The United States has a higher rate of babies born too early – and therefore at greater risk of death or health problems – than more than 125 other countries, including Rwanda, Uzbekistan, China and Latvia, according to a report out today.

About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks.

Click to view interactive map and charts

While nearly two thirds of all pre-term births worldwide occur in Sub-Saharan African and Asia, the U.S. rate shows that “this is not just a developing country issue,” says Chris Howson, vice president for global programs at the March of Dimes.

His organization, along with the World Health Organization, Save the Children and the Partnership for Maternal, Newborn & Child Health, produced the report. It says about one million pre-term babies worldwide die shortly after birth, while others can suffer lifelong health problems.

Born Too Soon is a joint effort of almost 50 organizations, including the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

“This report sounds the alarm that prematurity is an enormous global health problem that urgently demands more research and resources,” said Craig Rubens, MD, PhD, executive director of GAPPS and contributor to the report.

“Even if every known intervention was implemented around the world, we would still see 13.8 million preterm births each year; we could only prevent 8 percent,” he said.

Maternal risk factors include being under- or over-weight, having diabetes or high blood pressure, smoking, being younger than 17 or over age 40.

Rates within countries can vary widely. In the U.S., for example, the pre-term birth rate for white women in 2009 was 10.9 percent, compared with 17.5 percent for African American women, the report says.

In the U.S. and some other developed countries, pre-term births are also linked with a higher use of fertility drugs, which are associated with mothers carrying twins, triplets or more, increasing the chance of early labor. Some births in the U.S. are also induced early, either because the mother is having health problems or for the convenience of the doctor or mother.

Because pre-term births are costly and dangerous, physician groups, organizations like the March of Dimes and even some employers have ongoing efforts to discourage women and their doctors from scheduling births before 39 weeks, unless there is a health reason to do so. The Obama administration launched a $40 million program in February aimed at reducing the number of premature births, especially elective deliveries.

Those elective early births are also the subject of a March of Dimes education campaign, which says even though the absolute numbers are small, the risk of death for babies born just one to two weeks early is twice as high as for those born at 39 weeks.

Howson says the groups that signed on to the report have made a variety of suggestions for lowering the rate worldwide, ranging from inexpensive injections that can be given to mothers in preterm labor to help develop fetal lungs to encouraging women to have health exams before they get pregnant to check for risk factors.

“A preterm baby indicates a failure in the system,” he says.

This article was reprinted from kaiserhealthnews.org 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.

A new study finds U.S. physicians are performing Pap smears far more often than needed to prevent cervical cancer.

The study, published in The Milbank Quarterly, examines Pap smear usage alongside cervical cancer mortality data in the U.S. and the Netherlands between 1970 and 2007.

Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCI

While American doctors performed about three or four times as many Pap smears as Dutch doctors did, the rates at which women developed or died from cervical cancer were roughly equal for the two nations.

“This strongly suggests that the Dutch approach to cervical cancer screening is much more efficient than the U.S. approach. We did detect some potential shortcomings in the Dutch approach, but the evidence suggests that the U.S. could move substantially in the direction of the Dutch program, at considerable economic savings, without sacrificing health benefits,” said co-author Martin L. Brown, Ph.D., of the National Cancer Institute.

KEY POINTS

• In the U.S., women received three to four times the number of Pap smears over a period of three decades as women in the Netherlands, yet the two countries’ cervical cancer mortality rates were similar.

• The Netherlands follows a model of screening based on governmental guidelines; the U.S. has traditionally followed a model based on decisions by individual physicians, insurance plans and guidelines from medical organizations.

The Netherlands has long treated cancer screening as a national public health endeavor carried out by doctors who generally follow National Ministry of Health guidelines, the study reports.

Meanwhile, the U.S. follows a medical model: individual doctors choose who to screen and how often. U.S. doctors select from or ignore guidelines from various organizations and from the government’s U.S. Public Health Service.

Overall, in the Netherlands, cancer screenings adhere to the most recent evidence. There, a woman generally undergoes a lifetime total of 7 Pap smears between ages 30 and 60. Doctors typically screen patients every five years, depending on their age and risk level.

“In the U.S., actual medical practice lags behind and diverges strongly from evidence-based guidelines,” says Brown. Screening guidelines U.S. doctors adopt from highly influential medical societies vary widely, calling for anywhere from 20 to 33 Pap smears. Screenings often take place annually, without regard for a woman’s age or risk.

While the study discussed only cervical cancer evidence, the authors did note that its themes might apply to differences in screening for many preventable diseases.

