Sunday, August 31, 2014

For those of us involved in our communities, creating neighborhood spaces and cultural livability are keys to revitalization. Yes, we can improve our health by improving the quality of the neighborhoods we live in and yes, we can follow a shared vision toward this accomplishment. From the Project for Public Spaces, here are 11 principles for creating great community places.



Effective public spaces are extremely difficult to accomplish, because their complexity is rarely understood. As William (Holly) Whyte said, “It’s hard to design a space that will not attract people. What is remarkable is how often this has been accomplished.”

PPS has identified 11 key elements in transforming public spaces into vibrant community places, whether they’re parks, plazas, public squares, streets, sidewalks or the myriad other outdoor and indoor spaces that have public uses in common. These elements are:

  1.  The Community Is The Expert

    The important starting point in developing a concept for any public space is to identify the talents and assets within the community. In any community there are people who can provide an historical perspective, valuable insights into how the area functions, and an understanding of the critical issues and what is meaningful to people. Tapping this information at the beginning of the process will help to create a sense of community ownership in the project that can be of great benefit to both the project sponsor and the community.
  2. Create a Place, Not a Design

    If your goal is to create a place (which we think it should be), a design will not be enough. To make an under-performing space into a vital “place,” physical elements must be introduced that would make people welcome and comfortable, such as seating and new landscaping, and also through “management” changes in the pedestrian circulation pattern and by developing more effective relationships between the surrounding retail and the activities going on in the public spaces. The goal is to create a place that has both a strong sense of community and a comfortable image, as well as a setting and activities and uses that collectively add up to something more than the sum of its often simple parts. This is easy to say, but difficult to accomplish.
  3. Look for Partners

    Partners are critical to the future success and image of a public space improvement project. Whether you want partners at the beginning to plan for the project or you want to brainstorm and develop scenarios with a dozen partners who might participate in the future, they are invaluable in providing support and getting a project off the ground. They can be local institutions, museums, schools and others.
  4. You Can See a Lot Just By Observing

    We can all learn a great deal from others’ successes and failures. By looking at how people are using (or not using) public spaces and finding out what they like and don’t like about them, it is possible to assess what makes them work or not work. Through these observations, it will be clear what kinds of activities are missing and what might be incorporated. And when the spaces are built, continuing to observe them will teach even more about how to evolve and manage them over time.
  5. Have a Vision


    The vision needs to come out of each individual community. However, essential to a vision for any public space is an idea of what kinds of activities might be happening in the space, a view that the space should be comfortable and have a good image, and that it should be an important place where people want to be. It should instill a sense of pride in the people who live and work in the surrounding area.
  6. Start with the Petunias: Lighter, Quicker, Cheaper

    The complexity of public spaces is such that you cannot expect to do everything right initially. The best spaces experiment with short term improvements that can be tested and refined over many years! Elements such as seating, outdoor cafes, public art, striping of crosswalks and pedestrian havens, community gardens and murals are examples of improvements that can be accomplished in a short time.
  7. Triangulate

    “Triangulation is the process by which some external stimulus provides a linkage between people and prompts strangers to talk to other strangers as if they knew each other” (Holly Whyte). In a public space, the choice and arrangement of different elements in relation to each other can put the triangulation process in motion (or not). For example, if a bench, a wastebasket and a telephone are placed with no connection to each other, each may receive a very limited use, but when they are arranged together along with other amenities such as a coffee cart, they will naturally bring people together (or triangulate!). On a broader level, if a children’s reading room in a new library is located so that it is next to a children’s playground in a park and a food kiosk is added, more activity will occur than if these facilities were located separately.
  8. They Always Say “It Can’t Be Done”

    One of Yogi Berra’s great sayings is “If they say it can’t be done, it doesn’t always work out that way,” and we have found it to be appropriate for our work as well. Creating good public spaces is inevitably about encountering obstacles, because no one in either the public or private sectors has the job or responsibility to “create places.” For example, professionals such as traffic engineers, transit operators, urban planners and architects all have narrow definitions of their job – facilitating traffic or making trains run on time or creating long term schemes for building cities or designing buildings. Their job, evident in most cities, is not to create “places.” Starting with small scale community-nurturing improvements can demonstrate the importance of “places” and help to overcome obstacles.
  9. Form Supports Function

