Women's Health

The Louisiana Health Care Redesign Collaborative on Thursday said that the New Orleans-area health care system requires $400 million in short-term federal funds to help hospitals, physicians and nurses affected by Hurricane Katrina, the New Orleans Times Picayune reports. The 40-member committee, established to make recommendations to Louisiana Gov. Kathleen Blanco (D-La.) and HHS Secretary Mike Leavitt on reforms for the system, recommended that the federal government provide:
$120 million to help recruit and retain health care workers through signing bonuses and other financial incentives;

$150 million to compensate hospitals that remained open during and after the hurricane;

$100 million to increase Medicare reimbursement rates to account for the increase in labor costs since the hurricane; and

$30 million to compensate physicians for the treatment of uninsured patients.

Jack Finn — president of the Metropolitan Hospital Council of New Orleans, which supports the recommendations — said, “There is a sense of urgency to this.” However, “how the panel’s recommendations will fare with Leavitt, who said earlier this year that he wants the redesign plan to be revenue-neutral,” remains “unclear,” the Times-Picayune reports. The committee plans to make final recommendations to Leavitt by mid-October (Moller, New Orleans Times Picayune, 8/18).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

FDA and the Massachusetts Institute of Technology on Thursday announced plans to co-develop an automated system that will search existing federal and private health care databases to monitor potential problems with prescription drugs and medical devices, Long Island Newsday reports. The current review system involves the manual inspection of reports voluntarily submitted to FDA. According to Scott Gottlieb, FDA’s deputy commissioner for scientific and medical affairs, reports often are submitted months or even years after adverse events have occurred, and as a result, problems often are underreported. Gottlieb says a more automated system that would scour multiple databases — such as those compiled by health insurance providers and agencies including the Veterans Administration — would be superior in detecting patterns that indicate potential risks. The system would model methods developed to identify infectious disease outbreaks, bioterrorism attacks and the spread of bird flu. FDA also plans to publish reports for doctors that would alert them of the detected problems related to specific drugs and devices, potentially prompting doctors to reciprocate by reporting problems they discover to the FDA, according to Newsday. The reports would be similar to the CDC’s Morbidity and Mortality Weekly Report, which regularly alerts doctors to outbreaks of disease (Long Island Newsday, 8/17).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Health Canada is warning consumers and patients not to drink products containing hydrogen peroxide for medicinal purposes because they can cause serious harm or death when ingested. Anyone who is currently using hydrogen peroxide in this manner should stop immediately and consult a health care provider.

Ingestion of hydrogen peroxide can cause serious harm or death, as well as irritation or ulcers in the stomach and intestines. Health Canada has not authorized any hydrogen peroxide product advertised to treat AIDS, cancer, emphysema or any other serious and life-threatening diseases. There are, however, several high strength hydrogen peroxide products authorized for sale in Canada as disinfectants and as dental bleaching applications, which are health products for professional use only.

Health Canada advises Canadians to contact the Health Products and Food Branch Inspectorate at 1-800-267-9675 if they find any hydrogen peroxide product advertised in Canada to treat AIDS, cancer, emphysema or any other serious and life-threatening diseases. Consumers requiring more information about this advisory can contact Health Canada’s public enquiry line at (613) 957-2991, or toll free at 1-866-225-0709.

To date, no adverse reactions suspected to be associated with the ingestion of hydrogen peroxide have been reported to Health Canada. To report a suspected adverse reaction to this or any other health product, please contact the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) of Health Canada by one of the following methods:

The CADRMP adverse reaction reporting form, including a version that can be completed and submitted online, is located on the MedEffect portal of the Health Canada Web site.

Health Canada issues Public Warnings when there is a high probability that the use of, or exposure to, a product will cause death or other serious adverse health effects, such that the public should stop using the product immediately.

Health Canada

A new policy at clinics in the UNC Health Care system in North Carolina has limited access to care for low-income patients, according to a petition recently submitted to system President Erskine Bowles with signatures from more than 1,100 state residents, the Raleigh News & Observer reports. John Hammond, a retired University of North Carolina-Chapel Hill professor, and Florence Soltys, a faculty member at the UNC schools of medicine, social work and nursing, led the petition effort. The petition alleges that most UNC clinics do not schedule appointments for uninsured patients. In addition, according to the petition, a new policy at the clinics that requires payment at time of service limits access to care for low-income patients. The clinics use an automated appointment confirmation system with a telephone message that informs patients of their obligation to pay at the time of service. Hammond said that the policy represents “a conscious effort to intimidate, embarrass or otherwise discourage people from showing up.” Bowles and UNC-Chapel Hill Chancellor James Moesor plan to meet with UNC Health Care CEO William Roper to address the concerns raised in the petition, a Bowles spokesperson said. UNC Health Care receives more than $40 million annually in state funds and is “traditionally a break-even operation,” according to the News & Observer. Roper said of the petition, “The notion that anything we have done has in any respect moved us away from our historic mission to serve the people of North Carolina is just wrong, wrong, wrong” (Fisher, Raleigh News & Observer, 8/18).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Researchers have found an association between physical fitness and the brain in 9- and 10-year-old children: Those who are more fit tend to have a bigger hippocampus and perform better on a test of memory than their less-fit peers.

