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November 2016

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Giving Back and Making a Difference

Texas Southern University & MD Anderson Cancer Center

By Texas Southern University The award-winning documentary film Until 20, recently premiered on the campus of Texas Southern University... PAGE 4

PAGES 14-15

Houston Health Department HIV & AIDS Awareness By d-mars.com News Provider The Houston Health Department (HIV-STD Viral Hepatitis Prevention) is a vital component to the prevention of HIV/AIDS in this city.

The Transport Workers Union MTA Health & Welfare Trust Partners with Cigna and Kelsey-Seybold Clinic

PAGE 6

How Hospitals Can Boost Profits While Providing Value By d-mars.com News Provider Hospitals must do what they can to stand out from the pack if they want to maintain a healthy level of profit growth and avoid the revenue loss that results from missing the mark on quality. PAGE 10

PAGE 12 PAGE 22

Medical Education Needs More of a Public Health and Prevention Focus

Employers and Health Care

I think there are things for all of us to do as long as we’re here and we’re healthy. - Gwendolyn Brooks

November 2016 3

Journal Behind The

Message from the Publisher

MR. D-MARS

SR. PUBLISHER Keith J. Davis, Sr.

CO-PUBLISHER

Tiffany Davis, RN-BSN, MSN, CNE

VICE PRESIDENT Kim Floyd

ASSOCIATE EDITOR Dawn Paul

ACCOUNTING MANAGER Eugenie Doualla

“Giving Back and Making a Difference” is the theme for this issue of the d-mars.com Health & Wellness Journal. It’s a great thing to see our community volunteering and giving back to one another. However, are we really giving back and making a difference in the area of health? Are we paying it forward and sharing vital health information to make for a better community? It is so important to spread the health knowledge, as our community can live longer. Happy health! This month we shine the spotlight on the Transport Workers Union - MTA Health & Welfare Trust (TWU-HWT). TWU-HWT recently held a ribbon cutting ceremony for its Telemedicine Clinic. Partnering with Cigna and the Kelsey-Seybold Clinic, this clinic is the first of its kind in the Harris County area. With dedicated and committed health partners Cigna and the Kelsey-Seybold Clinic, this pilot program was designed by Tanya Allen-Meekins, TWU-HWT Benefits Manager. Wanting to give employees additional quality health and wellness services and more convenience, the Telemedicine Clinic is a great initiative.

SENIOR ACCOUNT EXECUTIVES

As always, thank you for your continued support of d-mars.com. When you support us, you are supporting more than just our company; you are supporting the communities in which we live and work. Working together, we can succeed in making positive things happen.

PHOTOGRAPHY

Contents

C.J. Johnson C.T. Foster Tiffany Black L.C. Poullard Grady Carter Tony Gaines

MULTIMEDIA DIRECTOR Andrea Hennekes

LAYOUT & GRAPHIC DESIGNER Angel Rosa

SOCIAL MEDIA COORDINATOR Charlette Washington

EXECUTIVE ASSISTANT Tashara Callaway

DISTRIBUTION

Booker T. Davis, Jr. Rockie Hayden

CONTRIBUTING WRITERS Houston Health Department The National Eye Institute Texas Southern University Leah Rapley d-mars.com News Provider

Texas Southern University News................................................................................................................................................................................................... 4 Houston Health Department............................................................................................................................................................................................................6 Guilt-Free Holidays Are Ahead......................................................................................................................................................................................................... 8 Tapping Evolution to Improve Biotech Products...................................................................................................................................................................... 8 CMS Releases Final Rule on Quality Payment Program.........................................................................................................................................................10 How Hospitals Can Boost Profits While Providing Value......................................................................................................................................................10 Hazards of Working in Healthcare................................................................................................................................................................................................12 Medical Education...............................................................................................................................................................................................................................12 Liver Cancer..........................................................................................................................................................................................................................................13 The TWU-HWT Telemedicine Clinic............................................................................................................................................................................................14-15 National Eye Institute News...........................................................................................................................................................................................................16 So, You Like Your Coffee?................................................................................................................................................................................................................. 17 National Healthy Skin Month..........................................................................................................................................................................................................18 6 Steps to Better Digestion.............................................................................................................................................................................................................18 Health & Wellness Recipes..............................................................................................................................................................................................................19 Depression Among Women.............................................................................................................................................................................................................20 American Adult Women and ADHD...............................................................................................................................................................................................20 Employers and Health Care............................................................................................................................................................................................................22 OTC Pain Medicine Overdose..........................................................................................................................................................................................................23 MD Anderson and HISD Partner.....................................................................................................................................................................................................24 Nine Laws Effective in Reducing Underage Drinking Fatalities........................................................................................................................................24 Sports Medicine News.....................................................................................................................................................................................................................26

MR. D-MARS Tip of the Month “One man can be a crucial ingredient on a team, but one man cannot make a team.” —Kareem Abdul-Jabbar

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November 2016

Texas Southern University & MD Anderson Cancer Center

Award-Winning Documentary, Until 20

By Texas Southern University Contributing Writer

he award-winning documentary film Until 20, recently premiered on the campus of Texas Southern University in the Nabrit Science Center. Until 20 is an independent film produced by CNN Executive Producer and Vice President of Program Development, Diversity and Inclusion Geraldine Moriba. It was created to raise awareness about childhood cancers and stimulate conversations about how today’s youth should strive to live the best life possible.

Dr. Valerae O. Lewis, Chair of the Orthopedic Oncology Team at MD Anderson Cancer Center, Dr. Rodney Hunter, COPHS Assistant Professor and Moriba participated in a panel discussion following the screening. The film is about James Ragan, a Latino Texas native who was diagnosed with osteosarcoma at age 13. The story is James’s journey as a promising Division One golfer trying to save the life of the next kid with cancer before his own time runs out. Along the way, he falls madly in love and learns about the power of family. This is a film about the depth of life and not the length of it. “What James does after his diagnosis is the basis of a story one will never forget,” Moriba said. “This is an emotionally compelling story that moves people to action, especially young adults. It’s about how to live a good life.” For more on Until 20, please visit www.Until20.com.

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November 2016

Houston Health Department HIV & AIDS Awareness

What Is PrEP?

By d-mars.com News Provider

he Houston Health Department (HIV-STD Viral Hepatitis Prevention) is a vital component to the prevention of HIV/AIDS in this city. They are selfless in their efforts to eliminate HIV, viral Hepatitis and sexually transmitted diseases through the adoption of health promoting behaviors among the residents of Houston. This department continues to be proactive in the fight of HIV/AIDS in our community. The department’s mission is to work in partnership with the community to assess, plan, and implement effective public health strategies to reduce the spread of HIV, viral Hepatitis and other sexually transmitted diseases in the City of Houston. In addition to their numerous outreach efforts, the department is raising awareness on PrEP. PrEP (short for Pre-Exposure Prophylaxis) is a new way to help prevent HIV. It’s a prescription medicine that when taken every day, greatly reduces your risk of getting HIV by blocking the virus.

PrEP Questions & Answers If I take PrEP, can I stop using condoms? Because PrEP only protects against HIV, it is strongly suggested that you use condoms to prevent the spread of sexually transmitted diseases. Condoms can help you prevent things that PrEP can’t—like pregnancy, or STIs like gonorrhea and syphilis. What happens if I miss a dose or only take PrEP once in a while? To be effective at preventing HIV, PrEP must be taken every day as prescribed by your doctor. If you miss one dose, that’s okay. Take your next dose as planned. If you miss two or three doses while you’re sexually active, or if you don’t take PrEP as prescribed, check in with your doctor to make sure that you’re still HIV-negative. You can restart your PrEP routine after you get a new negative HIV test. What if my doctor doesn’t know about PrEP? If your primary care doctor is unfamiliar with PrEP, call AIDS Foundation Houston at 713-623-6796. AIDS Foundation Houston can help you find PrEP services, so you may continue seeing your primary doctor for the rest of your health needs. If you want your primary care doctor to handle your PrEP services, AIDS Foundation Houston can contact your doctor on your behalf to talk about what PrEP is, and how it might be beneficial to you. Does PrEP interfere with my birth control pill? To date, research shows that hormonebased birth control drugs do NOT interact

with PrEP. As advocated by the U.S. Women and PrEP Working Group, a coalition of more than 50 women from leading AIDS and women’s health organizations, more research needs to be done studying women and their prevention choices to avoid both HIV infection and pregnancy. How effective at preventing HIV is PrEP? If taken correctly and consistently, PrEP is 92%–99% effective in reducing your risk for HIV. How long does it take PrEP to become effective after you start taking it? How long does it take to become protective? It’s estimated that it takes at least seven days for PrEP to reach high levels of protection in the body. When used correctly,

