While many health care regulations are in place to provide consistent and quality care, as well as protect the vulnerable, some are outdated, expensive and not particularly useful.

So, the state Department of Health and Mental Hygiene endeavored to clean house. Officials began collecting input from the public in April and have released a draft report on changes that could be made in the fall – some changes may be done through regulation and others may require legislation.

Joshua M. Sharfstein, the department secretary, said he heard those who operate facilities about the costs of regulations, some that may no longer necessary or could be tweaked. The changes could have wide ranging impact.

In Maryland, there are: 230 skilled nursing facilities serving an estimated 25,240 individuals; 1,375 licensed assisted living providers approved to care for almost 20,000 residents; 123 licensed adult medical day care programs with capacity to serve approximately 7,000 adults; 1,500 licensed community mental health programs and with some 116,948 consumers; 200 community based providers for those with developmental disabilities at 2,600 sites serving more than 22,500 people; and 1,000 certified substance abuse treatment programs with about 21,000 seeking treatment a month.

Many of the regulations on the list for change had to do with the level of training providers needed, the intervals for reporting, the definitions of providers and changes in technology.
“Some of the regulations are important for protection of public,” said Sharfstein. “But there is a real balance to be struck. We don’t presume they every regulation needs to stay there forever. We need to look on a case by case basis.”

To see the report or make a comment, click here.

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

Today is the first official World Health Organization World Hepatitis Day.

It was created to increase awareness about the viral infections and the diseases they cause – and call for more prevention, screening and control, according to WHO.

The viruses – A, B, C, D and E – cause inflammation of the liver, and in some cases can lead to cirrhosis and liver cancer. Hundreds of millions of people are living with the viral infections around the world and about a million people a year die from them, according to the U.S. Centers for Disease Control and Prevention.

The A and E viruses are spread by water and food contaminated with feces, while B, D and C are spread by blood and body fluids, through childbirth, injecting drugs or transfusions.

The federal and international agencies say there have been successes in treating hepatitis – notably a vaccine for hepatitis B offered to children in 178 countries. The vaccine is estimated to prevents 700,000 deaths a generation. The vaccine also eliminates the risk of contracting hepatitis D. And there’s a newer vaccine for hepatitis A and one is in development for E.

Tests for the viruses also make the blood supply safer. And access to screening and treatment is better for those who are infected, the groups say.

Now efforts are being made to make people aware that they may have hepatitis so they can be screened and treated. And in poorer countries, the focus in on getting people clean water and safe food. Perhaps by next World Hepatitis Day there will be some more progress.

Posted by Meredith Cohn at 2:50 PM | Permalink | Comments (0)
Categories: General Health
        

Governments need to plan for roads and schools and other services, so they estimate the number of people who might be around in coming years to use them.

A new study may help make the educated guesswork a little more scientific. The study, funded by the National Institutes of Health, proposes a new method of predicting fertility rates by using a new statistical technique.

The new method mathematically compensates for uncertainty and should allow governments that more specific information on large-scale population changes that they need to plan for infrastructure and services.

The conventional method of predicting the fertility rate relies on the average number of times a woman gives birth during a lifetime and the estimated change to the number as a woman ages. Analysts create a range by adding and subtracting .5 children to the average rate predicted. But they could not calculate how likely it was that variations would actually occur.

The new method uses a statistical formula to take into account historical fertility estimates and the likelihood of future trends. It uses the historical rates for the country as well as 195 other countries, since fertility patterns are the same in all countries.

Authors of the study say the new method has a 1 in 10 chance that the fertility rate will be greater or less than that actually observed. The findings appear in the journal Demography.

“More accurate forecasts of fertility trends will allow officials to better plan for a country’s municipal, economic and social needs,” said the program official for the study, Michael Spittel, in a statement. Spittel was formerly of the Demographic and Behavioral Sciences branch at the National Institute of Child Health and Human Development, the NIH institute that funded the study, and now at the NIH’s Office of Behavioral and Social Science Research.

Researchers came from the National University of Singapore, the University of Washington in Seattle, the United Nations, South Africa’s University of Witwatersrand and the INDEPTH research network.

They looked at fertility rates over time to help develop the model. Women used to give birth to an average of six or seven children, then five children and then a stable two, or replacement level. In the last five years, 20 countries have entered this phase. The United States fell below the replacement rate and then recovered to two today.

Using this information, the researchers were able to forecast trends through 2100 using the new method.

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

Join us noon July 27 at baltimoresun.com/healthchat for a live chat on non-surgical treatments for sciatica with Dr. Steven Cohen of Johns Hopkins. Injury to the sciatic nerve will cause leg pain, weakness, numbness, or tingling, according to the U.S. National Library of Medicine. Treatments vary, depending on the underlying cause, but can include over-the-counter pain killers and physical therapy.

Cohen is an associate professor and researcher with Hopkins School of Medicine and professor of anesthesiology at Uniformed Services University of the Health Sciences and director of Pain Research at Walter Reed Army Medical Center.

Can't make the chat? Come back later to read the transcript.

Posted by Kim Walker at 6:45 AM | Permalink | Comments (0)
Categories: General Health
        

McDonald's Happy Meals are going on a diet in what the fast food company describes as a way to help kids eat healthier.

The meals that are popular with children, but not so with nutritionists, are getting a 20 percent reduction in calories beginning next year.

The french fry portion will be smaller and apples and low-fat milk added to the meal.

The fast food company said it will also change its marketing message encouraging kids to eat well and exercise.

The Happy Meal makeover is part of a expansive effort by McDonald's to make its food healthier.

