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July 05 2015


Hotel fitness centers in Europe?

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June 29 2015


My Thoughts on Universal Health care in response to another's comments.

Initially this started as a comment in response to another person's comment in an article totally unrelated to health care. I decided to expand upon it because I am tired of people here using this as an excuse for denying 45 million Americans the right to have health care:

   See article here

Ask Canada how well that works, and while you're at it, ask them why they come here for their healthcare. Because it's the best in the world. Most countries in Europe have the same problem.



  First let me state why I feel qualified to speak to this point:

1) I am originally from Canada and I am an RN with 18 yrs working in the US health care system and almost 10 years in the Canadian system.

   Before any one accuses me of leaving Canada because of the Health Care system there, I'll tell you now that had nothing to do with it. In fact, if my first employer here in the US is any indicator I made every effort to work in an environment similar to my Canadian experience, meaning I worked at a county run hospital where everyone was treated regardless of insurance.

2) I have family still living in Canada including elderly parents so I can speak truthfully about the health care they receive.

3) My current job involves going in to people's homes to care for them under the umbrella of Medicare, Medicaid, Tricare or VA Fee based programs here in Texas.

                   Canada wins hands down in the provision of health care services for the particular demographic of patients I am most familiar with. My elderly parents get the types of services I could only dream of providing for my patients.  My parents are not wealthy and are totally dependent on the Canadian health insurance programs both through the provincial health insurance plan, Veterans Affairs and the municipal programs provided by the city in which they live.

                  Universal health insurance works in most other nations, yes there are problems, just as there are in any system.  However in those countries with universal or national health care programs everybody receives basic health care including regular medical check ups and preventative care.  

       Yes, there are those with money who get impatient or lose faith in their own country's health care providers and seek help elsewhere. It might interest many to know that while I was working as a nurse in Canada I took care of several wealthy (and in one case not so wealthy) Greek, Italian and other Europeans who came to Canada because they felt they could get better care there.

                  If the US health insurance companies were more willing to provide affordable coverage for every body that included preventative health care programs they would save billions of dollars that are currently spent on dealing with the results of poor health care choices and preventable catastrophic illnesses.

            The majority of middle income Americans are just one catastrophic illness away from bankruptcy and homelessness with insurance plans that have massive deductibles and 20% to 30% co pays for hospitalization and diagnostic testing. Many drug plans are set up so that Doctors are forced to prescribe less effective medications because the insurance co pay their patient's get hit with makes it so that their patient can't afford to pay for the medication that would do the best job for them. 

                 Then there are the unscrupulous employers who lay off employees due to excessive sick leave...


Since starting this article I was moved to address further points on the above linked article and will included parts of that exchange below:

   Then why do other countries, including Canada, come here for their big operations, like heart transplants and such? Because we have the best trained doctors in the world. The competition (read capitalism and private practice) makes for better training. Andrea L.

My response:

Funny, Canada has a large number of foreign born Doctors who go there to train as well. In fact I worked at a major teaching hospital in Canada and took care of the recipient of the first Heart transplant performed in North America after the failed attempts in the sixties.

I had also taken care of patients and worked with Doctors who came from all over the world to Canada and Toronto Western Hospital for kidney transplants and training in Transplant Medicine, Peritoneal Dialysis and several other specialty areas.

All in Canada

        I could write reams about this subject but will have mercy on the rest of you all and end this one here.

  *Please be civil in your comments this is not flagged for adult content!

June 23 2015


Physical fitness: tips for the law enforcement executive.

Unique work demands and corresponding stress levels increasingly require that those in the law enforcement profession establish lifelong wellness habits. However, one 40-year longitudinal study from 1950 through 1990 found that, appallingly, the life expectancy of a retired male police officer in the United States was 66 years. (1)

Why do some officers succumb to life-threatening habits, such as the lack of physical activity and exercise, smoking and excessive drinking habits, and depression, that increase the risk of obesity? To counter the obesity epidemic and general lack of physical fitness, law enforcement professionals should spend as much time as necessary adequately establishing lifelong wellness routines.


