New asthma guidelines urge daily control
Wed, 29 Aug 2007 17:01:24 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Breathing easier without limiting activities is the goal of new government guidelines that urge more attention to asthma sufferers' day-to-day symptoms, not just their severe attacks.
Some 22 million Americans have asthma, and guidelines updated Wednesday by the National Institutes of Health stress the importance of adjusting therapy until their asthma is under good control.
"Asthma control is achievable for nearly every patient," said Dr. Elizabeth Nabel, director of NIH's National Heart, Lung and Blood Institute. "Patients really should accept nothing less."
The guidelines reflect a shift already under way, as specialists seek to teach patients that a flare-up isn't the only sign of trouble. Someone who only avoids an attack by giving up exercise, or who thinks it's normal to wake up at night coughing or wheeze while running, doesn't have asthma well-controlled.
And the recommendations come at a key time: Asthma hospitalizations peak in September and October, said Dr. Homer Boushey of the University of California, San Francisco, a guideline co-author. Patients aren't as good at taking asthma-prevention medication during the summer and can be caught by surprise when schoolchildren start bringing home fall viruses.
Asthma is a chronic lung disease caused by inflammation inside airways that in turn makes them super-sensitive, narrowing in response to irritants that wouldn't bother a healthy lung. Symptoms include wheezing, coughing, chest tightness and difficulty breathing.
There is no cure, but daily medications are very effective at reducing inflammation and preventing flareups. Yet asthma kills about 4,000 people a year and causes almost half a million hospitalizations.
The guidelines are aimed at doctors, but include some patient-friendly advice:
_Give your doctor details about day-to-day symptoms and whether you've adjusted activities to avoid wheezing, to help him or her monitor both current impairment and future risk of a severe attack.
_Every patient needs a written "action plan" with instructions for daily treatment and what to do is asthma worsens. Share that action plan with teachers and coaches.
_Inhaled corticosteroids are the foundation of preventive treatment for all ages. Patients also need inhaled rescue medication. To ensure patients know how to use each, practice with "dummy" inhalers in the doctor's office.
_Children ages 5 to 11 usually do very well on low doses of a single drug, the inhaled corticosteroid, instead of the combination treatments required by many adults. There are a variety of additional medications for more severe asthma, all with side effects to consider in picking the right cocktail.
Schwarzenegger tries to save health plan
Wed, 29 Aug 2007 18:33:17 GMTBy LAURA KURTZMAN, Associated Press Writer
SACRAMENTO, Calif. - The prognosis for universal health care in California is grim this year, and experts say a failure could set back similar efforts nationwide for years to come.
Unions, doctors and other powerful interests are arrayed against Gov. Arnold Schwarzenegger's $12 billion-a-year plan to make medical insurance mandatory. He has threatened to veto the Democrats' less ambitious alternative and take his plan to the ballot instead.
A showdown could come as early as Thursday, when the Democrats plan to put Schwarzenegger's proposal to a vote in the state Assembly. The aim is to show how little support it has.
With the campaign for the White House under way, what happens in the nation's most populous state could have especially wide repercussions.
"If we fail, it will have the effect of a wet blanket on health reform nationally," said Robert Ross, president of the California Endowment, a foundation devoted to health care. "I think the presidential candidates will all look with a very watchful eye at what happens in California."
Following the lead of Massachusetts, which passed universal health care last year, Schwarzenegger announced his own plan last January to provide everyone in California with insurance. As many as 6.7 million people in California, or 18.5 percent of the population, are uninsured.
The Republican governor's plan would impose new fees on doctors, hospitals and employers. The uninsured would be required to buy coverage, though the poorest would be subsidized.
The governor says his plan is fair because it would spread the burden. But doctors are fighting him, as are unions, because they say it asks too much of the working poor. Hospitals, most of which would get more funding, have stayed on the sidelines.
The governor's own party has offered him no help. GOP leaders skewered the tax increases, making it highly unlikely the plan will receive the bipartisan support it needs to pass. A two-thirds vote is required.
The Democrats, who control both houses of the Legislature, crafted an alternative written in such a way that it needs only a simple majority. It would require employers to spend at least 7.5 percent of payroll on health care, or pay that amount into a state-run pool. That is almost double what the governor has proposed, and he has warned he will veto it.
