed (OR, 6.44; 95% confidence interval [CI], 4.5-9.2), not leaving home daily (OR, 3.35; 95% CI, 1.6-6.9), and being unable to care for oneself (OR, 2.97; 95% CI, 1.8-4.8) were associated with the highest risk of death during heat waves. Preexisting psychiatric illness (OR, 3.61; 95% CI, 1.3-9.8) tripled the risk of death, followed by cardiovascular (OR, 2.48; 95% CI, 1.3-4.8) and pulmonary (OR, 1.61; 95% CI, 1.2-2.1) illness. Working home air-conditioning (OR, 0.23; 95% CI, 0.1-0.6), visiting cool environments (OR, 0.34; 95% CI, 0.2-0.5), and increasing social contact (OR, 0.40; 95% CI, 0.2-0.8) were strongly associated with better outcomes. Taking extra showers or baths (OR, 0.32; 95% CI, 0.1-1.1) and using fans (OR, 0.60; 95% CI, 0.4-1.1) were associated with a trend toward lower risk of death.

Conclusion  The present study identified several prognostic factors that could help to detect those individuals who are at highest risk during heat waves and to provide a basis for potential risk-reducing interventions in the setting of heat waves.

Published online August 13, 2007 (doi:10.1001/archinte.167.20.ira70009).

One common thing that happens to many of us is getting caught in the “yes” trap.

We are asked to do something that we really don’t want to do.

But instead of saying no, we feel we should do it and so we say yes.

Reasons to say when you really mean no:

There are many reasons why we say yes when we really mean no.

• One reason is we are afraid to say no.
• We may fear being rejected by the person asking us.
• Instead of standing up for what we really believe or want, we cower and say yes. Or we fear having a confrontation with the person.
• Instead of saying no, you say yes to avoid getting into a conflict.
• People who have low self-confidence can sense that other people are more powerful than them. They often don’t want to get into situations that could turn into disagreements.

Circumstances in your life for which you say yes but mean no:

• You’re shopping for clothes and the salesperson makes some suggestions. Do you ever buy something you don’t really like that well just because you don’t want to say no to the salesperson?
• You’re at the beauty salon or barbershop getting your hair cut. The stylist makes some suggestions about how to cut your hair. You don’t really want it that way but you let her cut it anyway because you don’t want to say no.
• You’re at a restaurant and the waiter recommends a particular dish. Even though you don’t usually like this particular food, you order it and eat it anyway.
• You get a phone call from someone selling something. You want to say no but instead you end up buying the item.
• Someone comes to the door selling magazine subscriptions. Even though you don’t need any magazines you agree to purchase a subscription.
• Your sister calls to see if you can baby sit her kids on Saturday night. There is no special occasion; they just want some time without the kids. You say yes even though you and your husband had planned to go to the movies on Saturday night. (She relies on you all the time even though she does have a baby-sitter that she could call)
• At work, a co-worker asks you to complete a report for them. You agree, even though it means you will need to work late to finish it.
• Sometimes people say yes even when it is inconvenient or costly to do so.

Sometimes you may find that you are doing more than the person you are helping out. It’s pretty easy for someone to take advantage of you once they find out that you are an easy target.

Some people will use you once they know that you usually say yes. They also may not even realize that you are being inconvenienced or that you really didn’t want to say yes.

What happens in these situations is that you start to have resentments towards the people that continually ask you or expect you to do things. They, on the other hand, may just think that you are happy to do these things.

What makes someone say yes when they don’t want to? Many feelings are hiding under the surface.

How to stop saying yes?

• In order for you not to confront the person you learn to avoid the situation by immediately giving in to what the other person wants.
• In order to make it stop you need to first recognize what situations you say yes in when you mean no.
• Then, the only way to stop is to stop saying yes. Learn to say no.
• You need to be strong but you don’t need to be mean or angry. A simple no is enough.
• If the person asks you for a reason why you can’t do something you can tell them truthfully why not or you can let them know that you just don’t have the time to allow it anymore.

Learning to Say No:

For one week, keep a notebook handy. For the first few days, write down anytime someone asks for something that you want to say “no” to.

Write down who asked you, what they asked for and your actual response to the person and the rest of the conversation. Look at the things in the list and see which ones really should have been “no”.

Ask yourself these questions:

• Is the request a reasonable one?
• Is this a high priority for me?
• Why do I want to do this?
• Why don’t I want to do this?

Rewrite the dialogue as if you were talking to the person but instead of yes, tell them no.

For the rest of the week continue to write down these incidents, however, this time, actually tell the person “no” when you mean no. It will be hard at first, but will get easier the more you do it. You’ll feel so empowered the first time you stand up for yourself!

When a person is besieged, with stress, it frequently causes confusion and it becomes more difficult to make good decisions.

Stress triggers a series of emotions, including worry, anxiety, confusion, feeling a lack of protection and support, and stress proves negative thinking.

When a person feels a lack of protection and support the person will frequently feel defeated and believes that they do not have the aptitude to act or react to a problem.

When a person is anxious, they will feel a sense of uneasiness because the mind is fretting over a fear that aggravated the stress.

