Texas Holdem – Hand Rankings For Texas Hold’em Poker

Knowing the hands of Texas Hold’em is so important you shouldn’t play it if you don’t. If you have to ask questions about hands during the game, you’ll give your hand away. It’s as simple as that. To avoid embarrassment and begin to understand the game and the reasons you want the cards you do, check out the following hand rankings: The Royal Straight Flush is a rare and beautiful creature in poker. It is the unicorn of poker. Even if you played every day of your life, you will rarely see one and even more rarely actually get one yourself. It is like the hole in one in golf. It is a straight. It is a flush. And it is made up of the highest cards in the deck. Look for an ace, king, queen, jack and ten of the same suit. The Straight Flush is slightly less lackluster than it’s more royal counterpart, but exciting and wonderful nonetheless. This hand is still rare and made up of five cards of the same suit, ranked in succession. An example would be the six, seven, eight, nine, ten of clubs in one hand. Next, you’ll be wanting the four of a kind. This is pretty obvious. You have a four of a kind when get four cards of the same number. Look for four kings, four tens, or four fives for instance. The Full House is also a pretty good hand. It happens when you have three cards of one type and two cards of another type. To determine whether or not one full house ranks higher than another, look at the set of three cards first. The one that is larger wins. For instance three jacks and two tens beats three tens and two jacks. A flush is something special, too. If you have five cards of the same suit, you’re laughing, but be careful to hide your glee. You don’t want to give your opponents an advantage. If there are multiple flushes, look for the hand with the highest card in the flush. An example of a flush would be a three, seven, ten, queen, and ace of diamonds. After a flush, you’re looking for a straight. This is when there are five cards in your hand that rank in succession. The ace can be played as either a high card or low card. Straights are very common in Texas Hold’em. Look for an eight of hearts, ten of spades, jack of diamonds, queen of hearts, and king of clubs for example. The three of a kind is a more lowly creature, but it wins its fair share of hands. If you hit one of these with a pocket pair and one in the community cards, it’s called “a set.” If you have two cards in the flop and one in your hand, it’s called a “three of a kind.” Look for three fours, three queens, or three aces for example. Two pair comes next. This is when your best five poker cards create a pair twice. Look for two aces and two queens or two fives and two threes for instance. One pair is next. It’s pretty self explanatory. Look for one pair in your hand. For instance, two threes or two jacks. High card is the next hand in the ranking. This happens when you don’t get anything and your hand only counts for the high card. Even if you had an ace, a pair of twos could beat you. Published at: https://www.isnare.com/?aid=117568&ca=Recreation

Texas Holdem Bluffing – How To Effectively Bluff At Texas Hold’em

Texas Hold’em can be a pretty mysterious game. Although the community cards allow all the players an insight into each other’s hands, they won’t tell the whole truth. Players who can use this to their advantage while bluffing, will find winning easier than not. And players who can ascertain when others are bluffing, will find winning is the name of the game. Here’s what you need to know: First, the two cards in your hand are the only two cards that can help you to win. They are the only cards that set you apart from your opponents. And, they are the only two cards that you have that the other players aren’t aware of. And second, the community cards are there for everybody. So, if there are four spades showing, chances are that your flush isn’t the only one. The reason you need to know this is so that you can focus not only on what those cards mean to you, but on what those cards mean to everyone else. The most important two hands to watch your opponents for are their straight and flush possibilities. In order to bluff successfully, you need to be careful not to let on anything that you don’t want the others to know. For instance, this can mean holding out on betting until a later round, or betting smaller or larger than you think your hand warrants. It also means controlling your body physically. For instance, sharp intakes of breath, sweating, flushed cheeks, tapping fingers, fidgeting, eye movements, facial expressions, lip biting and many other movements can indicate to others whether your hand is good or bad. This is especially true if you are consistently repetitive with these gestures. Checking is one way to prevent your opponents from understanding your hand. They may think your hand is weaker than it is and it protects you from betting too early. Another way to bluff is to consistently raise and to push your opponents to the point that they believe you have an excellent hand. The strategy behind this type of bluffing is to get your opponents to bet early on at reasonable or high amounts and then fold later in the hand as you increase your bets considerably. To see if your opponents are bluffing against you, simply read the cards. If the community cards look good, their hand could be the real thing. However, good community cards are good for everybody and they may not be the only one with a good hand. If the community cards are bad, raises could signal a high pocket pair or a straight or flush possibility. By reading the cards, watching for tell-tale signs from your opponents and monitoring betting behavior, you should be able to tell when your opponents are for real and when it’s a bluffing game. Published at: https://www.isnare.com/?aid=116995&ca=Recreation

