Category Archives: Preventative Medicine

Oak Knoll School of the Holy Child will host "ACL: The Physical and Mental Prevention and Recovery," a panel discussion, on Monday, September 23, 2019, from 6:30-8 p.m. on the school's 11-acre campus in Summit, New Jersey.

The event is free and open to the public. Pre-registration suggested.

The school's panel of doctors will discuss both prevention and recovery of the ACL injury. Physical and mental aspects will be discussed and how proper training is vital to both the prevention and recovery of such a prevalence injury. The conversation will focus on preventative techniques and then transition into what happens after injury. We will then focus the conversation on both the physical and mental aspects of rehabilitation and coming back from what once was thought to be a career ending injury.

Our Panel:

Andrew A. Willis, M.D.: A sports medicine surgeon specializing in athletic injuries and disorders of the shoulder, knee, elbow, wrist, and hand at the Sports Medicine Center and the Hand & Upper Extremity Center at Tri-County Orthopedics.

Lonnie Sarnell, Psy.D.: A a licensed psychologist who provides clinical and sport psychology services for children, adolescents and adults, at her private practice in Millburn, NJ.

Brianne O'Connor, PT, DPT: Graduated with honors from Columbia University with a Doctorate in Physical Therapy.

Jeff Boucher: Owner of Parisi Speed School in Morristown

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Oak Knoll to Host ACL Prevention and Recovery Panel - Patch.com

HERSHEY, Pa. Can a computer be used to explain why an environmental toxin might lead to neurodegenerative disease? According to Penn State College of Medicine researchers, a computer generated-simulation allowed them to see how a toxin produced by algal blooms in saltwater might cause Amyotrophic Lateral Sclerosis (ALS).

The researchers investigated an environmental toxin called -Methylamino-L-alanine (BMAA) that has been linked to significantly increased occurrence of sporadic ALS in populations with frequent dietary consumption of food sources containing high levels of BMAA including the Chamorro population of Guam where ALS incidence is approximately 100 times greater than other populations.

The toxin is produced by cyanobacteria, a blue-green algae, and can occur in marine ecosystems. According to the researchers, BMAA accumulates in sharks, shellfish and bottom feeders so populations relying mainly on these food sources may be at risk.

Elizabeth Proctor, assistant professor of neurosurgery, and Nikolay Dokholyan, professor of pharmacology, used a computer to investigate why exposure to the toxin may lead to the development of diseases like ALS.

According to the researchers, if BMAA becomes part of a protein called copper-zinc superoxide dismutase (SOD1), the protein may adopt a form that is toxic to neurons.

Proctor, who holds a doctorate in bioinformatics and computational biology, said the study may be a model for investigating non-genetic cases of ALS, which account for 90% of all diagnoses.

Our results suggest a need for further investigation of SOD1 modification patterns in ALS patients, Proctor said. If we can determine the molecular patterns of disease onset and progression, it may aid in the development of lifestyle and preventative interventions for sporadic ALS.

What eluded researchers was an explanation for why BMAA led to the development of ALS and other neurodegenerative diseases.

In their study, published in PLOS Computational Biology, Proctor and Dokholyan proposed that BMAA causes the protein SOD1 to fold into a form that is toxic to neurons.

Proteins are built using 20 amino acids according to specific recipes coded in DNA. Slight changes to the ingredients can result in proteins that arent able to function the way they are supposed to. Proctor said if enough BMAA is present in a motor neuron that is building SOD1, it may be mistaken for the amino acid L-serine, which has similar properties.

According to the researchers, who used computer modeling to see what the protein would look like with BMAA instead of serine, this substitution critically alters the structure and stability of the protein.

More than 150 mutations of SOD1 have been associated with ALS, but the structural changes from those mutations arent enough to affect the stability of the protein according to Nikolay Dokholyan, professor of pharmacology and co-author of the study.

SOD1 has a higher level of stability compared to most normal proteins, said Dokholyan, who has a doctorate in physics. Although many mutations in this protein are associated with ALS, the resulting changes to its structure are not strong enough to cause significant destabilization.

Serine, the amino acid that BMAA competes with, occurs ten times in the recipe for SOD1. The researchers tested their theory by substituting BMAA for serine in each of those ten occurrences using a computer program developed by Dokholyan. They observed that BMAA incorporation had detrimental effects to the structure and stability of the protein and caused it to fold, or adopt its shape, incorrectly.

According to the researchers, studying patterns of SOD1 modifications in patients may be useful in developing potential interventions for sporadic ALS. One example of a possible intervention is L-serine supplementation for people exposed to a high amount of BMAA.

Although the study suggestions a connection between two pieces of ALS evidence, Dokholyan says many molecular factors contribute to the presentation of symptoms that doctors see.

A variety of gene mutations and external factors, like BMAA exposure, are associated with ALS, Dokholyan said. If we can figure out one pattern out, it may give clues for how to unlock others.

David Mowrey, of the University of North Carolina at Chapel Hill also contributed to this study.

This work was supported by the National Institutes of Health Grants R01GM080742 and R01GM114015.

The authors declare no conflict of interest.

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Research suggests how environmental toxin produced by algae may lead to ALS - Penn State News

Yale professor Michael Murray and a team of scientists want to collect over 100,000 samples of DNA in the coming years.

They want yours, too.

Since its recent launch in September, a new DNA sequencing project called Generations has been collecting blood samples from willing patients across the Yale New Haven Health System. Researchers plan on sequencing the protein-making parts of the genetic material in the blood to better understand, prevent and treat diseases and cancers.

The project may sound like 23andMe, the for-profit DNA testing company that is famous for predicting ones ancestral makeup. But Murray, a professor of genetics at the School of Medicine, said Generations is much more complex.

What theyre doing is not to be dismissed, but it only covers a small amount of risk, he said. Well be looking at more genes and more conditions, and well be looking at them in a more detailed way.

The process is free and fairly simple. Once a patient reads and signs a consent form, they can do a blood test. A few weeks later, he said, if the samples test positive for a gene variant that could lead to certain diseases, the patient is notified.

In the best case, you could do it all in a half hour, he said.

Murrays team collects the DNA from blood tests instead of cheek swabs because it is more reliable. And unlike blood donations, which can turn potential donors away for their medicine use or sexual orientation, Generations wants as many samples as possible, with the goal of collecting over 100,000 individuals DNA.

All one needs is a medical record number, he said, and that can be generated on the spot for Yale students.

Theres no age or health status inclusions or exclusions. Anybody thats interested can sign up, he added.

