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The breakdown of this information is included in Exhibit "C" at the end of these minutes asthma symptoms vs heart attack buy singulair mastercard. Robin spoke about the audit process performed by both the Stop-Loss carriers and the insurance companies for claims asthma symptoms list discount singulair 4 mg visa. Robin MacDonald stated 531 2 any claim that comes in to Florida Blue over $40 asthma symptoms at 30 buy generic singulair,000 is automatically reviewed by their auditors asthma definition 35 discount singulair. Insurance companies are heavily regulated by both State and Federal authorities, the Blue Cross Blue Shield Foundation, and Florida Blue itself hires auditors to come in and look at the claims. Robin Riley responded that claim auditors used to charge for the audit based on the amount of money recovered (a percentage usually). This process has changed and almost all companies charge a flat fee for the service. The auditors will work with the carrier to process any refunds that need to be processed. Robin MacDonald said the auditors basically go line-item by line-item and if they find an error, they send the report to Florida Blue first for investigation, if there is a refund due Florida Blue will reimburse us. Tasha Morgan asked if the Committee wanted to pay for this service out of Reserve Funds and the Committee indicated they would. Myrna Spencer made a motion to do the third-party audit using the Health Management Systems vendor. Myrna Spencer explained the program requirements and costs, and it is sponsored by Florida Hospital. She then explained we have setup the scholarships through the Wellness Funds for 2018. Chairman Handley asked if we were going to keep it at 10 scholarships and if we want to continue funding this program. The decision before the Committee is whether they are ok with funding 100% of the scholarship from the Wellness Funds for up to 10 employees. The program starts up in August, so that gives time for a group to go out and make presentations to 532 3 employees to generate interest. Staff will reach out to the Hospitals and see if they have grants available for this year. New Business: Tobacco Cessation Program/Incentives: Rebecca Cable stated after the discussion of chronic conditions and high-cost claims presented by Florida Blue, this was a good lead-in to talking about Tobacco Cessation Programs. This has been brought to the Insurance Committee previously and was struck down, most likely because it was considered to be invasive and a personal choice issue. The County is not going to force someone to submit to a swab test or anything, it would be voluntarily reported and would allow us to offer assistance to tobacco users that want to quit. Pamela Rogers discussed the meetings she attends quarterly with multiple Counties and Municipalities, and this is where the information came from. The majority of the participating governments had some sort of Tobacco Cessation Program. Implementation, if the Committee feels we should move forward, would be for the 2018-2019 Plan Year. Chairman Handley informed the new Committee Members that this came before the Committee two years ago, and after various motions back and forth and much discussion, it was ultimately scrapped. Omar DeJesus asked if we felt that employees would be honest or if we would have to use the swab? Robin MacDonald stated Florida Blue does have a Tobacco Cessation program, and also pointed out that because we are a public entity and we receive federal funds, falsifying the affidavit that would be signed is prosecutable as insurance fraud. Myrna Spencer stated that she is against it because it could lead to other things. Nothing is mentioned about alcohol, and that can be a serious problem for people too. Omar DeJesus stated it would have to be completely voluntary in order to get the discount. Vicki Pontius stated she agrees that smoking (tobacco users) is a dangerous health risk, as is diabetes, etc.

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Meredith and colleagues reviewed 270 documents and found only 11 with a randomized controlled design asthmanefrin purchase singulair 10 mg fast delivery. Three programs-Battlemind asthma symptoms emphysema order singulair with a mastercard, Comprehensive Soldier Fitness asthma definition key quality 5mg singulair, and Combat Operational Stress Control-are discussed in more detail below asthma treatment 4 addiction singulair 4 mg low price. Battlemind Battlemind, which is now called Resilience Training, is an Army program designed to foster resilience by teaching self-confidence and mental toughness in the context of deployment and transitioning home. Developed by researchers at Walter Reed Army Institute of Research, Battlemind is a psycho-educational intervention that uses a cognitive and skills-based Copyright © National Academy of Sciences. There are several Battlemind modules,1 the most prominent of which are Battlemind Debriefing and Battlemind Training. Among its goals are to identify the traumatic events that have placed a significant demand on unit members; to normalize thoughts and reactions; to discuss anger, withdrawal, and sleep problems; and to emphasize what individuals can do for themselves and their comrades. The debriefing seeks to restore a sense of duty and honor to the participants in order to enable them to proceed with their mission (Orsingher et al. Unlike other types of psychological debriefing, Battlemind Debriefing minimizes the degree to which traumatic events are recounted in order to avoid re-traumatization (Adler et al. Battlemind Training, on the other hand, is expressly designed for the post-deployment period. It reinforces the point that specific skills that serve individuals well in combat need to be reframed and adapted for the transition home. A randomized controlled trial involving 2,297 soldiers looked at Battlemind Debriefing and Battlemind Training interventions that were held 1 month post-deployment. The study found that Battlemind had positive effects on psychological health when compared to stress education, but only for those with high levels of combat exposure. The study also found less stigma surrounding help seeking immediately after the Battlemind session but not at follow-up. The control group was a standard postdeployment stress and homecoming brief and thus was more active than the survey-only condition used in the Castro et al. Some of the Battlemind modules have been converted from a standalone program into components of Comprehensive Soldier Fitness. Comprehensive Soldier Fitness In 2009 the Army launched the $125 million Comprehensive Soldier Fitness program (U. The Penn Resiliency Program is based on positive psychology as well as on cognitive behavioral theories of depression, and it includes training in assertiveness, negotiation, social skills, creative problem solving, the use of optimism and positive explanatory approaches, and decision making. Versions of the program are also available for military families and Army civilians, although this committee found no evidence of their implementation with these groups. For example, in the Comprehensive Soldier Fitness Program Evaluation Report #3: Longitudinal Analysis of the Impact of Master Resilience Training on Self-Reported Resilience and Psychological Health Data (Lester et al. The only resilience or psychological health measures that saw significant improvement post-exposure were emotional fitness (a 1. External reviews, discussed below, have raised similar questions concerning the effect sizes of reported findings and related problems in accurate interpretation of the impact. More recently, in another internal non­peer-reviewed report, the Comprehensive Soldier and Family Fitness Program Evaluation Report #4: Evaluation of Resilience Training and Mental and Behavioral Health Outcomes, Harms et al. Therefore, the subsequent mediation analysis performed by the authors cannot be interpreted as evidence of intervention/program impact. The meta-analysis found that although the program reduced symptoms of depression, the effect size was small, and the program did not prevent, delay, or lessen "the intensity or duration of future psychological disorders" (Brunwasser et al. Prevention trials in adolescents and children find that an improvement in subclinical levels of depression is a more likely outcome than the prevention of a depression diagnosis in the future (Stice et al. Like Steenkamp and colleagues, they criticize the application of the Penn Resiliency program in the face of the small effect sizes found in the meta-analysis by Brunwasser et al. They assert that resilience training may "harm our soldiers by making them more likely to engage in combat actions that adversely affect their psychological health" (Eidelson et al. To support this view, Smith cites a study by Norem and Illingworth (2004) finding that when a positive mood is induced, individuals who are pessimists display decreased ability to problem-solve.

