Category Archives: Preventative Medicine

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

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

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

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

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

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

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

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

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

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

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

Edit Storyline

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

Certificate: TV-PG

Runtime: 24 min

Aspect Ratio: 1.33 : 1

See the rest here:
"M*A*S*H" Preventative Medicine (TV Episode 1979) - IMDb

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Overview

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

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

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

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

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

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

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

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

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

Clinical Preventive Services & Programs

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

Understanding the Economics for Investment

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

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

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

Economics for Policy Action

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

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

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

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

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

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

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

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

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

An Economic Case for Preventive Health

Mortality from Modifiable Risk Factors

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

Childhood Vaccinations Reduce Health Care Costs

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

Prevention and Health Capital Theory

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

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

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

Preventive Care and Quality Adjusted Life Years

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

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

Prevention in Minority Populations

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

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

Policies of Prevention

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

Policy Prevention of Obesity

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

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

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

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

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

Childhood Immunization Policies

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

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

An Economic Case Conclusion

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

Original post:
Preventive healthcare - Wikipedia

Blend's new healthy cafe opening Aug. 30.

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

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

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

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

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

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

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

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

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

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

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

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

See the article here:
Find balance, and coffee, at Blend Cafe and Yoga - Fall River Herald News

Lahey Health is pleased to announce that family medicine physician Angela Karavasilis, DO, has joined Lahey Health Primary Care, Beverly. Dr. Karavasilis specializes in adult primary care, preventative medicine and womens health. The practices mission is to encourage patients to make healthy choices in order to develop and maintain good health.

Dr. Karavasilis has been practicing family medicine since 1995 when she received her degree from the University of New England College of Osteopathic Medicine. She completed both her internship and residency at St. Clares Hospital in Schenectady, New York. She is board certified in family medicine and is a member of the American Academy of Family Physicians. Dr. Karavasilis is fluent in English and Greek.

Lahey Health Primary Care, Beverly is committed to providing Beverly and its surrounding communities with the highest quality medical care, delivered in a safe and compassionate environment. The board certified medical staff is trained to focus on improving the health and well-being of all its patients.

Lahey Health Primary Care, Beverly provides primary care for adults, including same-day sick appointment, immunizations, phlebotomy and referrals to specialists throughout the Lahey Health network of physicians and clinicians.

Dr. Karavasilis is accepting new patients. Lahey Health Primary Care, Beverly, is located at 152 Conant St., Beverly. To learn more or schedule an appointment call 978-927-1919 or visit http://www.lahey.org/primarycarebeverly.

Read more:
Karavasilis joins Lahey Health Primary Care in Beverly - Wicked Local Beverly

When it comes toCBD, or cannabis in general, little research has been done on cats and dogs. Are cannabis preparations safe for use in animals? Does marijuana affect pets the same way as humans? Many pet-owners are looking for something to support their animals health, but there is little quality control with respect to the numerous pet-focusedCBDproducts that are available in the medical marijuana sector and the hempCBDgrey market. And there arent many trusted, educated individuals who can provide professional guidance on cannabinoid therapies forpets.

To help pet-owners become better informed about the use of cannabis for their four-legged companions, Sarah Russo of ProjectCBDspoke withGary Richter,DVM, an integrative medicine veterinarian based in Oakland, Calif. Richter considers cannabis to be part of a holistic approach to animal medicine. Due to marijuanas Schedule I status, veterinarians are not allowed to write letters of recommendation for their clients or tell them where to obtain cannabis medicine. But Richter is able to speak about the benefits ofCBDand cannabis therapeutics forpets.

ProjectCBD:Can you tell us about your work? Based on what youve seen in your practice, what types of conditions may cannabis medicine alleviate inpets?

Richter:My practice applies western, complementary, and alternative approaches. That could include acupuncture, chiropractic, Chinese and western herbs, nutritional supplementation, and more. Animals can benefit from medical cannabis for many of the same reasons it helps peoplefor pain, seizure control, gastrointestinal disorders, anxiety-related issues. Weve also seen positive results withcancer.

ProjectCBD:Why is there a lack of research studies on cannabis in dogs and cats? What areas of cannabinoid medicine in animals would you like to see investigated moredeeply?

