Partnering to lessen Weight problems in Delaware


From Healthy People 2020 Tales in the Field, a set highlighting communities nationwide which are addressing the key Health Indicators (LHIs).

Over the U . s . States, greater than one in three adults have obesity—making it a significant and pricey ailment. In the condition of Delaware, obesity rates rose from 13% in 1992 to twenty-eightPercent in 2007. Fortunately, the prevalence continues to be relatively level since 2007, remaining near to 29% from 2007 through 2015. Although less than the nation’s weight problems rate, the popularity in Delaware is comparable to the U . s . States overall. 

In response to those figures, the state’s Division of Public Health (DPH), which belongs to the Delaware Department of Health insurance and Human Services, helped form the Delaware Coalition for Eating Healthily and Active Living (DE HEAL) in 2009. As well as in 2010, the coalition released an extensive plan for weight problems prevention. The coalition provides statewide leadership and coordination of exercise and healthy diet programs, and works as a catalyst for developing weight problems prevention efforts.

DPH’s Physical Activity, Diet, and Weight problems Prevention (PANO) program is part of the coalition—and provides technical help support a variety of weight problems prevention initiatives in Delaware. “Involving individuals from a number of disciplines, from healthcare to transportation, allows us to take an inclusive method of improving Delawareans’ health,” states Dr. Karyl Rattay, Director of DPH. 

“We follow a social-ecological model,” adds Laura Saperstein, who manages the PANO program. That means DPH supports efforts like building “complete communities” (communities with walking and biking options), increasing opportunities for physical activity at schools and work sites, and educating individuals on healthier habits, in order to decrease overweight and weight problems in Delaware.  

“And since we’re a little program,” Saperstein continues, “strategic partnerships are actually important for growing our impact.”  

Funding Programs by Motivating Participants  

One ongoing effort involves an engaged and interdependent model for funding healthy weight activities in Delaware. Former Governor Jack Markell convened the Delaware Council on Health Promotion and Disease Prevention (CHPDP) in 2010 to help with the combat weight problems. CHPDP created a web-based “clubhouse”—a portal where residents can log their healthy activities. 

When residents log miles (for walking, biking, or any other activities), they earn points, or “kudos.” And thanks to donations in the private sector, these kudos then fund wellness programs at local nonprofit organizations. “It will get adults to exercise and it moves money to local organizations, which in turn offer related programs,” Saperstein explains. 

“We used a number of our federal CDC funding for the initial website build and marketing,” she says. “And there is an enormous push to obtain local companies to place money into the building blocks side from it so that as people exercise more, more money gets donated.”  

The the initiative? Motivate the very first Condition. Also it does!  

Success through the figures 

From June 2015 to October 2017, Motivate the very first Condition has: 

  • Registered 3,600 users  
  • Tracked a million miles of exercise 
  • Donated $106,000 for statewide non-profit organizations to put toward healthy programming 

Certainly one of the participating organizations may be the YMCA of Delaware, which uses the funds to offer Healthy Weight as well as your Child, an evidence-based program where families get active and discover healthy habits together. There are approximately 30 individuals each 15-week session, and the YMCA has already completed several sessions.  

Planning Physical Environments that Promote Health 

The PANO program also works with other state departments, local governments, planners, and developers to combine walking and biking possibilities residents have near to home. “Using the social-environmental model implies that we glance at the social determinants of health,” Saperstein states. “We are thinking about creating healthier communities with increased use of exercise and healthy food choices.Inches 

To advance this goal, DPH helped create Delaware’s Plan4Health initiative, that was brought through the Delaware Chapter from the American Planning Association and also the Delaware Public Health Association. “We focused first on Kent County because her greatest weight problems rate within the condition,” Saperstein explains. “We created a guiding document for that county to use then when it came time for you to redo their comprehensive plan, they had already identified the public health priorities to include in the plan.”  

People of the initiative are now reaching to other counties and towns to speak the significance of including health equity considerations within their comprehensive plans.  

“We’re seeing improvements where developers convey more understanding and produce better designs, like including bike lanes and not building in the center of nowhere. They see how complete communities tend to be more profitable—and they’re attractive to millennials.” 

Discussing the various tools to create Communities Healthier 

In another effort, DPH partnered with the College of Delaware’s Institute for Public Administration to create the Toolkit for any Healthy Delaware. It provides sources for local governments to assess—and try to improve—their towns’ opportunities for exercise and use of well balanced meals and environments. 

“It’s the counties and towns that ultimately result in the decisions,” Saperstein highlights. “But we’ve created a relationship using the Department of Transportation so that now, once they see plans for a new development, they ask the way it will impact health.”  

It’s the partnerships that cause positive steps that Saperstein finds most gratifying concerning the PANO program’s work. “When developers visiting the table with plans that demonstrate guidelines for building communities with use of exercise, it implies that they’re listening—and that they’re prepared to change. That’s a success story i believe.Inches 

About Tales in the Field

Every month, this series highlights how communities nationwide are addressing the Healthy People 2020 Leading Health Indicators (LHIs). LHIs really are a subset of 26 Heathy People 2020 objectives that communicate high-priority health problems. Tackling the LHIs appropriately will dramatically lessen the main reasons for dying and avoidable illnesses.

