Tuesday, January 27, 2009

Health Care and SIDS

Thousands of infants die suddenly every year in the U.S. from Sudden Infant Death Syndrome (SIDS). According to the American SIDS Institute, SIDS is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Willinger et al, 1991). In a typical situation parents check on their supposedly sleeping infant to find him or her dead. This is the worse tragedy parents can face, a tragedy which leaves them with a sadness and a feeling of vulnerability that lasts throughout their lives. Since medicine can not tell them why their baby died, they blame themselves and often other innocent people. Their lives and those around them are changed forever. Unfortunately, we cannot expect to prevent all SIDS deaths now. To do so requires a much greater understanding of SIDS, which will be achieved only with a commitment from those who value babies and with a considerably expanded research effort.

According to BabyCenter.com, researchers have learned a great deal about SIDS in the past three decades, but they still have no definitive answer to that question. Some experts believe that SIDS happens when a baby with an underlying abnormality (for example, a brain defect that affects breathing) sleeps tummy-down or is faced with an environmental challenge such as secondhand smoke during a critical period of growth. Others have published studies that contradict this hypothesis.

KidsHealth by the Nemours Foundation reports that a lack of answers is part of what makes sudden infant death syndrome (SIDS) so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and claims the lives of about 2,500 each year in the United States. It remains unpredictable despite years of research. Even so, the risk of SIDS can be greatly reduced. First and foremost, infants younger than 1 year old should be placed on their backs to sleep — never face-down on their stomachs. As the name implies, SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. It's a frightening prospect because it can strike without warning, usually in seemingly healthy babies. Most SIDS deaths are associated with sleep (hence the common reference to "crib death") and infants who die of SIDS show no signs of suffering. While most conditions or diseases usually are diagnosed by the presence of specific symptoms, most SIDS diagnoses come only after all other possible causes of death have been ruled out through a review of the infant's medical history and environment. This review helps distinguish true SIDS deaths from those resulting from accidents, abuse, and previously undiagnosed conditions, such as cardiac or metabolic disorders. When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined may contribute to cause an at-risk infant to die of SIDS. Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather. African-American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than caucasian infants. More boys than girls fall victim to SIDS. Other potential risk factors include:
--smoking, drinking, or drug use during pregnancy
--poor prenatal care
--prematurity or low birth-weight
--mothers younger than 20
--tobacco smoke exposure following birth
--overheating from excessive sleepwear and bedding
--stomach sleeping

According to KidsHealth, foremost among these risk factors is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child's jaw, therefore narrowing the airway and hampering breathing. Another theory is that stomach sleeping can increase an infant's risk of "rebreathing" his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby's mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS. Also, infants who succumb to SIDS may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him or her at greater risk for SIDS.

However, there are things that can be done to reduce the risk of SIDS according to the American SIDS Institute:

1. Get medical care early in pregnancy, preferably within the first three months, followed by regular checkups at the doctor's office or health clinic. Make every effort to assure good nutrition. These measures can reduce the risk of premature birth, a major risk factor for SIDS.
2. Do not smoke, use cocaine, or use heroin. Tobacco, cocaine, or heroin use during pregnancy increases the infant's risk for SIDS.
3. Don’t get pregnant during the teenage years. If you are a teen and already have one infant, take extreme caution not to become pregnant again. The SIDS rate decreases for babies born to older mothers. It is highest for babies born to teenage mothers. The more babies a teen mother has, the greater at risk they are.
4. Wait at least one year between the birth of a child and the next pregnancy.The shorter the interval between pregnancies, the higher the SIDS rate.

1. Place infants to sleep on their backs, even though they may sleep more soundly on their stomachs. Infants who sleep on their stomachs and sides have a much higher rate of SIDS than infants who sleep on their backs.
2. Place infants to sleep in a baby bed with a firm mattress. There should be nothing in the bed but the baby - no covers, no pillows, no bumper pads, no positioning devices and no toys. Soft mattresses and heavy covering are associated with the risk for SIDS.
3. Keep your baby’s crib in the parents’ room until the infant is at least 6 months of age. Studies clearly show that infants are safest when their beds are close to their mothers.
4. Do not place your baby to sleep in an adult bed. Typical adult beds are not safe for babies. Do not fall asleep with your baby on a couch or in a chair.
5. Do not over-clothe the infant while she sleeps. Just use enough clothes to keep the baby warm without having to use cover. Keep the room at a temperature that is comfortable for you. Overheating an infant may increase the risk for SIDS.
6. Avoid exposing the infant to tobacco smoke. Don't have your infant in the same house or car with someone who is smoking. The greater the exposure to tobacco smoke, the greater the risk of SIDS.
7. Breast-feed babies whenever possible. Breast milk decreases the occurrence of respiratory and gastrointestinal infections. Studies show that breast-fed babies have a lower SIDS rate than formula-fed babies do.
8. Avoid exposing the infant to people with respiratory infections. Avoid crowds. Carefully clean anything that comes in contact with the baby. Have people wash their hands before holding or playing with your baby. SIDS often occurs in association with relatively minor respiratory (mild cold) and gastrointestinal infections (vomiting and diarrhea).
9. Offer your baby a pacifier. Some studies have shown a lower rate of SIDS among babies who use pacifiers.
10. If your baby has periods of not breathing, going limp or turning blue, tell your pediatrician at once.
11. If your baby stops breathing or gags excessively after spitting up, discuss this with your pediatrician immediately.
12. Thoroughly discuss each of the above points with all caregivers. If you take your baby to daycare or leave him with a sitter, provide a copy of this list to them. Make sure they follow all recommendations.

