By MARSHA SILLS
Advocate Acadiana bureau
LAFAYETTE — Lafayette Parish schools may soon have a
medical director to serve as an adviser to the school district’s nursing
staff.
School Board
members will be asked during their regular 5:30 p.m. meeting Wednesday to
consider adding the position.
The physician
would be available as a consultant to the nursing staff, as well as serve as
a liaison between the school system and the medical community, said Betty Alford,
schools nursing supervisor.
The expertise is
needed as more students “with serious health problems in the regular
classroom” are in the school system, Alford said.
“We have
situations where the nurse may feel that the child needs further medical care
and she’ll be able to talk to the doctor about this and get a recommendation
from a School Board physician,” Alford said.
Because of the
number of students with special health needs, the district added two
additional school nurse positions for a total of 16 nurses at the district’s
43 schools.
The school district is still working on a
job description for the medical director position, but the district hopes to
develop a memorandum of understanding with University Medical
Center to contract with
one of its physicians.
At Wednesday’s
meeting, board members will also be updated about the district’s plans to
open a school-based health center at Carencro Middle School.
The district had
hoped to open the health center this fall, but funding questions stalled the
project.
Last year, the
district received a state grant to cover planning expenses and recently more
grant money to push the project forward, said Burnell
Lemoine, schools superintendent.
He said Opelousas
General has agreed to partner with the school district and help staff the
clinic.
Our Lady of
Lourdes Regional Medical Center operates the parish’s
only other school-based health clinic at Northside High School. The Lourdes’ health center has been open since
1996 and offers free minor healthcare, counseling and health education to Northside students.
The partnership
and plans for the Carencro Middle clinic await board approval, Lemoine said.
The clinic could
be operational by the end of the calendar year, pending board approval and
the bidding process for a portable clinic building, Lemoine said.
http://www.2theadvocate.com/news/acadiana/52396227.html
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LSUHSC's
Leigh 1 of only 10 RWJF health policy fellows
Leslie Capo
Louisiana State
University Health
Sciences Center
New Orleans, LA
Janet Leigh, BDS, DMD, Chair of the Department of Oral Medicine and Radiology
at LSU Health Sciences Center New Orleans School of Dentistry, is one of ten
Health Policy Fellows selected by the Robert Wood Johnson Foundation (RWJF)
for 2009-10. She is the first dentist to be selected since 1999. The award
comes with a grant in the amount of $165,000 for the residential stay,
travel, research, conferences, and other leadership development activities.
The Robert Wood
Johnson Foundation Health Policy Fellows program provides the nation's most
comprehensive experience at the nexus of health science, policy and politics
in Washington D.C. The fellowship is an outstanding
opportunity for exceptional midcareer health professionals and behavioral and
social scientists with an interest in health and health care policy. Fellows
experience and participate in the policy process at the federal level and use
that leadership experience to improve health, health care and health policy.
The fellowship is a 12-month residential experience in Washington, D.C.
with continued health policy leadership development activities.
Fellows actively
participate in the formulation of national health policies in congressional
offices and accelerate their careers as leaders in health policy. The
Institute of Medicine (IOM) conducts and administers the fellowship with
funding support from and in collaboration with RWJF.
The Washington experience
prepares individuals to influence the future of public health and health care
and accelerate their own career development. Beginning in September with an
intensive three-and-a-half-month orientation arranged by the IOM, fellows
meet with key executive branch officials responsible for health policy and
programs, members of Congress and their staff, and representatives of health-
and health policy-related interest groups. Fellows also participate in
seminars on health economics, major federal health and health research programs,
the congressional budget process, current priority issues in federal health
policy and the process of federal decision-making.
In November,
fellows join the American Political Science Association Congressional
Fellowship Program for an overview of the national political process. The
concentrated orientation is designed to prepare fellows for immediate success
on the Hill.
Fellowship
assignments begin in January. During these assignments, fellows are
full-time, working participants in the policy process with members of
Congress. Fellows typically will: help develop legislative proposals; arrange
hearings; brief legislators for committee sessions and floor debates; and
staff House-Senate conferences.
Fellowship
assignments are supplemented throughout the year by seminars and group
discussions on developing health policy, the general policy and governmental
process, as well as media training and leadership development. Fellows are
asked to prepare a formal presentation on a policy-oriented research issue
with which they have been engaged. Fellows also take part in meetings of the
IOM and other health policy organizations, as well as cultural and social
functions.
Dr. Leigh
developed and directs the LSUHSC HIV Outpatient Dental Clinic at the Interim LSU
Public Hospital
and was appointed, in 1994, the dental director of the Delta AIDS Education
and Training Center. In 1997, the governor of Louisiana appointed
her to the Governor's Commission on HIV and AIDS, and, in 1999, Dr. Leigh
chaired that commission. She spearheaded the creation of an oral HIV/AIDS
clinical research program at LSUHSC and is funded as principle investigator
through the US Health Resources and Services Administration Community Based
Dental Partnership Program and a Special Project of National Significance as
well as through the National Institutes of Health.
Dr Leigh received
her BDS from Guy's Hospital Dental School University of London, and a DMD
from the University of Pennsylvania School of Dental Medicine, where she also
completed a fellowship in oral medicine and received board certification. She
has received the Pfizer Award for Excellence in Research, Education, Patient
Care and Community Outreach, the LSUHSC School of Dentistry award for
Excellence in Research, and a New Orleans City Business Women of the Year
award for generating funding for educational opportunities for dental health
professionals and increasing access to dental care for HIV/AIDS patients in Louisiana. In March
2008, at the American Dental Education Association annual meeting, Dr Leigh
was named the American Dental Education Association/Sunstar
Americas Inc. Harry W. Bruce Legislative Fellow.
http://www.genengnews.com/news/bnitem.aspx?name=59575981
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Ten exceptional
health professionals have been selected as Robert Wood Johnson Foundation
Health Policy Fellows for 2009-2010. The ten fellows will utilize their wide
range of academic, public health, clinical and community-based experience to
provide health policy leadership on Capitol Hill to improve health and health
care.
Each year, fellows
are selected through a competitive selection process. They leave their
academic settings and professional practices to spend a year in the nation's
capital. A three-month orientation program is followed by a nine-month
assignment in which fellows work in a congressional office or the executive
branch. Work assignments are supplemented throughout the year with health
policy leadership development activities and media training.
"This is a
particularly remarkable year to contribute much-needed practical knowledge of
health and health care to Washington,
D.C. Our fellows will have the
chance to impact health reform directly," said Michael Painter, J.D.,
M.D., RWJF senior program officer and 2003-2004 Robert Wood Johnson Health
Policy Fellow. "The 'hands-on' health and health care experience of our
fellows provides a critical perspective to the reform debate."
In September,
following the one-year experience, fellows can choose to extend their Washington stay past
the fellowship period through the end of the legislative session. Once
they've completed the program, fellows return to their respective
institutions or take another appropriate position where they further develop
their health policy leadership skills. They become part of a nationwide
alumni network and typically return to Washington
yearly to attend the Institute
of Medicine's annual
meeting and get an update on issues and trends in health and health care
policy.
Over 200 fellows
from universities, colleges and other health-related organizations across the
nation have participated since 1973. The following fellows have been selected
for the 2009-2010 program:
·
Andrew
Bindman, M.D., professor of medicine, health
policy, epidemiology and biostatistics at the University of California San
Francisco (UCSF) and director of the California Medicaid Research Institute.
·
Gustavo
D. Cruz, D.M.D., M.P.H., associate professor and director of public health
and health promotion in the Department of Epidemiology and Health Promotion
at the New York University (NYU) College of Dentistry.
·
Sheldon
D. Fields, Ph.D., R.N., F.N.P.-B.C., associate professor of Nursing at the
University of Rochester Medical Center School of
Nursing.
·
David
Keller, M.D., clinical associate professor of pediatrics at the University of Massachusetts
(UMass) Medical
School.
·
Janet E. Leigh, B.D.S., D.M.D., professor
and chairman of oral medicine and radiology at Louisiana
State University
(LSU) Health Sciences Center.
