Inflammatory Bowel Disease Is As Canadian As The Mounties

24 — Canadians from coast to coast are remarkably prone to inflammatory bowel disease, possibly the result of a climate that discourages bacterial activity and promotes sterile conditions in childhood. About 0.5% of Canadians have inflammatory bowel disease, which means ulcerative colitis and Crohn’s disease together strike about one in 350 persons, according to a study published in the July issue of the American Journal of Gastroenterology. “Canada has the highest incidence and prevalence of Crohn’s disease yet reported,” wrote Charles N. Bernstein, M.D., of the University of Manitoba here, and colleagues. The researchers found that ulcerative colitis, the inflammatory bowel disease that affects only the large intestine, strikes an average of 194 of every 100,000 Canadians, with 11.8 new cases per 100,000 each year. Crohn’s disease, which affects the large and small intestines, is even more common in Canada and affects about 234 per 100,000 people, with an incidence of 13.4 per 100,000 each year. By comparison, ulcerative colitis prevalence is 58 to 157 per 100,000 in Northern Europe and about 167 per 100,000 for an area of Minnesota. Crohn’s disease prevalence ranges from 27 to 48 per 100,000 in Northern Europe to 144 per 100,000 in an area of Minnesota. Some Third World nations and areas in tropical latitudes have still lower rates. Although the reasons for these differences remain unclear, the hygiene hypothesis may help explain the distribution in Canada, said Richard Fedorak, M.D., of the University of Alberta in Edmonton, a co-author. “If you live in an environment that’s too clean or too sterile as a child your intestines are not exposed to bacteria of the same types and numbers you would be exposed to in a tropical area,” he said. which is especially true for Canada because much of the country has cold winters with little bacterial activity in the soil. Then if the genetic triggers are present, “your intestine is not able to tolerate bacteria as you get older and starts to destroy itself,” he added. Supporting this speculation, the researchers discovered differences among provinces: Nova Scotia in the Maritimes consistently had the highest rates of ulcerative colitis (19.2 incidence and 247.9 prevalence per 100,000) and Crohn’s disease (20.2 incidence and 318.5 per 100,000), Following closely is Alberta, with ulcerative colitis incidence of 11.0 and prevalence of 185.0 per 100,000 and Crohn’s disease incidence of 16.5 and prevalence of 283.0 per 100,000, and Manitoba had likewise high rates of ulcerative colitis (15.4 incidence and 248.6 prevalence per 100,000) and Crohn’s disease (15.4 incidence and 271.4 prevalence per 100,000); Whereas British Columbia, on the west coast, consistently had much lower rates of both ulcerative colitis (9.9 incidence and 162.1 prevalence per 100,000) and Crohn’s disease (8.8 incidence and 160.7 prevalence per 100,000). British Columbia proved to be an outlier, particularly for Crohn’s disease perhaps because of its milder winters, more precipitation, and “because its population ethnic make-up is somewhat different from the rest of Canada,” the researchers wrote. Much of British Columbia’s immigration in the past 20 years has been from Asia, they said.

check this site out

Cronkhite-Canada syndrome associated with rib fractures: a case report

A and B, Jejunum; C and D, Ileum. Figure 3. Endoscopic views. Colonoscopy identified numerous, hyperemic, sessile and pedunculated polyps in the colorectum. A, Descending Colon; B, Transverse Colon. Two months later, he was admitted to our hospital for the second time with frequent diarrhea (7-8 times per day) and a weight loss of 7 kg. Laboratory data showed that his serum albumin level was 28.2 g/L and serum calcium 1.7 mmol/L. His chest radiograph showed fractures of the left sixth and seventh ribs (Figure 4 ). Since the patient had not suffered from any load or trauma in the chest, this concomitant complication initially led us to presume that there was a possibility of rib metastasis of a malignant tumor. Emission Computed Tomography (ECT) was performed and it showed no increased tracer uptake in the skeletal system. Bone densitometry tests on vertebrae lumbales and caput femoris were normal. Further examination for checking bone metastasis was not performed because of the patient’s financial situation, and his examinations and clinical features indicated no definite malignant tumor. Since his nutritional status was poor and he had no complain of pain in chest, orthopedic surgeons and chest surgeons advised us to supply calcium and nutrition for him and to restrict his chest wall movement. After one-month treatment, which was similar to our previous treatment except for the corticosteroid therapy, his clinical condition markedly improved again. His serum albumin level increased to 35.2 g/L and calcium to 1.9 mmol/L. However, the rib fractures persisted.

