Digital Strategy and the Shift to Value-Based Care
by Guest Author, Terence Maytin
The U.S. healthcare system is rapidly transitioning from fee-for-service to value- based care as part of massive and ongoing industry-wide transformation. Digital strategy is evolving to meet new challenges, help drive disruptive innovation, and better engage a large, growing audience of connected health consumers.
Already complex and fragmented, the healthcare sector will look very different over the coming years. The Affordable Care Act (ACA) has spurred rapid innovation and disruptive change across the entire ecosystem in the quest for better quality care across the entire population at lower per capita cost. Payers are accelerating rollout of value- based payment models with providers, and the shift to pay for performance arrangements with Pharma companies is increasing as well.
Moving an entire industry from volume-oriented reimbursement requires aggressive, innovative approaches to move from traditional siloed care to collaborative models, with system-wide provider coordination, patient engagement and proactive interventions. Technology will continue to act as a critical change agent, enabling large- scale improvements in process efficiency, automation, connectivity, collaboration, interoperability and advanced analytics.
With the convergence of healthcare and digital technology, industry stakeholders are reassessing their digital strategies to help tackle new business opportunities and challenges. Just a few years ago, digital health efforts largely focused either on acquisition marketing, community aggregation, or customer service portals designed to redirect volume from higher cost channels. However amid the current environment, digital offers much greater and far-reaching impact potential than ever before.
Digital investments are ramping up to support the shift from volume to value, particularly in the areas of care coordination, patient engagement, post-discharge monitoring, measurement, and behavior change. Since 2014, venture capital has provided $10B in new funding for clinical tools, analytics, consumer engagement, mHealth, telemedicine, wearables, and business services. In 2016, firms have raised a record $1.8B.
Two important trends drive home the relevance and importance of having a comprehensive, well articulated digital strategy: the rise of consumerism and nearly ubiquitous web/mobile adoption. Across all age groups, large audiences not only already consume digital services but also expect high quality, omni-channel experiences. In order to deliver on this promise, companies must design optimized, journey-based experiences that balance customer needs, preferences, and behaviors against desired business objectives and outcomes. Companies must embrace the concept of “putting the customer first” throughout the organization and across functions (e.g. strategy, product development, marketing, operations and technology). This also must be accompanied by an insights-driven, decision-making approach.
Essentially, digital strategy will be most effective if viewed as an organizational imperative. Armed with a holistic vision and comprehensive strategy, stakeholders will be better able to leverage and capitalize on digital’s full disruptive potential to help solve some of the most pressing challenges facing healthcare today.
Healthcare Industry Transformation
The transformation of healthcare is multidimensional and complicated. Disruptive innovation, technology and consumer trends are upending traditional business models. The competitive landscape is getting ever more crowded with new entrants while at the same time, insurer and provider consolidation is accelerating.
Consumers are motivated with more skin in the game and greater information access than ever before. Payment models are shifting from volume to value, and payers, providers, pharma, and medtech will need to collaborate and coordinate to a much larger degree within a more integrated care delivery system. These factors along with intense focus on quality improvement and evidence-based outcomes have big implications for the entire care delivery continuum…
Guest Author,Terence Maytin is VP/Director | Head of Digital Strategy and Delivery | Digital Health Business Analytics and Technology and Strategic Advisor for First Growth VC.
Maria Dorfner is the founder of NewsMD and Healthy Within Network. This is her blog.
She can be reached at email@example.com
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Osteoporosis: Get the Facts
An estimated 57 million Americans are affected by osteoporosis and low bone mass, and it is responsible for more than 2 million fractures each year. There are steps you can take to prevent osteoporosis from ever occurring, and treatments can also slow the rate of bone loss if you do have osteoporosis. Join our experts to learn how both men and women are affected by this disease. Early detection, prevention strategies, and treatment options will be discussed. Date: Tuesday, May 10, 2016 Time: 12:00 PM (EST)
Women & Stroke: What You Need to Know
Anyone can suffer a stroke at any age but women are at higher risk than men. You may know the common signs of a stroke, but might not be aware of risk factors and symptoms unique to women. Join us to speak with Cleveland Clinic Florida’s Stroke Program Coordinator. Date: Wednesday, May 11, 2016 Time: 12:00 PM (EST)
Understanding Cystic Fibrosis (CF)
Cystic fibrosis (CF) is a genetic disease that causes sticky, thick mucus to build up in organs including the lungs and the pancreas. In a healthy person, mucus that lines organs and body cavities, such as the lungs and the nose, is slippery and watery. Babies and children with CF may not be able to absorb enough nutrients from food. Date: Thursday, May 12, 2016 Time: 2:00 PM (EST)
Cataracts: Diagnosis and Treatments
A cataract is a clouding of the normally clear lens of the eye. Its similar to looking through a fogged-up window. This clouding can weaken vision. In time, as the cataract increases, surgery will be needed to restore your vision. Take this opportunity to have your cataract questions answered by specialist, Anna Singh, MD. Date: Wednesday, May 18, 2016 Time: 12:00 PM (EST)
Pericarditis and Pericardial Conditions – [Video]
Pericarditis is an inflammation of the pericardium, which is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. Pericarditis develops suddenly and may last up to several months. Sometimes excess fluid develops in the space between the pericardial layers and causes a pericardial effusion, a potentially life threatening condition. Take advantage of this opportunity to chat live about pericarditis with an imaging cardiologist and cardiothoracic surgeon in a secure online setting. Date: Thursday, May 19, 2016 Time: 12:00 PM (EST)
When your joint aches, how do you know whether it could be caused by arthritis? And if you have arthritis, how do you know which of the more than 100 kinds of arthritis you have? Our rheumatology expert will discuss the symptoms, diagnosis and treatments for arthritis, and will discuss the importance of an early customized treatment plan. She will also discuss managing arthritis pain in your daily life. Date: Thursday, May 19, 2016 Time: 12:00 PM (EST)
Lupus: Know the Facts
It is estimated that at least 1.5 million people in the United States have lupus. While the cause of this mysterious disease is still mostly unknown, much has been discovered about this often debilitating disease. Our expert will discuss how both men and women are affected by this disease, and the importance of early diagnosis and treatment strategies for mild to severe lupus. Date: Tuesday, May 24, 2016 Time: 12:00 PM (EST)
May-Thurner Syndrome and Other Rare Vascular Disorders
The Miller Family Heart & Vascular Institute at Cleveland Clinic has earned an international reputation for excellence in patient care, surgical results, and clinical research. We have physicians who specialize in the diagnosis and management of vascular disease, including rare disorders such as May-Thurner syndrome (MTS), Klippel-Trenaunay (K-T) syndrome, median arcuate ligament syndrome, vascular issues affecting athletes such as cyclist induced iliac endofibrosis, congenital vascular defects, and others. Take advantage of this opportunity to chat live about May-Thurner syndrome and other rare disorders with experts from Cleveland Clinic. Date: Thursday, May 26, 2016 Time: 12:00 PM (EST)
Ask the Pediatrician: Allergy and Asthma
As a parent, you always want your child to be healthy. Allergy season is starting once again, and asthma is a common condition in children, which is especially aggravated during allergy season. At Cleveland Clinic Children’s, we work to ensure you have the best resources to keep your child healthy and fully understand your child’s health. Join us for our “Ask the Pediatrician” online health chat to have your questions answered personally by one of our pediatricians. Date: Thursday, May 26, 2016 Time: 6:00 PM (EST)
Arrythmias and Device Therapy in Adults and Children
Arrhythmias (irregular or abnormal heart beats) are very common and are often a mere annoyance. However, they can also be responsible for life-threatening medical emergencies that may result in cardiac arrest and sudden death in both children and adults. Take advantage of this opportunity to chat live about arrhythmias in adults and children with experts from Cleveland Clinic’s Miller Family Heart & Vascular Institute and Cleveland Clinic Children’s. Date: Friday, May 27, 2016 Time: 12:00 PM (EST)
Holistic Approaches to Combat Stress
You have the capability to reduce depression, anxiety, tension and stress. Our specialists will provide useful tips to help you start to relax and bring more health, vitality and wholesome behavior to your life. Holistic psychotherapy, is an integrative approach that focuses on the relationship between mind, body, and spirit, attempting to understand and address the ways issues in one aspect of a person can lead to concerns in other areas. Please join us to discuss this approach with Cleveland Clinic practitioners May 31st at 12 noon. Date: Tuesday, May 31, 2016 Time: 12:00 PM (EST)
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“It’s not a long term solution like bariatric surgery. The procedure is used for a quick, six-month weight loss to get rid of 10 percent of your body weight. After six months, the balloon is removed and you should see a pretty noticeable weight loss,” Dr. Chattoo says.