·
Gregg
Margolis, Ph.D., associate director of the National Registry of Emergency
Medical Technicians (NREMT).
·
Mark
D. Schwartz, M.D., associate professor of medicine at New York University
(NYU) School of
Medicine.
·
Barbara
Tobias, M.D., associate professor of family medicine and director of the Predoctoral Division and the Family Medicine Clerkship in
the Department of Family Medicine at the University Of Cincinnati
College Of Medicine.
·
Margaret
C. Wilmoth, Ph.D., M.S.S., R.N., professor of
nursing at the University of North Carolina, Charlotte.
·
Shale
L. Wong, M.D., M.S.P.H., pediatrician and associate professor at the
University of Colorado, School of Medicine.
http://www.physorg.com/wire-news/10762235/rwjf-health-policy-fellows-have-unique-opportunity-to-influence.html
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By MARSHA SHULER
Advocate Capitol
News Bureau
Hospitals and
physicians are bearing the brunt of cuts the state’s health agency made
Monday to help close a funding gap in the government health insurance program
for the poor.
Health-care providers
have been waiting for the plan since the Legislature approved $6.28 billion
in Medicaid funding.
That budget
requires DHH to reduce spending by $240 million.
The new rules
published by the state Department of Health and Hospitals go into effect today.
Lower payments to
hospitals and physicians account for two-thirds of the announced reduction:
$40.5 million to hospitals and $19 million to physicians.
Physician services
to patients age 16 and under would be spared from cuts under the state’s
proposal. But other physicians would take a 10 percent reduction.
State Medicaid
director Jerry Phillips said the new round of reductions, plus the
compounding effect of cuts made last year and adoption of efficiencies “will
begin to address” the $240 million gap.
Phillips said the
agency will do a projection in October “and see if there are other
adjustments that need to be made.”
Meanwhile, there
could be some extra temporary state relief on its way from the federal
government to cushion cuts, Phillips said.
The federal
Centers for Medicare and Medicaid Services have notified the state that with Louisiana’s rising
unemployment rate the federal government will pay a little more of Medicaid
program costs, Phillips said. Exactly how much is not yet known, he said.
Today, the federal
government pays 80 percent and the state 20 percent under economic stimulus
legislation.
The health-care
cuts are being proposed a month into the state budget year, which began July
1. By the time the proposal is fully implemented, the cuts will be spread
over 10 months instead of 12.
The proposed cuts
are not sitting well with representatives of provider groups who are hoping
the health agency comes up with ideas to offset them.
“This is going to
be tough,” Louisiana Hospital Association Vice President Sean Prados said. “Hospitals with a large volume of Medicaid
patients are going to be faced with some tough business decisions.”
A
hospital-by-hospital analysis is under way to determine individual facility
impact, Prados said.
Prados said cuts in physician reimbursement could
lead to health-care access problems.
“It’s one of those
vicious cycles. Physicians drop out and more people come to emergency rooms.
You cannot find docs in certain specialties now,” Prados
said.
Reductions in
payments to those who provide home and community-based care to the
developmentally disabled could lead to lost services, said Shawn Fleming,
deputy director of the Developmental Disabilities Council.
“You have
unreliable services and if the rate cut happens it could make it so that the
availability is even less. Providers are less inclined to stay,” Fleming
said. There is a 9,000 person backlog of people waiting for services, he
said.
Fleming noted that
more expensive care in institutions is not being cut.
Department of
Health and Hospitals Secretary Alan Levine touched on budget cuts during an
appearance before the Press Club of Baton Rouge during a question-and-answer
session following his talk.
Levine said a
conscious decision was made to shield from cuts physician care for patients
age 16 and under.
“We want to
mitigate the impact on children,” Levine said. “We are trying to target the
reduction away from pediatric specialties.”
Meanwhile, people
who use hospital emergency rooms needlessly could be subject to a small
co-pay to discourage use, Levine said. That proposal has not yet been reduced
to a rule for publication, he said.
Levine said the
budget proposal also attempts to rein in some of the costs associated with
providing home and community-based care for the developmentally disabled. He
said DHH would remove $9.1 million from the New Opportunities Waiver program.
The budget of NOW has more than doubled from 2003 when it was $150 million,
he said.
During his Press
Club speech, Levine spoke mostly about the potential loss of $1.1 billion in
federal health-care funding in the coming years and what he called the
short-sightedness of the Obama administration’s proposed health-care revamp.
http://www.2theadvocate.com/news/52396847.html?index=1&c=y
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The Washington Times | 08.04.09
By Audrey Hudson
A mental health crisis that has swamped this
city's care facilities as surely as Hurricane Katrina's floodwaters washed
over the Lower 9th Ward is about to become even worse, care providers say.
New Orleans already is struggling with fewer than half
of the inpatient beds for the mentally ill that it had before the 2005
hurricane - even as suicide rates and the number of people with mental health
problems have doubled.
That shortage is
about to become even more acute with the scheduled closing Sept. 1 of the New
Orleans Adolescent Hospital (NOAH), the city's only public hospital still
providing inpatient services for the mentally ill.
The closure,
designed to trim $14 million from the state's 2010 budget, will leave New Orleans with 133
beds for mental health inpatient care and will make the city jail - with 60
of those beds - the city's largest psychiatric ward.
Before Katrina,
"We had a functional system, not a Rolls-Royce, but we managed to treat
patients," said Dr. Kevin U. Stephens, director of health for the city
of New Orleans.
State funding for
mental health services has risen steadily since the storm, from $37.4 million
in 2006 to $74.4 million this year. Even so, Dr. Stephens said, "We have
no real significant inpatient capability, and outpatient treatment is
limited."
That shortage of
facilities is felt most strongly by residents like Byron Turner, who four
years after Katrina still is haunted by visions that eventually drove him to
seek professional help.
"Life was
real good for me before Katrina," he said. "I had no mental health
issues ever in my life. I was never homeless. I had jobs. I had two
automobiles before the storm."
Today, he is
homeless and taking medication to reduce his bouts of anger. Sometimes he's
angry about his situation, sometimes he just gets frustrated with himself.
Sometimes, he's still angry over the hurricane.
"I still see
the bodies. I still see the dead children. I still see the elderly people floatin' in the water. I still see the water," Mr.
Turner said.
Overwhelmed public
health agencies in New Orleans can only guess how many of the city's
residents are, like Mr. Turner, still struggling to cope with the mental and
emotional consequences of a maelstrom that swept away whole neighborhoods and
stole away friends, relatives, homes and social networks - the glue that
holds people's psyches together.
"We all kind
of crazy after Katrina," drawled Judge Arthur L. Hunter, who presides
over the city's mental health court, a special facility that has convened
weekly since December 2003 and handles between 100 and 200 cases a year.
"Everyone
suffers from post-traumatic stress disorder, whether their house flooded or
not," the judge said.
Mental health is
not easily measured, and attempts to quantify the explosion in mental health
care needs after Katrina vary from agency to agency, but efforts have been
made. One of the most comprehensive was by the World Health Organization,
which surveyed about 1,000 Katrina-affected residents of Louisiana,
Alabama and Mississippi some six months after the
storm.
Comparing the
results to a pre-Katrina study in the same area, the WHO found that the
number of residents with serious mental health problems had shot up from 6.1
percent to 11.3 percent, and the number with mild to moderate problems had
risen from 9.7 percent to 19.9 percent.
The Health Sciences
Center at Louisiana
State University
produced similar findings in a 2007 report, which found that nearly 20
percent of the New Orleans
population was suffering from serious mental illness. When the Federal
Emergency Management Agency surveyed displaced families living in trailers
and hotel rooms in Louisiana
in February 2006, it found that 44 percent of the dwellers suffered from
significant psychological distress.
