Those eligible to purchase Health Insurance from companies offering coverage in the Exchange include:

• Individuals without employer coverage and their dependents.
• Self-employed individuals and their dependents.
• Owners and Employees of Small Businesses with less than 100 employees and their dependents.

The following eight conditions will NOT be permitted under the new law:

• Insurers turning applicants down.
• Insurers cancelling Policies.
• Insurers turning down individuals with preexisting conditions.
• Insurers charging higher premiums to those with preexisting conditions.
• Insurers requiring long waiting periods before preexisting conditions are covered.
• Insurers charging individuals higher premiums because of past health insurance claims.
• Insurers charging higher premiums for women than for men.
• Insurers charging older persons as high a premium as they want.

For further information presented in a question and answer format that addresses many of the current questions individuals have regarding the new Health Reform Law, go back to the main menu and click Links/Resources. Next scroll down to Kaiser Health News and click. This will provide you with a number of options to further examine.

The rate of melanoma is rising more rapidly than that of any other cancer. The incidence has increased not only among younger (under age 30) Americans, but also among those age 60 and over.Older men in particular, have higher melanoma incidence and mortality rates than the general population. This year nearly 8,000 people will die of the disease, according to the National Cancer Institute, and about half of them will be white men over the age of 50.

Play it safe in the sun by observing the following tips:

• First and foremost, limit sun exposure - especially from 10AM to 4PM, when the sun's rays are strongest.
• Never use tanning beds or sun lamps, which can increase the melanoma risk.
• Wear a wide-brimmed hat and sunglasses that protect your eyes from ultraviolet A and B rays (UVA and UVB).
• Wear long sleeves and pants made with tightly woven fabrics.
• Sit in the shade or under an umbrella at the beach, even if it's cloudy.
• Wear sunscreen with a 30SPF or higher with wide spectrum UVA and UVB protection. Reapply often and liberally, especially after swimming or exercise. Consider using sun-screen with zinc oxide or titanium dioxide, physical sun blocking agents that offer maximum protection.
• And finally, remember that you can get melanoma even if you wear sunscreen. Use it in conjunction with other measures.

It's normal with aging to experience a decline in both hearing and the balance nerve cells located in the inner ear. The latter control balance by providing ongoing feedback via nerve signals to the brain about the head's motion and position relative to gravity. Studies have shown that the reduction in the number of nerve cells in the vestibular system of the inner ear begins at about age 55. There can also be a decline in the nerve cells of the cerebellum - an area of the brain that is involved in balance and posture - and the brain stem, which receive those signals. In spite of any other health factors that may be involved, the study published in the Journal of the American Geriatrics Society does show a correlation between hearing loss and walking difficulties.

Taking steps to preserve your hearing could potentially improve your balance and help you avoid the walking difficulties that could put you at risk of falls. If you are suffering from dizziness or unsteadiness that affects your balance, consult with your doctor who can take steps to ensure that your vestibular system is functioning properly.

Preparation is the key to safety when living alone. Start by creating a written and detailed Action Plan that will help protect you, and comfort those who worry about you being by yourself, in the event of an emergency.

These guidelines should be incorporated into your Action Plan:

• Decide who you will call in an emergency (911 or a friend, neighbor, family member, etc.)Tape these phone numbers to back of every phone in the house and tell the people you've selected that they are on your emergency contact list.
• Visualize how you are going to get to the telephone.Consider where the phones are and make sure there is a phone in the rooms you frequent the most; especially, the bathroom where many falls take place. Remember, you may have to crawl or slide to a phone.
• Have daily conversations with friends or family. This will keep you socially engaged and at the same time provide a safety net - if you don't call or answer a call the person you talk to every day will know something may be wrong.
• Have a document in an accessible place (like on the refrigerator or the bedroom bureau), listing your name SSA number, insurance information, and all other important medical information.
• Consider getting a personal emergency response system that is worn around the neck or wrist. These allow you to press a button that immediately contacts emergency personnel in case of an accident.
• Prepare your home. Home modifications will help preserve your independence and your safety. You can install simple solutions yourself - like high-watt-low energy light bulbs and nonslip pads on stairs, bathroom tiles, and furniture. Ask you doctor to prescribe a home evaluation in order to have a physical or occupational therapist assess your home and decide which medical equipment or renovations would be best for you. Medicare may pay for evaluations and equipment if deemed medically necessary.

