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Maintaining affordable access to prescriptions in a post-pandemic world

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As the Covid-19 pandemic continues to evolve, pharmacy networks have largely delivered against the challenge to meet critical health care needs. Pharmacies across the country remain open to accommodate patients, and anticipated drug shortages and supply chain concerns from early in the pandemic have not come to fruition.

As patients start to head back to doctors’ offices for routine care and elective procedures, there may be a pent-up demand for prescription drugs as people start new medications and adjust their current ones. In this time of global disruption and change, it’s imperative that plan sponsors have a transparent and accessible pharmacy benefit manager (PBM) to manage their pharmacy benefit and ensure plan members receive affordable prescription drugs. For organizations who don’t have a strong partner or are experiencing current issues that have exposed a need for more transparent coverage, here are three ways to reevaluate your pharmacy spend and ensure you and your members have more affordable pharmacy benefits:

Understand PBM business models
PBMs play a significant role in how well plan sponsors such as employers, health plans and government entities can maintain and reduce their drug spend. Plan sponsors should always make an effort to understand a current or potential PBM partner’s business model, as it determines all other decisions an organization can make regarding its pharmacy benefit, including how much data it can access or what financial metrics it needs to meet.

Two main PBM models are available for consideration: traditional and pass through. Both models may claim to be transparent; however, a traditional model is less visible about its business practices and offers volume discounts and high rebates. A true pass-through model passes 100% of all pharmacy discounts (“zero spread”) and 100% of all rebates back to the plan sponsor, and its business practices are auditable, making it a more transparent option. Each model has important differences in how they operate, and plan sponsors need to determine which will best fit their company’s needs. In today’s uncertain times, having a transparent PBM who will identify areas for cost savings and grant access to all claims data is essential for ensuring an organization doesn’t overspend.

Look for formulary and utilization techniques that reduce wasteful spending
Formularies, or drug mixes, play an essential role in an employer’s overall plan cost, but it is difficult to quantify and is often overlooked in the PBM evaluation process. It’s important to look for partners who offer cost-effective alternatives, such as generics or less expensive brands, to drive lower net costs. With lower average wholesale prices, plan sponsors can achieve substantial rebates without paying more, ultimately lowering per member per month (PMPM) costs, which is a strong metric to identify a plan sponsor’s “all in” pharmacy benefit expenses. A robust formulary should also include techniques for reducing wasteful spending, which helps ensure plan sponsors aren’t spending more money than they need to.

Don’t overlook specialty pharmacy benefits
Specialty medications are expected to exceed 50% of drug spend over the next three years, so it’s no surprise that this area should be a primary consideration for pharmacy benefit management. Members who use specialty medications should be receiving personalized pharmacist support to make sure medications are being used appropriately, side effects are being managed, and individuals are receiving condition-specific support for their health needs.

Furthermore, there are nuances with specialty medications, as some require a clinician to administer them, which may fall under the medical benefit instead of the pharmacy benefit. Channel management strategies can help control specialty spend and generate savings by shifting the coverage of certain drugs from the medical benefit to the pharmacy benefit. Work with a partner who is experienced in specialty pharmacy to ensure the unique needs of members are met, while costs are better managed.

Ultimately, PBMs who are transparent, offer formularies that reduce wasteful spending and have experience in specialty pharmacy are better poised to meet the needs of plan sponsors and ensure the most affordable drug coverage options. With heightened pressure from the pandemic, PBMs have an increased expectation to be flexible, responsive and work with the best interest of plan sponsors and their members in mind.

Photo: Stas_V, Getty Images

 

 

 

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HEALTH

Can You Get COVID-19 Twice?

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Young Afro American woman standing on city street with protective mask on her face. Virus pandemic and pollution concept.

As thousands of people around the world recover from COVID-19 — and experts warn that there could be a second wave of the novel coronavirus later this year — one big question remains: do those who have been infected have immunity, or is it possible that they could get COVID-19 again?

The answer isn’t clear. According to the Centres For Disease Control in the US, the immune response to COVID-19 “is not yet understood.” Meaning, researchers are still trying to determine whether those who have been exposed develop immunity to the virus and, if so, how long it lasts. Drawing comparisons to a previous outbreak, the CDC explains that “patients with MERS-CoV are unlikely to be reinfected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.”

The World Health Organisation takes it one step further, noting that there’s currently no evidence that even those who have confirmed antibodies will be protected from a second infection.

