What If It's Not Depression?

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Publisher :
ISBN 13 : 9781950367641
Total Pages : pages
Book Rating : 4.3/5 (676 download)

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Book Synopsis What If It's Not Depression? by : Achina P. Stein

Download or read book What If It's Not Depression? written by Achina P. Stein and published by . This book was released on 2021-04-06 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Is depression really the cause of your symptoms? You''re tired. You have trouble sleeping and thinking, you feel down and stressed out, and you worry that you''ve lost your edge. You''re plagued by many physical symptoms, too! Your doctor told you that you were depressed, handed you a prescription for an antidepressant, and referred you to a psychiatrist. Your heart of hearts truly believes that you''re not depressed, but you don''t know what causes you to feel this way. What if It''s Not Depression? is for the person who is sick and tired of feeling sick and tired, doesn''t know why they suffer, is tired of going to doctors who just hand them prescriptions, and is willing to do the work so that they aren''t crippled by multiple chronic problems requiring multiple medications. Psychiatrist and certified functional medicine practitioner Dr. Achina Stein will transform your health through her winning strategies and help you: Figure out whether you''re really depressed or not, and what''s actually causing you to feel this way Get off that emotional roller coaster Clear up that brain fog and increase your energy and vitality Avoid being stamped with a lifelong mental illness diagnosis that requires years of medication Add quality years to your life What if It''s Not Depression? solves your problems by looking for the root causes of your emotional symptoms and helps to bring your mind, body, and spirit back into balance naturally without medication. There is hope for you!

It's Not Always Depression

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Author :
Publisher : Random House
ISBN 13 : 0399588159
Total Pages : 320 pages
Book Rating : 4.3/5 (995 download)

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Book Synopsis It's Not Always Depression by : Hilary Jacobs Hendel

Download or read book It's Not Always Depression written by Hilary Jacobs Hendel and published by Random House. This book was released on 2018-02-06 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: Fascinating patient stories and dynamic exercises help you connect to healing emotions, ease anxiety and depression, and discover your authentic self. Sara suffered a debilitating fear of asserting herself. Spencer experienced crippling social anxiety. Bonnie was shut down, disconnected from her feelings. These patients all came to psychotherapist Hilary Jacobs Hendel seeking treatment for depression, but in fact none of them were chemically depressed. Rather, Jacobs Hendel found that they’d all experienced traumas in their youth that caused them to put up emotional defenses that masqueraded as symptoms of depression. Jacobs Hendel led these patients and others toward lives newly capable of joy and fulfillment through an empathic and effective therapeutic approach that draws on the latest science about the healing power of our emotions. Whereas conventional therapy encourages patients to talk through past events that may trigger anxiety and depression, accelerated experiential dynamic psychotherapy (AEDP), the method practiced by Jacobs Hendel and pioneered by Diana Fosha, PhD, teaches us to identify the defenses and inhibitory emotions (shame, guilt, and anxiety) that block core emotions (anger, sadness, fear, disgust, joy, excitement, and sexual excitement). Fully experiencing core emotions allows us to enter an openhearted state where we are calm, curious, connected, compassionate, confident, courageous, and clear. In It’s Not Always Depression, Jacobs Hendel shares a unique and pragmatic tool called the Change Triangle—a guide to carry you from a place of disconnection back to your true self. In these pages, she teaches lay readers and helping professionals alike • why all emotions—even the most painful—have value. • how to identify emotions and the defenses we put up against them. • how to get to the root of anxiety—the most common mental illness of our time. • how to have compassion for the child you were and the adult you are. Jacobs Hendel provides navigational tools, body and thought exercises, candid personal anecdotes, and profound insights gleaned from her patients’ remarkable breakthroughs. She shows us how to work the Change Triangle in our everyday lives and chart a deeply personal, powerful, and hopeful course to psychological well-being and emotional engagement.

