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Antibiotic-resistance gonorrhoea now much harder & sometimes impossible to treat – WHO

Decreasing condom use, increased urbanization and travel, poor infection detection rates, and inadequate or failed treatment all contribute to the emergence of antibiotic-resistance gonorrhoea that is now much harder, and sometimes even impossible, to treat.

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Antibiotic-resistance gonorrhoea – a common sexually-transmitted infection – is now much harder, and sometimes even impossible, to treat. This is according to the World Health Organization (WHO), which released the dire warning following scrutiny of data from 77 countries.

The WHO, more specifically, reported widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones – are finding cases of the infection that are untreatable by all known antibiotics.

“The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” said Dr Teodora Wi, medical officer for human reproduction at WHO.

Worryingly, according to Wi, “these cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common.”

Every year, an estimated 78 million people are infected with gonorrhoea. Gonorrhoea can infect the genitals, rectum, and throat. Complications of gonorrhoea disproportionally affect women, including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV.

Decreasing condom use, increased urbanization and travel, poor infection detection rates, and inadequate or failed treatment all contribute to this increase.

The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in drug-resistant gonorrhoea. WHO GASP data from 2009 to 2014 find widespread resistance to ciprofloxacin [97% of countries that reported data in that period found drug-resistant strains], increasing resistance to azithromycin [81%], and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone [66%].

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Currently, in most countries, ESCs are the only single antibiotic that remain effective for treating gonorrhoea. But resistance to cefixime – and more rarely to ceftriaxone – has now been reported in more than 50 countries. As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give 2 antibiotics: ceftriaxone and azithromycin.

The R&D pipeline for gonorrhoea is relatively empty, with only three new candidate drugs in various stages of clinical development: solithromycin, for which a phase III trial has recently been completed; zoliflodacin, which has completed a phase II trial; and gepotidacin, which has also completed a phase II trial.

The development of new antibiotics is said to be not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished.

The Drugs for Neglected Diseases initiative (DNDi) and WHO already launched the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit research and development organization, hosted by DNDi, to address this issue. GARDP eyes to develop new antibiotic treatments and promote appropriate use, so that they remain effective for as long as possible, while ensuring access for all in need. One of GARDP’s key priorities is the development of new antibiotic treatments for gonorrhoea.

“To address the pressing need for new treatments for gonorrhoea, we urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline. In the short term, we aim to accelerate the development and introduction of at least one of these pipeline drugs, and will evaluate the possible development of combination treatments for public health use,” said Dr Manica Balasegaram, GARDP director. “Any new treatment developed should be accessible to everyone who needs it, while ensuring it’s used appropriately, so that drug resistance is slowed as much as possible.”

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Gonorrhoea can be prevented through safer sexual behavior, in particular consistent and correct condom use. Information, education, and communication can promote and enable safer sex practices, improve people’s ability to recognize the symptoms of gonorrhoea and other sexually transmitted infections, and increase the likelihood they will seek care. Today, lack of public awareness, lack of training of health workers, and stigma around sexually transmitted infections remain barriers to greater and more effective use of these interventions.

There are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea. Many people who are infected with gonorrhoea do not have any symptoms, so they go undiagnosed and untreated. On the other hand, however, when patients do have symptoms, such as discharge from the urethra or the vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even though people may be suffering from another kind of infection. The overall inappropriate use of antibiotics increases the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases.

“To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures,” said Dr. Marc Sprenger, director of Antimicrobial Resistance at WHO. “Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on that particular infection – and longer term, a vaccine to prevent gonorrhoea.”

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This report is based on two papers included in a special supplement of PLOS Medicine:

Health & Wellness

Lesbian, gay and bi adolescents at elevated risk for engaging in polysubstance use

Lesbian, gay and bisexual adolescents were more likely than heterosexual adolescents to be polysubstance users versus non-users across multiple classes of use: experimental users, marijuana-alcohol users, tobacco-alcohol users, medium-frequency three-substance users, and high-frequency three-substance users.

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Lesbian, gay and bisexual adolescents were more likely than heterosexual adolescents to be polysubstance users versus non-users across multiple classes of use: experimental users, marijuana-alcohol users, tobacco-alcohol users, medium-frequency three-substance users, and high-frequency three-substance users. In general, sexual orientation identity differences in polysubstance use class membership were larger for females, especially bisexual females, than for males.

