Jones & Bartlett Learning Author and Health Policy and Law Expert Joel Teitelbaum Weighs in on the Latest Affordable Care Act Litigation

More than six years after becoming law, the Affordable Care Act (ACA) remains heavily litigated.  Since 2010, dozens of lawsuits have been lodged against it, with four of them reaching the United States Supreme Court – a remarkable number given the law’s relatively short lifespan and the fact that the Court only grants approximately 80 of the 8,000 case petitions it receives each year.  ACA litigation continued apace over the past year, with two new important decisions handed down in May of 2016.

One decision was issued by the Supreme Court, but in fairness the word “decision” is a bit of an overstatement, as the Court – currently reduced to 8 members following the death of Justice Scalia and the Senate’s failure to take up President Obama’s nomination to replace him – punted on the merits of the case.  At stake in Zubik v. Burwell is whether religiously-affiliated, not-for-profit employers that oppose contraception are effectively “complicit” in the provision of contraceptives to their women employees by virtue of filing a form with their insurance carrier that attests to their opposition, which in turn triggers a process by which the insurance provider and the federal government provide the contraceptive coverage.  (Under the ACA, for-profit companies that employ more than 50 people must provide insurance coverage for the 20 types of contraceptives for women approved by the Food and Drug Administration, but not-for-profit companies can exclude themselves from this requirement by filing the form.)  Under the separate process, the employer is not on the hook for any associated costs, and coverage is supplied through an insurance policy that is distinct from the employer’s.

Nonetheless, multiple religiously-affiliated, not-for-profit employers sued, claiming that the filing of the form violates the Religious Freedom Restoration Act, a statute prohibiting the federal government from “substantially burdening” religious beliefs unless the law is necessary to achieve a “compelling” government purpose.  On May 16th, the Supreme Court sent the case back to the federal Court of Appeals, expressing “no view on the merits of the case, [including] whether petitioners’ religious exercise has been substantially burdened, whether the government has a compelling interest, or whether the current regulations are the least restrictive means of serving that interest.”  In a brief opinion, the Court wrote that both the employers and the federal government stated in briefs to the Court that it was feasible that “contraceptive coverage could be provided to petitioners’ employees, through petitioners’ insurance companies, without any such notice from petitioners….  Given the gravity of the dispute…the parties should be afforded an opportunity to arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”

 The second noteworthy ACA decision of 2016 was handed down by a federal trial court judge just a few days before the Zubik opinion was issued – but House of Representatives v. Burwell is a case that may eventually end up at the Supreme Court as well, given what’s at stake: whether the ACA’s insurance premium cost-sharing subsidies are subject to annual appropriations by Congress.

Under the ACA, insurance companies that want to sell products in the online marketplaces set up by the law must cover certain “essential health benefits” and demonstrate an “actuarial value” (i.e., the percent of covered claims paid by the plan) ranging from 60% to 90%.  Eligible people who buy these qualified health plans are entitled to both premium assistance (in the form of refundable tax credits) and cost-sharing subsidies.  Eligibility for premium assistance ranges from 100% to 400% of the federal poverty level; eligibility for income-adjusted cost-sharing assistance is effectively capped at 250% of poverty, though the majority of marketplace plan enrollees receive this type of assistance.  The federal government pays both types of subsidies directly to health insurers, which in turn pass on savings to those members who qualify for one or both types of subsidies.

Under the ACA, premium assistance subsidies are considered mandatory (as opposed to discretionary) spending, require no annual appropriation, and are not specifically at issue in House of Reps. v. Burwell.  However, Republican members of the House of Representatives sued the Obama Administration over the ACA’s cost-sharing provisions, contending that the law as written requires those subsidies to be appropriated annually.  Unsurprisingly, the Administration argued that interpreting the ACA in this way would produce severe health insurance market defects that the ACA was, in fact, designed to cure.  But the trial judge agreed with the plaintiffs, concluding that the cost-sharing subsidies are subject to annual appropriations, and that Congress is at liberty to decide whether to appropriate the needed funds.  As is typical in high-stakes cases where an appellate court is likely to supersede a trial court decision, the trial court judge stayed her ruling pending appeal, meaning that for now the cost-sharing assistance will continue to flow to insurance companies and the people they insure.

In the end, for the time being at least, the parties and the law in both Zubik v. Burwell and House of Reps. v. Burwell are left in a state of uncertainty.  Thus both cases bear close watching: Zubik could implicate the operation of the ACA’s contraception mandate, while House of Reps. v. Burwell could produce the kind of result that could fundamentally undermine the ACA as a whole.

