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May 13, 2010 Volume VI, No. 50

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this week's issue, nationwide studies reveal the influence of a mother's smoking habits and depression on a child's smoking behavior, and expectations for weight gain when a family history of diabetes exists.

In prevention, get a step-by-step plan for reducing Metabolic Syndrome.

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

This week's DM news:

Table of Contents

  1. Influences on Adolescent Smoking
  2. Diabetes & Weight Gain
  3. Behavioral Healthcare in Medical Homes
  4. DM, Wellness in the Medical Home
  5. Home Visit Tasks
  6. Lifestyle Management
  7. Reducing Metabolic Syndrome Risk
  8. Managing Care Transitions

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Adolescent Smoking May Be Influenced by Mothers' Smoking or Depression

A new study by SAMHSA reveals that adolescents aged 12 to 17 living with mothers who are current smokers or who have had a major depressive episode in the past year are far more likely to smoke than adolescents not living under these circumstances.

The study shows that adolescents living with mothers who currently smoke were nearly three times more likely to take up smoking than adolescents living with non-smoking mothers (16.9 percent versus 5.8 percent). Similarly, adolescents living with mothers who have suffered from a major depressive episode in the past year were almost twice as likely to take up smoking as adolescents not living in that situation (14.3 percent versus 7.9 percent). In addition, the study revealed adolescents living with mothers who had a major depressive episode and were current smokers were more than four times more likely to smoke than adolescents living with mothers who had neither of these conditions (25.3 percent versus 5.6 percent).

More than 1 in 4 (25.6 percent) of adolescents live with mothers who currently smoke and nearly 1 in10 adolescents (9.7 percent) live with mothers who have experienced a major depressive episode in the past year. About 1 in 27 (3.7 percent) of all adolescents live with mothers with both of these conditions.

"These findings highlight factors that influence smoking among adolescents. It also suggests that prevention of smoking requires attention to multiple risk factors, including mental illness in the family," said SAMHSA Administrator Pamela S. Hyde, J.D. "Knowing the factors that contribute to smoking helps to design and implement the best approach towards prevention and well-being."

To learn more about this research, please visit:

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People with Family History of Type 2 Diabetes Gain More Weight Overeating

Healthy people with a genetic predisposition to Type 2 diabetes gain more weight overeating over the short term than their non-genetically-prone counterparts, according to Australian researchers. In a 28-day study at Sydney’s Garvan Institute of Medical Research, scientists set out to mimic the kind of overfeeding that typically takes place during feasting periods, like Christmas. Seventeen otherwise healthy people with a family history of Type 2 diabetes, along with 24 people without any family history, took part in the research. The groups were matched for age, weight and lifestyle. Each person was asked to eat 1,250 calories a day beyond their energy requirements --- all carefully calculated in advance. They were given a variety of high-fat snacks such as cookies, chocolate bars and dairy desserts to supplement their normal diets. Their weight, fat distribution and blood insulin levels were measured at the start of the project, after three days and at 28 days.

On average, the people with a family history of diabetes gained over a kilogram more than the rest (7 lbs (3.4 kg) as opposed to 4 lbs (2.2 kg)) over 28 days. They also had more insulin circulating in their systems after only three days, before they showed any detectable difference in weight gain from the other group. "Our study shows just how quickly the body reacts to overeating, and how harmful it can be in susceptible people. While we expected differences between the two groups, we were surprised by the amount of extra weight the diabetes-prone group gained," said the researchers.

An early warning sign of diabetes is the development of "insulin resistance," usually triggered by excess body fat. Insulin is a hormone made by the pancreas, which helps the body use glucose for energy. Insulin resistant muscle cannot respond properly to insulin from the bloodstream, leading to high levels of sugar in the blood. High blood sugar levels damage tissues and organs, so the body works very hard to reduce them by producing more insulin. Eventually, the insulin-producing cells in the pancreas become exhausted and Type 2 diabetes develops. "Insulin resistance can start to develop at least a decade before clinical diabetes, and this study helps us examine its very early stages in healthy adults," said the researchers.

At the end of the study, participants were helped to lose weight, with both groups being equally successful. Interestingly, the "biggest loser" belonged to the group with a family history of diabetes.

To learn more about this research, please visit:

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Integrating Primary Care and Behavioral Healthcare

Individuals with severe and persistent mental illnesses are likely to die 20 years earlier than people without such conditions, says Liz Reardon, president of Reardon Consulting and a member of the National Council for Community Behavioral Healthcare (NCCBH) Integration Consulting Team. Putting the right medical home services in place for adults with chronic mental illness can help to reduce this disparity, suggests Reardon, explaining why the earliest medical homes for children with complex health needs are great models for behavioral healthcare organizations.

