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Fewer than 30% of older adults who need more intensive treatment for high blood pressure actually get it, new research shows. And the problem may be worsening.

Nearly half of U.S. adults about 116 million people have high blood pressure, also known as hypertension. When not properly controlled, it can lead to serious health problems, including heart attack, stroke and kidney disease.

"We haven't been doing well, despite robust evidence demonstrating the strong benefits of good blood pressure control in older adults," said Dr. Nicholas Chiu, the study's lead author and a clinical fellow at Beth Israel Deaconess Medical Center in Boston. "This is a major public health gap that needs to be tackled."

Common in older adults, high blood pressure is a leading cause of preventable death and an under-recognized contributor to premature disability, according to the most recent hypertension care guidelines from the American College of Cardiology and American Heart Association.

Since 2017, high blood pressure has been defined by those organizations as a reading of 130 mmHg and higher for systolic blood pressure, the "top" number of a reading, or 80 and higher for the diastolic measurement, or "bottom" number. The old definition was 140/90 and higher.

For the new study, published Friday in the AHA journal Hypertension, researchers looked at a decade of national data from a sampling of adults 60 and older who visited their primary care provider and previously had been diagnosed with high blood pressure. The research team zeroed in on which patients underwent "appropriate antihypertensive intensification," defined as adding an anti-hypertensive drug to their care for high blood pressure.

Based on office blood pressure measurements, treatment intensification was warranted in as many as 7,404 primary care visits captured in the data from 2008 to 2018, representative of up to 293 million visits nationally.

In determining who had high blood pressure, the researchers used three varied blood pressure targets those published by ACC/AHA, the European Society of Cardiology, and the American College of Physicians/American Academy of Family Physicians (ACP/AAFP). The researchers also came up with their own all-inclusive measure that met all three guidelines.

Appropriate intensification of medicine over the study period never exceeded 27.5%. That was according to the most liberal measure, the all-inclusive yardstick, for patients who hadn't previously been taking drugs for high blood pressure. By that same measure, just 15.3% of patients already on hypertension drugs had appropriate intensification.

Under all three of the published sets of targets, the percentage of patients receiving appropriate treatment intensification declined over the study period. Most dramatically, under ACP/AAFP targets, appropriate treatment intensification decreased from nearly 25% of patients in 2008-2009 to about 15% in 2015-2018.

Chiu called for professional societies to use more uniform blood pressure targets. "That could provide a bit more clarity" on what the best treatment strategy might be, he said.

While the study didn't address the reasons behind the low numbers, senior author Dr. Kenneth Mukamal offered several theories, including doctors' concerns that blood pressure-lowering drugs might cause older adults to fall, and patients' reluctance to add more medications that might have more side effects.

He also said it can be difficult for primary care providers to treat high blood pressure aggressively in a typical 15-minute visit.

"We're trying to control not just blood pressure, but cholesterol and diet and weight, and the documentation burdens have grown bigger as well. Speaking from my own experience, it's harder than ever to be a primary care doctor," said Mukamal, associate professor of medicine at Beth Israel Deaconess Medical Center.

He said future studies are needed to learn which strategies will motivate medical professionals to better treat high blood pressure among older adults. One strategy, Mukamal said, might involve "tweaking the medical record systems to automatically alert doctors to add a medication when a person's blood pressure is above where we'd like it to be."

Dr. Robert Brook, who was not involved in the new research, called it "an important study (that) highlights the remarkably high rates of treatment inertia in real-world clinical practices."

"There's a need for innovative strategies," said Brook, a professor and director of cardiovascular disease prevention at Wayne State University in Detroit. "Growing evidence supports reducing or eliminating the mandatory role for physicians in the day-to-day management of uncomplicated hypertension. Algorithm-driven care delivered by pharmacists or nurses or trained community health workers has proven to improve blood pressure control in a variety of trials and vanguard programs."

Patients also need to be more proactive, and know their blood pressure levels at home and in the clinic, Brook said. "They should work with their provider and encourage them to make the necessary treatment changes to achieve blood pressure control."

If you have questions or comments about this American Heart Association News story, please email [emailprotected].

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Many older adults may not get the intensive blood pressure treatment they need - American Heart Association News

Whether we liked it or not, among the kids schoolbooks and the empty takeaway boxes, working from home was the norm for many people during the pandemic. And remote and hybrid working are still in vogue. According to the Office for National Statistics, the proportion of hybrid workers in the UK rose from 13% in early February this year to 24% in May. As many as 14% of British workers were fullyremote.

