Flat-Belly Foods (Diet & Fitness teacher)

If you have been wondering how to lose your stomach fat fast, then the best way is to start eating foods that burn belly fat along with regular exercise.
There are foods that have been shown to help people burn fat. How? some foods can burn more calories to digest than the food itself, which helps your body burn stored fat, other foods can speed up your metabolism so you can burn fat fast and some foods can make you feel full on fewer calories.
Here is a list of healthy belly fat burning foods
Organic apple cider vinegar
Drinking a small amount of organic apple cider vinegar before meals can help burn belly fat fast. Mix 1-2 teaspoons of organic apple cider vinegar with a glass of water or with 1-2 teaspoon of honey and take it before every meal. It speeds up your metabolism, helps Control weight, helps lower bad cholesterol, helps lower blood sugar levels and cleanse the body of toxins.
Almonds
Eating a handful of six or more raw or roasted almonds everyday can help you lose belly fat. Almonds have high fiber content and low calories.
Almonds are loaded with protein, calcium, magnesium, potassium, vitamin E and other antioxidants.It can help reduce heart disease risk, help lower cholesterol levels and help the body to maintain a normal blood pressure.
Grapefruit
Eating grapefruit can help you burn belly fat.
Researchers at Scripps Clinic found that participants who ate half a grapefruit before each meal lost an average of 3.6 pounds in 12 weeks
Grapefruit has a high fiber content, low-calorie fruit and it is loaded with vitamin C, It contains cancer-fighting compounds and it reduces insulin levels.
Green tea
Green tea is good for losing belly Fat. Researchers found that green tea antioxidants known as catechins raise the metabolism and help burn fat faster.
Other Studies have shown that drinking two to four cups of green tea every day can help you burn 17 percent more calories. It contains potent antioxidant properties that maintain LDL cholesterol levels and sugar levels in our blood, drinking green tea everyday promote your heart health as well.
Chilies or cayenne pepper
Cayenne pepper is one of the best fat burning spices; it contains capsaicin, that helps speed up the metabolism and therefore burn more calories after eating.

My Diet and Fitness Routine

Diet And Fitness Programs

Diet refers to the intake of food and nourishment for the growth and maintenance of the body. Dieticians or nutritionists consider a diet as a balanced meal that contains appropriate portions of all nutrients. A good diet helps a person to maintain good health. Fitness is the overall well being of the body. Diet is a therefore an important part of fitness.A good diet is one of the means to fitness and in turn, good health. Fitness programs include a combination of exercises and a balanced diet. Both these aspects go hand-in-hand and hence, fitness cannot be achieved by following only one of them.

A fitness program that is beneficial on a long-term basis always incorporates diet suggestions. Research has proved that by following a diet, the food a person ingests is burnt up only through exercise. With recent studies showing that most people lead an inactive life, fitness programs that include stretching and aerobic exercises can help the body keep its mobility. Programs that lay emphasis on weight loss also suggest routine workouts for faster results. "Low carb" diets are also popular with weight loss enthusiasts. However, doctors and medical practitioners indicate that weight loss can be maintained only if the person has sufficient exercise.
Increase in physical activity is of prime importance in any fitness program. If work schedules and lifestyle do not permit it, it is advisable to visit a fitness center at least thrice a week. Exercise helps the body to increase immunity levels. It also increases stamina for a more active life. For people suffering from chronic diseases such as arthritis, physical mobility is a must. Exercises help them minimize disability due to such disease.
Fitness programs that combine physical activity with diet are more advantageous for a lasting effect on health. These fitness programs have in house nutritionists, doctors and psychologist to help participants at each step. These fitness programs not only help in weight loss but also promote a healthier lifestyle.

Healthy Lifestyle

Here are 8 benefits of a healthy lifestyle.
This Article is written to reach the public with a simple and clear method to point out and to reap the benefits of a healthy lifestyle while reducing the risks of chronic diseases such as diabetes.
With the increased understanding of our bodies that we have gained from science over the past few decades, the benefits of a healthy lifestyle are becoming more apparent, along with the reasons why we should detoxify the body at least once a year to remove harmful bacteria, and even worms, from our digestive system. For people of all ages, weights, and abilities the benefits of a healthy lifestyle are endless. But for now let's look at eight simple benefits of a healthy lifestyle.
1. Your Health:
Good Health is not something that you buy from a drug store or a department store, but can be achieved by practicing collective patterns of health-related behavior, based on choices made from available options. Following this logic, if you wish to realize the benefits of a healthy lifestyle, you have to repeat some healthy pattern as a part of your daily or weekly activities, some patterns like eating right and exercising. Other benefits includes: Reduced health care costs, reduced illness and injuries, reduced doctors visit, Keeps you employed and improved employee/employer relations.
2. Weight:
Managing your weight is the key to attaining all of the health benefits of a Healthy Lifestyle. A weight reduction of just 10 percent will significantly reduce risk of heart disease and other obesity-related illnesses. Obesity/overweight is the second leading contributing factor to many childhood diseases such as orthopedic disorders, sleep apnea, type II diabetes mellitus, asthma, high blood pressure and cholesterol, skin disorders, emotional and psychosocial problems (Spigel, 2002), and many more. Weight-bearing exercise such as walking and strength training helps slow the onset of and/or prevent osteoporosis and some research shows that participating in such activities can actually build bone density and begin to reverse the disease. Other benefits are: Weight reduction, reduced tension and stress, improved well-being, Enhanced self-image and self-esteem and improved physical function.
3. Exercise:
Although drugs alone can often bring cholesterol down to normal levels, diet and exercise provide benefits that drugs don't. They'll lower blood pressure, reduce weight, and lower the risk of developing diabetes. A sedentary lifestyle is a dangerous risk factor for disease. Exercise and a healthy diet helps the body use insulin more efficiently and can help control, alleviate and prevent many diseases. Exercise, cessation of tobacco consumption, eating a high-fiber, low-fat diet, controlling body weight, and learning to cope with stress, reduce the risk of heart disease.
4. Medical:
We all want a trim and have healthy body for a variety of aesthetic, social and medical reasons. Healthy living is truly the best medicine. In a study conducted by Tufts University at the New England Medical Center, among patients with cardiovascular disease, an exercise program was shown to significantly reduce LDL cholesterol and other risk factors beyond what's provided by drug therapy. Even modest weight loss can help reduce medical and pharmacy costs, help avoid bariatric surgery, and co-morbidities such as asthma, hypertension, and diabetes.
5. Wellness:
Wellness is about being comfortable in your space: your body, your attitude, and your environment. A healthy lifestyle can greatly increase a person's longevity. And even though catching something contagious like a cold or flu is sometimes unavoidable, having the wisdom that feeling healthy is a better way to live should have you asking yourself why you are not taking action to live each day as beneficially as possible. The issue with a lot of people nowadays is that they are so busy working and/or taking care of everyone around them, that they neglect their own health and wellness. Make sure your heart is healthy and your bones are strong and Keep it that way to see the benefits of a healthy lifestyle.
6. Care:
The best way to ensure good health is by taking care of yourself. The Care stakes are high but the potential rewards are great-preventing premature death, unnecessary illness, and disability, controlling health care cost, and maintaining a high quality of life into old age. With a healthy lifestyle, you are who you are and you don't have to be self-conscious about those things that you otherwise would be if you didn't care about your lifestyle
7. Control:
With a healthy lifestyle, you have more control of your life as you work with your body against those aspects of living which may work to hold you back if you would let them. With a healthy lifestyle, you have control over your sleep patterns so that you feel generally well rested throughout the day. With a healthy lifestyle, everything works together to help other aspects of your lifestyle make sense and benefit you. Science has proven that healthy weight loss, healthy eating and fitness routines make dramatic improvements in health, and help control common chronic illnesses like high cholesterol, high blood pressure, diabetes, stress, and general lack of stamina.
8. Strength:
Another benefit of a healthy lifestyle is a steady flow of stamina and strength; you can perform activities and exercises that will enhance your flexibility. With a healthy lifestyle, you have a balanced and varied diet that provides your body its needed nutrients and energy as well. You have strength to train to help build the muscle that supports the bones and joints; therefore decreasing the risk of falls and fractures. Cardiovascular exercise, also known as aerobic exercise, strengthens the heart muscle, therefore increases the heart's efficiency. As we age, our bones biologically begin to lose mass and strength. Weight-bearing exercise such as walking and strength training helps slow the onset of and/or prevent osteoporosis and some research shows that participating in such activities can actually build bone density and begin to reverse the disease.

