StemCell Therapy

Primary care is where preventative medicine takes place. It is the job of your primary care provider or family doctor to help you prevent illness or disease from occurring. Your health and well-being is our No. 1 priority. Our goal is to protect you from disease, promote and maintain your good health and prevent disability or even death. Preventative medicine involves many things from the simple to the complex and from the young to the elderly.

As a primary care provider, it is my responsibility to manage my patients chronic medical conditions and provide information and education on how to prevent chronic illness. This is accomplished through resources and one-on-one teaching about healthy lifestyle choices and preventative screenings.

Starting with the very young, well-child examinations are vital to ensure the child is growing and developing as a normal child should. As a primary care provider, I measure developmental milestones with each year of age. These exams occur from the time the child is born until the adolescent becomes an adult at 18 years of age. Vision and hearing screening as well as immunizations are an important part of preventing disease and keeping children well. Dental screenings are essential to prevent cavities and other more serious mouth issues. Parents are educated on the proper nutrition, activities and healthy habits that will help children learn and grow. This is where prevention starts! Teaching children good healthy habits now prevents them from becoming obese, having type 2 diabetes, joint problems, cavities and many other ailments. Mental health screenings are also performed as children grow and become more like adults during their middle and high school years.

Young adults are the next area of focus for preventative medicine. Similar to children, hearing and vision screenings are performed and good dental health habits are encouraged by keeping regular checkups. Immunizations continue with young adults to include HPV, meningitis, TDAP and annual flu vaccines. Sexually transmitted disease screenings and PAP smears begin with young adults. Educating young adults on alcohol, tobacco and drugs continues. Many aspects of safety to prevent accident or injury are discussed as well. All of the education provided to children continues into adulthood, with emphasis on issues like diet, exercise and avoiding risky behaviors.

Middle age is another very important era where preventative medicine continues to build. In addition to the preventative topics already shared, patients now become more regularly engaged with regard to routine check-ups to monitor weight, blood pressure and blood work to screen for high cholesterol or even thyroid issues. Mammograms to screen for breast cancer, PSA levels/prostate exams to screen for prostate cancer, PAP smear exams for cervical cancer screening and annual immunizations are done. Chest X-rays and low dose CT scans of the lungs are completed for smokers and smoking cessation options are discussed and encouraged. Screening for alcohol abuse is involved as well.

As we continue to age and approach our senior years of life, preventative medicine remains crucial. Pneumonia and shingles vaccine are very important in this age group as these immunizations can help prevent these infections from occurring or reduces the severity if they do occur. In addition, DEXA scans to monitor bone density looking for osteoporosis begin. This is the top of the pyramid, so to speak, as all of the other things we taught the little ones in the very beginning of life are the base.

Preventative medicine expands throughout the lifespan from infancy to the elderly. There are many areas of prevention that I have not covered in this short article, so it is vital to have an appointment scheduled with your primary care provider or family physician. Your health truly is your wealth. Making routine visits with your primary care provider when you are healthy could prevent you from a long-term chronic illness in the future.

Dr. Lorina Zenz is a certified nurse practitioner with Lima Memorial Internal Medicine & Family Healthcare.

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Prevent issues through lifetime of medical care - The Lima News - Lima Ohio

When it comes to exercise, most of us think that we have to put on workout gear or break a sweat to count toward our cardio goals. Luckily, for the fitness-averse, research is proving that Lizzy Bennet had it right all along: All we really need is to go for a walk.

Extensive research proves that walking puts off heart disease, high blood pressure, and strokes. It can even help you live longer! A University College London meta-analysis found that walking reduced the chance of dying during the study period by 32 percent and the risk of cardiovascular events by 31 percent.

Think you need to power walk to get these results? Not quite. The positive results affected participants who walked as few as five and a half miles per week at a pace of about two miles per hour (thats thirty minutes per mile!). So even your casual strolls can do good for your heart.

Consistent walking prevents joint pain and your likelihood of getting painful arthritis and osteoporosis. An American College of Rheumatology study found that most adults with arthritis walk less than 1,500 steps a day (under one mile). Tripling this amount to 4,500 steps a day protected the participants from developing arthritic limitations. These dailystep goals are so doable that they can easily fit into your usual schedule.

Theres a reason whywalking it offis advisedand workswhen youre stressed. Walking reduces your stress hormones, and various studies, including research published in the American Journal of Preventative Medicine, have found that it also eases depression. In this study, women with mild to moderate depression who walked for two hundred minutes a week (about half an hour a day) experienced improved mental health, physical functioning, energy, and social skills. Even if you dont suffer from clinical depression or anxiety, walking can help lighten your worries and your mood.

Any form of exercise helps you maintain a healthy weight, but walking is an easy way to keep it in check. Researchersat Stanford University found that the amount of daily walking activity is strongly tied to obesity levels around the world. Cities where people have healthy walking habits (4,600-6,000 average daily steps) also have lower obesity levels.

On wishing to see her sister Jane, Lizzy tells her father,I do not wish to avoid the walk.The distance is nothing when one has a motive; only three miles. I shall be back by dinner." We should all take such a casual attitude toward a strollso walk with purpose to a healthier and happier you.

Photo Credit: YouTube

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Research Affirms the Health Benefits of Elizabeth Bennet's Favorite Exercise - Verily

As a child growing up, if she needed to see a doctor, it was Dr. James Gottfriedshe would visit. Now after graduating with her undergraduate from University of Kentucky and doctorate from Ohio University, Tinker is returning to her hometown to practice as a family physician alongside Gottfried.

As a family physician who started in her new position Monday, Tinker said she will take care of everyone from birth to the very end at geriatric age and everything in the middle, but that wasnt her original plan. In fact, when she started college, she planned on working with animals rather than people.

To be honest, I originally went to school to be a horse veterinarian, Tinker said. It is quite a change. So I started working as a veterinary technician in Kentucky and what I loved was when pets came in and the family was there. What I realized was I was really enjoying the human interaction I was getting.

Thats when she started thinking maybe working with people would be a good change.

So I started thinking about that and at the same time I was pretty interested in preventative medicine and eating well, eating properly to nourish the body on its own without a lot of other medicine, she said. So that just got me on the right track.

Tinker said shesreally excited to be living in and serving her home community.

As a family physician I do a lot of prevention and preventative care, she said.

I look forward to helping to improve the health of our community, whether that be eating better, exercising more, preventing the onset of chronic disease, making sure kids get all the immunizations needed (or) setting people up for a good, healthy life. Thats my main goal.

Tinker is accepting new patients and will serve with Dr. Gottfried at Northern Ohio Family Practice, a private physicians group which is able to do its own lab work, osteopathic manipulation (like chiropractic care) and other services in addition to the regular doctor visits. Nothern Ohio Family Practice is located at 257 Benedict Ave., Building C, Suit 1.

Tinker is available from 8 a.m. to 5 p.m. Monday, Tuesday and Friday; 8 a.m. to 8 p.m. Thursdays and from 8 a.m. to noon some Saturdays.

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Norwalk grad comes home as new family physician - Norwalk Reflector

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Theres been a lot of uncertainty about the possibilities for startup entrepreneurs in the healthcare sector. Biotech is too slow andtoo risky, the naysayers complain, to be a solid venture. Luckily, such old school cowardice is gradually being debunked. In an age where consumers are increasingly in control of theirhealth, the potential for startup success in theindustry has never been more real.

Related: 4 Ways Entrepreneurs Can Innovate in the Healthcare Space

Dr. Tonmoy Sharma didnt come to the United States to be an entrepreneur. By the time he joined the American Psychiatric Association in 2004, he had already studied medicine on three continents and had almost 20 years of experience as a physician. Dr. Sharma opened a six-bed facility to treat addiction in 2009, and now hes CEO of a booming healthcare business, Sovereign Health, thats changing the way addiction is treated. And its surpassed the national average in clinical effectiveness. "With all of the recognitions Sovereign Health has received over the past few years, says Veena Kumari, Sovereigns Chief Scientific Officer, I wasn't surprised to see such impressive clinical outcomes for Sovereign Health's programs.

But many are still surprised to see that successful healthcare and innovative entrepreneurialism have such a fertile overlap. Here are some reasons you should be thinking about making a move to the medical economy.

