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When you’ve been hurt by someone, it’s not always easy to let it go. But holding on to a grudge will only make you feel worse—and not just emotionally. Resentment can cause your blood pressure to spike and trigger the release of stress chemicals that can make you physically sick. And the truth is: It doesn’t really do any good anyway. As the saying goes: “Not forgiving is like drinking poison and expecting the other person to die.”
The paradox is, when you’ve been wronged, forgiveness is the only thing that provides relief from the pain. Sound like a bitter pill to swallow? Read on to learn how to practice forgiveness of others (and yourself), helping you release the heavy burden of resentment and experience more freedom.
1. Understand forgiveness
Before you attempt to force forgiveness on your most tender hurts, consider what it is you’re asking of yourself: Forgiving doesn’t mean that you condone what happened or that the perpetrator is blameless. It is making the conscious choice to release yourself from the burden, pain, and stress of holding on to resentment.
Forgiving doesn’t mean that you condone what happened or that the perpetrator is blameless. It is making the conscious choice to release yourself from the burden, pain, and stress of holding on to resentment.
2. Feel your pain
Hurts can run deep, even if at first glance they don’t seem to make a big impact. It’s important to give yourself permission to acknowledge and honor the pain that’s very real for you. Notice where you feel it in your body and ask yourself, “What do I need right now?” Maybe you need to feel supported, take more time, or do something kind for yourself. Allowing space for the pain in this way can help you know whether you’re ready to release it from your heart and mind.
3. Name it
Whether you’ve hurt yourself or have been hurt by another, allow yourself to be honest and simply name the feelings that are there. They might include guilt, grief, shame, sorrow, confusion, or anger. As you consider the act of forgiveness, any of these feelings can arise. A study at UCLA found that when you name your emotional experience it turns the volume down on your amygdala, the emotion center of the brain, and brings resources back to your pre-frontal cortex, the rational part of your brain. So, by naming the feeling you can create space and not get overwhelmed.
4. Let it out
Keeping hurt feelings bottled up only causes additional stress to your mind and body. Even if the memory is difficult to confront, see if you can share how you’re feeling. You can write about it in a journal or talk about it with a friend or a professional counselor. Sharing helps you expand your perspective, and perhaps even see what happened through a different lens.
5. Flip your focus
If possible, see if you can flip your focus from being the victim to putting yourself in the other person’s shoes. For example, consider the life the person lived that led them to this hurtful action. This is difficult to do, but remember, you’re not condoning any action. This exercise is just about trying to see that, as humans, we are deeply impacted by our own traumas and life experiences, which greatly inform how we show up and act in the world. If you are able to do this, compassion naturally tends to flow from this more understanding perspective.
6. Take action (start small)
Whether you are forgiving yourself or another person, taking action can help to facilitate healing and make you feel more empowered. It’s best to start with smaller misdeeds to get into practice and feel what’s possible. Writing a letter or having an uncomfortable conversation can be difficult and even scary, but often a sense of empowerment emerges from the self-compassionate action of listening to yourself and doing something that supports you.
7. Remember, you’re not the first or last
When you’ve been hurt, it’s common to feel like you’re the only one who has ever been wronged in this way. In fact, it’s likely that this transgression (or something similar to it) has been made many, maybe even millions of times before throughout human history. Making mistakes is part of our shared human experience. Remembering you are not alone in experiencing this kind of pain can help to loosen your grip on your resentment.
8. Have patience; forgiveness is a practice
Forgiveness isn’t a quick-fix solution. It’s a process, so be patient with yourself. With smaller transgressions, forgiveness can happen pretty quickly, but with the larger ones, it can take years. As you begin with the smaller misdeeds and then move onto the harder ones, be kind to yourself, take deep breaths, and continue on.
9. Stop blaming
We all know it can feel good now and again to complain to a friend—misery loves company, right? Well, not exactly. Researcher Brené Brown, author of Rising Strong, says, “Blaming is a way to discharge pain and discomfort.” It gives us a false sense of control but inevitably keeps the negativity kicking around in our minds, increasing our stress and eroding our relationships.
10. Practice more mindfulness
A recent study surveyed 94 adults who had been cheated on by their partners, and found a correlation between traits of mindfulness and forgiveness. In other words, it can be said that the more you practice mindfulness, the more you strengthen your capacity for forgiveness.
11. Find meaning and strength through your pain
As you practice working with the pain that’s there, you grow key strengths of self-compassion, courage, and empathy that inevitably make you stronger in every way. As psychiatrist and Holocaust survivor Viktor Frankl wrote in Man’s Search for Meaning, even in the most horrific and painful circumstances, we have the freedom to create meaning in life, which is a powerful healing agent.
