Weight loss by overweight girls can lower their risk for type 2 diabetes in adulthood.

Posted on September 3, 2010 by admin

By David R Donohue, M.A.

Weight loss by overweight girls can lower their risk for diabetes in adulthood, according to the results of an analysis from the Nurses’ Health Study II reported in the June 2010 issue of Diabetes Care.

“These findings suggest that ensuring that overweight kids reverse their weight gain is critical to limiting their future risk of diabetes as adults,” said lead author Edwina Yeung, PhD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, in a recent news release.

The goal of the analysis was to evaluate the association of childhood overweight, along with other life course weight characteristics, with the development of type 2 diabetes in adulthood.

In the Nurses’ Health Study II, a total of 109,172 women reported on their recalled level of body fatness at ages 5, 10, and 20 years using 9-level pictorial diagrams (somatotypes) reflecting extreme thinness (category “1″) to obesity (category “9″). Body mass index (BMI) was calculated from recalled weight at age 18 years and in adulthood. Those participants who reported having type 2 diabetes completed a supplementary questionnaire.

Compared with women who had never been overweight, women who were overweight as an adult (BMI > 25 kg/m2) but not before adulthood had an adjusted RR of 8.23 (95% CI, 7.41 – 9.15). For women who were also overweight at age 10 years (somatotype ≥ “5″) and at age 18 years (BMI > 25 kg/m2), the adjusted RR was 15.10 (95% CI, 13.21 – 17.26). Women who had increased childhood size but who did not continue to be overweight in adulthood did not have an increased risk for adult diabetes.

“Increased body size starting from childhood is associated with a greater risk of diabetes in adulthood,” the study authors write. “However, women who become lean in adulthood do not have an increased risk.”

Limitations of the study include observational design, use of recalled somatotype instead of BMI for measurement of childhood size, population generalized  limited to Caucasian women, and possible residual confounding.

“The findings demonstrate that the importance of childhood overweight stems largely from adult overweight,” the study authors said. “It remains important then to promote lifestyle changes from youth so that the adverse trajectory could be avoided. Multiple interventions that childhood overweight can be addressed have been suggested, but these remain to be fully tested.”

The National Institute of Child Health and Human Development, the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases provided funding for this analysis. The study authors have disclosed no relevant financial relationships.

References: Diabetes Care. 2010;33:1364-1369. Abstract

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Smart and Nimble Companies Need to Rethink Older Worker’s Role in New Wave of Global Business Expansion

Posted on September 2, 2010 by admin

 

The “Silver Tsunami” Will Engulf All Global Business Operations  

By David R Donohue, M.A.

The Alliance for Excellent Education, a Washington, DC-based national policy and advocacy organization said, in 1970 the United States was the #1 high school educational system among 24 industrialized countries; today it’s fallen to 18th place.  In the second half of the twentieth century, growth in high school graduation was the driving force behind increased college enrollments. The decline in high school graduation since 1970 (for cohorts born after 1950) has flattened college attendance and completion rates as well as growth in the skills and talent levels of the U.S. workforce at all levels.

Adding more fuel to the fire shows that the United States has remained similarly stagnant in the attainment of higher education degrees. American fifteen-year-olds rank 15th of 29 OECD countries in reading literacy. In mathematics literacy, American fifteen-year-olds rank 24th of 29 OECD countries.

 The origins of this dropout problem have yet to be fully investigated. Evidence suggests a powerful role for the family in shaping educational and adult outcomes. A growing proportion of American children are being raised in disadvantaged families. This trend promises to reduce significant economic productivity and promote greater inequality in the America of tomorrow.

As the current recession is ebbing at 5MPH, most people understand about the ageing of our worker society in the abstract. But few have grasped either the size of the silver tsunami or the extent of its consequences. This is particularly true of the corporate world whose focus is on the quarter and not the future.

Global companies in the rich world are confronted with a rapidly ageing workforce. Nearly one in three American workers will be over 50 by 2012, and America is a young country compared with Japan and Germany. China is also ageing rapidly, thanks to its one-child policy. This means that companies will have to learn how to deep-mine the skills and talents of older workers over the long term, rather than confront huge waves of retirements as the baby-boomers leave the work force in droves, which could be a disaster for business.

Today, most global companies are remarkably ill-prepared. There was a flicker of interest in the problem a few years ago but it was snuffed out by the recession. The management literature on older workers is a mere molehill compared with the mountain devoted to recruiting and retaining the young, but again the question is,  can the skills, education and talent levels of these younger workers be the sole engine that drives future business success?

Companies are still stuck with an antiquated model for dealing with ageing, which assumes that people should get pay rises and promotions on the basis of age and then disappear when they reach retirement. They have dealt with the burdens of this model by periodically “downsizing” older workers or encouraging them to take early retirement. This has created a dual labor market for older workers, of cosseted insiders on the one hand and unemployed or retired outsiders on the other.