Darcy Phelan, DrPH with the Johns Hopkins Bloomberg School of Public Health, hopes that policy makers will consider these findings as they address ways of preventing cervical cancer that are more efficient. “These findings suggest that broad adoption of a policy to extend the Pap screening interval will protect patient safety while reducing costs. This will be especially important as prevention costs escalate in the context of human papillomavirus (HPV) vaccination among girls and young women.”

Both experts noted that the U.S. Preventive Services Task Force included extension of the interval in its recently updated cervical cancer screening guidelines.

Phelan added that the study confirms the importance of screening all women, as most cervical cancers occur among those never screened or not screened within the recommended interval.

Screening all women has great potential to reduce persistent racial and ethnic disparities in cervical cancer in the U.S., she says.

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.

Mother Jones: Santorum In ’93: More Government Needed in Health Care

Rick Santorum (Photo: Gage Skidmore)

If elected president, Santorum vows, he will end the “tyranny” of President Obama’s Affordable Care Act. Yet as an up-and-coming congressman in the early 1990s, Santorum took a much different line. Then—like now—health care was one of the nation’s most divisive issues. In 1993, Republicans were up in arms about a health care reform bill spearheaded by Hillary Clinton and pushed by President Bill Clinton. … During that fiery debate, Santorum said it would be a mistake to allow the delivery of health care services to be determined only by the market. He asserted that Republicans were “wrong” to let the marketplace decide how health care works. He instead argued that government should play a “proactive” role in shaping the health care marketplace “to make it work better” (Andy Kroll and Tim Murphy, 3/5).

The Atlantic: Making The Best Of What Is Often The Very Worst Time Of Our Lives (Book Excerpt)

As difficult as things are now, these may turn out to be the good old days. How we die is already a public health crisis, and care for people through the end of life is poised to become a generation-long social catastrophe. … Very soon, for the first time in human history, older people will outnumber younger people on our planet. In the United States, one in five adults is 65 or older. … Those of us who are concerned about long-term care have good reasons to worry. The nursing homes of the future — our future! — may make today’s nursing homes look like luxury hotels. It doesn’t have to turn out that way (Ira Byock, 3/7).

American Medical News: Legal Risks Of Going Paperless

System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability. … Studies are mixed about how EMRs will impact liability for physicians. … Whatever the future holds for EMRs, it’s important that doctors reduce their liability risks during system implementation, legal experts say. Being aware of potential legal pitfalls prevents doctors from falling victim to technology intended to do good — not cause hardship (Alicia Gallegos, 3/5).

The Daily Beast: Talking About Sex Is the Only Way To Stop HIV

[The United States has] been stuck at about 50,000 new infections each year for more than a decade. Compared with the challenges facing places like sub-Saharan Africa, our failure is particularly galling: we have plenty of drugs that work, the money and systems to administer them, and effective, if not particularly popular, ways to interrupt the spread (condoms, clean needles, abstinence). So why aren’t we doing better? The answer is blindingly simple: sex. Almost all HIV in the U.S. is spread by sexual intercourse, yet when faced with this fact, we act like a bumbling junior-high-school kid hearing about the birds and the bees for the first time. As a result, we have before us an unabated 30-year epidemic of a sexually transmitted disease (Kent Sepkowitz, 3/5).

This article was reprinted from kaiserhealthnews.org 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.

Photo Dan Shirley

By Julie Appleby
KHN Staff Writer

While controversy over one aspect of the Obama administration’s contraception rule – whether and when religiously affiliated employers must comply – has dominated recent headlines, that debate has obscured other questions about how the rules will actually be implemented.

Under the health law, insured women will qualify for contraceptives without a copaymentas part of a range of preventive medical services. But insurers and advocates are frustrated by the lack of details. They’re asking, for example, whether surgical procedures must also be covered at no additional cost to patients.

“The unknown answers to the myriad of questions remain very worrisome,” says Judith Lichtman, senior advisor to the National Partnership for Women and Families, an advocacy group in Washington D.C.

America’s Health Insurance Plans (AHIP), the industry lobbying group, sent a list of questions to the Department of Health and Human Services (HSS) in September, asking for clarification on what types of contraceptives must be covered and how insurers should structure their policies. A spokesman for AHIP says the group is still awaiting answers to some questions.

Contraceptives are part of a package of women’s preventive health care services under the Affordable Care Act — including screening for diabetes, counseling about sexually transmitted diseases and breast feeding support — that must be provided without deductibles or co-pays in all new policies beginning Aug. 1. The package was drawn up after recommendations from the Institutes of Medicine (IOM). Other parts of the health law also provide no-cost-sharing preventive services for children and all adults, such as certain cancer screenings and immunizations.