'The walking wounded'
Equally telling
are the suicide figures, which almost tripled in the year after Hurricane
Katrina, according to the Metropolitan Human Services District (MHSD) and
other mental health authorities. Dr. Jeffrey Rouse, the deputy New Orleans coroner
dealing with psychiatric cases, was widely quoted in 2006 as saying the
annual suicide rate had jumped from about nine people per 100,000 before the
storm - slightly below the national average of 10 - to something over 26 per
100,000.
Altogether since
2006, reports show 101 suicides and 726 suicide attempts in a population that
has ranged between 200,000 and 300,000. In the first five months of 2009
alone, 24 suicides and 82 attempts were reported - roughly double the
national average.
They are "the
walking wounded - untreated, they jump off bridges, they hang themselves, and
they shoot themselves in the head,"said Dr.
Stephens, who has noted a spike in mental illness in his own office since the
storm - including two suicides and other psychotic breakdowns.
"What we have
is PTSD on steroids," the doctor said.
Recovery will
require many years of sustained effort and commitment by public health
officials and by the victims - people like Mr. Turner, who said he recognizes
he is still in the first phase of dealing with his trauma.
"I'm still
thinking at certain streets I might walk down, you know, I might think that
I'm still, I'm swimming. I might think that I'm trying to get in a boat
still," he said as he described his quest to get to a place where the
word "normal" has some meaning again.
In the meantime,
he must still walk those streets where the flooding was deepest - some where
the water was 16 feet deep - and where memories come back with the greatest
force.
"I actually
saw my friend's grandmother's body floatin' in
front of me. I'm like, lord, that's Miss Mary floatin'
right there, and she's actually dead, stiff as a piece of plywood, you know.
"So, these
things are real," Mr. Turner said.
City, state and
federal agencies have pointed fingers at one another for four years, seeking
to lay blame for the failure of the levees that allowed the floodwaters to
wash over the city. But as far as Dr. Stephens is concerned, that is no
excuse for ignoring people like Mr. Turner.
"We as a
society have to reach out and take care of them," he said. "Society
needs to come in and be the safety net."
But the necessary
health infrastructure no longer is there. Before Katrina, the city had 10
public and private hospitals with a total of more than 400 beds available for
inpatient treatment of the mentally ill. Today, there are just seven
hospitals, operating with fewer than 170 beds - a number that will be reduced
further when NOAH closes.
Fight over NOAH
Mayor C. Ray Nagin protested the planned closing in an April 24 letter
to Gov. Bobby Jindal, saying, "The City of New
Orleans has faced a significant health care crisis since Hurricane Katrina.
These changes would have the greatest negative impact on our poorest citizens
who are frequently underinsured or uninsured."
Mr. Nagin added that those poor residents "have few
options for obtaining primary, emergency, or mental health services from
other providers. Due to lack of insurance, they receive exorbitant bills they
cannot afford if they do seek services in community hospitals."
State Rep. Neal
Abramson, whose district includes New
Orleans, mounted a last-ditch effort to keep the
hospital open.
"For people
who need the facility, they are looking at over an hour of travel, and most
people don't have the means to get there," said Mr. Abramson.
For those who
don't have cars, he said, the hospital might as well be moving to Arkansas.
Mr. Abramson
succeeded in getting $14 million for NOAH funding added to the state's budget
on June 25 - the same day Mr. Jindal vetoed a
separate bill that had funding for the hospital.
"The only way
that hospital will close is if the governor vetoes the money again," Mr.
Abramson said at the time. And the governor did.
Mr. Jindal said in his veto statement that Mr. Abramson's
plan would have required the money to be pulled from other health resources
in the state, forcing "unacceptable cuts" in those resources.
"NOAH operates at twice the daily cost as other state inpatient
facilities," the statement added.
Mr. Jindal also argued that the Department of Health and
Hospitals plan he backed required no reduction in outpatient or inpatient
services for the region as a whole, and provided for community-based
outpatient mental health services in New
Orleans.
But the veto also
means mentally ill patients who have relied on NOAH will have to find somewhere
else to go for inpatient services.
"I've told
people for so long, just don't come back [to New Orleans] right now,"
said Cecile Tebo, administrator of the New Orleans
Police Department Crisis Unit that responds to 911 calls involving the
mentally ill.
"Don't come
back if you have any kind of special needs; this is not the place to be if
you have elderly that are really sick, if you have children with special
needs or people in the family with mental illness or mental retardation; this
is just not a good place to be right now," said Mrs. Tebo,
whose own staff of volunteers is just a little more than half the size it was
before Katrina.
"Hopefully, I
won't have to say that in like five years. I'll say, 'Come on in, we got it
figured out.' "
In that respect,
Mrs. Tebo has a great deal in common with mental
health patients such as Mr. Turner, who also would like to say they have it
figured out.
"No I'm not
normal. I would love to be normal again," said the man who still sees
bodies floating through the streets.
"I would love
to get back to my life that I had before Katrina ... you know?"
http://www.washingtontimes.com/news/2009/aug/04/mental-illness-tidal-wave/
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La. Health department cuts Medicaid providers
By MELINDA
DESLATTE
Associated Press
writer
Louisiana will start paying less money Tuesday to
many private health care providers for taking care of Medicaid patients, a move the state health department estimates
will save $86 million this year.
Health and
Hospitals Secretary Alan Levine said he also is weighing whether to require
adults in the Medicaid program to pay a "very small co-pay" if they
use emergency rooms for non-emergency care.
The cuts come as
the health department shrinks its spending to $7.9 billion in the new fiscal
year that began July 1, down $240 million from last year.
Nearly all the
cuts will be levied on the Medicaid program for the poor, elderly and
disabled. But Jerry Phillips, state Medicaid director, said the department
believes it can cover nearly two-thirds of that gap through efficiencies and
the continuation of other cuts made during the last budget year.
The rest of the
cuts fall largely on the private health providers, particularly doctors and
private hospitals that care for Medicaid patients.
Among the cuts,
private and community hospitals around the state will be paid 5 percent to
more than 6 percent less for Medicaid services, depending on the type of
services. Rural hospitals won't be cut.
Primary care
doctors and other physicians who treat Medicaid patients older than 16 will
get paid 10 percent less. Levine said he wanted to limit the impact of the
cuts on children's services, so the rates paid to pediatric doctors and
pediatric specialists won't be changed.
State health
officials said it will take about a month to fully implement the rate
changes. Phillips said the department will review the cuts in October to
determine if further reductions are needed to keep the budget balanced.
Payment cuts to
private hospitals account for nearly half the estimated savings.
Hospital leaders
are "looking at everything from hiring freezes to layoffs to suspension
of services and anything they can do to reduce expenses," said John Matessino, president of the Louisiana Hospital
Association.
Even with the
cuts, Levine has said the hospitals are receiving more money from the state
than they did two years ago. Also, the hospitals will share in a one-time
$213 million payment this year to help them cope with revenue losses caused
by hurricanes.
Matessino said the hurricane recovery payment
"will help soften this blow a little bit, but not much. That's a
one-time thing and these are rates that go forward" annually.
Health care
companies that provide medical equipment, ambulance services, lab work, X-ray
services and community- and home-based care services for the developmentally
disabled also will take rate cuts, under the changes Phillips described
Monday.
Levine said
co-payments for adult Medicaid patients who visit emergency rooms for care
they could receive at a clinic or doctor's office also were being considered,
but he said he didn't know when a decision would be made or how much the
co-payments might be.
http://www.2theadvocate.com/news/52385022.html#
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by Robert Travis
Scott, The Times-Picayune
BATON ROUGE --
Children's Hospital in New Orleans could bear the brunt of budget cuts in
Medicaid reimbursements to private hospitals as the state health agency
grapples with ways to reduce spending this year, Department of Health and
Hospitals Secretary Alan Levine said Monday.
A spokesman for
the Uptown medical facility, one of the largest providers of Medicaid
services in the state, said Children's officials are working with the
department to mitigate a potentially "tremendous blow" to the
hospital. Medicaid is the state-federal program for low-income recipients.
"We're
confident that the discussions with DHH will result in a reimbursement
structure that the hospital can live with, "
said Vice President of Marketing Brian Landry. "We're not planning to
cut service in any way."
