Carrie Underwood Says Her Second Pregnancy Is ‘Harder’ on Her Body Than Her First

If you’ve been pregnant once, you might think you know exactly what’s in store for you when round two comes around. But it can actually be a whole different ball game, as Carrie Underwood is finding out.

“It’s definitely different than the first time,” Underwood told Entertainment Tonight at the 2018 CMT Artists of The Year ceremony in Nashville on Wednesday.

“When they say every pregnancy is different, it really is. Just different symptoms,” said the country singer, who has a 3-year-old son named Isaiah with husband Mike Fisher. “I feel like this one is just a little harder on my body for some reason. But it’s been really good.” Underwood—who revealed she had three miscarriages prior to this pregnancy, which she announced in August—added, “I’m squeezing myself into whatever dresses I can squeeze myself into.”

Yep, every pregnancy is different, and many people find the second can be more difficult than the first.

First off, your circumstances and priorities have shifted. You’re busy running around after baby number one while you’re pregnant with your second—and balancing pregnancy and parenting at the same time can be exhausting.

This, in addition to any other life changes that occurred since your first pregnancy (like a change in job), adds extra stress to your plate that may be felt in many different ways. “It’s harder on your body,” Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, previously told SELF.

There are also a few physiological reasons that the second pregnancy may feel tougher than the first.

The way your body is changing and the hormone fluctuations that occur can vary between pregnancies, as women’s health expert Jennifer Wider, M.D., previously told SELF. This can make them feel different as well.

Second pregnancies can also progress a little more quickly than the first because your body is already familiar with the physiological responses that are coming. “It goes through the routine much quicker than with your first pregnancy, where your body is really trying to figure out what’s going on,” Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at The University of Illinois College of Medicine at Chicago, previously told SELF.

Some people also appear to be further along at an earlier stage in their second pregnancy. This is because the abdominal muscles were stronger during the first pregnancy, keeping the uterus inside the pelvis for a bit longer. “With the second baby, the muscles have been stretched so the uterus pops out faster,” Yvonne Bohn, M.D., an ob/gyn at Providence Saint John’s Health Center in Santa Monica, Calif., previously told SELF. “It gives women the appearance that they’re getting bigger, faster.” You don’t necessarily gain more weight with baby number two, Dr. Greves said—it just appears that way.

So, just know that your second time around may feel or look very different from your first—and that’s totally fine.


This Waterproof Foundation Is Amazing at Hiding Breakouts (and It’s On Sale)

I know I’ve said this a lot in the past, but I have a new (new) favorite foundation. This one is a lot different than the others I keep in my makeup drawer, not just because it’s new to me, but also because it’s totally waterproof. As the name implies, Cargo Cosmetics’ Swimmables Longwear Foundation is meant to hold up even if you go swimming in it. I haven’t jumped into an actual body of water while wearing it, but I can say that the product stayed put on my sweaty face as I ran a few miles on the treadmill, which for me, is a makeup first. Although I never really use much waterproof makeup—save for an occasional application of cry-proof mascara at weddings—I’ve established a deep connection (one could even say love affair) with this foundation that I honestly didn’t expect.

When I apply this liquid foundation (in shade #70 to be exact) with my Beautyblender, it glides on seamlessly and blends in ridiculously well with my cafe au lait skin tone. Although it’s long lasting and full-coverage, it doesn’t feel like I’m wearing cake face once it fully dries. In fact, I typically apply an extra coat over bad breakouts or dark spot areas, and even then my skin still looks like actual skin. Not only does it look great immediately after application but it also stays put all day until I wash my face at night, even when I haven’t set it with translucent powder.

As much I already love this full-coverage foundation (we’re practically soulmates at this point) I love it even more now that it’s on sale at Ulta—originally $34, it’s on markdown right now for $24. Although I don’t yet need to stock up on another bottle since a little goes a long way, I’m still tempted to add one to my online shopping cart, you know, just in case.

Corn in Trader Joe’s and Whole Foods Salads Recalled Over Listeria and Salmonella Concerns

Salads containing corn have been recalled at several major grocery stores this week—including Whole Foods, Trader Joe’s, and 7-Eleven—due to possible contamination with listeria and/or salmonella bacteria. The problem was discovered on Tuesday when GH Foods CA, LLC received word that their corn supplier was recalling its corn over listeria and salmonella fears, according to the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS).

