mn healthcare news mar 2016

March 2016 Volume 14 Number 3

Epidemic Gun Violence

Gary Slutkin, MD

Antidepressants By Lee Beecher, MD

Atrial FibrillationBy Lin Yee Chen, MD, MS

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MARCH 2016 MINNESOTA HEALTH CARE NEWS 3

4 NEWS

7 PEOPLE

8 PERSPECTIVE A new ecosystem for health Creating a shared vision

10 10 QUESTIONS Expanding access to care

12 PUBLIC HEALTH Americas gun violence epidemic Applying a medical

model of control By Gary Slutkin, MD

14 CARDIOLOGY Atrial brillation Irregular heartbeats take a toll

By Lin Yee Chen, MD, MS

16 PEDIATRICS Childhood obesity Assessing risks and prevention

By Jessica Larson, MD, and Claudia Fox, MD, MPH

18 CALENDAR

20 SENIOR CARE Adult day programs Looking at a well-kept secret

By Barb Zeis

22 DENTAL HEALTH Implants A permanent solution to missing teeth

By Matthew Karban, DMD, MD, and Paul Thai, DDS

26 ONCOLOGY Colon cancer Preventable, treatable, and survivable

By Avina Singh, MD

28 BEHAVIORAL HEALTH Antidepressants Treating the whole patient By Lee Beecher, MD,

DLFAPA, FASAM

MARCH 2016 VOLUME 14 NUMBER 3

Douglas L. Wood, MD, FACP, FACCCenter for Innovation at Mayo Clinic

Jane Anderson, APRN, CNP, DNPDirector, M Health Nurse Practitioners Clinic

Minnesota Heath Care News is published once a month by Minnesota Physician Publishing, Inc. Our address is 2812 East 26th Street, Minneapolis, MN 55406; phone 612.728.8600; fax 612.728.8601; email [email protected]. We welcome the submission of manuscripts and letters for possible publication. All views and opinions expressed by authors of published articles are solely those of the authors and do not necessarily represent or express the views of Minnesota Physician Publishing, Inc., or this publication. The contents herein are believed accurate but are not intended to replace medical, legal, tax, business, or other professional advice and counsel. No part of this publication may be reprinted or reproduced without written permission of the publisher. Annual subscriptions (12 copies) are $36.00/ Individual copies are $4.00.

CONTENTS

PUBLISHER Mike Starnes | [email protected]

EDITOR Lisa McGowan | [email protected]

ASSOCIATE EDITOR Richard Ericson | [email protected]

ART DIRECTOR Joe Pfahl | [email protected]

OFFICE ADMINISTRATOR Amanda Marlow | [email protected]

ACCOUNT EXECUTIVE Stacey Bush | [email protected]

Medical Innovation vs.

Medical EconomicsMedical EcconomicsWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWhhhhhhhhhhhhhheeeeeeeeeeeeeeeeennnnnnnnnnnnnnnnnnnnnn ppppppppppppppppppppppppppppaaaaaaaaaaaaaaaaaaaaaaaaaaayyyyyyyyyyyyyyyyyyyyyymmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmeeeeeeeeeeeeeeeeennnnnnnnnnnnttttttttttttt pppppppppppppppppppppppoooooopppppppppppppppooooopppppppppppppppppppppppppoooooooooollllllliiiiiiiiiccccccccccccciiiiiiiiieeeeeeeeeeeeeeeeeeesssssssssssssssssssssss WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWhhhhhhhhhhhhhhhhhhhhhhhheeeeeeeeeeeeeennnnnnnnnnnnnnnnnnnnnn ppppppppppppppppppppaaaaaaaaaaaaaaaaaaaaaaayyyyyyyyyyyyyyyyyyyyymmmmmmmmmmmmmmmmmmmmmmmmmmmeeeeeeeeeeeeeeeeeennnnnnnnnnnntttttttttttttttt ppppppppppppppppppppoooooooooooolllllllllllllllllliiiiiiiiiiiiiiiiiiiiiii iiiiooooooollllllliiiiiiiiiii iiiiooooooolllllllliiiiiiiiiiiiiiiccccccccccciiiiiiiiiiieeeeeeeeeesssssssssssssssspppppppppppppppppppp yyyyyyyyyyyyyyyyyyyyyypppppppppppppppppppaaaaaaaaaaaaayyyyyyyyyyyyyymmmmmmmmmmmmmmmeeeeeeee pppppp

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Background and Focus: The pace of innovation in medical science is rapidly Th f i ti i di l i i idlescalating. From more accurate diagnostic equipment, to the use of genomicdata, to better surgical techniques and medical devices, to new and more efcacious pharmaceuticals, breakthroughs occur nearly every day. These advances face many challenges when incorporated into medical practice.Several signicant factors limit this adoption, including the economic models around how patient use of new science will be utilized. Twentieth century health insurance, medical risk management, and reimbursement models are controlling 21st century medical care and patients are the losers.

Objectives: We will review examples of recent scientic advances and the difculties they face when becoming part of best medical practice, despite their clear superiority over existing norms. We will look at prevailing thinking behind economic models that govern how health care is paid for today. Our panel of industry experts will explore potential solutions to these problems. We will look at ways to create balance between payment models, new technology, and increased quality of life.

Panelists include: Hamid R. Abbasi, MD, PhD, FACS, FAANS

Board Certied Neurosurgeon, Tristate Brain and Spine Institute Susan McClernon, PhD

Faculty Director, U of M Health Services Management ProgramSponsors include: Tristate Brain and Spine Institute

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MINNESOTA HEALTH CARE ROUNDTABLE

4 Minnesota HealtH care news March 2016

News

Essentia Health Using Technology to Remotely Monitor Heart Healthessentia Health Fargo has started using implanted miniature, wireless monitoring sensors to help manage heart failure in patients. it is the first in the region to use the cardioMeMs HF system.

the system measures pressure in the artery using a sensor that is im-planted in the pulmonary artery in a non-surgical procedure. increased pulmonary artery pressures occur before weight and blood pressure changes, and are often considered as indirect measures of worsening heart failure. Patients transmit daily sensor readings to their health care providers from their homes, allowing providers to easily track the data and adjust treatment if needed to reduce the likelihood of hospitalization.

this is something that is going to be very beneficial in patients who have heart failure, said samantha

Kapphahn, interventional cardiolo-gist at essentia Health. For patients who have been hospitalized in the last year, this can decrease their risk of being readmitted, help with med-ication changes, and overall improve their quality of life.

