Touseprose

Brittany Jordan-Arthur was at loggerheads with her 7-year-old daughter one recent morning. The little girl simply did not want to head out the door to summer camp, finding any and all excuses to hang back.

But instead of expressing exasperation or annoyance — knowing that would make her daughter dig in her heels even more — Jordan-Arthur, a psychologist at Harvard-affiliated McLean Hospital, decided to use a valuable communication technique: validation. Like many skills, the more you practice validation, the easier it becomes to apply when it’s most needed. Here’s what to know and do.

What is validation?

An approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

And that’s precisely what happened in Jordan-Arthur’s stalemate with her daughter.

“I just sat with her and said, ‘You really don’t want to go.’ It was a great example of saying, ‘I hear you,’ and ultimately I didn’t tell her she had to go or why — she came to that conclusion herself,” Jordan-Arthur says. “We walked out the door without all the need for explanations.”

Many try validation but don’t succeed

Validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. How?

“They jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

How can you offer validation?

Jordan-Arthur shares these pointers for validating another person:

• Give them your full attention.
• Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
• Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
• Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
• Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Does validation condone troubling behavior?

Validation isn’t the same as condoning someone’s bad or frustrating behavior, Jordan-Arthur notes. It’s not akin to reassuring them when reassurance isn’t appropriate.

“You may be afraid you’re going to communicate that you approve of their behavior or agree with their actions or choices,” she says. “But if you slow down and validate how someone feels in the moment, before a poor decision is made, validating accomplishes exactly the opposite.”

Try this phrasing instead:

• “I hear that this is important to you.”
• “I can see how this has been so upsetting/difficult/scary for you.”

How can you validate teens?

Validating teenagers isn’t dissimilar from the tactics Jordan-Arthur used with her 7-year-old — the problems just tend to be bigger. For example, teens often feel stuck with teachers they don’t like or complain that teachers seem overly harsh.

“Parents have lots of urges to say, ‘Oh, the teacher isn’t that bad’ or ‘I’m sure they mean well,’ defending the teacher and his or her perspective,” Jordan-Arthur says. “The odds are, by the time a kid is a teen, they also have that skill, but it’s going to take them a moment to get there.”

Here’s what to say instead:

• “I hear that you don’t feel respected.”
• “It’s so hard to feel helpless.”
• “It’s difficult to feel your teacher has control over how well you do in class.”

“You can validate their feelings even if you feel the teacher is being respectful,” Jordan-Arthur adds.

How can you validate adults?

Validating other adults in your professional or personal life involves much the same approach. With a colleague who’s feeling undervalued at the office, for instance, try saying, “It makes total sense that you’re feeling really frustrated. I know how important your work is to you.”

If you’re arguing with a spouse or partner, you can believe them as being genuine, Jordan-Arthur says, despite a difference of opinion. Try saying, “I can tell that this issue feels really important to you and you want me to pay attention to what you’re saying.”

It’s also wise to pay attention to the other person’s body language during heated moments. After validating them — but before offering a potential solution to a problem — look for clues that they’re calming down, such as breathing and gesturing more slowly.

“I encourage people to count to 10 in their heads, because we still tend to jump the gun and not wait for the other person to feel that validation,” she says. “If we do that, they’ll often move past the idea that ‘this person wronged me’ and start solving the problem on their own.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Picture this: you’re with friends in an unfamiliar forest using only a map and a compass to guide you to an upcoming checkpoint. There are no cell phones or GPS gadgets to help, just good old brainpower fueled by a sense of adventure as you wind through leafy trees and dappled sunlight.

This is not an excursion to a campsite or a treasure hunt. It’s a navigation sport called orienteering — a fun way to get outside, exercise, and maybe even help fight cognitive decline, according to a 2023 study.

What is orienteering?

Orienteering combines map and compass reading with exercise. Competitors (“orienteers”) race against a clock to reach checkpoints in outdoor settings that can range from city parks to remote areas with mountains, lakes, rivers, or snowy fields.

“You can go out in a group or on your own. You get a very detailed map and navigate your way to checkpoints that record your time electronically,” says Clinton Morse, national communications manager with Orienteering USA, the national governing body for the sport in the United States.

Because orienteers are racing the clock, they might run on trails, hike up hills, or scramble around boulders. That’s for foot-orienteering events. There are also orienteering events with courses geared for mountain biking, cross-country skiing, or canoeing.

How might orienteering affect thinking skills?

A small 2023 study published online in PLoS One found a potential link between orienteering and sharp thinking skills.

