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January 13, 2011 Volume VII, No. 27

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this week's issue, find out the key strategy to lower risk of colon cancer death in your population. Also, see how high sugar consumption is affecting teens' health.

We also present new market research in tobacco cessation programs in the industry.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Heart Disease & Sugar
  2. Lung Disease & Vitamin D
  3. Healthcare Performance Update
  4. Home Visits for Heart Failure Patients
  5. ER Interventions for Discharged Patients
  6. Benchmarks in Tobacco Cessation
  7. Colon Cancer Death Risk & Exercise
  8. Healthcare Case Management in 2011

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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High Sugar Consumption May Increase Risk Factors for Heart Disease in American Teenagers

Teenagers who consume a lot of added sugars in soft drinks and foods may have poor cholesterol profiles — which may possibly lead to heart disease in adulthood, according to first-of-its-kind research reported in Circulation: Journal of the American Heart Association. The National Health and Nutrition Survey (NHANES) of 2,157 teenagers (ages 12 to 18) found the average daily consumption of added sugars — any caloric sweeteners added to foods or beverages by the manufacturer during processing or the consumer — was 119 grams (28.3 tsp or 476 calories), accounting for 21.4 percent of their total energy. According to researchers, previous studies indicate that the largest contributors of added sugars to the diet are sugary beverages such as sodas, fruit drinks, coffees and teas.

Teens consuming the highest levels of added sugars had lower levels of high density lipoprotein levels (HDL), the good cholesterol, and higher levels of triglycerides and low density lipoproteins (LDL), the bad cholesterol. Teenagers with the highest levels of added sugar consumption at more than 30 percent of total energy had 49.5 milligrams/deciliter (mg/dL) compared to 54 mg/dL of HDL levels in those with the lowest levels of added sugar consumption — a 9 percent difference.

The study included dietary recall from one 24-hour period that researchers merged with sugar content data from the U.S. Department of Agriculture My Pyramid Equivalents Databases. Researchers estimated cardiovascular risk by added sugar consumption of less than 10 percent up to more than 30 percent of daily total energy. Two days of dietary data were used among a subsample of 646 adolescents and the key findings remained consistent:

  • Those with higher intake of added sugar had higher LDL levels of 94.3 mg/dL compared to 86.7 in those with the lowest levels, a 9 percent difference.
  • Triglyceride levels in those with the highest consumption were 79 mg/dL compared to 71.7 mg/dL among the lowest, a 10 percent difference.
  • Overweight or obese adolescents with the highest level of added sugar consumption had increased signs of insulin resistance.
The American Heart Association recently recommended a specific upper limit for added sugars intake, based on the number of calories an individual needs throughout the day, according to their energy expenditure, sex and age. For example, an appropriate amount for an individual with an energy requirement of 1,800 calories per day (an average teenage girl ages 14-18 might be in this calorie range) would be no more than 100 calories from added sugars. An individual with a requirement of 2200 calories per day should eat or drink no more than 150 calories from added sugars.

To learn more about this research, please visit:

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Vitamin D Deficiencies May Impact Onset of Autoimmune Lung Disease

A new study from the University of Cincinnati (UC) shows that vitamin D deficiency could be linked to the development and severity of certain autoimmune lung diseases. Brent Kinder, MD, UC Health pulmonologist, director of the Interstitial Lung Disease Center at the University of Cincinnati and lead investigator on the study, says vitamin D deficiencies have been found to affect the development of other autoimmune diseases, like lupus and type 1 diabetes. "We wanted to see if lack of sufficient vitamin D would also be seen in patients who are diagnosed with an autoimmune interstitial lung disease (ILD) and whether it was associated with reduced lung function,” said Dr. Kinder.

Some ILD patients first discover they have an undifferentiated connective tissue disease, a chronic inflammatory autoimmune disease that affects multiple organ systems but is not developed enough for physicians to easily recognize and categorize. Autoimmune diseases occur when the body produces abnormal cells that turn on the body and attack major organs and tissues. Connective tissue diseases include lupus, scleroderma, polymyositis, vasculitis, rheumatoid arthritis and Sjogren's syndrome.

Researchers evaluated 118 patients from the UC ILD Center database — 67 with connective tissue disease-related ILD and 51 with other causes of lung fibrosis — for serum 25-hydroxyvitamin D levels, which indicate levels of vitamin D in the body. Then, they evaluated associations between these serum levels and the patients’ conditions. Overall, those with connective tissue disease-related ILD were more likely to have vitamin D deficiency — 52 percent versus 20 percent — and insufficiency — 79 percent versus 31 percent — than other forms of ILD. Among this same group of patients, reduced serum 25-hydroxyvitamin D levels were strongly associated with reduced lung function.

