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MEDICINE & PUBLIC HEALTH

MEDICINE & PUBLIC HEALTH. Chen-Ya Huang,MD,MPH,Ph.D Medical Director, MS-IPA Adviser, Empire Health Plan Assistant Clinical Professor, Rutgers New Jersey Medical School. FOCUS OF PUBLIC HEALTH. Population-Based Health Analysis Preventive diseases/prolonging life/promote health.

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MEDICINE & PUBLIC HEALTH

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  1. MEDICINE & PUBLIC HEALTH Chen-Ya Huang,MD,MPH,Ph.D Medical Director, MS-IPA Adviser, Empire Health Plan Assistant Clinical Professor, Rutgers New Jersey Medical School

  2. FOCUS OF PUBLIC HEALTH • Population-Based Health Analysis • Preventive diseases/prolonging life/promote health. • Federal-State-local-Community Partnership • Incorporated the interdisplinary team approach ( Epidemiology, Biostatistics,Enviromental science, Behavior health, social-economic-political sceiences,insurance and legal issues • Prevalence of Infectious diseases decreased in 20 Century, More focus on chronic diseases/Cancers/CVD.

  3. PUBLIC HEALTH SURVEILLANCE • Early Warning System for impending health emergency • Epidemiology of health problems, inform health policy and strategy. • Diagnosis, investigate/monitor health hazard of the community. • Assessing current services and evaluating whether they are meeting the objective of health care system • Global effort to improve health care for all.

  4. Federal-State-Local health Departments • About HHS (Health and Human Services) • Providing essential human services, especially • for those who are least able to help themselves • * CMS (Centers for Medicare & Medicaid Service) • *CDC (Centers for Disease Control and Prevention) • *FDA ( Food and Drug Administration) • *NIH ( National Institute of Health) • SAMHSA (Substance Abuse and Mental Health Services Administration) • * IHS (Indian Health Service) • State Health Departments State-wide PH program, regulating hospitals &healthcare biomedical laboratory and prevention. • County & City Health Departments. • New York City Department of Health and Mental Hygiene.

  5. US Health Care Reforms • 1798 Marine Hospital Service(MHS) • 1887 Public Health Service(PHS) • 1931 National Institute of Health(NIH) • 1965 Social Security Act (SSA) Medicare (Part A & Part B) and Medicaid • 1985 COBRA • 1986 Emergency Medical Treatment and Active Labor Act • 1996 HIPAA(Health Insurance Portability and Accountability Act) HEIDS QUALITY Quidlines rated by NCQA. • 1997 Balance Budget Act(BBA): Medicare Advantage Plan. (Medicare Part C):HMO,PPO,FFS.,Medical saving account plans. • 2003 Medicare Modernization Act: Medicare Part D. • 2010 Patient Protection and Affordable Care Act (ACA): cost control, Cut MA plans, Individual mandate, Health Insurance Exchange, ACO, PCMH, IPAB( Independent Payment Advisory Board for Cost 2015).

  6. ACA of 2010 • October 1,2013: enrollment & Plan selection. • January 1, 2014:coverage start. • The market place will automatically if qualify for discount based on income. • The Exchange will subsidized private insurance 7 million people in 2014 who currently lack of adequate coverage. • IT system connect the Exchange to CMS, insurers and IRS system for eligible for federal subsidies for help pay insurance premium.

  7. Comments on US Health Care • High cost: 17%GDP, up 6.9% yearly, $7420 per person. $227Billion for prescription. • ACA cost: $940 Billion for 10 years. Cut Medicare $500 Billion in 10 years.3.8% new Medicare tax on unearned income. • Medicare Advantage Plan: Lower benefit and higher copayment. • 2019: higher Part B premium for earning $85,000. • The ACA too much regulations, red tap, more bureaucracy. Increase cost for healthiest people. Health care rationing leading to Single Payer System. It is a political movement.

