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The Sickly State of Public Hospitals

There are many types of hospitals but the most well known are the Public Hospitals. What sets them apart is that they provide services to the indigent (people without means) and to minorities.

Historically, public hospitals started as correction and welfare centres. They were poorhouses run by the church and attached to medical schools. A full cycle ensued: communities established their own hospitals which were later taken over by regional authorities and governments - only to be returned to the management of communities nowadays. Between 1978 and 1995 a 25% decline ensued in the number of public hospitals and those remaining were transformed to small, rural facilities.

In the USA, less than one third of the hospitals are in cities and only 15% had more than 200 beds. The 100 largest hospitals averaged 581 beds.

A debate rages in the West: should healthcare be completely privatized - or should a segment of it be left in public hands?

Public hospitals are in dire financial straits. 65% of the patients do not pay for medical services received by them. The public hospitals have a legal obligation to treat all. Some patients are insured by national medical insurance plans (such as Medicare/Medicaid in the USA, NHS in Britain). Others are insured by community plans.

The other problem is that this kind of patients consumes less or non profitable services. The service mix is flawed: trauma care, drugs, HIV and obstetrics treatments are prevalent - long, patently loss making services.

The more lucrative ones are tackled by private healthcare providers: hi tech and specialized services (cardiac surgery, diagnostic imagery).

Public hospitals are forced to provide "culturally competent care": social services, child welfare. These are money losing operations from which private facilities can abstain. Based on research, we can safely say that private, for profit hospitals, discriminate against publicly insured patients. They prefer young, growing, families and healthier patients. The latter gravitate out of the public system, leaving it to become an enclave of poor, chronically sick patients.

This, in turn, makes it difficult for the public system to attract human and financial resources. It is becoming more and more destitute.

Poor people are poor voters and they make for very little political power.

Public hospitals operate in an hostile environment: budget reductions, the rapid proliferation of competing healthcare alternatives with a much better image and the fashion of privatization (even of safety net institutions).

Public hospitals are heavily dependent on state funding. Governments foot the bulk of the healthcare bill. Public and private healthcare providers pursue this money. In the USA, potential consumers organized themselves in Healthcare Maintenance Organizations (HMOs). The HMO negotiates with providers (=hospitals, clinics, pharmacies) to obtain volume discounts and the best rates through negotiations. Public hospitals - underfunded as they are - are not in the position to offer them what they want. So, they lose patients to private hospitals.

But public hospitals are also to blame for their situation.

They have not implemented standards of accountability. They make no routine statistical measurements of their effectiveness and productivity: wait times, financial reporting and the extent of network development. As even governments are transformed from "dumb providers" to "smart purchasers", public hospitals must reconfigure, change ownership (privatize, lease their facilities long term), or perish. Currently, these institutions are (often unjustly) charged with faulty financial management (the fees charged for their services are unrealistically low), substandard, inefficient care, heavy labour unionization, bloated bureaucracy and no incentives to improve performance and productivity. No wonder there is talk about abolishing the "brick and mortar" infrastructure (=closing the public hospitals) and replacing it with a virtual one (=geographically portable medical insurance).

To be sure, there are counterarguments:

The private sector is unwilling and unable to absorb the load of patients of the public sector. It is not legally obligated to do so and the marketing arms of the various HMOs are interested mainly in the healthiest patients.

These discriminatory practices wreaked havoc and chaos (not to mention corruption and irregularities) on the communities that phased out the public hospitals - and phased in the private ones.

True enough, governments perform poorly as cost conscious purchasers of medical services. It is also true that they lack the resources to reach a substantial segment of the uninsured (through subsidized expansions of insurance plans).

40,000,000 people in the USA have no medical insurance - and a million more are added annually. But, there is no data to support the contention that public hospitals provide inferior care at a higher cost - and, indisputably, they possess unique experience in caring for low income populations (both medically and socially).

So, in the absence of facts, the arguments really boil down to philosophy. Is healthcare a fundamental human right - or is it a commodity to be subjected to the invisible hand of the marketplace? Should prices serve as the mechanism of optimal allocation of healthcare resources - or are there other, less quantifiable, parameters to consider?

Whatever the philosophical predilection, a reform is a must. It should include the following elements:

Public hospitals should be governed by healthcare management experts who will emphasize clinical and fiscal considerations over political ones. This should be coupled with the vesting of authority with hospitals, taking it back from local government. Hospitals could be organized as (public benefit) corporations with enhanced autonomy to avoid today's debilitating dual effects: politics and bureaucracy. They could organize themselves as Not for Profit Organizations with independent, self perpetuating boards of directors.

But all this can come about only with increased public accountability and with clear measuring, using clear quantitative criteria, of the use of funds dedicated to the public missions of public hospitals. Hospitals could start by revamping their compensation structures to increase both pay and financial incentives to the staff.

Current one-fits-all compensation systems deter talented people. Pay must be linked to objectively measured criteria. The Hospital's top management should receive a bonus when the hospital is accredited by the state, when wait times are improved, when disrollment rates go down and when more services are provided.

To implement this (mainly mental) revolution, the management of public hospitals should be trained to use rigorous financial controls, to improve customer service, to re-engineer processes and to negotiate agreements and commercial transactions.

The staff must be employed through written employment contracts with clear severance provisions that will allow the management to take commercial risks.

Clear goals must be defined and met. Public hospitals must improve continuity of care, expand primary care capacity, reduce lengths of stay (=increase turnaround) and meet budgetary constraints imposed both by the state and by patient groups or their insurance companies.

All this cannot be achieved without the full collaboration of the physicians employed by the hospitals. Hospitals in the USA form business joint ventures with their own physicians (PHO - Physicians Hospital Organizations). They benefit together from the implementation of reforms and by the increase of productivity. It is estimated that productivity today is 40% less in the public sector than in the private one. This is a dubious estimate: the patient populations are different (sicker people in the public sector). But even if the figure is incorrect - the essence is: public hospitals are less efficient.

They are less efficient because of archaic scheduling of patient-doctor appointments, laboratory tests and surgeries, because of obsolete or non-existent information systems, because of long turnaround times and because of redundant lab tests and medical procedures. The support - which exists in private hospitals - from other (clinical and nonclinical) personnel is absent because of impossibly complex labour rules and job descriptions imposed by the unions. Most of the doctors have split loyalties between the medical schools in which they teach and the various hospital affiliates. They would tend to neglect the voluntary affiliates and contribute more to the prestigious ones. Public hospitals would, therefore, be well advised to hire new staff, not from medical schools, share risks with its physicians through joint ventures, sign contracts with pay based on productivity and put physicians in the governing boards. In general, the hospitals must shrink and re-engineer the workforce. About half the budget is normally spent on labour costs in private hospitals - and more than 70% in public ones. It is no good to reduce the workforce through natural attrition, mass layoffs, or severance incentives. These are "blind", nondiscriminating measures which affect the quality of the care provided by the hospital. When compounded by work rules, seniority systems, job title structures and skewed grievance procedures - the situation can get completely out of hand.

The government must contribute its part. Public hospitals cannot comply or compete with the demands of national, publicly traded HMOs with political clout and the capacity to raise capital to finance hyper-sophisticated marketing. Public policy must be written to support "safety net" institutions. They must be allowed to organize their own MCOs (Managed Care Organizations of patients), to insure patients and to market their services directly to groups of potential consumers. This way they will save the 20% commission that they are paying HMOs currently. If they become more efficient and reduce utilization, they will absorb the full benefits, instead of ceding them to contracting groups of patients and insurance companies or even to the government's medical insurance plans. The hospitals will thus be able to construct their own networks of suppliers and share their risks with their physicians or with the insurance companies as best suits their objectives.

An example: a Public Hospital with its own healthcare plan is likely to make use of all its specialists and facilities, increase capacity utilization and profits - whereas today only its primary care, less lucrative, services are used by independent HMOs.

