Archive for the ‘SOCIAL ISSUES’ Category

“FLU SHOTS – 2010″

Friday, August 27th, 2010

CDC Officials Urging Public To Get Flu Shot Sooner This Year.

The Wall Street Journal (8/25, Mckay) reports that this year, CDC and other health officials are urging Americans to get the flu shot, which contains protection against three strains, most notably, H1N1, early. CDC Director Thomas Frieden stated, “I think last year will be a plus rather than a minus in terms of vaccine coverage,” and added that the agency is working on new technology that will allow vaccines to be produced faster. Nevertheless, CDC officials are aware that some people are still hesitant to get the vaccine because of concerns that it was not adequately tested, or because they believe H1N1 is not a major health threat.

(adapted from E.M.Today)

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Promoting Prevention through the Affordable Care Act


NEJM | August 25, 2010 | Topics: Implementation, Public Health
Howard K. Koh, M.D., M.P.H., and Kathleen G. Sebelius, M.P.A.

Too many people in our country are not reaching their full potential for health because of preventable conditions. Moreover, Americans receive only about half of the preventive services that are recommended1 — a finding that highlights the national need for improved health promotion. The 2010 Affordable Care Act2 responds to this need with a vibrant emphasis on disease prevention. Many of the 10 major titles in the law, especially Title IV, Prevention of Chronic Diseases and Improving Public Health, advance a prevention theme through a wide array of new initiatives and funding. As a result, we believe that the Act will reinvigorate public health on behalf of individuals, worksites, communities, and the nation at large (see table) — and will usher in a revitalized era for prevention at every level of society.

Major Sections Related to Prevention in the 2010 Affordable Care Act.
First, the Act provides individuals with improved access to clinical preventive services. A major strategy is to remove cost as a barrier to these services, potentially opening new avenues toward health. For example, new private health plans and insurance policies (for plans or policy years beginning on or after September 23, 2010) are required to cover a range of recommended preventive services with no cost sharing by the beneficiary. These services include those rated as “A” (strongly recommended) or “B” (recommended) by the U.S. Preventive Services Task Force (USPSTF), vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and preventive care and screening included both in existing health guidelines for children and adolescents and in future guidelines to be developed for women through the U.S. Health Resources and Services Administration (HRSA). Examples of covered services include screening for breast cancer, cervical cancer, and colorectal cancer; screening for human immunodeficiency virus (HIV) for persons at high risk; alcohol-misuse counseling; depression screening (when systems are in place to ensure accurate diagnosis, effective treatment, and follow-up); and immunizations.
The prevention theme also affects individuals covered by public insurance programs. A number of policy changes will be phased in over time. For example, starting January 1, 2011, Medicare will cover, without cost sharing, an annual wellness visit that includes a health risk assessment and a customized prevention plan. Full coverage of many USPSTF-recommended services will also be available under Medicare with no cost sharing. Similarly, in 2013 and beyond, state Medicaid programs that eliminate cost sharing for preventive services recommended by the USPSTF or ACIP may be eligible for enhanced federal matching funds for providing those services.
Second, the law promotes wellness in the workplace, providing new health promotion opportunities for employers and employees. For example, the Act authorizes funds for grants for small businesses to provide comprehensive workplace wellness programs. The law also requires the secretary of health and human services to assess existing federal health and wellness initiatives and directs the Centers for Disease Control and Prevention (CDC) to survey worksite health policies and programs nationally.
Third, the Act strengthens the vital role of communities in promoting prevention. New initiative opportunities are designed to strengthen partnerships between local or state governments and community groups. For example, new Community Transformation Grants promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities. Also, in further recognition that immunization is a foundation for public health, the Act authorizes states to use their funds to purchase vaccines for adults at federally negotiated prices. Grants for states will also support demonstration projects to improve vaccination rates.
Fourth, the Act elevates prevention as a national priority, providing unprecedented opportunities for promoting health through all policies. For example, a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies, will develop a prevention and health promotion strategy for the country. The council will build on the foundation of preceding prevention initiatives, such as Healthy People (which has set the country’s health promotion and disease prevention agenda for the past 30 years),3 as well as efforts of expert groups such as the USPSTF, the Community Preventive Services Task Force, and the ACIP. A new Prevention and Public Health Fund, with an annual appropriation that begins at $500 million in fiscal year 2010 and increases to $2 billion in fiscal year 2015 and beyond, will invest in a range of prevention and wellness programs administered by the Department of Health and Human Services. Initial funds have already been invested in strengthening public health infrastructure, prevention research, surveillance, integration of primary care into community-based behavioral health programs, HIV prevention, obesity prevention, and tobacco control. Reinvigorated planning will also involve a national strategy to improve the quality of health care, improved data collection on health disparities,4 and authorization of a host of other new programs. Most newly authorized programs await appropriations and future funding as available through the annual budget process (exceptions are noted in the table).
The Act authorizes heavy investment in bolstering a primary care workforce that can promote prevention. For example, the law appropriates up to $1.5 billion for the National Health Service Corps between fiscal years 2011 and 2015 to place health care professionals in underserved areas, complementing other new investments for community health centers administered through HRSA. To guide future placements of health care professionals, a new National Health Care Workforce Commission will analyze needs.
Since tobacco dependence and obesity represent substantial health threats, the Act addresses these specific challenges in a number of ways. For example, the directives for the new health plans established after September 23, 2010, also include coverage, with no cost sharing, of tobacco-use counseling and evidence-based tobacco-cessation interventions, as well as obesity screening and counseling for adults and children. Starting this year, pregnant women on Medicaid will receive coverage, without cost sharing, for evidence-based tobacco-dependence treatments; in 2014, states will be forbidden from excluding from Medicaid drug coverage any pharmaceutical agents for smoking cessation, including over-the-counter medications, that have been approved by the Food and Drug Administration. To promote healthy weight for populations, the Act appropriates funds for fiscal years 2010 through 2014 for demonstration projects to develop model programs for reducing childhood obesity. And on the policy front, menu-labeling provisions require the disclosure of specified nutrient information for food sold in certain chain restaurants and vending machines. Collectively, these complementary actions in the clinic and the community will benefit individuals as well as populations.
In short, to prevent disease and promote health and wellness, the Act breaks new ground. We believe the law reaffirms the principle that “the health of the individual is almost inseparable from the health of the larger community. And the health of each community and territory determines the overall health status of the Nation.”3 Moving prevention toward the mainstream of health may well be one of the most lasting legacies of this landmark legislation.
This article (10.1056/NEJMp1008560) was published on August 25, 2010, at NEJM.org.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
Dr. Koh is Assistant Secretary for Health, and Ms. Sebelius is the Secretary for Health and Human Services, Department of Health and Human Services, Washington, DC.
References
1. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-2645
2. The Patient Protection and Affordable Care Act, P.L. 111-148, 23 March 2010.
3. Koh HK. A 2020 vision for healthy people. N Engl J Med 2010;362:1653-1656
4. Siegel B, Nolan L. Leveling the field — ensuring equity through national health care reform. N Engl J Med 2009;361:2401-2403

