In addition to making suggestions for changes in programming, services and facility usage, an advisory board offers prestige and credibility. Maximize the committee’s community visibility and medical credentials by including its names in your club literature and club newsletters. Provide a brochure with information about your committee to potential and existing members.

Advisory committee members could eventually refer patients/clients to your facility if they become comfortable with your programs, staff capabilities and physical space/equipment. Mary Swanson, president of HealthCare Resources, says that it generally takes six months before physicians feel comfortable referring their patients to you. Pat Pine, executive director, Western Association of Clubs, emphasizes the need to have a credible, credentialled, well-trained staff before expecting physicians to refer patients to you.

Advisory committee members could offer lectures for your members. Each committee member can submit an outline or list of topics they feel comfortable with, and you can create a lecture series each month featuring a different committee member.

Also, encourage your advisory committee to submit articles to your newsletter. Make reprints to distribute at community meetings.

Your committee, when used to full advantage, can help grow your business significantly. Ernie Zaik, former general manager of the Western Reserve Club (WRC) in Tempe, Ariz., found that he was able to increase not only membership sales, but also revenues in wellness programs at his club.

High blood pressure (HBP) is very common in adults, and is under-diagnosed and under-treated. It is a major risk factor in the causation of heart disease, stroke, and kidney disease, and it is more common in the African-American population. Treatments include diet, exercise, and medications. Yet, despite its potentially devastating sequelae, many HBP patients are not adequately treated: their BP remains elevated.

In recent years, doctors have recommended that HBP patients monitor their BP at home. While this is easy to do in theory, in actuality there have been substantial differences between BP measured electronically and that reported by patients themselves. It has also been shown that 24-hour BP measurement is far more accurate than occasional measurements taken by patients.

To obtain more accurate readings, Mary A.M. Rogers, Ph.D., M.S., and her colleagues at the State University of New York-Upstate Medical University in Syracuse designed a randomized, controlled trial utilizing 24-hour automatic ambulatory BP monitoring (ABPM) at baseline and at the study termination 8 weeks later, to determine BP levels and changes in those levels more accurately.

Sixty patients with diagnosed HBP were randomized to the study group, which received ABPM with centralized reporting and processing of their BP data, including weekly reports provided to their primary physician — as well as to the patients themselves. The readings were transmitted over telephone lines. Sixty-one patients were randomized to the control group, which received usual care. Their BP treatment was given according to the recommendations of the Joint National Committee on HBP, with BP measurements done at office or clinic visits.

The results showed that BP readings decreased for the study patients, but increased or remained the same for the control group. Mean (average) diastolic pressure, the lower number, decreased 2.0 mm in the study group, but increased by 2.1 mm in the controls; mean systolic (higher number) decreased 4.9 mm in the ABPM group, but increased 0.1 mm in the controls. The differences were even more significant in the African-American patients. The main reason for the difference, according to the study authors, was more frequent changes in type and dose of BP medications in the study patients.

In this randomized, controlled trial, a telecommunication service utilizing ABPM was effective in decreasing BP in patients with established HBP. BP decreased in patients who used the service, while it worsened in patients receiving usual care. The authors state, “[A]ccurate and timely information is an essential cornerstone for the provision of quality medical care. Technological advances…must be tested and, if efficacious, be made available. Our results suggest that this telecommunications service may be a useful adjunct to antihypertensive therapy and warrants investigation in larger study samples.”

We understand from experience that erectile dysfunction may ruin a relations, but there are strong and effective remedy for premature ejaculation in our time! Rapid ejaculation or PE is the most common kind of sexual dysfunction in guy younger than 40 years.

To keep costs within a manageable budget, they employed several cost-saving strategies: 1) They hired a construction manager and subcontracted the various trades; 2) They utilized a steel frame building as a base; 3) They eliminated aesthetic items that didn’t contribute to member service or functionality; and 4) They bid and selected all furnishings themselves, rather than using an interior designer.

Ten months after ground-breaking, they opened a 68,748-square-foot facility that was built for $40.27 per square foot vs. the typical costs of $70 to $120 per square foot.

The community responded; the club signed up 1,440 people prior to opening, and after six months had 2,300 memberships. Their goal was 3,000 members the first year. Not only have they turned a profit in their sixth month, but they expect to break even the first year.

The center of the computer screen or monitor should be at or slightly below eye level and a comfortable distance from the user.

