20100707
Will you lose more pounds at a bigger diet center?
NEW YORK (Reuters Health) - Weight loss loves company, hints new research.
For every additional 10 people signed up at a clinical center for a weight loss trial, the average person loses half a percent more weight, the study found.
Dr. Arne Astrup of the University of Copenhagen in Denmark and his colleagues delved into a database of 22 weight-loss centers across five countries, gathered in a previous large clinical trial.
Each center served between 4 and 85 men and women, and all of the more than 600 total participants were instructed to follow a nutritionally balanced diet of 800 to 1,000 calories a day. (Typical recommendations for non-dieters range from 1,600 to 2,400 calories per day, depending on gender, age, and level of activity.)
The average participant started the trial weighing 242 pounds, and lost 24 pounds (10 percent of their body weight) after 2 months on the low-calorie diet. Average weight loss among the centers ranged from 6 percent to 12 percent.
Taking into account age, initial body mass index (a measure of weight in relation to height) and sex, the researchers found that 10 more participants at a center translated into a modest half a percent climb in weight loss for the average person at that center. An average 200-pound woman, for example, would have dropped one extra pound over those 2 months.
The idea to investigate such a link came to the team of Danish and Belgian researchers after they noticed the relative performance of weight loss, or bariatric, surgeons. Those who have more experience, they write in the journal Obesity, tend to provide safer and more effective treatments.
Weight loss center size may reflect quality of care in a similar way, Astrup told Reuters Health by email. He noted that investigators, study coordinators and dieticians working at weight loss centers serving large numbers of participants would tend to be more experienced than those at smaller centers.While he notes that the study is "the first of its kind," Pedro Teixeira of the Technical University of Lisbon, in Portugal, is concerned that 2 months is too short to determine a diet's effectiveness.
Teixeira, who was not involved in the study, also suggests that other factors left unaccounted for could explain some of the differences seen across centers. In separate studies, he has identified a set of weight loss predictors, including self-motivation and realistic expectations.
The researchers, too, point to other possible explanations for their preliminary findings. A larger center may have a larger pool of subjects, for example, allowing them to recruit more highly motivated individuals than smaller centers.
Regardless, if an obese or overweight person seeking treatment is given the option, "larger centers with more patient flow are probably the best," advised Astrup. "Go for the big ones."
Source: Will you lose more pounds at a bigger diet center?
For every additional 10 people signed up at a clinical center for a weight loss trial, the average person loses half a percent more weight, the study found.
Dr. Arne Astrup of the University of Copenhagen in Denmark and his colleagues delved into a database of 22 weight-loss centers across five countries, gathered in a previous large clinical trial.
Each center served between 4 and 85 men and women, and all of the more than 600 total participants were instructed to follow a nutritionally balanced diet of 800 to 1,000 calories a day. (Typical recommendations for non-dieters range from 1,600 to 2,400 calories per day, depending on gender, age, and level of activity.)
The average participant started the trial weighing 242 pounds, and lost 24 pounds (10 percent of their body weight) after 2 months on the low-calorie diet. Average weight loss among the centers ranged from 6 percent to 12 percent.
Taking into account age, initial body mass index (a measure of weight in relation to height) and sex, the researchers found that 10 more participants at a center translated into a modest half a percent climb in weight loss for the average person at that center. An average 200-pound woman, for example, would have dropped one extra pound over those 2 months.
The idea to investigate such a link came to the team of Danish and Belgian researchers after they noticed the relative performance of weight loss, or bariatric, surgeons. Those who have more experience, they write in the journal Obesity, tend to provide safer and more effective treatments.
Weight loss center size may reflect quality of care in a similar way, Astrup told Reuters Health by email. He noted that investigators, study coordinators and dieticians working at weight loss centers serving large numbers of participants would tend to be more experienced than those at smaller centers.While he notes that the study is "the first of its kind," Pedro Teixeira of the Technical University of Lisbon, in Portugal, is concerned that 2 months is too short to determine a diet's effectiveness.
Teixeira, who was not involved in the study, also suggests that other factors left unaccounted for could explain some of the differences seen across centers. In separate studies, he has identified a set of weight loss predictors, including self-motivation and realistic expectations.
The researchers, too, point to other possible explanations for their preliminary findings. A larger center may have a larger pool of subjects, for example, allowing them to recruit more highly motivated individuals than smaller centers.
Regardless, if an obese or overweight person seeking treatment is given the option, "larger centers with more patient flow are probably the best," advised Astrup. "Go for the big ones."
Source: Will you lose more pounds at a bigger diet center?
Napan and crew win military honors for heroic rescue in Afghanistan
The call came while Napa pilot Scott St. Aubin and his four-man California National Guard Blackhawk medical helicopter crew were flying back to base after a two-day support mission in northeastern Afghanistan.
A 16-man U.S. Army squad was pinned down in an ambush in the rugged Pech River Valley and needed to get one of their soldiers out for immediate medical treatment.
Any rescue attempt would have to navigate difficult terrain in the heat of an intense battle.
It would be an effort that would be different from the vast majority of medevac missions, where ground and air units kill or run off the enemy before an unarmed medical helicopter lands.
Months earlier in their year-long 2009 Afghanistan tour, the crew of Dustoff 24 had mentally prepared for the decision they made that day, vowing to risk their lives and go in during a battle if necessary to save a life.
According to crew-member interviews and official accounts of the rescue mission from California National Guard, Dustoff 24 not only rescued five incapacitated soldiers without landing, but helped direct air support attacks and drop off ammunition to the beleaguered U.S. Army squad while dodging rifle fire and avoiding rocket-propelled grenades.
What’s more, Dustoff 24 went into the ambush six times with unforgiving terrain that only allowed the helicopter one way in and out of the narrow valley — making it easy for Taliban fighters to know where the helicopter would appear next.
“It really was by the grace of God that we weren’t hit,” Chief Warrant Officer Scott St. Aubin said in an interview, recounting that neither his crew nor the helicopter were struck by a single bullet.St. Aubin and two of his crew recently earned the prestigious Distinguished Flying Cross medal for their efforts, while medic Emmett Spraktes of Dixon earned the Silver Star for tending to his patients in the middle of combat.
Finishing what he started
St. Aubin, 38, like much of his crew, is different from the average U.S. Army soldier. As a member of the California National Guard, he holds a regular job as a probation officer with Solano County and has lived in Napa with his wife and daughter since he moved here in 1999.
“Most of our people are either cops or firefighters as well,” he said. For example, Staff Sgt. Spraktes, 48, is an officer with the California Highway Patrol.
To St. Aubin, the National Guard was a way to stay involved with the military after cutbacks in the ‘90s convinced him to curtail a would-be career with the Air Force, where he served before leaving for college in 1995. When he finished school, the military was going through a reduction in force and the Air Force told him they had little room. So, even though he came from an Air Force family, St. Aubin settled into civilian life.
“Right around that time, I met my wife and moved to California,” he said.
Then came Sept. 11 and the global war on terror.
“I started watching what was going on,” he said. “I really wanted to go back and fly helicopters for the military.”
The California National Guard put him in the cockpit.
“It really allows me to give back,” St. Aubin said. “I’m the constant citizen-soldier, at the same time I’m allowed not to be thrown to the wind like an active-duty soldier.”
Being in the National Guard, on that year-long tour in Afghanistan, he said, allowed him to “kinda try and finish something I started a long time ago.”
Suspended in mid-air
The crew of Dustoff 24 didn’t know how bad things were when they first heard the call for help that July day in 2009 — but they soon learned.
“Initially we didn’t understand there was a critical patient,” St. Aubin said, adding as Dustoff 24 got closer, the radio traffic from attack helicopters also informed them that there was a heavy firefight in the area.
The soldiers were halfway up a mountain, at about 1,000 feet, St. Aubin estimates, and no other ground combat units could get to them because of the terrain.
Spraktes said the way in was very narrow.
“The area was very steep and rugged,” he said. “The only way in ... it was pointing toward where we think the main body of Taliban fighters were.”
That meant the crew wouldn’t be landing. They would be doing an uncommon maneuver called a “combat hoist.” The medic is lowered at a slow speed as the helicopter approaches the wounded soldier, reducing the amount of time the helicopter ends up stationary over the drop zone.
Something went wrong that time, however, Spraktes recalled.
“As we’re making the final approach, they’re lowering me down ... about two-thirds of the way down the hoist stops.”
Suspended in mid-air, with bullets crackling past him, Spraktes said he called up to the crew on his radio.
“I said ‘Get me on the ground now. I am like a (expletive) piñata down here.’”
Spraktes said the crew member in the helicopter operating the hoist had to hit the deck to avoid incoming fire, stopping the hoist. For Spraktes, watching bullets hit the landscape around him, it was an eternity. In retrospect, he figures that eternity lasted for 15 seconds before the hoist lowered him to the ground.
He was a welcome sight for the soldiers, and in some ways, entertainment.
“I imagine from their perspective watching me come down the wire, it must have been a good show. A couple of them raised their hands and said ‘Man, that was badass.’”
The combat situation was not as good, Spraktes said.
“There are 16 guys down there and most of them are the age of my oldest son, in their mid-20s. Two of their (other) guys are injured and there are two heat casualties.”
No ‘Blackhawk Down’
Up above, the rest of the crew of Dustoff 24 could see a group of Taliban fighters breaking off to flank the soldiers, and Taliban armed with RPGs coming up in the rear. The squad was getting low on ammunition and in the searing heat, wearing all their gear, they were out of water.
Not wasting time, Spraktes said he directed the soldiers to take different cover so their position could be better defended. But the most gravely wounded soldier worried him. Spraktes knew that he would die if not flown to a field hospital immediately. He placed the soldier on a stretcher-like apparatus to be hoisted to the helicopter.
Meanwhile, St. Aubin noticed Taliban on a ridge and helped direct an attack from two OH-58 Kiowa Warrior helicopters armed with cannons and rockets that had arrived to help. An Apache helicopter also aided the group.
With their help, the flow of the battle created lulls where there was less danger. With repeated evacuations, Dustoff 24 was also able to hoist a soldier shot in the leg and one with an open fracture of his ankle, plus two men rendered listless from heat exhaustion.
On one run, Dustoff 24 flew low and slow near the ground and dropped off ammunition and water.
Eventually, the remaining members of the squad on the ground had an opportunity to move out of the area and return to base.
St. Aubin attributes Dustoff 24’s success to the ability of soldiers and air support to keep the enemy pinned down, making the Taliban rely on what he calls “spray and pray,” where fighters hunker down behind cover and shoot without aiming.
Nonetheless, St. Aubin and the crew were well aware of the danger if their helicopter had been hit and forced to crash land.
“We’re the rescue effort,” he said. “We don’t want to become the effort. You’ve seen the movie ‘Blackhawk Down.’ Once a Blackhawk goes down, that becomes the effort.”