TetelbaumJoel Teitelbaum, JD, LLM is an Associate Professor and the Vice Chair of Academic Affairs in the Department of Health Policy at the George Washington University School of Public Health and Health Services. He also serves as Managing Director of the School’s Hirsh Health Law and Policy Program. Along with co-author Sara Wilensky, Professor Teitelbaum is the author of Essentials of Health Policy and Law, Third Edition from Jones & Bartlett Learning. (Qualified instructors are invited to request review copies here.) Professors Teitelbaum and Wilensky are also the authors of an annually updated chapter on health reform which may be bundled with any Jones & Bartlett Learning text at no additional cost.

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Postpartum: Exercise Tips

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This month, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert postpartum exercise tips.

You have just given birth.  Congratulations!  Now you are probably wondering “how soon after birth can I start exercising?”  The American College of Obstetricians and Gynecologists (ACOG) recommends a gradual resumption of exercise as soon as you feel up to it.  However, it would be prudent to wait for your six-week postpartum checkup to ensure everything is okay before launching into an exercise routine.

Generally, if you exercised throughout your pregnancy and had a normal vaginal delivery, it would be safe to begin light exercise such as walking, stretching and modified push-ups within a week of giving birth.  It is important to begin slowly by doing light aerobic exercise such as walking for a few minutes and increase the duration of each walk by an additional few minutes each day.  Try not to push yourself too hard too soon.  Let your sense of comfort be your guide.

If you had a c-section, make sure that you check with your doctor first and expect to wait until you recover from your operation before going back to your exercise program.  A typical incision from a c-section can take anywhere from 4-6 weeks to heal and may be some time after that before you feel ready to start exercising again.  However, easy walking is recommended as it can promote healing, help prevent blood clots, postpartum blues and other complications.

If you weren’t active during your pregnancy or tapered off your regular fitness routine during the months leading up to your delivery, make sure that you check with your doctor or midwife before beginning exercise.  Remember that your joints and ligaments will still be loose for about three to five months after delivery, which can make you susceptible to falling and joint injuries.

Some women like to engage in group exercise classes and if you want to participate in group exercise classes find one that is taught by a postpartum exercise specialist.  Many YMCAs, recreation centers, gyms and yoga studios offer excellent exercise classes for new mothers.  Additionally, low-impact classes that focus on toning and stretching are very effective.

Remember, exercise is good for you, but don’t overdo it for the first few months after giving birth.  Your body needs time to heal, and you need time to adjust to your new role and bond with your baby.  If you have any concerns about developing a workout routine, consider consulting a professional such as an exercise physiologist that has certifications with either the NSCA or ACSM for help.

Many women that have given birth have legitimate questions and concerns about exercise and their body. The following lists some of those questions:

How careful should I be with my abdominal muscles after birth?  During pregnancy, some women develop a gap in their abdominal muscles as their stomach expands during pregnancy and labor, a condition called diastasis recti.  It takes four to eight weeks after giving birth for this gap to close.  If you start doing abdominal exercises before this gap fully closes, you run a very real risk of damaging those muscles.  To find the gap where the muscles have separated, lie flat on your back with your knees bent. Place the fingers of your left hand, palm facing you, just above the navel.  Place your right hand on your upper thigh.  Inhale deeply and then exhale.  As you exhale, lift your head and shoulders off the floor and slide your right hand up your thigh toward your knee.  This will make your abdominal muscle tighten; you should be able to feel the gap where the muscles have separated.  If you feel a gap, consult your doctor to see if it is safe to begin an abdominal strengthening program. Your health care provider can provide you a program that incorporates pelvic tilts, leg slides, crunches and/or sit-ups.

What effect does exercise have on breastfeeding?  The simple answer to this question is it won’t.  As long as you drink plenty of water, vigorous exercise will not impact the amount or composition of your breast milk.  If your breasts are sore or tender; avoid any form of exercise that aggravates the condition. Try wearing a supportive sports bra while working out, and try to nurse your baby before you exercise so your breasts won’t feel uncomfortably full.

Are there physical signs that I’m exercising too much too soon?  Too much physical activity after birth has the potential to cause your vaginal discharge to become redder and flow more heavily, a condition called lochia.  This is a warning to slow down.  It is important to inform your doctor immediately if vaginal bleeding restarts if you thought it had stopped or you experience any pain while exercising. Another sign of over exercising, is feeling exhausted instead of invigorated when you are done.  This is a warning to slow down and take it a little easier.

