Archive for the ‘ROUND-UPS and Other Posts’ Category

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Reading, Writing…Weight Control?

Conversation Continues
Tuesday, May 15th, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Kelly Malcom, Editor, CFAH’s Health Behavior News Service.

A recent report by the Institute of Medicine has called on the nation’s schools to play a key role in stemming the steady increase in childhood obesity by requiring physical education and including food literacy along with other staple subjects such as reading and math. In a Wall Street Journal article, Dan Glickman, chairman of the panel that wrote the report, said, “If you believe this is a massive national problem, you have to deal with it in a systems way.” Yet, the article continues, the challenge is in making the changes.

Schools in Massachusetts are going so far as to ban bake sales and limit access to junk foods during the school day. While it may seem like a lot for schools to take on, many health policy experts see schools—where kids spend much of their day—as a prime target for the fight against obesity.

Earlier this year, the Obama administration unveiled changes to the federally-funded National School Lunch Program to upgrade nutritional standards and ensure that kids receive more fruits and vegetables while at school.  California has already begun to address the way kids eat at school by banning soda and offering low calorie foods.  The changes seem to be working. New research shows that, compared to teens in 14 other states, California students consumed on average 158 fewer calories per day.

New research also suggests that gym class and recess are a benefit to kids mentally as well as physically, by encouraging cooperation and conflict resolution. Esther Entin, M.D., a pediatrician and clinical associate professor of Family Medicine at Brown University’s Warren Alpert School of Medicine, reports on research in The Atlantic that “suggests that recess time can be considered a potentially influential part of the school day that can foster important skills in individual students and in school communities.” Despite this, continues Entin, academic, budgetary and overcrowding issues have conspired to reduce recess.

Case in point: A recent study in the American Journal of Preventive Medicine reveals that in California, where there is a mandate requiring 200 minutes of school physical education every ten days, kids in districts that offered phys ed performed better on fitness tests.  Surprisingly, only half of the CA school districts studied fulfilled the state mandate for PE.

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Employee Wellness Programs: The Carrot or the Stick?

Conversation Continues
Monday, April 23rd, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Kelly Malcom, Editor, CFAH’s Health Behavior News Service.

Employee wellness programs sound like a good idea. After all, it’s in a company’s best interest to have a healthy, productive workforce and to try to keep the cost of group insurance down.  Before any benefits of such programs can be realized, however, companies need buy-in from their employees.

A recent HBNS news story reported that creating teams with potential lottery-style cash rewards motivated more employees to complete health risk assessments, a core feature of many wellness programs.   “There is often this assumption if we just give people ‘x’ amount of dollars, the bigger ‘x’ is, the more effective it will be.  One can argue that lotteries take advantage of the fact that people don’t understand probabilities very well,” said Kevin Volpp, MD, co-author of the study.

Some employers use incentives tied directly to health insurance, as Washington Post’s Sarah Kliff writes: “Some wellness programs use carrots, decreasing a worker’s health insurance premiums if they enroll in a smoking cessation program or start hitting the gym. Some use sticks, setting higher deductibles or premiums for those who can’t meet a certain body-mass index or do not quit smoking.”  Other employers forgo the carrot and the stick altogether by making wellness programs compulsory.

Kevin Volpp, a professor at the University of Pennsylvania School of Medicine, who has studied the use of incentives in health insurance programs, says, “We’re seeing a big move in this direction driven by employers’ concern about rising health costs and their sense that employee behavior has a lot to do with high cost.”  A recent USA Today/Kaiser Health News story details one such company, which subjects its employees to an annual health check to determine how much they will pay in insurance premiums.

However, Julie Appleby reports that some approaches raise the disturbing possibility of discrimination based on health status: “While supporting wellness programs in general, several patient advocacy groups warned the Obama administration last March that additional consumer protections are needed. Tying medical test results to financial incentives or penalties in premiums or deductibles could discriminate against some workers, especially those who already have health problems…”

Whether these programs can really curb health insurance costs is still up for debate, but there is growing evidence to support them.  According to a recent study in the American Journal of Health Promotion, employees who participated in a health-improvement program had fewer medical costs over three years than those who did not.

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Advance Directives: Rarely Easy, Always Important

Inside Health Care
Tuesday, April 10th, 2012

Inside Health Care posts feature recent news and blog posts from the health care community and are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Monica Kriete, CFAH Communications Associate.

