I came across a post the other day on the excellent Roni’s Weigh  blog that asked readers “What are your UNhealthy Habits?” It was interesting to see that a lot of readers picked the same things, and that many of the habits centered on a person’s bedtime routine, such as not flossing at night, not removing makeup and/or washing your face.

I shouldn’t be surprised, though, given that I’m guilty of the same things. I’ve tried to trick myself into doing these things more consistently such as brushing/flossing right after dinner or putting face moisturizer on the nightstand, but after long days at work, good intentions go by the wayside.

So, I was curious what doctors thought about nighttime habits. Dr. Richard Lamson, a family medicine physician with Greater Baltimore Medical Center, offered his tips.

3 things never to skip before bed:
 
1. Dental hygiene (brush, floss, etc.): Overnight bacteria working on the leftovers in your teeth are a big source of dental plaque.  Dental disease is more than just what happens in your mouth, it also is implicated in heart disease and stroke.
 
2. A brief review of the day, and plan for tomorrow.  I find it helpful to think of at least one thing from today for which I am grateful, and it helps to get the worries about tomorrow out of my brain before trying to sleep.
 
3.  A few minutes of quiet meditation.  Pay attention to breathing, tight muscles, comfort.  This is not a time for thinking, worrying, planning.  Just be there and be aware.
 
3 things to skip before bed
 
1. Heavy meals: this can lead to acid reflux, increased absorption of calories, and overweight.  Also includes high-fat snacks.
 
2. Television, especially the news.  TV is very activating at a time when your brain should be going to sleep  TV news in particular is highly stressful.  Really, do you need to know about another bombing or murder just before you sleep?
 
3. Going online: perhaps even more activating than television, as it requires two-way participation.
 
Other helpful ideas:
 
Gentle stretching before bed can reduce muscle soreness the next morning.  No heavy exercise, just stretch your legs, low back, and neck and shoulders a bit.  This can reduce night cramps and restless legs, and enhance the meditation practice.
 
Good sex with a favorite partner can improve sleep.  Even just quiet conversation and cuddling helps.
 
Take the TV, computer, smart phone, etc. out of your bedroom.
 
Caffeine is often bad for sleep.  More than a small amount of alcohol can be activating.  Smoking can also keep you awake.
 
If you're the type who wakes up in the night and worries for a long time, put a pad of paper next to your bed.  When you wake up, write down what you're worried about, or the solution.  Then forget it and go back to sleep.  Meditate again if you want.
 
For help with implementation, it's always helpful to know what you're already doing.  I recommend a diary of whatever habit you're trying to break.  For example, if you overeat, keep a small notebook nearby where you write down what you're eating.  Looking at the week's food intake can help you plan how to avoid overeating.  Similarly, writing down what you're doing before going to sleep can sometimes help you find what you need to change.
 
Change one thing at a time.  For example, stop going online after 1 hour before bedtime.  Set a timer so you will turn off the computer or smart phone.  Keep a diary of your successes.

So, readers, tell us what you think below.

Posted by Kim Walker at 6:30 AM | Permalink | Comments (0)
Categories: General Health
        

A growing number of Maryland smokers are seeking help to quit through the state health department's tobacco Quitline, which offers counseling, support services and coaching sessions over the phone.

The free, confidential service received 1,429 calls as of January 25, up from 900 calls last November, according to the Maryland Department of Health and Mental Hygiene. Ads for the service feature Baltimore native and actress Nicole Ari Parker, who lost her grandmother to smoking-related cancer.

The Maryland Tobacco Quitline (1-800-QUIT-NOW) provides coaches who work with callers over four telephone sessions to devise a plan to help them break the addiction. Coaches follow up with printed materials to help you stay on track and while supplies last, callers can get free nicotine replacement therapy such as the patch or gum, mailed to their homes. The Quitline, which launched in June 2006 and has had about 64,000 calls, is manned 8 a.m. to 3 a.m. seven days a week.

For more information, check out www.smokingstopshere.com

I wonder if the spike in calls is due to folks making New Year's resolutions to quit. Have you? How are you doing so far? 

Posted by Kelly Brewington at 12:00 PM | Permalink | Comments (0)
Categories: General Health
        

Still digging out from last night's nasty storm? We are too. My husband recently came in complaining that the storm dumped plenty of that wet, heavy kind of snow that makes shoveling safely extra challenging.

With that in mind, here are some good tips from the American Physical Therapy Association that came in handy during last February's Snowpocalypse.

Posted by Kelly Brewington at 8:43 AM | Permalink | Comments (1)
Categories: General Health
        

Nearly 26 million Americans have diabetes -- 7 million of whom don't even know it -- according to new data out today from the Centers for Disease Control and Prevention.

The new figures mark an increase from 2008, when the agency found 23.6 million Americans with diabetes, nearly 8 percent of the population. The disease, characterized by high blood sugar, puts people at risk for heart attack, stroke, high blood pressure and kidney failure. It's the seventh leading cause of death in the nation.

The CDC also found an increase for what can be a precursor to diabetes, known as prediabetes. Some 79 million adults in the U.S. have prediabetes in which blood sugar is elevated, just not to the threshold considered for a diabetes diagnosis, the CDC reports. Prediabetes increases a person's risk for not only diabetes, but also stroke and heart disease.

The findings suggest a real increase in cases as well as more people living longer with the disease. Changes in how testing is recorded could also play a role, the report stated.

Posted by Kelly Brewington at 2:17 PM | Permalink | Comments (1)
Categories: General Health
        

As if we didn't get enough warnings this week of the hazards of smoking -- a new study links it to increased risk of breast cancer.