PrEP provides 92%–99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed. If I’m not having sex right now, do I still need to take PrEP? If you feel your risk for HIV has changed recently and it doesn’t make sense for you to take PrEP anymore, then talk to your doctor about discontinuing PrEP. If you’re just experiencing a temporary “lull” in your sex life lasting less than a month or two and expect to be sexually active again in the near future, it may not be advisable to discontinue PrEP. Ask your doctor. If you are HIV-negative and think you might be at risk of getting HIV, taking PrEP can give you protection and peace

of mind. PrEP does not protect against sexually transmitted diseases like gonorrhea or syphilis, so you should continue using condoms to prevent the spread of sexually transmitted diseases. One PrEP pill a day is 92% effective at preventing HIV. For more information on PrEP, please contact the Houston Health Department at 832-393-5010, AIDS Foundation Houston, Inc. or visit www.preptopreventhiv.org. One pill. Once a day. PrEP now. Prevent HIV. Sources Houston Health Department AIDS Foundation Houston, Inc. www.preptopreventhiv.org

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November 2016

Guilt-Free Holidays Are Ahead

By Leah Rapley

Contributing Writer

t is getting close to the holidays. If you’re anything like me, you know this time of year brings all the good holiday eats. Sweet potato pie, mac and cheese, my aunt’s famous ooey gooey pumpkin cake and my uncle’s spicy fried turkey are some of my favorites. Now there’s nothing wrong with a little indulging and you can’t deprive yourself, but it’s important to remember not to overdo it during the holidays. I want to offer a few of my tips that can help you have a guilt-free holiday while still eating some of your favorite foods.

Tip 1: Have a balanced plate The key to navigating the kitchen while reducing the chances of putting on pounds, is making sure that you have all food groups represented on the plate. In my family, our holiday meals are full of carbs/starches and fat, so I try to make sure I get small portions of the carbs and fats and fill my plate with lots of veggies and protein.

Tip 2: Choose healthy substitutes when cooking You would be surprised at what foods you can substitute with healthier ver-

sions and still get a flavorful finished product. So, instead of using milk, try adding almond milk. Or when a recipe asks for flour, try using oat flour or coconut flour instead. Rule of thumb, if you do decide to make these adjustments, don’t tell your family beforehand or you may be left with a lot of leftovers.

Tip 3: Portion control When I say portion control, I do not mean you need to come to dinner with measuring cups and food scales. Limit yourself to one plate. Yes, one plate and a dessert. If the meal was so out of this world and you can’t help but to go back for more, just get seconds

of proteins and veggies. Avoid having seconds of foods that are high in carbs/starches, fats and sugar.

Tip 4: Plan ahead This is this most important tip to having a guilt-free holiday. We all know that on Thanksgiving Day, we are about to have a feast, so plan for it! Literally make a plan for how much you plan to eat that day and how often you will eat. Since you know much of the meal will equate to a cheat meal, plan to do an intense workout before feasting time. When you workout before, your body will be craving energy, so your body will use the food that it consumes af-

terwards as fuel for recovery.

Tip 5: Drink water On any given day, it is important to drink water throughout the day. But it will be especially important to drink water during the holidays. Drinking water will not only help flush out the toxins from food but also help you feel full which means (Ding! Ding! Ding!) you will eat less. Though I am not a health expert, these tips have helped me stay healthy through the holidays. Hopefully my tips can help you have a guilt-free holiday season.

Biotech

Tapping Evolution to Improve Biotech Products By d-mars.com News Provider

cientists can improve protein-based drugs by reaching into the evolutionary past, a paper published in Nature Biotechnology proposes. As a proof of concept for this approach, the research team from Emory, Children's Healthcare of Atlanta and Georgia Tech showed how "ancestral sequence reconstruction" or ASR can guide engineering of the blood clotting protein known as factor VIII, which is deficient in the inherited disorder hemophilia A. Other common protein-based drugs include monoclonal antibodies, insulin, human growth hormone and white blood cell stimulating factors given to cancer patients. The authors say that ASR-based engineering could be applied to other recombinant proteins produced outside the human body, as well as gene therapy.

It has been possible to produce human factor VIII in recombinant form since the early 1990s. However, current factor VIII products still have problems: they don't last long in the blood, they frequently stimulate immune responses in the recipient, and they are difficult and costly to manufacture. Experimental hematologist and gene therapist Chris Doering, PhD and his colleagues already had some success in addressing these challenges by filling in some of the sequence of human factor VIII with the same protein from pigs. "We hypothesized that human factor VIII has evolved to be short lived in the blood to reduce the risk of thrombosis," Doering says. "And we reasoned that by going even farther back in evolutionary history, it should be possible to find more stable, potent relatives." Doering is associate professor of pediatrics at Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Health-

care of Atlanta. The first author of the paper is former Molecular and Systems Pharmacology graduate student Philip Zakas, PhD. Doering's lab teamed up with, Trent Spencer, PhD, director of cell and gene therapy for the Aflac Cancer and Blood Disorders Center, and Eric Gaucher, PhD, associate professor of biological sciences at Georgia Tech, who specializes in ASR. ASR involves reaping the recent harvest of genome sequences from animals as varied as mice, cows, goats, whales, dogs, cats, horses, bats and elephants.

Using this information, scientists reconstruct a plausible ancestral sequence for a protein in early mammals. They then tweak the human protein, one amino acid building block at a time, toward the ancestral sequence to see what kinds of effects the changes could have. The research team showed that amino acid changes toward ancestral sequences could make human factor VIII more stable and less likely to be inhibited by recipient antibodies. 'This exemplifies how understanding the evolutionary history of a protein can help engineer better versions of the protein for therapeutic use," Gaucher says. "ASR is a widely accessible strategy that utilizes both known and unknown natural protein diversity to rapidly probe a protein design space that has already been refined by natural selection for beneficial properties," the authors conclude. Source: www.sciencedaily.com

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November 2016

Business

CMS Releases Final Rule on Quality Payment Program

By d-mars.com News Provider

he Centers for Medicare & Medicaid Services (CMS) has put out its final rule for its new quality payment program, and your hospital’s providers are going to have to change the way they report quality measures to Medicare. Thankfully, CMS’ final rule has quite a few options for providers to participate in quality reporting, according to the website for the Department of Health & Human Services (HHS). Hospitals need to be aware of the changes, as they may affect your facility’s overall reimbursement, especially if you employ providers directly.

Details of program Per a new website CMS created for the quality payment program, providers who must participate in the new quality payment program are physicians, nurse practitioners, physician assistants, clinical nurse specialists and certified registered nurse anesthetists. Also, participating providers must either bill more than $30,000 a year to Medicare, or provide care for more than 100 Medicare patients in a year. Those who don’t meet this threshold are exempt. To replace the former sustainable growth rate formula, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under MACRA, the new quality payment program has two participation

tracks for providers: • advanced alternative payment models (APMs), such as accountable care organizations (ACOs), and • the Merit-based Incentive Payment System (MIPS). Depending on whether your hospital participates in an ACO or other APM, your physicians may have different requirements under MACRA. Both tracks reward clinicians for keeping patients healthy and providing highquality care.

More options for providers, hospitals If your hospital isn’t participating

in an APM just yet, you’ll likely get a chance to sign on in the near future. CMS plans to expand the types of APMs available to providers and hospitals, as well as their scope. Right now, it’s been focusing on areas such as bundled payments for joint replacement and comprehensive quality models for primary care. In the future, the agency will add additional options for various facilities and specialties, including the chance to participate in the second phase of ACOs. By 2018, CMS wants to have at least 25% of eligible clinicians participating in APMs. For those facilities that won’t be part of an APM right away, clinicians will receive reimbursement under MIPS.

And CMS has drastically simplified reporting requirements for MIPS. Most participants will only have to report six quality measures, including an outcome measure, for at least 90 days. Groups using the MIPS web interface must report 15 quality measures for a full year. Depending on the type of facility where a provider’s employed, they may also have to report additional information about improvement activities and advancing care information through electronic health records (EHR) systems (which replaces the meaningful use program for providers). In addition, they’ll submit data about costs. CMS will use this information in later years to influence whether providers receive pay cuts or bonuses for their performance. If providers aren’t ready to report quality measures fully under MIPS, they can take advantage of partial-year reporting. They can also opt to submit “test” measures once the system goes into effect in January. While neither option will earn providers the incentive payments they’d receive from full participation in MIPS or APMs, both will allow them to avoid pay cuts. Hospitals need to make sure the infrastructure is in place for providers to fully participate in the quality reporting program starting in 2017, whether you’re already part of an APM or will have providers electronically report measures through MIPS. Source: www.healthcarebusinesstech. com

Business

How Hospitals Can Boost Profits While Providing Value

By d-mars.com News Provider

ospitals must do what they can to stand out from the pack if they want to maintain a healthy level of profit growth and avoid the revenue loss that results from missing the mark on quality. This is especially true in today’s climate that’s increasingly focused on value. An article from Hospitals & Health Networks lays out some of the biggest revenue-related changes for hospitals over the past few years, which include: • the shift to value-based and bundled payments from payors • shrinking market growth due to outpatient surgery centers and urgent care centers • fewer referral sources because more physicians are contracted with specific hospitals, and • more value-conscious patients who are sensitive to healthcare costs. These elements make it tougher for

hospitals to expand their business. Seeing fewer patients, and receiving lower reimbursement for treating them, can wreak havoc on a facility’s budget and profit margins. But there are ways to help your hospital thrive under these conditions.

