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			Thursday, April 16, 2009 News Clipping Archives *Maryland / Regional* MHA, insurers debate state hospital rates (Daily Record) Among the casualties of Maryland's budget cuts is the smoking-cessation program that's funded by the decade-old tobacco settlement. (Washington Post) For County, Big Cuts And Several Changes (Washington Post) Virginia Trying To Make Sleeping Infants Safer (Washington Post) City initiative targets cardiovascular disease (Baltimore Sun) Laurel senior center construction to begin (Prince George’s County Gazette) Quest to pay $302 million to settle medical-test misbranding case (Daily Record) Advocating for children in need (Prince George’s County Gazette) Baltimore Child Abuse Center - Spreading the Word about Sexual Abuse (Baltimore Afro-American) Local Org. Takes Health Care to Classrooms (Baltimore Afro-American) *National / International* A Policy Cocktail for Fighting HIV (Washington Post) The Reluctant Organ Donor (New York Times) Q & A - Heartfelt Changes (Baltimore Sun) Opinion A Patchwork Safety Net (Washington Post) Back in the Hospital Again (New York Times) *Maryland / Regional* MHA, insurers debate state hospital rates By Danielle Ulman Daily Record Thursday, April 16, 2009 It became apparent Wednesday just how far apart the Maryland Hospital Association and insurers are when it comes to how much the state’s hospitals should be allowed to charge. At a Health Cost Services Review Commission meeting, representatives of insurance companies said they would prefer no increase in the annually adjusted base hospital rates. The hospital association on the other hand requested an increase of 2.9 percent over rates from fiscal 2009. The commission, which regulates state hospital rates, suggested an increase to base rates of 0.49 percent. Additionally, the commission said talks would resume between all interested parties to reach a consensus on the rates that will go into effect on July 1. If rates went up by 0.49 percent, Carmela Coyle, president and CEO of the hospital association, said 90 percent of hospitals would have to halt renovations and 70 percent would have to freeze salaries. “Our sense is that the current Health Services Cost Review Commission proposal cannot stand,” Coyle said. Last year a workgroup of staff from the commission, the hospitals, the hospital association and public and private insurance firms came to a near consensus to raise rates 4.7 percent over fiscal 2008 rates. The commission said a smaller increase in rates this year is appropriate as Maryland’s budget shortfall has negatively affected the state’s Medicaid payments. Maryland is the only state in the country with government-controlled rates for hospital services. The commission regulates fees that hospital charge for things like day charges, emergency room service and lab services. However, it does not regulate physicians’ fees or freestanding clinics. Last month, the hospital association said the economic crisis caused state hospitals to lose $466 million in the fourth quarter of 2008. Overall, the hospitals’ operations brought in larger profits than last year, but their investments have resulted in realized and unrealized losses. Those losses have reduced the cash positions of many hospitals, the commission said. The commission said it is aware of the issues hospitals are having because of the economy, but it must also take into account the larger economic picture, which has made health care unaffordable for many. Medicare allows the state to operate under the rate-setting commission instead of agreeing to its reimbursement rates, as long as the state outperforms the nation over time. The system, known as the “waiver test,” is based on a calculation that shows that the federal government’s Medicare payments in Maryland have not grown faster than payments around the country. The latest waiver test, completed in December 2007, showed Maryland’s waiver cushion at 6.82 percent, far lower than the margin of 10 percent to 15 percent that the state usually carries. If the cushion falls to zero, Medicare will no longer participate in the state’s system. Barry Rosen, an attorney for United HealthCare Services Inc. said the federal budget is unsustainable. If the recession continues, Rosen said raising hospital rates would be “terrible for the state,” and if the recession ends, Medicare costs will have to be reduced in order to get the deficit under control. “Either way, you have to beat the nation,” he said. The hospital association said the volatility of the economy has caused the waiver cushion to fluctuate and has requested that the commission thoroughly review its calculations before it sets rates this summer. Copyright 2009 Daily Record. Among the casualties of Maryland's budget cuts is the smoking-cessation program that's funded by the decade-old tobacco settlement. By Lisa Rein Washington Post Thursday, April 16, 2009 The Tobacco Use Prevention and Cessation Program will be cut to $7 million annually from $21 million. Health-care advocates successfully pressed to keep the cut to two years instead of the permanent reduction that was proposed. But they say the change puts at risk the state's free smoking-cessation hotline, local health department stop-smoking programs, school-based prevention programs and surveys of cigarette use. 