Thursday, March 23, 2017

HHS Secretary Backs Medicare Balance Billing

HHS Secretary Backs Medicare Balance Billing


3/20/2017 by Norman Tabler, Jr.  | Faegre Baker Daniels


"Price’s rationale is that balance billing would help persuade more physicians to accept Medicare patients—physicians who currently don’t accept Medicare patients because the payment rates are too low.  Attracting more physicians would help address the physician shortage that currently  limits access by the elderly to health care."

Erin Allen and me: Toward Clarity in the Use of Human Tissue in Research

Toward Clarity in the Use of Human Tissue in Research


Abstract:
The issues of ownership of human tissue and individuals’ consent for its use in research are of national importance. Three influential court cases have determined that individuals do not retain a property interest in research tissues. The issue currently in question is what degree of individual understanding and informed consent is appropriate to both protect researchers from lawsuits for their use of human tissue in research, while simultaneously providing individuals and groups of individuals with the appropriate degree of understanding and informed consent. We present a 2-tiered approach that might resolve this issue.


Catholic Social Teaching and the Duty to Vaccinate.

 2017 Apr;17(4):36-43. doi: 10.1080/15265161.2017.1284914.

Catholic Social Teaching and the Duty to Vaccinate.

Author information

1
a North Dakota State University and University of North Dakota School of Medicine.
2
b North Dakota State University.

Abstract

Since the last century, vaccination has been one of the most important tools we possess for the prevention and elimination of disease. Yet the tremendous gains from vaccination are now threatened by a growing hesitance to vaccinate based on a variety of concerns or objections. Geographic clustering of some families who choose not to vaccinate has led to a number of well-publicized outbreaks of vaccine-preventable diseases. Of note is that some of these outbreaks are centered within some Christian religious groups that increasingly avoid vaccination due to moral concerns, fears about safety, or doubts about the necessity of vaccines. We argue from the perspective of Catholic social teaching on why there is a moral duty to vaccinate.

"'Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline,' they conclude."

'Sea of despair': Death rates stay up for US working-class whites


Offering what they call a tentative but "plausible" explanation, they write that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a "cumulative disadvantage" over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease and suicide.
"Ultimately, we see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline," they conclude.

Saturday, March 18, 2017

Burden of childhood obesity shifting to poorer families in Mexico

Burden of childhood obesity shifting to poorer families in Mexico



"Among all children in 2012, 28.8% were either at risk for obesity (preschool children) or had overweight or obesity. Among preschool children, 23.8% were considered at risk for obesity; 9.7% had overweight or obesity, with a higher combined prevalence observed in boys (35.2%) vs. girls (31.8%; P < .001). The combined prevalence of overweight and obesity among school-aged children was 34.4%, again with a higher prevalence observed in boys (36.9%) vs. girls (32%; P < .001). The combined prevalence of overweight and obesity among adolescents was 35.8% for girls and 34.1% for boys, with a slightly higher trend observed for girls (P = .03), according to the researchers."

The Development and Impact of a Social Media and Professionalism Course for Medical Students

 2017 Mar 8:1-9. doi: 10.1080/10401334.2016.1275971. [Epub ahead of print]

The Development and Impact of a Social Media and Professionalism Course for Medical Students.

Author information

1
a Himmelfarb Health Sciences Library , The George Washington University , Washington, DC , USA.
2
b Department of Medicine , The George Washington University , Washington, DC , USA.
3
c Department of Medicine , The George Washington University , Washington, DC , USA.
4
d Department of Pediatrics , Children's National, The George Washington University , Washington, DC , USA.

Abstract

PROBLEM:

Inappropriate social media behavior can have detrimental effects on students' future opportunities, but medical students are given little opportunity to reflect upon ways of integrating their social media identities with their newly forming professional identities.

INTERVENTION:

In 2012, a required educational session was developed for 1st-year medical students on social media and professional identity. Objectives include identifying professionalism issues and recognizing positive social media use. The 2-hour large-group session uses student-generated social media examples to stimulate discussion and concludes with an expert panel. Students complete a postsession reflection assignment.

CONTEXT:

The required social media session occurs early in the 1st year and is part of the Professionalism curriculum in The George Washington University School of Medicine. Reflection papers are graded for completion.

