http://medlib.med.utah.edu/pcp/
Marc E Babitz, MD, department of family and preventive medicine, University of Utah School of Medicine, discusses the weaknesses of US heath care. He describes the US health care system as the “room to room to room” system. Physicians see patients in clinic exam rooms, emergency rooms, and operating rooms. To improve health care in the US, we need to focus on caring for the patient who is not in the room.
The US spends more than any other country on health care: over $1.2 trillion/year (2001), 14% of GDP, or 4,000/individual/yr is spent on
health care costs.
However, the US is last among industrialized nations in health care quality: Infant Mortality: ranking from 18th – 22nd in the world, Life Expectancy: ranking from 16th –24th in the world, Overall Health Care: 37th in the world (WHO Report 2000).
Barriers to Health Care:
Financial— 42.5 million working uninsured, 20+ million on Medicaid.
Geographical— rural, urban, transportation.
Availability— US physicians 30% primary care, 70% subspecialty, 9a-5p hours of operation, full clinic schedules (busy but inefficient).
Culture and Language.
Steps to a Solution:
1. Identify population: geographic boundaries, economic boundaries, ethnicity, children, elderly, pregnant, homeless, uninsured.
2. Assess needs: qualitative/subjective data—interviews, focus groups, surveys. Talk to everyone who has an interest in your population (e.g. government officials, parents, teachers, physicians, social workers, public health department). No one person will have “all the answers.” Quantitative/objective data—obtain epidemiological data from health department, community emergency departments.
3. Design Intervention—prioritize population needs. Interventions must satisfy the following considerations: Accessible, Acceptable, Accountable, Comprehensive, Coordinated, Continuing.
4. Assess Efficacy—measure whether intervention is making a difference. Cease intervention if no, celebrate if yes.
Wednesday, November 24, 2004
Tuesday, September 14, 2004
More than Heaven and Hell
Many interpret the Bible to say that one must confess Jesus is the Christ to qualify for salvation. The Bible also states that at some future date "all knees shall bow and all tongues shall confess that Jesus is the Christ." Does this mean that everyone despite our comportment in this life will be saved and go to heaven. Well, yes and no. This issue comes down to our understanding of salvation and heaven.
Paul discussed the redemption of the the body at the time of the resurrection by describing differing states of quickening, "there are bodies Celestial... Terestrial... and Telestial." These states are likened unto the differing glories of the sun, moon and stars in magnitude respectively. So, according to Paul all men will be resurrected, saved from hell, and redeemed to some level of glory by the grace of God. But, only those who are raised to Celestial glory not only receive salvation from hell but also exaltation.
What is the Mormon concept of heaven, salvation, and exaltation? Mormons believe that one who qualifies for the highest degree of Celestial glory will, together with their spouse to whom they have been married for time and eternity, live with God the Father and His Son Jesus Christ. They will receive perfect glorified bodies, will be able to progress in intelligence, power, and have eternal increase until they have become like God. They will have Eternal families and enjoy the same sociality enjoyed in this life. Some consider this concept of heaven and salvation as heresy, sacrilege, and blasphemy.
I desire an eternal family and eternal progression in the next life and these are things that other faiths have no concept of. Mormon missionaries are not telling people that they are going to hell if they don't become Mormons but that there is more to the next life than just heaven and hell. Ask yourself. What does you’re religion teach about the what heaven in like? What have you always felt it will be like? Do you want to just be saved from hell, or do you want an Eternal family and Eternal progression?
Paul discussed the redemption of the the body at the time of the resurrection by describing differing states of quickening, "there are bodies Celestial... Terestrial... and Telestial." These states are likened unto the differing glories of the sun, moon and stars in magnitude respectively. So, according to Paul all men will be resurrected, saved from hell, and redeemed to some level of glory by the grace of God. But, only those who are raised to Celestial glory not only receive salvation from hell but also exaltation.
What is the Mormon concept of heaven, salvation, and exaltation? Mormons believe that one who qualifies for the highest degree of Celestial glory will, together with their spouse to whom they have been married for time and eternity, live with God the Father and His Son Jesus Christ. They will receive perfect glorified bodies, will be able to progress in intelligence, power, and have eternal increase until they have become like God. They will have Eternal families and enjoy the same sociality enjoyed in this life. Some consider this concept of heaven and salvation as heresy, sacrilege, and blasphemy.
