Health Care and Happiness

Almost everyone likes to be happy. Yahoo News reported that new research shows being happy can add several years to life. A Dutch researcher has indicated from studies done over 60 years that effects of happiness on longevity were "comparable to that of smoking or not". That special flair for feeling good could lengthen life by between 7.5 and 10 years. The finding brings a vital new piece to a puzzle currently being assembled by researchers worldwide on just what makes us happy -- and on the related question of why people blessed with material wealth in developed nations no longer seem satisfied with their lives.

Once the province of poets or philosophers, according to the Yahoo News release, the notions of happiness and satisfaction have been taken on and dissected, quantified and analyzed in the last few years by a growing number of highly serious and respected economists -- some of whom dub the new field "hedonics", or the study of what makes life pleasant, or otherwise. Growth in material wealth adds little to happiness. But happiness can be bolstered by friendship and human community, as well as larger social factors such as freedom, democracy, effective government institutions and rule of law. Economists are working to put "happiness" indicators (a new kind of quality-of-life index) into the measurement of growth. Happiness itself, according to the specialists, is generally accepted as "the overall appreciation of one's life as a whole", in other words a state of mind best defined by the person questioned. in general "happiness does not appear to prolong the deathbed." Among healthy populations, on the contrary, happiness appeared to protect against falling ill, thus prolonging life.

According to the research provided by the article released on Yahoo News, happy people were more inclined to watch their weight, were more perceptive of symptoms of illness, tended to be more moderate with smoking and drinking and generally lived healthier lives. They were also more active, more open to the world, more self-confident, made better choices and built more social networks. Chronic unhappiness activates the fight-flight response, which is known to involve harmful effects in the long run such as higher blood pressure and a lower immune response. Studies on job-satisfaction failed to address the question of life-satisfaction at work. educate people in the art of "living well", helping to develop the ability to enjoy life, to make the best choices, to keep developing and to see a meaning in life.

Medical New Today reported a study by Carnegie Mellon in 2005 that indicated the strongest links between positive emotions and health were found in studies that examined "trait" emotions, which reflect a person's typical emotional experience, rather than "state" emotions, which reflect momentary responses to events. People who typically report more positive emotions experience lower rates of chronic illness, symptoms and pain. Moreover, among the elderly who live on their own or with family rather than in retirement homes, positive emotional dispositions are linked to living longer. In contrast, positive emotions are not associated with increased longevity in studies of other populations, and though possibly beneficial for recovery from less serious diseases, extremely positive emotions are in some cases associated with poorer outcomes among those with serious illness.

The Carnegie Mellon study further indicated that one problem in interpreting the literature is that in many cases, it is difficult to distinguish between the effects of positive and negative emotions. For example, do elderly living on their own or with family live longer because they are happy or because they are not sad? Interestingly, people's experiences of positive and negative emotions are partly independent in some circumstances. For instance, in looking back over the last month or year, one can reasonably report having been both happy and sad. A definitive answer to whether positive or negative emotions are contributing to a health outcome can only come from studies that measure both types of emotions and examine their independent effects. Consequently, it is difficult to conclude from the existing literature whether happiness leads to a healthier and longer life or unhappiness results in a less healthy, shorter one. The authors also were concerned with the possibility that some measures of positive emotions may themselves be direct indicators of physical health. For example, adjectives such as "energetic," "full-of-pep," and "vigorous" may reflect a positive mood, but may also reflect how healthy one feels. Self-rated health has been found to predict illness and longevity above and beyond objective health measures such as physician ratings. Consequently, it is important for future research to include standard measures of self-rated health to help exclude the possibility that researchers are merely predicting good objective health from good perceived health masquerading as positive emotions. And, emotions can have a direct impact on health; for example, they may influence lifestyle choices, or the function of the immune and autonomic nervous systems. Alternatively, they suggest that positive emotions may also influence health by mitigating the harmful effects of stress.

A follow up study done by the same Carnegie researcher in 2006, reported in Psychosomatic Magazine, showed the people who report positive emotions are less likely to catch colds and also less likely to report symptoms when they do get sick. This held true regardless of their levels of optimism, extraversion, purpose and self-esteem, and of their age, race, gender, education, body mass or prestudy immunity to the virus. Also, when they do come down with a cold, happy people report fewer symptoms than would be expected from objective measures of their illness. In contrast, reporting more negative emotions such as depression, anxiety and anger was not associated with catching colds. That earlier study, however, left open the possibility that the greater resistance to infectious illness among happier people may not have been due to happiness, but rather to other characteristics that are often associated with reporting positive emotions such as optimism, extraversion, feelings of purpose in life and self-esteem. The new study finds that happiness and other positive emotions play an even more important role in health than previously reported. Researchers found that when happy people contract a virus, or “catch a cold”, they report fewer symptoms and in fact, are less likely to contract the virus at all.

