Posts Tagged ‘depression’

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning.  Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

“Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

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Foreclosure Is Hazardous to Your Health

Monday, November 14th, 2011

Falling behind on mortgage payments harms more than just finances; the stress and strain can negatively impact physical and psychological health.  In 2009, 2.2 percent of all American homes — more than 2.8 million — were in some stage of delinquency.  Researchers examined data collected in 2006 and 2008 on nearly 2,500 Americans who took part in the Health and Retirement Study, a nationally representative sample of Americans aged 50 and older.  The data included information about general health, psychological health, income and whether the person had fallen behind on paying their mortgage.  People who were behind between 2006 and 2008 reported more depressive symptoms, increased food insecurity and were more likely to not take prescription medications as prescribed because of the cost.

“People are making unhealthy trade-offs when they’re trying to make their mortgage,” said Dawn Alley, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine.  “We think it’s a very serious issue.”  The study was published in the American Journal of Public Health.

Nearly 32 percent of people who were having difficulty paying their mortgages didn’t take medications as prescribed because of costs, compared to the five percent who were able to make their mortgage payments.  “Depression, not taking medications and not spending enough money on nutritious food can exacerbate conditions you already have,” Alley said.

Nearly one-third of the people who were mortgage-delinquent reported fair or poor health compared to 19 percent who were able to pay their mortgages on time.  “The rise in mortgage defaults may have important public health implications that could ultimately prove costly to affected individuals, employers, the healthcare system, and society,” according to the study’s authors.

More than a quarter of people in mortgage default or foreclosure are over 50,” Alley said. For an older person with chronic conditions like diabetes or hypertension, the types of health problems we saw are short-term consequences of falling behind on a mortgage that could have long-run implications for that person’s health,” Alley said.

“This study has pinpointed an issue that until now has been somewhat under the radar, but which threatens to become a major public health crisis if not addressed,” said E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.  “Through research such as this, faculty epidemiologists and public health specialists provide valuable information and perspectives that are useful for government and private policy makers as they work to meet the health and economic needs of Americans.”

This study was co-sponsored by the National Institutes of Health and was conducted with support, resources and use of facilities from the Philadelphia Veterans Affairs Medical Center.

Another study by Janet Currie of Princeton University and Erdal Tekin of Georgia State University shows a direct relation between foreclosure rates and the health of residents in Arizona, California, Florida and New Jersey.  The researchers concluded in a paper published by the National Bureau of Economic Research that an increase of 100 foreclosures related to a 7.2 percent increase in emergency room visits and hospitalizations for hypertension, and an 8.1 percent increase for diabetes, among people in the 20 to 49 age group.

Writing in the Wall Street Journal, S. Mitra Kalita says that “Each rise of 100 foreclosures was also associated with 12 percent more visits related to anxiety in the same age category.  And the same rise in foreclosures was associated with 39 percent more visits for suicide attempts among the same group, though this still represents a small number of patients, the researchers say.  Teasing out cause and effect can be delicate, and correlation doesn’t necessarily mean foreclosures directly cause health problems.  Financial duress, among other issues, could lead to health problems — and cause foreclosures, too.  The economists didn’t find similar patterns with diseases such as cancer or elective surgeries such as hip replacement, leading them to conclude that areas with high foreclosures are seeing mostly an increase of stress-related ailments.”

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I’m So Sleepy…

Tuesday, September 13th, 2011

People who can’t sleep at night tend not to consider their problem to be an illness that requires treatment, or a good reason to call in sick.  That mindset could hurt employers and employees by making insomniacs drag themselves to work and sleepwalk through the day, according to a new study.  Researchers surveyed 7,428 employed people and found that 23 percent experienced some form of insomnia — such as difficulty falling asleep or waking up during the night — at least three times a week during the previous month, for at least one-half hour at a time.  It should come as no surprise that these sleep problems carry over to their jobs.  Insomniacs were no more likely than their coworkers who slept well to miss work, but were so consistently tired that they cost their employers the equivalent of 7.8 days of work in lost productivity every year — an amount equal to an average of roughly $2,280 in salary per person.  That adds up to $63.2 billion (and 252.7 workdays) for the entire nation.