Defensive Driving Schools In Texas: The Four Texas Online Sites You Need To Know! An article by Dan Ford with 353 words and 1482 views

Defensive driving refers to a state of knowledge. This state of knowledge involves the intricate knowledge of the road and mechanics of driving. The goal is to help drivers not only drive well, but drive safely when others around them make driving conditions poor. Texas offers several different defensive driving schools. Defensive driving schools in Texas are often available online. Four of these include Online Defensive Driving, a Sense of Humor Driving, Get Defensive, and Texas Defensive Driving Online. Online Defensive Driving One school that is based in Texas that is meant to help the Texan driver handle him or herself defensively is Interactive Online Defensive Driving. The program is available 24 hours a day, seven days a week. The course is segmented into six different sections. Then there is a test at the end. The computer will be the grader of the test and you will have the certificate sent to you. A Sense of Humor Driving One program that is centered in the state of Texas is A Sense of Humor Driving School. The sections include an introduction, the traffic safety problem, the student profile, the top 5 moving violation causing crashes, attitude, feelings, habits and emotions, driving challenges, traffic laws, procedures and driving emergencies, protective equipment, organ donation. There are also sections on seat belts, road signs, defensive driving strategies, road rage, DWI, and jeopardy. Get Defensive Get Defensive.Com offers another option for Texas drivers. The course is easy and can be done online. The site keeps track of the progress and offers help for course takers. The course itself is based on defensive driving. There are statistics, animations, driving examples, videos showing the difference in signs, traffic lights and more. The course is complete when the final exam is taken. Texas Defensive Driving Online Finally, there is the Texas Defensive Driving Online. The course is self paced. In other words, you can take the course in how ever much time it takes you to take it. You can retake the final exam. The defensive driving course is a six hour course and covers 12 chapters, with quizzes available after each chapter. Published at: https://www.isnare.com/?aid=12620&ca=Automotive

Tips to Choose Good it Support Company Texas-Related Information on Domain and Server Texas

IT support companies play a vital role in most organizations and business. It is they who solve the IT-related problems of their clients in the toughest of times and during the craziest business hours. Providing the clients with the latest software solutions is vital to the success for both the IT solution company and its client. Before Choosing an IT Support Company Texas for future service assistance, it is important to make sure whether the concerned company has a good repute in this field and among its client. They provide quality service to their client without fail or negligence on their part. Such factors ensures the brand image of such IT support companies. It’s best for the business organizations to choose from a locally based IT Support Company Texas because they are more accessible and can be at your service throughout the day. Clients don’t have to take the pain of traveling. Reliability can be a big issue with those IT support companies that are located outside Texas. Clients can select from those IT support companies stationed outside only if they have a fair idea of the company and are well-aware of their client and service history. With the increasing rise in the numbers of such companies and tough competition among them it is important to figure out the right company. For transmission of large technical information, a domain server is a vital requirement for most business organization. The domain server basically acts like a phonebook which has all the contents, information, domain names and host names collected over a number of networks including the internet. The first thing that one needs to do is to register the domain server by contacting your domain server. Domain name is important for businesses which deal with websites. The physical location or IP address of each host name is found in such Domain and Server Texas. A Domain and Server Texas acts as a complete directory of all similar domain names and IP addresses. All related information is stored in such server and it acts as a central registry for host companies who keep a regular track of the registry to update information on name servers. As soon as one registers the domain server the domain name gets added to the list of name servers. This information is then redirected to the domain registry for allowing other name servers or IP addresses in the internet for later use. IT Support Company Texas cannot work alone without the help of such domain servers. Both are essential for the proper functioning of business as well as IT support companies. Such companies are important for the smooth running of business as they can provide solutions ranging from a variety of complex IT-related problems. Ensuring a spam free PC, overcoming Backup difficulty problems, dealing with Software licensing issues, removing Spyware-related problems, upgrading an outdated technology or software, resolving problems related to systems crashing, misuse of internet and installation of virus definitions are the some the notable solutions that such IT support companies provide. Published at: https://www.isnare.com/?aid=886682&ca=Computers+and+Technology

