Mandy Moore: Africa health care cure

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Editor's note: Mandy Moore is a singer-songwriter, actress, and an ambassador for Population Services International. The opinions expressed in this commentary are solely those of the writer.

(CNN) -- I've just returned from a visit to Tanzania with the global health and development organization Population Services International to better understand the challenges facing health workers in the developing world. The outbreak of Ebola only underscores the dire need for trained health workers -- a global shortage of nearly 7.2 million health workers, according to the World Health Organization.

About half of the spending on health care in Africa goes to private providers and care can be unregulated and quality inconsistent. During my week on the ground, however, I met PSI community health workers, nurses, doctors and business owners who deliver controlled and quality health care across Tanzania.

Mandy Moore

PSI has ensured quality care by applying proven commercial franchising strategies -- think McDonalds or Subway -- to health care. PSI operates a franchise network that spans 31 countries and serves 10 million people every year. In Tanzania, the franchise is called Familia.

Lucy, a Familia community health worker, goes out into the community every day and educates women about family planning and other health issues. Lucy then refers these women back to the neighborhood Familia clinic located right in the village she serves.

I joined Lucy for a session she organized at a modest apartment building with a few rooms separated by concrete walls and colorful fabric curtains. When I climbed the stairs to the front porch, about a dozen women with babies who were seated on straw mats greeted me. Lucy began to talk with them about their contraception options, and they had lots of questions for her. The most vocal was a gregarious woman named Sophia.

Sophia had used condoms and pills to space her births, but when Familia began offering longer-term methods like implants, she switched. The implant prevents pregnancy for up to three years, and she shared with us how it was a great weight off her shoulders. She told the group that she wanted to be able to plan her family size, so she and her husband could save for the future. Lucy reiterated that for women like Sophia, access to family planning is a key to health and economic stability.

According to a report by the United Nations Population Fund and Guttmacher Institute, returns on investment in contraception can be recouped four times or more by reducing the need for public spending on social services. This is something Lucy knows well -- before she ended the session, she gave out vouchers to our new friends for a consultation at their local Familia clinic.

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Mandy Moore: Africa health care cure

More Than 5,000 Health Care Workers Attend Ebola Training

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TIME Health ebola More Than 5,000 Health Care Workers Attend Ebola Training CDC and Mount Sinai health workers demonstrate how to put on and off Ebola personal protective equipment at an Ebola education session in New York City Alexandra Sifferlin "We are having a family meeting"

More than 5,000 health care and hospital infection control workers gathered at the Javits Center in New York City for an Ebola education session amid growing concern among hospital workers over Ebola preparedness.

We are having a family meeting, Kenneth Raske, president of the Greater New York Hospital Association (GNYHA) told TIME. The turnout is spectacular. We may not answer every question [today], but we are committed to finding the answers.

The event, which was streamed live nationwide, featured Centers for Disease Control (CDC) experts offering live trainings on how to safely care for patients with Ebola. It was hosted by the Healthcare Education Project from GNYHA/1199SEIU and Partnership for Quality Care.

New York governor Andrew Cuomo helped kick off the event, touting New Yorkers resilience and ability to always rise to the occasion from 9/11 to Hurricane Sandy. We have a new challenge we must meet today, said Cuomo. New York City Mayor Bill de Blasio also made an appearance, thanking health care workers.

Regardless of immigration status, we will help them all, said de Blasio, referring to the possibility of patients with Ebola coming into a New York City emergency room.

The session included a hands-on demonstration of personal protective equipment (PPE) led by Dr. Bryan Christensen of the CDCs domestic infection control team for the Ebola response. On Oct. 20, the CDC revised its guidelines for Ebola-related care, recommending full-coverage PPE and supervision while taking PPE on and off.

Christensen supervised registered nurse Barbara Smith of Mount Sinai Health System as she demonstrated how to put on and take off all the pieces of PPE: sanitizing her hands, putting on her first set of gloves, sitting in a chair to put on her foot covers, donning her suitand finally doing a little jig, to audience laughter, once she was completely suited. Afterward, she took off each piece, sanitized her gloves numerous times and checked for any holes. The entire process took 15 to 20 minutes, which the CDC said cannot be rushed.

