Study outlines risks for teen passengers
Mon, 03 Mar 2008 22:44:42 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Car crashes are the leading cause of death for tweens and teens, and a new study outlines some of the most dangerous circumstances: Riding unbuckled with new teen drivers on high-speed roads. These were the three biggest risk factors contributing to car crash deaths for passengers aged 8 to 17, the study found.
While young drivers have higher chances of dying, the six-year study focused on nearly 10,000 children passengers who were killed in car crashes. More than half — 54 percent — were riding with a teen driver. Drivers younger than 16 were the most dangerous.
Also, more than three-quarters of the fatal crashes occurred on roads with speed limits higher than 45 mph, and nearly two-thirds of the young passengers were not wearing seat belts, the researchers found.
Other dangerous circumstances for young passengers included drivers who'd been drinking alcohol, male teen drivers, and driving on weekends.
The message for parents is simple and sobering: Don't let your teen ride with a teen driver who has less than a year's experience driving. Insist on seat belts. And practice ways teens can resist peer pressure to ride with other teens, said Dr. Flaura Koplin Winston of The Children's Hospital of Philadelphia, the study's lead author.
"Knowing the risks can help parents and teens make smart decisions about which rides are safe, and which ones are off limits," said Winston, the founder of the hospital's Center for Injury Research and Prevention.
The researchers examined national data on serious car crashes including those resulting in death between 2000 and 2005. During that time, 2.5 million children aged 8 to 17 were involved in crashes and 9,807 died.
The risk of death for kids riding with drivers aged 16 to 19 was at least double that of those riding with drivers aged 25 and older. There were about two deaths per 1,000 crashes for young passengers with 25-plus drivers, versus more than four deaths in the younger group.
The study, conducted with State Farm Mutual Automobile Insurance Co., appears in the March edition of Archives of Pediatrics & Adolescent Medicine. State Farm funded the research.
Recent federal data indicate that the percentage of U.S. 16-year-olds with driver's licenses has fallen since 1998 , during a time when restrictions on teen driving generally increased.
But no states have all the restrictions recommended by State Farm, the American Academy of Pediatrics and the Philadelphia hospital.
For example, they say the minimum age for a learner's permits should be 16. But nine states grant them to 14-year-olds and at least 30 others give them to 15-year-olds. Also, the groups say drivers younger than 18 should not be allowed to have more than one teen passenger without adult supervision, but only 34 states have that restriction, according to data provided by the hospital and State Farm.
Rosie Jermakian, a Bethesda, Md., 16-year-old, said the study results hit home, particularly because of a recent spate of teen car crashes in the Washington, D.C. area, including one that involved a friend. Rosie's stepmother does research at the Philadelphia hospital but was not involved in the study.
"Teen drivers don't always think," said Rosie, who has a learner's permit and hopes to get her license soon. "Sometimes they think they're just in this little bubble where they can't get hurt and they don't really think of the consequences."
Winston, the study author, said that means teen passengers and their parents have to take precautions, and the Jermakian family does.
"I've told her flat out, in regard to some of her friends who I don't believe have been well taught in these areas, that she is not to get in a car with them driving," said Joel Jermakian, Rosie's father.
Her parents also have told her to call them for a ride if she ever faces a potentially dangerous driving situation.
Jermakian said the study "reminds us that in raising teens, constant dialogue about all these kinds of things is important."
____
On the Net:
Archives: http://www.archpediatrics.com
Hospital tips: http://www.chop.edu/youngdrivers
Problems hamper sickle cell treatment
Mon, 03 Mar 2008 22:26:39 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - The news is grim: Ten years after government approval of the first sickle cell treatment, only a tiny fraction of patients use the drug — despite new research showing the disease is far more painful than doctors ever suspected.
Ignorance on the part of both physicians and patients is to blame for underuse of hydroxyurea, concludes an expert panel convened by the National Institutes of Health.
Worse, there's no other treatment in the pipeline for a disease that afflicts up to 100,000 Americans, most of them black — not only shortening their lives but causing regular pain attacks so severe that they frequently require long hospitalizations.
There are a few bits of hope on the horizon. Hospitals around the country just began a long-awaited study to see if the same ingredient that powers the impotence drug Viagra may prevent death from a leading sickle cell killer, lung damage known as pulmonary hypertension.