It’s not clear how many Taliban fighters there were in the area, but Spraktes believes there were at least 11 Taliban casualties noted on a sweep of the area.
“For me, I can honestly say that day, my crew and I were doing what we normally would do,” St. Aubin said. “We were not trying to earn any medals ... It was valuable to me to do that mission even if I didn’t earn any medals. We were just trying to get these kids home, that’s all.”
Source: Napan and crew win military honors for heroic rescue in Afghanistan
A 16-man U.S. Army squad was pinned down in an ambush in the rugged Pech River Valley and needed to get one of their soldiers out for immediate medical treatment.
Any rescue attempt would have to navigate difficult terrain in the heat of an intense battle.
It would be an effort that would be different from the vast majority of medevac missions, where ground and air units kill or run off the enemy before an unarmed medical helicopter lands.
Months earlier in their year-long 2009 Afghanistan tour, the crew of Dustoff 24 had mentally prepared for the decision they made that day, vowing to risk their lives and go in during a battle if necessary to save a life.
According to crew-member interviews and official accounts of the rescue mission from California National Guard, Dustoff 24 not only rescued five incapacitated soldiers without landing, but helped direct air support attacks and drop off ammunition to the beleaguered U.S. Army squad while dodging rifle fire and avoiding rocket-propelled grenades.
What’s more, Dustoff 24 went into the ambush six times with unforgiving terrain that only allowed the helicopter one way in and out of the narrow valley — making it easy for Taliban fighters to know where the helicopter would appear next.
“It really was by the grace of God that we weren’t hit,” Chief Warrant Officer Scott St. Aubin said in an interview, recounting that neither his crew nor the helicopter were struck by a single bullet.St. Aubin and two of his crew recently earned the prestigious Distinguished Flying Cross medal for their efforts, while medic Emmett Spraktes of Dixon earned the Silver Star for tending to his patients in the middle of combat.
Finishing what he started
St. Aubin, 38, like much of his crew, is different from the average U.S. Army soldier. As a member of the California National Guard, he holds a regular job as a probation officer with Solano County and has lived in Napa with his wife and daughter since he moved here in 1999.
“Most of our people are either cops or firefighters as well,” he said. For example, Staff Sgt. Spraktes, 48, is an officer with the California Highway Patrol.
To St. Aubin, the National Guard was a way to stay involved with the military after cutbacks in the ‘90s convinced him to curtail a would-be career with the Air Force, where he served before leaving for college in 1995. When he finished school, the military was going through a reduction in force and the Air Force told him they had little room. So, even though he came from an Air Force family, St. Aubin settled into civilian life.
“Right around that time, I met my wife and moved to California,” he said.
Then came Sept. 11 and the global war on terror.
“I started watching what was going on,” he said. “I really wanted to go back and fly helicopters for the military.”
The California National Guard put him in the cockpit.
“It really allows me to give back,” St. Aubin said. “I’m the constant citizen-soldier, at the same time I’m allowed not to be thrown to the wind like an active-duty soldier.”
Being in the National Guard, on that year-long tour in Afghanistan, he said, allowed him to “kinda try and finish something I started a long time ago.”
Suspended in mid-air
The crew of Dustoff 24 didn’t know how bad things were when they first heard the call for help that July day in 2009 — but they soon learned.
“Initially we didn’t understand there was a critical patient,” St. Aubin said, adding as Dustoff 24 got closer, the radio traffic from attack helicopters also informed them that there was a heavy firefight in the area.
The soldiers were halfway up a mountain, at about 1,000 feet, St. Aubin estimates, and no other ground combat units could get to them because of the terrain.
Spraktes said the way in was very narrow.
“The area was very steep and rugged,” he said. “The only way in ... it was pointing toward where we think the main body of Taliban fighters were.”
That meant the crew wouldn’t be landing. They would be doing an uncommon maneuver called a “combat hoist.” The medic is lowered at a slow speed as the helicopter approaches the wounded soldier, reducing the amount of time the helicopter ends up stationary over the drop zone.
Something went wrong that time, however, Spraktes recalled.
“As we’re making the final approach, they’re lowering me down ... about two-thirds of the way down the hoist stops.”
Suspended in mid-air, with bullets crackling past him, Spraktes said he called up to the crew on his radio.
“I said ‘Get me on the ground now. I am like a (expletive) piñata down here.’”
Spraktes said the crew member in the helicopter operating the hoist had to hit the deck to avoid incoming fire, stopping the hoist. For Spraktes, watching bullets hit the landscape around him, it was an eternity. In retrospect, he figures that eternity lasted for 15 seconds before the hoist lowered him to the ground.
He was a welcome sight for the soldiers, and in some ways, entertainment.
“I imagine from their perspective watching me come down the wire, it must have been a good show. A couple of them raised their hands and said ‘Man, that was badass.’”
The combat situation was not as good, Spraktes said.
“There are 16 guys down there and most of them are the age of my oldest son, in their mid-20s. Two of their (other) guys are injured and there are two heat casualties.”
No ‘Blackhawk Down’
Up above, the rest of the crew of Dustoff 24 could see a group of Taliban fighters breaking off to flank the soldiers, and Taliban armed with RPGs coming up in the rear. The squad was getting low on ammunition and in the searing heat, wearing all their gear, they were out of water.
Not wasting time, Spraktes said he directed the soldiers to take different cover so their position could be better defended. But the most gravely wounded soldier worried him. Spraktes knew that he would die if not flown to a field hospital immediately. He placed the soldier on a stretcher-like apparatus to be hoisted to the helicopter.
Meanwhile, St. Aubin noticed Taliban on a ridge and helped direct an attack from two OH-58 Kiowa Warrior helicopters armed with cannons and rockets that had arrived to help. An Apache helicopter also aided the group.
With their help, the flow of the battle created lulls where there was less danger. With repeated evacuations, Dustoff 24 was also able to hoist a soldier shot in the leg and one with an open fracture of his ankle, plus two men rendered listless from heat exhaustion.
On one run, Dustoff 24 flew low and slow near the ground and dropped off ammunition and water.
Eventually, the remaining members of the squad on the ground had an opportunity to move out of the area and return to base.
St. Aubin attributes Dustoff 24’s success to the ability of soldiers and air support to keep the enemy pinned down, making the Taliban rely on what he calls “spray and pray,” where fighters hunker down behind cover and shoot without aiming.
Nonetheless, St. Aubin and the crew were well aware of the danger if their helicopter had been hit and forced to crash land.
“We’re the rescue effort,” he said. “We don’t want to become the effort. You’ve seen the movie ‘Blackhawk Down.’ Once a Blackhawk goes down, that becomes the effort.”
It’s not clear how many Taliban fighters there were in the area, but Spraktes believes there were at least 11 Taliban casualties noted on a sweep of the area.
“For me, I can honestly say that day, my crew and I were doing what we normally would do,” St. Aubin said. “We were not trying to earn any medals ... It was valuable to me to do that mission even if I didn’t earn any medals. We were just trying to get these kids home, that’s all.”
Source: Napan and crew win military honors for heroic rescue in Afghanistan
Deadline Is July 10 To File Requests For Public Assistance After May Storms
State agencies, local and tribal governments as well as certain private nonprofits in Oklahoma counties hit hard by the May 10-13 storms and tornadoes have just a few days remaining to file their official requests for federal assistance.
The deadline to file a Request for Public Assistance (RPA) is Saturday, July 10.
Filing such a request with the state is the first step in the process of applying for federal reimbursements under the Federal Emergency Management Agency's (FEMA) Public Assistance (PA) Grant Program.
Applicants must file RPAs within 30 days of a Public Assistance amendment to a presidential disaster declaration. President Obama issued Oklahoma's major disaster declaration on May 24 and amended it June 11 to include PA for Alfalfa, Cleveland, Grant, Major, McIntosh, Noble, Okfuskee, Osage, Pottawatomie and Seminole counties.
"We would like all eligible applicants to get in their requests for assistance quickly," said Federal Coordinating Officer Gregory W. Eaton. "The sooner those forms get to state specialists, the sooner we can start the process of getting their eligible costs reimbursed."The grants are obligated to the state to reimburse applicants for expenses they incurred while taking emergency measures to protect lives and property; cleaning up downed trees, power poles and other debris; and making repairs to public infrastructure, including roads, bridges and public utilities.
Although the program is oriented to public entities, private nonprofit organizations may apply directly to FEMA via the RPA for uninsured costs of debris removal and emergency protective measures. Additionally, nonprofits may qualify for FEMA assistance to make infrastructure repairs if they provide critical services, such as fire and emergency rescue; medical treatment; power, water and sewer resources; and communications systems.
Source: Deadline Is July 10 To File Requests For Public Assistance After May Storms
The deadline to file a Request for Public Assistance (RPA) is Saturday, July 10.
Filing such a request with the state is the first step in the process of applying for federal reimbursements under the Federal Emergency Management Agency's (FEMA) Public Assistance (PA) Grant Program.
Applicants must file RPAs within 30 days of a Public Assistance amendment to a presidential disaster declaration. President Obama issued Oklahoma's major disaster declaration on May 24 and amended it June 11 to include PA for Alfalfa, Cleveland, Grant, Major, McIntosh, Noble, Okfuskee, Osage, Pottawatomie and Seminole counties.
"We would like all eligible applicants to get in their requests for assistance quickly," said Federal Coordinating Officer Gregory W. Eaton. "The sooner those forms get to state specialists, the sooner we can start the process of getting their eligible costs reimbursed."The grants are obligated to the state to reimburse applicants for expenses they incurred while taking emergency measures to protect lives and property; cleaning up downed trees, power poles and other debris; and making repairs to public infrastructure, including roads, bridges and public utilities.
Although the program is oriented to public entities, private nonprofit organizations may apply directly to FEMA via the RPA for uninsured costs of debris removal and emergency protective measures. Additionally, nonprofits may qualify for FEMA assistance to make infrastructure repairs if they provide critical services, such as fire and emergency rescue; medical treatment; power, water and sewer resources; and communications systems.
Source: Deadline Is July 10 To File Requests For Public Assistance After May Storms
Many With Early Breast Cancer Don't Complete Therapy
Slightly less than half of early-stage breast cancer patients complete their full prescribed course of hormone therapy, finds a new study.
U.S. researchers examined the automated pharmacy records of 8,769 women diagnosed with stage 1, 2 or 3 hormone-sensitive breast cancer between 1996 and 2007. Each woman filled at least one prescription for hormone therapy within a year of breast cancer diagnosis. The women used tamoxifen (43 percent), aromatase inhibitors (26 percent) or both (30 percent).
