News

This is from Katherine Hobson’s column, On Fitness.

As kids start the fall sports seasons, parents of girls need to know about their specific risks.

There is a helpful link to the four most common sports injuries, a description of each and more about why they happen.

Informed parents and young female athletes can work to bring those risks down.

US News and World Report

“Author and journalist Michael Sokolove sees a particular problem in the women’s sports arena, which he says faces an “epidemic” of injuries. (Here’s a list of common sports injuries in women.) In his recent book Warrior Girls, he explores the tension between telling our daughters that they can do anything the boys can do and recognizing the reality that girls may be particularly susceptible to crippling injuries.

“You talk to a lot of young women with multiple ruptures of the anterior cruciate ligament (ACL). Is it really more prevalent in women?
There’s a lot of research on this, and it’s ongoing. But the way it’s usually said is that in the sports that girls and boys play in common and by the same rules—including soccer and basketball—girls are considered 5 to 8 times more likely to suffer an ACL injury. Just two times the rate of incidence would be significant!

“Doctors have a lot of different theories as to why. What’s the consensus?
In the midteens, boys get stronger and girls tend not to, at least not to the same degree. That’s unfair, but it’s a fact. And girls are more flexible compared with boys; they have lots of flexibility, but not enough muscle to keep their joints in stable, safe positions. That can lead to ankle, back, hip, and knee injuries. Or, in swimmers, shoulder injuries. Second, researchers say that girls tend to run in a more upright position than boys. They are more likely to decelerate with their knee locked and out in front of them, which can hurt the ACL. Ideally, everything is lined up; the feet and knees are under the hips, and the butt is down—it’s what the old gym teachers used to call the athletic position. Programs that attempt to change girls’ movement patterns so they run and land more safely have shown promise.

“You say girls have adopted a “warrior” ideal, where withstanding pain is a sign of strength.
I think we want our kids not to be soft, which is a good goal. At its best, sports really teaches that. My own daughter is a college swimmer, and she’s really, really tough; she’s not easily stopped by momentary disappointment. That came from her swimming. [As a society,] we are particularly eager for our daughters to be tough. But that sometimes goes too far. We have a culture of playing children to exhaustion and demanding more difficult athletic schedules.”

Source:  US News and World Report, August 15, 2008

News

This study is the the first to examine how much prescription-sharing goes on among adults and the results were a surprise.

While it is common for both sexes, researchers noted that the highest rate of drug-sharing was among women of reproductive age at 36.5%.

Prescription-sharing is considered risky by safety experts. You may think you have the same prescription as someone else but you don’t. The dosage could be different. The generic could be different. If you became pregnant, the drug may be one you should not take.

Keep your own prescriptions filled.

Keep each person’s separate from the others.

Medication mistakes are so easy to make and can cause so much trouble.

You also don’t want to set a bad example for kids. Recently there have been stories about kids “borrowing” from their parents’ medicine cabinets so that they can get high at home.

Wonder where they learned that?

Medpage Today

“According to a survey, 28.8% of women and 26.5% of men said they had shared or borrowed someone else’s prescription drug during their lifetime (rate ratio 1.08, 95% CI 1.04 to 1.13), Margaret Honein, Ph.D., of the CDC, and colleagues reported online in the Journal of Women’s Health. Women of reproductive age — 18 to 44 — had the highest rate at 36.5%, which the researchers found particularly troubling.

The most common medications borrowed or shared in this age group were for allergies (43.8%) or pain (42.6%), followed by antibiotics (32.3%).

The reasons most frequently cited were that they already had a prescription for the medication but ran out or didn’t have it (71.8%), they had the same problem (49%), or they got it from a family member (44.2%).

“Prescription medication borrowing and sharing are a concern for women’s healthcare providers and public health professionals because of the potential health effects for women and the possibility of teratogenic effects on the developing embryo or fetus,” the researchers said.

An estimated 11.7 million potentially teratogenic medications were prescribed from 1998 to 2001 to women of childbearing age, they said, “suggesting that potentially teratogenic medications are available for borrowing and sharing in this population.”

They concluded, “The risks of medication sharing should be discussed with patients when a healthcare provider is prescribing a medication that might be of teratogenic or other risk if the medication is used by persons other than those for whom it was prescribed.”

The sharing of prescription medications can have many unintended consequences in addition to possible teratogenic effects, the researchers said, including allergic reactions, unanticipated side effects, interactions between drugs, antibiotic resistance, a possible reduction in birth control efficacy, and addiction or abuse.

Source:  Medpage Today, August 26, 2008

Citation: Journal of  Women’s Health. 2008; DOI: 10.1089/jwh.2007.0769.

Headline News

The public has been warned about pharmaceutical products sold on the Internet by unknown sources.

Now comes a warning about the kinds of products which have the most benign reputation.

The bottom line remains the same:

First, know from whom you are buying anything you swallow or put on your body.

Second, be sure your doctor knows what you are taking or using which may not be a prescription—-the often-cited rule is this: If something is powerful enough to help you, it is powerful enough to hurt you.

If you are not certain about a website’s sponsorship, don’t even think about buying important medicines or products there.

