Category Archives: Occupational Health

Ballet stretches her body’s limits, insurance brings peace of mind


By Heidi de Marco
KHN Staff Writer


Allynne Noelle has had two metatarsal stress fractures, a torn foot ligament, and two broken ribs. Yet, the 32-year-old ballerina considers herself pretty lucky.

Allynne Noelle 3 300Noelle says not to be fooled by the graceful movements on stage − ballet is a full-contact sport.

“As beautiful as the art form of ballet is, it’s extremely demanding on the body,” said Noelle, a principal dancer with the Los Angeles ballet. “It works every single muscle and fiber.”

The annual injury rates at ballet companies run between 67 and 95 percent.

The annual injury rates at ballet companies run between 67 and 95 percent, according to a study by the American Journal of Sports Medicine.  But ballerinas and their male counterparts often dance through the pain.

“You’re kind of raised with the idea that you’re stronger than any pain you feel,” said Noelle, who once danced with a 103-degree fever that led to her hospitalization with pneumonia. Continue reading


App lets you determine your neighborhood’s radon risk


Screen Shot 2014-01-21 at 11.28.29From the Washington State Department of Health

Olympia, January 21, 2014 – Washington residents now have a new online map to check and see if their neighborhood has a geological risk for the cancer-causing gas, radon, using a new state app. The new app is offered by the state Department of Health’s Washington Tracking Network.

Some areas of the state, such as Spokane and Clark counties, are well-known for having higher levels of radon, but the new online map shows that there are some areas around the Puget Sound such as Pierce and King counties that might come as a surprise.  Continue reading


Cancer rehab begins to bridge a gap for patients



By Rachel Gotbaum

This story was produced in collaboration with NPR

It was her own experience with debilitating side effects after cancer treatment that led Dr. Julie Silver to realize there is a huge gap in care that keeps cancer patients from getting rehabilitation services.

Silver was 38 in 2003 when she was diagnosed with breast cancer. Even though she is a physician, she was shocked at the toll chemotherapy and radiation took on her body. Silver was dealing with extreme fatigue, weakness and pain.

“I was really, really sick, sicker than I ever imagined,” says Silver, who is an assistant professor at Harvard Medical School. “I did some exercise testing and I tested out as a woman in my 60s. So I had aged three decades in a matter of months through cancer treatment.”

Silver went to her oncology team for help. They told her to go home and heal. “The conversation should have been, ‘We’re going send you to cancer rehab to help you get stronger,’” she says. But that’s not what happened, and after Silver came to realize that her experience was typical, she set out to change the system for other patients.

In 2009 she started a program designed to offer cancer survivors rehabilitation therapy after treatment. It’s called STAR and is now offered in almost all 50 states. The program is growing, as is research showing that many of the quality-of-life problems cancer survivors have are physical and can be helped with rehab.

But even with the awareness of its benefits growing, there is still a disconnect for patients.

“Patients are getting stuck, and they don’t know where to go,” says Dr. Rebecca Lansky, a rehabilitation specialist at the University of Massachusetts Medical Center. She says the focus on cancer care is on treatment and that cancer patients suffering from major side effects often fall through the cracks. She recalls one patient who struggled with the side effects of tongue cancer treatment.

“He had radiation to the whole jaw and neck so he couldn’t open up his mouth for six months,” Lansky said. “He had a feeding tube, and he kept going to his oncologist saying, ‘How can I get better? What I can do? He finally got referred to me and we are now opening up his jaw six months after he has been unable to move.”

Dr. Rebecca Lansky examines a patient (Photo by Rachel Gotbaum/For KHN)

Dr. Rebecca Lansky examines a patient (Photo by Rachel Gotbaum/For KHN)

A 2008 study of breast cancer patients in the Journal of Clinical Oncology found that 90 percent of the patients needed rehab but only about one third were getting the therapy.

“I’ve seen cases where someone has had a lot of pain, and they’ve done scans and it’s not a malignancy and maybe they have done exploratory surgery to see what is happening and not really finding much except a lot of scar tissue,” says physical therapist Jennifer Goyette, a STAR trained therapist who works with cancer patients in Worcester, Massachusetts. “I am able to get them a lot of relief and a lot of times patients don’t need to have further intervention. They don’t want to be on the narcotics for the pain management. They would rather come here.”

One of Goyette’s clients is 56-year-old cancer survivor Deborah Leonard. For two years after her treatment for early stage breast cancer, Leonard had swelling, pain and a large mass in her breast –which was not cancer.

“Clearly I didn’t have that before the surgery, because the tumor was so small and this was much bigger, and it just kept getting bigger,” says Leonard. “By nighttime my breast was extremely swollen and very painful.”

At first doctors thought Leonard might have an infection and gave her antibiotics. When that didn’t work they did another surgery to remove scar tissue. But the problem returned. Her doctors were suggesting a third surgery when Leonard finally found Goyette.

After three sessions with Goyette doing what is called lymphatic drainage, Leonard felt much better. Goyette uses manual pressure to clear Leonard’s lymphatic system, allowing the build up of fluid causing Leonard’s pain and swelling to subside.

“I had a 6-inch mass that is now down to half its size,” says Leonard.

“I’m sleeping at night, I have energy again. More people need to know about this because you don’t have to be a martyr and grin and bear it. This works.”

The issues are different for every type of cancer – head and neck cancer patients may need swallowing and speech therapy; blood cancer patients may need therapy similar to cardiac rehab to rebuild their strength and stamina; and patients treated for colon cancer can get help from physical therapists with back pain and abdominal swelling.

Most insurers do cover rehab for cancer patients, but sometimes patients must battle to get more than the standard 9 to 12 sessions covered. Another barrier to care is that too few oncologists and cancer surgeons refer their patients to rehab.

