Matt Masiello, M.D., MPH

Author: MattMasielloMD

  • Local schools adopt fitness, nutrition programs

    JOHNSTOWN — New state and federal regulations and guidelines addressing wellness issues have swept through school systems, rewriting health, physical education, consumer sciences and school lunch programs.

    Although some say the changes are making a difference, most agree that it takes more than rules.

    “We have changed constantly over the 20-plus years I’ve been here,” Marian Boyer, food service director, said from Forest Hills High School.

    “There is much more awareness among students, teachers and parents about food and nutrition.”

    Selections now have less salt, more whole grains and less fat, John Smithmyer, food service director, said at Portage High School.

    The number of a la carte items has been reduced drastically to encourage students to choose from the main selections.

    “It is not hard to meet the requirements,” Smithmyer said. “It is hard to get the children to make the right choices. It is not something they do at home. Just exposing them here is not enough.”

    School nurses are now required to measure and weigh all students, complete a body mass index and report to parents, along with information about obesity levels and dangers. Parents of children in or near the obese range are encouraged to work with family health-care providers, said Debbie Stutzman, school nurse for Berlin-Brothersvalley School District.

    But that is not enough, declared Dr. Matthew Masiello, chief wellness officer at Windber Research Institute.

    “It goes far beyond sending out the notices,” Masiello said.

    “You need leadership at the school level.

    “We will become successful in school when the leadership – whether it is the principal or the superintendent or someone else – commits themselves to addressing these issues.”

    School lunch menus still have too many unhealthy foods, Masiello said, adding that healthy selections are not always well presented.

    “Are you going to provide healthy choices, and unhealthy choices?” he asked. “It is a rare school where you can find a healthy meal.”

    Masiello urges schools to involve parents by sending the school nurse or a hospital dietitian to parent-teacher organizations.

    If school administrators and parents are concerned about grades and test scores, a student’s health is the first step.

    “Exercise and nutrition are significant factors in regard to grades,” he said. “It will improve academic success of their children. That has been proven over and over again.”

    Healthy teachers make the best instructors when it comes to wellness issues, Masiello said, urging teachers to adopt a healthy lifestyle.

    Schools are getting the message, Portage school nurse Lisa Dividock said. But there is a lot of inertia on the unhealthy side.

    “Fast food, time management and the computer age have all taken their toll,” Dividock said. “The guidelines forced the parents and the teachers and the media to look at it.”

    Many families face financial hardships when it comes to buying fresh fruits and vegetables or even getting gasoline to get to the doctor or participate in wellness programs, she added.

    Dividock has seen improvements. Vending machines at Portage are are not as sugar-and-fat-filled as they once were, and they are shut off during the school day.

    20120517-161839.jpgTreadmills, weight benches and other equipment at a new wellness center attract a significant number of students for workouts every morning, Portage Principal Ralph Cecere said.

    “We are pleased with the turnout,” Cecere said.

    A similar fitness center at Greater Johnstown Middle School is a big part of the success of the Trojan Afterschool Program, Principal Darren Buchko said.

    About 130 students a day participate in the program, which also provides homework help; tobacco, drug and alcohol prevention; social responsibility awareness; and clubs geared to student interest. The program continues as Summer in the City after the school year, Buchko said.

    “They are trying to get these kids ready,” Buchko said. “They are already exposed to potentially dangerous and harmful habits. We deal with everything from cyber issues like social networking dangers to what you’d call the old school issues of drugs and alcohol.”

    Community Action Partnership, the Girl Scouts and Greater Johnstown YMCA provide programming during the after-school and summer programs.

    It provides incentive for students to be active instead of sitting at home with electronic entertainment, YMCA fitness director Debbi Smith said.

    “We are trying to get these kids to come in on the premise that moving around can be fun,” Smith said. “We have to get the kids out and let them be kids again.”

    Collaborating with organizations such as the YMCA is one way schools are finding ways to provide more wellness programs without spending more tax dollars. Many have also found grant funding that supports fitness and nutrition initiatives.

    At Forest Hills School District, grants brought mountain biking and fishing programs, Superintendent Edwin Bowser said.

    “We do a lot of things in lifelong learning activities,” he said.

    The high school also provides daily nutrition tips as a part of morning announcements and schedules special activity-promoting events throughout the year. A Pumpkin Run in the fall, for instance, featured an outdoor obstacle course over hay bales.

