Too much physical activity may lead to Arthritis

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 30,2009

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High levels of physical activity may result in knee damage and eventually arthritis for middle-aged men and women.

MRI showed evidence of knee abnormalities, including cartilage damage and ligament lesions, in active adults with no pain or other symptoms.

Osteoarthritis affects 27 million Americans.

Middle-aged men and women who engage in high levels of physical activity may be unknowingly causing damage to their knees and increasing their risk for osteoarthritis, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

“Our data suggest that people with higher physical activity levels may be at greater risk for developing knee abnormalities and, thus, at higher risk for developing osteoarthritis,” said Christoph Stehling, M.D., research fellow in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF) and radiology resident in the Department of Clinical Radiology, University of Muenster, Germany.

Osteoarthritis is a degenerative joint disease that causes pain, swelling and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the most common form of arthritis and affects an estimated 27 million American adults.

The UCSF study involved 236 asymptomatic participants who had not reported previous knee pain and were enrolled in the National Institutes of Health Osteoarthritis Initiative. Study participants included 136 women and 100 men, age 45 to 55, within a healthy weight range. The participants were separated into low-, middle-, and high-activity groups based on their responses to the Physical Activity Scale for the Elderly (PASE) questionnaire. PASE is a standard test that scores an older individual’s physical activity level, based on the type of activity and the time spent doing it. Several factors contribute to the final PASE score, but a person whose activity level is classified as high typically might engage in several hours of walking, sports or other types of exercise per week, as well as yard work and other household chores.

Subsequent MRI analysis by two musculoskeletal radiologists indicated a relationship between physical activity levels and frequency and severity of knee damage. Specific knee abnormalities identified included meniscal lesions, cartilage lesions, bone marrow edema and ligament lesions. Abnormalities were associated solely with activity levels and were not age or gender specific.

“The prevalence of the knee abnormalities increased with the level of physical activity,” Dr. Stehling said. “In addition, cartilage defects diagnosed in active people were more severe.”

The findings also indicated that some activities carry a greater risk of knee damage over time.

“This study and previous studies by our group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health,” Dr. Stehling said. “Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease.”

Dr. Stehling noted that there is a need for prospective studies to evaluate the influence of low-impact versus high-impact physical activity on disease progression.

Coauthors of the study are Nancy E. Lane, M.D., Michael C. Nevitt, Ph.D., M.P.H., Charles E. McCulloch, Ph.D., and Thomas M. Link, M.D., Ph.D.

Source: Radiological Society of North America (RSNA)


With cold and flu season upon us, it’s more important than ever to employ good practices to control the spread of infections and avoid illness.

“We need to be proactive not only to keep ourselves healthy, but to avoid transmitting illness if we’re sick,” said Eileen Finerty, RN, MS, CIC (certified in infection-control), nursing director for infection control and occupational health at Hospital for Special Surgery (HSS) in Manhattan.

Hospital for Special Surgery has one of the lowest infection rates of any hospital in the country and was recently commended by the New York State Department of Health for its low infection rate in patients undergoing hip replacement. The overall infection rate refers to all infections acquired by patients in the hospital, not only viruses such as those that cause the flu.

Infection control in the health care setting is critical. Nationwide, hospital-acquired infections result in 100,000 deaths each year.

“We emphasize infection control as a best practice,” said Thomas P. Sculco, M.D., surgeon-in-chief at HSS, “and strive to maintain it at every level of patient care from washing hands to a clean and safe environment for our patients in the operating room and the entire hospital.”

HSS employs a combination of infection-control measures, according to Ms. Finerty. Some are highly sophisticated and others are basic good practices.

Strategies used by the hospital to keep germs in check can be adapted for use at home and in everyday life, according to Ms. Finerty. These practices include:

1 – Good hand hygiene using sanitizers.

Hospital: Hand sanitizers located all around the hospital have a sensor that dispenses foam without the need to touch it. The sensor detects hand motion and automatically releases foam.