The Commission on Cancer, the arm of the American College of Surgeons that accredits cancer programs in U.S. hospitals, recently announced new requirements aimed at improving care for survivors of cancer including better access to rehabilitation therapy.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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More than 24,000 Snohomish County residents earn food worker certification online


At signA record 24,000 Snohomish County residents earned a food worker card through online training in 2012, compared to less than 5,000 who earned their cards in a classroom, Snohomish County health officials report.

A food worker card is required for anyone who:

  • Works with unpackaged food, such as in a restaurant or bar
  • Touches food equipment, such as washing dishes
  • Works at any surface where people put unwrapped food, including grocery store cashiers

The county began to offer the food worker card classes online in the spring of last year. The online course takes about one hour to go through the curriculum and take the test.

The popularity of the online course has reduced the need for in-person classes, officials said, so the Snohomish Health District plans to reduce the number of in-person classes to four a month in English and to one a month in Spanish next year. .

Starting January 1, Health District will offer four classes a month in English and one in Spanish at the Snohomish Health District auditorium in the Rucker Building, 3020 Rucker Ave., Everett.

  • The in-person classes in English will be offered the first and third Thursday of each month at 10 a.m. and 2:30 p.m.
  • The in-person classes in Spanish will be offered the first Tuesday of each month at 10 a.m.
  • In-person classes will no longer be offered in Lynnwood.

The online training program also provides instruction in Korean, Russian, Mandarin, Cantonese, Vietnamese, Cambodian and Closed Caption

The cost of the training and test for a food worker card remains at $10.

Food worker cards are good for three years and are valid anywhere in Washington state.

The Health District accepts cash only for the in-person classes, and Visa or MasterCard only for online classes.

Find details at

To learn more about food safety classes and the food safety program, visit, keyword search “Food Class.” Optionally, call 425.339.5260 to hear a list of class dates.

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$100-dollar bill inside a capsule

Workers’ poor health costs employers $344 billion, study finds


By Julie Appleby

Health costs aren’t just about how much employers pay to provide health insurance: Workers’ poor health costs employers $344 billion annually in lost productivity and absenteeism, a research group estimates.

“Employers haven’t looked at the impact of health on absence from work or on performance while at work,” says Thomas Parry of the Integrated Benefits Institute, a nonprofit group that includes employers and benefit firms among its members.

Improving workers’ health through wellness programs and other efforts, Parry says, will pay off in the short term with improved productivity and fewer days off to illness. Long range, it may also slow rising medical costs if workers’ health improves.

The institute used its own data, along with data from the Bureau of Labor Statistics, to come up with the estimate.  Of that total, $227 billion are costs associated with workers taking days off because they are sick or showing up at work and underperforming.

An additional $117 billion is associated with wage replacement, including worker’s compensation costs and disability payments.

Those costs add up to more than the $232 billion Parry says private employers spend on medical coverage for their workers each year.

“To focus only on costs is missing the boat,” he says. “Unless we think about a healthier workforce, we will never crack this nut.”

The value of wellness and disease prevention programs has been widely debated, but many analysts think such programs reduce spending over time. An increasing percent of employers are tying financial incentives, such as insurance discounts, to employees actively participating in wellness efforts. Some even require them to meet specific medical guidelines for such things as cholesterol, blood pressure or weight.

To slow their cost growth, many employers have also raised deductibles.  Supporters of high-deductible plans say workers will act as better consumers of health care if they’re paying more out of their own pocket. Parry says that might be true, but the flip side is that some workers pay also put off needed care.

“And that may have productivity consequences,” he says.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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office workers - Square

Workplace clinics expand focus beyond injuries and preventive care


By Michelle Andrews

On-site workplace clinics used to be primarily focused on patching up people who got injured on the job. Then companies added primary care and started emphasizing preventive screenings and other “wellness” services.

Now, some big employers are beefing up their clinic offerings further with a host of add-ons, including physical therapy, dental and vision exams, mental health counseling and even acupuncture and massage.

The new services may not always improve a company’s bottom line. But they’re a convenient perk for busy employees and can help maintain employee productivity by reducing absences.

In addition, in competitive industries such as technology and financial services, such benefits can help retain employees and attract new ones, experts say.

In 2011, 31 percent of employers with 500 or more workers had on-site clinics, and another 9 percent said they were considering them, according to the annual survey of employer health plans by human resources consultant Mercer.

“It’s a matter of providing enhanced access and making it easier for workers to get enhanced services,” says Bruce Hochstadt, a Mercer consultant.

When Linda Wolohan’s doctor prescribed physical therapy last December to treat a bulging disk in her back, she opted to use a physical therapist at the Valley Forge, Pa., headquarters of her employer, Vanguard, rather than one near her home an hour away.

“It was convenient,” says Wolohan, 54, who works in the mutual fund company’s public relations department. “Getting to a physical therapist near home was hard to schedule.”

Wolohan paid $10 a session, a slightly lower co-payment than if she had used a physical therapist in the community.

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Obstetrics And Dentistry

Like most companies that provide on-site clinics, Vanguard is self-insured, meaning the company pays its employees’ health-care claims directly.

Given the high volume of employee physical therapy claims, it made sense financially to provide the service in-house, says Julie Clark, who oversees the clinic, the company gym and other wellness services.

The company has three part-time physical therapists at the clinic, which opened last year. The clinic staff, which also includes a doctor, a nurse practitioner and a couple of nurses, is employed by CHS Health Services, a Reston, Va.-based company that staffs and runs 115 on-site health clinics in 32 states.

Employees’ costs vary. Some employers provide clinic services free. Discounted co-payments such as the one Wolohan paid are common, experts say.

“They want to encourage employees to take advantage of the services on-site,” says Ed McNamara, vice president of sales and marketing at CHS. “It’s a productivity savings and an employee-benefit savings.”