But while you shouldn’t be lulled into a false sense of security, you also shouldn’t panic over headlines suggesting that some COVID-19 patients have tested positive after they recovered. “There are reports of people testing positive twice, even weeks apart,” Natasha Bhuyan, MD, physician and regional director at One Medical, told POPSUGAR. “However, experts don’t think these individuals were reinfected. Instead, it’s possible that viral particles remained in their system. These viral particles are suspected to be ‘inactive,’ meaning the people were not contagious at that point.”

In a recent interview with BBC, WHO’s technical lead Maria Van Kerkhove, MD, similarly called these tests “false positives.” Still, as Dr. Bhuyan went on to explain, “very little is known about individual immunity against COVID-19,” including whether any possible protection would last weeks, months, or years.

Another question that remains unanswered? “We don’t know if immunity to infection means [people] cannot transmit this infection to others,” David Cutler, MD, a family medicine physician at Providence Saint John’s Health Centre in Santa Monica, CA, told POPSUGAR. In other words, by not taking the necessary precautions, you could unknowingly put others at risk. “Repeated susceptibility to COVID-19 is just one of many areas of uncertainty regarding the novel coronavirus which causes this disease,” he said.

Until experts know more or we develop a vaccine that can help us safely achieve herd immunity, continue to follow CDC guidelines, by practicing social distancing, wearing a cloth mask in public, and washing your hands and cleaning surfaces frequently.

POPSUGAR aims to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out resources from the WHO, the NHS, and GOV.UK.



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Addressing maternal mental health issues during Covid-19 and beyond

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women's health

Pregnancy is always a time of heightened anxiety, but in the age of global pandemic, women are facing unprecedented stressors. Between 10-20% of women experience postpartum depression/anxiety, and for up to 30% of women, symptoms can actually begin during the pregnancy. Perinatal mood disorders have been associated with worse maternal and neonatal outcomes such as increased rates of preterm birth, decreased rates of breastfeeding, impaired infant bonding, and abnormal infant and child development – many of which come with steeper costs.

Certain risk factors for postpartum mood disorders may be exacerbated by the current pandemic including fear of childbirth, poor social and financial support, stressful life events, and adverse pregnancy outcomes. Additionally, recommended coping techniques including reaching out to family and friends for support, getting out of the house, making time for oneself, and exercising may be difficult to accomplish due to social distancing requirements and stay at home orders. Current treatment and counseling resources may also be more limited than in normal times.

The human and economic costs of untreated maternal mental health issues are meaningful, and these outcomes only stand to be intensified by the added stressors of Covid-19 – concerns about the way the virus will impact prenatal care, hospitals continuing to change their visitation policies, and so many unknowns surrounding the impact of the virus on pregnant women and babies. For some women, higher risks of intimate partner violence compound this situation. With these increased stressors, there is cause for concern that maternal mental health could emerge as a secondary public health crisis, the scope of which we may not realize for years to come.

Adjusting to a new normal for prenatal care
Prenatal care has been transformed in recent months due to the pandemic. While some of these changes, like embracing telemedicine for routine prenatal appointments, are arguably for the better, this certainly provokes anxiety for many women who had a set plan for how their pregnancy and prenatal care would look.

Studies have shown that telemedicine appointments are safe for routine prenatal appointments that don’t require ultrasound, lab work or cervical checks, especially for low-risk pregnancies. A medical study showed that a hybrid of in-person and videoconference prenatal visits for low-risk obstetric patients had similar pregnancy outcomes to the traditional in person visits. The American College of Obstetrics and Gynecology (ACOG) and the Society of Maternal Fetal Medicine have also recommended decreasing the number of ultrasounds to lessen the possible risk of transmission of COVID-19. Patients are now screened for the infection prior to appointments, and visitors are often not allowed in with them even for long-awaited ultrasounds.

Decreased access to typical in-person providers can also lead to increased anxiety for many women. For some patients, this may happen if their in-person provider is called to be a laborist on labor and delivery and for others it could be because their provider themselves is ill with Covid-19. Other women are not yet as comfortable with virtual appointments. Meanwhile other expectant mothers in areas more highly affected by Covid-19 are reluctant to even come into the office for necessary in-person appointments as they fear contracting the virus and what that could mean for their pregnancy. This is problematic, as inconsistent prenatal care has been linked to adverse pregnancy outcomes including low birth weight, preterm labor, and stillbirth. Providers should be aware of these concerns, reassure patients of all of the measures being taken to prevent the spread of infection during in person appointments, and take time to explain to patients the reasoning behind the use of telemedicine for routine appointments.

