Task Force Report on State Response to Alzheimer’s Nears Completion

Thirty-one states have published a plan to respond to what advocates describe as the “escalating crisis” of Alzheimer’s Disease. Connecticut may be next, and is one of 13 states currently in the midst of developing plans.

The Connecticut Chapter of the Alzheimer’s Association was among the leaders in crafting and shepherding legislation in the 2013 General Assembly session to create a task force to study the care provided to persons diagnosed with Alzheimer's disease and dementia in the state.  That Task Force has been up and running throughout the fall, and is poised to announce its recommendations next month, just ahead of the start of the 2014 legislative session in February.

The 23-member task force of key agencies and community stakeholders convened in September, under the auspices of the Legislative Commission on Aging, to prepare findings and recommendations on ways to improve early detection, better coordinate health care services, set training requirements for health care providers and other professionals, services for early-stage and younger onset, and support to family caregivers.

The Task Force was co-chaired by State Commissioner on Aging Edith Prague and Rep. Joseph Serra of Middletown.  Members included Laurie Julian of the Alzheimer’s Association in Connecticut and other diverse community stakeholders appointed by legislative leadership and representatives from state agencies including the Department of Public Health, Department of Emergency Services, Department of Banking, Department of Labor and Department of Social Services, as well as six current legislators.

Over 5 million Americans are living with Alzheimer’s, and as many as 16 million will have the disease in 2050. Nearly one in every three seniors who dies each year has Alzheimer’s or another dementia. The cost of caring for those with Alzheimer’s and other dementias is estimated to total $203 billion in 2013, increasing to $1.2 trillion (in today’s dollars) by mid-century. Between 2000 and 2010, nationally, the number of people who died as a result of breast cancer, prostate cancer, heart disease, stroke and HIV all declined, while the number of people who died with Alzheimer’s increased by 68 percent.

In Connecticut, there were 820 deaths due to Alzheimer’s Disease in 2010, there are more than 63,000 individuals with Alzheimer’s in nursing homes in the state and it is estimated that 68% of nursing home residents have a cognitive impairment. As of 2010, there were an estimated 2,800 people between age 65-74 with Alzheimer’s in Connecticut, 30,000 between 75 and 84, and 37,000 age 85 or older.

The task force, in accordance with the legislation, will make recommendations in areas including:

• services provided to persons diagnosed with Alzheimer's disease and dementia; including persons with early-state and early-onset of Alzheimer's disease, and such persons' family members and caregivers
• legislative policy changes to better serve such persons, family members and caregivers;
• coordination between state agencies and private community-based health care providers to serve such persons, family members and caregivers;
• case management services for such persons, family members and caregivers;
• the transition of such persons from one health care facility to another; and
• the placement of such persons in community-based settings or health care facilities other than nursing home facilities, when feasible.

The state legislature acknowledged the growing numbers of residents impacted by the disease, passing the bill unanimously earlier this year, with 67 co-sponsors. It was signed into law in June by Gov. Malloy.  The Alzheimer’s Association has been actively involved in the effort. The organization’s   Connecticut chapter is based in Rocky Hill, with regional offices in Hamden, Norwalk, Norwich and New Milford.

In accordance with the legislation, the task force report is due to be published early next month, according to officials at the State Legislative Commission on Aging.

Hartford Hospital Will Devote Annual Fundraiser to Mental Health

The call to action regarding mental health awareness and treatment, which intensified in the aftermath of the Sandy Hook Elementary School murders a year ago, now has a strong local voice for the New Year.  Hartford Hospital is kicking off a campaign to end the stigma of mental illness at the annual Black & Red Gala on January 25, 2014 at The Bushnell Center for the Performing Arts in Hartford. The goal is to obtain 5,000 pledges, spreading the message that changing attitudes can begin to change minds.

Proceeds raised at this year’s Black &Red will benefit the Institute of Living (IOL) at Hartford Hospital. The IOL will be better able to respond to this national call to action with improved access to mental health care for adolescents and young adults –a critical need not only in Connecticut, but throughout the nation. Support will help carry out critically needed research, offer increased services and treatments, and provide much needed education to those impacted by mental illness.

An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. In addition, mental disorders are the leading cause of disability in the U.S. and Canada. Many people suffer from more than one mental disorder at a given time.