Workers at American Express facilities in Phoenix and Salt Lake City have access to dental services at a van that parks at each of the facilities. In addition to dental exams and cleanings, employees can get fillings and crowns, among other treatments. Services are free for employees enrolled in the company dental plan.

American Express varies the on-site services it offers based on employee needs, says David Kasiarz, senior vice president for global compensation and benefits. The company may provide an OB/GYN at a call center with a mostly female workforce, for example, or a dermatologist in Florida and Phoenix, where skin cancer is more common than in other areas.

On the coasts, especially in Silicon Valley and Southern California, a growing number of companies have added acupuncture, massage therapy and chiropractic services to their clinic offerings, experts say.

“The companies that tend to do it see it as a retention tool,” says Ha Tu, a senior researcher at the Center for Studying Health System Change, who co-authored a study about workplace clinics. “They’re perks, as opposed to offering massage therapy, for example, and expecting direct payoff.”

Mental Health Care

Employers are also paying more attention to mental health issues. Some are adding services at their on-site clinics.

In other cases, they’re linking the employee assistance program, which provides short-term counseling and mental health referrals, with the clinics, says Julie Stone, a senior consultant with benefits consultant Towers Watson.

Services can take many forms. At Prudential Financial, health-care providers at the company’s eight clinics began noticing employee stress from the financial crisis and recession a few years ago. So the company made budget coaches available by phone.

“The financial situation was affecting their health,” says Myrtho Montes, who manages all the company’s on-site health programs.

KHN wants to hear from you: Contact Kaiser Health News
This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Shopping Bag

Can retailers revamp primary care?


By Julie Appleby
KHN Staff Writer

In-store medical clinics like those at Walmart – having established a beachhead with relatively healthy patients looking for convenient, low-cost care for simple problems – are eyeing a bigger prize, the millions of Americans with costly illnesses such as diabetes and heart disease.

Just as Walmart and other retailers shook up the prescription drug business by offering $4 generic drugs, the industry now aims to apply its negotiating and marketing clout to tackle problems that vex consumers and the health sector: unpredictable costs, a lack of primary care doctors and inefficient management of chronic illnesses, whose costs drive the majority of health care spending.

“It’s sad that the existing health care establishment has not figured out a way to make primary care affordable and accessible,” says Jerry Avorn, a professor of medicine at Harvard.  “We should not be surprised if someone outside of our world comes in and does it for us.”

Last week, Walmart’s ambition to become the nation’s largest provider of primary health care services became known when a confidential document the giant retailer sent to some of its strategic partners leaked out.

The request for information sought partners who could help Walmart in a variety of areas, including monitoring patients with diabetes, asthma, high blood pressure, heart disease, obesity and other conditions.

Walmart backed away from parts of its own document, saying it did not intend to build a “nationally integrated, low cost primary care platform.” Indeed, it is hard to imagine what a national platform would look like given the wide variation of state laws governing health care delivery.

 The Association of American Medical Colleges estimates a shortfall of 21,000 primary care doctors by 2015.

But clearly, Walmart and other retailers are looking for ways to expand services at their in-store clinics.

Already, CVS Caremark, the largest operator of in-store clinics with nearly 550, and Walgreens have set up programs aimed at helping diabetics monitor and control their condition, which includes counseling chats with pharmacists. Weight loss programs and counseling are on tap at some retail clinics. Truck drivers can pull their 18-wheelers into the parking lots of more than 600 such in-store centers nationwide to get their mandatory federal health exams.

“There are real savings to containing the cost of the chronically ill in this country,” says Helena Foulkes of CVS/Caremark, which offers in-person and telephone conversations with pharmacists to diabetic patients enrolled in its “Pharmacy Advisor” program. Some employers also send workers to the firm’s MinuteClinics for blood tests and other health screenings. “More and more of clients are actively looking for wellness programs and they see retail clinics as one element.”

In part, the clinics see a pure business opportunity based on consumer convenience and cost savings, which they can market to the public, employers, insurers and hospitals. Costs are roughly 30 percent to 40 percent less than similar care at a doctor’s office and 80 percent cheaper than at an emergency room, according to a study in published this year in the American Journal of Managed Care.

That’s attractive to insurers. Use of retail clinics among patients with insurance rose tenfold from 2007 to 2009, the study found, with clinic visits representing about 7 percent of all medical visits for 11 common acute conditions: “If these trends continue, health plans will see a dramatic increase in retail clinic utilization … particularly among, young, healthy and higher income patients living close to retail clinics,” the study concluded.

Still, while less expensive than going to an emergency room or doctor’s office on a per-visit basis, “if more people seek care, that could increase health care spending,” says one of the co-authors of the study, RAND researcher and medical professor Ateev Mehrotra of the University of Pittsburgh School of Medicine.

The majority of retail clinics are in the South and Midwest and are likely to be in areas with lower overall poverty.

The California Healthcare Foundation found the No. 1 thing consumers liked about the in-store clinics was predictability: the cost of the service was clear ahead of time.

“That contrasts with most people’s experience of health care, where if you walk into a doctor’s office or an urgent care clinic, you have no idea what the charge will be,” says Mark Smith, president and CEO of the foundation.

Interest in clinics is also spurred by the federal health law, which, among other things, will create incentives for small businesses to offer wellness programs for workers.

“An employer with 50 to 250 employees can’t afford to bring in a company to do corporate wellness,” but it could partner with a retail clinic and send employees there for blood tests, nutrition counseling or diabetes management, says Stewart Levy, president of Health Promotion Solutions in Newtown, Pa., a consulting firm that is working with the retail clinic industry.

The growth of retail clinics – both in sheer numbers and the scope of services they offer – is one of several avenues being pursued to revamp primary care, which is facing a shortage of physicians. The Association of American Medical Colleges estimates a shortfall of 21,000 primary care doctors by 2015.

