Tuesday, May 5, 2015

Texas Legislature Honors Physician for Starting Helmet Giveaway Program

Larry C. Driver, MD, of Houston, was recognized by the Texas House of Representatives on Thursday for launching Texas Medical Association’s (TMA’s) Hard Hats for Little Heads bicycle helmet giveaway program, in honor of two recent milestones. The program reached its 20th year, and TMA exceeded 200,000 free helmets given to Texas children to protect them from head injury.

“I am humbled to accept this recognition on behalf of Texas physicians, medical students and residents, TMA Alliance members, and other volunteers who have contributed over the years to make Hard Hats for Little Heads a success,” said Dr. Driver, who practices at MD Anderson Cancer Center. “This is an example of how Texas physicians care about Texans, especially young Texans. We are all about looking out for their safety.”

Rep. J.D. Sheffield, DO, of Gatesville, a TMA member who has sponsored several Hard Hats helmet giveaway events, made the presentation, which declared April 30 as Hard Hats for Little Heads Day.

“Twenty years ago this man brought the idea to TMA to give away helmets free,” said Representative Sheffield after he introduced Dr. Driver. “Since the program began 20 years ago, more than 200,000 helmets have been given — that’s 10,000 heads per year that have been protected from trauma. During Child Safety Month, it is fitting that we raise awareness about head trauma and the importance of wearing a helmet,” he said.

In 1994, Dr. Driver was living in San Angelo when a young neighbor fell off her bike and suffered a concussion. She was not wearing a bicycle helmet. The doctor knew a helmet could have prevented her injury, so he began to create a bike helmet giveaway program whereby he and his physician colleagues could prevent brain injuries in children.

TMA adopted Dr. Driver’s idea, and the Hard Hats for Little Heads program was born. San Angelo physicians, with the help of the local police department, gave away the program’s first 500 helmets.

Through Hard Hats for Little Heads, Texas physicians urge children to be active and to stay safe: The program’s motto is “Get Moving. Stay Safe. Wear a Helmet.” TMA encourages helmet use for all sports on wheels: biking, inline skating, skateboarding, and riding a scooter. Studies have shown that properly worn bike helmets can prevent up to 85 percent of brain injuries. Head injury is the most common cause of death and serious disability from bike crashes.

“How many of you have children?” Representative Sheffield asked House members. “I hope you insist they wear a helmet every time they ride a bike. And that you do the same yourself.”

Hard Hats for Little Heads is made possible through a grant from TMA’s philanthropic arm, the TMA Foundation (TMAF), thanks to top donors — Blue Cross and Blue Shield of Texas, Prudential, and two anonymous foundations — and gifts from physicians and their families, and friends of medicine.

Thursday, April 30, 2015

Protect Tobacco Control Funding to Save Lives

By David Lakey, MD, and Eduardo Sanchez, MD, MPH, FAAFP
Former Commissioners of the Texas Department of State Health Services (DSHS)

Proven public health policy solutions can be hard to come by. New diseases and new circumstances make tackling health problems difficult even under the best scenarios. However, if there is one public health problem for which clear answers are readily available, it’s the toll of tobacco.

Fifty years after the dangers of tobacco were first proven, tobacco remains Texas’ number one needless killer, cutting short more than 30,000 lives each year—roughly three people every hour. And every year an estimated 24,000 more Texas kids will smoke their first cigarette and start the cycle of addiction all over again.

An astounding 90 percent of the people who regularly smoke became addicted to tobacco in their teens or earlier. That means if we want to reverse the epidemic of cancer, heart disease, stroke, emphysema and other serious diseases that tobacco causes, we have to start with kids.  

Youth are particularly susceptible to the addictive qualities of nicotine, just as they are particularly susceptible to tobacco industry marketing.

The good news is we have time-tested, science-based best practices proven to stop kids from smoking.

A well-funded pilot project from 1998-2003 in the Beaumont-Port Arthur area resulted in a 41-percent decrease in the high school smoking rate (from 40.1 percent to 23.6 percent) and a 32-percent decrease in the middle school smoking rate (from 24.5 percent to 16.6 percent).

We CAN replicate this success only with adequate funding applied in more areas across the state; we can replicate this success only if the Texas Legislature makes tobacco prevention a priority.

The Texas Senate’s budget proposal would reduce tobacco prevention funding by over 30 percent.    

