US Tops World in Health Care Spending, Results Lag

US is biggest spender on health care, OECD says, but US life expectancy low among rich nations

By GREG KELLER

The Associated Press

PARIS

The United States ranks near the bottom in life expectancy among wealthy nations despite spending more than double per person on health care than the industrialized world's average, an economic group said Tuesday.

Life expectancy at birth in the U.S. was 78.1 years in 2007, according to the Organization for Economic Cooperation and Development.

That's a year less than the OECD average of 79.1, and puts the U.S. just ahead of the Czech Republic, Poland and Mexico, where spending on health care is many times less per person, the Paris-based organization said in its latest survey of health trends among its 30 rich member countries.

Total U.S. spending on health care was $7,290 a person in 2007, nearly two-and-a-half times the OECD average of $2,984. The figures include spending by both individuals and governments.

Spending on health care in the U.S. grew more quickly between 1997 and 2007 than in France, Italy, Germany and Spain, averaging 3.4 percent annually over the period. The U.S. growth rate was still below the OECD average of 4.1 percent.

The U.S. far outspent the next biggest health care spenders, Norway and Switzerland, despite the fact that those countries' life expectancies are two to four years longer, according to the report.

The report notes that, in addition to the U.S., Denmark and Hungary also have lower life expectancies than would be predicted by their relative wealth and levels of health care spending.

On the other hand, the Japanese and the Spanish live longer on average than their national income and their health care spending would predict.

The U.S. also underperforms other rich countries in the health of its youngest.

U.S. infant mortality, at 6.7 deaths per 1,000 live births, was well above the OECD average of 3.9 in 2007. Only Mexico and Turkey had worse rates of infant mortality. In Luxembourg, the top performer, the infant mortality rate was only 1.8.

The report noted that research suggests many factors beyond the quality of a country's health system, such as income inequality and individual lifestyles and attitudes, influence infant mortality rates.

Per capita spending on pharmaceuticals rose by almost 50 percent over the last 10 years in OECD countries, reaching a total of $650 billion in 2007. The U.S. was the world's biggest spender on pharmaceuticals, spending $878 per person, with Canada next at $691 per person and the OECD average at $461.

The report was released as the U.S. Senate is considering a health care overhaul promised by President Barack Obama during his presidential campaign.

The Danger and Opportunity of Health Care Reform for Health Promotion

Article Summary
Brooke Gilliland

Editor’s Notes
The Danger and Opportunity of Health Care Reform Providing a Huge Influx of Funds for Health Promotion…and How to Avert Danger
By: Michael P. O’Donnell, PhD, MBA, MPH
American Journal of Health Promotion, 2009;24[2]:iv

http://healthpromotionjournal.com/publications/journal/editors_notes_pdfs/ajhp-24-02-editornotes.pdf

This article was written by Michael P. O’Donnell who is Editor in Chief of the American Journal of Health Promotion.

Mr. O’Donnell begins by describing a conversation between himself and a friend that initially sounds sarcastic in nature. The friend, who apparently was in the private sector health promotion field, says that the last thing that he wants is for the federal government to invest large amounts of money in health promotion without first considering the consequences. Mr. O’Donnell’s initial reaction to this statement was the same as mine – confusion. After consideration, he reasoned that his friend was considering how the influx of the huge resources of the federal government could and would overwhelm the private health promotion industry. Such an influx of resources would in turn eventually result in job losses, business closures, and lower tax revenues. Also negatively affecting the government coffers would be increased payments for unemployment benefits. Eventually, these monetary losses could end up causing the government funded health promotion field to fail if that happened, he questioned, would the public be willing to pay for those previously ”free” services? Would there be any incentive for the private sector to reestablish itself in this sector? Mr. O’Donnell goes on to laud the private sector’s facility to provide innovative, cost-effective services above and beyond that of any governmental agency.

There is a description of the Health Promotion FIRST Act (2004) and its provision to advance the health promotion infrastructure in non-governmental organizations to avoid governmental competition or interference.

In conclusion, in order to achieve the most effective and beneficial use of all resources, Mr. O’Donnell stresses the importance of maintaining and nurturing the private sector’s contributions while adding the assets of the federal government in a non-competitive manner.

A study of rural church health promotion

Posted by Kechuang Wu
This study examined the beliefs of church leaders about health and associations between these beliefs and the church health promotion environment (CHPE). Perceptions of the CHPE by leaders and members of the same churches were also compared. Interviews were conducted with pastors (n = 40) and members (n = 96) of rural churches. They were Baptist (60%), and 57.5% were predominantly White, while 42.5% were Black. Leaders’ beliefs regarding talking about health topics in sermons were associated with the presence of health messages in the church. There was also a significant association between leaders’ beliefs about members’ receptivity to health messages and the presence of messages in the church. Leaders’ and members’ perceptions of the CHPE were discordant. While some leaders’ beliefs may be related to the CHPE, other factors may explain why programs and policies exist in some churches and not others.

Citation: Williams, R.M., Glanz, K., Kegler, M.C., & Davis, E. (2009). A study of rural church health promotion environments: Leaders' and members' perspectives. Journal of Religious Health. Published online. Dec 4, 2009.

Pogmegranate for cancer treatment/prevention?

Review by Kyle Bahnsen

Citation:
Lansky, E.P., Jiang, W., Mo, W., Bravo, L., Froom, P., Yu, W., Harris, N.M., Neeman, I. and Campbell, M.J. (2005). Possible synergistic prostate cancer suppression by anatomically discrete pomegranate fractions. Investigational New Drugs. 23: 11-20.