Minnesota Makes Progress on Some Adverse Health Eventsthere were a total of 316 adverse health events reported to the Minne-sota Department of Health (MDH) from october 2014 to october 2015, according to the departments 12th annual adverse Health events re-port. that number is up slightly from last years report, which showed 308 reported adverse health events.

of the 316 reported events, 30 percent (93 cases) resulted in serious injury and about 5 percent (13 cases) led to death. Both statistics were similar to last years report, which included 98 serious injuries and 13 deaths. the number of deaths asso-ciated with adverse health events has

stayed steady over the last four years.

the most frequently reported adverse health events were pres-sure ulcers (104), falls associated with serious injury or death (67), and surgeries/invasive procedures performed on the wrong site/body part (29). there was an increase in procedures done at the wrong spine level in this years report.

the type of event most likely to lead to serious patient harm or death was falls, with four of the 67 cases leading to death. Medication errors accounted for 14 cases (four of which led to death) and neonatal events accounted for seven cases (five of which led to death). overall, in the 12 years the report has been published, the most common causes of serious harm or death have been falls, medication errors, and suicide/attempted suicide.

improvements were made in the categories of falls and surgical errors related to a failure to remove all materials involved in the operation. the number of falls associated with serious injury or death declined to

67, the lowest ever reported, and the number of fall-related deaths is the lowest it has been since 2011. those related to retained foreign objects from surgery declined to 22, also the lowest ever reported and a sig-nificant decrease from the previous years 33 cases.

although even one avoidable death or injury is too many, this years report shows the progress we are making, especially in preventing falls, said ed ehlinger, MD, Min-nesota commissioner of health. our approach of openness and public reporting is helping to encourage overall improvements and new op-portunities to protect patients.

MDH and its partners will work to improve these statistics in 2016 by focusing on addressing prenatal safety; working with surgery and procedural teams to address full and accurate completion of the Minne-sota time out process for every pa-tient every time; and implementing standardized processes for specimen collection and transport to prevent biological specimen loss or damage.

Study Finds Rural Obstetric Units Closinga study from the University of Minnesota school of Public Health shows that obstetric units in rural hospitals are closing because of staffing difficulties, low birth vol-ume, and financial burdens.

researchers analyzed hospital discharge data from between 2010 and 2014 and conducted interviews to identify factors that contributed to the closing of obstetric units at rural hospitals. they found that 7.2 per-cent of the hospitals had closed their obstetric units. the units that closed were within hospitals that were typically small and located in com-munities with reduced resources such as lower family incomes and fewer obstetricians and family physicians.

the decline of obstetric units interferes with the goals set by the Patient Protection and affordable care act concerning timely access to quality care for women, says Peiyin Hung, doctoral student and lead author of the study. rural women in these communities need to travel an average of 29 miles and up to 65 milesfor intrapartum care.

researchers found that women living in low-income communities and places where there were fewer obstetric providers were more likely to terminate their obstetric services.

the continued decreases in the number of family physicians being trained and choosing to provide obstetric care may put obstetric services in rural communities in danger, said Hung. appropriate regionalization of maternity care needs to be implemented, partic-ularly in rural communities with greater risk of obstetric service discontinuation.

according to Hung, future poli-cy changes could help rural hospi-tals keep their obstetric units open. currently, the improving access to Maternity care act is under revision. this act aims to identify maternity care workforce shortage areas and it may help in monitoring and preparing for potential obstetric unit closures based on local perina-tal needs, said Hung.

in addition, the study showed that more than half of pregnant women in rural areas are covered by Medicaid, which means the program plays a substantial role in the future of rural hospitals obstetric units.

Future studies should examine the effects of obstetric unit closures on local womens maternity care accessibility, childbirth costs, and maternal/neonatal outcomes, espe-cially among women in rural areas where obstetric resources are very limited, said Hung.

EMTs Using New Technology to Determine Childrens Medication Dosagenorth Memorial has begun us-ing new software to help its first responders determine appropriate medication dosages for children.

the system, made by Handtevy, helps get medication to children faster by quickly calculating precise dosages based on size and weight. emergency medical technicians and paramedics use the system on electronic tablets, which allow them to make dosage adjustments quickly while in the field.

Previously, emergency respond-ers used paper materials to calculate proper dosages. north Memorial is the first ambulance service in Min-nesota to use the new technology.

Fortunately we dont get kids who are extremely sick very often, but when we do they need help very fast, said John lyng, MD, med-ical director for north Memorial ambulance and air care. any type of condition for a child that you can think of we are able to treat more effectively now.

north Memorial is using about 300 tablets with the new technolo-gyone for each ambulance and a helicopter. the health care system hopes to implement it into north Memorial Medical centers emer-gency room in the future.

March 2016 Minnesota HealtH care news 5

News to page 6

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HCMC Richfield Clinic to Move, Double in SizeHcMc has announced its richfield clinic at the Hub shopping center will move to a location two blocks away at Market Plaza in richfield. the new clinic location will be twice the size it is now.

the current location has served our patients well for 20 years, but weve simply outgrown the physical space, said scott wordelman, vice president of ambulatory care at HcMc.

the new clinic will have a full-service pharmacy, offer extend-ed hours and saturday appoint-ments, and offer free parking.

as we add new community and neighborhood locations, like Golden Valley and st. anthony Village where we opened clinics in recent years, we also want to improve our existing clinics where we have a loyal patient base and we are doing that in richfield, said wordelman.

the Market Plaza location gives us flexibility to respond to the health care needs of the community while providing room to do even more, like expand our Health care Home program.

Fairview Health Opens Sleep Center in BurnsvilleFairview Health services has opened a new sleep center on the Fairview ridges Hospital campus in Burnsville.

the center offers treatment for disorders such as sleep apnea, insomnia, narcolepsy, snoring, and sleep walking, which can affect overall health and contribute to problems such as weight gain, diabe-tes, mood disturbances, and higher mortality rates. the center offers home sleep studies and virtual care for certain sleep conditions to make it more convenient for patients.

in simple terms, our brain will not work well without sleep and

our body needs the restoration sleep provides, said conrad iber, MD, medical director of the Fairview sleep Program. our happiness, safety, critical thinking, and phys-ical health all depend on regular, uninterrupted, and adequate daily dose of sleep.

with the new location, sleep specialists now offer consultations and studies at five Fairview Health locations in the metro area. More than 3,500 patients visited the sleep centers last year.

HCMC Tests Bikes as Winter Emergency Disaster Response ToolsHennepin county Medical center (HcMc) partnered with the 2016 winter cycling congress three-day conference to test whether bicycles could assist during winter disasters.

on the morning of Feb. 3, 20 to 30 participating bicyclists rode across an area encompassing 30

miles of checkpoints along the Minneapolis bikeway system and neighborhood streets. the situation simulated a power outage over a widespread area with gridlocked traffic that prevented emergency ve-hicles from reaching disaster scenes. Bicyclists completed assignments meant to test the effectiveness of using bikes to respond to emergency situations under winter conditions, such as moving supplies, where they were asked to haul a 40 pound sandbag, or just clock their speed in reaching a destination.

they may be asked to deliver supplies to a specific location or complete other tasks as assigned, said John Hick, MD, medical direc-tor for emergency preparedness at HcMc. should there be a disaster that affects traffic or infrastructure downtown, having bicycles navigate alternative routes could prove to be an essential resource to perform emergency response activities.

similar simulations have taken place at previous cycling congress events, but this is the first time one has taken place in winter.

6 Minnesota HealtH care news March 2016

News from page 5

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UCare for SeniorsSM lets you choose from plans that cover prescription drugs, travel, eyewear, dental, fi tness programs like Healthways SilverSneakers Fitness and more. There are low or no co-pays for primary care visits with most plans. And youll get to talk to a real person 24/7 when you call customer service. Its just what youd expect from health care that starts with you.