go to this web-site

Australian Soccer Hit By Match-fixing Scandal

Related Content URGENT – UNGA-Rouhani-Sanctions Nine people were arrested on Sunday, and six of them were charged in court Monday, including the coach of Victorian Premier League team Southern Stars, a group of his players and a Malaysian national. Five of those involved were British players who had been reportedly been offered to the Melbourne-based club at the start of the season on a non-payment basis. The Australian Football Federation (FFA) website said the arrests were made after it received data on suspicious betting patterns involving the Southern Stars in August, which it passed on to Victorian state police. “Integrity measures put in place by football have been effective in detecting this activity,” FFA chief David Gallop told reporters Sunday. “From the FFA’s point of view we’ll initiate proceedings under our own codes of conduct. You can be sure that we will throw the book at them. “That means life bans on a worldwide basis.” Police said more than $2 million had been bet on the team, which is bottom of its division — a second-tier competition below the national A-League. Gerry Gsubramanian, 45, is accused of being the contact man for overseas betting syndicates who organized with the players the outcomes of matches. “He receives phone calls. He is given advice on how the Southern Stars players are to perform,” Detective acting senior sergeant Scott Poynder told the court, according to the Australian Associated Press. “Video showed some of the players were doing some unusually poor play. For that work he received payment. Some of the bets are in the hundreds of thousands of dollars.” Gallop said he had been told by police it was considered an “isolated issue.” “This highlights the fact that lower league games, which aren’t under the scrutiny of things like a global television broadcast, are potentially more susceptible to this kind of activity,” Gallop said. “At this stage the police have indicated to us that they are looking at an isolated issue in Victoria and we need to be guided by the police in that regard.” The controversy adds to a difficult year for Australian sport, which has been rocked by the drug scandals involving leading Australian Football League team Essendon as well as the country’s rugby league competition. “This was flagged earlier this year by the Australian Crime Commission that there were links with organized crime, trafficking of performance-enhancing drugs and match-fixing,” journalist Jim Wilson of the Seven Network told CNN’s World Sport.

visit the site

Foreign Doctors’ Training Stepped Up, Says Gmc

UK doctors encouraged to gain overseas experience

Yet they make up only 36% of doctors on the medical register. The GMC said new reforms included an induction programme, better checks and a review of the present testing system. Niall Dickson, chief executive of the GMC, said: “We absolutely acknowledge that when it comes to the serious end of the scale, those from overseas are more likely to appear, and we have set about a series of reforms to address this.” A new induction programme for all arriving doctors is due to launch as a pilot scheme in early 2013. It will combine online training in British medical practices with a one-day course covering some of the key issues facing new arrivals. Continue reading the main story Start Quote The UK is still short of doctors and so we must ensure that those who come from overseas are given adequate support End Quote Dr Vivienne Nathanson BMA There will also be a review of the Performance and Linguistic Assessments Board (PLAB) test for overseas doctors. This is the system whereby doctors have to demonstrate their clinical skills and competence before they can join the medical register in the UK. The GMC said there is also a new system of checks – known as revalidation – that began this month. This requires all doctors in the UK to show they are keeping up to date and are fit to practise, based on an annual appraisal and feedback from patients, doctors, nurses and other colleagues. The UK is the first country in the world to introduce such a system across its whole healthcare system, the GMC said in a statement. The figures for disciplinary action were initially obtained in a Freedom of Information request to the GMC by the Sunday Telegraph . They show that in the last five years, there have been 669 doctors either struck off or suspended, and 420 of them were trained abroad.

