Showing posts with label CBT. Show all posts
Showing posts with label CBT. Show all posts

Monday, July 24, 2017

Tai Chi Helps Breast Cancer Survivors Beat Insomnia, Depression

There are few things worse than lying awake in bed, staring at the clock, knowing your alarm is going to go off in a few hours, and you’re still wide awake. Insomnia can be a never-ending cycle of constantly worrying yourself awake, night after night. A lack of sleep can make anyone feel terrible, emotionally and physically, but it’s especially troublesome for breast cancer survivors. Tai chi, a noncompetitive martial art known for its health and relaxation benefits, may help those warriors get more rest, a study finds.


About 30% of breast cancer survivors who have insomnia also wrestle with depression, fatigue, and a greater risk of illness. Researchers from UCLA say tai chi promotes significant improvements in sleep health in breast cancer survivors struggling to get enough shut-eye. It’s so effective, the researchers write in the Journal of Clinical Oncology, that it rivals cognitive behavioral therapy – the “gold standard” of treatment – in that the benefits endure longer than a year. [1]


Cognitive behavioral therapy (CBT) is considered the go-to insomnia treatment by the American Academy of Sleep Medicine. Much like it sounds, CBT involves learning how to identify and change negative thoughts and behaviors that make it hard to fall asleep and stay asleep. It works, but it can get pricey; and it can sometimes be difficult to find professionals who are trained in the therapy method.




Tai chi is much more widely available, with libraries, churches, community centers, and other public venues offering free or low-cost classes. If that doesn’t appeal to you, you can always look up instructional videos on YouTube.


Of course, there are also some pretty potent sleep aids on the market, but there are good reasons to avoid them: Some of them, including the popular drug Ambien, have been called “as risky as cigarettes,” because they increase the risk of cancer and sudden death so significantly.


Testing Tai Chi’s Impact on Sleeplessness


For the study, researchers recruited 90 breast cancer survivors, ranging in age from 42 to 83, who had insomnia three or more times a week, and who also suffered with depression and drowsiness in the daytime. Each volunteer was randomly assigned to weekly CBT or weekly tai chi instruction, for three months. [2]


The participants were evaluated at intervals for the next year to track their insomnia symptoms, as well as their symptoms of fatigue and depression, and to determine whether there was any improvement.


Fifteen months into the study, 46.7% of those in the tai chi group, and 43.7% of those in the CBT group continued to show robust, clinically significant improvement in their insomnia symptoms. [1]



Dr. Michael Irwin, the study’s lead author, said:


“Breast cancer survivors often don’t just come to physicians with insomnia. They have insomnia, fatigue and depression. And this intervention, tai chi, impacted all those outcomes in a similar way, with benefits that were as robust as the gold standard treatment for insomnia.” [1]


Many of the participants continued to practice tai chi after the study concluded – a reflection of the motivation Irwin says he’s observed in breast cancer survivors.


“They often are seeking health-promoting activities because they recognize that the mindfulness approach, or health-based lifestyle interventions, may actually protect them.” [2]


Read: Green Tea and Tai Chi Reduce Inflammation, Enhance Bone Health


In previous research, Irwin and his fellow researchers found that tai chi could help reduce inflammation in breast cancer survivors, and may even reduce the likelihood of the disease recurring. [2]


Sources:


[1] UCLA Health Services


[2] Newsmax





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About Mike Barrett:


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Mike is the co-founder, editor, and researcher behind Natural Society. Studying the work of top natural health activists, and writing special reports for top 10 alternative health websites, Mike has written hundreds of articles and pages on how to obtain optimum wellness through natural health.

Sunday, April 16, 2017

Erdogan Poised For Victory Based On Early Referendum Results Although "Yes" Lead Is Shrinking

Update 4: 95.5% of the vote is in, and Yes is down to the lowest lead so far, 51.6$ vs 48.4%.



* * *


Update 3: With 93% of the vote in, Yes is down to just 52%.



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Update 2: with over 75% of the vote counted, the "Yes" has 54.2% of the vote, versus 45.8% for the "No" and rising.



* * *


Update: it may be closer than expected after all, because as votes continue to trickle in, the Yes margin continues to erode, and with 61% of the vote counted, Yes is now at 56% versus 44% for No.




* * *


As previewed yesterday, on Sunday Turks voted on a referendum on the country"s presidential system whose outcome will likely place sweeping new powers in the hands of President Tayyip Erdogan and herald the most radical change to the country"s political system in its modern history. The package of 18 amendments would abolish the office of prime minister and give the president the authority to draft the budget, declare a state of emergency and issue decrees overseeing ministries without parliamentary approval. Effectively, Erdogan would become the closest thing to a despot possible in a "democratic" system.