What everyone can do: Sanitize hands frequently using an alcohol-based liquid hand cleaner. Use about a tablespoon, rub it into your hands and let it dry. Do not wipe it off. Ms. Finerty carries a hand sanitizer in her purse at all times.

2 – Frequent hand-washing.

Hospital: Hospital staff are instructed to wash their hands often. Signs around the hospital say: “Good Hand Hygiene Saves Lives.”

What everyone can do: Wash your hands for at least 15 seconds. You can sing “Happy Birthday” to get an idea of how long it should take. Work up a good lather and rub your hands together.

3 – Good ventilation.

Hospital: Clean air in operating rooms and the use of special panels to direct air flow to maintain the most sterile environment possible for the patient.

What everyone can do: Open the windows and let in some fresh air to ensure adequate ventilation. A stagnant, stuffy environment causes germs to re-circulate around the house.

4 – Controlling the spread of germs.

Hospital: The entire staff is trained in infection-control measures, such as coughing into a tissue and not into one’s hand. Boxes of tissues are located throughout the hospital. Staff are encouraged to stay home if they have a contagious illness.

What everyone can do: Carry tissues and dispose of them properly and immediately after coughing or sneezing. Then wash your hands or use a hand sanitizer. You can also cough into your sleeve to avoid getting germs on your hand that can later be spread.

In general, when you’re outside or at work, or if you have come in contact with a sick person, avoid touching your face. Germs on your hand get you sick when they enter your body through your eyes, nose or mouth, or through a break in the skin. Don’t go to work if you’re sick.

5 – Cleaning and disinfecting.

Hospital: HSS housekeeping staff is especially diligent about cleaning. The routine entails mopping, cleaning, and disinfecting surfaces, getting into cracks and crevices where bacteria can grow.

What everyone can do: Make it a habit to clean and disinfect surfaces, especially in the kitchen and bathroom. Be especially wary about kitchen sponges, which can harbor large amounts of bacteria. “When in doubt, throw it out,” Ms. Finerty advises.

If someone in the household is sick, disinfect high touch personal items like phones and other equipment around the house.

6 – Flu shots.

Hospital: All staff are encouraged to get a flu shot, and the hospital has a high rate of compliance.

What everyone can do: Get a flu shot to lower the possibility of getting sick. It protects you and those around you.

7 – A separate room.

Hospital: Patients who have a contagious infection are given a private room.

What everyone can do: When a family member is sick, keep his belongings separate, give him a separate trash bag for his tissues and dispose of them properly, and maintain a sanitary environment.

If you’re outside and notice someone who looks ill, try to stay at least three feet away from him. An uncovered cough can spray droplets and germs three feet or more into the air.

8 – Diligence and good habits.

Hospital: Signs, staff training and hand sanitizers around the facility remind HSS employees of the importance of proper hygiene.

What everyone can do: Remember to maintain good practices and develop beneficial habits that will help keep you and those around you healthy.

Source: Hospital for Special Surgery


Why some vaccines may require a booster

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 28,2009

Preventing disease is the goal of every health care provider and fortunately every year, new vaccines are being added to assist in disease prevention. But do all vaccines boost immunity for the same period of time? And, if not, when are additional ‘booster shots’ needed to keep immunity strong?

In this month’s issue of Pediatrics, the Journal of the American Academy of Pediatrics, Michael Pichichero MD, Director of the Rochester General Research Institute, based at Rochester General Hospital in Rochester NY, studies the medical necessity for occasional booster shots to sustain immunity.

It is a well known medical fact that a booster shot for tetanus is needed every 10 years to maintain your immunity. But, what happens if you fail to get that booster? “Fortunately, a patient has a window of opportunity to get a booster shot even after getting a dirty wound,” said Dr. Pichichero. “In this case, the booster shot will take hold before the tetanus infection can establish itself. The problem is that this scenario is not true for all diseases.”

In his published study, Dr. Pichichero, an international authority on vaccines and vaccine-induced memory, discusses the effectiveness of booster vaccinations and disease progression. “We found that for slow moving infections like hepatitis, immune memory is activated within plenty of time to prevent the disease after a person has been vaccinated and booster vaccines are not needed” said Dr. Pichichero. “Other examples of vaccines that do not appear to require boosters because the pace of disease progression is slow include: polio, measles, mumps, and German measles.”