The new study, which used magnetic resonance imaging to measure the relative size of specific structures in the brains of 49 child subjects, appears in the journal Brain Research.

“This is the first study I know of that has used MRI measures to look at differences in brain between kids who are fit and kids who aren’t fit,” said University of Illinois psychology professor and Beckman Institute director Art Kramer, who led the study with doctoral student Laura Chaddock and kinesiology and community health professor Charles Hillman. “Beyond that, it relates those measures of brain structure to cognition.”

The study focused on the hippocampus, a structure tucked deep in the brain, because it is known to be important in learning and memory. Previous studies in older adults and in animals have shown that exercise can increase the size of the hippocampus. A bigger hippocampus is associated with better performance on spatial reasoning and other cognitive tasks.

“In animal studies, exercise has been shown to specifically affect the hippocampus, significantly increasing the growth of new neurons and cell survival, enhancing memory and learning, and increasing molecules that are involved in the plasticity of the brain,” Chaddock said.

Rather than relying on second-hand reports of children’s physical activity level, the researchers measured how efficiently the subjects used oxygen while running on a treadmill.

“This is the gold standard measure of fitness,” Chaddock said.

The physically fit children were “much more efficient than the less-fit children at utilizing oxygen,” Kramer said.

When they analyzed the MRI data, the researchers found that the physically fit children tended to have bigger hippocampal volume – about 12 percent bigger relative to total brain size – than their out-of-shape peers.

The children who were in better physical condition also did better on tests of relational memory – the ability to remember and integrate various types of information – than their less-fit peers.

“Higher fit children had higher performance on the relational memory task, higher fit children had larger hippocampal volumes, and in general, children with larger hippocampal volumes had better relational memory,” Chaddock said.

Further analyses indicated that a bigger hippocampus boosted performance on the relational memory task.

“If you remove hippocampal volume from the equation,” Chaddock said, “the relationship between fitness and memory decreases.”

The new findings suggest that interventions to increase childhood physical activity could have an important effect on brain development, Kramer said.

“We knew that experience and environmental factors and socioeconomic status all impact brain development,” he said.

“If you get some lousy genes from your parents, you can’t really fix that, and it’s not easy to do something about your economic status. But here’s something that we can do something about,” Kramer said.

Source:
University of Illinois at Urbana-Champaign

Public Health minister Caroline Flint is working across government on a new strategy to increase the public’s fitness and activity levels.

The Prime Minister asked Caroline Flint to work across government to develop a strategy building on and developing existing work to transform the population into a fitter and more active nation in the run up to the 2012 Olympic and Paralympic Games.

She will report to Patricia Hewitt, Secretary of State for Health and Tessa Jowell, Secretary of State for Culture, Media and Sport and Olympics Minister. Speaking at the Rowing World Championships at Dorney Lake, near Windsor, – the venue of the 2012 Olympic rowing and sprint canoeing events – Ms Flint outlined how she intends to fulfil her new physical activity role.

She said: “We will be working in partnership with the Department for Culture, Media and Sport / Department for Communities and Local Government / Department for Transport / Department for Education and Skills and delivery bodies like Sport England and will build on the good work that has already taken place. We will also look at further opportunities for physical activity across the board and consider the gaps and priorities. By taking the ‘Small Change Big Difference’ approach we will look at ways we can support the public to make minor changes that will make a long term difference to their health.

“We need to ensure that sport and active recreation are accessible to all.

“The biggest gains to health and to the economy will be made by encouraging more physical activity among groups of people who don’t normally do any. We want to help people build physical activity into their daily routines and another approach could be encouraging more active travel.We know, for example, that one in five of all car journeys are less than one mile. If we could continue to encourage more people to travel by bicycle or on foot for these journeys we would overcome traffic congestion and improve health.

