To express our appreciation for a year's worth of excellence, the PTA will host Staff Appreciation Day on Tuesday, April 26. All SAS teachers, staff, and administrators will be treated to a meal in their division, provided and staffed by parents. There is also a lovely Halal buffet in the PTA office. Please help support this special day with a contribution of food, time, or money. Click link to view the details by your child's division.
from Singapore American School http://ift.tt/1pPxK42
Thursday, March 31, 2016
Staff Appreciation - Volunteers Needed
Staff Appreciation - Volunteers Needed
To express our appreciation for a year's worth of excellence, the PTA will host Staff Appreciation Day on Tuesday, April 26. All SAS teachers, staff, and administrators will be treated to a meal in their division, provided and staffed by parents. There is also a lovely Halal buffet in the PTA office. Please help support this special day with a contribution of food, time, or money. Click link to view the details by your child's division.
from Singapore American School http://ift.tt/1pPxK42
from Singapore American School http://ift.tt/1pPxK42
Raising The Age Of Purchase For Tobacco Products: Lessons Learned from Tobacco21
In 2015 the Greater Kansas City Chamber of Commerce—in partnership with Blue Cross and Blue Shield of Kansas City, the Health Care Foundation of Greater Kansas City, and many other business, health, nonprofit, and government leaders—launched Healthy KC, a project to improve health outcomes in our region.
Out of these discussions came Tobacco21|KC—an effort to raise the age of sale for tobacco products to twenty-one throughout Greater Kansas City as a strategy to reduce youth smoking. The effort launched in October 2015, and the community response has been overwhelming. Less than one month after our announcement, two of our area's largest local governments passed Tobacco21 ordinances, and six other cities passed Tobacco21 ordinances soon thereafter. As we write this, nearly half of our region's more than 2 million residents live in Tobacco21 communities, and many more local governments will consider the proposal this spring.
Though progress on Tobacco21|KC has been rapid, it hasn't been without some lessons learned —some of them we anticipated, but others we discovered only by misstep. Here are a few tips for smoking prevention advocates and other funders based on our experiences with Tobacco21|KC:
- Assess your community's readiness.
A few key conversations with area health departments, civic leaders, and a policy maker or two can give you a good sense about whether your community is likely to be supportive of a Tobacco21 policy. Before making the issue a matter of public debate, do your homework to make sure you understand your chance at success.
- Build a team.
Trust us, the work involved in a Tobacco21 effort is more than you would expect. Build a team of people with different backgrounds, skills, networks of contacts, and schedules. Some key constituencies to include are members of the business community, health experts, educators, youth, representatives of local health departments, and veterans and other representatives of the armed services. Each of these constituencies has a unique story to tell and role to play.
- Include the business community.
People may expect the local health community to support Tobacco21, but we also suggest recruiting businesses to stand with you. This may surprise people who don't recognize health as a key economic development engine, and this will immediately disarm anyone who claims that this effort could hurt local businesses.
- Find your champion and listen.
The right champion can be your personal tour guide through the municipal policy-making process. This champion should be a respected leader with political savvy and knowledge of the city or county council—it can be a member of the city council, a civic leader within the community, or perhaps even the mayor. Trust your champion's advice and guidance.
- Lay the groundwork.
Be sure you've done your homework so that when Tobacco21 becomes a topic of public and political conversation, you have a long list of supporters and a strategy for moving forward. The Tobacco21|KC effort had more than 100 endorsers before we publicly launched our campaign.
- Ask your elected officials where they stand—that is, don't make any assumptions.
Tobacco21 policies are nonpartisan, and support can come from unexpected places. Assign someone from your effort to speak to each elected official and present the issue to him or her for his or her reaction. Ideally, this person on your team will have an established relationship with, or some other connection to, the policy maker.
- Localize the issue.
You know the old saying about all politics being local? Well, it is certainly true with Tobacco21. Local voices impact local governing bodies, so make sure that your effort is localized as much as possible. Fact sheets, statistics, speakers providing testimony, endorsers—all of these should be as local as possible.
- Remember the power of personal stories.
The data around Tobacco21 are compelling, and it is easy to articulate them to city councils in a powerful way. However, more powerful than any data we've seen are personal stories about tobacco that can be shared at public meetings.
- Plan for opposition.
You may be lucky and have a Tobacco21 policy pass without opposition, but if opposition appears, be ready for it. In Kansas City, Missouri, the bulk of opposition was from vaping shops. Plan for such a possibility and know how you will respond.
- Pay attention to the ordinance language.
You might think that drafting a Tobacco21 ordinance is as simple as crossing out "18" and replacing it with "21." However, the changes are more complicated than that, particularly around how an ordinance treats purchase and sale versus possession and use. Some state laws also affect how Tobacco21 ordinances must be worded.
- Remember electronic cigarettes.
Electronic cigarettes (e-cigarettes) and alternative nicotine delivery systems are the wild frontier in this work. If possible, include these mechanisms in your Tobacco21 ordinances and when doing so, be thoughtful about the language that is used to define these products, as they are ever changing. The Tobacco Control Legal Consortium has a great resource here.
- Consider enforcement early on in the planning process.
This is one of the murkiest spaces, as city, county, and state laws around youth tobacco access can differ, each with their own enforcement body. As best as possible, do your homework to fully understand how your current tobacco policies are enforced and which entities are ultimately responsible for ensuring compliance. Each city is different and, depending on size, may or may not have the infrastructure and capacity to enforce a Tobacco21 policy.
To learn more about the Tobacco21|KC effort and our progress to date, click here.
Related reading:
"A Foundation's Win At Public Health Policy On Smoking," by Billie Hall of the Sunflower Foundation (Topeka, Kansas), GrantWatch section of Health Affairs Blog, June 15, 2010.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1VWetdO
Raising The Age Of Purchase For Tobacco Products: Lessons Learned from Tobacco21
In 2015 the Greater Kansas City Chamber of Commerce—in partnership with Blue Cross and Blue Shield of Kansas City, the Health Care Foundation of Greater Kansas City, and many other business, health, nonprofit, and government leaders—launched Healthy KC, a project to improve health outcomes in our region.
Out of these discussions came Tobacco21|KC—an effort to raise the age of sale for tobacco products to twenty-one throughout Greater Kansas City as a strategy to reduce youth smoking. The effort launched in October 2015, and the community response has been overwhelming. Less than one month after our announcement, two of our area’s largest local governments passed Tobacco21 ordinances, and six other cities passed Tobacco21 ordinances soon thereafter. As we write this, nearly half of our region’s more than 2 million residents live in Tobacco21 communities, and many more local governments will consider the proposal this spring.
Though progress on Tobacco21|KC has been rapid, it hasn’t been without some lessons learned —some of them we anticipated, but others we discovered only by misstep. Here are a few tips for smoking prevention advocates and other funders based on our experiences with Tobacco21|KC:
- Assess your community’s readiness.
A few key conversations with area health departments, civic leaders, and a policy maker or two can give you a good sense about whether your community is likely to be supportive of a Tobacco21 policy. Before making the issue a matter of public debate, do your homework to make sure you understand your chance at success.
- Build a team.
Trust us, the work involved in a Tobacco21 effort is more than you would expect. Build a team of people with different backgrounds, skills, networks of contacts, and schedules. Some key constituencies to include are members of the business community, health experts, educators, youth, representatives of local health departments, and veterans and other representatives of the armed services. Each of these constituencies has a unique story to tell and role to play.
- Include the business community.
People may expect the local health community to support Tobacco21, but we also suggest recruiting businesses to stand with you. This may surprise people who don’t recognize health as a key economic development engine, and this will immediately disarm anyone who claims that this effort could hurt local businesses.
- Find your champion and listen.
The right champion can be your personal tour guide through the municipal policy-making process. This champion should be a respected leader with political savvy and knowledge of the city or county council—it can be a member of the city council, a civic leader within the community, or perhaps even the mayor. Trust your champion’s advice and guidance.
- Lay the groundwork.
