Obesity epidemic in the US: What to do?


By Maureen Aylward

One third of Americans are overweight and nearly a third of people under 20 are obese. We asked our Zintro experts to discuss the current leading ideas, approaches, or policies that are being developed to address the obesity epidemic in the US.
Sandra Ham, an expert in epidemiology and obesity, says that the obesity epidemic requires a systems approach because its causes and solutions are interrelated across multiple sectors of society including the food system, schools, the built environment, and healthcare system. “The environment in the US is obesogenic, meaning that it is easier to become obese than to maintain a healthy weight because unhealthy foods are cheaper than healthy foods and physical activity has been engineered out of everyday life, Ham says. “Current leading ideas and approaches target some key interactions between policy, the physical environment, social environment, healthcare system and individual behavior.”

Ham says that childhood obesity is the primary target for several reasons:

  • Overweight and obese kids are more likely to become obese adults than to become healthy weight adults.
  • Research is showing that some obesity-related diseases including type 2 diabetes are more severe and difficult to manage when they occur in youth versus adults.
  • Kids who adopt healthy habits for eating and physical activity are more likely to continue those habits throughout their lives.

“One strategy is to empower youth to make healthy choices that affect their environment. Farm-to-school programs purchase fresh fruits and vegetables from local farmers to serve for school breakfasts and lunches. Kids learn about sustainable and local agriculture while also learning how to choose to eat a healthy diet that includes locally-grown foods,” Ham says. “The potential long-term benefits go beyond healthy weight—youth may become more educated consumers with a taste for farm-fresh produce that supports the local and regional economy.”

Another strategy Ham suggests is to promote healthy eating at the policy level. “The USDA recently revised the minimum nutrition standards for school breakfasts and lunches and is working on standards for snack foods and beverages that are sold in schools outside mealtimes,” she says. “The aim of these policies is to make schools a safe haven from the obesogenic food environment where it is easier for kids to choose to consume healthy foods and beverages than junk foods and sugar-loaded beverages.”

David Koivuranta, an expert in corporate health and wellness, says that quite often the focus is on looking outside ourselves for a solution to weight problems; however, the cause or the source of the obesity epidemic is actually inside of us. “It relates to physical, chemical and emotional stress from our environments that are creating a chronic stress response in our bodies. Because of this, our nervous systems and endocrine systems are stuck in habits and patterns that suppress the immune systems, digestive systems, and reproductive organs. This sets the stage for weight gain that cannot be lost until these underlying problems are addressed,” he says.

Koivuranta explains that a return to lifestyle choices that promote optimum physical, chemical, and emotional well being on a maintenance level will foster an environment in the body that can not only decrease body fat and increase lean muscle, but also heal chronic illnesses and diseases. “There is hope and there is a step-by-step process to get it done. Society can benefit, but it will take a a paradigm shift from our crisis care model of health care to one of prevention and proactive choices that meet our expectations of health, happiness and prosperity in life.”

Karen Russell, a registered dietetic technician and health coach, thinks the obesity epidemic has gotten out of hand. “Diabetes is also on the rise in the US. I see overweight men and women along with their children. The only way to stop this epidemic is to make changes in how we shop, cook and eat,” she says. “Dieting is the old way of doing things and is a negative approach that is temporary most of the time. Dieting is restrictive and unbalanced.

Russell suggests a more positive approach, which is to incorporate small changes in the ingredients used in recipes. “People benefit from learning what to do step by step so changes can be made to live the right way without deprivation or starving. Also getting rid of inflammatory foods so that the digestive system can function at it’s best is best practice and can lead to losing weight,” she says.

What do you think?

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More on health care shifts


By Maureen Aylward

It seems the healthcare system is shifting again to address reductions in costs and maintaining quality. We asked our Zintro experts to comment on these shifts, changes, and new trends, such as hospital mergers, insurer moves to purchase provider practices, and employers’ greater interest in employee care.

Laurie Gelb, a health care strategy and research consultant, says that it is not business as usual, but survival. “Mergers and acquisitions, which first made tentative inroads into healthcare in the 80s, is back with a vengeance because the fee for service outpatient/inpatient continuum no longer fares well under an increasingly regulated, standardized, constrained clinical practice model,” she says. “No clearly improved model has yet emerged. Integration in the medical home is a hedge toward a favorable cost and efficiency position when comparative effectiveness research, process improvement, and electronic medical records consolidation finally begin to bear fruit or when their failure to converge costs and outcomes will point to a better way entirely.”

Gelb says that we may yet see a backlash against cookbook medicine as it is now being written, paving the way for more technology-based solutions. “But those solutions will have be funded from the private sector, probably from outside the health care system. One area to look at is DME innovation. CMS and other payors are leasing and buying mediocre equipment under an archaic contracting system at tremendous expense,” says Gelb.

