Urgent and Occupational Health Care Blog

The Truth Behind Cancer Myths

2008-06-26T05:07:00.000-07:00

Every day, we read or hear about something we eat or do that can cause or prevent cancer. Often, what we hear one day will be the exact opposite of what we hear the next day. Dr. Joseph Imperato, medical director of radiation oncology at Lake Forest Hospital, sets the record straight on some of what has been said to cause cancer or help prevent it.

Antiperspirants

"One of the most common myths is that antiperspirants cause breast cancer," Imperato said. Proponents of this myth say when we use aluminum-based antiperspirants under our arms, our bodies absorb this aluminum, which goes into the lymph nodes and blocks them. These blocked lymph nodes, they believe, cannot effectively remove toxins, and breast cancer subsequently develops.

"In reality, when pathologists examine lymph nodes of patients with breast cancer, they never actually find a build-up of aluminum in the lymph nodes of the breast," said Imperato. "There is no truth to this myth."

Artificial sweeteners

Aspartame (aka Nutrasweet and Equal), approved in 1981 by the FDA, has also been a frequent target of cancer myths. Vocal groups have claimed aspartame is linked to increased incidence of brain and central nervous system cancers. Studies conducted to evaluate the truth of this claim found that the increased incidence of brain and nervous system cancers actually began to rise in 1973, eight years before aspartame went on the market.

EMFs

Electro-magnetic fields are emitted by devices that produce, use or transmit electric power, such as power lines and household electronics like microwaves, televisions and electric blankets. Over the past 15 years, several studies have evaluated the effect of residential exposure to EMFs and its relationship to an increased risk of cancer.

Most findings have been inconclusive, but the National Institute of Environmental Health Sciences recommends increasing the space between people and devices that emit EMFs, as well as discouraging children from playing near power lines.

With the widespread use of cellular phones, people have also become concerned about the effect of EMFs so close to the brain. Studies have been conducted, but it's difficult to draw conclusions because cell phones have only been around for a short time, and because technology changes so quickly.

While no study has conclusively proven that cell phones cause brain tumors, the FDA has suggested that those concerned should reserve cell phones for shorter conversations and switch to hand-free devices that place more distance between the antenna and the phone user.

Stress

Myths about stress causing cancer are particularly disturbing in that they blame the victim. The myth insinuates that our responses to day-to-day life stressors cause cancer. While major stressors may have an impact on the immune system, Imperato said responses to day-to-day stressors do not cause cancer. "In fact, since primitive times, man has always dealt with day-to-day stressors," he said.

Yoga or meditative activities have been touted to prevent or cure cancer. Imperato noted that while yoga and meditative activities do not prevent or cure cancer, activities that strengthen the mind-body connection do help people come to terms with their situation and may help them to maintain a positive outlook.

While it is not possible to achieve zero risk of cancer, actions that consistently prove to have some protection against cancer include eating a healthy diet with a variety of fruits and vegetables and exercising. And don't smoke, because even small amounts of cigarette smoke have been linked to cancer.

Protect yourself from the sun

2008-06-23T05:05:00.000-07:00

Summer sun brings more to worry about than a burn. Melanoma, a very common and deadly form of skin cancer, is most often caused by spending too much time in the sun without protection from ultraviolet (UV) radiation. People with fair skin and lighter hair are at greatest risk but anyone, regardless of skin color, is at risk from excessive sun exposure.

Cases of melanoma have been rising at an alarming rate, faster than any other form of cancer, and will affect one person in 50 by 2010 -- that compares to one in 1,500 people just 70 years ago.

Helping kids protect themselves and learn good skin care habits is especially important. Sunburn at any age can cause melanoma, but 80 percent of sun damage occurs before the age of 18.

"Parents play a key role in stemming the tide of melanoma," said Dr. Moira Ariano, M.D., a Wheaton dermatologist and supporter of the Glen Ellyn-based Jack H. Marston II Melanoma Fund, which raises funds and awareness to fight melanoma. "Kids need to learn good habits early and parents can set a good example."

Jack's Fund offers these sun protection tips to help reduce the risks of skin cancer:

* Don't burn. Always use sunscreen, even on cloudy days. This applies to all outdoor activities: sports, shopping, picnicking, walking or jogging, gardening, even waiting for a bus.

* Use sunscreen with sun protection factor (SPF) 15 or higher, and with ingredients that block both UVB and UVA rays. Apply sunscreen liberally and reapply every two hours.

* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.

* Be sure to apply sunscreen all over, including your ears, lips, neck, hands and feet.

* Stay out of the sun when it's strongest, between 10 a.m. and 2 p.m.

* Avoid tanning and UV tanning booths. The UV radiation emitted by indoor tanning lamps is many times more intense than natural sunlight. Dangers include burns, premature aging of the skin, and the increased risk of skin cancer.

* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months. Zinc sunscreen is especially good for small children.

* Examine your skin head-to-toe every month and see a dermatologist for a skin and mole check. Early detection is the key to beating melanoma.

Exercise and Health

2008-06-21T05:02:00.000-07:00

A recent study in the Journal of the American Medical Association shows that even exercising less than standard recommendations offers some health benefits. But it was published just one month after another study found that getting beyond the standard 30 minutes of daily moderate activity brings dramatically better weight control.

The emerging message of these and previous studies seems to be: The benefits of physical activity vary with how much you do.

The good news that every little bit helps comes from a study of 464 sedentary, post-menopausal women who were all either overweight or obese.

The women were randomly assigned to one of four activity-level groups:

Three of the groups provided supervised exercise at either 50, 100 or 150 percent of the National Institutes of Health recommended physical activity, which aims for about 30 minutes five days a week.

The fourth group was a non-exercising group. The group at 50 percent exercised for an average of 72 minutes weekly. The group at 150 percent got in an average 192 minutes of weekly exercise.

Participants were not instructed to cut calories. After six months, three different measurements showed all three activity groups were more fit, even in the 50 percent group that exercised the equivalent of 15 minutes five days a week. Each increase in exercise brought a greater improvement in fitness.

The JAMA study adds further support to the 2001 findings from the Women's Health Study that those who walked even 60 to 90 minutes weekly developed about half the heart disease as sedentary women. However, in this new study, only the group exercising the longest showed a drop in blood pressure.

The other recently published study found that it may take a lot of exercise to affect weight loss.

The study randomly assigned 202 men and women ages 25 to 50 to either be on a standard behavior change weight reduction program or one that required more exercise. Participants were about 30 to 70 pounds overweight. Both programs included a low-calorie diet. The standard program instructed members to burn about 1,000 calories per week (about 30 minutes a day of moderate activity, such as walking); the high-exercise group was asked to burn about 2,500 calories per week (about 75 minutes of exercise a day).

After one year without group support, average exercise levels were roughly the same for both groups and the high-exercise group had lost only slightly more weight than the standard group.
However, there remained a link between participants who exercised the most and weight loss.

Those who were exercising the equivalent of at least 75 minutes five days a week lost more than 10 times as much weight as those exercising less than 30 minutes five times a week. Participants exercising the most also showed much less weight regain.

A variety of studies over the years have shown an association between 30 minutes of daily moderate exercise and reduced heart disease and diabetes. Some studies have shown 30 minutes of daily exercise can lead to weight loss and/or a fitter body. However, as these studies show, if you've been exercising and not losing weight, you may need to add another 15 to 30 minutes of activity, change what you eat, or both.

Medicare to cover sleep apnea testing

2008-06-19T04:59:00.000-07:00

Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.

A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea -- letting people snooze in their own beds instead of spending the night in a sleep laboratory.

It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.

"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," said Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.

Today, Medicare pays for sleep apnea treatment -- called CPAP, a mask that blows air through the nose while sleeping -- only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. Final approval is expected in March.

While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.

Sleep apnea doesn't just deprive family members of their own zzzzs. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.

Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.

Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.

Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways and apnea in the family.

Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring -- or until daytime sleepiness gets so bad they can't function.

Only then comes the test debate.

There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.

But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles drive.

For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and a doctor checks the recordings later.

A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, said Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change.

"You have this good feeling that everything was taken care of, when in fact it wasn't," he said.
"It certainly is possible to diagnose severe apnea at home," added Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"

Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.

Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients -- but should be administered by sleep specialists.

Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.

In fact, Medicare concluded a sleep-lab test isn't perfect, either -- and thus proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.

That's important, because about half of apnea patients prescribed CPAP struggle to use it, said Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent.

What he calls tricks of the trade -- trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils -- early could keep more of them in care.

Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.
Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.

"There's a different level of comfort being at home," Miles said.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

UV Rays can harm eyes

2008-06-17T04:57:00.000-07:00

Most people know the harmful effects that ultraviolet rays can have on the skin. But many are not aware of the damage that they can cause to the eyes. Possibly the most frightening aspect of UV damage is that it is cumulative, meaning the negative effects may not present themselves until years later.

A recent survey, sponsored by Transitions Optical, Inc., revealed that although 82 percent of respondents knew that extended exposure to the sun could cause skin cancer, only 9 percent knew it could damage vision. Additionally, only one in six respondents said they wear sunglasses when they prepare for extended exposure to the sun and only approximately one third said they wear a hat.

"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion," said Daniel D. Garrett, senior vice president of Prevent Blindness America. "But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well."
Prevent Blindness America offers an online resource for patients and their loved ones to learn more about what they can do to protect their eyes.

Extended UV exposure has been linked to eye damage including:

* Cataracts -- a major cause of visual impairment and blindness worldwide. Cataracts are a cloudiness of the lens inside the eye that develops over a period of many years. Laboratory studies have implicated UV radiation as a cause of cataract. Furthermore, studies have shown that certain types of cataract are associated with a history of higher ocular exposure to UV and especially UV-B radiation.

* Age-related macular degeneration -- a leading cause of vision loss in the United States for people age 55 and older. Exposure to UV and intense violet/blue visible radiation is damaging to retinal tissue and scientists have speculated that chronic UV or intense violet/blue light exposure may contribute to degenerative processes in the retina.

* Pterygium -- a growth of tissue on the white of the eye that may extend onto the clear cornea where it can block vision. It can be removed surgically, but often recurs, and can cause cosmetic concerns and vision loss if untreated.

* Photokeratitis -- essentially, a reversible sunburn of the cornea resulting from excessive UV-B exposure. It can be extremely painful and can result in temporary loss of vision. There is some indication that long-term exposure to UV-B can result in corneal and conjunctival degenerative changes.

Fortunately, eye protection doesn't have to be expensive to be effective. Quality sunglasses should block out 99 to 100 percent of both UV-A and UV-B radiation and prices vary. For UV protection in everyday eyewear, there are several options like UV-blocking lens materials, coatings and photochromic lenses.

Recognizing Anaphylaxis

2008-06-15T04:55:00.000-07:00

An anaphylactic reaction may start off innocently enough, with a tingling or itching sensation or a strange metallic taste. Other common symptoms include hives, a sensation of warmth, trouble breathing or swelling of the mouth and throat. Symptoms may develop within minutes or as long as two hours after exposure, but life-threatening reactions may take up to several hours to appear.

Because exposure to any offending substance can quickly progress to severe anaphylaxis and even death, persons experiencing a combination of the following symptoms are advised to seek emergency care right away:

* Difficulty breathing due to narrowing of airways and swelling of the throat
* Wheezing, coughing or unusual (high-pitched) breathing sounds
* Confusion, slurred speech or anxiety
* Difficulty swallowing
* Swelling of the tongue, throat and nasal passages
* Localized edema or swelling, especially involving the face
* Itchiness and redness on the skin, lips, eyelids or other areas of the body
* Skin eruptions and large welts or hives
* Skin redness, at the site of a bee sting, for example
* Bluish skin color, especially the lips or nail beds, or grayish in darker complexions
* Nausea, stomach cramping, vomiting/diarrhea
* Heart palpitations (feeling the heart beating)
* Weak and rapid pulse
* Dizziness, a drop in blood pressure, fainting or unconsciousness, which can lead to shock and heart failure

115-year-old's brain worked perfectly

2008-06-13T15:59:00.000-07:00

A Dutch woman who was the oldest person in the world when she died at age 115 in 2005 appeared sharp right up to the end, joking that pickled herring was the secret to her longevity.

Scientists say that Henrikje van Andel-Schipper's mind was probably as good as it seemed: a post-mortem analysis of her brain revealed few signs of Alzheimer's or other diseases commonly associated with a decline in mental ability in old age.

That came as something of a surprise, said Gert Holstege, a professor at Groningen University, whose findings will be published in the August edition of Neurobiology of Aging.

"Everybody was thinking that when you have a brain over 100 years, you have a lot of problems," he said in a telephone interview with The Associated Press on Friday.

He cited a common hardening of arteries and the build up of proteins associated with Alzheimer's disease as examples.

"This is the first (extremely old) brain that did not have these problems."

Van Andel was the oldest living person in the world at the time of her death in 2005 in the Dutch city of Hoogeveen, according to the Guinness Book of World Records.

In 1972, the then 82-year-old Van Andel called the University of Groningen in order to donate her body to science. She called again at age 111 because she worried she might no longer be of interest. At that time Holstege began to interview her, testing her cognitive abilities at ages 112 and 113. Though she had problems with her eyesight, she was alert and performing better than the average 60- to 75-year-old.

Dr. Murali Doraiswamy of the Center for Aging at Duke University, not associated with the study, said it is unusual and valuable.

In the first place there are few "super-centenarians" - people 110 and older - alive at any one time, a slim proportion of the world's population and a scant number even compared to those who reach 100 years.

As a result, he said, there are few chances to study brains as old as hers.

"It's very rare to be able to do not only a post-mortem, but also be able to have tested her two, three years before she died," said Doraiswamy.

"For a scientist, getting the opportunity to study someone like that is like winning the lottery."
Doraiswamy, an Alzheimer's expert, said that the proportion of brains with some buildup of proteins associated with the disease increases with age. As a result, experts theorize anybody who lives long enough will get them eventually.

When Van Andel died, the director of the elderly home where she was living declined to give a cause of death, pointing to her extremely advanced years.

Holstege said she died of cancer.

"She died from stomach cancer, and you and I can also die from stomach cancer," he said, adding that her case demonstrates that very old people die of diseases, not simply old age.

"It is very important to treat the elderly as normal people, as if they are 50 or 60."

He noted that Van Andel was operated on at age 100 for breast cancer and survived 15 more years.

When she was born in 1890, she weighed only 3.5 pounds, and her mother expected her to die in infancy. Van Andel's husband died in 1959. She had no children.

Longevity was in her genes, as all her siblings lived past 70, and her mother died at the age of 100.

Asked what advice she would give to people who want to live a long time, she once quipped: "Keep breathing."

Can drinking flat soda ease an upset stomach?

2008-06-10T07:20:00.000-07:00

THE BELIEF:

Drinking flat soda can ease an upset stomach.

THE FACTS:

It is not often that a soft drink is seen as medicinal. But when it comes to stomach distress, many people view a cup of flat soda as just what the doctor ordered.

The quick and popular remedy -- usually in the form of cola, ginger ale or clear sodas -- is said to help settle the stomach with its slight fizz and replenish fluids and glucose lost by vomiting and diarrhea. Parents also find that children who are verging on dehydration but reluctant to consume any liquids are more amenable to soda.

However, research shows that may not be a great idea. In a recent study, British researchers conducted a review of the medical literature going back to the 1950s in search of scientific evidence supporting the claim. They found none. Then, after a biochemical analysis, they compared the contents of colas and other sodas with over-the-counter oral rehydration solutions containing electrolytes and small amounts of sugar.

The soft drinks, the authors found, not only contained very low amounts of potassium, sodium and other electrolytes, but also in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. "Carbonated drinks, flat or otherwise, including cola, provide inadequate fluid and electrolyte replacement and cannot be recommended," they said.

THE BOTTOM LINE:

Flat soda, a popular remedy for upset stomach, may do more harm than good.

No belly full of laughs: Bigger waistlines and stroke linked

2008-06-09T19:03:00.000-07:00

The connection between belly fat and the brain intensified last week. Many Americans have obsessed about abdominal fat for, oh, decades. A new study from the Oakland, Calif.-based Kaiser Permanente Division of Research revealed that people who have large waistlines in their 40s are more likely to develop Alzheimer's disease and other dementia conditions in their 70s.

Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.

"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.

Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.

Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.

A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.

While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.

There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.

It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.

Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.

"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."

About a third of all women suffer migraine headaches. The ratio is one in 10 among men.

"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."

Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.

A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.

In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.

"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."

KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE

Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:

Sudden numbness or weakness in the face, arm or leg, especially on one side.
Sudden confusion or trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness or loss of balance.
Sudden, severe headache with no known cause.

Fake patients test Vermont medical students

2008-06-08T19:00:00.000-07:00

The patient talked a mile a minute, hopped off the exam table, paced around and poked through the cupboards when the medical students entered the exam room.

The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.

One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.

"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.

Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.

But the training does much more than prepare them for the test.

"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.

"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.

UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.

"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.

That's when the concept of practicing on fake patients was introduced.

The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.

They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.

"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."

For $20 an hour, they not only act, they also instruct students and offer feedback.

"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.

At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.

Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.

Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.

The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.

The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.

"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."

House Calls Making a Comeback

2008-06-07T18:57:00.000-07:00

John Devine is 82 years old and has no interest in leaving home to socialize with others.
He'll pass on the so-called "senior activities" and get-togethers. He would rather read in the library of his assisted-living facility in Burien.

Wanting to stay home makes doctor visits and routine checkups a bit difficult, though. But Devine, a small, spry man with a Scottish brogue and a mischievous smile, has that taken care of. He has a doctor make a house call to him about once a month for a checkup and to help coordinate any other medical care he needs.

Once considered on the verge of extinction, house calls are making a comeback.

In 1997, The New England Journal of Medicine called doctor house calls a "vanishing practice." But eight years later, a Journal of the American Medical Association article found from 1998 to 2004 the annual number of house calls increased 43 percent, to just over 2 million. For Devine, who doesn't have major medical problems and jokes he specializes in inactivity, having a doctor come to him is ideal. Though a bit forgetful about everyday things, he can easily recite Shakespeare from memory.

"To hell with the medicine, it's wonderful having her here," Devine said, sitting in his blue recliner while his physician, Dr. Sarah Babineau, checked his blood pressure, listened to his heart and went over some medical concerns and upcoming appointments. "There's nothing like it. We can talk and have conversations and I get my checkups."