This continuing 20th century model cannot last in our changing 21st century global economy. The number of young people, particularly those with valuable math, science, communication and engineering skills, is shrinking. And governments are raising retirement ages and making it more difficult for companies to shed older workers, in a desperate attempt to cope with their under funded pension systems. Even litigation-averse Japan has introduced tough age-discrimination laws.

Companies will have no choice but to face the difficult problem of creatively managing older workers. How do you encourage older people to adapt to new practices and technologies? How do they get senior people to take orders from young whippersnappers? Happily a few companies have started to think seriously about these problems—and generate insights that their more stick-in-the-mud peers can imitate. The leaders in this area are retail companies. Asda, a subsidiary of the equally gerontophile Wal-Mart, is Britain’s biggest employer of over 50′s. Netto, a Danish supermarket group, has experimented with shops that employ only people aged 45 and over.

Many industrial companies are also catching the silver wave. Some are reworking or building new processes to accommodate older workers. A forthcoming article in the Harvard Business Review by Chris Loch of INSEAD and two colleagues looks at what happened when BMW decided to staff one of its production lines with workers of an age likely to be typical at the firm in 2017. At first “the pensioners’ line” was less productive. But the firm brought it up to the level of the rest of the factory by introducing 70 relatively small changes, such as new chairs, comfier shoes, magnifying lenses and adjustable tables.

Some companies, particularly in energy and engineering, are also realizing that they could face a debilitating loss of quality skills when the baby-boomers retire en masse. Bosch asks all retirees to sit down for a formal interview in an attempt to “capture” their wisdom for younger workers. Construction companies such as Sweden’s Elmhults Konstruktions and the Netherlands’ Hazenberg Bouw have introduced mentoring systems that encourage prospective retirees to train their replacements.

Older and Poorer? That one option 

Companies will have to do more than this if they are to survive the silver tsunami wave. They will have to rethink the traditional 20th century model of the career. This will mean breaking the time-honored link between age and pay—a link which ensures that workers get ever more expensive even as their faculties decline. It will also mean treating retirement as a phased process rather than a sudden event marked by a sentimental speech and a gold watch.

There are signs that this is beginning to happen. A few firms have introduced formal programs of “phased retirement”, though they usually single out white-collar workers for the privilege. Some, notably consultancies and energy companies, have developed pools of retired or semi-retired workers who can be called upon to work on individual projects. Asda allows employees to work only during busy periods or take several months off in winter (a perk dubbed “Benidorm leave”).

Abbott Laboratories, a large global health-care company headquartered in Lake County, IL USA, allows veteran top executive’s, such as Philip Deemer of Lake Forest, IL to work for four days a week or take up to 25 extra days of holiday a year.

But there is one big problem with such seemingly neat arrangements: the plethora of age-discrimination laws that have been passed over the past few years make it harder for companies to experiment and easier for a handful of malcontents to sue. Ok, so we need to get very creative on this and begin to look at older workers as a trusted and experienced business asset to catch the new wave of global expansion that’s just around the corner. On the other hand, we can  sit tight and just hope that people with skills, talents and proven experience will come calling to our companies, but that is the 100 to 1 longshot for the gamblers.

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FDA’s Alarmed Over Growing Drug Safety Issues!

Posted on September 1, 2010 by admin

By David R Donohue, M.A.

Since 2005,  when the Food and Drug Administration’s (FDA’s) Drug Safety Oversight Board (DSB) was formed, the topics discussed by its members have evolved from ones pertaining to a single drug or drug class to those broaching much broader drug safety issues.

Hot topics of discussions have included the deaths among children with attention deficit hyperactivity disorder (ADHD) taking stimulants, the abuse and misuse of opioids, fire risks linked to alcohol-based skin preparations, and the potential cancer risk of CT radiation.

The DSB formed in 2005 and mandated by law in 2007 in response to public calls for closer scrutiny of overall drug safety that had major human safety issues. For example, in the late 1990s and early 2000s of several high-profile drugs, including Hismanal (Janssen), Propulsid (Janssen), and Vioxx (Merck).

“During this time of turbulent drug withdrawal, the FDA faced both internal and external challenges,” said an FDA CDER science policy analyst.

“The FDA at that time had no formal mechanism to resolve differences in opinion or decide when and how to communicate and alert the public about a drug safety issue under evaluation,” the analyst explained. “Externally, the FDA was often criticized for acting too slowly when presented with adverse event data and drug safety signals.”

The board is not a federal advisory committee but, rather, an internal management council that does not fall under the Federal Advisory Committee Act. It provides advice to the CDER director on handling and communicating important and often emerging drug safety issues and provides a forum for discussion about how to address these issues.

Death Among Children With ADHD is Targeted

Among issues recently tackled by the board was the sudden and unexplained death among children with ADHD taking stimulants. “The controversy involved whether the drugs caused an increased cardiovascular risk in children without known cardiac disease,” said Martin Kaufman, DPM, CDER science policy analyst. “They were already labeled for children with cardiac disease. There was also controversy about the need for cardiac testing before a child was started on a stimulant medication for ADHD.”

