Going to a farmers market is a great way to make sure you are eating fresh, healthy foods and reducing your carbon footprint by buying locally

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 They also allow farmers to establish relationships with their customers and create a sense of loyalty. The USDA maintains a National Farmers Market Directory where you can locate a farmers market near you, find out what products are available there, and the types of payment they accept. If there is no farmers market in your area, consider starting your own. There may be grant programsavailable to help you get started.

Keep your home free of pests without using pesticides

imageSummer temperatures can be pleasant, but warm weather also attracts insects and rodents. This is the time of year when ants, cockroaches, mice and other pests could stay in or around your home in search of water, food and a place to hide or reproduce. You can control insects and rodents without pesticides following these tips: Food restriction

  • Securely close the boxes and bags of cookies, cereal or candy to keep out roaches or ants.
  • Store foods such as flour, sugar, rice or pasta in airtight plastic bags or containers.
  • Dispose of waste in food you find on the floor, the table, the surfaces of the furniture and shelves and other parts of the kitchen or dining room.
  • Do not leave any food on the plates of your pet because it could attract cockroaches, ants and rodents.
  • Remember to take out the kitchen garbage frequently, preferably every night.

Restriction of water and fluids

  • Do not allow water or other liquids in the kitchen or other areas of the home build. Cockroaches can not survive more than a week without water.
  • Wash and dry dishes immediately after eating.
  • Repair water taps , keys or pipes in the kitchen, bathrooms, garden and around your house to prevent water leakage.
  • Avoid leaving puddles or excess water when watering plants. Standing water provides mosquito breeding.
  • Open the bathroom window after a shower to remove the steam. Vapor drops are enough to satisfy cockroaches and other insects.

Access Restriction

  • Seal cracks around pipes, doors and windows to keep out insects.
  • Repair holes in window screens.
  • Lock the space under the doors.
  • Before arriving home have check for eggs, larvae and small insects hidden in bags or boxes for your purchases.
  • Discard or recycle the boxes or envelopes that do not need to avoid a haven for cockroaches or rodents.
  • Place mice traps inside and outside your home where your children or pets do not have access.

Substance use during childhood or adolescence is linked to long-term health risks

The risk of developing drug dependence or abuse is greater for individuals who start using these substances in adolescence or early adolescence than for those who start during adulthood.According to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA), people who start using substances at a young age are at greater risk of needing treatment later.In 2011, 74 percent of people ages 18 to 30 who were admitted for substance abuse treatment started using substances at 17 or younger. The report also showed that 10.2 percent of those admitted for treatment started using at age 11 or younger.

In addition, those who start using substances at a younger age are more likely to be using more than one substance when they are admitted for treatment.More than 78 percent of those admitted who reported starting to use substances at age 11 or younger also reported abusing two or more substances when they started treatment. In contrast, for those who reported starting to use substances at age 25 to 30, less than half as many 30.4 percent reported abusing two or more substances.

Early to late adolescence is considered a critical risk period for the beginning of alcohol and drug use,” said SAMHSA Administrator Pamela S. Hyde.Knowing the age a person starts the use of a substance can inform treatment facilities so that they can better provide timely and appropriate prevention and treatment programs.”

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The most common allergens in the removal of food  are milk, wheat and soybeans. Any allergen present but not declared on the label of a product poses a serious risk to health. 

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Top Allergens in Food Recalls graphic - milk, wheat, soy (350 x 710)


If you are allergic to any food ingredient, you probably looked at the label. But some labels may not be as reliable as they should. In fact, the allergens will not be listed on the label, called “covert or undeclared allergens” are the main cause of withdrawal of food from the market by the Food and Drug Administration.

The FDA strives to reduce the number of such removals on three fronts: investigating the causes of these errors, collaborating with industry in terms of best practices and devising new ways to detect the presence of allergens.

Federal law requires food labels controlled by the FDA sold in the United States identify major food allergens they contain. In some people, these-the allergens milk, egg, fish, shellfish, nuts, wheat, peanuts or peanut and soybean can cause life-threatening reactions. A food with a label skip mandatory allergen information is deceptively identified and may be seized by the FDA. However, companies usually remove these foods market voluntarily.

