Community health workers help type 2 diabetes care

Feb. 11, 2013 ? Researchers who conducted a clinical trial in American Samoa to test whether community health workers could help adults with type 2 diabetes found that the patients who received the intervention were twice as likely to make a clinically meaningful improvement as those who remained with care only in the clinic. The results appear in the journal Diabetes Care.

Newly published results from a randomized controlled clinical trial in the Pacific U.S. territory of American Samoa add clear evidence for the emerging idea that community health workers can meaningfully improve type 2 diabetes care in medically underserved communities.

In the U.S. territory, 21.5 percent of adults have type 2 diabetes. Meanwhile, 58 percent of families are below the U.S. poverty level. The research team, led by public health researchers from Brown and The Miriam Hospital, wanted to test whether four trained local community health workers led by a nurse case-manager could extend the reach of the territory's limited medical staff.

For their study, published online in the journal Diabetes Care, the team recruited 268 Samoans with type 2 diabetes and randomly assigned them, according to their villages, into two groups: One panel received a personal, culturally tailored intervention from community health workers, and one group continued with only their usual primary care.

After a year, members of the group that received the intervention were twice as likely as those in the usual care group to have made a clinically significant improvement in blood glucose levels, the researchers found.

"This approach of using community health workers and home visits can work to help individuals better manage their diabetes," said Stephen McGarvey, professor of epidemiology (research) at Brown University, a co-author and principal investigator of the study. "This adds to the small list of randomized trials designed to look at the efficacy of community health workers to help underserved patients."

Cultural context

For the intervention group, the community health workers trained by the researchers and led by the nurse would visit each patient's home or workplace either weekly, monthly or quarterly depending on the patient's level of health risk from the disease. The workers would test and explain blood glucose readings, remind patients to keep up with medicines and doctors' clinic visits, and lead educational discussions about diet and exercise based on educational materials developed by the research team. If patients were having problems caring for themselves, the workers were trained to help them solve the problems.

Patients could choose from a menu of eight topics for their educational discussions.

The basic model for the intervention came from the successful "Project Sugar 2" trial in Baltimore, but study lead author Judith DePue of The Miriam and Brown said she and her team made many cultural adaptations after conducting extensive ethnographic research, including focus groups with patients.

The educational materials were in both English and Samoan. The foods and activities represented in the text and visuals were familiar and accessible in the territory's culture. All the community health workers were local residents, and the community health worker visits were free of charge (DePue's research found that even small co-pays were deterring some of the territory's residents from seeking primary care).

"We really needed to make it work in this setting," DePue said. "The adaptation that we did, we think, was part of why it was successful."

The study's main measure of that success was a blood glucose level called HbA1c. At the beginning of the study the average level in the intervention group was 9.6 percent and in the traditional care group was 10 percent. After a year, the intervention group members brought levels down to 9.3 percent on average, while among the traditional care group the average level remained at 10 percent.

Meanwhile, more than 42 percent of patients in the intervention group were able to reduce their HbA1c level by more than half a percentage point, a reduction that diabetes researchers consider clinically significant.

The researchers acknowledge that 9.3 percent is still much higher than the goal recommended by the American Diabetes Association of less than 7 percent. Still, the greatest improvements in the study occurred among the highest-risk patients who received the most frequent community health worker interactions. Future work in this resource-poor setting, DePue said, may need more sustained support or a more comprehensive approach.

But McGarvey and DePue said the overall results should encourage health officials to consider community health worker models for diabetes 2 care in areas, from Baltimore to American Samoa, where physician's office care has not proven to be enough.

"We believe the findings here may also be generalizable to other diabetes patients in resource-poor and high-risk populations," they wrote in Diabetes Care. "This study adds to the growing body of evidence showing community health workers ability to improve diabetes outcomes and related behaviors."

In addition to McGarvey and DePue, other authors on the study are Shira Dunsiger and Rochelle Rosen of Brown and The Miriam Hospital; Andrew Seiden of Brown; Jeffrey Blume of Vanderbilt University; Michael Goldstein of the VHA National Center for Health Promotion and Disease Prevention; and Oferia Nu'solia, and John Tuitele of the Tafuna Clinic of the American Samoa Department of Health.

The National Institute of Diabetes, Digestive and Kidney Disorders funded the study with grant R18-DK075371.