I desire an eternal family and eternal progression in the next life and these are things that other faiths have no concept of. Mormon missionaries are not telling people that they are going to hell if they don't become Mormons but that there is more to the next life than just heaven and hell. Ask yourself. What does you’re religion teach about the what heaven in like? What have you always felt it will be like? Do you want to just be saved from hell, or do you want an Eternal family and Eternal progression?
Friday, September 10, 2004
Proof of God’s Existence
It is impossible for man to prove God’s existence. It is like-wise impossible for man to disprove God’s existence.
It is impossible for man to prove God’s existence. It is like-wise impossible for man to disprove God’s existence. Man acceptance of God is based on faith, hope, and imperfect knowledge because if he were to have a perfect knowledge of God, he would be god. “Eternal life is to know God” Eternal life equals life as god. Also, rejection of God is also based on faith and imperfect knowledge. And, just as Dr. Lund argues, an Atheist would have to be a god to prove that God does not exist.
Gerald Lund states about an antangonistic and agnostic character in the Book of Mormon: "Korihor will consider only evidence that can be gathered through the senses. In such a system, it is much easier to prove there is a God than to prove there is not a God. To prove there is a God, all it takes is for one person to see, hear, or otherwise have an experience with God, and thereafter the existence of God cannot be disproved. But here is what it would take to prove there is no God: Since God is not confined to this earth, we would have to search throughout the universe for him. We assume God is able to move about, so it would not be enough to start at point A in the universe and search through to point Z. What if after we leave point A, God moves there and stays there fore the rest of the search? In other words, for Korihor to say that there is no God, based on the very criteria he himself has established, he would have to perceive every cubic meter of the universe simultaneously. This creates a paradox: In order for Korihor to prove there is no God, he would have to be a god himself! Therefore, in declaring there is no God, he is acting on "faith," the very thing for which he so sharply derides the religious leaders!
Gerald Lund's "Countering Korihor's Philosophies." (Ensign, July 1992)
It is impossible for man to prove God’s existence. It is like-wise impossible for man to disprove God’s existence. Man acceptance of God is based on faith, hope, and imperfect knowledge because if he were to have a perfect knowledge of God, he would be god. “Eternal life is to know God” Eternal life equals life as god. Also, rejection of God is also based on faith and imperfect knowledge. And, just as Dr. Lund argues, an Atheist would have to be a god to prove that God does not exist.
Gerald Lund states about an antangonistic and agnostic character in the Book of Mormon: "Korihor will consider only evidence that can be gathered through the senses. In such a system, it is much easier to prove there is a God than to prove there is not a God. To prove there is a God, all it takes is for one person to see, hear, or otherwise have an experience with God, and thereafter the existence of God cannot be disproved. But here is what it would take to prove there is no God: Since God is not confined to this earth, we would have to search throughout the universe for him. We assume God is able to move about, so it would not be enough to start at point A in the universe and search through to point Z. What if after we leave point A, God moves there and stays there fore the rest of the search? In other words, for Korihor to say that there is no God, based on the very criteria he himself has established, he would have to perceive every cubic meter of the universe simultaneously. This creates a paradox: In order for Korihor to prove there is no God, he would have to be a god himself! Therefore, in declaring there is no God, he is acting on "faith," the very thing for which he so sharply derides the religious leaders!
Gerald Lund's "Countering Korihor's Philosophies." (Ensign, July 1992)
Not believing in God is too risky.
Theist, Atheist, Agnostic. Lets weight the risks and benefits.
What do you get if you believe in God and God does not exist? A good, happy life. A few restrictions. However, I do not regret never smoking, drinking, lying, cheating, stealing, killing, fornicating, idoliterating or adulterating. Oh, and I have to pay 10% tithing. But church has been a nice social club and is worth the money. Believing in God helps me and inspires me through the hard times.
So what do you get if you believe in God and God exists? All of the above and a chance at Eternal rewards.
What do you get if you do not believe in God or don’t know and God does not exist? I get to do what I want but have to learn from my own mistakes. I risk suffering adversity alone. I make up my own rules. I risk hurting others and risk have regrets. But when I die, I die and its over. There may hope in reincarnation.
What do you get if you do not believe in God or don’t know and God does exist? All of the above and the risk of Eternal punishment.
