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We give you many useful information about health

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We give you many useful information about health

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We give you many useful information about health

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We give you many useful information about health

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Rabu, 09 November 2011

Local, organic foods not always safer

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AppId is over the quota
WASHINGTON (AP) — Shoppers nervous about foodborne illnesses may turn to foods produced at smaller farms or labeled "local," ''organic" or "natural" in the hopes that such products are safer. But a small outbreak of salmonella in organic eggs from Minnesota shows that no food is immune to contamination.

While sales for food produced on smaller operations have exploded, partially fueled by a consumer backlash to food produced by larger companies, a new set of food safety challenges has emerged. And small farm operations have been exempted from food safety laws as conservatives, farmers and food-lovers have worried about too much government intervention and regulators have struggled with tight budgets.

The government has traditionally focused on safety at large food operations — including farms, processing plants, and retailers — because they reach the most people. Recent outbreaks in cantaloupe, ground turkey, eggs and peanuts have started at large farms or plants and sickened thousands of people across the country.

"While it's critical that food processors be regularly inspected, there is no way the Food and Drug Administration would ever have the resources to check every farm in the country, nor are we calling for that," says Erik Olson, a food safety advocate at the Pew Health Group. "Unfortunately, there are regulatory gaps, with some producers being completely exempt from FDA safeguards."

The FDA, which oversees the safety of most of the U.S. food supply, often must focus on companies that have the greatest reach. A sweeping new egg rule enacted last year would require most egg producers to do more testing for pathogens. Though the rule will eventually cover more than 99 percent of the country's egg supply, small farms like Larry Schultz Organic Farm of Owatonna, Minn., would not qualify. That farm issued a recall last week after six cases of salmonella poisoning were linked to the farm's eggs.

A new food safety law President Barack Obama signed earlier this year exempts some small farms as a result of farmers and local food advocates complaining that creating costly food safety plans could cause some small businesses to go bankrupt. The exemption covers farms of a certain size that sell within a limited distance of their operation.

Food safety advocates unsuccessfully lobbied against the provision, as did the organic industry. Christine Bushway of the Organic Trade Association, which represents large and small producers, says food safety comes down to proper operation of a farm or food company, not its scale.

"How is the farm managed? How much effort is put into food safety?" she asks. "If you don't have really good management, it doesn't matter."

Smaller farms do have some obvious food safety advantages. Owners have more control over what they are producing and often do not ship as far, lessening the chances for contamination in transport. If the farm is organic, an inspector will have to visit the property to certify it is organic and may report to authorities if they see food being produced in an unsafe way. Customers may also be familiar with an operation if it is nearby.

But those checks aren't fail-safe. The FDA has reported at least 20 recalls due to pathogens in organic food in the last two years, while the Agriculture Department, which oversees meat safety, issued a recall of more than 34,000 pounds of organic beef last December due to possible contamination with E. coli.

Egg safety is equally ambiguous. While many people like to buy cage-free eggs, those chickens may be exposed to bacteria on the grounds where they are roaming.

So what can a consumer do? Experts say to follow the traditional rules, no matter what the variety of food. Cook foods like eggs and meat, and make sure you are scrubbing fruit and cleaning your kitchen well.

Do your part, and hope for the best, the experts say.

"Labels like organic or local don't translate into necessarily safer products," says Caroline Smith DeWaal of the Center for Science in the Public Interest. "They are capturing different values but not ensuring safety."

Bushway of the Organic Trade Association says one of the best checks on food safety is the devastating effect a recall or foodborne illness outbreak can have on a company's bottom line.

"It's just good business to make sure you are putting the safest products on the market," she says.

Associated Press

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Sabtu, 01 Oktober 2011

Viewpoint: Why Dr. Feelgood Isn't Always Wrong

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AppId is over the quota

Dr. Conrad Murray, personal physician to Michael Jackson, is currently on trial in Los Angeles for involuntary manslaughter, two years after the death of the singer — of "acute propofol intoxication" — was officially ruled a homicide by the L.A. County coroner's office.

Let me start by saying that administering the anesthetic drug propofol for sleep, as Murray has acknowledged doing for Jackson, even while the doctor feared his patient had developed an addiction to it, is inexcusable. The drug has no medical use outside the operating room and anesthesia isn't "sleep." It's more like a controlled form of coma.

But that being said, giving addicts the drugs they want isn't always quackery. In fact, it can often be lifesaving. Indeed, "Dr. Feelgood," a term of disparagement that has long been used to describe doctors who inadvertently or deliberately prescribe psychoactive drugs to addicts, may sometimes do real good.

Increasingly, evidence suggests that maintenance prescribing, as it's known, may benefit addicts at least as much as direct efforts to get them to quit entirely. Simply giving addicts more drugs sounds like the last thing that could improve health or spur recovery, but the pharmacology of opioids like heroin and OxyContin — the kinds of drugs that contribute to the vast majority of overdose deaths in the U.S. — makes it practical.

Once a person has become dependent on these drugs, a steady, regular, maintenance dose will no longer produce a "high" or any impairment. Rather it will allow addicts to function normally. Studies increasingly support the use of substitute drugs like methadone and buprenorphine (Suboxone, Subutex) for opioid addicts, as well as the use of addicts' actual drug of choice like heroin. As a handful of studies also suggest, there may be reason to hope that amphetamine could possibly even help methamphetamine and cocaine addicts.

MORE: Can Amphetamines Help Cure Cocaine Addiction?

