Health Care and HPV

According to an article in the New York Times this week, one in four teenage girls have received the relatively new vaccine against cervical cancer. The figures represent the government’s first substantial study of vaccination rates for the vaccine, Gardasil, which is Merck & Company’s heavily advertised three-shot series that goes after the sexually transmitted human papillomavirus, or HPV. The vaccine protects against strains of the virus that cause about 70% of cervical cancers. Health officials recommend that girls get the shots when they are 11 or 12, if possible, before they become sexually active. Also, 11 is the age when children are generally due for a round of vaccinations. The survey covered children only from 13 to 17.

The results, according to the NY Times, are based on nearly 3,000 girls for whom the researchers could verify vaccination information through medical records. Proponents of the vaccine had been hoping for much higher vaccination rates, saying the shots could significantly reduce the nearly 4,000 cervical cancer deaths that occur each year in the United States. However, many families are cautious about the safety of new vaccines, and other aspects of the vaccine may also give some families pause. It is expensive, selling for about $375, although many health insurers now cover it. And there are questions about whether it confers lifetime immunity or if a booster shot will be needed.

According to the Centers for Disease Control (CDC), Most people with HPV do not develop symptoms or health problems. But sometimes, certain types of HPV can cause genital warts in men and women. Other HPV types can cause cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis. The types of HPV that can cause genital warts are not the same as the types that can cause cancer. HPV types are often referred to as “low-risk” (wart-causing) or “high-risk” (cancer-causing), based on whether they put a person at risk for cancer. In 90% of cases, the body’s immune system clears the HPV infection naturally within two years. This is true of both high-risk and low-risk types. Genital warts usually appear as small bumps or groups of bumps, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. Warts may appear within weeks or months after sexual contact with an infected person. Or, they may not appear at all. If left untreated, genital warts may go away, remain unchanged, or increase in size or number. They will not turn into cancer. Cervical cancer does not have symptoms until it is quite advanced. For this reason, it is important for women to get screened regularly for cervical cancer. Other less common HPV-related cancers, such as cancers of the vulva, vagina, anus and penis, also may not have signs or symptoms until they are advanced.

To attain the greatest impact on cervical cancer prevention, the ACS provides the following supporting recommendations:
1.) Screening:
--It is critical that women, whether vaccinated or not, continue screening according to current ACS early detection guidelines.
--A preventive health care visit in which vaccination is discussed or offered represents an appropriate opportunity to offer Pap screening to sexually active patients.
--HPV testing before initiating vaccination is not recommended.
2.) Vaccine Implementation and Utilization:
--Public health and policy efforts are needed to ensure access and encourage high HPV vaccine coverage for all racial, ethnic, and socioeconomic groups, particularly for females of color, immigrants, those living in rural areas, low-income and uninsured females, and others who have limited access to health care services.
--Strategies should be implemented to maximize adherence to vaccination recommendations, including coadministration with other recommended adolescent vaccines, once sufficient safety data are available.
--The use of noncomprehensive visits (eg, minor illness visits, camp/sports physical visits) and alternative vaccination sites for adolescents unable to access comprehensive preventive care is encouraged.
3.) Education:
--There is a critical need for education of providers, policy-makers, parents, adolescents, and young women about cervical cancer prevention and early detection, including the need for regular screening even after vaccination.
4.) Research:
--Ongoing research and surveillance should be conducted in diverse populations, including research on duration of protective immunity, population- and lesion-based changes in type-specific prevalence for the full spectrum of carcinogenic and noncarcinogenic genital HPV types, changes in Pap test performance characteristics, changes in screening practices and behaviors, comprehensive surveillance for reproductive toxicities, increasing vaccine coverage and acceptability, and impact on safe sexual behavior.
--Safety and efficacy of prophylactic HPV vaccine for the prevention of other anogenital cancers and head and neck cancers in males, as well as females, should be evaluated.
--Research is needed regarding the design of sustainable vaccination programs in less developed countries.

According to the CDC, there are important steps girls and women can take to prevent cervical cancer. The HPV vaccine can protect against most cervical cancers. Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can identify abnormal or pre-cancerous changes in the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find high-risk HPV on a woman’s cervix, may also be used with a Pap test in certain cases. The HPV test can help healthcare professionals decide if more tests or treatment are needed. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine does not protect against all cervical cancers. Unfortunately, there is currently no vaccine licensed to prevent HPV-related diseases in men. Studies are now being done to find out if the vaccine is also safe in men, and if it can protect them against HPV and related conditions. The FDA will consider licensing the vaccine for boys and men if there is proof that it is safe and effective for them. There is also no approved screening test to find early signs of penile or anal cancer. Some experts recommend yearly anal Pap tests for gay and bisexual men and for HIV-positive persons because anal cancer is more common in these populations. Scientists are still studying how best to screen for penile and anal cancers in those who may be at highest risk for those diseases.

