W ords of ellness The newsletter of the Collaborative Support Programs of New Jersey Institute for Wellness and Recovery Initiatives ● www.cspnj.org ● Volume 3, Number 1 ● July 13, 2009 SCHIZOPHRENIA AND CANCER
In a recent article in the journal Cancer,1 a team of
• A personal wellness quiz (taken from a 2004
researchers from a university department of
Canadian healthy workplaces initiative).
psychiatry in France looked at cancer rates for
• A personal wellness goals form (which is more of
people diagnosed with schizophrenia. This was a
a checklist for working with a trainer for physical
large-scale study, covering 3470 patients over an 11-
year period. The researchers observed that “during
• A “personal wellness plan worksheet,” which is a
the 11-year follow-up, 476 (14%) patients died; the
2-page tool which seems well organized for some
mortality rate was thus nearly 4-fold higher than in
people to plan personal wellness improvements.
the general population. Cancer was the second most
• A “personal wellness assessment,” which is
frequent cause of mortality.” They went on to
another tool for self-assessing individual wellness,
observe that lung cancer was the most frequent form
with a decent (but not exclusive) focus on diet and
of deadly cancer in men, and the second most
frequent form of deadly cancer (after breast cancer)
• A “wellness pyramid,” which is another tool for
in women, and that duration of smoking was a strong
conceptualizing personal wellness, and is neither
predictor of death in both men and women. This
the wellness pyramid promulgated with the “Zone
study highlights the importance of helping
Diet” nor the one put for by Kelley, et. al. in
people living with a diagnosis of schizophrenia and
• “Top Ten Ways to Improve Personal Wellness,”
which is a set of primarily diet-related guidelines
• Increase their appropriate use of medical
screening, in order to detect cancers and other
conditions at a point when life can be saved.
A link to a “personal wellness checklist” provided by
California State University-Pomona is broken. Also
DEFINITIONOFWELLNESS.COM
included are several articles on walking and wellness.
Www.definitionofwellness.com is a website,
primarily providing information collected from
external sources, which provides some basic information about the world of wellness, along with some handy tools. The home/definitions section goes beyond defining ten dimensions and sub-dimensions (Social, Occupational, Spiritual, Physical, Intellectual, Emotional, Environ-mental, Financial, Mental, and Medical), to provide, for most of these, a self-assessment tool, along with a section variously named “steps to encourage…,” “steps for improving…,” “what are barriers to…,” etc.
1 Tran E, Rouillon F, Loze JY, Casadebaig F, Philippe A,
2 Kelley J, Frisch N & Avant K (1995). A trifocal model of nursing
Vitry F & Limosin F (2009). Cancer mortality in patients
diagnosis: wellness reinforced. Nursing Diagnosis;Jul-Sep;6(3):123-
with schizophrenia: an 11-year prospective cohort study.
to increase the cost sharing for prescriptions or block access to expensive medications, through a combination of: • increased co-pays • tiered formularies, where typically the most
expensive medications require a higher copay
A TIMELY THOUGHT ON THE SECOND MAN ON THE MOON
• closed formularies in which the plan refuses to
July 21 marks the fortieth anniversary of the first
walk by human beings on the moon, an event
• pressure through the pharmacy on the prescriber
identified by Apollo XI mission commander Neil
to switch the patient to a similar medication with
Armstrong as “One Small Step for Man, One Giant
• pressure on the prescriber to avoid the most
expensive medications, by requiring inconvenient
Almost everybody is aware that Armstrong was
and time-consuming “prior authorization”
joined on his walk by New Jersey native and
resident Edwin “Buzz” Aldrin. Not everybody is
• fail-first programs, where a patient must be shown
aware of Aldrin’s struggles with alcoholism,
not to have been aided by a lower-cost option
depression, and possibly bipolar disorder, or his
before the plan will pay for the more expensive
challenges. In 2001, Aldrin stated “Recovery
• Quantity limitations, in which a patient will
was not easy. Perhaps the most challenging
receive coverage for up to a finite number of
turnaround was accepting the need for assistance
doses of the medication in a month, regardless of
and help. Looking back at it now--with over 22
how many doses he or she needs. This control is
years of sobriety--this was probably one of my
often exerted, for example, on the “triptan”
greatest challenges. But it has also been one of
the most satisfying because it has given me a
People who have public health coverage such as
sense of comfort and ease with where I am now.4
Medicare, Medicaid, or State Pharmaceutical
Assistance Programs5. Such programs have been
ECONOMICS OF MEDICATION
forced in many cases to employ some of the cost
It is apparent that the cost of medication for
control methods adopted by private insurance. In
enduring health conditions is an important factor
some states, the costs of medications have caused the
in our health care. The number of medications a
programs to make it harder for a person to become
person uses, and the high cost of medications
which are not available in generic form has
economic effects on 3 different populations.