According to BabyCenter.com, a great resource for SIDS information, put your baby to sleep on his back. This is the single most important thing you can do to help protect your baby.The rate of deaths from SIDS has dropped more than 50 percent since 1994, when the Back to Sleep campaign was launched by the American Academy of Pediatrics (AAP), the U.S. Public Health Service, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs. Make sure that anyone who cares for your baby — relatives and babysitters, for example — knows not to place your baby on his tummy to sleep. Most people don't know that side sleeping isn't safe, either. In fact, if your baby sleeps on his side rather than on his back, his risk of SIDS is doubled. That's because babies placed on their side can easily end up on their tummy. Of course, by the time your baby is 5 or 6 months old, he may be able to roll over in both directions, making it a challenge to keep him on his back at night. At this age his risk for SIDS starts to drop, though, so just do your best to get him settled on his back, and then don't worry if he rolls over. Keep in mind that putting your baby on his back all the time can cause him to develop a flat spot on the back or side of his head, called plagiocephaly or flat head syndrome. You can help prevent this condition by learning how to position your baby when you lay him down. (If you have any questions about your baby's sleep position, talk to your doctor or nurse.)

SIDS is a tragedy whenever it happens, and too often occurs as a result of unintentional negligence on the part of parents or caregivers. However, when a baby succumbs to death by SIDS, everyone suffers--family, friends, pediatricians, and the community mourn the loss of innocent life. More education and research needs to happen on the part of new parents and medical providers to ensure that the statistics of SIDS death are reversed to a vastly reduced rate of infant mortality.

Until next time. Let me know what you think.

Friday, January 23, 2009

Health Care and School Nutrition

Sixty schools throughout the United States have instituted a nutrition program aimed at promoting increased fruit and vegetable consumption according to ArcaMax Health and reported by the Fort Worth, TX, Star Telegram. And, according to the National Dairy Council (NDC), the breakfast and lunch programs offered through your school do more than provide a meal and satisfy your child's hunger during the day. They help meet your child's daily nutrient needs and maximize his or her potential for learning. Studies show that eating school breakfast and school lunch is associated with improved academic performance. According to the Journal of the National Dietetic Association, the National School Lunch Program (NSLP), created in 1946, currently operates in nearly all public and many private schools in the United States, providing subsidized meals to more than 30 million children each school day. More than 10 million children also take advantage of the School Breakfast Program (SBP), which became a permanent federal program in 1975.

The NDC reports that a healthy breakfast is an essential part of being prepared to learn. Yet, today's fast-paced lifestyle sometimes prevents children from eating a balanced breakfast before heading off to school. Also, school lunch is a convenient and economical option for busy families. A new report issued by the Institute of Medicine of the National Academies encourages families and schools, along with industry and communities, to take action and reverse the rapid rise in childhood obesity. Parents are called upon to provide healthful foods at home and encourage physical activity by limiting children's recreational TV, videogame, and computer time to no more than 2 hours a day. Additionally, schools are called upon to implement standards for all foods and beverages served on school grounds, including those from vending machines. It also recommends that schools expand opportunities for children to engage in at least 30 minutes of moderate to vigorous physical activity each day.

According to RedOrbit.com, making healthy food choices available to school kids is a priority for many lawmakers. You are what you eat, they say - and plenty of school kids are testing that theory every day. To keep kids healthy, legislators are taking a look at how to help them with nutritious choices at school. From 2005 through 2007, state lawmakers enacted about 46 bills related to school nutrition standards. Foods and beverages that pack more nutritional punch and carry less fat, sugar and empty calories are under consideration. California, Mississippi, New Jersey, North Carolina, Oregon and Rhode Island took different approaches, but all enacted school nutrition legislation last year in 2007, with two dozen states considering similar laws in 2008.