“Without advance directives, even a loving child may be ignorant of her parent’s wishes,” author Susan Jacoby writes in a recent New York Times editorial, Taking Responsibility for Death.  When Susan’s own mother died, many years after writing her directives, Susan said, “It was an immense comfort to me, at a terrible time, to have no doubts about what she wanted.”

Unfortunately, implementing an advance directive can sometimes be more complicated than writing one.  Amy Berman, Program Officer for the John A. Hartford Foundation, writes about her uncle being pressured to rescind his “do not resuscitate” order (DNR) in order to undergo surgery to repair a broken hip.  Her blog post, Can Someone Override Your Advance Directive?, raises a number of questions: Did the doctor pressure her uncle because “DNRs can hurt the physician’s quality metrics”?  Or was it because, as a commenter points out, “putting a patient under anesthesia for a procedure constitutes a positive intrusion into their own life support mechanisms”? And lastly, is it possible to write a directive that will account for every contingency?

Even in more clear-cut situations, implementing an advance directive is not always easy.  At the GeriPal blog, Dr. Dan Matlock writes about Being Accused of Murder in spite of a patient’s very clear-cut advance directive: “The patient had suffered a devastating stroke. Her advance directive (notarized no less) stated that she did not want any artificial means of life support, specifically mentioning artificial nutrition or hydration.” Yet in order to convince the primary care team that the artificial hydration the patient had been given should be discontinued, Dr. Matlock had to call the patient’s sister, who had been granted medical power of attorney. Remarkably, the patient’s primary care doctor accused Dr. Matlock of murder, an experience that is not uncommon among palliative care specialists, according to a study Dr. Matlock cites.

All three essays show that carrying out an advance directive can be tricky and appointing a health care proxy or medical power of attorney with whom you’ve had a frank discussion about your end-of-life wishes can help.  For more information, check out the Prepared Patient® feature article Advance Directives: Caring for You and Your Family.

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Worried Sick or Worried Well

Patient Perspectives
Friday, March 9th, 2012

Patient Perspectives round up recent posts from patient blogs and are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it. By Kelly Malcom, Editor, Health Behavior News Service

 

Anxiety can be a familiar and unwelcome companion to those with illness. Whether it’s the sudden headache that sends you searching online for possible diagnoses or the agonizing wait for test results, worrying about your health can be almost as bad as illness itself.

“A little bit of worried-well behavior is not necessarily bad,” writes Anne Polta on her HealthBeat blog. “Sometimes it can prompt people to take necessary action. Sometimes the patient even turns out to be right.” But often, especially for those with new or vague symptoms, an online search for answers leads to anxiety and sometimes requests for unnecessary tests. However, “I don’t think we’d want to return to an era when patients were told a minimum of information and paternally advised not to worry,” Polta says.

Jackie Fox at Dispatch from Second Base couldn’t agree more.  She writes, “I have often said that telling us how we should feel about our diagnosis is like telling us we should be six feet tall or have brown eyes. The same thing can apply to worrying. Some of us are just wired that way….”  For those in the midst of treatment, worrying over lab results, worsening symptoms or the possibility of a recurrence can cast an even greater shadow over one’s life. Jackie discusses her own personal approach to worry: “Some of my online buddies have shared their fears of an upcoming oncology visit or blood test, and I’ve thought of reaching out the same way, but I can’t bring myself to do it.” Her tendency to worry and not share is just part of who she is.

Even those who aren’t prone to anxiety aren’t immune from it either. Blogger WarmSocks recounts a recent appointment with her rheumatologist where she went in relatively worry free and left wondering what to make of a rash. “I waltzed into the appointment feeling great.  A few sore joints here and there, but nothing worth mentioning.  By the time I left, I sat dejectedly in my car and sighed.  What did I do to deserve this?”

How we react in the face of anxiety over illness is personal and can vary from one situation to the next. As Jessie Gruman writes in Appointment in Samarra: Our Lives of Watchful Waiting, “…people respond to such uncertainty in very different ways.  Some shut it out…Some of us find the idea of waiting in the face of an impending threat is too passive a strategy and we take matters into our own hands…The manner in which we watchfully wait may shift as the meaning of our illness and its threat change over time.  Despite our varied responses, however, we share more than just an undercurrent of anxiety.”

Whether it’s worrying about the onset of an illness or worrying about the decision to end treatment, the waiting and uncertainty can indeed be the hardest part.

Related Links:

-          The Waiting is the Hardest Part – Jessie Gruman

-          Cancer Survivorship and Fear - Andrew Schorr

-          Prepared Patient: Watchful Waiting: When Treatment  Can Wait – Health Behavior News Service

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