Overall, only about 49 percent of the women completed their full prescribed regimen of hormone therapy, the study found. After 4.5 years, 32 percent of the women had stopped taking their hormone therapy. Of those who did not stop, 72 percent finished on schedule (meaning they took their medication more than 80 percent of the time).
Those most likely to discontinue hormone therapy early were found to be women younger than 40. Among these women and women older than 75, those who had a lumpectomy rather than a mastectomy and those who had other medical illnesses were more likely to discontinue the therapy. Those most likely to complete 4.5 years of hormone therapy were Asian/Pacific Islanders, women who'd undergone chemotherapy in the past, those who were married and women who had longer prescription refill intervals.
In general, the researchers said, women stop hormone therapy early for a variety of reasons, including such side effects such as joint pain, hot flashes and fatigue; a lack of understanding about the benefits of the therapy; and the high cost of medications and insurance co-payments.
"Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer," the study's leader, Dr. Dawn Hershman, an associate professor of medicine and epidemiology at Columbia University Medical Center, said in a news release from the Journal of Clinical Oncology. The study appears online June 28 in the journal.
"It's very disturbing that patients under 40 had the highest discontinuation rates because those patients have the longest life expectancy," Hershman said. "If we can better understand the issues surrounding compliance with hormonal therapy, this might help us understand why patients don't adhere to other treatments that are moving out of the clinic and into the home, such as oral chemotherapy, as often as we would like."
SOURCE: Journal of Clinical Oncology, June 28, 2010, news release.
HealthDay
U.S. researchers examined the automated pharmacy records of 8,769 women diagnosed with stage 1, 2 or 3 hormone-sensitive breast cancer between 1996 and 2007. Each woman filled at least one prescription for hormone therapy within a year of breast cancer diagnosis. The women used tamoxifen (43 percent), aromatase inhibitors (26 percent) or both (30 percent).
Overall, only about 49 percent of the women completed their full prescribed regimen of hormone therapy, the study found. After 4.5 years, 32 percent of the women had stopped taking their hormone therapy. Of those who did not stop, 72 percent finished on schedule (meaning they took their medication more than 80 percent of the time).
Those most likely to discontinue hormone therapy early were found to be women younger than 40. Among these women and women older than 75, those who had a lumpectomy rather than a mastectomy and those who had other medical illnesses were more likely to discontinue the therapy. Those most likely to complete 4.5 years of hormone therapy were Asian/Pacific Islanders, women who'd undergone chemotherapy in the past, those who were married and women who had longer prescription refill intervals.
In general, the researchers said, women stop hormone therapy early for a variety of reasons, including such side effects such as joint pain, hot flashes and fatigue; a lack of understanding about the benefits of the therapy; and the high cost of medications and insurance co-payments.
"Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer," the study's leader, Dr. Dawn Hershman, an associate professor of medicine and epidemiology at Columbia University Medical Center, said in a news release from the Journal of Clinical Oncology. The study appears online June 28 in the journal.
"It's very disturbing that patients under 40 had the highest discontinuation rates because those patients have the longest life expectancy," Hershman said. "If we can better understand the issues surrounding compliance with hormonal therapy, this might help us understand why patients don't adhere to other treatments that are moving out of the clinic and into the home, such as oral chemotherapy, as often as we would like."
SOURCE: Journal of Clinical Oncology, June 28, 2010, news release.
HealthDay
Act Against AIDS: the First Year
In April 2009, CDC and the White House launched Act Against AIDSExternal Web Site Icon. (AAA), a 5-year, $45-million communication campaign. After almost 20 years since the last national HIV campaign, it was past time to again initiate a national conversation about one of the worst epidemics this country has ever experienced. In the United States, we have approximately 56,000 new infections annually. The AAA campaign was designed to combat complacency about the HIV/AIDS epidemic and support CDC’s goals for reducing new HIV infections in the U.S. Now, a little more than a year since its launch, CDC has released the First Year-End Report: April 2009–March 2010. This report highlights some of the achievements and developments of this multifaceted campaign. Among the most significant accomplishments of AAA in its first year were the many partnerships forged and the successful releases of three AAA campaign phases. In all, the first year brought more than 430 million media impressions, which represent the estimated number of times a campaign message was seen or heard.
9 ½ Minutes Campaign Phase
The first phase of AAA, called 9½ MinutesExternal Web Site Icon., delivers the key message to the general public that right here in the United States, every 9½ minutes, someone’s brother, mother, sister, father, or neighbor is infected with HIV. We worked to reach people by placing public service announcements, securing donated advertising space, hosting HIV prevention education and testing events, and moving people to seek information about HIV prevention online and in their community.
In two other AAA phases we focused on African Americans because while they comprise only 12% of the U.S. population, they account for nearly half (45%) of all new HIV infections and almost half of all Americans living with HIV, a staggering statistic.
Black MSM Testing Campaign Phase
In September 2009, we launched a phase to encourage HIV testing on a regular basis among black men who have sex with men (MSM).This Black MSM HIV testing phase was designed through collaboration with an expert consultant work group of Black MSM and began delivering HIV testing messages to young Black MSM through on-line banner ads.i know Campaign Phase
Another phase of AAAA launched this year, called i knowExternal Web Site Icon., seeks to get African American men and women aged 18–24 years talking about HIV with peers, partners, and families. Launched in March 2010, the i know phase of AAA utilizes social media to encourage open and frequent dialog about HIV, both on-line and off. i know features celebrity Web videos, radio PSAs, a Facebook fan page, live Twitter feeds, and other platforms intended to create an informative dialogue about HIV and what can be done to prevent it.
All of the AAA activities have had incredible reach. National media coverage includes highlighting the campaign on CNN’s “House Call with Dr. Sanjay Gupta;” The Tavis Smiley Radio Show on PBS; The Bev Smith Show’s interview with President Barack Obama about National HIV Testing Day; USA Today: “i know AIDS initiative targets young blacks with social media;” and CNN Headline News: “New social media effort arms young adults in the fight against HIV.”
For this effort and perhaps any outreach—the key is partner collaboration. CDC has been joined in this effort by partner organizations in both the public and the private sectors that have contributed immensely to the first year of AAA. Our partners have been able to have input into the development of campaign phases and are able to extend the reach of important HIV prevention messages. For example, in our first year, AAA partnered with 14 national African American organizations to develop the Act Against AIDS Leadership Initiative (AAALI). These partners have contributed greatly to the successful first year of AAA, integrating HIV prevention messages into their networks. Most importantly, these highly influential national organizations specifically reach those populations at greatest risk. In the second year of AAA, AAALI is expanding to include membership of organizations that specifically reach men who have sex with men (MSM) and Latinos, both groups that are disproportionately affected by HIV.
The campaign utilizes traditional mass media, television, radio, billboards, and print, as well as social media—through the Internet such as banners, buttons, widgets, and videos—to distribute lifesaving messages further and faster than was possible almost 30 years ago when this epidemic surfaced. The possible reach using traditional and new media is unprecedented.
We want to hear your thoughts on the campaign. I invite you to take time to post your response to the AAA campaign here. Let us know what you are doing to raise awareness and reduce the infection rates of HIV and let us know what we can do better. Thank you.
Source: Centers for Disease Control and Prevention
9 ½ Minutes Campaign Phase
The first phase of AAA, called 9½ MinutesExternal Web Site Icon., delivers the key message to the general public that right here in the United States, every 9½ minutes, someone’s brother, mother, sister, father, or neighbor is infected with HIV. We worked to reach people by placing public service announcements, securing donated advertising space, hosting HIV prevention education and testing events, and moving people to seek information about HIV prevention online and in their community.
In two other AAA phases we focused on African Americans because while they comprise only 12% of the U.S. population, they account for nearly half (45%) of all new HIV infections and almost half of all Americans living with HIV, a staggering statistic.
Black MSM Testing Campaign Phase
In September 2009, we launched a phase to encourage HIV testing on a regular basis among black men who have sex with men (MSM).This Black MSM HIV testing phase was designed through collaboration with an expert consultant work group of Black MSM and began delivering HIV testing messages to young Black MSM through on-line banner ads.i know Campaign Phase
Another phase of AAAA launched this year, called i knowExternal Web Site Icon., seeks to get African American men and women aged 18–24 years talking about HIV with peers, partners, and families. Launched in March 2010, the i know phase of AAA utilizes social media to encourage open and frequent dialog about HIV, both on-line and off. i know features celebrity Web videos, radio PSAs, a Facebook fan page, live Twitter feeds, and other platforms intended to create an informative dialogue about HIV and what can be done to prevent it.
All of the AAA activities have had incredible reach. National media coverage includes highlighting the campaign on CNN’s “House Call with Dr. Sanjay Gupta;” The Tavis Smiley Radio Show on PBS; The Bev Smith Show’s interview with President Barack Obama about National HIV Testing Day; USA Today: “i know AIDS initiative targets young blacks with social media;” and CNN Headline News: “New social media effort arms young adults in the fight against HIV.”
For this effort and perhaps any outreach—the key is partner collaboration. CDC has been joined in this effort by partner organizations in both the public and the private sectors that have contributed immensely to the first year of AAA. Our partners have been able to have input into the development of campaign phases and are able to extend the reach of important HIV prevention messages. For example, in our first year, AAA partnered with 14 national African American organizations to develop the Act Against AIDS Leadership Initiative (AAALI). These partners have contributed greatly to the successful first year of AAA, integrating HIV prevention messages into their networks. Most importantly, these highly influential national organizations specifically reach those populations at greatest risk. In the second year of AAA, AAALI is expanding to include membership of organizations that specifically reach men who have sex with men (MSM) and Latinos, both groups that are disproportionately affected by HIV.
The campaign utilizes traditional mass media, television, radio, billboards, and print, as well as social media—through the Internet such as banners, buttons, widgets, and videos—to distribute lifesaving messages further and faster than was possible almost 30 years ago when this epidemic surfaced. The possible reach using traditional and new media is unprecedented.
We want to hear your thoughts on the campaign. I invite you to take time to post your response to the AAA campaign here. Let us know what you are doing to raise awareness and reduce the infection rates of HIV and let us know what we can do better. Thank you.
Source: Centers for Disease Control and Prevention
20100706
Millions Need to Be Screened for Cancer, According to Reports in CDC Vital Signs
Millions Need to Be Screened for Cancer, According to Reports in CDC Vital Signs™
Most adults are getting recommended breast and colon (colorectal) cancer screenings. Yet more than 22 million adults have not had screening tests for colon cancer, and more than 7 million women have not had a recent mammogram to screen for breast cancer as recommended, according to reports in a new monthly scientific publication called CDC Vital Signs.
Colon Cancer
- Screening tests can find colon cancer. Colon cancer screening tests can find precancerous polyps so they can be removed before they turn into cancer, thus preventing the disease. Screening tests can also find colon cancer early, when treatment works best.
