Amir

Restlessness becomes a part of everyday life for a person with ADHD. Almost nothing holds a person’s attention for more than a few seconds. They want to read one moment but watch television the next. The hardest part of all is keeping still, as something deep inside urges them to keep moving. The individual does something first and then thinks of its consequences later. Their mind is a playground of a thousand thoughts, each overlapping with the other. These symptoms are common signs of ADHD (attention deficit hyperactivity disorder.) Websites like The Human Condition provide comprehensive information on the topic. How does it affect children and adults, and what are the ways of dealing with it? Read on to know.

Symptoms of ADHD in children and adults

ADHD present in childhood will most likely continue into adulthood. However, the three main factors are hyperactivity, inattention, and impulsivity. Children suffering from it are prone to fidgeting, talking excessively, being easily distracted, having trouble focusing on tasks, forgetting their daily tasks, constantly misplacing things, and failing to follow instructions. It manifests itself as forgetfulness, unpredictable behavior, inability to keep steady employment, anxiety, and chronic restlessness in adults.

What are the different types of ADHD?

There are three main types of attention deficit disorder. These are predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and combined presentation. The first one is characterized by an inability to complete any work or follow a daily routine. In the second one, an individual may fidget, talk at inappropriate times, snatch things and act out of impulsion. A person with the third type of disorder exhibits combined symptoms of the other two.

What are the causes of this disorder?

Extensive studies and research has shown that both genetic and non-genetic factors cause attention deficit disorder. Parents are thought to pass it on to their offspring, though the inheritance process is complex and can’t be linked to a single genetic fault. Individuals with this disorder have specific areas in their brains that are smaller than the other. Studies have noted an imbalance in the neurotransmitter levels in the brain. Other factors that cause extreme attention deficit are premature delivery, alcohol and tobacco use during pregnancy, low weight during birth, and exposure to toxins in the environment.

Is there a treatment for ADHD?

Treatment usually involves both medication and behavior therapy. However, for children between four to five years of age, behavior therapy is strongly recommended. It requires behavior management, including a system of rewards. Children are motivated to stick to a routine, follow instructions, organize the things around them when you reward them at the end. For adults, the therapy involves breaking down tasks, close monitoring, follow-ups, and medication. Medication for ADHD is divided into stimulants like methylphenidate, non-stimulants including guanfacine and antidepressants.

Dealing with ADHD in everyday life

Attention deficit disorder can have an enormous impact on an individual’s daily life, whether children or adults. Children can benefit from a healthy diet with plenty of fruits and vegetables, exercising regularly, creating a sleep-friendly routine, constantly motivating them, and planning the day thoroughly. Adults, too, can benefit a lot if they follow these steps religiously. In addition, they should also try to avoid multitasking, cutting off distractions like cell phones while driving, setting up reminders, and preparing to-do lists regularly.

These are some essential things that everybody should know about ADHD or attention deficit hyperactivity disorder. The more a person knows about it from sources like The Human Condition, the more it helps them deal with it effectively and seek timely help.

A balanced, healthy diet is not complete without some essential vitamins and minerals. If you want a healthy life, make sure your meal plan consists of plenty of fruits, vegetables and other main food groups! Or, to further safeguard your intake, consider taking specific vitamin supplements.

Vitamin supplements are of two types; multivitamins and individual vitamins. Before deciding which one to take, ensure you speak to a dietitian to access your nutritional needs. In this article, you’ll find your simple guide to different types of vitamins.

What are individual vitamins?

Dietitians typically prescribe individual vitamins to prevent or treat specific nutrient deficiencies. The term individual vitamins refer to vitamin supplements tailored to address a particular nutrient deficiency.

Dietitians often place people with vitamin deficiencies on restrictive diets that consist of individual vitamins. For example, people with a vitamin C deficiency take individual vitamin C supplements to correct the disorder.

Most common types of vitamins

There are 13 vitamins that are essential to your health. These vitamins produce enzymes and hormones that ensure the proper functioning of your nerves and organs. In addition to boosting your immunity, vitamins are essential for the growth, maintenance, and regulation of bodily processes.

Vitamins fall under two main categories; fat-soluble vitamins and water-soluble vitamins. There are four fat-soluble vitamins; vitamins A, D, E, and K. The remaining nine are vitamins that are water-soluble. This includes Vitamins C, B1, B2, B3, B5, B6, B7, B9, and B12.

What are multivitamins?

Multivitamins are supplements that contain varying amounts of vitamins and minerals. Sometimes, they have ingredients like fatty acids, amino acids, and herbs. Given that there isn’t a one-size-fits-all to multivitamins, their nutrient composition differs by brand and product.

The nutrients in multivitamins are often derived from natural or synthetic sources. Multivitamins are available in supermarkets, online stores, and pharmacies. They usually come in various forms, including chewable gummies, liquids, powders, capsules, and tablets. Keep in mind that some vitamin supplements may contain ingredients that can diminish the potency of medications.