Babineau works part time for Providence ElderPlace, a nonprofit for older adults that aims to keep them out of nursing homes and living in the community. The costs often are cheaper than nursing homes, said the program's referral specialist, Corina Kroll. Medicare or Medicaid pay for most services, which include hospitalizations, dental, vision, home care and prescriptions. The program also provides transportation for members to see physicians and participate in activities at its Rainier Valley facility. And it provides house calls.

For those who pay out of pocket, the costs are between $3,700 and $4,200 a month, which includes housing.

After his checkup is complete, Devine's routine with Babineau, who he says reminds him of his three daughters, is to walk down the hall for some coffee, then sit briefly in front of the fireplace in the library. The slower pace gives her more time to really care for her patients.

"Seeing people in their environment I get a better grasp of what their lives are like," said Babineau, who also is a full-time family doctor at Swedish Medical Center. "(In the clinic) time crunch is a huge thing for me. At home, I get to share special moments with these patients."

She spends Mondays, Thursdays and occasional Wednesdays driving to see her 55 to 60 patients around the Seattle area. She has so many, she can usually only visit once a month, but will add more appointments if necessary. The patients' average age is 80 and many suffer from advanced dementia. One of her patients is a 100-year-old woman still living on her own on Capitol Hill.

"We take care of a really frail population and if they're living independently we keep an eye on them," Babineau said. "A lot of these people would fall through the cracks and would be sent to a nursing home otherwise."

Several other programs around Seattle offer home visits to older patients. Doctors Home Visits, which calls house calls "an old concept renewed," offers a service area from Seattle to Lynden, just a few miles south of the British Columbia border. Carena Inc., headquartered in downtown Seattle, provides house calls or workplace doctor visits to employees of companies who contract their services.

For 10 years, The Home Doctor, located in the Tacoma suburb of Lakewood, has provided house calls to more than 500 homes in the greater Puget Sound area. The service started in 1998 after someone called the clinic asking if a physician could make a home visit.

The next call was to Medicare and Medicaid for authorization, said Home Doctor President Charles Plunkett. Once they figured out how to bill patients, they started with one home and expanded. Physicians, nurse practitioners and podiatrists visit adult family homes, assisted living facilities, homes for the mentally ill, Alzheimer's residences and skilled nursing homes, Plunkett said.

"Caring for the elderly in all settings is expensive in dollars, time and emotion," Plunkett said. "Just getting Grandma' " (or Grandpa) to the physician takes a toll on the patient, the family member or caregiver. Patients with dementia become agitated when out of their environment. Just sitting in a doctor's waiting room is stressful and exposes this vulnerable population to increased risk of sickness and infection."

He said an increasing number of specialists are not accepting Medicare or are limiting the number of patients. And adult family home and assisted living operators serving those on Medicare and Medicaid are dealing with flat revenues and increasing expenses.

"Care management is needed, but only available with HMO and special needs plans," Plunkett said. "Families are left to fend for themselves" and learn what he calls a Byzantine system.

For Babineau, who tries to recruit patients from her full-time practice to join Providence ElderPlace's program, she said even for her -- someone who is a part of the health care system -- it is difficult to navigate.

"A lot of people caring for their parents are living on the edge and this helps," she said. "This is long-term care the way it should be."

Bird flu detected in Hong Kong market

2008-06-06T18:56:00.000-07:00

Hong Kong health workers slaughtered 2,700 poultry in a market Saturday after chickens were found to be carrying the dangerous H5N1 bird flu virus, officials said.

The slaughter may be extended to all live poultry in the territory if the virus is detected in any other locations, Secretary for Food and Health York Chow said.

"Since we have detected the virus in the market, we will cull all the chickens in this market," Chow told reporters. "If we find another positive detection in another market, then we will assume that the risk is much higher and we need to cull all the chickens in all the markets."
Hong Kong TV Cable showed health workers wearing protective gear placing live poultry from nine stalls into bags to prepare for the slaughter.

Routine bird flu checks detected the H5N1 virus in five samples of chicken waste. The samples were collected June 3 from three vendors in the market in the Sham Shui Po residential district, Chow said.

Health officials declared the market an infected area and suspended all sales of live poultry there, a government statement said.

Chow said authorities were tracing the origin of the infected chickens.

Chow also ordered a 21-day ban on the supply of live poultry from mainland China and from local farms.

Occasional H5N1 infections in wild birds are common in Hong Kong but the territory has not suffered a major outbreak of the disease since the virus killed six people in 1997.

That prompted the government to slaughter the territory's entire poultry population of about 1.5 million birds.

At least 241 people have died of bird flu worldwide since 2003, according to the World Health Organization.

Most human cases have been linked to contact with infected birds, but health experts worry the virus could mutate into a form that passes easily among humans, sparking a pandemic that might kill millions of people.

Toe Implants offer Relief from Arthritis

2008-06-05T09:07:00.000-07:00

Those who suffer from hallux rigidus, or degenerative arthritis of the big toe, have new reason to lace up their gym shoes. A new cartilage resurfacing implant may allow these patients to maintain their active lifestyle.

Hallux rigidus affects the large joint at the base of the big toe. While some joint wear and tear commonly occurs after age 30, doctors increasingly are seeing this type of arthritis in younger, more active patients, according to Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. Injury to the big toe joint also can cause arthritis.

People with arthritis of the big toe will have pain and stiffness while walking. Conservative treatments include wearing stiff-soled shoes or inserts. If those treatments don't work, options have included joint fusion or joint replacement. But both have drawbacks. The new Arthrosurface HemiCAP system was approved by the FDA in 2006 for treatment of moderate and advanced arthritis of the big toe. The system replaces damaged cartilage with contoured implants precisely matched to the patient's anatomy using three-dimensional mapping technology. Matching the curvature of the cartilage allows for proper function of the big toe joint.

Because the implant preserves the joint, it allows for an active lifestyle. Independent studies show that after this outpatient procedure, patients experience reduced pain, rapid recovery and significant range of motion. The HemiCAP implant also is being used in the shoulder, hip and knee. "This is the new wave of what's happening in orthopedics," said Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. "The implant is set into the same level of the remaining cartilage and acts as brand-new cartilage. You're not destroying the joint but resurfacing the joint.

"The procedure takes about 35 to 40 minutes for each foot, done a few months apart. It's done under twilight sedation, which falls between wakefulness and complete unconsciousness, and a local anesthetic. After the procedure, patients wear a removable cast for two weeks and then wear a gym shoe and begin physical therapy. Stone cautions that it's important to choose the patient properly. "This is for people with a moderate of amount of arthritis," he said. "If the joint is really destroyed, you can't do this." The implant should last around 20 years, about as long as an artificial joint, he said.

With joint fusion, surgeons remove the damaged joint between the two bones and allow the bones to grow together. Joint fusion eliminates arthritis pain, but it restricts movement of the big toe joint and limits the shoes that may be worn, especially for women. It's often used for older, less active patients.

Joint replacement involves replacing the joint surface with plastic, metal or a silicone compound. This procedure may relieve the pain and preserve joint motion. But artificial joints made of silicone can cause tissue reactions. And because so much bone and cartilage is removed, any future surgery is more difficult.As for the new treatment, "Long-term studies will show how effective this implant will be in allowing a patient to walk and how long the implant itself will last," said Dr. Tayeb S. Hussain, a podiatrist with Evanston Podiatric Surgeons who has done a few procedures. "I'd give it at least a year and a half until long-term studies are evaluated to know whether it's a standard procedure," he said.

"I reserve it for people with any cartilage deterioration. Women can return to wearing heels within three to four weeks. It's best for patients who have cartilage deterioration under age 60 who still want to be active."

Too Much Medical Care Harmful?

2008-06-04T09:05:00.000-07:00

Too much medical care could be harmful to your health.

That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.

The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.

The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.

The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.

Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.
The more resources available at a hospital equaled more care and in turn, more chances for errors and complications, according to the study.

To help consumers better identify which hospitals are more or less aggressive with their care, Consumer Reports magazine launched the Consumer Reports Health Ratings Center, which ranks hospitals and soon will rate other health care providers.

Launched in conjunction with the Dartmouth study, the online tool at ConsumerReportsHealth.org lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).

The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.

For example, hospitals in New York and Los Angeles top the list of most aggressive care, while Scott & White Memorial Hospital in Temple, Texas, is the most conservative.

Seattle ranks on the lower, more conservative end of the spectrum when treating patients.
Of the 18 Seattle-area hospitals listed on the site, larger ones such as Swedish Medical Center, the University of Washington Medical Center and Virginia Mason had higher percentiles. They ranked 44 percent, 33 percent and 29 percent respectively.

Jefferson Healthcare in Port Townsend, St. Francis Hospital in Federal Way and Olympic Medical Center in Port Angeles ranked on the low end at 2 percent and 3 percent.

The numbers tend to be lower because the larger hospitals usually have more complicated cases, often referred to them by the smaller ones, according to the Washington Hospital Association.
The association said it was pleased with where Seattle and Washington as a whole fall on the Consumer Reports rankings, which indicates Seattle patients are getting the care they need and want, but are not getting a lot of unnecessary care.

"If we had any hospitals with exceptionally high scores, I would worry that patients were getting much more care than they needed or wanted," spokeswoman Cassie Sauer said.

"Spending hours and hours in medical appointments, tests and treatments -- particularly when there's no evidence they will make any difference -- could offer false hope, hurt quality of life, and create significant medical bills. I think many Americans assume that more care is better care, but that is certainly not always the case"

Dust Mites and Allergies

2008-06-03T09:03:00.000-07:00

THE BELIEF:

Dust mites make allergies worse.

THE FACTS:

Most people with allergies or asthma know well the hazards of dust mites, the microscopic household critters long said to be one of the most common triggers of allergic symptoms.
But that is not what studies show. Scientists repeatedly have found that various physical and chemical methods recommended for controlling dust mites, such as sprays and impermeable bed covers, do little by themselves to prevent allergies. If they do work, it usually is as one of several steps taken to reduce allergens.

An analysis published in 2008, for example, looked at 54 randomized studies that compared various mite-control measures with placebo interventions, or none at all, in people with asthma. It found that the control measures made no significant difference. A 2007 study followed 126 asthma patients, some of whom were trained to use control measures such as impermeable bed covers and others who used placebo interventions. After two years, the scientists found that the groups showed no difference in their use of inhalers or reductions in symptoms like wheezing and coughing.

These and other studies suggest that people with allergies and asthma would do well to rely on a broad program of interventions, such as frequently washing clothes and blankets, using air conditioning instead of humidifiers, and strictly limiting exposure to allergens such as smoke and strong odors.

THE BOTTOM LINE:

Research suggests that controlling dust mites alone may not prevent allergies.

Think About Green Tea

2008-06-02T09:02:00.000-07:00

Tea is the most popular beverage in the world, second only to water. It has been enjoyed in Eastern countries for more than 4,000 years and Chinese and Japanese traditions attribute many healing properties to this beverage. Today, scientists around the world are supporting these traditions as they use rigorous research methods to identify the many health benefits of green tea.

Recent studies reveal green tea's benefits as an antioxidant, promoter of glucose tolerance, and protector of the liver, detoxification system and the cardiovascular system. Two studies also show that green tea is a powerful agent in the prevention and treatment of cancers. The tea is made from unfermented leaves of the Camellia sinensis plant. These leaves contain polyphenols, chemical substances known to have strong antioxidant properties. The polyphenol found in green tea, called catechin, is a powerful antioxidant and is said to inhibit the growth of cancer cells and kills cancer cells without harming healthy tissues.

Green tea, just like all other healthy foods and beverages, should be consumed in moderation. Studies show that consuming between one to four cups of green tea per day offers the most benefit. Other great teas to try, each with various health benefits, include red tea, white tea and black tea. Drinking tea is an excellent way to relax and refresh the body and mind -- while benefiting your health.

Little League Baseball can be Dangerous

2008-06-01T08:58:00.000-07:00

No doubt the Little League bleachers are buzzing in Wayne, N.J., and just about any youth baseball diamond that learns about a May 19 lawsuit filed by the Domalewski family.
The New Jersey parents of former pitcher Steven Domalewski sued bat manufacturer Hillerich & Bradsby Co., plus the official Little League organization and the retail outlet Sports Authority, after their then-12-year-old son was struck by a batted ball right above the heart while he was on the mound during a 2006 game.

Steven suffered brain damage from the blow. His heart stopped beating and doctors estimate his brain was deprived of oxygen for about 15 to 20 minutes.

The bat in question was a 31-inch, 19-ounce Louisville Slugger TPX Platinum model. The filing attorney claimed the defendants knew, or should have known, the bat could potentially injure youth players not ready for the velocity of a batted ball coming off this particular make of aluminum bat. A major premise in the suit is that aluminum bats cause the ball to travel faster than wooden bats.

Not surprisingly, legal blogs are robust with comments about whether this is a legitimate or frivolous lawsuit.

Pause. Debate among your own brain synapses. OK, back to the column.

Little League Baseball has denied any wrongdoing. The game in which Steven Domalewski sustained the injury was a Police Athletic League contest rather than a Little League event. Attorney Ernest Fronzuto countered that Little League Baseball officially approved the bat and by its actions led players, coaches and parents to believe the bat was safe for play among 10-, 11- and 12-year-olds.

Fronzuto told The Associated Press he sees this case as raising public awareness about whether youth baseball is safe or if there are precautions that would help protect children.
As it happens, researchers at the Center for Injury Research and Policy at the Nationwide Children's Hospital in Columbus, Ohio, are releasing a study Monday almost squarely on the subject.

Dawn Comstock, a Ph.D. faculty member at The Ohio State University's College of Public Health, has long staked youth sports injuries as her research focus. She and colleague Christy Collins published a study in the June edition of the medical journal Pediatrics that analyzes injuries in high school baseball in the past three seasons, from 2005 through 2007.

The study is the most comprehensive look at high school baseball in the past 10 years and "the first to examine all injuries attributed to being hit by a batted ball at the high school level," wrote journal editors.

While high school baseball has a relatively low rate of injury compared to other sports -- Comstock and Collins are in the midst of comparing nine different sports -- it has the largest proportion of fractures (even more than football) and second-largest proportion of injuries that resulted in a time loss of more than seven days (trailing only boys' soccer).

More than 11 percent of all baseball injuries are caused by a batted ball. Collins said the majority of those injuries, 64 percent, involve the head, face or teeth. Line drives to the chest did not represent a significant incidence level in the high school study. Collins, clearly not intending to directly comment on the New Jersey lawsuit, suggested that high school players are likely to be more coordinated and "better able to shield themselves from the ball and get their gloves up."
Nonetheless, the authors of the study documented severe enough injuries to the head and teeth to recommend that all pitchers and infielders "wear helmets with face shields (a bar to protect but not disrupt vision) or at least mouth guards and eye protection."

Collins acknowledged that any such protective gear is not part of the baseball mind-set.
"We know that mouth guards, face shields and eye protection are proven to be successful," Collins said. "We plan to conduct research on why this protective equipment is not worn, whether it is because coaches and parents are not aware of the equipment or whether it is not part of the culture of the sport."

The temptation is to think more the latter, that adults are just not ready for infielders in helmets with face bars chomping on mouth guards. Infielder chatter might go a bit mushy, among other things. But it doesn't take too many bloody lips or close calls to the eye socket of novice players to reconsider the use of protective gear. Pitchers wearing flak jackets or other chest protectors seems excessive, though the guess here is that might be less a stretch in Wayne, N.J.

"Mouth guards are much more commonly worn in basketball these days, especially here in Ohio where we all watch (Cleveland Cavaliers star) LeBron James always wear one," said Collins.
"There are more youth softball leagues in which pitchers wear helmets. Compared to other sports, baseball is reluctant to change. But even a dental injury, which can be costly for parents, has a permanent effect on a child's life. Lots of those teeth don't grow back."

The Secret World of your Elbow

2008-05-31T08:56:00.000-07:00

The crook of your elbow is not just a plain patch of skin. It is a piece of coveted real estate, a special ecosystem, a bountiful home to no fewer than six tribes of bacteria. Even after you have washed the skin, there are 1 million bacteria in every square centimeter.

These are not bad bacteria. They are what biologists call commensals, creatures that eat at the same table with people to everyone's mutual benefit. Though they were not invited to enjoy board and lodging in the skin of your inner elbow, they are giving something of value in return.
They are helping to moisturize the skin by processing the raw fats it produces, said Dr. Julia Segre, of the National Human Genome Research Institute.

Segre and colleagues reported their discovery of the six tribes in a paper published online Friday in Genome Research. The research is part of the human microbiome project, "microbiome" meaning the entourage of all microbes that live in people. The project is a government-financed endeavor to catalog the typical bacterial colonies that inhabit each niche in the human ecosystem.

The project, in its early stages, has established that the bacteria in the human microbiome collectively possess at least 100 times as many genes as the mere 20,000 or so in the human genome.

Since humans depend on their microbiome for various essential services, including digestion, a person should be considered a superorganism, microbiologists said, consisting of his or her own cells and those of all the commensal bacteria. The bacterial cells outnumber human cells by 10-1, meaning that if cells could vote, people would be a minority in their own body.

Segre reckons there are at least 20 different niches for bacteria, and maybe many more, on the skin, each with a characteristic set of favored commensals. The types of bacteria she found in the inner elbow are different from those that another researcher identified a few inches away, on the inner forearm. But each of the five people Segre sampled harbored much the same set of bacteria, suggesting this set is specialized for the precise conditions of nutrients and moisture that prevail in the human elbow.

Microbiologists think humans and their commensal bacteria are continually adapting to one another genetically. The precision of this mutual accommodation is indicated by the presence of particular species of bacteria in different niches on the human body, as Segre has found with denizens of the elbow.

Other researchers have found that most gut bacteria belong to just 2 of the 70 known tribes of bacteria. The gut bacteria perform vital services such as breaking down complex sugars in the diet and converting hydrogen, a byproduct of bacterial fermentation, to methane.

The nature of the gut tribes is heavily influenced by diet, according to a research team led by Dr. Ruth Ley and Dr. Jeffrey Gordon of the Washington University School of Medicine in St. Louis.
With the help of colleagues at the San Diego and St. Louis zoos, Ley and Gordon scanned the gut microbes in the feces of people and 59 other species of mammals, including meat eaters, plant eaters and omnivores. Each of these three groups has a distinctive set of bacteria, they reported in Friday's issue of Science, with the gut flora of people grouping with the other omnivores.
Despite the vast changes that people have made to their diet through cooking and agriculture, their gut bacteria "don't dramatically depart in composition from those of other omnivorous primates," Gordon said.