StrategicConsultant, an expert in managed care and HMOs, thinks that these health care shifts are related to the Affordable Care Act. “The Affordable Care Act is putting in requirements that health plans must maintain an 85% loss ratio except for small individual plans. This is driving consolidation among small plans that cannot continue to operate without member volume,” he says. “The larger plans are merging/acquiring smaller plans for a similar reason. The start-up costs for a new market make it difficult to hit targets. Instead, the strategy is to acquire a plan with established membership and physician networks. Other factors in the Affordable Care Act that are affecting the need to consolidate are the lowering of reimbursement by CMS. If you look at a market like Houston (where Health Spring had a presence), revenue is dropping from 118% of Medicare fee for service to 95%.”

StrategicConsultant thinks that the provider consolidation is also being driven by the Affordable Care Act but for different reasons. “The provider consolidation is being driven by changes in reimbursement models. CMS is looking to move toward a case rate payment for diseases. Individual doctors could be left out in the cold. Thus, we are seeing new physician groups being created and acquisition of physicians by hospitals. The hospital moves the physician to a salary payment instead of per visit, to a fixed cost instead of variable,” he says.

Anthony Cirillo, an expert in healthcare marketing and patient experience, says that these shifts are neither business as usual nor a sign of the economy. “It is more that the healthcare system will implode if left unchecked as it is. Costs are out of control, and a system of fee for services has contributed to that,” he says. “With accountable care organizations and bundled payments, healthcare providers now have to work together in a continuum of care to care for patients per-hospital, in-hospital, and post-hospital. Some are choosing to buy the components in the continuum to control it. For example, Highmark Blue Cross bought a hospital. Quality has economic repercussions. Value-based purchasing will take one percent of Medicare dollars from hospitals that they might earn back through clinical and patient experience performance. Likewise, hospital readmissions and hospital acquired infections all have economic repercussions.”

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Health care shifts again: Part 2


By Maureen Aylward

It seems the healthcare system is shifting again to address reductions in costs and maintaining quality. We asked our Zintro experts to comment on these shifts, changes, and new trends, such as hospital mergers, insurer moves to purchase provider practices, and employers’ greater interest in employee care.

Craig Howell, an expert in the sales and marketing area of the clinical molecular diagnostics industry, says that increasing consolidation in health insurers puts negative pressure on overall healthcare costs and will tend to stifle innovations in care. “We should anticipate more restrictive coverage policy from fewer insurers as they attempt to control cost and extract value from their new businesses. This will inevitably lead to fewer opportunities for innovative care and the payments for delivering improved care,” says Howell. “Increases in control over coverage policy will dovetail with implications of Affordable Care Act assuming it into existence. We may see a continuation on lowering payments, more difficulty to get appropriate reimbursement for innovative and valuable care, and more difficulty to enter new care into practice.”

Howell says these shifts will tend to negatively affect consumers and smaller businesses that will not have buying power to minimize care costs. “They will continue to pay more and get increasingly average care unless they pay out of pocket. The diagnostics area, which is long seen as a cost center, will also lose, especially the large manufacturers as they provide the lions share of routine diagnostics, They do not influence the overall healthcare system effectively to preserve a valuable position in the environment going forward,” he says. “The winners? Innovators who are smart enough to build medical evidence into the development areas and so can influence coverage policy and reimbursement access in comparative effectiveness and influencing medical practice effectively.”

Cardiac Rhythm Doc, a cardiac electrophysiologist and healthcare IT consultant, says that consolidation and contraction among hospitals and mass purchasing of medical practices (72% of physicians are now hospital owned) are occurring due to several factors:

“The increases were put in place by CMS to orchestrate the purchasing, putting all the players in the same sandbox before total cuts come through,” he says. “All these shifts will be accompanied by drastic changes in purchasing of drugs and devices. The government (and possibly ACOs) will purchase directly, drastically lowering prices, as has been done in Europe. These shifts are occurring at a time of physician shortages, which will, I think, spur the wireless health technology industry.”

Nicole Bradberry, a VP of Healthcare Operations, says that it is definitely not business as usual. “The healthcare system is fundamentally changing. Healthcare costs have increased at unprecedented levels for the past 10 – 15 years as HMO plans lost favor. These costs are unsustainable even without adding the 33 million new members to the rosters due to health reform legislation,” she says.