The products affected by the recall include 365 By Whole Foods Market BBQ Style Chopped Salad With Chicken and 365 By Whole Foods Market Chicken Fajita Salad, both with “best by” dates between October 17 and October 20, 2018, as well as GH Foods CA’s Santa Fe Style Salad With Chicken (“best by” dates between October 17 and October 18) and six-pound bagged BBQ Style Salad Kit With White Chicken (“best by” dates between October 17 and October 20). These items were only shipped to stores in California.

The issue also apparently affects three types of prepackaged salads sold at Trader Joe’s in certain states, according to a press release from the company. Specifically, it includes Trader Jose’s Mexicali Inspired Salad (sold in Colorado, Idaho, Louisiana, Oklahoma, Oregon, Tennessee, Texas, and Washington) as well as Trader Joe’s BBQ Flavored Chicken Salad and Field Fresh Chopped Salad with Grilled Chicken Breast (both sold in Colorado, Louisiana, New Mexico, Oklahoma, Tennessee, and Texas). All of the affected salads have “best by” dates between October 15 and October 20, 2018.

Additionally, FSIS posted similar recall notices about salads sold at 7-Eleven stores in Texas and others produced by GHSE, LLC, which were sold at retail locations in Florida, Georgia, and South Carolina.

To date, there haven’t been any confirmed illnesses reported in relation to any of the recalled foods.

The symptoms of listeria and salmonella may be similar—and similarly unpleasant.

Both listeria and salmonella are bacteria that can cause gastrointestinal illnesses, but in both cases, otherwise healthy adults rarely experience severe symptoms. The symptoms of a listeria infection usually start a few days after ingesting the contaminated food, but they can show up even a month later. And, according to the Mayo Clinic, those symptoms may include:

  • Nausea
  • Diarrhea
  • Fever
  • Muscle aches

The most worrying listeria-related issues are those that appear when the infection spreads beyond the gastrointestinal tract, which are most common among those people who are pregnant and those with weakened immune systems. As the FSIS notes, severe listeria infections may pose a risk for premature delivery, miscarriage, and stillbirth.

When it comes to a salmonella infection, as SELF wrote previously, you’ll probably start to feel symptoms between 12 and 72 hours after becoming infected. The symptoms of a salmonella infection can include:

  • Nausea
  • Vomiting
  • Diarrhea (sometimes with blood in your stool)
  • Abdominal cramps
  • Headache
  • Fever
  • Chills

As long as you’re able to rest and stay hydrated, most healthy adults are able to recover from a salmonella infection without serious issues in about a week. But young children, people who are elderly, and those with weakened immune systems may be more likely to experience complications.

If you’ve purchased any of the affected salads, don’t eat them. And check in with your doctor if you start to feel sick.

Although most of us can handle a minor salmonella or listeria infection, it’s important to know what you’re actually dealing with. And if you happen to be pregnant, it’s crucial that you talk to your doctor if you start to feel sick because there’s a potential for serious issues.

The companies all say that the affected salads have been removed from stores, but consumers may have already purchased them and could have them at home. So the FSIS urges everyone to check what they’ve brought and, if necessary, either throw it out or return it to where they bought it for a refund.


Aerobic exercise has antidepressant treatment effects

An analysis of randomized controlled clinical trials indicates that supervised aerobic exercise has large antidepressant treatment effects for patients with major depression. The systematic review and meta-analysis is published in Depression and Anxiety.

Across 11 eligible trials involving 455 adult patients (18-65 years old) with major depression as a primary disorder, supervised aerobic exercise was performed on average for 45 minutes, at moderate intensity, 3 times per week, and for 9.2 weeks. It showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.

Also, aerobic exercise revealed moderate-to-large antidepressant effects among trials with lower risk of bias, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks) and trials involving preferences for exercise.

Subgroup analyses revealed comparable effects for aerobic exercise across various settings and delivery formats, and in both outpatients and inpatients regardless of symptom severity.

“Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services,” said lead author Dr. Ioannis D. Morres, of the University of Thessaly, in Greece.

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Colored filter improves dyslexic children’s reading speed

Reading, one of the most difficult activities for children with dyslexia, can be improved by the use of green filters.