How to Practice Forgiveness: A Mini-Meditation
Try this short practice once a day and feel your forgiveness muscles growing.
Think of someone who has caused you pain (to start, maybe not the person who has hurt you most) and you’re holding a grudge against. Visualize the time you were hurt by this person and feel the pain you still carry. Hold tightly to your unwillingness to forgive.
Now, observe what emotion is present. Is it anger, resentment, sadness? Use your body as a barometer and notice physically what you feel. Are you tense anywhere, or do you feel heavy? Next, bring awareness to your thoughts; are they hateful, spiteful, or something else?
Really feel this burden associated with the hurt that lives inside you, and ask yourself: “Who is suffering? Have I carried this burden long enough? Am I willing to forgive?” If the answer is no, that’s OK. Some wounds need more time than others to heal.
If you are ready to let it go now, silently repeat these phrases: “Breathing in, I acknowledge the pain. Breathing out, I am forgiving and releasing this burden from my heart and mind.”
Continue this process for as long as it feels supportive to you.
This article appeared in the April 2017 issue of Mindful magazine.
You may have heard about cases of bird flu lately in the news, but there’s no reason to panic. Here’s what you need to know about bird flu and how to keep your family safe.
What Is Bird Flu?
Bird flu is a form of the flu (influenza) virus that usually infects birds and other animals. It’s not the same as the flu that many people get during cold-weather months, but it can cause similar symptoms. There are different strains (kinds) of bird flu; a common strain is H5N1 or H5.
How Does Bird Flu Spread?
Wild birds — like ducks, geese, swans, and crows — can spread bird flu to birds on poultry farms and cows on dairy farms. Other animals have gotten infected, too. People who work with animals that have bird flu are more likely to get it.
Bird flu spreads through an animal’s saliva (spit), mucus, milk, pee, or poop. These can get on an animal’s feathers or skin, in their cages, or on nearby items like farm equipment. When people touch tiny droplets or specks that have the virus and then touch their eyes, nose, or mouth, they can get infected. They can also get infected by breathing in the droplets or dust that’s contaminated.
Sometimes bird flu can spread by eating undercooked eggs or poultry, like chicken or turkey, or by having raw milk from animals, like cows, infected with the virus.
What Are the Signs & Symptoms of Bird Flu?
Bird flu can appear like other flu viruses, and symptoms include:
Severe bird flu may cause a person to have trouble breathing or a high fever, feel confused, develop seizures, and even die.
How Is Bird Flu Diagnosed?
To check for bird flu, doctors will take a sample of mucus by wiping a cotton swab inside the nose or throat. If your child has pinkeye, they may swab the eye. The samples are sent to a lab for testing.
Be sure to tell your doctor if your child has been near any animals and has symptoms of bird flu.
How Is Bird Flu Treated?
Doctors may prescribe antiviral medicine for bird flu, and it works best if children start taking it when symptoms first start. Kids with more serious symptoms are treated in the hospital.
For children with mild symptoms, at-home care may help them feel better as they recover. Make sure your child drinks lots of liquids to prevent dehydration, gets plenty of sleep, and takes it easy. Kids might feel hot or cold, so have them wear layers that are easy to remove. For fever and aches, you can give acetaminophen or ibuprofen, but avoid aspirin because it’s linked to Reye syndrome.
To avoid spreading the virus to other people, your child should stay home from school or daycare — ask your doctor for how long.
Can Bird Flu Be Prevented?
There’s no vaccine for bird flu, but scientists are working on one to prevent people from getting the virus. Health officials in many countries are taking steps to help prevent bird flu from spreading.
To help keep your family healthy:
Avoid touching birds. Watch them from far away. If you plan to travel somewhere there’s been an outbreak of bird flu, stay away from live bird markets, poultry farms, or any other places where there might be infected poultry. Check with agencies like the CDC for travel updates.
Wash hands often when going to places like farms, petting zoos, or ponds that have birds. Also, take your shoes off before stepping inside your home to avoid bringing in germs.
Have your family wear gloves, masks, and goggles when working near wild animals, birds, cattle, and other livestock. Make sure everyone washes their hands and changes clothes afterward.
Report animals that may be sick with bird flu or died from it. Call your state health department and stay away from anything the animal touched.
Cook poultry, eggs, meat, and seafood to the right temperature to destroy any flu viruses in raw or undercooked food. Be sure to use different cutting boards and utensils (like forks, knives, spoons, and chopsticks) for uncooked meats and other foods. Wash hands before and after eating.
