Light & Depression – How Eyes Can Make Us Happier

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Extreme close up of the iris of a blue eye

Image: JDrewes

Dr. Russell N. Van Gelder, UW professor of ophthalmology, will be giving a lecture, “Light & Depression – How Eyes Can Make Us Happier” at the UW Medicine Eye Institute (7th Floor, Ninth and Jefferson Building at Harborview Medical Center).

Dr. Van Gelder, who is also chairman of the Dept. of Opthalmology, is internationally known for his work on how light and our eyes can affect our moods – research that has implications for depression, seasonal affective disorder, and even jet lag.

This lecture is a part of the UW Medicine Eye Institute monthly, free brown bag lectures.

When:

  • Tuesday, October 12, noon

Where:

  • UW Medicine Eye Institute (7th Floor, Ninth and Jefferson Building at Harborview Medical Center).

For more information or to RSVP, please call 206-685-2314.

Image Credit: JDrewes in Wikipedia under Creative Commons Attribution-Share Alike 3.0 Unported license.

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Scale

Tools to fight obesity

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Focus on obesity

By Carolyn M. Clancy, M.D.

Obesity is literally a growing problem.

Today, 72 million Americans are obese. As you probably know, obese people are more likely to suffer from diabetes, heart disease and other chronic health problems.

But did you also know obesity can be bad for your budget?

It can.

On average, obese people spend $732 more each year on medical expenses than those with normal weight, according to a 2009 study sponsored by my agency, the U.S. Agency for Healthcare Research and Quality (AHRQ).

The study also found that obese workers are paid less than other workers.

The terms “overweight” and “obese” refer to a person’s overall body weight. People who are overweight carry the extra weight in muscle, bone, fat, and/or water. People who are obese have a high amount of extra body fat.

Obesity has become an epidemic, hurting people’s health and costing as much as $147 billion each year in the United States, according to the Centers for Disease Control and Prevention (CDC).

In 2009, nine States—Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and West Virginia—counted nearly one of three residents as obese, according to the CDC.

This is a serious development. In 2000, no State had such a high rate.

In contrast, Colorado and Washington, D.C., have the lowest rates with fewer than one in five residents classified as obese.

Americans need more information.

A recent AHRQ report shows that many patients don’t receive information from their clinicians about the risks of obesity or how to control or lose weight. This is true even for patients who already are overweight or obese:

  • Only one in four overweight children and teens was told by a doctor or health professional that they were overweight between the years 2003 and 2006.
  • During the same period, only 65 percent of overweight adults were told by a health professional that their weight was unhealthy—fewer than three years earlier.
  • Only about one-third of uninsured adults received that advice in 2004.
  • Obese people who are black, Hispanic, or do not have a high school diploma are less likely to receive advice about good food choices from their doctors. Only about one in four blacks and Hispanics received advice about eating lower-fat or low-cholesterol foods, for example.

As a nation, we’re taking steps to get healthier. First Lady Michelle Obama is raising awareness of childhood obesity through her campaign Let’s Move.

Earlier this year, the U.S. Preventive Services Task Force recommended that clinicians screen children aged 6 years and older for obesity and offer or refer them to intensive weight loss programs.

The Patient Protection and Affordable Care Act, which was signed into law last March, comes with important new benefits. This Act will help more children get health coverage, end lifetime and most annual limits on care, and give patients access to free, recommended preventive services.

The act now requires private insurance plans to provide obesity screening for all adults and children at no cost. Height, weight and body-mass index (BMI) measurements for children also are covered as a preventive service.

BMI is a number calculated from a person’s weight and height, providing an indicator of body fat for many people.

Beginning in January 2011, patients covered by Medicare and patients enrolled in new health plans created by the law will receive more preventive services.

This includes counseling from your health care provider on losing weight and eating healthfully.

Here are some steps you can take:

  • Know your BMI. The body mass index or BMI is the most common measure of overweight and obesity. BMI is based on height and weight and is used for adults, children, and teens. Calculate your BMI. For adults, a BMI of 30 or above means you are obese.
  • Talk to your doctor or nurse. Even if your doctor doesn’t talk about your weight, you can. Ask your doctor questions about how losing weight may help you. Also, ask about local programs and resources that can help you.

Just think: The steps you take to help your health will also help your wallet.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

____________________

Local Resources:

____________________

More Information

AHRQ Podcast
Obesity in America (TranscriptPodcast Help

U.S. Preventive Services Task Force
Screening for Obesity in Children and Adolescents
http://www.uspreventiveservicestaskforce.org/uspstf/uspschobes.htm

Centers for Disease Control and Prevention
Healthy Weight
http://www.cdc.gov/healthyweight/index.html

BMI Calculator
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

Healthfinder.gov
Watch Your Weight
http://www.healthfinder.gov/prevention/ViewTopic.aspx?topicID=25

Let’s Move
http://www.letsmove.gov/about.php

Current as of October 2010


Internet Citation:

Focus on Obesity. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, October 5, 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc100510.htm

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Nurse holds up stethoscope

Report calls for a more independent role for nurses

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By Andrew Villegas and Mary Agnes Carey
KHN Staff Writers

A new report released today may give nurses with advanced degrees a potent weapon in their perennial battle to get the authority to practice without a doctor’s oversight.