The government can limit the total number of healthcare plans available, so that the one propagated by the public hospital will stand out and not be swamped by hundreds of other plans. Such a public hospital plan could also be declared the "healthcare plan of default" - anyone who has not selected a plan will be automatically referred to and included in the public hospital plan.

Not every hospital can start an HMO plan. Only the big ones can support the necessary insurance payments, the reserve requirements and the marketing and administrative costs. The paradox is that big public hospitals are already committed to HMOs, insurers, other patient groups, or government-sponsored MCOs. These resist the inclusion of hospitals which own competing healthcare plans - in their networks. This is natural: a hospital with a plan - is a direct competitor of a private provider of healthcare management and insurance. Another obstacle is that governments are very reluctant to encourage the public sector on account of the private one. This is definitely out of fashion nowadays.

So, an alternative strategy looks more viable:

Public hospitals can act as direct contracting networks. They can team up, pool their resources, exercise political lobbying, relegate administrative and audit functions (data processing, claim processing, payment system, accounting, legal services) to a common centre. This will eliminate the need for middlemen like the HMOs. These joint networks will be able to negotiate contracts with other contractors: physicians, pharmacies, specialized laboratories and so on. This will assist the public hospitals to preserve a loyal and stable (low churning) patient base.

Finally, public hospitals are large employers with political muscle. All they lack is the will to exercise it. They should do it to force governments to adopt some unpopular decisions: offer incentives to HMOs which will refer patients to public hospitals, require HMOs to use all the range of services (both primary and speciality), compensate public hospitals directly for nonpaying patients.

But the public hospitals must begin to behave as public entities: they must open their decision making processes and make them community-oriented. They must shift from relying on contractual language to relying on administrative law (regulations) - except when it comes to employment. In a nutshell: they should be business oriented, on the one hand - and publicly accountable on the other.

There is the little matter of Public Relations and advocacy. Public Hospitals have a terrible image and they are doing very little to change it. They do not even collaborate with researchers trying to establish a factual fundament concerning "safety net medical and social care". In a world where images count more than realities this may well be the public hospitals biggest mistake.

Eight Ways to Improve the Operation of Public Hospitals

A public hospital can lease physical space or temporal slots, or computer equipment or any other equipment which suffers capacity underutilisation - to their physicians for private practice.

The lessee physicians will undertake to pay the hospital - either in the form of fixed fees or in the form of participation in the income (franchise arrangements).

They will also commit themselves to provide community-oriented, non profit services in return for the right to use what is, essentially, community property.

Another method of using the excess capacity is to sell it, rent it, or lease it to entrepreneurs who are not members of the hospital staff. There are many such possibilities: small laboratories, speciality medical services, primary care and specialist practitioners. All these would love to use the superior infrastructure of the hospital. The right to use this infrastructure can be given in the form of a concession, a franchise, a rental arrangement, or any other arm's length mode of collaboration. Professionals are likely to jump on the bandwagon when they realize that the hospital provides them with a "captive market" of patient. This is very much like the relationship between an "anchor" in a shopping mall and the small retail shops surrounding it. The small shops benefit from the business diverted in their direction from the big "anchor" outlets.

The next logical step would be to sell products and services to the community on a commercial, competitive basis. The hospital does not have to limit itself to the sale of medical goods and services. It can also sell medical legal services, use its print shop to offer print jobs, organize its social services as a profit centre and sell them to the community or to individuals, offer medical consultancy on a fee per service basis, even sell food from the hospital kitchen through a catering service or data to researchers from its archives. A natural extension of this approach would be "internal privatization".

A hospital is a collection of small (to medium) size businesses operating under one organizational roof. Laundry, cleaning, kitchen, the provision of television sets and telephones to patients, a business centre for the hospitalized businessmen - these are all profit or loss generating centres.

Internal privatization entails the transformation of the hospital into a holding company. This holding company will own and operate a host of corporations. Each corporation will constitute a separate contractor which will provide the hospital with a service or a product. Thus, all laundry will be done by a corporation which will charge the hospital for its services. The same will go for the kitchen, the printshop, the legal services and so on. These corporations will employ the former staff of the hospital. This way, the knowledge and experience accumulated within the hospital will not be lost. The corporations owned by the former employees will have a "right of first refusal" in the first five years following the transformation. The employee-owned corporations will be allowed to match the best offers in yearly tenders that the hospital will conduct for the services that they are offering.

These corporations will also be allowed to offer their services to other clients. Thus, they will reduce their dependence on one employer, the hospital. They will become truly entrepreneurial entities, competing for profits in a market environment.

A part of the re-engineering process is to determine which of the functions that the hospital fulfils are "core functions", indispensable functions without which the hospital will cease to exist or will change its identity to such an extent that it will no longer will be recognizable as a hospital. All other, "noncore", functions should be tendered out (a concept called "outsourcing"). They should be awarded in a tender to the most competitive bidders, regardless of their identity and previous allegiance. The hospital is likely to benefit from the transfer of functions, in which it has no relative competitive advantage, to outsiders whose expertise these functions are. This is somewhat akin to international (free) trade, where each nation optimizes its resources and passes the (beneficial) results of this optimization process to its trading partners.

To control this kind of transformation, medical information management systems need to be introduced. Many are available and they improve both the quality and the quantity of data available to the management of the hospital and, as a result, the decision making process. This will make it easier for the management to pinpoint which areas require doing what. For instance: the management of the hospital will be able to determine what kind of incentives should be provided to which members of the staff, where could costs be cut and where and how could productivity be improved.

Finally, a novel concept is emerging. Universities and hospitals are two important repositories of human knowledge and experience. Virtually every hospital somehow collaborates with an academic institution, or with a medical school.

There is symbiosis between hospital and medical and social researchers.

Hospitals should actively encourage this. It improves their image, it contributes to their ability to provide quality services. But should not do it for free. They should be contractual partners to the commercial exploitation of the results of research conducted within their premises or with their co-operation. There is a vast field for pharmaceutical, medical, genetic and bioengineering research - and a lot of opportunities to make money for the benefit of the entire community. By not getting commercially involved - hospitals give up money which really is not theirs to give up.

Sam Vaknin is the author of "Malignant Self Love - Narcissism Revisited" and "After the Rain - How the West Lost the East". He is a columnist in "Central Europe Review", United Press International (UPI) and ebookweb.org and the editor of mental health and Central East Europe categories in The Open Directory, Suite101 and searcheurope.com. Until recently, he served as the Economic Advisor to the Government of Macedonia.

The Meningitis

Symptoms commonly associated with both microbe and viral meningitis consist of acute onset of fever, headache, neck stiffness (meningismus), photophobia, and confusion. Microbe meningitis brings about significant morbidity (neurologic sequelae, particularly sensorineural hearing loss) and mortality and thus requires immediate antibiotic treatment.

With rare exceptions, only supportive care with analgesics is essential for viral meningitis. Because the clinical presentations of microbe and viral meningitis might be indistinguishable, laboratory studies from the cerebrospinal fluid are critical in differentiating these entities. Cerebrospinal fluid leukocyte pleocytosis (white blood cells in the cerebrospinal fluid) may be the hallmark of meningitis.

Microbe meningitis is generally characterized by neutrophilic pleocytosis (predominance of polymorphonuclear neutrophils in the cerebrospinal fluid). Typical causes of lymphocytic pleocytosis include viral infections (eg, enterovirus, West Nile virus), fungal infections (eg, cryptococcus in HIV-infected persons), and spirochetal infections (eg, neurosyphilis or Lyme neuroborreliosis).

Noninfectious brings about this kind of as cancer, connective tissue diseases, and hypersensitivity reactions to drugs can also trigger lymphocytic pleocytosis. The cerebrospinal fluid in bacterial meningitis is usually characterized by marked elevations in protein concentration, an very reduced glucose level, and, in the absence of previous antibiotic treatment, a positive Gram stain for bacteria.

