Tuesday, June 30, 2015

Austin Regional Clinic Strengthens Vaccination Policy

Austin Regional Clinic (ARC) announced today its physicians no longer will accept new pediatric patients whose parents opt not to have them vaccinated. The clinic will continue to care for children who cannot be vaccinated for medical reasons — their weakened immune systems make them unable to receive vaccinations, or they have adverse reactions to vaccines.

ARC adopted the new policy to protect all of its patients from disease, in light of the measles outbreak in California’s Disneyland. In that case one infected individual spread measles to more than 115 people in at least 21 states. ARC aims to protect patients with weakened immune systems or who cannot be vaccinated from accidental exposure.

“ARC’s primary concern is the safety of its patients,” the clinic said in a news release. “The [Disneyland] outbreak reemphasized how easily measles and other dangerous, vaccine-preventable illnesses can spread and how important it is to maintain safe facilities for patients.”

The decision is part of a small but growing trend among clinics and pediatricians who take seriously their responsibility to protect all of their patients from vaccine-preventable diseases. ARC also ultimately will discharge current unvaccinated patients whose parents are unwilling to begin a vaccination catch-up schedule. Keller pediatrician Jason V. Terk, MD, president of the Texas Pediatric Society, similarly discharged unvaccinated patients from his own practice in Keller. He wrote that accepting unvaccinated children in a practice can risk the health of other patients, especially in a waiting room environment.

“Some infants are too young to have received any vaccines, and some children have compromised immune systems because they are being treated for cancer,” he said. “Some may have undiagnosed conditions that put them at increased risk to vaccine-preventable diseases. All of these patients come together in a physician’s office when they need care. A physician who allows patients to go unvaccinated in his practice becomes complicit in the increased risk that such a choice creates and allows that risk to be hosted within the wall of the practice.”

In its announcement today, ARC Chief Medical Officer Russ Krienke, MD, echoed that sentiment:

“More than 400,000 infants, children, adolescents, adults, and seniors trust ARC for their health needs. It is our responsibility to ensure our facilities are safe for all of them,” said Dr. Krienke. “And while we respect the right of families to make their own choices for their children, we also respect the trust our patients put in us to ensure the safety of all, and our policies must honor that trust.”

Friday, June 26, 2015

Gestational Diabetes Takes Toll on Texas Moms and Babies

For many women, expecting a child is full of exciting new experiences, but many also face an unexpected health problem along the way: diabetes.

The most common form of diabetes pregnant women encounter — gestational diabetes mellitus (GDM) — is more prevalent than experts once thought, according to a new Medicaid report.

The report, Gestational Diabetes in Medicaid: Prevalence, Outcomes, and Costs, released by the Texas Health and Human Services Commission (HHSC), finds diabetes among women of childbearing age grew 40 percent from 2002 to 2012.  It suggests that “as many as 9 percent of all pregnant women in Texas may develop GDM prior to delivery.” That’s more than 18,000 women.

What it is

GDM occurs when a pregnant woman’s body is unable to make and use all the insulin she needs for pregnancy, making it difficult to convert blood glucose (blood sugar) into energy. GDM disappears after the baby is delivered, but in many cases it returns years later as type 2 diabetes.

According to the American Diabetes Association, the risk for developing GDM is about twice as high for overweight women, four times higher for obese women, and eight times higher among severely obese women, compared with normal-weight pregnant women.

Why it matters

Diabetes can affect the pregnant woman’s health, whether she carries the baby full term, and the health of the baby. The HHSC report says three groups of pregnant women — those with GDM, with pregestational diabetes mellitus (PGDM), or who are overweight or obese — are more likely to give birth before 37 weeks or require surgery to deliver the baby (a Caesarian section, or C-section). Obese women with PGDM are especially at risk; the report says they are four to seven times more likely to develop hypertension and require C-sections or need to be admitted to a hospital’s intensive care unit.

GDM affects the newborn as well as the mother. The Texas Department of State Health Services reports 12.5 percent of all infants born to diabetic mothers needed special care from a neonatal intensive care unit.

Not only is gestational diabetes unique in that it affects two people — the mother and her child — but also it keeps the diabetes cycle going for the next generation.