In the United States, each year it is estimated that over 6 million people are infected with genital HPV, according to the American Cancer Society (ACS). An estimated 20 million people in the United States, approximately 15% of the population, are currently infected as detected by HPV DNA assays. Almost half of the infections are in those aged 15 to 25 years. Point prevalence estimates for young women range from 27% to 46%. At least half of all sexually active men and women acquire HPV at some point in their lifetime, and modeling studies suggest that up to 80% of sexually active women will have become infected by age 50. There have been some concerns that the perception of safety resulting from introduction of a prophylactic HPV vaccine will lead to an increase in unsafe behaviors and premature sexual activity among adolescents ("behavioral disinhibition").

Some organizations have expressed their support for universal availability of HPV vaccines while emphasizing that vaccination should not be a substitute for sexual abstinence until marriage and fidelity after marriage as reported by the ACS. Media coverage has cited such concerns as a potential barrier to vaccine acceptance and implementation, and several small studies also have cited this as a barrier to parental and provider acceptability. Historically, similar concerns have been raised with regard to penicillin for syphilis, condom availability programs, and emergency contraception. Knowledge of HPV also varies among health care providers. Pediatricians and primary care providers may have limited familiarity with and understanding of HPV, whereas gynecologists may have greater understanding of HPV infection, regression, persistence, and progression to cervical cancer precursors.

Vaccinating against HPV is still a controversial issue. One consensus is that abstinence until marraige may be the best way to prevent contracting the disease in most cases. Another view is that vaccinations should be given to all girls starting at certain ages just as a purely preventive measure regardless of their personal home situation. Mandating vaccinations for HPV should be avoided, as it is not a disease that can be contracted by innocent contact with someone who has a disease such as measles or other communicable illnesses. Studies of patients who have been vaccinated are not entirely conclusive that there are no side effects or long term problems from receiving the medication to prevent HPV. The best way to maintain a healthy life and avoid HPV altogether is to wait until marraige before sleeping with someone and avoid sexual contact with anyone other than a monogomous heterosexual spouse.

Until next time. Let me know what you think.

Health Care and Vaccines

Roughly 25% of parents are not sure about vaccines for children according to a new study by the Center for Disease Control (CDC) noted in an article announced by Reuters Health this week. And, their doctor is a big reason for that concern. Many times, their is a lack of trust between patient and provider, and information can be sometimes difficult to find or understand about possible side effects, especially if there is a language or culture gap. However, according to HealthLink at the Medical College of Wisconsin, vaccines offer safe and effective protection from infectious diseases that have caused millions of illnesses and deaths. Vaccines have already eradicated smallpox worldwide, eliminated polio in the US, and significantly reduced the number of cases of measles, diphtheria, rubella, pertussis and other diseases. But there are still some areas where low immunization rates have led to disease outbreaks. By staying up to date on recommended vaccines, you protect yourself, your family and your community from serious, life-threatening diseases.

HealthLink reports that vaccines work this way: when people are exposed to disease germs, they produce substances called antibodies to fight them off. Usually, the antibodies destroy the invaders and the illness is prevented. Vaccines are made from the same germs (or parts of them) that cause disease, but the germs in vaccines are either killed or weakened so they won't make us sick. Vaccines cause us to produce antibodies against that particular illness just as it would if the real disease was attacking. The antibodies usually stay in our immune system for a lifetime and protect us from getting sick with the same disease again. This protection is called immunity. Most childhood vaccines give immunity to 90% to 99% of the children who get them. But occasionally a child will not respond to certain vaccines. This is another reason why it's important for all children to be vaccinated. Children who haven't responded to vaccination have to depend on the immunity of others around them for protection.

For most of these vaccines, the first shots should be given when children are still babies according to HealthLink. Children can be vaccinated at the doctor's office or at the local health department. Keep a list of the shots each child has received so you know when your children need more shots. Children will need these records to start most schools. Most of these shots can be given at any age, and a child who has gotten behind does not have to start over. The shots already given will still count, and the child will still develop immunity. Contact your doctor or health department clinic for details about getting back on schedule. Children are especially vulnerable to infections, so most vaccines are given during the first five to six years of life. Recommended vaccinations begin soon after birth. Ask about special programs that provide shots for kids - many public health clinics offer free vaccines or charge a small service fee.
Being aware of the vaccines that are recommended for infants, children, adolescents and adults - and making sure you receive these immunizations - is vital to protecting everyone. More info on what vaccines, how they work, and when to be administered can be found on the HealthLink site.