Be sure you’ve done your homework so that when Tobacco21 becomes a topic of public and political conversation, you have a long list of supporters and a strategy for moving forward. The Tobacco21|KC effort had more than 100 endorsers before we publicly launched our campaign.
- Ask your elected officials where they stand—that is, don’t make any assumptions.
Tobacco21 policies are nonpartisan, and support can come from unexpected places. Assign someone from your effort to speak to each elected official and present the issue to him or her for his or her reaction. Ideally, this person on your team will have an established relationship with, or some other connection to, the policy maker.
- Localize the issue.
You know the old saying about all politics being local? Well, it is certainly true with Tobacco21. Local voices impact local governing bodies, so make sure that your effort is localized as much as possible. Fact sheets, statistics, speakers providing testimony, endorsers—all of these should be as local as possible.
- Remember the power of personal stories.
The data around Tobacco21 are compelling, and it is easy to articulate them to city councils in a powerful way. However, more powerful than any data we’ve seen are personal stories about tobacco that can be shared at public meetings.
- Plan for opposition.
You may be lucky and have a Tobacco21 policy pass without opposition, but if opposition appears, be ready for it. In Kansas City, Missouri, the bulk of opposition was from vaping shops. Plan for such a possibility and know how you will respond.
- Pay attention to the ordinance language.
You might think that drafting a Tobacco21 ordinance is as simple as crossing out “18” and replacing it with “21.” However, the changes are more complicated than that, particularly around how an ordinance treats purchase and sale versus possession and use. Some state laws also affect how Tobacco21 ordinances must be worded.
- Remember electronic cigarettes.
Electronic cigarettes (e-cigarettes) and alternative nicotine delivery systems are the wild frontier in this work. If possible, include these mechanisms in your Tobacco21 ordinances and when doing so, be thoughtful about the language that is used to define these products, as they are ever changing. The Tobacco Control Legal Consortium has a great resource here.
- Consider enforcement early on in the planning process.
This is one of the murkiest spaces, as city, county, and state laws around youth tobacco access can differ, each with their own enforcement body. As best as possible, do your homework to fully understand how your current tobacco policies are enforced and which entities are ultimately responsible for ensuring compliance. Each city is different and, depending on size, may or may not have the infrastructure and capacity to enforce a Tobacco21 policy.
To learn more about the Tobacco21|KC effort and our progress to date, click here.
Related reading:
“A Foundation’s Win At Public Health Policy On Smoking,” by Billie Hall of the Sunflower Foundation (Topeka, Kansas), GrantWatch section of Health Affairs Blog, June 15, 2010.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1VWetdO
Tamiflu For All? Evidence Of Morbidity In CDC’s Antiviral Guidelines
The Centers for Disease Control and Prevention (CDC) has boiled down its public health campaign against influenza to a single slogan: "Take 3." Vaccines, everyday preventive actions like handwashing, and influenza antivirals.
Last year, because of a mismatch between the vaccine and circulating virus, the message was reduced to—essentially—"Take 1," as the CDC emphatically promoted oseltamivir (Tamiflu) for treating disease. The agency has stated: "Antiviral flu medicines are underutilized. If you get them early, they could keep you out of the hospital and might even save your life."
The CDC is one of the nation's most powerful voices when it comes to public health recommendations. That's why it's so important that its advice be scientifically sound and independently derived. Unfortunately, the CDC's advice on Tamiflu is neither. Here we explain why — and offer suggestions for what to do about it.
Tamiflu For All
CDC recommendations focus on treating those at higher risk of complications of influenza, and generally speak of "influenza antivirals" without reference to a specific product. However, oseltamivir is the only neuraminidase inhibitor in pill form. Further, the CDC holds that treatment "can be considered for any previously healthy, symptomatic outpatient," and also can be initiated beyond the FDA-approved two-day timeframe, creating a de-facto "Tamiflu for all" national recommendation.
While CDC states that oseltamivir can prevent serious complications and even death, by contrast, potential harms are not consistently highlighted alongside promotions of the drug and were not mentioned at the CDC's press conference. This oversight is conspicuous given high rates of nausea and vomiting associated with oseltamivir and recent analyses that raised concerns over possible renal harms and neuropsychiatric adverse events.
A Closer Look At The Evidence
Many of the CDC's statements are either contradicted by other prominent groups or are only supported by observational studies (Table 1).
Table 1. Sample Evidentiary Claims Underpinning Current CDC Recommendations For Treatment With Oseltamivir
| Evidentiary claims | Type of evidence CDC cites in support of claim | What others say |
| Reduced risk of complications of influenza: pneumonia | Pooled analysis of 10 RCTs, funded by manufacturer | FDA: "The data we've reviewed do not support this claim."
FDA approved label: "Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Tamiflu has not been shown to prevent such complications." |
| Reduced risk of complications of influenza: otitis media in children | 2 RCTs, funded by manufacturer | Cochrane: "Neither neuraminidase inhibitor significantly reduced the risk of otitis media and sinusitis in both adults and children." |
| Reduced risk of hospitalizations | Pooled analysis of 10 RCTs, funded by manufacturer | FDA: "[Oseltamivir] has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza." |
| Reduced risk of mortality | 1 observational study, without manufacturer funding
"Many observational studies" (uncited) | FDA: "The data we've reviewed do not support this claim." |
| Reduced duration of symptoms in adults | 3 RCTs, funded by manufacturer | FDA approved label: "1.3 day reduction in the median time to improvement in influenza-infected subjects receiving Tamiflu compared to subjects receiving placebo." |
For example, the CDC's official recommendations for influenza antivirals—a lengthy document last updated in 2011—claims statistically significant reductions in pneumonia and hospitalizations among adults treated with oseltamivir, citing a manufacturer authored pooled analysis of 10 randomized trials. The Food and Drug Administration (FDA) however—which had complete access to all trial data comprising the research program for oseltamivir—formally instructed Roche to cease from making a claim about reducing influenza complications in promotional materials.
In addition, it required Roche to print on the product label: "Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Tamiflu has not been shown to prevent such complications." Similarly, Cochrane reviewers determined that there was no compelling evidence to conclude the drug reduces the risk of serious complications such as pneumonia or hospitalizations.
The CDC's contention that influenza antivirals save lives is even more problematic. While the agency has promoted this as a key take-home message, the claim is based entirely on uncontrolled, retrospective observational studies, most from a single influenza season (2009-2010). CDC's reliance on observational studies makes apparent the fact that we lack more robust randomized trials demonstrating an alleged effect against mortality. But the agency's position is hard to reconcile with its own more technical evaluation: a World Health Organization (WHO)-sponsored and CDC co-authored systematic review of the observational studies cast serious doubts on their reliability, formally rating the quality of the data as "low." An additional concern is that the CDC's claim is, once again, directly contradicted by the FDA, which has stated that the data they reviewed did not support reduction in mortality by influenza antivirals.
CDC's advice is not derived from independent analysis of oseltamivir clinical trial data. Instead of scrutinizing the raw trial data the way FDA routinely does, CDC relies on journal publications. This practice seems particularly ill-advised in the case of influenza antivirals since the majority of treatment trials of oseltamivir have never been published in journals and evidence that systematic reviews of neuraminidase inhibitors funded by industry have more optimistic conclusions than those authored by independent parties. In April 2014, Cochrane released a comprehensive set of formerly confidential clinical study reports on oseltamivir and zanamivir, but to date the CDC has not indicated an intention to review these and update their recommendations.
Other countries have been more self-critical and are re-evaluating the evidence supporting national policies for influenza antivirals. The UK Parliamentary Accounts Committee, for example, led an investigation into the £424 million spent by the government on oseltamivir, ultimately concluding that the case for stockpiling was "based on judgement rather than on evidence." In Germany, prominent civil society organizations are likewise questioning the substantial government investments in influenza antivirals and calling for a re-examination of the role of these drugs in public health programs.
