Smoking ban leads to major drop in heart attacks
By MIKE STOBBE, AP
Medical Writer
Dec 31,2008
A smoking ban in one Colorado city led to a dramatic drop in heart attack hospitalizations within three years, a sign of just how serious a health threat secondhand smoke is, government researchers said Wednesday. The study, the longest-running of its kind, showed the rate of hospitalized cases dropped 41 percent in the three years after the ban of workplace smoking in Pueblo, Colo., took effect. There was no such drop in two neighboring areas, and researchers believe it's a clear sign the ban was responsible.
The study suggests that secondhand smoke may be a terrible and under-recognized cause of heart attack deaths in this country, said one of its authors, Terry Pechacek of the U.S. Centers for Disease Control and Prevention.
At least eight earlier studies have linked smoking bans to decreased heart attacks, but none ran as long as three years. The new study looked at heart attack hospitalizations for three years following the July 1, 2003 enactment of Pueblo's ban, and found declines as great or greater than those in earlier research...
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Wednesday, December 31, 2008
Tuesday, December 02, 2008
Too much TV leads to child obesity, smoking, alcohol, pregnancy and poor school performance
Lots of TV and Web harms kids' health
Reuters
Dec 2, 2008
Spending a lot of time watching TV, playing video games and surfing the Web makes children more prone to a range of health problems including obesity and smoking, U.S. researchers said on Tuesday.
U.S. National Institutes of Health, Yale University and the California Pacific Medical Center experts analyzed 173 studies done since 1980 in one of the most comprehensive assessments to date on how exposure to media sources impacts the physical health of children and adolescents...
The studies offered strong evidence that children who get more media exposure are more likely to become obese, start smoking and begin earlier sexual activity than those who spend less time in front of a screen, the researchers said.
Studies also indicated more media exposure also was linked to drug and alcohol use and poorer school performance, while the evidence was less clear about an association with attention deficit hyperactivity disorder, they added.
"I think we were pretty surprised by how overwhelming the number of studies was that showed this negative health impact," NIH bioethicist Dr. Ezekiel Emanuel, one of the researchers in the report released by the advocacy group Common Sense Media, said in a telephone interview.
...One study cited in the report found that children who spent more than eight hours watching TV per week at age 3 were more likely to be obese at 7. And research shows that many U.S. children, even toddlers, watch far more.
Dr. Cary Gross of Yale University.. said TV and other media content can have a profound impact on children's attitudes and beliefs, most notably among teens.
He cited a U.S. study by the RAND research organization published in November that showed that adolescents who watched more programing with sexual themes had a higher risk of becoming pregnant or causing a pregnancy.
Thirteen of 14 studies that evaluated sexual behavior found an association between media exposure and earlier initiation of sexual behavior, the researchers said.
Reuters
Dec 2, 2008
Spending a lot of time watching TV, playing video games and surfing the Web makes children more prone to a range of health problems including obesity and smoking, U.S. researchers said on Tuesday.
U.S. National Institutes of Health, Yale University and the California Pacific Medical Center experts analyzed 173 studies done since 1980 in one of the most comprehensive assessments to date on how exposure to media sources impacts the physical health of children and adolescents...
The studies offered strong evidence that children who get more media exposure are more likely to become obese, start smoking and begin earlier sexual activity than those who spend less time in front of a screen, the researchers said.
Studies also indicated more media exposure also was linked to drug and alcohol use and poorer school performance, while the evidence was less clear about an association with attention deficit hyperactivity disorder, they added.
"I think we were pretty surprised by how overwhelming the number of studies was that showed this negative health impact," NIH bioethicist Dr. Ezekiel Emanuel, one of the researchers in the report released by the advocacy group Common Sense Media, said in a telephone interview.
...One study cited in the report found that children who spent more than eight hours watching TV per week at age 3 were more likely to be obese at 7. And research shows that many U.S. children, even toddlers, watch far more.
Dr. Cary Gross of Yale University.. said TV and other media content can have a profound impact on children's attitudes and beliefs, most notably among teens.
He cited a U.S. study by the RAND research organization published in November that showed that adolescents who watched more programing with sexual themes had a higher risk of becoming pregnant or causing a pregnancy.
Thirteen of 14 studies that evaluated sexual behavior found an association between media exposure and earlier initiation of sexual behavior, the researchers said.
Wednesday, January 02, 2008
Lack of Deep Sleep contributes to Diabetes
Shortage of Deep Sleep May Increase Diabetes Risk
medpage TODAY
http://www.medpagetoday.com/Pulmonary/SleepDisorders/tb/7826
By Judith Groch, Senior Writer, MedPage Today
January 02, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
CHICAGO, Jan. 2 -- Sleep quality appears to play a role in diabetes risk, according to researchers here. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that, in this experimental study with healthy young adults, suppression of restorative "slow-wave" sleep without any change in sleep time, reduced their ability to regulate blood sugar levels, a risk factor for type 2 diabetes.
