Friday, February 5, 2021

Super Bowl Safety: Ways to Enjoy the Big Game During COVID-19















This Sunday is Super Bowl Sunday. Millions of people will settle in to watch the big game, but COVID-19 won’t be taking a football break. With variants of the virus spreading and vaccine distribution still in its early phases, the Centers for Disease Control and Prevention (CDC) is urging Americans to celebrate this year’s game in a safe, nontraditional way.

Have you ever attended a Super Bowl party? Traditionally, millions of people watch the game in large gatherings. However – no surprise – doctors and health care workers are strongly discouraging people from attending parties involving a lot of people in close contact with one another. That doesn’t mean you can’t still meet to watch the game. Just like most events, the safest option is hosting a virtual party or gathering only with your live-in family/roommates. 

If you opt for a virtual Super Bowl watch party, connect with friends via a text group or video chat. You can still don your favorite team’s logo or colors and make appetizers for the people you live with. 

If you do throw a game-watching party in person, take your TV outside or display the game outside using a projector, and have people sit at least 6 feet apart – especially if they don’t live together. CDC developed a list of tips to make small gatherings safer

If you’re lucky enough to be among the 25,000 or so fans going to the Super Bowl in Tampa, or if you’re attending another large Super Bowl event, you should take extra precautions to avoid getting sick: Call the venue in advance or check online about the safety measures being taken; arrive at the venue early to avoid crowds; and practice socially distancing at all times. Gotta cheer? Stomp, clap, or use noisemakers instead of yelling and cheering, to reduce transmission of droplets. 

And as always, people who attend any kind of gathering should wear a face mask, physically distance from others, and wash hands frequently.

Although Super Bowl Sunday is considered an unofficial holiday for many, it’s best for people to approach it like this past holiday season – with extra precautions – to help reduce the spread of COVID-19.

For a summary of these safety tips, check out the graphic below:



Monday, February 1, 2021

Teenagers, Sleep, and the Global Pandemic

Gregory Rodden, DO
Pediatric Resident at The University of Texas at Austin Dell Medical School
Member, Texas Medical Association

People across the world are suffering from a lack of sleep amidst the COVID-19 pandemic. Children and teens suffer from sleep problems, and parents must recognize and address these issues while the world restlessly awaits the resolution of this health crisis. Good sleep is essential for everyone, young people in particular.

More and more, we hear about the negative impacts of the pandemic on mental health. Sleep plays a critical role here. Severe sleep disturbances such as insomnia contribute to psychological stress, depression, and anxiety. The longer someone’s sleep disorders persist, the greater the impact they have on mental and physical health. 

Even before the pandemic, insomnia and delayed sleep-phase disorder (when a person routinely falls asleep two hours or longer after he or she should) were particularly prevalent among teens, but these issues have been worsened by the coronavirus. 

Whether teenagers are back to in-person learning or attending school virtually, they need to be in prime shape to thrive and learn. Teens, in particular, need about nine to nine and a half  hours of high-quality sleep on a nightly basis to keep their minds sharp and their bodies healthy. 

During our teenage years, most of us experienced a natural shift of our circadian rhythm, or sleep cycle, that delayed our internal bedtime to 11 pm or later. Couple this with early school start times, usually between 7 and 8 am, and it becomes clear why so many of us were groggy during our first few classes in high school. Sleep time was also scrunched by the time demanded for extracurriculars, sports, jobs, etc. 

Given these facts, what can we do to promote healthy sleep for our children, particularly teenagers, during and after the pandemic? 

Here are a few quick tips to help teens get that much-needed sleep: 

1. Help them to buy into the idea. Most teens like to feel a sense of autonomy over their ideas and decisions. Drop hints and clues that will help your teen to see how quality sleep will help to achieve his or her goals. When they feel like it’s their own idea, teens are more likely to change their behavior. 

2. Get some sun exposure. Make sure your teen is getting some sun early in the day to help keep their biological (circadian) clock well-regulated. This internal clock, which uses light and darkness to help prepare you to be active or sleep, is most sensitive to light (or darkness) from about two hours before the usual bedtime until the hour before usual wake-up time in the morning. The earlier they’re exposed to bright light, the earlier their body will set them up for sleep hours later.

3. No caffeine after lunchtime. Stimulating substances like caffeine will delay your teen’s natural bedtime. Studies show teens’ caffeine intake leads to an increase in sleep difficulties, sleep disturbances, and morning tiredness.

4. Set a daily bedtime and wake time. Keeping a consistent routine plays a key role in maintaining good, healthy sleep habits. 