CDC officials also reviewed Ebola care protocols in detail, from what to wear and how to discard linens (they cant be washed) to the way hands should be washed and how to use an alcohol rub to clean gloves before removing them, something that is not usually part of standard procedure. For respiratory protection, the CDC recommends either a powered air purifying respirator (PAPR) or a disposable respirator like N95. Emory University Hospital uses the former; the Nebraska Medical Center uses the latter. When we use equipment we are not used to, it makes it difficult, said CDCs Dr. Arjun Srinivasan. The way we address this is practice, practice, practice.

Massive education sessions like this have been held before over health threats like anthrax, H1N1 and smallpox. We had to have this in a convention center to accommodate folks, George Gresham, president of 1199SEIU United Healthcare Workers East told TIME. Back in the 80s when the AIDS epidemic first started, I was a health care worker myself, and it was the unknown that was the mystery, and the fear, and I think thats the same here.

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More Than 5,000 Health Care Workers Attend Ebola Training

It's Time for Open Enrollment for Health Care Exchanges

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You have a three-month window to shop around for a better deal on individual health insurance.

The federal and state health care exchanges are gearing up for a second year, but there is little reason to grab for the aspirin bottle. Here's good news: You're likely to find more insurance policy options this year -- and far fewer technical glitches.

Open enrollment for individual health insurance for 2015 runs from November 15, 2014, to February 15, 2015. This period applies to those who shop on the government exchanges or buy a policy from an agent or directly from an insurer. Go to http://www.healthcare.gov for the link to your state's exchange. (The federal government runs the marketplaces for many states.)

If you enrolled during last year's disastrous rollout, your policy will be renewed automatically unless you make a change. Even if you already have insurance, you should review other options. Your current policy may no longer be the best match.

This is your opportunity to make a change if you were unpleasantly surprised by some of the features in your policy. Perhaps you discovered that your doctors or drugs weren't covered, or your health condition has changed. "Some plans that were competitive in 2014 are not as competitive in 2015, and a lot of consumers would be better off comparing plans again," says Elizabeth Carpenter, director of the health care reform practice at consulting firm Avalere Health.

Whether you're enrolling for the second time or the first, you'll probably find more choices for 2015. According to the U.S. Department of Health and Human Services, 77 more insurers will be selling policies on the exchanges for 2015, a 25% increase from last year. United Healthcare, for example, sold policies on four exchanges last year, but hopes to sell on 24 exchanges in 2015. Cigna is entering three additional states.

Average premiums are generally rising, but the size of the increase can vary significantly by state, based on competition and insurers' claims costs. A study of nine state exchanges by Avalere found average premiums for silver plans will increase by as much as 16% in Indiana but by just 2.5% in Rhode Island. Average silver plan premiums will fall by 1.4% in Oregon. "Most people last year picked the policy with the lowest or second-to-lowest premiums, but that plan may no longer be the lowest-cost plan," says Cynthia Cox, a senior policy analyst for Kaiser Family Foundation.

But premiums are only part of your overall costs. Depending on the plan you choose, the plans with the lowest premiums could end up charging large co-payments for drugs and medical care.

Individual plans sold on and off the exchanges are categorized as bronze, silver, gold or platinum, based on the percentage of health care costs that they cover. A bronze plan should cover an average 60% of costs, while a platinum plan covers about 90%. Bronze plans charge the lowest premiums, but you'll pay more out of pocket if you need a lot of care. With platinum plans, your premiums will be higher, but your deductibles and co-payments will be lower.

Look at your medical expenses for last year and calculate what you would have paid out of pocket for your drugs, medical care and premiums. If you have more medical expenses, a platinum or gold policy with the higher premium -- but low co-payments -- may cost you less in the end. If you have few medical expenses, it may make sense to buy a bronze or silver plan, which has a lower premium but less robust coverage. Some insurers, such as United Healthcare and Aetna, offer online tools that itemize your expenses for the year.

