Are you also planning to start your first session with your therapist? Do you also feel anxious and do not know what to talk about?

What to expect from the first session?

Whether you are an introvert or an extrovert, there will be times during your first session when you will feel like you have "run out" of things to say. Psychologists too agree that it is not uncommon for people to come to the session and be unsure on what they want to discuss. This happens because opening up is tough and may not come as easily, especially when you are just getting to know your therapist.

While some therapists give you an assessment to help them understand you better, others might let you lead the conversation.

However, if you are unsure on what to say in your first session, here are some things and ideas you can ponder upon:

Start with 'small' issues

It may seem like you need to start off strong and with things like "deep" and "serious" issues. However, it is okay to start with small things that bothers you at work, or at home. These small things can lead to bigger things, rather than starting with a big incident of your life.

Journal, if you must

It is always a great idea to track your thoughts, patterns and behaviors by keeping a journal. It helps you see and reflect on how things have triggered your thoughts and changed your mood.

Present feelings

Try to focus on how you feel in the present. When you are in therapy, instead of thinking hard about what happened during the week, try to ponder upon what made you book the session today. Did something happen today? Or did something happened at work?

Are you thinking about something again and again?

Depression and anxiety both involve rumination. It is a tendency that leads one to think about the same thing over and over again. Usually, it happens when you have a hard time falling asleep one night and that you mind would not stop thinking about it. If something similar is happening to you, it is best that you talk about this to your therapist too.

Relationships

If you are having trouble with your partner, or how one communicates, it is important you share this with your therapist. However, relationships always do not mean your love life. This could be about anything, it could be about you and your parents, your kids, your siblings, and even about your pets. If you have lost someone close and this has affected your mood significantly, you can also talk about that. If you felt betrayed by a close friend, you can also talk to your therapist about it.

Past Traumas

If there is a traumatic incident that to this date impacts how you think or talk, it is important that you bring it up with your therapist. It may seem difficult to talk about it the first thing in the first session. However, it is okay to do that, because your thoughts are kept confidential, and it is important that you remember that.

New challenges

Everyone likes their comfort zones, and no body wants to go to a new place, try new things, and come across new challenges, etc. However, it is part and parcels of our lives to come across new things. It can be difficult to navigate and this is where talking to your therapist about it can help.

With measles cases soaring to nearly 900 across the United States, public health officials are raising the alarm over what is rapidly becoming an escalating crisis. The U.S. Centers for Disease Control and Prevention (CDC) has reported 884 cases in 29 states, a whopping threefold increase over all of 2024. With ten states now reporting active outbreaks, the urgent question remains- is prevention really the only cure?

The United States, in 2000 having declared measles eliminated, now confronts a sobering resurgence. Most of the cases currently, 646, are from Texas, where an outbreak based in West Texas continues to expand after almost three months. Some of the states that are struggling with ongoing outbreaks are Indiana, Kansas, Michigan, Montana, New Mexico, Oklahoma, Ohio, Pennsylvania, and Tennessee.

Unfortunately, two West Texas unvaccinated children and a New Mexico adult have died from measles complications. These deaths reinforce the outbreak's severity and the vulnerability of unvaccinated groups.

Adding to the worry, North America is not alone in this battle. Nearby nations report similar crises — Ontario, Canada, has recorded more than 1,020 cases, and Mexico's Chihuahua state has recorded 605 cases attributed to the Texas outbreak, reports the World Health Organization (WHO).

Why Is Measles Making a Comeback?

Measles is among the most infectious viruses, able to stay in the air and on surfaces for hours after a person infected with it coughs, sneezes, or even breathes. In an extremely immunized population, the disease cannot spread — an effect called "herd immunity." But when vaccination rates are low, vulnerability pockets form.

A number of factors are to blame for the outbreak:

Waning Vaccination Coverage: CDC reports a troubling trend. For the 2023–24 school year, vaccination coverage of kindergartners in the United States declined to 92.7% for the MMR vaccine from 93% in the last school year. Worryingly, vaccine exemptions reached 3.3%, a record high.

Regional Vulnerabilities: In the epicenter of the outbreak, Gaines County, Texas, MMR vaccination coverage has fallen to a mere 82%, well short of the 95% required to ensure herd immunity. Not surprisingly, children have borne the brunt: of 198 cases in the region, 153 were in people under the age of 18, the majority of whom were unvaccinated or whose vaccination status was unknown.

Global Trends and Misinformation: Globally, vaccine hesitancy, driven by misinformation, concern over side effects, and public health messaging distrust, is weakening immunization efforts. Discredited theory linking MMR vaccines to autism, though disproven, remains active, with special presence on social media outlets.