This month’s story includes a program that’s addressing the Diet, Exercise, and Weight problems LHI subject.

Take a look at other Tales in the Field on


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New Vaccine and Drug Trials Could Buoy Combat Aids

LONDON (Reuters)—Researchers announced the launch of two big studies in Africa on Thursday to check a brand new Aids vaccine along with a lengthy-acting injectable drug, fuelling wants possible ways to safeguard from the virus that triggers AIDS.

The beginning of the 3-year vaccine trial involving 2,600 women in southern Africa implies that the very first time in greater than a decade nowadays there are two big Aids vaccine numerous studies happening simultaneously.

The brand new study is testing a 2-vaccine combination produced by Manley &amp Manley (JNJ.N) (J&ampJ) using the U.S. National Institutes of Health (NIH) and also the Bill &amp Melinda Gates Foundation. The very first vaccine, also supported by NIH, started an effort last November.

Simultaneously, GlaxoSmithKline’s (GSK.L) majority-owned ViiV Healthcare unit is beginning another study enrolling 3,200 women in sub-Saharan Africa to judge the advantage of giving injections every two several weeks of their experimental drug cabotegravir.

The ViiV initiative, that is likely to run until May 2022, also offers funding in the NIH and also the Gates Foundation.

Women really are a major concentrate fighting against the std since in Africa they account in excess of 1 / 2 of brand new Aids infections.

ViiV can also be running another large study using its lengthy-acting injection in Aids-uninfected men and transgender ladies who have relations with men. That study began in December 2016.

Although modern Aids drugs have switched the condition from the dying sentence right into a chronic condition and preventative medications might help, a vaccine continues to be viewed as critical in moving back the pandemic.

The most recent vaccine experiments try to develop the modest success of the trial in Thailand in ’09, when an early on vaccine demonstrated a 31 percent decrease in infections.

“We’re making progress,” stated J&ampJ Chief Scientific Officer Paul Stoffels, who believes it ought to be easy to achieve effectiveness above 50 %.

“That may be the goal. Hopefully, we obtain much greater,” he told Reuters.

The brand new vaccines require one dose to prime the defense mechanisms an additional shot to improve our body’s response.

Considerably, J&ampJ’s latest vaccine uses so-known as mosaic technology to mix immune-stimulating proteins from various Aids strains, representing various kinds of virus from around the globe, that ought to create a “global” vaccine.

One good reason why making an Aids vaccine has demonstrated so hard previously may be the variability from the virus.

Initial clinical results reported in an AIDS conference in Paris in This summer demonstrated the mosaic vaccine was safe and elicited a great immune response in healthy volunteers.

Some 37 million individuals all over the world presently have Aids and around 1.8 million grew to become recently infected this past year.

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Healthy People 2020 and Diabetes Advocacy Alliance Celebrate five years of Partnership


Through The Diabetes Advocacy Alliance

As American Diabetes Month involves a detailed this November, we’re searching back and celebrating the Diabetes Advocacy Alliance’s (DAA) proper partnership with Healthy People 2020.

The Diabetes Advocacy Alliance (DAA) is really a coalition of twenty-two people, representing patient, professional and trade associations, other nonprofit organizations, and corporations, all u . s . within the need to alter the way diabetes is observed and treated in the usa. The DAA was created and started activities in The month of january 2010. Three people from the DAA function as co-chairs: American Diabetes Association Pediatric Endocrine Society and Novo Nordisk Corporation. The DAA aims to unite and align key diabetes stakeholders and also the bigger diabetes community around important diabetes-related policy efforts to be able to elevate diabetes around the national agenda.

Our partnership with Healthy People 2020, that was first announced on November 19, 2012, concentrates on individuals with diabetes and individuals in danger of developing it. Our work includes staff from federal agencies with representatives from the 22 people from the DAA, cooperating to succeed four Healthy People 2020 Diabetes objectives associated with stopping diabetes among individuals in danger and improving glycemic control among individuals with diabetes.

Our partnership has three primary goals:

  1. Coordinate activities that promote understanding of diabetes prevention or protection against complications from diabetes
  2. Facilitate data collection to watch progress toward achievement of Healthy People 2020 Diabetes objectives
  3. Support mix-sector collaboration to affect policy and system changes

We’re happy with our accomplishments, which through the years have incorporated:

  • Participating at work of Disease Prevention and Health Promotion’s (ODPHP) 2012 National Health Promotion Summit in Washington, D.C.
  • Planning and applying four Spotlight on Health webinars on protection against diabetes type 2, emerging diabetes technologies, diabetes self-management education and support, and improving diabetes screening and referrals to diabetes prevention programs (more details can be obtained here)
  • Taking part in the 2015 Healthy Aging Summit, co-backed by ODPHP and also the American College of Preventive Medicine, with content centered on diabetes and seniors
  • Getting together DAA people and representatives of countless federal agencies through planning and convening five in-person conferences, that have permitted for discussing of research and insights and encouraged collaboration in diabetes screening, prevention and care quality measures diabetes self-management education and support and diabetes and rural health

On our partnership activities.

What’s going to the way forward for our partnership hold? Because of the accomplishments you’ve seen up to now, we expect to ongoing our joint efforts meant for diabetes prevention and care, and await the establishment of objectives for Healthy People 2030.


