In typhoid fever there is need of certain dietary modifications due to increase need of energy during typhoid fever. The following dietary modifications are required during typhoid fever:

Energy requirements in typhoid:

In typhoid fever, like any other fever the BMR (basal metabolic rate) increases. Due increased BMR the energy requirement increases. The energy need is also more if there is restlessness. But due to loss of appetite the patient of typhoid fever, may be able to take only 1000 kcal to 1200 kcal per day. This energy (food) consumption should be gradually increased to meet increased energy need in typhoid fever.

Protein requirements in typhoid:

During typhoid fever protein requirement also goes up. Increased protein intake will also make the recovery much faster. Foods with high protein and easy digestible foods like eggs should be taken to make up the increased requirements of energy.

Carbohydrates requirements in typhoid:

Increased requirement of energy during typhoid fever is generally met by increased intake of carbohydrates. The carbohydrates should be easily digestible as well as easily absorbable. Well cooked, easily digestible carbohydrates like starches, glucose, honey, sugarcane etc. should be taken in liberal amounts during typhoid.

Fats requirements in typhoid:

The fat requirement in typhoid fever is mainly for increased requirements of energy (as fats are the providers of highest calories). The fats should be easily digestible and easily absorbable (like butter, cream and milk fat). If diarrhea, is a presenting symptom of typhoid, than fat intake should be restricted.

Mineral requirements:

There is excessive loss of electrolytes like sodium, potassium and chloride due to increased sweating and also due to diarrhea in some patients with typhoid. Salty soups, broths, fruit juices and milk help compensate the loss of electrolytes.

Vitamins requirements in typhoid:

Infection and fever can increase the requirement of vitamins (vitamin A, B complex and C). Due to increased requirements the vitamin supplementation may be required or supplied adequately in the diet.

Dietary fibers in typhoid:

Due to the chance of injury in the digestive tract in typhoid the diet should contain less fiber. All types of harsh and irritant foods also should be avoided.

Fluids requirement in typhoid:

In typhoid there may be increase loss of fluid and electrolytes. In order to compensate for the losses through the sweat and also to ensure adequate volume of urine for excreting waste, a liberal intake of fluids is very essential. Fluid intake should be 3 to 4 liters per day during fever. Fluids may be taken as water, tea, milk, juices and soups.

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The day after a panel of experts advised the Food and Drug Administration to go ahead with plans to revoke approval of Avastin to treat breast cancer, European authorities moved in the opposite direction.

The European Commission gave the OK to an expansion of Avastin's approval to include using the drug in combination with Xeloda, a chemotherapy drug, to treat metastatic breast cancer, Genentech parent company Roche said Thursday.

The Europeans considered the same information that hasn't proved persuasive to U.S. regulators. Among other things, a study called RIBBON 1 found Avastin plus Xeloda increased progression-free survival of women by 2.9 months over women getting Xeloda alone.

 

In a statement, Genetech's Chief Medical Officer Dr. Hal Barron said the company is "pleased with this outcome because it means that women with metastatic breast cancer and their physicians will now have an additional treatment option in Europe."

The diverging decisions show how two regulators can reach different conclusions about the clinical significance of the same data.

In explaining its decision to seek the withdrawal of Avastin's fast-track approval for breast cancer, the FDA wrote last year about data from RIBBON 1 and other studies:

The addition of Avastin to chemotherapy resulted in only a small delay in tumor growth (i.e., progression-free survival, PFS), and the average time it took for tumors to progress seen in these trials was much shorter than had been expected based on the data from an earlier trial that led to accelerated approval.

Typhoid is a common waterborne disease, especially in the developing countries due to lack of safe drinking water supply and poor personal hygiene among people (due to high prevalence of illiteracy and poverty). Another important cause of transmission of typhoid is the ability of Salmonella (the causative organism of typhoid is Salmonella typhi and Salmonella paratyphi) organism to survive even in freezing temperature for long time and survive in ice creams for long duration. Due to the ability the organisms to survive in ice cream and extreme cold they are easily transmitted through ice cream.

In the developed countries typhoid is almost eradicated by provision of safe drinking water to the entire population and by improvement of environmental sanitation. Poor habits of defecation (e.g. open air defecation in many developing countries) are a major cause of high prevalence of typhoid in developing world.

• To maintain adequate nutrition during typhoid fever is very important. Loss of appetite may be a problem during typhoid fever and during this time marinating of adequate nutrition may pose a problem.
• During typhoid fever there may be water and electrolyte disturbance in the body due to loss of body fluids and inadequate intake of oral fluids. Diarrhea is sometimes a symptom of typhoid and need fluid replacement. Maintaining of water and electrolyte is very important during water and electrolyte fever.
• Along with maintaining of adequate nutrition (mainly calorie) the provision of adequate quantity of protein through diet is also very important. Without adequate protein the recovery from typhoid fever may be slower. Proteins are also essential for healing of wounds.
• By taking a planned and balanced diet the recovery from typhoid fever is much faster. With proper diet the symptoms of typhoid fever also disappear faster.

By planning a proper diet for a patient of typhoid fever, the recovery from typhoid fever can be very fast and without much complications of typhoid fever.

 

 

iStockphoto.com

Can seniors afford to pay more for Medicare?

Medicare patients would pay more â€" in some cases much more â€" under a bipartisan bill introduced in the Senate today. But can they really afford it?

Sens. Tom Coburn (R-OK) Joe Lieberman (I-CT) say the savings to be realized from their bill would both help reduce the nation's debt and shore up Medicare's shaking financial situation.

Among other things their bill would combine the current separate deductibles for Medicare's Part A (hospital and inpatient care) and Part B (physician and outpatient care) into one single deductible. Because so few Medicare patients actually use hospital care each year, that would have the effect of raising out-of pocket spending for the majority of people on the program.

 

To discourage what they say is the overuse of care because supplemental private insurance covers what Medicare doesn't pay, the bill would also prohibit such policies from paying the first $550 per year in required cost-sharing and limit coverage to 50 percent of a newly created $7,500 out-of-pocket annual maximum beneficiaries could be required to pay.

Wealthier beneficiaries, meanwhile (those earning more than $85,000 per year) would have to pay higher premiums, and would face a higher out-of-pocket maximum threshold.

But while the legislation, if passed, could take relieve some financial pressure on Medicare, a new study from researchers at Kaiser Family Foundation and the Urban Institute suggests that seniors overall aren't as prosperous as many politicians seem to think.

Half of seniors had income lower than $22,000 in 2010; 25 percent had income lower than $13,000. Only five percent had incomes above $85,000.

And while 91 percent of today's Medicare beneficiaries have savings, in most cases those nest eggs aren't nearly enough to pay substantial medical bills. Half of seniors have savings less than $50,000; a quarter have less than $8,400 money set aside. Ten percent had more than half a million dollars, half of those people had a million dollars or more.

Yet even with today's Medicare coverage, health spending accounted for an average of nearly 15 percent of the average Medicare household's budget in 2009, according to another Kaiser study. That's three times the health care spending for those not on Medicare.

Sure, most of the changes that are envisioned for Medicare are not for this generation, but for the coming one. But the future doesn't look much better for the baby boomers, the researchers found. While incomes are likely to rise somewhat, income inequality is likely to rise as well. That means beneficiaries who are white and college-educated are likely to fare better than blacks or Hispanics, or those with less education.

Tuberculosis is still a general public health problem in many developing countries such as India. As tuberculosis is common in developing countries, where poverty and malnutrition are also rampant, tuberculosis takes a huge toll on health of the nation as a whole and affects individual health in particular. Tuberculosis patients are generally malnourished and malnutrition is one of the cause of reduced body immune status (malnutrition can not supply adequate proteins and proteins are vital in maintaining immune status of an individual). Due to the possibility of malnutrition in tuberculosis patients it is important to provide proper nutrition to them with adequate protein in the diet. Tuberculosis diet should be a balanced one with provision of all essential nutrients.

The following dietary modifications are recommended in tuberculosis:

Energy:

The requirement of energy (calorie) is increased in tuberculosis. This increased energy requirement is to minimize weight loss and for speedy recovery from tuberculosis.

Proteins:

Tuberculosis generally has fever of long duration and in fever of long duration there is considerable loss of tissues and to compensate tissue loss the protein intake should be higher in tuberculosis. Serum albumin is also reduced in tuberculosis.

Carbohydrates:

The carbohydrate content of diet of tuberculosis patient should be enough to meet increased energy demands, which generally comes from carbohydrates.