A study described in an article by Brazilian and French researchers reports increased reading speed for nine- and ten-year-old volunteers with dyslexia who used green filters. The filters had no effect on age-matched children without dyslexia.

Colored filters for the treatment of learning disabilities were first patented in 1983. They were also designed for use by children with autism and attention deficit hyperactivity disorder (ADHD).

“However, studies of their efficacy were methodologically flawed. We used a highly rigorous methodology for the first time,” said Milena Razuk, first author of the article, published in the journal Research in Developmental Disabilities.

The filters are not widely used in Brazil owing to a lack of research, although they have been adopted in some countries, such as France.

Razuk, who completed her PhD in April at Cruzeiro do Sul University (São Paulo, Brazil), performed the experiment while in France on a research internship at Paris Diderot University (Paris 7), with support from the Sao Paulo Research Foundation — FAPESP.

Eighteen children with dyslexia and 18 without dyslexia were selected for the study at Robert Debré Hospital in Paris. The researchers decided to use yellow and green filters in the experiment.

“Twelve colors are available, but we chose two because a very long test would be too demanding for the volunteers,” said José Angelo Barela, a professor at São Paulo State University’s Rio Claro Bioscience Institute (IBRC-UNESP) in Brazil and principal investigator for the project.

Faster Reading

All 36 children were asked to read passages from children’s books suited to their reading age. The texts were displayed on a computer screen with a yellow filter, a green filter, and no filter.

Their eye movements were recorded with the Mobile EyeBrain Tracker®, a French eye-tracking device certified for medical purposes, consisting of goggles fitted with cameras that record the movements of each eye independently via infrared light signals.

“A child with dyslexia has to fix his or her gaze on the words for a longer time to understand a text. Reading speed is slower as a result,” Barela told.

While the filters did not affect reading speed for the children without dyslexia, the eye-tracking device detected a statistically significant difference for children with dyslexia, who read fastest with the green filter, fixing their gaze on groups of words for 500 thousandths of a second, compared with 600 thousandths of a second using the yellow filter or no filter. The fixation period with or without filters was 400 thousandths of a second for children without dyslexia.

The authors of the study stress that they did not evaluate whether the use of a green filter improved comprehension of what was read and that further research is needed to explore this dimension.

Dyslexia is poorly understood

The causes of dyslexia are unknown. In addition to reading difficulties, other deficits have been found to be associated with the disorder, including impaired sensorimotor integration. “It’s as if some source of noise disturbs the brain’s communication with the rest of the body,” Razuk said.

Extensive testing has shown that neither impaired eyesight nor intellectual deficiency is part of the condition. “IQ must be normal or above average for dyslexia to be diagnosed,” noted the FAPESP-supported researcher.

In the article, the authors of the study say the improvement in reading time with the green filter might be due to changes in the visual stimuli available for central nervous system processing.

Other studies have suggested that colored filters may reduce cortical hyperexcitability in the brain, which may be greater in dyslexic people, thereby attenuating contrasts in visual stimuli and hence improving reading performance.

This suggestion was reinforced by a 2015 study in which functional magnetic resonance imaging (fMRI) showed significant activation of the cerebral cortex during reading with colored filters (mostly blue in this case) compared with reading without filters. The authors hypothesized that the filters reduced visual stress and distortion, enhancing visual processing and reading performance.

The next step for the group at IBRC-UNESP will be to use fMRI scans to analyze the brain activity of dyslexic children while reading. Barela has purchased an MRI machine with funding from Brazil’s National Council for Scientific & Technological Development (CNPq).

‘Geek Girl’ gamers are more likely to study science and technology degrees

Girls who play video games are three times more likely to choose physical science, technology, engineering or maths (PSTEM) degrees compared to their non-gaming counterparts, according to new research from the University of Surrey.

The study, funded by the British Academy and published in the journal Computers in Human Behaviour, found that 13-14 year old girls classed as ‘heavy gamers’ — those playing over nine hours a week — were three times more likely to pursue a PSTEM degree compared to girls who were non-gamers.

It also found that 100 per cent of girls in the study who were already in PSTEM degrees were identified as gamers. However, the same could not be said for boys where a similar amount of gamers existed regardless of degree type, leading to thoughts that boys experience far less pressure to conform to the video gamer stereotype if they were studying a PSTEM degree.

