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


Primary Care Doctors, Endocrinologists Feel Ill-Equipped to Provide Ideal, Multi-Disciplinary Team Care

Nearly one-third of doctors surveyed said they did not have enough time and did not receive sufficient reimbursement to provide comprehensive care to their patients with diabetes, according to the results of a study of endocrinologists and primary care doctors published today in American Health & Drug Benefits.

An online survey of 300 physicians and online discussion group of 12 physicians conducted by Abt Associates, Inc. and sponsored by the National Changing Diabetes® Program (NCDP) found that 32 percent of physicians felt unable to provide comprehensive diabetes care, and most cited time or reimbursement as the major barrier. Furthermore, 83 percent of physicians surveyed said Medicaid reimbursement was inadequate, while 67 percent said private insurance reimbursement was inadequate.

More than 24 million Americans have been diagnosed with diabetes and another 57 million have prediabetes, which puts them at high risk for developing the debilitating disease. In 2007, diabetes and prediabetes cost the U.S. healthcare system an estimated $218 billion in medical expenses and lost productivity and is a leading cause of disability. Despite advances in treatment and education, the incidence of diabetes continues to rise at an alarming rate each year.

“People who have diabetes or are at high risk for developing diabetes need the best possible care to effectively manage their disease. This includes comprehensive education so that they can make the lifestyle changes that could avert or reverse the course of diabetes,” said Dana Haza, senior director of NCDP, an initiative created by Novo Nordisk to drive systems change at the national and local level. “Clearly, we need to make some changes to the health care system if time and reimbursement levels are impacting the quality of care these people receive.”

The web-based survey polled 200 primary care physicians and 100 endocrinologists. On average, each doctor treated 239 patients per month. Endocrinologists who participated in the survey treated significantly more patients diagnosed with diabetes than primary care physicians, while primary care physicians had more patients deemed at high risk for developing diabetes.

Doctors surveyed said they did not feel they had adequate time with each patient to provide all the necessary care and education. “Diabetes is a complex disease,” Haza said. “By spending just 10 additional minutes with a patient, doctors believe they can have a significantly greater impact on the quality of health outcomes.”

“Without appropriate reimbursement in place, it is difficult or nearly impossible for doctors to provide their patients with the level of support they both require and deserve, let alone sustain a medical practice today,” said Dr. Anne Peters, former chairperson of the American Diabetes Association Council on Health Care Delivery and Public Health and director of the USC Clinical Diabetes Programs. “As a result, physicians spend less time with each patient and end up addressing only the most immediate aspects of diabetes care on a given visit rather than the broad spectrum of care they deserve,” Dr. Peters said.

“Diabetes requires multidisciplinary care and a team-based approach for the best outcomes,” Lana Vukovljak, Chief Executive Officer of the American Association of Diabetes Educators, said. “In addition to aggressively managing their blood glucose levels and monitoring their overall health, these patients benefit when provided substantial education on nutrition and the importance of weight loss, physical activity and smoking cessation,” said Ms. Vukovljak.

Physicians surveyed said they did not have adequate resources — including medical and administrative time, facilities, staff and materials — to ensure multi-disciplinary team care (32 percent), to provide lifestyle and behavior modification counseling (28 percent), or patient education on self-care and preventing complications (15 percent). Fewer than half (47 percent) of doctors surveyed said they had adequate resources to provide psychological and social status assessments.

The most common service that doctors provided their patients with diabetes was instruction in, and evaluation of, self-monitoring blood glucose levels. Blood glucose monitoring is critical for patients to prevent serious complications such as hypoglycemia, the leading cause of diabetes-related hospitalizations. While 89 percent of all doctors surveyed said they or their staff provided this service, fewer than half provided other services important to managing diabetes, such as medical nutrition therapy (36 percent) and multi-disciplinary care coordination (49 percent). Nearly three-quarters of all doctors surveyed said their practices provided annual eye exams and blindness education (74.5 percent) and weight loss counseling and physical activity instruction (76 percent).

Primary care physicians (92.5 percent) and their staff were more likely than endocrinologists (54 percent) to provide smoking cessation counseling. Yet endocrinologists were more likely (95 percent) to provide intensive insulin therapy instruction than primary care doctors (58.5 percent).

“Physicians who cannot provide comprehensive diabetes services within their own practices can and do refer patients elsewhere,” said Alyssa Pozniak, PhD, study co-author. “But this fragments the care of the diabetes patient, as we learned from the research.”

Data for the study was collected via a web-based survey of primary care physicians and endocrinologists as well as during a follow-on, online discussion group of a sample of physicians representing the two specialties. All participants treated adult patients with diabetes and were whole or part owners of their medical practice, and survey responses were based on the physicians’ perceptions and knowledge of their practice and patients.

Source: National Changing Diabetes Program


5 tips to a healthier thanksgiving for seniors

Thanksgiving can be fun and festive for some and emotionally and physically challenging for others. Since seniors are especially vulnerable to certain holiday-related health pitfalls, SCAN Health Plan offers these five tips to a healthier Thanksgiving – and holiday – season:

1. Don’t dine alone. Many senior centers provide opportunities for people to enjoy a hearty Thanksgiving meal in the company of others. Sharing the holiday with others not only lifts your spirits, but provides a well-balanced healthy meal. If you’re able, find out how to volunteer to help prepare and serve this year’s Thanksgiving feast.
2. Mind your heart. Calories and fat still count during the holidays. Overeating can lead to everything from heartburn to a heart attack. Limit gravies, butter and other high-fat choices with plenty of vegetables and lean white meat. If you experience chest pain, don’t delay seeing a doctor.
3. Drink in moderation. Besides a nasty hangover and obvious safety hazards, over-imbibing can have many negative effects – some social and some physical – including depression, an inflammation of the pancreas, hepatitis and an irregular heartbeat. Limit your intake to no more than one alcoholic drink per day for women and no more than two drinks per day for men. And never drink and drive.
4. Plan ahead. Be sure to have an up-to-date list of medications you are taking. If you do face a health emergency during the holidays, it’s important for your doctor to know your current medical conditions and have a list of your medications.
5. Keep your health in focus. If you feel under the weather – physically or mentally – during the holidays, don’t wait to visit your doctor. Colds, flu and depression are much more common during this season.

“Thanksgiving can be a joyous start to the holiday season, but it is especially important that seniors take care of themselves during this time,” said Tom Lescault, president of SCAN Health Plan Arizona.

As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of “Healthy Tips for Successful Aging” with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts “Senior Focus,” a broadcast dedicated to senior-related issues.

Source: SCAN Health Plan Arizona


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