Learn more about the benefi ts of UCare for Seniors in our new eGuide to Medicare at ucareplans.org. Or call (toll free) 1-877-523-1518 (TTY) 1-800-688-2534, 8 a.m. to 8 p.m. daily.

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Nancy Rost, MD, board-certied specialist in pediatrics, has joined Afliated Community Medical Centers (ACMC)Willmar. She earned her medical degree from the University of New Mexico School of Medicine and completed her residency in general pediatrics at Mayo Clinic. Most recently, Rost worked at Childrens Hospital of Aurora in Denver, Colorado. Ryan Lussenden, MD, general and bariatric surgeon, has also joined ACMCWillmar. Lussenden earned his medical degree from Albany Medical College in New York. He completed his general surgery residencies at Mayo Clinic and Santa Barbara Cottage Hospital in California and a bariatrics fellowship at Lahey Clinic in Burlington, MA. Most recently, Lussenden worked at Florida Medical Center in Sunrise, FL. In his position at ACMC, Lussenden will also provide outreach to the clinic in Benson.

Sounally Lehnhoff, CRNA, certied registered nurse anesthetist at Northwest Anesthesia, has received the quarterly Minnesota Hospital Associa-tions Good Catch for Patient Safety award. She was recognized for taking action during a preoperative timeout when she noted that the patients blood bank band had the wrong patient name and did not match the patients identication band. Surgery was delayed an hour so a new blood type test and cross-match could be conducted. Lehnhoff earned her master of nurse anesthesia degree at Mayo School of Health Sciences.

Elizabeth Moorhead, MD, hospitalist physi-cian, has joined Hennepin County Medical Center. Moorhead cares exclusively for hospitalized patients and works with primary care providers to ensure a smooth transition for the patient as they move from the hospital to their home. She earned her medical degree at the University of Minnesota and complet-ed a residency in internal medicine at the University of Illinois in Chicago.

Sister Mary Madonna Ashton, of the Sisters of St. Joseph, has been named a 2016 National Wom-ens History Month honoree by the National Wom-ens History Project. She served as president and CEO of St. Marys Hospital in Minneapolis (now owned by Fairview) for 20 years before becoming the rst woman, nun, and non-physician to serve as Minnesota Commissioner of Health from 1983 to 1991. In her role as commissioner, she made prog-

ress addressing smoking cessation and AIDS prevention in Minneso-ta. After her term, she founded St. Marys Health Clinics for people without access to heath care, run by volunteer physicians and nurses. She opened the rst clinic in 1992 and that grew to 11 clinics by the time she retired in 2000. Sister Mary Madonna earned her master of social work from St. Louis University and a master of hospital administration from the University of Minnesota. At age 92, she is the oldest living recipient and the second sister to be honored since the project launched in 1980.

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Health does not mean the absence of disease. It means enabling people to live their lives fully so that they can meet the needs of all those who rely upon them. Health care innovations can promote these aims, by discovering and implementing solutions to improve both health and care processes.

The problem with such innovation is not a lack of advances in genetics, drugs, and devices, but rather a lack of innovation in the delivery system itself. Successful innovation is signicantly impeded by payment systems that focus on the number of visits, tests, and procedures, rather than on the need to improve health.

A new vision of what health should be Health care is just a small part of the larger ecosystem of health. We have to think about health at home, at work, or at school, and then integrate in aspects of public health, mental health, access to care, integration of care, affordability, insurance, technology, and infrastructure.

This new ecosystem starts with a vision of what health should be, including all the determinants of health, in which innovation is needed to make our new vision function. It should start with a deep understanding of what people need, followed by a way to bring about accessible and affordable services within a system that is capable of rapid, adaptive change.

In my view, this new ecosystem for health will be initiated and implemented by individuals and organizations outside of established medical institu-tions, in response to real and personal challenges. The resulting products and services could create a new network of resources, or could alter existing networks. Of course, success will depend on access, affordability, outcomes, and trust. Established medical institutionssuch as Mayo Clinicwill need to remain relevant and identify their place and role within the new ecosystem. With these forces at play, the new ecosystem for health will thrive because it will be based on peoples actual needs.

Signs of changeEvery year, I see more individuals, entrepreneurs, and health care providers challenge assumptions, take risks, and make signicant changes for the future of health. These brave souls recognize that the existing structure is too entrenched, and we nd our country, for the most part, still burdened with skyrocketing pharmaceutical prices, shackled to reimbursement systems based on sickness care,

and wrestling with rising insurance costs, despite the Affordable Care Act (ACA).

There is no question that we need a new model to achieve changes in health. Some of the most prom-ising momentum Ive seen comes from a relatively small annual gathering of innovators and disruptors called the Transform conference, hosted by the Mayo Clinic Center for Innovation. Transform engages peo-ple to boldly create a sustainable future for health. In 2015, more than 700 attendees from 34 states and 15 countries participated in the three-day event, where they learned of innovations such as:

A remote blood glucose monitoring system that allows parents to view blood sugar levels

of children when they are away from home. Software developer John Costik created the device for his son, who was born with type 1 diabetes.

Oscar, an alternative insurance company developed by entrepreneur Mario Schlosser. Paying its rst benets in 2014, Oscar now claims 40,000 members, more than doubling the number of members in the last open en-rollment period in New York, one of the most competitive insurance markets in the country.

Latino Health Access in Santa Ana, California, created by America Bracho, MD, to improve the health of those living at or near the poverty line. Latino Health Access trains local com-munity health workers or promotores, who go door-to-door to promote healthful eating, exercise, and preventive medical tests.

Taking the rst stepsPhysicians need to think about health rst, and then what it means to truly understand peoples health needs. Physicians then have to create care plans that focus on their patients health goals rather than on narrowly dened treatments or guidelines based solely on clinical measures or processes.

Consumers need to insist on having health, meaning the ability to live a meaningful, produc-tive life without the burden of illness. This includes burdens imposed by physicians with prescriptions and proscriptions that are not relevant to a persons goals for health.

This new ecosystem is already starting to form, as people and organizations gravitate toward resources and connections that work for them and as entrepreneurs create innovations in response to what truly benets people. I hope that we continue to see more changes like these within our health care system.

A new ecosystem for healthCreating a shared vision

PE RSPEC T IVE

8 MINNESOTA HEALTH CARE NEWS MARCH 2016

Douglas L. Wood, MD, FACP, FACC

Center for Innovation at Mayo Clinic

Dr. Wood is the medical director of the Center for Innovation and a practicing cardiologist at Mayo Clinic. He previously served as vice-chair of the Department of Medicine, and chair of the Division of Health Care Policy and Research at Mayo. He served on the Governors Health Care Reform Task Force and has been a leader in health reform in Minnesota. Dr. Wood has held important posts in the American College of Cardiology and the American Medical Association and has been an adviser to the Secretary of Health and Human Services in both Republican and Democratic administrations.

Consumers need to insist on having health.

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T o rehabilitate a body, we start with the mind and soul.

If you or someone you know needs rehabilitation after an accident, surgery, illness or stroke, we have a simple premise for you to consider: To recover physically, you need support mentally and emotionally. How positive and how determined someone is can make all the difference. We believe the most effective therapy treats your body, mind and soul. Thats our approach.