However, there is frequently substantial overlap between the cerebrospinal fluid findings in bacterial and nonbacterial meningitis, and differentiating these entities at presentation is really a significant clinical challenge.

Etiology:

The microbiology of microbe meningitis within the United States has changed dramatically following the introduction from the Haemophilus influenzae conjugate vaccine. The routine use of this vaccine in the pediatric population has essentially eliminated H influenzae as a trigger of meningitis, resulting in a shift in median age among sufferers with microbe meningitis from 9 months to 25 years.

Microbe agents causing meningitis vary according to host age. In infants younger than 3 months, E coli, Listeria, and group B streptococci are the most common brings about of meningitis. For kids three months to 18 many years of age, S pneumoniae and N meningitidis are the most common brings about, with H influenzae a concern between nonimmunized kids.

For adults aged 18-50 many years, S pneumoniae and N meningitidis are the leading brings about of meningitis, whereas the elderly are at chance for those pathogens as well as for Listeria. Additional bacteria should be considered for postneurosurgery sufferers (S aureus, P aeruginosa), sufferers with ventricular shunts (S epidermidis, S aureus, gram-negative bacilli), pregnant patients (Listeria), or neutropenic sufferers (gram-negative bacilli, including P aeruginosa).

Subacute or chronic meningitides may be caused by M tuberculosis, fungi (eg, Coccidioides immitis, Cryptococcus neoformans), and spirochetes such as Treponema pallidum (the bacterium causing syphilis) or Borrelia burgdorferi (the bacterium causing Lyme disease). The diagnosis of meningitis triggered by these organisms may be delayed simply because many of these pathogens are difficult to culture and need special serologic or molecular diagnostic techniques.

Pathogenesis:

The pathogenesis of bacterial meningitis involves a sequence of events in which virulent microorganisms overcome the host defense mechanisms. Most instances of bacterial meningitis begin with bacterial colonization of the nasopharynx. An exception is Listeria, which enters the bloodstream via ingestion of contaminated food.

Pathogenic bacteria such as S pneumoniae and N meningitidis secrete an IgA protease that inactivates host antibody and facilitates mucosal attachment. Many of the causal pathogens also possess surface characteristics that enhance mucosal colonization. N meningitidis binds to nonciliated epithelial cells by finger-like projections known as pili.

Once the mucosal barrier is breached, bacteria obtain access to the bloodstream, where they should overcome host defense mechanisms to survive and invade the CNS. The bacterial capsule, a feature typical to N meningitidis, H influenzae, and S pneumoniae, is probably the most important virulence factor in this regard.

Host defenses counteract the protective effects of the pneumococcal capsule by activating the alternative complement pathway, resulting in C3b activation, opsonization, phagocytosis, and intravascular clearance from the organism. This defense mechanism is impaired in patients who have undergone splenectomy, and this kind of patients are predisposed to the development of overwhelming bacteremia and meningitis with encapsulated bacteria.

Activation from the accentuate system membrane attack complex is an essential host defense mechanism against invasive disease by N meningitidis, and sufferers with deficiencies from the late accentuate components (C5-9) are at elevated chance for meningococcal meningitis.

The mechanisms by which bacterial pathogens obtain access to the CNS are largely unknown. Experimental studies suggest that receptors for microbe pathogens are present on cells within the choroid plexus, which might facilitate movement of these pathogens to the subarachnoid space.

Invasion from the spinal fluid by a meningeal pathogen results in elevated permeability of the blood-brain barrier, with leakage of albumin to the subarachnoid room, wherever local host defense mechanisms are inadequate to control the infection.

Usually, complement elements are minimal or absent in the cerebrospinal fluid. Meningeal inflammation leads to increased, but still reduced, concentrations of complement, inadequate for opsonization, phagocytosis, and removal of encapsulated meningeal pathogens. Immunoglobulin concentrations are also reduced in the cerebrospinal fluid, with an average blood to cerebrospinal fluid IgG ratio of 800:1.

Although the absolute quantity of immunoglobulin within the cerebrospinal fluid increases with infection, the ratio of immunoglobulin within the cerebrospinal fluid relative to that in the serum remains low. The ability of meningeal pathogens to induce a marked subarachnoid space inflammatory response contributes to many from the pathophysiologic consequences of bacterial meningitis.

Although the microbe capsule is largely responsible for intravascular and cerebrospinal fluid survival from the pathogens, the subcapsular surface elements (ie, the cell wall and lipopolysaccharide) of bacteria are more essential determinants of meningeal inflammation. The major mediators of the inflammatory process are thought to be IL-1, IL-6, matrix metalloproteinases, and tumor necrosis aspect (TNF).

Within 1-3 hours after intracisternal inoculation of purified lipopolysaccharide in an animal model, there's a brisk release of TNF and IL-1 to the cerebrospinal fluid, preceding the improvement of inflammation. Indeed, direct inoculation of TNF and IL-1 to the cerebrospinal fluid produces an inflammatory cascade identical to that seen with experimental bacterial infection.

Cytokine and proteolytic enzyme release leads to loss of membrane integrity, with resultant cellular swelling. The improvement of cerebral edema contributes to an increase in intracranial pressure, potentially resulting in life-threatening cerebral herniation. Vasogenic cerebral edema is principally caused by the increase in blood-brain barrier permeability.

Cytotoxic cerebral edema results from swelling from the cellular elements from the brain simply because of toxic factors from bacteria or neutrophils. Interstitial cerebral edema reflects obstruction of flow of cerebrospinal fluid, as in hydrocephalus. The literature suggests that oxygen free radicals and nitric oxide might also be important mediators in cerebral edema.

Other complications of meningitis consist of cerebral vasculitis with alterations in cerebral blood flow. The vasculitis leads to narrowing or thrombosis of cerebral blood vessels, resulting in ischemia and feasible brain infarction. Understanding the pathophysiology of bacterial meningitis has therapeutic implications.

Even though bactericidal antibiotic treatment is critical for adequate treatment, rapid bacterial killing releases inflammatory bacterial fragments, potentially exacerbating inflammation and abnormalities of the cerebral microvasculature. In animal models, antibiotic treatment has been shown to cause rapid bacteriolysis and release of microbe endotoxin, resulting in increased cerebrospinal fluid inflammation and cerebral edema.

The importance of the immune response in triggering cerebral edema has led researchers to study the role of adjuvant anti-inflammatory medications for bacterial meningitis. The use of corticosteroids has been shown to decrease the chance of sensorineural hearing loss between kids with H influenzae meningitis and mortality among adults with pneumococcal meningitis, and these agents are routinely given at the time of initial antibiotic therapy.

Clinical Manifestations:

Between sufferers who produce community-acquired bacterial meningitis, an antecedent upper respiratory tract infection is typical. Sufferers having a history of head injury or neurosurgery, especially those having a persistent cerebrospinal fluid leak, are at particularly high risk for meningitis.

Manifestations of meningitis in infants may be hard to recognize and interpret; consequently, the physician should be alert towards the possibility of meningitis in the evaluation of any febrile neonate. Most sufferers with meningitis have a rapid onset of fever, headache, lethargy, and confusion.

Fewer than half complain of neck stiffness, but nuchal rigidity is noted on physical examination in 30-70%. Other clues seen in a variable proportion of instances include altered mental status, nausea or vomiting, photophobia, Kernig's sign (resistance to passive extension from the flexed leg with the patient lying supine), and Brudzinski's sign (involuntary flexion of the hip and knee when the examiner passively flexes the patient's neck).

More than half of patients with meningococcemia produce a characteristic petechial or purpuric rash, predominantly on the extremities. Although a change in mental status (lethargy, confusion) is typical in bacterial meningitis, up to one third of patients present with normal mentation. From 10% to 30% of sufferers have cranial nerve dysfunction, focal neurologic signs, or seizures.