cool training

David Gray

The BMA has published updated guidance called Broadening your Horizons which says that it is more important than ever before for doctors and trainees to gain international experience. UK doctors who work within overseas health systems for a time can gain highly useful experience that will benefit the NHS, other clinicians and developing countries, argues the BMA. The guidance is designed to support UK doctors at all stages of their careers who are considering working or training in developing countries and rejects concerns that time working abroad can damage a doctors career prospects. It also helps employers and medical educators in the NHS to assist those who choose to undertake work abroad. The guidance says gaining experience overseas can be mutually beneficial by: supporting health improvements in developing countries providing opportunities to share skills, knowledge and experience equipping doctors to adapt to a changing NHS and deal with a diverse range of diseases in the UK helping trainees to identify career paths for the rest of their professional lives. As well as giving a detailed account of the application process, the guidance also includes personal accounts from doctors working internationally an advice on expenses and employment entitlements whilst on placement; how to find a placement; how to secure time out from training or employment; and revalidation requirements. Dr Mark Porter, chair of BMA Council, said: The opportunity to work in developing countries has long been valued by doctors at all stages of their careers, and with an increasingly diverse patient population in the UK those experiences are more important than ever. We know that working in developing countries can benefit a doctors career as well as the NHS, but many doctors believe time out will have a negative impact on their professional development, and often trainees think overseas working isnt an option for them. This guidance has been produced to show that opportunities to work internationally exist, support those wanting to work overseas, and to address concerns raised by our members. Working in a developing country should be seen as positive career move, not a negative one and we hope that our guidance will help doctors, trainers and employers to facilitate opportunities for UK doctors to work or volunteer in developing countries.

look at this

Your Career As A Medical Coding Specialist

Medical specialists overcharging – study

Medical procedures also have a specified set of numerical designations that describe the exact procedure performed. Also read Medical Billing and Coding Job Opportunities Martha R. Gore Medical coders usually work in hospitals or doctors offices; however, some may have their own business. They work in clean, well-lighted surroundings. Usually they work 40-hour weeks but some overtime may be required. In hospitals, they may work day, evening, or night shifts if the billing department operates 24 hours per day. There is little to no contact with patients. Salary and Job Outlook The salary range for a medical coder ranges from a high of $58,488 to a low of $33,777 with $43,995 being the average. The job outlook is expected to be better than average through 2016 with faster than average growth at a projected increase of 18 percent. Government regulations regarding health information and billing will ensure that there are plenty of job opportunities available. There will also be the need to replace workers leaving the work force due to retirement. Medical Coding Programs and Colleges Certified medical coders are trained in anatomy, physiology, and medical terminology. They must understand the etiology, pathology, signs, symptoms, and disease processes. Coders may receive an associates or bachelors degree at one of over 200 colleges and universities across the country. Many more institutions offer a coding certificate program.

go to website

The Job of Certified Medical Coders

As a result of this incentive to overcharge, medical schemes are reluctant to pay out for the benefits resulting in increasing complaints from members. The registrar of the Council for Medical Schemes, Monwabisi Gantsho, said that, last year, more complaints were received about the manner in which medical schemes and administrators pay for benefits than in any other complaint category. Of a total 5 915 complaints received by the registrarCMS, 2 411 related to benefits. Of these, 846 complaints related to instances where medical schemes incorrectly funded the benefits claims at their respective scheme rates and not in full. Unfortunately, this results in members having to foot the outstanding balance of the bill. According to the medical schemes act, your medical scheme must legally cover: Your benefit conditions in full, as per the invoice submitted by the healthcare provider. Your scheme is not allowed to use your personal medical savings account to pay for benefit conditions. The diagnosis, treatment, and care of roughly 300 serious and costly health conditions fall under benefits, including 270 diseases such as tuberculosis and cancer; and 25 chronic conditions including asthma, epilepsy and hypertension. Your scheme is entitled to nominate a designated service provider such as a doctor, pharmacy or hospital as the first-choice provider when you need treatment or care for the benefits condition. If you choose to use a nondesignated service provider and it is not an emergency situation, you may have to pay a portion of the bill. If you have a condition that is classified as a benefit, most schemes require you to register for a benefit before they will start reimbursing you as per the benefits requirements. Schemes avoid payments Gantsho notes that medical schemes are not dealing with benefits in a uniform manner and different complaints bear testament to this: Some schemes have deliberately programmed their systems to fund members benefits accounts at scheme rates and then pay the balance only after the council investigates a complaint. Other complaints related to instances where schemes underpaid claims or made no payment owing to the fact that members did not use the services of the designated service providers of the scheme, whether voluntarily or involuntarily. Some members did not qualify for benefits as their treatment did not form part of treatment protocols, but some protocols were contravening the (act) in that they were not evidence-based. This means members had been offered an incomplete package, he said.