    A fit-athon at Richland Elementary gets students excited about moving and exercising, said Tom Smith, assistant high school principal.

    At Richland High School, the weight training and fitness center attracts a cross-section of students, Principal Brandon Bailey said.

    When it comes to drug and alcohol prevention, students take the lead at Richland, Bailey said.

    “We are pretty proud of the program,” Bailey said. “We have a group of high school students who do a lot of prevention, teaching the younger kids all about the evils of alcohol, tobacco and drug use. I think it’s a pretty effective program.”

    Faculty members screen and train participating high school students, he explained.

    At Rockwood School District, teachers are setting an example through a Rockwood Biggest Loser competition, school nurse Amanda Custer said. So far, the 25 participants have lost a combined 157 pounds.

    Communication with parents through newsletters, school website postings and the media help boost wellness programs in Central Cambria School District, middle school Principal Kim McDermott said.

    Recent examples include the NFL Fuel Up to Play 60 Challenge, a 10,000-steps program using pedometers, and the Hoops for Hearts program that doubles as a fundraiser for the American Heart Association.

    **This article was published in the Tribune Democrat on 2/25/12

    http://tribune-democrat.com/local/x843245185/Local-schools-adopt-fitness-nutrition-programs

    ;

  • Heart health: Smoking a prime heart disease culprit

    20120517-160303.jpgDr. Bernard Leech of Conemaugh Family Medicine Center has been known to ask patients if he can prescribe medicine that costs $7 a day and causes shortness of breath, raises blood pressure and heart rate, reduces oxygen levels, contains cancer-causing chemicals and will ultimately cause death.

    When patients balk, he points out that he just described their smoking habit.

    Although smoking is often associated with an increased risk of cancer, tobacco is also the No. 1 risk factor for heart disease.

    “Cigarettes increase your risk of atherosclerosis,” Dr. Jeanne Spencer, Memorial Medical Center family medicine residency program director said at the Family Medicine Center.

    Atherosclerosis refers to the buildup of fats as plaque on artery walls. Atherosclerosis in the arteries of the heart can lead to heart attacks.

    “Nicotine causes vasoconstriction, which is when the blood vessels spasm and close down a bit,” Spencer said. “If they tighten down when they are already narrowed (by atherosclerosis), you are in bigger trouble.”

    Smoking also increases the heart rate, but cuts down on the amount of oxygen pushing carbon monoxide and other waste materials into the bloodstream, said Michelle George, Memorial’s tobacco cessation/prevention program coordinator.

    And while the local medical experts stress the hazards of tobacco use, they understand the challenge quitting presents.

    ‘Dependency triangle’

    In 1988, a report by Surgeon General C. Everett Koop compared characteristics of tobacco addiction to heroin and cocaine addiction.

    “It is never going to be easy,” Leech said. “Ultimately, it boils down to empowering the individual to make that change. Our job is to assist them to that goal.”

    George says there are three aspects to the smoking addiction: Nicotine addiction, habit and emotion. Successful quitters have to break free from all three sides of the dependency triangle.

    Nicotine replacement therapy can help ease quitters through the withdrawal, she added.

    The second issue is breaking the smoking habit, which requires changes in routine, George said.

    “When do you smoke?” she asks. “When you get up in the morning? When you’re driving a car? You can modify your life-style. Take your coffee back to the bedroom and read the paper.”

    Spencer put it this way:

    “Try to change the routine.

    “Don’t sit in your smoking chair at smoking time and think you are not going to smoke.”

    20120517-160436.jpgThe third area, emotional dependency, also requires a change in routine. Smokers often light up when they feel stressed.

    “See what you can do in place of going out and having that cigarette,” George said.

    ‘Ready to quit’

    Memorial and Somerset Hospital each offer tobacco cessation classes that encourage participants to quit smoking by showing the health benefits and offering strategies for success.

    Tools include nicotine replacement products such as patches and chewing gum.

    But a study published last month in the scientific journal Tobacco Control casts some doubt on the value of replacement therapy.

    The study by Harvard Medical School’s Center for Global Tobacco Control and the University of Massachusetts found those using the replacement therapy were just as likely to relapse as those who quit “cold turkey.”

    Local cessation advocates believe more study is needed and continue to suggest nicotine replacement as a tool.

    “It helps get them through that relapse,” George said. “The patches help them not have as severe withdrawal symptoms. But they have to be ready to quit.”

