Month: April 2018

2018-01-22T15:57:00

EUCRISA may cause side effects including allergic reactions at or near the application site. These can be serious and may include hives, itching, swelling, and redness. If you have any of these symptoms, stop using EUCRISA and get medical help right away.

The most common side effect of EUCRISA is application site pain, such as burning or stinging.

EUCRISA is for use on skin (topical use) only. Do not use EUCRISA in your eyes, mouth, or vagina.

INDICATION
EUCRISA is a prescription ointment used on the skin (topical) to treat mild-to-moderate eczema (atopic dermatitis) in adults and children 2 years of age and older.

See Full Prescribing Information at EUCRISA.com.

For more information, call 1-866-EUCRISA (1-866-382-7472).

This article is sponsored by Pfizer Inc.

¹ Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allerg Clin Immunol. 2006;118:152-169.
² Oszukowska M, Michalak I, Gutfreund K, et al. Role of primary and secondary prevention in atopic dermatitis. Postep Derm Alergol. 2015;32(6):409-420.
³ Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.
⁴ Bieber T. Atopic dermatitis. Dermatol. 2012;1(3):203-217.
⁵ EUCRISA^® (crisaborole). Full Prescribing Information. December 2016.
⁶ Jarnagin K, Chanda S, Coronado D, et al. Crisaborole topical ointment, 2%: a nonsteroidal, topical, anti-inflammatory phosphodiesterase 4 inhibitor in clinical development for the treatment of atopic dermatitis. J Drugs Dermatol. 2016;15(4):390-396.

2018-01-22T15:59:00

(BPT) – The daily routine for a parent can be hectic and stressful, and having a child that is living with atopic dermatitis (eczema) can be difficult.¹

Eczema is a common skin condition that may develop during childhood.² Eczema typically occurs in characteristic areas of skin and is often identified by scaly or dry patches.^2,3 Nearly 18 million children and adults across the United States live with the condition.⁴ About 90 percent of those with eczema have the mild-to-moderate form of the disease.⁵ And you shouldn’t be too surprised your child has eczema, if you have asthma, hay fever, or eczema yourself. Genetic factors are associated with eczema.^3,4

If your child has eczema, the following tips may help you care for your child and their skin.

1. Know what to watch for.

Eczema may look different on different people, so it’s important to know what to watch for.² The face, neck, arms and legs are common sites for many people, depending on their age.² Eczema often appears as a rough, red skin rash.³ If you think your child has eczema, talk with a doctor to learn what to look for and discuss a possible treatment plan. Here’s another tip: consider pajama or bath time as an opportunity to take a moment and check for any changes in your child’s skin.

2. Tame the triggers.

For some, eczema may flare, or get worse, when they’re exposed to different triggers, even if they are currently treating their eczema.² Food choices, sweat, stress, and clothing types may all be possible triggers for your child’s eczema.^3,6 Monitor your child’s skin, and if you notice a change, talk to their doctor to find the strategies that may best identify these triggers.

3. Prepare appropriately.

As a parent, you’ve probably learned that children never stop moving. Purses are filled with all sorts of things to help keep your child entertained. That preparation can also be applied to eczema. For example, heat and sweat are common causes of flares. Try dressing your child in comfortable, loose clothing or uniforms that have been washed before your child wears them.⁶ Don’t forget those new gym clothes and soccer jerseys!

4. Adjust bath time routines.

Children take baths—for obvious reasons!—but bath time might be a challenge for children with eczema. Try to limit bath time to 5-10 minutes up to once per day with warm, not hot, water.⁷ Applying a moisturizer soon after bathing may also help ensure your child’s skin is moisturized.^2,7

5. Understand your options.

There is no cure for eczema, but there are treatment options available. EUCRISA^® (crisaborole) ointment, 2% is a steroid-free topical ointment for people with mild-to-moderate eczema and can be used on all skin tones from face to feet, for adults and kids as young as 2 years old.⁸ EUCRISA is a topical treatment that works both above and below the skin to treat eczema.⁹ The specific way EUCRISA works is not well defined.⁸ It can be applied topically to the skin, including the face. Do not use in the eyes, mouth or vagina.⁸ Talk to your child’s doctor to see if EUCRISA is right for your child and visit www.EUCRISA.com to learn more.

