Virtual assistant service for health care: five tips for success


Virtual Assistant jobs are considered a crème service to help entrepreneurs and professionals in expanding their business on minimum possible cost. This is actually an online version of years old personal secretary service.

Today, in the technologically developed scenario, personal assistant service is not only limited to that old concept of completion of administrative tasks, instead today it has become much more extensive. These online personal assistants are not only able to conclude your administrative assignments but also handle many of your professional needs, such as, preparation of powerpoint presentation, content preparation, blog marketing , appointment scheduling, travel itinerary planning, email support service etc.

But while deciding to hire a medical virtual assistant service, be focused on a few essentials. These are the crucial tips to help you in outsourcing virtual assistant needs and getting good services.

  • First consider generic but important questions which would help you in getting the best virtual assistant service provider. These questions are – Does the virtual assistant service provider possess the skill set which you require to get your important tasks done? Has your Virtual assistant ever done the similar task earlier?
  • Now think about your needs and consider questions, What is your actual needs and is it wise to outsource those needs to the Virtual Assistant Service provider
  • Now conduct a simple R & D. This will be helpful in your endeavor to get a good online personal assistance service provider. You can check for the work-reviews of your secretary service provider. This will assist you in knowing all the shortcomings of your virtual assistant service provider. Hence, you would be able to make a better decision on your selection of virtual assistant service provider.
  • While outsourcing your secretarial needs to a virtual assistant service provider, you must figure out on advance basis which services you want your VA to do and how many hours she will be working for you. It is also intelligent to decide upon rates and other details prior to hiring a Virtual Assistant. Such sincerity would not let any money issue rise its head; thus, preventing you from all the mind bogging issues.
  • Communicate daily with your virtual assistant service provider. This would help your visitors in staying updated with all of your requirements and you in getting every detail of your assignment.



Want a medical virtual assistant for your health care services company? Find out what to look for!


Many online business owners have watched the popularity of social media sites grow by leaps and bounds in a very short period of time. They have also come to the realization that these social media sites would be a wonderful way to do some small business marketing of their business. The problem that most online business owners encounter is the fact that they do not have the time to consistently focus their marketing energy on these particular sites. A way to combat this issue is to hire a Virtual Assistant. Better even yet, hire a Social Media Virtual Assistant. This is a Virtual Assistant who is well versed in social media sites and how to market on them.


Sounds easy enough right? Actually there are a few tips and suggestions to take into consideration when hiring a Social Media Virtual Assistant. Remember you are not just hiring a Virtual Assistant, you are hiring a Virtual Assistant who “specializes” in social media. When locating one of these VA’s you will want to inquire about their experience. Ask what social media accounts do they utilize on a regular basis, how many followers/friends they have, if they have ever managed a business account before, and their ideas for promoting your business on these sites.


Usually dependent upon the answers to these particular questions, you will be able to decipher if they do in fact know how to implement social media management correctly.


Once you choose a Social Media Virtual Assistant it is important that you check up on her, especially in the beginning. Once you feel comfortable and are starting to see the traffic on your website rise, you can let her manage on her own. Just make sure that you are content with her performance from the very beginning. You do not want to find out when it is too late. If the situation is not working out, you can then continue to look for a VA who fits the bill. Many VA’s can “claim” to specialize in Social Media marketing, but the proof is in the results. Period.


Contact Golean Health for more information about working with a dedicated medical virtual assistant.



Causes of Hypertension


A blood pressure of 140/90 or higher is considered high blood pressure. Both numbers are important. If one or both numbers are usually high, you have high blood pressure. If you are being treated for high blood pressure, you still have high blood pressure even if you have repeated readings in the normal range.



About 90% to 95% of hypertension cases, called primary, or essential hypertension, have no known cause. Primary hypertension may be influenced by factors such as genetic makeup, weight, or salt intake. Research is underway to learn more about the role that genes play in hypertension, as well as to explore the association between hypertension and factors such as obesity, low birth weight, and low levels of nitric oxide. Nitric oxide is a molecule that affects the smooth muscle cells that line blood vessels. People with low levels of nitric oxide have been found to have high blood pressure; especially African-Americans with low levels of the molecule.


