As a physician anesthesiologist, I know how challenging it can be to treat patients who are in pain. For most people, pain is temporary. But for more than 100 million Americans, there is no end to pain.

Chronic pain can be broad or focused, dull or sharp, distracting or excruciating, and in many cases, debilitating.

Your likelihood of experiencing chronic pain increases with age. Gender can also influence how much pain you have. In general, women report having more pain than men.

The Serious Effects of Pain

Living with chronic pain can affect your life in many ways:

Mental health changes. According to a 2006 survey from the American Academy of Pain Medicine, almost two-thirds of people living with chronic pain have reported a decrease in overall happiness and 77 percent reported feeling depressed.
Increased fatigue. Pain can affect your daily functioning, resulting in decreased concentration, diminished energy levels, and difficulty falling or staying asleep.
Decreased job performance. Chronic pain costs the U.S. more than cancer, heart disease, and diabetes. Health economists estimate that the cost of chronic pain may be as high as $635 billion a year, according to a report published in the Journal of Pain. We can only guess how many people have been limited in their professional advancement because of pain.
Which Doctor Is Best at Treating Pain?

If you  are experiencing pain, your first stop should be to visit your primary care physician. A 2010 analysis of a national medical database found that 13 percent of all doctors visits were to discuss pain. Of these visits, 45 percent were at a primary care physician's office. Less than 1 percent of those surveyed sought help from a specialized pain physician.

Specialized pain physicians are underused by patients, probably because the specialty is relatively new and people don't know about it. These physicians are trained to treat difficult pain conditions using the most advanced treatments.

I like to compare pain physicians to football players. The goal of all of these doctors is the same — to relieve pain — but the role they play varies:

Anesthesiologists spend four years of their training managing anesthesia and pain control in surgical patients. Most pain specialists are anesthesiologists, and they can offer a full array of pain treatments.
Neurologists focus on targeting the neural, or nerve, aspects of pain. Treatments include medications and procedures to treat nerve-related pain.
Physical medicine and rehabilitation physicians focus on relieving pain and improving their patients' day-to-day functioning via physical therapy and physical reconditioning.
The Future of Pain Treatment

Recently, the American Society of Anesthesiologists analyzed dozens of peer-reviewed medical journals from the past year to create its first Women’s Pain Update. Highlights from the report include:

Success with alternative pain-relief methods such as music, yoga, and rose oil.
Breast cancer research that found the type of anesthesia used during breast cancer surgery can affect how quickly and comfortably you recover.
New research has also led to the development of medications that can decrease nerve irritation and depression caused by pain. Similarly, there are several new procedures that can treat pain.

For example, pain specialists can use X-ray or ultrasound imaging guidance to provide relief through steroid injections that target specific nerves and areas of the spinal cord. The procedure is fairly low risk when administered by a physician specifically trained in interventional pain treatments. All three major pain societies, the American Pain Society, the American Society of Interventional Pain Physicians, and the American Academy of Neurology, state that epidural steroid injections are best suited for those with a pinched or inflamed nerve root (also called radiculopathy).

However, we still have a lot to learn about steroid procedures. Studies have shown that any type of epidural injection — including saline — can relieve pain. In fact, such injections provide twice the pain relief of intramuscular steroid injections, without the associated risks.

Don't resign yourself to a life  in pain. If you are one of the millions of people lacking an effective remedy for your pain, a trained pain medicine physician may be able to help you achieve your pain management goals.

While I aim for 20 or 30 minutes of daily exercise, I never miss an opportunity to sneak in extra movement throughout the day. After all, your muscles have no idea if you’re in a fancy gym or in your kitchen — as long as you’re working them, they’ll get toned!

By doing little exercises throughout the day wherever you can — in the kitchen, in your car, while you brush your teeth, or while you're sitting at your computer — you’ll keep the oxygen flowing and stretch and tone your muscles.

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You’ll also boost your metabolism: Did you know you can burn up to 500 calories per day just by fidgeting? It’s true! I like to call these little movements "fidget-cizes." They take only one minute or less and they really do work! Fidget-cizes don't replace your regular workouts, but when life gets too hectic, use these moves as a way to squeeze in a little extra fitness all day long. Here are a few of my favorites. Give them a try!

• Squeeze that butt: Do it in the elevator, as you're walking down the aisles of a grocery store, and while you're waiting in line at the bank. No one will know — and it's so effective!
• Work those legs: Try doing leg lifts at your desk or squats while you brush your teeth at night.
• Add some steps to your day: Whenever you can, sneak in extra walking. Park your car far away from the store, take the stairs instead of the elevator at work, or do a few laps of the mall before you shop this weekend. Every step counts!
• Tuck that tummy: If you're relaxing in the living room in front of the TV, try lying on the floor or on a blanket and doing crunches. Make a deal with yourself that you'll do them throughout each commercial break. Easy!
• Take a “dip” on the couch: Sit at the edge of the couch and place your palms down on each side of you. Move forward so that your body is off the couch, bend your elbows behind you, and lower your body toward the floor with your knees bent and feet together. Bend and extend your arms multiple times as you watch TV — you’ll lose that arm jiggle in no time!
• Stretch it out: Tension can build up in the neck and shoulders simply from sitting at your desk, and it gets even worse as the long work day drags on. Stretching encourages those tense muscles to relax and counteracts any tightness from poor posture and tired muscles. Try doing my Shoulder and Chest Relaxer, One-Arm Reach, and Neck and Shoulder Release at your desk — you'll probably start an office trend!
• Get firm on the phone: If you spend a lot of time on the phone like I do, don't just sit there — make it a workout by "pretending" to sit! Press your back flat against a wall and lower your body by bending your knees to a 45- to 90-degree angle. Hold the position for as long as you can.
• Get lean while you clean: Did you know that by doing household chores — carrying laundry upstairs, vacuuming, making your bed, dusting — you can burn up to 400 calories an hour? You’ve got to do these tasks anyway, so you might as well turn on some music and think of it as exercise!

Go ahead: Turn idle time into exercise time and look for every opportunity to move your body. All of those little moments will add up to major health benefits — you’ll see!

Maria Sharapova isn’t just a talented athlete. With supermodel looks, it’s no surprise that the Russian-born blonde has endorsement deals with a slew of beauty and fashion brands and has been photographed for the “Sports Illustrated” Swimsuit Issue. (She even edged out rival Serena Williams to be named the highest paid female athlete in 2014 by “Forbes” magazine.) 

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The five-time Grand Slam winner, who is currently gearing up for this year’s US Open, took time out of her busy schedule to chat with Everyday Health at a recent Supergoop! press event. She reveals her healthy skin habits, how she stays energized during a tough match, and more. 

1. The most important step in her beauty routine: As one of the best tennis players in the world, Sharapova spends plenty of time out in the sun practicing and playing grueling matches. To ensure her fair skin stays protected, she reaches for SPF almost as soon as she wakes up. And in fact, she says she’s been an avid sunscreen user since her teenage years. 