Texas Holdem – Learn To Play Texas Hold’em Poker In Minutes

As playing poker become more and more popular, it is increasingly more important for every day people to understand the importance of the game. Many people will be asked to play or watch the game in social situations and knowing how to play the game and knowing how the game works can make playing and watching more interesting and more fun. No one wants to be left out and the game provides an excellent past time for people of all ages and backgrounds. Poker is a card game that requires that players vie for a central pot full of chips that may or may not represent money. The pot is awarded to the player with the best combination of cards or to the player who makes an uncalled bet. Poker is a game with hundreds of variations, but all versions follow the same basic pattern. The dealing position rotates among all the players. This position is normally marked by a dealer button. In a casino, a house dealer handles the cards for each hand, and the button is rotated clockwise among the players to help the dealer determine the order of betting. In some versions of poker, players are required to make forced bets called blinds or antes at the beginning of each hand to help raise the action in the game. The dealer shuffles, cuts and the cards are dealt to the players, one at a time, in a clockwise direction. After the deal, the first of several betting grounds begins. As the rounds progress, the players hands develop and the betting continues as more cards are dealt or previously dealt cards are replaced. All bets are gathered into the central pot. When players bet during the betting round, opponents are required to fold, call or raise. If no opponents choose to match the bet or raise, the hand ends immediately and the bettor wins the pot. No cards are required to be shown and the next hand begins. Because the hand is not revealed, bluffing is possible. If more than one player remains at the end of the last betting round, there will be a showdown. All remaining players must reveal their hands. The player with the best hand ranking wins the pot. The three most popular variants of poker are draw poker, stud poker and community card poker. In draw poker, players receive five or more cards, which are hidden and then can replace these cards a certain number of times throughout a hand. In stud poker, players receive cards one a time, some of which are displayed to their opponents. In community card poker, such as the ever popular Texas Hold’em, players receive hidden pocket cards one at a time and then receive other community cards which are displayed on the poker table. Poker has been around for hundreds of years. Learning at least one variation of the game is time well spent. If you’re not sure which version to learn, try Texas Hold’em. It’s the most popular variant on the market today. Published at: https://www.isnare.com/?aid=118015&ca=Recreation

Family Caregiver – Part 7 – Toileting the Wheelchair Patient at Home

My husband uses a catheter only on road trips, not around the house. He is generally continent, generally. I keep an ear pealed for his call and hope I get him to wherever he needs to be to answer nature’s call.

* A urinal is kept alongside the bed on his night table for use during the night. He sometimes feels confident enough to use the urinal himself without waking me. That’s okay when it works. Lately he uses the urinal, replaces it onto his night table without my assistance, and then a couple hours later tries to use it again when there is still urine in it from the previous use. You can guess what happens… I’ve started placing reusable bed pads on the floor against the bed and draped down the side of the bed to catch accidental spills. You can never have too many bed pads.

* I have considered having him use an external catheter at bed time. I know of a family where the husband does use a Texas catheter at night. That man is apparently not as fidgety as my husband. I’m afraid the way my husband tosses and turns as part of the Parkinson’s disease, he would be wrapped in the tubing and the collection bag would be useless. So the urinal is our only choice for now. And a couple reusable bed pads on the bed. You may have luck with the catheter, or absorbent underwear. My husband will not wear the underwear at all.