Finding growth opportunities The article discusses four key areas hospitals should focus on to increase their chances of success and boost their growth potential: 1. Patient-reported outcomes. Hospitals already have to focus on patients’ outcomes for certain targeted conditions and illnesses due to mandates from the feds. But it’s also crucial for facilities to improve their performance regarding the outcomes that matter most to patients, such as treatment length and convenience, and total recovery time. Hospitals that shine in this regard will attract more patients. 2. Comprehensive solutions to health problems. It’s not enough for

hospitals to simply treat patients for one specific acute problem. Because hospitals are gradually becoming more responsible for general population health, they must take a holistic approach to patients’ treatment that focuses on their outcomes over the entire continuum of care. Besides offering options such as surgery, hospitals should partner with other providers to expand into other areas, including preventive care like nutrition counseling and wellness programs. 3. Brand credibility. Patients have many choices for their health care. Because of this, they’re more likely to be influenced in their decision based on

what they’ve heard about a hospital’s reputation. Big name facilities such as Johns Hopkins have a clear advantage here, but smaller facilities can build on any successful press they’ve received for any reason (from positive performance on rankings to innovative quality initiatives) to help increase their credibility – and their business. 4. Market development. Besides building on their image, hospitals should also work on providing other services that make them more attractive to patients. Price transparency is one big area where hospitals can dominate the market and increase patient traffic. By setting clear prices, being up front about expenses and relating the costs of care to its quality, hospitals can convince costconscious patients about the real value of their care. Plus, payors are also more willing to work with hospitals that can present concrete financial data to show how their costs relate to quality of care.

Sources www.healthcarebusinesstech.com www.hhnmag.com

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November 2016

Career

Hazards of Working in Healthcare orkplace violence (WPV) is a recognized hazard in the healthcare industry. WPV is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It can affect and involve workers, clients, customers and visitors. WPV ranges from threats and verbal abuse to physical assaults and even homicide.

Violence Safety and Health Topics Page with information that can help you properly evaluate your workplace and prepare to prevent or minimize the likelihood of violence at your workplace. The agency has also developed an OSHA Instruction CPL 02-01-052, Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents. This instruction provides direction to OSHA officials who conduct inspections in response to complaints of workplace violence or programmed inspections at worksites in industries with a high incidence of workplace violence (e.g., health care).

Hazard Evaluation and Solutions

Identifying risk factors:

In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions. One of the best protections healthcare employers can offer their workers is to establish a zerotolerance policy toward workplace violence. The policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with workers of the facility. By assessing their worksites, employers in the healthcare industry can identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well written and implemented Workplace Violence Prevention Program, combined with engineering controls, administrative controls and training can reduce the incidence of workplace violence. It is critical to ensure that all workers know the policy and understand that all claims of workplace violence will be investigated and remedied promptly. OSHA has developed a Workplace

Known risk factors to consider include working with persons with a known history of being violent or with unstable or volatile individuals in certain healthcare settings. OSHA has also developed guidance for employers and workers in healthcare and social services: • Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers (EPUB | MOBI). OSHA Publication (OSHA-3148), (2015).

By d-mars.com News Provider

Guidance for developing a workplace violence prevention program: CDC - The National Institute for Occupational Safety and Health (NIOSH) recommends that all hospitals develop a comprehensive violence prevention program. Non-hospital settings where violence has been determined to exist are advised to do the same. No universal strategy exists to prevent violence. The risk factors vary from facility to facility

and from unit to unit within a facility. Employers are advised to form multidisciplinary committees that include directcare staff as well as union representatives (if available) to identify risk factors in specific work scenarios and to develop strategies for reducing them. All affected workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers’ policies, procedures, and materials on violence prevention. • The US Department of Health and Human services (DHHS) has developed information for Hospital Workers: Violence Occupational Hazards in Hospitals. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-118, (2012, February). • Workplace Violence Prevention for Nurses. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication Number

2013-155. • Oregon OSHA’s recommendations, Violence Prevention Program - Online, provides information about methods to recognize, evaluate and respond to risk factors related to workplace violence. • The Washington State Department of Labor and Industries has a page with information on workplace violence in healthcare settings. Included on this webpage are various guidance documents and training materials that you may find useful in developing your workplace program. If you work in a home healthcare environment, the US Department of Health and Human Services provides information highlighting the need to address workplace violence in your workplace. Home Healthcare Workers: How to Prevent Violence on the Job. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-118, (2012, February). Source: www.osha.gov

Education

Medical Education Needs More of a Public Health and Prevention Focus

By d-mars.com News Provider

f future physicians are to best serve the changing health needs of patients and their communities, medical education must put greater emphasis on public health and prevention, experts say in a supplement to October's American Journal of Preventive Medicine (AJPM). The supplement, including more than 30 research papers and commentaries authored by top medical educators and public health professionals, is sponsored by the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention (CDC). It grew out of a conference, "Patients and Populations: Public Health in Medical Education," that the AAMC and CDC organized in 2010 as part of a commitment to strengthen collaborations between academic medicine and public health. Historically, the public health, popu-

lation health, and prevention aspects of medical education were often omitted from physician training, supplement editors Rika Maeshiro, MD, MPH, of AAMC; Denise Koo, MD, MPH of CDC; and C. William Keck, MD, MPH, of the Northeastern Ohio Universities College of Medicine, in Rootstown, Ohio, write in an introductory essay. But, they add, "efforts to develop health professionals who can improve health, and not just deliver health care, should be a continuing priority for the academic medicine and public health

communities." There is an urgent need for physicians "with a better appreciation for these issues to help address complex public health challenges that include rising chronic disease burdens, persistent health disparities, and healthcare financing that encourages treatment over prevention," they write. In his commentary, Institute of Medicine President Harvey V. Fineberg, MD, PhD, notes that although public health and medicine "approach the challenge of health and health care from distinct, complementary perspectives," many initiatives "are bringing the principles, values, experience, and analytic perspectives of public health into the daily practice of medical education." A number of papers in the supplement go into detail about how some of those initiatives are more effectively integrating public health and prevention principles and practices into medical education. AAMC Chief Academic Officer John E. Prescott, MD, underscores the need

for that trend to become even more common. "Producing better physicians for the future clearly requires a reconsideration of their education," he says in his essay. In the future, he notes, physicians must be "skilled team players, who excel in systems-based practice, who provide patient-centered care, and who can work with and in their communities to improve health." Judith Monroe, MD, the Director of CDC's Office for State, Tribal, Local, and Territorial Support, concurs in her essay, noting that "There is power in the collaboration of medicine and public health, and we need to find better ways to harness this power to meet our current and future challenges." Reference: Elsevier Health Sciences. (2011, September 28). Medical education needs more of a public health and prevention focus. ScienceDaily. Retrieved October 19, 2016 from www.sciencedaily.com/releases/2011/09/110928105718.htm

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November 2016 13

Health

Despite Strides Against All Cancers, Liver Cancer Rates on the Rise By d-mars.com News Provider

ore people are surviving cancer, according to the American Cancer Society (ACS). From 1991 to 2012, the rate of cancer deaths declined about 23 percent. Despite that progress, one type of cancer has actually become more common - liver cancer. New cases have tripled in the past 36 years and death rates also increased during this period. From 2003 to 2012, death rates increased by 2.7 percent per year. In 2016, the ACS estimates more than 39,000 new cases will be diagnosed and over 27,000 people will die from liver cancer. What’s driving the increase in liver cancer when so many other types of cancer are declining? Multiple factors could be in play, says Thomas F. Nealon III, national board chair and CEO of the American Liver Foundation (ALF). “Decreased tobacco use, as well as improvements in detection and treatment, is thought to have contributed to the overall decline in cancer death rates,” Nealon notes. “However, researchers have found an increase in heavy drinking and binge drinking in some areas of the country. Other significant liver cancer risk factors such as obesity and hepatitis have also increased.”