Family Ties to PPHStudies show that at least 15 to 20% of patients with primary pulmonary hypertension have an inherited form of the disease. It is unclear whether it is a sporadic gene defect in these families.


Two main types of hypertension are recognized. By far the most common is Essential Hypertension, sometimes called Primary Hypertension. This is hypertension in which there is no identifiable cause. Ninety five percent of all persons living with hypertension have essential hypertension. Although researchers have been unable to pinpoint its specific causes, several risk factors definitely increase an individual’s chance of developing essential hypertension.


Changes in the arteries can complicate the problem. Normally the arteries are rather springy; in addition to expanding and contracting in rhythm with the heart, they adjust themselves to the volume of the blood and to other conditions within the body, stretching or tightening up as necessary to raise, lower, or maintain blood pressure. Various factors — stress, for instance — as well as diet, heredity, lifestyle, and aging, have a detrimental effect on the arteries. They become less elastic and thus less able to adjust to changes in the body; and they tend to become coated with arterial cholesterol plaque, a fatty deposit that clogs them, just as deposits in your house’s pipes can cause your sink to back up.


In most people, the causes of hypertension (also known as high blood pressure) are not known. This type of high blood pressure is called primary, or essential, hypertension. In some people, the cause of hypertension is the result of another medical problem or medication. When the causes of hypertension are known, the condition is referred to as secondary hypertension.


Approximately 30% of cases of essential hypertension are attributable to genetic factors. For example, in the United States, the incidence of high blood pressure is greater among African Americans than among Caucasians or Asians. Also, in individuals who have one or two parents with hypertension, high blood pressure is twice as common as in the general population. Rarely, certain unusual genetic disorders affecting the hormones of the adrenal glands may lead to hypertension.

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Pulmonary Hypertension Symptoms


What are the symptoms of pulmonary hypertension? Here is what you must see for differentiating it from other diseases of pulmonary and cardiac origin.What should be the symptoms that I will have to look for? Though the early symptoms of the disorder are non-specific they may develop over time. These are the most important symptoms that are commonly present if you are a pulmonary hypertension patient:* shortness of breath, * Dyspnea* fatigue * non-productive cough * angina pectoris * fainting or syncope* peripheral edema (swelling around the ankles and feet).


There may be hemoptysis (coughing up blood) in some cases but that is very are rare.Although these symptoms are indicative of a major problem, these develop gradually over time thus delaying the patients to see the physician. Some people may delay it so much that they will not go to the doctor for years. This will further deteriorate your health and makes your recovery very much difficult.There are even some differences in the symptoms of pulmonary hypertension that arises in the arteries and veins of the pulmonary vasculature. If it is of the venous origin it will make you short of breath while you are lying flat (orthopnea) or sleeping (paroxysmal nocturnal dyspnea), while in the pulmonary arterial hypertension (PAH) it typically does not have such symptoms.What signs will a physician check in pulmonary hypertension? As long as the physician is regarded, he might have to check some significant signs in your arsenal.


For this he will have to perform a physical exam on you thus to look out for typical signs of this disease such as:* a loud P2 (pulmonic valve closure sound)* (Para)sternal heave * jugular venous distension* pedal edema * ascites* hepatojugular reflex* clubbing * tricuspid insufficiencyWhat is the significance of these signs for the physician?These signs are of the cardiovascular origin and therefore are of utmost importance for the physician to scrutinize the disease.


There is usually an increased pulmonic component of the second heart sound which indicates paradoxic or splitting that is present is severe right ventricular dysfunction. Here the second heart sound may be palpable in many instances to the physician.In many a cases there might be regurgitation of the pulmonic origin also called as Graham Steell murmur.Most of the times a murmur of tricuspid regurgitation can well be present, while a right ventricular lift (heave) may also be noted.In cases of volume overload or right ventricular failure, or even when both co exists there is an elevated Jugular venous pulsations.


