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Looking at digestive health needs

MADISON, Wis. (WMTV) — While half of us say digestive health is among our top four health concerns, most of us fall short of our daily fiber needs.

This may lead to tummy troubles that hamper our summer fun. What we put in our grocery cart can help reduce constipation, diarrhea or other digestive health. This simple grocery cart makeover can support digestive health all summer long, whether you are heading on vacation, to the beach or just plan to chill with friends on the patio.

when it comes to nutrients for digestive health, your grocery cart should include both probiotics and prebiotic fiber. Probiotics are the healthy bacteria that live in the gut. Prebiotic fiber is the food that fuels the healthy bacteria, helping maintain a healthy digestive balance. The average adult only consumes 15 grams of fiber daily, short of the 25 grams (women) and 38 grams (men) of daily fiber recommended by the Institute of Medicine.

During grilling season, you may want to focus on meat, poultry or seafood. Adding vegetables such as asparagus, peppers, zucchini and mushrooms to the grill can increase fiber intake. A cart filled with probiotics includes products such as kombucha, kefir and fresh sauerkraut.

The best way to maintain digestive health while traveling this summer
Keeping bathroom routines consistent when away from home is essential. Not listening to your body either because you don’t want to stop the fun or you just don’t like the facilities may lead to uncomfortable constipation. Eating new foods while on vacation may upset digestive balance.

Supporting your gut’s beneficial bacteria before and during a trip with probiotics may help support your intestinal health. Pack high-fiber snacks such as pears, nuts and whole-grain crackers.

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An unlikely winner in the long-running bull market: Health insurers

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Young doctors

The bull market, which is about to become the longest running in recent history, has produced healthy returns for investors. The SP 500 is up well over 300 percent over the last nine years, but health insurance stocks have logged even more impressive gains.

The SP Managed Care sector, made up of the largest insurers, has gained more than 1,100 percent during the market’s bull run. That’s more than twice as much as the gains in the biotech sector. The iShares Nasdaq Biotech Index ETF is up about 500 percent during the period.

Yet, in March 2009, when the stock market hit bottom, health insurance stocks hardly seemed like a sure bet. In the lead up to the passage of the Affordable Care Act, the threat of a single-payer plan and new Obamacare regulations weighed on insurers.

“The perception was that the Affordable Care Act was going to be bad for health insurers,” explained Wells Fargo analyst Peter Costa, “and insurance stocks were really very broken.”

“In April of 2009 they were at the deepest discount to the market that they’d been since the 1990s … (trading) at a 50 percent discount to the S P 500 forward price earnings multiple,” said Matt Borsch, health-care analyst at BMO Capital.

Nine years later, two of the biggest health-care winners have seen large growth in part because of Obamacare.

The Medicaid boom

Medicaid expansion under the ACA has resulted in nearly 15 million people gaining coverage under the government health program for the poor and disabled. At the same time, over the last decade, states have increasingly turned to insurers to manage their Medicaid programs.

Medicaid insurer WellCare Health Plan’s shares have gained more than 4,000 percent since March 2009, while its membership has nearly doubled to 4.3 million, and its annual revenues have nearly tripled from $6.9 billion to an estimated $18.7 billion this year.

WellCare shares continue to outperform. The stock is up 46 percent year to date, trading just below analysts’ mean price target of $296 per share. The high analyst target of $325 per share would imply another 10 percent gain over the next 12 months.

Rival Centene’s shares have gained nearly 1,800 percent over the last nine years. Its membership has grown through a series of acquisitions from 1.4 million in 2009 to 12.3 million in its most recent quarter, and annual revenues have ballooned from $3.4 billion to an estimated $59.8 billion this year.

Centene is up 42 percent year to date, trading near record highs; the high analyst price target of $160 on the stock implies another 11 percent gain over the next 12 months.

At the same time that the Medicaid business has expanded, the Medicare has seen big growth over the last decade as more baby boomers have aged into the government health plan for seniors.

For the major health insurers that has meant that their government business has grown faster than the commercial employer and individual insurance plan business. Government plans now account for more than 50 percent of the industry’s insurance revenues.

More diverse businesses

Government plans have been one of the growth drivers for the nation’s largest insurer, UnitedHealth Group, which is up 19 percent year to date, and has seen shares gain nearly 1400 percent over the last nine years.