“It’s important for me to think about sunscreen early in the day, because as you go about your day, you’re thinking about the challenges ahead and the activities you’re doing and [sunscreen] is almost not on your mind anymore,” she says. “I have a bottle of sunscreen next to my shower, so I wake up, take a shower, towel off, and apply.” When she’s playing tennis, Sharapova relies on Supergoop! Everyday Sunscreen Broad Spectrum SPF 50, which she says has a lightweight texture and doesn’t sting her eyes as she sweats. 

RELATED: 10 Best SPFs for Every Skin Concern

2. Her glow-boosting secret: In addition to slathering on SPF in the morning, Sharapova starts her day with a whole lot of water to stay hydrated and keep her skin fresh. “I usually wake up and drink more than a half liter of water, just to get my mind ready and aware that I need to drink [water],” she explains. 

3. How she relaxes before a big match: For Sharapova, getting enough sleep is one of the keys to her success. “I love to sleep. I love taking naps,” she says. “That’s been part of my regimen since I was a young girl. I used to have a morning and afternoon practice, and I’d come home and have lunch and then take a 45 minute nap. To this day, I enjoy doing that if I have the opportunity.” 

4. Her favorite pre-game meal: When it comes to food, Sharapova keeps it simple. “I’ve learned a lot over the years about how I react to foods and how much energy I have,” she says. “Usually, I eat a little bit of chicken and a lot of green vegetables [before a match].” Sharapova also likes to whip up her own green juices, visiting local stores to pick up veggies and adding lemon and kiwi for sweetness. 

5. How she stays confident: One of the easiest ways Sharapova gives herself a boost is by spritzing on her favorite perfume before walking out the door. And before she steps onto the court, she reminds herself of how lucky she is to be following her dream. 

“I’ve played this sport for a long time and put in a lot of work and effort,” she says. “And that moment when you’re about to go on the court — that’s what you work for, that’s the goal — it’s a privilege. No matter if you win or lose, the opportunity to go out there is pretty special. It’s very powerful.”

Major depression isn’t always so easy to spot in yourself or someone you love. Use these clues to determine when treatment is needed.

Everyone feels a little down in the dumps now and then. But sadness and withdrawal can become crippling, putting you at risk for a number of serious conditions and consequences, including suicide.

Depression symptoms aren't always as obvious as frequent crying and overwhelming despair. “Oftentimes the changes are subtle, and the person may not notice, but their friends and loved ones may,” says Boadie W. Dunlop, MD, director of the mood and anxiety disorders program in the psychiatry department at Emory University School of Medicine in Atlanta.

There's no one pattern. Depression symptoms may gradually progress from the mild, such as choosing to stay home to watch TV instead of going out with friends, to the more severe, such as thoughts of suicide. Or someone may go from seeming perfectly happy to being totally depressed in a matter of days or weeks. The progression varies from person to person.

“Depression symptoms are particularly troubling if someone displays more than one, or if they persist for more than two weeks,” says Simon Rego, PsyD, associate professor of clinical psychiatry and behavioral sciences at Albert Einstein School of Medicine and director of psychology training at Montefiore Medical Center in the Bronx, New York.

RELATED: 10 Drug-Free Therapies for Depression

To help you recognize depression that warrants concern, whether in yourself or a loved one, here are six depression symptoms — some of which you might even find surprising — that you shouldn’t ignore:

1. Trouble Sleeping Despite being slower in demeanor and motivation, depressed people often lie awake at night, unable to sleep, says Sarah Altman, PhD, a clinical psychologist in the department of psychiatry and behavioral health at The Ohio State University Wexner Medical Center in Columbus. On the other hand, some depressed people may find it difficult to get out of bed and may sleep for long periods during the day.

2. Loss of Interest in Favorite Activities Some people turn to hobbies they enjoy when they feel blue, but people with major depression tend to avoid them. “So if a person who loved spending time with her grandchildren suddenly doesn’t want to see them, or a guy who loves to fish suddenly hangs up his rods, it’s a red flag,” says Tina Walch, MD, psychiatrist and medical director of Northwell Health's South Oaks Hospital in Amityville, New York.

3. Increase in Energy Ironically, when depressed people have made a decision to do something drastic, such as killing themselves, they may go from lackadaisical and slowed to more energetic. That's because they feel a sense of relief in having come to a resolution, Dr. Walch says, "so if you notice a drastic switch like this, you should be very concerned."

4. Change in Appetite Some people overeat when they're depressed or anxious, but in people with severe depression, the opposite is usually true. “A depressed person may stop eating because he or she is no longer concerned with physical well-being,” says John Whyte, MD, MPH, a board-certified internist in Washington, DC and author of Is This Normal?: The Essential Guide to Middle Age and Beyond. “Disregard for personal hygiene is also cause for concern,” Dr. Whyte adds.

5. Touchiness “In some people, depression manifests as more irritability and impatience than feeling down,” Dr. Dunlop says.

6. An Emerging Dark Side “A person who is severely depressed may become preoccupied with death and other morose topics,” Walch says. For example, he or she may talk about what things will be like “after I am gone,” and may also become more likely to take uncalculated risks.

The Next Step: Getting Help

If you notice any of these serious depression symptoms in yourself or someone you love, reach out and get help. “In most people, depression, even major depression, is a very treatable disorder," Walch says. "There is a wide range of medications and therapies that have been proven to work." Specifically, here's what you should do:

Assess the severity. If you or a loved one is considering harming himself or herself, or is having other dark thoughts, immediate treatment is critical. “Go to the nearest emergency room or contact your local or a private mental health provider,” Walch says. Or contact the National Suicide Prevention Lifeline at 800-273-8255 (TALK).
Create a safe environment. “If the person expresses suicidal thoughts, remove any potentially lethal items from the home, such as guns,” Dunlop says.
See a mental health professional. “It doesn’t have to be a psychiatrist — it can also be a psychologist or therapist,” Whyte says.
Be kind. “Blaming or chastising depressed people for feeling low or unmotivated is not helpful and typically serves to reinforce negative feelings they already have,” Dunlop says. “Instead, open the discussion in a nonjudgmental way and encourage the person to seek help.”
Ignore the stigma. “The recent story of the [suicidal] German copilot [Andreas Lubitz] has not been helpful in terms of the stigma surrounding depression,” Walch says. “Depressed people who are suicidal are not murderers. Suicidal thinking can be a depression symptom, but homicidal thinking is not.”
Look to resources. “There are many organizations that have online resources about depression,” Dr. Altman says. They include the National Institute of Mental Health, the National Alliance on Mental Illness, and the American Psychological Association.

More Americans are surviving cancer than ever before, but as the population ages, even more will develop the disease.

That's the good and bad news from the 2017 Cancer Progress Report from the American Association for Cancer Research, released Wednesday.

According to the report, the cancer death rate dropped 35 percent among children and 25 percent among adults from 1991 to 2014. That translates to slightly more than 2 million fewer cancer deaths.

On the flip side, new cancer diagnoses are predicted to rise from nearly 1.7 million this year to 2.3 million in 2030, said the association's president, Dr. Michael Caligiuri.

And this year alone, more than 600,000 Americans are predicted to die from cancer, according to the report.