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Unnecessary Tests and Treatment Explain Why Health Care Costs So Much

This story was co-published with NPR’s Shots blog.

Two years ago, Margaret O’Neill brought her 5-year-old daughter to Children’s Hospital Colorado because the band of tissue that connected her tongue to the floor of her mouth was too tight. The condition, literally called being “tongue-tied,” made it hard for the girl to make “th” sounds.

It’s a common problem with a simple fix: an outpatient procedure to snip the tissue.

During a pre-operative visit, the surgeon offered to throw in a surprising perk. Should we pierce her ears while she’s under?

O’Neill’s first thought was that her daughter seemed a bit young to have her ears pierced. Her second: Why was a surgeon offering to do this? Wasn’t that something done free at the mall with the purchase of a starter set of earrings? 

“That’s so funny,” O’Neill recalled saying. “I didn’t think you did ear piercings.”

The surgeon, Peggy Kelley, told her it could be a nice thing for a child, O’Neill said. All she had to do is bring earrings on the day of the operation. O’Neill agreed, assuming it would be free.

Her daughter emerged from surgery with her tongue newly freed and a pair of small gold stars in her ears.

Only months later did O’Neill discover her cost for this extracurricular work: $1,877.86 for “operating room services” related to the ear piercing—a fee her insurer was unwilling to pay.

At first, O’Neill assumed the bill was a mistake. Her daughter hadn’t needed her ears pierced, and O’Neill would never have agreed to it if she’d known the cost. She complained in phone calls and in writing.

The hospital wouldn’t budge. In fact, O’Neill said it dug in, telling her to pay up or it would send the bill to collections. The situation was “absurd,” she said.

“There are a lot of things we’d pay extra for a doctor to do,” she said. “This is not one of them.”

Kelley and the hospital declined to comment to ProPublica about the ear piercing.

Surgical ear piercings are rare, according to the Health Care Cost Institute, a nonprofit that maintains a database of commercial health insurance claims. The institute could only find a few dozen possible cases a year in its vast cache of billing data. But O’Neill’s case is a vivid example of health care waste known as overuse.

Into this category fall things like unnecessary tests, higher-than-needed levels of care or surgeries that have proven ineffective.

Wasteful use of medical care has “become so normalized that I don’t think people in the system see it,” said Dr. Vikas Saini, president of The Lown Institute, a Boston think tank focused on making health care more effective, affordable and just. “We need more serious studies of what these practices are.”  

Experts estimate the U.S. health care system wastes $765 billion annually—about a quarter of all the money that’s spent. Of that, an estimated $210 billion goes to unnecessary or needlessly expensive care, according to a 2012 report by the National Academy of Medicine.

ProPublica has been documenting the ways waste is baked into the system. Hospitals throw away new supplies and nursing homes discard still-potent medication. Drugmakers combine cheap ingredients to create expensive specialty pills and arbitrary drug expiration dates force hospitals and pharmacies to toss valuable drugs.

We also reported how drug companies make oversize eyedrops and vials of cancer drugs, forcing patients to pay for medication they are unable to use. In response, a group of U.S. senators introduced a bill this month to reduce what they called  “colossal and completely preventable waste.”

But any discussion of waste needs to look how health care dollars are thrown away on procedures and care that patients don’t need—and how hard it is to stop it.

Just ask Christina Arenas.

Arenas, 34, has a history of noncancerous cysts in her breasts so last summer when her gynecologist found some lumps in her breast and sent her for an ultrasound to rule out cancer, she wasn’t worried. 

But on the day of scan, the sonographer started the ultrasound, then stopped to consult a radiologist. They told her she needed a mammogram before the ultrasound could be done.

Arenas, an attorney who is married to a doctor, told them she didn’t want a mammogram. She didn’t want to be exposed to the radiation, or pay for the procedure. But sitting on the table in a hospital gown, she didn’t have much leverage to negotiate.

So, she agreed to a mammogram, followed by an ultrasound. The findings: no cancer. As Arenas suspected, she had cysts, fluid-filled sacs that are common in women her age.

The radiologist told her to come back in two weeks so they could drain the cysts with a needle, guided by yet another ultrasound. But when she returned she got two ultrasounds: one before the procedure and another as part of it.  

The radiologist then sent the fluid from the cysts to pathology to test it for cancer. That test confirmed—again—that there wasn’t any cancer. Her insurance whittled the bills down to $2,361, most of which she had to pay herself because of her insurance plan.

Arenas didn’t like paying for something she didn’t think she needed and resented the loss of control. “It was just kind of, ‘Take it or leave it.’ The whole thing. You had no choice as to your own care.”

Credit: Steve Bronstein Getty Images

Arenas, sure she’d been given care she didn’t need, discussed it with one of her husband’s friends who is a gynecologist. She learned the process could have been more simple and affordable.

Arenas complained to The George Washington Medical Faculty Associates, the large Washington, D.C., doctor group that provided her treatment. Her request to have the bill reduced was denied. Then bill collectors got involved, so she demanded a refund and threatened legal action.

She said she never got to speak to anyone. Her demand was routed to an attorney, who declined her request because there was “no inappropriate care.” She also complained to her insurance company and the Washington, D.C., attorney general’s office, but they declined to help reduce the bill.