The Legislature
and Gov. Bobby Jindal produced a state budget with
$260 million in health department cuts that must be implemented in the fiscal
year that began July 1. For example, the agency plans to lower reimbursements
to hospitals for certain uncompensated services at emergency rooms that
patients could get at less expense with a primary-care physician, Levine
said.
But much of the
budget reduction will come from decreased support for urban hospitals and
doctors treating patients eligible for federal matching Medicaid dollars.
Because Children's
Hospital is "highly reliant" on Medicaid, it is in line for a large
piece of the budget cut, Levine said. As the state budget was being wrapped
up in June, it appeared the hospital might be cut by more than $30 million,
but Levine on Monday did not put a figure on the potential hit.
In addition to
tapping Medicaid's regular reimbursement program, Children's Hospital makes
extensive use of Medicaid's outlier program, which provides higher
reimbursements to compensate for extraordinary medical services such as
intensive care, Levine said.
The nonprofit
Children's Hospital will draw about $216 million in net patient revenue this
year, Landry said. It is one of the state's leading neo-natal and pediatric
intensive care providers and has been expanding its pediatric cardiac surgery
unit.
About 68 percent
of the hospital's patients are financed by Medicaid, whereas most hospitals
do not exceed 50 percent, Landry said.
"We've never
turned a family away because of a family's ability to pay,
" Landry said. "We plan to continue that in the
future."
Children's has
reserves of money that have been used to finance expansions. The hospital,
which regained its business after Hurricane Katrina, is licensed for 238 beds
and keeps a medical staff of just under 400. Last year it had about 8,000
admissions and handled about 50,000 emergency room visits. The hospital
recently announced a deal to join forces with Touro
Infirmary.
http://www.nola.com/health/index.ssf/2009/08/childrens_hospital_facing_budg.html
New Orleans hospital has one-of-a-kind treatment for
breast cancer patients
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New Orleans hospital has one-of-a-kind treatment for
breast cancer patients
Meg Farris /
Eyewitness News
NEW
ORLEANS – New Orleans now has the
first hospital in the country with a complete and total treatment program for
a condition that many patients don't like to talk about, often leaving them
suffering in silence.
It was not long
after Hurricane Katrina, when Jody Calcote had lost
her home, when another tragedy struck.
"I was living
in trailers and I had seen the lump in my breast myself," Calcote said.
Only in her mid
40s, she faced chemotherapy, radiation, two mastectomies and reconstruction.
"I prayed
really hard and I have a very supportive husband and four children and family
and friends,” Calcote said. “They were awesome.”
But then Jody
faced something else – a medical condition that happens to nearly 30 percent
of breast cancer patients. Her arm, on the side where 15 lymph nodes were
removed, started getting bigger.
"It's just
very heavy very achy very, a lot of weight, say like if I was to blow dry my
hair, I would have to stop in-between blow-drying my hair because my arm is
so heavy," Calcote explained.
Pictures of other
patients show just how big and abnormal an arm or leg with lymphedema can become. The lymph system is a spider web
of vessels carrying a clear fluid, playing an important role in draining
fluid from your body tissue and in fighting infections. But what's so
discouraging about lymphedema is even with special
wraps, compression garments, lymphatic drainage massages and pumps, lymphedema keeps getting worse as time goes on.
Some people have
so many infections each year, they can't keep a job.
"It won't be
immediately after surgery, sometimes it could be a year after surgery, it could be five years after surgery. It's not a medical
problem that many people talk about mainly because these patients start
hiding. They start wearing large clothes. They don't leave their house,"
said Dr. Marga Massey, a reconstructive microsurgeon at The Center for Restorative Breast Surgery
in New Orleans.
Massey is one of
the few surgeons in the world who is trained to do surgery where lymph nodes,
along with the fat, arteries and veins, can be transferred from another area
of the body to help ease the swelling. You can still see Jody's scar where
she had it done.
"This has
been a wonderful thing and you know it makes, makes me a different person. It
makes me feel good again, you know, makes me feel whole again," adds Calcote.
Massy travels
around the world helping people with lymphedema.
Some are born with problems, some have it from an
infection from a parasite, others from lymph node surgical removal and
radiation. But now she has made New
Orleans one of her four regular clinic locations,
practicing out of The Center for Restorative Breast Surgery, the only
hospital in the world dedicated to breast reconstruction.
Her skill
attracted Sharon DuBois from Wabash, Indiana,
whose endometrial cancer surgery and removal of 24 lymph nodes in her abdomen
and groin area, resulted in lymphedema in the leg.
"Large enough
that one (leg) is bigger than the other, so I wear slacks mostly or very long
skirts, ankle length skirts. I don't wear little dresses any more," said
DuBois.
"Lymphedema is not just a physical problem. It is an
emotional problem. It is a chronic disorder. Many of these patients have
difficulty with depression. They lose themselves in this disorder," said
Massey.
After having lymph
node transfer surgery, Sharon
was up and around the very next day.
"Well I won't
be cured of course, but I am hoping with all the therapy that I do, that I
can keep it from getting any worse. That's my main prayers," added DuBois.
"I talk to
several doctors everyday from all over the country, where they've never heard
of this type of operation," said Massey.
And that's
Massey's main message, that those suffering have hope through medical
technology. It's technology that is slowing down the progression and even, in
some cases, significantly reversing lymphedema.
"It's been
kind of the holy grail of reconstructive microsurgery, is trying to find out
what the answer to the puzzle is to fix that and there hasn't been anything
that's worked definitively. They've tried things over the last 20-25 years
with really poor outcome," said Dr. Scott Sullivan, a reconstructive microsurgeon at The Center for Restorative Breast
Surgery.
"It's really
an ingenious approach to lymphedema," said
Massey. "We don't know all the answers. I really hope that, we hope that
we will find out some of the answers from doing this type of work."
And you can learn
more about this lymphedema treatment at a free
support group meeting with Dr. Massey on Wednesday August 12th. That'll be
from 5 – 7 p.m. at the hospital at 1717
St. Charles Ave. Call 504-899-2800 or
1-888-899-2288 for more.
http://www.wwltv.com/topstories/stories/wwl080309cbnocenter.a63acd45.html
[BACK TO TOP]
By ELLYN
COUVILLION
Advocate staff
writer
ST. AMANT — The
cousins who gathered recently for a visit around the dining room table in a
family home have more in common than their kinship.
For each of them,
there has been a parent, a Bourgeois, who is either suffering from probable
Alzheimer’s or who has died a victim of the disease.
The cousins’
parents were siblings in the family of 12 children born to Maurice and
Elizabeth Bourgeois, between the years of 1918 and 1941.
Of those 12
siblings, 10 were or have been victims of Alzheimer’s, described as a
progressive and fatal brain disease by the national Alzheimer’s Association.
For most of them,
the onset of the illness came when they were in their 60s and 70s, family
members said.
“It is dreadfully
hard to go through, watching them decline,” said Iva Tullier
of her mother, the late Cecilia “Cil” Bourgeois
Lambert, and of her nine aunts and uncles who were or are affected.
Family members,
many of whom live in St. Amant and the surrounding
area, said they also believe that their grandparents, Maurice “Mac” and Elizabeth “Belle”
Bourgeois, suffered from the disease.
The disease, which
affects memory and other intellectual abilities, according to the Alzheimer’s
Association, can’t be diagnosed definitively until after death, when a
patient’s brain can be examined.
To strike back at
the disease, more than 60 first cousins — the children of those 12 Bourgeois
siblings — and their own children will be participating for the next 15 years
or more in a study of the Institute for Dementia Research and Prevention at
the Pennington Biomedical Research
Center.
Before the study,
which takes yearly cognitive assessments of the participants, began this
spring, many of the Bourgeois cousins met with Jeffrey Keller, director of
the institute, at the Holy Rosary Catholic Church in St. Amant.
It had been a
meeting place the previous year for another study the family participated in last
year, with the Mayo Clinic in Jacksonville,
Fla.