Know the risk factors

Know the symptoms

Education, increased awareness and early detection have helped drive decreases in some of the most common forms of cancer, including breast, colorectal and prostate cancers. Among other advocacy and research organizations, ALF and Bayer hope to achieve the same success with efforts to boost awareness of liver cancer. “It’s important for people to learn about liver cancer risks, the value of early detection and liver cancer treatment options,” Nealon says. “Our Are You At Risk? campaign aims to provide actionable information in the fight against liver cancer.” Liver cancer can be difficult to detect in its earliest, most treatable stages, so it’s important to be aware of liver cancer risk factors and what you can do to reduce your risks. It may be possible to reduce liver cancer risks by limiting alcohol consumption, eating a healthy diet, controlling weight and protecting against Hepatitis B and C. These are the most common risk factors thought to contribute to liver cancer, along with family history.

Only a doctor can diagnose liver cancer, but it’s important to be aware of possible symptoms. Liver cancer signs often don’t appear until later stages, but talking to a doctor at the first sign of a problem could aid in earlier detection.

Other risk factors include: • Exposure to arsenic in drinking water - Naturally occurring arsenic can contaminate drinking water and affect the liver.

Common liver cancer symptoms include:

• Being of a certain ethnicity - Asian Americans and Pacific Islanders have the highest liver cancer rates in the U.S. • Steroid use - Anabolic steroids may increase cancer risks. • Travel - People may be exposed to Hepatitis B while traveling in countries where the disease is common.

• Fatigue • Loss of appetite and feeling full too quickly after eating very little • Nausea and vomiting • Unplanned weight loss • Pain in the abdomen or right shoulder blade • Fluid buildup or swelling in the abdomen • Jaundice “As with many forms of cancer, early detection can make a difference in treating liver cancer,” Nealon says. “Being aware of risk factors and symptoms could help people get diagnosed and begin potentially life-saving treatment much sooner.” To learn more about liver cancer, visit the ALF website (www.liverfoundation.org/livercancer). – BPT PP-810-US-2251

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November 2016

The TWU-HWT Tel Offers Health & Wel By Transport Workers Union – MTA Contributing Writer

he Transport Workers Union - MTA Health & Welfare Trust (TWU-HWT) recently held a ribbon cutting ceremony for its Telemedicine Clinic. Partnering with Cigna and the Kelsey-Seybold Clinic, this clinic is the first of its kind in the Harris County area. With dedicated and committed health partners Cigna and the Kelsey-Seybold Clinic, this pilot program was designed by Tanya Allen-Meekins, TWU-HWT Benefits Manager. Wanting to give employees additional quality health and wellness services and more convenience, the Telemedicine Clinic is a great initiative. Ms. AllenMeekins has planned and implemented this cost-free program that will allow the hourly METRO employees to conveniently visit with a physician and nurse to seek medical care and treatment. Ms. Allen-Meekins’ goal is to continue to promote health and wellness and decrease chronic long-term medical conditions. The onsite nurse, Ms. Shantay Phoenix, is available daily to schedule appointments, render assistance with claims issues and find additional resources that may be needed for the hourly METRO employees. The Telemedicine Clinic visit is conducted by way of an online video to discuss their medical concerns and plan of care. The clinic is equipped to perform various laboratory tests that may be necessary to evaluate a medical diagnosis. Upon completion of the visit, the physician is able to E-Scribe medication (directly to the pharmacy) and the nurse will provide the patient with an after visit summary and physician’s excuse to complete their visit.

About Kelsey-Seybold Clinic. Your Doctors for Life. Kelsey-Seybold is Houston’s largest and most renowned private multi-specialty physician group. They are a multispecialty group practice that offers medical care in more than 50 medical specialties including primary care, outpatient surgery centers, an accredited Sleep Center, advanced radiology services, 14 onsite Kelsey pharmacies. Kelsey-Seybold Clinic was founded in 1949 by Dr. Mavis Kelsey in Houston’s famous Texas Medical Center. Today, it is Houston’s premier accountable care organization. You can expect high-quality, preventive care from Kelsey-Seybold, as well as patient-centered care, caring and compassionate attention, expertise in diagnosing and treating

acute and chronic illnesses, convenient lab hours, easy access to advanced diagnostic technologies, after-hours and weekend assistance, and a collaborative, multidisciplinary approach and secure Electronic Medical Record system. When you become a patient of Kelsey-Seybold, you’re KelseyConnected. This means you’re immediately connected to a caring and compassionate team of specialists who share your medical history through one Electronic Medical Record, then work together with a clearer picture of your health. It’s medical care that revolves around you.

About Cigna Cigna is a global health service company dedicated to helping people improve their

health, well-being and sense of security. They have sales capability in 30 countries and jurisdictions, and more than 90 million customer relationships throughout the world. Their more than 39,000 employees serve customers just about everywhere. Every day, their team works together with their customers in ways they find proactive, personal and empathetic. That spirit of true partnership goes deeper than paying claims, and is often life-

changing — helping customers stay prevent sickness, obtain access to h care, recover from illness or injury, re to work and provide for their fam Worldwide, they offer their customer their families peace of their mind a sense of security. They are with the the way, through the most critical p in their lives. Cigna works together with custo to help them lead a healthy, secure

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November 2016 15

lemedicine Clinic llness for Employees

well, health eturn milies. rs and and a em all points

omers e life.

Cigna provides cus“We are so happy to partner with tomers with personsuch an amazing, forward-thinking ally relevant products and services, organization as Transport Workers and they help cusUnion – MTA Health & Welfare Trust. tomers reduce health costs and achieve Their dedication to wellness and optimal health outimproving the lives of their members comes. As an adis tireless. The launch of the new vocate for their customers, their team Telemedicine program is a testament helps navigate an ofto the dedication, and I believe there ten confusing health care or insurance is much more to come.” system so custom– Jodi Berry, Cigna ers get the care and financial protection they need. Cigna understands a cus- their health, well-being and security tomer is an individual, so they can needs, and maximize value. They help them achieve what’s most im- collaborate with their vast network portant to them. They put the pow- of health care professionals and other of information in their customers’ er colleagues around the world to hands. Cigna provides information ensure all their customers obtain their customers need to improve quality, cost-effective health care, their health, identify and fill gaps in benefits and insurance protection.

Q&A with Tanya Allen-Meekins, TWU-HWT Benefits Manager What has been the feedback from employees about the Telemedicine Clinic? The feedback has been very good. The employees have expressed their excitement by having a clinic convenient to them that addresses their medical needs and a benefits office to address any benefit questions. The employees are excited about the ability to speak with a physician at this clinic to discuss in detail a plan of action for their care and the doctor’s ability to send the prescription directly to the pharmacy of their choice. The Telemedicine Clinic is a one stop shop for all of their health and wellness needs. Talk about the partnership with Cigna and the Kelsey-Seybold Clinic to make this clinic a reality. The partnership with Cigna and the Kelsey-Seybold Clinic was formed in 2007. The partnership with TWU has been going strong since 2011. Since the inception of the TWU partnership with Cigna and the Kelsey-Seybold Clinic, there has been a wellness program. The wellness program started with an initiative promoting walking and physical activity. This program provides healthy snacks, screenings, educational material and water three times a week as well as care from registered nurses. The program expanded with kiosks at select facilities to help make employees aware of their number, giving them the ability to track their numbers on a daily basis. Another extension of the program is the Telemedicine Clinic. What are the goals for the Telemedicine Clinic? We want to continue to educate by performing onsite wellness screenings and utilizing the nurse navigator to encourage preventive screenings and set up appointments. The clinic will also be used for early detection of various medical conditions, allowing for a plan of care to support their diagnosis more efficiently.

Tanya D. Allen The Telemedicine Clinic has already started seeing patients, with several employees taking advantage of the health and wellness services that the clinic has to offer. Per the Labor Agreement, only full-time employees are eligible for the full benefits that the clinic has to offer, but employees who are not full time are able to receive flu shots. The Telemedicine Clinic is open on Wednesday through Friday from 9:00AM to 3:00PM to service the hourly Metro employees. Allen-Meekins says, “As the benefits manager, I’m promoting health and wellness as a priority to support healthier outcomes for our employees. I am so grateful for Cigna and the Kelsey-Seybold Clinic for this health and wellness partnership that will benefit our employees.” TWU-HWT looks forward to the continued care that the Telemedicine Clinic will offer and plans to open more Telemedicine Clinics at their freestanding METRO locations in the near future. Sources Transport Workers Union – MTA www.cigna.com www.kelsey-seybold.com

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November 2016

Visual Cortex Plays Role in Plasticity of Eye Movement Reflex

NIH-funded mouse study may illuminate underpinnings of brain’s ability to adapt and function By the National Eye Institute