- About a third of people are not getting screened as recommended. This could be because they don't know they can get colon cancer, they don't have insurance or a doctor, or their doctor hasn't recommended screening.
Breast Cancer
- Mammograms save lives. The best way to find breast cancer is by having a mammogram (an X-ray of the breasts). Mammograms can find breast cancer early, before it is big enough to feel or cause symptoms and when it is easier to treat.
- Some women are not getting mammograms as recommended. About one of five women between the ages of 50 and 74 has not had a mammogram in the past two years. This may be because their doctor didn't tell them to get one, they don't have insurance and can't afford one, or they don't think mammograms work.
What Can Be Done?
- Health departments can find out why some groups of people are not being screened, and create programs to solve these problems and increase screening.
- Doctors and other health care providers can tell patients who should be screened about test options, make sure patients who can't afford tests know about free screening services in their area, and remind patients when a screening test is due.
- People can ask their doctor about getting screened, get screened as recommended, and see their doctor promptly if a screening test shows there might be a problem.
For more information, please read the reports:
- Vital Signs: Colorectal Cancer Screening Among Adults Aged 50–75 Years—United States, 2008
- Vital Signs: Breast Cancer Screening Among Women Aged 50–74 Years—United States, 2008
 |  |
Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)
More Aged Care Beds for North Western Tasmania
Support from the Gillard Government’s Zero Real Interest Loans initiative has helped deliver more aged care services in Deloraine.
The Government’s Zero Real Interest Loans initiative provides low-cost finance to aged care providers to support the construction or expansion of aged care facilities in areas of need.
Minister for Ageing Justine Elliot toured the $1.3 million extension at Kanangra Hostel that is providing nine new beds supported by a $100,000 Zero Real Interest Loan. Kanangra Hostel can now provide care for 48 residents.
Minister Elliot said: “The Gillard Government is supporting the development of new aged care places through capital grants and low-cost finance.
“We believe older Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“In the last Budget, the Government has extended the Zero Real Interest Loans initiative to support the development of up to 2,500 new aged care places.
“A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for older Australians and their families,” Minister Elliot said.
Tasmanian aged care providers have already been offered more than $16 million in Zero Real Interest Loans to support 130 new aged care places. The initiative has resulted in 15 new places delivering services with a further 79 places in the construction and planning phases.
Minister Elliot said: “Providing low-cost finance is a practical and commonsense way we can help aged care services expand. It is great to see Tasmanian aged care providers taking full advantage of this assistance from the Government.
“In addition to the construction jobs, the facility provides an ongoing boost to the local economy, creating more jobs in the aged care sector,” Minister Elliot said.
The Gillard Government is reforming aged care. We are taking full funding and policy responsibility to build a nationally consistent system. This national system will be supported by one-stop shops for better access to services, more highly qualified staff, more aged care places, better access to GP and primary care and stronger protections for older Australians receiving care.
Souce: Australian Government Department of Health and Ageing
The Government’s Zero Real Interest Loans initiative provides low-cost finance to aged care providers to support the construction or expansion of aged care facilities in areas of need.
Minister for Ageing Justine Elliot toured the $1.3 million extension at Kanangra Hostel that is providing nine new beds supported by a $100,000 Zero Real Interest Loan. Kanangra Hostel can now provide care for 48 residents.
Minister Elliot said: “The Gillard Government is supporting the development of new aged care places through capital grants and low-cost finance.
“We believe older Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“In the last Budget, the Government has extended the Zero Real Interest Loans initiative to support the development of up to 2,500 new aged care places.
“A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for older Australians and their families,” Minister Elliot said.
Tasmanian aged care providers have already been offered more than $16 million in Zero Real Interest Loans to support 130 new aged care places. The initiative has resulted in 15 new places delivering services with a further 79 places in the construction and planning phases.
Minister Elliot said: “Providing low-cost finance is a practical and commonsense way we can help aged care services expand. It is great to see Tasmanian aged care providers taking full advantage of this assistance from the Government.
“In addition to the construction jobs, the facility provides an ongoing boost to the local economy, creating more jobs in the aged care sector,” Minister Elliot said.
The Gillard Government is reforming aged care. We are taking full funding and policy responsibility to build a nationally consistent system. This national system will be supported by one-stop shops for better access to services, more highly qualified staff, more aged care places, better access to GP and primary care and stronger protections for older Australians receiving care.
Souce: Australian Government Department of Health and Ageing
Reforms Means Better Health Services for Older Residents of Devonport
Devonport seniors today joined Minister for Ageing, Justine Elliot and Member for Braddon Sid Sidebottom to discuss the Gillard Government’s health and aged care reforms which mean better support and better care for older Australians.
Minister Elliot said: “Older Australians are among the first and the biggest beneficiaries of the Government’s health reforms.
“We believe older Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“Local Hospital Networks, local aged care services and primary care services will work together to provide better care to older Australians.
“A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for older Australians and their families,” Minister Elliot said. Member for Braddon Sid Sidebottom said: “Almost 15 per cent of Tasmania’s population is aged 65 years and over and the Government’s reforms will build a health system that people can rely on, one that extends care beyond the hospital door.
“The Labor Government has already delivered the most significant reforms to the pension system in its 100 year history. For more than 20,000 pensioners in Braddon, these reforms have delivered increases of up to $100 a fortnight for single pensioners and $74 a fortnight for couples combined.
“Now we are working on reforms that will help older Australians have better health, hospitals and aged care services”, Mr Sidebottom said.
Minister Elliot explained how the Government’s investment of more than $900 million over the next four years will build a seamless national aged care system covering basic care at home through to high level residential care.
Minister Elliot said: “We are building a national aged care system with more aged care places, more highly skilled aged care workers, better access to GP and health services and stronger protections for those receiving care.
“The Government is also making it easier for older Australians and their carers to find the services that best suit their need by establishing one-stop shops for aged care information and assessment,” Minister Elliot said.
Delivering better health and aged care in Braddon
Last year more than 1,180 older people in Braddon received aged care services
This Government last year provided:
+ More than $35 million to aged and community care providers to provide care;
+ $5 million for a GP Super Clinic in Devonport;
+ $791,800 of elective surgery funding for the North Western Regional Hospital for surgical equipment; and
+ More than $684,000 was provided to support four respite services.
Souce: Australian Government Department of Health and Ageing
Minister Elliot said: “Older Australians are among the first and the biggest beneficiaries of the Government’s health reforms.
“We believe older Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“Local Hospital Networks, local aged care services and primary care services will work together to provide better care to older Australians.
“A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for older Australians and their families,” Minister Elliot said. Member for Braddon Sid Sidebottom said: “Almost 15 per cent of Tasmania’s population is aged 65 years and over and the Government’s reforms will build a health system that people can rely on, one that extends care beyond the hospital door.
“The Labor Government has already delivered the most significant reforms to the pension system in its 100 year history. For more than 20,000 pensioners in Braddon, these reforms have delivered increases of up to $100 a fortnight for single pensioners and $74 a fortnight for couples combined.
“Now we are working on reforms that will help older Australians have better health, hospitals and aged care services”, Mr Sidebottom said.
Minister Elliot explained how the Government’s investment of more than $900 million over the next four years will build a seamless national aged care system covering basic care at home through to high level residential care.
Minister Elliot said: “We are building a national aged care system with more aged care places, more highly skilled aged care workers, better access to GP and health services and stronger protections for those receiving care.
“The Government is also making it easier for older Australians and their carers to find the services that best suit their need by establishing one-stop shops for aged care information and assessment,” Minister Elliot said.
Delivering better health and aged care in Braddon
Last year more than 1,180 older people in Braddon received aged care services
This Government last year provided:
+ More than $35 million to aged and community care providers to provide care;
+ $5 million for a GP Super Clinic in Devonport;
+ $791,800 of elective surgery funding for the North Western Regional Hospital for surgical equipment; and
+ More than $684,000 was provided to support four respite services.
Souce: Australian Government Department of Health and Ageing
Should I Use Vitamin Supplements?
If you open any fitness magazine, you're almost sure to find an advertisement for the latest vitamin supplement. From promises of increased heart health to a longer life, you might not be sure how to separate the fact from the fiction. The truth is that research on dietary supplements' role in preventing diseases is still in the early stages. There are many conflicting opinions about the value of vitamins. One thing to keep in mind is that if you haven't been eating healthy foods for a long time, vitamin and mineral supplements are probably not going to make up for your poor eating habits.
Source: Woman Activity Tracker
Source: Woman Activity Tracker
New $1.57 million Cooma dementia day-care and HACC centre
Services for older residents and people with a disability of Cooma and surrounds have received a boost with the opening of a $1.57 million dementia day care.
The purpose built dementia day-care centre is the eighth centre to be opened as part of the joint Australian and New South Wales Government-funded Home and Community Care program.
The centre includes new office space for HACC services and a Meals on Wheels distribution centre.
The Gillard Government contributed $942,000 and the Keneally Government provided about $628,000 towards the construction of the centre.
Minister for Ageing Justine Elliot said, “Dementia day-care centres are one way we are responding to the challenges of an ageing population by providing outings, day trips and support to people with dementia and their carers.”
“This new dementia care centre is an example of all levels of government and the community working together to take concrete steps to deliver more services for older Australians to help people living in and around Cooma,” Minister Elliot said.
The Cooma-Monaro Shire Council arranged cash and in kind contributions totalling $60,000.
The NSW Minister for Ageing and Disability Services, Peter Primrose, said: “The Home and Community Care program delivers affordable and accessible care to help meet the individual needs of older people, or younger people with a disability, and their carers.
“The day-care centre would assist older residents who needed some assistance to continue living in their own homes and communities rather than moving into permanent residential care,” Minister Primrose said.
Member for Eden-Monaro Mike Kelly said: “I am delighted that the people of Cooma and surrounds will have access to this important centre.
“Our community like the rest of Australia is facing the challenges of an ageing population and this funding will make a real difference to people living in our area.”
“These services offer assistance to people in our region who really need them,” Mr Kelly said.
Souce: Australian Government Department of Health and Ageing
The purpose built dementia day-care centre is the eighth centre to be opened as part of the joint Australian and New South Wales Government-funded Home and Community Care program.
The centre includes new office space for HACC services and a Meals on Wheels distribution centre.
The Gillard Government contributed $942,000 and the Keneally Government provided about $628,000 towards the construction of the centre.
Minister for Ageing Justine Elliot said, “Dementia day-care centres are one way we are responding to the challenges of an ageing population by providing outings, day trips and support to people with dementia and their carers.”
“This new dementia care centre is an example of all levels of government and the community working together to take concrete steps to deliver more services for older Australians to help people living in and around Cooma,” Minister Elliot said.
The Cooma-Monaro Shire Council arranged cash and in kind contributions totalling $60,000.