    Dr. Matthew Masiello, director of the Center for Health Promotion and Disease Prevention at Windber Research Institute, said the study and the patches illustrate misconceptions.

    “We have to put it into context,” Masiello said. “There has to be a level of education accessible to use the products effectively. These patches will work if you use them effectively.

    “These studies tell us we have to stop thinking that the product is going to be it for us. You need to be working toward the optimal environment. You can’t think the product is going to change all of your environment.”

    The experts had several tips they like to share with smokers who want to quit.

    George and Spencer both urge smokers to set a quit date.

    As the date approaches, remove ashtrays and stashes of tobacco from the house.

    “Getting people around you to quit helps a lot,” Leech said.

    “That way you are not exposed to it.”

    Above all, be committed, Spencer said.

    “Most people try three times before they actually quit,” she said. “If they fail on the first try, we tell them to just do it again.”

    ‘Learn and live’

    Masiello’s tobacco-prevention advice took a different direction.

    “Get a high school education,” Masiello said. “I know that sounds absurd, but we have seen the research: The higher education level you obtain, the better you are going to take care of yourself.

    “We need to do a better job of keeping kids in high school.”

    It won’t be long before many Americans have additional incentives to quit, Masiello predicts.

    “Businesses are going to stop hiring smokers,” he said. “We now see 80 percent of the people don’t smoke.”

    Employees who smoke drive up a company’s health-care costs and increase absenteeism, he said.

    Masiello applauded Geisinger Health Care system’s new policy to stop hiring tobacco users, as of Feb. 1.

    All job applicants – including full-time and part-time positions, volunteers and students enrolled in the system’s schools – are now required to complete urine testing.

    Geisinger is not the first company to adopt a similar policy, which is legal in 20 states.

    More employers are bound to join the cause, Masiello said.

    “You are not affecting people’s rights,” he said. “You are helping them get healthy.”

    **This article was published in the Tribune Democrat on 2/18/12

    http://tribune-democrat.com/local/x1265287779/Heart-health-Smoking-a-prime-heart-disease-culprit

  • Matthew Masiello and Jessica Lynn Kurtz | Child protection must also focus on human rights

    All too often, adults at multiple levels of societal and academic responsibility fail to appropriately identify, react and respond to extreme allegations of child abuse. Defending children is an issue that should transcend all political and legal aspects of society.

    All adults have a moral and social responsibility to take action against child-related violence. The United States prides itself on championing fundamental liberties, yet there is clearly a void in terms of protecting the rights of children in this country.

    20120517-165845.jpgDeveloped in 1989, the United Nations’ Convention on the Rights of the Child is an international set of standards and obligations that sets forth the full spectrum of social, political and economic rights to be afforded to children. The U.S. has yet to ratify the convention. The only other U.N. member state to decline to ratify this international document is Somalia.

    As a result of the serious lack of academic and political attention paid to child human rights in the U.S., children frequently lack the protections they require and deserve. American society needs to experience a greater level of awareness and insight to the many violence-related issues affecting this vulnerable population.

    So, how can we accomplish this? Or better still, how can a U.S. center of higher education, as Penn State and Syracuse University are presently attempting, take on the task of addressing the sexual, physical and mental abuse of children in America and identify themselves as leaders in such a cause?

    Most U.S. colleges and universities currently lack comprehensive research and study programs directed to the rights of children. To a significant degree, such academic activity can be found at many international academic and research centers. Though Penn State should be commended for developing the Penn State Hershey Center for the Protection of Children, the current description of activities and participants is lacking in identifying international experts in the area of child abuse and/or child human rights.

    The challenge for American academic institutions would be to create progressive and new interdisciplinary initiatives focused on the human rights of children – An Institute for the Study of Human Rights of Children. The social sciences, medicine and law, as well as education, are just a few of the areas that can serve as the foundation to this U.S.-based field of study.

    Child human rights encompass more than just child abuse or child protection. An increased and deeper knowledge of the special issues that children face and how to create a safer society for them will ultimately be the best response to the child-sex scandals facing Penn State and Syracuse universities as well as our country.

    A simpler approach would be to investigate the accusations of abuse, change institutional policy, donate money to child protection agencies, lobby for a new law for better reporting processes, or develop a limited academic or research initiative.

    While each of these alternatives has its own merits, realistically, little more will be contributed to society in general. They will only serve as political or academic Band-Aids to a much larger societal wound.

