TIME medicine

Generic Drug Discount Programs Work — for Everyone

Americans are increasingly participating in programs that fill cheaper versions of prescription drugs

More and more Americans are buying the cheaper generic versions of prescription drugs, new research published in JAMA Internal Medicine shows.

In 2006, Walmart introduced what would become one of many generic drug discount programs that allowed people to pay just $4 to fill prescriptions of generic drugs. The program was meant to help people meet difficult medical costs–especially more vulnerable groups like the elderly and low-income populations.

At first, the program didn’t appear to gain a lot of traction. In 2007, only 3.6% of patients receiving prescription drugs were partaking in a program. But similar programs popped up at other pharmaceutical retailers like Rite Aid, CVS and Walgreens and has since gotten much more popular.

The researchers looked at a 2010 national household survey of health care usage among patients over age 18 who had at least one prescription during that year. They found that among the 13,486 adults identified in the survey as having at least one drug prescription, 3,208 were users of generic drug discount programs, and overall program use was at about 23%–much higher than the 3.6% participation rate three years earlier.

Researchers also found that people who were elderly, sick, uninsured and living in rural areas were more likely to participate in the programs, but interestingly, there were no significant differences across education levels or race/ethnicity groups. “Generic drug discount programs were not considered inferior despite the common perception that generic drugs are of poor quality,” the study authors write. “In fact, generic drug discount programs offer convenience by not requiring insurance claims to be filed.”

The researchers think the mere fact that more pharmaceutical retailers have offered similar programs is one of the reasons there’s greater uptake across the board, and while participation could still be higher, plenty of people of different backgrounds are taking part in the cost savings programs.

TIME Heart Disease

Healthy Behaviors Can Prevent 4 Out of 5 Heart Attacks

A study of Swedish men shows just how beneficial healthy living is for the heart

We all know the basic tenets of a healthy lifestyle–maintaining a good diet and waist size, exercising, not smoking and drinking alcohol in moderation. But how healthy will they get you, exactly? A new study published Monday in the Journal of the American College of Cardiology quantifies the effects of a healthy lifestyle and finds that practicing these behaviors can prevent four out of five coronary events in men.

Researchers looked at a study population of 20,721 healthy Swedish men between the ages of 45 to 79 and followed them for more than a decade, asking them about their lifestyle choices and behaviors from levels of physical activity to their smoking status.

Men didn’t have to stick to every healthy behavior to see results: Every good habit was associated with a reduced risk for heart attack. Eating a low-risk diet plus drinking alcohol in moderation was associated with a 35% reduced risk of heart attack compared to those in the high-risk group. When men combined even more behaviors, the protective effects soared. Men who don’t smoke and walked or cycled at least 40 minutes a day, exercised at least one hour a week, had a waist circumference under 37.4 inches, drank moderately, and ate a diet of fruits, veggies, legumes, nuts, reduced-fat dairy products, fish and whole grains had an 86% lower risk of heart attack than those with high-risk behaviors.

It’s not all good news, of course. Only 1% of men in the study–and about the same amount of the U.S. population–keeps this kind of heart-healthy regime.

TIME Infectious Disease

Pregnant Women and the Flu: Why Influenza Is More Dangerous for Expectant Moms

Immune responses are enhanced during pregnancy, study finds

Only 50% of pregnant women get the flu vaccine, but they’re among the most vulnerable to influenza. When mothers-to-be catch the virus, they tend to get much sicker than other healthy adults, and it increases their risk for delivering prematurely.

A new Stanford University study published in the Proceedings of the National Academy of Sciences looked at why pregnant women are so susceptible to the flu, and they found the culprit may be over-zealous cells that are key to fighting off infection.

Researchers collected immune cells from about 50 women, half of whom were pregnant and half who weren’t. They then infected the cell samples with influenza virus in a lab. In the samples from the pregnant women, two types of white blood cells, called natural killer and T cells, had enhanced immune responses, causing them to attract even more immune cells to help fight the virus.