The increased risk was modest, and pertains only to women who smoked before menopause, according to the research appearing in the latest Archives of Internal Medicine. The data was gleaned from the long-running Nurse's Health Study, where Harvard researchers examined the records of nearly 112,000 women between 1976 and 2000, checking for women who smoked or who were around secondhand smoke.

Some 8,772 breast cancer cases developed during a follow-up. People who smoked a lot in their youth for a long amount of time were most likely to develop breast cancer, the report concluded. Meanwhile, not smoking or exposure to parents who smoked at home were not related to increased risk for breast cancer.

The carcinogens in cigarettes have long been known to cause lung cancer, as well as several other types including kidney, bladder and pancreatic cancers, according to the National Cancer Institute. But the relationship with breast cancer has been inconclusive for years.

The new study says it's the largest thus far to examine the risk associated between tobacco use and breast cancer. Past studies have tried to investigate the link, but their results were mixed and the relationship was unclear. This study, however, found that smoking impacts a woman's cancer risk depending on her age and hormones may be at play.

“Smoking before menopause was positively associated with breast cancer risk, and there were hints from our results that smoking after menopause might be associated with a slightly decreased breast cancer risk,” the study states. “This difference suggests an antiestrogenic effect of smoking among postmenopausal women that may further reduce their already low endogenous estrogen levels.”

Associated Press photo

Posted by Kelly Brewington at 10:00 AM | Permalink | Comments (0)
Categories: Cancer
        

Join us noon Jan. 26 for a live chat on shingles, a viral infection that affects more than 1 million people a year. Anyone who's had the chicken pox can get the painful rash, though senior citizens are more at risk. A recent study says the vaccine for the infection reduced the incidence of shingles outbreaks by 55%.

Dr. Paul Christo, director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine, will take reader questions on how to protect yourself against shingles and how to cope with the pain. Go to baltimoresun.com/healthchat.

Can't make the chat? E-mail questions in advance to healthcalendar@baltsun.com. A transcript of the chat will be available on this page after it's finished.

(Los Angeles Times file photo)

Posted by Kim Walker at 6:30 AM | Permalink | Comments (0)
Categories: General Health
        

Life expectancy in the U.S. lags behind other prosperous nations and smoking and obesity are to blame, explains a new report from the National Research Council.

While over the last 25 years, U.S. life expectancy at age 50 has been on the rise, it's still behind such nations as Australia and Japan, despite outspending them on health care, the report explains. Concerned about the trend, the National Institute on Aging asked a global team of researchers for answers. The result is a massive report that delves into the differences and blames much of the disparities on Americans' past smoking habit and the nation's obesity epidemic.

That smoking is to blame in the states may sound odd, considering smoking bans are all the rage in the U.S. while Europe is just catching on. Well, Americans' smoking habit goes back some fifty years when smoking rates were higher here than in Europe or Japan. The consequences of that unhealthy behavior are playing out now, explains a summary of the report.

Nevertheless, the report predicts good news could be down the pike. Since major efforts to reduce smoking are underway now, life expectancy likely will improve 20 to 30 years from now. 

Rising obesity rates, however, paint a gloomier picture. Obesity alone accounts for between a fifth and a third of the shortfall in American's lifespans. And if that problem doesn't improve, it could offset the gains in life expectancy expected from people quitting smoking.

Posted by Kelly Brewington at 3:18 PM | Permalink | Comments (0)
Categories: General Health, Medical studies
        

The food industry wants to make it easier for consumers to see the calorie and fat content of the foods they buy.

New food labels that will be easier for consumers to spot were announced today by the Grocery Manufacturers Association and the Food Marketing Institute.

The labels, called Nutrition Keys, will be placed on the front of food packages. The information will be simple and easy-to-read and tell consumers how key nutrients fit into a healthy diet. Some labels will also include information on "nutrients to encourage," or those that are underconsumed by the public. They include: potassium, fiber, Vitamin A, Vitamin C, Vitamin D, calcium, iron, protein.

The labels will be phased in by the end of the year. Food products will continue to have the nutritional labels currently on food products as well.

The new labels were created in response to a request by First Lady Michelle Obama last year. Obama has made child nutrition a key part of her platform.

Posted by Andrea Walker at 11:54 AM | Permalink | Comments (3)
Categories: Diet and exercise
        

I blogged last week about a new emphasis the federal government is putting on breast feeding, but because of health reasons many mothers aren't able to do it even if they want to.

To get the benefits that come with breast feeding, some mothers are getting their breast milk from other women. An NPR article explores the practice.

The article talks about a facebook group called "Eats on Feets" that helps moms find women willing to donate breast milk. The idea is for mothers to be able to get the milk for free.

But the Food and Drug Administration warns that feeding babies donated milk leaves them exposed to diseases, such as HIV. The NPR article said that there are milk banks that mothers can use where the women who donate are tested for diseases.

In promoting breast feeding last week the Surgeon General's office pointed to research that has shown breastfeeding protects babies from infection and illnesses, such as diarrhea and pneumonia. Breastfed babies are also less likely to develop asthma, according to the surgeon general's office. Babies who breastfeed for six months are less likely to become obese.

Breastfeeding is also good for moms who have a decreased risk of breast and ovarian cancers.

But is it worth taking the risk of using another women's breast milk? What do readers think?

Posted by Andrea Walker at 4:47 PM | Permalink | Comments (3)
Categories: Pediatrics
        

The authors of a new study suggest it might be. 

Pet lovers, I know what you're thinking: Kick the world's cutest doggy out of the bed? (Yes, you are! Yes, you are!) That's absurd. Well, the paper coming out in the February in the CDC journal Emerging Infectious Diseases documents cases where humans were likely infected with diseases through their beloved pets.

Even the most well-groomed and healthy-looking pets can carry dangerous bacteria, parasites and viruses that could causes serious illness, the report warns.