Contributing Writer

y peering into the eyes of mice and tracking their ocular movements, researchers made an unexpected discovery: the visual cortex – a region of the brain known to process sensory information – plays a key role in promoting the plasticity of innate, spontaneous eye movements. The study, published in Nature, was led by researchers at the University of California, San Diego (UCSD) and the University of California, San Francisco (UCSF) and funded by the National Eye Institute (NEI), part of the National Institutes of Health. “This study elegantly shows how analysis of eye movement sheds more light on brain plasticity– an ability that is at the core of the brain’s capacity to adapt and function. More specifically, it shows how the visual cortex continues to surprise and to awe,” said Houmam Araj, Ph.D., a program director at the NEI. Without our being aware of it, our eyes are in constant motion. As we rotate our heads and as the world around us moves, two ocular reflexes kick in to offset this movement and stabilize images projected onto our retinas, the light-sensitive tissue at the back of our eyes. The optokinetic reflex causes eyes to drift horizontally from side-to-side— for example, as we watch the scenery through a window of a moving train. The vestibulo-ocular reflex adjusts

our eye position to offset head movements. Both reflexes are crucial to survival. These mechanisms allow us to see traffic while driving down a bumpy road, or a hawk in flight to see a mouse scurrying for cover. The two reflexes occur automatically as a result of signals from the brainstem, an evolutionarily older part of the brain. These reflexes also are precisely coordinated in relation to each other. When one of the two reflexes is impaired by age or alcohol, for example, the other compensates. This orchestration requires adaptive plasticity, said the study’s lead investigator, Massimo Scanziani, Ph.D., who at the time of the study was professor of neurobiology at UCSD before moving to UCSF. Scanziani collaborated with the study’s first author, Bao-hua Liu, Ph.D., a post-doc at UCSD and Andrew Huberman, Ph.D., now associate professor at Stanford University. Scanziani and his colleagues sought to understand the origins of this adaptive plasticity by studying the eye movements in mice before and after disabling their vestibular ocular reflex. In their mouse model, disabling the vestibulo-ocular reflex increases the optokinetic reflex. They measure the increase by holding the mouse’s head still and then presenting the mouse with visual stimuli in the form of black and white horizontal stripes that rotate around the mouse. A camera records the animal’s eye movements. More forceful eye movements indicate an increase in optokinetic reflex activity. To test the visual cortex’s role in the

Neuron projections from the visual cortex have been known to extend to cells of the brainstem that regulate innate motor behaviors. This image shows a neuron projection from the visual cortex. Photo credit: Dr. Massimo Scanziani. plasticity of these reflexes, the researchers applied a technique called optogenetics, which uses light to turn target cells on or off. The researchers targeted inhibitory neurons in the visual cortex to turn them “on,” thus silencing that region of the brain. Silencing the visual cortex led to a significant reduction in the activity of the optokinetic reflex, suggesting that it is the visual cortex that is involved in mediating the plasticity between the optokinetic and the vestibulo-ocular reflexes.

Next, the researchers sought to learn more about how the visual cortex modulates the reflexes. It has long been observed that a collection of neural projections from the visual cortex extends to cells of the brainstem that regulate innate motor behaviors. The scientists lesioned these projections and again observed a decrease in the optokinetic reflex. Such findings suggest that the neural projections are the anatomical structures by which the visual cortex adjusts the plasticity of the optokinetic reflex, Scanziani said. The findings shed new light on the role of the mammalian cortex in orchestrating eye movement, according to Scanziani. “Most of our reflexes are encoded in the brainstem, but from an evolutionary standpoint, the ability for one’s cortex to modify these reflexes expands one’s behavioral repertoire as the circumstances require,” he said. “If you’ve ever noticed how people in an audience tend to cough after a solo musical performance ends, you’ve seen this ability to modify reflexes in action. It’s an ability that appears to have been an attribute important for survival. After all when you’re hiding from a tiger, it would be the very worst moment to cough.” The study was supported in part by NEI grant R01 EY025668. References: Liu, Bao-hua et al. “Cortico-fugal output from visual cortex promotes plasticity of innate motor behavior.” Published online in Nature, October 12, 2016. DOI:10.1038/nature19818

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November 2016 17

Health

So, You Like Your Coffee?

4.1% of people in the U.S. currently meet the criteria for clinical depression. In a Harvard study published in 2011, women who drank 4 or more cups per day had a 20% lower risk of becoming depressed. Another study with 208,424 individuals found that those who drank 4 or more cups per day were 53% less likely to commit suicide. Bottom Line: Coffee appears to lower the risk of developing depression and may dramatically reduce the risk of suicide.

that caffeine can increase fat burning in the body and boost the metabolic rate.

The Caffeine Can Drastically Improve Physical Performance

By d-mars.com News Provider

offee is actually very healthy. It is loaded with antioxidants and beneficial nutrients that can improve your health. The studies show that coffee drinkers have a much lower risk of several serious diseases. So, if you like your coffee, that’s good. Here are some health benefits of coffee that have been confirmed in actual human studies.

Coffee Can Help You Burn Fat Did you know that caffeine is found in almost every commercial fat burning supplement? There’s a good reason for that…caffeine is one of the very few natural substances that have actually been proven to aid fat burning. Several studies show that caffeine can boost the metabolic rate by 3-11%. Other studies show that caffeine can specifically increase the burning of fat, by as much as 10% in obese individuals and 29% in lean people. However, it is possible that these effects will diminish in long-term coffee drinkers. Bottom Line: Several studies show

Caffeine stimulates the nervous system, causing it to send signals to the fat cells to break down body fat. But caffeine also increases Epinephrine (Adrenaline) levels in the blood. This is the “fight or flight” hormone, designed to make our bodies ready for intense physical exertion. Caffeine makes the fat cells break down body fat, releasing them into the blood as free fatty acids and making them available as fuel. Given these effects, it is not surprising to see that caffeine can improve physical performance by 11-12%, on average. Because of this, it makes sense to have a strong cup of coffee about a half an hour before you head to the gym. Bottom Line: Caffeine can increase adrenaline levels and release fatty acids from the fat tissues. It also leads to significant improvements in physical performance.

Coffee May Protect You From Alzheimer’s Disease and Dementia Alzheimer’s disease is the most common neurodegenerative disease and the leading cause of dementia worldwide. This disease usually affects people over 65 years of age. Unfortunately, there is no known cure

Coffee May Help You Live Longer for Alzheimer’s. However, there are several things you can do to prevent the disease from showing up in the first place. This includes the usual suspects like eating healthy and exercising, but drinking coffee may be incredibly effective as well. Several studies show that coffee drinkers have up to a 65% lower risk of getting Alzheimer’s disease. Bottom Line: Coffee drinkers have a much lower risk of getting Alzheimer’s disease, which is a leading cause of dementia worldwide.

Coffee Can Fight Depression and Make You Happier Depression is a serious mental disorder that causes a significantly reduced quality of life. It is incredibly common and about

Given that coffee drinkers are less likely to get many diseases, it makes sense that coffee could help you live longer. There are actually several observational studies showing that coffee drinkers have a lower risk of death. In two very large studies, drinking coffee was associated with a 20% lower risk of death in men and a 26% lower risk of death in women, over a period of 18-24 years. This effect appears to be particularly strong in type II diabetics. In one study, diabetics who drank coffee had a 30% lower risk of death during a 20 year study period. Bottom Line: Several studies show that coffee drinkers live longer and have a lower risk of premature death. Source Authority Nutrition authoritynutrition.com

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November 2016

Healthy Lifestyle

National Healthy Skin Month The Best Skin Products for Black Skin By d-mars.com News Provider

lack skin contains melanin -- a natural substance that provides pigment and color to dark skin. This same substance also makes black skin more prone to discolorations and dark spots. To keep black skin looking its flawless best, adapt to using products that nurture and enhance black skin and help you put your best face forward. Clear, even skin tone, free from spots and discolorations, is the desire of most people of color. www.LiveStrong.com offers tips when it comes to taking care of our skin.

Cleansers A good skin care regimen for black skin should include use of a daily skin cleanser. Skin cleansers rid the skin of dirt, makeup and oil, leaving it clean and refreshed. A cleanser specifically formulated for black skin is best; you should refrain from using cleansers containing abrasive ingredients such as alco-

irritate and dry out the skin. Products consisting of retinol or vitamin A should also be avoided as these rob the skin of moisture. Consider products containing natural ingredients including bees wax, soy oil and corn oil.

hol, dyes, propylene glycol, lanolin and fragrances. Such ingredients may lead to irritation of the skin or hyperpigmentation. Be sure to cleanse the skin gently.

Toners A black skin care regimen should include a skin toner. Skin toners offer many benefits to the skin including: restoring the natural pH balance of the skin, reducing skin oil secretions, sloughing away dead skin cells, clearing away impurities and encouraging blood circulation. Skin toners give the skin a brighter, livelier appearance and should be applied to the face and neck following the cleansing process. Avoid skin toners containing harmful ingredients such as isopropyl alcohol, ethanol and alcohol. For best results, choose a skin toner especially designed for dark skin.