OUTCOME:

The study began in 2012 and ran through 2014; a total of 313/505 participants (62%) volunteered for the study. Assessment occurred through qualitative analysis of students' reflection assignments. Most students (65%, 203/313) reported considering changes in their social media presence due to the session. The analysis revealed themes relating to a broader understanding of online identity and opportunities to enhance careers. In a 6-month follow-up survey of 76 students in the 2014 cohort who completed the entire survey, 73 (94%) reported some increase in awareness, and 48 (64%) made changes to their social media behavior due to the session (response rate = 76/165; 46%), reflecting the longer term impact.

LESSONS LEARNED:

Opportunities for discussion and reflection are essential for transformational learning to occur, enabling understanding of other perspectives. Incorporating student-submitted social media examples heightened student interest and engagement. The social media environment is continually changing, so curricular approaches should remain adaptable to ensure timeliness and relevance. Including online professionalism curricula focused on implications and best practices helps medical students develop an awareness of their electronic professional identities.

Chuck Norris has good news for overweight people

Chuck Norris has good news for overweight people


"Diet and exercise – two things we think of as a foundation for healthy living. Just consider the findings of a recently published report in the International Journal of Epidemiology. As if any more proof were needed, it makes a clear connection between eating more of certain fruits and vegetables and living longer. According to a Meta study conducted by Imperial College London, it’s estimated that if people ate 10 portions of fruits and vegetables a day, an estimated 7.8 million premature global deaths could be avoided each year. For the study, a portion was characterized as 800 grams (for context, consider that one medium apple constitutes around 182 grams).
Those who consume up to 10 portions fruits and vegetables a day are said to be rewarded with a 24 percent lower risk of heart disease, a 33 percent lower risk of stroke, a 28 percent lower risk of cardiovascular disease, a 13 percent lower risk of cancer and a 31 percent lower risk of dying early when compared to not eating fruit or vegetables."




Read more at http://www.wnd.com/2017/03/chuck-norris-relates-something-overweight-people-should-know/#MBtT260UDQOBRy08.99

"Qatar is home to one of the most unequal societies in the world when it comes to gender, according to a new index."

Qatar’s gender gap is one of the largest in the world, new index says



"Qatar is home to one of the most unequal societies in the world when it comes to gender, according to a new index.
The country ranked 117th out of 122 nations listed in business school INSEAD‘s Gender Progress Index 2017, which was released this month.
That puts Qatar behind all of its Gulf peers.
According to the report, the low score had to do with a lack of female political involvement, as well as the low number of men pursuing higher education in Qatar.
That said, none of the Gulf countries fared particularly well in the index.
The UAE was the highest-ranked GCC nation at 85th. Kuwait was 99th, Bahrain 103rd, Saudi Arabia 110th and Oman was 113th."

"Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain."

 2017 Mar 16. pii: tobaccocontrol-2016-053424. doi: 10.1136/tobaccocontrol-2016-053424. [Epub ahead of print]

Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys.

Author information

1
Department of Population Health, New York University School of Medicine, New York, USA erin.rogers@nyumc.org.
2
VA New York Harbor Healthcare System, New York, USA.
3
Department of Economics, Bentley University, Waltham, Massachusetts, USA.
4
National Bureau of Economic Research, New York, USA.
5
Department of Health Policy and Management, City University of New York School of Public Health, New York, USA.

Abstract

OBJECTIVES:

To estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA.

METHODS:

Using 2006-2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile.

RESULTS:

In the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001).

CONCLUSIONS:

Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.

Government is power. "Companies will need to adjust."

VAT will curb unhealthy consumption



"VAT and excise duties will change the behaviour of individuals, companies and countries. It is essential that the GCC apply it together, otherwise there is a risk that smuggling will increase.
Companies will need to adjust. Tax and duties will represent an increased cost to them, a cost that they will initially have to pass on to their customers. But over time, they may find different ways to source or produce their products, which may bring the price of producing the product down. There is, naturally, no guarantee that consumers will see any reductions, but they might, particularly on products that are sensitive to price: companies are always keen to keep impulse purchases low, because otherwise consumers won’t buy so many."

PTSD, Orientation to Pain, and Pain Perception in Ex-prisoners of War who Underwent Torture

 2017 Feb 17. doi: 10.1097/PSY.0000000000000461. [Epub ahead of print]

PTSD, Orientation to Pain, and Pain Perception in Ex-prisoners of War who Underwent Torture.

Author information

1
1The Bob Shapell School of Social Work, Tel Aviv University, Israel 2Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel.

