Stress Less in 7 Steps

from the Healthy Living area

You know the feeling: the more you do, the more it seems you have to do. As challenges mount in your work, relationships, finances and health—sometimes in several areas of your life at once—they can easily turn from trying to overwhelming.

The source of your stress may be temporary, such as producing a big holiday party, so the pressure ends in a short time. More serious stressors are long-lasting or out of your control, such as what the stock market is doing or a major medical problem.

Yet, often, we take responsibility for solving every detail, every problem, every adversity, whether it’s realistic or even sensible to do so.

“Women are always chronically multitasking and under stress. This year (with the economic crisis), in particular, it’s more difficult,” says Nancy Molitor, PhD, an assistant professor of clinical psychiatry and behavioral sciences at Northwestern University, Feinberg School of Medicine, Chicago.

Preventing stress in real life may be virtually impossible, but managing it well is extremely important for both your physical and emotional health.

When stress hits

Stress floods your body with hormones, weakens your immune system, affects brain function and worsens many chronic medical conditions.

While short-term stress might cause worry or a sleepless night, stress that lasts longer can produce or contribute to high blood pressure, digestive difficulties, fatigue, heart problems, neck and back pain, obesity, breathing disorders, headaches, insomnia, anger, depression, lowered sexual desire, and more. Fortunately, there are many good ways to short-circuit the effects of stress (see suggestions below).

People differ in what triggers their stress as well as in which methods successfully manage it. What works to lower your stress might not work for your best friend. The wisest course is to find several effective de-stressing techniques. “You have to have a whole bunch of things in your toolkit,” says Dr. Molitor, who is also a psychologist in private practice in Wilmette, Illinois, and a Public Education Coordinator for the American Psychological Association.

To manage stress, she says, you need to develop ways to pace yourself and take time out. Stress relievers are vital, she adds, “like paying yourself first, or putting on your oxygen mask (on an airplane) before taking care of your kids.”

Facing challenges

Ramona Russell has been on the Stress Express ever since going to college full-time while working three jobs. “I have a very Type A personality and I’m intense. I’m a recovering perfectionist,” she says.

When she was 29, Russell had a demanding job working for a start-up nonprofit organization in Sacramento. “I did everything, from training volunteers to public relations and marketing.” Then the unthinkable happened: her younger sister, Liz, just 26 years old, was diagnosed with advanced breast cancer. At the same time, the nonprofit Russell worked for began to sink. “It made what was going on with my sister so much worse,” she recalls.

Although she had not been much of an athlete in her teen years, Russell had taken up running after college and ran in a marathon the year before her sister’s diagnosis. After her employer folded, Russell put off looking for another job so she could help with her sister’s care. She credits regular running (about 25 miles per week when she’s not training for a marathon) with reducing the ongoing stress she was experiencing. “It helped keep me focused and enabled me to better support my sister,” she says.

Repetitive exercise, such as running, brings forth the stress-busting “relaxation response,” according to research conducted by Herbert Benson, MD, of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Harvard Medical School. Benson and his colleagues found that the relaxation response changes the way your body and brain react to stress. Put simply, you slow your metabolism, heart rate and breathing; lower your blood pressure; and reduce muscle tension. Recent research shows that the relaxation response can change gene expression for long-term benefits.

That process worked for Russell as she coped with her sister’s illness and death, the loss of two other young family members and separation from her brother, who enlisted and went to war. “When I run, I feel things melt away,” she says. “It gives you energy you didn’t have.” Running also sparked an idea for a business that Russell, now 33, created in her sister’s memory. Called Uptown Liz (www.uptownliz.com), the shopping Web site refers customers to products that benefit charitable causes.

Stress-busters that work

Don’t worry—you can get good stress relief from exercise without running a marathon. “There’s tons of research on this,” says Dr. Molitor. “Physical exercise of a very moderate amount, two times a week or more, is the best thing you can do to cope with chronic stress.”