Fats:

The fat content should be moderate in tuberculosis, because too much fat can frequently cause stomach upset and diarrhea.

Vitamins:

The diet of tuberculosis patient should have adequate amount of vitamins. Because some anti tubercular antibiotics use vitamins for their metabolism, especially vitamin B6, so vitamin content should be adequate in diet, especially vitamin B6.

Minerals:

The mineral content of tuberculosis diet should be high, especially calcium content. Liberal amount of calcium is required for proper and faster healing and recovery of tuberculosis. For enough calcium, milk and milk products should be taken in liberal quantities. There may also be anemia in tuberculosis patients due to malnutrition and iron should be supplied adequately in diet or supplemented artificially.

There's a lot of chatter about how public policy can influence doctors' decisions about which new patients to see and which to turn away.

One big question: Does the squeeze on Medicare that has limited the program's pay increases to doctors lead them to see fewer of those patients?

Some researchers decided to look at recent data for clues. And they found a slight drop â€" a little less than 3 percent in the proportion of doctors taking new Medicare patients between 2005 and 2008.

But that drop, which still left 93 percent of docs taking new Medicare patients, wasn't much compared with the hit for patients with typical private insurance.

 

For those people, there was a 5.5 percentage point drop, leaving about 88 percent of physicians who would add them as new patients.

The greater decline in doctors accepting private insurance was "unexpected," the researchers write in the latest issue of Archives of Internal Medicine, where the findings appear.

What's going on? I asked lead author Dr. Tara Bishop, an internist and assistant professor of public health at Weill Cornell Medical College in New York. She said there are a couple of possible reasons. Some doctors may be bucking the administrative hassles of private insurance, she said.

Medicare may not always pay top dollar, but it's pretty reliable. And, she said, Medicare is still the largest payer, so it's hard for doctors not to accept those patients.

For her part, Bishop sees patients with all kinds of insurance. But she said the findings are worrisome. "If these trends continue we may have problems getting care to patients in the ambulatory setting," she said. "It's possible patients might have health insurance but not be able to see a doctor."

We all know Revitol Stretch Mark Prevention cream is claimed to bring back the normal shape in skin with stretch marks (may be due to any reason such as pregnancy, obesity or any other cause) and transform the skin. The bringing back of normal shape of skin is said to be due to increase in the natural production of collagen as well as elastin, which makes the stretch marks (and also scar marks, which occurs due to injury to skin) of the skin less noticeable. Older stretch marks are more difficult to heal and for that, treatment should start during pregnancy, before stretch marks develop, to prevent stretch marks from developing by improving the elasticity and firmness of skin.

The Revitol anti-stretch mark cream or revitol stretch mark prevention cream contains several ingredients, such as Argirelene, antioxidants, vitamins, moisturizers etc. which comes from squalene oil, aloe vera extract, grapefruit seed extract and some other materials. Revitol stretch mark prevention cream also contains glyceryl stearate, glycerin, vegetable emulsifier, stearic acid, allantoin, potassium sorbate, sodium benzoate etc.

Now, the question is, does Revitol stretch mark prevention cream actually works?

The question is not easy to answer. Manufacturer of Revitol Stretch Mark prevention cream guarantee the effectiveness of the product and to support their guarantee, they offer a 90-day money back policy if anybody would ever want their money back, if any customer is not satisfied with their result. The manufacturer of Revitol Stretch Mark prevention cream do not claim that their will be complete removal of stretch marks. The manufacturer claims that there will be significant (?) reduction of stretch marks in the skin after using the Revitol Stretch Mark prevention cream and it can prevent (to a greater extent) development of stretch marks.

If you are thinking to use Revitol Stretch Mark prevention cream you should read honest reviews and decide on your own. It is better to use the Revitol Stretch Mark prevention cream for prevention of stretch marks, rather then using it after stretch marks develop. Another important point about Revitol Stretch Mark prevention cream is the 90-day money back policy of the product. This type of money back policy is usually given by honest manufacturers, as they are sure of the effectiveness of their products.

Enlarge Amriphoto/iStockphoto.com

Swaying to and fro can help you rest easier.

Amriphoto/iStockphoto.com

Swaying to and fro can help you rest easier.

Nuts and yogurt came out as big winners in new research we discuss in this week's podcast, while potatoes were losers. The contest? Which foods can help you keep weight off as you age.

Nuts also came up big in a post about food allergies, though in a more ominous light: They're one of the more common causes of extreme allergic reactions to food in kids, a new allergy estimate shows.

We've also got some news about hammocks. It turns out the gentle rocking motion makes people fall asleep faster, and they sleep more deeply. These findings could inspire new ways to help insomniacs, the researchers say.

And we hit the latest controversy in health policy: a survey from consulting giant McKinsey & Co. found as many as 30 percent of employers might drop health insurance in a few years because of the federal law overhauling health care. But the results, at odds with other research, sparked questions about how and why the survey was conducted.

And we hear about the dark history of eugenics laws in North Carolina and the forced sterilizations that once occurred there.

To subscribe to the Your Health podcast, click here.

What is pseudoacromegaly?

Pseudoacromegaly is a medical condition with some clinical features of acromegaly, but without any increase in growth hormone or IGF-1 (intrinsic growth factor). Pseudoacromegaly is commonly associated with insulin resistance and there are reports of Pseudoacromegaly in patients receiving minoxidil (an arterial vasodilator medicine sometimes used in high blood pressure when other antihypertensive drugs fail to act) at high doses.

What are the complications of acromegaly?

Acromegaly may cause complications such as severe headache, high blood pressure, enlargement of heart, heart failure, diabetes mellitus, kidney failure, visual defects (especially loss of vision in the outer visual fields known as bitemporal hemianopia) due to compression of optic nerve. Other less serious complications of acromegaly are excessive sweating and seborrhea (excess production of sebum). Both of these indicate active growth hormone producing pituitary tumor.

How acromegaly is diagnosed?

Initially acromegaly is suspected by appearance of patients. After clinical suspicion of an individual, imaging and laboratory investigations are used for confirming diagnosis.

• MRI scan of brain using gadolinium contrast is commonly used imaging technique for delineation of the pituitary from other brain tissues.
• Estimation of IGF-1 in blood is highly sensitive for diagnosis of acromegaly and is commonly used for diagnosis.
• Growth hormone values (especially single value) may be of little use as blood levels of growth hormone vary greatly even in healthy individuals. If growth hormone level is used for diagnosis of acromegaly, it should be estimated 2 hours after a 75 or 100 gram glucose tolerance test. GH levels are suppressed in normal individuals and normally below 1 ?g/Liter.  Growth hormone levels higher than1 ?g/Liter is confirmatory of acromegaly if taken 2 hours after a 75 or 100 gram glucose tolerance test.
• Other laboratory tests can support diagnosis of acromegaly, such as thyroid stimulating hormone (TSH), gonadotropic hormones (such as lutinizing hormone or LH and follicle stimulating hormone FSH), prolactin, adrenocorticotropic hormone (ACTH) etc.

Enlarge Courtesy Archives of Otolaryngology â€" Head & Neck Surgery

A 9-year-old boy's tongue just before it was freed from the neck of a metal water bottle by Duke University doctors.

Courtesy Archives of Otolaryngology â€" Head & Neck Surgery

A 9-year-old boy's tongue just before it was freed from the neck of a metal water bottle by Duke University doctors.

This is a post for all the kids who stick their tongue in places they shouldn't, and the parents who tell them not to.

Late one afternoon last September, an EMT crew delivered a 9-year-old boy to the emergency room at Duke University Hospital in North Carolina. His problem was obvious. His tongue was stuck inside a metal drinking bottle. Really stuck.

The boy was drooling and unable to swallow. He was scared and in pain.

At school a few hours before, he'd pushed his tongue through the bottle's neck and sucked hard, creating a vacuum. Funny, right?

Not so much, actually. His tongue swelled, and he couldn't get it out. Neither could anybody at the school. The bottle wouldn't budge even after the EMTs arrived and drilled holes in it to break the vacuum.

 

So, it was off to the hospital for the lad. The ER docs took a look and quickly paged the otolaryngology resident on call, Dr. Chad Whited.

After the kid got plenty of pain medicine, the team cut off the bottom of the bottle with a saw used to remove casts. Then, with the tongue exposed, they tried "gentle traction, lubricant, a malleable retractor and a popsicle stick" to loosen it, according to a report about the case in the latest issue of the Archives of Otolaryngology â€" Head & Neck Surgery. No dice.

