Some Respect, Please, for the Afternoon Nap

KINDERGARTNERS fight against naptime because they want to be just like the grown-ups. But those grown-ups would give anything for a chance to close their eyes during the endless time between lunch and dinner.

You know the feeling — your screen starts to blur, your eyelids become heavy, your mouth feels cottony, and you would give back all the perks of adulthood to be able to curl up on the floor.
Now, out of Greece, comes permission to do exactly that. A study of more than 23,000 adults shows that those who napped for about 30 minutes each week had a 37 percent lower risk of dying from a heart attack than those who did not.
So this should mean that all working Americans will receive permission from their bosses to close their eyes every afternoon at about 4 p.m., right?
Don’t bet your blankie on it.
This is hardly the first study showing that sleep is more than simply time when we really should be at work. Other studies, though few as extensive as the Greek research, show that short periods of sleep during the day increase productivity and creativity while reducing stress. And even without surveys, we know this from experience.
When you need a nap, you need a nap. Nothing — not caffeine, not a chocolate bar, not a pill — recharges the battery in the same way.
Which is why so many of us have been sneaking naps at work for years. Mark Lipschutz, a computer specialist in Philadelphia, for one, acknowledges disappearing out to the company parking lot when the need hits. There he reclines the front seat of his car, sets the alarm on his mobile phone, puts on the eyeshade he carries for just this purpose and sacks out. Eight or 10 minutes are often enough. More than 20 and he wakes up groggy.
Jen Singer has been known to tell clients that she can’t make a 1 p.m. conference call because “I have a meeting.” What she does not tell them, she confesses, is that “it’s a meeting with my pillow.” She edits a Web site called MommaSaid.net from home, which makes it easier to nap without being seen.
(As one who also works from home, I understand this strategy; I have been known to tell my children that I am on a “conference call” for an hour and cannot be disturbed. Heaven forbid they find out that Mom is asleep in the mid-afternoon.)
The most interesting thing that Mr. Lipschutz and Mr. Singer have to tell us is not that they nap, but that they feel the need to sneak those naps. They don’t simply announce “I am off to take a nap,” in the same matter-of-fact tone as “I’m off to lunch” or “I’m done for the day” (or “I’m on a conference call”).
This is not the case in other parts of the world. The legacy of the siesta lingers in Spanish culture, and in some countries of the Far East, workers all put their heads on their desks in the middle of the day and snooze as one.
Nor has it always been an embarrassment to nap in the West. Thomas Edison was famous for his ability to catnap anywhere. Winston Churchill napped once a day, without apology, during World War II.
“You must sleep sometime between lunch and dinner,” Churchill said, explaining that this includes taking off one’s clothes and climbing into bed. “Don’t think you will be doing less work because you sleep during the day. That’s a foolish notion held by people who have no imaginations. You will be able to accomplish more. You get two days in one.”
But over the last several decades, as workdays lengthened, as executives began to brag that they functioned best on a mere four hours’ sleep a night, as Americans started bringing their laptops along on vacation — when they took those vacations at all — sleep has come to be seen as a luxury at best, and as a weakness at worst.
The only way the Greek napping study will make a substantive difference in the average workday is if it somehow helps to redefine sleep as something macho and competitive. A few companies out there have added rooms outfitted with couches, recliners, comforters and pillows to their menu of life/work perks. Some businesses describe these rooms not in terms of health and well-being, but as a way to gain a competitive edge.
At the office of the law firm Kilpatrick Stockton in Raleigh, N.C., for instance, the room in question is called the Power Room. As in power nap. As in “taking away the stigma of napping and replacing it with strength and energy,” says Carol Vassey, the firm’s office manager.
Sleep as strategy. As secret weapon. As business plan. Call it what you must. And then get some rest.

Behavior: More Children, Eating More Graham Crackers

By ERIC NAGOURNEY
Published: February 20, 2007
Puppies do it. Chickens do it. Even preschoolers do it.