5. No screens allowed in the bedroom at night. This includes cell phones, computers, tablets, televisions, etc. The blue light from the screen, and looking at virtual/online content, will keep your teen up late into the night

6. Keep the bedroom cool and dark. To fall asleep, our core body temperature needs to drop somewhat, so cooler bedroom temperatures will be helpful. The experts suggest a temperature of around 65 degrees Fahrenheit. 

The blue light that comes from devices like cell
phones has been known to keep people from 
falling sleep, according to studies. 
7. Advocate for later school start times. The American Academy of Pediatrics has endorsed a school start time of 8:30 am or later for middle and high schools

8. Know when to ask for help. If your teen is suffering from insomnia despite trying the tips above and other tips for good sleep hygiene, it may be worthwhile to speak to their primary care physician about getting the help of a sleep expert

A good night’s sleep benefits our bodies more than we realize. When we sleep, we give our mind a chance to restore and boost memory and learning abilities – and for teenagers, who are still developing both physically and mentally – sleep is particularly important. The COVID-19 pandemic has thrown a wrench into a lot of aspects of their daily lives, sleep likely being one of them. However, if we help our teens build better sleeping habits, they can develop both mental and physical resilience that will boost their well-being, especially during this uncertain time.  

Friday, January 22, 2021

Protecting Postpartum Women: The Need to Extend Medicaid Postpartum Coverage in Texas


Rebecca Teng, MD
Austin Obstetrician and Gynecologist
Member, Texas Medical Association Committee on Reproductive, Women’s and Perinatal Health

While traditional obstetric care often focuses on the time of a woman’s pregnancy through the time of the delivery of the baby, there is a growing recognition about the need for more attention to the time after she delivers. During this postpartum period – increasingly referred to as the fourth trimester – a new mother will need medical care, and she needs health insurance to help her obtain that care. Medicaid, which covers 53% of all Texas births, should cover women not only throughout their pregnancies but also for a full year after they give birth.  

During the pregnancy, women see the physician more frequently than at any other time of a typical healthy person’s life. Visits ramp up near the end of pregnancy, as physicians who provide obstetrical care and their medical teams are looking for any condition that may affect the mother or an infant and might change their recommendation about the baby’s delivery. After delivery, the postpartum period is a time of potential vulnerability for the new mother. As every parent knows, the arrival of a newborn, no matter how loved, means many sleepless nights, new stress, and relationship challenges; but this period is especially dangerous for those who might have unstable insurance coverage or who are uninsured. Even before the pandemic, one-quarter of Texas women of reproductive age lacked health insurance. Without coverage, women are less likely to access primary, specialty, and preventive care services to be healthy, increasing the risk of preventable issues and tragedies.

Following childbirth, postpartum women need ongoing treatment for any underlying chronic health conditions, such as hypertension or diabetes, or to treat complications that might arise in the following year, some of which are life-threatening if untreated. These complications include severe postpartum depression and heart disease. 

In addition, healthy pregnancies do not begin at conception, but well before. Once a woman becomes pregnant, an obstetrician-gynecologist or family physician caring for her cannot undo cumulative years of poor health stemming from little or no care prior to getting pregnant. For example, if a woman has had uncontrolled diabetes, this can increase the risk of birth defects in the infant and the risk of complications. One example is shoulder dystocia (a condition when one or both of a baby’s shoulders get caught inside the mother’s pelvis during labor); another is a potentially greater need for the mother to have a cesarean delivery (commonly known as a C-section, surgically delivering the baby). Also, if deliveries are less than 18 months apart, there can be a higher risk of preterm labor, growth issues, and placental issues. 

According to Texas’s own expert panel, women’s lack of access to regular, preventive primary and specialty care before and after pregnancy contributes to Texas’ high rate of maternal deaths. Nearly one-third of new mothers’ deaths occur 60 days or more postpartum – the same time many low-income women lose their pregnancy-related Medicaid coverage. Among Black women, the numbers are far worse: Black women account for 31% of maternal deaths but only 11% of births. 

As tragic as maternal deaths are, they are only one part of the story. For every woman who dies in conjunction with having a baby, 50 to 100 women suffer a severe illness or complication, often with lasting consequences. According to the American College of Obstetricians and Gynecologists, nearly seven in 10 women report at least one physical problem in the first year after delivery, and one in nine women may experience symptoms of postpartum depression. Extending women’s Medicaid coverage for a full year after they have their baby would prolong their care to help address and resolve these complications.