Lost Connections

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Publisher : Bloomsbury Publishing
ISBN 13 : 1526634082
Total Pages : 417 pages
Book Rating : 4.5/5 (266 download)

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Book Synopsis Lost Connections by : Johann Hari

Download or read book Lost Connections written by Johann Hari and published by Bloomsbury Publishing. This book was released on 2020-11-12 with total page 417 pages. Available in PDF, EPUB and Kindle. Book excerpt: THE INTERNATIONAL BESTSELLER: A radically new way of thinking about depression and anxiety 'A book that could actually make us happy' SIMON AMSTELL 'This amazing book will change your life' ELTON JOHN 'One of the most important texts of recent years' BRITISH JOURNAL OF GENERAL PRACTICE 'Brilliant, stimulating, radical' MATT HAIG 'The more people read this book, the better off the world will be' NAOMI KLEIN 'Wonderful' HILLARY CLINTON 'Eye-opening' GUARDIAN 'Brilliant for anyone wanting a better understanding of mental health' ZOE BALL 'A game-changer' DAVINA MCCALL 'Extraordinary' DR MAX PEMBERTON Depression and anxiety are now at epidemic levels. Why? Across the world, scientists have uncovered evidence for nine different causes. Some are in our biology, but most are in the way we are living today. Lost Connections offers a radical new way of thinking about this crisis. It shows that once we understand the real causes, we can begin to turn to pioneering new solutions – ones that offer real hope.

Undoing Depression

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Publisher : Little, Brown Spark
ISBN 13 : 0316266957
Total Pages : 380 pages
Book Rating : 4.3/5 (162 download)

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Book Synopsis Undoing Depression by : Richard O'Connor

Download or read book Undoing Depression written by Richard O'Connor and published by Little, Brown Spark. This book was released on 2021-09-28 with total page 380 pages. Available in PDF, EPUB and Kindle. Book excerpt: The bestselling approachable guide that has inspired thousands of readers to manage or overcome depression — fully revised and updated for life in the 21st century. Depression rates around the world have skyrocketed in the 20‑plus years since Richard O'Connor first published his classic book on living with and overcoming depression. Nearly 40 million American adults suffer from the condition, which affects nearly every aspect of life, from relationships, to job performance, physical health, productivity, and, of course, overall happiness. And in an increasingly stressful and overwhelming world, it's more important than ever to understand the causes and effects of depression, and what we can do to overcome it. In this fully revised and updated edition — which includes updated information on the power of mindfulness, the relationship between depression and other diseases, the risks and side effects of medication, depression’s effect on thinking, and the benefits of exercise — Dr. O'Connor explains that, like heart disease and other physical conditions, depression is fueled by complex and interrelated factors: genetic, biochemical, environmental. But Dr. O'Connor focuses on an additional factor that is often overlooked: our own habits. Unwittingly we get good at depression. We learn how to hide it, and how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion. Undoing Depression teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to "do" depression—and we can learn how to undo it. With a truly holistic approach that synthesizes the best of the many schools of thought about this painful disease, and a critical eye toward medications, O'Connor offers new hope—and new life—for sufferers of depression.

Living Like You Mean It

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Publisher : John Wiley & Sons
ISBN 13 : 0470377038
Total Pages : 213 pages
Book Rating : 4.4/5 (73 download)

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Book Synopsis Living Like You Mean It by : Ronald J. Frederick

Download or read book Living Like You Mean It written by Ronald J. Frederick and published by John Wiley & Sons. This book was released on 2009-03-03 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: In LIVING LIKE YOU MEAN IT, author Ronald J. Frederick, does a brilliant job of describing why people are so afraid of their emotions and how this fear creates a variety of problems in their lives. While the problems are different, the underlying issue is often the same. At the core of their distress is what Dr. Frederick refers to as feelings phobia. Whether it s the experience of love, joy, anger, sadness, or surprise, our inborn ability to be a fully feeling person has been hijacked by fear--and it s fear that s keeping us from a better life. The book begins with a questionnaire-style list that help readers take an honest look at themselves and recognize whether and how they are afraid of their feelings. It then moves on to explore the origins of fear of feeling and introduces a four-part program for overcoming the fear: (1) Become aware of and learn to recognize feelings--anger, sadness, joy, love, fear, guilt/shame, surprise, disgust. (2) Master techniques for taming the fear. (3) Let the feeling work its way all the way through to its resolution. (4) Open up and put those feelings into words and communicate them confidently. With wisdom, humor, and compassion, the book uses stories and examples to help readers see that overcoming feelings phobia is the key to a better life and more fulfilling relationships.

