P2JW013000-6-D00100-1--------XA CMYK Composite CL,CN,CX,DL,DM,DX,EE,EU,FL,HO,KC,MW,NC,NE,NY,PH,PN,RM,SA,SC,SL,SW,TU,WB,WE BG,BM,BP,CC,CH,CK,CP,CT,DN,DR,FW,HL,HW,KS,LA,LG,LK,MI,ML,NM,PA,PI,PV,TD,TS,UT,WO Weighing Issue How Often Should You Go on the Scale BURNING QUESTION D4 © 2015 Dow Jones & Company. All Rights Reserved. Eric Gay/Associated Press HEALTH & WELLNESS Buckeyes Prove Themselves SPORTS D6 THE WALL STREET JOURNAL. * * * * * * Tuesday, January 13, 2015 | D1 Tot Therapy: Psychiatrists Join Up With Pediatricians How Well Are You Listening? We’re Naturally Bad Listeners, Even With Loved Ones; Steps to Avoid ‘Burnout’ BY ELIZABETH BERNSTEIN BY MELINDA BECK PHASES OF LISTENING WELL Many parents know the scenario: Their child shows signs of anxiety or depression, throws fits or has trouble focusing. They tell the pediatrician, who has only 15 minutes to see them, a crowded waiting room and limited experience with mental-health issues. If the problem seems serious, the parents get a list of child psychiatrists or psychologists to call. There is a monthslong wait to see them and many don’t take insurance. It is little wonder that only about 1 in 5 children with diagHEALTH nosable mental-health JOURNAL problems gets treatment. Now, more pediatricians are embedding mental-health professionals into their practices, where they can help spot problems early, provide care fast or reassure parents that a child’s behavior is normal. Integrated care, as it is called, has other advantages: Pediatricians often see patients annually for a decade or more and follow families closely. If issues arise, instead of giving parents a referral, they can do a “warm handoff,” personally introducing them to a therapist down the hall. In some practices, mental-health professionals The very first step, before the conversation even begins, is to pick up on hints and signals that the other person needs to talk. You seem swamped. I feel totally swamped, too. Actually, I have a little time right now. Everything OK? Let the other person disclose the issue. Acknowledge and provide legitimacy for their experience and feelings. If you dismiss or minimize, the conversation will probably end. Something bad happened this morning. I went to that job interview, and I really messed up. Oh, no! What happened? Encourage the other person to elaborate. Ask open-ended questions. Use verbal cues to show you want to hear the whole story. Lean forward. Make eye contact. I prepped for four hours last night, and I made notes of all my recent projects. But I just couldn’t concentrate. I kept yawning! I couldn’t remember what to say. It was like my brain was frozen. I’m so discouraged. There is less stigma associated with a doctor’s office than a mental-health clinic, so families are more receptive to treatment. Oh, dear. Did you feel like you were getting sick? Did you get enough sleep? Show you heard what the other person said by paraphrasing and using a verbal ‘checkout.’ So you stayed up late, you got up early, and you couldn’t concentrate—is that right? Continue asking questions and listening so you can collaborate together on possible solutions. Yes, I am exhausted. I’m not sleeping well, and I feel totally run down. I’m getting nowhere. Hmmm. Let’s think. Do you feel qualified for the jobs you are interviewing for? Or is there some other kind of work you’d rather focus on? Scotty Reifsnyder When Traci Ruble and her husband, Clemens Gantert, climbed into bed one night recently, he began telling her about his day at his software startup. He explained that changes in a state law would affect his business. And he told her about a technical problem he was having with a security certificate for the software. After several minutes, Ms. Ruble turned to look at him. Then she burst out laughing, picked up the remote and turned on the TV. “Whatever you are saying is like speaking Greek to me,” said Ms. Ruble, who is a marriage and family therapist. “I can’t believe you get paid to listen for a living,” Mr. Gantert replied, calling her on her behavior. Why is it so hard to listen to our loved ones? Experts say we’re naturally just not good at listening for a whole range of reasons. We have a tendency to swap stories, so we interrupt. We’re uncomfortable with emotions, so we avoid focusing too closely on someone else’s. We’d rather talk about ourselves, so we rush the talker along. And there is something relationship researchers call “listener burnout.” We’ve all endured someone’s endless droning on and on, often about the same old problems. When we offer quick advice or suggest ways to fix the situation, we may be unconsciously trying to protect ourselves from burnout. “Good listeners overcome their natural inclination to fix the other’s problems and to keep the conversation brief,” says Graham D. Bodie, an associate professor of communication studies at Louisiana State University, who studies listening. It isn’t as easy as it sounds. Practice “active listening,” a term experts use to describe the way you listen when you are an engaged presence in the conversation, fully in the moment with the other person, not just sitting there, half paying attention. Think of the different ways you can listen to music. You can put it on in the background while you’re doing something else. Or you can put on your headphones, give it your undivided attention and really notice how it