Concerns about Covid-19’s impact on health outcomes
SARS-CoV-2, the virus that causes Covid-19, has only been in circulation since late November/early December, and not much is known about how this virus affects pregnant women and their unborn children. Early studies have shown that pregnant women are not at higher risk for contracting the virus and do not have a worsened clinical course. However, based on the immunologic changes of pregnancy and observations from other respiratory viruses including influenza, SARS, and MERS, it is possible that pregnant women are at increased risk of developing severe pneumonia from SARS-CoV-2. Initial case series also showed no vertical (mother to baby) transmission, but recent evidence shows that it may be possible, with one case study showing an infant born with positive antibodies to the virus. SARS and MERS, also coronaviruses, were associated with adverse pregnancy outcomes including preterm labor, intrauterine growth restriction, increased risk of NICU admissions, increased risk of miscarriage, and stillbirth.

While it is unclear whether or not Covid-19 infections are associated with adverse pregnancy outcomes (a large trial including infected pregnant women is ongoing), obstetricians are seeing an uptick in second and third-trimester pregnancy losses, and a case study was recently reported in the literature of a second-trimester pregnancy loss caused by a placental infection with SARS-CoV-2 infection. There are still so many unknowns, and it’s this uncertainty that is driving increased anxiety and impacting mental health overall.

Shifting birth plans and adapting to changing hospital policies
Many women have been forced to reevaluate their birth plans, for fear of contracting the virus while in the hospital, as well as concerns about delivering alone due to changing hospital visitation policies. Early on in New York, some hospitals stopped allowing visitors altogether. Thankfully most hospitals are now allowing a single visitor for laboring women, with only a few requiring the support person to leave after delivery. Some hospitals are screening for Covid-19 infection with temperature and symptoms checks while others are choosing to test all pregnant women and their partners. If a support person screens or tests positive, he or she will not be allowed in the delivery room, while if a laboring woman screens or tests positive, the recommendation is separation from the baby after birth to prevent neonatal infection. Women who are fearful of delivering alone or being separated from their baby have sometimes chosen to deliver at an alternate hospital or have not truthfully disclosed when they or their partner have experienced symptoms of coronavirus infection, which can put medical personnel at risk.

Intimate partner violence
For far too many women, the trauma of intimate partner violence intensifies mental health conditions. Intimate partner violence is more common during pregnancy than when a woman is not pregnant, with approximately 324,000 pregnant women in the United States experiencing abuse each year. Often abuse starts for the first time when a woman becomes pregnant. With increased social isolation and fear of coronavirus infection, experts have cause for concern that intimate partner violence is increasing during Covid-19 stay at home orders, as it has during previous pandemics and other natural disasters. Many women are afraid to report abuse to begin with, and with safety nets breaking down, schools closed, and fewer in-person medical appointments, the risks are heightened. Joblessness and financial strain as well as multiple people in a household spending large amounts of time quarantined together increases tension that can lead to increased violence.

Empowering providers with solutions
As the pandemic continues, we as the medical community can take steps to ensure we’re effectively identifying and treating mental health issues, and helping women during this unprecedented time:

  1. Screening – ACOG recommends screening all women during pregnancy for mood disorders and performing comprehensive screening for postpartum depression at the postpartum visit. It is imperative that all pregnant and postpartum women continue to be screened for postpartum depression and mood disorders even when appointments occur virtually and that appropriate resources are available for treatment of mental health disorders. ACOG also recommends screening every woman for intimate partner violence at the first prenatal visit, at least once per trimester, and postpartum. However, during this pandemic increased screening may be warranted.
  2. Referring – Obstetric providers should be referring patients appropriately when screening is positive. A list of mental health providers, intimate partner violence counselors, and shelters in each provider’s area should be readily available, and each provider should be aware of how referrals are being handled during the pandemic.
  3. Listening – Obstetric providers should make time to talk to women at each prenatal appointment, whether in person or remote, about specific concerns or anxieties that they have around the pandemic and be ready to address those concerns. Providers should discuss birth plans with women as due dates near, and discuss new changes in hospital policies surrounding visitors, masks, and COVID-19 testing at the same time reassuring patients that they will be well cared for.
  4. Embracing Telemedicine and Other Virtual Platforms – Newer telemedicine platforms are available to fill in the gaps in between visits and are increasingly covered as a benefit by employers. These can provide mental health counseling, mental health prescriptions, and obstetric education by nurse midwives and obstetricians as well as subspecialists. Some also have a variety of provider types including pediatricians, lactation consultants, physical therapists, and back to work coaches. During the birth, video platforms should be offered to allow additional people (including a doula) to be virtually present in the delivery room if the patient chooses.

Now more than ever, women and families need comprehensive care that supports both physical and mental health. By utilizing all available resources, and tapping into what we know about how best to screen and treat maternal mental health issues, we can help mitigate the risks and preserve the care of our women and families – during the pandemic and beyond.

