New Quality Site

A consolidated site to compare a host of quality reports on your hospital is now available.

Robert Wood Johnson has launched the National Directory for Comparing Health Care Quality. No new quality data is available but it pulls together a host of publicly available quality reports into one site. 

Through an interactive map of the United States on the site, you can pull up lists of available reports by state, and link to the actual data.

Data about cost right is presented alongside the data about quality.

RWJ believes that this site will encourage healthy competition amongst health care systems and physicians to improve their product.

I checked it out and the site is uneven at best but give it a test run and see what you think.

Lithium May Prevent Parkinson's Disease

Michael J. Fox, Parkinson's Sufferer

The Journal of Neuroscience Research reports that the drug lithium has been found to greatly prevent the buildup of the toxic proteins and brain cell loss linked to Parkinson's disease.

Commonly used to treat bipolar disorder, it has demonstrated a neuroprotective effect in diseases such as Huntington's disease, Alzheimer's and amyotrophic lateral sclerosis. 

Investigators at the Buck Institute for Research have started preclinical studies to determine the proper lithium dosage for humans, and initiate Phase II clinical trials in conjunction with Parkinson's disease.

New Administration Wellness Strategy Announced

Government health officials recently announced the National Prevention and Health Promotion Strategy (PDF), a plan aimed at increasing the number of Americans who are healthy at every stage of life. 

This Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society and work together to achieve better health for all Americans.

To realize this vision and achieve this goal, the Strategy identifies four Strategic Directions and seven targeted Priorities. The Strategic Directions are:

• Healthy and Safe Community Environments: Create, sustain, and recognize communities that promote health and wellness through prevention.

• Clinical and Community Preventive Services: Ensure that prevention-focused health care and community prevention efforts are available, integrated, and mutually reinforcing.

• Empowered People: Support people in making healthy choices.

• Elimination of Health Disparities: Eliminate disparities, improving the quality of life for all Americans.
 

Recommendations to reduce the leading causes of preventable death and major illness are further targeted.

• Tobacco Free Living 

• Preventing Drug Abuse and Excessive Alcohol Use 

• Healthy Eating 

• Active Living 

• Injury and Violence Free Living 

• Reproductive and Sexual Health 

• Mental and Emotional Well-Being

The wellness strategy was developed by the National Prevention Council, which is composed of 17 federal agencies who consulted with outside experts and stakeholders.

This is all great but a) can we fund it? and b) will people follow it? 

If you want a sobering outlook on the latter, read this.

$3 Trillion in Lost Benefits Suffered by Caregivers

A new Met Life study shows that almost 10 million adults over the age of 50 are becoming caregivers for their own parents, resulting in a loss of $3 trillion in wages, pension and Social Security benefits for time taken off from work.

The MetLife Mature Market Institute, the National Alliance for Caregiving, and the Center for Long Term Care Research and Policy at New York Medical College analyzed data from the Health and Retirement Study conducted biannually by the University of Michigan and the National Institute on Aging. 

Female caregivers are the hardest hit. 

• Their average losses are equivalent to a total of $324,044, compared to average losses for men of $283,716.
   
• Adult caregivers are more likely to suffer from fair to poor health than noncaregivers.
   
• Caregiving sons and daughters provide parents with comparable care, although daughters are more likely to offer basic care while caregiving men often provide financial assistance.  

And that is the classic model. In my own personal case, my wife and I purchased a condo for my mom to live in when she moved to Florida. That provided her with financial relief for a good five years. Now that her health has worsened she has moved in with my sister who is providing the ADL type of care. Thankfully she is retired so the economic impact has not been as bad. But her health and emotional well being has suffered as a result.

There are no good answers here yet there are resources available to help. Search online or just search this blog. We have written about many of them. More here.

Technology Does Not Necessarily Improve NH Care According to Residents

A new study suggests that comprehensive health information technology (HIT) does not lead to any measurable positive or negative effects on the health outcomes of elderly nursing home residents. 

The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. 

Directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area, researchers found no statistically significant impact of the introduction of HIT on residents.

• 60% of residents said they noticed no change in their care, but 30% said they felt care had improved (vs. about 7% that said it had declined).
   
• Residents also voiced favorable reactions toward electronic record-keeping platforms such as mobile phones.
   
• Seventy-one percent of residents said they believed that handheld devices improve care, and 73% said they are glad staff use handheld devices to track and manage their care.