• Medicare (www.medicare.gov) Scroll down to the bottom left of the home page to find the link "Compare Home Health Agencies In Your Area". Click to find Medicare approved home health agencies near you, along with information on your rights as a home health patient and what to expect when you hire an aide or nurse.
• Eldercare (www.eldercare.gov/Eldercare.net) This web-site allows you to search by zip code, city, or state to find caretaker resources, along with other helpful news regarding living alone and aging.
• Independent Living Centers (www.virtualcil.net/cils) to locate organizations in your area that help older people who live alone.

You will be asked to select a State and provide the County name in which you reside. You will then need to click 'Show Plans' and scroll down to the comparison chart. Now you should be better able to make an informed decision as to which plan best suits your needs.

The most common cause of angina is coronary heart disease, defined by narrowing or blockages in the coronary arteries, which carry the blood to the heart. As we age, arteries can become clogged with a cholesterol-laden substance called plaque, particularily in those who smoke, are sedentary, are obese, or who consume a diet high in saturated fats.

Classic angina symptoms include heaviness, aching, or pressure below the breastbone. During a typical episode of angina, cardiac nerves and pain receptors in the heart convey feelings of chest discomfort to the brain. Also, there are the less traditional symptoms, including shortness of breath, nausea, tingling, sweating, dizziness and pain in the teeth.

Women are more likely than men to experience the less traditional symptoms. The concern is that some women may ignore these symptoms because they do not recognize them as angina.

It must be added that chest pain doesn't always signal angina. Other potrential sources of chest discomfort include acid reflux, a pulled muscle or muscle tension, gallstones, inflammation in the cartilage of the ribs, and problems in the spine's cervical region. This said, it is best to remember that ANY chest discomfort warrants and examination by your doctor.

You can find the AHRQ card template on the Internet at ( www.ahrq.gov/qual/pillcard/pillcard.htm) and print it out or save it to your personal computer so you can customize it with your own medication instructions.

To avoid medication mix-ups, the AHRQ recommends that you describe each type of pill - its shape and color, for instance - and note any distinct markings if two pills look alike. To help with this, the AHRQ website contains images of pills that you can copy, color on the computer, and add to your pill card. You can also do this by hand.

Keep your pill card near your medications or in a visible place, like on the refrigerator or bathroom mirror.

Review your pill card with your doctor periodically to make sure that your dosages are correct and that you're not still taking anything that you do not need. Also, check with your pharmacist if you notice a change in the color, shape or size of your pills - generic medicines in particular often change appearance.

One of the most important steps you can take to protect yourself is to supply all of your doctors, particularly specialists, with as complete a medical status as possible, including a list of conditions you have and the drugs and supplements you take.

The following 33 drugs are considered to be potentially inappropriate for patients 65 years of age and older and may result in various adverse effects:

DRUG(generic/brand name) ADVERSE EFFECTS

• Barbiturates(Nembutol, Mebarol, Amobarbital, Butabarbital, Pentabarbital, Secobarbital) Highly addictive,more adverse effects than most sedatives
• Flurazepam(Dalmane, Somnol, Novo-Flupam, Apo-Flurazepam)May cause Central Nervous System (CNS) problems
• Meprobamate(Equanil, Meprospan 200, Meprospan 400, Probate, Apo-Meprobamate Highly addictive
• Chlorpropamide(Diabinese, NovoPropamide, Apo-Chlorpropamide)Prolonged hypoglycemia-Low blood sugar
• Meperidine(Demerol) Confusion,CNS problems
• Pentazocine(Talwin, Talwin Nx)Confusion,Hallucinations
• Trimethobenzamide(Tigan,Stemetic,Tebamide, Tribenzagan, Trimazide)Can effect motor control
• Belladonna alkaloids(Donnatal,Barbidonna)Hallucinations,confusion
• Dicylomine(Bentyl, Bentylol, Spasmoban, Formulex) Nausea,Hallucinations
• Hyoscyamine(Levsin,Hyosol, A-Spas-S/L, Cystospaz, Levbid, Levsinex Timecaps, Symax SL) Arrhythmia,dizziness,blurred vision
• Propantheline(Pro-Banthine)Arrhythmia,dizziness,blurred vision
• Carisoprodol(Soma,Vanadom)Poorly tolerated,weakness
• Chlorzoxazone(Parafon Forte DSC, Remular-S, Paraflex) Poorly tolerated,weakness
• Cyclobenzaprine(Flexeril)Poorly tolerated,weakness
• Metaxalone(Skelaxin)Poorly tolerated,weakness,sedation
• Methocarbamol(Robaxin)Poorly tolerated,weakness,sedation
• Amitriptyline(Elavil)Poorly tolerated,sedative effects unpleasant
• Chlordiazepoxide(Librium)Strong sedation,Adverse CNS effects
• Diazepam(Valium)Prolonged sedation,risk of falls
• Doxepin(Sinequan)Poorly tolerated,sedative effects unpleasant
• Indomethacin(Indocin)Adverse CNS effects
• Dipyridamole(Persatine)Sudden blood pressure drop
• Ticlopidine(Ticlid)Anti-clotting,more toxic than aspirin
• Methyldopa(Aldomet,Aldoril)Low resting heart rate,exacerbate depression
• Reserpine(Harmonyl, Serpasil, Serpalan, Novoreserpine) Depression,sedation, blood pressure drop
• Dispyramide(Norpace, Norpace CR)Could induce heart failure,other complications
• Oxybutynin(Ditropan,Ditropan XL,Oxytrol)Weakness, sedation, poor tolerance
• Chlorpheniramine(Chlor-Trimeton,Aller-Chlor, Chlorate, Chlo-Amine)Increased heart rate,disorientation
• Cyproheptadine(Periactin)Increased heart rate, disorientation
• Diphenhydramine(Benadryl,Nytol)Increased heart rate, disorientation
• Hydroxyzine(Vistaril,Rezine, Atarax)Increased heart rate, disorientation
• Promethazine(Pheneragan, Promacot)Increased heart rate, disorientation
• Propoxyphene(Darvon, Darvon-N)Highly addictive;avoid if depressed with suicidal thoughts.

C.difficile is a rising threat. Few Americans had heard of this intestinal bug until a study sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC) showed the prevalence of C.Diff is 20 times higher than previous estimates. Findings suggest that on a average day, nearly 7,200 hospitalized patients - 13 of every 100- are colonized or, more often, infected with C.diff, and about 300 patients will not survive it.

C.difficile bacteria are everywhere in the environment. Three percent of healthy humans carry it in the gut, but carriage rates in hospital patients tend to be much higher, and elderly persons being treated with antibiotics are most at risk of developing infections.This happens because the antibiotics administered kill the "friendly" gut flora and C.Diff flourishes as a result. In fact, Hospital infections kill 90,000 Americans a year. These bacteria produce spores when they encounter unfavorable conditions. Transmission of infection is through the ingestion of these spores which can survive on surfaces, floors and even clothing for years and, with the exception of chlorine bleach, are resistant to many disinfectants and antiseptics, including alcohol hand gel. Do not conclude that C.difficile is confined exclusively to hospitals and similar institutions. It's also a growing problem among otherwise healthy people and the problem is growing worse. It is, according to the Centers for Disease Control, responsible for tens of thousands of cases of diarrhea.

Some people who are infected with C.difficile never become sick, though they can still spread the infection. Others have bouts of watery diarrhea with nausea and abdominal pain and cramping. And, an increasing number of persons develop severe inflammations of the colon. Complications of C.difficile infections include dehydration, kidney failure, bowel perforation, toxic megacolon and death. Signs and symptoms of this potentially life threatening illness include profuse, watery diarrhea 10 or more times a day, a fever, often greater than 101F, abdominal pain which may be severe, blood or pus in the stool, nausea, dehydration and weight loss.