When in an experimental setting, deep, restorative slow-wave sleep (stages 3 and 4) was suppressed in healthy young adults, there was a 25% decrease in insulin sensitivity, with a rise in the risk of type 2 diabetes, found Esra Tasali, M.D., of the University of Chicago, and colleagues. There was no change in total sleep time.
The findings were comparable in diabetes risk to gaining 18 to 29 pounds, and the sleep quality of volunteers in their 20s was that of those in their 60s, Dr. Tasali and colleagues reported in the Dec. 31 issue of the Proceedings of the National Academy of Sciences.
Slow-wave sleep is associated with transient metabolic, hormonal and neurophysiologic changes, all of which could potentially affect glucose homeostasis, the researchers wrote.
They studied nine normal-weight, healthy adults -- five men, four women -- ages 20 to 31. At baseline, the volunteers spent two consecutive nights in the sleep lab where they were monitored but slept undisturbed for 8.5 hours.
After that, they were studied for three consecutive nights, but when brain waves indicated they were drifting into slow-wave sleep, they were subtly disturbed by sounds about 250 to 300 times a night, administered through bedside speakers.
The sounds were loud enough to disrupt deep sleep but not enough to cause awakening. With this technique the researchers disrupted slow-wave sleep by about 90% (88 ± 3%, P<0.0001). The volunteers required more interventions as slow-wave pressure, the body's need for deep sleep, accumulated with each night.
After three nights, the decrease in insulin sensitivity was remarkably consistent for eight of the nine participants. Under normal circumstances, when insulin sensitivity decreases, the insulin response should increase reciprocally so that glucose tolerance is maintained.
However, after slow-wave-sleep suppression, the decrease in insulin sensitivity was not compensated for by an increase in insulin release, because the insulin response remained virtually unchanged, they said.
Consistent with an increased diabetes risk, daytime glucose tolerance measured after each night was reduced by 23% to within the range reported in older adults with impaired glucose tolerance, the researchers reported.
The researchers noted that the size of the decrease in insulin sensitivity was not correlated with measures of sleep fragmentation, including the total number of microarousals on the third night of the intervention (r=0.31, P=0.42).
Inadequate beta cell compensation for a given decrease in insulin sensitivity results in a fall in the so-called disposition index (insulin sensitivity times insulin response), which is a validated marker of diabetes risk. Indeed, they said, this measure was 20% lower after slow-wave sleep suppression.
The decrease in slow-wave sleep is similar to that occurring over four decades of normal aging. Normal young adults spend 80 to 100 minutes a night in slow-wave sleep, whereas those older than 60 generally have fewer than 20 minutes of slow-wave sleep.
Thus, Dr. Tasali said, "in this experiment, we gave people in their 20s the sleep of those in their 60s."
In exploring possible mechanisms for the decreased insulin sensitivity, the investigators wrote that insulin resistance can develop rapidly when circulating levels of cortisol are elevated.
However, they found that mean plasma cortisol profiles at baseline and after slow-wave suppression were essentially identical (P=0.92). Thus, they said, the decrease in insulin sensitivity cannot be attributed to increased cortisol concentrations.
There is an alarming rise in the prevalence of type 2 diabetes that is generally attributed to the epidemic of obesity and the aging of the population. As the burden of diabetes on public health continues to rise, so does the need to understand its pathogenesis, the researchers wrote.
The current evidence demonstrates a clear role for slow-wave sleep in the maintenance of normal glucose homeostasis. Chronic shallow non-REM sleep, decreased insulin sensitivity, and elevated diabetes risk are typical of aging, they said.
Thus, strategies to improve both sleep duration and also sleep quality should be considered as a potential intervention to prevent or delay the development of type 2 diabetes in elderly individuals as well as the obese, Dr. Tasali and colleagues concluded.
No conflicts of interest were reported.
The study was supported by the National Institutes of Health.
Primary source: Proceedings of the National Academy of Science
Source reference:
Tasali E, et al "Slow-wave sleep and the risk of type 2 diabetes in humans" PNAS Early Edition 2008: DOI: 10.1073/pnas.0706446105.
medpage TODAY
http://www.medpagetoday.com/Pulmonary/SleepDisorders/tb/7826
By Judith Groch, Senior Writer, MedPage Today
January 02, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
CHICAGO, Jan. 2 -- Sleep quality appears to play a role in diabetes risk, according to researchers here. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that, in this experimental study with healthy young adults, suppression of restorative "slow-wave" sleep without any change in sleep time, reduced their ability to regulate blood sugar levels, a risk factor for type 2 diabetes.