To listen to this complimentary HIN podcast, please visit:

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Best Practices for Medical Home Physician Practices

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is James Kerby, M.D., vice president of medical affairs at Grand Valley Health Plan.

Question: What are some best practices for medical home physicians or practices to help patients better manage their wellness and chronic disease?

Response: (Dr. James Kerby) For those that have chronic illnesses, we have implemented shared appointments where we have a practitioner, along with a health coach and often a nurse, meet with anywhere between eight and 10 individuals at a shared appointment to do their actual diabetes visit, for example, but do it in a group setting in terms of education and support in developing individual DM plans.

Also, we use report cards for our patients with diabetes. After their diabetes visit, we give them a report card of where they stand with goals that have been established for different parameters, such as the HbA1C level or completion of their annual diabetic retinopathy eye examination. Also, for wellness support, we use health risk assessments (HRAs) to interact with our well individuals and try to enhance their activities in maintaining their health.

For more information on DM in a patient-centered practice, please visit:

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Home Visit Tasks

Sometimes it takes a home visit to a patient with complex chronic conditions to understand the barriers to care compliance that they face. We wanted to see which tasks are being performed during home visits.

Click here to view the chart.

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Changing Lives with Lifestyle Management

Numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This executive summary documents 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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Taking Steps to Reduce Risk of Metabolic Syndrome

In a new study in the American Journal of Preventive Medicine, researchers found that daily volume of physical activity is related to Metabolic syndrome (MetS). Using data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005–2006, investigators from the Pennington Biomedical Research Center, Baton Rouge, LA, analyzed a sample of 1446 subjects, 523 with MetS and 923 without MetS. These subjects wore high-quality accelerometers and their activity levels placed them into three step-defined physical activity categories: sedentary (less than 5000 steps/day), low-to-somewhat-active (5000–9999 steps/day) and active-to-highly-active (greater or less than 10000 steps/day).

Compared to the sedentary group, odds of having MetS were lower for each higher category of daily steps. In the total sample, the odds of having MetS were 40 percent lower for the "low-to-somewhat-active" and 72 percent lower for the "active-to-highly-active" groups compared to the sedentary group. Among men, the odds of MetS were 24 percent lower in the "low-to-somewhat-active," although not significant, and it was 69 percent lower in those categorized in the "active-to-highly-active" compared to the sedentary group. For the women, those categorized as "low-to-somewhat-active" had 53 percent lower odds and those in the "active-to highly-active" group had 72 percent lower odds of having MetS compared to the sedentary group.

Higher levels of steps/day were associated with significantly lower odds of having at-risk cardiovascular disease (CVD) profiles for the total sample, and also separately for men and women. In the total population, each additional 1000 steps/day was associated with an 8 percent to 13 percent reduction in the odds of high waist circumference, a low level of HDL-cholesterol and high levels of triglycerides. For men, each additional 1000 steps/day was associated with a 6 percent to 11 percent reduction in odds of high waist circumference, a low level of HDL-cholesterol and high levels of triglycerides. For women, each additional 1000 steps/day was associated with a 6 percent to 17 percent reduction in the odds of high waist circumference, a low level of HDL-cholesterol and high levels of triglycerides.

While cardiovascular health benefits of physical activity have been well documented in literature, the current study supports and expands on these findings by including accelerometer-determined steps/day, an objective measure of the total volume of daily ambulatory physical activity, in a representative sample of U.S. adults. Capturing total volume of physical activity in steps/day is important since it considers all domains (transportation, recreation, household and occupation) and provides an objective measure rather than relying on self-reported, which can often be biased.

MetS is made up of unhealthy CVD risk factors including abdominal obesity, high levels of triglycerides, low level of HDL-cholesterol, elevated blood pressure and elevated fasting glucose level as defined by the American Heart Association/ National Heart, Lung and Blood Institute (AHA/NHLBI). According to the NHANES 1999–2004, approximately 36 percent of the U.S. adult population has MetS.

To learn more about this research, please visit:

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Managing Care Transitions Across Sites

Tighter management of transitions in care — particularly for older adults with complex acute or chronic conditions — can help to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality. Please share how your organization is coordinating key care transitions by completing HIN's second annual e-survey on Managing Care Transitions Across Sites by May 31. You'll 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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