What We Need
The open data movement is creating new cultural norms for assessing the benefits of therapies and the public deserves an open process in the use of these data for developing public health guidelines. In order to ensure that guidelines reflect comprehensive, objective appraisals of all available data, we propose the following key principles:
Transparency
The process of developing broad public health recommendations demands high-quality evidence and rigorous and transparent methods. These methods should be pre-specified, documented in detail, and publicly available. In the presence of inadequate or contradictory information, the CDC's guidelines should be conservative in their endorsement of any intervention and present safety issues alongside known benefits. The similarities and differences in working assumptions regarding safety or efficacy as compared to the FDA should be discussed and recommendations should be regularly updated as new evidence emerges with data sources underpinning guidance clearly delineated.
Underlying Trial Data
The increasing public availability of trial data that previously was only shared with regulators creates an obligation to review these data. Such data are now available for influenza antivirals and should be analyzed by the CDC to evaluate the accuracy of its recommendations.
Prospective Trials
Independently funded clinical trials should be conducted addressing evidence gaps and ensuring high-quality data underlie the formulation of public health recommendations. Given the large number of patients who are infected with influenza every season, it should be easy to recruit patients for large randomized trials that assess even rare events. The CDC could fund this, as could any other agency with a public health mission involving the control of influenza.
Conflict Of Interest Disclosures
The CDC should be held to the same standards as investigators and physicians and publicly disclose potential conflicts of interest held by the agency and its individual members, as is required of its external advisory committee members. For example, the CDC influenza website does not disclose that it received a $198,000 grant from Roche that was directed to the CDC's "Take 3" campaign. Such disclosure is essential to the CDC upholding its mandate as an independent, objective arbitrator of health information.
Patient-Centered Guidelines
CDC recommendations are developed through the federal advisory committee process and do not include input from patients and general physicians — the two groups most affected by and involved with yearly influenza illness. It bears remembering that influenza is not an "expert" disease, but a common one with as many as 5-20 percent of Americans symptomatic each year, according to CDC. As such, physicians have valuable experience to contribute and diverse patient groups will have varying preferences around the benefits and harms of influenza antivirals. The CDC should give general physicians and patients a seat at the table in developing its priorities and approach for influenza management.
This year, we should greet the end of the influenza season with a resolution to reevaluate current recommendations for the use of influenza antivirals. The public deserves government recommendations designed under a transparent process that fully leverages emerging opportunities in open data and promises to strengthen our ability to make evidence-informed public health decisions.
Authors' Note
Kenneth Mandl and Florence Bourgeois declare no competing interests. Peter Doshi is a co-recipient of a UK National Institute for Health Research grant for the Cochrane review discussed in this article (HTA – 10/80/01 Update and amalgamation of two Cochrane Reviews: neuraminidase inhibitors for preventing and treating influenza in healthy adults and children). This review focused on oseltamivir, manufactured by Roche, and zanamivir, manufactured by GSK. Doshi also received €1500 from the European Respiratory Society in support of his travel to the society's September 2012 annual congress in Vienna, where he gave an invited talk on oseltamivir. Peter Doshi gratefully acknowledges the American Association of Colleges of Pharmacy for its funding support ($10,000) for a study to analyze written medical information regarding the possible harms of statins. AACP had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript. Doshi is also an associate editor of The BMJ and an unpaid member of the IMEDS steering committee at the Reagan-Udall Foundation for the FDA, which focuses on drug safety research.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1M3Hxhi
Tamiflu For All? Evidence Of Morbidity In CDC’s Antiviral Guidelines
The Centers for Disease Control and Prevention (CDC) has boiled down its public health campaign against influenza to a single slogan: “Take 3.” Vaccines, everyday preventive actions like handwashing, and influenza antivirals.
Last year, because of a mismatch between the vaccine and circulating virus, the message was reduced to—essentially—“Take 1,” as the CDC emphatically promoted oseltamivir (Tamiflu) for treating disease. The agency has stated: “Antiviral flu medicines are underutilized. If you get them early, they could keep you out of the hospital and might even save your life.”
The CDC is one of the nation’s most powerful voices when it comes to public health recommendations. That’s why it’s so important that its advice be scientifically sound and independently derived. Unfortunately, the CDC’s advice on Tamiflu is neither. Here we explain why — and offer suggestions for what to do about it.
Tamiflu For All
CDC recommendations focus on treating those at higher risk of complications of influenza, and generally speak of “influenza antivirals” without reference to a specific product. However, oseltamivir is the only neuraminidase inhibitor in pill form. Further, the CDC holds that treatment “can be considered for any previously healthy, symptomatic outpatient,” and also can be initiated beyond the FDA-approved two-day timeframe, creating a de-facto “Tamiflu for all” national recommendation.
While CDC states that oseltamivir can prevent serious complications and even death, by contrast, potential harms are not consistently highlighted alongside promotions of the drug and were not mentioned at the CDC’s press conference. This oversight is conspicuous given high rates of nausea and vomiting associated with oseltamivir and recent analyses that raised concerns over possible renal harms and neuropsychiatric adverse events.
A Closer Look At The Evidence
Many of the CDC’s statements are either contradicted by other prominent groups or are only supported by observational studies (Table 1).
Table 1. Sample Evidentiary Claims Underpinning Current CDC Recommendations For Treatment With Oseltamivir
| Evidentiary claims | Type of evidence CDC cites in support of claim | What others say |
| Reduced risk of complications of influenza: pneumonia | Pooled analysis of 10 RCTs, funded by manufacturer | FDA: “The data we’ve reviewed do not support this claim.”
FDA approved label: “Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Tamiflu has not been shown to prevent such complications.” |
| Reduced risk of complications of influenza: otitis media in children | 2 RCTs, funded by manufacturer | Cochrane: “Neither neuraminidase inhibitor significantly reduced the risk of otitis media and sinusitis in both adults and children.” |
| Reduced risk of hospitalizations | Pooled analysis of 10 RCTs, funded by manufacturer | FDA: “[Oseltamivir] has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.” |
| Reduced risk of mortality | 1 observational study, without manufacturer funding
“Many observational studies” (uncited) |
FDA: “The data we’ve reviewed do not support this claim.” |
| Reduced duration of symptoms in adults | 3 RCTs, funded by manufacturer | FDA approved label: “1.3 day reduction in the median time to improvement in influenza-infected subjects receiving Tamiflu compared to subjects receiving placebo.” |
For example, the CDC’s official recommendations for influenza antivirals—a lengthy document last updated in 2011—claims statistically significant reductions in pneumonia and hospitalizations among adults treated with oseltamivir, citing a manufacturer authored pooled analysis of 10 randomized trials. The Food and Drug Administration (FDA) however—which had complete access to all trial data comprising the research program for oseltamivir—formally instructed Roche to cease from making a claim about reducing influenza complications in promotional materials.
In addition, it required Roche to print on the product label: “Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Tamiflu has not been shown to prevent such complications.” Similarly, Cochrane reviewers determined that there was no compelling evidence to conclude the drug reduces the risk of serious complications such as pneumonia or hospitalizations.
The CDC’s contention that influenza antivirals save lives is even more problematic. While the agency has promoted this as a key take-home message, the claim is based entirely on uncontrolled, retrospective observational studies, most from a single influenza season (2009-2010). CDC’s reliance on observational studies makes apparent the fact that we lack more robust randomized trials demonstrating an alleged effect against mortality. But the agency’s position is hard to reconcile with its own more technical evaluation: a World Health Organization (WHO)-sponsored and CDC co-authored systematic review of the observational studies cast serious doubts on their reliability, formally rating the quality of the data as “low.” An additional concern is that the CDC’s claim is, once again, directly contradicted by the FDA, which has stated that the data they reviewed did not support reduction in mortality by influenza antivirals.
CDC’s advice is not derived from independent analysis of oseltamivir clinical trial data. Instead of scrutinizing the raw trial data the way FDA routinely does, CDC relies on journal publications. This practice seems particularly ill-advised in the case of influenza antivirals since the majority of treatment trials of oseltamivir have never been published in journals and evidence that systematic reviews of neuraminidase inhibitors funded by industry have more optimistic conclusions than those authored by independent parties. In April 2014, Cochrane released a comprehensive set of formerly confidential clinical study reports on oseltamivir and zanamivir, but to date the CDC has not indicated an intention to review these and update their recommendations.
