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Foods That Keep You Healthy from Head to Toe

There are many motivations for sticking with a healthy diet. Eating more of the good stuff (and less of the junky stuff) can help you prevent cancer, extend your lifespan, protect your heart and manage your weight. But one thing we don't always remember is that your diet affects not just your weight, but your body from the top down, the inside to the outside. Your body transforms the foods you eat into the cells that make up your hair, nails, skin and bones, along with your brain, heart, blood and joints. You literally are what you eat.   Here are some of the key nutrients that keep your body in tiptop shape from head to toe.   Hair At its staggering growth rate of 0.4 millimeters per day, it takes more than 2 years to grow 12 inches of hair. Add lean meats and beans to your diet to make the most of every millimeter. These foods will also give you zinc to help keep your body in hormone balance and prevent hair loss. B-vitamins from leafy greens, peas, tomatoes and carrots also support cell growth for healthy hair.   Brain Boost your brainpower by noshing on foods with high ORAC (Oxygen Radical Absorption Capacity) scores—a sign that the food is rich in disease-fighting antioxidants. Plums, cherries, avocadoes, berries, navel oranges and red grapes top the ORAC charts. (Glance through the alphabetical list for more disease-fighting ratings at oracvalues.com.)   Considering your brain is about 80% water, drink at least 64 ounces of water per day. Essential fatty acids (named "essential" because your body cannot make them) help you grow brain cells and stay sharp, so feed your brain with regular doses of fish, nuts, seeds, avocado, and olive oil.     Eyes Good nutrition can keep your peepers peppy throughout the years. The antioxidants for brain health also help the eyes, but really keep your eye on including foods with lutein and zeazanthin (pronounced zay-a-za-thin). These carotenoids, found in spinach, collard greens and kale, protect the retina from macular degeneration.   Teeth & Bones Everyone knows you need calcium for bone health, but are you getting enough? Most adults need between 1,000 and 1,200 milligrams of calcium daily. Low-fat milk, cheese, yogurt, almonds, spinach and soybeans are all good sources of dietary calcium. And calcium doesn't act alone! Its partner-in-crime is vitamin D, which is necessary for proper calcium absorption. Some fish and eggs provide this key vitamin, but there are not many natural food sources of this bone builder. Instead, vitamin-D is often added to milk, margarine and some breads and cereals.   Joints Put a wiggle in your walk with gelatin and vitamin C. These nutrients are key precursors to collagen, the material that cushions our joints and keeps our tendons and connective tissue strong. Gelatin can be found in powdered supplement form or in your basic Jell-O mix. Boost your vitamin C intake with fruits and veggies, especially strawberries, oranges, pineapple, cauliflower and green peppers.   Heart Soy and flaxseed both pack double punches when it comes to heart protection. Soymilk, edamame, tofu and other soy products are packed with cholesterol-lowering phytochemicals and heart healthy soluble fiber. Flaxseed is also another source of soluble fiber that comes with a side of omega-3 fatty acids, which may help reduce your risk of heart disease. Sprinkle some ground flaxseed in your oatmeal or yogurt, or even add it to your favorite baking recipe.   Intestines Protect your gut with probiotics. These powerful little bacteria support the natural environment in your intestine and combat disease-causing microorganisms. You can find yogurt, kefir and milk supplemented with probiotics. They are often under the name L. Acidophilus.   Fiber is also essential to a healthy gut. Whole grains, especially oats and bran, beans, nuts, fruits and vegetables can help you reach your goal. Getting your daily 20-35 grams of fiber keeps your gut and colon health moving in the right direction.   Skin We'll wrap it all up, literally, with nutrition for the skin. It is important to nourish your body's largest organ. Maintain disease-free and healthy looking skin with alpha-lipoic acid (ALA). This antioxidant is more powerful than vitamins C and E, and protects your skin cells from damage and many of the elements it's exposed to each day. Get your fair share of ALA with spinach, broccoli and beef. Vitamins C, E, K, and A, as well as B-vitamins are also important for radiant, nourished skin. Enjoying a variety of colorful fruits and vegetables can help you reach the recommended amount of these vitamins.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1669