Done right, supporters say, expanding services through retail clinics could provide better access for many patients and lower costs, and provide an outlet for an expected jump in demand for care in 2014, when millions more Americans get insurance through the federal health law.

But obstacles remain. Will retail clinics be able to translate their success with simple acute problems to a more long-range and intensive monitoring of complex conditions? Will employers and consumers embrace the idea? Will clinics become components of new, integrated collaborations between doctors, hospitals and insurers?

“Asthma and diabetes are not something you get one time and get fixed,” says health care consultant Ian Morrison, who follows trends in the industry. “How effective will they be in managing that over the long term?”

While studies have shown that retail clinics provide similar – or even better – quality care for simple conditions such as sore throats, researchers haven’t yet looked at their ability to do more complex monitoring of patients, often called disease management.

Data is mixed on the success of such programs and some have been shown not to save money. Recently, a study of eight disease management firms that used nurse-based call centers failed to save Medicare money.

Another challenge is the wide variety of laws governing medical centers. Some states, including New York and California, prevent clinics (or hospitals) from directly employing physicians, nurse practitioners or physician assistants.

Other states cap the number of nurses each doctor can oversee. Efforts to expand nurses’ or physician assistants’ ability to practice autonomously are often fought by state medical associations.

“It’s interesting that I can go from Washington D.C., where I can be certified to take care of patients autonomously, to Georgia, where I can do very little because I have to have a supervisor who is a physician overseeing what I do,” says Ken Miller, an associate dean in the school of nursing at Catholic University and a past president of the American College of Nurse Practitioners.

While a few centers operated by retailers have doctors on site, the vast majority of staff are nurse practitioners or physician assistants. According to the Convenient Care Association, the industry’s trade group,there are more than 5,000 nurse practitioners working in the clinics, making up 95 percent of the clinicians.

If more patients with chronic illnesses can be seen in settings like retail clinics, where they can stop by on the way home from work or on the weekends, Miller and others say they may be more likely to take their medications, monitor their blood sugars and take other actions to prevent a worsening of their disease.

“If you have a stable diabetic, why should that person be going in to see a physician when a nurse practitioner can manage care of that patient?” he asks.

Primary care doctors fear retail clinics will skim off the healthiest patients, leaving them with more complex or older patients, with no corresponding increase in reimbursement from insurers or the government. They also worry that the expansion of retail clinics into caring for patients with chronic illnesses will further fragment the care such patients receive.

In a statement, the American Academy of Family Physicians says a better answer for such patients is “the development of a health care system based on strong, team-based … care.”

For their part, the clinic industry says it can be an ally for overworked doctors. In the future, clinics could use nurse practitioners and physician assistants to do triage, particularly on the least complex patients,  so doctors could “use their training and skill to focus on patients with long term needs,” says Caroline Ridgway, policy and communications director at the retail clinic industry’s trade group.

But unless payment incentives are changed to reward quality over volume – and laws changed so nurse practitioners and physician assistants can provide more direct care in all states, there will be an increasing burden on primary care doctors as more Americans become insured, she says.

“Insuring 30 million more people isn’t going to matter if they don’t have anywhere to go,” says Ridgway.

The majority of retail clinics are in the South and Midwest, according to a 2010 RAND Study. They’re more likely to be in areas with lower overall poverty and only 12.5 percent were in medically underserved areas, the RAND report said, although 21 percent of the U.S. population lives in such areas.

“The research did not support the claim by some champions.. that these clinics are improving access to care for the medically underserved: retail clinics are more likely to be located in relatively affluent sections of large urban areas,” the report concluded.

Still, about 35 percent of clinic patients are either uninsured or have high deductible insurance plans that put them on the hook for hundreds, if not thousands, in out-of-pocket costs, says Tine Hansen-Turton,  executive director of the Convenient Care Association.

“We are seeing people who are vulnerable,” she says.

For much of their brief history, retail clinics have focused their services on a narrow menu, mainly treatments for acute conditions, such as strep throat or ear infections, vaccinations, and physical exams needed for summer camp or other programs.

But retail clinics are moving beyond just a simple menu of services in part because “it wasn’t a financially sustainable model to be restricted to those things,” says Smith at the California HealthCare Foundation.

Now, the medical community is seeing what other industries have experienced: an interloper gaining a foothold in a market niche, then expanding. “Think about Toyota, they didn’t start off by competing with Cadillac and BMW. They started with cheap little cars but got better and better over time,” Smith says.

PHOTO CREDIT: Michael Lorenzo

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Full-body x-ray scan of a woman

TSA to conduct new study of safety of airport x-ray body scanners


Full-body x-ray scan of a womanby Michael Grabell
ProPublica, Nov. 2, 2011, 5:40 p.m.

The head of the Transportation Security Administration testified today that the agency will perform a new, independent study on the safety of X-ray body scanners after lawmakers raised questions about a ProPublica investigation at a Senate hearing on aviation security.

The story, researched in conjunction with the PBS NewsHour, reported that while the radiation emitted from the machines is extremely low, scientific studies have concluded that they could still increase the risk of cancer.

It also reported that the Food and Drug Administration went against the advice of a 1998 expert panel, which recommended the agency set a mandatory federal safety standard for the machines.

Several members of that panel said they were concerned about widespread use of X-ray scanners, including in airports.

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The TSA uses two types of body scanners to search for explosives — an X-ray machine that uses ionizing radiation, a form of energy that has been shown to damage DNA, and a millimeter-wave machine that uses radiofrequency technology, which has not been linked to cancer.

Sen. Susan Collins, the top Republican on the homeland security committee, recommended that the Department of Homeland Security independently evaluate the health effects of the X-ray scanners and “establish a goal of using radiation-free screening technology.”

Questioned about the story by Sen. Joe Lieberman, TSA Administrator John Pistole said that the agency has already conducted several independent studies showing that the radiation is equivalent to the dose received in about three minutes of flying at typical cruising altitude.