United’s health plan membership has grown from 32 million to nearly 50 million over the last nine years; its Medicaid and Medicare membership has more than doubled, during the period.

But new business segments outside of health insurance have a played big role in growing the health-care giant’s annual revenues from $87 billion in 2009 to an estimated $225 billion this year. The health services and products under the Optum division have become a key driver of top-line growth.

“They diversified and started gaining non-insurance businesses,” said Deep Banerjee, health-care credit analyst at Standard Poor’s.

United’s Optum unit now accounts for 20 percent of revenues, and includes data analytic services, pharmacy benefit management, physician practices and outpatient surgical centers.

Banerjee notes that revenues from the services businesses are not subject to the ACA regulatory caps, which require insurers to spend at least 80 percent of premium revenues on medical care. That makes them more profitable.

“As the non-regulated cash flows have increased (for insurers) … the investment community has taken a more of a liking to them,” said Banerjee.

United’s success has been part of the impetus behind the increasing number of vertical health insurer deals. More health plans have acquired health-care providers and services in order to have greater control over medical costs in their health plans.

Pharmacy benefit giant CVS Health’s $69 billion deal for Aetna and Cigna’s $54 billion deal to buy pharmacy benefit firm Express Scripts are both predicated on trying to driving cost efficiencies by having greater control over a wider range of members’ care.

For both mergers, diversification of revenues could serve as a bulwark against potential new regulation of pharmacy benefit rules as the Trump administration has pledged new reforms for curbing high drug costs.

New threats of disruption

Beyond government regulation, investors have been focused on the potential threat of health care disruption from tech giants.

This week, Google parent Alphabet took a $375 million stake in Oscar Health to help the 6-year-old health insurer expand its current Obamacare exchange business and develop commercial Medicare Advantage plans by 2020.

This spring, Amazon made a very public entry into health care with the acquisition of online pharmacy Pillpack and its venture to develop a better employee health benefit system with J.P. Morgan and Berkshire Hathaway.

Wells Fargo analyst Peter Costa says right now insurers are well positioned to weather the threat from the upstarts, noting that industry has invested heavily in analytics and data systems.

“I would say they have the technological savvy and they already have the health-care knowledge, whereas companies coming in from the tech side … don’t have the knowledge from the health-care side,” Costa explained.

On the political front, one of the biggest threats over the last 18 months has been the Republican push to cut funding for Medicaid. But the efforts sputtered along with the attempted repeal of Obamacare.

Meantime, Democrats have revived the health reform debate over single-payer Medicare For All, nine years after investors were rattled by the prospect of single-payer health care under the ACA.

If either side gains traction, analysts say the major insurers have positioned themselves to adjust more readily to the shifting landscape over the last decade.

“Even if it’s Medicare for all, it would probably be Medicare Advantage for All,” with the government funding private Medicare plans, said Banerjee.

“Health care today is a public-private partnership … it’s very hard to see a system without a private player meaningfully involved,” he said.

Bertha Coombs

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Prolonged sitting: Short bouts of activity reduce health risks

A newly published meta-analysis has discovered that even short breaks from prolonged sitting can reduce some of the adverse metabolic effects associated with it. Short stints of low-level activity can make a real difference.

Sitting for long periods is unhealthful, but a small change in behavior might help.

In Western society, sitting down for long periods of time is now the norm; at the office, watching television, playing video games, our lives are easily filled with physical inactivity.

The negative health consequences of sedentary living are also growing clearer.

As Dr. Meredith Peddie, co-author of the new study, explains, “Most of us spend about 75 percent of our day sitting or being sedentary, and this behavior has been linked to increased rates of diabetes, cardiovascular disease, some cancers, and overall mortality.”

The exact reasons why prolonged sitting is so unhealthful are not fully known, but certain metabolic factors are thought to play a part.

For instance, long periods with little exertion reduce insulin sensitivity and glucose tolerance, while increasing levels of triglycerides — the main constituent of body fat — in the blood.

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Reducing the impact of sitting

Dr. Peddie led a group of researchers at the University of Otago in New Zealand; they were joined in their efforts by scientists from the University of Prince Edward Island and the University of Guelph, both in Canada.

