California governor signs bill to stop circumcision ban
Sacramento, CA, United States (AHN) – California Gov. Jerry Brown signed a bill Monday prohibiting cities and counties from banning male circumcision.
The bill was the result of a San Francisco measure, the first of its kind, designed to prohibit child circumcision there. The initiative drew national attention. A judge in July ordered the circumcision ban off the November ballot, but Los Angeles assemblyman Mike Gatto’s bill proceeded through the Legislature and was passed with a unanimous vote. Gatto argued that such bans were an affront to the exercise of “personal, medical and religious freedom.”
Circumcision is the removal of the male foreskin, a practice that has roots at least as far back as Biblical times. Many proponents believe it was commanded by God in a covenant with Abraham. Opponents of circumcision say it is akin to “genital mutilation,” the forced removal of a healthy body part from an unconsenting child.
Circumcision rates in the United States have been declining. According to the Centers for Disease Control and Prevention, currently half of all males born in U.S. hospitals are circumcised.
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Oakland clinic provides medical care to ex-offenders
Oakland, CA, United States (KaiserHealth) – Most former inmates leave California prisons with no consistent place to get medical care. Instead, they rely on a scattershot of county-funded clinics or end up at county emergency rooms. But in California, that’s beginning to change.
The state negotiated with the Obama administration to gain early access to funds available under the federal health law. Starting last month, counties began enrolling all low-income residents — including ex-offenders — into a version of Medi-Cal.
Ex-convict Darren Thurmond wears a prison-issued grey sweat suit, stretched tightly over his large belly and carries a crumbled brown paper bag, as he climbs out of the prison van stopping just outside the metal gates of San Quentin.
Waiting for him is Don Williams – a counselor from a local health clinic who’s here to give Thurmond a ride to Oakland.
“I’m not sure how many times I can do this, man,” Thurmond says to Williams.
Thurmond has been in and out of prison in the last twenty years for cocaine and methamphetamine possession. Now at age 45, all the drug use and hard living has damaged his heart.
Like many ex-convicts, he says hasn’t had health insurance since he was a kid, and his heart problems were first diagnosed and brought under control in prison. But each time Thurmond gets out, he’s left with a 4-week supply of medication and no insurance. Now that’s changing.
With the early expansion of health coverage this summer, former inmates will be covered for preventive care, prescription drugs, specialty visits and mental health and substance abuse. One place where Thurmond will now get care is at the non-profit Healthy Oakland, his first stop after his release from prison.
This is one of the few clinics in the state that offers medical care to ex-convicts who have typically been excluded from public insurance programs like Medi-Cal.
Thurmond sits down for a full medical checkup with George Pearson, the clinic’s physician assistant. They discuss his heart problems, his weight and the painful arthritis that’s overtaking Thurmond’s hips.
Pearson says a 45-year old ex-convict will often have the ailments of someone 10 years older. They have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. To be sure, these ailments stem from living a hard life, but it’s also because they have common medical problems that go untreated.
“So the hypertension becomes heart failure. The diabetes becomes diabetic neuropathy, which can lead to amputation, even blindness,” Pearson says.
Researchers say that when these pervasive problems are left untreated, they can lead right back to prison or jail, and that giving ex-offenders health insurance and assigning them a regular doctor brings some order to their chaotic lives.
“Their whole life is transitional. And it lacks stability. You need a facility that’s going to be the home of their records, [that's] going to know them as a person,” Pearson says. Having a regular health care provider can prevent ex-offenders from over utilizing the ER.
Expansion of Care in Some Counties
Some county health departments are using the new federal money to re-structure their safety nets to provide a fuller array of services. For example, Alex Briscoe of the Alameda County public health department says he’s adding mental health specialists to primary care clinics.
“Historically, services for this population are fragmented and tend to be episodic. And what we’re trying to do is prepare for health reform by assigning all consumers in our system, all clients in our system, to a medical home.”
Those preparations are especially important as California begins to comply with a court order to reduce its state prison population. To relieve overcrowding, tens of thousands of lawbreakers are expected to be put on probation in their home towns instead of going to state facilities. That means even more ex-offenders signing up for the expanded health coverage.
However, health researchers say the new enrollees will likely only add to a maxed out Medi-Cal system. Wait times for specialists have long plagued Medi-Cal across California, largely due to the state’s low reimbursement rate.
Still, providing coverage is important for public health, experts say. Emily Wang of the Yale School of Medicine says many former inmates return home with communicable diseases.