Avoid touching or having raw dairy products, like raw milk. Choose ones that have been pasteurized (heated to kill the bird flu virus and other germs) by checking the food label.
Get a flu shot. It won’t prevent bird flu, but it can help your child stay healthy by avoiding the seasonal flu. That way, there’s less chance of getting the two flus at the same time.
Can My Bird or Other Pets Get Bird Flu?
Birds and other pets may get bird flu if they go near another animal that has the virus. Making sure your pets are safe helps keep your family healthy, too. So follow these tips:
Keep your pet bird and its food and water inside, away from anyplace where it could be exposed to an infected animal. Avoid letting your pet drink or eat from ponds or other places where wild birds may have flown over and spread the virus.
Clean the birdcage often. Wash your hands right away and after handling the bird or touching its poop.
Try to make sure any birds on your property (like those in a chicken coop) stay away from wild birds. To be extra safe, wear a mask when you’re near your birds.
Prevent other pets (like cats and dogs) from getting near wild birds, raw meat and poultry, and raw milk so they don’t get infected.
If you have a bird feeder, clean any surfaces that bird poop has touched and wash your hands.
The United States and other countries have stopped importing live birds and bird products (like meat and eggs) from countries where there have been outbreaks of bird flu. So if you buy a pet bird, it should not have been exposed to the virus.
Still, there is an illegal market for buying and selling exotic birds and other animals. Before you buy any animal as a pet, find out where it was born and raised. If you have more questions, talk with a veterinarian.
Eating a diet filled with animal products can disrupt our microbiome faster than taking an antibiotic.
If you search online for “Crohn’s disease and diet” or “ulcerative colitis and diet,” the top results are a hodgepodge of conflicting advice, as you can see below and at 0:15 in my video Preventing Inflammatory Bowel Disease with Diet.
What does science say? A systematic review of the medical literature on dietary intake and the risk of developing inflammatory bowel disease finds that Crohn’s disease is associated with the intake of fat and meat, whereas dietary fiber and fruits appear protective. The same associations are seen with ulcerative colitis, the other major inflammatory bowel disease—namely, increased risk with fat and meat, and a protective association with vegetable intake.
Why, according to this meta-analysis of nine separate studies, do meat consumers have about a 50 percent greater risk for inflammatory bowel disease? One possibility is that meat may be a vehicle for bacteria that play a role in the development of such diseases. For instance, meat contains “huge amounts of Yersinia.” It’s possible that antibiotic residues in the meat itself could be theoretically mucking with our microbiome, but Yersiniaare so-called psychotropic bacteria, meaning they’re able to grow at refrigerator temperatures, and they’ve been found to be significantly associated with inflammatory bowel disease (IBD). This supports the concept that Yersinia infection may be a trigger of chronic IBD.
Animal protein is associated with triple the risk of inflammatory bowel disease, but plant protein is not, as you can see below and at 1:39 in my video. Why? One reason is that animal protein can lead to the formation of toxic bacterial end products, such as hydrogen sulfide, the rotten egg gas. Hydrogen sulfide is not just “one of the main malodorous compounds in human flatus”; it is a “poison that has been implicated in ulcerative colitis.” So, if you go on a meat-heavy, low-carb diet, we aren’t talking just about some “malodorous rectal flatus,” but increased risk of irritable bowel syndrome, inflammatory bowel syndrome (ulcerative colitis), and eventually, colorectal cancer.
Hydrogen sulfide in the colon comes from sulfur-containing amino acids, like methionine, that are concentrated in animal proteins. There are also sulfites added as preservatives to some nonorganic wine and nonorganic dried fruit, but the sulfur-containing amino acids may be the more important of the two. When researchers gave people increasing quantities of meat, there was an exponential rise in fecal sulfides, as seen here and at 2:37 in my video.
Specific bacteria, like Biophilia wadsworthia, can take this sulfur that ends up in our colon and produce hydrogen sulfide. Eating a diet based on animal products, packed with meat, eggs, and dairy, can specifically increase the growth of this bacteria. People underestimate the dramatic effect diet can have on our gut bacteria. As shown below and at 3:12 in my video, when people are given a fecal transplant, it can take three days for their microbiome to shift. Take a powerful antibiotic like Cipro, and it can take a week. But if we start eating a diet heavy in meat and eggs, within a single day, our microbiome can change—and not for the better. The bad bacterial machinery that churns out hydrogen sulfide can more than double, and this is consistent with the thinking that “diet-induced changes to the gut microbiota [flora] may contribute to the development of inflammatory bowel disease.” In other words, the increase in sulfur compounds in the colon when we eat meat “is not only of interest in the field of flatology”—the study of human farts—“but may also be of importance in the pathogenesis of ulcerative colitis…”
The healthcare industry is undergoing rapid transformation, and with it comes the growing demand for support professionals who can ease the administrative burden on medical practitioners. One of the most promising career paths in this domain is that of a medical virtual assistant. Whether you’re looking for a flexible remote job or transitioning from a traditional healthcare role, becoming a medical virtual assistant offers a fulfilling and practical way to contribute to patient care from behind the scenes. For more information about virtual medical assistants, please visit website here.