Overtreatment related to mammograms is a common problem. The national cost of false-positive tests and overdiagnosed breast cancer is estimated at $4 billion a year, according to a 2015 study in Health Affairs. Some of this is fueled by anxious patients, some by doctors who know that missing a cancer diagnosis can be grounds for a medical malpractice lawsuit. But advocates, patients and even some doctors note the screenings can also be a cash cow for physicians and hospitals.

With Arenas’ permission, we shared her case with experts, including Dr. Barbara Levy, vice president of health policy for the American College of Obstetricians and Gynecologists and three radiologists. 

Levy said there’s a standard way to treat a suspected breast cyst that’s efficient and cost-effective. If the lump is large, as in Arenas’ case, a doctor should first use a needle to try and drain it. If the fluid is clear and the lump goes away there’s no cause for concern or extra testing. If the fluid is bloody or can’t be drained, or the mass is solid, then medical imaging tests can determine if it’s cancerous.

However, doctors often choose to order imaging tests rather than drain apparent cysts, Levy said. “We’re so afraid the next one might be cancer even though the last 10 weren’t,” she said. “So, we overtest.”

Levy and the radiologists agreed that at least some of Arenas’ care seemed excessive. But their opinions varied, which shows why it can be difficult to reduce unnecessary care. Standards are often open-ended, so they allow for a wide range of practices and doctors have autonomy to take the route they think is best for patients.

The American College of Radiology recommends an ultrasound for a 32-year-old—Arenas’ age at the time of the procedure—with an unidentified breast mass. Mammograms are also an option, but “most benign lesions in young women are not visualized by mammography,” the guidelines state.

Dr. Phillip Shaffer, a radiologist who’s practiced for decades in Columbus, Ohio, said he didn’t think Arenas needed the mammogram. “I wouldn’t do it,” he said. “If I did an ultrasound and saw cysts, I’d say you have cysts. In 32-year-olds the mammogram does almost nothing.”

Dr. Jay Baker, chair of the American College of Radiology breast imaging communications committee, agreed that the ultrasound alone would have “almost certainly” identified the cyst. But, he said, maybe something about the lumps concerned Arenas’ radiologist, so a mammogram was ordered.

None of the radiologists consulted by ProPublica could explain why two ultrasounds on the return visit would be necessary. According to Arenas’ medical records, the practice told one reviewer that two were done to make sure the cysts hadn’t changed.

Shaffer didn’t buy it. “They just billed her twice for one thing,” he said.

Levy, the gynecologist, said it’s “excessive” to do two ultrasounds. And, she said, there was no need to send clear fluid to pathology.

Arenas offered to waive her privacy rights so the practice that provided her treatment could speak to ProPublica. Officials from the practice declined to comment. Her medical records show that in response to reviews by her insurance company and the attorney general’s office, her doctors said the care was appropriate. 

Since then she has her cysts drained without images in her gynecologist’s office for about $350. But Arenas said on two occasions she’s used a needle at home to do it herself. (Doctors do not recommend this approach.) She admits it was an extreme choice, but at the time she worried she would be subjected to more unnecessary tests.

“I was taken advantage of because I was a captive audience,” she said.

In a brick-and-glass office park just outside Roanoke, Virginia, Missy Conley and Jeanne Woodward have battled on behalf of hundreds of patients who believe they’ve been overtreated or overcharged. The two work for Medliminal, a company that challenges erroneous and inflated medical bills on behalf of consumers in exchange for a share of the savings.

The two women excitedly one-up each other with their favorite outrages. How about the two cases involving unnecessary pregnancy tests? One of the patients was 82—decades past her childbearing years. The other involved a younger woman who no longer had a uterus.

Another case involved an uninsured man who fell off his mountain bike and hurt his shoulder. The first responders pressured him to take an air ambulance to a hospital when it would have been faster for his friends to drive him. He got charged $44,000 for the whirlybird. Such unexpectedly pricey flights—and the aggressive billing that comes with them—have been featured in stories by NPR, The New York Times and The Atlantic.

Medliminal gets dozens of calls a week from consumers who are fed up with the medical system.

Woodward, a nurse and certified medical auditor, regularly sees patients billed for unnecessary lab tests. A man with diabetes may only need his glucose measured, but the doctor may order a bundle of 14 unnecessary tests, she said. The extra tests inflate the tab.

If there’s a billing dispute it can take months of phone calls and emails to get a case resolved, said Conley, who gained an insider’s knowledge during years working for insurance companies.

Patients fighting bills on their own often give up and pay the bill or let it go to collections, she said. “The whole system is broken,” Conley said.

Saini, president of The Lown Institute, said profit is a major driver of overuse.

“Providers are getting constant messages from superiors or partners to maximize revenue,” Saini said. “In this system we have, that’s not a crime. That’s business as usual.”

Patients aren’t true health care consumers because they typically can’t shop by price and they often don’t have control over the care they receive, Saini said. The medical evidence may support multiple paths for providing care, but patients are unable to tell what is or is not discretionary, he said. Time pressure adds urgency, which makes it difficult to discuss or research various options.

“It’s sort of this perfect storm where no one is really evil but the net effect is predatory,” Saini said.

