Huawei to Open Research Center in Finland

PARIS — Huawei Technologies, a Chinese maker of telecommunications equipment, said on Monday that it planned to open a research and development center in Helsinki next year, accelerating its investments in Europe, where its business is expanding rapidly.

The move illustrates a trans-Atlantic difference in attitudes toward Huawei. The company has been largely shut out of the United States market for network gear because of Congressional concerns about possible security threats — fears the company insists are unfounded.

While Huawei has faced difficulties in some European markets, like France, it has done better elsewhere. Huawei employs more than 7,000 people in the region, and it says that total could double in the next three to five years. Huawei already has a research center in Italy and is studying the possibility of opening one in Spain. It also recently announced a $2 billion investment in Britain.

The planned center in Helsinki, involving an investment of 70 million euros, or about $90 million, will work on smartphone development, including features like user interfaces and power management, the company said. When the center opens next year, it will employ 30 people, but this could grow to 100 over the next five years, the company said.

The announcement is a plus for the Finnish technology industry, which has been suffering from the woes at Nokia. The company was once the world’s biggest cellphone maker, but its market share has fallen sharply in recent years.

“The open and innovative environment in Finland,” Huawei said, “is an ideal place for Huawei to strengthen our global R.& D. capabilities for devices, creating opportunities for both Huawei and the Finnish telecommunications industry.”

Huawei has been known mostly for its network equipment, but the company is pushing to make a name for itself with its handsets.

Mobile devices accounted for 22 percent of its revenue last year, an increase of 37 percent. That compares with growth of 12 percent for the overall business.

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Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

DealBook: Delta Takes 49% Stake in Virgin Atlantic for $360 Million

There are few more lucrative airline routes than the one between the financial powerhouses of New York and London. On Tuesday, Delta Air Lines signaled that it was going after that business-heavy market, agreeing to buy a 49 percent stake in Virgin Atlantic from Singapore Airlines for $360 million.

The deal will provide Delta with more access to Heathrow Airport, one of the world’s busiest hubs, where takeoff and landing rights are limited because of high demand and tight capacity. New York, where all major airlines are battling to attract high-paying passengers, is the top international destination from Heathrow.

Singapore bought its stake in 2000 for £600.3 million ($966 million), but it has been dissatisfied with the returns, analysts said. While Delta had considered buying Singapore’s stake two years, the carriers could not agree on a price.

On Tuesday, Delta and Virgin Atlantic said they would apply for antitrust immunity from American and European competition authorities in order to coordinate fares and flight schedules, as well as offer seats on each other’s planes. Virgin Group, headed by the British billionaire Richard Branson, has said it does not plan to sell its 51 percent controlling majority in Virgin Atlantic.

Delta has a strong partnership with Air France-KLM that serves many European destinations, but it is not a strong contender in the London market. Delta has nine daily flights to Heathrow from New York, Boston and Atlanta. But it has no direct flights from other top markets like San Francisco, Chicago, Washington, D.C., Miami or Los Angeles, requiring passengers to connect through its other hubs.

Heathrow is operating at full capacity, and the British government has rejected expansion plans to build a third runway. As a result, landing and takeoff rights, known as slots, are limited, making them rare and prized commodities for the airlines.

Getting more slots, however, is no simple matter even for an airline like Delta, which has global ambitions. Delta has just 0.3 percent of the Heathrow slots, according to the Airport Coordination Limited, which is responsible for slot allocations at airports in Britain.

British Airways dominates Heathrow, with 53 percent of the slots, followed by Lufthansa of Germany, with 5.6 percent, and Virgin with 3.3 percent. American and United each have 2.3 percent.

British Airways’ hold on the airport actually increased in the last year after it completed the acquisition of British Midland International from Lufthansa. The acquisition was challenged by Virgin Atlantic, which claimed it would distort competition and simply reinforce the dominance of British Airways. The deal, however, was cleared by the European Commission in March under certain conditions, including that 14 of the 56 daily slot pairs British Airways received from British Midland be released to other carriers.

Still, Delta’s move is a challenge to American Airlines and British Airways, which are partners in the Oneworld global alliance. The two carriers dominate the New York to London market with 15 daily flights and a shuttlelike schedule of departures every 20 or 30 minutes in the peak evening hours. British Airways and American received antitrust immunity two years ago allowing them to coordinate their schedules and fares.