This guide walks you through everything you need to know about becoming a medical virtual assistant—what it involves, the skills required, and how to succeed in this thriving field.
Understanding the Role
A medical virtual assistant is a remote professional who provides administrative, clerical, and at times clinical support to doctors, nurses, clinics, and hospitals. Unlike general virtual assistants, these professionals are specialized in healthcare and must understand medical terminology, documentation, and workflows.
Typical tasks include:
Scheduling patient appointments
Managing emails and calendars for physicians
Handling billing and insurance claims
Transcribing medical notes
Responding to patient inquiries
Updating medical records
Depending on the employer, duties may vary slightly, but the goal remains the same: to streamline healthcare operations and allow providers to focus more on patient care.
Why Pursue This Career?
1. High Demand in Healthcare
Healthcare professionals are often overwhelmed with paperwork and administrative responsibilities. The shift toward more efficient and patient-centered services means healthcare providers are actively looking for dependable support staff who can work remotely. This has opened the door for individuals with organizational skills and a background in healthcare administration or customer service to find rewarding work as a medical virtual assistant.
2. Flexibility and Independence
Unlike traditional office roles, working as a medical virtual assistant offers a high degree of flexibility. You can work from home, manage your schedule, and take on clients from different parts of the country—or even the world. This makes it an excellent option for parents, caregivers, students, or anyone needing a more adaptable work-life balance.
3. Opportunity for Growth
The skills you acquire as a medical virtual assistant can lead to long-term career growth. Many professionals expand their services into medical billing, coding, patient advocacy, or health coaching. Some even go on to start their own virtual assistant businesses or agencies.
Qualifications and Skills You Need
While there’s no single path to becoming a medical virtual assistant, certain qualifications and competencies will significantly increase your chances of success.
Educational Background
Having a background in healthcare, medical administration, or related fields is highly beneficial. However, even those with general administrative experience can transition into this field with the right training.
Consider the following options:
A degree or certificate in medical office administration
A medical assistant diploma
Coursework in anatomy, medical terminology, and healthcare systems
Technical Skills
Since the role is remote, a strong grasp of technology is essential. You should be comfortable using:
Electronic health record (EHR) systems
Scheduling and calendar apps
Email and communication platforms
Medical billing software
Word processing and spreadsheets
Soft Skills
To excel as a medical virtual assistant, you’ll also need to cultivate soft skills such as:
Attention to detail
Discretion and confidentiality (especially with patient data)
Time management
Excellent communication (both verbal and written)
Empathy and professionalism when dealing with patients
Certification (Optional but Recommended)
While certification is not mandatory, it can give you a competitive edge. Some programs specifically train individuals to become medical virtual assistants. Look for reputable training providers that offer coursework in HIPAA compliance, patient communication, and practice management.
Steps to Becoming a Medical Virtual Assistant
Now that you understand what’s involved, let’s break down the path to launching your career.
1. Assess Your Experience and Interests
Take stock of your current skills. Do you have a background in healthcare or customer service? Are you already familiar with EHR systems or scheduling software? Identify gaps in your knowledge and areas where you may need training.
2. Get the Necessary Training
If you’re new to the healthcare field, enroll in a training program that covers the basics of medical administration. These courses often include:
Medical terminology
HIPAA regulations
EHR system training
Insurance and billing basics
Both short-term certificate programs and more comprehensive courses are available online and in person.
3. Prepare Your Work Environment
As a remote worker, you’ll need a reliable setup. At a minimum, ensure you have:
A high-speed internet connection
A computer with updated software
A headset for communication
A secure and quiet workspace
You’ll also need tools to manage your workload, such as task management apps and password managers.
4. Build a Strong Resume and Portfolio
Your resume should highlight relevant skills, even if they were gained in non-healthcare roles. Include your proficiency in software, communication abilities, and any certifications.
If possible, create a small portfolio demonstrating:
Sample scheduling tasks
Mock transcription work
Examples of email correspondence or calendar management
Even hypothetical examples can help showcase your abilities.
