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Friday, 10 June 2016

Princess Health and June 10th, 2016 Big Day. Princessiccia

Princess Health and June 10th, 2016 Big Day. Princessiccia

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June 10th, 2016 Big Day

I didn't get as much sleep as I needed or wanted last night, but apparently it was enough to make a difference for me today. I woke feeling rested and ready for a big day.

It's been a really big day, work wise. I've been going non-stop since 6am and it isn't over until just after 8pm. Once again, my activity level will be my workout today. My three hour location broadcast earlier today was in the sun, constantly moving. Honestly, I probably should have consumed more water.

I'm in between location broadcasts at the moment--writing this from the studio.

Having what I need when I need it is imperative on days like today. It takes minimal planning, but it does take planning. My midday broadcast was an event where the client was giving away free hamburgers, hotdogs, potato chips, ice cream and cupcakes. I enjoyed some good food right before and planned on my late lunch not too long after, so I made it through just fine. Had I not planned well, I would have had a harder time getting through that broadcast without feeling the need to blow through a good amount of calories. Staying connected in good support also helps.

I'm about to take off for my broadcast at a big rodeo where I plan to ride a mechanical bull. There will be video, I'm sure.

I'll make it home afterward, grab a decaf, relax--prepare dinner and very likely, go to bed early. Doesn't much sound like me on a Friday night, but that's the plan. Tomorrow starts another busy day with two location broadcasts, including our final turn at the 101 Wild West PRCA Pro Rodeo.

I've maintained the integrity of my calorie budget. I'm remaining abstinent from refined sugar, I'm meeting or exceeding my #watergoal each day and I'm staying connected in support. I feel great about maintaining the fundamental elements of my plan in the middle of such a crazy-hectic schedule.

I received a wonderful email this morning in response to last night's blog post. I'm awaiting approval to share some of the very interesting information it contained.

Have an amazing Friday night!

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Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Ashland hospital expands into wellness and prevention programs. Princessiccia

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By Judi Kanne
Kentucky Health News

Hospitals� basic business is taking care of the sick and injured, not keeping people from getting sick. But more and more of them are getting into wellness and prevention, not only to help their communities but to make money.

King's Daughters Heart and Vascular Center
One of those is King�s Daughters Medical Center in Ashland, which has developed an innovative strategy for building relationships with local employers to help their employees live healthier lives.

King�s Daughters began by focusing on self-insured employers, who can get the most direct benefit from reduced health-care expenses. It used one-to-one employer outreach activities such as a farm-to-table employer lunch, to which more than 126 local employers were invited.

The first question for employers, said Matt Ebaugh, vice president and chief strategy officer at King�s Daughters, is �Do you understand what is driving the cost for your employees?� because �Self-funded employers do not always have the analytics or tools needed to understand where those costs come from.�

King�s Daughters used Strategic Health Services of Alpharetta, Ga., to create a portal for health risk assessment, biometric screening results, claims analytics and personal health profiles of employees.

While the program is aimed at wellness, it also finds new cases for the hospital. �We knew if we did a smart thing for local employers, demonstrated value, and coupled it with good customer service, then when employees needed a higher level of care, they would come to us,� Ebaugh said.

By means of screenings for diabetes, cholesterol, and body mass index, employees become patients.

Diabetes screening can be critical. About 86 million American adults are pre-diabetic, but nine out of 10 people who are don�t know it, according to the federal Centers for Disease Control and Prevention. That can be detected with health-risk assessment lifestyle questionnaires.

Beyond individual screenings, hospitals can examine the emerging risks in a population using claims data. That can also help them show employers what�s driving up their costs. Claims also indicate which employees are most likely to use hospital and pharmacy services.

�We need to find innovative ways to motivate individuals to change old and dangerous patterns,� Ebaugh said, because simple lifestyle changes can dramatically cut the risk for developing diabetes.

But getting healthy may require offering financial and other incentives to get people to participate in wellness programs. The Ashland hospital plans to try gamification, incorporating into the workday a set of programmed games and activities that remind sedentary employees to get up, stretch, and move around.

The idea is to make health and fitness fun, a social experience and accessible to as many members as possible. Gamification programs include computer notifications or other reminders that stimulate sedentary disruption and track activity. In some cases, motivation includes team competition in which employees win points by stopping to stretch.

Ebaugh said such programs have been shown to work and are critical in some cases, because a pre-diabetic employee may not be motivated enough to change eating and exercise patterns. �Knowing is not enough,� he said. �We anticipate the energy and participation with gamification will increase as a result of more engaging activities.�

The hospital first started a wellness program for its own employees, and plans to add gamification to it, Ebaugh said: �It�s important our model work well to show our employers the success we are having with our internal employees.�

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

Thursday, 9 June 2016

Princess Health and June 9th, 2016 Observing And Analyzing. Princessiccia

Princess Health and June 9th, 2016 Observing And Analyzing. Princessiccia

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June 9th, 2016 Observing And Analyzing

A good friend of mine joked, with a smile, "I can't stand you, Mr. I'm Not Trying To Lose Weight!! I'd kill for 3.2 pounds." 