• Understand what you can control: Stress often comes from trying to control situations or people’s actions that are beyond our control. Avoidance also raises stress. Recognize the choices you do have, Dr. Molitor advises. You may not be able to control world financial markets, but you can read your statements, control how you invest and make choices about how to spend your available income.
• Say good things about yourself: This one is so simple, but many of us reinforce our stress by piling on with an internal negative voice. Research shows that affirming your personal values keeps production of cortisol, the stress hormone, low. The next time you catch yourself putting yourself down in your thoughts, say or write something good about yourself instead. And make the goals you set for yourself realistic.
• Encourage the relaxation response: Try activities that use repetitive motion or sounds while also pushing aside everyday thoughts that might pop up. This helps quiet your mind. Good stress-relieving repetitive activities: knitting, running, prayer, playing a musical instrument, meditating or chanting a word or phrase.
• Keep meals and sleep healthy: Eat more veggies, fruits and whole grains. Avoid sugar, caffeine and fatty foods as much as possible. Good fuel promotes emotional resilience and calm. And avoid eating when you’re not hungry—another sign of chronic stress that can just lead to more tense feelings. Stress might also cause sleep loss, which makes you feel more stressed. Support healthy sleep by winding down at night, avoiding caffeine or food before bed and leaving enough time for a good night’s rest.
• Find a passion: Stress can narrow your vision, so it helps to move outside the boundaries of your current situation. Start with a small step—a one-night class in an artistic interest you haven’t pursued before or two hours of volunteer effort for a community or charitable project—then see where that first step takes you. Many women find stress relief through a new passion for a career, hobby or cause.

For more information on the health topics mentioned in this article visit

the HealthyWomen.org areas below.

 

Stress: www.healthywomen.org/condition/stress

 

Healthy Living: www.healthywomen.org/ages-and-stages/healthy-living/managing-stress

Mental Health Center: www.healthywomen.org/healthcenter/mental-health

Wellness in Practice Blog: www.healthywomen.org/womentalk/blog/wellness-practice

 

 

 

 

© 2011 HealthyWomen.  All rights reserved. Reprinted with permission from HealthyWomen. 1-877-986-9472 (toll free). On the Web at: www.HealthyWomen.org.

De-Stress Your Environment

from the Healthy Living area

by Pamela M. Peeke, MD, MPH

It’s usually easy to tune out the minor irritants our work and home environments throw our way. Most irritants aren’t major health risks. But, watch out. When minor environmental irritants turn toxic, your surroundings can make you more vulnerable to chronic stress.

Take a minute now to look around the room you are sitting in. Use all your senses to detect any of these common environmental stressors:

• Clutter
• Too much noise
• Unpleasant odors
• Uncomfortable furniture
• Bad lighting
• Poor ventilation

How many have you identified?

Now, look around for things you easily can change and do so.

Many of us can’t make significant changes in our surroundings, particularly at work. So, we need to use our stress-solving skills to buffer ourselves against toxic environmental stress.

Try these problem-solving suggestions for the following environmental stressors:

Climate Control-Your Office or Theirs?
If you have a client or co-worker who loves extreme temperatures -either freezing or tropical — that interfere with your productivity or attention span, suggest that you have meetings in your office.

Scent-sational?
If someone in the office consistently comes to work bathed in the latest perfume, anonymously suggest to the office manager that you adopt a “scent free” office (we have this policy and it works well).

Clutter Control
You are sure to feel overwhelmed if your surroundings are cluttered. To combat clutter, keep only your current project materials in view. You will feel more confident and be better able to concentrate.

Re-Arrange Stress
Consider rearranging the furniture so that you face away from the line of sight, if you work in an office cubicle. With your desk turned around you have more control over when people can catch your eye. Your co-workers may be less likely to needlessly interrupt you.

Ear Protection, Please
Bring earplugs to work, if your office is noisy, or try to escape to an empty conference room for a temporary “noise break.”

When de-stressing your surroundings, you can’t address all the stressors at one time. Carry a notebook with you and write down environmental sources of stress when you notice them. Just having that list will empower you. You might even enlist significant others in your life to help trouble shoot solutions with you.

Here are more stress-busting ideas to use to de-stress your environment:

• In the office, take breaks to look out the window. Don’t have one nearby? Take a break once an hour, find a window and look outside. Focusing your eyes at a distant view will cause your eye muscle to relax. Looking at nature also has a proven calming effect.
• At home and work, use calming pictures and muted pastel colors to soothe you.
• Play soft music in the background — whatever you like. It’s quite calming and can act as “white noise” to neutralize toxic noises in your environment.
• Personalize your office space with family photos and pictures of pets and favorite vacation spots. Look at them often.
• Combat clutter. At home, if you haven’t used something within the past year consider tossing, selling or giving it away.
• At home, impose a TV-time limit on yourself (and others). TVs in the living room are the ultimate noise pollution. Try moving the TV to a new location where you don’t see (and turn it on) so readily. Definitely get the TV out of the bedroom – watching TV in bed can interfere with your sleep patterns and cause you to develop sleep-related problems.
• Decorate with soothing objects to look at — things that give you pleasure to see every day. These things are important to have in your living and working space.