The Institute of Medicine report says nurses should take on a larger and more independent role in providing health care in America, something many doctors have repeatedly opposed, citing potential safety concerns.

It calls for states and the federal government to remove barriers that restrict what care advanced practice nurses — those with a master’s degree — provide and includes many examples of nurses taking on bigger responsibilities.

“A qualified health care professional is a terrible thing to waste,” Cheryll Jones, a pediatric nurse practitioner in Ottumwa, Iowa, told the authors.

“We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health care system . . . .” — Donna Shalala

The report calls for elimination of “regulatory and institutional obstacles” including limits on nurses “scope of practice” — which are state rules about what care people who are not physicians can provide.

The findings come from the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, a collaboration among nurses, doctors, health care business leaders and academics that studied the issue for two years.

While the report addresses a ongoing battle being played across state legislatures, it’s not clear if the new report will have any impact on those battles. The panel is planning a meeting next month to discuss ways to implement its recommendations.

The new federal health care law provides more funding for nursing education and nurse-led clinics, but this study could also propel the nurses’ argument for more authority to deliver care independently from physicians.

“We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health care system — in leadership, in education and training, and in the design of the new health care system,” said Donna Shalala, a former Health and Human Services secretary and chair of the IOM’s committee on the future of nursing. “We can’t be fighting with each other if we really are going to have a high quality system that we can afford.”

Doctors maintain that even with an advanced degree, these nurses do not have the same education that physicians get in medical school and residency programs and that patient safety could be compromised.

For years advanced practice nurses — as well as a host of other caregivers such as chiropractors and physical therapists —have butted heads with doctors over “scope of practice” considerations.

Doctors maintain that even with an advanced degree, these nurses do not have the same education that physicians get in medical school and residency programs and that patient safety could be compromised.

They are also wary that their practices could see significant patient losses if the nurses were allowed to practice more independently.

In its recommendations, the committee said Medicare and Medicaid should reimburse advanced practice nurses the same as a physician for providing the same care. “When you do the same job you ought to be paid the same,” Shalala said.

Also, the report calls for nurses to be allowed to admit patients to the hospital or to a hospice and for the Federal Trade Commission and the Department of Justice to review existing scope of practice provisions for “anticompetitive” practices.

The Obama administration has signaled its commitment to increasing the number of primary care providers, including nurses. Late last month the Department of Health and Human Services announced $320 million in grants to strengthen the health care workforce.

The grants include $31 million to 26 nursing schools to increase full-time enrollment in primary care nurse practitioner and nurse midwife programs and $14.8 million for nurse-managed health clinics.

In addition, Peter Buerhaus, a registered nurse, heads the newly formed National Health Care Workforce Commission, which was set up under the new law to advise lawmakers on how to change the health care workforce to better fit America’s needs.

Experts predict that more physicians, nurses and other medical professionals will be needed to care for the 32 million additional Americans who will get coverage beginning in 2014 under the sweeping health care law.

Nurses’ groups say that they can help ease a physician shortage. Last week, the Association of American Medical Colleges said in a report that in 2015, there will be a shortage of nearly 63,000 doctors across all specialties in America.

Dr. Rebecca J. Patchin, a former nurse who is now anesthesiologist and member of the American Medical Association’s Board of Trustees, said that physicians must be involved to help protect patients.

“We think that care in the operating room or care in the office is best done with physician involvement and oversight,” Patchin said. “Due to that additional training that they have … when or if a complication occurs they are better equipped to handle it.”

The battle is being waged across the country. Colorado, for instance, recently became the 16th state to allow nurse anesthetists to work without a doctor’s oversight.

In Michigan, nurses are pushing for legislators there to allow advanced practice nurses to prescribe drugs. Other fights over scope of practice for registered nurses loom in Kentucky, North Carolina, Iowa and Minnesota.

But, Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists, said the clashes between nurses and doctors scare the public.

“It’s exactly what people worry about when they worry about what health reform will bring,” he said. “Patients and voters say ‘If you’re talking about taking the docs out of my health care, I want no part of it.’”

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.

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Calendar

UW Medicine’s Seattle Public Library lecture series begins this week

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Learn about issues that affect your health, and new ways doctors are treating common health problems at the UW Medicine & The Seattle Public Library 2010-2011  free public lecture series.

  • All lectures start at 6:30 p.m., Microsoft Audorium, Central Public Library, 1000 Fourth Ave., Seattle.
  • Call 206.685.1933 for details.

Wednesday, October 6: Lessons in lessening your migraine pain

  • Dr. Sylvia Lucas, founder and director of the UW Medicine Neurology Headache Center

Wednesday, November 3: The gift of giving: How one living donor can start a chain of transplants

  • Dr. Connie Davis, UW professor of medicine and director, Kidney Care and Transplantation Services

Wednesday, December 1: Baby boomers need to get smart when it comes to the heart

  • Dr. Larry Dean, director, UW Medicine Regional Heart Center

Wednesday, February 2: Harnessing the body’s own healing potential

  • Dr. Kim Harmon, UW Sports Medicine

Wednesday, March 2: New treatments in the pipeline for Parkinson’s patients

  • Dr. Hojoong “Mike” Kim, UW Medicine Neurology

Wednesday, April 6, 2011: It’s a team effort to help those with ADHD

  • Dr. Christopher K. Varley, UW Child & Adolescent Psychiatry
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Seattle Children's Whale Logo

Medication errors prompt review at Seattle Children’s

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Seattle Children’s will conduct a complete review of the way it administers medications after three serious incidents involving medication errors occurred, Dr. David Fisher, the hospital’s medical director, said Friday.