While the above tips may help you manage your child’s eczema, always be sure to talk to their doctor to help identify the best treatment plan. To learn more about EUCRISA, visit www.EUCRISA.com.

IMPORTANT SAFETY INFORMATION & INDICATION

Do not use EUCRISA if you are allergic to crisaborole or any of the ingredients in EUCRISA.

EUCRISA may cause side effects including allergic reactions at or near the application site. These can be serious and may include hives, itching, swelling, and redness. If you have any of these symptoms, stop using EUCRISA and get medical help right away.

The most common side effect of EUCRISA is application site pain, such as burning or stinging.

EUCRISA is for use on skin (topical use) only. Do not use EUCRISA in your eyes, mouth, or vagina.

INDICATION
EUCRISA is a prescription ointment used on the skin (topical) to treat mild-to-moderate eczema (atopic dermatitis) in adults and children 2 years of age and older.

See Full Prescribing Information at EUCRISA.com.

For more information call 1-866-EUCRISA (1-866-382-7472).

This article is sponsored by Pfizer Inc.

¹ Lifschitz C. The Impact of Atopic Dermatitis on Quality of Life. Ann Nutr Metab. 2015;66(suppl 1): 24-40.
² Bieber T. Atopic dermatitis. Dermatol. 2012;1(3);203-217.
³ Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allerg Clin Immunol. 2006;118:152-169.
⁴ Hanifin JM, Reed ML. A population-based survey of eczema in the United States. Dermatitis. 2007;18(2):82-91.
⁵ Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016;75(3):494-503.
⁶ Oszukowska M, Michalak I, Gutfreund K, et al. Role of primary and secondary prevention in atopic dermatitis. Postep Derm Alergol. 2015;32(6):409-420.
⁷ Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.
⁸ EUCRISA^® (crisaborole). Full Prescribing Information. December 2016.
⁹ Jarnagin K, Chanda S, Coronado D, et al. Crisaborole topical ointment, 2%: a nonsteroidal, topical, anti-inflammatory phosphodiesterase 4 inhibitor in clinical development for the treatment of atopic dermatitis. J Drugs Dermatol. 2016;15(4):390-396.

2018-01-23T09:01:00

(BPT) – –

2018-01-23T15:11:00

(BPT) – Grandparents today play an active, important role in families’ lives, serving as caregivers, playmates and educators for their grandchildren. It’s important to protect yourself with an annual flu vaccine so you can continue doing the things you love with your families!

–

2018-01-25T08:01:00

(BPT) – Dru Riddle of Fort Worth, Texas, is one of the estimated 7.5 million people afflicted with psoriasis across the United States. A nurse anesthetist and university professor, Riddle understands first-hand the importance of receiving the proper treatment as quickly as possible and treating the condition with safe, effective medicine. Diagnosed with psoriasis in 2003 and psoriatic arthritis (PA) in 2010, Riddle underwent the treatment trials and errors common to many sufferers of PA before he was connected with a health care provider who prescribed a more aggressive plan that included biologics. Before doctors put him to a biologic therapy, Riddle suffered for several years with skin lesions and joint pain. “Finally I was switched to an injectable biologic medication,” Riddle says. “Those medications have really helped control my disease and the symptoms.”

A condition that is more than skin deep

Psoriasis often presents as patches of itchy, flaky skin, while PA — which affects about a third of psoriasis patients — results in joint swelling and pain, which may cause permanent damage. Both conditions are a product of the body’s immune system attacking itself instead of the foreign invader that should be its target.

PA can usually be identified by psoriasis-like skin inflammations. However, sometimes the joint pain and swelling appear first. This can make it difficult for doctors to properly diagnose the condition.

Initially, Riddle’s condition was treated topically with little to no effect. The relief he found with the right medicines was life-changing and he has vowed to help others with PA find the right care.

“I recommend anyone with PA be extremely aggressive with their treatment,” Riddle says. “The risks of not treating your PA are so much greater than treating it.”