Make Healthy Food Delicious

Nutrition counts especially when it comes to protecting the health of your visual system. For instance, It aids in the prevention of a series of vision conditions and eye diseases. An example of a vegetable that fits into this category is the Carrot. Carrots are an important part of your daily diet for healthier eyesight. From that point of view, if you are interested in foods that are good for your eyes, here are a variety of reasons why Carrots are a beneficial addition to your nutrition plan.
1. Protects Eyesight: Carrots are among the various foods for eyesight rich in Vitamin A, which according to scientific research, may prevent the age related vision disorder called macular degeneration. This particular vitamin helps the part of the eyes called the macular which is responsible for improving visual acuity (sharper eyesight). As we age the normal function of the macular begins to decline significantly. According to drvita.com, a deficiency in this vitamin may lead to blindness. The AMDF: The American Macular Degeneration Foundation states that macular degeneration is the leading cause of blindness in the United States affecting more Americans than cataracts and glaucoma. Consumption of just 1 serving of Carrots per day can actually decrease your risk of developing this vision disorder by 40%.
2. Prevents Cataracts: Research suggests that the Carotenoids in Carrots especially Beta - Carotene, may aid in the prevention of cataracts. Cataracts are formed when the eye lens becomes cloudy. This causes a blockage of light entering the eyes which may lead to blindness. Eye surgery procedures can correct this problem. However, as the saying goes, an ounce of prevention is better than cure. The preventative nutrition that carrots supply the eyes helps you to avoid the expense and the risk associated with eye surgery. Carrots supply the eyes with the right nutrition that prevents cataracts from developing in the first place.
3. Prevents night blindness: This food for eye health consist of Vitamin A that helps improve night vision. A deficiency in Vitamin A causes night blindness. This negatively affects your ability to see clearly at night and in dim light. Even though your ability to see clearly at night diminishes with age, Vitamin A can help to either slow the progression of poor night vision or even prevent this vision loss. Always consult your eye care physician to determine both the correct dosage of Vitamin A needed to suit your individual needs, in addition to whether or not there are any underlying medical conditions affecting your eyesight.

Fitness & Nutrition : How to Prepare a Healthy Diet Food Plan

Many workout and fitness plans get derailed by some common mistakes and bad habits.
Be careful to avoid these...
Failing to fuel your body with sound nutrition -- Nutrients are key to the regeneration of muscles. Your body needs protein and vitamins... not excess fat and junk food. Make sure what you take in each meal furthers your fitness goals, rather than hamper them. Go with lean meat, fruits and vegetables over processed and fatty foods. Make sure you eat regularly to keep your metabolism moving and to maintain energy for those workouts. Plan your meals like you plan your workouts if possible. It matters just as much.
Being active only during workouts -- Most of us live sedentary lives. Workouts become harder to stick with when they're the only time you're physically active. Sitting around slows circulation and fat burning, counteracting your workouts. Do more outside the gym. Park the car and walk more. Play sports. Play with your kids or dog. Add hobbies and get out more. Or stay in, clean up the yard or pick up around the house. It's true what they say about bodies in motion -- tend to stay in motion, and that's a good thing.
Drinking sports drinks instead of water -- Sports drinks contain electrolytes. They also contain sugar, and not the good kind. Most sports drinks contain high fructose corn syrup, which sends your liver into overdrive to process the high sugar concentration, storing anything else as fat. Check the labels of sports drinks to avoid the extras that you don't need, and only drink sports drinks when you need them -- they're not meant to quench your everyday thirst. Unless your workout is intense -- and we're talking marathon-intense -- you probably don't need a sports drink. If you need some flavor, try a spritz of lemon or lime. You may also try infusing your water with fruit (berries, pineapple, cucumber, orange, etc) to add flavor but no calories to your drink. Give them a try.
Working out without focus and efficiency -- A good cardio session can take 20 to 30 minutes. Keep in mind that cardio doesn't only mean running, jogging or an exercise machine either. Dancing is a form of cardio also! A good weight workout can take 30 to 45 minutes. That 60-second rest period becomes 3 minutes if you don't watch the clock, making a 30-minute workout last more than an hour. Keep moving throughout the workout to completion. Too long of a rest period can decrease your workout's effectiveness.
Working out without a battle plan -- Some people walk into the gym and wing it -- with no sense of how well they're working out all their muscles, and then wonder why they don't make progress. Write down a workout plan: Map out all your workouts to the set. Figure out your goals and set a plan to get there. Read books for ideas if you must, or take advantage of the trainers the gym makes available. The trainers can advise you on proper form, the right machines for you, the frequency of your workouts and so much more. The cost of one or two sessions is well worth it when you consider the invaluable advice you'll get. Stick to your plan, and keep notes. A good plan allows you to monitor your progress.
Doing incomplete workouts -- Doing cardio alone doesn't develop fat-burning muscle like weights do. Focusing on chest exercises shortchanges other muscles that now have to compensate to balance an overdeveloped chest with your body. You don't have to work out every muscle group every day. Alternate upper and lower body workouts, and mix up heart-strengthening cardio with strength training. Stay balanced, and your body will show the results.
Failing to push yourself-- Pushing your body as reasonably far as possible is the key to making progress. An un-challenging 20-minute cardio session or easy sets don't test your body. Make sure once you start finding sets easy that you increase the weight to continue meeting your goals.
Failing to vary your routine -- Once your body accustoms itself to a routine, your growth slows, this is also referred to as a plateau. A workout strengthens your body by taking you beyond your comfort zone. Change exercises in your workout plan periodically. Switch your cardio from the treadmill to the exercise cycle. Use a barbell instead of dumbbells for those bicep curls. Take a class you've never tried --there's something for everyone offered in most gyms these days. Don't be afraid to take your workouts outside the gym also!
Trying to do too much at once -- Enthusiasm can push you into doing too many sets, lifting too much or running too long. At best, your body's extra soreness hampers future workouts, but injury is the true risk. If you push your body too far, it breaks.
Working out without stretching -- Stretching beforehand prevents muscle cramps and injuries by loosening up your ligaments and muscles. Stretching after workouts loosens up your muscles and ligaments, promoting healing.
You also want to get enough rest between workouts to let your body heal. Your body needs time to repair the damage a workout does. Alternate days of strength training -- do upper body one day, lower the next. This way, you'll be sure to minimize damage. A little soreness is OK. After all, the tiny tears in muscles that result from working out create mass as they're repaired. The most important thing to remember to do after a great workout is to nourish your body with protein, which helps to repair the muscles.