The lifetime of an individual bacterium in the human superorganism may be short, since millions are shed each day from the skin or gut. But the colonies may survive for a long time, cloning themselves briskly to replace members that are sacrificed. Where these colonies come from and how long they last is not known.

Dr. David Relman of Stanford University has tracked the gut flora of infants and found that their first colonists come from their mother. But after a few weeks the babies acquired distinctive individual sets of bacteria, all except a pair of twins who had the same set. Relman said he was trying to ascertain if the first colonists remain with an individual for many years.

Strong Link Between Crime and Lead Exposure

2008-05-30T08:53:00.000-07:00

The first study to follow lead-exposed children from before birth into adulthood has shown that even relatively low levels of lead permanently damage the brain and are linked to higher numbers of arrests, particularly for violent crime.

Previous studies linking lead to such problems have used indirect measures of lead and criminality, and critics have argued that socioeconomic and other factors may be responsible for the observed effects.

But by measuring blood levels of lead before birth and during the first seven years of life and then correlating the levels with arrest records and brain size, Cincinnati researchers have produced the strongest evidence yet that lead plays a major role in crime.

The team also found that lead exposure is a continuing problem despite the efforts of the federal government and cities to minimize exposure.

The average lead levels in the study "unfortunately are still seen in many thousands of children throughout the United States," said Dr. Philip Landrigan, director of the Children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

The link between criminal behavior and lead exposure was found among even the least-contaminated children in the study, who were exposed to amounts of lead similar to what the average U.S. child is exposed to today, said Landrigan, who was not involved in the study.

"People will sometimes say, 'This is in the past. We are cleaning up lead. We don't have lead problems anymore,' " said criminologist Deborah Denno of Fordham University in New York, who was not involved in the study. "The Ohio study says this is still a big problem."
Nationwide, about 310,000 children between 1 and 5 have blood lead levels above the federal guideline of 10 micrograms per deciliter, and experts suspect that many times that number have lower levels that are nonetheless dangerous.

"It is a national disgrace that so many children continue to be exposed at levels known to be neurotoxic," said Dr. David Bellinger, of the Harvard Medical School, who wrote an editorial accompanying the research.

Although some urban soil is contaminated with lead from gasoline, 80 percent of lead exposure comes from houses built before 1978. Paint in such houses often contains up to 50 percent lead and, even though it has been covered by newer, lead-free paints, it flakes or rubs off.
About 38 million U.S. homes, 40 percent of the nation's housing, contain lead-based paint, according to the U.S. Department of Housing and Urban Development. The problem is particularly acute in urban areas, which typically have older housing that has not been renovated.

More recently, parents and authorities have become concerned about lead-based paint in toys imported from China.

Researchers have long known that lead exposure reduces IQ by damaging brain cells in children during their early years.

It is also known that lead increases children's distractibility, impulsiveness and restlessness and leaves them with a shortened attention span, all factors considered precursors of aggressive or violent behavior.

A landmark 1990 paper by Denno linked lead to increases in criminal behavior, but the children in the study were not tested for lead levels. The diagnosis was based on their physicians' evaluation, Denno said.

The Cincinnati Lead Study enrolled 376 pregnant women in Cincinnati between 1979 and 1984, measuring their blood lead levels during pregnancy and the children's levels during the their first seven years.

In the first of the new studies, environmental health research Kim Dietrich of the University of Cincinnati College of Medicine studied 250 of the original group, correlating their lead levels with adult criminal-arrest records from Hamilton County, Ohio.

Controlling for a variety of factors, including parental IQ, education, income and drug use, Dietrich and colleagues found that the more lead in a child's blood from birth through age 7, the more likely he or she was arrested as an adult. The tie between high lead and violent crime was particularly strong.

They found that 55 percent of the subjects (63 percent of males) had been arrested, and that the average was five arrests between the ages of 18 and 24.

The higher the blood-lead level at any time in childhood, the greater the likelihood of arrests. "The strongest association was with violent criminal activity: murder, rape domestic violence, assault, robbery and possession of weapons," Dietrich said.

Blood levels in the children ranged from 4 to 37 micrograms per deciliter.

The researchers found, for example, that every 5-microgram-per-deciliter increase in blood lead level at age 6 was accompanied by a 50 percent increase in violent crime later in life.
Confirming previous findings, the effect of lead was strongest in males, who had an arrest rate 4.5 times that of females.

"We need to be thinking about lead as a drug and a fairly strong one," Dietrich said.

In the second study, radiologist Kim Cecil and her colleagues examined a "representative sample" of 157 members of the same group using whole-brain MRI scans. They found that those with the highest blood levels of lead during childhood had the smallest brain volume.
For those with average lead level in the study, their brains were about 1.2 percent smaller. The most affected regions of the brain were those regulating decision making, impulse control and attention, among other areas.

"The most important message is that lead affects brain volume, independent of demographic and social factors that are often used to explain away poor outcomes" in life, Cecil said. "This is independent biological evidence showing that the brain is affected by lead."

Getting in Shape by Cycling

2008-05-29T06:57:00.000-07:00

As the days get warmer and longer, more riders will hop on their bicycles for a spin. Just how fast and where you go will determine if your bike is a piece of fitness equipment or simply a comfortable, recreational way to save gas and enjoy the outdoors.

Ask Craig Undem about bicycling and fitness. He will give you a short but insightful answer.
"Go climb hills," said Undem, a local cycling coach who operates the Cycle U training company in Seattle and regularly serves as an instructor for the Cascade Bicycle Club.

Undem said too few cyclists choose hills for workouts, when doing so a couple times per week can transform your body composition (goodbye, fat) and dispel any doubts that cycling is a top calorie burner among physical activities.

"Hills give you more bang for the buck," Undem said. "You might choose to go on a slow, steady ride for 20 miles (about an hour's worth for experienced riders and more like two hours for novices). But if you do moderate hills for 30 minutes that will burn more calories."

Undem said moderate hills translates to "a grade of 4 to 6 percent, not too steep, especially if you're just getting back into shape." He said you want to work at an exertion rate of 70 to 90 revolutions per minute, or rpm. You can determine this level by purchasing a bicycle computer (about $50 retail) or comparing that pedaling rate of 70 to 90 rpm to how that registers on a indoor stationary bike.

"You want that cadence to be moderately intense," Undem said. "It keeps you in a safe zone and gives you a great workout."

Increasing your intensity levels in short bursts (enough to be out of breath but not gagging) elevates cycling to one of the best calorie-burners among all physical activities. In fact, statistics from the American Council on Exercise (the primary certification group for personal trainers) equates bicycle racing with a vigorous game of basketball and not far off running at a brisk clip that would leave most people gasping.

Adding hills to any bicycle ride is easy enough here in the Pacific Northwest. Undem said to do it most efficiently requires more expertise than you might think. For instance, Cycle U teaches a "boot camp" devoted strictly to going up and down hills. It runs for eight two-hour sessions.
"It's a lot like skiing once you get into it," explained Undem. "There is a lot of technique."
Some highlights: Sit more upright in the bike saddle when you're climbing a hill. Don't pull your arms back too hard or too much when navigating the upward slope. And breathe deeply as you work.

One more tip for climbers that applies to all cyclists as they roll back outside this spring. Undem said too many recreational riders forget to drink water during the ride and eat something if they are going more than a hour nonstop. Sports nutritionist will suggest a snack and water is good idea some time in the hour before your ride.

Cycle U and the Cascade Bicycle Club offers plenty of other courses for beginners as well as the most savvy riders. You can learn how to ride a bike -- "there are plenty of people who come to us that never learned as kids," Undem said -- or perhaps take a refresher course on how to shift gears. Cascade instructors might go to the bike shop with you to pick out just the right model.

Not surprisingly, the Cascade club, the country's largest with a membership base of 10,000, works with a significant percentage of injured athletes from other sports. Basketball, running and tennis lead the list, mostly due to balky knees that are treated less jarringly on a bike.
Lateral movement fells basketball and tennis players, Undem said. Runners tend to not rest their bodies enough and stride themselves right into overuse injuries.

"Cycling has a locked range of motion so those runners, tennis players and basketball players can exercise without doing any more harm to the knees," Undem said.

The key strategy is to add intensity to your bike workouts, whether you are rehabbing an injury, cross training or deciding to make your commute your daily workout. All cycling for fitness will turn up noticeable changes in your body composition and personal energy level if you add some hills and maybe incorporate a few all-out sprints for 30 seconds or less when it is safe to do.

"Cycling is a real tonic for the body," Undem said. "Work harder and it will charge you up. You will feel good even after you're off the bike."

Quality Critical to Health Care Reform

2008-05-28T06:49:00.000-07:00

Expanding healthinsurance coverage is a critical step in health reform, but reforms willnot be successful if they fail to also address the quality and cost of care.

That is the conclusion of The Quality Crossroads Group, a broad groupof stakeholders drawn together to identify strategies to address thecomplex challenges confronting the U.S. health care system. The group laysout a five-point agenda in an article published today in Health Affairs that serves as a vision for quality in an election year when patient safety, the plight of the uninsured, and rising costs are making front-pagenews.

"Quality improvement is intricately connected with containing costs andexpanding coverage. Yet too often, quality is left out of the equation,"says co-author Margaret E. O'Kane, president of the National Committee forQuality Assurance. "Poor quality care is a major contributor to runaway health care costs.

Improving quality is a key part of making coverage affordable."

"The future of health care reform rests on the ability for diversegroups, at national, state, and community levels, to work to achieve consensus. We cannot achieve the important policy goals outlined in this paper without collaboration," says co-author Janet Corrigan, president and CEO of the National Quality Forum. "The thinking in this paper, by leadersin the quality movement across the country, represents a successful effort to collaborate in moving beyond rhetoric and sparking real change," sheadded.

If taken up by the new President, Congress and others, the five-point reform plan put forward by the 13 authors of the paper would mobilize true change in the nation's vast, complicated, and expensive health care system.

The reform plan calls for:

A national center to support effectiveness research. The U.S. invests too little in understanding what works and what does not for a whole array of technologies, drugs, and treatments. In order to ensure that our health care dollars are wisely spent, we need to systematically identify where critical gaps in evidence exist and fill them.

Models of accountable health care entities capable of providing integrated and coordinated care. The sickest patients often suffer the most from lack of care coordination across settings. They see multiple specialists, get an array of tests, and take multiple medications - usually without a "health care home" or central coordinator of care. Achieving high levels of coordination will require investments in organizational supports that go beyond information technology. IT is a critical enabler of management, but is not sufficient to produce high-quality, efficient, and patient-centered care.

Payment models that reward high-value care. There are nearly 10,000 codes for payment for medical procedures, but not one for outcomes or results. The Quality Crossroads Group believes that if quality is not tied to payment, providers' behavior will not appreciably change, and if it does not change, access to insurance and care will continue to decline.

We need to aggressively develop models of payment that reward clinically effective and efficient care and yield high patient satisfaction. Those might include innovative ideas like bundled chronic care episodes.

A national strategy for performance measurement, including standardized measures of patient and population health. We need a common vision of what quality care means. To get there, we need to agree on what we are measuring and how we are measuring it. Performance information is a public good and federal funding for the National Quality Forum, a private sector standard-setting organization, will facilitate development of a comprehensive portfolio of standardized measures that is continually assessed and updated.

A multistakeholder approach to improving population health. Obesity is a national crisis that demands solutions that lie mostly outside of health care. The public sector can do much to promote population health. For example, in Arkansas, nearly 38 percent of young people are overweight or at risk of becoming overweight. State officials implemented a strategy to target children in schools, focusing on what they eat and how often they exercise. We must make a concerted public- and private-sector effort -- similar to the one we mounted for tobacco control -- to achieve the outcomes we know are possible.

Executing the most popular Yoga position

2008-05-27T06:47:00.000-07:00

HOW TO DO A DOWNWARD DOG

Place your feet hip-width apart on the floor, toes facing forward.

Place your hands shoulder-width apart on the floor, lightly spread the fingers.

Keep your tailbone lifted towards the sky and gently push down through the heels. If you're a beginner, you might not get your heels all the way to the floor at first -- that's OK.

Open your upper back by rotating the shoulder blades away from one another. Keep the shoulders away from the ears and press down firmly through all fingers and thumbs. Place more weight onto your feet than your hands.

Shifting the weight back to the hips is the key element in feeling the energizing effect of this posture. Pull your navel toward your spine and lift the pelvic floor muscles. Lift your kneecaps up and contract the quadriceps muscles.

Maintain this pose for 5 to 10 deep breaths.

Stress Relief From Yoga

2008-05-26T06:44:00.000-07:00

Funny thing. When Jenny Hayo first started practicing yoga in 1996, she thought of it as "purely an exercise option." Within two years, she was teaching classes and digging deeper.

Her appreciation of yoga as a personal methodology changed with each new mentor. Hayo realized yoga is energizing in ways beyond the workout, and said she sees no reason why the rest of us can't tap into it for stress relief and everyday vigor.

"The interesting point of modern-day yoga is it is looked at as exercise by most people," says Hayo, who teaches at 8 Limbs Yoga Center in the Capitol Hill neighborhood, plus some classes at the downtown Zum health club. "Ninety-five percent of people get into yoga that way. But no one is complaining. It puts people on the yoga mat and that's great."

In fact, Seattle P-I venture capital columnist and blogger John Cook noted earlier this month in an item about the TeachStreet free online directory that there are no fewer than 984 yoga classes in the Seattle area.

That's a lot of yoga mats.

For her part, Hayo, 33, learned yoga is more than meets the physical plane and any form of the seemingly undoable lotus position.

"The name, '8 Limbs,' comes from the eight principles of yoga," Hayo said. "As you practice yoga, you can begin to feel the physical, emotional, mental and energetic benefits."

There are different interpretations, but fundamentally the "eight limbs" of yoga include body postures, breathing exercises or control of "prana," personal observances, control of the senses, concentration and inner awareness, devotion or meditation, universal morality and union with the divine.

Hayo acknowledged that most of us would recognize the body postures, breathing and meditation components. The remaining "limbs" are less familiar but powerful, even if you commit to just minutes of yoga daily or one session a week.

The ideal strategy for yoga novices is a one-on-one session with an instructor -- "it will cost about the same as an appointment with your massage therapist," Hayo said. But you can certainly get an energy boost from a beginner's class at your local yoga studio (look for a teacher who offers different versions of the same posture depending upon experience and fitness level).

Or you can begin with the "downward-facing dog" pose, which Hayo said is one of the "inversion" postures that can instantly energize the body.

Yoga brings balance, said Hayo, who works with numerous clients to match a customized set of postures to their needs. "The downward dog can help if you feel tired or anxious (or both)."
The downward dog is a more accessible version of the handstand or headstand, which likely most American adults have not done since, oh, fifth grade. Yet maybe there is more to those childhood handstands than just playing or showing off.

"I have teacher who calls headstands and handstand the 'yogi's coffee,' " Hayo said.

The downward dog pose looks, not surprisingly, a lot like a dog stretching its paws in front and its rear high in the air. For us humans, it starts with putting your hands in alignment with your shoulders and hips as you move to hands and feet on the floor. Novices often spread the hands too far apart and the feet too close together.

Next, as you come into all fours, place your knees under your hips and gently extend your spine. As you put your hands on the mats, spread the fingers a bit with the middle finger straight ahead.

Lift your pelvis toward the ceiling and pull the hips back. Your eyes look to the feet. The feet are even with the hips. Resist moving them closer to the hands just put the heels down. If your heels don't touch, they will if you do the downward dog regularly.

Hayo said a good practice is to hold the posture for five slow, purposeful breaths.
"Keep at it," she said. "You will get mental clarity while in the pose. I tell students to experience it until it feels right. You will know."

What keeps yoga regulars coming back is, to be sure, a combination of results. But one of the most satisfying is increased energy, not just after class but the rest of the day or week. You feel more clear-headed. You stand more upright. There is less tiredness midday. Who can resist that in today's hurly-burly?

Well, there is one problem. You might call it the Foot-and-Leg-Over-the-Head mental block.
To that end, 8 Limbs and other local yoga studios are eager to attract beginners with basics classes and special weekend workshops, such as the "Yoga for Men" class, 2:30 to 4:45 p.m. at the 8 Limbs center in West Seattle, on May 18. Instructor Greg Owen will be working to help reluctant men get past "what they feel is their lack of flexibility."

Owen plans to help men connect yoga movement and breathing with ways to ease the strain and pain of "sore lower backs, tight hamstrings and stiff shoulders."

A good deal for at least four limbs.

Stress in the Workplace

2008-05-25T09:44:00.000-07:00

The longer he waited, the more David worried. For weeks he had been plagued by aching muscles, loss of appetite, restless sleep, and a complete sense of exhaustion. At first he tried to ignore these problems, but eventually he became so short-tempered and irritable that his wife insisted he get a checkup.

Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him. They had been good friends when she worked in the front office at the plant, but he hadn't seen her since she left three years ago to take a job as a customer service representative.

Her gentle poke in the ribs brought him around, and within minutes they were talking and gossiping as if she had never left.

"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three.

We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."

"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks.

All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval. Most of the time I'm caught between what the customer wants and company policy.

I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her.

No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.

The concept of job stress is often confused with challenge, but these concepts are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.

But for David and Theresa, the situation is different-the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.

Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.

According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

Solvents in the Workplace

2008-05-24T09:05:00.000-07:00

A solvent is a liquid that can dissolve another material. In industry the term solvent is generally applied to the kinds of substances known as "organic solvents" that are widely used to dissolve organic chemicals such as oils and resins.

Examples of such solvents include kerosene, acetone, petroleum distillates and naphthas. Potential solvent uses are limitless and include degreasing, cleaning, stripping, thinning and finishing. Solvents are used extensively in many industries.

How Can Exposure To Solvents Affect Health?

Excessive solvent exposures can lead to health problems.

Solvents are ABSORBED (enter the body) by the following routes:

Inhalation

This is the most important route of exposure for most solvents. Once inhaled, the vapors which arise from solvents can directly irritate the upper respiratory tract (nose, throat and bronchial tubes) and the lungs. Solvent vapors can also be easily absorbed from the lungs into the bloodstream and travel to other parts of the body to produce additional harmful effects.