Abstract

OBJECTIVE:

Studies suggest that torture survivors often suffer long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture, or rather the subsequent posttraumatic stress disorder (PTSD), explains these pain problems. Furthermore, while catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations.

METHODS:

Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain-threshold, and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain.

RESULTS:

While chronic pain was associated with PTSD (.44<β<.49; p<.002), increased pain perception was correlated with torture (.33<β<.65; p<.05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β=.18, .19; p<.05). Fear of pain moderated the association between torture and pain perception (β=.41, .42; p<.017).

CONCLUSIONS:

The findings suggest that chronic pain is contingent upon the psychological toll of torture, i.e. PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to prior experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences following trauma.

“I worry that the philosophy of the country is going towards health, happiness, smoke weed...”



World's first marijuana gym is in (where else?) California



Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in New York, said the option is dangerous.
“I worry that the philosophy of the country is going towards health, happiness, smoke weed,” Krakower said. "You are glorifying weed and saying it’s this agent that’s going to cure everything. I don’t think that’s going to be the case.”

"Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes."

 2016 Jan-Jun;25(1):17-22. doi: 10.4103/0972-6748.196050.

Medical students' attitude toward suicide attempters.

Author information

1
Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
2
Department of Psychiatry, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
3
College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Abstract

BACKGROUND:

Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes.

OBJECTIVES:

This study was aimed to assess the medical students' attitudes toward suicide attempters.

MATERIALS AND METHODS:

A cross-sectional study was conducted in a tertiary care medical institute of Haryana, a Northern state of India. Two hundred and five final year medical students were recruited through total enumeration method. "Suicide Opinion Questionnaire" was administered to assess their attitudes toward suicide attempters.

RESULTS:

Only minority had previous exposure of managing any suicidal patient and attended suicide prevention programs. Majority agreed for suicide attempters being lonely and depressed. Nearly half of the students reported small family, disturbed interpersonal relationship, weak personality, self-punishment approach, cultural inhibitions in emotional expression, national instability, and disbelief in afterlife, as a major push to attempt suicide. Compared to boys, girls reported the greater contribution of weak personality and self-destructive behaviors and lesser contribution of family disturbances and religious convictions as suicide triggers. They held favorable attitude for only one-third of the attitudinal statement, and they were uncertain for two-third of the attitudinal statements.

CONCLUSIONS:

Such a high proportion of uncertain responses imply toward lack of awareness and clinical expertise for managing suicide attempters. It also signifies the urgent need for enhancing their educational and clinical exposure, to improve their attitudes toward patients presenting with self-harm.

"I don’t know where or when I learned that I needed to curb any narcissistic tendency I might feel, even in grieving, but I most certainly caught on quick."

The Essential Mundanity of Grief

I don’t know where or when I learned that I needed to curb any narcissistic tendency I might feel, even in grieving, but I most certainly caught on quick.


"I don’t know where or when I learned that I needed to curb any narcissistic tendency I might feel, even in grieving, but I most certainly caught on quick. I recently found a diary I had sporadically written in the year following my mom’s death. It makes my nerves itch to read it, not because of what it says, but because of what it so actively and assertively avoids saying. Even in the privacy of my own pages, I didn’t let myself wallow in my loss. I wrote about everything except it. I wrote about the boy I was fixated on, about reading Melville, and—this is as close as I got to the truth—about how I was feeling a general sense of malaise.

It’s no sin to be obsessed with dating and crushes at nineteen. I should give sad nineteen-year-old me a break. But then there is also a repeated refrain throughout the journal that seems impossible to believe at face value, and if I hadn’t been the author of it myself I would be tempted to call it fake. In these pages, my younger self keeps wondering why I can’t just be “happy.” I keep wondering if art will be my path toward this elusive happiness, or if continuing to study literature will deliver the clap of inspiration I felt my life was missing. I wrote entry after entry confused about my sadness, as though the reason weren’t right in front of me: I’d lost my mom and was trying to live on as if it was not so big a deal. I was pledging a clueless allegiance to a happiness script even in the gloaming of my grief."

"Scientists say that smoking cannabis increases the risk of stroke by 26 percent and heart failure by 10 percent."

Study: Smoking marijuana raises the risk of heart attack, stroke




"Scientists say that smoking cannabis increases the risk of stroke by 26 percent and heart failure by 10 percent.