Here we often see Large V waves due to severe tricuspid regurgitation.Hepatomegaly is often always present with palpable pulsations of the liver along with an abnormal abdominal-jugular reflex. Ascites (abdominal swelling due to the accumulation of fluid) are present in untreated patients or in patients with worsening decompensated right heart failure.Pitting edema with varying degrees may be present while if you are bedridden you are likely to developExtremity examination may reveal pitting edema of varying degrees.


Patients who are bedridden may have presacral edema.On examination of the lungs the findings are usually normal for the general population.Now you must keep in mind that these are the signs that help the physicians to diagnose your disease. For further diagnosis and confirmation of pulmonary hypertension, the physicians may also require more important and specific tests.


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Dementia and Delirium



The term ‘organic mental disorder/syndrome’ in psychiatry is used when there is a ‘disease of the body’ which present with psychiatric symptoms. In contrast, ‘functional mental disorders’ are considered to be ‘disease of the mind’. Classifying psychiatric disorders in this way is becoming outdated now that more is known about the ‘organic’ basis of functional illnesses, such as abnormal brain structure in schizophrenia. However, the term organic is still commonly used in clinical practice and communication and is included in the ICD 10.

In the next section we will focus on two ‘organic disorders’ which effect cognitive function. Other organic disorders for example:

Organic hallucinosis Organic delusional disorders Organic mood disorders Organic anxiety disorders will not be mentioned here, as they present almost similar to their ‘functional’ counterpart.


Delirium and Dementia:

In both delirium and dementia, there is a generalized impairment of brain function which causes global impairment in cognitive function and altered mood and behaviour. The difference between the two is that delirium is an acute syndrome characterized by fluctuating levels of consciousness and attention whereas dementia is a chronic syndrome which occurs in clear consciousness without rapid fluctuations. Both conditions are more common in older people, but the diagnoses need to be considered in any patient who presents with a generalized impairment of brain function.


  1. Delirium:

Delirium is more likely to occur in children, the elderly and individuals with brain insult when the brain ‘vulnerable’. People with dementia are particularly at risk and so it is always important to rule out superimposed delirium if the cognitive function of people with dementia deteriorates acutely. Another high risk group are people admitted to medical ward-studies have found 15-50% evidence of delirium.

The features of delirium will be summarized and contrasted with typical symptoms of dementia in a table below.


Management of delirium:

The primary goal is to investigate and treat the underlying cause. Some causes of delirium are:

Medications and drugs: Anticholinergic, anticonvulsant, anxiolytic, digoxin, corticosteroids, Alcohol , solvents, illicit drugs Infection Endocrine: hypoglycemia, hyperparathyroidism, Addison’s disease, thyroid disease. Metabolic: electrolyte imbalance, hypoxia, organ failure, vitamins deficiency (esp. thiamine), prophyria. Neurological: infection such as encephalitis or meningitis, raised intracranial pressure, space occupying lesions, head injury, epilepsy.

While trying to find the primary underlying cause, it will be necessary to manage the patient symptomatically.

Ø The patient should be nursed in a well lit room by as few people as possible, in order to reduce confusion. Ø Sedation with low doses of antipsychotic drugs may be required (prescriber should have knowledge about the prescribed medication( its side effect, its metabolism, half-life, dosage etc) Ø Orient the patient by gently calming them down and use cues to indicate time of day (window, clock). Avoid excessive ‘reminders’ if this cause patient’s distress.

  1. Dementia:

Dementia is a chronic usually progressive generalized impairment of the brain function. The risk increase with age: 5% >65 and 20% >80

Typical symptoms of dementia include:

Memory (amnesia): is virtually always affected, with short term-memory and memory for recent events being lost first. Memory of events from the distant past is usually preserved until the very late stages of the illness. Orientation in time and place: are lost relatively early in the illness which may result in the person becoming lost and wandering aimlessly. In the later stages of the illness, orientation in person may be lost with the person not recognizing familiar people or themselves. Praxis: the ability to coordinate complex motor function is affected. The person may not be able to perform acts on command but still perform spontaneously., or may be unable to carry out a sequence of tasks despite being able to perform each task individually. Language function (Dysphasia): is impaired, initially with finding words(nominal dysphasia or anomia), progressing to difficulties generating speech (expressive dysphasia), comprehending speech (receptive dysphasia) or combination of the two (mixed dysphasia). Abstract thinking and judgment: are impaired, leaving the person unable to deal with problems or unfamiliar situations. Personality changes: are common, often involving a coarsening of pre-existing personality traits. Social behaviour: deteriorates, often becoming shallow or inappropriate. Mood changes: are common with depression irritability and anxiety all occurring in some cases