I Don't Want to Talk About It

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Publisher : Simon and Schuster
ISBN 13 : 0684865394
Total Pages : 390 pages
Book Rating : 4.6/5 (848 download)

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Book Synopsis I Don't Want to Talk About It by : Terrence Real

Download or read book I Don't Want to Talk About It written by Terrence Real and published by Simon and Schuster. This book was released on 1999-03-11 with total page 390 pages. Available in PDF, EPUB and Kindle. Book excerpt: A bestseller for over 20 years, I Don’t Want to Talk About It is a groundbreaking and hopeful guide to understanding and destigmatizing male depression, essential not only for men who may be suffering but for the people who love them. Twenty years of experience treating men and their families has convinced psychotherapist Terrence Real that depression is a silent epidemic in men—that men hide their condition from family, friends, and themselves to avoid the stigma of depression’s “un-manliness.” Problems that we think of as typically male—difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage—are really attempts to escape depression. And these escape attempts only hurt the people men love and pass their condition on to their children. This groundbreaking book is the “pathway out of darkness” that these men and their families seek. Real reveals how men can unearth their pain, heal themselves, restore relationships, and break the legacy of abuse. He mixes penetrating analysis with compelling tales of his patients and even his own experiences with depression as the son of a violent, depressed father and the father of two young sons.

What If It's NOT Depression?

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Author :
Publisher : Independently Published
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.3/5 (513 download)

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Book Synopsis What If It's NOT Depression? by : Do Ifmcp Stein

Download or read book What If It's NOT Depression? written by Do Ifmcp Stein and published by Independently Published. This book was released on 2020-02-13 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Is Depression Really the Cause of Your Symptoms? You're tired. You have trouble sleeping and thinking, you feel down and stressed out, and you worry that you've lost your edge. You're plagued by many physical symptoms, too! Your doctor told you that you were depressed, handed you a prescription for an antidepressant, and referred you to a psychiatrist. Your heart of hearts truly believes that you're not depressed, but you don't know what causes you to feel this way. What if It's Not Depression? is for the person who is sick and tired of feeling sick and tired, doesn't know why they suffer, is tired of going to doctors who just hand them prescriptions, and is willing to do the work so that they aren't crippled by multiple chronic problems requiring multiple medications. Psychiatrist and certified functional medicine practitioner Dr. Achina Stein will transform your health through her winning strategies and help you: Figure out whether you're really depressed or not, and what's actually causing you to feel this way Get off that emotional roller coaster Clear up that brain fog and increase your energy and vitality Avoid being stamped with a lifelong mental illness diagnosis that requires years of medication Add quality years to your life What if It's Not Depression? solves your problems by looking for the root causes of your emotional symptoms and helps to bring your mind, body, and spirit back into balance naturally without medication. There is hope for you!