The clinic sent
medical personnel to the church in 2008 to take blood samples from
participating family members.
The Bourgeois
family members’ participation in the studies reflects an increased involvement
of the family over the years to help find answers for their loved ones’
struggles with the disease, a form of dementia.
They had begun to
ask themselves “Were we just going to sit back and watch all our aunts and
uncles losing touch?” said Kim Robertson, the daughter of James and
Bridget “Dutsie”
(Bourgeois) Sheets.
Robertson’s mother
was diagnosed with probable Alz-heimer’s about two
years ago, Robertson said.
“What breaks our
heart is, they’re such great people,” said Carla Axel, the sister of Iva Tullier, at a recent gathering of some of the cousins, at
the St. Amant home of Iva and her husband, Randy Tullier.
While the research
the family is involved in might not yield answers for decades, the effort has
had an immediate, beneficial effect for the cousins, said Doug Bourgeois, the
son of Doyle “Pomp” and Catherine Bourgeois.
“The best thing
is, you have someone to talk to … to just kind of have this emotional
support,” Doug said, about the help that family members give each other.
His father is now
“living with Alzheimer’s,” he said.
For a long time,
people didn’t talk about what was happening in the family, he said.
“You don’t want to
admit it’s happening,” Doug said.
Family members,
though, eventually
began confronting the issue more openly, particularly at the Bourgeois family
reunions that have been held annually for more than 40 years.
“We started seeing
another aunt, another uncle just slipping away. A lot of the support started
at the reunions, talking,” Robertson said.
Tullier said that her mother was the second
Bourgeois sibling to be diagnosed. Her family believes she had the disease
for some 15 years, before she passed away in 2008 at the age of 82.
“She was extremely
athletic, a hard, hard worker; worked good with her hands, had beautiful
handwriting, crocheted … (she was) a wonderful seamstress,” Tullier said.
She tells of how
her Uncle “Pomp,” Doug’s father Doyle Bourgeois, a retired barber, would cut
the hair of elderly homebound persons, as a community service for many years.
Her Aunt Barbara,
Barbara Bourgeois Schexnaydre, is “still feisty and
wants to do things for you … it’s the ‘mother’ in her,” Tullier
said.
The late Dorothy
Ann “Dot” Bourgeois, the oldest of the Bourgeois siblings, “loved being the
oldest. She was always dressed to a T,” Tullier
said.
“She was the
matriarch,” she said.
Listening to
family members, it’s easy to see that there are many family stories of the
hard-working, fun-loving Bourgeois siblings.
“I would say they
all lived wonderful, full lives, with great families, great kids,” Tullier said. “They all had jobs; there were lots of
college graduates, lots of solid marriages,” she said.
All of the
siblings are married to their original partners or were, at the time of their
death, with the exception of one of the sisters, who was widowed and later
remarried, Tullier said.
The flip side of
all the happy memories is that it’s painful to see the vibrant personalities
slip away, with the onset of Alzheimer’s.
Five of the
Bourgeois siblings are now deceased; four of them were diagnosed with the
disease before their deaths, according to family members.
Of the surviving
seven Bourgeois siblings, six are now showing symptoms of the disease, family
members said.
At age 77, Gabriel
“Gabe” Bourgeois, who has not experienced symptoms of the disease, recently
returned from a trip to Europe with one of
his grandsons and some friends.
“It was
beautiful,” said Gabe of the trip that included a visit to Paris
and a river barge cruise to Prague.
In early August,
he’ll be in Canada,
with family members, at a gathering, held every five years, of the
descendants of the 17th-century Acadians.
Gabe has watched
his brothers and sisters become ill with Alzheimer’s and said he wants to
live life to the fullest.
An enthusiastic Zydeco dancer, Gabe travels from his home in St. Amant to New
Orleans every Thursday night to go dancing, he said.
“I don’t know when
it’s going to hit me or if it will,” Gabe said of Alzheimer’s. “I’m trying to
live life as fully as I can.”
His attitude of
joie de vivre appears to be a strong family trait.
It’s telling that
on the two occasions when Bourgeois family members met researchers at the
church in St. Amant, they cooked up jambalaya for
everyone.
In addition to
volunteering for research studies, Bourgeois family members have become
active in fundraisers.
In June of last
year and this year, the family hosted “A Time to Remember,” an event held in
Gonzales to benefit Alzheimer’s Services of the Capital Area, an organization
that works to “make a significant difference in the lives of all those coping
with Alzheimer’s disease” in the area, according to its literature.
Last year, the
“Time to Remember” fundraiser raised approximately $22,000, and this year,
the event that featured a silent auction, dessert social and entertainment,
raised more than $20,000, Tullier said.
As they have in
previous years, family members will also be taking part in this year’s
fundraising “Walk/Run to Remember” event of Alzheimer’s Services, to be held
Saturday, Sept. 26.
Registration will begin that day at 8 a.m.,
at the LSU “Old Front Nine,” near the corner of Nicholson Drive and Nicholson
Extension, with the 5K race to begin at 9 a.m., and the 5K walk and one-mile
“fun walk” starting shortly after that.
In addition to
participating in the walk-a-thon, Bourgeois family members will also be
presenting Alzheimer’s Services with the money that they and others have
collected all year for the “Mac & Belle Fund,” named in honor of the
first cousins’ grandparents.
Tullier’s brother, Randy Lambert, began the
fundraiser, which encourages folks to save their spare change for the cause
and presented family members with crockery bean pots for keeping their
change, Tullier said.
The Bourgeois
family has become known in the St. Amant area as an
informal resource for those who are coping with Alzheimer’s in their own
families.
“Right here in the
neighborhood, people know what we’ve been through,” Tullier
said.
“Periodically,
somebody will call or we’ll run into someone in the grocery” looking for the
name of a sitter, perhaps, or to discuss aspects of the disease, Tullier said.
“That’s good with
us. We’re here, and if we can help somebody else …” she said.
“I think my new
mission in life has become (being) a spokesperson for Alzheimer’s,” said Tullier, who is on the Education Committee of Alzheimer’s
Services of the Capital Area.
The Bourgeois
family members have tried to approach their situation with a sense of humor
and practicality, and it doesn’t hurt that they’re part of a big family, they
said.
“We have the
blessing of having a multitude of family we can draw from” for help and
strength, said Angela LeBlanc, the daughter of Vernon and Barbara (Bourgeois) Schexnaydre.
http://www.2theadvocate.com/features/52373247.html
[BACK TO TOP]
Sometimes
government gridlock is not a bad thing. As a result of dissatisfaction by
Blue Dog Democrats over health care reform legislation, there will be no
floor vote before Congress breaks for August recess.
This means members
of the U.S. House, including New Hampshire's Carol Shea-Porter and Paul Hodes, will have to bring pending legislation home and
answer a lot of questions being posed by Granite Staters.
It also means they
will have to defend their efforts in light of a Republican proposal being
touted by Louisiana Gov. Bobby Jindal — one that
appears better suited to the task.
Jindal's plan foregoes the government's entry into
the insurance business and heavily favors individual responsibility and
choice. It begins to address issues all but ignored by the House plan,
especially portability.
To be fair,
getting a cogent presentation from the GOP has been like pulling teeth. But
being late should not mean being ignored.
President Obama's
rhetoric has not been matched by the legislation written in the House. It
would appear Jindal's does, while avoiding a
drastic expansion of the federal bureaucracy and an additional trillion
dollars of debt.
Come August
recess, Granite Staters need to hold Shea-Porter's
and Hodes' feet to the fire and demand truly
bipartisan health care reform — the only reform that will work.
August is when
political battles can heat up. This congressional recess, health care will be
on the front lines.
So, as
Shea-Porter, Hodes and hundreds of other lawmakers
leave Washington
and fan out across the country, it may look as if they're retreating from the
hard fight of these last few weeks. However, party leaders of both sides say
now is when the real advance begins.
http://www.citizen.com/apps/pbcs.dll/article?AID=/20090804/GJOPINION02/708049839/-1/CITNEWS08
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LAPolitics
| 08.03.09
John Maginnis
With congressmen
back in their districts for August recess, the month ahead could be when the
American people begin to get their minds around how to change the healthcare
system. For Alan Levine, it's about time.