The DNA sequences will then be stored in a biobank, or a data repository, for researchers to access and analyze in conjunction with patients medical records. With such a large amount of data, Chair of the Department of Laboratory Medicine Brian Smith said that Generations can look for trends that would not be as apparent in smaller study groups.

And because the New Haven area mimics locally what the entire United States looks like in terms of ethnic origin, Smith said the data will be especially helpful in making connections between diseases and genes.

The fact that there are so many people from a wide spectrum of genetic backgrounds, combined with the information from the electronic medical record, really gives us the ability to understand that a gene is clearly associated with a medical problem, he said.

Privacy is a big concern for the project. Since Murray and his team are working within the health system, which legally requires strict confidentiality measures for patient data, the genetic data they collect will be kept safe, Murray said.

But he is well-prepared for the task. In fact, that is what Yale hired him to do.

The researcher came from Geisinger Health in Pennsylvania last year, where he helped to create a biobank with over 50,000 patients genetic data.

Now at Yale, Murray plans on replicating that project, but at roughly twice the size. However, much of the testing his team will do will happen later on, as they work out any kinks in the system, he added.

For example, once it becomes available, Generations will also use samples to predict patients responses to certain medicines. Armed with such information, Murray said, doctors could know if a patient may need more or less of a medication to reach the desired outcome, compared to the average person.

You dont start everything at once, he said. Every sample they receive will be tested in the future once more features roll out.

To chair of the genetics department Antonio Giraldez, who participated in Generations himself, the project is also a way to prevent costly diseases that can pop up later in life. If a babys genetic data reveals that they have a high chance of developing cancer, he said, preventative measures could be taken to make sure cancer does not arise saving thousands of dollars.

I hope that many people in greater Connecticut [participate], he said.

Partial genome sequencing costs hundreds of dollars, according to Smith.

Matt Kristoffersen | matt.kristoffersen@yale.edu

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Have DNA? These Yale geneticists want it - Yale Daily News

A documentary featuring world class athletes speaking about the pros of a plant-based diet claims eating meat could kill you.

The Game Changers focuses on the truth in nutrition and features the likes of Arnold Schwarzenneger talking about the benefits of veganism in sports training.

It also aims to debunk the theory that people need to consume meat to build muscle and claims eating meat can cause cancer and cardiovascular disease.

On the documentarys website, it claims, citing a Harvard study, avoiding animal products can reduce the risk for coronary heart disease by 55 per cent.

Arnold Schwarzenneger is one of many former and current athletes interviewed in The Game Changers. Source: The Game Changers

Dr Dean Ornish, founder of the Preventative Medicine Research Institute, is also cited in the trailer stating eating plants can reverse diabetes and heart disease.

The doco also features interviews with Formula 1 driver Lewis Hamilton, Australian Olympic sprinter Morgan Mitchell, and former NFL players Griff Whalen and Derrick Morgan.

While the documentary calls on a number of scientific studies, its been criticised by some experts.

Brian St Pierre, Director of Performance Nutrition at Precision Nutrition, told Mens Health while getting people to eat plants isnt bad the documentary shouldnt be telling people meat will kill them.

Some have criticised the documentary for claiming eating meat could kill people and cause many health problems. Source: Getty Images (file pic)

That is a false dichotomy, Mr St Pierre said.

Instead, teach them the benefits of adding more wholesome plant foods to their meat intake and then teach them to eat higher-quality meat options.

He added another alternative could be telling people to swap some meat for plant-based protein and find a happy middle ground.

UK mens news site Joe.co.uk also criticised the documentary with health writer Alex Roberts writing its a huge generalisation to claim all meat has the same risk.

High levels of saturated fat are linked to conditions such as atherosclerosis, true, Roberts wrote.

But a very lean cut of turkey is not as harmful as a fatty, rib eye steak, for instance.

Vegan mixed martial arts fighter James Wilks who was heavily involved in the documentary rebukes the criticism, saying the documentary never makes the claim that all meat carries the same risk.

Writing to Yahoo News Australia after publication he said the above criticism suggests that dietary fat is the only issue ... It's far more complicated than that, with meat containing other inflammatory mediators, concentrated pesticides, toxic heavy metals etc.

He also pointed to the raft of experts featured in the film, and claimed the documentary had been accredited by the American College of Lifestyle Medicine as well as the US Defense Health Agency.

The Game Changers premieres in Australian cinemas on Wednesday.

Do you have a story tip? Email: newsroomau@yahoonews.com.

You can also follow us on Facebook and Twitter, download the Yahoo News app from the App Storeor Google Play and stay up to date with the latest news with Yahoos daily newsletter. Sign up here.

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New documentary claims eating meat could kill you - Yahoo News Australia

Alex Gorelik, CTO & Founder of Waterline Data

According to IDC, all the data thats being created and captured in healthcare is projected to grow by 36 percent (CAGR)more than any other industry.

While managing growing volumes of data is a common challenge for many organizations across all sectors, healthcare is uniquely set apart by the sheer number of new data sources thats being made availablewith new sources being added all the time. This is driven in large part by advancements in telemedicine, personalized or precision medicine, as well as IoT-based medical and personal health devices. While this flood of real-time data and analytics adds to the opportunities for all kinds of data-driven benefits like more advanced and customized care as well as faster drug development, it also means healthcare organizations will have to manage increasingly large and varied data assets. This is creating some big challenges that these organizations will need to resolve, including how to ingest and organize the information, ensure it complies with HIPAA and other regulations, and make it valuable for all stakeholders.

The problem is compounded as healthcare focuses on population health management and becomes more preventative rather than merely reactive. This, of course, requires capturing and analyzing even more data that can be used to detect early indications of health risks. Meanwhile, there has been a shift toward more remote health monitoring and response. You may go to Kaiser and think your medical professionals are all on site, but its becoming more common for hospitals to tap the expertise of specialists who could live elsewhere on the globe. They connect via teleconference systems and trade data from different systems located in different countries, all with different regulatory requirements. Using data-driven collaboration to provide the best possible care for individuals or enable the most comprehensive research for global responses to disease outbreaks while meeting various compliance needs is no easy task.

