Monday, July 27, 2009

Tweet Your Senator on HealthCare Insurance Reform

Healthcare insurance reform is currently a hot issue. You can make your voice heard via Twitter--by Tweeting your Senator in favor of healthcare reform.

Tweet Your Senator is a new feature now available at BarackObama.com.

Tweet Your Senator is easy and simple to use. You enter your zipcode and a pre-populated tweet is created that is directed at one of you Senators.

After you are done entering your zipcode, you press a button, and the tweet goes up to your Twitter page and is ready to be sent. If your senator is not on Twitter, the tweet will include your Senator's name rather than their Twitter handle.

The Tweet Your Senator page also contains an interactive map that is very interesting. If you tweet you might see your face.

To Tweet Your Senator go here.

Advice and Insight into Alzheimer's disease
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Wednesday, July 22, 2009

Walmart and the Alzheimer's Caregiver

My name is Bob DeMarco, I am an Alzheimer's caregiver. My mother Dorothy, now 93 years old, suffers from Alzheimer's disease.

I learned in my role as an Alzheimer's caregiver that exercise, bright light, socialization, and simple tasks that allow my mother to use her brain have a positive effect on my mother's quality of life and behavior.

I am always searching for new ways to keep her active and in the world.

About a year ago, I came up with a new idea and decided to give it a try.

I took my mother to Super Walmart for an outing. If you have a super Walmart near you, you already know the parking lot is usually jammed.

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When we arrive at Walmart, I look around for a parking space. We do not use the handicapped spot. Reason? Exercise (mission accomplished).

We park, and I walk my mother up to the entrance to the store. Next, I get her into one of those electric shopping carts that allow you to drive around the store. This forces my mother to use her brain (mission accomplished).

When I take her into Walmart we drive around through all the departments. This allows my mother to use her brain for an extended period of time, and to be exposed to the bright lighting (mission accomplished).

My mother usually gets nervous when she is around large groups of people. The experience in Walmart exposes her to lots of people, and sometimes when she is stopped people actually say 'hi' or start talking to her (mission accomplished).

The trip to Walmart satisfies a need to keep her in and attached to the outside world. (mission accomplished).

If I let my mother sit around (actually lay around at home), she often falls into a dark mood. Sometimes she will just stop talking, or worse utter words like " I would be better off dead", or, "I am living on overtime".

I noticed years ago, when I take her out into the world her behavior improves, she starts smiling, and often starts interacting with others (this really makes me feel good--mission accomplished).

To be honest, we both benefit from the trip to Walmart.

My mother gets out, gets some exercise, gets exposed to bright light: while riding in the car, walking up to the store, and in the store. She gets to see people and do one one of her favorite things--shop. She likes the cloths section almost as much as she likes grabbing a box of Cheez-it off the shelf.

For me? I get out in the world and stay attached to other human beings. This beats staying at home day after day--all alone.

The trip to Walmart is like a respite to me. Even though I am a man, I can now tell you the price of everything we buy. I can tell you we save lots of bucks while shopping in Walmart--another benefit.

We now go to super Walmart weekly.

My advice to you? Get out in the real world and smell the Cheez-it(s).

Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for advice and insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 700 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.

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Sunday, July 19, 2009

Caring for Our Parents (Book Review)

This is a serious book by an accomplished journalist, writer--Howard Gleckman.

'If you are a Boomer, you should buy this book and put it on the coffee table. You will need it in the future to take care of yourself. The notes section of this book, alone, is worth the purchase price. The 22 pages of notes come in the form of a bibliography that you will be referring to over and over in the years ahead.

Caring for Our Parents is chock full of information and example that you, and I, will need as we age'. --Bob DeMarco, the Alzheimer's Reading Room

Wednesday, July 08, 2009

Roubini Still Concerned About the Economy


In conclusion, the outlook for the U.S. economy remains very weak. The recent rally in global equities, commodities and credit may soon fizzle out as worse-than-expected earnings and financial news take their toll on this rally, which has gotten ahead of improvements in actual macroeconomic data.

Source: RGE Monitor Newsletter email
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Lingering Concerns:

Labor market conditions are still quite dire, more than 3.4 million jobs have been lost in 2009 and about 6.5 million have been lost since the beginning of the recession. Compare this with the 2.5 million jobs lost in the recession of 2001; 1.5 million lost in the recession of the early 1990s; 3 million in the one of the early 1980s; 2.2 million in the one of the 1970s.

The pace of job losses has fallen from the 600K plus per month registered between December and March 2009 to about 350K in May and 467K in June; the average monthly job losses in this recession is now at about 360K. While the recent slowing of losses is a positive development, we have to put this in perspective: in previous post-war recessions, average monthly job losses have ranged between 150 thousand and 260 thousand. Moreover, average weekly hours in private nonfarm payrolls are at the lowest since 1964, as employers have cut employees’ hours. Job openings and turnover openings continue to fall and are at the lowest levels since 2000, indicating continued weakness in the economy.

