Category Archives: Preventative Medicine

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The Diamond Princess cruise ship (shown docked in Yokohama, Japan, on February 10) was quarantined in the city after passengers tested positive for coronavirus.

When passengers booked their vacations on the ill-fated Diamond Princess, they were likely looking forward to hanging out in a hot tub, not a hot zone. Now most of them are quarantined off the coast of Japan, hoping to avoid testing positive for the 2019 novel coronavirus, which has already infected more than 200 people on the cruise ship.

Health officials in protective gear removed suitcases from the Diamond Princess cruise ship in Yokohama, Japan. Its believed they belonged to passengers evacuated and taken to hospitals after testing positive for coronavirus.

The fact that the largest outbreak of COVID-19 outside of mainland China is happening on a cruise cant be reassuring to travelers who are already skittish about health issues on boat-based trips, which are well known incubators of gastrointestinal illnesses. The Center for Disease Control and Prevention (CDC) offers a helpful database of cases, broken down by year.

The vast majority of cruises dont experience any problems. But confined spaces mean that even one sick person can create a serious situation, explains Tullia Marcolongo, executive director of the nonprofit International Association for Medical Assistance to Travelers. Its the domino effect, and you have nowhere to go, she says.

Cruise companies work to minimize the risk of illness by maintaining cleanliness and monitoring health on board their ships. In response to the coronavirus outbreak, Carnivalthe parent company of Princess Cruiseshas introduced expanded protocols, including enhanced onboard sanitation measures with non-toxic materials and pre-boarding medical evaluations, as needed. On its website, Royal Caribbean Cruises touts its health and safety program, such as internal and external inspections, frequent water systems testing, and strict food handling rules.

Passengers can do their part, too. The first thing I would say is that the power is in your hands, Marcolongo says. She means that literally. Frequent hand washing can be a critical preventative measure for norovirus, colds, and other yucky things circulating on a ship. To make sure you scrub long enough, sing Happy Birthday twice, she suggests, and dont miss the spots between your fingers. If theres no soap and water nearby, use an alcohol-based hand sanitizer. Many ships make sanitizer stands readily available to passengers, Marcolongo adds.

David Parenti, director of the George Washington University Travelers Clinic and professor of medicine at the George Washington University School of Medicine and Health Sciences, advises being aware of when youve held handrails and touched other surfaces. Until you can wash your hands, dont stick them in your eyes or mouth.

Unfortunately, Parenti says, there are lots of other ways to get sick, both on ship and on land. It all has to do with luck. If youre on a ship with norovirus, thats bad luck. If you are on a cruise ship, you will need to eat. Those risks are something you dont have a lot of control over, he says.

This is where you should sit on the plane to avoid getting sick.

To be proactive, travelers can set up a pre-vacation doctors appointment to make sure their immunizations are up to date. Depending on your destination, that flu shot might be important even if youre taking off in the middle of the summer. Keep in mind that the U.S. influenza season is the opposite of the Southern Hemisphere, Parenti notes. He recommends getting the vaccine for Hepatitis A and checking on your immunity to measles; you could possibly use another shot. (A measles case was responsible for a different cruise quarantine in May 2019.)

Because of the limited number of medications on board, its smart to pack whatever you think you might need, Marcolongo adds. That includes first-aid basics as well as some standard over-the-counter supplies, which for gastrointestinal issues include Loperamide (Immodium) and oral rehydration salts.

Miami-based attorney Jack Hickey once represented cruise companiesand now sues them over personal injury claims. His advice? What I tell people is get trip insurance and make sure it covers an air ambulance. Travelers who experience emergencies and need to pay for transportation will be in for some serious sticker shock otherwise.

Be realistic about what kind of care you can actually expect on board a ship. If you get sick or injured, get back to the U.S. as quickly as possible, Hickey advises. Although cruises undoubtably excel at hospitality, he says, they tend to be lacking when it comes to medical care. Its not a hospital, but a ship carrying 3,000 to 6,000 people and going to isolated areas of the world, says Hickey, who thinks there typically arent enough doctors and staff to handle a heavy workload, and that the facilities arent adequately equipped. Almost uniformly, they have X-ray machines. But [ships] do not have good machines or people who know how to read films well, he says.

The coronavirus quarantinewhich is keeping people cooped up in tight cabins for weeksis a reminder that mental health problems could also arise, especially for anyone with issues around anxiety or claustrophobia. Travel insurance doesnt necessarily cover that, Marcolongo notes.

Learn how the coronavirus compares to Ebola, flu, and other outbreaks.

As scientists learn more about the virus and how its transmitted, there may be more scrutiny of ventilation systems on cruise ships, Parenti adds. In a hospital, its possible to put a patient in a respiratory isolation room with frequent air exchanges.

Thats not an option for most cruise accommodations. The next best choice, according to Parenti? I would take a window, personally. At least you could open it and get a breeze that way.

Vicky Hallett is a Florence, Italy-based health and travel writer. Follow her on Instagram.

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STATEN ISLAND, N.Y. -- I never get sick anymore. So, when a bug caught me right before Thanksgiving, I was both annoyed and worried. Getting sick before a family holiday is a big drag, because you want to be with your family, you just dont want to leave them with whatever it is youve got.

When I taught, I was constantly ill. Kids are mobile petrie dishes. I even developed pneumonia from my kids once, a fact my then Principal seemed unaware of when she questioned my six day absence. She also seemed unaware that pneumonia is contagious.

...Sigh...

I dont miss being in that type of environment. I do miss my kids, especially around the holidays.

I read on the WeAreTeachers Helpline Facebook page recently that administrators seemed to be coming out of the walls at one school, making surprise visits into classrooms. Probably looking to catch somebody with their feet on their desk showing a video, like in that movie Bad Teacher.

Yeah. Cause, you know, the day ends at three and we have summers off.NOT!!!

I always played it a bit looser during the holidays because I love celebrations. And, for some of my kids, family holidays werent always that great. So, we created an alternate family in our room. We ate food and watched movies and wrote about the holidays. And, we laughed. A lot. Because, laughter is the way to a persons heart.

And, I mean, you really had to laugh. Here we were, fifteen kids and one teacher stuck in a windowless room by the gym. Hardly anybody knew where we were, unless we called for help. We were an island unto ourselves.