Theres venture capital looking for the next great startup right now. That money will find someone, and it could be you. The last quarter of 2015 saw 172 VC deals in the biotechnology and medical devices sectors, to the tune of $2 billion in investment capital. How quick is your math? Thats an average investment of about $11.6 million per deal.

If youve got a big idea for the world of medicine, and can organize a team of crackshot scientists(or maybe you have medical background and want to go into business), nows not the time to hold back. Get out there and start pitching for startup capital.

Related: 3 Mobile Solutions to Healthcare Industry Problems

Lets be honest, we dont need another Snapchat. What we do need are better vaccines, more cost-effective medicines, customer friendly healthcare systemsand preventative medicine for the underprivileged. Theres a humanitarian element to this, but theres also the fact that its simply good business. Before anything else, all successful businesses meet a need.

Consumers are increasingly interested in preventative maintenance and personal wellness. This presents myriad opportunities for nonmedical health sectors like the $16 billion yoga industry.

Innovating on the ground floor in wellness doesnt require a PhD, it just takes good business sense and a willingness to help people look out for their own health. How about an app that helps you find healthy options when youre dining out? HealthyOut beat you to that one, but keep thinking in that direction. The next great health and wellness idea is right around the corner.

The medical economy is stable. Healthcare expenses for the average American family are starting to level out. Theyre up by just 4.3 percent this year, the smallest increase the post-9/11 era has seen. This is good for consumers, although health care expenses still put a lot of pressure on most Americans and their employers.

Its also good for entrepreneurs, who can help consumers find ways to make their dollars work for them more efficiently. With good businesses working in their favor, costs dont need to be so high, and innovative companies can still be lucrative. The days of exploitative big pharma preying upon sick Americans are finally on the wane, and that means the little guy can step in and help clean up the mess.

Related: Healthcare Franchises May Be Just What the Doctor Ordered

We may not know what the future holds for Snapchat and Silicon Valley tech, but people will always need healthcare services --which means the healthcare industry isnt going anywhere either. Its a good sector to stake your claim in just for that. So when youre thinking about your next big idea, consider the possibilities in this overlooked dark horse of a startup sector. If you put your efforts to work in the healthcare industry, you just might find it rewarding in all the right ways.

Chirag Kulkarni is a serial entrepreneur and advisor. He is the CEO of Insightfully, which is using AI to discover what employees skills and passions are to reallocate human capital within the enterprise. He has also spoken at Accenture, In...

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3 Reasons Entrepreneurs Should Consider the Opportunities in Healthcare - Entrepreneur

As a child, I used to dread going for my annual checkup. Whether it was the anxiety of receiving shots or being poked and prodded, the lollipop at the end never really made up for the angst beforehand. With age comes wisdom, however, and I now understand why a health check is important for the human body to function properly.

In a security scenario, a health checkup has become indispensable, from basic patch hygiene to monitoring the configuration of a security information and event management (SIEM) solution itself. Thats why IBM Security and ScienceSoft have joined forces to introduce the Health Check Framework Manager app for IBM QRadar to help security analysts conduct checkups on their QRadar deployment.

The app allows access to set up and administrate the Health Check Framework (HCF) for IBM QRadar SIEM. The HCF helps analysts understand the state of QRadar performance to identify whether its flawless or has misconfigurations that may result in overlooked attacks on the IT environment.

The HCF monitors a variety of essential QRadar performance parameters through 60 operational metrics and 25 health markers. The solution delivers statistics such as as events per second (EPS) and flow per interval (FPI), event and flow timelines, and incoming log data quality according to a preset schedule or on demand.

Once the checkup is complete, the HCF automatically generates a comprehensive report and sends it to QRadar admins. The report delivers a detailed analysis of QRadars essential features, showing whether the parameters meet the baseline requirements. It also provides a clear vision of the deployment state and pinpoints anomalies to address.

Overall, the Health Check Framework Manager app delivers:

The HCF is a unique solution to review the QRadar operational state. Manual checks can consume unreasonable amounts of human effort and time, since the average number of events per second checked with QRadar can reach 10,000 or higher. Developing custom add-ons is more expensive compared to the HCF.

One recent high-level project involved delivering the HCF for QRadar to a big North American bank that services more than 15 million clients worldwide. The banks broad IT environment required an automated monitoring tool. The HCF and Manager app were installed to detect and report any deviations in the security network so the banks security team could respond quickly and prevent the instances of missed offenses.

Regular health checks are vital for any security tool to ensure proper functioning, so dont put off that checkup any longer. Make an appointment with the security doctor by downloading the new app on IBM Security App Exchange to integrate HCF and QRadar SIEM.

Watch the on-demand webinar: Improve Threat Visibility and Operational Efficiency

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Preventative Medicine: Get a Health Check for Your SIEM - Security Intelligence (blog)

A study done by the Johns Hopkins Bloomberg School of Public Health indicates that adults over age 60 and teens do about the same level of physical activity. According to the CDC, out of ten high school students, less than three do 60 minutes of physical activity a day. The same is true of older adults, raising concerns that both of these age groups are at risk for diabetes, heart disease, stroke, and other illnesses. This study backs up these findings.

The research gathered data from 12,529 individuals using information from the National Health and Nutritional Examination Surveys done in 2003-04 and 2005-06. During these surveys, individuals work activity monitoring devices for seven days except when in the shower or sleeping. The devices recorded all activity within that period. The end result showed that neither teens nor those over age 60 met the World Health Organizations physical activity guidelines.

These findings were published in Preventative Medicine on May 30, 2017.

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Diabetes Health in The News: Teens and 60-Year- Olds Do the Same Level of Physical Activity - Diabetes Health (press release)

LONDON Greater consumption of coffee could lead to a longer life, according to two new studies published Monday.

The findings have resurfaced the centuries-old conversation on coffees health effects.

One study surveyed more than 520,000 people in 10 European countries, making it the largest study to date on coffee and mortality, and found that drinking more coffee could significantly lower a persons risk of mortality.The second study was more novel, as it focused on non-white populations. After surveying over 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites, the researchers found that coffee increases longevity across various races.

People who drank two to four cups a day had an 18% lower risk of death compared with people who did not drink coffee, according to the study. These findings are consistent with previous studies that had looked at majority white populations, said Veronica Wendy Setiawan, associate professor of preventative medicine at USCs Keck School of Medicine, who led the study on nonwhite populations.

Given these very diverse populations, all these people have different lifestyles. They have very different dietary habits and different susceptibilities and we still find similar patterns, Setiawan said.

The new study shows that there is a stronger biological possibility for the relationship between coffee and longevity and found that mortality was inversely related to coffee consumption for heart disease, cancer, respiratory disease, stroke, diabetes and kidney disease.

The study on European countries revealed an inverse association between coffee and liver disease, suicide in men, cancer in women, digestive diseases and circulatory diseases. Those who drank three or more cups a day had a lower risk for all-cause death than people who did not drink coffee.

Both studies were published in the Annals of Internal Medicine.

We looked at multiple countries across Europe, where the way the population drinks coffee and prepares coffee is quite different, said Marc Gunter, reader in cancer epidemiology and prevention at Imperial Colleges School of Public Health in the UK, who co-authored the European study.

The fact that we saw the same relationships in different countries is kind of the implication that its something about coffee rather than its something about the way that coffee is prepared or the way its drunk, he said.

The biological benefits and caveats

Coffee is a complex mixture of compounds, some of which have been revealed in laboratories to have biological effects, Gunter said.

Studies have shown that certain compounds have neuroprotective and anti-inflammatory properties that can help reduce risk for illnesses like Parkinsons disease.

In the European study, people who were drinking coffee tended to have lower levels of inflammation, healthier lipid profiles and better glucose control compared with those who werent. It is still unclear which particular compounds provide health benefits, but Gunter said he would be interested in exploring this further.

Both studies separated smokers from nonsmokers, since smoking is known to reduce lifespan and is linked to various deceases. However, they found that coffee had inverse effects on mortality for smokers too.

Smoking doesnt seem to blunt the effects of coffee, Gunter said. It didnt matter whether you smoked or not. There was still a potential beneficial affect of coffee on mortality.

However, Dr. Alberto Ascherio, professor of Epidemiology and Nutrition at Harvard T.H. Chan School of Public Health, said people should be wary of this finding.