Mental health stigma can be divided into two distinct types, according to the Hartford Hospital website:

• social stigma is characterized by prejudicial attitudes and discriminating behavior directed towards individuals with mental health problems as a result of the psychiatric label they have been given.
• perceived stigma or self-stigma, is the internalizing by the mental health sufferer of their perceptions of discrimination and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes.

The annual gala – Hartford Hospital's lead fundraising event - will feature entertainment by Barenaked Ladies, winner of two American Billboard Music Awards and two Grammy nominations.

Individuals attending the event will be asked to sign a “pledge” to...

• Show compassion by reaching out to those in need of help. I will not let anyone suffer in silence.
• Have the courage to speak up and challenge stereotypes and attitudes. I will not tolerate or perpetuate stigma.
• Teach by sharing my own experiences with mental illness and encouraging others to share their stories with me. I will learn in order to change.
• Demand a change in how we view and address mental illness. I will help lead the way.

The pledge, and additional information about mental illness and the Hartford Hospital initiative, is now available on a new webpage on the Hospital’s website, at www.stopthestigma.org   Individuals do not need to attend the event in order to sign the pledge – that can be accomplished directly on the website.

 “We will be looking to our employees of Hartford Hospital and across the Hartford HealthCare system to take the pledge. As a healthcare leader in the community and the state, it is our duty to set the example and stop the stigma associated with mental illness. Together, we can do it,” said Stuart Markowitz, M.D., President Hartford Hospital and Hartford Region, Senior Vice President Hartford HealthCare.

Harold (Hank) Schwartz, M.D., Hartford HealthCare Regional Vice President, Psychiatrist in Chief, Institute of Living at Hartford Hospital, says for some people, a mental illness may be a lifelong condition, like diabetes. “However, as with diabetes, proper treatment enables many people with a mental illness to lead fulfilling and productive lives. By helping combat the stigma associated with mental illness, we can help increase the number of people that seek treatment.”

Examples of common mental illnesses include bipolar disorder, depression, PTSD, schizophrenia, OCD, anxiety disorders, eating disorders, ADD/ADHD, autism and Asperger’s.  CT by the Numbers has previously reported on research underway at the Institute of Living.

A year ago, over $1,000,000 in net proceeds was raised at the Black & Red gala for Hartford Hospital’s transplant services.

New Haven Is Among Most Walkable Cities in America, Ranks #8 Nationwide

New Haven is one of America’s most walkable cities, with 11.2 percent of commuters walking to work, the 8th highest percentage in the nation, among cities with populations of at least 100,000.  The top 10 list of Most Walkable Cities, published by GOVERNING magazine, notes that many of top communities are in the Northeast, and that communities across the country are stepping up efforts to enhance alternative ways of commuting from home to work. The top cities were Cambridge, MA (24.5%), Columbia , SC (20.7%), Berkeley, CA (18.1%), Ann Arbor, MI (15.5%), Boston, MA (15.5%), Provo, UT (12.2%), Washington, DC (11.9%), New Haven, CT (11.2%), Syracuse, NY (11%) and Providence, RI (10.8%).

Overall, 67 percent of New Haven commuters use their car, 11.2 percent walk, 4.8 percent bike or use other modes of transportation, and 1.7 percent work from home., according to the data developed from the U.S. Census Bureau's American Communities Survey, which included 300 metropolitan areas.

Nationally, only 2.8 percent of workers primarily commuted by walking last year, a figure that remains mostly unchanged from recent annual estimates, GOVERNING reported.

Among the New Haven walkers, 36 percent are age 16-24, 52 percent are age 25-44, 9 percent are age 45-64 and 2 percent are age 65 or older.  The median age of walk commuters is 27.8, according to the date.  In categorizing individuals, a person’s longest distance traveled is used, so those walking tp transit stations are designated as public transportation commuters, even though a portion of their daily commute involves walking.

Among Connecticut’s most populous cities, in Bridgeport 4.3 percent of commuters walk to work; in Stamford the figure is 4.7 percent, in  Hartford 7.9 percent, and in Waterbury 2.6 percent.

Newtown High School Students Win International Public Health Education Contest

Each year, about 3.5 million children die before their 5th birthday due to preventable diseases, mainly diarrhea and acute respiratory diseases.   According to survey data from the Global School-based Student Health Survey, over 15 percent of schoolchildren in some countries say they rarely or never wash their hands before eating.