    The input from the community and potential partners, the understanding of how other spaces function, the experimentation, and overcoming the obstacles and naysayers provides the concept for the space. Although design is important, these other elements tell you what “form” you need to accomplish the future vision for the space.
  10. Money Is Not the Issue

    This statement can apply in a number of ways. For example, once you’ve put in the basic infrastructure of the public spaces, the elements that are added that will make it work (e.g., vendors, cafes, flowers and seating) will not be expensive. In addition, if the community and other partners are involved in programming and other activities, this can also reduce costs. More important is that by following these steps, people will have so much enthusiasm for the project that the cost is viewed much more broadly and consequently as not significant when compared with the benefits.
  11. You Are Never Finished

    By nature good public spaces that respond to the needs, the opinions and the ongoing changes of the community require attention. Amenities wear out, needs change and other things happen in an urban environment. Being open to the need for change and having the management flexibility to enact that change is what builds great public spaces and great cities and towns.

Tuesday, August 26, 2014

With autumn coming soon, your thoughts might turn to Thanksgiving and sweet potatoes. Well, mine do. The thing is, sweet potatoes should be considered year round. Good in lowering diabetes episodes of insulin resistance, helpful in lowering blood pressure and decreasing the risk of colon cancer, and gosh darn they taste good too. The following article from Medical News Today explains why they should be eaten often.



What are the health benefits of sweet potatoes?

Monday 25 August 2014 - 12am PST


Sweet potatoes pack a powerful nutritional punch. They have got over 400% of your daily needs for vitamin A in one medium spud, as well as loads of fiber and potassium. They have got more grams of natural sugars than regular potato but more overall nutrients with fewer calories.
 
Despite the terms sweet potato and yam often being used interchangeably, they are actually not even botanically related. Yams are almost exclusively grown in Africa and are more dry and starchy compared to a sweet potato. So how did these two vegetables become so intertwined?

There are two different varieties of sweet potatoes, firm and soft. When soft sweet potatoes were being cultivated in the Americas, African slaves began calling them yams because of their resemblance to their familiar native vegetable. The name caught on as a way to distinguish between the two types of sweet potatoes. Today, you are unlikely to find a true yam in the grocery store unless you are shopping in an international market.

This MNT Knowledge Center feature is part of a collection of articles on the health benefits of popular foods. It provides a nutritional breakdown of the sweet potatoes and an in-depth look at its possible health benefits, how to incorporate more sweet potatoes into your diet and any potential health risks of consuming sweet potatoes.

Nutritional breakdown of sweet potatoes

One medium sweet potato (2" diameter, 5" long, approximately 114 grams) provides 162 calories, 0 grams of fat, 37 grams of carbohydrate (including 6 grams of fiber and 12 grams of sugar), and 3.6 grams of protein according to the USDA's national nutrient database.
Sweet potatoes
Sweet potatoes pack a powerful nutritional punch. They have got over 400% of your daily needs for vitamin A in one medium spud, as well as loads of fiber and potassium. 
One medium sweet potato will provide well over 100% of your daily needs for vitamin A, as well as 37% of vitamin C, 16% of vitamin B-6, 10% of pantothenic acid, 15% of potassium and 28% of manganese. You'll also find small amounts of calcium, iron, magnesium, phosphorus, zinc, vitamin E, thiamin, riboflavin and folate.

Sweet potatoes are a great source of beta-carotene, a powerful antioxidant known to give orange vegetables and fruits their vibrant color, which is converted to vitamin A in the body. Consuming foods rich in beta-carotene may reduce the risk of developing certain types of cancer, offer protection against asthma and heart disease and delay aging and body degeneration.

Keep the skin on! The color of sweet potato skin can vary from white to yellow, purple or brown but no matter what color it is, make sure you do not peel it off. A sweet potatoes skin contributes significant amounts of fiber, potassium and quercetin.

Possible health benefits of consuming sweet potatoes

Consuming fruits and vegetables of all kinds has long been associated with a reduced risk of many adverse health conditions. Many studies have suggested that increasing consumption of plant foods like sweet potatoes decreases the risk of obesity, diabetes, heart disease and overall mortality while promoting a healthy complexion, increased energy, and overall lower weight.