Coma, papilledema, and Cushing's triad (bradycardia, respiratory depression, and hypertension) are ominous signs of impending herniation (brain displacement through the foramen magnum with brain stem compression), heralding imminent death.

Any patient suspected of having meningitis demands emergent lumbar puncture for Gram stain and culture from the cerebrospinal fluid, followed immediately by the administration of antibiotics and corticosteroids. Alternatively, if a focal neurologic process (eg, brain abscess) is suspected, antibiotics should be initiated immediately, followed by brain imaging (computed tomography or magnetic resonance imaging) and lumbar puncture performed only if there is no radiologic contraindication.

Inflammatory Breast Cancer

Inflammatory breast cancer has no lump or mass that can be felt. It is a very rare and dangerous type of breast cancer. It cannot be detected by self breast examination and mammogram. In inflammatory breast cancer there is infiltration of the skin and lymph vessels of the breast by cancer cells. The symptoms of inflammatory breast cancer are a swollen, red and warm breast which is brought on by the lymph vessels becoming blocked by the breast cancer cells. The breast has a typical appearance of an individual with cellulite. Other symptoms of inflammatory breast cancer include, on the affected side, enlarged lymph nodes present under the arm or it may be above the collar bone.

Since it cannot be diagnosed by self breast examination, mammogram, core biopsy, ultrasound scan or even an MRI it is diagnosed by a biopsy, that is, a surgical biopsy or a skin biopsy. Since inflammatory breast cancer is a rapid growing cancer it requires equally aggressive treatment, which includes local treatment and systemic or total body treatment.

The treatment usually starts with chemotherapy, systemic treatment, surgery and then radiation therapy, which are the local treatments; this is then followed by additional chemotherapy and then hormone treatments.

Some of the symptoms of inflammatory breast cancer are:

o One breast is larger than the other

o There is a discharge from the nipple

o The skin is warm or hot to the touch

o Swelling of breast

o Orange like texture to the skin

o There is pain and/or the breast feels itchy

o Skin has a red or pink coloration

o There are swollen lymph nodes under the armpit and sometimes there may be swollen lymph nodes of the neck

o The nipples appear to be flattened or inverted

o The entire breast or a small portion of the breast has a rash

o There are ridges or thickened areas of the breast.

If an individual has any of the above symptoms which persist for more than a week it is necessary that the individual speak with her physician who would then take the necessary course of action.

However, sometimes, there are very common mistakes made when it comes to treating inflammatory breast cancer. They are:

o The surgeon may think it is best if the breast is removed and sometimes the breast is removed too early. This early removal of the breast increases the risk of the disease making reappearance.

o Patients may not get the specific chemotherapy dose and also the patient may require two treatments of radiation therapy a day rather than only one treatment, as inflammatory breast cancer is a rapid growing cancer. This is where the importance of an experienced radiologist in inflammatory breast cancer is necessary.

o If a patient has had got the improper or incorrect treatment it will be difficult to go back and improve on the outcome.

oIt is extremely difficult to measure the response to the treatment, as a mass or a nodule is not present in inflammatory breast cancer.

There is no particular age at which an individual could get the disease. However, studies have shown that the average age ranges from about 45 and 55 years of age, but patients could be younger or older than this age range. The amount of new cases of inflammatory breast cancer diagnosed every year in the United States varies.

Breast Cancer

The cancer is a term for diseases in which abnormal cells divide uncontrollably invading near by tissue and spreading to other parts of the body via blood stream or lymphatic system.

Similarly, in breast cancer, a single cell begins to divide and grow abnormally. This is the most common kind of cancer in women. Besides being women, age is the other important factor for developing breast cancer.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

The breast cancer is classified into:

-Ductal carcinoma in situ (DCIS)

-Lobular carcinoma in situ (LCIS)

-Inflammatory breast cancer

-Recurrent breast cancer

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen. Recurrent breast cancer that has come back after it has been treated.
Early detection through regular breast self-exams and a regular program of mammogram and physical exams show excellent results in curing it. Breast self exam is the process developed by the American cancer society for women to examine the breasts monthly. This process can reveal breast problem. Any swelling or unusual lumps or hardness in the breast is the indication of breast disease and a reason to rush to your doctor.

There are various factors, which increases the chance of getting disease as a breast cancer. Like:

1) Older age

2) A mother or sister with breast cancer.

3) Drinking alcoholic beverages.

4) Being white.

5) Treatment with radiation therapy to the breast/chest.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers.

Tests related to detect and diagnose breast cancer are:

1) Mammogram - In which X ray is done of the breast.

2) Biopsy - The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump.

3) Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is examined in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.

There are different 4 types of treatment option for breast cancer patients:

1) Surgery- Most patients with breast cancer have surgery to remove the cancer from the breast.

2) Radiation therapy - Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells.

3) Chemotherapy -Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

4) Hormone therapy - Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream.

Diabetes: African Americans Deadly Foe

Diabetes is having a devastating effect on the African American community. Diabetes is the fifth leading cause of death in African Americans and their death rates are twenty seven percent higher than whites.

Over 2.8 million African Americans have diabetes and one third of them don't know they have the disease. In addition, twenty five percent of African Americans between the ages of 65 - 74 have diabetes and one in four African American women, over the age of 55, have been diagnosed with the disease

The cause of diabetes is a mystery, but researchers believe that both genetics and environmental factors play roles in who will develop the disease.

Heredity

Researchers believe that African Americans and African Immigrants are predisposed to developing diabetes. Research suggests that African Americans and recent African immigrants have inherited a "thrifty gene" from their African ancestors.

This gene may have enabled Africans to use food energy more efficiently during cycles of feast and famine. Now, with fewer cycles of feast and famine, this gene may make weight control more difficult for African Americans and African Immigrants.

This genetic predisposition, coupled with impaired glucose tolerance, is often associated with the genetic tendency toward high blood pressure. People with impaired glucose tolerance have higher than normal blood glucose levels and are at a higher risk for developing diabetes.

What is Diabetes?

Diabetes, commonly know as "sugar diabetes", is a condition that occurs when the body is unable to properly produce or use insulin. Insulin is needed by the body to process sugar, starches and other foods into energy. Diabetes is a chronic condition for which there is no known cure; diabetes is a serious disease and should not be ignored.

Diabetics often suffer from low glucose levels (sugar) in their blood. Low blood sugar levels can make you disorientated, dizzy, sweaty, hungry, have headaches, have sudden mood swings, have difficulty paying attention, or have tingling sensations around the mouth.

Types of Diabetes

Pre-diabetes is a condition that occurs when a person's blood glucose levels is higher than normal but not high enough for a diagnosis of type II diabetes. Pre-diabetes can cause damage to the heart and circulatory system, but pre-diabetes can often be controlled by controlling blood glucose levels. By controlling pre-diabetes you can often prevent or delay the onset of Type II diabetes.

Type I or juvenile-onset diabetes usually strikes people under the age of 20, but can strike at any age. Five to ten percent of African Americans who are diagnosed with diabetes are diagnosed with this type of the disease. Type I diabetes is an autoimmune disease where the body produces little or no insulin and this type of diabetes must be treated with daily insulin injections.

Type II or adult onset diabetes is responsible for ninety to ninety-five percent of diagnosed diabetes cases in African Americans. Type II results from a condition where the body fails to properly use insulin. According to the American Diabetes Association, "Type II is usually found in people over 45, who have diabetes in their family, who are overweight, who don't exercise and who have cholesterol problems." In the early stages it can often be controlled with lifestyle changes, but in the later stages diabetic pills or insulin injections are often needed.