The team of investigators, from Weill Cornell Medical College, Columbia University Stroud Center and the New York State Psychiatric Institute, said that the absence of positive or negative effects from HIT usage with residents is encouraging. 

There are two issues here. One is the resident's perception of technology, which seems to be favorable. So therefore a facility that is adopting such technology could have a perceived marketing advantage. Much like hospitals that tout their robotic technology. What is not revealed is whether there was any clinical improvement as a result of technology. This study would suggest not.

From a consumer viewpoint, a facility that is investing in HIT, whether it clinically has been proven or not, also sends a message that it values resident care and is continuously trying to improve. Ask about their adoption of technology if shopping for mom or dad.

High Levels of Physical Activity Could Reduce Silent Stroke Risk

Researchers at Columbia University and the University of Miami found the risk of silent strokes was 40% lower in older people who reported high levels of physical activity.

The researchers recorded the exercise habits of 1,238 participants, who were on average 70 years old and have never had a stroke. Adjusting for demographic and cardiovascular risk factors, the results indicated that:

• intense activities such as racquetball, tennis, jogging, and hiking significantly lowered rates of small brain infarcts, areas of dead tissue resulting from lack of blood supply, compared to those who were either slightly active or sedentary.
   
• the benefits of moderate to high activity levels were wiped out for those on Medicaid or without health insurance. These participants, who were highly active, showed the same risk.
   

Researchers hypothesized that the overall adverse life experience for those who are uninsured or have Medicaid mitigates the protective effect of leisure-time physical activity further noting it is consistent with the extensive literature on social status being associated with a higher risk of cardiovascular disease independently of access to care.

Perhaps health reform will have a positive affect for these people. However, it is only up to the individual to further take the responsibility for their overall health including diet and in this case, heavier physical activity. And frankly many people are in denial that they need that help.

Read more about this study.

CLASS Act Could Be on Chopping Block

The Community Living Assistance and Supportive Services (CLASS) Act is under threat of repeal and Leading Age is leading a charge to save it. Since this Act could become a viable means to pay for long-term care you may want to get involved. Here's how.

Congressional Call-In for CLASS
On Tuesday, Leading Age will be hosting a Call-In Day to Save CLASS. Call 888-785-9795 on Tuesday, July 26, and tell your members of Congress 3 main reasons repealing the program would be a mistake:

CLASS Helps Americans - The CLASS program provides families with an affordable way to plan for future supports and services. CLASS will allow more Americans the ability to remain in their homes while getting the care they need.

CLASS Saves Money - The Congressional Budget Office said CLASS will reduce the budget deficit by $83 billion over 10 years. The program also saves federal dollars spent on Medicaid by reducing the number of people relying on the program for long-term services and supports.

Americans Support CLASS - A Kaiser Family Foundation/Harvard poll found that 76% of Americans support the CLASS Act program.

If you are a Twitter user, you can tweet the following messages:

@kaiserfamfound poll found that 76% of Americans favor #CLASSAct http://bit.ly/qw6Q1G CC: @whitehouse

@WhiteHouse, the #GangofSix proposal to repeal #CLASSact is illogical. CLASS is solvent, helps reduce #Medicaid costs http://bit.ly/nMUiDA

Please include the #CLASSact hashtag.

The coalition supporting CLASS is strong, but your voice makes it stronger.

Thanks

Pre-Existing Condition Insurance Plan (PCIP)

Under the Affordable Care Act a new federal insurance program for those with pre-existing conditions was created.

It will provide a health coverage option for you if you:

• have been uninsured for at least six months
• have a pre-existing condition
• have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. 

This program will provide coverage until 2014 when you will have access to affordable health insurance choices through an Exchange, and you can no longer be discriminated against based on a pre-existing condition.

Eligible enrollees receive primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care.  

Visit www.pcip.gov for information on services and enrollment or call 1-866-717-5826 (TTY 1-866-561-1604).

Workplaces Need Caregiver Affinity Groups

Fran Melmed writing for TLNT recently reported on the need for more caregiver affinity groups in the workplace. Citing the Pew Internet Project’s latest study on the social life of health information, Pew found that caregivers use social network sites for updates and gathering information support more than other online social network participants.

• 28% of caregivers follow friends’ health updates, compared with 21% of other social network site users. 