“Working with Sport England, the grass roots delivery body, and with private and third sector organisations will be a key aspect of promoting activity, and government funded programmes put into place by the Amateur Rowing Association are being hailed as an example of what can be achieved in partnership.”

The need to increase the nation’s fitness levels is also highlighted by a new report, due to be published this Friday, which forecasts that there will be a significant increase in adult obesity levels by 2010.

Figures show that if we sit back and do nothing obesity prevalence in men will rise from 22 per cent in 2003 to 33 per cent in 2010.

At the Championship event, the ARA launched a guide to partnerships between Rowing and Health to complement a number of new, innovative rowing programmes, such as the Indoor Rowing in Schools and Adult Learn to Row courses.

Caroline added: “Programmes such as the Indoor Rowing In Schools will enable many more people to discover and realise an enthusiasm for rowing and activity. Rowing has never been so accessible and case studies demonstrate its power to transform sedentary lifestyles.”

Richard Caborn, Minister for Sport added: “Getting more people to do more sport and physical activity is a priority for us, and there’s real scope for us to build on the very good work that is already taking place across the country.

“Sport cuts across all aspects of life which is why in government we have to work across departments to get people active.

” The Amateur Rowing Association’s indoor rowing scheme is a good example of the impact a club to school link can have. As a result of this initiative, more children – and many who would not have tried the sport before – are participating in a high quality club environment, enjoying themselves, and getting fit.”

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1. The Amateur Rowing Association (ARA) is the national governing body for all forms of rowing in England, including recreational, competitive, traditional, coastal and indoor and is responsible for the Great Britain team.

2. Eight Regional Sports and Health Seminars have been held since November 2005. A final seminar is planned for October. The seminars have aimed to ‘showcase’ best practice partnerships between sports clubs, PCTs and local authorities, alongside a networking opportunity for potential local partners. As ‘live’ events, the seminars were able to share best practice in a way that written toolkits and resources cannot.

3. Since 2004, the ARA has received Ј264,167 in funding through the PE School Sport and Club Links (PESSCL) programme led by the Department for Education and Skills and the Department for Culture Media and Sport to develop resources for use in clubs and schools, support delivery via Community Sports Coaches and provide backup through Coaching and Development Officers.

4. The Prime Minister asked Caroline Flint to undertake the physical activity role in May 2006.

For further information please visit:
UK Department of Health

Direct-to-consumer prescription drug advertisements have made every “state and stage of existence … a pathology in the need of pharmaceutical ‘intervention,’” and the “result has been soaring medical insurance costs, toxic side effects and new tensions between doctors and patients, who increasingly badger doctors for the drugs they’ve seen on TV,” Jonathon Rowe, an issues director at Commercial Alert and a fellow at the Tomales Bay Institute, writes in a Christian Science Monitor opinion piece. The ads have “immersed us all in a pervasive drug culture that seems to have no boundaries,” and life has become a “petri dish of biochemical deficiency and need,” Rowe writes, adding, “The ads really are selling the disease more than a cure.” According to Rowe, “Medicine is supposed to be about science, not huckstering; about healing people, not persuading more of them that they are sick.” He adds that, although pharmaceutical companies maintain that they seek to educate the public through the ads, “there are far better ways … than to spend billions of dollars a year pushing pills.” Rowe writes that “Washington should listen” to the more than 200 medical school professors, 40 health and seniors group and many members of the American Medical Association who have “urged restrictions” on the ads (Rowe, Christian Science Monitor, 8/21).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

A new survey of 6,810 teens showed that more than half of them work, and 514 of them had been injured on the job.

“The findings from this study clearly indicate that work-related injuries among youth are a significant health problem,” report Kristina M. Zierold, Ph.D., assistant professor of family and community medicine at Wake Forest University School of Medicine, and Henry A. Anderson, M.D., chief medical officer of the Wisconsin Division of Public Health.

Writing in the American Journal of Health Behavior, the authors report that 150 of the teens were injured severely enough that activities at home, work, or school were affected for more than three days, and 97 filed for workers’ compensation.

The study, funded by the National Institute for Occupational Safety and Health, was conducted in Wisconsin while Zierold was an epidemic intelligence service officer with the Centers for Disease Control and Prevention. “Developing programs and strategies to reduce injury must be made a priority,” Zierold said.

But training on the job – where safety could be stressed – often is given by another employee. “This type of training usually consists of explaining how to do the work and how to work the equipment, without emphasis on safety issues,” Zierold said. “In other instances, no training is given at all.” She said there were no standards governing the safety training.