CNN has reported about the happiness quotient. The Declaration of Independence affirms that we have an inalienable right to pursue happiness, and it is something people do with a vengeance. Americans will spend $750 million on self-help books and more than $1 billion on motivational speakers. More than 100 colleges now offer classes in positive psychology -- the science of happiness. With all those resources focused on achieving happiness, the nation should be brimming with joy. Our culture implores us to buy bigger, newer, better things, but research shows "stuff" does not buy happiness. By and large, money buys happiness only for those who lack the basic needs. Our genes hardwire us to reproduce, but children can have a small negative effect on happiness, research shows. When you follow people throughout their days, as they're going about their normal activities, people are about as happy interacting with their children, on average, as when they're doing housework. They're much less happy than when they're exercising, sleeping, grocery shopping, or hanging out with friends. In fact, neither unhappiness nor joy last as long as we expect. As you've probably guessed, winning the lottery will not guarantee a life of bliss. By the same token, becoming disabled does not relegate one to a life of unhappiness. The disabled spend their days about as happy as the general population. In general for most people, the older you get the happier you get -- until you reach very old age.

According to a Pew Research Center survey, the happiest age group is men 65 and older; the least happy: men 18 to 29. The survey also found:
--Married people are happier than singles.
--College grads are happier than those without a college degree.
--People who were religious are happier than those who aren't.
--Sunbelt residents are happier than other U.S. residents.
--Republicans are happier than Democrats -- but both are happier than independents.

Research shows, according to the Harvard study, most people have an innate level of happiness, and we can also try to boost our happiness a little bit above this natural "set point." You should pass on buying lottery tickets and find small things you can do every day that bring you joy, whether it's going for a walk or cooking a meal or reading a book. There is good evidence that people express at least some fundamental emotions like disgust, anger and happiness in a very similar way all around the world. Happiness from the most traditional cultures to the most modern depend heavily on close family and other human relationships. Additionally, in a report released to Reuters by researchers in January, 2008, those who indicated upbeat moods had lower levels of cortisol — a “stress” hormone that, when chronically elevated, may contribute to high blood pressure, abdominal obesity and dampened immune function, among other problems. In the study, published in the American Journal of Epidemiology, women who reported more positive emotions had lower blood levels of two proteins that indicate widespread inflammation in the body. Chronic inflammation is believed to contribute to a range of ills over time, including heart disease and cancer. Researchers have long noted that happier people tend to be in better health than those who are persistently stressed, hostile or pessimistic.

Health and happiness are very closely tied together in the human body and spirit. Your happiness, or lack of it, can have a direct effect on your health. Depression and mental instability as a result of being unhappy leads to physical maladies that must be treated with counseling, medication, and ongoing therapy until the patient recovers. There are physical, mental, and spiritual levels when dealing with happiness and your health. No one person ever has a life free of unhappiness. However, everyone has the option to choose happiness even in tough times. Remember, your character is not formed by what happens to you but rather by how you deal with it.

Until next time. Let me know what you think.

Health Care and Doctor Visits

People are not going to the doctor as much these days. About 22% of Americans have reduced the number of times they see their doctor because they want to save money in these tough economic times, according to a survey released this month by the country's state insurance regulators (National Association of Insurance Commissioners) according to the San Francisco Chronicle. Eleven percent of those surveyed also said they had cut back the number of prescription drugs they take or the dosage of those medications to make the prescription last longer. Some physicians noted an increase in such behaviors by their patients and were concerned about potential health consequences.

Men are the usual culprit most of the time according to a survey released on WebMD in 2007, which was conducted by Harris Interactive for the American Academy of Family Physicians. The report indicated that many U.S. men only go to their doctor when they're extremely sick, skipping preventive care. While most men -- 85% -- said they seek medical treatment when they're sick, almost all -- 92% -- said they waited at least a few days to see if they felt better before seeking care. In the survey, most men indicated that they have health insurance, have a doctor, and feel comfortable talking to their doctor. Nearly 80% said they felt they were in excellent, very good, or good health. However, feeling fine doesn't always mean you're in tip-top shape. For instance, someone who dodges doctor visits might not know whether their cholesterol or blood pressure is too high. Those problems don't have obvious symptoms. Men may be more likely to see their doctor if their wife or partner encourages them to do so, according to the survey--nearly 80% said their spouse/significant other influences their decision to go to the doctor. When men do go to the doctor, most say they always or usually follow their doctor's advice.