Caligiuri said the increase in cancer cases is simply a consequence of more people living longer. As the report noted, 53 percent of U.S. cancer diagnoses occur among those aged 65 and older, and that population segment is expected to grow from about 49 million in 2016 to just over 74 million in 2030.

"The longer people live, the higher the incidences of cancer are going to be," Caligiuri said.

"The longer you live, the more likely are the chances for serious genetic mutations that cause cancer, and the weaker your system is in repairing your DNA when you do have those genetic changes," he explained.

Dr. Anthony D'Amico is a professor of radiation oncology at Harvard Medical School in Boston. He said, "The most likely explanation for the progress in cancer survival is a combination of advances in cancer treatment coupled with early detection through screening."

The AACR report noted that death rates for many of the most commonly diagnosed cancers in the United States -- including breast, colorectal, lung and prostate cancer -- have been declining for more than a decade. But deaths from other forms of cancer -- brain, liver and uterine cancer -- have been increasing.

RELATED: 'Cancer Pen' Could Help Surgeons Spot Tumor Cells in Seconds

And progress has not benefited every American equally, the researchers noted. Disparities in cancer care continue between whites and blacks, the insured and uninsured, the poor and the elderly.

But there is progress in treatment. Between August 2016 and July 2017, nine new anticancer drugs were approved by the U.S. Food and Drug Administration, the report said. In addition, the FDA approved the use of eight existing drugs for fighting new cancers.

Two of the new drugs are immunotherapeutics, called checkpoint inhibitors. These treatments increase survival and improve the quality of life for patients with many types of cancer.

Progress was also seen in drugs that target specific cancer molecules. In fact, seven of the new drugs do just that, the researchers said.

The FDA also approved a new optical imaging agent to help doctors see brain tumors and more accurately guide their removal.

The keys to more progress in preventing and curing cancer include basic science to understand the biology of cancers, Caligiuri said, then making those findings relevant to cancer treatment through animal and early human trials. Next comes testing on many people to see how safe and effective these new treatments are, he added.

In addition, more studies are needed to better understand the risks for cancer and to develop ways to lower those risks. These include lifestyle changes -- such as not smoking, eating a healthy diet and exercising -- and screening to detect cancer early.

On the cancer prevention side, cigarette smoking declined by nearly 39 percent from 2000 to 2015, which should mean fewer cases of lung cancer in the future, the report said.

The researchers also said that, in the future, nearly all cases of cervical cancer and many cases of oral and anal cancer could be prevented if girls and boys received the human papillomavirus (HPV) vaccine.

Yet, only 63 percent of girls and fewer than 50 percent of boys had received at least one dose of HPV vaccine in 2015, the study reported.

According to D'Amico, "There is still a lot more to do, but we are going in the right direction in terms of discovery, screening and biology."

Cancer is not an inexpensive disease. Direct medical costs in 2014 were nearly $88 billion, the report said. This does not include the indirect costs, such as lost productivity from cancer-related care and death.

Yet the U.S. National Institutes of Health (NIH) received only $30 billion in funding for 2014, Caligiuri said. And of that total, only about $5 billion went to the U.S. National Cancer Institute.

Not surprisingly, Caligiuri believes that both the NIH and the FDA need more money to spend on cancer research and treatment if further progress in the fight against cancer is going to happen.

"The limiting step for more progress against this beast called cancer is funding," Caligiuri said. "The data clearly show that when we have the funding, we can make phenomenal progress."

Diagnosing irritable bowel syndrome isn’t like diagnosing other diseases. Your doctor can’t take a swab or a vial of blood and test it to determine the problem. There is no single test that can point to IBS as the cause of your symptoms.

Instead, when you go to your doctor about IBS symptoms like diarrhea, constipation, abdominal pain, and stomach cramps, he has to rule out other conditions and then pay careful attention to your symptoms before giving you a diagnosis.

Diagnosing IBS “For years, anyone who had gastrointestinal symptoms that couldn’t be explained was told they had IBS,” says Steven Field, MD, a gastroenterologist and clinical assistant professor of medicine at New York University School of Medicine in New York City. But now doctors use the "Rome criteria," which are a specific set of symptoms that have to be present in order to give a diagnosis. In addition, the criteria designate red-flag symptoms that don’t point to IBS, he says.

Giving your doctor detailed information about your symptoms and when you experience them will go a long way toward getting an accurate diagnosis. Here’s what your doctor considers before he makes a diagnosis:

Laboratory tests to rule out other conditions. To make sure something other than IBS isn’t causing your symptoms, your doctor may run blood tests, test your stool sample, order an X-ray, or perform a colonoscopy (a procedure in which your doctor uses a small flexible camera to look inside your colon).

Your symptoms. Under the Rome criteria, a diagnosis of IBS can be made if you have had abdominal pain during at least 12 weeks during a 12-month period, even if those 12 weeks aren’t consecutive, and if you experience two of these three things:

• A bowel movement that causes the abdominal pain to go away
• A change in the frequency of your bowel movements
• A change in your stool’s appearance (it becomes hard and lumpy or loose and watery

Other signs of IBS include mucus in your stool, a swollen abdomen, an urgency to have a bowel movement, having trouble passing stool, or a feeling that your bowel isn’t empty after going to the bathroom.

If you have red flag symptoms. Your doctor will also be looking for red-flag symptoms that aren’t associated with IBS, Dr. Field says. Those include: 

• Blood in your stool
• Fever
• Unexplained weight loss
• Pain or diarrhea that’s so intense it wakes you up when you’re asleep
• What triggers your symptoms. The factors that bring on your symptoms are another clue as to whether or not you have IBS. Eating such items as fried and greasy foods, caffeine, dairy products, chocolate, alcohol, and carbonated drinks often trigger symptoms, but the exact food triggers are different for everyone. Large meals may also trigger IBS symptoms.

Stress — which can result from major life changes such as getting married or getting a new job — is also a major trigger for IBS symptoms, Field says. And for women, symptoms are usually more severe during their menstrual period, possibly because of the effect of hormones on IBS.

The bottom line: Giving your doctor detailed information about your symptoms and knowing what triggers them will help with your diagnosis. Many doctors recommend keeping a food diary to determine exactly what brings on your symptoms and sharing that information with your doctor to make a better diagnosis and get you the right treatment.

By Marie Suszynski | Medically reviewed by Cynthia Haines, MD

Diabetis

People with depression tend to die earlier than expected -- a pattern that has grown stronger among women in recent years, new research finds.

The study followed thousands of Canadian adults between 1952 and 2011. Overall, it found people with depression had a higher death rate versus those without the mood disorder.

The link only emerged among women starting in the 1990s. Yet by the end of the study, depression was affecting men's and women's longevity equally.

The findings do not prove that depression itself shaves years off people's lives, said lead researcher Stephen Gilman.

The study could not account for the effects of physical health conditions, for example.

"So one explanation could be that people with depression were more likely to have a chronic condition," said Gilman, of the U.S. National Institute of Child Health and Human Development.

RELATED: Can 'Magic Mushrooms' Kick-Start Depression Treatment?

But even if that were true, he added, it would not mean that depression bears no blame -- because depression can take a toll on physical health.

"Many studies have found that people with depression have higher risks of heart disease and stroke, for example," Gilman said.