Bradberry says that this fundamental change can be seen in these shifts:

  • Accountable Care and Patient Centered Medical Homes are the current buzz words.
  • Primary care is getting a much needed focus as the true managers of cost.
  • CMS and HHS are fostering innovation with grants and the never before release of government owned healthcare data.
  • Payors are re-thinking traditional payor-based case, disease, and wellness management. This is spurring hospitals and payors to partner or buy primary care.
  • Primary care groups are either signing up or trying to consolidate on their own.
  • Employers seem to be the last group at the table but the most important one outside of primary care itself.
  • The patients and the health care system will win if the employers and primary care join forces to be the leaders behind the next truly accountable care model.

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Health care shifts again


By Maureen Aylward

It seems the healthcare system is shifting again to address reductions in costs and maintaining quality. We asked our Zintro experts to comment on these shifts, changes, and new trends, such as hospital mergers, insurer moves to purchase provider practices, and employers’ greater interest in employee care.

Rob Miraglia, a health care marketing and sales consultant, says there are several reasons for the mergers and acquisitions, vertical integration, and employer’s interest in their employees’ medical care. “They include increasing revenues with a lower increase in expenses, which involving layoffs of redundant positions, fear of upcoming legislation, increasing size for economies of scale, and protection against other potential buyers, among others,” he says. “The over-riding issue is cost reduction. In the case of hospital mergers, it includes the fear of lowered Medicare and other third party reimbursements with the new health care plan. With insurers purchasing provider practices, it’s for more control over spending and costs. That is also why employers are more interested in their plans than before.” Miraglia says that for actual patient care, there may be an improvement with hospital mergers due to improved EMR and information sharing. “The caveat is if the merger doesn’t reduce the headcount of caregivers, especially RNs. The vertical integration and employee interest in plans could be more ominous. Both can lead to increased profits at the expense of care, as was seen with the early MCOs in the 1980s,” he notes.

Martin Kleckner, Chief Operations and Business Development Officer for The Nicholas Conor Institute for Pediatric Cancer Research, says that these healthcare shifts are a reflection of business as usual. “Going back in time to the 1990s, many articles in industry publications such as Modern Healthcare and Health Affairs have stories of provider system mergers for the purpose of cleaning up balance sheets, lowering costs via economies-of-scale, increasing negotiation prowess relative to the managed care payer community (not to mention re-engineering, process improvement and total quality management – TQM),” he points out. “Hospital mergers to accomplish these goals are an indication of business as usual. Insurer initiatives to purchase provider (physician) practices are generally a reflection of the long-standing Kaiser Permanente business model. Employer moves to self insure and influence employee wellness are likewise indications of business as usual.”

Kleckner says that its business as usual because the underlying engineered economy of fee-for-service reimbursement remains essentially unchanged. General efforts by providers to cut costs in response to annual or periodic reimbursement reductions cannot be considered as significant shifts in market behavior. The same goes for payer moves to shift costs to the patient-consumer. “I see the market shift more in the form of disease management and value-based delivery and pricing, something that has been argued for by Michael Porter of Harvard University. It’s also the advent of molecular diagnostics, prospectively companioned with therapies expressly designed to specific diseases and disorders, Kleckner says.

He points out the recent announcement by Cornerstone Health Care (High Point, North Carolina) that it was shifting from a traditional fee-for-service model to a population value-based program. “While this move may be seen as laudable, it is hardly revolutionary when you recall that managed care and capitation models have been around for decades. What is distinguishable, perhaps, is that disease management is possibly supplanting population management as the model of choice. By performing a relatively higher volume of certain procedures and handling more cases of a certain disease, providers are expected to be clinically better at it than other less specialized institutions. Moreover, by performing more procedures, these provider systems become more cost efficient, thereby enabling them to enjoy a higher margin than their competitors. Again, while this is encouraging, the shift is likely to be glacial in terms of market transition speed. Several key drivers are involved: the rising cost of care relatively to an unsustainable funding resource, a national population that is living much longer than the original designers of both Medicare and Social Security had planned for, diseases being chronic rather than acute, and an overall poor quality of care that exacerbates it all,” Kleckner says.

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Seeking Experts to work on Healthcare Industry Consulting Projects


Zintro is a business network that makes it easy for Clients (expert-seekers) to connect with Experts for consulting engagements (ranging from one half hour phone consults to multi-month on-site engagements). Some of the uses include:

·         for market research

·         to get challenging business or technical questions answered

·         to potentially hire them for consulting projects

·         to potentially hire them for full-time employment

·         to potentially buy products or services from them

 

Zintro has almost 40,000 experts (browse) across every single industry sector. These experts have opted-in to receive system-matched inquiries from our almost 10,000 clients. Over 1,000 inquiries come in every month.

 

Zintro currently has open Healthcare Industry consulting projects.  Click on the links below to see more detail about the projects and/or to reply directly to the Client.