The board ultimately recommended that the available information was insufficient to make definitive conclusions and that the issue should continue to be monitored. It also recommended that CDER issue a drug safety communication to coincide with publication of a study that found an association between stimulant use and sudden unexplained death.

Consideration of a change in the drug label to include the potential risk for cardiovascular adverse events in children with ADHD who are otherwise healthy should be pending follow-up information from another study partly funded by the FDA, said Steven Osborne, MD, executive director of CDER.

Alcohol-Based Skin Preps

Another recent topic of discussion was the safe use of alcohol-based skin antiseptics in the operating room. Fires in the operating room possibly linked to these preparations occur at an estimated annual rate of 50 to 200 per year.

In that case, the board recommended changing the label to contain a stronger message, talking to hospitals that had fires, and studying how alterations in the design, materials, and specifications might reduce risks for fires.

A Matter of Opinion

Although for the most part the FDA has “moved away from internal struggles or dissention and is in general working better together,” Dr. Osborne acknowledged that some of the DSB meetings still invite “spirited opinions.” Rather than detail this discussion in the public summaries, it is best for the public make its own conclusions, Dr. Osborne said. “I think you can assume that if it’s a hot topic in the outside environment, there are a variety of opinions in the drug safety board meeting.”

Adding information about the nature of the meeting to the public summaries could be counterproductive, added Dr. Osborne. “Rather than being transparent, it could just be opening up a larger can of worms; we’re trying to do our best in offering information but not trying to complicate our own process here.”

Dr. Gregory D. Busse, PhD, from the Office of Communications at CDER, stressed the importance of ensuring the information in these summaries is accurate and correct and presented in the proper context.

Not all safety issues lead to formal discussion by the board. For example, said Dr. Osborne, the board is aware that the diabetes drug rosiglitazone (Avandia; GlaxoSmithKline) is on all major news outlets, but the board has not been asked to play a role in formal discussions on safety issues pertaining to this drug as of yet.

Drug Safety Communications

As for the FDA’s Drug Safety Communications, Dr. Busse outlined when such a communication might be required. For example, a communication might be released if the safety issue involves a drug that is widely or frequently used, if an adverse event is serious or life threatening, or if there are new contraindications for a drug that providers need to know to prescribe it appropriately.

According to Dr. Busse, the board has “outreach” initiatives to organizations that should learn the information contained in a particular communications. Staff also use professional societies to “facilitate the movement of the information to their constituents,” he said.

Dr. Busse and colleagues are in the process of developing a program to determine whether these communications are reaching the intended audience and are having an effect on clinical practice.

“Ultimately, our goal is to have a kind of bidirectional relationship with the patient healthcare community where we not only issue a drug safety communication, but we’re also listening to the feedback and are tailoring those communications so that they get the information they’re most interested in and we can provide them with the information that’s relevant to them,” Dr. Busse said.

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Moderate exercise shown to treat cardiovasculat disease as well as prvent it!

Posted on August 31, 2010 by admin

By David R Donohue, M.A.

A series of eye opening  presentations at the European Society of 2010 Cardiology Congress in Stockholm, Sweden today, emphasized how even moderate regular exercise can reverse the damage of existing heart disease,  while also preventing it. This 2010 Congress is reversing long held beliefs that only high-intensity exercise could have a positive inpact on reversing damage done by heart disease, while preventiong it.  Cardiovascular diseases are the leading cause of death in the United States and developing world today.

 Lead researcher, Dr Brage Amundsen M.D.  (Norwegian University of Science and Technology [NUST], Trondheim) explained how his group is learning how to improve heart-failure patients’ peak oxygen consumption (VO2). Low peak VO2 is a driver of poor prognosis in postinfarction heart-failure patients, he explained. The NUST group has conducted similar studies on the benefits of interval training for patients with metabolic syndrome.

 Preliminary studies show that patients using the interval regimen improve their peak VO2by a much larger margin than the moderate continuous-training group and that patients in the interval-training group exhibited reverse left ventricular remodeling, reduction in pro-B-type natriuretic-peptide (proBNP)–a marker of hypertrophy and severity of heart failure–and improvement in left ventricular ejection fraction. In vitro cell studies showed that interval training was associated with a reduction of endothelial-cell volume, and functional measures of single myocytes indicate improvements to muscle contractility and oxygen consumption in the interval group.

“A lot of people think this [high-intensity exercise] must be very hard, so we have to be a bit more realistic and inform the patients that it’s not that hard and that anybody can do it,” he said.

A Role for Strength Training

In a separate presentation, Dr François Carré (Hôpital Pontchaillou, Rennes, France) described research on a variety of exercise modalities showing that cardiovascular patients benefit from strengthening large muscles in addition to aerobic exercise, so “well-done” resistance training should be encouraged on top of aerobic exercise. His group’s research has shown that the benefits of exercise generally far outweigh the risks for cardiovascular-disease patients, but exertion does increase the risk for cardiovascular adverse events, “so the physician must evaluate the individual risk, propose an individual program, and give quality education to the patients to start an exercise program that they can support.”