Other researchers are testing if inhaling nitric oxide could stem pain attacks. And scientists are developing ways to improve sickle cell survival through bone-marrow transplants that have helped some children but that typically are too risky for adults.
Still, that work is centered in a handful of specialty hospitals — far removed from the day-to-day struggles of sickle cell sufferers, who often show up in emergency rooms desperate for pain relief only to be falsely stigmatized as narcotic-seekers.
"It's sort of amazing how ignored this disease is," says Dr. Sophie Lanzkron of Johns Hopkins University in Baltimore, which this month opened a special clinic to handle those pain crises that already has begun reducing ER visits.
"The whole idea that the first genetic disease described to man has just one FDA-approved medication, it's just amazing."
Sickle cell is a devastating inherited disease of deformed red blood cells that can't carry enough oxygen, common among people with ancestors from Africa, Latin America, the Middle East and the Mediterranean.
It causes oxygen-carrying hemoglobin — the stuff that gives blood its color — to clump inside red blood cells. The clumps change the normally soft, round cells into a sickle shape that can't squeeze through tiny blood vessels. Beyond that pain, patients suffer infections and eventually organ damage. They frequently live only into their 40s.
Doctors have long measured sickle cell's severity by how often patients seek care for pain crises. But last month, Virginia Commonwealth University researchers reported stunning evidence that that practice downplays the disease: Patients recorded their pain levels daily — showing more than a quarter were in pain on 95 out of every 100 days. Yet most toughed out even severe, crisis-like pain at home, reserving doctor and hospital visits for just the most intense episodes.
Now contrast that suffering with the NIH panel's findings: Roughly half of adolescent and adult sickle cell patients are candidates for hydroxyurea, an old and inexpensive anti-cancer pill — costing less than $100 a month — proven to dramatically reduce sickle cell pain crises, hospitalizations and some organ damage. It may even prolong survival. Yet few use it, possibly as few as 5 percent of those who qualify.
Why? There aren't better treatments. The main alternatives are regular blood transfusions, and intravenous narcotic painkillers plus fluids to ease pain crises.
Instead, the panel found:
_Few patients are treated by specialists in sickle cell while concerns about hydroxyurea's side effects have been overblown — both among patients and among general physicians who either don't know about or don't heed national prescribing guidelines, says Dr. Otis Brawley, an Emory University hematologist who led the panel.
The drug can cause temporary drops in some types of blood cells, making patients vulnerable to infection or bleeding. So doctors carefully monitor patients beginning treatment, lowering the dose if needed. Also, a theoretical risk of birth defects requires contraceptive use.
But other fears — that it can cause cancer, or slow children's growth — have proved unfounded, stresses Brawley.
_The drug is formally approved just for adolescents and adults, while sickle cell can be particularly hard on children. Small pediatric studies suggests it works in youngsters, too, but a larger study nicknamed Baby HUG is now under way to prove that in children under 2.
_It can take up to six months for hydroxyurea to improve health, and some patients give up too soon.
_And too often, teenagers who did well with the drug fall out of treatment as adults, when they lose insurance and access to pediatric sickle cell clinics.
"It's a disease that has not gotten enough attention," says a frustrated Brawley. "We need to start stressing how do we get optimal care to a group of individuals who deserve it because they are human beings who are suffering."
___
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
___
On the Net:
Info on sickle cell studies: http://www.clinicaltrials.gov/ct2/show/NCT00492531?termsildenafil+and+sickl
e+cell&rank1 and http://www.clinicaltrials.gov/ct2/show/NCT00094887?termnitric+oxide+and+sic
kle+cell&rank1
Long workweeks keeping Americans up late
Mon, 03 Mar 2008 23:14:42 GMTNEW YORK - Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.
Roughly one-third of those surveyed said they had fallen asleep or become very sleepy at work in the past month.
Just how big a deal that is depends, of course, on your job. Last week, the chairman of the Nuclear Regulatory Commission acknowledged it should have done more to investigate a tip that security guards routinely took naps while on the job at a Pennsylvania nuclear plant.