 

 

A SMALL SAMPLE OF ACTIVE CONSULTING PROJECTS:

 

Continuing Medical Education (CME) Marketing 

Looking for a consultant to help with marketing live and online CME for a state medical society…more

 

Certified Medical Assistant

I would like to consult with a practicing CMA who can speak to the standard of care in communicating positive tests results to the ordering physician…more

 

Radiologist 

I need an expert in skeletal injury on a child. There are allegations of abuse…more

 

Dental Insurance 

Please explain how an oral surgeon has to file for more than one quadrant alveoplastymore

 

Destruction of Meds

Destruction of meds at an assisted living center in Texas…more

 

HIPAA

We are a medical software startup. Our software in practice would send patient diagnostic data over the web to be interpreted by a program running on our web server and then sent back to the physician. No identifiable patient data is stored and everything would be sent over SSL-128…more

 

Municipal Insurance

Seeking an insurance and risk management consultant to launch a unique first nations municipal insurance program…more

 

Leiomyosarcoma (LMS)

Leiomyosarcoma with pulmonary mets need referral to an expert for second opinion…more

 

Sales Force Effectiveness Pharmaceutical

I am looking for expertise in sales force effectiveness with specific focus on current trends, new technologies, governmental regulations on pharmaceutical industry and its impact on sales force effectiveness…more

 

Medicare

Would like to set an appointment to speak with someone to see if my husband should keep my insurance as a supplementary to medicaremore

 

Medicare Value Based Purchasing For Hospitals

Our professional services company caters to hospitals.  Hospitals should have financial incentive to hire our company because we help them raise their HCAHPS scores, which in turn, will help the hospital receive full financial reimbursements through the Value-Based Purchasing (VBP) program from the Centers for Medicare and Medicaid Services (CMS)…more

 

 

 

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For Clients (expert-seekers): In under 90 seconds, you can contact hundreds of relevant business or technical experts within any industry sector. Click here to post an Inquiry (free & anonymous).

 

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The benefits of gut bacteria: Part 3


By Maureen Aylward

Recent articles in science magazines extol the benefits of bacteria in the gut. Most recently, that gut bacteria affect mood and behavior. We wanted to know how this research affects industries such as food science, medicine, and others. We asked our Zintro experts to comment and the comments kept coming from many different perspectives! Here is Part 3 in a three part series on gut bacteria and its implications and potential.

Shobhana Natarajan, PhD, an expert in genetics, says that homemade yogurt and other fermented foods have been a part of the diet in ancient civilizations and some modern cultures for several generations. “Yogurt is made by inoculating warm milk with a small amount of fresh yogurt and allowing it to ferment overnight. Fermentation of milk requires the activity of the Lactobacillus species of bacteria present in the inoculum. Lactobacilli convert the sugars in milk to lactic acid. The increase in acidity leads to precipitation and solidification of milk solids to form yogurt. Consumption of yogurt by humans introduces lactobacilli into the gut and these bacteria have recently been found to aid digestion, reduce the risk for cancer, and affect mood and behavior. Understandably, probiotics (foods that contain helpful bacteria) have made their way onto the shelves of grocery stores,” he says.

Research on gut bacteria has shown that it is the metabolic products of these bacteria that have a profound effect on health. “Basic fermentation products like acetic acid, propionic acid, and butyric acid are formed by the bacteria using undigested parts of the food consumed by humans as substrates,” Natarajan says. “Needless to say, the products formed by fermentation of undigested good foods like fibrous vegetables are better than the products formed by undigested foods like red meat. The adage ‘we are what we eat’ now has an addendum: ‘It also depends on what our gut bacteria eat and the molecules they produce!’”

Lisa Mittry, a nutrition consultant, points out that this is not new information. “We live or die through our gut. I see patients daily that have a myriad of digestive issues that can be remedied once the gut flora has been brought into balance,” she says. “If micronutrients are not being absorbed properly, if elimination is not efficient, if GERD is disrupting life and sleep as a result of an imbalance, of course there will be health effects and it will include mood and behavior including neurotransmitter balance.”

Mittry explains that probiotics are one of the top five recommended supplements. “The word probiotic is derived from the Greek meaning for life. Probiotics consist of live, beneficial, healthy bacteria that help us in many ways. Friendly bacteria reside in the intestinal tract and contribute to our health by improving nutrition and protecting against disease. Antibacterial soaps, washes and wipes, impure water, processed foods, stress, chronic dehydration, oral contraceptives, mercury amalgams, total toxic load and nutrient-deficient diets disrupt healthy flora,” she says. “Stress upsets the delicate balance of the intestinal flora and causes imbalances of friendly bacteria which can lead to Candida, autoimmune, and inflammatory diseases. A low or insufficient population of good bacteria can produce serious health problems, and can lead to an inability to absorb nutrients.”

