Is Telemedicine the Future of Healthcare?

Although there are still several issues to be resolved, it is evident that developments in telemedicine will be a part of the future of healthcare, especially in rural areas. Telemedicine would give patients in underserved areas access to a consulting specialist through interactive video transmissions. However, as well as working out all of the technical aspects, payment issues, malpractice liability and licensing requirements must be addressed.

For rural areas, telemedicine will solve many of the problems concerning a lack of specialists to consult on a variety of patient cases. Patients who must be referred to another physician may normally have to travel several miles. With telemedicine, these patients have to go no further than their local doctor's or physician assistant's office.

The Konawa Community Health Center in Southeast Oklahoma has taken telemedicine on the road. They have a van equipped with the latest telemedicine equipment and staffed with a PA, nurse practitioner, licensed practical nurse and a medical secretary. The van travels 40 to 60 miles to nine surrounding communities, three times a week. The mobile clinic was established after Konawa won the first telemedicine grant offered by Southwestern Bell Telephone in the amount of $50,000.

This type of program is needed in states like Oklahoma, which has 30% fewer physicians per 1,000 residents than the national average. From the van, images of the patient's skin lesions and ENT tissue can be sent to the consulting physician via electronic dermascope, otoscope, and ophthalmoscope that operate with a 20-power video camera microscope. Other equipment in the van includes a cellular telephone, fax modem, copier and two examining rooms. There is also a laboratory where a variety of tests can be performed including urinalysis, pregnancy tests and hematocrits. Electrocardiogram strips and lab reports can be sent by fax modem.

While telemedicine may be the answer to dealing with the problems of providing healthcare in underserved areas, its ultimate success may depend on how payment issues are resolved. The most important discussion regarding payment policy is whether the Health Care Financing Administration (HCFA) will allow telemedicine services to be paid for under Medicare. The actions of the HCFA are usually a good indicator of how other payors will approach the issue. William England, project officer for telemedicine research for HCFA believes that Medicare won�t pay for telemedicine because the program has never covered anything but in-person consultation. England believes that a government study researching the effectiveness of electronic consultation will take at least five years.

Electronically mediated consultations with the patient, including interactive consultations where a primary care practitioner and a specialist confer about a patient by interactive video, are currently not covered under Medicare. Electronically mediated interaction is not covered when it replaces direct, personal contact. Those who are against payment for video consultation compare them to telephone consultations, which are not covered by Medicare. Others say that the specialist should receive the normal amount for traditional consultations while payment for the primary care practitioner would depend on the level of involvement. Also still to be determined is whether telemedicine is safe and effective for all specialty applications and the level of documentation necessary to assure the service was provided appropriately.

The question of the safety and effectiveness of telemedicine leads to the issue of malpractice liability. Although payment issues are an important factor, the problem of malpractice liability could be the biggest obstacle to the overall implementation of telemedicine. The public perception may be that a consultation via video is inadequate and the consulting physician would be working with incomplete data. Establishing technical standards and videotaping the entire consultation would limit liability. Policies must also be put in place to protect the patient's right to privacy, as medical records are electronically transmitted.

Another problem facing proponents of telemedicine is that of state licensing requirements. The current state licensure system requires that physicians practicing telemedicine be licensed in every state in which they practice. This is a hindrance to physicians who want to provide telemedicine consultations to citizens residing in other states. The easiest way to resolve this may be to consider the patient as the one being electronically transported rather than the physician. Five states, Kansas, Texas, Oklahoma, South Dakota and Nevada, currently block interstate telemedicine. At least 20 other states are considering similar legislation. Since consultations conducted over state lines are a form of interstate commerce, they could become a concern of the Federal Trade Commission; although they have shown no signs of involvement.

Nationally recognized multi-specialty clinics, such as the Mayo Clinic in Rochester, Minnesota, are delaying plans for telemedicine expansion primarily due to liability and state licensing issues. On the bright side for consumers, there is on-going discussion concerning creating a model state telemedicine license that, if adopted by each state, would allow interstate electronic consultation.