Time to cut through the top of the bottle, they decided. After gently snaking a thin metal ribbon between the rim of the bottle and the boy's tongue for protection, they used some disinfected tinsnips from the hospital's engineering department to slice through.

After the doctors got started, it took them about 10 minutes to cut the bottle free. "The patient was really sore but very relieved, as was his mother," Whited tells Shots.

Attending physician Dr. Walter T. Lee, a co-author of the paper describing the case, says he's never seen or heard of anything quite like it in his dozen years of practice. But there are reports in the medical literature of people's tongues getting caught in glass bottles, cans and balloons.

So what should parents do if a kid's tongue gets trapped? "Kids will be kids," Lee, a dad as well as doctor, acknowledged. "The main thing is to trust your parental instinct. You can try to get if off, but if the kid is screaming in pain or is uncooperative there's no shame in showing up at the emergency room."

But don't take too long deciding, Lee says. The big worry about this boy's case was that his tongue would become so swollen it would interfere with his breathing. Happily that didn't happen. The picture below, taken right after the bottle was removed, shows the boy's swollen but liberated tongue.

Enlarge Courtesy of Archives of Otolaryngology--Head & Neck Surgery

All's well that ends well.

Courtesy of Archives of Otolaryngology--Head & Neck Surgery

All's well that ends well.

The most common cause of acromegaly is excessive growth hormone producing and secreting pituitary tumor. Acromegaly can also result due to other less common tumors such as tumor of pancreas, lungs, and adrenal glands which also secrete excess growth hormone.

This is the commonest cause of acromegaly and accounts for more than 90% of cases of acromegaly. Pituitary adenoma is a benign tumor of pituitary gland. Pituitary adenomas produce excess growth hormone and as they expand in size (due to growth of tumor), they may compress surrounding brain tissues, such as optic nerve and visual disturbances. Increasing size of tumor may also lead to headache, which is seen in many acromegaly patients. The growing (expanding) pituitary adenoma can also compress the normal pituitary tissue and lead to reduced production and secretion of pituitary hormones such as testosterone, which can cause impotence in men and changes in menstruation and breast discharge in women.

Some patients (especially young adults diagnosed with acromegaly), tend to have aggressive tumors which grow very fast and invade and compress surrounding brain tissues, whereas some patients have slowly growing tumors and symptoms may take many years to develop.

Pituitary adenomas are not genetically inherited and arise due to spot mutation and spontaneously. Mutation occurs in the genes which controls the transmission of chemical signals within pituitary cells.

Other tumors causing acromegaly:

There are tumors, other than pituitary adenomas, which can secrete growth hormone and cause acromegaly, e.g. tumors of lungs, pancreas and adrenal glands. Sometimes these tumors produce growth hormone themselves, but in general these tumors produce Growth Hormone Releasing Hormone (GHRH), which stimulate pituitary gland to produce and secrete more growth hormone. Estimation of blood GHRH can establish case of acromegaly and removal of the tumor secreting GHRH can bring down growth hormone level to normal and improve symptoms of acromegaly.

Enlarge iStockphoto.com

Doctors who talk to a patient before surgery are less likely to operate on the wrong limb than those who first see the patient when he or she arrives in the operating room.

iStockphoto.com

Doctors who talk to a patient before surgery are less likely to operate on the wrong limb than those who first see the patient when he or she arrives in the operating room.

Back in 2004, the Joint Commission, a group that certifies health care providers, issued rules to try and prevent wrong-site surgery â€" terrible blunders involving the wrong limb or the wrong surgery.

The rules were supposed to became mandatory in hospitals and accredited outpatient centers. At the time, the president of the group that issued the rules called them so obvious that even if they weren't "quite Dick and Jane" simple, they were "pretty close."

He predicted that marking the correct site for surgery on each patient and conducting a timeout could help stop doctors from amputating the wrong leg, cutting into the wrong patient, or performing the wrong surgery.

But these devastating mistakes have continued unabated, and recent estimates put the number at 40 per week in the United States. Studies of wrong-site errors have consistently revealed a failure by physicians to participate in a timeout. Patient safety experts are now demanding a more nuanced, standardized approach.

 

"The Joint Commission didn't tell people how to do it, so people didn't necessarily do it effectively," said surgeon John Clarke, clinical director of the Pennsylvania Patient Safety Authority, and an expert on wrong site procedures. "There are there subtleties that make a difference."

Communication, it turns out, is essential. Doctors who talk to a patient in the pre-operative area are less likely to make a wrong-site error than those who first see the patient when he or she is wheeled into the operating room.

The attitude of the doctor â€" the captain of the team in the operating room â€" is just as important. Those who explicitly ask lower-ranking members to say something if they see something that doesn't look right are less likely to make an error.

Atul Gawande, a Harvard Medical School surgeon and New Yorker writer, noted the value of teamwork in his recent book The Checklist Manifesto: How to Get Things Right. When introductions in the operating room were made before a surgery, Gawande writes, the average number of complications and deaths fell by 35 percent.

Not doing so can have serious consequences. Pennsylvania officials recently described one such case in which a surgical technician realized that a surgeon was operating on the wrong side, but didn't say anything until the patient was in the recovery room after surgery.

Preventable mistakes like these happen when lower level staff members are fearful of incurring the wrath of the surgeon, Clarke said. "There's a big difference between hospitals that take care of patients and those that take care of doctors," he added.

Some hospitals are devising ways to ensure that doctors participate in the timeout: the final step and last line of defense. A recent study of wrong site errors in Colorado found that in 72 percent of 132 cases, doctors did not.

One Minnesota hospital uses a "timeout" towel: The nurse in charge throws a sterile towel over the surgical instruments, which are not to be uncovered until the timeout has been completed.

The prevalence of type 1 diabetes mellitus is approximately 5%-10% of all diabetes patients, which is estimated to be approximately 10 to 20 millions in the world. Every year approximately half a million individuals below 14 years of age are diagnosed with type-1 diabetes worldwide. Undoubtedly, type-1 diabetes is the primary type of diabetes among children below 10 years of age and the incidence of type1 diabetes is increasing. The rate of prevalence of type-1 diabetes varies greatly in different parts of the world, e.g. in China the prevalence rate of type-1 diabetes is less than 0.1 per 100,000 population, whereas in Finland the prevalence of type-1 diabetes is as high as 37 per 100,000 people.

It was previously thought that type-1 diabetes is essentially a disease of the young (most commonly affect younger age group) and was distinguished from type2 diabetes, which is generally diagnosed at much older age than type-1 diabetes. But the scenario is changing and presently new-onset type 1 diabetes is diagnosed in adults.

There are several organizations and research foundations which are engaged in research, to find a solution for type 1 diabetes and trying to find a cure, such as JDRF (Juvenile Diabetes Research Foundation). The aim of foundations such as JDRF is to fund research activities across the globe and find a cure for type 1 diabetes.

The Diabetes Research Institute Foundation is another research foundation, dedicated for research in diabetes and to find a cure for diabetes, which is founded by a group of parents with children with diabetes with an aim of finding a cure for type-1 diabetes. Other well known organizations involved in diabetes research and cure include, ADA (American Diabetes Association), International Diabetes Federation (with branches in over 160 countries), Canadian Diabetes Association, Diabetes Australia etc.

 

Enlarge Michael McCloskey/iStockphoto.com

"We stand by the integrity and methodology of the survey," McKinsey says.

Michael McCloskey/iStockphoto.com

"We stand by the integrity and methodology of the survey," McKinsey says.

Under fire from Democrats in Congress, consulting firm McKinsey & Co. today released its methodology for a controversial survey that found as many as 30 percent of employers might drop health insurance after the new health law takes effect in 2014. But the hot water McKinsey's in doesn't seem to be cooling off.

From the start, the survey raised eyebrows because its findings were so at odds with other studies that predicted far fewer employers would drop insurance for their workers. McKinsey acknowledged in its original article about employers' possible reaction to the law's implementation that "our survey educated respondents about its implications for their companies and employees before they were asked about post 2014 strategies."

What that "education" was, however, was unknown. Until now, that is.

 

It turns out that in question 41, employers were told, "Assume exchanges become an easy, affordable way for individuals to obtain health insurance." Then they were given examples of how much low and moderate-income workers would likely have to pay for that insurance, given the availability of federal subsidies. (Hint: Not that much; the maximum annual premium for a family of four earning $44,100 is likely to be around $2,778, they were told.)