They set out to explore whether small changes in behavior may be effective at minimizing some of the negative acute metabolic and vascular effects of long periods of sedentary behavior.

To investigate, the team assessed 44 existing studies that focused on interrupting prolonged sitting with various amounts and types of movement. Their findings were published recently in the journal Sports Medicine.

More specifically, they were interested in the effect of up to 24 hours of prolonged sitting following a meal. They measured its influence on various factors, including glucose, insulin, and triglyceride levels, blood pressure, and vascular function.

They compared these effects with individuals whose sitting was interrupted with light to moderate activity.

They found that even light-intensity activity every 30 minutes had significant effects.

Physical activity of any intensity was shown to reduce concentrations of glucose and insulin in the blood up to 9 hours after the meal. Similarly, levels of fat in the blood were also reduced, but this only occurred 12–16 hours after activity began.

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A robust and positive effect

Dr. Peddie and colleagues were particularly surprised that the beneficial changes they saw were not affected by the intensity of the activity or the age or weight of each participant. Similarly, the type of meal eaten before the prolonged sitting did not influence the results, either.

We should all be finding ways to avoid sitting for long periods, and to increase the amount of movement we do throughout the entire day.”

Dr. Meredith Peddie

Much more research still needs to be done to understand how to mitigate the impact of prolonged sitting.

Next, the researchers hope to uncover more information about how the timing of breaks impacts the results. They would also like to know which activities are the most effective, and how long active sessions need to be.

However, the studies that the scientists analyzed did not record enough data on blood pressure and vascular measures. They hope that future studies might include more information about cardiovascular effects of sitting with or without short active breaks.

The take-home message, however, is simple: we all need to make an effort to move more.

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A Health Chip Is Part of a Broader Move by Apple Into Healthcare

It’s no secret that Apple (NASDAQ:AAPL) has designs on the healthcare market. At the device maker’s annual shareholder meeting earlier this year, Apple CEO Tim Cook signaled a broader interest in the field, saying that the company was in a “great position” to innovate because it wouldn’t be reliant on reimbursements from insurers or federal programs like Medicare and Medicaid. “The more and more time we spend on this,” Cook said, “the more excited I am that Apple can make a significant contribution here.”

Apple’s latest foray into the field may be its most ambitious yet. Apple’s Health Sensing hardware segment is looking to hire engineers to develop custom chips to process data from “health, wellness, and fitness sensors,” according to a job posting cited by CNBC. This could mark an even deeper move into healthcare by the iPhone maker.

Image source: Apple.

A chip off the old block

The job posting cited a need for “sensor ASIC [application-specific integrated circuit] architects to help develop ASICs for new sensors and sensing systems for future Apple products. We have openings for analog as well as digital ASIC architects.” An ASIC is a processor customized for a specific use or application.

The Apple Watch and iPhone already have a number of sensors, such as those to monitor heart rate and sleep quality, and the company has been working to develop others. Early last year, Apple was said to have a team of biomedical engineers working to create a noninvasive sensor designed to monitor blood sugar levels in those who have diabetes. Cook was reportedly wearing a next-generation watch prototype to monitor his own sugar levels, though a public version with those capabilities might still be years off. 

Developing a customized chip that better interacts with a variety of sensors could advance Apple’s push further into the health field.

A broad interest in heart health

Late last year, Apple showed the first indication of its growing healthcare ambitions when it introduced the Apple Watch Series 3. The new Watch debuted an improved heart rate monitor that provides wearers with more accurate heart measurements during workouts and can detect potentially life-threatening spikes in a user’s heart rate. 

Next, the company partnered with Stanford Hospital in a study to determine if the Apple Watch could accurately identify an irregular heart rhythm, which is often a precursor to a stroke. An earlier study sponsored by app maker Cardiogram showed the Apple Watch could detect atrial fibrillation — a potentially serious heart ailment — with 97% accuracy. 

Apple was also chosen as one of nine companies to participate in a pilot program with the U.S. Food and Drug Administration (FDA) to precertify companies creating software-based medical apps and devices. On the heels of that program, AliveCor’s KardiaBand electrocardiogram (EKG) reader became the first FDA-approved medical device accessory for the Apple Watch.