While it might seem that such a strong response to the flu is exactly what expectant mothers would want, it can be too much of a good thing, says Dr. Catherine Blish, assistant professor of infectious diseases at Stanford School of Medicine and the study’s senior author. “Having too many immune cells in the lung can cause inflammation that makes it hard to breathe,” she says, which might help explain why pregnant women who get the flu are at greater risk for pneumonia and death. “If these findings are confirmed in bigger studies and then natural infection, they could explain why pregnant women do so poorly.”

“We normally think that these particular cells are suppressed by pregnancy to protect the fetus—it’s what we all learned in medical school,” Blish says. “And we found when we used a generalized stimulation that that was the case. But there’s something specific about flu that leads to this enhanced response.”

Getting the flu vaccine helps protect pregnant women, Blish says, and she and her team “really strongly recommend” that all women who are pregnant or considering getting pregnant get vaccinated.

Blish and her colleagues plan to study whether other viruses have the same effect and whether it’s possible to treat severe influenza by turning down this immune response. But even if these findings eventually lead to new therapies, she says, “the most important thing to remember is that influenza vaccine is really the best tool to prevent infection in the first place.”

TIME Infectious Disease

The Liberian Church Stopping Ebola With Gospel and Chlorine

Dr. Mosoka Fallah, an epidemiologist and immunologist, speaks with residents during a neighborhood Ebola training session in Monrovia, Liberia.
Dr. Mosoka Fallah, an epidemiologist and immunologist, speaks with residents during a neighborhood Ebola training session in Monrovia, Liberia, Aug. 30, 2014. Daniel Berehulak—The New York Times/Redux

The Free Pentecostal Global Mission Church in the Chickensoup Factory district of Monrovia uses the pulpit to teach about the deadly virus, one sermon at a time

“Lord,” shouts the Reverend Joseph T.S. Menjor into a microphone. “We are tired of this situation. We are calling on you to cast this abomination from our country. Jesus, we want our land to be free of Ebola. Cast out this disease!”

The pastor is leading his people in prayer, but it is not a moment of quiet reflection. No, his congregation is on its feet, swaying to a gospel hymn, eyes closed and hands raised in supplication. At Menjor’s call, the 600 or so congregants of the Free Pentecostal Global Mission Church in the Chickensoup Factory district of Monrovia, Liberia chant a chorus of amens and launch into a cacophony of individual prayers, symbolically casting the evil of Ebola to the ground with repeated downward thrusts of their hands.

Menjor is not just trusting in God to solve the Ebola problem. The minister is taking concrete steps to protect his people, and his community, from an outbreak of a deadly virus that has already claimed 2,800 lives and sickened thousands more across Liberia, Sierra Leone and Guinea. Over 1,500 of those fatalities occurred in Liberia, with the densely packed seaside capital of Monrovia the worst affected. The disease, which is transmitted through contact with infected bodily fluids, has no vaccine, and there is no cure.

Preventing Ebola’s spread is the only solution, says Menjor. As with most establishments across the capital, large plastic vessels fitted with spigots and filled with a diluted chlorine solution flank the church doors. Ushers remind churchgoers to wash their hands thoroughly before entering. No one shakes hands anymore. Newcomers are greeted with broad smiles instead of the reverend’s personal embrace. While the church has grown in numbers since the outbreak — “When people are scared of dying, they flock to God,” chuckles Menjor — the pews are no longer tightly packed. The church offers two Sunday services instead, and broadcasts its sermons over the radio.

The Chickensoup Factory church branch, named after a powder soup manufacturing plant that used to be in the area, has also pioneered an Ebola Task Force designed to push the message of prevention into the homes of congregants and community members. Each Sunday, Rebecca Scotland, a founding member of the task force and a nursing instructor at a nearby teaching hospital, delivers her own talk before the sermon.