Pregnancy related diabetes or gestational diabetes can occur in pregnant women. Gestational diabetes is often associated with high glucose blood levels or hyperglycemia. Gestational diabetes affects about four percent of all pregnant women. The disease usually goes away after delivery, but women who suffer from gestational diabetes are at a higher risk for developing diabetes later in life.

Symptoms of Diabetes

The most common symptoms of diabetes include:

excessive urination including frequent trips to the bathroom

increased thirst

increased appetite

blurred vision

unusual weight loss

increased fatigue

irritability

Complications from Diabetes

Diabetes can lead to many disabling and life threatening complications. Strokes, blindness, kidney failure, heart disease, and amputations are common complications that effect African Americans who have diabetes

Kidney Disease

"Diabetes is the second leading cause of end stage kidney disease in African Americans, accounting for about thirty percent of the new cases each year," says the National Kidney Foundation of Illinois. Up to twenty-one percent of people who develop diabetes will develop kidney disease.

Amputations

Diabetes is the leading cause of non-traumatic lower-limb amputations in the United States. More than sixty percent of non-traumatic lower-limb amputations in America occur among people with diabetes and African Americans are almost three times more likely to have a lower limb amputated due to diabetes than whites. According to Center for Disease Control (CDC), about 82,000 non-traumatic lower-limb amputations were performed among people with diabetes in 2001.

Blindness

African Americans are twice as likely to suffer from diabetes related blindness. Diabetics can develop a condition called "Diabetic Retinopathy", a disease affecting the blood vessels of the eye, which can lead to impaired vision and blindness. Diabetes is the leading cause of new cases of blindness in people from 20 - 74 years of age and up to 24,000 people loose their sight each year because of diabetes.

Heart Disease

People with diabetes are up to four times more likely to develop heart disease as people who don't have diabetes. Atherosclerosis (hardening of the arteries) is more common in diabetics and can lead to increased risk of heart attacks, stroke, and poor circulation throughout the body.

Diabetes Risk Factors

You have a greater risk for developing diabetes if you have any of the following:

Obesity

Family history of diabetes

Pre-diabetes

Low physical activity

Age greater than 45 years

High blood pressure

High blood levels of triglycerides

HDL cholesterol of less than 35

Previous diabetes during pregnancy or baby weighing more than 9 pounds

Diabetes has had a devastating effect on the African American community; it is the fifth leading cause of death and second leading cause of end stage kidney disease in African Americans.

African Americans suffer from complications from diabetes at a much higher rate than the rest of the population. African Americans are three times more likely to have a lower limb amputated because of diabetes and twice as likely to suffer from diabetes related blindness.

If you have any of the diabetes risk factors you should contact your physician and have a blood glucose test. Also discuss with your physician lifestyle changes you can take to lower your chances of developing diabetes.

Why the Obama Health Care Plan is Important

The Obama health care plan, whether you believe in all of it's tenets or not, is one that at least gets us pointed in a direction. Putting it another way, the cost of inaction will drive us even further into a country that cares more about political lobbying than the real needs of our people. It's important to really understand what Mr. Obama's health care plan is about in order to make a fair judgment one way or the other.

I'm a small business owner without the comforts of a big company medical plan. Fortunately for me, my wife IS employed by a large company and we DO have decent, not great health care. But, what if neither of us had this luxury? I was with two of the largest technology companies in the world, Oracle and HP, but was eventually laid off some years back, like so many other unfortunate individuals.

The Obama health care plan is trying to fix some serious flaws in it's system. I recently visited a terminally ill college friend of mine. He was initially denied even a visit to the hospital. He finally got approval and was diagnosed as having only a few weeks left to live. His family then lobbied to have insurance over his cost of home care to live out his short life in dignity and quality. Now, it has been proven over and over again that home care for the terminally ill saves money and provides for a much better quality of life than a hospital stay. Why deny someone this option?

We all recognize that employers are struggling during these tough economic times. And, costs of hospitalizations and the like have increased over 100%, but consider the options for no health care reform. It will continue to be pushed out to the next generation and then the next. The answer then would be to burden our children and our children's children. Is this the legacy we want to leave behind?

The Obama health care plan really is about a few key tenets. Probably the most important component to me is that of preventative health care. This hot button is debated amongst so many people. On the one hand, the bloated medical systems want to care for you only after you come down with an illness. Wouldn't it make more sense to prevent the illness in the first place? Things such as quality screening to make sure you are exercising regularly, eating properly, etc. Wouldn't you rather stay well, rather than go to the hospital when you're sick?

Another key component of the health care plan is around the use of technology. The US is one of the few developed countries that really are a leader in this area. How is it possible that we cannot figure out how to fix our antiquated medical reporting system? Transportable medical records would reduce errors, increase efficiency and save all of us money! Why can't the doctor that I saw for my dislocated shoulder 10 years ago be able to easily share that information to my new doctor who's treating me for arthritis? An efficient sharing and collaborating of medical records would allow for a better health experience for the patient.

Finally, competition in insurance coverage is a serious flaw in our system today. The Obama health care plan is target to correct this problem. Why should a few insurance companies make the bulk of the money? If there is little to no competition, there's no way to know whether you are getting insurance at competitive rates and whether the quality of care is at its highest.

The real answer to the debate on the Obama health care plan, though, is the cost of INACTION. We all know that the health care system is severely broken. Let's make a step forward, instead of lobbying to take two steps backward.

David Chan is a small business owner who cares deeply about health care issues insurance. Having once worked for two of the largest global technology companies in the world, he has personal experiences with the US health care problems we face. David Chan's latest blog on the Obama health care plan discusses the key components of the plan and why they are important to all of us.

Obama Health Care - How it Affects Middle Class Americans

Obama health care has received mixed emotions from people all over the nation. Some are in favor, others feel that the government has completely taken control of their rights. For the middle class Americans, many believe Obama care will adversely affect themselves and the upper class. While it does make significant changes to our current system, every class will be affected in one way or another.

It is believed by many individuals and institutions that low-income families will benefit greatly, and have health insurance for perhaps the first time ever. However, this benefit to the lower income class means that high-income families will pay considerably, most of it in the form of increased taxes. Obama care is a touchy subject with many Americans, who feel they will be forced to pay stiff penalties if they do not buy health insurance coverage.

Middle class Americans feel that they may suffer the most, and cannot see a way out as they attempt to pay for basic necessities such as childcare, food, housing, utilities, etc. In their minds, it they are already struggling to meet these obligations, how in the world can they afford health insurance? But if they don't purchase it, according to Obama laws they will face penalties if they fail to get health insurance coverage.

Struggling with the rising cost of insurance has been a problem for years, and the debate has continued regarding how to get the United States health care system under control. Under Obama health care, families who earn in excess of $250,000 per year will face an increase in Medicare tax from 1.45% to 2.35% - same for individuals who earn $200,000 per year. Since there is now no option regarding whether an individuals decides to purchase health insurance coverage or not, they will face penalties.

Americans who already have health insurance may think "So what? What's the big deal?" In fact, Obama health care may affect those who previously had health insurance coverage. While it seems that having more people paying in to the system would mean lower insurance premiums, that may not be the case. According to congressional estimates, by the year 2016 individual premiums may be 10 to 13% higher than they are currently.

Several factors that play in to the equation include the fact that in 2014, insurance companies will no longer be able to deny coverage or charge increased premiums due to existing conditions. Add to that the fact that shortly thereafter, insurers will no longer be able to set lifetime limits on coverage, nor will they be able to drop insured individuals who become ill. What does this mean? In a nutshell, Obama health care means that more sick people will be covered, and those costs are greater to insurance companies than those of healthy individuals. All of this may ultimately counteract the benefits of a larger health care pool.

At the current time, it is difficult to determine exactly how it will affect Americans in specific classes, or who will ultimately end up paying the most for mandatory health care coverage. One thing is for certain - while some believe that this is the best thing since buttered bread, others aren't nearly so optimistic. In a few years, we will all be able to determine just how Obama health care has affected our lives personally.