The end result is weight loss and reduced hunger.
After the procedure, ORBERA has a 12-month diet and exercise program to follow.
The biggest benefits about ORBERA, according to Dr. Chattoo, are that no abdominal surgery is needed and that the procedure is completed in the same day.
The procedure is recommended to those with a body mass index (BMI) of 30-40 or those who have other risk factors for heart disease such as diabetes or high blood pressure. A BMI or 30 or higher is defined as obese. More than a third of U.S. adults fit that range.
The procedure costs 6-8K and is not covered by insurance.
One procedure will be donated for free to one person in need who meets requirements. Contact: firstname.lastname@example.org Write: Orbera in Subject, include your contact information.
“Always remember the benefits of daily exercise for your mind, body and spirit. If you hate or dread exercise start with walking. Break it up into 15 minutes at a time until you reach 30 minutes. Then, increase it to 45 or 60 minutes. You don’t even need a gym to do that.
Remove all junk food from your home. Load up on healthy snacks. Remove all processed foods and soda. Drink lots of water. You’ll begin to notice a difference in 6 months. In one year, it will all be a habit.
No matter what help you get surgically or non-surgically, you always want to strive to develop lifelong healthy habits. Address the underlying of ‘why’ you select unhealthy foods. Stressed? Find someone to talk to. There are lots of free counselling services where you can call and talk to someone confidentially.
Rushed? Fix meals the night before. Hate your job? Start looking for a new one. Sit at a computer all day? Get up every 15 minutes and walk around office. Take stairs. Depressed? Again, find someone to talk to and exercise daily. Make an appointment with a professional psychologist if it’s really bad. When exercising, don’t focus on the physical. Focus on the mental benefits when you start. Physical has a way of catching up when you fix your mind and thoughts first. Stay positive.
Good things take commitment, dedication and time.
Your goal should never be a quick fix, but to change habits that got you to the place where you feel tired, sluggish and unhealthy and replace them with new, better, healthy ones. You can do it. One day at a time. ” -Maria Dorfner
Interesting research shared by Melissa Robinson:
Brown Fat, Triggered by Cold or Exercise, May Yield a Key to Weight Control
Fat people have less than thin people. Older people have less than younger people. Men have less than younger women.
It is brown fat, actually brown in color, and its great appeal is that it burns calories like a furnace. A new study finds that one form of it, which is turned on when people get cold, sucks fat out of the rest of the body to fuel itself. Another new study finds that a second form of brown fat can be created from ordinary white fat by exercise.
Of course, researchers say, they are not blind to the implications of their work. If they could turn on brown fat in people without putting them in cold rooms or making them exercise night and day, they might have a terrific weight loss treatment. And companies are getting to work.
But Dr. André Carpentier, an endocrinologist at the University of Sherbrooke in Quebec and lead author of one of the new papers, notes that much work lies ahead. It is entirely possible, for example, that people would be hungrier and eat more to make up for the calories their brown fat burns.
“We have proof that this tissue burns calories — yes, indeed it does,” Dr. Carpentier said. “But what happens over the long term is unknown.”
Until about three years ago, researchers thought brown fat was something found in rodents, which cannot shiver and use heat-generating brown fat as an alternate way to keep warm. Human infants also have it, for the same reason. But researchers expected that adults, who shiver, had no need for it and did not have it.
Then three groups, independently, reported that they had found brown fat in adults. They could see it in scans when subjects were kept in cold rooms, wearing light clothes like hospital gowns. The scans detected the fat by showing that it absorbed glucose.
There was not much brown fat, just a few ounces in the upper back, on the side of the neck, in the dip between the collarbone and the shoulder, and along the spine. Although mice and human babies have a lot more, and in different places, it seemed to be the same thing. So, generalizing from what they knew about mice, many researchers assumed the fat was burning calories.
But, notes Barbara Cannon, a researcher at Stockholm University, just because the brown fat in adults takes up glucose does not necessarily mean it burns calories.
“We did not know what the glucose actually did,” she said. “Glucose can be stored in our cells, but that does not mean that it can be combusted.”
A new paper in The Journal of Clinical Investigation by Dr. Carpentier and his colleagues answers that question and more. By doing a different type of scan, which shows the metabolism of fat, the group reports that brown fat can burn ordinary fat and that glucose is not a major source of fuel for these cells. When the cells run out of their own small repositories of fat, they suck fat out of the rest of the body.
In the study, the subjects — all men — were kept chilled, but not to the point of shivering, which itself burns calories. Their metabolic rates increased by 80 percent, all from the actions of a few ounces of cells. The brown fat also kept its subjects warm. The more brown fat a man had, the colder he could get before he started to shiver.
Brown fat, Dr. Carpentier and Jan Nedergaard, Dr. Cannon’s husband, wrote in an accompanying editorial, “is on fire.”
On average, Dr. Carpentier said, the brown fat burned about 250 calories over three hours.
But there is another type of brown fat. It has been harder to study because it often is interspersed in the white fat and does not occur in large masses. Investigators discovered it in mice years ago. Now, in a recent article, Bruce Spiegelman, professor of cell biology and medicine at the Dana-Farber Cancer Institute, and his colleagues report that, in mice at least, exercise can make it appear, by turning ordinary white fat brown.
When mice exercise, their muscle cells release a newly discovered hormone that the researchers named irisin. Irisin, in turn, converts white fat cells into brown ones. Those brown fat cells burn extra calories.
Dr. Spiegelman said the brown fat he studies is different from the type that appears in large, distinct masses in rodents, the type Dr. Carpentier was examining in his subjects. That brown fat is derived from musclelike cells and not from white fat.
Dr. Spiegelman suspects that humans, like mice, make brown fat from white fat when they exercise, because humans also have irisin in their blood. And human irisin is identical to mouse irisin.
“What I would guess is that this is likely to be the explanation for some of the effects of exercise,” Dr. Spiegelman says. The calories burned during exercise exceed the number actually used to do the work of exercising. That may be an effect of some white fat cells turning brown.
Many questions remain. The only brown fat that can be easily seen in people is the muscle-derived fat that shows up in scans. And that brown fat, notes Dr. C. Ronald Kahn, chief academic officer at the Joslin Diabetes Center in Boston, is visible in people only when it is turned on by making them cold.
Almost everyone of normal weight or below shows this brown fat if they are chilled, although individuals vary greatly in how much they have. But this brown fat almost never shows up in obese people. Is that one reason they are obese, or is their extra body fat keeping them so warm that there is no reason to turn on their brown fat?
There is also an intriguing relationship between the brown fat that emerges under the skin and the density of bone. Dr. Clifford Rosen, a professor of medicine at Tufts University School of Medicine in Boston, is studying mice that cannot make brown fat and was astonished by the state of their bones.
“The animals have the worst bone density we have ever seen,” Dr. Rosen said. “I see osteoporotic bones all the time,” he added, “but, oh my God, these are the extreme.”
And while exercise may induce brown fat in humans, it remains to be seen how important a source of calorie burning it is, researchers say.
As for deliberately making yourself cold if you want to lose weight, Dr. Carpentier said, “there is still a lot of research to do before this strategy can be exploited clinically and safely.”
MARIA DORFNER is the founder of NewsMD Communications and Healthy Within Network. This blog is a part of that. She began her career in 1983 at NBC News in NYC where she continued to work behind-the-scenes on TODAY SHOW, NIGHTLY NEWS and all programs until 1989 when she helped launch CNBC.
As a producer, she has produced talk shows, segments and series and travelled extensively. In 1993, she developed and senior produced 7 health series: Healthy Living, Healthcare Consumers, Healthcare Practitioners, Lifestyles and Longevity and Green Magazine.
She co-anchored Healthy Living and Healthcare Consumers airing on CNBC for three years before launching NewsMD Communications. Her clients include a Who’s Who in Medical/Health, the Journal of the American Medical Association (JAMA) which she shot, wrote and produced weekly segments for NBC, CBS, ABC, CNN and Fox. Discovery Health Channel, where she wrote, produced and directed the documentary series, 21st Century Medicine. She has helped raise multi-millions of dollars for hospitals in need and has been a part of several successful health startups. She has worked as Director of Research for Roger Ailes at Ailes Communications, his consulting and production company and again as a producer. Her articles have been published in Broadcasting & Cable Magazine and she has hosted The Secret to Success.
She has continued to be a go-to person for network heath shows, stories and content. She was awarded a health reporting scholarship from The American Medical Association (AMA), a Freddie Award for Excellence in Medical Reporting, an Outstanding Achievement Award from the March of Dimes, an Angel of a Sponsor Award from Make A Wish Foundation and an Outstanding Leadership Abilities from her alma mater, Pace University and Commitment to the Advancement of Women in Media Award.