Image source: AliveCor.

Big tech’s interest in health is growing

Apple isn’t the only technology company expressing an interest in the healthcare field. Earlier this year, Amazon, Berkshire Hathaway, and JPMorgan Chase announced a collaboration with an initial focus of providing employees with more cost-effective healthcare options.

Google parent Alphabet recently announced a sizable investment in start-up insurer Oscar, adding $375 million to an earlier infusion of $165 million. Oscar’s goal is to rely heavily on data in an effort to make healthcare less expensive and more efficient. 

Apple is gradually expanding the health-related capabilities of its devices. With sales of smartphones leveling off, a move into healthcare could provide the company with another potentially lucrative opportunity.

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Always worried about your health? You may be dealing with health anxiety disorder

This condition can interfere with your life, but it’s highly treatable.

Image: © XiXinXing/Getty Images

You spend hours on the Internet researching health information. When you get a scratchy throat you automatically think cancer — not a cold. And even when medical tests come back showing that you’re healthy, it doesn’t make you feel better. In the back of your mind you still feel like something is wrong.

If this sounds like you or a loved one, it may be health anxiety.

Health anxiety is a condition that causes healthy people to worry that they are sick — even when they have no symptoms, or minor symptoms like a scratchy throat.

“People with health anxiety for the most part tend to fear severe illness, such as HIV, cancer, or dementia. They worry far less about strep throat, twisting their ankle, or getting a cold,” says Dr. Timothy Scarella, instructor in psychiatry at Harvard Medical School. This fear that they have a serious illness can interfere with their daily life. It might lead them to seek out unnecessary testing, to waste hours in the doctor’s office, and to spend days consumed by worry. But it’s not only their own health that people with health anxiety may focus on. “Some people also worry excessively about their children’s health,” he says.

Health anxiety is a relatively common condition, known to affect some 4% to 5% of people. But experts believe it may be underreported and that the percentage could be closer to 12% — or even twice that, says Dr. Scarella. Unlike other anxiety disorders that are more prevalent in women, health anxiety appears to affect men and women equally.

Not all health worries indicate health anxiety

Being concerned about your health is not the same as health anxiety. It’s normal to be worried about your health from time to time. You may wonder if your stomachache is a sign of a more serious condition. If you have had a severe illness in the past, you may be anxious about an upcoming imaging scan.

“There is a difference — at least medically speaking — between a person who has no symptoms or minimal symptoms and is frequently worried and anxious about being or getting sick and a person who is worried about concerning symptoms,” says Dr. Scarella. However, he notes that anxiety about real health conditions can also become problematic.

People with health anxiety often misinterpret normal or benign physical symptoms and attribute them to something more serious. For example, if they were to compress an arm while asleep, instead of rolling over and shaking off the numb feeling, they might worry they were having a stroke. Symptoms produced by anxiety — which can include muscle pain, chest pain, heart rate changes, headaches, and dizziness, among others — can heighten existing anxiety about one’s health.

Is it health anxiety?

So how do you know if you are sick, or if you’re just anxious about being sick? Here are some telltale signs of health anxiety:

  • You have no symptoms, but still fear that you are sick.

  • When a doctor reassures you that you don’t have an illness or a test shows you’re healthy, it doesn’t relieve your nervousness.

  • You find yourself constantly seeking health information online.

  • If you read a news story about a disease, you start worrying that you have it.

  • Your worries about your health are interfering with your life, family, work, or hobbies and activities.

Most often, people with health anxiety have a pattern of this behavior that a primary care physician may begin to notice over time. “I talk to people who call their doctor five, six, or seven times a week,” says Dr. Scarella. “Every three or four months they may go to their doctor looking for an HIV test despite the fact that they haven’t had any new sexual partners or any experiences that would elevate their risk.”

Does testing ease the nerves?

While testing may seem like a quick, easy way to alleviate health-related worries, for people in whom health anxiety has become uncontrollable, testing rarely provides lasting relief. “Repeated testing is unable to reassure people with health anxiety; people don’t feel calmed when they get new information that disproves their fear,” says Dr. Scarella. Doctors often fall into this trap, thinking “What’s the harm in doing a test to reassure this person?” It seems like a reasonable approach. But, ultimately, no amount of testing ends the worry, Dr. Scarella says, and in fact, it may only serve to reinforce the anxiety.