“Treating substance abuse, HIV, hepatitis C will reduce the disease rates in our communities,” she says.
But Wang and others say health insurance though is no magical cure for a group of people with more pressing, every day needs.
After Darren Thurmond finished his doctor’s visit at Healthy Oakland, this reporter drove him to a pharmacy to pick up his many prescriptions. By bus, this trip would’ve taken an hour, plus a painful walk with his arthritic hips.
Afterward, we headed to a Mexican restaurant in downtown Oakland for lunch. Thurmond says he had fantasized in prison about authentic enchiladas.
He’s thankful that he now has a regular doctor, he says. But he’s homeless. Living in his van, he’s unsure how he’ll get to his appointments to get his blood work checked or his prescriptions refilled.
“Being homeless, often I have the time to do it, but I don’t have the gas to get there,” Thurmond says.
For now, Thurmond is thinking pragmatically. On his first day out of San Quentin the basics are his main concerns: finding a job, getting money for food and gas, and a place to shower. “I’m pretty resourceful,” he says with no hint of pity. “I know a few places where I can shower.”
Alex Liu contributed to this story.
– Provided by Kaiser Health News.
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Fewer antibiotics prescribed after warnings of overuse
Washington, DC, United States (AHN) – Recent warnings over misuse and overuse of antibiotics appears to be paying off.
A new report released Thursday from the Centers of Disease Control and Prevention shows that since 1993-1994, the number of prescriptions written and filled for children under 14 years of age declined 24 percent.
The findings reveal that doctors prescribed fewer antibiotics for colds and sore throats, but little or no change was seen in prescriptions for ear infections.
Antibiotics are often used for viral infections and are not effective. Misuse can lead to treatment failure and resistance.
Experts say doctors incorrectly prescribe antibiotics more than 50 percent of the time, most often with respiratory infections.
The decline in antibiotic prescriptions was partially attributed to physician enlightenment, fewer doctors office visits and better vaccines.
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Supply of flu vaccine expected to rise this year
Atlanta, GA, United States (AHN) – More flu vaccine doses are expected this year compared to last, according to the Centers for Disease Control and Prevention on Thursday.
Recommendations remain the same. The CDC says all Americans older than six months should be vaccinated each year. The vaccine is typically administered in a single dose.
New this year–people over 65 can opt for a high dose form of the flu known as Fluzone High-Dose. The CDC has not yet issued a formal recommendation that the new Fluzone High Dose be used by older patients due to the fact that it is new, and data is still being collected about its effectiveness.
The CDC also noted that while just 65 percent of health care workers, and less than half of pregnant women, got flu shots in 2010, both were improvements from previous years.
In the 2011-12 season, 166 million doses are expected to be produced versus 157 million last year.
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Robot seals comfort Japan tsunami survivors
Fukushima, Japan (AHN) – Two small robotic seals are being used to comfort elderly victims of Japan’s tsunami and earthquake.
Many in Japan are still dealing with the memory of the devastating Japan earthquake, tsunami and nuclear meltdown at Fukushima. The March disaster killed thousands and left scores more injured and homeless.
More than half of the tsunami victims were over the age of 65, and in one nursing home south of the tsunami-ruined Fukushima Daiichi nuclear plant, elderly Japanese survivors are finding comfort in a couple of furry robotic seals.
The Paro seals, nicknamed Love and Peace by residents of the Suisyoen Nursing Home, were gifts from the robotic division of the Japanese company Daiwa House. Suisyoen’s general manager said that using this kind of therapeutic robot lowered the barriers that would normally be in the way of using live animals. The seals have helped the elderly residents cope and have literally given them something to hold on to.
Animals are frequently used as therapy for elderly patients and these two robotic pet seals, with their anti-bacterial coating, provide the same companionship a pet gives. The elderly residents can hold onto them, hug them and bring them along to group activities.
Residents say the seals are as cute and soft and cuddly as a living creature, except when the batteries run out.
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APGAR test may predict teens’ success in school.
Helsingborg, Sweden (AHN) – A baby’s first test, at infancy, may be an indicator of success in later years.
The APGAR test, given to babies right after they are born, evaluates an infant’s heart rate, breathing, muscle tone, skin color and reflex irritability, each on a two-point scale. Scores of 8 or above are signs of good health. New research sheds light on the importance of the grade as a child develops.