And, I was trying to show my kids how to celebrate. For a lot of them, life was hard. Learning should be both rigorous and joyful. It should never be difficult.

I cant get over the fact that, when I was working, staff were encouraged to come in sick, which is a huge mistake. Youre not at your best, and you need to be because teaching is totally unpredictable. Secondly, youre exposing your kids to germs as well as receiving several handfuls from them. Bad, all the way round. Im glad that the effort to ensure paid sick days is gathering steam. And teachers have 10 sick days a year, which is one a month. But, as one principal told me, that doesnt mean you should use them.

...Sigh...

A teachers job is not to make things easier for their administrator. It is to teach their students how to become compassionate, intelligent, mature individuals in a complex world. Anything else is just window dressing or worse.

So much for Memory Lane. Back to aging.

What are the risk factors for people over 65? According to WHO (The World Health Organization), theres a lot to be concerned about. Injury due to falls is high up there. Patterns of what they term harmful behavior can lead to illnesses later on. Five chronic conditions (diabetes, cardiovascular disease, cancer, chronic respiratory diseases and mental disorders) account for 77% of illness and 85% of death rates. Poverty is higher among older women than older men. Social isolation and exclusion and elder maltreatment often occur.

So, what can we do to stave all of this off? As you know, Im a big believer in preventative medicine, seeking help and treatment before the problems arise. I also believe strongly in acupuncture, chiropractic medicine, massage therapy and good oral health care. All of these factor into general wellness and a breakdown in any part of your system as you age can also affect other areas of your body.

A friend who is exactly 24 hours younger than me (we were born in the same hospital 24 hours apart and only met in 1977!) told me recently he had pneumonia and bells went off in my head. I told him post haste to seek treatment and that pneumonia was nothing to **** with. Trust me, it only gets worse with age, as many things do.

I dont want to sound alarmist, but if we dont take extraordinary care of ourselves now, we wont be around for the really great things in life like grandchildren, cruises, binge watching Netflix and just doin nuthin. This is the time of our lives when all that and more should be available to us and well want to take advantage of them. But, to paraphrase a Billy Joel tune, no sense having an expensive car if you cant drive it because your back problems are too severe.

You have to get proactive because, sadly, our health care system in America is profit driven and there is no profit to be made in a cure. So it benefits certain parties if we all remain sick.

The best way to care for yourself is to listen to your body. You pretty much know when things are off, much as you do with the car you drive. If something feels amiss, have it checked out. Better a false alarm than alarming news.

Be kind to yourself and to others. And, hold those grey heads up!

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The Old Guy: On a healthy way of life for my generation - SILive.com

Republican and Democratic Arkansas lawmakers formed a new legislative caucus focusing on early childhood well-being. The caucus will work with early childhood advocates to create an agenda for the 2021 Arkansas General Assembly.

The Arkansas Early Childhood Well-Being Caucus will be chaired by Sen. Trent Garner, R-El Dorado, and Rep. Denise Garner, D-Fayetteville. Bipartisan members from the Senate and the House have joined the caucus.

During my career as a nurse practitioner and advocate for behavioral sciences and education, Ive learned the importance of early intervention to insure the best outcome, Rep. Garner said. As around 80% of a childs brain is developed by age 3 and 90% by age 5, its imperative to make certain our children are receiving everything they need to thrive and that we have policies in place to help make that happen.

As a son of a kindergarten teacher, I saw firsthand the importance of early childhood development, Sen. Garner said. Im excited to be part of this group of bipartisan legislators who are working together to move Arkansas in a new and better direction for our children.

There are more than 190,000 children in Arkansas under age 5.

The new caucus will spend the next several months hearing from experts on brain development, nurturing environments, and the impacts of social determinants of health outcomes.

The caucus held its first meeting Thursday (Jan. 16) with 16 legislators in attendance. The meeting featured a presentation on Brain Development by Dr. Nikki Edge, Professor in the Department of Family and Preventative Medicine at UAMS and a presentation on Prenatal to Age 3 by Jamie Morrison Ward, President of the Arkansas Association for Infant Mental Health.

We are thrilled with the opportunity to raise awareness and educate Arkansans on the critical developmental period of prenatal to age 3, said Ward. The formation of the Early Childhood Well-Being caucus is a testament to the importance of the early years, and we are very fortunate to have a legislature that is interested in learning how to positively impact the health and education of our states youngest citizens and their families.

The caucus plans to meet every month or every-other month.

In addition to Garner and Garner, members of the caucus include: State Senators Bruce Maloch, D-Magnolia; Greg Leding, D-Fayetteville; Keith Ingram, D-West Memphis; Will Bond, D-Little Rock; State Representatives Tippi McCullough, D-Little Rock; David Whitaker, D-Fayetteville; Jay Richardson, D-Fort Smith; Don Glover, D-Dermott; LeAnne Burch, D-Monticello; Andrew Collins, D-Little Rock; Dan Douglas, R-Bentonville; Chris Richey, D-West Helena; DeAnn Vaught, R-Horatio; Cindy Crawford, R-Fort Smith; Jeff Wardlaw, R-Warren; and Jon Eubanks, R-Paris.

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Bipartisan legislative group forms Arkansas Early Childhood Well-Being Caucus - talkbusiness.net

January 17, 2020 -What healthcare providers really want is to do is the right thing for their patients. They just need sustainable financial support for doing that, health economist Mark McClellan, MD, PhD, said at the start of an interview with RevCycleIntelligence.

The healthcare industry has in earnest attempted to transform not only clinical outcomes, but also the financial aspect of care for about a decade now. Yet progress with the adoption of alternative payment models (APMs) has been slow, explained McClellan, the former CMS administrator and current Robert J. Margolis MD Professor of Business, Medicine and Policy, Fuqua School of Business.

One in three healthcare payments flows through an APM, the Health Care Payment Learning & Action Network (LAN) which McClellan also serves as co-chair for their Guiding Committee recently found using the latest data from 62 health plans, seven fee-for-service Medicaid states, and traditional Medicare.

But fee-for-service still dominates even a decade later.

According to LANs data, approximately 39 percent of healthcare payments made in 2018 were under fee-for-service. Another 25 percent were fee-for-service with some link to quality and/or value. These payments included pay-for-reporting or pay-for-performance incentive payments.