    A holistic, educational approach based on the advanced study of the human rights of children may allow the U.S. to move ahead and be identified as a leader in terms of how we can most optimally care for and protect our children. It will assure a better and safer life for our children.

    A new, progressive, academic approach will increase the national sense of moral and social responsibility, filling the presently existing void in how we should respect, and, yes, honor our children by finally providing them with the safeguards they deserve.

    **This article was published in the Tribune Democrat on 1/6/12

    http://tribune-democrat.com/editorials/x1477841616/Matthew-Masiello-and-Jessica-Lynn-Kurtz-Child-protection-must-also-focus-on-human-rights

  • Local programs offer incentive for healthy living

    20120518-174043.jpgPrevention of heart disease begins young, experts say, encouraging parents to instill proven nutrition and exercise lifestyles from infancy.

    But with childhood obesity rates tripling in the past 30 years, many worry that Americans are losing the battle.

    “This is the first generation of Americans that will not live as long as the generation before,” said Dr. Lawrence Rosenberg, a pediatrician with Conemaugh Physicians Group of Johnstown.

    Rosenberg urges parents to be proactive by creating a healthy environment in their homes and getting the whole family involved.

    Fellow pediatrician Dr. Matthew Masiello, chief wellness officer at Windber Research Institute, takes the advice a step further. Healthy patients begin with healthy doctors, Masiello said.

    “You have to get yourself fit,” Masiello said. “Then you are able to help your patients. As physicians, we have to start taking care of ourselves.”

    The strategy has been proven by the decrease in tobacco use. As more doctors quit smoking, Masiello said, they were able to help more of their patients find strategies to quit. As government policies and businesses continued to limit opportunities to smoke, tobacco use has declined even more.

    “It comes down to education and policy,” Masiello said.

    For parents, education should begin even before the baby is born, he said.

    “When I was training, breastfeeding was an issue we talked about in terms of the antibodies and the extra vitamins and minerals that came from the mother,” Masiello said.

    “We now know that breastfeeding is much more than that. Those kids are going to have better weight control when they get older. It is going to have a positive effect throughout their lives.”

    Part of the benefit, doctors believe, comes from getting mothers thinking about nutrition and wellness early.

    “Parents are more cognizant of weight issues,” Masiello said. “When parents absorb the educational aspects of breastfeeding, there is a connection with good nutrition later in life.”

    Health education for parents is vital to any program addressing childhood wellness and disease prevention, Rosenberg said, recalling earlier attempts to stem the obesity epidemic. When leaders first recognized the rise in the obesity rate, he said, hundreds of different programs were introduced addressing the issue at various levels, such as psychology, nutrition, medicine and education.

    “They were all uniformly unsuccessful,” Rosenberg said. “Then a study by the University of Washington showed you have to have the whole family buy into a program. It is pivotal for success.”

    Several local health-care organizations are offering evidence-based programs based on findings such as the Washington study.

    Memorial Medical Center is bringing the Edwards LifeSciences spring wellness events back to four locations in Cambria and Somerset counties, with outreach to more than 30 schools.

    Families will be invited to come together to the one-day events, coordinator Michelle George said.

    The programs will provide health screenings and information to parents while children participate in a fun, healthy activity.

    “We try to encourage healthy behavior through physical activity, even among those who don’t normally play basketball or football,” George said.

    A schedule for the spring wellness events will be announced soon, she said.

    Somerset Hospital has been conducting KidShape programs for several years in Somerset County, with funding from the Highmark Foundation. Windber Research Institute is reintroducing KidShape for Cambria County families.

    The Windber program is being held at Greater Johnstown YMCA, with support from the YMCA and Alternative Community Resource Program.

    KidShape targets children in the 85th percentile and above on body mass index screenings conducted at all schools, Masiello said.

    “That is the public health approach: To gather all these players together to bring these programs into focus.”

    Parents attend two-hour sessions each week for nine weeks with their children, meeting with nutrition, exercise, and mental-health professionals during every session. Participants move through seven different stations addressing all aspects of weight loss and healthy lifestyle, exercise physiologist and program coordinator Mike Seibert said from Somerset Hospital.

    “Parents learn as the kids learn,” Seibert said. “They tell us, ‘we want to do better; we just don’t know how.’ ”

    Working together with other families is an important part of the KidShape mission, fitness director Debbi Smith said at the YMCA

    “This just a starting point for these kids who are changing their lives,” Smith said. “We get the kids into the environment where they are surrounded by like-minded individuals, trying to make themselves healthy and to have fun.”