Yesterday's maintenance weigh-in was truly unexpected. I haven't handled my schedule very well. Instead of me managing it, I've allowed it to manhandle me. My point is, too little sleep and a big bunch of missed workouts, should have translated to a slight gain. It didn't. And I'm not complaining AT ALL. I'm just observing and analyzing. 

I can see where this whole I'm not trying to lose weight thing can possibly read annoying to anyone starting out or in the middle of intense struggle along the way. But before you yell, "shut-up Sean, Mr. I'm Not Trying To Lose Weight," at your computer or device screen, consider--I've been at all points along this road. And some of those places, I hung out for quite some time. 

What this is really proving to me is how the metabolism can effectively be transformed. If you told me I'd be eating 2300 calories per day and somehow, still losing weight, I would have never believed you. I was convinced my metabolism was stuck on super slow. It might have been for a very long time. But clearly, it's different now. I'm blessed and very grateful. But my bigger point is this: There's hope for anyone who believes they're forever in a down position with their metabolism.

I'm not a nutrition expert, obviously. But I think the gradual evolution of my food plan is chiefly responsible for this quicker metabolism.

I eat a lot of, what I call, "one ingredient foods" or "foods without a nutrition label." As in, an egg is an egg, an apple is an apple, natural peanut butter is simply peanuts, an avocado is an avocado, you get the idea. Granted, I certainly eat some processed stuff--but for the most part, it's very simple things. The abstinence from refined sugar for over two years, I truly believe--has contributed in a major way.

My opinion, based on what I've learned from others and the analysis of everything, on the whole--is this: The body recognizes and processes these things I'm eating easier and much faster. I'm not throwing it many heavily processed curve balls or refined sugar--I'm also getting more than enough water every day...and so, the metabolism works more efficiently. 

So what now? Do I add more calories? When I commit to a more structured weight training program (longtime readers, even though I might deserve it--please refrain from bursting out in laughter), I'll need to add a fairly good amount of calories, I'm sure. Even just a more consistent combination of cardio/strength training will require more calories, I'm certain.

If we study this from the right perspective, it offers a tremendous amount of hope for yet another wonderful part of our individual transformations along the way. Perhaps right around the corner for some--maybe further down the road for others. But, it's possible. 

Once again I wasn't able to blog late afternoon instead of last thing at night. That plan is clearly a work in progress.

Isn't everything a work in progress? 

Today, I maintained the integrity of my calorie budget. I remained abstinent from refined sugar. I met my #watergoal and I exercised well with nearly two hours of walking around my location broadcast this evening. I'm dropping in bed at a fairly reasonable hour.

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Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

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As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."
KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.
Princess Health and A Serious Challenge to the 2012 Low-carbohydrate "Metabolic Advantage" Study. Princessiccia

Princess Health and A Serious Challenge to the 2012 Low-carbohydrate "Metabolic Advantage" Study. Princessiccia

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Warning: this post will be a bit more wonkish than usual, because I need to get detailed to make my points. To read a summary, skip to the end.

In 2012, David Ludwig's group published an interesting RCT that suggested a substantial "metabolic advantage" resulting from a high-protein, very-low-carbohydrate diet (VLC) (1). In other words, this diet led to a higher energy expenditure relative to a normal-protein, low-fat diet (LF) over a one month period (a low-glycemic-load, normal-protein diet was in the middle and not significantly different from the other two). Resting energy expenditure (REE) was slightly but significantly higher on the VLC diet, and total energy expenditure (TEE) was elevated by a whopping 300+ kcal/day! I covered the study at the time, describing it as "fascinating" and "groundbreaking", and calling for the study to be replicated so we can be more confident in its unexpected result (2).

This finding has been used by Ludwig, Gary Taubes, and others to support the carbohydrate-insulin hypothesis of obesity, although there is no evidence that the effect was mediated by insulin, and also no evidence that it was mediated by reduced carbohydrate rather than increased protein (3).

Since I published that post, my confidence in the finding-- and particularly the common interpretation of it that reducing carbohydrate intake to a very low level increases REE and TEE-- has gradually been eroding. This is partially because other studies have generally reported that the carbohydrate:fat ratio of the diet has little or no effect on REE, TEE, or fat storage (4, 5, 6, 7, 8, 9, 10).

Read more �

Princess Health and Nonprofit says most of the 52 Kentucky hospitals it grades on patient safety got Bs and Cs, and KentuckyOne got five Ds. Princessiccia

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Kentucky Health News

A nonprofit group that rates hospitals recently doled out its hospital safety scores and found that most Kentucky hospitals scored a 'B' or 'C' in overall patient safety, and that five of the six Kentucky hospitals that got Ds are owned by the same hospital system.

The Leapfrog Group, a non-profit organization that rates hospitals, evaluated more than 2,500 hospitals nationwide, including 52 in Kentucky. Most of Kentucky's hospitals were not rated because rural critical-access hospitals don�t have to report their quality measures.

It found that 21.2 percent (11) of Kentucky's hospitals got As, which was much lower than the national average of 31 percent, while 11.5 percent (6) got Ds, more than the national average of 6.3 percent. Additionally, 23 percent (12) got Bs and 44 percent (23) got Cs.