Researchers asked 158 healthy people, ages 18 to 87, about their health, activities, navigation abilities, and memory. About half of the participants had varying levels of orienteering experience. The other participants were physically active but weren’t orienteers.

Compared with study participants who didn’t engage in orienteering, those who were orienteers reported

• having better navigational processing skills (recognizing where objects were, and where participants were in relation to the objects)
• having better navigational memory skills (recalling routes and landmarks).

The study was observational — that is, not a true experiment — and thus didn’t prove that orienteering boosted people’s thinking skills. But the link might be plausible.

“Aerobic exercise releases chemicals in the brain that foster the growth of new brain cells. And when you use a map and connect it to landmarks, you stimulate growth between brain cells,” says Dr. Andrew Budson, lecturer in neurology at Harvard Medical School and chief of cognitive and behavioral neurology at VA Boston Healthcare System.

Where can you find orienteering opportunities?

There are about 70 orienteering clubs across the United States, and many more around the world (the sport is extremely popular in Europe). To find an orienteering event in your area, use the club finder tool offered by Orienteering USA.

How can you get started with orienteering?

People of all ages and athletic levels can take part, because orienteering courses vary from local parks to wilderness experiences. Costs are about $7 to $10 per person for local events, or $25 to $40 per person for national events, plus any travel and lodging expenses.

To make orienteering easy at first, Morse suggests going with a group and taking things slowly on a short novice course. “You don’t have to race,” he says. “Some people do this recreationally to enjoy the challenge of completing a course at their own pace.”

The trickiest part is learning to read the map. Morse’s advice:

• Turn the map as you change directions. Hold the map so that the direction you’re heading in is at the top of the page. For example, if the compass indicates that you’re heading south, turn the map upside down, so the south part is on top and easier to follow.
• Create a mental image of what the map is telling you. If there’s a fence along a field on the map, build a picture of it in your mind so you can recognize it when you see it, even if you haven’t been there before.

Tips for safe and enjoyable orienteering events:

• Dress appropriately. Wear comfortable clothes including long pants, good walking shoes, and a hat.
• Lather up. You’ll be outside for at least an hour, and you’ll need sunblock and possibly tick and bug spray depending on the terrain. Preventing tick bites that can lead to Lyme disease and other tick-borne illnesses is important in many locations.
• Bring some essentials. Pack water, a snack, sunblock, bug spray, and your phone. (Keep the phone turned off unless you need to call for help.)
• Use good judgment. Know that the shortest route on the map won’t always be the best, since it might take you up a hill or through thick vegetation. It might be better to go around those areas.

Once you learn the basics of orienteering, you can make it more physically challenging (and a better workout) by going faster and trying to beat your previous times, or by signing up for a more advanced course that’s longer and requires more exertion and speed.

And no matter which event you take part in, enjoy the adventure. “You’re not just following a path, you’re solving puzzles while being immersed in nature,” Morse says. “It’s a great way to experience the outdoors.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Just about everyone has met or seen someone who has a tic disorder. Many tic disorders are diagnosed during childhood. Less often, a tic disorder like Tourette syndrome is diagnosed in adulthood — as was the case for Scottish singer Lewis Capaldi.

What are tics?

Tics are very common, with as many as one in five children experiencing them at some point. They can be a motor tic, which is a sudden brief movement — like a shrug, finger tap, or grimace — or they can be a noise, such as a word, grunt, or throat clearing.

In some cases, the movements or noise can be more complex, such as an unusual way of walking, saying particular words, or echoing the words of others (echolalia). Tics are involuntary, although they can sometimes be suppressed.

Tics may be temporary or long-lasting: about a third will go away entirely, a third improve with time (sometimes with treatment, though it's often not needed), and a third are long-lasting.

What is Tourette syndrome?

If someone has both motor and vocal tics that last more than a year, starting in childhood, they are said to have Tourette syndrome (TS).

It’s hard to know exactly how common Tourette syndrome is, as many children go undiagnosed. The Centers for Disease Control and Prevention (CDC) estimates that one in 162 children has Tourette syndrome. TS is about four times more common in boys than girls.

What causes Tourette syndrome?

We don’t know exactly what causes TS. There are likely some genetic factors, but psychological and environmental factors play a role as well.

Many children with TS also have either attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). Stress, fatigue, or excitement can make tics worse, as well. There has also recently been an increase in tic disorders — some meeting criteria for TS — among teens who have seen videos of others with tics on social media. These are called functional tic disorders.