By 2020, the fast food chain said it will reduce added sugars, saturated fat and calories by changing portion sizes and changing recipes. By 2015,McDonald’s plans to reduce sodium in its food by an average of 15 percent.

"Still, some nutrition groups say that McDonald's is not going far enough.

"McDonald’s deserves credit for not only taking these steps, but for acknowledging its role in today’s epidemic of diet-related disease in so doing," said Kelle Louaillier, executive director of Corporate Accountability International. "It’s a good first step, however the corporation has yet to address the central issue, its aggressive brand marketing to kids. And so long as burgers, fries, and soda offerings to kids, alongside toys, remain central to that brand, health professionals will continue to call for the marketing to stop."

What do you all think? Is McDonald's going far enough?

Posted by Andrea Walker at 5:08 PM | Permalink | Comments (2)
Categories: Diet and exercise
        

Maryland health officials plan to release today their newest plan to control cancer, a set of diseases responsible for one in four deaths in the state.

The officials say the plan to be used by health care providers, policy makers, communities and individuals is ambitious, aiming to save some 1,200 more people a year. Now, about 10,000 Marylander die a year from all kinds of cancer.

“Cancer remains a leading cause of death and we have to attack it from multiple angles,” said Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene, in an interview before the announcement at Johns Hopkins. (Look for full coverage in the Baltimore Sun tomorrow or on Baltimoresun.com later today.) Update: Story is here.

The plan is required by each state by the U.S. Centers of Control and Prevention, which notes that the cost nationally from cancer was more than $206 billion in 2006. In Maryland, it was estimated to be $3.9 billion.

Officials from the public and private sectors who contributed to the report outlined the steps that should be taken by all stakeholders. It takes into account the latest research and strategies on prevention, early detection and treatment for the disparate types of cancer that most commonly afflict Marylanders and Americans, such as breast and prostate, lung, colon and ovarian cancer.

The overall goal is to decrease cancer mortality to160 deaths per 100,000 Marylanders from 187 deaths per 100,000 recorded in 2006.

Officials note that Maryland has come a long way in controlling cancer. Until the epidemic peaked in the state in 1990, Maryland had the third highest cancer mortality rate in the country. The rate decreased enough by 2000 to rank the state 11th and 20th by 2006.

But the population is aging and more cancers are likely to be found, the report says. That makes lifestyle choices for younger people all the more important, said Dr. Kevin J. Cullen, director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center.

Smoking and eating habits are the two most crucial elements to change, said Cullen, who is also a member of the Maryland State Council on Cancer Control that facilitate the plan that involved input from hundreds of people.

“Many cancers are preventable, probably the majority of them, if people did the simple things of not smoking and keeping their body weight in recommended range the overall burden of cancer would probably drop by at least half.”

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

A much needed child hospice has opened in Baltimore today.

Dr. Bob’s Place opened its new inpatient hospice facility near downtown at 838 N. Eutaw Street. The facility will serve children 18 and under with life limiting illness. The facility has private rooms where parents can stay the night.

Dr. Bob's Place becomes the second hospice in the state to serve children. Gilchrist Kids, a division of Gilchrist Hospice in Towson, began serving kids last year.

Dr. Bob's Place began its home-based services in March.

Children are often underserved in the hospice community. Most die in intensive-care units at hospitals or in emergency rooms, where the focus is on treatment rather than comfort and quality of life.

Only about 10 to 20 percent of dying children recieve hospice care, according to the National Hospice and Palliative Care Organization. Research has shown it can be more costly and complicated to care for dying children. Insurance rules have also made it difficult for children to qualify for hospice coverage.

Posted by Andrea Walker at 12:14 PM | Permalink | Comments (0)
Categories: Pediatrics
        

The obesity trend continues, according to the latest report from the U.S. Centers for Disease Control and Prevention.

Considering 2010 data, a third of American adults are obese and 17 percent of kids are obese. In 12 states, more than 30 percent are obese. In Maryland, 27 percent are.

It’s a problem in every state, CDC officials say – no state came in at less than 20 percent and no state met the national Healthy People 2010 goal to lower obesity to 15 percent within a decade.
Here’s a link to the data, from the Behavioral Risk Factor Surveillance System, which is a phone surgey of 400,000 adults.

“State obesity rates are still high,” said CDC Director Dr. Thomas Frieden, in a statement. “Some of the leading causes of death are obesity-related - heart disease, stroke, type 2 diabetes and certain types of cancer. We must continue our efforts to reverse this epidemic.”

According to the report, the South had the highest rate, at 29.4 percent. The Midwest’s rate was 28.7 percent, the Northeast’s was 24.9 percent and the West’s was 24.1 percent.

Is it hopeless?

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

Doctors around the region and the nation are looking to treat pancreatic cancer before it starts by examining cysts. (See story here.)

About 13 percent of people have pancreatic cysts but only a small number will become cancer. With all the imaging and testing, they still can’t say with certainty which will develop into cancer. So, some people have major surgery when they don’t need it.

But Johns Hopkins scientists may have developed a gene-based test to distinguish between the precancerous ones and the benign ones. A report on the test is published in the July 20 issue of Science Translational Medicine.

Cysts are generally found when a patient has imaging for another reason.

Dr. Bert Vogelstein, co-director of the Ludwig Center at Johns Hopkins and a Howard Hughes Medical Institute investigator, and colleagues looked at cysts from 19 patients and searched for mutations in 169 cancer-causing genes. They identified two mutations: one in the KRAS gene, known for its prevalence in pancreatic cancers, and the GNAS gene, not previously been associated with pancreatic cancer.