Summary:
This 2005 study, on tertiary prevention of prostate cancer was particularly interesting because it not only evaluated the use of the pomegranate fruit as a whole, but it evaluated the effectiveness of the juice polyphenols, the pericarp peel, and the pomegranate seed oil, individually. While this study was primarily focused on using the pomegranate plant as a synergist to other chemotherapeutic agents, it points to the need for future pilot studies concerned with it primary prevention properties of tumor suppression. The pomegranate fragments in this study were used on PC-3 human prostate cancer cells in vitro. Prostate cancer cells were obtained from 145 different samples, and the dose of pomegranate fragment used remained constant. Results from this randomized controlled trial demonstrated that all three of the separate pomegranate fragments (seed, skin, and oil), had synergistic affects on prostate cancer cell proliferation, invasion, and phospholipase A-2 expression.

Mammogram Debate

Article Summary
Brooke Gilliland

Mammogram Debate Took Group by Surprise
By GINA KOLATA
Published: November 20, 2009

This article discusses the federal Preventative Services Task Forces’ November 2009 recommendation that women need to get (and should get) mammograms less frequently than previously suggested. Further, the article describes how this recommendation instigated and uproar of opposition response. Several groups were described as being upset about the recommendation due to the perceived health consequences. However, other groups expressed anger that there were political overtones regarding the Obama administration’s recent healthcare reform gestures.

The history of the task force and the method of choosing its members were explained. Members of the task force expressed surprise at the negative responses to their recommendation. Other physicians, not in the task force, were incredulous as to the naiveté of the task force physicians. Those doctors could not believe that the task force members would not expect their recommendation to be met with indignation by the general public and cancer groups. The task force members believe that they are insulated from political and popular influences, but others find that hard to believe.

Personal note: possibly adding to the controversy of the agency’s mammogram recommendation was the fact that they simultaneously recommended against teaching breast self-examination (BSE). They graded BSE as a Grade D recommendation meaning “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Also from the federal Agency for Healthcare Research and Quality’s (AHRQ) website http://www.ahrq.gov/clinic/USpstf/uspsbrca.htm on December 4, 2009 the USPSTF “unanimously voted to update the language of their recommendation regarding women under 50 years of age to clarify their original and continued intent.”

Health Policy in the News

Nov 30, 2009
Lawmakers Battle It Out Over Health Bill In Senate: Democrats Deeply Divided On Abortion, Government-Run Public Option. Published by the Associated Press.

Health promotion in nurses: Is there a healthy nurse in the house?

Health promotion in nurses: Is there a healthy nurse in the house?

Deborah McElligott, RN, ANP, HNP, AHN-BCa ,⁎, Sarah Siemers, RN, MSN, ANP a , 1 ,

Lily Thomas, PhD, RNb , 2 , Nina Kohn, MAb , c , 3

This study was designed to compare health-promoting behaviors of acute-care and critical-care nurses. The study was a descriptive pilot study using a convenience sample of registered nurses from a tertiary hospital. The nurses were given a questionnaire with 52 questions related to the following topics: nutrition, stress, spirituality, health responsibility, interpersonal relations, and physical activity.

Although there were not any statistical differences among baseline date of the RNs, the acute care nurses scored better overall. Each question had a possible answer ranging from 1-4. An answer of 1 = never, 2 = sometimes, 3 = often, and 4 = routinely. The higher the score, the better in terms of leading a healthy life. The following is a table from the study showing the results between the two groups.

.

Table 3

Comparison of critical-care nurses (n = 54) and floor nurses (n = 46)

HPLP II scores Critical care, M (SD) Floor, M (SD)

Overall score 2.52 (0.35) 2.69 (0.46)

Subscale category

Interpersonal relations 2.98 (0.46) 3.05 (0.48)

Spiritual growth 2.76 (0.52) 2.95 (0.51)

Nutrition 2.52 (0.43) 2.73 (0.55)

Health responsibility 2.36 (0.45) 2.53 (0.56)

Physical activity 2.32 (0.73) 2.46 (0.80)

Stress management 2.14 (0.49) 2.35 (0.53)

As you can see, the acute-care nurses scored better in all categories when compared to critical-care nurses. The two areas with the largest weakness included physical activity and stress management.

"Holistic caring and nurturing of self support a healthy

balance and increase productivity and a fuller participation

in the life experience (Eliopoulous, 2004). Support of this

paradigm shift to an emphasis on self-care provides the

energy for nurses to enhance their care of patients, families,

and communities." (McElligott et. al, 2009).

McElligott, D., Siemers, S., Thomas, L., Kohn, N. (2009). Health promotion in nurses: Is there a healthy nurse in the house? [Electronic version]. Applied Nursing Research 22: 211-215

Oct 4, 2009

Health insurance bills could be hardship for many.
By RICARDO ALONSO-ZALDIVAR
Associated Press Writer

Cultural competent care
Lee and Weise (2009)
When East Meets West: Intensive Care Unit Experiences Among First-Generation Chinese American Parents
The Journal of Nsg Scholarship 41 (3), 268-275.

This was a qualitative and phenomenological study with a convenience sample of 25 first-generation Chinese American families, with infants hospitalized in the ICU's of three San Francisco area teaching hospitals.

