This study is correct that day care needs some light shined on it to help in the fight against childhood obesity, and not mentioned is the fight against childhood type 2 diabetes. Focusing attention on one factor (day care) should not be the case although this article does bring up some excellent weaknesses and problems with our day care facilities and systems which needs to be highlighted and parents need to heed.
With 82 percent of American children under the age of six in child care centers while their parents work, parents need to be concerned about the food their children consume away from their control. Children in full-time day care can consume two-thirds of their daily calories and this is under the control of other adults and their nutritional guide.
The study disclosed that most states have minimal requirements for healthy eating and physical activity while a child is in day care. These requirements may not meet public health care recommendations.
Day care centers that quality for government financial assistance must meet guidelines that call for children to get foods high in nutrients, but low in fat, sugar, and salt. Studies have found that some day care centers fall short of meeting these standards. Other day care centers that receive no federal assistance are under no requirements to provide at the same standards and many do not.
Then the other problem is that children do not always eat what they are served and demand foods that they should not have. So day care caters to these demands rather than have the children complain that they are hungry when the parents pick them up.
Often the children do not eat enough of the recommended foods if they eat any at all.
Some day care providers provide healthy foods and eat the same foods with the children to encourage the children to eat them. Most Head Start programs follow this model. Other studies show that the providers often do not coach the children to heed their feeling of fullness or hunger. Many just make comments about how much or how little the child was eating and do nothing to reinforce good eating.
When it comes to physical activity, day care seems to have no standards or even guidelines that they follow. Studies have followed children at day care centers and in many the children were sedentary more than 80 percent of the time under observation. The studies that many children are not getting much exercise because staffers do not encourage this or they take physical activity away as a punishment.
What should parents do? Because you are giving control of your child or children to a day care center, several suggestions are offered that can help parents. For physical activity, look at the entire center, outdoor areas, and indoor areas and ask questions about how they are used and if they have scheduled activity times. Know that the larger child care centers have more specific regulations for food and physical activity while home-based child care centers may not.
Look at the eating area and ask how food is served. Are meals served family style for the children able to help themselves and are the children taught how to take responsibility for what the put on their plate. This gives them a good sense of what to eat and does not give them situations of a pile of food being place on their plate that they may not eat.
Ask to see a menu and look at the variety of foods offered. Look for duplications on certain days and especially watch for fried foods such as chicken nuggets, fish sticks, and french fries and these should raise red flags about the variety and healthfulness of the foods. Then ask the staff about how the children are doing at mealtimes and whether the children are willing to try new foods.
Carry this over to the home setting and ask the child what he had to eat. If the child says he had something that he does not eat at home, don't be afraid to ask the care center for the recipe and continue to engage the child in conversations about the day care center. Look for both positives and potential warning signs. Also check the child's weight on a regular basis and compare it to what the doctor says is normal or near normal weight for size and age.
September 23, 2011
September 22, 2011
Salt – Blood Pressure Debate Goes On
When scientists have an agenda, we get more conflicting views than scientific evidence. The salt-blood pressure message is one of the more hotly debated issues lately. One group says that reducing salt consumption would have no clear health effect and another group shows that the meta-analysis was faulty and proves it reasonably. Read the discussion here and read it carefully.
This is a good example of what bad science can do and how it misled people around the world with false headlines. At least others are continuing the debate and continue to encourage people to reduce salt intake.
Of course the salt industry body, the Salt Institute, does not agree and a vice president , Morton Satin plainly states, “this compulsion to regulate is being pushed by a gaggle of activist ideologues who have long ago abandoned science to take up the salt-bashing cudgel.” The Salt Institute is probably the group that has funded some of the worst science studies.
The World Health Organization has set a global goal to reduce dietary salt intake to less than 5g per person by 2025. The problem is not whether to reduce salt intake, but how to do it effectively. The problem is not the salt people add to food they cook, it is the salt that food processors add to food before it is sold and this is becoming a global trend.
They believe a four-point program is required and form the basis of a comprehensive policy. The first point would be establishing and evaluating a public awareness campaign for communication of the problem. Next would come a progressive salt targets for reformulating existing processed foods and engaging with the food industry in setting new standards for foods. This would be followed by surveying the population for salt intake, measuring the progress of reformulation and effectiveness of communications. Finally, engagement of the food industry, to include regulation to create a level playing field to not disadvantage the more enlightened and progressive companies.