Environmental, Health and Safety Audits - Tips For Success

Since the early 1970's, private industries have recognized the benefits of conducting environmental, health and safety audits at their regulated facilities. In general, the purpose of an environmental, health and safety audit is to ensure compliance with the myriad of environmental, health and safety regulations that have been promulgated by the Occupational Health and Safety Administration (OSHA), the Environmental Protection Agency (EPA), the Nuclear Regulatory Commission (NRC), and many other federal, state and local agencies. In addition, contemporary audits include the implementation of environmental health and safety management systems such as ISO 14001 and OHSAS 18001 and adherence to corporate standards or guidelines. In order for an environmental, health and safety audit to be successful, the author offers the following tips:

    A lead auditor must be assigned. This person will have the primary responsibility for assembling the audit team, defining the scope of the audit, preparing the agenda and audit plan, reviewing the draft report, and following up with any required corrective actions upon completion of the audit.
    A primary site contact will need to be assigned. In most cases, this contact will be an environmental, health and safety manager or a person with similar responsibilities. This person should have access to all important environmental, health and safety records and permits, and should have unimpeded access to every physical area of the facility. In addition, verify that the primary site contact communicates with the highest ranking member of management at the site about the audit and its schedule. Nothing causes more of an uproar than conducting an environmental, health and safety audit at a facility where the senior management team is unaware of its occurrence. Of course, if your company has a policy that "surprise audits" are acceptable then that's a different story.
    Pre-planning for an environmental, health and safety audit is as important as the audit itself. Much of the success of an environmental, health and safety audit program depends upon careful planning. At least two weeks prior to the on-site activities, the lead auditor should prepare and distribute an agenda to all involved personnel, including the site contact.
    Provide a list of requested documents and programs to the site contact. Copies of these documents should be received by the audit team well in advance of the on-site activities. Important documents to be included on this list are regulatory permits such as air permits, wastewater permits, radioactive materials licenses, storm water permits, etc. Written programs and associated training materials for regulatory programs such as hazard communication, chemical hygiene, respiratory protection, bloodborne pathogens, and hazardous waste management. If you are uncertain if any of these programs apply to a given facility, go ahead and include it on the list and provide the respondent with the "not applicable" option. For larger facilities, having a site map may also be helpful.
    Review written documents. The amount of time that you will have on-site will generally be limited to one week or less. For larger facilities you must use your on-site time wisely. To the extent possible, review as many of the written documenst prior to the on-site activities. Make notes of important items that you will want to verify during the on-site activities. Prior to the on-site activities, become reacquainted with important regulatory requirements, and review state and local requirements
    Review publicly available databases for site regulatory information. Go on-line to the various regulatory databases maintained by OSHA, EPA, and state agencies to see historical information on regulatory inspections, air emissions, hazardous waste generation, etc. What you're looking for is to determine the site's regulatory history and any prior history of violations. If violations have occurred in the past, when on-site you will want verify that systems are in place to prevent repeat violations.
    Refine the agenda. Based on the review of the documents, refine the agenda so that there is adequate time to review the items where there may be concerns or areas where there may be higher risk. Don't waste your valuable on-site time on trivial issues.
    Make sure that the primary site contact has dedicated adequate time. Nothing is more frustrating for an audit team than to have a primary site contact that is constantly leaving to go attend other meetings or perform other duties. In addition to dedicating adequate time for the audit team, the primary site contact should also reserve a conference room of adequate size, has internet access, and can be secured overnight. During an audit you will be working long hours and reviewing many sensitive documents. You don't want to waste time having to pack up your materials at the end of each day.
    Once on-site, conduct an opening conference. Persons that should be at this opening conference include the audit team members, the primary site contact, key operational personnel, and if available, the site manager. During the opening conference introductions should be made, the agenda review, the purpose of the audit review, key schedule items, and the timing of the closing conference. In addition, site personnel should indicate if any special activities are occurring that will prevent them from being available for questions.
    After the opening conference, I generally like to take a brief tour of the facility. This tour should not be of any significant detail, but more of a tour to become familiar with the facility. Make notes of areas that you will want to return to for a more detailed examination.
    Compare statements made in plans and programs with actual records and activities. Discrepancies between the two may be an indication of program gaps.
    At the end of each day the audit team should meet with the primary site contact to review any unanswered questions. Provide the primary site contact with a list of potential findings or areas that need further investigation. In many cases, these items may be resolved simply by locating the correct records.
    On the evening before the closing conference, plan on it being a long evening. You will want to prepare a draft list of audit findings. Audit findings should be written as precise as possible. Avoid subjective terms such as "all", "many", "poor", or "inadequate." Provide evidence to support the findings. If further investigation is necessary, state so.
    Conduct the closing conference. On the final day of the audit, a closing conference should be conducted. It is preferable that the same attendees that were in the opening conference be present. During the closing conference the audit team should thank everyone for their time and cooperation, all draft audit findings should be reviewed, key concerns should be voiced, and a schedule and distribution list for the draft report should be indicated. It is important that every finding that will be in the draft report be presented. There should not be any surprise finding in the draft report.
    Prepare and submit the draft report to the distribution list for review. Make sure that the distribution of the draft audit report is controlled. In some cases where there are significant regulatory findings, e-mail distributed of the draft report should be avoided. Hard copies of the draft report, sent via over night express delivery may be preferred. If there are significant regulatory findings, check with your company's legal counsel prior to distributing.
    After review and comment of the draft report, finalize the report and prepare a corrective action plan. This is the most important part of any audit. Now that deficiencies have been found, corrective actions must be performed. A process for tracking the completion of all findings, the priority, and the responsible person(s) is absolutely necessary. Failure to correct found deficiencies in a timely can represent a significant liability to the company. Simple and affordable corrective action software systems are available and should be considered a must have for any environmental, health and safety audit program.

Conducting an environmental, health and safety audit is a valuable tool for improving the EH&S performance at a given location. However, in order to be successful the audit team and site personnel must carefully plan the audit, and ensure that adequate follow-up is conducted on corrective actions to be performed.

NSW Work Health and Safety Laws and the PCBU

Are you aware that as a property owner or controller of an asset you have a duty of care to those who access, conduct work on and use your property?

Duty of care explained

A duty of care is a duty to take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure persons who are closely or directly affected by your act or omission.

Now that we have established the duty of care, how does this apply to me?

On January 2012 in New South Wales, the new Work Heath and Safety Act 2011 replaced the existing Occupational Health and Safety (OHS) Laws in NSW.

How is this change relevant to me?

The crucial change in the Work Health and Safety Act 2011 is the amendment of the definition for which bodies or individuals are now responsible for the application and ongoing management of a duty of care.

Part of the amendment to the existing definitions includes the specification of who accepts liability to execute and maintain duty of care.

Definitions under the Work Health and Safety Act 2011

Person conduction a business or undertaking:

A person conducting a business or undertaking (PCBU - the new term that includes employers) has the primary duty to ensure, so far as is reasonably practicable, that workers and other persons at a workplace are not exposed to health and safety risks.

Worker:

The definition of a 'worker' includes any person who carries out work for a 'person conducting a business or undertaking' (PCBU - the new term that includes employers).

This term 'worker' includes any person who works as an:

    employee
    trainee
    volunteer
    outworker
    apprentice
    work experience student
    contractor or sub contractor
    employees of a contractor or sub-contractor
    employee of a labour hire company assigned to work for a PCBU.

A PCBU has a duty of care to ensure effective consultation, cooperation and coordination on safety matters. A PCBU must ensure that the facilities are available, accessible and adequate.

Who is considered a person conducting a business or undertaking (PCBU)?