Patient privacy is another issue facing telemedicine. State rules governing privacy often conflict with each other. Many believe that the possibility for confusion concerning state regulations is a real dilemma.

Intrastate telemedicine programs, however, are flourishing. There are currently 50 interactive programs in the United States, up from only three in 1991 and twice as many as last year. Where there are still several aspects of telemedicine to be worked out, the benefits to rural areas are worth continuing the discussions. Telemedicine can provide underserved areas with access to quality healthcare that may not otherwise be available. Bioethics, such as Arthur Caplan at the University of Pennsylvania, believe that the socio-economic barriers facing telemedicine may take 20 years to overcome.

nutritions for teens

Nutrition Know How

What you eat has a life long effect on your health and well-being. To look and feel good, you have to eat adequate amounts of the proper foods. Many teenagers don't always choose the food that is best for their health. They may not want to eat what the rest of the family is eating or they may eat poorly at school, although the food at the school cafeteria is required by law in the United States to meet certain nutritional standards, you may not be eating their food.

Nutrition... Nutrition... Nutrition... Adults are always talking about good nutrition and eating the right foods. Isn't it enough to eat the things that we enjoy eating? Not necessarily, unless you like eating foods rich in vitamins, minerals and other essential nutrients. Sounds boring? It doesn't have to be. If you are going to eat well you have to take some of the initiative and responsibility for what you eat. You'll be doing your family a big favor as well as learning how to take care of yourself.

Nutrients build your body and allow it to function. Each nutrient has at least one specific job, and no other nutrient can cover for any of the others. Because you need many different nutrients to stay healthy, you have to eat a wide variety of foods in order to get all of them. If you stick to just one or two favorite foods, you'll run short of the nutrients you must have to stay well.

A lot of the foods that we like to eat don't have much nutritional value. These foods are referred to as "junk food" = empty calories, because while they provide calories that can be turned into energy, they don't provide much else in the way of things our bodies can use.

There are six types of nutrients: protein, carbohydrates, fats, vitamins, minerals, and water. In simple terms, nutrients are the chemicals that your body gets from food. If your body gets the right fuel, just like a car, it will run smoother. Nutrients in food allow your body to break down the food you eat into energy so can use function. When you go for a run, swim a few laps, or even talk on the phone you are using energy that your body has produced. When you are taking a test, you're using brain power, which is really energy that is coming from the food you had last night for dinner and this morning for breakfast. One nutrition key is to never skip breakfast, especially the morning of tests. Your body has not received energy for more than 12 - 15 hours and will not be able to function at its peak without that boost you get from food.

Protein
Every single cell in your body is made up of protein. Hair and fingernails consist of fibers of protein called keratin. Collagen is the protein that strengthens your skin, blood vessels, bones and teeth. Even your muscles are held together by the protein fibers called myosin and actin. In fact, about one-fifth of your body weight is protein. Every chemical reaction that takes place in your body -- that is a lot -- is dependent on proteins. These important nutrients help us build new cells and repair damaged body tissue. Because your tissues are constantly being destroyed and rebuilt, and because unlike carbohydrates your body has no means to store protein, you must make sure you get enough of this important nutrient to keep all your vital processes functioning. During digestion, large molecules of protein are broken down into smaller, simpler units called amino acids. The body requires 22 amino acids in specific patterns to make human protein and thus do its necessary functions. Your body can produce all but nine of these amino acids. The nine that can not be produced are called essential amino acids because they must be supplied by your diet. In order for your body to properly use proteins, all of the essential amino acids must be present in your system. A food that contains all the essential amino acids is called a complete protein. Examples of foods high in protein include: meats, fish, lentils, nuts, dairy products such as cheese or yogurt and beans.