The findings are based on 3,410 Canadian adults who were followed for up to several decades. The first wave of participants was interviewed in 1952, the next in 1970, and the final in 1992.

At each wave, roughly 6 percent of adults had depression, based on a standard evaluation.

And on average, those people had a shorter life span. For example, a 25-year-old man who was depressed in 1952 could expect to live another 39 years, on average. That compared with 51 years for a man without depression.

Men with depression at any point had a higher risk of dying over the coming years, versus those free of the disorder.

The picture was different for women, though. The connection between depression and mortality only surfaced in the 1990s.

Women with depression at that point were 51 percent more likely to die by 2011, compared with other women. That brought their risk on par with depressed men.

The reasons are unclear. "Why would depression be less toxic to women at one time point than another?" Gilman said.

He speculated that societal shifts have some role. Women in recent decades have been much more likely to juggle work and home life, or be single mothers, for example.

Another possibility, Gilman said, is that women tend to suffer more severe depression these days.

There was some evidence that the impact of depression lessened over time. Men with depression in 1952 no longer showed a higher death risk after 1968, for example -- unless they also had depression at the later interviews, too.

As for causes of death, there was no evidence that suicides explained the risks among people with depression.

"There were actually few suicides," Gilman said. "People with depression died of the same causes that other people did -- like cardiovascular disease and cancer."

Dr. Aaron Pinkhasov is chairman of behavioral health at NYU Winthrop Hospital in Mineola, N.Y.

He said depression can indirectly shorten life span in a number of ways. Depressed people are less able to maintain a healthy lifestyle, and are more vulnerable to smoking and drinking. They may also be less equipped to manage any physical health conditions.

"Once depression sets in, you may not have the motivation or energy," said Pinkhasov, who was not involved with the research.

Gilman said his study can't say whether treating depression erases the higher death risk associated with it.

But, Pinkhasov said, there is evidence that depression treatment can help people better control high blood pressure and diabetes, for example.

He stressed that there are various effective treatments -- from "talk therapy" to medication.

"Don't blame yourself for being 'weak,' or tell yourself you should just snap out of it," Pinkhasov said.

John Hamilton, a counselor at Mountainside Treatment Center in Canaan, Conn., agreed.

He said that women, in particular, can have a "sense of shame" over mental health symptoms in part because they feel they need to be the rock of the family. "They might even have people around them saying, 'Snap out of it, you have kids,'" said Hamilton, who also had no role in the study.

"But depression is no different from any other chronic disease," he said. "We need to have a compassionate, nonjudgmental approach to it."

The results were published Oct. 23 in the journal CMAJ.

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Overview

What is hepatitis?

“Hepatitis” means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver; the most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?

Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

What is Hepatitis C?

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.”

Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection.

Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

Statistics

How common is acute Hepatitis C in the United States?

In 2014, there were an estimated 30,500 cases of acute hepatitis C virus infections reported in the United States.

How common is chronic Hepatitis C in the United States?

An estimated 2.7-3.9 million people in the United States have chronic hepatitis C.

How likely is it that acute Hepatitis C will become chronic?

Approximately 75%–85% of people who become infected with Hepatitis C virus develop chronic infection.

Transmission / Exposure

How is Hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.

People can become infected with the Hepatitis C virus during such activities as

• Sharing needles, syringes, or other equipment to inject drugs
• Needlestick injuries in health care settings
• Being born to a mother who has Hepatitis C

Less commonly, a person can also get Hepatitis C virus infection through

• Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
• Having sexual contact with a person infected with the Hepatitis C virus

Can Hepatitis C be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.

Can you get Hepatitis C by getting a tattoo or piercing?

A few major research studies have not shown Hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of Hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is needed to determine if these types of settings and exposures are responsible for Hepatitis C virus transmission.

Can Hepatitis C be spread within a household?

Yes, but this does not occur very often. If Hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

How should blood spills be cleaned from surfaces to make sure that Hepatitis C virus is gone?

Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.

How long does the Hepatitis C virus survive outside the body?

The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks.

What are ways Hepatitis C is not spread?

Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Who is at risk for Hepatitis C?

Some people are at increased risk for Hepatitis C, including:

• Current injection drug users (currently the most common way Hepatitis C virus is spread in the United States)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile instruments
• People with known exposures to the Hepatitis C virus, such as
  • Health care workers injured by needlesticks
  • Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
• HIV-infected persons
• Children born to mothers infected with the Hepatitis C virus

Less common risks include:

• Having sexual contact with a person who is infected with the Hepatitis C virus
• Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

What is the risk of a pregnant woman passing Hepatitis C to her baby?

Hepatitis C is rarely passed from a pregnant woman to her baby. About 6 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.

Can a person get Hepatitis C from a mosquito or other insect bite?

Hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood, organs, or semen if I have Hepatitis C?

No, if you ever tested positive for the Hepatitis C virus (or Hepatitis B virus), experts recommend never donating blood, organs, or semen because this can spread the infection to the recipient.

Symptoms

What are the symptoms of acute Hepatitis C?

Approximately 70%–80% of people with acute Hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellow color in the skin or eyes)

How soon after exposure to Hepatitis C do symptoms appear?

If symptoms occur, the average time is 6–7 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people infected with the Hepatitis C virus do not develop symptoms.

Can a person spread Hepatitis C without having symptoms?

Yes, even if a person with Hepatitis C has no symptoms, he or she can still spread the virus to others.

Is it possible to have Hepatitis C and not know it?

Yes, many people who are infected with the Hepatitis C virus do not know they are infected because they do not look or feel sick.

What are the symptoms of chronic Hepatitis C?

Most people with chronic Hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.

How serious is chronic Hepatitis C?

Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 19,000 people die every year from Hepatitis C related liver disease.

What are the long-term effects of Hepatitis C?

Of every 100 people infected with the Hepatitis C virus, about

• 75–85 people will develop chronic Hepatitis C virus infection; of those,
  • 60–70 people will go on to develop chronic liver disease
  • 5–20 people will go on to develop cirrhosis over a period of 20–30 years
  • 1–5 people will die from cirrhosis or liver cancer

Tests

Can a person have normal liver enzyme (e.g., ALT) results and still have Hepatitis C?

Yes. It is common for persons with chronic Hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6–12 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.

Who should get tested for Hepatitis C?

Talk to your doctor about being tested for Hepatitis C if any of the following are true:

• You were born from 1945 through 1965
• You are a current or former injection drug user, even if you injected only one time or many years ago.
• You were treated for a blood clotting problem before 1987.
• You received a blood transfusion or organ transplant before July 1992.
• You are on long-term hemodialysis treatment.
• You have abnormal liver tests or liver disease.
• You work in health care or public safety and were exposed to blood through a needlestick or other sharp object injury.
• You are infected with HIV.

If you are pregnant, should you be tested for Hepatitis C?

No, getting tested for Hepatitis C is not part of routine prenatal care. However, if a pregnant woman has risk factors for Hepatitis C virus infection, she should speak with her doctor about getting tested.

What blood tests are used to test for Hepatitis C?

Several different blood tests are used to test for Hepatitis C. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person's bloodstream.