There were many stressors noted for both fathers and mothers of these hospitalized infants. The seven themes were identified to be unique in this sample: perceived incompetence, self blame, blame from others, filial piety, lack of support in US, communication issues and cultural differences.

This study was designed to help health care workers to provide culturally competent care and to understand Chinese American parents' perceptions while their infants are hospitalized in the ICU. I believe many of these themes can be carried over to the care of adult Chinese American patients and their families.

Almost all of the parents demonstrated perceived incompetence: they lacked confidence in taking care of their sick children and considered themselves "stupid" or not as intelligent as the nurses taking care of their infants. They felt helpless and frustrated.

Many mothers and fathers demonstrated self-blame, they felt that they caused the preterm labor or medical condition that plagued their infant. One mother felt that she consumed too many cold foods during her pregnancy, Asians often follow a strict diet during their pregnancy consisting of hot foods only. The one father blamed himself because of his career choice as a chemist: that the toxins he exposed himself to harmed his infant.

Blame from others came from extended family members and spouses. Mother-in-laws would blame their daughters-in-law for not following a traditional diet during her pregnancy, thus causing the infants illness. One husband blamed his spouses hypothyroidism and hypertension for their child's illness. One infant had a skin tag on his ear, the father blamed the mother for the defect: she ate too many pig ears during her pregnancy.

Many first generation Chinese Americans do not have any support in the US. Their families are all over seas. Even if they do have close family in the US, the to not utilize it because of filial piety. It is taboo to cause their elders stress or worry. Communication barriers with lack of fluency in the English language is another issue. This can lead to miscommunication of a medical diagnosis and treatment.

Cultural differences were another obstacle. In the postpartum period the mothers are not supposed to cold air and need to consume hot foods only. One father reported elevated stress levels because he was expected continue performing his duties at work, at home, and to his spouse who spent much of her time in the NICU visiting their infant. He had to drive across town everyday to obtain a live chicken from Chinatown, bring it home to his mother-in-law to prepare, they bring it across town again to the hospital for his postpartum wife to consume.

This is an abbreviated summary of a very interesting piece of research. I recommend that you read this article in it's entirety if you get the chance.

Racial Disparity Persists After On-Pump and Off-Pump Coronary Artery Bypass Grafting

Cooper, W.A. et al. (2009). Racial Disparity Persists After On-Pump and Off-Pump Coronary Artery Bypass Grafting. Circulation, 120:S59-S64.

Background— Race has been shown to be an independent risk factor for operative mortality after coronary artery bypass grafting (CABG). This study sought to determine the extent to which race is a risk factor for adverse events, long-term mortality, and whether off-pump surgery (OPCAB) modifies that risk.

Methods and Results— The Society of Thoracic Surgeons Adult Cardiac Database at Emory Healthcare affiliated hospitals was queried for all primary isolated CABG records from 1997 to 2007. A propensity score was formulated to balance the patient groups with respect to treatment assignment (OPCAB or CABG on cardiopulmonary bypass). Multivariable logistic regression was used to assess the impact of black race and OPCAB on in-hospital outcomes (death, stroke, myocardial infarction, and their composite, major adverse cardiac events). Cox proportional hazards regression model and Kaplan–Meier curves determined whether black race affected long-term all-cause mortality. Interaction terms were constructed to test whether OPCAB surgery influences surgical results differently in black patients than in white patients. There were 12 874 consecutive CABG patients, including 2033 (15.8%) blacks and 10 841 (84.2%) whites. Survival at 3, 5, and 10 years for blacks (87.5%, 81.4%, 63.8%) was significantly lower than for whites (90.7%, 85.2%, 67.1%, P<0.001).> (adjusted odds ratio, 0.77; 95% CI, 0.44 to 1.36) and whites (adjusted odds ratio, 0.72; 95% CI, 0.53 to 0.99) who had OPCAB had lower risk-adjusted odds of major adverse cardiac events than their racial counterparts who had CABG on cardiopulmonary bypass.

Conclusions— Short- and long-term outcomes are significantly worse in black than in white patients undergoing primary isolated CABG. OPCAB does not narrow the disparity in outcomes between blacks and whites.

Link to free full article: http://circ.ahajournals.org/cgi/content/full/120/11_suppl_1/S59

health care reform

Coverage Denied: How the Current Health Insurance System Leaves Millions Behind
“Pre-Existing Conditions” Affect Millions of Americans
http://www.healthreform.gov/reports/denied_coverage/index.html

New DNA test outperforms PAP test for cervical cancer

Sankaranarayanan, R., Nene, B.M., Shastri, S.S., Jayant, K., et al. (2009). HPV screening for cervical cancer in rural India. New England Journal of Medicine, 360, 1385-1394.

An eight year study of over 130,000 women in India financed by the Bill and Melinda Gates Foundation is the first to show that a single screening with the HPV DNA test is better than all other methods at preventing advanced cervical cancer and death. In a cluster randomized trial of 52 villages, groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or Visual Inspection of the cervix with Acetic Acid(VIA) (34,074) or to receive standard care (31,488, control group). Over an 8 year period of follow-up, cervical cancer was diagnosed in 127 subjects who had the HPV test (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced
disease) in the control group (hazard ratio for the detection of advanced cancer in
the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were
34 deaths from cancer in the HPV-testing group, as compared with 64 in the control
group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). There was no reduction in risk for advanced cervical cancer or death in the PAP or VIA groups compared to the control group.