It is equally apparent that there is no “easy answer” to
People who pay most or all of their medication
this problem. While many people would assert that
costs themselves often find themselves spending
the costs of new medications in the US are inflated,
increasing fractions of their incomes on
there is certainly no obvious force which would
medications. People who have private health
insurance with medication coverage are impacted
because insurance premiums have been rising
The use of generic medications is equally
every year, due in large part to increasing
problematic. A generic medicine is one where the
medication costs. Those costs are generally
original drug maker’s patent has expired, and other
borne by the insured party as higher premiums.
companies are legally able to submit an application to
Medication cost increases also lead health plans
5 In New Jersey, Pharmaceutical Aid for the Aged and Disabled,
Dosing/Instructions Total Daily one half tablet Breakfast & Dinner
Apply to feet as needed when athlete’s foot
Another problem with using generic medications to
medication of the same formula of active
control costs comes when there is no generic equivalent
ingredients. The generic medication is priced
of the same medication. The patient and physician may
significantly lower than the original brand-name
need to consider whether another medication in the
drug, due both the absence of research and
same class could accomplish the desired effect at a
development costs and competition. The FDA
lower cost. Of course, in many cases there is no lower
does not require the generic medication to have
cost option without negative medical effects.
identical “bioequivalence”7 as the original brand-
To illustrate this, we come back to Alexandra
bioequivalence to be demonstrated as in the
Fleming, a fictional patient whose medication list we
introduced in our September 1, 2008 issue as an
example of good tracking (see list in box above). We
are now interested in the cost of her meds. Using
prescribing difficulty. In many cases, the patient
mail-order prices, we find that if she does not have
switched to a generic medication could be
any kind of insurance coverage or patient assistance,
receiving 4/5 of the active ingredient versus the
she would be spending about $410 per month for this
brand-name product. Increasing the prescribed
regimen. One medication, Byetta, accounts for over
dose by 25% is not an option, because other
half of her drug costs. Byetta is the only drug in its
generic copies of the same medication (or even
class, “incretin mimetics,” which are used to treat
alternate batches) might have 100% or even
Type II Diabetes. In Ms. Fleming’s case, she is using
125% of the dose strength of the original. This
this med9 in combination with another diabetes
is particularly problematic for medications which
medication, Glucophage (metformin). She and her
have a narrow “therapeutic window,”8 meaning
physician probably had a dialog regarding the choice
that the dosing range between effective doses
and doses which can cause significant side-
• Glucophage alone did not provide adequate control
effects or even death is relatively small.
• Other oral medication classes and choices had side-
effects/risks (pancreas depletion, cardiac risks, risk
of low blood sugars) which were not worth taking
7 A measure of the availability and effects of the drug in an
• She could be treated on Byetta without the need to be
animal body, projected as a measure of its availability in
placed on Insulin, which is a more complicated
the human body 8 Examples include Coumadin (warfarin), Digoxin
(digitalis), Lithium, and Tylenol (acetaminophen)
9 Which she injects twice a day into the skin of her abdomen
regimen that has undesired side-effects (weight
available in artificially sweetened or whole-grain
versions. The bottom line: Convenience Stores, like any other setting, can be as healthy or unhealthy as
If Ms. Fleming were without prescription
you choose to make them.