Hey, I am a theist because of what I get out of it. If there is an after-life and if there is a God, I want to be ready to meet Him and be judged by Him; my actions, thoughts, and desires. What do I loose? Well, so far I have everything I have ever wanted. And even when bad things happen in my life, some lose, some adversity, my faith in God strengthens me, and gives me hope. What hope? That If I do what I believe God wills me to do in this life that the things that matter most: family, friends and ability to love will go with me into the next life. Rabbi Kushner a renowed Jewish Rabbi in a BYU talk of the year in 1995 said that believing in God gave him value as an individual and self worth to think that the supreme intelligence, being, and power of the universe cared about what he ate for breakfast, who he slept with, what clothes he wore, and what he did on Sunday.
Agnostics declare ignorance or the reality of God's existance. They, in many cases, honestly conclude that they do not have enough circumstancial evidence one way or another to convince them of God's existence. Well, this is also a risky position.
See, an agnostic is making a big assumption. He is counting on that his ignorance of God’s existence justifies him from any penalties. But, if God does exist, it’s God who makes the rules and not man. There is a chance that ignorance will not be an acceptable excuse for violating God’s rules. “For my thoughts are not your thoughts, neither are your ways my ways, saith the LORD.” (Isa. 55:8)
What do you get if you believe in God and God does not exist? A good, happy life. A few restrictions. However, I do not regret never smoking, drinking, lying, cheating, stealing, killing, fornicating, idoliterating or adulterating. Oh, and I have to pay 10% tithing. But church has been a nice social club and is worth the money. Believing in God helps me and inspires me through the hard times.
So what do you get if you believe in God and God exists? All of the above and a chance at Eternal rewards.
What do you get if you do not believe in God or don’t know and God does not exist? I get to do what I want but have to learn from my own mistakes. I risk suffering adversity alone. I make up my own rules. I risk hurting others and risk have regrets. But when I die, I die and its over. There may hope in reincarnation.
What do you get if you do not believe in God or don’t know and God does exist? All of the above and the risk of Eternal punishment.
Hey, I am a theist because of what I get out of it. If there is an after-life and if there is a God, I want to be ready to meet Him and be judged by Him; my actions, thoughts, and desires. What do I loose? Well, so far I have everything I have ever wanted. And even when bad things happen in my life, some lose, some adversity, my faith in God strengthens me, and gives me hope. What hope? That If I do what I believe God wills me to do in this life that the things that matter most: family, friends and ability to love will go with me into the next life. Rabbi Kushner a renowed Jewish Rabbi in a BYU talk of the year in 1995 said that believing in God gave him value as an individual and self worth to think that the supreme intelligence, being, and power of the universe cared about what he ate for breakfast, who he slept with, what clothes he wore, and what he did on Sunday.
Agnostics declare ignorance or the reality of God's existance. They, in many cases, honestly conclude that they do not have enough circumstancial evidence one way or another to convince them of God's existence. Well, this is also a risky position.
See, an agnostic is making a big assumption. He is counting on that his ignorance of God’s existence justifies him from any penalties. But, if God does exist, it’s God who makes the rules and not man. There is a chance that ignorance will not be an acceptable excuse for violating God’s rules. “For my thoughts are not your thoughts, neither are your ways my ways, saith the LORD.” (Isa. 55:8)
Saturday, August 21, 2004
Irritable Bowel, Chronic Fatigue, and Fibromyalgia
http://jama.ama-assn.org/cgi/content/short/292/7/852
A clinical review in JAMA discusses a new theory into the misunderstood diseases of Irritable Bowel, Chronic Fatigue, and Fibromyalgia. It also suggests how these three disorders may be connected. Irritable bowel disease can present with many different symptoms. However, bloating after eating a meal is the most common symptom. Researchers discovered that the increased gas had less to do with an intolerance to any particular kind of food and more to do with bacterial overgrown in the small intestine. Bacteria do serve a critical role in the colon or large intestine. However, the small intestine between the stomach and the colon in healthy people is a mostly sterile environment. This is achieved by the acidity of the stomach which kills most bacteria which enters in the upper GI tract. On the other end a special valve at the insertion of the small intestine to the large intestine called the iliocecal valve prevents bacteria in the colon from ascending up and overgrown in the small intestine. Well, in the case of irritable bowel that is just what happens. The symptoms of bloating come from certain disaccharide like sorbitol, lactose, lactulose, and fructose found in certain foods which are not absorbed entirely in the upper small intestine, reach the bacteria in the lower small intestine and cause the bacteria to grow and produce gas. The small bowel gets distended due to the gas causing pain and bloating. The iliocecal valve keeps the gas bottled up in small intestine from being released into the colon and then expelled as flatus. Glucose and sucrose are easily absorbed in the upper small bowel and do not cause bacterial overgrown, gas production, bloating, and abdominal pain.