The test's manufacturer, Qiagen, with financing from the Gates Foundation, is able to provide the test for $5, a factor which is essential for use in developing countries where most women get no screening and cervical cancer kills more than 250,000 people a year.

The new test requires a cervical scraping, but it is mixed with reagents and read by a machine that runs on batteries without water or refrigeration. It takes less than 3 hours to generate results and does not require a trained pathologist. It can even work with vaginal swabs taken by women themselves.

According to the authors, women could be screened with the DNA test once at 30 and then once every 10 years.

New treatment option for pancreatic cancer

Pancreatic cancer is considered a largely incurable disease with the one year survival rate at 20% and the five year survival rate at only 4%.  These numbers reflect the challenge of treating pancreatic cancer and the need for new innovative drugs.  Recent research reported this week by Healthday News on a new drug, AMG 479, shows promise for treatment of this deadly cancer.  Because insulin-like growth factor is known to play a role in cancer growth, AMG 479 is subsequently designed to interfere with the activity of insulin-like growth factors, specifically IGF-1 and IGF-2.  This is the first drug found to interfere with these factors without cross reacting with the closely related insulin receptor.  Researchers reported an 80% inhibition rate of tumor growth.  Consequently AMG 479 appears to be an excellent candidate to be used alone or in combination with Gemcitabine, the only current available treatment for pancreatic cancer which has not yet shown to increase survival rates.  Future research on this promising treatment for pancreatic cancer is certainly needed.

Valproate study

A  recent study reported in this week’s edition of the New England Journal of Medicine examined the neurological effects of valproate on children exposed to the medication during fetal development.  The study included 309 children from 25 epilepsy centers in the United Kingdom and United States.  Periodical assessment of the children up to age six was planned and these published results were noted after three years of evaluations.  It was found that IQ scores were significantly lower in those children who were exposed to valproate when compared to other epilepsy drugs including carbamazapine, lamotrigine, and phenytoin.  It was also found the neurological effects were dose dependent with higher doses being associated with decreased IQ scores. Consequently, after examining the results, the authors stressed the importance of utilizing other anti-seizure drugs as first line therapy especially in women of child bearing age.

Multivitamins No Cancer, Heart Help, Study Says

Associated Press 2009. http://www.msnbc.msn.com/id/29106052/

The largest study on multivitamin use showed that heart health and cancer risk is not reduced. An eight year study on postmenopausal women was completed by Marian Neuhouser, a researcher for the Fred Hutchinson Cancer Research Center in Seattle. The study included over 160,000 women over the age of 50, 42% of which were regular vitamin users. The results of the study showed that fairly equal numbers of vitamin users and nonusers developed various cancers, heart attacks, and other cardiovascular problems. Furthermore, almost 10,000 deaths occurred in both users and nonusers.

It is recommended that people maintain a healthy diet, both rich in fruits and vegetables and low in red meat. These habits are known to not only decrease cancer risk, but also reduce cardiovascular risk.

Living Wills and pre-hospital lifesaving care

Mirarchi, F.L., Kalantzis, S., Hunter, D., McCracken, E., and Kisiel, T. (2009).
Triad II: Do living wills have an impact on pre-hospital lifesaving care?
The Journal of Emergency Medicine 36 (2), 105-115.

This is posted on behalf of Bobbie Fiore:

There is confusion regarding the interpretation of living wills and DNR especially
in the pre-hospital setting. A three part study done at Hamot Hospital, Erie, Pa
addressed this issue. The Realistic Interpretation of Advanced Directives I or
TRAID I study included EMS, doctors, and nurses who reviewed a living will and then were asked the code status. The results indicated that 89% of EMS, 79% of nurses, and 64% of doctors were incorrect in stating the code status as DNR.
.
TRIAD II used only paramedics and EMS participants. They were given clinical
information and a living will and then told the patient’s condition had changed.
They were given options for intubation, no intubation, defib, no defib or
call for medical direction. Many surveyed chose to delay their responses
feeling that the living will meant DNR.

It is being recommended that an out-of-the-hospital DNR be obtained from
a health care provider. It was also interesting to note that there have
been recommendations to consider the elimination of living wills.

Blood Pressure Drug May Not Ease Irregular Heartbeat

SOURCES: Aldo P. Maggioni, M.D., director, ANMCO Research Center, Florence, Italy; Anne M. Gillis, professor, medicine, and director, arrhythmia program, University of Calgary, Alberta, Canada; April 16, 2009, New England Journal of Medicine) Retrieved April 15, 2009 from, http://www.healthfinder.gov/news/newsstory.aspx?docid=626049

Early research showed some promise that Valsartan would reduce the number of atrial fibrillation episodes in patients. "But in the patients we randomized in this study, it was not useful in preventing recurrence," said study author Dr. Aldo P. Maggioni, director of the ANMCO Research Center in Florence. His team published the findings in the April 16 issue of the New England Journal of Medicine. The study included 1,442 patients, half given Valsartan and half given a placebo. These patients were followed over a one year period and were found to have almost equal numbers of AFIB episodes (51.4% in those taking Valsartan and 52.1% in those taking the placebo). The overall evidence does not support use of Valsartan in preventing recurrent episodes of AFIB.