To support these needs, IDC for its part recommends big investments in health IT, blockchain and analytics tools along with effective strategies for digital transformation. A big enabling part of this transformation requires using AI and machine learning technology thats taught to recognize patterns in unstructured data and automatically converting it into structured data that can be retrieved and analyzed. This is how you automate many of the time-, cost- and resource-intensive manual processes that often sink an organizations big data ambitions. These steps include:

1. System and Silo Consolidation:

The healthcare industry is constantly consolidating. This creates a challenge in integrating all the disparate systems and data silos that need to come together to provide a big data ecosystem that can draw from all the incoming streams of data and various data sources. This means everything from hospital monitoring machines to personal IoT-enabled medical devices. Together, they can paint a holistic picture of a patients health and medical needs, accelerate pharmaceutical drug development and so much more. Using AI and machine learning-driven technology to automate data classification and consolidation across systems, departments and organizations around the world in this way can dramatically cut the time, cost and required expertise of migrating disparate data into centralized data lakes.

Furthermore, to avoid complicating effortsits complex enough alreadydont try to build Rome in one day. Start with a few critical projects that require certain data that can be processed in order to form your projects bloodstream. Focus on a few key systems and get them cleaned up. Dont try to boil the ocean all at once. Settle on a few essential use cases to launch with. Apply your automation, curation, assessment of data quality, etc., and then use it in your AI and ML initiatives. Once youre able to demonstrate success, steadily build on those successes.

2. Data Lake Management:

After suffering some setbacks due to improper management, data lakes are regaining the luster they first captured in 2010 when organizations began using them to cost-effectively store their raw data. The problem? The data lake is great for storing data, but not so great when it comes to generating value. Organizations would often dump their data there with no proper management, leaving the data to rot ungoverned and unused. But the emergence of the cloud has combined with the development of new AI-driven cataloging techniques that help automate and simplify many management functions that keep data lakes healthy. Organizations can now use them to combine data from different systems in one place where the stored data can be rendered governable, searchable and accessible.

3. Packaging Data:

Storing all your data in one data lake doesnt automatically make it usable. All that data is still streaming in from all kinds of different sources, including medical records, patient surveys, cancer or cardiac registries, claims records, and so on. You need to be able to recognize and find data regardless of its source and then format and provision it for use according to what the use case requires. This is what will enable the self-service retrieval and analytics that todays medical practitioners want in order to provide better care. Sure, theyre more data-savvy now than ever, but you still need to package data in a way that makes sense to them.

4. Governance:

Healthcare generates oceans upon oceans of data, and all of it needs to be governed. This is an area that requires absolute automation to ensure every bit of data adheres to the rules governing that particular bit of data. All have to be maintained. Some data can be seen but not copied. Some data can be shared by one party with another party but only if anonymized. There are a lot of regulations and restrictions. Only granular governance will ensure youre deriving the most value from both restricted and unrestricted data without breaking any industry or governmental rulesor disobeying the patients stated data privacy and security preferences. For governance to work, you need to make sure all your data is properly identified so that the automated enforcement rules theyre bound by can be applied.

As advancements continue to be made in AI and machine learning to further enable data automation, the healthcare industry is poised for a dramatic transformation that will greatly improve the quality of care for humankind. But data automation cant be applied in one fell swoop. It requires deliberate implementation across many iterative stages. Making those modest moves to automate now will get you on track towards the giant leaps that data will undoubtedly make in the quality and effectiveness of healthcare.

About Alex Gorelik

Alex Gorelik, the author of the newly published book, The Enterprise Data Lake (published by OReilly Media), is CTO and founder of Waterline Data as well as three startups. He also served as GM of Informaticas Data Quality Business Unit. In addition, Alex was an IBM Distinguished Engineer and co-founder, CTO at Exeros and Acta Technology.

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4 Steps Healthcare Organizations Need to Take to Automate Their Data - - HIT Consultant

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Newswise New Brunswick, N.J., September 17, 2019 In what is believed to be the largest dataset study to date examining the role of race on survival outcome for pediatric patients with Hodgkin lymphoma, investigators at Rutgers Cancer Institute of New Jersey have found that black patients have significantly worse overall survival at five years than white patients when accounting for all available clinical variables. The work is being presented as part of a mini oral presentation at the Annual Meeting of the American Society for Radiation Oncology (ASTRO) in Chicago this week.

The National Cancer Database, which captures oncology data from more than 1,500 facilities accredited by the Commission on Cancer, was utilized in the study. Identified and evaluated was a final sample of 9,285 eligible patients aged 21 and younger with a diagnosis of stage 1 to stage 4 Hodgkin lymphoma from 2004 to 2015.

Eighty-three percent of patients were white, 12 percent black and five percent other. Black patients were found to be younger (under age 15), at a lower stage of disease when diagnosed, less likely to have a sub-type of disease known as nodular-sclerosis, and more commonly to exhibit what are known as B symptoms (fever with no infection, night sweats, unexplained weight loss). This population also was found to be of lower income and lower education status, and more likely to be under/uninsured. Similar among the races were treatment interventions, including use of chemotherapy, radiation therapy, or combined modality therapy (chemotherapy followed by radiation). Clinical features and survival outcomes were evaluated using various statistical tests and models.

Black patients experienced a five-year overall survival of 91.5 percent compared to 95.9 percent experienced by their white counterparts. This difference was seen across all stages of disease. There were also differences in stratification of risk factors by race. Specifically, under age 15, stage 4 disease, presence of B symptoms, treatment with radiation, and income were prognostic factors for overall survival in white patients but not for black patients. Among the age groups 15 and younger, 16 to 18 years, and older than 18, poorer overall survival was associated for black patients compared to whites (95.4 percent versus 97.7 percent, 87.1 percent versus 96.1 percent, and 91.6 percent versus 94.6 percent respectively).

The race-based disparity demonstrated through this work transcends that of differences in socioeconomic status, notes the works senior investigator, Rutgers Cancer Institute radiation oncologist Rahul Parikh, MD, who is the director of the Laurie Proton Therapy Center at Robert Wood Johnson University Hospital, an RWJBarnabas Health facility. Future research should focus on understanding the biological causes of this disparity and identifying ways to alleviate it, adds Dr. Parikh, who is also an associate professor of radiation oncology at Rutgers Robert Wood Johnson Medical School.

Along with Parikh, other investigators on the work are Karishma Khullar, MD, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; Zorimar Rivera-Nunez, PhD, Rutgers Cancer Institute and Rutgers School of Public Health; Sachin R. Jhawar, MD, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; Richard Drachtman, MD and Peter D. Cole, MD, both Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School; and Bradford S. Hoppe, MD, MPH, University of Florida, Gainesville.

Related work published earlier this year by Parikh and colleagues believed to be the largest study to date involving this same population showed improved overall survival in those who received combined modality treatment versus chemotherapy alone in early stage patients (JAMA Oncology, doi: 10.1001/jamaoncol.2018.5911).