Photo: damircudic, Getty Images

 

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Exercises For Tight Hips and Weak Glutes From Sitting

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Sitting for prolonged periods of time can give you something called “dormant butt syndrome,” where your glutes don’t fire or, in other words, they are “asleep.” Your hips also tend to get tight, Annie Mulgrew, VP founding trainer at CityRow and NASM-certified personal trainer, told POPSUGAR. But, there are moves you can do to counteract these effects.

Mulgrew said that exercises requiring hip extension are underrated because people can do them right at home and they will mitigate tightness. “When you sit, you’re in hip flexion, and so the front of your hips in particular tend to get really tight,” she further explained. The Romanian deadlift, good morning, and bridge variations are examples of exercises she suggests to open up your hips, and she added that they target your glutes and hamstrings. This is also important for people who might focus more on lower-body exercises that are quad dominant (think squats, for example) as opposed to glute dominant (think deadlifts).

What’s more, “these require spinal extension, which is great because, when sitting, we tend to do the opposite,” Mulgrew said, “we can round our spine.” (At least that’s what I do.) At the same time, you’re engaging your core, as she noted, “in order to do anything with hip extension, your abdominals have to activate.” So, the moves are basically a win-win-win: they help with hip tightness, reverse poor posture, and target your booty muscles.

Ahead, check out how to do the exercises that Mulgrew classified as good for hip tightness and firing up your glutes! We’ve included a few examples of the moves with added resistance or single-leg variations as well. Note: this is not a workout. Plus, read up on her advice for making home workouts harder by increasing time under tension.



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CVS head of specialty pharmacy sees future of healthcare at home after Covid-19

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Mail-order prescriptions are nothing new, but pharmacists have turned to a number of other tools to help patients access their prescriptions during the Covid-19 pandemic.  The head of CVS Health’s specialty pharmacy strategy, Prem Shah, said he expects to see more patients continue receive healthcare at home after the pandemic ends.

Though CVS Health had been building up its arsenal of digital tools before the Covid-19 pandemic, stay-at-home orders forced the pharmacy giant to lean more on them. The company has seen a surge in the use of its support services since the beginning of March.

“We started our journey in the digital space in specialty 5 or 6 years ago,” said Shah, who is executive vice president of specialty and product innovation for CVS Health. “The pandemic has allowed us to really test our capabilities virtually, across the board for the PBM. We quickly realized virtual healthcare and support services were going to be critical with social distancing rules in place.”

For example, the company began offering secure text messaging with a nurse or a pharmacist. CVS Health saw a 30% increase in encounter volume, with some patients asking for help with managing their specialty medication, while others needed help finding supplies beyond the medication itself.

CVS Health also saw an uptick in calls to Accordant nurses, which are trained to help patients with rare conditions. More than a third of the calls were for questions about Covid-19.

Shah said CVS Health had also been working with health plans to help them identify which members face the highest risk from Covid-19, so they could reach out to them and make sure they understood everything that is available to them under their plan.

Looking to the future after the Covid-19 pandemic, Shah expects to see a bigger shakeup in traditional care settings.

“If you were to ask me even three months ago, we would say we have many fragmented sites in which we provide these services,” he said. “One of the things I think you’ll see stick in healthcare… how people think about their healthcare workforce is going to be a little more nimble. You’re not requiring someone to go into a specific setting.”

For example, hospitals have typically been a hub for cancer care. But with the pandemic, CVS Health helped patients that were receiving infusions in a hospital setting transition to in-home care.

“Over time, I think you’ll see care move to patients’ homes,” Shah said.

Telehealth has been another big part of the push to care for patients remotely. But there’s still plenty of room to build on these services.

“The real question with telehealth and these other things has to be how do we improve the quality of care?” Shah said. “The industry needs to push hard, but I do think there’s a better care model.”

Photo credit: Irina_Strelnikova, Getty Images

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How Working Out at Home Changed My Fitness Goals

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The first time I was congratulated for losing weight, I had just gotten my wisdom teeth out. For the past week, the only thing I had been able to stomach was chocolate pudding, plain yoghurt, and lukewarm soup, but my doctor didn’t know that. All she saw were the numbers on the scale ticking downwards — a cause for celebration, not concern.

I liked what my doctor was saying. For once, I felt like I had done something important — like I might actually have a shot at looking like the models I loved to compare myself to. I felt powerful, in control, and enjoyed being praised for what could only be my newfound commitment to health and fitness. In the moment, I didn’t feel like acknowledging that my weight loss was by no means the result of a healthy lifestyle.