What is the best way to lose weight after giving birth?  From an exercise standpoint, the most effective way to lose weight after delivery is to engage in regular aerobic activity such as walking, jogging, swimming or biking.  Exercise duration should amount to 150 minutes or more each week and involve the major muscles groups of the body to be effective.  The key is to be patient and consistent and with proper dietary intervention the mother should aim at losing no more than a pound a week, especially if breastfeeding.  For further information on postpartum weight loss, view the Postpartum: Nutrition Tips.

The key to regaining normalcy after childbirth is to listen to your health care provider, listen to your body for any unusual changes and give yourself the time needed to get back to your normal lifestyle.

This six-part blog series discusses the current nutrition and exercise recommendations for women before, during, and after pregnancy.  Pregnancy can certainly be a trying and confusing time and these articles are intended to provide answers to the most popular questions women (and often their providers) ask.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com. Questions will be answered on a monthly basis.

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Postpartum: Nutrition Tips

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This month, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on postpartum nutrition.

Congratulations!  If you are reading this article, it means you have delivered or you are getting close to delivery.  Nutritional intake postpartum is important, as there must be a balance between fueling your body for healing and breastfeeding and weight loss.

This article will focus on several nutrition concerns women have postpartum – weight loss, breastfeeding needs, healthy snacking, fluid consumption, vitamin and mineral intake, caffeine and alcohol consumption, and exercise.

Weight Loss

The goal is for gradual weight loss postpartum at the rate of approximately 1lb/week (or 4.5lbs/month) after the first month.  Although many want to return to their pre-pregnancy weight quickly, rapid weight loss may lead to fatigue, decrease bone mineral density, negatively impact mood, and may interrupt milk supply (if breastfeeding).  Most women return to their pre-pregnancy weight within a year by eating a healthy diet and incorporating moderate exercise back into their routine.  Remember, the weight gained during pregnancy was gradual so the weight loss will be gradual as well.  Don’t fall victim to fad diets, as they will most likely set you up for short-term success and long term disappointment.

Breastfeeding Needs

An additional 500 kcal/day is recommended for woman who breastfeed.  This may be higher in cases where the mother is underweight, exercising vigorously, and/or nursing more than one infant.  The increased needs can be met by adding healthy snacks similar to those consumed during pregnancy.  By listening to your body’s hunger signals, you will be able to stay well fueled.

Healthy Snacking

In addition to consuming well-balanced meals, snacks are a very important to help fuel breastfeeding and ensure safe weight loss.  Use your hunger level to gauge if you need to consume a light, moderate, or heavy snack.  Examples of a light snack would include fresh fruit, raisins, dry cereal, low-fat Greek yogurt or low-fat pudding. A moderate snack would include fruit with peanut butter, oatmeal, cereal and milk or yogurt parfait.  A heavy snack would include a peanut butter or lean protein sandwich, cheese and crackers or omelet.  For more information refer to Healthy Snacking 101.

Fluid Consumption

Fluid needs increase with breastfeeding and women who are breastfeeding may notice increased thirst.  It is important to drink enough to quench your thirst.  It is often advised that fluid intake for women should be 91oz or 11.5cups per day.  This, though, can vary due to activity level and environmental conditions thus hydration levels are best assessed by urine color and frequency.  You know you are well hydrated if you are urinating frequently and it is pale yellow in color.  Top fluids to consume include water, fruit juices, low-fat dairy, decaffeinated coffee and tea, low-sodium soups, and water-rich fruits and vegetables.  Limit sodas, sugary beverages, and drinks containing caffeine and alcohol.

Caffeine and Alcohol Consumption

According to the Institutes of Medicine, breastfeeding mothers can consume occasional small amounts of caffeine and alcohol.  A moderate amount of caffeine would be 2-3 cups of coffee/day or approximately 200-300mg/caffeine per day.  Guidelines for consuming alcohol include 1) waiting until your baby has established a breastfeeding pattern (~3 months of age), 2) wait at least four hours post-single alcoholic drink before breastfeeding, and/or 3) express breast milk prior to consuming an alcoholic beverage to use for a later feeding.

Vitamins and Minerals

Two minerals that often require special attention for postpartum women include calcium and iron.  See chart below for more information.  In addition, postpartum woman should consume a variety of foods to provide the vitamins and minerals necessary for healthy and breastfeeding.  These vitamins and minerals are plentiful in a varied diet, but it is often recommended that breastfeeding mothers continue to take a pre-natal vitamin.  This is best discussed with your Physician and/or Registered Dietitian.