The Mindful Way through Depression

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Author :
Publisher : Guilford Press
ISBN 13 : 1462508014
Total Pages : 289 pages
Book Rating : 4.4/5 (625 download)

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Book Synopsis The Mindful Way through Depression by : Mark Williams

Download or read book The Mindful Way through Depression written by Mark Williams and published by Guilford Press. This book was released on 2012-06-04 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: If you’ve ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all. In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. This e-book includes an audio program of guided meditations, narrated by Jon Kabat-Zinn, for purchasers to stream or download from the web. See also the authors' Mindful Way Workbook, which provides step-by-step guidance for building your mindfulness practice in 8 weeks. Plus, mental health professionals, see also the authors' bestselling therapy guide: Mindfulness-Based Cognitive Therapy for Depression, Second Edition. Association for Behavioral and Cognitive Therapies (ABCT) Self-Help Book of Merit

When Someone You Know Has Depression

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Author :
Publisher : JHU Press
ISBN 13 : 1421420155
Total Pages : 155 pages
Book Rating : 4.4/5 (214 download)

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Book Synopsis When Someone You Know Has Depression by : Susan J. Noonan

Download or read book When Someone You Know Has Depression written by Susan J. Noonan and published by JHU Press. This book was released on 2016-06 with total page 155 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Following on the success of Managing Your Depression, Susan Noonan's new book is for family members and friends of people with depression or bipolar disorder. A certified peer specialist at McLean Hospital (a comprehensive psychiatric hospital affiliated with Harvard University), Susan draws on her experiences providing support and education for those living with or caring for a person who has a mood disorder. A family member who has a mood disorder affects the entire family. Further, family members and close friends are often the first to recognize the subtle changes and symptoms of depression--and they are also the people who provide daily support to their loved ones, often at great personal price. Caring for someone with a mood disorder differs from caring for someone with a physical medical disorder, in ways that complicate the caregiving role. A concise and practical guide to the daily management of depression and bipolar depression written for the caregiver, the book explains how to reinforce lessons the patient has been taught in therapy, how to role model resilience skills, and how caregivers can and must care for themselves. It describes effective communication strategies and advises how to find appropriate professional help. Its many tables and worksheets convey much needed information in an accessible way. References, Resources, and a Glossary complete the package. Overall the book helps readers navigate the depression or biopolar disorder of someone close to them, providing readers with words to say and things to do as they try to help someone change the course of a sometimes confounding and often disabling illness"--

Your Depression Map

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Author :
Publisher : New Harbinger Publications
ISBN 13 :
Total Pages : 324 pages
Book Rating : 4.:/5 ( download)

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Book Synopsis Your Depression Map by : Randy J. Paterson

Download or read book Your Depression Map written by Randy J. Paterson and published by New Harbinger Publications. This book was released on 2002 with total page 324 pages. Available in PDF, EPUB and Kindle. Book excerpt: Based on the premise that depression is not an isolated disorder but a cluster of related disorders, this workbook asks readers to look at the multiple causes and symptoms of their depression and the myths that may hinder healing. Illustrations, charts & graphs.

The UltraMind Solution

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Publisher : Simon and Schuster
ISBN 13 : 1416566058
Total Pages : 447 pages
Book Rating : 4.4/5 (165 download)

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Book Synopsis The UltraMind Solution by : Mark Hyman

Download or read book The UltraMind Solution written by Mark Hyman and published by Simon and Schuster. This book was released on 2008-12-30 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: From the ten-time New York Times bestselling author of Ultrametabolism, The Blood Sugar Solution, and Eat Fat, Get Thin comes The UltraMind Solution. —Do you find it next to impossible to focus or concentrate? —Have you ever experienced instant clarity after exercise? Alertness after drinking coffee? —Does your brain inexplicably slow down during stress, while multitasking, or when meeting a deadline? —Do you get anxious, worried, or stressed-out frequently? In The UltraMind Solution, Dr. Mark Hyman explains that to fix your broken brain, you must heal your body first. Through his simple six-week plan, Dr. Hyman shows us how to correct imbalances caused by nutritional deficiencies, allergens, infections, toxins, and stress, restoring our health and gaining an UltraMind—one that’s highly focused, able to pay attention at will, has a strong memory, and leaves us feeling calm, confident, in control, and in good spirits.