Other data set exploration by Rutgers Cancer Institute investigators includes that of radiation oncologist Nisha Ohri, MD and colleagues. She is the senior author on work presented during a poster presentation this past Sunday at ASTRO that evaluated the change in volume of a lumpectomy cavity during hypofractionated breast radiation therapy and assessed the benefits of adaptive planning for lumpectomy boost delivery.

A retrospective review of Rutgers Cancer Institute data identified 37 eligible patients who were treated with hypofractionated radiation therapy followed by a lumpectomy boost from October 2017 to December 2018. Two separate CT scans were obtained. The first was utilized to plan whole breast irradiation and the second to plan the lumpectomy cavity boost. Patient and tumor variables were examined for correlation with change in lumpectomy cavity volume between CT scans.

The mean reduction in lumpectomy cavity volume with adaptive boost planning was 18.8 percent. Adaptive planning allowed for significant reductions in mean heart and lung doses. In comparing the 18 patients (47.4 percent) who had a significant reduction in lumpectomy cavity volume (defined as 20 percent or greater) to those who did not, no significant differences were found in age, body mass index, breast volume, tumor size, history of re-excision, or presence of an implantable marker. Length of time from surgery to initial CT scan was significantly associated with a reduction in lumpectomy cavity volume, and patients who had a large initial lumpectomy cavity volume often demonstrated significant volume reduction with adaptive boost planning. With these findings, investigators note that adaptive lumpectomy cavity boost planning can be considered for select patients to reduce normal tissue exposure, although longer follow-up is needed to assess the clinical benefits.

Along with Dr. Ohri, other investigators on the work include Mutlay Sayan, MD; Zeinab Abou Yehia, MD; Irina Vergalasova, PhD; Marc Reviello, CMD; Shicha Kumar, MD, and Bruce Haffty, MD, all Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School.

Rutgers Cancer Institute faculty members are also collaborators on a number of other on-site presentations and abstracts/posters published in conjunction with the ASTRO annual meeting that are not listed here.

About Rutgers Cancer Institute of New Jersey

As New Jerseys only National Cancer Institute-designated Comprehensive Cancer Center, Rutgers Cancer Institute, along with its partner RWJBarnabas Health, offers the most advanced cancer treatment options including bone marrow transplantation, proton therapy, CAR T-cell therapy and complex robotic surgery. Along with clinical trials and novel therapeutics such as precision medicine and immunotherapy many of which are not widely available patients have access to these cutting-edge therapies at Rutgers Cancer Institute of New Jersey in New Brunswick, Rutgers Cancer Institute of New Jersey at University Hospital in Newark, as well as through RWJBarnabas Health facilities.

Along with world-class treatment, which is often fueled by on-site research conducted in Rutgers Cancer Institute laboratories, patients and their families also can seek cancer preventative services and education resources throughout the Rutgers Cancer Institute and RWJBarnabas Health footprint statewide. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-8013 or visit http://www.cinj.org/giving.

###

For journalists contact:

Michele Fisher, Public Relations Manager

732-235-9872

michele.fisher@rutgers.edu

For patient appointments/inquiries contact:

844-CANCER-NJ (844-226-2376)

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Racial Disparities in Survival Outcomes Shown in Pediatric Hodgkin Lymphoma Patients - Newswise

Management at the worst performing government centres in the UAE were immediately replaced while bosses at the best performing have been rewarded with bonuses as the country seeks to improve services for its residents.

Sheikh Mohammed bin Rashid Al Maktoum, Vice President, Prime Minister and Ruler of Dubai, on Saturday revealed the UAE's top five and bottom government centres following a comprehensive evaluation.

In a tweet, he said: "Today I reviewed the comprehensive evaluation report of services in 600 government centres. We had promised to announce the five best and worst centres."

Taking the best centre position was Fujairah's Federal Authority for Identity and Citizenship while Sharjah's Emirates Post received the worst centre ranking.

The Ministry of Education's Ajman Centre, Ajman Traffic and Licensing Centre, Wasit Police Station in Sharjah and Sheikh Zayed Housing Programme's Ras Al Khaimah Centre were also named among the best performers.

Muhaisnah Preventative Medicine Centre in Dubai, General Pension and Social Security Authority's Sharjah Centre, Bani Yas Social Affairs Centre in Abu Dhabi and Tawteen Centre in Fujairah were identified among the worst.

Sheikh Mohammed said in comments published by state news agency WAM: "We directed immediate management replacement in the worst centres with highly capable leaders. We ordered director-generals to closely monitor their entities and improve centres' performance in a month and I will visit."

"Teams of the best centres will receive a two-month salary reward," he added.

Service centres, ministries and entities, along with ministers, managers and services provided will undergo an annual evaluation, with transparent reporting of results, Sheikh Mohammed said.

"We have the courage to evaluate ourselves and our teams because the cost of hiding mistakes is much higher," he noted.

Excerpt from:
Revealed: the UAE's best and worst gov't centres - ArabianBusiness.com

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BJ is appalled when his patient has entry wounds entering his body from 3 different directions. Col. Potter reminds him of Lt. Col. Lacy, 163rd Combat Infantry, the CO with the highest casualty rate of any single battalion in the sector. Apparently, Lacy refused to obey an order to retreat and subjected his men to hell. Poor Klinger: he has tried chicanery, malingering and endless flim-flammery, but now, Klinger is pulling out the heavy artillery, voodoo, to get his Section 8. Lacy visits the Post Op and one of his own men, Corporal North, turns away. Margaret is intrigued with the virile Lacy until she lunches with him and Lacy tells Margaret of his latest plan to take Hill 403. His plan is based on a plan used in the WWII Battle of Monte Casino...and it has a 20-30% casualty rate. Margaret understands this translates to 100 men and she leaves the table, sick. BJ and Hawkeye despise Lacy and his hypocracy; he thrives on his war games. Potter writes an unprecedented letter to I Corp ... Written byLA-Lawyer

Certificate: TV-PG

Runtime: 24 min

Aspect Ratio: 1.33 : 1

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"M*A*S*H" Preventative Medicine (TV Episode 1979) - IMDb

Preventive healthcare (alternately preventive medicine, preventative healthcare/medicine, or prophylaxis) consists of measures taken for disease prevention, as opposed to disease treatment.[1] Just as health comprises a variety of physical and mental states, so do disease and disability, which are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices. Health, disease, and disability are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.[1][2][3]

Each year, millions of people die of preventable deaths. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures.[4] Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases.[4] This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle.[4] According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, two thirds of this group from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases.[5] This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases.[5] Preventive healthcare is especially important given the worldwide rise in prevalence of chronic diseases and deaths from these diseases.

