Thursday, 31 January 2013

Princess Health and Common beliefs about obesity and weight loss found to be myths.Princessiccia

Princess Health and Common beliefs about obesity and weight loss found to be myths.Princessiccia

Think going to gym class drives weight loss, or that breastfeeding protects a child from obesity? Think again, because these are among seven popular myths about obesity myths, according to an international team of researchers.

The seven popular but largely inaccurate beliefs, which lead to poor policy decisions, inaccurate public-health recommendations and wasted resources, were identified by the team led by David Allison, associate dean for science in the School of Public Health at the University of Alabama at Birmingham.

Here are the seven myths:

Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.
Fact: Small changes in calorie intake or expenditure do not accumulate indefinitely. Changes in body mass eventually cancel out the change in calorie intake or burning.

Myth 2: Setting realistic goals in obesity treatment is important. Otherwise, patients become frustrated and lose less weight.
Fact: Some data suggest that people do better with more ambitious goals.

Myth 3: Gradually losing weight is better than quickly losing pounds. Quick weight losses are more likely to be regained.
Fact: People who lose more weight rapidly are more likely to weigh less, even after several years.

Myth 4: Patients who feel �ready� to lose weight are more likely to make the required lifestyle changes, do health-care professionals need to measure each patient�s diet readiness.
Fact: Among those who seek weight-loss treatment, evidence suggests that assessing readiness neither predicts weight loss nor helps to make it happen.

Myth 5: Physical-education classes, in their current form, play an important role in reducing and preventing childhood obesity.
Fact: Physical education, as typically provided, does not appear to counter obesity.

Myth 6: Breastfeeding protects children against future obesity.
Fact: Breastfeeding has many benefits for mother and child, but the data do not show that it protects against obesity.

Myth 7: One episode of sex can burn up to 300 Kcals per person.
Fact: It may be closer to one-twentieth of that on average, and not much more than sitting on the couch.

The research team also defined six �presumptions" that are generally held to be true even though more studies are needed before conclusions can be drawn, such as the idea that regularly eating versus skipping breakfast contributes to weight loss. Studies show it has no effect.

The same goes for the idea that eating vegetables by itself brings about weight loss, or that snacking packs on the pounds. According to Allison and colleagues, these hypotheses have not been shown to be true, and some data suggest they may be false.

The researchers also identified nine research-proven facts about weight loss. For example, weight-loss programs for overweight children that involve parents and the child�s home achieve better results than programs that take place solely in schools or other settings.

Also, many studies show that while genetic factors play a large role in obesity, �Heritability is not destiny.� Realistic changes to lifestyle and environment can, on average, bring about as much weight loss as treatment with the most effective weight-loss drugs on the market. (Read more)

Wednesday, 30 January 2013

Princess Health and Poor, rural mothers-to-be have high levels of stress, and few resources to help them handle it, small-scale study concludes.Princessiccia

Princess Health and Poor, rural mothers-to-be have high levels of stress, and few resources to help them handle it, small-scale study concludes.Princessiccia

Low-income pregnant women in rural areas experience high levels of stress, but lack the appropriate means to manage their emotional well-being, according to a small-scale study at the University of Missouri. The authors suggest that rural doctors should link these women with resources to help manage stress, Medical Xpress reports.

"Many people think of rural life as being idyllic and peaceful, but in truth, there are a lot of health disparities for residents of rural communities," Mizzou nursing professor Tina Bloom told Medical Xpress. "Chronic, long-term stress is hard on pregnant women's health and on their babies' health. Stress is associated with increased risks for adverse health outcomes, such as low birth weights or pre-terms deliveries, and those outcomes can kill babies."

Researchers studied about 25 rural pregnant women. Through interviews, researchers discovered that financial problems were one of the biggest stressers for them. Financial stress was exacerbated by the women's lack of employment, reliable transportation and affordable housing. The women also said that small-town gossip, isolation and interdependence of their lives with extended family members also increased stress. Almost two out of three women showed symptoms of depression, and one in four displayed symptoms of post-traumatic stress disorder. (Read more)

Tuesday, 29 January 2013

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

By Molly Burchett and Al Cross
Kentucky Health News

If Kentucky expands its Medicaid program, it will probably be able to reduce the cost by requiring patients whose incomes are above the federal poverty level to help pay for their care. That could make it more feasible for the state to expand the program to people with incomes up to 138 percent of the poverty line.

A proposed federal policy will let states charge co-payments and increased premiums for doctor visits and some prescription drugs and hospital care. Robert Pear of The New York Times reports that the policy is designed to encourage states to expand Medicaid under the federal health-care reform law, with generous federal help. By shifting costs to patients, the state and federal governments would pay less.

That adds a new perspective to the cost consideration in Kentucky's debate over expansion of Medicaid. It could influence the state's decision, Republican state Sen. Julie Denton of Louisville said Friday during a legislative panel at the Kentucky Press Association convention.

Denton cautioned that the state needs to fix its problems with Medicaid managed care before it expands the program. Democratic Gov. Steve Beshear has said he wants to expand Medicaid if the state can afford it, and since there is no deadline for deciding whether to participate in the expansion, the debate may carry over into 2014.

Some Republicans have said Kentucky can't afford the expansion. If the state expands Medicaid eligibility to 138 percent of poverty from its current threshold of 70 percent, the federal government would pay all the cost of the expansion until 2017, when the state would begin helping out, with its share reaching 10 percent in 2020. The federal share of the state's current program is 72 percent.