My name is Felicia Starks and I am a certified personal fitness trainer and lifestyle weight management specialist. My passion is optimum health & fitness as well as financial freedom and my mission is inspire and empower people to live a fit & healthy lifestyle while taking control of their own financial future. You've come to the right place if you need to lose belly fat and bring your sexy body back but you are...
Tired of working out hard and long yet seeing little to no results?
I'll provide practical fitness tips and recipes to help everyday women shrink fat effortlessly with or without a gym membership.
"You don't have to get it right, just get MOVING!"

A HEALTHY FOOD PLATE

Take a look at your plate the next time you have a meal. It will most probably be more than half a plate of cereals - rice or chapathies-  along with rasam, buttermilk, pickles, pappads, chips and deep fried vegetables,a starchy vegetable, dhal, whole grams or maybe a few pieces of meat and a bowl of  something sweet. Eating this way will increase insulin resistance, lipid levels, and weight. It also becomes difficult for the body to control its blood sugar levels, and this increases the risk of diabetes complications. 

By changing the proportions of food on your plate,you can improve your health and trim your waistline. This will help you manage diabetes better.The American Diabetes Association recommends that half the plate should include non- starchy vegetables, one quarter should be filled with lean protein, and the other quarter should have some additional carbohydrates. This visual dietary control is called the ‘Plate Method’. You do not have to measure your food accurately. Just fill your plate to match the prescribed dietary proportions.

The Plate Method for healthy living and controlling diabetes has become quite popular. It is an easy and helpful way to plan meals for everyone, especially for those who wish to gain better control of their blood sugar levels, blood pressure and / or body weight. 

First:  You need to choose a plate. Plate sizes have grown over the years. An ideal size is 9 inches wide, no wider.

Second:  Fill half the plate with approximately 2 cups or more non – starchy vegetables An easy way to meet this requirement is to eat one bowl of salad along with your side vegetables.

Cabbage 

Broccoli

Carrots

Tomatoes 

Mushrooms

Cucumbers

Spinach

Greens (all varieties)

 Beans 

Cauliflower

Third:  Your plate should provide approximately 45 to 60 grams of carbohydrate, Choose whole grains over processed and refined grains. 

Whole Cereals

Rice 

Whole wheat Bread 

Potatoes

Yam

Tapioca

Fourth:  Fill the other quarter of the plate with protein such as :

Chicken

Fish

Egg

Lean meat

Dhal and whole grams,  nuts

Dairy products

Fifth: There are two more items. First, is a small glass of low fat or skim milk or small cup of yogurt  and next is a small piece of fruit 50 to 100 gms.

THE PLATE METHOD…

Strategies for changing eating habits in diabetes:

Avoid sugary drinks, added sugar (e.g., honey, brown and white sugar),  avoid high fat cooking methods ( i.e., shortening, butter, hydrogenated oil, margarine), use low fat oils ( e.g., olive, canola, safflower, etc.), eat less salt, eat lean cuts of meat, eat regularly. Use healthy cooking methods like steaming or boiling or stir- frying.

The Plate Method provides the following benefits:

• An eating style that is nutritionally sound

• A lower fat intake

• Improved carbohydrates distribution

• A greater intake of fiber

• More fruits and vegetables (antioxidants and photochemical)

The Plate Method works anywhere:

This approach also works well when eating out. Just visualize how the foods would fill up your plate. If you are lacking in vegetables, order up a salad. And if the meat portion looks too large, share it with someone.

Your diet can improve your health 

With the plate method, your meals will be high infibercontent and low in saturated fat, cholesterol and carbohydrates. It will…

• Maintain blood glucose and lipids as near normal as possible

• Provide appropriate calories for weight loss or weight maintenance

• Prevent or delay diabetes related complications through decreasing your risk of heart disease and    stroke

• Improve overall health through optimal nutrition

Plan your plate with your dietitian.

A Look At Health Food Through Heritage

The belief that picking superior foods may help these wanting a healthier life-style has damaged many civilizations during history. The concept of health food draws from moral, strict and political guidelines, although it is widespread understanding that a specified number of nourishment is vital for one to keep to call home. The ingredients one selects could disclose a lot about his lifestyle and beliefs. Moreover, it discloses values concerning the romance of what one eats and well being. With the variety of healthy food vendors popping out nowadays, employing websites like OrganicFinder can certainly help a whole lot.
In many destinations in the world today, the concern is not with all the quality of nutrition, but finding enough to provide nutrition to permit one to endure. Generally in most of the globe, people challenge to get enough to eat. Nevertheless, in richer countries, there is more matter regarding quality-of products taken.
The matter for better-quality foods has sources from your Jewish and Christian scriptures, where Jewish dietary regulations were viewed as a a part of a covenant with lord. The nutritional constraints were implemented to set apart the Hebrew folks from these inside the lands where they existed. These limitations were quite step-by-step, but did not enable the person to take such foods as rabbit, pork or shellfish.
Comparable varieties of constraints are observed in lots of different communities as well. The Pythagoreans averted eating legumes. The Hindus continue steadily to avoid consumption of meat. Pork is averted by both the Jews and the Muslims. In certain offices of Catholicism, the Sisters declare to occur simply to the Sacraments of bread and wine. Health limitations present protection for your voter from spiritual as well as physical hurt.
As technology started to focus on diseases caused by nutrient insufficiency, there is a returned focus on the grade of meals one's consumed. This result in the development of supplements. Products, such as for instance cod liver oil were suggested to improve the health of children from the 1920s.
Later developing spiritual sects, including the Seventh Day Adventists and Mormons taught their followers to avoid products for-a better lifetime and well-being. These incorporated alcohol, tea, espresso and cigarette. The rules were trained to guard the temple of-the human body.
Outside strict communities, there's been an increasing interest in reducing meat in vegetarianism. Some have become part through consideration for animals and others for political causes. The others follow the practice to boost balanced eating. One of the very contemporary choices would be to minimize one's diet to cereal grains in addition to seasonal develop from the nearby spot as health-food. Click here to see the set of organic food firms in your area.