 

Diabetes

Sweet potatoes are considered low on the glycemic index scale, and recent research suggests they may reduce episodes of low blood sugar and insulin resistance in people with diabetes. The fiber in sweet potatoes makes a big difference too. Studies have shown that type 1 diabetics who consume high-fiber diets have lower blood glucose levels and type 2 diabetics may have improved blood sugar, lipids and insulin levels. One medium sweet potato provides about 6 grams of fiber (skin on).

The Dietary Guidelines for Americans recommends 21-25 grams of fiber per day for women and 30-38 grams per day for men, which most people do not reach.

 

Blood pressure

Maintaining a low sodium intake is essential to lowering blood pressure, however increasing potassium intake may be just as important. According to the National Health and Nutrition Examination Survey, fewer than 2% of US adults are meeting the daily 4,700 mg recommendation for potassium.3 One medium sweet potato provides about 542 milligrams.

Also of note, high potassium intake is associated with a 20% decreased risk of dying from all causes.7

 

Cancer

Among younger men, diets rich in beta-carotene may play a protective role against prostate cancer, according to a study conducted by the Harvard School of Public Health's Department of Nutrition.4 Beta-carotene has also been shown to have an inverse association with the development of colon cancer in the Japanese population.3

 

Digestion and regularity

Because of its high fiber content, sweet potatoes help to prevent constipation and promote regularity for a healthy digestive tract.

 

Fertility

For women of childbearing age, consuming more iron from plant sources appears to promote fertility, according Harvard Medical School's Harvard Health Publications. The vitamin A in sweet potatoes (consumed as beta-carotene then converted to vitamin A in the body) is also essential during pregnancy and lactation for hormone synthesis.

 

Immunity

Plant foods like sweet potatoes that are high in both vitamin C and beta-carotene offer an immunity boost from their powerful combination of nutrients.

 

Inflammation

Choline is a very important and versatile nutrient in sweet potatoes that helps with sleep, muscle movement, learning and memory. Choline also helps to maintain the structure of cellular membranes, aids in the transmission of nerve impulses, assists in the absorption of fat and reduces chronic inflammation.6
In a study published by the Journal of Medicinal Food, purple sweet potato extract was found to have positive anti-inflammatory and antilipogenic effects as well as free radical scavenging and reducing activity.

 

Vision

According to Duke ophthalmologist Jill Koury, MD, vitamin A deficiency causes the outer segments of the eye's photoreceptors to deteriorate, damaging normal vision. Correcting vitamin A deficiencies with foods high in beta-carotene will restore vision.5
 
Also of note, the antioxidant vitamins C and E in sweet potatoes have been shown to support eye health and prevent degenerative damage.

A higher intake of all fruits (3 or more servings per day) has also been shown to decrease the risk of and progression of age-related macular degeneration.

How to incorporate more sweet potatoes into your diet

Avoid buying sweet potatoes with soft skin or wrinkles, cracks or soft spots. Store in a cool, dry place for up to 3-5 weeks.

Roast sweet potatoes to bring out their natural flavor. There is no need to add in marshmallow topping or loads of butter, sweet potatoes have a naturally sweet and creamy taste that can be enjoyed all on their own. To add a little spice without extra calories, try sprinkling on cinnamon, cumin or curry powder.

Roasted sweet potatoes
Roast sweet potatoes to bring out their natural flavor. To add a little spice without extra calories, try sprinkling on cinnamon, cumin or curry powder. 
The fastest way to prepare a sweet potato is in the microwave. Prick the potato with a fork and then microwave on high until soft. Make sure to let it cool for several minutes, and then drizzle with olive oil or top with fat-free plain Greek yogurt.

Try adding roasted sweet potatoes and pecans to a salad and top with balsamic vinegar. You also can try adding sweet potato to your favorite pancakes or hash browns.

Try these simple and healthy recipes to incorporate more sweet potatoes into your diet:
Roasted Sweet Potato Fries
Sweet Potato Chips
Heart Healthy Chipotle Chili
Sweet Potato Hummus

Potential health risks of consuming sweet potatoes

Beta-blockers, a type of medication most commonly prescribed for heart disease, can cause potassium levels to increase in the blood. High potassium foods should be consumed in moderation when taking beta-blockers.

Consuming too much potassium can be harmful for those whose kidneys are not fully functional. If your kidneys are unable to remove excess potassium from the blood, it could be fatal.
 
It is the total diet or overall eating pattern that is most important in disease prevention and achieving good health. It is better to eat a diet with variety than to concentrate on individual foods as the key to good health.

