About one in five US adult cigarette smokers have tried an electronic cigarette


eFrom the CDC

In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as e-cigarettes, up from about 10 percent in 2010, according to a study released today by the Centers for Disease Control and Prevention.

Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010.  This study is the first to report changes in awareness and use of e-cigarettes between 2010 and 2011.

During 2010–2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic Whites, those aged 45–54 years, those living in the South, and current and former smokers and current and former smokers.

In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers.  Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.

“E-cigarette use is growing rapidly,” said CDC Director Tom Frieden, MD, MPH. “There is still a lot we don’t know about these products, including whether they will decrease or increase use of traditional cigarettes.”

Although e-cigarettes appear to have far fewer of the toxins found in smoke compared to traditional cigarettes, the impact of e-cigarettes on long-term health must be studied.

Research is needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people.

“If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative,” said Tim McAfee, MD MPH, director of the Office on Smoking and Health at CDC.

  • For quitting assistance, call 1-800-QUIT-NOW (1-800-784-8669) or visit www.smokefree.gov.
  • Also, visit www.BeTobaccoFree.gov for information on quitting and preventing children from using tobacco.

Nurse practitioners say pay policies limit their practices more than scope-of-practice laws


SCA0416By Alvin Tran

Many nurse practitioners say restrictive payment policies impact how they care for patients more than state laws governing what care they can give, according to a new study.

In the study, published Thursday by the National Institute for Health Care Reform, researchers found that while so-called “scope of practice” laws did not appear to restrict the primary care services nurse practitioners can provide to patients, they do affect how the advanced nurses are paid.

Researchers at the Center for Studying Health System Change conducted telephone interviews with 30 nurse practitioners, practice managers, and physicians working in a variety of clinical settings — all of which employed nurse practitioners.

The researchers focused on six states representing a range of legal scope-of-practice restrictions: Maryland, Arizona, Michigan, Indiana, Massachusetts, and Arkansas.

Based on the interviews, Dr. Tracy Yee and her colleagues found that nurse practitioners — registered nurses with advanced degrees — faced greater challenges in the states with more restrictions on how they practice.

In states such as Arkansas and Indiana where they cannot practice without a doctor’s supervision, nurse practitioners are not recognized as primary care providers by the traditional Medicaid program, and that affects how they deliver care to patients as well as how they are paid.

Other challenges in more restrictive states include disentangling the billing system involving public and private payers, ordering tests and procedures, and establishing independent primary care practices. And though private and public payers must adhere to scope-of-practice laws, they often impose additional restrictions on how these nurse practitioners practice, the study found.

Many nurse practitioners told researchers that restrictive payment policies had a much greater impact on their day-to-day practice than the current scope-of-practice laws enacted in their states.

“Payers are in a position to determine what services NPs are paid for, their payment rates, whether NPs are designated as primary care providers and assigned their own patient panels, and whether NPs can be paid directly,” the authors of the study wrote.

Such policies “might hamper the efficiency of our provider capacity,” Yee said. “NPs can be doing more; they could be seeing more patients; they could be reaching communities that are underserved more often.”

States might consider making clearer what nurse practitioners can and can’t bill for — particularly in Medicaid and from other private payers, Yee added.

Dr. Angela Golden, president of the American Association of Nurse Practitioners, says she wasn’t surprised by the study’s findings on scope-of-practice laws. “It’s really important for people to recognize that removing those outdated laws will especially help people in medically underserved areas,” she said. “Fifty-five million people live in medically underserved areas.”

But Dr. Reid Blackwelder, the president-elect of the American Academy of Family Physicians, said he believes a more collaborative approach among physicians, advanced practice nurses, and physician assistants would pay dividends.

“This discussion is often tied to the concept that an [advanced practice nurse] does what a family physician does or takes the place of a family physician. … What’s really important is that these roles are not interchangeable — they’re different,” he said during an interview.  ”Each is critical and each has a role to play. You can’t just take one and make due if you can’t have the other.”

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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Seattle Business magazine announces its 2013 Leaders in Health Care Awards


SBM0313_CoverThis month’s issue of the Seattle Business magazine features the magazine’s 2013 Leaders in Health Care Awards. This year’s Lifetime Achievement award goes to Margaret Stanley, board chair of the Washington Health Benefit Exchange.

To learn more go to the magazine’s home page or click on the links below to read about the winners in each category.

Winner: Margaret Stanley, Board Chair,Washington Health Benefit Exchange

Winner: Robert Thompson, M.D., Valley Medical Center/Renton RotaCare Clinic
Silver Award: Jane Dimer, M.D., Chief of Women’s Health, Group Health Cooperative
Silver Award: Anthony Back, M.D., Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance

Winner: Mark Secord, Executive Director/CEO, Neighborcare Health
Silver Award: Scott Bosch, President/CEO, Harrison Medical Center
Silver Award: Norm Hubbard, Chair, Seattle Cancer Care Alliance

Winner: Rainer Storb, M.D., Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
Silver Award: William Catterall, M.D, UW Medicine
Silver Award: Paul O’Donnell, M.D., Seattle Cancer Care Alliance

Winner: Mobisante Inc.
Silver Award: Advanced Medical Isotope Corporation
Silver Award: Impel NeuroPharma

Winner: Alder Biopharmaceuticals
Silver Award: OncoGenex Pharmaceuticals
Silver Award: Adaptive Biotechnologies Corporation

Winner: Infectious Disease Research Institute (IDRI)
Silver Award: SIGN Fracture Care International
Silver Award: Institute for Health Metrics and Evaluation (IHME), University of Washington

Winner: Pioneer Square Clinic/Harborview Medical Center
Silver Award: YMCA of Greater Seattle
Silver Award: Asian Counseling and Referral Service (ACRS)

Winner: King County
Silver Award: Faculty & Staff Wellness Program, Western Washington University
Silver Award: Swedish Wellness Works, Swedish Medical Center


Social media “likes” can indicate hospital quality – studies


like-thumb-facebookBy Jordan Rau

Millions of dollars and some of the best minds in health care have been devoted to measuring how good a hospital is. But two studies suggest users of two social media giants, Facebook and Yelp, may do a solid job of reflecting quality.

The findings are particularly important as more people are turning to the Internet to evaluate health care providers. Fourteen percent of Americans went online last year to consult rankings or reviews of hospitals or medical facilities, according to a survey by the Pew Research Center.