Of course, these figures include not only employees but also chief executives, traditionally seen as office stalwarts given their position and status. But can the boss really work as effectively in their converted barn or their gardenoffice?

Mark Chaffey of technology talent hub hackajob is one of these hybrid CEOs. If a CEO works remotely, they have a little bit more headspace to shut out the noise and do any deep work which is really important, he says. Remote working forces a culture of output and accountability rather than a culture of presenteeism and micro-management. Ive found it largelypositive.

David Tuck, group chief executive of Kin + Carta Europe, is another hybrid boss who believes this set-up works. Most organisations have a few offices across the country or globe, so CEOs have almost always been hybrid. And working from home enables some focused work, such as strategic initiatives or prepping for board meetings, hesays.

The fundamental question is, what do people want from their CEOs? Their time? Rarely. Its usually their energy. Their energy is what feeds and drives people. Thats best done in person, but it can be done remotelytoo.

But not all CEOs feel the same. Netflix co-founder Reed Hastings has said that he does not see any positives in remote working, and David Solomon, chief executive of Goldman Sachs, famously denounced the practice, declaring it an aberration that were going to correct as soon aspossible.

Their energy is what feeds and drives people. Thats best done in person, but it can be done remotelytoo

Research from global recruiter Robert Walters earlier this year found that 60% of professionals feel disengaged under remote working due to a lack of face time with leaders within their organisation. They claimed that their output and morale were lower as a result of seeing their CEO just once aweek.

The research concluded that remote work was killing company culture, even at the top. There are functional and operational elements of the CEO role that can be done remotely, and there are benefits from having more personal thinking time, says Toby Fowlston, CEO of Robert Walters. But when it comes to the softer aspects of leadership, it requires a high degree of face-to-face interaction. You really need to sit down with them over lunch and have honest and authentic conversations. Younger workers also need to watch and learn from their grey-haired bosses first-hand. Without all of this, you end up with echo-chamber management.

When it comes to the softer aspects of leadership, it requires a high degree of face-to-face interaction

Dan Goman, CEO of digital media supply chain and distribution platform Ateliere, agrees that less visibility, over time, does equal lower morale. This is despite Goman hailing the success of Atelieres move to a hybrid schedule consisting of two days in the office per week. Weve seen higher employee satisfaction, and weve seen higher productivity overall. Retention and engagement rates have been off the charts. And personally, I am connecting differently with staff, via recorded video messages or internal company newsletters. But I do all this from the office. Sometimes I am the only one here, but it is important for me as a leader to be visible. People want to see me here and be ready to give them quick answers, support andfeedback.

Chaffey doesnt see this as an impediment to his leadership role. I work one day a week in the office and the rest from home. I dont see hybrid working as an issue, because we have an all-hands meeting every Wednesday, so the company knows that they will have that interaction with me every week. They can submit anonymous questions in real time, every week, and I make it clear that people can always come to me directly if they ever have any questions or queries, hesays.

Because I outline all this so heavily, people have got more access to me now than they ever have done previously. Employees really value the trust I give them. They feel empowered and supported and I think this is better than me being in the office five days aweek.

Another remote CEO, Simon Waterfall of premium craft soda-maker Soda Folk, says he misses the camaraderie of the office and being able to offer quick support to colleagues struggling professionally or personally. You cant take them for a coffee if theyre 200 miles away. But personally, I enjoy the fewer and more focused meetings and not being dragged into office politics, he says. We try and meet up regularly, particularly when we need creative brainstorming sessions. So, perhaps if youre a creative business, hybrid working may not be the best long-term answer. But really, working as a hybrid CEO is a mindset and its certainly something you could also do in a FTSE 100business.

Anita Williams Woolley, professor of organizational behaviour and theory at Carnegie Mellon Universitys Tepper School of Business, agrees. You can still be a role model if employees have access to you, she says. You dont need to be in a specific physical location. If companies are committed to hybrid working, then it can be more effective if CEOs are also working in the same fashion. It will ensure that all systems and processes work well. It could be an issue for some employees if they see their boss working remotely and they have been denied the option to do so themselves.

It seems that, provided you give your people the choice of hybrid working, it can be a successful model.

The rest is here:
The rise of the hybrid CEO - Raconteur

Recognising the rights of innocent parties suffering the deep impacts of crime, state governments since 1992 have established and developed end-to-end support services for victims.

The Department of Justice provides victims of crime with access to quality services from the start to the finish of their contact with the criminal justice system, as well as a stronger voice in the judicial process.

By allowing victims a more formal role in the justice system, we aim to significantly contribute to their recovery and healing, Department Director General Dr Adam Tomison says.