"Given this information, how likely do you think your company would be to discontinue employee health coverage?" they were then asked. That question alone prompted 36.6 percent of small (fewer than 49 worker) businesses to say they would definitely or probably stop offering coverage and 26.3 percent of larger firms to say the same thing.

Still, McKinsey insisted that it did not intend its survey â€" which was conducted for its own use, and not at the behest of any particular client â€" to be used "as a predictive economic analysis of the impact of the Affordable Care Act."

The statement from the company read, "We understand how the language in the article could lead the reader to think the research was a prediction, but it is not."

And after two weeks of complete silence, McKinsey now says the survey has its full backing. "We stand by the integrity and methodology of the survey," the company said.

But critics are anything but assuaged. "This report is filled with cherry-picked facts and slanted questions â€" it did not provide employers with enough information for them to make honest choices and fair evaluations," said Senate Finance Committee Chairman Max Baucus, who was one of the first to demand the McKinsey release its methodology. "Rather than correct the major deficiencies in their report, McKinsey has chosen to again stand by their faulty analysis and misguided conclusions."

Meanwhile, yet another study is out today that conflicts with McKinsey's take on the matter. Avalere Health, a Washington-based consulting firm, did its own its own interviews and examined existing studies, and concluded that the overall market for employer-provided health insurance "will likely remain relatively stable after 2014," when the law takes full effect.

Said Avalere, "Stability in (employer-provided insurance) is driven by expectations that large firms, whose policies cover more people than small- and medium-firm policies combined, will continue offering health benefits" as well as the likelihood that smaller firms will take advantage of new opportunities afforded them to purchase lower cost insurance under the law.

Several studies conducted in the United States and some countries of Europe shows several striking results such as the collision rate of individuals (drivers) with type-1 diabetes is twice as that of normal or non diabetic individuals, which shows that there is increased risk of driving collisions in the individuals with Type 1 diabetes. There are several reasons for increased risk (double) of driving collisions for drivers who are suffering from, type 1 diabetes.

The first reason is eye complication (diabetic retinopathy) of patients with diabetes (type 1 diabetes as well as type 2 diabetes), which results in loss of vision (mainly peripheral vision) and/or visual acuity. Due to visual impairment, the driver with type 1 diabetes may not be able to read street signs properly, which may lead to motor accidents such as collisions. If drivers can not read the road signs properly, it may hamper driving, e.g. signs of speed limit, if missed may lead to accident due to over speeding.

The next or second reason is peripheral neuropathy caused by type-1 diabetes. Due to development of peripheral neuropathy, the diabetic individuals may not have normal sensation in their feet, which can impair drivers ability to control speed and also apply appropriate pressure to the brakes during driving and lead to collisions and other accidents.

Hypoglycemia (lower than normal blood sugar level) can have effect on state (level) of consciousness and thinking process, both of which are essential for driving. If there is impairment in thinking process, coordination and consciousness (all of which are vital for driving and avoiding accidents) there may be increased incidence of collisions and other motor accidents.

To avoid collisions and other accidents, individuals with type-1 diabetes the following steps are recommended:

• Do not drive when blood glucose is below 70 mg/100 ml of blood. If you need to drive, you should first treat hypoglycemia and wait till your blood sugar is above 90 mg/100 ml of blood.
• If you are type 1 diabetes patient, learn about the causes of hypoglycemia in type 1 diabetics (you).

National Institutes of Health (NIH) have funded some research for safe driving by type 1 diabetics. You can find the internet version which has proved to be beneficial for type 1 diabetics.

Click this link for the internet version of the training for safe driving by type 1 diabetics.

Enlarge Damian Dovarganes/AP

Belmont Senior High School cafeteria manager Carol Avalos stocked a refrigerated case with milk cartons in the Los Angeles school's cafeteria last month. The chocolate milk on the top shelf will soon be a thing of the past.

Damian Dovarganes/AP

Belmont Senior High School cafeteria manager Carol Avalos stocked a refrigerated case with milk cartons in the Los Angeles school's cafeteria last month. The chocolate milk on the top shelf will soon be a thing of the past.

This week's podcast is stuffed with food stories.

We talk about the best and worst fruits and vegetables when it comes to pesticide residues, according to the Environmental Working Group. The advocacy group identifies apples, celery and strawberries as being the worst, while pointing to onions, sweet corn and pineapples as the best.

We also discuss the Los Angeles School District's recent ban of chocolate milk from school lunches. And whether the Obama administration will consider screening for more E.coli strains in light of the recent outbreak of foodborne illness in Europe.

We chat about new rules from the FDA that will require makers of sunscreens to more clearly define how their products protect against ultraviolet rays. The rules, which take effect next summer, could lead to confusion, even for a lifeguard.

Plus, we'll hear a story about stem cell research that could potentially replace heart cells that are damaged or destroyed by heart disease.

To subscribe to the Your Health podcast, click here.

Enlarge Charles Krupa/AP

Sugarsnap peas are ready for harvest at the Many Hands Organic Farm in Barre, Mass., in the summer of 2009.

Charles Krupa/AP

Sugarsnap peas are ready for harvest at the Many Hands Organic Farm in Barre, Mass., in the summer of 2009.

It may seem counterintuitive, but foods that are grown to organic standards can contain commercially manufactured pesticides.

A U.S. Department of Agriculture survey of produce that found nearly 20 percent of organic lettuce tested positive for pesticide residues piqued our interest. Lots of the lettuce contained quite a bit of spinosad, a pesticide marketed by Dow Chemical under the brand name Entrust.

 

So we called Jeff Gillman, a professor of nursery management at the University of Minnesota, who has written about organic practices for lay readers. Right off the bat he told us:

When people are buying organic food, they often make the incorrect assumption that there are no pesticides. It's true that organic production often uses fewer dangerous chemicals, but certain pesticides are allowed.

It turns out that a key factor in chemicals being cleared for use on organic crops is whether they occur naturally. Spinosad, for example, comes from the soil bacterium Saccharopolyspora spinosa. It can fatally scramble the nervous systems of insects. It's also poisonous to mollusks.

The USDA maintains an official list of substances that can and can't be used for organic farming. Other potent natural extracts that have been approved for use as pesticides include pyrethrin, derived from chrysanthemums, and azadirachtin, from the Asian neem tree, which was also detected on some samples of organic lettuce.

All three of these substances are considered slightly toxic by the EPA.

Synthetic compounds can also make it onto the list as pesticides, if they are relatively nontoxic combinations that include minerals or natural elements, such as copper or sulfur. But some naturally occuring substances, such as nicotine and arsenic are off limits.

Are naturally derived pesticides less toxic than synthetic ones? The answer depends a lot on the dosage, says Gillman. "To control fire blight on the same acre of land," he explains, "I could use a tiny amount of a potent synthetic that has proved safe over the last 50 years, or a much larger amount of an organic pesticide." He demurs on saying which is better, saying, "I want people to know that there are definitely tradeoffs."

In the USDA tests, there was ten times as much spinosad on organic lettuce than was found on conventionally cultivated fruits and vegetables.

Gillman wasn't alarmed by the spinosad finding:

It's a relatively new chemistry, relatively safe, and extremely effective against some pests. Now, if I heard about high levels of copper being detected, I'd be more scared than for this stuff.

Copper compounds are used to fight fungal and bacterial diseases in plants. Copper isn't very toxic to humans, he says, but it can accumulate in the soil and eventually become poisonous to plants and even worms at high concentrations.

The seeming contradiction between organic labeling and potentially harmful pesticide practices may lie in the relative leniency of the USDA organic guidelines, Gillman says. Various organic certification agencies, such as the Oregon Tilth, have tighter rules. (Check out this roundup of acceptable and forbidden pesticides.)

Gillman says just because an organic farmer used some authorized chemicals is no reason to shun the food. But it's important for consumers to know what's going on. For him, the answer to the ambiguity around organic labeling is to go local. "I go to the farmers market and talk to the growers to see who is serious about reducing pesticide use," he says. "I'd rather buy food from someone who used Roundup once than someone who uses organic pesticides all the time."

Stretch marks on the skin occur, when there is excessive stretching on the skin for prolonged period of time, (such as due to pregnancy, skin over abdomen becomes stretched for several months or in case of obesity there may be stretch marks anywhere in the body where there is excess deposition of fat in the subcutaneous tissues i.e. tissues just below the skin or dermis).