It wasn't until a videotape of guards sleeping in a "ready room" at the Peach Bottom plant in south-central Pennsylvania surfaced several months after it got the tip that the NRC announced in September a special investigation.
While sleepy workers know they're not performing as well as they could during the day, work is what's keeping them up nights, according to the survey, which found workdays are getting longer and time spent working from home averages close to four-and-a-half hours each week.
It seems people are also trying to squeeze in more time for themselves and their families, even if it means less sleep. The average wake up is at 5:35 a.m. and it's followed by about two hours and 15 minutes at home before heading out to work, according to the survey. Average bedtime is 10:53.
Audits sting hospitals physicians
Sat, 01 Mar 2008 13:07:39 GMTBy KEVIN FREKING, Associated Press Writer
WASHINGTON - In coming weeks, private audit companies will begin scouring mountains of medical records. Their mission: Determine if health care providers erred when billing Medicare and require them to return any overpayments to the federal government. The auditors will keep a tidy percentage for their services.
The contractors have shown they're pretty good at their work. In just three years, they've returned more than $300 million to the federal government — and that's just from three states. That experiment is winding down. But a larger, national program will soon take its place.
The rollout of "recovery audit contractors" will be gradual. They'll monitor health care providers in 19 states beginning this spring. In October, an additional five states will join.
Health care providers are nearly unanimous in their dislike of the program's continuation, much less its expansion. Many lawmakers have similar sentiments, though it was Congress in 2006 that made the program permanent. A bill sponsored by Rep. Lois Capps, D-Calif., calls for a one-year moratorium.
The program's critics say that contractors have too much incentive to question as many claims as possible. That's because they get to keep about 20 percent of the overpayments.
"What we have here is bureaucrats and government contractors coming in and trying to second guess what doctors and nurses have done in a hospital setting," said Don May, vice president for policy at the American Hospital Association. "They're playing Monday morning quarterback."
While the contractors are often described as overzealous, that's a compliment as far as one watchdog group is concerned.
"A little zealotry is what were looking for on the part of the taxpayers," said Leslie Paige, spokeswoman for Citizens Against Government Waste. "We think it's about time."
The government will spend about $430 billion this year on Medicare, which provides health coverage to 44 million elderly and disabled people. The sheer size of the program, with more than 1.2 billion claims filed each year, not only makes it ripe for fraud but for mistakes. The Office of Management and Budget estimates that payment errors total about $10.8 billion a year.
To put the number of Medicare claims in perspective, that's 4.5 million claims each work day and 9,579 claims per minute. Rarely does the government and its contractors give those claims a detailed review. The agency has contractors that process claims. It also has an inspector general. But, now, auditors will routinely review patient's medical records as well as the claim.
It's the contractors' job to find both overpayments — and underpayments. Besides returning overpayments to the government, they return underpayments to health care providers. So far, they've returned $20 million, mostly to hospitals.
A report from the Centers for Medicare and Medicaid Services shows that contractors reviewed about 930 million claims in Florida, California and New York during the program's first 2 1/2 years. They identified errors in less than 0.2 percent of the claims reviewed.
Among the errors: A hospital billed Medicare for conducting multiple colonoscopies on the same patient on the same day. In another instance, a provider billed for one type of diagnosis, respiratory failure, but a look at the medical record indicated another principal diagnosis, sepsis, which is a potentially deadly infection.
Hospitals appealed in about 11 percent of the overpayment cases. Only 5 percent were fully or partially overturned.
Those statistics tell Medicare officials that the program is working.
"We've had substantial recoveries," said Kerry Weems, the acting administrator for the Centers for Medicare and Medicaid Services. "And if you look at the rate at which our decisions are overturned, that rate is pretty low."
Health care providers say the CMS statistics are misleading. Many appeals have not been completed. Also, many providers won't appeal because of the amount of money and time it takes.
"It costs at least $2,000 to run an appeal all the way through the process," May said.
When providers overcharge the government, they also have to refund any overcharged copayments or deductibles to the patient. If providers need more time to repay the government, they can apply for a repayment plan. If a provider just refuses to pay, the Medicare contractor processing their claims will deduct from future payments until the debt is paid.
Hospital officials said the repayments make the job of providing care more challenging and have the potential to force them to reduce services or charge customers more to make up the expense.