Our extensive victim services network of staff performs in a fraught environment at the coalface of the interaction between the justice system and a victim, Dr Tomison says.

For victims who request assistance, Court Counselling and Support Services (CCSS) helps from after a crime has been committed through to the court process, including family violence civil matters.

The Victim-offender Mediation Unit (VMU) becomes involved at the pre-and post-sentence stages and the Victim Notification Register (VNR) provides information during an offenders incarceration.

The challenge for the victim of crime is that it was an unwanted and traumatic experience, CCSS Director Teresa Tagliaferri says.The victim is facing a situation they were not in control of and then results in them having to embark on a healing journey.

This is difficult enough to work through from a personal perspective but is also occurring at the same time as a complicated police investigation and/or court process, she says.

The biggest changes CCSS has seen over the years include the expansion of its specialist services, reflected in the Child Witness Service and Family Violence Service, and the regionally-based combined Victim Support and Child Witness Service.

The voluntary nature of these services is important as it is empowering the victim of crime to have control about what they need, Ms Tagliaferri says. We provide our services with compassion, ensuring the principles of trauma-informed practice.

The VMU offers a reparative pre-sentence mediation service that is voluntary for victims and offenders, and a post-sentence process for victims when offenders are subject to supervised orders in the community.

The VNR also comes under that unit and is a vital cog in the Departments support structure for victims which has been operating for 21 years.

Headed by 19-year VNR veteran and experienced social worker Anne Martin, the register keeps victims apprised of an offenders status in the criminal justice system and endeavours to meet the needs of victims as well as being cognisant of the rights of offenders.

Victims can apply to go on the register at any time during an offenders passage through the correctional system, from which the VNR gathers information for victims.

A victims trauma can be long-lasting and were often talking to people who have lost a loved one and that loss is forever, Ms Martin says.

This is why the information (about an offender) that we pass on, its important we do it as sensitively and full of compassion as we can.

Commissioner for Victims of Crime Kati Kraszlan commended victim-facing staff who had often spent many years at the coalface.

Someone like Anne at the VNR may have been dealing with the same victims of crime since an offender was locked up 20 years ago, as well as taking countless other victims through the sentencing, incarceration, community supervision and eventual release process, she says.

While people may not always like what the VNR has to say, they do their job in a supportive and professional manner.

Ms Kraszlan is hosting the Victim Voices conference, which will map out the victim experience, on Friday, 16 September in Perth.

Chief Justice Peter Quinlan, cyber safety expert Paul Litherland and Dr Tomison are among speakers at the free event at the State Library of WA.

Tickets for the event are free, but must be booked at justice.wa.gov.au/victim-voice-conference.

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Recovery and healing at the heart of victims of crime services - Government of Western Australia

Meghan Markle has launched her latest attack on the royal family, saying she was happy to leave in part because she lost control of her beloved social media accounts claiming her images were instead given to people who were calling my children the N-word.

The 41-year-old rookie podcaster insisted in a scathing interview with New York Magazines The Cut that she and husband Prince Harry never stood a chance in the UK because just by existing, we were upsetting the dynamic of the hierarchy.

She also admitted that their decision to flee royal life as well as launch legal action against her own estranged father has torn apart both their families.

Harry said to me, I lost my dad in this process. It doesnt have to be the same for them as it was for me, but thats his decision, she said in the profile published Monday.

Despite this cost, Markle told interviewer Allison Davis ahead of her latest royal-bashing, Im, like, so excited to talk.

During the sitdown at her $14.65 million mansion in Californias celeb-packed Montecito, Markles eyes became alight and devilish when she asked, Do you want to know a secret?

Im getting back on Instagram, she said, launching into her biggest gripe about her short-lived time as a senior royal how she had to sacrifice her online life.

Her only Instagram account for a time became @KensingtonRoyal, one shared with Harrys brother, Prince William, and Williams wife, Kate Middleton and one Markle had no control over.

It was a big adjustment a huge adjustment to go from that kind of autonomy to a different life, she complained of losing the 3 million followers she had spent years growing.

Now, instead of posting her own snaps, the historic images were shared with royal watchers around the world via the press.

Theres literally a structure by which if you want to release photos of your child, as a member of the family, you first have to give them to the Royal Rota, she griped of the UK media royal pool, sharing the historic images with royal watchers worldwide.

Why would I give the very people that are calling my children the N-word a photo of my child before I can share it with the people that love my child? she asked.

Her comments did not specify whether she was accusing the press, the public or her new royal handlers of making such racist slurs. However, The Cut stressed that she was notably still ruffled over it.

You tell me how that makes sense and then Ill play that game, she said.