When in an experimental setting, deep, restorative slow-wave sleep (stages 3 and 4) was suppressed in healthy young adults, there was a 25% decrease in insulin sensitivity, with a rise in the risk of type 2 diabetes, found Esra Tasali, M.D., of the University of Chicago, and colleagues. There was no change in total sleep time.
The findings were comparable in diabetes risk to gaining 18 to 29 pounds, and the sleep quality of volunteers in their 20s was that of those in their 60s, Dr. Tasali and colleagues reported in the Dec. 31 issue of the Proceedings of the National Academy of Sciences.
Slow-wave sleep is associated with transient metabolic, hormonal and neurophysiologic changes, all of which could potentially affect glucose homeostasis, the researchers wrote.
They studied nine normal-weight, healthy adults -- five men, four women -- ages 20 to 31. At baseline, the volunteers spent two consecutive nights in the sleep lab where they were monitored but slept undisturbed for 8.5 hours.
After that, they were studied for three consecutive nights, but when brain waves indicated they were drifting into slow-wave sleep, they were subtly disturbed by sounds about 250 to 300 times a night, administered through bedside speakers.
The sounds were loud enough to disrupt deep sleep but not enough to cause awakening. With this technique the researchers disrupted slow-wave sleep by about 90% (88 ± 3%, P<0.0001). The volunteers required more interventions as slow-wave pressure, the body's need for deep sleep, accumulated with each night.
After three nights, the decrease in insulin sensitivity was remarkably consistent for eight of the nine participants. Under normal circumstances, when insulin sensitivity decreases, the insulin response should increase reciprocally so that glucose tolerance is maintained.
However, after slow-wave-sleep suppression, the decrease in insulin sensitivity was not compensated for by an increase in insulin release, because the insulin response remained virtually unchanged, they said.
Consistent with an increased diabetes risk, daytime glucose tolerance measured after each night was reduced by 23% to within the range reported in older adults with impaired glucose tolerance, the researchers reported.
The researchers noted that the size of the decrease in insulin sensitivity was not correlated with measures of sleep fragmentation, including the total number of microarousals on the third night of the intervention (r=0.31, P=0.42).
Inadequate beta cell compensation for a given decrease in insulin sensitivity results in a fall in the so-called disposition index (insulin sensitivity times insulin response), which is a validated marker of diabetes risk. Indeed, they said, this measure was 20% lower after slow-wave sleep suppression.
The decrease in slow-wave sleep is similar to that occurring over four decades of normal aging. Normal young adults spend 80 to 100 minutes a night in slow-wave sleep, whereas those older than 60 generally have fewer than 20 minutes of slow-wave sleep.
Thus, Dr. Tasali said, "in this experiment, we gave people in their 20s the sleep of those in their 60s."
In exploring possible mechanisms for the decreased insulin sensitivity, the investigators wrote that insulin resistance can develop rapidly when circulating levels of cortisol are elevated.
However, they found that mean plasma cortisol profiles at baseline and after slow-wave suppression were essentially identical (P=0.92). Thus, they said, the decrease in insulin sensitivity cannot be attributed to increased cortisol concentrations.
There is an alarming rise in the prevalence of type 2 diabetes that is generally attributed to the epidemic of obesity and the aging of the population. As the burden of diabetes on public health continues to rise, so does the need to understand its pathogenesis, the researchers wrote.
The current evidence demonstrates a clear role for slow-wave sleep in the maintenance of normal glucose homeostasis. Chronic shallow non-REM sleep, decreased insulin sensitivity, and elevated diabetes risk are typical of aging, they said.
Thus, strategies to improve both sleep duration and also sleep quality should be considered as a potential intervention to prevent or delay the development of type 2 diabetes in elderly individuals as well as the obese, Dr. Tasali and colleagues concluded.
No conflicts of interest were reported.
The study was supported by the National Institutes of Health.
Primary source: Proceedings of the National Academy of Science
Source reference:
Tasali E, et al "Slow-wave sleep and the risk of type 2 diabetes in humans" PNAS Early Edition 2008: DOI: 10.1073/pnas.0706446105.
Tuesday, January 01, 2008
Racial stereotyping in the Emergency Room
http://www.cnn.com/2008/HEALTH/01/01/painkillers.race.ap/index.html?eref=rss_topstories
Study: Whites more likely to get narcotics in ER
CHICAGO, Illinois (AP) -- Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds.
Even for severe pain, narcotics such as oxycodone were prescribed less frequently for minorities.
Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites.
The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race in both urban and rural hospitals, in all U.S. regions and for every type of pain.