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It's Time for Open Enrollment for Health Care Exchanges

Competition keeps health-care costs low, U.S. researchers find

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Medical practices in less competitive health-care markets charge more for services, according to a study conducted by researchers at the Stanford University School of Medicine and the National Bureau of Economic Research.

The study, based on U.S. health-care data from 2010, provides important new information about the effects of competition on prices for office visits paid by preferred provider organizations, known more commonly as PPOs. PPOs are the most common type of health insurance plan held by privately insured people in the United States.

The study will be published Oct. 22 in the Journal of the American Medical Association.

"The research comes out of trying to understand some dramatic changes that have occurred in the health-care system over a couple of decades," said the study's lead author, Laurence Baker, PhD, professor of health research and policy at Stanford.

One striking change is the shift from practices with one or two doctors toward larger, more complex organizations with many physicians. One important impact of this can be reductions in the amount of competition among physician practices. The study sought to understand how variation in the amount of competition within a region affects the amounts doctors are paid, an important consideration when developing health policy.

"This has always been an important issue, and now it's even more important as policy moves us more and more toward larger practices," said study co-author Kate Bundorf, PhD, associate professor of health and research policy.

The pluses and minuses

There is a push through the private sector and through Medicare to encourage the formation of larger practices, which could improve the efficiency of the health-care system, said Bundorf. The potential benefits of such organizations are clear: Doctors working in a group can easily exchange information about a patient's medical history and have the staff to support a large volume of patients, for example. However, there is little evidence about how larger groups could affect health-care spending.

"It's an important question for the U.S. health-care system right now," said Baker. "If we move toward larger practices, how can we get the benefits but avoid the challenges higher prices would create?"

The study assessed the relationship between competition among medical providers and prices paid by PPOs for the most commonly billed services within 10 prominent physician specialties. The researchers developed innovative measurements to make the comparisons.

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Competition keeps health-care costs low, U.S. researchers find

What to Know About Health Care Open Enrollment

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The stakes are higher for picking your health care insurance this year, whether choosing employer-sponsored plans or health exchange coverage.

An individual must have some kind of coverage or pay the individual mandate penalty. For 2015, this will be $325 per adult in a family and half that much for each child under 18, up to $975 per household.

"Everyone should get some kind of coverage," said Timothy Jost, a professor at Washington and Lee University School of Law.

Here are things you should know about open enrollment:

Know your employer's open enrollment period.

Open enrollment for all health care exchanges is shorter for 2015: Nov. 15 to Feb. 15. Individuals may qualify for special enrollment periods beyond this time frame if, for example, they get married, have a baby or move.

Some employees can decline employer-sponsored insurance and instead pursue tax credits on public exchanges. Employer-sponsored insurance must be affordable and offer adequate coverage, said Andrea Riggs, director of communications for GetInsured. If the employee's contribution toward a plan is less than 9.5 percent of the employee's household income, then it is deemed affordable.

An employee with low enough wages may also be eligible for Medicaid, Jost said.

Don't just focus on the premiums, Riggs said. A few employers, for example, do not cover hospitalization, Jost said. What's the out-of-pocket limit? Does your employer offer a Health Savings Account (HSA), which can roll over and is yours to keep?

Healthy people who need less care should be more comfortable paying lower premiums (the amount paid for your health plan by you and/or your employer) with less coverage, Riggs said. This means higher co-pays (fixed amount paid for a service) and higher deductibles (the amount paid out of pocket before an insurer will pay up). People who need more care should opt for richer benefits (lower co-pays, lower deductibles) with higher premiums.