Understanding biosimilars

In his quest for the right treatment regime, Riddle was diligent about his self-care and joined a number of clinical trials for the types of biologics that have been so integral to his treatment plan. It was thanks to his proactive approach to treating his condition that he started learning more about biosimilars.

Biosimilars are safe, effective and affordable alternatives to conventional biologic medicines, similar to generic offerings in other medicinal categories. Widely used in Europe, biosimilars have faced a biologics-dominated market in the United States that has so far been successful in limiting their availability. Expanding the biosimilars market in the United States will require manufacturers, the government and regulatory groups to work together to craft new policies, making access to these potentially life-changing treatments their top priority.

Riddle applauds the option of safe, effective and affordable biosimilars for patients.

“The expense of the biologic medication can be prohibitive — they’re very costly,” Riddle says. “So some people may benefit from a more affordable biosimilar medication. That medication has the same efficacy, meaning it works just as well as the biologic.”

Learning more about your options

“There’s no need to be afraid of the medicine,” says Christine Simmon, Executive Director of The Biosimilars Council, a group working to support the broad components of the biosimilar industry and enabling increased access to safe, effective and affordable biosimilar medicines. “Learn more about your options, talk to your doctor and make sure you’re receiving the medication that is the most effective treatment for your condition.”

If you have psoriasis and/or PA, you deserve to know all of your options, including biosimilars. Your doctor can provide you the information you need on these treatment options. To prepare for your next doctor’s visit and have your initial questions answered, visit http://biosimilarscouncil.org/ today.

2018-01-25T09:03:01

(BPT) – At age 64, Bob Carlson was diagnosed with non-small cell lung cancer, and he felt the diagnosis was like “an expiration date being stamped on his life, like a milk carton,” and the time he had left “wasn’t nearly enough.” Bob, his wife, Julia, and doctors chose chemotherapy to combat his illness—but according to Bob, his quality of life after taking the treatments was non-existent.

Bob became so sick from the chemotherapy that he felt the treatments were almost worse than the disease itself. He talked to his doctor, who said there was nothing else they could do. Bob was on the verge of giving up hope when his physician sent him to a different research center. There, Bob met with another physician who presented him with a new option and renewed his fight.

Understanding the changing lung cancer treatment landscape

Lung cancer is the most common cancer worldwide, representing approximately 13 percent of all cancer diagnoses. While a cure for lung cancer does not currently exist, cancer immunotherapy is changing the treatment landscape and improving the prognosis for many people with lung cancer. Several immunotherapy treatments are approved for lung cancer by the U.S. Food and Drug Administration (FDA), including some as a first-line treatment for advanced lung cancer patients.

Immunotherapy is widely considered to be the most promising new cancer treatment approach since the development of the first chemotherapies in the 1940s. Cancer immunotherapy treatments harness and enhance the innate powers of the immune system to fight cancer.

According to a report published in the Annals of Oncology by the Cancer Research Institute, a nonprofit organization dedicated to the advancement of cancer immunotherapy research, there are over 2,004 immunotherapy agents in development with over sixty clinical trials evaluating immunotherapy combinations in lung cancer. There are 26 immunotherapies approved by the FDA, including six immunotherapy agents for the treatment of lung cancer.

“Today, the lung cancer space has the largest number of combination clinical trials underway, evaluating how two or more medications can work better when taken together. These trials hold much promise for patients, but there are still a lot of misperceptions surrounding clinical trials, with many people thinking that these studies are only an option after other treatments have failed,” said Dr. Jill O’Donnell-Tormey, chief executive officer and director of scientific affairs at the Cancer Research Institute. “However, many of the clinical trials currently underway are evaluating immunotherapy treatments for front-line use.”

The Cancer Research Institute offers the Cancer Immunotherapy Clinical Trial Finder as a free resource to help patients match themselves with appropriate trials based on their specific cancer diagnosis, stage, and treatment history.

“We hope that the Clinical Trial Finder will help more people learn about potential clinical trial options earlier in their patient journey so that they might have better outcomes,” said Dr. O’Donnell-Tormey.