For those who may have missed it, we urge readers to skim the preview, especially since the outcome appears to be largely decided, and according to Turkish media which appears to have broken the news embargo, with over 30% of the votes counted with a turnout of 87%, the pro-Erdogan "Yes" camp is set for a victory, as close to 60% of the votes allegedly support the proposed political system overhaul.




       
         


While we expect allegations of vote-rigging to emerge, especially in light of recent polls which showed a much closer margin between the "Yes" and "No" camps, we doubt there will be much political push from Turkey"s European "partners", especially since Erdogan still holds the trump card of releasing over 2 million Syrian refugees in Europe"s general direction should his now virtually supreme powers be disputed by Brussels or Berlin.


As for the market, as Barclays reported yesterday, it will likely take a Yes vote favorably, as it will mean little to no change in the Turkish political system.


As a reminder, from Barclays this is what a "Yes" outcome would mean for markets:


YES: A “yes” outcome would likely result in a broad-based, yet potentially short-lived, relief rally


Despite the market’s anticipation of a “yes” outcome, we think the associated reduction in near-term political uncertainty would likely still deliver some relief rally, allowing a temporary reprieve for the TRY and a steeper curve in anticipation of a “gradual” unwinding of tight liquidity policy.


In FX, still-large TRY political risk premia and undervaluation suggest room for appreciation following a “yes” outcome. While our estimate of the lira’s political risk premia has reduced from 15pp at the end of January, it remains relatively large at 8pp (Figure 6). Furthermore, our short-term Financial Fair Value (FFV) model suggests a 4% undervalued TRY against the USD (Figure 7).



We believe risk-reward argues for being long TRYZAR targeting January highs of 3.90 with a stop-loss at 3.67 for a reward to risk ratio of 3:1 (spot reference: 3.73). We prefer this to short USDTRY as South Africa’s similarly low risk-adjusted real interest rate differentials and heightened political risk should provide a degree of protection in the event of a “no” outcome. The trade also remains positive carry.


In rates, very low bond risk premia suggest a rates rally following a “yes” is likely to be concentrated at the front end of the yield curve as market participants will likely price a gradual unwinding of the CBT’s liquidity tightening measures. As such, we reiterate our existing trade recommendation of paying the 1s5s TRY cross-currency swap spread targeting -30bp with a stop-loss of -100bp.


For Turkey sovereign credit, we maintain our Market Weight rating. This balances our concerns about a likely medium-term deterioration of Turkey’s credit metrics in a presidential system on the one hand with relatively attractive valuations and likely reduced near-term political uncertainty in a “yes” vote on the other hand. In the near term, we see potential for further spread compression of Turkey against South Africa, especially in the 5y sector of the curve (Turkey ‘22s vs SOAF ‘22s), with South Africa remaining vulnerable to adverse developments.


In the corporate credit space, we also have a Market Weight rating on Turkish banks and corporates. In the case of a “yes” vote, we would expect bank seniors to benefit more than corporates given the more significant spread pick-up relative to the sovereign. Higher beta seniors trading at a discount of over 100bp to the sovereign as well as new-style Tier 2s yielding over 7% are likely best positioned to benefit, in our opinion, although this could be met with more Tier 2 supply. We would expect the opposite reaction to a “no” vote, with IG-rated corporates and more expensive bank seniors as well as old-style Tier 2s to be less vulnerable in any sell-off

Turkish Referendum Full Preview

This Sunday, Turkey will vote in a hotly contested referendum on the presidential
system, whose outcome could place sweeping new powers in the
hands of President Tayyip Erdogan and herald the most radical change to
the country"s political system in its modern history.


The package of 18 amendments would abolish the office of prime minister and give the president the authority to draft the budget, declare a state of emergency and issue decrees overseeing ministries without parliamentary approval.



Opinion polls have given a narrow lead for a "Yes" vote, which would replace Turkey"s parliamentary democracy with an all-powerful presidency and may see Erdogan in office until at least 2029.  The outcome will also shape Turkey"s strained relations with the European Union. The NATO member state has curbed the flow of migrants - mainly refugees from wars in Syria and Iraq - into the bloc but Erdogan says he may review the deal after the vote. Some 55 million people are eligible to vote at 167,140 polling stations across the nation, which open at 7.00 am (0400 GMT) in the east of the country and close at 5 pm (1400 GMT). Turkish voters abroad have already cast their ballots.