• 20% of caregivers who use social network sites say they have gathered health information on such a site, compared with 12% of other users.

Pew also pointed out these same sites “can be a source of encouragement and care." No argument there. Working with my healthcare clients, I see the value that say Caring Bridge or CarePages brings to patients and their families. That community is something that health providers do not provide typically.

We have reported extensively in this blog on caregiver health and well-being. But we have not talked about the employer's role as much. Yet, caregivers still in the workplace need employers who care for them too. And that manifests through EAP programs, flexible schedules, volunteer benefit programs and more.

Ms. Melmed argues that "emotional support and advice from people who’ve “been there” will also be critical." She advocates for the creating an affinity group — a caregivers community - in the workplace. I agree.

Does your employee have a caregiver group? Ask. And perhaps think about taking the lead in forming one. Caregivers in the workplace desperately need support and need to know that others are experiencing what they are experiencing.

More Praying About Their Health

Investigators at the University of Massachusetts surveyed 30,080 adults in 2002 and 22,306 adults in 2007 and discovered that more Americans are praying about their health.

• In 2002, 43% of those surveyed said they prayed about their health. 
• That number jumped to 49% in 2007, according to The New York Times.
• In 1999, only 14% of survey participants reported praying about their health.

Groups less likely to pray include those who exercise regularly and those with higher incomes. More like were individuals who were more devout include women, African-Americans, older and married people, and those whose health status had changed. 

Many things contribute to the healing process. Prayer, like a positive attitude is certainly one of those intangibles. And there have certainly been documented medical miracles where physicians themselves can cite nothing more than divine intervention. 

We will probably never know what prayer does to prevent or heal but in my opinion it certainly can't hurt anything.

Elder Financial Abuse Spikes 12% Since 2008

Older Americans are losing $2.9 billion annually to elder financial abuse, a 12 percent increase from the $2.6 billion estimated in 2008, according to “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America's Elders.” Crimes involving strangers made up more than half (51 percent) of reported cases Next were crimes involving family, friends and neighbors as perpetrators (34 percent) Exploitation from the business sector accounted for 12 percent of reported cases.  Medicare and Medicaid fraud represented four percent.  Robberies and crimes classified as “scams perpetrated by strangers” increased from nine percent to 28 percent from 2008 to 2010. Other major findings from the study, which was produced in collaboration with the National Committee for the Prevention of Elder Abuse (NCPEA) and the Center for Gerontology at Virginia Tech, include: •  Women were nearly twice as likely to be victims of elder financial abuse as men. •  Most victims were between the ages of 80 and 89, lived alone and required some help with either healthcare or home maintenance. •  Nearly 60% of perpetrators were males, mostly between ages 30 and 59. •  Victims were particularly vulnerable during the holidays when overall dollar losses due to family and friends were higher than any other category. Read more: “Preventing Elder Financial Abuse” And check out my about.com topic on abuse as well.

When It's An Emergency Elderly Not Treated As Well in Hospitals

A Canadian study reveals that hospitals that provide quality care for young people do not always provide the same quality care for the elderly in emergency situations.

The study, published in the Journal of the American College of Surgeons, evaluated the condition of elderly patients 30 days after they underwent emergency surgery. 

Previous studies have shown that steps can be taken to improve patient outcomes for elderly people undergoing elective surgery, such as consultation and pre-surgical testing to reduce the risk of heart attacks and strokes, aggressive medical management and referrals to clinics that perform high volumes of the most complex procedures.

These options are often not available to elderly patients who require emergency surgery. Researchers suggest that one strategy that could help would be more collaboration with geriatricians. At St. Michael's Trauma Program in Toronto, a geriatrician sees every patient over 60 who experiences a major injury and makes recommendations regarding their care and treatment. 

The program has shown significant benefits, with fewer consultation requests to internal medicine and psychiatry, meaning more efficient care, and a reduction in delirium, which can be common among elderly hospital patients, costly, preventable, and associated with higher morbidity and mortality. 

And, they have found that fewer elderly patients are being discharged from the hospital to long-term care facilities.

A consumer takeaway from this would be to look for a geriatrician for the care of your loved ones as they age. That person's specialized knowledge coupled with the relationship you develop could be enough to help when emergencies arise.

COPD Patients Can Improve Condition with Physical Activity

New research shows a combination of exercise classes and confidence-building programs can lead to an increase in physical activity for COPD patients.