Policy decision- Radiation devices not banned, April 15, 2008

The U.S. Nuclear Regulatory Commission today announced it will not ban the use of cesium-137 chloride (CsCl) radiation devices, such as those used by hospitals to irradiate blood, before a replacement technology is available. Banning or phasing-out cesium chloride radiation sources at before a replacement form or other technology is available would be counterproductive, because society would lose the many benefits these sources provide in medicine, industry and research,said NRC Chairman Dale Klein. The AHA had urged the commission not to ban or require replacement of the devices for similar reasons.
AHA News Now, April 15, 2009 (www.aha.org)

Background information obtained from position letter from AHA to U.S. NRC, dated October 14, 2008: A recent National Academy of Sciences study recommends the replacement or elimination of CsCl due to its potential risk to individuals, society and the environment if improperly handled or used in a malicious act. While we understand the NRC’s concerns, the AHA urges the Commission to proceed cautiously as it considers these complex issues, particularly the medical use and research applications of CsCl, so as not to adversely impact patient care and advances in biomedical research. Blood irradiation is medically necessary for some patients to prevent transfusion-associated graft versus host disease. CsCl blood irradiators are the most reliable, efficient and low-maintenance tools available. Hospitals that have blood donation centers or treat significant numbers of immuno-compromised patients often own such irradiators. CsCl irradiators also play an important role in medical research related to understanding and treating cancer and other serious illnesses. They also are used to develop countermeasures for radiologic terrorism.
Letter can be retieved at: http://www.aha.org/aha/letter/2008/081014-cl-pollack-nrc.pdf

Hand Hygiene!

This is an interesting and important, but different kind of blog...

We learned at the beginning of our academic journeys in nursing that handwashing is the single most effective method to prevent infection, right? Then why do some places struggle to meet hand hygiene compliance rates? Isn't this something we want for every patient, every nurse, every health care worker?

The Joint Commission yesterday, April 13, 2009, released a guide to help health care practitioners assess compliance with hand hygiene guidelines. The Joint Commission's National Patient Safety Goals require accredited organizations to follow recognized hand hygiene guidelines. The monograph reviews the strengths and weaknesses of commonly used approaches to measuring compliance, and includes examples of assessment tools submitted through the Consensus Measurement in Hand Hygiene project, a collaboration with infection prevention and control organizations. The monograph can help health care organizations more effectively measure compliance and strengthen improvement activities that save lives and money.

The fact that this monograph needed to be put inplace sends a message that we are not all doing our part and/or we all can not agree on how comliance is measured. You can visit the monograph at: http://www.jointcommission.org/NR/rdonlyres/68B9CB2F-789F-49DB-9E3F-2FB387666BCC/0/hh_monograph.pdf

Myocardial Infarction in Women: Promoting Symptom Recognition, Early Diagnosis, and Risk Assessment

Zbierajewski-Eischeid, Samantha J. RN, MS; Loeb, Susan J. PhD, RN, Dimensions of Critical Care Nursing, Issue:Volume 28(1), January/February 2009, pp 1-6.

Even with national campaigns to help increase awareness, most people do not realize that heart disease is now the leading cause of death for women. Women experiencing an acute cardiac event often do not recognize the symptoms or are misdiagnosed by healthcare providers because of atypical symptom presentation. This can lead to a significant delay in treatment and a less desirable recovery outcome. To help promote early identification of cardiac risk and cardiac events, this article highlights the range of symptom presentation in women with myocardial infarction and focuses on how advanced clinical nurses can increase nurses' and the public's understanding of this disease in women.

I liked this article, because it is a systematic review that reveals the the importance of stressing the atypical symptoms of female MI patients and that ther is often a delay in treatment due to these symptoms (fatigue, mild heartburn, etc). It also stresses the importance of communicating not only the with the licensed health care professionals, but also nursing students that women admitted to acute care hospitals for non-MI diagnosis must be evaluated for occurence of MIs during the hospital stay.

Summary- Heart disease is the leading cause of death for women in the US, but many women are still unaware of this fact despite significant attempts to heighten awareness. Also, healthcare providers often do not possess sufficient knowledge of differences in symptoms, diagnosis, risk, treatments and outcomes between men and women with heart disease.Advanced clinical nurses are the ideal healthcare providers to address this knowledge gap through educating their nursing colleagues, nursing students, and their female patients, as well as advocating with physicians. Through heart health promotion initiatives, delays in seeking care, misdiagnosis, and less aggressive treatment of women can be effectively addressed. In summary, education is key to reducing the mortality rate for women. Therefore, encouraging patients and providers to take advantage of the numerous educational opportunities provided by campaigns promoting women's awareness of heart disease is essential. Achieving the goal of educating women to recognize symptoms, assess risk, and seek early diagnosis for MI will contribute to improved treatment outcomes, elimination of gender disparities, and reversal of current trends regarding cardiovascular disease-related deaths in women.

Injury Prevention in Youth Sports

Veigel, Jake D.1; Pleacher, Michael D.2 Current Sports Medicine Reports, Volume 7(6), November/December 2008, pp 348-352.

Thought this was an interesting article as my daughter just injured her arm and ended up with a cast this week... tis the spring season! Enjoy~ Kris

Sport is the principal cause of injury in children and adolescents. Youth participation in organized athletics is estimated to be 45million in the United States alone. These injuries influence health and fitness and have socioeconomic impact. Many injuries can be prevented. This article outlines the efficacy of current injury prevention strategies in youth sports through the use of educational programs, rule changes in baseball and hockey, safety equipment, and conditioning programs.