"These findings suggest that there is a high prevalence of vitamin D deficiency in patients with ILD, particularly those with connective tissue disease,” Dr. Kinder says. "Therefore, vitamin D may have a role in the development of connective tissue disease-related ILD and patients’ worsening lung function. One of the next steps is to see if supplementation will improve lung function for these patients. If these findings are confirmed and vitamin D supplementation is shown to be effective in clinical trials, this may also provide a more natural, inexpensive treatment for the illness," adds Dr. Kinder.

To learn more about this research, please visit:

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Healthcare Performance Update — Healthcare Trends for 2011

Was 2010 a better year for healthcare than 2009, and what were the best and worst business ideas in healthcare over the last 12 months? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews reviews the top healthcare trends and concerns for 2011 derived from HIN's October 2010 survey results.

To listen to this complimentary HIN podcast, please visit:

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How-to’s of Home Visits for Heart Failure Patients

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Michele Gilbert, M.S.N., education coordinator of the heart failure team and pulmonary hypertension program at Hackensack University Medical Center.

Question: What are the components and goals of the home visits conducted by the heart failure team?

Response: We have spent a lot of time teaching our home care nurses to be astute observers. One thing the nurse will do is interview the patient regarding their health practices and understanding of the disease. We give patients basic educational information. When the nurse conducts the visit, she does a complete physical assessment, as well as an assessment of the patient’s functional abilities. We use the Minnesota Living With Heart Failure Questionnaire, which addresses functional status for the patient, at the first and last visits to ensure that the patient’s functional status and ability to self-manage is improving. We find out what the patient has been eating and what they’re doing. We get our baseline.

On subsequent visits, the nurse might empty the patient’s pantry and show them how much sodium they’ve been eating. They ensure the patient understands where to find hidden sources of sodium. The nurse continues to assess the patient’s progress. They will provide them with a daily system for weighing themselves and recording their weight. The patient’s ability to self-medicate is also assessed. If they don’t have a system for taking their medications, we provide one, such as a seven-day pillbox with four compartments.

For more information on heart health, please visit:

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

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ER Interventions for Recently Discharged Patients

Many avoidable ER visits are by patients recently discharged from the hospital. We wanted to see how organizations reduce unnecessary ER visits by patients recently discharged from the ED or hospital.

Click here to view the chart.

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2010 Performance Benchmarks in Tobacco Cessation

This white paper summarizes results of the Healthcare Intelligence Network’s second annual Tobacco Cessaton & Prevention e-survey conducted in November 2010, revealing the efforts of 84 healthcare organizations to curb these trends, including program availability, program components and reimbursement trends.

To download this complimentary white paper, please visit:

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Consistent Exercise Associated With Lower Risk Of Colon Cancer Death

Consistent exercise is associated with a lower risk of dying from colon cancer, according to a new study from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. The study is among the first to show that physical activity can make the disease less deadly. The Washington University researchers worked with colleagues from the American Cancer Society and examined data from the American Cancer Society Prevention Study II (CPS II) to look at whether changes in physical activity influenced either the incidence of colon cancer diagnosis or the risk of death from the disease.

The CPS II study included more than 150,000 men and women. To determine how exercise affected colon cancer, the researchers compared their levels of physical activity between 1982 and 1997 and linked those activity levels both to the number of colon cancer diagnoses between 1998 and 2005 and to the number of colon cancer deaths that occurred between 1998 and 2006. It turned out that those who exercised consistently for at least 10 years had the lowest risk of colon cancer death.

According to the researchers, the benefits of starting an exercise program include not just preventing colon cancer and death from the disease but also reducing risk of heart disease, diabetes and other cancers. Physical activity can even be beneficial after a cancer diagnosis has already been made. “There is evidence that being physically active can reduce the risk of recurrence and death following a cancer diagnosis,” said the researchers. “Even those who haven’t been physically active can begin exercising after their diagnosis and see some real benefits as well.”

To learn more about this research, please visit:

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Healthcare Case Management in 2011

Targeted case manager interventions across the healthcare continuum are generating significant ROI and positive clinical outcomes resulting from more effective care coordination and reduced health resource consumption. Complete HIN's second annual Survey of the Month on Healthcare Case Management by January 31, 2011 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

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