These are the findings reported in “Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity”, an article published in LGBT Health, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.

The study by Robert W.S. Coulter, Deanna Ware, Jessica N. Fish, and Michael W. Plankey aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents (in this case, living in 19 US states). The researchers also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

The researchers analyzed data from 119,437 adolescents who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

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A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages.

“Compared with their heterosexual peers, gay/lesbian and bisexual adolescents—especially females—are at heightened risk of engaging in multiple types of polysubstance use,” the researchers concluded, recommending that “designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.”

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Health & Wellness

Teens face health and safety risks exploring sex online

Online sexual experiences can predict whether they become victims of sexual assault one year later.

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Photo by Sergey Zolkin from Unsplash.com

Teens spend hours every day on internet-connected devices, where limitless opportunities to explore sexuality online. These opportunities don’t come without big risks, though. A researcher from Michigan State University found that online sexual experiences can predict whether they become victims of sexual assault one year later.

The findings, published in the Journal of Youth and Adolescence and funded by the National Institutes of Health, are part of a study that is the first of its kind to investigate online sexual experiences using a person-centered approach, which identifies specific patterns of behaviors in sub-groups of people rather than general observations across a large group. This approach allowed researchers to track the girls’ online experiences – and subsequent offline experiences – more intricately than prior studies.

“It makes sense that engaging in risky behavior online would translate to offline risks,” said Megan Maas, research author and MSU assistant professor of human development and family studies at MSU. “But we were able to identify specific online behavioral patterns that correlated with susceptibility to different offline outcomes – which was never captured from conventional approaches before.”

Maas and colleagues assessed data from 296 girls between 14- and 17-years-old, who self-reported their online and offline sexual experiences over five years. Additionally, the girls would visit a lab each year for a trauma interview to measure experiences such as sexual abuse, assault or violence that may go undetected in a survey.

“By assessing the teens’ online sexual experiences using the person-centered approach, we were able to group the teens into four classes of experience patterns, which predicted sexual health and victimization outcomes one year later,” Maas said.

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The four classes were:

  • Online inclusive: These teens have a high probability of having several online sexual experiences, including looking at internet porn, chatting with strangers about sex, sending nude photos and posing provocatively on social media. This class often has strangers posting sexy comments on their social media accounts, requesting nude photos and soliciting them for sex.
  • Seekers: These teens purposefully seek out internet porn, chat with others about sex and post sexy photos on social media, but purposefully do not have a sexy profile picture and do not receive a lot of online attention from others.
  • Attractors: This class of teens gets attention from others online, though they’re not explicitly looking for it. They had a sexy social media profile, had people requesting nude photos, received comments about how sexy they are and have strangers solicit them for offline sex.
  • Online abstinent: This group had little probability in having online sexual experiences.

The goal was to pinpoint online patterns of sexual experiences related to three offline outcomes one year later: HIV risk, sexual assault and intimate partner violence, Maas said.

They discovered that attractors were more likely to be sexually assaulted than the seekers; online inclusive were likely to be sexually assaulted or engage in risky sex, especially if they’d experienced prior sexual abuse or assault; whereas, the seekers were more likely to have a physically violent romantic partner, especially if they’d experienced prior sexual abuse or assault.

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Maas explained that her findings demonstrate how critical it is for teens to receive education to understand how online sexual experiences may shape their offline experiences. Specifically, she hopes that schools and families will educate youth on sexual health and consent as well as healthy relationships, as their online experiences could have serious consequences.

“Rather than trying to tackle the impossible – like eliminating teens’ exposure to porn or ability to sext – we can and should educate them about these realities and risks and offer alternatives for learning about and expressing sexuality,” Maas said.

Maas hopes that her findings will inspire parents to proactively talk to their kids about risks they face online, as well as to establish rules early in their lives that can prevent girls’ from putting too much emphasis on their sexy social media presence.

“The best strategy for parents to follow is to limit time and space for internet usage,” Maas said. “Establish a time limit they can be on a device, and don’t allow screens in bedrooms. There are apps for parents that can help control screen time – and plenty of ways to involve their kids in activities that don’t rely on the internet at all.”