As if saving lives were not reason enough to invest in tobacco prevention, consider also the financial impact. Texas households currently pay an average of $750 each in combined federal and state taxes as a result of tobacco-caused government health care expenditures.

The cost-effectiveness of tobacco prevention programs holds up to the most intense scrutiny. In fact, a 2009 analysis of a four-county prevention and cessation program done here in Texas proved that it saved $252 million in medical care costs and lost productivity for just $11 million in operating costs. It also resulted in nearly 30,000 fewer smokers in one year.

Tobacco prevention is good health policy and it’s good fiscal policy.

To find funding for tobacco prevention, legislators need only look at the $1.9 billion the state receives annually from tobacco tax revenues and the annual tobacco settlement payment.  The state currently spends less than 1 percent of those funds on tobacco prevention.

As the Legislature begins to work out the final budget numbers for the next two years, we implore the decision makers not to turn back the clock on tobacco prevention, but to invest more to prevent more Texas kids from getting lured into the deadly, devastating trap of tobacco.

This is one public health problem we know how to solve.  It is imperative that the Texas Legislature put that knowledge to use and  invest more of our state money wisely to address the leading preventable cause of death in our state.

David Lakey, MD
Former Commissioner of the DSHS (2007 to 2015)

Eduardo Sanchez, MD, MPH, FAAFP
Former Commissioner of the DSHS (2001 to 2004)

Tuesday, April 28, 2015

Ensuring Good Vision for Your Child

By Charlotte M. Akor, MD
Abilene pediatric ophthalmologist
TMA Leadership College Class of 2015

One of the best ways to ensure your child has good vision from birth and throughout childhood is to be an observant parent who attends all your child’s routine appointments with your pediatrician. The most common cause of vision loss in children is amblyopia. Amblyopia has several causes including droopy eyelids, cataracts, crossed eyes, or a need for glasses. If this condition is not detected and treated by age 9, a child’s vision cannot be restored. There is also a type of severe amblyopia called occlusion amblyopia. If this type of amblyopia is not detected and treated during infancy, there will be irreversible vision loss.

Your child most likely had his or her first eye exam in the hospital. The pediatrician examines your infant’s eyes in the newborn nursery. The pediatrician checks for normal eyelids and lashes, a clear cornea and lens, and a normal red reflex. The doctor is checking for droopy eyelids, cataracts or cloudy lens, and serious pediatric eye cancers like retinoblastoma. In addition to vision loss from these conditions, amblyopia can cause additional vision loss. If the pediatrician finds no abnormalities on this exam and your child blinks to light, he or she has normal eyes. At the 2-month, 4-month, and subsequent visits, the pediatrician checks for strabismus or misalignment of the eyes and continues to make sure the eyes appear normal.

Sometimes parents can be the first person to pick up retinoblastoma by an abnormal red reflex when they take a picture. The red eye in the picture does not appear normal or appears unequal to the other eye. If parents detect an abnormal red reflex and express concerns to the pediatrician, a complete eye exam with a pediatric ophthalmologist or eye physician is a must. Retinoblastoma can cause serious visual disability and/or death if left untreated.

Many times parents are the first ones to notice strabismus or misalignment of the eyes. Crossed or misaligned eyes are normal the first two to three months of life. If present after that time, the condition can lead to blindness called strabismic amblyopia or vision loss caused by crossed eyes. If crossed eyes are still present at age 6 months, it is very unlikely it will go away by itself.  Often misaligned eyes run in the family. Treatment for this condition can include glasses, patching, and/or eye surgery. A complete eye exam with the pediatric ophthalmologist will help you find a plan to ensure good vision in your child.

Your child will be asked to read a pediatric eye chart or have a vision screening at age 3 or 4 years at the pediatrician office. This exam will determine if your child will see the eye doctor to prescribe glasses. The type of amblyopia or vision loss caused by not obtaining glasses at the appropriate age is called refractive amblyopia. If glasses are not obtained at a young age, the child will not be able to develop 20/20 vision.

Close monitoring is important to make sure a child has proper vision development. Additional information about children and visual development is available at the following websites.


Wednesday, April 22, 2015

Texas Women’s Health Program: Fewer Women Served

By Janet Realini, MD
San Antonio Physician
President, Healthy Futures Alliance

The number of women served by the state-funded Texas Women’s Health Program dropped precipitously between fiscal years (FYs) 2011 and 2013, according to a recently released report from the state Health and Human Services Commission. The report shows that nearly 26 percent fewer women received services. This means about 30,000 fewer women received services such as cancer screenings, preventive care, and contraception through the program in FY 2013 than did in FY 2011.