The drug was also linked to a variety of factors known to increase cardiovascular risk, including obesity, high blood pressure, smoking and alcohol use.

As more states look to legalize the drug, or to prescribe it medically to alleviate symptoms of other diseases, the study sheds new light on how the drug can seriously affect cardiovascular health.

"Wife beating is the most common and widespread form of intimate partner violence in Ethiopia."

 2017 Mar 16;17(1):6. doi: 10.1186/s12914-017-0115-5.

Wife beating refusal among women of reproductive age in urban and rural Ethiopia.

Author information

1
Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia. eshetugurmu@gmail.com.
2
Population and Gender Research Unit, Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia. eshetugurmu@gmail.com.
3
Population and Gender Research Unit, Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia.

Abstract

BACKGROUND:

Wife beating is the most common and widespread form of intimate partner violence in Ethiopia. It results in countless severe health, socio-economic and psychological problems and has contributed to the violation of human rights including the liberty of women to enjoy conjugal life. The main purpose of this study is to assess the levels and patterns of wife beating refusal and its associated socio-cultural and demographic factors in rural and urban Ethiopia.

METHODS:

The 2011 Ethiopian Demographic and Health Survey (EDHS) data based on 11,097 and 5287 women in the reproductive age group (i.e. 15-49 years) living in rural and urban areas, respectively,were used in this study. Cronbach's alpha was used to assess the internal consistency of the measure of women's attitudes towards wife beating. The Statistical Package for Social Sciences was applied to analyze the data. A binary logistic regression model was fitted to identify variables that significantly predict respondents' refusal of wife beating. Separate analysis by a place of residence was undertaken as attitude towards wife beating vary between rural and urban areas.

RESULTS:

The likelihood of refusing wife beating in Ethiopia was significantly higher among urban women (54.2%) than rural women (24.5%). Although there was a significant variations in attitude towards refusing wife beating among different regions in Ethiopia, increasing educational level, high access to media, age of respondents were associated with high level of refusal of wife beating. In contrast, rural residence, being in marital union, high number of living children, being followers of some religions (Muslim followers in urban and Protestants in rural) were associated with low level of refusal of wife beating.

CONCLUSION:

The findings of this study reveal that wife beating in Ethiopia is a function of demographic and socio-cultural factors among which age and educational attainment of respondents, number of living children, religious affiliation, marital commitment and region of residence play significant roles. As factors governing perceptions and behaviours of individuals and institutional settings appear to shape knowledge and attitude towards gender equity and equality, awareness creation and behavioural change initiatives should be considered to abolish violence against women.

"Bariatric surgery is commonly viewed as a 'low-effort' means of losing weight, and individuals who opt for this surgery are often perceived to be 'cheating.'"

 2017 Apr;24(1):96-110. doi: 10.1080/13648470.2016.1249339. Epub 2017 Feb 8.

Not 'Taking the Easy Way Out': Reframing Bariatric Surgery from Low-effort Weight Loss to Hard Work.

Author information

1
a MC-ASU Obesity Solutions Initiative , Arizona State University , Tempe , AZ , USA.
2
b The School of Human Evolution and Social Change , Arizona State University , Tempe , AZ , USA.

Abstract

Cultural notions equating greater morality and virtue with hard work and productive output are deeply embedded in American value systems. This is exemplified in how people understand and execute personal body projects, including efforts to become slim. Bariatric surgery is commonly viewed as a 'low-effort' means of losing weight, and individuals who opt for this surgery are often perceived to be 'cheating.' This extended ethnographic study within one bariatric program in the Southwestern United States shows how patients conscientiously perform this productivity. By prioritizing discourses that focus on their own hard work and the inherent value and necessity of their surgery, patients and practitioners alike contest the dominant public views of surgically-induced weight loss.

"Women do not have an active role in the workplace in the Kingdom of Saudi Arabia."

 2016 Nov 1;30(4):302-319. doi: 10.1891/1541-6577.30.4.302.

The Challenges of Cultural Competency Among Expatriate Nurses Working in Kingdom of Saudi Arabia.

Author information

1
College of Nursing, King Saud University, Riyadh, Saudi Arabia.

Abstract

BACKGROUND AND PURPOSE:

To explore the cultural challenges facing expatriate nurses working in the Kingdom of Saudi Arabia (KSA). Women do not have an active role in the workplace in KSA. Concepts of religion, culture, and language are considered to be crucial and often the lack of women's participation is attributed to these factors.