Here are some tips about Vaccine Safety from HealthLink:
1.) Vaccines are very safe, but they are not perfect. Like any other medicine they can cause reactions. Usually these are mild, like a sore arm or a slight fever. Serious reactions are rare; your doctor or nurse can explain any risks. Keep in mind that in almost every case, getting the disease is much more dangerous than getting the shot.
2.) Tell your doctor if anyone in your family has had a bad reaction to a vaccine, and ask if there are any reasons why a vaccine is not recommended. After receiving a vaccine, children might be fussy due to pain, fever or other mild reactions.
3.) If children have pain:
Give acetaminophen (such as Tylenol). Do not give aspirin to children - it can have serious side effects in some cases.
4.) If children have a fever:
--Give them plenty to drink.
--Clothe them lightly - do not cover or wrap them tightly.
--Give them acetaminophen. Do not use aspirin.
--Sponge them in a few inches of lukewarm (not cold) bath water.
5.) If a child's arm or leg is swollen, hot or red where the shot was given:
--Put a clean, cool washcloth over the sore area for comfort.
--If redness or tenderness increases after 24 hours, call the doctor's office or clinic.
--Give acetaminophen for pain. Do not give aspirin.
6.) Call the doctor's office or clinic if children:
--Become pale or limp.
--Have been crying for more than 3 hours and won't stop.
--Have rectal temperature of 105°F or higher.
--Have a high-pitched cry that isn't normal.
--Are shaking, twitching or jerking.
--Continue to fuss for more than 24 hours.

The CDC recommends the following vaccines for teens and college students, especially new freshmen in college dorms:
--Tetanus-Diptheria-Pertussis vaccine
--Meningococcal vaccine*
--HPV vaccine series
--Hepatitis B vaccine series
--Polio vaccine series
--Measles-Mumps-Rubella (MMR) vaccine series
--Varicella (chickenpox) vaccine series
--Influenza vaccine
--Pneumococcal polysaccharid (PPV) vaccine
--Hepatitis A vaccine series

Keeping up with vaccinations at home and abroad is a very serious matter. Choosing to ignore them can be a very dangerous decision. So far this year, the US is seeing more breakouts of communicable diseases due to lack of vaccinations, especially in the new immigrant populations coming into the country. Additionally, there are reports of widespread pandemics in certain parts of the world, including many third world or underdeveloped nations, that have led to high death rate among both adults and children. Diseases such as Measles, Smallpox, and worse can be picked up easily if exposure to infected individuals happens, and you have not been vaccinated. For much detailed information about vaccines, you can visit websites such as Vaccines.org or the CDC.gov to get up to speed on vaccinations.

Until next time. Let me know what you think.

Health Care and Health Insurance Cost Disclosure

Congress is interested in finding ways to lower healthcare costs and increase access to coverage for all Americans according to HealthCareFinanceNews.com in an article released today. It would require that an employer disclose the amount of money it pays for an employee's health insurance coverage on the employee's annual Form W-2. The proposal also calls for employers to disclose the aggregate value of health insurance coverage under multiple plans, if employees are covered by more than one plan, such as major medical, dental plan and vision coverage.

If Americans could see clearly what healthcare costs, they would understand why wages have been stagnant in recent years according to the report. Once workers are informed, they might seek changes including improved efficiency, reduced waste and fewer unnecessary procedures, balanced with the natural need to have good coverage. As long as people are insulated from the cost and just think someone else is paying for it, then it's easy to overlook expenses. However, according to the article, once employees realize they themselves are paying for it, it should spark a genuine conversation about what to do.

According to MedicalNewsToday.com, some business groups have said they oppose the proposed bill because some larger businesses already report health coverage costs in an annual compensation sheet that compiles the costs of health care, retirement, transportation and any other benefits that accompany wages. Others cited cost as a major concern because benefit information typically is kept separate from payroll information, and creating a way to "interface" the two systems would introduce significant new costs, CongressDaily reports. In addition, some business groups are concerned that disclosing the cost information to the government could lead to additional taxation or determining the amount of total payroll employers spend on health coverage. However, the senators believe that showing employees the cost of health care they lose in wages will encourage them to be more thoughtful in making health care decisions and help reduce health care costs.

The US Department of Health and Human Services (HHS) reports that disclosure is needed. For the benefit of their employees, employers are encouraged to request that the health insurance plans, third party administrators, providers, and others with which they contract make available to enrollees in the health plans they sponsor the cost or price of their care. As consensus develops through broad-based national collaborations on approaches for measuring and reporting cost or price information for the benefit of consumers, employers are encouraged to adopt these approaches and to request that those with which they contract do the same. And, employers are encouraged to work to assure that cost or price information is made available with quality information. Employers also are encouraged to request that those with which they contract join broad-based, public-private collaborative efforts to develop strategies to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases.

According to the National Association of Self-Employed (NASE), health insurance premiums grew about 4.7% for family coverage and cost about $12,680 in 2008, as reported by the Kaiser Family Foundation. Congress is hoping more transparency among employers and employees regarding health costs is on the horizon. They have introduced legislation would require employers to report what they pay for all polices provided to workers, including health insurance or separate dental and vision plans. Earlier this year, the Congressional Budget Office argued that if workers knew what they or their employers pay for health care, it might encourage them to reign in health care costs more actively. The proposal would require employers to include the amount paid for health insurance coverage on the W-2 Form. It would inform workers about the total cost of their coverage and what they may be giving up in wages.

More disclosure would be beneficial to employees and consumers. When information is available, more intelligent decisions can be made when purchasing insurance. Legislation to make full disclosure might backfire if legislators are unable to develop language suitable to manage administration of disclosure. Private market insurance must work for more consumer friendly ways to make price disclosure available.