What age is Tourette syndrome most likely to start?

TS usually begins between 2 and 15 years, with an average age of onset of 6 years, although in some cases it shows up later in the teen years. While TS usually gets better or completely resolves during adolescence and adulthood, it can be really tough for kids who have it. Having TS increases the risk of anxiety, school problems, sleep problems, mood disorders, and even suicide.

How is Tourette syndrome treated?

There is no cure for tics, but there are ways to make them more manageable and less frequent, which can make a big difference.

• CBIT. This approach involves training a person to recognize when the tics are going to happen and engaging a competing response that is more socially acceptable. It could be something like taking deep breaths, or substituting a different, more subtle movement for the disruptive one. This is called comprehensive behavioral intervention for tics, or CBIT. It can be very effective; the problem is that it can be difficult to find therapists trained in this form of treatment, and it is not always covered by insurance.
• Medications. If CBIT is not an option or not adequately helpful, medications are sometimes prescribed. Medication is usually not necessary, and is always a second choice behind behavioral therapy.

To learn more about TS and how to manage it, you can visit the CDC page, the NIH page, or the website of the Tourette Association of America.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

The media uproar that swirled a few weeks ago around leprosy in the US drew attention away from ongoing heat and extreme weather that pose far more danger to most of us. But does a single case of a man diagnosed with leprosy in central Florida suggest that anyone anywhere in the US could get leprosy? Might this become the next pandemic? Just how worried should we be?

Read on to set the record straight about leprosy. (Spoiler alert: there will be mention of armadillos.)

Why did leprosy make the news?

In August, one case of leprosy in central Florida was described in the journal Emerging Infectious Diseases. This report was widely covered by the news media, with headlines like “CDC confirms leprosy outbreak in Florida: What to know if you’re traveling to the state” (WKYC) and “Central Florida is a hot spot for leprosy, report says” (CNN).

One reason for concern raised by experts was the fact that the man diagnosed had no identifiable risk factors for the disease. That is, he had not traveled to a place where leprosy is common and had no contact with anyone who had the disease. Past research has suggested the organism that causes leprosy can survive in soil. And that raised the possibility that this man’s work as a landscaper put him at risk for leprosy.

What is leprosy?

Leprosy, or Hansen’s disease, is a chronic infection caused by Mycobacterium leprae bacteria. (That’s a close relative of the organism that causes tuberculosis.) This ancient disease, which affects skin, nerves, and linings of the eyes and upper respiratory tract, is described in some of the earliest human writings (including the Old Testament), and genetically identified in archeological remains dating back to 2000 BC.

Common symptoms of leprosy include:

• red and/or thickened patches on the skin
• reduced sensation, numbness, or weakness in the hands or feet
• nonhealing wounds, blisters, and cracks in the skin of the hands or feet.

Left untreated, this may lead to skin deformities. Surgical amputations may be necessary to control skin ulcers that fail to heal or are chronically infected.

How does leprosy spread?

Usually, the infection spreads from person to person through respiratory droplets shared during prolonged, close contact. Coughing or sneezing, for example, can release respiratory droplets, which can be breathed in by people who are nearby.

Some cases of leprosy have been linked to animal contact, such as the nine-banded armadillo and Eurasian red squirrels.

However, in about a third of cases, no clear risk factor can be identified.

How common is leprosy?

For most people in the US, leprosy is not a major health concern. In recent years, about 180 cases of leprosy have been diagnosed annually. Though this represents an uptick from fewer than 100 cases in 1999 and 2000, the disease remains rare in the US.

Worldwide, it’s a different story: according to the World Health Organization, more than 200,000 cases in 120 countries are diagnosed each year. The highest numbers of cases are in Brazil, India, and Indonesia.

Has leprosy become common in Florida?

No. There have been about 20 cases per year in Florida since 2015. As is true nationally, this represents an increase from prior years.

But some experts speculate that leprosy may be endemic now in central Florida, where about 80% of the state’s cases are diagnosed. Endemic means there are enough sources of infection (such as infected people or animals) in a particular area to allow the disease to spread, even if no new cases are brought in from elsewhere.

Since some people with infection have no risk factors for the disease, it’s possible leprosy has become endemic there. But that remains unproven.

Myth versus truth: Common misconceptions about leprosy

Misunderstanding fuels stigma and discrimination against people who have leprosy. Maybe you’ve heard some of these falsehoods.

