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News From The Annals Of Family Medicine: July/August 2009
The Primary Care Paradox and the Need to Integrate Primary and Specialty Care to Improve the Quality of Healthcare
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National Institute for Health and Clinical Excellence (NICE) Starts Work On Setting Quality Standards, UK
The National Institute for Health and Clinical Excellence (NICE) welcomes the referral of four clinical areas by the Department of Health following advice from the National Quality Board and will now begin work on setting NICE quality standards for the NHS using a pilot process.
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CareFirst BCBS Covers ENO Measurement For Diagnosis, Asthma Treatment
Apieron, Inc. said that CareFirst BlueCross BlueShield has adopted a positive coverage policy for the measurement of exhaled nitric oxide (eNO). The Medical Directors of CareFirst determined that the published, peer-reviewed evidence is sufficient to support benefit coverage for the treatment of asthma. The policy, effective July 20, 2009, states the measurement of exhaled nitric oxide is considered medically necessary in the management of asthma patients. CareFirst is the largest health care insurer in the Mid-Atlantic region, serving nearly 3.4 million members in Maryland, District of Columbia and portions of Virginia.
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Changes In Stair Design Could Help Fight Obesity

Some simple changes in the design and location of staircases could help to make buildings more "physical activity friendly" and contribute to the fight against obesity, according to an article in the June Southern Medical Journal, official journal of the Southern Medical Association. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. "Changing stair design to encourage their use requires a set of interventions on both architectural and legislative levels to create physical environments that support active living," write the authors, led by Dr. Ishak A. Mansi of Louisiana State University Health Sciences Center, Shreveport. His wife, architect Nardine M. Mansi, is one of the co-authors. Current Design Discourages Staircase Use Encouraging people to take the stairs instead of the elevator or escalator is a promising approach to increasing moderate physical activity, the Mansis and their co-authors believe. "It involves a lifestyle choice that must be made (people must get to their destination) and it requires no personal financial cost." But would climbing the stairs a few times a day really have that much of an impact on overweight and obesity? The authors point out that ordinary day-to-day physical activities contribute the most to total energy expenditure the key factor in maintaining a healthy body weight. Research suggests that light to moderate physical activity is most effective in motivating people who are currently inactive and obese. But current approaches to stair design pose a problem. "Stairs are frequently hidden from entrances, with only small signs denoting their locations, typically in connection to the fire exit," according to the article. Fire exits are usually guarded by heavy doors, not carpeted, and not air-conditioned. Architects find it challenging enough to comply with current building codes emphasizing fire safety and accessibility. "As a result, a conscious focus on health does not enter the design process." Suggestions for Improving Stair Design Some simple interventions can do much toward encouraging people to take the stairs, research suggests. For example, a study performed at a Centers for Disease Control and Prevention building found that playing music in stairwells and displaying motivational signs significantly increased the use of stairs. These and other measures to make stairs attractive, safe, and readily accessible could help to make buildings more "physical activity-friendly," the authors write. They suggest several ways to make stairs more comfortable and inviting for example, making staircases wider with less height per step and adding music, lighting, and air-conditioning. Such efforts would readily fit in with recommended policy and environmental changes to increase physical activity. "State and local agencies are being encouraged by federal and nongovernmental organizations to use policy interventions to address the public health problem of physical activity," according to the Mansis and their co-authors. They call for physicians, architects, and other professionals to work together to promote change in such policies. They conclude, "Perhaps now is the time to address the need for standard national building codes that incorporate health concerns and support active living." About the Southern Medical Journal The Southern Medical Journal is published monthly by the Southern Medical Association and Lippincott Williams & Wilkins. Devoted solely to continuing education, the Journal publishes annually more than 200 original clinical articles directed to the practicing physician and surgeon on topics such as hypertension, osteoporosis, alcoholism, obesity, dementia, asthma, and diabetes and includes monthly CME features. About the Southern Medical Association The Southern Medical Association (SMA) has been serving physicians" needs since its inception in 1906. SMA"s mission is to promote the health of patients through advocacy, leadership, education, and service. Mark your calendars to attend the Annual Scientific Assembly of Southern Medical Association, December 3-5, 2009 at the Gaylord Texan Resort and Convention Center in Dallas, Texas. About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices Lippincott Williams & Wilkins


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