Skin Contact

Solvents can be absorbed through the skin and travel to other parts of the body. Solvents can also break down the natural protective oils and fats of the skin. This can cause the skin to become dry, cracked and inflamed.

Mouth Contact

Solvents can enter the body and bloodstream through the mouth and digestive system. Although not a common route of entry, mouth contact with contaminated hands, food and cigarettes can occur and be dangerous.

Health Effects Are Dependent On What Factors?

Toxicity of the solvent.
Route of exposure.
Amount of exposure.
Individual worker's susceptibility.
Combination with other chemical exposures.

All of these factors are important in determining whether a person will experience any damaging health effects from solvent exposures. For example, a worker who already has respiratory breathing problems, such as asthma, may experience breathing difficulties while working around solvent vapors that do not produce any health effects in a person without respiratory problems.

What Acute (Short-Term) Effects Can Occur?

Solvent health effects that are ACUTE follow a single or short-term chemical exposure and usually occur soon after the exposure. Acute effects generally last only minutes, hours or days and are reversible once the exposure is over. Since they occur shortly after exposure, they are more easily identified. Common acute effects from solvent exposure include:

Respiratory Irritation

Exposure to solvent vapors can irritate respiratory mucous membranes. This can produce a burning sensation of the nose, throat or chest and lead to coughing. Inhalation of very high concentrations of solvents may result in severe irritation of the lungs and a condition called pulmonary edema, or fluid in the lungs. Symptoms of pulmonary edema include coughing and difficulty in breathing and require prompt medical attention.

Eye Irritation

Exposure to high concentrations of solvent vapors may produce eye irritation. This can lead to burning, tearing, and painful eyes. Dermatitis. Acute contact with a solvent can cause a breakdown of protective fats and oils in the skin. Skin may become reddened, itchy, and blistered. Central Nervous System Depression. The central nervous system consists of the brain and spinal cord. Solvent exposure can affect the brain like alcohol and lead to a state similar to being drunk. Large exposures can produce central nervous system effects including euphoria, feeling "high," dizziness, lack of coordination, headaches, fatigue and nausea.

Heart Arrhythmia

Solvents, particularly chlorinated hydrocarbons (those with chlorine molecules attached to carbon), can increase the irritability of the heart muscle at high exposure levels. This can lead to irregular heartbeats called cardiac arrhythmia.

What Chronic (Long-Term) Effects Can Occur?

Solvent exposures can produce CHRONIC health effects, which occur after repeated exposures and are often long-lasting or irreversible. Symptoms may appear gradually, so they may be initially ignored. This can make it hard to identify the chronic health problems related to solvent exposure.

Chronic health effects include:

Respiratory Effects

Repeated irritation of the respiratory tract may result in bronchitis and produce symptoms of chronic cough and sputum production. Dermatitis. Long-term exposure can lead to chronic dermatitis. The skin can become dry, thickened, cracked, hardened and flaky.

Nervous System

Most organic solvents affect the central nervous system, primarily the brain. With increasing levels of exposure, these effects include feeling "high," irritability, nervousness, weakness, tiredness, dizziness, sleeplessness, disorientation, confusion and even unconsciousness.

Long-term exposure has been associated with effects such as difficulty in thinking and personality changes. A few solvents, such as n-hexane and methyl n-butyl ketone, can damage the peripheral nerves, which are nerves to sensory organs and muscles. Symptoms of nerve damage include pain, loss of sensation, and weakness, usually beginning in the toes, then the fingers and moving up the legs and arms.

Liver

Some solvents, particularly chlorinated types, can damage the liver, causing a type of hepatitis. There may be no symptoms. If there are symptoms, they may include: nausea, pain in the right side, yellow skin and eyes, dark urine and light-colored bowel movements. Hepatitis may be detected by blood tests of liver function.

Blood

A few solvents, such as glycol ethers, affect the blood, either by damaging blood cells that are circulating in the body or decreasing the production of new blood cells. There usually are no symptoms until blood counts are extremely low, resulting in tiredness or infections. Benzene is one solvent that is known to be particularly dangerous; it can cause anemia (low blood counts) and also leukemia (cancer of the white blood cells).

Reproductive Effects

Although chemicals may affect reproduction in females and males, there are no definitive studies that demonstrate the effects of solvents on human reproduction. Cancer. Benzene is the only commonly used solvent that has been associated with cancer in exposed workers. A number of other solvents, including carbon tetrachloride, chloroform, 1,4-dioxane and trichloroethylene have caused cancer in laboratory animals. Vinyl chloride has been known to cause angiosarcoma of the liver in humans.

What Should You Do If You Develop Symptoms That May Be Related To Solvent Exposure?

Inform your employer and consult a physician. Many health problems that can be related to solvent exposures can also be caused by other medical problems which may need immediate treatment. Special laboratory tests can be performed to assess solvent exposures.

How Can Exposure To Solvents Be Reduced or Prevented?

The best way to guard against the harmful health effects of solvents is to prevent or minimize exposure. As a first step, be aware of the hazards and safe handling procedures for materials on the job. This information must be available to you and usually is provided in Material Safety Data Sheets (MSDS), employer instructions and container warning labels.

Secondly, use the procedures and equipment that are available. Employers are responsible for providing safe work conditions.

The most important ways of preventing exposure are:

Substitution of a solvent with a less hazardous substance.
Enclosure of the process or containers where the solvent is being used (so it never enters the air you breathe).
Exhaust ventilation systems that function effectively.
Redesign of a process (to eliminate a step releasing vapors or requiring liquid contact).
Personal protective equipment (should be used only when engineering controls such as enclosure of a process are not feasible).
Respirators should be worn as a part of a comprehensive respiratory protection program. Other protective gear such as gloves, aprons, goggles and face shields should be used when appropriate.
Good housekeeping practices (essential to ensure exposures are minimal).

What Other Hazards Are Posed By Solvents?

Solvents can be flammable or explosive, and exposing them to flame or hot surfaces can also form highly toxic decomposition products. Ignition sources such as welding torches, lit cigarettes and sparks should be kept away from solvent use and storage areas. I

n addition, some chemicals are incompatible with solvents and mixing will produce toxic gases, heat or fire. Oxidizers (e.g., sodium chlorate) and strong acids and bases (e.g. sulfuric acid, sodium hydroxide) should never come in contact with solvents. Refer to Material Safety Data Sheets or chemical suppliers' information for special hazards.

Protecting your ears

2008-05-23T09:02:00.000-07:00

The safest way to protect your ears is to always wear hearing protectors anytime you are around loud noises. You can protect your ears by wearing special earplugs or special earmuffs. There are hundreds of kinds available. There are formable earplugs you can mold to your ears and premolded earplugs that come in several sizes. There are canal caps that are attached to headbands and are very convenient if you work in intermittent noise where you need to take your earplugs on and off throughout the day. Some earplugs have stems so you can insert them without touching the part that goes inside your ear. You can also get earplugs custom molded to fit your ear. Earmuffs come with large and small earcups, different types of headbands, and different types of ear cushions. There is something for everyone and for every environment.

Ventilation for Airborne Hazards.

2008-05-22T08:59:00.000-07:00

A good ventilation system at your work site is an effective method of keeping both toxic and nuisance materials out of the air and out of your lungs. Some toxic materials capable of causing chronic lung disease, if inhaled in large enough quantities, include asbestos fibers, chlorine, silica dust (silicon dioxide) and arsenic fumes. Examples of nuisance materials (those that don't usually have a bad effect on the lungs when exposures are kept under reasonable control) include cellulose fibers, glycerin mist, limestone, plaster of paris and tin oxide.

The first step in keeping the air clean is to prevent materials from escaping from their containers by using covers and lids. Solvent vapors can be kept out of the air by keeping solvent tanks covered when not in use. Furthermore, airborne dust levels can be reduced by keeping operations which generate dust, such as sandblasting operations, separated from other work areas.

However, when it is not possible to keep toxic materials contained, it is important to remove dirty or contaminated air from the work area and replace it with clean air.

How Should Dirty Air Be Removed From The Workplace?

The best way to remove contaminated air from the work area is with the use of what is called "local exhaust ventilation." Typical window or cooling fans were not designed to remove contaminated air from individual work areas and are not recommended for this purpose.

What Is Local Exhaust Ventilation?

Local exhaust ventilation is an effective method for removing airborne toxic or nuisance materials at their point of origin, thereby preventing them from entering your lungs. Examples of processes that use local exhaust ventilation include welding and grinding operations. To be effective, a local exhaust ventilation system should include: 1) a collector or hood, 2) ducts to carry the air, 3) the right choice of fan, 4) a device to clean the air if required, and 5) exhaust system.

What Should You Do To Use A Local Exhaust Ventilation System Correctly?

Simple but important points in working with a local exhaust ventilation system include:

Try not to put yourself between the source and the opening of the air exhaust hood. If you do this, you will breathe contaminants as they are drawn into the hood.

Do not block fresh air supply for the workroom.
Do not block or obstruct hoods.
Protect ventilation ducts from damage and holes.
Keep operation close to the hood to improve capture of vapors and fumes.
Be aware of special precautions required when ventilating potentially explosive or corrosive vapors.
Prevent recirculation of exhaust air back into the workplace.
Evaluate the ventilation system periodically to ensure it is operating as designed.

What If You Have Problems With The System?

Problems can occur with ventilation equipment, like any other tool used at work. Contact your employer if you experience problems with a ventilation system. Most often a routine maintenance program of cleaning out ducts, replacing fan blades and repairing leaks will restore a system to full operation.

Fight a Fire or Flee?

2008-05-21T08:56:00.000-07:00

Workplace fires and explosions kill hundreds and injure thousands of workers each year. One way to limit the amount of damage due to such fires is to make portable fire extinguishers an important part of your fire prevention program. When used properly, fire extinguishers can save lives and property by putting out a small fire or controlling a fire until additional help arrives.

A fire is the most common type of emergency for which small businesses must plan. A critical decision when planning is whether or not employees should fight a small fire with a portable fire extinguisher or simply evacuate. Small fires can often be put out quickly by a well-trained employee with a portable fire extinguisher. However, to do this safely, the employee must understand the use and limitation of a portable fire extinguisher and the hazards associated with fighting fires. Evacuation plans that designate or require some or all of the employees to fight fires with portable fire extinguishers increase the level of complexity of the plan and the level of training that must be provided employees.

Battling Eye Strain

2008-05-20T08:46:00.000-07:00

Your eyes hurt. Your head aches. And there you sit, peering at your computer monitor. If you're one of the many people who use computers every day — either for work or personal use — you may experience eyestrain as a result.

Eyestrain: Signs and symptoms

Common signs and symptoms include:

Sore, tired, burning or itching eyes
Watery eyes
Dry eyes
Blurred or double vision
Headache and sore neck
Difficulty shifting focus between monitor and paper documents in your work area
Color fringes or afterimages when you look away from the monitor
Increased sensitivity to light
Eyestrain associated with computer use isn't thought to have serious or long-term consequences, but it's disruptive and unpleasant. Though you may not be able to change the nature of your job or all the factors that can cause eyestrain, you can take steps to reduce the strain.

New habits can help relieve eyestrain

A few simple adjustments in how you work or surf the Internet can give your eyes a much-needed rest.

Follow these simple tips to reduce eyestrain:

Take eye breaks. Throughout the day, give your eyes a break by forcing them to focus on something other than on your screen.
Try the following exercise: Hold a finger a few inches in front of your face; focus on the finger as you slowly move it away; focus on something far in the distance and then back to the finger; slowly bring the finger back toward your face. Next, shift your focus to something farther than eight feet away and hold your eyes there for a few seconds. Repeat this exercise three times, several times a day.
Change the pace. Try to stand up and move around at least once every hour or so. If possible, lean back and close your eyes for a few moments. At the very least, try to give yourself a five-minute rest every hour. Do other work, such as phone calls or filing, during this time.
Blink often to refresh your eyes. Because many people blink less than normal when working at a computer, dry eyes can result from prolonged computer use. Blinking produces tears that can help moisten and lubricate your eyes. Make a conscious effort to blink more often.
Consider using artificial teardrops. Available over the counter, artificial tears can help relieve dry eyes that result from prolonged sessions at the computer.
Practice relaxation. Ease muscle tension with this relaxation exercise: Place your elbows on your desk, palms facing up; let your weight fall forward and your head fall into your hands; position your head so that your eyebrows rest on the base of your palms, with your fingers extended toward your forehead; close your eyes and take a deep breath through your nose; hold it for four seconds, then exhale. Continue this deep breathing for 15 to 30 seconds. Perform this simple exercise several times a day.
Get appropriate eyewear. If you wear glasses or contacts, make sure the correction is right for computer work. Most lenses are fitted for reading print and may not be optimal for computer work. Glasses or contact lenses designed specifically for computer work may be a worthwhile investment.

Put your workstation in order

Take some of the strain off your eyes by making sure your desk space is set up in an appropriate and eye-friendly way.
Adjust your monitor. Position your monitor directly in front of you about 20 to 28 inches from your eyes. Many people find that putting the screen at arm's length is about right. If you need to get too close to read small type, consider increasing the font size.
Keep the top of your screen at eye level or below so that you look down slightly at your work. If it's too high or too low, it can lead to a sore neck. If you have your monitor on top of your central processing unit (CPU), consider placing the CPU to the side or on the floor. And if you wear bifocals or trifocals, keep in mind that you may have a tendency to tilt your head backwards so that you can see through the lower portion of your glasses. To adjust for this, consider lowering your monitor a few inches or buying glasses designed for computer work.
Position your keyboard properly. Place your keyboard directly in front of your monitor. If you place it at an angle or to the side, your eyes have to focus at different distances from the screen, a tiring activity.
Keep reference materials nearby. Place reading and reference material on a document holder beside your monitor and at the same level, angle and distance from your eyes as the monitor is from your eyes. This way your eyes aren't constantly readjusting.
Check the lighting and reduce glare. Bright lighting and too much glare can make it difficult to see objects on your screen and strain your eyes. To check glare, sit at your computer with the monitor off. This allows you to see the reflected light and images. Note any intense glare. The worst problems are generally from sources above or behind you, including fluorescent lighting and sunlight.
If possible, place your monitor so that the brightest light sources are off to the side, at a right angle to your monitor. Consider turning off some or all of the overhead lights. If you need light for writing or reading, use an adjustable desk lamp. Close blinds and shades and avoid placing your monitor directly in front of a window or white wall. Use a glare-reducing screen to minimize glare from overhead lighting. Finally, adjust the contrast and brightness on the monitor to a level that's comfortable for you, making sure the letters on the screen are easy to read.
Also wipe the dust from your computer screen regularly. Dust on the screen cuts down on contrast and may contribute to glare and reflection problems.

If problems still persist, it could be a sign of a more serious problem

See your doctor if you have:

Prolonged eye discomfort
A noticeable change in vision
Double vision
But if you're like most people, making a few simple adjustments can help keep your eyes rested and ready.

We serve the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Ask NIOSH for help

2008-05-19T08:54:00.000-07:00

Do you think a health hazard exists in your workplace? Do any of the following stories resemble situations at your workplace?

A factory worker was feeling numbness and tingling in her fingers. She learned that three coworkers had the same problem, and two had headaches while at work but not over the weekend. Some workers said the air at work smelled bad. Their supervisor noticed the smell but didn’t think it was anything to worry about.

A manager noticed that employees in one work area had more skin rashes in the past year than the year before. He wanted to know why, but didn’t know what to do.

A work crew was putting cement tiles on a roof. They were working outside, but the air seemed dusty. The saws used to cut the tiles were noisy. Someone told them that this work was dangerous and they should have it checked out.

At no cost to employers or employees, or their representatives, the NIOSH Health Hazard Evaluation (HHE) program may be able to help with problems like these. This site lets you know about the program and how to ask for NIOSH help. It also has links to reports from thousands of HHEs done by NIOSH.

Preventing Back Injuries at Work

2008-05-18T08:40:00.000-07:00

Whether it's dull and annoying or screaming for attention, back pain can make it hard to concentrate on your job.

Many occupations — such as nursing, construction and factory work — may place significant demands on your back. Even routine office work can worsen back pain if you fall into risky habits.

But you often can avoid back pain and injuries by understanding what causes them and focusing on prevention.

What causes back injuries?

Doctors aren't sure about all of the causes of back pain. In fact, most back problems are probably the result of a combination of factors. Some factors, such as family history, aren't preventable. Other factors, such as weight, fitness and flexibility, can be controlled by changing your lifestyle.

Still other factors are work related, and you may or may not be able to modify these to prevent injury.

Four work-related factors are associated with increased risk of back pain and injury:

Force

Exerting too much force on your back may cause injury. If your job is physical in nature, you might face injury if you frequently lift or move heavy objects.

Repetition

Repetition refers to the number of times you perform a certain movement. Overly repetitious tasks can lead to muscle fatigue or injury, particularly if they involve stretching to the end of your range of motion or awkward body positioning.

Posture

Posture refers to your position when sitting, standing or performing a task. If, for instance, you spend most of your time in front of a computer, you may experience occasional aches and pains from sitting still for extended periods of time. On average, your body can tolerate being in one position for about 20 minutes before you feel the need to adjust.

Stress

Pressures at work or at home can increase your stress level and lead to muscle tension and tightness, which may in turn lead to back pain.

How to avoid injuries

Your best bet in preventing back pain and injury is to be as fit as you can be and take steps to make your work and your working environment as safe as possible.

Be fit

Even if you move around a lot on your job or your job requires physical exertion, you still need to exercise. Regular exercise is your best bet in maintaining a healthy back. First of all, you'll keep your weight in check, and carrying around a healthy weight for your body's frame minimizes stress on your back.

You can do specific strengthening and stretching exercises that target your back muscles. These exercises are called "core strengthening" because they work both your abdominal and back muscles. Strong and flexible muscles will help keep your back in shape.

Pay attention to posture

Poor posture stresses your back. When you slouch or stand with a swayback, you exaggerate your back's natural curves. Such posture can lead to muscle fatigue and injury. In contrast, good posture relaxes your muscles and requires minimal effort to balance your body.

Standing posture

If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level. Don't bend forward to do desk work or handwork.