Why take multivitamins?

The most significant reason why you should take multivitamins is to complement an unbalanced diet. As we mentioned earlier, multivitamins may not be suitable for everyone. Older adults may benefit from taking multivitamins that contain vitamin B12, calcium, and vitamin D. Similarly, vegans and vegetarians are susceptible to becoming deficient in vitamin B12, vitamin D, fatty acids, calcium, iron, and zinc because of their plant-based diets.

Dosage is a critical aspect to consider when taking multivitamins. While excessive intakes are suitable for some people, high amounts can be harmful to many others. Remember that you could exceed your recommended dosage by incorporating multivitamins and nutrient-dense foods into your meal plan. To mitigate excessive intake, ensure you consult a doctor to determine the appropriate dosage suitable for you.

Ovarian induction refers to using hormonal therapy to stimulate ovulation and increase the chances of pregnancy. It involves using drugs historically designed to stimulate ovulation in women who failed to ovulate independently, particularly women with irregular menstrual cycles. You can opt for ovarian induction independently or as an element of other assisted reproductive technologies like in vitro fertilisation and intrauterine insemination. Below is a complete history of ovarian induction.

• The discovery of gonadotropins and their influence on menstrual cycle regulation was the birth of reproductive endocrinology. In 1927, Ascheim and Zondek successfully isolated human chorionic gonadotropin (hCG) from pregnant women’s urine. In 1930, Cole and Hart discovered what is now known as pregnant mare serum gonadotropin (PMSG), leading to the birth of the technique of superovulation. Then methods were developed to superovulate young mice using PMSG and hCG to induce ovulation and estrus. It took 40 years for this technique to be described as an anovulation treatment in humans.
• Early studies that examined PMSG in women were complicated due to the development of antibodies to the gonadotropins, leading to treatment failure. In addition, some patients developed cross-reacting antibodies with their gonadotropins. As such, the development of methods for isolating and purifying human gonadotropins in quantities large enough was a huge milestone in the history of ovulatory dysfunction treatment and ovulation induction. Although experts at the time recognised that follicle-stimulating hormone (FSH) and luteinising hormone (LH) was present in the urine of menopausal women, the urine amount was too high and the extraction method too complicated for urine to be an acceptable source of human gonadotropin. Consequently, attention shifted to obtaining gonadotropins from the pituitary gland.
• Gemzell was the first person to report induction of ovulation using pituitary derived gonadotropins in 1958. Gemzell’s work was confirmed in the US in 1960 by Buxton and his colleagues at Yale University. In their work, induction ovulation was accomplished using pituitary extracts with FSH activity with hCG as a substitute for LH.
• Donini reported human gonadotropin extraction from human menopausal urine in enough quantities and later introduced HMG use for ovarian stimulation as an amenorrhea treatment. Although the extraction process development for urinary-derived gonadotropins offered a safer and easily accessible source of LH and FSH, the product’s purity was still low. Additionally, there were issues with the standardisation of doses from one batch to another. The desire for monotherapy with FSH alone led to Serono developing urinary FSH with less LH activity. This formulation was successful in patients with polycystic ovary syndrome and for superovulation in IVF.
• The first pregnancy that used recombinant human FSH was recorded in 1992 during ovarian stimulation for IVF. Subsequent studies then showed that low-dose FSH allowed safe stimulation of patients with PCOS. Recombinant FSH development offered good advantages to the urine-derived HMG at the time. However, it wasn’t until the development of high-performance liquid chromatography and immunoaffinity purification that urinary-derived gonadotropins could be obtained with fewer levels of copurified non-gonadotropin proteins. As such, this allowed for a dependable standard dose of combined human gonadotropins. Presently, there are many gonadotropin formulations for ovarian induction, recombinant FSH and LH, and combined gonadotropins obtained from the urine. As such, your fertility clinic has excellent flexibility in determining personalised stimulation protocols.

Ileana Hernandez of Manatt, Phelps & Phillips talks about healthcare fraud in the future.

Q: What do you think is one of the most overlooked areas for fraud in healthcare/medicine?

A: I think one of the most overlooked issues is people who commit fraud in Medicare Part D because there are so many prescription drugs being dispensed. I think that’s an area that very few people are looking at.

Q: What is the next big issue, besides the opioid crisis, where healthcare fraud will possibly be happening?

A: Well, I think we’re going to see a lot in the area of hospital contracts and whether or not hospitals are overcharging patients. There is also the issue of patient dumping—when there is no community care available, and hospitals will either take patients in even if they don’t have insurance, or their only option is to put them on a gurney and wheel them out of the hospital onto the street or leave them at a bus stop. So that’s also going to be an area where we’re going to see more litigation.

Q: What is the future of healthcare fraud? How do you think it will change over time?