The researchers then tested 132 precancerous pancreatic cysts for those mutations and found GNAS mutations in more than half and KRAS mutations in 108. Nearly all had one or the other or both. There were no differences in age, gender or smoking histories of the patients. And the mutations were not found in benign cysts. 

“There has long been a need for accurate, quantitative ways to identify cysts that are more worrisome and to help patients avoid unnecessary surgeries for harmless cysts,” said Vogelstein, the Clayton Professor of Oncology at the Johns Hopkins Kimmel Cancer Center.

He notes more studies are needed before the gene-based test can be widely offered. Other scientists working on the test are from Hopkins, Memorial Sloan-Kettering Cancer Center and Indiana University.

Posted by Meredith Cohn at 2:10 PM | Permalink | Comments (0)
Categories: Cancer
        

An existing anti-seizure drug may help those who are likely to get Alzheimer’s disease, according to a new study.

More research is needed, but the results mean doctors may someday use levetiracetam, now used on epilepsy patients, to slow the loss of brain function before Alzheimer’s kicks in. The disease is expected to affect up to 16 million Americans by 2050 and has no cure.

The study effects “could be like taking your foot off the accelerator or tapping the brakes, and possibly could slow the progression on that path [to Alzheimer’s],” said principal investigator and neuroscientist Michela Gallagher, founder and a member of the scientific board of AgeneBio, a biotechnology company, in a statement. “We need further clinical studies with longer exposure to the drug to, first of all, make sure with rigorous evaluation that the drug is effective in the longer term, and, equally important, that it does no harm.”

The study conducted at Johns Hopkins was to be presented July 20 at the International Congress on Alzheimer’s Disease in Paris and was funded by the National Institute of Health.

Researchers tested 34 healthy older adults but had memory troubles beyond their years, or a condition called amnestic mild cognition impairment. They received the drug in one phase and a placebo in another phase. Tests and functional MRIs showed the drug reduced the kind of brain activity that impairs memories and may accelerate Alzheimer’s.

See a video of the researcher explaining the study above.

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

The food police have made their latest Xtreme Eating Awards, “dishonorees” that are doing their best to overfeed America.

The list of eight were unveiled in the Nutrition Action Health Letter of the Center for Science in the Public Interest  and include lots of stuffed, stacked and topped foods.

“If Americans are feeling a little more full when lumbering out of The Cheesecake Factory, Applebee’s, Denny’s, and other chains, it’s not in their heads,” said CSPI nutrition director Bonnie Liebman, in a statement. “It’s as if the restaurants were targeting the remaining one out of three Americans who are still normal weight in order to boost their risk of obesity, diabetes, heart attacks, and cancer.”

The government says the average eater should consumer about 2,000 calories a day, and no more than 20 grams of saturated fat and 1,500 milligrams of sodium. As part of health care reform, calorie counts will soon have to be on the restaurant menus.

Here’s the top five on the list:

+Denny’s Fried Cheese Melt: Four fried mozzarella sticks and melted American cheese grilled between two slices of sourdough. With fries and marinara sauce, it has 1,260 calories, 21 grams of saturated fat and 3,010 mg of sodium (Equal to two Pizza Hit personal pan pepperoni pizzas.)

+The Cheesecake Factory Farmhouse Cheeseburger: A burger topped with grilled smoked pork belly cheddar cheese, onions, lettuce, tomato, mayo and a fried egg. It has 1,530 calories, 36 grams of saturated fat and 3,210 mg of sodium. No fries. (Equal to three McDonald’s Quarter Pounders with cheese.)

+Cold Stone Creamery PB&C Shake: 24 ounces of peanut butter, chocolate ice cream and milk. It has 2,010 calories and 68 grams of saturated fat. (Equal to two 16-ounce T-bone steaks plus a butter baked potato.)

+Applebee’s Provolone-Stuffed Meatballs With Fettuccine: Meatballs stuffed with provolone cheese atop fettuccine with a marinara sauce and a Parmesan cream sauce. With garlic bread, it’s 1,520 calories, 43 grams of saturated fat and 3,700 mg of sodium. (Equal fo two Applebee’s 12-ounce ribeye steaks plus a side of garlic mashed potatoes.

+The Cheesecake Factory Ultimate Red Velvet Cake Cheesecake: Red velvet cake topped with a layer of cheesecake topped with another layer of red velvet cake and topped that with another layer of cheesecake and cream cheese frosting, chocolate shavings and whipped cream. It has 1,540 calories and 59 grams of saturated fat. (Equal to a Pizza Hut Personal Pan Pepperoni Pizza and two Quarter Pounders with cheese, though the cake has an additional days’ worth of saturated fat.)

“Perhaps calorie labeling will usher in a new era of common sense at America’s chain restaurants, and chains will compete with each other to come up with new, healthy menu items with more vegetables, fruits, and whole grains,” said CSPI’s Michael F. Jacobson, in a statement.

Justin Wilson, senior research analyst at the Center for Consumer Freedom, which represents restaurants and food companies, responded with:

"The Center for Science in the Public Interest’s “Xtreme Eating Awards” is just another stunt to chastise the American public for occasionally indulging in life’s simpler pleasures. The notorious self-proclaimed “food cops” appear to fundamentally disagree with the notion of personal responsibility in choosing what we eat. Instead, they believe they know what’s best for the American public, no matter how bland it might taste."

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (2)
Categories: Diet and exercise
        

The Institute of Medicine is recommending that eight more preventive health services for women be added to the list health plans will have to cover at no cost to patients because of health care reform.