“If half of these children are girls, and they’re already overweight in their teenage years and stay that way, the whole cycle is going to repeat,” said John Menchaca, MD, a Fort Worth pediatrician.

Dr. Menchaca says in his 35 years of caring for patients, he frequently saw overweight children of diabetic mothers. Because of the mother’s GDM diagnosis during pregnancy, these infants already have an increased risk for diseases and conditions like heart disease, high blood pressure, obesity, and type 2 diabetes.

“It’s very bothersome,” he said. “It has significant adverse effects on the offspring to have a mother with gestational diabetes, or maternal obesity, or having gained a lot of weight during pregnancy.”

Texas physicians say obesity during pregnancy is a preventable health condition that poses significant risks for mothers and infants. Texas Medical Association policy recommends women receiving prepregnancy counseling be informed of the risks of obesity in pregnancy for both mother and baby, and be encouraged to undertake a weight-reduction program.

Identifying and treating overweight and obese young women “basically starts the prevention process, before the next generation is conceived,” Dr. Menchaca said. “It’s exceedingly hard to achieve … but we can’t do nothing.”

For more on GDM’s toll on Texas, including its financial costs, check out the June issue of Texas Medicine magazine.

Wednesday, June 24, 2015

Infographic: 9 Facts About Men’s Health

June is Men’s Health Month. The infographic below illustrates nine facts you may not have known about men’s health and offers lifestyle choices to prevent diseases and stay healthy.

Friday, June 19, 2015

Public Opinion Split on ACA

Who likes and who dislikes the Affordable Care Act (ACA), America’s health system reform law?

In anticipation of the King v. Burwell Supreme Court decision, Kaiser Family Foundation (KFF) published its latest tracking poll gauging the public’s opinion on the ACA. Some results could be expected, while some might seem surprising.

Overall, slightly more people dislike the ACA than like it: The number of individuals who reported a favorable view on the ACA (39 percent) declined three percentage points since April’s tracking poll, once again dipping below the number of people with an unfavorable opinion, which remained unchanged at 42 percent.

An interactive graphic is available on the KFF website, where you can view differences in people’s opinion of the ACA based on political party affiliation, income, age, gender, race/ethnicity, and insurance status. Here are a few takeaways from this month’s polling results:

  • Republicans have a more unfavorable opinion of the ACA (69 percent opposed), while Democrats have a more favorable opinion (65 percent in favor).
  • Adults 50-64 years old had the least favorable opinion of the ACA out of all the age groups (48 percent unfavorable), while 18-29 year-olds were the age group with the highest percent of individuals reporting no opinion (28 percent).
  • Blacks and Hispanics have a much more favorable opinion of the ACA (59 percent and 48 percent, respectively) than whites (33 percent), who were the highest percentage race/ethnicity group with unfavorable ACA opinion (50 percent).

Thursday, June 18, 2015

Dad’s Vaccination Helps Protect Baby From Whooping Cough

As a dad-to-be, you’re thinking of all the things you hope to pass on to your child: maybe your sense of humor, your love of sports or music, or your eye color. One thing you don’t want to pass on to your new baby is whooping cough, or pertussis, a highly contagious disease that can be deadly for infants. As we honor dads this Father’s Day, the physicians of Texas Medical Association (TMA) urge dads- and grandfathers-to-be to get vaccinated, before baby arrives.

“Vaccinating dads and others who will come into contact with the baby is the best way to ensure they will not get pertussis and inadvertently infect the infant,” said C. Mary Healy, MD, of Houston, a pediatric infectious disease specialist and member of TMA’s Committee on Infectious Diseases. “The vaccination is safe, and everyone should be vaccinated against whooping cough to protect themselves and their baby.”

Whooping cough is especially dangerous for infants younger than 1 year of age. The Texas Department of State Health Services (DSHS) says more than half of babies under 1 year of age who get pertussis must be hospitalized. Many will have serious complications, like pneumonia or apnea (slowed or stopped breathing), and some become so sick they will die.