Dr. Pichichero Study

The study found, however, that there are several newer vaccines that may require booster shots to remain effective during a lifetime, including vaccines for diphtheria, all three types of spinal meningitis caused by bacteria, and the new vaccine to prevent cervical cancer. “Booster shots are needed in these cases because the disease progression is too fast for the memory response to occur in time,” said Dr. Pichichero.

The study offers several important findings. “Pediatricians and family doctors must begin to anticipate the need to provide booster vaccinations for several of the newer vaccines introduced in recent years,” said Dr. Pichichero. “And, public health agencies, such as the Centers for Disease Control, must begin to consider the cost of booster shots as they calculate the cost-benefit of vaccines. Up to now, cost calculations for the introduction and public payment of meningitis vaccines and the cervical cancer vaccine have not included the need (and cost) of periodic boosters, nor the consequences of missed boosters with disease development later in life.”

While the article has a strong and clear scientific basis, Dr. Pichichero acknowledges that only continued monitoring will determine whether he is correct in his assessment of the need for booster shots for certain diseases. “We do not want to face a diphtheria epidemic in the U.S. as occurred in Russia a decade ago due to lack of boostering of adults,” said Dr. Pichichero.

Dr. Pichichero was a member of the discovery team of the first bacterial spinal meningitis vaccine against Haemophilus influenzae type b, commonly called Hib; and participated in the foundational studies of the second spinal meningitis vaccine against pneumococci called Prevnar; and the third spinal meningitis vaccine against meningococcus called Menactra. He was an early champion for the introduction of safer whooping cough vaccines, called acellular vaccines. He has ongoing support from the National Institutes of Health to study the prospects of an ear, sinus and bronchitis vaccine. He has also received financial support for his research from vaccine companies including GlaxoSmithKline, MedImmune, Sanofipasteur and Wyeth (now Pfizer).

Source: Rochester General Health System


Findings Underscore Urgent Need to Reform CBO Scoring of Preventive Care

The diabetes population in the United States will almost double over the next 25 years and annual medical spending on the disease is projected to hit $336 billion, up from $113 billion today, according to a study published in the December issue of Diabetes Care. The National Changing Diabetes® Program (NCDP), a program of Novo Nordisk, commissioned the analysis by a team from the University of Chicago.

According to the forecast, the number of Americans living with diabetes will rise from 23.7 million in 2009 to 44.1 million in 2034. For the Medicare program, the increases over the next 25 years are even more dramatic: the number of Americans living with diabetes and covered by Medicare will rise from 6.5 million to 14.1 million, and Medicare spending on diabetes will almost quadruple, skyrocketing from $45 billion this year to $171 billion in 2034. Based on this projection, “Medicare spending alone will represent just over 50% of direct spending on diabetes in 2034,” the authors concluded.

Unlike past efforts to predict trends in diabetes, the model developed by the University of Chicago team considers the natural progression of the disease, effects of treatment and obesity rates in the United States, which are “factors that are currently not used by government budget analysts,” according to the authors.

“Obesity is a significant driver of future increases in the number of Americans with diabetes,” said Michael O’Grady, Ph.D., one of the study authors and a senior fellow at the National Opinion Research Center at the University of Chicago. “While our modeling, as well as that done by the Centers for Disease Control and Prevention, project obesity rates leveling off, neither model has obesity rates lowering substantially. High obesity rates among the American population over an extended period of time substantially increases the probability of developing type 2 diabetes.”

This forecasting model, which the authors contend improves the rigor of the estimates of health care spending for diabetes, was designed to inform policymakers as they explore ways to control spiraling health care costs. Currently, official government estimates of the potential costs and cost offsets associated with proposed preventive health legislation do not consider savings that may occur more than 10 years out, thus providing an incomplete view of preventive health measures as an investment.