How national
healthcare will change and how Louisiana will adjust to it consumes much of
the waking hours of the secretary of the Department of Health and Hospitals,
whose daily to-do list, as it is, might be the most demanding in state
government.
There are days
when Levine's plight seems like that of Sisyphus, the mythical king condemned
to push a giant boulder uphill, only to have it roll back down over and
again. The difference is that Levine, rather than being beaten down, seems
ready to hit the rock each morning with wonkish
enthusiasm, ready to talk healthcare with whoever will listen.
Since he came here
from Florida last year, his overarching goal
has been to revamp Louisiana's
dysfunctional public healthcare system, which is built around an outdated
statewide charity hospital network that anyone with the means or a Medicaid
card avoids. He is the lead architect of the Jindal
administration's proposal to the federal government to phase in a
managed-care insurance model that would rely on community-based primary care
clinics instead of public-hospital emergency rooms. But he must wait to see
if and how his proposal fits in with whatever new healthcare mandates arise
from Congress.
That long-term
goal would be challenging enough if his short-term problems did not seem so
insurmountable. Within the context of overall declining state revenues,
Levine has some immediate crises threatening to make everything worse.
His and the
state's most pressing concern is a looming big jump in the Louisiana's Medicaid match rate, which
goes from 28 percent to 37 percent beginning late next year. That would cost
the state an extra $700 million more per year, beginning in late 2010. The
feds tie match rates to personal per capita income, which spiked in Louisiana in the
post-hurricane economy. Despite Levine's entreaties, federal bureaucrats have
shown litle flexibility toward the unprecedented
circumstances, and so it will take an act of Congress to save the state's
healthcare system from being wrecked. The congressional delegation is working
on it.
"There are no
marginal solutions" to a $700 million cut, he said, which would cause
"massive elimination of programs," especially with another $400
million in federal stimulus funds running out the same year the new Medicaid
costs kick in.
At the same time
he is trying to work out a repayment plan on $771 million owed to the feds
for disallowed Medicaid and transportation payments from ten years ago.
Then there is the
$492 million the state claims that FEMA owes it for replacing Katrina-wrecked
Big Charity hospital in New Orleans,
though FEMA has offered only $150 million. Before then, Levine must referee a
turf battle over governance of a new hospital between LSU and Tulane, which
he has likened to the Arab-Israeli conflict.
Lastly, a new
audit role will decrease the federal government's payment to state hospitals
for treating the uninsured by $130 million next year, or almost 15 percent.
Adding to the
weight of the rock Levine pushes is that his boss, Gov. Bobby Jindal, is sitting on top and writing opinion pieces in
national publications panning the president's and Democrats' healthcare
revamp plans.
The state needs
some big breaks, amounting to over $2 billion, from the Obama administration
and Democratic Congress, about whom Jindal--potentially
a presidential contender himself--has had few kind words to offer, from the
stimulus bill to healthcare reform.
Levine keeps his
shoulder to the rock while fearless leader reloads his slingshot.
Still, the
secretary has taken time to read most of the 1,000-page House healthcare
bill--"some portions twice"--and shares Jindal's
concerns about what changes a government-run plan would force on private
insurance in years to come. He also fears what employer mandates or penalties
would do to small businesses, like the hamburger restaurant he still owns in Tallahassee.
One senses,
however, given the historic changes in the works, that
Levine is primed for the challenge of integrating his vision for improved
coverage and access to public healthcare with whatever plan Congress sends to
the states. If the rock doesn't crush him first.
[BACK TO TOP]
John Kennedy
Maybe Barack Obama
should just give up on health care reform and resign from the presidency
while he's at it.
It's obvious that
most Americans are very happy with the way their insurance companies handle
their health care.
They approve of
the way insurers give them lists of doctors from which to choose, the way
procedures are determined to be allowed, which medicines should be
prescribed, how long they should be treated, how much it all costs, etc.
We understand
that, in order to turn a profit, insurance companies have to turn away people
with serious health problems, limit hospital stays and limit coverage only to
spontaneous health issues. It's not fair to expect the insurance companies to
cover our every medical problem, especially those that we bring to the table
when any one of us signs a contract with these honorable, upstanding,
righteous icons of American private industry.
Please, President
Obama, stop trying to help us change the American way. Our insurance
companies know how to make our health problems profitable, and what's more
American than that? Maybe we ought to let them make the laws, too. Oh, wait,
they already do.
John Kennedy
New Orleans
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124936393745650.xml&coll=1
[BACK TO TOP]
Gary Beauchamp
Every American who
now has a health care plan through his employer should ignore most of the
frills of the various health care reform proposals and take note of the most
important one that affects them. That is the one in the Democrats' plan that
will allow employers to discontinue insurance coverage by paying the
government a tax.
If the employer
does this, employees will essentially be forced into the government plan,
which could affect their choice of doctors and treatment.
The often repeated
mantra by President Obama -- that if you like what you have, you can keep it
-- is not necessarily true. You can keep it if your employer doesn't opt out
and pay the tax instead. So the choice is not yours alone.
Democrats claim
most employers won't do this, but do you want to bet your health care on a
political promise?
Gary Beauchamp
Laplace
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/124936383345650.xml&coll=1
[BACK TO TOP]
Cheryl Blanke
Re: "Calming
health care hysteria," Your Opinions, July 30.
Hysteria does not
begin to express the way people feel regarding this bill.
As far as whether
government can be trusted to do anything right, please refer to the
bureaucracy and inefficiency of the Corps of Engineers, FEMA, Medicare, the
Post Office and Amtrak. Now the government is asking the people to trust them
with our lives.
The facts that are
in this bill have caused the hysteria: i.e., the government will decide what
level of treatment you will have at end of life.
This is rationed
health care. There will be a government committee that decides what
treatments or benefits you receive.
Cheryl Blanke
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1249276830277180.xml&coll=1
[BACK TO TOP]
by Lindsey Tanner,
The Associated Press
CHICAGO -- Depression in children as young as 3 is real and not just a passing grumpy mood, according to
provocative new research.
The study is
billed as the first to show major depression can be chronic even in very
young children, contrary to the stereotype of the happy-go-lucky preschooler.
Until fairly
recently, "people really haven't paid much attention to depressive
disorders in children under the age of 6," said lead author Dr. Joan Luby, a psychiatrist at Washington
University in St. Louis. "They didn't think it could
happen ... because children under 6 were too emotionally immature to
experience it."
Previous research
suggested that depression affects about 2 percent of U.S. preschoolers, or roughly
160,000 youngsters, at one time or another. But it was unclear whether
depression in preschoolers could be chronic, as it can be in older children
and adults.
Luby's research team followed more than 200
preschoolers, ages 3 to 6, for up to two years, including 75 diagnosed with
major depression. The children had up to four mental health exams during the
study.
Among initially
depressed children, 64 percent were still depressed or had a recurrent
episode of depression six months later, and 40 percent still had problems
after two years. Overall, nearly 20 percent had persistent or recurrent
depression at all four exams.
Depression was
most common in children whose mothers were also depressed or had other mood
disorders, and among those who had experienced a traumatic event, such as the
death of a parent or physical or sexual abuse.
The new study,
funded by the National Institute of Mental Health and released Monday in the
August issue of Archives of General Psychiatry, did not examine depression
treatment, which is highly controversial among children so young. Some
advocates say parents and doctors are too quick to give children powerful
psychiatric drugs.
Though sure to
raise eyebrows among lay people, the notion that children so young can get
depressed is increasingly accepted in psychiatry.
University of Chicago psychiatrist Dr. Sharon Hirsch said the
public thinks of preschoolers as carefree. "They get to play. Why would
they be depressed?" she said.
But depression
involves chemical changes in the brain that can affect even youngsters with
an otherwise happy life, said Hirsch, who was not involved in the study.