The referendum has bitterly divided a nation which has already seen extensive political fracture over the past year, including one "failed coup" attempt last summer. Erdogan and his supporters say the changes are needed to amend the current constitution, written by generals following a 1980 military coup, confront the security and political challenges Turkey faces, and avoid the fragile coalition governments of the past. Opponents say it is a step towards greater authoritarianism in a country where around 40,000 people have been arrested and 120,000 sacked or suspended from their jobs in a crackdown following last July"s failed coup, drawing criticism from Turkey"s Western allies and rights groups, and resulting in the worst diplomatic relations between Turkey and Europe in recent history. Relations between Turkey and Europe hit a low during the referendum campaign when EU countries, including Germany and the Netherlands, barred Turkish ministers from holding rallies in support of the changes. Erdogan called the moves "Nazi acts" and said Turkey could reconsider ties with the European Union after many years of seeking EU membership.


On the eve of the vote, Erdogan held four separate rallies in Istanbul, urging supporters to turn out in large numbers. "April 16 will be a turning point for Turkey"s political history... Every vote you cast tomorrow will be a cornerstone of our revival," he told a crowd of flag-waving supporters. "There are only hours left now. Call all your friends, family members, acquaintances, and head to the polls," he said.


Erdogan and the ruling AK Party, led by Prime Minister Binali Yildirim, have enjoyed a disproportionate share of media coverage in the buildup to the vote, overshadowing the secular main opposition Republican People"s Party (CHP) and pro-Kurdish People"s Democratic Party (HDP). Erdogan has sought to ridicule CHP leader Kemal Kilicdaroglu, playing videos of his gaffes during rallies, and has associated the "No" vote with support for terrorism.


Kilicdaroglu has accused Erdogan of seeking a "one-man regime", and said the proposed changes would put the country in danger. "This is not about right or left... this is a national issue... We will make our choices with our children and future in mind," he said during his final rally in the capital Ankara.


The government says Turkey, faced with conflict to the south in Syria and Iraq, and a security threat from Islamic State and Kurdish PKK militants, needs strong and clear leadership to combat terrorism.


While recent polls suggest a pick-up in momentum for “yes”, they remain close, and the large share of “undecided” voters is adding to the uncertainty. According to Wall Street banks like Barclays, a “yes” outcome will likely result in a broad-based, yet potentially short-lived, relief rally driven by a reduction in near-term political uncertainty. In the event of a less-expected “no” outcome, Barclays expect a negative market reaction and positioning for this looks most attractive via FX options.


Below is a full preview of the Turkish referendum, whose outcome should be known sometime on Sunday night, courtesy of Barclays.


Referendum countdown


Turkey is heading for a public referendum on the presidential system on 16 April, this Sunday. The recent polls suggest a pick-up in momentum in favor of “yes” (Figure 1) and this is also evident in the latest surveys of pollsters such as Metropoll and Gezici, which show “yes” at around 53% as opposed to earlier surveys of below 50%. The “yes” and “no” outcomes still appear to be close on average, however, and the associated margin of error (2-3% according to pollsters) along with the large share of “undecided” voters underscores the binary nature of the referendum outcome.



Achieving 50%+ support for the “yes” campaign (AKP-MHP) might look relatively straightforward at first sight, given a combined voter base of 61% (November 2015 election results) and the almost perfectly aligned rhetoric and policies of the parties. Recall that the transformation of the political landscape before and in the aftermath of the November 2015 elections led to a firm macro-level consolidation of Turkish politics along two lines: the “nationalist front” (mostly AKP and MHP voters) and the “social democrat front” (mostly CHP and HDP voters).


However, polls suggest a less comfortable race for the “yes” campaign: i) a large number of MHP voters seem to still be unconvinced by the “yes” campaign, and ii) the true color of the “undecided voters” is hard to decipher: pollsters say voters are increasingly refraining from revealing their preference due to the mood created by the extraordinary state of affairs, and “undecided” voters could be skewed towards “no”. Metropoll argued that more than 75% of undecided need to vote “no” for it to win; while historically, undecided voters have tended to either vote for the status quo or not participate in elections. The low polling response rate due various factors (such as peer pressure in the South East and the Black Sea regions according to some pollsters) is yet another complication that could potentially be distorting the poll results.


Nevertheless, momentum has picked up in favor of “yes” based on the most recent polls, and this has also been echoed by the political expert media commentary. Among the key catalysts, experts note the following.


  1. The effectiveness of President Erdogan’s campaign to push the “yes” votes of the AKP electorate higher (from the 80% level to the 90% level), as well as its impact on convincing more of the MHP electorate to vote “yes”.