The myth: Leprosy is extremely easy to spread. In the past, this myth led to isolation of people with leprosy in “leper colonies” that quarantined entire communities of people with the infection.

The facts: About 95% of people are naturally immune to leprosy. And, because spread of infection between people requires close and prolonged contact, it’s not nearly as contagious as many other infections. So it’s not readily spread by being in a room with an infected person, or by touch. And, within one week of treatment (see below), a person with leprosy is no longer contagious. As a result, isolation from others is unnecessary.

The myth: Leprosy causes parts of the body, such as fingers or ears or the nose, to fall off.

The facts: Body parts do not fall off. Sometimes surgical amputations are needed to treat nonhealing wounds and infections, two complications of longstanding nerve damage related to leprosy.

The myth: There are no treatments for leprosy.

The facts: There are effective antibiotics for leprosy. To cure the infection, people may need to take a combination of different antibiotics for a year or more.

The bottom line

Some of the news coverage on the case of leprosy in Florida seems more dire than necessary. In fact, the risk of developing leprosy in central Florida, or elsewhere in the US, remains exceedingly low.

And it’s highly unlikely leprosy will become the next pandemic. However, some experts predict that vulnerable populations in the US, such as homeless people living in close contact with poor hygiene and inadequate medical care, could experience outbreaks of leprosy in the future.

While risk seems low now, it’s a good idea to keep leprosy in mind if you have unexplained rashes or nerve damage, especially if you live in a place where the disease is common or have had contact with an infected person. Otherwise, there’s little reason to have leprosy on your short list of health concerns.

Follow me on Twitter @RobShmerling

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Summer is an ideal time to take a hike, especially if you have the opportunity to explore one of our country’s many state and national parks. But if you venture far from home, it’s essential to make sure you’re prepared for the local climate and other conditions you may encounter on the trail, especially if you’re not an experienced hiker. Higher temperatures than you’re accustomed to or other extreme weather can be deadly.

“If you’re taking a hike in mid-July in the Arizona desert, there’s a very different list of considerations than if you’re in the mountains of Montana or the forests of North Carolina,” says Dr. N. Stuart Harris, chief of the Division of Wilderness Medicine at Harvard-affiliated Massachusetts General Hospital. Here’s a run-down of what to consider before you hit the trail.

Traveling companions, safety notifications, and orientation

First, it’s safer to travel in pairs or a group of people. But always tell someone not on your hike where you’re going, your anticipated route, and when you expect to return. National parks often require reservations or permits for overnight stays or treks to certain locales, and keep a record of day-hikers, so sign up as requested. If you end up getting injured or lost, the information can make a huge difference in locating you more quickly.

Remember to bring a map and know how to orient yourself. In many wilderness areas, cell service may be spotty or nonexistent, so don’t count on using your phone’s GPS.

In the desert, you may be able to see for 50 miles in the distance. But if you’re in a steep, wooded area, you might not be able to see 100 yards ahead and it’s much easier to become disoriented, says Dr. Harris.

Be ready for heat, humidity, and other weather hazards

Check forecasts first. Always check the forecast so you can be prepared for weather changes. Temperatures may drop and wind may increase as you climb higher. If you’re in an area prone to thunderstorms, lightning injury should definitely be on your radar, says Dr. Harris. Learn these lightning safety tips from the Centers for Disease Control and Prevention. Because these storms usually strike in the afternoon, you can minimize your risk by hiking in the earlier part of the day.

Hydrate well. During any type of exercise — especially hiking, which often demands a fair bit of exertion — be sure to drink extra water to replace the fluid you lose from sweating. On a warm day, you might not notice you’re sweating if it’s breezy. Pay attention to any signs or alerts advising hikers on how much water is best to carry.

Consider humidity. Temperature isn’t the only consideration, however. “If you’re in Arizona and the temperature is over 100° F, your body may be better able to release heat by sweating than if you’re in a very humid area,” says Dr. Harris. In the Great Smoky Mountains, for example, the temperature in July may be only in the high 80s. But humidity levels usually hover around 75% or higher. That means your sweat will evaporate more slowly, so your body’s natural cooling mechanism doesn’t work as efficiently. Be sure to rest and hydrate if you start feeling overheated.