The general consensus in healthcare is that fee-for-service is one of the primary reasons why the industry is sinking. The financing mechanism encourages providers to protect their bottom lines by delivering more services, which results in unnecessary costs and utilization, as well as a sick care system.

APMs aim to get the healthcare system back to one that incentivizes just that health. The models tie provider reimbursement to the value of care, meaning providers get paid based on their patient outcomes and/or costs.

So, what is preventing widespread adoption of the models that promise to fix healthcare? And what needs to be done to hit the value-based tipping point? RevCycleIntelligence spoke with McClellan and other industry experts, as well as those on the frontline of value-based care, to explore the state of payment reform and strategies for progress.

The status quo is no longer working in healthcare.

National healthcare spending increased to $3.6 trillion in 2018 and is slated to reach nearly $6 trillion in the next seven years. Meanwhile, patients are not seeing the benefits of greater healthcare spending. According to data from the Kaiser Family Foundation, the US lags behind similarly wealthy countries. In some cases, such as with rates of all-cause mortality, premature death, death amenable to healthcare, and disease burden, the US is not improving as quickly as their peers.

The failings of the current healthcare system are not new to healthcare stakeholders, but there is a fresh push to fix the problems, according to Theresa Dreyer, MPH, lead of value-based care at the Association of American Medical Colleges (AAMC).

There's a new urgency as the cost of care continues to increase to really adopt some ideas that have been existing in the market for decades and apply them to broader and broader patient groups, she said.

Those ideas? Value-based care.

One of the things that we see out of our teaching hospitals is a real readiness to understand that the status quo may not be the way that healthcare is provided going forward, said Dreyer, who leads three AAMC collaboratives for teaching hospitals that participate in alternative payment models. Many organizations see value-based care as a way of continuing to invest in the clinical changes that they are dedicated to.

While most hospitals and physicians feel that value-based care is the right thing to do for their patients, the stakeholders are not getting on board with the vehicles being used to convey value-based care.

Harold D. Miller, president and CEO, CHQPR

The data shows that the healthcare industry is about a third of the way with adopting a value-based reimbursement system. But the data does not tell the whole story, Harold D. Miller, president and CEO for the Center for Healthcare Quality and Payment Reform argued.

We have moved backwards rather than forwards, said Miller, a former member of the federal Physician-Focused Payment Model Technical Advisory Committee that was created by Congress to advise the HHS Secretary on the creation of APMs.

The payment models that are being used by and large are actually making things worse rather than better in most cases, he elaborated. They are very problematic for patients in many cases because they create incentives to reduce spending without appropriate quality protections built into them. They are forcing many small practices and hospitals out of business.

Physicians have been skeptical about accountable care organizations (ACOs), bundled payments, and other popular APMs. A 2018 survey of over 3,400 physicians found that many doctors (41 percent) feel value-based care and reimbursement will have a negative impact on patient care as a whole and many more (61 percent) feel the APMs will have a negative impact on their bottom lines.

Another survey published in NEJM Catalyst that same year also found that only about half of clinicians believe the alternative payment method will take off.

There is data to support their skepticism. A recent report from the non-profit Catalyst for Payment Reform showed that APMs in the commercial sector only realized small care quality improvements. Additionally, hospital readmission rates one of the most popular care quality metrics used in APMs barely improved under the value-based arrangements.

CMS has also expressed concerns about one of its largest APM demonstrations. According to the federal agency, the Medicare Shared Savings Program, which currently governs 517 accountable care organizations (ACOs), has actually increased Medicare spending.

We've learned in the last few years that it's not enough just to pay a healthcare provider fee-for-service and give them a little bonus or a penalty for doing something we think we'd like them to do, like buy an electronic record system or report on a quality measure, McClellan said.

Pay-for-performance, shared savings, and other similar APMs are a good place to start, but the models are not enough for sustainable, effective support for truly better care models that can improve outcomes and lower costs significantly, he added.

CMS and other major payers have started to recognize that APMs built on fee-for-service are not leading to the results they had hoped for a decade ago, and these stakeholders are refining their value-based care strategies to hold providers more accountable for outcomes as result.

After six years of experience, the time has come to put real accountability in accountable care organizations, CMS Administrator Seema Verma said in 2018 after announcing the agencys plan to revamp the Medicare Shared Savings Program.

What she meant by accountability was downside financial risk. In risk-based APMs, providers are accountable not only for the savings they achieve through the model, but also financial losses. If providers in APMs with downside financial risk exceed their spending benchmarks, they must repay a portion or all of the losses to the payer.

CMS sees financial risk as the future of value-based care, according to Dreyer. The agency believes that holding providers financially accountable for losses will result in more meaningful changes and outcomes.

However, downside financial risk may not be the key to unlocking value-based care success in APMs, industry experts contended.

The notion that somehow if you push financial risk onto physicians or hospitals, you are going to get better quality care or lower cost is just wrong. It is an insurer view of things, Miller said. The main issue with risk is that current APMs put providers at risk for outcomes they cannot control, he explained.

Miller pointed to APMs for oncology care as a prime example.

The biggest cost of cancer care is drugs and one of the places where you've seen the fastest increases in drug prices has been in oncology drugs, he said. It doesn't do anything to promote better care to try to put physicians at risk for that. What we have seen is small oncology practices going out of business because they can't afford to actually treat their patients and the payment models don't solve that.

Focusing the future of value-based care on risk-based APMs could also alienate many providers from the transition away from fee-for-service, Dreyer added.

There's a risk of leaving behind organizations that are newer on the value-based care journey, she said. The new models are focused explicitly on organizations that already have experience and if you don't already have this experience, it'll become harder and harder to enter into the market.

If risk-based APMs are not the appropriate next step for the value-based care transition, then what is? According to McClellan, the answer lies in episode- or population-based payments.

Source: Xtelligent Healthcare Media

APMs should be less about the level of financial risk involved and more about supporting the activities and infrastructure providers need to engage with value-based care, McClellan insisted.

What really works is giving healthcare organizations payments that are more tied to the people and the whole episodes of care that they are providing, he said.

Population- and episode-based payments give providers the flexibility they need to deliver care, he explained. With the flexible payments, providers can invest more resources into things like paying for team-based approaches to care or paying for services that aren't medical and weren't paid for under fee-for-service models.