The research was led by Dr Anesa Hosein, Lecturer in Higher Education and Programme Director of PhD in Higher Education at Surrey, and a Physics graduate with a self-confessed ‘Geek Girl’ gamer past. Dr Hosein believes identifying and targeting certain female groups early may be a way to encourage more to study it at degree level and beyond.

Dr Hosein said: “Despite the pioneering work of people like Jocelyn Bell Burnell and Surrey’s own Daphne Jackson, the first female Physics professor, there are still too few female PSTEM role models for young women.

“However, our research shows that those who study PTSEM subjects at degree level are more likely to be gamers, so we need to encourage the girl gamers of today to become the engineering and physics students and pioneers of tomorrow.

“It therefore makes sense, in the short-term, that educators seeking to encourage more take up of PSTEM subjects should target girl gamers, as they already may have a natural interest in these subjects. We need to get better at identifying cues early to recognise which girls may be more interested in taking up PSTEM degrees.”

Dr Hosein recommends that educators use the results from her study to increase girls’ participation in PSTEM subjects in a number of ways. ‘Geek Girls’ who have a pre-disposition towards gaming should be identified early by teachers or parents and encouraged to explore PSTEM degree pathways, for example through attending gaming expert talks. School educators could also start including gaming in PSTEM degrees to increase engagement of girl gamers. It is also important for girls who do not fit a geek video gaming stereotype to meet and see more alternative PSTEM female role models during their school education.

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Carrying My Father’s Memory, and His Coffee Cup

At Penn Station in Manhattan I hold my dad’s stainless steel coffee thermos tight in my hand when I board the train bound for Hawthorne, New Jersey, for a shoe modeling job. This morning I am French pedicure-ready to have my feet photographed for a health care catalogue. Sitting at a window seat, I have my modeling portfolio in my bag next to me, and a tight grip on the thermos as the train lurches forward.

This is the first booking from my modeling agency in the month since my dad died.

The call from the sheriff plays on repeat each day in my mind. I can’t shake the thought of my dad beneath the burnt debris and charred metal from the fire and explosion at his home. I imagine a large piece of metal or wood being moved by firemen, and Dad underneath.

I don’t want to imagine his face being unidentifiable. I wanted to rush there to be by his side even though the sheriff suggested it would be best to wait until after the autopsy. I ended up waiting a few days, until the cremation, when I went to Syracuse to collect his remains in an urn. While there, my first stop was to his home, a pole-barn turned in a house 21 miles from Syracuse, in the countryside, and when I looked down the long snowy driveway to the remains of my dad’s home, it still smelled ashy in the air from the fire.

His home was an open cavity, a carcass of wood and charred metal in the snow. The bony corpse of the barn was all that was left. Gone were the windows and the door to a place where he had lived for only half of a year, but always spoke about with an elated tone in his voice about the new beginnings he felt there, among the peace and quiet.

The only things that were left were in his car, his white Hyundai Elantra.

The doors to his car were unlocked. Dad didn’t feel the need to lock his doors out in the country.

The thermos was the first thing I saw in his car, something I surely wanted to keep. I imagined him drinking from it when I saw it in the cup holder, the coffee inside frozen solid. The silver stainless steel tumbler was something he probably used every day. I imagine him stopping at the local gas station down the road to fill it up with coffee, I imagine him drinking from it while driving to his sales job, the coffee pepping him up for his day.

I brought the thermos along today, for luck during the train ride and at the shoe modeling photoshoot in New Jersey. I take a sip of coffee from the thermos. The warmth from the coffee I made this morning calms me. Even though I’ve washed the thermos and scrubbed at the inner sides of it with a sponge, it still smells like old breath, cigarettes, and day-old coffee—the essence of Dad.

The rhythm of the train reminds me of my past trips to Syracuse, before Dad moved to the country when he didn’t want me to visit him where he lived with his roommates. Instead I would meet him at the train station for a little while before my return trip back to Manhattan. We would sit across from each other at a small green table in the train station. I’d have all my luggage at my feet, I’d be wearing my favorite denim jacket and stilettos, maybe a silk bandana around my head. He usually wore a dress shirt with two pockets with an assortment of pens bursting out, and navy pants he’d pair with sneakers. His eyebrows rising behind his large eyeglasses while we caught up on each other’s lives over train-station coffee.