* A urinal is in the bathroom for when he’s not able to stand at the toilet. One in the basement for when he’s working around the workshop, one near the kitchen table for sudden urges that don’t make it to the bathroom. A urinal is kept in the basket of his scooter, kept under cover in an unobtrusive cloth bag. With a box of tissues packed alongside.

* Boxes of pop-up facial tissues are everywhere for use with the urinal, or wiping noses.

* A box of disposable latex gloves is kept at the toilet for use as needed.

* Adapting clothing helps with dressing and toileting. Try to keep the male patient in pants that are loose around the waist and hips and have a long fly zipper. Try to eliminate underwear. I have changed the zipper in his slacks to be extra long, extending all the way to the crotch seam. Zippers can be added to legs to get over braces. Zippers can open a tight neckline. Velcro can be used instead of zippers. A seamstress may be able to fix/adapt clothing to make dressing and functioning easier. My experience is with a male patient. I cannot imagine how a woman copes with incontinence comfortably.

* To protect the wheelchair seat from wetting accidents, small absorbent seat pads, like a miniature bed pad, can be used. Lacking the special pads, a layer of folded hand towels will help.

* A reusable, waterproof bed pad and a bed pad with handles can be helpful to protect bedding from wetting accidents and to move the patient around the bed. If the bed pad has handles it is easier to grasp the handles than to grab a fist full of cloth to reposition the patient. A bed pad with handles can also be used to protect a recliner and helps to position the patient.

* If you use a bed pad for repositioning the patient, to pull him up towards the head of the bed, remember that when you pull the bed pad up, the bedding is now exposed without protection. You will want to have a second absorbent bed pad in place under the pad that will be used for repositioning, so that when it is pulled towards the head of the bed, there will still be protection under the patient. I use a total of 5 bed pads in various positions on the bed, including the one with handles. Plus the one I lay on the floor.

* My husband uses a male oriented, split front toilet seat. It helps him to position himself so he can use the toilet properly. When he sits for any length of time I place a pillow or two behind him since this type seat has no lid to lean back onto. I make sure the pillows are “old” in case they get soiled or fall into the toilet.

* There are grab bars around the perimeter of the bathroom. When I roll his wheelchair into the bathroom he can grab hold of the bars along the wall to assist in getting himself up and onto the toilet. I stand behind and help him up holding him under the arms until he is standing,or as close to standing as he is able. I then stand off to one side and pull the wheelchair out of the bathroom so it is behind me and then, stepping into position behind him again, I am able to help him onto the toilet, or to stand if he is up to trying. On days when he is not as strong, he will use the urinal while seated in the wheelchair, or I will use the gait belt to transfer him to the toilet.

* Heavy duty grab bars were installed on each side of the toilet for him to hold onto when standing at the toilet or when lowering onto and getting up from the toilet. They work really well. We had them professionally installed during some other modification work. They are almost 2″ in diameter, jut out from the wall on both sides of the toilet, and swing up out of the way when not needed. VERY handy for when I have to climb around him to get into the bathroom, as for his morning wash-up. I wheel him in first then I have to get around to be in front of him. I have to squeeze between the sink and his wheelchair. To do this, the grab bars must be up to allow clearance for me to get through. Once I get around front of the wheelchair, if he decides to use the toilet, I step out of the way as best I can, and I lower the bars down. My husband says our bathroom is the size of a postage stamp. It’s a little larger than that, but not much – 6 ft. x 8 ft. We had the bathroom door frame enlarged too, so his wheelchair would fit through the opening.

Caring for my husband these 13 years has given me a genuine understanding and sympathy for other caregivers and their individual situations. I am always looking for a better, easier way to help him through the day. If he’s happy then we’re both happy.

Karen Shiffert is the inventor and manufacturer of the Skid Seat (R) developed in the course of caring for her physically disabled husband. Her company, Caregivers Aide,LLC offers products she has either developed or discovered to help her care for her husband.
You may visit her web site http://caregiversaide.com/ to see her Skid Seat for repositioning a patient into a wheelchair, her Bed Sled, a reusable bed pad with handles, and other related items you may find useful in caring for your loved one.