Sitting posture

To promote comfort and good posture while sitting, choose a chair that supports your back. Adjust the chair so that your feet stay flat on the floor. If the chair doesn't support your lower back's curve, place a rolled towel or small pillow behind your lower back. Remove bulky objects, such as a wallet, from your back pockets when you sit because they can disrupt balance in your lower back.

Lift properly

There's a right way and a wrong way to lift and carry a load. Some key tips for lifting the right way include letting your legs do the work, keeping objects close to your body and recruiting help if a load is too heavy.

Adjust your work space

Look at the setup of your office or work area. Think about how you could modify repetitive job tasks to reduce physical demands. Remember that you're trying to decrease force and repetition and maintain healthy, safe postures. For instance, you might use lifting devices or adjustable equipment to help you lift loads. If you're on the phone most of the day, try a headset. Avoid cradling the phone between your shoulder and ear to free up your hands for yet another task. If you work at a computer, make sure that your monitor and chair are positioned properly.

Adopt healthy work habits

Pay attention to your surroundings and abilities on the job. Take these steps to prevent back pain:

Plan your moves

Reorganize your work to eliminate high-risk, repetitive movements. Avoid unnecessary bending, twisting and reaching. Limit the time you spend carrying heavy briefcases, purses and bags. If you're carrying something heavy, know exactly where you intend to put it and whether that space is free from clutter.

Listen to your body

If you must sit or stand for a prolonged period, change your position often. Take a 30-second timeout every 15 minutes or so to stretch, move or relax. Try standing up when you answer the phone, to stretch and change positions. If your back hurts, stop activities that aggravate it.

Minimize hazards

Falls can seriously injure your back. Think twice before wearing high heels. Low-heeled shoes with nonslip soles are a better bet. Remove anything from your work space that might cause you to trip.

Work on coordination and balance

Just walking regularly for exercise can help you maintain your coordination and balance. You can also perform balance exercises to keep you steady on your feet.

Reduce stress

Being under stress causes your muscles to tense, and this can make you more prone to injury. In addition, the more stress you feel, the lower your tolerance for pain. Try to minimize your sources of stress both on the job and at home. Develop coping mechanisms for times when you feel especially stressed. For instance, perform deep-breathing exercises, take a walk around the block or talk about your frustrations with a trusted friend.

Preventing Falls From a Ladder

2008-05-17T08:38:00.000-07:00

1. Choose the right ladder for the job.First you need to make sure that a ladder is the best equipment for what you need to do. Would a scaffolding or a mechanical lift be better?

Many times, the ladder is the only physical support you have while you are working. If it fails, you can fall. That's why it is so important to find the right ladder when you do need to use one.

The three main types of ladders—step ladders, straight ladders, and extension ladders—are used in different situations for different tasks.

Before you start using a ladder, ask yourself two questions.

Is the ladder long enough? It should be long enough for you to set it at a stable angle and still extend at the top to give you something to hold on to when you get on the ladder to descend. Setting the ladder at the right angle helps you keep your balance on the ladder. It also helps keep the ladder from falling backwards.

Make sure the ladder extends 3 feet (3 rungs; 0.9 meters) above the surface you will be working on.

Make sure the ladder is placed at a stable angle. For every four feet (1.2 m) high the ladder is, the base should be 1 foot (.3 m) out from the wall

For example, if you will be working on a 10 foot-high roof (3 m), you need a ladder that is at least 14 feet (4.25 m) long. The base should be 2 ½ feet (.75 m) from the wall. Is the ladder in good working condition? It shouldn’t be missing pieces or be cracked or otherwise damaged. Check the duty rating on extension ladders – is it high enough for the weight you will be putting on it? Longer ladders don’t always have higher duty ratings, so be sure to check. In construction, the most common ratings are:

• Type 1 supports up to 250 pounds (113 kg).
• Type 1A supports up to 300 pounds (136 kg).
• Type 1AA supports up to 375 pounds (170 kg).

2. Tie the top and bottom of the ladder to fixed points.

Tie both sides of the top of the ladder to a fixed point on the roof or other high surface near where you are working. The bottom should be tied to a fixed point on the ground. Securing the ladder in this way prevents the ladder from sliding side-to-side or falling backwards and prevents the base from sliding.

Tying the ladder off at the beginning of the day and untying it at the end will only take you about 5 minutes. It can make all the difference for your safety. If you need to move the ladder around, allow extra time for this important step, or consider using something else, such as a scaffold.

3. Don't carry tools or other materials in-hand while climbing the ladder.

Take precautions when you are going up or down a ladder. Instead of carrying tools, boards, or other materials in your hands, use a tool belt, install a rope and pulley system, or tie a rope around your materials and pull them up once you have reached the work surface. Ask for help if you need to use more than one hand to pull them up.

Carrying tools or anything else in your hands as you climb the ladder can throw you off balance.

When you climb a ladder, you should always have 3 points of contact to keep you stable. That means that you either have both feet and one hand gripping the ladder, or both hands and one foot, at all times. If one of your hands is full, you can't maintain your 3 points of contact and aren't stable on the ladder.

Preventing Construction Falls

2008-05-16T08:35:00.000-07:00

CDC/NIOSH works in partnership with The Center for Construction Research and Training (CPWR), Hollywood, Health and Society, and the Spanish-language network Telemundo to develop and evaluate this new approach to disseminating workplace safety and health information.

The storyline, part of Telemundo's hit show Pecados Ajenos (weeknights at 10 PM), is intended to raise awareness among Spanish-speaking construction workers, and their friends and families, about the safety risks they often face at work and how to prevent them.

The focus of the storyline was determined by a few basic facts:

• More than 2 million Latinos work in construction in the U.S.
• Every day, four construction workers die on the job, and one of them is Latino.
• Falls are the most common cause of fatal injuries to construction workers.
• The consequences of a fall affect not only the worker, but also his family and community.

Construction falls can be prevented. Contractors and foreman can do many things to organize the worksite to be safer for their employees. But workers themselves can also make some inexpensive, simple changes to the way they work that can save their lives.

Ladders are one of the most common pieces of equipment on a construction site. But that doesn't mean they are safe. There are construction workers who are injured or killed falling from a height every day. Using ladders more safely is one way to start preventing falls at your work site.

Your co-workers can learn a lot from you.

At first, you might be the only one who is concerned with safety at your worksite. But over time, other workers will see that the foreman will give you the time you need to be safe. They will see how many little things add up to big effects on safety. And they will see how they, too, can help to make your worksite safer.

So, set an example!

Don't worry about being the first—they'll thank you for it later.

Workers Memorial Day

2008-05-15T08:34:00.000-07:00

Workers Memorial Day, April 28, was established to recognize workers who died or were injured on the job. On average, 16 workers in the United States die each day from injuries sustained at work , and 134 are estimated to die from work-related diseases .

Daily, an estimated 11,200 private-sector workers have a nonfatal work-related injury or illness, and as a result, more than half require a job transfer, work restrictions, or time away from their jobs .

An estimated 9,000 workers are treated in emergency departments each day because of occupational injuries, and approximately 200 of these workers are hospitalized . In 2005, workers' compensation costs for employers totaled an estimated $89 billion .

Workers Memorial Day 2008 also will commemorate the thirty-seventh anniversary of the creation of the National Institute for Occupational Safety and Health in the U.S. Department of Health and Human Services and the Occupational Safety and Health Administration in the U.S. Department of Labor.

While much progress has been made in preventing work-related injuries, illnesses, and deaths since NIOSH and OSHA were created in 1971, more remains to be done. The occasion of Workers Memorial Day encourages us to think of ways in which we all can help to achieve the goal of safer and healthier workplaces.

Firefighters at risk for Cancer

2008-05-14T08:32:00.000-07:00

A new study suggests that firefighters face higher-than-average risks of several types of cancer, adding to evidence that the job carries hazards beyond the fires themselves.

A number of studies have found that firefighters have elevated cancer rates, though they have not always been consistent in the specific types of cancer.

In the current study, researchers found that professional firefighters had higher-than-expected rates of colon cancer and brain cancer. There was also evidence, albeit weaker, that they had elevated risks of bladder and kidney cancers, as well as Hodgkin's lymphoma.

Dr. Letitia Davis with the Massachusetts Department of Public Health in Boston, and colleagues report the findings in the American Journal of Industrial Medicine.

Firefighters are exposed to many potentially cancer-causing chemicals released from burning materials. At the scene of the fire, toxic substances such as benzene, lead, uranium and asbestos can be inhaled or absorbed through the skin.

Though firefighters wear a breathing apparatus and other protective equipment while battling blazes, they typically do not wear the gear when they're merely in the vicinity of the fire. There can also be health hazards at the firehouse, where idling trucks expose firefighters to diesel exhaust.

For their study, the researcher combed through nearly two decades' worth of data from the Massachusetts cancer registry. Between 1986 and 2003, the registry recorded 2,125 cancer diagnoses among professional male firefighters.

The researchers found that, compared with men in other occupations, firefighters had nearly twice the risk of brain cancer and a 36 percent higher risk of colon cancer. They also showed higher risks of bladder cancer, kidney cancer and Hodgkin's lymphoma, but the evidence was weaker due, in part, to the relatively small number of cases.

Other researchers have called for greater efforts to protect firefighters from the toxic substances that may be fueling these elevated cancer rates -- including less cumbersome protective equipment that firefighters can keep on when they are near a fire.

Experts also recommend that firefighters shower as soon as they return to the firehouse, in order to remove contaminated soot from their skin.

At the end of life, a turn to "slow medicine"

2008-05-13T08:10:00.000-07:00

Edie Gieg, 85, strides ahead of people half her age and plays a fast-paced game of tennis. But when it comes to health care, she is a champion of "slow medicine," an approach that encourages less aggressive — and less costly — care at the end of life.

Slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency-room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.

Slow medicine, which shares with hospice care the goal of comfort rather than cure, is increasingly available in nursing homes, but for those living at home or in assisted living, a medical scare usually prompts a call to 911, with little opportunity to choose otherwise.

At the end of her husband's life, Gieg was spared these extreme options because she lives in Kendal at Hanover, a retirement community affiliated with Dartmouth Medical School that has become a laboratory for the slow-medicine movement. At Kendal, it is possible — even routine — for residents to say "No" to hospitalization, tests, surgery, medication or nutrition.

Charley Gieg, 86 at the time, was suffering from a heart condition, an intestinal disorder and the early stages of Alzheimer's disease when doctors suspected he also had throat cancer.

A specialist outlined what he was facing: biopsies, anesthesia, surgery, radiation or chemotherapy. Edie Gieg doubted he had the resilience to bounce back. She worried, instead, that such treatments would accelerate his downward trajectory, ushering in a prolonged period of decline and dependence. This is what the Giegs said they feared even more than dying, what some call "death by intensive care."

Many people in their 80s and 90s — and their boomer children — want to pull out all the stops to stay alive. The costliest patients — the elderly with multiple chronic illnesses — are the only group with universal health coverage under Medicare, leading to huge federal expenditures that experts agree are unsustainable as boomers age.

Dr. Tom Rosenthal, UCLA's chief medical officer, said aggressive treatment for the elderly at acute-care hospitals can be "inhumane," and that once a patient and family were drawn into that system, "it's really hard to pull back from it."

"The culture has a built-in bias that everything that can be done will be done," Rosenthal said, adding that the pace of a hospital also discourages "real heart-to-heart discussions."
Beginning that conversation earlier, he said, "sounds like fundamentally the right way to practice."

That means explaining that elderly people are rarely saved from cardiac arrest by CPR, or advising women with broken hips that they may never walk again, with or without surgery, unless they have the stamina for physical therapy.

"It's almost an accident when someone gets what they want," said Dr. Mark McClellan, a former administrator of Medicare.

The term slow medicine was coined by Dr. Dennis McCullough, a Dartmouth geriatrician and author of "My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved One."

Among the hard truths is that nine of 10 people who live past 80 will wind up unable to take care of themselves, either because of frailty or dementia.

"Everyone thinks they'll be the lucky one, but we can't go along with that myth," McCullough said.

Too much, too little sleep tied to ill health in CDC study

2008-05-12T20:18:00.000-07:00

People who sleep fewer than six hours a night - or more than nine - are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies.

The study also linked light sleepers to higher smoking rates, less physical activity and more alcohol use.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don't get proper shuteye, said Dr. Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine.

"The data is all coming together that short sleepers and long sleepers don't do so well," Kramer said.

The study released Wednesday is based on door-to-door surveys of 87,000 U.S. adults from 2004 through 2006 conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Such surveys can't prove cause-effect relationships, so - for example - it's not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study's lead author.

It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 percent smoking.

The overall U.S. smoking rate is about 21 percent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 percent.

Results were similar, though a bit less dramatic, for obesity: About 33 percent of those who slept less than six hours were obese, and 26 percent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 percent.

For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.

Stress or psychological problems may explain what's going on with some of the lighter sleepers, experts said.

Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected Columbia University sleep researcher.

"We're getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity," said Gangwisch, who was not involved in the study.

Train Quarantined in Ontario

2008-05-11T08:14:00.000-07:00

Authorities quarantined a train in Ontario Friday after a woman died and several others reported being ill. But a doctor later ruled out a serious infectious disease and said the train would likely soon resume its journey.

Dr. David Williams, Ontario's chief medical officer, said that an elderly woman who died on the train did not have an infectious disease and the illnesses were unrelated.

A passenger who was airlifted to a hospital and five others who reported being sick had unrelated minor illnesses, Williams said. He called it a confluence of three different events.
One person was hospitalized in stable condition, said Laurel Ostfield, a spokeswoman for Ontario's minister of health.

"The origin of the illness that caused the passenger death is unknown at this time," Williams said. "Lab tests have to date have eliminated a number of serious infectious illnesses."

Williams anticipated that the train will continue onto Toronto later Friday.

Officials were keeping passengers from leaving the train, said Steve Trinier, the director of ambulance services in the area.

The train, carrying 269 passengers and 30 crew members, was being held in the station in the town of Foleyet, 500 miles northwest of Toronto. The station was evacuated.

The cross country Via passenger train was headed from Vancouver to Toronto when emergency officials received a call Friday morning and met the train in Foleyet.

Health officials were on the alert for norovirus, which can cause stomach flu and can be caught through contact with infected people or by touching or ingesting contaminated items.

Who Gets Treated in a Pandemic?

2008-05-10T08:30:00.000-07:00

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health-care disaster hits, said Dr. Asha Devereaux. She is a critical-care specialist in San Diego and lead writer of the task-force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task-force members said.
Their recommendations appear in a report appearing today in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

People older than 85
Those with severe trauma, which could include critical injuries from car crashes and shootings.
Severely burned patients older than 60.
Those with severe mental impairment, which could include advanced Alzheimer's disease.
Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency-operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Georgetown University public-health-law expert Lawrence Gostin, who was not on the task force, called the report an important initiative but also "a political minefield and a legal minefield."

If strictly followed, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said.

Children of Smokers Less Healthy than they seem

2008-05-09T07:33:00.000-07:00

Children with smoking parents may not be as healthy as they appear.

A study presented at the American Thoracic Society International Conference shows that although children of smokers may not exhibit respiratory problems, they may still be suffering from damage to their airways.

Some researchers claim that children of smokers are more likely to have respiratory problems such as puffing, wheezing, and cases of pneumonia.

However it is unclear if there is impairment in children who have no respiratory complaints or diagnosed problems.

The study consisted of 244 children ages 4 through 12 who had no history of lung or airway ailments. Based on the smoking patterns of parents, the children were separated into four groups:

(1) never smokers
(2) smoking after birth but not during pregnancy
(3) during pregnancy but not after birth
(4) before and after both. Children of smoking parents were found to have reductions in lung function similar to that in smokers.

Smoking after birth contributed more to lung impairment than smoking during pregnancy alone.

Researchers believe that, with the growing number of outdoor smoking bans, there may be an increasing trend for parents to smoke inside the home. While no ill effects of passive smoking have been demonstrated from outdoor smoke, if such a trend proves to be true, children exposed to indoor smoke could see diminished lung function over time.

It remains controversial whether personal smoking habits go beyond affecting the health of a single individual, and whether outdoor smoking bans make any sense from a scientific standpoint..

A look back to Workplace Injury Stats in 1992

2008-05-07T10:19:00.000-07:00

Most Americans between the ages of 22 and 65 spend 40 to 50 percent of waking hours at work. Every year millions of Americans suffer injuries and thousands experience deaths in our workplaces. Yet little effort has been made to estimate either the extent of these injuries, deaths, and diseases or their cost to the economy. Thus, important questions about workplace safety and the economic resources expended due to workplace health problems remain unanswered.

In this study, we address these questions by presenting estimates of the incidence, prevalence, and costs of workplace-related injuries, illnesses, and deaths for the entire civilian workforce of the United States in 1992. We also consider controversies surrounding cost methodologies, estimate how these costs are distributed across occupations, consider who pays the costs, and address some policy issues.

Our major findings are as follows:

Roughly 6,371 job-related injury deaths, 13.3 million nonfatal injuries, 60,300 disease deaths, and 1,184,000 illnesses occurred in the U.S. workplace in 1992.

The total direct and indirect costs associated with these injuries and illnesses were estimated to be $155.5 billion, or nearly 3 percent of gross domestic product (GDP).

Direct costs included medical expenses for hospitals, physicians, and drugs, as well as health insurance administration costs, and were estimated to be $51.8 billion.

The indirect costs included loss of wages, costs of fringe benefits, and loss of home production (e.g., child care provided by parent and home repairs), as well as employer retraining and workplace disruption costs, and were estimated to be $103.7 billion.

Injuries generated roughly 85 percent whereas diseases generated 15 percent of all costs.
These costs are large when compared to those for other diseases. The costs are roughly five times the costs for AIDS, three times the costs for Alzheimer's disease, more than the costs of arthritis, nearly as great as the costs for cancer, and roughly 82 percent of the costs of all circulatory (heart and stroke) diseases.

Workers' compensation covered roughly 27 percent of all costs. Taxpayers paid approximately 18 percent of these costs through contributions to Medicare, Medicaid, and Social Security.

Costs were borne by injured workers and their families, by all other workers through lower wages, by firms through lower profits, and by consumers through higher prices.

Our study appears to be the first to use national data to produce estimates on costs for occupational injuries and illnesses. Prior studies have underestimated costs by ignoring nondisabling injuries, deaths, and workplace violence, by taking inadequate account of diseases, and, most importantly, by relying on only one or two sources of data.