How a clinical trial made all the difference

In August 2013, Bob became the very last patient to enroll in a particular clinical trial for non-small cell lung cancer, evaluating a checkpoint inhibitor—a promising immunotherapy approach that works by “taking the brakes off” the immune system to allow it to mount a stronger and more effective attack against cancer.

Once he started the immunotherapy treatment in the clinical trial, Bob and his doctors realized in short order that the treatment was working. “We saw tumor reduction rather quickly—which was amazing. And to top it off, unlike chemotherapy, which involved lengthy infusions that took many hours and left me ill due to the side effects, the experience of having the immunotherapy treatment in this case only took about 30 minutes, and has very little impact on my quality of life. You take your medicine, and you go on with your life. I have had to make zero lifestyle changes,” said Bob.

Now, almost five years later, Bob and Julia are back pursuing their hobby of wildlife photography and travel. He is hopeful that more patients will benefit from emerging immunotherapy treatments—through new FDA-approved therapies and through clinical trial participation.

“My only wish is that I had known about the immunotherapy clinical trial sooner,” he continued. “And I hope that through continued research more immunotherapy treatments are discovered that work for all patients with all cancer types.”

There are many other cancer patients and survivors, like Bob, who have been given new hope thanks to cancer immunotherapy research and clinical trials. For more information on cancer immunotherapy and how to match with an open clinical trial, visit the Cancer Research Institute Cancer Immunotherapy Clinical Trial Finder at https://www.cancerresearch.org/patients/clinical-trials.

2018-01-26T10:29:00

(BPT) – There are 18.8 million veterans in the U.S., according to the most recent U.S. Census. More than 9 million are seeking treatment at their local U.S. Department of Veteran Affairs medical center, and more than 39,000 are homeless on any given night, according to the U.S. Department of Housing and Urban Development.

There are many ways to help a veteran in need. Below are a few suggestions on how you can make a difference in a veteran’s life this year.

Tie your passion to your action.

We all have passions that bring us joy. There are many ways that suit your interests to give back while helping veterans in need. For example, do you like to spend time outdoors? Many organizations host volunteer activities like cleaning a veterans memorial in the community. Are you more of a people person? Give your time to a local veterans facility to connect with a resident in need of company.

Reach out to a veteran service organization to learn more.

The American Legion Auxiliary (ALA), The American Legion and Sons of The American Legion are actively involved in veteran causes with local units across the U.S. They offer community through memberships, organize and hold volunteer events throughout the year. As a first step, visit the websites of each organization and look for a unit close to you. Meeting with these organizations or others can kick-start your efforts to get involved with the veteran community.

Donate a day of service.

Everyday life can get messy with full-time jobs and commitments. One way to identify free time for charitable activities is to use a day off engaging in community service. “Donate” your Memorial Day to help the ALA distribute handmade poppies that support veterans in local hospitals, visit a veterans facility or deliver a meal or care package.

Give a gift.

Extend your thankfulness to the veteran community by making a gift. Mark your calendar for Nov. 27, 2018, when you can participate in #GivingTuesday, a global giving movement, by making a monetary donation to an organization that dedicates its efforts to helping veterans. Whether you come together as a family, a company, a community or by yourself, a donation can make a real difference.

Helping a veteran can be a year-long commitment or a one-day activity. To learn more about how to take the first step, visit www.ALAforVeterans.org.

2018-01-30T06:01:00

(BPT) – Online vision apps can be a great resource for health-related information, but if you rely on them to preserve your eye health and detect potential problems, you could be doing more harm than good, the American Optometric Association warns.

“Eye health is critical to overall good health,” says Dr. Christopher Quinn, president of the AOA. “If someone chooses to forego an annual eye exam with a doctor of optometry because they think an online test or mobile app screening is enough, they’re making a mistake that could put their vision and health at risk.”

The AOA, which represents more than 44,000 doctors of optometry, optometric professionals and optometry students, supports state and federal policies that protect patients from the potential dangers of online vision test apps. Here are four of the many reasons why patients should not rely on online eye screenings or mobile apps:

1. Vision test apps or online tests can’t diagnose or treat serious eye problems.

These tools simply use measurements to gauge what is known as visual acuity, or sensitivity. However, many vision and eye health conditions don’t have obvious signs or symptoms in their earliest stages. Online tests can miss serious conditions that a comprehensive eye exam would catch.