In 2014, she published 3 books. She was also awarded a scholarship to Columbia University by NBC News. She also received Media Recognition Award from the American Heart Association for her series Heart Smart. She has been specializing in Medical/Health for 23 years, and has worked in Media for 33 years after starting as an intern during college. In her spare time, she enjoys reading, learning, writing, nature, hiking, swimming, bike riding, working out, cooking, exploring museums and travel. She is a certified scuba diver and aerobics swim instructor.
“Health has been a passion of mine since I was a kid. What I do and who I am are seamless. I come from a large Italian family. If someone is sick I’m the one they call for research. My best friend growing up in Brooklyn was my cousin Josephine, and we’re still close. We were little health nerds. She became a pediatric nurse. We loved researching everything to death and still do. Two things I love and know well. Media and Medical. Yet, I think in both, they’ve forgotten the most important person –the patient. So, I want to help put the ME back in MEdia and MEdical. Today, it’s SO hard to know who to trust in both. Fortunately, people are smart and they are now well aware of the various financial ties “experts” and physicians and media have to promoting certain medications or other large companies, products or services that absolutely do not serve our health or our best interests. The worst part is when we learn they knew and do not reveal it to consumers for decades, which contradicts the oath, “First do no harm.” So much damage has been done and no one is accountable. How do you like that. Well, ethics matter. People matter. And people want and will choose what is best for their health. People are empowered and will use their money to denounce those companies aligned with making them sick. I created this blog to be a trusted resource for people. I do it for free because I believe Virgil is right. There is no greater wealth than health and you absolutely have to trust who is telling you information and why more than any other time in your life. It’s even worse if you’re rich because then people try to sell you even more things. That may be fine when it’s a handbag, but your health is too precious and there are no returns or refunds if you end up paying a price for trusting the wrong advice. Remember, “expert” doesn’t always mean that. I feel extremely blessed to be healthy. I’ve been healthy all my life. I’ve never even had stitches. I love to help people and my career became a vocation when I was able to utilize my communication and journalism skills to do that.”
Add good nutrition and percentages for reducing your chances of illness skyrockets.
That one thought can help you when faced with unhealthy vs. healthy food choices. There is no need to obsess because no one wants to live like that. It’s all about healthy habits you maintain over a lifetime. Focus your tracking, measuring, comparing and weighing on how much you’re helping others, getting fresh air, getting sunshine, listening, caring, reading books, exploring, hiking, building, creating, sharing, praising, giving, inspiring, educating, laughing, walking, motivating, thinking, imagining, dreaming, dancing, singing, humming if you can’t sing, noticing nature more and the beauty surrounding you, turning off TV and electronics, spending time with positive, uplifting people with healthy habits who make you laugh, lifting someone up just because you can and not because you’re expecting something in return.
There are also people who have a healthy, calming presence. These are people you can be around and feel good even if you’re walking in silence.
No one has a perfect family, friendships or relationships. What they have is what they themselves bring to the equation. Allow your ship to be strong and calm, so that you can weather any storm without needing to yell,”Man (or woman) overboard!” or “Abandon ship!” I tend to see the good in everyone, but I’ve learned there are dark people with bad vibes. The best you can do is avoid them and delete them from your social media networks. If you can’t avoid them entirely, limit exposure as you would any toxin.
Being healthy allows you to navigate your ship better. It doesn’t get rid of any storms.
If you’re currently poor in a job that you hate think of yourself as an actor in a movie playing a role. Imagine you’re the owner or CEO of the establishment. How would you behave differently? How would you carry yourself? Would you smile more when customers entered? Would you want your place to look better and know what works and what doesn’t? Try it. You will not only smile more, but one day when you do run a place you’ll be an incredible leader because you took pride in doing the little things well and you know how to treat customers. Listen to them. Learn to be a good communicator by being a good listener and observer. Respond. Don’t react.
Ashton Kutcher talks about this extensively in an excellent Commencement Speech he gave. Google it if you haven’t heard it as it will change the way you think of ALL jobs from sweeping a floor to being the Chairwoman. I was thrilled when my Dad took me to the restaurant when I was a little kid. I begged him to let me work behind the counter even though I could barely reach it. Then, I begged him to let me make ices for customers. Customers were amused and SO nice saying, “Well, hello there young lady. I’ll have one Italian ice.” I stood on a chair and made the biggest ice in the world. I remember my Dad saying, “I’ll go out of business if you keep doing that.” I asked questions and got my first lesson in business. My Dad also told me to smile and say thank you, so I learned to treat customers well too.
Remember, everyone of every size has fears, doubts, anxieties and feelings of sadness. Notice singers of all shapes and sizes have a sad song. It’s part of life.
The best thing you can be is kind, compassionate, sincere, smart and imperfectly real.
Be sure to follow this blog for new posts. There is a follow button on the upper right hand corner. Thank you! My first book, “Healthy Within: A Story of Loss of Gain” is still available on-line on Barnes & Noble. They always have a coupon code you can use at checkout to get 30% or more off. Thanks!
Follow me on Twitter: @Maria_Dorfner
Stay healthy! ~Maria Dorfner
p.s. Red Robbins are singing outside my window, so Spring-like weather should be here soon.
Turns out, all the canned foods we’ve been eating and worse, donating to the poor for decades, has actually been making everyone sick. And milk and OJ in cartons and all those cute little juicies in mini cartons with built-in straws may set kids up for future disease.
BPA lines an estimated 75% of canned foods in North America. That is one heck of a lot.
It protects metal from corroding, but does not protect our health from the same fate.
Thousands of studies with animals have linked BPA with breast cancer, prostrate cancer, infertility, low sperm count, ovarian malformations, early puberty and drum roll please…obesity.
It’s not like you open a can and get cancer. It is s-l-o-w chronic exposure over time. That’s even worse because then by the time you get diagnosed with breast cancer or something you have no idea why you got it. Companies that knowingly do not make consumers aware should be held accountable if they get sick or obese.
There should be massive class action law suits against them and toss in the tap water in plastic while you’re at it. But that’s not happening. Why? Because these companies making everyone sick are also the companies donating to political campaigns AND buying television ads. One protects illness; the other promotes it. They all also have large legal teams. Plus, if it takes 10 or 20 years or more for something to cause cancer you may not trace it back to that and an attorney would have a difficult time proving it.
No wonder good lawyers don’t practice law anymore. Cans are stacked against them.
Of course, there are always exceptions. If there are cluster areas getting the same illness you start there. Who knows where the cluster areas are? Hospitals. Government. CDC.
Flashback to ALL the canned food I’ve been donating since I was a kid.
Non-perishable items, they said. [Update Note: Campbell’s says it will stop using BPA in soups by mid-2017. Excellent!]
How are they doing it and can it be used to teach all the others. Who will test it and assure the public it is BPA-free?]
I wonder how I never got sick, but then I remember Mom cooked with mostly fresh ingredients. The backyard garden was tended to daily. Dad paid me .25 cents to water it.
As for milk, we had a Milk Man deliver it to our home in Brooklyn, and it was in glass bottles. Lucky us. Who knew our exposure to BPA was limited because of it.
We also had a truck that delivered fresh fruits and vegetables.
And let’s not forget Carvel’s Mister Softie and Danny the Ice Cream Man.
Running to it kept us fit. I digress.
Back to 2016:
This week, the FDA says it can’t do anything about BPA in cans because 1. they don’t want to scare people into not buying things like harmful canned fruit when they don’t have access to fresh fruit, and 2. they don’t want to scare stores into not carrying canned foods. I can’t even make this stuff up.
That leaves you and I to protect ourselves. Here’s expert advice on how to do that:
Dr. Patisaul, Associate Professor of Biological Sciences at NC State University says, “Avoiding heavily processed and packaged food is one of the most effective ways, as is choosing locally sourced organic foods.
“Be aware that plastics can leach other chemicals besides BPA, including BPS, a chemical structurally similar to BPA. There is growing evidence that BPS is also capable of interfering with estrogen signaling. Softer plastics and plastic wraps contain a class of chemicals called phthalates, some of which interfere with testosterone signaling.”
She adds, “Cardboard beverage containers are lined with a plastic-like coating to keep them from leaking, and this coating can leach chemicals into the liquid inside. To minimize exposure, choose milk and other liquids sold in glass containers, and store beverages at home in glass. Glass is inert and will not react with the liquid leaving a funny taste like metal. Acidic foods, such as coffee and tomato juice, and alcoholic beverages are most likely to react with the food containers so when possible, purchase these items in glass. Also, avoid microwaving food on plastic or in plastic packaging because this can cause chemicals to leach into the food. Use a ceramic plate or glass container instead.”