Already on the list are breast cancer, diabetes and heart screenings. The U.S. Department of Health and Human Services wanted to find gaps and turned to the institute, an independent panel that offers advice to government policymakers and health professionals. Officials looked at existing guidelines and evidence of the effectiveness of the preventive measures.

Suggested in its report are: screening for gestational diabetes, human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30, counseling on sexually transmitted infections, counseling and screening for HIV, contraceptive methods and counseling to prevent unintended pregnancies, lactation counseling and equipment to promote breast-feeding, screening and counseling to detect and prevent interpersonal and domestic violence, yearly well-woman preventive care visits to obtain recommended preventive services.

“This report provides a road map for improving the health and well-being of women,” said committee chair Linda Rosenstock, dean of University of California, Los Angeles’ School of Public Health, in a statement. “The eight services we identified are necessary to support women's optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness.”

Sen. Barbara Mikulski, who sponsored an amendment to the health care legislation that added coverage for other preventive services, applauded the report. She said, the it means, “We are saying hello to an era where decisions about preventive care and screenings are made by a woman and her doctor – not by an insurance company, members of Congress, or a stranger – and women are guaranteed preventive screenings and care with no additional co-pays or deductibles.”

The institute report also recommended that Health and Human Services create a commission to recommend new services over time. It should be separate from the groups that assess evidence of effectiveness – Mikulski’s amendment came after the U.S. Preventive Services Task Force, which makes recommendations to doctors and health systems, said women under 50 years old need not get breast cancer screenings, opening the door for insurers to deny coverage.

Posted by Meredith Cohn at 4:35 PM | Permalink | Comments (1)
Categories: Health care reform
        

Calorie counting matter a lot when people are trying to control their weight, so some researchers decided to see how accurate the stated calories on restaurant boards are.

The researchers, lead by Lorein E. Urban at Tufts University, discovered that overall they aren’t far off. But individual foods had the wrong information. Some were understating calories and some were overstating, indicating poor portion control, especially at sit down restaurants but also at some fast food places.

They looked at 42 restaurants and 269 food items in three states, according to a study published in the July 20 issue of the Journal of the American Medical Association. Americans get a little more than a third of their calories in restaurants.

Of the 269 items, 108 had energy contents at least 10 calories higher than the state amount and 141 had energy contents at least 10 calories lower. Nineteen percent of those with higher calorie counts were off by more than 100 calories, and those one tended to be found in the sit-down restaurants.

About 10 percent of food items from all restaurants were off by 289 calories or more.

The authors concluded the overall numbers support more legislation requiring menu labeling to aid consumer decisions, but the accuracy of individual items could jeopardize efforts of some to lose weight.

Not sure if this would make people trust the menus more or less.

Associated Press photo

Posted by Meredith Cohn at 3:10 PM | Permalink | Comments (1)
Categories: Consumer health, Diet and exercise
        

The U.S. News and World Report rankings are out, and Johns Hopkins tops the list again.

It was followed by Massachusetts General in Boston and Mayo Clinic in Rochester, Minn. Of 5,000 hospitals examined, 17 were at the top or near the op in 16 specialties. And 140 ranked in at least one specialty.

In adult categories, Hopkins ranked #3 in Cancer, #3 in Cardiology & Heart Surgery, #3 in Diabetes & Endocrinology, #1 in Ear, Nose & Throat, #3 in Gastroenterology, #3 in Geriatrics, #2 in Gynecology, #3 in Nephrology, #1 in Neurology & Neurosurgery, #2 in Ophthalmology, #5 in Orthopedics, #1 in Psychiatry, #4 in Pulmonology, #15 in Rehabilitation, #1 in Rheumatology, and #1 in Urology.

In pediatric categories: #9 in Cancer, #26 in Cardiology & Heart Surgery, #8 in Diabetes & Endocrinology, #12 in Gastroenterology, #10 in Neonatology, #12 in Nephrology, #3 in Neurology & Neurosurgery, #11 in  Orthopedics, #9 in Pulmonology, and #9 in Urology.

The University of Maryland Medical Center was nationally ranked in 9 categories: #22 in Cancer, #31 in Cardiology & Heart Surgery, #29 in Diabetes & Endocrinology, #38 in Ear, Nose & Throat, #47 in Geriatrics, #27 in Nephrology, #28 in Orthopedics, #20 in Pulmonology, and #44 in Urology. It was high performing in 3 others.

Union Memorial was nationally ranked in three categories: #33 in Cardiology & Heart Surgery, #50 in Diabetes & Endocrinology, and #34 in Orthopedics. It was high performing in 8 other categories.

Johns Hopkins Bayview Medical Center was nationally ranked #13 in Geriatrics and high performing in 8 other categories.

Sheppard and Enoch Pratt Hospital was nationally ranked #6 in Psychiatry.

Several other area hospitals got high marks for many of their specialties. See the full list from the region here.  

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (3)
Categories: Consumer health
        

Educators who become preceptors for young doctors are missing opportunities to teach them about medical ethics, according to a new study.

Physicians in training face all sorts of bioethics questions during their day – from what do about a patient who can’t afford medicine to a patient that refuses treatment. But doctors who oversee residents don’t always take time to talk about the issues, say bioethicists at the Johns Hopkins Berman Institute of Bioethics.

“Teaching about ethics and professionalism in real time is a very important part of the training experience,” said Dr. Joseph Carrese, the study's lead author and a core faculty member at the Berman Institute, in a statement. “It appears from our findings that opportunities to identify those issues and teach about them were missed.”