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Story Source:

The above story is reprinted from materials provided by Brown University.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. J. D. DePue, S. Dunsiger, A. D. Seiden, J. Blume, R. K. Rosen, M. G. Goldstein, O. Nu'solia, J. Tuitele, S. T. McGarvey. Nurse-Community Health Worker Team Improves Diabetes Care in American Samoa: Results of a randomized controlled trial. Diabetes Care, 2013; DOI: 10.2337/dc12-1969

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/most_popular/~3/avnbaoTTBFQ/130211102308.htm

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Leaving hospital? Heed care tips or you may return

WASHINGTON (AP) ? Michael Lee knew he was still in bad shape when he left the hospital five days after emergency heart surgery. But he was so eager to escape the constant prodding and the roommate's loud TV that he tuned out the nurses' care instructions.

"I was really tired of Jerry Springer," the New York man says ruefully. "I was so anxious to get out that it sort of overrode everything else that was going on around me."

He's far from alone: Missing out on critical information about what to do at home to get better is one of the main risks for preventable rehospitalizations.

"There couldn't be a worse time, a less receptive time, to offer people information than the 11 minutes before they leave the building," said readmissions expert Dr. Eric Coleman of the University of Colorado in Denver.

Hospital readmissions are miserable for patients, and a huge cost ? more than $17 billion a year in avoidable Medicare bills alone ? for a nation struggling with the price of health care.

Now, with Medicare fining facilities that don't reduce readmissions enough, the nation is at a crossroads as hospitals begin to take action.

"Patients leave the hospital not necessarily when they're well but when they're on the road to recovery," said Dr. David Goodman, who led a new study from the Dartmouth Atlas of Health Care that shows different parts of the country do a better job at keeping those people at home.

And The Associated Press, teamed with the Robert Wood Johnson Foundation, found hospitals are hunting innovative ways to fix a key hole in this health care: Those missed instructions.

In Portland, Ore., nurses at Oregon Health & Science University start teaching heart failure patients what they'll need to do at home on their first day in the hospital, instead of just on their last day.

In Salt Lake City, a nurse acts as a navigator, connecting high-risk University of Utah patients with community doctors for follow-up treatment and ensuring both sides know exactly what's supposed to happen when they leave the hospital.

Some techniques are emerging as key, Coleman said: Having patients prove they understand by teaching back to the nurse. Role-playing how they'd handle problems. Finding a patient goal to target, like the grandmother who wants her heart failure controlled enough that her feet don't swell out of her Sunday shoes.

____

You'd be mad at having to return your car to the mechanic within a month, yet rehospitalization after people get their hearts repaired too often is treated as business as usual, laments Dr. Ricardo Bello, a cardiac surgeon at New York's Montefiore Medical Center.

Heart surgeons try to prevent that by re-examining patients two to three weeks after they go home. But Montefiore patients tend to be readmitted sooner than that.

So last fall, Bello's team began a special clinic where nurses check heart surgery patients about a week after they go home, at no extra charge ? and have a chance to re-teach those discharge instructions when people are more ready to listen.

Plus, for that first month at home, patients are supposed to wear a bracelet with a phone number to reach Montefiore's cardiac unit 24 hours a day with any worries.

"It changed my conception of dealing with a doctor," said Michael Lee, 60.

Montefiore surgeons repaired a life-threatening crack in Lee's aorta, the body's main blood vessel, but his recovery derailed days after getting home. He quit some medications. He was scared to wash the wound that ran from chest to navel, an infection risk. He developed a scary cough and called that special clinic in a panic.

It turned out the cough was a temporary nuisance ? but nurses discovered a real threat: Lee's blood pressure was creeping up, a risk to his healing aorta. Those pills Lee quit were supposed to keep it extra low, a message he'd missed. And some hands-on instruction reassured Lee that he could handle his wound without tearing it.

Without the clinic, "he's definitely somebody we would have been called to see in the emergency room," said physician assistant Jason Lightbody.

_____

In heart failure, a weakly pumping heart allows fluid to build up until patients gasp for breath. Spotting subtle early signs like swelling ankles or creeping weight gain is crucial. But at the Oregon Health & Science University, nurse practitioner Jayne Mitchell spied as patients were told what to watch for as they were discharged ? and they barely paid attention.

