Not sure if this is the right approach. I was brought unto be personally responsible for my actions and not rely on others to create ways to help me do the right things. Part of my thinks money spent on these grants could be better spent elsewhere. These ideas seem to be only shotgun approaches and do not really address underlying issues.
Still, I think their hearts are in the right place.
Through a series of small grants, we’re is exploring the utility of applying behavioral economic principles to perplexing health and health care problems—everything from getting seniors to walk more to forgoing low-value health care.
At a recent meeting in Philadelphia we challenged grantees to compete in an Innovation Tournament. The goal was to identify testable ideas that leverage behavioral economic principles to help make people healthier by working with commercial entities. Participants were assigned to groups and made their best pitches to their colleagues. And of course we used a behavioral economics principle (financial incentives) to increase participation: Each member of the first, second and third place teams received Amazon gift cards.
Eight teams made the finals:
1. Love Lock: This team addressed the issue of driving and texting by proposing an app that could be installed on your cell phone that would send reminders not to text while driving. This team would work with car insurance and mobile phone carrier companies and provide discounts to those who get it installed. The behavioral economics principles being tested are default choice and opt-out.
2. McQuick & Fit: Too many people eat unhealthy food. This team’s idea was to have a rewards card that can only be used to purchase healthy food. With each purchase, the customer would earn points toward free, healthy foods. Online orders would be placed through a website that would feature salient labeling and allow for defaults to order healthy meals. The behavioral economics principles at play include pre-commitment, default choice, labeling, and incentives.
3. Just Bring Me Water: The problem tackled by this team is “regrettable” calories—mindlessly consuming whatever is put in front of you, such as free bread at a restaurant, or soda on a plane. The innovation: when booking a table online or calling for a reservation, you could ask to “opt-out” of the complimentary bread or chips that are offered. This would reduce the consumption of regrettable calories.
4. Lunch Club: This group looked at addressing gluttony through a partnership with a chain restaurant. When going out for a meal, portions are typically bigger and diners consume more. But what if you had the option of doggy-bagging one third of the meal for another meal—framed as “buy dinner and get lunch free”? And, if you took this option, you would get a scratch off as an enhanced incentive and immediate reward. The behavioral economic principles being tested here include loss aversion, active choice, and incentives.
5. Snooze, But Don’t Lose: People don’t get enough good sleep, which leads to poor executive functioning and safety issues. To increase safety, productivity, and efficiency, this group proposed using a Fitbit to build in reminders to go to bed earlier and provide feedback on good sleep. The behavioral economic principles at play are pre-commitment and loss aversion.
6. Google Coach: This team’s idea was to create good habit formation, specifically commitment to a health plan, whether it was getting more sleep, adhering to a diet, or taking vitamins regularly. The group proposed partnering with Google and using its calendar and mobile phone platform to program smart defaults that are personalized to the individual. For example, people could actively schedule exercise or sleep based on their schedule on Google calendar. The group hypothesized that intelligent defaults are better than people planning themselves (without defaults).
7. The Basketeers: This team wanted to optimize consumers’ baskets at grocery stores and supermarkets, increasing the amount of healthy items purchased. The group suggested partnering with an online supermarket to create different packages of food for customers to purchase. For example, there could be the J-Lo package, which would bundle together food items that this aspirational star would most likely eat. In addition, when checking out, the website would assess the customer’s basket for healthier options, such as switching whole milk for skim milk. As a reward, consumers would get discounts and express delivery for choosing healthier options.
8. Team REV (Re-Engineering Vending): Soda and other sugar sweetened beverages lead to obesity. This team proposed partnering with beverage companies to make vending machines more fun, while optimizing them to help people make healthier beverage selections. For instance, the vending machine would have sensors and as you approach the unhealthy items, the healthier item buttons would light up. The behavioral economics principle applied here is choice architecture.
The participants voted for their top three choices. Lunch Club came in third while Love Lock and Google Coach tied for first place. And, you might wonder, how does a group of behavioral economists and psychologists break a tie? By playing rock, paper, scissors. Team Love Lock won.
This post originally appeared in the RWJF Pioneering Ideas Blog.
- How a behavioral economist eats Thanksgiving dinner (washingtonpost.com)
- What behavioral economics is and what it is not.. (mostlyeconomics.wordpress.com)
- Meet the ‘Genius’ Whose Ideas About Behavioral Economics Could (Someday) Change Lives (psmag.com)
- Decisions, Decisions…Behavioral Economics and Behavioral Change (rwjfblogs.typepad.com)
- Eight Innovative Ideas to Influence Health Behavior (rwjfblogs.typepad.com)
- Next challenges in behavioral economics (alessandroinnocenti.wordpress.com)
- Lose weight, Get Gold in Dubai (blogs.wsj.com)
Large coverage expansions under the Affordable Care Act have reignited concerns about physician shortages. The Association of American Medical Colleges (AAMC) continues to forecast large shortfalls (130,000 by 2025) and has pushed for additional Medicare funding of residency slots as a key solution.
These shortage estimates result from models that forecast future supply of, and demand for, physicians – largely based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment. Here are a few reasons why.
1. Most physician shortage forecast modelsassume insurance coverage expansions under the ACA will generate large increases in demand for physicians. The standard underlying assumption is that each newly insured individual will roughly double their demand for care upon becoming insured (based on the observation that the uninsured currently use about half as much care). However, the best studies of this – those using randomized trials or observed behavior following health insurance changes – tend to find increases closer to one-third rather than a doubling.
2. A recent article in Health Affairs found that the growing use of telehealth technologies, such as virtual office visits and diagnoses, could reduce demand for physicians by 25% or more.
3. New models of care, such as the patient-centered medical home and the nurse-managed health center, appear to provide equally effective primary care but with fewer physicians. If these models, fostered by the ACA, continue to grow, they could reduce predicted physician shortages by half.
4. New research has shown that physicians do an enormous amount of work that can be handled competently by medical assistants, licensed practical nurses, social workers, pharmacists and others. Proper delegation to other health care professionals and non-professionals in this way can further reduce the need for physician labor and increase the efficiency of health care services — though providers will have to pursue these changes to the see the benefits.
5. Finally, the number of active physicians per-capitavaries by more than a factor of two across states in the US (Massachusetts has more than double the physicians per capita as Idaho) and even more across smaller regions. Though health care quality and access surely suffers in some areas, there is little correlation with physician supply overall – a testament to the fact that there is a very wide range of physician supply capable of supporting successful health care.
As modeling technology continues to evolve and the effects of ACA implementation become clearer, new models should be able to account for physicians’ shifting responsibilities and new ways of practicing. It is also certainly possible that new care models will place additional demands on physicians to manage their patients’ conditions and coordinate their care. Nevertheless, on the whole, the latest research suggests that calls to redirect taxpayer dollars to subsidize physician residencies may be premature.
David Auerbach is a policy researcher at the nonprofit, nonpartisan RAND Corporation.
- No, There Won’t Be a Doctor Shortage (nytimes.com)
- Doctor Shortage Could Ease As Obamacare Boosts Nurses, Physician Assistants (forbes.com)
- Nurse practitioners and physician assistants could aid in physician shortage (ruthbeckmannmurray.wordpress.com)
- The Coming Obamacare Nuclear Option That Will Destroy the Good Life for Doctors (economicpolicyjournal.com)
Twelve ideas to help you stay healthy during flu season
The 2013 flu season has begun, and while it is still early in the season, cases have already been reported in the U.S. Winter gatherings can bring together people who are vulnerable to the cold & flu virus.
People who get together for the winter holidays can be exposed to viruses from other parts of the region and can pick up and spread the illness from wherever they’ve been. Here are some small, individual changes you can make lending to a healthy winter season.
- Drink black or green tea with lemon and honey. Drinking hot tea while breathing in the steam stimulates the cilia – the hair follicles in the nose – to move out germs more efficiently. Lemon thins mucus and honey is antibacterial.
- Consume enough protein. Diets that are too low in protein can deplete the immune system. The current recommendation for protein intake is at least 60 grams per day for adult women and at least 75 grams per day for adult men, depending on age, activity level and if they need to gain/lose weight.
- Slowly exhale. When walking past a person who is sneezing or coughing, slowly exhale until you’re past them. This avoids you inhaling contaminated air.
- Try Zinc lozenges. If you get a scratchy throat, zinc lozenges can relieve cold symptoms faster.
- Eat your fruits and vegetables. Eating 5 or more fruits and vegetables each day will provide many vitamins and minerals necessary for your immune system to function properly. Try to choose more vegetables than fruit.
- Sanitize your space. You can sanitize commonly touched items (cell phones, grocery carts, keyboards, gym equipment) to help the spread of germs. Remember, rhinoviruses causing cold & flu symptoms can live on surfaces for up to 48 hours!
- Pamper your nose. The job of your nose is to filter allergens, bacteria, and viruses floating in the air. By using saline nasal rinses, you can help flush germs and clear secretions in your upper airway.
- Consume enough water. The urge to drink water can decrease in colder months, but the need for water is still important. Consuming enough fluids will eliminate toxins from your lymph system which keeps your immune system functioning properly.
- Get a massage for your immune system! Massage increases circulation which boosts immunity by nourishing cells with more oxygen filled blood. Click here to learn about our massage services.
- Sanitize your brushes. Think about the items you may reuse every day and consider cleaning or replacing them (cosmetics and make up brushes, toothbrushes, hair brushes, hand towels). A quick swipe of an alcohol wipe on a tube of lipstick or washing make up brushes in an antibacterial soap can support a healthy immune system.
- Sleep. Research shows that adults need 7-8 hours of sleep to stimulate an immune response from our natural killer cells which are the cells that attack viruses.
- Humidity. Dry air in the winter can cause your lips, mouth, & nose to become dry and cracked. Cracked skin can be an entry point for bacteria and viruses. Consider a humidifier to help keep moisture in the air.
Homemade Sani Wipes:
Fold or cut paper towels or napkins and put them into a wipe container. Use 1 1/2 cup of warm water, add 1 Tbsp. of coconut oil, and 1 tsp. of alcohol. Add 3 drops of lavender oil if you like. Then mix well and pour the mixture into the container of napkins to saturate them. Makes 2 containers.
Your health and wellness crew in WELLAWARE wish you a healthy winter season.
- Patz, A. (2013, December). Live healthy. Health 27(10).
- CDC. (2013, November 22). Seasonal Influenza. Retrieved fromhttp://www.cdc.gov/flu/
- CDC. (2012, October). Nutrition for everyone: protein. Retrieved fromhttp://www.cdc.gov/nutrition/everyone/basics/protein.html
- Beyond an Apple a Day: 10 Germ-Busting Tips for Cold and Flu Season (redtri.com)
- Study Finds How Flu Evolves to Escape Immunity (medindia.net)
- Above the inFLUence > If you’re sick, don’t work. If your work requires you to come in sick, let us know. (newsreview.com)
- Tip of the Week: Cold and Flu Season (pacusher.wordpress.com)
- Personalized Flu Vaccines Approved By FDA: New, Unique Options For The Elderly, Children, And People With Allergies (medicaldaily.com)
- 5 Tips on How to Stay Flu Free (roserenea91.wordpress.com)
- Vaccines, Flu & Other Seasonal Ailments: What You Need To Know (whnt.com)
Anyone who has spent time with an elder parent in the hospital knows just how easy it is for one problem to be solved only to have the person discharged with different problems. This is not necessarily the fault of the medical caregivers or the hospital itself — it’s a result of a system that puts older people into beds and keeps them there. Add in bed alarms, the inability to move much, and that hospitals isolate elder patients from their routines and support communities, and you have a recipe for unsuccessful care, a result of age associated hospital complications.
So I recommend reading The Hospital is No Place for the Elderly, a November 20, 2013 article that appeared in the The Atlantic. This piece aptly illustrates the conundrum of frail elderly patients with chronic health issues admitted to hospitals where medical care focuses primarily on fixing acute health problems. The difficulty is that most of frail elders’ medical issues cannot be fixed — but the quality of their lives can improve. Author Jonathan Rauch also describes several programs in the United States — teams of physicians, nurses, and other health professionals — that collaborate to keep patients as healthy as possible and out of the hospital. The teams even save money.
Many team-based support programs for frail elders run deficits, despite that they are so successful, but Rauch reports that the climate is changing, as Medicare and some insurance companies develop a more welcoming attitude toward innovative health care programs. The Affordable Care Acthas designated money to support innovative and new models of care delivery. (To learn more about other innovative programs you might also want to read Atul Gwande’s 2011 New Yorker article about changing models of medical care.)
One of the most interesting parts of The Atlantic article was the description of the team meetings where participants collaborate and coordinate patients’ medical care in order to help elders stay as healthy as possible.
Best Atlantic Article Quotes
- The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and tries to nip problems in the bud.
- These people aren’t on death’s doorstep, but neither will they recover. Physically (and sometimes cognitively), they are frail…
- Patients were presented not as bundles of syndromes—as medical charts—but as having personal goals, such as making a trip or getting back on their feet. The team tries to think about meeting patients’ goals rather than performing procedures.
- One-third of older adults admitted to ICU deemed “frail” (medicalnewstoday.com)
- Elderly patients are at risk of readmission after hospital stays (express.co.uk)
Finding it easy to empathize with these patients because of a short term musculoskeletal condition.
Hoping that health care providers will be able to find ways to treat all who experience this chronic condition without interference from the government.
People who suffer with chronic musculoskeletal pain face a daily struggle with their sense of self and find it difficult to prove the legitimacy of their condition.
A new study, funded by the National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme, systematically searches for, and makes sense of, the growing body of qualitative research on musculoskeletal pain to help understand the experiences of patients suffering from chronic pain.