As well, Dr Rainer Rauramaa (Kuopio Research Institute of Exercise Medicine, Finland) presented research that suggests regular moderate-intensity exercise ought to be considered a “cornerstone” in the treatment of hypertension even if the impact is modest.

Early studies suggested that exercise did not improve resting blood pressure, but a more detailed look at the data showed that genetic factors play a major role in determining the response of a patient’s blood pressure to exercise. Rauramaa’s group also found that exercise’s influence on blood pressure lasts only a few days, so the earlier studies may have simply missed the benefit of exercise by measuring the patients’ blood pressure several days after their last exercise. His group found an improvement in carotid intima-media thickness in patients who exercised, but the improvement did not appear until three years into their study.

Dr Rauramaa said, “I would be happy if I could convince everybody with coronary artery disease to participate in a moderate exercise program,” he said. He recommends patients stick to the professional guidelines by exercising three or four times a week, 30 minutes per session, at moderate exertion. He cited previous studies showing that patients who attempt to exceed that effort are at increased risk for potentially lethal arrhythmias.

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Simple Tips to Get Rid Of Your Stress!

Posted on August 30, 2010 by admin

By David R Donohue, M.A.

Work is piling up and your facing multiple deadlines, or maye you have trouble making your house payments. When you have a miserable day, you probably make a dash for your favorite route and try to work out your frustrations over a few miles. But there’s a chance the very thing you’re doing to unwind could set you up for — a runner’s/race walkers ultimate stress.

“Stress and anxiety can contribute to injuries,” says Bill Sayers, Ph.D., associate professor of sports medicine at the University of Texas. “When you’re under a great deal of stress, your energy levels get sapped, and you can’t recruit muscles as effectively or react quickly.”

Recently, a study published in the Journal of Science and Medicine in Sport reported that athletes who had recently dealt with a “minor life event” or “hassle” (family, work, health, or financial issue) were more prone to injuries than those under less stress. Another study from the British Journal of Sports Medicine reported that even elite athletes were more likely to get hurt if they competed while angry, confused, fatigued, tense, or depressed.

That’s not to say you can run only when you’re calm and collected. Cortisol and adrenaline (“flight or fight” hormones) can boost performance when released in small amounts. A temporary case of pre-race anxiety, for example, can quicken your pace, says Swanik. It’s chronic stress — when you feel completely exhausted and on-edge for weeks on end — that makes you vulnerable. When cortisol levels are elevated for too long, your muscles and immune system don’t function at their best.

So what’s a runner to do in these especially tense times? By being aware of the ways stress can impact your running, you’ll be able to find peace — and stay healthy — on the roads.

Stress Symptom: To Watch For

Whether you zone out or go over every last detail of the fight you had with your spouse, when you’re frazzled, you’re less likely to pay attention to everything from good posture to potholes. Research published in Behavioral Medicine indicated that stressed-out athletes had a narrower peripheral visual field and increased distractibility than those who were relaxed.

THE SOLUTION
Run on a flat, well-lit surface, and try to pick a scenic route you find calming. “When you’re on edge, it’s easy to stop enjoying your runs,” says Bruce Gottlieb, who has advised professional and Olympic athletes in Boulder, Colorado, for the past 20 years. “So run in a place that will help you be present in the moment.” Another option: Hop on the treadmill and crank your iPod — music is a proven stress reliever.

Stress Symptom: YOU’RE FIRED UP

Resist the urge to go all-out in an effort to blow off steam, says Mike DeWitt, head track and field coach at Ave Maria University, Naples Florida said,  ”You’re more likely to be tired when stressed, and when you start your run already fatigued, your form will suffer,” he says. “You’ll have trouble maintaining good posture, you might struggle with your leg turnover or foot strikes. These things can lead to injury, especially during a tempo run or an interval workout.”

THE SOLUTION
“Take it down a notch and keep the pace comfortable,” DeWitt says. Run with someone whose per-mile pace is a minute or more slower than yours. You should be able to keep a conversation without panting. Bonus: Venting to a running buddy can be therapeutic.

 Stress Symptom: Things to Watch For

You’re sitting at your T.V. or computer and suddenly you realize your shoulders are near your ears and your jaw is clenched. It’s natural for muscles to tighten up, but if you start running immediately after a tough day, you might strain something — especially an area that’s already weak or vulnerable. “Stress can cause changes in the body that may most adversely affect areas that are not working at their optimum potential, such as an old injury with resultant scar tissue or reduced flexibility,” says Larry Frieder, a Boulder, Colorado, chiropractic sports physician.

THE SOLUTION
Improve your flexibility and strength — especially in those weak, injury-susceptible spots. Plus, strength and flexibility workouts encourage you to listen to your body. During a massage, stretching session, or weight workout, you might notice that your left hamstring is tighter or weaker than your right one, for instance. Working to resolve that issue now could save you the grief of physical therapy later.

Stress Symptom: Are You Eating OK?