The new plan: Learn by doing.

Every morning, hospitalized patients weigh themselves in front of a nurse, record the result and get quizzed on what they'd do at home. Gained 2 pounds or more? Call the doctor for fast help. Lots of day-to-day fluctuation? A weekly log can help a doctor tell if a patient is getting worse or skipping medication or having trouble avoiding water-retaining salty food.

Step 2: These patients need a check-up a week after they go home. The hospital makes the appointment with a primary care doctor before they're discharged, to ensure they can get one.

And for some high-risk patients who live too far away to easily track, Mitchell is pilot-testing whether a high-tech option helps them stick with care instructions.

During that first vulnerable month at home, those patients record their morning weight, blood pressure and heart rate on a monitor called the Health Buddy. It automatically sends the information back to Mitchell's team at OHSU and also will flash instructions to the patient if it detects certain risks.

In Sun River, Ore., Richard W. Pasmore's phone rang one morning. Nurses three hours away in Portland saw that his weigh-in was high and adjusted his medications over the phone.

The 67-year-old Pasmore thinks it prevented a return to the hospital: "It kept them totally abreast of everything that was happening with me." And by the end of the month, he says he'd gotten in the habit of his morning heart failure checks.

___

At the University of Utah, nurse Stephanie Wallace links high-risk patients to the outside care that could keep them from returning. And she's the one whose phone rings when that care falls through.

Consider the single mother who couldn't afford post-hospital blood tests to make sure her blood-thinning medication was working properly, or time off work to get them and didn't speak enough English to seek help. When the woman missed her lab appointment, Wallace pieced together the trouble, helped her enroll in a program for low-income patients ? and stressed the importance of sticking with this care.

"It's not that they don't understand why they're sick. They don't grasp the importance of why they need follow-up," Wallace said.

_____

The customized programs reflect the Dartmouth study's findings that there's great geographic variability in hospital readmissions.

In Miami, for example, more than a quarter of Medicare patients with heart failure returned to the hospital within a month in 2010, the latest data available. That's double the readmission rate for those patients in Provo, Utah.

In Dearborn, Mich., the readmission rate for pneumonia was 20 percent, twice that of hospitals in Salt Lake City.

"Every place is different and faces different challenges in terms of improving care after patients are discharged from the hospital," Goodman said.

___

Online:

Care About Your Care: http://www.careaboutyourcare.org

Dartmouth Atlas of Health Care: http://www.dartmouthatlas.org

Source: http://news.yahoo.com/leaving-hospital-heed-care-tips-may-return-091051643.html

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Chinese Actress Claims To Be Super Gamer, Supposedly Plays 5 ...

Chinese actress Li Xiao Ran (????is known for many things in China; she's famous for her roles on both the big screen and the TV screen as well as her prowess as a dancer. The one thing that she really isn't known for is being a gamer, and now she's out to change that.

Best known for her roles in Hong Kong movies Dragon Tiger Gate and Wu Xia, Li made a recent appearance on the popular Chinese variety talk show "Day Day Up" (????). On the show, Li claimed that she was a gamer, and that her love of video games and gaming culture is so extreme that she could be classified as a video game "Kong" (???). The "Kong" suffix is basically Chinese for otaku (nerd), and Ms. Li says that she's a gaming otaku.

During her appearance on the show, Li was the mystery guest?the hint about her contained a tiny tidbit about how Li can play five different games on five different tablets at the same time. Li herself claimed on the show that whenever she has time she plays online games, saying "When I'm at home I can play on my computer while I'm eating."

Unfortunately there isn't a video or pictures of Li playing on five tablets at once, but many believe her. Chinese games are often designed to be played with one hand so that the player can smoke or eat while playing, so playing multiple one handed games isn't that hard. Li's also been known to play video games during the little off time she receives during film shoots, and other actors she's worked with have called her out on her gaming.

Li's status as a gamer isn't anything new?on another talk show last year, Li said that her ideal partner would have to be a gamer, someone she can play with. However, Li is probably one of the biggest mainland Chinese actors/actresses to be a gamer, Edison Chen aside of course (though he's also Canadian and in Hong Kong).

?????????????5???? [People's Daily]

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Kotaku East is your slice of Asian internet culture, bringing you the latest talking points from Japan, Korea, China and beyond. Tune in every morning from 4am to 8am.