CMS said it also has safeguards in place to ensure that patient information is handled securely. Providers, when they sign up for Medicare, also agree to make any necessary information available to the agency or its contractors.
One of the hospitals targeted by the Recovery Audit Program was the Rehabilitation Institute at Santa Barbara, Calif. The center treated patients who needed extensive therapy because they suffered a stroke, brain injury or other serious injury.
According to the institute's CEO, the private auditor for California, PRG-Schultz International, reviewed medical records for about 314 patients. In all but a handful of cases, the contractor determined the patient failed to meet Medicare's criteria for admission into an inpatient rehabilitation facility.
With a $2.9 million IOU to the government hanging over its head, the 50-year-old rehab hospital hurried up its search for a partner or buyer. It decided that selling its assets to a local hospital was the best way to ensure its services to the Santa Barbara community would continue.
Meanwhile, the facility appealed and thus far has won all the cases that have been completed, said Melinda Staveley, the hospital's CEO at the time.
After hearing complaints from the California congressional delegation, Weems ordered PRG-Schultz to stop reviewing certain claims made by rehab facilities such as the one in Santa Barbara. It was clear that the auditor as well as contractors who heard the appeals had not consistently applied Medicare's payment policies, he said.
One person intimately familiar with the rehab center is the congresswoman now calling for a moratorium of the audit program. Capps' late husband, Walter, was treated there after a car wreck. Her husband was a member of the House, his term cut short by a fatal heart attack in October 1997.
Capps, a nurse, said the hospital was "essentially driven out of business by this government program run amok."
She is concerned that legitimate Medicare bills are being denied for reasons that aren't being well communicated to the providers.
Weems said he has tried to address many of the concerns. When the program goes national, all contractors must have a medical director on staff. The agency also is limiting how far back auditors can look when reviewing patient records. The limit will be three years, but under no circumstances, before Oct. 1, 2007.
Finally, the agency is working on regulations that would defer repayment until after the appeals process is completed. Currently, the money is taken back regardless of the appeal status, which providers say is a financial burden and akin to guilty until proven innocent.
But what gets health care providers most upset is when auditors determined a procedure or hospital admission was not medically necessary.
May said that there's a "lot of gray area" when it comes to whether a patients needs to be admitted to a hospital or rehab facility. Often the patients have diabetes or other complicating factors that prompt a physician to want closer monitoring.
"You need a physician looking at these daily if not more so to make sure the patients are being managed effectively," May said.
____
On the Net:
Centers for Medicare and Medicaid Services report: http://www.cms.hhs.gov/RAC/
American Hospital Association: http://www.aha.org
Obese Children Face More Complications During Surgery
Tue, 04 Mar 2008 04:47:03 GMTMONDAY, March 3 -- Obese children are much more likely than normal-weight children to have breathing-related problems during surgery, says a University of Michigan Health System study.
The researchers, who looked at 1,380 normal-weight, 351 overweight, and 294 obese children, aged 2 to 18, who had elective, non-cardiac surgery, found that obese children had a higher rate of difficult mask ventilation, airway obstruction, major oxygen desaturation (decrease in oxygen in the blood), and other airway problems.
Specifically, the study found that:
- 19 percent of obese children and 11 percent of normal-weight children experienced major airway obstructions.
- Almost 9 percent of obese children and 2 percent of normal-weight children experienced difficult mask ventilation.
- 17 percent of obese children and 9 percent of normal-weight children experienced major oxygen desaturation.
- Obese children also had higher rates of asthma (28 percent vs. 16 percent), hypertension, sleep apnea and type 2 diabetes, all of which contribute to problems during surgery.
However, despite the increased risk of adverse events among the obese children in this study, none suffered significant illness.
The study is published in the March issue of Anesthesiology.
"Based on current trends, it is likely that anesthesiologists will continue to care for an increasing number of children who are overweight or obese, so it is vital that we are aware of the higher risk they face in the operating room," lead author Alan R. Tait, a professor in the department of anesthesiology at the U-M Health System, said in a prepared statement.
About 15 percent to 17 percent of children and adolescents in the United States are obese, according to background information in the study.
More information
The Nemours Foundation has more about childhood obesity.