Treatment

Can acute Hepatitis C be treated?

Yes, acute hepatitis C can be treated. Acute infection can clear on its own without treatment in about 25% of people. If acute hepatitis C is diagnosed, treatment does reduce the risk that acute hepatitis C will become a chronic infection. Acute hepatitis C is treated with the same medications used to treat chronic Hepatitis C. However, the optimal treatment and when it should be started remains uncertain.

Can chronic Hepatitis C be treated?

Yes. There are several medications available to treat chronic Hepatitis C, including new treatments that appear to be more effective and have fewer side effects than previous options. The Food and Drug Administration (FDA) maintains a complete list of approved treatments for Hepatitis C.

Is it possible to get over Hepatitis C?

Yes, approximately 15%–25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

What can a person with chronic Hepatitis C do to take care of his or her liver?

People with chronic Hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.

Vaccination

Is there a vaccine that can prevent Hepatitis C?

Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.

Hepatitis C and Employment

Should a person infected with the Hepatitis C virus be restricted from working in certain jobs or settings?

CDC's recommendations for prevention and control of the Hepatitis C virus infection state that people should not be excluded from work, school, play, child care, or other settings because they have Hepatitis C. There is no evidence that people can get Hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact.

Hepatitis C and Co-infection with HIV

What is HIV and Hepatitis C virus coinfection?

HIV and Hepatitis C virus coinfection refers to being infected with both HIV and the Hepatitis C virus. Coinfection is more common in persons who inject drugs. In fact, 50%–90% of HIV-infected persons who use injection drugs are also infected with the Hepatitis C virus. To learn more about coinfection, visithttp://www.cdc.gov/hiv/resources/factsheets/hepatitis.htm.

Depression often feeds a substance abuse problem, but the opposite may also be true. Find out just how intertwined these two conditions are.

Mood disorders, like depression, and substance abuse go together so frequently that doctors have coined a term for it: dual diagnosis. The link between these conditions is a two-way street. They feed each other. One problem will often make the other worse, according to the Anxiety and Depression Association of America (ADAA).

About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder, the ADAA reports.

Compared with the general population, people addicted to drugs are roughly twice as likely to have mood and anxiety disorders, and vice versa, according to the National Institute on Drug Abuse (NIDA).

The Shared Triggers of Depression and Substance Abuse

When it comes to substance abuse and depression, it isn't always clear which one came first, although depression may help predict first-time alcohol dependence, according to a study published in 2013 in the Journal of Clinical Psychiatry.

The conditions share certain triggers. Possible connections between depression and substance abuse include:

The brain. Similar parts of the brain are affected by both substance abuse and depression. For example, substance abuse affects brain areas that handle stress responses, and those same areas are affected by some mental disorders.
Genetics. Your DNA can make you more likely to develop a mental disorder or addiction, according to research published in 2012 in Disease Markers. Genetic factors also make it more likely that one condition will occur once the other has appeared, NIDA reports.
Developmental problems. Early drug use is known to harm brain development and make later mental illness more likely. The reverse also is true: Early mental health problems can increase the chances of later drug or alcohol abuse.
The Role of Environment

Environmental factors such as stress or trauma are known to prompt both depression and substance abuse.

Family history is another factor. A study published in the Journal of Affective Disorders in 2014 found that a family history of substance abuse is a significant risk factor for attempted suicide among people with depression and substance abuse.

These types of dual diagnosis may also be traced back to a time in early life when children are in a constant process of discovery and in search of gratification, according to David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and president of the New York Institute for Psychoanalytic Self Psychology.

RELATED: 6 Depression Symptoms You Shouldn’t Ignore

Any interruption or denial of this natural discovery process can manifest clinically and lead people to believe that everything they feel and think is wrong, he explains.

This idea, which Dr. MacIsaac says is based on the work of Crayton Rowe, author of the book Empathic Attunement: The 'Technique' of Psychoanalytic Self Psychology, challenges the idea that people dealing with depression try to self-medicate using drugs or alcohol. In fact, people with a dual diagnosis may be doing just the opposite, MacIsaac suggests.

"Individuals who are severely depressed drink to feed this negativity," he explains. "Initially it's soothing, but only for about 15 minutes. After that individuals sink deeper and deeper and feel worse than they did before."

For these people, MacIsaac points out, negativity is "where they get their oxygen." Any inclination that treatment is working will trigger a need to go back into the black hole of negative discovery, and alcohol will intensify their depression, he adds.

Why Simultaneous Treatment Is Important

Successful recovery involves treatment for both depression and substance abuse. If people are treated for only one condition, they are less likely to get well until they follow up with treatment for the other.

If they are told they need to abruptly stop drinking, however, depressed people with a substance abuse problem may be reluctant to undergo treatment, MacIsaac cautions. "They cling to drinking because they are terrified of losing that negativity," he says.

People with dual diagnoses must understand the root of their issues on a profound level, MacIsaac says. Once they understand, he says, they may have the ability to change. Treatment for depression and substance abuse could involve therapy, antidepressants, and interaction with a support group.

If you think you need treatment but are unsure where to start, the American Psychological Association provides the following suggestions:

Ask close friends and relatives whether they have recommendations for qualified psychologists, psychiatrists, or other mental health counselors.
Find out whether your state psychological association has a referral service for licensed mental health professionals.

Carolyn Jacob, MD, director of Chicago Cosmetic Surgery and Dermatology, doesn’t just treat patients with psoriasis — she manages her own. Dr. Jacob has been living with psoriasis since she was 14 years old.

Jacob’s psoriasis primarily affects her scalp and nails, both of which can be tough to hide. “I hated it when I had scalp involvement, which would show flakes on my clothing and itch constantly,” Jacob says.

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Embarrassed about her nail psoriasis, Jacob used to paint them a color that would mask her symptoms. The National Psoriasis Foundation says that about half of all people with psoriasis will have symptoms affecting the nails, which can include changes in color, thickening of the nails, separation of the nail, and the formation of pits or holes.

An Accessible Skin Care Routine

For healthy skin, Jacob knows she has to keep her skin clear and moisturized as much as possible. She uses CeraVe cleanser, available at many drugstores. “It adds ceramides to the skin, which help to rebalance the natural moisturizing factor in your skin,” she says. She follows that up with CeraVe lotion.

Other daily psoriasis treatment tips that Jacob offers her patients and practices herself include:

• Cleanse and moisturize your skin just once daily to avoid drying.
• Use a soft cloth or your hands to lather up with cleanser; never use a loofah on skin that’s actively flaring because the rubbing and scratching could worsen symptoms.
• If you have psoriasis on your face, Jacob advises against using harsh toners because they can be aggravating.
• During the frigid Chicago winters, Jacob switches to a cream or moisturizing cream from a lighter lotion because it’s more hydrating for thirsty winter skin.
• For scalp psoriasis, she recommends over-the-counter favorites like Neutrogena T/Gel, DHS tar shampoos, or those containing salicylic acid (her personal pick is Neutrogena T/Sal.) For something stronger, she likes Clobex, a steroid shampoo that you can get with a prescription from your dermatologist.