“Often, the screen is too high for kids, so that they have to tilt their head up and back,” Merrill says. “The chair seat is often too deep, so that they must either sit forward without back support, or sit so that the back of their knees is tight against the edge of the seat.” If this is the case, a footstool permits the proper posture while children grow into the chair.

While having the correct equipment is essential, people should also learn the right typing techniques. “The arm and hand technique for typing is similar to the proper technique for playing a piano,” Merrill said. “The principle is to use the whole arm rather than just the hands and the fingers. Wrists should be about level with the arms, rather than way lower or way higher.” Children should be taught to hold the mouse gently, rather than jerking it around or pressing it very hard.

Parents should monitor their children’s computer use. Hours of game playing expose a child to the same hand and eye movement over and over. “A good environment won’t take the place of frequent breaks, sufficient exercise and good nutrition, but it does eliminate the stress of placing the body in bad positions,” Merrill said.

“Kids should be getting up about every half hour or so to change positions. You don’t want them spending hours in front of the computer without a break and then going directly to the TV screen.”

Surprisingly, the odd positions that some kids assume at the computer are not all bad. One mom described her son’s behavior like this: “He puts his feet up on the desk and leans back and he takes the keyboard in his lap or props it on his knee.” Although it drives adults nuts, this type of behavior can be a blessing. “Active, fidgety kids probably are less at risk for repetitive stress injuries than the ones who stay put for hours on end,” Merrill said. “Moving often is important for children as well as for adults.”

But it doesn’t have to be this way. A well-planned computer area pays dividends in satisfaction and good health for the whole family.

Good planning consists not only of choosing a quiet spot out of the family’s daily traffic, but also in outfitting the area properly to support comfortable use.

The advantages of a quiet location are obvious, but what’s this about proper equipment? When people — whether adults or children — park themselves in front of the computer for long periods, side effects such as repetitive stress injuries, eyestrain and headaches can occur. The proper equipment can minimize such side effects.

In families where everyone uses the computer, setting up a single workspace can be tricky. But it’s doable, thanks to adjustable chairs, articulating keyboard trays that attach to a desk or table and pull out, and swing-arm supports to hold the monitor. Office supply outlets generally stock these items, along with armrests and footstools, to further customize the work area for each user.

There is one caveat to the “one-home-office-fits-all” arrangement. If very young children will also be using the computer, consider buying separate computer furniture for them and setting up two areas.

“Smaller children need tables or desks that fit them, and many furniture companies are making much smaller chairs suited for kids,” said Barbara Merrill. Merrill is physical therapist in Saratoga, Calif., and a certified ergonomist who counsels companies and individuals on physically appropriate work environments.

If you are going to create or upgrade a computer area, start with the chair, because it is the single most important item contributing to comfort. A proper chair allows the trunk to be supported while the arms can move freely.

“Good muscle tone makes it easier to sit up straight, but nobody can remain upright while seated for long periods of time without good back support from the chair,” Merrill said. The height of the chair is also important — it should permit the user to sit with his or her feet on the floor, with about three finger-widths of space between the chair edge and the back of the knees. Merrill prefers a chair with arms that can support the forearms, but comfort is key. “A good chair feels like a comfortable shoe,” she said.

Here we will look at tort liability topics, such as those above. We will also look at areas such as

1) property loss (including natural causes such as fire, tornado and earthquake, and human causes such as vandalism and theft);

2) financial business loss (including occurrences like interruption of business and embezzlement);

3) contract loss (including membership contracts, facility contracts, vendor contracts and game contracts.); and

4) human rights loss (which include sexual harassment, right to participate, and age or sex discrimination).
In each upcoming column, a different aspect of risk management will be addressed.

RISK MANAGEMENT RESOURCES

1.Presents a large variety of risk-management topics with emphasis toward competitive athletics.

2.Recreation and Sport Managers. Kendall-Hunt Publishing Co., Dubuque, Iowa, 2011. (Sport law text that presents a broad range of legal and risk-management information.)

3.Public Entity Risk Institute, Fairfax, Va., 2011. (Free publication that provides detailed information on risk management and risk identification.)

Doctor is co-author of Law for Recreation and Sport Managers (2nd ed.); Legal Aspects of Waivers in Sports, Recreation and Fitness Activities; and Waivers & Releases for the Health & Fitness Club Industry (3rd ed.). He is professor emeritus in sport management at Georgia Southern University, and owns Sport Risk Consulting, a consulting business.