A number of concerning themes arose from the study, published today in the Health Services and Delivery Research journal, which highlighted:
- Patients struggling with the fundamental relationship with their body, and a sense that it is no longer ‘the real me’.
- A loss of certainty for the future, and being constantly aware of the restrictions of their body.
- Feeling lost in the health care system; feeling as though there is no answer to their pain.
- Finding it impossible to ‘prove’ their pain; “if I appear ‘too sick’ or ‘not sick enough’ then no one will believe me”
Kate Seers, Professor of Health Research at Warwick Medical School and Director of the Royal College of Nursing Research Institute, was a collaborator on this study. She explains, “Being able to collate this vast amount of information from patients paints a worrying picture about the experiences they have with chronic non-malignant pain. Our goal has to be to use this information to improve our understanding of their condition and, consequently, the quality of care we can provide.”
“Having patients feel that they have to legitimise their pain, and the sense that doctors might not believe them, is something that should really concern us as health care professionals.”
The study also identified a number of ways in which patients can move forward with their lives.
The key for some people appears to be building a new relationship with the body and redefining what is ‘normal’, rather than trying to maintain the lifestyle before the pain. Developing an understanding of what the body is capable of and becoming confident to make choices can aid the process of living with musculoskeletal pain.
Dr Francine Toye, of Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, explains, “This paper shows there can be value in discussing the condition with other people who are going through the same experience and knowing that you are not alone. Of course you can learn about your condition from various sources, but sharing your experience seems to really help people to move forward.”
77 studies of chronic musculoskeletal pain were included in the meta-ethnography, with collaborators from Nuffield Orthopaedic Centre, the University of Warwick, Glasgow Caledonian University, Leeds Metropolitan University, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and the University of Calgary.
- The daily struggle of living with chronic pain creates a ‘new self’ (medicalnewstoday.com)
- To live with chronic pain, find a ‘new normal’ (futurity.org)
- Tips for treating patients suffering from chronic pain (mychroniclifejourney.wordpress.com)
- Is This the Same Person??? (noonegetsflowersforchronicpain.wordpress.com)
- Veterans and the Triad of Chronic Pain (psychologytoday.com)
- LIVING WELL: Kennedy’s back problems led to treatments today (murfreesboropost.com)
- Chronic Pain and Anxiety (noonegetsflowersforchronicpain.wordpress.com)
- Discovery Channel Documentary “Pain Matters” Chronicles the Burdens of Living with Chronic Pain (hispanicbusiness.com)
[Press release] Dispelling an urban legend, new study shows who uses emergency departments frequently
“…frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.”
While it has often been said that the most frequent users of overburdened hospital emergency departments are mentally ill substance abusers, a study out today (Dec. 3) by researchers from NYU Wagner and the University of California, San Francisco, has found that this belief is unfounded – an “urban legend.”
Co-authored by John Billings of NYU’s Robert F. Wagner Graduate School of Public Service and Maria C. Raven of the University of California and published in the December issue of Health Affairs, the new analysis of hospital emergency department (ED) use in New York City by Medicaid patients reveals that conditions related to substance abuse and mental illness are responsible for a small share of the emergency department visits by frequent ED users, and that ED use accounts for a small portion of these patients’ total Medicaid expenditures. However, according to the study, frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.
The article, “Dispelling an Urban Legend: Frequent Emergency Department Users Have Substantial Burden of Disease,” analyzes data on emergency department visits by 212,259 New York City residents who received their first emergency department care in 2007. The researchers reviewed each patient’s eligibility, ED use, Medicaid fee-for-service spending, and diagnostic history. The main part of the analysis covers the three years before each patient’s first visit to a hospital emergency department, the 12 months after the initial visit, and the subsequent two years. As the authors write, “contrary to urban legend, most repeat users in the study did appear to have relatively strong linkage to ambulatory care, at least as evidenced by their high rates of primary and specialty care visits. Except for ED users with ten or more visits in the index [initial] year, ambulatory care visit rates actually exceeded ED visit rates.”
While hospital emergency department use is not a major cost driver for the Medicaid program, an improved understanding of Medicaid beneficiaries who frequently obtain ED care could help inform the current policy debate over how to meet the significant needs of this population and how to contain Medicaid expenditures, according to the researchers.
Importantly, the analysis indicates that “predictive modeling” based on information provided at a patient’s initial ED visit could be used to identify individuals likely to return to the emergency department frequently. Billings and Raven write that the predictive modeling approach, coupled with an understanding of the characteristics of frequent ED users, offers health care institutions an opportunity to design targeted, cross-system health care interventions to keep future high users from having to return to the hospital for emergency care.
“It is also important to note that only a small number of ‘frequent fliers’ are ultra-high ED users or serial high ED users, with frequent ED use year after year,” Billings and Raven assert. “To date, most thinking by providers and policy makers about the problem of frequent ED users has focused on these serial users, but the overwhelming majority of frequent users have only episodic periods of high ED use, instead of consistent use over multiple years. More needs to be learned about these patients (they, too, could be interviewed in the ED), and predictive modeling and quick intervention will probably be critical since their repeat ED use is unlikely to continue over time.”
John Billings is a professor of health policy and public service at NYU Wagner, where he directs the Health Policy and Management Program. Maria C. Raven is an assistant professor in the Department of Emergency Medicine at the University of California, San Francisco, School of Medicine.
The authors are available for interview about their findings: contact NYU public affairs officer Robert Polner via the phone number or email address listed with this release.
- Dispelling an urban legend, new study shows who uses emergency departments frequently (medicalxpress.com)
- [NCHS Data Brief] Emergency Department Visits by Persons Aged 65 and Over: United States, 2009 – 2010 (jflahiff.wordpress.com)
- Homeless people much more frequent users of emergency department and other health-care services (eurekalert.org)
“This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.”
Researchers take a page from weather forecasting to predict seasonal influenza outbreaks in 108 cities across the country
Scientists were able to reliably predict the timing of the 2012-2013 influenza season up to nine weeks in advance of its peak. The first large-scale demonstration of the flu forecasting system by scientists at Columbia University’s Mailman School of Public Health was carried out in 108 cities across the United States.
Results are published online in the journal Nature Communications.
The flu forecasting system adapts techniques used in modern weather prediction to turn real-time, Web-based estimates of influenza infection into local forecasts of the seasonal peak by locality. Influenza activity peaked in cities in the southeast as early as December 2012, but crested in most of the country in the first weeks of 2013.
Year to year, the flu season is highly variable. It can happen anywhere from December to April. But when it arrives, cities can go from practically no cases to thousands in a very short time. “Having greater advance warning of the timing and intensity of influenza outbreaks could prevent a portion of these influenza infections by providing actionable information to officials and the general public,” says first author Jeffrey Shaman, PhD, assistant professor of Environmental Health Sciences at Columbia University’s Mailman School of Public Health.
For the public, the flu forecast could promote greater vaccination, the exercise of care around people sneezing and coughing, and a better awareness of personal health. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, are necessary.
The new study builds on the researchers’ 2012 study that used the system to retrospectively predict the peak of the flu in New York City for the years 2003-2008. That research was limited to one city and performed as a test of the system. The current study is the first to make predictions in actual real-time and for the whole country.
Beginning in late November of 2012, the researchers used the flu forecasting system to perform weekly estimates for 108 cities. They shared the results with the CDC and posted them online in an academic archive. Near the end of 2012, four weeks into the flu season, the system had predicted 63% of cities accurately. As the season progressed, the accuracy increased. By week four, it successfully predicted the seasonal peak in 70% of the country. It was able to give accurate lead-times up to nine weeks in advance of the peak; most lead-times were two to four weeks.
The flu forecasts were also much more reliable than those made using alternate, approaches that rely on historical data. “Our method greatly outperformed these alternate schemes,” says Dr. Shaman.
The researchers saw regional differences in the accuracy of the system, but they were likely within normal variation. “As an example, retrospectively, we’ve been able to predict the flu in Chicago very well; this year we did a terrible job in that city. For other cities, the opposite held. It averages out. On the whole the system performed very well,” Dr. Shaman says. However, there were hints of geographical differences. “We were able make better predictions in smaller cities. Population density may also be important. It suggests that in a city like New York, we may need to predict at a finer granularity, perhaps at the borough level. In a big sprawling city like Los Angeles, we may need to predict influenza at the level of individual neighborhoods.”
Google Flu Trends Goes “Off the Rails”
The researchers designed the flu forecasting system to use combined data from 1) Google Flu Trends, which makes estimates of outbreaks based on the number of flu-related search queries, and 2) region-specific reports from the Centers for Disease Control on verified cases of flu. The system approach is analogous to weather forecasting, which employs real-time observational data to reduce model forecasts error. In the last year, the researchers slightly modified the system to be more representative of flu rather than flu and other respiratory problems. Nevertheless, there was unusual level of “noise” in the data related to problems with Google Flu Trends.
How did this happen? One explanation is the high number of media stories about the flu, including some about the flu forecasting system itself. The result was a spike in people using Google to research the flu, which could have overloaded the Flu Trends algorithm. It’s an irony not lost on Dr. Shaman. “There was a tremendous amount of media attention accorded to the flu last year. I was part of the problem myself,” he says. Another factor may have been the particular strain of flu in circulation. “The flu was very virulent and was making people very sick, more so than previous seasons,” says Dr. Shaman. Again this could have led to spike in flu-related Google search queries. (In October, Google announced that it has revised the Flu Trends, which Dr. Shaman hopes will make flu forecasting more accurate.)
The system will be put back in action as soon as the flu season begins again. “Right now there are few cases of the flu, but as soon as the needle starts to move, we will start making predictions,” says Dr. Shaman. This season the forecasts will be more readily available to the public on a website hosted by Columbia’s Mailman School of Public Health expected to launch in the coming weeks.
Worldwide, influenza kills an estimated 250,000 to 500,000 people each year, according to the World Health Organization. In the U.S. 3,000-49,000 die from the flu every year, and about 45% of Americans were vaccinated for the flu, according to the CDC.
Co-authors include Wan Yang and James Tamerius, post-doctoral students of Dr. Shaman (Dr. Tamerius is currently at the University of Iowa); Alicia Karspeck at the National Center for Atmospheric Research; and Marc Lipsitch at the Harvard School of Public Health.
Funding was provided by the National Institutes of Health (GM100467, ES009089) and the Department of Homeland Security. Dr. Lipsitch discloses consulting or honorarium income from the Avian/Pandemic Flu Registry (Outcomes Sciences; funded in part by Roche), AIR Worldwide, Pfizer and Novartis. All other authors declare no competing financial interests.
- Will You Get the Flu? This Real-Time Flu Forecaster Could Tell You (healthland.time.com)
- Flu predictions get more accurate (philedufutureboytech.wordpress.com)
- Flu predictions get more accurate (news.cnet.com)
- Flu predictions get more accurate (news.cnet.com)
- First real-time flu forecast successful (eurekalert.org)
- Scientists Use Weather Forecasting Methods to Predict Flu Season Peak (usnews.com)
- Real-Time Flu Forecast Predicts Outbreaks in Each US City (livescience.com)
- Flu Forecast: Scientists Develop Predict Influenza By Utilizing Weather Forecasting Ideas (wonderfultips.wordpress.com)
From 2010 to 2013, The Pew Charitable Trusts conducted a comprehensive assessment of the federal food additives regulatory program. Relying on a transparent process that engaged stakeholders, Pew examined food additive issues in partnership with the food industry, the public interest community, and the federal government, including the U.S. Food and Drug Administration, or FDA. We held five expert workshops and published six reports in peer-reviewed journals. This report summarizes our findings and provides recommendations to address the problems that we identified.
With more than 10,000 additives allowed in food, Pew’s research found that the FDA regulatory system is plagued with systemic problems, which prevent the agency from ensuring that their use is safe. The cause of this breakdown in our food safety regulatory process is an outdated law with two significant problems:
First, the law contains an exemption intended for common food ingredients; manufacturers have used this exception to go to market without agency review on the grounds that the additive used is “generally recognized as safe,” or GRAS, in regulatory parlance. FDA has interpreted the law as imposing no obligation on firms to tell the agency of any GRAS decisions. As a result, companies have determined that an estimated 1,000 chemicals are generally recognized as safe and have used them without notifying the agency. The firms usually use their own employees, consultants, or experts whom they select and pay to make the safety decision with no disclosure or apparent efforts to minimize the inherent conflicts of interest.
Second, the law does not give FDA the authority it needs to efficiently obtain the information necessary to identify chemicals of concern that are already on the market; set priorities to reassess these chemicals; and then complete a review of their safety. Moreover, the agency has not been given the resources it needs to effectively implement the original 1958 law. As a result, FDA has not reevaluated the safety of many chemicals originally approved decades ago, generally rechecking safety only when requested by a company to do so, or when presented with allegations of serious adverse health effects.
What FDA says today about the safety of additives
“It’s perhaps a time to look at what the legal framework looks like and what opportunities there are now to ask and answer questions in new ways because of advances in science and technology.”
— FDA Commissioner Margaret Hamburg, (Reuters, May 2013)
“We’re not driven by a sense that there is a pressing public health emergency. But there are decisions being made based on data that we don’t have access to, and that creates a question about the basis on which those decisions are made.”
— FDA Deputy Commissioner for Foods Michael Taylor, (Associated Press, March 2013)
“FDA plans to issue guidance to industry on meeting the GRAS criteria established under the Act.”
— FDA spokeswoman Theresa Eisenman, (USA Today, August 2013)
To remedy these problems, Pew’s report recommends that Congress update the Food Additives Amendment of 1958 to ensure that FDA:
- Approves the first use of all new chemicals added to food.
- Reviews new uses or changes to existing uses of previously approved additives.