They may be designed to test for near-sightedness or far-sightedness, but can’t adequately evaluate overall eye health. For example, an online screening might be able to detect symptoms of near-sightedness, but isn’t designed to catch signs of glaucoma.

2. Vision test apps aren’t held to the same standards as doctors of optometry.

People put their eye health at risk when they choose convenience over care and today, 17 states have regulations in place to safeguard patients from unproven technologies and practices that can compromise the established and proven standard of care. And there is good reason.

Right now, online vision screening services and mobile apps aren’t required to meet the definition of a comprehensive eye exam, or clinically prove their technologies provide the same level of care you would get from a qualified eye care doctor. In addition, they are not approved by the U.S. Food and Drug Administration (FDA).

3. Patients may not get the care they need.

Even if an app accurately indicates a problem with vision acuity, patients might not follow up as recommended with a doctor of optometry, who can diagnose issues and work with you to develop solutions to eye health and vision care needs.

Additionally, a comprehensive eye exam conducted by an optometrist can be an important step in identifying health conditions that might not have been detected otherwise, such as diabetes and high blood pressure. An optometrist can help you understand the seriousness of the condition and suggest and implement appropriate treatment.

4. You could be risking your eye or overall health.

Online vision screening apps might not catch signs of a serious problem. Missing the signs of an eye health or overall health issue can put you at risk.

“People may think they’re doing something good by using a mobile vision app,” Quinn says. “Unfortunately, an online eye test does not completely cover any one of the 12 components of a regular in-person, comprehensive eye exam, something everyone needs to ensure they’re protecting and preserving their vision.”

To learn more about vision health, visit www.aoa.org.

2018-01-30T09:01:00

(BPT) – Pregnancy is an exciting time in a woman’s life, filled with countless physical, emotional and lifestyle changes. Pregnant women often do research, read books or consult friends and family to determine what to expect during those nine months and how to best combat the symptoms that may arise. While issues like morning sickness and cravings are to be expected, there are several uncomfortable, but common, effects soon-to-be moms may be less likely to anticipate.

“A woman is going to experience numerous changes to her body during pregnancy,” says Dr. Alyssa Dweck, an OB-GYN, author and expert on women’s health. “Although there is abundant information about issues like backaches and morning sickness, there are a number of common symptoms women are less inclined to talk about because they either consider them taboo or embarrassing.”

While each woman’s pregnancy experience will be unique, Dr. Dweck shares some of the lesser-known, but common, health nuisances to expect when expecting:

1. Constipation

Some common causes of constipation among pregnant women include increased progesterone levels, which influences intestinal motility, increased pressure from the growing uterus and the recommended supplementation of iron. To help diminish constipation, women can try increasing their fiber and fluid intake and limit iron supplements to three times a week.

2. Yeast infections

The hormonal changes that come with pregnancy often increase the chance of developing a vaginal yeast infection. However, according to a 2016 Danish nationwide cohort study, even a single, low dose of fluconazole (the leading prescription pill to treat yeast infections) may increase miscarriage risk. Instead, Dr. Dweck recommends MONISTAT 7 for vaginal yeast infections, as it relieves symptoms four times faster and works on more of the most common strains of yeast than the prescription oral pill. Nevertheless, women should always check with their own healthcare provider before using any treatment during pregnancy.

3. Heartburn

Heartburn and indigestion are most frequent during the third trimester, as the growing uterus places pressure on the stomach and the muscle tone of the esophagus relaxes. To help minimize heartburn, eat smaller, more frequent meals throughout the day, sit or stand after a meal and avoid spicy, greasy and fatty foods. OTC antacids are typically safe, but it is important to speak to an OB-GYN before taking.

4. Varicose veins

Many women develop varicose veins during pregnancy. As blood volume increases and the uterus enlarges, additional pressure is put on the veins in the pelvis, lower extremities and the rectal area. Elevate the legs to improve circulation, avoid sitting or standing in the same position for extended lengths of time and try to exercise regularly, if possible.