Decreases in the number of women served were particularly significant in West Texas (64 percent), the High Plains (53 percent), and Central Texas (42 percent). The number of payment claims for contraceptives dropped by more than half, from 191,159 in FY 2011 to 88,281 in FY 2013.

In 2011, the state Family Planning Program budget was cut severely. Then in 2013, the Texas Women’s Health Program became fully state-funded, with Texas losing federal matching money that contributed $9 dollars for $1 the state spent. Even with this increased state contribution and fewer women served, however, Texas still saved money, according to the report. By preventing an estimated 8,359 unplanned births in FY 2014, the 2013 program saved $93.6 million in Medicaid costs, with a net state savings of $6.42 million.

The service reductions documented in this report are of great concern to both the Texas Women’s Healthcare Coalition and Healthy Futures Alliance. We appreciate the state’s 2013 investment in women’s health care, but there is still much to do to rebuild our injured women’s-health safety net and restore service to low-income women. By ensuring access to quality preventive care and effective contraception, we can build a stronger, healthier Texas.

Tuesday, April 21, 2015

HPV Vaccination Helps Prevent Head and Neck Cancer

Big news: A vaccination is available to prevent cancer. The vaccine, when given to preteens, can help prevent them from contracting oropharyngeal cancer, a head-neck cancer affecting the throat and tonsils. Human papillomavirus (HPV), for which a vaccine is available, causes more than 70 percent of oropharyngeal cancer cases. This particular head and neck cancer recently became the most common cancer HPV causes, even more common than cervical cancer.

About 39,500 people will get oral cavity or oropharyngeal cancer in 2015, and 7,500 people will die from these cancers, according to the American Cancer Society. During Oral, Head and Neck Cancer Awareness Month in April, Texas physicians want to encourage parents to get their adolescents vaccinated.

“We now understand that HPV is an important risk factor for head and neck cancer,” said oncologist Debra Patt, MD, MPH, MBA, of Austin, and a member of Texas Medical Association’s (TMA’s) Committee on Cancer. “I have so many patients, mostly men, affected by this disease, and knowing this is now largely preventable makes prevention efforts more important.”

HPV’s ties to cervical cancer have been widely reported, but oropharyngeal cancer has surpassed cervical cancer in number of cases, according to the Centers for Disease Control and Prevention. On average, 12,417 cases of HPV-related head-neck cancer are diagnosed annually, compared to 11,422 cases of cervical cancer. White men between the ages of 35 and 55 who don’t smoke are most frequently affected by head and neck cancer, almost four times more than women, according to the Oral Cancer Foundation.

HPV is the most common sexually transmitted infection in the nation. More than half of sexually active people will have the virus sometime in their lives.

Dr. Patt said stopping the HPV infection can help prevent the cancer. That’s why doctors recommend HPV vaccination for boys and girls. And getting the vaccination before they are exposed to the HPV virus, which is transmitted through intimate skin-to-skin or sexual contact, is important.

Doctors recommend 11- and 12-year-old boys get the vaccine, though males 9 through 21 years of age — even as old as age 26 — might benefit. Girls should get the vaccination at 11 or 12 years of age, but they can get it as early as 9 and through age 26.

The HPV vaccine, which requires three shots over a six-month period for full coverage, is safe and effective. The current vaccine, introduced in 2006, protects against cervical and other genital cancers, along with genital warts. Health researchers recently developed an improved HPV vaccine to provide even greater protection.

“Unfortunately, many individuals will remain at risk because their parents made a decision not to vaccinate them against HPV and protect them from oropharyngeal and other cancers,” said Dr. Patt.
In Texas, less than half of boys aged 13-17 years (48 percent) completed the vaccination series, according to the 2013 National Immunization Survey — Teen. For girls, the vaccination rate is higher, with 74 percent completing the series.

One Texas legislator, Rep. John Zerwas, MD (R-Richmond), wants to see those numbers improve. Rep. Zerwas recently introduced House Bill 1282, which calls for the creation of a strategic plan for HPV-associated cancer. The bill seeks to increase vaccination and screening rates and reduce the amount of HPV-related cancer illness and death.