METHODS:

A descriptive qualitative approach was used with two methods of data collection: interviews and focus group. The study was located in a hospital setting in Al-Riyadh at KSA. There were 20 non-Muslim nurses of different nationalities who participated in this study.

RESULTS:

Several themes emerging from the nurses' experience of caring for Muslims such as the inability to carry out nursing duties because of religious and cultural factors and language barriers. Most of the nurses have provided similar examples and discussed the same issues, such as patient's families, fasting, and prayer having a negative impact on care from their perspective.

CONCLUSION:

There is a lack of expatriate nurses' orientation concerning religion and culture. The nurses acknowledged the importance of language when they start dealing directly with patients and associated this language barrier with their inability to provide proper care.

Friday, March 17, 2017

"When some scientists hear the word "bioethics," they break out in intellectual hives."

 2017 Mar 16;15(3):e2001934. doi: 10.1371/journal.pbio.2001934. eCollection 2017.

Genome editing: Bioethics shows the way.

Author information

1
Division of Medical Ethics, NYU School of Medicine, New York, New York, United States of America.

Abstract

When some scientists hear the word "bioethics," they break out in intellectual hives. They shouldn't. Good bioethics is about enabling science to move forward. Bioethics pushes scientists to acknowledge that they operate not within a vacuum but within a society in which diverse perspectives and values must be engaged. Bioethicists give voice to those divergent perspectives and provide a framework to facilitate informed and inclusive discussions that spur progress, rather than stall it. The field is needed to advance cutting-edge biomedical research in domains in which the benefits to be had are enormous, such as genome editing, but ethical concerns persist.

Esophagus and stomach: Being overweight in your 20s increases your risk of these 2 cancers by 60 per cent

Being overweight in your 20s increases your risk of these 2 cancers by 60 per cent





"If you’re in your 20s and trying to lose weight, new research may inspire you to get started: American scientists say that people who are overweight in their 20s and become obese later in life are three times more likely to develop esophagus and stomach cancer.
It could be because of decades of acid reflux problems, heartburn and tampering with hormones as youth put on excess weight. The findings come out of the U.S. National Cancer Institute – it’s the latest findings pointing to obesity as a key factor in cancer risk."

"The trouble is, once you accept the proposition that popularity corresponds to value, the game is over for the performing arts."

THE FATE OF THE CRITIC IN THE CLICKBAIT AGE


By

   


"The trouble is, once you accept the proposition that popularity corresponds to value, the game is over for the performing arts. There is no longer any justification for giving space to classical music, jazz, dance, or any other artistic activity that fails to ignite mass enthusiasm. In a cultural-Darwinist world where only the buzziest survive, the arts section would consist solely of superhero-movie reviews, TV-show recaps, and instant-reaction think pieces about pop superstars. Never mind that such entities hardly need the publicity, having achieved market saturation through social media." 

Osteoblast-derived lipocalin 2 suppresses appetite

Osteoblast-derived lipocalin 2 suppresses appetite

Nature Reviews Endocrinology
 
 
doi:10.1038/nrendo.2017.30
Published online
 

Economics to launch a great weekend!

Economics to launch a great weekend!

Round One

Round Two

Weighed down: 20 years of Government action on obesity

Weighed down: 20 years of Government action on obesity




"In the run-up to the 2008 election, the Labour-led government's efforts to tackle obesity became a hot topic, with National accusing it of taking a "nanny state" approach to Kiwis' food choices.

The debate was heightened by the Government's plans to rewrite the decades-old Public Health Bill, with National claiming it could allow politicians to decide what went in school lunch boxes and when people should use public transport.

Those "nanny state" fears were seen as in part responsible for National's victory at the 2008 election, and led to a sharp change in approach to government work on obesity.

New education minister Anne Tolley scrapped the restrictions on junk food at schools, saying teachers should not have to act as 'food police'."



Monday, March 13, 2017

"Even before the 2014 draft guidance for LDT, many laboratorians saw the FDA as encroaching on the practice of laboratory medicine."

Ken GatterMD, JD
From the Department of Pathology, School of Medicine, Oregon Health Sciences University, Portland.


"Even before the 2014 draft guidance for LDT, many laboratorians saw the FDA as encroaching on the practice of laboratory medicine."



cf., 

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0077-ED

and

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2013-0020-ED