In one case, an infant being treated in the hospital’s intensive care unit died after receiving ten times the intended dose of the drug calcium chloride.

“We believe this mistake occurred because of a mathematical miscalculation. The patient, an infant who was profoundly fragile, later died of complications of the overdose,” Dr. Fisher said in a prepared statement.

In the second case, a critically ill newborn was being transferred from another hospital to Seattle Children’s by the Children’s neonatal ambulance team, when a member of the team administered medications without an order from a physicians.

These medications are often administered to infants who are having difficulty breathing, Dr. Fisher said, but Seattle Children’s policy requires that they only be administered on orders from a physician. “The order step did not happen in this case.”

The infant later died, but the cause of death has not yet been determined. “I want to stress that it is quite possible that these medications have nothing to do with the death of this infant,” Dr. Fisher said.

The third case involves an adult who arrived at the Seattle Children’s emergency room with “life-threatening respiratory distress” that required immediate attention, Dr. Fisher said.

Initially the patient’s condition improved, but then worsened. In response, a hospital physician incorrectly ordered a medication to be given intravenously that should be given intramuscularly. This patient did recover and was transferred to a hospital for adults.

The hospital is scheduling a full-day review of its medication administration practices, during all non-emergent operations, including outpatient clinics and elective surgeries will be suspended.

Dr. Fisher said that in response to these events, Seattle Children’s will look at its entire medication delivery system, reviewing the clinical records of each incident and performing a “detailed root-cause analysis to determine why our usual safety processes failed.”

While awaiting the results of this review, the hospital is allowing only pharmacists and anesthesiologists to prepare doses of calcium chloride in non-emergent situations and has required more than 1000 clinical staff to attend mandatory meetings to review medication safety policies and practices, Dr. Fisher said.

The hospital is scheduling a full-day review of its medication administration practices, during all non-emergent operations, including outpatient clinics and elective surgeries will be suspended.

In addition, the hospital plants to enlist the help of “an independent team of patient safety experts to perform a comprehensive review of our medication ordering, dispensing, and administration,” Dr. Fisher said, and will “commit whatever financial resources it takes to provide the safest environment possible.”

In a related story, today’s Seattle Time’s, staff reporters Sean Collins Walsh and Janet Tu report that “recent deaths of two babies under the care of Seattle Children’s hospital has prompted a Seattle father to speak out, saying his family is still waiting for answers about why their 2-year-old son was left with irreversible brain damage after heart surgery at the hospital earlier this year.”

Walsh and Tu write:

Osman Ali, who was born with a heart defect “but was doing everything that a normal child” that age would do, lost his ability to see, speak and walk after the Feb. 5 surgery at Children’s, said his father, Nasir Ali.

According to the story, “Seattle Children’s declined to comment on the case, saying it needed more time to review it.”

To learn more:

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Trike Square

Fisher-Price recalls more than 10 million products

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From the U.S. Consumer Product Safety Commission

By CPSC Blogger on September 30, 2010

Recalled Fisher Price Tricycle

Click on image to learn more

Fisher-Price is recalling more than 10 million children’s products that were sold in the United States.

Fourteen models of the Fisher-Price Trikes and Tough Trikes toddler tricycles can cause serious injury, including genital bleeding when a child sits, strikes or falls on a pretend plastic ignition key.

CPSC and Fisher-Price know of 10 injuries, including six girls between the ages of 2 and 3 who needed medical attention after falling against the pretend key that is sticking up in front of the toddler tricycle seat.

Fourteen models of Fisher-Price Trike and Tough Trike tricycles have pretend keys sticking up in front of toddler tricycle seats that can cause serious injury.

Recalled Fisher Price infant activity centers with inflatable balls

Click on image to learn more

There are seven models of infant activity centers with inflatable balls in which the valve from the balls comes off. We know of 14 valves found in children’s mouths. There were three reports of a child beginning to choke on the valve. In total, we have 46 reports of the valves coming off.

Children can fall on or against pegs on the back legs of nearly 950,000 Fisher-Price high chairs. We know of seven children who fell on or against these legs and needed stitches and one who had a tooth injury.

Wheels detach from these green and purple Little People vehicles

Fisher-Price Little People Wheelies Stand ‘n Play Rampway cars

Click on image to learn more

And finally, the wheels can come off of two cars in the Fisher-Price Little People Wheelies Stand ‘n Play Rampway, posing a choking hazard to young children.

One of the recalled Fisher Price high chairs showing defective part

Click on image to learn more

Fisher-Price did the right thing in agreeing to provide consumers with free remedies for these products. But all companies must do better.

They must give more attention to building safety into their products.

They must work to ensure that they are adhering to safety standards.

And if any company finds itself with a defective product or one that is causing injuries, it must report the problem to CPSC immediately.

Meanwhile, as moms, dads and caregivers, you, too, have a role. We thank the dozens of you who reported these incidents. Thanks to you, CPSC was able to investigate, work with Fisher-Price on a remedy and recall these products.

If a toy breaks in your child’s hands or if your child suffers an injury from a product, tell us so that we can investigate. And if you own one of these recalled products, stop using it and contact Fisher-Price for free repair kits and replacement products.