What to wear and bring

Many park websites offer detailed safety tips specific to the terrain and weather you may encounter on a hike, so check before you go. Five basics to consider are as follows:

• If your hike involves rocky or uneven terrain, hiking boots will offer more support than tennis shoes.
• You’ll be more comfortable in lightweight, moisture-wicking clothing, but bring extra layers and rain gear, if the weather forecast suggests this is appropriate. Temperature drops can be surprising in some places when the sun wanes, so be prepared to layer up as needed if you’re out longer than expected.
• Wear a wide-brimmed hat and sunglasses to shield you from the sun’s glare — and don’t forget to apply sunscreen to all exposed skin before you set off.
• Along with plenty of fluids, bring high-energy snacks. If you get off course or encounter a problem, you’ll be glad you did.

Additionally, depending on where you’re hiking, you may need to dodge rash-inducing plants, including stinging nettles, poison oak, or poison ivy. Bring insect repellent to fend off biting insects and follow prevention strategies for ticks, which may harbor bacteria responsible for Lyme disease and other illnesses. Finally, carry a first aid kit with bandages for cuts and scrapes and moleskin for blisters.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Think of prostate cancer surgery and what likely comes to mind is a radical prostatectomy, which is an operation to remove the entire prostate gland along with the seminal vesicles that produce semen. However, men with localized prostate cancer — meaning cancer that is still confined to the prostate — have another surgical option.

Called focal therapy, this alternative procedure treats only the cancerous part of the prostate and leaves the rest of the gland intact. The aim is to remove “clinically significant” tumor tissue, cancer that would spread further if it wasn’t treated at all. While there is a small risk that some cancer may be left behind after treatment, focal therapy also has the benefit of minimizing risks for erectile dysfunction and urinary incontinence, which are both potential side effects of radical prostatectomy. And growing evidence shows it can be an effective strategy.

Last year, researchers reported that 1,379 men treated with focal therapy or radical prostatectomy had similar cancer outcomes after five years of follow-up. The men were 66 years old on average, and doctors treated them with a technique called high-intensity focused ultrasound, or HIFU. This approach destroys cancer by subjecting it to high-energy ultrasound waves that heat tumors to high temperatures.

Now, findings from the same research team show that focal therapy is also an effective option for older men with prostate cancer. During this newer study, researchers assessed outcomes for 649 men ages 70 and above who were treated at 11 sites in the United Kingdom. Two-thirds of the men had cancer with an intermediate risk of further spread, and the remaining third had more aggressive, high-risk prostate tumors that are more dangerous.

All the men were treated with HIFU or a different type of focal therapy, cryotherapy, that destroys cancer by freezing it. The primary goal of the study was to assess “failure-free survival,” whereby treated men avoid a prostate cancer death, or worsening disease leading to further interventions.

What the data reveals

After follow-up durations ranging up to five years, 96% of the men were still alive, and the overall failure-free survival rate was 82%. No differences in outcomes between HIFU- and cryotherapy-treated men were reported. The men with high-risk cancer had worse outcomes: their failure-free survival rate was 75%, compared to 86% among men with intermediate-risk disease.

But 88% of the high-risk men and 90% of the intermediate-risk men also avoided hormonal therapy, a treatment that — because of its side effects — most men don’t want. The authors concluded that focal therapy may be an acceptable treatment that controls prostate cancer in older men as well as radical prostatectomy does.

It’s important to note that complications from focal therapy are possible. For instance, a small percentage of men in the new study developed urinary tract infections, and some also wound up with urinary retention, a treatable condition that occurs when the bladder can’t empty completely. The authors didn’t assess functional outcomes after surgery, such as erectile dysfunction or urinary incontinence. But mounting evidence from other studies shows that long-term urinary incontinence after focal therapy is very rare.

The findings are encouraging, but Harvard experts emphasize that more evidence with focal therapy is still needed. “Despite promising results such as those reported in this and other studies, long-term outcomes (e.g., 10 to 15 years or more) following focal therapy must still be assessed to fully determine how this treatment option compares to radical prostatectomy or radiation therapy,” says Dr. Boris Gershman, aurologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School focusing on prostate and bladder cancer. “Additional studies can also help us refine the types of prostate cancer that focal therapy is most appropriate for, and which types should be given therapies that treat the entire prostate gland.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

When you’re low on energy, is it worth trying yerba mate, yaupon tea, matcha, and other beverages invading the coffee and tea space that promise similar energy perks and health benefits? Often marketed as wellness drinks, coffee alternatives like these are trending, according to the International Food Information Council.

So, how do a few popular alternatives stack up nutritionally? Do they rely on caffeine for an energy boost? Do they contain potentially healthy (or unhealthy) plant compounds?

