October 2010

Smoking has been on the decline in the United States for the past five decades. Anti-smoking laws have helped, and price increases too, but education efforts have had the greatest impact.

In 1965 42 percent of the American population smoked. By 2006, that percentage had been cut in half to 20.8 percent, but since then smoking cessation efforts have stalled. About 24.8 million men and 21.1 million women smoke, according to the American Heart Association.

In order to nudge the rate down even further, more public smoking bans are under consideration. But I wonder if we may be on the brink of a backlash in the face of hostile public opinion toward the American government – and a shaky economy that keeps many people in a state of continual stress.

This is what apparently is happening in Greece, where there are more smokers than you can shake a Marlboro box at. Among teens and adults over the age of 15, 42 percent light up, about the same as the U.S. rate in 1965.

But now Greece is in a state of near economic collapse, and the government is trying every which way to save money. There is very fertile ground in the area of health care, with so many people indulging in the unhealthy habit. On Sept. 1, a ban on smoking in enclosed public areas went into effect, which includes restaurants and bars.

Officials estimate that smoking costs the Greek health-care system about $3 billion a year, nothing to sniff at in a nation that has found itself in such a deep economic hole.

Nevertheless, the anti-smoking campaign has not gone down well with the Greek citizenry, who are already livid (and prone to display their outrage in public demonstrations) over government austerity measures that include salary reductions and pension cuts.

“The sacrifices have … stoked the nation’s innate anti-authoritarianism – an instinctive rebelliousness that authorities may not like but have encountered repeatedly in recent months,” the UK Independent reported last week.

In violation of the ban, the country’s restaurants and bars have announced that they’ll be bringing out the ashtrays again, setting up yet another confrontation with authorities.

As we start the second decade of the 21st century, several trends are coming into focus. Austerity certainly seems to be one of them, and government/citizen conflict is clearly in the news as well. Americans are also traditionally skeptical of government, which is not necessarily a bad thing.

But this ought to be a heads-up for U.S. health officials as they forge their new wellness agenda over the next several years: education and positive reinforcement seem to be the best agents of change.

Photo: http://www.flickr.com/photos/superfantastic/166215927/

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Medical loss ratio issue resolved … for now

Unless you believe in total deregulation of the insurance industry, it makes sense to require that a certain percentage of a health insurer’s income go toward direct medical services. And that’s what the health care reform law passed in March does – 80 percent of income must be spent on actual health care services.

But how do you define “direct”? Not surprisingly, insurers prefer a broad interpretation, one that includes the cost of commissions to agents selling their policies.

The “medical loss ratio” issue was resolved – for the time being – at a meeting of the National Association of Insurance Commissioners (NAIC) last week in Orlando. The NAIC conclusions are actually recommendations that will go to Health and Human Services Secretary Kathleen Sebelius for a final ruling.

Consumer groups felt they achieved a measured victory out of the recommendations. In the above example, sales commissions must be considered a part of an insurer’s administrative cost – not an expense connected with direct medical care. Direct costs should include payments to physicians, nurses, hospitals and other health care providers – but not expenses related to billing, or controlling fraud, according to a report Friday in Kaiser Health News.

The insurance industry disagrees and argues that the new rules will stifle competition, since only the largest companies will be able to comply. As a result, look for more market concentration beginning in 2011, these analysts say.

A major caveat: After a year or two of playing give and take with the Democratic leadership in Washington, health insurers are now actively courting ties with Republicans who are poised to take over important congressional leadership posts.

Cigna’s political action committee had been giving money to both Democrats and Republicans on a 50-50 basis during the health reform debate. They now reportedly favor Republican candidates 70-30.

How much of a game changer that will turn out to be is anybody’s guess.

– From Psychotherapy Finances

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Our first dog, a beagle, chewed his way through several pieces of furniture and pairs of shoes. A friend of mine has been dealing with “inappropriate toileting” and other brands of unpleasant behavior by his dog when he spends longer days at work.