Oral Hygiene Prevents Health Problems

Most of us know that oral hygiene is critical to healthy teeth, white smiles and first impressions. But not nearly as many are familiar with the extreme consequences of what can happen if you don't take care of your mouth.
Most individuals have some inflammation of the gums -- i.e. gingivitis -- that goes unchecked. A study published in the National Library of Medicine reports that 10 to 15 percent of adults will develop severe periodontitis, which is an advanced form of gum disease that begins to deteriorate bone, too.
"Gingivitis has always been a major concern for the public," explains Dr. Harold Katz, a bona fide dentist to the stars, who founded the California Breath Clinic in Beverly Hills. Katz, also a bacteriologist, has a legacy of oral care research, including creating the high-quality line of TheraBreath products (therabreath.com).
"But more studies are emerging that support the idea that dental health can reflect your overall health, too. Gum disease can contribute to an increased risk for heart disease, and it can worsen diabetes. Bad oral hygiene may even be a risk factor for dementia," Katz added.
According to Katz -- as well as mounting medical research -- poor oral hygiene can lead to many physical problems. The Journal of the American Geriatric Society just released a study showing that elderly people who brushed their teeth less than once a day were up to 65 percent more likely to develop dementia, compared to seniors who brushed daily.
Dental check-ups can also point out other areas of concern among pregnant women. A professor at the European Society of Human Reproduction and Embryology's annual meeting suggested that gum disease can affect healthy conception much like obesity. Plus, pregnant women have a 65 to 70 percent chance of experiencing pregnancy gingivitis, where gums develop exaggerated inflammation and plaque buildup due to fluctuating hormones.
Expectant mothers with gum disease even suffer a higher risk of a premature birth. But oral hygiene can work toward prevention, too. Reuters Health just released findings that indicate pregnant women with gingivitis who use mouthwash have more of a chance of carrying their baby to full term.
Another study recently presented to the American Heart Association revealed that patients who received routine teeth cleanings had a 24 percent lower risk of heart attack than those who didn't maintain regular dental care.

Fruit for People with Diabetes

Mrs.Sheela Paul &Ms.Rohini, - DietitiansDiet Department.



 

























People with diabetes should avoid fruits as they contain “a lot of sugar”.This is not true. 

Fruit has been enjoyed by mankind from the very earliest of time. In terms of nutrition, fruits form one of the food groups in the daily diet and are very good sources of several vitamins, minerals, electrolytes and

Kudos to The New York Times Magazine for Examining the "Feel-Good War" on Breast Cancer!

In last week's The New York Times Magazine, Peggy Orenstein wrote an article called "Our Feel-Good War on Breast Cancer".  The piece is lengthy but well researched, insightful, and well worth the reading time.

Peggy, a breast cancer survivor herself, hits every key public health issue- cancer screenings, treatment options, "awareness" raising, message framing, funding, and research.  As someone who has been critical of "awareness" raising, I was happy to see the issue discussed front and center.  For me, her interview with Dr. Gayle Sulik (Sociologist and Founder of the Breast Cancer Consortium) was the most striking.  A key quote from Dr. Sulik (I added the bolding):

“You have to look at the agenda for each program involved.  If the goal is eradication of breast cancer, how close are we to that? Not very close at all. If the agenda is awareness, what is it making us aware of? That breast cancer exists? That it’s important? ‘Awareness’ has become narrowed until it just means ‘visibility.’ And that’s where the movement has failed. That’s where it’s lost its momentum to move further.”

Peggy also tackles the issue that is an ongoing challenge in public health and medicine:  screening.  Screenings are tests that look for diseases before you have symptoms.  Ideally, screening will identify diseases early when they are easier to treat and have better outcomes.  For breast cancer, the key screening test is a mammogram (x-ray of the breasts).  However (as Peggy points out), we seldom hear about the research that demonstrates limited effectiveness of mammograms for reducing cancer death.  This is not the research cited in the communication materials from advocacy organizations.  We also tend not to hear about the negative side effects of screening large segments of the population.  There can be false positive tests: which subject the patient to unnecessary medical intervention and emotional distress.  There can also be over-treatment for the detected cancer, even if it turns out to be a non-aggressive tumor.

When I was working in suicide prevention, one of the best articles I read was "Screening as an Approach for Adolescent Suicide Prevention" by Dr. Juan Pena and Dr. Eric Caine.  The authors dedicate a section of the paper to key decisions and tasks to resolve before implementing a screening program.  While the public health issue and screening tests are different, I believe many of their decision points are generalizable to almost any health issue.  The table presenting these decisions and tasks is a great reminder to public health professionals and clinicians that recommending and undertaking a screening program should be strategic and the decision should be re-visited regularly.  For example, the authors highlight:

• Key Decision:  Population and Setting- Is the screening program consistent with the target population's community or cultural values?
• Key Decision:  Screening Instrument- What will be the false positives and false negatives rates in the population to be screened?  Are these rates acceptable?
• Key Decision:  Staffing and Referral Network- Are there effective treatments available for the types of conditions being screened for?
• Key Decision:  Quality Assurance- How will the screening program be monitored to ensure that protocols are followed?
• Key Decision:  Legal and Ethical Issues- Has sufficient informed consent been given to parents and youth about risks, benefits, and limits of screening?

Going back to the "Feel-Good War" article:  I like that Peggy did not just point out all the flaws in our current breast cancer screening and treatment systems.  Instead, she invited her interviewees to recommend potential improvements.  Some ideas were noted in two key areas:

• Message Re-Framing:  Rather than offering blanket assurances that “mammograms save lives,” advocacy groups might try a more realistic campaign tag line. The researcher Gilbert Welch has suggested this message, “Mammography has both benefits and harms — that’s why it’s a personal decision.”

• Funding Re-Distribution:  Peggy asked scientists and advocates how some of that "awareness" money could be spent differently. She highlights the February recommendations of a Congressional panel (made up of advocates, scientists and government officials) that called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities. 

Tell Me What You Think:

• What do you think about the "pink culture" or awareness raising around breast cancer?  Will it effectively lead us to our goal of prevention?
• In addition to message re-framing and funding re-distribution, what else would you recommend to help improve the approach to breast cancer prevention, screening, and treatment?

"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

Social Media: Providing Connections, Voices, Adventures to Many with Chronic Illness

I am in awe of social media.  