Post-acute rehabilitation services from the Good Samaritan Society are offered at multiple inpatient and outpatient locations throughout Minnesota and the Minneapolis/St. Paul area.

To make a referral or for more information, call us at (888) GSS-CARE or visit www.good-sam.com/minnesota.

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10 QUESTIONS

Please tell us about the kinds of care you provide at the Nurse Practitioners Clinic? The Nurse Practitioners Clinic offers broad pri-mary care for the majority of every-day health needs, including wellness and preventive care, acute and short-term illness care, minor injury care, and ongoing chronic care. That means men, women, and children can be seen for everything from routine health maintenance exams to throat/chest infections, bone/joint injuries, and diabetes care. Our providers are able to prescribe medication when appropriate. If a patient needs more complex or emergency care, we quickly ar-range for them to see a University of Minnesota Health physician or specialist. Services also include routine lab tests and a pharmacy consultant to meet with patients about multiple medications.

How are you different from a regular primary care physician clinic? There are more similarities than differences. The rst major difference is that this clinic is led by experienced nurse practitioners who focus on the quality of care and a pleasant care ex-perience. Our certied nurse practitioners are especially known for their gentle, holistic care and for considering a persons overall health situation when treating a specic need. Second, the clinic was designed for convenience for the majority of health needs. We offer easy access for those who live or work downtown as well as same-day and walk-in care.

What are the biggest reasons a patient would come to your clinic?

Patients tell us that they like both the convenience and quality of care for

most of their health needs. Same-day and walk-in appointments are

other important reasons. Its a good solution for anyone looking for compassionate, thorough care providers who are backed by the

expertise of University of Minnesota Health world-class research and

innovative care and treatments. It lls the gap between a retail/convenience

clinic and a clinic for medically complex specialty care patients.

What are the biggest misperceptions about the services you offer? There are

two. The rst is misunderstanding the role of nurse practitioners. Nurse practitioners

are educated to treat a broad range of patient needs. They earn a masters or doctoral

degree plus advanced graduate education, and they have clinical experience in a specialty

beyond their four-year degree in nursing. They undergo national certication, state licensing,

periodic peer review, and evaluationssimilar to physicians. The second misconception is that

a nurse practitioner-led clinic is similar to a retail walk-in clinic. In fact, this clinic is more similar to

a family practice primary care clinic that serves as both a health care home and an acute care destination.

Where are you in terms of patient census pro-jections? Since opening in April 2015, we are seeing in-

creased awareness of the clinic as we get more established. Were meeting expected projections and plan to continue

growth to meet the needs of the growing East Downtown Minneapolis area.

Expanding access to careJane Anderson, APRN, CNP, DNPDr. Anderson, a nurse practitioner, is director of the M Health Nurse Practitioners Clinic and clinical assistant professor at the University of Minnesotas School of Nursing.


What can you tell us about your relationship with the University of Minnesota? We are part of University of Min-nesota Health (or M Health, for short). M Health is a partnership between University of Minnesota Physicians and Fairview Health Services. The clinic was opened as a result of the Universitys School of Nursing partnering with University of Minnesota Physicians to ll a downtown Minneapolis clinic gap. The clinic also serves as a clinical rotation site for nursing, pharmacy, and other health pro-fessional students from the University of Minnesota. When needed, we are able to collaborate seamlessly with and to refer patients to specialty partners and exper-tise at M Health.

How did you choose your location for the rst clinic? RS Eden, owner of the adjacent Emanuel House for low income, transitional adults, asked us to partner and provide a community clinic for their tenants and clients and for the greater East Downtown as their community initiative. With all of the housing growth, new stadium, and other retail construction and light rail transit blue and green lines just one block from the clinic, we knew it would be convenient for people in the surrounding area.

What criteria will be used for expansion? We are able to take care of patient same-day needs in the current clinic and

continue to ask patients for feedback. We are considering bringing additional services to this clinic as well. As demand grows, we will consider options such as evening and weekend hours and on-site care at large employers.

How do patients pay for your services? We accept most insurance plans, including the Hennepin Health Plan, to best serve the population and community around us. Patients can also pay out of pocket.

What are the most important things you want the public to know about the services you offer? Were proud of a 97 percent patient satisfaction rate, demonstrating that patients value this care model. Were dedicated to convenient, quality care for busy people in downtown Minneapolis. Patients appreciate the great variety of

services from minor to complex and acute to ongoing careall delivered in a calm, pleasant environment. Our patients often visit us the rst time for convenience, and then they come back based on their satisfying experience.

The University of Minnesota Health Nurse Practitioners Clinic is located at 814 S. Third St., Minneapolis, MN 55415. Hours are 8 a.m. to 5 p.m., Mondays through Fridays.


Nurse practitioners are educated to treat a broad

range of patient needs.

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PUBLIC HEALTH

People have known for a long time that violence begets vio-lence, but I dont think people truly understood that violence is scientically a contagious problem. When we apply epi-demic control methods to prevent violence, we are able to drastically reduce shootings, killings, and other violent acts.

A disease control modelAfter my medical training in infectious diseases, I landed in the mid-dle of a refugee crisis in Somaliaone million refugees spread over 40 camps with six doctors to provide health services. I focused on

containing and treating tuberculosis and cholera; three years later, I was hired by the World Health Organization (WHO) and assigned to containing the AIDS epidemic in Uganda.

When I returned to Chicago 10 years later, friends began telling me about kids shooting other kids with guns. I asked many people: What are you doing about it?

No one seemed to have any new or promising solutions. The way I saw it, politicians and public policy experts were calling for the same solutions to what was clearly a growing problem of vio-lence, particularly in urban areas. The problem was stuck.

Trained in science as a physician, I turned to data for answers. When I mapped areas of high violence in Chicago and other cities, I saw that violence clearly clustered in communities, reminding me of the clustering I had seen overseas with infectious epidemics, including cholera. After years of research, it became abundantly clear that violence behaves like contagious disease, sharing the same characteristics of clustering, spread, and transmission. And thats good news overall, as epidemics are most effectively reversed not by antibiotics or vaccines, but by behavioral changes centering on a three-step, common-sense health approach:

U Interrupt transmission: detect and nd rst cases.

U Prevent further spread: nd others who have been exposed but may not be contagious now.

U Shift the community norms: build group immunity through community activities, public education, and remodeling of behavior.

This health approach successfully reversed Ugandas AIDS epidemic and contained the Ebola virus in Sierra Leone and Liberia. Its also the basis for the Cure Violence model, which strives to make violence as rare as plague or cholera are today.

StrategiesCure Violence applies disease control strategies to:

1) Detect and interrupt potentially violent conicts. Whenever a shooting happenswhether it involves a crime, a personal dispute, a domestic assault, or a mass shootingtrained outreach workers deploy in the community and at the hospital to cool down emotions and to prevent retaliations. Workers also talk to key people in the

Applying a medical model of control

By Gary Slutkin, MD


violence begets vio- containing and treating t

el

We evaluate and treat all types of brain and spine problems, no matter how complex. Our team of renowned, world-class surgeons, is committed to living and serving the communities of the Midwest and beyond.

