You’ve got e-Mail – From your doctor

Montefiore’s Patient/Doctor Secure Messaging Service Growing Rapidly

More and more patients in the Bronx and Westchester are benefiting from a new patient-friendly Internet service called MyMontefiore, which quickly and easily helps them get prescriptions filled, retrieve lab results, answer billing questions and, perhaps most importantly, allows them to have an online, private dialogue with their physicians.

Approximately 35,000 patients in the Bronx and Westchester who now receive their care at Montefiore Medical Center use the online service — and more sign up each month.

Patients Young and Old Like Privacy, Rapid Response of MyMontefiore

Joyce Denis is a 31-year-old patient who lives in the Bronx and who is being treated at Montefiore’s Institute for Reproductive Medicine and Health. After two miscarriages, she is now 6 weeks pregnant. She has been using MyMontefiore’s web site for two years to communicate with her physician, Nanette Santoro, MD, a reproductive medicine specialist at Montefiore Medical Center.

“I think MyMontefiore is wonderful,” says Ms. Denis. “I just log onto my home page and I ask the doctor by email questions that I forgot to ask in the office visit, or if I’m worried that my hormone injections aren’t working and if there is anything I can do at home. Or I email requesting lab results, which come back within a day by email. It saves a lot of time compared to playing phone tag. Everyone replies on their own time. It’s also very private. I like that.”

For the past year, Anne and Thomas Kearney, both age 82, who live in Yonkers, have been using the service to communicate with Jonathan Greenberg, MD, a internal medicine specialist at Montefiore, who practices in Eastchester. They use it a lot for tests. Just a few weeks ago Thomas Kearney had lab tests and an X-ray and Dr. Greenberg got back to him via email with the results and a suggestion that he see a gastroenterologist. “It’s great,” said Anne Kearney, “no telephone calls.”

Physicians Like the Remote Access, Accuracy of Email

The online service has proved popular among physicians as well as patients. Some 537 primary care practitioners and 125 specialists now use MyMontefiore.

Dr. Santoro is a fan of the privacy and anywhere/anytime features of the system. “I can keep in touch with patients when I am traveling to conferences anywhere in the United States,” she says. “I can do simple things, like adjust medication dosages. I like that email communication respects both my time and hers. It’s not for complex questions. You still have to have office visits; but it is very efficient and private for simpler things.”

“I was very wary of using MyMontefiore, at first,” said Arthur Hopkins, MD, an internal medicine specialist at Montefiore, who practices in Westchester. “I worried about a deluge of patient email; but it didn’t happen. The system is not perfect, but most patients are respectful of my time.”

Dr. Greenberg, who specializes in care for the elderly, has 418 patients signed up to use MyMontefiore. He likes email because of the clarity and directness of the messages, whereas phone messages are “not as clear,” he says. “Having email is of course more work, and comes on top of phone and personal visits and postal mail, but everyone in today’s digital world has that,” he says.

MyMontefiore has caught on especially with physicians who treat younger patients. Dr. Heidi Sanger, an internal medicine specialist at Montefiore, who practices in Eastchester, treats a number of younger women and has 633 patients who use the email system.

MyMontefiore’s Added Value to Patients / Ease of Use

“While MyMontefiore provides an alternative communications tool for patients and physicians in the digital age, it is a more comprehensive platform than that,” said Stephen Rosenthal, a corporate vice president at Montefiore. “For example, once patients enroll, MyMontefiore sends them outbound messages that encourage them to manage their own health, to get flu or allergy shots. We also alert parents about CDC warning on pediatric medications. After these educational messages introduce patients to the benefits of the system, they begin to use it in other ways. We frequently see a spike in medical office usage and of online scheduling and other services after we send out these public health messages.”

MyMontefiore is easy to use. Patients who request appointments simply log into the system, look at their physician’s office hours and give three choices of a time when they are available for an appointment. Within a couple of days the appointment is confirmed. They then get a reminder of the appointment several times before visiting the physician’s office.