Fortunately, the Healthy Texas Women (HTW) program – and the new Healthy Texas Women Plus program – help fill the coverage gap by providing low-income women preventive and basic primary care before and after pregnancy as well as some specialty services for the 12 months following delivery. HTW Plus, launched in September 2020, builds on HTW by providing one year of limited specialty care coverage for the three conditions and illnesses most likely to contribute to maternal mortality or morbidity: postpartum depression, which one in eight women develop; cardiovascular and other coronary conditions; and substance abuse disorders. 

However, these programs do not provide comprehensive coverage like Medicaid does, meaning women with complex medical needs will not have coverage for all the services they need. 

Comprehensive coverage matters. Women who live in states with prolonged coverage are more likely to have ongoing access to health care before, during, and after pregnancy, and they are more likely to get postpartum treatment when they suffer severe complications. They also are less likely to die after having their baby. 

Extending postpartum Medicaid coverage would give eligible women health insurance longer, allowing them to continue treatment for any known health conditions. Women also could obtain treatment for any other conditions that may develop, such as diabetes  or cancer. Protecting continuity of care also would allow women to have one fewer transition in the tumultuous time of the first year after delivery and bolster their ability to have the continued support of their medical team. Extending postpartum Medicaid coverage for a year would align mothers’ care with that of their infants, who have guaranteed Medicaid coverage for the first year of their lives. This improvement might also decrease the likelihood the mother would need to seek emergency care (and face that extra expense) as women probably could be cared for in outpatient offices and clinics rather than having to rush to the hospital with an emergency.

It is for these reasons that the Texas Medical Association supports enactment of comprehensive health care coverage initiatives, including extending full Medicaid coverage for 12 months to postpartum women who otherwise lose coverage 60 days postpartum, as well as extending comprehensive coverage to low-income, uninsured, working-age adults.* Extending postpartum Medicaid coverage has wide support among many physicians, medical societies, and hospitals, including the Texas Pediatric Society, Texas Association of Obstetricians and Gynecologists, American Congress of Obstetricians and Gynecologists District XI (Texas), Texas Academy of Family Physicians, and Texas Hospital Association, along with numerous national societies. There also is bipartisan congressional support. By extending postpartum Medicaid coverage to a full year, we can better support the health of Texan mothers, infants, and families. 

*As a result of federal public health emergency (PHE) COVID-19 legislation, states must maintain Medicaid coverage for anyone enrolled in Medicaid on or after March 18, 2020, including postpartum women. This temporary coverage extension is currently set to expire in June 2021, but will renew with every extension of the PHE.

Thursday, January 14, 2021

Have Texans Been Skipping or Postponing Medical Care During the COVID-19 Pandemic? Major Takeaways From a Recent Statewide Poll

Shao-Chee Sim
Episcopal Health Foundation

During the COVID-19 pandemic, a time when our personal and community health should take center stage, Texans have been skipping or delaying medical care. That’s according to the Episcopal Health Foundation’s (EHF’s) Texas COVID-19 Survey report released late last year. This finding is significant because delay or avoidance of medical care might increase Texans’ risk of serious illness or death due to preventable or treatable health conditions.
This EHF study from August-September 2020 backs the results of two earlier national reports. The Kaiser Family Foundation (KFF) Health Tracking Poll in May 2020 found that close to half of adults said they or someone in their household postponed or skipped medical care due to the pandemic. The Centers for Disease Control and Prevention estimated 41% of Americans delayed or avoided seeking medical care as of June. Both reports documented the impact of the pandemic on Americans’ seeking of medical care early in the pandemic. 

The EHF survey is the first-ever statewide survey to capture COVID-19’s influence on Texans’ medical care-seeking behavior (See the EHF report’s methodology.) 

What does the EHF COVID-19 Survey find?
More than one-third of Texans (36%) say they or someone in their household have skipped or postponed some type of medical treatment because of COVID-19. One-third of Texans skipped or postponed preventive care like wellness visits, cancer screenings, blood pressure and cholesterol tests, drugs/alcohol counseling, and vaccines. A small percentage also sidestepped diagnostic care like tests, office visits, and procedures needed to diagnose or monitor a disease. Make no mistake, 36% is a big percentage of people not going to the doctor when they should. 


The survey also revealed other troubling patterns. Almost three-quarters of respondents skipped or postponed both regular check-ups and dental check-ups as part of their preventive care. Nearly one-third (30%) put off preventive screenings and immunizations for their child. Nearly the same amount of people (28%) missed or put off seeing their physician for chronic, ongoing conditions. While the survey shows smaller groups of Texans are neglecting more serious medical procedures like surgery (17%) and cancer treatment (4%), delaying care for chronic conditions can be dangerous. 