Our areas of specialty include:7\bS`\ObW]\OZZSORSàVW^^`SaS\bSÒ\ROcbV]`W\bVSORdO\QSR[W\W[OZZgW\dOaWdS=::74A^W\OZ4caW]\>`]QSRc`S;W\W[OZZgW\dOaWdSA78]W\b4caW]\]TTS`W\UÒ^WR`SQ]dS`gO\R`SZWST0SbbS`W[OUW\U`SacZbaeWbV]cbbVSQZOcab`]^V]PWO]TOQ]\dS\bW]\OZ;@7bSab]c`]^S\c^`WUVb;@7aQO\\S`Wa]\S]TdS`gTSeW\bVSCA

We offer clinical care at the following locations: Tristate Brain & Spine Institute/ZSfO\R`WO;< River View Health1`]]Yab]\;< /RdO\QSRA^W\SO\R>OW\1ZW\WQ3RW\O;

community about ongoing disputes, recent arrests, recent prison releases, and other situations, using mediation techniques to resolve disputes peacefully. They follow up with conicts for as long as needed to ensure that they do not become violent.

2) Identify and treat people at the highest risk of violence. Trained outreach workers establish contact, develop relationships, and work with those most likely to be involved in violence. After establishing trust, they attempt to convince these high-risk individuals to reject the use of violence, discussing the cost and conse-quences and teaching alternative responses to situ-ations. Workers then provide ongoing treatment, seeing clients several times a week and assisting with needs such as drug treatment, employment, and leaving gangs.

3) Mobilize the community to change norms. Workers engage leaders in the community, residents, business owners, faith leaders, service providers, and those at high risk, to stress that violence should not be viewed as normal, but as a behavior that can be changed.

OutcomesIn 2000, Cure Violence received its rst grant to create a demonstration site focusing on this new health approach to violence prevention in the most violent Chicago neigh-borhood. The rst experiment resulted in a 67 percent drop in shootings and killings in West Gareld Park. Our next four high-risk neighborhoods resulted in a 45 percent drop. The approach has since been replicated over 60 times in 25 U.S. cities and in eight countries on four continents. Cure Violence is currently ranked 17th on the list of Top 500 global NGOs (non-governmental organizations) by the Swiss non-prot Global_Geneva, which also lists it as the top NGO focused on reducing violence.

Multiple independent evaluations supported by the Justice Department, the Centers for Disease Control (CDC), Johns Hopkins University, Northwestern University, and the University of Chicago have documented 30 to 50 percent and 40 to 70 percent reductions in shootings and killings under the Cure Violence approach to vio-lence prevention.

Personal transformationsThe model transforms not just communities, but individual lives as well. Meet Stacy L., a participant in the CeaseFire Illinois program (the Chicago arm of Cure Violence) from Englewood, Chicagos most violent neighborhood:

First I got shot at 18. Then I got shot again at 21. I was just in a rage of revenge, revenge, revenge. The Cure Violence staff came to me and taught me how to let go. I feel like if he (a Cure Violence staff member) wouldnt have never taught me how to let go, Id still be blood thirsty.

Stacy L., a program participant in Englewood, Chicago.

Stories such Stacys demonstrate how this global program can save lives. Deploying this common-sense, proven, evidence-based health approach, rooted in science, as a complement to traditional law enforcement, has been provenover and overto drastically

reduce violence and reinvent high-risk, violent communities, transforming them into growing, economically viable, vibrant neighborhoods.

Health as the solution to violence Cure Violence, along with other health leaders who have implement-ed or researched successful violence reduction efforts, believes that we need a national movement focused on explaining violence as a

barrier to health and, ultimately, a national priority to bring evidence-based practices to scale. In light of this philosophy, our work is now focused around:

U>V}V>>`Li>>V>>}reduce violence

U1}ii>V>ii>>vi-vention to interrupt the spread of violence; and

U}}LVi>>ìì-gy tools to community-based violence prevention programs

ì>`}iVi>>i>problem, we recognize that the people committing violence, as well as those who have been affected through injury and

exposure, essentially have a health problema problem of exposure, contagion, and trauma. Violence poses a serious public health threat


In the U.S., homicide is the leading cause of death

for African Americans ages 10 to 24.

Americas gun violence epidemic to page 34

Do you have patients with trouble usingtheir telephone due to hearing loss, speechor physical disability?

If sothe TED Programprovides assistive telephoneequipment at NO COSTto those who qualify.

Please contact us,or have your patientscall directly, for moreinformation.

1-800-657-3663www.tedprogram.org

The Telephone Equipment Distribution Program is funded through theDepartment of Commerce Telecommunications Access Minnesota (TAM)and administered by the Minnesota Department of Human Services

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CARDIOLOGY

Atrial brillation (AF) is the most common heart rhythm abnormality in the adult population. The lifetime risk of AF is one in four and there are at least 2.7 million people living with AF in the U.S., according to the Centers for Disease Control and Prevention. In the most basic terms, AF occurs because electrical signals cause the chambers of the heart to beat out of sync, too fast, or too slow. These irregular beats dont effectively circulate blood through the heart, creating an environment that is conducive to clotting.

This condition is an important public health problem for two reasons. First, AF is becoming increasingly common. Researchers at-tribute this increase to the aging population and growing prevalence of risk factors such as obesity. Second, AF contributes to 130,000 deaths per year and is associated with an increased risk of stroke, heart failure, cognitive decline, and dementia.

How is AF diagnosed?In most cases, patients will feel palpitations or the sensation of an irregular heartbeat. It is common for AF patients to experience other symptoms such as shortness of breath, chest discomfort, fatigue, or poor stamina.

Though rare, some patients may not experience any symptoms whatsoever. However, these patients are still at risk for the poten-tially deadly health events that other AF patients face. Because the condition can go undetected, its important to routinely visit a pri-mary care physician who can determine a patients risk factor.

The condition can be easily diagnosed using a standard elec-trocardiogram (ECG), performed in a clinic or physicians ofce, or by an ambulatory heart rhythm monitor, which may be worn by patients at home or in the course of daily activities. Both devices are painless ways to record the electrical activity that takes place in your heart. The ECG test captures data from short durations. But, the ambulatory heart rhythm monitora portable set-uprecords longer periods of electrical activity. Because the ambulatory heart rhythm monitor reects intermittent episodes of heart activity, this arrangement is particularly useful in diagnosing early stage AF.

What causes AF?The common risk factors for AF include advancing age, hyperten-sion or high blood pressure, diabetes, heart disease, coronary artery disease, heart failure, obesity, and obstructive sleep apnea. Men are also more likely to experience this condition. Similar to other heart conditions, AF can sometimes cluster in families.

Other health conditions such as lung disease, pneumonia, and even surgery can cause a person to develop AF. In particular, an overactive thyroid gland, called hyperthyroidism, is linked to AF. Its important to test for hyperthyroidism upon receiving an AF


Atrial fibrillation

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diagnosis. Thats because overactive thyroids can be treated, miti-gating the risk of AF. As with other heart conditions, behaviors like binge drinking and smoking can cause or exacerbate AF.