But along with that, they do have more accountability for improving quality outcomes and keeping total costs of care down, he stressed.

Only about 5 percent of healthcare payments made in 2018 flowed through one of these models, LAN reported. And payers do not expect much growth in these types of payments. A survey of payers conducted by LAN found that payers expect the most growth in upside-only and two-sided risk APMs.

Mark McClellan, MD, PhD, co-chair of LAN's Guiding Committee

To progress with value-based care and related payment reforms, Miller suggested that the healthcare industry start with identifying a metric to improve. Successful APMs target opportunities to reduce spending or improve quality, which may include cutting spending on services with little benefit to the patient or avoiding complications of a specific treatment.

Payers and providers then need to identify changes in services, as well as barriers in the current payment system, that prevent changes in care delivery. Once stakeholders do that, they can design the APM to overcome the barriers and deliver higher-value care.

With an APM design, payers and providers must determine how to operationalize the model (i.e., create CPT/HCPCS codes and modifiers, determine patient eligibility, adjust payments for performance). Finally, stakeholders can implement the model, assess its performance, make improvements.

What sets Millers APM approach apart from others is his emphasis on changes in care delivery, which he believes will result in value-based care that leads to positive outcomes.

It's not the payment model that comes first, it's the care delivery, he said. And you have to know what the care delivery model is in order to know how to pay for it.

Source: Health Care Payment Learning & Action Network

The healthcare industry is not as far along the value-based care continuum as industry experts predicted a decade ago, and many believe reform is needed for current payment reform efforts. But those on the frontline of care delivery are still pushing forward with care and payment transformations in anticipation of a more advanced world.

With advancements in technology, healthcare is heading in a new direction. Community-oriented, coordinated, team-based care is now possible thanks to new and improved data sharing, consumer-facing healthcare apps, telemedicine, and other capabilities.

But fee-for-service does not align with this version of care delivery.

The right APMs can help providers develop the capabilities they need to deliver higher quality, lower cost care. For example, an ACO agreement enabled an independent primary care practice in Louisiana to get the data it needed to start performing wellness visits consistently, improve coding, advance chronic disease management, and other value-adding activities.

Darrin D. Menard, MD, FAAFP, local medical director for Aledades Louisiana and Southeast ACO

That, in turn, started increasing revenue, said full-time physician at the practice Darrin D. Menard, MD, FAAFP. Once the dollars from savings started coming in, that helped us go further with value-based care.

APMs have contributed to an uptick in, among many capabilities, preventative care and care management, population health management tool implementation, connected health use, and social determinants of health strategies.

But engaging with an APM to bolster care quality and lower costs is not easy for certain providers.

It's very difficult for an independent primary care practice to enter into the world of value-based care by themselves. Value-based care by definition is team-based care, Menard explained. I tried for many years on my own to work with Blue Cross to increase reimbursement for value-based care and I failed over and over again.

Gary Stuck, DO, chief medical officer at Advocate Aurora Health, knows about the benefits of size. Advocate Aurora Health is one of the largest non-profit health systems in the country, and its scale helped the health system to succeed in the Medicare Shared Saving Program, Stuck said in an interview.

But the chief medical officer attributed the health systems $61 million in savings to more than scale.

We use many strategies to get to that number, but the key here is that we focus on getting patients the right safe, high-quality care at the right time and the right place. We know that we can provide high quality care at a lower cost when we coordinate care across the continuum, he said.

Specifically, the health system has invested in expanding its integrated care management and post-acute care networks to optimize the control of chronic conditions and focus on the right level of care including a home-first mentality, Stuck stated.

Advocate Aurora Health also partners with a platform called NowPow to address the social determinants of health, which can impact between 10 and 20 percent of outcomes.

Gary Stuck, DO, chief medical officer, Advocate Aurora Health

Our care team members use it to screen for non-clinical barriers to good health and then make referrals to programs, accessing a database of thousands of community resources to help with transportation, food banks or other services, Stuck explained. Then, patients can be connected to the resources that better enable them to get on the road to better health.

Menard was able to break into this value-based world and start engaging in similar activities through an ACO, too. But his ACO was run by Aledade, which brought local primary care practices together to establish a value-based contract and help them implement value-based care.

They gave me the tools to become successful and then having their voice with the different insurance companies, said Menard, who eventually became the local medical director for Aledades Louisiana and Southeast ACO. The ACO gave us a whole team of practices across the state that we could actually finally move the needle on value-based care in a lot of these practices.

With access to infrastructure and resources, Menard is now part of a risk-based ACO and Track 2 of Medicares Comprehensive Primary Care Plus program. The practice leader plans to continue taking on risk through APMs, but he still had some suggestions for improvement.

For one, benchmarking that does not solely rely on historical expenditure data could help providers stick with APMs, he stated. Attribution could also use some improvement. When payers switch an enrollees primary care provider, that can knock those patients off of a small practices cohort of patients eligible for an APM. Additionally, new independent physicians starting out do not have the patient base necessary to engage in current APMs even if they are providing some of the best quality care around.

Current APMs may have some flaws, but providers are dedicated to continuing their journey to value-based care through the models.

Bottom line: We have embraced value-based care as a way to deliver better health. Advocate Aurora Health will continue to pursue whatever program makes the most sense for the system and our patients, Stuck said.

As they currently stand, APMs may not be perfect but industry experts and providers agree that value-based care is the future of healthcare. As provider organizations and payers prepare to take on more advanced APMs, the healthcare industry needs to step back and assess its progress with value-based care implementation thus far.

As Miller pointed out in his APM development guide, assessing and improving how to approach care delivery and payment reform is key. And these improvements will be critical to accelerating the transition to higher quality, lower cost care.

We need payment reform goals that are aligned with where we'd like to get, McClellan said, and hopefully, by 2025 not just by 2030 or 2035.

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Entering the Next Phase of Value-Based Care, Payment Reform - RevCycleIntelligence.com

Last week we started talking about financial New Years resolutions, and your first step was to create a budget. When creating a budget, many people find that an awful lot of their spending is going towards debt. Lets start off with how to deal with that.