'It's very unfortunate,' said Vincent DeMarco of the Maryland Citizens' Health Initiative, which led the campaign for the current $2 tax on cigarettes. He said three factors are believed to influence someone's decision not to start smoking: a high tax on cigarettes, a smoke-free workplace and prevention programs. Maryland gets high marks for the first two, but the cut to prevention programs carries 'very significant and potentially deadly consequences,' he said. Copyright 2009 Washington Post. For County, Big Cuts And Several Changes More Cameras to Catch Speeders By Rosalind S. Helderman Washington Post Thursday, April 16, 2009 The Maryland General Assembly adjourned its annual legislative session Monday, after tackling issues of statewide importance but also focusing on local concerns. The legislature's 90 days of work were dominated by the need to adopt a lean budget, as tax revenue has dropped in the tight economy. The assembly passed an almost $14 billion operating budget that included deep spending cuts, particularly in aid to counties. That means almost $30 million less in state aid to Prince George's County government, $31 million less to Montgomery and $22.7 million less to Anne Arundel. Southern Maryland counties have lost funding as well. Much of that revenue comes from highway user funds, a portion of the gas tax given to counties. Prince George's and Montgomery County leaders have warned that the loss of state funds will make balancing their budgets harder. County councils in both jurisdictions are weighing budget proposals that include recommendations to lay off employees. "County governments have been beaten up," said Del. Murray D. Levy (D-Charles), who serves on the House Appropriations Committee. He said lawmakers looked for other ways to help counties, given the budget situation. Some legislators said the outcome could have been worse for counties. Legislators chose not to saddle them with the pension costs of their teachers, now paid by the state. And buoyed by federal stimulus dollars, state spending on schools remained robust. In other issues of local interest, counties and municipalities gained the authority to use cameras to catch speeders in school zones and highway work areas. Prince George's officials said they plan to pursue the idea quickly; in Anne Arundel, leaders said they don't like the idea. Montgomery officials are examining how the statewide authorization will affect their camera program, launched as the state's pilot program in 2006. The county will get to keep cameras it has erected on residential roads; elsewhere, counties can use cameras only near schools. But to comply with the new program, Montgomery will be allowed to use cameras near schools only from 6 a.m. to 8 p.m. "Obviously, people were trying to satisfy multiple political needs. It didn't come out in necessarily a coherent fashion," said Sen. Richard S. Madaleno Jr. (D-Montgomery). He cited the example of a camera near Walter Johnson High School in Bethesda that catches speeders 24 hours a day but will soon have to be turned off at night and on weekends. "I don't know why we're going to say it's okay to speed now but not at other times of the day," he said. Efforts to change the Washington Suburban Sanitary Commission met with mixed success. The joint Prince George's-Montgomery utility has been plagued by leadership disputes and aging infrastructure. The legislature unanimously agreed to put in place protections for whistleblowers who report wrongdoing at the agency. And it agreed the WSSC should circulate its annual financial audits to lawmakers. But a push to restructure the WSSC governing board foundered. The agency is run by a six-person board, split evenly between members appointed by the Montgomery and Prince George's executives. The group frequently deadlocks 3 to 3, and relations have soured so badly in recent months that if one Montgomery member is absent and the other two are outnumbered, they sometimes walk out of meetings to prevent the board from having a quorum. Sen. Jamie B. Raskin (D-Montgomery) proposed requiring that at least one commissioner from each county be included in the majority of any motion approved by the board. Raskin argued that the bill would force the commissioners to break their long-standing gridlock and work together. The bill also would have eliminated the possibility that commissioners from one county could take advantage of the absence of a member from the other to make changes with which their counterparts would disagree. The bill passed the Senate, but it could not move ahead without approval of the House delegations from both counties. Montgomery delegates approved the idea, but it stalled after the Prince George's County Council voiced opposition. "The point of the bill is simply to keep the business of the WSSC going, even if one member is absent," Raskin said. "I feel like we had a good start this year in injecting some badly needed reform. We'll definitely be back next year to continue the work." Prince George's lawmakers had several bills of note. They agreed to prevent the county school board from spending funds on a new headquarters office complex. They also persuaded colleagues to give the state-appointed Prince George's County Hospital