Mittry offers a list of 21 examples of how a probiotics can contribute to healthy gut flora balance, which is essential for good overall health.

1.      Enhanced intestinal health and improve digestion

2.      Promotes regular bowel function

3.      Restores flora and lessens side effects after a course of antibiotics. Antibiotics disrupt the normal bacteria of the gut and cause behavioral changes, such as depression and anxiety. Antibiotics deplete your body of essential nutrients.

4.      Helpful in the reduction of inflammation

5.      Can have an integral role in normalizing and decreasing serum cholesterol and triglycerides

6.      Fights infectious diseases

7.      Helps prevent production and absorption of toxins produced by disease-causing bacteria which reduces the toxic load of liver

8.      Improves nutrient absorption

9.       Prevents against vaginal and urinary tract infections

10.  Boosts immune function- 70% of your immune system is located in your gut. If your gut is overloaded with bad bacteria, there is a good chance your immune system is not functioning optimally. Bacteria residing in the gut influences brain chemistry and behavior.

11.  Protects against invasion of pathogenic viruses, yeasts, Candida, parasites and bacteria

12.  Reduces of hospital infections after surgery

13.  Supports healthy skin (eczema, psoriasis and rashes)

14.  Addresses gastrointestinal syndromes (helpful for diarrhea, constipation, gas, bloating, IBS, leaky gut)

15.  Produces digestive enzymes and B-vitamins, including B-12

16.  May reduce incidence of lifelong allergies, asthma and atopic eczema when taken during pregnancy and after birth

17.  May decrease production of intestinal carcinogens

18.  Taken during the first trimester of pregnancy will help women lose weight after their child’s birth

19.  Improves enzymatic activity

20.  According to new research reported in the journal Gut Pathogens, supplementing with probiotics may reduce symptoms of anxiety, and helpful for stress and autoimmune diseases.

21.  Protects against cancer development and progression (e Pylori)

Dave Zuro, a health and wellness consultant, says that the introduction of oral antibiotics can disrupt the normal gut flora, and this can cause people to become more anxious and less cautious. “This can lead to an increase in brain-derived neurotrophic factor (BDNF), which has been linked to depression and anxiety,” he says. “Once the oral antibiotics are discontinued, the bacteria content in the gut returns to normal and normal behavior and brain chemistry is restored.”

Katherine Sanchez, health and nutrition communication consultant, says that gut bacteria can be helpful or harmful to humans, depending on its make-up. For example, high levels of Lactobacillus bacteria are helpful for digestion, weight control, and producing B-vitamins (which we then absorb and use); whereas high levels of bacteria such as E-coli can sicken or even kill us. How do we get the right bacteria into our gut? “Eat healthy (yogurt and milk, fruits and veggies, whole grains, beans, peas and other legumes) and cut down on foods with lots of refined carbs (breads, cookies, cakes, muffins, donuts, bagels, crackers, and other floury foods that are not 100 percent whole-grain), sweets and fatty foods,” she recommends.

Sanchez believes that for food companies, this research translates into a world of opportunity. “Companies that will benefit the most will incorporate latent good bacteria into food formulations without adversely impairing taste or texture. Prebiotics (insoluble fibers such as bran, whole grains, and fruit and vegetable matter) help gut bacteria to grow and do their job. There are opportunities in this market,” she says. “Companies that want to be on the cutting edge of the probiotic/prebiotic trend should find ways to replace product formulations calling for refined flours with whole-grain versions. Using pea flour, soy flour and other legume flours are inexpensive ways to up the prebiotic potential of foods. Plus, they’ll help a company earn food label bragging rights for being healthier than competitors’ products in other ways, such as cholesterol reduction and preventing heart disease.”

Taylor Reid, an expert in agriculture, says that in general, traditional food manufacturers are unlikely to know about recent studies or have much interest in them. The growing supplements industry, on the other hand, is likely to seize on it. “Likewise, traditional medicine is unlikely to be affected. But, there is also a growing demand for naturopathic physicians, herbalists, and natural healers who are likely to have known about these connections for a number of years. There’s a reason Sandor Katz’s book Wild Fermentation sells well,” says Reid. “Mainstream nutritionists tend to focus on excesses (fats, sugar, salt) and deficiencies (vitamins, fiber, water, protein). Some may take notice, many may not.”

Reid points out the power that media can have on promoting healthy gut bacteria.  “What happens can depend on whether the national press or daytime talk shows (never underestimate the Oprah Factor) pick up on this research or not. If they do, then you might start seeing commercial formulations in drug stores, or even proprietary formulations manufactured by pharmaceutical corporations and sold by prescription,” he says.