There are many cream based preparations available in the market with tall claims of removing stretch marks completely. But the fact is, no cream can remove stretch marks completely. Most of the anti-stretch mark creams can remove stretch marks significantly, but not completely. But unfortunately most anti-stretch mark cream manufacturers’ claim that their product can remove stretch marks completely, which is in truth very far from it. If you are thinking to buy anti-stretch mark cream for your stretch marks, buy anti-stretch mark cream or product which do not give false promise but deliver what they claim.

While searching for an effective anti-stretch mark cream, I came across many products with claims to remove stretch marks completely. But I know that no product can remove stretch marks completely, because stretch marks cause deposition of fibrous tissues, collagen etc. in the area which have permanent presence. In presence of permanent fibrous tissues (which can not be removed by use of any medication available at present), it is not possible to remove stretch marks completely and any body claiming to remove stretch marks completely is a false claim.

If you are thinking to buy anti-stretch mark cream, do not fall into traps with false and tall claims and instead go products that have realistic claims and which can deliver what they claim.

Stretch marks on the skin occur, when there is excessive stretching on the skin for prolonged period of time, (such as due to pregnancy, skin over abdomen becomes stretched for several months or in case of obesity there may be stretch marks anywhere in the body where there is excess deposition of fat in the subcutaneous tissues i.e. tissues just below the skin or dermis).

There are many cream based preparations available in the market with tall claims of removing stretch marks completely. But the fact is, no cream can remove stretch marks completely. Most of the anti-stretch mark creams can remove stretch marks significantly, but not completely. But unfortunately most anti-stretch mark cream manufacturers’ claim that their product can remove stretch marks completely, which is in truth very far from it. If you are thinking to buy anti-stretch mark cream for your stretch marks, buy anti-stretch mark cream or product which do not give false promise but deliver what they claim.

While searching for an effective anti-stretch mark cream, I came across many products with claims to remove stretch marks completely. But I know that no product can remove stretch marks completely, because stretch marks cause deposition of fibrous tissues, collagen etc. in the area which have permanent presence. In presence of permanent fibrous tissues (which can not be removed by use of any medication available at present), it is not possible to remove stretch marks completely and any body claiming to remove stretch marks completely is a false claim.

If you are thinking to buy anti-stretch mark cream, do not fall into traps with false and tall claims and instead go products that have realistic claims and which can deliver what they claim.

Obama administration officials unveiled a plan to improve our nation's prosperity. No, not with more jobs, but by helping Americans stay healthy at every stage of life.

iStockphoto.com

But first, they got a workout congratulating each other on a job well done with the National Prevention Strategy, a plan required by the federal law overhauling health care, during a Thursday media briefing.

Some of the key players behind the plan, including Department of Health and Human Services Secretary Kathleen Sebelius, Surgeon General Regina Benjamin and Senator Tom Harkin, were on hand to outline a broad, and sometimes cryptic, blueprint for improving the nation's health.

 

Sebelius said the plan "will help us transform our health care system away from a focus on sickness and disease to a focus on prevention and wellness." That shift, she said, would help "people live long and productive lives and can help combat rising health care costs."

Some 17 federal agencies are expected to be involved in executing the plan, which was developed by the National Prevention Council. The plan would draw on a wide range of health workers, institutions, community-based organizations and government agencies for help.

The strategy aims to reduce leading causes of death and illness, such as smoking, bad eating habits and drug abuse.

"For every dollar we invest in prevention, we save $6," said Sen. Tom Harkin (D-IA), a major supporter of the strategy, who was also in attendance. We need to provide an approach that makes it easier to be healthy and harder to be unhealthy."

Programs such as the newly unveiled nutritional guidance called MyPlate are a start. It's "a simple tool on how to eat," said Surgeon General Benjamin. "Empowering people to make healthy choices."

She also noted the big challenge will be changing the way people think about health in this country. Rather than trying to cure a disease, the focus will be on how to prevent it. "It's too important for us to not make these investments," she said.

Under the plan, there will be a yearly status report that tracks and measures progress.

Alcoholism is one of the commonest (and there is no second opinion in this regard) substance abuse disorders and substance abuse disorders are major public health problem in many countries. The substance abuse disorders are more common in developed and underdeveloped (poor) nations. The developing countries have comparatively lesser problem of substance abuse, but in most developing countries also it is a major public health problem.

It is estimated that in the United States more than 10% (approximately 12%) adults suffer from alcohol dependency syndrome at some point in their life. In England (United Kingdom) the number of individuals with alcohol dependence (also called dependent drinkers) is estimated to be approximately 3 million and the number is increasing, unfortunately. According to a conservative estimate by WHO (World Health Organization) there are more than 140 million individuals (drinkers) who are dependent to alcohol, throughout the world. WHO also estimates that in United States and most European countries (the Western European countries mainly) have 10% to 20% of men and 5% to 10% of women meet the criteria for alcoholism at some point of their life.

Most medical communities consider alcohol as a drug of abuse. Like all drugs of abuse, alcohol satisfies the definition of drug abuse or drug addiction. The definition of drug abuse states that, drug addiction is a chronic, relapsing central nervous system disease, which is characterized by compulsive drug seeking and use of the abused drug.

In general alcohol abuse is more common among men, in compare to women. But in recent years, the difference is reducing and more women are drinking excessively and becoming alcoholics.

Men can tolerate alcohol better than women, i.e. the male liver can handle alcohol better than female liver (liver is the organ where alcohol is metabolized). In another word, same quantity of alcohol can have more deleterious effect in female than male of same body weight and age. Women also get intoxicated with lower quantity of alcohol in compare to men.

Enlarge Richard Drew/AP

Smoking and high rates of obesity in the U.S. are holding down gains in life expectancies, a new analysis finds.

Richard Drew/AP

Smoking and high rates of obesity in the U.S. are holding down gains in life expectancies, a new analysis finds.

Like politics, all health is local.

The expected lifespans for Americans born recently are impressive: 75.6 years for males and 80.8 years for females who entered the world in 2007.

We're living longer than ever. Well, some of us are. But many Americans aren't faring so well.

 

A fresh analysis of recent changes in longevity finds there are wide variations in how long people in the U.S. can expect to live, depending on their county of residence. So for American men, the life expectancy ranged from 65.9 to 81.1 years. For women, the outlook ranged from 73.5 to 86.0.

And when the outlook for Americans' lifespans is compared to those for people in other countries with the best life expectancies, we're falling behind.

As Dr. Christopher Murphy, senior author of the study, said in a statement, "Eight of 10 counties are not keeping pace," despite the U.S. spending more on health care per person than any other country on the planet.

Five counties in Mississippi, the researchers say, have the worst life expectancies for women â€" all less than 74.5 years, which is lower than places including El Salvador and Peru. Four of the same counties have the lowest life expectancies for men â€" all less than 67 years.

What are we doing wrong? High rates of obesity and smoking are two of the biggest factors in the poor relative performance for Americans, the researchers say.

Where are the Americans who've got it right? Women live an average of 86 years in Collier County, Florida. Men in Fairfax County, Virginia, live 81.1 years.

The analysis was performed by researchers from the Institute for Health Metrics and Evaluation at the University of Washington, with help from colleagues at Imperial College London.

The results were published online by the journal Population Health Metrics.

Ryan’s “vouchercare” is a false choice

Paul Krugman spends time today ripping Paul Ryan once more. Ryan’s plan is to limit government spending way off into the future (starting with people who are now 55) by giving them a flat Medicare voucher and then telling them to try it on for size in the individual insurance market. The joke is that there is a rational way to try to introduce some consumer-choice competition into Medicare. Essentially there are two alternatives to dealing with the mess that is Medicare. Oneâ€"try to manage Medicare spending both with a global budget (the IPAB) and with specific restrictions on care that’s delivered that’s wasteful or unnecessary (via changes in FFS payment). That’s essentially the route the ACA goes. Two, give recipients a voucher that lets them choose between competing entities that can’t charge more than the value of the voucher and actually are mandated to compete on the correct things (outcomes, service, etc) like they do in Holland and in Alain Enthoven’s theories. That’s rational managed competition under a global budget, and the winners in that would look more like Kaiser and Group Cooperative than today’s insurers. Ryan’s idea is just to subsidize the dysfunctional private marketplace and to repeal the minor restrictions the ACA puts on health insurers while he does itâ€"a sure-fire recipe for disaster.