11 Nice Ways to Say 'No' to Food Pushers

During family gatherings, food temptations are everywhere. From stuffing and pumpkin pie on Thanksgiving to eggnog and sugar cookies in December, to barbecues in the summer, the seasonal temptations are endless. It can be tough enough to navigate the buffet without having your great aunt force an extra helping of potatoes on your plate or resisting Grandma Dolly's pleas that you take a second piece of her famous apple pie. There's always some kind of event going on: birthday parties, family get-togethers, company meetings, bridal and baby showers--and all of these events have one thing in common (besides all the tempting food): food pushers.   Food pushers range from well-intentioned loved ones to total diet saboteurs. Regardless of their motivation, it's important to stick to your guns. You can always be honest and say that you're simply trying to eat healthier, but if that response gets ignored (or doesn't come easily), the following retorts to their food-forcing ways will keep you in control of what goes on your plate and in your mouth!   The Push: "It's my specialty, you have to try it!" Your Response: "I will in a bit!" Why It Works: Stalling is a great tactic with food pushers. Odds are the offender won't follow you around making sure you actually try the dish. If they catch up with you by the end of the party to ask what you thought, tell them that it slipped your mind but you'll be sure to try it next time.   The Push: "This [insert name of high-calorie dish] is my favorite. You'll love it!" Your Response: "I had some already—so delicious!" Why It Works: A white lie in this situation isn't going to hurt anybody. You'll get out of eating food you don't want or need, and the food pusher will have gotten a compliment on what probably is a delicious dish.   The Push: "It's just once a year!" Your Response: "But I'll probably live to celebrate more holidays if I stick with my diet plan!" Why It Works: People can sometimes see healthy eating as vain—a means to the end result of losing weight and looking better. It's harder for a food pusher to argue with you if you bring attention to the fact that you eat right and exercise for better health and a longer life. Looking good just happens to be a side effect!   The Push: "Looks like someone is obsessed with dieting…" Your Response: "I wouldn't say obsessed, but I am conscious of what I eat." Why It Works: Words like "food snob" or "obsessed" are pretty harsh when they're thrown around by food pushers. But don't let passive-aggressive comments like this bring you down—or make you veer away from your good eating intentions. Acknowledging your willpower and healthy food choices might influence others to be more conscious of what they eat. Sometimes you just have to combat food pushers with a little straightforward kindness.   The Push: "If you don't try my dish, I'm just going to have to force you to eat it!" Your Response: "Sorry, but I don't like (or can't eat) [insert ingredient here]." Why It Works: It's hard to argue with someone's personal food preferences. If someone doesn't like an ingredient whether its sweet potatoes, pumpkin, or butter, odds are that he or she hasn't liked it for a very long time. If you'd like to get creative with this one, go into detail about how you got sick on the ingredient as a kid or how your mom says you always threw it across the room as a baby. Who can argue with that?   The Push: "You need some meat on your bones." Your Response: "Trust me, I'm in no danger of wasting away!" Why It Works: This food push is definitely on the passive-aggressive side. Using humor to fight back will defuse any tension while making it clear where you stand.   The Push: "One bite isn't going to kill you." Your Response: "I know, but once you pop you can't stop! And I'm sure it's so delicious I wouldn't be able to stop!" Why It Works: This is another situation where humor will serve to distract the food pusher from his or her mission. It's a way to say "thanks, but no thanks" while making it clear that you're not interested in overindulging.   The Push: "But it's your favorite!" Your Response: "I think I've overdosed on it; I just can't eat it anymore!" Why It Works: If you have a favorite holiday dish that everyone knows you love, it can be especially tough to escape this push. If a loved one made the dish specifically for you, the guilt can be enough to push you over the edge. But people understand that food preferences change, and most have been in that situation of enjoying a dish so much that they can't touch it for awhile.   The Push: [Someone puts an extra helping on your plate without you asking.] Your Response: Push it around with your fork like you did as a kid to make it look like you tried it. Why It Works: While putting food on someone else's plate can be viewed as passive-aggressive, it was probably done with love. (Let's hope!) Making it look like you ate a bite or two can be an easy way out of the situation, but you can also just leave it alone and claim that you've already had your fill. (After all, you didn't add that extra helping!)   The Push: "Have another drink!" Your Response: "I have to drive." Why It Works: No one will argue with the fact that you want to drive home sober. If they do, you should have no qualms walking away from the conversation, period. If they offer a place for you to stay, you can always get out of the situation by blaming an early morning commitment or the fact that you need to get home to let the dog out. Kids will also get you out of everything.   The Push: "We have so many leftovers. Take some!" Your Response: "That's OK! Just think, you'll have your meals for tomorrow taken care of." Why It Works: Not every party guest wants to deal with the hassle of taking food with them, and this makes it clear that you'd rather the food stay. If the host is insistent, you can feign worry that they'll go bad in the car because you're not going straight home, or it'll go bad in your fridge because you've already been given so many leftovers at other parties recently. Or be polite and take them. You'll have more control of your food intake away from the party anyway. So whether you don't eat the leftovers at all or whether you split a piece of pie with your spouse, you're in control in this situation.   These tactics can work wonders in social situations, but honesty is sometimes the best policy. A simple "No, thank you" is hard for a food pusher to beat, especially if it's repeated emphatically. Remember, too, that it's okay to have treats in moderation, so don't deprive yourself of your favorite holiday foods. Just make sure that you're the one in control of your splurges—not a friend, family member or co-worker who doesn't know your fitness and health goals!     Do you have a favorite way to say, "No, thank you," to food pushers? Share your strategies in the comments section to the right. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1685