"The gaps between whites and nonwhites have not appeared to close at all," said study co-author Dr. Mark Pletcher of the University of California, San Francisco.
The study appears in Wednesday's Journal of the American Medical Association. Prescribing narcotics for pain in emergency rooms rose during the study, from 23 percent of those complaining of pain in 1993 to 37 percent in 2005.
The increase coincided with changing attitudes among doctors who now regard pain management as a key to healing. Doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs such as temperature and pulse.
Even with the increase, the racial gap endured. Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics.
Don't Miss
Journal of the American Medical Association
MayoClinic.com: Pain Quiz
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research. She was not involved in the current study.
The study's authors said doctors may be less likely to see signs of painkiller abuse in white patients, or they may be undertreating pain in minority patients.
Patient behavior may play a role, Pletcher said. Minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control," he said.
Stricter protocols for prescribing narcotics may help close the gap.
A New York hospital recently studied its emergency patients and found no racial disparity in narcotics prescribed for broken bones. Montefiore Medical Center aggressively treats pain and is developing protocols for painkillers that dictate initial dosages and times to check with patients to see whether they need more pain medicine, said Dr. David Esses, emergency department associate director at Montefiore.
Such standards may eliminate racial disparities, Esses said.
In the study, opioid narcotics were prescribed in 31 percent of the pain-related visits involving whites, 28 percent for Asians, 24 percent for Hispanics and 23 percent for blacks.
Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain.
Health Library
MayoClinic.com: Health Library
In more than 2,000 visits for kidney stones, whites got narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent and blacks 56 percent.
The data came from a well-regarded government survey that collects information on emergency room visits for four weeks each year from 500 U.S. hospitals. The new study was funded by federal grants.
"It's time to move past describing disparities and work on narrowing them," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study.
Fisher, who is black, said he is not immune to letting subconscious assumptions inappropriately influence his work as a doctor.
"If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," he said.
Study: Whites more likely to get narcotics in ER
CHICAGO, Illinois (AP) -- Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds.
Even for severe pain, narcotics such as oxycodone were prescribed less frequently for minorities.
Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites.
The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race in both urban and rural hospitals, in all U.S. regions and for every type of pain.
"The gaps between whites and nonwhites have not appeared to close at all," said study co-author Dr. Mark Pletcher of the University of California, San Francisco.
The study appears in Wednesday's Journal of the American Medical Association. Prescribing narcotics for pain in emergency rooms rose during the study, from 23 percent of those complaining of pain in 1993 to 37 percent in 2005.
The increase coincided with changing attitudes among doctors who now regard pain management as a key to healing. Doctors in accredited hospitals must ask patients about pain, just as they monitor vital signs such as temperature and pulse.
Even with the increase, the racial gap endured. Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors' suspicions that minority patients could be drug abusers lying about pain to get narcotics.
Don't Miss
Journal of the American Medical Association
MayoClinic.com: Pain Quiz
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research. She was not involved in the current study.
The study's authors said doctors may be less likely to see signs of painkiller abuse in white patients, or they may be undertreating pain in minority patients.
Patient behavior may play a role, Pletcher said. Minority patients "may be less likely to keep complaining about their pain or feel they deserve good pain control," he said.
Stricter protocols for prescribing narcotics may help close the gap.
A New York hospital recently studied its emergency patients and found no racial disparity in narcotics prescribed for broken bones. Montefiore Medical Center aggressively treats pain and is developing protocols for painkillers that dictate initial dosages and times to check with patients to see whether they need more pain medicine, said Dr. David Esses, emergency department associate director at Montefiore.
Such standards may eliminate racial disparities, Esses said.
In the study, opioid narcotics were prescribed in 31 percent of the pain-related visits involving whites, 28 percent for Asians, 24 percent for Hispanics and 23 percent for blacks.
Minorities were slightly more likely than whites to get aspirin, ibuprofen and similar drugs for pain.
Health Library
MayoClinic.com: Health Library
In more than 2,000 visits for kidney stones, whites got narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent and blacks 56 percent.
The data came from a well-regarded government survey that collects information on emergency room visits for four weeks each year from 500 U.S. hospitals. The new study was funded by federal grants.
"It's time to move past describing disparities and work on narrowing them," said Dr. Thomas L. Fisher, an emergency room doctor at the University of Chicago Medical Center who was not involved in the study.
Fisher, who is black, said he is not immune to letting subconscious assumptions inappropriately influence his work as a doctor.
"If anybody argues they have no social biases that sway clinical practice, they have not been thoughtful about the issue or they're not being honest with themselves," he said.
Thursday, December 20, 2007
Uninsured more likely to die of cancer: we need universal health care!