- Streamlines its decision-making process so it is timely and efficient.
- Upgrades its science to determine safety.
- Uses the scientific tools and data it needs to set priorities to reassess the safety of chemicals already allowed in food and to take action where necessary.
- FDA’s trans fat decision: An opening for regulating salt, sugar? – Los Angeles Times (latimes.com)
- Not all chemicals in your food are labeled – or tested (examiner.com)
The link below was recovered from the Purdue Libraries website. This Best Medicine: Health Information from the Federal Government page is a great resource for investigative consumers and the health conscious.
- Centers for Disease Control, and Prevention
- ClinicalTrials.govGUIDES TO FINDING AND EVALUATING HEALTH INFORMATION ON THE WEB
- Good Resource Tools for Medical and Health Information (sciencepowerx.wordpress.com)
After years of state spending cuts, mental health budgets increased in 37 states this year, according to a new report by the National Alliance on Mental Illness.
“Arguably the most notable development was that Texas increased mental health spending by $259 million over two years, the largest increase in its history,” NAMI said in a statement accompanying the report. South Carolina, which had cut mental health programs the deepest in recent years, was also among those states to increase funding this year.
Overall, the increased investment in mental health, spurred in part by the deadly shootings last year in Aurora, Colo., and Newtown, Conn., represents a dramatic reversal from recent years. Between 2009 and 2012, state spending in mental health services dropped by $4.35 billion.
According to NAMI, only six states decreased mental health funding this year – Alaska, Wyoming, Nebraska, Louisiana, North Carolina and Maine.
Aside from money, the NAMI report said states enacted other measures related to mental health. Five states passed legislation to improve the early identification of mental illness in children and youth. Seventeen states adopted laws to tighten restrictions on gun ownership by those considered dangerously mentally ill. And 19 states tinkered with laws pertaining to court-ordered treatment of those with mental illness.
- Newtown shooting prompts increase in mental health funding, not gun control – CTV News (knlive.ctvnews.ca)
- Funding cuts puts Atlanta mental health program at risk (onlineathens.com)
- Gov. McDonnell launches investigation into mental health policies (wtvr.com)
- Newtown Prompts Flood of Mental-Health Spending by U.S. States (bloomberg.com)
- Study examines delivery of outpatient mental health treatment (medicalnewstoday.com)
- NAMI co-hosting mental health discussion (mercedsunstar.com)
- Increasing Access to Psychotropic Medications | Mental Health Summit (pharmaceuticalintelligence.com)
- Mental health conditions cause greater stigma in families than physical problems (psypost.org)
Vitamin supplements are a billion-dollar industry. We want to stay healthy and fit and help our bodies with this. But perhaps we are achieving precisely the opposite?
“We believe that antioxidants are good for us, since they protect the cells from oxidative stress that may harm our genes. However, our bodies have an enormous inherent ability to handle stress. Recent research results show that the body’s responses to stress in fact are important in preventing our DNA from eroding. I fear that the fragile balance in our cells can be upset when we supplement our diet with vitamin pills, says Hilde Nilsen to the research magazine Apollon. Nilsen is heading a research group at the Biotechnology Centre, University of Oslo.
Maintenance of genes
Our DNA – the genetic code that makes us who we are – is constantly exposed to damage.
In each of the hundred trillion cells in our body, up to two hundred thousand instances of damage to the DNA take place every day. These may stem from environmental causes such as smoking, stress, environmental pathogens or UV radiation, but the natural and life-sustaining processes in the organism are the primary sources of damage to our DNA.
How can the repair of damage to our DNA help us stay healthy and live long lives?
A small worm provides the answer
To answer this question, Hilde Nilsen and her group of researchers have allied themselves with a small organism – a one millimetre-long nematode called Caenorhabditis elegans (C. elegans). This roundworm, which lives for only 25 days, is surprisingly sophisticated with its 20,000 genes; we humans only have a couple of thousand more.
C. elegans is a fantastically powerful tool, because we can change its hereditary properties. We can increase its ability to repair DNA damage, or we can remove it altogether. We can also monitor what happens when damage to DNA is not repaired in several hundred specimens and through their entire lifespan. Different “repair proteins” take care of various types of damage to the DNA. The most common ones are repaired by “cutting out” and replacing a single damaged base by itself or as part of a larger fragment.
Affecting lifespan with the aid of genes
In some specimens that do not have the ability to repair the damage, the researchers observe that the aging process proceeds far faster than normal. Is it because the damage accumulates in the DNA and prevents the cells from producing the proteins they need for their normal operation? Most researchers have thought so, but Hilde Nilsen doubts it.
One of the genes studied by the researchers has a somewhat shortened lifespan: on average, this mutant lives three days less than normal. Translated into human terms, this means dying at the age of 60 rather than at 70. -”We were surprised when we saw that these mutants do not in fact accumulate the DNA damage that would cause aging. On the contrary: they have less DNA damage. This happens because the little nematode changes its metabolism into low gear and releases its own antioxidant defences. Nature uses this strategy to minimize the negative consequences of its inability to repair the DNA. So why is this not the normal state? Most likely because it comes at a cost: these organisms have less ability to respond to further stress ‒ they are quite fragile.
Hilde Nilsen and her colleagues have now -for the very first time -”shown that this response is under active genetic control and is not caused by passive accumulation of damage to the DNA, as has been widely believed.
Can do great harm
The balance between oxidants and antioxidants is crucial to our physiology, but exactly where this equilibrium is situated varies from one person to the next.
“This is where I start worrying about the synthetic antioxidants. The cells in our body use this fragile balance to establish the best possible conditions for themselves, and it is specially adapted for each of us. When we take supplements of antioxidants, such as C and E vitamins, we may upset this balance,” the researcher warns.
“It sounds intuitively correct that intake of a substance that may prevent accumulation of damage would benefit us, and that’s why so many of us supplement our diet with vitamins. Our research results indicate that at the same time, we may also cause a lot of harm. The health authorities recommend that instead, we should seek to have an appropriate diet. I’m all in favour of that. It’s far safer for us to take our vitamins through the food that we eat, rather than through pills,” Hilde Nilsen states emphatically.
- DNA repair- Why should you care? (antisensescienceblog.wordpress.com)
[Press Release] The Human Health Costs of Losing Natural Systems: Quantifying Earth’s Worth to Public Health
Scientists Urge Focus on New Branch of Environmental Health
NEW YORK (November 19, 2013) — A new paper from members of the HEAL (Health & Ecosystems: Analysis of Linkages) consortium delineates a new branch of environmental health that focuses on the public health risks of human-caused changes to Earth’s natural systems.
Looking comprehensively at available research to date, the paper’s authors highlight repeated correlations between changes in natural systems and existing and potential human health outcomes, including:
Forest fires used to clear land in Indonesia generate airborne particulates that are linked to cardiopulmonary disease in downwind population centers like Singapore.
Risk of human exposure to Chagas disease in Panama and the Brazilian Amazon, and to Lyme disease in the United States, is positively correlated with reduced mammalian diversity.
When households in rural Madagascar are unable to harvest wild meat for consumption, their children can experience a 30% higher risk of iron deficiency anemia—a condition that increases the risk for sickness and death from infectious disease, and reduces IQ and the lifelong capacity for physical activity.
In Belize, nutrient enrichment from agricultural runoff hundreds of miles upstream causes a change in the vegetation pattern of lowland wetlands that favors more efficient malaria vectors, leading to increased malaria exposure among coastal populations.
Human health impacts of anthropogenic climate change include exposure to heat stress, air pollution, infectious disease, respiratory allergens, and natural hazards as well as increased water scarcity, food insecurity and population displacement.
“Human activity is affecting nearly all of Earth’s natural systems—altering the planet’s land cover, rivers and oceans, climate, and the full range of complex ecological relationships and biogeochemical cycles that have long sustained life on Earth,” said Dr. Samuel Myers of the Harvard School of Public Health and the study’s lead author. “Defining a new epoch, the Anthropocene, these changes and their effects put in question the ability of the planet to provide for a human population now exceeding 7 billion with an exponentially growing demand for goods and services.”
- Impacts Of Losing Natural Systems On Human Health (naturalhistorywanderings.com)
- The human health costs of losing natural systems: Quantifying Earth’s worth to public health (eurekalert.org)
- Quantifying earth’s worth to public health: scientists urge focus on new branch of environmental health (medicalnewstoday.com)
- Study: Ecosystem alterations leading to widespread human health impacts (summitcountyvoice.com)
- Human Health Depends On A Healthy Environment (freshwaddabrooks.com)
- Human Health Depends On A Healthy Environment (wonderfultips.wordpress.com)
- Human Health Depends On A Healthy Environment (huffingtonpost.com)
- Climate change effects on spread of disease (unmod360.wordpress.com)
From the 25 November 2013 posting at HealthCetera – CHMP’s Blog
[Center for Health Media & Policy at Hunter College (CHMP): advancing public conversations about health & health policy]
Older adults face many important decisions about their health and financial well-being. Whether it’s making retirement savings last longer or authorizing a health proxy, the ability to make good choices has consequences for a senior’s quality of life, aging in place, and end of life care. According to a new study from Rush University, presented yesterday at the Gerontological Society of America Conference in New Orleans, Internet use is associated with better health and financial decision-making among older adults.
“The Internet has become the primary corridor for finding information and assisting in decision-making on finances and healthcare,” said Bryan James, Associate Professor, Department of Internal Medicine, Rush Alzheimer’s Disease Center in Chicago and lead author of the study. “The Internet is becoming what we call ‘proto-normative,’ meaning you have to have some ability or savvy to function online these days.”
Recent research from Pew’s Internet and American Life Project show that slightly more than half (53%) of all seniors are now online. However, James said there remains a significant portion of older adults who use the Internet infrequently, or not at all. This may have important implications for quality of life and independence, including the ability to age at home.
James pointed to the digital divide between older and younger people. In addition to the general anxiety expressed by older adults express about computers and the Internet, there are also certain parts of the aging process that may may pose obstacles to Internet use, such as cognitive decline, as well as decline in hearing, vision, and motor skills.
Evaluating Health Information (from Health Resources for All, edited by Janice Flahiff)
Anyone can publish information on the Internet. So it is up to the searcher to decide if the information found through search engines (as Google) is reliable or not. Search engines find Web sites but do not evaluate them for content. Sponsored links may or may not contain good information.
A few universities and government agencies have published great guides on evaluating information.
Here are a few
The Family Caregiver Alliance has a Web page entitled Evaluating Medical Research Findings and Clinical Trials
…And a Rumor Control site of Note (in addition to Quackwatch)
National Council Against Health Fraud is a nonprofit health agency focusing on health misinformation, fraud, and quackery as public health problems. Links to publications, position papers and more.
[Reblog] A field guide to The Diagnosis Difference (with a request from the the blogger, Ms. Fox for responses)
The Pew Research Center released a report today on people living with chronic conditions: The Diagnosis Difference.
Policy makers, patient advocates, entrepreneurs, investors, clinicians — all health care stakeholders — can use the data to map the current landscape. There are still barren patches, where people remain offline and cut off from the resources and tools. But there are lush valleys, too, where engagement and change is happening.
I see e-patients as the guides to those valleys since unless you are living with chronic conditions — or love someone who is — you don’t see that side of the internet. So here’s my request: provide your evidence. Show what you have learned.
First, a quick summary of the report:
1. 45% of U.S. adults have a chronic condition (For some, that’s a revelation and there is still a considerable distance to go before that reality is widely known. For you, that’s not the news. That’s just proof that we have a sample that matches the CDC’s estimate and you can therefore trust the data.)
2. 72% of adults with chronic conditions have internet access, compared with 89% of U.S. adults who report no conditions. There are digital divide implications to this because having a chronic disease is an independent factor in predicting if someone has access — apart from things like age, income, and educational attainment.
4. Self-tracking is a massive activity, particularly for people living with 2 or more chronic conditions, and this group is more likely to use formal means, not just tracking in their heads as many “well” trackers do. For example, 41% of health trackers who report having one or more chronic conditions use pencil and paper and 14% of this group uses a medical device such as a glucometer.
5. Living with a chronic condition has an independent, significant effect on behaviors that are often described as signs of consumer health engagement, like reading up on drug safety, medical treatments, or delivery-of-care reviews. Internet users living with chronic conditions are more likely than others to read or watch someone else’s commentary or personal experience about health or medical issues online.
I want to stop a moment and give some examples of what that might look like.
- Someone living with cancer might follow Lisa Bonchek Adams’s blog, learning abouthow to prepare for having a port placed.
- Someone living with diabetes might check out Diabetes Mine to learn how other PWDs (people with diabetes) rank tech tools and quality of life measures.
- Someone living with a heart condition might read Carolyn Thomas’s blog to gain reassurance that their post-diagnosis PTSD is not in their head.
- Someone living with a lung condition might learn from Propeller Health about why they, in particular, should get a flu shot.
- Someone living with high blood pressure might search Inspire.com for insights on how to keep it under control.
And now we come to the category that personally means the most to me since I’ve spent time in rare disease communities: the 16% of U.S. adults who are living with “other conditions,” like rheumatoid arthritis, epilepsy, or fibromyalgia (to name a very few of thousands). They are hardly ever in the mainstream spotlight. They may have awareness days or weeks or months that their communities honor, but you won’t see the National Football League wearing their colors.
The internet is their spotlight. A blog, a hashtag, a YouTube channel, or a Facebook group can be their lifeline. Yes, they consult clinicians like everyone else, but those who are online know that the path to health — for them — is often found in the advice shared by someone like them or the person they are caring for. The feeding tip that will help their baby get the nutrients she needs to grow. The heating-pad tip that will ease their painsomnia.