There are many methods for prevention of disease. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider.[6] Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer.[6] However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate.[7][8]

Preventive healthcare strategies are described as taking place at the primal, primary, secondary, and tertiary prevention levels. In the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention.[9] Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation",[9] though the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years,[10] more particularly in epigenetics, which point to the paramount importance of environmental conditions - both physical and affective - on the organism during its fetal and newborn life (or so-called primal life).[11]

Primordial prevention refers to measures designed to avoid the development of risk factors in the first place, early in life.[13][14]

A separate category of "health promotion" has recently been propounded. This health promotion par excellence is based on the 'new knowledge' in molecular biology, in particular on epigenetic knowledge, which points to how much affective - as well as physical - environment during fetal and newborn life may determine each and every aspect of adult health.[18][19][20] This new way of promoting health is now commonly called primal prevention.[21] It consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave[22] - ideally for both parents - with kin caregiving[23] and financial help where needed.

Another related concept is primordial prevention which to refers to all measures designed to prevent the development of risk factors in the first place, early in life.[13][14]

Primary prevention consists of traditional "health promotion" and "specific protection."[15] Health promotion activities are current, non-clinical life choices. For example, eating nutritious meals and exercising daily, that both prevent disease and create a sense of overall well-being. Preventing disease and creating overall well-being, prolongs our life expectancy.[1][15] Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level.[1] On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.[15]

Food is very much the most basic tool in preventive health care. The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled [24] A "food desert" is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation .[25] There have been several grassroots movements in the past 20 years to encourage urban gardening, such as the GreenThumb organization in New York City. Urban gardening uses vacant lots to grow food for a neighborhood and is cultivated by the local residents.[26] Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods. These programs often hold educational events as well such as cooking and nutrition guidance.[27] Programs such as these are helping to provide healthy, affordable foods to the people who need them the most.

Scientific advancements in genetics have significantly contributed to the knowledge of hereditary diseases and have facilitated great progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.[1] Similarly, specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines (such as regular hand-washing) became mainstream upon the discovery of infectious disease agents such as bacteria. These discoveries have been instrumental in decreasing the rates of communicable diseases that are often spread in unsanitary conditions.[1] Preventing #Sexually transmitted infections is another form of primary prevention.

Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease.[15] Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury[15] whereas secondary prevention aims to detect and treat a disease early on.[28] Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease.[1] For example, early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.[1]

Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.[1] Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.[28] For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.[1]

The leading cause of death in the United States was tobacco. However, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.[4]

The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.[29]

In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in the year 2000,[30] it is still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by the year 2015.[31] Of these deaths, about 64% were due to infection (including diarrhea, pneumonia, and malaria).[30] About 40% of these deaths occurred in neonates (children ages 128 days) due to pre-term birth complications.[31] The highest number of child deaths occurred in Africa and Southeast Asia.[30] In Africa, almost no progress has been made in reducing neonatal death since 1990.[31] India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths in 2010. Targeting efforts in these countries is essential to reducing the global child death rate.[30]

Child mortality is caused by a variety of factors including poverty, environmental hazards, and lack of maternal education.[32] The World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in the year 2000, assuming universal healthcare coverage.[32]

Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar.[33] Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week.[34] Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Eating healthier and routinely exercising plays a huge role in reducing an individuals risk for type 2 diabetes. About 23.6 million people in the United States have diabetes. Of those, 17.9 million are diagnosed and 5.7 million are undiagnosed. Ninety to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults.[35]

In the case of a Sexually transmitted infection (STI) such as syphilis health prevention activities would include avoiding microorganisms by maintaining personal hygiene, routine check-up appointments with the doctor, and general sex education, whereas specific protective measures would be using prophylactics (such as condoms) during sex and discouraging sexual promiscuity.[1] STIs are common both historically and in today's society. STIs can be asymptomatic or cause a range of symptoms. The use of condoms reduces the risk of acquiring some STIs.[36] Other forms of STI prophylaxis includes: abstinence, testing and screening a partner, regular health check-ups, and certain medications such as Truvada.

Thrombosis is a serious circulatory disease affecting thousands, usually older persons undergoing surgical procedures, women taking oral contraceptives and travelers. Consequences of thrombosis can be heart attacks and strokes. Prevention can include: exercise, anti-embolism stockings, pneumatic devices, and pharmacological treatments.

In recent years, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization.[37] However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer.[37]

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries.[38] Tobacco is an environmental carcinogen and the major underlying cause of lung cancer.[38] Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials.[39] Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death.[38] Therefore, prevention of tobacco use is paramount to prevention of lung cancer.

Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the US who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking.[39] Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy.[39]

Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs.[39]

Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and a $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state.[40]

Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products.[41] Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million.[41] Recommended actions to reduce tobacco use include: decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources.[41] In Wuhan, China, a 1998 school-based program, implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use.[42]

Skin cancer is the most common cancer in the United States.[43] The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States.[43] Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime.[43]

The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons.[43] Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure.[43] Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure.[43]

Most skin cancer and sun protection data comes from Australia and the United States.[44] An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries.[44] Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF)in order to get a tan.[44] Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary.[45][46][47] A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15.[48]

Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a Pap test every 35 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada.[49]

In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed an almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer.[49]

Colorectal cancer is globally the second most common cancer in women and the third-most common in men,[50] and the fourth most common cause of cancer death after lung, stomach, and liver cancer,[51] having caused 715,000 deaths in 2010.[52]

It is also highly preventable; about 80 percent[53] of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat (see Colorectal cancer).

Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ)revealed health disparities in the United States. In the United States, elderly adults (>65 years old)received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people.[54] Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care.[54] Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications.[55]

These sorts of disparities and barriers exist worldwide as well. Often, there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi.[56] Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher.[56] Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services.[57]

With lifestyle factors such as diet and exercise rising to the top of preventable death statistics, the economics of healthy lifestyle is a growing concern. There is little question that positive lifestyle choices provide an investment in health throughout life.[58] To gauge success, traditional measures such as the quality years of life method (QALY), show great value. However, that method does not account for the cost of chronic conditions or future lost earnings because of poor health.[59] Developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally.