Our newest dog, an adopted shelter mutt, is a model canine citizen, chilling out for hours if required. He doesn’t beg. He is not unnecessarily vocal. When he sees you pick up his dish at dinner time, his tail thumps the floor.

How is it that dogs can have such vastly different personalities? The answer may be that, like people, some dogs are optimists while others are pessimists, a new study claims. And the pessimists are the ones that participate in what researchers call “undesirable separation-related behavior” (SRB).

The British study was published this month in Current Biology, complete with doggy diagrams of how the research was conducted and recommendations for therapy in order to “minimize relinquishment” in cases where an exasperated owner can’t take it anymore.

I particularly liked the mathematical formulas in the text of the report.

In the study, 24 shelter dogs were observed first to find out which ones acted out when left alone (SRB). Next, each animal was given two bowls in a room – one with a small amount of food in one corner and the other, in an opposite corner, empty. Once the dog understood which was which, researchers started placing empty bowls of food randomly around the room, some closer to the “full” corner and others closer to the “empty” corner.

“Test trials allowed us to measure whether dogs ran quickly to the ambiguous locations (indicating anticipation of food: an ‘optimistic’ judgment) or more slowly (a ‘pessimistic’ judgment),” the researchers wrote. “We could thus investigate whether dogs showing higher levels of SRB also behaved more ‘pessimistically’, indicating an underlying negative affective state.”

All or most of the dogs checked the bowls for food eventually, so the investigators scored them on how quickly or slowly they ran to the empty bowl, discovering that they had been short-changed.

The dogs that displayed the most “optimistic” behavior by padding quickly over to the empty bowl, also showed the least SRB.

The authors indicated that the bad behavior can be modified but take my word for it, this would be at great personal effort and expense. Rather, I think that this is canine personality coming through.

(That does not mean that the pessimistic dogs are unworthy, by the way. Quite to the contrary, I admire them for their world view and their determination not to be duped. Accommodations need to be made, however.)

Naturally, I also must salute the optimistic dog, the category into which our current friend falls. Here’s a dog brought to a shelter and assigned to Death Row, since he had heartworm and tick disease and was assumed to be a lost cause. Someone from the rescue group decided to give him a shot.

He went through painful heartworm treatment, and months of antibiotics, without a whimper or snap, endearing himself to his keepers at every turn. Now he’s a healthy 4-year-old dog, an optimist who stuck it out and discovered that his faith eventually paid big dividends in chicken, hamburger and bacon.

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Speaking of dog therapy, I heard this joke on the radio the other day: A poodle and a collie were walking down the street. The poodle said: “I can’t take it anymore. My owner’s mean, I’m left alone all the time and my girlfriend left me for a schnauzer.” The collie said: “Why don’t you go see a psychiatrist?” The poodle said: “I can’t. I’m not allowed on the couch.”

Photo: A model canine citizen, our current dog, Miles, does not beg, fold, spindle or mutilate.

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I’m a football fan and have come to enjoy the college version of the sport more than watching the pros in the NFL. But as we approach mid-season, we’re seeing more and more players seriously banged up, and still taking the field.

If you listen to the TV sports announcers, it’s a bad of honor and a sign of toughness when these college kids suit up and take the hits even though they may be suffering from a major sprain, broken bone or other injury.

The real trouble is, the vast majority of college players never make it to the NFL and even if they are drafted, chances of making a pro team or becoming a star are minimal. This applies even more so to high school football players, although at least the good ones may realize some benefits if they can land an athletic scholarship to a university.

But a new study from Purdue University reveals that they may be paying a high price.

Researchers found that some players who take hits on the field are competing with an undiagnosed brain injury. Previous studies focused on players who had diagnosed concussions.

In this study, researchers monitored 21 players from a Lafayatte, Ind. high school by putting sensors in their helmets and noting who took continual hits or at least major hit. They then isolated 11 of the players who fell into that “roughed up” category.