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Healthcare.gov

You can now compare health plan prices and benefits online

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Health Insurance Prices, Restrictions Now On Federal Consumer Website

By Jessica Marcy
KHN Staff Writer

Healthcare.gov, the website created by the new health law to be a one-stop consumer resource, today unveiled detailed cost and benefits information about health plans available in the individual insurance market.

Healthcare.gov

Click on image to go to Healthcare.gov

It’s the first time such data have been made public – either by the government or industry.

The site will also list the percentage of applications turned down and of people who are charged more than that health plan’s advertised price.

HHS officials say now consumers will be able to solve some of the mysteries behind costs and denials.

By entering basic information such as age range, location and health status, visitors can compare plans based on monthly premium estimates, maximum out-of-pocket limits, annual deductibles, and coverage for benefits such as mental health, substance abuse and pregnancy.

Since its July 1 launch, healthcare.gov has had more than 1.8 million visits, according to Todd Park, the chief technology officer of the Department of Health and Human Services, who says visitors are “overwhelmingly positive” about the site.

KHN reporter Jessica Marcy recently spoke with Park and Karen Pollitz, who heads the consumer support division at HHS Office of Consumer Information and Insurance Oversight. Here are excerpts of the interview:

What exactly are the prices? Are they sticker prices or real prices?

Karen Pollitz: Sticker price would be a good way to describe it. Price has always been sort of an elusive concept in the individual health insurance market and it remains so today. Insurers all have a base price, or a sticker price, that they may advertise or they may post for a health insurance policy.

Portrait of Karen Pollitz

Karen Pollitz

But, the price that you actually pay will depend on characteristics unique to you – your age, your family size, where you live, your gender, also your health status and your health history.

While some of these demographic factors may be posted and knowable to you, you won’t really know until you try to apply for the policy whether you’ll be accepted at all or be given something close to the sticker price.

[KHN Editor's note: while in car dealerships the "sticker price" usually is higher than the price the buyer negotiates, in this case, the "sticker price" is the lowest, or base, price.]

Something that is unique now, and it’s really a breakthrough, is that we show on healthcare.gov the sticker price — what we call the premium estimate, for each of the policies that is displayed.

Then we also give consumers new data about how often applicants for that policy get turned down or get charged more than the advertised price, so it’s at least clueing you in to what to expect when you leave this information site and go out to buy coverage.

What do you think will be the impact of publishing the information?

Portrait of Todd Park

Todd Park

Todd Park: We believe that information empowers consumers and empowered consumers make for more efficient and effective marketplaces — marketplaces that are more competitive, that pay more attention to what consumers want, where consumers can express their preferences more energetically and aggressively.

Consumers currently can’t sign up directly for policies on the site. Does that discourage users and will they ever be able to buy coverage there?

Park: They will not be able to buy coverage on healthcare.gov. Secretary Sebelius has been very, very clear that she never wants healthcare.gov to become a sales site. She wants it to be an information utility that people use to research their options.

Pollitz: Down the road, when [health insurance] exchanges are developed, there will be an option for consumers to select a health plan and enroll online if they want to purchase coverage through the exchange.

Would you like to add any more features or data? If so, what and when?

Pollitz: Absolutely. The next thing is to provide comparable information for small employers to what [is available] for individuals and families.

We will be developing measures of plan performance and other important information tools for consumers so that they can understand more about how these plans will operate in practice, how they would actually cover not only specific benefits but also whole episodes of care.

We have a long way to go and a lot of exciting things to come.

Why do you think so many Americans continue to be confused by the new health law?

Pollitz: The health care system is incredibly complicated. Sorting all of that out is going to involve a lot of changes. Certainly there has been continued argument about whether we should be moving down this way, so there’s a lot of disinformation.

I’m hoping that whatever else is happening in the fray, that this website continues to stay on the path and just give people straight up information — not a sales job one way or the other of products or politics.

If the GOP does take over Congress, is there any concern that they might defund the program?

Pollitz: I can’t really speak to that. Right now, what I do is very much focused on implementation [of the new law] and this week on implementation of healthcare.gov.

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.

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surgeons performing surgery in operating room

Cheap pill may save lives when given before surgery

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By Richard Knox

This story comes from KaiserHealthNews partner, NPR’s health blog Shots .

Patients at risk of a heart attack who are having surgery can cut their death risk 35 percent by simply taking a drug called a beta blocker.

The cost: A dollar per patient. That’s the bottom line of a large Veterans Affairs study in the October issue of the journal Anesthesiology.

And here’s why your doctor might take notice: The new study may allay earlier doubts that beta blockers for surgery patients may pose more harm than good.

The new study looked at the effect of beta blockers taken around the time of surgery in nearly 39,000 VA patients undergoing operations of any kind.

Beta blockers are widely used pills that blunt the effect of the stress hormone adrenaline on the heart, slowing the heartbeat. The idea is that in somebody at risk of a heart attack, the drug shields the heart from the stress of surgery, which can jack up the heart rate.

This isn’t the first study to show a protective effect of beta blockers in surgery patients with known heart disease or cardiovascular risk factors such as high blood pressure, high cholesterol and smoking.

Since 1996, a series of studies that randomly assigned such patients to beta blockers or placebo pills suggested the drug could lower death risk by up to 90 percent.