Next, Maas plans to explore why these online experiences predict offline risk and victimization. For instance, if teen girls feel obligated to engage in unwanted sexual activity if they have already sent a nude photo, or if boys feel entitled to sex from girls with sexy social media profiles. She hopes this follow-up study will clarify these findings to provide more specific guidance for sexual health and internet safety programming without attributing blame to survivors.

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Study suggests why some young adults may be more likely to engage in unsafe sex

A study found that heterosexual men tended to choose more passive strategies in condom negotiation (and were most likely to agree to sex without a condom); heterosexual women tended to choose more assertive strategies (like withholding sex); and MSM tended to aim for more verbal but selecting strategies that were not confrontational.

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Photo from Pixabay.com

Gender, sexual orientation, and the desire to form lasting romantic relationships appear to influence sexual risk-taking among young adults, according to a new research published in the Journal of Sex Research.

As far as the researchers are aware, this is the first study to directly compare how heterosexual men, heterosexual women, and men who have sex with men (MSM) differ in their approach to condom decision-making with a new sexual partner.

The findings may help explain why some young people engage in unsafe sex even though they are aware of the risk for sexually transmitted infections (STIs), HIV, cervical cancer, and unplanned pregnancy.

To explore this aspect of risk, researchers studied how heterosexual men (157 participants), heterosexual women (177), and MSM (106) aged 18-25 years, recruited from Amazon’s Mechanical Turk system (a crowdsourcing marketplace) and a university in Canada, make decisions about using condoms.

Participants were presented with a vignette describing an encounter with a hypothetical new sexual or romantic partner and were asked to rate their attitudes and likelihood of choosing particular courses of action, as well as their relationship motivation.

Results showed that all three groups had a preference for different condom negotiation strategies– heterosexual men tended to choose more passive strategies (and were most likely to agree to sex without a condom); heterosexual women tended to choose more assertive strategies (like withholding sex); and MSM tended to aim for a balance, choosing more verbal strategies than heterosexual men, but selecting strategies that were not confrontational.

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The findings may also explain some of the motives and reasoning that influence risky behaviours. For example, the study suggests that heterosexual women may be more willing to take risks when they both have stronger relationship motivation and view their partner as having more relationship potential.

“Understanding what factors make it more difficult to recognize risk during a sexual encounter, such as the desire for a long-term romantic relationship and partner familiarity, can lead to better prevention”, says Dr. Shayna Skakoon-Sparling from the University of Guelph, Canada who led the research. “It is particularly striking that women had lower expectations that their partner would be interested in condom use–this highlights how challenging heterosexual women expect the negotiation of condom use to be.”

The authors conclude that the findings have important implications for policy and prevention and should inform the creation of more effective sexual health education programs and interventions.

This is an observational study, so no firm conclusions can be drawn about cause and effect and the authors point to several limitations including that it did not involve women who have sex with women, or any other gender/sexuality minority groups, which could limit the generalisability of the findings. They also note that a hypothetical scenario may not invoke the same emotional response or reflect real-life behavior.

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Health & Wellness

Drugs used to enhance sexual experiences, according to study

While people of all genders and sexual orientations reported engaging in substance-linked sex, gay and bisexual men were more likely to have done so; homosexual men were 1.6 times as likely as heterosexual men to have used drugs with the specific intent of enhancing the sexual experience in the last year.

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Combining drugs with sex is common regardless of gender or sexual orientation. This is according to new research by UCL and the Global Drug Survey, which looked into global trends of substance-linked sex.

The findings, published in The Journal of Sexual Medicine, revealed that alcohol, cannabis, MDMA and cocaine are the drugs most commonly combined with sex.

Respondents from the UK were the most likely to combine drugs with sex, compared with the US, other European countries, Australia and Canada.

“While using drugs in combination with and to specifically enhance the sexual experience tends to be associated with gay and bisexual men, we found that in our sample, men and women of all sexual orientations engaged in this behavior. However, differences between groups did emerge,” said the study’s lead author, Dr. Will Lawn (UCL Psychology & Language Sciences). “Harm reduction messages relating to substance-linked sex in general should therefore not only be targeted towards gay and bisexual men, as they are relevant to all groups.”

As part of the Global Drug Survey, roughly 22,000 people responded to online questions about which drugs they used in combination with sex, in addition to questions about whether they used drugs to specifically enhance their sexual experience, and how these drugs affect the sexual experience.