Those facts spurred a group of Newtown High School student to action.  They participated in the World Health Organization’s Touching Lives School Talent International Contest.  The one-minute educational video they produced was selected by a jury of international experts as the winning entry in the middle/high school age category (age 10-16) and was the only United States-based entry to win its category.

The Newtown Public Health class submitted the video at the start of the school year, and it was selected this fall among the winners in various age categories.  Their video now appears on the website of the Pan American Health Organization, and has begun to appear on other public health websites, including the Connecticut Public Health Association.  It was designed, written and produced in the opening weeks of school, just prior to  the mid-September entry deadline.

Experts point out that “just rinsing your hands is not washing.” In order for hands to be clean, soap and water must be used, for at least 20 seconds. Handwashing with soap is the most effective and inexpensive way to prevent diarrheal and acute respiratory infections. Together, they are responsible for the majority of all child deaths, officials report.

Turning handwashing with soap before eating and after using the toilet into an ingrained habit could save more lives than any single vaccine or medical intervention, cutting deaths from diarrhea by almost half and deaths from acute respiratory infections by one-quarter, experts predict.  They also point out that a vast change in handwashing behavior is critical to meeting the Millennium Development Goal of reducing deaths among children under the age of five by two-thirds by 2015.

The educational video is preceded with the words “A Message from Newtown High School’s Public Health Class” filling the screen. It then begins with a male student gently singing over a strumming guitar, reminding viewers of the importance of hand-washing in rhyming lyrics, including urging viewers to “always think, 20 seconds at the sink.”  The video then features a variety of voices repeating “20 seconds” in nearly a dozen world languages.  It concludes by suggesting “don’t be part of the problem, be part of the solution.”

The video was edited by Amylee Anyoha.  Students in the Newtown High Public Health Class included Jess Amante, Maddie Erhardt, Enea Musaka, Sarah Craig, Kelly O’Connell, Chris Beaurline, Sydney Allen, Gabby Durkin, Tim Krapf, Amanda Paige, Taylor Strolli and Heather McKeown.

In the 2013 #TouchingLives School Talent International Contest, students could work individually or in a group, and all the countries in the Americas, were eligible and encouraged to develop songs, videos, illustrations, written compositions or any other expression of art promoting hand washing. The contest was, according to organizers, “about giving your personal touch to change the world.”

Pediatrician’s Invention to Stop Pain of Injections Could Improve Public Health

Many parents bring their infants and young children to the doctor for injections and leave muttering “there’s got to be a better way,” their child in tears or traumatized by the shot – or shots – administered to prevent illness and disease.  When Amy Baxter left the pediatrician’s office with her youngster, she resolved to find that better way.

Baxter, who attended Yale University as an undergraduate, Emory Medical School, and is now an emergency pediatrician, pain researcher and inventor in Atlanta, successfully developed  - with financial support from the National Institute of Health – a game-changing  device that combines high frequency, low amplitude vibration and a unique reusable ice pack a combination specifically designed to remove pain from the injection.

By stimulating competing sensations, nerve transmission of sharp pain, itching, or burning is blocked.  Simply put, the shots don’t hurt – and independently verified research indicates that it works.

As inventor of the unique needle pain blocking device - called Buzzy - Baxter founded a company that manufactures and distributes the product nationwide.  It is now in 1,200 children’s and adult hospitals across the country, including Yale-New Haven Hospital, Connecticut Children’s Medical Center, and Lawrence & Memorial Hospital in New London,  and it is being used in Connecticut, with varying frequency, by about 100 physicians in medical practices all across the state, from Ashford to Westport.

Buzzy is a bee-shaped palm sized device (wings included) that appears as cute as a toy but has a more important mission – to alleviate pain, thus eliminating the onset of fear. Baxter’s company, Georgia-based MMJ Labs, produces the fast, effective solution– which has applications beyond children, and beyond injections, to other ailments and sources of quick, sharp pain.

Since its launch in 2009, Buzzy has amassed more than 36,000 users, $1 million in annual revenue, and rapidly increasing sales.  Baxter is one of Inc. Magazine’s Top Women in Tech to Watch, and is asked all over the world to educate physicians, nurses, Child Life specialists, and others about the importance of pain management.

“I invented Buzzy after experiencing first-hand the indifference of the healthcare system to the pain and suffering of children. As a pediatric emergency physician and pain researcher, I have learned that pain relief is not just a luxury; it actually improves the outcomes of procedures,” Baxter explains.