When Jacob’s psoriasis flares, she turns to a prescription Avène product called Akérat cream because it contains exfoliators and softeners to soothe the skin.

Daily Psoriasis Treatment Starts from the Inside Out

Jacob knows that psoriasis and its treatments are more than just skin deep. She sticks to a healthy, balanced diet to help keep inflammation down and her symptoms in check. She eats salmon and walnuts for the omega-3 fatty acids, which can help reduce inflammation and promote better heart health. Jacob also takes omega-3 supplements for an extra boost. “They are great for inflammatory conditions, especially psoriasis, and they help balance cholesterol levels and improve your skin texture,” she explains. The heart-healthy supplements can prove particularly beneficial since people with psoriasis have a 58 percent greater chance of suffering a major cardiovascular event like a heart attack, according to the National Psoriasis Foundation.

Stress is also a trigger for psoriasis, so Jacob tries to keep it in check, particularly by exercising. With twin toddlers and a busy schedule, she has to make time to work out. How does she fit it in? “I get up early to exercise so it is done for the day,” she says. It’s a prudent strategy that’s backed by a study from the August 2012 issue of Archives of Dermatology, which found that women who engaged in regular vigorous exercise were less likely to develop psoriasis.

Another of Jacob’s secrets: avoiding alcohol. “It makes stress worse and makes psoriasis worse,” she says. The National Psoriasis Foundation notes that alcohol can interfere with psoriasis treatments and causes side effects when combined with many psoriasis medications. Plus, alcohol can change the way you perceive and manage your stress, according to the National Institute on Alcohol Abuse and Alcoholism.

Find What Works for You

Jacob’s psoriasis is now well controlled with biologic medications, and she says her skin, scalp, and nails stay pretty healthy. Her best advice? Work with your dermatologist to find the right treatment for you.

“The availability of biologic medications was life changing — to not have to deal with other messy medicines that do not work well, to not itch, and to have normal nails is wonderful,” she says. “This type of treatment makes me feel like a normal person again!”

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With the news of SurveyMonkey CEO David Goldberg's accidental death on a treadmill, we are reminded that there are risks to exercise, particularly when using gym equipment. Because a treadmill is powered by a motor, rather than self-propelled, accidents can happen, especially when people lose their balance. Injuries can include bruises, sprains, broken bones, concussions, and sometimes, even death. 

While the Consumer Products Safety Commission reported over 24,000 emergency room visits associated with treadmills in the United States in 2014, deaths are rare. That said, it's important for people to know their physical limits and keep safety in mind when using a treadmill.

Beauty

A new study cast doubts on the existence of seasonal depression -- a mood disorder linked to reduced sunlight in the winter months.

This form of depression -- known as seasonal affective disorder (SAD) and recognized by the mental health community for nearly 30 years -- "is not supported by objective data," the new study claims.

Depression comes and goes, said study lead researcher Steven LoBello. If someone experiences depression in the fall and winter, "it doesn't mean that seasonal changes have caused the depression," added LoBello, a professor of psychology at Auburn University at Montgomery, Ala.

For the study, LoBello and colleagues used data from a telephone survey of more than 34,000 U.S. adults asked about depression and then gathered information on time of year, latitude and more when measuring depression.

LoBello noted the study found no evidence that symptoms of depression were season-related and said, "If this seasonal pattern of depression occurs at all, it may be fairly rare."

Dr. Matthew Lorber, acting director of child and adolescent psychiatry at Lenox Hill Hospital in New York City, also said that seasonal affective disorder may not be a "legitimate diagnosis."

Big drug companies, Lorber said, pushed to have SAD recognized as a standard diagnosis. "It then allowed them to market to a new population to use their medications. That was a motivating factor in creating this disorder," said Lorber, who wasn't involved in the new study.

LoBello thinks the seasons have no place in the diagnosis of depression, and he would like to see these criteria discontinued.

His reasoning? Assuming a cause that isn't accurate may lead patients to pursue treatments that won't deliver relief, LoBello said.

According to the new report, published Jan. 20 in Clinical Psychological Science, seasonal affective disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the bible of psychological diagnosis -- in 1987.

RELATED: Why Depression Is Underreported in Men

LoBello isn't the first to explore the validity of this diagnosis.

Kelly Rohan, an associate professor of psychology at the University of Vermont, has done her own research on seasonal depression and found "no season differences in reports of depressive symptoms."

"I certainly did not argue that this means SAD does not exist," she said. "However, only a minority of depression cases are actually SAD."

So, how come other research has found that a significant percentage of the public suffers from this condition? (The American Academy of Family Physicians says up to 6 percent of U.S. adults have winter depression, and as many as one in five have mild SAD symptoms).

It all depends on how the studies are done and how the questions are asked, Rohan said. "Also, SAD depressive symptoms tend to be less severe than in nonseasonal major depression and mood tends to be back to normal in the spring and summer," she said. "So when you take all the depressed people in this sample -- including the minority that claims to be SAD -- and look at seasonal differences in their depression scores, I am not surprised that it is a wash."

For the study, LoBello and colleagues used the 2006 Behavioral Risk Factor Surveillance System. The 34,000-plus respondents had been asked about the number of days they felt depressed in the past two weeks. The researchers matched these responses with the location of each person and the day, month, latitude and amount of sun exposure when interviewed.

People who responded to the survey in the winter months, when sunlight exposure was low, had no greater levels of depressive symptoms than those who responded to the survey at other times, the researchers said.

In addition, the researchers found no evidence for seasonal differences in mood when they zeroed in on more than 1,700 participants with clinical depression.

People with sleep apnea are at increased risk for depression, but continuous positive airway pressure (CPAP) therapy for their apnea may ease their depression, a new study suggests.

The Australian study included 293 men and women who were newly diagnosed with sleep apnea. Nearly 73 percent had depression when the study began. The worse their apnea, the more severe their depression.

However, after three months, only 4 percent of the 228 apnea patients who used CPAP for an average of at least five hours a night still had clinically significant symptoms of depression.

At the start of the study, 41 patients reported thinking about harming themselves or feeling they would be better off dead. After three months of CPAP therapy, none of them had persistent suicidal thoughts.

The study appears in the September issue of the Journal of Clinical Sleep Medicine.

"Effective treatment of obstructive sleep apnea resulted in substantial improvement in depressive symptoms," including suicidal thoughts, senior study author Dr. David Hillman said in a journal news release. Hillman is a clinical professor at the University of Western Australia and a sleep physician at the Sir Charles Gairdner Hospital in Perth.

RELATED: 6 Things People With Sleep Apnea Wish You Knew

"The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression," he added.

People with symptoms of depression should be screened for sleep apnea by being asked about symptoms such as snoring, breathing pauses while sleeping, disrupted sleep and excessive daytime sleepiness, the researchers said.

Sleep apnea affects at least 25 million American adults. Untreated sleep apnea increases the risk of high blood pressure, heart disease, stroke, type 2 diabetes and depression, according to the American Academy of Sleep Medicine.

1 / 11   Boost Your Mood With Seasonal Bounty
It’s winter, and depending on where you live, it could be very cold and gray, with sunshine in short supply. The winter doldrums plus holiday high anxiety make this season especially stressful and depressing for many people. But you might be able to eat your way to a better mood. Load your plate with these winter foods for depression to lift your spirits.