Wallace says bout half of hospitals have adopted the routine use of beta blockers in at-risk surgery patients. If it were universally used, he says, it would save about 7,000 lives a year.

The new study is not a randomized trial. It looked back at how many people died within a year of surgery if they took beta blockers or not. Its authors say this provides a more realistic picture than carefully controlled look-ahead studies.

“This is what happens in real life,” says study leader Arthur Wallace of the San Francisco Veterans Affairs Medical Center. “And still it reduces mortality by 35 percent. That’s pretty good.”

Wallace says about half of hospitals have adopted the routine use of beta blockers in at-risk surgery patients. If it were universally used, he says, it would save about 7,000 lives a year.

He hopes the new study will address doubts raised by a 2007 study called the Perioperative Ischemic Evaluation trial, or POISE. It concluded that beta blockers prevent heart attacks among surgical patients, but raised the risk of deaths and severe strokes.

In the wake of POISE, an expert committee of the American College of Cardiology and the American Heart Association last year backed away  from its earlier recommendation to use beta blockers routinely in surgical patients with known or suspected heart disease.

The new guidelines urge more care in the timing and dose of beta blockers for surgery patients.

“When POISE came out, we thought, oh my goodness, maybe we’ve done something wrong,” Wallace says. “We’ve been telling people for 10 years to use this drug. Maybe we’ve made a mistake.”

So the San Francisco group decided to use the VA’s computerized record system to see how beta blockers affected the death rate among its surgical patients from 1996 to 2008.

The new study found no evidence that patients who got beta blockers around the time of surgery had more strokes. “We just didn’t see any strokes,” Wallace says. “We didn’t have enough to say anything about it.”

He says the POISE study came up with different results because it used an unusually high dose of beta blockers – 16 to 32 times higher than the usual dose.

One other apparent lesson from the new San Francisco study: It’s a very bad idea to take beta blockers away from patients already on the drug when they enter the hospital for surgery. The VA study finds that quadruples patients’ risk of death.

Wallace says hospitals routinely stop patients’ routine medications when they come into the hospital to prevent bad drug interactions. “We have to change the way pharmacies think,” 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.

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Gilda’s Club Talks for October

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Upcoming Seattle Lectures at Gilda’s Club Seattle.

Gilda’s Club is a non-profit group that provides meeting places where men, women and children living with cancer and their families and friends join with others to build emotional, social and educational support as a supplement to medical care.

The club’s services are free and include support and networking groups, lectures, workshops and social events in a nonresidential, homelike setting.

The club is named in honor of Gilda Susan Radner was an American comedienne and actress, best known for her years as a cast member of Saturday Night Live.

Radner, who died at 42 of ovarian cancer, helped raise the public’s awareness of the disease and the need for improved detection and treatment.

Lectures are held on Thursday evenings at Gilda’s Club, 1400 Broadway, Seattle.

Please RSVP to attend.

Refreshments served 6:45-7:00 pm

Lecture begins 7:00-8:30 pm

All lectures are open to the public. There is no cost to attend our lectures.

Please RSVP 24+ hours in advance to attend and pre-register for Noogieland childcare a minimum of 72 hours in advance.

10/7/10 Breast Cancer Screening in the United States: Where are we now?

Join Connie Lehman, MD PhD FACR, to learn what the data show regarding the benefits and potential harms of screening mammography.

She will review the evidence used by the United States Preventive Services Task Force (USPSTF) for their recent controversial recommendations to avoid routine mammography in women in their 40s, review current research and recommendations for early breast cancer detection in average and high risk women, and share insights on what the future may hold for early breast cancer detection.

This is important info for any woman so invite your family and friends to attend.

10/14/10 Exercise for a Healthy Inner Body

The lymphatic system is an important component of the immune system and is a clearing house for toxins and bacteria.

The lymphatic system is impacted by many disorders, including cancer, chronic disease and sedentary lifestyles, and can lead to swelling: lymphadema.

Sherry Lebed, co-founder of Healthy Steps, will teach us about the lymphatic system and how certain easy exercises such as The Healthy-Steps Program may help reduce swelling and severity of lymphadema, increase range of motion, and help you have a better working immune system – through gentle, easy, fun exercises to great music.

This will be followed by a presentation on prosthetics and proper bra fitting by Kristi Lulay, providing information for a better quality of life for women following breast surgery; fulfilling their need for femininity, restoring a positive body image and renewing confidence and self-esteem.

10/21/10 Keeping Intimacy Alive

An open conversation about sexuality and communication, told from the perspective of a journey with breast cancer, but applicable to any experience with cancer.

Learn from an oncology and sexuality specialist and listen to a cancer survivor and her partner share their story, helping you to embrace a new perspective of intimacy.

This lecture features Dr. Julie Taguchi and is being sponsored by Genentech BioOncology.

To learn more:

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Ovarian Cancer Research Symposium

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The Marsha Rivkin Center for Ovarian Cancer Research at Swedish Medical Center is hosting its 2010 Ovarian Cancer Research Symposium in Seattle, October 28-29.