Written by Megan Ware, RDN, LD, registered dietitian and nutritionist

Wednesday, August 20, 2014

So where do you sit on this study reported in "Science"? You may be in for a shock...Researchers from Harvard and the University of Virginia found that people would prefer getting electric shocks than to spend time alone in thought.


People prefer electric shocks to time alone with thoughts

A study found that people prefer electric shocks to time alone with their thoughts.
iStockphoto


A study found that people prefer electric shocks to time alone with their thoughts.

In the rush of everyday life, many people say they crave a moment of solitude, but a startling new study finds that people don’t really enjoy spending even 10 minutes alone with their thoughts.

In fact, we find our own musings so unsatisfying that, in research done at the University of Virginia, many people chose to administer painful electric shocks to themselves rather than sit in quiet contemplation, researchers from that university and Harvard reported Thursday.

“I was surprised that people find themselves such bad company,” said Jonathan Schooler, a psychology professor from the University of California, Santa Barbara, who was not involved in the research. “It seems that the average person doesn’t seem to be capable of generating a sufficiently interesting train of thought to prevent them from being miserable with themselves.”

The study, published in the journal Science, adds a perplexing result to the field of mind-wandering. Eleven separate experiments showed that we find our own thoughts painfully dull.

The researchers first tried giving participants in a psychology laboratory anywhere from 6 to 15 minutes alone to think. They weren’t allowed to fall asleep, and they weren’t allowed to check their cellphones. Overall, people rated this idle time as not very enjoyable — a 5 on a scale of 0 to 9.

The researchers wondered whether the artificial laboratory environment was the problem and instead gave people the same task in the comfort of their own homes. Their enjoyment was even lower at home than in the laboratory. Nearly a third of people admitted they cheated by checking their phones or listening to music.

Then, the researchers either allowed people to sit alone and think, or do an activity such as reading a book or using the Internet — although they weren’t allowed to communicate with others. The people doing activities that distracted them from their own thoughts were much happier.

Timothy Wilson, a University of Virginia psychology professor who led the work, was discussing the weird results in the living room of his Harvard collaborator, psychology professor Daniel Gilbert, and they began brainstorming another experiment. If people found it so unpleasant to be alone with their thoughts, what lengths might they go to in order to escape themselves?

To answer this question, they started by exposing volunteers to positive and negative stimuli, including beautiful photographs and mildly painful electric shocks. They asked the people how much they would pay to avoid the shock experience if they had $5 to spend. Then, the researchers told the 55 participants to sit in a room and think for 15 minutes. If they wanted, they also had the option to shock themselves by pressing a button, feeling a jolt resembling a severe static shock on their ankle.

“I have to tell you, with my other co-authors, there was a lot of debate: ‘Why are we going to do this? No one is going to shock themselves,’ ” Wilson said.

To their surprise, of the 42 people who said they would pay to avoid the shock, two-thirds of men chose to shock themselves, and a quarter of women did. One person pressed the button 190 times.


The researchers were stunned. People were choosing an unpleasant sensation instead of freely cogitating on whatever they wanted.

Despite a fair amount of searching, researchers did not find a single subset of people for whom ruminating on their own was clearly enjoyable.

One of the experiments recruited people ranging from 18 to 77 years old from a church and a farmer’s market. Regardless of age, education, income, gender, or smartphone or social media use, people basically found being alone with themselves not very fun and kind of boring.

That sheds new light on previous mind-wandering studies, such as one by Harvard researchers in 2010 that showed people were not happy when their attention wandered. It seemed reasonable to think that they were less happy because the distraction was inconvenient.

“We’re trying to get our tax returns done, but our minds keep drifting away to an upcoming vacation, and as a result, we spend the whole weekend reading and re-reading the stupid 1040 form,” Harvard’s Gilbert, a co-author of the new paper, wrote in an e-mail. “Well, if that’s true, then mind-wandering should be an annoyance when we’re trying to get something else done, but it should be a delight when we have nothing else to do.”

Quite the opposite, the new study suggests.

So, are we just kidding ourselves when we say we love spending time alone with our own thoughts?

Wilson wants to study the phenomenon further; he wonders whether people who regularly meditate will rate the experience differently. Schooler said the study suggests that steps could be taken to help people enjoy spending time alone.