Kids today are heavier than ever before as reported by RedOrbit.com. Over the past three decades, obesity rates have nearly tripled for children aged 2 to 5 (from 5% to 14%), more than quadrupled for children aged 6 to 11 (from 4% to 19%), and more than tripled for youths aged 12 to 19 (from 5% to 17%). Today, 17.1% of kids aged 2 to 19 are obese, and almost 30% don't exercise enough. Being overweight puts children and teenagers at greater risk for developing type 2 diabetes, heart disease, asthma, sleep apnea and psychosocial problems such as low self-esteem. Added into the mix are the annual medical costs of obesity estimated at $75 billion. Taxpayers fund about half of this through Medicare and Medicaid.

Schools get cash reimbursements from the federal government for each full meal they sell that meets its requirements according to RedOrbit.com. Children who purchase a la carte items are less likely to buy a reimbursable school meal. And some of these extra "competitive" foods (sodas, water ices, chewing gum, hard candy, jellies and gums, marshmallow candy, fondant, licorice, spun candy and candy-coated popcorn) are, by federal law, not allowed in food service areas during lunch periods. Twenty-six states limit when and where they may be sold beyond the federal requirements, but kids know how to buy them in vending machines or school stores during the school day. And, school districts participating in the federal National School Lunch Program and School Breakfast Program must meet nutrition guidelines established by the U.S. Department of Agriculture that limit fat in full school meals and track protein, calcium, iron, vitamin A, vitamin C and calories. Many states, however, exceed those guidelines, which don't include specific standards for cholesterol, sodium, carbohydrates, fiber or sugar content. School nutrition legislation can help provide children with healthy choices, establish good lifelong eating habits and get food to those who are hungry, while bringing federal meal reimbursement money into states. Studies show that children will choose healthier foods when given the option, and well-nourished students do better in school.

School nutrition is vitally important in fostering a healthy and positive learning environment for children to achieve their full potential, according to the National School Boards Association. And, according to SchoolBreakfast.org and the School Nutrition Association, a school breakfast is proven to be good for children's bodies and their minds. Research shows that children who eat breakfast have improved memory, problem-solving skills, verbal fluency and creative abilities. School breakfast includes dairy, protein, whole grains and fruits, in appropriate portion sizes for kids, while meeting federal nutrition guidelines based on the Dietary Guidelines for Americans. Breakfast really is the most important meal of the day and provides the necessary energy to start a day of learning and achievement. Breakfast helps you be your best and research has shown that children who eat breakfast at school:
--Score better in standardized tests.
--Have fewer health issues.
--Behave better in class.
Research also shows that kids who skip breakfast rarely make up for missed nutrients later in the day — so skipping breakfast could also affect the activities after school that you really love.
Some kids skip breakfast at home because they think it's too early to eat. By the time they get to school, they are really hungry.

However, there is much more room for improvement according to eScienceNews.com in a report by the Journal of the American Dietetic Association. Schools need to do even more to reduce the availability of high-calorie, low-nutrient foods and make school meals more nutritious. Although the majority of US schools offer breakfasts and lunches that meet the standards for key nutrients (such as protein, vitamins A and C, calcium and iron), reimbursable school meals remain too high in saturated fat and sodium, and children are not consuming enough fruits, vegetables and whole grains. Many public schools are constrained in providing better meals because of limited funds. Although more than 70% of schools serve meals that meet standards for many nutrients that contribute to healthful diets, few schools (less than 10%) meet all nutrition standards, primarily because most meals served contain too much fat, too much saturated fat or too few calories. And, although most schools offer the opportunity to select a balanced meal, few students make the more healthful choice.

Public schools, especially since they are responsible for spending tax dollars, must be very aware of serving the best types of nutritional foods for children and teens. There are many success stories about improving the food in cafeterias, but much more needs to be done. Occasionally, the food can hurt more than help, and the cost to upgrade the quality may significantly impact the budget for school districts in areas dealing with limited finances. Foods high in fat are not nutritious, and better quality can cost more than what the school can afford. In the long run, children must have food in both breakfast and lunch programs that meet the criteria for nutrition, taste, quality, and affordability.

Until next time. Let me know what you think.

Wednesday, January 21, 2009

Health Care and the New National Health Care Agenda

A new President took the Oath of Office on January 20, 2009, with a new agenda of change for the country. Barack Obama will have his hands full with many pressing needs in homeland security, the economy, the war on terror in Iraq and Afghanistan, and health care reform. He has proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference according to the White House website. The Obama plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans.

President Obama, according to the White House, has proposed the following guidelines:
--Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
--Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
--Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
--Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
--Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
--Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
--Ensure everyone who needs it will receive a tax credit for their premiums.

The White House also reports that the President's plan will reduce costs and save a typical American family up to $2,500 as reforms phase in:
--Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
--Require hospitals to collect and report health care cost and quality data.
--Reduce the costs of catastrophic illnesses for employers and their employees.
--Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

According to Law.com, when you talk about Obama's health care agenda, there are several parts. The reauthorization of SCHIP, or the State Children's Health Insurance Program, which entails federal funding to states to insure low-income children whose families don't meet Medicaid income eligibility guidelines, has happened. Health-related information technology, through provisions in the stimulus package, is a big initiative. So is comparative effectiveness research, which is an analysis of different ways to treat a medical condition and whether there is any science that justifies the more expensive treatment approach. One thing that hasn't happened is expanding access to health care. That's far more difficult. It is far more controversial, and not going to be as easy as everyone seems to think it's going to be.