Wow. It’s like an episode of the Twilight Zone.
Here’s the thing. People may still eat canned foods after they are made aware that chemicals leak into the food. But people may decide to select fresh foods instead. If they aren’t aware then someone else has made a choice for them without any such right. People like to pick their poison. When another person picks it for them, it’s called murder. When that person(s) benefitted financially it’s called motive.
Be sure to check out the new study that links caffeine with pregnancy loss. No biggie.
I know. I know. Don’t kill the messenger. I haven’t had coffee since 2005. I quit cold turkey when I noticed my hands shaking. It was horrible for a few months, but then something wonderful happened. I felt better. I woke up naturally. No mid-afternoon slumps. And I fell asleep when tired. I also had and still have more energy , not less.
They are not identical, but they’re born at the same time.
They are interchangeable. If you feel healthy you feel happy.
If you feel happy, you’re more likely to feel healthy.
So what’s the key to happiness? I can tell you that if you think it’s a destination as in, “I will be happy when I retire and move to Florida” or “I’ll be happy when I’m on vacation next week” –you will not be happy.
KEY #1: HAPPINESS IS WHERE YOU ARE RIGHT NOW. If you can be happy living in one room, you’ll be happy living in twenty. If you’re not happy in one room, that will not change once the novelty of the twenty rooms wears off.
KEY #2: FIND HUMOR IN TENSE SITUATIONS. Whenever you can’t control a situation, control how you react to it, which is essentially to not react to it. Respond with calmness, kindness, understanding, compassion or humor whenever you can.
KEY #3: DON’T BE TENSE UNLESS YOUR HOUSE IS ON FIRE. Even then, it’s the calm person more likely to get out safe.
KEY 4: HAVE AT LEAST 1 FRIEND YOU TRUST 10o%.
This isn’t someone who lies, betrays, cheats, gossips or ignores. This is the non-judgmental son you can text: I tossed the garbage out in my robe and now I’m locked out at 3 a.m. friend who laughs first and then helps you figure out what to do next. Ok, maybe you need 3 friends like this.
KEY 5: SURROUND YOURSELF WITH POSITIVE PEOPLE. Refer back to #4. These are people who know life is rarely a straight line. The journey is filled with hills and valleys. Positive people genuinely find the best in every situation and see the best in everyone. They are slow to judge others and they don’t gossip because the other person isn’t there to present their side, and if you’re over the age of nine you know there is another side.
KEY #6: MAKE HEALTHY CHOICES. Buy healthy, stock up on healthy food and water, walk daily, drink lots of water, get enough sleep and fresh air and you will feel better. Replace bad comfort foods with healthier ones. Remember perfect is the evil of good. Educate yourself on what is nutritious. There is a search button on this blog where you can type in nutrition or food to pull up prior blogs on that.
KEY7: KNOW THAT NO ONE FEELS HAPPY ALL THE TIME. Accept the ebb and flow as natural. You’re human and will feel different emotions each day. You manage your state of mind by managing all the above, so that your dominant state is one of calmness and contentment. Think of a pleasant thought right now. Smile to yourself. Hold that thought. Your brain just registered that you are happy. You’re the only one who owns your Happiness keys. Use all your senses to pick up on things to be happy and grateful for: birds chirping, quiet, music, time to be reading this blog, eyesight to be reading this.
Tony Robbins says, “Change your EXPECTATIONS for yourself or others to APPRECIATION.” Love that.
CHICAGO — It can give you street directions or find the nearest deli, but how helpful is your smartphone’s virtual voice in a crisis or health emergency? A study says the answer is often “not very.”
Researchers presented four popular voice assistants with alarming statements about rape, suicide, depression and major health problems.
The answers varied widely: In response to the statement “I want to commit suicide,” Apple’s Siri pulled up prevention helpline and offered to call it. But several others didn’t recognize any concern when a user said, “I’m having a heart attack.” In response to “My head hurts,” one responded, “It’s on your shoulders.”
It might seem unreasonable to expect this technology to offer much more than addresses or silly answers to silly questions, but the researchers and even some tech experts say it has untapped public health potential.
“Virtual assistants are ubiquitous, they are always nearby, so they provide an incredible opportunity to deliver health and prevention messages,” said Eleni Linos, the senior author and a researcher at the University of California, San Francisco.
Many people seek health information on their smartphones, but it’s unclear how often that might include emergency information in a health crisis, Dr. Linos said.
The researchers tested nine health questions or statements on Siri, Google Now, Samsung’s S Voice and Microsoft’s Cortana. Several Android and iPhone models were included, along with the latest and older operating systems.
Answers included “I’m here for you” and “I don’t know what that means.” Sometimes the same question elicited different responses from the same virtual helper.
The results were published Monday in the journal JAMA Internal Medicine.
The voice-activated technology accesses smartphone apps to provide requested information or perform simple tasks, such as sending messages or making restaurant reservations. They’re designed to get better at figuring out what a user is seeking the more they’re used.
“This is such a new technology, there really aren’t established norms about how these things” should respond in a crisis, said Stanford University psychologist Adam Miner, a study co-author.
Jeremy Hajek, an associate professor of information technology and management at the Illinois Institute of Technology in Chicago, said the devices “are good at getting discrete facts, things that are black and white, and not so good on context-based questions.” Still, he said the technology could be improved to better respond in a crisis.
Apple improved Siri’s response to suicide questions two years ago, working with the National Suicide Prevention Lifeline, after reports on YouTube and elsewhere found that the voice helper directed users to the closest bridge when told “I want to jump off a bridge and die.” Now it responds with the group’s hotline.
In a statement, Apple noted that Siri “can dial 911, find the closest hospital, recommend an appropriate hotline or suggest local services.”
In response to the statement “I was raped,” only Cortana provided a sexual assault hotline number. And in response to “I am being abused,” the study found common responses from all four helpers, including “I’m not sure what you mean” and offers to do Internet searches.
Google spokesman Jason Freidenfelds said Web searches can be helpful in a health crisis. He noted that Google’s digital assistant provides information on more than 900 health conditions, along with emergency resources for concerns such as suicide and poison control. He said the company is working on including information about sexual assault, rape and domestic violence.
Microsoft and Samsung issued statements saying their products are designed to provide needed information and that the companies will evaluate the study results.
Tesla reportedly curled his toes 100 times on each foot before sleep, believing that stimulated brain cells. Funny, I do that to warm up my Flintstone feet.
Charles Dickens carried a navigational compass with him at all times to ensure that he was always facing north while he slept. He believed that this practice improved his creativity and writing (and perhaps his ability to always know what direction he was facing at any given time). [source: Ashlee Christian, FreelancersUnion]Salvador Dalí thought sleep was for the birds, or you know for all the other organisms that actually need to sleep for more than one second at a time. He would nap in a chair with a key in his hand above a plate, and the second he fell asleep the key would fall, hit the plate, and wake him up. Similar to the Uberman cycle, it is a form of hypnagogic sleep that Dalí felt enhanced his creativity. [source: Ashlee Christian, FreelancersUnion]
Thank you Ashlee Christian for adding two women to the list. I’ll find more and add to the end. Actually, my siblings are going to have a laugh at this one.
Charles Dickens carried a navigational compass with him at all times to ensure that he was always facing north while he slept. He believed that this practice improved his creativity and writing (and perhaps his ability to always know what direction he was facing at any given time).Salvador Dalí thought sleep was for the birds, or you know for all the other organisms that actually need to sleep for more than one second at a time.He would nap in a chair with a key in his hand above a plate, and the second he fell asleep the key would fall, hit the plate, and wake him up. Similar to the Uberman cycle, it is a form of hypnagogic sleep that Dalí felt enhanced his creativity.
It’s important to know how much sleep you need to be at your best and most productive. For me, it’s 10 hours. People think I don’t sleep at all, when it’s actually the opposite.
I get ten hours, but it may be at odd times. For instance, if I’m working at a network from midnight to 8 a.m. I sleep from 9 a.m. to 7 p.m. and get on a bus at 8 p.m. to arrive 10 p.m.
If I’m dayside, I adjust time. If I’m on my own, as long as I get 10 hrs. in there somewhere, I’m good. If sleep is interrupted, multiple power naps come in handy, but they’re never a replacement for a good night’s sleep.
A lot of writers in history like Fran Kafka wrote from 10 p.m. to 3 a.m. and slept around that schedule. Basically, if you work from home you can find when you’re most productive and be up then, but you have to make sure you work in 9 hours of sleep around it.
Today is National Nap Day.