The stages of AFAs researchers have learned with heart failure, there are various stages of AF progression. In its earliest stage, AF is intermittent or paroxysmal. During this stage, there may be mild enlargement of the atria, which are the upper chambers of the heart.

As early stage AF progresses, it be-comes persistent, lasting more than 7 days. During this stage, more structural changes can occur, such as tissue scarring called brosis and further enlargement of the hearts upper chambers.

When it is at its most advanced stagealso called the permanent stageAF is entrenched and the hearts normal rhythm can no longer be maintained. During this stage, the upper chambers of the heart can be severely enlarged. This stage is sometimes accompanied by other cardiovascular complications.

Treating AFThere are three pillars of treatment for AF:

1) preventing strokes or blood clots using anticoagulants, commonly referred to as blood thinners

2) preventing AF recurrences by striving to maintain normal heart rhythm

3) controlling the rate of AF without aiming to maintain normal rhythm

To prevent strokes, physicians can use warfarin (common brand names include Coumadin and Jantoven) or other new blood-thinning agents. War-farin blocks the livers ability to produce proteins that are necessary to coagulate blood. This means clots are less likely to form, which reduces the risk of stroke.

Often, heart experts will use these anticoagulants as they work to achieve and maintain normal rhythm in patients.

To achieve normal rhythm, doctors can use rhythm medications or anti-arrhythmic medications designed to reset the electrical impulses that are causing AF. This approach works well for some patients, but not all patients. Another commonly prescribed medication is beta-blockers, which help control a patients heart rate.

One effective alternative for maintaining normal rhythm is catheter ablation, a minimally invasive medical procedure that


Some patients may not experience any

symptoms whatsoever.

Atrial brillation to page 32

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PEDIATRICS

Childhood obesity has reached epidemic proportions. In the U.S., nearly one out of every three children and adolescents is overweight or obese. Minnesota is no exception: 27 percent of our youth are overweight or obese, triple the rate from just one gener-ation ago. Although the rates of childhood obesity seem to be leveling off, the numbers of kids with severe forms of obesity are increasing.

Common questionsAs rates of childhood obesity increase, many parents seek informa-tion regarding terms and denitions. Among their questions:

How do I know if my child has a problem with extra weight? Doctors use the body mass index, or BMI, to determine if a person has overweight or obesity. The BMI is a calculation that uses height and weight to estimate how much body fat someone has. If the BMI is between the 85th and 95th percentile for age and sex, then the child has overweight. If the BMI is above the 95th percentile for age and sex, then the child has obesity. (To calculate your childs BMI, visit the Centers for Disease Controls calculator at nccd.cdc.gov/dnpabmi/calculator.aspx). These words, overweight and obe-sity, are clinical terms used to characterize the risk someone has for developing weight-related health problems. People with overweight have a modestly increased risk of developing weight-related health problems, and people with obesity have a high risk of developing health problems.

So whats wrong with having overweight or obesity? Multiple studies show that carrying extra weight stresses our bodies and our minds. Children and adolescents with overweight or obesity are at risk of developing multiple health problems. These include, for example, high blood pressure, diabetes, liver disease, irregular men-strual periods, sleep apnea, and joint pain. Further, some children and adolescents with extra weight have difculties with socialization due to bullying or mental health issues, such as low self-esteem or even depression. Finally, studies also show that youth with severe forms of obesity, especially teenagers, do not grow out of their extra weight; very often they become adults with obesity. Thats why pre-vention and early intervention are so important.

How did obesity become such a problem? There are multiple contributors to carrying extra weight. The primary determinant of a persons shape or size is their genetics. Simply put, carrying extra weight tends to run in families. But there are many other factors at play. These include dietary factors, such as easy access to high cal-orie, ultra-palatable foods (think cheesy crackers) and large portion sizes. (Ask your grandparents how many french fries came with restaurant meals in their day. It was likely a tiny fraction of what is served today.) Other factors include limited physical activity and poor sleep. The use of technology, such as cell phones and video games, has crept into many of our lives and displaced our outdoor free play and even our sleep time. Increasingly, stress has also been linked to obesity. Some people eat in response to stress, i.e., for coping. Addi-tionally, increases in stress hormones can lead to weight gain.16 MINNESOTA HEALTH CARE NEWS MARCH 2016

Assessing risks and preventionBy Jessica Larson, MD, and Claudia Fox, MD, MPH

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Addressing the problemAddressing a widespread problem such as pediatric obesity can seem overwhelming. It will likely take the coordinated efforts of families and health care providers, as well as schools and communities, to solve this problem. We know that prevention is the most effective strategy. Teaching fam-ilies healthy habits and creating an environment that encourages those habits is the best approach.

Preventing pediatric overweight and obesityA number of common-sense practices can help prevent obesity and promote overall health:

Healthy eating. Since children have lower daily calorie needs, it is very easy for extra calories to start adding up quickly. A diet high in fruits, vegetables, and whole grains will ll children up without giving them extra calories. On the same note, avoiding or limiting processed and fast foods will minimize foods that are high in calories and low in nutritional content. Many experts recommend that families limit eating out to no more than once per week. Additionally, many children also get a signicant number of extra calories in the beverages they drink. This is especially true for so called sugar-sweetened beverages, such as soda, sports drinks, avored milks, and fruit drinks. Doctors recommend that children avoid these beverages. Too many children drink sugar-sweetened beverages regularly, when they really should be treated like a dessert.

Finally, it is important for children and families to have a regular eating schedule. Children should have breakfast every day, and fam-ilies should try to sit down to have a meal together as many nights a

week as they can. When families eat together, they tend to consume less and eat healthier.

Regular physical activity. Too many of our chil-dren do not get enough physical activity. The American Academy of Pediatrics recommends children get at least one hour of physical activity every day. This may be

accumulated through the day, and includes time spent in recess, gym class, team sports, and outside play. A good strategy is to make it part of family time. Families that are active and play together tend to be healthier.

Limiting screen time. As our children spend more time in front of screens, they spend less time in active play. Simply by

limiting screen time, children will spend more time being active. It has also been found that children tend to eat while theyre in front of a screen, and the foods are not usually as healthy. Most important-ly, there is a direct correlation between having a television or other screen in a childs bedroom and the time they spend with that screen. Keeping screens out of childrens bedrooms allows parents to moni-tor both the quantity and the quality of screen time. The American Academy of Pediatrics recommends limiting screen time to less than two hours per day and keeping screens out of childrens bedrooms.


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Childhood obesity to page 19

Colorectal CancerC l t l CAwareness Month

Colorectal cancer is the third most common type of non-skin cancer and the second-leading case of cancer death among both men and women in the U.S. Each year about 136,000 people arediagnosed with colorectal cancer and more than 50,000 die of the disease. Men andwomen have similar incidence rates through age 39, but at age 40 and older, rates arehigher in men.

Colorectal cancer often starts as polyps(growths on the walls of the intestine),which can become cancer over time. Undergoing a screening can help prevent colorectal cancer by allowing doctors to detect and remove polyps before they become cancerous. Rates of colorectalcancer incidence and mortality due to the disease have been declining over the past two decades, largely to increased use of screening tests.