Although more people with no known risk factors, including children, are contracting C.difficile infections, your risk is greatest if you:

Are taking or recently have taken antibiotics, especially ampicillin, amoxicillin, clindamycin, fluoroquinolones and cephalosporins. Other antimicrobials, including antiviral and antifungal drugs, and chemotherapy medications also can lead to increased risk.

Are 65 years of age or older. Older adults have a disproportionately high infection rate.

Have a serious underlying illness or weakened immune system.

Are or have recently been hospitalized, especially for an extended period. In general, larger hospitals have higher infection rates than do smaller hospitals.

Live in a nursing home or longterm care facility. Often the infection spreads when patients are transferred from hospitals to other facilities.

Have had abdominal surgery.

Have a chronic colon disease such as inflammatory bowel disease or colorectal cancer.

Take prescription or over-the-counter antacids. By reducing stomach acid, these drugs may allow C.difficile to pass more easily into the intestine.

Have had a previous C.difficile infection.

Among the steps you can take to stop C.difficile from infecting you is to take antibiotics only when absolutely necessary and, even then, ask your Doctor to prescribe one that has a narrow range that you take for the shortest period of time so as to disrupt intestinal bacteria the least. You my also consider Probiotic Supplements which help replace beneficial bacteria that antibiotics destroy. Only Saccharomyces boulardi has proved effective in C.difficile infections however. Last of all, the simplest and one of the best preventatives is to wash, wash, wash your hands! See Hand Washing 101 article on this same Health Alerts Page.

To learn more, Consumers Union offers information on states requiring hospitals to report infection rates. Go to www.stophospitalinfections.org/learn.html and click on "State Hospital Infection Disclosure Laws." Also, the Leapfrog Groups website www.leapfroggroup.org provides ratings of 1,300 U.S. hospitals and information on infection prevention measures. You can also Google the Centers for Medicare & Medicaid Services, at hospitalcompare.hhs.gov that reports quality information on hospitals. The Committee to Reduce Infection Deaths, hospitalinfection.org. and finally, the Society for Healthcare Epidemiology of America. Go to shea-online.org and click on "Patient Guides."

When you take a calcium supplement, it's the amount of elemental calcium that's the key to bone health. If the amount isn't clearly stated on the bottle, check the Nutrition Facts label, which will include how much elemental calcium - often listed simply as "calcium" - is in a serving size. The following example illustrates the point. Tums Ultra 1000 contains 1,000mg of calcium carbonate per tablet, BUT only 40% of the calcium carbonate is elemental calcium, meaning one tablet has only 400mg of the essential mineral needed.

Too many times the recommended serving size on the supplement label does not meet your daily calcium requirement. Again using the same simple example, Tums Ultra 1000 lists a serving size as two tablets, adding up to 800mg of calcium - not nearly enough for adults over the age of 50, who should get 1,200 to 1,500mg a day.

If you have questions about the correct dosage, ask your doctor or health care provider how many pills you should take per day. Also, it's best to spread out your daily dosage of calcium so you don't take more than 600mg of elemental calcium at one time; the body absorbs larger amounts less efficiently. Finally, take calcium carbonate with meals, because this type of calcium is absorbed better in the presence of stomach acid.

If you've been diagnosed with heart failure or have been told that you may be at risk, it's important that you work with your doctor to develop a treatment plan that addresses your needs and the severity of your disease. The two basic components of most treatment plans are medication and lifestyle changes.

The best way to respond to heart failure is to educate yourself, listen to your doctor's advice and pay attention to what your body is telling you.

Warning signs of heart failure tend to develop gradually. Because they come on slowly, in the disease's early stages, signs and symptoms may be missed or attributed to another condition. Here are some of the most common signs and symptoms of heart failure and some of what causes them.

Shortness of Breath- Because the heart can't pump blood fast enough, it "backs up" in the veins that connect the lungs to the heart causing fluid to leak into the lungs, producing shortness of breath, especially when lying down.

Cough or Wheezing-Similar to shortness of breath, the leaking fluid into the lungs produces a cough or wheeze.

Swelling of Body Tissues-When blood flow back to the heart slows, fluid builds up in tissues such as the lungs, feet, legs and abdomen. The kidneys also become less efficient in disposing of water and sodium. making tissues more susceptible to fluid retention.