10 Tips to Keep from Overeating at a Party

Temptations abound at parties, but celebration doesn't have to mean overindulgence. Follow these tips to stay on track. Say no the first time to passed hors d'oeuvres. Chances are good that food will come around again. See what's being served before you decide what to eat. Limit your alcohol. Inhibitions are lowered with every drink, and those cocktails aren't calorie free. Alternate alcohol with water or another calorie free drink. And don't combine alcohol with caffeine. Caffeine speeds up the rate at which alcohol is metabolized, and it masks the effect of the alcohol. Eat before you go. Don't go to a party starving. Eat a hard-boiled egg and an apple, a banana with some peanut butter or a slice of turkey. The protein will fill you up for few calories. You'll be less likely to binge if you're not overly hungry. Treat appetizers as a meal. If you're going to eat 400 calories worth of appetizers, know that that's your dinner. Don't expect to go home and eat a "real" meal. Survey the spread before you fill your plate. Confronted by so many rich foods, you might want to start piling up the food, but stop and take a deep breath. Think before you serve yourself (and try to serve yourself, so you control the serving size). Keep track of what you're eating. Don't mindlessly eat, and try not to eat and make conversation at the same time. If your eating and drinking is spread out, you might not realize how many calories you're eating. Just because you're not eating an entire meal doesn't mean that those are free calories. Buddy up. If you're worried about eating too many sweets, share your dessert with someone else. You'll eat less and not do as much damage. Use a smaller plate, or commit to just one round of food. Don't pile your food so high that's it's falling off the plate. Be choosy, and stick to proper serving sizes. Take only those foods you really like, and don't overload on them. Bring a dish, if appropriate. If you bring something healthy, like salsa with vegetables, whole-grain crackers and light dip or a large salad, you know there's at least one option for you at the party. Take small helpings of other dishes and load up on your healthier one.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1355

The Truth about Alcohol and Heart Health

The idea that alcohol may be good for your heart has been around for a while. While moderate drinking may offer health benefits, drinking more can cause a host of health problems. So should you turn to alcohol to protect your heart? Here's what you need to know, from what alcohol can really do, to how much you should drink, to which types of drinks—if any—are healthier than others. Use this information in conjunction with your healthcare provider's advice. Research on Alcohol and Heart Disease In several studies of diverse populations, moderate alcohol consumption has been associated with a reduced risk for certain cardiovascular diseases, such as coronary heart disease. These studies were observational—not experimental—and therefore had some limitations. However, they showed the need for experimental studies regarding alcohol intake and heart disease. So in 1999, a meta-analysis was conducted on all experimental studies to date to assess the effects of moderate alcohol intake on various health measures (such as HDL "good" cholesterol levels and triglycerides), and other biological markers associated with risk of coronary heart disease. As research on this topic continued to expand, researchers conducted another systematic review of 63 studies that examined adults without known cardiovascular disease before and after alcohol use. This latest meta-analysis was published in a 2011 issue of the British Medical Journal (get a link to the full report in the Sources section below). The analysis of these numerous studies suggests that moderate alcohol consumption (defined below) helps to protect against heart disease by:

  • Raising HDL "good" cholesterol
  • Increasing apolipoprotein A1, a protein that has a specific role in lipid (fat) metabolism and is a major component of HDL "good" cholesterol
  • Decreasing fibrinogen, a soluble plasma glycoprotein that is a part of blood clot formation
  • Lowering blood pressure
  • Reducing plaque accumulation in the arteries
  • Decreasing the clumping of platelets and the formation of blood clots
However, these studies did not show any relationship between moderate alcohol intake and total cholesterol level or LDL "bad" cholesterol. And while some studies associated alcohol intake to increased triglycerides, the most recent analysis of moderate alcohol intake in healthy adults showed no such relationship. What's the Definition of "Moderate" Alcohol Consumption? A moderate alcohol intake is defined as up to 1 drink per day for women and up to 2 drinks per day for men. One drink contains 0.6 fluid ounces of alcohol and is defined as:
  • 12 fl. oz. of regular beer (5% alcohol)
  • 4-5 fl. oz. of wine (12% alcohol)
  • 1.5 fl. oz. of 80-proof distilled spirits (40% alcohol)
  • 1 fl. oz. of 100-proof distilled spirits (50% alcohol)
Are Certain Types of Alcohol Better Than Others? While a few research studies suggest that wine maybe more beneficial than beer or sprits in the prevention of heart disease, most studies do not support an association between type of alcoholic beverage and the prevention of heart disease. At present time, drinking wine for its antioxidant content to prevent heart disease is an unproven strategy. It still remains unclear whether red wine offers any heart-protecting advantage over white wine or other types of alcoholic beverages. Health Risks of Drinking Too Much While moderate drinking may have some health benefits, heavy or binge drinking can have a toxic effect on your health and your heart. Heavy drinking is the consumption of more than 3 drinks on any day or more than 7 drinks per week for women and more than 4 drinks on any day or more than 14 drinks per week for men. Heavy drinking in particular can damage the heart and lead to high blood pressure, alcoholic cardiomyopathy (enlarged and weakened heart), congestive heart failure, and stroke. Heavy drinking puts more fat into the circulation in your body, raising your triglyceride level. It's also associated with an increased risk of cirrhosis of the liver, cancer of the gastrointestinal tract and colon, breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes. Binge drinking is the consumption within 2 hours of 4 or more drinks for women and 5 or more drinks for men. Binge drinking is also associated with a wide range of other health and social problems, such as sexually transmitted disease, unintended pregnancy, and violent crimes. Who Should NOT Drink According to the 2010 Dietary Guidelines for Americans, the following people should not drink alcohol:
  • Adults who cannot restrict their alcohol drinking to moderate levels, as listed above
  • Anyone who is younger than the legal drinking age
  • Women who are pregnant or may become pregnant
  • Anyone taking a medication (prescription or over-the counter) that can interact with alcohol. Talk to your doctor or pharmacist about the medications you take and alcohol consumption
  • Individuals with certain medical conditions such as liver disease, hypertriglyderidemia, and pancreatitis. Talk to your doctor regarding your health history and alcohol consumption
  • Individuals who plan to drive, operate machinery or take part in other activities that require attention, skill, or coordination or in situations where impaired judgment could cause injury or death, such as swimming
Conclusion Research indicates that a moderate alcohol intake has been associated with a decreased risk for certain cardiovascular diseases, particularly coronary heart disease. However, health professionals and dietary guidelines suggest that if you don't drink, don't start. There are other, healthier ways to reduce your risk of heart disease like not smoking, eating right, getting regular exercise and maintaining a healthy weight. To find out if a moderate alcohol intake is appropriate for you, talk to your doctor about your consumption of alcohol, medical history, and any medications you use. Sources American Heart Association. "Alcohol, Wine and Cardiovascular Disease," accessed March 2011. www.americanheart.org. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA, "Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies," British Medical Journal 2011; 342:d636. doi: 10.1136/bmj.d636. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ, "Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effect on lipids and haemostatic factor," British Medical Journal 1999; 319:1523-8. United States Department of Agriculture Center for Nutrition and Policy Information. "2010 Dietary Guidelines for Americans," accessed March 2011. www.cnpp.usda.gov.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1622

Nearly 50 dachshunds rescued, looking for forever homes

Two Florida animal rescue facilities have taken in 47 dachshunds and are looking for a forever home for each of them.