A: I think we’re going to see a rise in whistleblower cases. In 2016, the Department of Justice recovered more than $3 billion from whistleblowers—more than double all of the recoveries from health care fraud. I think that’s an indication that people are becoming aware, and they know there is a whistleblower reward out there for them if they will step up and do the right thing. In addition, I think we’re going to see an increase in self-reporting—companies taking a look at their contracts and seeing whether they are overcharging.

Q: What is your opinion on healthcare fraud? Has it changed since you became a partner with Manatt? If so, how so?

A: I still think it’s underreported because people aren’t aware enough to know what the issues are or how they can get involved. People should be mindful of their healthcare, but there are things out there, like whistleblowers, to help you expose fraud.

Q: Any predictions for the future?

A: I think the next big area will be medical devices, such as hip and knee replacements. We’re going to see those cases increase and the trend of whistleblowers coming forward with those things.

Q: Any advice for people who are committing fraud in healthcare?

A: I would tell them to stop, step back and take a look at what they’re doing. Usually, people don’t mean to do anything wrong; it is business as usual for them, and no one thinks of the consequences. But, on the other hand, people should know there are consequences, and prosecutors are looking to make examples out of people.

Q: What more can be done to combat healthcare fraud?

A: The government has been making great strides in the last couple of years; I think we’ve seen this with the Affordable Care Act, and it is just going to continue. People should know they have the right to report information if they see something that doesn’t seem right. The government has significant resources to help people step forward—they should take advantage of it.

Q: What are the typical types of fraud in healthcare?

A: It can be billing, claims, drugs, medical devices…anything related to health care. I think that is what makes it so difficult because there are so many elements out there, and it is so easy to get caught up in the day-to-day operations and forget about what they’re doing. I think that’s why we see so many people getting caught up in this—it was just part of their job, and they didn’t know about it.

One of the most significant legal issues facing the health care industry today is not a specific case or statute but rather an ongoing “perfect storm” that will affect nearly every company in various ways. This onslaught includes several sweeping new requirements and restrictions imposed by numerous federal and state statutes, regulations, and court opinions. That perfect storm is the opioid crisis and litigation that is resulting from it.

The opioid crisis and the corresponding legal and political response will affect health care in many ways. One of the groups that will be most affected is chronic pain sufferers who rely on the services of pain management physicians to make their lives manageable.

Attorney Ken Julian of Manatt, Phelps & Phillips LLP, who is widely acknowledged as one of California’s leading white-collar criminal defense litigators and an authority on health care, believes that the opioid crisis and resulting litigation will have a chilling effect on physicians who will be afraid to prescribe opioids at all, much less high doses. In Mr. Julian’s words, “As a result, the relative ease with which chronic pain patients could secure prescriptions for opioids as recently as a few years ago will disappear.”

This will leave many of these patients in agony and unable to find any relief. Moreover, since they won’t be able to procure prescriptions for opioids, many of them will turn to the black market and illegal drugs such as heroin and fentanyl, which carry a high risk of overdose and death.

Julian also believes that the opioid crisis will also prompt insurers to place more significant restrictions on the use of opioids, making it more difficult for patients who need them as a result of surgery or chronic pain to obtain treatment. Many, if not most, insurers already impose strict limits on opioid prescriptions and monitor doctor shopping very closely.

In states that have enacted Good Samaritan laws, physicians are protected from civil liability when prescribing opioids to patients in good faith, even if the doctor’s treatment fails. However, Julian believes that “the immunity provided by Good Samaritan laws will be of little solace because doctors may fear that their efforts could expose them to criminal prosecution.”

Julian also notes that the opioid crisis is not likely to go away any time soon and will only intensify. “The federal government is expected to make recommendations for new prescribing guidelines in the very near future,” Julian predicts.

In addition, many state governments are passing laws creating more stringent restrictions on opioid prescription practices that may narrow the scope of a doctor’s discretion in prescribing certain controlled substances or result in more involvement from board-certified pain management physicians to reduce physician shopping and drug diversion. In the latter instance, pharmacies will be required to report any prescriptions that exceed a certain threshold value of controlled substances.

There has been some question about whether further governmental regulation of opioid prescribing is necessary or appropriate government intrusion into what is essentially a matter between a doctor and a patient. There is no question that opioid abuse presents real problems, and there are people who need help. However, it is essential to remember that most individuals who seek treatment for chronic pain from their physicians do not become addicts.

In addition, it should be kept in mind that the current crisis was created by “pill mills” and unscrupulous doctors who were willing to operate outside of the law to make money by providing vast numbers of prescriptions for opioids.

It is indisputable that many people have become addicted to opioids due to being prescribed high-dose pain meds after surgery or an injury. However, most individuals can taper off when they no longer need them without becoming addicts.

The current opioid crisis revolves primarily around illicit drugs such as heroin and fentanyl, which are powerful, addictive, dangerous, and deadly. While there is no question that people who become addicted to pain medication prescribed by their doctors find it extremely difficult or impossible to stop taking the opioids without incurring excruciating withdrawal symptoms, those who become addicted to heroin and fentanyl have no such difficulty.