But maybe there’s a larger message, too, about the handwringing that routinely happens about the attention-consuming devices that have become almost like an extra digital limb. Maybe the problem isn’t our smartphones; the problem is human nature. We are in a mutually enabling relationship with technology.

“I think this could be why, for many of us, external activities are so appealing, even at the level of the ubiquitous cellphone that so many of us keep consulting,” Wilson said. “The mind is so prone to want to engage with the world, it will take any opportunity to do so.”

Monday, August 18, 2014

When it comes to food labeled "natural" it most often has more to do with marketing than the contents of the package. What you may think as being "natural" and what a manufacturer is calling "natural" may well be two completely different things...so be forewarned.

 Los Angeles Times -

Food buyers lean toward 'natural,' a claim that's hard to define


When you buy a box of crackers labeled "natural," do you just assume they're organic? Don't. When you choose an "all natural" chocolate syrup for your kids' ice cream, are you thinking it has less sugar? Read the label.

But what about those "natural" chips? Surely the package with the peaceful farm scene on the front means something about what's inside — right?

There's something about "natural" food that appeals to consumers. In one study from the consumer research firm Mintel, people were given a list of food product claims and asked which ones mattered most to them. "Natural" tied for No. 1 with the claim that a product contained a full serving of fruits or vegetables.


But many of us are at a loss to define exactly what "natural" means. And, according to Michele Simon, a public health lawyer based in Northern California, that state of confusion is right where the food industry wants us.

"Natural," it turns out, doesn't have a definition — at least not from the Food and Drug Administration, which regulates most packaged food. (The U.S. Department of Agriculture regulates meat and poultry and has its own definitions.)

"There's a disconnect between what consumers think natural means and what manufacturers think it means," says Nicole Negowetti, a law professor at Valparaiso University Law School in Indiana, who wrote a paper for the Brookings Institution about litigation over the word "natural" on food labels.

It's a disconnect that has led to more than 200 lawsuits, filed by the Center for Science in the Public Interest and other groups, challenging use of the word "natural" on products that contain genetically modified ingredients or high fructose corn syrup, among other things, Negowetti says. None of the suits has been adjudicated, but some have been settled out of court.

The FDA has been under some pressure to define "natural," and the agency has been petitioned by Consumer Reports to ban its use on food labels. The FDA has so far done neither.

But consumers might need to switch gears because those "natural" labels could be disappearing, several industry watchers say. Descriptions such as "Great Plains Multigrain" Wheat Thins and words such as "simply" and "pure" might be in line to take the place of "natural." Pillsbury has a line of "Simply … Cookies." And there are "Simply Cheetos Puffs" on store shelves.

"Manufacturers are just moving on," Negowetti says.

Companies also are making specific statements on labels, such as no GMOs (genetically modified organisms) or no artificial colors, according to Lynn Dornblaser, the director of Innovation and Insight at Mintel.

"In the bigger picture, this is the way things are going," she says. "Companies are talking more and more about what's in the product rather than slapping some ill-defined label on it."

Daniel Fabricant, who left the FDA to become chief executive of the Natural Products Assn., says the landscape isn't perfect, but shoppers should consider what's important. The naturalness of Goldfish crackers shouldn't be judged on the fact "that they didn't grow on a goldfish tree," he says, but on the fact that the dyes used are plant extracts, which is OK by him.

(Of course, consumers can use the "nutrition facts" label, governed by federal law and required to include such information as calories, amount of fat and sugar and ingredients. Still, those can be hard to interpret, in part because the listings are in grams.)

Consumers are being "duped to think certain foods are something they're not," says Urvashi Rangan, executive director of Consumer Reports Food Safety and Sustainability Center. She says companies should be making claims that are verifiable, such as organic, which has a legal definition.

Several companies declined to talk about their use of the word "natural"; several others did not return calls and emails. A representative of the Grocery Manufacturers Assn., a trade group, also wouldn't discuss the term, saying that it tells companies to abide by FDA stipulations that the claim "natural" be truthful and not misleading.

The FDA didn't want to talk either.

But in a statement, the agency said it "understands and appreciates that consumers depend on accurate labeling when making food choices. That's why we have clearly defined certain terms that have public health implications, like 'low-fat' or 'light.' Defining 'natural' represents additional challenges when food has been processed and is no longer the product of the earth." The FDA also says it 'has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances."