“Because so many high school students are working during the school year, we advocate introducing a safety training course within the school health curriculum,” she said. Such training could be geared to the youth’s developmental level and age. Zierold said, “Training would emphasize how to identify work-related hazards, how to protect themselves from hazards, and how to address their supervisors with their safety concerns. With the safety training, teens could feel empowered at the workplace by knowing their rights and how to protect themselves.”

The researchers note that nationally each year, “approximately 70 children die from injuries inflicted at work; hundreds are hospitalized and tens of thousands require treatment in hospital emergency rooms. The National Pediatric Trauma Registry and the National Center for Health Statistics report that occupational injuries are the fourth-leading cause of death among youth ages 10-19.”

The new survey showed that the jobs most likely to lead to injury were in lumber mills (51 percent were injured on the job), lumber yards (40 percent), manufacturing (37 percent), gas stations (36 percent), someone else’s farm (36 percent), and construction (30 percent.). Some of the jobs and the required tasks that teens do in these jobs are illegal, Zierold said.

The survey found that the 10 most common jobs for teens were in restaurants and fast food (1,135 of the 6,810), babysitting and lawn care (957), the family business or family farm (644), grocery stores (316), department stores (261), construction, (152), newspapers (135), hospitals, clinics and nursing homes (124), other farms (109), and gift or hobby shops (107). Another 274 said they were self-employed. The survey found that the number of hours worked each week varied from just five hours to more than 40 hours a week (about 3 percent of the sample). The survey showed that 159 teens – about 4 percent – reported working after 11 p.m. on school nights. And 579 teens in the sample – 16 percent – reported working more than 23 hours a week, the equivalent of an adult half-time job.

“Based on our analysis, we surmise that working later hours may involve circumstances that place teens at greater risk for severe occupational injury,” Zierold said. Late at night, when managers have gone home, “teens may be asked to perform more prohibited or hazardous tasks than when supervisors are present.” Zierold said, “Prohibiting teens from working long and late hours, improving safety training, and increasing communications between teens and their coworkers and supervisors may help reduce the occurrence of injury.”

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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation’s medical schools. It ranks 32nd in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Contact: Robert Conn

Wake Forest University Baptist Medical Center

A program that helps parents talk to their children about skin cancer risks may promote sun-safe behaviors, especially when parents and children have a high-quality relationship, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Approximately one in six individuals will develop skin cancer during his or her lifetime, according to background information in the article. The recent increase in skin cancer incidence has been attributed to various forms of high-risk sun exposure among young people, including sunbathing, inadequate use of sunscreen and other protective measures and the use of tanning beds or lamps. Recent preventive interventions have targeted children in school or community settings, but widespread rates of dangerous behaviors persist in young people.

Rob Turrisi, Ph.D., The Pennsylvania State University, University Park, and colleagues evaluated a parent-based intervention and assessed family characteristics that may contribute to the effectiveness of such a program in 469 parent-child pairs. Of those, 340 were assigned to the intervention group, in which parents received a handbook that encouraged them to communicate skin cancer risks, promote safe behaviors and discourage tanning, sunbathing and other high-risk activities. The other 129 were assigned to the control group. The children were all 9 to 12 years old, in fourth through sixth grade and from southern Idaho or eastern Tennessee. Forty-five days after parents in the intervention group received the handbook, children in both groups underwent an assessment in which they were asked questions about their sun-related habits and their family dynamics.

Among children who were in the intervention group, several family variables increased the effectiveness of the program. Children in the intervention who exhibited average levels of compliance–measured by how often they reported obeying their parents or following their parents’ rules–had less frequent sunburns than those in the control group, but those with above-average compliance developed even fewer sunburns. Among children who reported that their parents had a low level of monitoring–for instance, that parents do not typically know where a child is or is going–the intervention had a larger effect on sunburn severity than among those who reported that their parents monitored them closely. The quality of the parent-child relationship, the child’s level of compliance and the frequency of negative communication all affected sunbathing tendencies among those in the intervention group–the program was most effective in families with a high-quality parent-child relationship, a high level of compliance and a low level of negative communication.

The findings are consistent with current theories regarding effective parenting, the authors write. “Since the intervention was parent based, it follows that if the child feels that the parent encompasses many general positive qualities (e.g., the parent is warm, loving, trusting and a good listener and shows respect for the child), the child will be more likely to listen to his or her parents about issues such as skin cancer risks,” they continue. “Furthermore, if the child is willing to comply with parental demands, the parent will have more influence in encouraging sun-safe behaviors and discouraging unsafe sun-related behaviors. Also, it is important that the parent does not exhibit negative communication patterns that can negate the effectiveness of positive communication.