The majority of study participants did not physically miss work as a result of insomnia, said lead author Ronald Kessler, Ph.D., a psychiatric epidemiologist at Harvard Medical School.  They frequently show up too tired to perform their job effectively (a phenomenon known as “presenteeism”).  “Employers these days want their workers to stay home if they’re sick.  If they know you’re absent, they can at least find ways to fill in for you,” Kessler said.  “But you can’t stay home every day if you’re chronically sleep deprived, so these people get in the habit of going to work and then not performing.”

According to Kessler, “It’s an underappreciated problem. Americans are not missing work because of insomnia.  They are still going to their jobs but accomplishing less because they’re tired.  In an information-based economy, it’s difficult to find a condition that has a greater effect on productivity.”

Fully 23 percent of employees were estimated to have insomnia; that statistic was verified by sleep medicine experts, who independently evaluated a sub-sample of the study group.  Researchers also found that employees aged over 65 are less likely to be insomniacs (14 percent) and that men were less likely (20 percent) to have trouble sleeping than women (27 percent).  Because the typical cost of insomnia treatment ranges from $200 annually for a sleep aid to $1,200 per year for behavior modification therapy, the study’s author believes that screening and treating workers’ sleep issues may be worthwhile for employers.

“When we actually did the calculations we were amazed at the extent of the problem,” Kessler said. “It seems unbelievable that more than 250 million days a year of lost productivity can be attributed to insomnia.  Yet this hasn’t really been on anyone’s radar.  Worker screening programs and programs to teach workers good sleep hygiene may be very effective and could actually save employers money.  These programs might help people feel a lot better and get more done on the job.”

Donna Arand, Ph.D., a spokeswoman for the American Academy of Sleep Medicine, says the study underlines a problem that is well recognized by sleep specialists.  “What struck me most about the study was the fact that workers really weren’t calling in sick,” she says. “People with chronic insomnia are going to work but they aren’t functioning at their maximum.  We all experience this from time to time, but for people with insomnia it could be happening every day.  One of the most important things is to try to get up at the same time every day and go to bed at the same time every night, even on the weekends.  Routine is the key.”

People can be described as insomniacs when they have trouble sleeping for at least a month.  The causes can be alcoholism, anxiety, coffee, and stress; it can also result from medical conditions like depression.  The more insomniacs think about getting enough sleep, the more stressed they become, and that results in even less sleep.

“Now that we know how much insomnia costs the American workplace, the question for employers is whether the price of intervention is worthwhile,” Kessler said.  “Can U.S. employers afford not to address insomnia in workplace?”

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Why Are More Middle-Aged Women Killing Themselves?

Tuesday, August 9th, 2011

A recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found a 49 percent increase in emergency department visits for drug-related suicide attempts for women 50 years and older.  Women in the 40-69 age bracket are at greater risk of killing themselves than other women, according to research on age-specific suicide rates between 1998 and 2007.  In 2007, this age group comprised 60 percent of the 7,328 suicides reported among women.  The question is:  Why is this happening to middle-aged women?

There is a possibility that it is a question of numbers: One in four American adults has a treatable mental health condition; women in the 40-69-year-old age group represent one of the nation’s fastest-growing populations.  Alternatively, it could be a function of baby boomers’ elevated rates of substance abuse, a critical risk factor in suicide, said Julie Phillips, Ph.D., a social demographer and associate professor at Rutgers University.  According to Phillips, the age-specific rates were derived from data from the National Center for Health Statistics and the Census Bureau.

During the nine-year time period studied, suicide rates remained fairly stable for women younger than 40; for women older than 70, suicide rates declined.  Women 50 and older may be in crisis because pain and sleep disorders — widespread problems related to aging — often lead to increased use of prescription drugs, said Albert Woodward, Ph.D., the project director of SAMHSA’s Drug Abuse Warning Network.  According to the SAMHSA report, suicide attempts involving drugs to treat anxiety and insomnia rose 56 percent.  Woodward said that middle-aged women may experience depression because of declining health and other negative life events.   Loneliness and depression also are risk factors for suicide.  “Older women, especially in the U.S., are more isolated and separated from daily human contact outside of work and the internet,” said Ellyn Kaschak, Ph.D., emeritus professor of psychology at San Jose State University and the editor of the journal Women & Therapy.