In a study published last month in the American Journal of Medical Quality, researchers compared the activity on the Facebook pages of 40 hospitals in the greater New York City metropolitan region with more traditional methods of measuring hospital quality, including mortality rates and  patient experience surveys  that hospitals conduct for Medicare.

After controlling for confounding influences, such as the size of a hospital and the length of time it had a Facebook page, the researchers found that hospitals with lots of “Likes” tended to have lower mortality rates and substantially better patient reviews.

“This study’s findings suggest that the number of ‘Likes’ on a hospital’s Facebook page can be used as a proxy for patient satisfaction and an indicator of hospital quality,” wrote the researchers, who work at the Healthcare Innovation Technology Lab, a nonprofit research group in New York.

Another paper published last November in BJM Quality & Safety examined Yelp reviews of hospitals using a very similar methodology.

Researchers from the University of California, San Francisco focused on 270 hospitals that had at least six reviews on Yelp, which is a popular site for people to post consumer opinions about restaurants and other businesses.

The authors compared the reviews with how they did on more traditional measurements of patient satisfaction surveys, mortality and readmissions.

The hospitals that did the best on Yelp, garnering four or five stars, tended to have better mortality and readmission outcomes.

The hospitals that did the best on Yelp, garnering four or five stars, tended to have better mortality and readmission outcomes. The relationship with patient surveys was even stronger, although not quite as close as it was in the Facebook study.

Dr. Naomi Bardach and her fellow UCSF researchers wrote that “the data suggest that the ratings posted on the commercial website may be capturing experiences similar to those driving the more systematically collected HCAHPS ratings.” (HCAHPS is the acronym for the patient experience surveys.)

Social media “allows people to share information much more readily” than they do in other parts of their lives, said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied hospital quality extensively. “If you had a colonoscopy and it wasn’t a great experience, you very well might post it on Facebook, because Facebook lowers the threshold for sharing personal information. My sense is social media as a way to build or hurt hospital reputation is going to grow.”


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.


Washington insurers and agents fined more than $2 million in 2012


State seal of Washington stateThe Washington State issued more than $2 million in fines against insurers, agents and brokers in 2012, the Washington State Office of the Insurance Commissioner reports

Fines collected by the insurance commissioner’s office deposited in the state’s general fund to pay for other state services.

“Ideally, we’d have full compliance and no fines,” said Insurance Commissioner Mike Kreidler. “But the reality is that sometimes it takes a fine to get a company to address problems. And in many cases, these fines were accompanied by compliance plans aimed at making sure the problems don’t recur.”

The fines totaled $2,033,990 —  higher than the previous year’s $1.4 million.

Violations included:

The agency posts all disciplinary orders – including those that don’t include fines – at www.insurance.wa.gov/orders/enforcement.asp.


Medical research, FDA and mental health care face budget bite


CDC lab shot eggBy Mary Agnes Carey
KHN Staff Writer

Doctors serving Medicare patients. Scientists looking for a better way to treat diabetes. HIV patients who can’t afford to buy their medications. These are but some of the many people who will be affected by the automatic federal spending cuts that officially take effect today.

Both Democrats and Republicans say they didn’t like the budget reductions, called the sequester, but they couldn’t agree on how to stop them.

The $85.3 billion in cuts for fiscal 2013, which ends Oct. 1, are part of a larger package of $1.2 trillion in trims scheduled to occur over the next decade. The reductions are split evenly between defense and domestic programs.

The sequester would not affect Medicaid, the joint federal-state health program for the poor. However, Medicare spending would be cut by 2 percent through reductions in payments to hospitals, physicians and other care providers, including Medicare Advantage plans and the companies running the Medicare Part D plans. By law, the Medicare cuts don’t begin until April 1.

But other health care efforts would be among the government programs that face reductions of about 9 percentaccording to the Office of Management and Budget.

The full impact likely won’t be felt for weeks as the cuts roll out, and some lawmakers have suggested that sequestration cuts could be dealt with as part of negotiations to fund the government after the current continuing resolution expires March 27.

Dr. Gary Wiltz, the chairman-elect of the board of the National Association of Community Health Centers, one of the groups facing those cuts, said the reduced federal funding will cause the centers to dramatically curtail services and estimates that as many as 900,000 patients could be turned away from care. “Many of them cannot afford to go anyplace else,” he said in a statement.

President Barack Obama speaks during a visit to Newport News Shipbuilding earlier this week (Photo by Alex Wong/Getty Images).

President Barack Obama Tuesday called on Congress to work out a different scenario for dealing with the nation’s fiscal problems and avert the “painful, arbitrary budget cuts.”

Addressing workers at a shipbuilding facility in Newport News, Va., he said, “Instead of cutting out the government spending we don’t need — wasteful programs that don’t work, special interest tax loopholes and tax breaks — what the sequester does is it uses a meat cleaver approach to gut critical investments in things like education and national security and lifesaving medical research.”

He is urging a combination of spending cuts and additional federal revenues through changes in the tax code.

But Republicans are opposed to any increase in taxes to fund the spending. Senate Minority Leader Mitch McConnell, R-Ky., criticized the president Thursday for failing to offer “a serious plan.”

“Instead of directing his cabinet secretaries to trim waste in their departments, he’s going to go after first responders. And teachers,” McConnell said. “And almost any other sympathetic constituency you can think of. … He’ll say he has no choice but to release criminals into the streets and withhold vaccines from poor children. And somehow, it will be everyone’s fault but his. Nonsense.”

The president and congressional leaders are meeting at the White House today on the issue.

Trims In Health Programs

White House summary of the sequestration’s effects includes these health-related programs:

  • The National Institutes of Health would be forced to “delay or halt vital scientific projects and make hundreds of fewer research awards,” which means that “several thousand personnel could lose their jobs,” the White House said. Twelve thousand scientists and students would be impacted because the National Science Foundation would offer 1,000 fewer research grants and awards.
  • The Food and Drug Administration would be able to do fewer drug approvals and conduct 2,100 fewer inspections at domestic and foreign facilities that manufacture food products.
  • Cuts to the Mental Health Block Grant program would mean that 373,000 adults and children would not receive mental health services. “This cut would likely lead to increased hospitalizations, involvement in the criminal justice system and homelessness for these individuals,” according to the White House document.
  • Cuts to the AIDS drug assistance program could result in 7,400 fewer patients having access to HIV medications, and the Centers for Disease Control and Prevention could conduct approximately 424,000 fewer HIV tests.
  • The Indian Health Service and tribal hospitals and clinics would also be hit by sequestration, with 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits, according to the White House analysis.