5. Start Applying or Pitching Your Services
You can look for employment opportunities through:
Job boards focused on remote work
Healthcare staffing agencies
Freelancing platforms
Direct outreach to clinics or physicians
Some medical virtual assistants choose to work independently, offering services to private practices on a contract basis. Creating a professional website or LinkedIn profile can help establish credibility and attract potential clients.
6. Keep Learning and Stay Compliant
Healthcare regulations change frequently. To remain effective and trustworthy, you should stay current with compliance standards, especially regarding patient privacy. Participate in ongoing training, subscribe to healthcare newsletters, and consider joining professional groups for virtual assistants.
Overcoming Common Challenges
Like any career, working as a medical virtual assistant comes with its own set of challenges. The key is to anticipate and address them early on.
Navigating HIPAA and Patient Privacy
One of the most important aspects of your job is maintaining the confidentiality of patient information. Be prepared to undergo HIPAA training and set up secure systems for storing and transmitting data. Always follow best practices for data protection.
Managing Time Zones and Availability
If you’re working with clients in different regions, be mindful of time zone differences when scheduling appointments or handling tasks. Tools like time zone converters and scheduling platforms can help.
Handling Emotional or Stressed Patients
In some cases, you may need to speak directly with patients who are anxious or upset. A calm and empathetic tone, along with clear communication, can go a long way in creating a positive interaction.
Tips for Long-Term Success
To truly thrive as a medical virtual assistant, consider the following strategies:
Niche down: Focus on a specialty like dermatology, pediatrics, or mental health. This allows you to become an expert in a specific area and tailor your services accordingly.
Track your achievements: Keep records of the time you save clients, how you improve workflow efficiency, or positive feedback received. This can be useful for raising rates or expanding your business.
Network and collaborate: Join online forums, attend virtual healthcare events, and engage with others in the industry. Referrals and partnerships often stem from these connections.
Stay organized: Use calendars, task lists, and CRM tools to manage multiple clients and maintain high-quality service.
Set boundaries: While flexibility is a perk, it’s important to set working hours and stick to them. This helps prevent burnout and ensures consistency for clients.
Final Thoughts
A career as a medical virtual assistant is not only in demand—it’s impactful, flexible, and offers plenty of room for growth. If you’re detail-oriented, communicative, and interested in supporting healthcare providers, this path may be the perfect fit. With the right preparation and mindset, you can build a thriving career while playing a vital role in the healthcare ecosystem.
Start by investing in your skills, creating a professional work environment, and seeking opportunities that align with your strengths with DocVA, LLC. The journey may require dedication, but the rewards—both personal and professional—are well worth it.
President Donald Trump reignited concerns about a possible “mental decline” after attempting to leave the Oval Office without signing an executive order.
Following a joint press conference with Health Secretary Robert F. Kennedy Jr. on Monday, Trump thanked the press and began to exit. In a clip circulating on X, someone can be heard asking him to sign the order before leaving.
“I’ll sign that, yeah,” Trump replied before turning around to sign the executive order, which aims to lower the cost of prescription drugs for Americans.
The incident added to mounting concerns over a series of recent missteps by the president. He previously insisted a photoshopped image of Kilmar Abrego Garcia was real, confused Harvard with Harlem, and misstated the date the Philadelphia Eagles visited the White House.
Monday’s flub left some social media users once again questioning Trump’s mental aptitude.
“No talks of mental decline?” one X user wondered. President Joe Biden’s mental and physical fitness was a frequent target of criticism from MAGA supporters, who used it as a rallying point in efforts to push for his removal from office.
“His brain is broken,” a second added.
“Is he ok,” another social media user wondered.
“Again? This isn’t the first time,” one user declared. Trump previously exited without signing executive orders in 2017 during his first term, and, most recently, on April 2, also referred to by Trump as “Liberation Day.”
Several social media users also labeled the president “Dementia Don,” a nickname given to the president by his critics, similar to Trump supporters’ nickname for Biden, “Sleepy Joe.”
For some individuals in their late 60s, it may be worthwhile to get “catch-up” HPV testing, according to findings from a large study.
Credit: iStock
Testing for the presence of cancer-causing types of the human papillomavirus (HPV) is now a standard part of screening for cervical cancer, some times with simultaneous Pap tests (known as co-testing). But cervical cancer screening is recommended to stop at age 65 in many places and, for a variety of reasons, many older adults stop getting screened for cervical cancer well before that age.