Caregivers Aide Skid Seat has won the 2011 Caregiver Friendly Award from Caregiver Magazine.

Visit http://caregiversaide.com/ to view her products and accompanying video demonstrations.

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Caregiver Stress – It Can Sneak Up on You!

I ran into my friend Mary yesterday, and found her in the middle of a crisis. Mary is 75 years old, and although she is active and relatively healthy for her years, she’s had some fairly serious health issues these last few years. But that hasn’t stopped her from taking on caregiving her ex-husband!

Perhaps it’s because he’s the father of her 3 children, who are dispersed across the US. Or maybe it’s knowing he has no one else nearby to care for him. None of her children live near enough to help their father as he ages, encounters serious health issues and is being moved from home to home, as facilities are not able to meet his needs. So that leaves Mary.

She looked exhausted, haggard and totally stressed! My first thought was… “Mary, why doesn’t he move to Texas, where your daughter lives, or to where one of your sons live? After all, he is their father. Shouldn’t they be taking care of him instead of you?” Mary’s reply. “Oh no, I don’t want to burden my daughter or sons with this.”

How do we get caught up in this kind of thinking? Why is Mary willing to risk her own health to take care of an ex-husband? Hard to say, but it’s oh so common.

Self Care Comes First

Having gone through this myself, when my mother was ill, I realize the stress and how easy it is in the middle of everything that’s going on, to forget to pay attention to yourself. After all, didn’t I get seriously ill within 6 months after she passed away? So I warn her… “be careful Mary, you don’t want to get sick like I did. Then your kids will have two parents to worry about!”.

It’s easy to loose track of yourself, as you scramble to keep up with another person’s life. But no matter how important this person is to you, you must remember that if you get too stressed and fall ill, you become the recipient of care rather than the caregiver, and are no help to anyone.

It’s OK to Put Yourself First

A wonderful process in dealing with overwhelming situations is to prioritize. First focus on taking care of yourself, then worry about taking care of others. It makes sense that when you take care to protect your own energy, you have more left to give to others. Caring ceases to be a good thing when it’s at the expense of your own health.

If you find yourself in a major caregiving role and you’re all alone, remember to reach out for some help. Help comes in many forms: friends, family, pastors, churches and support groups. Whatever you do, don’t take it all on by yourself!

Some of the ways you can minister to yourself and relieve some of the stress of caregiving, is to remember to make time to do the things that bring you joy and relaxation. My friend Mary regularly attended an exercise class, and she loved it. But over the 6 months since she’d taken on helping her ex-husband, she had not attended one class. As a friend, I made her promise me she’d be at the very next class. She was immediately less stressed once she agreed.

Warning Signs That You’re Overdoing It…

Loss of energy or joy of life
Emotional or physical exhaustion
Health problems
Disturbed sleep – not enough or sleeping too much
Changes of appetite – not eating or eating too much
Marital problems
Family problems
Alcohol or drug abuse
Neglect or abuse of the older person

Strategies to Better Manage Stress

1. Have realistic expectations
2. Ask for help
o get your family involved
o find support groups
o consult professionals
3. Take are of yourself
o Talk with someone about how you’re feeling
o Mind your own health
o Put aside time for yourself to do things you enjoy
o Eat nutritious meals
o Exercise regularly
4. Keep up your social contacts

Providing care for an elderly loved one can certainly be stressful, but there are ways to reduce the stress. Becoming aware is the first step. It’s necessary to realize your situation and start paying attention to yourself and how well you’re managing, before you can begin to do something about it.

For more infomation please contact us at http://www.seniorhomecareusa.com.

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Caregivers for Disabled Adults

Making the decision to care for a disabled adult is a life altering resolution to an already difficult situation. Weather a sibling or non-family member, the decision to become a caregiver for a disabled adult means change. Once, a mother of a disabled child once said it was like learning to live in Holland. In a lot of ways, her comparison was valid. As the parent of a disabled child you learn a new language and how to live in a completely new environment with a new focus in life. Every choice made reflects “what’s best for my child”.