I am in awe of it in my professional life.  I have connected with colleagues all over the world who share my passion for public health, health communication, blogging, pop culture- you name it.

I am also in awe of it in my personal life.  As someone who lives with a chronic illness, I have connected with others who suffer from similar symptoms, offer support, advocate for patient rights, and recommend creative solutions to balancing work and life.

In the past month, I have been struck by several examples of how social media is transforming the lives of people with chronic illness.  Without the networks available within social media, many of these people may have been very isolated due to their conditions.

On March 11, 2013 NBC Nightly News with Brian Williams ran a story about Virtual Photo Walks.  The project's tagline is "Walk the walk for those who can't".  Using the social media platform Google+, Virtual Photo Walks enables people to become "interactive citizens" again.  They connect with smart phone enabled photographers to "travel" and see places and people that they used to see...or always wished that they could.  The news story profiled a woman with Lupus who could not travel due to her serious health condition.  She always wanted to go to Italy and with Google+ she did.  We watched World War II veterans no longer able to travel, "visit" the USS Arizona Memorial through the collaboration of photographers and Google +.  It was incredible to watch.    

On April 5, 2013 CNN Tech ran a story called "On Twitter, Roger Ebert Found a New Voice".  The story describes how Roger became an avid twitter user in 2010, years after cancer had silenced his voice.  He wrote, 

"Twitter for me performs the function of a running conversation. For someone who cannot speak, it allows a way to unload my zingers and one-liners".

As someone growing up in the 80's, I regularly watched "Siskel and Ebert and the Movies".  Keeping up with Roger through twitter and his blog "Roger Ebert's Journal" in recent years has been a seamless transition.  I felt like the show never ended.  I kept up with his running commentary and of course- his movie reviews.

Sustaining your presence in the world is important with a chronic illness.  I felt that point strongly when reading his final blog post, "A Leave of Presence".  

"What in the world is a leave of presence?  It means I am not going away".  

Please Share:

• What creative ways do you see social media being used to support those with chronic (or acute) illnesses?
• Why do you think these communication channels are so effective in "sustaining your presence"?

Writing Public Health Blogs: Do We Get Back What We Put In?

Last week I attended a great webinar hosted by AcademyHealth called: “Traditional and New Methods for Disseminating What Works”.  One of the speakers was Dr. David Kindig and he touched on the evaluation component of writing a public health blog- do we get back what we put in?  As the tweet below indicates, this is an important question for all of our blogs.

My exploration of this question nicely coincides with the theme for this week’s National Public Health Week- “Return on Investment”.  I was initially going to write just my own thoughts, but then decided it would be a much richer piece if I could incorporate input from other public health bloggers.  The following colleagues were kind enough to send me their thoughts:

Jim Garrow: The Face of the Matter, Public Health Memes

Elana Premack Sandler: Promoting Hope, Preventing Suicide for Psychology Today

Jonathan Purtle: The Public's Health for the Philadelphia Inquirer

Michael Siegel: The Rest of the Story: Tobacco News Analysis and Commentary

Thomy Tonia: International Journal of Public Health-Blog 

1. How much time do you dedicate to your blog per day/week/month?

Jim: I wish I could post more blogs per week; right now I'm averaging about a post a week (sometimes it'll be 3-4 posts in a week, sometimes no posts for a few weeks in a row). Each post takes about an hour between research, linking and writing. And I've got to be constantly on the lookout for new and time-relevant material.

Elana: When I was writing weekly, I spent 3-5 hours a week researching, writing, editing, and posting (using the content management software, sometimes the hardest part!). I have a background in journalism, so I'm able to write and self-edit relatively quickly. Now that I'm posting only once a month, I probably spend 5-7 hours a month between culling through stories of interest, thinking about the relevance of various topics, writing, editing, and posting. It's actually more challenging to post only once a month, as I get out of practice and have more material to comb through to see what rises to the top.

Jonathan: On average, a 500-750 word post takes me 4-5 hours. I currently post twice a month. I used to post weekly, but the time burden was too much. 

Michael: Approximately one hour per day, mostly devoted to writing my daily posts.

Thomy: I blog as part of my job as an Editorial Assistant/ Social Media Editor for the International Journal of Public Health. When I was focused only on the blog, I dedicated about 4 hours per week (divided between blogging and visiting other blogs/public health sites- to get ideas, keep informed and interact). Since I now also manage the twitter and Facebook accounts, I have reduced my blog time to 2-3 hours per week. 

Leah: I spend about 5 hours on each blog post- between finding the story, writing, and marketing the posts on social media. Since I try to address topics that are hot in the news that week or that day (like Jim says above), I'm constantly on the lookout for relevant stories.  Throughout the week I save all my possible stories/links/ideas on a spreadsheet and pick the best one.  While my posting frequency has varied over the past three years of writing Pop Health, my goal is to post at least once per week.

2. Who is the audience for your blog?

Jim: The blogs that I write are written for professionals in the fields of public health and emergency management. My thought is that I can affect more change by finding and teaching best practices to the people on the ground actually working with the public.

Elana: My blog is read by mental health and public health professionals as well as laypeople interested in psychology, mental health, pop culture, and suicide prevention. Since I blog on a site that does a lot of promotion for itself, I have a relatively wide readership. Each post can generate 500-2000 hits; I haven't done any real numbers-running, but 100-300 hits on the day the post is published is probably average, and then each post accrues hits over time.

Jonathan: The general public in Philadelphia and surrounding areas. Given the size of the health care sector in the region, I like to think health professionals read it as well. I also dream that policy makers read it—although I’m not sure if either health professionals or policy makers read Philly.com.

Michael: Incredibly diverse audience of anti-smoking advocates, groups, and researchers, smokers’ rights advocates, government agencies, tobacco companies, newspaper reporters, stock market analysts, consumers, trade groups, and policy makers.

Thomy: Originally, our intended audience was mainly public health students, as we are affiliated with the Swiss School of Public Health. However, especially through social media, our audience seems to be not only public health students and professionals but also people who just have an interest in public health. Nevertheless, it is not easy to know exactly who our audience is, as we do not get a lot of comments and it is difficult to know who actually reads the blog. We try to engage people to write guest posts for us. This generally works quite well.

Leah: I write for a broad public audience with an interest in public health, pop culture, or both. Therefore, I use it as a platform to breakdown and explain public health/communication concepts (e.g., "teachable moments"; "cue to action"). From the analytics, emails, and comments that I receive, I know that I have a large following among public health professionals, students, and teachers.  I have heard from more than one faculty member to say that they use my blog with their students to demonstrate the connection between public health and their everyday lives (e.g., movies, magazines, advertising).

3. What is the ideal “return/s on investment” for your blogging efforts? 

Jim: I've been writing blogs relevant to public health and emergencies for more than six years. I've found it to be one of the best investments I've made in my career, even with the huge investment in time and effort required for success.  I've found that the best return I've realized is my network of contacts and friends across the country and around the world; none of whom I would've met without being available and "out there" online.