Dad would talk fast, hyper from the caffeine. He had overcome his alcohol addiction, and liked to remind me that he was completely sober, and coffee had become his drink of choice. We both were coffee addicts.

I caught him up on my modeling career. Telling him even though I had finally booked a modeling job advertising shoes with Marshalls that was shot in Central Park on the steps near the Bethesda Fountain and that I was hand modeling with the food magazine Bon Appétit, the other castings weren’t leading to much.

Whenever we said our goodbyes at the station, I’d tell him I’d call when I got back to the city. Sometimes I did. Sometimes I would tell myself I’d call him the next day. A few weeks could pass before I called him.

Remembering our train-station conversations as I sit on the train now, I remember being in Syracuse and hearing the Maple Line going to Manhattan being called; while I walked up the long ramp to the train platform, I didn’t know I’d see my dad only a few more times. I had taken our train station visits, coffee-chats, phone calls, and our relationship for granted.

Courtesy of Author

I hear my arrival in Hawthorne, New Jersey, on the train announcement. I run my hands through my hair and try to forget about the fire for a minute and that this happened to my father.

All the time I’ve spent building my portfolio seems like a waste of time. Modeling in this moment seems superficial, just shallow. It’s just a shoe. All I had worked for, growing my modeling portfolio with magazine tear-sheets and experience, it doesn’t seem as though it’s been time well spent.
The train is already pulling into the station in Hawthorne, though. I’m expected to follow through, I traveled all this way, I was direct booked for this photo shoot; no casting this time; just photos shown from my agent to the marketing director. The doors to the train open.

I want to honor my commitment to the job and who I’m expected to be. I try to focus on how I used to be, as I stand up. I tell myself I will enter the photo studio with a friendly smile. I will present myself to them as courteous and thankful for the lunch buffet, and plenty of coffee to refill up on. I tuck Dad’s thermos into the side pocket of my bag, which holds my modeling portfolio, and get off the train. I’m supposed to call the photo studio, someone from there will pick me up.

At the photo studio, it’s large and open like a warehouse and with high ceilings and multiple production sets in motion, the art director welcomes me with a relaxed set of pants and a button-up shirt to change into. I sweep my long hair up into a ponytail to keep it out of the shot. I place my feet into soft warm slippers and stretchy foam flats and more comfort shoes. With each shoe, I delicately point my toe toward the camera and become unmoved, as though my whole body is aggrieved and meant to be still.

Being still has become my forte.

Holding a pose, putting pressure on my calves to hold a position, an orchestrated balance of breathing, precision, and staying quiet during the shot. My limbs, legs and foot, frozen, exhaling softly to keep the right angle, while a photo assistant adjusts a strap on my shoe, or the photographer directs me to move my foot an inch this way or that.

During a short break I add lotion to my legs and feet and change into a new outfit, and fill up dad’s thermos halfway before the next take.
Back on set under the lights I work hard to stay complacent, content, and dry-eyed. I focus deeply on the shoe, the color, the shape of it, the laces tied into a neat bow, remaining poised and professional, getting the image just right. I try not to think about the last time I had used my feet to model it was for a magazine editorial on nail polish, and Dad was alive.

I’m comfortable, while standing in a numb state with my eyes staring at my foot until it becomes blurry and I blink to the sound of the camera’s shutter. The photographer, assistants and art director are all staring at me, at my foot, and I feel as though I want to run back to the city.

I’m okay I tell myself, I’ve been doing this type of work for years, until I think about Dad’s skin, his legs, his ankles. The autopsy results concluded Dad died of thermal injuries and inhalation of smoke and combustion from the fire and explosion. I think of the medical examiners words on the phone a couple days afterward. There was soot in his airways, throat, and nose. Full charring on his whole body except the areas of the neck and upper chest, to the bone in some areas of the lower legs, blackened to the ankles.

I feel trapped inside the shoe I’m wearing, time starts to feel slower with each new style, waiting for the photographer. The set starts to feel too hot.

I hug everyone goodbye casually when the last shot is accomplished and eagerly grab my bag and want to run into the assistant’s car when I’m taken back to the train station.