Until next time. Let me know what you think.

Health Care and the Flu

Flu season is upon us. Pediatrician Vincent Ianelli says that the CDC recommends that children and teens should start getting their flu vaccine in September, or as soon as the flu vaccine becomes available, so many kids have started getting flu shots already. That's great as we prepare for this year's flu season, but parents should remember that they do have more options this year, even as experts recommend that all children get vaccinated against the flu. That option is between a flu shot and FluMist - the nasal spray flu vaccine. FluMist isn't for every child, but it is a good option to consider in getting your child vaccinated against the flu if he is older than age 2 and doesn't have any health problems. And in recent years, the recommended ages for getting a flu vaccine has greatly expanded, from just high-risk kids a few years ago to all kids between the ages of 6 months and 2 years (2004), from all kids 6 months to age 5 (2006) to the current recommendations that all children older than ages 6 months to 18 years should get a flu vaccine (2008 and 2009 flu seasons).

The New York Times reports that the flu usually begins abruptly, with a fever between 102 and 106 °F. (An adult typically has a lower fever than a child.) Other common symptoms include a flushed face, body aches, chills, headache, nausea, and lack of energy. Some people have dizziness or vomiting. The fever usually lasts for a day or two, but can last 5 days. Somewhere between day 2 and day 4 of the illness, the "whole body" symptoms begin to subside, and respiratory symptoms begin to increase. The flu virus can settle anywhere in the respiratory tract, producing symptoms of a cold, croup, sore throat, bronchiolitis, ear infection, or pneumonia. The most prominent of the respiratory symptoms is usually a dry, hacking cough. Most people also develop a sore throat and headache. Nasal discharge (runny nose) and sneezing are common. These symptoms (except the cough) usually disappear within 4 - 7 days. And, sometimes, the fever returns. Cough and tiredness usually last for weeks after the rest of the illness is over.

According to the NY Times, Influenza A usually arrives in the late winter or early spring. Influenza B can appear at any time of the year. The most common way to catch the flu is by breathing in droplets from coughs or sneezes. Less often, it is spread when you touch a surface such as a faucet handle or phone that has the virus on it, and then touch your own mouth, nose, or eyes. Symptoms appear 1 - 7 days later (usually within 2 - 3 days). Because the flu spreads through the air and is very contagious, it often strikes a community all at once. This creates a cluster of school and work absences. Many students become sick within 2 or 3 weeks of the flu's arrival in a school. Tens of millions of people in the United States get the flu each year. Most get better within a week or two, but thousands become sick enough to be hospitalized. About 36,000 people die each year from complications of the flu.

One alternative to the traditional flu shot is to use Flumist. However, Dr. Ianelli also indicates that for one thing, Flumist can't be given to everyone, including:
--children younger than age 2.
--adults older than 50 years old.
--children with medical conditions, such as asthma or reactive airway disease, diabetes, chronic heart disease, chronic lung disease or a weakened immune system.
--children younger than age 5 who have had problems with recurrent wheezing.
--children who are taking aspirin.
--teens who are pregnant.
So, basically, that means it should mostly be given to healthy children, which leaves out most high-risk children who need a flu vaccine.

Also, according to the NY Times, if you have mild illness and are not at high risk, take these steps:
--Rest.
--Take medicines that relieve symptoms and help you rest.
--Drink plenty of liquids.
--Avoid aspirin (especially teens and children).
--Avoid alcohol and tobacco.
--Avoid antibiotics (unless necessary for another illness).

If the flu is diagnosed within 48 hours of when symptoms begin, especially if you are at high risk for complications, antiviral medications may help shorten the length of symptoms by about one day. The U.S. Centers for Disease Control and Prevention (CDC) recommends using oseltamivir (Tamiflu) or zanamivir (Relenza), which are active against both influenza A and B for patients who need to be treated. These medicines affect different viruses. Each of these medicines has different routes of administration and different side effects. Talk to your doctor about whether one of these drugs is right for you. Treatment is usually not necessary for children, but if the illness is diagnosed early and the patient is at risk of developing a severe case, it can be started. Oseltamivir (Tamiflu) is the best choice for children age 12 and older. Zanamivir (Relenza) is not FDA-approved for children under age 7. Treatment will only help if started early and only if the illness is actually influenza. It will not help treat a regular cold. A yearly flu vaccine is currently recommended for many people. Possible complications if you catch the flu, especially for those at high risk, include:
--Pneumonia.
--Encephalitis (infection of the brain).
--Bronchitis.
--Sinus infections.
--Ear infections.

According to the CDC, the single best way to prevent seasonal flu is to get vaccinated each year, but good health habits like covering your cough and washing your hands often can help prevent respiratory illnesses like the flu. There also are flu antiviral drugs that can be used to treat and prevent the flu. If you are not considered to be an individual in one of the high risk groups, it makes sense to get a flu shot or use the Flumist to prevent feeling really sick if you happen to catch the illness. Use common sense about personal hygiene, especially during flu season. Avoid close contact with anyone who may have the flu and practice good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Until next time. Let me know what you think.