"When you
have that problem, you just don't have that ability to feel good," she
said.
And, in fact, Luby said she has separate, unpublished research showing
that chemical changes seen in older children also occur in depressed
preschoolers.
Dr. Helen Egger, a
Duke University psychiatrist who also has
studied childhood depression, said it is common among people in her field to
first see depressed kids in their teens. Their parents will say symptoms
began very early in childhood, but they were told, "Your child will grow
out of them," Egger said.
Typical
preschoolers can be moody or have temper tantrums, but they quickly bounce
back and appear happy when playing or doing everyday activities. Depressed
children appear sad even when playing, and their games may have themes of
death or other somber topics. Persistent lack of appetite, sleep problems,
and frequent temper tantrums that involve biting, kicking or hitting also are
signs of possible depression, Egger said.
Luby said another sign is being preoccupied
with guilt over common mishaps. For example, a depressed 3-year-old who
accidentally breaks a glass might keep saying, "Mommy, I'm sorry I did
that," and appear unable to shake off that sense of guilt for days, she
said.
University of Massachusetts psychologist Lisa Cosgrove said she is
skeptical about the accuracy of labeling preschoolers as depressed, because
diagnostic tools for evaluating mental health in children so young aren't as
well tested as those used for adults.
And Cosgrove said
that while early treatment is important for troubled children, "we just
have to make sure that those interventions aren't compromised" by
industry pressure to use drugs.
Previous research
has suggested that rising numbers of preschoolers are taking psychiatric
drugs, including Prozac, which is used to treat depression.
Egger said that
there is little research on the effects of psychiatric medicine in very young
children, and that psychotherapy should always be tried first.
Dr. David Fassler, a University
of Vermont psychiatry
professor, emphasized that depression in very young children is still pretty
rare. However, without treatment, "it can have a devastating and often
lasting effect on a child's social and emotional development," he said.
"Hopefully,
studies such as this will help parents, teachers, and pediatricians recognize
the signs and symptoms of preschool depression so they make sure young
children get the help they need and deserve," Fassler
said.
http://www.nola.com/health/index.ssf/2009/08/depression_in_preschoolers_des.html
[BACK TO TOP]
New Orleans CityBusiness |
08.03.09
The debate over
health care reform is shaping up to be one of the more divisive issues in
American history, and the dispute is likely far from over after Congress
blocked President Obama’s wish to put a plan in motion before its August
recess.
Meanwhile, a
growing number of Americans are faced with the prospect of health care they
either can’t afford or can’t access. Nearly everyone agrees a fix is in
order, but there’s little consensus on how to correct the problem.
The president is
finding resistance to the sweeping changes he proposes within his own party.
Conservative Democrats, along with Republicans, are adamantly opposed to any
additional government intrusion into the private sector in the wake of
financial industry bailouts and auto industry takeovers.
But as the
discussion becomes increasingly politicized, the goal of improving the
availability and standard of medical care is taking a back seat. The issue is
raising some crucial questions for the medical industry besides who will pay
for the proposed reform.
One of the more
pressing concerns receiving little attention in the ongoing debate is the
woeful shortage of physicians and nurses the health care industry faces.
Today, patients
face long waits at doctors’ offices and emergency rooms because there aren’t
enough medical professionals to handle the workload. That problem will only
be exacerbated if universal care is put into play.
That’s not a
statement for or against universal care, only a statement of fact.
The American
Medical Association says the United
States could lack as many as 200,000
physicians and 800,000 nurses by 2020. Medical school enrollment has increased
in recent years, but the number of applicants has leveled off as the
profession’s appeal is waning.
Almost 8,000
people turn 60 each day, or about 330 an hour, according to the U.S. Census
Bureau. These aging baby boomers will only add to the burden already facing
the medical profession.
Before broadening
access to health care, Obama and members of Congress must address the
conditions stretching the medical profession beyond its limits. Failing to do
so will only lower the quality of care available.
http://www.neworleanscitybusiness.com/viewStory.cfm?recID=33816
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Curlew
Island, LA - A Mississippi man fishing off the Louisiana coast had to be med-evaced
to a New Orleans
hospital and rushed into surgery.
The coast guard
says it happened around 10:00 Saturday morning near Breton Sound about 85
miles southeast of New Orleans.
A coast guard
rescue swimmer lowered into the 30-foot fishing boat determined the man; a
56-year-old from Jackson,
Mississippi needed medical
attention. The coast guard says his injuries may have been life-threatening.
Dr. Alan Wyatt with the LSU Health Sciences
center says shark attacks in general are pretty rare. They happen about 100
times around the world and 10 to 15 people actually die from their attacks.
Dr. Wyatt says a bull shark, which can be aggressive, is most likely to have
attacked the man.
http://www.fox8live.com/news/local/story/Man-bitten-by-shark-off-the-cost-of-Louisiana/fzq_SuW7VkicGjH-t4G8vA.cspx
[BACK TO TOP]
The New York Times | 08.03.09
By TARA
PARKER-POPE
Married people
tend to be healthier than single people. But what happens when a marriage
ends?
New research shows
that when married people become single again, whether by divorce or a
spouse’s death, they experience much more than an emotional loss. Often they
suffer a decline in physical health from which they never fully recover, even
if they remarry.
And in terms of
health, it’s not better to have married and lost than never to have married
at all. Middle-age people who never married have fewer chronic health
problems than those who were divorced or widowed.
The findings, from
a national study of 8,652 men and women in their 50s and early 60s, suggest
that the physical stress of marital loss continues long after the emotional
wounds have healed. While this does not mean that people should stay married
at all costs, it does show that marital history is an important indicator of
health, and that the newly single need to be especially vigilant about stress
management and exercise, even if they remarry.
“When your spouse
is getting sick and about to die or your marriage is getting bad and about to
die, your stress levels go up,” said Linda Waite, a sociology professor at
the University
of Chicago and an
author of the study, which appears in the September issue of The Journal of
Health and Social Behavior. “You’re not sleeping well, your diet gets worse,
you can’t exercise, you can’t see your friends. It’s
a whole package of awful events.”
The health
benefits of marriage, documented by a wealth of research, appear to stem from
several factors. Married people tend to be better off financially and can
share in a spouse’s employer health benefits. And wives, in particular, act
as gatekeepers for a husband’s health, scheduling appointments and noticing
changes that may signal a health problem. Spouses can offer logistical
support, like taking care of children while a partner exercises or shuttling
a partner to and from the doctor’s office.
But in the latest
study, researchers sought to gauge the health effects of divorce, widowhood
and remarriage in a large cohort of people over time.
Among the 8,652
people studied, more than half were still married to their first spouse.
About 40 percent had been divorced or widowed; about half of that group were remarried by the time of the study. About
4 percent had never married.
Over all, men and
women who had experienced divorce or the death of a spouse reported about 20
percent more chronic health problems like heart disease, diabetes and cancer,
compared with those who had been continuously married. Previously married
people were also more likely to have mobility problems, like difficulty
climbing stairs or walking a meaningful distance.
While remarrying
led to some improvement in health, the study showed that most married people
who became single never fully recovered from the physical declines associated
with marital loss. Compared with those who had been continuously married,
people in second marriages had 12 percent more chronic health problems and 19
percent more mobility problems. A second marriage did appear to heal
emotional wounds: remarried people had only slightly more depressive symptoms
than those continuously married.
The study does not
prove that the loss of a marriage causes health problems, only that the two
are associated. It may be that people who don’t exercise, eat poorly and can’t
manage stress are also more likely to divorce. Still, researchers note that
because the effect is seen in both divorced and widowed people, the data
strongly suggest a causal relationship.
One reason may be
changes at the cellular level during times of high stress. In an Ohio State
University study,
scientists analyzed blood samples of people undergoing the stress of caring
for a loved one with Alzheimer’s disease. The research focused on telomeres,
which insulate and protect the ends of chromosomes; with aging, telomeres
shorten and the activity of a related enzyme also declines.