I shouldn’t have gotten out, I feel far from the city and my bed.

On the platform I wait for the Manhattan-bound train, pleased that I made it through the photoshoot without bawling or telling anyone what was really on my mind. I reach for my dad’s thermos in the side pocket of my bag to savor the few last sips left.

It’s not there.

I dig around inside my bag furiously while the wind hits my cheek, my eyes bulging and burning with tears. I can’t find it. I frantically call the studio phone number, a shiver in my voice, to the first person who picks up I blurt out that I’ve lost my thermos and ask if anyone can find it. My voice is choked up. I’m nauseous as I speak about what it looks like.

I imagine the photo assistants searching for it under shoe boxes and under couches in the waiting area. I pace the platform: my eyes tearing up, heart racing, waiting, stuck there, hoping the thermos wasn’t buried in the dark way back behind a piece of furniture and unable to be seen.

It was more than a thermos to me, it was a piece of my goodbye to my dad.

I feel so guilty for making the assistant drive back to the train station to bring me the found thermos, and when I grab it like a selfish child I’m no longer the prim shoe model wearing a comfortable foamy shoe. I’m carrying the wreckage and debris from the fire on my back, I’m the raging heat and the blistered ruins meeting the cold air, I’m the crying and freezing wind against the pole-barn in the country. I clutch the thermos close to me.

On the way back to Manhattan, I sit embarrassed and rocking along with the pulse of the train with my irresponsibility and being so neglectful. My heart aches at how close I came to losing an heirloom. I won’t use it again, I tell myself. The thermos is too close to the day before my dad had died, it has already seen its last sips. This thermos is as close to my dad’s last breath as I’d ever be.

University choice and achievement partly down to DNA

Research from King’s College London has shown for the first time that genetics plays a significant role in whether young adults choose to go to university, which university they choose to attend and how well they do.

Previous studies from King’s College London have shown that genetics plays a major role in academic achievement at school, with 58% of individual differences between students in GCSE scores due to genetic factors. However, there are few studies looking at genetic influences on academic achievement beyond school education.

Using data from the Twins Early Development Study, funded by the Medical Research Council, the researchers found that genetic factors explained 57% of the differences in A-level exam results and 46% of the difference in achievement at university. They also found genetics accounted for 51% of the difference in whether young people chose to go to university and 57% of the difference in the quality of the chosen university.

Dr Emily Smith-Woolley, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), who co-led the research said: ‘We have shown for the first time that genetic influence on educational achievement continues into higher education. Our results also demonstrate that the appetite young adults have for choosing to continue with higher education is, in part, influenced by their DNA.’

The researchers also found that shared environmental factors — such as families and schools — influenced the choice of whether to go to university, accounting for 36% of the differences between students. In a previous study, the researchers also found shared environment accounts for almost 40% of the differences in whether students chose to take A-levels.

However, shared environmental influences appear to become less important over time for educational achievement. While shared environment accounts for up to 20% of differences in achievement in secondary school, the researchers found the influence of shared environment dropped off for achievement at A-levels and was negligible for achievement at university.

Dr Ziada Ayorech, from the IoPPN, who co-led the research said: ‘Unlike secondary school, where students tend to share educational experiences, university provides young people with greater opportunity to be independent and to carve out their interests based on their natural abilities and aptitudes. Students’ unique environments — such as new friends, and new experiences — appear to be explaining differences in university achievement and the role of shared environment becomes less significant.’

Interestingly, differences in the quality of university young people chose was strongly influenced by genetics (47%) even after accounting for A-level achievement, suggesting factors other than ability play an important role in university choice. University quality was assessed using the ‘Complete University Guide’ rankings for the year in which the students entered university.

The results were based on studying 3,000 pairs of twins from the UK as well as 3,000 genotyped individuals. Comparing identical and non-identical twin pairs allows researchers to determine the overall impact of genetics on how much people differ on measures like exam scores. If identical twins’ exam scores are more alike than those of non-identical twins this implies the difference between twin pairs is due to genetic factors.

Twin studies are not able to identify specific genetic variations which are linked to educational achievement. Nonetheless, the researchers were able to demonstrate a small genetic effect on university success just using DNA from individuals. They used ‘genome-wide polygenic scores’, which add-up the effects of thousands of DNA variants which have previously been linked to educational success in large genetic studies.