The above are just some of the symptoms and the presentation will depend largely on the cause and type of dementia. It is important to attempt to establish the type of dementia as this will influence treatment and prognosis. The four commonest causes are:

Alzheimer’s disease, Vascular dementia, Mixed dementia (usually vascular & Alzheimer’s) and Lewy body dementia

Other causes and types:

Degenerative: Parkinson’s dementia, Huntington’s dementia, Pick’s disease, Normal pressure hydrocephalus Infections: Creutzfeld-Jacob Disease (CJD), HIV, Neurosyphilis, cerebral abscess, UTI Space-occupying lesions: tumors, subdural hematoma Traumatic: severe head injury, boxing Endocrine: hypothyroidism, Cushing’s disease, hypopituitarism Metabolic: anemia, hypoxia, organ failure Toxic: heavy metals (lead, mercury, iron), chronic alcohol abuse (alcohol dementia), medication with anticholinergic propensity. Autoimmune: SLE, sarcoidosis.

The above list (like in delirium) is short and by no means extensive as the causes are many and the above are only a short examples ( think common sense: any insult to the brain can cause you to have any number of psychiatric symptoms be it dementia, psychosis, depression or any other)

Management of dementia:

Ø History & mental state examination: as the patient with dementia is often unable to give a full account of their problems, an informant presence is important. Scales such as the Mini-Mental State Examination (MMSE) are useful screening tests and quick to administer. Much detailed scales and psychological testing may be needed to confirm or establish the diagnosis. Ø Physical examination & investigations: are important to establish cause and therefore treatment (reversible or irreversible). Ø Medications: the current drugs can be divided into two groups. First the drugs which increase acetylcholine (Aricept, Galantamine). The second group is the works through receptors affecting GABA (Memantine). Both groups are licensed for Alzheimer’s, but in practice are worth trying in the most of the dementias. The clinical effect appears after months and monitoring done by history taking and MMSE score. Antidepressants may be useful, as well as antipsychotic (but due to anticholinergic side effect, they showed be used by a person aware of their advantages and disadvantages). Ø Psychological & social treatment: simple behavioural techniques such as prompts can be useful for mild memory impairments. Revalidation and reminiscent therapy also could be tried. Social support especially for carer is extremely important and is one of the major management targets

Features of delirium and dementia (comparison):

In the next table a simplified approach comparing delirium vs. dementia (remember that the two can co-exist esp. in the elderly)





Acute, usually within hours or days

Gradual, usually within months

Diurnal variation

Yes, usually worse at night

Maybe worse at night


Days or weeks, usually less than 6 month

Months or years


Drowsy or hypervigilant



Usually poor

Usually maintained


Disoriented in time, often place and person

Disorientation usually in time then place, in person much later

Instant recall


Usually intact until late


Impaired STM & LTM

Impaired STM, LTM much later


Muddled, confused

Reduced, slow



Less common


Common usually visual

Only in later stages


Reversal of sleep-wake cycle


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The Insurance Coach


“Success is not something you pursue. Success is something you attract.” (Jim Rohn)

Part 3 of the five principles of Dynamic Leadership acknowledges that as leaders, we lead by example – whether we want to or not! It also highlights the importance of having high Personal Integrity. Let’s spend some time discussing each of these issues and their implications.

LEADERSHIP BY EXAMPLE All leadership is leadership by example. Both prospects and policyholders will make note of how you act. To be dynamic, a leader must practice self-discipline, be a perpetual student, become efficient, prioritize tasks well, determine materiality, and practice delayed gratification.

