Monday, October 31, 2011

What is Auditory Processing Disorder (APD) Or Central Auditory Processing Disorder (CAPD)?

APD can be defined as difficulties in the perceptual processing of auditory information by the Central Nervous System. Put simply APD is a deficit in the neural processing of auditory information. The child has normal hearing but experiences difficulty in discriminating, processing and understanding sound signals.

Difficulties discriminating between speech and noise /sounds is a common experience for the child with APD. The disorder can often go undetected but can significantly impact a child's ability to cope with the language requirements of a classroom and to develop essential reading and writing skills. Typically a child with APD copes well in a one to one context but experiences difficulty in large classroom environments.

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Signs of APD

APD can even impact the child's ability to socialize and follow conversations. Typically a person may experience difficulties in the following:

Children with CAPD may exhibit:

Short attention span Difficulty following instructions Easy distraction May be noise sensitive or reactive to loud noises eg. Vacuum cleaner - May be overwhelmed by very noisy environments

School-aged children with CAPD may exhibit:

Difficulty following complex verbal directions Spelling and reading difficulties Language delay / disorder Poor sound / phonological awareness needed for literacy skills (reading and writing) Difficulty maintaining attention to auditory information Frustration and distractibility Difficulty with sound localization Difficulty following the flow of discussions Difficulty listening / comprehending when there is background noise Difficulties with short term auditory memory Facts about APD Boys are 3 times more likely to have auditory processing disorder than girls Almost 75% of children with APD have had a speech or language difficulties Children with APD often have a history of middle ear infections (otitis media) A child with Auditory Processing Disorder does NOT have an intellectual or cognitive problem

What to do?

Consult an audiologist or speech pathologist in your area. An Audiologist can only conclusively diagnose APD however Speech Pathologists do have an important role in supporting diagnosis and some forms on intervention particularly relating to language processing and literacy.

What is Auditory Processing Disorder (APD) Or Central Auditory Processing Disorder (CAPD)?

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Sunday, October 30, 2011

Social Empowerment of Women

The indicators of social empowerment of women include the base of gender inequality, sex ratios, life expectancy rates and fertility rates which shows the general status of women in terms of literacy, economic growth, availability of health care and birth control facilities, educational status of women, age at marriage, literacy rates and participation of women outside the home. Gender inequality is a worldwide phenomenon and leaving aside some Nordic nations, gender inequality base reflects very poorly for almost all major countries in the world. Sex ratio is against women in Asia and even though life expectancy has gone up around the world including in Asia it has not improved the overall status of women in much of the world. Same is the case with fertility rates which have declined in some regions including Asia but the positive impact of this change on women around the world is not as much as that was desired. Glaring gender gap exists in terms of literacy rates though it is narrowing across Asia. The figures for female literacy rates are not at all encouraging in the developing world. Now let's focus on various issues that are closely associated with the social empowerment of women.

Social empowerment of women: Ending violence against women

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Violence against women is a real fact and we need to acknowledge the real tragedy behind this crime. It totally shatters the women from the core psychologically as well as physically. It is time that community development and feminist values are made an integral aspect of empowerment of women. Women need to be educated and made aware of their rights and they should be encouraged to stand united against the biased and discriminating social environment which directly and indirectly affects their psychological and physical self. Education and awareness would be a big step towards the fight against gender based violence. Only through education and awareness we can connect with the vast majority of women living in various parts of the world and prevent them from falling pray to the numerous forms of possible violence in their life. We have to accept the fact that women are constantly under the threat of violence from various sides. The oppressive structures of the society need to be changed and oppression of women need to be stopped but it won't happen through some quick fix solutions. The change can be only possible through social empowerment of women at the grass root level with education and awareness.

Social empowerment of women: Issues related to social empowerment of women

When we talk of social empowerment of women then we are actually addressing various issues which might be applicable to different parts of the world for improving the overall status of women. Among them the prominent issues relate to education for women, health for women, nutrition for women, drinking water and sanitation for women and their family, housing and shelter for women and their family, environment and the connection with women, participation of women in the field of science and technology, care for women under difficult circumstances, fighting the violence against women and rights of the girl child.

Social empowerment of women: Education for women

We need to accept the fact that gender inequality and discrimination has been the norm of the society and in this regard it touches all aspects of the life of women. Education and training for women is one of the major goals of social empowerment of women which need to be universally made applicable to all parts of the world. This will definitely enhance the awareness in women which in turn will increase her confidence. A confident and well aware woman would be able to tackle inequality and discrimination in a far better way than an ill-equipped and ill-trained woman. But on the other hand we have to accept the fact that women and girls never had equal access to education as men and boys have. Illiteracy is the highest among the female of the population. Women are far behind in terms of having gainful occupation or vocation because of lack of skills and education. There is an enormous gender gap in secondary and higher education. Moreover religious and caste equations have made things worse in many parts of the world. The work has to start at the grass root levels. The educational systems need to be made more accessible to women at grass root levels and they need to be revamped to include gender sensitive educational system which prevents sex stereotyping and discrimination. Social organizations can play a major role in universalizing education at the basic ground level. This can be achieved through increasing the enrollment and retention rates of girl child in the primary schools and offering quality education and skills to them so that they can stand up on their feet and live a dignified life.

Social empowerment of women: Healthcare for women

Coming to the health of women we need to understand that women are facing very difficult times at all stages of their life cycle. It is sad to note that a section of our society is highly prejudiced against the girl child and in fact can be labelled as criminals of the highest order as they practice the heinous crime of female feticide. Then we have the problem of high infant mortality and maternal mortality and one of the major reasons for this being the early child marriages. Quality health care for women is not available in many parts of the world. Women's right to informed choice regarding her reproductive rights is another area which needs attention. Talking of reproductive rights women even don't have affordable choice of family planning methods. Education and awareness in this regard is nonexistent and absent. Women are vulnerable to sexually transmitted diseases and other endemic, infectious and communicable diseases. HIV/AIDS is another major problem. Women's traditional knowledge of health care and nutrition, alternative systems of medicine are actually underutilised and not recognized. It is necessary to recognize these alternative systems and integrate them with the main stream health care systems to make it work in tandem. This shall help in providing reasonable and quality health care for women.

Social empowerment of women: Nutrition, drinking water, sanitation and housing

For women, from the stage of infancy and childhood to the stage of adolescent and reproductive phase the risk of malnutrition is the highest. There is a close link between the health of an adolescent girl who becomes a pregnant and lactating woman latter and the health of the infant child. Macro and micro nutrients are needed for these special conditions but they are not available to the vast majority of women. In house the women and girl child face great discrimination as regards to good nutritious food. This happens in the early growth period of a child as well as to a pregnant and lactating woman. Other major issues are drinking water and sanitation especially in rural areas and urban slums. Housing and shelter are also area of attention including adequate and safe accommodation for single women, heads of the households, working women, students, apprentices and trainees. These are very real issues of the very real world that we live in. Without addressing these basic needs we cannot think about any meaningful step towards social empowerment of women.

Social empowerment of women: Women and environment conservation

Social empowerment of women and environment is closely linked. Women can play a major role in conservation and restoration of the environment. Rural women use unconventional and nature friendly source of energy in the form of animal dung, crop waste and fuel wood. Using of solar energy, biogas, and smokeless stoves can really help the rural women as they can act as environmental friendly tools.

Social empowerment of women: Participation of women in development of science and technology

Women's empowerment cannot be complete without their equitable participation in science and technology. Women have special role to play in the area of science and technology. They can bring a wave of creative and generative energy in the field of science and technology. Today their participation is restricted and limited to very less numbers because of widespread discrimination at the basic education levels and lack of opportunities for pursuing higher studies. Reducing drudgery with the help of science and technology is another major area of importance for freeing women from the never ending domestic chores and making her contribute to the mainstream of the society.

Social empowerment of women: Helping women in difficult times

Women in difficult circumstances need special attention. These include women in extreme poverty, destitute women, women in conflict situations, women affected by natural calamities, women in less developed regions, disabled widows, elderly women, single women in difficult circumstances, women heading households, women who are displaced from employment, migrant women who are victims of marital violence, deserted women and prostitutes. These women are in difficult circumstances which are not of their own making. They are the victims of the selfish streak of society. It is ironical to note that women become the primary pray for all the malice and sins of the society. It is time to reverse this phenomenon. Organizations especially the grass root level social organizations should come in large numbers to help these women who are at the receiving end for a sin which is not of their making.