Carbohydrates
Most of our energy comes from carbohydrates. Carbohydrates are chemical compounds of carbon, hydrogen and oxygen. They provide us with calories which can be converted into energy. There are two types of carbohydrates: simple, which are sugars, or complex, which are starches. It's a good idea to try to eat more complex carbohydrates because your body get longer sustained energy from these foods. Examples of complex carbohydrates include: potatoes, pasta, bread, rice, lentils, cereals and fruits and vegetables. Compare these to the simple carbohydrates such as cookies, candy bars and other sugar foods which provide a quick jolt of energy, but then leave your body craving more. These simple carbohydrates are known as "empty calories" because they lack vitamins, minerals, fiber or anything of value to your system.

Fats
While too much fat is bad for your health, we do need some to survive. By cutting down on your fat intake you can reduce your chances of developing heart disease or cancer, not to mention staying in better physical shape and maintaining a healthy weight. There are three types of fat: saturated, monounsaturated and polyunsaturated. Saturated fats are the worst type because they raise the cholesterol level in your blood, which can lead to heart disease. The more saturated the fat is, the more solid it will appear at room temperature. This includes animal products such as butter, cheese, milk and meats. Monounsaturated fats are the types in nuts and fruit and polyunsaturated fats are found in oils. If you are trying to reduce the fat content in your diet, try broiling rather than frying your food, use skim milk rather than whole milk, use low-fat salad dressing or yogurt, and cut down on red meats.

Fiber
Okay, you are right, there is no nutritional value in fiber. But we do know that fiber absorbs water, helping both keeping away hunger pangs and to keep the colon healthy by allowing bowel movements to be regular. softer and easier to pass. Fiber has an important role in protecting us from certain diseases, such as heart disease, high blood cholesterol, some cancers and bowel conditions. It also can keep us leaner (people who eat a lot of fiber are less likely to be overweight). Fiber is present in the cell walls of all plants, but is NOT found in any food obtained from animals. It can be found in all foods of plant origin like fruits, vegetables and nuts. It is also found in unrefined breads, cereals, brown rice, corn kernels and beans. Cellulose and pectin, found in all stringy vegetables and apples (and other fruit) cannot be digested, but they are important as roughage.

Water
Our bodies are about two-thirds water, and we need to ensure that we keep up this balance in order to remain healthy. That's why it is recommended that you drink at least eight glasses of water every day. This will keep all your organs hydrated so that they can function properly, and water also helps to flush toxins and other impurities out of your body. Water serves many other crucial functions including: respiration, digestion, metabolism, body temperature regulation and excretion. Water is also responsible for dissolving and transporting nutrients through the body. Only oxygen is more important to sustaining human life than water. So, drink a tall glass of water and stay healthy!

From Your Plate, Not a Pill

Sure you can buy vitamins and minerals in bottles, but the best source of them is from the foods you eat. Since different foods have different vitamins, the best way to make sure you're covered is to eat a variety of foods everyday. Here is another time when "Pyramid Power" comes in handy. Remember, lots from the bottom, less from the middle, and a little from the top. This should ensure a healthy diet that will keep you full of energy and healthy. If your life is very, very hectic, a vitamin supplement can help make up for what you may be lacking in your fast-paced life. There are other times too when a vitamin supplement is necessary, like when you are healing from surgery or a wound. So, vitamins from a bottle are important at times and for many medical conditions.

Teen Pregnancy

How bad is the problem?

