It is Community Health Improvement Week, and one Utah family care physician wants people to use the time to think about the effects that stress may be having on their mental and physical health.

Dr. Christopher Valentine, Medical Director for Optum in Utah, said stress in the short term is an important response, a signal to the body that something isn't right. But chronic stress, over time, can affect the heart and manifest itself in other ways - from back pain and digestive issues, to fatigue, depression and trouble sleeping. He says the first step is recognizing the source of the stress.

"We have to identify which are the things that we have control over, and which are the things that we really don't have control over?," he said. "By really defining things into a couple of different buckets, and then looking and saying, 'What are some things where I can take some steps in order to kind of resolve that issue?'"

He added meditation and deep breathing are often underutilized, but can make a big difference. He suggests breathing in, counting to four, holding it for seven seconds, and finally releasing the breath over seven to eight seconds - and repeating that several times - can help "reset" the body under stress.

Valentine explained the human hormonal and nervous systems have not adapted well to modern life. When people deal with uncertainties at work or at home, or even with themselves, he said the body ramps up to fight what it senses is "an existential threat." Over time, this can take a toll on the heart and brain. Valentine added other factors - like diet, exercise and genetics - also come into play, but being able to manage stress is important. And that means cultivating healthy daily habits.

"Speaking from personal experience, the best that I feel and I guess enhancement of my coping mechanisms in being able to deal with stress, is most strongly correlated to sleep and exercise," he continued.

The American Heart Association has also laid out three simple tips to manage stress. They are online at 'heart.org.'

They may sit empty right now, but high school athletic fields and gyms will soon be active with practices for fall sports ramping up. Health advocacy groups in Minnesota hope more schools are being proactive in preparing for a cardiac emergency.

Each year, according to the American Heart Association, about 23,000 children 18 and younger experience cardiac arrest outside of a hospital. Many states are adopting laws requiring schools to have response plans in place, either for sporting events or in the classroom - but Minnesota isn't among them.

Dale Wakasugi, owner of My AED and CRP Solutions and a volunteer for the American Heart Association of Minnesota, is a former Minnesota high school referee who experienced cardiac arrest during a game several years ago.

"Several people came to my rescue, including a 16-year-old high school student who had just learned CPR," he said. "Her and several bystanders came out and did two rounds of CPR - no response. They put an AED on me, one shock, and brought me back."

Wakasugi, who is now a certified CPR trainer and sells life-saving devices, said he hopes his story inspires school districts to train staff and have the right equipment onsite until Minnesota requires such planning. Supporters of a bill tried to get it passed last session, but there was some pushback over certain language. Backers hope to get the differences sorted out next year.

Minnesota law does require CPR training for students, and Wakasugi said that, as a whole, the state is among the leaders for survival rates. Still, he said, it's important to keep raising awareness, especially among younger people.

"That's why there are several foundations out there now trying to encourage screening for high school students," he said.

Health experts have said sudden cardiac arrest among young people is rare. But Wakasugi and other advocates say detecting issues ahead of time can prevent a tragedy on the court, in the field or in the classroom. Officials say the preparation that could be required can be standalone guidelines, or merged with a school's existing emergency response plan.

Nurses with an expired union contract in Oregon are holding an informational picket on Friday. Negotiations on a contract with Samaritan Pacific Communities Hospital in Newport started in April, but the two sides have yet to reach a deal. The nurses are represented by the Oregon Nurses Association. Their contract expired on June 30th.

Brook Clark, a registered nurse at the hospital and member of the union, wants Samaritan to bring its pay up equal to other Samaritan hospitals. Clark also noted that about a quarter of staff are traveling nurses.

"That cost is really going to eat into our budget as an organization and that cost is going to eventually trickle down to our patients and our community," she said.

Traveling nurses are paid more than local nurses. The Oregon Nurses Association notes Samaritan Pacific Communities Hospital is one of the most profitable hospitals in the state. A bargaining session takes place on Friday. The nurses have also an informational picket planned for Friday. Samaritan Pacific Communities Hospital CEO Lesley Ogden says the talks are on the right path and he hopes they'll agree to a package "that is competitive in our market and will help Samaritan retain and attract the best nurses to care for our patients and the communities we serve."

Clark says housing, child care and other living costs are higher in Newport, and added that the hospital has struggled to stay fully staffed at times.

"Even with the travelers, we still have very regular holes in our staffing that are due to the fact that we can't recruit and retain nurses out here on the coast," she explained.

Clark added the nurses at her hospital do the same work as other nurses in the Samaritan system and their wages should reflect that.

"It really comes down to just the principle of things. It comes down to treating our nurses equally, fairly, and treating us with respect," she said.

Nurses at Samaritan Albany General Hospital reached a deal with their managers on a new contract earlier this week.

Research shows many people in low-income California communities are having a hard time filling their prescriptions because pharmacies in their area are struggling and even closing.

One in four communities in Los Angeles County, for example, is now considered a "pharmacy desert."

Dima Qato, associate professor of pharmaceutical sciences at the University of Southern California, and her team have developed a mapping tool that reveals the extent of the problem, which she said hits communities of color hardest in both urban and rural areas.

"I think that it's getting worse," Qato observed. "In the next several years, a lot of chains have announced plans to close many of their stores. At the same time, one and three independents are at risk for closing."

Qato would like to see Congress reform the practices of pharmacy benefit managers, who decide where a patient can go to fill their medications, how much a pharmacy will be paid and which pharmacies are considered "in network" for health insurance. The bipartisan Pharmacy Benefits Manager Accountability Act, currently in Congress, would increase oversight of the industry.

Qato argued stronger policies could keep more independent pharmacies from going out of business, which could also improve health equity.

"It's due to the role of pharmacy benefit managers and low reimbursement rates, and the growth of pharmacy networks, which restrict where patients can and cannot go," Qato outlined. "Sometimes, patients have to bypass the nearest pharmacy to go to another pharmacy that's within their network."

University of Southern California researchers have called for policies encouraging pharmacies to locate in pharmacy deserts, including increases to Medicaid and Medicare reimbursement rates for those most at risk for closure.


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