A person conducting a business or undertaking as defined under the WHS act includes each of the following:

    Body Corporates who employ staff or subcontractors
    Employers, Self employed, partners, franchisees, franchisor
    Principal contractors, subcontractors
    Business who control workplaces, fixtures, fittings, plant at workplaces

As all of our clients fall into one of these categories, we need to get the point across to our clients that they must show that they have done everything that is reasonable to ensure a safe workplace and safe work practices operate at their building.

The body corporate under the act is included as a 'person conducting a business or undertaking' and has a primary duty to ensure the health and safety of workers they engage, direct or influence.

What can I do to ensure I am not exposed as a result of these legislative changes?

Firstly you have a legislative requirement to ensure that you or your existing management firm has effective control measures in place for your asset.

The Work Health and Safety Regulation 2011 (WHS Regulation) specifies obligations about the work environment and welfare facilities including:

    managing risks to health and safety
    personal protective equipment
    training and instruction
    workplace facilities
    emergency plans
    first aid.

How can I ensure these processes are adequately addressed?

As a property owner and the liable party for the application of this duty of care it is essential that you review, audit and participate in the development of these processes.

The engagement of a management firm does NOT mitigate your responsibility.

You are responsible for the ongoing application and systematic approach to work health and safety regardless of the engagement of a management firm. In fact the engagement of a firm that does not practice safe work practices in line with legislation can be an act of negligence on behalf of the appointing entity.

We recommend that to protect yourself and your building, that you exercise caution with such an engagement.

To protect the interest of the building, we would suggest the following actions we referred to when appointing a building or facility management provider.

    Review policies and procedures relating to the Work Health and Safety of their employees and subcontractors.
    Provide evidence of the these tools in use and that they can explain each of the required functions within

It is most important that any management firm has contractor management framework that identifies the 5 stages of contractor management and how specific actions should be taken at each and every stage:

    Preselection
    Engagement
    Induction and Pre Start
    On the job
    Review

If you are concerned that your current provider is not meeting these legislative requirements, it might be time to intervene and take action to rectify the situation. This could include up-skilling your current provider, engaging expert consulting advice to support your current provider or going out to market to engage a firm that is competent and comfortable with meeting all such obligations.

Any of these actions show that the PCBU has attempted to improve the situation and move towards providing a safer environment. Doing nothing is not an option under this new legislation and an unfortunate accident that seriously injures or kills someone will be too late.

It is advised that you seek professional advice on whether the firm you have currently engaged or are considering are suitably qualified (tertiary qualification) in the field of Occupational Health and Safety.

Massachusetts Health Insurance Plan

Hillary Clinton and All the King's Men couldn't do it but the State of Massachusetts did it with out too much fuss. I'm talking about the new health insurance plan of course.

Congress sometimes acts like a hapless bunch of morons it seems. That's a good reason to keep the important things out of their hands. They spend more money and waste more time than any other entity on earth.

Look at the MedicareRx Plan designed by these geniuses. It gave billions back to the drug industry, confused the hell out of me and all other senior citizens, and leaves a big gap in drug coverage.

Nice!

Maybe Congress should be adjourned immediately until this country can get back on its feet again. The adjournment would last until the special interest groups living in Washington-who are out to destroy our country-find themselves out of work and all have moved out of town. Congress is elected and controlled by special interest groups. It's time to return the government to the people.

Maybe it's time to return most powers to the states other than national defense and international relations. If congress could concentrate on that only, we would free ourselves of much of the current baloney. Mainland Security is a joke. Make each state responsible for their own interest.

We don't need the Federal Government to tell us how to run (and screw up) our local affairs. What we need is the money they gobble up and waste continually.

Are nation is broke. The needs of the people are not being taken care of. We are International dupes.

Doesn't something have to be done?

Well, Massachusetts has taken the lead. We no longer need a Federal health insurance plan. Let the states use the Massachusetts Plan or similar plan.

The federal government should go back to cleaning its closets.

What Is Health Now?

The question in the title is a very important one, and I think all of us should have this question in mind and search for a complete answer. The truth is though, that we only ask about health when we have a serious problem. A official definition of health is given by The World Health Organization who defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". For 1946 it was not a bad definition, but let's face it, times have changed and life has evolved since then, so today we have 2 new aspects of health to consider: emotional health and spiritual health. If we take a step back and try to see the "big picture" we realize that each aspect of health influences the other aspects, for example if someone has an emotional problem it will cause physical problems, spiritual problems, mental problems and social problems too, so it's very important to solve the problem when we first see it even if we don't think that an emotional problem is important. In the incipient phase the emotional problem could be solved by simply talking to a friend, but if we let it develop it could need serious professional help. After this example I think you will want to know more about each aspect of health, so let's see what they mean and how can we improve them.

Physical health - the first thing that comes to my mind when I think about perfect physical health are babies - they are the best example because they run all around the place and use their energy until they fall asleep. If we could do the same, I'm sure we would have a better physical health. A definition of physical health would be that it is a state in which all of the organs are functioning well 100% of the time, so in order for that to happen we have to give our body good nutrients, good exercise and enough rest. It may sound too simple, but it shouldn't be more complicated than this.

Mental health - one good example for this is inventor Thomas Alva Edison, he tried and failed more thousand times to invent the light bulb, but he was strong enough mentally not to give up, and he eventually succeeded. Mental health is a state of well-being that allows you to reach your true potential and contribute to the community. It may seem strange for some of you, but actually helping others is the greatest thing that we can do and it keeps us happy and healthy, so in order to improve your mental health start by helping the people around you, I can tell you for sure that you will feel very good by doing so.

Emotional health - imagine a little girl on a Christmas evening opening her presents, that for me is an example of good emotional health, because gratitude and happiness are the healthiest emotions for us. I think emotional health is about feeling good, grateful, happy and not being afraid to share these emotions with all the people we interact with. A good way to improve our social health is by doing both physical and mental exercises that we like to do, for example if you like to play tennis and chess, please do so as often as you can.

Social health - the best indicator for social health is the ability to make friends. The social aspect of health is very important, because we are social beings and it's scientifically proven that if someone is ill and their loved ones are with them, they recover faster than if they were to stay alone. A tip on how to improve your social health would be to understand the fact that "it's nice to be important, but it's more important to be nice".

Spiritual health - is the most important aspect of health from my perspective because it influences all aspects of our health and often it is neglected. We have to take care of our soul as well as we take care of our physical body and the best way to do this is by meditation. Please don't be scared if you don't know what meditation is or how you can do it, because it's a lot easier than you think, in fact you don't have to do anything, just stay still and silent. If you can remain still and silent for 15 minutes a day and gradually increase this interval to an hour a day, it will have a great influence on your spiritual health and on your overall health too.

Health Food Matters

Some of my friends say that they would rather not know anything about health food and how exactly they are eating because ignorance is bliss and enjoying food is more important than anything else. But I would say knowledge is power, that's what drives me to read and understand what healthy eating is all about, why some people become so interested in health food, and what convicts people want to change their lifestyle. Knowing what is good to eat helps you plan your diet more wisely and safeguard what is most important, your health. Here, I have put together four most talked about topics in healthy eating and health food: Fats, Meat, Fiber, and Sugar. If you never know these facts before, perhaps they would change your whole perspective about eating right, just as it had for me.

1. Meat for Strength

Meat may not exactly be called a health food but it provides us many micronutrients such as vitamin B12, calcium, and vitamin that a growing body needs and is a major source of protein. For instance beef contains highly absorbable trace minerals like iron, zinc, and manganese. Poultry and seafood contribute vitamin B6, and pork is a rich source of thiamine. However, meat and poultry contain quite a bit of fat, and about one-third of that fat is saturated. Saturated fatty acid in the diet has been shown to be positively correlated with total blood cholesterol levels, cholesterol levels, and negatively correlated with (beneficial) HDL cholesterol levels. Saturated fat intake is at least as closely related to arterial clotting. A high intake of animal fat may increase the risk of a number of cancers, including cancer of the colon, breast, prostate and pancreas. I used to care nothing about health food and crave for meat because of its taste and even insisted that I have meat for every meal. But after having learnt so much about healthy diet, I wouldn't dare whisper "long life to all meat-lovers!" like I have so blatantly in the past.