She also blamed the intense scrutiny for the seeds of Megxit, saying it stemmed from a plan to remove the press packs guise of public interest in reporting on them because their lives were taxpayer funded.

If they left the country and made their own money, then maybe all the noise would stop, Meghan said, saying they hoped at first to serve in other parts of the British Commonwealth, such as Canada.

Anything to just because just by existing, we were upsetting the dynamic of the hierarchy. So we go, Okay, fine, lets get out of here. Happy to, she said.

That, for whatever reason, is not something that we were allowed to do, even though several other members of the family do that exact thing, she complained, without citing specific examples.

Finally going back to the UK this summer to help celebrate Queen Elizabeth IIs Platinum Jubilee was surreal and bittersweet, she said, knowing none of it had to be this way.

The former Suits star admitted that she had initially assumed her TV career would help make royal life a breeze.

I was an actress, she said. My entire job was, Tell me where to stand. Tell me what to say. Tell me how to say it. Tell me what to wear, and Ill do it.

Now, she wishes she had seen movies that forewarned of the likely pressures, such as 2004s The Prince & Me, in which Julia Stiles plays a student who falls for a Danish prince, just to clash with his family.

Yeah. That wouldve been really helpful. That wouldve been a very key tutorial to have had in advance of all this, she told the interviewer, who noted she said it not quite sarcastically but with a steel rod in it.

Despite her N-word claim, Markle believes her clash came not from racism but just from her being American.

However, she insisted that being half black had made her brief time in the royal family all the more pivotal, recalling the high praise of a South African cast member of the live-action version of The Lion King at the London premiere in 2019, before she fled.

He looked at me, and hes just like light. He said, I just need you to know: When you married into this family, we rejoiced in the streets the same we did when Mandela was freed from prison,' she claimed.

Markle who has taken digs at the royal family on her new Spotify podcast hinted that there is likely far more to come.

Its interesting, Ive never had to sign anything that restricts me from talking, she said.

I can talk about my whole experience and make a choice not to, she said, saying she has only held back because she is still healing.

I think forgiveness is really important. It takes a lot more energy to not forgive But it takes a lot of effort to forgive. Ive really made an active effort, especially knowing that I can say anything, she said.

However, she would not reveal just how intimate that will get with their upcoming docu-series for Netflix.

While Markle again insisted it is not a reality TV show, she would not elaborate on just how far it will differ from one.

The piece of my life I havent been able to share, that people havent been able to see, is our love story, she said of Harry, with whom she is like salt and pepper because we always move together.

I hope that is the sentiment that people feel when they see any of the content or the projects that we are working on, she said, vaguely.

Whats so funny is Im not trying to be cagey, she said.

When the media has shaped the story around you, its really nice to be able to tell your own story.

See the rest here:
Meghan Markle was 'happy' to leave the royal family, get her social media accounts back - New York Post

Research on excessive digital media usage finds pediatric vision suffers negative effects

Pediatric eye health is important in all aspects of a childs life and development. Not simply represented by clarity, vision is a functional system thatwhen operating at its best is both flexible and efficient.

Vision is a primary sensory input that influences a childs learning, development, demeanor, and stamina, and is biologically unsuited for the excessive near demands of the digital culture children find themselves in.

Todays families face the challenges of managing an onslaught of digital media in their lives. Digital media includes a child interfacing with television content, cellular phones, tablets, computers, etc.

Digital media devices and the technology they deliver have many benefits, including the expansion of communication tools, easy and immediate access to information, and the ability to accommodate both our childrens strengths and challenges.

As with all things, the benefits of technology are counteracted by risks.

The current exposure to digital media has a profound effect on children. We have never had a generation of infants and toddlers with such increased near visual demands and sensory stimulation brought on by the cell phones and tablets that they interact with daily.

The excess near demands experienced by children of all ages creates a visual system that is fatigued and unable to operate efficiently.

Common Sense Media Research reported in 2021 that use of entertainment media alone approached 9 hours daily in teenagers and 6 hours daily in tweens.1 For both tweens and teens, screen media use increased 17% since the start of the pandemic.1 These statistics are staggering and often lead to parents feeling helpless and out of control when addressing screen time habits and their children.

Excessive digital media use has also proven to risk addiction in children. Addiction to device use, addiction to social media, and addiction to gaming are very real and serious consequences that are noted in the pediatric population.

In 2018 the World Health Organization added a gaming disorder to the International Classification of Diseases.2 MRI studies reveal that gaming and smart phone addictions change the physical structure of the brain in a manner that parallels drug and gambling additions.