“The size of the current diabetes population exceeds many prior forecasts and we expect that the future growth of population and its associated costs will be explosive. Finding ways to reduce the number of people who develop diabetes is both a national public health priority and a fiscal imperative,” said Dr. Elbert Huang, the lead author of the paper and an assistant professor of medicine in the Department of Medicine at the University of Chicago. “The best way to stem the dramatic rise in diabetes is to implement proven preventive care programs on a national level. This will require that policymakers understand that diabetes prevention is a long-term investment that will only reap benefits over decades, not years.”

The Congressional Budget Office (CBO), which assesses the cost of proposed legislation, does not typically consider any cost savings beyond 10 years. Because diabetes develops over a long period of time, with the highest costs coming later in life of the disease, savings are far more apparent at 25 years than at 10 years. For this reason, policymakers need a long-term analysis of costs in order to make accurate decisions that reflect the true impact of prevention programs.

“Managing diabetes means preventing the pain and expense of diabetes complications, including heart disease, amputation, kidney disease, and blindness,” said Michael Mawby, Chief Government Affairs Officer and director of the NCDP, a diabetes leadership initiative established by Novo Nordisk to drive health systems change at the national and local level, which funded the research. “Therefore, it is critical that lawmakers see the long-term projections of the impact of diabetes interventions.”

Legislation introduced earlier this year is designed to lead to a more accurate assessment of the costs and benefits of preventive health, including preventing complications and delaying progression of chronic diseases such as diabetes. The bipartisan Preventive Health Savings Act of 2009 (HR 3148), calls on the CBO to weigh clinical or observational studies when modeling projected costs and savings related to preventive health, and in certain circumstances, to look beyond the traditional 10-year budget window.

Source: National Changing Diabetes Program


HearUSA Audiologist Offers Strategies for Dealing With “Invisible Handicap”

For many of the millions of hearing impaired Americans, especially the 27 million living with untreated hearing loss, the holidays may not be all that happy, says audiologist Cindy Beyer.

Dr. Beyer, senior vice president of HearUSA, one of America’s largest hearing care and hearing aids companies, said studies have linked hearing loss to stress, frustration, and social isolation, “which can easily be intensified at holiday gatherings with families and friends, when many of those with hearing impairment may find conversations both difficult and isolating.”

“Hearing loss is often labeled ‘the invisible handicap’ because there are no outward signs of a handicap or limitations,” said Dr. Beyer. “As a result, we are unlikely to be aware that accommodations may be necessary to avoid a breakdown in communication.”

Here are some suggestions from Dr. Beyer for making holiday meals and celebrations more comfortable and enjoyable for those with hearing impairment and for the people around them.

– Speak clearly and distinctly, but not too fast. And never shout.
– If you’re asked to repeat something, do so without raising your voice and appearing annoyed.
– If your comment or question is still not being understood after repetition, reword it. Some words are easier to understand than others.
– In a group situation, be sure that the person is included in the conversation. If not, bring him or her back in.
– When speaking, look directly at the person and try not to be more than five feet apart.
– Your facial expressions and gestures and your overall body language are important aids in communicating, so try to be sure that you have the listener’s attention and that the room is well lit.
– Conversation is greatly enhanced when there is no distracting background noise from a radio or television.
– Dining out? Choose a quiet restaurant. Noisy conversations and the clatter of dishes and tableware in a crowded dining area are barriers to effective communication.
– Ask if there is anything you can do to make communication easier. For example, conversation will be much easier to understand in a room with carpeting and well-upholstered furniture than in a room with tiled floors, high ceilings or wooden furniture.

While almost all hearing loss can be successfully treated with hearing aids, only 25% of the 36 million Americans with hearing loss have them, according to the Better Hearing Institute, which notes that most hearing aids users report significant improvement in their interpersonal relationships and social lives.

“Today’s digital hearing aids are smaller, smarter and more comfortable than ever before,” said Dr. Beyer. “I can think of no greater gift during the holiday season than encouraging a loved one or a friend with untreated hearing loss to consider the impact they could have on their lives.”

Source: HearUSA


Food safety tips for healthy holidays

Parties, family dinners, and other gatherings where food is served are all part of the holiday cheer. But the merriment can change to misery if food makes you or others ill.