Moisturizers A balanced black skin care regimen must always include a daily moisturizer. Opt for moisturizers containing "humectrants," or products that draw

Sunscreen

water to the skin. When choosing a moisturizer, choose one containing ingredients such as hyaluronic acid, glycerin, dimethicone or urea. Alcohol-free and scent-free moisturizes are best since those containing alcohols and perfumes

Like any other skin type, black skin requires protection from the sun. Always apply a sunscreen to keep your skin well protected from the harmful rays of the sun. Using a sunblock provides a barrier of protection between your skin and the sun, forcing sun rays to bounce off the skin. Use a sunscreen with an SPF 15. If you suffer from a medical condition such as lupus or have discolorations and dark spots, look for a sunscreen with an SPF 30. Apply sunscreen 20 minutes before sun exposure, taking care to apply it generously on all exposed parts of the body. Take care of your skin! Source www.livestrong.com

Healthy Lifestyle

Too Much Gobble, Gobble? 6 Steps to Better Digestion

By d-mars.com News Provider

heer and goodwill aren’t the only things Americans share during the holiday season. We also swap germs, overindulge in seasonal foods and spirits, and stew in stress — all of which can lead to digestive woes. You know you’ll have to work hard at self-control if you don’t want the numbers on the scale to climb by the end of the holiday season. But you can also take steps to minimize stomach upset, indigestion, bloating, reflux and general intestinal distress during the holidays.

So good yet so bad Holiday foods taste good because they’re often rich, and high in fat and sugar — qualities that cause not only weight gain but also digestive discomfort. During this hectic time of year, most of us eat more — especially at celebrations. Giving up holiday treats and favorite dishes would be like going through the season without a single cornucopia or twinkling decoration. Rather than suffering digestive distress through indulgence, or choosing to deprive yourself entirely, start with a plan for how you’ll deal with holiday digestive upset, then take action.

Steps to feel better • Stay hydrated. The hectic pace of the holidays may make you forget to drink enough water. What’s more, overindulging in holiday libations like cocktails, wine, champagne and beer can actually dehydrate your body. Non-alcoholic sugary beverages like mulled cider, hot chocolate and pumpkin-flavored coffees can also throw off your body’s balance. Remember to drink plenty of water every day throughout the holidays. • Prioritize food choices. Sure, that slice of pumpkin pie looks great on the plate and tastes yummy going down, but will it be worth the heartburn and bloating you’ll experience later? Raw veggies are a healthful and fiber-filled alternative to fatty hors d’oeuvres, but be aware that raw vegetables can also cause bloating and gas. Pay attention to the foods that trigger discomfort and decide how important they really are. You may be able to substitute something else that’s just as satisfying but less upsetting to your stomach. • Promote gut health. If your digestive tract is already in good shape, it will be better equipped to handle occasional holiday overindulgence. Taking a probiotic supplement, like Family Flora Daily Balance, can support the growth of good gut bacteria that aid in digestion. Family Flora's DualAction formula helps populate the gut

with healthy bacteria and also provides prebiotics, the “food” that helps probiotic bacteria thrive and multiply inside the body. The probiotic + non-GMO prebiotic blend helps promote improved digestion, support gut flora renewal and colon health, and maintain healthier gastrointestinal function. The neutraltasting powder can be mixed into any cold food or beverage. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Visit www. familyflora.com to learn more. • Reduce portion sizes. Do you give yourself license to overindulge during the holidays, figuring you’ll pay for it later when you step on the scale? Large portions can also make you pay for them right away when you feel indigestion or reflux after finishing a big meal. Reducing portion sizes can help ease holiday strain on your stomach and digestive tract. One easy trick for controlling portion sizes — serve yourself on a dessert-

size dish, rather than a large dinner plate. Smaller portions will look like more on a smaller plate. • Limit variety. Whether a buffet or a sit-down dinner, holiday meals often feature multiple dishes that just look so good you want to try them all. Mixing too many different foods, however, can lead to stomach upset. Trying everything — even if it’s just a bite or two — can rack up the calories, fat and sugar. Instead, choose just a few favorites to have at each meal. If you have a spoon of green bean casserole with your Thanksgiving turkey, pass on the yams and plan to have them with tomorrow’s leftovers. • Keep exercising. Along with all the other benefits exercise brings, it can also promote digestive health. In addition to its positive physical effects, exercise can also help relieve holiday stress — a contributor to holiday stomach upset. Whether it’s an hour at the gym or 30 minutes on a yoga mat in your living room, it’s important to maintain an exercise regimen throughout the holidays. The holidays are meant to be a time of enjoyment, and that includes eating foods you just don’t have around at other times of the year. With some proactive steps, you can help ensure your holidays stay bright and your stomach stays healthy throughout the season. – BPT

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November 2016 19

Health & Wellness Recipes What Do You Do With That Leftover Thanksgiving Turkey? For more recipes, please visit www.CookingLight.com.

Curry Turkey Salad

Turkey-Pasta Soup

Ingredients • • • • • • • • • • • • •

2 tablespoons reduced-fat sour cream 2 tablespoons plain yogurt 1 tablespoon fresh lime juice 1 tablespoon honey 1 teaspoon curry powder 1/4 teaspoon salt 1/4 teaspoon freshly ground black pepper 2 cups chopped cooked turkey 1 cup seedless red grapes, halved 1/2 cup diced celery 1/4 cup chopped red onion 2 tablespoons cashew pieces 20 mini pita rounds

Dried Cherry-Toasted Almond Turkey Salad Sandwiches Ingredients

• • • •

Ingredients

• 1 tablespoon olive oil • 1/2 cup chopped carrot • 1/4 cup chopped celery • 1/4 cup minced onion • 1 garlic clove, minced • 2 cups water • 1/3 cup chopped 33%-less-sodium ham (about 2 ounces) • 1/4 teaspoon freshly ground black pepper • 4 (14-ounce) cans fat-free, less-sodium chicken broth • 1 cup uncooked ditali (about 4 ounces short tube-shaped macaroni) • 3 cups chopped cooked turkey • 3 cups thinly sliced napa (Chinese) cabbage

• • • • • • •

1/4 cup slivered almonds (about 1 ounce) 1/4 cup plain fat-free yogurt 3 tablespoons low-fat mayonnaise 1 teaspoon bottled ground fresh ginger (such as Spice World) 1/8 teaspoon crushed red pepper 3/4 cup thinly sliced celery 1/4 cup chopped red onion 1/4 cup dried cherries 1/4 cup golden raisins 8 ounces roasted turkey breast, chopped 4 (6-inch) whole wheat pitas, cut in half

Preparation

Heat oil in a large Dutch oven over medium-high heat. Add carrot, celery, onion, and garlic; sauté 3 minutes or until tender. Add water, ham, pepper, and broth; bring to a boil. Add pasta; cook 8 minutes or until pasta is done. Stir in turkey and cabbage; cook 2 minutes or until cabbage wilts.

Preparation

Combine first 7 ingredients in a large bowl. Add turkey, grapes, celery, onion, and cashews; stir gently to combine. Serve with pitas.

Heat a small nonstick skillet over medium-high heat. Add almonds; cook 2 minutes or until toasted, stirring constantly. Remove from heat; set aside. Combine yogurt, mayonnaise, ginger, and pepper in a medium bowl. Add almonds, celery, and next 4 ingredients (through turkey), stirring well to combine. Spoon 1/3 cup turkey mixture into each pita half.

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November 2016

Mental Health

Depression Among Women • Having a baby with a birth defect or disability. • Pregnancy and birth complications. • Having a baby or infant who has been hospitalized.

By d-mars.com News Provider

epression interferes with daily life and may last for weeks or months at a time. Depression is a common and serious illness. National survey data showed that about one 1 out of 10 women 18-44 years old experienced symptoms of major depression in the past year. Most people, even those with the most severe forms of depression, can get better with treatment.

Depression can also occur among women with a healthy pregnancy and birth.

Treatment Depression is treatable and most people get better with treatment. If you think you may be depressed, the first step to seeking treatment is to talk to your health care provider. You can ask your health care provider for a referral to a mental health professional or visit CDC’s Resources to find help in your area. See CDC’s depression treatment to learn about seeking treatment for depression.

Postpartum Depression Postpartum depression is depression that occurs after having a baby. Feelings of postpartum depression are more intense and last longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby. “Baby blues” symptoms typically resolve on their own within a few days. About 1 in 8 women experiences postpartum depression. View your state’s prevalence of postpartum depression using PRAMStat, an online data platform from the Pregnancy Risk Assessment Monitoring System.

Symptoms of Postpartum Depression The symptoms of postpartum depres-

How Depression Affects Fathers sion are similar to symptoms for depression, but may also include • Crying more often than usual. • Feelings of anger. • Withdrawing from loved ones. • Feeling numb or disconnected from your baby. • Worrying that you will hurt the baby. • Feeling guilty about not being a good mom or doubting your ability to care for the baby.