I had always been a healthy weight, but was never traditionally thin, so this kind of admiration was new to me. In years past, I would try to suck in my gut during dance class, shrinking my profile in the mirror as much as I could, and becoming frustrated when I couldn’t make my backside look completely flat like the other girls. I became obsessed with my size and thought that if I could just lose a few more pounds, I would look the way I was “supposed to.” I didn’t know how, but I knew that getting thinner was my ultimate goal.

As I went through high school, I placed more and more value on superficial measures of skinniness that (spoiler alert) I was never able to fully achieve. Thigh gaps, flat stomachs, and, most importantly, the numbers on the scale, were the determining factors in how I felt about myself. What I heard that day in the doctor’s office only confirmed my own toxic ideas about weight loss: skinniness meant health, and fitness wasn’t anything without it.

A few years later I was off to college, and most of the exercise I attempted there continued to centre around weight loss. I’d have a great workout and still find myself discouraged if I felt like I was gaining weight. Likewise, I’d pick up terrible eating habits and become delighted once I found that they were helping me become closer to a skinnier ideal.

When social distancing became the new normal, however, my goals were temporarily derailed. I was home, hungry, and didn’t have anyone around me to impress — not even my doctor. Without a gym or any motivation to do anything other than skim through social media and watch Tiger King, I turned to home workouts. Not as a means to lose weight, but as a way to pass the time and keep myself moving during a long period of isolation.

I started off half heartedly with a few videos that promised to target my abs and arms, and they delivered. The next morning my muscles were sore in a new way — a good way — and although I didn’t initially believe that the various sets of crunches and planks would ever become easier, I was interested in the idea that a workout could mean more than just a smaller dress size.

I was finally working out because I wanted to feel like my best self no matter what my body looked like externally.

For the next month, I worked my way through different home workouts, even attempting intense HIIT exercises I used to avoid at all costs. In those four weeks, I grew stronger than I ever had when all I cared about was losing weight. My body was changing in a way I liked, but I was more excited about my ability to fly through the workouts I had initially struggled with, challenging myself in new ways and genuinely enjoying myself in the process. Workouts were now something I looked forward to instead of something I dreaded, and I noticed real progress that had nothing to do with my weight.

It took a few weeks of social distancing and some chaotic circumstances, but I was finally working out because I wanted to feel like my best self no matter what my body looked like externally. Going into my second month of home workouts, I’m continuing to view my health in terms of strength and nutrition, not weight loss and quick diets. Now when I approach my fitness, I remember to be mindful about what it is I actually want to achieve and whether or not I’m being honest with myself about my goals. Home workouts were my unexpected saving grace, but even when the gyms open back up and social gatherings resume, these are habits I’ll want to keep forever.



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Funding roundup: Mental health startup led by former Uber exec gets $100 million

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Telehealth once again captured investors’ attention this week when Amwell raised a large funding round.

The Boston-based company raised $194 million from previous investor Allianz X and drugmaker Takeda.

Though Amwell had been talking to investors well before the Covid-19 pandemic started, the telehealth company and its competitors have seen a surge of visits as a result. For its part, Amwell said it had been seeing up to 5,000 visits per day since the pandemic started.

Other digital health companies have seen a boost as a result. Read more about the companies that raised funding this week:

 

Mindstrong

Amount raised $100 million

Headquarters: Mountain View, Calif.

The Covid-19 pandemic has put behavioral health into the spotlight, as worries about health and job security have come to the forefront. Many digital health startups in this space focus on mindfulness and other general wellness goals, but Mindstrong has a bit of a different approach.

The company focuses on providing virtual care to people living with a serious mental illness, such as bipolar disorder or major depression. Through its app, it connects users to therapists, psychiatrists and care coordinators.

Mindstrong also said it is developing a technology that patients can use to monitor their symptoms based on their smartphone usage, such as how they type of scroll on their phone.  The company conducted a study with a ketamine clinic to determine which smartphone features would be the best predictors of a user’s mood. But, as noted by STAT, little data is available to the public.

Still, the company has a strong roster of backers. General Catalyst, ARCH Venture Partners, Foresite Capital, 8VC, Optum Ventures and What If Ventures participated in its series C round.

Mindstrong also recently named a new CEO, bringing in Uber’s former product head Daniel Graf to lead the company.

“Mindstrong has clinically demonstrated that it can deliver health assurance to people who suffer from serious mental illness in a cost-effective manner,” General Catalyst Managing Director Hemant Taneja said in a news release. “I am excited to see Daniel and team scale the Mindstrong service with this capital to make a meaningful difference for this significant yet underserved population in our society.”