Delta’s challenge in New York comes at a weak time for American Airlines, which has been in bankruptcy for over a year and which counts New York as one of its five major hubs. Delta is spending $1.2 billion in New York to build a new
terminal at Kennedy Airport to replace its outdated facilities there. It has also expanded its presence at La Guardia Airport, which serves mostly domestic locations, with a deal to exchange landing right with US Airways.

United Airlines, for its part, holds a dominant position at Newark Liberty International Airport since merging with Continental Airlines in 2010.

Virgin was founded by Mr. Branson in 1984 with flights to New York. From the start, it embraced an image of fun travel and cheaper fares. It now has 38 airplanes in its fleet and flies to more than two dozen destinations. But the airline, which is not aligned with any of the three global groups – ­Star Alliance, Sky Team and Oneworld Alliance – has struggled in recent years because of high fuel prices.

The announcement in New York came a day after Virgin disclosed its plans to start domestic flights within the United Kingdom in the spring, with service to Edinburgh and Aberdeen in Scotland. Thanks to slots at Heathrow that British Airways gave up, Virgin will add 24 domestic flights a day.

The Virgin Group also own 25 percent of Virgin America, a low-cost domestic carrier that is independent of its international namesake. American law forbids foreigners from owning more than 25 percent of a domestic
airline. The European Union has a similar requirement barring non-European carriers from holding a majority stake in a European Union airline.

Air France-KLM is also considering buying part of Mr. Branson’s stake in Virgin Atlantic, according to reports in the British media. Such a deal, if it happened, would further strengthen Delta, which is a partner with Air France within the Sky Team alliance.

With the deal, Delta is wading into an old and often feisty rivalry opposing Virgin and British Airways.

Willie Walsh, who runs the parent company of British Airways, the International Airlines Group, said recently that Delta was really more interested in Virgin’s slots at Heathrow than in preserving the airline or its brand.

“I can’t see Delta wanting to operate the Virgin brand because if they do, what does that say about the Delta brand?” Mr. Walsh told Britain’s Telegraph newspaper in an interview. “Delta believes they are the No. 1 airline in the world, so what they would want to do is acquire the slots at Heathrow to enable them to have a strong presence at Heathrow.”

The comments drew a quick response from Mr. Branson, doubled with a characteristic challenge.

“Rumors have been spread in the press that I am planning to give up control of Virgin Atlantic and, according to Willie Walsh (who runs BA) that our brand will soon disappear,” Mr. Branson said on Monday in a statement titled “Sorry BA ­we’re not going anywhere.” “This is wishful thinking and totally misguided. Will BA never learn?”

Mr. Branson then offered to give employees of British Airways £1 million if Virgin Atlantic disappeared within the next five years. If it was still in business then, he challenged Mr. Walsh to pay the same amount to Virgin’s employees.

“Let’s see how much they believe this,” he said. “Let them put their money where their mouth is.”

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Romania Faces Upheaval as Ponta Coalition Wins Vote

PARIS — Romania’s center-left government overwhelmingly won parliamentary elections, according to partial results released Monday, an outcome that threatened to push the country into further political upheaval because of bitter rivalry between the prime minister and the president.

The central electoral office said the center-left alliance led by Prime Minister Victor Ponta won about 59 percent of the seats in the 452-seat legislature, followed by about 17 percent for a center-right group linked to President Traian Basescu. Around 81.45 percent of the votes have been counted.

The clear victory in Sunday’s election made Mr. Ponta the front-runner for prime minister. But Mr. Basescu, who has the power to appoint a prime minister, has indicated that he would not select Mr. Ponta, in part because Mr. Ponta tried to have him impeached over the summer.

During the campaign, Mr. Basescu called Mr. Ponta a “compulsive liar” and an “ogre” and said that appointing the man who tried to oust him would be like swallowing a pig. Mr. Ponta’s coalition, in turn, threatened a new impeachment effort if it won a majority and Mr. Ponta was not named prime minister.