Examining the Research

Using the body mass index (BMI)--a measurement tool to determine excess body weight in relation to height--obesity classifies as a range of 30 or higher and overweight between 25 to 29.9. The BMI has become a potential indicator of hypertension, certain cancers, and diabetes. Estimates place ranges of overweight and obesity between 60 and 65 percent in the general population with approximately one-third of the general population classified as obese. (2)

Many statistics and related information exist about the health status of the general population, and several concern the law enforcement profession. In October 2003, the author administered a questionnaire to 75 law enforcement executives and other professionals. Part of the questionnaire included a BMI exercise and nutritional assessment. Based on the BMI, 80 percent of the respondents classified as overweight with approximately one-third identified in the obese category. (3)

Additionally, research has identified 53 stressors associated with police work. (4) Officers suffer more often from heart disease, hypertension, and diabetes than the general public. They have an above average risk for heart attacks, obesity, arthritis, ulcers, and cancer while also prone to bouts of depression and suicide. Further, nearly 30 percent of police officers overindulge in alcohol compared with 10 percent of the general population.


The costs for illnesses and diseases are staggering. After adding expenses for injuries, the impact is beyond calculation. Many of the maladies to which countless law enforcement personnel succumb refer to "modifiable risk factors," which means that health conditions and related costs can be affected. For example, disease costs include heart diseases at $183 billion; cancer, $157 billion; diabetes, $100 billion; and arthritis, $65 billion. (5)

Identifying the Issues

Most entry-level law enforcement training academies employ a significant amount of hours of physical training as a key component in their curricula, yet some may lack mandated guidance or standards relative to contemporary wellness or exercise science. Further, such training sometimes does not link physical fitness with the skills needed for the job. Exercises used in academy training should be performed correctly and be relative to the health requirements or job duties of veteran officers. Unfortunately, some departments have abandoned fitness standards after being sued by employees for failing to make these crucial connections. Further, disconnects in education and training can manifest unfavorably later in law enforcement officers' careers. Performing physical activity requires a sufficient knowledge base and a commensurate level of education and skill to avoid hazardous and even deadly lifestyles to an employee's health.

Furthermore, department leaders must believe and participate in lifelong wellness for their employees to embrace the concept. Some law enforcement organizations assign an individual to implement the standards without conducting the proper research regarding the needs of their particular agency; doing so may set up the department to fail. The standards implementation approach is effective but, generally, not the first step. Organizations must have adequate internal marketing and a genuine interest in employee health to respond to resistance from employee groups that might seek to thwart attempts to impose such mandates.

The law enforcement community should examine its physical fitness training and long-term health programs to ensure an efficient and competent force. The beginning point for establishing lifelong wellness habits starts with incorporating best practices (e.g., exercise science) in entry-level fitness programs. The physical training goal should match other mandated, physically demanding classes, such as arrest and control strategies and defensive tactics, that directly align with the actual skill needs of patrol officers. Contemporary exercise includes screening and testing fitness levels and designing individual exercise prescriptions linked to other physical demands of the law enforcement profession. Departments can use professional resources to educate their law enforcement personnel to incorporate wellness habits at entry-level training that will last an entire career and, further, lifetime. For example, one research and education organization used law enforcement job task analysis data to develop corresponding fitness assessments, testing protocols, and related standards applicable to police and firefighter personnel. (6)

Arguments for not implementing fitness standards often center around the cost involved and, perhaps, a union's disapproval. Certainly, department heads should take cost-effectiveness into consideration when developing long-term health programs. And, they should examine other far more costly factors, such as police academy and related on-duty injuries, chronic use or abuse of sick leave, and early medical retirements. Organizations should implement plans to redirect this money to lifelong wellness initiatives. Every law enforcement agency should consider several factors as a worthwhile investment and savings, including corporate wellness programs; insurance companies that offer lower premiums to organizations demonstrating a commitment to lifelong wellness plans; and exercise and nutritional science education for employees.

Selecting a Physical Trainer

What does the law enforcement profession need to succeed in lifelong wellness initiatives? Mounting evidence points to the physical trainer as a critical link in the chain of physical fitness. The obesity epidemic and corresponding need to hire the most skilled physical trainers should particularly concern those in the law enforcement profession, their loved ones, and the communities they serve.