Help denounce food allergic reactions

The first step is to learn more about the problem. Dr. Steven Gendel, PhD, coordinator of food allergens FDA emphasizes that consumers can help denouncing allergic reactions to foods to the consumer complaint coordinatorFDA his district. “We serve each of the complaints to determine the appropriate course of action,” he says.

“What we’re trying to find,” explains Dr. Gendel, “is what foods are the most affected, which allergens are the most encountered and how they might have succeeded in labeling errors. These answers will help us reduce the number of withdrawals by undercover allergens “.

Food recalls and allergens involved

In search of these answers, Dr. Gendel has inspected data on the withdrawal from the market by the FDA collected and finding some clear trends.

For example, between September 2009 and September 2012, approximately one third of the foods reported to the FDA as serious health risks involved undercover allergens. The five types of foods most often implicated in retirement due to food allergens were baked goods, snacks and sweets, sweets, dairy products, and dressings (such as salad dressings and sauces ).

The allergens most frequently involved in food recalls were milk market, wheat and soybeans. Consumers can find products which have been recently recalled in the electronic portals FDA and Research and Education on Food Allergies ( FARE,disclaimer icon for its acronym in English) and asking firms that develop .

Within the category of candy, there were many allegations of covert dairy products containing dark chocolate.For example, covert dairy led to the withdrawal of several treats in chocolate covered bar whose labels say “no dairy” or “vegan”. “This represents a significant risk to consumers who are allergic to milk,” warns Dr. Gendel.

The root of the problem

The data on the withdrawal of food from the market indicate that such labeling errors are due mostly to the use of the wrong label. This can happen when similar products made with different ingredients alérgenos- among them, are sold with similar packaging.

Dr. Gendel also found errors relating to the use of new technologies such as computerization and the ability to print the label directly on the packaging. This can save costs, but also create new opportunities for error.

The data suggest that the removal of food allergens can be reduced by raising awareness of the market over the industry, and performing simple changes in the way the packaging, labels and ingredients are handled and monitored in production facilities.

To encourage improvements, the FDA shares its findings with industry conferences and cooperates with the Alliance in Favor of Preventive Controls for Food Safety (FSPCA, for its acronym in English). FSPCA’s mission is to expand the safe production of food creating training programs and outreach in support of preventive controls described in the Act Modernization of Food Safety (FSMA, for its acronym in English)  from the FDA.

The FDA explores new ways to detect allergens

Of course, keep food free from banned allergens requires the use of good methods for detecting them.

The most common test used worldwide is the essay by enzyme-linked immunosorbent assay (ELISA, for its acronym in English), which uses antibodies (parts of the immune system that help neutralize viruses and bacteria) and spectroscopic detection to find allergens.

Dr. Mark Ross, PhD, chemist FDA says that the ELISA test is the standard test because it is easy to use, relatively inexpensive and scientists have been improving it over time. But the ELISA, like similar tests used in medicine, can have false positive results, so backup methods are needed. In addition, some allergens are so similar that scientists need other than the ELISA test to differentiate. Dr. Ross is collaborating with other researchers from the FDA to design analysis methods allergens founded on mass spectrometry, a technology that determines content more effectively allergenic proteins of the complex mixture of proteins, fats, sugars and chemicals that make up a food.

“If someone wants to analyze a food seeking an allergen, peanut, with mass spectrometry can detect and distinguish between 11 different peanut allergen proteins” he explains.

The FDA researchers are also designing methods of DNA analysis, in particular to detect allergens in fish and seafood.

This article is available on the website of Consumer Goods FDA , in which the latest on all FDA-regulated products are published.

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During the holiday season, it seems that all we do is shop, shop, shop. While not paying attention when you purchase holiday gifts places your wallet at risk, not paying attention when you purchase groceries can place your health at risk.

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If you don’t take certain safety steps while grocery shopping, you can risk food poisoning. Grocery shopping is where safe food handling should start, by following these recommendations you can make sure the food you bring home is safe.