“JOINT VENTURE”©

Tuesday, August 10th, 2010

Remember moments, not days,

When health-care became your undying goal –

Remember moments, not days,

As service to injured or ill became your soul.


Emergency Poetry

Sunday, March 28th, 2010

POETRY BY DRJPWINTER

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TO SEASONS OF COEUR

drjpwinter

As young love brilliance faded,
Storms of passion now jaded -
As friendship salvage tenets stated,
Love and the spirit must be traded.

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“TO FAMILIES OF EMERGENCIES”

drjpwwinter

Harmony or storms

Riding life’s ocean waves –

With dangerous sneaker forms

Which always, love saves.

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“TO EMERGENCIES BONDING”

jpwinter

Nature’s bucky balls fly

In cosmos carbon flight -

Not to any naked eye

Bonds of absolute might.

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“TO THE CALL – STAT, STAT, STAT”

drjpwinter

ER team looks for life’s sign

DOA, Trauma Red and Code Blue -

Emergency calls define

As malpractice and lawyers ensue.

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TO FAVORITE DAUGHTERS

drjpwinter

One never knows of  love

As depth of breaths recede -

And graceful prayer rains from above,

A newborn rainbow when dark clouds preceed.

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“TO THE SEASONALLY EMERGENT”

drjpwinter

Winter wonderland

Spring wildflower in hand -

Summer parade band

Fall colors in ocean sand.

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“TO MY MENTOR MRYUK”

drjpwinter

Wizard to honor

Comrade to hail –

Physician of poisons

Career sunset sail.

HOMELAND FOUND IN IRELAND Farmland of County Cork – OWENS

Saturday, May 30th, 2009

Having travelled from Coeur d’ Alene through London, to Ireland, we found the land of green…and my ethnic and my heritage.  In County Cork, 20 or so miles from City Cork, a few miles south of the small area of Mallow, near the Mourne Parrish, whe the Bishop was coming to confirm the next generation, was a small farm…after we found an ol’ Irish gal pushing a stroller, a great-granddaughter perhaps, then to an ol’ gentleman who had heard and met some Owens in the past…”not many around now…” and then a young lad…5-7 years who said, he didn’t know, but, “was it important!”  And he added, the yound lady with him was “Polish” and she wouldn’t know…to the old possibly bachealor dairy farmer, pushing a wheelbarrow full of cow manure with a three prong pitchfork laid across, working so hard to see us through the coke-bottom thickened glasses with nails of a working farmer…skeptical to come close perhaps firstly, then, offering the Gealic version of Gealic or a mix, sure to confuse a traveler.  But, he knew the name, lahakaneen or lakahaneen, and knew the farm and the name.  And he knew just down the hill and the most two important turns of the travel.  For this was my homeland, Ireland, through County Cork, across the ocean, the Ellis Isle and New York, and later, MinnEsOtaH.  Kiss the ol’ farmhouse for all the Owens, alive and passed, for this was THE homeland, in Ireland, on this day.  God bless all Irish!