As I wrote at the top, unless you are living with chronic conditions — or love someone who is — you don’t see that side of the internet. So let’s open up the landscape.
Please post in the comments what you have learned online from a fellow spoonie, from a fellow caregiver, from a fellow traveler along the path to health. What would you tell someone just diagnosed with your condition to do, especially in tapping into the resources available online? When someone asks you, maybe over Thanksgiving, about why you spend time online, what will you say?
Post it here [at Samantha Fox's blog] . Links to blogs, videos, tweets — all are welcome.
I was at a cocktail party, struggling to describe in just a few sentences what I do for a living, when my friend Paul Tarini broke in and said, “You’re an internet geologist. You study the rocks, you don’t judge them.” Exactly. I study patterns in the online landscape and provide data so people can make better decisions about the social impact of the internet.
My other favorite description of the kind of research I do is “nowist” (meaning: instead of being a futurist, understand what people are doing now and be alert to changes).
“Health care gadfly” describes my role outside the fray, as an observer, hopefully contributing to the public conversation in a useful way.
Ted Eytan coined the phrase “community colleague” for people who collaborate by default. That’s me. My work is enriched by the health geek tribe. I can’t imagine doing the work I do without the help of my community.
- How US adults with chronic health conditions share health information online? (gadgetrends.ro)
- Pew Report: Chronic Health Conditions Impact 45% Of American Adults, Contribute To 75% Of Health Care Costs (medicaldaily.com)
- The Diagnosis Difference: Those with Chronic Conditions Have Different Online Habits (drhiphop85.com)
- Increased frailty associated with childhood cancer survivorship (2minutemedicine.com)
- Chronic Conditions and Medical Complexity (rehabcare.com)
- What we see and what we cannot see. What we share and do not share. And why. (snideeffects.com)
- Ill workers ‘feared losing jobs’ (standard.co.uk)
On a personal note. Back in 1972 the religion classes for juniors and seniors at my high school were composed of electives. I took the marriage class. One week was spent on contraceptives. The material on the different types was fact based. Since it was a Catholic school abstinence was emphasized! Still, I was a bit taken aback that we were given all the facts in order to make our own decisions. Didn’t tell my parents about this! But the week’s focus on contraception did reinforce what we were taught at home – responsibilities for our actions.
On a somewhat related note – my heart goes out to all who are sexually abused and feel that a sexual relationship (and/or a relationship that is disproportionally based on the needs of others) is the only way out of a bad (often home) environment.
Qualitative Study Explores Women’s Perceptions of Pregnancy Risk
In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to “Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions,” by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response.
The most common reason women gave for their perceived low risk of pregnancy was perceived invulnerability to pregnancy. Study participants understood that pregnancy could happen, but for reasons they couldn’t explain, thought they were immune or safe from pregnancy at the time they engaged in unprotected sex. One reported that she “always had good luck,” while another said, “…It’s like you believe something so much, like ‘I just really don’t want children,’ [and] for some reason, I thought that would prevent me from getting pregnant.” This type of magical thinking—that pregnancy somehow would not happen despite acknowledged exposure—suggests a disconnect between the actual risk of pregnancy incurred by an average couple who does not use contraceptives (85% risk of pregnancy over the course of a year) and a woman’s efforts to protect herself from unintended pregnancy.
Equal proportions (one-third) of respondents thought they or their partners were sterile, said the possibility of pregnancy “never crossed my mind” and reported that (often incorrect) contraceptive use was the reason they thought they were at low risk. Perceptions of infertility were not based on medical advice, but rather on past experiences (e.g., the respondent had unprotected sex and didn’t get pregnant) or family history. Among those who thought they were protected by their contraceptive method, most women reported inconsistent or incorrect method use. For example, one woman felt a few missed pills did not put her at risk: “I just thought…they were like magic. If I missed it one day, it wouldn’t really matter.”
The authors suggest that further research is needed to quantify the proportion of women at risk of pregnancy who believe they are not at risk, and reasons why they hold that belief, in order to better address misconceptions around pregnancy risk with the goal of preventing unintended pregnancy. Additionally, they suggest that health care providers should seek to better understand patients’ beliefs regarding their ability to get pregnant and the efficacy of contraception so as to address these topics, and that public health campaigns should dispel myths, address magical thinking, and call attention to the general problem of low health literacy.
“Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions” is currently available online and will appear in a forthcoming issue of Social Science & Medicine.
- Statistics on Abortion from Abort73.com (whyyoushouldbeprochoice.wordpress.com)
- Why young women are going off the pill and on to contraception voodoo | Hadley Freeman (theguardian.com)
- [Brookings Institute report] Isabel V. Sawhill and Quentin Karpilow – Three Facts about Birth Control and Social Mobility (jflahiff.wordpress.com)
- A Major Cause of Unplanned Pregnancies (vitalisticvixen.com)
- Pope Francis sends out survey to ask Catholics about gay sex, abortion and contraception (independent.co.uk)
- Theory post about Abortion (violetlightning.wordpress.com)
I do admire this physician’s initiative and perseverance in finding financial resources to serve the costliest patients in Camden.
I’m re-reading an essential healthcare article by Atul Gawande, published in the New Yorker in January, 2011. **I can hardly believe that was only about three years ago. It made a huge impression on me. The article begins with a profile of Dr. Jeffrey Brenner, whose explanation of his work to identify trends in emergency room use in Camden is the title of this post.
As a medical student at Robert Wood Johnson Medical School, in Piscataway, he had planned to become a neuroscientist. But he volunteered once a week in a free primary-care clinic for poor immigrants, and he found the work there more challenging than anything he was doing in the laboratory. The guy studying neuronal stem cells soon became the guy studying Spanish and training to become one of the few family physicians in his class. Once he completed his residency, in 1998, he joined the staff of a family-medicine practice in Camden. It was in a cheaply constructed, boxlike, one-story building on a desolate street of bars, car-repair shops, and empty lots. But he was young and eager to recapture the sense of purpose he’d felt volunteering at the clinic during medical school.
I like to read this article every year or so. I appreciate the appeal of untangling complicated problems and balancing your work between data-driven analytics and the expertise of real, live people.
“For all the stupid, expensive, predictive-modelling software that the big venders sell,” he says, “you just ask the doctors, ‘Who are your most difficult patients?,’ and they can identify them.”
A lot of what Brenner had to do, though, went beyond the usual doctor stuff.
Here I would argue that nurses are trained for the type of work Brenner describes. Yes, there are special doctors who are turned on by this kind of work, but far more common are nurses who take a holistic view of their patients’ lives.
If it were up to him, he’d recruit a whole staff of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived. With the tens of millions of dollars in hospital bills they could save, he’d pay the staff double to serve as Camden’s élite medical force and to rescue the city’s health-care system.
But that’s not how the health-insurance system is built. So he applied for small grants from philanthropies like the Robert Wood Johnson Foundation and the Merck Foundation. The money allowed him to ramp up his data system and hire a few people, like the nurse practitioner and the social worker who had helped him with Hendricks. He had some desk space at Cooper Hospital, and he turned it over to what he named the Camden Coalition of Healthcare Providers.
There is so, so much more good stuff in this piece. It’s getting to the point where I am just copying and pasting, any it’s better to simply read the whole thing.
** THE HOT SPOTTERS - Can we lower medical costs by giving the neediest patients better care?
New Yorker, January 2011
- “Visionary Family Physician Seeks to Revamp Health Care Delivery System” (aafp.org)
- Doctors Burn Out (precisionmedicalbilling.wordpress.com)
- New Jersey hospitals reach out to patients to reduce ER visits (nj.com)
- Readers Write: Help Us, Atul Gawande, You’re Our Only Hope (histalk2.com)
- With expanding coverage doctors likely to accept new Medicaid patients (medicalnewstoday.com)
About three years ago, the nation’s top public health agency picked its battles. Now, it’s issuing its own report card on reaching those goals: Pretty good but needs improvement.
The seven “winnable battles” singled out by the Centers for Disease Control and Prevention set goals for 2015, such as cutting adult smoking to 17 percent and pushing childhood obesity down to about 15 percent.
The agency released its first progress report Thursday, and CDC officials said they’re mostly pleased.
To keep pace with emerging public health challenges and to address the leading causes of illness, injury, disability, and death, the Centers for Disease Control and Prevention (CDC) initiated an effort to achieve measurable impact on selected Winnable Battles. These Winnable Battles were chosen based on the magnitude of the health problems and our ability to make significant progress to improve outcomes.
There are evidence-based strategies available now to address the critical health challenges presented by each of the Winnable Battles areas. We have established important indicators and targets for measuring progress. Together with our partners, we can have a meaningful impact on health through a dedicated focus on these Winnable Battles.
In 2010, CDC identified the following Winnable Battles:
- Tobacco – Tobacco use is the leading preventable cause of disease, disability, and death in the U.S.
- Nutrition, Physical Activity, and Obesity – More than 72 million adults and 12 million youth in the U.S. are obese
- Food Safety – Foodborne diseases sicken 1 out of 6 Americans each year
- Healthcare-Associated Infections (HAIs) – 1 out of 20 hospitalized patients contracts an HAI
- Motor Vehicle Safety – Motor vehicle crashes are a leading cause of death among Americans ages 1 to 54
- Teen Pregnancy – The U.S. has one of the highest rates of teen pregnancy of any developed nation in the world
- HIV – More than 1 million people in the U.S. are living with HIV
- CDC report card on priorities: Pretty good, needs improvement (globalnews.ca)
- How The CDC Did On Its Most Recent Report Card (wonderfultips.wordpress.com)
- CDC report card: Good, bad marks on target battles (boston.com)
- CDC report card: Good, bad marks on target battles (star-telegram.com)
Non-Specialist Health Workers Play Important Role in Improving Mental Health in Developing Countries
Non-specialist health workers are beneficial in providing treatment for people with mental, neurological and substance-abuse (MNS) problems in developing countries — where there is often a lack of mental health professionals — according to a new Cochrane review.
Researchers, led by the London School of Hygiene & Tropical Medicine, say non-specialist health workers (such as doctors, nurses or lay health workers) not formally trained in mental health or neurology, and other professionals with health roles, such as teachers, may have an important role to play in delivering MNS health care. The study is the first systematic review of non-specialist health workers providing MNS care in low- and middle-income countries.
After examining 38 relevant studies from 22 developing countries, researchers found that non-specialist health workers were able to alleviate some depression or anxiety. For patients with dementia, non-specialists seemed to help in reducing symptoms and in improving their carers’ coping skills. Non-specialists may also have benefits in treating maternal depression, post traumatic stress disorder as well as alcohol abuse, though the improvements may be smaller.
Lead author Dr Nadja van Ginneken, who completed the research at the London School of Hygiene & Tropical Medicine’s Centre for Global Mental Health with funding from the Wellcome Trust Clinical PhD programme, said: “Many low- and middle-income countries have started to train primary care staff, and in particular lay and other community-based health workers, to deliver mental health care. This review shows that, for some mental health problems, the use of non-specialist health workers has some benefits compared to usual care.”
Cochrane Abstract is here
Check with a local academic, health/medical, or public library for free or low cost access to full text.
People who can accurately remember details of their daily lives going back decades are as susceptible as everyone else to forming fake memories, UC Irvine psychologists and neurobiologists have found. In a series of tests to determine how false information can manipulate memory formation, the researchers discovered that subjects with highly superior autobiographical memory logged scores similar to those of a control group of subjects with average memory. “
Finding susceptibility to false memories even in people with very strong memory could be important for dissemination to people who are not memory experts. For example, it could help communicate how widespread our basic susceptibility to memory distortions is,” said Lawrence Patihis, a graduate student in psychology & social behavior at UC Irvine. “This dissemination could help prevent false memories in the legal and clinical psychology fields, where contamination of memory has had particularly important consequences in the past.”
- People who don’t forget can still be tricked with false memories (medicalxpress.com)
- How Many Of Your Memories Are Fake? (theatlantic.com)
- People with superior recall powers vulnerable to false memories (universityofcalifornia.edu)
- Remember That? No You Don’t. Study Shows False Memories Afflict Us All (science.time.com)
From time to time I glanced at JAMA cover art when working at various libraries.
Never quite understood the art. However, now I feel like part of JAMA’s soul is diminished….
From the 6 November 2013 Kevin MD article by JEFFREY M. LEVINE, MD
Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays.JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers that displayed over 2,000 pieces of art, JAMA has taken a great leap backwards and replaced the cover art with a pedestrian table of contents. The cover art that once distinguished JAMA from an array of leading medical journals has been demoted to an inside page, eliminating one of the more visible, inspiring beacons that once linked the humanities to medical science.
The cover art was always important to me. As a teenager envisioning my future, I saw copies of JAMA on my uncle’s desk. He was a medical doctor, and for me the JAMAcovers joined the visual arts to the science of medicine and gave me inspiration. As the years passed, I enjoyed seeing the distinguished covers of JAMA in medical libraries, and frequently picked them up to read the commentary. Glancing from the scientific articles to the essays on the cover art, my vision of the combination of art and medicine was validated. Over the years I received JAMA in my office and tacked many of my favorite covers to the wall by my desk.
The art swept across the vast panorama of civilization and human history. Just about any painter you can imagine has been featured on a JAMA cover. In addition the covers displayed Japanese Ukiyo-E prints (February 4, 1998), a 15th Century Apothecary Treatise (September 8, 1999), and African bronze statuary (April 6, 2011). One of my favorites was the photo of the Lewis Chessmen, a set that was carved from walrus ivory in the 12th Century and found in the Outer Hebrides off the coast of Scotland (February 16, 2011).