1. Pay off bad debt: Notice I said bad debt. Not all debt is bad, such as a mortgage in a low interest rate environment. Bad debt is high interest, nondeductible debt such as credit cards etc. The two best ways to attack your debt are paying off the smallest balances first and then adding all of the previous payments to the next highest balance, etc. Its called the snowball effect. The other way is to pay off the highest interest debts first then the next highest and so on. This is my preferred way since you end up paying less in interest overall with this method. Whichever way you choose, just get rid of the debt. In my opinion this is the number one obstacle to financial success.

2. Get a check-up: Not a financial one, but rather a medical one. Go see your doctor and get a yearly check-up. Why am I including this on a financial checklist? Because poor health can cost a lot of money. The healthier you are, the less money youll spend on healthcare, which can potentially mean more retirement income. Preventative medicine is a lot cheaper than treating a chronic condition after its developed. Plus, youll feel better too.

3. Rebalance your portfolio: We have seen a big run up in the stock market in recent years, which means that the portfolio you designed five or ten years ago probably looks nothing that today. An unrebalanced portfolio is likely much more heavily invested in equities today than you may have intended, which translates to more risk than you planned for. Its easy to let it ride when the market is doing great, but understand that a severe correction could hurt you more than you intended.

4. Consider a Health Savings Account (HSA): An HSA lets you contribute up to $3,550 for yourself or $7,100 for your family and can be used to pay for medical expenses on a pre-tax basis. That could translate to up to a 37% savings on those expenses.

5. Look at what professionals are there to support you: These include your financial advisor, your CPA and attorney. Yes they cost money but are worth it. A good CPA makes you money, not costs you money. The same goes for a tax smart financial advisor.

6. Review your estate documents and beneficiaries: While you might not need these during the course of your daily life, when that life comes to an end, you want to make sure youve made smart decisions regarding your planning in order to minimize the impact to your family when you're incapacitated or gone.

7. Review your budget for waste: Since we started this series with creating a budget, lets end it with reviewing one that you have. Now that you know what youre spending your money on, look at what expenses you can eliminate in order to free up more money in order to increase your savings and investments.

I hope this helps make 2020 for best financial year yet!

T. Eric Reich, CIMA, CFP, CLU, ChFC is president and founder of Reich Asset Management and can be reached at 609-486-5073 or eric@reichassetmanagement.com.

Securities offered through Kestra Investment Services, LLC (Kestra IS), member FINRA/SIPC. Investment advisory services offered through Kestra Advisory Services, LLC (Kestra AS), an affiliate of Kestra IS. Reich Asset Management, LLC is not affiliated with Kestra IS or Kestra AS. The opinions expressed in this commentary are those of the author and may not necessarily reflect those held by Kestra Investment Services, LLC or Kestra Advisory Services, LLC. This is for general information only and is not intended to provide specific investment advice or recommendations for any individual. It is suggested that you consult your financial professional, attorney, or tax advisor with regard to your individual situation.

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Financial new year resolutions, part one The Reich Report - Press of Atlantic City

Soldiers must be ready and capable to conduct the full range of military operations to defeat all enemies regardless of the threats they pose. But bad sanitation can keep them from the mission.

According to a 2010 public health report from the U.S. National Library of Medicine National Institute of Health, "Influenza and pneumonia killed more American soldiers and sailors during the war [World War I] than did enemy weapons." The pandemic traveled with military personnel from camp to camp and across the Atlantic in 1918, infecting up to 40 percent of soldiers and sailors. In this instance, the enemy came in the form of a communicable disease.

Preventative measures and risk mitigation work to impede history from repeating itself, keeping the Army both ready and resilient. One such preventative measure implemented in Jordan was a week-long Field Sanitation Team (FST) Certification Course last month at Joint Training Center-Jordan.

U.S. Army Spc. Shelby Vermeulen, with 1st Squadron, 303rd Cavalry Regiment, 96th Troop Command, Washington Army National Guard, works through the steps of water purification during a Field Sanitation Team Certification Course.

(Photo by Sgt. 1st Class Shaiyla Hakeem)

U.S. Army Sgt. Matthew A. Kolenski, with 898th Medical Detachment Preventative Medicine, 3rd Medical Command (Deployment Support) "Desert Medics," has been an Army preventative medicine specialist (68S) for more than seven years. He said 68Ss and FSTs help mitigate unnecessary illnesses, allowing soldiers to focus on their mission.

U.S. Army Spc. Shelby Vermeulen, with 1st Squadron, 303rd Cavalry Regiment, 96th Troop Command, Washington Army National Guard, drops a chlorine tablet into water during a Field Sanitation Team Certification Course.

(Photo by Sgt. 1st Class Shaiyla Hakeem)

Army regulations require certain units to be equipped with an FST, preferably a combat medic (68W), but any military occupational specialty can fill this position. The 40-hour certification covered areas such as improvised sanitary devices, testing water quality, identifying appropriate food storage areas, placement of restrooms, controlling communicable diseases, proper waste disposal, dealing with toxic industrial materials and combating insect-borne diseases.

U.S. Army Spc. Shelby Vermeulen (center), with 1st Squadron, 303rd Cavalry Regiment, 96th Troop Command, Washington Army National Guard, tests a water sample for chlorine residuals during a Field Sanitation Team Certification Course.

(Photo by Sgt. 1st Class Shaiyla Hakeem)

The goal of the course was to "enable soldiers to maintain combat readiness and effectiveness by implementing controls to mitigate DNBI [disease non-battle injury]," said Kolenski.

He said environmental testing and figuring out how to mitigate problems before they start can drastically decrease DNBIs. These injuries can include heat stroke, frostbite, trench foot, malnutrition, diarrheal disease -- anything that can take a service member out of the fight. Sometimes reducing risk can be as simple as washing hands or taking out the trash.

"If you reduce the trash, you'll mitigate the flies, which reduces the chance that you'll get a gastrointestinal issue," explained Kolenski, "Because you can't fight if you're in the latrine [restroom]."

A week-long Field Sanitation Team Certification Course, spearheaded by U.S. Army Sgt. Matthew A. Kolenski (far right), with 898th Medical Detachment Preventative Medicine, 3rd Medical Command (Deployment Support) "Desert Medics," was held from Dec. 9 - 13, 2019 at Joint Training Center-Jordan.