Three of them were diagnosed with concussions. Of the remaining eight, four were not diagnosed as having been injured but imaging scans and cognitive tests revealed that changes in brain function had taken place.

“So half of the players who appeared to be uninjured still showed changes in brain function,” said Larry Leverenz, clinical professor of health and kinesiology at Purdue. “These four players showed significant brain deficits.

“Technically, we aren’t calling the impairment concussions because that term implies very specific clinical symptoms, such as losing consciousness or having trouble walking and speaking. At the same time, our data clearly indicate significant impairment.”

The goal is to be able to detect more subtle differences in brain function after a tough game, or even a hard practice. The result could be better safety regs that keep kids out of the line of fire if they show signs that all is not well even though they may appear to be OK.

“We’re not yet sure exactly how many hits this is, but it’s probably around 50 or 60 per week, which is not uncommon,” said Eric Nauman, associate professor of mechanical engineering and an expert in musculoskeletal trauma. “We’ve had kids who took 1,600 impacts during a season.”

The sports injury problem gets attention from coaches and athletics officials around the country, but not surprisingly the emphasis is on concussions. The National Association of State High School Associations, for example, launched a new online course this year for coaches called, Concussion in Sports – What You Need to Know.

As the association points out, concussions pose a particular risk for adolescents. But now it’s apparent that the concerns need to go a step beyond that. Program directors should be looking at all players who have been taking hits on the field.

It would be helpful, too, if we could bring some common sense to the idea – which seems to be baked into the American culture – that playing with an injury is heroic, and a sign of distinction and honor.

Photo: Thomas Talavage, Purdue associate professor of biomedical engineering and electrical and computer engineering, from left, and biomedical engineering doctoral student Evan Breedlove, monitor impact data from high school football players. (Purdue University photo/Andrew Hancock)

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Public schools aren’t just teaching institutions these days. They are expected to provide a wide range of social services, from mental health counseling to family intervention and classroom discipline. They are expected to offer social activities in order to assist busy parents.

With all this and more on a teacher’s plate, it’s easy to see why being a schoolteacher can be a stressful job.

Here’s one more factor that most people don’t consider: Teachers in the U.S. also have to deal regularly with the threat of violence—not only from their students but from their students’ parents.

The American Psychological Association has been looking into this issue with its Task Force on Violence Against Teachers. The panel issued a report in August at the APA’s annual convention in San Diego.

The task force survey found that 27 percent of U.S. teachers had been verbally threatened by students in the past year; 37 percent were subjected to obscene or sexual remarks from students. Thirteen percent reported that they’d been intimidated by a student’s parent.

The days when parents almost automatically sided with a teacher in an issue involving their child are long, long gone.

“These numbers did not differ by school setting, by gender of the teacher or by years of teaching,” Task Force Chair Dorothy Espelage, a psychologist at the University of Illinois in Urbana-Champaign, told the APA Monitor on Psychology this month.

The task force found that 5 percent of teachers had seen a doctor because of an attack. Another 15 percent said they were attacked but opted not to see a physician. Twenty-five percent reported property damage from a student, and 22 percent said a student had thrown something at them.

Thirteen percent said a parent had thrown an object at them.

The results were based on a survey of 4,735 teaches nationwide. Here’s a more detailed breakdown of the data.

This isn’t a new problem, of course. It’s been growing for decades. You might easily blame a more permissive attitude in society for the issue, and that undoubtedly plays a role. But schools are charged with so many tasks these days that education almost seems secondary.

There’s widespread sentiment that the public school system is failing, that it’s riddled with problems, and many students aren’t getting the skills they need to compete in the job market.

That may be true, but the APA study sheds some additional light on why this is happening. Teachers get into the business to teach, and I’m sure that’s what they’d like to do. Instead they have to play counselor, social worker and activities director.

Add another requirement to their skills repertoire: self-defense.

Photo: School violence in the class film Blackboard Jungle http://www.flickr.com/photos/nostri-imago/2872099576/

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