US News and World Report and HealthDay News

“About one in five ayurvedic medicine products purchased on the Internet contain significant levels of lead, mercury or arsenic, a new study finds.”
Source: US News and World Report and HealthDay News,  August 26, 2008

News/Commentary

Today’s news began with the image of a man arrested, along with two others, in what may or may not have been on a trip planned to harm presidential candidate Barack Obama.

Earlier this year, one young man was apprehended.

He had a map to Camp David where the president spends many weekends.

He had much, much more. Weapons.

His lawyer says he was not planning to act.

Presidential campaigns are not the only events that draw out criminals or mentally dangerous people, but they are an event everyone understands.

Everyone is paying attention.

The hazards should be as close to zero as possible with security levels at peak.

As today’s news shows, even with all eyes on one man, the safety of one man can’t be assured.

This article, by a Washington psychologist, is about the prevention of a possible attempt on the president’s life by a young man and why we all have a responsibility to help prevent violence, whatever the cause.

Appearing in today’s paper, the author could not have guessed what one of the morning’s headlines would be.

Washington Post

Source:  Washington Post,  August 26, 2008

News/Commentary

Each of us makes decisions every day which affect what our last years and our last hours will be like.

No, we certainly don’t have control. Many things happen no one could have done anything about. There are many ways, though, in which we can help ourselves live better, longer—-the health goal of most people closing in on 70 years of age or older.

Patients and those they are closest to have decisions to make.

Physicians and other care-givers do, too.

“Chronological age is a very imperfect determinant on which to base medical decision-making,” according to an article by Dr. William J. Hall of the Highland Hospital Center for Healthy Aging in Rochester, and quoted by Jane Brody, who is the Personal Health columnist for The New York Times. Her columns are packed with good information and equally good advice.

New York Times

“The fastest-growing segment of the population consists of people over 85, and by 2050 some 800,000 Americans will have celebrated their 100th birthday.

“Doomsayers consider this a terrifying trend, bound to bankrupt Social Security and Medicare and overwhelm the ability of doctors and medical facilities to care for the burgeoning population of the oldest old.

“But there is increasing evidence that the societal burden of increased longevity need not be so drastic. Long-term studies have shown that how people live accounts for more than half the difference in how hale and hearty they will remain until very near the end.”

Source: The New York Times, August 25, 2008

Headline News

Reports say that this data does not include statistics since the economic changes this year.

However, it is significant. It will be possible to assess the net impact of economic decline in 2008 on the uninsured more clearly. If government programs which brought about this reduction are cut, there goes the improvement out the 2008 window.

Associated Press

Source: Associated Press, August 26, 2008

Commentary

The Washington Post

“COLLEGE OFFICIALS who have signed on to the provocative proposition that the legal drinking age of 21 isn’t working say that they just want to start a debate. Perhaps when they get done with that, they can move on to whether Earth really orbits the sun. Any suggestion that the current drinking age hasn’t saved lives runs counter to the facts.

“More than 100 presidents and chancellors from such top universities as Duke and Johns Hopkins say it’s time to rethink the drinking age, contending it has caused “a culture of dangerous, clandestine ‘binge-drinking.’ ” The statement does not specifically advocate reducing the drinking age, but many who signed it say they thought legal drinking should begin at 18. (Emphasis added)

“Health and safety experts have reacted with dismay, because raising the drinking age has saved many lives. In 2001, the Centers for Disease Control and Prevention reviewed 49 studies published in scientific journals and concluded that alcohol-related traffic crashes involving young people increased 10 percent when the drinking age was lowered in the 1970s and decreased 16 percent when the drinking age was raised. The retreat from a lower drinking age translates into some 900 lives saved each year among 16- to 20-year-olds. Those who would argue that other factors, such as safer cars, are responsible should take a good look at numbers posted by Mothers Against Drunk Driving showing alcohol-related traffic fatalities among 16- to 20-year-olds decreasing 60 percent between 1982 and 2006 while non-alcohol-related fatalities increased 34 percent.

“The college presidents are right about binge drinking. Each year, some 1,700 college students die from causes related to alcohol use; there is also the toll of injuries and sexual assaults fueled by alcohol. But where is the logic of solving the underage drinking problem by lowering the age even more? Henry Wechsler, the Harvard expert whose studies of binge drinking popularized the phrase, put it best, comparing lowering the drinking age to “pouring gasoline to put the fire out.” (Emphasis added)

Source: Washington Post, August 24, 2008

Citation Sources: Centers for Disease Control and Prevention. Research studies by Henry Wechsler, Harvard University.

Headline News

The Bush administration’s position on a new regulation to protect the rights of health care employees who are anti-abortion, due to be implemented in 30 days, is: “There is nothing in this rule that would in any way change a patient’s right to a legal procedure.”

The absence of comment from associations representing not-for-profit hospitals—-teaching and community ones—- is sufficient to suggest that those institutions must believe that this is a regulation they are equipped to manage as it applies to their own work forces.

For example, if you go to a hospital today, you likely will have care-givers who are African-Americans, Asians (from many different cultures), Caucasians, Hispanics (from many different cultures) and Middle-Easterners (from many different cultures.)