The study, which examined illnesses thought to be transmitted by pets in countries around the globe, runs down some pretty creepy examples. A 69-year-old man whose cat licked his hip replacement wound came down with meningitis. And a 9-year-old boy with a cat with fleas got plague. You read that correctly.

The study is quick to point out that zoonotic infections, as they are known, are rare. Good hygiene is key to keeping the risk of infection down, the report states.

But the risk of getting sick from sleeping with, kissing, or being licked by pets is real, especially considering that more than 60 percent of American households have a pet, the study states. According to one survey, among dog owners, 53 percent snuggle up with their pooch and among adult cat owners, 62 percent let their kitty sleep with them.

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (4)
Categories: Medical studies
        

Surgeon General Regina M. Benjamin this week issued a call to action to support breastfeeding, saying it needs to be made easier for women to perform the practice.

About 75 percent of U.S. babies start out breastfeeding, but only 13 percent are still exclusively breastfeeding at the end of six months, according to statistics from the Centers for Disease Control and Prevention.

The surgeon's general office said women point to many obstacles to breastfeeding. They may find no support from family members and don't have time or a private place to pump at work.

Benjamin outlines ways families, employers and health care professionals can make it easier to breast feed. They include:

* Communities should expand programs that give mothers peer counseling and support

* Clinicians should promote breastfeeding to patients and make sure they have information on how to breastfeed

* Employees should provide women with break time and a private space to pump. They should also create lactation support programs.

Research has shown that breastfeeding protects babies from infection and illnesses, such as diarrhea, infections and pneumonia. Breastfed babies are also less likely to develop asthma, according to the surgeon general's office.

Babies who breastfeed for six months are less likely to become obese. Breastfeeding is also good for moms who have a decreased risk of breast and ovarian cancers.

Posted by Andrea Walker at 4:48 PM | Permalink | Comments (4)
Categories: Pediatrics
        

The state of Maryland received a grade of "F" from the American Lung Association for its efforts at stopping smoking and other uses of tobacco products.

Maryland wasn't alone though.

The American Lung Association said most states "failed miserably" at passing laws that would protect citizens from the ailments that come with tobacco use.

Maryland continues to inadequately fund tobacco use prevention and cessation programs, the lung association's Maryland chapter found. In 2011, $4.3 million was allocated for the programs, compared to $19.6 million two years ago.

The association also noted failed legislation that would have redefined the definition of cigarettes to include what they called "little cigars." Little cigars are wrapped in paper and contain tobacco, but weigh less. The lung association believes they are more likely to be bought because they resemble cigarettes. A bill regarding little cigars passed in the Senate of the General Assembly, but failed in the House.

Maryland got an "A" for its efforts at creating smokefree air, a "C" for its cigarette tax and an "F" for its cessation programs.

(photo courtesy of AFP/Getty)

Posted by Andrea Walker at 7:00 AM | Permalink | Comments (5)
Categories: General Health
        

The number of Marylanders without insurance has stayed pretty much the same for the last five years, according to a report by state health officials.

About 14.5 percent, or an average of 720,000, non-elderly Marylanders were uninsured from 2008 to 2009, according to the Maryland Healthcare Commission. Like most other years, that is below the national average of 18 percent. Maryland has a higher rate of employment-based coverage than the rest of the country, which contributes to the lower number of uninsured, state officials said.

Young people and those who dropped out of school are more likely to be uninsured, according to the report. For instance, 26 percent of people age 16 to 19 didn't have insurance and 42 percent of people in families where the adults didn't have a high school diploma also didn't have insurance.

Low-income families were also less likely to have insurance coverage. People living at or below 200 percent of the poverty line accounted for 48 percent of Maryland's uninsured, but are just 23 percent of the nonelderly population.

Hispanics make up just 9 percent of the nonelderly population, but 24 percent of the uninsured.

The report also indicated that small businessed may have a hard time providing insurance for their employees. Adults who work for firms with fewer than 100 workers make up 38 percent of all workers, but 62 percent of uninsured adult workers.

Posted by Andrea Walker at 5:35 PM | Permalink | Comments (1)
Categories: General Health
        

Walmart, the world's largest retailer, unveiled a plan today to offer its shoppers healthier food options.

Michelle Obama, who has a campaign to battle childhood obesity, was on hand for the announcement.

Check out more details at the Consuming Interest blog and tell us what you think about the plan.

(Photo courtesy of Associated Press)

Posted by Andrea Walker at 12:11 PM | Permalink | Comments (0)
Categories: Diet and exercise
        

Maryland scored an "A" from the Center for Science in the Public Interest in a nationwide ranking of states' efforts to detect, investigate and report food-borne illnesses.

The report, All Over the Map, offers a 10-year review of food safety measures in the states based on data gleaned from the Centers for Disease Control and Prevention. Maryland was one of seven states that received top marks for its investigating and reporting systems. States that scored As reported eight and nine outbreaks per million people each year, the report found.

The more food-borne outbreaks states reported the higher their grade. Huh? You ask? Well, more reporting means more attention to safety, according to the folks at CSPI.

 “States that aggressively investigate outbreaks and report them to CDC can help nail down the foods that are responsible for making people sick,” said CSPI food safety director Caroline Smith DeWaal in a statement.  “But when states aren’t detecting outbreaks, interviewing victims, identifying suspect food sources, or connecting with federal officials, outbreaks can grow larger and more frequent, putting more people at risk.”

In Maryland, the health department examines outbreaks through its Infectious Disease and Environmental Health Administration, the Laboratories Administration and local health departments. The system helps identify threats, evaluate strategies to evaluate and prevent outbreaks, according to a statement by the Department of Health and Mental Hygiene. 