Richter:I think ultimately the reason for the lack of therapeutic-oriented research is because cannabis is federally illegal and theres no funding. Generally, its pharmaceutical companies that are putting most of the money into medical research. Once theres a legal pathway and money to be made in veterinary products, that research will happen. I would like to see more general research on the use of cannabis in animals, focusing on some of the ailments that it seems be the most effective forespecially gastrointestinal issues, pain, and inflammation. Many veterinary patients see dramatic effects with cannabis for these ailments. Cancer studies would be a much longer road and more challenging to puttogether.

ProjectCBD:What is your response when veterinarians say: There isnt enough scientific data to show cannabis is safe and effective for treatinganimals.

Richter:In a perfect world, we would benefit from more scientific information. However, the case reports and anecdotal evidence about the efficacy of cannabis medicine are already overwhelming. In veterinary medicine, practitioners typically have no problem using off-label medicationsthose not explicitly approved for use in dogs or cats. But mention medical cannabis, which has a mountain of evidence for efficacy in humans, and they suddenly say, You cant do that, theres been no research on dogs! Itsdisingenuous.

ProjectCBD:Is there a difference between the endocannabinoid system in a dog or a cat as compared to ahuman?

Richter:In the big picture, theyre very similar. One striking difference is there appears to be a greater concentration of cannabinoid receptors in the dogs brain than there are in most other animals. This is significant because it makes dogs more susceptible toTHCoverdose, potentially giving them a certain amount of neurologic impairment in the short-term. This phenomenon is known as static ataxia. Otherwise, when cannabis medicine is used effectively, their endocannabinoid system will act in the same way it would for ahuman.

ProjectCBD:IsTHCcombined withCBDbeneficial for pets? If so, whatCBD:THCratios do you suggest for yourclients?

Richter:It depends on both the condition thats being treated as well as the individual animal. Many people in the cannabis community have heard about theentourage effect. The ratio ofTHCtoCBDis an important part of that. There are conditions that respond better to medicine with a certain amount ofTHCin it. The ratios that I have used include hemp-basedCBDwith very littleTHC, as well asCBD-rich marijuana with a 20:1CBD:THCratio andTHC-dominant medicine with littleCBD. The research suggests that patients with cancer and chronic pain benefit from products that haveCBDandTHC, rather thanCBDalone. It reallydepends.

ProjectCBD:Do you see animals coming into the veterinary hospital after having too muchTHC? How much of a problem isthat?

Richter:Obviously whenever were talking aboutTHCand pets, dosing becomes very important. At no point is the goal for the pet to get stoned. If that happens, then it means theyve gotten too much. The aim is to give them enough cannabis to be effective, but not so much that theyre going to be negatively compromised. It is extremely uncommon to see an animal show negative signs when they have been properly dosed with cannabis as medicine. The worst effect would be drowsiness. If thats that case, the owner may have to decrease the dose. Its not uncommon for a dog, or sometimes a cat, to show up at a veterinary hospital having eaten a cannabis-infused edible that belonged to the owner. The good news is that cannabis toxicity is nonfatal and does not cause long-term effects. However, those animals that get into their owners stash may require immediate medical care. I have seen and heard of a couple of cases where pets did notsurvive.

ProjectCBD:But you just said that cannabis toxicity in nonfatal. Youve seen cases where an animal ate too much cannabis and actuallydied?

Richter:One case that I have personally seen was a dog that got into a bunch of cannabis edibles and the owner didnt bring his dog to the veterinarian immediately. They called us the following day. Unfortunately, the dog had vomited and aspirated while at home, his lungs filled with fluid, and he wound up dying from a systemic infection related to that. To be honest, if this dog had received medical treatment the day he ate cannabis, he almost certainly would have been fine. It was only because the owner waited, and by that time it was too late. It was very sad. But this type of event is really quiterare.

ProjectCBD:Whats your preferred way to administer cannabis medicine toanimals?

Richter:I prefer a liquid preparation, usually an oil. With liquids, its very easy to adjust the dosage. If youre giving something like a pill or an edible, it can be difficult to figure out how to titrate the right amount. Furthermore, theres every reason to believe thatCBDandTHCare going to be partially absorbed directly into the bloodstream through the tissues of the mouth, sublingually. If we put a liquid in an animals mouth, some of the medication will be absorbed directly and has a chance to be moreeffective.

ProjectCBD:A lot of people say they want to start giving cannabis orCBDmedicine to their pet, but theyre not quite sure about the right dose. Is there a good way to calculate the ideal amount for youranimal?