WJHG reported that the Alaqua Animal Refuge in Freeport, Florida, and the Save Underdogs Rescue in Fort Walton Beach, Florida, took in the dogs.

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“They were going to be taken to a local shelter that wasn't a no-kill shelter so ... the reason it was so urgent for us to get them within this 24-48 hour time period was because they were going to be euthanized,” Alaqua Animal Refuge communications director Mary Chris Murry told WJHG.

On Sunday, Save Underdogs shared on Facebook that the 47 dogs were on their way to Florida from Arkansas. 

Save Underdogs founder Terri Bondi told Northwest Florida Daily News she learned of the situation from a friend in Arkansas. Laurie Hood, Alaqua Animal Refuge founder, said the dogs came from a man in Arkansas who was breeding dachshunds, but he became disabled and he was unable to care for them. WEAR reported the dogs came from a hoarding situation.

“I thought it was originally 30 dogs and thought I could manage it,” she said. “But when it was 50 ... It was perfect timing that Alaqua had space. We kept 22.”

The total turned out to be 47. Bondi said the man in Arkansas decided to keep three of the dogs.

Alaqua took in 28 dachshunds, according to a post on the organization’s Facebook page, leaving Save Underdogs with 19. 

The dogs range in age from several months old to 5 years old. Those interested in adopting may visit the Save Underdogs website and the Alaqua Animal Refuge website for more information and to contact the organizations to find a forever friend.

Your cat really does like you, in fact more than food, study says

Cats have gotten a bad rap, at least according to a new study that found your feline really does like you, even if it doesn’t always know how to show you, and it actually likes interacting with you more than it prefers food.

The study from Oregon State University researchers in the journal “Behavioral Processes” also determined that cats are trainable if given the right motivation.

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“Increasingly cat cognition research is providing evidence of their complex socio-cognitive and problem-solving abilities,” the study authors reported. 

Scientists studied pets and shelter cats and observed what happened when felines were given a choice of different stimuli, including toys, food, social interaction and scent.

Both pets and shelter cats preferred interacting with humans first, followed by food, the study found.

“Nonetheless, it is still common belief that cats are not especially sociable or trainable” according to researchers.

The disconnect could be due to an ignorance about the stimuli cats prefer and what motivates them.

Increase in rattlesnake attack on dogs, Texas vets report

Veterinarians in some parts of Texas have reported an increase in the number of dogs bitten by rattlesnakes this year, according to media reports. 

“The snakes are coming out of hibernation, they’re cranky and are more likely to strike when other times they might try to avoid that,” Jim Holcomb of Hill Country Animal Hospital in Austin told KVUE.

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The story does not offer any specific figures to back the claim.

If you live in an area that is especially populated by rattlesnakes, some veterinarians recommend the Red Rock Rattlesnake vaccine, which helps dogs develop antibodies that can neutralize rattlesnake venom. 

Dogs need to be 16 weeks old to receive the vaccine. Although it can help slow the effects of the venom, it is still important to get your dog to the vet immediately if you suspect a rattlesnake bite.

Related: Texas family’s toilet snake surprise leads to discovery of dozens more

The Houston Chronicle is reporting that recent hotter-than-usual weather has at least one upside: rattlesnakes rattle more when its warmer, serving as the perfect warning for you and your best friend.

A growing debate: Is vaping hazardous?

U.S. health officials say the rapidly expanding industry of e-cigarettes and vaping caters to children with a new unhealthy habit, tantalizing them with flavors such as Strawberry Shortcake Ice Cream and brands like Devil’s Juice.

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But those who vape say health officials are just carrying water for the tobacco and pharmaceutical companies, which make money from selling cigarettes and products that help people quit smoking.

Representatives of the vaping industry -- a phenomena in its own right estimated to be worth $10 billion -- said it has been unfairly disparaged and that their nicotine delivery system is far safer than traditional tobacco, pointing to studies in England.