According to HealthAtoZ.com, Today, doctor visits have become more complex. Doctors are making more diagnoses per visit and managing multiple medications. And the patient may spend only 15 minutes actually seeing the doctor. That's why many patients are challenging the traditional model of "follow doctor's orders." With Web and other drug advertising, people are likely to ask more questions or voice strong opinions about their care. And research shows that patients who are active and involved with their own health care decisions tend to get better results. To get the most out of your visit, approach it as if you were planning for a business meeting. Organize your thoughts, establish an agenda, and by all means, write things down. Do you have symptoms? Jot down notes about when they started, what happens when they occur and what makes them better or worse. Are you on a medication? Write down questions about how long you're supposed to take it, the likely side effects, the costs, and if there is any food, drink or activities you should avoid while taking the medication.

HealthAtoZ.com also gives very helpful tips about visiting your health care provider. Physicians offer these other recommendations to make your visit to the doctor's office an effective and beneficial one:
1.) Choose a doctor you like. After all, this relationship is an intimate one, and hopefully long-standing. You should feel comfortable asking questions and discussing your health care with your doctor. If he or she speaks in jargon, don't be shy about asking for a simpler explanation. And remember, there's no such thing as a dumb question.
2.) Make an appointment early in the day if you can. A doctor can be knocked off schedule by emergencies or longer-than-expected hospital rounds, or just trying to see too many patients in one day. The earlier your appointment, the less likely you'll be affected by schedule changes. If the doctor is running late, you should be given an update or estimate of his or her arrival. If you're not told, ask.
3.) Involve the office staff. Many people express frustration at having to wait to talk to their doctors about simple health care questions. If this happens, try asking a nurse or another member of the physician's patient-care team to answer any routine questions.
4.) Mention all medications you are taking. This includes all the medications prescribed by other doctors, over-the-counter pills and supplements you take - and even those medications you are supposed to take, but don't. Make a list, or better yet, eliminate any doubt by bringing all your pill bottles.
5.) Tell the doctor about what you used to do, but can no longer do. Sometimes patients come to accept a certain level of disability, particularly if it's the result of a condition that has come on slowly. For example, if you used to run but your knee bothers you, or if you used to garden or knit, but your hands and fingers ache, these are things you should tell your doctor. If you don't share these problems with your doctor, you may miss out on treatments.
6.) Tell the doctor about your concerns - or fears. Make a list, in order of importance, of medical concerns or worries you may have. If you smoke, if you're depressed or under stress, or if you're having incontinence problems, these may be difficult subjects to talk about, but your doctor can help.
7.) Mention if a family member has recently been diagnosed with a serious disease or condition. Family history is crucial information for a doctor. Many patients provide this information when they make an initial visit, but it's also important to keep this information current.
8.) If you travel outside of the country, be sure to let your doctor know, particularly if you're going to formerly remote places in Africa and Asia. This information can become key if you come down with vague "flu-like" symptoms.
9.) Bring along a family member or friend. If you think you may have a hard time remembering or understanding the doctor's recommendations, it's OK to have someone accompany you to the office. Because of patient confidentiality, however, it may not be appropriate for your companion to ask for confidential information on a follow-up phone call, unless you have given the doctor permission to provide such information.
10.) Before you leave, make sure you know what you're supposed to do next. When are you due back? Are you supposed to call, or will someone from the office call with your lab results? What routine screenings are coming up next? How should you prepare for them? Don't leave the doctor's office unclear about what happens next. Otherwise, you'll be making follow-up calls to the office.

Remember, your relationship with your doctor is a partnership. Effective communication will help you and your doctor make the best decisions for your health. It's common to feel confused, and overwhelmed. These feelings and your health condition can make it especially difficult to keep track of and prepare for appointments, medications, and tests. When you go to your doctor you want to accomplish two main goals:
( 1 ) Assist your doctor in determining your medical needs and most appropriate treatment plan;
( 2 ) Ensure that your receive timely access to medical care and the related services you need.

Americans made over 1.1 billion visits to physician offices and hospital outpatient and emergency departments in the last year, which works out to an average of four visits per person per year, according to statistics released by the U.S. Centers for Disease Control and Prevention. With all this activity in the health care marketplace, patients and physicians need to communicate effectively at the time of service and with all follow up visits and correspondence. Time is too precious to waste on ineffective medical solutions, expense, and confusion. The vast majority of medical practitioners are extremely interested in the health and well being of their patients, and effective results benefit both the medical community and the public. Be prepared to work with your doctor when you have your next visit. Don't be afraid to ask questions and seek other options. Trust your doctor and listen to the prognosis. But don't forget, he works for you. The medical industry wants to heal the sick; but overall, it's your health. Make sure you find a physician that fits you for mutual benefit.

Until next time. Let me know what you think.