Confusion brings forth its own problems, since a person confused often has difficulty sorting through their thoughts, emotions and the have difficulty understanding others when they are speaking.

When a person thinks negative, it often brings forth additional problems, since decisions are often initiated by negative emotions. This is a marking of denial and a refusal to look at all angles of a problem.

When a person is negative it often leads to added stress, since negative brings forth withdrawal, procrastination, hostility, inability to agree, and represses a persons ability to use their creative side.

If a person does not use the creative side of the brain then he or she will have difficulty solving problems. As we can see, stress has many fundamentals that surround its function; therefore, understanding the entirety of stress can eliminate confusion.

Negative can be analyzed carefully, since it can benefit us in many areas of life. For example, scientist are negative-positive in that they hinder the process of learning or performing linking it to a situation in question by postponing the information in response to other evidence.

In other words, a scientist will argue points until a fact is proven. This is positive negative thinking also known as negative transfer. When a person is thinking negative thoughts in a series of patterns, a harmful act leads to stress.

Stress then is a constraining act that causes a tug-a-war in the mind. One thought pushes against the other thought, pulling the thoughts in a separate direction. When the mind is boggled down with push-pull thinking, it often causes a person to feel confused.

What it takes to unboggle the mind is to sit down, take a few deep breaths and collect your thoughts. Understand that your emotions are part of your thinking process and the emotions control anger, sadness, joy, happy and so forth.

If you are stressed then your emotions is taking the lead and controlling your life. Therefore, you must collect your thoughts to find the answer to your problems. Problems come in all sizes. Some of us have more problems than others do.

Reviews: how you handled the problems in your past

When you think life is getting you down, then look back over the years and review how you handled all the problems in your past. You will see that you overcome many obstacles and made decisions through the procedure.

If you see that, you made a bad decision in your past then use it to your advantage instead of using it against your self. Thinking positive brings forth rewards.

I always tell myself everyday that something good will come my way because I put forth the efforts to make it happen. Instead of allowing stress to interrupt, my life when good fails, instead I move forward and patiently wait for the good to come my way the next day.

This may continue, but I promise you with this in mind good will knock on your door as long as you put forth the effort. If you are sitting around waiting for things to happen you are wasting your life and inviting stress to take control. If you have, problems do something about it.

For example, you can review the options in your mind to see what could benefit you. If you are besieged with work then take some time off for your self to get it together and think about what you can do to abolish overloads.

Life is too stitch complicated as it is to sit around allowing stress to rule your mind and body. Remember stress causes confusion and confusion leads to disorder.

You can improve your personal growth with sports because you learn so many lessons on the field or court.

You need to learn how to work as a team, how to feel supported by others, how to support others, and how to accept winning/losing in a graceful way.

It helps kids became more social and it also helps them build lasting relationships.

As you grow, you take those lessons and you learn from it. It also teaches you the difference between listening and hearing.

Significance of Listening in Sports

For those who are not aware of the fact that hearing is the act of picking up vibrations and turning them into sound bits. Listening happens to be where you can understand those messages into phrases and sentences. You get the message, sort of speak.

With listening you will not only hear someone talking, but you are listening to them and following directions. When it comes to sports, you have to know when to listen to someone and when you should listen to yourself.

You need to learn when to follow instructions and when to give instructions. The key to sports is that it makes you a good leader. A good leader knows when to speak and when to listen.

They know when to get ideas from teammates and when they need to give their team direction. You can improve your personal growth because it teaches you how to be a good leader.

You will lose if are not a good leader. After a couple loses, you see what it takes to bring the team to victory. Also, when you are part of a team you get to know different people. It also teaches you how to deal with certain people.

Basic Needs

If you look at Maslow’s hierarchy of needs you have basic needs, safety, social, self esteem, and self actualization. When it comes to sports, you satisfy your basic needs by having a team.

You get the attention and time required to become a good athlete. You also get guidance needed to play the sport.

Safety

Then for safety, you are taught how to play the game safely. You may also feel safe in a group to tell others how you feel and come up with your own ideas. There are so many people in a board room who do not speak because they are afraid to be judged.

They don’t recommend good ideas because they are afraid. Sports teach you how to let people know your ideas irrespective of being judged.

Social Needs

It helps you feel comfortable speaking up. Then for social needs, sports let you to feel like you are apart of something. It makes you feel important because you have a role and you need many other people to help you and there are many other people who are depending on you.

Sport teams are a support system. If you get use to being part of a support system you won’t feel so awkward in new situations and you will also understand you role in the group easier.

Self Esteem

Teams also help with self esteem. Self esteem is the most important part of the hierarchy. If you don’t have self esteem then you can never make it in the world and have fulfillment.

Sports give you self esteem so that you can be secured with who you are. You need to find a way that will make you feel good about yourself and sports is the ticket.

When you win in sports you feel so good about yourself, but if you lose, it can be a little hard to accept. It’s the same way when it comes to goal setting.

You will be able to set your goals and then if you fail, from being in sports, you will know how to pick up and accept your defeat, but still reach for better things.