    Parents learn how to take better care of themselves and create healthier homes, Seibert said.

    “What I am asking the families to do is take the lead again,” Seibert said.

    “Take an active role in their kids’ health. The kids are counting on the parents to be the food cookers and shoppers.”

    Program director Vicki Clark said KidShape fits well into the YMCA’s new national focus: “For Youth Development; For Healthy Living; For Social Responsibility.”

    “KidShape hits all those components for us,” Clark said.

    Facilitators check in with families after three months, then six months and then a year after the final session.

    “If the families are held accountable, and they are working together, it works,” Seibert said.

    “We are hoping that we connect with these kids so when they are in the grocery store, they start looking at what is on the labels. Instead of sitting around watching TV, we encourage them to go outside.”

    Enrollment information

    • KidShape, Somerset County.

    Mike Seibert at 445-3330.

    • KidShape, Cambria County.

    Windber Research Institute KidShape line 361-6966.

    • Memorial Medical Center, Edwards LifeSciences screenings.

    (866) 839-3867.

    Consumer advice

    Here are some shopping and nutrition tips from Dr. Lawrence Rosenberg, a pediatrician with Conemaugh Physicians Group of Johnstown:

    • Shop on a full stomach, with a list and not with children.

    • Everybody older than 2 should drink skim milk.

    • Start meals with salads or light soup, lingering with 15 minutes of conversation at the dinner table.

    • Serve all meals on salad plates, with salad forks.

    • Get rid of frying.

    • Limit protein to a serving the size of your palm, and cook only one serving for each person. The rest is vegetables you will eat if you are hungry.

    • Snack on fresh-cut carrots or other vegetables in front of the television.

    • Mix children’s sugary cereal with more healthy cereal, gradually reducing the sugar content until it’s gone.

    **This article was published in the Tribune Democrat on 2/25/12

    http://tribune-democrat.com/local/x1875167287/Local-programs-offer-incentive-for-healthy-living

  • Press Release: Highmark Foundation reaches more than 210,000 school children with bullying reduction measures

    20120517-164639.jpgPITTSBURGH (Dec. 7, 2011) – According to Bullying Prevention: The Impact on Pennsylvania School Children, a report released by the Highmark Foundation today, 13 percent of Pennsylvania school children have experienced reductions in bullying behavior through exposure to the Olweus Bullying Prevention Program (OBPP), funded by the Foundation for the region’s schools. The wide-scale implementation represents the largest in the nation and has led to Pennsylvania’s rise as a national leader in bullying prevention.

    By 2012, OBPP will reach 210,000 students, 13 percent of all public schools, more than 17,000 teachers and approximately 345,000 parents. It has been classified as a model program by the Blueprints for Violence Prevention, a project of the Center for the Study and Prevention of Violence at the University of Colorado.

    “A safe school climate is so important to the overall health and well-being of children, and this report showcases the impact of evidence-based OBPP in schools and the positive effect they have on decreasing bullying incidents,” said Yvonne Cook, Highmark Foundation President. “It is the Highmark Foundation’s goal to continue to collaborate between public and private entities and offer this model program to others in an effort to affect more positive change across the system.”

    The 2011 report brings to light a two year analysis of bullying prevention program outcomes from more than 400 Pennsylvania schools. The Highmark Foundation supported the report’s development by renowned bullying prevention experts at Windber Research Institute, the Center for Safe Schools and Clemson University, which reflects the significance of the scope of bullying prevention efforts made in Pennsylvania schools through Highmark Healthy High 5, a five-year initiative of the Highmark Foundation.

    Highmark Foundation reaches more than 210,000 school children with bullying reduction measures

    The 2011 data, compiled through student self-reports, indicates that the percentage of students being bullied two to three times per month or more (between 2008 and 2010) decreased by 10 percent among elementary students, 15 percent among middle school students and 13 percent for high school students. Students’ incidents of bullying others 2-3 times per month or more also decreased.

    “Bullying prevention has certainly become a higher priority on the national agenda through anti-bullying legislation and federal lawmakers,” said Dr. Matt Masiello, Director of the Center for Health Promotion and Disease Prevention at Windber Research Institute. “The positive results found within Pennsylvania schools can serve as an even greater example for other states to follow. Students themselves are emerging as leaders and ongoing data collection and analysis predicts even more positive change for the future.”