Other countries have been more self-critical and are re-evaluating the evidence supporting national policies for influenza antivirals. The UK Parliamentary Accounts Committee, for example, led an investigation into the £424 million spent by the government on oseltamivir, ultimately concluding that the case for stockpiling was “based on judgement rather than on evidence.” In Germany, prominent civil society organizations are likewise questioning the substantial government investments in influenza antivirals and calling for a re-examination of the role of these drugs in public health programs.
What We Need
The open data movement is creating new cultural norms for assessing the benefits of therapies and the public deserves an open process in the use of these data for developing public health guidelines. In order to ensure that guidelines reflect comprehensive, objective appraisals of all available data, we propose the following key principles:
Transparency
The process of developing broad public health recommendations demands high-quality evidence and rigorous and transparent methods. These methods should be pre-specified, documented in detail, and publicly available. In the presence of inadequate or contradictory information, the CDC’s guidelines should be conservative in their endorsement of any intervention and present safety issues alongside known benefits. The similarities and differences in working assumptions regarding safety or efficacy as compared to the FDA should be discussed and recommendations should be regularly updated as new evidence emerges with data sources underpinning guidance clearly delineated.
Underlying Trial Data
The increasing public availability of trial data that previously was only shared with regulators creates an obligation to review these data. Such data are now available for influenza antivirals and should be analyzed by the CDC to evaluate the accuracy of its recommendations.
Prospective Trials
Independently funded clinical trials should be conducted addressing evidence gaps and ensuring high-quality data underlie the formulation of public health recommendations. Given the large number of patients who are infected with influenza every season, it should be easy to recruit patients for large randomized trials that assess even rare events. The CDC could fund this, as could any other agency with a public health mission involving the control of influenza.
Conflict Of Interest Disclosures
The CDC should be held to the same standards as investigators and physicians and publicly disclose potential conflicts of interest held by the agency and its individual members, as is required of its external advisory committee members. For example, the CDC influenza website does not disclose that it received a $198,000 grant from Roche that was directed to the CDC’s “Take 3” campaign. Such disclosure is essential to the CDC upholding its mandate as an independent, objective arbitrator of health information.
Patient-Centered Guidelines
CDC recommendations are developed through the federal advisory committee process and do not include input from patients and general physicians — the two groups most affected by and involved with yearly influenza illness. It bears remembering that influenza is not an “expert” disease, but a common one with as many as 5-20 percent of Americans symptomatic each year, according to CDC. As such, physicians have valuable experience to contribute and diverse patient groups will have varying preferences around the benefits and harms of influenza antivirals. The CDC should give general physicians and patients a seat at the table in developing its priorities and approach for influenza management.
This year, we should greet the end of the influenza season with a resolution to reevaluate current recommendations for the use of influenza antivirals. The public deserves government recommendations designed under a transparent process that fully leverages emerging opportunities in open data and promises to strengthen our ability to make evidence-informed public health decisions.
Authors’ Note
Kenneth Mandl and Florence Bourgeois declare no competing interests. Peter Doshi is a co-recipient of a UK National Institute for Health Research grant for the Cochrane review discussed in this article (HTA – 10/80/01 Update and amalgamation of two Cochrane Reviews: neuraminidase inhibitors for preventing and treating influenza in healthy adults and children). This review focused on oseltamivir, manufactured by Roche, and zanamivir, manufactured by GSK. Doshi also received €1500 from the European Respiratory Society in support of his travel to the society’s September 2012 annual congress in Vienna, where he gave an invited talk on oseltamivir. Peter Doshi gratefully acknowledges the American Association of Colleges of Pharmacy for its funding support ($10,000) for a study to analyze written medical information regarding the possible harms of statins. AACP had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript. Doshi is also an associate editor of The BMJ and an unpaid member of the IMEDS steering committee at the Reagan-Udall Foundation for the FDA, which focuses on drug safety research.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1M3Hxhi
The Payment Reform Landscape: Where We Started On Transparency Tools And Where We Need To Go
Today we live in the age of information. Modern technology is abundant, providing many with access to a wealth of knowledge and resources. With so much information at our fingertips, we can easily learn more about many of the choices we face in daily life and compare the available options.
For instance, a shopper in the market for an umbrella (which those of us in California have finally needed again) can easily understand her options using powerful Internet search engines that instantly generate endless webpages, videos, and images. She can access an online marketplace to compare hundreds of umbrellas by feature, color, manufacturer, and price, while also having access to quality ratings in the form of stars and written reviews. Such in-depth but quick comparisons are at the consumer's fingertips.
However, when this savvy shopper tries to apply the same process to find a health care provider for low back pain, she is less successful. Instead of countless webpages with a host of information at her disposal, she is limited to one site offered through her insurer and/or employer. Instead of easy-to-understand comparison points and quality ratings, the site provides medical information that can often be difficult to interpret.
A consumer who yesterday easily chose a $14 yellow umbrella with a 4.5 star quality rating in 15 minutes is now frustrated and wonders why shopping for health services is vastly different from the retail experience. She needs a comprehensive online marketplace that guides her to the care she needs (and away from unnecessary care) and allows her to compare hundreds of providers by location, price, network status, and quality.
The Evolution Of Transparency Tools
With high expectations regarding the availability of information, consumers are baffled why something as seemingly simple as comparing providers on price and quality is so difficult. As an increasing number of consumers enroll in high-deductible health plans and tiered networks and assume more financial responsibility for their care, the lack of adequate tools is an obstacle to effectively managing health care and associated costs.
However, it's important to note that today's transparency tools, and the quantity and quality of data they provide, have come a long way. As consumer and industry needs have shifted over time, transparency tools have evolved to try to keep pace, and we have witnessed an expansion in their capabilities. For instance, in 2012, when Catalyst for Payment Reform (CPR) first released specifications for the evaluation of transparency tools, we identified the need to look for whether price and quality information were both available and displayed simultaneously. Today, this feature is nearly ubiquitous.
However, we are still pushing for toolmakers to make further strides, including creating overall value ratings that help consumers identify their "best buy" when shopping for care. In evaluating tools, it's now less critical to assess the inclusion of a number of basic features, and more important to look for specific, targeted features that will best help a given population find and use the information provided.
There Is Still More Work to Be Done
While tools aiming to make health care quality and price information available to consumers may not ever provide 'the total Amazon experience,' there are some key features they must possess to move these tools meaningfully in the right direction. Our latest specifications highlight a continued need for transparency tools to:
- Be widely available to consumers in most markets and for most insurance products;
- Accurately display a consumer's real time financial liability, including any remaining deductible, copays, and out-of-pocket maximum;
- Accommodate a variety of benefit and network designs;
- Incorporate priority quality measures and patient-generated reviews in quality scores;
- Combine quality and price into an overall value rating;
- Show prices that are as accurate as possible;
- Allow consumers to tailor search results to their personal preferences (e.g., location, quality, price); and,
- Be paired with consumer engagement strategies to ensure information is not only available, but acted upon.
Better Tools May Not Translate To Widespread Use
The transparency market is working to catch up with the demand created by the increasing number of consumers who need to shop for health care providers and services. However, even as tools evolve to meet their needs, user engagement tends to be low.
This trend seems to be in contrast to the apparent increase in consumer price seeking behavior and desire to use price and quality information. According to a recent survey by Public Agenda, 56 percent of consumers reported trying to figure out their out-of-pocket expense, or how much their insurer pays a provider, prior to receiving care. Furthermore, when seeking price information, 21 percent of consumers tried to compare prices across multiple providers, and 69 percent of consumers believe a website showing how much different providers charge for care would help them to better manage their health care spending.
This gap between the desire for the retail experience in shopping for health care services and the utilization of available transparency tools is puzzling; the very consumers who want the information the tools provide may not be using them. This phenomenon may have to do with poor or inadequate communication to the consumer about the availability of information, where it is located or how to use it. Consequently, when it comes to price and quality data, availability of information may not yet be translating to better consumer decision making.