With an estimated 45 million children and adolescents involved in organized athletics in the United States, it is not surprising that sport is the primary cause of injury in young people. The majority of injuries are mild strains, sprains, and contusions, with few severe enough to require hospitalization. Despite the relatively low severity of these injuries, they can have a significant impact. Injuries may lead to reduced participation in sport and fitness activities, thus contributing to the childhood obesity epidemic. Injury also may disrupt potential benefits of sport, including increased self-esteem, community involvement, and increased fitness. Injury has direct costs from evaluation, treatment, and rehabilitation, and indirect costs of parental sick leave and lost productivity if parents miss work to tend to an injured child.

Many youth sport-related injuries can be prevented. Prevention strategies include educational programs (rules and safe play/injury prevention programs), rule changes (no checking/limited checking in hockey); , safety equipment (increased use of helmets and headgears in sports, eye protection in squash, leg braces for volleyball) , and preseason and in-season conditioning programs (specific sport exercises, warm-up and cool-down exercises).

Based upon the recent available data, there are numerous strategies that can be implemented in youth sports to effectively prevent injuries. Enhancing the safety of athletes may lead to greater enjoyment of and longer participation in sports. Given the recent pediatric obesity epidemic, it stands to reason that medical professionals should promote safe and enjoyable physical activities for our youth. Strong evidence exists that supports the implementation of altered rules, use of safety equipment, and participation in specific conditioning programs. Enforcement of rules designed to protect athletes should be uniform. Education of parents and coaches must continue regarding evolving injury prevention methods. Sports medicine providers who care for young athletes are in a unique position to stay abreast of new literature on injury prevention and to educate athletes, parents, and coaches of new ways to protect our young athletes.

Collection and Use of Cancer Family History in Primary Care

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

Prepared by:
McMaster University Evidence-based Practice Center, Hamilton, ON
Task Order Leaders:
Nadeem Qureshi, M.B.B.S., D.M.
Brenda Wilson, M.B., Ch.B., M.Sc, M.R.C.P.(U.K.), F.F.P.H.

Authors:
Nadeem Qureshi, M.B.B.S., D.M.
Brenda Wilson, M.B., Ch.B., M.Sc., M.R.C.P.(U.K.), F.F.P.H.
Pasqualina Santaguida, B.Sc..P.T., Ph.D.
June Carroll, M.D., C.C.F.P., F.C.F.P.
Judith Allanson, M.B., Ch.B., F.R.C.P., F.R.C.P.(C.), F.C.C.M.G., D.A.B.M.G.
Carolina Ruiz Culebro, M.D.
Melissa Brouwers, Ph.D.
Parminder Raina, Ph.D.
AHRQ Publication No. 08-E001
October 2007

Suggested Citation:
Qureshi N, Wilson B, Santaguida P, Carroll J, Allanson J, Ruiz Culebro C, Brouwers M, Raina P. Collection and Use of Cancer Family History in Primary Care. Evidence Report/Technology Assessment No. 159 (prepared by the McMaster University Evidence-based Practice Center, under Contract No. 290-02-0020). AHRQ Publication No. 08-E001. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.

This article/book was a systematic review of 56 English-only studies evaluating primary care practitioners' (PCP's) collection of family histories of breast, colorectal, ovarian, or prostate cancers in adults.

The review addressed three research questions: 1.) What is the evidence that patients know their family history of the four types of cancer cited above and report it accurately? 2.) How well do family history collection tools improve the acquisition of such information by PCP's? and 3.) What tools exist to help PCP's adequately evaluate and act upon family history-based risk factors and how well do any such tools perform?

This review was a thorough exploration of the above questions and developed numerous results and conclusions. These included the fact that respondents are more likely to accurately report relatives who are free of cancer (indicating specificity) than to report relatives who have had cancer (indicating sensitivity). Also, family history reporting may be more accurate for first degree relatives than second. In addition, accuracy could be influenced by the type of cancer involved and by the type of information collection method.

In the discussion of the recommendations of the authors, several points were noted. Among these were that a consensus should be reached regarding the extent of family history necessary for given clinical situations, the value of patient-completed tools in history collection and risk assessment, and that further research is necessary into the specifics of tool design, update interval, and the role of family history tools and risk assessment tools in the primary care setting.

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1b.chapter.93702

In conclusion, this article is a useful examination of the strengths and weaknesses of family cancer history collection and data assessment tools and methods of interpretation in the primary care setting.

Blog #2: Health Promotion

This article was about a study that was done in regards to one women’s belief about the long-term effects of taking multivitamin supplements daily. The woman in the article is in her 70s and has been taking a multivitamin supplement for the past thirty years of her life with the hope of decreasing her risk of developing heart disease and certain types of cancers. Her parents both had passed away from cancer when they were around her current age.

However, the article describes a recent study published in February of 2009, which mainly focused on the diet and health practices of postmenopausal women. The study discovered that taking multivitamin supplements do not help to decrease ones risk of developing heart disease or certain types of cancers. The study further suggested that a person who eats fruits and vegetables has a lower risk of developing these diseases versus someone who takes multivitamin supplements. The article does suggest that if a person’s goal is to maintain a general well being or to fill in any deficiencies a person may have, such as anemia, taking a multivitamin is sensible.

Study: Multivitamins don't lower older women's cancer risk

Abedin, Shahreen. (2009). Study: Multivitamins don't lower older women's
cancer risk. Retrieved on April 13, 2009 from http://www.cnn.com/
2009/HEALTH/02/10/multivitamins.cancer/index.html?iref=newssearch.