The largest factor is the responsibilities of the food manufacturing industry to contribute to the process. To avoid future illness and expenses, everyone needs to participate to include industry, society, governments, academia, and health organizations. Denial and procrastination will only add cost to the outcome.
Writing in the British Medical Journal, UK researchers say that the United Nations needs to make reducing salt intake a global health priority. The also advocate that if voluntary measures do not work, nations should compel the food industry to cut salt levels in manufactured foods.
There are five articles related to this issue and I have listed one near the top and the other four are here for your information: Article 1, Article 2, Article 3, and Article 4.
This is a good example of what bad science can do and how it misled people around the world with false headlines. At least others are continuing the debate and continue to encourage people to reduce salt intake.
Of course the salt industry body, the Salt Institute, does not agree and a vice president , Morton Satin plainly states, “this compulsion to regulate is being pushed by a gaggle of activist ideologues who have long ago abandoned science to take up the salt-bashing cudgel.” The Salt Institute is probably the group that has funded some of the worst science studies.
The World Health Organization has set a global goal to reduce dietary salt intake to less than 5g per person by 2025. The problem is not whether to reduce salt intake, but how to do it effectively. The problem is not the salt people add to food they cook, it is the salt that food processors add to food before it is sold and this is becoming a global trend.
They believe a four-point program is required and form the basis of a comprehensive policy. The first point would be establishing and evaluating a public awareness campaign for communication of the problem. Next would come a progressive salt targets for reformulating existing processed foods and engaging with the food industry in setting new standards for foods. This would be followed by surveying the population for salt intake, measuring the progress of reformulation and effectiveness of communications. Finally, engagement of the food industry, to include regulation to create a level playing field to not disadvantage the more enlightened and progressive companies.
The largest factor is the responsibilities of the food manufacturing industry to contribute to the process. To avoid future illness and expenses, everyone needs to participate to include industry, society, governments, academia, and health organizations. Denial and procrastination will only add cost to the outcome.
Writing in the British Medical Journal, UK researchers say that the United Nations needs to make reducing salt intake a global health priority. The also advocate that if voluntary measures do not work, nations should compel the food industry to cut salt levels in manufactured foods.
There are five articles related to this issue and I have listed one near the top and the other four are here for your information: Article 1, Article 2, Article 3, and Article 4.
September 21, 2011
Group Practices Not for All Doctors
It is good to hear this from the medical community. With the decline in the number of primary care physicians, some wanting to retire, some retiring, some leaving the rat race for concierge practice, and few new additions the the profession, it is good to see that some doctors are again heading for their own practice. It is unknown at this time whether shared medical appointments (SMAs) will work for these doctors, but hopefully a few will try.
Some doctors are not meant for working in groups. This is a real problem because many physicians simply do not know how or want to get along with their fellow doctors. When doctors are fresh out of residency, they are ill prepared to work as part of a group because of the competitive nature of their training. If they are in a group practice, compensation is based partly or entirely on productivity which leads to a treadmill type of practice with no place for true caring for the patient. This dismays and deludes many doctors who actually want to serve the patients.
Multispeciality groups are not working either as many of the specialists want their portion and the primary care group is often left on the short side of compensation. This creates more tension within these groups and disputes about how the funds are distributed.
Other problems include bureaucracy, which many doctors feel limits their effectiveness and practice and others resent those who have authority in situations that they can handle or where bureaucracy sets limits to avoid certain situations. Many doctors have been in their own practice, but now are being forced to consolidate and they resent being told what they can and can't do – in other words they find it difficult to stop being the boss.
Another dislike of many of the younger physicians is they expect to have a life outside the office and when they are on call – both they and many older physicians do not like the interruptions and resent that they may not know the particulars about a patient. It is these “cold calls” that they feel do not serve the needs of the patients or themselves. This causes conflicts because they feel that if the patient if one of theirs, they should be the one in control.
There are other problems that are minor, but you may read the article and the complete discussion here.
Some doctors are not meant for working in groups. This is a real problem because many physicians simply do not know how or want to get along with their fellow doctors. When doctors are fresh out of residency, they are ill prepared to work as part of a group because of the competitive nature of their training. If they are in a group practice, compensation is based partly or entirely on productivity which leads to a treadmill type of practice with no place for true caring for the patient. This dismays and deludes many doctors who actually want to serve the patients.
Multispeciality groups are not working either as many of the specialists want their portion and the primary care group is often left on the short side of compensation. This creates more tension within these groups and disputes about how the funds are distributed.