"The governor and the Legislature are inches apart, but neither side wants to give that final inch," said Larry Levitt, a vice president with the Kaiser Family Foundation.
Success in California could be crucial to Democrat John Edwards' presidential hopes. The former North Carolina senator's plan for nationwide health care is a compromise between Schwarzenegger's and the Democrats'.
"What the experience in California shows is it's very hard to do," Levitt said.
With his background in fitness, Schwarzenegger has taken to health care with gusto. The former bodybuilder and Hollywood action hero has held summits and town hall meetings across the state, telling people they must take responsibility for their health and make sure they have insurance.
But support for his ideas has slipped as the debate has bogged down. In December, the nonpartisan Field Poll found it was favored by 52 percent of voters. By August, that had fallen to 33 percent; that is about equal to the number who said they supported a single-payer system run by the government.
Depending on when lawmakers decide to adjourn, there may be less than two weeks before the legislative session ends.
While the governor and Democratic leaders insist they want a deal on health care, one lawmaker has concluded that failure might be the best option.
"I hope that none of these ill-conceived, quickly thrown together plans will pass this year," said state Sen. Sheila Kuehl, the Santa Monica Democrat who chairs the Senate Health Committee and advocates a single-payer system. "Because really, that is not good for California."
UK tries pictures to discourage smokers
Wed, 29 Aug 2007 13:08:07 GMTLONDON - Cigarette packs will be required next year to display such graphic images as diseased organs in a bid to scare smokers into snuffing out their butts, the government announced Wednesday.
Britain will be the first member of the European Union to require such warnings, Health Secretary Alan Johnson said.
"We have already made a lot of progress with stark written warnings on cigarette packs," Johnson said.
The images include an unhealthy lung, a chest cut open for heart surgery and a large tumor on a man's neck. In all, Britain chose 15 images from a selection developed by the European Commission.
Smoking has been banned in public places in Britain, and the legal age for buying tobacco will be raised from 16 to 18 next year.
The new warnings will be required on cigarette packs in the second half of 2008, the department said.
Woman miscarries after ambulance crash
Wed, 29 Aug 2007 15:58:06 GMTTOKYO - A pregnant woman miscarried in western Japan on Wednesday after nine hospitals refused to admit her and the ambulance transporting her crashed on its way to a tenth, news reports said.
The incident triggered an immediate outcry in Japan, where the government has promised to improve medical care for pregnant women as it struggles to reverse a declining birth rate.
The 38-year-old woman, who was in the sixth month of her pregnancy, was being driven to a hospital near the western city of Osaka early Wednesday after she suffered stomach cramps and bleeding, according to Kyodo News agency and other local media.
Nine hospitals closer to her home in Nara prefecture, more than 25 miles away, had refused to admit her, saying they were full, the reports said.
Her water broke two hours into her journey. Ten minutes later, the ambulance collided with a minivan.
She was transferred to another ambulance and reached the Osaka hospital a full three hours after she contacted emergency services, according to Kyodo. But her baby was pronounced dead on arrival, the reports said.
"This is a very grave incident," Heath Minister Yoichi Masuzoe told public broadcaster NHK late Wednesday. "The Health Ministry will conduct a thorough investigation," Masuzoe said.
Police were ed as saying they are not sure the accident caused the woman's miscarriage. The woman and ambulance staff were not injured in the accident.
In a similar incident last year, a pregnant woman died in Nara after being refused admission by about 20 hospitals that said they were full.
Miss. ranked fattest state in nation
Tue, 28 Aug 2007 13:04:13 GMTBy EMILY WAGSTER PETTUS, Associated Press Writer
JACKSON, Miss. - Mississippians need to skip the gravy, say no to the fried pickles and start taking brisk walks to fight an epidemic of obesity, experts say. According to a new study, this Deep South state is the fattest in the nation.
It also became the first state to crack the 30 percent barrier for adults considered obese, with West Virginia and Alabama just behind, according to the Trust for America's Health, a research group that focuses on disease prevention.
Aside from being a butt of late-night talk show jokes, the obesity epidemic has serious implications for public policy.
If current trends hold, these states could face enormous increases in the already significant costs of treating diabetes, heart disease and other ailments related to extra weight. The leanest state in the rankings was Colorado, with an obesity rate projected at a much lower 17.6 percent.