Intensive Lobbying Campaign

The sequester threat, however, has led to an intensive lobbying campaign by industry and patient advocacy groups. While the cuts to Medicare are limited, hospitals and other medical providers who will be absorbing them argue that the latest reductions are especially difficult because they already sacrificed some of their federal funding in the 2010 health care law.

In a January report, the American Hospital Association noted that hospitals have contributed an average of 28,000 new jobs per month in 2012 and that hospitals employ almost 5.5 million people and support an additional 10 million jobs.

“Congress should not overlook the economic contribution of hospitals as it considers further deficit reduction proposals,” association president and chief executive officer Rich Umbdenstock said in a statement.

More than 270 organizations, including Research!America, the Mayo Clinic and Yale School of Medicine, wrote to Capitol Hill earlier this month seeking changes.

Among their concerns, they warned that sequestration “will negatively impact U.S. competitiveness just as other nations are aggressively boosting their investments in research and development.”

In addition, more than 300 Alzheimer’s researchers said in a separate letter to the Hill that the cuts would be devastating. “A robust commitment to high-impact Alzheimer’s research is essential if we hope to stop this disease before it destroys the nation’s health and financial well-being,” they wrote to congressional leaders.

The American Medical Association and other medical organizations are also fighting sequestration, urging Congress to take a “more targeted, rational approach that allows careful assessment of how to fulfill its long-term commitment to seniors, uniformed service members and their families, and public health and safety priorities.”

Even if Congress finds a way to stop the cuts, that’s no guarantee that Congress won’t trim agency budgets even more in the yearly appropriations process or as lawmakers seek a larger deal to reduce the deficit.

“The sequester is a better deal if … that’s the only thing that happens,” said Joseph Antos, a health care expert at the American Enterprise Institute, a conservative think tank. “I think a pretty good bet is that we’re going to get a sequester … but on top of that we’re going to see additional cuts in Medicare.” Medicaid, he and other analysts speculate, is likely to remain off the table.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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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How mom’s death changed my thinking about end-of-life care

Charles Ornstein with his mother Harriet Ornstein on his wedding day, weeks after she was mugged in a parking lot and knocked to the pavement with a broken nose. (Randall Stewart, Photo courtesy of Charles Ornstein)

Charles Ornstein with his mother Harriet Ornstein on his wedding day, weeks after she was mugged in a parking lot and knocked to the pavement with a broken nose. (Randall Stewart, Photo courtesy of Charles Ornstein)

by Charles Ornstein

This story was co-published with The Washington Post.

My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we’d gathered to discuss: When was it time to let Mom die?

It had been a grueling day at the hospital, watching — praying — for any sign that my mother would emerge from her coma.

Three days earlier she’d been admitted for nausea; she had a nasty cough and was having trouble keeping food down.

But while a nurse tried to insert a nasogastric tube, her heart stopped. She required CPR for nine minutes.

Even before I flew into town, a ventilator was breathing for her, and intravenous medication was keeping her blood pressure steady. Hour after hour, my father, my sister and I tried talking to her, playing her favorite songs, encouraging her to squeeze our hands or open her eyes.

Doctors couldn’t tell us exactly what had gone wrong, but the prognosis was grim, and they suggested that we consider removing her from the breathing machine. And so, that January evening, we drove to a nearby restaurant in suburban Detroit for an inevitable family meeting.

My father and sister looked to me for my thoughts. In our family, after all, I’m the go-to guy for all things medical. I’ve been a health-care reporter for 15 years: at the Dallas Morning News, the Los Angeles Times and now ProPublica.

And since I have a relatively good grasp on America’s complex health-care system, I was the one to help my parents sign up for their Medicare drug plans, research new diagnoses and question doctors about their recommended treatments.

In this situation, like so many before, I was expected to have some answers. Yet none of my years of reporting had prepared me for this moment, this decision. In fact, I began to question some of my assumptions about the health-care system.

I’ve long observed, and sometimes chronicled, the nasty policy battles surrounding end-of-life care. And like many health journalists, I rolled my eyes when I heard the phrase “death panels” used to describe a 2009 congressional proposal that would have allowed Medicare to reimburse physicians who provided counseling to patients about living wills and advance directives.

The frenzy, whipped up by conservative politicians and talk show hosts, forced the authors of the Affordable Care Act to strip out that provision before the bill became law.

Politics aside, I’ve always thought that the high cost of end-of-life care is an issue worthy of discussion. About a quarter of Medicare payments are spent in the last year of life, according to recent estimates.

And the degree of care provided to patients in that last year — how many doctors they see, the number of intensive-care hospitalizations — varies dramatically across states and even within states, according to the authoritative Dartmouth Atlas.

Studies show that this care is often futile. It doesn’t always prolong lives, and it doesn’t always reflect what patients want.

In an article I wrote for the Los Angeles Times in 2005, I quoted a doctor saying: “There’s always one more treatment, there’s always one more, ‘Why don’t we try that?’ … But we have to realize what the goals of that patient are, which is not to be in an intensive-care unit attached to tubes with no chance of really recovering.”

That made a lot of sense at the time. But did it apply to my mom?

We knew her end-of-life wishes: She had told my dad that she didn’t want to be artificially kept alive if she had no real chance of a meaningful recovery. But what was a real chance? What was a meaningful recovery? How did we know if the doctors and nurses were right?

In all my reporting, I’d never realized how little the costs to the broader health-care system matter to the family of a patient. When that patient was my mother, what mattered was that we had to live with whatever decision we made. And we wouldn’t get a chance to make it twice.

As my mom lay in the ICU, there was no question that her brain function was worrisome. In the hours after she was revived, she had convulsions, known as myoclonus, which can happen if the brain lacks oxygen. After that, she lay still. When the neurologist pricked her with a safety pin, she didn’t respond. When he touched her corneas, they didn’t reflexively move.

I began checking the medical literature, much like I do as a reporter. I didn’t find anything encouraging. Studies show that after 72 hours in a coma caused by a lack of oxygen, a patient’s odds of recovery are slim to none. I asked my writing partner in New York to do additional research. She, too, found nothing that would offer much hope.

But couldn’t my mom beat the odds? Harriet Ornstein was a feisty woman. At age 70, she had overcome adversity many times before. In 2002, weeks before my wedding, she was mugged in a parking lot and knocked to the pavement with a broken nose. But she was there to walk me down the aisle — black eyes covered by makeup.

She had Parkinson’s disease for a decade, and in 2010 she suffered a closed head injury when a car backed into her as she walked down a handicapped ramp at the drugstore. Mom persevered, continuing rehabilitation and working to lead as normal a life as possible. Might she not fight through this as well?