Other problems include bureaucracy, which many doctors feel limits their effectiveness and practice and others resent those who have authority in situations that they can handle or where bureaucracy sets limits to avoid certain situations. Many doctors have been in their own practice, but now are being forced to consolidate and they resent being told what they can and can't do – in other words they find it difficult to stop being the boss.
Another dislike of many of the younger physicians is they expect to have a life outside the office and when they are on call – both they and many older physicians do not like the interruptions and resent that they may not know the particulars about a patient. It is these “cold calls” that they feel do not serve the needs of the patients or themselves. This causes conflicts because they feel that if the patient if one of theirs, they should be the one in control.
There are other problems that are minor, but you may read the article and the complete discussion here.
September 20, 2011
EHRs May Help People With Diabetes
I don't know whether to laugh at this one or have some other thoughts. I realize that some medical health insurance companies are now covering dental, vision, and hearing as part of the same policy. With many companies, it is still necessary to get each covered through different individual companies at outrageous prices.
How is it then that people are claiming that electronic health records improve care and the outcomes for patients with diabetes. If they have have an insurance policy that covers everything and all (the dentist, eye doctor, hearing doctor, medical doctors are all on the same network) communicate with each other, then what the study findings show may be possible. This does require a stretch to believe that this is happening on a nationwide basis.
Even the authors admit there are some performance gaps, the study does not use the prospective approach, and is is not a randomized controlled trial. Even admitting the a randomized controlled trial will never happen for this type of study does make sense, but when doing look back studies, more care does need to be practiced which is not evident from the press releases and I do not have access to the full study.
At least one blogger has his doubts and expresses them here. Even HealthDay News was cautious in their headline by using the term might boost diabetes care. From the article in Medscape, it appears that everything is positive until near the end of the article.
I think there are dreams in the eyes of the authors of the article published in the New England Journal of Medicine. Yes, I think once all forms of the medical profession that I mentioned above are on the same EHR system or interact with different EHR systems to track patients, we may see improvements in diabetes care over the paper chart systems, but many improvements will need to be in place and communications will have to greatly improve between the different professions.
Indeed a lofty ideal that needs to be a goal, but doubt it will happen in the near future. Some additional agruments have been raised in the comments to this blog and we need to be aware of them.
How is it then that people are claiming that electronic health records improve care and the outcomes for patients with diabetes. If they have have an insurance policy that covers everything and all (the dentist, eye doctor, hearing doctor, medical doctors are all on the same network) communicate with each other, then what the study findings show may be possible. This does require a stretch to believe that this is happening on a nationwide basis.
Even the authors admit there are some performance gaps, the study does not use the prospective approach, and is is not a randomized controlled trial. Even admitting the a randomized controlled trial will never happen for this type of study does make sense, but when doing look back studies, more care does need to be practiced which is not evident from the press releases and I do not have access to the full study.
At least one blogger has his doubts and expresses them here. Even HealthDay News was cautious in their headline by using the term might boost diabetes care. From the article in Medscape, it appears that everything is positive until near the end of the article.
I think there are dreams in the eyes of the authors of the article published in the New England Journal of Medicine. Yes, I think once all forms of the medical profession that I mentioned above are on the same EHR system or interact with different EHR systems to track patients, we may see improvements in diabetes care over the paper chart systems, but many improvements will need to be in place and communications will have to greatly improve between the different professions.
Indeed a lofty ideal that needs to be a goal, but doubt it will happen in the near future. Some additional agruments have been raised in the comments to this blog and we need to be aware of them.
September 19, 2011
Make Sure You Are Aware of All The Risks
I am concerned that many patients are needing to tell their doctor after a medical procedure - “I'm sure you didn't tell me about those risks!” There are a lot of reasons for this, some problems belong to the patients and a good number belong to the physicians or the inadequate papers supplied to the patients. Read this article for a better understanding.
Since I am a patient, I will tackle the errors made by patients. One of the biggest errors made by patients is putting complete trust in the doctor and not reading the papers that are supplied beforehand by the doctor's team. Yes, they are given to you to read and that is what you are to do. After reading these papers, make a list of questions either not covered by the papers or that you have concerns about. These should all be answered to your satisfaction before you allow any operation or procedure to proceed.