So, what about the constipation, diarrhea, or a combination of the two which are common symptoms in irritable bowel. Well, these symptoms are due to what kinds of bacteria are growing in the small intestine and what gases they produce. Methane gas causes decreased paristalsis and constipation. Other gases include hydrogen, and hydrogen sulfide. Diarrhea is related to toxins released by certain bacterias which stimulate the small intestine to secrete water. In the colon, a variety of bacteria are found that all compete with one another so no one kind overgrows the others. In the small intestine it is common for one or two specific bacterial species to overgrow and cause the symptoms of irritable bowel.
So, what about fibromyalgia and chronic fatigue syndrome. It's no revelation that these mysterious disorders seem to run together. Well, researchers have discovered that fibromyalgia and chronic fatigue may be caused by the same small intestine bacterial overgrown as irritable bowel. Turns out there is a great new test to diagnose irritable bowel. Symptomatic patients can be given a dose of oral lactulose and then a breathalizer test can be taken measuring for increased methane, hydrogen, and hydrogen sulfide production. Well, it turns out that patients with irritable bowel symptoms have higher gas production than healthy individual. What was even a greater surprise was that almost 100% of individuals suffering from fibromyalgia and chronic fatigue symptoms also had positive lactulose challenge, breathalizer tests. This means that having fibromyalgia and chronic fatigue could be linked to bacterial overgrown and irritable bowel (chronic fatigue can be associated with post mononucleosis as well as other potential chronic infectious, genetic, and environmental diseases and exposures).
However, not all individuals with irritable bowel have fibromyalgia. This is due to the kind of bacteria that is overgrown in the small bowel and the individual's immune reponse to the specific bacterial strain. According to the article, bacteria as well as signs of inflammation where found in neighboring lymph nodes adjacent to the small intestine in suffers of fibromyalgia and chronic fatigue. The subsequent inflammatory reaction to the bacteria results in the characteristic body aches, pains, malaise, and fatigue.
So, what to do about it. Well no official studies have been perfomed. But the review article suggests several ideas. While symptoms persist, an irritable bowel sufferer should temporarily avoid foods that contain complex disaccharide such as lactose (dairy products), sorbitol (apple juice), and even fructose (fruit) in some cases. Suffers will need to learn which foods cause bloating, constipation, and diarrhea. Temporarily eliminating these from the diet will stop feeding the bacteria in the lower small intestine and prevent the bacterial overgrown and gas production.
Another idea it to replace bad bacteria with good bacteria. Since, bacterial overgrown is believed to be due to one or two offending stains of bacteria, adding good bacteria to the mix could help control bacterial overgrown by increasing the competition for food between good and bad bacteria. Yogurt and Cranberry juice have not been shown effective in helping to alleviate symptoms of irritable bowel due to active yogurt culture and antibiotic properties in the later. This is probably because these also contain lactose and fructose which exacerbate the condition. Several prescription and nonprescription products which contain milk bacteria (Lactobacillis acidophilis) or other mixed strains of bacteria (probiotics) may be helpful (Culturel, Bifidobacterium bifidus, fecal probiotics). Probiotic therapies have proven successful in the treatment of inflammatory bowel (Crohns disease, Ulcerative colitis, Clostridium difficile colitis, recurrent diarrhea, rota virus?).
Finally, 14 day treatment with the antibiotic Flagyl (metronitazole) is also effective at treating irritable bowel. However, doctors feel uneasy about relying on antibiotic treatment due to possible emergence of resistant basteria strains.