The United States has the highest rates of teen pregnancy and births in the western industrialized world. Teen pregnancy costs the United States at least $7 billion annually.
Nearly four in 10 young women become pregnant at least once before they reach the age of 20—nearly one million a year.2 Eight in ten of these pregnancies are unintended3 and 79 percent are to unmarried teens.
The teen birth rate has declined slowly but steadily from 1991 to 2000 with an overall decline of 22 percent for those aged 15 to 19. These recent declines reverse the 24-percent rise in the teenage birth rate from 1986 to 1991. The largest decline since 1991 by race was for black women. The birth rate for black teens aged 15 to 19 fell 31 percent between 1991 to 2000. Hispanic teen birth rates declined 12 percent between 1994 and 2000. The rates of both Hispanics and blacks, however, remain higher than for other groups. Hispanic teens now have the highest teenage birth rates. Most teenagers giving birth before 1980 were married whereas most teens giving birth today are unmarried.
The younger a teenaged girl is when she has sex for the first time, the more likely she is to have had unwanted or non-voluntary sex. Close to four in ten girls who had first intercourse at 13 or 14 report it was either non-voluntary or unwanted.
Who suffers the consequences?
Teen mothers are less likely to complete high school, (only one-third receive a high school diploma)7 and more likely to end up on welfare (nearly 80 percent of unmarried teen mothers end up on welfare).
The children of teenage mothers have lower birth weights9, are more likely to perform poorly in school10, and are at greater risk of abuse and neglect.
The sons of teen mothers are 13 percent more likely to end up in prison while teen daughters are 22 percent more likely to become teen mothers themselves.
What helps prevent teen pregnancy?
The primary reason that teenage girls who have never had intercourse give for abstaining from sex is that having sex would be against their religious or moral values. Other reasons cited include desire to avoid pregnancy, fear of contracting a sexually transmitted disease (STD), and not having met the appropriate partner.13 Three of four girls and over half of boys report that girls who have sex do so because their boyfriends want them to.
Teenagers who have strong emotional attachments to their parents are much less likely to become sexually active at an early age.
Most people say teens should remain abstinent but should have access to contraception. Ninety-five percent of adults in the United States—and 85 percent of teenagers—think it important that school-aged children and teenagers be given a strong message from society that they should abstain from sex until they are out of high school. Almost 60 percent of adults also think that sexually active teenagers should have access to contraception.
Contraceptive use among sexually active teens has increased but remains inconsistent. Three-quarters of teens use some method of contraception (usually a condom) the first time they have sex.17 A sexually active teen who does not use contraception has a 90 percent chance of pregnancy within one year.
Parents rate high among many teens as trustworthy and preferred information sources on birth control. One in two teens say they "trust" their parents most for reliable and complete information about birth control, only 12 percent say a friend.
Teens who have been raised by both parents (biological or adoptive) from birth, have lower probabilities of having sex than teens who grew up in any other family situation. At age 16, 22 percent of girls from intact families and 44 percent of other girls have had sex at least once.20 Similarly, teens from intact, two-parent families are less likely to give birth in their teens than girls from other family backgrounds.
When should I talk to my child about sex?
Before they make you a grandparent. One of every 3 girls has had sex by age 16, 2 out of 3 by age 18. Two of 3 boys have had sex by age 18.
Surprise: Your teen wants to hear from you. Seven of ten teens interviewed said that they were ready to listen to things parents thought they were not ready to hear.23 When asked about the reasons why teenage girls have babies, 78 percent of white and 70 percent of African-American teenagers reported that lack of communication between a girl and her parents is often a reason teenage girls have babies.

Air Travel Concerns

Jet Lag

Jet lag is caused by traveling at great speeds over many time zones. This unbalances the "circadian rhythms," or biological clock, which is set by the pineal gland (a tiny organ in the brain). Eye cells send light and darkness messages to this gland, which releases melatonin (a sleep-inducing hormone) in response to darkness. Thus, abrupt changes in time zones can upset melatonin production, which ultimately unbalances the body's sleep-wake cycle. These biological functions, combined with travel-related physical and emotional stress, cause jet lag.

Common symptoms of jet lag include headaches, irritability, upset stomach, sleeplessness, gastric discomfort, chills and inability to concentrate. Symptoms may be worse if you are traveling west to east (away from the sun), because light helps to preserve the body's equilibrium. Travel from east to west (to an earlier time zone) results in fewer jet lag symptoms, and traveling northward or southward does not affect the body's circadian rhythms at all.