Truth be told, I was already somewhat skeptical about physician predictions. Just last summer, my dad’s heart stopped, and it took more than 10 minutes of CPR to revive him. Doctors and nurses said a full neurological recovery was unlikely. They asked about his end-of-life choices.

Mom and I stayed up late talking about life without him and discussing the logistics of his funeral. But despite it all, he rebounded. He was home within weeks, back to his old self. I came away appreciative of the power of modern medicine but questioning why everyone had been so confident that he would die.

Also weighing on me was another story I wrote for the Los Angeles Times, about a patient who had wrongly been declared brain-dead by two doctors. The patient’s family was being urged to discontinue life support and allow an organ-donation team to come in.

But a nursing supervisor’s examination found that the 47-year-old man displayed a strong gag-and-cough reflex and slightly moved his head, all inconsistent with brain death. A neurosurgeon confirmed her findings.

No one was suggesting that my mom was brain-dead, but the medical assessments offered no hint of encouragement. What if they were off-base, too?

Over dinner at the Chinese restaurant, we made a pact: We wouldn’t rush to a decision. We would seek an additional medical opinion. But if the tests looked bad — I would ask to read the actual clinical reports — we would discontinue aggressive care.

A neurologist recommended by a family acquaintance came in the next morning. After conducting a thorough exam, this doctor wasn’t optimistic, either, but she said two additional tests could be done if we still had doubts.

If more tests could be done, my dad reasoned, we should do them. My sister and I agreed.

On Friday morning, the final test came back. It was bad news. In a sterile hospital conference room, a neurologist laid out our options: We could move my mom to the hospice unit and have breathing and feeding tubes inserted. Or we could disconnect the ventilator.

We decided it was time to honor my mom’s wishes. We cried as nurses unhooked her that afternoon. The hospital staff said it was unlikely that she would breathe on her own, but she did for several hours. She died peacefully, on her own terms, late that night — my dad, my sister and I by her side.

I don’t think anyone can ever feel comfortable about such a decision, and being a health reporter compounded my doubts.

I was fairly confident that we did what my mom would have wanted. But a week later, when I was back in New York and had some emotional distance, I wondered how our thinking and behavior squared with what I’d written as a reporter. Did we waste resources while trying to decide what to do for those two extra days? If every family did what we did, two days multiplied by thousands of patients would add up to millions of dollars.

Curious how experts would view it, I called Elliott S. Fisher. I’ve long respected Fisher, a professor of medicine at Dartmouth and a leader of the Dartmouth Atlas.

The Atlas was the first to identify McAllen, Texas, subject of a memorable 2009 piece in the New Yorker by Atul Gawande, for its seemingly out-of-control Medicare spending.

I asked Fisher: Did he consider what my family did a waste of money?

No, he said. And he wouldn’t have found fault with us if we decided to keep my mom on a ventilator for another week or two, although he said my description of her neurological exams and test results sounded pessimistic.

“You never need to rush the decision-making,” he told me. “It should always be about making the right decision for the patient and the family. … We have plenty of money in the U.S. health-care system to make sure that we’re supporting families in coming to a decision that they can all feel good about. I feel very strongly about that.”

Plenty of money? How did this mesh with his view that too much money is spent on care at the end of life? He said his concern is more about situations in which end-of-life wishes aren’t known and cases where doctors push treatments for terminal illnesses that are clearly futile and that may prolong suffering.

“I don’t think the best care possible always means keeping people alive or always doing the most aggressive cancer chemotherapy,” he said, “when the evidence would say there is virtually no chance for this particular agent to make a difference for this patient.”

I left the conversation agreeing with Fisher’s reasoning but believing that it’s much harder in practice than it is in theory. You can know somebody’s wishes and still be confused about the appropriate thing to do.

The past few weeks have been the most difficult of my life. I hope what I learned will make me a better, more compassionate journalist.

Most of all, I will always remember that behind the debate about costs and end-of-life care, there are real families struggling with real decisions.

Senior reporter Charles Ornstein is board president of the Association of Health Care Journalists and can be reached at charles.ornstein@propublica.org.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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One-on-one interventions help prevent teen pregnancy


Seattle Children's Whale LogoBy Yolanda Evans, MD
Seattle Children’s

This article first appeared on Seattle Children’s Teenology 101 blog.

While the rate of teen pregnancy in the United States has declined in recent years, it remains the highest among industrialized nations.

More than 750,000 high-school-age girls become pregnant every year, according to the Centers for Disease Control and Prevention.

Now, a new study suggests that intervention approaches that combine contraception and condom education with leadership training, one-on-one coaching, and peer engagement can help reduce the risk of pregnancy and sexually transmitted infections in teen girls.

The study, published Feb. 25 in JAMA Pediatrics, followed more than 200 high-risk 13- to 17-year-old girls for two years. The girls were coached in everything from choosing the right birth control to developing better relationships with their parents to asking a partner to use a condom.

Multifaceted approach to reducing teens’ risky sexual behaviors

The most effective interventions often involve a holistic approach like the one the study took, says Yolanda Evans, MD, of Seattle Children’s adolescent medicine division.

“It’s important for girls to be knowledgeable and to know how to advocate for themselves,” she says. “You can have birth control, but you have to take it. You can have condoms, but you have to be comfortable enough to ask your partner to put one on.”

The study showed that girls who receive one-on-one and peer counseling, in addition to education about how to prevent pregnancy felt more connected to their families and more confident in refusing unwanted sex. They also placed less importance on having sex than their peers who did not receive coaching and education.

Evans says that girls’ self-esteem and their openness with their families can make all the difference: “Research shows that families who communicate about sex and reproductive health have teens who wait longer to start having sex. That’s really huge. If you can delay your sexual debut, you’re going to be less likely to engage in risky behaviors.”

50 percent of U.S. teens have sex before they finish high school

According to Evans, one of the reasons that the U.S. teen pregnancy rate remains higher than other countries may be Americans’ lack of openness about the topic.

“In the United States, we don’t talk about sexual activity, yet it’s portrayed in our media,” she says. “No parent in any country wants their child to have sex unless they’re absolutely ready. The difference is talking with our kids about it and our expectations about sexual behavior.”

Evans acknowledges that for many parents, talking with their kids about sex is an intimidating task. But, she says, the payoff is huge.