The basics on coffee and tea

According to a National Coffee Association survey, 70% of American adults drink coffee, and 62% of those do so daily. Observational studies have linked compounds in coffee beans called polyphenols and antioxidants with health benefits, including a lower risk of type 2 diabetes, heart disease, and neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease. Yet most of us probably don’t drink it for those reasons.

Coffee aficionados enjoy a caffeine energy boost that improves clarity and focus, and savor its fragrance and rich, deep flavor. Still, not everyone is a fan: caffeine makes some people feel jittery, and the caffeine and acidity can irritate sensitive stomachs.

Coffee’s cousin, tea, is the second most popular beverage globally behind water, and is enjoyed by a third of Americans. Most types of tea contain about half the caffeine of coffee (herbal teas have little to none) with less acidity. Tea contains health-promoting antioxidant compounds, such as flavanols.

Caffeine comparison: 8 ounces of brewed coffee contains about 95 mg caffeine; instant coffee about 60 mg; black tea about 47 mg; and green tea about 28 mg.

What to know about yerba mate

Yerba mate (or mate) is an herbal tea from the Ilex paraguariensis tree in South America that has an earthy and more bitter flavor than other teas. It contains antioxidant polyphenols like chlorogenic acid, plus as much caffeine as coffee or more (80 to 175 mg per cup). Preliminary research suggests it might promote weight loss and lower blood cholesterol, but studies are inconclusive. Users report less fatigue and better focus — likely from its caffeine content — but without jitteriness.

Downside: Certain processing methods of mate, such as drying the leaves with smoke, may introduce polycyclic aromatic hydrocarbons — the same carcinogenic substances that are found in grilled meats. Some research links drinking large amounts of mate over time with increased risk of certain cancers, including head and neck, stomach, bladder, and lung. However, unsmoked mate (which is processed by air drying) may be safer.

What to know about yaupon tea

Like mate, yaupon is an herbal tea. Native to the US, it has a mellow grassy flavor similar to green tea. It contains chlorogenic acid and antioxidants that are purported to decrease inflammation and boost energy. This tea has 60 mg caffeine per cup and also provides theobromine, a compound structurally similar to caffeine found in cocoa beans and many teas. Theobromine increases blood flow and may increase energy and alertness, but this boost is slower to start and lasts longer than caffeine, which provides a quick but short-lived boost.

Downside: The combination of theobromine and caffeine may increase heart rate and interfere with sleep, especially if you drink a large amount of yaupon or sip it too close to bedtime.

What to know about matcha tea

Matcha comes from the same Camellia sinensis plant as green tea. However, unlike green tea, matcha is grown in the shade, which protects it from sunlight and oxidation and contributes to its bright green color and higher polyphenol content. Whole tea leaves and stems of matcha are ground into a fine powder, which is then whisked with hot water or milk. Matcha contains about 40 to 175 mg caffeine per cup and has the same antioxidant polyphenols as green tea, specifically theanine and catechins. However, because whole leaves are used to make matcha, it may contain higher concentrations than standard green tea.

Downside: While green tea has low to moderate amounts of caffeine, matcha can have very high amounts, even more than coffee.

What to know about chicory coffee

Chicory is the root of the Chicorium Intybus plant that is dried, roasted, and ground to produce a beverage. Chicory contains prebiotic fiber called inulin that caramelizes during roasting, giving the drink a dark brown color with a nutty, sweeter, and less bitter flavor than traditional coffee. It tastes similar to regular coffee but does not offer the same energy boost, as it is caffeine-free. (Some people mix chicory coffee with brewed coffee for a lower-caffeine drink.) Animal studies show that chicory root has anti-inflammatory properties. Inulin may benefit the gut microbiome and bowel health, but the small amounts found in chicory coffee are not likely to provide such a benefit.

Downside: The chicory plant comes from the same family as ragweed, so chicory coffee may cause allergic reactions in people sensitive to ragweed pollen.

The bottom line

Coffee-alternative wellness drinks may contain similar plant compounds to those found in regular coffee and green or black tea. It’s fine to choose them if you like the taste. Just don’t assume that they’re healthier, because no strong evidence supports claims of weight loss, heart health, or cancer prevention.

These beverages are best enjoyed plain or with only a touch of lemon, honey, unsweetened milk, or plant milk. Processing and added ingredients can negate any health-promoting effects from naturally-occurring plant compounds. For example, some research suggests that adding protein and fat to tea through milk or creamer can reduce antioxidant properties and might deactivate flavonoids. And even if natural compounds remain intact, saturating a beverage with sugar, half-and-half, syrups, or whipped cream transforms it into a dessert, neutralizing any potential health perks.