According to DotMedNews, if the new administration is to succeed in pushing through health care reform, it will require bipartisan cooperation. Following is a quick look at what the president-elect plans in key health policy areas, compiled from platform documents, the American Association of Retired Persons (AARP), and Internet sources.
-Replace personal tax exclusions for employer-provided health insurance with a $2,500 tax credit ($5,000 for families) to help people buy their own insurance.
-Close the "doughnut hole" in President Bush's Medicare Part D Prescription Drug Act, which limits seniors' benefits.
-Allow individuals to buy any plan available, regardless of state of residence.
-Lower drug costs by allowing imports of less expensive drugs from Canada and other developed nations.
-Use health information technology, such as electronic records, to reduce health care system billing.
-Hold costs down by letting seniors choose from a pool of competing private plans and one public plan similar to Medicare.
-Require that all children have health insurance, with costs subsidized by repealing President Bush's tax cuts for households earning more than $250,000.
-Allow children up to age 25 to keep coverage under their family health plan.
-Revise the "antiquated" Medicare reimbursement system for doctors to provide "fair and reasonable" physician payments to ensure access to high-quality care.
-Medicare recipients will use primary-care doctors as gatekeepers for their basic health care needs. (Now, many seniors go directly to specialists for chronic conditions and bypass internists, which is not cost-effective.)
-Doubling Federal funding for cancer research and re-instating embryonic stem cell research .

Experts estimate, according to DotMedNews, that Barack Obama's plan would cost the American people about $1.7 trillion, but they say figures are all over the map as no one can guess what people will choose to do if and when changes are made to the U.S. health system. The plan is probably too much of a radical departure from the traditional U.S. healthcare system to pass during the next four years, experts say. However, the next four years will set the stage for changes to come, and the program will likely be passed in increments.

According to ZDNet Healthcare, the President calls for creating a $634 billion fund, over 10 years, to cover the uninsured, paid for by rolling back the Bush tax cuts and reducing Medicare payments. Liberals are going hip hip hooray. And, Conservatives should know a big source of savings will be cutting out the reimbursement advantages of private Medicare Advantage plans, created under the Bush Administration. According to NPR.com, Conservative opponents detect a move toward universal health care — and a danger in the return to what they characterize as the failed economic policies of the 1930s. That's when the theories of economist John Maynard Keynes held sway: He argued that significantly distressed economies need big infusions of government money. This current President is not afraid to spend money. Obama is also proposing to extend Medicaid benefits to workers receiving unemployment checks, as well as their families; to have the government pick up, for one year, 65% of COBRA premiums paid by laid-off workers to extend their job-based insurance coverage; and to significantly increase unemployment benefits, job training and food stamp funding.

America is on the road to financial jeopardy with the new stimulus package. The US must watch out so bankruptcy is not the end result in the long term in order to make people happy in the short term. Health care is a complicated issue, and there are huge consequences if the Congress and the President decide they want to spend money that doesn't exist.

Until next time. Let me know what you think.

Thursday, January 15, 2009

Health Care and Breast Cancer

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop according to BreastCancer.Org. Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

According to the Susan G. Komen Foundation, there are many risk factors linked to breast cancer. Some of these risk factors affect risk a great deal and others by only a small amount. And some risk factors you can’t change. For instance, just being a woman and getting older increase your chances of getting breast cancer. However, there are things you can do to reduce your risk of breast cancer. Leading a healthy lifestyle can help lower risk. Also, having a general understanding of what factors may increase your risk can help you work with your health care provider to develop a breast health plan that is right for you. Finally, getting regular screening tests can detect breast cancer early when it’s most treatable.

According to BreastCancer.org, a tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body. The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor.
Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general. While there are steps every person can take to help the body stay as healthy as possible (such as eating a balanced diet, not smoking, limiting alcohol, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

When talking about cancer and other chronic diseases, according to the Susan G. Komen Foundation, the same thing applies: Prevention refers mainly to lowering the risk of getting a disease rather than completely eliminating the risk. cancer tends to be caused by a combination of many different factors, some of which are usually under a person's control (like physical activity), some of which are out of person's control (like age) and some of which are still unknown. Since so many factors drive risk and we can change only a portion of these, we cannot completely avoid some level of risk. For breast cancer, most risk factors that we have some control over have only a modest effect on risk. Although this means that there is no one magic bullet for preventing breast cancer; it also means there's no one factor that will cause it. Even women with a BRCA gene mutation don't have a 100% chance of getting the disease. In fact, most people diagnosed with breast cancer have only an average risk of disease, and it is impossible to know which factors actually came together to cause the cancer. This doesn't mean that prevention is some kind of illusion though. It's certainly not. The disease process is just so complex, it's hard to pin down how a specific set of risk factors will affect an individual person. However, when we look at groups of people it becomes clearer. For example, if we find that there is a 20% reduction in risk of breast cancer in a certain population, we can predict that there will be a 20% reduction in risk among a similar group of people. What we don't know is which individuals in the group will get the prevention benefit.