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The benefits of gut bacteria: Part 2


By Maureen Aylward

Recent articles in science magazines extol the benefits of bacteria in the gut. Most recently, that gut bacteria affect mood and behavior. We wanted to know how this research affects industries such as food science, medicine, and others. We asked our Zintro experts to comment and the comments kept coming from many different perspectives! Here is Part 2 in a three part series on gut bacteria and its implications and potential.

Dr. Wilco, PhD, an expert in holistic and natural nutrition, says it is known that the stomach is our second brain. “The digestive track acts on its own intelligence. A more accurate statement would be that every cell in the body contains the intelligence of your whole being. The body’s natural equilibrium is the key factor in maintaining a healthy state, without disease. The bacteria in the gut depend on this homeostasis,” he says. “We are chemistry. All the biochemical elements of our body self interact with the internal and outer environment. This symbiosis is of utmost importance to be able to manifest radiant health.”

Wilco says that the delicate and complex intelligence of life has become severely challenged due to interacting with the outer environment, especially when natural surroundings have become chemically polluted. “Gut bacteria, like our soil, is part of an intricate cycle. Everything is linked; life’s intelligence is merged. All the elements of life that we consist of and interact with are bound to the laws of nature. And, these laws need to be upheld when a balance and so perfect physical and mental health is desired,” Wilco says.

For this reason, it is clearly understood why foreign chemical elements disturb the intricate biochemical balance. It becomes clear that the emotional behaviors are directly linked to the corruption of biochemical laws. “When the one cleans up the outer environment is cleaned up and produces unadulterated foods for consumption, our inner gut, our pristine health, will be restored. We need to work with Mother nature, not against her.”

Denis M’Gee, an animal nutritionist, says that over the past decade or more the animal feed and production industries have increasingly adopted the use of prebiotics and probiotics as a healthy alternative to in-feed antibiotics. “This natural solution to improve gut health and gut environment has been successfully adopted and improves animal health and performance. These latest findings that a healthy gut environment can also provide behavioral benefits, such as a better response to stress, will only reinforce the use of natural solutions as animal welfare and environmentally friendly solutions,” he says

Francisco Ysunza, an animal scientist, offers these thoughts on gut bacteria:

  • The brain and the gut have been shown to have interconnectedness, so it makes sense to relate them on behavior.
  • The gut has been explained as the other brain because of its non-brain-mediated influence upon several body functions.
  • The gut has been understood as an external or exposed part of the body (contents are not actually in the body until absorbed), so anything within its tract, including bacterial activity, may stimulate or involve nerve responses. And behavior is ultimately nerve mediated, so it is brain development.

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The benefits of gut bacteria


By Maureen Aylward

Recent articles in science magazines extol the benefits of bacteria in the gut. Most recently, that gut bacteria affect mood and behavior. We wanted to know how this research affects industries such as food science, medicine, and others. We asked our Zintro experts to comment and the comments kept coming from many different perspectives! Here is Part 1 in a three part series on gut bacteria and its implications and potential.

ProfJ, a nutrition consultant and professor, says that research into gut bacteria is showing all sorts of implications for the future. “The research shows altered digestive bacteria can change mood disorders as well as obesity. Different human cultural groups have different microbes in intestinal tracts,” he says. “And this could affect how disease is treated in the future. For example, doctors may test to determine the specific microbes indivsuals harbor in order to treat disease. It may mean a change in diet to treat mental health disorders or irritable bowel syndrome.”

ProfJ thinks the recent findings may impact pharmaceutical companies negatively, if there is a decreased need for medicines that affect intestinal bacteria. “Anyone taking antibiotics who gets a yeast infection can attest to this,” ProfJ says. “Antibiotics can kill off bacteria and upset the natural balance of bacteria and yeast in the body.”

Triveni Shukla, PhD, a processed food and food ingredient expert, believes that gut bacteria is essential for good health. “Gut bacteria can fight cancer and obesity, enhance immunity, control mood and behavior, and manage decay (inflammation by cytokine 6) and repair (via cytokyne 10) in the human body,” he says. “We live disease free with bacterial genes 99 percent of the time. We manage 3.3 million bacterial genes for good health and a cancer free life. This constitutes our personal MICROBIOME that begins to form right after birth.”

Shukla says that 75 percent of our immunity resides in and stems from our digestive system, which is the immuno-control organ for the body. “It is a living factory that produces vitamins, short chain fatty acids, influences sex hormones and cholesterol day by day, and suppresses carcinogens. We need to treat and augment these bacteria for treating disease.”