Risk Factors for Depression Experiences that may put some women at a higher risk for depression include • Stress. • Low social support. • Difficulty getting pregnant. • Being a mom to multiples, like twins, or triplets. • Losing a baby. • Being a teen mom. • Preterm (before 37 weeks) labor and delivery.

According to a 2010 study using data from 1993 to 2007, approximately 4% of fathers experience depression in the first year after their child’s birth. By a child’s 12th birthday, about 1 out of 5 fathers will have experienced one or more episodes of depression. Younger fathers, those with a history of depression, and those experiencing difficulties affording items such as a home or car were most likely to experience depression. Source: www.cdc.gov

Mental Health

Empowering the Estimated 4 Million American Adult Women Living with ADHD By d-mars.com News Provider

ttention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder1 that affects an estimated 4 million women and 6.4 million men in the U.S. 2,3†± The key feature of ADHD is a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development.1 ADHD can affect adults at school or work, at home, and/ or in social settings, so it is important to build awareness of the potential signs of ADHD. Only a health care professional can diagnose ADHD. In a continued effort to highlight the impact of ADHD on adults in the U.S., Shire is proud to launch the ADHDadulthood campaign. The campaign focuses on the ways ADHD symptoms could potentially affect someone’s everyday life. Tasks such as keeping track of

one’s keys, staying focused at work and standing in check-out lines at stores may be more difficult for adults living with ADHD.1 Having some of these symptoms does not necessarily mean you have ADHD. “ADHD is estimated to affect 1 in 23 adults in the U.S. 2* ADHD may appear differently in adults than it does in children and teenagers,1” said Duane Gordon, President, Attention Deficit Disorder Association. “Adults with ADHD may often experience hyperactivity, impulsivity and inattention.1 These three core symptoms may create challenges at work and at home,1 impacting their lives. Our goal, in partnership with Shire, is to empower adults experiencing these symptoms to talk with a health care professional and seek support for managing their ADHD.” Through ADHDadulthood, Shire aims to empower and inspire adults experiencing ADHD symptoms to learn more about the disorder and start a

conversation about ADHD with their health care team. Only a doctor can diagnose ADHD. For more information, visit www.ADHDadulthood.com and talk to your doctor. – BPT †Diagnosis should be based on a com-

plete history and evaluation of the patient. Medication may not be appropriate for all patients. ± Based on the National Comorbidity Survey Replication of 3,199 adults ages 18 to 44 years conducted from 2001-2003 and applied to the full US population ages 18 and over. *An estimated 4.4% of adults had ADHD (based on clinical interview) in the U.S.; data from the National Comorbidity Survey Replication of 3,199 adults ages 18 to 44 years conducted from 2001 to 2003. 1 American Psychiatric Association. Neurodevelopmental Disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 2 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. 3 Howden LM, et al. Age and sex composition: 2010. US Census Bureau; 2011

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November 2016

Policy

Employers and Health Care

Key Provisions Under the Affordable Care Act for Employers with Fewer Than 25 Employees By d-mars.com News Provider Small Business Health Care Tax Credit The Small Business Tax Credit helps small businesses afford the cost of health care coverage for their employees and is specifically targeted for those businesses with low- and moderate-income workers. Businesses that have fewer than 25 full-time equivalent employees, pay average annual wages below $50,000 (indexed annually for inflation), and contribute a uniform 50% or more toward employees’ self-only health insurance premiums may qualify for the small business tax credit. As of 2014, this credit is available to those eligible small businesses that purchase coverage for their employees through the Small Business Health Options Program (SHOP), described below, and may be worth up to 50% of the employer’s premium costs (35% for tax-exempt employers). Use the Tax Estimator tool to help determine if you qualify and what the credit may look like for your business.

Small Business Health Options Program (SHOP) Small employers looking to provide coverage for their employees can do so through the Small Business Health Options Program (SHOP), part of the new Health Insurance Marketplaces. SHOP is open to those employers with up to 50 full-time equivalent (FTE) employees and offers small employers increased purchasing power to obtain a better choice of high-quality coverage. SHOP also pools risk for small groups and reduces administrative complexity, thereby helping to reduce costs. In addition, if you offer your employees coverage through the SHOP and meet other eligibility requirements, you may be able to claim the Small Business Tax Credit worth up to 50%. Enrollment in SHOP is offered anytime during the year. For more information, visitHealthcare.gov or call the SHOP Call Center at 1-800706-7893 (TTY users: 1-800-706-7915), Monday through Friday, 9 a.m. to 7 p.m. EST. You can also use the SHOP FTE Calculator to determine if you meet the size requirements for SHOP.

Employer Health Care Arrangements (Employer Payment Plans) Employer health care arrangements, also known as employer payment plans, generally include those arrangements where the employer does not establish a health insurance plan for its own em-

ployees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the Marketplace or outside the Marketplace). Under IRS Notice 201354, such arrangements do not satisfy the market reforms under the Affordable Care Act and may be subject to $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code. Small employer temporary relief from excise tax: Under IRS Notice 2015-17, small employers with less than 50 full-time (including full-time equivalent) employees that offer employer payment plans get temporary relief from the excise tax for 2014 and through June 30, 2015. For more information about these types of arrangements and the temporary relief for small employers and certain other entities, including S corporations, refer to IRS’s FAQs.

assets. If treated as a plan asset, employers have discretion to determine a reasonable and fair allocation of the rebate. For more information on the federal tax treatment of Medical Loss Ratio rebates, refer to IRS's FAQs.

Limits on Flexible Spending Account Contributions For plan years beginning on or after January 2013, the maximum amount an employee may elect to contribute to health care flexible spending arrangements (FSAs) for any year is capped at $2500, subject to cost-of-living adjustments. Note that the limit only applies to elective employee contributions and does not extend to employer contributions. To learn more about FSA Contributions, as well as what is excluded from the cap, refer to this document provided by the IRS.

Medical Loss Ratio Rebates

Additional Medicare Withholding on Wages

Under the ACA, insurance companies must spend at least 80% of premium dollars on medical care rather than administrative costs. Insurers who do not meet this ratio are required to provide rebates to their policyholders, which is typically an employer who provides a group health plan. Employers who receive these premium rebates must determine whether the rebates constitute plan

Effective January 1, 2013, ACA increases the employee portion of the Medicare Part A Hospital Insurance (HI) withholdings by .9% (from 1.45% to 2.35%) on employees with incomes of over $200,000 for single filers and $250,000 for married joint filers. It is the employer’s obligation to withhold this additional tax, which applies only to wages in excess of these thresholds.

The employer portion of the tax remains unchanged at 1.45%.

New Medicare Assessment on Net Investment Income Effective January 1, 2013, a 3.8% tax will be assessed on net investment income such as taxable capital gains, dividends, rents, royalties, and interest for taxpayers with Modified Adjusted Gross Income (MAGI) over $200,000 for single filers and $250,000 for married joint filers. Common types of income that are not investment income are wages, unemployment compensation, operating income from a non-passive business, Social Security Benefits, alimony, tax-exempt interest, and self-employment income.

90-Day Maximum Waiting Period As of January 1, 2014, individuals who are eligible for health coverage will not have to wait more than 90 days to begin coverage. HHS, IRS, and the Department of Labor have issued final rules on how employers should apply the 90day rule. For more information, please visit the U.S. Small Business Administration (SBA). Source www.sba.gov

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November 2016 23

Medicine

Are You at Risk for an OTC Pain Medicine Overdose? By d-mars.com News Provider

f you are one of the millions of Americans suffering from pain and turn to over-the-counter (OTC) pain medicines to get relief, you may be at risk of overdose. Taking too much OTC pain medicine can lead to serious side effects, such as stomach bleeding, ulcers, liver damage and even death. The American Gastroenterological Association (AGA) surveyed consumers and gastroenterologists to find out more, and discovered that many adults report taking more than the recommended dose of an OTC pain medicine. The survey was conducted by Harris Poll,* with sponsorship support from McNeil Consumer Healthcare. To help you get safe pain relief, refer to these common myths and facts so you can keep yourself and your family safe from OTC pain medicine overdose complications.

Myth 1: Drug labels are just guidelines. Many consumers believe they know how to best treat their pain when it comes to reaching for the medicine cabinet, with 40 percent admitting they perceive the dosing directions on OTC pain medicines as just guidelines —

they know what works for them. Conversely, American consumers take appropriate safety measures in many aspects of their lives. Most people always wear a seat belt when riding in a car, have smoke detectors in their home, and have anti-virus software on their computers. Yet, only 32 percent of people say they always read the drug facts label on an OTC pain medicine they haven’t taken before, which can be a costly or even fatal oversight. Fact: Medicine labels can change periodically, as can health conditions and situations. Byron Cryer, MD, chair of the AGA Gut Check: Know Your Medicine campaign and associate dean of the University of Texas Southwestern Medical Center, emphasizes the importance of following dosing directions. “Read and follow the drug facts label — every time — to avoid potential overdose complications,” Cryer says.