Richter:Theres a dosing range that you could start at. Its best to begin at the low end. Every few days, slowly increase the dose. If youve achieved the desired effect for whatever is being treated, then youre probably done. Just like people, animals will develop a tolerance for the psychoactive effects of theTHC. Over time they will be able to take more medicine without any demonstrable side effects. Medical cannabis is not the answer for all pets. Some animals do better on it than others, just likepeople.

ProjectCBD:In general, how knowledgeable are veterinarians about cannabistherapeutics?

Richter:This is a big problemthe lack of education. The California Veterinary Medical Board is very much against the use of medical cannabis for pets. They dont want veterinarians speaking with pet owners about it at all, except to say that it is bad and not to useit.

ProjectCBD:What is the legal status ofCBDas a medicine foranimals?

Richter:Cannabis is federally illegal across the board, includingCBDfrom hemp. Even in California, a trailblazing medical marijuana state, as a veterinarian Im not able to provide people with a medical marijuana recommendation for their pet. Nor am I able to provide them with cannabis products. But I can talk with people about how medical cannabis might benefit their animals. Unless something dramatic changes on the legal front, theres still going to be access problems for people looking to get medicinal cannabis for theirpets.

ProjectCBD:Any words of advice for someone who wants to treat their pet with cannabis orCBD?

Richter:If at all possible talk to a veterinarian. Cannabis is medicine and its dosing should be carefully calculated. Its important to know the concentration ofTHCandCBDin milligrams for ones pet. Once you have that information, you can look for a product that suits your pets needs. When in doubt, err on the side of under-dosing because you can always slowly increase the dose and monitor the effect. And make sure the medicine is free of mold, pesticides, and othercontaminants.

ProjectCBD:There are many hemp-basedCBDproducts on the market for pets. How do you feel about the quality of these products in general? What are your thoughts about hemp-derivedCBD?

Richter:I dont want to disparage hemp-basedCBDproducts because I think they do have a positive medical effect. Many people start with hemp products because of their relative ease of accessibility. But in many cases, we dont know the source of theCBDin these products. I recommend that people do their due diligence as they should with any vitamin or supplement. Call the company and ask where the product is coming from and how its being produced. There is no government oversight to make sure that these companies are selling authentic and safe products. A pet owners only other option is to get a card and go to a medical marijuana dispensary if they want something that may be more effective than hemp-derivedCBD. Ideally, you would look for a product that is organic and produced locally. You want to know how theCBDwas extracted and the full spectrum of cannabinoids that arepresent.

ProjectCBD:Are there any guidelines or recommendations you have for people who want to make their own cannabis preparations for theirpets?

Richter:Thats tricky. You wont know the concentration of cannabinoids in what you make at home, unless you have it analyzed. If you do use your own preparation, start with extremely minute dosing and slowly work your way up. Youd much rather under-dose thanoverdose.

ProjectCBD:Sometimes people who dont have medical complaints like to take cannabis as preventative medicine to maintain good health and well-being. Would you recommend something like that for ananimal?

Richter:Thats an excellent question I have often asked myself. The purpose of the endocannabinoid system is to maintain homeostasis within the body. Its logical to consider using cannabis as preventative medicine much in the same way that a person would take a multivitamin. If thats the case, I would consider keeping the dosage toward the very low end. We need to see more research on the use of cannabis as preventative medicine in people as well asanimals.

ProjectCBD:Are there any resources for people to educate themselves about cannabis medicine for pets or to find a cannabis friendly veterinarian in theirarea?

Richter:Firstly, I would say talk to your regular veterinarian about cannabis. Even if they cant give you the information, they may know someone in the area that can. Additionally, there is a national organization called the American Holistic Veterinary Medical Association (AHVMA). It isnt a given that a member of theAHVMAincorporates medical cannabis into their practice, but most people who are open to it are also holistically minded. That would be a good place to find a veterinarian and to begin a conversation. For resources, a colleague of mine and I taught anonline course for Greenflower Media. The class provides a comprehensive description of how medical cannabis works in pets, ways to dose, and how to find a good product. And I have a book coming out later this year. Its calledIntegrative Health Care for Dogs and Cats. It has a whole section on medical cannabis, with dosing guidelines. A colleague of mine, Rob Silver, released a book last year calledMedical Marijuana and Your Pet.

ProjectCBD:Thank you for your time andinformation.