Once the service or treatment is provided, the bill is on its way, with little forgiveness.

In 2015, Dr. Dong Chang, the director of the medical intensive care unit at Harbor-UCLA Medical Center, a public hospital in Los Angeles, decided to see whether the care being delivered in his ICU was appropriate.

Resources were scarce in his ICU, and he suspected it might be possible to manage them better. So, he and his colleagues reviewed the records of all the patients in the unit over the course of a year to see whether the patients might have been either too sick, or too healthy, to benefit from intensive care.

The results shocked them. They determined the care may not have been beneficial to more than half of the patients. “ICU care is inefficient, devoting substantial resources to patients less likely to benefit,” their study, published in the February edition of JAMA Internal Medicine, concluded.

Chang and his team also reviewed the use of intensive care at 94 hospitals in two states, Maryland and Washington, focusing on four common conditions that can lead to treatment in an intensive care unit.

They found wide variation in the types of patients hospitals determined needed intensive care.  One hospital put 16 percent of patients with diabetic ketoacidosis, a serious condition that can result in a coma, in intensive care, while another hospital did so with 81 percent of such patients. The range for patients with pulmonary embolisms was from 5 percent to 44 percent and for those with congestive heart failure, it was 4 percent to 49 percent.  

Chang attributes the difference to doctors using intensive care based on their habits, hunches or training. Profit, he said, may also be a motive, but it didn’t appear to be a driving force.

“We really don’t have good standards and a good discussion going on about who should receive ICU care,” Chang said.

The unnecessary intensive care can also be harmful. The study found intensive care patients underwent more invasive procedures, like the insertion of catheters, including central lines, which carry the risk of infection. Overuse of the ICU is bad for patients who don’t need it, Chang said. Survival rates were also no better at the hospitals that used intensive care the most.

Reducing unneeded intensive care stays would save big money. Intensive care costs about $10,000 for a typical stay and accounts for 4 percent of national health care expenditures, according to research cited by Chang’s team.

If the hospitals in Maryland and Washington with the highest rates of intensive care use had behaved more like those with lower use, it would save around $137 million, the study estimated. That’s the savings for fewer than 100 hospitals in two states. There are about 4,000 hospitals nationwide, suggesting that reducing unnecessary intensive care use could save billions of dollars a year. 

Chang hesitated to call the overuse of intensive care “wasted” health care spending. He said the medical literature calls it “non-beneficial” care, which is maybe a nicer way of saying the same thing.

For O’Neill, her dispute of the fee for her daughter’s ear piercing was a trip into the hell of medical billing.

O’Neill is an attorney, so she knows how to weed through fine print. But it took her untold hours and phone calls to the hospital and her insurance company to root out the issue. The hospital had initially billed her insurer for the $1,877.86 for “operating room services” related to the ear piercing. The company rightly rejected payment for the cosmetic procedure. So, the hospital billed the family, according to her medical and billing records and correspondence.

The surgeon billed the family an additional $110, which O’Neill paid.

The operative report describes the piercing in obscure technical terms: “The bilateral lobules were prepped with betadine and a 18 gauge was used to pierce the left lobule in the planned position …”

O’Neill said she got nowhere in several conversations with the manager of the hospital’s team that deals with payments directly from consumers. Then in mid-July, O’Neill wrote a letter to the manager explaining that they were at an impasse and urged the hospital to cancel the bill.

In early August, ProPublica contacted the hospital and surgeon to inquire about the ear piercing. The hospital spokeswoman replied in an email that, generally speaking, ear piercings during surgery are rare and only done at the request of a family. (The medical records say O’Neill requested the ear piercing.) It would not result in a separate operating room charge, she wrote.

The spokeswoman’s explanation didn’t jibe with the hospital’s bill, which even listed the billing code for ear piercing. She declined to discuss O’Neill’s case or explain the discrepancy.

In mid-August, the self-pay manager sent O’Neill a letter saying, “the remaining balance of $1,877.86” would be removed “as a one-time courtesy adjustment.”

The manager added that the hospital hadn’t done anything wrong. The account was “correctly documented, coded, charged and billed according to industry standards,” she wrote.

And that’s just the problem. The hospital’s $1,877 bill for the ear piercing was within industry standards.

As for O’Neill, she and her daughter had to endure one additional insult. The surgeon’s piercing of one ear was off-kilter so it had to be redone. This time O’Neill had it done at the mall, for about 30 bucks.

From (find the original story here); reprinted with permission.

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Promoting Diet Counseling like a Priority for Clinicians


By Kellie Casavale, PhD, RD, Diet Consultant, and Richard D. Olson, MD, Miles per hour, Director, Division of Prevention Science, ODPHP

Evidence is obvious that diet plays an important role to maintain a healthy body and preventing chronic disease. But when individuals go to the physician, they’re unlikely to get diet counseling in their health care.

Within their recent JAMA article, Diet Counseling in Clinical Practice: How Clinicians Can Perform Better, Drs. Scott Kahan and JoAnn Manson discuss why diet will get excluded from the conversation during visits to the doctor — and offer achievable and accessible methods to incorporate diet counseling into clinical practice.