Genome-wide polygenic scores only explained a small fraction of the differences in A-level exam results, university achievement and young people’s choices in higher education, and not the higher percentages identified from comparing twins. The researchers say this discrepancy is because much larger genetic studies are needed to identify more DNA variants linked to educational success.

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Alzheimer’s: 7 Tips for Medical Visits

People who have dementia due to Alzheimer’s disease need regular medical care to address a range of health and behavioral issues. If you provide care for a loved one who has dementia, you’re sure to have lots of questions for his or her doctor—and limited time. To get the most out of your loved one’s medical appointments, consider these seven tips.

1. Schedule wisely.

Plan appointments for your loved one’s best time of day and, if possible, when the doctor’s office is least crowded. Bring snacks and water and a portable activity your loved one enjoys.

If going to the doctor has been a problem in the past, wait until the day of the appointment to tell your loved one. If necessary, offer a reward after the visit, such as stopping for ice cream on the way home.

2. Be prepared.

Make a list of issues you’d like to address with the doctor, such as concerns about medication side effects or aggressive behavior. Make a list of every medication your loved one takes, even over-the-counter medications and supplements, or bring the labeled containers in a bag. If your loved one lives in a facility, relay medications that your loved one is taking there or any concerns staff members might have.

Early in the disease, be sure to have your loved one sign a privacy release form at the doctor’s office, so the doctor can freely discuss your loved one’s medical condition with you.

3. Be specific.

Be ready to answer questions about your loved one’s symptoms and behavior. Have you noticed any changes in your loved one’s health, memory, mood, or behavior? When did the changes begin?

Do you have concerns about your loved one’s ability to drive or live independently? As the disease progresses, your insight might be the critical factor in determining what’s best for your loved one.

If the doctor prescribes medication for your loved one, find out exactly what time of day and how much of the drug should be taken. Ask why the medication is being prescribed and how long it might be before you see any improvement. Also, ask your doctor what side effects might occur.

4. Take notes.

Bring a pad and pen to jot down information from the doctor. You might also record the conversation so that you can listen to it again later. Or bring a friend or another family member and ask him or her to take notes or to stay with your loved one while you take notes. If you don’t understand something the doctor tells you, ask for clarification.

5. Consider the future.

Ask the doctor to discuss what to expect in the next year or two. You might ask about advance directives, long term care, or nursing home placement. You might also discuss hospice or palliative care. Knowing what to expect can help you prepare.

6. Ask for referrals or recommendations.

If you need help, ask. The doctor can refer you to various community resources, such as the local area agency on aging, meal services, senior centers, respite care, and support groups.

7. Deal promptly with conflict.

If something annoys you about a particular appointment or if a misunderstanding arises, discuss it with the doctor right away. Work as a team to resolve the problem, rather than rushing to switch doctors. A change could be confusing to your loved one and detrimental to his or her care in the long run.

Medical Appointment Checklist (PDF file requiring Adobe Reader)

Updated: 2016-11-29

Publication Date: 2002-12-05

Living With Asthma: 7 Rules You Should Always Follow

Living with asthma means that seemingly harmless substances can spark a cascade of events that leaves you gasping for air. (Asthma pathophysiology involves a pretty wild and terrible chain reaction.) Although medication can help subdue asthma symptoms like shortness of breath, coughing, chest pain or tightness, and wheezing, there are other steps you can take to lower the odds you’ll find yourself fighting to breathe. Here are seven life rules experts say everyone with asthma should follow.

1. Get your flu vaccine every year.

If you haven’t, you need to go get your flu vaccine (ideally before Halloween this year). It’s not something to shove down your to-do list until…surprise! It’s suddenly summertime and you never got your shot. This is especially true if you have asthma, even if it’s mild or well-controlled, according to the Centers for Disease Control and Prevention (CDC). Having asthma doesn’t raise your risk of coming down with the flu, but it makes it more likely that you’ll have complications like asthma attacks and pneumonia.

If you have asthma, your airways are prone to inflammation and producing excess mucus. The muscles surrounding your airways can tighten up, too. All of this prompts asthma symptoms. As the CDC explains, the flu can cause even more airway inflammation, which might make your asthma way worse or lead to complications. It can also make your airways more sensitive to the triggers that bring about symptoms in the first place. It’s no wonder that asthma is one of the most common conditions in adults who are hospitalized due to the flu, according to the CDC. Getting vaccinated can help you avoid that.