US NEWS
Uninsured More Likely to Die From Cancer Following Diagnosis
Report finds they're less likely to get screening tests, so have advanced disease
By Steven Reinberg
Posted 12/20/07
THURSDAY, Dec. 20 (HealthDay News) -- People diagnosed with cancer who don't have health insurance are more likely to die because they are less likely to get screening tests and so are typically diagnosed with advanced disease, a new study from the American Cancer Society finds.
The finding proffers strong evidence that differences in cancer survival are directly related to lack of access to health care.
"If you are uninsured, and you are diagnosed with cancer, you have a 60 percent greater chance of dying from cancer than if you were insured and diagnosed with cancer," said Dr. Otis Brawley, chief medical officer at the cancer society.
"There is not a cohort of insured and a cohort of uninsured cancer patients that have the same five-year survival," Brawley added. "It's always the uninsured who do worse."
Part of the problem is that uninsured people don't have access to screenings, Brawley said. "But part of it is that uninsured people don't have access to the best doctors or have access to good doctors who are overwhelmed. The end result is the quality of care the poor folks get is not as good as the quality of care of the wealthier or the insured," he said.
There are also people who are underinsured, Brawley said. While these people have access to care, high co-pays and deductibles make the care unaffordable, particularly high-priced chemotherapy drugs, he noted.
"Where it becomes frightening and morally reprehensible is people who have significant pain and can't get narcotics and other pain medications they need, because they can't afford them," Brawley said.
People don't realize they are underinsured until after they have gotten sick, Brawley said. "There are a substantial number of Americans who don't realize they are a cancer diagnosis away from economic disaster," he noted.
The study, in the January/February issue of CA: A Cancer Journal for Clinicians, used data from the National Cancer Database, which is the only national registry that collects data on patient insurance.
The report is an overview of systems of health insurance in the United States. It has data on the association between health insurance, screening, stage at diagnosis, and survival for breast and colorectal cancer.
The link between access to care and cancer outcomes is particularly striking for cancers that can be prevented or found early by screening and for which there are effective treatments, including breast and colorectal cancer.
Only about 38.1 percent of uninsured women aged 40 to 64 have had a mammogram in the past two years, compared with 74.5 percent of insured women. In addition, 20 percent to 30 percent of uninsured women are diagnosed with late-stage breast cancer, compared with 10 percent to 15 percent of women with private insurance, according to the study.
Uninsured women are less likely to be diagnosed with early breast cancer than women who are privately insured. This disparity was greatest among white women, where almost 50 percent of those with private insurance were diagnosed with early-stage cancer, compared with fewer than 35 percent of uninsured white women.
Moreover, 89 percent of insured white women were living five years after breast cancer diagnosis compared with 76 percent of uninsured white women. For black women, five-year survival rates are 81 percent for those with private insurance and 65 percent for uninsured women.
For men and women aged 50 to 64 who have private insurance, 48.3 percent were screened for colorectal cancer in the past 10 years compared with fewer than 18.8 percent of the uninsured.
In addition, uninsured patients are more likely than those with private insurance to be diagnosed with stage IV colorectal cancer and less likely to be diagnosed with stage I colorectal cancer, the researchers found.
For whites, 66 percent of insured patients survive colorectal cancer for five years, compared with 50 percent of those without insurance. For blacks, five-year survival rates are 41 percent among the uninsured compared with 60 percent among privately insured patients.
Additional findings in the study include:
Uninsured women were less likely to have a Pap test in the past three years than insured women (68 percent vs. 87.9 percent).
Among insured men, 37.1 percent had a prostate specific antigen test, compared with 14 percent of uninsured men.
People aged 18 to 24 have the highest probability of being uninsured.
Lower-income people are more likely to be uninsured.
Blacks, Hispanics, Asian American/Pacific Islanders, and American Indian/Alaska Natives are more likely to be uninsured than whites.
Of those without insurance, 53.6 percent have no usual source of health care.
The uninsured are more likely to delay care, not receive care, and not obtain prescription drugs because of costs.
Among people who saw a health-care provider, those without insurance were less likely to be advised to quit smoking or lose weight.
Brawley noted that while some of the uninsured qualify for Medicaid, coverage doesn't begin until the cancer has been diagnosed.
"You have someone who is uninsured and poor -- gets none of the screenings, gets none of the early detection opportunities -- when they finally go to the doctor, it's because they are so sick, they can no longer go to work, or their family is forcing them to go to the emergency room," Brawley said. "What you have is someone who a year ago we could, relatively cheaply, fix, maybe even cure, but now that they have ignored their symptoms, it's no longer fixable, we are going to treat them, but the treatment is going to be very expensive."
