Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Friday, October 11, 2013

The Health Must-Eat List

must-eat Food shopping is a daunting task these days, especially if you're trying to eat right. With supposed health benefits screaming from labels and the actual ingredients in mighty fine print, you practically need a PhD in nutrition to bring home the right mix.

To the rescue: the Health Must-Eat List. It's "designed to help you shop healthy in every aisle of the grocery store," says Caroline Kaufman, RDN, a family nutrition expert in San Francisco. Our guide will lead you to the best choices while helping you cut through the hype and make smart decisions about which foods are worthy of your grocery dollars. "The Health Must-Eat criteria aren't influenced by marketing claims on the label," Kaufman says. "They're based on how healthy the food is on the inside—what it's made of."

Of course, fresh fruits and vegetables are automatic must-eats. But let's get real—most of us rely on packaged products, too, from crackers to cups of yogurt to frozen dinners. That's where the Health Must-Eat List comes in. Together with a panel of leading nutrition and food science experts, the editors of Health came up with a detailed but simple formula to identify healthful fare that you can truly feel good about eating.

In order to qualify, a food must not only be free of all the bad stuff you don't want or need—trans fats, tons of added sugar, potentially harmful preservatives and the like—but also contain nutrients that enhance your physical well-being. For example, it might have calcium, which boosts bone health, or live active cultures, which promote digestive health. "Think of Must-Eat foods as junk-food antidotes—they help restore the dietary equilibrium," says expert panelist Adam Drewnowski, PhD, director of the Center for Public Health Nutrition at the University of Washington.

To determine the criteria, our panel carefully reviewed years of health and nutrition research, looking at what the most scientifically sound studies have shown us over time. Once the formula was set, we dispatched a team of a dozen nutritionists and Health editors to scour supermarket shelves. We also put out an open call to food manufacturers to submit their newest and healthiest products for consideration.

The results: Of the more than 3,500 products that we reviewed, nearly 1,000 foods and beverages from 225 different brands made it onto our list. "It is encouraging that there are now many more healthy products available than there were a few years ago," says expert panelist Walter Willett, MD, Fredrick John Stare professor of epidemiology and nutrition at the Harvard School of Public Health.

On these pages, you'll find our best bets in four categories—frozen treats, nut butters, packaged fruit and snacks, cookies and crackers. (We'll cover more types of food in future issues of Health.) Whether you need a nutritious dinner staple or are looking for a power treat to tide you over until your next meal, each of these picks plays a key role in a balanced diet. Shop easier, eat better: It really is as simple as that.


frozen-treats-ice-cream Frozen treats
Watch out for added sugar here; we eliminated any product that listed it as the first or second ingredient. Also avoid foods that contain artificial sweeteners, which are used to sweeten products without adding calories—but can contribute to weight gain by training us to prefer their flavors over the natural sweetness of whole foods.

breakfast-peanut-butter Nut butters
Nut butters are a delicious way to get protein and healthy fats. But sugar is a potential pitfall—many nut butters that didn't make our list had sugar as the second ingredient, after nuts. Also avoid partially hydrogenated oils (a source of unhealthy trans fats), which some manufacturers use to prevent separation.

dried-fruit Packaged fruit
It's best to eat fruit in as close to its natural form as possible. That means saying no to fruit packaged in gels or syrups that contain lots of sugar or artificial sweeteners. Canned, jarred or cups of fruit in 100 percent fruit juice, or dried or freeze-dried fruit with no added sugar, were the only kinds that made our list.

potato-chips Snacks, cookies, and crackers
Look for snacks made primarily from whole grains (popcorn counts!) and choose one that, when combined with your other choices throughout the day, keeps you under your daily sodium limit. Steer clear of snacks that are made only from refined grains, contain partially hydrogenated oils or shortening (sources of trans fat) or are loaded with sugar—again, an easy trick is to skip any product that lists sugar as the first or second ingredient.

cheese-chunk Cheese
Cheese gets a bad rap, but it can be nutritious (in addition to delicious). For one, it's a good source of calcium, which helps build bone and plays a role in muscle function, nerve transmission and regulating blood pressure. It also fuels your body with protein, vitamin D, phosphorus, and zinc. FREE Healthy Living Email Newsletter

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The Health Must-Eat List: Top Cheeses

Cheese gets a bad rap, but it can be healthy. For one, it's a good source of calcium, which helps build bone and plays a role in muscle function, nerve transmission, and regulating blood pressure. Plus, it serves up healthy doses of protein, vitamin D, and zinc. Just choose wisely and enjoy in moderation.

Products available in grocery stores nationwide unless otherwise noted.

applegate-cheddar Applegate Organics Mild Cheddar cheeseApplegate Naturals American cheese, $4.99 for 8 oz.
Applegate Naturals Cheddar cheese Medium, $5.99 for 7 oz.
Applegate Naturals Emmentaler Swiss cheese, $5.99 for 7 oz.
Applegate Naturals Extra Sharp Aged Cheddar cheese, $5.99 for 8 oz.
Applegate Naturals Havarti cheese, $5.99 for 7 oz.
Applegate Naturals Monterey Jack cheese with jalapeño peppers, $4.99 for 7 oz.
Applegate Naturals Muenster cheese, $4.99 for 7 oz.
Applegate Naturals Provolone cheese, $4.99 for 7 oz.
Applegate Naturals Yogurt cheese with live active probiotic cultures, $5.99 for 8 oz.