Even if it was in some way true, it doesnt make sense to me, because by smoking, you increase your mortality several-fold. Then, if you reduce it by 10% drinking coffee, give me a break, said Ascherio, who was not involved in the study.I think its a dangerous proposition because it suggests that a smoker can counteract the effects of smoking by drinking coffee, which is borderline insane.

The studies complement work that has been done on coffee and mortality, he said, and it has been reasonably documented that coffee drinkers have a lower risk of death.

With all observations from previous studies, however, its difficult to exclude the possibility that coffee drinkers are just healthier to begin with, Gunter said.

People who avoid coffee, particularly in places like the US and Europe where drinking the beverage is very common, may do so because they have health problems. Their higher mortality rate could be a result of them being less healthy to begin with.

I think that the solid conclusion is that if youre a coffee drinker, keep drinking your coffee and be happy, Ascherio said. And if youre not? I think you can go on drinking your tea or water without a problem.

Meanwhile, Gunter and Setiawan stand a bit more firmly on coffee as a health benefit.

The takeaway message would be that drinking a couple cups of coffee a day doesnt do you any harm, and actually, it might be doing you some good, he said.

Moderate coffee consumption can be incorporated into a healthy diet and lifestyle, Setiawan said. This studies and the previous studies suggest that for a majority of people, theres no long term harm from drinking coffee.

But as you know, the news on coffee has not always been positive. And the argument over the merits of your daily cup of joe dates back centuries. Lets take a look at the timeline.

1500s headline: Coffee leads to illegal sex

Legend has it that coffee was discovered by Kaldi, an Ethiopian goatherd, after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself. But it was the Arabs who first started coffeehouses, and thats where coffee got its first black mark.

Patrons of coffeehouses were said to be more likely to gamble and engage in criminally unorthodox sexual situations, according to author Ralph Hattox. By 1511 the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast believe it was more likely a reaction to the unpopular comments about his leadership. The ban didnt last long, says Pendergrast, adding that coffee became so important in Turkey that a lack of sufficient coffee provided grounds for a woman to seek a divorce.

1600s headline: Coffee cures alcoholism but causes impotence

As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasnt always safe to drink, so most men, women and even children drank the hard stuff.

Local ads such as this one in 1652 by coffee shop owner Pasqua Rose popularized coffees healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches and stomachaches, even prevent miscarriages.

But in London, women were concerned that their men were becoming impotent, and in 1674 The Womens Petition Against Coffee asked for the closing of all coffeehouses, saying in part: We find of late a very sensible Decay of that true Old English Vigour. Never did Men wear greater Breeches, or carry less in them

1700s headline: Coffee helps you work longer

By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.

1800s headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead

In the mid-1800s America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kelloggs Caramel Coffee and C.W. Posts Postum (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Posts ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.

1916 headline: Coffee stunts your growth

While inventions and improvements in coffee pots, filters and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.

Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffees impact on common aliments of the era, such as nervousness, heart palpitations, indigestion and insomnia.

1927 headline: Coffee will give you bad grades, kids

In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the startling fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.

1970s and 80s headline: Coffee is as serious as a heart attack

A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.

Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.

A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who dont consume coffee. But the study only asked questions every five years, and didnt isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or Doooonuts, if youre Homer Simpson.

Millennium headline: Coffee goes meta

Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, cant tip the balance one way or another. We take a look at some of the years. The results for coffee? Mostly good.

2001 headline: Coffee increases risk of urinary tract cancer

But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.

2007 headline: Coffee decreases risk of liver cancer

Some of these data analyses found preventive benefits for cancer from drinking coffee, such as this one, which showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.

2010 headline: Coffee and lung disease go together like coffee and smoking

A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.

2011 headline: Coffee reduces risk of stroke and prostate cancer

A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.

As for prostate cancer, this 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.

2012 headline: Coffee lowers risk of heart failure

More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.

2013 headline: Coffee lowers risk of heart disease and helps you live longer

For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasnt a higher risk among those who drank more than five cups a day.

How about coffees effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.

2015 headline: Coffee is practically a health food

As a sign of the times, the U.S. Department of Agriculture now agrees that coffee can be incorporated into a healthy lifestyle, especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar. You can read their analysis of the latest data on everything from diabetes to chronic disease here.

2017 headline: Yes, coffee still leads to a longer life

The largest study to date on coffee and mortality surveyed 520,000 people in 10 European countries and found that regularly drinking coffee could significantly lower the risk of death.

Another study with a focus on non-white populations and had similar findings. That study surveyed 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites. The varying lifestyles and dietary habits of the people observed in both studies led the authors to believe that coffees impact on longevity doesnt have to do with how its prepared or how people drink it it has to do with the beverages biological effect on the body.

But stay tuned. Theres sure to be another meta-study, and another opinion. Well keep you updated.

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Drinking More Coffee Leads to a Longer Life, Two Studies Say - wnep.com

NEGAUNEE TOWNSHIP, Mich. (WLUC) In the last decade, tobacco use has declined nationally, but the U.P. smoking rate of 23 percent remains higher than both state and national averages.

Tobacco's negative effects hit rural areas like the U.P. harder than urban ones, according to the Centers for Disease Control and Prevention. A CDC study found adolescents in rural regions begin smoking earlier than those in urban areas. That's a problem, since adolescents' brains are still developing and more vulnerable to addiction.

The likelihood for addiction is greater, said Dr. Kevin Piggot, a family and preventative medicine physician. So when you talk to most adults in regards to when they began smoking, they began in their teenage years.

As cigarette smoking declined, use of other tobacco products like e-cigarettes and chewing tobacco rose.

But we do know still nicotine is present, Dr. Piggot said. Nicotine is an addictive substance and the whole issue of becoming addicted results for many people in a lifelong use of that substance.

Experts said quitters who get both medication and therapy have the best chance of success. But those resources can be hard to find in some parts of the U.P.

If we look up here where we may not have active tobacco cessation classes going on, resources to counselors that can work with somebody quitting tobacco, then that can be a limitation, said Sarah Derwin, health educator at the Marquette County Health Department.

For a link to a list of cessation resources, click here.

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Tobacco use continues in UP - UpperMichigansSource.com

Tulane University scientists will get $12 million for animal studies to test drug combinations to treat Lassa fever and to develop a vaccine for the deadly virus, which can attack internal organs and cause bleeding from the mouth, nose and other places.

Tulane's medical school says a team led by Robert Garry is getting grants from the National Institutes of Health for two five-year studies.

One, getting $5.7 million, will evaluate a drug mixture to treat the virus, which is common in parts of West Africa. The other will provide $6.3 million to develop a vaccine based on a recently discovered possible target for antibodies on the surface of the virus, a news release Tuesday said.

"In West Africa, we need a drug to treat acutely infected patients as well as a preventative measure to stop it," said Garry, professor of microbiology and immunology at Tulane University School of Medicine. "Vaccine initiatives in rural Africa are difficult so you are never going to be able to vaccinate everyone. You need to be able to treat people when they get sick."

Some 100,000 to 300,000 people a year get sick from the virus, most often transmitted in food contaminated with rat feces or urine. About 5,000 of them die, according to the Centers for Disease Control and Prevention's website.

Garry said the vaccine will include both Lassa and Ebola fever glycoproteins surface structures that can be targeted to keep a virus from infecting host cells.

"Ebola is likely to come back, and Lassa isn't going away so you have to protect against both," Garry said. "We think we can do it with one shot."

The other project will test three antibodies that have done well in early animal studies, to see which mixtures work best. Tulane is working on this project with scientists at Zalgen Labs in Germantown, Maryland; The Scripps Research Institute in La Jolla, California; the University of Texas Medical Branch at Galveston and the Sanford Burnham Prebys Medical Discovery Institute in La Jolla.

___

Online:

Lassa fever: http://www.who.int/mediacentre/factsheets/fs179/en/

Medical school: http://www2.tulane.edu/som/

Centers for Disease Control and Prevention: https://www.cdc.gov/vhf/lassa/index.html

Excerpt from:
Tulane gets $12M for Lassa fever animal studies - Lexington Herald Leader

Preventive healthcare (alternately preventive medicine or prophylaxis) consists of measures taken for disease prevention, as opposed to disease treatment.[1] Just as health encompasses a variety of physical and mental states, so do disease and disability, which are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices. Health, disease, and disability are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.[1][2][3]

Each year, millions of people die of preventable deaths. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures.[4] Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases.[4] This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle.[4] According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, two thirds of this group from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases.[5] This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases.[5] Preventive healthcare is especially important given the worldwide rise in prevalence of chronic diseases and deaths from these diseases.