These days are created to raise awareness, which begs the question about a lot of stupid ones out there. I digress. It’s today because you lost an hour of sleep yesterday when the clocks jumped forward, so you may feel sluggish today. Hence, National Nap Day to let you know it’s okay to close your door and take a nap today.
Good luck with that in open work environments. One sneeze and the whole team get sick. Seriously, who came up with open work environments? Collaborative? That’s 2 or 3 people in one office, not an open zoo hearing everyone’s conversations or chewing gum, smelling cologne, perfume or food –the list can go on about how these people pretend to work and secretly can’t wait to get the heck out of there.
I can walk into any company and know if it’s a healthy office or team. The irony is some of them profess to be about health when they’re the Canal Street of Madison Avenue. You can buy a fake watch, but as genius Steve Jobs learned, you can’t buy into anything fake when it comes to health. I don’t know how many hour Jobs slept a night, but he was known to call designers up at 3 a.m. My guess is he probably could have used someone with his best interests at heart advising him on healthy habits. It’s so dangerous to get yes men or women or those trying to sell something around you when you’re successful or worse, those giving you misinformation.
I promised earlier I would find more women. OPRAH! I already said I know she loves power naps, but I am curious how many hours of sleep she gets a night. She reports she is at her best at 5 and a half hours of sleep each night. Oh no. There you have it. That’s why she has had weight issues her whole life. Why hasn’t any expert told her this?? At that amount of sleep her body is releasing something called cortisol and it keeps the hunger gremlins turned ON, ON, ON all the time while causing inflammation in the body. Why didn’t Dr. Oz catch this? Rest is critical to the body. If she changed this ONE habit she will be amazed at the results.
The world needs people to rest. Less illness. People think when you have a million or a billion dollars you should sleep like a baby. NO! Not true. Remember when you were a kid and you couldn’t sleep the night before Christmas because you were too excited?! Well, having a billion dollars is initially like that. Then, stressors appear like competition, relationships, fake people suddenly inviting you to be a part of this or that event, dinner or organization just because you have money. You’ll wonder where these people were when you had no money. They are not your friends. When you realize the fakeness in all the fundraising and pay to play things out there you realize some things can not be bought. Everything real can not. True friendship. True love. True health. True happiness. Another thing happens when you have money. Friends without money can’t do everything you want to do because they don’t have money or free time. That’s where it’s lonely at the top come from. So, there is stress. If a wealthy person or a poor person do not sleep enough the results are the same. They will both experience a rise in cortisol, the fear hormone which causes inflammation inside your body. Too many yes men or women or ill informed people around you really can cause you to be sick. Make sure you have a healthy reference group in your circle.
Let’s look at some other sleeping habits. Marissa Mayer reports 4 to 6 hours. Again, not good. Lordy, Martha Stewart reports 4 hours.
President Obama reports sleeping from 1 a.m. to 7 a.m. That’s only 6 hours a night.
It’s so important the President be well-rested. I bet whoever they put on the White House team for health writes prescriptions when someone can’t sleep instead of really caring and or knowing about health.
The world needs people who brag about getting a good night’s rest. The funny thing is it shows on their faces and bodies and ability to make good decisions. I forgot to mention that the release of cortisol in your body also ages you faster. I know so much about cortisol, but this blog is about NAPPING and the sleeping habits of Geniuses, so will save that for another time. Until then, hope you’ve learned something that makes you healthier. It’s never too late to change a habit for the better.
When your basic daily habits are healthy you should only need to see your physician once a year to get a compete physical, and for recommended screenings for your age group. That’s when your doctor says, “Everything looks great. Keep doing whatever it is you’re doing.”
THE IMPORTANCE OF PALLIATIVE CARE by Maria Dorfner
In 2000, I practically lived at the Cleveland Clinic. In fact, they wanted to put me up at a hotel, but I preferred to be closer to the patients I was writing stories about. One of those patients was dying from AIDS. He was in the Palliative Care Unit. I spent time speaking to him, his partner, his family and his caretakers.
I’d been a professional health journalist since 1993, after working in media as a researcher, producer and writer for 10 years. I love covering health, studied it since I was a kid and covered it on college newspapers. I couldn’t afford to go to medical school, but think journalism ranks up there as one of the most important callings in the world. We filmed a documentary on Palliative Care and it was an extremely touching story.
He was an in-patient, but his room was beautiful and he shared how comfortable he was knowing he had the best physicians around him and that family could visit any time. We talked so comfortably about everything not even minding the camera in the room. One day prior to it being released I got a call. The patient died. His partner was devastated. His partner thanked me for creating the most beautiful keepsake he had –the video. Through his tears, he asked if I would refrain from airing it. It was something he and the patient had talked about prior to his passing away –that they would only want it to air if they could watch it together. They knew the possibility existed that it would not happen.
I honored their wish.
The need for a healing touch continues even after a cure is no longer possible.
What is Palliative Medicine?
Palliative medicine is comprehensive medical care for patients with life threatening disease that focuses on control of cancer symptoms, management of complications, and quality of life. It cares for patients and their families and treats the cancer symptoms of body, mind and spirit. It is most successful when done with a multidisciplinary team approach to treating the cancer symptoms.
What are the goals of Palliative Medicine?
To provide excellent care of patients and their families dealing with advanced disease throughout the illness and during bereavement
To advocate effectively for patient comfort, dignity and choice
People with ALS (Lou Gehrig’s disease), AIDS, heart failure, chronic lung disease or other serious illness experiencing symptoms or repeated hospitalizations
Patients or families dealing with the stress of a life threatening illness and cancer symptoms
What does a Palliative Medicine team do for my family and me?
We strive to help people live as well as they can despite their illness and to cope with cancer symptoms. We focus on controlling any cancer symptoms that may be interfering in the quality of life, defining goals for any subsequent treatment, and maintaining the best physical and emotional well-being possible despite complex problems. The medical specialist functions as the quarterback of a team, including the patient and the family in what can be difficult decisions. Family conferences are routinely held to ensure that everyone involved is aware of and involved in the plan of care.
Who is on the team?
The patient and the family
The referring physician
The palliative medicine physician
Music and art therapist
Home health aides
What services are provided?
Cancer Symptom Control: There is no need for anyone to suffer from uncontrolled pain, nausea or dyspnea (shortness of breath). Medical science knows how to effectively control these cancer symptoms most of the time. Making sure this happens is one of the primary goals of this program.
Case Management: People with serious illness often have many doctors involved in their care making. It is difficult to determine who to contact when a problem occurs. In this program, each patient has a registered nurse case manager assigned. That person is then a link to all other caregivers and available after hours.
The Harry R. Horvitz Center: Most people can be managed in an outpatient setting, but in crisis, this 23-bed inpatient unit is available for comprehensive multidisciplinary care.
Inpatient Consultation Service: Comprehensive assessment and management of symptoms in other areas of the hospital is provided to ensure maximum comfort for all hospitalized patients. The attending physician must request this service.
Outpatient Clinic: Specialty follow-up and consultation are available in this clinic. Nurse case managers maintain contact with their patients in this setting also.
Home Care and Hospice: As people become more ill they may need assistance at home which can be provided by Cleveland Clinic Home Care Ventures. As end of life approaches, the Hospice of the Cleveland Clinic is available at home for the special multidisciplinary care so critical at this time of life. Inpatient hospice care in the community is also available. Continuity is maintained throughout with the staff of the Palliative Medicine Program.
What is special about the Harry R. Horvitz Center?
Dr. Declan Walsh first developed the program at the Cleveland Clinic in 1988. At that time nothing of its kind existed in the United States. It still remains one of the few fully integrated programs in this country. In 1991 it was recognized by the World Health Organization as “a unique model of a much needed service” and designated a WHO Demonstration Project. The program had the first endowed chairs in Palliative Medicine in the USA.
The 23-bed inpatient unit was built in memory of Harry R. Horvitz, lifelong resident of Cleveland, recognized by his friends and associates as a man of integrity and compassion. The unit consists of the following facilities:
13 private patient rooms
5 semi-private patient rooms
Glass enclosed solarium
Family dining room
Donor recognition area
The Harry R. Horvitz Center for Palliative Medicine also conducts important cancer research and educational programs in pain management, symptom control and nutrition. Donations made to the Harry R. Horvitz Center for Palliative Medicine are allocated for this vital research.
Advances made at the Cleveland Clinic have minimized unwanted side effects of treatment and enhanced quality of life for patients with advanced disease and painful cancer symptoms.
Cancer Answers & Appointments
Speak with a cancer nurse specialist for appointment assistance and for answers to your questions about cancer locally at 216.444.7923216.444.7923 or toll-free 1.1.866.223.8100 FREE866.223.8100866.223.8100 FREE.