Social empowerment of women: Fighting against violence and discrimination

Violence against women is heinous crime against humanity. Violence can be both physical and psychological and it happens at the domestic front as well as at other levels of the society. It is in fact openly practiced in many societies through various forms which include customs and traditions. Sexual harassment at work, dowry related violence and trafficking of women and girls are different types of violence against women. Discrimination against women starts when they are just children. Girl child discrimination is the most prevalent form of harassment seen from the early age of a child. Parental sex selection, female feticide, female infanticide, child marriage, child abuse including sexual and psychological abuse and child prostitution are the many kinds of violence and discrimination against the girl child that is seen within the home as well as the society. Special awareness and education programmes needs to be formulated and implemented at every level to fight the violence against women. Strict laws need to be formulated to fight the crime of violence against women. More than formulating the laws the priority should be to implement and enforce these laws so that we can root out violence against women. This is necessary for any meaningful social empowerment of women.

Social Empowerment of Women

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Saturday, October 29, 2011

Financial Literacy

Periodically Christian schools struggle with financial problems.  There are many reasons.  A common symptom is the lack of money.  However, the real reason might be donor engagement or declining enrollment.  Those problems may have arisen a few years ago but this is the first year for a budget deficit.  Some members of the board may assume the deficit is due to overspending rather than a lack of income.

If we think we are spending too much we look for ways to reduce expenses (cut staff, eliminate raises, eliminate staff training, delay maintenance, buy cheaper books, restrict internet access, etc.). It relieves some of the pressure but fails to solve the problem. The donors continue to disengage or enrollment continues to decline. The decline in enrollment may accelerate because the parents see or expect a reduction in quality.

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Often when we pay attention to a symptom the problem goes unattended or worsens.

Most board members rarely look at the financial report. The two primary reasons are; too many numbers and they are unsure how to interpret the information. Since the financial report seldom receives the attention it deserves, the warning signs are missed and the problem is ignored until the symptoms cause a crisis.

How can financial literacy help?

Financial literacy is the ability to read the financial reports and understand the message. There are two parts. The first is having the right information presented in a useful way. Knowing the importance of the numbers is the second part.

For some parochial schools, donor engagement is a very important financial number. One way to measure engagement is by tracking the average gift per donor. However, telling the board that the average gift at the spring festival was is accurate but useless. It is more useful to tell the board that the average gift has been steady at for the past three years. Better still is to remind the board that inflation averages 3% per year so a consistent average of per year implies declining engagement. With that information, the board members realize that donors are disengaging. They are giving a smaller and smaller percentage of their income each year or fewer of them are giving at all. Either way, the board becomes aware of the problem before the budget crisis distracts them. The board has time to look for ways to increase donor engagement.

The best way is to provide a graph. If the graph shows the donor trend and the donor trend adjusted for inflation, the board will see the gap forming. The discussion happens early in the cycle when it is easy to solve and before it affects the budget. In the preceding example, the trend is important.

Many schools have a tuition fund, trust, or foundation. The interest from the fund provides scholarship money for some students. In this case, there is a direct relationship between interest rates, fund balance, and the number of students who will receive scholarships. The critical financial figure here is the ratio between fund balance, students, and interest rates. In this case, the ratio is important. Knowing the ratio each month will help to predict the enrollment or identify an obstacle to enrollment.

An important point is that the balance sheet and income or profit and loss statement are accounting tools. It is important for the board members to receive them so they can audit the bookkeeping. However, they need the financial numbers so they can monitor the economic health of the school. The finance committee can act as the auditors. The entire board needs to act as economic advisors.

Next Step

Identify the 3 - 5 most important financial figures

Find a meaningful way to present them to the board at each meeting (graphic, ratio, tabular form, etc.) with the goal of making the information understandable at a glance

Spend time educating the board about what to look for (For exampe: The trend line should be up, never flat or down. The ratio should always be above 0.53.) and what to do about changes (do more marketing in the northeast neighborhoods, communicate better with the donors, etc.)

Avoid discussing the income or balance sheet except during the annual budget meeting (encourage the finance committee to study the details each month)

Ask the board to set year-end goals for each of the 3 - 5 numbers selected and discuss progress toward those goals at each meeting

Because of the structure, traditions, and community served, different schools will choose different numbers to monitor. Some numbers may be external such as shifts in the local demographics. Problems take time to solve. It takes more time to recognize a problem than it does to solve it. Reacting to symptoms allows the problem more time to grow and keeps one from looking for the underlying problem.

Conversely, having a board that is financial literate prevents or preempts problems. Financial literacy ensures there is more time available for the mission and students. Your school will be more sustainable. The 3 - 5 key financial figures provide a tool for training the board to be proactive analysts and problem solvers.

Financial Literacy

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Thursday, October 27, 2011

Laura Bush Smoking - Did She Really Stop?

Is Laura Bush still smoking? Or has she already quit? Looking at the contrasting reports, nobody really knows if the former First Lady has quit smoking.

Married to George W. Bush in 1997, Laura Lane Welch Bush was born in November 4, 1946. Considered as one of the most popular first ladies, she served alongside her husband from January 2001 to January 2009.

Health Literacy

During her tenure as first lady, she advanced interests close to her heart such as literacy, education, and women's health. She actively became involved with The Heart Truth as an ambassador. The Heart Truth is an awareness campaign about heart disease and stroke in women.

Her involvement in the Heart Truth is what brought her habit of smoking in the spotlight. Smoking is one of the major risk factors in heart disease and stroke. Nicotine, an ingredient of cigarettes and tobacco products, has the ability to narrow blood vessels. Most of Laura Bush's speeches talked about the role of smoking in heart disease and stroke.

Some people felt that if she is still smoking, she is not credible to be an ambassador.

Laura Bush said she has stopped. But reports claiming otherwise still surface. Personally, I don't think that her habit of smoking should be the main point here. What is most important is that as ambassador of The Heart Truth, she is spreading the fact that smoking kills through heart disease and stroke. She is making more and more people aware of the fact that heart disease is the number 1 killer American women today.

Through her very own experience, Laura Bush knows that quitting is very difficult. That's why for her, the secret to quitting is not to start. Do not start the habit. Because once you start, you are already giving away your life. Quit smoking now!

Laura Bush Smoking - Did She Really Stop?

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Wednesday, October 26, 2011

Health Benefits of Exercise Include Keeping Your Mind Sharp

Science spends a lot of time investigating what causes mental decline as we age, and not much on what things might prevent it. Now the health benefits of exercise appear to include keeping your mind sharp as well as your body fit.

Work appearing in the June 9, 2009 issue of Neurology is some of the first to look what factors might help you hold on to your mental function.

Health Literacy

The exciting new study found older people who retained their cognitive function had a unique profile.

They had at least a high school education and 9th grade literacy level. They exercised moderately (or vigorously if they were in shape) at least once a week and they didn't smoke or live alone or if they did they were also still active outside the home.

The work involved examining 2,500 subjects, both men and women aged 70 to 79 who were living in either in Memphis, TN or Pittsburgh, PA and taking part in the Health, Aging and Body Composition study. The cognitive skills of the subjects were tested at the beginning of the eight year study, and then again in years 3, 5 and 8.

As the researchers expected, many of the participants showed cognitive decline as the study progressed - about 53% had minor cognitive decline and 16% experienced major cognitive decline. About 30% of the subjects showed no cognitive decline. Unexpectedly, a few had even improved their scores.

The researchers wondered what made the difference in those who experienced cognitive decline compared to the subjects who didn't.

The answers were quite eye opening.

Exercisers who did either light or vigorous workouts once a week were 30% more likely to hold on to cognitive function than those who didn't workout.

Education also played a part. Those who had a high school education were almost three times as likely to retain function than those who hadn't graduated from high school. Literacy levels, of 9th grade or better, made a subject nearly five times as likely to avoid decline as those with lower levels of literacy.

Nonsmokers were twice as likely to stay sharp. Seniors who continue to work (or volunteer) as well as those who didn't live alone were 24% more likely to hold on to cognitive functioning. There was no effect on cognitive skills linked to conditions like diabetes or high blood pressure.

Many people think becoming senile as you age is unavoidable and while one in four older adults experiences some form of cognitive decline this isn't a part of healthy aging.

What this work is telling us is that you can keep your mind sharp as you age but you need to plan now to do so.

It's important to challenge your brain - give it a workout by taking up different things, enjoying hobbies and pursuing interests.

There's no one mental exercise that's shown itself so much better than any other - anything that has your mind working is a good choice.

But that's not all you should be doing.

Being mentally active works best when you're living well - eating healthy, being active as much as you can, avoiding tobacco and other unhealthy substances while keeping those appointments for regular medical checkups and screenings.

"The take-home message from the study is, you can maintain your cognitive function in late life," explains study author Alexandra Fiocco, a postdoctoral fellow at the University of California, San Francisco.