Posted by Kelly Brewington at 11:15 AM | Permalink | Comments (0)
Categories: General Health
        

GBMC Healthcare has enhanced its use of information technology in ways it said will improve and lower the cost of care.

The system - which owns Greater Baltimore Medical System, Gilchirst Hospice Care and Greater Baltimore Medical Associates - has implemented the following technology tools

* A Computerized Provider Order Entry (CPOE) system - This allows all physician orders, such as requests for lab work and follow-up visits, to be done by computer. No orders will be written by hand. The medical system believes this will help with patient safety and cut back on medication errors.

* Electronic health records - Patient records will be kept on a computer rather than in paper files.

* Electronic practice management system for physician offices - Physician offices will be able to automate their patient registration and schedule clinical activity such as prescription writing and lab results management. The system, eClinicalworks, will be rolled out first at Greater Baltimore Medical Associates (GBMA) practices. GBMA is the group of more than 40 multi-specialty physician practices on the hospital's Towson campus and in satellite locations across the region.

Posted by Andrea Walker at 3:32 PM | Permalink | Comments (1)
Categories: Business of health
        

Antidepressants can reduce hot flashes in menopausal and postmenopausal women, a recent study has found.

Women who took the medicine escitalopram experienced a reduction in the frequency and severity of menopausal hot flashes, compared to women who received a placebo in the study.

The study, conducted by researchers at the University of Pennsylvania School of Medicine, was published in the Januaray 19 issue of JAMA.

Hormone use for hot flashes has been reduced over the years. But no other treatments have worked as well, the researchers said.

The eight-week trial involved 205 women, some who recieved 10 to 20 mg/d of escitalopram or a matching placebo. The average number of hot flashes at the beginning of the study was 9.8 per day. Those taking escitalopram experienced an average of 5.26 hot flashes per day by week 8.

Posted by Andrea Walker at 7:00 AM | Permalink | Comments (0)
Categories: Medical studies
        

As many as 129 million Americans under 65 have a pre-existing medical condition -- some 2.5 million in Maryland -- that could cost them their health insurance if the health reform law is repealed, the Obama administration warned in a report today.

Having a medical problems like heart disease, high blood pressure and asthma could drive up the cost of purchasing care, or cause people to be be rejected by insurers all together, according to the study by the Department of Health and Human Services.

The administration released the analysis, a first attempt to qualify the number of Americans with pre-existing conditions, to coincide with Republican efforts today to debate repeal the sweeping health care overhaul passed last year.

The report also includes detailed estimates at the cost of repeal in each state. Here's Maryland's.

Maryland Gov. Martin O'Malley joined the administration's assault on the repeal in a conference call with health Secretary Kathleen Sebelius.

O'Malley said without reform health care costs would continue to rise. Those soaring costs have been a huge drain on businesses, stifling the economy, he said. 

"There is no way our business can expand if we are watching health care costs rise by 50 percent and wages stay stagnant," he said.

O'Malley said Maryland is looking forward to implementing the health care law. In fact, just last week, a state panel gave O'Malley a 16-point plan with recommendations on how to roll out health reform in the state.

"We firmly believe in Maryland that this is important, not only to create more affordable more comprehensive health care for all, but we see this as an opportunity to make our economy more competitive," O'Malley said.

Nationwide, the report found that people ages 55 to 63 are at particularly high risk with 48 to 86 percent of them living with some sort of pre-existing medical problem. Even those who are in good health are at risk, the study warns. Some 15 to 30 percent of healthy people under 65 are likely to develop a pre-existing condition over the next eight years. And some of those with pre-existing conditions are already struggling -- one in five, or 25 million, don't have insurance. 

It will be interesting how the fight over repeal will go in Congress as lawmakers near a vote tomorrow. This Tribune story notes that a new Quinnipiac poll found that Republicans have considerable public support for the repeal, with 54 percent of independent voters in favor of getting rid of it.

Posted by Kelly Brewington at 4:13 PM | Permalink | Comments (3)
Categories: Health care reform
        

Some 6 percent of surgeons reported having suicidal thoughts in the last year, but many are reluctant to seek help because they feared it would impact their medical license, according to a new study in the Archives of Surgery.

The study, based on an anonymous survey of nearly 8,000 surgeons, found suicidal thoughts were tied to doctors' worries about making an error, a history of depression and burnout on the job. 

Researchers at the Mayo Clinic found of the 6 percent who reported having suicidal thoughts in the previous year, just 26 percent sought help. Concerns about the impact on a license is real; 80 percent of state medical boards ask about prior mental illness and 47 percent ask about it during application renewal, the study said.

Older surgeons were more likely to contemplate suicide -- those 45 and older had one and a half to three times the rate as the general population. Being married and having kids were associated with lower rates, the study said.

The grim study also mentions that doctors in general have a higher rate of suicide than the general population. But they tend to have the same rate of depression as the population at large. Clearly more study is done to figure out what surgeons' risk factors are and how to get them help, the study states.

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Health care professionals
        

Confused about health care reform? "What does it mean for me?" you ask? 

Baltimore HealthCare Access, a nonprofit that connects city residents with medical care programs in Maryland, aims to offer answers with a community forum tomorrow.

The free event, called "Baltimore Health Care Now and Later," will kick off with remarks from Mayor Stephanie Rawlings-Blake and feature forums tailored to seniors, business owners and general health care consumers. The first in series of quarterly community-outreach events, the program aims to inform consumers about their health care options and clear up misconceptions about the sweeping national health care overhaul passed last year.

“It’s really going to be a major shift in how health care is done in this country and people need to be aware of this,” said Therese McIntyre, a spokeswoman with Baltimore HealthCare Access. “They need to know how important this law is and what the facts really are.”

