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Microsoft word - vol 3 no 1 july 13 2009W ords of
The newsletter of the Collaborative Support Programs of New Jersey Institute for Wellness and
Recovery Initiatives ● www.cspnj.org ● Volume 3, Number 1 ● July 13, 2009
SCHIZOPHRENIA AND CANCER
In a recent article in the journal Cancer,1 a team of
• A personal wellness quiz (taken from a 2004 researchers from a university department of Canadian healthy workplaces initiative). psychiatry in France looked at cancer rates for • A personal wellness goals form (which is more of people diagnosed with schizophrenia. This was a a checklist for working with a trainer for physical large-scale study, covering 3470 patients over an 11- year period. The researchers observed that “during • A “personal wellness plan worksheet,” which is a the 11-year follow-up, 476 (14%) patients died; the 2-page tool which seems well organized for some mortality rate was thus nearly 4-fold higher than in people to plan personal wellness improvements. the general population. Cancer was the second most • A “personal wellness assessment,” which is frequent cause of mortality.” They went on to another tool for self-assessing individual wellness, observe that lung cancer was the most frequent form with a decent (but not exclusive) focus on diet and of deadly cancer in men, and the second most frequent form of deadly cancer (after breast cancer) • A “wellness pyramid,” which is another tool for in women, and that duration of smoking was a strong conceptualizing personal wellness, and is neither predictor of death in both men and women. This the wellness pyramid promulgated with the “Zone study highlights the importance of helping Diet” nor the one put for by Kelley, et. al. in people living with a diagnosis of schizophrenia and • “Top Ten Ways to Improve Personal Wellness,” which is a set of primarily diet-related guidelines • Increase their appropriate use of medical screening, in order to detect cancers and other conditions at a point when life can be saved. A link to a “personal wellness checklist” provided by California State University-Pomona is broken. Also DEFINITIONOFWELLNESS.COM
included are several articles on walking and wellness. Www.definitionofwellness.com is a website, primarily providing information collected from external sources, which provides some basic information about the world of wellness, along with some handy tools. The home/definitions section goes beyond defining ten dimensions and sub-dimensions (Social, Occupational, Spiritual, Physical, Intellectual, Emotional, Environ-mental, Financial, Mental, and Medical), to provide, for most of these, a self-assessment tool, along with a section variously named “steps to encourage…,” “steps for improving…,” “what are barriers to…,” etc. 1 Tran E, Rouillon F, Loze JY, Casadebaig F, Philippe A, 2 Kelley J, Frisch N & Avant K (1995). A trifocal model of nursing Vitry F & Limosin F (2009). Cancer mortality in patients diagnosis: wellness reinforced. Nursing Diagnosis;Jul-Sep;6(3):123- with schizophrenia: an 11-year prospective cohort study. to increase the cost sharing for prescriptions or block access to expensive medications, through a combination of: • increased co-pays • tiered formularies, where typically the most expensive medications require a higher copay A TIMELY THOUGHT ON
THE SECOND MAN ON THE MOON
• closed formularies in which the plan refuses to July 21 marks the fortieth anniversary of the first walk by human beings on the moon, an event • pressure through the pharmacy on the prescriber identified by Apollo XI mission commander Neil to switch the patient to a similar medication with Armstrong as “One Small Step for Man, One Giant • pressure on the prescriber to avoid the most expensive medications, by requiring inconvenient Almost everybody is aware that Armstrong was and time-consuming “prior authorization” joined on his walk by New Jersey native and resident Edwin “Buzz” Aldrin. Not everybody is • fail-first programs, where a patient must be shown aware of Aldrin’s struggles with alcoholism, not to have been aided by a lower-cost option depression, and possibly bipolar disorder, or his before the plan will pay for the more expensive challenges. In 2001, Aldrin stated “Recovery • Quantity limitations, in which a patient will was not easy. Perhaps the most challenging receive coverage for up to a finite number of turnaround was accepting the need for assistance doses of the medication in a month, regardless of and help. Looking back at it now--with over 22 how many doses he or she needs. This control is years of sobriety--this was probably one of my often exerted, for example, on the “triptan” greatest challenges. But it has also been one of the most satisfying because it has given me a People who have public health coverage such as sense of comfort and ease with where I am now.4 Medicare, Medicaid, or State Pharmaceutical Assistance Programs5. Such programs have been ECONOMICS OF MEDICATION