The remedy to the problem is "making sure that everyone who wants health insurance can get affordable health insurance," Brawley said. "In this country, we need to have an open conversation about this issue."
One expert thinks this study highlights the need for a health insurance program that covers everyone.
"Sadly, many Americans must face the challenges of cancer with no insurance coverage, or with Medicaid, which is often grossly inadequate as coverage," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a co-founder of Physicians for a National Health Program.
For these cancer patients, diagnosis is delayed and survival is shortened, Woolhandler said. "We need nonprofit national health insurance to be sure that everyone gets the health care they need, particularly people with cancer."
For more on health insurance, visit Physicians for a National Health Program.
Copyright © 2007 ScoutNews, LLC. All rights reserved.
Uninsured More Likely to Die From Cancer Following Diagnosis
Report finds they're less likely to get screening tests, so have advanced disease
By Steven Reinberg
Posted 12/20/07
THURSDAY, Dec. 20 (HealthDay News) -- People diagnosed with cancer who don't have health insurance are more likely to die because they are less likely to get screening tests and so are typically diagnosed with advanced disease, a new study from the American Cancer Society finds.
The finding proffers strong evidence that differences in cancer survival are directly related to lack of access to health care.
"If you are uninsured, and you are diagnosed with cancer, you have a 60 percent greater chance of dying from cancer than if you were insured and diagnosed with cancer," said Dr. Otis Brawley, chief medical officer at the cancer society.
"There is not a cohort of insured and a cohort of uninsured cancer patients that have the same five-year survival," Brawley added. "It's always the uninsured who do worse."
Part of the problem is that uninsured people don't have access to screenings, Brawley said. "But part of it is that uninsured people don't have access to the best doctors or have access to good doctors who are overwhelmed. The end result is the quality of care the poor folks get is not as good as the quality of care of the wealthier or the insured," he said.
There are also people who are underinsured, Brawley said. While these people have access to care, high co-pays and deductibles make the care unaffordable, particularly high-priced chemotherapy drugs, he noted.
"Where it becomes frightening and morally reprehensible is people who have significant pain and can't get narcotics and other pain medications they need, because they can't afford them," Brawley said.
People don't realize they are underinsured until after they have gotten sick, Brawley said. "There are a substantial number of Americans who don't realize they are a cancer diagnosis away from economic disaster," he noted.
The study, in the January/February issue of CA: A Cancer Journal for Clinicians, used data from the National Cancer Database, which is the only national registry that collects data on patient insurance.
The report is an overview of systems of health insurance in the United States. It has data on the association between health insurance, screening, stage at diagnosis, and survival for breast and colorectal cancer.
The link between access to care and cancer outcomes is particularly striking for cancers that can be prevented or found early by screening and for which there are effective treatments, including breast and colorectal cancer.
Only about 38.1 percent of uninsured women aged 40 to 64 have had a mammogram in the past two years, compared with 74.5 percent of insured women. In addition, 20 percent to 30 percent of uninsured women are diagnosed with late-stage breast cancer, compared with 10 percent to 15 percent of women with private insurance, according to the study.
Uninsured women are less likely to be diagnosed with early breast cancer than women who are privately insured. This disparity was greatest among white women, where almost 50 percent of those with private insurance were diagnosed with early-stage cancer, compared with fewer than 35 percent of uninsured white women.
Moreover, 89 percent of insured white women were living five years after breast cancer diagnosis compared with 76 percent of uninsured white women. For black women, five-year survival rates are 81 percent for those with private insurance and 65 percent for uninsured women.
For men and women aged 50 to 64 who have private insurance, 48.3 percent were screened for colorectal cancer in the past 10 years compared with fewer than 18.8 percent of the uninsured.
In addition, uninsured patients are more likely than those with private insurance to be diagnosed with stage IV colorectal cancer and less likely to be diagnosed with stage I colorectal cancer, the researchers found.
For whites, 66 percent of insured patients survive colorectal cancer for five years, compared with 50 percent of those without insurance. For blacks, five-year survival rates are 41 percent among the uninsured compared with 60 percent among privately insured patients.
Additional findings in the study include:
Uninsured women were less likely to have a Pap test in the past three years than insured women (68 percent vs. 87.9 percent).
Among insured men, 37.1 percent had a prostate specific antigen test, compared with 14 percent of uninsured men.
People aged 18 to 24 have the highest probability of being uninsured.
Lower-income people are more likely to be uninsured.
Blacks, Hispanics, Asian American/Pacific Islanders, and American Indian/Alaska Natives are more likely to be uninsured than whites.
Of those without insurance, 53.6 percent have no usual source of health care.