Dr. Jim Winter (Owens of County Cork)

anxiety and worry

Wednesday, February 25th, 2009

Today is now.  Now is current.  It is what is.  Yesterday is a trail of previous now.  Tomorrow is a feeling of now coming to be, but it is not.  Now is the moment.  Worry less by focusing on now.  Now is the mind not thinking but of the now.  Remember as in an emergency, only the focus is the emergency.  All past and future stop.  Focus is now.  Time leaves as focus intensifies to the now.  Less anxiety happens when focus is on the now moment.  Now…

music is not soul…it is the soul

Friday, February 13th, 2009

Music is the soul.  Music is the release of life.  Music is the now.  Do not wonder how the musician can create but wonder why.  Music is not the future, nor the past.  Music is the now.  Be bold musicians.  Be brave musicians.  Wonder only beyond the noise, create only beyond the universe.    drjpw

“DRUGS’ HALL OF SHAME” – IT’S NOT ABOUT PERFORMANCE

Sunday, November 18th, 2007

DRUGS…PROFIT…PERFORMANCE…DRUGS…CHEAT…ILLICIT…UNETHICAL…

PROFIT…

PERFORMANCE…CHEAT…ABUSE…LIE…DIE

So much of our world is drug oriented. We understand overall, that without drugs, even chemicals, our world would be full of disease, food sources would be lessened, and conveniences would be limited. As this thesis is written, the touch is embracing plastic keys, rubberized mouse pads, vinyl coated wiring – my elbows pushing steadily on laminate. The rubber tips of my work tools include rubber ear tips on my stethoscope, rubberized tubing to the metal plated bell to listen to patients’ hearts with a plastic cover shield to clean off.

So what is the deal with the lead in the toys? The recent recall included over 405,000 lead contaminate toys from the Chinese manufacturers. Some of the toys recalled were “Duck Family,” Robot 2000, Big Red Wagons, Winnie-the-Pooh spinning products.

To my knowledge, no child has been severely poisoned with these toys, nor injured in a poisoning sense with these lead toys. The greatest majority of lead cases these days are from old paints…pre-1976…when lead was taken out of the USA marketplace of paints. So old paint chips that children eat or ate, especially in older home and apartment buildings renovations, was and are the source. But the biggest reduction in lead overall in the USA was the reduction of lead in gasoline. This essentially stopped the big problem. More discussion of lead poisoning was when under Clinton’s administration, the lead limits were reduced to an absolute low level despite little or no data to support the new change. But even with this new limit in children, few ever have had disease.

Nicotine in itself is a drug, a chemical that has been used obviously in smoking addiction, but in itself is not a bad thing. It has been used in industry in a variety of compounds. Nicotine, however, is the buzz in smoking. Just good old craziness allowed the U.S. to create multi-millionaire attorneys fighting for “our rights” and for those who “didn’t know” cigarettes were bad, yet the USA funds tobacco, the tribes sell tobaccos at reduced prices to entice smoking, and the CDC funds research to explore “the nicotine drug cure,” and it is all still legal. At a recent American Heart Association meeting, research on the new nicotine vaccine has made some promising head roads. One year and five shots later, the vaccine doubled the number of “stopped” addicted smokers from about 6% to 15% over the year. The problem still exists that less than 10%, some say lower, smokers of cigarettes ever stop that consistently try to stop. How many smokers? About 46-50 million in the U.S. and about half of them will try to stop sometime. The vaccine is a potentially great drug to help. The nicotine blocker med which castMD has written on before still helps to, but so far is not necessarily more effective than the patch or the gum. Stopping smoking takes good old will power.

And then there is the date-rape drugged toys. Most of this happened if not all was with the “Aqua Dots” toys. It seems that one of the chemicals in the surrounding coating changes or gets metabolized in the body when eaten. This is an extremely unique and interesting mass-market finding. It is really quite amazing that it was found. The GHB that was found is extremely difficult to measure generally. Many times in the ER, labs can not find it. It is metabolized quickly. Some of the previous day’s internet drug providers (illicit) sold chemicals that would convert to GHB. Some of these chemicals are still passed around and used at “rave parties” and other parties. GHB is a dangerous drug. It is illicit. It can kill you or make you unable to defend, protect, or interact. Thusly, called the date-rate drug. However, it was a prescription drug known as Rohypnol that was one of the original date rape drugs. It is also now illegal in the U.S., but probably can be found in the international markets illegally…not sure of legally however. Always open your own beverage and never leave one sitting around…especially in the club scene.