Elana: For me, the ideal return on investment is reader engagement. I really get a lot out of seeing reader comments (the good and the not-so-good) and corresponding with readers via the comments section, or with friends and more personal connections on Facebook when I promote my posts there.

Jonathan: The ideal return is three-fold: (1) A public which understands that health is about more than just individual choices. A public which begins to see the reverberating impacts of social/economic policies, beyond the health care sector, on people’s health. A public which is knowledgeable about trauma theory and research on trauma/stress. (2) Networking. (3) Increased readership. While this is the most measurable, I’m not convinced it means all that much. Who’s reading? How are they reading? How is the information changing their perceptions? Is it at all? We have no idea.

Michael: The ideal “return on investment” is the blog having an actual impact on public policy.

Thomy: Increasing readership and dissemination of ideas is always a good return. We would ideally like to have more engagement in the form of interaction (e.g., comments). Networking is also quite satisfying and really helps broaden our blogging horizons. As a public health journal, we are also interested in disseminating our research articles.  I personally would like to see more and more public health students, researchers and professionals having blogs and engaging in social media to learn new things, disseminate their knowledge, “meet” interesting people and also –why not- for the fun of it!

Leah: Pop Health began as a hobby that just happened to incorporate my field of public health.  Now it has become a key part of my professional portfolio.  Therefore, the key returns are now different than three years ago.  Now, I'm looking for increased readership and referrals to my site.  I'm looking for increased dialogue with readers and colleagues.  I'm also looking for new and exciting professional opportunities (e.g., guest blogging, writing, and teaching) that can emerge by branding my expertise in this niche of public health.

4. Do you measure these “returns”?  If so- how?

Jim: I've seen a tremendous benefit professionally. As a direct result of my online identity and interactions, I've been invited to more than a dozen international, national and regional conferences to speak on those topics I blog about.  But even beyond those personal returns, I've seen a tremendous benefit professionally. Not only am I able to call on friends I've made around the globe to help with ideas for work, but I've grown as a result of being forced to flesh out my ideas. When I write about something, I want it to be well thought-out and considered. By writing these ideas out, I am forced to consider not only my idea, but how it affects other, larger problems...Without writing it out, I would just have a nugget of an idea, no more than that.

Elana: I measure this ROI very unscientifically. I notice which topics generate more interest (both in terms of hits, which are tracked by Psychology Today, and comments) either on the Psychology Today site or on Facebook. I've wanted to get more sophisticated with Google Analytics, but can't do that as I don't actually manage the website that hosts my blog. I've also enjoyed meeting people at professional conferences who recognized my name because of my blog. That really blew me away - it meant that I was really reaching people (not just my Mom!).

Jonathan: Philly.com tracks usage statistics and sends them to us on a weekly basis. Posts on animals, kids, and pop culture typically do the best.

Michael: Yes, but not formally. I assess the actions of public health agencies and organizations to determine whether the blog seems to be changing their thinking about these issues. I also assess the state of public opinion in the field regarding these issues.

Thomy: We keep track of visitors, time spent on blog (etc.) via Google Analytics and StatCounter. We also monitor the most popular posts and try to have some ongoing themes corresponding to these popular posts.  Regarding the “return on investment” to the Journal, we are trying to monitor whether articles that have been featured in the blog are downloaded more often from our website.

Leah: I have used Google Analytics and Blogger Statistics for measurements like page views, referring sites, and key words used to find Pop Health. I also take note of the posts that stimulate more engagement with readers- I would note that more dialogue seems to take place directly on social media where I market the posts (i.e., Facebook & Twitter) vs. the comment section on the blog itself.  As a result of the blog, I have also been invited to guest write on other sites like The Public's Health- so tracking those opportunities helps me to measure return on investment as well.

Evaluation and Return on Investment are key concepts in public health

With public health professionals constantly being asked to do more with less, it is imperative that we show how our investments are paying off. It is important to think of "investments" broadly- they are not just money...they are our time too.  As you can see from the responses to question #1, creating and maintaining a blog is a huge commitment.  And although we write for a variety of audiences with different goals (ranging from promoting research to trying to impact policy), we share the challenge of trying to evaluate those goals.

Therefore, we need to lead ongoing dialogue about the goals and evaluation of public health blogs. CDC's National Prevention Information Network (NPIN) is continuing its "In the Know: Social Media for Public Health" webcasts this spring and the June 4, 2013 event will focus on Measurement & Evaluation.  I look forward to continuing this discussion there and elsewhere.

Thank you again to Jim, Elana, Jonathan, Michael, and Thomy for your contributions!  I appreciate you making the time and sharing your experiences.

I would like to invite other public health bloggers to weigh in on these questions:  

• How much time do you dedicate to your blog per day/week/month?
• Who is the audience for your blog?
• What is the ideal “return/s on investment” for your blogging efforts? 
• Do you measure these “returns”?  If so- how?

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Seth MacFarlane: An Oscar Host who is Harmful to Comedy and the Public’s Health

This week’s post for Pop Health was co-written by Beth Grampetro, MPH, CHES. Beth has been working in college health promotion for 7 years and her interests include feminism online and in popular culture. You can follow her on twitter @bethg24. 

The role of society is important in public health.  Health is not just influenced by individual decisions and behaviors.  It is also influenced by our interactions with the world around us- our communities, our families, our workplaces, our schools, entertainment, celebrities, and the media.  These interactions can have a very strong influence (good or bad) on the public’s health.

With that in mind, we were horrified to witness host Seth MacFarlane’s monologue and ongoing commentary during Sunday night’s Oscars.  According to Nielsen ratings, approximately 40.3 million viewers tuned in to the Oscar telecast.  This broad audience watched MacFarlane, a widely known celebrity, make jokes about domestic violence, female actresses’ bodies, and various forms of discrimination.

In the opening number, MacFarlane sang a song entitled “We Saw Your Boobs”, about the scenes in various movies where actresses in the audience had appeared topless. While it has been reported that the actresses were in on the joke, it is nonetheless disturbing that this number passed muster- especially given that several of the scenes he referenced were from movies where the actresses he named portrayed rape victims.

Other jokes included a reference to Jennifer Aniston’s past as a stripper, a congratulatory statement about how great all the actresses who “gave themselves the flu” to lose weight looked in their dresses, and a comment about how Latino actors (in this case Javier Bardem, Salma Hayek, and Penelope Cruz) have difficult-to-understand accents “but we don’t care because they’re so attractive.”

MacFarlane also tried some jokes that had men as their targets but still managed to get mud on a few women in the process. He joked that Rex Reed was going to review Adele’s performance (a reference to Reed’s recent movie review in which he called Melissa McCarthy a “hippo”) and made a joke about 9-year-old nominee Quvenzhané Wallis dating George Clooney. Some defenders of MacFarlane’s performance argued that these jokes were meant to be about the men in question, but ignored the fact that they were made at the expense of women and girls.