If this regulation is straight-forward, fine. We all have to guided by our own consciences.

If it is a sub-rosa strategy for hassling patients and other employees who don’t agree with them, events will reveal that.

Additional regulatory action can be taken if there are problems.

Everyone who cares about patients’ rights, workers’ rights and the abortion issue, be they pro or con, will be watching closely.

Reuters

“Health officials released a controversial regulation on Thursday to protect health professionals who do not want to provide abortions or certain other health care services.

“The regulation could strip federal funding from employers or institutions that fire a doctor, nurse, pharmacist or other health professional who refuses to provide abortion care or information.

“But it no longer defines some types of contraception as abortion, after family planning groups complained an earlier draft would have defined abortion to include birth control pills and the intrauterine device or IUD.

“This is about protecting the right of a physician to practice medicine according to his or her moral compass,” Health and Human Services (HHS) Secretary Michael Leavitt told reporters in a conference call. “There is nothing in this rule that would in any way change a patient’s right to a legal procedure.”

“He said it enforces three existing federal laws. Those laws allow providers to opt out of offering the abortion pill RU-486 and emergency contraception.

“The Planned Parenthood Federation of America said the regulation was deliberately vague.

“At least they wrote a definition of abortion,” Roger Evans, director of litigation at the group, told reporters.”

Source: Reuters, August 21, 2008

News/Commentary

By Cheree Cleghorn, Editor

From a British medical journal, a study of U. S. family practices shows that every phase of tests—-from ordering to reporting back to patients—-has a higher error rate than is acceptable.

Most patients understandably want good news—-or at least, don’t want to hear bad. Too many still assume that “no news is good news.”

No news is no news. Period.

Ask your doctor when the results of any test are expected. If it is not urgent, allow one extra day for lab back-ups, holidays or other delays. Then call your doctor to ask for your results if you have not heard.

You only have you to pay attention to. They have to pay attention to all of their patients.

You can’t correct errors in test ordering or whether tests are performed correctly, but you can prevent failures in reporting test results to you.

Do call when you don’t hear. It is important that you know about every test result, including “normal.”

New York Times

“In about three out of four cases, patients suffered as a result of the mistakes, the study showed. In about 24 percent of cases, the mistake led to delays in proper treatment. In 22 percent of the errors, the mistake forced the patient to spend additional time or money. Mistakes caused pain and suffering in 11 percent of the cases; and 2 percent of the time, the mistake resulted in poorer health. (Emphasis added)

“The report, published in the journal Quality & Safety in Health Care, looked at testing procedures and mistakes that were reported anonymously by 243 doctors, nurses and staff members in eight small and large family physician practices in seven states. During an eight-month period, researchers from the University of Chicago analyzed the error reports related to medical testing, including ones they observed “should not have happened and that you don’t want to happen again.” The tests included lab work, diagnostic imaging and other procedures like pulmonary function tests and electrocardiograms. ”

Source: New York Times, Well, August 21, 2008

Citation Source: Quality and Safety in Health Care, 2008; 17: 286-290. doi:10.1136/qshc.2007.024869

News/Commentary

This is an objective analysis of both candidates’ positions on health care.

Short and insightful.

There are two totally different approaches to reshaping health care for the 21st century. Both candidates have to make assumptions over which they have no control, most specifically, where’s the money coming from and where can money be saved?

If this were easy, we wouldn’t be where we are today.

There is no split-it-down-the-middle solution.

Give them credit for trying. Whoever wins will have one big fight on his hands.

Which is why we are where we are today.

We have not settled on what we believe to be right, fair and achievable in health care.

Until we do, any elected official is going to find it all but impossible to get enough votes to take constructive action.

We have had so many surprises: the obesity epidemic is an example. How can we calculate savings from prevention when prevention efforts for one major risk factor, obesity, are failing on a grand scale? Thirty years later, AIDS still is with us and may not be the victory story everyone hoped for. An influenza pandemic (which refers to how many people get sick not how serious it is) is likely; the 1918 influenza epidemic killed more young adults than older ones.

We cannot predict the rate or cost of change, regardless of who is sworn in in January.

The assumptions made, for instance, about health plan participation or the adoption of electronic medical records are simply that: assumptions. There are models for making educated estimates but that’s all they are. Humans are not models and are quite unpredictable. So, there’s that.

Everybody is going to have to give up something to get this nation’s people insured, period.

So far, it is not clear who the first volunteers will be.

We should not ask our candidates to do funny math to persuade us.

Choices need to be made. Real ones.

We show no sign of being ready to do that. America is mad and scared.

Those are not the same as being ready to change.

New England Journal of Medicine

“The McCain and Obama health plans are best viewed as sketches rather than finished portraits, with many important details yet to be revealed. Still, the 2008 presidential election clearly offers voters dramatically different alternatives. The candidates’ opposing visions of health care reform reflect fundamentally different assumptions about the virtues and vices of markets and government. With the debate over how to reform U.S. health care far from settled, whoever wins the presidency can expect fierce opposition to any attempt at comprehensive reform.”

Source: New England Journal of Medicine, Volume 359:781-784, August 21 2009, Number 8. (Perspective/Free)