Alcohol, cannabis, MDMA and cocaine were most commonly used, while GHB/GBL and MDMA were rated most favorably. For instance, MDMA increased ’emotionality/intimacy’ the most, while GHB/GBL increased ‘sexual desire’ the most.

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While people of all genders and sexual orientations reported engaging in substance-linked sex, gay and bisexual men were more likely to have done so; homosexual men were 1.6 times as likely as heterosexual men to have used drugs with the specific intent of enhancing the sexual experience in the last year.

Alcohol, cannabis, MDMA and cocaine were most commonly used, while GHB/GBL and MDMA were rated most favorably.
Photo by Roberto Roman from Unsplash.com

Drugs typically considered as ‘chemsex’ drugs – methamphetamine, mephedrone and GHB/GBL – were more commonly used by gay and bisexual men in combination with sex, which the researchers say highlights the continued need for certain targeted harm reduction messages.

As the survey respondents were self-selecting rather than a representative sample, the researchers say their estimates of prevalence will be substantially larger than the general population. However, relative differences between groups are expected to be reliable.

While country of residence was not asked specifically, currency was used as a proxy. This revealed that those from the UK were more likely to have combined all drugs, except for cannabis, with sex; this trend was particularly strong for mephedrone.

The researchers say that understanding how and why people use drugs is essential if we are to deliver harm reduction messages that are in touch with peoples’ lived experience.

“By engaging with your audience and accepting that drugs provide pleasure as well as harms, you can deliver harm reduction messages in a more trustworthy and nuanced manner,” said Lawn.

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Senior author Professor Adam Winstock, founder and director of the Global Drug Survey, added: “By appreciating how different drugs affect sex we can tailor our harm reduction messages. These pragmatic messages can save lives.”

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Health & Wellness

How easy is it to get on the Keto Diet train?

Our bodies know what’s going on when we are eating too much and thus, the digestive system begins to try and first hasten and then stabilize our metabolism. Eventually however, age will mean our bodies slow down whether we like it or not. You will put on more weight and easier, than when you were in your teenager years when you’re over 30.

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The majority of people don’t gain weight suddenly. It happens over a long extended period of time. Our bodies know what’s going on when we are eating too much and thus, the digestive system begins to try and first hasten and then stabilize our metabolism. Eventually however, age will mean our bodies slow down whether we like it or not. You will put on more weight and easier, than when you were in your teenager years when you’re over 30.

So how does this even happen? It’s the little things that eat away at your weight goals. The snacking between meals is definitely going to have an accumulative effect on our health. The bag of chips here and there will eventually pile up. Carbs are the thing you need to avoid or at least decrease in your overall diet. It’s not the butter on your toast that’s making you fat, it’s that plate of pasta or noodles that is doing the damage. The only modern solution when it comes to diets then is, the keto diet.

Do you want to know how you can jump aboard this train?

A leaner breakfast

For the most part the modern day breakfast is full of carbs. Take a look at your cereal box and for every 100 grams, check out the carbohydrates grams. It’s common for 100 grams of cereal to be made up of 40-50 grams of just carbs. That is a lot for just 100 grams and that should tell you what you’re up against. This normality of consuming so many carbs is astonishing in our culture. It should be the opposite whereby we focus on getting a leaner breakfast. If you’re unsure or are leaning towards not changing your breakfast habits, you’ll love this.

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Instead of a bowl of cheerios or granola, cook up 3 to 4 slices of bacon. Instead of a toast, cook yourself a French crepes omelette with chives, butter, tomatoes and some roast chicken. Rather than making yourself a bowl of oatmeal, make yourself a plate of smoked salmon and avocado. What’s not to like? What are you really missing out on if you didn’t have a big bowl of kellogs or weetabix this morning?

Not every meal is a hassle

Meals with carbs as the main part, are not as quick and easy to make as you might think. Pasta is by far the most popular dish when it comes to a carb-heavy meal. You might read on the back of a packet of rigatoni that it only takes 5 minutes to cook in boiling water, but how long will it take to bring the water up to a boil? In reality you’re looking at around 15 or 20 minutes to make a pasta dish with all the other ingredients. With a keto diet, you need only to begin cooking lean mean straight in a pan. Actually you don’t have to cook one meal out of your day. You can lower the risk of heart complications with KetoLogic which swaps one meal out for a KetoMeal that comes in the form of a milkshake. You’re not eating a meal that’s heavy in carbs but gives you some natural sugars, fats and proteins in one. This meal can be made in under a minute, so you have more time to get on with things in the day.