Health Care and Consumer Reform

The Washington Post online has reported this month that about 82% of Americans are not happy with the current system of health care in the U.S., and they want it overhauled. The Commonwealth Fund survey indicated that the majority of people in the study interview are very frustrated with health care issues such as inefficient and time-consuming record keeping and timely access to medical care. Americans want and deserve improved quality of care with more affordable options. They also want and deserve improved performance by medical providers, access to health care locations, and better treatment by physicians and staff at the time of service.

MSNBC reported the findings and indicated that about a third of those surveyed wanted a complete rebuilding of the U.S. health care system, and about half wanted fundamental change. The majority of respondees felt that health insurance should be simplified, and about 90% of those in the survey supported a wider use of health information that could be shared more efficiently between medical providers. Overall, about 16% of those surveyed felt the system works well and only needed minor reform. The views held were similar regardless of income and insurance status.

The Commonwealth Fund also reported that efficiency and accountability among health care providers needed improvement. Medical providers should be rewarded for high quality care and patients shoudl be incentivized for seeking health providers that offer the best and most efficient care. The number of uninsured should be reduced, and all Americans should have access to affordable care. Americans want a regular family physician who is available to see them on a timely basis and get referrals to specialists and other medical providers. They want improved quality and timeliness of care.

According to the report as released on the Washington Post website, the majority of Americans are very frustrated with the way their health care is managed. There is a lack of coordination including the delay in getting test results and the amount of follow up that is required by the patient. Almost half of those surveyed said they had to make multiple calls to find information. Important health data is not shared between doctors and nursing staff on a timely basis or at all, and the majority of patients wanted access to their medical records. People want a single point of service and coordination of medical information about their care. Patients also reported major issues with contacting physicians for appointments, phone advice, and after hours follow up.

Recommendations by the Commonwealth Fund were offered for improved care--moving away from fee-for-service plans and paying doctors and hospitals based on quality of care. Barriers should be removed that prevent doctors from sharing vital information; doctors and hospitals should be accredited based on quality measures; patient information should be more readily available to physicians at the point of care; and accountability for patient care should be more clearly enforced. Doctors and other medical providers should be trained to work as teams. And the federal government should mandate and support electronic health care records as an alternative to control costs and ease access to information by providers.

In February, 2008, Consumer Reports conducted a similar survey asking questions on how the health care system should be changed. About 80% of the respondees said that a reformed system should guarantee the following: coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a pre-existing condition; coverage that continues even when people are laid off, changing jobs, or starting their own business; premiums, deductibles, and out-of-pocket expenses that are affordable relative to family income; and, the ability of people to keep their current health insurance if they choose. Additionally, the Consumer Reports survey also found that Americans are worried about escalating health costs, regardless of their financial status. Overall, 81% of those polled by CR said they're concerned about being able to afford health care in retirement, 68% worry about being bankrupted by medical bills following a serious illness or accident, and 65% fear losing their job-related health coverage.

Consumers were asked their support on the following issues:
-- The most popular proposal -- a mixed public/private system that would require all uninsured Americans to buy health insurance -- drew support from half of the respondents.
-- Thirty-six percent of respondents support public insurance, similar to the Canadian health-care system.
-- One-third of respondents favored a mix of employer-sponsored plans, private health-insurance plans, Medicare, Medicaid, and other public programs, which is the arrangement we have today.
-- Only 26% supported the idea of giving tax incentives for individuals to purchase insurance and relying on market pressures and competition among insurance companies to hold prices down.

The report also offered the following suggestions for improved health care:
1.) Complete coverage: Private insurance and public programs must be expanded to guarantee that everyone is covered from cradle to grave, regardless of health status and ability to pay.
2.) Fair cost spreading: No family should face financial ruin to pay for healthcare. Costs should be spread fairly among government, employers, and consumers.
3.) Safer care: Millions of Americans are harmed each year by the care they receive. Improved safety systems would save billions of health-systemdollars.
4.) Better care: Comprehensive, easy-to-understand public information about the safety, cost, and quality of care by doctors, hospitals, and nursing homes would help consumers and employers choose the best care.
5.) Prevention: Smoking and obesity related illnesses such as certain cancers, heart disease, and type 2 diabetes threaten to overwhelm health expenditures. The primary-care physicians whose job it is to prevent and control those conditions are the most poorly paid of all doctors. Our system should find ways to fix those problems.

It is true that Americans should have the best health care system in the world, but asking the government to pay for it (ultimately the American taxpayers) is not the best course of action. Mandating certain controls, such as sharing health records may reduce costs, but the issues raised by common database sharing need to be fully fleshed out in order to eliminate any potential problems associated with access to patients' private medical information. Transparency of medical information and costs is an area of health care that should be greatly improved. Better access to physicians is also something that should also be improved. Whatever the methods, Americans deserve a health care system that functions more like a finely tuned jet engine than a propeller driven bi-plane.

Until next time. Let me know what you think.