affects you. That is active listening. To actively listen to a person, you will need to master certain behaviors—some verbal, some nonverbal—that signal your interest. Researchers call these “immediacy behaviors.” Start by putting your phone away and turning off the TV. Sit close to and lean toward your loved one. Let your facial expressions reflect what he or she is saying. Be sure to make eye contact. (Your mother was right when she said, “Look at me when I am Please turn to page D4 evaluate patients and devise treatment plans that pediatricians or nurses carry out. Currently, it often takes eight to 10 years from when symptoms are first noticed before children get care for mental-health issues, says Gregory Fritz, president-elect of the American Academy of Child and Adolescent Psychiatrists, which endorses integrated care. By combining forces with primary-care doctors, “the potential to intervene early and make a lifelong difference is huge,” he says. There is less stigma associated with a doctor’s office than a mentalhealth clinic, so families are more receptive to treatment. Medical issues such as stomach aches, headaches, asthma and obesity often have psychological components and vice versa. “Our mantra is, let’s put the head back on the body and treat the whole child,” says Marian Earls, a member of the Mental Health Leadership Work Group at the American Academy of Pediatrics, which has championed integrating medical and mentalhealth care for years. Integrated care has been slow to catch on. Only about one-quarter of pediatric practices have some sort of formal arrangement with mentalhealth professionals, Dr. Earls estimates. Coordinating insurance is a Please turn to the next page People gargle mouthwash thinking it will get rid of bad breath, but that is the minty liquid’s least effective function. Dentists say mouthwash and other rinses can be beneficial to overall oral health and an important part of daily oral hygiene routines but aren't essential. Mouthwashes can be divided into two main categories: cosmetic and therapeutic. Cosmetic YOUR rinses reduce and HEALTH help control bad breath and leave a pleasant taste in the mouth, said Peter Arsenault, division head of operative dentistry at Tufts University School of Dental Medicine. But, “they don’t really deal with the actual cause of bad breath—they don’t kill the bacteria and they don’t chemically inactivate the compounds that cause bad breath,” said Dr. Arsenault. Therapeutic rinses have more targeted functions and come both overthe-counter and by prescription. They can help reduce tooth plaque or gingivitis, inflammation of the gum which can lead to gum disease. They can also help neutralize the acidity of the mouth to lessen the decay pro- cess. They may hydrate individuals who suffer from dry mouth, and help soothe canker sores. Fluoride and xylitol rinses aid in cavity prevention. Sales of mouthwash have been robust, increasing each year over the past five years, according to data from Euromonitor International, a market research firm. In 2008 sales of mouthwashes and rinses totaled $1.4 billion and were projected to go up to $1.5 billion in 2014. The American Dental Association, a professional association of dentists, tests products and has a council on scientific affairs which evaluates products to determine if they are safe and effective. Those that pass the tests receive a seal, which can be found on the product. Currently, 128 mouthwashes have the seal. The ADA has found just two products that satisfy claims they eliminate bad breath and neither are mouthwashes. They are toothpastes, said Clifford Whall, director of the seal of acceptance program at the Chicago-based ADA. Some therapeutic rinses work by neutralizing the pH of the mouth, said Dr. Arsenault. When the bacteria in our mouth consume carbohydrates and sugars, their metabolic waste is acid. The acid draws out the minerals, resulting in an acidic mouth that leads to tooth decay. An important ingredient to look for in such rinses is xylitol, a naturally occurring sugar alcohol which certain bacteria are unable to metabolize. “It kind of results in the bacteria in your mouth choking,” said Dr. Arsenault. Xylitol stimulates salivary function due to its sweetness and taste and helps restore the mouth to a neutral level of acidity. But some dentists, such as Judith Jones, a professor of general dentistry at Boston University, recommend looking for alcohol-free mouthwashes because they can dry out the mouth. A dry mouth can end up encouraging bacterial activity, resulting in worse breath. Alcohol is used as a preservative—to increase the shelf life of mouthwash—and as a carrier for flavor. The alcohol itself isn't the antispectic. Rather, it dissolves essential oils (like menthol and eucalyptol) or active ingredients, which together have an antiseptic effect. The therapeutic mouthwashes with the ADA seal currently have alcohol in them, said Dr. Whall. “Your saliva is more than adequate to keep the mouth moist,” said Dr. Whall. “It might be an issue for people who have dry mouth,” as alcoPlease turn to the next page Sales of mouthwash are rising as people seek to control breath and tooth decay. P2JW013000-6-D00100-1--------XA BY SUMATHI REDDY Alamy Rinse Well: Mouthwash Is More Than Just a Minty Taste Composite MAGENTA BLACK CYAN YELLOW
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