From Treating Signs and symptoms to Addressing Causes
While treating individuals with diabetes in her own endocrinology practice, Dr. JoAnn Manson observed a design. “I often see from my knowledge about patients that dietary factors were playing a significant role in bloodstream sugar control, putting on weight, and overall health,Inches she states. She saw exactly the same dietary factors playing in other patients’ bloodstream pressure and cholesterol problems.

JoAnn E. Manson, MD, DrPH, Chief, Division of Preventive Medicine, Brigham and Women’s Hospital

That is why Manson made the decision to pivot from the concentrate on clinical practice to some concentrate on population health insurance and prevention research in order to address the danger factors of chronic disease as opposed to just disease management. “I’ve been astounded by the compelling evidence that diet and lifestyle drive the chance of the main chronic illnesses within the U . s . States — diabetes type 2, coronary disease, cancer, and lower the road. Evidence with this has arrived at a vital mass.”

Challenges in Addressing Diet in Clinical Settings
Why isn’t diet more often addressed in clinical settings? Manson traces area of the problem to school of medicine, where almost no time is spent researching diet. “Physicians frequently emerge from school of medicine and residency with limited learning diet and insufficient confidence within their capability to provide diet counseling for their patients,” she states. Also it doesn’t help that patient interactions are frequently brief and centered on acute conditions instead of prevention and changes in lifestyle.

“As a clinician myself, I understand there are numerous time pressures,” states Manson. That is why she stresses that clinicians can discuss nutritional changes progressively with time, putting aside only a couple of minutes of every trip to talk diet. “This isn’t a 1-time event in which you counsel someone and expect it’ll transform their existence,” she states. “This must be a measure at any given time with higher follow-up.”

Practical Advice for Clinicians
The JAMA article offers concrete recommendations for counseling patients on nutritional behavior change. “Focus on small steps — and utilize the accessible sources inside your practice,” states Manson. She stresses that diet counseling is really a team effort. Bigger practices may bring on dedicated health coaches or dietitians to assist support patients, but small practices could possibly get support involved with screening patients and monitoring their nutritional change progress.

For instance, a helper can provide patients a nutritional screening questionnaire prior to the visit. The clinician may then engage patients with evidence-based techniques like motivational interviewing, which attracts on patients’ self-reported nutritional habits to inquire about questions and suggest small changes. Manson states an exchange might go such as this: “I observe that you’re getting 3 portions of sugary soda every single day. That’s been associated with elevated chance of diabetes.” Then your clinician could suggest the little step of swapping certainly one of individuals daily sodas for water or any other calorie-free beverage.

And positive messages really are a must. “It’s not only saying ‘don’t do this,’ because that does not work,” she states. “The technique is to point out substitutions.” Patients could trade a candy for a number of nuts, or perhaps a sugary dessert for any bowl of fruit.

Clinicians searching to begin the conversation about nutritional changes will find a useful table within the JAMA article with types of realistic substitutions to point out to patients. Manson also suggests the Nutritional Guidelines for Americans like a primary source of clinicians. The Nutritional Guidelines offers evidence-based diet strategies for Americans ages 2 and older. Additionally towards the guidelines, ODPHP supplies a toolkit of handouts in British and Spanish to assist clinicians talk to patients about appropriate food choices. ODPHP developed these sources according to research with providers to deal with the difficulties of diet counseling in clinical settings. Patients and clinicians might also find useful advice through MyPlate, the American Heart Association, and also the American Cancer Society.

A Proactive approach
Manson emphasizes that boosting diet counseling within the doctor’s office will need action from various players — and states she sees indications of progress. “Medical students are with more instruction in diet, for instance. A number of this might be grassroots.”

Manson also cites the key role of reimbursement. Consistent coverage for diet counseling and obvious policies in insurance coverage encourage clinicians and patients to create diet counseling important. “It needs to be really obvious what’s covered and just what isn’t,” she states, “and hopefully clinicians can get reimbursed of these interactions.”

Overall, she states, more jobs are needed. “This remains the initial step of the proactive approach,Inches Manson states, “where clinicians recognize their key role in assisting patients modify behavior and enhance their dietary status.”


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Phys Erectile dysfunction: How Running Might or might not Assist the Heart

Phys Erectile dysfunction


If 50 men run 3,510 marathons during the period of 30 years, will their heart health suffer or improve?

New research delving into precisely that question concludes that the reply is concurrently reassuring and complex, with lengthy many years of endurance training seeming to not harm runners’ hearts, but additionally not always to profit them within the ways in which the runners themselves most likely expected.

In the last 4 decades approximately, attitudes concerning the results of strenuous exercise around the heart have whipsawed. At some point, lots of people thought that endurance exercise will be a cure all for heart disease. A 1977 report within the Annals from the New You are able to Academy of Sciences, for instance, intimated that marathon running and a healthy diet plan would immunize runners completely against coronary artery disease, or even the buildup of plaques within the arterial blood vessels that’s the hallmark of cardiovascular disease.

But after a little runners died of cardiac arrest, including, famously, Jim Fixx, the writer of “The Complete Book of Running,” back in 1984, many scientists, physicians and athletes started to fret that lengthy-term, strenuous exercise might really be harmful to the center. Meant for that concept, a couple of studies recently have discovered the hearts of lifelong male endurance athletes could have more plaques or any other indications of heart disease, for example scarring, compared to hearts of less-active men of the identical age. A little study presented in a recent meeting from the Radiological Society of the usa, for example, discovered that among several middle-aged male triathletes, individuals who most frequently trained and competed demonstrated a little more scarring in their hearts compared to other athletes.