Minerals RDA Benefit Sources
Calcium RDA:

1000mg (19-50yo)

1300mg (adolescents)

 

Protect bone density, aid in muscle relaxation, blood coagulation, transmission of nerve impulses, may slightly increase weight loss milk, cheese, yogurt, tofu,

cottage cheese, fish (sardines, salmon, clams), greens, calcium-fortified

beverages such as orange juice and soymilk

Vitamin D RDA: 600 IU

 

Enhances calcium absorption fatty fish, fortified dairy and soy products, fortified eggs, fortified cereals
Iron RDA: 15mg

 

Indicated to help return to pre-pregnancy levels and/or if blood loss higher than normal during vaginal delivery dried fruits, iron-fortified cereals,

lean red meat, fish, poultry, dried fruits

 

Exercise

Exercise postpartum is an important part of physical and emotional recovery.  Specific guidelines for postpartum exercise (vaginal and Cesarean delivery) will be discussed in the June 2016 article.

Quick Tips

  • Plan ahead. Make sure you have plenty of healthy foods and snacks on hand prior to the baby’s arrival.
  • Hydrate! Grab a water bottle or two.  Always carry a water bottle with you.  If you are breastfeeding, keep another one next to the chair or in the room you intend to use for most of your nursing.
  • Keep snacks accessible. Placing them by your water bottle, in the diaper bag, and near the chair you nurse will ensure you have the fuel you need when you are hungry.
  • Nursing is a great time to hydrate and snack. While sitting to nurse, you have ample time to provide your body with nourishment.
  • Eat balanced meals – meals that include carbohydrates, proteins, and fats.
  • Consume calcium rich foods throughout the day.
  • Do not weigh yourself more than one time/week. Remember the goal is gradual weight loss.
  • Avoid fad diets. Instead focus on consuming healthy meals and snacks.
  • If you feel that you need nutrition support, consult with a Registered Dietitian.

Nutritional needs postpartum vary and it is valuable for women to be in tune with their body’s needs and understand the basic recommendations.  If you feel confused or feel that your questions are not being answered to your satisfaction, make an appointment with a Registered Dietitian who can help you meet your needs for a safe and healthy recovery.

Stay tuned for next month’s article that will focus on postpartum exercise recommendations.

This six-part blog series discusses the current nutrition and exercise recommendations for women before, during, and after pregnancy.  Pregnancy can certainly be a trying and confusing time and these articles are intended to provide answers to the most popular questions women (and often their providers) ask.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com. Questions will be answered on a monthly basis.

 

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Benefits of Exercise During Pregnancy

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This month, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert insights on the benefits of exercise during pregnancy.

When you’re struggling to keep a meal down during the first trimester, adapting to a changing body in the second, or huffing and puffing to make it to the bathroom as you near your due date then hitting the gym might be the last thing on your mind.  But a growing body of research suggests that exercise has big benefits for both you and your baby.  Even a simple walk around the block or a session of stretching can lead to an improved mood, better sleep, an easier labor and a quicker recovery.

For all of our adult life we have been told that regular exercise provides a myriad of benefits such as keeping weight off and helping prevent diseases such as diabetes, heart disease, stroke and certain cancers.  During pregnancy, there are even more reasons to keep moving- or get moving, even if you haven’t had an exercise routine in the past.

Exercise during pregnancy has been found to:

  • Reduce risk of pregnancy complications: In one 2012 study, women who participated in fitness programs four times a week were less likely to develop gestational diabetes and less likely to have unplanned cesarean sections than those who didn’t exercise.
  • Lower odds of delivery complications: In a study of women in Spain, women who exercise three times a week gained less weight during pregnancy and were less likely to have macrosomic babies (babies weighing more than nine pounds at birth). Having a heavier baby can lead to complications for both mother and baby during delivery.
  • Faster post-delivery recovery: the more you increase your pregnancy fitness, the faster you will recover physically after childbirth and the more fit you will be after delivery.  In the same study, women who exercised recovered earlier after labor, resuming regular activities faster than those who did not exercise.
  • Boost your mood: Women are more susceptible to depression during pregnancy, with an estimated one in two of all women reporting increased depression or anxiety while they are expecting. Research has found that exercise during pregnancy reduces depression by releasing endorphins that help improve mood while diminishing stress and anxiety.
  • Lower blood pressure: Blood pressure occasionally increases during pregnancy, but too much and it can be a warning sign of preeclampsia. Staying active during pregnancy- in one recent study by simply walking regularly- has been found to keep blood pressure from rising.
  • Ease back and pelvic pain: There’s no denying that the growing fetus puts extra pressure on your lower body, resulting in low back pain and aching pelvis. Exercising, however, may result in less lower-back and pelvic pain especially during the latter stages of pregnancy.
  • Fight fatigue: Low –level tiredness plagues many women during the first trimester and then again late in the third trimester. While it may seem paradoxical, sometimes getting too much rest can make you feel more tired.  So getting a little more exercise (never pushing to exhaustion) may be the right solution to improving energy levels.  Going for a walk or doing a yoga class can make a big difference to boosting your energy levels.
  • Improve sleep: While many pregnant women report having difficulty falling asleep, recent studies have shown that women who exercise consistently (as long as it is not too close to bedtime) fall asleep quicker, sleep deeper and wake up feeling more refreshed that women who did not exercise.
  • Relieve constipation: An active body encourages active bowels. Walking briskly for 30 minutes can go a long way to keeping pregnant mothers regular.