Shukla suggests that people include prebiotics and probiotics in the diet. Prebiotics include onion, garlic, inulin, jerusalam artichoke, banana, apple, asparagus, whole grain products, gums, and hydrocolloids. Probiotics include cultures of Lactobacillus acidophilus, L.casei, L. fermentum, L. salivarius, L. brevis, L. lichmannum, L. cellubiosis, B. adolescensis, B. lognum, and B lactis that are found in yogurt, kefir, Indian Dahi, Kimchi, sauerkraut, brined olive, and newly designed cheeses.

Grace Farfaglia, a registered dietician and lecturer, says that creating a hygienic environment in your home may have gone a little too far. “We need bacteria. The gut-brain connection is an interesting revelation. Organisms in the gut produce neuroendocrine molecules, such as serotonin and gamma-aminobuyryic acid (GABA), that are involved in communication between bacteria and the host. Gases produced by their metabolism, specifically nitric oxide, hydrogen sulfide, and carbon monoxide are neurotransmitters. Thus, it is the focus of research to see what roles microbes play in nervous system functioning and mood disorders,” says Farfaglia.

Farfaglia points out that certain types of intestinal dysfunction (imbalance of bacteria and yeasts) cause a disruption of gut motility for genetically susceptible individuals. “Sixty percent of individuals with a low grade inflammation in the gut also have a psychiatric co-morbidity. Gut dysfunction results in pain, irritability, diarrhea and constipation,” she says. “Other disease-microbe connections that investigators have identified are in obese individuals who have a pro/ALA genotype with low levels of certain gut bacteria. This may play an important role in the development and treatment of obesity and metabolic disease.”

New therapeutic and holistic approaches may be on the horizon for individuals with mental heath, GI, immune disorders, and metabolic disease like diabetes, says Farfaglia. “Today there are many high-potency probiotic supplements on the market to colonize the gut with beneficial bacteria. Physicians are just beginning to use them in their everyday practice. Food companies are developing new probiotic products, but few of them are non-dairy. Live bacteria are not viable in some foods, and the creation of a bacteria-friendly product may not have universal taste appeal,” she says.

Christie Moore, a vegetarian food industry expert, says that one of the best super foods for mood and behavior, mental focus, and nutritional support is blue-green algae. “It provides 64 readily absorbed nutrients, including essential amino acids, fatty acids, vitamins, trace minerals, chlorophyll to provide cellular oxygen, and the PEA molecule shown to lower stress, increase focus and clarity, lift and brighten mood, and enhance well-being,” she says. “The over 400 friendly bacteria living in a healthy intestinal tract are essential for digestion and nutrient absorption. These must be present for the proper functioning of the brain and nervous system. Our mood and stress responses are directly affected by the nutrients available in our food supply.”

Moore says that the food science industry is responsible for the foods and beverages we consume, and regrettably the current food supply is predominately processed and often contains synthetic additives. “Deficiencies result and deprive neurotransmitter precursors and impair hormone synthesis,” she says. “Recent interest in super foods has prompted studies regarding antioxidant protection for our cells while providing needed nourishment not available in many of our foods today.”

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Innovation in health information technology


By Maureen Aylward

In our coverage of the healthcare industry this week, we turn to health information technology. This is always a fascinating area with so many applications. We asked our Zintro experts what they believe are the most innovative sectors of health information technology today and which companies are leading the way.

Milestones, a healthcare project manager, says that data stream technology and availability, such as automated checkout systems in grocery chains, hardware stores, and even renting DVDs, is a trend that is advancing into the healthcare world. “Step one has been gathering vast healthcare data that are held in the minds of healthcare providers and charting methods that keep providers in the loop on patient health. All of these data must be gathered in an efficient reproducible manner to accomplish the goal of automating healthcare,” says Milestones. “The current solution is electronic medical records. Companies that provide EMR solution are Epic, McKesson, Cerner, Allscripts, and GE Centricity. These EMR products need to standardize to become truly efficient between systems.”

An area that is showing real progress is the virtual eICU solution. “This solution combine a variety of data sources, including audio and video, into a remote command center allowing intensivist physicians and nurses to remotely watch over multiple ICU rooms at the same time,” says Milestones. “Using virtual ICU technologies allows smaller medical facilities to provide ICU level care without having expensive intensivists on staff.”

Milestones says that many companies will be involved in this transition, but at the center of integration and connectivity is Cisco. “A simple Google search on Cisco and healthcare will provide an interesting take on its view of the future. It makes sense that the leader in connect technologies together will play a key role in healthcare connectivity,” he says.

Mark Elliot, a 20-year veteran of the pharmacy sector of healthcare information technology, says that nearly all claims are processed in real-time with pharmacies receiving complete adjudication of member eligibility, drug utilization compliance, pricing, and/or alternative recommendations from healthcare payers in seconds. “Electronic prescribing is promoted by Medicare and Medicaid with incentives to physicians through government funds made available by the American Recovery and Reinvestment Act of 2009,” he says.