Applegate Organics Mild Cheddar cheese, $5.99 for 5 oz.
Applegate Organics Monterey Jack cheese, $5.99 for 4 oz.
Applegate Organics Muenster Käse cheese, $5.99 for 5 oz.
cabot-cottage-cheese Applegate Organics Provolone cheese, $5.99 for 5 oz.

BelGioioso Asiago wedge, $3.99 for 5 oz.
BelGioioso Fresh Mozzarella balls, $4.99 for 8 oz.

BelGioioso Parmesan wedge, $3.99 for 5 oz.
BelGioioso Romano wedge, $3.99 for 5 oz.

Cabot Cottage cheese, $1.99 for 16 oz.; at select grocery stores.
Cabot Monterey Jack shredded cheese, $3.50 for 8 oz.; at select grocery stores.
Cabot Seriously Sharp Cheddar bars, $3 for 8 oz.
Cabot Sharp Light Cheddar bars, $3 for 8 oz.; at select grocery stores.

Cracker Barrel Aged Reserve Cheddar cheese, $3.99 for 8 oz.
kraft-havarti Cracker Barrel Cracked Black Pepper Cheddar cheese, $3.99 for 8 oz.; at select grocery stores.
Cracker Barrel Extra Sharp Cheddar cheese, $3.99 for 8 oz.

Frigo Cheese Heads Light string cheese, $4.99 for 12.
Frigo Cheese Heads string cheese, $4.99 for 12.

Horizon Organic Classic American cheese slices, $4.50 for 12.

Kraft 2% Milk Singles, $2.99 for 12 oz.
Kraft Natural Cheese Havarti, $2.99 for 7 oz.
Kraft Shredded Mozzarella with a Touch of Philadelphia, $2.99 for 8 oz.
Kraft Singles, American, $2.99 for 12 oz.

mini-babybel Mini Babybel Bonbel, $3.99 for 6.
Mini Babybel Cheddar, $3.99 for 6.
Mini Babybel Light, $3.99 for 6.
Mini Babybel Mozzarella Style, $4.99 for 10.
Mini Babybel Original, $3.99 for 6.

Organic Valley American Singles, $5.89 for 8 oz.
Organic Valley Baby Swiss cheese, $6.69 for 8 oz.
Organic Valley Mild Cheddar Cheese, Reduced Fat, Reduced Sodium, $5.59 for 8 oz.
Organic Valley Monterey Jack cheese, $5.59 for 8 oz.
Organic Valley Mozzarella Shredded, Part Skim, $5.09 for 6 oz.
Organic Valley Mozzarella Stringles, Low Moisture, Part Skim, $5.39 for 6 oz.
Organic Valley Pepper Jack cheese, $5.59 for 8 oz.
polly-o-mozzarella Polly-O Shredded Low-Moisture Part Skim MozzarellaOrganic Valley Vermont Extra Sharp Cheddar cheese, $12.59 for 16 oz.

Polly-O Jalapeño string cheese, $4.49 for 10 oz.; at select grocery stores.
Polly-O Natural Low-Moisture Part-Skim Mozzarella cheese, $4.49 for 12 oz.; at select grocery stores.
Polly-O Shredded Low-Moisture Part-Skim Mozzarella cheese, $3.69 for 8 oz.; at select grocery stores.
Polly-O String Natural Reduced-Fat Mozzarella cheese made with 2% milk, $4.49 for 10 oz.; at select grocery stores.

Sargento Chef Blends Shredded 4 State Cheddar cheese, $3.79 for 8 oz.
Sargento Deli Style Sliced Medium Cheddar cheese, $3.49 for 11.
Sargento Natural Blends Cheddar-Mozzarella cheese snacks, $4.79 for 12.
Sargento Natural Blends Deli Style Sliced Sharp Cheddar-Jack cheese, $3.49 for 11.
Sargento Natural Light string cheese snacks, $4.79 for 12.
sargento-swiss Sargento Ultra Thin Sliced Pepper Jack cheeseSargento Natural Reduced Fat Colby-Jack snacks, $4.79 for 12.
Sargento Shredded Reduced Fat Cheddar Jack cheese, $3.79 for 8 oz.
Sargento Shredded Reduced Fat 4 Cheese Mexican, $3.79 for 8 oz.
Sargento Shredded Reduced Fat Mozzarella cheese, $3.79 for 8 oz.
Sargento Traditional Cut Shredded Sharp Cheddar cheese, $3.79 for 8 oz.
Sargento Ultra Thin Sliced Pepper Jack cheese, $3.49 for 18.
Sargento Ultra Thin Sliced Swiss cheese, $3.49 for 18.
Sorrento Galbani Stringsters Reduced Fat Mozzarella string cheese, $4.29 for 12 oz.; at select grocery stores.

Stella Parmesan wedge, $4.99 for 5 oz.
Stella Romano wedge, $4.99 for 5 oz.