“Finally, when parents are already aware of their child’s activities, they are more capable of making sure that their child is adequately protected from the sun, which can prevent severe burns,” they conclude. “Parents can be viable change agents for child behavior and the quality of the family relationship is critical to the success of such interventions.”
(Arch Dermatol. 2006;142:1009-1014.)

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Editor’s Note: This study was supported by a grant from the American Cancer Society to Drs. Turrisi, Hillhouse and Robinson. Dr. Robinson has served as a consultant to 3M Pharmaceuticals. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Vicki Fong

JAMA and Archives Journals

The Healthcare Commission will today (Friday August 18th 2006) warn that it suspects the NHS of widespread non-compliance with legislation on race relations designed to promote equality.

It will release results of an audit suggesting most trusts have not met responsibilities to publish information under the Race Relations (Amendment) Act 2000.

Inspectors spent 30 minutes scanning each website of all 570 NHS trusts, looking for information that legislation has required public bodies to publish since May 2002.

In that half an hour, they could only find this information the websites of seven NHS trusts, around one per cent of the total.

As part of a duty to promote race equality, all NHS trusts should publish:

– a race equality scheme and action plan setting out how the organisation will make race equality central to all its functions, reviewed every three years

– annual employment monitoring statistics showing the ethnic profile of the workforce, including access to training and promotion, as well as numbers of job applicants and short-listed candidates

– the outcome of race equality impact assessments demonstrating what action has been taken to address any adverse impact of an organisation’s policies.

In the time allowed under the audit, Commission inspectors could find:

– none of the information required on 31 per cent of trust websites

– an updated race equality scheme on 60 per cent of trust websites

– employment monitoring statistics on six per cent of trust websites

– race equality impact assessments on two per cent of trust websites

The Commission stresses that the audit is not a definitive test of compliance, but says the findings do suggest a significant problem with the number of trusts meeting statutory codes of practice.

As a result, the inspectorate has this week written to NHS trusts urging them to check they meet their legal responsibilities. It plans to identify the apparent worst offenders and warn them that unless they demonstrate action they risk taking a hit in the annual performance ratings.

It has also passed the findings to the Commission for Racial Equality, which has powers to warn and prosecute organisations that fail to comply.

Jamie Rentoul, the Healthcare Commission’s Head of Strategy, said: “It is not unreasonable to expect legislation to take a little time to bed in. But we were surprised and disappointed by the apparent extent of the problem at this stage.

“Trusts should take this seriously because NHS services have not always found it easy to reach all sections of the community. They employ a particularly large and diverse section of the workforce so it is important they demonstrate what they are doing.

“This is why we are putting trusts on notice that they must put their houses in order. If they fail to do so then we, and the CRE, will have to take action. The duty to promote race equality is not an optional extra.”

The Race Relations Act 2000 was part of the response to the public inquiry into the murder of Stephen Lawrence. The law instructs public sector bodies to actively seek to reduce inequalities between races, both in service provision and employment.

The NHS has long recognized that people from ethnic minority groups have poorer access to services and outcomes from treatment. The Commission’s surveys of patients show these groups are more likely to be negative about their healthcare.

The inspectorate points out that the NHS is the biggest employer in the world with 1.4 million workers. It says that a relatively large number of these – almost 40 per cent – are from black and minority ethnic groups.

Inspectors found a race equality scheme at 73 per cent of trusts in the southeast, compared with 54 per cent in the central region, 55 per cent in the north and 63 per cent in the southwest.

They found a race equality scheme most easily on the websites of primary care trusts followed by mental health, ambulance and learning disability trusts. They found a race equality scheme on the websites of fewer than half of acute hospital trusts.

Surinder Sharma, the National Director for Equality and Human Rights, said: “The Department of Health takes these findings very seriously. All NHS organisations must ensure that they are fully compliant with the Race Relations Act and publicly set out how they are meeting their responsibilities.

“Whilst the Healthcare Commission’s audit is not a definitive test of co-operation, it does point to serious issues of concern. I am personally looking to every NHS Trust to give immediate attention to remedying this situation, not just to comply with legislation, but also because race equality remains a core element of our drive to improve access to healthcare, combat health inequalities and develop a diverse workforce.”

The Department of Health says it will notify all NHS chief executives of the importance of responding to these findings in a prompt professional manner, and will be issuing new equality guidance to non-executive directors of NHS boards.

– Race equality audit (pdf 51kb)

– More information about equality, diversity and human rights

Further information on the Healthcare Commission is available on healthcarecommission