The Annual Survey of the Bureau of Labor Statistics (BLS) provides the most reliable and comprehensive data on nonfatal injuries. However, it misses roughly 53 percent of job-related injuries. This omission, in part, is due to the exclusion of government employees and the self-employed and also, in part, due to illegal underreporting by private firms.

Contrary to the Annual Survey data, we find small firms have exceptionally high injury rates.
Occupations contributing the most to costs included truck drivers, laborers, janitors, nursing orderlies, assemblers, and carpenters. On a per capita basis, lumberjacks, laborers, millwrights, prison guards, and meatcutters contributed the most to costs.

Occupations at highest risk for carpal tunnel syndrome include dental hygienists, meatcutters, sewing machine operators, and assemblers. Among well-paid professions, dentists face the highest risks.

Any of the major sources of data, such as the Bureau of Labor Statistics, National Institute for Occupational Safety and Health, workers' compensation systems, or National Health Interview Survey, by themselves underestimate the numbers of injuries and illnesses.

Greater efforts need to be directed toward gathering data on job-related injuries and illnesses. The United States needs a comprehensive data bank for fatal and nonfatal injuries and all illnesses. Future researchers should not have to investigate the over 20 sources of primary data and 300 sources of secondary data that we investigated.

Asthma Worsened by Obesity

2008-05-06T06:50:00.000-07:00

In asthma patients, dynamic hyperinflation, following a test measure airway hypersensitivity, is greater in obese individuals than in their nonobese counterparts, which helps explain why asthma is perceived to be more severe in patients with a higher body mass index (BMI), investigators in New Zealand report.

A BMI is the ratio between height and weight, and is used to classify people as underweight, overweight or normal weight.

"The greater dynamic hyperinflation means that obese individuals lose the ability to inhale as deeply or exhale as fully as normal weight individuals," Dr. D. Robin Taylor explains in an American Thoracic Society statement.

Taylor's team at the University of Otago in Dunedin studied the changes in airway expansion and lung volume that occur with acute constriction of the bronchial tubes in a group of 30 adult women with asthma. Ten women each were classified as normal weight, overweight, or obese, and lung volumes were measured.

The degree of bronchial constriction following the airway sensitivity test did not vary by group, the team reports in the American Journal of Respiratory and Critical Care Medicine. The only significant difference among the subjects was a decrease in vital capacity that significantly corresponded with increasing BMI.

Lung volume measurements also showed that the volume of air retained in the lung following exhalation was significantly higher as BMI increased, while the amount of air that could be inhaled was lower.

These variations "were significantly greater in relation to BMI" after taking into account the effects of "airway hyperresponsiveness, the severity of airflow obstruction, and lung volume measurements, indicating the effect of BMI was an independent one," the investigators note, meaning that BMI alone was associated with the severity of asthma.

This puts obese individuals at greater disadvantage due to enhanced gas trapping, they point out, a significant contributor to difficulty in breathing.

Taylor and his associates also noted that conventional lung function tests "may have limitations when used to evaluate symptoms in obese patients with asthma, with the potential for misinterpretation" in the absence of lung volume measurements.

Healthy Trust Occupational Health Clinic

2008-05-05T15:13:00.000-07:00

Healthy Trust Occupational Health Clinic serves as your companies ‘team doctor ’

Challenging government regulations and rising workers’ compensation premiums may make navigating through a workplace injury daunting to an employer. Having a health care partner completely dedicated to the health and safety of your employees not only results in a productive work force, it is also vital to the bottom line.

Healthy Trust Immediate Medical Care, a locally owned and operated occupational medicine clinic, is comprised of trained and certified professionals striving to ensure worker health and safety in the Chicago North Shore suburbs.

Along with skilled treatment of job-related injuries, Healthy Trust Immediate Medical Care can provide your company with drug and alcohol testing, respirator mask fitting, audio testing, immunizations, diagnostic services, customized wellness plans, preventive screenings, and other health services. Many of these services can be provided at your worksite or office.

An occupational medicine physician is similar to a team doctor for a sports team. The ultimate goal is to get the employee (athlete) healthy and back into the workplace quickly. In the past, occupational medicine was thought to only be practical for the industrial corridor—construction and manufacturing companies, refineries and other industrial organizations.

Today, representatives from all businesses, industrial and professional, are recognizing the benefits of a strong working relationship with an occupational medicine provider.

Healthy Trust Immediate Medical Care serves as the company’s medical department, providing health care services to employees. With proper testing, Healthy Trust providers may spot pre-existing medical conditions that otherwise have gone unnoticed.

Healthy Trust Occupational Health Clinic can also assist in the development of a drug and alcohol testing program in an effort to monitor a safe work environment. “Employers can increase the productivity of their employees,” says Medical Director Dr. Boris Gurevich. “Whether it’s flu shots or wellness programs, there is a substantial return on each dollar spent.”

Time is a major factor in the workplace today. Many companies now operate outside of the traditional 9 to 5 workday and need a health care provider to accommodate the odd-hour schedules of their employees. Healthy Trust Occupational Health Clinic makes this easy.

Extended hours help to alleviate the stress of taking time out of the workday to receive necessary health care services.

The physicians and other clinical providers at Healthy Trust Immediate Care are trained in occupational health issues and are ready to provide reliable and professional services for all segments of business and industry.

Healthy Trust Occupational Health Clinic serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Walking While Working

2008-05-05T08:37:00.000-07:00

On the heels of research finding that fat-burning enzymes shut down while sitting, Mayo Clinic researchers believe they may have the cure for inactive 9-to-5ers chained to their desks: walking workstations.

According to experts, the walkstations, which resemble treadmills with computers attached, represent a bold new step by the medical community in an effort to fight the rising obesity epidemic.

James Levine, an endocrinologist at the Mayo Clinic, came up with the walkstation idea about three years ago while talking to an ABC producer about new obesity research; it indicated that people with obesity fidget less and are more likely to sit than people who aren't obese.

During the conversation, Levine gave her four ideas to revolutionize offices. Six weeks later, he began putting them into action as part of his NEAT (non-exercise activity thermogenesis) initiative to transform offices into gyms.

"Support from the Mayo Clinic was unbelievable. People at Mayo said this is very important," Levine said. "They literally assigned 50 to 60 builders to do this, night and day. I would show up at 3 in the morning, people would be there painting walls, designing desks."

Fifteen years of research at the Mayo Clinic has shown that sitting all day long at the office is actually quite harmful to human health and that people who are obese tend to be seated two hours more than leaner people, according to Levine.

We're chair-based. People being seated all day is crucial to why obesity occurred," he said.
Levine first tested the newly designed office with his own research staff for six to 10 weeks. Then he approached Steelcase to collaborate and develop walkstations that can now be integrated into any office.

"They call it a walkstation, I call it a dream for my patients," he said. "One can write manuscripts, talk on the telephone while walking one mile per hour. Patients with weight problems are burning 100 to 150 calories more per hour, potentially 1,000 more per day. That number is profoundly important."

In offices with walkstations, employees can also hold conferences on the move. Levine's research team even developed "Meeting in Progress" stickers that indicate that a person is not to be interrupted as they're walking.

A month ago, Deb Bailey, director of corporate communications at Steelcase, began to use one of the walkstation units available at her office.

"I walked by a couple of times [and] saw other people using them," she said. "I was shocked at the way they were sending e-mails, checking e-mails while on the treadmill. Then I thought, why not be multitasking in a healthy way?"

Bailey now uses the walkstation daily.

"I jump on it for an hour. In the morning, I check e-mails; it's a nice period of time," she said. "I think I'm more productive [throughout the day as a result. It gets the adrenaline pumping."
She is quick to dismiss criticism of the new units.

"People will say it's a treadmill. It's not like I'm trying to talk and run. I keep it at a 1.3 miles per hour gait," she said. "It's very much regular activity. The only thing I do differently is bring a pair of walking shoes. It's not designed to be strenuous. It's the same thing you would be doing if you were on campus walking from building to building."

She also adds that the walkstation is an excellent remedy for the midafternoon post lunch sugar slump.

"We only look at a change in posture as a good way of adding energy. Why not stand up and do this? Or a 30-minute conference call, do it from a walkstation," Bailey said.

Growing Trend?

Four walkstations are currently in use at Wal-Mart's corporate offices in Bentonville, Ark., and at Salo, a financial outsourcing firm in Minneapolis, according to Bud Klipa, president of Details, a Steelcase company. Hundreds of walkstations have already been reserved for customers, including some Fortune 500 companies.

The walkstations are also extending into some schools. Traditional school desks are removed from classrooms; kids are then free to sit on the floor with their laptops, stand or move around as they're listening to their teachers.

Student behaviors in those schools improved substantially, according to Levine.
The response from the scientific community the walkstations has been largely positive.

"Often in science when you come up with ideas that are offbeat, the standard response of many scientists is very skeptical. Sometimes it's unhelpful because it makes people think scientists argue all the time," said George Brooks, a professor in the Department of Integrative Biology at the University of California at Berkeley. "When I sent an e-mail to NIH[National Institutes of Health] [about the whole project], no scientist was opposed to it. They said, "How can we be involved?' It's fantastic. It's been incredible, quite amazing."

Brooks believes that the walkstations are an important step in the fight against obesity.

"Physical activity is gone from our jobs, as a consequence people are overweight, diabetic, and it's even leading to some forms of cancer. We need to be active at least one hour a day," he said. "The walk stations are a revolutionary step in terms of putting physical activity in the workplace in a way people are still effective at their jobs."

Brooks insists that investing in workplace fitness has great benefits for employers, despite financial costs.

"If organizations try to implement it, we'll see if people will do it. I think people will resist it mightily," he said. "But people who will do it will be healthier, more effective, and happier."

Urgent Care In Tucson

2008-05-04T16:43:00.000-07:00

A surgeon and a physician assistant who took care of injured troops in Iraq and Afghanistan are now using their emergency treatment skills at a new urgent care cetner they’ve opened in north central Tucson.

Dr. David Orringer, a surgeon, and Davidson Hall, a physician assistant, partnered to open Velo Med Urgent Care in a 6,400-square-foot building at 50 E. Croydon Park Road, off North Stone Avenue a block south of River Road. The urgent care business is using 4,400 square feet of space and Orringer and Hall plan to rent the remaining 2,000 square feet to a tenant.

Although trained as a surgeon, Dr. Orringer said he had never considered getting involved with an urgent care facility until after treating wounded military personnel.

"A lot of what you get in the field is bare bones operations," Dr. Orringer said. "You’re treating people with few resources and so you have to be prepared to see anything and everything — and you have so many guys depending on you. So urgent care is the same except in a little more of a controlled environment, with better equipment and better resources and a fully trained staff."

Orringer believes his military experience now serves him and Hall well as they see "pretty much anything and everything." He realized while in Iraq and Afghanistan that handling emergency treatment never gets boring and has a component of excitement about it that he thrives on.
The building was designed by Edward Marley, of Swaim Associates LTD Architects. Orringer said Marley, like himself, is a cycling enthusiast and the clinic’s reception area has been designed in the pattern of a bicycle.

An accomplished classical pianist and opera singer who once considered that as a career, Dr. Orringer achieved the rank of major and served as the medical director for the Air Force’s Combat Search and Rescue mission in Iraq and Afghanistan for four months each location before leaving the Air Force in 2007. Hall was a combat medic in Iraq during Desert Storm and also served with the 82nd Airborne and as a Special Forces Medic.

Orringer was awarded the Sikorsky Rescue Award, given to those involved in the rescue of someone in combat.

According to the Sikorsky website, the Winged-S Rescue Award Program was created in 1950 to honor all those who perform rescues flying a Sikorsky helicopter. "Through this award, we gratefully acknowledge the humanitarian efforts of all pilots and crewmembers who put themselves in harm’s way to save others and fulfill company founder Igor Sikorsky’s vision of the helicopter as a unique and powerful life-saving instrument," the website says.

Orringer and Hall met while practicing at another urgent care facility in Tucson and decided to open Velo Med Urgent Care facility.

The facility, which employees 16, including two other part-time physicians, has five exam rooms and a sixth which also is used for minor surgical procedures. There also is an X ray suite, a lab and a limited onsite pharmacy.

The clinic specializes in sports or work injuries, physical exams, lacerations, sprains, rashes, allergies, colds and coughs and sore throats and walk-ins are encouraged.

Originally from New England, where he studied classical piano at Dartmouth, Dr. Orringer said he "really fell in love with Tucson" and decided to stay here. Because there are not enough primary care physicians and emergency rooms are overcrowded here in Tucson, Dr. Orringer said he felt that his new clinic could offer a good intermediate solution for patients.

His sole disadvantage in Tucson is that he doesn’t get much opportunity to use his classical piano and opera training. "It’s mostly just singing in the car," he laughed.

Georgia Tackling the Plight of the Un, and Under Insured

2008-05-01T07:06:00.000-07:00

For those hoping state leaders will find a way to help pare down the number of uninsured Georgians, the doctors are in.

Whether their diagnoses and cures are the right ones depends on who you listen to. Among the major proposals in front of lawmakers is a move by Gov. Sonny Perdue to embrace high-deductible health care plans and accompanying health savings accounts. Also getting attention is a pair of proposals from Lt. Gov. Casey Cagle, one that would give a financial boost to free clinics and another that would provide more information to health-care consumers. Rounding out the bunch is a proposal by Insurance and Safety Fire Commissioner John Oxendine to force health insurance companies to get his approval before they can raise premiums.

Critics question how valuable some of those free-market ideas might be and focus on efforts to expand what they see as tried-and-true government programs, such as the joint state-federal Medicaid health insurance plan for lower-income Georgians.

All of the ideas are aimed at trying to get at least some of an estimated 1.7 million uninsured Georgians onto an insurance plan, or to at least tame costs so they can afford one if they choose.
Though legislative leaders haven't necessarily rallied behind a single idea yet, some are just happy the issue is being mentioned.

"We're just elated that this is on the table to figure out how to start addressing this," said Jimmy Lewis, the CEO of HomeTown Health, an organization of small and rural hospitals.

THE CHEAPEST PRODUCT ON THE MARKET

Mr. Perdue's major initiative is an effort to promote high-deductible health-care plans. Those plans don't provide as much coverage of routine visits to the doctor or other small medical costs. Instead, patients have to pay a more sizable deductible than under other plans, one usually met only because of a long-term illness or a major accident.

In return, they pay less in monthly premiums than for more traditional and comprehensive coverage.

Supporters say the high-deductible plans often bring in many workers who would otherwise be unable to afford health insurance.

"This will be the cheapest product on the market," said Rep. Mickey Channell, R-Greensboro, a key legislative voice on health-care issues and a sponsor of the House version of Mr. Perdue's proposal.

The governor's idea, which Mr. Oxendine has recently said was largely taken from his previous proposals, would exempt premium payments for the high-deductible plans from the state's premium tax and allow Georgians to claim the payments as deductions on their state income taxes if they're not already doing so on their federal taxes.

And it would change state laws that some read as barring rewards for healthy behaviors that many high-deductible plans use to help members build up their health savings accounts.
Those accounts allow members to save the money they need to cover the small-ticket medical costs until they reach the deductible.

Critics aren't sure the plans will work.

"The problem is that they don't really address the bulk of the uninsured population," said Timothy Sweeney, a senior health-care analyst at the private Georgia Budget and Policy Institute, which advocates more funding for social programs.

Even the high-deductible programs are financially out of reach for many lower-income families trying to find health care, critics say, and some who could already pay for insurance but don't because of the current high prices.

"A certain number of people might be able to get insurance," said Alan Essig, the institute's executive director. "But then there's a question of whether they could have afforded it anyway."
Mr. Channell counters that 30 percent to 35 percent of those who sign up for the plans nationwide are uninsured when they do so.

OTHER IDEAS

Both of Mr. Cagle's ideas seem to enjoy fairly broad support among those who follow health-care issues. One proposal would give grants of up to $30,000 toward planning a free clinic and up to $150,000 for existing clinics that work with lower-income patients.

The idea is that those clinics could provide some of the less-urgent and preventative care that would keep uninsured patients out of the emergency room, where the cost of care is far higher.
Mr. Sweeney cautions against seeing the clinics as a cure.

"Free care at a clinic certainly does not replace health insurance," he said.

A separate measure by Mr. Channell would give doctors a $25-an-hour tax credit for working at one of the clinics.

Mr. Cagle would also create a Georgia Health Marketplace, which would help consumers shop around for various health-care options.

Mr. Sweeney and Mr. Essig argue that the state might already have the best solution for its uninsured residents: Medicaid. Raising the eligibility rate could bring thousands of new people into the system, with the federal government picking up 60 percent of the costs.

"That may be a more effective way of enrolling people, getting people health care, than some of the more individual ways that we're talking about now," Mr. Essig said.

Some say there are problems with that approach. Expanding Medicaid would be expensive -- even with federal help -- and would likely rankle some of the free-market conservatives in the GOP-controlled Legislature. Mr. Channell said he thinks it is unlikely to pass.

Mr. Lewis of HomeTown Health said expanding Medicaid would exacerbate another problem. Hospitals now complain that they lose 15 cents for every dollar they spend treating Medicaid patients because of low reimbursement rates.

"It would just accelerate the demise of a number of providers and force them out of business," he said.

You're sick, They're quick

2008-04-29T07:43:00.000-07:00

You're sick. They're quick.

That's the big idea behind putting small health clinics inside retail stores ranging from Wal-Mart to H-E-B.

And with more than half of walk-in clinic patients saying they will return again because of extended hours and short wait times, the battle for customers with minor ailments, such as strep throat, earaches and bladder infections, is heating up in Houston.

By year's end, the number of so-called "convenient care" clinics located inside drug stores and supermarkets is set to double in the area.

This week, CVS and Walgreen Co. announced they would each install eight in-store clinics around town by the end of 2007. RediClinic, the Houston-based outfit funded in part by AOL co-founder Steve Case, is adding three more locations inside H-E-B grocery stores by Thanksgiving.
"It's for busy people. We're not here to take the place of a primary-care physician, but sometimes people call a doctor and cannot get in for two or three days. They need fast treatment so they can get back to work," said Marcy Sawyer, manager of Houston operations for CVS's MinuteClinic concept.