Combining drama with call and response, Scotland mimes Ebola symptoms for the congregation to identify. She fans her face and mimes taking her temperature. “Fever!” the congregation shouts. She feigns weakness, swaying on her feet. She clutches her stomach and bends over a pretend bucket. “Vomiting!” calls out a member of the choir. She squats in front of the pulpit and blows a raspberry into the microphone. “Diarrhea!” laughs the congregation.

The game of symptoms charades over, Scotland collapses in front of the pulpit, pretending to be sick. One of the prayer leaders, playing the part of a concerned relative, rushes to her side to offer comfort. Scotland jumps up with a stern “No!” The easiest way to get Ebola, she explains, is by touching infected people. “If you think you are sick, or someone in your family is sick, call 4455,” the national emergency hotline number. “The good news about Ebola is that there are survivors. It is not a death sentence. If you can get to the hospital, you have a chance.”

But knowing how difficult it is to find care in a city with more Ebola patients than room to treat them, she instructs the congregation on how to wear long sleeves and gloves before tending sickened family members. She explains how to mix a chlorine and water solution for cleaning hands and skin, and a stronger one for cleaning up vomit, blood and diarrhea. “Most Ebola infections happen at the bedside, when family members are caring for their loved ones,” she explains to TIME after the sermon. “If we can teach our members how to take care of themselves while taking care of their family members, we can go a long way towards stopping this disease.”

Scotland’s now weekly sermon was inspired by the illness of a beloved member of the church leadership, choir director Deborah Kamanda, who contracted Ebola caring for her younger sister and died Aug. 23. It was the first time Ebola had come to the congregation, and spurred the leadership into action. “We couldn’t save Deborah, but we knew we could stop that from happening again.” The task force, which was launched a week after Kamanda took sick, bore fruit immediately. Scotland’s guidance helped save Kamanda’s husband, Alex T. J. Kamanda, a science teacher who nursed his wife for eight days before a bed opened up in one of the city’s overcrowded treatment facilities.

While Kamanda, 39, stayed by his wife’s side, church members kept him in a steady supply of gloves, extra clothes and chlorine powder. “For me it was traumatic, seeing someone you love suffering so much, and not even being able to touch her without gloves, ” says Kamanda, sitting in front of the empty porch where his wife spent her last listless days before going to the treatment center. “But I didn’t get sick.” It’s a double blessing: his four-year-old son, who was staying with his grandparents at the time, still has a family, unlike the country’s hundreds of Ebola orphans.

The guidance of Monrovia’s churches is spreading beyond their congregations. When one of his neighbors got sick, Kamanda’s example inspired the victim’s son, Victor T. Bumbeh, to use the same protective measures. He didn’t get sick either. “It’s a fearful disease,” says the jobless 27-year-old. “I understand why people are afraid. But with the right protections, not everyone who touches it dies.” To members of the Chickensoup Factory church, casting Ebola from Liberia may start with God, but education, counseling and a good dose of chlorine are just as important.

TIME medicine

5 Signs Your Hormones Are Out of Whack

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When it's normal, and when to see your doctor

Raise your hand if, in the last few weeks, you’ve felt tired, bloated, or cranky. Sound familiar? Then you know the drill: Every month, your hormones—the body’s itty-bitty secret weapon—come out to play, wreaking havoc on your mood, skin, and mind. While levels generally stabilize after your period, various factors, like stress (yup, keep those hands raised) and anxiety can throw them off balance. So how can you tell if your symptoms require an office visit? Alyssa Dweck, MD, an OB-GYN at the Mount Kisco Medical Group in New York shares the five red flags that might merit a doctor’s note.

Fatigue

Exhaustion is one of the most, well, exhausting symptoms to a doc, since it has so many possible causes. “If you’re tired after a week of final exams or late nights at work, then you’re probably fine,” says Dr. Dweck. “But if you constantly feel worn out and notice weight gain, appetite fluctuations, and a change in bowel movements, it could be a sign of an underactive thyroid.” Yes, fatigue happens to everyone, but if yours doesn’t feel logical, then it’s worth getting it checked out.