Choose low-end ways to de-stress your surroundings if high-priced solutions are out of reach. If that $500 ergonomically correct chair isn’t realistic, what about a beautiful $10 pillow to sit up against? Or, a small stool to support your feet and ease your lower back? Do you have a comforting screen-saver? A beach view or the universe works nicely.

Be creative! See if you can make your surroundings a bit less stressful today.

For more information on the health topics mentioned in this article visit the HealthyWomen.org areas below.

Managing Stress: www.healthywomen.org/ages-and-stages/healthy-living/managing-stress

Stress: www.healthywomen.org/condition/stress

Anxiety and Depression Center: www.healthywomen.org/healthcenter/anxiety-and-depression

Mental Health Center: www.healthywomen.org/healthcenter/mental-health

© 2011 HealthyWomen All rights reserved. Reprinted with permission from HealthyWomen. 1-877-986-9472 (toll-free). On the Web at: www.HealthyWomen.org.

How to Stay Healthy When Studying Online

It’s a route that many students are taking nowadays because it allows them the freedom to do many things simultaneously while providing them with a great deal of flexibility too. Online education is in high demand because you can earn while you learn, you don’t have to spend as much as you do on traditional degrees, and you can stay at home and avoid the significant changes that college entails. However, when you study online, it’s best to take a proactive approach to prevent health problems, both minor and major.

·        You’re at risk for illness when you don’t get enough exercise and stay all day at home; so no matter how much work you have, no matter that you’ve always been a couch potato who has never exercised, it’s time to start right now. When you work out for at least half an hour a day, you prevent all kinds of diseases and keep illness at bay. A short, brisk walk is enough to rejuvenate you and boost your energy.

·        You could be stressed out if you have too many things on your plate – studying, working and having to balance social and familial obligations could become too much to handle and you start falling sick or feeling down more often. Regular exercise and taking time out to enjoy yourself once in a way helps reduce the burden you carry and lightens and raises your spirits.

·        One of the downsides to online education is that it isolates you and removes you from the social aspect of education. You don’t get to interact with teachers and classmates, and this makes concentration and studying a little more challenging. Some students thrive and flourish in this kind of environment; others however, start to pine for some form of human contact and this affects their mental and physical health. The solution to this problem is to seek out other learners close to where you live and form study groups whenever time permits; if this is not possible, try and form virtual groups and use video and voice chat to enhance your learning.

·        When you spend most of your time at home or in front of the computer, you tend to eat whatever is available and easily ready in a short time. Junk food forms a major part of your diet, and before you know it, your health suffers and your weight balloons up. So make a conscious effort to eat healthy – salads and juices if you don’t have time to cook, and sandwiches made with whole-wheat bread and filled with nutritious food instead of fatty meats for your meals will do your mental and physical health a world of good.

The best way to look after your health when you study online is to be proactive and take charge of it right from the word go – it’s easy to prevent obesity and illness rather than fight them after they’ve taken root.

 

 

By-line:

This guest post is contributed by Carrie Oakley, who writes on the topic of online college . Carrie welcomes your comments at her email id: carrie.oakley1983(AT)gmail(DOT)com.

De-stress in 10 Minutes or Less

from HealthyWomen’s e-newsletter, HealthyWomen Take 10

When stress or anxiety has you feeling tied up in knots, jittery or unable to fall asleep, you can lower your mental tension by using a physical technique-progressive muscle relaxation.

This method enables you to lower your body’s stress response and calm your spirits by identifying and releasing tension in your muscles.

You can practice progressive muscle relaxation in any quiet space. Sit or lie down (on your back or side) in a comfortable position. But, be warned—if you do progressive muscle relaxation exercises in bed, you may fall asleep before finishing a full cycle!

Take off your shoes before beginning. Loosen tight clothing.