While some people constantly consult their doctor and request testing, in other cases health anxiety causes people to avoid the doctor entirely, which can lead to treatable conditions going undiagnosed. “There are real risks in not going to the doctor — for example, not getting appropriate cancer screenings,” says Dr. Scarella. This avoidance can become very dangerous when someone has a real condition but is afraid to get checked out for fear of bad news—such as a person who has appendicitis but puts off going to the doctor.

Treating health anxiety

“The most important thing to know about health anxiety is that it’s a treatable problem,” says Dr. Scarella. Statistics show that anxiety disorders, in general, are vastly undertreated. Only 37% of people with anxiety disorders receive treatment, according to the Anxiety and Depression Association of America.

This may reflect the stigma related to these conditions, and in the case of health anxiety, people may not actually attribute their symptoms to anxiety, but truly believe they are sick. And they may not know that help is available.

For people who are suffering from health anxiety, it’s not helpful to tell them that their symptoms are fake or it’s all in their head, says Dr. Scarella. “It’s often more constructive to encourage them to look at what the worry is doing to their life,” he says. “How is it interfering with the things they enjoy?”

If you suspect you might have health anxiety, focus on what you’re losing. Would you rather spend several hours in the emergency room waiting for a test result — when you already had the same test two weeks ago — or do something you love?

Then seek an evaluation from a mental health professional. Your primary care doctor can provide a referral.

It’s common for people with health anxiety to have other mental health conditions as well, such as depression, other types of anxiety disorders, or post-traumatic stress disorder, says Dr. Scarella. Because of this, treatment may need to address multiple issues. Treatment options include medications and psychotherapy, often in the form of talk therapy, which can help you manage and move past your worries.

But ultimately, those who seek help are often able to overcome the constant anxiety. “This can get better,” says Dr. Scarella.

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Colorado hospital lays off 40 to improve financial health

Southwest Memorial Hospital in Cortez, Colo., laid off 40 employees amid financial struggles partially attributed to overstaffing, according to The Journal.

The layoffs, which represent a 9.5 percent staff reduction, took place Aug. 14. 

Tony Sudduth, interim CEO of the hospital’s operator, Cortez-based Southwest Health System, said in a news release obtained by The Journal that SHS board members saw the move as a necessary step.

“We do not take this lightly. Our employees are the heart and soul of our hospital, and this was a tough decision,” Mr. Sudduth said. “These organizational changes are unfortunately necessary in order to improve productivity and create greater efficiency in how we provide care to our community. Our board is confident that we will be better positioned to serve our hospital and its path to financial health for years to come.”

The layoffs primarily affect nonclinical administrative and support roles. Affected employees may reapply if jobs reopen, the report states.

Mr. Sudduth partially attributed the workforce reduction to overstaffing issues. He said a recent review showed staffing levels at the hospital exceeded productivity standards and best practices when compared with numerous critical access hospitals or similar hospitals in Colorado.

The hospital also recently conducted a Medicaid rebilling effort of 11,000 claims to try to increase revenue, but results were not what officials expected, according to the report.

Moving forward, the hospital plans to focus on areas such as revenue cycle, charge capture and materials management to turn around its finances.


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Base Mental Health Clinician: Respond to stress in healthy ways

During the course of life, everyone experiences challenges and stress, and it is important to respond and process resulting emotions in healthy, constructive ways. Capt. Crystal Ditto, licensed clinical social worker, manages the Alcohol and Drug Abuse Prevention and Treatment Program, as well as the Intensive Outpatient Program, at Wright-Patterson Air Force Base. Ditto shared insights on this topic:

Your career path has informed your approach to coping with stress and traumatic events. What can you tell us about that?

Ditto: I was prior enlisted Security Forces for 10 years; so my firsthand perspective on stress is beyond the textbook. In the SF environment, I realized how important it was to not only practice effective self-care but to also look out for your brothers- and sisters-in-arms. Depending on the type of job one has, the supposed “normal” situation varies. Any type of trauma can present as a potential for concern if not managed in a healthy way.

There are a lot of common responses to stress or a traumatic event. What are some you’ve noticed?