Health Care and Newborns

Going home with a new baby is exciting, but it can be scary, too, according to the National Institutes of Health. Newborns have many needs, like frequent feedings and diaper changes. Babies can have health issues that are different from older children and adults, like diaper rash and cradle cap. Your baby will go through many changes during the first year of life. You may feel uneasy at first. Ask your health care provider for help if you need it. And, according to the Nemours Foundation, consider recruiting help from friends and family to get through this time, which can be very hectic and overwhelming.

While in the hospital, use the expertise around you. Many hospitals have feeding specialists or lactation consultants who can help you get started nursing or bottle-feeding. In addition, nurses are a great resource to show you how to hold, burp, change, and care for your baby. For in-home help, you might want to hire a baby nurse or a responsible neighborhood teenager to help you for a short time after the birth. In addition, relatives and friends can be a great resource. They may be more than eager to help, and although you may disagree on certain things, don't dismiss their experience. But if you don't feel up to having guests or you have other concerns, don't feel guilty about placing restrictions on visitors. The University of Virginia Health System says that assessing the health of a newborn is very important for detecting any problems in their earliest, most treatable, stages.

Since newborns require constant attention, the UVAHS also provides valuable information about looking for any warning signs to monitor the health of babies. Your newborn baby is going through many changes in getting used to life in the outside world. Almost always this adjustment goes well, however there are certain warning signs you should watch for. Some general warning signs with newborns include, but are not limited to:
--no urine in the first 24 hours at home. This can be difficult to assess, especially with disposable diapers.
--no bowel movement in the first 48 hours.
--a rectal temperature over 100.4° F (38° C) or less than 97.5° F (36.5° C).
--a rapid breathing rate over 60 per minute, or a blue coloring that does not go away. Newborns normally have irregular respirations, so you need to count for a full minute. There should be no pauses longer than about 5 seconds between breaths.
--retractions, or pulling in of the ribs with respirations.
--wheezing, grunting, or whistling sounds while breathing.
--odor, drainage, or bleeding from the umbilical cord.
--yellow coloring of the eyes, chest, or extremities.
--crying, irritability, or twitching which does not improve with cuddling and comfort.
--a sleepy baby who cannot be awakened enough to nurse or nipple.
--any signs of sickness (i.e., cough, diarrhea, pale color).
--the baby's appetite or suck becomes poor or weak.

Every child is different, so trust your knowledge of your child and call your child's physician if you see signs that are worrisome to you. If any of these signs should occur, you should contact the doctor right away or take the newborn to the nearest medical facility. Waiting too long or ignoring these medical issues may seriously jeopardize the health of the newborn. Even if the infant is not in imminent danger, any significant change of health, especially in the first 30 days or less, should be addressed as a matter of precaution. Newborns are, indeed, fragile. And they are totally dependent on adults to make sure that their health needs are attended to as a matter of safety and ongoing care during the first days and weeks of life out of the womb.

A very good online resource for newborn information is KeepingKidsHealthy.com. One of the areas they detail is material concerning pre-mature babies. These newborns require extreme care from health care facilities, physicians, medical staff, and parents. A normal pregnancy lasts nine months, or about 38 to 42 weeks. Newborns are considered to be premature if they are born before they are 37 weeks old. Although there are many risk factors that can help to predict which pregnancies are at risk for premature delivery, in most cases, no cause is found. Among the risk factors that may increase your chances of having a premature baby include:
--Having delivered a previous premature baby, which puts you at a 20-40% of having another premature baby.
--Multiple gestation pregnancies, such as twins, triplets, etc. The risk increases with each additional fetus.
--Placental abruptions and placenta previa are two causes of bleeding that can lead to a premature delivery.
--Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid.
--Infections during pregnancy, especially if they spread to the uterus or placenta.
--Diabetes.
--High blood pressure.
--Preeclampsia, which causes maternal high blood pressure, proteinuria (spilling protein in your urine), and swelling.
--Maternal smoking or use of illicit drugs.
--Maternal malnutrition, especially if it leads to poor weight gain during pregnancy.
--Fibroids, an abnormally shaped uterus and cervical incompetence.
--Becoming pregnant while being treated for infertility, having a previous abortion in the 2nd trimester, and not having prenatal care.
--Problems with the fetus can also lead to a premature delivery, including infections, poor growth and certain birth defects.

The site also recommends that if you think you have risk factors for having a premature baby, be sure to discuss them with your obstetrician. You may have to be seen by a perinatologist, who is a doctor that specializes in high risk pregnancies. If you believe that you are having preterm labor, then you should call your doctor. Among the symptoms of preterm labor include frequent uterine contractions, pain, and increased vaginal discharge, especially if bloody (it may be your mucus plug) or a lot of clear fluid (which can be your water breaking). The more mature your baby is at birth, the more likely that it is that he will not have any problems, so that babies born at 26-29 weeks have a much better chance of surviving and growing up either normal or with mild or moderate problems. Babies born at 30-33 weeks usually do even better, and have a very high rate of survival. After 34 weeks, babies are usually only mildly immature and usually do very well. KeepingKidsHealthy.com has much more detail that can assist you in learning more about pre-mature birth and other newborn needs.