Thus, there's room to improve how the market connects consumers to the information they need when they need it. Are convenience and a smooth consumer experience enough to make a positive difference in the uptake and utilization of these tools? For instance, a tool that is seamlessly integrated into the insurance plan, and which reflects our shopper's benefit design, could enable her to search for providers treating low back pain based on both in-network status and cost and quality tier as outlined in her health insurance plan. The tool is making relevant information passively available to our shopper at the right time. Is this enough?
Or, alternatively, is it necessary to use engagement strategies to drive proactive utilization of the tool? For example, our umbrella shopper is offered a gift card worth up to $150 if she uses the available transparency tool to select and make an appointment with a provider, an approach similar to one used by Priority Health. Enticing engagement strategies and other educational activities such as this can help ensure consumers are gaining access to available information at the right time and incorporating it into decision making.
With the continued rise of high-deductible health plans and other "consumerism" models, we can expect to see the market respond to consumer needs and behavior. However, in the meantime, employers and other health care purchasers on the buy side of the market must continue to choose tools carefully to try to meet the needs of their populations.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1q5RXmS
The Payment Reform Landscape: Where We Started On Transparency Tools And Where We Need To Go
Today we live in the age of information. Modern technology is abundant, providing many with access to a wealth of knowledge and resources. With so much information at our fingertips, we can easily learn more about many of the choices we face in daily life and compare the available options.
For instance, a shopper in the market for an umbrella (which those of us in California have finally needed again) can easily understand her options using powerful Internet search engines that instantly generate endless webpages, videos, and images. She can access an online marketplace to compare hundreds of umbrellas by feature, color, manufacturer, and price, while also having access to quality ratings in the form of stars and written reviews. Such in-depth but quick comparisons are at the consumer’s fingertips.
However, when this savvy shopper tries to apply the same process to find a health care provider for low back pain, she is less successful. Instead of countless webpages with a host of information at her disposal, she is limited to one site offered through her insurer and/or employer. Instead of easy-to-understand comparison points and quality ratings, the site provides medical information that can often be difficult to interpret.
A consumer who yesterday easily chose a $14 yellow umbrella with a 4.5 star quality rating in 15 minutes is now frustrated and wonders why shopping for health services is vastly different from the retail experience. She needs a comprehensive online marketplace that guides her to the care she needs (and away from unnecessary care) and allows her to compare hundreds of providers by location, price, network status, and quality.
The Evolution Of Transparency Tools
With high expectations regarding the availability of information, consumers are baffled why something as seemingly simple as comparing providers on price and quality is so difficult. As an increasing number of consumers enroll in high-deductible health plans and tiered networks and assume more financial responsibility for their care, the lack of adequate tools is an obstacle to effectively managing health care and associated costs.
However, it’s important to note that today’s transparency tools, and the quantity and quality of data they provide, have come a long way. As consumer and industry needs have shifted over time, transparency tools have evolved to try to keep pace, and we have witnessed an expansion in their capabilities. For instance, in 2012, when Catalyst for Payment Reform (CPR) first released specifications for the evaluation of transparency tools, we identified the need to look for whether price and quality information were both available and displayed simultaneously. Today, this feature is nearly ubiquitous.
However, we are still pushing for toolmakers to make further strides, including creating overall value ratings that help consumers identify their “best buy” when shopping for care. In evaluating tools, it’s now less critical to assess the inclusion of a number of basic features, and more important to look for specific, targeted features that will best help a given population find and use the information provided.
There Is Still More Work to Be Done
While tools aiming to make health care quality and price information available to consumers may not ever provide ‘the total Amazon experience,’ there are some key features they must possess to move these tools meaningfully in the right direction. Our latest specifications highlight a continued need for transparency tools to:
- Be widely available to consumers in most markets and for most insurance products;
- Accurately display a consumer’s real time financial liability, including any remaining deductible, copays, and out-of-pocket maximum;
- Accommodate a variety of benefit and network designs;
- Incorporate priority quality measures and patient-generated reviews in quality scores;
- Combine quality and price into an overall value rating;
- Show prices that are as accurate as possible;
- Allow consumers to tailor search results to their personal preferences (e.g., location, quality, price); and,
- Be paired with consumer engagement strategies to ensure information is not only available, but acted upon.
Better Tools May Not Translate To Widespread Use
The transparency market is working to catch up with the demand created by the increasing number of consumers who need to shop for health care providers and services. However, even as tools evolve to meet their needs, user engagement tends to be low.
This trend seems to be in contrast to the apparent increase in consumer price seeking behavior and desire to use price and quality information. According to a recent survey by Public Agenda, 56 percent of consumers reported trying to figure out their out-of-pocket expense, or how much their insurer pays a provider, prior to receiving care. Furthermore, when seeking price information, 21 percent of consumers tried to compare prices across multiple providers, and 69 percent of consumers believe a website showing how much different providers charge for care would help them to better manage their health care spending.
This gap between the desire for the retail experience in shopping for health care services and the utilization of available transparency tools is puzzling; the very consumers who want the information the tools provide may not be using them. This phenomenon may have to do with poor or inadequate communication to the consumer about the availability of information, where it is located or how to use it. Consequently, when it comes to price and quality data, availability of information may not yet be translating to better consumer decision making.
Thus, there’s room to improve how the market connects consumers to the information they need when they need it. Are convenience and a smooth consumer experience enough to make a positive difference in the uptake and utilization of these tools? For instance, a tool that is seamlessly integrated into the insurance plan, and which reflects our shopper’s benefit design, could enable her to search for providers treating low back pain based on both in-network status and cost and quality tier as outlined in her health insurance plan. The tool is making relevant information passively available to our shopper at the right time. Is this enough?
Or, alternatively, is it necessary to use engagement strategies to drive proactive utilization of the tool? For example, our umbrella shopper is offered a gift card worth up to $150 if she uses the available transparency tool to select and make an appointment with a provider, an approach similar to one used by Priority Health. Enticing engagement strategies and other educational activities such as this can help ensure consumers are gaining access to available information at the right time and incorporating it into decision making.
With the continued rise of high-deductible health plans and other “consumerism” models, we can expect to see the market respond to consumer needs and behavior. However, in the meantime, employers and other health care purchasers on the buy side of the market must continue to choose tools carefully to try to meet the needs of their populations.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1q5RXmS
Wednesday, March 30, 2016
Time to Go to the Orthodontist
I am an Invisalign Teen®brand spokesperson and all opinions expressed are my own.
Is it time for your child to see an orthodontist?
I always assumed that teenagers saw orthodontists, but what I found with my first child is that it is good to get an initial consult much sooner.
In fact, by the time my oldest son was a teenager, he had been through the first phase of braces due to alignment issues that needed some action before all his baby teeth were lost. From this experience, I found out kids as young as 8 or 9 can receive an orthodontist evaluation.
I also found out that the first orthodontic appointment was pain-free! The orthodontist simply checked Ryan's mouth with a full evaluation, reviewed his dental records, looked at current teeth alignment, asked questions about potential jaw issues or pain, and examined X-rays. He gave us several suggested treatment timelines and we opted to wait a year before beginning his first phase. I have several friends who took their kids into the orthodontist who told them that everything was fine. In our case, it was reassuring to me to know exactly what was going on and our different options.
When my second boy was 10, I took him to his first orthodontist appointment. As with my first, it was obvious that he would need orthodontic intervention! The orthodontist agreed and mentioned that he would be a good candidate for Invisalign® Teen clear aligners. He recommended that we wait until all his baby teeth had fallen out. We returned for two more checkups over the next 2 years. Reid had one stubborn baby tooth that was just hanging in there! The orthodontist said that 6 months after he lost that last tooth, we could start the Invisalign Teen treatment. Reid lost that tooth right before the holidays 2015…so we are returning in another month to see if everything is ready to go. If all goes according to plan, he will start with Invisalign Teen treatment around his 13th birthday.