There are many methods for prevention of disease. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider.[6] Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer.[6] However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate.[7][8]

Preventive healthcare strategies are described as taking place at the primal, primary, secondary, and tertiary prevention levels. In the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention.[9] Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation",[9] though the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years,[10] more particularly in epigenetics, which point to the paramount importance of environmental conditions - both physical and affective - on the organism during its fetal and newborn life (or so-called primal life).[11]

A separate category of "health promotion" has recently been propounded. This health promotion par excellence is based on the 'new knowledge' in molecular biology, in particular on epigenetic knowledge, which points to how much affective - as well as physical - environment during fetal and newborn life may determine each and every aspect of adult health.[16][17][18] This new way of promoting health is now commonly called primal prevention.[19] It consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave[20] - ideally for both parents - with kin caregiving[21] and financial help where needed.

Primary prevention consists of traditional "health promotion" and "specific protection."[13] Health promotion activities are current, non-clinical life choices. For example, eating nutritious meals and exercising daily, that both prevent disease and create a sense of overall well-being. Preventing disease and creating overall well-being, prolongs our life expectancy.[13][1] Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level.[1] On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.[13] In the case of a sexually transmitted disease such as syphilis health promotion activities would include avoiding microorganisms by maintaining personal hygiene, routine check-up appointments with the doctor, general sex education, etc. whereas specific protective measures would be using prophylactics (such as condoms) during sex and avoiding sexual promiscuity.[1]

Food is very much the most basic tool in preventive health care. The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled [22] A "food desert" is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation .[23] There have been several grassroots movements in the past 20 years to encourage urban gardening, such as the GreenThumb organization in New York City. Urban gardening uses vacant lots to grow food for a neighborhood and is cultivated by the local residents.[24] Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods. These programs often hold educational events as well such as cooking and nutrition guidance.[25] Programs such as these are helping to provide healthy, affordable foods to the people who need them the most.

Scientific advancements in genetics have significantly contributed to the knowledge of hereditary diseases and have facilitated great progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.[1] Similarly, specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines (such as regular hand-washing) became mainstream upon the discovery of infectious disease agents such as bacteria. These discoveries have been instrumental in decreasing the rates of communicable diseases that are often spread in unsanitary conditions.[1]

Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease.[13] Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury[13] whereas secondary prevention aims to detect and treat a disease early on.[26] Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease.[1] For example, early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.[1]

Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.[1] Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.[26] For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.[1]

The leading cause of death in the United States was tobacco. However, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.[4]

The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.[27]

In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in the year 2000,[28] it is still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by the year 2015.[29] Of these deaths, about 64% were due to infection (including diarrhea, pneumonia, and malaria).[28] About 40% of these deaths occurred in neonates (children ages 128 days) due to pre-term birth complications.[29] The highest number of child deaths occurred in Africa and Southeast Asia.[28] In Africa, almost no progress has been made in reducing neonatal death since 1990.[29] India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths in 2010. Targeting efforts in these countries is essential to reducing the global child death rate.[28]

Child mortality is caused by a variety of factors including poverty, environmental hazards, and lack of maternal education.[30] The World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in the year 2000, assuming universal healthcare coverage.[30]

Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar. Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week.[31]Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Eating healthier and routinely exercising plays a huge role in reducing an individuals risk for type 2 diabetes. About 23.6 million people in the United States have diabetes. Of those, 17.9 million are diagnosed and 5.7 million are undiagnosed. Ninety to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults.[32]

STIs are hugely common both in our history and in today's society. Such infections can cause a range of symptoms from harmless to potentially lethal. Due to the fact that it is difficult to self-diagnose during the early stage of some STIs, it is imperative that primary and secondary prevention methods are used. Condom and other barrier use prevents the transmission of many STIs. But, for others such as syphilis, condom use will only protect a user when the chancre (or syphilitic sore) is located on the penis or in the vagina. Unfortunately, chancres can be found not only on the external genitals but on the anus, in the vagina or rectum, and on the lips or inside the mouth.[33] Due to this, prevention should focus not only on condom use, but on abstinence, picking a safe and reliable partner, and on regular screenings.

In recent years, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization.[34] However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer.[34]

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries.[35]Tobacco is an environmental carcinogen and the major underlying cause of lung cancer.[35] Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials.[36] Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death.[35] Therefore, prevention of tobacco use is paramount to prevention of lung cancer.

Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the US who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking.[36] Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy.[36]

Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs.[36]

Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and a $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state.[37]

Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products.[38] Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million.[38] Recommended actions to reduce tobacco use include: decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources.[38] In Wuhan, China, a 1998 school-based program, implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use.[39]

Skin cancer is the most common cancer in the United States.[40] The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States.[40] Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime.[40]

The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons.[40] Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure.[40] Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure.[40]

Most skin cancer and sun protection data comes from Australia and the United States.[41] An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries.[41] Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF)in order to get a tan.[41] Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary.[42][43][44] A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15.[45]

Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a pap test every 35 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada.[46]

In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed an almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer.[46]

Colorectal cancer (also called bowel cancer, colon cancer, or rectal cancer) is globally the second most common cancer in women and the third-most common in men,[47] and the fourth most common cause of cancer death after lung, stomach, and liver cancer,[48] having caused 715,000 deaths in 2010.[49]

It is also highly preventable; about 80 percent[50] of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat (see Colorectal cancer).

Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ)revealed health disparities in the United States. In the United States, elderly adults (>65 years old)received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people.[51] Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care.[51] Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications.[52]

These sorts of disparities and barriers exist worldwide as well. Oftentimes there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi.[53] Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher.[53] Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services.[54]

Overview

There is no general consensus as to whether or not preventive healthcare measures are cost-effective, but they increase the quality of life dramatically. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others argue in favor of "good value" or conferring significant health benefits even if the measures do not save money[7][55] Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health effects.[7]

A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death.[7] Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure.[7] These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure.[7] Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans.[56] Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources.[56]

While these specific services bring about small net savings not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs.[57][58] Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment.[59][60] Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized.[55]

Cohen et al. (2008) outline a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large.[8] The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits (in quality-adjusted life-years or QALY's) of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALY's.[61] In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease.[8] Cohen et al. (2008) suggest that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.[8]

Cost-Effectiveness of Childhood Obesity Interventions

There are at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies.[62] They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis (CEA) has led to a better understanding of projected cost reductions and improved health outcomes.[63][64] The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions.[62]

Gortmaker, S.L. et al. (2015) states: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote 50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)."

The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion US dollars and 80 million US dollars, respectively.

Some challenges with evaluating the effectiveness of child obesity interventions include:

The health economics of preventive care in the US

The cost-effectiveness of preventive care is highly debated topic. While some economists argue that preventive care is valuable and potentially cost savings, others believe it is an inefficient waste of resources.[68] Preventive care is mostly composed of annual doctors check-ups, annual immunization, and wellness programs.

The Affordable Care Act and Preventive Healthcare

The Patient Protection and Affordable Care Act also know as just the Affordable Care Act or Obamacare was passed and became law in the United States on March 23, 2010.[69] The finalized and newly ratified law was to address my issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs.[70] Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents plan until the age of 26, expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances and insurance companies were to include coverage for preventive health care services. [71] The U.S. Preventive Services Task Force has categorized and rated preventative health services as either A or B, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage they have also provided many recommendations to clinicians and insurers to promote better preventative care to ultimately provide better quality of care and lower the burden of costs. [72]

Health insurance and Preventive Care

Healthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life.[73] Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act, specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the US Preventive Services Task Force free of charge to patients.[74][75] For example, UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage.[76]

Evaluating Incremental Benefits of Preventive Care

Evaluating the incremental benefits of preventive care requires longer period of time when compared to acute ill patients. Inputs into the model such as, discounting rate and time horizon can have significant effects of the results. One controversial subject is use of 10-year time frame to assess cost effectiveness of diabetes preventive services by the Congressional Budget Office.[77]

The preventive care services mainly focuses on chronic disease,[78] the Congressional Budget Office has provided guidance that further research in the area of the economic impacts of obesity in the US before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015, recognizes that the potential of the preventive care to improve patients health at individual and population levels while decreasing the healthcare expenditure.[79]