The uninsured are more likely to delay care, not receive care, and not obtain prescription drugs because of costs.
Among people who saw a health-care provider, those without insurance were less likely to be advised to quit smoking or lose weight.
Brawley noted that while some of the uninsured qualify for Medicaid, coverage doesn't begin until the cancer has been diagnosed.
"You have someone who is uninsured and poor -- gets none of the screenings, gets none of the early detection opportunities -- when they finally go to the doctor, it's because they are so sick, they can no longer go to work, or their family is forcing them to go to the emergency room," Brawley said. "What you have is someone who a year ago we could, relatively cheaply, fix, maybe even cure, but now that they have ignored their symptoms, it's no longer fixable, we are going to treat them, but the treatment is going to be very expensive."
The remedy to the problem is "making sure that everyone who wants health insurance can get affordable health insurance," Brawley said. "In this country, we need to have an open conversation about this issue."
One expert thinks this study highlights the need for a health insurance program that covers everyone.
"Sadly, many Americans must face the challenges of cancer with no insurance coverage, or with Medicaid, which is often grossly inadequate as coverage," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a co-founder of Physicians for a National Health Program.
For these cancer patients, diagnosis is delayed and survival is shortened, Woolhandler said. "We need nonprofit national health insurance to be sure that everyone gets the health care they need, particularly people with cancer."
For more on health insurance, visit Physicians for a National Health Program.
Copyright © 2007 ScoutNews, LLC. All rights reserved.
Tuesday, December 04, 2007
Thank you Dennis Quaid, for acting to protect everyone
Dennis Quaid and Wife Sue Drug Maker
By ROBERT JABLON –
Dec. 4, 2007
Associated Press
LOS ANGELES (AP) — Dennis Quaid and his wife sued the makers of heparin Tuesday after their newborn twins were inadvertently given massive doses of the blood thinner at a hospital.
The product liability lawsuit, filed in Chicago, seeks more than $50,000 in damages. It claims that Baxter Healthcare Corp., based in Deerfield, Ill., was negligent in packaging different doses of the product in similar vials with blue backgrounds. The lawsuit also says the company should have recalled the large-dosage vials after overdoses killed three children at an Indianapolis hospital last year...
By ROBERT JABLON –
Dec. 4, 2007
Associated Press
LOS ANGELES (AP) — Dennis Quaid and his wife sued the makers of heparin Tuesday after their newborn twins were inadvertently given massive doses of the blood thinner at a hospital.
The product liability lawsuit, filed in Chicago, seeks more than $50,000 in damages. It claims that Baxter Healthcare Corp., based in Deerfield, Ill., was negligent in packaging different doses of the product in similar vials with blue backgrounds. The lawsuit also says the company should have recalled the large-dosage vials after overdoses killed three children at an Indianapolis hospital last year...
It's not just incompetent teachers...it's cardiologists, too!
Washington Post
Health Highlights: Dec. 4, 2007
...Many U.S. Doctors Don't Report Colleagues: Study
While 96 percent of American doctors believe they should report incompetent or impaired colleagues, only 55 percent of those with direct personal knowledge of such doctors always did so in the previous three years, according to a survey of 1,662 doctors conducted between November 2003 and June 2004.
The survey also found that 93 percent of respondents said doctors should always alert authorities when they see other doctors make serious medical errors, but only 54 percent said they always did so in the previous three years,USA Todayreported.
The findings appear in the journal Annals of Internal Medicine.
The survey of cardiologists, family physicians, surgeons, anesthesiologists, internists and pediatricians found that cardiologists were least likely to say they always reported a serious medical error. Cardiologists and family doctors were least likely to report an impaired or incompetent colleague,USA Todayreported.
"The intent of the paper was not to criticize but to highlight the areas for improvement," said senior author David Blumenthal, a Harvard internist who directs Massachusetts General Hospital's Institute for Health Policy...
http://www.washingtonpost.com/wp-dyn/content/article/2007/12/04/AR2007120400849_2.html
Health Highlights: Dec. 4, 2007
...Many U.S. Doctors Don't Report Colleagues: Study
While 96 percent of American doctors believe they should report incompetent or impaired colleagues, only 55 percent of those with direct personal knowledge of such doctors always did so in the previous three years, according to a survey of 1,662 doctors conducted between November 2003 and June 2004.
The survey also found that 93 percent of respondents said doctors should always alert authorities when they see other doctors make serious medical errors, but only 54 percent said they always did so in the previous three years,USA Todayreported.
The findings appear in the journal Annals of Internal Medicine.
The survey of cardiologists, family physicians, surgeons, anesthesiologists, internists and pediatricians found that cardiologists were least likely to say they always reported a serious medical error. Cardiologists and family doctors were least likely to report an impaired or incompetent colleague,USA Todayreported.