Authority more time to find a private buyer for the long-troubled county-owned hospital system. The Prince George's delegation rejected a proposal by County Executive Jack B. Johnson (D) to adjust the homestead tax credit in the county, a measure that would have resulted in increased property taxes. And the assembly nixed an idea floated by Johnson and some lawmakers to explore state funding for a stadium in the county for the D.C. United soccer team. The legislature also agreed to extend the life of electronic bingo machines at a handful of commercial establishments in Calvert and Anne Arundel counties. The devices, which resemble slot machines, were set to become illegal June 30, but they generate significant state and local tax revenue. Under the bill, the bingo machines will be allowed until July 1, 2012. Copyright 2009 Washington Post. Virginia Trying To Make Sleeping Infants Safer Effort Highlights Risk of Suffocation By Maria Glod Washington Post Thursday, April 16, 2009 Virginia health officials have launched a campaign to teach parents how to put infants to bed safely after a state medical examiner's report showed that 12 babies suffocated in 2007 as a result of unsafe sleeping conditions, such as sleeping in the same bed with adults or with quilts, pillows or toys. State Health Commissioner Karen Remley said a nationwide study shows that the rate of children who die under such circumstances has risen in the past two decades. The Virginia report showed that as many as 49 additional children younger than 1 year old died in the commonwealth in 2007 in unsafe sleeping conditions, although in those cases the safety issues were not clearly the cause of death. "The thing that worries us is that these rates are increasing," Remley said. "We really need to get parents to understand that a lot of babies are dying from suffocation, and we can prevent those with a safe sleep environment, a safe crib." Remley said the agency is asking physicians and nurses to talk to new and soon-to-be parents about safely putting babies down for naps. It is also working to educate grandparents and babysitters by reaching out to churches and groups such as AARP. The outreach is part of a broader statewide campaign to prevent deaths of babies. In 2007, 839 infants died in Virginia. The state's infant mortality rate of 7.7 deaths per 1,000 babies born is worse than the rate in 29 other states, according to America's Health Ranking, a survey by the United Health Foundation. Gov. Timothy M. Kaine (D) set a goal of reducing that rate. In the fall, the Virginia Department of Health put together a working group to help women and families do all they can to ensure their babies are healthy by improving education about prenatal care, nutrition and other issues. That group includes physicians, health department officials and representatives from community groups such as the YWCA and the March of Dimes. To protect infants from accidental suffocation, health officials said, they should always be put to sleep on their backs. Babies should not sleep with parents or other children, officials said, or on soft surfaces such as waterbeds or comforters. Fluffy bedding and toys should be removed. Parents should use cribs that are certified as safe, and officials recommend looking for an approval label from the Juvenile Products Manufacturers Association. The cribs should have a firm, tight-fitting mattress and a tight-fitting bottom sheet. "We really want to have parents understand that streamlined is the best," Remley said. "All of those bumpers and comforters and toys are dangerous. It is better for babies to sleep by themselves. They can sleep in a little crib right next to mom and dad." A study by researchers with the Centers for Disease Control and Prevention, published in the journal Pediatrics, found a significant increase over the past two decades in the rate of children who die from accidental strangulation or suffocation in bed. From 1984 to 2004, the rate increased from 2.8 to 12.5 deaths per 100,000 live births, the study concluded. Researchers said that the causes of the increase are unknown and that babies died in beds, couches and cribs. Copyright 2009 Washington Post. City initiative targets cardiovascular disease By Kelly Brewington Baltimore Sun Thursday, April 16, 2009 The Baltimore Health Department has launched an effort to combat the city's biggest killer - cardiovascular disease. The initiative centers on education, prevention and treatment of a disease that kills 2,000 people in Baltimore each year, a disproportionate number of whom are black. Wal-Mart gave the city $50,000 to help fund the program. Information: www.baltimore health.org/disparities. Copyright 2009 Baltimore Sun. Laurel senior center construction to begin New facility almost twice the size of current location By Timmy Gelles Prince George’s County Gazette Thursday, April 16, 2009 Laurel seniors will have a new place to meet and greet next year. Construction of the Beltsville-Laurel Senior Activity Center, a 22,000-square-foot facility located adjacent to Laurel Regional Hospital on Contee Road, is scheduled to begin Friday and should be completed by early next summer, said County Councilman Thomas E. Dernoga (D-Dist.1) of Laurel. After more than eight years of planning and waiting, the new center