Did Bonds do it or not? Will the “asterisked” marked Hall of Fame baseball be delegated a fraud by another drug story? Not just another drug related story in recent and past news. Maybe all steroids should just be allowed in all athletics. Tell the athletes the risk, the wrestlers, the baseball players, and the Olympians. All these steroid abuse stories have hit the news just in the past months.

But the problem with that is…this story…

Doping in sports is a problem. But would you give or have someone else give your daughter or son steroids for performance enhancement? Watching little league and junior to senior sports makes me wonder. How far would a parent or caregiver go?

From the 1976 Olympians of East German come the latest stories of abuse, which is being called in a new documentary “The Great Olympic Drug Scandal: Revealed.” The sports “theme plan” developed relied on anabolic steroids. That year, 40 gold medals were placed over East Germany’s team members with a heavy emphasis on women’s swimming events winning all the golds in nearly all the events. Children were given oral tablets and injections, even on the day of competition in the Olympics, untraceable at that time. Coaches were rewarded by success, despite the unethical mark. Some athletes recruited prior to teenage were started on performance enhancement drugs. Doctors were required to sign confidentiality agreements despite the unethical mark.

Some of the athletes had sexual identity and self-worth problems while growing up. Many had obvious gynecological irregularities. In later life, sexual identity was explored and some even had sex changes. But many have been left out of the story lines…How has their lives been altered? How many have died unknown, changed forever by the decay of human value, gross ethical breaches of doctors, and limitless greed of self-flagellating coaches.

Systematic. Documented in abusive performance. Involuntary. Organized to destroy human life. Sidelined by death. Welcome to professional sports and Olympian sports.

Welcome to Beijing anyone?

Welcome to the Drugs’ Hall of Shame! It is NOT about performance…

EATING DISORDERS NEEDS INTERVENTION BEFORE IT’S TOO LATE

Tuesday, September 25th, 2007

Recently an article on “Scary Skinny” appeared in a tabloid which included many of the female movie stars and entertainers. This article was not a prelude to Halloween; however some of the eating problems at Halloween may be of note. Most of the stars highlighted are anorexic, or shall I say anorexic-appearing – so eating Halloween candy is out. Purging the calories is also a problem for the eating disordered patient.

Jessica Alba appeared in the photo with the shoulder girdle (shoulder, shoulder blade, collarbones) quite concave. It estimated her 5’6” body to be at a possible 110 pounds is all. Her supposed 15 pound weight loss was after a love breakup.

Now the world savior Angelina Jolie was more ill appearing. Her cachectic body with all front side ribs, collarbones, and breastbone sticking out was quite shocking to see. The article highlighted her weight at 105 pounds for this 5’8”. Brad Pitt was begging her to eat according to the article – a common loved one’s frustrating request in eating disorders. According to the article, she was eating under 1000 calories, which is a weight losing diet, as her needs would be 1500 to 2000 or more calories per day, depending on baseline activity and that beyond. Eating a daily small meal or a drink of lemon impregnated water is not a normalized diet for an active mother.

The actress, Renee Zellweger, at about 38 years old, should not be showing ligaments and tendons in her arms and legs. This star struggles with the fact she’s is getting older, and will struggle with weight as she ages, according to this article. This is a finding in eating disorders.

Other stars, Keira, Kate Bosworth, and even prior, Eva Longoria are intermittently grossly underweight. Their bony gauntness is a similar finding in eating disordered patients.

Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight.

Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions.

The main types of eating disorders are anorexia nervosa and bulimia nervosa. A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.

Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder are male.

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.1 Symptoms of anorexia nervosa include:

Resistance to maintaining body weight at or above a minimally normal weight for age and height

Intense fear of gaining weight or becoming fat, even though underweight

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

Infrequent or absent menstrual periods (in females who have reached puberty)

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession.

The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population

The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime.1 Symptoms of bulimia nervosa include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies.

People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Binge-Eating Disorder

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.  Symptoms of binge-eating disorder include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
The binge-eating episodes are associated with at least 3 of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating

Marked distress about the binge-eating behavior

The binge eating occurs, on average, at least 2 days a week for 6 months

The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise)

People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories.

Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Goals:

(1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed.

Several family and twin studies are suggestive of a high heritability of anorexia and bulimia, and researchers are searching for genes that confer susceptibility to these disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. Identification of susceptibility genes will permit the development of improved treatments for eating disorders.

(adapted: cdc/intouch/commentary)