(Photo by Sgt. 1st Class Shaiyla Hakeem)

Hazards are identified by sampling air, water, bacteria, pH levels, chlorine residue in water and bugs in the area.

"It was interesting to learn about the different standards for food facilities and rules on the preparation of the food," said U.S. Army Spc. Shelby Vermeulen, with 1st Squadron, 303rd Cavalry Regiment, 96th Troop Command, Washington Army National Guard, who serves as a combat medic at JTC-J.

This article originally appeared on United States Army. Follow @USArmy on Twitter.

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How the Army keeps one of its most lethal enemies from striking again - We Are The Mighty

Medical Technology is now available on all devices! Read it here for free in the web browser of your computer, tablet or smartphone.

To kick off the new decade, we find out how technological innovations are revolutionising hearing aids, speak to industry insiders to understand how 3D printing is changing dentistry, and examine the challenge of regulating implants as the market continues to expand and new technologies continue to blur the boundaries between what is and is not a medical device.

Sticking with implants, we delve into the complicated world of transhumanism and biohacking to find out how rising interest in tech implants could impact medical devices, explore ways that tech can unleash preventative personalised medicine with Verita, and learn more about a computerised kidney, which is helping to shed light on dehydration.

Plus, we take a look at the current state of the medical tourism industry to see how technology is impacting such a profitable sector, find out how combining wearables and drugs could help to treat Alzheimers, and as always we get the latest industry analysis and insight from GlobalData.

Timeline: the evolution of hearing aidsHearing aids have come a long way since the weird and wonderful vacuum tube contraptions of the 1800s, but its only within the last few decades that a truly transformative wave of fashionable, functional devices have started to appear. But how did this happen?Chloe Kentlooks back at the history of digital hearing aids, from the first devices of the 1990s to the innovative AI-powered technologies of the present day.Read more.

Open wide: how 3D printing is reshaping dentistryThe dental 3D printing market is expected to reach $930m by the end of 2025, and its application across different procedures is far-reaching, from the development of dentures to Invisalign retainer braces.Chloe Kentspeaks to Digital Smile Design directorGeorge Cabanasand Formlabs dental project managerSam Wainwrightto learn more about how 3D printing could help us all smile a little brighter.Read more.

Regulating implants: how to ensure safetyAs the implant market expands and new innovations become a reality, the challenge of regulating these new technologies is getting harder. With biohacking implants already being performed in tattoo studios, how will regulators ensure the safety of patients?Abi Millar reports.Read more.

From grinders to biohackers: where medical technology meets body modificationA new generation of patients are demanding medical interventions that not only make it easier to manage medical conditions, but also enhance their day-to-day lives. Engineers and researchers have responded with futuristic innovations that push the boundaries of biohacking.Chloe Kentrounds up the bizarre and brilliant innovations that could be the future of medicine as we know it.Read more.

Q&A: how tech can unleash preventative personalised medicine with VeritaVerita Healthcare Group is a company with fingers in many pies, but one of its key focuses is on bringing preventative healthcare to the masses through technology.Chloe Kentcatches up withJulian AndrieszandJames Grant Wetherillto find out more about the companys latest digital health acquisitions and what it sees in its future.Read more.

No filter: understanding how medicines impact dehydrationComputer models of a kidney developed at the University of Waterloo could tell us more about the impacts of medicines taken by people prone to dehydration.Natalie Healeyfinds out more.Read more.

Medical tourism: how is digital tech reshaping the industry?Medical tourism is a large and growing sector that is being driven by high costs and long waiting times in developed countries. But how is the rise of digital technology and Big Data influencing the development of medical tourism hotspots around the world?Chris Lofinds out.Read more.

Triple combo: calming Alzheimers agitation with ai, wearables and a novel drugBioXcel Therapeutics is developing an acute agitation drug, BXCL501, for Alzheimers disease. To improve management and prevention of agitation, the company is leveraging an existing wearable device and developing AI algorithms to predict and prevent aggressive agitation.Allie Nawratexplores this novel, triple combination initiative to prevent and treat symptoms of Alzheimers.Read more.

In the next issue of Medical Technology we take a look at the need for a more proactive approach to encourage health screening uptake, and explore ways that AI could help to make healthcare more human-centric.

Also in the next issue, we find out how a combination of virtual reality and haptics is being used to help virtually train surgeons to perform complex procedures, examine the potential of smell-powered diagnostics, and investigate the rise of chronic illness groups on social media platforms.

Plus, we examine how the uncertain future of Ehtylene oxide could impact device manufacturers, speak to Medidata about the companys merger with Dassault Systmes, and take a look at the recall of Bayers Essure contraceptive implant.

Link:
The future of implants in the latest Medical Technology - Verdict Medical Devices - Medical Device Network

Young adults who smoke a combination of combustible cigarettes and electronic cigarettes (e-cigs) are almost twice as likely to suffer a stroke as those who only smoke e-cigs, and nearly three times as likely to have a stroke as non-smokers, according to a study which appeared in the American Journal of Preventative Medicine.

In this 2019 study, researchers analyzed a sample of 161,529 participants from the Behavior Risk Factor Surveillance System survey. The population of interest were all between the ages of 18 and 44. They used logistic regression to examine the link between e-cig and combustible cigarette smoking while adjusting for patient demographics, comorbidities (with or without history), as well as concurrent use of both e-cigs and combustible cigarettes.

Following analysis, the results showed that dual use of e-cigarettes and combustible cigarettes was associated with 2.91 times higher odds of stroke versus nonsmokers (AOR=2.91, 95% CI=1.62 to 5.25) and 1.83 times higher odds versus current sole combustible cigarette users (AOR=1.83, 95% CI=1.06 to 3.17).Its long been known that smoking cigarettes is among the most significant risk factors for stroke. Our study shows that young smokers who also use e-cigarettes put themselves at an even greater risk, said lead investigator Tarang Parekh, MBBS, MSc, Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA in a press release.

This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative. We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and its not good.

Our findings demonstrate an additive harmful effect of e-cigarettes on smokers blood vessels, hearts and brains, added Mr. Parekh.

Mr. Parekh cautioned that people should consider this study as a wake-up call for young vapers, clinicians, and healthcare policymakers. There is an urgency to regulate such products to avoid economic and population health consequences and a critical need to conduct further research on the benefits and risks of smoking-cessation alternatives.