Skin changes

You’re breaking out—again. While those sudden zits could be caused by one too many nights of going to bed without washing your face, they may be indicative of something more. “Adult acne or cystic acne around the lower half of your face could suggest a high level of testosterone,” says Dr. Dweck. Although not a life-threatening problem, breakouts can take a toll on your psyche. Luckily, your doc can prescribe you medication to stabilize your hormone levels and clear up skin.

Hair growth

We’re talking really fast hair growth. “If you all of a sudden grow a beard within a month or notice coarse, dark hair popping up on your chest, back or arms, that could be indicative of a testosterone-secreting tumor,” explains Dr. Dweck. But don’t freak out: Tumors are rare, she notes, and can often be treated with drugs or surgery.

Weird periods

Just like fatigue, a messed-up menstrual cycle can be the result of many factors, like stress, thyroid issues, low estrogen, or polycystic ovary syndrome (PCOS). “The hallmark of PCOS is irregular or absent periods, but it could also present with difficulty losing weight or strange hair growth,” says Dr. Dweck. Generally, PCOS is managed through diet, exercise and birth control pills, but your doctor will work with you to develop a multi-faceted plan if she finds this to be the cause of your period problems.

Night sweats

Unless it’s unusually warm in your bedroom, waking up feeling overheated and sweaty could be the result of lower estrogen levels and infrequent ovulation—aka perimenopause. “Perimenopause can occur up to 10 years before you’re even near the age of menopause,” says Dr. Dweck, “so unless you’re having major menstrual issues before age 40, there’s a good chance your phantom sweating could actually be early menopause.” Either way, Dr. Dweck recommends making an appointment with your doc to make sure it’s nothing more serious.

This article originally appeared on Health.com.

TIME Developmental Disorders

How Brain Waves May Be the Clue to Diagnosing Autism

Unique EEG fingerprints reveal how autistic brains process sights and sounds

Diagnosing autism as early as possible, even before the first noticeable symptoms of social and developmental delays emerge, is becoming a critical strategy for reducing the condition’s most severe symptoms. Experts have long known that children with autism process sensory information – sights and sounds in particular – in different ways than unaffected children.

In a new study published in the Journal of Autism and Developmental Disorders, Sophie Molholm, from the departments of pediatric and neuroscience at Albert Einstein College of Medicine, proposes that those differences may lay the foundation for social and communication deficits in some children later on.

Molholm and her team took electroencephalogram (EEG) readings from more than 40 children aged six years to 17 years diagnosed with autism and compared their patterns to those of unaffected children of similar age and other characteristics. All children were given either a flash cue, a beep cue or a combination of both, and asked to press a button when these stimuli occurred. A cap with 70 sensors picked up the children’s brain responses every two milliseconds during these tasks, including those that recorded how the brain first processed the sensory information.

MORE: Behavior Therapy Normalizes Brains of Autistic Children

The children with autism showed a distinctly different brain wave signature from those without the condition. Specifically, the signals in those with autism showed differences in the speed in which the sights or sounds were processed, and in how the sensory neurons recruited neighbors in more far-flung areas of the brain to register and make sense of the information. And the more abnormal this multi-processing was, the more severe the child’s autistic symptoms. “By developing this tool in the older cohort of children we can then figure out which ones are the most promising and then go test them in younger children,” says Molholm.

It’s also possible that because the children she studied were older, the differences in their EEG patterns were the result of autism, rather than a sign of changes that precede the disorder. But, she says, “If you ask me to make an educated guess, I would say these are part of autism, and they represent neuropathology related to having the disorder. It seems unlikely to me that you get autism and then develop atypical auditory processing.”

MORE: Autism Symptoms Disappeared With Behavioral Therapy In Babies

Molholm says the sample was too small to use the profile for diagnosing autism, but it could lead to such a test if the results are confirmed and repeated. To confirm the findings, scientists will have to intervene with behavioral strategies for helping the different regions of the brain work in a more coordinated way when confronted with visual and auditory cues. If that reduces autism symptoms, then EEG profiling could become one of a number of new ways that doctors can start identifying those at highest risk – however young — of developing autism.