these details

Greedy medical specialists refuse to treat most children with serious health problems if they have public insurance

It almost sounds like the specialists are inflicting a kind of punishment on kids who have the “wrong” kind of public insurance that doesn’t pay the doctors as much in reimbursements as private insurance. Sick kids with Medicaid or CHIP had to wait over a month, about 44 days, for help. But privately-insured children with similar urgent conditions were seen in less than three weeks. For the study, research assistants compiled facts by working undercover — they posed as moms of children with seven common medical that affect large numbers of children and are serious enough to need timely specialty care: severe body rashes, obstructed breathing during sleep, Type 1 diabetes, uncontrolled asthma, severe depression, new onset seizures and a fracture that could affect bone growth. The researchers, pretending to be mothers, placed calls to a random sample of 273 clinics representing eight medical specialties in Cook County, Pennsylvania. Each of the investigators placed two calls, separated by one month, to each clinic using a script that varied only by insurance status. Only 34 percent of callers with Medicaid-insured children were told they could even get an appointment with the specialist. But if the researchers-posing-as-moms claimed they were calling about a child with Blue Cross Blue Shield PPO insurance, 89 percent were given appointments. It was obvious that how the doctor was going to get paid — whether by higher paying private insurance or by lesser paying public insurance — was of far more importance to the specialists’ offices than the severity of the child’s reported symptoms. What’s the evidence for this? In more 50 percent of calls to clinics, the caller was first asked for the child’s specific type of insurance coverage before being told whether an appointment could be scheduled with the doctor. In fact, in 52 percent of the time, the type of insurance coverage was the very first question asked. The University of Pennsylvania researchers who carried out the study noted in a press statement that previous studies have found that reimbursement amounts are the main reason doctors decide whether or not to treat patients with public insurance. But the authors of the new study think the health systems in which the doctors work may play the biggest role of all — because medical centers may have incentives that encourage doctors to avoid patients who don’t have the higher paying private insurance. This has created policies based on making the most money rather than policies based on what’s best for seriously ill kids.

see it here

Mo Health Report Aims To Answer Your Questions About Health Care Changes

In addition to stories written by our staff, we have partnered with Kaiser Health News, a leading independent source of reporting on health-related issues, and four other news organizations to broaden and deepen our coverage. Others in the Kaiser consortium are the Miami Herald, Seattle Times, Philadelphia Inquirer and the Texas Tribune. This site will regularly feature news about how the new program is affecting health care providers and consumers in the St. Louis region, the political fallout from the new law and news and analysis from authoritative sources across the country about the impact of the law. We welcome your feedback and questions. Staffing the site are: Virginia Young, Jefferson City bureau chief. She is covering the politics of health care, including the new exchanges and Medicaid funding. Her blog, “Capitol Perspectives,” appears at Contact her at Jim Doyle, business of health care reporter. His continuing series “Health Care: Changes and Choices” has probed a wide range of issues, including the strength of rural hospitals, executive compensation, and health industry consolidation. Contact him at Blythe Bernhard, medical and health reporter. Her reporting examines, among other subjects, the quality of care.

click for more

Lee health clinic to open next month

14, 2013, at 9:55 a.m. LEE, Maine With construction almost complete, Health Access Network will likely move into its new $500,000 Lee-area health clinic by mid-October, officials say. Builders were installing a walk-in ramp, overhead lighting and flooring to a building that Nichols Construction Co. LLC Superintendent Terry Sullivan said was about 90 percent built. Were looking at completing it on Oct. 15, Sullivan said Thursday. We are really just doing a lot of finishing work at this point. The building site is on Route 168, which is also known as Winn Road, opposite the campus administrative office and adjacent to the Lee town office, where a temporary clinic has been operating for more than a year. A physician assistant, mental health therapist, hygienist and school receptionist will staff the building when it is complete, school officials have said. Besides Lee Academy students and staff , residents from Lee, Winn, Springfield anyone who uses the Health Access offices in Lincoln can be treated in the clinic. Health Access Network is a federally funded community health center located on West Broadway in Lincoln which handles 13,000 patients or 50,000 visits annually. It also has a satellite site in Enfield. Announced originally in June 2012 and set for completion in September 2012, the clinics construction was delayed when RSU 67 officials , who were sharing the federal Department of Health and Human Services grant that was to pay for construction, dropped out of the deal in October. Cabinets, finished ceilings, and some electrical wiring remain to be installed. Landscaping and parking-lot paving will be done next week, Sullivan said. Health Access Network Chief Executive Officer Bill Diggins could not be reached for comment on Friday.

