Matt Masiello, M.D., MPH

Category: Healthy Living

  • Health is Everywhere

    BY MATT MASIELLO, MD, MPH
    Often times the feeling is the opposite; it is illness that is everywhere, not health. With the U.S. population experiencing a continuing surge of chronic illness, costing this country, we Americans, 80% of the money we spend on health, why should we think that illness is not here to stay. Sadly, the U.S. is not leading the international charge in maintaining and sustaining maximum health for all citizens. The present generation of U.S. children could be the first to have a lower life expectancy than their parents’. Forty-six-plus million individuals in this country live without health insurance and that number will only grow as the economy suffers.

    “Sick Around the World,” a Public Broadcasting Station (PBS) documentary, reviewed the stark comparisons between the health care systems of several countries to that of the U.S. The one interesting question asked of the health care leaders of the five countries was: “Would a citizen of your country ever go bankrupt over a hospital bill?” The response was “not possible” or “never,” along with a facial expression of surprise and wonder that the question was even asked. When the small country of Taiwan had the opportunity to re-invent their health care system in the 80s they identified the advice of those countries considered to have the best health systems. When asked, and again with a polite pause in the conversation, the Taiwan spokesperson responded that the U.S. was not one of those countries.

    These countries certainly have issues and obstacles in providing the very best health care. However, “health” is considered a human right and thus they are committed, through political will and leadership, in making it work.
    Ilona Kickbusch, a well-known health care author and academician, who has worked and lectured on both sides of the Atlantic, speaks of the roles of hospitals in the “health society of the 21st century.” At the 2007 World Health Organization-Health Promoting Hospital Network (WHO-HPH) meeting in Vienna, Austria, she eloquently and simply stated that “health is everywhere.” And in that environment she describes the important role of hospitals in identifying and utilizing “health.” Health care professionals from around the world gathered at the annual event to discuss how hospitals can identify themselves as public health advocates for their patients, hospital staff, community and environment. David Ollier of Hospitals and Health Networks wrote of the minimal participation by the U.S. in the international organization in his 2007 article, entitled “American Exceptionalism,” where he comments on “where one is a lonely number.” Nicely, so that “one” (hospital) is in Pennsylvania.
    The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” In the U.S. we do a good job in curing diseases and treat illnesses for some, not all. We are less proficient in the area of hospital based disease prevention, health promotion or public health or public health advocacy.

    So, what can U.S. hospitals and health care systems do to realize and benefit from the fact that health care can also be everywhere? First, there is the issue of leadership. We need a different type of health care leader. Hospital CEO’s, Presidents, Trustees should have training, experience, background and appreciation of the broad social and health issues of our day, as well as manage the day to day operations of the health care system. These new health care leaders must find that common ground of how hospitals can obtain the optimal profit margin as well as strategically serve as public health advocates for the communities they serve. Second, the international arena is the “health” classroom where we can learn. If we have the desire, fortitude and leadership to redesign our U.S. health care system our hospitals, managed care organizations and political leaders must make the effort to identify this new health care leadership as well as reach out internationally for this level of expertise. The WHO-HPH network would serve as a viable resource.

    According to Ilona Kickbush, hospitals must begin to live in the four domains of health – medical health, personal health, public health and the health market. In the health market alone, she describes 18 categories of potential activity. To participate and excel in these activities a new kind of political and health leadership must rise up and be able to speak beyond the important but limited topics of “access to care”, “health insurance for all”, or “reimbursement for clinical services.” For the U.S., we need to strategically create the balance between the attention and funding we provide for treatment of chronic illness and technology and the more encompassing “health society” of health promotion, wellness and disease prevention. As steam was an economic driver in the 1800s, steel in the 1850s, electricity in the early 1900s, the automobile in the 30s and information technology in 2000, health must become the driver in the decades to come. Kickbush and others have commented on these comparisons, with wellness, health promotion and medical technology as being the economic driver for 2050.

    And lastly, we must also be willing to retrain our health care professionals. Though we may need more nurses at the bedside of our hospitalized citizens we also need nurses, as well as physicians, who are trained to “clinically” promote the health of the patient beyond that of the hospital bed and back to their homes and work places. Europe, Asia and many other countries are forging ahead on these health care practices. We must work to change how we do health in America.
    It is time we counter the impression and opinions of others by reflecting upon a quote from Winston Churchill: “Americans are a wonderful people in that they always find the right answer…after they have tried every wrong answer first.” We can do better, we must do better, and we must find the right answer to better health.

    Dr. Matt Masiello, Director, The Center for Health Promotion and Disease Prevention, Windber Research Institute & Windber Medical Center, and Project Coordinator (U.S.-based), International HPH Network, World Health Organization-Collaborative Center (WHO-CC), Copenhagen Denmark, can be reached at m.masiello@wriwindber.org or (814) 619-6168

    4 December 2008 http://www.wpahospitalnews.com HospitalNews

  • Food Stamps, Poverty, and the Terribly Ignorant and Uncaring U.S. Politician

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    Poverty is increasing in America, with 17% of our citizens living in poverty, including 16 million of our children-our future. In several of our southern states, nearly 25% of the population lives in poverty. These states come close to Romania, considered an industrialized country, where their poverty rate is 25%. According to UNICEF, one American child in four is poor. When an educational minister from Finland, the country with the best educational system in the world, was asked what he could offer the United States as advice to enhance the educational status of the United States, his response was sobering – “nothing, there is too much poverty.”

    One shining light is the slow gains we have made in health care. For the first time in 37 years there are more Americans enrolled in a health care system. College students who will be buried in college loans now have affordable health care available to them. Our most vulnerable population now can enroll in a health care system with a pre-condition such as chronic illness; health promotion, wellness and disease prevention now are gaining some traction over the costly business of the latest and best technology, new and questionably safe medication; the unnecessary growth of some medical subspecialties and hospital surgical units, emergency rooms, and hospital executive office suites.

    So, what is our political response to this? Let’s randomly cut food stamps without offering a positive and sustainable alternative. The poor will work it out as the politicians go home to their comfortable homes and excellent health insurance, the best in the world in fact. And, this is their alternative; keep your food stamps, but let’s stop funding health care, even changes that have helped and will continue to help millions of our most needy.

    So, what should our response be as these politicians go home to their comfortable well- kept family and homes? Our educators and physicians, especially pediatricians, need to speak up. This, however, is a challenge and I will offer my opinion why in my next blog message on our ignorant and uncaring politicians.

  • 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

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  • 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

  • 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

  • JAMA Commentary Promotes Investment in Disease Prevention

    http://www.rwjf.org/publichealth/product.jsp?id=38452