Data indicates that fear of needles is growing among children and the general population, and Baxter says that’s reason for concern.  Especially troubling is the long-term impact of a growing population of needle-averse adults will have on their own health and the health care system.

She cites statistics that reflect a dramatic increase in the number and frequency of shots children receive as youngsters – as much as four times higher than 50 years ago – and sometimes as many as four or five shots in a single doctor’s office visit.  And she stresses that pediatricians generally do little or nothing to try to diminish the pain that accompanies those injections.  That, Baxter says, has dramatic and long-lasting effects, on children as well as their parents.   The youngsters come to view the visits as more about pain than health, and the parents begin to have second thoughts about continuing to inflict the pain of needles on their children, often regardless of the potential benefits.

In a TEDx talk in Atlanta last month, Baxter discussed the public health repercussions of having populations whose fear of vaccinations could turn them away from the very remedies that can improve their individual health and the health of entire populations, warning that “by ignoring pain we’re endangering the future of health care.”

In the talk, titled “Pain, Empathy and Public Health,” Baxter warned that “the number and the way were giving shots is causing needle fear” which may lead to today’s children electing to stay away or delay visits to doctor’s offices as adults – at considerable potential health peril.

In the face of a potential “public health tsunami,” Baxter says “the solution is not to stop vaccinating, it’s to start making the shots better— vaccines shouldn't have to hurt.”

Bullying Presents Ongoing Danger; Efforts to Educate Intensify As Incidents Continue

"From a young age, we teach children to say, 'Sticks and stones will break my bones, but names will never hurt me.' But this isn't true. Bullying hurts so much not because one individual is rejecting us but because we tend to believe that the bully speaks for others that if we are being singled out by the bully, then we are probably unliked and unwanted by most. Otherwise, why would all those others watch the bully tease us rather than stepping in to help support us? Absence of support is taken as a sign of mass rejection.”

That observation, in Social: Why Our Brains Are Wired to Connect, a new book by Matthew D. Lieberman, Director of the UCLA Social Cognitive Neuroscience laboratory, published by Random House, provides insight into why bullying has such dramatic impacts, including incidents in Connecticut.

A Hartford Courant review of state education records, published this fall, found more than 1,250 incidents of school bullying were reported to the state from 2005 to 2012. The state's largest cities — Hartford, Bridgeport and New Haven — reported the most incidents, with Hartford reporting 91 verified incidents.

A quarter of the state's high school students — and 35 percent of the state's ninth-graders — report having been bullied or harassed on school property, according to the state Commission on Children. The Connecticut School Health Survey shows that state high school students who report being bullied are more likely to get less sleep, miss school because they feel unsafe, feel depressed, or attempt suicide, the Courant reported.

New Recommendations Anticipated

The state Department of Education plans to make a series of recommendations to the 2014 General Assembly “to address current conditions in Connecticut.”  Those recommendations may include an examination of the terminology regarding bullying and climate in an attempt to signal increased and focused attention on improving school climate in addition to, or rather than, exclusively reacting to bullying incidents, as well as addressing the relationship between the definitions of bullying and harassment and the implications for actions that the district or state should take regarding reported incidents.

The Department prepared “Bullying and Harassment in Connecticut:  A Guide for Parents and Guardians” a year ago, in December2012.

Programs Respond and Teach

The Anti-Defamation League (ADL) is one of the leading organizations providing information and training for individuals who work with students on a daily basis, and anti-bias and anti-bullying programs for students ranging in age from fourth grade through seniors in high school. Such programs include “Names Can Really Hurt Us,” “Step Up!” and “Becoming an Ally.” The Connecticut ADL hosted two parent workshops in Greenwich this fall, just weeks after a 15-year-old Greenwich student took his own life on the first day of school this fall, and friends said bullying may have been a factor in the death.

The programs, which had been planned since the spring, sought to give parents strategies for bullying prevention and intervention. As part of the program, Greenwich High School students who had been trained by ADL talked to those in attendance about their experiences with bullying and cyber-bullying, Greenwich Time reported. “We offered strategies and resources that the parents found very valuable. It was a unique opportunity for parents and high school students to have an open and honest dialogue about bullying and cyber-bullying issues that face today’s youth,” said Marji Lipshez-Shapiro, ADL Connecticut’s Director of Education.