A large Swedish study, which compared school grades and graduation rates with APGAR scores, suggests that an APGAR score below 7 may portend cognitive deficits later in life. “It is not the APGAR score in itself which leads to lower cognitive abilities. It is the reason behind it,” said Dr. Andrea Stuart, a obstetrician at Central Hospital in Helsingborg, Sweden.
The researchers also noted that just 1 in 44 babies with low APGAR scores required special education, and mothers whose babies score low should not necessarily be concerned. Most babies who score low on the APGAR test go on to do just fine.
Researchers note that long term, the findings may prove useful if ongoing studies can isolate the problems causing low APGAR scores that lead to later deficits in cognitive ability.
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Former Rep. Mark Foley recovering from cancer surgery in Florida
Orlando, FL, United States (AHN) – Former U.S. Rep. Mark Foley is recovering from an operation to remove cancer cells in his prostate.
The 56-year-old lawmaker successfully underwent surgery late Friday in an Orlando hospital. He was diagnosed several weeks ago after skipping his annual check-up.
A former Lake Worth vice mayor and state lawmaker before being elected to Congress in 1994, Foley was said to have been considering running for mayor of West Palm Beach last year. He stepped down in 2006 from his congressional seat, at the time chair of the House Caucus on Missing and Exploited Children, a day after a report accused him of sending sexually explicit messages to a male House page.
The report said the congressman sent the text messages in 2004 but other House pages later came forward and accused him of inappropriate conduct as far back as his first year in office.
Upon his resignation, the six-term congressman checked into a rehabilitation facility and revealed that he is gay. He returned to the public stage in 2009 as host of a political radio talk show in North Palm Beach.
Foley was not sanctioned by the House Ethics Committee, nor was then-House Republican Speaker Dennis Hastert, who had known about Foley’s history with male pages and had faced calls to resign.
The Florida Department of Law Enforcement also did not charge the former congressman in connection with the allegations after a “thorough and comprehensive investigation.”
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Growing hospice care brings concerns about misuse
United States (KaiserHealth) – As she surveyed patients’ charts, Nancy Romeo, a medical review auditor at a hospice company, was surprised by the resilience of those supposedly near death.
One patient admitted to hospice care in 2002 was still healthy enough in 2007 to stroll around his yard at home, she found. Another patient received hospice care for four years before the company for which Romeo worked, SouthernCare, determined she was not dying. “I looked at charts every day, and almost every chart was inappropriate,” said Romeo, a nurse.
Nancy Romeo looks over files in the office of her lawyer Henry Frohsin on Thursday, Feb. 17, 2011, in Birmingham, AL.
In 2007, she filed a whistleblower lawsuit against SouthernCare claiming that the company had fraudulently enrolled patients in hospice. Eventually, the government obtained a $24.7 million settlement in the case. SouthernCare, based in Birmingham, AL, and one of the nation’s largest for-profit hospice companies, admitted no wrongdoing, and officials declined comment for this article.
Over the 28 years that Medicare has reimbursed providers for hospice services, it has been praised for giving critical medical and emotional support to dying patients and their families. When properly used – that is, at the very end of life – hospice care also has saved the government money. Providing dying patients with palliative care in their own homes, or in a hospice facility or nursing home, is far less expensive than continuing to order up futile medical treatments, studies have shown.
Indeed, advocates say more patients should be receiving hospice services earlier in the course of their illness. The median time spent in hospice care now is just 17 days.
But as hospice has moved into the mainstream – it is now serving 1.1 million Medicare patients a year – concerns about excessive costs and misuse have mounted.
Four in 10 Medicare beneficiaries now use the hospice benefit before they die. Patients agree to forgo treatments aimed at prolonging their lives, but can receive pain-relieving medication to ease the symptoms of a terminal illness, as well as attention from nurses, social workers and others.
Medicare’s bill for hospice care rose to more than $12 billion in 2009 from $2.9 billion in 2000. Although the benefit is intended for patients who have no more than six months to live,’ percent now receive hospice services for longer, according to the Medicare Payment Advisory Commission, or MedPAC, an independent congressional oversight panel. In 2009, 10 percent of patients remained in hospice beyond seven months. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not.
Financial Incentives
A primary concern of MedPAC is that this payment method encourages hospices to seek out patients likely to live longer. For-profit hospices in particular tend to have longer-staying patients, studies have shown.
“The financial incentives do in fact dictate behavior,” said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. “It’s a lucrative business, at least under the current reimbursement system.”
In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash.