Topics:

  • Origins of Ovarian Cancer
  • Developing Therapeutics
  • Biomarkers for Ovarian Cancer Diagnosis, Prognosis and Treatment
  • Novel Therapeutics in Ovarian Cancer

Keynote Speakers:

To learn more:

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An umbrella sheltering medicines - credit Microsoft

Pros and cons of selling insurance across state lines: a primer

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Selling insurance across state lines: still a partisan fight

By Phil Galewitz and Lexie Verdon

When Republican House leaders recently unveiled their “Pledge To America,” they revived an idea long popular with conservatives: legislation that would allow consumers to buy health insurance across state lines so that residents of a state with expensive health plans could find cheaper options elsewhere.

An umbrella sheltering medicines - credit MicrosoftAdvocates of the Republican proposal — including some insurers and small business groups — say it would give the more than 17 million Americans who buy individual coverage a greater choice of plans and the possibility of lower prices.

When they were writing the new health law, Democrats said they heard the GOP and they included a way to sell insurance across state boundaries.

They put in language allowing states to establish “health care choice compacts.” But Republicans say that the compacts won’t bring the same benefits.

Consumer advocacy groups are part of the political back-and-forth, arguing that such provisions would erode many state protections, leave policyholders with inadequate coverage and could actually lead to higher premiums for some people.

With the issue back in the news, here’s a short primer:

What currently restricts insurers from selling policies outside of their home states?

Insurers are allowed to sell policies only in states where they are licensed to do business. Most insurers obtain licenses in multiple states.

States have different laws regulating benefits, consumer protections and financial and solvency requirements. Even before the federal health law was passed, states could have opted to set up compacts for health insurance. But they did not.

What do advocates say are the main advantages of the Republican plan to allow insurers to sell across state lines?

The individual health insurance market is dominated in many states by just a handful of companies, so this provision would allow consumers to shop broadly for cheaper policies, supporters say.

“You shouldn’t limit people to products in the states they live in or make them move to get the insurance they want,” Tom Miller, a resident fellow at the American Enterprise Institute said.

J.P. Wieske, the executive director of the Council for Affordable Insurance, which represents companies selling individual health insurance, said replacing the compacts with a GOP proposal would simplify operations for insurers.

In addition, it will improve conditions “in a number of states that have ruined their market” by rigidly regulating policies. That has left consumers with higher rates and less competition, he said.

The Republican plan is hoping “to help turn those states into more competitive marketplaces,” he added. “They haven’t been able to do it on their own.”

Why is there skepticism about the Republican concept?

“It’s not the concept that is the problem. Quite the contrary, it’s a fine idea,” said Ron Pollack, founding executive director of Families USA, a consumer health care advocacy group.

But he expressed concern about efforts to de-regulate the market. “The real underlying issue is that Republicans and others who created this do not want to create adequate standards for the sale of health care.”

That would result in policies that “perpetuate the practices that have harmed consumers,” he said.

If insurers can sell beyond state lines, the concern is that consumers would be attracted to the least comprehensive policies because they would be cheapest – some call it “a race to the bottom.”

For example, someone could buy a policy in a state that doesn’t mandate coverage of diabetic supplies and then the consumer could be stuck with higher bills.

In addition, insurers selling across state lines might market policies to younger, healthier individuals. That could leave the insurance pool with older and sicker individuals, who would face ever-rising rates — or face being turned down — because their insurers would have fewer healthy people to spread risk.

That would “undermine insurance regulation in states doing serious regulation,” said Linda Blumberg, a senior fellow at the Urban Institute’s Health Policy Center.  “It would be destructive to those state efforts.”

There are also fears that consumers dealing with out-of-state companies would have difficulties resolving disputes. And, since health costs vary geographically, insurance purchased in one state might not cover as much of the cost of care in a more expensive state.

The federal health law backers say that it allows the advantages of cross-border sales while still protecting consumers. “I think we’re going to see a whole lot more choice available for consumers under the new law,” said Pollack.

How would the new “state compacts” work?

The new health law allows states to form insurance compacts but does not require that they do. States joining a compact, however, would be required to pass legislation authorizing that decision. States could begin the process starting Jan. 1, 2016.

Many of the details for the compacts will depend on federal regulations that have not been written yet, but plans in the compact must meet the new federal minimum requirements set in the health law and would be governed by the laws of the state in which the policies are “issued or written.”

Setting up a compact would be complex since states would likely have to settle a number of questions about regulation and consumer safeguards, said Blumberg.

Because of those types of bureaucratic issues and because many of the concerns about getting adequate health coverage are alleviated by the new federal law, she said, “I don’t think much of this is going to happen.”

The law also requires that the Office of Personnel Management, which oversees health benefits for federal employees, contract with insurers to offer at least two multi-state plans.

They would be offered through the health insurance “exchanges” – marketplaces being set up in 2014 to provide individual and small market coverage. The multi-state plans would be priced locally.

According to the law, these plans would have to meet the same requirements as other plans in the exchanges. States could add more benefits to the plans, although the states would have to bear the costs.

Why are Republicans critical of how Democrats handled the issue?

Conservatives say that the high minimum standard to which all plans must adhere in the health law works against consumer choice and that the GOP’s market-based system would allow growth of innovative plans that meet consumers’ needs.

The Republican proposal “is a serious, honest concept that is worth doing, if you don’t promise the moon,” said AEI’s Miller. He acknowledged that any such effort would need a framework to ensure consumer protections, solvency standards and accountability but he believes those measures would not be as restrictive as the provisions now in the federal health law.