forced in many cases to employ some of the cost It is apparent that the cost of medication for control methods adopted by private insurance. In enduring health conditions is an important factor some states, the costs of medications have caused the in our health care. The number of medications a programs to make it harder for a person to become person uses, and the high cost of medications which are not available in generic form has economic effects on 3 different populations. It is equally apparent that there is no “easy answer” to People who pay most or all of their medication this problem. While many people would assert that costs themselves often find themselves spending the costs of new medications in the US are inflated, increasing fractions of their incomes on there is certainly no obvious force which would medications. People who have private health insurance with medication coverage are impacted because insurance premiums have been rising The use of generic medications is equally every year, due in large part to increasing problematic. A generic medicine is one where the medication costs. Those costs are generally original drug maker’s patent has expired, and other borne by the insured party as higher premiums. companies are legally able to submit an application to Medication cost increases also lead health plans 5 In New Jersey, Pharmaceutical Aid for the Aged and Disabled, Dosing/Instructions
one half tablet Breakfast & Dinner
Apply to feet as needed when athlete’s foot Another problem with using generic medications to medication of the same formula of active control costs comes when there is no generic equivalent ingredients. The generic medication is priced of the same medication. The patient and physician may significantly lower than the original brand-name need to consider whether another medication in the drug, due both the absence of research and same class could accomplish the desired effect at a development costs and competition. The FDA lower cost. Of course, in many cases there is no lower does not require the generic medication to have cost option without negative medical effects. identical “bioequivalence”7 as the original brand- To illustrate this, we come back to Alexandra bioequivalence to be demonstrated as in the Fleming, a fictional patient whose medication list we introduced in our September 1, 2008 issue as an example of good tracking (see list in box above). We are now interested in the cost of her meds. Using prescribing difficulty. In many cases, the patient mail-order prices, we find that if she does not have switched to a generic medication could be any kind of insurance coverage or patient assistance, receiving 4/5 of the active ingredient versus the she would be spending about $410 per month for this brand-name product. Increasing the prescribed regimen. One medication, Byetta, accounts for over dose by 25% is not an option, because other half of her drug costs. Byetta is the only drug in its generic copies of the same medication (or even class, “incretin mimetics,” which are used to treat alternate batches) might have 100% or even Type II Diabetes. In Ms. Fleming’s case, she is using 125% of the dose strength of the original. This this med9 in combination with another diabetes is particularly problematic for medications which medication, Glucophage (metformin). She and her have a narrow “therapeutic window,”8 meaning physician probably had a dialog regarding the choice that the dosing range between effective doses and doses which can cause significant side- • Glucophage alone did not provide adequate control effects or even death is relatively small. • Other oral medication classes and choices had side- effects/risks (pancreas depletion, cardiac risks, risk of low blood sugars) which were not worth taking 7 A measure of the availability and effects of the drug in an • She could be treated on Byetta without the need to be animal body, projected as a measure of its availability in placed on Insulin, which is a more complicated the human body 8 Examples include Coumadin (warfarin), Digoxin (digitalis), Lithium, and Tylenol (acetaminophen) 9 Which she injects twice a day into the skin of her abdomen regimen that has undesired side-effects (weight available in artificially sweetened or whole-grain versions. The bottom line: Convenience Stores, like
any other setting, can be as healthy or unhealthy as
If Ms. Fleming were without prescription you choose to make them.