“About half of teens have sex before age 18,” she explains. “For us as adults and parents, we’re not helping the situation if we ignore the behavior. We need to be open about it, talk about it, tell them our expectations, discuss the consequences, really teach them to protect themselves, and teach them why waiting is a good idea.”

5 tips for talking to teens about sex

To help get the conversation started, Evans offers these tips for parents:

  1. Educate your teen about condoms and birth control. Teens need to know not only where to get condoms and birth control, but also about how to choose the best method and how to use them. Whether you have boys or girls, make sure they know how to protect themselves if they decide to become sexually active.
  2. Encourage your kids to get involved in youth leadership activities. Your child will develop skills that will help them talk with partners, negotiate relationships and speak up for themselves.
  3. Open up family communication channels. The more your teen feels comfortable talking to you, coming to you with questions, and knowing what your values and expectations are, the less likely she’ll be to engage in high-risk sex.
  4. Talk about consequences. Sex can come with consequences like unwanted pregnancy and STDS, as well as the emotional attachment that comes with having a sexual relationship with somebody. If you are open to teaching your teens about the consequences of having sex, they may be more willing to wait.
  5. Describe and model healthy romantic relationships. Point out healthy relationship behaviors and coach your teens about how to stand up for themselves in relationships. Girls should feel comfortable asking a partner to use a condom or turning down unwanted sex.

If you’re not comfortable talking to your teens about sex and relationships, Evans recommends bringing up the topic with your child’s doctor .

About Yolanda Evans, MD, MPH

Yolanda-Evans-MD-MPH_avatar-100x100My work is a ‘dream come true’ and it’s what I’ve wanted to do for as long as I can remember. I have the privilege of getting to know some amazing teens and hearing things about them that they may not have told anyone before. When I’m not working, I like trying new foods, traveling around the world, spending time with family and friends, and enjoying the fresh Washington air (though not quite as fresh as Alaska where I grew up, but very close!) – Yolanda Evans, M.D., Adolescent Medicine at Seattle Children’s

Learn more on our Teenology 101 blog:

Why teens choose to have sex
The big talk: Part 1, Talking to your teen about sex (video)
The big talk: Part 2, The birds and the bees (video)
10 tips for talking to your teen about sex
Teen girls, boyfriends, money, and sex

Pregnancy and STIs
Teen pregnancy
Teen pregnancy series
Sexually transmitted infections series

Birth control
Teens and birth control: Emergency contraception
Teens and birth control: Barrier methods
Teens and birth control: Hormone-containing methods
More on birth control (video series)

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FDA Updates Safety Recommendations for Metal-on-Metal Hip Implants


An FDA Consumer Update

The US Food and Drug Administration has updated its safety information and recommendations to patients and health care professionals based on the agency’s current assessment of metal-on-metal hip implants, including:

  • the benefits and risks
  • the evaluation of published literature
  • the results of an FDA advisory panel meeting held in June 2012


Implant components slide against each other during walking or running, which releases tiny metal particles. These particles may damage bone or soft tissue surrounding the implant and joint. Soft tissue damage could lead to pain, implant loosening, device failure and the need for revision surgery.

Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause discomfort or illnesses.

Recommendations for People Considering a Metal-on-Metal Hip Implant

  • Be aware that every hip implant has benefits and risks.
  • Discuss your options for hip surgery with your orthopedic surgeon.

Recommendations for People With Metal-on-Metal Hip Implants

  • If you are not having any symptoms and your orthopedic surgeon believes your implant is functioning properly, continue to follow-up routinely with the surgeon every one to two years.
  • If you develop new or worsening problems, such as pain, swelling, numbness, noise (popping, grinding, clicking or squeaking of your hip) or a change in your ability to walk, contact your orthopedic surgeon right away.
  • If you experience changes in your general health, including new or worsening symptoms outside your hip, let your doctor or other health care professional know you have a metal-on-metal hip implant.

For More Information

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Washington state’s pre-existing condition insurance plan closes enrollment March 2


Alert Icon with Exclamation Point!The Pre-existing Condition Insurance Plan (PCIP-WA), a temporary health insurance plan for people with pre-existing health conditions, will close to new enrollees after March 2, 2013, the Washington State Office of the Insurance Commissioner announced Tuesday.

Anyone who needs this coverage is encouraged to apply as soon as possible. All applications must be postmarked by March 2. Washington state is not unique. The federal government has ordered similar suspensions nationwide to ensure adequate funding.

Currently, 1,013 people are enrolled in Washington state’s plan.  The suspension will help ensure that there’s enough money to take care of enrollees through the end of 2013, when the Affordable Care Act takes effect and no one can be denied health insurance because of a pre-existing health condition.

This program insures people with serious, costly medical conditions. The most common conditions of enrollees include AIDS, cancer, diabetes, Crohn’s disease, and pregnancy. The average cost per member per month is $5,154.

“The Pre-existing Condition Insurance Plan was designed to be a stop-gap measure to help those most in need of coverage until 2014,” said Insurance Commissioner Mike Kreidler.

“If you’ve been without health insurance for at least six months, and have a serious medical condition or just received a diagnosis, don’t wait to enroll,” said Kreidler.  “If you wait, you could be without viable coverage until Jan. 1, 2014.”

The only exception to the enrollment suspension is if someone was enrolled in a PCIP in another state during the last six months and changes their residence. They can re-enroll in their new state after March 2.

To qualify for the Pre-existing Condition Insurance Plan, you must be a Washington state resident and:

  • Be a citizen or national of the United States or a legal resident of the United States
  • Have been uninsured for at least six months before applying and
  • Have a pre-existing condition

The benefits under the Pre-existing Condition Insurance Plan vary depending on which deductible you select, $2,500 or $500:

  • Rates for the $2,500 deductible plan range from $212-$848 per month depending on your age and whether or not you smoke.
  • Rates under the $500 deductible plan are $420-$1,680 per month, also depending on your age and whether or not you smoke.

Applications for the new plan are available at https://www.wship.org/PCIP-WA or by calling toll-free 1-877-505-0514.

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Are long-term care insurance rates going up for women?


Key Long-Term-Care Insurer To Raise Women’s Premiums

Although the Affordable Care Act seeks to end health plans’ use of gender to set prices, the new rules don’t apply to policies for long-term care.

By Michelle Andrews

Graph ThumbStarting next year, the Affordable Care Act will largely prohibit insurers who sell individual and small-group health policies from charging women higher premiums than men for the same coverage.

Long-term-care insurance, however, isn’t bound by that law, and the country’s largest provider of such coverage has announced it will begin setting its prices based on sex this spring.