Health Care and Financial Crisis

Americans are facing a financial crisis of mega proportions. Banks are disappearing faster than pies at a state fair pie-eating contest, and credit has become as scarce as hen's teeth. Wall Street is freaked out so bad that the stock market doesn't know what direction to go--up or down, but mostly down. The turbulence in the financial markets is heading toward a perfect storm of recession and economic hardship for many families and businesses all over the country. According to the Federal Reserve Bank of New York, the origins of this crisis lie in complex interaction of number of forces. Some were the product of market forces. Some were the product of market failures. Some were the result of incentives created by policy and regulation. Some of these were evident at the time, others are apparent only with the benefit of hindsight.

The interaction of these forces made the financial system as a whole more vulnerable to a range of different weaknesses according to the FRBNY. The models used by issuers to structure these products and by credit rating agencies to assess risk and assign ratings turned out to be much more sensitive to macroeconomic assumptions than was apparent to investors at the time. And, assumptions about home price appreciation and the correlation of defaults within the underlying collateral pool were particularly critical in this context. The intensity of the crisis is in part a function of the size of the preceding financial boom, but also of the speed of the deterioration in confidence about the prospects for growth and in some of the basic features of our financial markets. The damage to confidence—confidence in ratings, in valuation tools, in the capacity of investors to evaluate risk—will prolong the process of adjustment in markets. This process carries with it risks to the broader economy. Macroeconomic and supervisory policies have an important role to play in containing those risks.

The consensus of the FRBNY is that the U.S. economic and financial system is undergoing a very challenging period of adjustment, and we are likely to be living with a high degree of uncertainty for some period of time about the ultimate magnitude and duration of the slowdown underway. But it is important to recognize that we have already seen a lot of adjustment. Prices and risks in many markets already reflect a much more sober and cautious view of the world than they did a year ago. And the degree of stress on markets that we have seen over the past six months is due in part to the sheer magnitude and speed of that adjustment to a more cautious view of the future. Nevertheless, the challenges that remain are substantial. The speed and agility with which public policy makers and private financial institutions respond to the continuing pressures in a rapidly evolving environment will determine how quickly and how smoothly market conditions return to normal—and how rapidly the risks to the economic outlook are mitigated.

Much of the financial market meltdown trickles down to various aspects of the economy. In addition to banks, mortgage companies, and other credit agencies, the health care industry has been hard hit by the down turn in the present national financial crisis. According to the Nurse Entrepreneur Network (NEN), 16%, or $1.9 trillion, of the United States' gross domestic product (GDP) is currently being allocated for healthcare, and it's projected to reach $4 trillion (20% of the GDP) by 2015. On the surface, this appears to be a good thing because if more money is budgeted for healthcare, then more people can benefit from it. Yet there's an underlying irony--an increasing number of healthcare providers are operating in the red. In fact, according to the American Hospital Association, one-third of America's 5,000-plus hospitals are actually losing money, while another one-third is barely breaking even.

An aging population, an increasing number of uninsured Americans and slow-paying government aid programs all play a part in cramping the healthcare system's budget according to the Nurse Entrepreneur Network. As the Baby Boomers begin celebrating their 65th birthdays, the surge in America's elderly adult population will start placing tremendous stress on the healthcare system because additional services will be necessary to manage their medical conditions. In addition, there will be over 43 million retired adults depending solely on Medicare to cover their medical bills next year. On the other hand, a large portion of our younger generations do not have health insurance at all. Rising health insurance premiums and overall poverty rates are both contributing to this problem.

Expensive healthcare premiums make it harder for employers to afford coverage for their employees, creating an uninsured working class as reported by the NEN. Health insurance expenses are the fastest growing cost component for employers. So much so that according to Medical News Today, the proportion of the working class who received health insurance through their employers continues to fall every year. The majority of the reason for this decline is due to employees not participating in health benefits offered to them. The Kaiser Commission on Medicaid and the Uninsured reported that over 19% of full-time employees are uninsured. Add in the fact that emergency rooms are obligated to care for any patient who comes through its doors regardless of whether they have insurance or not, and what do you get? Answer: Millions of uninsured people who visit the emergency room to receive medical attention who are also relying on the hospital to foot the bill. To make matters worse, the U.S Census Bureau reported that number is still growing. This underprivileged class is forced to either go uninsured or rely on Medicaid for their healthcare bills, and neither option is a promising solution to the healthcare cash crunch equation.

As reported by the NEN, therefore, as a direct result of the cash crunch, hospitals and nursing homes are forced to make cuts in staffing and decrease technological advances to help defray costs. In addition, many healthcare institutions have started outsourcing positions to save money. For example, hospitals and nursing homes make cuts in staffing and special programming, as well as decrease capital spending, all of which could be harmful to their patients. Another way that institutions cut back is by outsourcing positions and providing terms of net-30, net-60 or higher to their vendors. The aging population and increasing number of uninsured patients are going to continue to grow, placing even more stress on the United States' healthcare system in the future.