About the Author

Nancy Oliveira, MS, RD, LDN, CDCES, Contributor

Nancy Oliveira is manager of the nutrition and wellness service at Brigham and Women’s Hospital in Boston. In addition, she is the primary science writer at The Nutrition Source website from the Harvard T.H. Chan School … See Full Bio View all posts by Nancy Oliveira, MS, RD, LDN, CDCES

Editor’s note: Second in a two-part series on friendship and neurodiversity. Click here for part 1 .

We all are different. We all are unique. This is cause to celebrate.

Yet for many children and families, the current landscape of friendships and social spaces can feel unwelcoming. Flexibility and inclusivity are often lacking, leaving little room for children who are neurodiverse, such as those who are on the autism spectrum or who have attention deficit hyperactivity disorder or intellectual disability.

There are many tools and organizations to help children with neurodevelopmental differences practice friendship-building skills and connect through social opportunities. But a larger community effort is needed, as well.

Below are some ways to welcome those who are neurodiverse into your social circle and activities. Friendship is a two-way street, of course, and all of us stand to gain in creating wider, more inclusive circles of friends. Everyone can be a friend; everyone deserves to have friends.

Start here: Understanding neurodiversity

Understanding neurodiversity — the different ways that people think, communicate, learn, and interact with their environment — is a crucial first step.

Becoming aware and accepting of these differences creates room for people who are neurodiverse to participate in social spaces just as they are. By making room for differing abilities, we demonstrate that we value authenticity and diversity.

It may help to know that:

• Many children who are neurodiverse engage in self-stimulatory behaviors like rocking back and forth, hand movements, or pacing. This may be a helpful way for them to self-soothe, or might satisfy sensory needs such as feeling too much stimulation or not enough stimulation.
• As with all children, behavior is communication and expresses desires, wants, needs, and dislikes.
• And as is true with many children, some behaviors, like silly noises or loud remarks, can also be ways of obtaining attention or communicating what is wanted, or not wanted, in a given situation.

What does it mean to be inclusive?

There is more to inclusion than being together.

Inclusion is the practice of making someone part of a group. It ensures that those who might otherwise be excluded, such as people with disabilities or members of marginalized groups, have the same rights, choices, and access to opportunities as others in the community.

Being in the presence of others opens the door to new friendships and social opportunities. But this alone is not true inclusion and does not promote belonging. Children with diverse abilities are often still stuck on the sidelines.

Sitting next to someone new at lunch or inviting someone to join a game or activity on the playground helps others feel invited and included. Parents, teachers, and other adults can help by modeling or encouraging warm, inclusive actions like these — and not just on the playground or at school.

Expanding from inclusion to belonging

Belonging goes one step further by ensuring that people feel valued and fully a part of their community. For children, cultivating belonging could mean

• going the extra mile after inviting a new friend to join a game of soccer at the park by making sure to pass them the ball.
• at the lunch table or at a birthday party, including a child with neurodiverse abilities into the conversation and creating the space for them to participate.

Actions like these help us recognize the value we each have to share. And, of course, it’s not only children who can hold out a hand. Together, by prioritizing genuine connections with people who are neurodiverse, learning and understanding one another’s needs, we can create a social landscape where everyone can belong.

How to be a good friend

Openness and kindness can foster a meaningful connection. Whether you’re a child or an adult, you can help through:

• Clear communication
  • Use clear and concise language and repeat information as needed.
  • Be open to different ways of connecting, such as through text messaging, online gaming, social media, or structured activities based on shared interests.
  • Outline plans in advance and be open to when a particular event, activity, or social interaction might need to be cut short.
• Awareness and openness
  • Be aware of sensory sensitivities and needs. Adjustments to lighting, noise, and seating can help create a more sensory-friendly environment.
  • Sometimes a consistent social space is most comfortable for people who are neurodiverse. Learn the types of socializing and social gestures your friend appreciates best.
  • Be welcoming to different ways of communicating, whether through signs, gestures, pictures, devices, or other equipment.
  • Focus on connection and shared interests rather than social convention.
• Listen and learn
  • Listen and learn how to support people who are neurodiverse — don’t assume!
  • Ask questions to understand social preferences and needs. Figure out together what fosters connection and comfort in your friendship.
  • Make space for people with diverse abilities to be themselves and be comfortable.
  • Be patient. Be flexible.