Though frequently confused as a harmless illness of childhood, measles can be fatal. Measles attacks the respiratory tract first and then the rest of the body, producing high fever, cough, nasal discharge, red, watery eyes, and a characteristic rash that initially appears on the face and travels downward.

Measles can have serious complications, including:

• Pneumonia: One of the main causes of death in measles.
• Blindness: Due to scarring of the cornea.
• Encephalitis: Fatal brain swelling that may result in permanent brain damage or death.

The CDC says the rash accompanied by fever may rise to more than 104 degrees Fahrenheit. Most healthy children will bounce back, but for at-risk groups — especially the unvaccinated — the virus can rapidly become deadly.

Why MMR Vaccine is The First Line of Defense?

CDC and WHO are in agreement: vaccination is still the best way to prevent measles. The measles, mumps, and rubella (MMR) vaccine is most often given in two doses — the first dose between 12 and 15 months, and the second dose between 4 and 6 years. The vaccine is safe, works, and has decades of proven success.

For those worried about declining immunity, taking an extra dose is harmless. Those vaccinated prior to 1968 with an ineffective "killed" virus vaccine should have at least one additional dose.

Where vaccination coverage is over 95%, outbreaks are uncommon because the virus has few susceptible hosts. Widespread exemptions and misinformation have, however, resulted in severe immunity gaps, enabling measles to gain a foothold once again.

The increase in cases is not so much a matter of gaps in healthcare logistics. It is symptomatic of deeper loss of faith in science and public health organizations.

Experts refer to a range of factors promoting vaccine hesitancy:

Misinformation: Rumors about the side effects of vaccines, with a focus on unfounded speculations about an MMR-a Autism link.

Skepticism following COVID-19: Distrust generated by the pandemic has seeped over into routine vaccination.

Needle Phobia or Side Effects: Fear and misconceptions regarding ingredients or eventual outcomes of vaccines remain a concern among parents.

Similar trends globally are reflected in concerns. In the United Kingdom, for example, MMR vaccination coverage at age 5 decreased to their lowest levels since the 2010–11 periods, contributing to more than 2,900 cases of measles to date this year.

Is Prevention the Only Cure?

Plain and simple, yes. There is no antiviral therapy for measles. Supportive care — treating fever, maintaining hydration, and managing secondary infections — is all that can be provided once infection has been established.

In the absence of curative treatments, vaccination is not only the best weapon against measles — it is the sole weapon.

Public health experts stress that immediate action is imperative. Targeted public awareness campaigns, coordination with global agencies such as WHO and UNICEF, and combating vaccine misinformation directly are key strategies. Re-establishing trust and guaranteeing mass vaccination is the only long-term solution to forestalling future outbreaks.

The current upsurge in cases of measles all over the U.S. and globally is a chilling reminder: complacency can reverse decades of public health advances.

In a time of unparalleled access to medical information and resources, no child should ever die from a preventable illness like measles. The way forward is simple — revitalize immunization programs, fight misinformation, and advance community health through fact-based, science-driven advocacy.

Preventing measles isn't merely about saving individual lives — it is about protecting future generations.

As a part of World Immunization Week, which is observed from April 24 to 30, to promote the life-saving power of immunization, notes the World Health Organization (WHO), India has launched a week-long campaign to vaccinate 100% of children against measles and rubella. This is a move described as crucial to country's goal of eliminating the two viral diseases by 2026, noted Union Health Minister JP Nadda.

As per WHO, this week aims to promote the power of immunization to protect people of all ages against vaccine-preventable diseases. Vaccines are one of humanity's greatest achievements, notes WHO. Since 1974, they have saved 150 million lives.

As per India's aim, Nadda suggests that health workers must not only ensure complete vaccination overage, but also remain vigilant through robust disease surveillance. “Measles is very contagious. Even a single case must be treated as a warning signal. We have to cover immunity gaps and ensure no child is left behind,” he said.

As per WHO, India has reported 4,388 cases of measles and 527 cases of rubella so fat this year.

What Are Measles And Rubella?

Measles is a highly contagious viral infection marked by symptoms such as high fever, rash, cough, red eyes, muscle pain, and headache. Though often seen as a childhood illness, measles can lead to severe complications, including pneumonia, brain swelling (encephalitis), and even death, particularly in malnourished children and those with weakened immune systems.