Do race/ethnicity, household income, and educational level matter in explaining Texans’ medical care-seeking behavior during the pandemic?
Yes, apparently people of different incomes and race/ethnicity adopted different habits about seeking health care during the pandemic. For example, Hispanic Texans were more likely to say they skipped or postponed cancer treatments than white Texans (9% vs. 3%). (The number of responses from Black Texans was too small to ensure statistical accuracy.) 
EHF also found that households with annual income less than $75,000 are more likely to skip or delay doctor visits for chronic conditions such as diabetes and high blood pressure than households with higher income (34% vs. 21%). 

Texans with less than a college degree are more likely to skip or postpone doctor visits for chronic conditions than their counterparts with a college degree or more (34% vs. 17%). (See Tables One, Two, and Three for details.)

So what does this tell us about the health of Texans?
As the pandemic continues, it is disconcerting that six months after the pandemic started, more than one-third of Texans were still skipping or delaying medical care, and 70% of those who skipped medical care were putting off their medical and dental check-ups or exams. 

Some ethnic minorities have been more likely to skip or postpone cancer treatments, and Texans with fewer resources and less education are more likely to delay doctor visits for their chronic conditions. 

We already knew that avoiding preventive care and delaying addressing health issues might lead to bigger, more serious health problems in the future. That is why it is important to conduct further research to better understand the underlying reasons why Texans have been avoiding medical care and to study whether and in what ways telehealth/telemedicine can address these medical care needs. 
   
The pandemic has caused tremendous disruptions in our society. Knowing the enormous health, economic, and social costs of continuing to defer medical care, the survey findings serve as an important reminder for policymakers, regulators, medical professionals, and public health communities to develop policies and programs that encourage Texans to seek appropriate and timely medical care. 

If Texans prioritize our general health needs as we fight to avoid COVID-19 (by socially distancing, wearing masks, and washing hands frequently), we not only boost the overall health of our community but also we avoid suffering other health problems as the number of COVID-19 cases in the state continues to increase.

Table One: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Race/Ethnicity

Total

White

Hispanic

Black

Skipped or postponed regular check-ups of exams

69%

66%

70%

77%

Skipped or postponed dental check-ups of exams

70%

68%

73%

65%

Preventative screenings such as mammograms, colonoscopies, or other screenings

38%

41%

37%

31%

Doctor visits for chronic conditions such as diabetes and high blood conditions

28%

29%

29%

25%

Doctor visits for symptoms you were experiencing

39%

37%

44%

43%

Reproductive health care visits

20%

18%

23%

15%

Immunizations for your child or other child wellness visits

30%

23%

30%

28%

Mental health care

19%

22%

17%

12%

Physical therapy or rehabilitation care

17%

14%

21%

16%

Surgery

17%

16%

18%

11%

Cancer treatments*

4%

3%

9%

1%

*Denotes statistically significant difference between Hispanic Texans and White Texans at p<.05

Table Two: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Household Income

Total

Under $75K

$75K +

Skipped or postponed regular check-ups of exams

69%

71%

70%

Skipped or postponed dental check-ups of exams

70%

69%

71%

Preventative screenings such as mammograms, colonoscopies, or other screenings

38%

37%

39%

Doctor visits for chronic conditions such as diabetes and high blood conditions*

28%

34%

21%

Doctor visits for symptoms you were experiencing

39%

43%

38%

Reproductive health care visits

20%

33%

29%

Immunizations for your child or other child wellness visits

30%

26%

16%

Mental health care

19%

19%

15%

Physical therapy or rehabilitation care

17%

18%

15%

Surgery

17%

19%

16%

Cancer treatments                                                                       

4%

5%

4%

*Denotes statistically significant difference between Households with income less than $75K and households with income more than $75K at p<.05.

Table Three: Type of Medical Care Skipped or Delayed by Texans Due to COVID-19 by Educational Level

Total

Less than college

College+

Skipped or postponed regular check-ups of exams

69%

68%

73%

Skipped or postponed dental check-ups of exams

70%

68%

72%

Preventative screenings such as mammograms, colonoscopies, or other screenings

38%

36%

42%

Doctor visits for chronic conditions such as diabetes and high blood conditions*

28%

34%

17%

Doctor visits for symptoms you were experiencing

39%

43%

33%

Reproductive health care visits

20%

18%

25%

Immunizations for your child or other child wellness visits

30%

31%

29%

Mental health care

19%

17%

23%

Physical therapy or rehabilitation care

17%

19%

14%

Surgery

17%

18%

16%

Cancer treatments

4%

6%

2%

*Denotes statistically significant difference between Texans with less than a college degree and Texans with a college degree at p<.05.
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