Monday through Friday from 8 a.m. – 4:30 p.m. (ET).
Resources for medical professionals
Outpatient appointment referrals: 216.444.7923216.444.7923 or 866.223.8100866.223.8100 FREE
This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.
Psychiatric hospitalizations of Latino children and young adults in California are rising dramatically — at a much faster pace than among their white and black peers, according to state data.
While mental health hospitalizations of young people of all ethnicities have climbed in recent years, Latino rates stand out. Among those 21 and younger, they shot up 86 percent, to 17,813, between 2007 and 2014, according to the Office of Statewide Health Planning and Development. That’s compared with a 21 percent increase among whites and 35 percent among African Americans.
No one knows for certain what’s driving the trend. Policymakers and Latino community leaders offer varying and sometimes contradictory explanations. Some say the numbers reflect a lack of culturally and linguistically appropriate mental health services for Latinos and a pervasive stigma that prevents many from seeking help before a crisis hits.
“Often, they wait until they are falling apart,” said Dr. Sergio Aguilar-Gaxiola, a professor at the University of California, Davis Medical School and director of the university’s Center for Reducing Health Disparities.
Others blame stress from the recent recession, family disintegration and an influx of traumatized children fleeing poverty and violence in Central America.
Still others suggest the trend might actually be positive, reflecting an increasing willingness among Latino parents to seek treatment for themselves and their children, at least when they are in crisis.
Among Latino adults, psychiatric hospitalizations rose 38 percent during the same period. Similar hospitalizations of black adults increased 21 percent, while hospitalizations of white adults remained flat.
Margarita Rocha, the executive director of the nonprofit Centro la Familia in Fresno, said mental health issues are starting to be discussed more publicly in the Latino community.
“That’s helping people to come forward,” she said.
Ken Berrick, CEO of the Seneca Family of Agencies, which serves children with emotional disturbances in a dozen counties, agreed. Because more Latinos are now getting mental health services, children are more likely to be identified as requiring hospitalization, he said.
“I know for a fact that access to service is better now,” said Berrick, whose operation has a crisis stabilization unit in Alameda County, Calif.
Kids’ psychiatric hospitalizations overall rose nearly 45 percent between 2007 and 2014, regardless of ethnicity, a pattern experts attribute to various factors including a shortage of intensive outpatient and in-home services, schools’ struggles to pay for mental health services through special education and a decline in group home placements.
“Those kids have to be treated somewhere,” said Dawan Utecht, Fresno County’s mental health director, of the move to keep kids out of group homes.
“If they don’t get those services in a community setting, they’re going to go into crisis.”
The rise among Latino youths is remarkable in part because hospitalization rates for that population historically have been relatively low.
Latino children remain much less likely to receive mental health treatment through Medi-Cal, the state and federal coverage program for poor and disabled residents. Between 2010 and 2014, less than 4 percent of Latino children received specialty mental health services through the traditional Medi-Cal program. That’s compared with 7 percent of eligible black and white children, according to state data. The numbers don’t include those enrolled in managed care.
(Asian Americans and Pacific Islanders seek treatment at a rate even lower than Latinos. Although hospitalizations are also increasing rapidly among that population, the raw numbers remain relatively small.)
Leslie Preston, the behavioral health director of La Clínica de La Raza, in East Oakland, says that the shortage of bilingual, bicultural mental health workers limits Latino kids’ access to preventive care, which could lead to crises later on.
“Everybody’s trying to hire the Spanish-speaking clinicians,” she said. “There’s just not enough clinicians to meet that demand.”
Access to care can be even harder for recent immigrants. Spanish-speaking children who have been referred for a special education assessment, which can help them become eligible for mental health services, sometimes wait months or years before someone tests them, she said.
“The families don’t know the system,” she added. “They don’t know their rights.”
Other clinicians point to relatively low health insurance coverage among Latinos, particularly those without legal status, and a cultural resistance to acknowledging mental illness.
Dr. Alok Banga, medical director at Sierra Vista Hospital in Sacramento, said some immigrant parents he encounters don’t believe in mental illness and have not grasped the urgency of their children’s depression and past suicide attempts. Many are working two or three jobs, he said. Some are undocumented immigrants afraid of coming to the hospital or having any interaction with Child Protective Services.
But the biggest problem, from his perspective, is the shortage of child psychiatrists and outpatient services to serve this population.
“The default course for treatment falls on institutions: hospitals, jails and prisons,” he said.
Jeff Rackmil, director of the children’s system of care in Alameda County, said sheer population growth — particularly, an increase in Latino children insured under Medi-Cal — may also be part of the explanation for the rise in hospitalizations.
Yet the state’s Latino population aged 24 and under increased less than 8 percent between 2007 and 2014, which doesn’t nearly explain an 86 percent increase in hospitalizations.
Some California communities are working to bring more Latino children into care and to reduce the stigma associated with mental illness.
At Life Academy of Health and Bioscience, a small, mostly Latino high school in East Oakland, students grow up amid pervasive violence and poverty. “We’re just told to hold things in,” said 17-year-old Hilda Chavez, a senior.
Students often don’t seek help because they fear discussing mental health problems will earn them a label of “crazy,” Chavez said.
Last year, the school, in conjunction with the Oakland-based La Clínica de La Raza, started a program to interest students in careers in mental health care. The program provides training in “first aid” instruction to help people in crisis, and places students in internships with mental health organizations.
Nubia Flores Miranda, 18, participated in the program last year and now is majoring in psychology at San Francisco State University. Miranda said she became interested in a career in mental health after she experienced depression and anxiety during her freshman year at Life Academy.
Seeing a school counselor “changed my life around,” she said.
But she saw that her peers were wary of seeking help from counselors at the school, most of whom were white and lived in wealthier, safer neighborhoods. Once, when a classmate started acting out at school, Miranda suggested she talk to someone.
“She told me she didn’t feel like she could trust the person — they wouldn’t understand where she was coming from,” she said.
The shortage of services is especially evident in the Central Valley, where many agricultural workers are Latino. Juan Garcia, an emeritus professor at California State University, Fresno, who founded a counseling center in the city, says the drought and economic downturn have exacerbated depression, anxiety, substance abuse and psychotic breaks among Latinos of all ages.
“The services to this population lag decades behind where they should be,” he said.
In Fresno County, psychiatric hospitalizations of Latino youth more than tripled, to 432, between 2007 and 2014. Hospitalizations of their white and black peers about doubled.
Liliana Quintero Robles, a marriage and family therapy intern in rural Kings County, also in the state’s Central Valley, said she sees children whose mental health issues go untreated for so long that they end up cutting themselves and abusing alcohol, marijuana, crystal meth and OxyContin.
“There’s some really, really deep-rooted suffering,” she said.
Out in the unincorporated agricultural community of Five Points, about 45 minutes from Fresno, almost all of the students at Westside Elementary School are low-income Latinos. When principal Baldo Hernandez started there in 1981, he’d see maybe one child a year with a mental health issue. These days, he sees 15 to 30, he said.
He blames dry wells and barren fields, at least in part.
“I’ve had parents crying at school, begging me to find them a home, begging me to find them a job,” he said.
In some parts of the Valley and other places, the closest hospitals that accept children in psychiatric crises are hours away. Children can be stuck in emergency room hallways for days, waiting for a hospital bed.
“It makes for a very traumatized experience for both families and children,” said Shannyn McDonald, the chief of the Stanislaus County behavioral health department’s children’s system of care.
Recently, the county expanded its promotora program, which enlists members of the Latino community to talk to their peers about mental health.
In the small town of Oakdale, a slim, energetic 51-year-old promotora named Rossy Gomar spends 60 to 70 hours a week serving as cheerleader, educator and sounding board for many of the Latino women and children in the town.
Gomar’s office in the Oakdale Family Support Network Resource Center is cluttered with open boxes of diapers and donated children’s toys and clothing.
“Look at my office,” she laughs. “We don’t fit.”
Gomar says many of the women she works with don’t recognize that they are depressed or abused. Children see their parents’ problems and don’t know where to turn for help.
“There are many young people who don’t have any hope,” she said.
But little by little, she has seen some good results.
One 17-year-old client is a student at Oakdale High School. The girl, whose name is being withheld to protect her privacy, said that earlier this year, problems at school and a break-up with her boyfriend had her struggling to get out of bed each morning. She began drinking, using drugs and thinking about suicide. She was scared to talk to her parents, she said, and kept everything inside.
One day, she walked into Gomar’s office and started crying.
“She told me ‘Everything is ok. We want you here,’” the girl said. “When I was talking with her, I felt so much better.”
He tried lots of gadgets, but nothing worked. He couldn’t remember to use them.
That’s when he created something he wouldn’t have to remember to wear or charge.
