Insurers go to the people

From 2019, the changing pattern of provision of primary health care within the MHI. This was announced by the head of the organization of the MHI Federal Fund of obligatory medical insurance Svetlana Kravchuk. However, it is not a medical component, and the control of insurers, and feedback with patients.

All the years of the compulsory medical insurance system in the country, insurance companies have been criticized for the fact that their activity is no insurance component as such, they are engaged solely in the redistribution resulting from the Federal Fund and the least care about the protection of patients ‘ interests. And after the chamber has published the amounts used by the insurance companies on their own needs, and raised the issue of their exclusion from the system, talking about the fact that without them it is possible to do, started at the highest level. The point in this debate has put President Vladimir Putin declared that the current model should not be broken, and reformed.

The first step in reform was the creation of the Institute for insurance attorneys who have engaged in informing of insured persons. In particular, sending TEXT messages about the approaching time of passing the examination. Now the insurers intend to develop channels of feedback are insured with insurance representatives.

According to Kravchuk, the centre starting from January 2019 of the Federal project Development of primary health care the establishment of quality management systems of medical care and accompany the patient in the treatment process, including protection of his rights. And one of the main indicators of development of the project, the proportion of health facilities primary care, which will operate the contacts. This may be the post insurance representative, telephone, the terminal to communicate with the insurance company. In 2019 this share is expected to be 30.7 percent across Russia in 2020 47.8 percent, by 2024 73%.

Another indicator of the project the number of regions of Russia, which will open offices for the protection of the rights of the insured.In 2019 it will be developed under the legal framework, in 2020, similar offices will be opened in 36 regions in 2021 in 48 regions, and by 2024, all 85. The purpose of these offices work with citizens ‘ complaints, and the effectiveness of innovations will be the share of complaints resolved in the pretrial order. According FFOMS, today insurance companies decide out of court for more than 50% of conflict situations, and by 2020 this figure is expected to grow to 65.1% , to 2024, not less than 77%.

Changing approaches to the control of expert activities of insurance companies. Territorial funds responsibility monthly analysis of morbidity and mortality. With the growth of citizens for medical aid more than 10%, will impose control over the causes of such a surge. Insurers will be required to carry out the examination and to submit proposals to improve the quality of medical care. And health facilities to conduct analysis of the identified violations by the insurers and send them a plan of measures on elimination of violations. Expertise at all levels of care will create a system of management quality in each region, say in Ffose. Will decrease the incidence is unknown, but it is obvious that the amount of paperwork in hospitals will grow even more.

Irina Reznik

People with more knowledge about benefits of physical activity may also exercise more

Most people have a poor understanding of how much physical activity is good for you, and what health benefits such activity conveys. But the better your knowledge on these topics, the more physical activity you’re likely to get, according to a study published November 28, 2018 in the open-access journal PLOS ONE.

A study from Central Queensland University in Australia, led by Stephanie Schoeppe, surveyed 615 Australian adults about their physical activity as well as their level of knowledge about physical activity’s health benefits and the risks of inactivity. Based on their answers, each participant was assigned a ranking in four areas: knowing that physical activity is beneficial and inactivity is harmful; knowing that specific health conditions are related to inactivity; knowing how much physical activity is recommended; and applying this knowledge to one’s own risks. Participants were 24.4% male and 75.3% female, between 18 and 77 years old, with a median age of 43, and had a range of education levels and employment statuses relatively representative of the general Australian population.

While the vast majority (99.6%) of participants strongly agreed that physical activity is good for health, most were not aware of all the diseases associated with inactivity. On average, participants correctly identified 13.8 out of 22 diseases associated with a lack of physical activity. Moreover, 55.6% incorrectly answered how much physical activity is needed for health, and 80% of people failed to identify the probabilities of developing diseases without physical activity. A significant association was found between these scores on knowledge of the probabilities of inactivity-related diseases and how active a person was. Future research is needed to determine whether the results hold true equally between men and women, and whether the survey-based data correctly gauges a person’s true levels of physical activity.