“But that being said, I am concerned that there is a perception that they are not as safe as they could be,” Pistole said. “And since we are using a different technology, that being the millimeter-wave scanner, that does not have that same perspective, I will take that back and we will conduct an independent study to address that.”

In recent years, the TSA has commissioned tests of the X-ray machines, also known as backscatters, by the Food and Drug Administration and the Johns Hopkins University Applied Physics Laboratory. In addition, survey teams from the Army Public Health Command visit airports to check the machines. The TSA says the results have all confirmed that the backscatters don’t pose a significant risk to public health.

But David Brenner, director of Columbia University’s Center for Radiological Research, said in a recent interview that while the dose is low, the chances of someone getting cancer increase as TSA puts millions of airline passengers through the machines.

“Why would we want to put ourselves in this uncertain situation where potentially we’re going to have some cancer cases?” he asked. “It makes me think, really, why don’t we use millimeter waves when we don’t have so much uncertainty?”

Robin Kane, the TSA’s assistant administrator for screening technology, told ProPublica and PBS that the health risk is small compared to the security benefit. Having both technologies is important, he added, to improve detection capabilities and find the most cost-effective solution.

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Mildew from a wooden soap dish - Photo by Bob Baylock

Removing mold helps reduce asthma and respiratory infections — study


Mildew from a wooden soap dish - Photo by Bob Baylock

By Glenda Fauntleroy, Contributing Writer
Health Behavior News Service

A new evidence review finds that ridding homes and offices of mold and dampness can help reduce respiratory infections and troubling symptoms for asthma sufferers across the globe; however, the best way to eliminate the mold remains unclear.

Mold is one of the most important environmental triggers of symptoms such as coughing and wheezing, according to National Institute of Environmental Health Sciences.

“Mold is found in many homes with basements, in apartments and walkouts that are partially or fully below ground, and in buildings that have been flooded or have poor humidity control,” said Peter Thorne, head of the occupational and environmental health department at the University of Iowa. “Homes and office buildings alike have problems.”

But does “remediating” or relieving homes, offices and schools of dampness and mold make a big difference? Lead reviewer Riitta Sauni at the Finnish Institute of Occupational Health in Tampere, Finland, said that results are mixed.

PHOTO: Bob Baylock under Creative Commons license

Key Points:

  • Ridding homes and office buildings of mold can reduce the incidence of respiratory illness and decrease asthma-related symptoms, a new Cochrane review finds.
  • While removing mold from offices and homes can reduce coughing and wheezing, the best method for mold removal remains to be determined.
  • Mold can be costly to remove from buildings, which can be re-infected even after cleaning and fungicide treatments.

“We were happy to find evidence that remediation of mold-damaged houses decreased the severity and amount of symptoms in patients with asthma and respiratory infections,” Sauni said. “Unfortunately, we did not find evidence that remeditation could prevent these diseases.”

The review appears in the September issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Remediation of mold and dampness requires total or partial renovation of a building, or cleaning with a fungicide or bleach solution. Sauni and her team looked at eight studies with 6,538 participants who had their homes, schools or workplaces remediated by a mixture of these methods.

The reviewers say that because the available studies did not offer high-quality evidence and sample sizes were small, “drawing hard conclusions was difficult.”

Nonetheless, the review found that when compared to doing nothing at all, repairing houses decreased asthma-related symptoms as well as the amount of respiratory infections in adults.

Remediation also decreased the number of acute care visits in children and students’ visits to physicians for common colds.

In one South Wales study, for instance, 115 members of the group who had their homes remediated with the complete removal of visible mold, a fungicide treatment and installation of a fan, were more likely to see improvement in their respiratory symptoms for six and 12 months afterwards, compared to those in the control group whose homes were not cleaned.

The reviewers, however, could not determine which method of remediation was superior to significantly improving asthma symptoms.

“The studies have shown that after cleaning and fungicide treatment, a large number of the buildings were soon re-infected with molds, and also a partially remediated office building had to be repaired more thoroughly,” Sauni said, adding that mold removal can be costly.

“Sometimes, if the structures are damaged widely, the easiest and most cost-effective possibility is to pull down the damp building and build a new one,” she said.

The reviewers concluded that better research is necessary to give evidence of improved outcomes.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.


Online Video: Breakthroughs in Spine Surgery


UWTV is offering the Ninth Annual Harborview Spine Symposium: Breakthroughs in Spine Surgery.

Learn about care and recovery from complicated spinal cord injuries, with case studies and in-depth research. From vertebroplasty to disc replacement, this series delivers the most recent developments in spine treatment from national experts as well as doctors at with UW Medicine.

To view:

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Valley Medical Center opens urgent care clinic in Auburn


Valley Medical Center has opened a new urgent care clinic in Auburn at 1000 Auburn Way S.

The 4,350 square-foot facility will provide walk-in, extended hour access for non-emergency, acute illness and injury care that is either beyond the scope or availability of a primary care practice, the hospital said.

The new facility will also house Valley Medical Center’s Occupational Health Clinic.


  • The urgent care clinicians are available to see patients, from infants to the elderly, Monday through Friday, 8:00am to 8:00pm; Saturday and Sunday, 8:00am to 4:00pm.
  • Occupational Health hours are currently 9:00am to 5:00pm on Tuesdays, with additional days and hours to be added soon, the hospital said.

On the job injuries are treated on a walk-in basis with no appointment necessary.

A ribbon-cutting event will be held Thursday, June 30th at 10:00am at Auburn Urgent Care/Occupational Health Services. The public is welcome to attend.

The public can also take a tour of the of the new clinic now through July 31, 2011.