Americans spend over three trillion a year on health care but have a higher rate of infant mortality, shorter life expectancies, and a higher rate of diabetes than other high-income nations because of negative lifestyle choices.[60] Despite these large costs, very little is spent on prevention for lifestyle-caused conditions in comparison. The Journal of American Medical Association estimates that $101 billion was spent in 2013 on the preventable disease of diabetes, and another $88 billion was spent on heart disease.[61] In an effort to encourage healthy lifestyle choices, workplace wellness programs are on the rise; but the economics and effectiveness data are still continuing to evolve and develop.[62]

Health insurance coverage impacts lifestyle choices. In a study by Sudano and Baker, even intermittent loss of coverage has negative effects on healthy choices.[63] The potential repeal of the Affordable Care Act (ACA) could significantly impact coverage for many Americans, as well as The Prevention and Public Health Fund which is our nations first and only mandatory funding stream dedicated to improving the publics health.[64] Also covered in the ACA is counseling on lifestyle prevention issues, such as weight management, alcohol use, and treatment for depression.[65] Policy makers can have substantial effects on the lifestyle choices made by Americans.

Because chronic illnesses predominate as a cause of death in the US and pathways for treating chronic illnesses are complex and multifaceted, prevention is a best practice approach to chronic disease when possible. In many cases, prevention requires mapping complex pathways[66] to determine the ideal point for intervention. In addition to efficacy, prevention is considered a cost-saving measure. Cost-effectiveness analysis of prevention is achievable, but impacted by the length of time it takes to see effects/outcomes of intervention. This makes prevention efforts difficult to fundparticularly in strained financial contexts. Prevention potentially creates other costs as well, due to extending the lifespan and thereby increasing opportunities for illness. In order to establish reliable economics of prevention[67] for illnesses that are complicated in origin, knowing how best to assess prevention efforts, i.e. developing useful measures and appropriate scope, is required.

Overview

There is no general consensus as to whether or not preventive healthcare measures are cost-effective, but they increase the quality of life dramatically. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others argue in favor of "good value" or conferring significant health benefits even if the measures do not save money[7][68] Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health effects.[7]

A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death.[7] Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure.[7] These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure.[7] Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans.[69] Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources.[69]

While these specific services bring about small net savings not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs.[70][71] Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment.[72][73] Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized.[68]

Cohen et al. (2008) outline a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large.[8] The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits (in quality-adjusted life-years or QALY's) of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALY's.[74] In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease.[8] Cohen et al. (2008) suggest that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.[8]

There are at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies.[75] They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis (CEA) has led to a better understanding of projected cost reductions and improved health outcomes.[76][77] The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions.[75]

Gortmaker, S.L. et al. (2015) states: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote 50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)."

The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion US dollars and 80 million US dollars, respectively.

Some challenges with evaluating the effectiveness of child obesity interventions include:

The cost-effectiveness of preventive care is a highly debated topic. While some economists argue that preventive care is valuable and potentially cost saving, others believe it is an inefficient waste of resources.[81] Preventive care is composed of a variety of clinical services and programs including annual doctors check-ups, annual immunizations, and wellness programs.

Clinical Preventive Services & Programs

Research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for health promotion and disease prevention. The need for and interest in preventive care is driven by the imperative to reduce health care costs while improving quality of care and the patient experience. Preventive care can lead to improved health outcomes and cost savings potential. Services such as health assessments/screenings, prenatal care, and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings.[82][83] Specifically, health assessments/screenings have cost savings potential, with varied cost-effectiveness based on screening and assessment type.[84] Inadequate prenatal care can lead to an increased risk of prematurity, stillbirth, and infant death.[85] Time is the ultimate resource and preventive care can help mitigate the time costs.[86] Telehealth and telemedicine is one option that has gained consumer interest, acceptance and confidence and can improve quality of care and patient satisfaction.[87]

Understanding the Economics for Investment

There are benefits and trade-offs when considering investment in preventive care versus other types of clinical services. Preventive care can be a good investment as supported by the evidence base and can drive population health management objectives.[8][83] The concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care. For example, preventive care that may not save money may still provide health benefits. Thus, there is a need to compare interventions relative to impact on health and cost.[88]

Preventive care transcends demographics and is applicable to people of every age. The Health Capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced. It treats health as a stock that provides direct utility. Health depreciates with age and the aging process can be countered through health investments. The theory further supports that individuals demand good health, that the demand for health investment is a derived demand (i.e. investment is health is due to the underlying demand for good health), and the efficiency of the health investment process increases with knowledge (i.e. it is assumed that the more educated are more efficient consumers and producers of health).[89]

The prevalence elasticity of demand for prevention can also provide insights into the economics. Demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence.[86] Reduction in prevalence subsequently leads to reduction in costs.

Economics for Policy Action

There are a number of organizations and policy actions that are relevant when discussing wthe economics of preventive care services. The evidence base, viewpoints, and policy briefs from the Robert Wood Johnson Foundation, the Organisation for Economic Co-operation and Development (OECD), and efforts by the U.S. Preventive Services Task Force (USPSTF) all provide examples that improve the health and well-being of populations (e.g. preventive health assessments/screenings, prenatal care, and telehealth/telemedicine). The Patient Protection and Affordable Care Act (PPACA, ACA) has major influence on the provision of preventive care services, although it is currently under heavy scrutiny and review by the new administration. According to the Centers for Disease Control and Prevention (CDC), the ACA makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible, copayment, coinsurance, or other cost sharing.[90]

The U.S. Preventive Services Task Force (USPSTF), a panel of national experts in prevention and evidence-based medicine, works to improve health of Americans by making evidence-based recommendations about clinical preventive services.[91] They do not consider the cost of a preventive service when determining a recommendation. Each year, the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review.[92]

The National Network of Perinatal Quality Collaboratives (NNPQC), sponsored by the CDC, supports state-based perinatal quality collaboratives (PQCs) in measuring and improving upon health care and health outcomes for mothers and babies. These PQCs have contributed to improvements such as reduction in deliveries before 39 weeks, reductions in healthcare associated blood stream infections, and improvements in the utilization of antenatal corticosteroids.[93]

Telehealth and telemedicine has realized significant growth and development recently. The Center for Connected Health Policy (The National Telehealth Policy Resource Center) has produced multiple reports and policy briefs on the topic of Telehealth and Telemedicine and how they contribute to preventive services.[94]

Policy actions and provision of preventive services do not guarantee utilization. Reimbursement has remained a significant barrier to adoption due to variances in payer and state level reimbursement policies and guidelines through government and commercial payers. Americans use preventive services at about half the recommended rate and cost-sharing, such as deductibles, co-insurance, or copayments, also reduce the likelihood that preventive services will be used.[90] Further, despite the ACAs enhancement of Medicare benefits and preventive services, there were no effects on preventive service utilization, calling out the fact that other fundamental barriers exist.[95]