  2. The tailwind provided by escalating tensions with the Netherlands and the EU, which is likely to help consolidate the nationalist vote.

  3. The positive impact of the improving economic sentiment recently on the “yes” campaign (Figures 2 and 3).

  4. The tactical missteps of the main opposition party CHP (i.e. comments by party officials) influencing undecided AKP voters in favor of “yes”.


Overall, it is hard to simplify the referendum to a probability exercise of an early election under yes/no outcomes, given that it is far more complex and the implications are unclear (both scenarios entail an early election possibility, in our view). While markets will likely perceive near-term political risks (i.e. an early election) to be lower in the scenario of a “yes” outcome, medium-term concerns about policy uncertainty and institutional strength are likely to remain; the Venice Commission opined that constitutional changes will remove checks and balances, leading to weaker institutions. The influence of presidential advisors on policymaking and the transformation to a “new economic model” would likely be solidified under a presidential system accompanied by an accommodative monetary policy bias, a potentially looser fiscal stance and an increase in quasi-fiscal spending focused on infrastructure projects via the sovereign wealth fund (SWF). We believe that, even in the event of a “yes” outcome, the likelihood of an early election in Q4 2017/Q1 2018 is still non-negligible as President Erdogan may choose to bring forward presidential elections (from August 2019).


* * *


Market implications for FX, local rates and sovereign credit


The market appears largely positioned for an outcome consistent with polls that suggest a “yes” result is most likely. In FX option markets, for example, the volatility-adjusted premium for USDTRY calls versus puts has recently dropped to multi-year lows and below-average kurtosis suggests little demand for negative tail-event protection (Figure 4). In bonds, TurkGB risk premia remain extremely low and currently offer less return than USTs on a hedged basis (Figure 5). Finally, in EM credit, Turkey YTD has outperformed the broader Bloomberg Barclays USD EM sovereign index, partially reversing the c.10% underperformance in 2016 (in total return terms).


YES: A “yes” outcome would likely result in a broad-based, yet potentially short-lived, relief rally


Despite the market’s anticipation of a “yes” outcome, we think the associated reduction in near-term political uncertainty would likely still deliver some relief rally, allowing a temporary reprieve for the TRY and a steeper curve in anticipation of a “gradual” unwinding of tight liquidity policy.


In FX, still-large TRY political risk premia and undervaluation suggest room for appreciation following a “yes” outcome. While our estimate of the lira’s political risk premia has reduced from 15pp at the end of January, it remains relatively large at 8pp (Figure 6). Furthermore, our short-term Financial Fair Value (FFV) model suggests a 4% undervalued TRY against the USD (Figure 7).



We believe risk-reward argues for being long TRYZAR targeting January highs of 3.90 with a stop-loss at 3.67 for a reward to risk ratio of 3:1 (spot reference: 3.73). We prefer this to short USDTRY as South Africa’s similarly low risk-adjusted real interest rate differentials and heightened political risk should provide a degree of protection in the event of a “no” outcome. The trade also remains positive carry.


In rates, very low bond risk premia suggest a rates rally following a “yes” is likely to be concentrated at the front end of the yield curve as market participants will likely price a gradual unwinding of the CBT’s liquidity tightening measures. As such, we reiterate our existing trade recommendation of paying the 1s5s TRY cross-currency swap spread targeting -30bp with a stop-loss of -100bp.


For Turkey sovereign credit, we maintain our Market Weight rating. This balances our concerns about a likely medium-term deterioration of Turkey’s credit metrics in a presidential system on the one hand with relatively attractive valuations and likely reduced near-term political uncertainty in a “yes” vote on the other hand. In the near term, we see potential for further spread compression of Turkey against South Africa, especially in the 5y sector of the curve (Turkey ‘22s vs SOAF ‘22s), with South Africa remaining vulnerable to adverse developments.


In the corporate credit space, we also have a Market Weight rating on Turkish banks and corporates. In the case of a “yes” vote, we would expect bank seniors to benefit more than corporates given the more significant spread pick-up relative to the sovereign. Higher beta seniors trading at a discount of over 100bp to the sovereign as well as new-style Tier 2s yielding over 7% are likely best positioned to benefit, in our opinion, although this could be met with more Tier 2 supply. We would expect the opposite reaction to a “no” vote, with IG-rated corporates and more expensive bank seniors as well as old-style Tier 2s to be less vulnerable in any sell-off.


NO: Positioning for a “no” outcome looks most compelling via FX options


The less-expected “no” outcome will likely result in larger market movements as a higher risk of an early election would increase risk premia in the local bond curve, weigh on the lira and increase FX implied volatility, in our view.