Typical symptoms of foodborne illness are vomiting, diarrhea, and flu-like symptoms, which can start anywhere from hours to days after contaminated food or drinks are consumed.

The symptoms usually are not long-lasting in healthy people—a few hours or a few days—and usually go away without medical treatment. But foodborne illness can be severe and even life-threatening to anyone, especially those most at risk:

  • older adults
  • infants and young children
  • pregnant women
  • people with HIV/AIDS, cancer, or any condition that weakens their immune systems
  • people who take medicines that suppress the immune system; for example, some medicines for rheumatoid arthritis

Combating bacteria, viruses, parasites, and other contaminants in our food supply is a high priority for the Food and Drug Administration. But consumers have a role to play, too, especially when it comes to safe food handling practices in the home.

“The good news is that practicing four basic food safety measures can help prevent foodborne illness,” says Marjorie Davidson, a consumer educator at FDA.

1. Clean:

The first rule of safe food preparation in the home is to keep everything clean.

  • Wash hands with warm water and soap for 20 seconds before and after handling any food. “For children, this means the time it takes to sing ‘Happy Birthday’ twice,” says Davidson.
  • Wash food-contact surfaces (cutting boards, dishes, utensils, countertops) with hot, soapy water after preparing each food item and before going on to the next item.
  • Rinse fruits and vegetables thoroughly under cool running water and use a produce brush to remove surface dirt.
  • Do not rinse raw meat and poultry before cooking. “Washing these foods makes it more likely for bacteria to spread to areas around the sink and countertops,” says Davidson.

2. Separate:

Don’t give bacteria the opportunity to spread from one food to another (cross-contamination).

  • Keep egg products, raw meat, poultry, seafood, and their juices away from foods that won’t be cooked. Take this precaution while shopping in the store, when storing in the refrigerator at home, and while preparing meals.
  • Consider using one cutting board only for foods that will be cooked (such as raw meat, poultry, and seafood) and another one for those that will not (such as raw fruits and vegetables).
  • Keep fruits and vegetables that will be eaten raw separate from other foods such as raw meat, poultry or seafood—and from kitchen utensils used for those products.
  • Do not put cooked meat or other food that is ready to eat on an unwashed plate that has held any egg products, or any raw meat, poultry, seafood, or their juices.

3. Cook:

Food is safely cooked when it reaches a high enough internal temperature to kill harmful bacteria.

  • “Color is not a reliable indicator of doneness,” says Davidson. Use a food thermometer to make sure meat, poultry, and fish are cooked to a safe internal temperature. To check a turkey for safety, insert a food thermometer into the innermost part of the thigh and wing and the thickest part of the breast. The turkey is safe when the temperature reaches 165ºF. If the turkey is stuffed, the temperature of the stuffing should be 165ºF. (Please read on for more pointers on stuffing.
  • Bring sauces, soups, and gravies to a rolling boil when reheating.
  • Cook eggs until the yolk and white are firm. When making your own eggnog or other recipe calling for raw eggs, use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powdered egg whites.
  • Don’t eat uncooked cookie dough, which may contain raw eggs.

4. Chill:

Refrigerate foods quickly because harmful bacteria grow rapidly at room temperature.

  • Refrigerate leftovers and takeout foods—and any type of food that should be refrigerated—within two hours. That includes pumpkin pie!
  • Set your refrigerator at or below 40ºF and the freezer at 0ºF. Check both periodically with an appliance thermometer.
  • Never defrost food at room temperature. Food can be defrosted safely in the refrigerator, under cold running water, or in the microwave. Food thawed in cold water or in the microwave should be cooked immediately.
  • Allow the correct amount of time to properly thaw food. For example, a 20-pound turkey needs four to five days to thaw completely when thawed in the refrigerator.
  • Don’t taste food that looks or smells questionable. Davidson says, “A good rule to follow is, when in doubt, throw it out.”
  • Leftovers should be used within three to four days.

Also, use care with stuffing.