The U.S. consumer is still the engine of U.S. growth, and contributes to over 70% of aggregate demand. While saving rates are headed for the high single digits and high oil prices together with long-term rates keep putting a dent in personal consumption, the over-leveraged consumer is finding some support in the tax breaks of the fiscal stimulus package. Yet the over-indebted U.S. consumer – whose deleveraging process yet has to start – will likely continue to put the brakes on consumption, while the savings rate continues to creep up. While this will encourage a rebalancing in the U.S. and global economy, in the medium-term it isn’t likely to support strong U.S. and global growth.

Housing starts appear to have stabilized and will likely move sideways for quite some time. However, housing demand is not yet improving at a pace that can guarantee that the lingering inventory overhang will dissipate. This implies that home prices will continue to fall. RGE Monitor expects home prices to continue to fall through mid-2010.

U.S. industrial production has been contracting for 17 months in a row – with a short break in October 2008. Industrial production usually finds a bottom shortly after the ISM manufacturing index does. While the index probably found its bottom back in December 2008--at depression levels of 32.9--industrial production remains in a mode of contraction that started in January 2008.

Financial conditions are showing some improvement. Banks are borrowing at zero interest rates and higher net interest margin can definitely help rebuild capital. Regulatory forbearance, changes in FASB (Financial Accounting Standards Board) rules and under-provisioning might enable banks to post better than expected results for a few quarters. However, relaxation of mark-to-market rules reduces the banks’ incentives to participate in the Public-Private Investment Program (PPIP) and therefore reduces the likelihood that the program will succeed in clearing toxic assets from banks’ balance sheets. The muddle-through approach might be successful in a scenario in which the U.S. and global economy recover soon and go back to potential growth during 2010, but according to RGE’s forecasts, this is highly unlikely. While we might have positive surprises coming from the banking system in the next couple of quarters, the situation could turn around again after that, jarring confidence in financial markets in a way that would spill into the real economy. Increases in the unemployment rate, well beyond the rates envisioned by the adverse scenario of the recent bank stress tests, imply that recapitalization needs are larger than what the too-lenient stress test prescribed. The U.S financial system – in spite of the massive policy backstop – thus remains severely damaged, and the credit crunch remains unlikely to ease very fast.

A sharp rise in public debt burden – the U.S. Congressional Budget Office estimates that the public-debt-to-GDP ratio will rise from 40% to 80% (in the next decade), or about $9 trillion – will also put a dent on growth. If long-term rates were to increase to 5%, the resulting increase in the interest rate bill alone would be about $450 billion, or 3% of GDP. The implication is that the fiscal primary surplus will have to be permanently increased by 3% of GDP, which could constitute further pressure on the disposable income of the U.S. consumer.

Not only does the U.S. economy face downward risks to growth in the medium-term, but potential growth might fall as well. The U.S. population is aging. With employment still falling – and another jobless recovery on the horizon – the rate of human capital accumulation will fall. Moreover, workers who remain unemployed for a long period of time lose skills, while young workers that enter the workforce, but don’t find a job, don’t acquire on-the-job skills. Reduced investments in worker training and education, coupled with lower capital expenditure, are a recipe for lower productivity ahead.

Deflationary pressures are still present in the U.S. economy. Demand is falling relative to supply and excess capacity is still promoting slack in the goods markets. Moreover, the rising slack in labor markets, which is pushing down wages and labor costs, implies that deflationary pressures are going to be dominant this year and next year. This implies that the Fed will keep monetary policy loose for a while longer. However, discussion of an exit strategy has to start now as investors’ concerns about the Fed’s ballooning balance sheet and expectations of inflation both mount.

There are also signs that a double-dip recession could materialize toward the second half of next year, or in 2011. If oil prices rise too much, too fast, too soon, that’s going to have a negative effect in terms of trade and real disposable income in oil-importing countries. Also, concerns about unsustainable budget deficits are high and are pushing long-term interest rates higher. If these budget deficits are going to continue to be monetized, eventually, toward the end of next year, there is a risk of a sharp increase in expected inflation that could push interest rates even higher. Together with higher oil prices, driven up in part by this wall of liquidity rather than fundamentals alone, this could be a double whammy that would push the economy into a double-dip or W-shaped recession by late 2010 or 2011.

In conclusion, the outlook for the U.S. economy remains very weak. The recent rally in global equities, commodities and credit may soon fizzle out as worse-than-expected earnings and financial news take their toll on this rally, which has gotten ahead of improvements in actual macroeconomic data.