  1. A mom and her son shop in the grocery store together.Keep raw meat, poultry, and seafood separate from other foods in your grocery cart. This will keep the meat juices that may contain bacteria away from other items in your shopping cart. By wrapping these raw items in an additional plastic bag, usually provided near where meat is displayed, you can further prevent drippings from contaminating other items.
  2. Buy cold foods last. If cold grocery items are allowed to stay at room temperature for longer than 2 hours, they can start growing bacteria that cause food poisoning. Often when we’re holiday grocery shopping we’re purchasing unusual foods or items in bulk. The extra time it takes to find these items means we move through the store slower. More people in the store shopping also means checkout may take longer than usual.

These delays can quickly add up and your perishable items may be out of refrigeration too long. By purchasing your cold food items last, you don’t have to worry about the time it took you to track down the nutmeg.

  1. Ask the cashier to place your raw meat, poultry and seafood items in a separate bag. This way you won’t have to worry about raw meat juices leaking on ready-to-eat items, like bread or pies.
  2. Purchase a meat thermometer. If you do not already own a meat thermometer, make sure to pick up this cooking essential during next trip to the grocery store. A thermometer will help you ensure all your holiday dishes are fully cooked. The color or texture of food does not accurately indicate that it reached a high enough temperature to incapacitate bacteria.

Just as you have a procedure for storing your holiday gifts when you get home, you should have a system for storing your food.  It is important to immediately place your cold items in the refrigerator or freezer to avoid them getting warm enough for bacteria to grow.

When you place items in the fridge, you should be able to place your raw meat, poultry and seafood on the bottom shelf of the refrigerator where it will not drip on ready-to-eat items. To further avoid cross-contamination from raw juices, place your raw meat on a plate or similar container that will prevent dripping.

By: Amelia Kermis, MPH CHES, Food Safety Education Staff, Food Safety Inspection Service, USDA

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The strength of the 40-plus nation coalition fighting the Islamic State of Iraq and the Levant ultimately will defeat the terrorist group, the commander of Combined Joint Task Force Operation Inherent Resolve said here today.

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Army Lt. Gen. James L. Terry provided an operational update to Pentagon reporters.

“The fact that we have so many nations united in this mission, I think, is really significant,” he said. “Various countries will contribute national capabilities on different timelines. The strength of this team is in our common purpose, and what unites us is a strong resolve to combat this threat.”

Three Foundational Priorities

The general described the combined joint task force’s three foundational priorities.

“First, we will contribute to build and maintain the coalition,” he said. The task force provides an organizing framework to synchronize and integrate capabilities and amplify the efforts of 40-plus nations, which provides strategic advantage, Terry explained.

“Second,” he said, “as a coalition, we will relentlessly pursue Daesh in order to degrade and destroy its capabilities and defeat their efforts.” Daesh is a name for the terrorist organization that’s based on an Arabic acronym and is the preferred term among Arab nations in the coalition.

As of today, 1,361 airstrikes have been conducted, and two nights ago, 53 precision strikes supported Iraqi security force operations around Sinjar and Zumar, resulting in those forces regaining about 100 square kilometers of ground, Terry said.

“Combined efforts like these,” he added, “are having a significant effect on Daesh’s ability to command and control, to resupply, and to conduct maneuvering.”

The coalition will continue to be persistent in striking the terrorists at every possible opportunity, Terry said, while working to deny them safe haven and sanctuary. This, he added, will be done through precision strikes and by enabling partners to expand their footprint and influence and to remove the opportunities for the terrorists to manipulate youth, harm citizens, deny basic services and recruit fighters.

The key, Terry said, is assisting the Iraqi government in improving the country’s security forces, which he said are regaining their confidence and proving more capable every day. Iraqi forces have retaken many critical areas, such as Mosul Dam, Haditha, Rabiya and Zumar, he noted.

The final priority, the general said, is the coalition enabling regional partners as part of a broader diplomatic, intelligence, military and economic effort.