Antibiotics aren’t doing what they’re supposed to do anymore. You know, kill infections. Since Alexander Fleming invented penicillin 75 years ago, nearly all bacteria have mutated into strains impervious to antibiotics. Those souped up bacteria now kill hundreds of thousands of people, at a minimum, each year. And according to a new issue of medical journal The Lancet focused on antibiotic-resistant bacteria, things could soon get a whole lot scarier.+
“Rarely has modern medicine faced such a grave threat. Without antibiotics, treatments for minor surgery to major transplants could become impossible…,” argue a team of UK medical experts in one article in a series on antibiotic resistance (paywall) in The Lancet. ”Infection-related mortality rates in developed countries might return to those of the early 20th century,” they say.
The reason antibiotics are no longer doing what they’re supposed to is mainly that they’re being given to the wrong patient. Instead of people with severe infections or risk of infection, the majority of antibiotics are consumed by animals and people who aren’t sick enough to justify their use.
Pigs, chickens, cows, fish and other animals consume the majority of the 100,000-200,000 tonnes (110,000-220,000 tons) of antibiotics manufactured each year, as farmers try to keep growing large and healthy animals under unsanitary conditions. The bacterial strains created in these conditions can spread to humans.
At the same time, perverse incentives in poor countries encourage overuse. People often take antibiotics available over-the-counter, says The Lancet’s report on global resistance, and self-medication by consumers is common. The lack of sound medical care in some areas means that pharmaceutical companies are the chief source of information on when to take antibiotics and in what dose.
- Superbugs are spreading in Europe as antibiotics are overused (qz.com)
- IL Expert: Antibiotic-Resistant Superbugs a Growing Threat (publicnewsservice.org)
- Guess What Happens When The Antibiotics Stop Working (theawl.com)
- ‘Re-engineer healthcare to develop antibiotic resistance’ (thehindu.com)
- New warning says ‘superbugs’ could erase century of medical advances (foxnews.com)
- Worldwide Antibiotics Warning: Resistance ‘Growing’ (prayingforoneday.wordpress.com)
- Antibiotics Warning: Resistance ‘Growing’ (news.sky.com)
[AHA article] (Aerobics /Preventive Medicine pioneer) Dr. Kenneth Cooper is keynote speaker at Scientific Sessions 2013
Back in college I took a “physical fitness” class. One of Dr. Cooper’s books was required reading. Very inspiring. Good to see he is still a living example of his well tested theories of aerobic exercise and wellness program benefits.
From the 18 November American Heart Association article
In the early 1960s, when the great Space Race was being fueled by the escalating Cold War, a former track and basketball star from Oklahoma envisioned himself soaring through the Milky Way.
This tall, lanky fellow was an Army doctor, but the lure of space flight led him to transfer to the Air Force. He became certified in aerospace medicine. Then he developed training programs for astronauts – some for before they took off, others to help them remain in shape while floating weightlessly in outer space. All along, his sights were set on becoming among a select group of “science astronauts.”
Imagine how different life on Earth would be today if Kenneth Cooper, MD, MPH, hadn’t shifted gears.
Cooper actually was still in the Air Force when he published “Aerobics,” a book that did as much for the health of Americans as the Apollo 11 lunar landing did for the aerospace industry. Cooper’s book, by the way, came out first – more than a year before Neil Armstrong planted the U.S. flag on the moon.
That book is now available in more than 40 languages. Cooper has spoken in more than 50 countries, and written 18 more books. He is the “Father of Aerobics” and a big reason why the number of runners in the United States spiked from 100,000 when his book came out to 34 million in 1984.
Having proven the benefits of preventive medicine and wellness in the military, he was ready to shift to the private sector.
The private sector, however, wasn’t ready for him.
When he opened his clinic in Dallas, naysayers told him, “You can’t limit your practice to taking care of healthy people. People only want to see their physicians when they’re sick.” And those were the kind ones. Others turned him in to the local medical society’s board of censors.
“They thought I was going to kill people by putting them on treadmills for stress testing,” Cooper said. “I’d been doing it in the Air Force for 10 years!”
The big picture turned out more clearly. Baby Boomers became exercisers, triggering a fitness craze that produced what he calls “the glory years of health in America.” As Boomers have aged, and future generations have made fitness a lower priority, health had spiraled in the wrong direction. It’s been 17 years since the Surgeon General recommended 30 minutes of physical activity most days of the week, and the statistics show that most Americans aren’t doing it.
“For many years, I’ve put people into five health categories, ranking them from very poor to excellent. Research constantly shows that major gains can be made by moving up just one category, even if it’s just from very poor to poor,” Cooper said. “If we can get the 50 million Americans who are totally inactive today to move up just one category, think of the dramatic effect that would have. Just by avoiding inactivity!”
- A Prescription From the ‘Father of Aerobics’ – Exercise Is Medicine (debbiestrauch.wordpress.com)
- Aerobic Exercise Improves Memory, Brain function and Physical Fitness (parasyaseen.wordpress.com)
RESS Abstract 19453/157 (Omni Dallas Hotel, Dallas Ballroom D-H)
Just one minute of CPR video training for bystanders in a shopping mall could save lives in emergencies, according to research presented at the American Heart Association’s Scientific Sessions 2013.
Researchers used a one-minute CPR video to improve responsiveness and teach compression only CPR to people with no CPR experience.
Participants were divided into two groups: 48 adults looked at the video, while 47 sat idle for one minute. In a private area with a mannequin simulating a sudden collapse, both groups were asked to do “what they thought best.” Researchers measured responsiveness as time to call 9-1-1 and start chest compression and CPR quality reflected by chest compression depth, rate and hands-off interval time.
Adults who saw the CPR video called 9-1-1 more frequently, initiated chest compression sooner, had an increased chest compression rate and a decreased hands-off interval, researchers said.
“Given the short length of training, these findings suggest that ultra-brief video training may have potential as a universal intervention for public venues to help bystander reaction and improve CPR skills,” said Ashish Panchal, M.D., Ph.D. lead researcher of the study.
- Watching just one-minute CPR video increases reaction in an emergency: Study (sunnewsnetwork.ca)
From a previous post (which includes videos)
A link to information about the new CPR guidelines (Compression - Airway- Breathing) may be found here.
A presskit with media materials, statements from experts, and real life stories may be found here.
- The 2010 AHA Guidelines for CPR and ECC update the 2005 guidelines.
- When administering CPR, immediate chest compressions should be done first.
- Untrained lay people are urged to administer Hands-Only CPR (chest compressions only).
DALLAS, Oct. 18, 2010 — The American Heart Association is re-arranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation andEmergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.
Recommending that chest compressions be the first step for lay and professional rescuers to revive victims ofsudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).[Editor Flahiff's emphasis]
“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” said Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart Association’s Emergency Cardiovascular Care (ECC) Committee. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”
In previous guidelines, the association recommended looking, listening and feeling for normal breathing before starting CPR. Now, compressions should be started immediately on anyone who is unresponsive and not breathing normally.
All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim’s brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.
The change in the CPR sequence applies to adults, children and infants, but excludes newborns.
Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005:
- During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.
- Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.
- Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
- Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
- All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.
Seems I’m reading and re-posting criminal justice items today…
Selected this one because I am an ardent opponent of the death penalty. And when the death penalty is abolished, there still are plenty of criminal justice issues that need addressing/resolving.
This statistic is new to me. Justice needs to be served, but life without parole for nonviolent offenders? The punishment in these cases does not fit the crime.
Excessive Sentences for Drug and Property Crimes; Extreme Racial Disparities Shown
From the 13 November 2013 ACLU press release
NEW YORK – In the first-ever study of people serving life without parole for nonviolent offenses in the United States, the American Civil Liberties Union found that at least 3,278 prisoners fit this category in federal and state prisons combined.
“A Living Death: Life Without Parole for Nonviolent Offenses” features key statistics about these prisoners, an analysis of the laws that produced their sentences, and case studies of 110 men and women serving these sentences. Of the 3,278 prisoners, 79 percent were convicted of nonviolent, drug-related crimes such as possession or distribution, and 20 percent of nonviolent property crimes like theft.
“The punishments these people received are grotesquely out of proportion to the crimes they committed,” said Jennifer Turner, ACLU human rights researcher and author of the report. “In a humane society, we can hold people accountable for drug and property crimes without throwing away the key.”
The ACLU estimates that, of the 3,278 serving life without parole for nonviolent offenses, 65 percent are Black, 18 percent are white, and 16 percent are Latino, evidence of extreme racial disparities. Of the 3,278, most were sentenced under mandatory sentencing policies, including mandatory minimums and habitual offender laws that required them to be incarcerated until they die.
“The people profiled in our report are an extreme example of the millions of lives ruined by the persistent ratcheting up of our sentencing laws over the last forty years,” said Vanita Gupta, deputy legal director of the ACLU. “We must change our sentencing practices to make our justice system smart, fair, and humane. It’s time to undo the damage wrought by four decades of the War on Drugs and ‘tough-on-crime’ attitudes.”
Douglas Ray Dunkins Jr., who has served 22 years so far, told the ACLU, “It’s devastating, horrible, not being around to see [my children] graduate and go to school.” Dicky Joe Jackson, who has served 17 years, said, “I would rather have had a death sentence than a life sentence.”
The federal courts account for 63 percent of the 3,278 life-without-parole sentences for nonviolent offenses. The remaining prisoners are in Louisiana (429 prisoners), Florida (270), Alabama (244), Mississippi (93), South Carolina (88), Oklahoma (49), Georgia (20), Illinois (10), and Missouri (1). The ACLU estimates that federal and state taxpayers spend $1.8 billion keeping these people in prison for life instead of more appropriate terms.
In addition to interviews, correspondence, and a survey of hundreds of prisoners serving life without parole for nonviolent offenses, the ACLU based “A Living Death” on court records, a prisoner survey, and data from the United States Sentencing Commission, Federal Bureau of Prisons, and state Departments of Corrections obtained through Freedom of Information Act and open records requests.
“A Living Death” features comments from the prisoners’ family members, and in multiple instances, prisoners’ sentencing judges express frustration and outrage at the severity of the punishment the law required. Judge Milton I. Shadur told Rudy Martinez as he sentenced Martinez to life without parole: “[F]airness has departed from the system.”
The report includes recommendations to federal and state governments for changes in sentencing and clemency. The proposed policy reforms would help bring balance back to sentencing—crucial steps to reduce our nation’s dependence on incarceration.
“We must change the laws that have led to such unconscionable sentences,” said Turner. “For those now serving life without parole for nonviolent offenses, President Obama and state governors must step in and reduce their sentences. To do nothing is a failure of justice.”
The ACLU has placed ads online and in print to raise public awareness of the prisoners serving life-without-parole for nonviolent offenses and the larger problem of mass incarceration. Featuring photographs of six prisoners profiled in “A Living Death,” the ads will appear multiple times in print and online in such national outlets as Jet, The Nation, The New York Times, USA Today, and The Washington Post.
The report is available here:
- 8 Shocking Facts From the ACLU’s Report on Life Without Parole (nation.time.com)
- 23 Petty Crimes That Have Landed People in Prison for Life Without Parole – New ACLU report documents the disturbing growth of endless sentences. (newsforage.com)
- ACLU: Alabama 3rd in state prisoners serving life without parole for non-violent crimes (al.com)
- ACLU: more than 3,200 serving life without parole for nonviolent crimes (jurist.org)
- ACLU: Over 3,000 Prisoners Serving Life Without Parole for Nonviolent Crimes (abcnews.go.com)
According to recent news reports, the city of Edinburgh is getting tough on those who seek sensual pleasures outside of the confines of their own homes. The police have asked that condoms be banned from saunas as a way of trying to prevent sexual activity on the premises, and city Councillors have been asked to stop issuing licenses for saunas and massage parlours.
Besides being a naïve and impractical way to prevent people from having sex, there has been, unsurprisingly, a strong condemnation of such a move on the grounds of its potential negative effect on public health. The charity Scot-pep, for instance, has warned that implementing the police proposal on condoms could lead a HIV epidemic, as well as the proposal to limit establishments where sex workers can meet clients puts them at greater risk from some of the inherent hazards of plying their trade outdoors.
There has been a long history in the United Kingdom of a connection between the criminal justice system and public health. In some cases, it has been a beneficial relationship in which everything from firearms restrictions, requirements for seat belts, motorcycle helmets and child safety seats and restrictions on intoxicating substances, provide examples where the criminal justice system has been used to mitigate or prevent behaviours that are harmful to individual and population health. Nevertheless, not all intersections of criminal justice and public health are mutually beneficial. What is most notable is the distinct progression that has been made from a so-called “policing model of public health”, that often focused on ideas of moral hygiene and legal moralism, which remained influential in Britain into the 19th century, towards more social models of public health that focus on health promotion, harm reduction and social justice.
How many of us have our emergency medical information in our physical wallets? This might not be a relevant question today because patient healthcare records are stored online in this digital age.
What happens if something unfortunate occurs when one is traveling and do not have access to Internet or even a smartphone? One possible solution is to have a paper-based health card in your wallet.
But, then the health card can hold only limited information. So, what is the prioritized information that the card can hold? I can think of the following important information:
- Name, age, gender, blood group
- Family history, allergies
- Personal doctor’s contact number
- Unique healthcare Id linked to one of your unique identification cards (E.g. Election Card, Driving License, etc.)
This card works well in a scenario when the person is in an emergency situation, and someone else looks at the card and shares the information possibly to a national healthcare toll-free number (wishful thinking!) or healthcare provider referencing the unique healthcare Id.
Most wallets contain pictures of family members, identification cards, credit and debit cards, cash, and coins. In this crowded wallet, do we have room to add this important card that might save our lives?
Most important, how does the other person know the existence of this precious card in our wallet?