And even Simon says it would be hard to advise the government on how to define the word for a food supply in which much of the soy and corn are genetically modified and many products are highly processed.

People also shouldn't confuse natural with healthful: "Natural" potato chips might mean that the potatoes were not bleached, says Fabricant, of the natural products group. "It's still a bag of potato chips. I certainly prefer the ones that still look and feel like a potato."

Friday, August 15, 2014

Are you one of those people who salts their food before tasting it? According to a Washington Post story on a study published in the NEJM, salt intake is too high in 181 of 187 countries and accounts for 10% of cardiovascular related deaths. Next time you're salting up those French Fries, remember all process food is already loaded with salt.

 

Salt intake is too high in 181 of 187 countries around the world

 
 
August 14 at 3:03 PM
 

Virtually every adult on the planet consumes too much salt, Tufts University researchers have determined, with an average of 3.95 grams of sodium consumed per person per day--nearly double the two grams daily recommended by the World Health Organization.

The taste for soy in Asia, stews in Eastern Europe and bread and processed food in the United States leads to 1.65 million deaths annually from diseases attributable to excess sodium consumption, a major cause of high blood pressure the world over, according to a study published Thursday in the New England Journal of Medicine. Forty percent of those deaths occurred before the age of 70, and 84 percent were in low- and middle-income countries.

The death rate, mainly from heart disease and stroke, was lowest in Kenya (four deaths per million adults) and highest in Georgia (1,967 deaths per million).

In 181 of 187 countries for which data was available, adults consume too much sodium, the researchers concluded. Adults in only a handful of African nations -- notably Kenya, Cameroon and Gabon -- were able to keep their sodium consumption below the recommended level.

Nearly 10 percent of all deaths from cardiovascular causes were attributed to excess sodium intake. "One in 10 is quite large," said Dariush Mozzafarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, who led the research. He noted the "enormous rates of stroke in China, Eastern Europe and Central Asia."

Reduction of sodium intake leads to lower blood pressure and may result in fewer deaths. "What needs to be done is to have a national, coordinated policy" on salt in food for the United States, Mozzafarian said. The FDA has said it plans to work with the food and beverage industries to voluntarily reduce salt in food, an approach that has shown some success in the United Kingdom, Mozzafarian said.

Consumers need to "stand up and ask the government to do something about sodium in the food supply," he said.

In contrast to the recommendations of the WHO, the American Heart Association and other groups, a large study in the same edition of the New England Journal of Medicine reported that consumption of three to six grams of salt a day was associated with "a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake."

The study suggested that people who consumed fewer than three grams of sodium daily faced a 27% higher risk of death or a heart attack or stroke, underscoring the degree to which the proper amount of salt intake remains a controversial subject.

The Tufts researchers collected information on salt intake in 66 countries that account for 74.1 percent of the world's adult population and modeled it for the rest. They estimated that regional average sodium consumption ranged from a low of 2.18 grams to a high of 5.51 grams, with the greatest salt consumption in eastern Europe and Central Asia.

Monday, August 11, 2014

A new study published in a journal of the American Association for Cancer Research demonstrates another good reason to get up an exercise. Postmenopausal breast cancer risk decreases rapidly after the onset of regular exercise. Today's as good as any day to start living healthier.


MNT/Medical News Today:

Postmenopausal breast cancer risk decreases rapidly after starting regular physical activity

 
Monday 11 August 2014 - 2am PST
 


Postmenopausal women who in the past four years had undertaken regular physical activity equivalent to at least four hours of walking per week had a lower risk for invasive breast cancer compared with women who exercised less during those four years, according to data published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"Twelve MET-h [metabolic equivalent task-hours] per week corresponds to walking four hours per week or cycling or engaging in other sports two hours per week and it is consistent with the World Cancer Research Fund recommendations of walking at least 30 minutes daily," said Agnès Fournier, PhD, a researcher in the Centre for Research in Epidemiology and Population Health at the Institut Gustave Roussy in Villejuif, France. "So, our study shows that it is not necessary to engage in vigorous or very frequent activities; even walking 30 minutes per day is beneficial."

Postmenopausal women who in the previous four years had undertaken 12 or more MET-h of physical activity each week had a 10 percent decreased risk of invasive breast cancer compared with women who were less active. Women who undertook this level of physical activity between five and nine years earlier but were less active in the four years prior to the final data collection did not have a decreased risk for invasive breast cancer.