In the new study, about 62% of women who were invited to undergo this “catch-up” testing for HPV (intervention group) had a test within the next year. In a comparison group of women not invited for catch-up testing, only about 2% had either a Pap test or an HPV test over the next year.
The rate of CIN2+ lesions diagnosed in the intervention group was significantly higher than in the comparison group (3.9 vs. 0.3 per 1,000 eligible women, respectively). CIN2+ lesions are often called precancers because these types of cell changes can go on to become cancer. Finding these lesions early allows doctors to remove them before they can progress.
Women who were furthest behind on regular screenings—that is, had one or no screenings since age 50—had nearly twice the rate of CIN2+ lesions as women who had been screened two or more times since age 50, the researchers found.
The study findings were published July 6 in PLOS Medicine.
“It may be time to reevaluate cervical cancer screening at older ages,” said lead investigator Mette Tranberg, Ph.D., of the University Research Clinic for Cancer Screening at Randers Regional Hospital in Denmark. “Our data show that it could really be beneficial to [offer catch-up HPV testing] for these older, insufficiently screened women.”
The findings support recommendations in some countries, such as the United States, where a history of negative screening results is recommended for stopping screening at age 65, after which the risk of a new HPV infection developing into cervical cancer is very low, said Nicolas Wentzensen, M.D., Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics (DCEG), who was not involved in the study.
Dr. Tranberg cautioned, however, that catch-up HPV testing could have potential downsides.
As with any screening approach, she said, it’s important to weigh the potential benefits of catching precancers or early cancers with the potential harms. Those harms include being treated for lesions that would never have developed into cancer during a woman’s lifetime.
Overall, Dr. Wentzensen said, the study reinforces the importance of women continuing to stay up to date on cervical cancer screening as they get older.
“This study was able to evaluate the prevalence of precancer in this specific population. Understanding the prevalence of precancer is one part of the puzzle to inform screening recommendations in an any age group,” he said. “This study clearly shows that there [are potential precancers over age 65] and that offering an HPV test in this population to identify those who may need treatment could be helpful.”
The challenges of screening older individuals
Almost all cervical cancers are caused by infection with high-risk types of HPV, particularly HPV 16 and HPV 18. Most HPV infections go away on their own, but for some people an infection can persist for years and lead to abnormal cervical cells that form cervical lesions. If left untreated, these lesions may progress to cervical cancer.
Unlike Pap tests, which look for abnormal cells in a sample of cervical cells, an HPV test checks the cells for the presence of genetic material (DNA or RNA) from high-risk HPV types.
Many countries, including the United States, have begun transitioning to HPV testing as the primary approach to cervical cancer screening. Women who test positive for HPV are referred for follow-up testing, which may include a Pap test or colposcopy (visual inspection of the cervix under magnification) and a biopsy to see how abnormal the cells are and how much of the cervical tissue is affected.
HPV tests are very good at detecting infection with the virus, but because these tests have only been available for the past 10 or so years, most women over age 65 have never had one. Instead, most older women have had Pap tests for routine cervical cancer screening.
However, Pap tests are less effective in older women compared to younger women because physiological changes after menopause make it more difficult for doctors to collect samples from the part of the cervix where cell changes typically start.
Even though cervical cancer tends to be diagnosed at younger ages than many cancers—in the United States the median age at diagnosis is 50 years—it does affect older women.
Experts say new approaches to prevent cervical cancer in women over the age of 65 are needed because women over this age continue to be diagnosed with and die from the disease. In the United States, for example, women 65 and older account for more than 20% of new cases of cervical cancer and around 37% of deaths from the disease.
Dr. Tranberg and her colleagues wondered whether giving women over age 65, particularly those who have fallen behind on screening, a catch-up HPV test could help bridge this gap in cervical cancer prevention.
Catching up with an HPV test
In the study, more than 11,000 Danish women aged 65 to 69 from one region of Denmark were invited to get an HPV test. They were able to choose between having a cervical sample collected by their doctor or using a vaginal self-collection kit to be mailed back for testing, known as self-sampling.
Women were included if they had no record of screening in the past 5.5 years. A comparison group of about 33,400 Danish women from Denmark’s remaining four regions were offered usual care, which included getting a Pap test or HPV test as needed—for example, if they had vaginal bleeding.
About 62% of women in the catch-up testing group had an HPV test within 12 months, while only 2% of women in the comparison group got either a Pap test or HPV test within the same time frame.
Using patient records from a centralized data network in Denmark, the researchers compared the rates CIN2+ lesions diagnosed in the two groups. In the catch-up group, 3.9 out of every 1,000 eligible women were found to have a CIN2+ lesion, compared with 0.3 out of every 1,000 eligible women in the comparison group.