This proposed rule could have important implications not just for state finances, but for Medicaid patients. It means that a family of three with an annual income of $30,000 could be required to pay $1,500 in premiums and co-payments, Pear reports in the Times.

As published in the Federal Register last week, the rule proposes to "update and simplify Medicaid premium and cost sharing requirements, to promote the most effective use of services and to assist states in identifying cost-sharing flexibilities." It proposes "new options for states to establish higher cost sharing for nonpreferred drugs and to propose higher cost sharing for non-emergency use" of emergency rooms.

Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, told Pear that the administration had not adequately defined the �nonemergency services� for which the poor might have to pay. "In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out," Pear writes.

The proposed rule has no limit on emergency department charges for "non-emergency use." It says the hospital will have responsibility to assess the individual clinically and ensure access to other sources of care before requiring payment, which could pose problems for hospitals.

The public has until Feb. 13 to comment on the proposed rule, which can be submitted at www.regulations.gov.

Monday, 28 January 2013

Princess Health and Prescription-painkiller epidemic is spurred by societal shift, experts say: People think every problem has a pill for an answer.Princessiccia

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Experts explain changes to state prescription-tracking system.Princessiccia

By Molly Burchett
Kentucky Health News

The Kentucky All-Schedule Prescription Electronic Reporting system, the key to fighting doctor-shopping for painkillers in the state, has undergone several changes since the legislature passed House Bill 1 last year to crack down on so-called pill mills. An expert panel at "The Different Faces of Substance Abuse"conference last week in Lexington addressed the more recent changes to KASPER.

�The new legislation has brought prescription drug use into the medical arena when it had not been before,� said Dr. Michelle Lofwall, member of the KASPER Advisory Council, created last year by Gov. Steve Beshear.

Very soon Kentucky will be sharing KASPER data with all seven border states, which will be provided automatically in reports, and all agreements to enable this exchange have already been signed, said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

One important but little-reported change is that KASPER reports can now be included in patients� medical records. Prior to the passage of HB1, this was a felony and created workflow problems for physicians.

Attorney General Jack Conway has steered money from a mortgage settlement to enable the necessary system upgrades to KASPER that will bring about additional changes, said Ingram. Starting in July, dispensers of drugs will be required to report data every 24 hours instead of the current weekly timeframe, improving the timeliness of the data.

Changes are also coming to the regulations associated with HB1, since medical licensure boards have �gotten an earful� and have revisited the regulations to make them more straightforward and common sense, KASPER program manager Dave Hopkins said.

Ingram said, �With any big policy change, there are going to be unintended consequences. . . . The legislature will take a look at the unintended consequences. If you want to make drastic changes, it�s going to be chaos for a while.�

�In a lot of things with government, great ideas are complicated by reality,� said Dr. Ryan Stanton, UK Good Samaritan Hospital emergency-room physician and medical director, as he painted a more realistic picture of KASPER from when he first created an account with the system in 2005.

Stanton said recent changes have included timelier and more accurate reports that make the system easier to use. He said more such improvements are critical to catch those who "abuse in spurts," and are also important because physicians have minimal time and need to spend more time with patients instead of in front of a computer.

The use of KASPER has increased significantly since the passage of HB 1, with the number of reports requested increasing from 811,000 in 2011 to 2.69 million in 2012.

Medications containing the painkiller hydrocodone, including Lortab, Lorcet and Vicodin, remain the most-prescribed type of controlled substance in Kentucky, 41.5 percent of the total.

Click here for more information about KASPER.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Princess Health and Ky. parents strongly favor increasing school dropout age, a step that could make future high-school students healthier.Princessiccia

Princess Health and Ky. parents strongly favor increasing school dropout age, a step that could make future high-school students healthier.Princessiccia

A statewide poll has found that Kentucky parents overwhelmingly favor increasing the state�s school dropout age, and doing so might help future high-school students' health, according to the Foundation for a Healthy Kentucky, which sponsored the poll.   

After being told the legislature may raise the dropout age to 18 from 16, 85 percent of Kentucky parents said they favor the move, and 77 percent of parents said they strongly favored it.

Besides their homes, school is where children spend most of their time, and the overall health and well-being of students affect their ability to learn.  Healthy kids learn better and students� academic achievement in turn affects their ability to be healthy and stay well in the future.



�People may not realize that education is a health issue, but research tells us that completing high school is directly related to our health status in later life,� said Dr. Susan Zepeda, President and CEO of the foundation. �Increasing the dropout age is one strategy aimed at improving the graduation rate in the state. We hope this polling data will encourage a deeper conversation among parents, education experts and policy makers to explore this and other strategies to help our children succeed at school and lead a more healthy life.�


The dropout-age question was part of the Kentucky Parent Survey, which provided a snapshot of parental views on a number of issues involving health care, school and home life. It surveyed parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky.

The poll was conducted in July and August 2012 by the Center for Survey Research at the University of Virginia.  More than 1,000 parents and guardians of children under 18 from throughout the state were interviewed by telephone, including landlines and cell phones.  The survey's margin of error is plus or minus 3 percentage points. 

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Princess Health and FDA likely to make hydrocodone painkillers harder to prescribe.Princessiccia

Princess Health and FDA likely to make hydrocodone painkillers harder to prescribe.Princessiccia

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)