That is the finding of a new study that looked not at falling in love but at how children eat when they are in larger groups. Like animals, the researchers found, the preschoolers ate more.
The researchers, who report their findings online in The Archives of Disease in Childhood, say it has often been observed in animals and adults that consumption goes up as the number eating increases. People will even keep eating past the point when their appetite has been satisfied.
But it was not known whether this held true for young children, a question that may have implications for fighting the obesity problem. The researchers, Dr. Julie C. Lumeng and Katherine H. Hillman of the University of Michigan, set out to answer it by studying more than 50 children at a preschool.
The tools of the study were simple: hungry children, a snack area and that mainstay of childhood, graham crackers. The researchers looked at how children ate when they were in groups of three or nine. They found that in the larger groups, the children ate 30 percent more.
There are two main theories for why people eat more in bigger groups. One is that in larger groups, people socialize more, extending the length of their meals and their contact with food. The other is called the arousal theory and suggests that the sight of others eating leads to more and faster consumption, especially in animals, which may feel they are competing for food.
“In animals, you’re going to be a little more frenzied when you eat in a group,” Dr. Lumeng said.
This also appears to be the case with preschoolers — not that the researchers saw snarling and clawing as the graham crackers were put out. But they did note that the children in larger groups ate not only more but faster.

Those Multiple Choices in Long-Term Care Policies

By ROBERT D. HERSHEY Jr.
Published: February 25, 2007
INSURANCE, they say, is one product you can’t buy when you need it most. When it comes to coverage for long-term care, however, a myriad of choices makes even timely buying a daunting process.

Although industry statistics indicate that more than two of three people turning 65 will eventually need such care — which may be provided in a nursing home, assisted-living facility or at home — even deciding whether you should buy long-term care insurance is a challenge.
Then there’s the design of the actual policies, which may be customized for each buyer’s pocketbook and unknowable health future.
“There’s a million different variations and permutations,” said Steve Killiany, a planner and long-term care specialist at the West Financial Group in Bethesda, Md. “There’s the benefit period, the amount of daily benefit, inflation protection, the waiting period” and other considerations like the financial strength of the insurance company.
The popularity of these policies is arising from several factors, including the climbing cost of health care, longer life expectancies, and a desire to avoid relying on family members who may live far away for care. If you’re wealthy enough, of course, there may be little need for this coverage. If you’re poor enough, Medicaid will pick up the bill. Not only is there a huge middle ground between rich and poor, but people differ in their desire to draw down assets instead of passing them along to the next generation.
A couple with $1 million, for example, may want to be sure that they leave a legacy big enough to put a grandchild through college, rather than risk draining all their funds if they need care for a long time. Mr. Killiany generally considers those with assets of $200,000 to $4 million as candidates for long-term care insurance, but other experts shun any upper limit.
“Money is a very touchy subject,” said Jesse R. Slome, executive director of the American Association for Long-Term Care Insurance, an agent trade group based in Westlake Village, Calif. “Some people are unwilling to spend what they’ve accumulated and sometimes kids don’t want them to.”
If you decide to join the eight million Americans who now have long-term care policies, either individually or through employers, an even tougher question may be when to buy.
There is no simple answer, but Mr. Killiany suggests doing so around the age of 50, when you’re relatively young and probably healthy enough to qualify for a modest premium.
You’ll be wise to compare terms of two or three different companies and, if you have the opportunity, a group plan. In general, healthy people do better with individual policies; those in poor health or with a family history of disease, may do better in a group. Industry leaders are companies like John Hancock, MetLife, MassMutual, Prudential and Genworth.
A typical company policy for a 65-year-old buyer might pay benefits of $150 a day for three years — a total of about $164,000 — with payments starting 90 days after a claim is made. With automatic inflation protection to raise the daily benefit 5 percent each year, the annual premium with Hancock for people with a standard health rating would be $1,650 if you buy at age 50, $1,840 if you buy at 55, $2,233 at 60, $2,845 at 65, $4,225 at 70 and $6,560 at 75.
Once you have been assigned the appropriate risk category, your annual premium will not rise, regardless of your claims or deteriorating health, unless your company wins regulatory approval to raise premiums for all its policy holders in your state.
(If you move, the rules in the state where you bought the policy apply.)
In buying a policy, you can choose almost any number of years — or a lifetime — of benefits and raise or lower the daily dollar amount or the waiting period before benefits begin. Inflation protection against rising costs of care can be on either a simple or a compound basis — or you can choose to do without it.
Premiums, which generally rise 8 or 9 percent for each year you wait to apply, also depend on which of three main health-related risk categories — preferred, standard or substandard — you are assigned. The preferred, or good-health, designation typically saves 10 to 20 percent.
The average age of individual buyers is the early 60s; for applicants in their 70s, only one in five qualify for good-health discounts and two-fifths of this age group are denied coverage at any price, according to the American Association for Long-Term Care Insurance.
Premiums are also governed by other considerations, like whether you are married and, if you are, whether your spouse is also applying for a policy.