Analysts said Mr. Basescu could be forced to back down due to the large margin of the center-left’s victory, which made Mr. Ponta’s reappointment seem inevitable. As of Monday morning, the president had not announced his intentions.

If he refused to appoint Mr. Ponta, the standoff threatened to produce a protracted political fight that could destabilize the country, undermine its struggling economy and delay a loan deal from the International Monetary Fund that Romania is hoping to negotiate when its current arrangement expires early next year.

In Bucharest, the Romanian capital, political commentators called the election “Basescu’s revenge.”

“The most we can hope for is that it is not a long war, and the parties find a compromise,” said Cosmin Stan, a leading Romanian broadcaster with Realitatea Television.

Romania, a poor Balkan country that has struggled to shed the legacy of decades of dictatorship under Nicolae Ceausescu, has undergone some of its worst political turbulence in recent memory. The country has weathered a series of unstable governments and come under criticism from the European Union and the United States. In October, the European Commission, the union’s executive body, said that concerns about corruption and fraud had prompted it to block development aid potentially worth billions of euros. All the while, the public remains deeply disillusioned amid a simmering dissatisfaction with austerity — including a 25 percent cut in public sector wages — for which many voters blame Mr. Basescu.

Mr. Ponta, at 40 the youngest prime minister in the European Union, has been locked in a bitter power struggle with Mr. Basescu, a 61-year-old former sea captain. The acrimony was made worse by the July impeachment vote, which Mr. Basescu called a “coup d’état” and which drew sharp criticism from the European Union and the United States. Mr. Ponta had accused Mr. Basescu of overreaching his mandate by, among other things, refusing to appoint ministers chosen by the prime minister.

Many Romanians say they are tired of the dueling leaders, and in a sign of that discontent, the populist People’s Party of Dan Diaconescu, a flamboyant television station owner who campaigned in a white Rolls-Royce and is being investigated for fraud, won about 14 percent of the vote, according to the partial results. As part of his campaign, Mr. Diaconescu has promised around $26,000 to every Romanian who starts a business.

But the feud between Mr. Ponta and Mr. Basescu dominated the election.

Under the Constitution, the president must name a prime minister from the party that receives a majority, in consultation with the party. Mr. Ponta is the coalition’s choice. The candidate for prime minister then needs to be approved by the Parliament, where Mr. Ponta’s center-left coalition has won a strong majority. While the Constitution gives the president the prerogative to name the prime minister, he cannot ignore the popular vote.

George Calin contributed reporting from Bucharest, Romania.

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Huawei to Open Research Center in Finland

PARIS — Huawei, a Chinese maker of telecommunications equipment, said Monday that it planned to open a research and development center in Helsinki next year, accelerating the company’s investments in Europe, where its business is expanding rapidly.

The move emphasizes a trans-Atlantic difference in attitudes toward Huawei, a company that has been largely shut out of the U.S. market for network gear because of congressional concerns about possible security threats — fears that the company insists are unfounded.

While Huawei has faced difficulties in some European markets, like France, it has done better elsewhere. Huawei employs more than 7,000 people in the region, and it says that total could double within the next three to five years. Huawei already has a research center in Italy and is studying the possibility of opening one in Spain. It also recently announced a $2 billion investment in Britain.

The planned center in Helsinki, involving an investment of €70 million, or about $90 million, will work on smartphone development, including things like user interfaces and power management, the company said. When the center opens next year, it will employ 30 people, but this number could grow to 100 over the next five years, the company said.

The announcement is a shot in the arm for the Finnish technology sector, which has been suffering from the woes at Nokia. The company, once the biggest mobile phone manufacturer in the world, has suffered a precipitous fall in market share in recent years.

Although Huawei has been known mostly for its network equipment, the company is pushing to make a name for itself with its handsets. Mobile devices accounted for 22 percent of its revenue last year, growing 37 percent. That compares with growth of 12 percent for the overall business.

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

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Changes to Agriculture Highlight Cuba’s Problems

HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.

“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”

The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.

President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”

No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”

Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.

“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”

A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.

In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.

“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.

Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.

But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.

The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.

Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.

But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.

Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.

“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”

For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.