  8. OBESITY:PUBLIC HEALTH ENEMY #1 • Abdominal Obesity(women>35in. Men>40in.) • BMI: Normal 18.5-25, Over weight 25-30, Obesity>30. • Adipose tissue as an Endocrine Organ System. Role in hormones, growth factors, cytokines which may disrupt cellular mechanism, hall mark of malignancy. • High risk visceral fat: A key component in Cardiometabolic Risk. INSULIN RESISTANCE Vascular inflammation Dyslipidemia Hypertension IT IS ALL ABOUT CALORIES and SUGARS.

  9. METABOLIC SYNDROME • Increase risk for Heart attack,stroke,PAD. • Elevated Blood Pressure>130/85 • Abdominal Adiposity: Waist>30inches(Asians) • Low HDL: Men<40. Women<50 • Elevated triglycerides: >150 • Elevated blood glucose: Fast blood glucose>110.(prediabetes 100-125,diabetes>126).

  10. INSULIN RESISTANCE • Aging may reduce insulin sensitivity and leading to high blood sugar. • Insulin resistance: coexist with obesity and lead to T2DM. • Asian has more insulin resistance than other ethnic group. • Sugar and High-Fructose Corn Syrup (HFCS) linked to increasing diabetes and new cases of heart disease. Not only caused obesity epidemic of school kids, It can lead to liver toxicity (Non-Alcoholic Fatty Liver),play a role in Alzheimer and some forms of cancer.

  11. PRE-DIABETES • PRE-DIABETES:70 million Americans at high risk for developing diabetes. • Fast Blood Sugar:100-125mg/ml. • Postprandial BS: 140-199mg/ml. • Triglycerides < 150. A1c >5.7% • Pre-diabetes is reversible. It will lead to diabetes within 10 years. • WARNING SIGNS: Inability to focus, bloating, sleepiness after meals, weight gain, high triglycerides, high blood pressure, hunger,acanthosis Nigerian, and depression.

  12. HEAT STROKEA TRUE MEDICAL EMERGENCY • Exertional Heat Stroke: It is a life-threatening condition with high body temperature 104F or higher. High morbidity and mortality, especially when therapy is delayed. Rhabdomyolysis: break down damaged muscle tissue with myoglobin and leading to kidney failure and/or multiple organs failure and death. • Heat cramps: Painful muscle cramps &spasms (legs and abdomen) Heavy sweating, normal temp. • Heat exhaustion: Weakness, heavy sweating, cool clammy skin, weak pulse, dizziness ,nausea,vomiting,fatigue,normal temperature. • Heat Stroke: fatal if not properly treatment ASAP. Hyperthermia( BT 104F-106F)(40C-41.1C) Confuse,headache,nausea, vomiting, rapid pulse, hot and dry skin, sweating likely if involved in vigorous activity. Hallucination,agitation.seizure and coma.

  13. MULTIPLE CEREBRAL INFARCTS • Ischemia stroke due to injury of blood vessels in the brain. • Disturbance of blood supply to brain due to atherothrombolic or embolic. • Ischemia infarcts may cause focal neurological deficits: Slow speech if infarction on left side of brain. Frequency of falls due to muscular weakness. Depression will follow with decline in cognition and post traumatic stress. • Physical therapy, speech training and intensive psychotherapy are timely important.

  14. PRISON HEALTH SERVICES • Correction Department mission is not health care but to maintain custody and control of inmates as required by laws. • Split of prison health care from the jurisdiction of correction authority is essential for the inmates to receive good medical care. • Prison medical care in Taiwan is in a state of chaos and crisis as a case of former president in prison. • Medical Parole Board: Allow inmates to be release to a community health facility for medical and mental health care.

  15. Rabies,CKD &Mental Health • Preventive Medicine • Vaccinations & Surveillance. • Early Diagnosis &Early treatment. • Public Health Education • Primary Care Coordinating Care • Culture and Political factors • Community mental Health Clinics • Chronic Disease Management.

  16. LIFE EXPECTANCY • Sexagenarian 60-69. Septuagenarian 70-79. Octogenarian 80-89. Centenarian 100-109 • From age 65 at the different time frame: 1900:76.9yr, 2000:82yr, 2040: 85yr.2060:100yr • BLUE REGIONS on earth: Okinawa Japan, Sardinia Italy, Loma Linda USA Nicoya Peninsula Costa Rica

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