TIME Infectious Disease

Ebola ‘Pretty Much Contained’ in Senegal and Nigeria

Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14.
Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14. Salvatore Di Nolfi—EPA

Good news for containment of an outbreak that has killed more than 2,800 people

The outbreaks of Ebola in Senegal and Nigeria have been “pretty much contained,” the World Health Organization said Monday.

There have been no new confirmed cases of Ebola in Senegal since the first case was reported Aug. 29, and the last case of Ebola reported in Nigeria was Sept. 8, the WHO’s regional office for Africa said in a statement. The news comes on the same day the WHO released details from the second meeting of the International Health Regulations Emergency Committee on Ebola. One of the top conclusions from the group was that travel and trade should continue in West Africa:

“Flight cancellations and other travel restrictions continue to isolate affected countries resulting in detrimental economic consequences, and hinder relief and response efforts risking further international spread,” the committee said.

The Committee reiterated WHO stances on making sure health care workers are protected from possible infections and ensuring people who are quarantined still have access to food and water.

There are currently 5,833 cases of Ebola in Sierra Leone, Liberia, Guinea, Senegal, Nigeria and the Democratic Republic of the Congo (though the DRC outbreak is thought to be unrelated to the others). Among those cases, 2,833 people have died.

 

TIME Infectious Disease

6 Ways Climate Change is Making Us Sick

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Spaces Images—Getty Images/Blend Images

Climate change and global health are intimately connected new research argues

Just a day after the People’s Climate March, one of the largest international environmental marches, a new analysis of 56 studies on climate change-related health problems shows that increasingly, global temperatures and severe weather events will continue to have a major impact on global health.

In the U.S. alone, several cities are expected to experience many more frequent hot days by the year 2050, and New York City and Milwaukee for example, may have three times their current average of hot days that reach over 90 degrees. According to researchers from the University of Wisconsin, this is just one consequence of human-driven climate change.

Currently, 97% of scientists studying climate agree that climate change is caused by humans. The new study, which is published in JAMA, lays out what these wide ranging effects on public health are.

Here’s a breakdown of how climate change will impact human health:

Heat-related health problems
In the researchers’ findings, they report that heat-related deaths represent more fatalities than all other weather events combined, and the frequency of hot days is expected to increase across all U.S. cities. Other research, like a recent July CDC report confirmed earlier this summer that heat-related health problems in the U.S. are growing. Since outdoor workers are impacted by heat, there are also significant economic-related implications—and by 2050s, the researchers report that workdays lost due to heat could reach 15 to 18% in South East Asia, Central America and West and Central Africa.

Respiratory problems
Climate-related pollution can trigger respiratory problems, commonly due to poor air quality, as exhibited in large cities like Beijing. The researchers report that 43 million people in the U.S. alone live in places that are over the EPA’s health standards for fine particulate matter in the air, and that can come from forest fires, which are thought to increase as temperatures continue to rise and droughts are prolonged. Pollen is also thought to increase with climate change, which is terrible news for people with seasonal allergies.

Infectious diseases
In the U.S., diseases like West Nile, dengue fever, and chikungunya virus are increasing in warm and muggy states like Florida, and all three of those diseases are thought to have a connection to warmer temperatures. The Natural Resources Defense Council (NRDC) says that the rise of temperatures and changes in rainfall patterns have contributed to longer summers, and therefore these diseases—which are insect-borne—have longer seasons.

Waterborne diseases
Climate change is projected to continue to cause heavier rain events, and the researchers note that gastrointestinal disease among kids has been tied to heavy rain fall in both the U.S. and India. Earlier this summer, citizens in Michigan and Toledo, Ohio were banned from drinking tap water after an algae bloom, caused in part by agricultural runoff, moved to the region’s water intake area and contaminated the drinking water.