The event also features health screenings, games for children and will highlight elements of the health care reform law that are available to consumers now. It takes place from 1 p.m. to 6 p.m. at the Harry & Jeanette Weinberg YMCA, 900. E. 33rd St., Baltimore. For more information: www.bhca.org  or call 410-649-0500.

Worried that the forum takes place at the same time as the Ravens big playoff match up against the Steelers? Not to fret. The kind folks at Baltimore HealthCare Access plan to set up a 52-inch screen to show the game during the health fair. Nice.

Posted by Kelly Brewington at 10:23 AM | Permalink | Comments (0)
Categories: Health care reform
        

School lunches may soon contain more fruits and vegetables and fewer french fries and cardboard pizza.

The Agricultural Department has proposed what would be the first nutritional overhaul of school lunches in 15 years, the Associated Press reported. The guidelines, which would apply to lunches subsidized by the federal government, calls for schools to cut sodium in lunches by half, serve low fat milk and use more whole grains. It would also establish calorie limits for school lunches.

The new guidelines are based on recommendations by the Institute of Medicine, a division of the National Academy of Sciences.

The proposal comes as more emphasis has been placed on the country's childhood obesity problem. Michelle Obama has made it her platform as First Lady and President Obama recently signed a child nutrition bill into law.

Sarah Paliln also recently entered the debate saying at a Pennsylvania school that parents should decide what their kids eat, not the federal government. The Pennsylvania School System was considering whether to ban sweets from school.

What do you readers out there think? Should the federal government require healthier school lunches?

Posted by Andrea Walker at 7:00 AM | Permalink | Comments (0)
Categories: Diet and exercise
        

The CDC released today a first of its kind analysis of racial disparities in health with the hope of drawing attention to some persistent gaps and shedding light on unexpected ones.

While race was the primary focus of the report, it also delved into differences in health outcomes by income, gender and geography. The report is huge and has plenty of interesting -- and disturbing -- findings. Among the biggest disparities:

     + Black babies are 1.5 to 3 times more likely to die than infants born to women of other races

     + Heart disease and stroke, the nation's leading causes of death, account for the largest proportion of inequality in life expectancy between whites and blacks, despite the existence of low-cost treatment.

     + Men of all races are nearly four times more likely to commit suicide than women. American Indians and whites have nearly twice the rate of suicide as that of blacks, Asians and Hispanics.

     + Prescription drugs kill more people than illegal drugs, a reversal from 15 to 20 years ago. Drug deaths increased from 2003 to 2007 among men and women of all races except Hispanics. Whites have the highest rates of drug-related deaths.

Many of the national statistics are mirrored here in Baltimore, where officials have been trying to combat similar disparities, notably between whites and blacks and rich and poor. This afternoon, in fact, Baltimore Health Commissioner Dr. Oxiris Barbot is giving a presentation to the city council on strategies to do so.

“Access to healthy foods, healthy housing, healthcare, safe neighborhoods, education and employment opportunities, and transportation – often collectively referred to as social determinants of health – play as important a role in keeping us healthy as they do in making us sick,” Barbot said in a statement. “Eliminating health disparities and achieving health equity in Baltimore City will only be possible through bringing together multiple public, private and community partners to address these issues collaboratively.”

The health department has been working to lower the city's high infant mortality rate through an initiative called B'more for Healthy Babies. Meanwhile, the city's Virtual Supermarket program tries to combat the existence of "food deserts" where fresh, healthy food is hard to come by.

Posted by Kelly Brewington at 3:03 PM | Permalink | Comments (0)
Categories: General Health
        

Early diagnosis is best in most medical cases. That’s certainly true for dementia, doctors say. And some researchers at Johns Hopkins have found an online tool can help seniors determine whether they should seek a more thorough evaluation from their physicians for the malady.

The tool, which is still being refined, doesn’t diagnose. It lets the seniors know if they are at risk and should get a physical exam, blood work and images.

“As the population ages and dementia becomes more prevalent, it's important to get people diagnosed early,” says Jason Brandt, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, said in a statement.  “Alzheimer's disease and other types of dementia don't just creep up on you. They're incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

The Dementia Risk Assessment asks questions about a person’s risk factors for dementia, including whether the person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury. The tool also offers a simple memory test, said Brandt, the leader of the study that appears online in the journal Alzheimer's & Dementia.

The study looked at responses from 357 people over age 50 who took the assessment at  alzcast.org. The assessment takes about five to 10 minutes, and Brandt says it separates those who are really at risk verses common forgetfulness that creeps up on older people. Those are people, for example, who just can’t remember where they put the keys.

There are methods to slow cognitive decline or even restore brain function with some forms of dementia. Though, there is no cure for Alzheimer’s disease.

Posted by Meredith Cohn at 11:05 AM | Permalink | Comments (0)
Categories: geriatrics
        

Researchers at Johns Hopkins Hospital have determined it is safe to transport kidneys, a finding they believe will allow for more transplants of the organ.

Doctors have worried that the longer a kidney is kept outside the body, the more likelihood there was that it wouldn't function as well than if it came from a live donor.

The Hopkins researchers looked at whether the amount of time a kidney was kept outside the body on ice had any harmful affects - and found there were none.

The findings were published online in the American Journal of Transplantation.

The researchers first tested a kidney shipped from California to The Johns Hopkins Hospital in Baltimore in 2007. Over the next three years they tested 56 other kidneys transported to 30 transplant centers in the United States and Canada.

These kidneys also suffered no harm. Once transplanted the kidneys began allowing the patient to urinate and cleared waste out of his or her system.

The kidneys studied traveled an average of 792 miles and spent an average of 7.6 hours outside of the body.

The researchers said the findings are particularly beneficial for the practice of "kidney paired donations." This process allows a family member to give a kidney that may be incompatible with a loved one to someone else who needs the organ. In exchange, that person's family member will get a compatible organ from someone else. Johns Hopkins pioneered this procedure.