“Gender pricing is good for insurance companies,” said Bonnie Burns, a policy specialist at California Health Advocates, a Medicare advocacy and education organization, “but it’s bad public policy and it’s bad for women.”

Genworth Financial says the new pricing reflects the fact that women receive two of every three claims dollars. The change will affect only women who buy new individual policies, or about 10 percent of all purchasers, according to the company. The new rates won’t be applied to existing policyholders or those who apply as a couple with their husbands.

“This change is being made now to reflect our actual claims experience and help stabilize pricing,” Genworth Financial spokeman Thomas Topinka said in an e-mail.

Women’s premiums may increase by 20 to 40 percent under the new pricing policy, said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. The average annual premium for a 55-year-old who qualified for preferred health discounts and bought between $165,000 and $200,000 of coverage was $1,720 last year, according to the association.

Experts say they expect other long-term-care insurers will soon follow suit.

Long-term-care insurance provides protection for people who need help with basic daily tasks such as bathing and dressing. It typically pays a set amount for a certain number of years — say, $150 daily for three years — for care provided in a nursing home, assisted living facility or at home. Never a very popular product with consumers, many of whom found it unaffordable, in recent years the industry has struggled and many carriers have raised premiums by double digits or left the market.

Consumer health advocates say they aren’t surprised that women’s claims for long-term-care insurance are higher than men’s.

Because women typically live longer than men, they frequently act as caregivers when their husbands need long-term care, advocates say, thus reducing the need for nursing help that insurance might otherwise pay for. Once a woman needs care, however, there may be no one left to provide it.

“Women live longer alone than men,” Burns said. “If you don’t have a live-in caregiver when you start needing this kind of care, you’re in big trouble.”

LuMarie Polivka-West knows the potential problems all too well. Polivka-West, 64, is the senior director of policy and program development for the Florida Health Care Association, a trade organization for nursing homes and assisted living facilities. (I first spoke with Polivka-West two years ago, when she discussed the financial challengesshe and her two brothers faced caring for their aging parents.)

About 15 years ago, she bought a long-term-care policy. The company went out of business after five years, and she let her policy lapse rather than switch to another plan with higher premiums and less comprehensive coverage. But she’s reconsidering that decision. Polivka-West’s husband is four years older than she is. Her mother died of Alzheimer’s disease at age 89 after struggling with it for eight years. What if a similar fate awaits her?

Polivka-West thinks insurers shouldn’t be allowed to charge her more just because she’s a woman.

“The Affordable Care Act recognized the gender bias in health insurance,” she said. “The same [rules] should apply to long-term-care insurance.”

The federal health overhaul sought to eliminate the coverage and price discrepancies in the larger health insurance market. A 2012 study by the National Women’s Law Centerfound that 92 percent of top-selling health plans in the individual market practiced sex-based pricing in states where the practice was allowed. (Fourteen states banned or limited the practice, according to the report.) Nearly a third of plans charged women at least 30 percent more than men for the same coverage, even plans that did not include maternity benefits, the study found.

Insurers that sell individual and small-group health policies on the state-based health insurance exchanges or outside them on the private market in 2014 will be able to vary premiums based only on geography, family size, age and tobacco use. (Plans that have grandfathered status under the law are exempt from these requirements.)

Under federal laws against sex discrimination in the workplace, employers are generally prohibited from charging women more than men for the same health insurance coverage.

Meanwhile, Genworth Financial says it won’t switch to gender-based pricing for long-term care in two states—Colorado and Montana–that prohibit varying premiums based on gender in all health insurance products.

As states move to bring their laws into conformance with the gender rating requirements under the Affordable Care Act, some advocates see an opportunity.

“Any state with a strong advocacy group could be advocating for a very broad-based prohibition against gender rating” in all insurance products, says Donna Wagner, the associate dean for academic affairs at the College of Health and Social Services at New Mexico State University who also chairs the policy committee for the Older Women’s League, an advocacy group.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

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.

Osteoarthritis thumbnail

Osteoarthritis – from NIH MedlinePlus magazine


From NIH MedlinePlus magazine 

What Is Osteoarthritis?

Osteoarthritis is the most common type of arthritis. People usually have joint pain and stiffness. Unlike rheumatoid arthritis, it does not affect skin tissue, the lungs, eyes, or blood vessels.

In osteoarthritis, cartilage—the hard, slippery tissue that protects the ends of bones where they meet to form a joint—wears away. The bones rub together, causing pain, swelling, and loss of motion. Over time, the joint also may lose its normal shape. Bone spurs—small deposits of bone—may grow on the edges of the joint. Also, bits of bone or cartilage can break off inside, causing more pain and damage.

Where does osteoarthritis occur?

Hands—Osteoarthritis of the hands seems to run in families. Women are more likely than men to have hand involvement. For most, it develops after menopause. Small, bony knobs may appear on the end joints (those closest to the nails) of the fingers. Fingers can become enlarged and gnarled, and may ache or be stiff and numb. The base of the thumb joint also is commonly affected.

Knees—Symptoms include stiffness, swelling, and pain. This makes it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips—There is pain and stiffness of the joint itself. But sometimes pain is felt in the groin, inner thigh, buttocks, or even the knees. Osteoarthritis of the hip may limit moving and bending. This can make dressing or other daily activities a challenge.

Spine—There is stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can put pressure on the nerves where they exit the spinal column. This results in weakness, tingling, or numbness of the arms and legs. In severe cases, bladder and bowel function can be affected.

Osteoarthritis Basics: The Joint and Its Parts

Joints allow movement between the bones and absorb the shock from walking or other repetitive motion. Joints are made up of:

Cartilage. A hard, slippery coating on the end of each bone.

Joint capsule. A tough membrane that encloses all the bones and other joint parts.

Synovium (sin-O-vee-um). A thin membrane inside the joint capsule that secretes synovial fluid.

Synovial fluid. A fluid that lubricates the joint and keeps the cartilage smooth and healthy.

Ligaments, tendons, and muscles. Tissues that surround the bones and joints, a llowing the joints to bend and move. Ligaments are tough, cord-like tissues that connect one bone to another. Tendons are tough fibers that connect muscles to bones. Muscles are bundles of specialized cells that, when stimulated by nerves, either relax or contract to produce movement.

A Healthy Joint

Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues.

A  Joint With Severe Arthritis

A Joint With Severe Osteoarthritis. Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

A Joint With Severe Osteoarthritis.
Illustration: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

With osteoarthritis, the cartilage wears away. Spurs grow out from the edge of the bone, and synovial fluid increases. The joint feels stiff and sore.