The ethicists conducted a two-week observational study of 53 internal medicine residents and the 19 preceptor physicians overseeing them. Findings were described in the July issue of Medical Education. Preceptors taught about ethical issues only12 percent of the time. 

The main hurdle to discussing issues more often is time, Carrese said. But he said strategies can be developed to streamline difficult conversations. One idea is a checklist that can help doctors assess a patient’s decision-making ability in an emergency or other clinical situations.

It goes by the acronym, CURVES: Choose and Communicate, Understand, Reason, Value, Emergency and Surrogate.

“If we better understand what the barriers and needs are,” Carrese says, “then we as ethics faculty are going to be in a better position to help preceptors and enhance how they teach trainees about ethics in real time.”

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

Baltimore City Department of Recreation and Parks has launched a program called Walking for Fitness that is focused on helping families establish better lifestyle habits.

The program is free and runs through Aug. 13. Participants meet at Druid Hill Park Reservoir at 9 a.m. Saturdays.

Experts hand out nutritional information and offer fitness demonstrations and wellness checks, as well as healthy snacks.

About 50 people already are registered and the city is looking for more. All ages are welcome, but be prepared for some exercising.

This week there will be Zumba, the Latin-dance inspired aerobics. Brick Bodies will host warm-up exercises. Shoppers Food Warehouse will provide water.

Call 410-396-7900 for more information.

Baltimore Sun file photo/Barbara Haddock Taylor

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (2)
Categories: Diet and exercise
        

Public health officials know that kids who watch their heroes smoke in movies are much more likely to begin smoking. And while those at the National Cancer Institute who track onscreen tobacco use say the incidents on film are dropping, there are still enough shots to be a problem.

In a report from the U.S. Centers for Disease Control and Prevention, the Cancer Institute says for the fifth straight year, the number of incidents of smoking in movies rated G, PG or PG-13 has dropped. The drop was 71.6 percent from 2005 to 2010 (2,093 incidents to 595 incidents).

Three major motion picture companies with stated polices of reducing tobacco use on camera dropped an average drop of 95.8 percent, compared to a drop of 41.7 percent among independent film companies and three other major companies without polices.

The report said kid with the highest amount of exposure to onscreen smoking are about two times as likely to begin smoking as those with the least exposure, and policies do have an impact.

Think watching people smoke in the movies makes you want to smoke?

Baltimore Sun file photo of John Waters telling movie-goers not to smoke in the theater

Posted by Meredith Cohn at 2:33 PM | Permalink | Comments (0)
Categories: Cancer
        

Johns Hopkins Hospital has begun testing a new device designed to replace blocked aortic valves in patients who can’t have major open-heart surgery because they are elderly or have other serious medical conditions.

Surgery for the implant is minimally invasive, and may be the only hope for some patients. Called CoreValue, the device is placed inside a damaged valve through a catheter threaded through a leg artery to the aorta, the heart’s main blood vessel.

It is a self-expanding compressed metal scaffold with three flexible tissue leaflets. A sheath covering the valve is removed and the leaflets can then open and close and direct blood flow around the body.

The first two patients -- aged 84 and 90 -- had their procedures July 8. Already approved in Europe, reports show that it has allowed blood flow to more than double.

“The people most likely to benefit from this approach are incredibly weak, often bedridden because of their severely narrowed, aortic valve,” said interventional cardiologist Dr. Jon Resar, an associate professor and director of Hopkin’s adult cardiac catheterization laboratory.

He and cardiac surgeon Dr. John Conte are leading the Hopkins part of the study, which includes 40 medical centers. The device maker, Minneapolis-based Medtronic, is funding the tests.

About 1,200 are expected to get the devices during the two-year study. Doctors note that it won’t be a cure-all for everyone. Up to 30 percent may die within a year from disease-related complications. But without the device, and a drug-only treatment, up to half could die within a year.

Conte estimate that more than 300,000 elderly American have severe aortic stenosis, or narrowing, but traditional open-heart surgery is too risky. Debilitated patients can get immediate relief from chest pain, he said.

For more information on the trial, go here.

Photo courtesy of Medtronic

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

Children in states that offer dentists higher Medicaid payments are more likely to receive dental care, according to a new study.

The study found children who had private insurance got the most care, but more than a third of children are covered by public health insurance, such as Medicaid and the Children’s Health Insurance Program. Dental care is required but states can choose the payments to dentists and the rates vary greatly.

Sandra Decker at the U.S. Centers for Disease Control and Prevention took a look at the payments and care from 2000-2008 and merged the information with data from a CDC questionaire called the National Health Interview Survey.

Many states dropped fees over the time period. Five states increased it – Maryland has increased its payments, but not in the time studied for this report in the Journal of the American Medical Association.

The state now leads the nation in insuring the dental needs of kids, according to the Pew Charitable Trust. The state took action on the payments as part of a plan developed by the Maryland Dental Action Coalition after the death of Deamonte Driver, a Prince George’s child who died from an infected tooth.

The number of low-income kids who received dental services increased from about 11 percent in 2000 to about 42 percent in 2009.

But the problem remains across the country. Decker said those in public plans were about 13 percentage points less likely to have seen a dentist than those with private insurance. Those with no insurance were 40 percent less likely to have seen a dentist than those with private insurance.

“Changes in state Medicaid dental payment fees between 2000 and 2008 were positively associated with use of dental care among children and adolescents covered by Medicaid,” she wrote. “For example, a $10 increase in the Medicaid prophylaxis payment level [from $20 to $30] was associated with a 3.92 percentage point increase in the chance that a child or adolescent covered by Medicaid had seen a dentist.”

