Federal agencies should take advantage of opportunities to promote integration of primary care and public health
WASHINGTON — The traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of ensuring the health of populations, says a new report from the Institute of Medicine. Integration of these fields will require national leadership as well as substantial adaptation at the local level, said the committee that wrote the report.
[ The report is free and available at http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx
The above link also includes a briefing slides (an overview) and a report brief.]
The report recommends ways that the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) could foster integration between primary care and public health through funding, policy levers, and other means. Collaboration presents an opportunity for both primary care and public health to extend their reach and achieve the nation’s population health objectives, the committee noted.
The committee’s recommendations are based on its review of published papers as well as case studies in specific cities — Durham, N.C.; New York City; and San Francisco — where integration efforts have taken place. The review showed that successful integration of primary care and public health requires community engagement to define and tackle local population health needs; leadership that bridges disciplines and jurisdictions and provides support and accountability; shared data and analyses; and sustained focus by partners.
The Patient Protection and Affordable Care Act (ACA) authorizes HRSA and CDC to launch several new programs. The agencies should coordinate these programs and funding streams with other partners at the national, state, and local levels to spur momentum. Promising opportunities include building incentives to promote interactions with local public health departments into HRSA’s funding for community health centers; encouraging hospitals to treat primary care and community health as priorities as they strive to earn federal tax exempt status through demonstrated community benefits; and fostering collaboration among health departments and community health centers to improve the provision of preventive clinical services to Medicaid recipients.
The medical home model and the new accountable care organizations (ACOs) established by ACA also offer opportunities for integration. As more primary care practices move toward the patient-centered medical home model, public health departments could work with these practices and spread the benefits of care coordination to the community, the committee said. As ACOs — groups of hospitals and clinicians that work together to provide primary care and other health care services to Medicare beneficiaries — begin operating, they should reach out to health departments to forge links to community programs and public health services.
Training primary care and public health professionals in aspects of each other’s fields will help promote a more integrated work force, the report adds. HRSA and CDC should work together to develop training grants and teaching tools that can prepare the next generation of health professionals for shared practice. For example, HRSA should use its Title VII and VIII primary care training programs to support curriculum development and training opportunities that involve aspects of public health, and CDC’s Epidemic Intelligence Service officers could assist HRSA-supported community health centers in using public health data to guide the care they provide.
“While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives, such as building both a national hospital system and an extensive biomedical research infrastructure and significantly expanding high-tech clinical capacity through investments in specialty medicine,” said committee chair Paul J. Wallace, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group, Falls Church, Va. “It’s time we did the same for primary care and public health, which together form the foundation of our population’s overall well-being. Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely.”
The report was sponsored by the Centers for Disease Control and Prevention, Health Resources and Services Administration, and United Health Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineering, and National Research Council together make up the independent, nonprofit National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
Potential market for savory, fish-oil fortified yogurts reported in the Journal of Dairy Science
From the 28 March 2012 article at Eureka news alert
Amsterdam, The Netherlands — Many consumers want to increase their intake of heart-healthy n-3 fatty acids, found naturally in fish and fish products, but find it difficult to consume the levels recommended by the American Heart Association. Scientists at Virginia Tech have demonstrated that it may be possible to achieve the suggested daily intake in a single serving of a savory-flavored yogurt, providing an easily incorporated dietary source for these valuable fatty acids. Their work is detailed in the April issue of the Journal of Dairy Science®.
“The international popularity of yogurt and the health-promoting properties associated with probiotics, minerals, vitamins, and milk proteins suggest yogurt could be an excellent vehicle for the delivery of n-3 fatty acids,” says lead author Susan E. Duncan, PhD, Professor and Director of the Macromolecular Interfaces with Life Sciences Program, Food Science and Technology, Virginia Tech. “Recent innovations in exotic yogurt flavors provide innovation opportunities. We tested different levels of fish oil in a savory chili and lime flavored yogurt, and found that a 1% concentration of fish oil, which provides more than the suggested daily intake, could be acceptable to a large proportion of the general population, and have a potential market among health- and nutrition-conscious consumers.”