Ditto: Although each person will have an individualized reaction, a common stress response may include hyperarousal – whenever you’re a little jumpier or on edge, and you feel like your anxiety level is higher than the standard baseline. Another common response is sleep difficulties due to racing thoughts or excessive worry. You may also feel a loss of appetite, nausea or chest tightness. The mind-body connection is powerful.

What other situations have you experienced that dealt with stress?

Ditto: As a Security Forces member, I was part of a first-responder team for Hurricane Katrina in 2005. We helped evacuate 30,000 people from the Superdome in New Orleans. I literally stared trauma, death and sheer chaos in the face. My team returned after 14 very long days/nights, and we were told to just go home – with no debrief.

I was confused by my ensuing emotional response, without understanding why these feelings were overtaking my ability to process information. I’ve lost several close friends to suicide.

Fast-forward in my career, I find it a lot easier to connect with my patients because I’ve navigated the darker paths in life. With support of SFS command, I conduct weekly visits/walk-arounds with intent of focusing on prevention. The past two and a half years with the Defenders, my family, have been rewarding and effective.

What advice do you give people who are stressed or have been traumatized?

Ditto: You have to get ahead of it and recognize the symptoms before the severity and duration increase. Everyone will process emotions differently, so just be mindful of your capacity. Just because you experience a normal reaction to an abnormal situation doesn’t mean you are “broken” or “crazy” – just be patient with yourself and activate your support system.

What are some healthy, productive things people can do?

Ditto: Find someone to confide in and process your feelings. Being able to talk about what you are feeling can be like releasing a pressure valve to avoid combustion. If the standard social circle isn’t meeting your needs, reach out to any mental health provider. We offer BHOP, or the Behavioral Health Optimization Program, as a first stop within the Family Health Clinics.

After any traumatic on-base event, we automatically activate the Disaster Mental Health Team. A wonderful feature of DMH, if imminent safety concerns are not present, is that nothing is documented. Someone can talk about whatever occurred, and nothing goes on the record.

Who are some of your best partners in assisting people dealing with stress and trauma?

Ditto: We work closely with the Chaplain Corps, Military Family Life Consultants and Military OneSource. We also count on our four-legged friends, the Pet Therapy dogs, as a great resource. For civilians, there is the Employee Assistance Program.

What physical outlets or pursuits can help?

Ditto: People work through things in different ways – some people like to run or go to the gym, some prefer yoga or hiking. Activate what has helped you in the past. There is no need to “reinvent the wheel” if something works. Avoid increased substance use because it’s merely a band-aid, and the trajectory is not ideal.

Can you talk more about the ADAPT approach?

Ditto: People can do a self-referral to ADAPT if they feel they have been drinking too much alcohol; however, if they meet diagnostic criteria for having a substance use disorder, command is notified to ensure appropriate treatment recommendations are completed. This is not punitive.

Trust me, as prior SF, you could not tell me treatment was positive due to fear of arming restrictions, but the perspective I have now demonstrates the “get ahead of it” approach.

Whenever someone doesn’t self-identify, there is potential for an alcohol-related incident (i.e., a DUI, intimate partner violence or a physical injury). This prompts the two other types of referrals: command or medical, which are reactive versus proactive.

How can people reinforce their feelings of safety and security?

Ditto: It comes down to patience, self-care and challenging negative cognitions. If a person overgeneralizes their feelings to assume the world is always unsafe based on an isolated or infrequent incident, they will experience difficulties with daily functioning. Unexpected things will always arise, but this does not mean the world is always unsafe.

It’s normal to question safety when incidents go against the “just world” concept – meaning the perception that good things happen to good people, and bad things happen to bad people. The world is not perfect or just. Perfection is not realistic.

Any final thoughts on coping skills?

Ditto: It’s important for people who have been through something to realize that an emotional reaction is expected. In fact, it is completely adaptive to have all kinds of emotions following during/after an event.

“Fight, flight or freeze” is a very real concept, so if you need to cry, then cry – release the pressure valve. It’s also healthy to set boundaries for yourself in how much information you consume. Don’t allow yourself to consume third-party information that reinforces uneasy feelings.