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Dangerous ignorance: These cancer-symptoms disregard the majority of the people – Video

Cancers are diverse, their symptoms are extremely different. Many people are not aware of the signs, or take potential warning signs are not serious. This is mainly because that the symptoms for cancer are also often more benign diseases. However, through regular checkups and early start of treatment the chances of recovery could be significantly increased. These 5 signs of cancer you should not ignore:

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1. Persistent Cough. Cough is usually associated with a cold or a flu-like effect and is no cause for concern. Who but a persistent cough should undergo a more detailed examination – medical specialists advise: “most of the time a cough means cancer. But a persistent cough needs to be investigated to find out if it could be lung cancer,“ says Therese Bartholomew from the Cancer Prevention Center.

2. Persistent Heartburn. Heartburn can have many causes: for example, excessive Stress, or to fat and sweet food. The symptoms only occasionally, there is no reason to worry. However, continuous heartburn is an indication of the pharynx and larynx can be cancer.

3. Itchy Skin. The danger of moles, it is often underestimated: A mole can become a malignant melanoma develop – so a black skin cancer. There are signs: Persistent itching or Burning at the relevant point of Time. A person notice this symptoms, physicians recommend a visit to the skin doctor.

4. Blood in the stool. Blood in the stool can be numerous causes and most of them point to the more benign disease than cancer: Some of the main causes are hemorrhoids or minor tearing to the Mucous membrane. Specialists recommend a yearly examination of the stool from the age of about 50 years.

5. Swollen Lymph Nodes. Persistently swollen lymph nodes, not pain, may be an indication of cancer of the lymph nodes. In particular, if this pain persists-free swelling over a longer period of time and not back. A medical examination is therefore recommended.

New service in south London reduces hospital readmissions for people with bipolar disorder

A new specialist programme at South London and Maudsley NHS Foundation Trust (SLaM) has been shown to significantly reduce the rate of hospital readmissions for people with bipolar disorder, in an early-stage audit funded by the NIHR Maudsley Biomedical Research Centre. The findings have been published in BJPsych Bulletin today.

Bipolar disorder is a condition in which an individual experiences recurrent episodes of mania, hypomania and depression. Bipolar disorder is fairly common: one in 50 adults will be diagnosed with the condition. An initial three-year audit of admissions at South London and Maudsley NHS Foundation Trust showed that there were approximately 500 hospital admissions of people with bipolar disorder each year. Two-thirds of these were re-admissions in that three year period, and approximately 150 people were admitted more than once a year. This audit strongly evidenced the need for a strong focus on effective preventative strategies in service users’ recovery programmes.

The OPTIMA Mood Disorders Service was established in 2015 to address this need. The Core Programme is an intensive, specialist programme for people who have recently had frequent hospital admissions for manic or depressive episodes. At the time of the audit, 30 people had been through the OPTIMA programme. The average rates of hospital admission and home treatment for these 30 patients, over the three years prior to them beginning the programme, were calculated using their electronic health records. These were compared to the average rates of admission for the patients over their post-programme period (an average of 9.5 months).

The average rate of hospital readmission post-OPTIMA was substantially lower than the average rate over the three years pre-OPTIMA. The finding provides initial evidence that the treatments provided by the OPTIMA programme are successful in reducing hospital readmissions for frequently admitted patients.

The core programme is designed to consolidate recovery. It involves a range of treatments tailored to the individual, including frequent psychiatric review, expert pharmacotherapy (therapy using pharmaceutical drugs), specialist nursing interventions, occupational therapy and individual and group psychoeducation.

Psychoeducation helps people with bipolar disorder gain more control over their illness. It sensitively looks at the past course of illness to identify episode triggers and early warning signs of mania or depression. By recognising that an episode is just beginning and accessing help early, the development of full episodes can be prevented. Pragmatic planning on when and how to access help in a developing crisis is essential. The programme also offers occupational therapy, which helps service users find a balance between rest, work and leisure activity when building their functional recovery following a bipolar episode.