“Iraqi security forces must be a capable force — one that can restore Iraq’s sovereign borders, retake territory from Daesh and secure the Iraqi people,” Terry said. “An offensively minded and trained security force, backed by an inclusive government of Iraq, is the key to future stability.”

Additional U.S., Coalition Troops

Terry said an additional authorization for 1,500 U.S. personnel has been approved, and that they will serve in noncombat roles supporting additional advise-and-assist requirements and the effort to build partner capacity.

“In addition, we anticipate coalition contributions that should produce at least an additional 1,500 personnel in these efforts,” he said.

“We’re seeing initial successes in this fight,” Terry said, adding that the terrorists have been halted in transitioning to the defense and are attempting to hold what they currently have. This, he said, may result in some local counterattacks.

The challenges that lie ahead will require patience, Terry said.

“The government of Iraq understands the great threat they face, and they are resolved to defeat it,” he told reporters. “The combined joint task force represents … a new chapter of what I assess will be a successful campaign to bring the coalition’s power to bear and, ultimately, lead to the defeat of Daesh.”

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Biological agents are organisms or toxins that can kill or incapacitate people, livestock and crops. A biological attack is the deliberate release of germs or other biological substances that can make you sick.

The three basic groups of biological agents that would likely be used as weapons are bacteria, viruses and toxins. Most biological agents are difficult to grow and maintain. Many break down quickly when exposed to sunlight and other environmental factors, while others, such as anthrax spores, are very long lived. Biological agents can be dispersed by spraying them into the air, by infecting animals that carry the disease to humans and by contaminating food and water. Delivery methods include:

  • Aerosols - biological agents are dispersed into the air, forming a fine mist that may drift for miles. Inhaling the agent may cause disease in people or animals.
  • Animals - some diseases are spread by insects and animals, such as fleas, mice, flies, mosquitoes and livestock.
  • Food and water contamination - some pathogenic organisms and toxins may persist in food and water supplies. Most microbes can be killed, and toxins deactivated, by cooking food and boiling water. Most microbes are killed by boiling water for one minute, but some require longer. Follow official instructions.
  • Person-to-person - spread of a few infectious agents is also possible. Humans have been the source of infection for smallpox, plague, and the Lassa viruses.

Specific information on biological agents is available through the Centers for Disease Control and Prevention.


Before a Biological Threat

Unlike an explosion, a biological attack may or may not be immediately obvious. While it is possible that you will see signs of a biological attack, as was sometimes the case with the anthrax mailings, it is perhaps more likely that local health care workers will report a pattern of unusual illness or there will be a wave of sick people seeking emergency medical attention. You will probably learn of the danger through an emergency radio or TV broadcast, or some other signal used in your community. You might get a telephone call or emergency response workers may come to your door.

The following are things you can do to protect yourself, your family and your property from the effects of a biological threat:

  • Build an Emergency Supply Kit, which includes items like non-perishable food, water, a battery-powered or hand-crank radio, extra flashlights and batteries.
  • Make a Family Emergency Plan. Your family may not be together when disaster strikes, so it is important to know how you will contact one another, how you will get back together and what you will do in case of an emergency.
    • Plan places where your family will meet, both within and outside of your immediate neighborhood.
    • It may be easier to make a long-distance phone call than to call across town, so an out-of-town contact may be in a better position to communicate among separated family members.
    • You may also want to inquire about emergency plans at places where your family spends time: work, daycare and school. If no plans exist, consider volunteering to help create one.
    • Knowing your community’s warning systems and disaster plans.
    • Notify caregivers and babysitters about your plan.
    • Make plans for your pets
  • Check with your doctor to ensure all required or suggested immunizations are up to date. Children and older adults are particularly vulnerable to biological agents.
  • Consider installing a High-Efficiency Particulate Air (HEPA) filter in your furnace return duct. These filters remove particles in the 0.3 to 10 micron range and will filter out most biological agents that may enter your house. If you do not have a central heating or cooling system, a stand-alone portable HEPA filter can be used.
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Avoid using heart rate monitors or take fetal pictures of “remembrance”

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Ultrasonography is the most widely used medical method for imaging the fetus during pregnancy.