Here are some questions, and answers when we could determine them, about the rules:

1) Are male-based contraceptive methods, such as vasectomies or condoms, covered by the rule?

An HHS official said on Friday that women’s preventive services guidelines apply to women only.

Guidelines issued by the Health Resources and Services Administration, part of HHS, require coverage without cost sharing for “all Food and Drug Administration-approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity” as prescribed by a provider, according to the Federal Register.

The insurers’ letter from September says they interpreted the rule to include only female-based contraception and that the requirement to waive co-payments “does not apply to methods and procedures intended for males.”

But Adam Sonfield, senior public policy associate at the Guttmacher Institute, a reproductive health research group, says the language is unclear, and it would be foolish to exclude vasectomies. For one thing, he says, they are less expensive and pose a lower risk of complications than female surgical sterilization methods. Plus, he says, waiving co-payments for services for one sex but not the other raises issues of discrimination.

“I can’t see how it would be in anyone’s interest to treat them differently,” says Sonfield.

2) Are over-the-counter products like female condoms, spermicides, sponges covered by the rules and, if so, will they require a prescription and how will insurers reimburse policyholders for purchases at retail stores?

Products that must be covered without cost-sharing include over-the- counter contraceptives when they are prescribed by doctors, the HHS official said Friday. But getting a prescription for such items raises other issues, say advocates and insurers.

Insurers wrote HHS in September that “it is unclear what specific over-the-counter products are to be included.”

In addition, the letter warned that requiring a prescription for such items “would increase the burden on an already over-burdened primary care system and drive up administrative costs.”

Insurers wrote the industry has no simple way to track and reimburse policyholders who purchase those items at retail stores. Setting up such systems, “could cost tens of millions” and exceed the cost of the products themselves.

Requiring a prescription should definitely not be required, says Lichtman, who said such a move would make using contraception more difficult and expensive for women.

3) If a hospital stay is required for surgical procedures, such as when a women gets her tubes tied, would the procedure be covered without cost sharing?

Insurers say it is not clear if hospitalization or complications that might occur from surgery would be covered without the patient paying a co-payment or a deductible because they are not considered preventive.

Sonfield at Guttmacher argues they would be covered.

“It’s like saying you have to cover blood transfusions, but not the hospital stay,” he says. “That doesn’t make sense. If you’re covering it, you’re covering it all.”

HHS has not weighed in on this question, but is expected to issue additional guidance in the coming months.

Julie Appleby reports on the implementation of the health care overhaul law, the interplay of health care treatments and costs, trends in health insurance, and policy issues affecting hospitals and other medical providers. Her KHN stories have appeared in USA Today, the Washington Post, the Philadelphia Inquirer and MSNBC, among others. Before joining KHN in March 2009, Appleby spent 10 years on the health care industry and policy beat for USA Today. She also worked at the San Francisco Chronicle, the Financial Times in London and the Contra Costa Times in Walnut Creek, Calif. She serves on the board of the Association of Health Care Journalists and her education includes a Master of Public Health degree. | Contact: JulieA@kff.org

4) Will insurers be required to cover all products in a class, such as all IUDs, or all birth control pills? Can insurers require a co-pay for a brand-name drug if a generic is available?

Many insurers have “tiered” pharmacy benefits under which patients pay differing amounts for brand-name, as opposed to generic, products. Some require patients who choose a brand-name drug, when an equivalent generic is available, to pay the price difference between the two. Insurers say HHS guidance allows them to use such “reasonable medical management” to help control costs. That would include allowing insurers to charge patients for brand name drugs, it says.

The HHS official confirmed that, but stressed the plan must “accommodate any individuals for whom it would be medically inappropriate by having a mechanism for waiving the otherwise applicable cost-sharing for the branded version.”

Advocacy groups and insurers are in discussions with HHS over those and other questions related to preventive care, says Lichtman. Her group hopes the agency will soon release additional guidelines that “are broad enough so that all methods prescribed by doctors necessary for women’s health will be covered.”

5) Who will be covered for contraceptives without co-payments?

The package of women’s preventive care benefits must be offered in all new insurance policies sold to individuals and employers starting Aug. 1, as well as in most policies that renew afterwards on the date that they renew. There is an exception for insurance provided by certain nonprofit religious employers who object to birth control.