Self-Discipline: It’s rare that a person’s responsibilities consist only of tasks that are enjoyable. Inevitably, we must do what’s necessary in order to accomplish our goals – whether fun or not. Being in alignment with one’s values and purpose makes it much easier to overcome procrastination and focus on the matters at hand that will best propel you towards the achievement of your goals. Ask yourself, “Which pain is greater? The pain of working on the uninteresting, the repetitive, the uncomfortable? or The pain of not achieving your goals and dreams?”

Perpetual Learning: We live in the information age. Developments seem to occur at an ever increasing pace. The leaders that embrace knowledge win. Period. Work on your personal development. Read every day. It’s often been said that leaders are readers. Learn new success principles, develop new perspectives, and gain new insights into yourself. Read. Listen to tapes. Lead the pack.

Efficiency: Working hard is sometimes called for. Working smart is always called for. Working smart is a key to finding a balance between work and life. When the mind has an opportunity to rest, it regains its creativity. That’s why vacations were introduced. Haven’t you ever struggled with the solution to a problem, only to give up, go to bed, and have the answer come to you just as you’re dozing off? Frequently, working harder is not the best way to make progress. In fact, we sometimes find that we’re pushing ahead in the wrong direction. People look to you for insight, vision, and energy. When you’re efficient with the tasks at hand, you create opportunities to become innovative, creative, gain insight, clarify your vision, and recharge.

Prioritization: I often find that using to-do lists is a great way to stay on track and get things accomplished. A problem can arise because often an easily completed task is relatively unimportant. If we don’t have a clear picture of what’s important, we can spend the good part of our day “crossing off”, and find ourselves at the end of the day with a short list consisting of the most important items. Of course by that time, we’re a little too tired to give those tasks the attention they deserve. So… we postpone them until the next day. Work on the things that matter most when you’re sharpest. Get the meaningful things out of the way first.

Materiality: The concept of materiality is related to prioritizing, but has other implications as well. Ever find yourself focusing on things that don’t really make a difference, maybe because you just find them easier to do? Dynamic leaders work on the things that matter most. Learn to discern what’s important/urgent and what a task that can be delegated is. Becoming clear on what matters most allows you to delegate effectively – assigning tasks to the resources that can best get the job done. Even if you can do it better, does it matter?

Delayed Gratification: Goal-setting is a powerful mechanism for achieving meaningful success. A properly stated goal is stated in positive terms, in the present tense, is measurable (you can tell when you’ve achieved it), and has a deadline. Rewarding yourself for a job well done is important, but don’t reward yourself until you’ve either reached your goal or reached a milestone on your way there. Don’t get distracted by rewarding yourself prematurely. A well earned reward is much sweeter than one that’s ill-gotten. Set the example. Accomplish what you set out to do. Then reward yourself for a job well-done. People admire those who show self-discipline.

HIGH PERSONAL INTEGRITY Personal Integrity goes beyond being honest. That’s a given… In many ways, practicing personal integrity ties together many of the keys we’ve already discussed. It reflects an understanding of leadership by example and demonstrates our appreciation of the eight universal wants/needs of others (Sense of Accomplishment, Sense of Belonging, Sense of Empowerment, Respect, Recognition, Direction, Sense of Significance, and Sense of Purpose).

Personal integrity can be summed up as “Do What You Say You’re Going To Do.” Be a person that others can depend on. Create a sense of trust. Set the example as a leader.

When you tell someone you’ll take care of something (a task, project, issue, thing), you do – every time, at work or at home
When you say you’ll be somewhere, you are. And you’re on time, regardless of whether the other people are or not
When someone leaves you a voice- or e-mail message, you return it – every time, every person (my only exception is a solicitor who doesn’t ask for a call back)
When someone helps you solve a problem or develops a new, better method, you give them the credit – every time
When you’ve caused a problem, or allowed a problem to arise, you take responsibility for it – every time, at work or at home

In my experience, the leaders I’ve worked with who are strong and looked up to, always seem to act this way. Neither their position nor busy schedule will keep them from living in integrity. I’ve had phone calls returned from the busiest, most well-known business leaders in the state.