will replace the current Phelps Senior Center, located at 701 Montgomery St., which operates out of the former Laurel High School and is only 10,500 square feet. Dernoga said the project will cost about $6.5 million and the Maryland-National Capital Park and Planning Commission will build the facility. West Laurel resident Clare Ferguson, 73, said having a new senior center will actually be more central than its current space in Old Town. "It will be closer for the folks in Beltsville. We have seniors in the friendship club from all over the county. You're shocked when you get a list and look at the addresses," she said. Curt Curtis, 75, of Laurel, president of the Laurel Senior Friendship Club's All Together Laurel Area Seniors, a nonprofit that has been involved with lobbying for a new center, said 14,000 people age 55 or older are within 10 miles of the new center. "It's a beautifully designed building," he said. "And it's designed for seniors by seniors." Ferguson said the new center will have art studios for painting or ceramics, wellness areas and weight rooms. "They just come up there for companionship, but there's going to be a little more for them to do," she said." Dernoga said he was pleased to see the project begin but saddened that many seniors who were instrumental in the process have passed away along the way. "A number of people who started on this are no longer with us," he said. "A lot of seniors were probably wondering if they were ever going to see it open." Dernoga thanked the senior citizens for their involvement with the project. "A great thing about this project is the seniors were hands on with program, it was really a hands-on senior project and very citizen-driven," he said. Curtis, Ferguson and Dernoga all thanked Del. Barbara A. Frush (D-Dist.21) of Beltsville for her assistance in completing the project's final stages, particularly dealing with Dimension Healthcare as they were being shopped for buyers by the Hospital Authority, a seven-member state task force appointed last May to seek out and review bids on the county-owned hospital system. "Barbara got us over the final hurdles," he said. "Barbara helped us get through the hospital authorities," Dernoga said. Frush was unavailable for comment as of press time. E-mail Timmy Gelles at tgelles@gazette.net. Copyright 2009 Frederick News-Post. Quest to pay $302 million to settle medical-test misbranding case Associated Press Daily Record Thursday, April 16, 2009 NEW YORK — Medical lab operator Quest Diagnostics Inc. will pay $302 million and one of its business units will plead guilty to misleading labeling practices for a diagnostic test as part of a settlement with the federal government. In a statement Wednesday, the Department of Justice said the settlement represents one of the largest recoveries ever in a case involving a medical device. Quest and its subsidiary Nichols Institute Diagnostics will pay the U.S. $262 million plus interest to resolve civil charges for misleading product claims. Meanwhile, subsidiary Nichols will plead guilty to a criminal misbranding charge and pay a fine of $40 million. Both civil and criminal charges involved marketing materials for a parathyroid hormone test. Quest also entered into a non-prosecution agreement. Quest also agreed to pay various state Medicaid programs about $6.2 million to resolve similar misleading labeling claims. In its case, the government said the Madison, N.J.-based company's subsidiary inaccurately labeled unproven advantages to the Nichols Advantage Chemiluminescence Intact Parathyroid Hormone Immunoassay. “The American public has the right to expect medical device manufacturers to make accurate claims in their labeling, especially when the failure to meet those claims could indicate that the performance of the device is suspect,” said U.S. Attorney Benton J. Campbell, in a statement. The settlement represents about 4 percent of the company's revenue in 2008, which reached $7.25 billion. The investigation was sparked by the filing of a “whistle-blower” lawsuit, which normally involves an insider coming forward with claims of wrongdoing. In this case Thomas Cantor will receive about $45 million under a provision that allows whistle-blowers to share in the proceeds of the settlement. Cantor is the founder, president and owner of Scantibodies Laboratory Inc. He had been trying since 2000 to alert the medical community about problems with the test, he said in a statement. In 2004, the Justice Department started their investigation, and in 2005 the test kits were recalled. His lawsuit claimed that some dialysis patients went through unnecessary surgery to remove their parathyroid and were given unnecessary treatment. “This was a very, very serious problem,” Cantor said. Quest said it had been cooperating with the government since 2004 and has not admitted to the government's civil allegations, but agreed to the settlement “to put the matter” behind it. The payments have already been reserved. “Quest Diagnostics conducts its business with the highest standards of quality and integrity, and we regard NID's failure to meet our standards as unacceptable,” said Michael E. Prevoznik, Quest's general counsel, in a statement. “This settlement resolves a five-year old government investigation, and puts it behind