Senior author, Professor Allan Young, Director of the Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said: “It is extremely encouraging to see that our specialist OPTIMA programme is successfully helping people with bipolar disorder, resulting in fewer readmissions to hospital. However, this early-stage audit does have some limitations. It examines a relatively small number of patients and a relatively short period of time post-programme, a more extensive study is required to confirm these benefits.”

First author, Dr. Karine Macritchie, Lead Consultant Psychiatrist at OPTIMA said: “The period immediately following hospital admission for bipolar depression or mania is often a very vulnerable time for people struggling with this illness. Our early results show that this period offers a valuable opportunity to optimise on-going treatment and to prevent loss of recovery, episode recurrence and re-admission.

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Why some people overeat when they’re upset

The idea of eating a tub of ice cream to cope with being upset has become a bit cliche. Though some might not need a tub of chocolate swirl to help perk themselves up again, there do seem to be systematic differences in the way that people cope with upsetting events, with some more likely to find solace in food than others.

This matters because when eating to cope with negative feelings is part of a broader tendency to overeat, it is likely to be associated with obesity and being overweight. More people than ever are now overweight and obese, with recent estimates suggesting that by 2025, 2.7 billion adults worldwide will be affected by obesity, risking health issues such as cardiovascular disease, type 2 diabetes and cancer.

So why do some people manage their emotions with food while others don’t? One psychological concept that helps to explain this difference is adult attachment orientation. Depending on the extent to which we fear abandonment by those we love, adults fall somewhere on the dimension of “attachment anxiety”. Where we fall on this dimension (high or low) determines a set of expectations about how we and others behave in personal relationships. These are developed as a response to the care we received as an infant and this can characterise your attachment style.

A recent meta-analysis – a study bringing together the results of many other studies – showed that the higher a person’s attachment anxiety, the more they engage in unhealthy eating behaviours, with a knock-on effect on body mass index (BMI). Two other studies have also shown that patients undergoing weight loss surgery are likely to have higher attachment anxiety scores than a comparable lean population, and it is thought that this difference is partly explained by the tendency to overeat.

Understanding attachment anxiety

For a long time, we have known that people who are have high attachment anxiety are more likely to both notice upsetting things and find it harder to manage their emotions when upset. This is because of how attachment orientations come about in the first place. The dynamics and feelings relating to our most important long-term relationships, including in early life, act as a templates that guide our behaviour in subsequent relationships and in stressful situations.

If we receive consistent care from a caregiver, which includes helping us to cope with problems in life, we develop a secure attachment orientation. For people high in security, when a negative life event occurs, they are able to seek support from others or soothe themselves by thinking about the sorts of things that their caregiver or other significant person would say to them in that situation.

However, inconsistent care – where the caregiver sometimes responds to another’s needs but at other times does not – leads to attachment anxiety and a fear that our needs won’t be met. When negative life events occur, support from others is sought but perceived as unreliable. People with high attachment anxiety are also less able to self-soothe than people with a secure attachment.

We recently tested whether this poor emotional management could explain why people with attachment anxiety are more likely to overeat. Importantly, we found that for people high in attachment anxiety it was harder to disengage from whatever was upsetting them and to get on with what they were supposed to be doing. These negative emotions were managed with food and this related to a higher BMI.

It is important to note, however, that this is only one factor among many that can influence overeating and BMI. We cannot say that attachment anxiety causes overeating and weight gain. It might be that overeating and weight gain influences our attachment orientation, or it could be a bit of both.

Managing eating behaviour

There are two approaches that appear promising for attachment anxious individuals seeking to manage their eating behaviour. These involve targeting the specific attachment orientation itself and/or improving emotion regulation skills in general.