Dr. LeslieBeth Wish, a psychologist and licensed clinical social worker in Sarasota, FL, has found  a surprising increase in suicide attempts by women aged between 45 and 54.  Women are susceptible to depression but older women may also be suffering from pre-menopause hormone fluctuations that can affect mood changes and depression.  According to Dr. Wish, women in their middle years are more aware of their mortality and may be disenchanted that they will never be happy.  Becoming an empty nester also is stressful.

Of greater concern is the 67 percent increase of women taking hydrocodone, and an astonishing 210 percent increase for women taking oxycodone.  According to SAMHSA administrator Pamela S. Hyde, J.D., “The steep rise in the abuse of narcotic pain relievers by women is extremely dangerous and we are now seeing the results of this public health crisis in our emergency rooms.  Emergency rooms should not be the frontline in our efforts to intervene.  Friends, family, and all members of the community must do everything possible to help identify women who may be in crisis and do everything possible to reach out and get them needed help.”

Because they are often members of the so-called “Sandwich Generation,” middle-aged women frequently discount their own needs as they organize commitments to jobs, marriages, kids, and aging parents.  Many say they don’t get enough sleep and eat too much junk-food.  According to medical experts, these habits — combined with soaring cortisol (a steroid hormone, or glucocorticoid, produced by the adrenal gland) levels — from stress — could mean this will be the first generation of women who don’t live five to seven years longer than males.

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Poor Education Can Lead to Alzheimer’s

Monday, August 8th, 2011

As many as 50 percent of Alzheimer’s cases worldwide could be avoided if risk factors such as depression, obesity and smoking were eliminated, either with lifestyle changes or treatment of underlying conditions.  Even modest cuts in the level of risk factors could prevent millions of cases of the memory-robbing illness, the researchers said.  As an example, a 25 percent cut in seven common risk factors – such as poor education, obesity and smoking — could prevent as many as three million Alzheimer’s cases around the world and up to half a million in the United States alone.  The new research is being presented at the Alzheimer’s Association International Conference (AAIC) and published online in The Lancet Neurology.

“The idea here is to get a better bead on exactly how we can start untangling what the risk factors are, so that we can not only treat and modify Alzheimer’s but also start talking about prevention of Alzheimer’s,” said Mark Mapstone, associate professor of neurology at the University of Rochester Medical Center.  “The field is working very hard (to figure out) what these risk factors are so we can start heading this disease off before it starts.”

Led by Deborah Barnes of the University of California San Francisco (UCSF), the researchers revisited earlier epidemiological studies on links between Alzheimer’s and seven vital risk factors: poor education, smoking, low physical activity, depression, hypertension during mid-life, obesity and diabetes.  They estimated that these risk factors account for 17 million cases of Alzheimer’s worldwide (approximately half of the estimated 34 million cases of dementia globally) and three million of the 5.3 million estimated cases in the United States.  Some factors appeared to have a greater impact on Alzheimer’s risk than others.  The UCSF team estimated that worldwide, 19 percent of Alzheimer’s cases can be attributed to low education; 14 percent to smoking; 13 percent to physical inactivity; 10 percent to depression; five percent to mid-life hypertension; 2.4 percent to diabetes; and two percent to obesity.  In the United States, more than 20 percent of cases can be traced to low physical activity; 15 percent to depression; 11 percent to smoking; eight percent to mid-life hypertension; seven percent to mid-life obesity; seven percent to low education and three percent to diabetes.

Dr. Ronald Petersen of the Mayo Clinic said the findings have important public-health implications and will help raise awareness of the need for prevention.  The study offers “an uplifting message for aging and cognition,” he said, insofar as it suggests that lifestyle factors can be modified to alter Alzheimer’s risk, at least at the societal level.  But, with the exception of increasing physical activity, there is scant evidence that interventions are successful in altering an individual’s chances of developing Alzheimer’s.