365 Everyday Value Organic Light string cheese, $4.99 for 6 oz.; at Whole Foods Market.

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Friday, July 26, 2013

UPDATE: Travelers' Health - Outbreak Notice, Cholera in Haiti

Warning - Level 3, Avoid Nonessential TravelAlert - Level 2, Practice Enhanced PrecautionsWatch - Level 1, Practice Usual Precautions

An outbreak of cholera has been ongoing in Haiti since October 2010. According to the Ministere de la Sante Publique et de la Population (MSPP), as of May 22, 2013, 657,117 cases and 8,096 deaths have been reported since the cholera epidemic began in Haiti. Among the cases reported, 363,740 (55.4%) were hospitalized. Cases have been officially reported in all 10 departments of Haiti. In Port-au-Prince, the country’s capital, 176,935 cases have been reported since the beginning of the outbreak. Cases in Port-au-Prince have been reported from the following neighborhoods: Carrefour, Cite Soleil, Delmas, Kenscoff, Petion Ville, Port-au-Prince and Tabarre.

For more information on cholera cases, see the Health Summary Report from MSPP.

Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food is often contaminated by water containing cholera bacteria or by being handled by a person ill with cholera.

Since the earthquake, the U.S. Department of State has maintained a travel warning for Haiti urging U.S. citizens to avoid all nonessential travel to Haiti. For more information, see http://travel.state.gov/travel/cis_pa_tw/tw/tw_5541.html.

Most travelers are not at high risk for getting cholera, but people who are traveling to Haiti should still take their own supplies to help prevent the disease and to treat it. Items to pack include

A prescription antibiotic to take in case of diarrheaWater purification tablets*Oral rehydration salts*

*In the United States, these products can be purchased at stores that sell equipment for camping or other outdoor activities.

Although no cholera vaccine is available in the United States, travelers can prevent cholera by following these 5 basic steps:

Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use.Use safe water to brush your teeth, wash and prepare food, and make ice.Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.

*Piped water sources, drinks sold in cups or bags, or ice may not be safe. All drinking water and water used to make ice should be boiled or treated with chlorine.
To be sure water is safe to drink and use:

Boil it or treat it with water purification tablets, a chlorine product, or household bleach.Bring your water to a complete boil for at least 1 minute.To treat your water, use water purification tablets, if you brought some with you from the United States, or one of the locally available treatment products, and follow the instructions.If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinkingAlways store your treated water in a clean, covered container.Before you eat or prepare foodBefore feeding your childrenAfter using the latrine or toiletAfter cleaning your child’s bottomAfter taking care of someone ill with diarrhea

*If no soap is available, scrub hands often with ash or sand and rinse with safe water.

Use latrines or other sanitation systems, like chemical toilets, to dispose of feces.Wash hands with soap and safe water after using toilets or latrines.Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water.

What if I don’t have a latrine or chemical toilet?

Defecate at least 30 meters away from any body of water and then bury your feces.Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. Do not put plastic bags in chemical toilets.Dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water.Boil it, cook it, peel it, or leave itBe sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through.Do not bring perishable seafood back to the United States.

*Avoid raw foods other than fruits and vegetables you have peeled yourself.

Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources.

Before departing for Haiti, talk to your doctor about getting a prescription for an antibiotic. If you get sick with diarrhea while you are in Haiti, you can take the antibiotic, as prescribed. Also, remember to drink fluids and use oral rehydration salts (ORS) to prevent dehydration.

If you have severe watery diarrhea, seek medical care right away.

Medical care facilities are strained with the high number of people who are ill. If you will be traveling to Haiti, CDC recommends that you purchase medical evacuation insurance in the event that you become ill while in Haiti. (See the U.S. Department of State list of U.S.-Based Air Ambulance or Medical Evacuation Companies.) If you are in Haiti and need medical care and you do not have access to medical evacuation, you can contact the Embassy of the United States in Port-au-Prince, Haiti, (American Citizens Services Unit office hours are 7:00 a.m. to 3:30 p.m., Monday through Friday. The Consular Section is closed on U.S. and local holidays.):

Boulevard du 15 October, Tabarre 41, Tabarre, Haiti
Telephone: (509) (2) 229-8000
Facsimile: (509) (2) 229-8027
Email: acspap@state.gov


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NEW: Guidance for Reducing Health Risks to Workers Handling Human Waste or Sewage

Workers who handle human waste or sewage are at increased risk of becoming ill (i.e., from water-washed, waterborne and water-carried diseases). To reduce this risk and protect against illness, including cholera, the following guidance should be followed by workers and employers.

Wash hands with soap and water immediately after handling human waste or sewage.Avoid touching face, mouth, eyes, nose, or open sores and cuts while handling human waste or sewage.After handling human waste or sewage, wash your hands with soap and water before eating or drinking.After handling human waste or sewage, wash your hands with soap and water before and after using the toilet.Before eating, removed soiled work clothes and eat in designated areas away from human waste and sewage-handling activities.Do not smoke or chew tobacco or gum while handling human waste or sewage.Keep open sores, cuts, and wounds covered with clean, dry bandages.Gently flush eyes with safe water if human waste or sewage contacts eyes.Use waterproof gloves to prevent cuts and contact with human waste or sewage.Wear rubber boots at the worksite and during transport of human waste or sewage.Remove rubber boots and work clothes before leaving worksite.Clean contaminated work clothing daily with 0.05% chlorine solution (1 part household bleach to 100 parts water).

Workers handling human waste or sewage should be provided proper PPE, training on how to use it, and hand washing facilities. Workers should wash hands with soap and water immediately after removing PPE. The following PPE is recommended for workers handing human waste or sewage:

Goggles: to protect eyes from splashes of human waste or sewage.Protective face mask or splash-proof face shield: to protect nose and mouth from splashes of human waste or sewage.Liquid-repellent coveralls: to keep human waste or sewage off clothing. Waterproof gloves: to prevent exposure to human waste or sewage.Rubber boots: to prevent exposure to human waste or sewage.