I've learned that orthodontic treatment isn't just cosmetic. Crowded and overlapping teeth can be a hygiene issue; some kids have a bite that lead to jaw and tooth problems; and extreme cases can affect breathing and eating. I also know that you child's first orthodontist appointment will be an informational visit and can put kids at ease about returning, and ultimately, mom and child will be armed with knowledge that allows them to make future treatment decisions.
I am very relieved that Reid will be receiving Invisalign Teen clear aligners to align his teeth. His older brother's traditional metal braces caused problems several times when brackets and/or wires were broken – and it always seemed to be the weekend or at night! I know from wearing Invisalign clear aligners myself that there are no emergency runs to the orthodontist and I always had the previous trays that I could wear if something happened to the current set until I could see my doctor. I've also learned that Invisalign Teen treatment includes up to six free replacement aligners, although data shows that a very small percentage of teens require them.
For me, I love that the technology has become so advanced that they're able to treat more complex cases, so it's definitely worth getting a consultation if it's something you've considered for your teen. For my son, he is mostly excited that wearing Invisalign Teen is much more subtle than traditional braces! A win win for both of us!
Kids Activities Blog is excited to be working with the maker's of Invisalign Teen clear aligners again this year. Holly Homer is an Invisalign Teen brand spokesperson and thrilled to be talking about her Invisalign treatment experience as well as starting a new Invisalign Teen clear aligners journey with one of her boys. All opinions expressed are her own. Full disclosure.
The post Time to Go to the Orthodontist appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1q3RzFq
Time to Go to the Orthodontist
I am an Invisalign Teen® brand spokesperson and all opinions expressed are my own.
Is it time for your child to see an orthodontist?
I always assumed that teenagers saw orthodontists, but what I found with my first child is that it is good to get an initial consult much sooner.
In fact, by the time my oldest son was a teenager, he had been through the first phase of braces due to alignment issues that needed some action before all his baby teeth were lost. From this experience, I found out kids as young as 8 or 9 can receive an orthodontist evaluation.
I also found out that the first orthodontic appointment was pain-free! The orthodontist simply checked Ryan’s mouth with a full evaluation, reviewed his dental records, looked at current teeth alignment, asked questions about potential jaw issues or pain, and examined X-rays. He gave us several suggested treatment timelines and we opted to wait a year before beginning his first phase. I have several friends who took their kids into the orthodontist who told them that everything was fine. In our case, it was reassuring to me to know exactly what was going on and our different options.
When my second boy was 10, I took him to his first orthodontist appointment. As with my first, it was obvious that he would need orthodontic intervention! The orthodontist agreed and mentioned that he would be a good candidate for Invisalign® Teen clear aligners. He recommended that we wait until all his baby teeth had fallen out. We returned for two more checkups over the next 2 years. Reid had one stubborn baby tooth that was just hanging in there! The orthodontist said that 6 months after he lost that last tooth, we could start the Invisalign Teen treatment. Reid lost that tooth right before the holidays 2015…so we are returning in another month to see if everything is ready to go. If all goes according to plan, he will start with Invisalign Teen treatment around his 13th birthday.
I’ve learned that orthodontic treatment isn’t just cosmetic. Crowded and overlapping teeth can be a hygiene issue; some kids have a bite that lead to jaw and tooth problems; and extreme cases can affect breathing and eating. I also know that you child’s first orthodontist appointment will be an informational visit and can put kids at ease about returning, and ultimately, mom and child will be armed with knowledge that allows them to make future treatment decisions.
I am very relieved that Reid will be receiving Invisalign Teen clear aligners to align his teeth. His older brother’s traditional metal braces caused problems several times when brackets and/or wires were broken – and it always seemed to be the weekend or at night! I know from wearing Invisalign clear aligners myself that there are no emergency runs to the orthodontist and I always had the previous trays that I could wear if something happened to the current set until I could see my doctor. I’ve also learned that Invisalign Teen treatment includes up to six free replacement aligners, although data shows that a very small percentage of teens require them.
For me, I love that the technology has become so advanced that they’re able to treat more complex cases, so it’s definitely worth getting a consultation if it’s something you’ve considered for your teen. For my son, he is mostly excited that wearing Invisalign Teen is much more subtle than traditional braces! A win win for both of us!
Kids Activities Blog is excited to be working with the maker’s of Invisalign Teen clear aligners again this year. Holly Homer is an Invisalign Teen brand spokesperson and thrilled to be talking about her Invisalign treatment experience as well as starting a new Invisalign Teen clear aligners journey with one of her boys. All opinions expressed are her own. Full disclosure.
The post Time to Go to the Orthodontist appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1q3RzFq
Badminton IASAS BBQ
Volunteers are needed for the badminton IASAS BBQ on Friday, April 8 from 9:00 a.m. to 12:30 p.m. outside of outside of the high school cafeteria. Click for more info or to volunteer.
from Singapore American School http://ift.tt/1pLS0nf
Badminton IASAS BBQ
Volunteers are needed for the badminton IASAS BBQ on Friday, April 8 from 9:00 a.m. to 12:30 p.m. outside of outside of the high school cafeteria. Click for more info or to volunteer.
from Singapore American School http://ift.tt/1pLS0nf
from Singapore American School http://ift.tt/1pLS0nf
Booster Senior Scholarships
The Booster Club is pleased to grant scholarships to 10 graduating seniors for their contributions to the SAS school community. Each recipient will receive a cash award in the amount of $2,000. Click for more information or to apply now.
from Singapore American School http://ift.tt/1M1E2bp
Cook Love Eat with Celebrity Chef Sarab
The Booster Club proudly invites you to a Southeast Asian cooking demonstration followed by lunch with Singaporean celebrity chef, Sarab Kapoor, featuring Thai, Indonesian, Singaporean, and Indian cuisines on Friday, May 6 at 11:00 a.m. at the APS Lifestyle Gallery in the Boat Quay area. Tickets are $70 per person and include a complimentary cookbook by the chef (a $35 value), lunch, and a goodie bag. Purchase your tickets at the Booster Booth or online at sasboosterstore.com.
from Singapore American School http://ift.tt/1q3J11u
PTA Coffee this Friday!
Join us for a PTA coffee on Friday, April 1 in the PTA office from 9:00 a.m. to 10:00 a.m. Enjoy coffee, tea, and refreshments while you learn about what the PTA does, how we help the school, and ways you can get involved in 2016-17. There are so many ways to get involved with your child's school community. We can help you find the right fit. No job is too small and the big jobs, we will tackle together!
from Singapore American School http://ift.tt/1on85yK
Booster Senior Scholarships
The Booster Club is pleased to grant scholarships to 10 graduating seniors for their contributions to the SAS school community. Each recipient will receive a cash award in the amount of $2,000. Click for more information or to apply now.
from Singapore American School http://ift.tt/1M1E2bp
from Singapore American School http://ift.tt/1M1E2bp
Cook Love Eat with Celebrity Chef Sarab
The Booster Club proudly invites you to a Southeast Asian cooking demonstration followed by lunch with Singaporean celebrity chef, Sarab Kapoor, featuring Thai, Indonesian, Singaporean, and Indian cuisines on Friday, May 6 at 11:00 a.m. at the APS Lifestyle Gallery in the Boat Quay area. Tickets are $70 per person and include a complimentary cookbook by the chef (a $35 value), lunch, and a goodie bag. Purchase your tickets at the Booster Booth or online at sasboosterstore.com.
from Singapore American School http://ift.tt/1q3J11u
from Singapore American School http://ift.tt/1q3J11u
PTA Coffee this Friday!