The NSW Minister for Ageing and Disability Services, Peter Primrose, said: “The Home and Community Care program delivers affordable and accessible care to help meet the individual needs of older people, or younger people with a disability, and their carers.
“The day-care centre would assist older residents who needed some assistance to continue living in their own homes and communities rather than moving into permanent residential care,” Minister Primrose said.
Member for Eden-Monaro Mike Kelly said: “I am delighted that the people of Cooma and surrounds will have access to this important centre.
“Our community like the rest of Australia is facing the challenges of an ageing population and this funding will make a real difference to people living in our area.”
“These services offer assistance to people in our region who really need them,” Mr Kelly said.
Souce: Australian Government Department of Health and Ageing
Better Clinical Training for Tasmanian Students - $4.5 Million
Up to an additional 250 medical, nursing and allied health students are expected to be trained in Tasmania each year by 2013 following a $4.5 million commitment for new clinical training infrastructure across the state.
Minister for Ageing Justine Elliot and Member for Lyons Dick Adams today toured the Deloraine Hospital which will receive funding to provide students with access to virtual training centres, additional training rooms and accommodation for students in clinical training.
Minister Elliot said: “We believe hard working Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“We are increasing the numbers of doctors and nurses and improving training for doctors, nurses and allied health professionals.
“This initiative is one way we are working hard to provide more doctors and nurses. It will help support our additional 1200 GP training places and 1,100 nurses,” Minister Elliot said.
The $4.5 million is being provided through the Gillard Government’s $90 million Innovative Clinical Teaching and Training Grants (ICTTG) program. The program is designed to use innovative models to increase the number of health professionals receiving clinical training.
More than 400 applications for funding were received with total funding requested in excess of $900 million.
Mr Adams said: “A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for Australian families.
“This initiative will allow an extra 128 students to be housed in regional areas each year while they are training, helping to recruit and retain doctors and nurses in areas that we need them most.
“The Gillard Government is determined to deliver better health care and today’s announcement is great news for patients, families and students in Tasmania,” Mr Adams said.
Deloraine Hospital will become one of five new Rural Interprofessional Clinical Education and Training Centres (RICETCs) to deliver the training across regional Tasmania. The four others to be developed are Queenstown, Smithton, St Helens and Oatlands.
Souce: Australian Government Department of Health and Ageing
Minister for Ageing Justine Elliot and Member for Lyons Dick Adams today toured the Deloraine Hospital which will receive funding to provide students with access to virtual training centres, additional training rooms and accommodation for students in clinical training.
Minister Elliot said: “We believe hard working Australians deserve better. Better health services and better aged care services and that is why we are getting on with the job of reforming our health, hospitals and aged care system.
“We are increasing the numbers of doctors and nurses and improving training for doctors, nurses and allied health professionals.
“This initiative is one way we are working hard to provide more doctors and nurses. It will help support our additional 1200 GP training places and 1,100 nurses,” Minister Elliot said.
The $4.5 million is being provided through the Gillard Government’s $90 million Innovative Clinical Teaching and Training Grants (ICTTG) program. The program is designed to use innovative models to increase the number of health professionals receiving clinical training.
More than 400 applications for funding were received with total funding requested in excess of $900 million.
Mr Adams said: “A strong economy and decisive action by the Government during the global financial crisis has enabled these important investments to be made, providing a fairer share and more support for Australian families.
“This initiative will allow an extra 128 students to be housed in regional areas each year while they are training, helping to recruit and retain doctors and nurses in areas that we need them most.
“The Gillard Government is determined to deliver better health care and today’s announcement is great news for patients, families and students in Tasmania,” Mr Adams said.
Deloraine Hospital will become one of five new Rural Interprofessional Clinical Education and Training Centres (RICETCs) to deliver the training across regional Tasmania. The four others to be developed are Queenstown, Smithton, St Helens and Oatlands.
Souce: Australian Government Department of Health and Ageing
FEMA Prepares For Landfall Of Hurricane Alex
With Hurricane Alex expected to make landfall early Thursday morning, the Department of Homeland Security's Federal Emergency Management Agency (FEMA) is continuing to coordinate the federal response and support of the state of Texas in preparing for the storm. Alex is the first hurricane of the 2010 Atlantic hurricane season.
Yesterday, President Barack Obama issued an emergency disaster declaration for Texas that enables FEMA to identify, mobilize and provide equipment and resources necessary to alleviate the impacts of the emergency. FEMA continues to closely monitor Hurricane Alex and remains in close contact with state and local officials in Texas, as well as all hurricane-prone states to ensure they have the resources they need should a storm strike.
"As Hurricane Alex moves closer to south Texas, every resident living in the area should be taking the steps they need to prepare," said FEMA Administrator Craig Fugate. "It's critical that people remember to listen to their local and state officials. FEMA's first priority, as we continue to line up resources on the ground, is to support our state and local partners in their efforts to keep families and communities safe."
In anticipation of a possible landfall in Mexico that will impact counties in south Texas, in the desire to work proactively and aggressively to prepare for the storm, FEMA has coordinated the following: * Federal Coordinating Officer Brad Harris has been designated to coordinate the federal response in the region. He, along with members of one of FEMA's Incident Management Assistance Teams (IMAT), along with additional FEMA personnel, are on the ground working with state officials as they prepare for the impact of the hurricane. FEMA has also assigned a liaison officer for the Texas Department of Emergency Management.
* FEMA has staged commodities at a facility outside San Antonio in readiness to provide support for the response. This includes more than 1.1 million meals, more than 400,000 liters of water, more than 41,000 tarps and more than 100 generators, as well as other commodities such as cots, blankets and personal kits.
* U.S. Northern Command has activated a U.S. Army North Defense Coordinating Office (DCO) and Defense Coordinating Element (DCE) in support of operations, to provide assessment and coordination as required. DCOs and DCEs work very closely with federal, state, tribal and local officials to determine what unique Department of Defense capabilities can assist in mitigating the effects of a natural disaster.
* The American Red Cross has deployed 17 Emergency Response Vehicles (feeding trucks) to south Texas, and has also sent additional volunteers to the area, along with 2000 cots, blankets and hygiene kits to support sheltering efforts in the area. The Red Cross is prepared to support 20 post landfall shelters in South Texas and kitchen equipment is also being brought into the area.
FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror. For more information on FEMA's activities, visit www.FEMA.gov.
FEMA is not the whole team - FEMA is part of the emergency management team. That team includes federal partners, state, tribal and local officials, the private sector, non-profits and faith-based groups, and most importantly - the general public.
Individual and community preparedness is the responsibility of everyone. Individuals, families and businesses should prepare emergency supply kits and develop family emergency plans. Our team can only be as prepared as the public, which is why it is important that people living in hurricane-prone areas take steps to prepare and protect their family. Emergency preparedness information for individuals and businesses is available online at www.Ready.gov.
Source: FEMA
Yesterday, President Barack Obama issued an emergency disaster declaration for Texas that enables FEMA to identify, mobilize and provide equipment and resources necessary to alleviate the impacts of the emergency. FEMA continues to closely monitor Hurricane Alex and remains in close contact with state and local officials in Texas, as well as all hurricane-prone states to ensure they have the resources they need should a storm strike.
"As Hurricane Alex moves closer to south Texas, every resident living in the area should be taking the steps they need to prepare," said FEMA Administrator Craig Fugate. "It's critical that people remember to listen to their local and state officials. FEMA's first priority, as we continue to line up resources on the ground, is to support our state and local partners in their efforts to keep families and communities safe."
In anticipation of a possible landfall in Mexico that will impact counties in south Texas, in the desire to work proactively and aggressively to prepare for the storm, FEMA has coordinated the following: * Federal Coordinating Officer Brad Harris has been designated to coordinate the federal response in the region. He, along with members of one of FEMA's Incident Management Assistance Teams (IMAT), along with additional FEMA personnel, are on the ground working with state officials as they prepare for the impact of the hurricane. FEMA has also assigned a liaison officer for the Texas Department of Emergency Management.
* FEMA has staged commodities at a facility outside San Antonio in readiness to provide support for the response. This includes more than 1.1 million meals, more than 400,000 liters of water, more than 41,000 tarps and more than 100 generators, as well as other commodities such as cots, blankets and personal kits.
* U.S. Northern Command has activated a U.S. Army North Defense Coordinating Office (DCO) and Defense Coordinating Element (DCE) in support of operations, to provide assessment and coordination as required. DCOs and DCEs work very closely with federal, state, tribal and local officials to determine what unique Department of Defense capabilities can assist in mitigating the effects of a natural disaster.
* The American Red Cross has deployed 17 Emergency Response Vehicles (feeding trucks) to south Texas, and has also sent additional volunteers to the area, along with 2000 cots, blankets and hygiene kits to support sheltering efforts in the area. The Red Cross is prepared to support 20 post landfall shelters in South Texas and kitchen equipment is also being brought into the area.
FEMA coordinates the federal government's role in preparing for, preventing, mitigating the effects of, responding to, and recovering from all domestic disasters, whether natural or man-made, including acts of terror. For more information on FEMA's activities, visit www.FEMA.gov.
FEMA is not the whole team - FEMA is part of the emergency management team. That team includes federal partners, state, tribal and local officials, the private sector, non-profits and faith-based groups, and most importantly - the general public.
Individual and community preparedness is the responsibility of everyone. Individuals, families and businesses should prepare emergency supply kits and develop family emergency plans. Our team can only be as prepared as the public, which is why it is important that people living in hurricane-prone areas take steps to prepare and protect their family. Emergency preparedness information for individuals and businesses is available online at www.Ready.gov.
Source: FEMA
Department of Health and Ageing Ministerial and departmental media releases
Better Clinical Training for Tasmanian Students - $4.5 Million
Up to an additional 250 medical, nursing and allied health students are expected to be trained in Tasmania each year by 2013 following a $4.5 million commitment for new clinical training infrastructure across the state.
6 July 2010
New $1.57 million Cooma dementia day-care and HACC centre
Services for older residents and people with a disability of Cooma and surrounds have rece.
6 July 2010
Reforms Means Better Health Services for Older Residents of Devonport
Devonport seniors today joined Minister for Ageing Justine Elliot and Member for Braddon S.
6 July 2010
More Aged Care Beds for North Western Tasmania
Support from the Australian Government’s Zero Real Interest Loans initiative has helped deliver more aged care services in Deloraine.
Up to an additional 250 medical, nursing and allied health students are expected to be trained in Tasmania each year by 2013 following a $4.5 million commitment for new clinical training infrastructure across the state.
6 July 2010
New $1.57 million Cooma dementia day-care and HACC centre
Services for older residents and people with a disability of Cooma and surrounds have rece.
6 July 2010
Reforms Means Better Health Services for Older Residents of Devonport
Devonport seniors today joined Minister for Ageing Justine Elliot and Member for Braddon S.