When you don’t have the time or energy to cook, some people end up in the drive-thru, while others skip meals. Either way, your diet suffers. What’s more, the healthy nutrients you are eating aren’t getting fully absorbed. “Blood rushes away from the stomach when we’re stressed, which leads to less digestive enzyme production and weaker digestion,” says Craig David, a certified fitness nutrition specialist. “Poor digestion can also lead to poor nutrient absorption, which can lead to a loss of lean muscle tissue.”

THE SOLUTION
Eating small, frequent mini-meals that include a lean protein, complex carbohydrate, and monounsaturated fat (like almond butter on whole-wheat toast or guacamole and carrot sticks) helps stabilize your blood sugar. This will keep your metabolism and digestive tract humming and will make it easier to resist unhealthy snacks.

Try Vitamin B-rich foods such as, Liver, tuna, oats, turkey, Brazil nuts, bananas, potatoes, avocados and legumes to trigger serotonin, a calming brain chemical.

FRESH START
While the rush of endorphins you get from exercise can be the perfect antidote to stress, running when you’re really wound up can lead to more problems. Here’s how to loosen up before you lace up and after you’re done.

JUST BREATHE
Calm your nervous system and press the “reset” button by focusing on your breath. Close your eyes, and imagine the air moving deeper into your belly with each inhale and pushing more air out on each exhale.

WARM UP
To combat stress-induced tightness, start off with a five-minute walk. Gradually pick up the pace.

VISUALIZE A FUN RUN
Conjure up an image of the last time you smiled when you were running and do everything you can to mimic that run.

COOL-DOWN
Try a 10-minute yoga or Pilaties routine to boost your flexibility and help prevent injuries and musle soreness.

FEEL BETTER
Frazzled? While lying in bed, take your pulse. Get up, and take it again in two minutes. If your heart rate is 10 beats per minute or more faster, run easy today. Remember have some fun in your workouts.

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Tips on Starting a Racewalking Program.

Posted on August 28, 2010 by admin

Race Walking 101

By David R Donohue, M.A.

Do you feel the need for speed? Race walking may be just the solution. Although race walking is a technique that can be used at any walking speed it is generally used by walkers to increase their speed and endurance. Plus the race walking technique provides a great aerobic workout and burns more calories per mile than fitness walking or running.

Race walking is not just slow running. You’ll use different muscles in different ways (glutes, hips and hamstrings) as you endlessly hone your technique, which is really nothing but solid fitness walking technique taken to an extreme. You’ll also use more energy (that is, calories) than running at equivalent speeds or walking at slower speeds.

Competitions exist at all levels, from local all-comers races to national elite or masters races affiliated with USA Track & Field, the national governing body. In the Olympics, men compete in the 20K (12.4 miles) and 50K (31.1 miles), while women race the 10K (6.2 miles), but that will change to 20K in 1999. Elite men, by the way, can accomplish a 5:30-5:45 mile and hold barely over a 7-minute pace for a 50K. Elite women can hold a sub-7-minute mile for a 10K. Makes me tired thinking about it.

Birth of the Sport

Race walking developed as one of the original track and field events of the first meeting of the English Amateur Association in 1880. The first race walking codes came from an attempt to regularize rules for popular 19th century long distance competitive walking events, called Pedestrianism had developed, like footraces and horse racing, as a popular working class British and American pastime, and a venue for wagering. Walkers organized the first English amateur walking championship in 1866, which was won by John Chambers, and judged by the “fair heel and toe” rule. This rather vague code was the basis for the rules codified at the first Championships Meeting in 1880 of the Amateur Athletics Association in England, the birth of modern Athletics. With Football (soccer), Cricket and other sports codified in the 19th century, the transition from professional Pedestrianism to amateur race walking was, while relatively late, part of a process of regulations occurring in most modern sports at this time.

Race Walking Has Two Rules

The support leg must straighten when the heel touches the ground in front of you and remain straight through the vertical (as it passes underneath the body), and one foot must be on the ground at all times. Both rules are judged by the human eye (not slow-motion video replay!). Yes, you can be disqualified (one disadvantage compared to running) if three different judges separately decide you have violated a rule. But, it does make it more challenging!

Note that a “straight” leg doesn’t mean a locked knee. That can damage soft tissue or bones. In accomplishing the second rule, the best walkers will have just contacted the ground with the front heel as the rear toe is about to leave the ground.

Basic fitness walking technique must be fine-tuned and exaggerated. A few tips to help you along:

  • Work on shin strength to perfect a good heel strike with a straight knee, and work on calf strength to have the power for a strong push off. Feel as if the leg is lengthening behind you when you push off.
  • Hips must begin to rotate forward and backward as you reach with each step — not only from the top of your leg, but from your waist. Allow each hip to drop downward as the non load leg swings underneath the body. Feel as if your hips are wrapping around a pole in front of you, not swinging from side to side.
  • Keep your elbows tucked in to your waist as they swing dynamically. A powerful punch forward (without reaching forward) helps your rear foot push off.
  • Avoid leaning backward. Try to keep your weight over the balls of your feet. Any lean is from the ankles, not the waist.
  • Relax. You have to be loose in the shoulders and waist.