Originally posted here:
The Risk of Stroke is Significantly Higher for Young Adults who Use Both E-Cigs and Combustible Cigarettes - DocWire News

While the new year rings in a laundry list of intimidating healthful resolutions, one goal we can easily achieve in 2020 is to reinstate our relationship with plants.

Whether enjoying a tulsi-based tea to help with a cold, taking a lemon balm bath to support Seasonal Affective Disorder, or adding a few drops of CBD oil to our skin for pain relief, plant-based medicines are seemingly endless. You probably already have ingredients in your pantry (or medicine cabinet) right now.

Cinnamon, lavender, peppermint, garlic, ginger, chamomile, and echinacea can all be used to support a healthy lifestyle. Through alocal community education program called Reciprocal Roots, those interested in wellnesscan learn how to properly infuse the beneficial components of plants into teas, salves, oils and tinctures.

Prior to the early 1900s, we had an herbalist in every house, she said during a recent interview. We called them mom and grandma. The deep relationship between humans and nature coupled with generations of sitting bedside with the sick led to a rich history in herbal remedies for both preventative and diagnostic care.

Grohmanmakes it easy to learn, hosting seminars at several locations across Western New York including Singer Farm Naturals in Appleton, Crazy Train Apothecary in Lewiston, The Schoolhouse Wellness Center in Lockport and Burning Books in Buffalo.

During classes, new and returning students gather around atable, sipping Kristins tea and talking plants. Each week is different, sometimes delving into a topic such as Herbal Support for the Winter Blues or focusing on one plant for the evening. I teach a healthy balance of phytochemistry along with anatomy and physiology. Being an herbalist is just as much understanding the human body as it is understanding plants. If you dont understand how your body works, then you dont know how to treat it,she explained.

Hand-outs, flip charts, and herbal samples adorn the large table. Some students bring binders with years of notes. Some are sitting down without a pen and taking it all in. Everyone is brimming with questions and Kristin has the answers. Her students include children, teens, adults, business owners, retirees, men, women and even a pharmacist. She stands at the head of the table and presents information about the chemistry of plants, its reactions with our body, and even touches on the safety of herbal interactions with prescribed medications. If she doesnt know the answer, she finds it after class and follows up with the class.

Kristin, along with the help of her husband, Kanjo, a Buddhist priest, are actively growing thereach of Reciprocal Roots. They haveheldtwo herbal conferences where vendors, guests, and speakers from around the United Statesgathered atSinger Farms to share knowledge and break bread.

Outside of community events, Reciprocal Roots offers retail products that are balanced to be safe and effective for anyone who wants to consume them.Shopperscan find teas, elixirs, tinctures and their magazine at Singer Farm Naturals and during select Lockport Community Markets. For a more personalized experience, Reciprocal Roots offers consultation services, where Kristin recommend recipes, blends, and practices specific to the needs of an individual. Their next endeavor is a large scale, strategically planned, medicinal garden for community use this year. On the distant horizon: a full herbal school with lots of land to cultivate.

I just want to educate. I want people to have their health be in their own control, Grohman said. I want everyone to know the biggest lie they have ever been told is that they are separate from nature. We know it deep in our DNA that plants are medicine. Thats scientific. We have receptors that match the phytochemistry of plants and turn on switches of healing in us. They restore us. They do not deplete.

For more information on events and services, check out the Reciprocal Roots Facebook page or email Kristin at reciprocalroots@gmail.com.

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Herbs for Health: Lockport herbalist teaches the roots of wellness - Lockport Union-Sun & Journal

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The state of Yap is scattered across the Pacific Ocean, its coral atolls and volcanic islands spanning some 600 miles. Home to 11,000 people, Yap, part of the Federated States of Micronesia, hovers just north of the equator, roughly 1,000 miles east of the Philippines.

Last summer, the states health authorities found themselves in a bind. Dengue fever, a painful mosquito-borne disease, was spreading on the main island, and clinics on outer islands urgently needed preventative medical supplies. But Yaps main means of transportation, a diesel-burning cargo ship, wasnt working.

Grist / Fourleaflover / Getty Images

Fortunately, there was a backup plan. In early September, hospital staff loaded packages onto two 50-foot, double-hulled sailing canoes, called vaka motus. Ten sailors then zipped between Yaps islands, hoisting sails and using wooden paddles, ducking into aquamarine lagoons when storms raged. Small engines burning coconut oil gave an extra boost, while solar panels replenished batteries to charge communications equipment. Within two weeks, theyd dropped medical supplies to more than a dozen far-flung islands.

It was the perfect way to do it, said Peia Patai, a vaka captain who led the operation. Although the dengue outbreak still persists in Yap and other Pacific Islands, health officials said the vakas helped close an urgent transportation gap.

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Patai oversees a fleet of vakas for Okeanos, a nonprofit that builds canoes and trains people to sail them. The foundation operates six vaka motus between Yap and Pohnpei, also in the Federated States of Micronesia, plus Palau, Marshall Islands, and Vanuatu. Okeanos has also built eight larger vaka moanas, operated by independent voyaging societies, which can sail the open ocean.

Ive got big dreams, Patai said by phone. I want this to grow from two canoes to maybe 10 canoes per country. I want them to start using canoes for sea transportation like the olden days.

Rui Camilo

For thousands of years, navigators in the Pacific used stars, ocean currents, and wind patterns to guide vessels across vast ocean expanses. Early canoes were sculpted from tree trunks and lashed together with coarse fibers from materials such as coconut palm seeds. But centuries of colonization and disease eroded the canoe-based cultures. Today, many remote islands like Yap rely on oil-guzzling freighters to deliver goods and shuttle passengers; not every place can accommodate airplanes.

In recent decades, a pan-Pacific revival has flourished as navigators preserve and reclaim traditional sailing methods. Patai, who is from the Cook Islands, first learned celestial navigation in 1991, after serving in the Australian Navy. Hes since earned the title of master navigator. Patai says he feels a responsibility to pass this knowledge to younger generations not only to honor the past, but also to prepare for the increasingly dire outlook for island nations.

For me, the only way for us to go into the future is to relearn our past, he said.