Blog #1: Health Promotion

Anna Emery:  Health Promotion Blog #1

The article below was taken from Health Magazine 2009.  The article is very interesting as it focuses on a special kind of adipose tissue referred to as brown fat.   With the help of ongoing research, there have been studies that have discovered that some adults may also have brown fat which, when the particular individual is in a colder environment, is triggered to burn off calories in an attempt to raise the temperature of the individual at any given time.  Each time the individual is exposed to cold temperatures, more brown fat is released and the individual loses weight by burning calories.  This article focuses on the different studies that have proven brown fat no longer only exist in newborns and animals but now brown fat also exists in adults.  Additionally, the article mentions that there may be a drug on the market that may help to trigger brown fat to be released to burn more calories and as a result lose weight, without enduring cold temperature.  However, realistically the article does not say that being cold is the best way to lose weight, but rather brown fat along with diet and exercise may do the trick! 

I current work in Labor and Delivery at Magee-Womens Hospital where I interact with babies and pregnant mothers.  One of the first basic rules of newborns is that most babies will lose weight before he or she gains any weight.  The main for this is due to the high levels of adipose tissue or brown fat that the baby has stored.  So, in the first few hours to days of birth if the baby has trouble maintaining his or her temperature, the brown fat that is stored in the body is triggered to burn calories and, as a result, can the newborn to lose weight.  For this reason, I found this article so very interesting because to learn that now adults and infants alike have an adipose tissue capable of producing phenomenal results is remarkable.

"Brown fat" burns calories -- may lead to new obesity treatments   

Harding, Amber.  (2009). "Brown fat" burns calories -- may lead to new obesity treatments.  Retrieved on April 12th, 2009 from http://www.cnn.com/2009/HEALTH/04/10/brown.fat.obesity/index.html

 

How Much Fish to Eat While Pregnant?

Pallarito, Karen. (2009). How Much Fish to Eat While Pregnant?: Experts debate pros, cons of consumption and mercury exposure. HealthDay News. Retrieved on April 13, 2009 from http://www.healthfinder.gov/news/newsstory.aspx?docid=62260.


This article is self explanatory if you take a glance at the title... don't think I need to clue you in to the main idea:) However, the main points are as follows as outlined in the article:

• Pregnant women should include fish in their diet for optimal maternal health and fetal growth and development, but not so much as to expose babies to dangerous levels of mercury.
  
• U.S. FDA recommends no more than 12 oz/week, but scientists in nutrition & medicine state this is minimum amount needed.
• Both the FDA as well as the American College of Obstetricians and Gynecologists agree fish consumption should be of a low-mercury content. I.e. mothers are urged to avoid certain types of fish such as shark, swordfish, king mackerel and tilefish, which are higher in mercury. Some mothers were reading into the warnings and avoiding fish altogether. However, eliminating fish entirely is not a good thing.
  
• Fish contains lg amts of omega-3 fatty acids which are important for neural development; thus, limiting it can be detrimental to a child's development
• Several studies were highlighted that proved that when babies born to mothers who ate numerous servings of fish per week, their intelligence and motor skills test scores were higher than those who did not.

Brittney Kopas

"Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis"

Tobian, Aaron A.R., Serwadda, David, Quinn, Thomas C., Kigozi, Godfrey, Gravitt, Patti E., Laeyendecker, Oliver, Charvat, Blake, Ssempijja, Victor, Riedesel, Melissa, Oliver, Amy E., Nowak, Rebecca G., Moulton, Lawrence H., Chen, Michael Z., Reynolds, Steven J., Wawer, Maria J., Gray, Ronald H.Male Circumcision for the Prevention of HSV-2 and HPV Infections and SyphilisN Engl J Med 2009 360: 1298-1309

Prior clinical trials have shown that male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men. This study evaluated the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2), human papillomavirus (HPV) infections, and syphilis in HIV-negative men.

5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 were enrolled. 3393 were HSV-2 negative at enrollment. Of these subjects, 1684 were randomly assigned to have an immediate circumcision (intervention group) and 1709 to have circumcision after 24 months (control group). Subjects were tested for HSV-2, HIV infection, HPV, and syphilis at the beginning and at the end of the sutdy (24 months). In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months.

The study's results showed that male circumcision significantly reduced the incidence of HIV and HSV-2 infection and the prevalence of HPV infection. Therefore, male circumcision can have significant public health benefit.

Young Vegetarians may Have Eating Disorders

http://latimesblogs.latimes.com/booster_shots/2009/04/young-vegetarians-may-have-eating-disorders.html

The study analyzed data from surveys, questionnaires and observations taken at 31 Minnesota schools in 1998. The 2,516 adolescents and young adults in the study ranged in age from 15 to 23. The students were categorized as current vegetarians, former vegetarians or never vegetarian. A vegetarian diet can mean eating only plant sources or consuming some dairy and eggs or even some chicken and fish.

The study found that 19.6% of the current vegetarians and 20.9% of former vegetarians used some form of extreme, unhealthy weight-control behaviors (such as using a diet pill or laxatives or inducing vomiting), and 21.2% and 16%, respectively, said they had binged on food with a loss of control. In comparison, 9.4% of the never-vegetarian group had used extreme, unhealthy weight-control behaviors and only 4.4% said they had lost control while eating and binged.

The study was published in the Journal of the American Dietetic Assoc. and commented that physicians should screen their patients for eating habits and behaviors. Young adults are believed to result in such behaviors for adherence to social expectations. Also, binge eating disorders associated with a loss of control were caused by a lack of protein and fat in the diets of reported vegetarians.