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (0)
Categories: Medicaid/Medicare, Oral Health
        

On Wednesday at noon on baltimoresun.com/health, Dr. Paul Christo, a pain specialist at Johns Hopkins, will take readers' questions on treating children who have painful illnesses and issues, such as sickle cell pain, cancer pain, postoperative pain, fibromyalgia and CRPS. With even over-the-counter pain medication for children under increased scrutiny, we thought this would be a timely topic.

You can sign up for the chat in advance here and receive an email reminder when it starts. Or if you can't make the chat, email your questions in advance to healthcalendar@baltsun.com and come back to the same page to read the transcript.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Getty Images file

Posted by Kim Walker at 5:49 PM | Permalink | Comments (0)
Categories: Pediatrics
        

The federal government handed down some new regulations outlining how states should manage the exchanges where the uninsured will buy coverage in 2014.

They’re broad and give states wiggle room on naming insurers and controlling premiums, according to this story in the New York Times. But all the states will need a plan by Jan. 2013.

Maryland already passed legislation to set up the public body and board that will oversee the exchange but officials are still working out details. Joshua Sharfstein, secretary of the state Department of Health and Mental Hygiene and chair of the exchange board, said he’s reviewing the regulations to see how they will impact the effort.

“I think we’ve been moving pretty quickly with the exchange to get things set up,” he said. “I think the federal government provided some additional flexibility, which will be very much appreciated by states.”

In addition to setting up the exchange framework, officials have created the Governor’s Office of Health Care Reform and enacted some other consumer protections at the state level, noted Lt. Gov. Anthony Brown, who co-chairs the Health Care Reform Coordinating Council that is overseeing the reform effort. The panel met yesterday and Brown said there has been "real progress in the last six months in our efforts to lower costs, expand access and improve the quality of care for all Marylanders, but our work is just beginning.”

On another health care front that will also impact what people pay for care, Gov. Martin O’Malley has filled four positions on the Health Services Cost Review Commission, the body that sets hospital rates in the state.

The new chair will be John M. Colmers, the former secretary of the Department of Health and Mental Hygiene and the current vice president, Health Care Transformation and Strategic Planning for Johns Hopkins Medicine.

Other members will be Dr. Bernadette C. Loftus, the associate executive director of the Permanente Medical Group; Thomas R. Mullen, president and chief executive officer of Mercy Health Services and Mercy Medical Center; and Jack C. Keane, an experienced health care consultant with expertise in health care payment policy.

Posted by Meredith Cohn at 4:30 PM | Permalink | Comments (0)
Categories: Health care reform
        

Unsatisfied with controlling HIV, researchers at Johns Hopkins and other institutions say they aren’t giving up on a cure. They are beginning a five-year initiative to completely purge the virus from people already successfully suppressing it with antiretroviral drugs.

Hundreds of thousands of the estimated million Americans living with HIV are in relatively good health thanks to 20 years of advances in treatment. But the researchers want to rid the body of the virus still hiding in immune system cells.

The consortium working on the initiative includes nine universities and Merck Research Laboratories. It is called the Martin Delaney Collaboratory, after the well known AIDS activist.

Virologist Janice Clements, vice dean for faculty and a professor at the Johns Hopkins University School of Medicine, and Hopkins infectious disease specialist Dr. Robert Siliciano will serve as co-investigators. The group will be led by Dr. David Margolis at the University of North Carolina at Chapel Hill.

The National Institute of Allergy and Infectious Diseases will provide $32 million in funding for the group, which will pursue about a dozen projects to uncover how HIV remains hidden in the immune system’s T-cells and develop treatments.

“This group approach has me much more optimistic,” said Siliciano in a statement. He initially doubted a cure was possible after his initial discoveries about those small pockets of virus.
But, how he says, “After years of developing a better understanding of these HIV reservoirs, to the point where we can make and study latently infected T-cells in the laboratory, we are finally ready to go after them.”

Other partners on the project include Case Western Reserve University; the University of California, Davis; the University of California, Los Angeles; the University of California, San Diego; the University of California, San Francisco; The Gladstone Institute; the University of Minnesota; and the University of Utah.

Posted by Meredith Cohn at 12:30 PM | Permalink | Comments (4)
Categories: HIV/AIDS
        

John Hopkins researchers are finding an unusually high case of the sexually transmitted parasite Trichomonas vaginalis in older women.

The findings are so large that one of the researchers is calling for all sexually active women older than age 40 to get tested for the parasite. The research found that the STD is more than twice as common in this age group than previously thought.

Screening is especially important because in many cases there are no symptoms.

"We usually think of STDs as more prevalent in young people, but our study results clearly show that with trichomonas, while too many young people have it, even more older women are infected," senior study investigator Charlotte Gaydos, said in a statement.

Results of the study will be presented July 12 at the annual meeting of the International Society for STD Research, in Quebec City, Canada, by Gaydos and her co-investigators.

The study found that among 7,593 U.S. women between the ages of 18 and 89, women 50 and older had the highest trichomonas infection rate, at 13 percent. Women in their 40s were next, at 11 percent. The study collected test samples from women in 28 states and is believed to be the largest and most in-depth analysis of the STD ever performed in the United States.

Overall, the survey results showed that 8.7 percent of all women tested positive for the STD.

Posted by Andrea Walker at 7:10 AM | Permalink | Comments (1)
Categories: Medical studies
        

After a case of measles was identified last month, state health officials notified the public to be on the look out for symptoms. But no new cases have surfaced, the officials said today.