Experts say it takes one day for every time zone crossed to recover from jet lag symptoms. For example, if you cross six time zones, it will take six days to feel like your old self again. Although there are many methods for minimizing jet lag, it is impossible to eliminate it entirely.

One suggested method of minimizing jet lag effects is to drink plenty of water before, during and after the flight. Some doctors recommend that you drink two eight-ounce glasses of water right before departure. Dehydration is highly possible during airplane travel, due to dry cabin air. It results in diminished blood flow to your muscles, reduced kidney functions and fatigue, all of which induce jet lag. You can prevent dehydration by drinking one liter of water for every six hours of flight in addition to beverages you drink with meals. Even if you may not be thirsty, it is important to drink water on a regular basis throughout the flight, because the body's thirst mechanism does not warn you early about dehydration.

Researchers are now looking into "light therapy," which is a method of re-adjusting the body's inner clock by controlling exposure to natural and artificial light. One step in this strategy is to expose yourself to daylight as soon as possible once you arrive at your destination. Researchers also advise that you turn on your overhead light during your flight when it is daylight at your destination and turn off your light, or wear an eyeshade, when it is night there.

A second strategy is to try to reset the body's clock through the use of food. Many airlines have started serving their meals according to the destination's time zone. However, the "jet lag diet," another food strategy once thought to play an important role in minimizing the effects of jet lag, has been proven ineffective. (The Argonne jet lag diet consisted of eating certain foods at specific times in given amounts beginning three days before departure. A controlled study by the U.S. Army indicated that travelers practicing the jet lag diet actually fared worse than the "non-dieting" group.)

Another recent research strategy uses melatonin capsules as a possible method of combating jet lag fatigue. The capsules, which consist of concentrated amounts of melatonin, have been found to be successful in reducing fatigue when taken according to the destination's nighttime schedule.

Aside from "scientific" methods, you can take a number of simple steps to improve your ability to ward off jet lag. Physical conditioning during the two to three weeks before your trip can help increase your stamina and thereby reduce the fatigue caused by travel-related stress. And according to reports from airline crews, it is helpful to take non-stop flights and to schedule your departing flight in the morning, when you are most ready for a full day's worth of activities.

In addition, following a few simple "do's and don'ts" can help:

* Don't smoke, drink large amounts of alcohol, or take unnecessary medication while in flight.
* Do get a decent night's sleep before your flight.
* Do try to get some sleep during long flights.
* Do exercise while on board the plane by stretching, walking about the cabin, and doing fitness exercises in your chair (like squeezing a tennis ball for seven counts and then releasing).

Much of the stiffness and the uncomfortable, dazed feeling following a flight is simply the result of sitting inactively for long periods of time. You may want to ask airline representatives if they can provide a brochure for in-flight exercises.

Finally, limiting your activities the first day after your arrival will yield more hours of fun and productivity in the end.

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Flying with a Head Cold

A head cold can cause problems during air travel. Swollen mucous membranes can prevent pressure between the airplane cabin and your sinuses or inner ear from equalizing, sometimes resulting in pain during ascent and especially descent. Further, permanent ear or sinus damage can result.

Children with conditions which may cause "blocked ears," such as allergies or serious colds, should postpone air travel until their symptoms diminish. In general, avoid traveling with sick children or those who have been exposed to communicable diseases.

While your safest course of action with any head cold is to postpone your flight until your condition clears up, flying is particularly inadvisable when you have a high fever or ear or sinus pain. See a doctor if these symptoms appear or if you have an urgent reason for travel and you aren't sure if you should postpone your flight because of your condition. Your physician can counsel you on the advisability of travel and prescribe medications to help clear up your condition. Antibiotics may be necessary, and decongestants can be helpful.

If you must travel with a cold, use a decongestant and/or nasal spray before takeoff. If you have a long flight, check the label on your decongestant and time your doses so you will be able to take the decongestant about an hour before landing. Nasal sprays are best repeated right before descent.