Source: http://kotaku.com/5983281/chinese-actress-claims-to-be-super-gamer-supposedly-plays-5-different-games-simultaneously

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More coincidence than conspiracy at fashion week

NEW YORK (AP) ? During every season of designer previews at New York Fashion Week a few key, quirky items seem to pop up on different runways. They're not quite trends since one has to think they're partly for runway effect not retail orders, but they're part of the style zeitgeist nonetheless. So, how does the ball start rolling on items such as oversized fur mittens, harnesses or sleeveless coats?

It's safe to say designers don't take a meeting together to decide what direction to go in.

"The honest answer is some of it is plain and simple coincidence," said Cindi Leive, editor in chief of Glamour magazine. "These designers are creating hundreds of looks over the course of a season. It would be more unusual if there were no overlap."

Still, she said, there also are fashion cycles and sociological factors to consider as catwalk collections are prepared.

Take fur ? both real and fake. Leive said Sunday it has been on every runway so far on this fourth of eight days of fashion week.

After the recession, no one was touching fur, she said, but it has slowly made a comeback as people feel a little more comfortable about spending money. The interpretation this go-around has been impactful, with an emphasis on oversized unexpected fur touches such as hoods, handbags and boots, but they're not as expensive as a full-length coat.

It's important for fashion insiders to be aware of what's happening in other parts of culture, including politics and art, said Marie Claire executive editor Nina Garcia earlier in the week as she prepared to judge aspiring designers at "Project Runway."

"Successful designers soak it all in," she said.

Fashion week continues in New York through Thursday, when the influential Marc Jacobs closes out things. Runway previews then move on to London, Milan and Paris.

VICTORIA BECKHAM

The opening look at Victoria Beckham's show was a windowpane plaid coat. She also incorporated more sweaters and knits into her collection, with a nod to mod with some geometric, colorblocked shift dresses.

The most unexpected looks were the flashes of bright yellow, including a sleeveless trench; the techno shine she added to pleated skirts that the audience could only see as the models walked; and the long cape-style tuxedo coat.

One of the important evolutions for fall is the softer shoulder, which she used to tweak one of her popular zip-back, slim-fit dress silhouettes.

For shoes, she put models in lower kitten heels, made in collaboration with Manolo Blahnik, which was a bit of a surprise for a woman known for skyscraper stilettos.

"I'm always designing what I want to wear," she said.

CHRISTIAN SIRIANO

The "Project Runway" alum used the Russian opera as the inspiration for his fall runway show, using a book of Russian opera houses as reference.

The girl wearing this collection, he said, was on her way to see the Russian opera.

"I wanted it to be a story of what she wears during the day, what she'll wear for a cocktail dress, what she'll wear to the opera," he said.

His vintage-inspired day looks evoke many eras, from the 1940s to the 1960s, and were mostly separates of turtlenecks paired with loose leather trousers and faux fur vests in muted colors such as white, black and camel.

One ensemble included a pointed-toe flat in a penny loafer style, a surprise inclusion given fashion's love for the high heel. Siriano explained it as a way to ensure its wearability, and also because he "wanted it to be a bit more demure, a bit simple."

Other shoes in the collection included bootie heels and heeled penny loafers with gold trim, echoing the filigree that anchored many of the evening dresses that closed the show.

JOSEPH ALTUZARRA

Joseph Altuzarra's urban, confident, fashion-forward customer wears graphic black-and-white leather ? layers it on, in fact ? and then there's the fox or mink fur on top. She's not shy about drawing attention in fur mittens, shiny grommet embellishment and strategically placed zippers. She wears her high-waisted trousers with a low-slung belt.

His fall-winter collection also includes optic white pants and a khaki cotton sleeveless trench worn with a khaki four-button tailored skirt.

The silhouette he offers his customers is strong and slim, sometimes with a little bump at the hip.

"The design and construction emphasize the nip of the waist and exaggerate the hip, while shrunken proportions mixed with a bolder shoulder volume sharpen the classic silhouette," he says in describing the shape.

___

AP Writer Amanda Kwan contributed to this story.