People who live with constant road noise may face a higher risk of developing depression, researchers say.

The risk was about 25 percent higher for people living in areas with a lot of traffic, compared to those living in areas with little road noise. However, the risk was largely confined to those who were poor, unemployed, had limited education, smoked or had insomnia, the German study authors found.

"Although we can't say for sure, it has been thought that noise causes stress and annoyance," said lead researcher Ester Orban, of the Center for Urban Epidemiology at University Hospital Essen.

"If this noise persists over a long time and is constant and loud, it may contribute to depression," she said.

Orban cautioned that these findings only show that road noise is associated with depression, not that it causes depression. "Road noise seems to play a role, but I wouldn't talk about causality," she explained.

RELATED: How the Street You Live On May Harm Your Health

Orban said there are some simple things people can do to reduce their exposure to traffic noise, short of moving.

"If you feel annoyed by traffic noise you can use earplugs, and if traffic noise is disturbing your sleep, choose a bedroom away from the busy road," she suggested.

The report was published online Nov. 25 in the journal Environmental Health Perspectives.

For the study, Orban and her colleagues collected data on more than 3,000 people, aged 45 to 75, who took part in the Heinz Nixdorf Recall study. The study participants were followed for an average of five years.

Depressive symptoms include feeling lonely, sad, depressed, having trouble concentrating or feeling like a failure.

Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said this study adds to existing evidence that traffic noise is linked to an increased risk of depressive symptoms.

"This is not surprising, as we already have extensive evidence that noise is associated with both stress and heart disease," he said.

Given that depression is common worldwide and can have a negative effect on individuals and society, and given that its cause is complex, it's important to examine everything that may play a role, including environment and how it interacts with psychological, social and biological factors, Rego said.

Those with a low socioeconomic status and sleep disturbances may be particularly vulnerable to noise effects, he added.

"This suggests that, along with targeting biological factors with medications and psychological factors with treatments such as cognitive behavioral therapy, interventions may also be aimed at targeting environmental factors," Rego said.

Targeting environmental factors includes both individual and societal approaches, he added.

On an individual level, helping patients get a good night's sleep with better sleep practices may help lower the odds of depression, Rego said.

"On a larger scale, communities can work on improving urban planning to address traffic noise in order to help treat depression or perhaps even prevent it," he added.

Slower deterioration seen in people with more satisfying relationships, researchers say.

Loneliness and depression are linked to an increased risk of mental decline in the elderly, a new study suggests.

Researchers analyzed data from more than 8,300 American adults aged 65 and older who were assessed every two years between 1998 and 2010. Seventeen percent reported loneliness at the beginning of the study, and half of those who were lonely had depression.

Over the course of the study, mental decline was 20 percent faster among the loneliest people than among those who weren't lonely. People who were depressed at the start of the study also had faster mental decline.

However, lower mental function did not lead to worsening loneliness, according to the study scheduled for presentation Monday at the Alzheimer's Association International Conference in Washington, D.C. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

RELATED: The Health Risks of Loneliness 

"Our study suggests that even one or two depressive symptoms -- particularly loneliness -- is associated with an increased rate of cognitive decline over 12 years," study author Dr. Nancy Donovan said in an association news release. She is a geriatric psychiatrist at Brigham and Women's Hospital in Boston and an instructor in psychiatry at Harvard Medical School.

"We found that lonely people decline cognitively at a faster rate than people who report more satisfying social networks and connections. Although loneliness and depression appear closely linked, loneliness may, by itself, have effects on cognitive decline," she explained.

This is important to know for the development of treatments to enhance mental health and quality of life for older adults, she added.

The new study suggested a link between loneliness, depression and heightened risk of mental decline, but it did not prove cause-and-effect.

Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.

 tend to happen annually, at about the same time every year. This period is commonly referred .

However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.

For most people, a bout of flu is an unpleasant but short-lived illness.

For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.

Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.

The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.

One of the realities of 2014 is that when a baby is born, he or she has already been exposed to toxic chemicals. The evidence is in umbilical cords, which research has confirmed contain pesticides, waste from burning coal and gasoline, and garbage. Even if you try to do everything right (eat organic, buy natural products, live in a cabin in the middle of the woods, etc.), you can’t avoid all of the chemicals that have become pervasive.

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Bruce Lourie and Rick Smith researched the dominance of these chemicals while writing their first book, Slow Death by Rubber Duck: How the Toxic Chemistry of Everyday Life Affects Our Health (2009), which took a look at everyday items, including canned food, pajamas, Tupperware, and rubber ducks, that put toxins into our bodies. Their readers bombarded them with a simple question: If all this stuff is inside us, how do we get it out?

So the two authors, armed with Smith’s PhD in biology and collective decades working in the environmental field (Smith's the executive director of the Broadbent Institute and Lourie is the president of the Ivey Foundation), went out again to determine what actually worked to get toxins out of the body. Through a series of self-designed experiments on themselves and others, they take readers through their journey in Toxin Toxout: Getting Harmful Chemicals Out of Our Bodies and Our World.

Here are some key facts they learned about what actually matters when it comes to detoxing:

1. Chemicals are everywhere, but you don’t have to worry about all of them.Not all chemicals are actually going to damage us, Laurie said, and people have different tolerance to chemicals (though you may find that out the hard way). Some chemicals are disappearing from our lives (DDT, dioxin, lead) because of awareness of their dangers. “I joke sometimes that I’m a worrier, and I carry around a worry list with me,” Smith said. “In the book, we tried to come up with a short worry list.” The list included phthalates, BPA, pesticides, methyl paraben, triclosan, sodium lauryl sulphatel, and metals that can be harmful when they accumulate, such as aluminum, tin, and mercury. Yes, that’s still a long (and confusing) list, but there are some simple ways to avoid or eliminate them.

2. Avoid some toxins by shopping natural. Chemicals don’t just get into our bodies through what we eat — they come in through what we slather on our skin, what furniture we sit on, and what we breathe. While reporting for the book, Smith measured his urine before and after simply sitting and breathing in a new Chevy Tahoe for eight hours, and found that doing so had elevated his body's levels of four chemicals from the worry list. So shop smart (and roll down the windows when driving). “When you’re making a purchase, be it a cosmetic, a shampoo, or a new sofa, ask ‘Is this the most natural thing I could buy?’” Lourie said. Read ingredient labels and look up the ones you can’t pronounce. Do your research and check out eco-certifications before making big purchases like sofas or cars to see which, like the Tahoe, are made with dangerous chemicals. 

RELATED: 6 Easy Green Beauty Swaps

3. Organic is actually better, if you want to avoid pesticides. Recent research — particularly one study from Stanford that concluded organic produce doesn’t have more nutrients — has ignored the intended benefit of going organic, Smith and Lourie argue. Organic farming isn’t necessarily meant to yield more nutrient-dense food. It’s meant to make food that won’t contain excessive pesticides. (Yes, it may have traces of pesticides, because almost everything does. Remember the umbilical cords?) Smith and Laurie asked nine kids who hadn’t eaten organic before to eat an all-organic diet for five days while giving urine samples. The urine samples showed the switch yielded a big drop in pesticide levels. “Once people start eating organic food, pesticide reduction occurs in a matter of hours,” Smith said.