D Scher, MD, a consultant concentrating in business development for mobile health, says that the most innovative sectors in healthcare today involve companies and technologies that focus on making patients active participants in their own health care. “The reasons are obvious. Most chronic diseases are preventable and best managed when present with changes in lifestyles. Technology can do this with patient health record portal (PHR) in electronic health records (EHR) and with mobile technology,” says Scher. “PHR is the part of the EHR that is accessible to patients. It furnishes a summary of diagnoses, medications, allergies, and test results. It has educational online materials about diseases, medications, and procedures. A fully functional PHR is one of the key goals of Meaningful Use, the Federal regulatory requirements of EHRs.”

Scher says most of the larger EHR companies have some form of PHR. Mobile health, or mHealth, is the practice of medicine and public health supported by mobile devices. The term is commonly used in reference to using mobile communication devices, such as mobile phones and PDAs for health services and information. “MHealth has been in use in underdeveloped countries for almost ten years. It is gaining momentum in the Western world because of physician shortages and the severe increase in the number of patients with chronic diseases,” notes Scher. “Technologies include Alivecor’s ECG recording, InnovateWireless Health’s multidirectional medication adherence tools, and HealthPAL’s data collection from blood pressure monitors, weight scales, and pulse oximeters.”

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Trends in healthcare administration: Part 2


By Maureen Aylward

We asked our Zintro experts to comment on the growing trends in healthcare administration and management. Many responded with a diverse range of thoughts, opinions, and ideas. Take a look.

Dr. Luis Azpurua, a healthcare executive, says that there is a universal truth that delivering healthcare is costly, and the assigned healthcare budget always falls short to the needs. “The role of the healthcare manager is to maximize this budget in order to give coverage to as many people as possible while trying to sustain the highest quality standards based in medical evidence. Not an easy task,” says Azpurua. “To accomplish this, the medical manager has to rely on informatics technology (IT).”

Azpurua points out that it depends where in the world you are located. “There are clear differences between the development and use of IT. In the developed world, IT is already part of the healthcare system. The trend is to use cellular phones and tablets as tools for the everyday life. Future applications will be designed to be used everywhere, so the manager doesn’t have to be in office to keep in touch with clients. In the underdeveloped world, IT is beginning to be used the healthcare system. Right now, the software has to integrate the medical with the financial issues. It could be that the developing world will jump straight up to the top (or near the top) of technology once the IT network becomes part of healthcare systems,” he says.

David Silverman says that the profile of the hospital administrator has shifted from someone actually knowledgeable about running a hospital to that of a business executive that is running a business. “As the old guard retires, we are seeing CFOs elevating to the position of CEO; somehow, it is believed that the financial focus of these folks translates into knowledge of hospital administration,” he says. “In today’s economic environment, healthcare reform decisions are focused on bottom line impact rather than quality healthcare delivery. Granted, most products and services are mostly generic, and if the clinical result is the same, then go with the less expensive. But, is it really less expensive just because it cost a less?”

Silverman wonders if group purchasing organization (GPO) relationships will be given up for the sake hospitals jumping from GPO to GPO for the promise of bigger returns. “Is the current trend in healthcare (short-term savings) going to drive the GPO out of business and result in higher costs in the long term? My studies and interview say yes, the viability of the GPO will reside in a drastic business model change, more of a fee for service,” he says.

John Stanton, an expert in lockbox operations, points out that one trend in healthcare administration is the continued transition to electronic incoming and paid claims. “This trend will continue in the under 65 population as the US Administration continues to push toward automation that will result in significant savings in healthcare. Insurance information, including claims history, might be required to include in electronic medical records,” he says. “Auditors will now research the history of filing on a computer rather than wading through a room of folders containing paper files. Explanation of benefits statements will go the way of the bank statement and will be viewed online in the future.”

Eric Smet, a senior business development and marketing executive, says that in Europe, macroeconomic, demographic, and fiscal capacity constrains governments in allocating more public revenue to the healthcare budgets, which pressures healthcare administrators to continuously improve productivity. “A resulting trend is the shifting of procedures from inpatient to ambulatory care, which occurs in both the fee-for-service healthcare markets (i.e. Belgium) and in the managed care markets (UK, Scandinavia). Efficiently managing the continuous increase in outpatient volumes will become a prime concern for many hospital administrations in the immediate and longer term future,” says Smet.

Performance scores for healthcare providers, for both ambulatory and inpatient care, will become more publicly visible and the relative weight of patient’s experience will become more important (versus cost and health outcome parameters, Smet suggests. Patient satisfaction surveys and tracking of the overall experience at the hospital will become mandatory practice and the obtained results will increasingly influence hospital policies and budget allocations.

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