___

Follow Samantha Critchell on Twitter at http://twitter.com/AP_Fashion

Source: http://news.yahoo.com/more-coincidence-conspiracy-fashion-week-183426501.html

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Rare Afghan fashion show seeks to empower women

An Afghan model wears a dress creation by Shahar Banoo Zeerak, during a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013. Afghan models parade down a candle-lined catwalk as men and women watch from the audiencThe rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

An Afghan model wears a dress creation by Shahar Banoo Zeerak, during a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013. Afghan models parade down a candle-lined catwalk as men and women watch from the audiencThe rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

Afghan model Farkhunda Taheri, 17, speaks during an interview with The Associated Press next to a painting of Bamiyan's statue after a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013. The rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

An Afghan model applies makeup prior to a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013.The rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

An Afghan model walks wearing a dress creation by Shahar Banoo Zeerak, a dress designer, model and organizer of a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013. Afghan models paraded down a candle-lined catwalk as men and women watch from the audience in a restaurant off a muddy street in Kabul. The rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

Afghani models are seen backstage after presenting a fashion show in Kabul, Afghanistan, Friday, Feb. 8, 2013. The rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society. (AP Photo/Musadeq Sadeq)

KABUL, Afghanistan (AP) ? Afghan models paraded down a candle-lined catwalk Friday as men and women watched from the audience in a restaurant off a muddy street in Kabul.

The rare fashion show in this war-weary capital was a small production but a big idea ? part of an Afghan group's efforts to empower women by breaking down barriers in this highly conservative Muslim society.

"The situation always gets tougher and tougher every day by day, but we should not back down. We are here to move on and move forward, so I think if women step up and they show up in this field, I think they will do a good job," said Shahar Banoo Zeerak, the designer whose clothes were featured in the show.

The idea of women on display remains mostly taboo in Afghanistan more than a decade after the 2001 U.S. assault that ousted the Taliban from power after a five-year reign of terror by the fundamentalist movement.

Some women still don't go outside without wearing blue burqas that cover them from head to toe. Violence against women is still common in Afghanistan, and there are reports of women being stoned, executed in public or imprisoned for having affairs with men. Women have even set themselves on fire to escape domestic violence.

Friday's fashion show was organized by Young Women for Change, an independent, nonprofit Afghan organization committed to empowering Afghan women and improving their lives.

Most of the 10 models, including three young men, who showed off 33 designs including colorful short-sleeved dresses, jeans, tunics and more traditional outfits ? were Afghan women who volunteer for the group.

One of them, 17-year-old Farkhonda Taheri, had never even seen a fashion show before. She said her father and other family members were supportive of her decision to participate, but her grandmother was not happy.

"The biggest challenge for us that we cannot do these things in Afghanistan because people do not like it," she said afterward. "I was excited because I felt I am going to bring a change."

She said it was important for Afghan youths to take risks to bring change as the country struggles to achieve a semblance of normalcy, with international combat forces preparing to withdraw by the end of 2014.

"Who will bring the peace? We are going to bring it. Afghans. The new generation," Taheri said.

There have been a few other fashion shows in Afghanistan, but most were geared toward an international audience and seldom featured Afghan women or a mixed Afghan audience. Reflecting the obstacles, the organizers did not permit local Afghan media to film the event to protect the women, who on occasion appeared without headscarves and in short skirts.

"It may not be perfect and professional but it's a beginning," said Salma Gul, the 26-year-old tailor who made the clothes.

Organizers said they had two reasons for staging the show despite fears of violence in a country that sees frequent bombings and suicide attacks, often against targets deemed un-Islamic by extremists. One was to raise money for the advocacy group and the other was to gradually change attitudes toward women.

A spokesman for the advocacy group, Mohammad Zafar Salehi, said they earned more than $1,000 from the show, which sold tickets and drew mostly group members and friends.

"We want to change the mindset of the people but at the same time I worry about the security of the girls," he said as the famous Afghan rock band Morchaha performed in another room. "I believe in a change that can be slow."

___

Online:

Advocacy group's site ? http://www.youngwomenforchange.org/

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2013-02-08-Afghan-Fashion%20Show/id-869c9a1747384eea9692272c0d1e0fdf

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Debt BlogDebt Management Plans - Tips For Avoiding DMP Pitfalls

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Posted in Finance
February 9, 2013

Most people are involved in some type of financial transaction or decision every day. Sometimes they can get way behind in their debts and financial obligations with no clear way to pay them off. Some resort to debt management plans, which can help if you are careful in setting up the plan. Do you know how to avoid the pitfalls?