Bob DeMarco is a citizen journalist and twenty year Wall Street veteran. Bob has written more than 700 articles with more than 18,000 links to his work on the Internet. Content from All American Investor has been syndicated on Reuters, the Wall Street Journal, Fox News, Pluck, Blog Critics, and a growing list of newspaper websites. Bob is actively seeking syndication and writing assignments.


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Tuesday, July 07, 2009

Is your Elderly Parent Taking Their Medication as Prescribed? Doubt It

I learned the hard way that my mother was not taking her hypertension medicine as prescribed. I discovered this many months after she was diagnosed with dementia and probable Alzheimer's.

If I had paid attention sooner, would it have made a difference in her diagnosis? I'll never know for certain.

This I believe. If I had paid attention, I would have realized sooner that something was wrong. Very Wrong. This would have allowed me to get my mother taking her medication as prescibed and gotten her diagnosed sooner.

Here is how I discovered my mother was not taking her prescription medicines as prescribed.

I went to the pharmacy and asked for a print out of the previous 12 months. When I looked, I was aghast.

If you have an elderly parent here is my advice to you. Don't be lazy, get the printout from the pharmacy. After a quick review you will know if the medications were purchased and if they were taken on schedule.

You can put you head in the sand and wait for Alzheimer's or dementia to present in someone you love. Or, you can start paying attention to the little things. The little changes in behavior that come with dementia long before it is detected.

I guess you could say we were fortunate. Two of the worst things that can happen from not taking hypertension medication are a heart attack or a stroke.

Early detection of Alzheimer's is important and critical to the quality of life your loved one is likely to experience. We got there early and my mother has benefited.

Enough said.
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Patients Can't Recall Their Medication to Tell Doctors
“We think doctors may be prescribing more medications because the patients aren't giving them the right information about what they are taking ..... I've seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using."
Doctors rely on patients to accurately tell them what prescription medications - and what dosages -- they are taking in out-patient visits. (A patient's chart may not always be available or complete.) That information is essential for physicians to monitor whether a drug is working, and whether it may have adverse interactions with any new medications prescribed.

Depending on patients' recall of their drugs, however, may be dangerous to their health.

New research from Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart. That number climbed to 65 percent for patients with low health literacy.

“It was worse than we expected,” said lead author Stephen Persell, M.D., an assistant professor of medicine, and of the Institute for Healthcare Studies at the Feinberg School, and a physician at Northwestern Memorial Hospital. “It means doctors can't ask patients to tell them the medications they are taking for their chronic conditions like hypertension. It's very hard to get at the truth of what medications the patient is actually taking.”

The study will be published in the November issue of the Journal of General Internal Medicine.

The Northwestern study looked at 119 patients, average age 55, from community health centers in Grand Rapids, Mich. Researchers asked them to name their antihypertensive drugs and then compared their answers to the drugs listed in their medical charts.

While the study focused on low-income patients, Persell said other patients likely have similar trouble recalling the names and dosages of all their medications, particularly those who take a lot of different drugs and the elderly, who may have cognitive limitations.

The gap between what medications a doctor thinks a patient is taking - and what a patient actually takes - is a new focus for improving the safety and quality of health care. One third of the nation's 1.5 million adverse drug events occur in out-patient settings, resulting in a cost of $1 billion annually. Persell thinks this "knowledge of medication gap" may be one of the causes.

The goal is "medication reconciliation," a term in the healthcare field that means patients and their healthcare providers understand and agree on the medications the patients are using and should be using.

Persell's study also showed patients with low health literacy were prescribed more antihypertensive medications than other patients and had higher blood pressure by about five points.

“We think doctors may be prescribing more medications because the patients aren't giving them the right information about what they are taking,” he said.

Even examining patients' medical records won't necessarily tell a doctor what pills a patient is swallowing. Persell said some patients continue to fill old prescriptions even if a doctor has changed the dosages or the medication.

“I've seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using," Persell said.

The solution is to ask patients to bring all their current medicine bottles to doctor appointments, so the physician can compare them to what has actually been prescribed in the medical charts, Persell noted. That's how he learned a patient he had switched to a cheaper version of a drug continued to take the older expensive one along with the new one, so he was double dosing himself.

"This could have caused a dangerous drop in his heart rate and blood pressure," Persell said.

The Northwestern study indicates a need for future research to address how patients' inability to name their medications -- particularly those with limited health literacy -- impacts hypertension control and drug safety, Persell said.

The study was funded by a career development award from the Agency for Healthcare Research and Quality, a Centers for Disease Control and Prevention Career Development Award and the Michigan Department of Community Health.
Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for advice and insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 700 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.

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