Married people — and in some cases committed partners or even siblings — are entitled to discounts of 15 to 40 percent because they have a presumed care provider living with them, thereby reducing the cost or likelihood of claims. There is also, in effect, a volume discount for the second policy.

If a couple can afford only one policy, said Dee Balliett, a partner at Balliett Financial Services in Winter Park, Fla., it may be a good idea to buy coverage on the healthier, younger person. If a husband is older than his wife and he has the only policy, for example, his wife may be left with no one to care for her after his death — and without insurance.
Long-term care policies also take time to buy — usually several weeks, while the company evaluates statements you have made about your health, perhaps checking them with your doctor. You may also be subject to an interview, probably by telephone, in which the company gauges your mental acuity.
The questioner may ask you to name as many fruits or vegetables as you can, for example, or to perform simple arithmetic calculations. Insurers pay particular attention to signs of memory loss, which can hint at many years of claims by people in good physical health.
“It’s the cognitive claim that terrifies” the companies, Mr. Slome said. “Insurers are less concerned about disease and conditions that will kill somebody than those that will allow them to live for many years.”
Healthy buyers should welcome such checking, even if it involves answering questions that a 4-year-old could handle, because it suggests that their premiums won’t be subsidizing poor risks, a situation that makes experts wary of some group plans.
You can generally reduce coverage, and premiums, at any time — but you cannot raise coverage without making a fresh application.
Although each policy contains a customized mix of options, the industry has standardized much of the contract language, helping to make policy premiums eligible for tax breaks. For example, for you to collect benefits, you must be unable under federal law to perform two or three of six “activities of daily living” without substantial assistance. These “triggers” involve bathing, dressing, eating, going to the toilet, continence and basic mobility.
Specialists recommend that the policy specify that this determination be made not by the company, but by your own licensed health care practitioner (not necessarily a doctor).
Last year, 36.5 percent of claims paid by eight top long-term insurers were for nursing home care, 33.9 percent for care in the home and 29.6 percent for assisted-living costs.
While women use long-term care for an average 3.7 years, compared with 2.2 years for men — and are also more likely to be without a spouse — Mr. Slome considers a policy that pays for three years a good, middle-of-the-road choice for most people. Only 8 percent of claimants exhaust benefits in that time, the association has found. (You may stop and restart claims as your health permits.)
BENEFITS can be paid under three methods. The main one these days is called reimbursement, with the company paying either you or your provider only when you receive services it deems eligible. The other methods are indemnity, under which the insurer pays a set amount directly to you so long as you obtain some care, and disability, under which you get a full benefit if you are eligible, whether or not you choose to use any services.
Insurance specialists warn that one of the most costly mistakes made by buyers, particularly those under 70, is shunning inflation protection in order to minimize their premiums.
Another major error, Mr. Killiany said, is trying to save money by not taking a full benefit for home care on the assumption that such care will always cost less than care in an institution. But dealing with progressive illness at home, with individualized nursing care, can be far more expensive than it is in a nursing home.
While long-term care insurance can be expensive, careful choices of coverage and deductibles, along with the possible tax breaks, can make it more accessible. You can deduct premiums from federal income taxes to the extent that they and other medically related expenses exceed 71/2 percent of adjusted gross income. And 37 states now offer deductions or credits for long-term care insurance premiums. (New York and New Jersey are among them; Virginia’s deduction begins for 2007.) And premiums can be up to 100 percent deductible for businesses.
Moreover, you can save as much as 8 percent or so by paying premiums annually instead of monthly or quarterly.
Nonetheless, this coverage is not for everyone, experts caution — and certainly not for those who can ill afford the premiums.
“I don’t put long-term care at the top of the list” for sound old-age financial planning unless you have significant assets and want to leave an inheritance, said Ms. Balliett in Florida. “But if that’s your choice, then you better get it.”