Credit and debt issues are critical life altering realities for almost everyone. The daily decisions we make in handling the balance between the two determines our credit worthiness in the eyes of financial institutions. As we all know, if you have a bad credit rating, then borrowing funds or purchasing many items will become difficult or impossible. But what happens when you get so far in debt that you have no clear way to pay it all off? Many people resort to a debt management plan (DMP). These are payment plans structured in a way so that the borrower is better able to pay off their debts, and is agreed to by the borrower and creditors. The benefits can include lower interest rates and fee waivers.

Once you and the creditors have accepted the DMP, it is important to:

* make regular and timely payments

* always read your monthly statements to make sure your creditors are getting paid according to your plan

* contact the organization responsible for your DMP if you will be unable to make a scheduled payment, or if you discover that creditors are not being paid

If the payments are not made to your DMP and creditors on time, you could lose the progress you've made on paying down your debt, or the benefits of being in a DMP, including lower interest rates and fee waivers. The creditors may not forgive any more late payments and you will incur more 'late' marks on your credit report as well as more late fees, increased debt and a longer pay off period. So, once you are on a debt management plan, make sure that you are never late on any payments. DMPs are not for everyone. You should agree on a DMP only after a certified credit counselor has spent time thoroughly reviewing your financial situation, and has offered you specific advice on managing your money. You may be able to work out a payment plan directly with your creditors. But if you decide that you need to work with a credit counselor and get additional advice and assistance, ask questions like these to help you find the best counselor for your situation and make sure you get full and complete anwsers.

Some Important Questions to Ask When Choosing a Credit Counselor to Handle your DMP:

1. What services do you offer? Look for an organization that offers a range of services, including budget counseling, savings and debt management classes, and counselors who are trained and certified in consumer credit, money and debt management, and budgeting. Counselors should discuss your entire financial situation with you, and help you develop a personalized plan to solve your money problems now and avoid others in the future.

2. Are you licensed to offer your services in my state? Many states require that an organization register or obtain a license before offering credit counseling and debt management plans.

3. Do you offer free information?

4. Will I have a formal written agreement or contract with you?

5. What are the qualifications of your counselors? Are they accredited or certified by an outside organization? If so, which one? If not, how are they trained? Try to use an organization whose counselors are trained by an outside organization that is not affiliated with creditors.

6. Have other consumers been satisfied with the service that they received? Once you've identified credit counseling organizations that suit your needs, check them out with your local consumer protection agency, and Better Business Bureau.

7. What are your fees? Are there set-up and/or monthly fees? Get a detailed price quote in writing, and specifically ask whether all the fees are covered in the quote.

8. How are your employees paid? Ask them to disclose what compensation it receives from creditors, and how they are compensated.

9. What do you do to keep my personal information confidential and secure? They should have safeguards in place to protect your privacy.

Get the information you need to make an informed decision.

About the author: Greg Smith publishes information on Debt Help issues at http://www.debt-help-i.com/. Visit the web site for the latest on debt and credit issues and solutions. This article may be freely reprinted as long as the author's information and URL links remain intact.

Author: Greg Smith

Source: http://www.caishi.net/307725-Debt-Management-Plans-Tips-For-Avoiding-DMP-Pitfalls.html

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Yen gains after comments from Japan official - Currencies ...

By William L. Watts and Myra P. Saefong, MarketWatch

SAN FRANCISCO (MarketWatch) ? The yen climbed sharply versus the dollar and euro Friday after Japan?s finance minister said the currency?s fall had caught the government by surprise ? a remark the ministry later described as a misstatement.

The dollar /quotes/zigman/4868099/sampled USDJPY -0.9939% traded at 92.75 yen in recent action, down from ?93.41 in North American trade late Thursday. The dollar had bought as much as ?93.70 early Friday. For the week, the greenback is little changed versus the yen.

The euro /quotes/zigman/4868097/sampled EURJPY -1.2492% fetched ?123.93, down from around ?125.32. For the week, the euro has lost more than 2% versus the yen.

Week ahead: Currency wars at G-20

Currency wars are likely to dominate the G-20 meeting in Moscow even if most countries will try not to make any explicit accusations. .