All workers who handle human waste or sewage should receive training on cholera prevention. The training should include information on basic hygiene practices; use and disposal of personal protective equipment; proper handling of human waste or sewage; signs and symptoms of cholera; and ways in which cholera can be transmitted. Workers must also be urged to promptly seek medical attention if displaying any signs or symptoms of cholera, such as vomiting, stomach cramps and watery diarrhea.

Vaccination recommendations for workers exposed to sewage or human waste should be developed in consultation with local health authorities. Tetanus vaccinations should be up to date, with consideration also given to the need for polio, typhoid fever, Hepatitis A and Hepatitis B vaccinations.

The recommendations made in this document are based on best practices and procedures. Worker health and safety risks are likely to vary among specific locations and a trained health and safety professional should be consulted to create site specific worker health and safety plans.

CDC (Centers for Disease Control and Prevention) [2002] Guidance for Controlling Potential Risks to Workers Exposed to Class B Biosolids. National Institutes for Occupational Safety and Health: 2002-149. http://www.cdc.gov/niosh/docs/2002-149/2002-149.html.


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NEW: Travelers' Health - Outbreak Notice, Cholera in Haiti


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NEW: Travelers' Health - Advice about Cholera for Travelers Arriving in the United States from Haiti

There is an outbreak in Haiti of a disease called cholera. Cholera is an infection that can cause severe diarrhea and can result in life-threatening loss of fluids from the body (dehydration). Without proper care, a person can die from this disease.

People most often get cholera by drinking water or eating food that has cholera germs in it. Water can be contaminated with the feces of a person sick with cholera. Food can be contaminated by water that has cholera germs in it or if prepared or handled by a person sick with cholera.

Contact CDC 24 Hours/Every Day
Phone: 1-800-CDC-INFO (232-4636)
TTY: (888) 232-6348
Email: cdcinfo@cdc.gov
CDC’s website on the Haiti cholera outbreak:  http://www.cdc.gov/haiticholera/


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New: Travel Health Alert Notice: Cholera


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Monday, June 17, 2013

Many Americans have poor health literacy

An elderly woman sent home from the hospital develops a life-threatening infection because she doesn't understand the warning signs listed in the discharge instructions. A man flummoxed by an intake form in a doctor's office reflexively writes "no" to every question because he doesn't understand what is being asked. A young mother pours a drug that is supposed to be taken by mouth into her baby's ear, perforating the eardrum. And a man in his 70s preparing for his first colonoscopy uses a suppository as directed, but without first removing it from the foil packet.

Each of these examples provided by health-care workers or patient advocates illustrates one of the most pervasive and under-recognized problems in medicine: Americans' alarmingly low levels of health literacy - the ability to obtain, understand and use health information.

A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health material. This means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower. About 52 percent had intermediate skills: They could figure out what time a medication should be taken if the label says "take two hours after eating," while the remaining 12 percent were deemed proficient because they could search a complex document and find the information necessary to define a medical term.

Regardless of their literacy skills, patients are expected to manage multiple chronic diseases, to comply with drug regimens that have grown increasingly complicated and to operate sophisticated medical devices such as at-home chemotherapy equipment largely on their own.

Health literacy "affects every single thing we do," said Susan Pisano, a member of the Institute of Medicine's health literacy roundtable and vice president of communications for America's Health Insurance Plans, the industry trade association. "The implications are mind-boggling."

As recently as a decade ago, the problem of health literacy was largely the province of academic researchers who published study after study documenting the glaring mismatch between the dense, technical and jargon-heavy materials routinely given to patients, some written at the graduate school level, and their ability to understand them.

These days, health literacy is the focus of unprecedented attention from government officials, hospitals and insurers who regard it as inextricably linked to implementing the health-care overhaul law and controlling medical costs.

The new law, which contains explicit references to health literacy, requires that information about medications and providers be made accessible to those with limited skills. In October, President Obama signed the Plain Writing Act, which will boost that effort by directing federal agencies to use plain language in their materials.

Adding urgency to those endeavors is the projected influx into the health-care system of 32 million currently uninsured Americans who will begin to get coverage in 2014 under the new law.

"Health literacy is needed to make health reform a reality," Health and Human Services Secretary Kathleen Sebelius said last year as she launched the National Action Plan to Improve Health Literacy, an effort designed to eliminate medical jargon and the complex, often convoluted explanations that pervade handouts, forms and Web sites.

"A whole bunch of new people are going to be entering the health-care market and making decisions that involve not just cost and 'Is my doctor in the plan?' " but also complicated trade-offs about risks and benefits, said Cindy Brach, a senior policy analyst at the Agency for Healthcare Research and Quality, which has made improving health literacy a priority.

Keeping it simple

Studies have linked poor health literacy, which disproportionately affects the elderly, the poor and recent immigrants, to higher rates of hospital readmission, expensive and unnecessary complications, and even death. A 2007 study estimated the problem cost the U.S. economy as much as $238 billion annually.

Starting this year, the Joint Commission, the group that accredits hospitals, is requiring them to use plain-language materials and to "communicate in a manner that meets the patient's oral and written communication needs" in providing care.