But, adding still more complexity to the point, other recent reports have established that, even when longtime endurance athletes do develop heart disease for example coronary artery disease, their form of the condition might be not the same…

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Europe&#039s Aids Epidemic Growing at Alarming Rate, WHO Warns

LONDON (Reuters) – The amount of people recently identified as having Aids in Europe arrived at its greatest level in 2016 since records started, showing the region’s epidemic growing “at a truly alarming pace”, medical officials stated .

That year, 160,000 people contracted herpes that triggers Helps with the 53 countries that comprise the planet Health Organization’s European region, the company stated inside a joint report using the European Center for Disease Prevention and Control (ECDC).

Around 80 % of individuals were in eastern Europe, the report found.

“This may be the greatest number of instances recorded in a single year. If the trend persists, we won’t be able to offer the … target of ending the Aids epidemic by 2030,” the WHO’s European regional director, Zsuzsanna Jakab, stated inside a statement.

The popularity was particularly worrying, the organizations stated, because many patients had recently been transporting the Aids infection for quite some time when these were diagnosed, making herpes harder to manage and more prone to happen to be forwarded to others.

Early diagnosis is essential with Aids since it enables individuals to start treatment with AIDS drugs sooner, growing their likelihood of living a lengthy and healthy existence.

“Europe must do more in the Aids response,” stated ECDC director Andrea Ammon. She stated the typical time from believed duration of infection until one is diagnosed is 3 years, “which is way too long”.

The report stated new strategies were required to expand the achieve of Aids testing – including self-testing services and testing supplied by lay providers.

Almost 37 million people worldwide possess the hiv that triggers AIDS. Nearly all cases have been in poorer regions for example Africa, where use of testing, treatment and prevention is much more limited, however the Aids epidemic has additionally demonstrated persistent in wealthier regions like Europe.

The WHO European Region comprises 53 countries, having a population of nearly 900 million people.

The ECDC/WHO report discovered that in the last 10 years, the speed of recently diagnosed Aids infections in this area has risen by 52 percent from 12 in each and every 100,000 of population in 2007 to 18.2 for each 100,000 in 2016.

That decade-lengthy increase was “mainly driven through the ongoing upward trend within the East,” the report stated.

An ECDC study printed captured also discovered that around 1 in 6 new installments of Aids diagnosed in Europe have been in people older than 50.

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Mind: Therapy for Sexual Misconduct? It’s Mostly Misguided

The current boost in accusations of sexual harassment and assault has motivated some accepted offenders to find specialist help for that emotional or personality distortions that underlie their behavior.

“My journey now is to find out about myself and conquer my demons,” producer Harvey Weinstein stated inside a statement in October. The actor Kevin Spacey announced he could be “taking time essential to seek evaluation and treatment.”

Whatever mixture of damage control and contrition they represent, pledges such as these suggest there are standard treating perpetrators of sexual offenses. Actually, no such standard treatments exist, experts say. The perception of “sexual addiction” like a stand-alone diagnosis is within dispute.

“There aren’t any evidence-based programs I understand of for the type of men who’ve been in news reports lately,” stated Vaile Wright, director of research and special projects in the American Mental Association. That does not imply that these men cannot change their ways with specialist help.

Evidence that talk therapy and medicine can curb sexual misconduct is modest at the best, and virtually everything originates from treating severe disorders, like pedophilia and exhibitionism, experts stated — effective urges that can’t be switched off.

Still, there’s need to believe that these therapeutic approaches could be adapted to management of the boys charged with offenses varying from undesirable focus on rape.

“You’re really searching at two groups of individuals,Inches stated Rory Reid, a helper professor of psychiatry in the College of California, La, with a clinical practice concentrating on sexual dysfunctions.

“One is exactly what I call sexually compulsive behavior. Another is restricted to people committing non-consensual functions — sex offenders.” The very first group includes the school student failing out while he spends all his time surfing porn sites, or even the man who’s visiting prostitutes so frequently it’s threatening his livelihood and health.

Therapists treat these kinds almost as much ast they’d substance users: with 12-step programs group counseling sessions by teaching classic impulse-control techniques, like staying away…

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Indonesia Volcano: Indonesia Orders Immediate Evacuation as Greatest Alert Issued

DENPASAR, Indonesia, November 27 (Reuters) – Indonesia closed the airport terminal around the tourist island of Indonesia on Monday and purchased 100,000 residents living near a grumbling volcano spewing posts of ash to evacuate immediately, warning the initial eruption in 54 years might be “imminent”.

The airport terminal was closed for twenty-four hrs from Monday morning, disrupting 445 flights and a few 59,000 passengers, after Mount Agung, which wiped out countless individuals 1963, sent volcanic ash high in to the sky, and officials stated cancellations might be extended.

“Plumes of smoke are from time to time supported by explosive eruptions and also the seem of weak blasts that may be heard as much as 12 km (7 miles) in the peak,” the Disaster Minimization Agency (BNPB) stated inside a statement after raising the alert from three to the greatest degree of four.