Researchers from Michigan and Illinois enrolled 49 COPD patients into three groups. 

• One group engaged in upper-body resistance exercises with the self-confidence-building program.
• One group did upper-body resistance training and health education.
• The third group used gentle armchair exercises plus health education.  

COPD patients who attended self-confidence-building program increased their light physical activity.

Researchers concluded that pulmonary rehabilitation programs should focus on increasing people's self-confidence in their ability to increase their light physical activity in addition to encouraging people to increase moderate–to-vigorous physical activity.

COPD patients often lead sedentary lives but need not to according to this. Part of it is just getting started with an exercise program but certainly adding confidence building and coaching will help the patient actually believe they can do more.

Hospital Mortality Rates Rise in July

It has often been suspected that death rates in hospitals rise particularly in the summer when a new crop of medical residents start. Previous studies have been inconclusive. A new study lends validity to this theory.

Two authors independently abstracted data on outcomes. 

• Of the 39 included studies, 27 (69%) reported mortality. 
• Thirteen (33%) were of higher quality. Studies with higher-quality designs and larger sample sizes more often showed increased mortality and decreased efficiency at time of changeover.
• They found that mortality rates did increase between 8 and 24 percent in July, according to a Time blog post.

Researchers concluded that mortality increases and efficiency decreases in hospitals because of year-end changeovers, although there are no firm conclusions about the degree of risk posed.

According to study coauthor John Q. Young, MD, MPP, associate program director, residency training program at the Department of Psychiatry at University of California San Francisco School of Medicine, in a press release: "The 'July Effect' occurs when these experienced physicians are replaced by new trainees who have little clinical experience, may be inadequately supervised in their new roles, and do not yet have a working knowledge of the hospital system. It's a perfect storm."

Researchers do not recommend that patients avoid care when they need it, even during July.

Florida Proposing New Medicaid Fees

The state of Florida wants to impose $10 monthly premiums on Medicaid recipients who are not in nursing homes. Additionally, the state is proposing a $100 fee for Medicaid patients who use emergency rooms for routine care, according to Kaiser Health News.

State officials and consumer advocates say they do not expect the administration to approve Florida's proposals because they allegedly violate the Affordable Care Act. While the 2010 law gives states more flexibility, it does not allow them to enact new fees and premiums for existing beneficiaries.

While a dozen states charge Medicaid co-pays for ER visits, none charges more than $20 for those earning less than the federal poverty level. Medicaid recipients use the ER about three times as much as people with private insurance, according to recent studies. And that is often because they do not have a primary care physician.
Opponents of the ER fee argue it would be potentially lethal for impoverished Florida residents.

"You can imagine a host of examples, such as chest pains, false labor, children having problems breathing, where a very low-income person would have to make the decision not to go to the ER or risk being fined $100," Laura Goodhue, the executive director of the patient advocacy group Florida CHAIN, told Kaiser.

This is just a sign of the times.

Legislators are seriously considering cuts in Medicare payments to hospitals for uncollectible patient debt and the training of doctors; steps to eliminate Medicare "overpayments" to nursing homes; a reduction in the federal share of some Medicaid spending; and new restrictions on states' ability to finance Medicaid by imposing taxes on hospitals and other health care providers.

Medicare skilled nursing facility cuts (SNFs) of 11.3 percent are currently being proposed effective October 1. And the Centers for Medicare and Medicaid Services (CMS) must issue a final ruling by August 1. The Medicare Payment Advisory Committee has called for greater cuts of up to 30 percent. At the minimum, $100 billion in cuts can be foreseen.

The government is also trying to reduce their percentage of payment to states on the Medicaid side. States in turn are grappling with shortfalls. And that is leading to discussions around block grants, global spending caps and blended rates.

Needless to say more than just long-term care providers are in a panic. Hospital lobbyists are in full swing and even the AARP is concerned.

So you may want to brush up on your legislative and advocacy skills because you may be asked by your local health organizations to get involved.

Are For Profit Hospice Placing Profits Over People?

Some ethicists say that the goal of profitability of for profit hospice businesses interferes with the ability to provide quality end-of-life care.

Robert Stone, M.D., reporting in the Journal of Law, Medicine and Ethics, says that studies have shown that when for-profit hospices select longer-term patients, this results in overpayment, which, in turn, drains funds from the hospice program.