us.” Quest is also entering into a “corporate integrity agreement” with the Office of Inspector General of the Department of Health and Human Services. Shares of Quest rose 47 cents to $49.13. Copyright 2009 Daily Record. Advocating for children in need CASA/Prince George's County brings attention to Child Abuse Prevention Month By Elahe Izadi Prince George's County Gazette Thursday, April 16, 2009 For social worker Eric Lulow, work is personal. The 24-year-old Glenmont resident was abused as a child, spent his life bouncing around foster homes and was separated from his sisters. But he overcame it all thanks to people who throughout his life volunteered and advocated for his needs. Lulow, inspired by their kindness and determination, became a social worker. "It frightens me as to how I would have turned out" had he grown up with his abusive mother and stepfather, Lulow said. April is Child Abuse Prevention Month and Lulow's experience of growing up in the system is not uncommon in Maryland, where 13,000 children live in foster homes. Lulow belongs to the 3 percent of foster care children who age out of the system with college degrees. Children who age out are not permanently adopted. Lulow is now a case supervisor at Court Appointed Special Advocates/Prince George's County, the Hyattsville-based branch of the national CASA nonprofit organization that advocates for neglected and abused children. Lulow said he entered the foster care system in Michigan at the age of 8 after suffering years of abuse and neglect by his mother and stepfather, and he didn't leave the system until he turned 18. He was separated from two sisters who he hasn't seen in at least 10 years. Lulow said it was the people who took a vested interest in him and helped him throughout his journey, like his case manager and Court Appointed Special Advocate volunteer, who inspired him to pursue social work. He remembered when he encountered his stepfather as a 10-year-old while his case manager was with him. "I knew she would fight to the death to protect me, and it was the first time I felt that," he said. Lulow also said his CASA volunteer spent countless hours forging a relationship with him over fishing trips and rounds of catch while he bounced around five different foster homes. "This man was the first positive male role model I had in my life," Lulow said. "Working in the system now, I see there are very few male volunteers." CASA volunteers are charged with spending time with foster children, ensuring their needs are met and advocates for them in court to make sure they are placed in safe and loving homes. The volunteers provide judges with reports that help them make rulings. Prince George's CASA Program Coordinator Kelly Franks said there is always a need for more volunteers, especially in Prince George's County, where 600 to 700 children are in foster care. Only one Maryland jurisdiction, Baltimore city, has more children in the system. Franks also said she's seeing a rise in cases as the economy worsens and governments and nonprofits cut social service programs. "Child abuse is caused by a lot of different things like stress, substance abuse problems, mental health problems," she said. "When the economy starts to struggle, services drop and we see a rise in cases." Lulow said many people played vital roles in his life. His high school community in Tennessee, he said, pushed him to go to college. A former construction boss cosigned apartments and always found him work. And people in the system went beyond the bare minimum of what was expected of them to show they cared. "It wasn't one person doing everything for me, but it was a collective effort of being active in my life that really helped me to succeed," Lulow said. "People talk about my resiliency, but I really had so little to do with it." E-mail Elahe Izadi at eizadi@gazette.net. Court Appointed Special Advocates/Prince George's County volunteers have to complete 37 hours of pre-service training either through scheduled sessions or independent study. Call 301-209-0491 or visit www.pgcasa.org/news for dates of the latest training sessions. Copyright 2009 Prince George’s County Gazette. Baltimore Child Abuse Center - Spreading the Word about Sexual Abuse By Aaron Cahall Baltimore Afro-American Saturday, April 11, 2009 (April 11, 2009) - The elevator ride must seem slow, almost tortuous to the children who take it. They’re rising toward the fourth floor of the old brick building on the corner of 23rd Street and Charles Avenue because they may have been sexually abused. It’s a crime too rarely reported which almost no one, especially its victims, is eager to talk about. Those children imagine what the Baltimore Child Abuse Center must look like, and the image is probably bleak. It might involve stark, white institutional halls, icy cold examination tables and stern-faced staff. But then the elevator doors open. The welcoming room is brightly lit, with pastel-colored walls. Around the corner, a play room is stocked with toys, comfortable furniture and a TV playing a Disney movie. The center’s staff bustles with various tasks. It’s too much to say that it looks like hope. But to those children, it has to be a sign that things might not be as bad as they seem. For the center’s executive director, Adam Rosenberg, and