    The report findings also demonstrate that Pennsylvania school students are beginning to reach out to their peers in a more positive way. Findings show that the percentage of students who said they would “try to help the bullied student in some way or other” increased by 7 percent among elementary students, 10 percent among middle school students and 13 percent among high school students.

    The Highmark Foundation has led this coalition of OBPP experts, educators and public health professionals to implement OBPP to the largest population of students to date. With an evidence-based program in place and motivating outcomes on the rise in Pennsylvania, the positive impact of bullying prevention programming in schools is the driving force to fostering healthier, happier children.

    About the Highmark Foundation

    Created in 2000, the Highmark Foundation is a charitable organization, a private foundation and an affiliate of Highmark Inc. Its mission is to improve the health, well-being and quality of life for individuals who live in the communities served by Highmark Inc., its affiliates and subsidiaries. In 2006, the Foundation launched Highmark Healthy High 5, a children’s health promotion initiative designed to improve the health of children and adolescents, ages 6-18. Through a $100 million commitment, Highmark Healthy High 5 addresses five critical issues – nutrition, physical activity, grieving, self-esteem, and bullying prevention.

    The Highmark Foundation awards high-impact grants to charitable organizations and hospitals to launch programs aimed at improving community health and addresses four key areas of health care concern: chronic disease, communicable disease, family health, and service delivery systems. Find more information about the Highmark Foundation at www.highmarkfoundation.org

  • After the Volcano

    Another year and we find ourselves not only going back to Europe but being asked to go back. Having a World Health Organization Collaborative Center doing the asking is not a bad deal. Next week Mr Tom Kurtz, our CEO at the Windber Research Institute (WRI) will be leading a five person entourage from Pennsylvania to the World Health Organization Health Promoting Hospital Conference in Turku, Finland. This team will consist of Mr Kurtz, Dr. Carla Zema from St Vincent University, Barbara Adons, RN from St Mary Medical Center, Ms Charvonne Holliday and myself from WRI. Spending an extra week in the UK last year due to mother nature was certainly an event, especially for my 17 year old son who most definitely benefited from that academic and environmental experience. Some ground shaking work will be in the offering this year but hopefully, and only, from our own doing.

    20120517-163251.jpgAs these large international conferences go the plenary session is a key event where all of the participants, 500 in this WHO event, are expected to attend. Charvonne Holliday and I are preparing a presentation that will allow this esteemed audience to hear about the work our WRI team has done in the area of violence prevention. Over the years we have been successful in identifying funding for our community based projects due to our compulsive nature to evaluate and monitor what we do. The alternative to that at times and unfortunately is to fund a program, offer the program to the community but never fully or appropriately evaluate all the steps in that process. For the first time in the 19 years of this conference there will be a 2 hour workshop on just how to do that. The scientific committee of the organization has asked the Pennsylvania based group to be that scientific team doing the honors for this international group of hospital and health service administrators, public health professionals and health care workers.

    I have once again been asked to present our work at one of the break out sessions. Here we will talk about our collaborative project with one of the largest health care systems in Europe, Ospidal Civili. Per the invitation of this hospital I will have the opportunity to spend a week in Brescia, Italy prior to the WHO conference preparing this presentation and advancing this pediatric asthma clinical and health promotion project. While in Italy I will also be traveling to Padova where I will have the opportunity to present our bullying prevention work to the Psychology Dept at the University of Padova. This Center and the Windber Research Institute have been collaborating in determining the health effects of bullying and the cost benefit to prevention programs.

    And as I did last year, I will be moderating a session where several hospital and health system leaders will present their programs to that interested group of colleagues. In a similar session The Italian University and WRI will be presenting our collabotrative work on developing a pediatric clinical/health promotion data base.

    As we did at the Windber Research Institute and the Windber Medical Center several years ago, Tuku will be holding a event similar to our WHO Winter School, but this time in sunny Finland. Here, I will have the opportunity to teach new members of this 700 hospital organization about the Health Promoting Hospital Network and our many other projects, including the Windber and Copenhagan health promotion project which is about to be published. Lastly, I have the privilege to represent the United States and Pennsylvania at the Governance Board meeting of the organization.

    All of this is funded though our Pfizer grant as well as stipends we will receive from the World Health Organization Health Promoting Hospital organization and our Italian colleagues. Wish us well. We will do Pennsylvania proud. Baring any volcanoes we will be back June 5th to report on a successful journey.