MSN Money reports that many Americans are evaluating health care benefits for themselves and their families, and a startling percentage of citizens are considering denying themselves and their children health care to save money during this unstable economic environment. Nearly one in 10 were are likely as a result of the reported economic crisis to either drop their health insurance plan or switch to a plan with lower premiums and less attractive benefits according to a report issued by Zogby and BearingPoint--this would translate to almost 21 million American adults that are considering making sweeping changes in their health care behavior to cut expenses considering the number of insured adults in the country, according to the most current report from the U.S. Census Bureau. While Americans are looking at many ways to curb their expenses, this survey reveals for the first time that they are considering cutting back health care services and benefits as a result of the economic conditions. And, if a portion of those considering these extreme steps actually take action, the issues we face with uninsured and underinsured Americans will only be exacerbated – there could be a real negative impact on the overall health of Americans in the year to come.

The key issues of the health care system are often viewed as involving three basic dimensions: 1) the quality of health care provided, 2) access to the health care system, and 3) the cost of health care. Good systems should provide high quality medicine to all of the population requiring health care at affordable prices. The worldwide financial crisis and credit crunch will not spare the healthcare and medical communities, and they should brace for some major upheavals according to AcuteCareInc.com. Among those potential changes is likely to be a shake-up in the physician workforce as older physicians put off retirement while young would-be doctors meet resistance in securing medical school loans. At the same time, medical group practices will have trouble making payroll or updating technology. And hospitals will be forced to change their “bigger is better” mindset and delay massive construction projects. Also, according to Managed Healthcare Executive, as the market and investment income sinks, underwriting gains will be required, meaning higher premiums and competitive pressures. Smaller plans may also have exposure to reinsurance recoveries.

Managed Healthcare Executive reports that the pressures come from three directions: government, the commercial marketplace and providers. The cost of the bailout is high. The federal government must look for sources of funds or cost savings, and reductions in payments to Medicare Advantage plans are likely. Reductions in payments to providers, especially hospitals, are also likely, resulting in even more cost shifting. State governments, pressured by losses in their employee retirement funds as well as reduced tax revenues, will make similar cuts in Medicaid. The commercial market for insurance will shrink with job losses mounting. Smaller companies will stop offering coverage, accelerating an existing trend. In a worst case scenario, large insurers with self-funded business will find those companies not able to cover medical claims costs. Hospital systems have been cost shifting into private payers for years because of underpayments by Medicare and Medicaid, and that trend will accelerate. Tighter credit, higher capital costs, trouble collecting from patients, and the relentless need for hospitals to upgrade equipment and pay high personnel costs will force hospitals to increase charges to commercial payers even more. Another alternative is an unfunded mandate on health insurers, requiring them to provide broad coverage at prices set by the government. But this would create market conditions with high risk of failure by insurers like AIG. Once the financial sector recovers stability, it will be even more apparent that healthcare costs and lack of access are a huge drag on the economy and productivity.

The current financial mess will take time to sort out, and health care is going to play a major part in the scenario now unfolding on a daily basis. Americans will need to make some tough choices in the months and years ahead, especially with a new administration to take over in early 2009. Whatever the result, the needs of individuals, families and businesses should be a major consideration in any discussion relative to health care reform.

Until next time. Let me know what you think.

Health Care and Mold

More and more Americans are dealing with an ever increasing health issue concerning mold. According to the US Department of Housing and Urban Development (HUD), molds are living organisms that grow in damp places in your home. They stain or discolor surfaces and smell musty. There are hundreds of thousands of different types of mold. Mold can grow almost anywhere: on walls, ceilings, carpets, or furniture. Humidity or wetness, caused by water leaks, spills from bathtubs or showers, or condensation, can cause mold to grow in your home. Mold spores are tiny particles that float through the air. These can sometimes cause health problems, and according to HUD, mold does not affect everyone, and different people are affected differently when mold is breathed or inhaled.

The Mold Help Organization reports that molds can be found wherever there is moisture, oxygen, and something to feed on. In the fall, they grow on rotting logs and fallen leaves, especially in moist, shady areas. In gardens, they can be found in compost piles and on certain grasses and weeds. Molds grow in our homes in moist warm areas like damp basements, closets, and bathrooms, even after the moisture has dried up. Also, molds can grow in places where fresh food is stored, refrigerator drip trays, house plants, humidifiers, garbage pails, mattresses, upholstered furniture, or foam rubber pillows. The worst place that molds can grow, however, is inside wall cavities and flooring of our homes, wherever there may be cellulose materials they can feed on, such as wood, ceiling tiles, or plasterboard, even if they are not visible, and they have sustained water damage at one time or another. This is very common if there has been a plumbing leak or an inadequate roof. Actually, any type of water damage can cause a mold problem.