Gender differences in alcohol consumption and adverse drinking consequences: Crosscultural patterns 911biomed asthma attack purchase generic singulair from india. Gender comparisons of alcohol consumption in alcoholic and non-alcoholic populations asthma definition 6 studio discount singulair 5mg amex. Its land area of 51 thousand square kilometers is comparable with the size of Switzerland asthma treatment 5 steps cost of singulair. According to data from the 2000 national census (Instituto Nacional de Estadнstica y Censos asthma of the skin purchase singulair 5 mg on-line, 2001) there are 4 million inhabitants, including nearly 14% inmigrants, especially from Nicaragua. Migrant flow occurs in response to several factors: natural disasters, political conflict and structural economic imbalances. Among primary causes of death are circulatory diseases, tumors and reproductive system diseases. Alcohol consumption and alcohol-related problems have been a longstanding public health problem in Costa Rica. Alcohol-related matters have undergone change according to different historical, social and economic circumstances. Several studies (Bejarano & Sбenz, 2000; Bejarano, 2000; Jimйnez & Bejarano, 1991), as well as a few other references in the Latin American context (Alcarбz et al. Neither precise statistics nor reliable estimates of the male/female alcohol consumption ratio have been available until recent years. In fact, youngsters received strong social pressure to keep the cultural model of behavior intact (Escobar, 1974). In this model, the meaning of alcohol is linked with social integration and drinking is defined as a way to facilitate social solidarity. Alcohol is seen a culturally legitimate way to relieve the anxiety produced by social interaction, and that is why the cultural modeling of young people includes alcohol for every social activity in which they get involved. Since the seventies, different reports based on production and sales data have shown a low percapita consumption of alcohol (5 litres of absolute alcohol per year) when compared with developed countries. Nevertheless, drinking occasions, usually happening once or twice a week, are characterized by substantial amounts of alcohol intake. Data available in Costa Rica since 1990 clearly show that men consume more frequently than women in all age groups (Sбenz, 1999; Jimйnez & Bejarano, 1991). Men who are 20-49 years of age consume more frequently than younger and older men. According to the 1995 national survey on alcohol and drug abuse (Bejarano & San Lee, 1997), the prevalence of heavy drinking (5 or more drinks consumed per occasion) is higher in men (33. Recent research from the beginning of the new century (Bejarano & Ugalde, 2003) has shown that more educated women show a higher prevalence of heavy drinking (by 10%), and research on 7th to 9th grade students suggests an earlier age of onset. In fact, the age of onset of alcohol use for both young men and women is as low as eleven years, which is lower than the age of onset found in other Latin American and even European countries (Jernigan, 2001). This is a matter of growing concern at the national level, and particularly true in the school-based context as compared to the general population. The role of education, which shows special relations with drinking in different countries, the role of religion, the availability of alcohol, including its price, the role of having work and some mood-related reasons are key aspects to be surveyed in future investigations. The main variables are familial and other social settings for alcohol consumption, intimate relations and sexuality, social networks, aggression and childhood abuse, health and lifestyle, work experience, social role, gender inequality, and aspects of the drinking culture. The objectives of the Genacis study include the following: · · · · Comparisons of the drinking patterns between men and women. Development of improved culture- and gender-sensitive measures of alcohol consumption and alcohol-related problems. Domestic violence in Costa Rica has a growing importance, especially violence among intimate partners, and it is recognized as a public health problem and a citizenship security issue. As pointed out by Graham, Wells and Jelley (2002), research has found higher rates of domestic violence among intimate partners who drink heavily. The connections between alcohol consumption and violence suggest that the effects of alcohol could play a causal role in aggression or increase the incidence and severity of male violence against their partners. However, there is a considerable debate about the nature of the relationship between alcohol consumption and violence, and whether it is truly causal. Some authors believe that alcohol works as a factor increasing the likelihood of aggressive behaviour or violence by reducing inhibitions, affecting judgment and impairing the ability of the drinker to interpret cues.