There is of course another alternative. Just to let Medicare continue to spiral out of control on both costs and the quality of services it provides, and Ryan’s plan basically does that without a safety net

The NYTimes gets sensible on privacy

Today I got pretty depressed. I saw a link that 13 tech companies were funding a seminar put on by Deb Peel’s Patients Privacy Rights.org (and no I’m not helping with a link) It’s a big pity that sensible companies have been pressured into funding that organization and worse that somehow despite the gibberish Peel has spoken in so many places she’s accepted as being the main face of consumer concerns about privacy. Of course I’ve had my say about her in the past. However I was a little heartened by this Milt Freudenheim NY Times article which after decrying the “epidemic” of personal health information violations had both David Brailer and Wes Rishel basically saying, 1) yes there will be breaches, 2) no, that’s not a reason not to go electronic and c) we need a system that bans the illegitimate use of the dataâ€"rather than punishes the accidental breach. And no Deb Peel in sight. Well done NYT.

Medicare should pay less & differently

Easy to say. Rita Redberg from UCSF points out in the NY Times that Medicare pays for loads of procedures that we know are a waste of money. After all the COURAGE trial a while back showed that stents were a waste of money, and we put in more stents now than when the data were released. This shouldn’t be much of a surpriseâ€"we ignore the evidence all the time in making health care decisions. Brian Klepper in his wonderful but probably ineffective crusade to abolish the RUC shows that CMS (and therefore Medicare’s) payment methodologies are fundamentally flawedâ€"yet we can’t fix them either. So it’s easy to say Medicare should pay less and pay differently but the political will is just not there yet. It’s lucky the Chinese are so generous.

High costs cut drug use…and not in a good way

This pretty interesting study from Avalere Health confirms what several others have shown. If you add a user fee to any medical procedure people use less of it. And of course their decision to use it less is not based on whether it’s medically necessary or not; it’s based on how much it costs and what their income is. The difference with this study is that it’s about the use of expensive cancer drugs which are increasingly oral, now that oncologists aren’t being rewarded as much for delivering them via infusion. Co-pays of $500 or more saw “abandonment” rates of 25% or more. Other factors creating increased rates of abandonment included lower income (duh) and whether the patient was covered by Medicare or commercial insurance. The study was (of course) funded by a gaggle of drug companies. They didn’t fund the (non-existent) parallel study of which of these drugs actually did the cancer patients any good, but it’s not logical that cost should be the determi nant of whether a drugâ€"especially presumably a life-saving oneâ€"gets used.

Maybe there really is mobile health after all

OK, I’m kiddingâ€"but Ford Motor Co is excited enough about its new collaboration with WellDoc that it wanted to fly me to Detroit to take a look at it. (I declinedâ€"perhaps they should move their headquarters to San Tropez). Welldoc is a pretty interesting Web & iPhone based diabetes management tool (here’s a interview video I did with CSO Chris Bergstrom last February). Now Ford has put it in the car. Apparently they believe that it’ll interact with pollen counts and automatically turn on the AC (or at least this is what the “Wheels” blogger on the NYTimes took away from the meeting). But what is interesting is that they’ve integrated the speech to text version of Ford’s Syncâ€"which is the internal bluetooth system that allows people to talk to their car. It’s experimental, but it wouldn’t surprise me to see this in many more carsâ€"at least by the time I buy my next new one in 2024.

Wellpoint gets aggressive on inpatient payment changes

We’ve heard a lot of whining over the years from private insurers about how they have to pay more because Medicare pays less. But now Wellpoint is going to essentially use the ACA as cover to put all of its hospitals on a pay for performance planâ€"obviously related to the ACO ideas we’re hearing from CMS. The WSJ reports that all hospitals in Wellpoint’s networks are going to be paid future increases based on a formula for outcomes, patient safety and patient satisfaction. Thus far private insurers have been laggards in that they haven’t really mixed up payment schemes to incent better behavior by providersâ€"even though nothing was stopping them. They always claimed they would eventually. Maybe eventually is now.

Sorry, been busy!

You may have noticed that I haven’t been hanging around THCB much this week so far. Well I have a great excuse. This is my wife Amanda and our new daughter Colette. She was born on Sunday at 6 am and mom and baby are doing very well!

Where is there mHealth, really?

Health 2.0 aficionados will know that I’ve been railing against the term “mobile health” or “mHealth” for about three years. Health 2.0 is simply the next thing in health technology, and will remain so (whatever that might be). Sure we have a definition, but it’s about what’s happening not how it happens. Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part ofâ€"that’s the concept we call “unplatforms.” mHealth is like talking about cooking in the kitchen and only talking about the fridge. It’s damn important but you need a stove, a sink and more to make it all work.So if you have a mHealth strategy, as Susannah Fox might quote LOLcats, “URDoin it Rong”.

However, the place where it makes sense to talk abut mHealth is where there are only cell phones, and that place is large tranches of the rural developing world. This came up for me twice yesterday. once in a long chat with DataDyne’s Joel Selanikio who has a really cool product called EpiSurveyor that works not via SMS but via an app on simple phones and enables very cheap and easy data collection. The other was in a high profile announcement by Johnson & Johnson (a major funder of text4baby btw), which via its Babycenter subsidiary is introducingâ€"with USAID, State Department & the mHealth Allianceâ€" $10m program supporting the use of cell phones for maternal health in developing countries.

So for the health worker in the rural Bangladeshi village, lets have an mHealth strategy. For those of us in the developed world, we need an overall strategy to deal with data and applicationsâ€"whatever devices they are using.

Big community hospital CEO pay-out. Normal, criminal, both?

Salinas is a poor-ish rural California town down Highway 101 from Silicon Valley, and the financial contrast between the two is similar to that between Beverly Hills  and Bell, a California city where officials’ salaries sparked national outrage and then arrests. Now it turns out that the CEO of the local Salinas community hospital got a $4m retirement pay-out and a $150,000 a year pension and managed to stay on in his job for another two years at $668,000 a year and when he retired last week he got another payment of nearly $900,000. Can we expect the same in the Salinas case as in Bell? I doubt it because that would expose to the world that there are thousands of community hospitals all over America paying their CEOs the same kind of moneyâ€"ignoring the $1 million + salaries most AMCs dole out.  Can running a 300 bed hospital really be that difficult?

Feds on the Web: Medicare relaunches caregiver site

I’ve been impressed by the efforts of CMS and others in the Federal government to develop helpful websites. Medicare has just relaunched its Caregivers website. It’s got a nice variety of stories, links and resourcesâ€"including links to multiple partners offering support communities and other help. While the Physician Compare site had problems (and is a much more complex effort), I thought that Healthcare.gov was a good start to the complex world of finding health insurance, and the Health Indicators Warehouse is another good start at releasing masses of data in a usable format (FD Health 2.0’s Technology Guide is linked to as part of the site). Everything here can and will be improved, and much of this will be built on by the private sectorâ€"and that’s the way it should be. But given the scorn poured upon government, lets recognize the strides made.

It is difficult to determine the causes of alcoholism. Alcoholism is result of a complex mixture of environmental and genetic factors. It is difficult to determine whether genetics is more important cause of alcoholism or environment. There are many cases and studies that say genetics is more important and there are also studies which say environment is more important. The fact is, environment as well as genetics plays their role in causation of alcoholism.

Genetics play its role in causing alcoholism. Genes can influence the metabolism of alcohol and the role of genetics is clear from the fact that alcoholism runs in families. Individuals with genes that are predisposed to develop alcoholism tend to start drinking at an early age than individuals who are not genetically predisposed to become alcoholics. Studies have shown that, individuals starting to drink at younger age have higher risk of becoming alcoholics at later age, as more than 40% of alcoholics start drinking excessively by late adolescence.

Recent studies (evidence) shows that the role of genetics in causation of alcoholism is 50-60%, which leaves the remaining 40-50% to environmental factors. But if we consider at individual level any factor (environmental or genetics) may play the upper hand in causing alcoholism.

Environment plays an important role in causation of alcoholism. We all are aware that easy availability of alcohol is an important factor in alcoholism. In countries where alcohol is easily available and affordable, drinking and alcoholism are also high in those countries in compare to countries where alcohol is not easily available such as in the Middle East countries. Easy availability of alcohol may be one of the reason of alcoholism have family history. Due to easy availability of alcohol at home, children grow up in that environment and start drinking at early age and become alcoholics when they grow up.