Rubella, caused by a different virus, typically results in milder symptoms in children and adults. However, it poses a grave risk to pregnant women. Infection during pregnancy, particularly in the first trimester, can cause miscarriage, stillbirth, or congenital rubella syndrome (CRS) — a condition leading to serious birth defects like heart problems, deafness, and developmental delays. According to WHO, rubella control is essential for reducing infant mortality and morbidity.

History of Measles and Rubella Vaccination In India

India has a long battle with measles, which had accounted for a significant portion of global measle deaths. In order to tackle this, the country introduced measles vaccination in 1985, under the Universal Immunisation Programme. However, rubella vaccination lagged behind until the Measles-Rubella (MR) vaccination campaign was launched in 2017.

This massive drive aimed to immunize 410 million children between 9 months and 15 years of age, marking one of the largest vaccination campaigns in the world, according to the Ministry of Health and Family Welfare. Post-campaign, the MR vaccine was incorporated into India’s routine immunization schedule, with two doses given between 9–12 months and 16–24 months of age.

Since measles and rubella are both highly contagious, health authorities say that achieving very high vaccination coverage — over 95% — is critical for creating herd immunity and stopping outbreaks.

Is India Close To Its Goal?

Health Ministry data shows promising progress: in 2024–25, 93.7% of children received the first MR vaccine dose, while 92.2% received the second. However, to achieve disease elimination, India needs to push these numbers above 95% consistently across all regions.

Highlighting the importance of full coverage, Nadda called upon public representatives to actively support the campaign and spread awareness, particularly in hard-to-reach areas.

Despite progress, India faced a significant measles outbreak in 2023. The country was among 57 globally that saw major outbreaks after routine immunization services were disrupted during the Covid-19 pandemic. In 2023 alone, India reported 68,794 cases of measles and 2,930 cases of rubella.

Responding to the surge, the government intensified supplementary immunization activities, targeting areas where outbreaks occurred. The impact is visible: measles cases dropped by 73% and rubella by 17% in 2024 compared to the previous year.

With sustained efforts, India is now on a strong path towards achieving measles and rubella elimination by 2026.

Note: The data is taken from World Health Organization and Ministry of Health and Family Welfare, Government of India.

Fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), happens when extra fat builds up in liver cells without alcohol being the cause. Normally, the liver contains some fat, but if more than 5–10% of the liver’s weight is fat, it is considered a fatty liver. In its advanced stage, MASLD can develop into metabolic dysfunction-associated steatohepatitis (MASH), causing swelling and serious damage to the liver. Alarmingly, MASLD affects about 100 million people in the United States, including a growing number of children.

The disease often develops silently. Many people do not experience symptoms early on, but if it worsens, signs like fatigue, abdominal pain, jaundice, swelling, and even mental confusion may occur. Risk factors include obesity, diabetes, high cholesterol, rapid weight loss, poor eating habits, and certain medications.

A Breakthrough in Early Prediction

A new study offers hope for earlier detection. Researchers, led by Dr. Shiyi Yu from Guangdong Provincial People's Hospital in China, have developed a blood test that looks for five specific plasma proteins to predict MASLD years before symptoms show up. The findings are set to be presented at the Digestive Diseases Week meeting in San Diego.

The test was shown to be 84% accurate at predicting fatty liver disease five years in advance and 76% accurate at predicting it 16 years ahead of diagnosis. When additional factors like body mass index (BMI) and daily exercise habits were added, the prediction accuracy improved even more—over 90% at five years and 82% at 16 years.

This model was tested on two different groups—participants from the UK Biobank (over 50,000 people) and a separate group in China—showing promising results across diverse populations.

Why Early Detection Matters

Fatty liver disease not only damages the liver but also increases the risk of early death—primarily from cardiovascular diseases (CVD) rather than liver failure itself. The connection between MASLD and heart disease is strong, as both share causes like high blood sugar, high triglycerides, and obesity. That is why early diagnosis is crucial—not just to protect the liver, but also to manage the risk of heart disease.

Early identification through a simple blood test could lead to earlier lifestyle changes, medical monitoring, and interventions that can prevent serious complications like cirrhosis or heart attacks.

What You Can Do

Currently, there is no approved medication for MASLD. Treatment mainly involves:

• Maintaining a healthy weight through diet and exercise
• Controlling diabetes and cholesterol levels
• Avoiding alcohol
• Following medical advice if already diagnosed

Preventive steps include eating a balanced diet rich in lean proteins, fruits, vegetables, whole grains, and healthy oils, being physically active, and avoiding unnecessary medications.

Although the findings are considered preliminary until published in a peer-reviewed journal, this research marks a major advancement. It shows that a simple blood test could soon help millions of people know their risk decades in advance, giving them a chance to change the course of the disease before it's too late.