To use this technique, you will be tensing a muscle or group of muscles by tightening or squeezing them firmly. Hold that tension, then release quickly and relax. Notice the difference between how the muscles feel when they are tense and when they are relaxed.

1. Begin either at the top of your body, with your eyebrows, or at the bottom, with the toes and foot on your left or right side.
2. Inhale and focus on the individual muscle group as you tighten it. To tighten your foot, curl your toes in; for your hand, make a tight fist; for your eyebrows, raise them as high as they’ll go.
3. Hold that squeeze for about five seconds.
4. Release and relax for about 30 seconds. If you have time, you may want to repeat each tension/release twice.
5. Wherever you began your exercise, continue from that point downward (or upward) so that your muscles are tensed and relaxed in order.
6. Do one foot (or hand) at a time. After completing the entire leg (or arm), then switch to the other side.
7. Continue with abdomen, chest, neck/shoulders and face.
8. After you’ve finished, breathe slowly and deeply a few times. As you exhale, release any remaining tension. Enjoy the relaxed feeling for a minute or two before getting up.

For more information on the health topics mentioned in this article visit the HealthyWomen.org areas below.

Managing Stress: www.healthywomen.org/ages-and-stages/healthy-living/managing-stress

Anxiety and Depression Center: www.healthywomen.org/healthcenter/anxiety-and-depression

Mental Health Center: www.healthywomen.org/healthcenter/mental-health

© 2010 HealthyWomen All rights reserved. Reprinted with permission from HealthyWomen. 1-877-986-9472 (toll-free). On the Web at: www.HealthyWomen.org.

Just Another Headache?

from HealthyWomen’s e-newsletter, HealthyWomen Take 10

When the dull pressure of an occasional headache begins, you might chalk it up to work stress, lack of sleep or personal worries. If the ache is mild or moderate, you may consider it no big deal and simply reach for an over-the-counter drug—aspirin, acetaminophen , ibuprofen or naproxen sodium—instead of calling your health care professional.

Simple tension-type headaches are common, happening to 78 percent of adults, according to the National Headache Foundation. Such aches are dull (not stabbing or pulsating), may contract the muscles in the scalp or neck and generally occur on both sides of the head, without nausea or sensitivity to light and noise.

Yet occasional or episodic headaches may increase in frequency over time. Are you taking headache medication nearly every day, but feeling little relief? Does the aching often start when you wake up or in the evening? Are you having sleep problems?

If that describes you on 15 or more days a month, you have chronic tension-type headache. And you might also be suffering from unrecognized depression .

Although people with chronic tension-type headache often get through their daily activities, studies show they have significantly higher levels of depression , which affects overall functioning and quality of life. That depression might not be displayed as sadness or other classic signs of a depressive disorder, so the problem underlying the headaches may be missed by health care professionals and even patients themselves. What’s more, chronic pain itself can lead to depression .

If you suffer from chronic headaches, get help now to end the pain:

• Anyone taking headache medication more than two days a week needs to be examined by a medical professional. See your primary care provider or a specialist at a headache clinic (often affiliated with hospitals).
• Even if you are not depressed, antidepressants are often prescribed for chronic tension-type headache. These drugs provide more pain relief than standard over-the-counter medications.
• Biofeedback has also been shown to be helpful in ending chronic headache.

For more information on chronic pain, visit: www.healthywomen.org/healthcenter/chronic-pain

For more information on mental health, visit: www.healthywomen.org/healthcenter/mental-health

For more information on managing stress, visit: www.healthywomen.org/ages-and-stages/healthy-living/managing-stress

© 2010 HealthyWomen All rights reserved. Reprinted with permission from HealthyWomen. 1-877-986-9472 (toll-free). On the Web at: www.HealthyWomen.org.

Tai Chi May Improve Your Overall Health

 

Have you ever tried Tai Chi? If not it may be worth looking into…

The picture above certainly makes Tai Chi look enticing and relaxing.

Tai Chi originated in China and is often referred to as “meditation in motion.”  Tai Chi involves low-impact, slow motion mind-body exercises.  Movements are never forced, usually circular, not stressful on joints making it a great exercise for anyone of any age.

A growing body of research is now demonstrating multiple health benefits when Tai Chi is added to more traditional medical treatments.  Many of these studies were small but provide some interesting preliminary results.