"The intent of the paper was not to criticize but to highlight the areas for improvement," said senior author David Blumenthal, a Harvard internist who directs Massachusetts General Hospital's Institute for Health Policy...
http://www.washingtonpost.com/wp-dyn/content/article/2007/12/04/AR2007120400849_2.html
Saturday, December 01, 2007
Once considered an affliction of the lazy and indulgent, obesity now affects about one-third of Americans
Here are some quotes from an article on Forbes.com:
America's Most Obese Cities
Rebecca Ruiz
11-26-07
We are heavier than ever. Once considered an affliction of the lazy and indulgent, obesity now affects about one-third of Americans.
To determine which cities were the most obese, Forbes looked at 2006 data on body mass index, or BMI, collected by the Centers for Disease Control's Behavioral Risk Factor Surveillance System.
Andrews identified five ways cities could specifically address childhood obesity, as well as larger community health issues. These included improving public space and utilizing parks and recreation areas to encourage physical activity, as well as pursuing healthy food alternatives through community gardens and farmer's markets.
1. Memphis, Tenn.: 34%
2. Birmingham, Ala.: 31.3%
3. San Antonio, Texas: 31.1%
4. Riverside/San Bernardino, Calif.: 30.8%
5. Detroit: 30.4%*
6. Jacksonville, Fla.: 29.8%
7. Nashville, Tenn.: 28.8%
8. Oklahoma City: 27.5%
9. Kansas City, Mo.: 26.9%
10. San Diego, Calif.: 26.7%
11. Cincinnatti 26.3%
12. Indianapolis: 26%
13. (Tie) Baltimore: 25.8%
13. (Tie) New Orleans: 25.8%
13. (Tie) Virginia Beach, Va.: 25.8%
16 Atlanta, Georgia
17. (Tie) Milwaukee: 25.4%
17. (Tie) Richmond, Va
19. (Tie) Austin, Texas
19. (Tie) Las Vegas
"More cities are becoming aware of [obesity] and looking to play a role in improving the situation," Andrews says. He also pointed out that city leaders often preferred to follow a successful example as opposed to chart a new course: "They definitely want to be the second, but may not want to be the first," he says. Regardless, it's clear that rising rates of childhood obesity--17% of children and adolescents ages 12 to 19 are overweight--has prompted cities like Birmingham, Ala., San Diego and Richmond, Va., all on our list, to become more proactive in terms of obesity prevention.
http://www.forbes.com/health/2007/11/14/health-obesity-cities-forbeslife-cx_rr_1114obese.html?partner=aol
America's Most Obese Cities
Rebecca Ruiz
11-26-07
We are heavier than ever. Once considered an affliction of the lazy and indulgent, obesity now affects about one-third of Americans.
To determine which cities were the most obese, Forbes looked at 2006 data on body mass index, or BMI, collected by the Centers for Disease Control's Behavioral Risk Factor Surveillance System.
Andrews identified five ways cities could specifically address childhood obesity, as well as larger community health issues. These included improving public space and utilizing parks and recreation areas to encourage physical activity, as well as pursuing healthy food alternatives through community gardens and farmer's markets.
1. Memphis, Tenn.: 34%
2. Birmingham, Ala.: 31.3%
3. San Antonio, Texas: 31.1%
4. Riverside/San Bernardino, Calif.: 30.8%
5. Detroit: 30.4%*
6. Jacksonville, Fla.: 29.8%
7. Nashville, Tenn.: 28.8%
8. Oklahoma City: 27.5%
9. Kansas City, Mo.: 26.9%
10. San Diego, Calif.: 26.7%
11. Cincinnatti 26.3%
12. Indianapolis: 26%
13. (Tie) Baltimore: 25.8%
13. (Tie) New Orleans: 25.8%
13. (Tie) Virginia Beach, Va.: 25.8%
16 Atlanta, Georgia
17. (Tie) Milwaukee: 25.4%
17. (Tie) Richmond, Va
19. (Tie) Austin, Texas
19. (Tie) Las Vegas
"More cities are becoming aware of [obesity] and looking to play a role in improving the situation," Andrews says. He also pointed out that city leaders often preferred to follow a successful example as opposed to chart a new course: "They definitely want to be the second, but may not want to be the first," he says. Regardless, it's clear that rising rates of childhood obesity--17% of children and adolescents ages 12 to 19 are overweight--has prompted cities like Birmingham, Ala., San Diego and Richmond, Va., all on our list, to become more proactive in terms of obesity prevention.
http://www.forbes.com/health/2007/11/14/health-obesity-cities-forbeslife-cx_rr_1114obese.html?partner=aol
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