Fetal fetal ultrasonography provides images in real time.The fetal heart rate monitors Doppler ultrasonic devices are handheld devices that allow one to hear the heartbeat of the fetus. Both are prescription devices designed for use by trained health professionals. They are not intended for sale or use nonprescription medications, and FDA censorship categorically use to take videos and pictures of fetal keepsake.

“Although there is no evidence that there is any damage as a result of the ultrasound images and heart rate monitors, it is important that prudent use of these devices by providers trained health becomes” warns Dr . Shahram Vaezy, PhD, a biomedical engineer at the FDA.”Ultrasound can gently heating the tissue and in some cases also create tiny bubbles (cavitation) in some of them.”

The long-term effects of heating and cavitation of tissue are unknown. Therefore, ultrasonography should be performed only when there is a medical need, backed by a recipe and trained technicians.

The fetal keepsake videos are controversial, because exposing the fetus to ultrasound brings no medical benefit.The FDA knows of several companies that sell ultrasound imaging in the United States to fetal keepsake videos.In some cases, be that the ultrasound machine used for up to an hour to record a video of the fetus.

Although the FDA recognizes that fetal images can help strengthen the bonds between parents and the unborn baby, such opportunities are provided routinely during prenatal care. In creating fetal keepsake videos, there is no control over how long it will last one sonographic sign, how many sessions will be held or ultrasound systems work well. Instead, explains Dr. Veazy, “the proper use of ultrasound equipment covered by a prescription, ensures that pregnant women receive professional care that contributes to your health and your baby”.

Heart Rate Monitors Doppler ultrasound:

Similar concerns surrounding the sale and use of heart rate monitors Doppler ultrasound. These devices, which are used to hear the heartbeat of the fetus, are lawfully marketed as “medical devices prescription”, and can only be used by a health professional or under the supervision of one.

“When the product is purchased without a prescription and used without consulting a health care professional who is attending to the pregnant woman, there is no oversight on how the device is used. In addition, it is expected that exposure has little or no medical benefit, “says Dr. Vaezy. “Furthermore, the number of sessions, or duration, for the images of a fetus lack of controls, and that increases the possibility that the fetus and, ultimately, the mother damaged”.

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“By requiring employers to report when deaths or injuries occur, OSHA will work with employers to identify hazards and thus able to intervene before a tragedy occurs. We will also engage with employers, not only through inspections but with close to elimi

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Safety Fair in GeorgiaNew Requirements on Safety at Work

Enjoy a new year full of health and prosperity will have a new meaning for workers across the country in 2015. As of January 1 will require employers to notify the Occupational Safety and Health Administration (OSHA, for short in English) on deaths related to work within the first eight hours.

Employers will have 24 hours to report hospitalizations, amputation or loss of an eye. The above OSHA regulations require that employers just do reports on work-related hospitalizations and three deaths or more employees.

 Reports hospitalizations of individuals, amputation or loss of one eye were not necessary. The new requirements are as lifesaving purpose. Employers and workers can prevent future injuries by identifying and eliminating the most serious risks at work.

 “A death or injury at work is too and will do more to protect workers,” said Dr. David Michaels, assistant secretary of labor for OSHA.

 “By requiring employers to report when deaths or injuries occur, OSHA will work with employers to identify hazards and thus able to intervene before a tragedy occurs. We will also engage with employers, not only through inspections but with close to eliminate risks before they become fatal. “

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Vaccination is the best way to protect yourself from the flu. There are additional steps you can take to keep yourself and your family healthy this flu season.

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Get Vaccinated, take everyday precautions, take preventive antiviral medications

  • Everyone 6 months of age and older should get vaccinated against the flu.
  • Take everyday precautions, like washing your hands, to protect your health.


What is the best way to protect myself and my family from the flu?

Everyone 6 months of age or older should get the flu vaccine as soon as it is available in your area.

What everyday steps can I take to stop the spread of germs?

There are steps you can take in your daily life to help protect you from getting the flu.

  • Wash your hands often with soap and water or an alcohol-based hand rub.
  • Avoid touching your eyes, nose, or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.