Weight Gain- Fluid retention causes weight gain

Fatigue-With a reduced supply of freshly oxygenated blood to meet the body's needs, blood is diverted away from less vital organs, particularly muscles in the arms and legs, making them more susceptible to fatigue.

Reduced Appetite and Nausea-The digestive system receives less blood, thereby reducing appetite and causing digestive problems.

Difficulty Concentrating-Changes in blood components, such as an increase in sodium, can affect alertness, as can not getting enough blood to the brain.

Increased Heart Rate-To try to make up for its reduced capacity to pump blood, the heart beats faster.

Use warm water, not hot water and not cold water because hot water is hard on the hands and cold water will inhibit the sudsing of soap.

Next, you do not have to use expensive antibacterial soaps to try to kill the germs but you do need to work up a substantial lather of soap suds to dislodge the bacteria and suspend them in the suds.

While lathering your hands be sure to soap every millimeter of skin, including the thumbs, between the fingers, the backs of the hands and the undersides of the fingernails. Use a nail brush to be even more effective.

Now rinse your hands thoroughly with warm water to remove every last trace of soap suds (and germs).

Now that you have done such a great job, do not negate you efforts by grabbing the faucet tap (loaded with germs) or a door knob (especially in a public restroom). Instead use a paper towel to shut off the water and to open the door. That will go a long way in preserving the cleanliness of your hands.

Last of all - teach a child how to wash his or her hands!

In this study, researchers looked at the medical records of more that 4,000 veterans age 80 and older with high blood pressure. Participants who lowered their blood pressure to just below the upper limit of normal - 139/89 mm Hg - were less likely to die of any cause over a five year period than those who reduced their blood pressure to lower levels. This relationship held when the researchers took into account other illnesses that can lead to premature death.

These findings do not contradict current guidelines that recommend lowering blood pressure to below 140/90 mm Hg. But they do suggest that aggressive lowering of blood pressure beyond this level could be harmful for people over age 80, possibly because of reduced blood flow to vital organs.

If you are 80 or older and experience any symptoms of aggressive blood-pressure lowering such as dizziness, weakness, or thinking problems tell your doctor who then may make changes to your treatment regimen.

As people get older, a decrease begins in both the total time sleeping and the amount of time spent in the stage of sleep associated with dreaming. A newborn sleeps 16 hours per day. In contrast, the baby's 30-year-old mother sleeps six hours per day (if she's lucky), and only one quarter of this time ,or two hours, is occupied by the deepest stage of sleep.

Starting in middle age (between 46 and 60), not only does the amount of sleep per night start to decrease, but also the character of the sleep changes, People at these ages spend less time in the stage of sleep associated with dreaming and more time in the lighter stages.

As people get older, they are more likely to shift the time when they sleep, some going to bed and to sleep earlier and waking up earlier. Others are the opposite, staying up late into the night and sleeping much of the day. When people are in their 80s, these changes are even more pronounced. Their total time asleep per day may be only six or seven hours, including time spent in daytime naps. Even though a person may take several naps a day, the total time sleeping in naps is rarely over an hour. The idea that older individuals should sleep soundly for eight to ten hours is clearly wrong.

As a rule of thumb, one hour of sleep is required for two hours of being awake. As we get older, that ratio becomes closer to 45 minutes of sleep for each two hours awake. In other words, throughout the day you gradually accumulate a "sleep debt." By the end of a 16 hour day, a younger person owes the "sleep bank" eight hours. In contrast, an older person has a sleep debt of only about six hours. By the end of a week, you may have accumulated a sleep debt of 8 to 10 hours.

If you don't allow enough time for sleep, you become sleep deprived. Besides being sleepy during the daytime, sleep-deprived people often have problems with their thinking. They are slower to learn new things, they may have problems with their memory, and their ability to make judgements may be faulty, enough so that they may think they are starting to "lose it" when the real problem is not enough sleep.

Elderly people do not recover from sleep deprivation as quickly as younger people. In experimental situations where people are kept awake for 24 hours, those in their 70s take at least a day longer to recover from their subsequent daytime sleepiness than younger people. Gender may also make a difference in the time it takes to recover from sleep deprivation; women seem to be able to recover faster than men.