 

Rapid Micro Biosystems

Amount raised: $120 million

Headquarters: Lowell, Massachusetts

While much of the attention may be on finding a treatment for Covid-19, in the background, dozens of companies are working to make sure drugs are produced in a safe and efficient manner. One of them is Rapid Micro Biosystems, a company working to automate quality control to ensure products aren’t contaminated with bacteria, mold or fungi during the manufacturing process.

The Massachusetts-based company raised $120 million in funding, led by Hong Kong-based Ally Bridge. Geneva-based Endeavour Vision, Bain Capital Life Sciences and Longitude Capital also participated in the funding round.

Rapid Micro Biosystems plans to use the funds to support its commercial expansion in the U.S., Europa and Asia. It will also invest some of the funds into product development, including a rapid sterility test for the final release of products that it has been developing with the U.S. Biomedical Advanced Research and Development Authority (BARDA).

 

Holmusk

Amount raised: $21.5 million

Headquarters: Singapore, New York City

Health data analytics company Holmusk raised $21.5 million in funding led by Optum Ventures and Health Catalyst Capital. The startup is building a behavioral health analytics platform. Holmusk said it is combining mental health data with chronic conditions to help support the best treatment decisions for patients.

“Our team is encouraged by Holmusk’s evidence-based approach to improving care for people suffering from behavioral health disorders, and we look forward to working closely with the Holmusk team to support the next phase of growth” Optum Ventures Senior Principal Dr. Vijay Barathan said in a news release.

The startup acquired behavioral health EHR MindLinc from Duke University School of Medicine in 2016, giving it more than 20 years of longitudinal health data. With the new funding, Holmusk plans to expand its offices in New York.

Photo credit: Abscent84, Getty Images

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WEIGHT LOSS

Nurse Who Survived COVID-19 Shares Jaw-Dropping Photo Of What It Did To His Body

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A nurse from San Francisco is shining a light on the severity of COVID-19 with a shocking photo of the effects it had on his body.

Last week, Mike Schultz shared side-by-side images of himself with his over 40,000 Instagram followers of the dramatic 50-pound weight loss he experienced during an eight-week hospital stay as he was treated for the disease caused by the new coronavirus.

The 43-year-old told Health that in the photo on the left, he’s about 190 pounds. He added that he exercised every day and had no underlying health conditions.

“I weighed myself the other day and I’m down to 140 pounds, and I probably weighed less than that when I first got into rehabilitation,” he told the magazine. “I’ve never been this skinny before in my life.”

Schultz explained to Buzzfeed News the reason he decided to post his now-viral photos. “I wanted to show it can happen to anyone. It doesn’t matter if you’re young or old, have pre-existing conditions or not. It can affect you,” he said.

Schultz told CNN that he contracted the coronavirus in early March, “before any of the restrictions were out” and likely got it while attending Miami’s Winter Music Festival. His DJ boyfriend, Josh Hebblethwaite,was working at the event.

“We knew it was out there,” Schultz told Buzzfeed, noting that no “lockdowns” had been ordered at this point. “We just thought, ‘Well, we gotta wash our hands more and be wary of touching our face.’”

The Miami Herald reported that 38 people who attended the LGBTQ-friendly music festival later got sick, and three men died, 

On March 14, about a week after the festival, Schultz flew to Boston, where Hebblethwaite lives.

He told CNN that when he first arrived in Boston, he had a cough but “it wasn’t really a big deal.” But on March 17, he found himself with a fever of 103 degrees and was having difficulty breathing.

When Schultz arrived at the hospital, he was given a swab test and chest X-rays. He tested positive for the coronavirus and was also diagnosed with pneumonia and severe repertory distress syndrome, per CNN.

Soon after, he was intubated and placed on a ventilator to aid his breathing.

“That was the last time I saw my boyfriend,” Schultz told Health. “I texted him, ‘I’m scared.’ Soon after, I was sedated, and I don’t remember much after that.”

He was on the ventilator for four-and-a-half weeks, according to CNN. He told Buzzfeed that during this time it was like he was “in a coma.”

Schultz said that when he woke up from his ordeal, he believed only a week had passed. “I still had a tracheostomy [tube], I couldn’t talk, and my hands were so weak that my phone felt like it was 100 pounds,” he told Health.

He also noticed he had lost weight, but nothing could prepare him for what happened when he finally saw himself in the mirror. “I didn’t even recognize myself,” he told CNN. “I pretty much cried when I looked in the mirror, I was like ‘Oh my God.’”

Schultz is now slowly recovering.

“I’m doing breathing exercises to get my lung capacity up, and plenty of exercises to stabilize my legs so I can finally walk without doing a penguin shuffle,” he joked to Health.