Those who had rarely or never been screened in their 50s and early 60s (“insufficiently screened”) were more than twice as likely to have CIN2+ lesions as those who had been screened at least twice during that same time (“routinely screened”).
Overall, more women in the catch-up testing group chose to get a cervical sample collected by a clinician than to do self-sampling. But those who were insufficiently screened were much more likely to choose self-collection than those who were routinely screened.
Among the 2,000 women who conducted the testing via self-collection at home, 161 were found to be HPV-positive. Of this group, all except one completed follow-up testing with their doctor within the next 6 months.
This finding, Dr. Tranberg said, suggests that offering the opportunity for self-collection may be appealing to women who prefer not to get screening from a provider.
Balancing risk versus benefit
The study’s findings, Dr. Wentzensen said, highlight the importance of the recommendation in US cervical cancer screening guidelines that calls for women over 65 to continue screening until they have a series of normal results.
“We know there is risk [in this age group],” he said. “So clinicians need to work with patients to make sure they have had several consecutive normal HPV test results. For their patients who haven’t, he added, “you can’t just release them from screening.”
However, he cautioned that CIN2+ is not the best indicator of cervical cancer risk, because many of these lesions will never progress to cancer. A better measure, he said, would be CIN3+ lesions, which are much more likely to develop into cancer.
Dr. Tranberg acknowledged that CIN3+ would have been a better primary measure but, from a statistical standpoint, would have required an even larger study. However, the researchers did find that rates of CIN3+ were higher in the catch-up testing group than the comparison group.
Ultimately, Dr. Tranberg said, better tests and biomarkers are needed to differentiate between abnormalities that are harmless and abnormalities that will progress to cancer.
She also pointed out that given the potential harms of screening, such as overdiagnosis and overtreatment, it’s important to determine who would benefit most from receiving a catch-up HPV test.
One approach might be to offer catch-up testing to only those older women who have been insufficiently screened, and to make self-collection kits more widely available. HPV self-collection kits are already being used in several countries, including Denmark, and are under FDA review in the United States.
Meanwhile, Dr. Wentzensen and other DCEG colleagues are engaged in several collaborative efforts related to cervical cancer screening. They include initiatives to improve screening in communities where screening rates continue to lag (see below).
Screening centered around HPV testing “is now the preferred approach in most places in the world, and now it’s really a question of implementation and making sure that new developments reach the populations that need them the most,” he said.
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Kids are highly perceptive—so how can we give them feedback while also modeling mindfulness, calm, and kindness? Mindfulness Director and educator Alex Tzelnic shares tried-and-true tips for effective, mindful communication, whether in the classroom or at home.
Summary
Modeling mindfulness when we communicate with kids and students is a research-backed educational tool.
Giving wise feedback is a framework for encouraging students’ learning, without the sense they’re being criticized.
Teachers can create a Mindful Language Cheat Sheet with go-to phrases for clarity, calm, and kindness.
As much as we might like to believe that growing up involves possessing wisdom, kids have a way of undermining that perception. Think of how often our most well-intentioned advice is met with a dramatic eye roll. It can even feel like sarcasm is the primary purpose of eyeballs, with sight being just a byproduct, particularly if it is unsolicited feedback you’ve deigned to offer up.
Yet kids are also often in need of feedback. Without feedback they would be in danger of losing the eyes they are so adept at rolling (“Don’t run with scissors!”). Of course, their job is to test boundaries, and our job as educators and caregivers is to nudge them toward navigating those boundaries independently without letting them fall off the cliff. It can be a delicate balance.
As a Mindfulness Director at a PK-8 school, I often think about the ways we communicate with students and how language can be such a powerful way to model mindfulness.
What Happens When Teachers Model Mindfulness?
At the start of this school year, I shared with the faculty at my school just how impactful our communication styles can be. I related one of my favorite studies on mindfulness. It involved 599 high school students, and took place over the course of the year. The study found that students that had merely perceived their teachers as more mindful at the start of the year showed greater development in mindfulness and compassion by the end of the year.
The point I was trying to make was that one doesn’t have to have a deeply developed personal practice to have an impact on student well-being. As someone trying to encourage teachers to incorporate mindfulness into their classrooms, I wanted to let them know their ability to implicitly model mindfulness might be more powerful than any explicit mindfulness lessons. After all, teaching your own curriculum is challenging in and of itself, and people feel uncomfortable implementing a tool that is not part of their own personal repertoire. If somebody asked me to start weaving chemistry into my lessons, I’d be hard-pressed to even know where to begin.