Join us for a PTA coffee on Friday, April 1 in the PTA office from 9:00 a.m. to 10:00 a.m. Enjoy coffee, tea, and refreshments while you learn about what the PTA does, how we help the school, and ways you can get involved in 2016-17. There are so many ways to get involved with your child's school community. We can help you find the right fit. No job is too small and the big jobs, we will tackle together!
from Singapore American School http://ift.tt/1on85yK
from Singapore American School http://ift.tt/1on85yK
Open House on April 12
Join us on April 12 for a look at our preschool through grade two from 9:00 a.m. to 11:00 a.m. Registration is required. Book now for a limited space in either our preschool and pre-kindergarten tour or our kindergarten through grade two tour. Register at http://ift.tt/1LT7G2n
from Singapore American School http://ift.tt/1q3J0KM
from Singapore American School http://ift.tt/1q3J0KM
Open House on April 12
Join us on April 12 for a look at our preschool through grade two from 9:00 a.m. to 11:00 a.m. Registration is required. Book now for a limited space in either our preschool and pre-kindergarten tour or our kindergarten through grade two tour. Register at http://ift.tt/1LT7G2n
from Singapore American School http://ift.tt/1q3J0KM
How to Teach Kids Self Control
Imagine you are cooking dinner and your child is starving. You tell him to wait, but he wines and cries and pouts. You are tired of listening to him, whine so you allow him to have a snack. Teaching kids self control is hard.
Or imagine you are at a store and your child sees a toy that he really, really, really wants more than anything in the whole world. You just want some peace while you shop, so you let him have the toy and agree to buy it at the end of the shopping trip.
Or imagine you child desperately wants to play at a friend's house, but right now you are leaving as a family for a commitment or obligation. You child does not want to go with you. He wants to go to a friend's house. Okay fine. You make a concession and allow him to go to the friend's house instead.
But wait?
What if I told you holding your boundary firm and making your child wait was the single most important skill you can teach your child.
Teaching kids self-control or delayed gratification.
Research shows that "Children with worse self-control (less persistence, more impulsivity and poor attention regulation) at ages 3-11 tend to have worse health, earn less, and commit more crimes 30 years later than those with better self-control as children." (Source: Zero to Five).
Have you ever heard of the marshmallow test?
The Marshmallow Test was a series of studies on delayed gratification in the late 1960s and early 1970s at Stanford University. In these studies, kids were offered a choice: get one reward right now or wait twenty minutes and get two rewards. The reward was often a pretzel, marshmallow or mint.
The single reward was placed on the table, while the researcher left the room for about 20 minutes. As each child sat alone in the room staring at their marshmallow, they had to decide to wait and get double the marshmallows or eat the single marshmallow without waiting.
In follow-up studies, the researchers found that children who were able to wait longer for the larger reward tended to have better life outcomes. This was measured by test scores, educational achievement, healthy weight in adulthood and more.
20+ ways to teach kids self-control or delayed gratification.
You need not do all these things all the time or make them an exclusive part of your everyday life. Pick what works well for your family and use it when it's best for your parenting style and kids' personalities. Here are a few ideas to get you started:
- Play red light, green light.
- Teach kids to save money for something bigger they really want.
- Create an end of the day reward if kids complete all their chores.
- Teach kids to wait for dinner, despite being hungry, rather than giving snacks close to mealtimes.
- Play games that require focus and attention like memory.
- Teach your child to wait at the end of the line instead of cutting in front.
- Play freeze tag.
- Teach your kids to put a toy they really want on their birthday or Christmas list rather than buying it right away.
- Help your child practice yoga or meditation (this could be as simple as asking them to take 5 deep breaths) where they must sit still for a certain period of time.
- Have a staring contest.
- Teach your child to wait for another child to finish using a toy before he can play with it.
- Play follow the leader.
- Play the quiet game where everyone needs to be as quiet as possible and the first person to talk or make noise is out.
- Have kids sit for story time to improve focusing skills.
- Complete a listening activity where your child must repeat back instructions to you.
- Have kids play alone for at least 30 minutes a day. This encourages kids to have enough self-control to problem solve with their toys and entertain themselves without outside support.
- Teach kids to wait to interrupt you using the interrupt rule: putting their hand on your shoulder or leg to let you know they need to interrupt you.
- Teach your children how to wait for a treat like a cookie or cupcake.
- Teach your kids to self-regulate emotions. If your child is fussing or protesting, allow your child the opportunity to calm themselves a bit before intervening.
- Praise for effort and encourage hard work to achieve goals, rather than doing the work for your kids.
- Teach your kids to help with chores around the house before earning the privilege to watch movies, play outside or do fun activities.
Delayed gratification (or self-control) is the single most important skill you can teach your child. This valuable skill not only translates into better behaved children (it really does!), but it also shapes them into fabulous adults and develops great listening skills which is all we can hope for our kids!
The post How to Teach Kids Self Control appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1RKBk9j
How to Teach Kids Self Control
Imagine you are cooking dinner and your child is starving. You tell him to wait, but he wines and cries and pouts. You are tired of listening to him, whine so you allow him to have a snack. Teaching kids self control is hard.
Or imagine you are at a store and your child sees a toy that he really, really, really wants more than anything in the whole world. You just want some peace while you shop, so you let him have the toy and agree to buy it at the end of the shopping trip.
Or imagine you child desperately wants to play at a friend’s house, but right now you are leaving as a family for a commitment or obligation. You child does not want to go with you. He wants to go to a friend’s house. Okay fine. You make a concession and allow him to go to the friend’s house instead.
But wait?
What if I told you holding your boundary firm and making your child wait was the single most important skill you can teach your child.
Teaching kids self-control or delayed gratification.
Research shows that “Children with worse self-control (less persistence, more impulsivity and poor attention regulation) at ages 3-11 tend to have worse health, earn less, and commit more crimes 30 years later than those with better self-control as children.” (Source: Zero to Five).
Have you ever heard of the marshmallow test?
The Marshmallow Test was a series of studies on delayed gratification in the late 1960s and early 1970s at Stanford University. In these studies, kids were offered a choice: get one reward right now or wait twenty minutes and get two rewards. The reward was often a pretzel, marshmallow or mint.
The single reward was placed on the table, while the researcher left the room for about 20 minutes. As each child sat alone in the room staring at their marshmallow, they had to decide to wait and get double the marshmallows or eat the single marshmallow without waiting.
In follow-up studies, the researchers found that children who were able to wait longer for the larger reward tended to have better life outcomes. This was measured by test scores, educational achievement, healthy weight in adulthood and more.
20+ ways to teach kids self-control or delayed gratification.
You need not do all these things all the time or make them an exclusive part of your everyday life. Pick what works well for your family and use it when it’s best for your parenting style and kids’ personalities. Here are a few ideas to get you started:
- Play red light, green light.
- Teach kids to save money for something bigger they really want.
- Create an end of the day reward if kids complete all their chores.
- Teach kids to wait for dinner, despite being hungry, rather than giving snacks close to mealtimes.
- Play games that require focus and attention like memory.
- Teach your child to wait at the end of the line instead of cutting in front.
- Play freeze tag.
- Teach your kids to put a toy they really want on their birthday or Christmas list rather than buying it right away.
- Help your child practice yoga or meditation (this could be as simple as asking them to take 5 deep breaths) where they must sit still for a certain period of time.
- Have a staring contest.
- Teach your child to wait for another child to finish using a toy before he can play with it.
- Play follow the leader.
- Play the quiet game where everyone needs to be as quiet as possible and the first person to talk or make noise is out.
- Have kids sit for story time to improve focusing skills.
- Complete a listening activity where your child must repeat back instructions to you.
- Have kids play alone for at least 30 minutes a day. This encourages kids to have enough self-control to problem solve with their toys and entertain themselves without outside support.
- Teach kids to wait to interrupt you using the interrupt rule: putting their hand on your shoulder or leg to let you know they need to interrupt you.
- Teach your children how to wait for a treat like a cookie or cupcake.
- Teach your kids to self-regulate emotions. If your child is fussing or protesting, allow your child the opportunity to calm themselves a bit before intervening.
- Praise for effort and encourage hard work to achieve goals, rather than doing the work for your kids.
- Teach your kids to help with chores around the house before earning the privilege to watch movies, play outside or do fun activities.
Delayed gratification (or self-control) is the single most important skill you can teach your child. This valuable skill not only translates into better behaved children (it really does!), but it also shapes them into fabulous adults and develops great listening skills which is all we can hope for our kids!