"Once again Kentucky had fewer 'A'-rated hospitals than the national median and more hospitals rated near the bottom with increasing numbers of 'D's. More troublesome is the observation that five of the six hospitals receiving a 'D' are in the same hospital system," Dr. Peter Hasselbacher, emeritus professor of medicine at the University of Louisville, wrote in an op-ed for the Kentucky Health Policy Institute blog.

Except Lake Cumberland Regional Hospital, the Kentucky hospitals that got a D are owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University Hospital in Louisville; and St. Joseph Hospital and St. Joseph East in Lexington.

Richardson
Staffing cuts at the U of L Hospital have made it �unsafe� for seriously ill and injured patients, Dr. J. David Richardson, vice chair of surgery and president of the American College of Surgeons, told the university's top health officials in an email on June 7. He said the public hospital has �never been worse in the 34 years that I have been heavily involved with it,� reports Andrew Wolfson of The Courier-Journal.

"In an interview, Richardson said the problems are so great that the only solution is to 'unwind' the 2013 agreement in which the state turned over day-to-day management of the hospital to Catholic Health Initiatives," Wolfson reports. He said the letter understated the problems, which are making it impossible to conduct academic research at the hospital.

The two University of Kentucky hospitals got Cs from The Leapfrog Report. Pikeville Medical Center is the only Kentucky hospital evaluated that has had straight As since 2013, when the study began. Click here for Kentucky's Hospital Safety Scores.

KentuckyOne Health issued a statement saying University "is an excellent hospital with a dedicated and talented team of professionals that is staffed to meet the patient�s needs. Our focus has always been on quality, safety and patient experience."

On Sunday, June 12, KentuckyOne and the university ran a full-page ad in The Courier-Journal saying they are "committed to ensuring safe and effective patient care" and "Safety and quality are our top priorities." They said they take Richardson's concerns "seriously, and we are committed to reviewing and addressing the issues noted."

In 2012, when management of most of the hospital was given to KentuckyOne, "Officials said it would pump $1.4 billion into U of L health operations over 20 years. But the company has had financial troubles ever since, and in February 2014 announced it was laying off 500 employees in Kentucky," Wolfson notes.

The Leapfrog Group's analysis was developed under the guidance of the nation's leading patient safety experts and the scores were based on 30 measures of publicly available hospital safety data. The ratings are issued twice a year, for errors, injuries, accidents and infections. The report is peer-reviewed and published in the Journal of Patient Safety.

Hasselbacher noted legislation in Congress that would protect some hospitals from Medicare payment cuts if they serve more than average numbers of indigent and poor people.

"Care must be taken that this initiative, lobbied heavily by hospital organizations and their partners in academic medicine, is not interpreted to imply that is it acceptable to provide medical care of lower quality to poor people or in teaching hospitals," he wrote. "The fact that this protection is being considered at all is a tacit admission that our current methods of measuring quality and safety are flawed."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Salmonella outbreak in 35 states linked to live poultry; 21 cases reported in Kentucky; here are some tips to avoid infection . Princessiccia

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U.S. Centers for Disease Control and Prevention photo
Poultry specialists from the University of Kentucky are urging Kentuckians who raise chickens or ducks to take extra precautions against salmonella infection, since 21 cases have been reported in the state.

�Any contact with live poultry puts you at risk for salmonella infection,� Jacqueline Jacob, UK poultry extension project manager for the College of Agriculture, Food and Environment, said in a news release. �Salmonella germs can be in the birds� droppings and on their bodies and also on their cages, coops, hay, plants and the soil where they live and roam.�

Salmonella is a bacteria that makes people sick. Symptoms usually develop 12 to 72 hours after exposure and include diarrhea, fever and abdominal cramps. The illness usually lasts four to seven days. Children under 5, adults older than 65 and those with weakened immune systems are at the greatest risk of being severely affected.

These infections are part of a seven-state salmonella outbreak that have all been linked to contact with life poultry from multiple hatcheries. Jacob cautioned that any chicken can carry salmonella, even if it looks clean and healthy.

So far, more than 300 people have been infected, with more than one-fourth of those children aged 5 or younger, according to the federal Centers for Disease Control and Prevention.

�Many of the cases in the current outbreak are linked to backyard flocks, so we want to remind folks of simple things they can do to protect themselves," Jacob said.

Tips to avoid infection:
  • Wash hands thoroughly with soap and water immediately after touching live poultry or anything in the area where they live.
  • Do not let live poultry inside the house, or around areas where food or drink is located.
  • Do not let children younger than 5 handle or touch live poultry without supervision.
  • Adults should supervise the handwashing of young children.
  • Keep poultry away from your nose, mouth and eyes.
  • Wash your hands with sanitizer that has a 99 percent or higher bacteria kill rate after handling poultry at shows and fairs.
�It�s also a good practice to be careful when you wash equipment or eggs in the kitchen sink,� Jacob said. �You don�t want to cross contaminate food. Always use a good disinfectant to clean up in the kitchen when you�re finished.�

Click here for more advice from the CDC for backyard flock owners.
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