When you go in to get vaccinated, be sure to mention your asthma. While you could technically get the nasal spray vaccine, the CDC recommends people with asthma get the shot instead because the spray can cause wheezing.

2. Get vaccinated against pneumonia, too.

As you can tell, vaccines are kind of our thing. The CDC recommends that people with asthma stay up to date with their pneumococcal vaccination to protect against diseases like pneumonia, which, again, is especially likely in people with asthma.

There are two pneumococcal vaccines: the pneumococcal conjugate vaccine, which helps ward off 13 types of pneumococcal bacteria that commonly cause serious infections, and the pneumococcal polysaccharide vaccine, which targets 23 types of pneumococcal bacteria that can cause intense infectious illnesses. Ask your doctor which makes more sense for you, or discuss it with the pharmacist when you go get your flu shot—you can get both at the same time.

3. Know and avoid your triggers.

Everyone with asthma has triggers. Common ones include pollen, dust mites, mold, pet dander, respiratory infections like the common cold, cold air, exercise, smoke, and stress, according to the Mayo Clinic. Being exposed to a trigger can set off those respiratory system issues that make it hard to breathe properly.

It sounds like a no-brainer, but it’s worth spelling out here: “Avoiding kn​own triggers of asthma reduces the frequency and severity of asthma symptoms,” Jonathan Parsons, M.D., director of the Division of Pulmonary, Critical Care & Sleep Medicine at The Ohio State University Wexner Medical Center, tells SELF. If you’re not sure what your triggers are, talk to your doctor.

4. Regularly measure and record your peak airflow.

If you have asthma, you should use a device called a peak flow meter to measure how well your lungs expel air. This can help your doctor make decisions about your treatment and adjust your medications accordingly, the American Lung Association (ALA) says. Also, since it can be surprisingly tough to pick up on little changes in your ability to breathe, a peak flow meter can tip you off to problems before your symptoms become severe, Dr. Parsons says.

The price of peak flow meters varies depending on if you get a mechanical or electronic one, and that may also change whether or not your insurance covers it. Some are available for around $10, though.

If your readings start to vary from day to day or you notice they’re getting worse, it’s time to call your doctor about tweaking your treatment plan, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells SELF.

5. Keep tabs on how often you’re using your quick-relief inhaler.

A quick-relief inhaler is full of medication to open up your airways when your asthma is acting up. Clearly, an inhaler is a great part of your asthma toolkit, but if you’re relying on it a lot, it’s a sign that your asthma isn’t under control, the Mayo Clinic says.

If you have any questions about your asthma treatment or you feel like yours just isn’t as well-controlled as it should be, check in with your doctor. “Asthma, for all of its trouble, is largely a [manageable] disease,” Dr. Cascari says.

6. Don’t stop taking your medication just because you feel good.

In addition to a quick-relief inhaler, if you have asthma, you’re likely using long-term medicines meant to keep inflammation in your airways to a minimum. Don’t decide to just wean yourself off those or go cold turkey. “Many times, the reason people stop taking medicine is that they feel well,” Dr. Parsons says. “[But] the reason they feel well is the medicine is actually working.”

If your respiratory system seems fine and dandy and you’re interested in scaling back your medication, talk to your doctor. They should be able to weigh in on the situation and advise you on next steps.

7. Have an asthma action plan, and actually follow it.

An asthma action plan is a written document that outlines which medicines you should use based on the severity of your asthma symptoms (and at what doses). It also contains general information about your asthma triggers, your best reading from a peak flow meter, and phone numbers for your emergency contact and doctor. (This is why you should carry it around and give a copy to family members and friends who are around you regularly.)

If you and your doctor haven’t made one of these yet, you should do it soon. “The goal of an asthma action plan is to reduce or prevent symptoms and emergency department visits,” Dr. Parsons says.

Acting quickly when you start to have an asthma attack makes it less likely that it will become severe enough to require medical treatment, the Mayo Clinic says. Knowing exactly how to handle your symptoms makes it a lot easier to tame your condition and go on with your day.