Hospitals and health plans increasingly are turning to computer software that analyzes materials given to patients and flags overly technical language such as "myocardial infarction" (heart attack), "hyperlipidemia" (high cholesterol) and "febrile" (feverish). One program, developed by Bethesda-based Health Literacy Innovations, is being used by the National Institutes of Health, CVS and Howard University Hospital. It analyzes texts for complexity and suggests ways to simplify them.

Employers are pushing insurers to demonstrate that the materials they give patients are simple and intelligible, said Aileen Kantor, founder of Health Literary Innovations.

Instead of handing a patient pages of instructions, some hospitals and clinics are using videos or handouts with lots of pictures. Doctors at Boston Medical Center have pioneered an innovative program called Project RED, short for Re-Engineered Discharge, an effort that between 2006 and 2007 reduced readmission rates for the first month after discharge by 30 percent and costs by 33 percent. Instead of standard instructions, RED patients received a personalized discharge booklet, along with help making follow-up appointments and a call from a pharmacist a few days after they arrived home.

A positive test

Javed Butler, a heart surgeon at Emory University Hospital in Atlanta, said one obstacle to improving health literacy is the language that doctors typically use. "When we say 'diet,' we mean 'food,' but patients think we mean going on a diet. And when we say 'exercise,' we may mean 'walking,' but patients think we mean 'going to the gym.' At every step there's a potential for misunderstanding," said Butler, who added that he tries not to lapse into "medicalese" with patients.

It's not a problem only for those with basic skills. Paula Robinson, a patient education manager at the Lehigh Valley Health Network, which includes three hospitals in eastern Pennsylvania, said that even highly educated patients are affected, particularly if they're stressed or sick.

She cites the initial reaction of former New York mayor Rudolph Giuliani, who thought he was cancer-free when his doctor told him several years ago that his prostate biopsy was "positive." Actually, a positive biopsy indicates the presence of cancer.

Many patients, Robinson said, won't ask questions or say they don't understand, either because they are intimidated or worried about looking stupid. Some simply tune out or shut down, she said, and "a lot of people take things literally because of anxiety."

Robinson recounts one such case: A patient who had been prescribed daily insulin shots to control his diabetes diligently practiced injecting the drug into an orange while in the hospital. It was only after he was readmitted with dangerously high blood sugar readings that doctors discovered he was injecting the insulin into an orange, then eating it.

AHRQ's Brach said that some time-strapped doctors have complained that their schedules are too packed to add literacy concerns to the list.

But she said simple measures that are not unduly time-consuming can be integrated into the visit. They include a method called "teach back," which asks patients to repeat in their own words what they have just been told.

Illinois geriatrician Cheryl Woodson said she avoids making assumptions about her patients' health literacy. "You can't tell by looking," said Woodson, a solo practitioner in Chicago Heights.

"I never ask, 'Do you understand?" she added, "because they say, 'Uh-huh,' and you don't know what they understand. So instead I'll say, 'I know your daughter is going to want to know about this, so what are you going to tell her?' "

No literacy

Sometimes the problem is not health literacy, but the ability to read or write at all. It is estimated that 14 percent of adults are illiterate, but many find ingenious ways of compensating and take great pains to hide the problem.

Archie Willard said he avoided going to the doctor for years before he learned to read at age 54. Even today Willard, now 80, said he struggles with reading - he is severely dyslexic - and identifies his medication by the shape and color of the pill, not by reading the label.

Willard, who divides his time between Iowa and Arizona, said that before he learned to read he employed a strategy in medical settings common among those who cannot read or write. "I would say I couldn't fill out the paperwork because I forgot my glasses. And I didn't even wear glasses."

Many experts predict that efforts to boost health literacy may benefit even the minority who are proficient. "People worry about dumbing things down," Brach said, "but in the research, no one has ever complained that things were too simple. Everybody wants clear communication."

This story was produced through a collaboration between The Washington Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente.


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Saturday, June 15, 2013

Top green vegetables for your health -- and St. Patrick's Day

There are many ways to go green for St. Patrick's Day. In addition to sporting your green socks and downing a green beer, how about putting some green on your plate?

Green vegetables top the list of best-for-you veggies: They're great sources of fiber and the antioxidant vitamins A, C and K, plus scads of other vitamins and minerals, and they are typically low in calories. Keep them in mind as you work toward the new dietary guidelines' recommendation to fill half your plate with vegetables at every meal.

I asked Alexandra Postman, editor in chief of Martha Stewart's Whole Living magazine and an editor of that publication's "Power Foods" cookbook, and Jim White, spokesman for the American Dietetic Association, for their top picks. I was surprised and pleased by how many familiar favorites they named. Here's their guide to the most nutritious choices in the field of green. (All recipes can be found at washingtonpost.com/recipes.)

Erin go broccoli

Postman and White agree that broccoli can't be beat. It is very high in fiber and delivers a potent package of Vitamin C - 135 percent of what you need in a day - plus potassium and iron, Postman says. White adds Vitamin K and folate to that list. Like other green cruciferous vegetables (such as Brussels sprouts, kale, cabbage and bok choy), it contains nitrogen compounds known as indoles, which, Postman says, have been shown to prevent stomach tumors. In fact, eating broccoli may help reduce the risk of other cancers, too, by virtue of its being rich in carotenoids, antioxidants that are thought to "sponge up free radicals that promote cancer," Postman explains. Broccoli is also"very high in calcium for a vegetable," she adds, "though some will quibble" that not all the calcium it contains is easily absorbed by the body.