“This is a revolution,” Ryna Schalk of Wellington, Florida, told The Palm Beach Post. “There are people giving out misinformation about vaping because of Big Government, Big Tobacco and Big Pharma. Vaping is taking money out of their pocket.”

Read more about the growing vaping debate at the Palm Beach Post.

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.

Swoben has accused the insurer of “gaming” the Medicare Advantage payment system by “making patients look sicker than they are,” said his attorney, William K. Hanagami. Hanagami said the combined cases could prove to be among the “larger frauds” ever against Medicare, with damages that he speculates could top $1 billion.

UnitedHealth spokesman Matt Burns denied any wrongdoing by the company. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with program rules,” he wrote in an email.

Burns also said that “litigating against Medicare Advantage plans to create new rules through the courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members and is wrong.”

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 18 million elderly and people with disabilities — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year.

Although the plans generally enjoy strong support in Congress, they have been the target of at least a half-dozen whistleblower lawsuits alleging patterns of overbilling and fraud. In most of the prior cases, Justice Department officials have decided not to intervene, which often limits the financial recovery by the government and also by whistleblowers, who can be awarded a portion of recovered funds. A decision to intervene means that the Justice Department is taking over investigating the case, greatly raising the stakes.

“This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” said Patrick Burns, associate director of Taxpayers Against Fraud in Washington, a nonprofit supported by whistleblowers and their lawyers. Burns said the “winners here are going to be American taxpayers.”

Burns also contends that the cases against UnitedHealth could potentially exceed $1 billion in damages, which would place them among the top two or three whistleblower-prompted cases on record.

“This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” Burns said.

On Monday, the government said it wants to consolidate the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling and unsealed in March by a federal judge. Poehling also has alleged that the insurer generated hundreds of millions of dollars or more in overpayments.

When Congress created the current Medicare Advantage program in 2003, it expected to pay higher rates for sicker patients than for people in good health using a formula called a risk score.

But overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity found that these improper payments have cost taxpayers tens of billions of dollars.

“If the goal of fraud is to artificially increase risk scores and you do that wholesale, that results in some rather significant dollars,” Hanagami said.

David Lipschutz, senior policy attorney for the Center for Medicare Advocacy, a nonprofit offering legal assistance and other resources for those eligible for Medicare, said his group is “deeply concerned by ongoing improper payments” to Medicare Advantage health plans.

These overpayments “undermine the finances of the overall Medicare program,” he said in an emailed statement. He said his group supports “more rigorous oversight” of payments made to the health plans.

The two whistleblower complaints allege that UnitedHealth has had a practice of asking the government to reimburse it for underpayments, but did not report claims for which it had received too much money, despite knowing some these claims had inflated risk scores.

The federal Centers for Medicare & Medicaid Services said in draft regulations issued in January 2014 that it would begin requiring that Medicare Advantage plans report any improper payment — either too much or too little.

These reviews “cannot be designed only to identify diagnoses that would trigger additional payments,” the proposal stated.

But CMS backed off the regulation’s reporting requirements in the face of opposition from the insurance industry. The agency didn’t say why it did so.

The Justice Department said in an April 2016 amicus brief in the Swoben case that the CMS decision not to move ahead with the reporting regulation “does not relieve defendants of the broad obligation to exercise due diligence in ensuring the accuracy” of claims submitted for payment.

The Justice Department concluded in the brief that the insurers “chose not to connect the dots,” even though they knew of both overpayments and underpayments. Instead, the insurers “acted in a deliberately ignorant or reckless manner in falsely certifying the accuracy, completeness and truthfulness of submitted data,” the 2016 brief states.

The Justice Department has said it also is investigating risk-score payments to other Medicare Advantage insurers, but has not said whether it plans to take action against any of them.

Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find

Cynthia Brownfield was lucky. When her daughter, then 2 years old, tested for high levels of lead in her blood, she could do something.

Brownfield, a pediatrician in St. Joseph, Miss., got her home inspected and found lead in the windows. She got them replaced and had her pipes fixed, too. Her daughter, now 12, was probably affected, says Brownfield. But quick action minimized the exposure. Her daughter is now a healthy, fully-functioning preteen.