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What to Know About Health Care Open Enrollment

Many Elderly Found with Puzzling Mutations Linked to Leukemia, Lymphoma

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Health and Medicine for Seniors

Many Elderly Found with Puzzling Mutations Linked to Leukemia, Lymphoma

Researchers find no connection with blood cancer that seldom strikes senior citizens

Oct. 22, 2014 A surprisingly large percentage 5 percent of senior citizens over age 70 have been found to have genetic mutations linked to leukemia and lymphoma in their blood cells. The vast majority won't get blood cancer, however, as the incidence of these cancers is less than 0.1 percent among the elderly, according to the researchers at Washington University School of Medicine in St. Louis.

Mutations in the body's cells randomly accumulate as part of the aging process, and most are harmless. For some people, genetic changes in blood cells can develop in genes that play roles in initiating leukemia and lymphoma even though such people don't have the blood cancers, the scientists reported Oct. 19 in Nature Medicine.

"But it's quite striking how many people over age 70 have these mutations," said senior author Li Ding, PhD, of The Genome Institute at Washington University. "The power of this study lies in the large number of people we screened. We don't yet know whether having one of these mutations causes a higher than normal risk of developing blood cancers. More research would be required to better understand that risk."

The researchers analyzed blood samples from 3,000 people enrolled in The Cancer Genome Atlas project, a massive endeavor funded by the National Cancer Institute and the National Human Genome Research Institute at the National Institutes of Health (NIH). The effort involves cataloguing the genetic errors involved in more than 20 types of cancers.

The patients whose blood was analyzed for the current study had been diagnosed with cancer but were not known to have leukemia, lymphoma or a blood disease.

They ranged in age from 10 to 90 at the time of diagnosis and had donated blood and tumor samples before starting cancer treatment. Therefore, any mutations identified by the researchers would not have been associated with chemotherapy or radiation therapy, which can damage cells' DNA.

The researchers, including Genome Institute scientists Mingchao Xie, Charles Lu, PhD, and Jiayin Wang, PhD, zeroed in on mutations that were present in the blood but not in tumor samples from the same patients. Such genetic changes in the blood would be associated with changes in stem cells that develop into blood cells, but not to the same patient's cancer.

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Many Elderly Found with Puzzling Mutations Linked to Leukemia, Lymphoma

Flamingo Land behind plans for major coastal visitor attraction

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FLAMINGO Land has lodged a bid to create a botanic garden and roller coaster on the site of the former Futurist theatre.

Scarborough Borough Council has announced that the theme park company has its eyes set on developing the site of the resort's famous theatre, which closed in January after years of uncertainty.

Flamingo Land, between Malton and Pickering, is Yorkshire's largest visitor attraction and is proposing to create Flamingo Land Coast.

Details of its bid were released in a report to Scarborough Borough Councils cabinet and reveals it intends to create a development based around three environments with subterranean, coastline and sky theme.

It would include a glass-roofed botanical garden, a roller coaster, a 55m lighthouse structure and Space Shot Tower which propels customers 55 metres into the sky.

The site, overlooking Scarboroughs south bay, would also include an elevated sea view bar, restaurant and function space, walk-through aviary and new town square.

The company behind the plans were previously kept secret and was referred to as bidder B. But following public concerns about the credibility of any bidder being able to deliver such an ambitious seafront visitor attraction, Flamingo Land was revealed as the applicant.

The company is partnering with the Yorkshire-based property development company GMI Estates for the project.

Derek Bastiman, Scarborough Borough Council cabinet member for strategic planning and regeneration said plans were still very much in their infancy

Were delighted that weve been able to announce Flamingo Land and GMI as the identity behind bidder B, he said.

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Flamingo Land behind plans for major coastal visitor attraction

Phil Bee’s Freedom (NL), Big Legged Woman ( full version) @ the Nix, Enschede – Video

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Phil Bee #39;s Freedom (NL), Big Legged Woman ( full version) @ the Nix, Enschede
Phil Bee #39;s Freedom http://www.pbfreedom.com/ Phil Bee: vocals John F. Klaver, Guitar Berland Rours, Guitar Carlo van Belleghem, Bass Pascal Lanslots, Keys Arie Verhaar, drums.

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Phil Bee's Freedom (NL), Big Legged Woman ( full version) @ the Nix, Enschede - Video