Exercise benefits during pregnancy don’t just end with the mother. Recent research, whilst still ongoing, is beginning to show promising results and potential benefits for the fetus as well.  A few of the potential benefits of exercising during pregnancy for your baby:

  • Reduce susceptibility to diabetes: One study found that babies born to mothers who exercised during pregnancy had better insulin sensitivity, even as adults.
  • Boost brain health: Some preliminary research is showing that some mothers who exercised during pregnancy had children that were less prone to neurodegeneration in later life.
  • Lower BMI: Mothers exercising during pregnancy have children that were significantly less prone to obesity and diabetes with benefits extending into adulthood.
  • Fitter heart: One group of researchers looking at mothers who worked out during pregnancy found lower fetal heart rates at 36 weeks gestation (higher heart rates can be a sign of fetal distress). A follow up study found the benefits of the mother’s exercising even after birth.

Most studies on the benefits of exercise during pregnancy look at the effects of 150 minutes of activity per week. Those sessions could be five 30-minute sessions or three or four longer periods.  The benefits are incremental, researchers believe, which means that some exercise- even if you don’t hit that 150-minute mark- is better than none.  Anything that raises your heart rate and gets your muscles active counts- including walking, jogging, yoga, Pilates, dance, aerobics and swimming.  Remember, start out slowly, build up gradually and avoid contact sports and activities.

Stay tuned for next month’s article that will focus on postpartum nutrition tips.

This six-part blog series discusses the current nutrition and exercise recommendations for women before, during, and after pregnancy.  Pregnancy can certainly be a trying and confusing time and these articles are intended to provide answers to the most popular questions women (and often their providers) ask.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com. Questions will be answered on a monthly basis.

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Review: Professional Skills for the Pharmacy Technician is “the most valuable reference and educational tool available”

Professional Skills for the Pharmacy TechnicianThe recently published Professional Skills for the Pharmacy Technician by Stephanie C. Peshek just received a perfect score of 100 and 5 stars from Doody’s Review Service. Jennifer L. Colon, PharmD, MS, MBA, from Temple University School of Pharmacy, writing for Doody’s Review Service, calls it,

“…the most valuable reference and educational tool available for pharmacy technicians. [It] stands out [because it acknowledges] advancing technology and…the need to integrate pharmacy technicians as valued members of the healthcare team.”

Professional Skills for the Pharmacy Technician aids technicians in viewing themselves as professionals within the health system. This easy-to-read text addresses skills that facilitate interprofessional interactions in the workplace and increase safety in pharmacies by improving communication.

  • Helps students understand the background and history behind policies and workplace decisions
  • Uses real-life case studies and discussion questions to promote a review of the reasoning behind good and bad decisions
  • Aids pharmacy technicians in becoming key contributors in creating a quality work environment

Would you like to learn more? Preview a sample chapter, visit our website, or watch a webinar with the author:

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5-Star Review for Ethics in Health Administration: A Practical Approach for Decision Makers, Third Edition

Ethics in Health Administration, Third EditionExcellent news to share– Ethics in Health Administration: A Practical Approach for Decision Makers, Third Edition by Eileen E. Morrison just received a 5-star review. According to Joseph T. Norris, MA, from Saint Louis University, writing for Doody’s Review Service,

“This is a very good book for interested students and college professors to begin digging into the world of healthcare ethics from the perspective of business and administration.”

Given the many new advances in technology, as well as the roll out of the Affordable Care Act, today’s healthcare administrators require a strong foundation in practice-based ethics to confront the challenges of the current healthcare landscape. Ethics in Health Administration: A Practical Approach for Decision Makers, Third Edition translates the principles and practice of ethics into usable information for application to the real world of healthcare administration and the critical issues faced by today’s healthcare administrators.

What else makes the Third Edition so special?