Initially, try short bursts of speedier technique during your fitness walks, say to the next street corner. Slowly increase the length of those bursts. Soon you might find the flow of fine race walking feels easier and more graceful than fitness walking. Have fun with this new aerobic sport.

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Six Key Questions to Ask at Every Health Visit!

Posted on August 27, 2010 by admin

By David R Donohue, M.A.

Six Key Questions are designed to build knowledge, communication and strengthen your relationship between yourself and your healthcare team member. They will increase your involvement and responsibility for your health care outcomes. Patients will learn the importance of asking these Six-Key Questions in every health care visit, procedure or test to improve your health care outcome.

“Six-Key Questions to Ask At Every Health Care Visit.”

1. What is my main medical problem?

2. What do I need to do?

3. Why is it important for me to do this?

4. What is my medication for?

5. How do I take my medication?

6. What should I expect from the medication?

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Health Providers and Patients Need to Improve Communications to Maximize Health Outcomes.

Posted on August 26, 2010 by admin

By David R Donohue, M.A.

Doctor’s tend to be strongly opinionated and walk the bridge of their ship with confidence. Some patients worship their physicians and feel they can do no wrong. Others complain about the doctors they see — for keeping them waiting, have poor bedside manner, or because they doubt the physician’s clinical prowess.

Patients aren’t the only ones with opinions. Although doctors enjoy their interactions with most patients, they find visits with others downright unpleasant.

This issue is more common than most people imagine: Doctors describe almost 1 in 6 patients as difficult to work with, according to surveys.

 There are strategies doctors can use to help mend these strained relationships. They can, for example, hone their communication skills and strive to be as empathetic as possible. After all, we patients face many frustrations — long waits, short appointment times and brusque and sometimes burned-out physicians. We are lucky sometimes to get 15 minutes of face time.

But physicians have frustrations too. They work within an imperfect healthcare system that often doesn’t allow them the time or resources to provide the kind of care they’d like to deliver. They also have to deal with a wide range of patients and personalities who need not only outstanding clinical care, but emotional support as well.

 So it’s up to patients to help the interaction between provider and patient go smoothly as well. It all starts with recognizing what doctors might find irritating to deal with, and why.

Patients’ personalities play a significant role in how doctors respond to them. Doctor’s typically don’t appreciate patient’s who are abrasive or rude — who does? But the issues go beyond bad manners. Many physicians also struggle with patients who are incredibly demanding, highly emotional or are extremely passive.

A doctor’s demeanor also comes into play. A physician who doesn’t like to relinquish control, for example, may find patients who are highly engaged in their own care annoying, while another doctor may appreciate this kind of involvement.

Research has identified a number of specific patient behaviors that irritate doctors that include. Doctors hate it when patients insist on being prescribed a drug or given a medical test that the physician feels isn’t necessary. While patients may feel they’re advocating for themselves, doctors often view this kind of pressure as manipulative and a challenge to their professional judgment. That’s not to say that patients shouldn’t ask about drugs or tests they might have heard of — they should. But they need to be prepared to thoughtfully listen to the physician’s answer and not immediately dismiss the feedback.

 Physicians grow frustrated with patients who visit regularly but largely ignore the medical advice they’re given. For example, only about 50 percent of all patients take the medications they’re prescribed as directed. Compliance with lifestyle prescriptions such as weight loss and smoking cessation is even lower; fewer than 10% of patients successfully implement these types of behavioral changes over the long haul.

In many instances, the lack of follow-through is understandable — on an intellectual level. Medications may be stopped because they cause unpleasant side effects or cost too much money, and lifestyle changes are hard to make. On a strictly emotional level, however, noncompliance is frustrating to physicians who really do want to see their patients get better.

 Doctors are very busy and get aggravated by patients who are unnecessarily time-consuming. This includes patients who fail to answer questions directly and concisely, turning simple “yes” or “no” questions into long stories filled with loads of unrelated details.

Perhaps more frustrating, however, are patients who come in with multiple unrelated complaints and expect them all to be addressed in the course of one short office visit. Although doctors would like to be able to deal with all of the issues, they can’t feasibly do it in the amount of time they’ve been allotted. Thoroughly evaluating a patient for headaches alone can take up an entire visit; evaluating someone for headaches, leg pain, heartburn and fatigue would consume the entire morning.

Patients often hold their doctors accountable for problems that arise between them. Somehow it’s the doctor’s fault if they don’t get along. If he had just been more compassionate or spent more time with the patient things would have gone more smoothly; if she’d explained things more clearly, had more experience or was less judgmental, the patient would have been better served.

Doctors also frequently blame themselves for these troublesome encounters, feeling that in some way they’ve failed. They search for ways to manage their practice and emotions differently in hopes of improving relationships with the patients they find most difficult.

But the physician-patient relationship is a two-way street, and both parties need to do their utmost to make the dynamic partnership work. Or else, the end result is both parties come away with losers in a lost effort to optimize healthcare outcomes for all stakeholders.