The Pregnancy & Parenting section on iVillage.com has information about newborns and the first hours of life related to tests done by the hospital staff. After your child's birth, your baby will experience many important medical procedures, many of them mandated by law. But as long as your child is healthy (and 90% of full-term newborns are), we recommend requesting that all tests (except the Apgar evaluation, which must be performed immediately after the birth) be delayed for at least the first hour of your child's life. This will preserve a very special time for you and your partner to bond with your child immediately after the birth. The following tests and procedures may be performed: Apgar evaluation, eye prophylaxis, vitamin K injection, newborn metabolic screening, blood sugar testing, and hepatitis B vaccine. The Apgar test is a score (named for its creator, Virginia Apgar) that helps evaluate your baby's general condition at birth. The test is performed at one and five minutes after birth by evaluating the infant's heart rate, breathing efforts, muscle tone, reflexes and color and assigning a score of 0, 1 or 2 to each category. A total score of 10 is the highest, and most babies will rate between seven and nine by five minutes.

According to the March of Dimes, newborns send signals to their parents about how they feel and what they need. But as a new parent, you may not know how to read those signals. As the parent of a newborn, you will want to be aware of the following:
--How babies signal that they're hungry, tired, don't feel well or want to play.
--How sleep patterns change over time.
--How a newborn responds and moves.
--How to manage a crying baby.
And, among other issues, you will also want to be knowledgeable about these newborn traits:
--States of awareness
--Sleeping
--The newborn's senses
--Reflexes and movements
--Crying
--Eating
--Playing and break time

Providing nurture and care for a newborn is a full time job not to be taken lightly by any parent or health care provider. Knowing what to do is also as important as when to do it. If you have experienced a recent birth or are about to for the first time, take time to get educated on the best ways to manage their care. There are plenty of resources available that leave no doubt about the care and treatment for newborns. Newborns, regardless of whom or where, are precious gifts from God. Treat them accordingly.

Until next time. Let me know what you think.

Health Care and E-Health

Americans are very interested in getting information about health care information on the internet. The Pew Internet Project just released indicates that 10% of internet users say they searched for health information "yesterday," which in a tracking survey like this one yields a picture of the "typical day" online. Health has moved up in the "typical day" list (from 7% in 2006 to the current 10 percent of internet users), but for most people the average day includes lots of emails (60% of internet users), general searches (49%), and news reading (39%) if they are online at all (30% of internet users are offline on a typical day). The internet is an important source of health information and a force for change in health care.

The Journal of Medical Internet Research (JMIR) defines e-health as an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. Also, eHealth describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients.

According to Wikipedia, eHealth (also written e-health) is a relatively recent term for healthcare practice which is supported by electronic processes and communication. The term is inconsistently used; and some would argue it is interchangeable with health care informatics and sub sets, while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology:
1.) Electronic Medical Records: enable easy communication of patient data between different healthcare professionals (GPs, specialists, care team, pharmacy)
2.) Telemedicine: includes all types of physical and psychological measurements that do not require a patient to travel to a specialist. When this service works, patients need to travel less to a specialist or conversely the specialist has a larger catchment area.
3.) Evidence Based Medicine: entails a system that provides information on appropriate treatment under certain patient conditions. A healthcare professional can look up whether his/her diagnosis is in line with scientific research. The advantage is that the data can be kept up-to-date.
4.) Consumer Health Informatics (or citizen-oriented information provision): both healthy individuals and patients want to be informed on medical topics.
5.) Health knowledge management (or specialist-oriented information provision): e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking.
6.) Virtual healthcare teams: consist of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care).
7.) mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data, providing healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine).
8.) Medical research uses eHealth Grids that provide powerful computing and data management capabilities to handle large amounts of heterogenous data.

The publishers of Telemedicine and e-Health magazine indicate that eHealth covers all aspects of clinical telemedicine practice, technical advances, enabling technologies, education, health policy and regulation and biomedical and health services research dealing with clinical effectiveness, efficacy and safety of telemedicine and its effects on quality, cost and accessibility of care, medical records and transmission of same. Telemedicine applications play an increasingly important role in health care and provide tools that are indispensable for disease management, home telemetry, and remote care that encompasses not only rural health and battlefield care, but nursing home, assisted living facilities, and maritime and aviation applications. Advances in technology including wireless connectivity and mobile devices will give practitioners, medical centers, and hospitals important new tools for managing patient care, electronic records, and medical billing to ultimately enable patients to have more control of their own well being. As the nation once more addresses health care reform, the contributions of telemedicine need to be fully understood and appreciated and reimbursement policies must be in place for these applications.