Food insecurity
According to the report, climate change is expected to lower global food production by 2% per decade, even as demand increases 14%.

Mental health problems
The researchers show that serious weather events caused by climate change like Hurricane Katrina can leave people feeling utterly hopeless, displaced, full of anxiety and even with symptoms of post-traumatic stress disorder.

In a corresponding editorial, Dr. Howard Bauchner, the editor-in-chief of JAMA, and Dr. Phil Fontanarosa, the journal’s executive editor, write: “Understanding and characterizing this threat and educating the medical community, public, and policy makers are crucial if the health of the world’s population is to continue to improve during the latter half of the 21st century.”

When it comes to solutions, the researchers say reducing greenhouse gas emissions is a critical step in gaining better health and more economic stability. Starting Tuesday, the UN will meet for its 2014 Climate Summit, and the hope among many is that global public health will be an issue brought to the table—and addressed on an international scale.

TIME Infectious Disease

Ebola Lockdown in Sierra Leone Finds 150 New Cases

Ebola Sierra Leone Lock Down
A volunteer health worker talks with a resident on how to prevent and identify the Ebola virus in others, and distributes bars of soap in Freetown, Sierra Leone, Sept. 20, 2014. Michael Duff—AP

The lockdown was one of the most aggressive containment strategies employed so far in the outbreak

A three-day lockdown meant to contain the Ebola virus in Sierra Leone ended late Sunday night with officials hailing it as a “huge success” after health workers found almost 100 victims who perished from the disease and another 56 who have been infected.

The head of the Emergency Operations Center leading Sierra Leone’s Ebola response, Stephen Gaojia, called the lockdown “a huge success,” Reuters reports. About 123 people had contacted authorities by Sunday morning thinking they might be infected; 56 tested positive for the virus, 31 negative and 36 were still awaiting results.Final numbers will only be released once information is compiled from around the country.

The lockdown was one of the most aggressive containment strategies to be employed so far in the growing effort to contain the worst Ebola outbreak in history, which has killed more than 2,600 people across West Africa. Sierra Leone ordered its six million residents to stay indoors for three days, while 30,000 health workers, volunteers and teachers circulated, educating households on how to prevent the spread of the disease.

Health Minister Abubakkarr Fofanah told AFP that volunteers had managed to reach about 80% of homes and said: “Although this campaign has ended, there is a possibility we would have a similar one some other time.”

[Reuters]

TIME Sex/Relationships

10 Ways to Improve Your Relationship Instantly

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With everything going on in the lives of the average couple, it’s easy to forget the small gestures that keep a relationship ticking. What most couples don’t realize, though, is that it doesn’t take much to help your partner feel more valued every day. “Stringing together these little things is an ongoing way to make a change in your relationship,” says Dr. Gail Saltz, Health’s contributing psychology editor. The expert tricks here can fit easily into any routine — in minutes you’ll be on your way to building a stronger connection and lasting bond over time.

Turn off your smartphone

If you’re glued to Facebook during dinner, then it’s time to unplug. A study published in Computers in Human Behavior looked at data from 1,160 married people and found a negative correlation between heavy social-media use and relationship happiness. “When angry, some people may turn to texting to avoid saying something,” Saltz says. “It’s a way of creating distance.” While it doesn’t hurt to send a flirty or loving message, it does pay off to be more direct with your partner when something is really eating at you.

Go to bed at the same time

Feel like you never have a free moment together? Hitting the sack at the same time will help. “Bedtime might be the only opportunity you’re alone together all day,” says Barton Goldsmith, Ph.D., author of The Happy Couple: How to Make Happiness a Habit One Little Loving Thing at a Time. Even if you’re a night owl, you can always stay in bed until your partner drifts off. You should also make sure you’re both getting a healthy amount of shut-eye. A study from the University of California, Berkeley, looked at the sleep habits of more than 100 couples. Those who reported poor sleep were much more likely to argue with their significant other the next day.