"People are afraid they will experience cognitive decline as they age. But not everyone declines."

In fact, this work raises the very real possibility that cognitive decline might even be preventable with the health benefits of exercise being wider than ever thought before.

Health Benefits of Exercise Include Keeping Your Mind Sharp

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Monday, October 24, 2011

Construction - Building Industry Safety and Good Lifts by CIF

Construction Industry Federation (CIF) actively represents and serves over 3,000 members covering businesses in all areas of the Irish construction industry through a network of 13 Branches in 3 Regions throughout Ireland and through its 37 Sectoral Associations.

CIF delivers its services to members either directly or through its Branch Network and Sectoral Associations. Member firms come from all over sectors of the industry and span all sizes of firms from the very small to the very large. The 37 different Associations are grouped in four key categories:

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General Contractors, mechanical & electrical, specialist contractors, home builders

Each local CIF Branch will include members from each of these four sectors.

CIF's team of construction experts know the industry from experience, from member feedback and from research. As a member you too can benefit from our problem solving expertise.

What they Do

The CIF engages with Government, professional groups, business groups and the social partners on our members' behalf. They monitor issues and trends, initiate proposals and act in our members' interests at local, national and EU levels.

13 Branches

Represent members at local level throughout Ireland. Branch members and dedicated regional staff deal with issues affecting their localities and regions. They contribute to national policies through representation on the Federations Executive Body.

37 Associations

Represent general contracting, house building and specialist firms in Ireland's construction industry providing a forum for members to develop initiatives and deal with problems affecting each sector of the industry.

CIF Safety Services assist members in implementing best safety and health practices for the prevention of accidents. CIF Safety Services provides an extensive range of advice on Safety, Health and Welfare issues and also presents training courses designed specifically for the Irish Construction Industry as well as individual member company needs.

Public Consultation - Draft Working on Roads Code of Practice for Contractors with Three or Less Employees

The Health and Safety Authority has developed a draft Working on Roads Code of Practice for Contractors with Three or Less Employees which it intends to publish in accordance with section 60 of the Safety, Health and Welfare at Work Act 2005 (No. 10 of 2005).

The Safety, Health and Welfare at Work Act 2005 requires all employers to have a safety statement for all workplaces which is based on written risk assessments. This Code of Practice allows employers, who employ up to three people and are engaged in road works, to meet the legal requirement to have a safety statement in a simple and easy way.

This Code of Practice is based on the Health and Safety Authority's Safe System of Work Plans (SSWP). The SSWP relies heavily on pictograms to explain and clarify hazards and controls, thus creating a wordless document where safety can be communicated to all workers regardless of literacy or language skills.

At present there are five SSWP for employers to use; each one covers typical construction activities: Ground Works; House Building; Demolition; New Commercial Buildings and Civil Engineering. These SSWP are covered by the Code of Practice for Contractors with Three or Less Employees published in 2008.

This supplementary Code of Practice deals specifically with the Working on Roads SSWP. This code of practice can be used by any trade engaged in road works.

Operation of Passenger and Goods Lifts

Following a recent fatal accident involving operation of a goods lift, the Health and Safety Authority is asking all employers to ensure that the lifts on their premises have undergone the necessary thorough examination by a competent person.The HSAA would advise all employers in all sectors that passenger and goods lifts including pavement hoists and dumb waiters, are subject to requirements set out in chapter 2 of the Safety, Health and Welfare at Work (General Application) Regulations, [S.I No.299 and 732 of 2007].Lifts must have a periodic thorough examination by a competent person every 6 months. Reports of such examinations shall be kept available for inspection by a HSA inspector. All repairs required to lifts must also be carried out by a competent person. Under no circumstances should goods lifts be used for carrying passengers unless they meet all the requirements for passenger lifts. All employees should be clearly instructed on the dangers of inappropriate use of goods lifts.Lifts which are not designed for lifting persons shall be clearly marked to this effect. Employers are required to maintain a register of lifting equipment which shall also be kept available for inspection by a HSA inspector. Employers who currently have either passenger or goods lifts on their premises should ensure that they have undergone the required thorough examination and that the risks associated with the use of such lifts are addressed in the Safety Statement to ensure that these risks are controlled.

Electro-Technical council of Ireland (ETCI) launched its new publication ET215:2008 'Guide to the Maintenance, Inspection and Testing of Portable Equipment (Electrical Appliances and Tools) in the Workplace. This Guide is intended to help employers meet their statutory duties in this regard. The Guide is available as a free download.

Construction - Building Industry Safety and Good Lifts by CIF

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Sunday, October 23, 2011

Fun, Profitable, Wholesome Business You Can Start - Microbrewery

According to Wikipedia, "A microbrewery, or craft brewery, is a modern brewery [that] produces a limited amount of beer."

The ancient art of beer brewing began with the establishment of agricultural society and the cultivation of grains such as barley and wheat. Around 4000 BC, the Sumerians discovered the effects of drinking gruel that had been left to ferment; this ale became more alcoholic once brewers began malting the barley. Germinating the grain, then drying and heating it so that the starch turned to sugar, produced a more powerful fermentation and stronger flavor.

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In northern Europe, where the cultivation of wine grapes was unknown, but where grain flourished, brewing probably developed independently. A French doctor discovered that yeast is the microorganism responsible for the fermentation process.

Health experts have known for some time that moderate alcohol consumption actually benefits health. Studies have shown that those who consume moderate amounts of beer (one to two a day at most) have a 30-40% lower rate of coronary heart disease than those who don't drink.

Other health benefits of beer include:

--Increased amount of good cholesterol (HDL) in the bloodstream.
--Improved circulation.
--Decreased occurrence of blood clots.
--Variety of minerals.
--A similar amount of polyphenols, a type of antioxidant, to red wine.

The Wikipedia article continues, "In the early twentieth century, Prohibition drove many breweries in the US into bankruptcy because they could not rely on selling 'sacramental wine' as wineries of that era did. After several decades of consolidation of breweries, most American commercial beer was produced by a few very large corporations, resulting in a very uniform, mild-tasting lager.... Consequently, some beer drinkers craving variety turned to home brewing and eventually a few started doing so on a slightly larger scale. For inspiration, they turned to Britain, Germany, and Belgium, where a centuries-old tradition of artisan beer and cask ale production had never died out."

Microbrews were so popular, the trend caught on and hundreds of microbreweries sprang up. As they proliferated, some became larger than the microbreweries of the original definition, and the term came to include the concept of artisanal beer in the European tradition. The Association of Brewers reports that in 2006 there were 1,389 regional craft breweries, microbreweries, and brewpubs in the United States.

Thousands of beer lovers have realized their dreams by building successful microbrewery businesses. If you are so inclined, you can too. Microbrewery business plans are available online; because alcohol control is given to the states, laws vary by state. Some American microbreweries act as their own distributor (wholesaler) and sell to retailers and/or directly to consumers.

Thomas Jefferson said, "Beer, if drank in moderation, softens the temper, cheers the spirit, and promotes health." The key, of course, is moderation.

Fun, Profitable, Wholesome Business You Can Start - Microbrewery

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Saturday, October 22, 2011

ADD - ADHD, But Without the Drugs

Australia currently has well over 50 000 children on prescription drugs to manage their behaviour, diagnosed as being ADD/ADHD related. This makes us the third highest consumer of ADD/ADHD medication (per capita) around the globe. With approximately 4% of all primary school children affected, the prescription of Dexamphetamine has grown almost four fold between 1984 and 2001, while Ritalin prescription rose by 18 million tablets (an increase of over tenfold) during that same period.

While the argument and disparity of opinion regarding the diagnosis of ADD/ADHD, especially in schools is ongoing, the treatment and management of the behavioural impact is still largely relying on pharmaceuticals.

Health Literacy

Less known, are the number of adult sufferers of ADD and ADHD. A recent study conducted by the World Health Organisation across 10 countries, found that as many as 3.5% of working adults may be affected. However, the number of pharmaceutical treatments of the condition in adults lies quite low, with the US well in the lead with 12.7% of sufferers seeking treatment, verses countries such as the Netherlands sitting at just 2.7%.

Alternative treatments for these two conditions range from nutrition (as a common denominator is irritable bowel syndrome among ADD/ADHD sufferers), to brain-gyms such as the Dore program and specific exercise schemes. Although, producing some results, the outcomes of these programs have not been consistent, founded on a scientific and evidence based platform, or made a strong impact in the reduction of the use of pharmaceuticals.

Just released in Australia however, is a new approach (technology) that combines neuro-motor training using audio triggers and sensory feedback, with movement and timing exercises. The technology has produced groundbreaking results in the US over the past 10 years of clinical trials and research.