Screenings are recommended for every-one 50 and older, but if you have a family history of the disease, you should talk to your doctor about starting screening earlier.


Calendar Mar.-April 2016Mar.19 Hearing Loss Support Group Allina Health and the Hearing

Loss Chapter of America host this free support group for anyone who is hard of hearing. Come meet others in similar situations and gain insights from their experiences. For more information or to sign up, call Bob at (763) 537-7558.

Saturday, March 19, 9:30 a.m.12:00 p.m., Courage Kenny Rehabilitation Institute, 2nd Flr. Boardroom, 3915 Golden Valley Rd., Minneapolis

21 Infertility Support Group RESOLVE: The National Infertility Associa-tion offers peer-led support groups for couples experiencing infertility to connect with one another, share their stories, and receive support from others going through similar experiences. Contact the group hosts, Katie and Kendra, at [email protected] before attending your rst meeting.

Monday, March 21, 6:308 p.m., Ramsey County Upperwood Library, 3025 Southlawn Dr., Maplewood

21 Varicose Vein ScreeningPark Nicollet offers free screenings for anyone bothered by visible, bulging veins in their legs that cause pain, swelling, or cramp-ing. Surgeons will perform the screening and recommend a course of action. Those covered by Medicare or Medicaid are not eligible due to federal regulations. Other dates are also available. Call (952) 993-2651 to schedule your screening.

Monday, March 21, 3:004:30 p.m., Park Nicollet Heart and Vascular Center, Womens Center, 5th Floor, 6500 Excelsior Blvd., St. Louis Park

24 Diabetes on a BudgetFairview Health Services hosts this new class for anyone with diabetes. Come learn how to eat healthy and manage your diabetes without breaking the bank. Learn strategies for cost-effective diabetes testing supplies and determine if and how your medication costs can be lowered. For more information or to sign up, call (612) 672-6700. $5 fee.

Thursday, March 24, 23:30 p.m., Fairview ClinicsEdina, 6545 France Ave. S., Ste. 150, Edina

Apr.4 Growth Through GrievingHealthEast hosts this weekly group meeting for anyone who is grieving the loss of a loved one. While grieving can be painful and lonely, sharing experiences and support with others going through similar loss-es can help. Contact Ted at (651) 232-7397 or [email protected] for more information.

Monday, April 4, 45:30 p.m., Maplewood Professional BuildingSt. Johns Hospital, Watson Education Center, 2nd Flr., 1575 Beam Ave., Maplewood

11 Dads of Children with Special NeedsGroup Arc Greater Twin Cities and Minneapolis Early Childhood Family Education host this free networking group for fathers of children with all types of intellectual and developmental disabilities. Come meet others in similar situations and gain insights from their experiences. Childcare available. For more in-formation or to sign up, call (952) 920-0855.

Monday, April 11, 5:307:30 p.m., Wilder School, ECFE Parent Rm., 3328 Elliot Ave. S, Minneapolis

12 Aging in Place Options and ResourcesHennepin County Library and the Metropolitan Area Agency on Aging offer this free class for anyone who prefers to stay in their homes and age in place but needs assistance with issues such as home maintenance, personal care, food support, or transportation. Presented by representatives of Senior LinkAge Line. Call (612) 543-5669 for more information.

Tuesday, April 12, 67:30 p.m., St. Anthony Library, 2941 Pentagon Dr. NE, St. Anthony

23 Cancer Survivorship Conference The University of Minnesota hosts this free annual educational conference that focuses on questions and issues survivors and their families often face after cancer treatment or following stem-cell transplantation. Regis-tration required. To sign up, visit cancer.umn.edu/community-events-and-outreach. For more information, call Ashley at (612) 625-9340.

Saturday, April 23, 8 a.m.1:30 p.m., University of Minnesota, McNamara Alumni Center, 200 SE Oak St., Minneapolis

Mar.17 Colon, Anal, Rectal Cancer Support Group Minnesota Oncology and Colon & Rectal Surgery Associates offer this free monthly support group for individuals going through diagnosis, treatment, and life after colon, anal, or rectal cancer in a safe and welcoming environment. The group focuses on education, sharing, and connecting. Call Kim at (952) 928-2907 for more information.Thursday, March 17, 5:307:00 p.m., Minnesota Oncology, 6545 France Ave. S., Ste. 210, Edina

Send us your news:We welcome your input. If you have an event you would like to submit for our calendar, please send your submission to MPP/Calendar, 2812 E. 26th St., Minneapolis, MN 55406. Email submissions to [email protected] or fax them to (612) 728-8601. Please note: We cannot guarantee that all submissions will be used. CME, CE, and symposium listings will not be published.

Americas leading source of health

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The 5210 Rule. The American Academy of Pediatrics endorses the 5210 message as a guide for families trying to lead a healthy, active life:

5: Five helpings of a fruit or vegetable daily

2: Less than two hours of screen time per day

1: One hour of active play per day0: No sugar-sweetened beverages

Getting enough sleep. Sleep is now rec-ognized as an increasingly important part of healthy living and preventing overweight and obesity. Due to busy schedules and excessive screen time, many children do not get the sleep that they need at night. These limited or disrupted sleep schedules alter the hormones in the brain, which have a direct effect on metabolism and weight. The National Sleep Foundation recom-mends that children ages 3 to 5 get 1113 hours of sleep per night, and children ages 6 to 13 get 911 hours. Teenagers generally need at least 8 hours per night.

Treating pediatric overweight and obesityFor children who are overweight or obese, it can be challenging to know where to start. Families should discuss their concerns about

their childs weight with their health care provider. This may be a dif-cult subject to bring up with your childs doctor because sometimes families feel embarrassed or fear that they will be blamed for their childs weight status. However, the medical community is there to help

you and many doctors will be pleased to know that this is a concern you have. Just remember that if the health care provider uses words such as overweight or obese, they are not intend-ed to be negative. Instead these words describe the amount of risk your child has for developing weight-related health problems and how serious the problem can be. Depending on your childs BMI, some doctors may start with simple goal setting, or they may refer you to a dietician or a doctor who specializes in weight management. Treatment is most effective when the whole family is involved.

For more information, check out these websites:

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Jessica Larson, MD, is a board-certied general pediatrician with an inter-est in pediatric obesity, practicing at the Fairview Clinic in Elk River. Claudia Fox, MD, MPH, is an assistant professor in the Department of Pediatrics at the University of Minnesota and medical director of the University of Minnesota Masonic Childrens Hospital Pediatric Weight Management Program.

Childbood obesity from page 17

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SENIOR CARE

M arshall starts his day chatting with friends over a cup of coffee before he makes his way to exercise and then choir practice. After lunch he heads to the art room for pottery class, followed by a creative writing group. He makes plans with friends for the next day before heading home.

Marshall is an 82-year-old veteran with early-stage memory loss. He attends an adult day program a few miles away from the home hes lived in for more than 50 years.

Adult day programs such as Marshalls remain a well-kept secret in the world of senior services. As dened by the National Adult Day Services Association (NADSA), adult day programs are professional care settings in which older adults, adults living with dementia, or adults living with disabilities receive individualized therapeutic, social, and health services for some part of the day. Adult day participants maintain their independence and dignity, while caregivers enjoy the peace of mind that comes from knowing their family member is receiving care and staying active.