This procedure is accomplished more easily if the kidneys can be transported rather than having the patients travel long distances, the researchers believe.

Until 2007, hosptials and surgeons required patients to travel, rather than have the kidneys shipped.

The Hopkins researchers believe their findings provide more support for transporting kidneys.

Caption (Valerie Eigner, 59, left, and her daughter Jamie Conway, 30, both of Arbutus, recuperate at the University of Maryland Medical Center after a transplant operation  in which Eigner donated her kidney to her daughter. Photo by Amy Davis, The Baltimore Sun)

Posted by Andrea Walker at 10:55 AM | Permalink | Comments (0)
Categories: Medical studies
        

According to the Mayo Clinic, 1 of out 3 people undergoing cancer treatment experiences some level of pain. If you are one of those patients or know someone who is, visit baltimoresun.com/healthchat at noon Wednesday for our latest health live chat. Dr. Paul Christo, director, Multidisciplinary Pain Fellowship Training Program, Johns Hopkins University School of Medicine, will be taking reader questions.

Can't make it? A transcript of the chat will be available at the same link after the session ends. Send questions for consideration in advance to healthcalendar@baltsun.com.

Posted by Kim Walker at 9:32 AM | Permalink | Comments (0)
Categories: General Health
        

Treating premature babies with nitric oxide doesn’t seem to help stave off major problems or death, a new Johns Hopkins Children’s Center research finds.

The practice is widespread, but the babies who got nitric oxide were no less likely to die, develop chronic lung disease, suffer cerebral palsy or have neurological or cognitive impairments, according to the review of 22 major studies.

The finding will appear in the February issue of the journal Pediatrics. The researchers said there was a small difference in some babies, but not enough to warrant across-the-board use. They, instead, conclude that for babies born at less than 34 weeks, the decision to use nitric oxide should be done on a case-by-case basis.

“What we call for is careful evaluation by a team of clinicians of each patient’s risk-benefit profile, factoring in birth weight, degree of prematurity and degree of lung and brain maturation,” said lead investigator Pamela Donohue, in a statement.

The researcher note that there is evidence that nitric oxide is effective treatment in babies born near-term, or after 34 weeks.

Baltimore Sun file photo/Kim Hairston

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (0)
Categories: Pediatrics
        

The rate of abortion, in decline for nearly three decades, stalled in 2008, according to the Guttmacher Institute, a research organization that tracks abortion trends.

The rate was 19.6 abortions per 1,000 women in 2008. That’s down from 29.3 abortions per 1,000 women in 1981.

“In this time of heightened politicization around abortion, our stalled progress should be an urgent message to policymakers that we need to do more to increase access to contraceptive services to prevent unintended pregnancy, while ensuring access to abortion services for the many women who still need them,” said Sharon Camp, president and chief executive of Guttmacher, in a statement.

More women were also choosing a two-drug combination for a “medication abortion,” verses a surgical one, the group found. The number of such procedures was 199,000 in 2008, up from 161,000 in 2005. And as a percentage of nonhospital abortions, the early medication procedures rose to 17 percent from 14 percent.

Nearly 60 percent of abortion providers offer the drugs.

The group also found that the number of abortion providers was about the same in 2008, rising to 1,793 from 1,787. About 87 percent of U.S. counties – where about 35 percent of women in their reproductive years live -- had no one providing abortions.

Those nonhospital abortion providers reported an increase in “harassment,” which is defined by the group as picketing and blocking patient access.

The data was collected in the group’s 15th “census” or abortion providers. It’s published online in the Perspectives on Sexual and Reproductive Health.

Officials at Planned Parenthood Federation of America, which supports abortion rights, said the study “highlights the need for our leaders to ensure that all women and their partners have the information and affordable birth control options they need to prevent unintended pregnancy. The first step we can take as a nation is to increase access to affordable contraception. While many factors contribute to the abortion rate in the United States, this country’s very high rate of unintended pregnancy is the most important one of all.”

The group has launched a campaign called Birth Control Matters to advocate for prescription birth control without co-pays through the new health care law.

The National Right to Life Committee, which opposes abortion, said legislative and educational efforts have helped prevent an increase in abortions.

But, “with abortion continuing to claim the lives of more than 100,000 unborn children every month, we must continue to be vigilant in our efforts to educate the public and enact laws that protect unborn children and their mothers from the dangers of abortion and make sure they know that help is available,” said Randall K. O’Bannon, the group’s director of education and research, in a statement.

Posted by Meredith Cohn at 3:34 PM | Permalink | Comments (0)
Categories: Women's health
        

As Congressional Republicans vow to repeal the sweeping health care reform legislation, a consumer group warns doing so could have pricey consequences in Maryland.

Repealing health reform would hurt Marylanders with higher premiums, coverage denials for people with pre-existing medical conditions and increase state employer health care costs, according to study out today by the nonprofit consumer group Maryland PIRG.

The health care exchanges established by the legislation, designed to give consumers bargaining power when purchasing their own insurance, would disappear, forcing individuals to pay higher prices for coverage, the report states. Without the exchanges, individual premiums could go up by 20 percent by 2016, says the report The Cost of Repeal: Examining the Impact on Maryland of Repealing the New Federal Health Care Law.

Small businesses, already struggling to extend health care to their employees, would lose tax-credits to make health care costs more affordable, the report found. Employer-based health insurance could jump by $3,000 a year, the report estimates. And without the savings that health care reform, businesses would create nearly 5,000 fewer jobs by the end of the decade, the report found.

Repealing the law would mean $9.1 billion less in federal Medicaid and put the state’s 126 community health centers in peril, the report suggests.