Peia Patai, master navigator, Okeanos fleet commander, age 53When I was young, you could walk on the reef and collect seashells. Today, there is no more reef; its all been covered by water. Water is rising, the weather is totally changed. Typhoons are coming late. Its not something that we can ignore.Whenever a cyclone comes, weve learned to accept it and live through it, and once it finishes, you recover. Our people have always been very strong in those kinds of changes, and I think we will learn to adapt to [climate change]. We just have to start making the changes, and hope that those changes will continue to improve.Thats the only way we can have a better future, not for us, not for me, but for the younger generations, my childrens children. Sean Grado

The Pacific Islands are acutely vulnerable to the effects of climate change, which today include increased droughts, water scarcity, coastal flooding, and more powerful storms. Facing existential threats, including the disappearance of entire islands, leaders of these low-lying nations have played pivotal roles in securing international agreements to curb greenhouse gas emissions.

The most vulnerable atoll nations like my country already face death row due to rising seas and devastating storm surges, Hilda Heine, president of the Marshall Islands, told delegates at the United Nations climate conference in Madrid in December.

Its a fight to the death for anyone not prepared to flee, she said. As a nation we refuse to flee. But we also refuse to die.

Reviving canoe culture, Heine and others believe, could help Pacific Islanders navigate the rough waters ahead. The boats reduce the islands dependence on ships fueled by imported fossil fuels, and they serve as an important tool when disaster strikes, helping people move more nimbly, be it to flee storms or aid neighbors in need. Similar efforts are underway in other parts of the world, including the Pacific Northwest, where the Quinault Indian Nation, the Heiltsuk Nation, and others are combining cultural revival with climate resilience.

Heine has called for adding vakas to each of her countrys 24 island communities, which could operate like an inter-island ferry service. Marshall Islands and four other nations Palau, Kiribati, Nauru, and the Federated States of Micronesia are seeking nearly $50 million from the U.N.s Green Climate Fund, to build what they call indigenous community resilience through vaka networks in Micronesia.

Each vaka motu can hold up to three tons of cargo, or a dozen passengers. By building vessels, enlisting sailors, and producing biodiesel from coconuts, advocates also aim to develop local economies, particularly in areas reliant on subsistence farming and fishing. (Okeanos, a partner on the funding proposal, says its founder, Dieter Paulmann, has spent $25 million since 2006 to build and operate vakas, train crews, and do community outreach.)

Natalia Tsoukala

Vakas alone cant replace the trans-ocean freighters that haul thousands of tons of cargo across the world every day to do that, well need other sustainable shipping solutions. However, canoes are still an important piece of a more resilient future for these isolated communities, says vaka captain Iva Nancy Vunikura.

Iva Nancy Vunikura, vaka voyager, Okeanos captain, age 37In 2011, I hopped into a canoe and learned the ropes as I sailed. It was supposed to be a six-month journey, but turned into eight years. I got to connect back to my roots. Now Im sharing what Ive learned along the way.Anybody that comes on the vaka, we teach them how we look after the canoes, how we look after the people, how we work with the communities. This knowledge needs to be unlocked, as it has laid dormant for too long.Before, I didnt know much about my own culture. Now I can tell you stories of our forefathers. I belong to a proud family of traditional voyagers from the Pacific. Jess Charlton

She recalled how in 2015, in the wake of Cyclone Pam, she and other sailors, including Patai, delivered emergency supplies of food, water, and medicine to the outer islands of Vanuatu. They brought root cuttings of tapioca and kumura (sweet potato) so people could replant crops and rely less on imported, packaged foods. The vakas shuttled supplies for months as damaged diesel ships underwent repairs.

We might be small, but were doing something that contributes to how we live, Vunikura said from her home in Fiji.

Vunikura, a former rugby player for the national womens team, sailed for the first time in 2011. She worked on Okeanos 72-foot vaka called Uto Ni Yalo (Heart of the Spirit, in Fijian), touring 15 Pacific nations to promote sailing culture and ocean conservation. She has since logged over 60,000 miles on traditional sailing canoes, and now works with adults and children across the region.

Recently, she spent five months training a dozen men in Yap, where she says women dont traditionally sail. The Okeanos team had to first secure permission from a chief so Vunikura could participate.

We cant just come in and say I want to do this. We need to respect the custom and culture, she said. It was hard for me. But they accepted it and so I broke the barrier, you know? We need to be working as one.

Anthony Tareg

Among the biggest challenges to building a pan-Pacific vaka network is navigating cultural differences among Polynesian, Micronesian, and Melanesian communities, Patai said. You have to find out how people think, he noted. Another difficulty is getting people to work on the vakas long-term, rather than treating it only as a hobby.

Steven Tawake, operations coordinator, Okeanos Marshall Islands, age 33Growing up, our elders would tell us things like, when the spiderwebs are very low to the ground, it means strong winds are coming. Or when the ants are taking food to the trees, it indicates heavy rain is coming. When I started sailing in 2009, I recalled what our elders told us, and said, Oh, this is all part of navigation. Sharing the knowledge of sailing and navigation especially when we teach young ones is something that will keep our heritage alive.In 2017, I was sailing a canoe [to Saipan] from Yap, about 600 miles away. I encountered very strong winds, and I was struggling with my crew. I reached Saipan, and an old lady from the Caroline Islands called me. In the Carolinians, the women are the keepers of navigation knowledge. She sat down beside me, and she started singing chants to me. Other ladies came, and I was in the middle of them. It was something lovely. Okeanos

For the Okeanos crew, there may be ample opportunity to sail in the coming year. In the Federated States of Micronesia, the health department in Pohnpei has signed a contract for 100 days of sailing charters to bring doctors, medical personnel, and sick patients between the main island and six outer islands. In the Marshall Islands, the government is providing an annual subsidy to partially cover the costs of crews, insurance, and maintenance of the vakas there. Late last month, an Okeanos team helped nurses carry out tuberculosis screenings in remote island communities.

Vunikura said she doesnt know exactly what her 2020 plans entail. But shell undoubtedly be climbing aboard a vaka and promoting sustainable sea transportation in the Pacific.

This is what I do for a living, she said. Somebody asked me, What action would you do towards climate change? I just simply pointed at the canoe and said, Im living my action by sailing this canoe on our oceans.

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To safeguard their future, Pacific Islanders look to the past - Grist