A HuffPost Guide To Coronavirus



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How to Practice Positive Self-Talk

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Getting rid of negative self-talk and changing the way you view yourself isn’t all that easy — we won’t pretend it is. But switching over to positive thoughts, or positive self-talk, does not have to be daunting. Therapist Kati Morton, LMFT, told POPSUGAR that positive self-talk is simply making sure that the conversation always running through our heads is “more supportive and compassionate voice.”

Morton continued, “I think for a lot of people, talking positively to ourselves is difficult. If I’ve been thinking and talking to myself, saying that I’m lazy and stupid for years, then I can’t all of a sudden just decide to think I’m productive and super smart because I’m not going to believe that drastic shift. I can say it, but I don’t believe it. And I’m not a big believer in ‘fake it ’til you make it.'” Faking it is not how positive self-talk works — it’s not about giving yourself half-hearted pep talks in front of the mirror — and that’s where bridge statements come in.

Using Bridge Statements to Promote Positive Self-Talk

Similarly to how some people may not feel comfortable being body positive and are more into body neutrality, bridge statements act as that middle ground. They are phrases that help us see that we could change our mindset if we wanted to. “Bridge statements live in possibility land,” Morton explained.

Basically, instead of saying things like “I’m wonderful,” “I’m productive,” or “People love me,” Morton noted that we can say “It’s possible that I’m not as lazy or stupid as I think” and “I’m open to the thought that I might be wrong about that.” Bridge statements can work for how you view yourself mentally, physically, and emotionally, and they can also work situationally, Morton added. For example, see how bridge statements would apply below if you were delving into a project.

Negative self-talk: “I’m never going to get this done” or “It’s not going to go well.”

Bridge statement toward positive self-talk: “It’s possible that I could be good at this” or “I’m open to the idea that I could finish this in time.”

Bridge statements as a concept is something Morton uses a great deal in her California private practice. In fact, even she said that though she doesn’t have to use bridge statements in many areas of her life, two areas that she does struggle with are physical appearance and productivity. She typically needs to use bridge statements at least once a day for those areas.

This might go without saying, but negative self-talk can impact your mental health. “If we were talking to ourselves very negatively most of the time, that could have a really detrimental effect on our mood, our relationships, even just our motivation,” Morton explained. “It can really just hold us down and hold us back.”

How to Start Implementing Positive Self-Talk Throughout Your Day

Morton told POPSUGAR that our brains are wired to seek out threat and to look for negativity — this is related to our fight or flight response when we’re stress. Shifting our brains away from that and flexing our positivity muscle is difficult, but it is possible. “I always tell my patients, ‘Changing your thoughts to a more positive thinking can literally change your life,'” she said. Now that you know how positive self-talk works, here are ways you can start implementing this concept into your day-to-day routine.

  1. Pay attention to what you’re saying to yourself. Notice what thoughts might be holding you back.
  2. Use bridge statements. Transitioning from bridge statements to positive self-talk is completely dependent on the person and how deep those negative beliefs run. It could take a few days, a few months, or years of work. For more information, check out a video Morton recorded about bridge statements for her YouTube channel, which has over 900,000 subscribers. (Note: you can help support her mental health videos by signing up for her Patreon membership that funds her work online.)
  3. If bridge statements are too hard at first, Morton suggests coming up with two or three things that you like about other people or the situations around you. This externalises positivity and can sometimes be a little bit easier to follow through with.
  4. Another way to shift your brain into a more positive place without directly using bridge statements and trying positive self-talk right away is to write down positive affirmations or potential positive thoughts and put them in places you’ll see every day. “That repetition can slowly change the way that our brains work,” Morton said. “If it’s hard for you to do it actively, that’s a passive way to turn things around.”



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FITNESS

Why Is Leaving Coronavirus Lockdown Making Me Anxious?

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When the coronavirus lockdown began in March, most people’s lives changed in immeasurable ways. At the time, we were bombarded with (admittedly, very helpful) advice on how to cope with anxiety, should we experience it during lockdown. But with restrictions slowly starting to ease in many parts of the world, there are many people who have seen an increase in anxiety all over again, this time about leaving lockdown. Posts to the effect of “I felt anxious going into lockdown, and now I feel anxious about leaving lockdown” have been popping up around social media for the past couple of weeks, and it’s given rise to the term “re-entry anxiety.”

We wanted to find out exactly what re-entry anxiety is, whether it’s normal to be experiencing trepidation about leaving lockdown, and how to cope if you are feeling anxious.

What Is Re-Entry Anxiety?