  • Two new chapters on ethics surrounding the Affordable Care Act (ACA) of 2010 and Public Health make this text relevant to the issues facing today’s healthcare administrator
  • Fictional cases based on real-world events help to emphasize chapter content and create interest for the learner
  • Each chapter includes points to ponder, summary statements, websites, and additional resources to further enhance learning
  • The author’s reader-friendly writing style easily engages students while challenging them to think critically

Interested in learning more? Preview a sample chapter now or visit our website.

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During Pregnancy: Nutrition Tips

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This month, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert insights on nutrition during pregnancy.

Nutritional needs during pregnancy change as the pregnancy progresses. The first trimester of pregnancy not much changes in the way of calorie intake, but this is the time women often experience nausea and its side effects. As the pregnancy moves into the second and third trimesters, the effects of nausea tend to disappear and the calorie needs increase. Although no two pregnancies are the same, most women find that they tend to experience many of the same symptoms from one pregnancy to the next.

This article will focus on the most common nutrition concerns women have during pregnancy – Gastro-intestinal (GI) issues, weight gain, healthy snacking, fluid consumption, vitamin and mineral intake, nonnutritive sweeteners, and mercury.

GI Issues

Often woman experience nausea, vomiting, food aversions, cravings, taste changes, and/or reflux during the first trimester of pregnancy. The good news is that the symptoms usually subside after the first trimester or by mid-way through the second. The not-so-good news is that you may not feel well for several weeks and may have a hard time finding foods that are appealing. In addition, you may find that certain foods are harder to digest and/or cause heartburn (such as highly acidic foods, caffeinated beverages, chocolate, spicy foods, high fat foods).

The best advice is to keep a variety of foods and beverages available and snack frequently. Often consuming small amounts of food (and beverage) six times per day will help keep energy levels high and reduce the early symptoms of pregnancy.

Healthy Weight Gain

Weight gain during pregnancy is always a top concern. The Institute of Medicine (IOM) suggests that weight gain during pregnancy be based upon pre-pregnancy Body Mass Index (BMI). Note that these are averages and weight gain may not be steady from week to week (i.e. – one week you may gain two pounds and the next week a half pound). The goal is for a steady increase over several months. For the most accurate track of weight gain, weigh yourself once a week, on the same scale at the same time of day. It is best to weigh yourself nude first thing in the morning after you void and prior to consuming any food or beverage. The consistency is important to obtaining an accurate rate of gain. Although very important, it is often harder to get consistent weight checks at your provider appointments since you are fully clothed and the appointments are rarely at the same time or on the same scale.

Institute of Medicine suggested weight gain during pregnancy based upon pre-pregnancy BMI (Body Mass Index (BMI) = weight (kg)/height (m)2):

bmipregnancy

Healthy Snacking

Adding snacks to your daily routine is important, especially as the pregnancy progresses. Singleton pregnancy energy needs increase in the 2nd and 3rd trimesters adding 340 kcal and 452 kcal, respectively. For multiple pregnancies, sufficient energy and an additional 50 grams of protein per day is wise starting in the 2nd trimester.

Use your hunger level to gauge if you need to consume a light, moderate or heavy snack. Examples of a light snack would include fresh fruit, raisins, dry cereal, low-fat Greek yogurt, low-fat pudding. A moderate snack would include fruit with peanut butter, oatmeal, cereal and milk, yogurt parfait. A heavy snack would include a peanut butter or lean protein sandwich, cheese and crackers, omelet. For more information refer to Healthy Snacking 101.

Good sources of protein include: peanut or almond butter (2 TBSP = 7g), greek yogurt (5oz = 12g), milk (8oz = 8g), cheese (1oz=7g), eggs (1= 8g), beans (1/2c = 7g), chicken (1oz = 8g).

Fluid Consumption

Fluid consumption is necessary to keep energy levels high and reduce the incidence of headaches, nausea, dizziness, bloating, and constipation. It is estimated that consuming 10 glasses of liquids/day in addition to the liquids in foods will keep you hydrated. This, though, may vary and thus the best way to assess your hydration status is to aim for clear/pale yellow urine.

Vitamins and Minerals

Pregnant woman should consume a variety of foods to provide the vitamins and minerals necessary for a healthy pregnancy. These vitamins and minerals are plentiful in a varied diet, but supplementation may be necessary in some cases and should be discussed with your Physician and/or Registered Dietitian.

minerals

Nonnutritive sweeteners

Artificial sweeteners provide a sweet taste to foods and beverages without adding calories. Although there is no nutritional need to consume the sweeteners, you may choose to add them in your diet and should know which are safe and which to avoid.