As a patient, it is your responsibility to read and understand the procedure as delays on the day of the operation can be costly for you – rescheduling often is not covered by your insurance. And the hospital has unused time and wasted space as a result of your delay. That is why it is best to get questions resolve before the day of the procedure. That is another reason to get all the paperwork done before anything is to be done and beware of a doctor that waits until the day of the procedure.
If needed delay to procedure to have all the questions answered. The doctors and people involved in the procedure may not be happy, but most will understand and know that you are being as thorough as you should be and as they want you to be. Normally, there is time before any procedure to fit this in. If the doctor says I covered this and tries to get your signature without answering questions, refuse to sign and take this up with the insurance carrier and hospital administration or appropriate state agency to put the doctor on notice for improper behavior.
Physicians from my experience generally do an excellent job of explaining planned procedures to patients. The problems are that patients often tune the physicians out and the documentation of these conversations is often severely lacking and that unfortunately is putting it mildly. Even in a survey of 402 physicians, 87 percent reported that most or some of their patients were under- or misinformed.
Today with new technology, this problem should become less and less and doctors and healthcare organizations become aware the informed consent software exists.
Much of this software is very detailed and the packets patients receive is easy to understand and not written in legalese or medical jargon to confuse the patient.
Typically those packets include a copy of the procedure-specific consent form, which is comprehensive and easy to understand. Patients are always offered a copy of their consent form, which then serves as a transcript to help them remember the informed consent conversation and their choices.
Larger practices and hospitals that have invested heavily in automation have even more flexibility in documenting informed consent using software.
Software is a great improvement and helps reduce liability risk for physicians because the software is often procedure specific and the packets given to the patients have everything spelled out for them. If the patient tries to tune out the physician or just does not read the packet, problems remain with the patient and do not transfer to the physician.
The software also improves patient flow (at least for those that have read the packets) and time is not lost with questions covered in the packets. The packets will cover pre-procedure instructions and requirements of food and fasting. Then the packets will cover post procedure instructions and patient requirements. Lastly, the software generally improves patient understanding and satisfaction.
Since I am a patient, I will tackle the errors made by patients. One of the biggest errors made by patients is putting complete trust in the doctor and not reading the papers that are supplied beforehand by the doctor's team. Yes, they are given to you to read and that is what you are to do. After reading these papers, make a list of questions either not covered by the papers or that you have concerns about. These should all be answered to your satisfaction before you allow any operation or procedure to proceed.
As a patient, it is your responsibility to read and understand the procedure as delays on the day of the operation can be costly for you – rescheduling often is not covered by your insurance. And the hospital has unused time and wasted space as a result of your delay. That is why it is best to get questions resolve before the day of the procedure. That is another reason to get all the paperwork done before anything is to be done and beware of a doctor that waits until the day of the procedure.
If needed delay to procedure to have all the questions answered. The doctors and people involved in the procedure may not be happy, but most will understand and know that you are being as thorough as you should be and as they want you to be. Normally, there is time before any procedure to fit this in. If the doctor says I covered this and tries to get your signature without answering questions, refuse to sign and take this up with the insurance carrier and hospital administration or appropriate state agency to put the doctor on notice for improper behavior.
Physicians from my experience generally do an excellent job of explaining planned procedures to patients. The problems are that patients often tune the physicians out and the documentation of these conversations is often severely lacking and that unfortunately is putting it mildly. Even in a survey of 402 physicians, 87 percent reported that most or some of their patients were under- or misinformed.
Today with new technology, this problem should become less and less and doctors and healthcare organizations become aware the informed consent software exists.
Much of this software is very detailed and the packets patients receive is easy to understand and not written in legalese or medical jargon to confuse the patient.
Typically those packets include a copy of the procedure-specific consent form, which is comprehensive and easy to understand. Patients are always offered a copy of their consent form, which then serves as a transcript to help them remember the informed consent conversation and their choices.
Larger practices and hospitals that have invested heavily in automation have even more flexibility in documenting informed consent using software.
Software is a great improvement and helps reduce liability risk for physicians because the software is often procedure specific and the packets given to the patients have everything spelled out for them. If the patient tries to tune out the physician or just does not read the packet, problems remain with the patient and do not transfer to the physician.
The software also improves patient flow (at least for those that have read the packets) and time is not lost with questions covered in the packets. The packets will cover pre-procedure instructions and requirements of food and fasting. Then the packets will cover post procedure instructions and patient requirements. Lastly, the software generally improves patient understanding and satisfaction.
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