In a preliminary study, tasters could not differentiate between low levels of fish and butter oils in unflavored yogurt, but they could discern yogurt flavored with oxidized fish oil, which has a strong fishy taste. A second panel underwent 6 hours of training so that they could accurately describe and measure lime, sweet, heat, acid, and oxidized flavor attributes. They found the fish flavor more pronounced than the lime and acid characteristics in a chili-lime flavored yogurt fortified with 1% oxidized fish oil, compared with yogurts containing .43% or 1% fresh fish oil. The oxidized flavor was higher in chili-lime yogurts containing oxidized fish oil and a high level (1%) of fresh fish oil.
In a second study, 100 untrained consumers who were generally nutritionally motivated and aware of the health benefits of n-3 fatty acids evaluated the overall acceptance and flavor acceptance of chili lime yogurt enriched with butter oil or fish oil. Fifty percent of the tested group rated chili-lime flavored yogurt fortified with 1% butter oil or fish oil in the positive end of the scale (“liked extremely” to “neither liked nor disliked”). Thirty-nine percent reported they would be highly likely or likely to consume the chili-lime flavored yogurt on a regular basis. The low overall acceptance of the product by the remaining 50% of the tested group may be attributed to the chili-lime flavor or the lack of sweetness in the product.
These studies demonstrate the potential for consumption of the entire suggested daily intake of n-3 fatty acids in a single serving of savory-flavored yogurt, providing an alternative and easily incorporated dietary source of these heart-healthy fatty acids.
“Innovation of unsweetened, savory flavoring in combination with the powerful health functionality of n-3 fatty acids and dairy components is of interest to a large segment of the health- or nutrition-aware population. A potential market exists for this population,” Dr. Duncan concludes.
Accidental ingestion of wire bristles has led to the need for surgery
PROVIDENCE, R.I. – Rhode Island Hospital physicians identified six cases of accidental ingestion of wire grill brush bristles that required endoscopic or surgical removal. The paper calls attention to the need for the public and physicians to be aware of this potential danger. It is published in the American Journal of Roentgenology and is now available online in advance of print.
David Grand, M.D., a radiologist in the diagnostic imaging department at Rhode Island Hospital, is the lead author of the paper. Grand explains that six patients were identified within an 18-month period who presented to the emergency department within 24 hours of ingesting grilled meat. Their symptoms were odynophagia (painful swallowing in the mouth or esophagus) or abdominal pain.
In all cases, a careful history revealed the patients had consumed meat cooked on a grill that was cleaned with a wire brush immediately prior to cooking…..
- Rhode Island Hospital study identifies the danger of grill brushes (eurekalert.org)
People enjoy watching tragedy movies like “Titanic” because they deliver what may seem to be an unlikely benefit: tragedies actually make people happier in the short-term.
Researchers found that watching a tragedy movie caused people to think about their own close relationships, which in turn boosted their life happiness. The result was that what seems like a negative experience – watching a sad story – made people happier by bringing attention to some positive aspects in their own lives.
“Tragic stories often focus on themes of eternal love, and this leads viewers to think about their loved ones and count their blessings,” said Silvia Knobloch-Westerwick, lead author of the study and associate professor of communication at Ohio State University. …
- Do tragedies make you happier ? Study shows how tearjerkers make people happier (talesfromthelou.wordpress.com)
- Study Shows How Tearjerkers Make People Happier (yubanet.com)
- Smiling through the tears: Study shows how tearjerkers make people happier (eurekalert.org)
- Can Watching Sad Movies Make You Happier? (newsfeed.time.com)
- Why watching tragedy films actually makes you HAPPIER (dailymail.co.uk)
While government officials have argued that “enhanced interrogation techniques” are necessary to protect American citizens, the effectiveness of such techniques has been debated. According to a recent study, when torture is used to elicit information, it is likely to be unexpectedly harsh yet ineffective. This study was published in a new article in Political Research Quarterly (PRQ) published by SAGE on behalf of the Western Political Science Association.
John W. Schiemann, author of the study and a political scientist at Fairleigh Dickinson University, found that information gleaned from interrogational torture is very likely to be unreliable, and when torture techniques are employed, they are likely to be used too frequently and too harshly. Furthermore, he found that for torture to generate even small amounts of valuable information in practice, the State must make the rational calculation to torture innocent detainees for telling the truth in order to maintain torture as a threat against those who withhold information.
Schiemann wrote, “Interrogators will continue to use torture and to increase its intensity in an attempt to ensure the detainee’s threshold is low enough to make him talk.” …
- Study finds interrogational torture harsh and ineffective (scienceblog.com)
- Interrogational torture: Effective or purely sadistic? (eurekalert.org)