Additionally, according to the eHealth Institute, eHealth resources can help:
--Improve health status by supporting healthy lifestyles, improving health decisions, and enhancing health care quality;
--Reduce health care costs by improving efficiencies in the healthcare system and prevention;
--Empower people to take greater control of their health by supporting better-informed health decisions and self-care;
--Enhance clinical care and public health services by facilitating health professional practice and communication; and
--Reduce health disparities by applying new approaches to improve the health of underserved populations.

Here are the 10 E's of eHealth, according to the JMIR:

1.) Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement.
2.) Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers.
3.) Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation, and much work still has to be done in this area.
4.) Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice.
5.) Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner.
6.) Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers)
7.) Enabling information exchange and communication in a standardized way between health care establishments.
8.) Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals.
9.) Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues.
10.) Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases.

In addition to these 10 essential e's, the JMIR says e-health should also be:
--easy-to-use,
--entertaining (no-one will use something that is boring!), and
--exciting.

Electronic medicine and eHealth are the future, and we need to use it now. Being able to access health care data quickly and efficiently will definitely help to reduce costs and decrease inefficiencies in the medical marketplace. eHealth is beneficial to insurance companies, medical providers, government, and patients. Americans deserve the best.

Until next time. Let me know what you think.

Health Care and Menopause

Menopause, or the permanent end of menstruation and fertility, is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss, according to the Mayo Clinic. Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.

Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms as described by the Mayo Clinic. Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average. The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:
--Irregular periods
--Decreased fertility
--Vaginal dryness
--Hot flashes
--Sleep disturbances
--Mood swings
--Increased abdominal fat
--Lost of breast fullness
--Thinning hair

Menopause affects every woman according to WebMD. Premature menopause symptoms (or early menopause symptoms) may include irregular periods or hot flashes. Other signs of menopause include night sweats, sleep difficulties, and irritability. Menopause treatments may include hormone replacement therapy, although this is not for every woman. Herbal remedies for menopause may include soy foods and natural supplements. If you have bleeding after menopause, call your doctor as it may indicate a more serious problem.

Menopause, according to the Mayo Clinic, begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process gets under way in your late 30s. By that time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, perhaps partially due to these hormonal effects. These changes are more pronounced in your 40s, as are changes in your menstrual pattern. Your periods may become longer or shorter, heavier or lighter, and more or less frequent.

Eventually, your ovaries shut down and you have no more periods according to Mayo Clinic. It's possible, but very unusual, to menstruate every month right up to your last period. You're much more likely, though, to have a gradual tapering off. Unfortunately, there's no way to know exactly which period will be your last. You have to wait until well after the fact — 12 months after, by official definition. In your final months before reaching menopause, it's still possible to get pregnant, but it's quite unlikely. The signs and symptoms of menopause are enough to tell most women they have begun going through the transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases further evaluation may be recommended.

Because this process takes place over years, menopause is commonly divided into the following two stages as reported by the Mayo Clinic:
1.) Perimenopause: This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer.
2.) Postmenopause: Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.

Researchers at Rush University Medical Center in Chicago have recently discovered some new and interesting relationships between menopause and sleep. In a recent study, they found that difficulty falling asleep and staying asleep increase as women go through menopause. The study also said that waking up earlier than planned also increases through late perimenopause -- before menopause -- but decreases when women become postmenopausal.

Also according to the Mayo Clinic, several chronic medical conditions tend to appear after menopause. By becoming aware of the following conditions, you can take steps to help reduce your risk:
1.) Cardiovascular disease: When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. Yet you can do a great deal to reduce your risk of heart disease. These risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated fats and plentiful in whole grains, fruits and vegetables.
2.) Osteoporosis: During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. That's why it's important during this time to get adequate calcium and vitamin D — about 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D daily. It's also important to exercise regularly. Strength training and weight-bearing activities such as walking and jogging are especially beneficial in keeping your bones strong.
3.) Urinary incontinence: As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence).
Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.

According to the U.S. Health & Human Services, eating a healthy diet and exercising at menopause and beyond are important to feeling your best. Most women do not need any special treatment for menopause. But some women may have menopause symptoms that need treatment. Several treatments are available. It's a good idea to talk about the treatments with your doctor so you can choose what’s best for you. There is no one treatment that is good for all women. Sometimes menopause symptoms go away over time without treatment, but there’s no way to know when.