Asbestosis_high_mag - thumb

Health law repeal would threaten coverage for asbestosis victims in Libby, Montana


By Phil Galewitz
KHN Staff Writer

This story was produced in collaboration with wapo

Julie Johnson grew up in Libby, Mont. — a picturesque Rocky Mountain community that was unknowingly poisoned for decades by deadly asbestos from a vermiculite mine six miles from town.

Her grandfather, a miner, her grandmother and an uncle died of asbestos-related disease. Both of her parents have the condition that has no cure. But she didn’t think it would hit her — until doctors last year found a spot on her lung.

Like many of the nearly 2,000 people from Libby who have asbestos-related disease and the 400 who have died from it, Johnson never worked at the mine, which was owned by chemical manufacturer W.R. Grace. It produced much of the world’s supply of vermiculite, a mineral used in insulation, fireproofing and soil conditioning, before closing in 1990.

But tremolite, a form of asbestos that was laced in the vermiculite ore, had been spread throughout the Libby area. Miners brought it home in heavy dust on their clothes helping to contaminate their families, residents took vermiculite to use for insulation and tailings were spread as ground filler around town, including at school and community sports fields. Federal officials in 2009 declared the area the first national public health emergency and have called it the nation’s worst environmental disaster.

Without health insurance, Johnson, 45, relied on a state-federal grant program and a medical plan funded by W.R. Grace to help pay for her medications and doctor visits. Yet, with Grace in bankruptcy and the grant program scheduled to end this summer, Johnson was concerned about how she was going to keep up with mounting health bills for medicines and tests.


The 2010 federal health law is providing help. One provision, authored by Senate Finance Chairman Max Baucus, D-Mont., gives full Medicare coverage to people who had lived in Libby for a total of at least six months over a 10-year period before their diagnosis of an asbestos-related disease.

“I feel good knowing I have this [coverage] and it’s never going to go away,” said Johnson. She is one of about 600 people from Libby who have signed up for Medicare as a result of the law, according to the Social Security Administration, which oversees the program with the Centers for Medicare and Medicaid Services.

Asbestos Fibers (red rod-like shapes) in lung tissue - Photo by Nephron

But she and others worry about Republican efforts to repeal the law.

“Losing this benefit would really knock the bottom out of people’s lives,” said Gayla Benefield, a Libby resident and Johnson’s mother.

U.S. Rep. Denny Rehberg, R-Mont., is among those fighting to overturn the law. “It’s tragic that assistance for so many deserving folks up in Libby was tied to the anchor of Obamacare, with all of its mangled policy, unconstitutional mandates and reckless deficits,” he said.

Rehberg, who has announced he is challenging Democratic Sen. Jon Tester and is making the health law an issue in the campaign, said he will continue working to help the people of Libby but would not say if he supports keeping the Medicare option for them.

Baucus defends the coverage for Libby. “This provision is important because it will provide vital medical services to Americans who — through no fault of their own—have suffered horrible effects from their exposure to deadly poisons,” he said.

Expansions Of Medicare Have Been Rare

Libby is in Lincoln County in northwest Montana

It is just the third expansion of Medicare eligibility since the federal health insurance program was established for the elderly and disabled in 1965. In 1972, Medicare added people with end-stage kidney disease and in 2001, people with amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

Unlike other deals senators secured in the law to help their own states, the Libby provision elicited no public outcry, mostly because of its relatively minor cost. The Congressional Budget Office said it would cost $300 million over the next decade.

For Johnson, being on Medicare means long-term security. Because of the contamination, “W.R. Grace proved that they are not to be trusted and I definitely wasn’t banking on having their medical plan for the rest of my life,” said Johnson who now lives in Kalispell, about 90 miles east of Libby.

Even with the new Medicare coverage, Grace has no plans to close its Libby medical plan, which has paid out about $21 million since 2000 and has about 1,100 current patients, said William Corcoran, a vice president at Grace. About 70 percent of those in the company plan are 65 and older.

Grace, a chemicals manufacturer based in Columbia, Md., that bought the mine in 1963, has been paying medical bills in Libby for years and agreed in 2008 to spend $250 million for an environmental cleanup of the town.  The company, which was driven into bankruptcy protection in 2001 by tens of thousands of asbestos poisoning claims mostly unrelated to Libby, reached a tentative civil settlement in 2008 to pay $3 billion to asbestos victims nationwide.

The federal-state grant program, which serves about 1,400 people, was intended as temporary aid and is slated to end in July.

That program was set up because the Grace medical plan failed to cover everyone who needed help, said Benefield, who also been a leading advocate to get help for the town’s residents. The Grace program hires its own doctors to independently verify if applicants have the type of asbestos-related disease connected to the Libby mine. The government program doesn’t have this independent verification process. Applicants merely have to submit information from their own doctor certifying they had asbestos-related disease.

In 2010, the company accepted 50 of the 83 people who applied for the program.  Grace officials said those rejected could not prove their disease was caused by asbestos. For example, if the lung disease was caused by smoking, it would not be covered.

Broader Coverage Under Medicare

Both the Grace and the government grant program pay only for health services related to asbestos disease and both supplement an individual’s private insurance. In contrast, the Medicare coverage pays for all types of health needs.

“The Medicare coverage will be extremely important,” said Tanis Hernandez, outreach coordinator of the Center for Asbestos Related Diseases, the government-funded clinic. She said many people have not yet enrolled because they can still get help from the grant program.

Exposure to asbestos is known to cause cancer and other lung diseases. The asbestos-related disease can take decades to show up on X-rays and other tests.

Out of a population of more than 10,000 people in Libby and the surrounding valley, new cases are being diagnosed at a rate of about four a week, according to Hernandez.

“I thought I was fine and I was not a smoker and was least exposed of my siblings,” said Johnson who works as a receptionist at a veterinary clinic. But there were early signs of health problems: She caught pneumonia when she was eight months pregnant, was diagnosed with Swine flu, and in the past few years she developed ear infections that took months to clear.