Brew a cup of coffee for your partner

Grand gestures aren’t the only way to express your love. Something as simple as brewing your partner a cup of coffee in the morning helps improve your relationship, says Terri Orbuch, Ph.D., a marriage researcher and author of 5 Simple Steps to Take Your Marriage From Good to Great. Orbuch has studied 373 couples for more than 28 years through the University of Michigan’s Survey Research Center, and her research shows that frequent small acts of kindness are a predictor of happiness in a relationship. “People may feel taken for granted,” Orbuch says. By doing these small tasks on a regular basis, you’ll help your partner feel noticed.

Bring up a funny moment from your past

Sometimes the best memories are the funny ones. In a Motivation and Emotion study, couples that remembered laughing together — like the time a grocery-store clerk did something funny in the checkout line — reported greater relationship satisfaction than those who remembered experiences that were positive but not necessarily when they’d laughed. “Laughter reminiscence packs an additional punch because people relive the moment by laughing again,” says study author Doris Bazzini, Ph.D., a psychologist at Appalachian State University in Boone, N.C.

Work up a sweat

It’s no secret that getting buff helps you out in the bedroom by boosting your endurance, strength and flexibility — but a sweat session also has more immediate effects. “Endorphins from exercise give you an adrenaline rush that boosts arousal,” Orbuch says. Activities that get your heart rate up, like hiking, running or biking, are guaranteed to have a positive effect on desire. “Any kind of arousal rush can be transferred to your partner and add passion to your relationship,” Orbuch says.

Health.com: 10 Best Workouts for Your Sex Life

Dance before dinnertime

Couples who frequently try new things together have higher-quality relationships, according to research published in the Journal of Personality and Social Psychology. And we’re not necessarily talking extreme activities like skydiving or traveling to an exotic corner of the world (though those work too) — the activities simply should be new to the two of you, and can last for as little as seven minutes, researchers say. Dinnertime is one moment it’s easy to try something new. Turn on some catchy music while you’re cooking and start dancing together, Orbuch suggests. Or you could try a new a cooking technique — homemade sushi, anyone?

Have sex in a different place

Getting busy often enough to satisfy you both is key. If you’re feeling so-so about your bedroom romps, it might be time for a change. One idea: try having sex in a room or area you’ve never done it in. “New elements of play stimulate the dopamine system,” Saltz says. “When you do something that causes you to release more dopamine, it’s a positive reinforcer.” Want to suggest a tryst in the kitchen? Don’t worry about making it a drawn-out conversation, she says. It can be as simple as a one-liner that hints at your intention like, “The kids are gone. How about the kitchen table?” As long as your partner is game for the idea too, nothing’s stopping you.

Give your partner a hug

Nonsexual touching like hugging or handholding is just as important as sex itself in keeping your relationship healthy. “Touching is probably the most definitive way to let other people know you’re in a relationship,'” Goldsmith says. In the long run, the more you touch your mate, the more you’ll feel comfortable with each other. “Touching is a way we calm ourselves down,” Goldsmith says. “Every time you do it, you’re sending a positive message to your significant other.”

Ask a new question

As a couple, you probably spend most of your time chatting about work, your kids or your friends. When’s the last time you stopped to ask something new about each other? Everyone changes as relationships progress, Orbuch says, so it’s likely your partner has different interests and passions from the early years of your relationship. So ask your partner about anything you wouldn’t normally — movies, music, even what you’d do with lottery winnings.

Say thank you

Think about the last time your partner did something to help you out or made you feel special, and then say “thank you” for it. “You get so comfortable with your partner, it’s easy to expect them to meet your needs,” Saltz says. Too often couples forget to express a simple thanks, whether one of you helps out with the chores or surprises the other with a gift. And have you ever said thank you to your partner for simply being in your life? It’s important to express gratitude for this — not just for what they’re doing for you, Goldsmith says.

This article originally appeared on Health.com.

More from Health.com:

18 Habits of the Happiest Families

13 Healthy Reasons to Have More Sex

20 Weird Facts About Love and Sex

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