Studies have shown that more than 95% of individuals suffering from alcoholism also have hypoglycemia (low blood sugar level). Individuals with childhood trauma (mental and physical trauma) have higher risk of alcoholism.

Related posts:

Alcoholism

Risk Factors of Osteoarthritis

What are the Risk Factors of Allergy?

Treatment of Alcoholism

Psychiatric Symptoms of Alcoholism

Risk Factors of Common Cold

Drugs used in Treatment of Alcoholism

Physical symptoms of Alcoholism

Rehabilitation of Alcoholics

Causes and Risk Factors of Nail Fungus Infection

National Archives

The Doughnut Corporation once sought the government's blessing for this ad.

On this week's podcast, we discuss a whole lot of food safety, from the German E. coli outbreak that has made thousands sick to a finding right here in the U.S. that many chickens have arsenic-laced livers.

And who can forget the songs from Mulligan Stew, a popular kids TV show about nutrition in the '70s? If you did, take a tour down memory lane with Renee Montagne as she checks out a new National Archives exhibit called What's Cooking, Uncle Sam?

You might be surprised at how far we've come since vitamin-fortified doughnuts.

We also discuss the latest in caffeine delivery devices, as well as beverages that aim to make us sleepy â€" and what they actual do to our bodies, as well as a the high cost of drugs.

You can find the podcast above, or at the bottom of the page under the podcast heading. To subscribe to the Your Health podcast, click here.

By JESSIE GRUMAN

You are sick with something-or-other and your doctor writes you a prescription for a medication.  She briefly tells you what it’s for and how to take it.  You go to the pharmacy, pick up the medication, go home and follow the instructions, right?  I mean, how hard could it be?

Pretty hard, it appears.  Between 20 percent to 80 percent of us â€" differing by disease and drug â€" don’t seem to be able to do it.

There are, of course, many reasons we aren’t.  Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage.

Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only one.  But it can be devilishly difficult to coordinate the green pill half an hour before breakfast, the yellow ones on an empty stomach four times a day and the orange one with a snack between meals.  It’s complicated; we don’t understand.  We’re busy; we forget. We’re sick; it’s confusing.

Some drugs produce uncomfortable side effects while others set off an allergic reaction. Every single day, we have to decide if the promised outcomes are worth the discomfort.

Kate Lorig, the developer of the Chronic Disease Self-Management Program, has listened to thousands of people talk about the challenges they face in taking their medications as prescribed.  “One of the reasons that folks do not take their meds is that they think they are not doing anything,” Lorig says. “This is especially true of medications that replace something that you no longer produce like thyroxin or medications for chronic conditions that help you get worse more slowly.   The trajectory of a disease is not something one can usually sense, and people start feeling that their drugs are not making them better. Another problem is that people expect drugs to work at once like aspirin and antibiotics.   Many drugs take days, weeks or even months for people to feel better.  They lose patience.”

Depression also plays a significant role: a meta-analysis published last week found that people with chronic conditions and who also were depressed were 1.76 times more likely to be non-adherent compared to people with chronic conditions who were not depressed.  This finding is particularly important because while depression is common in the general population, it is much higher in those over 65, who are also more likely to have additional chronic conditions, most of which require medications to manage and treat.

And then there are people like me who physically struggle to take pills.  I have a lazy swallowing reflex as the result of radiation to my throat, and I frequently gag on even small tablets.  And so I approach every single pill I take with a vivid fear of choking to death on it.  Good excuse for not following my chemotherapy regimen, no?

Add to this list of common explanations for why we don’t take our drugs as directed the media messages and cultural tropes that feed our ambivalence: “Drugs are dangerous!  What looks safe now may turn out to hurt you in the long run…remember Vioxx?”  “Ask your doctor about this drug that will make you feel calm and confident about a) your sexuality; b) your bathroom needs; c) your interpersonal relations; d) your eyelashes.” Then, compare my friend in excruciating pain from a spinal tumor who refuses strong pain medication because she doesn’t want to get addicted to it with the teenagers all over the country who seek out that same medication to ease the anxiety of growing up.

This is a complicated picture.

So it is no wonder that an encyclopedic Cochrane review that evaluated interventions to improve medication adherence found that “No one type of strategy improved medication use outcomes across all diseases, populations or settings, or for all outcomes.”  Think about it: What 10-page pamphlet, 10-minute counseling session or $10-off coupon could reliably help all of us overcome the barriers described above?

The review found that some strategies show modest promise: self-monitoring, greater pharmacist involvement, simplified dosing. Other strategies produce fewer (although some inconsistent) effects: reminders, skills training, financial incentives, use of lay health workers.  But research on medication adherence “is not well organized across diseases, populations and settings,” the review said, and “there are many gaps in the assembled evidence on medicines use strategies, such as those focusing on children, young people or carers, or those for people with more than one coexisting health problem.”

Unfortunately, this means that policy makers and health professionals have little guidance about what can be done to help us improve the way we use medications.

This is simply not good enough.

Ninety percent of American seniors and 58 percent of non-elderly adults use a prescription medication on a regular basis.  These numbers will increase as personalized medicine goes mainstream, offering us the opportunity to ingest exquisitely tailored medications that can counteract our genetic flaws to extend our lives.

Think about it: Hundreds of millions of dollars worth of research is translated into a drug that costs millions of dollars to produce, which in turn cost hundreds of dollars for a clinician to prescribe and tens of dollars for our health insurance to pay for â€" but the potential of that drug to alter the course of a disease depends on the actions of an individual: you, me, my friend with dementia, your aging neighbor, your grandchild with type 1 diabetes.  If we don’t take the drugs as directed, we don’t realize their benefit.

The nation has poured public and private money into basic research and drug development and invested heavily in training health care providers.  But as the Cochrane review demonstrates, the research that would strengthen the critical link between all those investments and the individuals who are ultimately responsible for ensuring that it has an effect is limping along: equivocal, uneven and irrelevant to many of those who stand to gain the most from the drugs available to them.   Meanwhile, such system-level remedies such as simple uniform medication labeling are lost in a morass of self-interested wrangling.

If the success of modern medicine to improve health relies so heavily on our actions, it’s time for more concerted, strategic approaches to reducing the significant barriers to us taking both the medicine and actions as recommended.

The systematic review found that there is no “magic pill” â€" no single intervention â€" that will solve the adherence problem.  Why should there be?  We know from other efforts to change complex behaviors, such as cigarette smoking, that it is only when a variety of approaches support, encourage, prompt and reward the new behaviors over time that significant numbers of people will adopt them.  Improving adherence will require a concerted effort by the pharmaceutical industry, health plans, pharmacists and clinicians to step up implementation of even mildly promising interventions to make it easier to follow recommendations.

The impetus for an increased investment to support medication adherence may, oddly enough, come from clinicians themselves.  With the advent of pay-for-performance and other incentives that link provider reimbursement to patient outcomes, we are no longer the only beneficiaries of the effective use of our drugs.  It is possible that this nudge will spark productive interactions between clinicians and patients about what and how the drugs they prescribe for us can be best used to help us prevent complications, slow the progress of our diseases and ease our suffering.

Jessie Gruman, PhD, is the founder and president of the Washington, DC -based Center for Advancing Health. She is the author of Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis. She blogs regularly on the Prepared Patient Forum.

Filed Under: Consumers

Tagged: Jessie Gruman, Medication adherence, Patient Jun 9, 2011

There is no cure for common cold and antibiotics do not work against common cold causing viruses. If your baby is suffering from common cold, you can make your baby comfortable by suctioning the mucus that may block the nose and keep the air of the room, moist. Do not use OTC (over the counter) medications for your baby to treat common cold. Cough and cold medications are not safe in children and should be avoided. If your baby is also suffering from fever, you can use fever reducing (anti pyretic) medications, such as acetamenophene (paracetamol). The dosing schedules and directions of dosing should be properly followed if fever reducing medications are given to a child. Acetamenophene should be avoided in infants below 3 months of age. Another fever reducing medication that can be used in place of acetamenophene is ibuprofen, but this should be used in children above 6 months of age. In presence of dehydration the above mentioned medications should be avoided and given o nly after correcting dehydration.