Are there medications I can take to prevent getting the flu?

If you are healthy but exposed to a person with the flu, antiviral drugs can prevent you from getting sick. Antiviral medications are prescription pills, liquids, or inhalers used to prevent or treat flu viruses. They are approved for adults and children one year and older. There are four antiviral drugs approved for treating the flu in the United States—oseltamivir (Tamiflu), zanamivir (Relenza), amantadine (Symmetrel), and rimantadine (Flumadine). The sooner you are treated with an antiviral, the more likely it will prevent the flu. Antiviral drugs are 70% to 90% effective at preventing the flu. Talk to your health care provider if you think you need antiviral drugs.

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The century epidemic of smoking has caused a huge public health catastrophe could have been avoided in the United States.

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  • Since the first published Report of the Directorate General of Health Services of the United States on smoking and health ” 50 years ago, more than 20 million people in the US have died from smoking.
  • If current rates continue, it is projected that 5.6 million people under 18 who live in the United States today will die prematurely from smoking-related diseases.
  • Most of the 20 million tobacco-related deaths occurred since 1964 occurred in adults who smoked; However, 2.5 million of these deaths occurred among nonsmokers from diseases caused by exposure to secondhand smoke people.
  • More than 100,000 babies have died in the last 50 years by the syndrome of sudden infant death, complications of premature birth, complications from low birth weight and other problems that occur during pregnancy as a result of parental smoking.
  • The tobacco epidemic was caused by the tobacco industry and is still maintained by it to deliberately provide misleading the public about the risks of smoking cigarettes.

Although significant progress has been made since the first report of the Directorate General of Health Services, published 50 years ago, smoking remains the largest single cause of preventable illness and death in the United States.

  • Smoking rates among adults and adolescents are less than half what they were in 1964; however, 42 million adults in the United States and nearly 3 million students in secondary and higher secondary school continue to smoke.
  • Each year, nearly half a million people in the US die prematurely from smoking.
  • More than 16 million people in the US. UU. suffering from illness caused by smoking.
  • On average, compared with those who never smoked, smokers suffer more health problems and disabilities by smoking, and ultimately lose more than a decade of life.
  • The estimated economic costs of smoking and exposure to smoke snuff attributed continue to rise and currently are close to 300 000 million annually, with direct medical costs of at least 130,000 million and productivity losses 150 000 million a year.

Scientific evidence can not be refuted: the inhalation of smoke snuff, particularly from cigarettes, is fatal. Since the first report of the Directorate General of Health Services of EE. UU. in 1964, evidence has linked smoking to disease in nearly every organ of the body.

  • In the US, smoking causes 87% of lung cancers, 32% of deaths from coronary heart disease and 79% of all cases of copd chronic obstructive pulmonary disease.
  • One in three cancer deaths are caused by smoking.
  • This report concludes that smoking causes colorectal and liver cancer, and increases the rate of failure of treatment of all cancers.
  • The report also concludes that smoking causes diabetes, rheumatoid arthritis and weakened immune system, increased risk of tuberculosis and death, and ectopic (tubal) and fertility problems, cleft lip and cleft palate in babies born to women who smoked during early pregnancy, erectile dysfunction and macular degeneration associated with age.
  • It is now known that exposure to secondhand smoke causes cerebrovascular accidents in nonsmokers.
  • This report found that in addition to causing a host of serious diseases, cigarette smoking affects the general state of health, impairs immune function and reduced quality of life.

Smokers have today an increased risk of lung cancer than smokers in 1964.

  • Although nowadays people smoke fewer cigarettes than 50 years, have a higher risk of lung cancer.
  • Changes in the design and composition of cigarettes that have been made since the 50s have increased the risk of lung adenocarcinoma, lung cancer more frequently.
  • The evidence suggests that the ventilated filters can contribute to higher risk of lung cancer by allowing smokers to inhale more deeply and thus carry carcinogens that cigarette smoke contains more internal parts of the lung tissue.
  • At least 70 of the chemicals contained in cigarette smoke are known carcinogens. The levels of some of these chemicals have increased because manufacturing processes have changed the content of cigarettes. The evidence suggests that higher levels of these chemicals in cigarettes today may have contributed to greater risks of lung adenocarcinoma, the most common lung cancer.

