Disease Management Update
Volume IV, No. 36
January 3, 2008

Dear Healthcare Intelligence Network Client,

As the holiday dust finally begins to settle this week, New Year's resolutions are on everyone's lips. And losing weight and smoking cessation are always popular resolutions on lists the world over — as well as healthy choices that can greatly reduce healthcare costs. This week's Disease Management Update looks at a study that may explain why smokers who quit often relapse as well as research suggesting diets high in sugar may be worse than high-carb diets.

Visit HIN's blog to read about some smoking cessation tips from University of Maryland Medical Center smoking cessation expert Dr. Kevin Ferentz, M.D.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Neuroimaging May Identify Smokers at High Risk for Relapse in Smoking Cessation Treatment
  2. Disease Management Q&A: Assessing Readiness to Change
  3. HealthSounds Podcast: Live Health-Coaching Session for Weight Management
  4. Too Much Fructose Could Leave Dieters Sugar Shocked
  5. Survey of the Month: Medical Homes Use To Manage Chronic Conditions
  6. Changing Lives with Lifestyle Management

1. Neuroimaging May Identify Smokers at High Risk for Relapse in Smoking Cessation Treatment

A new brain imaging study by researchers in the Abramson Cancer Center of the University of Pennsylvania shows that cigarette cravings in smokers who are deprived of nicotine are linked with increased activation in specific regions of the brain. Using a novel method of measuring brain blood flow developed by John Detre, M.D., associate professor of Neurology at Penn, this study is the first to show how abstinence from nicotine produces brain activation patterns that relate to urges to smoke. The findings, published in the December 19, 2007, issue of The Journal of Neuroscience, make an important contribution to understanding smoking urges, a key risk factor for relapse, at the brain level.

For the study, 15 regular smokers were analyzed using MRI arterial spin labeled (ASL) technology, a non-invasive technique for the measurement of cerebral blood flow (CBF) in the brain, to compare resting CBF across two scanning sessions that varied by length of periods of abstinence from smoking. Each participant was scanned in a resting state on two separate occasions: participants smoked a cigarette within an hour of the one scan, and abstained from smoking overnight for the other scan.

The findings indicate that abstinence-induced, unprovoked cravings to smoke are associated with increased activation in brain regions important in attention, behavioral control, memory, and reward. “The craving assessments used in our study predict relapse in smoking cessation treatment,” said Caryn Lerman, Ph.D., senior author of the paper. “If validated in larger studies, these results may have important clinical implications. For example, perfusion MRI may aid in the identification of smokers at increased risk for relapse who may require more intensive therapy.”

To learn more about this study, please visit:

2. Disease Management Q&A: Assessing Readiness to Change

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Richard Citrin, vice president of health and productivity at Corphealth Inc., Gregg Lehman, president and CEO of Gordian Health Solutions at the time of contribution and currently president and CEO of LifeFitness, and Sean Sullivan, president and CEO for Institute for Health and Productivity Management.

Question: What is an accurate assessment of a member’s readiness to change, and how do you create interventions that are applicable to each member’s stage of readiness?

Response: (Richard Citrin) There are a number of scales that can be done straightforwardly to identify and assess a member’s readiness to change. A good intervention program does an ongoing restratification process; that is, you’re noting where the member’s change is. You may find that there’s great success in taking a person from a pre-contemplative stage to a contemplative stage. That in itself may be an episode of care for that particular member.

It’s as if we’ve cooked up this notion of intentionality and why the time value of change is a very important element. Unfortunately, because of these short-term horizons, we don’t often have a chance to revisit members once they are either disenrolled or graduated or drop out. Or we, as health professionals, have lost our expert status because we missed an appointment or failed to send them a mailing we were supposed to send or the member developed some critical illness that has challenged them. But it certainly is very doable to measure those changes, and they should be measured on an ongoing basis.

(Greg Lehman) Many times somebody just does not want to participate; they’re not even at the pre-contemplative” stage. That’s not someone you want to engage in the program because they will not succeed. However, if you get somebody that’s pre-contemplative saying “Yes, I would like to quit smoking” or “Yes, I would like to lose weight but I’ve got these other stressors in my life,” then schedule a time to talk to this individual when you think they would be ready to listen. Talk to them about an intervention program custom designed to meet their needs.

For example, let’s assume somebody has diabetes. They also have heart disease, hypertension, and high cholesterol and may use tobacco. If you try to channel them into a diabetes management program and they’re not interested, they may be interested in losing 30 pounds or controlling their cholesterol or doing something else. It behooves the health coach to get them in the program where they can start to impact behavior, which will then positively impact all these other co-morbidities.

After the program is completed — and for us it’s a 12-month cycle — gauge that individual not just in terms of customer satisfaction but in terms of how well they feel they did in changing their behavior and managing urges to go back to their old lifestyle. Then, if you do a health risk assessment, a biometric screen, you’ll find out whether you’ve moved the needle in terms of their overall health. Keeping them engaged and then evaluating how well you’ve done is critically important in keeping them on the original track.

(Sean Sullivan) In the not too distant future, all of these programs will gain insights from looking at current health and productivity measurement tools. This will then enable them to approach people on the basis of how their problems are interfering with their ability to do their job. Because the ultimate incentive is to be able to get the job done.

For more details on coordinating care transitions for the elderly, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Live Health-Coaching Session for Weight Management

In a live coaching demo, "Coach Meg" (Wellcoaches CEO Margaret Moore) helps volunteer client Kathy Smith (not her real name) identify life issues that are keeping her from being her "best self" in managing her thyroid condition and weight issues. You'll hear how Coach Meg builds positive psychology into this real-life health coaching session, which was conducted as part of "Teaching Health Coaches to Integrate Positive Psychology with Physical Health to Improve Disease Management Outcomes," an audio conference now available on CD-ROM or via an On Demand re-broadcast on the Web.

To listen to this complimentary HIN podcast, please visit:

4. Too Much Fructose Could Leave Dieters Sugar Shocked

Many dieters may actually be cutting out the wrong foods altogether, according to findings from a recently published University of Florida (UF) paper. Dieters should focus on limiting the amount of fructose they eat instead of cutting out starchy foods such as bread, rice and potatoes, report the researchers, who propose using new dietary guidelines based on fructose to gauge how healthy foods are.

While table sugar is composed of both glucose and fructose, fructose seems to be the more dangerous part of the equation, UF researchers say. Eating too much fructose causes uric acid levels to spike, which can block the ability of insulin to regulate how body cells use and store sugar and other nutrients for energy, leading to obesity, metabolic syndrome and type 2 diabetes.

“Certainly we don’t think fructose is the only cause of the obesity epidemic,” said Dr. Richard Johnson, the senior author of the report, which reviewed several recent studies on fructose and obesity. “Too many calories, too much junk food and too much high-fat food are also part of the problem. But we think that fructose may have the unique ability to induce insulin resistance and features of the metabolic syndrome that other foods don’t do so easily.”

To learn more about this study's findings, please visit:

5. Survey of the Month: Medical Homes Use To Manage Chronic Conditions

Complete our survey on medical homes use by January 31, and you'll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Changing Lives with Lifestyle Management

Abandoning long-standing behaviors that are detrimental to one’s health is no simple feat, but it is necessary for an increasing number of people with life-threatening conditions such as diabetes, heart disease and obesity. This is why healthcare organizations are aiding such undertakings with lifestyle management (LM) programs. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:
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