When you make the decision to accept responsibility for a disabled adult, it mirrors many of the same issues. The only trouble is, the inroads made over a lifetime of care giving by parents are not automatically transferred to the new care giver. State, county, and local contacts for assistance programs are seldom passed along. Dealing with waiver and support programs can be confusing and at times, a gauntlet most people find impossible to manage. That said, if a caregiver you must be, then first face some facts. You’re moving to Holland and your life is changing.

My experience is in Texas and that said, I will refer to state specific issues. Each state will have similar initiatives; some will provide better programs, while other states will offer little in supported services. First do an Internet search of state services.







Use your state as the source and search for disability services. In the search engine text option use words; “Your county” Your State” Disability, Rehabilitation, Services. Then Search. If disabled, most adults qualify for Social Security Income (SSI). It’s not much assistance financially, but with it the disabled adult qualifies for Medicaid. That covers some financial assistance and medical insurance. That’s basics but we all know, that’s not the ultimate goal.

This is the time to get real investigative. As you well know, individuals with a disability have varying developmental levels. You’ve stepped up to the plate, so realistically, where do YOU want to go from here. More is better when it comes to independence but always keep in mind each person’s limitations. For this article, I’m assuming there is a degree of independence possible. Self care and communicative skills are required to move beyond custodial care and into the world of community integration. All things considered, you must be the judge of the disabled person’s ability to learn job skills and integrate socially. Training time is not important. Weather it takes a week or a month, learning a skill is the key. Rule of thumb, if a disabled person can keep the house, his room and bathroom clean, than he can be a dining room attendant at a fast food restaurant. If the disabled person conducts themselves appropriately in social settings, they’re ready for community integration.

Find a program. Make calls. Don’t stop reaching out. The Internet is the best possible search tool. Don’t stop until you find a program that fits your disabled adult’s needs.

Persistence is important. Sign up for every qualifying program, don’t stop calling until it’s active and finally and foremost keep good records. Use an expanding file folder, make a file folder for each program, save correspondence, make copies of letters and forms you send out and keep notes on every verbal and telephone conversation.

It’s hard to imagine administrators of programs could possibly be selective in application of policies but it happens all the time. If a program has a waiting list, ask the number on the list. Call back every few months and make someone provide a status. Get names. Be able to tell the next person the history on a subject including dates and who you spoke with.

Last but definitely not least. Join a support group. Association of Retarded Citizens (ARC) is a national organization. The ARC has social events for the disabled, caregiver training and state government inter-action and advocacy programs.

Charlotte Hoaks is the mother of a disabled 34 year old adult. Her son is currently working 15 hours a week at Wendy’s as a dining room attendant and has an active social life with family and ARC friends. As a single parent of a disabled child, Charlotte has learned by trial and error about navigating the “system” and living in Holland. Her favorite response when asked about raising her son alone: I didn’t put it on my list during high school career day, but I wouldn’t have missed it for anything. I’m the woman I am today because I raised a special person. He taught me strength, compassion, and peace of heart.

ARC information: http://www.thearc.org/NetCommunity/Page.aspx?&pid=183&srcid=-2

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Minority Children In Texas More Likely To Die of Asthma

Minority children in Texas are at higher risk for asthma, according to recent reports. One million children in Texas are considered asthmatic — more than ten percent of all children in the country diagnosed with the disease — and African-American and Puerto Rican kids are six times as likely to die from it as their counterparts, says a report from the National Center for Health Statistics. In the Southeastern region of the state alone, which includes the Houston-Galveston area, 76,450 children ages fourteen and under are afflicted with the condition. In 1997, 10,600 emergency room visits were related to pediatric asthma care, and over 200,000 hospitalizations in the state are still reported each year due to the disease.