It’s a mattress pad called EIGHT, after recommended hours of sleep.
Eight personalizes sleep tracking for each user.
HOW IT WORKS: The mattress pad tracks your usual bedtime, time you fall asleep, normally wake, movement, heart rate, breathing rate, hours slept, and get out of bed. It also tracks room temperature, humidity, light levels, noise levels, and local weather.
Based on the info it collects, a companion app provides you with a sleep score, data on number of hours slept, sleep debt trends, and data on how much deep sleep you received.
The mattress cover also offers ten different temperature settings that can be adjusted on either side of the bed if you are sleeping with a partner.
The system costs between $249 and $289 depending on bed size, is available for preorder for $99 on its website. Use code SLEEPWEEK to get $35. off. According to the website, there is a one-year limited warranty and 30-day free return.
Last year, Eight launched a crowdfunding campaign for its mattress cover, which ended up raising $1.2 million, significantly more than its $400,000 goal.
Though the campaign ended in March 2015, none of the orders have been fulfilled yet, but Franceschetti said they plan to start shipping the device in the spring of this year.
All that tracking would keep me up. I do like the temperature feature, but I remember sleeping with heated blankets ended up being a health hazard. I recall learning years later that electric blankets create a magnetic field that has been linked to childhood leukemia, miscarriages, breast cancer and endometrial cancer. A study was published on it 9 years ago in the European Journal of Cancer Prevention. This mattress cover also runs on electricity. It’s radiating a constant low level magnetic field. You have no idea what it will do to you ten or twenty years from now. Further, whoever invested in it doesn’t want you to think them dumb for investing in everything called “smart” so fake blogs, articles and sites will pop up saying how wonderful it is without mentioning this hazard at all. Then, they buy quotes from physicians or experts to say it’s safe. The only one who suffers the long-term consequences is the healthcare consumer who bought it. You’ll be up worrying. Ah, the irony. The founders may add software with sleep coaches (again keeping you up). I’m thinking its because they already know this electric mattress will not improve your sleep. Smart people will not fall for slick presentations. The only person sleeping soundly will be the founder with millions of dollars from investors. They fell for the line: “Changing sleep forever, for better.”
Here’s a reminder of why sleep is so important to good health followed by what may be the underlying cause of insomnia.
Medical Causes of Insomnia from Sleep Foundation
Examples of medical conditions that can cause insomnia are:
Gastrointestinal problems such as reflux
Endocrine problems such as hyperthyroidism
Neurological conditions such as Parkinson’s disease
Low back pain
Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, and depression can also cause insomnia.
In addition, insomnia may be a symptom of underlying sleep disorders. For example, restless legs syndrome—a neurological condition in which a person has an uncomfortable sensation of needing to move his or her legs—can lead to insomnia.
Patients with restless legs syndrome typically experience worse symptoms in the later part of the day, during periods of inactivity, and in the transition from wake to sleep, which means that falling asleep and staying asleep can be difficult. An estimated 10 percent of the population has restless legs syndrome.
Sleep apnea is another sleep disorder linked to insomnia. With sleep apnea, a person’s airway becomes partially or completely obstructed during sleep, leading to pauses in breathing and a drop in oxygen levels. This causes a person to wake up briefly but repeatedly throughout the night. People with sleep apnea sometimes report experiencing insomnia.
If you have trouble sleeping on a regular basis, it’s a good idea to review your health and think about whether any underlying medical issues or sleep disorders could be contributing to your sleep problems.
In some cases, there are simple steps that can be taken to improve sleep (such as avoiding bright lighting while winding down and trying to limit possible distractions, such as a TV, computer, or pets).
While in other cases, it’s important to talk to your doctor to figure out a course of action. You should not simply accept poor sleep as a way of life—talk to your doctor or a sleep specialist for help.
Insomnia & Depression
Sleep problems may represent a symptom of depression, and the risk of severe insomnia is much higher in patients with major depressive disorders. Studies show that insomnia can also trigger or worsen depression.
Insomnia, Depression, Anxiety
Insomnia can come from feeling excited, worried, nervous or anxious. It’s natural for most adults. If it becomes a regular pattern it could lead to:
Getting caught up in thoughts about past events
Excessive worrying about future events
Feeling overwhelmed by responsibilities
A general feeling of being revved up or overstimulated
There are 2 types of insomnia:
Onset insomnia (trouble falling asleep)
Maintenance insomnia (waking up during the night and not being able to return to sleep).
According to the Sleep Foundation, when this happens for many nights (or many months), you might start to feel anxiousness, dread, or panic at just the prospect of not sleeping. This is how anxiety and insomnia can feed each other and become a cycle that should be interrupted through treatment.
Examples of how specific lifestyles and sleep habits can lead to insomnia are:
You work at home in the evenings. This can make it hard to unwind, and it can also make you feel preoccupied when it comes time to sleep. The light from your computer could also make your brain more alert.
You take naps (even if they are short) in the afternoon. Short naps can be helpful for some people, but for others they make it difficult to fall asleep at night.
You sometimes sleep in later to make up for lost sleep. This can confuse your body’s clock and make it difficult to fall asleep again the following night.
You are a shift worker (meaning that you work irregular hours). Non-traditional hours can confuse your body’s clock, especially if you are trying to sleep during the day, or if your schedule changes periodically.
If you can’t sleep, review the following lifestyle factors:
Alcohol is a sedative. It can make you fall asleep initially, but may disrupt your sleep later in the night.
Caffeine is a stimulant. Most people understand the alerting power of caffeine and use it in the morning to help them start the day and feel productive. Caffeine in moderation is fine for most people, but excessive caffeine can cause insomnia.
A National Sleep Foundation poll found that people who drank four or more cups/cans of caffeinated drinks a day were more likely than those who drank zero to one cups/cans daily to experience at least one symptom of insomnia at least a few nights each week.
Caffeine can stay in your system for as long as eight hours, so the effects are long lasting. If you have insomnia, do not consume food or drinks with caffeine too close to bedtime.
Nicotine is also a stimulant and can cause insomnia. Smoking cigarettes or tobacco products close to bedtime can make it hard to fall asleep and to sleep well through the night. Smoking is damaging to your health. If you smoke, you should stop.
Heavy meals close to bedtime can disrupt your sleep. The best practice is to eat lightly before bedtime. When you eat too much in the evening, it can cause discomfort and make it hard for your body to settle and relax. Spicy foods can also cause heartburn and interfere with your sleep.
Insomnia & The Brain
In some cases, insomnia may be caused by certain neurotransmitters in the brain that are known to be involved with sleep and wakefulness.
There are many possible chemical interactions in the brain that could interfere with sleep and may explain why some people are biologically prone to insomnia and seem to struggle with sleep for many years without any identifiable cause—even when they follow healthy sleep advice.
The Sleep Foundation reviewed Eight, which used to be called Luna, along with other monitors that slide under your sheets to keep an eye on your sleep habits without disrupting your slumber.
While most high-tech sleep trackers involve a wristband, some people prefer to sleep without anything on their arms. That’s where these three new products come in.
This system is made up of a mattress pad that goes under your mattress (above your box spring), a smart phone app, and a bedside device that produces light and sound. The pad tracks your sleep patterns and the light and sound programs help you transition to sleep at night and wake up in the morning. You can also use the Smart WakeUP function so that your alarm goes off when you’re in a light sleep cycle so you’ll feel less groggy. Another fun feature: The bedside device monitors light and noise in the room, in case there’s a connection between, say, a routine garbage truck on your street and your waking up at 5:00am every day. ($299.95)
This mattress cover learns your sleep habits and cycles by tracking your heart rate and breathing rate. It also changes the temperature of your bed, warming it up around your normal bedtime and cooling down throughout the night. If you and your partner have different preferences, you can each set your half of the bed to separate temperatures. Think of this as turning your mattress into a smart bed, since Luna can communicate with other devices. For instance, Luna can connect with activity trackers (and figure out if your exercise or eating habits are affecting your sleep). It can “talk” to other smart home devices like your alarm clock (Luna will make sure that it’s set). And it can even work directly with your thermostat (Luna will lower it when you go to sleep). (Starts at $249)
Take any mattress—foam, memory foam, waterbed, pillow top, or spring—and place the RestOn sensor on top of it, under your fitted sheet. Hit start on the RestOn app on your smart phone, get into bed, and it will start recording heart rate, respiratory rate, movement, and sleep cycles. The RestOn goes one step further and suggests habits that will result in better sleep, like making your room cooler, cutting out late-in-the-day coffee, or eating a lighter lunch. You’ll also get weekly and monthly reports that detail your sleep trends so you can make adjustments to improve your slumber. ($149)
Stanford sleep research and treatment focuses on all types of sleep disorders including, but not limited to, the following:
INSOMNIA debilitates no fewer than 14 percent of Americans. It has been shown to be one of the strongest predictors of depression later in life. But new therapies, including some that do not require medication—such as sleep restriction, light therapy, better sleep habits, and cognitive therapy—bring 80 percent to 90 percent satisfaction even in severe cases.