To target attachment orientation, one possibility is a psychological technique called “security priming” designed to make people behave like “secures”, who cope well with negative life events. It results in beneficial effects more generally, such as engaging in more pro-social behaviours. One study showed that priming is related to snack intake. When people are asked to reflect on secure relationships in their life they eat less in a later snacking episode than when asked to reflect on anxious relationships in their life (though this work is very preliminary and needs replicating and extending).

Looking at emotion regulation, a recently published paper highlighted the importance of emotional eaters focusing on skills such as coping with stress rather than calorie restriction, when seeking to lose weight. This study did not look solely at those with attachment anxiety, however, so further work is needed explore this further.

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E-alerts dramatically cut heart attack rate for people hospitalized with A-fib

(HealthDay)—A simple pop-up alert on a computer screen could help save the brains and hearts of many hospital-bound people with an irregular heartbeat, a new clinical trial reveals.

Rates for heart attack and stroke plunged by close to 90 percent in people helped by the new program, the study found.

The computer alert warns doctors of the high stroke risk borne by individual patients who suffer from atrial fibrillation, a quivering heart rhythm that allows blood to pool and clot inside the heart.

Doctors who received this alert were nearly three times as likely to prescribe blood thinners to hospitalized patients with a-fib, said Dr. Gregory Piazza, a cardiovascular specialist with Brigham and Women’s Hospital in Boston.

As a result, rates for heart attack and stroke among the a-fib patients fell by 87 percent and 88 percent, respectively, over the three-month trial, Piazza’s group reported Saturday at the American Heart Association’s annual meeting in Chicago.

The magnitude of the reduction in risk of these life-threatening health problems surprised researchers, as it was “really beyond what we expected to see with the increase of anticoagulation,” Piazza said.

Blood thinners are very important to prevent stroke in a-fib patients, but prior studies say at least 30 percent have not been prescribed such a medication, researchers said in background information.

For this study, Piazza and his team created a program that analyzes computer chart data of patients with atrial fibrillation to calculate what is known as a CHADS-VASC score.

This commonly used diagnostic algorithm assesses risk factors for stroke in a-fib patients, said Dr. Mary Norine Walsh, medical director of the heart failure and cardiac transplantation program at the St. Vincent Heart Center in Indianapolis.

The test program issues a pop-up alert to doctors indicating that their a-fib patient has a high CHADS-VASC score. It even estimates their annual risk of stroke.

The pop-up then requires doctors to either prescribe a blood thinner or give a reason why such a medicine shouldn’t be used. Possible reasons include “bleeding risk is too high,” “patient is at high risk for falls,” or “patient refuses anticoagulation.”

To see whether the alert would make a difference, the researchers randomly assigned 458 a-fib patients so about half would have their records reviewed by the program.

About 19 percent of patients in the alert group had a prescription for blood thinners during hospitalization, at discharge and three months later, researchers found. By comparison, only 7 percent of the control group had been prescribed blood thinners.

By three months after hospitalization, the alert group had a dramatic effect on patients’ odds for heart attack or stroke, although that didn’t translate to a lessening of the death rate, the team noted.

Still, the study showed that reminder systems like this actually really work to cut the odds for cardiac events, said Walsh, who is president of the American College of Cardiology.

“We as physicians can’t keep everything in our brains all the time,” she said. “It’s clear in medicine if we have reminders, we more commonly prescribe drugs and take action.”

But even though doctors are moving toward the use of electronic health records, it’s not clear how easily hospital data centers could incorporate such an alert into their usual systems, Walsh said.

“All electronic health records could do it probably, but not all are set up to do it,” Walsh said. “I can tell you, my electronic health record doesn’t do this kind of thing. It’s not an automatic thing that happens.”

Adding such an alert system might be costly for some hospitals, Piazza added.

“Implementation of alert-based [computerized decision support] requires an investment in programming and medical informatics infrastructure which may not be available at some medical centers,” Piazza said.

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