As you go through the upcoming weeks, be mindful of old habits that don’t reflect the person you want to be or want to be known as. Work to change the habits that don’t support the direction you want to move in. Understand that every time we interact with others, we send a message – good or bad. Strive to send the right message. Avoid a message sent by default – that is, one without intent. This coming week, make an effort to return all phone calls and emails, and notice the impact it makes on others. Use your own experience as your best example. Aren’t you a bit surprised (and pleased) when someone actually returns your voicemail message? Be that kind of person. Make a positive impact on those around you as many successful entrepreneurs and keynote speakers like Richard Jadick and others do.

By taking Personal Responsibility for your actions, you increase your “attractiveness” and cause the people around you to think of you more often.

Leadership & Money Making – A Delicate Balancing Act


Little value comes out of the belief that people will respond progressively better by treating them progressively worse.- Eric Harvey

Recently, I received correspondence from a young attorney friend of mine who was just given notice by his employer that “it is not a good fit” for his current firm.  This attorney had only been at the firm for a short time (9 weeks). He had been given positive feedback by his “mentor” and had no negative comments. Then without notice he was called into the conference room to be told that he was not needed.

I was particularly troubled by this handling of my friend. What was this firm doing? Was he not productive? If so, shouldn’t they have told him that he was not productive?

I did some investigating by calling some of the associates at the firm that I knew.  It turns out that this particular firm had also gotten rid of three other attorneys in similar fashion in the past year.  All of the young associates are particularly aware of this treatment and are on the edge at all times because of it. It causes them to dart in and out of each other’s offices secretly meeting to whisper about the latest happenings in the office.

The morale is low among those that are not the “Chosen Ones”.  A few of them even admitted that they are constantly on the look for other employment in case they are called in for such a meeting.  None of them have families but a few are married. They get to work by 8 am and leave no earlier than 6 pm because they are afraid of being seen leaving the office.          

 The firm has been wildly successful since its inception just six short years ago and has grown from a firm of 7 to approximately 35 in that short time. But at what cost?  Money and success have come for the partners while the associates have been tapped out. It reminded me of the building of the pyramids. The Pharaohs sat back and reaped the glory while the men pulled the large blocks into position.

The problems that this firm has created for itself are enormous. Each employee knows deep down that it is every man or woman for him/herself. There is no loyalty.  They are only loyal to the dollar and to the clients because the clients might be secretly lured away from the firm in the event that the attorney decides to leave and start their own firm.

According to Ken Blanchard, “Poor leadership doesn’t just hold employees back from reaching their full potential, but actually sends them in the wrong direction and seriously impacts morale, employee retention and financial performance.”

This firm needs to get a handle on their employee morale. Having company picnics once a year is not the answer.  The mentor-mentee process broke down for this firm. Kudos to them for having such a process but apparently the partners in the firm didn’t give the mentor the input he or she needed to correct any problems with the associate. If they had, they might find that the actions could be corrected and most of all, the whispering among the other associates would be about how they really worked with that person and gave them a chance.

According to professional communication coach Christine Zust, this firm needs to understand the value of the Golden Rule and open communication in building a successful enterprise. This company may be enjoying financial success today, but if it continues its current practice of hiring and then firing people with no warning or justification, the firm will quickly establish a bad reputation in the community. Soon it will be difficult for the firm to find top talent because the word on the street will be “stay away from them.” There goes the firm’s growth strategy! Zust recommends that every firm, large or small, complete a core values assessment and review those values each year. Often times, companies and organizations that have the greatest problems are those whose actions are not aligned with their core values. For instance, if a firm says it values “education” but will not allow staff members to attend valuable professional development programs, the firm is living out of alignment with its core values. It is important, Zust says, for companies to identify core values and share them with employees so they can understand from the beginning of their employment what the firm values most. If the company’s values are not shared during the first interview, the interviewee should ask the interviewer what the company’s core values are. If a prospective employee clearly knows what the firm’s values are before s/he accepts the position, it makes the decision much easier of whether or not to work for that firm. 

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Health bill impacts on seniors


Some good and bad benefits for seniors

The massive health care bill President Obama signed March 23, 2010 will affect nearly all American families. The 2,407-page bill and its 153-page package of corrections, likely to gain final Senate approval soon, has something for just about everyone. Seniors will not be missed. Several items of impact for this group are good news, some bad, according to USA Today.