• The for-profit hospice industry grew by 128% between 2001 and 2008, while nonprofits expanded only 1% and government-sponsored hospices jumped 25%.

In short what investigators are saying is that the industry cherry picks. Stone says they do this by selectively recruiting long-term patients who don't have cancer, pay lower salaries and benefits to a less-skilled staff, and employ fewer registered nurses. By taking care of less acute patients and paying staff less yet receiving the same payment rate as those caring for more acute patients, they essentially can profit is what these investigators are saying.

Stone and his co-author, Joshua Perry, J.D., M.T.S., contend that these practices put non-profit hospices' financial survival at risk. The study also highlights questionable marketing practices used by for-profit hospices. One tactic involves sending representatives into nursing homes and giving residents branded gifts. Another is paying nursing home employees for future hospice referrals.

In another study, Dr. Melissa Wachterman, a general medicine research fellow, and a palliative care physician at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston., found that non-cancer diagnoses were more common in for-profit hospices. And, since hospice is paid a flat rate, they make a profit on these patients.

She did find that patients' care needs were met in both for-profit and non-profit hospice programs. Her study appeared in the Journal of the American Medical Association.

• She reported that non-profits had about 48% of patients with cancer compared to 34% in for-profit hospices while for-profit hospices were much more likely to have patients with dementia than were non-profits.
   
• For-profit hospices had a higher proportion of patients residing in nursing homes and a lower proportion living at home.
   
• People at for-profit hospice agencies were also likely to stay longer, an average of 20 days compared to 16 for non-profit hospices.

Dr. Joan Teno, a member of the board of the National Hospice and Palliative Care Organization, in speaking with Health Day News said that the notion that dementia patients might need less care than cancer patients, particularly in the area of pain management is not true.

As a consumer, you may not notice because the care for a loved one is probably paid for by insurance. The ultimate question is whether or not quality care is being compromised. At least one study suggests that it is not. What do you think?

Reprinted in part from my about.com blog of the same topic.

New Alzheimer's Care Site Promotes Community

The Alzheimer's Foundation of America (AFA) unveiled an interactive "community of care"

Web site that will help family caregivers meet other caregivers, learn about the brain disorder and connect "live" with experts.

Called Care Crossroads, the site addresses the feelings of isolation and stigma among Alzheimer's patients and caregivers. It also fills a growing need for alternate types of support services. For example social workers are standing by to respond to questions and concerns via live Skype and chat, as well as e-mail and phone calls to the organization's toll-free hot line at 866-232-8484.

Caregivers are introduced to other caregivers via "I Care" video stories and creative contributions, with more of each to be posted regularly.

The "House of Care" is the go-to place where visitors can click on specific rooms to learn more about strategies for behavioral challenges, recreational activities and safety issues appropriate for the specific stages of the disease.

Fresh Air Fund Needs Loving Host Families

While this is a little out of our usual realm of publication, I thought it was a good cause and the time frame for the need is closing quick.

In 2010, The Fresh Air Fund's Volunteer Host Family program, called Friendly Town, gave close to 5,000 New York City boys and girls, ages six to 18, free summer experiences in the country and the suburbs. Volunteer host families shared their friendship and homes up to two weeks or more in 13 Northeastern states from Virginia to Maine and Canada.

Thanks to host families who open up their homes for a few weeks each summer, children growing up in New York City’s toughest neighborhoods have experienced the joys of Fresh Air experiences. 





Fresh Air Fund Host Families

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Friendly Town host families are volunteers who live in the suburbs or small town communities. Host families range in size, ethnicity and background, but share the desire to open their hearts and homes to give city children an experience they will
never forget. Hosts say the Fresh Air experience is as enriching for their own families, as it is for the inner-city children. There are no financial requirements for hosting a child. Volunteers may request the age-group and gender of the Fresh Air youngster 
they would like to host. Stories about real Fresh Air host families and their New York City visitors are just a click away!


• If you or someone you know is able to host, please sign up now.
• Click here to learn more about becoming a host or call (800) 367-0003!




Fresh Air children are boys and girls, six to 18 years old, who live in New York City. Children on first-time visits are six to 12 years old and stay for either one or two weeks. Youngsters who are re-invited by the same family may continue with The Fund through age 18, and many enjoy longer summertime visits, year after year. A visit to the home of a warm and loving volunteer host family can make all the difference in the world to an inner-city child. All it takes to create lifelong memories is laughing in the sunshine and making new friends.