Make a commitment to wholeness

An inclusive community is one that values all people, and becomes whole by embracing its diversity and making all people feel like they belong. Schools, recreational programs, and community organizations all have a role in fostering inclusive social spaces and opportunities for people who are neurodiverse. And so do each of us.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd

In the US, we are fortunate to have a dizzying array of fruits that fill our grocery stores year-round. They come in all sizes, shapes, and colors, and we have all heard about the recommended five servings of fruits and vegetables a day. So, what are we eating them for? And how does the nutritional value vary between fruits? Is there any difference between whole fruits versus juice, fresh versus dried? Let’s take a look.

Differences between fruits

Just like other foods, different fruits have different nutrient values. Generally, whole fruits are good sources of fiber while fruit juices are not. And one cup of fruit juice, even 100% fruit juice, has a lot more sugar than one piece or one serving of whole fruit. In addition, whole fruits are more satiating than juices. When meeting the recommended fruit and vegetable intake, it is better to eat them (whole) than drink them (juice). However, one should not completely avoid drinking juice — if it is 100% juice — but you should limit consumption to no more than 4 to 8 ounces a day.

The freezer section of the grocery store is often stocked with quite a variety of frozen fruits. These are often peeled and cut already (like mango), which is convenient and often less expensive than fresh fruits. Frozen fruits are usually picked and quick-frozen near the point of harvest, therefore the nutrients are well preserved. Moreover, some seasonal fruits such as blueberries are readily available in frozen form. The key to selection is to choose plain frozen fruits without added sugar.

There are a number of fruits that are available in dried form, such as raisins, apricots, and pineapple — just to name a few. They also have good nutrient values, keep for a long time, are convenient to carry around, and are high in calories, making them a favorite for hikers and campers. However, some often have sugar added in the drying process, particularly mango and pineapple. Dried cranberries almost always have sugar added, as they are naturally very tart. Even for those without added sugar, the compact volume and sweetness make it quite easy to eat a lot in one sitting, and the calories can add up quickly.

Some dried fruits like raisins and apricots are also treated with sulfur dioxide to preserve freshness and color. For most people that is not a concern; however, some individuals are sensitive, especially those with asthma. Sulfur dioxide treatment is labeled on the package, so it is not difficult to avoid if necessary.

What about buying organic?

We have much choice when it comes to organic and conventionally grown fruits, be they fresh, frozen, or dried. Nutritionally, there is not enough difference to choose one over the other, though consumers might choose one over another based on farming practices and environmental impact. The US has regulations on pesticide use, but some fruits tend to have more residual pesticides than others, and it is always recommended that you wash fruits thoroughly before eating.

Differences in nutritional value

Different fruits are good sources of different nutrients. Citrus fruits are high in vitamin C, and other fruits are good sources of nutrients too. A few examples below:

Nutrient	Major functions	Good fruit sources
potassium	fluid and electrolyte balance, maintaining healthy blood pressure	oranges, raspberries, bananas, cherries, pomegranates, honeydew melons, avocados
iron	formation of red blood cells, brain growth in children	dried apricots, raisins
vitamin C	maintaining healthy immune system, wound healing, antioxidant	citrus fruits, strawberries, kiwi
folate	DNA synthesis, formation of red blood cells, early neural tube development in the fetus	oranges, mangos, avocados
vitamin A	night vision, cell growth, immune function	cantaloupe

Besides the above nutrients, certain fruits are also high in flavonoids. This is a diverse group of compounds, some of which are potent antioxidants that protect against oxidative damage, and may reduce the risk of certain diseases such as cardiovascular disease and diabetes. In particular, citrus fruits are high in the flavanones class of flavonoids, and blackberries, blueberries, cranberries, and cherries are high in the anthocyanidins class of flavonoids.

So, what fruits should we eat?

As you can see, there isn’t one fruit that has all the nutrients, so eating a variety is the key to good health. Try something new! Most adults should eat a variety of colors for about 2 cups a day. Prioritize whole fruits over juice. Eat what is in season, as it will be cheaper. And enjoy your fruits: eat mindfully to fully appreciate the smell, texture, and flavor. Bon appetit!

About the Author

Teresa Fung, MS, RD, ScD, Contributor

Teresa Fung is an adjunct professor at the Harvard T.H. Chan School of Public Health. She received her BS and MS in nutrition from Cornell University, and her ScD in both nutrition and epidemiology from HSPH. She … See Full Bio View all posts by Teresa Fung, MS, RD, ScD