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Track 1:Pain Management and Rehabilitation

The specialty of Pain Medicine, or Algiatry, is a discipline within the field of medicine that is concerned with the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. The typical pain management team includesmedical practitioners,Pharmacists, Clinical Psychologist, occupational therapists, physician assistant, nurse practitioners and clinical nurse specialists. Pain can be managed using pharmacological or interventional procedures by usingpain reliefs. There are many interventional procedures typically used forchronic back paininclude epidural steroid injections, facet joint Injections, neurolytic blocks, spinal cord stimulators and intrathecal drug delivery system implants. The Management goals when treatingback painare to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individuals ability to function in everyday activities, to help the patient cope with residual pain, to assess for side effects of therapy, and to facilitate the patients passage through the legal and socioeconomic impediments to recovery. For many the goal is to keep the pain to a manageable level to progress with rehabilitation, which can then lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.Migrainestypically present with self-limited, recurrent severe headacheassociated with autonomic symptoms. About 15-30% of people with migraines experience migraines with an aura. And those who have migraines with aura also frequently have migraines without aura. There are four possible phases of Headache: The prodrome, which occur hours or days before the headache, Theaura, which immediately precedes the headache, The pain phase also known as headache phase, The postdrome, the effects experienced following the end of a migraine attack.

Related Conferences of Pain Management and Rehabilitation:

2nd World Congress and Exhibition on Antibiotics and Antibiotic Resistance, October 13-15, 2016 Manchester, UK; 8th Annual Pharma Middle East Congress, October 10-12, 2016 Dubai, UAE; International Conference on Pharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE; 5th International Conference and Exhibition on Pharmacology and Ethnopharmacology, March 27-29, 2017 Orlando, USA; World Congress on Biotherapeutics, May 25-26, 2017 Mexico city, Mexico; International Conference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th International Conferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting on Cardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE.

Track 2:NSAIDs & Analgesics

Nonsteroidal anti-inflammatory drugs are a drug class that groups together drugs that provide analgesic (pain-killing) and antipyretic (fever-reducing) effects, and, in higher doses, anti-inflammatory effects. The termnonsteroidaldistinguishes these drugs fromsteroids, which, among a broad range of other effects, have a similareicosanoid-depressing, anti-inflammatory action. First used in 1960, the term served to distance new drugs from steroid relatediatrogenictragedies. The most prominent members of this group of drugs,aspirin,ibuprofenandnaproxen, are all availableover the counterin most countries.Paracetamol (acetaminophen) is generally not considered an NSAID because it has only little anti-inflammatory activity. It treats pain mainly by blocking COX-2 mostly in the central nervous system, but not much in the rest of the body. Most NSAIDs inhibit the activity ofcyclooxygenase-1 (COX-1) andcyclooxygenase-2 (COX-2), and thereby, the synthesis ofprostaglandinsandthromboxanes. It is thought that inhibiting COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects and that those NSAIDs also inhibiting COX-1, particularly aspirin, may cause gastrointestinal bleeding and ulcers.

Ananalgesicorpainkilleris any member of the group ofdrugsused to achieve analgesia, relief frompain. Analgesic drugs act in various ways on theperipheralandcentralnervous systems. They are distinct fromanesthetics, which temporarily affect, and in some instances completely eliminate,sensation. Analgesics includeparacetamol(known in North America asacetaminophenor simply APAP), thenon-steroidal anti-inflammatory drugs(NSAIDs) such as thesalicylates, andopioiddrugs such asmorphineandoxycodone. In choosing analgesics, the severity and response to other medication determines the choice of agent; theWorld Health Organization(WHO)pain ladder specifies mild analgesics as its first step. Analgesic choice is also determined by the type of pain: Forneuropathic pain, traditional analgesics are less effective, and there is often benefit from classes of drugs that are not normally considered analgesics, such astricyclic antidepressantsandanticonvulsants.

Related Conferences of Classification of Pain Relief Analgesics:

7th Annual Global Pharma, August 22-24, 2016 New Orleans, Louisiana, USA; Conference on Pharmacovigilance & Pharmaceutical Industry, August 22-24, 2016 Vienna, Austria; Conference on Pharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; Conference on Drug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference on Neuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference on Biopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference on Pharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 3:Physical and Physiological Approaches in Pain Medicine

Pain medicineandrehabilitationemploys numerous physical techniques like thermal agents and electrotherapy, such as therapeutic exercise and behavioral medical care, traditional pharmacotherapy to treat pain, sometimes as a district of knowledge domain or multidisciplinary program Transcutaneous electrical nerve stimulation has been found to be ineffective forlower back pain, but it would facilitate withdiabetic neuropathy.Acupuncture involves the insertion and manipulation of needles into specific points on the body to alleviate pain or for therapeutic functions. Research has not found proof that light therapy like low level optical device medical care is a good medical care forpain reliefCognitive behavioral Therapy(CBT) for pain helps patients with pain to know the link between one's physiology (e.g., pain and muscle tension), thoughts, emotions, and behaviors. A meta-analysis of studies that used techniques targeted around the thought of mindfulness, concluded, "Findings counsel that MBIs decrease the intensity of pain forchronic painpatients." Occupational therapists could use a range of interventions as well as training program, relaxation, goal setting, drawback determination, planning, and carry this out at intervals each cluster and individual settings. Therapists may go at intervals a clinic setting, or within the community as well as the work, school, home and health care centers. Activity therapists could assess activity performance before and when intervention, as a live of effectiveness and reduction in disability.

Related Conferences of Physical and Physiological Approaches in Pain Medicine:

InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th InternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE. Conference on Pharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; Conference onDrug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 4:Anesthesia as Pain Drug

In the practice ofmedicine(especiallysurgery) anddentistry,anesthesia is a temporary induced state with one or more ofanalgesia (relief from or prevention ofpain),paralysis(muscle relaxation),amnesia(loss of memory), andunconsciousness. Apatientunder the effects of anestheticdrugs is referred to as beinganesthetized. Anesthesia is freedom from pain. Each year, millions of people in the United States undergo some form of medical treatment requiring anesthesia. Anesthesia, in the hands of qualified professionals like Certified Registered Nurse Anesthetists (CRNAs), is a safe and effective means of alleviating pain during nearly every type of medical procedure. Anesthesia care is not confined to surgery alone. The process also refers to activities that take place both before and after an anesthetic is given. In the majority of cases, anesthesia is administered by a CRNA. CRNAs work with your surgeon, dentist or podiatrist, and may work with an anesthesiologist (physician anesthetist). CRNAs are advanced practice registered nurses with specialized graduate-level education in anesthesiology. For more than 150 years, nurse anesthetists have been administering anesthesia in all types of surgical cases, using all anesthetic techniques and practicing in every setting in which anesthesia is administered. Anesthesia enables the painless performance of medical procedures that would cause severe or intolerable pain to an un-anesthetized patient.

Related Conferences ofAnesthesia:

Conference and Exhibition onPharmacology and Ethnopharmacology, March 27-29, 2017 Orlando, USA; World Congress on Biotherapeutics, May 25-26, 2017 Mexico city, Mexico; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th InternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting on Cardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE; 7th AnnualGlobal Pharma, August 22-24, 2016 New Orleans, Louisiana, USA; Conference on Pharmacovigilance & Pharmaceutical Industry, August 22-24, 2016 Vienna, Austria; Conference on Pharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France.

Track 5:Pain Syndrome

Carpal tunnel syndrome(CTS) may be a medical condition within which the median nerve is compressed because it travels through the carpus at the carpal tunnel and causes pain, symptom and tingling, within a part of the hand that receives sensation from the median nerve.Piriformis syndromemay be a neuromuscular disorder that happens once the Sciatic nerve is compressed or otherwise irritated by the piriformis muscle inflicting pain, tingling and symptom within the buttocks and on the trail of the nerve descending the lower thigh and into the leg. Complex regional pain syndrome (CRPS) it's a chronic general un-wellness characterized by severe pain, swelling, and changes within the skin. CRPS usually worsens over time. it's going to at the start associate effect on} an arm or leg and unfold throughout the body; thirty fifth of individuals report symptoms throughout their whole body. Alternative potential effects include: general involuntary dysregulation; animal tissue edema; system, endocrine, or medical specialty manifestations; and changes in urological or gi operate.Central pain syndrome may be a neurologic condition caused by injury or malfunction within the Central system (CNS) that causes a sensitization of the pain system. The extent of pain and also the area unit as affected are associated with the reason behind the injury. Compartment syndrome is augmented pressure inside one in all the body's compartments that contains muscles and nerves. Compartment syndrome most typically happens in compartments within the leg or arm. There are unit 2 main sorts of compartment syndrome:acuteandchronic. Fibromyalgia(FM) may be a medical condition characterized by chronic widespread pain and a heightened and painful response to pressure. Symptoms apart from pain might occur, resulting in the utilization of the term Fibromyalgia syndrome (FMS). Alternative symptoms embrace feeling tired to a degree that ordinary activities area unit affected, sleep disturbance, and joint stiffness. Some folks additionally report problem with swallowing bowl and bladder abnormalities.