Just like pain patients who can take steady doses of painkillers to function, addicts who are given methadone, heroin, buprenorphine or other opioids aren't impaired. They don't have to spend their lives seeking street drugs, a supply that is unpredictable and unlike medical-grade drugs possibly impure, which can only do more harm. When addicts are stabilized and required to see the doctor regularly for prescriptions, their health and lives improve. Research even shows that when addicts are maintained on long-acting drugs like methadone, their stress response is reduced in a way that isn't seen with abstinence.

Hundreds of studies on methadone and buprenorphine use in opioid addicts support their efficacy. Maintenance prescribing reduces crime, mortality, and HIV and hepatitis rates more than abstinence-based treatment does, and is equally good at improving other outcomes like employment. Research also finds that when methadone clinics are shuttered or when maintenance prescribing is arbitrarily limited, overdose deaths and crime rates go up.

Moreover, for the most intractable cases of addiction, studies have so overwhelmingly supported the prescribing of heroin that countries including Germany, Switzerland, Denmark, the Netherlands and the U.K. now include it among their treatment options.

So, should we be praising our Dr. Feelgoods, rather than putting them in prison? Can we solve the crisis of prescription-drug addiction by legalizing maintenance prescribing of drugs other than methadone or buprenorphine? Can we prevent people from lying or committing crime to get drugs, simply by allowing them get them honestly?

The answers aren't clear, but here's one thing that is: the way we're currently dealing with the misuse of opioids isn't working. Legitimate pain patients are getting squeezed by measures meant to root out addicts. Overdose deaths are rising. Physicians who discover addicts in their practices tend simply to cut them off, often without even providing a referral to treatment. There's no evidence that any of this helps.

MORE:

Without Abstinence" href="http://healthland.time.com/2010/09/28/addiction-files-recovering-from-drug-addiction-without%c2%a0abstinence/">Addiction Files: Recovering From Drug Addiction, Without Abstinence

In fact, a study by Project Lazarus, a comprehensive program aimed at reducing overdose deaths in North Carolina, found that when one physician who was believed to be a Feelgood enabler of addicts had his medical license suspended, his former patients began dying of overdose at a greater rate than when he was practicing.

Other doctors refused to see these abandoned patients: they were viewed as addicts simply because they had been associated with a "bad" doctor. It's hard to know why they died, however. Did some pain patients commit suicide because of unrelieved agony, as has been known to happen in other cases in which doctors suddenly stopped prescribing (either voluntarily or due to legal issues)? Or were they addicts with a reduced tolerance?

The study's authors suggest that, whether the people who died were suffering from pain, addiction or both, being cut off abruptly lowered their tolerance and put them at risk for overdose. Project Lazarus has since established a buprenorphine maintenance clinic in an attempt to prevent similar problems in future cases.

Thoughtless prescribing — like giving out propofol — is clearly dangerous. But maintenance should be a widely available option. Expanding the drugs available for maintenance use and the settings in which maintenance is permitted should be studied.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.



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Peliculas Online

Sabtu, 10 September 2011

HEALTH MANAGEMENT. Financial incentives for doctors do not always help.

NEW YORK (Reuters Health) - health systems, how best to structure financial incentives for primary health care work better, not have found physicians to do, suggests a new paper.
And it is not clear that the incentives to reward doctors, wanted to improve patient care, do more and more good than damage, Australian researchers, data from studies of incentive programs in the United States, and Germany.
In these studies, researchers looked to see if distinguished doctors shown for different diseases, follow-up patients according to or achieved a result of health specific financial incentives such as often-such as a patient, that to quit smoking. Overall, the effects have been mixed.
"Many doctors, who already well simply claim the money with no change in behavior", said Anthony Scott, one of the review authors from the University of Melbourne, Reuters Health in an e-Mail.
"Incentives are not often on such doctors, which targeted the poorest quality of care." And (sometimes) the amount of money may not be sufficient, or doctors are simply not motivated by money from a large part, "he added."
He and his colleagues reviewed seven studies, doctors comparing performance, before and after incentive programs, or compared to the just a regular salary doctors in incentive programs.
Payments have been set up differently: in one case doctors have helped a small payment for each patient, which they smoking; in another model a large payout received clinics after the collision with a goal for the total number of patients a stop smoking helpline referred to additional rewards for each additional references.
Some seemed to help these incentives. Clinics, the incentives for a helpline smokers to get sent around four percent of their patients there, 11 percent rewarded referred to such as always. But in other cases, the promise of a payment does not, that doctors were better at screening for breast cancer or chlamydia.
Also with such as primary care pretty reward doctors, researchers and takes into account many different measures of performance, to fight, Jim Burgess said, health policy studies at Boston University and was not the new review.
"It is to the general problem as you an array of quality measures and try, one way to work the common Assembly and first comprehensive measure of the performance measures", he told Reuters Health.
"" "Most of what has gone before (in trials), has not generated really, what we think of as:"We are really ready to move forward on this.""
Some incentive programs actually can make worse certain doctors, run, or have no effect, he added. Do, for example, in a program, that is one group of doctors and are a payout for those then that on a certain measure-a type of system, which he studied popular - "People who know that she high, can not ranked in fact does not actually change effort."
However, there are hundreds of different incentive schemes, in the United States and Canada set up, said Scott. And the strategies in U.S. health care reform is part of cost-cutting by rewarding physicians who perform well.
The researchers were firm in their report, published in the Cochrane Library, that further study is needed to find out how to pay off financial rewards for patients and health systems. For now, they said any new incentive programs,-should be made, and takes into account unintended consequences.
The idea, said Burgess, to use 'tried take a broader view of patients' health very patient as a basis for doctors for the good work rewarding.