Related: (VIDEO) The negative effects of digital media on pediatric development

As optometrists, we know that the power of the accommodative (focusing) system is age dependent. Excess use of this system without the proper visual hygiene wears down the strength and stamina of accommodation.

Todays optometric practices diagnose many patients with accommodative insufficiency due to a world driven by excessive digital demands. These excessive near demands reveal significantly reduced accommodative clinical findings, including visual acuity that is reduced and variable and the detection of low amounts of against the rule astigmatism.

Recognizing these clinical findingsin addition to the asthenopia, headaches, and fatigue that accompany accommodative issuesare critical to properly treat our patients.

In addition to the accommodative system, we see an inherent stress put on the binocular vision system. Binocular vision development begins in the brain, and there are valid neurologic concerns that screen-based activity stimulates visual processing more heavily than even the sensory processing systemsthus interrupting the development of binocular vision.

In our practices, we see binocular vision dysfunction in the form of convergence excess and convergence insufficiency that are influenced by the excessive screen time of todays youth.

A close viewing distance when looking at digital devices also influences the onslaught of visual symptoms.

Clinical studies reveal that the close viewing distance often accompanying the use of handheld digital devices becomes even closer with prolonged use.3 A primary chief complaint of parents bringing young children in for an eye exam is the observation of how close the child views a cell phone or tablet.

The closer the viewing distanceaccompanied with excess usagethe more likely an increase in diagnoses of accommodative and binocular vision issues, and the visual symptoms that accompany them.

There are several treatment options available for accommodative and binocular vision issues. Reading glasses and bifocals are prescribed to support the visual systems and aim to decrease the patients visual symptoms. Vision therapy is another treatment option for accommodative and binocular vision issues, aimed at improving the efficiency of all aspects of visual function.

Its been known that the progression of myopia is influenced by genetic and environmental factors, but digital media also influences the progression of myopia development.

Todays emphasis on the treatment of myopiawith a goal of minimizing progressionforces an optometrist to examine the screen time habits of our patients. We know that there are modifiable behaviors that influence the development of myopia.

Scientific research demonstrates that increased outdoor exposure positively influences the development of myopia.4 The exact cause of this is not fully understood, but outdoor time likely contributes to a limit of near demands and will have a more positive impact on the visual system.

A January 2021 JAMA article shares, Home confinement due to coronavirus disease [in] 2019 appeared to be associated with a substantial myopic shift in children.5 This observation demonstrates the effect of excessive screen time on the development of myopia.

Beyond influencing a childs visual system, digital media also has a significant impact on the overall development of our pediatric population.

We know that early exposure to digital media negatively affects a childs intellectual, social, and emotional development. Elevated digital media use more specifically results in decreased cognition and language skills. Further, the way children use digital media has a strong correlation with their mental health.

An area to examine is the influence of technology on the quality of sleep among the youth.

In the Journal of Clinical Sleep Medicine, it was noted that Adolescents' bad sleep quality was consistently associated with the mobile phone use and number of devices in the bedroom, while in preadolescents, with Internet use and turning-off time.6

Children and teens with devices in the bedroom experience decreased sleep duration, increased daytime drowsiness, and decreased academic performance. Poor sleep habits align with additional issues in the realm of mental health.

Unhealthy online habits result in elevated incidences of anxiety, depression, and hyperactivity diagnoses. Structural changes in the brain related to cognitive control and emotional regulation are associated with a digital media addiction.7 Neurologic changes noted with digital media addictions correlate clinically with the patterns of substance behavior dependence.

The path of excessive and unhealthy digital media use may lead to mental health challenges and addiction in our adolescent population. This is a path that every family wants to avoid.

The best way to achieve balance in ones family regarding digital media use is to develop rules and boundaries. Each family can strive to create a system that works for them.

Digital media use can be classified in three categories, known as the the 3 Cs of media:

1. Consumption: taking in media in a passive manner2. Creation: active engagement and development of skills3. Communication: using media to connect to another person

A well-balanced approach to digital media limits consumption and communication to 1-2 hours daily. However, it is understood that schools rely heavily on digital devices in their educational model, and this does contribute to the stress on the visual system and impact on development.

Parents must focus on what they can control and create a home environment that supports the benefits of technology and balances screen time in a manner that has a positive effect on all aspects of their childs life.

As Catherine Steiner-Adair, EdD, author of The Big Disconnect, says: Parenting in the digital age challenges in ways the human brainAND heart can hardly process fast enough. We do not want to surrender ourselves unquestioningly to adapt to technology.

Original post:
Pediatric eye health and digital media: negative effects - Optometry Times