Medicare recipients gain drug coverage

AARP, the nation’s largest seniors watchdog organization, says most of their senior followers should benefit from a number of provisions. Some simple, some complex and some for the wealthy, some for the poor.

Seniors will gain additional prescription-drug coverage, closing the coverage gap on the notorious “doughnut hole,” the Medicare Part D out-of-pocket costs provisions. Created in the original program in 2006, seniors whose total drug costs reach $2,830 now must pay for all their drugs until they have spent $4,550. A provision in the new law will close that cost gap, and prevents them from having to pay thousands for these deductible costs.

The bill provides that seniors who reach the established coverage gap will now be eligible for a one-time, $250 rebate with future considerations too. Beginning 2011, brand-name drug prices are to be discounted 50% during their coverage gap time period. Each year until 2020, the drug discount will increase, finally reaching 75% of the cost.

Other seniors good benefits

Additional benefits for seniors are spelled out in the bill. Free preventive services such as cancer screenings, funding for all states to increase and improve community services for people with disabilities, and upping children’s age on policies. For those seniors who have children and insurance policies including them, the children will be able to remain on parents’ policies until they reach the age of 26.

Also, poor adult seniors will get Medicaid and Low-income senior families will receive federal subsidies to buy insurance. This will be a welcome assistance to those that decided or were thrust into to helping raise families in their later years.

Some senior bad benefits

On the other hand, those seniors who have Medicare Advantage plans — those select private plans combining hospital, physician and drug coverage — could watch premiums increase or have benefits diminished. The new law reduces Medicare payments to those plans and approximately 23% of all Medicare beneficiaries have those plans.

Also, seniors who still work or live off of investment income will see their capital gains taxes increase to help pay for the bill. Beginning in 2013,for the first time, the Medicare payroll tax will be applied to income from investment. The new 3.8 percent tax will impact seniors’ interest, dividends, capital gains and other investment income for those individuals earning more than $200,000 a year and couples making more than $250,000.

Medicare wage payroll taxes will increase for working seniors. The new health bill also would increase the Medicare payroll tax by a 0.9 percentage point to 2.35 percent, on wages above $200,000 for individuals and $250,000 for married couples filing jointly.

The new tax on investment income is higher than the 2.9 percent tax proposed by President Obama. “House Democratic leaders increased it so they could reduce the impact of a new tax on high-cost health insurance plans strongly opposed by labor unions. The 40 percent tax on health benefits would be delayed until 2018 and would apply only to premiums exceeding $10,200 a year for individuals and $27,500 for families,” according to FOX news.

Seniors of all ages, retired and those still working, will be impacted by the new health care bill, both good and bad. Only time will tell what the total costs to the country will be for them their children, and their grandchildren.

Climate Change Solutions Affect Public Health


How Reducing Greenhouse/Carbon Emissions can Improve Our Health

Recently, 192 countries met in Copenhagen in an effort to reduce greenhouse gas emissions and avert the adverse effects of climate change. Such effects include: species loss, disruption of ecosystems, population displacement, damaged livelihoods, altered agricultural productivity and economic imbalance on regional and local levels. Health professionals may be burdened with the fallout from increased frequency and intensity of heat waves, reduction in cold-related deaths, increased floods and droughts, changes of distribution in vector-borne diseases, changes in the risk of disasters and malnutrition. Logically then, mitigation strategies to reduce emissions should also have benefits on global public health. Unfortunately, these benefits have not received significant attention in international negotiations. This article intends to give a concise overview on the connection of several strategies with public health and to strengthen the case for mitigation.

Low Carbon Power Generation

A term that describes the use of zero carbon sources like wind, solar and geothermal, low carbon sources such as nuclear and natural gas, as well as carbon-limiting innovations such as carbon capture and storage.