6 July 2010
More Aged Care Beds for North Western Tasmania
Support from the Australian Government’s Zero Real Interest Loans initiative has helped deliver more aged care services in Deloraine.
20100705
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 6
Conclusions
For the majority of interventions, only sparse data are available, precluding firm conclusions for any single approach or for the optimal overall management of this condition. The paucity of evidence related to early versus delayed surgery is of particular concern, as patients and providers must decide whether to attempt initial nonoperative management or proceed immediately with surgical repair. The majority of the data is derived from studies of low methodological quality or from study designs associated with higher risk of bias
(e.g., observational and before-and-after studies). Overall, the evidence shows that all interventions result in substantial improvements; however, few differences of clinical importance are evident when comparisons between interventions are available. Complication rates were generally low and the majority of complications were not deemed to be clinically important; therefore, the benefit of receiving treatment for rotator cuff tears appears to outweigh the risk of associated harms. Future research is needed to determine the relative effectiveness of rotator cuff treatment options.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 5
Future Research
Recommendations for further research:
- Primary evidence is needed, comparing the effectiveness of early versus delayed surgery, nonoperative versus operative interventions, and among the nonoperative treatment options. Future research examining the comparative effectiveness of open, mini-open, or arthroscopic approaches is also a priority, as arthroscopic procedures are more costly and technically difficult.
- All future studies should employ a comparison or control group and should ensure comparability of treatment groups, optimally through the use of randomization.
- Future research should seek to minimize bias by blinding outcome assessors, using validated and standardized outcome assessment instruments, and ensuring adequate allocation concealment (where applicable) and the appropriate handling and reporting of missing data.
- Studies examining the long-term effectiveness of treatments over the course of several years are needed; at the very least, studies should follow patients for a minimum of 12 months.
- To avoid numerous studies on disparate interventions, the interventions and comparisons chosen for study should be guided by consensus regarding the most promising and/or controversial interventions.
- To ensure consistency and comparability across future studies, consensus is needed on outcomes that are important to both clinicians and patients. Moreover, consensus on minimal clinically important differences is needed to guide study design and interpretation of results.
- To permit the appropriate interpretation of results, future research needs to be reported in a consistent and comprehensive manner.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 4
Results
Description of Included Studies
The search strategy identified 5,677 citations; 137 unique studies met the eligibility criteria and were included in the review. The studies included 27 trials, 39 cohort studies, and 71 uncontrolled studies. The number of participants in the studies ranged from 12 to 224 (median=55 [IQR: 33 to 93]). The mean age of study participants ranged from 41.2 to 80 years.
Methodological Quality of Included Studies
All the randomized controlled trials and controlled clinical trials were considered to have a high risk of bias. The most common sources of potential bias were inadequate blinding, inadequate allocation concealment, and incomplete outcome data. The methodological quality of the cohort studies was moderate, with a median score of 5 stars on a possible score of 8 stars (IQR: 4 to 6). Common weaknesses in the design of the studies included lack of independent blind outcome assessment and failure to control adequately for potential confounding factors. Uncontrolled studies generally had moderate quality, with consecutive enrollment, adequate followup, and standardized outcome assessment being reported in 63 percent, 77 percent, and 44 percent of studies, respectively. Across all studies, a source of funding was rarely reported (n=49, 36 percent).
Results of Included Studies
The results of the included studies are presented by the key question(s) they address. A table with the summary of findings for nonoperative and operative interventions is presented below.
Key Question 1: Early versus late surgical repair. One study compared early surgical repair versus late surgical repair after failed nonoperative treatment. Patients receiving early surgery had superior function compared with the delayed surgical group; however, the level of significance was not reported.
Key Question 2: Comparative effectiveness of operative interventions and postoperative rehabilitation. A total of 113 studies examined the effectiveness of operative interventions, while 11 studies evaluated postoperative rehabilitation protocols following surgery. A median of 55 patients (IQR: 34 to 95) with a median age of 58.6 years (IQR: 55.5 to 61.7) were included in the operative studies. Males comprised an average of 64.6 percent of study participants. For postoperative rehabilitation, studies included a median of 61 participants (IQR: 36 to 79.5) with a median age of 58.0 years (IQR: 56.3 to 60.8). Males comprised an average of 58.9 percent of study participants.
Studies assessing operative treatments were categorized as focusing on an operative approach (e.g., open, mini-open, arthroscopic, and debridement), technique (i.e., suture or anchor type or configuration) or augmentation for RC repair. The majority of surgical studies (32 comparative studies and 58 uncontrolled studies) evaluated operative approaches. The comparative studies provided moderate evidence indicating no statistical or clinically important differences in function between open and mini-open repairs; however, there was some evidence suggesting an earlier return to work by approximately 1 month for mini-open repairs. Similarly, there was moderate evidence demonstrating no difference in function between mini-open and arthroscopic repair and arthroscopic repair with and without acromioplasty. There was moderate evidence for greater improvement in function for open repairs compared with arthroscopic debridement. The strength of evidence was low for the remaining comparisons and outcomes examined in the studies, precluding any conclusions regarding their comparative effectiveness. The uncontrolled studies consistently reported functional improvement from preoperative to postoperative scores, regardless of the type of approach used (open, mini-open, or arthroscopic), the study design, the sample size of the study, or the type of outcome measure used.
Operative techniques were examined in 15 comparative studies. Six studies compared single-row versus double-row fixation of repairs, providing moderate evidence of no clinically significant difference in function and no difference in cuff integrity. There was moderate evidence for no difference in cuff integrity between mattress locking and simple stitch. The evidence was too limited to make conclusions about the other techniques.
Eight studies, including three comparative and five uncontrolled studies, assessed augmentations for operative repair. The three comparative studies were relatively small and no overall conclusions were possible. Although the five uncontrolled studies evaluated different types of augmentation, they all indicated improvement in functional score from baseline to final followup.
Of the 11 postoperative rehabilitation studies (10 comparative, 1 uncontrolled), 3 compared continuous passive motion with physical therapy versus physical therapy alone. These three studies provided moderate evidence of no clinically important or statistically significant difference in function, but some evidence for earlier return to work with continuous passive motion. Each of the remaining studies examined different rehabilitation protocols; therefore, the evidence was too limited to make any conclusions regarding their comparative effectiveness.
Key Question 3: Comparative effectiveness of nonoperative interventions. Nonoperative interventions were examined in three comparative and seven uncontrolled studies. The studies included a median of 42 patients (IQR: 25.3 to 73.3), with a median age of 61 years (IQR: 60.4 to 61.5). Males comprised an average of 50 percent of participants. Each of the comparative studies assessed different interventions, including: sodium hyaluraonate versus dexamethasone; rehabilitation versus no rehabilitation (not otherwise specified); and physical therapy, oral medications, and steroid injection versus physical therapy, oral medications, and no steroid injection. The limited evidence precludes conclusions of comparative effectiveness. The degree of improvement in functional outcome scores varied considerably across the uncontrolled studies.
Key Question 4: Comparative effectiveness of nonoperative versus operative interventions. Five studies compared nonoperative to operative treatments, with a median sample size of 103 (IQR: 40 to 108). The mean ages in the studies ranged from 46.8 to 64.8 years. Males represented 55 percent of study participants. The interventions varied across studies, but generally the nonoperative arms included components such as steroid injection, stretching, and strengthening and were compared with open repair or debridement. The evidence was too limited to make conclusions regarding the comparative effectiveness of the interventions.
Key Question 5: Complications. A total of 85 studies provided data on 34 different complications of nonoperative, operative, and postoperative rehabilitation interventions. Complications were poorly reported, with studies providing limited information on how complications were defined and assessed. In 21 studies, it was reported that no complications occurred during the course of the study. In general, the rates of complication were low and the majority of complications were not deemed to be clinically important or were reported in few studies.
Key Question 6: Prognostic factors. Overall, 72 of the 137 studies examined the impact of prognostic factors on patient outcomes. General conclusions are limited, due to the varied methodologies across studies, particularly the different outcomes for which prognostic factors were evaluated. There is some evidence that tear size, age, and extent of preoperative symptoms may modify outcomes; while, workers’ compensation board (WCB) status, sex, and duration of symptoms generally showed no significant impact.
The following table summarizes the findings of the studies and indicates the overall strength of the evidence on each topic examined.
Summary of strength of evidence for nonoperative and operative interventions for RC tears
See Summary of strength of evidence for nonoperative and operative interventions for RC tears
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 3
Methods
Literature Search
The following bibliographic databases were searched systematically for studies published between 1990 and 2009: Medline®, Embase, Evidence-Based Medicine Reviews – The Cochrane Library, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTDiscus with Full Text, Academic Search Elite, Health Source, Science Citation Index Expanded (via Web of Science®), Scopus®, BIOSIS Previews®, and PubMed. Additional searches of the Grey Literature were conducted in Conference Papers Index, Computer Retrieval of Information on Scientific Projects (CRISP), Scopus®, as well as government Web sites by the U.S. Food and Drug Administration and Health Canada. Databases that yielded included studies (Medline®, Embase, Central, and CINAHL®) were searched again in September 2009 to identify recently published studies. Hand searches were conducted to identify literature from symposia proceedings from the following scientific meetings: Arthroscopy Association of North America (2007-2009), American Academy of Orthopaedic Surgeons (2007-2009), American Physical Therapy Association (2006-2008), American Shoulder and Elbow Surgeons (2005-2008), American Society of Shoulder and Elbow Therapists (2004-2008), European Congress of Physical and Rehabilitation Medicine 2008, Congress of the European Society for Surgery of the Shoulder and the Elbow (2009), and the Mid-America Orthopaedic Association (2006-2008). Ongoing studies were identified by searching clinical trials registers and by contacting experts in the field. Reference lists of relevant reviews were searched to identify additional studies. No language restrictions were applied.
Study Selection
Two reviewers independently screened titles and abstracts using general inclusion criteria. The full text publication of all articles identified as “include” or “unclear” were retrieved for formal review. Each full-text article was assessed independently by two reviewers using detailed a priori inclusion criteria and a standardized form. Disagreements were resolved by consensus or by third-party adjudication.
Controlled and prospective uncontrolled studies were included in the review if they were published in 1990 or later, included a minimum of 11 participants, focused on adults with a partial or full-thickness tear that was confirmed by imaging or intraoperative findings, and examined any operative or nonoperative intervention or postoperative rehabilitation. In addition, studies were required to report on at least one outcome of interest (quality of life, function, time to return to work, cuff integrity, pain, range of motion, and/or strength) and have a minimum followup duration of 12 months for operative studies. For the review update, only controlled studies were included.