It is hard to know who benefits from prevention as reported by the Susan G. Komen Foundation. We know some behaviors can lower the risk of cancer. For example, non-smokers are much less likely to develop lung cancer compared to smokers. However, we do not know which individuals prevent lung cancer by not smoking and which individuals would have remained cancer-free even if they had smoked. So while we know that not smoking lowers the chance that a person will develop lung cancer, we do not know how great this benefit is for any one person. And, furthermore, most smokers will never be diagnosed with lung cancer and some non-smokers will. Taking steps to prevent cancer does not ensure that a person never develops the disease. The good news is that most behaviors that are typically under a person's control and reduce the risk of breast cancer are part of a healthy lifestyle. Making healthy choices can have rewards beyond breast cancer prevention. Choosing a healthy lifestyle can lower the risk of other types of cancer as well as many other chronic diseases such as diabetes and heart disease.

Scientists are studying breast cancer to find out more about its causes according to The National Cancer Institute (NCI). And, they are looking for better ways to prevent, find, and treat it. Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early. Your doctor may suggest the following screening tests for breast cancer:
1.) Screening mammogram -- Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present. If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
2.) Clinical breast exam -- During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid. Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged. A thorough clinical breast exam may take about 10 minutes.
3.) Breast self-exam -- You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period. You should contact your health care provider if you notice any unusual changes in your breasts. Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

You should ask your doctor about when to start and how often to check for breast cancer according to the NCI. Common symptoms of breast cancer include:
--A change in how the breast or nipple feels.
--A lump or thickening in or near the breast or in the underarm area.
--Nipple tenderness.
--A change in how the breast or nipple looks.
--A change in the size or shape of the breast.
--A nipple turned inward into the breast.
--The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
--Nipple discharge (fluid).
Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Studies show breast cancer is women's number one health fear according to MyLifetime.com. But while it's true that breast cancer affects many women — between 1 in 8 and 1 in 10 will develop it within her lifetime — there's no reason to make yourself sick with worry. There are ways to reduce the risk, such as reduce alcohol consumption, exercise, eat healthy and reduce your weight if you are overweight, and regularly visit your doctor. Use the available options to maintain a healthy lifestyle and keep a regular self diagnosis for any changes in your body. Breast cancer is a killer. Stay on top of your health. Life is too precious to waste.

Tuesday, January 13, 2009

Health Care and Digitized Medical Records

Now there is a big push to digitize all health records. According to CNNMoney.com, President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic. Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline. Sounds good. But it won't be easy. In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

As reported by CNNMoney, it also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program. That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan. The biggest cost will be paying and training the labor force needed to create the network. But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts. Early government estimates showed about 212,000 jobs could be created from this program, but there simply aren't that many Americans who are qualified. Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law.

The savings of such a plan could be substantial. The CNNMoney report estimates that a fully computerized health record system could save the industry $200 billion to $300 billion a year.
That could ultimately slow the rapid rise of health care premiums, which have cut into Americans' paychecks. While wages are rising at a rate of around 3% a year, health care costs are growing at about three times that rate. Some say some of the hard work has begun. The Bush administration laid much of the groundwork for the program, leading to several pilot programs in a handful of states, as well as a standardization of medical records.

The State of Kentucky is moving forward with a plan to put the commonwealth at the top of the heap for health-care information technology, according to Cincinnati.com. Health-care providers have been reluctant to embrace IT on a large scale because there are no data to show it works. And, Kentucky ranks near the top nationally for heart disease, diabetes, obesity and a number of other ailments. But Kentucky is ready to take on the task by creating a statewide database of its 4 million residents. Implementing the technology on a statewide basis should cost about $500 million. The University of Kentucky and University of Louisville would manage data regarding patients' health status and outcomes. Upgrading the whole state should save money and reduce medical errors; and using electronic medical records, patient barcodes and wireless medical devices that check blood sugar or blood pressure and monitor prescription drug usage should help make patients healthier. The project should also generate jobs and new businesses in the state.

According to CNET News, some hospitals and medical offices, of course, are already wired, but right now, most people aren't able to view their records electronically. Naturally, companies like Microsoft have been plotting ways to fill that void. At least one recent study found security and privacy vulnerabilities remain as e-health advocates forge ahead with their plans. And, according to MLive.com, health care providers across the state of Michigan and the country are spending money on records software, but their systems are different, and much of the data still comes on paper. Patients see many different providers. The network aims to create a system to allow the information to flow. Advocates of the technology say its broad use can improve quality, reduce medical errors and care costs, improve administrative efficiency and reduce paperwork. And, SFGate.com reported that the slow shift of the American health industry from paper to digitized records has been fraught with complications, a major one being that hospitals, medical groups and insurance companies typically have closed computer systems that do not allow for the exchange of information.