Compared with a
control group, the Alzheimer’s caregivers showed telomere patterns associated
with a four- to eight-year shortening of life span. Dr. Waite said the stress
of divorce or widowhood might take a similar toll, leading to chronic health
and mobility problems.
None of this
suggests that spouses should stay in a bad marriage for the sake of health.
Marital troubles can lead to physical ones, too.
In a series of experiments,
scientists at Ohio
State studied the
relationship between marital strife and immune response, as measured by the
time it takes for a wound to heal. The researchers recruited married couples
who submitted to a small suction device that left eight tiny blisters on the
arm. The couples then engaged in different types of discussions — sometimes
positive and supportive, at other times focused on a topic of conflict.
After a marital
conflict, the wounds took a full day longer to heal. Among couples who
exhibited high levels of hostility, the wound healing took two days longer
than with those who showed less animosity.
“I would argue
that if you can’t fix a marriage you’re better off out of it,” said Janice Kiecolt-Glaser, an Ohio State
scientist who is an author of much of the research. “With a divorce you’re
disrupting your life, but a long-term acrimonious marriage also is very bad.”
http://www.nytimes.com/2009/08/04/health/04well.html?ref=health
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The New York Times | 08.03.09
By NATALIE ANGIER
As a confirmed
crab apple who has often been compared to the
splenetic Lucy Van Pelt character from Peanuts, I am gratified to learn that
should my real spleen ever decide to vent in earnest, the outburst may just
help save my life.
Scientists have
discovered that the spleen, long consigned to the B-list of abdominal organs
and known as much for its metaphoric as its physiological value, plays a more
important role in the body’s defense system than anyone suspected.
Reporting in the
current issue of the journal Science, researchers from Massachusetts General
Hospital and Harvard Medical School describe studies showing that the spleen
is a reservoir for huge numbers of immune cells called monocytes,
and that in the event of a serious trauma to the body like a heart attack,
gashing wound or microbial invasion, the spleen will disgorge those monocyte multitudes into the bloodstream to tackle the crisis.
“The parallel in
military terms is a standing army,” said Matthias Nahrendorf,
an author of the report. “You don’t want to have to recruit an entire
fighting force from the ground up every time you need it.”
That
researchers are only
now discovering a major feature of a rather large organ they have been
studying for at least 2,000 years demonstrates yet again that there is
nothing so foreign as the place we call home.
“Often, if you
come across something in the body that seems like a big deal, you think, ‘Why
didn’t anybody check this before?’ ” Dr. Nahrendorf
said. “But the more you learn, the more you realize that we’re just
scratching on the surface of life. We don’t know the whole story about
anything.”
Dr. Nahrendorf, with Filip K. Swirski, Mikael J. Pittet and a dozen other colleagues, performed the
initial studies using mice, but the scientists suspect the results will apply
to humans as well.
Ulrich H. von Andrian, an immunologist at Harvard Medical
School who was not
involved with the research, agreed that the findings were a surprise. “If one
had to guess the source of these cells, one would have thought it likely that
they were mobilized from the bone marrow rather than from the spleen,” he
said. “The discovery adds another layer of complexity not previously
associated with that organ.”
The latest work
also sounds a cautionary note against underestimating a body part or
dismissing it as vestigial, expendable or past its prime. In an accompanying
essay, Ting Jia and Eric G. Pamer
of Memorial Sloan-Kettering Cancer
Center admit that “the
spleen lacks the gravitas of neighboring organs” like the liver or the
stomach “because we can survive without it.”
Spleens can
rupture during contact sports, say, or in a motorcycle accident, at which point
surgeons have no choice.
“It’s such a vascularized organ, and the risk of big-time hemorrhaging
is so great, that if the spleen ruptures, it’s a surgical emergency,” said
James N. George, a hematologist with the University of Oklahoma Health
Sciences Center. “You have to remove it.”
The new findings
in no way counter the necessity of excising a ruptured spleen, the
researchers said, but they do suggest that the loss of the organ is more than
a mere “inconvenience,” as it has often been depicted, and could help explain
previous reports showing an enhanced risk of early death among people who
have undergone splenectomies.
In one study that
appeared in The Lancet in 1977, for example, researchers compared a group of
740 American veterans of World War II who had had their spleens removed as a
result of battle injuries with a similar size sample of veterans who had
suffered other war injuries but had kept their spleens. The splenectomized men, the researchers found, were twice as
likely to die of cardiovascular disease as were the veterans in the control
group. All of which means that despleening should
be diligently guarded against, particularly among our little sports warriors,
perhaps through the wearing of appropriate protective gear.
Researchers cite other
cases in which organs were presumed to be so dispensable that they could be
removed “prophylactically” — often with unfortunate
outcomes. In recent years, for example, many older women undergoing
hysterectomies have been advised to have their healthy ovaries removed at the
same time, the rationale being: if you are past your childbearing years, why
hang on to reproductive organs that might turn cancerous and kill you? Yet
follow-up surveys have shown that women who underwent elective ovariectomy had a heightened risk of dying during a given
study period, were more susceptible to heart disease and lung cancer and were
twice as likely to develop Parkinson’s disease compared with women who had
kept their ovaries. “Evolution has an edge on us,” Dr. Nahrendorf
said. “I would be very careful about saying, ‘You don’t need this organ, get rid of it.’ ”
Another reason to
esteem the spleen — a purplish, fist-size, five-ounce organ in the upper left
quadrant of the abdominal cavity, just behind the stomach and under the
diaphragm — is its illustrious medical and poetic history. Galen considered
the spleen to be a source of one of the four bodily humors, specifically the
black bile associated with irritable, melancholic cranks. In his poem,
“Spleen,” Charles Baudelaire describes a young narrator so weary and
despondent, unresponsive even to beautiful women and jesting men, that it is
as if the “green waters of Lethe” fills his veins.
More recently,
researchers determined that the spleen is like an elaborate wetlands, a Mississippi bayou for
filtering and freshening the blood. In other organs, blood flows through an
interconnected mesh of increasingly narrow arteries, veins and capillaries.
The spleen, by contrast, has a so-called noncapillary
circulatory system: as the blood flows in, it is dumped into puddle-like
sinusoids, and to get back out it must squeeze between cells. That dumping
and squeezing help filter out blood-borne parasites, aging blood cells too
brittle for compression and the little oxidized pellets, the BB’s, with which red blood cells are often pocked. The
spleen has often been called a graveyard for red blood cells, but it is more
of a recycling center, for the iron and other components are plucked out of
the cells and used to stock new hemoglobin cages.
Filtration,
cannibalization, and now — serious monocyte
cultivation. In the new study, the researchers began by looking at monocytes, the largest of the body’s white blood cells.
“It was recognized that these cells are the major repair workers after a
heart attack,” Dr. Nahrendorf said. “They remove
dead muscle cells, they start rebuilding stable scar tissue, they stimulate
the generation of new blood vessels.”
The cells make
haste to cut and paste. “Within 24 hours after a myocardial infarction,” Dr. Nahrendorf said, “there are millions of monocytes” congregating around the broken heart. All of
which would seem sensible, desirable, an excellent display of emergency
preparedness, except that Dr. Nahrendorf and his
principal colleagues were puzzled by one big unknown: Where did the rapid
response team come from? The numbers circulating in the blood were simply too
low. The researchers searched one organ after another, until they checked the
spleen and found the monocytic mother lode. “The
numbers there were huge, 10 times higher than what was in the bloodstream,”
Dr. Nahrendorf said.
By the
researchers’ reckoning, monocytes, like all blood
cells, are born in the bone marrow and at some point migrate to the spleen,
lured by cues yet to be identified. They sit and wait, a sessile bunch, but
when aroused by such chemical signatures of damage as angiotensin,
the cells surge forth without hesitation, a reaction the researchers hope
someday to understand well enough to recapitulate at will. Hail to the chief,
hail to the queen and hail to the monocytes
residing in my spleen.
http://www.nytimes.com/2009/08/04/science/04angier.html?_r=1&ref=health
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