The trainer had been informed that she was on medication for high blood pressure. After several months on the supplements, she collapsed in the club, and died of hypertensive stroke later in the day. (A review of the Crunch Fitness complaint can be found inThe Exercise Standards & Malpractice Reporter, 13(5): 72-75.)

You don’t need to look far to find similar types of threats to the financial security of fitness centers. Whether it be an injury on a weight machine, a slip and fall accident in the shower, or a sexual harassment or discriminationclaim, lawsuits of all sorts abound. The above case illustrates that the extent of the financial risk faced by clubs and other business entities is virtually unlimited.

A recent study of sport- and fitness-related cases3 between 1989 and 1996 (reported in From the Gym to the Jury) found 64 cases with awards or settlements over $1 million. Health club cases averaged jury awards of about $136,000, and settlements of about $193,000. The highest award in a health club case during that time period was $925,000. Awards and settlements involving resorts averaged more than $2 million each.

But the actual award or settlement is only part of the headache and cost involved. Consider the worry and stress as the suit drags on for years, the negative public relations your business will suffer, and the possibility of loss of insurance coverage or increased premiums.

Understanding risk management

From this, it is easy to understand why risk management is important to the financial stability of any business. Risk management is an ongoing process by which a fitness facilityattempts to control programmatic and financial risks to reduce costs, enable desirable programming and provide financial stability. Risk management at one time referred primarily to insurance; however, that is not so today. While insurance is still part of the process, risk management is now a much broader concept that involves the following: 1) the identification of risks; 2) the assessment of the magnitude of the risks; 3) the determination of the best way to handle or control those identified risks; and 4) the implementation of an ongoing plan.

‘Preemies’ are more than just small- they are developmentally unprepared for life outside the uterus. They have more problems with- hearing, vision, and speech. As the gestational age of the infant decreases, the risk increases.

Every week that an infant matures in utero buys your baby valuable time to grow and mature. Examples- an infant born at 24 weeks [6 months] weighs about 1 pound, their eyelids are fused and their lungs are very immature and need the help of a ventilator to assist in their breathing. Their chances of survival are about 1 in 10. An infant born at 36 weeks gestation weighs about 5 1/2 pounds, it’s vision and digestion are well developed. Their respiratory need are questionable?. Their chances of survival are 9 out 10.
Of major concern with premature infant’s is RDS- respiratory distress syndrome. Infants born before 32 weeks gestation-[8 months] are at an 11 % risk for developing RDS. Infant’s born before 37 weeks are at about a 4% risk. Their is a 1% risk for infant’s born after 37 weeks.

RDS- occurs when the infant’s lungs are immature and are collapsed due to a lack of a substance called surfactant. As an infant matures in utero the surfactant becomes available. If the infant’s lungs are suffering from RDS they will need assisted ventilation to exchange air with each breath. Approximately 14% of infants born before 32 weeks- need to be placed on ventilators. Compared to less then 1% of infants born after 37 weeks gestation.

Very special attention is needed to be given to these tiny babies. They include placement on a ventilator, enclosure in a heated closed incubator, special intravenous solutions for nutrition, muffling extraneous sound and light as well as special care for their very fragile skin care needs. Many great advances have been made in the survival rates of these very special infants but there is no substitution for a full term baby.

Prematurity in the United States has increased by about 20% since 1980. What causes to happen? We will be exploring many of these issues in the coming months. Hopefully this sharing of information will help you to decrease your risk of a premature birth.

Do you know that you can achieve pregnancy easy, naturally, fast despite your age? There are effective, safe and natural methods in which you may get pregnant quickly.

I’ve heard some people take antibiotics for this purpose. Also, is there any medication I can take with me to reduce symptoms if I do get sick?

Lynda

A.Traveler’s diarrhea is a problem suffered by many people visiting foreign countries. The cause is consuming food or beverages that contain strains of bacteria and/or parasites to which the traveler has never been exposed.

Usually, these germs usually do not cause disease in residents of the country.

To avoid overwhelming a spouse, make changes gradually. Try to keep new responsibilities from being all-consuming. Have realistic expectations. It may take time for your spouse to understand everything you need.

Try to reserve time for fun, so you don’t lose touch with each other. View things through your spouse’s eyes. Consider how you’d feel if the situation were reversed.

Keep communication open. Discuss things with each other reasonably and gently.