The Center for Disease Control indicates that molds are fungi that are found virtually everywhere, indoors and outdoors. Mold can cause or worsen certain illnesses (e.g., some allergic and occupation-related diseases and infections in health care settings). No conclusive evidence exists, however, to associate mold exposure with a multitude of other health problems, such as pulmonary hemorrhage or memory loss. The CDC conducts and supports activities to investigate the effect of mold on human health, to assist states in responding to concerns about mold, and to investigate concerns of employees and employers.

According to HUD, people with allergies to mold may get:
--Watery eyes
--Runny or stuffed noses
--Itching
--Headaches
--Difficulty breathing

Mold can also trigger asthma attacks as also reported by HUD. Some molds produce toxins (poisons) that may be hazardous if people are exposed to large amounts of these molds. Mold spores and related mycotoxins can also pose a serious health threat to individuals who have compromised immune systems.

The organization Mold Help reports that mold has certainly made its way into people's homes as well as the headlines on a regular basis. Many people still don't fully understand the health hazards of fungal exposure. The term toxic mold is somewhat misleading as it exudes an idea that certain molds are toxic, when actually certain types of molds produce secondary metabolites that produce toxins. The correct term is mycotoxins. Airborne mycotoxins from can definitely destroy one's health. Sometimes, people are unaware that they are breathing mold spores and mycotoxins until they are very sick. Certain people have a minor allergic reactions to the non-toxic mold, but once you leave the affected area they most likely recover with few serious side effects. However, if they have been exposed to the dangerous molds such as Stachybotrys or Chaetomium, they could suffer from a myriad of serious symptoms and illnesses such as chronic bronchitis, learning disabilities, mental deficiencies, heart problems, cancer, multiple sclerosis, chronic fatigue, lupus, fibromyalgia, rheumatoid arthritis, multiple chemical sensitivity, bleeding lungs, and much more.

The Mold Help Organization also reports that as most know, many molds can cause allergens that can affect some of the population, but some molds can also cause toxins, which can affect everyone, depending on the length of exposure. Approximately 25 million Americans suffer from allergic reactions to molds yet most of them don't even realize that when they're sneezing and sniffling the cause could be from fungi. The molds that produce airborne toxins that can cause serious symptoms, such as breathing difficulties, memory and hearing loss, dizziness, flu-like symptoms, and acid reflux. Common ailments from toxigenic mold---including allergies (hypersensitivity after initial toxicity), and excessive bruising---usually can be treated and reduced after people leave their contaminated environment. Often medication, diet, and other treatment protocols are necessary. But other health problems may remain permanently, such as brain damage and weakened immune systems. Eyesight, memory, coordination/balance, and hearing are generally the most common residual effects that often do not improve after treatment in most cases.

According to HUD, here are some tips to prevent and get rid of mold:
--Keep your house clean and dry.
--Fix water problems such as roof leaks, wet basements, and leaking pipes or faucets.
--Make sure your home is well ventilated and always use ventilation fans in bathrooms and kitchens.
--If possible, keep humidity in your house below 50% by using an air conditioner or dehumidifier.
--Avoid using carpeting in areas of the home that may become wet, such as kitchens, bathrooms and basements.
--Dry floor mats regularly.

HUD also reports how to find mold that might be growing in your home:
--Search for moisture in areas that have a damp or moldy smell, especially in basements, kitchens and bathrooms.
--Look for water stains or colored, fuzzy growth on and around ceilings, walls, floors, windowsills and pipes.
--If you smell a musty odor, search behind and underneath materials such as carpeting, furniture or stored items.
--Inspect kitchens, bathrooms and basements for standing water, water stains and patches of out-of-place color.

HUD indicates how to control moisture problems and mold:
--Fix any water problems immediately and clean or remove wet materials, furnishings or mold.
--Clean up spills or floods within one day. If practical, take furniture that has been wet outside to dry and clean. Direct sunlight prevents mold growth.
--Dry all surfaces and fix the problem or leak to prevent further damage.
--Install a dehumidifier when a moisture problem is evident or when the humidity is high.

The Mold Help Organization reports also that the disturbing factor about airborne mycotoxins is that it is impossible to know how much damage they have caused to one's health until it is too late. Therefore, it is imperative to not knowingly expose oneself even for brief periods of time in any place that smells moldy or has an appearance of mold or mildew. If you suspect that the air quality in your home is being compromised by mold spores you can have the air tested, but it can be quite expensive in some instances. It's worth it if it helps save your health. Mycotoxicosis, often mistakenly called "Toxic Mold Syndrome" out of ignorance, has reached epidemic proportions at a national level in the United States due to defective construction, lack of regular maintenance, shoddy and inappropriate building materials, ignorance, and lack of government involvement; all or in part due to the high costs of standard and substandard remediation. This illness has been so misunderstood; and some who profit from the misfortunes of these poor individuals even go so low as to claim that there is no evidence to back up the fact that mold can cause permanent neurological, psychological, immunological and pathological damage, despite the medical data from well respected physicians all over the world.

If you suffer from any immune deficiencies, allergies, or other health related issues that may be more susceptible to the ill effects caused by mold, take the precautions as outlined in this information to heart. Don't let mold creep up on you.