Fast Facts

  • Osteoarthritis is the most common type of arthritis. More common in older people, it is sometimes called degenerative joint disease.
  • Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), spine (neck and lower back), knees, and hips.
  • Some 27 million Americans age 25 and older have osteoarthritis.
  • Osteoarthritis is more likely in overweight people and among those with jobs that stress particular joints.
  • Exercise is one of the best treatments for osteoarthritis.
  • Before age 45, osteoarthritis is more common in men. After 45, it is more common in women.

Warning Signs of Osteoarthritis

  • Pain and stiffness in a joint after getting out of bed or sitting for long.
  • Swelling in one or more joints, especially those at the ends of the fingers (closest to the nail), thumbs, neck, lower back, knees, and hips.
  • Crunching feeling or the sound of bone rubbing on bone
  • Osteoarthritis may progress quickly, but in most people it develops gradually. It is relatively mild and interferes little with daily life in some people. Others have significant pain and disability.
  • If you feel hot or your skin turns red, or if your joint pain is accompanied by a rash, fevers, or other symptoms, you probably do not have osteoarthritis. Check with your health provider about possible other causes, such as rheumatoid arthritis.


A combination of the following methods are used to diagnose osteoarthritis:

Clinical history—You will be asked when the condition started and how your symptoms have changed since. You will also describe any other medical problems you or your family may have, and any medications being taken. This helps your doctor make a diagnosis and understand the disease’s impact on you.

Physical examination—Your doctor checks your strength, reflexes, and general health. She or he also examines bothersome joints and observes your ability to walk, bend, and carry out daily activities, such as dressing.

X rays—X-rays will help determine the form of arthritis and how much damage there is, including cartilage loss, bone damage, and bone spurs.

Magnetic resonance imaging —Magnetic resonance imaging (MRI) provides high-resolution computerized images of internal body tissues. It is used if there is pain, X-rays don’t show much, or there is damage to other joint tissues.

Other tests—Your doctor may order blood tests to rule out other causes of symptoms. Fluid may also be drawn from the joint for microscopic examination to determine whether the pain is from a bacterial infection or uric acid crystals, indicating gout.


Doctors often combine treatments to fit a patient’s needs, lifestyle, and health. Osteoarthritis treatment has four main goals: Improve joint function, keep a healthy body weight, control pain, and achieve a healthy lifestyle. Treatment plans can involve:

Exercise—Research shows that exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Your doctor and/or physical therapist can recommend the exercises best for you.

Weight control—Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility. A healthy diet and regular exercise help reduce weight. A dietitian can help you develop healthy eating habits.

Rest and relief from stress on joints—Learn to recognize the body’s signals, and know when to stop or slow down. Regularly scheduled rest prevents pain from overexertion. Proper sleep is important for managing arthritis pain. If you have trouble sleeping, relaxation techniques, stress reduction, and biofeedback can help.

Nondrug pain relief and alternative therapies—You may find relief from:

  • Heat or cold (or a combination of both). Heat—with warm towels, hot packs, or warm bath or shower—can increase blood flow and ease pain and stiffness. Cold packs (bags of ice or frozen vegetables wrapped in a towel) can reduce inflammation, relieving pain or soreness.
  • Massage uses light stroking and/or kneading of the muscles to increase blood flow and warm the stressed joint.
  • Complementary and alternative therapies—Some people have found relief from such therapies as acupuncture. A large study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) showed that acupuncture can relieve pain and improve function in knee osteoarthritis.
  • Nutritional supplements—such as glucosamine and chondroitin sulfate have been reported to improve osteoarthritis symptoms in some people.


When selecting medicines, your doctor will consider the intensity of pain, potential side effects of the medication, your medical history, and other medications you are taking. By working together, you and she or he can find the medication that best relieves your pain with the least risk of side effects.

The following medicines are commonly used to treat osteoarthritis:

Acetaminophen—A common over-the-counter pain reliever. It is often the first choice for osteoarthritis patients because of its safety and effectiveness compared to some other drugs.

NSAIDs (non-steroidal anti-inflammatory drugs)—A large class of medications for both pain and inflammation. It includes aspirin, ibuprofen, naproxen, and others. Some NSAIDs are available over the counter, while more than a dozen others are available only with a prescription. NSAIDs can have significant side effects. Anyone taking NSAIDs regularly should be monitored by a doctor.

Narcotic or central acting agents—Mild narcotic painkillers containing codeine or hydrocodone are often effective against osteoarthritis pain. But because of their potential for physical and psychological dependence, they are generally for short-term use.

Corticosteroids—Powerful anti-inflammatory hormones that may be injected into the affected joints for temporary relief. No more than four treatments per year are recommended.

Hyaluronic acid substitutes—These medications are injected to help lubricate and nourish joints. They are approved only for osteoarthritis of the knee.

Other medications—Doctors also may prescribe topical pain-relieving creams, rubs, and sprays, which are applied directly to the skin over painful joints. Because most medicines used to treat osteoarthritis have side effects, it is important to learn as much as possible about the medications you take, even the ones available without a prescription.


For many people, surgery helps relieve the pain and disability of osteoarthritis. You may have surgery to:

  • remove loose pieces of bone and cartilage (arthroscopy)
  • reposition bones (osteotomy)
  • resurface bones (joint resurfacing).

Surgeons also may replace affected joints with artificial ones called prostheses. These can last up to 15 years or longer. The surgeon chooses the prosthesis according to the patient’s weight, sex, age, activity level, and other medical conditions.

After surgery and rehabilitation, the patient typically feels less pain and moves more easily.

No pills, yet . . .

“There are no pills yet for osteoarthritis, but we’re working on it . . . “

“There are no pills yet for osteoarthritis, but we’re working on it,” says Linda Sandell, Ph.D., professor of Orthopaedic Surgery and of Cell Biology at the Washington University School of Medicine, in St. Louis. In osteoarthritis, the soft tissue called cartilage, which cushions the knees and other joints of the body, wears away, causing pain and loss of mobility.

“It’s a huge and growing public health issue,” says Sandell, who points out that more than 50 percent of people age 65 and over have osteoarthritis. “But it is not just a disease of old age; people get it when they’re young, too.”

Under a multi-year grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), she and her colleagues are studying stem cells in specially bred mice to determine whether there is a correlation between injury and healing.

“Every person has stem cells, and some people are better at repairing than others,” Sandell observes. “We need to find the gene, or genes, for cartilage repair and osteoarthritis in these mice, and target these genes in the development of medications that could be used in humans.