Doctors need to do their best to listen and communicate clearly; patients need to really hear what their physician has to say. That doesn’t mean they can’t ask questions or even challenge their doctor. It does mean they can’t totally ignore the guidance and advice they’re offered.

Physicians need to be willing to work collaboratively with patients, but patients need to carry out their end of the bargain. It’s up to patients to follow through with the advice they’re given. No one can take their medications for them or make the lifestyle changes necessary for good health in their stead.

Doctors need to be clear about what they can and cannot realistically provide for their patients. For example, the length of a typical office visit should be spelled out upfront, and patients should be informed about their options if they require additional time. Patients also need to be thoughtful and reflective about what they can ask of their doctors. They need to recognize, for instance, that more than one visit to the doctor may be necessary if they have a host of non-urgent problems they want addressed.

In most instances, there will be a middle ground where both parties walk away satisfied. In cases where doctors and patients can’t see eye to eye, ending the relationship is probably the healthiest option for everyone involved.

Unpleasant encounters between patients and their doctors take a big toll on both parties. They leave doctors — as well as patients — feeling frustrated, angry and resentful. Negative interactions can ruin a doctor’s day and even undermine the way she or he feels about the profession. But it is the patient who potentially has the most to lose from this type of friction: Being perceived as difficult by a physician may actually undermine the quality of care received.

Like any relationship, the best results generally come when two people are working together — not locking horns or determining who is top dog.

 Tomorrow: 6 Key Questions to Ask on Every Health Care Encounter

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Is Universal Healthcare UnAmerican?

Posted on August 25, 2010 by admin

By David R Donohue, M.A.

LAST Friday Jonathan Martin and Ben Smith published a piece in Politico entitled “The New Battle: What it means to be American.” The gist of the article says that conservatives and the Republican Party are moving away from culture-war issues and towards a struggle over the appropriate size and role of government. “Much of the right—including the noisy and influential tea party movement—sees greater and more immediate danger from the Obama administration and Congress on issues related to the role of government and the very meaning of America than from the old ‘social issues,’”

Ok, I’m going to move on and cite several of the conservative figures Martin and Smith interview, but actually, I think I’d better stop right there for a moment. Let’s take a look at the elision in that sentence: the part where we move from “the role of government” to “the very meaning of America”. What is the relationship of “the role of government” to “the very meaning of America”? There are certainly some functions that government assumes in other countries which are clearly un-American. For example, in some countries, the government enforces an official religion, such as in Saudia Arabia. In other countries, the government imprisons people and tortures them without trial. (Let’s not get into that for now.) But the left is at least as adamantly opposed to government playing these sorts of roles as anyone on the right is. So how does today’s right see “the role of government” as a dividing line between the right and left, in a sense that affects “the very meaning of America”? Here’s where former Bush administration official Peter Wehner says:

“What we’re having here are debates about first principles,” Wehner said. “A lot of people think [Obama is] trying to transform the country in a liberal direction in the way that Ronald Reagan did in a conservative direction in the 80′s. This is not the normal push and pull of politics. It gets down to the purpose and meaning of America.”

In the view of National Review editor Rich Lowry, that sense on the right of a fundamental shift has helped turn the role of government into a cultural issue, filling some of the emotional space formerly occupied by the traditional hot-button issues.

Questions about the role of government “have a cultural charge because people feel the definition of the country is changing,” Lowry said.

Just as the European Christian Conservatism in the 1970s and ’80s grew as part of a backlash against what were seen as the cultural excesses of the ‘60s, the new right of today amounts to a rebellion against the perceived threat of this era—a slippage toward European-style social liberal democracy.

Oh, okay. The phrase “European-style social liberal democracy” isn’t actually entirely clear; the United States is, in every meaningful sense, a European-style social democracy, albeit one with relatively low taxes, relatively parsimonious government entitlements, and relatively spectacular national parks. But you get the drift. The right, in Mr Martin and Smith’s view, is arguing that the “purpose and meaning of America” are not compatible with the economic elements of Barack Obama’s legislative agenda. That agenda, last time I looked, chiefly comprised universal health insurance, regulation of the financial sector, a carbon tax or carbon emissions limits, and an approach to shrinking future budget deficits that will fall more heavily on the rich and involve fewer cuts to existing social services and entitlements. Mr Wehner and Lowry, like many tea-party demonstrators, think that this economic agenda is un-American.

Mr Martin and Smith don’t explicitly say this, but one gets the feeling, reading their article, that they think the transition to this battle over “what it means to be an American”, in an economic sense, will calm some of the irrational frenzy of the old right-left culture wars over sexual identity, evolution, and so forth. If so, I would like to firmly disabuse them of that notion. Let’s put it this way: I support the Affordable Care Act, known to the right as ObamaCare. I do not react well to being told that my position on this issue does not reflect with “the purpose and meaning of America”. I see not a shred of evidence for such a claim. In fact, I believe that my support for universal health insurance, like my support for universal education, is rooted in the greatest traditions of American history and political thought. No doubt Wehner and Lowry feel the same about their positions on universal health insurance. The difference is that I’m not going to accuse them of betraying “the purpose and meaning of America.” I am not trying to turn a dispute over what government should do to improve America’s social and economic fairness and well-being into a shouting match over who is or isn’t a real American.