coverage for her Byetta, and did not have the
money for $2700 per year worth of Byetta, and
ALTERNATIVES TO CRISIS
CONVENIENCE STORES AND
Some people might view convenience stores as accessible to teens and young adults around the major sources of physical unwellness. Coolers are filled with soft drinks containing large amounts of sugar and caffeine. Shelves are Such “less than crisis” interventions have been stocked with chips and candies, containing large lacking in our adult system. Some money has amounts of carbohydrates with little redeeming been given to psychiatric emergency services in nutritional value. People’s addictions are fueled by large displays of cigarettes (and other tobacco intervention.” Reports have been mixed. Some products), sales of lottery tickets, and in some people have gotten mobile counseling to avoid a states, beer and other alcoholic beverages. crisis, others have found too much of a “safety assessment” approach and mentality. New This unwellness does not need to be a built-in Jersey’s Mental System Health Wellness aspect of convenience stores. Many stores have Recovery Transformation Action Plan identified increased their availability of fresh fruits, the requirement to develop two specific resources, Alternatives to Psychiatric Screening, and a sandwiches which can be made with reduced-fat statewide peer support warmline. Alternatives to meats, or on whole-wheat bread11. Single Screening pilot programs were grant-funded in servings may be available of cereals and other Atlantic and Morris Counties. No data has been foods which play a role in a healthy diet. Diet made available about those programs, their beverages, waters, and juices are readily contracted characteristics, and their outcome available in the coolers. Even some traditional 10 See, for example, www.rx4nj.org 11 To lower the glycemic index of a meal and provide additional dietary fiber. The most recent initiative was the state contracting to some psychiatric facilities, and a chance for quite and funding a statewide mental health warmline a few people with and without a mental illness to through the Mental Health Association in NJ. That line, at 877-292-5588, is now operational 8am- 10pm weekdays, and 5pm-10pm weekends. This is To locate self-help centers or groups anywhere in the a service where adults experiencing psychiatric state, contact the NJ Self-Help Group Clearinghouse. symptoms can call and talk to other adults with a mental illness. The state requires line workers employ a model of service known as Intentional ALTERNATIVES CONFERENCE
Peer Support (IPS), developed by leading mental CONTINUES TO INNOVATE
health peer recovery educator Sherry Mead. In IPS The annual Alternatives conference (www. • Support is about giving and receiving, versus a Alternatives-2009.org) is an event where every professional-client relationship which leads to presentation is made by an individual or team which includes someone living with a mental illness, and • Support is not based on psychiatric models or which is recognized as the single national conference which seeks to recognize and involve all factions of • Peers encourage one another to reevaluate how the mental health consumer/survivor/ex-patient each has come to know what he or she knows. movement. With the wide variety of interests and • Peer support is about creating relationships that viewpoints in our community, the conference is well- challenge people to take a broader worldview. • Trauma informs the peer support, meaning that relationships starts with “what happened to This year, one unique effort is a “pre-conference arts you?” rather than “what’s wrong with you?” institute, "Transforming Lives through the Arts." • Peer support goes into the relationship with a Coordinated by noted peer advocate Gayle Bluebird, specific intention: to communicate in ways this will be an all-day event where participants will be that help both people step outside their current offered a variety of hands-on arts activities, including painting, writing, performance, dance, humor and The warmline personnel will also match some others—all practical for use in peer support work. Also people up with “phone friends,” who will be able to included will be four unique spaces which will operate provide a long-term reciprocal relationship. The during the actual conference: an Arts Drop-In Center, phone friends mostly will not have IPS training. a Health and Wellness Fair, A Meditation Room, and a In addition to the new warmline, adults can, of course, find peer support in other places, Would you like to quit smoking? Or would you
like to help others quit smoking?