MyMontefiore is a product of Relay Health. It was introduced as a pilot program in 2006 and the following year was rolled out to all 21 Montefiore Medical Group office sites in the Bronx and Westchester. MyMontefiore is not considered an office visit by insurers, so it is not a reimbursable consultation. Nor is it yet integrated with a patient’s electronic medical record, though this is planned for the future.

Montefiore Medical Center encompasses 125 years of outstanding patient care, innovative medical “firsts,” pioneering clinical research, dedicated community service and ground-breaking social activism. A full-service, integrated delivery system caring for patients in the New York metropolitan region and beyond, Montefiore is a 1,491-bed medical center that includes: four hospitals — the Henry and Lucy Moses Division, the Jack D. Weiler Division, the North Division and The Children’s Hospital at Montefiore; a large home healthcare agency; the largest school health program in the US; a 25-site medical group practice integrated throughout the Bronx and Westchester; and, a care management organization providing services to 179,000 health plan members.

In 2008, The Children’s Hospital at Montefiore was ranked as one of “America’s Best Children’s Hospitals” in US News & World Report’s prestigious annual listing and also received honors in the magazine’s 2009 edition. The Leapfrog Group lists Montefiore among the top one percent of all U.S. hospitals based on its strategic investments in sophisticated and integrated healthcare technology.

Source: Montefiore Medical Center


It’s backpack safety time

Backpacks can be a leading cause of back and shoulder pain for millions of children and adolescents. As students prepare for school, the Minnesota Chiropractic Association (MCA) and the American Spine Foundation (ASF) want to shed light on backpack safety.

The MCA and ASF are offering parents tips on preventing unnecessary backpack pain and injuries.

– Does the backpack have two wide, padded shoulder straps? Non-padded straps are not only uncomfortable, but can also place unnecessary pressure on the neck and shoulder muscles.
– Does your child use both straps? Lugging a heavy backpack by one strap can cause a disproportionate shift of weight to one side, leading to neck and muscle spasms, low-back pain, and poor posture.
– Are the shoulder straps adjustable? The shoulder straps should be adjustable so the backpack can be fitted to your child’s body. The backpack should be evenly centered in the middle of your child’s back.
– Size is important. The backpack should never be wider or longer than your child’s torso, and the pack should not hang more than 4 inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking.
– Does the backpack have a padded back? A padded back not only provides increased comfort, but also protects your child from being poked by
sharp edges on school supplies (pencils, rulers, notebooks, etc.) inside the pack.
– Does the pack have several compartments? A backpack with individualized compartments helps position the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child’s back, and try to place the heaviest items closet to the body.

The MCA and ASF recommend that parents help children pack their backpacks properly, and make sure children never carry more than 10 percent of their body weight. For example, a child who weighs 100 pounds shouldn’t carry a backpack heavier than 10 pounds, and a 50-pound child shouldn’t carry more than 5 pounds.

Parents should ask their children to report any pain or other problems resulting from carrying a backpack. To find a doctor of chiropractic near you, visit MCA’s Web site at www.mnchiro.com.

Source: Minnesota Chiropractic Association


St. Jude Children’s Research Hospital scientists lead survey of genome that identifies new genes linked to cancer risk and treatment response

Scientists at St. Jude Children’s Research Hospital have identified inherited variations in two genes that account for 37 percent of childhood acute lymphoblastic leukemia (ALL), including a gene that may help predict drug response.

The findings stem from the first complete search of the human genetic blueprint or genome to look for inherited risk factors for ALL, the most common childhood cancer. Published in the August 16 advance online issue of Nature Genetics, the work offers the first proof based on a complete survey of the human genome that inheritance plays a role in childhood ALL.

Mary Relling, Pharm.D., St. Jude Pharmaceutical Sciences chair and the paper’s senior author, estimated that individuals who inherited variations in genes known as ARID5B or IKZF1 are almost twice as likely to develop ALL as those without the variations. Even then, she said, the risk remains low. ALL strikes roughly one in every 75,000 Americans. Sixty percent are children and teenagers.

“The genetic variations alone are not enough to cause the cancer. Like all cancers, pediatric ALL is a multi-factor disease,” Relling explained. “But these findings may give us a handle on the mechanism of the disease and drug responsiveness to it.”

