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."
Saturday, June 7, 2008
Friday, June 6, 2008
Bird flu detected in Hong Kong market
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.
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.
Thursday, June 5, 2008
Toe Implants offer Relief from Arthritis
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."
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."
Wednesday, June 4, 2008
Too Much Medical Care Harmful?
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"
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"
Tuesday, June 3, 2008
Dust Mites and Allergies
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.
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.
Monday, June 2, 2008
Think About Green Tea
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.
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.
Sunday, June 1, 2008
Little League Baseball can be Dangerous
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 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."
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