Related Conferences of Pain Syndrome:

Conference onDrug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 6:Pharmacological Approaches for Pain

There are several pharmacological interventions that may be accustomed manage pain in arthritis. However, in choosing the acceptable approach, the practitioner must take into account to consider the efficacy. Adverse side effects, dosing frequency, patient preference, and cost in choosing medication for pain management. When a patient develops the primary signs of an inflammatory arthritis, the most priority is symptom relief, with pain being the cardinal sign of inflammation that patients most wish facilitate with. However, it has become more and more clear that for inflammatory arthropathies like RA merely treating the symptoms with non- Steroidal anti- inflammatory drugs (NSAIDs) or analgesics in adequate, because features of the disease that lead to damage to the joints, and then to disability will carry on uncheck. In addition to symptoms relieving drugs, patients also need disease-modifying pain drugs that have been demonstrated to slow down or stop the damaging aspects of disease There are two aims in the pharmacological treatment; firstly to reduce inflammation or modulate the auto immune response and secondly to modulate the pain response. Medications is thought-about in 5 classes: simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), Disease modifying anti-rheumatic-drugs (DMARDS), Steroids, Biologics and other relevant Adjuvant analgesics (ex. antiepileptic and antidepressants used for pain relief).

Related Conferences of Physical and Physiological Approaches in Pain Medicine:

InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th InternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE. Conference onPharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; Conference onDrug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 7:Pain Management Specialist

To a certain extent, medical practitioners have always been specialized. Specialization was common among Roman physicians. The particular system of modern medical specialties evolved gradually during the 19th century. Informal social recognition of medical specialization evolved before the formal legal system. The particular subdivision of the practice of medicine into various specialties varies from country to country, and is somewhat arbitrary. Currently, there is no single field of medicine or health care that represents the preferred approach to pain management. Indeed, the premise of pain management is that a highly multidisciplinary approach is essential. Pain management specialists are most commonly found in the following disciplines:Physiatry (also called Physical medicine and rehabilitation),Anesthesiology,Interventional radiology,Physical therapy. Specialists in psychology, psychiatry, behavioral science, and other areas may also play an important role in a comprehensive pain management program. Selection of the most appropriate type of health professional - or team of health professionals - largely depends on the patient's symptoms and the length of time the symptoms have been present.

Related Conferences ofPain Management Specialist:

Conference and Exhibition onPharmacology and Ethnopharmacology, March 27-29, 2017 Orlando, USA; WorldCongress on Biotherapeutics, May 25-26, 2017 Mexico city, Mexico; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9thInternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 8:Chronic Pain and Prevention

Chronic painispainthat lasts a drawn-out time. In medication, the excellence betweenacute painand chronic pain has historically has been determined by an discretional interval of your time since onset; the 2 most typically used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at twelve months.Electrical Nerve Stimulationfor Chronic Pain may be a procedure that uses AN electrical current to treat chronicpain managementPeripheral nerve stimulation (PNS) space 2 varieties of electrical nerve stimulation. In either, atiny low generator sends electrical pulses to the nerves (In peripheral nerve stimulation) or to the funiculus (in funiculus stimulation) These pulses interfere with the nerve impulses that cause you to feel pain.

Related Conferences of Chronic Pain Management:

Conference and Exhibition onPharmacology and Ethnopharmacology, March 27-29, 2017 Orlando, USA; WorldCongress on Biotherapeutics, May 25-26, 2017 Mexico city, Mexico; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9thInternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE; 7th AnnualGlobal Pharma, August 22-24, 2016 New Orleans, Louisiana, USA; Conference onPharmacovigilance & Pharmaceutical Industry, August 22-24, 2016 Vienna, Austria; Conference onPharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France.

Track 9: Pain Medications

Narcoticsalso referred to asopioidpain relievers are used only for pain that's severe and is not helped by other forms of painkillers. When used rigorously and underneath a doctor's direct care, these medications are often effective at reducing pain. Narcotics work by binding to receptors into the brain that blocks the sensation of pain. When used rigorously and underneath a doctor's direct care, they'll be effective at reducing pain. Antidepressant medication for treatment of depression as well as other different disorders that will occur alone or together with depression, likechronic pain,sleep disorders, oranxiety disorders.Antidepressantsare medication used for the treatment of major depressive disorder and different conditions, chronic pain and neuropathic pain. Anticonvulsants, or anti-seizure medications, work as adjuvant analgesics. In different words, they can treat some forms of chronic pain even if they're not designed for that purpose. whereas the most use ofanti-seizuremedication is preventing seizures,anticonvulsantsdo seem to be effective at treating certain forms of chronic pain. These include neuropathic pain, like peripheral neuropathy, and chronic headaches like migraines.

Related Conferences ofPain Medications:

Conference onDrug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 10:Pain Management Nursing

PerianesthesiaNursingcould be a nursing specialty practice area involved with providing medical care to patients undergoing or convalescent fromanesthesia. Perianesthesia nursing encompasses many subspecialty observe space and represents a various range of practice environment and skill sets. Pain managementnurses are typically thought-about to be perianesthesia nurses, given the cooperative nature of their work with anesthetists and also thefact that a large proportion of acute pain issues are surgery related. However, distinct pain management certifications exist through the American Society forPain ManagementNurses.

Related Conferences ofPain Management Nursing:

InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th InternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE. Conference onPharmacognosy, Phytochemistry & Natural Products, August 29-31, 2016 Sao Paulo, Brazil; Conference onDrug Formulation & Bioavailability, September 05-06, 2016 Beijing, China; Conference onNeuropharmacology, September 14-16, 2016 San Antonio, Texas, USA; Conference onBiopharmaceutics and Biologic Drugs, September 14-16, 2016 San Antonio, Texas, USA; Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE.

Track 11:Orofacial Pain

Orofaical painis a general term covering anypainwhich is felt in the mouth, jaws and the face. Orofacial pain is a commonsymptom, and there are many causes.Orofacial pain has been defined as "pain localized to the region above the neck, in front of the ears and below theorbitomeatal line, as well as pain within theoral cavity,pain of dental origin and temporomandibular disorders".It is estimated that over 95% of cases of orofacial pain result from dental causes (i.e.toothachecaused bypulpitisor adental abscess).However, some orofacial pain conditions may involve areas outside this region, e.g. temporal pain in TMD. Toothache, or odontalgia, is any pain perceived in the teeth or their supporting structures (i.e. theperiodontium). Toothache is therefore a type of orofacial pain.Craniofacialpain is an overlapping topic which includes pain perceived in the head, face, and related structures, sometimes includingneck pain.All other causes of orofacial pain are rare in comparison, although the fulldifferential diagnosisis extensive.

Related Conferences ofOrofacial Pain:

2nd World Congress and Exhibition onAntibiotics and Antibiotic Resistance, October 13-15, 2016 Manchester, UK; 8th AnnualPharma Middle East Congress, October 10-12, 2016 Dubai, UAE; International Conference onPharmaceutical Method Development and Validation, November 24-25, 2016 Dubai, UAE; 5thInternational Conference and Exhibition onPharmacology and Ethnopharmacology, March 27-29, 2017 Orlando, USA; WorldCongress on Biotherapeutics, May 25-26, 2017 Mexico city, Mexico; InternationalConference on Biotech Pharmaceuticals, October 23-25, 2017 Paris, France; 9th InternationalConferences on Immunopharmacology and Immunotoxicology, November 20-22, 2017 Melbourne, Australia; 6th Global Experts Meeting onCardiovascular Pharmacology and Cardiac Medications, April 13-14, 2017 Dubai, UAE.