Helping Others with Depression

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Author :
Publisher : Johns Hopkins University Press
ISBN 13 : 1421439298
Total Pages : 273 pages
Book Rating : 4.4/5 (214 download)

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Book Synopsis Helping Others with Depression by : Susan J. Noonan

Download or read book Helping Others with Depression written by Susan J. Noonan and published by Johns Hopkins University Press. This book was released on 2020-12-29 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: It is of enormous value to the layperson, hungry for knowledge about how best to interact and help their loved one face the dreadful ravages of depression."—Nursing Times

Depression in Parents, Parenting, and Children

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Author :
Publisher : National Academies Press
ISBN 13 : 0309121787
Total Pages : 488 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Depression in Parents, Parenting, and Children by : Institute of Medicine

Download or read book Depression in Parents, Parenting, and Children written by Institute of Medicine and published by National Academies Press. This book was released on 2009-10-28 with total page 488 pages. Available in PDF, EPUB and Kindle. Book excerpt: Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. Depression in Parents, Parenting, and Children highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration. A major challenge to the effective management of parental depression is developing a treatment and prevention strategy that can be introduced within a two-generation framework, conducive for parents and their children. Thus far, both the federal and state response to the problem has been fragmented, poorly funded, and lacking proper oversight. This study examines options for widespread implementation of best practices as well as strategies that can be effective in diverse service settings for diverse populations of children and their families. The delivery of adequate screening and successful detection and treatment of a depressive illness and prevention of its effects on parenting and the health of children is a formidable challenge to modern health care systems. This study offers seven solid recommendations designed to increase awareness about and remove barriers to care for both the depressed adult and prevention of effects in the child. The report will be of particular interest to federal health officers, mental and behavioral health providers in diverse parts of health care delivery systems, health policy staff, state legislators, and the general public.

How You Can Survive When They're Depressed

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Author :
Publisher : Harmony
ISBN 13 : 0307556913
Total Pages : 322 pages
Book Rating : 4.3/5 (75 download)

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Book Synopsis How You Can Survive When They're Depressed by : Anne Sheffield

Download or read book How You Can Survive When They're Depressed written by Anne Sheffield and published by Harmony. This book was released on 2009-02-04 with total page 322 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each year more than 17 million Americans suffer from a depressive illness, yet few suffer in solitude. How You Can Survive When They're Depressed explores depression from the perspective of those who are closest to the sufferers of this prevalent disorder--spouses, parents, children, and lovers--and gives the successful coping strategies of many people who live with a clinical depressive or manic-depressive and often suffer in silence, believing their own problems have no claim to attention. Depression fallout is the emotional toll on the depressive's family and close friends who are unaware of their own stressful reactions and needs. Sheffield outlines the five stages of depression fallout: confusion, self-doubt, demoralization, anger, and finally, the desire to escape. Many people will find relief in the knowledge that their self-blame, guilt, sadness, and resentment are a natural result of living with a depressed person. Sheffield brings together many real-life examples from the pioneering support group she attends at Beth Israel Medical Center of how people with depression fallout have learned to cope. From setting boundaries to maintaining an outside social life, she gives practical tactics for handling the challenges and emotional stresses on a day-to-day basis.

Depression and Diabetes

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Publisher : John Wiley & Sons
ISBN 13 : 1119957478
Total Pages : 197 pages
Book Rating : 4.1/5 (199 download)

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Book Synopsis Depression and Diabetes by : Wayne Katon

Download or read book Depression and Diabetes written by Wayne Katon and published by John Wiley & Sons. This book was released on 2011-06-09 with total page 197 pages. Available in PDF, EPUB and Kindle. Book excerpt: In recent years, there has been a growing awareness of the multiple interrelationships between depression and various physical diseases. The WPA is providing an update of currently available evidence on these interrelationships by the publication of three books, dealing with the comorbidity of depression with diabetes, heart disease and cancer. Depression is a frequent and serious comorbid condition in diabetes, which adversely affects quality of life and the long-term prognosis. Co-occurrent depression presents peculiar clinical challenges, making both conditions harder to manage. Depression and Diabetes is the first book devoted to the interaction between these common disorders. World leaders in diabetes, depression and public health synthesize current evidence, including some previously unpublished data, in a concise, easy-to-read format. They provide an overview of the epidemiology, pathogenesis, medical costs, management, and public health and cultural implications of the comorbidity between depression and diabetes. The book describes how the negative consequences of depression in diabetes could be avoided, given that effective depression treatments for diabetic patients are available. Its practical approach makes the book ideal for all those involved in the management of these patients: psychiatrists, psychologists, diabetologists, general practitioners, diabetes specialist nurses and mental health nurses.