He says that other industries that were once strictly state-based, such as banking, have worked well with interstate competition. “It doesn’t mean you’re not regulated,” he said. “You’ll have better competition,” and still have safeguards.

This is an updated version of a story that was originally published Nov. 6, 2009

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.

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Infant Sleep Positioner Example

Infant sleep positioners pose suffocation risk

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Infant Sleep Positioner Example

Infant Sleep Positioner Example

Two government agencies are warning parents and other caregivers not to put babies in sleep positioning products as two recent deaths underscore concerns about suffocation.

The Food and Drug Administration (FDA) and the Consumer Product Safety Commission issued the warning after reviewing reports of 12 known infant deaths associated with the products.

The most common types of sleep positioners feature bolsters attached to each side of a thin mat and wedges to elevate the baby’s head.

The sleep positioners are intended to keep a baby in a desired position while sleeping. They are often used with infants under 6 months old.

To reduce the risk of Sudden Infant Death Syndrome (SIDS), the American Academy of Pediatrics recommends infants be placed to sleep on their backs on a firm surface free of soft objects, toys, and loose bedding.

Advice for Consumers

  • STOP using infant positioning products. Using this type of product to hold an infant on his or her side or back is dangerous and unnecessary.
  • NEVER put pillows, sleep positioners, comforters, or quilts under the baby or in the crib.
  • ALWAYS place a baby on his or her back at night and during nap time.

Suffocation and Other Dangers

In the last 13 years, the federal government has received 12 reports of babies known to have died from suffocation associated with their sleep positioners. Most of the babies suffocated after rolling from the side to the stomach.

“At this time, there is no scientifically sound evidence to support the medical claims being made by the manufacturers of these infant sleep positioners.”

In addition to the deaths, the commission has received dozens of reports of babies who were placed on their back or side in the positioners only to be found later in hazardous positions within or next to the product.

“We urge parents and caregivers to take our warning seriously and stop using these sleep positioners so children can be assured of a safe sleep,” says Inez Tenenbaum, chairman of the Consumer Product Safety Commission.

FDA pediatric expert Susan Cummins, M.D., M.P.H, says parents and caregivers can create a safe sleep environment for babies if they leave the crib free of pillows, comforters, quilts, toys, and other items.

“The safest crib is a bare crib,” she says. “Always put your baby on his or her back to sleep. An easy way to remember this is to follow the ABC’s of safe sleep—Alone on the Back in a bare Crib.”

Medical Claims

Some manufacturers have advertised that their products prevent SIDS, gastroesophageal reflux disease (GERD)—in which stomach acids back up into the esophagus—or flat head syndrome, a deformation caused by pressure on one part of the skull.

Although in the past FDA has approved a number of these products for GERD or flat head syndrome, new information suggests the positioners pose a risk of suffocation.

As a result, FDA is requiring makers of FDA-cleared sleep positioners to submit data showing the products’ benefits outweigh the risks. FDA is also requesting that these manufacturers stop marketing their devices while FDA reviews the data.

Infant sleep positioner manufacturers who are making medical claims without FDA clearance must stop marketing those products immediately, agency experts say, adding there’s no evidence the devices have benefits that outweigh the risk of suffocation.

“At this time, there is no scientifically sound evidence to support the medical claims being made by the manufacturers of these infant sleep positioners,” says Cummins.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Posted: September 29, 2010


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bluecrossblueshieldl_2

Regence drops child-only health insurance — Seattle Times

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Seattle Times health reporter Carol Ostrom reports in today’s paper that Regence BlueShield, will no longer offer child-only individual plans.

State insurance officials, writes Ostrom,” fear may trigger other insurers to drop similar policies.”

The Regence decision comes as regulations contained in the new federal health-care overhaul prohibit insurers from refusing coverage to children with pre-existing medical conditions.

Regence, in a statement, said the move affects only new policies and it is not dropping the 2,500 children it now insures under such policies.

To learn more:

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Twenty-dollar bill in a pill bottle

View: Can health reform reduce costs?

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Returning To The Argument: Can Health Reform Reduce Costs?

Jonathan Cohn, Senior Editor of The New Republic

This column is a collaboration between KHN and The New Republic .

Here we are again, having yet another argument about whether health care reform can really reduce costs.

The occasion this time is the recent announcement by several insurers of their intention to raise premiums on policies they sell directly to individuals.

The increases are necessary, the insurers say, because the Patient Protection and Affordable Care Act forces them to enroll sicker patients and provide more benefits.

And both changes will cost them money.

The critics of health reform have been quick to cite this announcement as proof that their suspicions were right all along.

They say it shows that the health overhaul will force us to pay more for our health care — via some combination of higher premiums, higher out-of-pocket payments and higher taxes — because that is what happens when government decides to expand coverage or strengthen benefits for everybody.

Think of health care reform as two separate sets of changes that, from a cost perspective, will push in exactly the opposite direction.

“These may be good things which consumers value,” conservative analyst Grace Marie-Turner wrote this week, “but they are not free.”

It’s an alluringly simple argument — and, if you’re among those people who are suspicious of government intervention anyway, an appealing one.

But is it the correct argument? Don’t be so sure.

Think of health care reform as two separate sets of changes that, from a cost perspective, will push in exactly the opposite direction.