Although no one likes to think about having a heart attack,would you know what to do if you were? Even if you know what to do, would you follow through and more importantly, would you do it quickly?

According to the National Heart, Lung, and Blood Institute close to one million people in the United States have heart attacks each year; and, about one fifth of them die. Half of the deaths occur in the first hour after heart attack symptoms start and before the person reaches a hospital. These numbers underscore the importance of recognizing heart attack symptoms quickly and responding to these symptoms just as quickly,

Now a study in the European Heart Journal (Volume 27, page 1408) reports that for women, persistent chest pain may be a waning of future heart problems - even when a woman has no evidence of blockages in her coronary arteries.

The findings come from a study known as WISE, a government-funded project designed to evaluate chest pain in women - a task that is less straightforward than in men. The central issue is that women are much more likely than men to suffer long-term chest pain in the absence of any large artery blockages. But that doesn't mean their chest pain is innocuous.

Among women in the study with no signs of clogged arteries, those with persistent chest pain for at least a year were more that twice as likely to suffer a heart attack, stroke or other cardiovascular complication over the next five years. The study included 637 women whose chest pain and other potential symptoms of coronary heart disease were evaluated by angiography (an x-ray examination of blood vessels that can detect blockages).

The take home message is if you are a woman, you should not simply live with chronic chest pain if angiography fails to detect artery blockages. Instead, you should ask your doctor about ways you can reduce any heart risk factors you have. Remember, a healthy diet and regular physical activity are two of the most important ways.

You probably know the symptoms of a heart attack, but it's just as important to know the symptoms of a stroke. Like a heart attack, a stroke is an emergency that requires immediate medical attention. Even a TIA, in which the stroke symptoms appear suddenly and quickly subside, is a medical emergency.

Whether you are having an ischemic or hemorrhagic stroke, the symptoms are the same. With a TIA, the symptoms are transitory, often lasting only minutes. If you or someone you are with experiences the sudden onset of any of the stroke symptoms listed below - even if the symptoms start to subside - you MUST call 911 or go straight to the hospital. Rapid diagnosis and treatment of a stroke may minimize damage to the brain tissue and improve the chances of survival. Stroke symptoms include:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.
Sudden loss, blurring,or dimness of vision.
Mental confusion, loss of memory, or sudden loss of consciousness.
Slurred speech, loss of speech, or problems understanding others.
A sudden, severe headache with no apparent cause.
Unexplained dizziness, drowsiness, or lack of coordination.
Nausea and vomiting, especially when accompanied by any of the preceding symptoms.

The importance of responding immediately to symptoms of a stroke is underscored by a study in the journal Neurology(Volume 64, page 817). Note that the warning signs of an ischemic stroke may occur up to seven days before the event itself, according to researchers, and these signs should be taken seriously to minimize the chance of a major stroke.

There is no universal rating system to help determine if a patient has delirium; however, the reliability of the following criteria tested positively in a study published in the Journal of Geriatric Psychology. Some central characteristics that researchers identified are listed below. Examples of the type of behavior that might indicate each characteristic are also included.

Shifting attention
Unable to concentrate during conversations.
Switches topics frequently.
Easily distracted.
Completely inattentive.

Poor orientation
Has problems articulating the date.
Doesn't know the days of the week.
Doesn't know where he or she is.
Has trouble recognizing family members.

Incoherence
Speech is difficult to understand.
Stops in the middle of a sentence.
Cannot express thoughts.

Restlessness and anxiety
Jumpy, edgy, or fidgety.
Suspicious of others.
Anxious and afraid.
Requires frequent reassurance.

Delusions and hallucinations
Perception is distorted or completely wrong.
Sees shapes or objects incorrectly.
Smells scents that are not there.

Poor cognition
Cannot spell simple words backwards.
Cannot do simple math.
Cannot recognize simple patterns of words or numbers.