Exactly the same genes, ARID5B and IKZF1, were confirmed to be altered in British children with ALL. That study was published by the Institute of Cancer Research in Surrey, England, in the same issue of Nature Genetics.

In the St. Jude study, researchers collaborated with colleagues from the Children’s Oncology Group (COG), who provided additional cases for genetic analysis. COG is an international group of medical institutions that cooperate in research studies and clinical trials of childhood cancer treatment.

Researchers scanned the genomes of 441 children with ALL and a control group of 17,958 cancer-free individuals for more than 300,000 common genetic variations known as single nucleotide polymorphisms or SNPs.

The search found 18 SNPs that differed significantly in frequency between individuals with and without ALL. Six of the 18 SNPs were associated with one of the four main subtypes of ALL.

The six included two SNPs linked to the ARID5B gene. About 11 percent of those in the control group inherit the leukemia-risk ARID5B variations from both mother and father, Relling said. In comparison, the same high-risk ARID5B SNPs were found in 38 percent of patients with a type of ALL known as hyperdiploid ALL. That subtype accounts for about 20 percent of ALL patients.

Three more SNPs were traced to the genes IKZF1 and DDC, which are next to each other on chromosome 7. IKZF1 is also known as IKAROS. Earlier research from St. Jude and COG linked acquired changes in IKZF1 to an increased risk of ALL relapse. The new evidence tying inherited variation in IKZF1 to an increased risk of developing ALL underscores the need for medications targeting variations in this gene, Relling said.

Both ARID5B and IKZF1 play important roles in normal development of lymphoid or white blood cells, she said. ARID5B belongs to a family of genes that make transcription factors, which help regulate gene activity. “If they have an inherited variation that affects the function of those genes, these are plausible pathways for how a normal lymphoid cell could be disrupted and transformed into a cancer cell,” Relling said.

Inherited variations in ARID5B might also influence patient response to chemotherapy, particularly to the drug methotrexate. “We found this same inherited variation also affected accumulation of the drug in leukemia cells. It accumulates better. That allows us to use a lower dose and still cure the leukemia,” Relling explained. “These findings may identify a new marker that could be used to help decide on doses of methotrexate in patients with varying ARID5B status.”

Scientists are not sure how the SNPs they identified influence cancer risk. But studies of variation in gene expression associated with the ARID5B gene indicate the inherited variations have a biological function. Researchers must still determine what it is.

Other authors of this paper include Lisa Trevino, Wenjian Yang, Deborah French, Geoffrey Neale, James Downing, Susana Raimondi, Ching-Hon Pui and William Evans, all of St. Jude; Stephen Hunger, University of Colorado, Denver; William Carroll, New York University Medical Center, New York; Meenakshi Devidas, University of Florida, Gainesville; and Cheryl Willman, University of New Mexico, Albuquerque.

This study was supported by the National Cancer Institute, the National Institutes of Health/National Institutes of General Medical Sciences Pharmacogenetics Research Network and ALSAC.

Source: St. Jude Children’s Research Hospital


Obesity remains No. 1 health problem for kids in 2009

  • Author: Health Informer
  • Filed under: Health News
  • Date: Aug 16,2009

Public concern about childhood obesity is on the rise and it continues to outrank all other health problems as the No. 1 concern for children in the United States.

According to a report released today by the University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health, the proportion of adults who believe childhood obesity is a big problem has increased from 35 percent of adults in 2008 to 42 percent in 2009.

While obesity has ranked as the top overall health concern for kids in the U.S. for the last two years, it has not always been the case for Hispanics or blacks.

“This is the first year the three major racial/ethnic groups all agree,” says Matthew Davis, M.D., director of the poll. “In 2008, among whites, the chief concern was obesity, while among blacks the chief concern was teen pregnancy, and among Hispanics the chief concern was smoking.”

In May 2009, the Poll asked adults to rate 23 different health concerns for children living in their communities.

Top 10 overall health concerns rated as a big problem for U.S. children in 2009:

1. Childhood obesity. Forty-two percent of U.S. adults rate childhood obesity as a big problem. In 2008, 35 percent of adults rated childhood obesity as the top overall health concern for children. In 2007, it was ranked No. 3.