"Physical activity is thought to decrease a woman's risk for breast cancer after menopause," said Fournier. "However, it was not clear how rapidly this association is observed after regular physical activity is begun or for how long it lasts after regular exercise stops.

"Our study answers these questions," Fournier continued. "We found that recreational physical activity, even of modest intensity, seemed to have a rapid impact on breast cancer risk. However, the decreased breast cancer risk we found associated with physical activity was attenuated when activity stopped. As a result, postmenopausal women who exercise should be encouraged to continue and those who do not exercise should consider starting because their risk of breast cancer may decrease rapidly."

Fournier and colleagues analyzed data obtained from biennial questionnaires completed by 59,308 postmenopausal women who were enrolled in E3N, the French component of the European Prospective Investigation Into Cancer and Nutrition (EPIC) study. The mean duration of follow-up was 8.5 years, during which time, 2,155 of the women were diagnosed with a first primary invasive breast cancer.

The total amount of self-reported recreational physical activity was calculated in MET-h per week. The breast cancer risk-reducing effects of 12 or more MET-h per week of recreational physical activity were independent ofbody mass index, weight gain, waist circumference, and the level of activity from five to nine years earlier.

Monday, August 4, 2014

Was it healthcare reform we needed or was it really insurance reform that should have been addressed? Because if it were the latter and we "reformed" the wrong thing, the result may not be what we needed - a shortage of doctors and ongoing rises in premiums. Maybe the problem is the antitrust exemption that is uniquely afforded the insurance industry.



Credit David Doran

Traditionally, there were a few ways that health insurers could keep premiums low for individual health plans. They could select people with no prior health problems, to limit the chances of getting stuck with big hospital bills. They could pare back the services and products they offered to avoid ones that could be expensive, like maternity care or prescription drugs. They could increase premiums or deductibles so their customers would pay a larger share of any eventual bills.

By changing the rules, the Affordable Care Act pushed health insurers toward a new strategy: limiting the choice of doctors and hospitals they’ll pay for. That move helped insurance companies keep premiums low despite all the new restrictions, but they’re inspiring resistance.

Plans sold this year in the new health insurance marketplaces were much more likely than previous ones to include what insurers call tailored or narrow networks. According to an analysis from the consulting firm McKinsey & Company, some 48 percent of plans offered in the most popular category included such features.

“Plans have fewer tools available to them to offer lower-cost coverage options than before, so they’re using these tools to do so,” said Brendan Buck, a spokesman for America’s Health Insurance Plans, an industry trade group. That’s because the Affordable Care Act outlawed a lot of the old options. 

Insurance companies can’t exclude sick customers. They all have to cover a defined set of basic health benefits. There’s a cap on how much they can ask patients to pay each year out of pocket, and rules about what percentage of average costs they must cover to sell their plans in a certain category.

McKinsey defined a “narrow network” plan as one that included less than 70 percent of the doctors and hospitals in a given metropolitan area, though some plans they surveyed covered less than 30 percent of local providers. The plans save money by allowing insurers to avoid hospitals and doctors that charge high prices.

Insurers can offer favored hospitals lots of guaranteed patients in exchange for lower prices, or can simply squeeze out hospitals that won’t negotiate on rates. That means that, in some markets, expensive, popular specialty hospitals aren’t covered. In some extra-narrow plans, only one big health system gets covered. Over all, the strategy has lowered premiums by 5 to 20 percent, according to an industry-funded study from the actuarial firm Milliman.

The concept is not new to health insurance, which suggests that many people may turn out to like the trade-off between low premiums and a smaller selection of providers. Traditional H.M.O.s, like Kaiser Permanente in California and Group Health Cooperative in Washington, have long attracted patients despite their lack of flexibility. And seniors are increasingly choosing private Medicare Advantage plans, which tend to have limited networks, but lower premiums and some extra benefits, over traditional Medicare, which covers every willing provider.

In the marketplaces, so far, consumers appear to have also been choosing the narrow network plans; over half of people who understood what they were buying deliberately chose the cheaper plan with fewer doctors, according to a recent survey from the health care research group the Commonwealth Fund. (The poll also found, however, that 25 percent of people who bought new insurance didn’t even understand such a choice was in play.)