related site

Majority Of Doctors Do Not Follow Treatment Guidelines For Adhd

Why the discrepancy? For one, say the authors, behavior management and counseling strategies are not always easily accessible to many families. And if they are available, in some cases they may be financially out of reach if insurers dont cover services provided by professionals in the local community. However, Adesman says when his investigators asked the doctors whether their decision to prescribe medication for first-line treatment was influenced by the availability of behavior therapy for their patients, he did not find evidence of a trend. So as much as I would like to think that doctors are prescribing medicine first line because behavior therapy is not available, that does not seem to be the case, he says. (MORE: Can Anesthesia Raise the Risk of ADHD? ) Its also possible that doctors are turning to medication because the long-term commitment that repeated behavioral-therapy sessions require may be onerous for parents. Adesman says clinicians may also be paying attention to some studies in school-age children that have shown that medicine can be more effective than behavioral therapy. Yet he argues this still does not justify its use in preschoolers. There is an important distinction, and that is that even if medication has been shown to be more effective in the short term than behavior therapy in school-age children, medication does not work quite as well or consistently in preschool kids. So a head-to-head comparison in school-age children may not necessarily be appropriate to extrapolate down to the preschool kids, he says.

this link

Franciscan Alliance acquires Medical Specialists

Alexander Stemer said he will remain president of what will now be called Franciscan Medical Specialists. The group’s employees will remain, and they will maintain all of their benefits, Stemer said. Aside from the new name, patients will not notice much change. The offices will maintain the same services. “There will be no apparent difference from the standpoint of the patient,” Stemer said. Gene Diamond, CEO of Franciscan Alliances Northern Indiana Region, said the physicians group is a good match for Franciscan. We’ve been chatting with these folks for years, he said. The reason we have persisted is because Alex (Stemer) himself and, obviously, the group he has led have established a pretty obvious excellent reputation for high quality. Given Alex’s abilities and his vision, it was pretty clear to us that this would be a good match. Stemer said Franciscan Medical Specialists will serve as a specialty arm in the northern region, recruiting and placing university-qualified physicians where they are most in need. The land beneath our feet in health care is shifting, he said. We’ll be looking for physicians looking to join larger organizations. Aside from his role as president, Stemer will work in strategic planning in the northern region. Diamond said Stemer already is beginning to work with Franciscan on its accountable care organization in the northern region. Medical Specialists was established in 1978 and has 12 locations in Lake, Porter and LaPorte counties. Its team consists of 55 physicians and surgeons, 11 nurse practitioners and two physician assistants. Franciscan Medical Specialist locations include Munster, Dyer, Hammond, Hobart, LaPorte, Merrillville, Michigan City, Schererville and Valparaiso. Franciscan Medical Specialists will honor the Franciscan mission statement, values and the ethical and religious directives for Catholic health care facilities, Diamond said.