Part of the problem, according to experts, is industrialization. Dr. David Rosenstreich, M.D., director of the division of allergy and immunology at the Albert Einstein College of Medicine in New York City, reports that incidences of the disease are not only increasing in the United States, but also in most developed nations. Twenty-one million Americans are currently living with the potentially fatal disorder, and that number is likely to increase.

Dr. Rosenstreich, who also served as a senior investigator on the InnerCity Asthma Study, which aims to identify factors related to the development of asthma in children, says that genes, allergies, environment, and socioeconomic factors related to quality and access to care are major contributing factors. Inner-city children in urban areas, like Dallas, Austin, and Houston, are far more vulnerable to elements that can cause or aggravate symptoms of the disease, and they are far less likely to have quality health insurance and access to outpatient health care. This would seem to validate one of the studies released this year by the non-profit organization, the Commonwealth Fund, which states that lack of health insurance is directly related to less access to care.

“If you look at inner-city children, they’re sensitized to more allergens and exposed to more allergens at higher levels in their homes, allergens that are difficult for them to avoid,” said Dr. Andrew Liu of the National Jewish Medical Center in Denver, who is also a part of the Inner-City Asthma Consortium. The Consortium, a federally-funded project involving ten medical centers nationwide, is designed to evaluate the severity of asthma in cities, as well as test treatments that block related allergic responses.

Perhaps even more disturbing is that the risk of the disease significantly increases with race. Twenty percent of Puerto Rican children have asthma, and thirteen percent of African-American kids do, as compared with eight percent of the national juvenile population. Over the last eight years, the asthma mortality rate has dropped — except in the case of minority children. Part of this could be due to genetic characteristics that make certain minorities, such as African-Americans, more sensitive to allergies and the adverse side effects that accompany the overuse of rescue remedies. But genetics alone are not enough to account for such a huge discrepancy.

In minority children, “the prevalence of asthma is about forty percent higher, but the difference in the adverse outcomes is three times, four times higher for hospitalizations,” said Dr. Laura Akinbami, researcher at the National Center for Health Statistics. “Given that we have the tools to prevent those things, that does reach the level of a public health crisis.”

The outrage surrounding this is particularly poignant when we consider that lack of health insurance could be one of the primary culprits. Poor children have less access to outpatient care — this has been proven. Many of them also lack health insurance — 1.2 million in Texas alone. These factors, combined with non-profit studies confirming that lack of access to quality healthcare is linked with lack of health insurance, would strongly suggest that lack of health insurance is a factor in the poor management of pediatric asthma. Asthma is a disease capable of being controlled with proper management, as many physicians will readily report, but that includes regular medical maintenance, which is much more difficult for poor families with inadequate, or no, health coverage to do. Instead, these families tend to rely on emergency rooms for acute attacks.

Texas Children’s Hospital in Houston, which sees one percent of all pediatric asthma patients in the United States, is working on this problem through the educational initiative, Texas Emergency Department Asthma Surveillance (TEDAS). TEDAS is designed to educate families on managing the disease, and doctors on more accurately diagnosing children’s severity and chronicity. Pediatric asthma patients seen through Texas Children’s, and four other program-participating hospitals’ emergency departments, were enrolled in a database in which their demographics, as well as their doctors’ diagnoses and evaluations were recorded. They then participated in an educational-based intervention. Asthma educators spent approximately thirty minutes with each patient, and then followed up in two weeks, then three months, to evaluate the program’s efficacy.

The results of TEDAS, a fairly simple and straightforward initiative, were significant. Emergency department staff was able to better assess patients’ chronicity and severity in even very young individuals, patients’ families and caregivers felt more confident in their ability to manage the condition, and well-asthma visits to physicians increased among participants. In addition, the program decreased the number of participants’ subsequent visits to the emergency room by forty percent.

“We see projects like TEDAS as laboratories developing models that can be replicated throughout the country,” said Gary Rachelefsky, M.D., TEDAS advisor and former president of the American Academy of Allergy, Asthma, and Immunology.

Other states have instituted similar programs with similar results. The five-year advertising campaign in New York City, the Childhood Asthma Initiative, reduced hospitalizations for asthma by one-third. In central Connecticut, the educational-based Easy Breathing Program also significantly cut emergency department visits and hospital stays.