In its Holiday Food Safety Success Kit, the Partnership for Food Safety Education recommends:

  • Whether it is cooked inside or outside the bird, all stuffing and dressing recipes must be cooked to a minimum temperature of 165ºF. For optimum safety, cooking your stuffing in a casserole dish is recommended.
  • Stuffing should be prepared and stuffed into the turkey immediately before it’s placed in the oven.
  • Mix wet and dry ingredients for the stuffing separately and combine just before using.
  • The turkey should be stuffed loosely, about 3/4 cup stuffing per pound of turkey.
  • Any extra stuffing should be baked in a greased casserole dish.

Source: U.S. Food and Drug Administration


Pre-emption of State Health Benefit Laws Is a Major Retreat; Insurance Rate Justification Shows Promise

Consumer Watchdog released a list of the 10 key positive and negative consumer protection provisions of the U.S. Senate health reform bill, HR 3590, which passed an important procedural vote this weekend.

The group lauded the bill’s dramatic expansion of coverage for those currently without health insurance and subsidies to help consumers afford care, but called for amendments as the bill is debated next week.

Consumer Watchdog said that two provisions allowing for pre-emption of state laws by less protective federal standards amounted to a major step backwards in coverage and affordability. Provisions requiring insurance companies to justify their rates and providing grants to states to develop “prior approval” systems are promising, but need further development to protect Americans from price gouging by health insurers.

“The ‘bad’ and the ‘ugly’ of the Senate bill threaten to undermine the ‘good.’ In particular, provisions of the Senate bill that would pre-empt more protective state standards will result in insurance policies that do not provide needed services and treatments when patients get sick and need health care the most,” said Jerry Flanagan, Health Care Policy Director for Consumer Watchdog. “If the government is going to require all Americans to have health insurance, then the government has the duty to ensure coverage is affordable. Insurance rate justification and prior approval of rates are essential to achieve affordability. However, even some of the ‘good’ provisions of the bill need additional clarifications and fixes to ensure that consumers get the coverage they pay for when the health care reform bills become law.”

The List of 10 of Consumer Protections: (details are below)

The Good:

1. Rate review. Insurers must publicly justify “excessive” rate increases, and federal grants would encourage states to require full “prior approval” of such increases. (Needs strengthening of prior approval, definition of “excessive.”)

2. Public Option. Bill retains an op-out public option and allows states to expand access to large employers.

3. Consumer rebates. Requires insurer rebates to consumers of administrative and overhead costs higher than 20% to 25%.

4. Minimum “loss ratio.” Insurers in some cases must assure that 85% of premiums are spent on medical care. (Should be expanded to all policies.)

5. Rescission ban. Insurers may not rescind policies except for “intentional misrepresentation” of material facts as determined by the coverage contract. (Needs much tighter definition.)

6. Guaranteed issue. Health insurance must be available to all, renewable for all, and rate differences, such as for age, are limited.

The Bad:

7. Mandate. Proof of insurance coverage is required of all Americans, while insurers are still largely free to charge what they want. (To keep insurers in check the bill needs a broader public option and mandatory rate approval to curb prices.)

8. Poor minimum coverage. Allowable minimum health plan, the “bronze” level, would cover only 60% of overall patient costs, including copays and deductibles. (Should be at least 75%.)

9. No employer requirement. Employers face only very weak fees for failing to even offer coverage. (Need more realistic requirements in House bill.)

The Ugly:

10. Race to the bottom on state protections. State benefit requirements would be preempted by “nationwide plans” and multistate “compacts,” which would be ruled by laws of the weakest states; weaker federal requirements would become the norm. Coverage of AIDS/HIV testing, reconstructive surgery, home health care services, and child delivery and mastectomy minimum hospital stays and more would likely be lost. (States must retain freedom to require stronger coverage for all types of policies.)

Source: Consumer Watchdog


Burnout and mental distress strongly related to errors by U.S. Surgeons

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 24,2009

Major medical errors self-reported by American surgeons are strongly related to both burnout and depression. Those findings appear today in the online edition of Annals of Surgery. The Mayo Clinic-led study included collaborators from Johns Hopkins and the American College of Surgeons.