Myth 2: Taking more than the recommended dose is harmless. One in four Americans are willing to take more than the recommended dose of OTC pain medicines because they believe their symptoms will go away faster. While patients might exceed the recommended dose for weeks or even months without complications, it can

take just one occurrence to put them in the hospital. Fact: Taking more than the recommended dose will not lead to quicker pain relief. Work with your health-care professional on the proper dosage and treatment for your individual health situation.

Myth 3: Mixing medicines is safe and effective.

intestine, while overdosing on acetaminophen can cause liver damage. If you are living with pain, get relief safely. The AGA encourages you to read medicine labels every time you take an OTC pain medicine. If you are still not receiving relief from your pain, talk to a health-care professional. Visit GutCheckFacts.org to learn more. – BPT

On average, a gastroenterologist sees 90 overdose cases per year due to OTC pain medicine. Most gastroenterologists (64 percent) report that their patients were unaware of the risks of taking more than directed and, when overdose complications arise, the mistake often involves taking two or more medicines with the same active ingredients at a time. Fact: “Mixing medicines is dangerous,” Dr. Cryer says. “Take only one product at a time containing the same kind of active ingredient.” Overuse of NSAIDs (nonsteroidal anti-inflammatory drugs) can cause stomach bleeding, stomach ulcers, and damage to the esophagus and small

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November 2016

Research

MD Anderson and HISD Partner for Youth Tobacco Prevention Program By d-mars.com News Provider HOUSTON- The University of Texas MD Anderson Cancer Center and the Houston Independent School District (HISD) have reached a first-of-its-kind agreement to provide access to an evidence-based, youth-oriented tobacco prevention and cessation program for all 110,000 HISD middle and high school students. A Smoking Prevention Interactive Experience (ASPIRE) will be made available in English and Spanish through HISD’s online learning and teaching platform, known as the HUB, and the curriculum will be used in required health and physical education classes across 46 high schools. “Reducing the devastating effects of tobacco in Houston’s youth is of paramount importance to our mission of eliminating cancer,” says Ethan Dmitrovsky, M.D., provost and executive vice president. “We are very pleased to announce this partnership as an important step toward improving the future health of our community.” ASPIRE was developed by MD Anderson researchers to provide an engaging curriculum for teens to learn about the dangers of tobacco use, thereby encouraging them to quit smoking or, better yet, never start. The program incorporates video-game-like components, customized messages, graphics, animations and streaming video. “The support and research from MD Anderson is an incredible, local resource to HISD,” said Annie Wolfe, HISD officer of secondary curriculum and development. “We are thrilled about this

testing of the original ASPIRE research study, which included 16 Houston schools in the early 2000s. Thus far, more than 14,000 HISD students have used ASPIRE, primarily through health and physical education programs.

About Houston ISD The Houston Independent School District is the largest school district in Texas and the seventh-largest in the United States with 287 schools and 215,000 students. The 334-square-mile district is one of the largest employers in the Houston metropolitan area with more than 28,000 employees. Follow HISD on Twitter.

About MD Anderson

partnership and all that it will provide for our students.” According to the Centers for Disease Control and Prevention, tobacco use remains the single largest preventable cause of death in the United States. Smoking is responsible for one third of all cancers and 90 percent of all lung cancers. “The vast majority of current smokers started before the age of 18. Each day approximately 3,200 adolescents start smoking,” says Alex Prokhorov, M.D.,

Ph.D., professor of Behavioral Science. “Previous approaches were no longer effective in preventing youth tobacco use, so we developed a more appealing program for today’s youth.” Prokhorov led the team that developed and launched ASPIRE in 2001. The program was translated into Spanish in 2011, adapted for mobile devices in 2013 and has also been expanded to include information about emerging tobacco products, such as e-cigarettes. HISD served as a source for the early

The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. The institution’s sole mission is to end cancer for patients and their families around the world. MD Anderson is one of only 45 comprehensive cancer centers designated by the National Cancer Institute (NCI). MD Anderson is ranked No. 1 for cancer care in U.S. News & World Report’s “Best Hospitals” survey. It has ranked as one of the nation’s top two hospitals since the survey began in 1990, and has ranked first for nine of the past 10 years. MD Anderson receives a cancer center support grant from the NCI of the National Institutes of Health (P30 CA016672).

Research

Nine Laws Particularly Effective in Reducing Underage Drinking Fatalities By d-mars.com News Provider

ew research reveals that nine laws designed to reduce underage drinking have been instrumental in saving more than 1,100 lives each year in the states that have adopted them, and that an additional 210 lives could be saved annually if they were adopted in every state. While all 50 states have adopted a core minimum legal drinking age of 21, a large number of states have adopted expanded underage drinking laws. Those additional laws were the focus of research done by a team at the Pacific Institute for Research and Evaluation (PIRE) in Calverton, Maryland, and which will be published in the March 2016 issue of the Journal of Studies on Alcohol and Drugs. Of the 20 expanded underage drinking

laws that were identified, nine were found to be particularly effective in reducing the number of fatal crashes involving underage drinking drivers. The authors examined each law's strengths and weaknesses in terms of coverage, sanctions for violations, exceptions, and ease of enforcement. Results showed wide variability in the strength of each underage drinking law and in the number of states that have adopted them. "We were surprised to find that half of the states have adopted 13 or fewer laws, that only five can be found in all 50 states and the District of Columbia, and that just one state, Utah, has adopted all 20," said lead author James Fell, now a principal research scientist at NORC at the University of Chicago. Fell said their particular interest was in the nine laws that made a significant difference in the number of fatal crashes. The nine minimum legal drinking age

laws associated with significant decreases in fatal crash ratios of underage drinking drivers were: possession of alcohol (-7.7%), purchase of alcohol (-4.2%), use alcohol and lose your license ( 7.9%), zero tolerance .02 blood alcohol concentration (BAC) limit for underage drivers (-2.9%), age of bartender ?21 ( 4.1%), state responsible beverage service program (-3.8%), fake identification support provisions for retailers (-11.9%), dram shop liability (-2.5%), and social host civil liability ( 1.7%). The nine laws are estimated to be cur-

rently saving approximately 1,135 lives annually. The researchers estimate that if all states adopted them, an additional 210 lives could be saved each year. Reference: NORC at the University of Chicago. (2016, March 30). New research: Nine laws particularly effective in reducing underage drinking fatalities: Wide variation found in number of states with special laws designed to reduce underage drinking. ScienceDaily. Retrieved October 19, 2016 from www.sciencedaily.com/releases/2016/03/160330174224.htm

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November 2016

Sports Medicine

Sports Medicine Physical of Future Could Help Athletes ‘ESCAPE’ Sudden Cardiac Death

By d-mars.com News Provider

young athlete in seemingly excellent health dies suddenly from a previously undetected cardiovascular condition such as hypertrophic cardiomyopathy in nearly every U.S. state annually. Although these conditions can be detected using electrocardiography (ECG) during a screening exam, the American Heart Association recommends against routine use of ECG, because it has a high false-positive rate. Limiting screening to a history and physical, however, usually fails to identify at-risk athletes. “The sports medicine physical lacks an effective way of ferretting out these heart problems,” says Gianmichel Corrado, MD, from Boston Children’s Hospital Division of Sports Medicine. Until now. Adding a simple, inexpensive ultrasound exam to the sports medicine physical could help identify athletes with these conditions. Corrado and colleagues devised the Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography (ESCAPE) protocol, which adds a two-minute focused ultrasound exam to the sports medicine physical. They designed a study which

showed the protocol reduces the falsepositive rate and demonstrated that the exam may detect cardiovascular conditions responsible for sudden cardiac death in this population. The original research was published January 22 in the

Journal of Ultrasound in Medicine. The researchers enrolled 65 male collegiate athletes, aged 18-25 years, in their study. Sports medicine physicians screened participants with a history and physical exam, ECG and focused

echocardiography. ECGs were positive in three athletes, but the focused ultrasound exams were normal. Another three athletes screened positive during the history and physical but were cleared both by ECG and focused ultrasound. The findings indicate that focused ultrasound could address the false-positive issue without adding significant time or cost to the sports medicine physical. ECG false-positives are problematic from multiple perspectives. Athletes who screen positive, approximately 10 percent of the population, must be held out of sports and referred to a cardiologist for additional tests to assess any possible underlying condition. Yet sudden cardiac death among athletes is miniscule among athletes, with estimates of incidence ranging from 1 per 23,000 to 1 per 300,000 worldwide. “The ESCAPE protocol provides peace of mind. We’ve shown it can easily be part of the preparticipation physical. It could be the sports medicine physical of the future,” says Corrado. The next step is to launch a multicenter study with the goal of actually finding the needle in the haystack -- the athlete with an undetected cardiovascular condition. Source: Science Daily

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