5. Body and facial hair growth

Hair is likely to grow faster and thicker during pregnancy on places other than just the head. Higher levels of estrogen extend the growth phase of hair, leading to less shedding and denser locks. Safe ways to get rid of these unwanted hairs during pregnancy include tweezing, waxing and shaving.

Regardless of whether a result of pregnancy is considered normal, pregnant women should readily consult their OB-GYN if they experience any changes or if they are looking for treatment solutions. Though health nuisances are bound to pop up during pregnancy, there are simple solutions to combat them so women can make the most of this wonderful time and prep for the arrival of baby. For more information, visit Monistat.com.

2018-01-31T08:31:00

(BPT) – Did you know that your zip code has a bigger impact on your health than your genetic code? It’s because of factors known as social determinants of health. Things like air quality, employment, education, the people you socialize with and the safety of your neighborhood all have an impact. In fact, 60 percent of a person’s life expectancy is driven by factors outside of the doctor’s office. Check out a few surprising things in your neighborhood impacting your health — and what to do about them:

Your Sidewalks

You might not think about it, but your sidewalks are impacting your health. The average person burns 100 calories walking a mile. If we all had more easily accessible sidewalks and spent more time walking, we could become more fit. The WalkWorks ChesCo! program in Chester County, Pennsylvania, a Healthiest Cities and Counties Challenge Spotlight winner, set a goal for community members to hit one billion steps in 2017, and reached it three months ahead of schedule. Reach your step goal by taking a sidewalk stroll every once in a while.

Your Grocery Stores

How easy is it to get to your nearest grocery store? The distance between your home and the nearest grocery store impacts your health immensely. The CDC defines a food desert as an area that lacks access to affordable fruits, vegetables, whole grains, low-fat milk and other foods that make up a full and healthy diet. In Bridgeport, Connecticut, residents in the East End neighborhood have spent the last 35 years with little or no grocery stores close by. Last year, a pop-up market ended the trend of food deserts and gave the neighborhood accessible, healthful options.The grocery stores in your neck of the woods might just influence your fruit and vegetable consumption.

Your Neighborhood Police

Community police work to keep your neighborhoods safe and lower violence rates. The Mind/Spirit/Body project in Jersey City, New Jersey, has made it a priority to recognize violence as a health issue, and has actively decreased violence within local neighborhoods by promoting healthy behaviors among its citizens. In the last 25 years, violent crime rates have decreased by 50 percent because of police. Next time you see an officer, thank them for keeping you safe!

Your Water System

Your water system impacts so many aspects of your daily life. From safe drinking water, to a healthy sewer system to curbing erosion from rainfall, communities must manage water in many ways. For example, according to the Environmental Protection Agency (EPA), sewer overflows happen about 75,000 times a year. Did you know sewage overflows can contaminate our waters, cause property damage and other public health threats? The city of Camden, New Jersey, another Challenge Spotlight Award winner, set up a program to reduce the number of sewage overflows in their region and improve water quality for all. The Camden SMART Initiative gathers community engagement through a variety of new mobile apps, community meetings and social media. Make sure to check to see if your community sewer system is in top shape to avoid contaminants.

Your Schools

The schools in your community matter. Many studies show that a higher level of education is a strong predictor of a longer life due to many factors, including higher income, social status, healthy behaviors and social well-being. The Steinhardt School at NYU completed a study, finding that 145,243 deaths could have been prevented in 2010 if adults who had not completed high school went on to earn a GED or high school degree. Education levels affect mortality rates over time. Your local teachers, schools and peers impact your life expectancy more than you know.

To learn more, visit: http://www.healthiestcities.org/ and join the conversation at #Healthiestcitieschallenge.

About the Healthiest Cities and Counties Challenge:

The Healthiest Cities & Counties Challenge is a collaboration between the Aetna Foundation, the American Public Health Association and the National Association of Counties to encourage small to midsize U.S. cities, counties and federally recognized tribes to create a positive health impact. The challenge will identify the best practices for achieving community and individual health, wellness and health equity.