No Depression # 76

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Publisher : University of Texas Press
ISBN 13 : 9780292719286
Total Pages : 148 pages
Book Rating : 4.7/5 (192 download)

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Book Synopsis No Depression # 76 by : Grant Alden

Download or read book No Depression # 76 written by Grant Alden and published by University of Texas Press. This book was released on 2008-10-01 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: For most of its thirteen-year history as a beloved and decorated music magazine, No Depression sought to be an instrument of change: to draw attention to the deep well of American musical traditions; to shine a light on performers whose gifts far exceed the size of their audiences or their pocketbooks; and to provide a safe harbor for the best long-form writing about music on the newsstand. These traditions continue through No Depression's now semi-annual series of bookazines. The inaugural bookazine, numberedND #76so as to make explicit the continuity betweenNo Depression's original and new formats, focused on the next generation of emerging roots music performers.ND #78, due out the fall of 2009, will focus on prominent families in American roots music, kinfolk who have stretched their artistic influence across generations. This will include in-depth pieces about bedrock clans of country music—the Carters and the Cashes—and folk music—the Guthries and the Seegers; profiles of country mavericks Steve and Justin Townes Earle and of jazz great Charlie Haden and his musically adventurous children; plus a more "metaphorical family" piece on the artistic "sons" of bluesman Rev. Gary Davis. The magazine's cofounders and coeditors, Grant Alden and Peter Blackstock, continue to guide the bookazine. The magazine's senior writers and contributors remain on board to shape the tone and voice of the bookazine, and its distinctive graphic design imprint continues in the hands of ND art director Grant Alden.

DSM-5 Classification

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Author :
Publisher : American Psychiatric Publishing
ISBN 13 : 9780890425664
Total Pages : 0 pages
Book Rating : 4.4/5 (256 download)

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Book Synopsis DSM-5 Classification by : American Psychiatric Association

Download or read book DSM-5 Classification written by American Psychiatric Association and published by American Psychiatric Publishing. This book was released on 2015-08-25 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This handy DSM-5(R) Classification provides a ready reference to the DSM-5 classification of disorders, as well as the DSM-5 listings of ICD-9-CM and ICD-10-CM codes for all DSM-5 diagnoses. To be used in tandem with DSM-5(R) or the Desk Reference to the Diagnostic Criteria From DSM-5(R), the DSM-5(R) Classification makes accessing the proper diagnostic codes quick and convenient. With the advent of ICD-10-CM implementation in the United States on October 1, 2015, this resource provides quick access to the following: - The DSM-5(R) classification of disorders, presented in the same sequence as in DSM-5(R), with both ICD-9-CM and ICD-10-CM codes. All subtypes and specifiers for each DSM-5(R) disorder are included.- An alphabetical listing of all DSM-5 diagnoses with their associated ICD-9-CM and ICD-10-CM codes.- Separate numerical listings according to the ICD-9-CM codes and the ICD-10-CM codes for each DSM-5(R) diagnosis.- For all listings, any codable subtypes and specifiers are included with their corresponding ICD-9-CM or ICD-10-CM codes, if applicable. The easy-to-use format will prove indispensable to a diverse audience--for example, clinicians in a variety of fields, including psychiatry, primary care medicine, and psychology; coders working in medical centers and clinics; insurance companies processing benefit claims; individuals conducting utilization or quality assurance reviews of specific cases; and community mental health organizations at the state or county level.