4. It’s better to adjust your habits than to go through a cleanse.  One of the most basic things you can do to get toxins out of your body is to drink more water. Another is to eat less animal fat and more (preferably organic) fruits and vegetables. But is the best way to do that a four-day juice cleanse? Probably not, say Smith and Laurie. "'Cleanse' makes it sound like it’s a special thing,” Lourie said. “If you’re eating more vegetables and drinking plenty of water, and you want to put the vegetables in the water, that’s a good thing to do. Just don’t be mistaken that if you do that for four days out of the year, you’re going to be detoxing your body — it doesn’t work that way.” It’s much better to incorporate fruits, veggies, and water into your daily diet.

5. Embrace sweat — and saunas. Toxins enter your body through what you eat, breathe and touch, and they go out the same way, through breath, digested food and drink, and sweat. While exhaling and urinating are pretty non-negotiable, a lot of us are engaged in a war against sweat. “We’re really confused as to what clean smells like,” Jessa Blades, an eco-blogger, tells the authors in the book.Antiperspirants and some deodorants prevent us from sweating out toxins while using toxic metals to keep the sweat in, a “double toxic whammy” Smith said. Lourie even admitted that he’s stopped using deodorant. Even if you change or quit your antiperspirant, you should try to sweat more, too. You can do this by exercising more or by using saunas to “detox through heavy sweating,” Lourie said. You’ll also end up drinking more water, which is good for eliminating toxins.

6. Be wary of fat. Fat holds on to toxins, which is part of the reason chemicals like DDT still hang around our systems. So if you’re eating lots of animal fat, you’re also eating the chemicals that the animal fat is holding. Then, you’re probably also putting on weight and thus adding fat to your body, which will hold on to those chemicals. “It’s a positive feedback loop,” Lourie said. In fact, if you’re worried about toxins and you’re overweight, losing that extra body fat should be the first step toward reducing the toxins in your body.

7. Push companies to do the right thing, and support regulation of toxins.“Only part of the solution to this problem is being a more careful consumer,” Smith said. ‘The other part is to be a more engaged citizen.” Remember when people learned that Subway bread contained a yoga mat chemical, and took to social media to demand that change? “Never has a company capitulated so quickly,” Smith said. It’s easier than ever to make your voice heard. 

1 / 10   Not All Milks Are Alike

The milk aisle is changing, and has a growing number of options for what to pour on your cereal or drink down as a late-night snack. But what do the newer types of milk mean for your heart health if you have high cholesterol? Old-fashioned cow’s milk, for example, is loaded with calcium and vitamins A and D, which are all good for your heart and overall health. But the saturated fat in whole milk — and even in 2 percent milk — may counteract those health benefits. When you're trying to get to healthy cholesterol levels, you'll want to limit the amount of saturated fat in your diet.

Alternative milks can provide similar nutritional benefits if you're lactose intolerant, allergic to certain proteins in cow’s milk, vegan, or simply prefer something other than cow's milk. “People choose a milk based on tolerability and taste — in addition to health beliefs,” says Deborah Krivitsky, RD, director of nutrition at the Cardiovascular Disease Prevention Center at Massachusetts General Hospital in Boston. “Each milk will provide different pluses and minuses.”

2 / 9   Use the Right Skin Care Products

When shopping for skin care products, there are three powerful ingredients you should look for to maintain youthful-looking skin, says Robinson. One, check the label for a serum containing antioxidants like vitamin C (Robinson likes Elizabeth Arden Prevage Anti-Aging Daily Serum), which will help brighten your skin; two, add retinoids, which increase cell turnover and stimulate collagen renewal, to your routine; and three, start using an alpha hydroxy acid exfoliator to remove the top layer of dead skin cells (Robinson is a fan of Peter Thomas Roth Un-Wrinkle Peel Pads, which are gentle enough to be used daily). 

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It's unclear what causes binge eating disorder.

Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.

Some risk factors for binge eating disorder include:

• A history of anxiety or depression
• A history of dieting (especially in unhealthy ways, such as skipping meals or not eating enough food each day)
• Painful childhood experiences, such as family problems

Symptoms of Binge Eating Disorder

People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.

Binge eating episodes are associated with three or more of the following:

• Eating much more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when you're not feeling hungry
• Eating alone, because you feel embarrassed about how much you're eating
• Feeling extremely disgusted, depressed, or guilty after eating

Some people also display behavioral, emotional, or physical characteristics, such as:

• Secretive food behaviors, including hoarding, hiding, or stealing food
• Feelings of anger, anxiety, worthlessness, or shame preceding a binge
• Feeling disgusted with your body size
• A strong need to be in control, or perfectionist tendencies

Binge Eating Disorder Treatment

If you have binge eating disorder, you should seek help from a specialist in eating disorders, such as a psychiatrist or psychologist.

There are several treatments available for BED. Treatment options may include:

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Even small skin traumas like a pimple or bug bite can leave you with complexion-busting dark spots. “This is one of the most common ailments that patients come to see me about,” explains Jeanine Downie, MD, director of Image Dermatology in Montclair, New Jersey. “It’s an annoying condition that affects all skin types, but the good news is that it’s fairly easy to treat.”

Find out how Dr. Downie helps patients treat and avoid marks on their complexions.

Everyday Health: What causes hyperpigmentation?

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Jeanine Downie: Any trauma or inflammation to the skin — either from acne, pimples, bug bites, or simply a bump, cut, or scratch — disrupts the surface layers where you have melanin, responsible for skin’s color. As the skin heals, it leaves behind residual pigmentation and dark spots.

EH: Is there anything you can do to prevent it?

JD: Unfortunately, if you’re prone to these dark spots, it’s tough to prevent them. Still, picking or scratching at an irritation will further traumatize the area, so hands off! You’ll also want to be vigilant about wearing sunscreen. As your skin gets darker, so will those hyperpigmented areas — it’s not like a tan is going to even out the color. Obviously, daily sunscreen wear is a must anyway, but this is just one more reason to protect your skin from UV rays.

EH: What steps can you take to treat it?

JD: The sooner you start taking care of your wound, the better it’ll look once healed. I recommend keeping the wound covered, especially if the skin is broken, and applying a topical healing ointment.

For large cysts or cuts, you may even want to see your dermatologist for a treatment plan. Once the pimple or cut has healed, apply 2% hydroquinone cream, which is available over-the-counter, or 4% hydroquinone, available by prescription from your doctor.

If the topical creams don’t quite do the trick, talk to your dermatologist about chemical peels or laser treatments to completely eliminate more stubborn discoloration.

EH: Is hyperpigmentation more common in people with darker complexions?

JD: No matter your skin color, everyone is susceptible to hyperpigmentation. Still, those with darker complexions seem to hold on to those spots for much longer because they have more melanin in their skin. It also means those hyperpigmented areas are going to be darker and more visible as well. Pregnancy and certain medications can increase your body’s production of melanin, and lead to hyperpigmentation as well.