“We were in the financial position where we could hire a plumber and change the windows,” she said. But others — even her own patients — may not be so fortunate. This reality may have implications even more far-reaching than generally accepted.

Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.

They studied the development of more than 1,000 New Zealanders born between April 1972 and March 1973. Because at that time gasoline still contained lead, exposure was common, creating a sizeable sample that included people across class and gender. More than half in that data set had been tested for lead-exposure at age 11, and the study tracked brain development and socio-economic status over the years — making for “a natural time” to use them to study lead’s health effects, said Aaron Reuben, a PhD candidate in neuropsychology at Duke University, and the study’s first author.

By the time study participants reached age 38, a pattern emerged: Children who were exposed to lead early in life had worse cognitive abilities, based on how their exposure level. The difference was statistically significant. They were also more likely to be worse off, socioeconomically, than those who had not been exposed to lead. The study found that no matter what the child’s IQ, the mother’s IQ, or the family’s social status, lead poisoning resulted in downward social mobility. That was largely thanks to cognitive decline, according to the research.

“Regardless of where you start out in life, exposure to lead in childhood exerts a downward pull to your trajectory,” Reuben said.

Though this research was set in New Zealand, it offers insight into a problem experts said is fairly ubiquitous in the United States and across the globe. The CDC estimates that as many as half a million children between ages 1 and 5 had blood lead levels high enough to cause concern: 5 micrograms per deciliter and up. At least 4 million households across the country have children experiencing significant lead exposure.

Last year’s water crisis in Flint, Mich., brought lead exposure front and center as a public health concern. Meanwhile, a Reuters investigation published this winter found elevated lead levels in almost 3,000 communities around the country. The Centers of Disease Control and Prevention recently changed its guidelines to suggest that any childhood exposure to the chemical is harmful, and is pushing to get rid of lead poisoning in kids by 2020.

In the U.S., children at risk are typically poorer and racial minorities — in part because they more often live in older houses with lead paint. This is a stark difference from the research population, which tended to be white. However, because the study spanned a period of time in which lead was still used in gasoline, the lead exposure measured in the study spanned a wider class spectrum.

That adds greater consequence to these findings, many said.

“Kids who are poor, or who have some of these other social determinants of health that are negative — they end up with a double whammy. Whatever health consequences they have from being poor, those are added to the additional consequences of being exposed to lead,” said Jerome Paulson, an emeritus professor and pediatrician at George Washington University. Paulson has researched lead’s effects on children, although he wasn’t involved with this study.

“If you want to talk about ‘breaking out of poverty,’ kids who have lead exposure are probably going to have more difficulties,” he added.

That said, these conclusions aren’t perfect. For instance, the research doesn’t account any variation in how the children who were tested may have been previously exposed to lead, or how their continued lead exposure through adulthood may have differed. Those who worked in jobs like construction, for instance, may have had greater lead exposure than those in white-collar jobs, Paulson noted. But on the whole, he said, it makes a strong case for the long-term impact of childhood lead exposure.

Pennsylvania, Maryland and Massachusetts, which all have cities with concentrated areas of older housing, have identified lead poisoning as a major child health hazard. The CDC has also embraced “primary prevention” — testing homes for lead and removing it before people move in and risk exposure. But securing resources for lead testing, screening and abatement poses its own set of challenges.

The JAMA study illustrates, in part, one such difficulty. Lead poisoning happens over years, not overnight. So illustrating the impact, even if it’s ultimately significant, is hard to do.

“Prevention doesn’t have a lot of pizzazz. If you prevent something from happening, it’s a wonderful thing, but it’s hard to measure and take credit for,” said David Bellinger, a neurology professor at Harvard Medical School and a professor in the environmental health department of the university’s public health school, who wrote a commentary that ran alongside the JAMA paper.

And funding for such programs is often unreliable, said Donna Cooper, the executive director of Public Citizens for Children and Youth, a Pennsylvania-based nonprofit that advocates on behalf of young people. For instance, the White House’s initial budget plans would boost some lead abatement funds but slash other grants used for similar purposes. And for many states, she said, even what’s long been available isn’t enough to meet the scope of the concern.

“We have very clear CDC guidance on what should be done, and no money to back it up,” Cooper said. “It ebbs and flows with the headlines.”

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