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No ditching the deserts

Contrary to almost every other diet out there, the keto diet doesn’t say you need to cut out deserts. In fact a cheesecake is quite within the normal boundaries of this diet. A lemon strawberry cheesecake is more than going to satisfy your cold sweet tooth. You can chop some fresh strawberries on top as well. Some whipped cream is also okay to have with it. Dairy ice cream is also allowed by this diet as really, you’re eating frozen fat and protein anyway. Butter chocolate tiffins are another great choice. The fat from the butter and the sugar from the chocolate is better than a slab of carbs such as a slice of cake. The only thing you need to take care of is though, is your calorie count. Don’t have a desert if it means you’re going to go over your limit.

The keto diet is incredibly inviting. You’re not missing out on anything. You get your fats and proteins from the bacon and eggs in the morning. You can take some salmon and salad with you to work. And still after dinner, enjoy a cheesecake or dairy ice cream. It’s little wonder that more people haven’t adopted this as their go-to diet.

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The benefits of sustained happiness

Maintaining a happy state of mind is not the easiest thing to do, but it does have some major benefits. We look at how happiness affects your body.

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The benefits of being happy…

For most people, happiness is an elusive state of being, a transitory experience that sneaks up on you on an idle Tuesday when you are drinking coffee and staring out the window. For a prejudiced community, or someone who is labelled as different, happiness can be even more fleeting.

The truth is that happiness is a skill that can be learned. Research has proven that levels of happiness can fluctuate depending on mental and physical input. Like any skill, it can be learned and perfected as long as you put in the time and effort to maintain a healthy mental state. The benefits of being happy are only now being researched and clinically proven. Here is how happiness can improve your quality of life.

STRONGER IMMUNE SYSTEM

The link between body and mind has long been discussed and debated on. Today, clinical experiments have proven that people exposed to the common cold are less likely to get sick if they are in positive emotional state. Researchers found that people who people who experienced longer periods of calmness, humility and happiness didn’t get sick and if they did, their recovery time was much shorter. They also found that if a person is depressed, moody or angry, their immune system was more vulnerable to attack.

Researchers found that people who people who experienced longer periods of calmness, humility and happiness didn’t get sick and if they did, their recovery time was much shorter.

BETTER HEART HEALTH

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It may sound clichéd, but happiness really is good for your heart, and that’s why having fun and playing at the mobile casinos Canada has to offer can actually keep you healthier! Multiple experiments have been done on heart health and happiness. The most significant research was done over a 10-year period where people were asked to rate their happiness levels every month while their blood pressure and cholesterol levels were tested. The data shows a direct correlation between a happy disposition and lower cholesterol and lower blood pressure.

IMPROVED PHYSICAL FUNCTION

While more research needs to be done in this area, some data shows that being happy can reduce the amount of pain you feel from inflammation or physical ailments. The feedback loop then kicks in allowing you to be more physically active which releases endorphins, which makes you feel happier and healthier. Just improving your outlook on life can change how you look on the outside.

LONGEVITY

Research into happiness and longevity is still on going but initial data shows that happier people tend to lead a more active and productive lifestyle, which in turn leads to a longer life.

The truth is that happiness is a skill that can be learned. Research has proven that levels of happiness can fluctuate depending on mental and physical input.

HOW TO KICK START YOUR HAPPINESS?

There are a few simple ways to boost your mood and get you on the path to sustained happiness.

  • Eat a healthier diet – Research has shown that eating more fruits and vegetables improves your diet, your mood and your health.
  • Get a good night’s sleep – Sleep is essential for maintaining a healthy body and mind. If you want to boost your mood, get a solid 7 to 9 hours of uninterrupted sleep every night.
  • Get out into nature – Studies have shown that being outside, in a park or in nature can boost your mood and your mental outlook. Just five minutes in nature can do more for your body than most prescription drugs.
  • Get active – Daily physical activity is the key. Do something physical every day and you body will thank you for it. Not only will you be physically stronger, you will also feel happier and more alive.
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