The short answer is that “post-lockdown anxiety is real,” said Dr Balu Pitchiah, consultant psychiatrist and scientific advisor to Cannaray, who added that it’s normal to feel like the storm might be subsiding, but the unknown danger remains.

Dr Elena Touroni, consultant psychologist and cofounder of The Chelsea Psychology Clinic in London, agreed. “We went into lockdown with the understanding that it was protecting us from harm,” Dr Touroni told POPSUGAR. “If you’ve been told that it’s not safe to be out and about, it’s only natural that leaving lockdown would trigger anxiety for some people.” She explained that many people have felt that their home has become a “safe bubble” during this time, so it’s normal that we might feel exposed when coming out of it.

What Is the Cause of Re-Entry Anxiety?

Dr. Touroni and Dr. Pitchiah both agreed that forced change is likely the root cause of re-entry anxiety. “In this context specifically, we need to be aware of the messages that have been given to us: like ‘stay home, stay safe,'” said Dr. Touroni. “It can take time to undo those kinds of messages, so it’s understandable that we might feel a sense of worry and anxiety.”

Dr. Pitchiah explained that people are typically used to routines, roadmaps, and specific timelines, but those simply don’t exist during the current COVID-19 pandemic. “The uncertainty of the future, unknown fear of the impact of the virus, and a forced change to the ‘normal’ way of life does cause a great deal of stress,” he said. “This leads to a feeling of a lack of control, anxiety, and a heightened perception of threat.” He explained that while the lockdown brought a great deal of relief for those who were forced to do multiple anxiety-inducing activities each day, “a number of us will now be quite comfortable with the new ‘norm’ and may now be worrying about what comes next.” He added that there’s also the “additional fear of catching the virus once we come out of lockdown due to exposure.”

Who Is Most Likely to Experience Re-Entry Anxiety?

“This world of COVID-19 has posed some very real anxieties for almost all of us,” said Dr. Touroni. “It has amplified health anxieties and caused financial worries about the future, and it’s likely to have exacerbated any preexisting anxieties even more. Anxiety itself is a feeling of threat or vulnerability to harm in the world, so it’s understandable that this would be heightened given everything that has happened.”

Many people have felt that their home has become a “safe bubble” during this time, so it’s normal that we might feel exposed when coming out of it.

When specifically speaking about re-entry anxiety and, in particular, how conflicting messages from governments could be contributing to this, Dr. Touroni admitted that distrust or uncertainty toward government is likely to have an impact. “It’s also about the way we relate to authority figures on a more personal level; whether we believe they’re there to protect us, or we’re more distrustful of them. If you have a tendency to not trust authority figures, then you’re more likely to experience the government as being neglectful or acting in a self-interested way.” She also explained that if you are generally more cautious day-to-day, then you’re more likely to experience a high level of anxiety getting back into the world in the post-lockdown phase.

People who weren’t anxious or worried about lockdown in the first place probably won’t experience re-entry anxiety, according to the experts. “I’ve noticed that the people who have generally found lockdown very difficult didn’t necessarily feel like they needed it in order to feel safe to begin with,” said Dr. Touroni. “Because of this, they’re not feeling particularly anxious about coming out of it. Whereas, the people who found lockdown comforting are the ones who are now experiencing more anxiety around coming back out.” She said that the latter group are generally the same people who embraced the idea of a “new normal” and focussed on finding a version of normal that made them feel safe. “The people who weren’t anxious to begin with don’t necessarily want a new normal and instead are experiencing a sense of loss (rather than anxiety) of things not going back to the way they were.”

How to Cope With Re-Entry Anxiety

Dr. Pitchiah has some simple strategies to managing any re-entry anxiety you may be experiencing, and it all starts with acknowledging that it is real. He also suggested trying to deal with one worry at a time, and categorising the things you can and can’t control (and focus on the former). One thing you can control is creating a calm environment which might coincidentally help to calm your feelings, too — a comforting blanket, soothing music, or a scented candle might help to make self-nurturing activities a priority. He also suggested establishing a routine (and sticking to it), picking out the positive elements in your daily life to focus your energy toward, and, most importantly, never hesitate to seek professional help if necessary; you are not alone.

When faced with returning to the “real world”, Dr. Touroni encourages everyone to be aware of the facts when it comes to the current levels of COVID-19 in their community. “Remind yourself that the numbers have gone down significantly in many parts of the country,” she said. “Be aware of the statistics and take an approach that is proportionate to how threatening the virus is to you (and your friends and family). Stay connected to your own goals and values in life. How do you want to live your life? Can you see the benefits of life reopening? What do you stand to gain from connecting with your friends and family again?”

POPSUGAR aims to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out resources from the WHO, the NHS, and GOV.UK.



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