Antihistamines are the most effective decongestants, but they can also cause drowsiness. Avoid driving after your flight if you have taken an antihistamine. If you are pregnant or have special problems, consult your physician before taking any medication.

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Flying with Children

Collapsible umbrella-type strollers are a convenient way to transport your small child or infant through airports. Lightweight, mesh storage bags that clip onto the back of the stroller can provide some portable storage space. Most airlines allow passengers to carry umbrella strollers on board for storage in the garment closet, but it's a good idea to check your carrier's policy ahead of time.

Fares and regulations for infants and small children vary, so check with your travel agent or airline for current information. If you plan to use an infant safety seat, it must be FAA-approved, and it may not be used at emergency exits or in the rows directly in front of or behind them. If you have not reserved a seat for your child and you bring a safety seat aboard in the hope that an empty seat will be available, you may be disappointed. In that case, the flight attendant will stow the safety seat for you.

It's a good idea to remember that unless you do purchase a separate ticket for your child, you will most likely be allowed only one carry-on bag. This may make it difficult to pack enough supplies for both you and your child, especially if it is a long flight.

Travel agents can supply you with a chart depicting your aircraft's seating arrangement. Some considerations when reserving seats will help you, your child, and your fellow travelers remain comfortable on board the aircraft. Bassinets can sometimes be reserved on international flights. Most are placed at bulkhead seats. Bulkhead seating provides more space in front of the passenger, but has a drawback - since there is no under-seat storage, infant feeding and changing supplies will be in the overhead bin, rather than at your arm's reach. If the airline allows, you may be able to use an umbrella stroller as infant seating during flight in the extra space in front of bulkhead seats.

Infants may be more comfortable seated away from the galley areas, which can be noisy during meal services. Young children will disrupt fewer fellow passengers if they are seated close to the washrooms, in aisle seats.

Adults who frequently accompany children on international flights recommend avoiding Monday and Friday flights, which are often crowded with business travelers. Mid-week flights are usually less crowded and may lend an atmosphere more conducive to the child's needs.

Aircraft cabins can be chilly, so include warm clothing in the hand luggage you carry on board. Some passengers experience slight swelling of their hands and feet during flight. If you remove your child's shoes during flight, it may be uncomfortable for the child when you put the shoes back on.

Although special meals for toddlers and children can be ordered in advance through many airlines, it is important to carry an adequate meal supply for infants. Carry enough supplies for a possible 24-hour delay, since unanticipated delays are not uncommon and may be lengthy in international travel.

Some airlines have formula and baby food on board, but travelers should not assume supplies will be available. Always call at least one day in advance to arrange meals for infants and small children. This allows the airline enough time to get supplies on board the plane, or if they do not prepare meals for small children or infants, it will allow you enough time to obtain the necessary supplies.

Airlines frequently prohibit flight attendants from mixing formulas for passengers, which makes ready-to-eat preparations most convenient. Also keep in mind that airline attendants are prohibited from serving you during take-offs and landings, so be sure to keep all necessary baby supplies close at hand. It's also a good idea to check with the airline before departure to see if they will have diaper wipes or bottle warming and cooling capabilities.

Children are generally not prone to motion sickness during flight, but they may experience discomfort during ascent and descent. In children, the ducts linking the middle ear and the nasal cavity are narrow, making it difficult for air pressure in the ears and nose to equalize when cabin pressure changes. Since frequent swallowing helps equalize air pressure, it's a good idea to bottle- or breast-feed infants during takeoffs and landings. If this is inconvenient, you can stimulate swallowing by placing drops of water on the infant's tongue with a plastic eyedropper. Small children should drink liquids or chew crackers or cookies. Avoid gum or small, hard candies, since unexpected turbulence could cause choking. Also keep in mind that turbulence can cause hot beverages to spill, so avoid them if you are holding a child in your lap.