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Congo’s new Ebola outbreak is hitting health care workers hard

Doctors Without Borders built and is running an Ebola treatment unit in Mangina, the epicenter of the current outbreak in the Democratic Republic of the Congo.

Karin Huster/Doctors Without Borders

Health care workers have been especially hard hit by the current outbreak of Ebola in the northeastern part of the Democratic Republic of the Congo (DRC). To date, nine of the 51 confirmed cases of Ebola have been in people caring for the ill, says Peter Salama, an epidemiologist based in Geneva, Switzerland, who heads the response to the outbreak for the World Health Organization (WHO).

“There’s an extremely low level of knowledge and awareness about Ebola in the area,” Salama says. “Early on, the health care workers took no precautions whatsoever, and unfortunately, we’re expecting more confirmed cases from that group.”

The outbreak is the 10th in the DRC since the disease first surfaced in 1976, and though it is the first to occur in this region of the country, Salama says he was surprised how little the affected communities knew about the deadly disease. In the past, health care workers have often been heavily affected during the early days of outbreaks, but the massive Ebola outbreak that caused more than 28,000 cases in West Africa in 2014–16 brought more attention to the risks and proper responses than ever before.

The virus has spread to seven health districts in North Kivu and Ituri, two northeastern provinces near the border with Uganda that have long been plagued by armed conflict between insurgent groups and government forces. This could vastly complicate efforts to contain its spread, as workers may have to travel with armed escorts. So far, however, security issues have not hampered the attempts to isolate the infected and to treat people, educate communities about personal hygiene precautions and safe burials, and conduct surveillance, Salama says. That’s in part because the majority of cases are in a single village, Mangina, where response teams have been able to work safely.

In addition to the confirmed cases, there are 27 probable ones. So far, 44 of the probable and confirmed cases have died. An experimental vaccine that has performed well in other studies now is being used in health care workers and others who may have come in contact with confirmed cases. Salama says more than 500 people have received the vaccine so far. In addition to response teams from the DRC’s Ministry of Public Health and WHO, two nongovernmental organizations, Doctors Without Borders and the Alliance for International Medical Action, have opened Ebola treatment centers to isolate and treat patients.

Robert Redfield, head of the U.S. Centers for Disease Control and Prevention in Atlanta, visited Kinshasa on Wednesday to meet with Minister of Public Health Oly Ilunga Kalenga. The next day, Kalenga led Redfield and a U.S. delegation to North Kivu, where the Americans toured an Ebola treatment center in the city of Beni.

Salama, who visited the affected area last week, led the WHO’s response to the DRC’s previous outbreak, which officially ended 1 week before this one surfaced. “It’s taking all the partners a little longer to get moving in this outbreak to be at the scale required to really deal with what is one of the more complex outbreaks of Ebola we’ve had in recent years,” says Salama, noting that they badly need more financial support from international donors. “This is a really tough one.”

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Seeking Hope for the Nation’s Slipping Health

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How Retail Mental Health Could Be Medicine’s Next Frontier


Throughout his residency and his last three years as a physician in psychiatry training at Mather Hospital in New York, Dr. Tamir Aldad saw upfront how thousands of mental health patients each year were sent home from the emergency room knowing they might not get follow-up treatment for several weeks.

Despite the urgency of care needed amid the nation’s opioid epidemic and related mental health crisis, millions of Americans like the patients Aldad sees are treated first in an ER, but often aren’t able to see a psychiatrist even after being screened for anything from substance abuse or phobias to PTSD or potential risk of self-harm. Aldad says they aren’t sick enough to be admitted so they “boomerang back to the ER in a couple weeks with the same or worse problem than they came in for in the first place.”

“There are 70% of patients with mental illness who are sent home because their symptoms aren’t severe enough to be admitted, but they don’t meet criteria for admission,” says Aldad citing New York City hospital statistics.

In New York alone, Aldad says the wait to see a psychiatrist in an outpatient clinic or doctor’s office is four to eight weeks. And it may be worse in other parts of the U.S. given there is a nationwide shortage of doctors and psychiatrists in particular.

“You could go through the phone book and beg psychiatrists to see them or they could get an appointment to see a psychiatrist on Park Avenue today, but you would need $500 to $600 to see them,” Aldad says.