Italy election symbols from garbage to impotence
Mon, 03 Mar 2008 21:12:40 GMTBy Philip Pullella
ROME - From the "No Garbage" party, to the "Don't row against the tide" party, to "Dr. Cirillo's party of existentialist impotents," there will be something for everyone in Italy's general election in April.
Nearly 180 symbols of political parties, movements, lists, sub-lists, sub-parties and a myriad of other groupings were presented to the Interior Ministry by Sunday's deadline.
Amid the usual forest of symbols with shields and crosses, flags, hammers and sickles, doves, suns, trees and seas, there are some symbols that raise eyebrows more than normal.
The symbol of the "No Monnezza" list takes its name from the Neapolitan slang for "no garbage," and is a sub list of an "animal rights" party of the southern Campania region.
The region has been in the news for all the wrong reasons lately. Its governor will stand trial in May in connection with the garbage crisis around the city of Naples, where tens of thousands of tons of rubbish have piled up in the streets.
There is the "Holy Roman Empire" list, which describes itself as "Liberal-Catholic." The symbol sports the picture of its founder, Mirella Cece, who started the group 21 years ago.
The symbol for "Dr. Cirillo's party of existentialist impotents" -- black lettering on a plain white background -- gives no hint of whether the good doctor is referring to political or sexual impotence. It is symbol number 132.
Dr. Cirillo appears to be a budding political mover and shaker in constant evolution. In past elections, he led the "Good Manners Party" and the "Free Condoms Party."
The hammer and sickle may be disappearing in Russia but no fewer than eight symbols sport it. The one with the longest name is "The Italian Communist Marxist Leninist Party."
Nearly 25 parties made it into the outgoing parliament, where small splinter groupings can often have a disproportionate influence on Italy's coalition politics.
Three parties descended from the now defunct Christian Democrats have symbols with a shield and cross, five far-right parties have a tri-colored flame that was once the symbol of neo-fascists.
There is a florist's shop of roses, carnations, and ivy decorating various symbols.
Those who feel that Italy is in dire economic straits and mired in social stagnation may be drawn to the "S.O.S. Italy Party," which has aligned itself with the centre right headed by former prime minister Silvio Berlusconi.
The name of Beppe Grillo, a popular comic-cum-crusader who has urged Italians to say "F--- off" to traditional politics, appears on six symbols, including one saying he should be prime minister and not frontrunners Berlusconi and Walter Veltroni.
Amid all the noise and haste of large parties, tiny parties, Sicilian and Sardinian separatists, rightists, leftists, and middle-of-the-roaders, perhaps one party will sound seductive to many.
Its symbol merely says: "I don't vote."
Poor Working Memory Tied to Low School Scores
Tue, 04 Mar 2008 04:47:09 GMTMONDAY, March 3 -- Poor working memory, rather than low intelligence, could be the reason why some children are underachievers at school, says a British study.
Working memory is the ability to retain and manipulate information. An example would be doing math without the aid of pen and paper or a calculator. Students need working memory for a variety of school-related tasks, such as following teachers' instructions or remembering sentences they've been asked to write down.
Using a new tool that they developed, a team at Durham University surveyed more than 3,000 children of different ages and found that 10 percent of them suffered from poor working memory, which seriously impairs their ability to learn.
The study authors also found that poor working memory in students is rarely identified by teachers, who often believe children with this problem are inattentive or have low intelligence.
If poor working memory -- believed to be genetic -- isn't identified and addressed in children, it can affect their long-term academic success and prevent them from achieving their potential, the researchers said.
The tool they developed and used in this study is a combination of a checklist and computer program that can be used in the classroom to assess memory capacity in children as young as 4 years old.
"From the various large-scale studies we have done, we believe the only way children with poor working memory can go onto achieving academic success is by teaching them how to learn despite their smaller capacity to store information mentally," lead researcher Dr. Tracy Alloway, of Durham University's School of Education, said in a prepared statement.
"Currently, children are not identified and assessed for working memory within a classroom setting. Early identification of these children will be a major step towards addressing underachievement. It will meant teachers can adapt their methods to help the children's learning before they fall too far behind their peers," Alloway said.
More information
The Nemours Foundation has more about children and memory.