Tai Chi has been suggested to:

• Decrease arthritis pain
• Improve quality of life and functional capacity in women with breast cancer or suffering side effects from breast cancer
• Lower blood pressure, improve triglyceride and cholesterol levels, improve exercise capacity (Journal of Alternative and Complementary Medicine 9/2008)
• Improve walking distance and quality of life in heart failure patients
• Lower blood pressure (Preventive Cardiology 9/2008)
• Improve balance and gait in post stroke patients and people with Parkinson’s disease
• Improve sleep quality and duration (Sleep 7/2008)
• Lowers stress levels

You may also find tai chi appealing because it’s inexpensive, requires no special equipment and can be done indoors or out, either alone or in a group.

Although tai chi is generally safe, consider talking with your doctor before starting a new program.

If you are looking for more info about heart health please visit www.heart-strong.com or check out our Facebook site at http://www.facebook.com/reqs.php#!/profile.php?id=1443402011

Women and Heart Disease Across the Lifespan Part 1 (Young Women)

This is the first of a three part series titled “Women and Heart Disease across the Lifespan.”  On this show we will concentrate on heart conditions that are more likely to affect young women. We will discuss the following conditions: palpitations, tachycardia, pericarditis, conditions that may occur during pregnancy, and premature heart disease.

Quick 3 Minute Overview on Blood Pressure

This is a video I filmed discussing high blood pressure, what your blood pressure numbers mean and things you can do to control your blood pressure. Why not take 3 minutes to learn the blood pressure basics…

5 Most Common Yoga Poses Done Wrong

April is National Stress Awareness month, it is the perfect time to start thinking about reducing stress to improve your health and live a more enjoyable life! Yoga is a cure for our current stress epidemic, but it is important that it’s done right. 

Yoga has been known to improve flexibility, strengthen muscles, and enhance balance.  However, if practiced incorrectly yoga can do more damage to the body than good.  Misaligned poses can lead to injuries ranging from aching joints to pulled muscles.  “Yoga injuries are often a result of not knowing or realizing your body’s limitations,” says yoga instructor and educational kinesiologist Candace Morano.  “This goes for beginners and advanced students, as some beginners underestimate how strenuous yoga can be and some who are more advanced overestimate their strength and flexibility,” says Candace.  Below, Candace highlights the Do’s and Don’ts of the top five yoga techniques commonly misaligned.  

#1 Seated Pose with Pranayama:

DON’T: Sit in a slumped position.  It decreases the ability to breathe into a straight, long spine.  “Not breathing fully into the torso and body can also lead to anxiety and low energy,” says Candace.

 DO: Sit in a comfortable cross legged position on the floor or on a blanket. Loop a yoga belt or one of your own comfortably around your lower ribs. The belt will serve as a boundary for feeling the connection between your diaphragm and breath.

 As you begin to breath feel your lower belly expand. Then feel your breath extend higher above the belt, into the mid-chest as you extend your breath further into your top chest. Follow this pattern as you begin to descend downward and start to exhale. Using the belt will help you understand how to breathe into the lower and upper torso and how to preserve the space that is created within, even as you exhale with full attention.

 #2 Standing Forward Bend:

DON’T: Hyper-extend knees.

DO: Slightly bend knees and move your hips directly over ankles. This will encourage top of shin forward and engage your front thighs and avoid hyperextension.  “Yoga practice has a building block effect,” says Candace.  “Remember to take what you learn in every pose and apply it to the next.”

The Standing Forward Bend is the practice of grounding into the support right under our feet. Standing tall in mountain pose, inhale, lift your arms upward and extend your spine forward towards your toes. Inhale from the heels to the balls of the feet, keeping the toes relaxed, and follow muscular attention upwards. Feel your kneecaps lift towards thighs and thighs engage strongly towards pelvis. This will help to bring the knees into alignment over the ankles. On the exhalation, stay with the essence of strength in front of legs as you practice releasing any tension in the back of the legs, back to the source under your feet; the earth. Practice this cycle of attention and breathe 3 times. Feel the upward magnetism of energy into the pelvic floor as you lift and extend back down through tailbone on the descent towards the earth.

#3 Warrior III Pose:

DON’T: Extend in one direction rather than feeling polar attraction of opposites.