Other studies have shown that increasing physical activity is effective.  But whether taking up crossword puzzles or losing weight impacts the path of Alzheimer’s — the pathology of which seems to begin years before symptoms appear — remains unknown.  Last year, a National Institutes of Health panel concluded – with some controversy — that the scientific evidence on lifestyle factors was negligible and said that intervention is helpful.  Petersen said that, while depression is clearly associated with Alzheimer’s, the causal direction could go either way, especially when the depression comes late in life.  “Is that really a risk factor for, or a function of, the disease?” he asked.  The question is, for the most part, irrelevant from a clinical perspective because depression should be treated anyway, Petersen said.

“Education, even at a young age, starts to build your neural networks,” so being deprived of it means poorer brain development, Barnes said.

“It gives us a little bit of hope about things we could do now about the epidemic that is coming our way.”  Alzheimer’s cases are expected to triple by 2050, to approximately 106 million globally.  “What’s exciting is that this suggests that some very simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a tremendous impact on preventing Alzheimer’s and other dementias in the United States and worldwide,” Dr Barnes said.

The study could be good news for people – usually family members – who are caregivers for individuals with Alzheimer’s. “Throughout the progression, I felt quite helpless…without any cure for (Alzheimer’s disease) yet, I could only watch,” said Rick Lauber, who acted as caregiver to his father, John, who developed the disease in his 60s and died at age 76.  As his father’s caregiver, Lauber had to take on unexpected responsibilities, such as moving him three times, taking him to doctor’s appointments, paying bills and becoming his father’s Joint Guardian and Alternate Trustee.  “As an adult child and a family caregiver, caring for Dad had to one of the hardest things imaginable,” Rick Lauber said.  “Watching him decline from a healthy, active, respected academic to a shell of a man was very challenging.  Dad was changing before my eyes and I could not do anything about this.”

According to the 2011 annual Facts and Figures release from the Alzheimer’s Association, nearly 15 million Americans provide 17 billion hours of unpaid care worth $202 billion every year.

This blog is dedicated to the memory of William A. Alter, the founder of our company who passed away August 8, 2008 of complications of Alzheimer’s disease.  To read about Bill Alter’s amazing career, please click here.

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Nurse Burn-Out, Depression Can Be Fatal to Patients

Tuesday, July 26th, 2011

The horror began last September 14 when an experienced Seattle nurse realized she’d overdosed a fragile baby with 10 times too much medication. The stunned nurse told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had transpired.  “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse.  In the nurse’s 24-year career, all of it spent at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the sole serious medical mistake she’d ever made, according to the public investigation.  “She was devastated, just devastated,” said her partner and co-parent of their two children.  That mistake turned out to be the start of a life that unraveled, contributing not only to the child’s death, an eight-month-old girl, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt’s suicide at age 50.

This story highlights the twin casualties caused by serious medical errors: The patient is the first victim, the person hurt or killed by a preventable error.  The second victim is the healthcare professional who has to live with the aftermath of making it.

There is no question that patients are the primary concern in a nation where one in seven Medicare patients experience serious harm because of medical errors and hospital infections each year.  Another 180,000 patients die, according to a study by the Department of Health and Human Services’ Office of Inspector General.  That’s nearly twice the 98,000 deaths attributed to preventable errors in the important 1999 report “To Err is Human,” by the Institute of Medicine, which fired up the nation’s patient-safety movement.  In the real world, doctors, nurses and other medical workers who commit errors are often traumatized, with reactions ranging from anxiety and sleeping problems to doubt about their professional abilities – as well as thoughts of suicide, according to two recent studies.

This sad story raises the issue of healthcare provider depression and burnout.  Writing on the allnursing.com website, an anonymous nurse says “While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant.  I have had ‘Treatment Resistant Depression’ for about 20 years — as long as I’ve been a nurse.  Now I am totally burned out, on major meds, and am seeking disability due to depression/anxiety.  I believe years of long hours, high stress, high expectations and little appreciation (from management, not patients) has contributed to this.  How many other jobs consider you a traitor because you call in sick?  And trying to get off for a sick child is an unforgivable sin.  How many other jobs want you to work overtime on the days you are scheduled, call you at all hours of the night or day when you are off, first pleading with you to come in, then laying a guilt trip on you if you say “NO!”  And let’s not forget the mandatory in-services and CEUs (continuing education units) that take time away from your family.  If any profession should understand the importance of the individuals’ physical, mental, social and spiritual self it should be nursing — -after all we are taught in nursing school about treating the patient as a whole, not just a disease!  Why don’t we treat our staff the same way.”