Take-Home Message:If you decide to give your pet cannabis medicine, get informed. The medicine you give your animal should have the same standards for anything you would put in your own body. Make sure the product is safe and tested for cannabinoid content, quality, and is free from any contaminants or additives. Seek guidance from a vet, if at all possible. Start your furry friend off on a low dose of cannabis medicine. And monitor the effects that cannabis has on their experience because, as George Eliot wrote, Animals are such agreeable friendsthey ask no questions, they pass no criticisms.

This story was originally published by Project CBD,a California-based nonprofit dedicated to promoting and publicizing research into the medical uses of cannabidiol (CBD) and other components of the cannabis plant.

Go here to see the original:
One Vet's Opinion On Marijuana As Medicine For Your Pet - The Fresh Toast

The Trump administration ordered the National Academies of Sciences, Engineering and Medicine to stop studying whether mountaintop removal mining in Central Appalachia poses a health risk to people living nearby.

The U.S. Department of Interiors Office of Surface Mining notified the National Academies in a letter Friday that it is halting the study while it reviews grants of more than $100,000. Regulators permitted the study panel to hold meetings scheduled for this week.

Virginia Tech crop and soil environmental sciences professor Lee Daniels is expected to present research in Lexington, Kentucky on Tuesday.

Last month, Susan Meacham, a professor of preventative medicine at Edward Via College of Osteopathic Medicine in Blacksburg presented findings from yearslong research that compares deaths and diseases in Virginias coalfields with other parts of the state.

The NAS study is serving a very important function in a very balanced and professional process, Meacham said. The NAS committees are highly respected, so we hope they will be able to continue the review and assessment of work currently available on surface mining and human health.

Meacham said listening to other presentations during her July appearance confirmed that there is a dearth of verified research on the effects of coal mining on community health.

A National Academies committee began holding meetings in March and was expected next spring to report on coals impacts on air, water and soil that could lead to health concerns, and to recommend areas of further research.

The committee has been hearing from university researchers and from state and federal regulators.

The Trump administration in May called for slashing tens of billions of dollars from the federal budget, including $122 million from the Interior Department.

The NAS said in a statement that the department cited the budget situation as prompting an agency-wide review of grants of more than $100,000.

The National Academies believes this is an important study and we stand ready to resume it as soon as the Department of the Interior review is completed, William Kearney, executive director, said in a statement. We are grateful to our committee members for their dedication to carrying forward with this study.

Daniels, a professor of crop and soil environmental sciences, is expected to talk with the committee Tuesday . He could not be reached for comment Monday.

The committee is looking at the relationship of surface coal mining with Central Appalachia residents health.

Meachams research initially was funded by the energy industry through the Appalachian Research Initiatives in Environmental Sciences project, which engaged a number of universities to look at different aspects of surface mining. VCOMs research into health differences was a small component.

Meacham said research is limited on the impact of mountaintop removal mining on health.

Her own work has found that deaths and illnesses from most chronic diseases are more prevalent in Virginias southwestern counties. However, that is not enough to say there is a cause and effect.

Rates for most chronic illnesses are higher in southwest Virginia than they are in neighboring counties that are similar geographically, and in other counties that share similar economic difficulties or that are as isolated from the rest of the state.

The environment plays some role in health, but so do other factors such as education, access to doctors, smoking, diet and exercise. She said it is not yet known whether the environment plays a greater role in health in coal-mining counties than elsewhere.

She is continuing to research that as well as look at ways to treat and prevent chronic illnesses in places with high rates.

Read this article:
Trump administration halts study on coal mining's impact on health - Roanoke Times

Preventive Medicine is the specialty of medical practice that focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. Preventive medicine specialists have core competencies in biostatistics, epidemiology, environmental and occupational medicine, planning and evaluation of health services, management of health care organizations, research into causes of disease and injury in population groups, and the practice of prevention in clinical medicine. They apply knowledge and skills gained from the medical, social, economic, and behavioral sciences. Preventive medicine has three specialty areas with common core knowledge, skills, and competencies that emphasize different populations, environments, or practice settings: aerospace medicine, occupational medicine, and public health and general preventive medicine.

Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures.

Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability.

Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings.

The purpose of the American Board of Preventive Medicine is::

The American Board of Preventive Medicine, Incorporated (ABPM) is a member board of the American Board of Medical Specialties. ABPM originated from recommendations of a joint committee comprised of representatives from the Section of Preventive and Industrial Medicine and Public Health of the American Medical Association and the Committee on Professional Education of the American Public Health Association. The Board was incorporated under the laws of the State of Delaware on June 29, 1948 as "The American Board of Preventive Medicine and Public Health, Incorporated."