The majority of Fresh Air children are from low-income communities. These are often families without the resources to send their children on summer vacations. Most inner-city youngsters grow up in towering apartment buildings without large, open, outdoor play spaces. Concrete playgrounds cannot replace the freedom of running barefoot through the grass or riding bikes down country lanes.


Fresh Air children are registered by more than 90 participating social service and community organizations located in disadvantaged neighborhoods in the five boroughs of New York City. These community-based agencies are in close contact with children in need of summer experiences in rural and suburban areas. Each agency is responsible for registering children for the program.


What do Fresh Air children enjoy?

•                Playing in the backyard

•                Laughing in the sunshine

•                Catching fireflies

•                Riding bicycles

•                Learning to swim

•                Running barefoot through the grass

•                Gazing at the stars on moonlit nights

•                Building sandcastles

•                Making new friends

•                Simple pleasures of life away from the inner-city

If you can't participate, donate.

You can give a child the experience of a lifetime with your gift to The Fresh Air Fund!


Every year, The Fresh Air Fund gives thousands of inner-city children the priceless gift of fun – and opens the door to a lifetime of opportunities. 

Whether it's a two-week trip to visit a volunteer host family, or a fun-filled and educational stay at one of our camps, our programs make for unforgettable memories – and open a world of new friendships and fresh possibilities. We are a not-for-profit agency and depend on tax-deductible donations from people like you to keep our vital programs flourishing.



THE FRESH AIR FUND, an independent, not-for-profit agency, has provided free summer vacations to more than 1.7 million New York City children from low-income communities since 1877. Nearly 10,000 New York City children enjoy free Fresh Air Fund programs annually. In 2010, close to 5,000 children visited volunteer host families in suburbs and small town communities across 13 states from Virginia to Maine and Canada. 3,000 children also attended five Fresh Air camps on a 2,300-acre site in Fishkill, New York. The Fund’s year-round camping program serves an additional 2,000 young people each year.

Physical and Emotional Health of Older Married Couples Tied Cloesly Together

A study of older married couples in the American Psychological Association’s journal Health Psychology, finds strong associations between their physical and emotional health. Spouses have a much greater impact on their partner’s health than previously known.

Researchers from the University of British Columbia and Pennsylvania State University tracked the emotional and physical histories of more than 1,700 older couples over a 15-year period. Participants ranged in age from 76 to 90 and many had been married for more than 40 years.

Researchers found a strong relationship between “depressive symptoms” (unhappiness, loneliness and restlessness) and “functional limitations” – the physical inability to perform such basic tasks as climbing stairs, picking up objects, cooking and shopping. Spouses’ depressive symptoms were closely associated with those of their partners. Functional limitations in one spouse was not only associated with their own depressive symptoms but also with depressive symptoms in the other spouse. Increases in depressive symptoms in one spouse were also associated with greater functional limitations in both spouses.

Researchers noted that these findings show just how interdependent, emotionally and physically, long-term couples can become and suggest a greater need for holistic healthcare approaches. In other words treat the couple not just the individual.

Researchers are not sure if this mimicking behavior is specific to long-term married couples and whether this would happen with Baby Boomers with more diverse relationship histories, including divorces and remarriages.

You read of stories where one spouse dies and the other spouse dies shortly after. You come to find these were often long marriages where neither was apart from the other very long. So maybe The Wedding Song is right where one line reads "Oh, a man shall leave his mother, and a woman leave her home. They will travel on to where the two will be as one."

Perhaps we really become one in more ways than we know.

14% of Strokes Hapen When You're Asleep

Researchers at the University of Cincinnati as reported in Health Day News have found that 14% of strokes happen when individuals are asleep resulting in about 58,000 emergency room visits annually.

According to the researchers, some of these patients would have been eligible for the clot-busting drug tPA if physicians had been able to pinpoint when the stroke started. If a stroke starts more than a few hours before a patient seeks treatment, tPA can cause bleeding that will extend and enlarge the stroke instead of helping.

That is why you should know some of the working signs of stroke:

• weakness on one side of the face
   
• sudden vision problems
   
• slurred speech
   
• sudden severe headaches
   
• sudden confusion.

 Find out more at the National Stroke Association.