According to Anthony Cirillo on the Hospital Impact website,“Two studies suggest that nurses working in hospitals are much more susceptible to depression than their counterparts in clinics, schools or other locations, especially if their hospital is high-volume.  A study in Journal of Clinical Psychiatry looked at the relationship between bed occupancy rates and absenteeism and found that those working in units that were 10 percent more crowded than the optimal rate had twice the rate of depressive illness than their counterparts in less crowded units.  The second study, appearing in Health Policy, is based on data from the 2005 National Survey of the Work and Health of Nurses in Canada. While looking at absenteeism in general, the report notes that depression is a “significant determinant” for missed work among RNs and LPNs, and that those who work in a hospital are more likely than those working in other settings to miss work.  One thing we might first observe is that with health reform, things will get much worse before they get better.  At some point, the estimated 35 million newly insured Americans will seek healthcare, potentially burdening the system.  And, of course this all impacts recruitment and retention and even further impacts whether folks choose to enter into the profession.”

According to the Nursing Center website, “Studies have also shown that nurses (the vast majority of whom are women) may be especially at risk.  This study surveyed 150 medical-surgical nurses from three hospitals to determine the prevalence and predictors of depression among female nurses.  All participants had at least a year of nursing experience and worked at least 20 hours per week.  Most (93 percent) were white; they averaged 38 years of age and 10 years’ hospital nursing experience.  Thirty-five percent of nurses had mild-to-moderate depressive symptoms; the most common included restless sleep, poor motivation, feeling bothered, and concentration problems; many reported feeling hopeful, happy, or joyful on only two days (or fewer) during the week before filling out the questionnaire.  Somatic symptoms, stressful major life events, greater occupational stress, and lower income were correlated with the presence of depressive symptoms.  Fatigue and low energy were bothersome to 43 percent of nurses; pain in extremities and joints, trouble sleeping, and back pain were also common.  Having a mortgage or loan of more than $10,000 within the previous year was the most commonly reported (43 percent) stressful major life event.  Others included changes in sleeping habits, vacation, and holidays.  The most highly ranked occupational stressors were having insufficient time to provide emotional support to a patient and to complete nursing tasks, being required to complete many non-nursing tasks (such as paperwork), and inadequate staffing.”

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Medicare, Medicaid Head Rallies Insurance Companies

Thursday, September 30th, 2010

Controversial CMS chief wants insurers to work with healthcare providers to make reform work.CMS administrator Donald Berwick has asked the insurance industry to work in good faith to implement healthcare reform in a timely manner. Dr. Berwick made his plea at a Medicare conference sponsored by America’s Health Insurance Plans, the health insurance industry’s trade group.

“We need your help, our nation needs your help,” Dr. Berwick said, noting that companies, CEOs, healthcare professionals and managers all play a role in achieving the objective, yet the insurance industry “can be among the keys of our success, the central part in navigating the success of healthcare reform.  We have a job to do, we need to make care better for America.”  Berwick told the audience that he plans to work with others at CMS to build relationships and partnerships to assure that the Patient Protection and Affordable Care Act works as intended.  “If we steadily work together to make care what it can become, trust will resurface and the rest will follow,’ he said.

Dr. Berwick, who President Barack Obama named to his post in a recess appointment that bypassed the Senate confirmation process, is not well liked by Republicans because he once wrote an article that praised Britain’s National Health Service, raising concern that he will introduce healthcare rationing.  He tried to allay those fears by saying “I urge lower costs without harming a hair on any patient’s head.  It’s a clear, stark reality.  Our healthcare system, in its current form, is not up to that job.  We cannot, with our current system of care, give Americans the care that they need and want and deserve.”

The most pressing issue is improving patient safety and cutting deaths that result from unnecessary medical errors, a specialty that Dr. Berwick developed when he headed the Institute for Healthcare Improvement.  He also called for improved prevention and treatment of diseases like obesity and depression.

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