The goal of reengineering how and who should conduct the training can foster the momentum a department requires to educate, train, and sustain during the most stressful times, producing a workforce with a level of health and fitness commensurate with the job demands. Such a combination ensures that law enforcement leaders have personnel who embrace a quality of life, which increases dedication to the profession during their tenure of employment and beyond.

Before hiring a physical trainer, managers should know the person's background, education, and certifications. Assigning unqualified trainers who place aggressive physical demands on personnel can prove harmful and even deadly. Departments should contact accredited professional organizations in the physical fitness industry, steering clear of vogue programs. Also, by teaming with the department's human resource manager, physician, cafeteria staff, union leaders, training academy director, certification personnel and professionals from accredited fitness organizations, agencies can begin holistically selecting a physical trainer. Once such a partnership is formed, organizations should ensure that trainers develop programs that match physical fitness demands with the body movements, joint actions, and biomechanics of an employee's particular job duties. For example, without properly training the shoulder and rotator cuff muscles (often neglected in shoulder training), the demands of defensive tactics training can end a career.

Departments should ensure that their physical trainers teach contemporary exercise science and use a functional fitness assessment, identifying the strengths and weaknesses in people seeking to be trained to a specific level of performance. Such an evaluation results in more individuals doing well, as opposed to a "one size fits all" approach in which only some survive. Those who do not prevail often are viewed as unable to "cut it" when, in fact, they received poor training.

Further, positive rein-forcement generates favorable results. The use of exercise as punishment for infractions (in the academy environment) does not reap rewards. In fact, it serves as a negative rein-forcement, which will turn people away from embracing the important aspects of exercise.


The goal of lifelong wellness is not to produce a "super" law enforcement officer who can push cars; jump over buildings, walls, or other obstacles; and run all day. Law enforcement agencies should implement programs that prepare officers within their own genetical potential to perform their jobs in good health for the length of their careers. The physical trainer plays a critical role in producing this type of officer. By using existing exercise and nutritional science, technology, and the expertise of those most knowledgeable in the industry, agencies can complete this mission.

No matter the perspectives, operations, budgets, resource allocations, or human resources, the up-front preparation in ensuring wellness in law enforcement academies and beyond can prove far less costly than not doing so. Lifelong wellness and fitness proves an investment now and in the future of American public safety personnel. Thus, selecting the best physical trainers for them is paramount. Law enforcement leaders should thoroughly review varied aspects of the health and fitness arena before placing an individual in this essential position. Further, they should examine whether the person needs to be in a sworn position.

Leaders should prepare for a department of healthy and fit personnel by recruiting, hiring, training, and educating the workforce for the future. Physical activity, exercise, and nutritional lifestyle changes are not blocks of time in stand-alone presentations. Rather, they offer a lifetime of rewards if implemented and maintained correctly. Investing the time to properly plan a fitness program and select the most desirable physical trainer for the department will glean the most positive results; planning the program takes time and effort.


(1) J.M. Violanti, J.E. Vena, and S. Petralia, "Mortality of a Police Cohort: 1950-1990, American Journal of Industrial Medicine 33, no. 4 (1997): 366-373.

(2) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999-2000.

(3) The Police Executive Leadership Program Class Exercise and Nutrition Questionnaire, administered by Daniel E. Shell, Division of Public Safety Leadership, Johns Hopkins University (Baltimore, MD, October 2003).

(4) Information in this paragraph was derived from Scott Teeter, "Police Officers' Stress Can Be Managed," The Oak Ridge Online-Community, August 20, 1998; retrieved on November 16, 2004, from http://www.oakridger.com/stories/082098/com_police.html.

(5) U.S. Department of Health and Human Services, National Institutes of Health, National Cost of Illness for Selected Diseases, 2000; http://www.nih.gov.

(6) For more information, visit the Cooper Institute at http://www.cooperinst.org.

RELATED ARTICLE: Recommendations for Agencies in the Quest for Lifelong Wellness

* Take time to properly plan an effective physical fitness program

* Hire qualified, professional trainers

* Develop fitness programs that match individual job duties

* Conduct internal marketing to educate employees and gain support

* Ensure consistent advocacy from agency leaders

* Discover the ongoing rewards

Mr.Shell, a retired lieutenant with the Maryland State Police, currently serves as the special projects coordinator for the Division of Public Safety Leadership at Johns Hopkins University.

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