The ADL programs explore stereotyping, prejudice, discrimination and scapegoating through the lens of students' experiences, and include student testimony, skits, videos and discussion groups. The ADL’s Names Can Really Hurt Us is described as a powerful, student-centered assembly program designed to give a voice to the targets of bullying and prejudice, build empathy in the perpetrators and inspire bystanders to become allies. ADL works with a team of students and school staff who participate in six hours of training and assist ADL in putting on a full-day program consisting of a morning assembly, break-out groups and a closing assembly.  During the morning assembly, student participants share their personal experiences with bullying, name-calling and prejudice in a safe forum. Students then participate in small group discussions led by student-teacher teams. The program culminates with a report of “next step” ideas, generated by students, to help create a welcoming and supportive school community.

Incidents Continue Despite Law

Stamford police arrested a 12-year-old girl and charged her with disorderly conduct for bullying another girl this fall. Police said an investigation began in September when the target's parents contacted police and said another student had repeatedly bullied the 13-year-old at school. When the bullying worsened and the targeted girl made comments about committing suicide, police said they immediately got involved. School administrators in Manchester last month suspended four Manchester High School students suspected of creating and posting degrading descriptions of female students, The Hartford Courant reported.

In Connecticut, the state legislature unanimously passed an anti-bullying law in 2011 that speeds school response, expands staff training, makes all school employees mandated reporters of bullying, addresses cyber bullying and launches statewide school climate assessments.  Under the state legislation, schools must report acts of bullying to the state. The state's definition of bullying includes "the repeated use by one or more students of communication, a gesture or a physical act directed at or referring to another student in the same district that causes physical or emotional harm or fear of such harm."

A 2011 U.S. Department of Justice survey shows that 54 percent of Asian-American teenagers, 38.4 percent of black students and 34.3 percent of Hispanics reported being bullied in the classroom. The survey found that 31.3 percent of white students reported being bullied.

In September, Michelle Pincince, Project Director of the Connecticut ADL’s A World of Difference Institute met with about 25 school resource officers from throughout Connecticut. The program, which took place at Redding Elementary School, was organized by Redding Police Chief Doug Fuchs, according to published reports.  A school resource officer is a law enforcement officer who is assigned to a school in his town, and who protects the students in the school and works to promote positive relationships between students and law enforcement. ADL runs 200 education programs and reaches over 20,000 individuals in Connecticut annually.  Since the school year began this fall, 31 Connecticut schools have participated in ADL programs. 

Nation of Coffee Drinkers, Across Every Demographic

Thanksgiving may be all about turkey, but odds are that most people around the table will wash it down with a cup of coffee.  According to the latest National Coffee Drinking Trends (NCDT) market research study, 63 percent of adults age 25-39 report drinking coffee every day, an increase of five percent from 2012 and a sizable jump from 44 percent who reported drinking coffee daily during 2010.  The study also found that just over 83 percent of U.S. adults drink coffee, and those who drink coffee at least once per week grew slightly to 75 percent of the population.

Coffee drinkers outnumber tea drinkers in the U.S.: 183 million coffee drinkers to 173.5 million tea drinkers.

Young people are drinking more coffee than in recent years, according to the data compiled by the National Coffee Association:  41 percent of 18-24 year olds are drinking coffee each day —up from the 31 percent of this age group who said they had a daily cup of coffee during 2010. Overall daily consumption of coffee among those 60+ rose to 76 percent from 71 percent last year, and for those 40-59 to 69 percent from 65 percent in 2012.

Most adult coffee drinkers said their lifelong habit began during their teenage years. In fact, 54 percent said they began drinking coffee between 13 and 19.  Another 22 percent reported their coffee cravings started between the ages of 20 and 24. This means that 76 percent of adult coffee drinkers began drinking coffee by the time they were 24, the report pointed out.

Analysts indicate that U.S. Coffee consumption is expected to increase through 2015 at an average annual rate of 2.7 percent, while tea consumption is expected to increase through 2015 at an average annual rate of 3.1 percent, the organization reported.

In a breakdown of ethnic groups, the National Coffee Association data indicates that 76 percent of adult Hispanic-Americans said they drank coffee yesterday, 13 percentage points ahead of the total population. By comparison, 47 percent of African-Americans and 64 percent of Caucasian-Americans said they drank coffee yesterday.

With holiday gift giving now in full swing, the data regarding single-cup brewing systems is of note.  The data, from earlier this year, indicates that 13 percent of the U.S. population drank a coffee made in a single-cup brewer yesterday - up from just 4 percent in 2010.  That number is expected to climb when 2013 year-end numbers are compiled.