To fill these potentially life-threatening gaps in U.S. healthcare, the 33-year-old physician and University of Chicago Booth Executive MBA student has developed an award-winning startup called Mindful Urgent Care staffed by a team of mental health professionals including psychiatrists to increase mental health access and speed quality and affordable treatment to a population of patients with unmet needs.

For his efforts, Aldad won $140,000 in the University of Chicago Booth School of Business’ New Venture Challenge and Global New Venture Challenge competitions that have launched startups like online food delivery service Grubhub and payment processor BrainTree. He says he’s also landed another $500,000 in funding from additional backers to help him open his first 3,000 square-foot retail clinic in September in New Hempstead, NY. A second 2,000 square foot clinic will open in midtown Manhattan in 2019.

He’s also hearing from additional potential investors he’s not ready to publicly disclose, which could be key to a business plan he has to open 35 centers in the greater tri-state area surrounding New York City in New York, Connecticut and New Jersey in the next five years.

It’s a unique approach to a market not tapped yet by big retailers. Though pharmacy chains like CVS Health and Walgreens Boots Alliance are big into retail health clinics, both confirm they don’t for now have plans to build out or add mental health services.

Such facilities cannot open fast enough. For years now, the U.S. health system has lacked enough primary care providers like family physicians and internists as more Americans with a pent up demand for treatment gained the ability to pay under the Affordable Care Act. And mental health needs in communities across the country are becoming as critical, with no way of filling the void in sight. Behavioral health facilities, hospitals and addiction centers cannot find the psychiatrists they need.

“We face a broad range of mental health issues, including the acute problems of opioid addiction and increasing rates of depression and suicide,” Dr. Darrell Kirch, a psychiatrist and chief executive of the Association of American Medical Colleges said in a report earlier this year on the psychiatrist shortage. There are 28,000 psychiatrists in the U.S., but three in five are 55 years of age or older, AAMC data shows.

But Aldad’s strategy is to meet patient need through a mix of psychiatrists and “physician extenders” like nurse practitioners and physicians assistants with mental health and psychiatric specialties to better triage patients in order to replicate the consumer-friendly Mindful Urgent Care model that will be open 15 hours a day and seven days a week.

Though big chains haven’t yet jumped on the retail mental health clinic concept, there have been other public and private urgent care centers open up in the space.

Psychiatric urgent care pioneers include Broadlawns Psychiatric Urgent Care in Des Moines and a new state-funded effort in North Carolina launched by Alliance Behavioral Healthcare, a managed care organization that asked a group of therapists in Durham to create a clinic, according to a report earlier this year in North Carolina Health News.

“Because we use physician extenders and not strictly psychiatrists, we are able to scale our model,” Aldad says. “By no means are we trying to compete for business and take away from psychiatrists in their practices, but we want to get these patients treatment. We want to give medication and provide simple symptom stabilization so you as a patient has relief.”

For now, Mindful Urgent Care has contracts with more than 30 health insurance companies through the New York psychiatrists that will be staffing and supervising the staff at the retail clinics.

But Aldad is hopeful the model will be attractive to health insurers on a broader scale given the move away from fee-for-service medicine that emphasizes volume of medical care delivered. Instead, insurers emphasize value-based care that encourages patients to get better treatment upfront in a doctor’s office. Such value-based models measure and reward providers based on how well they care for patients, treating them more holistically.

Value-based models reach out into the community to make sure patients get the right care, in the right place and at the right time so it’s quality and low cost. Health insurers like UnitedHealth Group, Anthem and Aetna and many others are now paying out more than half of their reimbursements to doctors based on such value-based formulas so Aldad’s idea should have merit with health plans.

Prices Mindful Urgent Care plans to charge are expected to cost $175 for an initial visit and $80 for follow-up care based on the average of what Medicare and private insurance pays, Aldad says. Most patients have coverage so they would likely pay significantly less based on their co-payments, deductibles and related out-of-picket costs.

“In value-based care, patient outcomes really matter and what we are instead seeing now is that patients in mental health are costing more and more,” Aldad said. “It’s even more costly if that hospitalization for mental illness is preventable because they couldn’t get in for a medication refill or they couldn’t get into their doctor’s office for an appointment. We have an opioid crisis and we have to proactively trend and work on how to prevent illness.”

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