The Oscars are billed as “Hollywood’s Biggest Night”, and it’s incredibly disappointing to see what is the biggest event for the entertainment industry turned into the worst office party in history, complete with a leering coworker who’s creating a hostile environment.  If MacFarlane succeeded at anything, it was reminding women that they’re expected to always be thin, be pretty, and be willing to shut up and take it, lest they spoil the whole evening.

There is evidence to show that (unfortunately) these types of jokes and messages that devalue women are believed and internalized within our communities.  For example, a 2009 study by the Boston Public Health Commission found that over half of teens surveyed blamed the singer Rihanna after she was beaten by her boyfriend Chris Brown.  In addition, research shows that a mere 3-5 minutes of listening to, or engaging in, fat talk can lead some women to feel bad about their appearance and experience heightened levels of body dissatisfaction.

Research also tells us that these internalized messages and social norms are correlated with serious public health outcomes.  For example, the CDC outlines the risk factors for sexual violence perpetration.  Under society level factors we find (among others):

• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women's inferiority and sexual submissiveness
• Weak laws and policies related to gender equity

So the issue is much bigger than if Seth MacFarlane was funny or made a good Oscar host.  The issue is about the quality of the role models we choose to represent our communities and the messages they send.  These messages can have a broad and long lasting influence on public health.  We hope the Academy will choose wisely next year.

president Promotes ObamaCare Amid Republicans Delaying Efforts

Republican lawmakers are trying hard to block the implementation of the Affordable Care Act popularly known as ObamaCare, which aims to provide affordable coverage for millions of Americans without health insurance. The law also aims to provide more comprehensive coverage and lower costs eventually.

House Republicans have a new strategy to block Obama Care—a compromise to raise the debt ceiling, but they are pushing for a vote to delay the health care law this weekend. Last week, the Republicans forwarded a bill to the Senate seeking to defund Obama Care.
On Thursday, House Speaker John Boehner maintained the position of his fellow Republicans. He said, “The American People don’t want the President’s health care bill.”

President Obama promoting ObamaCare

On the other hand, President Barack Obama is aggressively promoting ObamaCare prior to the implementation of a major provision of the bill on Tuesday, October 1, wherein government-regulated insurance exchanges are set to open.
In his speech at Maryland Community College, President Obama condemned “misinformation” surrounding the law, but he pointed out that Republicans failed in every step they take to stop it. “The closer we got to this date, the more irresponsible folks opposed to this law have become,” according to the President.

What you need to know about Obama Care

Under ObamaCare, most Americans should have health insurance by March 31, 2014. Government regulated insurance “exchanges” will be open for people who do not have health insurance from their employers. Through the “exchanges” people can purchase health insurance from competing insurance companies.
The exchanges will categorize the plans by tiers such as platinum, gold, silver, and bronze. The average cost for a silver plan is around $328 per month. The government will provide a subsidy for those whose incomes are 400% below the poverty level ($94,200 for a family of four) and ($45,960 for an individual).
Insurers cannot penalize people with underlying health conditions. They might be able to save money under the Obama Care if they are currently paying more because of their medical condition. The choice of doctors and hospitals maybe limited compared with their current insurance plans.
Americans who will not be able to buy insurance by March 31, 2014 could face a penalty of more than $95 per adult or 1% of household income in their 2014 tax bill. The penalty will climb to as much as $695 or 2.5% of income by 2016. People paying more than 8% of their income for health insurance and poor adults living in states not expanding Medicaid are exempted.
The health care law does not affect Medicare. Enrollment at government-regulated exchanges starts on October 1, and coverage starts by January 1, 2014.

The compromise: raising debt ceiling, delaying ObamaCare

This week, the House Republicans will propose a bill that would raise the federal government’s debt ceiling, but it contains a provision that would delay implementation of ObamaCare for one year. The bill will also include a provision for future tax reform, and the approval of the Keystone pipeline. The Democrats strongly oppose any budget bill that would defund the health care law.

Reforming Health Reform

It may say something about expectations for the Affordable Care Act that the simplistic “just repeal Obamacare” cries of Congressional Republicans are starting to be supplemented by proposals for its replacement.
The most detailed so far is from the conservative American Enterprise Institute, which has published an unexpectedly non-doctrinaire study authored by Harvard professor Michael Chernew and seven other respected academics.
It’s far from perfect, but it’s worth reading.
Structural details of the AEI proposal, modestly titled “Best of Both Worlds,” aren’t always clear (page 1 lists four “principles,” page 5 lists five “priorities”, and page 16 lists three “major planks”), but it does attempt a bipartisan approach, combining ideas from left and right.
Some of these ideas have been contained in other proposals, such as those of Wyden and Bennett and Fuchs and Emanuel (which may damn the AEI proposal in right-wing eyes), and most recently in a THCB piece by Martin Gayno. They include the elimination of the employer coverage tax preference, the provision of “premium support” subsidies for most individuals, and the establishment of a national insurance exchange. Together, they are designed to encourage individual choice and responsibility and to maximize competition between insurers, while removing some of the inequities of the present system (and of the ACA).
The AEI proposal assumes that eliminating the employer coverage tax preference will result in most individuals obtaining coverage through a national exchange, with national regulation of insurance plans. Current Medicaid eligibles will be included, with the replacement of acute care Medicaid funding by subsidies for conventional coverage. All individuals will be able to choose between fully-subsidized “basic plans” and more generous partially-subsidized options, typically with substantial deductibles tied to income and health status. Insurers will be encouraged to offer multi-year coverage and, unlike in the ACA, medical underwriting will be allowed. The only government financing will be for premium subsidies, to be funded by the additional income and payroll tax revenues resulting from elimination of the employer tax preference and by redirecting federal and state Medicaid payments.

A Dozen Hospitals Are Laying Off Staff and Blaming Obamacare. Don’t Believe Them.

Hospitals tend to be among the largest employers in their communities — which means that any individual decision to lay off staff can have an outsized local impact. And taken together, a dozen recent announcements seem to paint an especially dire picture for hospitals (and their communities) around the nation.

For example, NorthShore in Illinois says it will lay off 1% of its workforce. The staffing cuts “ensure NorthShore remains well positioned to deal with the unprecedented changes brought on by the Affordable Care Act,” according to a memo from the health system’s chief human resources executive.

And California’s John Muir Health is offering staff voluntary buyouts ahead of ACA implementation. “We’re being paid less, and we either stick our head in the sand or make changes for the future so patients can continue to access us for their care,” according to John Muir spokesperson Ben Drew.

When Obamacare was being debated in Congress, its opponents tried to tar it with a deadly label: “the job-killing health law.” So is the ACA finally living down to its sobriquet?

Not exactly. While the recent news makes for provocative headlines, the devil’s in the details — and the financial reports.