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Background: Vitamin and mineral supplements are commonly used to prevent chronic diseases.

Purpose: To systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer.

Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2005 to 29 January 2013, with manual searches of reference lists and gray literature.

Study Selection: Two investigators independently selected and reviewed fair- and good-quality trials for benefit and fair- and good-quality trials and observational studies for harms.

Data Extraction: Dual quality assessments and data abstraction.

Data Synthesis: Two large trials (n= 27658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.93 [95% CI, 0.87 to 0.99]). The study that included women showed no effect in that group. High-quality studies (k= 24; n= 324 653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor -carotene prevented CVD or cancer, and -carotene increased lung cancer risk in smokers.

Limitations: The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.

Conclusion: Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

Primary Funding Source: Agency for Healthcare Research and Quality.

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Recommended Preventative Medicine Guidelines for Giraffe (Giraffa camelopardalis sp.),

Preventative medicine is key to providing long-term health care for all animals, including giraffe (Giraffa camelopardalis sp.). Use of a preventative program helps to avoid intra- and inter- specific infectious disease, developmental problems, and in the long term management is cost effective.

Giraffe are commonly kept in zoological facilities and generally present few problems. In many instances however, giraffe can be difficult to clinically manage, due to the mechanics of dealing with a megavertebrates. Operant conditioning, even with limited physical facilities, may assist with the evaluation of captive giraffe and is encouraged. A preventative health care plan should also address the social and psychological needs og the individuals and the group as a whole. Activities that stimulate normal behaviors have beneficial physical effects on the animals and make for better display animals as well. Use of browse is strongly encouraged for this and other health effects addressed in the nutritional section.

Giraffe are difficult animals to physically examine due to the inherent dangers of manual and chemical restraint.1-3 In general, current recommendations advise against yearly immobilization for physical examinations until safe methods for routine sedation and handling are defined. When performed, a physical examination should include;

1. Visual examination during normal ambulation for symmetry, gait, and overall appearance.

2. Verification of permanent identification (microchip, tattoo, ear tag, patterning, etc.).

3. Physical examination to include auscultation, hoof condition and wear, ophthalmic and aural exam, visual assessment of the external genitalia, haircoat density, dental assessment, EKG when possible, etc.

4. Clinicopathologic assessment;

A. Bloodwork to include:

a. Complete blood count

b. Serum chemistry panel

c. Mineral panel

d. Serology to include Leptospirosis sp (17 serovar panel- Appendix II), Malignant Catarrhal Fever, Bluetongue, Brucellosis, M. paratuberculosis, and New World West Nile virus status.

B. Routine urinalysis.

5. Estimated or actual weight.

6. Fecal analyses

A. Parasite screen- fecal flotation, direct.

B. Enteric pathogen screen; salmonella, campylobacter

C. Mycobacterium paratuberculosis surveillance- 3 fecal cultures (see Appendix).

7. Tuberculosis (TB) test- intradermal testing can be performed in the caudal tail fold with 0.1cc Bovine PPD as opportunity arises. It is not currently recommended to immobilize giraffe on a routine basis for tuberculosis screening unless clinical signs support testing, a history of tuberculosis in the herd warrants screening, or impending shipment is to occur.

8. Recommended vaccinations-

A. Giraffe are susceptible to Clostridium tetani.4 Vaccination with tetanus toxoid should be performed every other year or opportunistically.

B. Other vaccination for infectious disease (Leptospirosis sp., rabies, etc.) is left to the discretion of the institutions and perceived risks. There are no reported infections with New World West Nile virus in giraffe and vaccination is not recommended at this time.

9. Prophylactic treatments as needed

A. Ivermectin

B. Vitamin E/Selenium

C. Pyrantel tartrate

D. Fenbendazole

10. Hoof trimming

A. Some animals can be conditioned to allow routine hoof trimming in a restraint. Hoof trimming should be performed as needed to prevent long-term problems.

Parasite Control

Routine fecal examination (minimum twice yearly) should be performed on all individuals. Persistent parasitemia should be addressed with rotational anthelmintics based on a comprehensive parasite program.5-6 Larval drug resistance can be determined prior to developing any deworming program as resistance has developed in giraffe herds in certain areas. Testing can be performed with Dr. Tom Craig at Texas A&M.

Literature cited

1. Bush, M. Anesthesia of high-risk animals: Giraffe. In: (Fowler, M.E., R.E. Miller, eds.) Zoo and Wild Animal Medicine, Current Therapy 4. 1999. W.B. Saunders Co. Philadelphia, PA. Pp. 545-547.

2. Bush, M., D.G. Grobler, J.P. Raath, L.G. Phillips, M. A. Stamper and W.R. Lance. 2001. Use of medetomidine and ketamine for immobilization of free-ranging giraffes. J.A.V.M.A. 218(2): 245-249.

3. Fischer, M.T., R.E. Miller, and E.W. Houston. 1997. Serial tranquilization of a reticulated giraffe (Giraffa camelopardalis reticulata) using xylazine. J.Zoo Wildl. Med. 28(2): 182-184.

4. Nofs, S.A., T.A. Reichard, W. Shellabarger. 2002. Tetanus in a Reticulated giraffe (Giraffa camelopardalis reticulata): Observations and implications at the Toledo zoo. Proc. Am. Assoc. of Zoo Vet. Ann Conf., Milwaukwee, WI Pp. 186-190.

5. Isaza, R., G.V. Kollias. Designing a trichostrongyloid parasite control program for captive exotic ruminants. In (Fowler, M.E. and R.E. Miller, eds.). Zoo and Wild Animal Medicine. W.B. Saunders Co. Philadelphia, PA 593-597.

6. Young, K.E., J.M. Jensen, T.M. Craig. 2000. Evaluation of anthelmintic activity in captive wild ruminants by fecal egg reduction tests and a larval development assay. J. Zoo Wildl. Med. 31(3): 348-352.

Appendix I

1. Fecal specimen testing for M. paratuberculosis from giraffe.

a. Collect at least 3 grams of feces daily for 3 days. Refrigerate specimens until the third specimen is obtained, place in seal able baggies or large seal able plastic tubes, place on ice and ship via overnight express to;

Johnes Testing Center

University of Wisconsin

School of Veterinary Medicine

2015 Linden Drive, West Room 4230

Madison, WI 53706-1102

Phone (608) 265-6463

2. Serology specimens for M. paratuberculosis ELISA and AGID.

a. Collect 1cc of serum in sealable plastic tubes and send on ice to;

Johnes Testine Center

University of Wisconsin

School of Veterinary Medicine

2015 Linden Drive West, Room 4230

Madison, WI 53706-1102

Phone (608) 265-6463

Appendix II

1. Leptospire titers-

a. Collect 2cc of serum in seal able plastic tubes and send on ice sent to;

National Veterinary Services Laboratory

1800 Dayton Road

Ames, IA 50010

Phone (515) 663-7266

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Preventive Medicine, Integrative Medicine and the Health of the Public by David L. Katz, Ather Ali - IOM , 2009 This paper explores the overlap and potential synergies of integrative medicine and preventive medicine in the context of the levels of prevention, acknowledging the deficiency of research on the effectiveness of practice-based integrative care. (4224 views)

Guide to Clinical Preventive Services - U.S. Preventive Services Task Force , 2009 Use this book to quickly determine the most appropriate preventative care for your patients. Although quite voluminous, it does provide quick access as well as a thorough review of the recommended screening guidelines for health care maintenance. (4681 views)

Preventing Chronic Diseases: A Vital Investment - World Health Organization , 2005 WHO is launching a global report on chronic diseases, which presents the latest scientific information and makes the case for increased and urgent action for chronic disease prevention and control. The report reviews the burden of chronic diseases. (9399 views)

Preventing Drug Abuse among Children and Adolescents - National Institutes of Health , 2003 This edition presents the updated prevention principles, an overview of program planning, and critical steps for those learning about prevention. It is an introduction to research-based prevention for those new to the field of drug abuse prevention. (6894 views)

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Preventive Medicine offers rewarding, plentiful, diverse and challenging careers, plus:

Our Graduate Education & Careers section features descriptions of ACPM's activities in support of graduate medical education, a directory of all preventive medicine residency programs, and specific information for Residency Program Directors, current preventive medicine residents, and prospective preventive medicine residents.