Few links are shared below to enter your healthcare information, download, and print the health card:
- Medicine Wallet Card – http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/safemeds/walletform.html
- Health Information Document – http://www.health.ny.gov/publications/0972.pdf
- Get My Health Card – http://www.getmyhealthcard.org/index.php/get-my-card
- Free Emergency Medical ID Wallet Card Generator (myfrugalsavings.com)
HUNTSVILLE, TX (11/13/13) — The Crime Victims’ Institute (CVI) at Sam Houston State University initiated a new series of reports to help victim advocates translate the latest research in the field into practical services and resources for victims, beginning with a study on firearms and intimate partner violence.
The report provides a summary of laws and policies that can be used to better protect victims of domestic violence.
In 2012, 114 women were killed by current or former intimate partners in Texas. Sixty percent of these victims were killed with firearms, and many of the incidents resulted in the death or injury of bystanders, including children.
Research has consistently demonstrated a link between firearms and lethal intimate partner violence. One study showed the most significant factor for predicting homicide in domestic violence cases was gun ownership by the abuser. Another study found that women living with a gun in the home have a significantly higher risk of being murdered, and that risk is 20 times higher when there is a history of abuse combined with gun ownership.
To protect victims of domestic violence, several laws and policies have been enacted. They include:
- The federal Gun Control Act of 1968 makes it illegal to purchase or possess firearms or ammunition by a person who has been convicted of a felony, who is the subject of a protective order, or who has been convicted of misdemeanor domestic violence.
- For protective orders to fall under this federal law, several factors have to be met, including a qualifying relationship, a hearing process, and a specific prohibition against the threat or use of force against the petitioner or child. There is an exception for government employees who use firearms to perform their duties, such as law enforcement officers or military personnel.
- Under the Lautenberg Amendment of 1996, the weapons prohibition was added to the federal law for a misdemeanor domestic violence conviction. Under this provision, the charge must include the threat or use of physical force or a deadly weapon against a spouse, co-habitant, parent or guardian. The law is retroactive, there are no exemptions for those who use weapons in their official duties, and the ban on gun ownership is effective for a lifetime.
- Texas law is similar to federal statues, but also prohibits concealed handgun licenses.
- Several Texas judges have required the surrender of firearms in domestic violence cases, verification of compliance by county attorneys, and notification of victims if weapons are returned. Many of these steps are identified in Texas Family Violence Bench Book.
- A manual published by the National Center on Protective Orders and Full Faith & Credit, “Enforcing Domestic Violence Firearms Prohibitions,” includes a firearms checklist for advocates, law enforcement, prosecutors and judges. It is available at http://www.fullfaithandcredit.org.
- As part of safety planning, advocates should discuss issues with victims about the ownership or use of weapons by the abuser.###
A copy of the report is available at http://www.crimevictimsinstitute.org/publications/.
- Putting research into practice on firearms and domestic violence (medicalnewstoday.com)
- Study: Doctors undertrained on diagnosing domestic violence injuries (kmov.com)
- Contextualizing Domestic Violence (beyondbinaries.org)
- Study: Domestic Violence Stays In Families Through Generations (houston.cbslocal.com)
- Speaking up to stop domestic violence (wpri.com)
- Study: Domestic Violence Costs Tennessee Nearly $1 Billion Annually (wreg.com)
- Every Domestic Violence Survivor Deserves Safe Housing (washingtonlegalclinic.wordpress.com)
- Survey Finds Significant Link Between Chronic Health Conditions and Domestic Violence (prnewswire.com)
Local health departments (LHDs) can play pivotal roles in U.S. communities by helping to link people with medical services and assuring access to care when it is otherwise unavailable. However, a new study in the American Journal of Preventive Medicine finds that many LHDs aren’t able to meet these goals, which could spell trouble for the uninsured and underinsured.
“Our report shows that in 2010, about 28 percent of LHDs had not conducted any of the three targeted activities in our study,” which looked at how LHDs assessed gaps in care, increased access to health services and used strategies to meet the health needs of the underserved, said lead author Huabin Luo, Ph.D, former research fellow with the Centers for Disease Control and Prevention and assistant professor in the department of public health at the Brody School of Medicine at East Carolina University.
In recent years, deep funding cuts have impacted local health departments. For example, between 2008 and 2009 alone, over 23,000 LHD jobs were eliminated. This combined with an increase in demand for health care services can mean an increase in health disparities for those who rely on community health care.
The study found that LHDs with larger budgets in bigger population centers were more likely to provide access to health services compared to smaller LHDs with fewer financial resources, where they may be needed more.
Hanen noted that as health insurance coverage becomes more widespread, LHDs will continue to identify and link people without health insurance to programs that provide health care services. “It cannot be overstated enough that poor housing, education, low income, unemployment and lack of transportation in a neighborhood are all interconnected and are all factors that determine health.”
- Cuts to Local Health Departments Hurt Communities (publichealthwatch.wordpress.com)
- Health cuts hurt inspections, but flu programs OK (news-journalonline.com)
- Health department warns of scam targeting restaurants (wkyt.com)
- Erie County Council discusses merging health, human services departments (goerie.com)
Yes to Calories on Menus, No to Soda Limits
Most Americans (69%) see obesity as a very serious public health problem, substantially more than the percentages viewing alcohol abuse, cigarette smoking and AIDS in the same terms. In addition, a broad majority believes that obesity is not just a problem that affects individuals: 63% say obesity has consequences for society beyond the personal impact on individuals. Just 31% say it impacts the individuals who are obese but not society more broadly.
Yet, the public has mixed opinions about what, if anything, the government should do about the issue. A 54% majority does not want the government to play a significant role in reducing obesity, while 42% say the government should play a significant role. And while some proposals for reducing obesity draw broad support, others are decidedly unpopular.
(The survey was conducted before the Food and Drug Administration’s proposal last Thursday to severely restrict trans fats nationwide.) 1
- When should we start addressing obesity in America? (consumersresearch.org)
- Roadmap to treat adults affected by obesity, overweight (medicalnewstoday.com)
The International Diabetes Federation released a report Thursday that said that 10% of the global population will have diabetes by 2035.
The report, which was released on International Diabetes Day, said that 382 million people will have diabetes by the end of this year, and that 592 million will be diabetic by 2035, CBS news reports. Many of those millions will be living in developing countries.
The IDF report also estimates that the percentage of diabetic Americans will jump from 8% to 11% by 2035. One person dies from diabetes every six seconds, which amounts to 1.5 million annual deaths.
IDF points out that the number of people with diabetes, especially the Type 2 form, has increased in every country. The number of total diabetes cases have increased 4.4 percent over the last two years, now affecting more than 5 percent of the global population.
“We haven’t seen any kind of stabilizing, any kind of reversal,” Leonor Guariguata, an epidemiologist and project coordinator for IDF’s Diabetes Atlas, said to Businessweek. “Diabetes continues to be a very big problem and is increasing even beyond previous projections.”
According to the report, despite better treatments and improving education strategies, the battle to protect people from diabetes and its complications “is being lost.”
Dr. Juliana Chan, a professor of medicine and therapeutics at the Chinese University of Hong Kong, told the BBC that in China, she feels the rising rates of diabetes are due to different genetic, lifestyle and environmental factors not helped by the fact that the country is becoming modernized rapidly.
China had the highest total number of citizens with the disease, with an estimated 98.4 million to be diagnosed by the end of 2013.
“It is typically an ageing disease, but the data shows that the young and middle-aged are most vulnerable. It is prevalent in obese people but emerging data suggests that for lean people with diabetes the outcome can be worse,” she explained.
- One in Ten People Could Suffer from Diabetes by 2035, Reveals Report (medindia.net)
- Diabetes: Asia’s ‘silent killer’ (bbc.co.uk)
Whether one is for or against all or parts of Obamacare, surely, we as a country can do better in providing needed health care to the poor, especially the poorest of the poor.
…For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn’t afford bus fare to a dermatology appointment. We sometimes pay for our patients’ medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country’s response to this problem has, at times, seemed toothless.
In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure was recently evaluated in the clinic. She couldn’t afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn’t possibly pay.
However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it’s a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can’t confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated.
- With no insurance, he used enemas to treat colon cancer. Now he’s going to die. (americablog.com)
- Healthcare Costs Driven By High Device, Drug Prices: Researchers (huffingtonpost.com)
Although a number of my posts voice my concerns about “Big Pharm”, I still get an annual flu shot and keep up with vaccines.
Why? Overall I believe they are good public health measures. Still believe in herd immunity and my responsibility to others.
From the 14 November 2013 post by at KevinMD.com
(Please read the comments also for good additional information.)
Dr. Google, you’ve let a whole lot of people down.
If you Google a vaccine question, and many parents have, you’re very likely to find a good, science-based answer — but it will be buried among dozens of sites with anti-science, pro-disease propaganda. The mountain of misinformation is staggering, with multiple anti-vaccine sites repeating each other in a seemingly endless loop of worry and dread. Let neither facts nor truth nor glimmer of honesty stay them from the swift completion of their self-appointed fear mongering rounds.
Fortunately, there are ways to make sure you’re getting reliable answers to your questions.
Start with the CDC’s vaccine home page, which leads to comprehensive information about just about any vaccine health topic.
Prefer an academic center over a government site? The Children’s Hospital of Philadelphia (perhaps the best children’s medical center in the world) has their own very comprehensive vaccine site, and even their own vaccine information app.
Looking for a more global view? Try the World Health Organization’s vaccine page.
Willing to put up with a little snark? Several good science bloggers frequently discuss vaccine topics, no holds barred, and end up with some robust back-and-forth in the comments. Try Respectful Insolence, The Skeptical Raptor, or Neurologica.
Finally, if what you’d like is a meta-search that looks at only the best vaccine information sources, and weeds out the crap, try this science based vaccine search engine.
Parents don’t have the time to wade through the idiocy — they want real, genuine information to help make decisions. Google won’t do that for you, but these links will.
Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.
This author is spot on in addressing a real problem: these mercola-type internet sites are very harmful. They have the right to free speech but we must combat what is clearly destructive and unsubstantiated ‘health’ information. These sites have found a niche and strike a nerve for a lot of people who have come to the realization that western medicine doesn’t always have a cure for what ails them.
These sites play off this reality and work to trump up a sense of conspiracy which we as humans seem to have a weakness for.
Some people are distrustful of major ‘government’ websites like CDC.
On my site, I am honest about each vaccine’s effectiveness and potential side effects. I also explain why I support their use, one at a time:
I hope it helps
- May Wright Along the same lines: what would be handy for people who want to try to refute anti-vaccine memes on social media (FB, Twitter, blogs) is a resource page which features some of the most popular “arguments” against vaccines, all in one place, and then has links to science-based refutations on various sites. So, for instance, it would have the meme I saw doing the rounds of Facebook this morning, that “Gardasil has killed and injured more women than the disease it’s meant to protect!!11!!”, or the one about “I’m not injecting aborted fetuses into my baby, #ProLife SAY NO TO VACCINES!!” and then a few links to credible sources of information which provide the relevant facts?
Maybe such a page or site already exists, if so I’d love a link to it.
- Vaccinations, “For the Greater Good” (vaccinesforchildren.wordpress.com)
- Vaccines: how they work & why they’re important (wgno.com)
- Homecoming week offers flu vaccine for first time (digitalbullpen.com)
[Journal Article] Public Engagement with Biotechnologies Offers Lessons for the Governance of Geoengineering Research and Beyond
In this paper, we reflect on our involvement in one of the first major research projects in the emerging area of geoengineering (the deliberate intervention in the planetary climate). The project, Stratospheric Particle Injection for Climate Engineering (SPICE), proposed an outdoor experiment that attracted substantial public scrutiny despite a strong consensus that the experiment posed no direct environmental risk. A programme of stakeholder engagement took place that sought a deep understanding of the views about the proposed experiment. The lessons from this experiment build on insights from public engagement with the biosciences and biotechnology. In particular, we see the importance of questions of context and purpose for scientific research. This has important implications for the governance of geoengineering research. Efforts to detach areas of research from public scrutiny by using thresholds, whether these are drawn at a particular level of environmental effect or at the doors of a laboratory, will encounter problems of public credibility. Geoengineering is unavoidably entangled in a political discussion that scientists should seek to understand and engage with.
The progress of biotechnology brings the potential for ever more intimate and disruptive interventions into human bodies and the natural environment. As previous papers in this series have described, there have been various attempts, especially in the last decade, to improve engagement between scientists and public groups on issues involving biotechnology . Engagement exercises, whether with particular non-science stakeholders or members of the general public, reveal layers of societal concern with these technologies. There is typically concern with the eventual downstream risks and the ethical implications of technologies. But these things are hard to assess in advance due to the profound uncertainty that surrounds emerging technology. Public engagement typically also reveals a set of “upstream” concerns.
When brought into dialogue about emerging technologies, before it is clear what the risks are likely to be, members of the public will typically express concern about the trajectory of technological pathways. A report of one large public dialogue exercise on Synthetic Biology drew out five questions for scientists that characterised public concerns about this nascent technology:
- What is the purpose?
- Why do you want to do it?
- What are you going to gain from it?
- What else is it going to do?
- How do you know you are right?
These questions get to the heart of the politics of emerging technologies and the foundations of public trust in scientific research. Conventional technology assessment considers the downstream products of research and innovation with a focus on technological risk and ethics. More recent anticipatory governance approaches, such as “constructive technology assessment” , “real-time technology assessment” , and “responsible innovation” , attempt to broaden the debate to include consideration of the processes and purposes of research, in line with the five questions above. Such approaches emphasise the importance of democratic deliberation in “opening up” the technological options and trajectories for appraisal. Geoengineering in general and the SPICE project in particular have become important test cases for this new mode of governance .