Safe: Stevia (PureVia, Sweet Leaf, Truvia), Sucralose (Splenda), Aspartame (Equal, NutraSweet, Nutra-Taste)

Avoid: Saccharin (Sweet’N Low), Acesulfame K (Sunnett, Sweet One, Ace-K), Nectresse

*Aspartame consumption should be limited to 1-2 foods or beverages/day.

Mercury

It is recommended that pregnant woman consume 8-12oz of seafood/week to boost omega-3 fatty acid intake. Some fish do contain higher levels of mercury and thus should be limited or avoided. White (albacore) tuna should be limited to 6oz/week and tilefish, shark, swordfish and king mackerel should be avoided. If you do consume seafood, it is important to refer to the Federal Drug Administration (FDA) website for updates.

Nutritional needs during pregnancy vary and it is valuable for women to be in tune with their body’s needs and understand the basic recommendations. If you feel confused or feel that your questions are not being answered to your satisfaction, make an appointment with a Registered Dietitian who can help you meet your needs for a safe and healthy pregnancy.

Stay tuned for next month’s article that will focus on the benefits of exercise during pregnancy.

This six-part blog series discusses the current nutrition and exercise recommendations for women before, during, and after pregnancy. Pregnancy can certainly be a trying and confusing time and these articles are intended to provide answers to the most popular questions women (and often their providers) ask.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com. Questions will be answered on a monthly basis.

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Jones & Bartlett Learning Introduces New Health Navigation Series

The Health Navigation SeriesAs the U.S. health system becomes more and more complex, the term “Health Navigator” is starting to appear in the national media as the newest emerging career. That’s why we are excited to announce the launch of the Health Navigation Series.

Developed under the editorial direction of Richard K. Riegelman, MD, MPH, PhD, this series of four textbooks and accompanying digital learning materials is designed for health navigator associate degree and certificate programs leading to employment as community health workers, patient navigators, and/or health insurance navigators.

This unique series meets the full range of Health Navigation education competencies based on the Community Colleges and Public Health Project Report—a joint initiative between the League for Innovation in the Community College and the Association of Schools and Programs of Public Health. What’s more, each title will serve as a free-standing text designed for a three semester hour course. Together the series will cover the 12 semester hours of required course work recommended for health navigation associate degree and academic certificate programs by the ASPPH Community Colleges and Public Health report.

“There is now a growing commitment to provide [Health Navigator] job positions and an emerging strategy for integrating these positions into the health care and public health systems.” —Kay Perrin, MPH, PhD

Principles of Health NavigationDue out this summer, the first text in the new Health Navigation series will be Perrin’s Principles of Health Navigation. It provides an overview of the content and knowledge competencies expected as part of health navigation education including health services delivery and health insurance, care of the individual, and accessing and analyzing health information competencies.

Additional titles will be available throughout 2017.

Would you like to learn more? Visit our website, read these blog posts, sign up for a webinar, or watch an interview with Richard K. Riegelman:

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Review: Patient Communication for Pharmacy is “a wonderful addition to pharmacy education”

Patient Communication for PharmacyThe rave reviews have begun for Patient Communication for Pharmacy: A Case-Study Approach on Theory and Practice by Min Liu and Lakesha M. Butler. It just received five stars and a perfect score of 100 from Doody’s Review Service.

According to Jennifer L. Colon, PharmD, MS, MBA, from Temple University School of Pharmacy, writing for Doody’s Review Service, it is,

“…a wonderful addition to pharmacy education. So little time is spent ensuring students move into the profession with appropriate communication skills. This is a unique, much needed entry in the field.”

Patient Communication for Pharmacy: A Case-Study Approach on Theory and Practice offers communication strategies to promote patient-centered care. Utilizing a case study approach, it develops readers’ understanding of the unique communication dynamics between pharmacists and patients, and assists them in strengthening the communication skills necessary for providing optimal patient outcomes.

  • Focuses on skills acquisition and an integration of communication and behavioral change theories
  • Addresses issues relevant to pharmacist-patient communication and relationship building including: health literacy, culturally competent care, patient compliance, conflict/emotionally charged conversations, and more
  • Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, student practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools

Would you like to learn more? Preview a sample chapter now or visit our website.

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Pre-Pregnancy: Exercise Program

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This month, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert insights on pre-pregnancy exercise.

Women considering becoming pregnant can benefit greatly by engaging in regular cardiorespiratory and strength training exercise. The following provides an effective pre- pregnancy aerobic and strength training routine for women that is easy to administer, requires minimal time and equipment, and confers important mental and physical benefits for the mother-to-be. In order to maximize the benefits from the workouts, the program should begin at least three months prior to pregnancy and be done consistently with good technique. This sample workout is not all-inclusive; women, who are already engaged in a regular workout routine, should continue their workouts with modifications as the pregnancy progresses. However, for women who are not engaged in a regular workout program, the sample provided below is an excellent place to start and will offer numerous benefits to both mother and fetus. *Note – Before beginning a workout program, discuss the plan with your health care provider.