In the confidential study, nearly 9 percent of U.S. surgeons responding said they made a major error in the three months prior to being surveyed. Over 70 percent attributed the error to themselves rather than a systemic or organizational cause. Results showed the components of surgeon burnout – emotional exhaustion, depersonalization and perception personal accomplishments – were related to errors; as was surgeons’ “mental quality of life” including depression.

“These results suggest that a surgeon’s personal mental health including burnout may have an effect on quality of care,” says lead author Tait Shanafelt, M.D. “Our aim is to encourage more research to find ways to reduce distress among surgeons and to provide better support when errors occur.” The authors say medical errors can haunt surgeons for years and contribute to distress.

Of the 7,905 surgeons participating in the survey, 8.9 percent or 700 reported making recent medical errors that they considered major. All participating surgeons also completed standardized survey tools to measure burnout, quality of life, and symptoms of depression. They also provided information on a variety of personal and professional characteristics. Researchers say they found no relation between errors and the work setting, method of compensation, number of nights on call per week, or number of hours worked. According to researchers, that finding suggests that reducing work hours for practicing surgeons may have little impact on limiting errors unless burnout is also addressed. They point out that the study has its limitations, as it relies on self-perception of errors and their severity. The researchers were also unable to determine if the association between distress and errors is causal.

Other authors on the study include Charles Balch, M.D., and Julie Freischlag, M.D., from Johns Hopkins; Gerald Bechamps, M.D., Winchester Surgical Clinic; Tom Russell, M.D., and Paul Collicott, M.D., American College of Surgeons; and Lotte Dyrbye, M.D., Daniel Satele, Paul Novotny, and Jeff Sloan, Ph.D., all from Mayo Clinic. The study was commissioned and supported by the American College of Surgeons. Dr. Bechamps was chairman of the ACS Committee on Physician Competency and Health at the time of the survey. Drs. Freischlag, Balch, and Collicott are all Fellows of the ACS. Dr. Russell is executive director of the ACS.

Source: Mayo Clinic


Amid the Flu Epidemic, don’t forget RSV in young children

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 23,2009

RSV found to cause far more emergency department visits and hospitalizations than seasonal flu

Influenza, particularly H1N1, has understandably captured the attention of public health officials, the media and the public. However, an analysis from Children’s Hospital Boston, based on patients seen in its emergency department (ED) during several recent flu seasons, shows that another virus – respiratory syncytial virus (RSV) – takes a substantially greater disease toll among young children than does seasonal flu.

Although the data come from the pre-H1N1 influenza era, the analysis, published online by the journal Pediatrics on November 23, is a reminder that RSV can cause serious illness in infants and young children. Prior studies have shown that by 3 years of age, nearly 100 percent of children are infected with RSV. According to the CDC, RSV is the most common cause of bronchiolitis and pneumonia in children under 1 year of age in the U.S.

The study, led by Florence Bourgeois, MD, MPH and Kenneth Mandl, MD, MPH, both of Children’s Division of Emergency Medicine and the Children’s Hospital Informatics Program, looked at acute respiratory illnesses in children aged 7 and younger, and found that patients infected with RSV had more than twice as many ED visits and six times more hospitalizations than those infected with seasonal flu. RSV-related illnesses were also twice as likely to lead to additional primary care clinic visits and to antibiotic treatment. The parents of children with RSV missed almost three times more workdays than parents of children with the flu, and parents of children under age 2 were nearly five times more likely to miss work when their child had RSV.

“RSV has been underappreciated,” says Bourgeois, who is also affiliated with Harvard Medical School. “There’s been disproportionate attention given to influenza, even though our data show morbidity to be very high from RSV. Based on our data, much more should be done in terms of prevention.”

The RSV season begins in October, but generally doesn’t peak until January and lasts through April/May, so it will become more visible in the coming months, she adds.