Lisa Painter

Scaks, F.M., Bray, G.A., Carey, V. J., Smith, S.R., Ryan D.H., Anton, S.D., McManus, K. Champagne, C.M, Bishop, L.M., Laranjo, N,. Leboff, M.S, Rood, J.C., deJonge, L., Greenway, F.L, Loria, C.M., Obarzanek, E, Williamson, D.A. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates The New England Journal of Medicine, Vol 360, 859-873.

The study randomly assigned 881 overweight adults to 4 different diets for a two year period. It did not compare popular diets but the diets contained healthy fats, high in whole grains, fruits, vegetables and cholesterol. Each study participant decreased 750 calories per day from baseline, exercised 90 minutes per week, maintained food diaries, met counselors and charted progress. There were no winners among the group. The average weight loss was 13 pounds at 6months. With a creep within 2 years with average weight loss of 9 pounds. All diets reduced risk for cardiovascular disease and diabetes at 6 months and 2 years.

Share your medical history with family using Google Health

This posting is pulled from an article by Jason Kincaid on "Tech Crunch" http://www.techcrunch.com/2009/03/04

Google Health was releaseed last May as a way to help individuals securely store their health information. Today, Google announced an exciting new feature which allows users to share their medical records with designated family or close friends.

From the tech crunch article: "The general idea behind the feature is that oftentimes during emergencies family members may not know the details of your medical history, like medical allergies. Such information can be lifesaving, but sharing extremely personal medical information is not something that should be taken lightly. Google is taking lengthy measures to ensure the security of the data, associating invite links to specific Email addresses and allowing users to track who has viewed their records. All shared records are also read-only."

Financial Incentives for Smoking Cessation

Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., et al. (2009). A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. N Engl J Med, 360(7), 699-709.

Volpp et al. (2009) compared the effectiveness of providing a financial incentive for smoking cessation with solely providing information about smoking cessation. Potential participants were identified through a survey distributed to employees of a company. Participants were randomized into an information-only and an information plus financial incentive group. All participants received information about local smoking cessation programs and smoking cessation methods (e.g. bupropion) covered by their health insurance. The financial incentive group also received financial incentives for completion of a smoking-cessation program ($100), for smoking cessation within 6 months after study enrollment ($250), and for continued abstinence from smoking for an additional 6 months after smoking cessation ($400). Participants could receive a total of $750. Abstinence from smoking was confirmed using a cotinine test, a biochemical test of saliva or urine samples.

Participants in the financial incentive group had significantly higher rates of smoking cessation than did the information-only group. 9.4% of the financial incentive group abstained from smoking 15 to 18 months after enrollment, compared with only 3.6% of the information-only group. Participants in the financial incentive group were also more likely to enroll and complete a smoking cessation program, and quit smoking within 6 months of enrollment in the study.

It is estimated that smoking costs employers $3400 per year because of decreased productivity, increased absenteeism, and an increased rate of illness. Therefore, this may be cost-effective for employers. However, long-term relapse rates were higher in both groups than that which is reported in the literature. Individuals volunteering to participate in this study may be more driven to quit than the average smoker. Lastly, study participants were mainly white with high income and education levels (i.e. the results may not be generalizable to other populations).

Cardiovasculare disease

Heart Ed 101
Lynne E. Smith
Journal of American College Health, Volume 56 No 6

Cardiovascular disease is the leading cause of death of Americans. It is the 5th leading cause of death for those between 15-24 years of age. As obesity increases, physical activity decreases, tobacco use and high serum cholestrols, there is evidence of early development of heart disease. This article suggests colleges incorporate heart health in their regular assessments. Smith believes that the college population provides a great opportunity to stress primary prevention.

Geriatric Screening and Preventive Care

Geriatric Screening and Preventive Care
Mary C. Spalding and Sean C. Sebesta
American Family Physician www.aafp.org/afp

The population greater than 65 years of age will increase to approximately 21% of the population within by 2050. The leading causes of death for persons 65 years and older are heart disease, malignant neoplasm, cerebrovascular disease and chronic lower respiratory disease. Therefore there is significant opportunity to provide education and counseling for preventative therapies. Those therapies include tobacco cessation, nutrition and exercise counseling. A reduction in tocacco use, a heart healthy diet and increase in physicial activity are known to increase life expectancy and improve health regardless of age. Another improvement strategy to decrease mortality include aspirin use for those patient who do not have contraindications. Evidence based medicine screening is recommended in population greater than 65 years for the following conditions: abdominal aortic aneursym (one time screening), alcohol misue (at least once), aspirin prophylaxis, breast cancer, calcuim supplements (females), cholestrol, colorectal cancer, depression, daibetes, diet, hearing impairment, hypertension, obesity, osteoporosis and visual impairment. Other screens had little or no impact.

SIDS

While I think it is important to do all we can as HPs to protect infants from accidental death, I believe in the case of SIDS, where no one can figure out why the baby died, we may need to look beyond the physical. There is research showing that plants have energy bodies - and so do animals. There is research in near death experiences that give convincing arguments that we continue after the death of our physical body. These cause us to consider the unseen forces of life itself. How about that tiny weight loss that occurs just after death?

Some go so far as to say we are a spirit having a physical experience in a physical body on earth. If you can hold that possibility perhaps you may be able to stretch a bit further and think it could be that some souls (individuals) come to experience birth only, or a short life, then choose to leave their body.