Aerobic Exercise: Should be done for a minimum of 150 minutes per week. This can be accomplished by exercising five days per week for the duration of 30 minutes per session. It is recommended that three of the workouts be weight bearing (i.e.- jogging, fast walking, dancing or tennis). The additional sessions should incorporate low impact exercise (i.e. – swimming, biking or moderate walking) to maximize recovery and variation. For women not accustomed to regular exercise, the program could begin with two workouts the first week and increase by an additional workout each successive week allowing the body to gradually adapt. Additionally, the duration of the first few workouts can also be reduced as needed. For example, start with 15 minutes per session and increase 5 minutes each workout until 30 minutes are met.

Strength Training: Should be conducted at least twice per week with a recovery of 72 hours between each workout. Strength training can be done on the same days as aerobic training or on the days in between. The order in which they are done is a personal preference. The following program is designed to be done at home and provides a basic foundation for strength and strength endurance helping offset some of the challenges that many women face before and during pregnancy (back and lower extremity pain, swelling, fatigue etc.). For women who are unaccustomed to strength training, it is recommended that for the first week she uses one set per exercise and increase by an additional set each week.

Sample program:

Warm up for 5 minutes using light exercise such as biking, step-ups, high knees in place, or jumping jacks. A thorough warm-up helps prepare the muscles and joints for the upcoming exercise by increasing muscle temperature, delivering oxygen rich blood to the muscles, and improving joint function and mobility.

The strength component includes planks, Russian twists, body weight squats, and knee pushups. The exercises were selected to strengthen all the major muscle groups of the body, provide core strength and stability, and help prepare women for some of the physical and mental challenges of pregnancy. The benefits of exercise during pregnancy will be addressed in a future article.

The Plank provides core strength and stability to the abdominal and lower back muscles and strengthens the upper back, arms, and shoulders. The plank is done lying prone on a mat or carpet. The forearms are placed flat on the floor alongside the ribcage and the upper torso is lifted on to the forearms supporting your weight. Using your toes, simultaneously lift the lower body so that the upper thighs are off the ground. Support the body on the forearms and toes whilst keeping the entire body straight. Each hold should be done for 20-30 seconds. Aim to complete at total of 3 sets with a 60-90 seconds recovery between each set.

Russian Twists delivers rotational strength and stability to the abdominals and lower back muscles. The twist is done by sitting on the floor, legs slightly apart and bent at 45 degrees. Recline the upper body slightly, anchoring the feet under a support for stability. Using a two-pound medicine ball held in both hands, slowly rotate the ball to either side of the body touching the ground if possible for 20-30 seconds. Aim to complete 3 sets with a 60-90 seconds recovery between each set.

Body Weight Squats offer strength and stability to the legs, hips, and knee joints. The squat is done by placing the feet approximately shoulder width apart with arms extended out from the body parallel to the floor. With feet flat on the ground, begin bending the knees, slowly lowering the body until the thighs are just above parallel, hold for a second and slowly return to the upright position. If there are problems with balance, hold onto a chair or doorframe for support. Aim to complete 3 sets of 8-10 repetitions with 60-90 seconds of recovery between each set.

Kneeling Pushup provides strength to the entire upper body. The exercise is done by kneeling on the ground with the legs together. While on the knees, lean forward until the hands are in the push up position approximately shoulder width apart supporting the upper torso. Keeping the arms tucked into the body; slowly bend the arms until they reach a right angle at the elbow, hold for a second and slowly return to the upright position. Aim to complete 3 sets of 8-10 repetitions with 60-90 seconds rest between each set.

Cool Down is an important opportunity to work on flexibility and assist the body in returning to its pre-exercise state. Stretching should involve all major joints of the body with each stretch being held for 20-30 seconds for 3 sets.

The advantages of developing a pre-pregnancy exercise plan are numerous not only from a health standpoint, but for physical and psychological benefits as well. In the long term, regular exercise has been linked to improved conception from reduced stress, weight control, and enhanced sleep quality.

This six-part blog series discusses the current nutrition and exercise recommendations for women before, during, and after pregnancy. Pregnancy can certainly be a trying and confusing time and these articles are intended to provide answers to the most popular questions women (and often their providers) ask.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com. Questions will be answered on a monthly basis.

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