Hospice operators say sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. Presently, most hospices rely on registered nurses to see patients and then relay information back to the office.
“This face-to-face visit is a way to limit the length of people staying on hospice, and it probably will increase the number of people who get discharged,” said Dr. David Casarett, an associate professor of medicine at the University of Pennsylvania and chief medical officer at the university’s Philadelphia-based hospice. “But will we be discharging the right people? I’m not sure.”
But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment – hospice patients in nursing homes – and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. The inspector general is now investigating unusual patterns of hospice stays.
Evidence produced in a series of lawsuits, too, suggests that hospices may need more careful oversight.
A regional vice president at Trinity Hospice, a now-defunct chain based in Texas, “strongly encouraged” employees to “find a way” to keep patients as long as possible, according to a 2005 internal report uncovered in a whistleblower lawsuit.
In 2006, the government obtained a $12.9 million settlement from another national chain, Odyssey Healthcare, after a former manager there said she was fired for trying to get the company to discharge patients who did not meet Medicare’s eligibility rules.
Both companies settled the cases out of court and did not admit wrongdoing. Odyssey was subsequently bought by Gentiva Health Services, and a company spokesman had no comment on the settlement.
Dementia’s Unpredictability
One of the main reasons for longer hospice stays is the increasing prevalence of patients with diseases, like dementia, that follow sometimes unpredictable paths. For instance, Alzheimer’s patients are three times more likely than cancer patients to stay in hospice beyond six months, MedPAC data show.
In 2009, Duane Chirhart, a retired airline pilot, questioned the cost of his aunt’s hospice care while she was in a nursing home in Minnesota. For more than two years, the nursing home had been taking care of most of her needs. At the same time, a hospice company billed Medicare $4,252 a month for its services, which included short visits by outside nurses.
“The employees who visited her were really caring people,” he said, “but there only were four or five hours a month when they were actually there.” Chirhart canceled the hospice service. His aunt, who has Alzheimer’s, is now 88 and still alive.
When the humorist Art Buchwald went into a hospice in February 2006, he expected to die within weeks of kidney failure. But his kidneys kept working, and Buchwald made national news when he quit hospice after five months. He died the following year.
To allow for greater flexibility, Congress ended the strict seven-month time limit imposed when the benefit was created. Now hospice care can continue indefinitely so long as the hospice said the patient is still likely to die within six months.
“To some degree, the growth in the number of beneficiaries and the duration of stays is the result of conscious policy changes,” said Jonathan Blum, deputy administrator of the Centers for Medicare & Medicaid Services.
Alexander Horvath, who is 85 and has dementia, is in his eighth month of care provided by the Jewish Social Service Agency Hospice, a nonprofit in Rockville, MD. His wife, Jacqueline, believes that he is receiving excellent, cost-effective care. The hospice has taken steps to prevent bedsores, for instance, by replacing his mattresses with special ones that help keep lesions from developing. “I want him to be as happy and comfortable as long as he possibly can be,” she said.
But the profit motive in hospice has become a greater concern as for-profits hospices have expanded. They now account for half of Medicare certified hospices. A study in the Journal of the American Medical Association published in February found 6.9 percent of patients tended by for-profit hospice providers remained for more than a year, while 2 percent of those in nonprofits did.
“Objectively if patients are in hospice more than a year, it kind of suggests that based on current hospice eligibility criteria they have been enrolled too early in the course of their terminal illness,” said Dr. Melissa Wachterman, the study’s lead author.
J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, based in Alexandria, VA., said longer stays are a good development, because the full benefit of hospice can’t be realized in just the final days of life. He said a hospice’s ownership type does not influence the nature of care provided, and credits hospices for enrolling patients earlier in their declines. “Hospices have gotten better and more sophisticated in marketing their services to patients whose illness are moving from chronic disease into terminal illness,” Schumacher said.
But some fear that hospice companies have become too aggressive. “There are rival companies trying to get people to sign up for who will care for them until they die,” said Lloyd Peeples, an assistant U.S. attorney who led the government’s case against SouthernCare. “I had no idea there were companies fighting over patients, just like telephone companies fighting over whether to sell you an iPhone or a Blackberry.”
jrau@kff.org
– Provided by Kaiser Health News.
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Johnson & Johnson halts production of drug-coated heart stents
Bridgewater, NJ, United States (AHN) – Consumer care products manufacturer Johnson & Johnson said it would halt the production of drug-coated heath stents by the year end.