Quality Assessment and Rating of the Body of Evidence
Two reviewers independently assessed the methodological quality of included studies. The Cochrane Collaboration’s “risk of bias” tool was used to assess randomized controlled trials and controlled clinical trials. Observational analytic studies were assessed using modified cohort and case-control Newcastle-Ottawa Quality Assessment Scales. The methodological quality of uncontrolled studies was assessed using a quality checklist developed by the University of Alberta Evidence-based Practice Center; the checklist consisted of three items: consecutive enrollment, incomplete outcome data, and standardized/independent approach to outcome assessment. In addition, the source of funding was recorded for all studies.
The body of evidence was rated by one reviewer using the EPC GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The strength of evidence was assessed for four key outcomes considered by the clinical investigators to be most clinically relevant: health-related quality of life, functional outcomes, time to return to work, and cuff integrity. The following four major domains were assessed: risk of bias (low, medium, high), consistency (no inconsistency, inconsistency present, unknown, or not applicable), directness (direct, indirect), and precision (precise, imprecise).
Data Extraction
Data were extracted by one reviewer using a standardized form and verified for accuracy and completeness by a second reviewer. Extracted data included study characteristics, inclusion/exclusion criteria, participant characteristics, interventions, and outcomes. Reviewers resolved discrepancies by consensus or in consultation with a third party.
Data Analysis
Evidence tables and qualitative descriptions of results were presented for all included studies. Comparative studies were considered appropriate to combine in a meta-analysis if the study design, study population, interventions being compared, and outcomes were deemed sufficiently similar. Results were combined using random effects models. Statistical heterogeneity was quantified using the I-squared (I2) statistic. Graphs were created to display the preoperative and postoperative scores of uncontrolled studies, cohort studies, and trials over the duration of the study followup period.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 2
Key Questions
The following key questions (KQ) were investigated for a population of adult patients with partial- and full-thickness RC tears:
1. Does early surgical repair compared to late surgical repair (i.e., nonoperative intervention followed by surgery) lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
2. What is the comparative effectiveness of operative approaches (e.g., open surgery, mini-open surgery, and arthroscopy) and postoperative rehabilitation on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
* Which operative approach should be used for different types of tears (e.g., partial-thickness or full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
3. What is the comparative effectiveness of nonoperative interventions on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength? Nonoperative interventions include, but are not limited to, exercise, manual therapy, cortisone injections, acupuncture, and treatments and modalities typically delivered by physical therapists, osteopaths, and chiropractors.
* Which nonoperative treatment approach should be used for different types of tears (e.g., partial-thickness, full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
4. Does operative repair compared with nonoperative treatment lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
5. What are the associated risks, adverse effects, and potential harms of nonoperative and operative therapies?
6. Which demographic (e.g., age, gender, ethnicity, comorbidities, workers’ compensation claims) and clinical (e.g., size/severity of tear, duration of injury, fatty infiltration of muscle) prognostic factors predict better outcomes following nonoperative and operative treatment?
* Which (if any) demographic and clinical factors account for potential differences in surgical outcomes between patients who undergo early versus delayed surgical treatment?
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
The following key questions (KQ) were investigated for a population of adult patients with partial- and full-thickness RC tears:
1. Does early surgical repair compared to late surgical repair (i.e., nonoperative intervention followed by surgery) lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
2. What is the comparative effectiveness of operative approaches (e.g., open surgery, mini-open surgery, and arthroscopy) and postoperative rehabilitation on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
* Which operative approach should be used for different types of tears (e.g., partial-thickness or full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
3. What is the comparative effectiveness of nonoperative interventions on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength? Nonoperative interventions include, but are not limited to, exercise, manual therapy, cortisone injections, acupuncture, and treatments and modalities typically delivered by physical therapists, osteopaths, and chiropractors.
* Which nonoperative treatment approach should be used for different types of tears (e.g., partial-thickness, full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
4. Does operative repair compared with nonoperative treatment lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
5. What are the associated risks, adverse effects, and potential harms of nonoperative and operative therapies?
6. Which demographic (e.g., age, gender, ethnicity, comorbidities, workers’ compensation claims) and clinical (e.g., size/severity of tear, duration of injury, fatty infiltration of muscle) prognostic factors predict better outcomes following nonoperative and operative treatment?
* Which (if any) demographic and clinical factors account for potential differences in surgical outcomes between patients who undergo early versus delayed surgical treatment?
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Introduction
The rotator cuff (RC) is comprised of four muscle-tendon units, which stabilize the humeral head within the shoulder joint and aid in powering the movement of the upper extremity.1 RC tears refer to a partial or full discontinuation of one or more of the muscles or tendons and may occur as a result of traumatic injury or degeneration over a period of years. The incidence of RC tears is related to increasing age; 54 percent of patients over the age of 60 years have a partial or complete RC tear compared with only 4 percent of adults under 40 years of age.2 Although not a life-threatening condition, RC tears may cause significant pain, weakness, and limitation of motion.1
Both nonoperative and operative treatments are used in an attempt to relieve pain and restore movement and function of the shoulder.3 The majority of patients first undergo 6 weeks to 3 months of nonoperative treatment, which may consist of any combination of pain management (medications and injections), rest from activity, passive and active exercise, and treatments with heat, cold or ultrasound. Failing nonoperative treatment, the cuff may be surgically repaired using an open, mini-open, or all-arthroscopic approach. A variety of postoperative rehabilitation programs are used to restore range of motion, muscle strength, and function following operative treatment.
Earlier operative treatment has been proposed to improve patient outcomes and result in an earlier return to work, and decreased costs;4,5 therefore, patients and clinicians face the difficult decision of when to forgo attempts at nonoperative treatment in favor of operative treatment. Moreover, the comparative effectiveness of the various nonoperative and operative treatment options for patients with RC tears remains uncertain.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
The rotator cuff (RC) is comprised of four muscle-tendon units, which stabilize the humeral head within the shoulder joint and aid in powering the movement of the upper extremity.1 RC tears refer to a partial or full discontinuation of one or more of the muscles or tendons and may occur as a result of traumatic injury or degeneration over a period of years. The incidence of RC tears is related to increasing age; 54 percent of patients over the age of 60 years have a partial or complete RC tear compared with only 4 percent of adults under 40 years of age.2 Although not a life-threatening condition, RC tears may cause significant pain, weakness, and limitation of motion.1
Both nonoperative and operative treatments are used in an attempt to relieve pain and restore movement and function of the shoulder.3 The majority of patients first undergo 6 weeks to 3 months of nonoperative treatment, which may consist of any combination of pain management (medications and injections), rest from activity, passive and active exercise, and treatments with heat, cold or ultrasound. Failing nonoperative treatment, the cuff may be surgically repaired using an open, mini-open, or all-arthroscopic approach. A variety of postoperative rehabilitation programs are used to restore range of motion, muscle strength, and function following operative treatment.
Earlier operative treatment has been proposed to improve patient outcomes and result in an earlier return to work, and decreased costs;4,5 therefore, patients and clinicians face the difficult decision of when to forgo attempts at nonoperative treatment in favor of operative treatment. Moreover, the comparative effectiveness of the various nonoperative and operative treatment options for patients with RC tears remains uncertain.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
Table of Contents
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Weight Loss: Slimming down with Lose Big
Fitness First joins the fight against obesity with its own exercise and nutrition programme
While weight-loss reality shows continue to be popular, many viewers often wonder if they would have the same success in dropping the kilograms and whether they could even try without some degree of safe supervision.
The good news, at least for some Bangkok residents, is that obese people or those unhappy with their health due to weight problems can now try a similar programme safely at some fitness clubs.
Inspired by the "Biggest Loser Asia" reality show, the new Lose Big programme is designed to support and motivate those with weight problems to shed kilos over 13 weeks.
At six branches of Fitness First across Bangkok, eight selected applicants will be provided with 50 hours guidance from two personal trainers. The trainers will advise on nutrition and provide firsthand supervise while also leading group activities, says Fitness First (Thailand) marketing manager, Orawan Kleawpatinon.
The fixed-price course costs less than the normal fees for a personal trainer, Orawan adds. And although the trainers are in charge of a team, they will customise the programme to fit each individual.
Takes committment
Orawan stresses that applicants must be committed to the programme fully, as they are required to attend group exercises at least four times a week for a class duration of a minimum of two hours.
Each branch of the fitness club will manage its schedule to suit the group of Lose Big applicants. While the classes for housewives or freelance workers can be held during the day, the schedule for office workers might be after work.
"We cannot guarantee the same weight-loss result," says Orawan, "as contestants in the show because there are many factors to take into account, as the applicants are not with us around the clock. However, Lose Big is an intensive programme where applicants can join group activities with friends who really understand each other. Determined applicants will make more progress than if they are working out alone."
"'The Biggest Loser' reality show demonstrates well that even the obese can achieve weight loss but it needs determination and there is no short cut."
Those not attending the gym can have fun learning about weight loss and weight control with the "Cut the Fat" game on Facebook.
In the game, everyone starts out weighing 200kg. They choose balanced food and activities to lose weight and achieve a high score.
nofollow
News Source: DAILY XPRESS
While weight-loss reality shows continue to be popular, many viewers often wonder if they would have the same success in dropping the kilograms and whether they could even try without some degree of safe supervision.
The good news, at least for some Bangkok residents, is that obese people or those unhappy with their health due to weight problems can now try a similar programme safely at some fitness clubs.
Inspired by the "Biggest Loser Asia" reality show, the new Lose Big programme is designed to support and motivate those with weight problems to shed kilos over 13 weeks.
At six branches of Fitness First across Bangkok, eight selected applicants will be provided with 50 hours guidance from two personal trainers. The trainers will advise on nutrition and provide firsthand supervise while also leading group activities, says Fitness First (Thailand) marketing manager, Orawan Kleawpatinon.
The fixed-price course costs less than the normal fees for a personal trainer, Orawan adds. And although the trainers are in charge of a team, they will customise the programme to fit each individual.
Takes committment
Orawan stresses that applicants must be committed to the programme fully, as they are required to attend group exercises at least four times a week for a class duration of a minimum of two hours.
Each branch of the fitness club will manage its schedule to suit the group of Lose Big applicants. While the classes for housewives or freelance workers can be held during the day, the schedule for office workers might be after work.
"We cannot guarantee the same weight-loss result," says Orawan, "as contestants in the show because there are many factors to take into account, as the applicants are not with us around the clock. However, Lose Big is an intensive programme where applicants can join group activities with friends who really understand each other. Determined applicants will make more progress than if they are working out alone."
"'The Biggest Loser' reality show demonstrates well that even the obese can achieve weight loss but it needs determination and there is no short cut."
Those not attending the gym can have fun learning about weight loss and weight control with the "Cut the Fat" game on Facebook.
In the game, everyone starts out weighing 200kg. They choose balanced food and activities to lose weight and achieve a high score.
nofollow
News Source: DAILY XPRESS
20100704
How much water should you drink each day?