All Breast Cancer Patients Are Not Treated the Same

By NICHOLAS BAKALAR
Published: January 23, 2007
When women with low incomes or low levels of education start chemotherapy for breast cancer, they routinely get insufficient doses, a new study suggests. That may be one reason they are less likely to survive the disease than other women.
The initial dose of chemotherapy is determined by the height and weight of the patient, and doses lower than 85 percent of the calculated amount and intensity are ill advised, according to current guidelines. Nevertheless, studies cited in the paper have shown that as many as half of breast cancer patients are not started on enough medicine.
Researchers studied 764 randomly selected patients at 115 sites throughout the United States. All the women had nonmetastatic breast cancer and were scheduled for treatment but had not yet started. The scientists collected information on age, level of education, marital status, ZIP code, height, weight, tumor characteristics and other diseases. Then they examined medical records to determine the planned and actual chemotherapy received.
Since the researchers knew the height and weight of the patients, they could calculate the required doses and determine which patients got the recommended amounts.
The study appears in the Jan. 20 issue of The Journal of Clinical Oncology. Several of the co-authors have received research funds or consulting fees from companies that sell drugs used in cancer treatment, and data collection was supported by Amgen.
There were no differences in dosage based on age, race, tumor stage or the kind of insurance a woman had.
But about 32 percent of the women with less than a high school education received insufficient doses, compared with 14 percent of high school graduates. Almost 22 percent of obese and severely obese women got a reduced dose, compared with fewer than 12 percent of those of normal weight. And while almost 20 percent of women who lived in the poorest ZIP codes got reduced doses, only 8 percent of those who lived in the richest areas did.
There were also geographic differences. After adjusting for other variables, women in the Southeast received lower doses more than five times as often as women in the Northeast or on the West Coast.
Because the study focused on initial treatment, the reduced doses were not the physician's response to a patient's actual side effects. Dr. Jennifer J. Griggs, the lead author of the study and an associate professor of internal medicine at the University of Michigan, speculated that there was nothing sinister in doctors' motives in reducing doses.
''We're giving toxic drugs, hoping that the patient will come back for her next course of therapy,'' Dr. Griggs said. ''I think doctors lower the dose in a benevolent desire to get people through their treatment.''
Why having less than a high school education or being poor or obese would lead to inadequate chemotherapy is not clear.
For overweight women, an effort to limit the side effects of the large doses required may have been one motive, but in clinical trials obese women experienced no more toxicity with the appropriate dose than women of normal weight did.
With women of lower income or educational attainment, the researchers suggest, physicians may have anticipated a failure to understand and stick with what is often a long and unpleasant treatment, so they pre-emptively reduced the dose in hopes of encouraging compliance.
The scientists offer no explanation for the geographic variations in dosage, but they suggest that lowered doses might be one reason for regional differences in breast cancer survival.
''Patients should not hesitate to ask about the dosing decision,'' Dr. Griggs said, ''and then offer the doctor a statement that gives the doctor permission to use a full dose. A dosing decision is not really the patient's responsibility. But if patients give the doctor the indication that they're fully committed to treatment, it will help ensure that we see fewer dose reductions.''