The Tdap vaccination (a combination vaccination that protects against tetanus, diphtheria, and pertussis) is recommended for adolescents and adults — including dads, siblings, and grandparents — who will have contact with the infant, according to the Centers for Disease Control and Prevention (CDC).

For the best protection, the CDC recommends the vaccine be administered to family members at least two weeks before they have contact with the baby. And because babies don’t always arrive on their due date, getting vaccinated a few weeks before the anticipated birth is best, said Dr. Healy.

“Every mom should be vaccinated during pregnancy to help protect the baby from pertussis,” Dr. Healy explained. “Vaccinating all of the newborn’s family members prior to the baby’s arrival provides even better protection.”

Physicians call it “cocooning,” vaccinating those who will be around a newborn to surround the infant in a vaccination “cocoon.” That, together with immunizing pregnant women, is the best way to protect the baby, said Dr. Healy, because, in most cases, infants catch pertussis from a family member or caregiver whose symptoms were so mild they didn’t know they had the illness.

Family members and caregivers around babies must defend the little ones against whooping cough because newborns cannot protect themselves yet. And because babies require a series of pertussis vaccinations, they are not fully protected until they’re close to 18 months of age. Until that time, babies rely on the vaccinations of those around them to avoid catching the disease.

Texas reported 3,985 pertussis cases in 2013, the most cases in a year since 1959, according to DSHS. Eleven percent of those patients (most of them children under age 1) ended up in the hospital, and all five of the people who died of pertussis in 2013 were infants. In 2014, the number of cases decreased slightly with 2,576 cases of pertussis and two infant deaths (based on preliminary data).

If you’re expecting a baby, physicians urge you to ask your doctor about the Tdap vaccine. TMA has published a fact sheet about the importance of pertussis vaccination, in English and Spanish.

Related: Mom’s Gift of Vaccination Protects Baby From Whooping Cough

Wednesday, June 17, 2015

Smoking Causes 12 Types of Cancer

You probably know by now that smoking is a major cause of lung cancer. What you might not know is that smoking can cause 11 other cancers in addition to lung cancer. What’s more, smoking is responsible for nearly half (48.5 percent) of the deaths from these cancers.

Research published in JAMA Internal Medicine found cigarette smoking caused nearly 168,000 deaths due to cancer in 2011. While the majority (75 percent) of those deaths were from lung cancer, a quarter were due to other types of smoking-related cancers, including larynx, oral, urinary bladder, esophageal, kidney, and liver cancers.

The study serves as another reminder of the many ways smoking can kill a person. The JAMA article, which took its data from interviews conducted by the Centers for Disease Control and Prevention, reports cigarette smoking caused 80 percent of lung cancer deaths, 77 percent of larynx cancer deaths, and 50 percent of esophageal cancer deaths. The data also revealed significant differences in the death rates of certain smoking-related cancers between men and women. Men are more likely to die from kidney, liver, stomach and myeloid leukemia cancers due to smoking, while women are more likely to die from larynx and pancreatic cancers due to smoking.

The report stresses more comprehensive tobacco control and tobacco cessation are needed if the United States wants to see a decline in deaths from these types of cancer. Read more.

Have you tried to quit smoking, or do you know someone who smokes, but who you wish would quit? Leave your thoughts in the comments.

Friday, June 12, 2015

More Patients Choose Hospice Care at End of Life If Their Doctor Recommends It

When it comes to dying, nearly everyone says they want a peaceful, painless death, outside of a hospital. To make good on this wish, some patients in their final days are choosing hospice care as an alternative to more aggressive treatments, procedures, and hospital stays aimed at prolonging life. And a new study shows physicians play a big role in hospice awareness.

The Brigham and Women’s Hospital (BWH) study, which was published in Health Affairs, reveals patients making end-of-life decisions are more likely to consider hospice if their physician actively recommends it as an option. Hospice care focuses on comfort and quality care instead of a life-saving cure.

"This new information provides a clear policy target for improving and advancing the quality of care for patients at the end of their lives," Ziad Obermeyer, MD, a physician researcher at BWH, said in a news release. "We need to know what our patients really want at the end of their lives. We need to remove the barriers to having these discussions and give our patients the care they actually want."

Read more.

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