These days, when she shows her Medicare card at the doctor’s office, Johnson sometimes gets strange looks. “They say, ‘You look so young. How can you be on Medicare?’ Then I explain I’m from Libby.”

PHOTOMICROGRAPH by Neprhon under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Map by Arkyan under GNU Free Documentation License.

To learn more:

  • Visit the Environmental Protection Agency’s Libby Asbestosis site.
  • Read the National Library of Medicine’s MedlinePlus page on asbestosis.
KHN wants to hear from you: Contact Kaiser Health News

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Red Stethoscope

More workplace clinics offering primary care


By Michelle Andrews

“That’s where the money is,” Willie Sutton famously quipped when asked why he robbed banks. There’s a similar rationale for employers who hope to improve employee health and contain costs with workplace health clinics: That’s where the people are.

Day in and day out, workers troop into the office, spending the better part of their waking hours there. What better place to have medical staff on hand, not only to treat sore throats and cut fingers but also to help employees stay healthy by offering on-site preventive tests and screenings, and health coaching to encourage healthful habits?

“They come in for a runny nose, and we have an opportunity to engage them about their weight, their smoking,” says Stuart Clark, president of commercial services for Comprehensive Health Services, a Reston-based company that operates more than 100 on-site health clinics for large employers. “They may not be ready for that, but we’re in the building with them,” he says. “We’ll work with them … every day.”

Until the 1980s, workplace health clinics generally existed to treat people who were injured on the job. Although that is still a key function, many employers are expanding the clinics’ role to include primary health-care services. In 2010, 15 percent of employers with 500 or more employees had clinics providing primary-care services, according to the consulting firm Mercer. Another 10 percent said they were considering providing those services this year or next.

Employer interest in on-site primary care is motivated by several factors, say experts. By making it easy for employees to get a mammogram or check their blood pressure, companies hope to avert expensive medical problems down the road.

In addition, employers hope that by ensuring that their clinic staff follows evidence-based guidelines for care, their workers will receive treatment that’s appropriate to their medical needs, says Ha Tu, a senior health researcher at the Center for Studying Health System Change and a co-author of a December research brief on workplace clinics. This would likely lead to fewer referrals to specialists, for example, and pricey imaging tests.

Prices for workplace clinic services are usually lower than those at a community-based clinic; sometimes they’re free.

Although some workplace clinics aim to function as their employees’ primary-care provider, most clinics supplement rather than replace their workers’ doctors.

Some companies operate their own clinics, while others contract with others to do so. Services vary widely, from preventive screenings and nutrition and exercise counseling to routine physicals and disease management services for workers with chronic conditions. Prices for clinic services are usually lower than those at a community-based clinic; sometimes they’re free.

Brent Laymon, a marketing manager at Pitney Bowes’s headquarters in Stamford, Conn., has his own primary-care physician, but he uses the company clinic for just about everything, including screening tests, blood work and flu shots. A few years ago, Laymon, now 57, stopped in at the clinic because his heart was racing and his skin felt clammy. The nurse practitioner on duty checked his blood pressure and then immediately put him in a cab and sent him to a cardiologist, who diagnosed a blocked artery.

More From This Series: Insuring Your Health

“If [the clinic] wasn’t there, I might have just blown it off and not gone to see my doctor,” says Laymon, who pays nothing for clinic services.

The cost of setting up and running an on-site health clinic generally makes it feasible only for employers with at least several hundred workers in one location. Now some smaller companies are banding together to operate joint clinics near their workplaces. And there’s a newer option being offered in some areas: mobile health vans that offer clinic services at clients’ work sites.

In March, Veronica Leon, who works in human resources for Hacienda La Puente Unified School District in Los Angeles County, visited a mobile health vehicle operated by her insurer, Kaiser Permanente, when it was parked outside the school district office in City of Industry, where she works.

The doctor whom she saw in the small, private room on the 40-foot van examined her and told her that the cough that was troubling her was likely related to seasonal allergies. Leon, 39, and the doctor also discussed weight management, including surgical options and diet. Leon says she would visit again if the van returns. “It would cut down on time away from work for a doctor’s appointment,” she says.

The van, which has visited more than 100 employers since it was launched last year, is the first of three that Kaiser Permanente plans to put out on the road. “Demand is increasing, and [right now] we only have one vehicle for all of Southern California,” says Larry Sharfstein, a regional practice leader at Kaiser Permanente. (Kaiser Permanente has no connection to Kaiser Health News.)

Although concerns have been raised by some health-policy experts that employers will stop offering health insurance and other health-care services to their workers once state-based exchanges begin selling insurance in 2014, the interest in workplace health clinics seems to indicate that just the opposite is happening, at least for now.

More than 30 million people are expected to gain health insurance under the health-care overhaul that became law last year, and many employers are worried that it will further strain an already overburdened primary-care system, says Bruce Hochstadt, a physician who heads up Mercer’s work site health practice. “A lot of employers are concerned about their employees’ access to health care under health reform,” he says. Rather than abandoning coverage, “we’re seeing a lot of employers maintaining coverage or adding clinics on-site.”

We want to hear from you: Contact Kaiser Health News

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Drawing of a woman on a ladder hanging Christmas lights

Holiday decorating the downfall of many


Drawing of a woman on a ladder hanging Christmas lightsClimbing chairs and ladders to decorate the tree, string Christmas lights and other holiday chores is the downfall of many, warns the American Academy of Orthopaedic Surgeons.

Researchers at the U.S. Centers for Disease Control and Prevention looked at emergency room visits over three holiday seasons and found that nearly 17,500 people needed treatment in emergency rooms due to holiday-decorating falls–nearly 6,000 per season.

About 10,000 (or roughly 60 percent) were men, and about 7,300 (or around 40 percent) were women, the CDC researchers found.