Bourgeois and colleagues prospectively studied children aged 7 and under visiting the Children’s Hospital Boston ED with acute respiratory illnesses during five consecutive seasons (2001-2006) – an average of 5,288 visits each year. A subgroup of children underwent viral testing; 23.6 percent were found to have RSV and 11.2 percent had influenza. To quantify additional healthcare visits and missed school and work days, the researchers conducted standardized interviews with 210 parents whose children had documented RSV or flu.

Using census data and data on pediatric acute respiratory illness from the National Hospital and Ambulatory Medical Care Survey, Bourgeois and colleagues were able to extrapolate their data nationally and determine population-based rates of RSV and flu illnesses. They estimate that 21.5 ED visits per 1,000 children were attributable to RSV, as compared with 10.2 per 1,000 for seasonal flu. Children under age 2 with RSV had the most visits – 64.4 per 1,000. Estimated hospitalization rates were 8.5 per 1000 for RSV, versus 1.4 per 1000 for flu. Nationally, caregivers missed an estimated 716,404 workdays each year for RSV and 246,965 for flu.

Although the study only looked at children age 7 and younger, the researchers believe their findings are relevant to older age groups, since young children drive transmission of viral infections, the researchers say. Recent hospitalization and mortality data indicate that, like flu, RSV disproportionately affects elderly persons.*

While H1N1 may change the equation this year – there are indications that it’s causing a greater burden of illness than seasonal flu – we shouldn’t relax our public-health vigilance once that epidemic starts to wane, says Bourgeois. “Many of the prevention measures people are following for H1N1 – such as frequent handwashing, using alcohol-based hand-sanitizers, and staying home when they’re sick – should apply every winter, to every viral season,” she says.

The study was funded by the National Library of Medicine, the National Institute of Child Health and Human Development, the Massachusetts Department of Public Health, the General Clinical Research Center at Children’s Hospital Boston, and the Agency for Healthcare Research and Quality. Clarissa Valim, MD, ScD, of Children’s Hospital Boston’s Clinical Research Program and the Harvard School of Public Health, and Alexander J. McAdam, MD, Ph.D., of the Department of Laboratory Medicine at Children’s, were co-authors.

*For further background, see:

Falsey AR; et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 2005 Apr 28;3 52(17):1749-59.

Thompson WW; et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003 Jan 8;289(2):179-86.

Hall CB; et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009 Feb 5; 360(6):588.

Source: Children’s Hospital Boston


Senate Health Bill raises taxes on families of special needs children

  • Author: Health Informer
  • Filed under: Health News
  • Date: Nov 21,2009

There are 18 separate tax hikes in the Reid-Obama healthcare bill. One of them caps the amount that can be deferred in Flexible Spending Accounts (FSAs) at $2500 per year (a similar provision was included in the Pelosi-Obama health bill and written about by Congressman Cathy McMorris-Rogers, R-Was., for National Review Online).

There is currently no limit to how much can be saved, though all monies must be used by the end of the year. Employers may put a cap in place for their employees, but this would put a cap in federal tax law for the first time. According to the Employee Benefit Research Institute (EBRI), 30 million American families use an FSA.

– For most people, the $2500 cap won’t be noticed. FSAs tend to be used for things like small deductibles, co-payments, eyeglasses, over-the-counter medicines, and laser eye surgery. The amount deferred in the typical FSA is probably much less than $2500 today
– There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year.
– Under tax rules, FSA dollars can be used to pay for this type of special needs education.

According to IRS Publication 502, Medical Expenses:

You can include in medical expenses fees you pay on a doctor’s recommendation for a child’s tutoring by a teacher who is specially trained and qualified to work with children who have learning disabilities caused by mental or physical impairments, including nervous system disorders.

You can include in medical expenses the cost (tuition, meals, and lodging) of attending a school that furnishes special education to help a child to overcome learning disabilities. A doctor must recommend that the child attend the school. Overcoming the learning disabilities must be a principal reason for attending the school, and any ordinary education received must be incidental to the special education provided. Special education include teaching Braille to a visually impaired person; teaching lip reading to a hearing-impaired person, or giving remedial language training to correct a condition caused by a birth defect.

Source: Americans for Tax Reform


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