The case was unusual. The last one in the state was in 2009. And officials at the Department of Health and Mental Hygiene feared others were exposed to disease as the infected person traveled from place to place.

And while the state may have dodged a bullet this time, officials want residents to stay alert and get vaccinated if they haven't been already -- most kids are given two sets of shots for measles as part of the measles, mumps and rubella (MMR) vaccine.

"With measles outbreaks in nearby states, this is hardly the moment to be complacent," said Frances Phillips, deputy secretary for public health services, in a statement. "Every Marylander should be up-to-date on measles vaccination."

The state and local health departments investigated illnesses that could have been measles, including some among those who were potentially exposed. But none turned out to be measles after lab testing.

There have been cases in other states, however. The U.S. Centers for Disease Control and Prevention has reported a high number of cases this year in Utah, New York, Minnesota and Virginia.

Quick identification is needed to control the spread of the highly contagious viral illness, officials said. It's spread through coughing, sneezing and contact with nose, mouth and throat secretions from infected people.

Symptoms first appear as a fever of 101 degrees or more, runny nose, watery red eyes and a cough. Then on the third to seventh day, a rash appear on the face and moves down.

Posted by Meredith Cohn at 11:30 AM | Permalink | Comments (0)
Categories: Consumer health
        

Jennifer Aniston told Jon Stewart last night that her dentist plays the guitar for her while she gets treatment. While I suspect it's probably because she's a major movie star (plus "That's Hollywood" as Aniston put it), I wonder if there are local doctors or dentists who have special -- even quirky -- methods to either put a patient at ease or just make a routine visit stand out. Some gynecologists have funny posters on their ceilings. And I'm sure pediatricians have many tricks up their sleeves.

Have an interesting story about your doctor? Share it in the comments.

Getty Images photo of Jennifer Aniston

Posted by Kim Walker at 12:54 PM | Permalink | Comments (5)
Categories: General Health
        

Fast food companies are often labeled as the bad guys in the fight againt obesity.

But recent research by Consumer Reports found that there are plenty of healthy options at fast food restaurants - consumers just aren't ordering them.

Hardee's and Carl's Jr. now offer charbroiled turkey brugers and Subway has egg-white omelets, the publication found. Little Caesars has pizza crust and sauce with no animal products.

"Indulgence wins over healthfulness every time," the publication quoted Darren Tristano, executive vice president of Technomic, a food-service research and consulting firm in Chicago, as saying.

When asked if they had eaten a healthful meal during their most recent visit to a fast-food restaurant, only 13 percent of those surveyed said yes, according to Consumer Reports. At pizza chains, just 4 percent said they'd ordered something healthful.

Subway, with a "Fresh Fit" menu and spokesman Jared Fogle (an everyday guy who lost 245 pounds partly by living on the chain's low-fat subs), had the most diet-conscious eaters. Almost half of respondents who ate there said they chose a nutritious meal.

Brings up the whole debate about how much personal responsibility plays in health problems. I am not turning into an advocate for the fast food companies, but seriously, no one can force people to make healthy choices.

What do you all think?

Posted by Andrea Walker at 11:59 AM | Permalink | Comments (8)
Categories: Diet and exercise
        

Maryland is middle of the pack, fat-wise, according to the annual report on fat from the Robert Wood Johnson Foundation and the Trust for America’s Health.

The obesity rate in the state is 27.1 percent, making it the 26th most obese state in the country.

Across the United States, more than two-thirds of states reported obesity rates over 25 percent. Twelve states have rates over 30 percent. The rate rose in 16 states and declined in none.

Mississippi is now the most obese state at 34.4 percent and Colorado is the least obese with 19.8 percent.

“Today, the state with the lowest adult obesity rate would have had the highest rate in 1995,” said Jeff Levi, executive director of the Trust for America’s Health, in a statement. “There was a clear tipping point in our national weight gain over the last twenty years, and we can’t afford to ignore the impact obesity has on our health and corresponding health care spending.”

The report authors recommend individuals make lifestyle changes and policymakers institute changes and fund programs that promote healthier diets and exercise, including nutrition and activity programs in schools.

Specifically, the report found over the last 15 years:

+Seven states have doubled their rate of obesity and another 10 nearly did.

+Maryland had increased its raking from 23rd most obese state to 26th by increased its rate more than 80 percent.

+The fastest rising rates are in Oklahoma, Alabama and Tennessee, and the slowest are in Washington, D.C., Colorado and Connecticut.

+Ten years ago no state had a rate above 24 percent.

+Diabetes rates have doubled in 10 states; Maryland’s rose from 5.1 percent to 9.1 percent. Hypertension rose from 21 to 28.2 percent. The rate was much higher for blacks at 36.3 percent and 33 percent for those who didn’t graduate from high school or earn less than $15,000 a year. 

What do you do to stay healthy? 

Posted by Meredith Cohn at 10:00 AM | Permalink | Comments (1)
Categories: Diet and exercise
        

A simpler and shorter course of antibiotic drugs could prevent tens of millions of people around the globe who have the bacteria that causes tuberculosis from getting full-blown TB, according to Johns Hopkins and South African scientists.

That may be particularly important to those who are HIV positive are at higher risk of catching the lung infections. The regiment could help 50,000 Americans and 22 million in sub-Saharan Africa.

The study, to be published in the New England Journal of Medicine, found the most streamlined combination worked. The does is 900 milligrams of the newer antibiotic rifapentine and the older isoniazid once a week for three months. The gold standard has been a daily dose of isoniazid for six months or longer.