But that’s what Martin and Smith say the right is trying to do. Here is my question to them over a culture-war argument: the right says, America is a Christian nation; I say America is a nation where Muslims and anybody else has the right to worship two blocks from ground zero. Here’s another culture-war argument: the right says,  America’s freedom is under attack and we can’t afford to give terrorists constitutional protections against torture; I say those constitutional protections against torture are exactly the freedom we’re trying to defend. Both of these are real arguments about the meaning of America, with roots in the country’s founding documents and originating political events. If you want to accuse me of being un-American in an argument like that, I’ll argue you’re wrong, but I can see why the accusation is germane, and I may call you un-American in your turn. But to call someone un-American because of their position on relative levels of taxation or the government’s role in regulating and guaranteeing health care insurance is an attempt to enlist fear and vindictive nationalism in the service of one’s own economic agenda. It’s an outrageous tactic, and it ought to be completely out of bounds in American politics, but its becoming the politically correct thing to do.

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Choosing A Healthy Diet That’s Right For You!

Posted on August 24, 2010 by admin

By David R Donohue, M.A.

When it comes to losing weight, everyone has an opinion about what works best. Low fat, low carb, or Mediterranean style—you’ve probably heard stories of people dropping major pounds by following one of these diets. The truth is you’ll lose weight on any diet as long as you take in fewer calories than you burn. The diet you choose should keep you satisfied and limit your cravings for junk. How do you decide what plan will work?

Researchers at the Harvard School of Public Health studied more than 800 overweight adults over 2 years, and researchers found that as long as people made healthy choices, the percentage of protein, carbs, and fat consumed didn’t really matter. All the study participants (divided into groups eating low fat, high fat, high carb, or high protein) lost about the same amount of weight when they ate fewer calories than they burned.

The bottom line: The diet you choose should make you feel good, keep you satisfied, and limit your cravings for unhealthy foods. So how do you decide what plan will work for you?

  • Try balancing various amounts of lean protein (poultry, fish, and lean beef), complex carbs (fruits, vegetables, and whole grains), and healthy fat (nuts, olive oil, and seeds). Find the combination that makes you full and energetic.
  • Keep a food journal of what you eat and how you feel. Over time, you’ll start to see patterns emerge.
  • If you’re like me, start following a good diet information source, such as My Pyramid. Gov http://www.mypyramid.gov/ . See our WEB page links under Good Eating for information.

When you decide what kind of diet to follow, here’s how to get the most out of it:

  • Low-fat diet. The amount of fat you eat varies according to the diet’s creator. The Ornish Diet, designed by cardiologist Dean Ornish to help people reverse heart disease, recommends that you eat 10 percent of your calories from fat. The American Heart Association, on the other hand, considers low fat to be up to 35 percent from fat. A low-fat diet should consist of lots of vegetables, fruit, whole grains, beans and legumes, and little meat. It is not an excuse to eat mountains of pasta or processed carbs (like fat-free cookies or crackers), as these will spike your blood sugar, make you hungrier, and add a lot of unnecessary calories.
  • Low-carb diet. Plans like Atkins, South Beach, and the “Paleo” diet claim that by cutting carbohydrates your body will have to dig into its fat stores for energy. That is often true, at least at first, until your body adapts to the decreased energy from carbs and rapid weight loss slows. Plus, if you chow down on artery-clogging bacon, butter, and steak every day and don’t choose heart-healthy protein and fat sources (like lean meats, nuts, and olive oil), you can develop other health problems and nutrient deficiencies. Watch out for saturated fat in foods like whole milk, butter, and meat, and be mindful of portion sizes when you’re following a low-carb diet. You might find it hard to sustain a low-carb diet over the long term because you have less energy and feel tired a lot. If that happens, just switch to another diet plan.
  • Mediterranean-style diet. This has gained popularity over the last few years as a healthy, balanced approach to eating. It emphasizes whole grains, fruits, vegetables, unsaturated fats from nuts and olive oil, and lean protein like fish and chicken. You don’t want to overdo the pasta, cheese, and alcohol on this diet because these calories add up quickly. This is a moderate-fat diet that offers a variety of choices and will suit many different tastes. You’ll find that if you are focusing on an active lifestyle a Mediterranean-style diet is a good first choice. It’s easy to get all the nutrients you need to sustain a healthy, energetic lifestyle with this method of eating.

When you’ve found the diet that suits you, you may notice that your weight starts to drop without a lot of effort. You’ll be more satisfied and less prone to cravings, which will help you be consistent with your plan. As long as you stick to your diet and combine it with a workout program that also fits your preferences—you will be able to lose weight and keep it off.

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