“In a way, each [emergency department] visit represents a failure,” said Marianna Sockrider, M.D., of Texas Children’s Hospital. “Managing asthma often comes down to good care and well visits. Ideally, if families take control of their children’s asthma — following action plans, using medication and controllers, communicating with their primary care providers — most of those [emergency department] visits aren’t needed.”

What many doctors seem to miss, however, is the extent to which the lack of quality health insurance may impede this management process. It’s difficult, if not impossible, for a poor family with no health insurance to afford the necessary medications, to see the doctor several times a year, and to constantly monitor their children’s activities. TEDAS, and other initiatives, are of vital importance, but so, too, are initiatives to make sure that families are insured. Similar results may be seen if more aggressive action was taken to enroll such children in low-income, and more affordable, health insurance plans.

Massachusetts may be on to something with its requirement that all individuals get some kind of health coverage, but that such plans — even private plans — could be subsidized by the state if one is below a certain income level. In the end, it’s a collaborative effort; we, as a country, got ourselves into an industrial, pollution-based mess that is now causing or aggravating many diseases. Now it’s our job to take care of each other and get ourselves out of it.

Precedent puts a new spin on health insurance. Learn more at [http://www.precedent.com]

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Long Distance Caregiving for a Loved One is Particularly Difficult

The phone rang at 5 a.m. John was sure it couldn’t be good news at that hour. He was right. Mom’s neighbors were calling him from 850 miles away in Texas to say that she was out watering her roses an hour ago on a cold, early spring morning. John knew that she had been failing. She wasn’t the same Mom he could always count to stand by him. Now he needed to stand by her. But how?

Families are now living further apart from each other. This is difficult because your elders require ever-increasing assistance, yet the distance between you makes it difficult to perform the tasks of a primary caregiver. But most elders are reluctant to leave their home of many years to move to the town in which their adult children live. This reluctance can become a stressful point of contention between adult children and their parent(s).

Often, it is a financial issue. In-home care and assisted living can be much more expensive in New York or California than in the center of the country. Resources simply may not stretch as far to allow one to live as one chooses. Regardless of the reasons, many adult children find themselves far away and concerned that parents are not doing as well as they may insist in those telephone visits.

There are some ways to help manage long distance caregiving:

* Try to visit as soon as possible to assess the situation. Take notes of possible problem areas and gather information about senior resources in their area.

* Make sure legal and financial affairs are in place. Keep copies of important papers and telephone numbers of contacts.

* Plan ahead to have back up providers to care for your own family in case you need to make an unexpected visit to your relative. It is also a good idea to bank some vacation or sick days from work for these visits as well.

* Seek the assistance of a Professional Care Manager specializing in assessing and monitoring the needs of the elderly.

* Consider all the options before moving your relative, but begin talking with them about this possibility. You could be surprised to learn they are willing to move closer to you, but they never mentioned this for fear of burdening you with their problems.

* Retain a copy of the Yellow Pages that serves your parent’s community. The next time your parent calls and you need to locate resources, you won’t need to search out numbers or call information long-distance.

When you live hundreds of miles away from an aging loved one, there is a constant level of anxiety over his or her welfare. Every family must make their own decisions about how to handle the situation. Dr. Mary Pipher, in her book Another Country, Navigating the Emotional Terrain of our Elders makes a convincing argument for having the aging parent(s) move near the adult child who will, or currently handles their financial or care decisions. It is an option that should be given much consideration. Be sure to have a contact person who lives close to the parent periodically checking on their health and cognitive status. Better yet, also have someone who can act upon your and her or his behalf until you can.

Use this article freely in print or electronic media, but please use author’s byline and let me know where and how it is used.

Linda LaPointe, MRA, has helped hundreds of families as an ElderLife Matters consultant and national educator. Find free informational articles, exercises, links, audio interviews and products to help families experiencing elder issues at her website [http://www.SOSpueblo.com]

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