Using a computer-linked technology known as Interactive Metronome, ADD/ADHD sufferers participate in a series of active sessions wearing headphones and following an audio prompt, to undertake an exercise setting off an electronic sensor, the timing of which is measured with accuracy of 100's of a second. The concentration, timing, and rhythm it requires, along with the repetitive nature of the program, stimulates the individual's ability to focus and strengthens the neural pathways. This allows sufferers to become more task orientated in other areas - such as in the class room and at work. This has a profound impact on their ability to be focussed and less disruptive in their behaviour.

With notable results being achieved after just 12 sessions in both children and adults alike, this new approach to ADD/ADHD management is likely to be welcomed by medical professionals, parents, and teachers here in Australia as it did in the states.

Certification courses for this technology are held in late April in Brisbane, Melbourne and Sydney for health professionals and educators. Visit for course details and further research information. Home operator courses are scheduled as per demand.

Interactive Metronome is also available as a home unit. Its additional benefits of generating improvement in cognition, timing/coordination (sport performance), and academic application (1-2 grade improvement in numeracy and literacy after just 12 sessions), makes it ideal for just about everyone in the family.

"Whether non-medicated treatment methods will take a foothold in Australia in terms of ADD/ADHD management, needs to be seen, however those that have chosen this technology over medication in the US, have definitely achieved some notable results and improvements", said Paediatric Occupational Therapist and Clinician, Dillen Hartley.

Traditionally, Australians often take a skeptical view when it comes to following in the foot-steps of our big brother the US, but in terms of reducing the use of medication in the treatment of ADD/ADHD, we may be well served to consider following this approach.

After all, the long term effects of 'drugging' our school children has not fully become apparent yet, but common sense tells us that it can't all be good...

And, why should we, especially if we do have pharmaceutical-free alternatives these days.

ADD - ADHD, But Without the Drugs

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Friday, October 21, 2011

Set Goals As A Family - Succeed As A Family

Setting family financial goals, that allow each member to participate, can be a powerful force. Personal goal setting alone changes lives and when you have each family member working together it will supercharge your results.

The more family members that are working toward a common goal the faster you will achieve results. What's more, when the entire family unit is working toward financial goals it can be a bonding experience that everyone will appreciate.

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Working toward family financial goals brings families closer together. You will find that your family will begin to operate as one unit in order to reach those goals. Many top business organizations, sports teams, charities and sororities share common financial goals that bring everyone involved closer together. It works for them so let the power of family financial goals work for you.

Family goals should be set for all areas of your life including: health, personal development, spiritual/ religious and life goals. This article will focus on family financial goals; however you can easily adopt the techniques to cover the remaining areas of your life. Once more, each individual person in the family should set their own personal goals and have full support from the family.

By setting common goals and working as a family to achieve financial freedom everyone involved gets a sense of purpose and something positive to work toward. Children, parents and other extended members of the family will all benefit from the support of working toward family goals.

How to set family financial goals.

Setting family financial goals begins with identifying objectives that your family wants to accomplish. Take some time to figure out what motivates everyone. Maybe one family member wants a vacation home at the beach, another person wants to retire next year and another member wants to have enough financial security to take a month off each year on family vacations. Find out what everyone dreams about because this will help you understand each others goals and you'll become closer because of it.

Once you have an understanding of what each family member wants it time to align your goals. Maybe you want to learn more about making investments, want to increase your 401k savings, would like that new car, or just want to have more money for a rainy day. The bottom line is that everyone in the family has to do their part. When everyone works together with a common goal of achieving financial freedom then everyone's life improves. The ability to set family financial goals and achieve family goals will improve every aspect of you personally and your family as a whole.

Family Financial Goals That Work.

There are effective goal setting techniques available that will allow your family to maximize the effectiveness of your financial goals. One helpful technique to aid in accomplishing your goals is to set them using the S.M.A.R.T method.

- S ' Significant & Specific. The more detailed you are able to make your family goals the closer you are to achieving them. This gives you a clear target to shoot for and when you see what you're aiming at you have a much better chance at hitting the bull's-eye.

Be sure to make your family financial goals significant. They must mean something to your family so that they are motivated to reach them. Setting a goal of saving for a gallon of gas probably won't motivate people but if it was to save gas for a weekend trip now that's another story. Remember kids, teens and young adults are motivated by lifestyle not money. So be sure to relate money to being able to afford the type of lifestyle your family wants to live.

- M - Motivational & Measurable. Creating measurable goals will allow your family to celebrate when you achieve them. This makes goal setting fun and a true bonding experience.

The family financial goals that you set should be motivational to the entire family. Create motivating goals that move family member to participate.

- A - Attainable. Dream huge and be realistic. You can be anything you set out to be; however growing gills so you can swim underwter probably won't happen.

- R - Results-oriented, Reasons & Related. One way to maximize the effectiveness of your family financial goals is to phrase your goals in the positive. Using results-oriented words like "I accomplished," "I received," or "I have", will direct your mind to focus on the outcome. Focusing on the outcome is one of the key steps to becoming financially free.

Your family financial goals should include the reasons too ' would you like money for college, a nice vacation, etc. It's the reasons behind the goals that make us want to accomplish them. Money doesn't matter it's what money brings us that matters.

Family financial goals must relate to each other so the family works as a single unit. Setting powerful family financial goals starts with making sure everyone's goals are heading in the same direction and not contradicting each other. For instance, if one family member's goal is taking a family trip to the beach next weekend and another goal is to work that weekend to save more money ' those contradict each other.

- T -Time. Your family financial goals should have a deadline. Decide on a specific time so you push each other to accomplish them by a certain date.

Take an evening and sit down together for dinner with no interruptions. Get everyone's dreams, goals and aspirations out. Find a way to align your goals to create a dynamic family that accomplishes goals together. Every goal you set out and accomplish together will bring everyone closer.

Set Goals As A Family - Succeed As A Family

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Thursday, October 20, 2011

How Difficult is Nursing School?

Good education is the key to success in every sphere of life. In order to get a good profession and a well paid job you will need to undergo serious training. This is applicable to all individuals looking to become nurses. It's worth noting that many people who considered enrolling in a nursing school program instead opted for far simpler options such as Red Cross CNA training.

The job involves a lot of serious responsibilities and you really need to be well trained to meet all the necessary criteria and help people get better treatment. At the same time, there are myths about the difficulty of nurse training. It is definitely worth asking the question: how hard is nursing school really?

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You have to get good literacy and numeracy skills in order to do well in nursing school. You have to be able to do basic math problems. This is a major concern for a lot of people, but the reality is that the prerequisites for nursing are not particularly hard. Moreover, you will get additional support from teachers and tutors if you have difficulties in this area of study.

Generally, apart from the good literacy skills, it helps if you are a fast learner. You will have to take serious science subjects that need a good level of understanding of chemistry and biology. The good news is that you will not get overly involved in these disciplines as part of your training. In addition, you will have to do plenty of exercises and preliminary tests as part of the course in order to get prepared for any exam so you will certainly learn your lessons. As long as you did well in high school and are determined to study seriously, you will find the nurse training not difficult.

How hard is nursing school in terms of training and study hours? In order to become a nurse you will need to learn a lot of things, but more importantly you will need to practice. The standard classes are not a lot, but they are sufficiently many to make your life a bit harder. There are practicum classes as well. These are much like unpaid internships. You will get to put the skills you have acquired into practice. These practice hours will also make your schedule busier. The good thing is that you can rely on some flexibility when you need it. All teachers are aware of the fact that the people on the course have a job that they go to and in most cases children to raise. In turn, they are quite understanding and helpful when you have hard time juggling with everything.

Overall, how hard is nursing school? It is not hard. You will do great as long as you are committed to studying and improving your skills. The training process will not be easy, but your efforts will certainly pay off eventually. The important thing is that you will receive the understanding and support you need as well as some flexibility when necessary. The teachers are certainly willing to aid you through the process. More importantly, given the specifics of the training the students get to form very string bonds between each other from the start. This means that you will receive even more help with studying and great support in general.

How Difficult is Nursing School?

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Wednesday, October 19, 2011

My Personal Greatest Hero - Jimmy Yen

Who do we most respect and admire? Why our Heroes of course. What are the characteristics of a Hero? Heroes are courageous and self-reliant, and they are greatly admired. Being courageous and self-reliant are the characteristics that create heroes. Being admired is something that comes afterward.