First there are the changes that will make health care more expensive. You got a taste of those this week on the six-month anniversary of the law’s enactment, when a set of new consumer protections went into effect — prohibiting insurers from, for example, refusing to pay emergency room charges just because a beneficiary went to a hospital outside of the normal provider network.

But the really big changes come in 2014, when carriers begin selling policies to individuals directly through new regulated marketplaces called insurance “exchanges.”

At that point, the policies insurers sell through the exchanges will have to include a basic set of benefits — and will have limits on how much out-of-pocket spending they can pass along.

Of course, something else will take place in 2014.

That’s the year that the vast expansions of insurance coverage happen. The government will start enrolling all poor people, rather than just women with children and other select groups, into Medicaid.

The law targets wasteful spending — that is, instances where either individuals or the government is paying too much for what some part of the health care industry is providing

And it will start offering subsidies to people who buy coverage through the exchanges.

More than 30 million additional people will end up getting insurance because of these changes in the health law, according to government projections.

All of these changes will cause more money to flow into the health care system, usually as premiums or taxes.

And you could make a pretty good case (in fact, I would make the case) that the benefits are worth the extra expense, since it means sparing millions of people from serious financial hardship and, in some cases, giving them access to medical care that could literally save their lives.

But that brings us to the second set of changes — the ones that are designed to make health care less expensive.

The law targets wasteful spending — that is, instances where either individuals or the government is paying too much for what some part of the health care industry is providing.

An example of this is the requirement, soon to be enacted, that insurers spend a larger portion of premium dollars on actual medical care.

(In wonk speak, that’s called setting higher “medical loss ratios.”)

Many experts believe this will act as a natural break on premiums in the private sector, since it will limit insurers’ abilities to raise prices if they’re not also providing more care.

But, particularly over the long term, the big savings in health reform will come from efforts to reduce wasteful care rather than wasteful payments.

Scores of studies, dating back decades, have shown that our medical system routinely provides unnecessary treatment — by failing to administer routine preventive measures, by duplicating treatments because of miscommunication among providers, and by doling out care that is at best unproven and at worst harmful.

The health overhaul attacks this problem by, among other things, rewarding use of electronic medical records and creating an institution to study which treatments work best.

It also imposes a tax on the most generous insurance policies — on the theory, widely supported by economists, that the tax will encourage insurers (and consumers) to find ways to save money.

So what’s the upshot, once you add up the ways the health law will make health care expensive and the way it will make care less expensive?

There’s obviously no way to be sure. But the best estimates we have, from government and independent authorities, is that over the first ten years or so total spending will be a little higher but by a trivial amount.

That is, we’ll be spending pretty close to what we would have without the law. That’s actually quite impressive, given all of the new benefits and security these reforms will provide.

More important, after ten years, according to these estimates, spending should actually start to rise a little more slowly. And it’s that long-term trend that really matters for our country’s future.

You shouldn’t be satisfied with that outcome. In order to get the health overhaul through Congress, its proponents had to soften the cost control provisions — by, for example, nixing a public option that could have helped bargain down payments to health care providers even more.

If health care spending doesn’t come down more dramatically, then it’s going to siphon away more and more resources from our society.

But that doesn’t mean health care reform can’t reduce costs. It simply means that, with some modifications, reform could reduce costs even more.

Jonathan Cohn is a senior editor at The New Republic .

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.


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A package of birth control pills.

US teen births drop, still highest in developed world

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By Sylviane Duval, Contributing Writer
Health Behavior News Service

A package of birth control pills.Teen birth rates in the United States are still 33 percent higher than in New Zealand, the developed country with the next highest incidence — even though U.S. rates have fallen from a high of 62 per 1,000 teens in the early 1990s to a record low of 41 in 2005, a new study finds.

The number has since leveled off to about 42 births per 1,000 teens.

The study, which looks at trends in birth rates from 1981 through 2006 among teen mothers by age and ethnic background, appears online in the Journal of Adolescent Health.

Authors led by Phyllis Wingo, Ph.D., found that this leveling off started in 2003, for all but two study groups.

The exceptions were 18- to 19-year-old white and Asian teens, which were still registering declines, and Hispanic teens, which showed increases.

Wingo, a former senior epidemiologist with the Centers for Disease Control and Prevention, said that the growing Hispanic population in the United States and cultural factors, such as condom use and even birthplace, might account for the latter discrepancy.

She also said that American-born Latinas ages 15 to 18 are more likely to have been pregnant than their foreign-born counterparts, but that the relationship is reversed in the 19-to-24-year age group.

The study reveals that, between 1981 and 2003, teen birth rates decreased significantly for all age, race and Hispanic-origin groups.

Overall, teen mothers were slightly older than before and had a slightly higher level of education. Decreased percentages of young mothers were married, and there was a drop in African-American teen mothers and a drop in teen mothers with two or more children.

While the authors attribute the decline to delayed experimentation with sex and increased use of contraception, they also suggest that abortion might not be a factor: abortion rates and birth rates both declined in this period according to the limited data available.

Patricia Paluzzi, president of the Healthy Teen Network, said that the study provides a helpful level of detail as different approaches and programs target different age and racial or ethnic groups.

“The study authors are on the right track, supporting innovative, multi-component, community-wide initiatives to reduce teen pregnancies and births in communities with the highest rates,” Paluzzi said. “Given the findings in this study, this comprehensive approach is needed to continue delaying births among teens.”

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.

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