Why International Medical Students Deserve A Place In Australian Hospitals

By 2025, it is predicted there will be 7.2 million international students studying globally. A recent British Council survey of 153,000 international students confirmed opportunities for migration exert an extraordinary impact on the choice of study destination. While students sought a high quality, internationally recognised education, the scope to remain and work was found to massively impact both decisions and expectations. In 1999, following the removal of a three-year eligibility bar , international students became immediately eligible to migrate to Australia. Within six years of the policy change, 52% of skilled migrants were selected onshore. International medical students have funded their own studies to meet Australian requirements. PhotoDu de CreativeDomainPhotography com By 2010, 630,000 international students were enrolled in Australian courses (all fields and sectors). Of these, 18,487 were undertaking health degrees, including over 3,000 medical and 10,000 nursing students. International medical student graduates grew 223% from 1999 to 2009, compared with 52% growth in Australian domestic graduates. International medical students In 2009, the majority of international medical students were enrolled at Monash, Melbourne, Queensland, New South Wales and Sydney universities. Their source countries were highly diverse most notably Malaysia (1,134 students), Singapore (577), Canada (437), the United States (84) and Botswana (74), followed by South Korea, Brunei, Hong Kong, Indonesia and Sri Lanka. These international students achieve stellar rates of immediate employment and are highly attractive to local employers. As demonstrated by yet-to-be-published research conducted for the Medical Deans of Australia, 45% of international students plan to remain in Australia when they commence their studies. By their final year, 78% accept intern places (virtually all those who are not scholarship students sponsored by their home governments). Australias Graduate Destination Survey from 2009-2011 reveals their employment outcomes to be near identical to those achieved by domestic students (99.6% working full-time at four months compared with 99.7%). The source country was almost irrelevant, with 100% of Canadian, US, Malaysian, Indonesian, Taiwanese, Norwegian and Botswanan students fully employed, compared with 97% from Singapore and 89% from China.

look these up

Australian government launches telehealth initiative

As part of Prime Minister Julia Gillards $620 million telehealth initiative, the Australian government is funding video hook-ups between medical specialists and patients. The nations Medicare program is offering 50-percent bonuses to specialists who adopt telehealth technology and 35-percent bonuses to doctors, nurses and midwives who participate in video consults with patients. The initiative which Gillard had promised to enact during her election campaign last year has the backing of the Rural Doctors Association of Australia (RDAA), which said it has real potential to improve access to specialists for rural and remote Australians. Currently many rural patients are forced to travel hundreds and even thousands of kilometers for specialist consultations, given the significant shortage of specialists in rural and regional Australia RDAA Vice President Peter Rischbieth told reporters. These patients face significant travel and accommodation costs, and long periods of time away from work, in getting to and from these consultations, which can be required at regular intervals for many conditions. But while offering incentives to providers to implement the technology and rebates to physicians, nurses and midwives for their time spent in consultations, the real question remains: Will providers see enough of a benefit to continue offering telehealth services after the government support dries up? As part of her National Digital Economy Strategy, Gillard is pushing for roughly 500,000 telehealth consultations per year within four years a process expected to be made easier as the nation moves to adopt a National Broadband Network. “The NBN should provide us high availability, high speed connections, which will allow us to conduct both video consultations, look at images such as radiology images and also, with high definition cameras, be able to see high definition images the same as watching a high definition television,” said Nathan Pinskier, a general practitioner in Melbourne who serves as the e-health spokesman for the Royal Australian College of General Practitioners. ‘Tyranny of distance’ While Pinskier was speaking to an Australian television station on Thursday, Gillard, in Darwin in the northern part of the country, and Health Minister Nicola Roxon, far to the south in Adelaide, were demonstrating a telemedicine consult to reporters and film crews. The interviews were part of a flurry of television, print and web news stories released to promote todays launch of the initiative. “I think the change is probably going to be an incremental one but, over time as we understand the utility of telehealth and how it fits into practice, it will make some substantial differences, particularly for patients and consumers in rural and remote locations, where they suffer the tyranny of distance,” Pinskier said. According to the RACGP, 96 percent of the nations doctors use computers for some clinical purpose. To that end, the organization urged its members not to rush out and buy telehealth equipment until it can complete an implementation guide. The group is also working on a set of telehealth standards for its members, which it expects to complete in October. We encourage all GPs to wait for guidance from the College before purchasing equipment or engaging in contractual arrangements with providers, said Mike Civil, chairman of the RACGPs Telehealth Standards Taskforce, in a statement issued last week. The RACGP is currently reviewing the different technologies and connection options to provide a choice from a range of vendor equipment as a means of ensuring interoperability between them. While the Australian Medical Association offered support for the initiative, Vice President Geoffrey Dobb said the organization is concerned that, once the four-year project runs its course and the federal funding concludes, providers will find it too expensive to keep it up or theyll pass the extra costs on to their patients.

official statement