Tip: For broccoli and other green vegetables, steaming is the best way to retain nutrients; boiling, microwaving or stir-frying may leach some away.

Recipe: Pasta With Broccoli and Garlic.

Per cup, raw:

31 calories,

2.4 grams of fiber

Popeye's favorite

Dark leafy greens such as spinach (along with dark romaine, collard greens and kale) are great sources of Vitamin K, which is "essential for blood clotting and bone healing," Postman says. A cup of spinach delivers nearly twice (181 percent) the Vitamin K you need daily. That nutrient also may help decrease inflammation in the body, Postman says; inflammation is thought to be at the root of many diseases, including cancers and cardiovascular disease. Although spinach is often touted for its iron content, Postman notes that the vegetable also contains oxalic acid, which limits the body's ability to absorb all that iron.

Tip: Spinach fresh from the garden is optimal; the stuff you buy in bags in the produce section may have lost nutrients during shipping and the time it sits on the shelf. Frozen spinach may be a better nutritional bet, Postman advises, as it's typically flash-frozen at its peak.

Recipe: Jumbled Greens.

Per cup, raw:

7 calories,

0.7 grams of fiber

Get artichoked up

These armadillo-looking items, members of the aster family, not only deliver loads of magnesium, folate and potassium, but also a dynamite dose of fiber. Postman's a big fan because artichokes help the liver produce bile, which helps your body process fatty foods, and because they promote muscle function. And get this: Postman says that artichokes may "stimulate sweet receptors. Eat some artichoke," she suggests, then drink water. "The water will taste sweet," she says.

Tip: Rather than canceling out steamed artichokes' nutrition by bathing the leaves in butter or hollandaise sauce, try dipping the leaves in heart-healthy olive oil or even broth.

Recipe: Baby Artichoke Salad.

Per medium 'choke: 60 calories, 6.9 grams of fiber

A spear that never hurts

This member of the lily family is bursting with folate: According to Postman, asparagus has moreof this nutrient than any vegetable (the majority of which contain some). Folate helps your body do away with homocysteine, an amino acid that contributes to cardiovascular disease. To that long-term benefit, add these two shorter-term effects that may make asparagus your favorite: White points out that asparagus can have "a mild laxative effect" and also serves as a diuretic, helping your body removed excess water and thus avoid bloating.

Tip: You can eat asparagus raw if you shave it thin with a vegetable peeler. Or enjoy it lightly steamed, grilled or roasted. According to "Power Foods," "Most of asparagus's nutrients are left intact, even after it is cooked."

Recipe: Asparagus With a Mushroom Ragout.

Per cup, raw: 27 calories, 2.8 grams of fiber

Celebrate with celery

Not exactly a dark-green vegetable, celery makes both Postman's and White's lists because it delivers at least its share of nutrients per calorie. White says celery serves up fiber, folate, Vitamin A and Vitamin C - "a lot of the same nutrients found in other green vegetables" but in easy-to-eat style. "It's a great snack to cut up and enjoy," he says. Postman agrees: "It's a great source of fiber, and it's a vehicle for healthy spreads."

Tip: Use celery as a "vehicle" for healthful toppings such as almond butter, peanut butter and raisins, or refried beans.

Recipe: Tangy Chicken Salad With Celery 3 Ways.

Per cup, raw: 16 calories 1.6 grams fiber


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D.C. Health Department issues measles alert

A woman infected with measles, a contagious and potentially dangerous disease, traveled through the District and Maryland after flying into Dulles International Airport, it was disclosed Monday.

The 27-year-old New Mexico resident landed at the airport Feb. 20 and left the region Feb. 22, from Baltimore-Washington International Marshall Airport. In between, D.C. Health Department officials said Monday, she spent time in the District, apparently in Georgetown and Columbia Heights.

The city Health Department said people exposed to measles should determine whether they have received two doses of measles vaccine. Those who have not or who show symptoms should contact their health-care providers, the department said.

People with measles should stay home for four days after the characteristic rash appears, the health department said. Other symptoms include fever, redness of the eye and a cough.

The department said that on Feb. 21, between 10:30 a.m. and 2:30 p.m., the woman apparently went from Georgetown to Columbia Heights, using buses on the D1 or D6 route for part of the trip. She apparently returned between 1:30 p.m. and 5:30 p.m. on an S2 or S4 bus, the health department said.

In Columbia Heights, the department said, she might have been at the Potbelly Sandwich Shop in the 1400 block of Irving Street NW.

Dr. Maggi Gallaher, medical director of the public health division of the New Mexico Health Department, said the woman apparently was exposed to measles while in Europe. She flew from BWI to Denver, and then to Albuquerque, Gallaher said.

She was hospitalized for a few days in New Mexico but is recovering at home, Gallaher said.

Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, said alerts sent out "a couple of dozen" times a year call attention to possible exposure to travelers with measles.

It is "a testament to the importance of making sure we're all vaccinated," he said.


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Friday, June 14, 2013

Patients find plenty of health information on line, but not all of it is reliable

The Internet has no equal as an information storehouse. The trick is to know how to get right to a source of useful information and not waste time on Web sites that are biased, trying to sell you something or just plain wrong.

Marvin M. Lipman, Consumers Union's chief medical adviser, recalls having a patient who made a Google search and somehow settled on an abdominal aortic aneurysm (a worrisome bulge in the body's main blood vessel) as the logical explanation for his midback pain. No reassuring on Lipman's part eased the patient's apprehension. It took a sonogram to convince him he wasn't at death's door.