Name a genuine Hero who followed the crowd? It's a crazy question, because Heroes don't follow the crowd. A hero may or may not lead other people, but all heroes lead themselves. Heroes are self confident independent thinkers who make courageous choices. By committing their entire focus to their goals, Heroes leave no time or energy for worry or self-inflicted emotional suffering. Heroism is a path to a joyful life as well as to inspired service.

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Want to be a Hero, just pick one to emulate - WRONG. To be heroic, don't emulate a hero, learn from one. Heroes don't follow anyone, they set their own course.

At the end of this article there is an exercise for considering your own greatest hero and which of their qualities inspire you.

Y. C. James (Jimmy) Yen (Yan Yangchu): (1893-1990) - Charismatic Visionary, Humanitarian, and Educator

An invasion of armies can be resisted, but not an idea whose time has come. - Victor Hugo

Go to the people
Live among them
Learn from them
Love them
Serve them
Plan with them
Start with what they know
Build on what they have. - Jimmy Yen

A leader is most effective when people barely know he exists. When his work is done, his aim fulfilled, his troops will feel they did it themselves. - Lao Tzu

My personal Greatest Hero is Jimmy Yen. You have probably never heard of Jimmy Yen - most Americans haven't. Not that he went without recognition. The novelist Pearl Buck wrote his biography. Time magazine wrote about him, and Reader's Digest wrote about him several times - once as a feature article. In 1943, Jimmy Yen received the prestigious Copernican award as one of 10 highly influential "modern revolutionaries" including Albert Einstein, Orville Wright, Walt Disney, and Henry Ford. He also received the Ramon Magsaysay Award for International Understanding in 1960, and in 1983 he received the Eisenhower Medallion of the People-to-People Foundation for his 'exceptional' contribution to world peace and understanding.

Jimmy Yen was a very unassuming man who never sought personal recognition or glory. He didn't start out with a huge vision, either. His greatest commitments were to his wife, his strong Christian faith, and to the people around him. His immense contribution to humanity began in a very small way, and grew, and grew, and grew exponentially.

In 1918, immediately after graduating from Yale University, Jimmy Yen was swept up into the First World War. He went to France as a YMCA volunteer to interpret for a few of the 180,000 Chinese peasants who had been brought to France by the Allied Forces to work as laborers.

While working among the Chinese laborers, Jimmy found these people to be eager and intelligent, but universally uneducated - that is, unable even to read or write their own name. Jimmy spent many hours reading Chinese language newspapers to these men and writing letters for them to send back to their loved ones in China.

Jimmy wished that he could teach his new friends to read and write, but there was a second reason for these people's illiteracy beyond the poverty and exceedingly hierarchal class structure of rural China. Chinese is an extremely complex language that is written using tens of thousands of intricate characters - each representing a complete word, rather than a letter.

Even more confounding for a common Chinese speaker trying to master reading and writing, the language that was read and written by educated Chinese at that time was Classical Chinese, which is not a written representation of conversational Chinese, but rather a formalized language virtually unchanged for 2000 years. It was as if the only path for an Italian to learn reading and writing was to learn to read and write Latin.

In spite of the great perceived difficulties, and the mediocre success that other YMCA volunteers had had in teaching the laborers to read and write Classical Chinese, Jimmy still visualized the laborers reading their own newspapers and writing their own letters home.

As he looked at the correspondence he was writing, Jimmy was struck by how often a very small number of characters (words) recurred. Inspired genius struck, and Jimmy selected 1000 characters that he believed could communicate virtually any idea.

Putting flesh on the bones of inspiration, Jimmy made the decision to teach the writing of Vernacular Chinese (Baihua) - a written representation of spoken Chinese - rather than Classical Chinese. Although there had been a effort to promote Baihua in China for several years, it had not gathered momentum, and Baihua remained virtually unused.

Jimmy offered to teach the laborers reading and writing using his 1000 Character System. 40 of the 5000 men in his camp accepted his offer. The training was so successful that many more wanted to join the next class.

Soon, almost all the laborers in that camp were writing their own letters home, and reading a newsletter Jimmy had printed for them in 1000 Baihua characters. Word spread rapidly, and other volunteers started teaching Jimmy's 1000 Character system throughout the Chinese laborer camps in France.

Jimmy then made a vow to return to his country of birth and educate everyone in rural China.

Jimmy returned to the United States, completed a Masters program at Princeton, obtained financial support from the YMCA-In-China program to launch a Chinese literacy program, and set sail for China with his new bride Alice - who was to become his lifetime companion and committed co-worker in the Literacy and Rural Reconstruction movements.

In 1923, Jimmy established the Chinese Mass Education Movement, and launched what quickly became a nationwide program to teach 1000 Character literacy.

In 1926, Jimmy expanded his work to address the four interlocking problems of ignorance, poverty, disease and civic inertia, with an integrated Rural Reconstruction program of education, livelihood, health and self-government - "integrated, people-centered and sustainable rural development" in his words.

In 1928, John D. Rockefeller Jr. made a large personal contribution to Jimmy's work and inspired many other Americans to do the same.

With the onset of the Second World War, Jimmy came back to the United States to raise funds for reconstruction in China. Jimmy made powerful friends in America - including Eleanor Roosevelt and Henry Ford - and in 1948 secured funding for post-war reconstruction through the "Jimmy Yen Provision" of the China Aid Act.

In 1950, when his work in China was halted by the incoming Communist government, Jimmy and Alice turned their attention to the world, working with rural reconstruction in the Philippines Thailand, India, Ghana, Guatemala, Columbia, Mexico and Cuba.

In 1960 Jimmy founded the International Institute of Rural Reconstruction in the Philippines.

In 1985 the Chinese government finally welcomed Jimmy back to China and acknowledged his immense contribution to Mass Education and Rural Reconstruction in China.

Today, the International Institute of Rural Reconstruction (IIRR), a worldwide organization based in the Philippines, continues the work begun by Jimmy and Alice Yen and serves as a living memorial to their work.

Beginning with the desire to teach a few simple laborers to read and write, Jimmy Yen's life unfolded over more than 70 years of service to directly benefit tens of millions of people around the world.

Best of all for me personally, Jimmy Yen is my uncle. In 1921 Uncle Jimmy married Alice Huie - my aunt and the daughter of my grandfather - the Reverend Huie Kin, pastor of the First Chinese Presbyterian Church of New York City.

For me, Jimmy Yen represents the ultimate in inspired selfless service. Day after day after day, he just did the best he could to take one more small step toward what he believed in. His commitment and enthusiasm were so infectious that people around the world became inspired by his vision.

Exercise: Who is my Personal Greatest Hero? Take pen and paper. Write why I admire my greatest hero, and which of their qualities I want to emulate in my own life.

My Personal Greatest Hero - Jimmy Yen

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Tuesday, October 18, 2011

The Impact of Technology on the Developing Child

Reminiscing about the good old days when we were growing up is a memory trip well worth taking, when trying to understand the issues facing the children of today. A mere 20 years ago, children used to play outside all day, riding bikes, playing sports and building forts. Masters of imaginary games, children of the past created their own form of play that didn't require costly equipment or parental supervision. Children of the past moved... a lot, and their sensory world was nature based and simple. In the past, family time was often spent doing chores, and children had expectations to meet on a daily basis. The dining room table was a central place where families came together to eat and talk about their day, and after dinner became the center for baking, crafts and homework.

Today's families are different. Technology's impact on the 21st century family is fracturing its very foundation, and causing a disintegration of core values that long ago were what held families together. Juggling work, home and community lives, parents now rely heavily on communication, information and transportation technology to make their lives faster and more efficient. Entertainment technology (TV, internet, videogames, iPods) has advanced so rapidly, that families have scarcely noticed the significant impact and changes to their family structure and lifestyles. A 2010 Kaiser Foundation study showed that elementary aged children use on average 8 hours per day of entertainment technology, 75% of these children have TV's in their bedrooms, and 50% of North American homes have the TV on all day. Add emails, cell phones, internet surfing, and chat lines, and we begin to see the pervasive aspects of technology on our home lives and family milieu. Gone is dining room table conversation, replaced by the "big screen" and take out. Children now rely on technology for the majority of their play, grossly limiting challenges to their creativity and imaginations, as well as limiting necessary challenges to their bodies to achieve optimal sensory and motor development. Sedentary bodies bombarded with chaotic sensory stimulation, are resulting in delays in attaining child developmental milestones, with subsequent impact on basic foundation skills for achieving literacy. Hard wired for high speed, today's young are entering school struggling with self regulation and attention skills necessary for learning, eventually becoming significant behavior management problems for teachers in the classroom.