ABCNews.com reports that even the definition of what makes up "electronic health records" is still a matter of some debate. While electronic systems could conceivably allow doctors to order tests, send prescriptions and keep track of every detail of an individual's medical history, some organizations have a very loose definition of what an electronic health record is. Procedures as rudimentary as electronic medical billing, for example, are assumed by some to fit the bill. One significant barrier to attaining a universal electronic health records system could be cost. And, physicians may be required to foot a bill of tens and thousands of dollars to invest in such a system for their offices, not to mention steep annual maintenance fees. For larger practices with more physicians, the additional cost may not pose much of a problem. But for an office with fewer than 10 or so physicians, electronic medical records may seem impractical and expensive.

According to ABCNews.com, with the novelty of electronic health records also comes new questions about how to keep the information private and secure. Particularly concerning to some is that many of the records may be stored on the Internet. The architects of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) -- more or less the law of the land when it comes to patient privacy -- did not anticipate Web-based health record systems so they have nothing in their act that regulates Web data handling and patient privacy. The privacy issue becomes even more questionable with the introduction of personal health records -- in short, a do-it-yourself approach to keeping track of your medical care. Google, Microsoft and a consortium of large employers known as Dossia Founders Group are just a few of the big Internet names that have begun to allow patients to create and maintain their records online.

According to ABCNews.com, advocates add that online personal health records can help eliminate redundant tests, better prepare doctors to see patients and result in better-informed patients. However, critics note that these records are not yet subject to the privacy standards set forth by HIPAA. And although the companies that maintain personal health records promise privacy, one cannot be 100% sure if their rights are being abused or how their information is being even used. Privacy advocates worry mainly about data-mining. And individuals may not even have absolute control over their personal health information. Consider, for example, this clause in Google Health terms and services that applies to personal health records maintained with the company: "When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services. However, Google may only use health information you provide as permitted by the Google Health Privacy Policy, your Sharing Authorization, and applicable law." The clause goes on to reiterate that Google is not a "covered entity" when it comes to HIPAA privacy regulations.

The new administration will have its hands full with lots of activities after the inauguration. Let's hope that the priorities of national security, the economy, and health care are effectively managed in order of importance.

Until next time. Let me know what you think.

Friday, January 9, 2009

Health Care and Consumerism for 2009

Consumer Directed Health Care has been a big buzz in the health care community for the last few years. According to MCOL.com, Consumer Directed Healthcare can be defined as health benefit plans that put consumers and their providers at the center of health care decision-making, giving them greater discretion and power over benefit dollars and medical care choices. These plans often include increased cost-sharing wrapped around an HSA, decision support tools to evaluate choices, “health coaches” to encourage care management, and incentives to promote healthy lifestyles. Rather than shielding consumers, CDH plans engage them on a direct basis.

CDH, as reported by MCOL, is based on “patient centeredness” which, as defined by the Institute of Medicine, refers to health care that establishes a partnership among practitioners, patients and their families to ensure that decisions respect patients’ wants, needs and preferences; and ensure they have access to education and support to make decisions and participate in their own care. Consumer Directed Healthcare and patient centeredness has given rise to the next “hot trend” in healthcare - the medical home. A medical home is not a house, clinic or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centric, compassionate, and culturally effective. A “whole person” orientation to healthcare delivery is at the core of the medical home. A personal physician is responsible for providing all the patient’s healthcare needs. Care is coordinated across all components of the patient’s healthcare community - hospitals, specialty physicians, pharmacists, social services, home health, nursing homes, and ancillary providers. And, it includes a vision of care for all stages of life, acute and chronic, wellness and prevention, and end-of-life.

According to the American Academy of Pediatrics, the basic tenets of the Patient Centered Medical Home include the following:
1.) Personal Relationship: Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
2.) Team Approach: The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing patient care.
3.) Comprehensive: The personal physician is responsible for providing for all the patient’s health care needs at all stages of life or taking responsibility for appropriately arranging care with other qualified professionals.
4.) Coordination: Care is coordinated and integrated across all domains of the health care system, facilitated by registries, information technology, and health information exchange to assure that patients get the indicated care when and where they want it.
5.) Quality and Safety: This includes using electronic medical records and technology to provide decision-support for evidence-based treatments.
6.) Expanded Access: Enhanced access to care available through systems such as open scheduling, expanded hours and new options for communication between patients and physicians.
7.) Added Value: Payment that appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home. The medical home is the next step toward true healthcare consumerism. With 45% of the U. S. population having a chronic medical condition accounting for $3 out of every $4 spent on healthcare, coordinated care delivery supported by a team-oriented medical management plan-of-action is a direction worth pursuing.