"We've got a long way to go. We love fried chicken and fried anything and all the grease and fatback we can get in Mississippi," said Democratic state Rep. Steve Holland, chairman of the Public Health Committee.
Poverty and obesity often go hand in hand, doctors say, because poor families stretch their budgets by buying cheaper, processed foods that have higher fat content and lower nutritional value.
Former Arkansas Gov. Mike Huckabee — a self-described "recovering foodaholic" who lost 110 pounds and tried to put his entire state on a wellness plan — explained during a Southern Governors' Association meeting last weekend that there are historical reasons poor people often fry their foods: It's an inexpensive way to increase the calories and feed a family.
Lack of exercise is a huge factor in obesity rates. The Centers for Disease Control and Prevention found last year that more than 22 percent of Americans did not engage in any physical activity in the past month. The percentage is greater than 30 percent in four states: Mississippi, Louisiana, Kentucky and Tennessee.
Mississippi's public schools already are taking steps to try to turn the trend around.
A new law requires at least 150 minutes of physical activity instruction and 45 minutes of health education instruction each week for students in kindergarten through 8th grade. Until now, gym class had been optional.
The state Department of Education also is phasing in restrictions on soft drinks and snacks.
All public schools are currently banned from selling full-calorie soft drinks to students. Next academic year, elementary and middle schools will allow only water, juice and milk, while high schools will allow only water, juice, sports drinks and diet soft drinks.
The state Department of Education publishes lists of snacks that are approved or banned for sale in school vending machines. Last school year, at least 50 percent of the vending offerings had to be from the approved list. That jumped to 75 percent this year and will reach 100 percent next year.
Among the approved snacks are yogurt, sliced fruit and granola bars, while fried pork rinds and marshmallow treats are banned. One middle school favorite — Flamin' Hot Cheetos — are on the approved list if they're baked but banned if they're not.
State Superintendent of Education Hank Bounds said he hopes students will take home the healthful habits.
"We only have students 180 days out of the year for seven hours in a school day. The important thing is that we model what good behavior looks like," he said Monday after finishing a lunch of baked chicken.
Bounds ate at a Jackson buffet that's popular with state legislators. The buffet included traditional, stick-to-your-ribs Southern fare: fried chicken, grits, fried okra, turnip greens.
Dr. William Rowley, who worked 30 years as a vascular surgeon and now works at the Institute for Alternative Futures, said if current trends continue, more than 50 percent of adult Mississippians will be obese in 2015.
Holland, who helps set the state Medicaid budget, said he worries about the taxpayers' cost of treating obesity.
"If we don't change our ways," he said, "we're going to be in the funeral parlors ... because we're going to be all fat and dead."
Here is the state-by-state breakdown of obesity rates, ranked from highest to lowest, released by Trust for America's Health:
Mississippi — 30.6
West Virginia — 29.8
Alabama — 29.4
Louisiana — 28.2
South Carolina — 27.8
Tennessee — 27.8
Kentucky — 27.5
Arkansas — 27.0
Indiana — 26.8
Michigan — 26.8
Oklahoma — 26.8
Missouri — 26.3
Texas — 26.3
Georgia — 26.1
Ohio — 26.0
Alaska — 25.8
North Carolina — 25.6
Nebraska — 25.4
North Dakota — 25.1
Iowa — 24.9
South Dakota — 24.9
Wisconsin — 24.8
Pennsylvania — 24.5
Virginia — 24.5
Illinois — 24.4
Maryland — 24.4
Kansas — 24.3
Minnesota — 23.7
Delaware — 23.6
Oregon — 23.3
Idaho — 23.2
Washington — 23.2
Maine — 23.0
Florida — 22.9
Wyoming — 22.8
California — 22.7
Nevada — 22.5
New Hampshire — 22.4
New York — 22.4
New Jersey — 22.2
New Mexico — 22.0
Arizona — 21.7
Utah — 21.1
Montana — 20.7
Rhode Island — 20.5
Connecticut — 20.1
Hawaii — 20.1
Vermont — 20.0
Massachusetts — 19.8
Colorado — 17.6
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On the Net:
Trust for America's Health: http://healthyamericans.org