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So what is the impact of technology on the developing child? Children's developing sensory and motor systems have biologically not evolved to accommodate this sedentary, yet frenzied and chaotic nature of today's technology. The impact of rapidly advancing technology on the developing child has seen an increase of physical, psychological and behavior disorders that the health and education systems are just beginning to detect, much less understand. Child obesity and diabetes are now national epidemics in both Canada and the US. Diagnoses of ADHD, autism, coordination disorder, sensory processing disorder, anxiety, depression, and sleep disorders can be causally linked to technology overuse, and are increasing at an alarming rate. An urgent closer look at the critical factors for meeting developmental milestones, and the subsequent impact of technology on those factors, would assist parents, teachers and health professionals to better understand the complexities of this issue, and help create effective strategies to reduce technology use. The three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans. Movement, touch and connection are forms of essential sensory input that are integral for the eventual development of a child's motor and attachment systems. When movement, touch and connection are deprived, devastating consequences occur.

Young children require 3-4 hours per day of active rough and tumble play to achieve adequate sensory stimulation to their vestibular, proprioceptive and tactile systems for normal development. The critical period for attachment development is 0-7 months, where the infant-parent bond is best facilitated by close contact with the primary parent, and lots of eye contact. These types of sensory inputs ensure normal development of posture, bilateral coordination, optimal arousal states and self regulation necessary for achieving foundation skills for eventual school entry. Infants with low tone, toddlers failing to reach motor milestones, and children who are unable to pay attention or achieve basic foundation skills for literacy, are frequent visitors to pediatric physiotherapy and occupational therapy clinics. The use of safety restraint devices such as infant bucket seats and toddler carrying packs and strollers, have further limited movement, touch and connection, as have TV and videogame overuse. Many of today's parents perceive outdoor play is 'unsafe', further limiting essential developmental components usually attained in outdoor rough and tumble play. Dr. Ashley Montagu, who has extensively studied the developing tactile sensory system, reports that when infants are deprived of human connection and touch, they fail to thrive and many eventually die. Dr. Montagu states that touch deprived infants develop into toddlers who exhibit excessive agitation and anxiety, and may become depressed by early childhood.

As children are connecting more and more to technology, society is seeing a disconnect from themselves, others and nature. As little children develop and form their identities, they often are incapable of discerning whether they are the "killing machine" seen on TV and in videogames, or just a shy and lonely little kid in need of a friend. TV and videogame addiction is causing an irreversible worldwide epidemic of mental and physical health disorders, yet we all find excuses to continue. Where 100 years ago we needed to move to survive, we are now under the assumption we need technology to survive. The catch is that technology is killing what we love the most...connection with other human beings. The critical period for attachment formation is 0 - 7 months of age. Attachment or connection is the formation of a primary bond between the developing infant and parent, and is integral to that developing child's sense of security and safety. Healthy attachment formation results in a happy and calm child. Disruption or neglect of primary attachment results in an anxious and agitated child. Family over use of technology is gravely affecting not only early attachment formation, but also impacting negatively on child psychological and behavioral health.

Further analysis of the impact of technology on the developing child indicates that while the vestibular, proprioceptive, tactile and attachment systems are under stimulated, the visual and auditory sensory systems are in "overload". This sensory imbalance creates huge problems in overall neurological development, as the brain's anatomy, chemistry and pathways become permanently altered and impaired. Young children who are exposed to violence through TV and videogames are in a high state of adrenalin and stress, as the body does not know that what they are watching is not real. Children who overuse technology report persistent body sensations of overall "shaking", increased breathing and heart rate, and a general state of "unease". This can best be described as a persistent hypervigalent sensory system, still "on alert" for the oncoming assault from videogame characters. While the long term effects of this chronic state of stress in the developing child are unknown, we do know that chronic stress in adults results in a weakened immune system and a variety of serious diseases and disorders. Prolonged visual fixation on a fixed distance, two dimensional screen grossly limits ocular development necessary for eventual printing and reading. Consider the difference between visual location on a variety of different shaped and sized objects in the near and far distance (such as practiced in outdoor play), as opposed to looking at a fixed distance glowing screen. This rapid intensity, frequency and duration of visual and auditory stimulation results in a "hard wiring" of the child's sensory system for high speed, with subsequent devastating effects on a child's ability to imagine, attend and focus on academic tasks. Dr. Dimitri Christakis found that each hour of TV watched daily between the ages of 0 and 7 years equated to a 10% increase in attention problems by age seven years.

In 2001 the American Academy of Pediatrics issued a policy statement recommending that children less than two years of age should not use any technology, yet toddlers 0 to 2 years of age average 2.2 hours of TV per day. The Academy further recommended that children older than two should restrict usage to one hour per day if they have any physical, psychological or behavioral problems, and two hours per day maximum if they don't, yet parents of elementary children are allowing 8 hours per day. France has gone so far as to eliminate all "baby TV" due to the detrimental effects on child development. How can parents continue to live in a world where they know what is bad for their children, yet do nothing to help them? It appears that today's families have been pulled into the "Virtual Reality Dream", where everyone believes that life is something that requires an escape. The immediate gratification received from ongoing use of TV, videogame and internet technology, has replaced the desire for human connection.

It's important to come together as parents, teachers and therapists to help society "wake up" and see the devastating effects technology is having not only on our child's physical, psychological and behavioral health, but also on their ability to learn and sustain personal and family relationships. While technology is a train that will continually move forward, knowledge regarding its detrimental effects, and action taken toward balancing the use of technology with exercise and family time, will work toward sustaining our children, as well as saving our world. While no one can argue the benefits of advanced technology in today's world, connection to these devices may have resulted in a disconnection from what society should value most, children. Rather than hugging, playing, rough housing, and conversing with children, parents are increasingly resorting to providing their children with more videogames, TV's in the car, and the latest iPods and cell phone devices, creating a deep and widening chasm between parent and child.

Cris Rowan, pediatric occupational therapist and child development expert has developed a concept termed 'Balanced Technology Management' (BTM) where parents manage balance between activities children need for growth and success with technology use. Rowan's company Zone'in Programs Inc. has developed a 'System of Solutions' for addressing technology overuse in children through the creation of Zone'in Products, Workshops, Training and Consultation services.

The Impact of Technology on the Developing Child

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Sunday, October 16, 2011

Yoga for Relaxation

Discover the true meaning of yoga...

In taking any modern yoga class, you will find parallels to ballet. Like ballet, the promise of poise, grace and flexibility encourages much interest. Yet if yoga is like any other exercise, it is only at first glance. Underneath the coveted health and fitness benefits of modern yoga practice are the roots of a great spiritual tradition blending cultures and religions.

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Unfortunately, through the westernization of yoga, we have lost an essential component of this peaceful practice. Though the ritual remains intact the meaning has gone astray. Where previously the postures of yoga practice were merely a branch of a tree; today they are viewed by western society as the tree itself. How do we bring meaning to our poses?

Modern Yoga's Roots and Benefits

Though the development of yoga cannot be pinned to an exact year, the discovery of the Indus seals, which show figures in the classic yoga asana (posture) of lotus pose, trace yoga back to at least 3000 BCE. At this time the Vedas were being written, which today's yoga postures are derived from. These gave birth to Vedic yoga, which accommodated the ancient Indians fixation on ritual and sacrifice. We see evidence of the importance of sacrifice in the yogic corpse posture. Lying as though we were placed in a coffin, this represents the ultimate sacrifice-that of death. Though seemingly morbid, corpse posture is one of hope when we understand that according to the Vedanta sutras, death results in liberation

Sacrifice was meant to join the material and the physical, and create the longed-for "union" that defines the word Yoga. The Vedanta sutras (vs.4:4,13-14) declare that the liberated soul is not materially motivated.. By asking us to free ourselves from the bondage of material motivation, compassion requires us to be selfless. Surely, this giving is an exercise in compassion. Even still, the modern practice of yoga facilitates this. Through postures and stillness, we alter our consciousness and therefore change our perspective. In our new realization of others as being part of the cosmic whole, we feel that in giving to them we are also giving to ourselves.