I realize that eating grilled or barbecued meat, or seafood also exposes us to carcinogens called heterocyclic amines (HCAs). These health hazardous substances form on foods as they cook on open flame or under the high heat of the grill, regardless of whether or not char is formed. Also, it's interesting to note that when fat drips onto the heat source, it creates flare-ups and smoke which then deposits on the food yet another group of carcinogens, called polycyclic aromatic hydrocarbons (PAHs).

One way to avoid these carcinogens and still enjoy grilled meats as health food is to put them under foil wraps before putting them on the fire. In addition, the food gets the aroma of grill, especially if you leave the top loosely sealed. Baking and roasting are healthier cooking methods. They are less likely to produce HCAs as the cooking temperature is lower, and cooking with liquid (boiling, steaming, poaching, stewing, etc) generates no HCAs.

2. Fiber for Digestion

Dietary fiber is found in plant foods, namely cereals, beans, peas, wheat, fruits and vegetables, and is the magic ingredient which helps maintains our digestive system in perfect shape. It's made up of the indigestible parts or compounds of the plant that pass relatively unchanged through our stomach and intestines, although bacteria in the large intestine can partly digest fiber through fermentation. Fiber slows down the rate of digestion of food, leading to a more gradual emptying of the food from the stomach into the small intestine. This basically means food gets digested sooner, and the indigestible bits, including the fiber, are moved out faster. Healthy digestion contributes to lower weight and increased health, which means less risk of getting many of the modern diseases such as colon disease and even diabetes. By slowing stomach emptying, fiber helps avoid the situation where the body has to produce large quantities of insulin (as a result of repeated rapid release of glucose into the intestine). This in turn helps protect against diabetes. A high fiber diet is even more important for older people as our digestive system slows down with age.

Fiber is also known to absorb water to become lighter, bulkier and easier to move along. This is why it helps prevent constipation. When it absorbs water in the stomach, it gives that feeling of fullness and therefore lessening the amount of food consumed. Thus, don't forget to drink plenty of water throughout the day, so that the fiber you eat can swell to be as light as possible.

3. Good Fats Makes the Difference

"Eat low-fat, low-cholesterol health food" is a very common advice given to me. But what really matters is the type of fat in the diet. Remember, not all fats are created equal. What's clear is bad fats, meaning saturated and trans fats, pose risk to health while good fats, meaning monounsaturated and polyunsaturated fats, lower the risk.

The key in getting health food is substituting good fats for bad fats. Saturated fats are found in animal products like meat, seafood, whole-milk dairy products (cheese, milk, and ice cream), poultry skin, and egg yolks and dairy. Some plant foods are also high in saturated fats, including coconut and coconut oil, palm oil, and palm kernel oil. Saturated fats raise total blood cholesterol levels more than dietary cholesterol because they tend to boost both good HDL and bad LDL cholesterol. Trans-fats are found in commercially prepared baked goods, margarines, snack foods, fried snack foods like French fries and onion rings, processed foods, and margarine; many of them are produced by heating liquid vegetable oils in the presence of hydrogen. This process is known as hydrogenation. The more hydrogenated an oil is, the harder it will be at room temperature. For example, soft margarine is less hydrogenated and so has fewer trans fats than a stick margarine. Trans fats are even worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL.

Good sources of healthy unsaturated fats are found in health food products derived from plant sources and fatty fish such as salmon. The two main categories are polyunsaturated fats found in high concentrations in sunflower, corn, and soybean oils and monounsaturated fats, which are found in high concentrations in canola, peanut, and olive oils. These healthy fats not only improve cholesterol levels but also protect the heart.

4. Sweets for Pleasure

Almost every food we eat contains sugar. It's better to enjoy a really extravagant dessert once in a while than to fill your daily diet with "fat-free" sugary treats which are basically empty calories and devoid of nutritional benefits. Other than table sugar, watch out for other forms of sugar, especially those words ending with "ol" or "ose". Consuming sugarless artificial sweeteners in so called health food may be more damaging than helpful to our health.

In order to keep the amount of sugar floating through your blood vessels at around a teaspoon, your body releases insulin whenever you eat foods that result in sugar entering your blood stream. Most carbohydrates fit this category. Sugar, most sweeteners, grains, cookies, pastries, cakes, pasta, and starchy vegetables like potatoes all lead to a release of sugar into your blood stream. Insulin works by stimulating your cells to sponge up this excess sugar out of your blood stream. Once inside your cells, sugar is used for energy, with any excess amount being converted to fat tissue. Excess insulin is known to cause weight gain due to storage of fat and sodium retention which leads to holding excess water and high blood pressure.

Reduce your intake of sugar and all foods that contain sugar. Some of the most concentrated sources of sugar are soda, cookies, chocolate bars, donuts, pastries, ice cream, and ketchup. Avoid sweeteners like molasses, corn syrup, high fructose corn syrup, and maple syrup, and replace table sugar in your beverage, cooking and baking with natural sweeteners such as honey. Do activities and exercises that build or maintain your muscles. Muscle tissue acts as a storage site for extra sugar. The more muscle tissue you have, the better you can regulate your blood sugar and insulin levels.

Community Health Assessment Tools In A Developing Society

Community health nursing synthesis the body of knowledge from the public health sciences and professional nursing theories for the purpose of improving the health of the entire community. Community health nursing practice therefore promotes and preserves the health of the population. The community is not an easily or consistently defined entity. It is a nebulous, complex concept. Thus a community in its broadest sense will be defined as a group of people living in an environment that has the ability to meet their life goals and needs.

The entry into the community is usually made possible by the chief medical officer through the issuance of letters to community leaders for easy acceptability and accessibility. Critical to the dynamics of a community are its patterns of communication, leadership and decision making and this occurs as a result of interaction between community members and the larger society. The different components of this community include people, environment and health care delivery system and together they determine the physical, social, mental states of wellness of the people.

For the people component there is:

a. Demographics such as population distribution, mobility, density and census data;

b. Biological aspects will include health and disease status, province/state of origin, nationality, age, sex, mortality.

c. Acquired aspects are twofold, social which takes into account occupation, activities, marital status, education, religion and cultural which include position, roles value, customs, norms, taboos.

For the environmental component there is:

a. Physical aspect which include natural resources, landscape, climate, terrain, relief, boundaries and limits;

b. Biological and chemical aspects such as animal reservoirs, toxic substances, food supply, standard of food control, water source, staple food, vector control, living arrangement, sewage disposal, water supply and refuse disposal;

c. Social aspects involve industry and economics, communication, transportation, recreation/recreational facilities and religion.

For the health care delivery system component, there is:

a. The organizational aspect involving government and private sectors, systems, linkages and

b. Resources which involve health personnel, health centers, clinics and hospitals, funds, services.

Through the complete understanding of these different components, then can health promotion, disease prevention and rehabilitative measures be implemented. Promoting health of the people and their welfare can be done through health education to both individuals and families. During these education sessions, various aspects of diseases, their prevention can be given as well as ways of rehabilitation when calamity strikes.

Community health problems will then be arrived at through two ways:

a. As perceived by the community and then

b. As perceived by the community health nurse.

A community diagnosis will then be reached, which can range from one to several. Recommendations can then be made to the appropriate people concerned.

In conclusion, the community health nurse, in doing this assessment, must strive to work as a team with the community involved and he/she must be able to achieve if not all, some of the eight components of primary health care, such as immunization against infectious diseases, an adequate supply of safe water, education concerning prevailing health problems and the methods of preventing and controlling them.