For the first time, women have the same probability of dying from many diseases caused by smoking than men.

  • In women, the risk of disease due to smoking have increased dramatically over the past 50 years and today are equal to those of men for lung cancer, COPD and cardiovascular disease. The number of women who die from epoc now exceeds that of men.
  • Evidence also indicates that women are more prone to severe COPD at an earlier age.
  • Between 1959 and 2010, significantly increased the risk of lung cancer among smokers. In women smokers, the risk increased tenfold. Among male smokers, the risk doubled.

Strategies and programs to control smoking proven, in combination with better strategies to quickly eliminate the consumption of cigarettes and other products of snuff that burn, will help to achieve a society free of disease and smoking-related deaths. 

  • You need to take additional steps to achieve the goal of eliminating the disease and deaths associated with smoking.
  • The tobacco control interventions based on evidence that they are effective still not enough used. Among the measures that we know are effective to prevent people from starting to smoke and encourage them to stop smoking campaigns are great impact on the media, snuff taxes high enough to make young people give up smoking and that motivate stop, easy access to smoking cessation treatments and promotion in medical environments, smoke-free policies and comprehensive control programs snuff with state funding to levels recommended by the CDC.
  • Illness and death from consumption of snuff in the US are caused mostly by cigarettes and other snuff products that burn. The rapid elimination of their consumption drastically reduce the public health burden.
  • Have been proposed new endgame strategies with the goal of eliminating smoking. Some of these strategies may be useful in the United States, in particular the reduction of nicotine in snuff products at levels that do not cause addiction.
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Beginning in 2015, CMS will implement the following improvements to the Nursing Home Five Star Quality Rating System:

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  • Nationwide Focused Survey Inspections: Effective January 2015, CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System. In Fiscal Year (FY 2014), CMS piloted special surveys of nursing homes that focused on investigating the coding of the Minimum Data Set (MDS), which are based on resident assessments and are used in the quality measures.
  • Payroll-Based Staffing Reporting: CMS will implement a quarterly electronic reporting system that is auditable back to payrolls to verify staffing information. This new system will increase accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing. Implementation will be improved by funding provided in the recently enacted, bipartisan Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014.
  • Additional Quality Measures: CMS will increase both the number and type of quality measures used in theFive-Star Quality Rating System. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are in use. Future additional measures will include claims-based data on re-hospitalization and community discharge rates.
  • Timely and Complete Inspection Data: CMS will also strengthen requirements to ensure that States maintain a user-friendly website and complete inspections of nursing homes in a timely and accurate manner for inclusion in the rating system.
  • Improved Scoring Methodology: In 2015, CMS will revise the scoring methodology by which we calculate each facility’s quality measure rating, which is used to calculate the overall Five Star rating.  We also note that sources independent of self-reporting by nursing homes already are weighted higher than self-reported components in the scoring methodology.

“Nursing homes are working to improve their quality, and we are improving how we measure that quality,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer. “We believe the improvements we are making to the Five Star system will add confidence that the reported improvements are genuine, are sustained, and are benefiting residents.”

Home Health Conditions of Participation

The proposed Home Health Conditions of Participation would improve the quality of home health services for Medicare and Medicaid beneficiaries by strengthening patient rights and improving communication that focuses on patient wellbeing. Currently there are more than 5 million people with Medicare and Medicaid benefits that receive home health care services each year from approximately 12,500 Medicare-certified home health agencies.

The proposed regulation, to be displayed Monday, October 6, at the Federal Register, would modernize the home health regulations for the first time since 1989 with a focus on patient-centered, well-coordinated care. Elements in the regulation include expansion of patient rights requirements; refocusing of the patient assessment on physical, mental, emotional, and psychosocial conditions; improved communication systems and requirements for a data-driven quality assessment; and performance improvement (QAPI) program.

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