According to the National Business Group on Health (NBGH), Consumerism is a new concept that encourages employees to take a more active role in their health care by using innovative plan design and offering tools and resources. Similar to other consumer ideals, providing information on cost and quality of services will allow employees to make informed decisions, resulting in better health, a sense of empowerment, and reduced cost. Consumer-directed health care (CDHC) often pairs this philosophy with a health benefits design that allows employees to have greater control, choice, and flexibility with their care. This benefit design is typically a high deductible health plan with a health savings account. According to the 13th annual National Business Group on Health/Watson Wyatt survey, combining a CDHC strategy with other tactics — effective information, high-quality care, health and productivity programs, and metrics — can greatly lower cost trend. Employers with 50% or more employee enrollment in a Consumer-Directed Health Plan (CDHP), achieve a 3.6% median medical cost trend, compared to 7.0% for those companies without a CDHP offering.

The NBGH also reports consumerism and consumer-directed health care are both new initiatives that require careful consideration, communication, and support for employees. Employers can easily integrate elements of consumerism into any plan type:
--Offer "calculators" that help employees assess their annual medical costs.
--Hold informative sessions to educate employees on tactics to receive the best care.
--Provide flexible spending accounts (FSAs) so employees are exposed to the cost of care, and learn to plan for future health expenses.
--Use creative cost sharing strategies to encourage greater use of preventive services and preventive medications.
--Consider benefits like health coaching and health care navigators.

According to BenefitsLink.com, employee benefits consultants are optimistic that consumer-directed health (CDH) will continue to see steady growth in 2009 and could even become part of health reform efforts, according to the fourth annual survey conducted by Inside Consumer-Directed Care and ISCEBS. However, employers' and employees' limited understanding about the plans remains a key barrier to the acceptance of the plans. Despite these concerns, many respondents were optimistic that enrollment will continue to grow as employers become more comfortable with the price setting and employees gain a better understanding of the potential cost-saving benefits. Workforce Management reports that health insurers are aggressively marketing high-deductible insurance plans that allow patients to reduce their out-of-pocket costs by improving their health. But employers, concerned with legal issues and upsetting employees, have largely stayed away. However, a prolonged recession could change that.

At the moment, the question of whether consumerism is the wave of the future remains open, although some surveys suggest these plans have significant growth potential. So far, employers are still waiting for definitive evidence about cost savings as they weigh the criticism that these plans could have an adverse impact on worker health and morale according to the Wall Street Journal. Consumerism in health is effective. Patients definitely save money. There is much work to be done, though, to satisfy consumers, employers, and the health care community to make it work as designed.

Until next time. Let me know what you think.

Tuesday, January 6, 2009

Health Care and 2009

Americans like to celebrate the New Year. Nothing says starting fresh more than fireworks, Auld Lang Syne, and staying up to see Dick Clark's New Year's Rocking Eve in Times Square to watch the ball drop. What about the Tournament of Roses Parade in Pasadena, California, or all the resolutions that everyone make to start the year all over again. Some of those will involve the traditional "feel good" personal health initiatives such as working out at the gym, losing weight, exercising, and a host of other ways to get in better shape. However, the majority of people drop those attitudes fade within a few weeks like new winter snow on a warm day. Additionally, there will be challenges with finances, the housing market, the stock market, banking, jobs and many other issues in the general economy. Americans should be prepared to tighten their belts in 2009.

According to Highbeam Research, the coming of a new year gives us cause to reflect on the events of the year past and to plan for a new and exciting year ahead. Personal and professional activities generally begin with vigor at the start of a new year, as we try to compensate for what was not accomplished in the old year. It is a time for renewing our values and planning for a better day.

Welcome to a brave new year. ‘Brave’ might be the appropriate word, considering the recent events in the world’s financial markets, according to Executive Healthcare Management. We don’t know yet how much this will affect the healthcare sector, but there are bound to be repercussions. Job losses, for example, could lead to more people joining the 15 percent of American who currently have no health insurance. Research funding could be harder to come by. Some healthcare companies may be forced to downsize, or even close their doors altogether. There is no need to despair, however. The healthcare sector is relatively recession proof – people will, unfortunately, always get sick – so provided we don’t panic, most of us should emerge unscathed. We could even see the situation as an opportunity to finally grasp the nettle, and transform our health system into one that provides good care to every citizen, not just to those who can afford it.