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You for Sale: Company Envisions ‘Vaults’ for Personal Data

Peter DaSilva for The New York Times

Michael Fertik, the founder and chief executive of Reputation.com, at its offices in Redwood City, Calif., where he has amassed a database of information collected on millions of consumers.

“YOU are walking around naked on the Internet and you need some clothes,” says Michael Fertik. “I am going to sell you some.”

Naked? Not exactly, but close.

Mr. Fertik, 34, is the chief executive of Reputation.com, a company that helps people manage their online reputations. From his perch here in Silicon Valley, he views the digital screens in our lives, the smartphones and the tablets, the desktops and the laptops, as windows of a house. People go about their lives on the inside, he says, while dozens of marketing and analytics companies watch through the windows, sizing them up like peeping Toms.

By now many Americans are learning that they are living in a surveillance economy. “Information resellers,” also known as “data brokers,” have collected hundreds to thousands of details — what we buy, our race or ethnicity, our finances and health concerns, our Web activities and social networks — on almost every American adult. Other companies that specialize in ranking consumers use computer algorithms to covertly score Internet users, identifying some as “high-value” consumers worthy of receiving pitches for premium credit cards and other offers, while dismissing others as a waste of time and marketing money. Yet another type of company, called an ad-trading platform, profiles Internet users and auctions off online access to them to marketers in a practice called “real-time bidding.”

As these practices have come to light, several members of Congress, and federal agencies, have opened investigations.

At least for now, however, these companies typically do not permit consumers to see the records or marketing scores that have been compiled about them. And that is perfectly legal.

Now, Mr. Fertik, the loquacious, lion-maned founder of Reputation.com, says he has the free-market solution. He calls it a “data vault,” or “a bank for other people’s data.”

Here at Reputation.com’s headquarters, a vast open-plan office decorated with industrial-looking metal struts and reclaimed wood — a discreet homage to the lab where Thomas Edison invented the light bulb — his company has amassed a database on millions of consumers. Mr. Fertik plans to use it to sell people on the idea of taking control of their own marketing profiles. To succeed, he will have to persuade people that they must take charge of their digital personas.

Pointing out the potential hazards posed by data brokers and the like is part of Mr. Fertik’s M.O. Covert online profiling and scoring, he says, may unfairly exclude certain Internet users from marketing offers that could affect their financial, educational or health opportunities — a practice Mr. Fertik calls “Weblining.” He plans to market Reputation.com’s data vault, scheduled to open for business early next year, as an antidote.

“A data privacy vault,” he says, “is a way to control yourself as a person.”

Reputation.com is at the forefront of a nascent industry called “personal identity management.” The company’s business model for its vault service involves collecting data about consumers’ marketing preferences and giving them the option to share the information on a limited basis with certain companies in exchange for coupons, say, or status upgrades. In turn, participating companies will get access both to potential customers who welcome their pitches and to details about the exact products and services those people are seeking. In theory, the data vault would earn money as a kind of authorization supervisor, managing the permissions that marketers would need to access information about Reputation.com’s clients.

To some, the idea seems a bit quixotic.

Reputation.com, with $67 million in venture capital, is not making a profit. Although the company’s “privacy” products, like removing clients’ personal information from list broker and marketing databases, are popular, its reputation management techniques can be controversial. For instance, it offers services meant to make negative commentary about individual or corporate clients less visible on the Web.

And there are other hurdles, like competition. A few companies, like Personal, have already introduced vault services. Also, a number of other enterprises have tried — and quickly failed — to sell consumers on data lockers.

Even so, Mr. Fertik contends Reputation.com has the answer. The company already has several hundred thousand paying customers, he says, and patents on software that can identify consumers’ information online and score their reputations. He intends to show clients their scores and advise them on how to improve them.

“You can’t just build a vault and wish that vendors cared enough about your data to pay for it,” Mr. Fertik says. “You have to build a business that gives you the lift to accumulate a data set and attract consumers, the science to create insights that are valuable to vendors, and the power to impose restrictions on the companies who consume your data.”

THE consumer data trade is large and largely unregulated.

Companies and organizations in the United States spend more than $2 billion a year on third-party data about individuals, according to a report last year on personal identity management from Forrester Research, a market research firm. They spend billions more on credit data, market research and customer data analytics, the report said.

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