Lipman had another patient who was referred to him after her primary-care physician told her she had Graves' disease (an overactive thyroid). She arrived for her appointment armed with computer printouts of useful, accurate information and fully prepared to discuss the pros and cons of treatment options for her problem.

Lipman says that nothing has changed the doctor-patient relationship as radically during his career as the Internet. As recently as 1995, about one in 10 American adults had online access; today, about three of four adults and just shy of 100 percent of teenagers use the Internet to get information and communicate with others, according to the Pew Research Center. The one-way flow of health information from doctor to patient is now a dialogue, or even, at times, a debate.

Caveatemptor.com

Google and Yahoo are among the most-used search engines. But almost anyone can pay these Web sites to display advertisements, or "sponsored links." And anyone with something to sell can set up a Web site with few if any checks and balances on what it says.

While information sites such as AOL sometimes post paid links, many links are nothing more than ads for individual products. By searching Google for "flu symptoms," for example, ads may pop up for Kleenex, Tylenol and the homeopathic preparation called Oscillococcinum.

The top "natural" (i.e., unpaid) search results might also include some sites marketing a specific product. For instance, a recent Google search on "enlarged prostate" yielded information from the Mayo Clinic and the National Institutes of Health but also the Web site for an unproven herbal product.

The other dots

You can also find health information on the generally commercial-free government Web sites (with addresses that end in ".gov") and academic ones (".edu").

Some not-for-profit organizations run Web sites (".org") that are ad-free, including ConsumerReportsHealth.org, which charges for some of its information, and some take advertising. Others are littered with advertising, and some are fronts for industries or manufacturers with a commercial agenda.

Consumers visiting an unfamiliar site should always check the "About Us" section for clues about who is funding the content.

Figuring out the pecking order among Web sites requires narrowing the choices to those that provide up-to-date, reliable and understandable information. Many qualify. No doubt your doctors can recommend personal favorites. This is Lipman's current Top 5 list:

www.cancer.gov for information about cancer.

www.cdc.gov for information about infectious diseases, travel medicine and epidemiology.

www.fda.gov for information about drugs.

www.medlineplus.gov for information about diseases.

www.usp.org for information about medicine and nutritional supplements.

(c) Copyright 2011. Consumers Union of United States Inc.


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Health insurers offer patients the option of paying extra for higher-priced care

When consumers and employers pick health plans, some increasingly are being offered a trade-off these days: They can get a hefty break on their premiums if they agree to pay more out-of-pocket when they use certain high-cost providers in their network or if they cut those providers out of their network altogether.

Blue Cross Blue Shield of Massachusetts this year introduced a "Hospital Choice Cost-Share" option. It tacks on extra charges when patients get certain services at 15 hospitals that the insurer says have higher costs than other providers. Patients pay an extra $1,000 for inpatient care or outpatient surgery at one of these hospitals, for example, and an extra $450 for high-tech imaging services.

Among the hospitals on the high-cost list are Harvard teaching hospitals Massachusetts General and Brigham and Women's in Boston as well as UMass Memorial Medical Center in Worcester.

Small businesses and individual policyholders who choose the new option can expect their premium increases to be reduced by half, to about 5 percent, says Jay McQuaide, a senior vice president at the insurer. "We believe our members can get the same quality of care in the lower-cost, high-value category," he says.

A report last year by Massachusetts Attorney General Martha Coakley found that although the prices negotiated between hospitals and insurers for services varied considerably, there was no correlation between higher prices and better quality of care.

Insurers say that businesses and individuals are increasingly interested in so-called "narrow" or "select" or "preferred" network plans. Like the BCBS of Massachusetts option, insurers generally first evaluate providers based on quality benchmarks. Those that meet standards are then segmented based on cost. Depending on the plan, pricier providers either don't make it into the network or are placed in tiers with higher out-of-pocket charges for consumers who use them.

Thomas Lee, a physician and the network president for Partners HealthCare, an integrated health-care system founded by Massachusetts General and Brigham and Women's hospitals, doesn't argue that people have to pay higher rates to get good care. Products such as Blue Cross's hospital choice option push providers to become more efficient, he says. "I don't think that's a bad thing."

The potential downside, he says, is that more-expensive hospitals often use the higher payments to subsidize less lucrative services, including burn units and pediatric mental health. When the market puts pressure on those higher payments, "what inevitably happens is that institutions look at what they're subsidizing and ask whether they can keep this going," he says.

That's a valid argument, but only up to a point, says Ha Tu, a senior health researcher at the Center for Studying Health System Change. "The difference in rates is not nearly explained by the subsidization of less profitable services or the teaching mission," she says.

For patients, the potential downside is that they may lose access to their doctors if they or their employers choose a plan with a narrower network. A doctor who only has admitting privileges at one of the higher-cost hospitals might not be a good choice for someone with the new Blue Cross plan, for example.

"The biggest thing is to educate consumers so they know what they're getting into," says Suzanne Curry, policy coordinator at Health Care for All, a Massachusetts-based consumer advocacy group.

In Minnesota, some people insured through HealthPartners have been getting an education in the new trade-offs. Last year the insurer introduced a network called Perform, which had only one difference from its other products: It excluded the Mayo Health System and its vaunted Mayo Clinic in Rochester. If any of the 34,000 customers in the Perform network want to include Mayo, their premiums could increase by up to 20 percent, says Andrea Walsh, executive vice president at HealthPartners.