“This new, simpler treatment regimen with rifapentine and isoniazid is highly effective and could transform therapy for latent tuberculosis in both those co-infected with HIV and those not,” said study senior author Dr. Richard Chaisson, a professor of infectious diseases at Hopkins and founding director of its Center for Tuberculosis Research.

“New treatment options are urgently needed to help control TB globally, and simpler regimens will substantially increase the number of people receiving therapy,” he said.

Not even 1 percent of those most likely to develop full-blown TB are getting drug treatment because of inconvenience, drug side effects and difficulty finding nearby health clinics, the scientists said. Yet, TB is the leading cause of death among people co-infected with HIV, which causes AIDS, leading to some half-million deaths annually among those co-infected.

But experts estimate that 2 billion people worldwide are infected with TB. Ten million become sick every year.

For more information, go to www.tbhiv-create.org.

Posted by Meredith Cohn at 5:00 PM | Permalink | Comments (0)
Categories: HIV/AIDS, Medical studies
        

A report from NBC shows a clinic run by the husband of presidential contender and opponent of big government Michele Bachmann has taken in at least $137,000 in Medicaid payments since 2005.

This might not be news except for Bachmann's pronouncements about Medicaid "swelling the welfare rolls" and her anti-government talk in general as a leader of the tea party.

Her camp says it would be descriminatory not to accept Medicaid patients at the Christian-focused mental health clinic, Bachmann and Associates, run by Marcus Bachmann.

But this Los Angeles Times story outlines other federal money the congresswoman may have benefited from, including some payments from a family farm that got federal agriculture subsidies.

So, is this just the media making more of something than it should? Is there a real hypocracy issue? Is there a greater issue of how much the government should spend on public health?

Posted by Meredith Cohn at 10:18 AM | Permalink | Comments (0)
Categories: Medicaid/Medicare
        

More screening means fewer people are dying of colorectal cancer, according to the U.S. Centers for Disease Control and Prevention.

Still, the CDC says in a new report that more people need to be screened to prevent more cases of colorectal cancer, the No. 2 killer in the United States.

The findings:

+The rate of new cases fell to 45.4 per 100,000 in 2007 from 52.3 per 100,000 in 2003.

+The death rate fell to 16.7 per 100,000 in 2007 from 19 per 100m000 in 2003.

+That’s 66,000 fewer cancers and 32,000 fewer deaths.

+Direct medical cost of the cancer was $14 billion 2010 and lost productivity was $15.3 billion.

+Screening, recommended at age 50, has increased to 65 percent in 2010 from 52 percent in 2002, but one in three people aged 50 to 75 was not getting screened.

“Colon cancer can be prevented, and we are making progress in getting more people screened,” said Dr. Thomas R. Frieden, CDC director, in a statement. “Those who receive these life-saving screening tests can lead longer, healthier and more productive lives. Saving our nation the health care costs associated with treating colon cancer is an additional benefit.”
See the report at www.cdc.gov/vitalsigns.

Posted by Meredith Cohn at 12:05 PM | Permalink | Comments (1)
Categories: Cancer
        

A large, new study of twins published in the Archives of General Psychiatry is adding more to the debate about the causes of autism. This one found that it may not be all about genes.

In an Associated Press story, researchers said that there may be more to a mother's age and conditions in the womb than previously thought.

The study found high rates of autism among identical twins, but also high rates among fraternal twins, who do not share all their genes. That means that the mother may have more of an impact -- from things such as as her stress, the medications she takes, her diet and her age.

Antidepressents may be one specific factor, though doctors do not advise women to stop taking them at this point because depression can also be a problem for the baby.

Autism, which affects a child's behavior and ability to communicate, is diagnosed in 1 out of 100 or more children.

Posted by Meredith Cohn at 11:04 AM | Permalink | Comments (1)
Categories: Autism
        

The Baltimore City Recreation & Parks Department is trying out something for summer – adult swim.

This is planned for large pools around the city. The pool at Riverside Park in South Baltimore, for example, will open from 5 p.m.- 7 p.m. on Mondays and Wednesdays. Here's the full schedule for city pools. 

If enough people show up, 25-30, they'll keep it up. They have to pay for staff and justify keeping all those kids out.

You must be 18 years or older. But this isn't the tiki bar. No glass, no alcohol cans or bottle allowed.

The cost is $1.50 per day, or $25 for a season pass. If that sounds like a good deal, get your goggles on.

Anyone else know of a cheap place to swim this summer?

Baltimore Sun photo of Riverside pool/Algerina Perna

Posted by Meredith Cohn at 2:00 PM | Permalink | Comments (2)
Categories: Diet and exercise
        

The consumer group Maryland PIRG Foundation has outlined in a new report the elements for an effective health insurance exchange, the marketplace where the uninsured will buy coverage under the health care reform law.

The report, called Building a Better Health Care Marketplace, calls for a marketplace run by and for Maryland businesses and consumers. It would need the power to negotiate lower premiums and quality measures. And it would need to be consumer friendly, as well as big and stable.

“Maryland leaders have the flexibility to craft an exchange that enhances choice and competition,” said Jenny Levin, Maryland PIRG Foundation’s state advocate, in a statement. “Consumers need this new exchange to lower costs and improve the quality of their coverage.”

The state legislature approved creation of the exchange this year and officials are waiting for more direction from the federal government on its actual format.

Until 2014, when we get a look at it in operation, are there things you think it should include, allow, forbid or aspire to be?

Posted by Meredith Cohn at 7:00 AM | Permalink | Comments (2)
Categories: Health care reform