The following steps can be taken to prevent common cold in babies:

• Keep your baby away from persons who are sick. Also, do not allow any sick person to visit your infant baby. Public gathering and public transport should be avoided to avoid contact with sick persons.
• It is important to remember that, common sense and plenty of soap water is important for preventing infection. Wash your hand (or anyone taking care of your baby) before touching your baby, with plenty of water and soap.
• Keep toys of your baby clean and wash or clean them regularly.
• Do not sneeze or cough inside your baby’s room and if it can not be avoided, sneeze in a tissue.
• Do not sweep your baby’s room, instead wipe with water and disinfectants. Common cold spreads by droplet from cough or sneeze and these may settle on the floor and get disturbed when room is swept, so avoid sweeping.

Related posts:

Symptomatic Treatment of Common Cold

Common Cold in Babies

Prevention of Common Cold

Reduce Common Cold by Reducing Risk Factors

Complications of Common Cold in Babies

Symptoms of Common Cold

What is Common Cold?

Alternative Medicine in Treatment of Common Cold

Treatment of Common Cold

Causes of Common Cold

Enlarge iStockphoto.com

Does your health insurance cover birth control pills?

iStockphoto.com

Does your health insurance cover birth control pills?

After asking Americans for their views on abortion recently, we decided to follow up with questions about birth control pills and family planning.

Specifically, should health insurance â€" both private policies and those bought with government assistance â€" cover the cost of oral contraceptives?

When it comes to private insurance, including employer-based policies, 77 percent of people said it should cover all or some of the cost of oral contraceptives. The remainder said women should pay for the pill themselves.

Now, what if someone is getting help from the government to buy private insurance? The results were about the same: 74 percent of people said the pill should be covered.

In both cases, the support for coverage was strongest among the young and people with at least a college education.

Separately, more than three-quarters of Americans support federal subsidies at clinics for low-income people to cover birth control and family planning â€" excluding abortions.

Finally, we asked if people knew whether their insurance covered birth control pills. The most common answer at 43 percent was "don't know." Thirty-one percent of people said their plans cover the pill.

Most insurance plans do cover the pill, and a majority of states have laws requiring insurance plans that cover prescription medicines to cover contraceptives.

Dr. Raymond Fabius, chief medical officer at Thomson Reuters, noted to Shots, that people were even more supportive of government subsidies for family planning services and contraceptives for the poor than they were of private insurance plans covering the pill.

The latest NPR-Thomson Reuters Health Poll drew responses in telephone interviews from more than 3,000 adults across the country. The margin for error is plus or minus 1.8 percentage points.

You can find the full text of the questions and the responses here. Find the detailed results of past polls on Thomson-Reuters' site here, or click on the "NPR-Thomson Reuters Poll" tag below for a roundup.

By DAVID DRANOVE

I have seen this film before. Folks get all excited about the potential for vertical integration to save our healthcare system, and then the facts emerge.

The results of the first major ACO demonstration project are in and unless there is some hidden meaning behind all the data, it looks like ACOs may not be the magic bullet that the Obama administration had hoped. The demonstration began under President Bush and the specific payment structure and quality incentive differ somewhat from the ACO rules under the Affordable Care Act, but the main features are the same â€" give an integrated provider organization a share of the savings if it can hold down Medicare spending while also offering some quality bonuses.

Despite the fact that the participants included ten of the nation’s best known physician-led integrated organizations, less than half were able to lower Medicare costs by the final year of the project and only two demonstrated consistent cost savings. And the methods used to achieve savings â€" nurse call centers and telephone health checkups â€" are the sorts of thing that don’t exactly require vertical integration.

There are going to be excuses â€" the ACOs need to be run by hospitals, they need more time to develop their information technologies, the performance incentives need to be strengthened. But that is the kind of ex post rationalizing one hears any time an experiment fails to support a theory. Maybe the theory (that vertical integration is the panacea for our ailing system) is wrong.

There remains a deep divide in both academia and amongst practitioners about the merits of vertical integration. Supporters of the ACA will continue to pin their hopes for Medicare savings on ACOs, the new evidence be damned. I have blogged that we need less top down direction about how to organize care delivery and I am sorry in a way to see the data bear me out. (Sorry because I am fresh out of magic bullets.) If the government is to play a role in the future of the health system, then it should either go all in on regulation (i.e., single payer) or fix the problems that are limiting the effectiveness of the free market (e.g., subsidize and standardize integrated health information systems; double down on antitrust enforcement.) Will these ideas work? I don’t know. But at least there isn’t a strong theoretical case to be made that they will fail.

Let’s stop this love affair with vertical integration. How many times do we have to keep seeing this bad movie?

P.S. I am currently reading The Quantum Story which is about the evolution of quantum physics. I barely understand much of it. But this much I do understand. When physicists perform experiments and the results do not confirm their theory, they reject the theory.

David Dranove, PhD, is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University’s Kellogg Graduate School of Management, where he is also Professor of Management and Strategy and Director of the Health Enterprise Management Program. He has published over 80 research articles and book chapters and written five books, including “The Economic Evolution of American Healthcare and Code Red.”

Filed Under: Op-Ed, THCB

Tagged: ACOs, David Dranove, Vertical integration Jun 2, 2011

If you or your child or any member of your family gets infected with common cold, you may decide to consult your doctor/pediatrician/family doctor. As most doctors are busy and appointment with your doctor may be brief, it is wise to know and learn the topics you need to discuss with your doctor, regarding common cold anyone of your family member may be suffering. Prepare for your appointment with your doctor and know what questions to ask your doctor and what to expect from your doctor.

You should be prepared for appointment before seeing your doctor. Write down the symptoms you or your child or any member of your family may have and for how long you may have the symptoms. Write down if there is any medical information or any medication being received for other medical ailment, about the patient of common cold worth mentioning to your doctor. Mention any recent exposure to people with similar symptoms. Finally write down what questions you might ask your doctor during appointment. You should also ask you doctor about the ways to prevent common cold.

You may ask the following questions:

• What is/are the causes of the symptoms?
• How long it may take for symptomatic improvement?
• What medications or foods to be avoided during treatment?
• Is there any need for tests?
• Am I contagious?
• When it is safe to return to work or school?
• Is there any home remedy or steps taken at home that will be helpful?

Your doctor may ask following questions before writing treatment for you:

• What are your symptoms and for how long they are present? Did all symptoms start at the same time?
• Is there any change in the symptoms severity (improved or worsened)?
• Do you have fever?
• Did you closely interact with any individual recently with similar symptoms?
• What medications/supplements you (patient) are taking at present?
• Do you at present have any illness (acute or chronic)?

You may be asked some other questions by your doctor based on different patient setting. Your doctor may ask different set of question to different patients with similar illness. Be prepared to answer the above mentioned questions accurately.

Related posts:

How to Prepare Yourself for Cold Sores, for Appointment with Doctor

How to Prepare for Doctor’s Appointment for Ringworm?

Reduce Common Cold by Reducing Risk Factors

What is Common Cold?

Symptomatic Treatment of Common Cold

Symptoms of Common Cold

Prevention of Common Cold

Prepare yourself for Appointment with your Doctor for Nail Fungus Infection

Treatment of Common Cold

Global impact of Common Cold

Enlarge Janice Carr; Jeff Hageman/CDC

A colorized scanning electron micrograph showing clumps of methicillin-resistant Staphylococcus aureus bacteria in 2005.

Janice Carr; Jeff Hageman/CDC

A colorized scanning electron micrograph showing clumps of methicillin-resistant Staphylococcus aureus bacteria in 2005.

European researchers have found a strain of drug-resistant Staphylococcus aureus that appears to have a novel way of defeating the antibiotic methicillin.

Bugs that can beat that antibiotic are known as methicillin-resistant Staphylococcus aureus, or MRSA, and present real challenges for prevention and treatment.

A report just published in the medical journal The Lancet Infectious Diseases describes the discovery of the new bug found in milk in England and in samples taken from people in Denmark and the U.K. Researchers came across the bacterium while investigating udder infections in Britain.

 

The upshot is that this staph germ â€" which doesn't contain the standard genetic bit known as mecA that MRSA bugs use to thwart methicillin â€" may go undetected on genetic tests that are used to rapidly detect MRSA or to check on the old-fashioned and slower results that come when the bacteria are grown on agar plates. Instead, the germ has a variation on mecA that's different enough to slip by the regular MRSA gene tests.

The paper's authors say they can't prove for sure that the bug is transmitted between cattle and people, but there is a fair amount of circumstantial evidence to support that jump.

The Washington Post reports the researchers said their finding doesn't mean people could get sick from pasteurized milk. But the germ could be passed on through unpasteurized milk, one of the authors said at a media briefing.