About 40 percent fell off a ladder, nearly one in seven fell off a roof, and one in ten fell off furniture.

About one in three broke a bone, one in four got away with scrapes and bruises, but about one in ten ended up in the hospital, the researchers found.

“If you plan on putting up holiday decorations and lights, it’s important to do so with caution. With the constant ladder climbing and stretching, it’s easy to lose your balance or be careless for just a moment,” said orthopaedic surgeon Sherwin SW Ho, MD. “Be sure to take your time and avoid taking safety risks to get the job done at a quicker pace.”ed.

Safety tips from the American Academy of Orthopaedic Surgeons:

Properly set up the ladder on a firm, level surface. When you are cleaning out the garage or closet, be careful pushing or pulling anything from shelves while standing on a ladder. You could lose your balance and fall off.

Watch for soft, muddy spots or uneven flooring, and never place a ladder on ground that is uneven.

Remember the 1-to-4 rule: the bottom of the ladder should be 1 foot away from the wall for every 4 feet that the ladder rises.

It’s very important to select the right ladder for the job. When working at low and medium heights, choose step stools or utility ladders.

Extension ladders are ideal for use outdoors to reach high places, as when hanging items from the rooftop.

Be careful when putting up holiday decorations, including lights and trees. Move materials with caution when on the ladder, and always position the ladder close to the work area, so you do not lose your balance and fall.

Be mindful of any rearranged furniture and new decorations and make sure others in the house are familiar with the changes as well.

Consider installing night lights in an area that is rearranged to avoid nighttime confusion.

To learn more:


The crippling costs of workplace obesity


By Donald Liebenson, The Fiscal Times

This story comes from our KaiserHealthNews partner

In spite of high unemployment numbers, there’s a lot of fat in the workplace—and it’s costing a bundle.


Photo: Asif Akbar

With studies over the past three years showing that American workers’ expanding waistlines are impacting corporate bottom lines even more dramatically than previously thought, through increased health care costs and decreased productivity, major corporations are taking action.

They can’t afford not to. Two thirds of Americans are obese or overweight today.

And as their health goes, so goes that of their employers. Health costs alone are an estimated $147 billion annually according to the Centers for Disease Control (CDC).

And private employers are hit with an estimated $45 billion a year in medical expenditures and work loss, according to a 2008 report by the Conference Board (the latest report available).

At Advocate Health Care, one of the largest health care providers in the Midwest, obesity cost nearly $6 million in lost productivity last year alone.

States and communities with high obesity rates also have a lot to lose . . . businesses are reluctant to locate to areas where workplace pools are unhealthy.

That’s six times as much as the costs attributed to smoking.

“Through our health-risk assessment, 69 percent of our population is overweight,” said Nicole Martel, senior manager for fitness and wellness at Advocate. “This is a huge focus for us.”

Losing Pounds or Losing Business

States and communities with high obesity rates also have a lot to lose.  “F as in Fat: How Obesity Threatens America’s Future 2010,” a report last month from advocacy organization Trust for America’s Health and the Robert Wood Johnson Foundation, said businesses are reluctant to locate to areas where workplace pools are unhealthy.

Those unhealthy “sites” are proliferating. Adult obesity rates have now jumped in 28 states, with 38 states declaring adult obesity rates above 25 percent, according to the report. Ten years ago not a single state had an obesity rate above 20 percent.

Obesity is called a gateway condition because it can lead to heart disease, diabetes, and hypertension. But overweight employees pay for their girth in other ways.

For starters, they can be vulnerable to pervasive weight discrimination. A Chicago-area recruiter who requested anonymity recalled an impressive job candidate who was very professional, had all the right credentials, and did well in the telephone screening.

To assist employers in establishing obesity-prevention programs, the CDC recently established LEAN Works, a free web-based resource.

But when she brought the candidate in for a face-to-face interview, she was shocked at his physical size. “The HR director of the company said to me afterward, ‘I’d be very hesitant to hire a guy like him because he clearly has something going on.’”

“Weight discrimination has increased 66 percent over the past ten years,” said Rebecca Puhl, director of research and weight stigma initiatives for the Rudd Center for Food Policy and Obesity at Yale University. “It’s very pervasive and hard to prove. Employers can mask the real reasons for refusing to hire someone.” Also, “obese women earn six percent less for the same work. Men earn three percent less.”

Significant Corporate Investments

In an effort to reduce costs, more companies are offering proactive wellness programs to their employees. IBM spends more than 1.3 billion a year on health care for the 450,000 employees, retirees, and family members it covers in the United States.

Between 2005 and 2007, the company saved $190 million in health care costs because employees took responsibility for adopting healthier behaviors.

Logo for CDC's LEAN Works! - A Workplace Obesity Prevention ProgramTo assist employers in establishing obesity-prevention programs, the CDC recently established LEAN Works, a free web-based resource.

“Employers realized several years ago that to slow [their health care] cost increases, they had to do a lot more than just treat people when they’re sick,” said Peter Hotz, a group vice president at Walgreen’s.

Advocate Health Care offers its 24,000 employees and their dependents an incentive point program. Participants can earn a $200 credit toward a reimbursement account for medical expenses as well as points for participating in sponsored programs. Cash cards worth $100 are awarded in bimonthly raffles, and an annual grand prize raffle offers the top prize of $5,000.

But companies can go even further. Linda Barrington, who co-wrote the Conference Board report and is managing director at the Institute for Compensation Studies at Cornell University, said, “Employers [should] think about the sort of draconian measures that New York’s mayor Michael Bloomberg has taken in forcing all restaurants to put calorie counts on the menus. It’s actually had a measurable impact. If you tell people how many calories [they consume,] they’re going to make healthier choices.”

PHOTO: Asif Akbar

To learn more:

Local Resources:

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.