The ancient philosophy of yoga saw its postures as part of a greater whole. Thousands of years ago during the time of Astanga yoga, posture practice was one piece of a more important whole. Astanga yoga, which originated during Vedic India, was derived of eight branches; yama (control and discipline), niyama (rules, methods and principle), asana (posture), pranayama (focused breathing), prathyahara(avoidance of undesirable action),dharana (concentration), dhyana (meditation) and samadhi (contemplation). In contrast, most contemporary yoga focuses on postures and uses breath work as a small component or an afterthought. Though admittedly, the current vision of yoga over-emphasizes asana, it is extremely important and has enormous benefits. The medically studied benefits of yoga include the following: Stress reduction, improved muscle strength and tone, increased energy and flexibility, improved balance and coordination and a reduction in depression.
Moving with Compassion

Through most of asana practice, we are unconsciously engaging in physical metaphor. Many yoga postures are named after and imitate the living world; tree pose, eagle pose, frog pose, cat pose. By developing postures that imitate the stance of animals, the vedic seers may have been seeking not only to embrace the qualities of these animals, but to formulate compassion for them.
The way that compassion serves as a partner to yoga's goal of liberation can be understood through reading the ancient yogic texts. Understand these vedas; whether they be the Rig Veda (knowledge of praise),Yajur-Veda (knowledge of sacrifice), Sama Veda (knowledge of chants), and Atharva-Veda(knowledge of atharvan), is likelier while deep in meditation. Understanding the vedic sutras, we are permitted to experience a bliss unknown through material grasping.

In this state everyday experiences fade away and a greater perspective unfolds. Over time, meditation also allows us to become more intuitive and receptive. This opens us up to others, enhancing our compassionate nature. This experience has been discussed by Eastern sacred-text expert "H.P. Blavatsky's in "The Voice of the Silence." Blavatsky writes: "Compassion is no attribute. IT is the LAW of LAWS--eternal Harmony, Alaya's SELF; a shoreless universal essence, the light of everlasting Right, and fitness of all things, the law of love eternal."

In order to experience compassion for others we must first extend it to ourselves. Straining too forcefully in a pose is counter to compassion. Why? Yoga teaches us that we are all connected, so when we hurt ourselves this pain eventually reaches others. Instead we must strive for gentle self-acceptance, competing with nobody-not even ourselves. This is essential to a rewarding experience of yoga.

Postures for Peace

By the time of Patanjali's yoga sutras, which were written near the beginning of the common era, we begin to see a discussion of the more practical aspects of yoga. Posture is discussed (be it mainly for meditative purposes), as is concentration of the mind during this exercise. In the Yoga-Sutra, Patanjali presents relaxation as the very essence of yoga practice. He teaches us that posture should be steady and comfortable .This sentiment is reflected in the postures (asanas) of today's practice. The physical dimension of yogic exercise requires us to have compassion for our limits. We are never asked to push, instead only to release. Mercifully, our small efforts are graced with us connecting to a life-force that is divine and encompassing.

Asanas urge us to see our body as divine, and to nurture health in this mortal temple. Yogic adepts understand that their body is flawed, however slender and toned it may look externally. This acknowledgement leads to less judgement of other's bodies. However pleasing to the eye a yogis shape may be, the same vedic texts that encourage the practice of yoga for health, also remind us that true "liberation" comes from being free of the cycle of rebirth-free of the physical form.

Yogic postures work in contrast to the western notion of exercise. Here we see exercise as an end, such as an end to overweight and fatigue. Yoga is different. While in most forms of exercise the physical results are the sole goal, in yoga the soul is the goal. The ancient tradition of yoga exercise stands apart in its doctrines. The ancient yoga texts insist that the mind and spirit are more important than the physical body. While many other eastern forms of mind-body fitness also encourage this awareness, no other physical practice has the ultimate goal of union with the divine. In yoga, the process of attaining this union is as important as the actual attainment.

Yoga practice is not a means to an end. It is an end in of itself. Even distinguished from vedas and sutras, the modern practice of yoga posture is a beautiful and calming pursuit. Though modern yoga practice makes little mention of the scriptures that it is based on, the experience of union and compassion can be woven into each pose. In doing this we are enhancing more than our practice, we are improving our life.

Yoga for Relaxation

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Autism Spectrum Disorder (ASD)

Autism is the most common neurological disorder affecting children; and also is one of the most common developmental disabilities affecting American and Canadian Children. ASD changes the way the brain processes information which affects all areas of a person's development.

Autism Spectrum Disorder is a neurological disorder resulting in developmental disability; this affects a person's communication, social understanding and behaviour including interests and activities. Autism usually appears around the first three years of a child's life and boys are more prone to autism than girls.

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No one person with ASD behaves or responds exactly the same way as others with the same diagnosis, each individual is quite unique. There are actually five different Autism Spectrum Disorders described under a diagnostic category, Pervasive Developmental Disorders [PDD].

1. Childhood Disintegrative Disorder[CDD]:
This is a rare condition that affects 0.2 in 10,000, symptoms are significant losses in social behaviour, language, and play. These symptoms usually appear after at least three years of normal developmental period. This disorder results in severe defects in cognitive ability.

2. Rett Syndrome:
This too is a rare condition that affects 1 in 10,000 and affects girls inclusively. Again significant regression after a period of normal development. Severe impaired language and psychotic motor skills and difficulty cognitive ability.

3. Autistic Disorder [AD]:
This condition is diagnosed more often and affects 20 in 10,000 cognitive impairments, deficits in non-verbal and verbal communications and social understanding, unusual behaviour and restrictive activities.

4. Pervasive Developmental Disorder - not already specified [PDD.NOS]:
This condition is often used in 15 in 10,000 diagnosed; this is also named a typical Autism. This condition is severe and pervasive impairment that can be found in some interaction or restrictive activities and interests.

5. Asperger Disorder - also called Asperger's Syndrome, and Asperger Syndrome, AS
This is a common disorder and is diagnosed 5 in 10,000. This condition can have mild to severe impairments along with social understanding, interactions, repetitive, restricted interests and activities Cognitive and language development is not delayed; however there are deficits in communications.

Early Signs of Autism: (12 to 24 Months) - children may demonstrate only a few of these symptoms -

- May appear deaf because they respond unevenly or not at all to sounds
- " Failure to Bond" (i.e. child is indifferent to parents' presence)
- Does not Point and Look
- Chronic gastrointestinal problems
- Self restricted/selected diet
- Repeated infections
- Reaction to vaccines
- Difficulty consoling during transitions (tantrums)
- Often begins to develop language then loses it or doesn't acquire language.
- Difficulty sleeping / wakes at night.
- Limited imaginative play
- Not interested in playing with other children

Many paediatricians and other physicians are not experienced in diagnosing Autism Spectrum Disorder (ASD) and the physicians fear making the diagnosis because they were trained to believe that ASD is incurable. Do not accept your doctor's advice if he or she proposes a "wait and see" approach or promises that your child will "catch up". If your child has normal development and then regresses, you should seek help immediately. As a child's brain develops it is pliable and there is a window of opportunity for recovery at a young age that however does diminishes as the child gets older.

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Autism Spectrum Disorder (ASD)

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Saturday, October 15, 2011

Yoga Position - What Does Each Type Do?

I often wondered what the value of each type of yoga position is, so I did some research to find out. All yoga positions help to develop strength and flexibility. Yet the type of yoga position that you do also offers some very specific benefits.

Standing Poses

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They are included in many poses and they help to align your feet and body. This type of yoga position is especially useful in improving your posture. Standing poses strengthen your legs while simultaneously increasing flexibility in your legs and hips. They add to the mobility of your neck and shoulders and they increase the flexibility in your pelvis and lower back. One of the most basic standing poses is Mountain Pose.

Seated Poses

These poses help increase flexibility in your hips and lower back, while also strengthening your back. They add suppleness to your spine and elasticity to your hips, knees, ankle and groin. They also encourage deeper breathing, which contributes to you feeling calm and peaceful.

Forward Bends

This type of yoga position helps stretch your lower back and hamstrings. Forward bends also release tension in your back, neck, shoulders, and increase the flexibility in your spine. They often promote a sense of calmness. I find forward bends particularly challenging since I have a considerable amount of stiffness in my neck due to an old gymnastics injury. This is the type of yoga position where I often use a prop such as a strap or block.

Back Bends

They open your chest, rib cage, and hips. They strengthen your arms and shoulders, while simultaneously increasing flexibility in your shoulders. They help relieve tension from the front of your body and hips and they also increase spinal stability. You should always do back bends as a complement to forward bends in order to maintain balance in your body.


Although balance poses can be challenging, I find them to be some of the most fun poses to do. They help you develop muscle tone and coordination and also strength and agility. They help improve your posture because you really need to elongate your spine in order to keep yourself from falling over. This type of yoga position helps train your mind to focus your attention; if your attention if not focused, you will not be able to do the pose.


I love to do twists. Twists release tension in your spine and increase shoulder and hip mobility. They also help relieve backaches by stretching and opening up your back muscles. I often experience tightness in my upper back and twists help me loosen up this area. It is important to always do twists on both sides of your body in order to ensure alignment and balance.

Supine and Prone Poses

Supine poses are done on your back. They help stretch your abdominal muscles, they open your hips, and increase your spinal mobility. They release tension and strengthen your back, arms and legs.