The four MinuteClinics that opened in Spring, Pearland and Missouri City this week give the chain 320 locations in 24 states.

How fast is MinuteClinic multiplying? Two months ago there were only 200 locations. Within three months there will be 400 across the U.S.

MinuteClinic CEO Michael Howe can see a time when 2,500 MinuteClinics in CVS stores will blanket the nation.

No appointments

Wal-Mart CEO Lee Scott has a similar vision for his stores. Last spring he announced his intention to roll out 2,000 in-store clinics over five to seven years.

Typically, clinics of this sort don't take appointments, stay open late, offer weekend hours and are geared toward sinus infections and pink eye, not broken bones or heart failure. A menu posted in the clinic lists all services and price transparency for those paying in cash.

But it's insurance companies that are driving the expansion of in-store clinics as much as consumer demand.

Two short years ago, most store-based clinics catered to a cash-only crowd. Today, 80 percent of MinuteClinic's visits are from people with health insurance, Howe said.

A recent study by Forrester Research showed only 3 percent of people surveyed have used store-based health clinics, but that group tended to be younger, more affluent and had children.
"Moms want a place to get their kids treatment fast. They don't want to wait around in a doctor's office for something minor," said Sawyer, a nurse practitioner who used to work in private practice.

The clinics in Walgreens, CVS and H-E-B all have contracts with major insurers such as Cigna, Humana, United Healthcare and Aetna. Medicare has also signed on. While the typical walk-in visit runs around $60 out of pocket, those with insurance frequently get a discount. The clinics say they bring affordable care to the uninsured.

Oppostion lines up

But many doctors see drawbacks, even though some medical professionals view the clinics as an essential relief valve on overburdened emergency rooms that end up practicing primary care.
The American Medical Association has sounded the alarm over the cozy nature that exists between some clinics and some insurance companies.

In Minnesota and Alabama, Blue Cross/Blue Shield and other providers lowered — and in some cases waived entirely — copayments for insured workers who sought primary care from a store-based clinic instead of a regular doctor's office. The AMA is lobbying to have that practice outlawed.

The group has also questioned the clinics' underlying business model of using nurse practitioners and physician assistants to prescribe medication. Those prescriptions then get filled just a few feet away at the pharmacy counter.

The AMA calls it a conflict of interest. The industry calls it synergy.

MinuteClinic's Howe says he understands consumers' obsessions with speed and affordablity. (He used to be CEO of Arby's.) Howe also takes issue with critics who imply clinics abuse prescriptions to gin up a store's sales numbers.

"We don't get many complaints — six for every 10,000 visits — and most of those are because the nurse practitioner wouldn't write a prescription," he said, adding MinuteClinic's personnel encourage everybody to get established with a primary care physician in case more complicated health matters arise.

Traditional Urgent Care vs the Retail Clinic

Traditional Urgent or Immediate Care Centers are just as quick, and just as inexpensive, but they have a huge advantage over retail clinics for the consumer because they are staffed by board certified physicians, and have an on site lab, and X-Ray which means they can treat a wider rangle of symptoms much more effectively. remember, there is no substitute for seeing a board ceritfied physician.

Walk in Care Expanding to Airports

2008-04-28T07:49:00.000-07:00

Reluctant to deal with the hassles of airport security, sales executive Michael D'Souza generally packs the syringes he needs for his daily medication in a bag that he checks when he travels.

The strategy backfired for the Toronto resident recently when he needed the medication while he was stuck during a four-hour delay at Newark Liberty. D'Souza found new needles when an airport customer service rep told him about a pharmacy that opened late last year in Terminal C.

"I don't think I've ever seen a pharmacy at an airport," he says. "But I thought: What a good idea. People are traveling sick all the time."

Last-Minute Prescriptions

Pharmacies and walk-in health clinics are opening at more airports in the U.S., hoping to capture a sizable portion of travelers and airport employees who want access to basic primary healthcare and to fill their prescriptions at the last minute.

Such facilities are common at large foreign airports, but domestic airports have mostly focused on services that cater to travelers' immediate needs. Several entrepreneurs are betting that there's pent-up demand for such services at airports in the U.S.

While similar to primary care physician offices, walk-in clinics generally focus on a limited range of medical services and medications. Nurse practitioners typically deliver the services.

Harmony Pharmacy, which launched at Newark Liberty late last year, will open another airport shop at the much-anticipated JetBlue Terminal 5 at New York's John F. Kennedy airport in September.

AeroClinic, which runs a walk-in clinic at Hartsfield-Jackson Atlanta, will open its second branch at Philadelphia International in the spring.

Solantic, which operates walk-in clinics at several Wal-Marts, will expand into the airport market by opening at Orlando International later this year. Atlanta-based AirportMD opens its first store in Miami next month, followed by another in Minneapolis in the fall.

"Airports lend themselves as an ideal market for retail-based care because [there are] a lot of people in between flights or who have downtime," says Tine Hansen-Turton, executive director of the Convenient Care Association, a trade group for retail walk-in clinics. "You also have employers who have hours not conducive to going to primary care providers."

Several factors are driving the trend:

Greater marketing emphasis. Airports are increasingly looking for non-aviation revenue to offset discounts and promotions given to airlines to court new flights. As a result, a greater array of services and retail shops that consumers normally don't associate with flying are starting to appear between gates, including health and wellness services.

Longer waiting time. Airports have always been a potentially attractive market, says Rosemary Kelly, marketing executive of AeroClinic. About 1.2 billion people traveled through the top 20 airports last year, not including the 500,000 employees who work there. "It's the largest consumer venue anywhere in the world," she says.

With more stringent security, fliers are arriving earlier, which gives them time to receive basic health services that wouldn't otherwise be feasible.

Growth of the retail clinics industry

Airports are a new market for an already fast-growing industry. According to the Convenient Care Association, there are about 950 clinics in the U.S., and more than 500 more will open by the end of this year. Many of them are at strip malls or in big-box drugstores, but transportation hubs are seen as an attractive growth market, says Hansen-Turton.

Menu Pricing

AeroClinic says its shop at Atlanta Hartsfield focuses on 30 of the most common requests among travelers. They include ear infections, stomachaches, flu shots, antibiotics, asthma inhalers and heart medication. It also offers some preventive care for people who have more time, including diabetes monitoring, cholesterol checking and drug testing.

While they take most insurance policies, including Medicare, a distinct feature of walk-in clinics is the menu pricing rare in other doctors' offices or hospitals. At Solantic, most services fall into one of three categories.

The Level 1 category -- seeing a nurse practitioner and getting a prescription -- costs US$59.

Level 2 service -- more complicated procedures, such as strep tests, EKG (electrocardiogram) or injections -- costs $109.

Level 3 procedures -- such as stitches and X-rays -- are $169.

Harmony Pharmacy has a narrower focus on pharmaceutical products, though it has some basic primary care services delivered by nurse practitioners. It specializes in filling prescriptions and selling sundries and other travel products. It has about 1,100 types of prescription drugs, says Ken Corroon, Harmony's CEO. "People go on vacation, and they forget their heart medication or Viagra. People have varying needs."

Politics and Health Care

2008-04-27T08:02:00.000-07:00

Democratic lawmakers in Washington say they're drafting a health care reform bill that would expand coverage for low-income kids. President Bush says he'll veto any such legislation, warning that it would lead the nation "down the path to government-run health care for every American."

Like that would be a bad thing.

What's particularly galling about Bush's position is that it's coming from a man who just underwent a colonoscopy performed at the taxpayer-funded, state-of-the-art medical facility at Camp David by an elite team of doctors from the taxpayer-funded National Naval Medical Center in Bethesda, Md.

If anyone understands the benefits of government-run health care, it's the president.

But let's not get sidetracked. Bush wasn't being entirely accurate when he derided the notion of government-run health care for every American. That might make for a fine little sound bite, especially among those who fear the specter of "socialized medicine," but it's not really what's at stake.

Rather, advocates of health care reform are seeking government-run insurance for every American, leaving the health care part to those who know best - doctors and nurses.

This is a crucial distinction at a time when 47 million Americans lack medical coverage and, according to researchers at Harvard University, about a third of the $2 trillion spent annually on health care in this country is squandered on bureaucratic overhead.

"Cuba is socialized medicine," observed Dr. Kevin Grumbach, who heads the Department of Family and Community Medicine at UCSF. "The government employs all the physicians and owns all the hospitals. That's not what anyone is talking about for this country."

Rather, the focus here is on two indisputable facts: that the United States spends about twice as much per person on health care as most other industrialized democracies, and that Americans on average do not live as long as people in countries that guarantee medical coverage to their citizens.

"Why have all other countries figured out a way to do this?" Grumbach asked. "Why are we the only ones that are so uncivilized?"

The United States spent an average of $6,102 per person on health care in 2004 (the latest year for which figures are available), according to the Organization for Economic Cooperation and Development.

Canada spent $3,165 per person, France $3,159, Australia $3,120 and Britain a mere $2,508. Life expectancy in the United States was lower than in each of these other countries and infant mortality was higher.

Looking at the numbers another way, the Kaiser Family Foundation determined earlier this year that health care spending accounts for 15.2 percent of the U.S. economy.

By contrast, health care spending represents 9.9 percent of Canada's gross domestic product, 10.4 percent of France's, 9.2 percent of Australia's and just 7.8 percent of Britain's.

And again, the citizens of these countries on average live longer than we do.

In Washington, Democratic lawmakers are crafting legislation to expand the State Children's Health Insurance Program, which subsidizes insurance for low-income kids.

The Senate Finance Committee last week approved a five-year plan to increase funding for the program through a 61-cents-per-pack increase in the federal cigarette tax. This would maintain coverage for 6.6 million recipients while adding 3.2 million uninsured kids to the system.

Bush told an audience in Nashville last week that the Senate bill is "the beginning salvo of the encroachment of the federal government on the health care system." He said he'd veto any such legislation making its way to his desk.

That's a fine how-do-you-do for a guy who had five growths removed from his colon on Saturday largely at the government's expense and had them promptly examined by government experts at the government-run National Naval Medical Center.

Happily, the tests showed no sign of cancer. So Bush can rest easy for another few years, thanks to all that government health care.

No one at the White House could be reached to discuss how much the president paid out of his own pocket for the colonoscopy and subsequent testing.

Presidents typically have their own health insurance, although the first-class treatment they receive is largely defrayed by taxpayer funds. In other words, they're prime beneficiaries of government-run health care - just like in Cuba.

In a paper found on the Web site of the Defense Department's Armed Forces Institute of Pathology, former White House physician George Fuller outlines the mission of the taxpayer-funded White House Medical Unit.

He writes that a primary purpose of the group is to provide "confidential, immediate and private access to preventive, routine and urgent care for the principals." This, Fuller adds, "is a 24-hour, seven-days-a-week commitment with no exceptions."

The quality of health care is so exacting, he observes, "that the president cannot even ride an elevator in the Eisenhower Executive Office Building without a physician escort."

According to Fuller, the president enjoys the benefits of medical and dental clinics in the White House, as well as "a fully equipped and supplied outpatient clinic" at Camp David, where Bush's colon was explored.

He says the White House Medical Unit also "keeps a unique and extensive library of medical facilities throughout the world" to provide for the president's health care needs during overseas travel.

All in all, Bush is the last person with a right to complain about government-run health care for every American. We should all be so lucky.

Studying Your Urgent Care Options

2008-04-26T16:00:00.000-07:00

You're enjoying a weekend getaway and wake up in your hotel room with a sore throat and high fever. You attend an out of town wedding and sprain your ankle on the dance floor. You're about to leave Disney and your child complains of ear pain. Where should you go for treatment?

Urgent care centers deliver ambulatory care in facilities outside of the hospital. They see people on a walk-in basis without an appointment. They are appropriate for people with an injury or illness that requires immediate care but is not necessarily serious enough to warrant an emergency room visit. Urgent care centers are not open 24 hours a day but their hours are more extended than a primary care physician and most have weekends and evenings hours.

Urgent care centers treat many problems generally covered in primary care physician's offices and also offer services that are generally not available such as X-rays. Some have minor trauma rooms to treat lacerations. They cost less than an emergency room visit and usually you can get in and out in less time.

Walk-in clinics, aka retail health clinics, provide a lower level of medical treatment but still may be effective depending on your needs. They are most often found in strip malls, drugstores and mega stores. Although not popular locally yet, Kiplinger reports they will experience brisk growth and expansion over the next few years. Both CVS and Walgreens have purchased retail clinic chains and have placed them in their stores in various parts of the country, and Wal-Mart is contracting with hospitals to open in-store clinics.

Walk-in clinics are generally open seven days a week and don't require an appointment. They are usually staffed by nurse practitioners or physician assistants. You will often find a price board for various services outside the clinic so you know the charges before you are seen. The clinics treat about 25 to 30 common ailments such as cold and flu, sinus, ear and bladder infections, pink eye, allergies, minor burns and rashes, sore throat and sprains. Some provide preventive care such as health screenings and vaccinations.

Clearly, if you are very sick you should see your doctor (if available), or go to an emergency room. Chest pain, abdominal pain, trouble breathing, high fever, deep tissue damage, acute weakness, severe burns and questionable broken bones are just some of the symptoms that probably warrant an emergency room visit. But, if it's less serious you might try an alternative.

Consider your symptoms and organize your medical plan when choosing what type of clinic to go to:

Urgent Care Centers can address more serious issues, have physicians to treat you, and most likely have X-ray facilities.

*Retail health clinics treat a limited number of common conditions.

*Check with your health insurer regarding coverage for urgent care and clinics.

*Clinics will not have your medical history so it is imperative that you can accurately articulate "the highlights" and detail any currently taken medications.

The American Academy of Pediatrics opposes the use of retail clinics as an ongoing source of medical care for children due to the inability to ensure continuity of care.

Urgent Care Centers Popping up in the Midwest

2008-04-23T19:15:00.000-07:00

New urgent care centers are popping up across the Midwest, mirroring a national trend and reaffirming patients' growing desire for convenience.

Healthy Trust Immediate Medical Care opened it's Wheeling, Illinois medical clinic in July or 2007. The aim of urgent care centers like healthy Trust Immediate Medical Care is to quickly treat patients who need immediate care but don't require the level of service provided at an emergency room. They're staffed by board certified physicians as well as other medical professionals. There's no need for an appointment, and most urgent care centers are open on weekends and evenings.

Patients with broken bones and earaches are prime candidates. Urgent care centers don't provide long-term management of chronic diseases, but they frequently have X-ray machines, laboratories and other features not found in most physicians' offices.

With many primary care doctors booking appointments weeks in advance and wait times of several hours at emergency rooms, the demand for urgent care centers is growing, experts said. Many insurers are helping drive the expansion by offering patients lower co-pays if they choose an urgent care center over an emergency room.

Urgent care centers like Healthy Trust, many of which were started by physicians' groups, first sprouted up in the early 1980s. Over the next 15 years, a decline occurred. Some of these centers went bankrupt, others were sold to hospitals and then closed. A resurgence began in the mid-1990s. There are between 12,000 and 20,000 of these centers nationwide, according to a 2004 report by the California Healthcare Foundation. A 2005 report in Emergency Medicine Review estimated as many as two new urgent care facilities open each week.

Dr. Boris Gurevich of Healthy Trust Immediate Medical Care points out that several of the urgent care centers locally are within a couple of miles of each other. "The question is how many of these centers will remain self supporting, how many will remain successful?"

Dr. Gurevich believes the centers that survive will provide the services of board certified physicians, and marketing which is directed toward helping the surrounding community get quality health care at an affordable price. he feels that retail clinics staffed by Nurse Practitioners without an onsite lab, and radiology have too narrow a diagnostic scope to survive long term.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

ER vs Urgent Care

2008-04-21T09:15:00.000-07:00

A headache attack has brought you to the brink of seeking medical treatment. Do you visit the local emergency room (ER) or should you visit an urgent care facility (UC)? According to a recent online survey conducted by the National Headache Foundation (NHF), more sufferers visited an ER; however, headache sufferers might benefit by seeking treatment at a UC facility.
According to the NHF online survey, 68% of survey respondents have visited an emergency room for headache treatment. Forty-five percent of respondents stated that they visited the ER at least one to two times in the last year to treat their condition.

Headache sufferers were asked about the treatments they received in the ER and in the UC. The survey showed the following distinctions: With regard to wait time, 67% waited less than one hour in the UC versus 33% in the ER during that timeframe.

When asked if the medical provider was polite and respectful, 67% responded favorably about the UC compared to 54% about the ER.

Respondents were asked if the diagnosis was clearly explained to them, of which 58% answered positively for the UC and 38% for the ER. As far as whether the treatment they received was effective, 53% responded affirmatively for the UC against 36% for the ER. Fifty-five percent stated that the UC staff provided clear instructions about what to do if the headache returned, countering the 37% for the ER. The survey queried sufferers as to whether they were made to feel like a drug seeker, with 29% stating that they did not feel that way when treated in the UC, while 50% said they did feel that way in the ER. When polled about being placed in a quiet area, 76% said that was the case in the UC, while 60% answered the same for the ER.

In the case of being provided with a home care plan prior to leaving, 43% of survey participants received one from the UC, but only 17% were provided with such a plan from the ER.

When survey respondents were asked about their overall experience, 50% described their level of satisfaction in the UC as very good or good compared with 36% who visited the ER.

“While the ER is familiar to many people, headache sufferers are encouraged to consider their local urgent care facility the next time they require immediate headache treatment,” said Dr. Roger Cady, vice president of the National Headache Foundation.

In cooperation with the Urgent Care Association of America (www.ucaoa.org), a second survey was conducted of healthcare providers about their experiences treating headache patients in an urgent care setting. The results of this survey indicated that sufferers could help their own cause by following the prescribed treatment regimen.

According to this survey, 67% of headache patients have failed to properly use their home plan before seeking assistance at a UC facility, and 59% of those in need of preventive medication are not receiving them. The healthcare providers surveyed indicated that 85% of the people they see have been previously diagnosed by another physician. The most common headache with which patients present in the UC is migraine.

“This data indicates that when a primary physician is not available, an urgent care center provides effective treatment in a sensitive environment for many headache sufferers,” said David Stern, MD, board member, Urgent Care Association of America.

The National Headache Foundation, founded in 1970 is a nonprofit organization dedicated to serving headache sufferers, their families and the healthcare providers who treat them; promoting research into headache causes and treatments; and educating the public to the fact that headaches are a legitimate biological disease and that sufferers should receive understanding and continuity of care.