- New Study: ‘Geoengineering to Cause Drought Worldwide’ (intellihub.com)
- Retooling the Planet: The False Promise of Geoengineering (resilience.org)
- We Don’t Geoengineer the Planet But We Have to Continue! (freeasthysweetmountainair.wordpress.com)
- Playing God: 4 Geoengineering Projects Doomed To Fail While Polluting The Earth (wakingtimes.com)
- Climate Change and Geoengineering (therebel.org)
- Strange Bedfellows? Climate Change Denial and Support for Geoengineering (yaleclimatemediaforum.org)
Seems to be a very humane law, even though it is controversial.
Oklahoma House Bill 1782 allows a medical provider to prescribe naloxone to a family member of someone who has a chance of overdosing. The drug helps restart breathing of someone who has overdosed.
Gail Box said she knows it can be difficult for parents to have conversations with their children about drug use.
But parents should consider talking to their children and also carrying naloxone if they think it could help save their children’s lives, she said.
“I wish, if I could go back, I would try to act on those feelings that I had at that time,” she said. “You can tell me anything you want, but I will always shoulder a great deal of guilt as a result of what happened to my son because as a parent, as a mother, it’s my job to protect him, and I didn’t.”
“There are people who have complete unintentional overdose who think they’re taking the right amount of pain medication, or they legitimately have a prescription but it’s not working so they take a little bit more,” White said. “This can also be critical in saving lives of people who are trying to use their pain medication appropriately.”
The law comes at a time when Oklahoma continues to see high rates of prescription drug abuse and overdose deaths.
Oklahoma ranks among the top five states with the highest rate of prescription overdose deaths. And prescription drug abuse is one of the fastest growing types of drug abuse in the state.
Prescription drug overdoses kill more people in Oklahoma than car accidents.
Oklahoma leaders plan to release the state’s strategy for combating prescription drugs in the next few months.
“It’s really good that we’re addressing this now as opposed to 10 years from now,” White said.
Before House Bill 1782 passed, naloxone was carried on many, if not all, paramedic ambulances and fire engines across Oklahoma, said Dr. Jeffrey Goodloe, the medical director for the emergency medical services system for Oklahoma City and Tulsa metros.
However, the law expands who can administer the drug. That’s where Goodloe’s concern comes in. Goodloe said he’s concerned about whether people who aren’t trained in medicine, such as law enforcement officers, will be able to deliver the drug appropriately.
“The first tenet of medicine … is do no harm, so in the process of helping people, we take an oath not to purposely harm them, and my concern with this bill is that, while its intent is nothing but admirable, the end result is I truly believe we will harm some people in fully executing its authority in the commission of trying to help people,” Goodloe said.
Goodloe said when people are given naloxone, they can wake up into a life-threatening withdrawal situation, suffering from horrific vomiting, extreme sweating and dangerously high heart rate and blood pressure.
Not every person given naloxone will go into this type of withdrawal, he said. However, it does occur.
- [Press Release] Prescription Drug Abuse: Strategies to Stop the Epidemic (jflahiff.wordpress.com)
- Oklahoma ranks 5th in drug overdose, expert explains how to lower that rank (kfor.com)
- Report says states are failing to curb prescription drug abuse (wqad.com)
- NM senator takes on prescription drug abuse (kansascity.com)
- Five more laws to help stop Maine’s prescription drug epidemic (bangordailynews.com)
- Prescription drug legislation unveiled (krqe.com)
- Report: W.Va. has highest rate of fatal overdoses (kansascity.com)
Imagine that you have not eaten anything for the past few hours. It is almost lunch time, and you are getting hungry. You receive an email. It is a survey asking about your political position regarding the welfare state. You answer the questions quickly and head off to lunch. Now imagine a different scenario. You have just come back from lunch. You are feeling full, as you sit down in front of your computer. You receive the same email. You answer the survey quickly and then get back to work. Do you think your answers in these two scenarios would be the same — or different?
- Learning from the 50 Worst Charities (lstarkblog.wordpress.com)
Americans donate over $300 billion annually to nonprofits, averaging about $1,000 per person. We feel good when we give to our favorite charities. At the same time, philanthropy is broken, and almost everyone knows it.
The causes that receive the most donations are not typically the ones that make the greatest impact. Instead, the personal whims and preferences of donors determine where dollars flow. People pick charities based more on reputation and trust than proven effectiveness. Many donors do not know how to define a “high performing” nonprofit, let alone how to identify one or assess whether there are more worthy charities. Donors respond to inspirational anecdotes in professionally-written fundraising material rather than asking for meaningful evidence of performance; simultaneously, they express concerns about high overhead costs and program effectiveness. Philanthropy is broken, and it needs to be reinvented.
But how? There are three key areas that can create a domino effect of improving charitable giving.
1. There must be greater honesty about charitable giving.
You Are More Inclined to Help the Poor, When You Need Calories (understandcancerin60minutes.wordpress.com)
- When your body needs calories, you’re more inclined to help the poor (scienceblog.com)
- When your body needs calories, you are more inclined to help the poor (eurekalert.org)
- When your body needs calories, you are more inclined to help the poor (chimac.net)
- Hunger Makes Humans More Charitable (counselheal.com)
- Learning from the 50 Worst Charities (lstarkblog.wordpress.com)
[News article] More Research Needed Into Substitution Principle and Regulation of Potentially Hazardous Chemical Materials, Experts Urge
Professor Ragnar Lofstedt, Professor of Risk Management and the Director of the King’s Institute for Risk Research, King’s College London and Editor of the Journal of Risk Research, has published a paper suggesting that the substitution principle is not the “white knight” as described by a number of regulatory agencies and NGOs and proposes that chemical substitution can only work effectively on a case-by-case basis.
The paper, published in the Journal of Risk Research, highlights how the Chemical Substitution Principle (where a potentially harmful chemical used in manufacturing or industry, is substituted for less dangerous alternative) has grown in popularity with chemical governing bodies and organizations in recent years. It highlights how a number of bodies are currently working on ‘substitution databases’ to aid companies in reducing the amount of harmful chemicals they use. The paper draws on three key case studies and states that the chemical substitution principle is a ‘blunt and imprecise regulatory instrument’ that is ‘surprisingly under-researched’ and ‘in need of further rigorous academic and regulatory analysis before it can be further used and promoted satisfactory in the chemical control area.’
Lofstedt uses evidence discussed in the paper to make recommendations for the future use of the chemical substitution principle, including the abolition of numerical targets set by regulatory bodies such as the European Chemical Agency for listing chemical substances of very high concern (SVHCs), and that, if the substitution principle is to be properly implemented, there is a need to do ‘comparative risk evaluations or risk-ranking exercises, to uncover how great the risk profile of the chemical in question actually is’.
The paper further suggests that greater support for evidence-based substitution and academic research into the scientific underpinnings of the chemical substitution principle is needed, along with a need for clear case studies and scientifically informed debates to help politicians become better informed about the pros and cons of the substitution principle.
- OSHA Releases New Resources to Help Employers Protect Workers from Hazardous Chemicals (workers-compensation.blogspot.com)
- The Future of the Toxic Substances Control Act: A Look at How Reform is Measuring Up (gielr.wordpress.com)
- Making regrettable substitution a thing of the past (blogs.edf.org)
- Stand Up For Safer Chemicals (workers-compensation.blogspot.com)
- Toxic Chemical Reform Must Help, Not Hinder, States and Victims’ Rights (huffingtonpost.com)
- EPA Web Tool Expands Access to Scientific, Regulatory Information on Chemicals (jflahiff.wordpress.com)
- [Repost] Getting Real About Chemical Risks (jflahiff.wordpress.com)
The twitter chat was last year, still I’m posting this timely topic. Because it is that, timely.
From June 19, 2012 PLoS Medicine have a new main series of seven articles on the next three weeks , titled “Big Food” , which examines the impact of the food and beverage industry in public health. An argument between PLoS and guest editors in new product launches reports writing the series in the fact that multinational food and beverage not been adequately discussed or raised skepticism regardless of their growing impact on the program global health and its role in the obesity crisis .According to the editors of PLoS Medicine :
” The food , unlike snuff and drugs, is necessary for life and is essential for health and disease , however, large multinational food companies control what people eat around the world , resulting an austere irony and sick . D’ billion people on the planet go hungry , while two billion are overweight or obese . “
The major food and beverage companies also play an important role in the global health scenario re -branding their companies as ” nutrition companies ” and market their people as experts in malnutrition , obesity . and even poverty in major conferences and meetings of the United Nations – but its main purpose is to improve profitability through the sale of food editors and posed the question: “Why do the global health community is this acceptable and how those conflicts play out ? “The series is three weeks to address these issues and discuss the role of food industry in the field of health.
Marion Nestle of New York University and David Stuckler of the University of Cambridge , the two guest editors of the series of the journal PLoS Medicine that the public health response created Food great so far as a “failure ” and state ” public health professionals must recognize the influence of the great food in the world food system is a problem, and take steps to reach a consensus on how to engage critically … [which ] alsoshould be given high priority to nutrition as they do on HIV , infectious diseases and other health threats . “
Nestler and Stuckler follow:
“They should support initiatives such as the restrictions on marketing to children , improved nutrition standards for school meals , and taxes on sugary drinks. The public health approach should be non-profit in alignment with Great Food public health goals . Without a concerted direct action to expose and regulate the interests of Great food , epidemics of poverty , hunger and obesity are likely to be more acute . “
The editors invite readers to join the debate on Twitter ( hashtag # plosmedbigfood ) and invite comments on your articles to be published over three weeks since the June 19, 2012 and collected http://www.ploscollections.org / Bigfood
People can join a chat on Twitter Wed 27 June at 13:00 ET .
Food Industry Needs Closer Monitoring By Public Health Authorities
Industry, diet, weightloss, slimming, Monitoring, Food, Authorities, health, Closer, fitness, Public Health
- Taiwan’s clumsy food safety response not fixing the root problem (wantchinatimes.com)
- Trans Fats: As Goes NYC. . . (wnyc.org)
- We Are What We Eat (bizgovsoc9.wordpress.com)
- Want to stop hunger? Shift the food industry to plant-based foods (dailykos.com)
- Will GM Labels Make Food Industry Ill? – Bloomberg (bloomberg.com)
I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong diagnosis… There is one “magic” question that you should be asking your physician(s):
“What else could this be?”
This very simple question about your condition/complaint can be extremely enlightening. Physicians are trained to develop extensive “differential diagnoses” (a list of all possible explanations for a set of signs and symptoms) but rarely have time to think past possibilities 1 through 3. That’s one of the reasons why so many patients have the wrong diagnosis – which is both costly in terms of medical bills, time, and pain and suffering.
There is a risk in asking this question – you don’t want to be over-tested for conditions that you are unlikely to have, of course. But I maintain that the cost/risk of living with the wrong diagnosis far exceeds the risk of additional testing to confirm the correct diagnosis. So my advice to patients is to keep this very important question in mind when you see your doctor for a new concern.
- Better tests needed to improve patient care, public health (medicalnewstoday.com)
- Mistakes even good doctors make (consumerreports.org)
- Hypochondriacs Rejoice: WebMD is Beefing Up Its Real-Life Doctor Support (betabeat.com)
- Admit when you fall short: The power of “I don’t know” (kevinmd.com)
International Council on Clean Transportation / by Sarah Chambliss, Josh Miller, Cristiano Façanha, Ray Minjares and Kate Blumberg
[Green Car Congress] Although many countries have adopted emission control regulations patterned on the European regulations, the significant majority of these have not implemented the latest and most stringent Euro 6/VI stage. A study by a team at the the International Council on Clean Transportation (ICCT) finds that if that lag persists and present trends in vehicle activity continue, early deaths from vehicle-related PM2.5 exposure in urban areas will increase 50% by 2030, compared to 2013.
Conversely, the report finds, if all countries were to follow an accelerated roadmap to Euro 6/VI-level regulations, in tandem with fuel-quality regulations limiting sulfur content to 10 to 15 parts per million (ppm), early deaths globally from road vehicle emissions would fall by 75% (200,000) in the year 2030, representing a cumulative savings of 25 million additional years of life…
- ICCT report finds global implementation of advanced emissions and fuel-quality regs could cut early deaths from vehicle emissions by 75% in 2030 (greencarcongress.com)
- Tsinghua study concludes existing regulations for diesel trucks and buses insufficient to reach NOx reduction target by 2015 (greencarcongress.com)
- MIT Study: Vehicle Emissions Cause 58,000 Premature Deaths Yearly in U.S. (dc.streetsblog.org)
- Study finds biodiesel use in HD trucks in Canada will result in very minimal changes in air quality and health benefits (greencarcongress.com)
- Five Bad Arguments From the Coal Industry – Bloomberg (bloomberg.com)
- Region to implement new law on fuel sulphur emissions in 2015 (theeastafrican.co.ke)
- Lawsuit Accuses EPA Of Not Doing Enough To Regulate Toxic Soot (thinkprogress.org)
- Air pollution death rate up in half of boroughs (standard.co.uk)
- Air pollution death rate up in half of London boroughs (standard.co.uk)
Just had to repost this. Last week at the Area Office on Aging (where I volunteer 6 hours or so a week), one of my clients was a 70 year old woman. She voiced much of what the woman below said, including feeling unwelcome. And this after 30+ years with the company! Maybe all workplaces should have time to read and discuss the article below…Multigenerational Teams Work best.
Thank you Marti Weston, thank you.
Last Thursday, on the Washington DC Metro, a woman sitting in front of me spoke to a seat mate about ageism, a term first coined by Dr. Robert Butler, the first director of the National Institute of Aging (NIA).