On Friday, during a parliamentary session, Japan Financial Minister Taro Aso said the dollar had ?abruptly risen to the ?90 level from the previous ?78-?79 level in a manner we didn?t anticipate.?

Later, however, a finance ministry official said Aso had meant to say the yen?s drop had been ?fast paced? rather than unexpected. See: Japan: Aso meant to say yen's fall 'fast-paced' .

Combined with indications Japanese exporters are starting to re-emerge as yen sellers, Aso?s comments were ?sufficient to drive a stop run down to a low of ?92.17 before a partial retracement,? said Adam Cole, currency strategist at RBC Capital in London.

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Aso?s remarks certainly don?t imply the yen?s fall is unwelcome, ?but does call into question the ?95-100 range [versus the dollar] that many were beginning to talk of? as a government objective, Cole said.

Taking a look at the bigger picture, seasonals are ?in favor of yen strength,? with March representing the end of Japan?s fiscal year, and the yen typically strengthening from mid-February through late-April,? said Christopher Vecchio, currency analyst at DailyFX, in an emailed note.

Given that, ?we very-well may be on the verge of the next bout of risk-aversion if political concerns stemming from Italy and Spain boil over,? he said. ?A drop back to ?120 in EURJPY can?t be ruled out at [the] present time.?

Euro falls vs. dollar

The euro, meanwhile, moved lower against the dollar.

European leaders reached an agreement Friday on a seven-year budget plan for the European Union, European Council President Herman Van Rompuy announced on Twitter without providing details after a final set of negotiations that stretched to around 24 hours. See: European leaders agree on 7-year EU budget deal.

?The EU budget deal, which confirms the EU?s appetite for austerity, provides continued support for the euro bears to bet against the euro based on a weak growth outlook,? said Richard Hastings, a macro strategist at Global Hunter Securities. ?But the market already understands this, so it looks like the budget conversation is a small catalyst in the same general direction.?

The euro had taken a tumble Thursday after European Central Bank President Mario Draghi said policy makers would watch the currency?s appreciation for any sign it is affecting the euro-zone inflation outlook. Draghi also said the euro?s recent rise is a sign of confidence in the shared currency.

He emphasized repeatedly that the ECB was maintaining an ?accommodative? monetary policy. Read Draghi: Euro reflects confidence, but eyeing rise.

The euro /quotes/zigman/4867933/sampled EURUSD -0.2687% , which pushed above $1.37 earlier this week, changed hands at $1.3365 in recent trade, down from $1.3392 in late North American action Thursday. For the week, its down about 2%.

Although down about 2% just this week, the currency is still up nearly 4.9% against the greenback compared with three months ago.

ECB's Draghi knocks euro back a bit

European Central Bank President Mario Draghi helped the euro to reverse some of its recent gains with slightly more dovish comments at his monthly news conference.

?What we note is that the latest data shows the euro-zone is stabilizing. More work is needed, however,? said Evan Lucas, a market strategist at IG Markets.

?Mario Draghi?s ?whatever it takes? comments that came [at midyear] last year was the flash point for the current rally and he is holding true to his word, meaning Europe is going to be a distraction, not a disaster,? Lucas said.

The ICE dollar index /quotes/zigman/1652083 DXY -0.02% , which measures the greenback against a basket of six major global currencies, rose to 80.234 from around 79.721 late in New York on Thursday. The index was about 1.4% higher for the week.

The WSJ dollar index /quotes/zigman/9625991 XX:BUXX -0.21% , a gauge that measures the greenback?s moves against a slightly wider basket of currencies, slipped to 71.53 from 71.66 Thursday.

Among other major currency pairs, the British pound /quotes/zigman/4867886/sampled GBPUSD +0.5417% climbed to $1.5794 from $1.5696, while the Australian dollar /quotes/zigman/4867876/sampled AUDUSD +0.3414% fetched $1.0317, compared with $1.0284.

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William L. Watts is MarketWatch's European bureau chief, based in Frankfurt. Follow him on Twitter @wlwatts. Myra Saefong is a MarketWatch reporter based in San Francisco. Follow her on Twitter @MktwSaefong. V. Phani Kumar contributed to this report.

Source: http://www.marketwatch.com/story/euro-inches-up-versus-us-dollar-after-tumble-2013-02-08

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