Our nation's health care system will be dissected this year according to the News-Leader of Springfield, Missouri. Problems associated with health care cost in the nation are multi-faceted with no easy solutions. A sluggish economy is hindering efforts to resolve this issue and more of our citizens are falling into the ranks of the uninsured. High health insurance costs have made insurance unaffordable and led employers and employees to drop health insurance. The only way we will ever get a handle on health care is to understand the cost drivers that are pushing health care cost up and hurting the uninsured and the insured. Insurance reforms to reduce premiums need to be addressed. Perhaps more competition could lead to better value in the system. Another step in the right direction would be more transparency from providers and insurance companies. The insured also need to be more proactive. The more the insurance company and/or state program pays, the higher premiums go up. We need to find ways to create a medical home (doctor's office, clinic) for patients to use instead of flooding our emergency rooms. Curbing use of the ERs would lead to cheaper cost and a better outcome.
A large segment of the uninsured falls between the ages of 21 and 35. Some feel they do not need insurance because they are young and healthy. Educating young citizens about the importance of health insurance would benefit everyone. A simple catastrophic policy with high deductible is not all that expensive and could be very beneficial when health care is necessary. Most Americans are employed and are creative, innovative, and hardworking people. They want solutions to improve our health care system. Waiting on government programs to pull us out of the quicksand is not the answer.

When it comes to health care, we can all agree that change is desperately needed according to the CEO of the Robert Wood Johnson Foundation (RWJF). The major health problems of our time will not be solved within the clinical care system as it is currently built, nor simply by addressing health care costs or expanding coverage. We can’t afford to just throw more technology or more intensive treatment at people, nor should we have to. More treatment isn’t the right prescription. We need better treatment and we need less disease if we want good health for all. Americans have worse health outcomes than patients in other industrialized nations, even though we spend nearly three times more on health care per person. We rank 46th globally in average life expectancy and 42nd in infant mortality. Race, ethnicity and income inequality affect the health of millions and the care they receive . America is founded in the pursuit of a vision, the realization of an ideal. In words that are built into our national DNA, all of us are created equal, endowed with the inherent and inalienable right to life, liberty and the pursuit of happiness. None of that is possible without good health. Making sure that every person in America has a fair chance for a healthy life and an equal opportunity for adequate health care is not about ideology, it’s about the future of our nation. Unfortunately, in today’s America, when it comes to health and health care, we are not all equal. In the U.S., health disparities are enormous. Decades of expert research tells us that education, economic development, housing, job security, geography, and income all affect health just as strongly as personal behavior. We even know now that poverty contributes to mortality of American adults at about the same rate as cigarette smoking. Right now, there are more than 47 million people in the United States without health insurance. The uninsured not only get sicker, but their outcomes are worse. In addition to those without coverage, there are many people who only have access to poor care, but don’t even know it.

The time has come to bridge the gap between “what we know” and “what we do,” according to the RWJF. Collaboration is key. Without it, the financial, clinical, professional and personal forces that frame our health and health care universe will continue to struggle with many of the same old pieces of the puzzle. People tell us they want to be more engaged in making their own health care decisions in partnership with doctors they choose, know and trust. They want doctors, nurses and hospitals to publicly report how they perform and they want to see solid evidence of what works best for them as patients. They want environments that make healthy choices the easy choices. Improvement is key too. People want their doctors, nurses and other health care professionals to hold “do it better” along side “do no harm” as the highest of their professional standards. They want everyone to receive exactly the same high quality of care. And people want their own voices heard as the community figures out how it is going to retool health care.

We must broaden our focus of what constitutes a “health issue” according to the CEO of the RWJF. Good health comes from healthy lifestyles, good choices, and a supporting environment in which to make those good decisions. While quality has long been at the top of the agenda when it comes to health care, it has only recently received attention in public health circles. As a society, we have not developed good ways to measure quality in public health practice, and we have not communicated the outcomes the public should expect from their local and state health authorities – such as immunizing all children, eliminating tobacco use and promoting regular physical activity – to people’s daily lives. Communicating the results that public health can deliver is critical to achieving such broad societal goals. Take childhood obesity. We’re at risk of raising the first generation of Americans to face substantially more disability and disease than their parents. A recent New England Journal of Medicine study shows that up to 37% of male and 44% of female teenagers in the U.S. will be obese by the time they turn 35 in 2020. Federal officials already put the cost of related medical expenses and lost productivity at $117 billion per year, and researchers predict one of every five dollars spent in the future on elder care will be related to obesity. These trends must be reversed, and we need to establish performance baselines and benchmarks that will help improve public health agencies’ performance and make them accountable to the people they serve. The path toward improving the quality of care in the U.S. is clear, straight, and passable. We expect success because the only ideology that counts here is the healthiest possible state of the union for all Americans.

Health care in 2009 will be a major concern not only for all Americans, but also for the new administration and legislators both at the state and federal levels. Government run health care is not the answer. The private sector must do a better job of making health care affordable and accessible to all Americans without heavy handed mandates or interference from legislation. We deserve the privilege of personal choice, and we must work together with insurance companies and the medical community to make it happen.

Until next time. Let me know what you think.