A report in the Archives of Internal Medicine(9Volume 166, page 1763) suggests that taking Viagra at bedtime may worsen severe obstructive sleep apnea. This may be disturbing news to many men, because erectile dysfunction is particularly common among those with sleep apnea. Viagra prolongs the action of nitric oxide, which promotes upper airway congestion, thereby contributing to sleep apnea. The researchers studied 14 men with severe sleep apnea, who spent a night in a sleep lab having their breath and blood oxygen monitored after they took a single 50-mg dose of Viagra or a placebo.

Just one dose of Viagra significantly increased the amount of sleep time with a lower blood oxygen saturation level; while asleep, men who took Viagra were not getting as much oxygen as those who took a placebo. They also had more breathing pauses per hour.

Bottom line advice on Viagra and sleep apnea is if you take Viagra and have sleep apnea, talk with your doctor about whether the pleasures you derive from taking the drug outweigh the risks of worsening your nighttime breathing problems.

A recent article from the Mayo Clinic Health Letter notes that neck circumference is one measurement that may be predictive of determining the risk of sleep apnea.The actual formula uses centimeters in its calculation, but approximate equivalents in inches are included here:

• If you have or are treated for high blood pressure, add 4 cm (about 1 1/2 inches) to the neck measurement.
• If you snore more than three nights a week, add an additional 3 cm (about 1 1/4 inches).
• If you're known to choke or gasp most nights, add an additional 3 cm (about 1 1/4 inches).

However, if your neck measurement is less than 43 cm (about 17 inches), but you have symptoms of sleep apnea, it's also important to speak with your doctor, as there may be some other treatable condition responsible for your symptoms.

Research reported in the journal Chest (Volume 127, page 1658 May 2005) shows that people who are overweight, drink a lot of carbonated beverages, snore, experience daytime sleepiness or insomnia, have a high blood pressure or asthma, or use anti-anxiety medications such as diazepam (Valium) are most likely to experience the problem.

The subjects were part of the Sleep Heart Health Study, a national trial that enrolled 15,314 people to investigate the link between breathing problems during sleep and cardiovascular disease. Among the questions was "how often in the past year, on average, have you been awakened during the night with heartburn or indigestion?" The responses indicated that 1/4 or 3,806 people, in this group reported the symptom at least twice a month. People with nighttime heartburn are at greater risk for more serious esophageal problems such as erosive esophagitis, Barrett's esophagus, and esophageal cancer.

With both obesity and GERD on the rise , medical researchers have found there to be a link between the two. An article in The American Journal of Gastroenterology examined the results of 20 studies involving more than 18,000 people with GERD. Overall, people who were overweight were 50% more likely to have GERD than normal weight people; obese individuals were more than twice as likely.

If you experience nighttime heartburn on a regular basis, or have bouts of asthma, a nagging cough or episodes of chest pain, talk with your doctor. In addition, try to control the risk factors identified in this study - for example, keep your weight and blood pressure under control and cut down on your soda intake.

Occasional memory lapses, such as forgetting why you walked into a room or having difficulty recalling a person's name, become more common as we approach our 50s and 60s. It's comforting to know that this minor forgetfulness is a normal sign of aging, not a sign of dementia.

Here are examples of the types of memory problems common in normal age-related forgetfulness, mild cognitive impairment and dementia.

Normal Age-Related Forgetfulness:

Sometimes misplaces keys, eyeglasses, or other items.
Momentarily forgets an acquaintance's name.
Occasionally has to "search" for a word.
Occasionally forgets to run an errand.
May forget an event from the distant past.
When driving, may momentarily forget where to turn. Quickly orients self.
Jokes about memory loss.

Mild Cognitive Impairment:

Frequently misplaces items.
Frequently forgets people's names and is slow to recall.
Finding the desired word becomes more difficult.
Begins to forget important events and appointments.
May forget more recent events or newly learned information.
May temporarily become lost more often.
May have trouble understanding and following a map.
Worries about memory loss. Family and friends notice the lapses.

Dementia:

Forgets what an item is used for or puts it in an inappropriate place.
May not remember having known a person.
Begins to lose language skills. May withdraw from social interaction.
Loses sense of time. Doesn't know what day it is.
Short-term memory is seriously impaired. Has difficulty learning and remembering new information.
May have little or no awareness of cognitive problems.

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