• At any self-help group • At any of New Jersey’s 30+ Self-Help Centers. Online resources: www.smokefree.gov
Each has a peer manager, peer facilitators, and a Help is available!
van/drivers. Centers are open at no charge to Call 1-800-QUIT NOW
anyone in New Jersey who is experiencing or has experienced a mental illness, and/or has Toll-free telephone centers are available to anyone received mental health services. While groups in the U.S. Each quitline is staffed by trained and organized activities may or may not be in cessation experts. The quitline counselors tailor a progress at any given time, someone walking in quit plan and advice for each individual caller. A during center hours should always find a major statewide study, conducted in California, coffeepot, a peer, and a sympathetic ear. showed that quitline use more than doubled a • The initiatives of the Turn-a-Frown-Around smoker's chance of successfully quitting. Foundation (973-746-7353, www.frowntosmile. Call 1-800-QUIT NOW and see for yourself.
org). This group offers phone buddies, visiting UPCOMING TRAININGS/MINI-CALENDAR
• Its second annual NAMI En Español conference Note: Our separate calendar edition will resume publication on or around September 1. • Its annual AACT-NOW15 forum for October 24 The following FREE trainings are presented by
our institute to the mental health recovery community, including individuals pursuing The Institute for Prevention will host an all-day
recoveries, practitioners, and family members. program on Friday, October 9 in Livingston. The
Trainings do fill up, and advance registration is Changing Role of the Health Care Provider in an
requested12. When you register, you will receive Increasingly Tobacco-Free World is planned as a
a confirmation which will include directions to symposium for all professionals working with tobacco dependent individuals including those who deal with mental illness or addiction. 732-9143815. Wellness 101: A Framework for Living &
www.njamha.org/links/newswire/tobaccoSTD.pdf Working. Many people living with a
diagnosis of mental illness are dying too Alternatives 2009 will be the 23rd annual occurrence of
the only national mental health conference organized conditions largely due to lifestyle choices and by and for people diagnosed with mental illnesses. It habits. This workshop is an overview of this will take place October 28 through November 1 in health crisis and will examine how we can proactively develop a lifestyle centered on The National Caregiver Conference will take place on
The New Jersey Psychiatric Rehabilitation
Wellness 102: Creating and Sustaining Lifestyle
Association (www.njpra.org) will host its annual
Habits & Routines. This workshop will empower
conference on November 12-13 at the Sheraton participants to explore lifestyle choices and habits Raritan Center, Edison. . Keynote speakers are: that can have a positive impact on their overall sense of well-being. Building from the wellness framework, participants will be able to discuss and strategize how they can adopt healthy lifestyle choices to create and sustain a personally defined The Supportive Housing Association (SHA) in
New Jersey will conduct its annual conference on
Friday, December 4 at the Pines Manor, Edison. SHA also conducts monthly meetings, often featuring senior state officials involved in housing NAMI NEW JERSEY (www.naminj.org) will host
and related services. SHA is also a resource for: a FREE13 three-day facilitator training for New
• A wide variety of agency and community Jersey residents who are willing to commit to co- initiatives to initiate and sustain supportive facilitating a weekly mental health support group14. • A regularly updated web-based listing of supportive housing and mental health employment opportunities. 12 Send an e-mail to WEC@cspnj.org 13 NAMI will also cover all meals, transportation, and 15 African-American Community Takes New Outreach
CSPNJ has scheduled our annual wellness and
recovery conference for March 18-19, 2010 at
the Pines Manor in Edison, NJ. Watch this
newsletter for further details!
WORDS OF WELLNESS
As part of its broad array of services to foster wellness and recovery for individuals with disabilities, the Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey (CSPNJ) offers this monthly newsletter, Words of Wellness. This publication features valuable information and resources, including details about educational events, to help people to achieve and maintain wellness. The purpose of this newsletter is to bring useful information to all of our readers, whether pursuing recovery themselves, supporting recovery in clients or family members, helping to administer and change our mental health and related services system, or researching the field and educating future practitioners. Words of Wellness co-editors are Jay Yudof and Peggy Swarbrick. Free e-mail subscriptions are available from email@example.com. We also welcome submissions and feedback at that address.
IMPARTING THE LANGUAGE OF CRITICAL THINKING WHILE TEACHING PROBABILITY Ben Gurion University of the Negev, Israel This paper reports a preliminary study of imparting to students a new kind of language, incorporating elements of critical thinking (CT), in the course of a mathematics (probability) lesson. In the paper, we describe and analyse one probability lesson, which is part of a