The move, announced by the firm on Wednesday, is expected to create a vacuum in the $4-billion market amid concerns over the use of stents on some patients.
Cordis Corporation, a Johnson & Johnson subsidiary, will likely shed 900 to 1,000 jobs this year and the firm is expected to take a $500 million to $600 million restructuring charge this quarter.
The decision to stop making the drug-coated heart stents is both caused by weaker sales and questions over the necessity of the device for some patients. In 2010, Cordis’ global sales of the heart stents plummeted to $627 million from $2.6 billion in 2006.
Recent research indicate that the stent – a small device inserted through blood vessels to keep arteries open in the heart, is overused by doctors. New drugs that are cheaper, safer and more effective for some patients are more effective ways for many cardiovascular sufferers to avoid heart attacks or strokes.
With Cordis’ move, the dwindling heart stent market would be left to three remaining companies.
Seth Fischer, Cordia chairman worldwide, also blamed an appellate court’s decision last week that favored unlicensed competition for eroding the firm’s pricing, sales and market share.
The 900 to 1,000 jobs to be lost are at Cordis’ facilities in Puerto Rico and Ireland.
Cordis observed its 50 years of being a leader in the development and production of breakthrough treatments for cardiovascular ailments in 2009. From a garage in Miami, Florida, Cordis has grown to a global giant with sales of $3.1 billion in 2008. About 50 percent of the sales were outside the U.S.
Cordis introduced in the 1990s the heart stent, which was named one of the Top 30 Innovations of the Last 30 Years by the Wharton Business Schools and PBS’ Nightly Business Report.
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The Mediterranean Diet
While we’re often suspicious of diets that are said to work magic, the Mediterranean diet is one we can actually get behind. Not only is it supported by studies of that region’s inhabitants, but the Mediterranean diet was named the second-best diet overall by the U.S. New & World Report , which assembled a team of actual health experts to produce the rankings. So, in support of better — and delicious — eating, here’s our guide to the Mediterranean diet. Besides sporting beautiful beaches , beautiful people and a downright agreeable climate, the Mediterranean boasts a diet that promotes both longevity and a decreased risk of heart disease. What is it about this menu that’s made it a contender for inclusion on Unesco’s world heritage list? Once you learn the secrets of this tasty and exotic diet, not only will you understand why it’s considered a cultural treasure worth preserving, you can also begin to incorporate Mediterranean-style cuisine into your own lifestyle and become more like the Adonis you know you are. what is the mediterranean diet? The Mediterranean countries border the Mediterranean Sea and include Portugal, Spain, Morocco, Italy, Greece, Malta, Tunisia, Egypt, Lebanon, and Israel. Since so many countries constitute the Mediterranean , there is no single diet that straddles the entire area; however, most Mediterranean cuisines share some common characteristics, and these shared elements make the Mediterranean diet healthier than a North American or a Northern European diet. eat like adonis At the top of the Mediterranean food pyramid are grains, fresh fruits and vegetables, olive oil, cheeses, yogurt, nuts, and legumes, all of which are consumed on a daily basis. Foods eaten on a weekly basis are fish and seafood, poultry, eggs, and sweets. Mediterranean people consume red meat less often on a monthly basis, and red wine accompanies most suppers, working out to about 1-2 glasses per day. the magic of the diet Fresh fruits, vegetables, and grains The staples of the Mediterranean diet, fresh fruits, vegetables, and grains are rich in antioxidants and vitamins, which help prevent cancer and heart disease, and boost the immune system. Most Mediterranean dishes contain copious amounts of garlic and onions. While they won’t do much for your breath, onions and garlic will help lower your blood pressure and fight infections. Olive oil Another main staple in the Mediterranean diet is olive oil. Mediterranean inhabitants can’t get enough olive oil; it is the main source of fat in the Mediterranean diet — and for good reason. Olive oil is high in monounsaturated fat, which, unlike the saturated fat found in animal products, helps lower blood-clogging LDL cholesterol. Not only does olive oil protect against heart disease by lowering blood pressure, but it coats the stomach to protect against ulcers, and contains several antioxidants to help fight cancer. Seafood & fish Since the Mediterranean countries are so conveniently close to the Mediterranean Sea, fresh seafood and fish dishes are eaten several times a week. The Mediterranean people may have thick skin, but they’ve got thin blood: Seafood contains omega-3 fatty acids, which lower the risk of heart disease by preventing blood clot formation in the arteries. Read on for more Mediterranean diet tips…
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