coverage for her Byetta, and did not have the
money for $2700 per year worth of Byetta, and ALTERNATIVES TO CRISIS CONVENIENCE STORES AND WELLNESS
Some people might view convenience stores as
accessible to teens and young adults around the
major sources of physical unwellness. Coolers
are filled with soft drinks containing large
amounts of sugar and caffeine. Shelves are
Such “less than crisis” interventions have been
stocked with chips and candies, containing large
lacking in our adult system. Some money has
amounts of carbohydrates with little redeeming
been given to psychiatric emergency services in
nutritional value. People’s addictions are fueled
by large displays of cigarettes (and other tobacco
intervention.” Reports have been mixed. Some
products), sales of lottery tickets, and in some
people have gotten mobile counseling to avoid a
states, beer and other alcoholic beverages.
crisis, others have found too much of a “safety
assessment” approach and mentality. New
This unwellness does not need to be a built-in
Jersey’s Mental System Health Wellness
aspect of convenience stores. Many stores have
Recovery Transformation Action Plan identified
increased their availability of fresh fruits,
the requirement to develop two specific resources,
Alternatives to Psychiatric Screening, and a
sandwiches which can be made with reduced-fat
statewide peer support warmline. Alternatives to
meats, or on whole-wheat bread11. Single
Screening pilot programs were grant-funded in
servings may be available of cereals and other
Atlantic and Morris Counties. No data has been
foods which play a role in a healthy diet. Diet
made available about those programs, their
beverages, waters, and juices are readily
contracted characteristics, and their outcome
available in the coolers. Even some traditional
10 See, for example, www.rx4nj.org 11 To lower the glycemic index of a meal and provide additional dietary fiber.
The most recent initiative was the state contracting
to some psychiatric facilities, and a chance for quite
and funding a statewide mental health warmline
a few people with and without a mental illness to
through the Mental Health Association in NJ. That
line, at 877-292-5588, is now operational 8am-
10pm weekdays, and 5pm-10pm weekends. This is
To locate self-help centers or groups anywhere in the
a service where adults experiencing psychiatric
state, contact the NJ Self-Help Group Clearinghouse.
symptoms can call and talk to other adults with a
mental illness. The state requires line workers
employ a model of service known as Intentional
ALTERNATIVES CONFERENCE
Peer Support (IPS), developed by leading mental
CONTINUES TO INNOVATE
health peer recovery educator Sherry Mead. In IPS
The annual Alternatives conference (www.
• Support is about giving and receiving, versus a
Alternatives-2009.org) is an event where every
professional-client relationship which leads to
presentation is made by an individual or team which
includes someone living with a mental illness, and
• Support is not based on psychiatric models or
which is recognized as the single national conference
which seeks to recognize and involve all factions of
• Peers encourage one another to reevaluate how
the mental health consumer/survivor/ex-patient
each has come to know what he or she knows.
movement. With the wide variety of interests and
• Peer support is about creating relationships that
viewpoints in our community, the conference is well-
challenge people to take a broader worldview.
• Trauma informs the peer support, meaning that
relationships starts with “what happened to
This year, one unique effort is a “pre-conference arts
you?” rather than “what’s wrong with you?”
institute, "Transforming Lives through the Arts."
• Peer support goes into the relationship with a
Coordinated by noted peer advocate Gayle Bluebird,
specific intention: to communicate in ways
this will be an all-day event where participants will be
that help both people step outside their current
offered a variety of hands-on arts activities, including
painting, writing, performance, dance, humor and
The warmline personnel will also match some
others—all practical for use in peer support work. Also
people up with “phone friends,” who will be able to
included will be four unique spaces which will operate
provide a long-term reciprocal relationship. The
during the actual conference: an Arts Drop-In Center,
phone friends mostly will not have IPS training.
a Health and Wellness Fair, A Meditation Room, and a
In addition to the new warmline, adults can, of course, find peer support in other places,
Would you like to quit smoking? Or would you like to help others quit smoking?
• At any self-help group • At any of New Jersey’s 30+ Self-Help Centers.
Online resources: www.smokefree.gov
Each has a peer manager, peer facilitators, and a
Help is available!
van/drivers. Centers are open at no charge to
Call 1-800-QUIT NOW
anyone in New Jersey who is experiencing or has experienced a mental illness, and/or has
Toll-free telephone centers are available to anyone
received mental health services. While groups
in the U.S. Each quitline is staffed by trained
and organized activities may or may not be in
cessation experts. The quitline counselors tailor a
progress at any given time, someone walking in
quit plan and advice for each individual caller. A
during center hours should always find a
major statewide study, conducted in California,
coffeepot, a peer, and a sympathetic ear.
showed that quitline use more than doubled a
• The initiatives of the Turn-a-Frown-Around
smoker's chance of successfully quitting.