Is it worth it? It depends on the situation. Barbara Gurstelle's older sister, Sally, died several years ago at age 50 after struggling for years with von Hippel-Lindau syndrome, a rare genetic disorder that causes abnormal blood vessel growth. Mayo Clinic doctors were the ones who finally were able to diagnose her illness. Over the years she received treatment elsewhere, but she returned to Mayo every so often for a workup. "It really contributed to her understanding of the disease," says Gurstelle, who lives near Minneapolis.

On the other hand, as a principal at a mid-size IT consulting firm who has taken part in trying to find affordable health insurance for the company, Gurstelle says she might be willing to accept Mayo as an out-of-network provider if the cost differential was big enough.

Her employees might agree. "Over time, employees faced with high out-of-pocket costs have become more willing to trade off some choice of providers for cost savings," says Tu.

Besides, networks aren't everything. "Most people want the option to go to Mayo, but if [a disease is] that bad a thing, you're going to find the money to go there anyway," Gurstelle says.

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail questions@kaiserhealthnews.org.


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Doctors try new models to push health insurers aside

Just about everyone agrees that the way we pay for primary care needs fixing. Under the current insurance model, doctors get paid for procedures and tests rather than for time spent with patients, which displeases doctors and patients alike and increases costs. Now some medical practices are sidelining health insurers entirely, instead charging patients a moderate membership fee each month. The approach gets a nod in the health-care overhaul law. But not everyone agrees it's the right way to go.

Seattle-based Qliance Medical Management's three clinics typically charge a patient about $65 a month for unlimited access to the practice's 12 physicians and nurse practitioners. (Fees vary depending on the level of service and the patient's age.) Office appointments last up to an hour, and clinics have evening and weekend hours, with e-mail and phone access to clinicians as well. Routine preventive care and many in-office procedures are free; patients pay for lab work and other outside services "at or near" cost, and they get discounts on many medications.

The average $700 to $800 per patient that Qliance receives annually in membership fees is up to three times more than a doctor in a standard insurance-based practice might make per patient, says Norm Wu, the company's president and chief executive. "So we can have a third the number of patients and get the same revenue per clinician, but with much less overhead," he says. The approach, he says, allows Qliance to funnel more money into the care itself - through longer office hours, for example, or better diagnostic equipment.

Bruce Henderson joined Qliance when its first clinic opened in 2007. Although at the time he had health insurance through his job, Henderson, now 63, was soon laid off. Now he pays Qliance $79 a month for primary care and carries a catastrophic medical plan with a $10,000 deductible, for which he pays $225 a month.

Henderson has high blood pressure, high cholesterol and Type 2 diabetes. Working with his Qliance doctor, he switched to lower-cost medications and reduced his monthly out-of-pocket costs from $500 to $100. He goes in regularly for blood work and exams to keep his diabetes in check. Periodically he also has early skin cancers removed and last month was in three times for a cyst removal. "The doctors will sit there with you as long as you need them to," he says. "They don't rush in and out."

A 2007 Washington state law encourages "innovative arrangements between patients and providers," such as direct-pay primary care.

There are 15 other direct-pay practices in Washington state, according to a 2010 report to the legislature from the state's insurance commissioner. Some are more conventional "concierge" practices, which are aimed at well-to-do patients, charging as much as $850 a month for personalized, high-touch services. But the biggest growth is in practices that charge fees in the $85 to $135 range, according to the report.

Although Washington state may be a hotbed of direct-pay activity, primary-care physicians in many other states are offering similar services. At Access Healthcare in Apex, N.C., for example, members pay $39 a month plus $20 per visit for unlimited primary-care services, says the practice's founder, Brian Forrest. Having run the subscription-based practice for 10 years, he is now expanding and expects the first franchises to open this summer.

Forrest, a physician, says that half of his clients have insurance, with their typical copayments for primary-care visits averaging $35 to $50. "For lots of insured patients, it's actually cheaper for them to see us," he says.

Washington state's representatives in Congress and its governor, Chris Gregoire (D), successfully pushed to involve direct-pay practices in the federal health-care overhaul. Under a provision in that law, insurers selling plans on the state-based insurance exchanges that will open in 2014 will be allowed to "provide coverage through a qualified direct primary care medical home plan . . . ."

As envisioned by Qliance, direct-pay practices like the one it operates will link to custom "wraparound" health insurance policies that would pick up where Qliance leaves off, providing specialist care, hospitalization and the like.

"What we're inventing here is a new relationship between primary care and insurance," says Garrison Bliss, chief medical officer for Qliance Medical Management. Patients would essentially have two monthly health-care fees: one that they'd pay to a doctor's office for their primary care and another they'd pay to an insurer for all their other care. Providing better primary care should reduce insurance claims for emergency care and hospitalization down the road, Qliance's Wu says.

This idea raises a host of questions, policy experts say, including how direct-pay primary-care practices could charge monthly fees for preventive care services that under the new law are supposed to be provided free.

Some experts have more fundamental reservations about this approach. While agreeing that the current payment model for primary care doesn't work very well, Robert Berenson, a fellow at the Urban Institute, says "it doesn't make any sense" to provide primary care outside the health insurance system. "This is not going to work for a lot of patients who can't afford the out-of-pocket subscriptions."

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail questions@kaiserhealthnews.org


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