The Patient Protection and Affordable Care Act also known as just the Affordable Care Act or Obamacare was passed and became law in the United States on March 23, 2010.[96] The finalized and newly ratified law was to address many issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs.[97] Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents plan until the age of 26, expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances and insurance companies were to include coverage for preventive health care services.[98] The U.S. Preventive Services Task Force has categorized and rated preventive health services as either A or B, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs.[99]

Health insurance and Preventive CareHealthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life.[100] Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act, specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the US Preventive Services Task Force free of charge to patients.[101][102] For example, UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage.[103]

Evaluating Incremental Benefits of Preventive CareEvaluating the incremental benefits of preventive care requires longer period of time when compared to acute ill patients. Inputs into the model such as, discounting rate and time horizon can have significant effects of the results. One controversial subject is use of 10-year time frame to assess cost effectiveness of diabetes preventive services by the Congressional Budget Office.[104]

The preventive care services mainly focuses on chronic disease,[105] the Congressional Budget Office has provided guidance that further research in the area of the economic impacts of obesity in the US before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015, recognizes that the potential of the preventive care to improve patients health at individual and population levels while decreasing the healthcare expenditure.[106]

An Economic Case for Preventive Health

Mortality from Modifiable Risk Factors

Chronic diseases such as heart disease, stroke, diabetes, obesity and cancer have become the most common and costly health problems in the United States. In 2014, it was projected that by 2023 that the number of chronic disease cases would increase by 42%, resulting in $4.2 trillion in treatment and lost economic output.[107] They are also among the top ten leading causes of mortality.[108] Chronic diseases are driven by risk factors that are largely preventable. Sub-analysis performed on all deaths in the United States in the year 2000 revealed that almost half were attributed to preventable behaviors including tobacco, poor diet, physical inactivity and alcohol consumption.[109] More recent analysis reveals that heart disease and cancer alone accounted for nearly 46% of all deaths.[110] Modifiable risk factors are also responsible for a large morbidity burden, resulting in poor quality of life in the present and loss of future life earning years2. It is further estimated that by 2023, focused efforts on the prevention and treatment of chronic disease may result in 40 million fewer chronic disease cases, potentially reducing treatment costs by $220 billion.[107]

Childhood Vaccinations Reduce Health Care Costs

Childhood immunizations are largely responsible for the increase in life expectancy in the 20th century. From an economic standpoint, childhood vaccines demonstrate a very high return on investment.[109] According to Healthy People 2020, for every birth cohort that receives the routine childhood vaccination schedule, direct health care costs are reduced by $9.9 billion and society saves $33.4 billion in indirect costs.[111] The economic benefits of childhood vaccination extend beyond individual patients to insurance plans and vaccine manufacturers, all while improving the health of the population.[112]

Prevention and Health Capital Theory

The burden of preventable illness extends beyond the healthcare sector, incurring significant costs related to lost productivity among workers in the workforce. Indirect costs related to poor health behaviors and associated chronic disease costs U.S. employers billions of dollars each year.

According to the American Diabetes Association (ADA), medical costs for employees with diabetes are twice as high as for workers without diabetes and are caused by work-related absenteeism ($5 billion), reduced productivity at work ($20.8 billion), inability to work due to illness-related disability ($21.6 billion), and premature mortality ($18.5 billion). Reported estimates of the cost burden due to increasingly high levels of overweight and obese members in the workforce vary,[113] with best estimates suggesting 450 million more missed work days, resulting in $153 billion each year in lost productivity, according to the CDC Healthy Workforce.

In the field of economics, the Health Capital model explains how individual investments in health can increase earnings by increasing the number of healthy days available to work and to earn income.[114] In this context, health can be treated both as a consumption good, wherein individuals desire health because it improves quality of life in the present, and as an investment good because of its potential to increase attendance and workplace productivity over time. Preventive health behaviors such as healthful diet, regular exercise, access to and use of well-care, avoiding tobacco, and limiting alcohol can be viewed as health inputs that result in both a healthier workforce and substantial cost savings.

Preventive Care and Quality Adjusted Life Years

Health benefits of preventive care measures can be described in terms of quality-adjusted life-years (QALYs) saved. A QALY takes into account length and quality of life, and is used to evaluate the cost-effectiveness of medical and preventive interventions. Classically, one year of perfect health is defined as 1 QALY and a year with any degree of less than perfect health is assigned a value between 0 and 1 QALY.[115] As an economic weighting system, the QALY can be used to inform personal decisions, to evaluate preventive interventions and to set priorities for future preventive efforts.

Cost-saving and cost-effective benefits of preventive care measures are well established. The Robert Wood Johnson Foundation evaluated the prevention cost-effectiveness literature, and found that many preventive measures meet the benchmark of <$100,000 per QALY and are considered to be favorably cost-effective. These include screenings for HIV and chlamydia, cancers of the colon, breast and cervix, vision screening, and screening for abdominal aortic aneurysms in men >60 in certain populations. Alcohol and tobacco screening were found to be cost-saving in some reviews and cost-effective in others. According to the RWJF analysis, two preventive interventions were found to save costs in all reviews: childhood immunizations and counseling adults on the use of aspirin.

Prevention in Minority Populations

Health disparities are increasing in the United States for chronic diseases such as obesity, diabetes, cancer, and cardiovascular disease. Populations at heightened risk for health inequities are the growing proportion of racial and ethnic minorities, including African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives and Pacific Islanders.[116]

According to the Racial and Ethnic Approaches to Community Health (REACH), a national CDC program, Non-Hispanic blacks currently have the highest rates of obesity (48%), and risk of newly diagnosed diabetes is 77% higher among non-Hispanic blacks, 66% higher among Hispanics/Latinos and 18% higher among Asian Americans compared to non-Hispanic whites. Current U.S. population projections predict that more than half of Americans will belong to a minority group by 2044.[117] Without targeted preventive interventions, medical costs from chronic disease inequities will become unsustainable. Broadening health policies designed to improve delivery of preventive services for minority populations may help reduce substantial medical costs caused by inequities in health care, resulting in a return on investment.

Policies of Prevention

Chronic disease is a population level issue that requires population health level efforts and national and state level public policy to effectively prevent, rather than individual level efforts. The United States currently employs many public health policy efforts aligned with the preventive health efforts discussed above. For instance, the Centers for Disease Control and Prevention support initiatives such as Health in All Policies and HI-5 (Health Impact in 5 Years), collaborative efforts that aim to consider prevention across sectors[118] and address social determinants of health as a method of primary prevention for chronic disease.[119] Specific examples of programs targeting vaccination and obesity prevention in childhood are discussed in the sections to follow.