Foundation (973-746-7353, www.frowntosmile.
Call 1-800-QUIT NOW and see for yourself.
org). This group offers phone buddies, visiting
UPCOMING TRAININGS/MINI-CALENDAR
• Its second annual NAMI En Español conference
Note: Our separate calendar edition will resume publication on or around September 1.
• Its annual AACT-NOW15 forum for October 24
The following FREE trainings are presented by
our institute to the mental health recovery
community, including individuals pursuing
The Institute for Prevention willhost an all-day
recoveries, practitioners, and family members.
program on Friday, October 9 in Livingston. The
Trainings do fill up, and advance registration is
Changing Role of the Health Care Provider in an
requested12. When you register, you will receive
Increasingly Tobacco-Free World is planned as a
a confirmation which will include directions to
symposium for all professionals working with tobacco
dependent individuals including those who deal with
mental illness or addiction. 732-9143815.
Wellness 101: A Framework for Living &
www.njamha.org/links/newswire/tobaccoSTD.pdf
Working. Many people living with a
diagnosis of mental illness are dying too
Alternatives 2009 will be the 23rd annual occurrence of
the only national mental health conference organized
conditions largely due to lifestyle choices and
by and for people diagnosed with mental illnesses. It
habits. This workshop is an overview of this
will take place October 28 through November 1 in
health crisis and will examine how we can
proactively develop a lifestyle centered on
The National Caregiver Conference will take place on WORKSHOP FULL
The New Jersey Psychiatric Rehabilitation Wellness 102: Creating and Sustaining Lifestyle Association (www.njpra.org) will host its annual Habits & Routines. This workshop will empower
conference on November 12-13 at the Sheraton
participants to explore lifestyle choices and habits
Raritan Center, Edison. . Keynote speakers are:
that can have a positive impact on their overall
sense of well-being. Building from the wellness
framework, participants will be able to discuss and
strategize how they can adopt healthy lifestyle
choices to create and sustain a personally defined
The Supportive Housing Association (SHA) in New Jersey will conduct its annual conference on
Friday, December 4 at the Pines Manor, Edison.
SHA also conducts monthly meetings, often
featuring senior state officials involved in housing
NAMI NEW JERSEY (www.naminj.org) will host
and related services. SHA is also a resource for:
a FREE13 three-day facilitator training for New
• A wide variety of agency and community
Jersey residents who are willing to commit to co-
initiatives to initiate and sustain supportive
facilitating a weekly mental health support group14.
• A regularly updated web-based listing of
supportive housing and mental health employment opportunities.
12 Send an e-mail to [email protected] 13 NAMI will also cover all meals, transportation, and
15 African-American Community Takes New Outreach
CSPNJ has scheduled our annual wellness and recovery conference for March 18-19, 2010 at the Pines Manor in Edison, NJ. Watch this newsletter for further details!
WORDS OF WELLNESS
As part of its broad array of services to foster wellness and recovery for individuals with disabilities, the Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey (CSPNJ) offers this monthly newsletter, Words of Wellness. This publication features valuable information and resources, including details about educational events, to help people to achieve and maintain wellness. The purpose of this newsletter is to bring useful information to all of our readers, whether pursuing recovery themselves, supporting recovery in clients or family members, helping to administer and change our mental health and related services system, or researching the field and educating future practitioners. Words of Wellness co-editors are Jay Yudof and Peggy Swarbrick. Free e-mail subscriptions are available from [email protected]. We also welcome submissions and feedback at that address.
Human Factors , 38(4), 574-592, 1996 USERS AS DESIGNERS: HOW PEOPLE COPE WITH POOR HCI DESIGN IN COMPUTER-BASED MEDICAL DEVICES Human Factors , 38(4), 574-592, 1996 Abstract In this paper, we examine how users interact with a computer-based infusion device adapted for terbutaline infusion to treat preterm labor in women experiencing high-risk pregnancies. This study examines: (1) the