TMA has published a fact sheet about the importance of HPV vaccination, in English and Spanish.

Monday, April 20, 2015

National Infant Immunization Week Underscores Importance of Vaccines

By Daniel Vijjeswarapu, MD 
Corpus Christi Pediatrician
President, Nueces County Medical Society

One of the best ways to protect our children is to make sure they have all their immunizations. Children under age 2 don’t have all the defenses they need to fight off infections, and vaccinations protect them from serious childhood diseases like whooping cough, measles, and bacterial meningitis. Nobody likes getting shots, but the pinch of a shot isn’t nearly as bad as those diseases. During National Infant Immunization Week, we urge parents to make sure your child’s vaccinations are up to date to protect against these preventable diseases that could cause your child to become very sick, even die.

As parents, we want to do what is best for our children to promote good health and help them reach their maximum potential. As an increasing number of parents are choosing to delay or even refuse immunizations for their children, pediatricians like me are concerned parents do not fully understand the potential dangers of not vaccinating their children, especially children under age 2.

Vaccines are among the most remarkable achievements in medicine during the past century. Today most young people in the United States have never seen a case of polio, thanks to vaccinations. When you don’t see a disease, understanding the benefits of prevention is difficult. So people have focused on the possible risk of infections and side effects. The increasing number of parents opting not to have their children vaccinated has led to more outbreaks of measles recently.

There has been a lot of talk in the media by some people attempting to link vaccines to autism, particularly the MMR vaccination (measles, mumps, rubella). Many studies have shown that autism is NOT associated with receiving vaccinations. MMR does not cause autism. While we still do not know exactly what does cause autism, it is likely many factors including genetics, environmental triggers, premature birth, and abnormal brain growth.

Evidence shows that children who have their immunization delayed because of alternate schedules are less likely to catch up or complete the vaccinations. There is no known benefit from delaying vaccination and no increased risk of receiving multiple vaccinations at one time. Vaccinations are needed to keep our children safe. Parents should ask questions and read the handouts provided by the physicians prior to vaccination. Parents need to know they are doing the right thing by immunizing their children. Please visit the following websites to learn more about vaccination during this week:

Daniel Vijjeswarapu, MD, is a pediatrician in Corpus Christi. He is president of the Nueces County Medical Society and a member of TMA’s Be Wise — ImmunizeSM physician advisory panel. 

Be Wise — Immunize is a service mark of the Texas Medical Association. 

Friday, April 17, 2015

Bill Protects Schoolchildren From Life-Threatening Allergic Reactions

Thirteen-year-old Cameron Espinosa, a middle school student in Corpus Christi, died after being stung by fire ants while playing football after school in September 2013. No one, including Cameron, knew he was allergic to fire ants before the incident; if they had, Cameron might have had a prescription for epinephrine at school.

Texas does not require schools to stock epinephrine unless it's prescribed for a specific student, but that could change if the legislature passes House Bill 2847 by Rep. Myra Crownover (R-Denton). The bill would force schools to stock unassigned epinephrine injectors that could be used on anyone in an emergency. The injectors — often called EpiPens after a popular brand of epinephrine injector — would allow coaches, school nurses, and other trained staff to immediately treat students who, like Cameron did, suffer a severe and unexpected allergic reaction, called anaphylaxis.

“This legislation is a significant achievement in protecting our young Texans at risk of anaphylaxis, by providing lifesaving epinephrine,” Louise Bethea, MD, an allergist and immunologist from The Woodlands, said in her testimony to the House Committee on Public Education.

Dr. Bethea told the committee severe allergic reactions can be caused by insect stings, medications, latex, and food allergies. “An estimated one in 13 U.S. children — about 160,000 in Texas — have food allergies. Up to 25 percent of children could have a serious reaction without having a history or diagnosis of food allergy,” she said.

“Emergencies happen everywhere in our communities, including schools. For many children, their first episode of anaphylaxis may occur at school, and because they have no history, they will not have available a prescribed auto-injector. To protect our students, our physicians have stepped up and starting working with their local school districts to raise awareness about anaphylaxis and provide training on epinephrine auto-injectors. This legislation not only will strengthen that effort in raising awareness, but also will allow for students throughout Texas to have access to epinephrine for an anaphylactic emergency.

“Seconds matter,” said Dr. Bethea. “Anaphylaxis can be fatal, and epinephrine immediately is the treatment of choice.”

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