A Closer Look at Industry Pressures

It’s clear that something is shifting in the hospital market. After years of employment growth, hospitals’ hiring patterns have largely leveled off. Collectively, organizations shed 9,000 jobs in May — the worst single month for the hospital sector in a decade.

Some of those decisions reflect industry-wide belt-tightening, as Medicare moves to rein in health spending by moving away from fee-for-service reimbursement and penalizing hospitals that perform poorly on certain quality measures.

And uncertainty around ACA implementation is trickling down to hospital staffing decisions, economists told  me. Many organizations still aren’t sure how the pending wave of newly insured patients will affect their profit margins, given that many of these individuals may be sicker and will be covered by Medicaid, which reimburses hospitals at lower rates than Medicare and private payers.

Using Twitter to Track Disease: Weighing the Advantages and Challenges

A few weeks ago I participated in a fantastic twitter chat on the use of social media for public health.  During the event, our moderators posed the following question: "Are there any other diseases (besides the flu) that we could track on social media?"

The question generated a very lively discussion that I was inspired to revisit on Storify this morning after reading the Washington Post's article, "Twitter becomes a tool for tracking flu epidemics and other public health issues."

The WP article highlights several advantages and challenges of monitoring public health diseases and/or conditions on twitter.  My twitter chat colleagues brought up many other important issues for us to consider, so I'm including these expanded lists:

Advantages:

• Offers real time data on health or behavior (Government data can often take weeks or months to be released)
• There is so much available data! 
• It could capture cases that would not otherwise be formally documented at a physician's office or hospital.
• It has proved helpful in tracking time sensitive disease outbreaks (e.g., Novovirus).  *Check out this article about how twitter was used to track Norovirus activity during a journalism conference.

Challenges:

• Accuracy and case definition (i.e., does a twitter user really have the flu or just a bad cold?)
• Tracking specific words like "sick" or "flu" can bring up a lot of content that is unrelated to the twitter user being ill themselves (e.g., "I'm so sick of this terrible weather").  *Check out how Johns Hopkins researchers are working to address this problem by better screening tweets.
• We must differentiate between tracking symptoms vs. tracking cases- they are not the same.
• Our search strategies should include various terms or slang that are used to describe the disease or behavior of interest.
• Caution: media coverage of certain illnesses can cause a spike in key words on twitter without a rise in actual cases.
• What are the privacy concerns?
• Twitter might not thoroughly capture diseases or conditions that carry stigma (e.g., mental illness) because users may be hesitant to discuss them in a public forum.
• Results could be skewed by populations who are over or under represented on twitter.
• Do we need to train "trackers" to intervene? E.g., what if they are monitoring dangerous tweets/behaviors like suicidal ideation and attempts?

While the challenges list is quite long, I hope we are not discouraged!  I think twitter is an enormous resource for public health professionals.  We just need to be thoughtful and thorough regarding how to use twitter effectively.

More Resources:

The Washington Post article and related stories shared great links to more information about research in this area:

• YouTube video on University of Rochester efforts to track influenza on twitter.  It also describes their related app: Germ Tracker (warning: it may have you hopping off your regular morning bus). 
• Johns Hopkins University article: "You Are What You Tweet: Analyzing Twitter for Public Health".
• Brigham Young University article: "'Right Time, Right Place' Health Communication on Twitter: Value and Accuracy of Location Information".
• A great article that highlights what we can learn from Google Flu (since their predictions were off this year)- emphasizes the importance of "re-calibrating" your models or algorithms each year.

What Do You Think?

• What other advantages and/or challenges should we add to the list?
• What other resources can you share?

  

Emergency Response to the Boston Marathon Bombings: Looking to Social Media for Information, Resources, and Connections

Boston is my second home.  I lived there for 6 years.  I went to school there.  I made some of the best friends of my life there.  I got married there.  I spent many Marathon Mondays along the race route cheering for friends, colleagues, and absolute strangers.  As many have reported on the news, Marathon Monday is the best day of the year in Boston and you have to experience it to truly understand its excitement and feeling of community.

I am absolutely heartbroken about yesterday's bombing at the Marathon.  In tears, I sat and watched the news alone in my home.  However, I did not feel alone.  As news broke, I quickly connected with Boston friends via text and social media to make sure they were okay.  Many had been watching at various points along the route.  I also connected with public health colleagues to follow the news and to catalog resources and information being deployed to my friends in Boston and also to those of us watching from home.

As with Hurricane Sandy last November, I think it is important to document all the ways that social media is being used to disseminate information and support public health and emergency management.  Here are the key themes that I saw:

Immediate Public Safety Concerns and Instructions

With the #tweetfromthebeat hashtag, Boston Police communicated regularly with twitter followers, instructing marathon spectators to clear the area around the finish line and refrain from congregating in large crowds.

Investigation

To assist with the investigation, Boston Police and FBI are asking all spectators and eyewitnesses to submit video and photos taken at the finish line.  This message has been widely disseminated via social media.

Reconnecting Runners, Spectators, and Resources

As we have seen with emergency management of natural disasters, social media and technology play a critical role in reconnecting victims with their families and friends.  For example, the following resources were quickly deployed on social media:

• American Red Cross: Safe and Well
• Google: Person Finder
• Google document: Local Boston residents offering shelter to displaced runners/friends/families

Resources for Journalists

Along with tweets from respected news organizations and reporters reminding each other not to speculate early on in the investigation, there were also formal resources circulated regarding how to effectively cover such a story.  For example, the Dart Center for Journalism & Trauma offers comprehensive resources on the reporting of disasters and terrorist attacks.  A resource focusing specifically on the Boston Marathon bombings was tweeted out:

Mental Health & Support Resources

Many public health professionals linked to resources to support those in distress following the bombings and/or those who needed help communicating about the events (e.g., discussing it with children).

HHS Secretary Sebelius tweeted about federal disaster resources:

Philadelphia (like many other cities) tweeted about local disaster resources:

Massachusetts General Hospital and other organizations tweeted out tips for discussing the Boston Marathon bombings with children:

As I discussed in my coverage of Sandy, the power of social media also brings challenges to public health and emergency management.  We have seen some early postings about the lessons learned from this event- which does include a discussion of concerns such as rumors spreading rapidly on social media.  For example, it was first reported that cell coverage in Boston was being turned off so that additional bombs could not be detonated remotely.  We later learned that information was not true.  The cell service was slow or not operational due to the extreme overload of users trying to communicate simultaneously.  There was also a lot of concern about very disturbing images of the crime scene and victims being shared on social media.

So there is much to learn about the use of social media for public health and emergency management through close examination of this event and others.  In any case, it is very clear that social media needs to be a part of every organization's disaster and response plan. 

Tell me what you think:

• What was your impression of the use of social media by federal/state/local organizations yesterday after the Boston Marathon bombings?  
• Can you share additional examples of how it was used effectively?  
• What did you see that concerned you?