So-called “gourmet coffee” is also heating up. Nearly one third (31 percent) of the population say they drink gourmet coffee every day. At the same time, consumption of traditional coffee declined by seven percentage points to 49 percent.

NCA's National Coffee Drinking Trends (NCDT) study has been conducted annually by NCA since 1950. It is the longest available statistical series of consumer drinking patterns in the U.S. The study engaged a nationally representative sample of 2,840 people 18 and older.  The 2014 report is due to be issued early next year. The National Coffee Association of U.S.A, Inc. (NCA), established in 1911, is the leading trade organization for the coffee industry in the United States.

Worldwide consumption of coffee in calendar year 2012 was estimated at around 142 million bags by the International Coffee Organization, an increase of 2.1 percent from 2011.  The U.S. remains the largest consuming country, although consumption in non-traditional markets has increased 50 percent since 2003, according to the report issued in August.

Earlier this year, USA Today reported that a study published online in the journal Mayo Clinic Proceedings, indicated that men younger than 55 who drank more than 28 cups of coffee a week (four cups a day) were 56% more likely to have died from any cause. Women in that age range had a twofold greater risk of dying than other women. The study looked at 43,727 men and women ages 20-87 from 1971 to 2002.  However the publication also noted a 2012 study that found that coffee drinkers ages 50-71 had a lower risk of death than their peers who did not consume coffee. In that study, researchers from the National Cancer Institute, part of the National Institutes of Health, and AARP found that the more coffee consumed, the more a person's death risk declined.

Connecticut Residents Are Extroverts, Neurotic and Open, National Study Finds

Connecticut ranks 47th among the states in conscientiousness, but #12 in extroversion and #16 in neuroticism, according to a new study published in a scientific journal and reported in TIME magazine.  Overall the state falls into the “temperamental and uninhibited” category, as does much of the Northeast, led by Vermont, Massachusetts and Pennsylvania.

Using personality test data from over one million people compiled over a decade, researchers identified three distinct personality regions in the country, and the degree to which each state reflected those characteristics.  The study was conducted by a multinational team of researchers led by psychologist and American expatriate Jason Rentfrow of the University of Cambridge in Great Britain. 

The study, which maps the American mood state-by state, found that West Virginia is the most neurotic state, Utah is the most agreeable (Washington D.C. – not surprisingly – is the least agreeable) and the Wisconsin has the country's most extroverted residents. The most conscientious state in the nation?  That would be South Carolina.

The Connecticut Scoreboard indicates that state residents are above the national average in three characteristics - extroversion, neuroticism and openness, but lag in agreeableness and conscientiousness. (rank among states in parentheses; a score of 50 is the national average in each category:

• Extroversion (12)  57.6
• Neuroticism (16)  53.4
• Openness (21)  53.9
• Agreeableness (43)  38.6
• Conscientiousness (47)  34.2

(sample size was 17,769)

The study, published in the Journal of Personality and Social Psychology, spanned 13 years and including nearly 1.6 million survey respondents from the 48 contiguous states and Washington, D.C.. (Alaska and Hawaii were excluded because not enough people responded to the researchers’ questionnaires.)

The subjects, recruited via websites and advertisements in the academic community as well as through platforms like Facebook, were asked to take one of three different personality surveys, though the most relevant one was what’s known as the Big Five Inventory, TIME reported. The survey measures personality along five different spectra: Openness, Conscientiousness, Extroversion, Agreeableness and Neuroticism.

(If you’d like to take the test, it is available online from TIME.)

Each of those categories is defined by more-specific personality descriptors, such as curiosity and a preference for novelty (openness); self-discipline and dependability (conscientiousness); sociability and gregariousness (extroversion); compassion and cooperativeness (agreeableness); and anxiety and anger (neuroticism). The inventory gets at the precise mix of those qualities in any one person by asking subjects to respond on a 1-to-5 scale, from strongly disagree to strongly agree, with 44 varied statements.

When the returns were tallied, TIME reported, the country broke down into three macro regions: New England and the Mid-Atlantic states, which the researchers termed “temperamental and uninhibited”; the South and Midwest, which were labeled “friendly and conventional”; and the West Coast, Rocky Mountains and Sun Belt, described as “relaxed and creative.”

One Month, Many Causes: Health & Wellness Lead the Way in November

If supporting a cause – whether with time, energy or resources - is on your to-do list, November is a great month to start if you’d like to focus on health and wellness efforts.