In 1952 the name was changed to The American Board of Preventive Medicine, Incorporated. In February 1953 the Advisory Board of Medical Specialties and the Council on Medical Education and Hospitals of the American Medical Association authorized certification by the Board of preventive medicine specialists in Aviation Medicine (the name was changed to Aerospace Medicine in 1963); in June 1955, preventive medicine specialists in Occupational Medicine; in November 1960, preventive medicine specialists in General Preventive Medicine; and in 1983, Public Health and General Preventive Medicine were combined into one specialty area of certification. In 1989 the American Board of Preventive Medicine was approved to offer a subspecialty certificate in Undersea Medicine (the name was changed to Undersea and Hyperbaric Medicine in 1999), in 1992 a subspecialty certificate in Medical Toxicology, and in 2010 a subspecialty certificate in Clinical Informatics.

The Board is a non-profit corporation, and no member (officer or director) may receive any salary or compensation for services. The Board consists of members nominated by the organizations listed below:

Read more here:
American Board of Preventive Medicine - a Member Board ...

We specialize in Primary Care Medicine with a focus on natural/alternative medicine and hormone replacement. It is our desire to treat the root cause of your medical problems, and not just the symptoms, so that you can live the healthiest, longest, and most enjoyable life possible. We take a different approach to your healthcare and believe strongly in treating our patients with natural, safe, and effective treatments that help the body to heal and repair. This involves taking the time to sit and listen to our patients and gathering all the information we need to really figure out what is going on. We try and avoid a rushed office visit where there is not enough time to really discuss the full extent of the problems you may be having. This type of medicine is known as Functional Medicine and goes much deeper into the cause of your health problems than standard approaches to health care.

We know that the body is very capable of healing itself and with the right knowledge, supplements, hormones, natural treatments, and lifestyle changes, you can start to overcome chronic disease and worsening health issues. You can begin to feel healthy again with a new energy and vitality for life that you may not have thought was possible. We believe you can feel young, energetic, and joyous about life at any age, and would love to help you achieve this. Please contact our office at one of our two locations to get some more information on how you can start feeling great again.

Altanta, GA 678-705-2118 5505 Peachtree Dunwoody Rd Suite 410 Atlanta, GA 30342

Ringgold, GA 706-891-1200 148 Cobb Parkway Ringgold, GA 30736

We Accept the following insurance plans: Cigna, Medicare, United, Blue Cross Blue Shield, and Humana We also offer very reasonable cash options for those who are uninsured, please call for more information.

What To Expect: We discover the root cause of many of your health problems by various methods. First, we gather a very detailed health history and review all of your concerns so that we can treat you as a holistic being. Then we gather information through various diagnostics that are appropriate for your conditions. These may include: comprehensive blood work, in depth hormone and full thyroid testing, salivary adrenal testing, micronutrient and immune testing, comprehensive stool analysis, heavy metal testing, bacterial and yeast overgrowth urine analysis, and other various tests. After we have collected the needed information, we than meet with you and review all the findings in detail to create a comprehensive treatment plan. This plan will include therapies such as nutrition, supplements, detox, exercise programs, and medications and hormones. You will have full input as to what testing you would like to pursue and what will go into your treatment plan. We will work with you closely to achieve your health goals and keep you headed in the right direction for optimal health and well being!

Read more:
Preventive Medicine - Home

Welcome to the physician preventive medicine jobs section. Below, we have listed all jobs that match the specialty you have selected. You can click on any of these jobs to see more information. Once you have found a job that you would like to apply for, you can either register or login to do so. If you need to narrow the results for your preventive medicine jobs further, you can use the search form below or visit the advanced search page.

Occupational Medicine Established Program | Hospital Employment | Midwest Location...

Occupational Medicine in a Midwest Metro of 260,000

Practice with Excellent Income...

Full-Time, Five-Day Work Week

Consider a premier Occupational Medicine position in Colorado. Have you...

This Occupational Medicine job is with an established team...

Southwest Metro Seeking Director of Occupational Medicine - $315,000 40-Hour Work Week...

Director of Occupational Medicine at a 100-Member, Multi-Specialty Group, 1 hour to...

Occupational Medicine Job Specifics:

Read the rest here:
Physician Preventive Medicine Jobs :: Physician Preventive ...