Photo: i'd like to drink water with ice / Jung-You Choi / flickr.com
How much water should you drink each day?
A simple question with no easy answers. Studies have produced varying recommendations over the years, but in truth, your water needs depend on many factors, including your health, how active you are and where you live.
Though no single formula fits everyone, knowing more about your body's need for fluids will help you estimate how much water to drink each day.
Health benefits of water
Water is your body's principal chemical component, comprising, on average, 60 percent of your weight. Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.
Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions.
How much water do you need?
Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water.
A couple of approaches attempt to approximate water needs for the average, healthy adult living in a temperate climate.
Even apart from the above approaches, it is generally the case that if you drink enough fluid so that you rarely feel thirsty and produce between one and two liters of colorless or slightly yellow urine a day, your fluid intake is probably adequate.
Factors that influence water needs
You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you're pregnant or breast-feeding.
During long bouts of intense exercise, it's best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be life-threatening. Fluid also should be replaced after exercise. Drinking 16 ounces of fluid per pound of body weight lost during exercise is recommended.
Beyond the tap: Other sources of water
Although it's a great idea to keep water within reach at all times, you don't need to rely only on what you drink to satisfy your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake, while the remaining 80 percent comes from water and beverages of all kinds.
For example, many fruits and vegetables such as watermelon and cucumbers are nearly 100 percent water by weight. Beverages such as milk and juice are also comprised mostly of water. Even beer, wine and caffeinated beverages such as coffee, tea or soda can contribute, but these should not be a major portion of your daily total fluid intake. Water is one of your best bets because it's calorie-free, inexpensive and readily available.
Dehydration and complications
Failing to take in more water than your body uses can lead to dehydration. Even mild dehydration as little as a 1 percent to 2 percent loss of your body weight can sap your energy and make you tired. Common causes of dehydration include strenuous activity, excessive sweating, vomiting and diarrhea.
Signs and symptoms of dehydration include:
Mild dehydration rarely results in complications as long as the fluid is replaced quickly but more-severe cases can be life-threatening, especially in the very young and the elderly. In extreme situations, fluids or electrolytes may need to be delivered intravenously.
Staying safely hydrated
It's generally not a good idea to use thirst alone as a guide for when to drink. By the time one becomes thirsty, it is possible to already be slightly dehydrated. Further, be aware that as you get older your body is less able to sense dehydration and send your brain signals of thirst. Excessive thirst and increased urination can be signs of a more serious medical condition. Talk to your doctor if you experience either.
To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. Nearly every healthy adult can consider the following:
If you drink water from a bottle, thoroughly clean or replace the bottle often. Refill only bottles that are designed for reuse.
Though uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in a condition called hyponatremia (low sodium levels in the blood). Endurance athletes such as marathon runners who drink large amounts of water are at higher risk of hyponatremia.
Do you want any water? :)
Water on the Brain: it's all in the mind
True or False?
1. People should drink at least eight glasses of water a day
2. We use only 10% of our brains
3. Reading in dim light ruins your eyesight
They're all false or unproved. And tea and coffee are fine for hydration.
1. People should drink at least eight glasses of water a day
2. We use only 10% of our brains
3. Reading in dim light ruins your eyesight
They're all false or unproved. And tea and coffee are fine for hydration.
Swine Flu: Advice for mothers and others who take care of babies
If a nursing mother or her baby comes down with swine flu, she will be naturally very, very concerned.
The advice below from the NHS (National Health Service) of the UK provide primary guidelines. However, it is imperative that the mother must cotact her doctor at once if there is the slightest sign of her, or her baby, catching swine flu.
Will breastfeeding protect my baby from swine flu?
Breastfeeding does not appear to reduce the likelihood of babies getting cold or flu. However, it should help reduce the risk of associated complications, such as pneumonia and chest infections. Back to top
What should I do if my baby gets flu?
Your doctor may recommend antiviral medication for your baby, and will advise you on the dose and how to give it to them. If you are breastfeeding, you should continue this: breast milk is easily digestible and your baby will find it comforting.
Should I stop breastfeeding if I need to take antiviral drugs?
Women who are breastfeeding can continue to do so while receiving antiviral treatment. If a mother is ill, she should continue breastfeeding and increase feeding frequency. If she becomes too ill to feed, expressing milk may still be possible. Antiviral drugs are excreted into breast milk in very small (insignificant) amounts, which are unlikely to have any side effects on your baby.
Can babies under the age of one take antivirals?
Tamiflu and Relenza are not licensed for use in babies under one. However, after evaluating all the available evidence, the European Medicines Agency has advised that babies may be treated with Tamiflu, and given the following advice:
- The appropriate dosage to treat children aged under one is 2-3mg/kg twice daily for five days.
- It is preferable to treat children under medical supervision.
- The capsule content can be diluted to prepare the correct dose.
Can my baby take Tamiflu as a preventative measure?
Whether babies without flu symptoms can take Tamiflu should be decided by an expert in the care of young children. The recommended dose for prevention in the under-ones is 2mg/kg once a day for 10 days (but must not exceed 10 days).
The best way to protect babies aged under one is by using tissues and throwing them away, washing your hands and the baby's hands thoroughly, and frequently and thoroughly cleaning surfaces, toys and equipment.
My salsa dancing class
Windy from The Nation say "Everytime I see someone dancing on the screen it makes me feel so alive. What with the swirling of the body, the beautiful movements of men and women entertwined in the music and rhythm that makes them and me both breathless.
So I decided after years and years of avoiding what I like, I decided to give in to temptations and actually started dancing! I enrolled in a salsa class and thanks to god, I found a good teacher this time who was polite and spoke slowly so that
I understand every step.
What I love about dancing is not so much the fact that you get to lose yourself, but I realised that dancing is about gaining control than losing it. First of all in salsa the man controls and leads the woman while the woman follows. That's not what I like, but what I learned is that if the man controls, and we don't like the way they lead us, we have the power to not follow. How cool is that? And my teacher always say "It's the man's fault" if they can't lead you the right way. So how cool is that?
So that is my update on my salsa class, I think it's the best thing that ever happened to me this year for now!"
So I decided after years and years of avoiding what I like, I decided to give in to temptations and actually started dancing! I enrolled in a salsa class and thanks to god, I found a good teacher this time who was polite and spoke slowly so that
I understand every step.
What I love about dancing is not so much the fact that you get to lose yourself, but I realised that dancing is about gaining control than losing it. First of all in salsa the man controls and leads the woman while the woman follows. That's not what I like, but what I learned is that if the man controls, and we don't like the way they lead us, we have the power to not follow. How cool is that? And my teacher always say "It's the man's fault" if they can't lead you the right way. So how cool is that?
So that is my update on my salsa class, I think it's the best thing that ever happened to me this year for now!"
The Wonderful No Starving Diet Control Program: Ive Just Lost 5 kgs in 12 Days!
Piset told she "Lost 5 kgs in 12 Days" I thing you can reading success story for weight control from her Thai is story
"This morning, I weighted at 91.6 kgs, a full 5 kgs reduction from 96.6 that I weighted in the pre-session weighted in February 5, 2010. I have accomplished all this eating 3 meals of meat, ham, sausage, eggs, non-fat chese, and non-fat milk, plus 2-3 protein snacks between each meal. There was never any moment of starvation. Never one moment of fears of the weight returning, as the trend had gone down steadily everyday as the coach had assured me from the beginning. My program will continue from 45 days of intensive control and a life long nutrition plan under advice from the coach.
I you used to be 80-85 kgs and found yourself gaining weight so rapidly, you would be glad to shed away those extra "loads!"
In 1994, at the age of 48, I was chosen the "champ" at a 400 members activity, being the heaviest participant in that event, weighting in at 86 kgs. Then, under advise, I quickly shed 8 kgs to 78 kgs in 4 months and returned my blood pressure to 120-80.
That time, I had quietly letting the weight return to test whether my rapid weight losing might be due to development of some kind of cancers. Then, it returned to the level of 80-82. That's where the weight had remained until last year, when it graually but consistently jumped up to 98 kgs. Under my own food control and exercise program, I was able to reduced it to 93 at times, followed by variation between 95-97 kgs. That's when a friend of mine convinced me to try out her program.
The coach used to weight nearly 60 kgs, at 42, a professionally very active teacher, failed to convince me at first. Then, after a month or so, I could see her becoming clearly slimmer and much healthier. So, I consented.
As, usual, no program or product name would be mentioned here to keep business and commercials out! Sorry about that.
My goal is 75-80 kgs after the 45 days program!
New Addition
The second stage of the weight reduction program might be a little slower:
As of this morning, March 12, 5 weeks from the beginning and 24 days since this blog was put up, I weighted in at 88.4 kg, that is 3.2 kg reduced from 24 days ago and 8.2 kg reduced from the beginning.
I will keep going until I can see 7 in the first digit!"
"This morning, I weighted at 91.6 kgs, a full 5 kgs reduction from 96.6 that I weighted in the pre-session weighted in February 5, 2010. I have accomplished all this eating 3 meals of meat, ham, sausage, eggs, non-fat chese, and non-fat milk, plus 2-3 protein snacks between each meal. There was never any moment of starvation. Never one moment of fears of the weight returning, as the trend had gone down steadily everyday as the coach had assured me from the beginning. My program will continue from 45 days of intensive control and a life long nutrition plan under advice from the coach.
I you used to be 80-85 kgs and found yourself gaining weight so rapidly, you would be glad to shed away those extra "loads!"
In 1994, at the age of 48, I was chosen the "champ" at a 400 members activity, being the heaviest participant in that event, weighting in at 86 kgs. Then, under advise, I quickly shed 8 kgs to 78 kgs in 4 months and returned my blood pressure to 120-80.
That time, I had quietly letting the weight return to test whether my rapid weight losing might be due to development of some kind of cancers. Then, it returned to the level of 80-82. That's where the weight had remained until last year, when it graually but consistently jumped up to 98 kgs. Under my own food control and exercise program, I was able to reduced it to 93 at times, followed by variation between 95-97 kgs. That's when a friend of mine convinced me to try out her program.
The coach used to weight nearly 60 kgs, at 42, a professionally very active teacher, failed to convince me at first. Then, after a month or so, I could see her becoming clearly slimmer and much healthier. So, I consented.
As, usual, no program or product name would be mentioned here to keep business and commercials out! Sorry about that.
My goal is 75-80 kgs after the 45 days program!
New Addition
The second stage of the weight reduction program might be a little slower:
As of this morning, March 12, 5 weeks from the beginning and 24 days since this blog was put up, I weighted in at 88.4 kg, that is 3.2 kg reduced from 24 days ago and 8.2 kg reduced from the beginning.
I will keep going until I can see 7 in the first digit!"
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