“The opportunity of a bigger eruption is imminent,” it stated, talking about an obvious glow of magma at Mount Agung’s peak overnight, and warning residents to evacuate some risk zone in a radius of 8-10 km (5-6 miles).

Sutopo, a BNPB spokesman, stated there was no casualties to date and 40,000 people had left the region, but thousands still required to move.

Video clip shared through the agency demonstrated volcanic dirt flows (lahar) around the mountainside. Lahar transporting dirt and enormous boulders can destroy houses, bridges and roads in the path.

Indonesia, renowned for its surf, beaches and temples, attracted nearly 5 million visitors this past year, and it is airport terminal works as a transport hub for that chain of islands in Indonesia’s eastern archipelago.

But tourism has slumped in areas of Indonesia since September when Agung’s volcanic tremors started to improve and also the alert level was elevated to maximum prior to being decreased in October when seismic activity calmed.

“I am really worried. Maybe I’ll go somewhere south which i think is going to be safe to avert being trapped through the ashfall,” stated Maria Becker, a German tourist remaining in Amed, around 15 km (9 miles) in the volcano.

Agung increases majestically over eastern Indonesia to some height of approximately 3,000 metres (9,800 ft). Northeastern Indonesia is comparatively undeveloped when compared to more heavily populated southern tourist hub of Kuta-Seminyak-Nusa Dua.

Indonesia’s Vulcanology and Geological Disaster Minimization Center (PVMBG), that is using drones, satellite imagery along with other equipment, stated predictions were difficult even without the instrumental tracks in the last eruption 54 years back.

In 1963, an eruption of Agung wiped out greater than 1,000 people and razed several villages by hurling out pyroclastic material, hot ash, lava and lahar.

Tracks now show the northeast section of Agung’s peak has inflamed in recent days “indicating there’s fairly strong pressure toward the topInch, PVMBG stated.

It cautioned when an identical eruption happened, it might send rocks larger than fist-size-up to eight km (5 miles) in the summit and volcanic gas to some distance of 10 km (6 miles) within three minutes.

Some analysis, however, suggests the threat shouldn’t be as great this time around because “energy at Mount Agung’s magma chamber isn’t as big” and also the ash column only around one fourth as high to date because the 20 km (12 miles) arrived at in 1963, Sutopo stated.


Indonesia airport terminal, about 60 km (37 miles) in the volcano, is going to be closed for twenty-four hrs, its operator stated.

Ten alternative airports happen to be ready for airlines to divert inbound flights, including in neighbouring provinces. Virgin Australia Holdings Limited stated it had been cancelling flights , while Jetstar was offering to switch Indonesia bound tickets for other destinations.

Television footage demonstrated countless holidaymakers camped within the airport terminal terminal, some resting on their bags, others using mobile telephones.

“We’ve been here (in Indonesia) for 3 days we’re going to leave today, but simply discovered our flights happen to be cancelled. We’ve got no information since the gates, the check-ins, happen to be closed indefinitely,” stated Carlo Oben from La.

Cover-More, Australia’s greatest travel insurer, stated on its website customers would simply be covered when they had bought policies prior to the volcano alert was initially issued on Sept. 18.

Indonesia’s hotel and restaurant association stated stranded vacationers at member hotels would acquire one night’s free stay.

The primary airport terminal on Lombok, alongside Indonesia, was closed after being open for much during the day, a spokesman stated.

Airlines avoid flying when volcanic ash exists since it can harm engines and may clog fuel and cooling systems and hamper visibility.

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As Healthcare Changes, Insurers, Hospitals and Drugstores Get Together


They appear like odd couples: Aetna, among the nation’s largest health insurers, is in talks to mix with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a very considered health system, became a member of forces by having an insurance start-up, Oscar Health, to provide individuals any adverse health plan in Ohio.

Aetna also offers new partnerships with large health systems which include hospitals and doctors’ groups in Northern California and Virginia.

These established players are venturing beyond their traditional lines of economic, since federal officials have quashed the mega-mergers suggested through the greatest insurers and blocked a deal between two large pharmacy chains.

Former adversaries are banding together, girding against upheaval inside a quickly altering healthcare atmosphere. They’re also bracing for that threats resulting from interlopers like Amazon . com eyeing a foray in to the pharmacy business or tech companies offering virtual health care using a computer or mobile phone.

“There’s been a powerful trend for health organizations to wish to broaden their footprint, especially for insurers to obtain more direct connection with the person,Inches stated Dr. John W. Rowe, an old hospital and insurance executive who’s a professor of health policy at Columbia College.

Because of the uncertainty within the Affordable Care Act and also the potentially limited benefit of the main insurance business, insurers are searching to follow along with the process went after by UnitedHealth Group. The large insurer, which acquired a series of outpatient surgery centers captured, has several lucrative healthcare companies like its very own pharmacy benefit manager as well as other talking to arms through its Optum unit.

As the companies promote these partnerships to employers and consumers as you-stop shopping, they might also put customers in a disadvantage by restricting their choices and growing medical costs.

Under these plans, people may be unable to see doctors outdoors the organization’s own medical group. Additionally, patients may worry their physician will decide to not order an…

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