One doesn’t have to have a deeply developed personal practice to have an impact on student well-being.
It can be illuminating to grasp that howwe show up and engage with students can be a crucial factor in their development. The study identified the characteristics of a mindful teacher as one that is calm, clear, and kind. The researchers concluded, “The presence of a calm, clear, and kind teacher can support students’ holistic growth, whether through modeling or need fulfillment.” Language can impart the kind of coded lessons that could meaningfully influence student behavior, letting them know that they are seen and supported, and in turn helping them see and support others.
How to Give Wise Feedback
Of course, it can be difficult to communicate with clarity, calmness, and kindness, particularly when you are outnumbered by an audience that is there because it has to be, and not necessarily because it wants to be. Though we might assume our statements are innocuous, from the student perspective much of our communication can feel critical. Asking, “Did you complete the assignment?” could be interpreted by a student as their teacher thinking they’re too inept to remember to get work done on their own.
To help with inadvertent critiquing, I also shared the concept of “wise feedback” with my faculty. Psychologist David Yeager explained that providing a clear and transparent statement about the reason feedback is being given helps adolescents understand that one has high standards that can be met, and the feedback comes across as encouragement rather than nagging. “I’m wondering if you completed that assignment, because there are some fascinating nuggets in there and I’m looking forward to hearing your thoughts on them,” lands much differently.
Language can impart the kind of coded lessons that could meaningfully influence student behavior, letting them know that they are seen and supported, and in turn helping them see and support others.
Yeager pointed to a study he conducted in which seventh grade social studies teachers returned papers to their students with corrections and either a neutral note or a note featuring wise feedback. Eighty percent of students who received the wise feedback ended up revising their essays as opposed to forty percent in the neutral note group. Anecdotally, I can report that the use of wise feedback in my own pedagogy has led to a significant reduction in eye rolling.
Mindful Language, Made Easy
At the end of my session with the faculty, I expressed that I was confident most teachers probably already do express the elements of mindful teaching even if they don’t realize it. One of the hallmarks for being an educator is having the patience and compassion required to nurture learning. But in the words of the Zen teacher Shunryu Suzuki, “You are perfect as you are and you could use a little improvement.” To expand our collective repertoire of mindful phrases, I gave everyone an index card so that we could take advantage of the assembled wisdom.
I asked teachers to help me create a “mindful language cheat sheet” that featured language they use when they are trying to communicate with clarity, calmness, and kindness. In other words, it was a collection of wise feedback. I then sent out a document that compiled these phrases, which featured such pearls of wisdom as:
Everything is figureoutable.
Worrying is paying a debt you don’t owe.
This is one day. There are many days.
Everyone’s best looks different. Focus on what your best looks like.
I’m walking with you in this.
When in doubt, breathe it out.
Thus, we were equipped with language to start the year that could help cut to the heart of the matter, support students through challenging moments, and bring a little levity to the proceedings.
In the ancient lore of meditation and mindfulness, we hear stories of legendary teachers who effortlessly transmit all their wisdom to adoring and rapt students in a single act. It’s an impossibly high bar for modern educators, of course, and not how regular learning occurs, which is most often in tiny moments that accumulate over the course of years. For us mere mortals that find ourselves in the position of dispensing wisdom—whether it is to students of mindfulness, students of chemistry, or students of Play-Doh—it typically takes a much higher word count to get our point across. Teaching is hard. But don’t forget, everything is figureoutable.
A California man battling stage 4 lung cancer was denied insurance coverage for a potentially life-saving double lung transplant just as he was preparing to fly to Chicago for the procedure, his family says.
Deron Wells, a 59-year-old husband and father of three, had been medically approved for a rare clinical trial lung transplant at Northwestern Medicine in Illinois, according to ABC 7.
Cigna, his insurer, had initially signed off on the necessary procedures and transport from UCLA Santa Monica Medical Center, where he had been receiving care. But on the day of his scheduled transfer, Cigna reversed course, denying coverage for both the transplant and the out-of-state medical transfer.
“The last option we have is for us to take him to Northwestern, period. I hope Cigna really understands the seriousness of the situation. We’re not just a number. We are talking about his life,” Janet Savarimuthu, the man’s wife, told the outlet.
Lung transplants are not typically considered standard treatment for cancer, which Cigna cited in its statement defending the denial, claiming their coverage guidelines are based on national clinical standards.
Wells’ family and friends launched an appeal and a public campaign in an effort to pressure the insurer to reconsider. A response to the appeal is expected by Thursday.
The man’s GoFundMe has raised more than $37,000 as of Friday morning.