OVERVIEW OF RESIDENCY TRAINING IN PREVENTIVE MEDICINEPreventive Medicine is an exciting specialty that links the knowledge and skills of clinical medicine with the special skill sets of medical management, research, and population health. Specialists work in diverse settings to promote health and to modify or eliminate the risks of disease, injury, disability, and death. Career paths include managed care, public health, occupational medicine, aerospace medicine, clinical medicine, informatics, policy development, academic medicine, international medicine, and research, covering all levels of government, educational institutions, organized medical care programs in industry, as well as voluntary health agencies and professional health organizations.

Preventive medicine is one of 24 recognized board certifications represented in the American Board of Medical Specialties (ABMS). Completion of residency training in preventive medicine is an essential step to become certified in one or more of the preventive medicine specialty areas: General Preventive Medicine/Public Health (referred to throughout the directory as GPM), Occupational Medicine (OM), and Aerospace Medicine (AM). There are currently 73 accredited Preventive Medicine residency training programs in the United States. Generally, programs are located in schools of medicine, schools of public health, state or local health departments, and in federal agencies (i.e., Centers for Disease Control) and military bases (i.e., Walter Reed Army Institute of Research). These programs are usually small and take an individualized approach to training. There are approximately 350 residents in training every year.

Residency program accreditation is accomplished through the Preventive Medicine Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME). The ACGME-RRC is the body which establishes accreditation requirements for residency programs and which reviews the programs to determine their compliance with the requirements.

Board certification is offered through the American Board of Preventive Medicine (ABPM). Established in 1948, ABPM is the body with responsibility for determining physician eligibility for certification and recertification in preventive medicine.

STRUCTURE OF AN ACCREDITED RESIDENCY PROGRAM IN PREVENTIVE MEDICINEIn addition to the knowledge of basic clinical sciences and skills common to all physicians, the distinctive aspects of preventive medicine include knowledge of and competence in these seven areas:

1) Application of biostatistical principles in methodology;

2)Recognition of epidemiological principles in methodology;

3)Planning, administration, and evaluation of health andmedical programs and the evaluation of outcomes ofhealth behavior and medical care;

4)Recognition, assessment, and control of environmentalhazards to health, including those of occupationalenvironments;

5)Recognition of the social, cultural, and behavioralfactors in medicine;

6)Application and evaluation of primary, secondary, andtertiary prevention, with specificity of these skills varying between General Preventive Medicine, Occupational Medicine and Aerospace Medicine; and

7)Assessment of population and individual health needs.

Prior to appointment in the program, residents must have successfully completed at least 12 months of clinical education in a residency program accredited by the ACGME, Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada. Resident experience must include at least 11 months of direct patient care in both inpatient and outpatient settings.

Residents should develop competency in the following fundamental clinical skills during this experience:

1) Obtaining a comprehensive medical history;

2) Performing a comprehensive physical examination;

3) Assessing a patients medical conditions;

4) Making appropriate use of diagnostic studies and tests;

5) Integrating information to develop a differential diagnosis; and

6) Developing, implementing, and evaluating a treatment plan.

The two year PM residency training includes didactics, clinical training, research, public health, and other population-based experiences.

The didactic training includes both residency-lead seminars, as well as the acquisition of a Masters in Public health or equivalent degree. Those residents entering with an appropriate degree enhance their didactics with additional coursework. Whether through a Masters in Public Health or other equivalent degree, prior to completion of the residency program, all residents must complete graduate level courses in epidemiology; biostatistics; health services management and administration; environmental health; and the behavioral aspects of health.

The practicum experiences take place across the two years of the residency, and include acquisition of skills in clinical and population prevention medicine. Examples of practicum experiences include: local, state and federal health departments, health maintenance organizations, peer review organizations, community and migrant health centers, occupational health clinics, industrial sites, regulatory agencies, NASA, and OSHA, research settings, to name a few. Please see "Examples of Preventive Medicine Training Opportunities" for more information.

COMBINED RESIDENCY TRAINING IN PREVENTIVE MEDICINE AND OTHER SPECIALTIESCombined residency training is designed to lead to board certification in each of the medical specialties providing training. Sometimes, combined training will reduce the length of training for both specialties by as much as one year. Since 1993, ABPM and the American Board of Internal Medicine (ABIM) have had in place formal, approved guidelines for combined training. This training is designed to lead to board certification in both preventive medicine and internal medicine, following four years of accredited residency training. Several programs also offer approved Family Medicine/Preventive Medicine training opportunities across four years.

Residencies which offer combined training programs must maintain their accreditation status through each specialty RRC. The ACGME does not accredit combined training programs of any kind.

RESIDENCY PROGRAM APPLICATION PROCESSYou should contact programs directly for further information and for application instructions. The program directors may also be able to provide you with names of specialists whom you could contact for information. For a list of Preventive Medicine (Public Health, General, Occupational and Aerospace) programs that participate in the Electronic Residency Application Service (ERAS) visit https://services.aamc.org/eras/erasstats/par/index.cfm.

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Resources for Medical Students - American College of ...

A Preventive Medicine specialist focuses on the health of individuals and defined populations in order to protect, promote and maintain health and well-being, and to prevent disease, disability and premature death. They may be a specialist in General Preventive Medicine, Public Health, Occupational Medicine or Aerospace Medicine. The distinctive components of Preventive Medicine include:

Specialty training required prior to Board Certification: Three years

To become certified in a particular subspecialty, a physician must be Board Certified by the American Board of Preventive Medicine and complete additional training as specified by the Member Board.

Addiction Medicine A Preventive Medicine physician who specializes in Addition Medicine is concerned with the prevention, evaluation, diagnosis, and treatment of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances including nicotine, alcohol, prescription medications and other licit and illicit drugs. Physicians specializing in this field also help family members whose health and functioning are affected by a loved ones substance use or addiction.

Excerpt from:
American Board of Preventive Medicine

The University of Michigan School of Public Health houses one of the oldest Preventive Medicine Residency programs in the country, dating back to 1969.

The central mission of the School of Public Health's residency in General Preventive Medicine and Public Health is to train highly-qualified physicians for careers in clinical preventive medicine and public health.

The mission is accomplished through the provision of rigorous academic course work resulting in a Master of Public Health degree in one of the following core areas of public health:

This mission is also accomplished by the provision of broad practicum experiences with concentrations in applied epidemiology, public health practice, and clinical preventive medicine, which are typically provided for populations with high levels of unmet health care needs.

The Public Health and General Preventive Medicine Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME) and prepares physicians for board eligibility by the American Board of Preventive Medicine.

Our resident, Dr. Courtland Keteyian (right), working in 2014 with Dr. Patricia Abott (left), the Director of Hillman Scholars in Nursing Innovation Program, on an MCubed project that combines sensor based technology into disease self-management interventions.

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Preventive Medicine Residency at the University of Michigan ...

The University of Maryland Baltimores (UMB) Preventive Medicine Residency (PMR) bears a history as one of the oldest and well-respected PMR programs. It is housed in the Department of Epidemiology and Public Health (EPH), previously Department of Epidemiology and Preventive Medicine, where a multidisciplinary team of outstanding physician experts is dedicated to training medical students, graduate students, and health professionals to improve the health of the public through the practice of preventive medicine.

The first department of preventive medicine in the United States was established at the University of Maryland at Baltimore (UMB) in 1833, and has been at the juncture of important events in the national and global history of preventive medicine. The (PMR) was established in 1965 to fill the aforementioned need to train physicians in preventive medicine and continues to train highly- qualified preventive medicine specialists, as demonstrated by the 100% passing rate on boards.

In the two-year PMR program, residents complete didactic, research, teaching, and field rotation activities, and earn a Master of Public Health (MPH) degree Epidemiology track. Both academic and practicum phases of the PMR are accredited by the Accreditation Council for Graduate Medical Education (ACGME) and fulfill the requirements for certification by the American Board of Preventive Medicine.

Distinguishing features of UMBs PMR program are 1) a research apprenticeship experience, in which residents assume progressive responsibility for planning, executing, and evaluating one or more research projects under close faculty supervision; and 2) a curriculum in Integrative Medicine incorporated in the training.

Our trained physicians, upon graduation, quickly assume leadership roles in health departments, federal agencies, and academic institutions.

Link:
Preventive Medicine Residency Program: Epidemiology ...