As I eavesdropped, the woman on the Metro spoke about comments from younger colleagues, the tendency of some to roll their eyes when she speaks, and remarks about her retirement, still about five years away if she waits until she is 65. “I feel so unwelcome,” she commented,” that sometimes I make jokes about my own retirement just to counteract what I hear.”
Yet as the conversation went on — my apologies for listening in — it was clear that this woman loved her job and was engaged in her work. Lots of people in their late 50s and 60’s can identify with this situation.
So I read with interest the November 10, 2013, Washington Post article, In an Era Plagued by Ageism, NIH Prizes Older Workers. Written by Post reporter Tara Bahrampour, the report details how the National Institutes of Health (NIH) has created a work environment that accepts — and even celebrates — its older and veteran staff members. The article also includes a link to the AARP 2013 list of best employers for people over age 50.
A Few Interesting Excerpts
- This year, NIH topped AARP’s list of best employers for workers over 50, based on criteria including career development opportunities, workplace accommodations, flexible scheduling, job sharing and other employee benefits.
- NIH offers perks with particular appeal for older employees, including flexible work schedules, generous telecommuting policies, opportunities to mentor younger workers and fitness programs geared for older bodies.
- The benefits were not part of a master plan but rather something that evolved, said Phil Lenowitz, deputy director of NIH’s office of human resources.
- A big draw for scientists such as Waldmann is the ability to view a project in terms of decades, rather than years.
Read the entire article to learn much more.
A Few More Links Where You Can Learn About Ageism
- Dr. Robert Butler, Founding Director of the National Institute on Aging - July 2010, AsOurParentsAge
- Multigenerational Teams Work Best - June 2011, AsOurParentsAge
As summed up by Marti -
Two broad reasons that a variety of age groups work together well and produce better results are:
- Every generation has its blind spots so the different ages and perspective help to avoid problems and compensate for them.
- Each generation can shine based on individuals’ experience.
- Ageism in Action – September 2013, Huffington Post,
- Readers Offer Tales of Silicon Valley Ageism – August 2013, SF Gate (San Francisco Chronicle)
- Ageism and Millennials – Part I and Part II - Dr. Bill Thomas’ Changing Aging blog
- Ageism in America – 2006, A PDF of a comprehensive report published by Dr. Robert Butler and the International Longevity Center (also founded by Dr. Butler).
- Raising Awareness about Ageism through Art ! (sharingconnection.wordpress.com)
- Ageism in the Workplace: A Growing Issue (mtannler.wordpress.com)
- Ageism: the Silent Killer (veteranstoday.com)
- Why the Tech Industry Needs to Deal With Its Ageism Problem (simplicity.laserfiche.com)
- Tapping into the Creative Potential of our Elders (3quarksdaily.com)
- Why Old Age Is Really Not For Sissies (agelessmarketing.typepad.com)
- Ageism: Its Effect On Seniors (awalker20099.wordpress.com)
[Magazine Article] Can the Defense Budget Shrink Without Risking National Security? (and yes, this is a public health issue)
Why is this related to public health? Because wasteful and duplicate military spending is a drain on the economy. Some of the duplicate spending could be spent in areas affecting public health as public transportation, basic health care, and education.
Of all the services that critics complain the Pentagon needlessly duplicates—from schools and rec centers to scientific research and grocery stores—the most expensive is health care. Ten percent of the Pentagon’s non-war budget—$53 billion—goes to health care. As with civilian health care, savings are achievable here but face implacable opposition from military retirees. But as no less a military enthusiast than John McCain said last year on the Senate floor, “We are going to have to get serious about entitlements for the military just as we are going to have to get serious about entitlements for nonmilitary.”
Fortunately, there are ways to cut defense spending without hurting military capabilities. Besides maintaining its war-fighting capability, DoD, like any entity, maintains a back-office bureaucracy to oversee its business functions. That overhead accounts for roughly 40 percent of its budget. It’s hard to compare different industries, or even government agencies, but one examination of 25 industries showed average overhead rates ranging from 13 to 50 percent, with the average across all industries being 25 percent. A RAND study of overhead and administration costs among defense contractors found them to be “tremendous drivers” of weapon costs at 35 percent. The largest domestic programs—Social Security and Medicare—get by with costs in the single-digits.
Cutting Pentagon overhead to the average would save roughly $80 billion a year. Looked at another way, the department employs 800,000 civilians. Not only is that more than the population of four states, it’s not quite half of all civilian federal employees, more than twice as many as the next-largest agency (Veterans Affairs), four times the number of civilian employees at the Department of Homeland Security and basically the size of all the remaining federal agencies combined. Think there might be some savings possible there?
- How to Cut Defense Spending Without Hurting the Military (defenseone.com)
- Pentagon leaning toward cutting troops, beefing up tech (stripes.com)
- Military Must Do More With Less (fortunascorner.wordpress.com)
- Ralph Nader: Giant Pentagon Budget Is Unauditable Year After Year (huffingtonpost.com)
- Pentagon offset budget cut impact in key areas -watchdog (reuters.com)
..Taking trans fats off the GRAS list won’t remove them from the food supply. Manufacturers can still petition the FDA for exceptions. But it goes a long way toward getting them out.
what the announcement really shows is how public health works: slowly, based on mounting scientific evidence, against constant and mounting headwinds of public ridicule and, much more important, industry lobbying and advertising.
..Companies seldom change unless they have to, which they say means unless consumers ask them to. If you don’t want trans fats or gluten or genetically modified organisms, fine with us! Just tell us with your food dollars! This is of course a way of saying that they don’t want government telling them what to do, and gives them a chance to shape the public opinion they say they simply obey, with millions of dollars in ad campaigns and lobbying.
The lesson, though, is not that the public shouldn’t trust science, because one year’s saturated-fats-are-evil message will eventually become next year’s hey-butter-is-great-when-you-look-at-Crisco. The road to strong public recommendations isn’t clear, as scientific research is slow and zigzags. Both food makers and scientists can be guilty of jumping the gun, depending on what they think they can sell or who they can get to fund big studies and endowed chairs.
The analogy I’m building toward is, of course, sugar-sweetened drinks. Scientific consensus has built to practically the bursting point that sodas make kids fat. Soda makers deride the officials who try to do something about it, and work as hard as they can to cast doubt on science. Mayor Bloomberg, though fairly trim, was their fattest target, in the Mrs. Doubtfire costume they dressed him up in when he tried to impost a portion limit on sodas in restaurants and movie theaters. Now that he’s leaving, they’ll find another target.
But opinion will change, national bodies start to fall into line as they did on trans fats and are doing with sugary drinks. The most outspoken enemies of sugar, like Robert Lustig, are trying to take it off the GRAS list–something that CSPI petitioned the FDA to do last February, asking it to study and determine safe levels of high-fructose corn syrup. The chance of an FDA announcement of that in six years seems pretty unlikely now. But soda makers already have more than dozens of low-sugar and sugar-free drinks: they have scores and scores of them. They’ve quietly been working to solve the problem, while spending (often literally) untold sums not to risk their core products. The advocates against trans fats who seemed so crazy even six years ago, when the New York trans fat ban went into effect, are seeming a lot less crazy today.
- NYC’s Bloomberg led the way on trans fats ban (miamiherald.com)
- Trans fat doesn’t stir much ‘nanny state’ debate (fngnutrition.ca)
- FDA’s Proposed Trans Fat Ban: An Attack on Freedom (heritage.org)
- No more trans fat: FDA banning the artery-clogger (webpronews.com)
- No more trans fat: FDA banning the artery-clogger (conservativeread.com)
- FDA to ban trans fats (cbs6albany.com)
- Trans Fat Ban?; Bullying and Bonding; Ask an Astronaut (wnyc.org)
- FDA To Ban Trans Fats (nycfitfoodfashion.com)
[Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospitals
A few years ago, I was working on a strategy for improving the quality and safety of VA healthcare. As part of this effort, I called up senior quality leaders of major healthcare organizations across the nation. One call is particularly memorable. Because I promised anonymity, I will not name names but this clinical leader was very clear about his responsibility: every month, he met with his CEO, who began the meetings with three simple questions: “How many patients did we hurt last month? How many patients did we fail to help? And did we do better than the month before?”
The CEO and the entire hospital took responsibility for every preventable injury and death that occurred and the culture of the place was focused on one thing: getting better. When I looked them up on Hospital Compare, they too had excellent outcomes and they regularly get “A” ratings for patient safety from the Leapfrog Group.
How do the BIDMCs and these other super-high performers pull it off? How do they build a culture of quality when so many organizations seem to struggle? High performance is complex, of course, and I won’t try to be overly simplistic. But a few things seem common among many high performing institutions. They seem to be focused on three things: timely, clinically relevant outcomes data; transparency within (and usually outside) the organization; and a constant focus on getting better.
You can see the kinds of data that BIDMC posts on its website – it’s not just the standard Hospital Compare stuff (which everyone has to do) but other data on a series of outcomes which are not required. When I hear Kevin Tabb, their current CEO talk about quality – it’s obvious that quality is not a platitude. He is genuinely focused on getting better.
So what’s the lesson from BIDMC, Mayo and other high performing institutions? There is no substitute for great leadership. Each of them seems to have been blessed with leaders who, despite all the wrong incentives in the healthcare system, prioritize patient care and drive their organizations to great performance. They are internally motivated and do all the things I describe above, despite the fact that our primary payment systems incentivize them to do more, not better. They are extraordinary leaders- with not only great vision but also the ability to execute that vision.
But here’s the risk: too many policymakers believe that all we need to do is figure out what BIDMC or Mayo or Kaiser does and just get everyone else to do it. Such an approach, while seemingly perfectly good on paper, fails to account for the human element. The strategies that they have used have been executed by individuals unusually focused on improving care. Barring substantial improvements in cloning technology, we can’t expect that each hospital will have a great leader.
We don’t expect that every technology company will have a Steve Jobs. In every industry, there are a few visionary leaders, but the rest of the organizations? They are run by mortals – and mortals respond to incentives. And here lies the problem: the incentives in the system are not motivating the typical CEO to improve care. Whatever strategy we employ around timely data, transparency, etc. won’t work until the leadership is properly motivated and focused on quality. And while that happens in pockets, it’s not happening across the entire healthcare system. And this is where we will pick up in my next blog: how to get the rest of the organizations to make quality a real priority.
Professor of Genetics Scott Williams, PhD, of the Institute for Quantitative Biomedical Sciences (iQBS) at Dartmouth’s Geisel School of Medicine, has made two novel discoveries: first, a person can have several DNA mutations in parts of their body, with their original DNA in the rest — resulting in several different genotypes in one individual — and second, some of the same genetic mutations occur in unrelated people. We think of each person’s DNA as unique, so if an individual can have more than one genotype, this may alter our very concept of what it means to be a human, and impact how we think about using forensic or criminal DNA analysis, paternity testing, prenatal testing, or genetic screening for breast cancer risk, for example. Williams’ surprising results indicate that genetic mutations do not always happen purely at random, as scientists have previously thought.
His work, done in collaboration with Professor of Genetics Jason Moore, PhD, and colleagues at Vanderbilt University, was published in PLOS Genetics journal on November 7, 2013.
Genetic mutations can occur in the cells that are passed on from parent to child and may cause birth defects. Other genetic mutations occur after an egg is fertilized, throughout childhood or adult life, after people are exposed to sunlight, radiation, carcinogenic chemicals, viruses, or other items that can damage DNA. These later or “somatic” mutations do not affect sperm or egg cells, so they are not inherited from parents or passed down to children. Somatic mutations can cause cancer or other diseases, but do not always do so. However, if the mutated cell continues to divide, the person can develop tissue, or a part thereof, with a different DNA sequence from the rest of his or her body.
f our human DNA changes, or mutates, in patterns, rather than randomly; if such mutations “match” among unrelated people; or if genetic changes happen only in part of the body of one individual, what does this mean for our understanding of what it means to be human? How may it impact our medical care, cancer screening, or treatment of disease? We don’t yet know, but ongoing research may help reveal the answers.
Christopher Amos, PhD, Director of the Center for Genomic Medicine and Associate Director for Population Sciences at the Cancer Center, says, “This paper identifies mutations that develop in multiple tissues, and provides novel insights that are relevant to aging. Mutations are noticed in several tissues in common across individuals, and the aging process is the most likely contributor. The theory would be that selected mutations confer a selective advantage to mitochondria, and these accumulate as we age.” Amos, who is also a Professor of Community and Family Medicine at Geisel, says, “To confirm whether aging is to blame, we would need to study tissues from multiple individuals at different ages.” Williams concurs, saying, “Clearly these do accumulate with age, but how and why is unknown — and needs to be determined.”
Just as our bodies’ immune systems have evolved to fight disease, interestingly, they can also stave off the effects of some genetic mutations. Williams states that, “Most genetic changes don’t cause disease, and if they did, we’d be in big trouble. Fortunately, it appears our systems filter a lot of that out.”
Mark Israel, MD, Director of Norris Cotton Cancer Center and Professor of Pediatrics and Genetics at Geisel, says, “The fact that somatic mutation occurs in mitochondrial DNA apparently non-randomly provides a new working hypothesis for the rest of the genome. If this non-randomness is general, it may affect cancer risks in ways we could not have previously predicted. This can have real impact in understanding and changing disease susceptibility.”
- Study finds novel genetic patterns that make us rethink biology and individuality (medicalxpress.com)
- Novel genetic patterns may make us rethink biology and individuality (scooprocket.com)
- A patchwork of genetic variation found in the brain: Surprising degree of variation among genomes of individual neurons from same brain (sciencedaily.com)
- New Technique to Determine Whether DNA is from Mom or Dad (medindia.net)