Repeal would undo key elements of the legislation that aim to get rid of discrimination by insurers, resulting in women paying higher premiums than men and insurers denying coverage to sicker patients, the report states. In addition, some 18,000 young adults in Maryland would lose the ability to stay covered under their parents’ plans.

Whether reform costs money or saves it has been a hotly debated point of late. This NYT piece takes a look at the battle -- over the math. 

Meanwhile, here in Maryland, officials are taking big leaps toward enacting health reform. Check out Meredith's story today about the plans. 

Posted by Kelly Brewington at 2:10 PM | Permalink | Comments (1)
Categories: Health care reform
        

Babies born less than a year after an older sibling were more likely to be diagnosed with autism, according to a new study in the journal Pediatrics.

Researchers at Columbia University examined the birth records of some 660,000 California second-born children to determine their odds of being diagnosed with the puzzling developmental disorder.

Second children conceived less than two years after the first baby were nearly twice as likely to develop autism. And those conceived less than 12 months after the first child were three times as likely to be diagnosed with autism. 

Now for the hard question: why?

Researchers aren't sure what the connection might be. One theory is that the a woman who recently had a child could have depleted levels of important baby-growing nutrients such as folate and iron. Still, researchers didn't test that idea. Peter Bearman, a Columbia sociologist who conducted the research said parents with children close in age might be more likely to notice when a sibling isn't developing on target.  Clearly, more research is needed to pinpoint what's at play here.

No one knows what causes autism and there is no cure, to the dismay of approximately 1 in 100 children nationwide thought to have the disorder.  But many researchers believe a combination of genetic and environmental factors are at work. Autism is actually a wide range of disabilities known as autism spectrum disorders and is marked by impaired communication and social interaction.

The study comes on the heels of last week's news further discrediting the 1998 study by Dr. Andrew Wakefield that first linked the measles, mumps and rubella vaccine to autism.  

Posted by Kelly Brewington at 10:27 AM | Permalink | Comments (7)
Categories: Pediatrics
        

Jhpiego, the international health nonprofit and affiliate of Johns Hopkins University, will expand on its work in eastern Kenya thanks to a $100 million award from the U.S. Agency for International Development.

Jhpiego has been working on health projects in Kenya for four years.  The group will lead the “APHIAplus Health Service Delivery” project over the next five years with the new award that will ensured easier access to care for the impoverished and underserved in community and hospital settings. Services will include family planning and HIV.

“Jhpiego is thrilled to be chosen for this project and join our Kenyan partners in providing innovative health strategies to improve health care services for those most in need and support Kenyans in carrying out this most important, life-changing work,” said Leslie Mancuso, Jhpiego president and chief executive, in a statement.

For the past four years, Jhpiego has led the $33.9 million, USAID-funded AIDS, Population and Health Integrated Assistance (APHIA II) project in Eastern Kenya. In that time, the program has counseled and tested over 1.1 million Kenyans. More than 8,000 of those who tested positive have begun antiretroviral treatment in the last two years.

Posted by Meredith Cohn at 11:03 AM | Permalink | Comments (0)
Categories: HIV/AIDS
        

The now infamous 1998 article that first linked the MMR vaccine to autism was not just incorrect, it was based on falsified evidence, according to a new article published in the medical journal BMJ.

Dr. Andrew Wakefield's study set off a global panic about the safety of a common childhood vaccine and today the emotional debate over the causes of the complex disorder rages on. 

The new BMJ evidence comes a year after the medical journal Lancet retracted the original paper. And last May, Wakefield was stripped of his license to practice medicine.

Last year's news was just the latest in a series of mounting evidence from the Institute of Medicine and others that found no link between the combination measles, mumps and rubella vaccine and autism. Nevertheless, many parents continue to cling to the possibility that the vaccine is unsafe. As a result, vaccination rates have dropped and measles cases surged. In 2008, more measles cases were reported in United States than any year since 1996, the CDC found.

The new BMJ report by British journalist Brian Deer interviewed families of the 12 children in the original study concluding that Wakefield misrepresented or falsified the experiences of the kids in the study.

Wakefield is still defending his research and on CNN called Deer a "hit man" trying to take him down.

Could this be the end of the vaccine-autism controversy? I asked that a year ago, when Wakefield's paper was retracted. But perhaps this ends it for good? What say you?

Posted by Kelly Brewington at 1:15 PM | Permalink | Comments (2)
Categories: Pediatrics
        

Severely injured patients who get IV fluids ahead of the emergency room are much more likely to die than those who don’t because of the delay in transporting them, according to new Johns Hopkins-led research.

IV fluids are standard care for trauma patients in Maryland and elsewhere, though there isn’t sufficient scientific evidence that it universally helps, says Dr. Elliott R. Haut, an associate professor of surgery, anesthesiology and critical care medicine in Hopkins’ School of Medicine and the study’s leader.

The research, published online in the February issue of Annals of Surgery, could spark changes to the decades-old practice.

“Giving IV fluids to patients before they go to the hospital can delay transport,” says Haut said in a statement. “Our study suggests it may be better to get patients to the hospital faster. Starting fluids takes time and the IV fluids may cause harm on top of the timing issue.”

Haut came to a similar conclusion about cervical collars before transport, saying they may not be necessary for some trauma patients pre-hospital and could delay needed treatment.

Fluids are given immediately to trauma victims whose blood pressure has dropped sharply because of blood loss. The fluids quickly raise pressure and keep the body’s systems working, which is especially helpful to those with traumatic brain injuries. But Haut says the fluids may make matters worse in patients whose low pressure temporarily stops bleeding.

Haut and his colleagues looked at data from 776,734 trauma patients in the American College of Surgeons’ National Trauma Data Bank between 2001 and 2005. About half got fluids pre-hospital. Those who were shot or stabbed were 25 percent more likely to die and those with severe head injuries were 35 percent more likely to die.