A clinical review in JAMA discusses a new theory into the misunderstood diseases of Irritable Bowel, Chronic Fatigue, and Fibromyalgia. It also suggests how these three disorders may be connected. Irritable bowel disease can present with many different symptoms. However, bloating after eating a meal is the most common symptom. Researchers discovered that the increased gas had less to do with an intolerance to any particular kind of food and more to do with bacterial overgrown in the small intestine. Bacteria do serve a critical role in the colon or large intestine. However, the small intestine between the stomach and the colon in healthy people is a mostly sterile environment. This is achieved by the acidity of the stomach which kills most bacteria which enters in the upper GI tract. On the other end a special valve at the insertion of the small intestine to the large intestine called the iliocecal valve prevents bacteria in the colon from ascending up and overgrown in the small intestine. Well, in the case of irritable bowel that is just what happens. The symptoms of bloating come from certain disaccharide like sorbitol, lactose, lactulose, and fructose found in certain foods which are not absorbed entirely in the upper small intestine, reach the bacteria in the lower small intestine and cause the bacteria to grow and produce gas. The small bowel gets distended due to the gas causing pain and bloating. The iliocecal valve keeps the gas bottled up in small intestine from being released into the colon and then expelled as flatus. Glucose and sucrose are easily absorbed in the upper small bowel and do not cause bacterial overgrown, gas production, bloating, and abdominal pain.
So, what about the constipation, diarrhea, or a combination of the two which are common symptoms in irritable bowel. Well, these symptoms are due to what kinds of bacteria are growing in the small intestine and what gases they produce. Methane gas causes decreased paristalsis and constipation. Other gases include hydrogen, and hydrogen sulfide. Diarrhea is related to toxins released by certain bacterias which stimulate the small intestine to secrete water. In the colon, a variety of bacteria are found that all compete with one another so no one kind overgrows the others. In the small intestine it is common for one or two specific bacterial species to overgrow and cause the symptoms of irritable bowel.
So, what about fibromyalgia and chronic fatigue syndrome. It's no revelation that these mysterious disorders seem to run together. Well, researchers have discovered that fibromyalgia and chronic fatigue may be caused by the same small intestine bacterial overgrown as irritable bowel. Turns out there is a great new test to diagnose irritable bowel. Symptomatic patients can be given a dose of oral lactulose and then a breathalizer test can be taken measuring for increased methane, hydrogen, and hydrogen sulfide production. Well, it turns out that patients with irritable bowel symptoms have higher gas production than healthy individual. What was even a greater surprise was that almost 100% of individuals suffering from fibromyalgia and chronic fatigue symptoms also had positive lactulose challenge, breathalizer tests. This means that having fibromyalgia and chronic fatigue could be linked to bacterial overgrown and irritable bowel (chronic fatigue can be associated with post mononucleosis as well as other potential chronic infectious, genetic, and environmental diseases and exposures).
However, not all individuals with irritable bowel have fibromyalgia. This is due to the kind of bacteria that is overgrown in the small bowel and the individual's immune reponse to the specific bacterial strain. According to the article, bacteria as well as signs of inflammation where found in neighboring lymph nodes adjacent to the small intestine in suffers of fibromyalgia and chronic fatigue. The subsequent inflammatory reaction to the bacteria results in the characteristic body aches, pains, malaise, and fatigue.
So, what to do about it. Well no official studies have been perfomed. But the review article suggests several ideas. While symptoms persist, an irritable bowel sufferer should temporarily avoid foods that contain complex disaccharide such as lactose (dairy products), sorbitol (apple juice), and even fructose (fruit) in some cases. Suffers will need to learn which foods cause bloating, constipation, and diarrhea. Temporarily eliminating these from the diet will stop feeding the bacteria in the lower small intestine and prevent the bacterial overgrown and gas production.
Another idea it to replace bad bacteria with good bacteria. Since, bacterial overgrown is believed to be due to one or two offending stains of bacteria, adding good bacteria to the mix could help control bacterial overgrown by increasing the competition for food between good and bad bacteria. Yogurt and Cranberry juice have not been shown effective in helping to alleviate symptoms of irritable bowel due to active yogurt culture and antibiotic properties in the later. This is probably because these also contain lactose and fructose which exacerbate the condition. Several prescription and nonprescription products which contain milk bacteria (Lactobacillis acidophilis) or other mixed strains of bacteria (probiotics) may be helpful (Culturel, Bifidobacterium bifidus, fecal probiotics). Probiotic therapies have proven successful in the treatment of inflammatory bowel (Crohns disease, Ulcerative colitis, Clostridium difficile colitis, recurrent diarrhea, rota virus?).
Finally, 14 day treatment with the antibiotic Flagyl (metronitazole) is also effective at treating irritable bowel. However, doctors feel uneasy about relying on antibiotic treatment due to possible emergence of resistant basteria strains.
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