If emissions are reduced, it is predicted that there would be a reduction in particulate air pollution and consequently, mortality. The largest effect would be in India, where particulate air pollution is the greatest, and the smallest in the EU, where electricity production from fossil fuels is quite clean. Studies predict significant reductions in mortality from acute lower respiratory tract infections (ALRI), chronic obstructive pulmonary disease (COPD), and ischemic heart disease (IHD). Costs of implementing low emission electricity production would be substantially offset by reduced pollution-related mortality, especially in China and India.

Efficient Household Energy

Residential energy use makes up a large part of our carbon emissions. High per head emissions countries like the UK and low per head emissions countries like India require different approaches. In the UK, focus would be on changes to insulation, ventilation control, fuel use, and occupant behaviors, whereas in India, where stoves are used for everything, a national program to introduce 150 million low-emission cookstoves would be appropriate.

Household energy interventions have greater potential to improve public health in low-income settings. If India’s cookstove program were completed, 87% of households would have clean combustion leading to less particulate air pollution and a reduction in mortality from ALRI, COPD and IHD. Benefits for ALRI’s in children would be immediate on introduction of the stoves whereas the benefits for IHD and COPD would only be seen later.

Alternative Urban Transport

Transport accounts for a quarter of global CO2 emissions and three quarters of that is from road traffic. Strategies include introduction of low-emission motor vehicles, increasing active transport (walking, cycling etc) and the creation of safe urban environments that facilitate active transport.

Lower-emission motor vehicles would reduce the health burden from urban outdoor air pollution, but a reduction in the distance travelled by motor vehicles could have a greater effect. Increase in the distances walked and cycled would lead to large health benefits. Largest gains would be from reductions in the prevalence of IHD, cerebrovascular disease (CVD), depression, dementia, and diabetes.

Reduced Livestock Production and Consumption

The agriculture sector contributes 10—12% of total greenhouse-gas emissions worldwide. Four fifths of these emissions come from livestock. A combination of technological improvements and reduction in production of foods from animal sources could provide an effective contribution to meet targets to reduce emissions.

A reduction in the intake of saturated fat from animal sources could lead to a reduction in IHD and CVD.


Efforts to mitigate climate change and reduce emissions can also have benefits towards public health. With low carbon power generation, more efficient household energy, alternative urban transport and a reduction in livestock production, reductions in the incidences of common diseases such as ischemic heart disease and chronic obstructive pulmonary disease are possible.

Nurses Take Top Honor Again


Nurses Have Lost Top Rank Only Once
Since 1999, when the nursing profession was added to the poll, nurses have ranked number one every year but one. That was 2001 when firefighters deservedly took the title in the poll which was held shortly after September 11.

Nurses play a key role in the health care team. It is essential for patients, caregivers and loved ones to trust nurses. Patient education is a major role for nurses and the success of patients outcomes depends on this level of trust. The fact that nurses continue to rank highest on this list year after year is a testament to the nursing profession.

The Nursing Shortage
Nursing is one of the most rewarding professions and yet it can be one of the most challenging both physically and emotionally. As the Baby Boom generation ages and begins to retire, a large portion of today’s nursing workforce will be lost. It is not being replaced at a pace necessary to keep up with this projected loss as well as the increasing need of an aging population.

It is important for young people to recognize the nursing profession as a career option and seriously consider a career in the nursing profession. This accolade helps to reinforce the opportunities and the recognition that nurses need and deserve.

Other Health Care Team Members
Other members of the health care field to be ranked fairly high were pharmacists (or druggists) who came in with a combined 70% of “high” or “very high” scores and medical doctors who had a combined “very high” and “high” score of 64%.

Bankers Take a Hit
The banking industry took a big hit in the poll this year with a 12 percent decline from 2007. Bankers fell from 35 to 23%. Given the state of the economy, this is not surprising. In 1988 during the savings and loan crisis, banker fell from 38% down to 26%. This is the first time bankers have fallen below 30% since 1996.

High school teachers ranked with a combined score of 65%; policemen and clergy each with 56%. Funeral directors scored 47%. On the lower end, journalists scored 25%, bankers 23%, building contractors came in at 22% and real estate agents at 17%. At the bottom of the list were telemarketers and lobbyists who scored in the “low” ranking from 60% and 64% of those polled respectively.