“Every person has stem cells, and some people are better at repairing than others.”

“But like heart disease or obesity, osteoarthritis is a complex disease; the research is difficult and expensive, and improvements are hard to measure. We need to change its image as an inevitable result of old age. It has a molecular start, and it takes a long time to develop. People often don’t realize that their joints are degenerating until late in the process when they begin to hurt.”

Sandell says people can’t change their age but they can reduce the risks of osteoarthritis, which, in addition to genetics, include prior joint injuries and being overweight, through exercise and a healthy diet. “First,” she urges, “no more couch potato. Check with your doctor, then start walking a couple of miles a day. Use—but don’t overuse—your joints.

“Pay attention to what your body is telling you. If your cartilage is okay but your knee is inflamed, ice it,” she advises. “Keeping fit is one of the keys to delaying arthritis.”

Ongoing research

Osteoarthritis is not simply “wear and tear” in joints as people get older.

Researchers are studying:

  • Tools to detect osteoarthritis earlier
  • Genes
  • Tissue engineering—special ways to grow cartilage to replace damaged cartilage
  • Medicines to prevent, slow, or reverse joint damage
  • Complementary and alternative therapies
  • Vitamins and other supplements
  • Education to help people better manage their osteoarthritis
  • Exercise and weight loss to improve mobility and decrease pain
  • Researchers are learning about sex differences that explain why women are more susceptible than men to anterior cruciate ligament (ACL) injuries, which can lead to osteoarthritis. These include structural differences of the knee joint and thigh muscles and differences in the ways male and female athletes move. They are also developing ways to protect young female athletes from these injuries.
  • Discovery of the various genetic mutations leading to osteoarthritis could lead to new treatments.
  • Longer-lasting materials and designs that more closely mimic natural knee movement are making total joint replacements more suitable for younger, more active osteoarthritis patients.
  • Despite the benefits, African American and Asian American patients are less likely than their white counterparts to choose total knee replacement. Also, researchers have found that race is more important than socioeconomic status in these decisions. That is an important first step toward improving access to knee surgery, and to help all patients make informed decisions about their treatment.
  • Surgical advances have made hip replacements safer for older patients. This helps older patients who have other conditions that previously would not have allowed them to have the procedure.
  • Less invasive surgical approaches and preoperative exercise programs have led to decreased hospital stays and faster recovery. If adopted nationwide, they could lead to major cost savings.

Articles in NIH MedlinePlus magazine are written by professional journalists. All scientific and medical information is reviewed for accuracy by representatives of the National Institutes of Health. However, personal decisions regarding health, finance, exercise, and other matters should be made only after consultation with the reader’s physician or professional advisor. Opinions expressed herein are not necessarily those of the National Library of Medicine. Photos and other images without credit lines are provided by NIH.

Chain Saw

What will the impact of sequestration be on Washington health programs?


In an effort to pressure Congress to come up with a deal to prevent the $85 billion in across-the-board spending cuts required by the sequestration agreement, the White House has released a list of programs that will be hit should the cuts go through.

Here is the White House’s list of cuts that will likely hit health-related programs in Washington state.

Protections for Clean Air and Clean Water:

Washington would lose about $3,301,000 in environmental funding to ensure clean water and air quality, as well as prevent pollution from pesticides and hazardous waste. In addition, Washington could lose another $924,000 in grants for fish and wildlife protection.

Vaccines for Children:

In Washington around 2,850 fewer children will receive vaccines for diseases such as measles, mumps, rubella, tetanus, whooping cough, influenza, and Hepatitis B due to reduced funding for vaccinations of about $195,000.

Public Health:

Washington will lose approximately $642,000 in funds to help upgrade its ability to respond to public health threats including infectious diseases, natural disasters, and biological, chemical, nuclear, and radiological events. In addition, Washington will lose about $1,740,000 in grants to help prevent and treat substance abuse, resulting in around 3800 fewer admissions to substance abuse programs. And the Washington State Department of Health will lose about $174,000 resulting in around 4,300 fewer HIV tests.

Nutrition Assistance for Seniors:

Washington would lose approximately $1,053,000 in funds that provide meals for seniors.

Education for Children with Disabilities:

In addition, Washington will lose approximately $11,251,000 in funds for about 140 teachers, aides, and staff who help children with disabilities.

To learn more:

  • Read the full list of programs the White House says will be affected here.
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Healthy Monday Tip: Make it a family affair



When parents eat healthfully, so does the rest of the family!

If children are exposed to a variety of nutritious foods at a young age, better options become the obvious choice.

Kids who are allowed to participate in the selection and preparation of healthy meals are more likely to try and enjoy the finished product.

Be a role model this week by trying an assortment of nutritious foods with your family.

Let The Kids Cook Monday boost their culinary skills and encourage family time and discussion.


About the Monday Campaigns:

The Healthy Monday Tips is produced by a national health promotion initiative called the Monday Campaigns.

The thinking behind the initiative derives from two studies done at the Center for a Liveable Future at Johns Hopkins Bloomberg School of Public Health by Jullian Fry and Roni Neff.

In one study, they reviewed the scientific studies that looked at ways to get people to adopt healthy habits.

In that review, they found that one of the most effective ways to keep people on track is simply to remind them from time to time to stick to it.

But when would be the best time send those reminders?

Fry and Neff decided to look at Monday, which many of us consider the start of our week.

To better understand how we thought and felt about Monday, they reviewed the scientific literature as well as cultural references to Monday in movies, songs, books and other forms of art and literature, even video games.

They noted that a number of scientific studies have found that we may suffer more health problems on Monday. For example, a number of studies find that Americans have more heart attacks and strokes on Monday.

There is also evidence that we have more on-the-job injuries on Monday, perhaps because we are not quite back into the swing of things, or are still recovering from our weekend.

Fry and Neff also found that while many of us, facing the return to work, may dread Mondays, Monday is also seen as a day for making a fresh start.

Fry and Neff concluded that Monday might be a good day for promoting healthy habits. Calling attention to the health problems linked to the first day of the work week, such as heart attacks and on-the-job injuries, makes Monday a natural day to highlight the importance of prevention.

And the Monday’s reputation as a day to make a fresh start offers the opportunity to help people to renew their efforts to adopt healthier habits.

Fry and Neff’s findings are put into practice by the Monday Campaigns, which helps individuals and organizations use Monday as a focus for their health promotion efforts, providing free research, literature and artwork, and other support.

To learn more about Healthy Mondays:

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