DO: From mountain pose, inhale lifting your left leg off the floor reaching your arms straight out in front of you and as best you can, bringing both hips points level to encourage them to be even and square. As you bring your torso forward, extend through your left leg imagining a see-saw playfully finding balance between the front and back body, using your arms and legs as anchors. Your head and chest stay lifted. Make sure to practice the other side and notice any differences and imbalances on one side versus the other.

#4 Upward Facing Dog:

DON’T: Tense and compress neck and shoulders, hyper extend elbows, or put any strain on the wrists.  “Tense shoulders cause problems in the wrists,” says Candace.

DO: Micro bend elbows or as much as needed until you can keep your shoulder blades engaged on back as you lift your chest high. Lie on your belly with your chin or forehead on the floor. Your palms are shoulder distance apart and next to your chest. Breathe into your hands, pressing evenly through the palms as if you were energetically pulling them back to your feet. Grounding hip points, legs and tops of feet down into earth, lift pubis, belly, chest and head toward the sky feeling the length you are creating from your waist to your armpits. Feel a soft bend in elbows as shoulder blades soften onto your back. This muscular action encourages your chest to expand while feeling vulnerability in the heart. Exhale and slowly lower back to the support of the earth allowing any stress, extra effort or tension to release.

#5 Triangle Pose:

DON’T: Hyper-extend the front knee or lean weight into bottom arm and front leg, shortening bottom side of front waist, allowing torso to lean in towards the center instead of lifting upward and away from the earth.

DO: Stand tall with your feet wide apart.  Turn your right toes forward and your left toes 45 degrees towards the front, arms extending in a T position. The instep of your back foot aligns with the heel of your front foot. Inhale, grounding into both feet and exhale tilting your hips towards your back leg and lifting your navel and chest as you extend your spine long and out over your front leg. Inhale, lifting from the earth up through your body.  Exhale with your right hand to your right ankle, a yoga block or the floor on the outside of the right foot if you have found flexibility without compromising the extension of both sides of the waist and spine. Inhale into the ball of the right toe mound, as you reach down into the support of the earth to rise up to extend upward to the expansion of the sky.

Practice taking your left arm forward towards the center on the inhale and then exhaling and extending the left arm back to the sky. This will give your body an exploration of its own intelligence via the breath and repetition of movement.

Candace Morano is a certified yoga teacher & educational kinesiologist based in New York.  If you would like additional information on Candace, please contact me or visit www.explorevidyayoga.com

The Christmas Coronary – Holiday Heart Attack

The Holidays are a joyous time to celebrate and spend time with family and friends. But they have also been found to increase the risk for heart problems. Heart related deaths and heart failure hospitalizations rise sharply around the winter holidays.

Several triggers for this increased risk have been reported in recent studies:

• Our normal routine is disrupted – we may be traveling, eating and drinking differently, under more stress and exercising less

• Cold weather can also be a trigger (especially when shoveling snow)

• Depression may be more prevalent – you may be missing a loved one more around the holiday season

For years I have been teaching people about the “5 E’s” these are five things that start with the letter E that can increase your risk for heart problems.

• EATING – heart attacks can be triggered by eating meals with a high fat content or eating heavy meals. Enjoy the holiday meals but remember moderation is key.

 • EXERTION – heart attacks can be triggered by too much exertion (again think about shoveling snow). Bundle up and take frequent rest breaks. Also if you are starting a new exercise routine – slowly increase your activity, don’t overdo it.

 • ELIMINATION – heart attacks can be triggered during straining to have a bowel movement. Remember to eat your fiber and drink plenty of water to avoid constipation.

• EXTREME EMOTIONS – heart attacks can be triggered by extreme emotions such as depression and anger. The holidays can be a stressful time, make sure you are taking time for yourself and your mental well-being.

• EXTREME TEMPERATURE CHANGES – heart attacks can be triggered by temperature changes, such as going out of your warm house out into the cold weather. Remember to bundle up and cover your mouth and nose with a scarf, breathing in the cold air suddenly can put stress on your heart.

So Enjoy the Holiday Season but remember to take care of your health – your heart will thank you for it!  Thinking about Healthy New Year’s Resolutions check out our books “Take Charge: A Woman’s Guide to a Healthier Heart” and “Take Charge: A Man’s Roadmap to a Healthy Heart” available at www.heart-strong.com