Until next time. Let me know what you think.

Health Care and DVT (Deep Vein Thrombosis)

Americans were shocked a few years ago by the death of a very well-known and popular news reporter, David Bloom. He suffered a DVT (Deep Vein Thrombosis) that resulted in his untimely death. According to USA Today, far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time. These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or being in similarly cramped quarters.

Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the invasion of Iraq. At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE. While there aren't good statistics, the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots — and at least 100,000 of them die.

According to the National Institutes of Health (NIH), blood clots occur when blood thickens and clumps together. Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body. A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus. PE, or Pulmonary Embolism, is a very serious condition. It can damage the lungs and other organs in the body and cause death. Blood clots in the thigh are more likely to break off and cause PE than blood clots in the lower leg or other parts of the body. Blood clots also can form in the veins closer to the skin's surface. However, these clots won't break off and cause PE. Also, according to USA Today, there are a host of risk factors and triggers: Recent surgery or a broken bone; a fall or car crash; pregnancy or taking birth control pills or menopause hormones; being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are obese. Some people have genetic conditions that cause no other symptoms but increase their risk, making it vital to tell your doctor if a relative has ever suffered a blood clot.

According to MedicineNet.com, arteries have thin muscles within their walls to be able to withstand the pressure of the heart pumping blood to the far reaches of the body. Veins don't have a significant muscle lining, and there is nothing pumping blood back to the heart except physiology. Blood returns to the heart because the body's large muscles squeeze the veins as they contract in their normal activity of moving the body. The normal activities of moving the body returns the blood back to the heart. There are two types of veins in the leg; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface.

Information from MedicineNet.com also says that deep veins, as their name implies, are located deep within the muscles of the leg. Blood flows from the superficial veins into the deep venous system through small perforator veins. As a result, superficial and perforator veins have one-way valves within them that allow blood to flow only in the direction of the heart when the veins are squeezed. A blood clot (thrombus) in the deep venous system of the leg is not dangerous in itself. The situation becomes life-threatening when a piece of the blood clot breaks off (embolus, pleural=emboli), travels downstream through the heart into the pulmonary circulation system, and becomes lodged in the lung. Diagnosis and treatment of a deep venous thrombosis (DVT) is meant to prevent pulmonary embolism. Clots in the superficial veins do not pose a danger of causing pulmonary emboli because the perforator vein valves act as a sieve to prevent clots from entering the deep venous system. They are usually not at risk of causing pulmonary embolism.

Additionally, according to the NIH, blood clots can form in your body's deep veins when:
--Damage occurs to a vein's inner lining. This damage may result from injuries caused by physical, chemical, and biological factors. Such factors include surgery, serious injury, inflammation, or an immune response.
--Blood flow is sluggish or slow. Lack of motion can cause sluggish or slowed blood flow. This may occur after surgery, if you're ill and in bed for a long time, or if you're traveling for a long time.
--Your blood is thicker or more likely to clot than usual. Certain inherited conditions (such as factor V Leiden) increase blood's tendency to clot. This also is true of treatment with hormone replacement therapy or birth control pills.

Many factors increase your risk for deep vein thrombosis (DVT) as reported by the NIH. Your risk for DVT increases if you have more than one of the risk factors listed. They include:
--A history of DVT.
--Slow blood flow in a deep vein from lack of movement. This may occur after surgery, if you're ill and in bed for a long time, or if you're traveling for a long time.
--Pregnancy and the first 6 weeks after giving birth.
--Recent or ongoing treatment for cancer.
--A central venous catheter. This is a tube placed in vein to allow easy access to the bloodstream for medical treatment.
--Being older than 60 (although DVT can occur in any age group).
--Being overweight or obese.

USA Today reports symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply. But here's the rub: Doctors are ill-informed, too. For example, studies suggest a third of patients who need protective blood thinners when they enter the hospital for major surgery don't get them. And patients can even be turned away despite telltale symptoms. The NIH says you can help prevent the condition by:
--Seeing your doctor for regular checkups.
--Taking all medicines your doctor prescribes.
--Getting out of bed and moving around as soon as possible after surgery or illness. This lowers your chance of developing a blood clot.
--Exercising your lower leg muscles during long trips. This helps prevent a blood clot from forming.
--Using compression stockings as your doctor directs to prevent swelling in your legs from DVT .

The NIH suggests that your risk of developing DVT while traveling is small. The risk increases if the travel time is longer than 4 hours, or if you have other risk factors for DVT. During long trips, it may help to:
--Walk up and down the aisles of the bus, train, or airplane. If traveling by car, stop about every hour and walk around.
--Move your legs and flex and stretch your feet to encourage blood flow in your calves.
--Wear loose and comfortable clothing.
--Drink plenty of fluids and avoid alcohol.

DVT is a dangerous health issue that should not be ignored. With over 100,000 deaths per year, recognizing DVT is an example of how simple preventive measures can help you stay safe and healthy.

Until next time. Let me know what you think.