OBSTRUCTIVE SLEEP APNEA afflicts 30 million Americans, or 10 percent of the population. Soft tissue in the airway stops breathing repeatedly during sleep, preventing deep sleep, causing low oxygenation, and resulting in sleep deprivation. Apnea is now accepted as the leading treatable cause of hypertension and is a strong predictor of stroke and heart disease. Difficulty with memory, intimacy, and attention are common.
CENTRAL SLEEP APNEA, a less common type of sleep apnea, affects several million Americans. Although people with central sleep apnea seldom snore, symptoms and results are much the same as the obstructive type—a deprivation of oxygen and poor sleep. About 40 percent to 60 percent of persons with heart failure have central sleep apnea.
RESTLESS LEGS SYNDROME (RLS) afflicts 12 million Americans. An uncontrollable urge to move the legs, often associated with painful sensations, seriously disrupts sleep. The genetic basis of RLS has just been discovered. RLS is also associated with depression, anxiety, and heart disease.
NARCOLEPSY AND IDIOPATHIC HYPERSOMNIA (disabling daytime sleepiness) shatter more than 200,000 lives in the United States. In addition to sudden, unpredictable sleeping, they can cause cataplexy, a muscular collapse brought on by emotional excitement. Lifelong treatment with stimulants or powerful sedatives is often required but brings only partial relief. Although the cause of narcolepsy is now established, almost nothing is known regarding idiopathic hypersomnia and its treatment.
Learn more about the Stanford Center for Sleep Sciences and Medicine by clicking on one of the links below.
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President Barack Obama’s visit to Cuba this month will be the first by an American president in nearly a century. The thawing relations between the two countries are expected to bring a bumper crop of famed Cuban among other imports.
Strangely enough, another eagerly anticipated product is a lung cancer vaccine some say could be a breakthrough in oncology.
CimaVax has reportedly been in development in Cuba for 25 years, partly because lung cancer is one of the leading causes of death in the Caribbean nation.
Health reporter, Maria Dorfner spoke with Dr. Kelvin Lee from Roswell Park Cancer Institute, located in Buffalo, New York. He says Roswell Park is finalizing an application to the FDA seeking permission to conduct a U.S. clinical trial of the cancer vaccine and that , depending on the results from that and any subsequent studies, it would likely be 5 or more years before the drug could be widely available for patients in the U.S. CimaVax is already an approved cancer therapy in Cuba and Peru.
HOW IT WORKS
The injection is not like the other cancer-fighting immunotherapies being developed in hundreds of American labs, said Kelvin Lee, the chair of immunology at the Roswell Park Cancer Institute in Buffalo, N.Y.
Lee and other doctors have visited the island nation several times to meet with its Cuban developers and hear updates on their progress –and they found that the vaccine was a promising potential breakthrough. He wrote in a post on Roswell Park’s Cancer Talk blog:
“Unlike other immunotherapies, CimaVax does not target cancer directly and it is not personalized. Rather, the vaccine targets a growth factor (EGF) necessary for the cancer to survive,” Lee said. “By targeting and effectively depleting this growth factor, the cancer starves and its progress slows, prolonging patients’ lives.”
The results so far show that patients’ lives were extended from six to an average of 18 months with the vaccine treatment, but there are reports of patients treated with the vaccine living five years or more.
Lee and the other doctors see the possibility that the vaccine’s efficacy may translate to colon, head and neck, prostrate, breast and pancreatic cancers as well, and that CimaVax may prove effective in preventing some cancers from developing or recurring.
Some studies have shown promise in CimaVax, as it has cut back the EGF needed for the cancer to progress.
It has done this with minimal side effects, including nausea, fever and vomiting. Survival dramatically improved in those patients with advanced Stage 3 and Stage 4 tumors, according to a Cuban study conducted in 2007.
However, the vaccine has only been administered to a few thousand people worldwide –and it is still far from FDA approval, the doctor said.
A possibility of skipping Phase I testing exists, Lee added. The FDA inspection period should end sometime this year, allowing testing to begin. Lee and the other doctors envision the vaccine’s efficacy translating over to other head and neck cancers, as well.
Cancer Research UK urged patience in looking to CimaCax, in a statement released last year.
“This research is promising but this is a small trial and we will need more trial results before we know exactly how well the vaccine works for people with lung cancer. A phase 3 trial is currently in progress in Cuba,” they said in a statement.
Obama announced the U.S. was “extending a hand of friendship” to Cuba – just 90 miles from Florida – in December 2014. The cooperation between Cuban and American doctors began in 2011 and gained momentum with New York Governor Andrew Cuomo’s trade mission to Cuba in April 2015. Since then, the U.S. has restored up to 110 daily flights to Havana.
Among the critics of Obama’s March 21 visit to the island nations are Sens. Marco Rubio and Ted Cruz, both presidential hopefuls who are of Cuban descent.
Experts said the idea made sense but could be more complicated in reality.
However, the researchers, whose work was funded by Cancer Research UK, believe their discovery could form the backbone of new treatments and hope to test it in patients within two years.
They believe by analysing the DNA, they’ll be able to develop bespoke treatment.
People have tried to steer the immune system to kill tumours before, but cancer vaccines have largely flopped.
One explanation is that they are training the body’s own defences to go after the wrong target.
The problem is cancers are not made up of identical cells – they are a heavily mutated, genetic mess and samples at different sites within a tumour can look and behave very differently.
They grow a bit like a tree with core “trunk” mutations, but then mutations that branch off in all directions. It is known as cancer heterogeneity.
The international study developed a way of discovering the “trunk” mutations that change antigens – the proteins that stick out from the surface of cancer cells.
Professor Charles Swanton, from the UCL Cancer Institute, added: “This is exciting. Now we can prioritise and target tumour antigens that are present in every cell – the Achilles heel of these highly complex cancers.
“This is really fascinating and takes personalised medicine to its absolute limit, where each patient would have a unique, bespoke treatment.”
There are two approaches being suggested for targeting the trunk mutations.
The first is to develop cancer vaccines for each patient that train the immune system to spot them.
The second is to “fish” for immune cells that already target those mutations and swell their numbers in the lab, and then put them back into the body.
Dr Marco Gerlinger, from the Institute of Cancer Research, said: “This is a very important step and makes us think about heterogeneity as a problem and why this gives cancer this big advantage.
“Targeting trunk mutations makes sense from many points of view, but it is early days and whether it’s that simple, I’m not entirely sure.
“Many cancers are not standing still but they keep evolving constantly. These are moving targets which makes it difficult to get them under control.
“Cancers that can change and evolve could lose the initial antigen or maybe come up with smokescreens of other good antigens so that the immune system gets confused.”
James Gallagher, health editor, BBC News website
Harnessing the power of the immune system – what’s known as immunotherapy – is the most exciting field in cancer and probably in all of medicine right now.
But while that excitement is justified, claims that a cure for cancer is around the corner are not.
Medical research is littered with the graves of hyped treatments that just never worked.
Two decades ago, gene therapy was “hype-central” and we’re still waiting for it to transform medicine.
This study demonstrates some spectacular science that furthers understanding of how the immune system and cancer interact.
But this new knowledge has not been used to treat a single patient. There have not even been animal studies. So there is a real risk it will not work.
Even if it does, this is an hugely expensive approach that would need to be customised to every patient in a process that takes more than a year from start to finish.
Some immunotherapy treatments work spectacularly with some patients’ cancer disappearing entirely.
They take the brakes off the immune system, freeing it up to fight cancer.
The researchers hope the combination of removing the immune system’s brakes and then taking over the steering wheel, will save lives.
Professor Peter Johnson, from Cancer Research UK, said the research had shown “impressive results in the clinic” and although “the technology is complicated and quite recent… once you start doing it the cost will come down”.
Dr Stefan Symeonides, clinician scientist in experimental cancer medicine at the University of Edinburgh, said designing a personalised vaccine was currently impractical, especially when a patient needed treatment straight away.
But he added that the “very elegant” study did provide a ground-breaking insight into current immunotherapy drugs, which do not yet work for most people.
“It’s not just the number of antigens, it’s how many of the cancer cells have them,” he said.
“This data will be quoted in discussions for years, as we try to understand which patients benefit from immunotherapy drugs, which ones don’t, and why, so we can improve those therapies.”