Policy Prevention of Obesity

Policies that address the obesity epidemic should be proactive and far-reaching, including a variety of stakeholders both in healthcare and in other sectors. Recommendations from the Institute of Medicine in 2012 suggest that concerted action be taken across and within five environments (physical activity (PA), food and beverage, marketing and messaging, healthcare and worksites, and schools) and all sectors of society (including government, business and industry, schools, child care, urban planning, recreation, transportation, media, public health, agriculture, communities, and home) in order for obesity prevention efforts to truly be successful.[120]

There are dozens of current policies acting at either (or all of) the federal, state, local and school levels. Most states employ a physical education requirement of 150 minutes of physical education per week at school, a policy of the National Association of Sport and Physical Education. In some cities, including Philadelphia, a sugary food tax is employed. This is a part of an amendment to Title 19 of the Philadelphia Code, Finance, Taxes and Collections; Chapter 19-4100, Sugar-Sweetened Beverage Tax, that was approved 2016, which establishes an excise tax of $0.015 per fluid ounce on distributors of beverages sweetened with both caloric and non-caloric sweeteners.[121] Distributors are required to file a return with the department, and the department can collect taxes, among other responsibilities.

These policies can be a source of tax credits. For example, under the Philadelphia policy, businesses can apply for tax credits with the revenue department on a first-come, first-served basis. This applies until the total amount of credits for a particular year reaches one million dollars.[122]

Recently, advertisements for food and beverages directed at children have received much attention. The Childrens Food and Beverage Advertising Initiative (CFBAI) is a self-regulatory program of the food industry. Each participating company makes a public pledge that details its commitment to advertise only foods that meet certain nutritional criteria to children under 12 years old.[123] This is a self-regulated program with policies written by the Council of Better Business Bureaus. The Robert Wood Johnson Foundation funded research to test the efficacy of the CFBAI. The results showed progress in terms of decreased advertising of food products that target children and adolescents.[124]

To explore other programs and initiatives related to policies of childhood obesity, visit the following organizations and online databases: U.S. Department of Agriculture, Robert Wood Johnson Foundation-supported Bridging the Gap Program, National Association of County and City Health Officials, Yale Rudd Center for Food Policy & Obesity, Centers for Disease Control and Preventions Chronic Disease State Policy Tracking System, National Conference of State Legislatures, Prevention Institutes ENACT local policy database, Organization for Economic Cooperation and Development (OECD), and the U.S. Preventive Services Task Force (USPSTF).

Childhood Immunization Policies

Despite nationwide controversies over childhood vaccination and immunization, there are policies and programs at the federal, state, local and school levels outlining vaccination requirements. All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. However, currently 18 states allow exemptions for philosophical or moral reasons. Diseases for which vaccinations form part of the standard ACIP vaccination schedule are diphtheria tetanus pertussis (whooping cough), poliomyelitis (polio), measles, mumps, rubella, haemophilus influenzae type b, hepatitis B, influenza, and pneumococcal infections.[125] These schedules can be viewed on the CDC website.[126]

The CDC website describes a federally funded program, Vaccines for Children (VFC), which provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. Additionally, the Advisory Committee on Immunization Practices (ACIP)[127] is an expert vaccination advisory board that informs vaccination policy and guides on-going recommendations to the CDC, incorporating the most up-to-date cost-effectiveness and risk-benefit evidence in its recommendations.

An Economic Case Conclusion

There are economic and health related arguments for preventive healthcare. Direct and indirect medical costs related to preventable chronic disease are high, and will continue to rise with an aging and increasingly diverse U.S. population. The government, at federal, state, local and school levels has acknowledged this and created programs and policies to support chronic disease prevention, notably at the childhood age, and focusing on obesity prevention and vaccination. Economically, with an increase in QALY and a decrease in lost productivity over a lifetime, existing and innovative prevention interventions demonstrate a high return on investment and are expected to result in substantial healthcare cost-savings over time.

Original post:
Preventive healthcare - Wikipedia

Blend's new healthy cafe opening Aug. 30.

Sure, theres plenty of yoga studios in the area, but few, if any, in Somerset come with a healthy cafe.

Janelle Chaves is planning to change that with her new venture, Blend Cafe and Yoga.

I really wanted a comfy place where you could meet with friends and have a bite to eat, said Chaves. In the cafe portion of Blend, guests will find cozy couches and love seats, cafe tables and a menu of healthy baked goods, breakfast bars, smoothies, iced teas and Rhode Island-based Borealis coffee.

For the grand opening on Aug. 30, Chaves said she wanted to start out with a smaller menu, but as it progresses, she said shell add salads, grain salads, yogurt parfaits and flatbread pizzas to the offerings in the coming months.

Working with two bakers Rachel Andrews and Aimee Wilding, both graduates of Johnson and Wales University theyve tested out various recipes for baked goods that are not only healthy, but also taste delicious.

So far, some of the menu items include The Detox Smoothie made with lemon, apple, cucumber, ginger, strawberries and coconut water; zucchini muffins; granola bars; and almond cake. Some of the offerings will also be organic and gluten-free, she said.

After working as a nurse for 10 years, Chaves said she wanted to go into preventative medicine, by opening a healthy cafe and yoga studio. Its something Ive been thinking about and planning for a few years, but never took the plunge, she added. I think Somerset has a need for a cute little healthy cafe.

When Chaves found out Jewels Day Spa was moving from its location at 255 County St., she said she jumped at the opportunity to open in the place that she called the ideal location. She divided the 1,120 square-foot space, located in a multi-business building, into two areas: one for the cafe at the front of the building, and the same size in the back for the yoga studio.

The yoga classes started July 1, and the night classes in particular have been booked up. When kids go back to school in the fall, Chaves said she expects the morning classes to become busier as well. She also plans to add more yoga classes to the schedule, to fit the times and types of classes customers request.

The offerings now include vinyasa yoga; chair yoga; Buti Yoga, which combines primal dance moves with yoga; restorative yoga by candlelight; sunrise gentle vinyasa; Chisel and Chill, a 45-minute strength class with 15 minutes of yoga; Buti Sculpt; and beginners yoga.

Drop-in prices for yoga classes are $12. She also offers various discounted packages.

For more information about Blend, heck out blendcafeandyoga.com.

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Find balance, and coffee, at Blend Cafe and Yoga - Fall River Herald News