Prone poses are done facing the floor. They strengthen your arms and back and open up your hips and groin. They relieve tension and increase flexibility in your spine. One of my favorite prone poses is Extended Seal because I find it very relaxing and it helps stretch out my shoulders and upper back.


This type of yoga position develops strength and stamina, particularly in your upper body. It also increases circulation because since your legs are higher than your heart, it reverses the normal flow of blood. Inversions help pull fluid out of your feet and legs, so they are great to do after you have been standing up for a long time. Advanced inversion poses require a great deal of strength and alignment and should only be learned under the guidance of a certified teacher. People with glaucoma, pregnant women and those who are menstruating should avoid inversion poses.

Relaxation Poses

Relaxation poses are usually done at the end of a yoga practice. They calm your mind and body and encourage a deep feeling of relaxation. This type of yoga position is often one of the most challenging poses to do, particularly for Westerners who often have a difficult time letting go. One of the most well-known relaxation poses is Corpse Pose.

There are hundreds of poses in yoga and they all provide wonderful benefits for your mind and body. By understanding each type of yoga position, you can choose a well rounded practice with asanas from each type or do those that meet your body's needs at any given time.

Yoga Position - What Does Each Type Do?

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Friday, October 14, 2011

10 Charity Event Theme Ideas

Every year, charity events raise significant amounts of money for non-profit groups. More than billion was raised in the United States through charity events in 2005 (according to Charity Navigator, a non-profit watchdog group), accounting for 15 percent of charities total earnings.

Large or small, charity events make an impact. Here are 10 top theme ideas for your next charity event.

Health Literacy

Themes for Sporting Events

Athletic events like the Susan G. Komen "Race for a Cure" are some of the world's largest charity fundraising events each year. But you don't need a million participants to make an impact; a great theme can still help you get noticed, even if you're a small organization. Here are some sports themes to try:

Costume themes, like superheroes or mascots. Anything you do is automatically more memorable if you're dressed up. Jump out of a plane, run a marathon or ride a bike in costume to draw attention to your cause. Seasonal events, like a Christmas Climb over the holiday season or a Turkey Trot during Thanksgiving. Cross-dressing themes are fun for male-dominated events like flag football

Themes for Dinner & Dancing Charity Events

Some events -- like charity balls or wine tastings -- are glamorous on their own, but a unique theme can pep up an otherwise-humdrum party. Here are some themes to try:

Ice theme - Definitely the coolest event in town! Hawaiian luau themes work great in the summer, but they can make an event really stand out in the middle of winter too. Murder mysteries keep everyone on their toes (and watching their backs) Spicy salsa evening - Cater your event with tapas and show off your sexy salsa dance moves. Ask participants to dress up in cultural attire too.

Specialty Themes for Charity Events

To make your event truly unique, create a theme based on your charity. Some charities have obvious connections, like pink parties for breast cancer charities or a dog show for animal shelters, but with a little imagination you can come up with an interesting theme for any charity, such as:
Hospitals and health charities - Create a tasteful theme around the medical profession, such as a Halloween costume parade through a local hospital (with permission, of course!), a "wear red" event for heart charities, or even a neighborhood carnival for kids cancer research. Think about what is special about your charity and base your theme on this concept. Third World aid charities - What region of the world does your charity help? Pick the best things about that area -- from African dancing to Asian cuisine -- and base your event on this theme. Literacy or education charities - Hold a cocktail party where everyone dresses up as a character from their favorite book, or do a reading marathon with a group of friends.

With a little creativity, you can turn any charity event into a uniquely-themed day that is sure to be remembered by your charity and its supporters.

10 Charity Event Theme Ideas

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Thursday, October 13, 2011

A Prescription For the Health Care Crisis

With all the shouting going on about America's health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it---people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they've encountered it, when people who've spent entire careers studying it (and I don't mean politicians) aren't sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he'd spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Health Literacy

Though I've worked in the American health care system as a physician since 1992 and have seven year's worth of experience as an administrative director of primary care, I don't consider myself qualified to thoroughly evaluate the viability of most of the suggestions I've heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.


No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach ,160 per person per year by the end of 2009 compared to the 6 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we've spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we've been getting for each dollar we spend.


This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can't attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country's GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).

Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.

Is it because of monstrous profits the health insurance companies are raking in? Probably not. It's admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of 6.7 million, which, if projected out, predicts a yearly profit of around .3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it's unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately billion per year. Total health care expenditures in 2007 were .2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren't likely different by any order of magnitude).

Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it's hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was .2 billion, only 0.1% of .1 trillion (see Table 1, page 3) in total health care expenditures for that year.

Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately 6 billion (see Table 2, page 4). Though this amounted to 10% of the .1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.

Is it from administrative costs? In 1999, total administrative costs were estimated to be 4 billion, a full 25% of the .2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it's hard to imagine it's shrunk to any significant degree since then.

In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:

1. Technological innovation.

2. Overutilization of health care resources by both patients and health care providers themselves.

Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they're treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don't have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we've figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we're great at doing in the United States is making technology available.

Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What's not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies---but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn't important---just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.

Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, "The Cost Conundrum," Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.

A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:

1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven't been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain "red flag" symptoms are present, most doctors would refer. If not, some would and some wouldn't depending on their training and the intangible exercise of judgment.

2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.

3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.

4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).

5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they're receiving a straight salary.

Gawande's article implies there exists some level of utilization of health care resources that's optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).

How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient---the "sweet spot"---in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn't mean every physician knows it or provides them. Data clearly show many don't. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.

In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.

But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next---


According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families---Implications for Reform, growth in health care spending "can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care." When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you'd be spending 60% of your income on health care but that as a result you'd enjoy, say, a 30% chance of living to the age of 250, perhaps you'd judge that 60% a small price to pay.

This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn't what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?

People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don't realize that we're already rationing at least some of it. It just doesn't appear as if we are because we're rationing it on a first-come-first-serve basis---leaving it at least partially up to chance rather than to policy, which we're uncomfortable defining and enforcing. Thus we don't realize the reason our 90 year-old father in Illinois can't have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn't). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we're so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).

So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980's (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn't want to give up.

But how do we decide whether we're getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn't provide great clinical benefit---demented patients score higher on tests of cognitive ability while on it but probably aren't significantly more functional or significantly better able to remember their children compared to when they're not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.

Who's best positioned to judge the value to society of the benefit of an innovation---that is, to decide if an innovation's benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public's views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone's imagination).


A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance---emergency rooms---which has significantly impaired the ability of our nation's ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors' appointments, long wait times in doctors' offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.


As Freaknomics authors Steven Levitt and Stephen Dubner state, "If morality represents how people would like the world to work, then economics represents how it actually does work." Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there's always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.

Here then is a summary of what I consider the best recommendations I've come across to address the problems I've outlined above:

1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It's harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn't be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group's higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory "open enrollment" period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that's driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of "good" and "bad" insurance that's currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a "public option" insurance plan open to all, I worry that if it's significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another's health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a "public option" remains comparable to private options, the very people it's meant to help won't be able to afford it.

2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn't have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that's true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let's not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I'm not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.

3. Decrease overutilization of health care resources by doctors. I'm in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what's truly best for their patients? The idea that external bodies---whether insurance companies or government panels---could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients' welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient's consideration, as long as they're careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn't). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients' welfare, meaning doctors' salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn't seemed to promote shoddy care when doctors feel they're being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.

4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:

* Making available the right resources for the right problems (so that patients aren't going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the "sweet spot" with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we've been seeing for the last decade).

* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don't actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it's just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should---we'd just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).

* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can't have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current "pre-pay for everything" model does.


Given the enormous complexity of the health care system, no single post could possibly address every problem that needs to be fixed. Significant issues not raised in this article include the challenges associated with rising drug costs, direct-to-consumer marketing of drugs, end-of-life care, sky-rocketing malpractice insurance costs, the lack of cost transparency that enables hospitals to paradoxically charge the uninsured more than the insured for the same care, extending health care insurance coverage to those who still don't have it, improving administrative efficiency to reduce costs, the implementation of electronic medical records to reduce medical error, the financial burden of businesses being required to provide their employees with health insurance, and tort reform. All are profoundly interdependent, standing together like the proverbial house of cards. To attend to any one is to affect them all, which is why rushing through health care reform without careful contemplation risks unintended and potentially devastating consequences. Change does need to come, but if we don't allow ourselves time to think through the problems clearly and cleverly and to implement solutions in a measured fashion, we risk bringing down that house of cards rather than cementing it.

A Prescription For the Health Care Crisis

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