Urgent Care in the Inland Empire

2008-04-20T10:32:00.000-07:00

Becki Genne tried to get her son in to see the pediatrician last week, after the 4-year-old spent several days coughing, sneezing and feverish. But since hundreds of other little kids are also coughing, sneezing and feverish this time of year, Genne couldn't get an appointment.

So, that's how they wound up at FirstCare in Millwood, one of more than a dozen urgent-care centers in eastern Washington and North Idaho.

"His doctor was full, we couldn't get in," says Genne, who was drawing pictures with her son Hunter while waiting to be seen at FirstCare.

Urgent-care centers -- walk-in clinics where you can be treated for a minor injury, sore throat or other nonemergency -- have been around since the 1970s. But they have become increasingly more popular in the last several years.

"It's an extremely rapidly growing niche of health care," says Dr. David Stern, an urgent-care physician in Illinois who serves as communications director for the Urgent Care Association of America. "It is largely driven by the fact that there's large numbers of healthy people out there who want care for acute problems without going to the emergency room."

But the clinics -- despite the word "urgent" in their name -- are not to be used for emergencies.
"If somebody has warning signs of chest pain, abdominal pain, especially if they're sweating or pale, we usually try to make sure they're stable and get them to the hospital emergency room," says Dr. Steve Thomas, medical director for FirstCare.

On a recent day at FirstCare in Millwood, an elderly woman who had fallen and bumped her head was directed to the emergency room at Valley Hospital and Medical Center for further treatment.

"Some people misunderstand the concept of urgent care and think it's an emergency department that just happens to be in your community," Stern says. "If you think you have an emergency, go to the emergency department."

Empire Health Services operates four FirstCare clinics around eastern Washington, employing some 13 physicians, Thomas says. Rockwood Clinic also operates several urgent care centers, as does U.S. HealthWorks. There are several single-office clinics in the area as well.

"I would say, right now, the market is saturated," Thomas says. "But it's good for the patients because, on average, the waiting times won't be as long."

But patients might expect slightly longer waits at urgent care centers in coming weeks. It's prime time for walk-in clinics, with cold and flu season underway.

"It's sort of like summertime at the beach," Stern jokes.

Most urgent care centers see lots of otherwise healthy people who have an acute problem. Once people start developing serious or chronic conditions, they turn to their family physician.
"People who are young and healthy are utilizing it," Stern says. "A lot of people are trying to fit things into the edges of their lives. We're a sort of a drive-through mentality ... Now it's almost to the point where we drive through for health care as well."

Hunter and his mom spent about 45 minutes waiting to be seen by Dr. Susan Ashley.
"I want to look in your ear and see if I see any potatoes in it," Ashley says to Hunter.

While Hunter played with her stethoscope, Ashley told his mom that everything looked fine in his exam. She said to expect it to take 10 or 11 days for the boy to feel back to his old self.
"Let it run its course," she tells Genne.

And with that, Hunter picked out a sticker and he and his mom were on their way.

Healthy Trust Immediate Medical Care

2008-04-19T08:01:00.000-07:00

Healthy Trust Immediate Medical Care in Wheeling, Illinois serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

The large, and modern clinic was opened in July of 2007 and is the culmination of a dream for it's founders Dr. Boris Gurevich, and Dr Leonid Shvartsman who have been practicing medicine on Chicago's North Shore since the late 1970's when they opened their first clinic at California, and Devon in the West Rodger Park community of Chicago.

The new clinic is one of the most modern, and complete medical clinics on Chicago's North Shore. It features an on site laboratory, and radiology department and is staffed with board certified physicians. What that means to the walk in patient is that they can be treated and diagnosed immediately in most cases for a wide variety of ailments unlike retail clinics which do not have diagnostic facilities, and are staffed by Nurse Practitioners.

In addition to providing Immediate Medical Care, the practice also provides primary medical care, internal medicine, family practice, endocrinology, urology, psychiatry, chiropractic, pain management, and physical therapy. The clinic features extended hours, and is open on weekends. They also have plenty of free parking adjacent to the clinic.

Why wait for hours in a crowded emergency room when the physicians at Healthy Trust Immediate Medical Care can see you in minutes at a fraction of the cost? No appointments are ever neccesary.

Urgent Care in the Aloha State

2008-04-17T08:06:00.000-07:00

The founder of an urgent care medical clinic in Kahala says clinics like his are a national trend and you can expect to see more across Hawaii.

Robert Ruggieri spent seven years as an attending physician in the emergency room of The Queen's Medical Center before founding Kahala Urgent across the highway mauka of Kahala Mall.

"I could see there were a lot of patients waiting for long periods of time that could be seen sooner in a clinic such as this," said Ruggieri.

National statistics say people who come to ERs with nonemergency conditions can expect to wait for three to four hours while people with more serious or time-sensitive issues are taken first.
"Many common bumps, bruises, sprains, lacerations that need suturing or stitches can be best served in an urgent care clinic than in an ER," Ruggieri said. "Since I opened May I've seen a lot of people with sinusitis and common colds."

He's also handled more urgent cases at his seven-day clinic, and even referred some to the hospital. But most walk-ins can be handled by him and his five full-time staff members.

Ruggieri says there already are half a dozen clinics in Waikiki, though they cater mainly to visitors, but he expects more urgent care clinics to open in the islands, as is also the case on the Mainland.

Rite Aid Pharmacy Adding Retail Clinics

2008-04-15T10:02:00.000-07:00

Camp Hill, Pa.-based Rite Aid Corp. reported total drugstore sales of $2.044 billion, a 50.7 percent increase, for the four weeks ending March 20, 2008, compared with $1.356 billion for the same time period last year. Same-store sales increased 2.6 percent; while pharmacy same-store sales rose 1 percent, and front-end same-store sales increased 5.7 percent. Prescription revenue accounted for 67.6 percent of drugstore sales. In addition, the company announced plans to roll out a pilot program with doctors at Columbia, Md.-based MedStar Health, offering urgent care services in four of its stores, beginning summer 2008. Rite Aid plans to add 12 more urgent care clinics after the pilot program is complete. The doctors will provide specialized urgent care services, in addition to treating minor ailments. Rite Aid operates more than 5,000 stores in 31 states.

Eleven New Urgent Care Clinics Opening in Orlando

2008-04-14T11:45:00.000-07:00

Orlando is experiencing a boom in urgent care clinics, with at least 11 new ones opening this year.

Among them:

Florida Hospital's Centra Care will open up to four new clinics, giving it a total of 20 in Central Florida.

Centra Care will hire 25 people to staff the facilities, giving it a total of 450 workers.

America's Urgent Care will open three new clinics, giving it a total of four locally.

The firm bought Pine Castle Walk in Clinic at 5636 Hansel Ave. in Pine Castle on Jan. 1 for an undisclosed amount and is doing $500,000 in renovations to the clinic.

The company is leasing space for another clinic in a new medical office building under construction in Celebration. America's Urgent Care is investing about $1 million in that location, which will open in November. Bush Architecture is designing the buildout. The company is still seeking a site for a fourth clinic somewhere in Orange County.

Minute Clinic this week opened a new Orlando location, its 500th nationwide and 10th in Orlando, with plans to open two more in Orlando this year.

The locations for the two new clinics have yet to be determined, says spokeswoman Jenna Scanlon. Minute Clinics in Orlando are most often located within CVS Pharmacies. Minute Clinic currently has 40 employees in Orlando, and will hire an unspecified number of workers for its new facilities.

The newest entry into the market, the MiniER, opened a 7,250-square-foot clinic at 12301 Lake Underhill Road in east Orlando on March 17 at a cost of just under $1 million. It plans to open another three Central Florida clinics in the next five years.

It's a trend that seems to be picking up steam. Consider: About 15 new clinics opened in Orlando during the past five years, says Dr. Franz Ritucci, president of the Orlando-based American Academy of Urgent Care Medicine.

"It's a growing market because the health care system is fairly broken," says Ritucci, adding that it's tough to get an appointment with a primary care physician, and emergency room wait times are extremely long. Says Ritucci, "It's a high-stakes adventure and investment, and you have to know how to do it right."

Healthy Trust Immediate Medical Care Walk-in clinic administers immediate non - urgent medical care during convenient hours. See our doctors for minor injuries or health problems, such as sprains, cuts, colds, flu's, and for other convenient health care services.

Medical Marts Retail Clinic's Shutting it's Doors

2008-04-13T17:12:00.000-07:00

Another large privately backed clinic operator closed its doors last week, this time Medical Marts. This group distinguished itself by having MDs as the providers in retail clinics in Utah Shopko stores and Illinois Meijer stores rather than Nurse Practitioners, or Medical Assistants.. Signs on the clinics say they are "temporarily" closed.

All phones are busy.

Medical Marts joins a growing list of privately based operators to close their doors, including CheckUps (Wal-Mart stores) and Corner Care Clinic (Medicine Shoppe). The web sites of both operators are still up and still show that all locations are open for business.

One can only imagine what’s going through the minds of retailers across the country who are looking to bring in their own clinic operators. All of these closings have taken place with national retailers, showing that even the most sophisticated are being surprised by the lack of staying power of some clinic operators.

All of which leads to what experts believe are the top three stumbling blocks:

Does the retail clinic business plan build in enough operating capital for at least two years of operating losses?

Does the cash flow plan anticipate major swings in seasonality?

Are average per-patient revenue assumptions based on actual fee schedules negotiated ahead of time with insurance payers or are they mere guesses?

Unfortunately, this probably isn't the end of some shakeout in the retail clinic industry.

2008 will likely see a few more doors closing before things settle into more stability among major retail clinic operators.

The bottom line for all these clinics is they need 25-30 patients per day to reach the break even point. It can take a couple of years or more to build some practices to that point. If the pockets aren't deep enough the clinic is likely to fail.

Wal-Mart Retail Clinics Close up in South East

2008-04-13T17:01:00.000-07:00

CheckUps, a start-up operator of walk-in medical clinics, has shut down 23 of the clinics operating in Wal-Mart stores in Florida and three other Southern states.

CheckUps, based in New York, fell behind in paying its nurses and other vendors late last year, apparently running short of cash to meet its bills, according to a lawyer for one of its creditors.
Nurses arriving for work at the clinics on Jan. 18 found them to be closed.

CheckUps stopped paying some of its nurse practitioners in December, and it owes about $108,000 to Medtracker Personnel, said Stephanie Granda, a lawyer for Medtracker Personnel, a Louisiana employment agency that provided nurses to CheckUps clinics.

Wal-Mart said Monday that it was concerned about the impact on clinic customers. “It is obviously not a good thing that CheckUps has decided to close,” said Deisha Galberth, a Wal-Mart spokeswoman.

Starting with three clinics it acquired in Florida, CheckUps added 20 more last year in Wal-Mart stores, expanding to Louisiana, Alabama and Mississippi.

William Armstrong, a spokesman for CheckUps, said Jack Tawil, an entrepreneur who is chief executive of the privately held company, was talking to investors and “evaluating which of the operations in the retail stores they should keep open.”

Industry experts estimate that a company can consume $300,000 to $600,000 to finance a clinic and keep it running until it passes the break-even point of 25 to 30 patients a day and becomes profitable.

Wal-Mart has leased space to about 80 clinics in stores across the country, including the CheckUps clinics now closed. They are all operated by independent firms, including 13 by RediClinics, a unit of Steven Case’s Revolution Health company, and two by hospital companies in Wisconsin and Florida.

While some of the Wal-Mart clinics are headed by doctors, most are run by nurse practitioners who are limited to providing routine medical care like giving flu shots or prescribing drugs for sore throats. Operators say their main clients are mothers with small children, and that about 30 percent do not have a family doctor.

Wal-Mart said it hoped the CheckUps clinics would not stay vacant for long.

“We are working to reopen the clinics as quickly as possible, whether or not they are operated by CheckUps,” Ms. Galberth said. CheckUps still holds leases on the spaces, which are typically near the store entrances, alongside eye-care centers and other convenience tenants that besides paying rent are meant to help Wal-Mart attract customers.

She said Wal-Mart was proceeding with plans to lease space for several hundred clinics in the next two years. Lee Scott, Wal-Mart’s chief executive, said last year that the chain could serve as landlord to as many as 2,000 clinics by 2014.

Mr. Scott said Wal-Mart was looking for more hospital partners to add to the Aurora Health Care system in Wisconsin, which is already operating in seven stores in that state, and the North Broward Hospital District on Florida’s east coast, which plans to open one soon.

Tine Hansen-Turton, the executive director of the Convenient Care Association, a clinics trade group, said Wal-Mart had also been discussing making leasing deals with independent clinic operators that would be affiliated with local and regional hospitals.

Urgent Care Clinics on the Rise

2008-04-13T16:06:00.000-07:00

Patients suffering from small problems - such as a persistent rash - often avoid emergency rooms and instead choose urgent care clinics or retail clinics inside pharmacies.

Figures on the number of urgent care clinics nationwide range from 12,000 to 20,000. Industry observers say after declining during the 1990s, the number of urgent care clinics is growing at about two a week.

In the Triangle, Duke University Medical Center has plans to open urgent care centers in Morrisville and Knightdale. Triangle Orthopaedic Associates is opening two more ortho urgent care centers to add to its Durham location.

Retail clinics, designed to take care of minor illnesses, are springing up even faster. Eight MinuteClinics have opened in the Triangle in the past year in CVS stores, and another five are planned. Other pharmacy chains, including Walgreens, are also warming to the concept.
"Urgent care clinics serve a necessary niche," says Paula Bickley of Raleigh-based Ad Hoc Consulting, which counts urgent care centers as clients.

Many facilities started as nothing more than a physician during evening hours. They have since expanded their menu of services - from providing digital X-rays to re-hydration and even advanced life support to stabilize a sick patient for transport to a hospital emergency department.

RESURGENCE OF URGENT CARE FACILITIES

The urgent care center concept dates to the late 1970s. A California HealthCare Foundation study found that the number of centers declined in the 1990s, mostly because independent clinics got gobbled up by local hospitals. The study said that implementing a hospital-style cost structure made these centers unprofitable - or the hospitals closed the centers down to avoid competition.

Also, in their early years, urgent care centers didn't do a good job of marketing their services, according to the study.

In recent years, entrepreneurs and hospitals have refocused urgent care clinics on providing minimal wait, episodic care for people who cannot see a doctor, don't have one, or become ill outside normal business hours. Many hospitals have embraced the idea of opening urgent care centers to eliminate overcrowding in their own EDs

"Clinics are focusing on the patient experience, offering more customer service training and treating the facilities more like a retail business," says Lou Ellen Horwitz of the Urgent Care Association of America. Horwitz says hospitals such as Duke University Medical Center, which has two urgent care centers in Durham, and Rex Hospitals, which has two centers in Wake County, see these units not only as a way to relieve overcrowding in emergency rooms but as a way to draw patients.

HIGHER TRAFFIC

Dr. Kevin Broyles, medical director for Duke's urgent care clinics, says the clinics helped reduce crowding at the hospital emergency department. "People didn't have access to care in Durham outside normal business hours," says Broyles.

In fact, ED admissions at Duke have been stable at about 58,000 a year since the clinics opened in 1998 and 2002 respectively. The first clinic saw 6,000 visits the first year, and the two are now up to about 70,000 visits a year.

Urgent care centers also see plenty of traffic from patients without family physicians. Ultimately, says Horwitz, the center encourages patients to find a doctor, especially if they suffer from any chronic conditions. "Urgent care should not replace the family physician," Horwitz says.

Yet in a rapidly growing area like the Triangle, where newcomers may not have had time to find a physician, urgent care centers fill the gap.

"We've got frequent flyers,'' says Thomas Haugh, practice administrator for Accent Urgent Care and After Hours Pediatrics, referring to patients who visit frequently.

The company has centers in Cary and Raleigh. Haugh says his staff also sees patients who find visiting a doctor during the daytime too inconvenient. Since 2001, the centers have seen visits increase by close to 10 percent a year.

PEERS AND RIVALS

Convenience is a driving force behind urgent care centers' popularity. Bickley, who helps centers connect with insurers, notes a Center for Studying Health System Change report showed patients wait times, and how quickly lab results were turned around.

Convenience is also the driving force behind the retail clinics that have surfaced nationwide. "Individuals are seeking greater access to health care services with a more patient-centric approach that matches today's busy lifestyle," says Kristen Broom, manager of operations for MinuteClinic. "We meet that demand by offering services seven days a week in convenient locations close to where patients live and work. No appointment is necessary," Administrators of urgent care centers say they are not concerned that retail clinics will take a bite out of their centers' business.

The clinics, frequently found in pharmacies, typically employ just one nurse practitioner and are focused on treating the simplest illnesses - like swimmer's ear, strep throat, pink eye and bladder infections. Anything more complicated is referred out. "We actually get a lot of referrals from them," Haugh notes. "Their protocols (illnesses that will or won't be treated) are pretty stringent.''

The retail clinic administrators agree. "We are not an urgent care center," says Broom. "We don't treat fractures or sprains, abdominal illnesses, lacerations and other conditions treated at urgent care clinics."

"I think the urgent care centers were worried initially, but they've developed positive relationships with the (retail) clinics,'' Bickley says.

Healthy Trust Immediate Medical Care Walk-in clinic administers immediate medical care during convenient hours. See our doctors for minor injuries or health problems, such as sprains, cuts, urinary infections, colds, flu's, and for other convenient health care services.

Healthy Trust Immediate Care Clinic is centrally for Chicago North shore residents located at 342 S. Milwaukee Avenue in Wheeling, Illinois.

Our modern facility was opened in in 2007 and is staffed with board certified physicians. We have an on site lab, and x-ray facility which means you don't have to wait for the results of most diagnostic tests.

If you have questions please give us a call at 847-243-0333.

Urgent Health Care Blog Debuts

2008-04-13T15:55:00.000-07:00

The Urgent Health Care blog debuts today to highlight news in the Urgent, and Immediate health care clinic fields across the United States.

The blog is sponsored by Healthy Trust Immediate Medical Care in Wheeling, Illinois. The Healthy Trust Immediate Medical Care clinic is the Chicago's area's newest, and most modern Immediate Health Care Clinic. Healthy Trust serves the Chicago North Shore Communites of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Libertyville, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.