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (0)
Categories: Medical studies
        

The Washington nonprofit Physicians Committee for Responsible Medicine is suing the USDA and HHS saying the agencies ignored the organization's proposal of a food guide that it maintains is healthier than the standard food pyramid.

PCRM, which champions animal rights and promotes vegetarianism, filed a lawsuit this morning in U.S. District Court in Washington saying the USDA and HHS violated federal law by not considering the group's alternative to the food pyramid.

The Feds revised the old school carb-heavy food pyramid in 2005 to emphasize whole grains, veggies and physical activity (there’s a reason that stick figure guy is climbing that pyramid). That didn’t stopped some critics who asserted the recommendations are beholden to agribusiness.

The Physicians Committee for Responsible Medicine endorses something called Power Plate, a plate divided into four food groups -- vegetables, fruits, legumes and grains -- and urges people to eat a variety of all four each day.  Meat and dairy don’t belong in daily recommendations, the group says.

Posted by Kelly Brewington at 11:37 AM | Permalink | Comments (9)
Categories: Diet and exercise
        

Researchers at the Kennedy Krieger Institute and four other institutions say they have discovered where the biological process of blinding begins for glaucoma, perhaps leading to new ways to treat the disease and other neurodegenerative diseases.

Glaucoma affects more than 60 million people, including children, and is the world’s second leading cause of blindness.

The biological pathway identified by the researchers is similar to Parkinson’s disease, the researchers said.

 “These findings are very exciting because they give us several novel targets for future interventions,” said Dr. Nicholas Marsh-Armstrong, senior study author and a research scientist at Kennedy Krieger, in a statement. “I believe these findings put us on the cusp of discovering a treatment for glaucoma that may also have relevance for a number of other neurodegenerative diseases.”

The findings were published this week in the Proceedings of the National Academy of Sciences. The researcher said the findings were unexpected.

The blindness from glaucoma is caused by damage to the optic nerve, which sends signals from the eye to the brain. In the latest study, researchers have pinpointed the specific location that appears to play a role.

They say it’s in the optic nerve head, where the information cables headed to the brain first exit the eye. There is a unique class of cells there called astrocytes that appear to be a factor.

Further studies will look at the pathway where things start to go awry and how the disease progression may be slowed.

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (0)
Categories: Medical studies
        

Last year during the H1N1 flu pandemic, we heard from a lot of area workers who were compelled to get flu shots by their employers -- but they were pretty much all health care workers.

Health care workers work with vulnerable populations, so it makes sense that the bosses would consider vaccinating everyone. And health care workers don't have the best record. Historically, only half of the health care work force gets a vaccination.

State and federal governments made sure the health care workers were among the first in line when there were shortages of the H1N1 vaccine, though officials made it clear that they were not requiring the shots.

But this year, I was surprised to hear from workers who said they were being required to get vaccinations -- and these people don't work in health care. These are professionals who might see clients, but not patients. Perhaps the bosses were thinking about employee absenteeism?

Have you been compelled to get a vaccination? Think your boss should be allowed to require you to?

Posted by Meredith Cohn at 1:56 PM | Permalink | Comments (4)
Categories: Consumer health
        

Wrong. We all know Americans are a chubby lot. But we'd prefer to convince ourselves otherwise.

Nine out of ten Americans call their diet healthy, according to a new Consumer Reports poll. But how folks define healthy is far from nutritious, the survey found.

Few of us limit sweets or fats and only about a third of us eat five or more servings of fruits and veggies, according to the survey of about 1,234 adults interviewed last fall.  Veggies are hard to store, or they go bad too fast, said 29 percent of respondents. Fourteen percent said they're too pricey. And another 13 percent said they just don't like 'em.

Worse still, folks don't seem to know how much they actually weigh. How's this for denial: One in three said they had a healthy weight, but actually had body mass indexes indicating they're overweight or obese. Even those on the slender side didn't have a good handle on their weight. Eight percent said they thought they were overweight when they weren't.

Baltimore Sun photo

Posted by Kelly Brewington at 9:37 AM | Permalink | Comments (0)
Categories: Diet and exercise
        

Researchers at the University of Maryland School of Medicine will be coordinating a team of international scientists looking at the genes that may make a person more likely to have a stroke – the nation’s third biggest killer and a leading cause of disability.

They’re specifically looking at the most common type of stroke called an ischemic stroke. It’s caused by a blood clot in the brain and is responsible for 80 percent of cases.

A $3.6 million grant from the National Institutes of Health will fund the research, at 17 sites, including 12 in the United States and 5 in Europe. It’s expected to take about four years and will be one of the largest stroke genetics research projects ever, said Dr. Steven Kittner, principal investigator and professor of neurology at Maryland and a researcher at the Baltimore VA Medical Center, said in a statement.

“Recent studies in conditions such as diabetes and lupus have shown that a large sample size, such as the one we will be using, can be vital in helping to uncover genetic influences in a complex disease, so we are eager to see what genetic variants we may find for stroke and what promise these discoveries may hold for prevention and treatment,” he said.

The researchers will look at DNA from at least 6,000 stroke patients. That will enable them to look at more than a million genetic variants for their association with stroke. They hope to find ones not previously linked to strokes. Researchers say risk factors such as hypertension and cigarette smoking can’t fully explain who will suffer a stroke and genetics may offer better clues.

There are nearly 800,000 strokes a year in the United States. Blood flow to the brain is cut off, increasing the risk of brain damage or death. Symptoms include numbness or weakness on one side, sudden loss of vision, sudden confusion or trouble speaking, dizziness and severe headache.

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (1)
Categories: Medical studies