Twenty-eight states already require insurers to cover contraceptives, although large, self-insured employers are generally exempted from state rules. But a 2010 Kaiser Family Foundation/HRET survey of employers found that 85 percent of large firms offered prescription contraceptives in their plans, although they often required a patient co-pay or deductible. (KHN is a program of the foundation)

As for the types of procedures covered, the IOM cites a 2011 Bureau of Labor Statistics analysis of 3,900 employer plans, which found that policy documents representing about 70 percent of participants did not mention sterilization. But when sterilization services were mentioned, nearly 90 percent of the policies covered both female and male surgical sterilization procedures.

PHOTO: Courtesy of Dan Shirley

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This article was reprinted from kaiserhealthnews.org 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.

The Daily Beast: How Karen Handel’s Komen Resignation Boosts Her Political Prospects

Even if you put politics and ideology completely aside, Karen Handel had to resign from Susan G. Komen for the Cure. It’s hard to think of the last time an employee did so much damage to such a respected brand in so little time. … But while Komen will sustain long-term damage, Handel probably will be just fine. Yes, she’s lost her position as Komen’s vice president for public policy. But Handel has long had political aspirations, and she’s now a right-wing cause célèbre. When she ran for the Georgia Republican gubernatorial nomination two years ago, she was attacked for being insufficiently anti-abortion. That’s unlikely to happen again. “It’s kind of hard to criticize her now,” Joel McElhannon, a Georgia-based GOP strategist, told the Associated Press (Michelle Goldberg, 2/8).

TIME: New Criteria May Change Alzheimer’s Diagnosis

Recently revised guidelines for diagnosing Alzheimer’s disease would reclassify nearly all patients who are currently diagnosed with mild or very mild Alzheimer’s as having mild cognitive impairment (MCI), a new study finds. The change may be confusing for doctors and misleading for patients and their families, says Dr. John Morris, a neurologist at Washington University in St. Louis. Reporting in the journal Archives of Neurology, Morris finds that 99.8 percent of patients now diagnosed with very mild Alzheimer’s dementia would actually be considered to have MCI, according to the latest guidelines. Among patients with mild Alzheimer’s, 92.7 percent would be reclassified as having MCI (Alice Park, 2/8).

KHN summarized other news coverage on Alzheimer’s this week: Obama Administration Pledges $156 Million For Alzheimer’s Research And Care (2/8).

American Medical News: The Limits Of Treating Loved Ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped. So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again — this time from an emergency department. The doctors there said she had a heart attack. … Professional ethics policies have long warned about the perils of physicians treating themselves or family members. … Yet medical board officials say such rules are commonly violated by well-meaning physicians, either knowingly or unknowingly (Carolyne Krupa, 2/6).

Scientific American Mind: Thinking About Mortality Changes How We Act

The thought of shuffling off our mortal coil can make all of us a little squeamish. But avoiding the idea of death entirely means ignoring the role it can play in determining our actions. Consider the following scenario: … It’s the middle of the night when you are suddenly awakened from a deep sleep by the sound of screams and the choking smell of smoke. … [S]ome thoughts of death shore up our beliefs, and other types of reflection make us reexamine them. Which kind leads to a better life? For their experiment, Blackie and Cozzolino recruited volunteers aged 17 to 76 and primed them in different ways (Wray Herbert, 2/6).

The New Yorker: Out The Window

Today is January, midmonth, midday, and mid-New Hampshire, and the writer sits in his blue armchair looking out the window. He is eighty-three. He teeters when he walks, he no longer drives, he looks out the window and watches birds come to his feeder. … The cow barn forty yards away was built in 1865, and he gazes at it every day of the year. His mother turned ninety in the Connecticut house where she had lived for almost sixty years, and she spent her last decade looking out the window. She died in a nursing home one month short of ninety-one. A year later, Jane, the writer’s wife, at forty-seven, was dying of leukemia (Donald Hall, 1/23).

Newsweek/Chicago Tribune: Life With Trig: Raising A Special-Needs Child

Families of children with special needs are bonded by a shared experience of the joys, challenges, fears, and blessings of raising these beautiful children whom we see as perfect in this imperfect world. … When I discovered early in my pregnancy that my baby would be born with an extra chromosome, the diagnosis of Down syndrome frightened me so much that I dared not discuss my pregnancy for many months. All I could seem to muster was a calling out to God to prepare my heart for what was ahead. My prayers were answered beyond my shallow understanding of what true joy could be (Sarah Palin, 2/9).

This article was reprinted from kaiserhealthnews.org 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.