The post How to Teach Kids Self Control appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1RKBk9j
Slow Cooker BBQ Pulled Pork
You won’t believe how easy our Slow Cooker BBQ Pulled Pork is to make for your family on those busy days when you just don’t have enough time to cook!
Another favorite fix it and forget it meal around our home is our Lemon & Thyme Slow Cooker Chicken. Oh my goodness it’s amazing!
With just 5 minutes preparation time and your slow cooker doing all the work, your family is going to enjoy one delicious meal that they’ll be begging for seconds on. You will definitely want to add this recipe to your mealtime rotation.
Slow Cooker BBQ Pulled Pork
Ingredients
- 3-4 pound pork roast
- 1 cup water
- 1 1/2 to 2 cup your favorite bbq sauce
Directions
First sear the pork roast in a hot pan with a small amount of olive oil. This step is totally unnecessary, but it adds flavor to your final dish. Place whole roast into slow cooker and add 1 cup water. Cover and cook on LOW for 10-12 hours. Take roast out and shred with two forks OR a great tip is to let your stand mixer shred it for you. Add enough barbecue sauce to your liking and mix it all together. Serve bbq pulled pork on rolls with homemade or store-bought chips. And maybe a salad?
The post Slow Cooker BBQ Pulled Pork appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/23351r3
Slow Cooker BBQ Pulled Pork
You won't believe how easy our Slow Cooker BBQ Pulled Pork is to make for your family on those busy days when you just don't have enough time to cook!
Another favorite fix it and forget it meal around our home is our Lemon & Thyme Slow Cooker Chicken. Oh my goodness it's amazing!
With just 5 minutes preparation time and your slow cooker doing all the work, your family is going to enjoy one delicious meal that they'll be begging for seconds on. You will definitely want to add this recipe to your mealtime rotation.
Slow Cooker BBQ Pulled Pork
Ingredients
- 3-4 pound pork roast
- 1 cup water
- 1 1/2 to 2 cup your favorite bbq sauce
Directions
First sear the pork roast in a hot pan with a small amount of olive oil. This step is totally unnecessary, but it adds flavor to your final dish. Place whole roast into slow cooker and add 1 cup water. Cover and cook on LOW for 10-12 hours. Take roast out and shred with two forks OR a great tip is to let your stand mixer shred it for you. Add enough barbecue sauce to your liking and mix it all together. Serve bbq pulled pork on rolls with homemade or store-bought chips. And maybe a salad?
The post Slow Cooker BBQ Pulled Pork appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/23351r3
Narrative Matters: On Our Reading List
Editor’s note: “Narrative Matters: On Our Reading List” is a monthly roundup where we share some of the most compelling health care narratives driving the news and conversation in recent weeks.
Stunting The Growth Of Children With Disabilities
Parents of children with severe disabilities concerned about being able to physically care for their children as they grow up are finding hope in a treatment known as “growth-attenuation therapy,” but questions about the ethics of the therapy, and a lack of long-term outcomes data, mire the treatment in controversy.
In The New York Times Magazine, Genevieve Field tells the story of Ricky Preslar, a boy born with a form of cerebral palsy that caused permanent brain damage and visual impairment. Ricky’s parents knew the road ahead for him and the family would only grow more difficult as he grew larger and more difficult for his parents to lift and manage on their own.
Growth-attenuation therapy has been around since the 1940s, but its use on a child with a disability was pioneered by doctors at Seattle Children’s Hospital in 2006. The therapy involves doses of estrogen high enough to stimulate the premature closing of growth plates in young children’s bones, thus reducing height. In the 2006 case, doctors also removed the patient’s uterus and breast nodules. Some disability rights activists and other ethicists say the treatment constitutes “unnecessary bodily manipulation” and violates the rights of people with disabilities. According to a recent survey, at least 65 children with disabilities have undergone the procedure, though the figure is likely underreported.
“At its core, the battle over growth attenuation is a battle between old and new ways of thinking about disability: the old ‘medical model,’ which regards disabilities as a problem to be fixed, and the new, ‘social model,’ which frames disability as a natural facet of the human experience,” Field writes.
Cardiology In The Developing World
When Khameer K. Kidia was diagnosed with hypertrophic cardiomyopathy in medical school, his treatment plan was relatively straightforward: he met with a senior cardiologist, who sent his scans to an expert at Mayo Clinic; he made an appointment with an electrophysiologist on the same floor as the cardiologist; and when his surgery date arrived, he walked across the street from his dorm to the hospital and was implanted with an investigational implantable cardioverter-defibrillator designed for young people who wanted a more active lifestyle.
Three years earlier, Kidia’s father had not been so fortunate. Afflicted with a variation of the same disease, Kidia’s father died one morning in his primary care doctor’s office while he was waiting for the insurance company to authorize an emergency evacuation to South Africa. In a Perspective article in The New England Journal of Medicine, Kidia grapples with the inequities between his and his father’s care.
“The $40,000 subcutaneous ICD that rubs against my rib cage is a constant reminder of these inequalities — and my responsibility to become the kind of doctor who will work to reduce them,” he writes. Though cardiovascular disorders are the most common cause of death worldwide, and more than 80 percent of deaths due to cardiovascular disease occur in developing countries, traditional global health efforts and funding have focused on infectious diseases, such as HIV-AIDS and malaria, Kidia writes.
The Unanticipated Consequences Of Treating Autism
For 50 years, John Elder Robison made the best of his autism, but when he was offered the chance to participate in an experimental study on the use of transcranial magnetic stimulation to treat the condition, he signed up (as did his son, who was also on the autism spectrum). The results defied expectations, Robison explains on The New York Times’ Well Blog. The treatment allowed him to process emotions as he’d never been able to before, but this proved somewhat devastating initially.
“Before the T.M.S., I had fantasized that the emotional cues I was missing in my autism would bring me closer to people,” Robison writes. “The reality was very different. The signals I now picked up about what my fellow humans were feeling overwhelmed me.” Eventually Robison adjusted to his post-treatment state, but the changes led to the breakup of his first marriage. In the end, he and his son found the procedure transformative — including in ways they could never have anticipated.
A Serial Killer Of Women
Heart disease is the number one killer of women in the United States. Complicating the matter is the fact that many women don’t experience the telltale signs of a heart attack—chest pain, tightness, or pain in the arm or jaw—until it’s too late. In heart attack survivor Sue Palmer’s case, she says she felt “kind of funny” and threw up twice in the middle of the night.
Though she was ready to dismiss her illness as a virus of some sort, Palmer’s husband convinced her to go to the hospital because she might be having a heart attack. Indeed, it turned out that Palmer was in the midst of a major heart attack when she arrived at the hospital, and due to the quick efforts of her doctors to suction out the blood clot and stent her right coronary artery, she survived. “My lesson is this: don’t think it can’t happen to you,” she writes in an essay for The Washington Post.
Appendix Cancer Patients’ Last Resort
Treatment options for patients with appendix cancer are limited and most are told the condition is fatal. But a growing number of patient—and surgeons—have been willing to try an aggressive, high-risk surgery that consists of cytoreduction combined with heated intraperitoneal chemotherapy, or HIPEC.
STAT reporter Eric Boodman followed cancer patient Stephen Phillips for three months as he consulted medical teams, decided on a physician, and underwent the surgery. The procedure can take 16 hours, in which the surgeon feels out and removes every last tumor in the patient’s abdominal cavity, then pumps hot chemotherapy into the abdominal cavity and sloshes it around to take care of any remaining cancer. Though controversial (the research has yet to catch up with clinical practice) and risky (Phillips has been back to the ICU and operating room since the operation due to complications), the procedure certainly seems to offer hope to those with few other options.
In Case You Missed It
In the March Narrative Matters essay, Carolyn Dickens, Denise Weitzel, and Stephen Brown, write about a patient with complex medical and social needs who returns to the hospital again and again, despite his care team’s best efforts to reduce readmissions.
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