November is American Diabetes Month (American Diabetes Association), Diabetic Eye Disease Month (Prevent Blindness America), National Alzheimer’s Disease Awareness Month (Alzheimer’s Disease and Related Disorders Association) and National Epilepsy Awareness Month (Epilepsy Foundation of America).  In addition, it is National Child Mental Health Month, National Family Caregivers Month (National Family Caregivers Association), and National Healthy Skin Month (American Academy of Dermatology).

November is also National Home Care Month (National Association for Home Care & Hospice) and National Hospice Month (National Hospice and Palliative Care Organization), as well as Great American Smokeout Month.  November 21 is designated by the American Cancer Society as the Great American Smokeout Day.

The week before Thanksgiving, November 17-23, is American Education Week, as designated by the National Education Association.

The previous week features World Kindness Day on November 13, World Diabetes Day on November 14, and National Philanthropy Day (Association of Fundraising Professionals) and America Recycles Day (National Recycling Coalition), both on November 15.  November 22 is National Family Health History Day, set by the U.S. Department of Health and Human Services, and November 23 is International Survivors of Suicide Day (American Foundation for Suicide Prevention).

Mothers Against Drunk Driving will highlight their Tie One On For Safety Campaign, between November 21 and January 1, coinciding with the holiday season.

Subway Reaches 40,000 Locations; Growth Continues for World’s #1 Fast Food Chain

The Connecticut-headquartered SUBWAY® restaurant chain, which has been providing franchising opportunities to entrepreneurs since 1965 and is approaching its 48th year in business, has opened its 40,000th location at an Apple Green petrol station in Ipswich, England.

The opening reflects the consistent growth of the Subway brand, which has opened nearly 2,000 new locations around the world since the start of the year. In 1965, Subway was founded by 17 year-old Connecticut high school graduate Fred DeLuca, along with family friend Dr. Peter Buck. The first restaurant opened in Bridgeport in 1965 and was called Pete’s Super Submarines. The first franchised Subway unit opened in 1974 in Wallingford.

“This is certainly a testament to the dedication and hard work of the entire Subway team, who I often refer to as The Greatest Team in Franchising History,” said DeLuca. “I am proud to be part of a team that provides thousands of jobs for people at our restaurants, field, offices, headquarters and partner offices around the world.  Our franchisees are a diverse group of small business owners who take a great deal of pride in serving their customers.”

CNN Money has reported that the “home of the $5 foot-long sub” is the most popular franchise (ahead of Quiznos, the UPS Store and Cold Stone Creamery) and biggest fast-food chain in the world, with an initial franchise fee startup is $15,000, a fairly low sum compared to other brands. With fewer than 8% of SBA-backed borrowers defaulting on their loans, Subway has a better track record than similar brands -- rival sub shop Blimpie has a 46% loan failure rate, and Quiznos is also well into the double digits, according to CNN Money.

This latest milestone puts the Subway brand far ahead of its competitors in the Quick Service Restaurant industry. Of the top restaurant chains, the next closest is more than 5,500 locations behind. Beyond that, the next three are between 21,000 and 33,000 behind, the company reported.

The combination of global branding, minimal upfront outlay of cash, and low loan default rates have made Subway the most popular brand in the last decade for entrepreneurs looking to open a franchise, the CNN website reported, based on the SBA's lending data.

The U.K. is the brand’s third largest market, behind the U.S. and Canada, with more than 1,500 locations.  In all, there are 14,000 International locations in 102 countries outside the U.S.  The Eastern European nation of Estonia recently witnessed the opening its first Subway franchise.

The company headquarters remains in Milford, with additional regional and country offices in Amsterdam, Beirut, Brisbane, Miami and Singapore, employing about 1,000 people in total. Worldwide, its franchisees provide more than 300,000 jobs in the communities where they are located. With a robust social community of over 25 million, Subway engages daily with consumers from around the world.

In 2012, Subway became the first quick service restaurant to meet the American Heart Association's Heart Check Meal Certification Program nutritional criteria.  Earlier this year, the Connecticut Post reported that DeLuca plans to reach 50,000 sandwich shops in four years. The chain, which has attracted customers with lower-calorie and reduced-sodium sandwiches, is competing with Yum! Brands in India, China and Japan, as it proceeds with plans to open 300 stores in each nation in the next three years, DeLuca told the Post.