The adult day modelAdult day services began to appear in the U.S. in the 1960s as a form of geriatric outpatient hospital care. In subsequent decades the adult day model has expanded to support the physical, mental, and social well-being of older adults and adults with disabilities and/or memory loss. According to NADSA, there are now more than 5,000 adult day centers in the U.S. serving more than 260,000 participants and caregivers.

What sets adult day services apart from other services available to seniors is the exibility they offer families. Seniors and adults can have their health and wellness monitored by trained professionals at day programs while they continue to live independently or with caregivers. This arrangement is often preferable to relocating to a senior living community, especially for older adults who do not require 24-hour assistance or monitoring.

Caregiversoften family membersbenet from adult day pro-grams, too. Because adult day services are typically offered during regular business hours, caregivers have opportunities to work, run errands, or just take a break from their caregiving duties while their loved one spends time enjoying the program.

Looking at a well-kept secretBy Barb Zeis


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Enrichment opportunitiesMany adult day programs offer a variety of enrichment activities and outings that improve the overall quality of life for participants. Exercise classes, creative arts program-ming, guest speakers, and educational eld trips are becoming more common offerings at adult day centers.

At the Amherst H. Wilder Founda-tions Adult Day program in Saint Paul, participants enjoy numerous creative arts activities thanks to partnerships with local professional artists and arts organizations. From painting to pottery, music, and storytelling, these arts enrichment programs are more than fun and games; they may help improve cognition and daily functioning, sparking interests and talents that go back decades.

Take Marshall, for example. His early-stage memory loss makes it hard for him to make it to doctors appoint-ments or remember the names of his grandchildren. But get Mar-shall singing and hes able to recall the lyrics to songs he sang more than a half-century ago without skipping a beat.

A growing body of research documents experiences similar to Marshalls, suggesting that Alzheimers disease and other forms of memory loss need not impair a persons creativity or imagination. The Memory and Aging Centers Hellman Visiting Artist Program at the San Francisco campus of the University of California invites visual artists, musicians, and writers to interact with patients, families, and academic researchers in the elds of dementia and Alzheimers. The Alzheimers Association, the American Associa-tion of Retired Persons, and the National Endowment for the Arts all cite studies supporting the value of arts-based programs for older people. Adult day service providers build on this emerging research by incorporating creative arts activities into their programs.

Beyond the cognitive benets of creative programs, creative arts encourage a sense of belonging. This becomes increasingly important for seniors who feel isolated from friends, family, and peers. Caregiv-ers with loved ones participating in the Wilder Foundations program tell us that creative arts activities help family members be more ac-tive, positive, and social overall. Some seniors nd new interests and passions. Others rekindle talents and joys they havent thought about in years. No matter what a persons interests or abilities, creative arts programs help our center be a place to belong and succeed.

Other benets of adult day servicesEach adult day program is different, but many offer similar benets, such as:

UFlexible schedules

U Affordability of programming compared to senior living facilities or other, more intensive services

U Transportation to, from, and during programming

U Variety of social, educational, and health activities

U Professional staff who specialize in caring for older adults and adults with disabilities and/or memory loss

U Community connections: many centers are located in neighborhood settings

Determining if adult day is right for someone you care forAdult day services have a wide range of benets for older adults and caregivers, but, like any form of care, its not right for everyone. Adult day services are best suited for older adults and adults with disabilities and/or memory loss who:

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Adult day participants maintain their

independence and dignity.

Adult day programs to page 25

DENTAL HEALTH

There have been many advances in modern dentistry, but den-tal implants may have sparked the most interest and enthu-siasm among consumers. The technology to replace missing teeth is hardly new; dental implants have a long and interesting history. There is archeological evidence of dental implants in an-cient China dating back 4,000 years, with bamboo pegs placed into the jaws. Throughout the early and mid 1900s, doctors developed varying types of implantable metal devices to help replace missing teeth. Todays titanium dental implant was originally developed by an orthopedic surgeon in Sweden and brought to North America

in the early 1980s. Since then, research has transformed the dental implant, as well as the surgery, into one of the fastest growing and most innovative procedures in dentistry.

From bridges to implantsPrior to titanium dental implants, the dental bridge was the conven-tional way to replace a missing tooth. After preparing adjacent teeth to t crowns over them and provide support for the missing tooth in the middle, the dental bridge was then cemented in place and remained xed.

How do implants differ? A dental implant is essentially a titanium screw that is implanted into the upper and/or lower jawbone, where it acts as an anchor. A ceramic or metal tooth is then screwed on top of the implant to replace the missing tooth. Like a conventional dental bridge, multiple implants can be placed in strategic positions, and a multi-tooth bridge can be attached to replace a varying number of teeth. For patients who are missing all of their teeth, multiple implants can be placed and an entire set of teeth can be screwed per-manently into place, sometimes within the same day of the surgery.

In most cases, dental implants function as a permanent replace-ment option, but we can also utilize implants to provide support to existing dentures or partial dentures. In these cases, a number of implants, typically two or more, can be placed into the jaw bone and allow the denture to snap into the implants, improving stability, retention, and comfort over the traditional denture.

Advantages and disadvantagesThere are many advantages of dental implants over conventional

techniques. Implants have been shown to last longer than a tradi-tional dental bridge or a removable partial denture. Once a dental implant has integrated with the bone, it is then a permanent xture in the jawbone. Since an implant is comprised of titanium, it will not form cavities like a natural tooth. An implant can last a lifetime, assuming the patient is healthy, has adequate bone volume sur-rounding the implant, and takes proper care of the implant. Dental implants help stimulate and preserve surrounding bone, preserve surrounding gingival (gum) tissue, and allow the patient to resume a normal diet. Without an implant or tooth root, the jawbone will usually shrink due to lack of stimulation of the bone. Dental im-plants help preserve the adjacent teeth by avoiding the need to alter additional healthy teeth to accommodate a conventional bridge.

Implants

A permanent solution to missing teethBy Matthew Karban, DMD, MD, and Paul Thai, DDS


In the next issue...

UZika

UElder nutrition

UBrain health

Your Guide to Consumer Information

There are some drawbacks and hurdles to dental implant therapy. There can be increased costs for implant procedures compared to other replacement options, and healing times can be longer. As with all surgical procedures, dental implants do have associated risks, such as poten-tial infection, swelling, discomfort, and lack of integration into the bone. Dental implants can also suffer from bone loss and gingival (gum) disease. They are dependent on hygiene habits and medical factors. Some medical conditions and habitssuch as uncontrolled diabetes and smokingcan increase the complication rate, but these risks are very rare, and do not necessarily rule out dental implant treatment. In fact, dental implants celebrate a very high success rate when compared to most other medical procedures or implanted de-vices. Research studies show a success rate of 96 percent and greater for dental implants, depending on certain factors and specics.

What to expectThe procedure is tailored to each individuals situation, but typically involves removal of the broken or diseased tooth. If possible, depend-ing on bone quantity and quality, the implant is placed immediat

mn healthcare news mar 2016

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