The National Institute on Health has suggestions on health care after menopause. Staying healthy after menopause may mean making some changes in the way you live.
--Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking.
--Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
--Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements.
--Learn what your healthy weight is, and try to stay there.
--Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

The NIA also offers other things to remember:
--Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
--Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
--Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is a change of life for all women who live to the age when it happens. It can be very frustrating and confusing for many women who have trouble dealing with the symptoms. Other family members also must deal with the physical and emotional issues that are brought on during this time. Consultation with primary care providers and other health care counselors will help you deal with the complications that are part of menopause. Remember that there are many resources available to you if you are experiencing this particular season of life. Use them.

Until next time. Let me know what you think.

Health Care and Heart Disease

Heart Disease is one of the top killers in the U.S. today. According to CBSNews.com, coronary heart disease kills almost half a million Americans a year. According to the American Heart Association, about 62 million Americans have some form of cardiovascular disease, which can include high blood pressure, coronary heart disease (heart attack and chest pain), stroke, birth defects of the heart and blood vessels, and congestive heart failure. Heart disease is by far the #1 killer in the U. S., although a third of those deaths could be prevented if people exercised more and followed better diets. There have been a few improvements, though, which comes from a reduction in risk factors like cholesterol, blood pressure, and smoking. Additionally, improvements in surgery and procedures are decreasing death rates to some degree.

According to the U.S. Department of Health and Human Services, heart disease is a group of diseases of the heart and the blood vessel system in the heart. Coronary heart disease, the most common type, affects the blood vessels of the heart. It can cause angina or a heart attack. Angina is a pain in the chest that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes in the shoulders, arms, neck, jaw, or back. Having angina means you're more likely to have a heart attack. A heart attack happens when a blood vessel is blocked for more than 20 minutes.

The American Heart Association says that some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
--Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
--Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. May occur with or without chest discomfort.
--Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

The HHS also indicates certain signs of a heart attack:
--Pain or discomfort in the center of the chest for more than 20 minutes.
--Pain or discomfort lasting more than 20 minutes in other parts of the upper body, including the arms, back, neck, jaw, or stomach. Other symptoms may include:
1.) unusual tiredness
2.) trouble sleeping
3.) problems breathing
4.) indigestion (upset stomach)
5.) anxiety (feeling uneasy or worried)

With Congestive Heart Failure, according to eDocAmerica, when the word "failure" is attached to a particular organ, e.g. kidney failure, liver failure, heart failure, etc., it conjures up thoughts of a final or terminal phase in the function of the organ. In most instances of organ "failure", however, there is a variable period of time in which the function is diminished prior to the time that the organ ceases to function altogether. This is particularly true of congestive heart failure (CHF). Depending on the cause for the heart failure, the course may be acute and severe, but typically the "failing" heart keeps working, just not as efficiently as it should. At issue is the underlying cause for the heart failure and how effectively it is managed. The most common reasons for developing CHF include:
--Coronary artery disease which results in diminished blood flow to the heart muscle.
--Heart attack with the development of "scar tissue" which interferes with the normal pumping action of the heart.
--High blood pressure which causes the heart to have to pump against higher resistance.
--Disease or deformity of the heart valves.
--Congenital heart disease
--Infection of the heart muscle or valves.

As may be expected, according to eDocAmerica, when the CHF is related to an acute event such as a heart attack or an infection, the course may be more rapid than when it occurs in association with a long-standing problem such as hypertension. In most cases, CHF is a chronic, long-term condition. A number of treatments are available that can help ease the workload of the heart and relieve symptoms. Lifestyle changes, medications, and surgery each play a role in the management of CHF. Beneficial lifestyle measures include not smoking, limiting alcohol consumption, eating a diet low in saturated fat and salt, and participating in a doctor-approved exercise program. A number of medications may be used, depending on the type of heart failure and its severity. The most common of these are diuretics (to help rid the body of extra fluid), digitalis, which strengthens the heart's pumping ability, ACE inhibitors, which reduce heart enlargement and improve heart function, and beta blockers, which can reduce the workload on the heart. Since hypertension is a leading cause for the development of CHF, use of medications to control blood pressure is highly important also. When coronary artery disease is contributing to the CHF, surgical procedures to open these arteries (angioplasty, stenting and coronary bypass) may be necessary. Other surgical treatments, depending on the underlying cause for the failure, include heart valve repair or replacement, correction of congenital heart defects, and pacemaker insertion. The diagnosis of Congestive Heart Failure is not synonymous with a death sentence. In most cases, CHF can be managed with improvement in symptoms and in quality of life.

There are many types of heart disease. Issues concerning heart disease are extremely important and should be diagnosed early if you feel that you are suffering from any symptoms. To not take action is life threatening. Make sure that you keep a healthy regimen and see a primary care physician on a regular basis. At some point, you may wish to take a stress test to make sure that your heart is in good shape. A healthy heart means a healthy life.

Until next time. Let me know what you think.