Vit A & OP/DR.'s and HMOs....

[Guest guest]

From ArthritisNew News:

Lyn

Excessive Vitamin A Intake Increase Osteoporosis Risk

Findings from a study of more than 1,200 women in Sweden suggest that a

high intake of vitamin A may lead to decreased bone mass and an

increased risk of osteoporosis bone fractures the researchers, Dr. Hakan

Melhus of University Hospital in Uppsala, Sweden, and colleagues

reported researchers in the November 15th issue of the ls of

Internal Medicine. ``For every 1 mg (milligram) increase in daily intake

of retinol, risk for hip fracture increased by 68%,´´ they wrote.

In the study, the researchers measured the bone density of 175 women,

ages 28 to 74, and had them keep a food diary, recording everything they

ate over the course of a week. The results showed women whose dietary

intake of vitamin A was more than 1.5 milligrams a day (mg/d) had

significantly lower bone density than women who reported less than 0.5

mg of the vitamin in their diets daily. The recommended daily allowance

(RDA) of vitamin A is 0.8 mg for women and 1 mg for men. In the second

part of the study, the researchers compared the vitamin A content of the

diets of 247 women who had suffered hip fractures, and 873 women of

similar ages who had not had fractures. ``We found a doubled risk for

hip fracture with dietary intake of retinol greater than 1.5 mg/d

compared with intake less than 0.5 mg/d,´´ they reported. Previous

research has shown that retinoic acid, a form of vitamin A, appears to

stimulate the activity of osteoclasts, cells that break down bone, and

to inhibit the activity of osteoblasts, bone-forming cells.

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Many Doctors not Happy with HMO Pressures

A survey of 766 physicians  working in managed care systems conducted

by Dr. Grumbach and colleagues from the University of California,

San Francisco found that about 75% felt pressured to see more patients

and 57% said that they felt pressure from their managed care

organizations to limit referrals. Asked if these pressures compromised

patient care, 24% and 17% of the doctors, respectively, said that they

did. But not all health maintenance organization (HMO) incentives are

negative. Physicians who are encouraged to deliver quality care and

boost patient satisfaction are more likely to be satisfied with their

job. The researchers report in the November 19th issue of The New

England Journal of Medicine that ``The physicians whose healthcare

systems used incentives keyed to productivity were less likely than

others to be very satisfied with their practices, whereas those whose

systems included incentives related to the quality of care or

patients´ satisfaction were more likely to be very satisfied´´.

They write: ``High-quality care is unlikely to flourish in an

environment that leaves physicians demoralized and leads many to believe

that the standards of care have been compromised. "

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