2. Drug abuse. Thirty-six percent of U.S. adults rate drug abuse as a big problem for children and has held at No. 2 since 2007.

3. Smoking. Ranked No. 1 in 2007, smoking continues to hold the No. 3 position since 2008, with 32 percent of U.S. adults rating it as a big problem for kids.

4. Bullying. Holding at No. 4, 31 percent of U.S. adults rate bullying as a big problem for children.

5. Internet safety. Continuing at No. 5, 31 percent of U.S. adults consider internet safety a big problem for kids, slightly up from 27 percent in 2008.

6. Child abuse and neglect. This issue, which was ranked No. 10 in 2007, holds at No. 6 and was rated as a big problem among 29 percent of U.S. adults, up from 25 percent in 2008.

7. Alcohol abuse. Up from No. 8 in 2008, 26.5 percent of U.S. adults consider alcohol abuse a big problem. For the 2008 poll, 23 percent of adults listed alcohol abuse as a health concern for kids. In 2007, alcohol abuse was ranked fourth overall.

8. Stress. New to the list in 2009, 26 percent of U.S. adults rate stress as a big problem for children.

9. Not enough opportunities for physical activity. Up one spot from 2008, nearly 25 percent of U.S. adults rate this as a big problem for kids.

10. Teen pregnancy. Falling three places from No. 7 to No. 10, 24 percent of U.S. adults rated teen pregnancy as a big problem in 2009.

Health issues for children not ranked in the top ten include: chemicals in the environment, driving accidents, sexually transmitted infections, school violence, depression, attention deficit/hyperactivity disorder, asthma, autism, eating disorders, neighborhood safety, dental problems, suicide andunsafe foods.

The National Poll on Children’s Health also found that adults from low-income households making $30,000 per year or less rated smoking and tobacco use as the top child health concern, while the middle and highest income households making $30,000 to more than $100,000 per year rated childhood obesity as the biggest health concern for kids.

Stress now ranks among the top 10 child health problems, and was especially of concern for children in lower-income communities.

“As we reported in July 2009, levels of stress among children may relate to economic stresses faced by their families in the current economic downturn,” says Davis, associate professor of general pediatrics and internal medicine at the U-M Medical School, and associate professor of public policy at the U-M Gerald R. Ford School of Public Policy. “The fact that stress rates so high in the list of child health problems is a reminder that most of the problems on the list are behavioral or psychological in nature.”

To address such problems successfully, Davis says children and families need not just access to medical and mental health care, but also guidance from community health and educational programs that cultivate healthy, protective behaviors and offer support when health problems arise.

Top three health concerns for children in 2009 by race/ethnicity:

Whites:
1. Childhood obesity by 39 percent
2. Drug abuse by 35 percent
3. Internet safety by 30 percent

Blacks:
1. Childhood obesity by 55 percent
2. Smoking and tobacco by 44 percent
3. Teen pregnancy by nearly 44 percent

Hispanics:
1. Childhood obesity by 46 percent
2. Bullying by 37 percent
3. Child abuse and neglect by nearly 37 percent

Other resources:

Full report, including Top 10 by race/ethnicity: www.med.umich.edu/mott/npch/pdf/20090810_Top10Report.pdf

Podcast: www.med.umich.edu/podcast/CHEAR/2009/2009_Top_10.mp3

C.S. Mott Children’s Hospital National Poll on Children’s Health: www.med.umich.edu/mott/npch

Prevention and treatment of childhood obesity, from the American Academy of Pediatrics: www.aap.org/healthtopics/overweight.cfm

Methodology: This report presents findings from a nationally representative household survey conducted exclusively by Knowledge Networks, Inc, for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered in May 2009 to a randomly selected, stratified group of adults aged 18 and older (n=2,017) from the Knowledge Networks standing panel that closely resembles the U.S. population. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 59 percent among panel members contacted to participate. The margin of sampling error is plus or minus 3 to 4 percentage points for the main analysis. For results based on subgroups, the margin of error is higher.

Source: University of Michigan Health System


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