his staff, that’s a good start. The remodeled welcome desk and play room are part of a renovation of the center provided by ABC2’s “Built Upon a Dream” project. That new look will boost the center’s efforts to spread the word about child sexual abuse throughout April, designated as National Child Abuse Prevention Month. “We want to tell people, you can prevent abuse,” said Rosenberg. “It’s not something that should be shoveled under.” This month, the center launched a media campaign that includes billboards, ads on a tenth of the city’s buses, and special events aimed at educating the public about the signs of possible child sexual abuse and resources available to help. Each year, the center evaluates and treats more than 900 children. But that may be just a fraction of the true numbers of children abused—according to estimates, only 10 percent of child sexual abuse is ever reported. That secrecy is the key problem with which the center struggles. Children who are abused may not speak up, and even if they do, their parents may not take the claim seriously. Worse, they may not consciously accept that abuse is occurring, rationalizing it as an overly friendly relative or other harmless situation. “The number one sign a child is being abused, is they’ll tell you they’re being abused and often we’re not listening,” said Rosenberg. “Listen to kids. These are real reports of abuse and we’re not listening.” The Baltimore Child Abuse Center was established in 1987 and incorporated as a private nonprofit organization in 1989. It works closely with Baltimore City Police, Child Protective Services and the State’s Attorney’s Office conducting interviews, providing medical exams and developing plans for therapy and treatment. The center was one of the first of its kind in the U.S., replacing an older system which often required an abused child to repeat their story as many as a dozen times—a process which could traumatize the child further. Instead, the center’s psychologists or social workers conduct what may be the only interview of an abused child, while law enforcement authorities watch through closed-circuit television in an adjoining room. The Baltimore Child Abuse Center operates on an annual budget of about $1 million, said Rosenberg, a former prosecutor with the Sex Offense Unit of the State’s Attorney’s Office who joined the center in May 2008. Private sources contribute 40 percent of operating expenses, with the rest coming from state and federal sources and organizations, including the United Way. The center’s primary mission is to give a voice to children who may have suffered sexual abuse, said Ruby Gudger, a treatment director at the center who conducts some of the interviews with possible victims. But it also takes a wider approach to treatment. In addition to connecting victims and their families with options for overcoming the abuse, the center looks at each family’s needs for getting that treatment. Depending on the case, a family may need food, transportation or help staying in their home. “They’re dealing with so many issues,” Gudger said. “[If] they’re trying to make sure they have a place to stay, they’re not going to treatment.” Also, the non-offending parent of a victim may need counseling themselves. In most cases, Gudger said those parents were themselves victims of sexual abuse. Occurrences of child sexual abuse cut through demographic lines and turn up in all groups, Rosenberg said, but at the center, certain statistical trends have emerged. As many as 90 percent of the abusers are male, and 75 percent to 80 percent are Black—likely a result of the city’s majority Black population, Rosenberg said. In cases the center saw between July 2007 and June 2008, 55 percent of abusers were a family member or other close relative, while only 10 percent were unknown to the victim. That number may change, Rosenberg fears, as one other, darker effect seeps out of the ongoing recession: a spike in cases of child sexual abuse, especially by relatives. With so many individuals out of work, home all day and frustrated, Rosenberg said some increase in cases is likely. The center hopes that its awareness campaign this month will curb that trend. But putting a public face on the crime isn’t always easy. Getting abuse reported in the first place is hard enough, but once a victim is treated, they’re not eager to become the poster-child for overcoming child sexual abuse. “We’re often called the best-kept secret in Baltimore,” said Gudger. “Because when people come to us, they don’t want people to know. When they leave, they don’t want to talk about it again.” The new bus banner advertisment created by the Baltimore Child Abuse Center. (Courtesy Photo) Copyright 2009 Baltimore Afro-American. Local Org. Takes Health Care to Classrooms By I.S. Yansané Baltimore Afro-American Wednesday, April 8, 2009 (April 8, 2009)- WASHINGTON- Students at C.W. Harris Elementary received health screenings that included dental, vision, body mass index, height and weight measurement and blood pressure at a fair organized by United Medical Center Foundation on April 2. The UMC fair is an ongoing pilot program at specific District schools that will follow students through their school matriculation and beyond in an effort to promote preventive care, collect data and foster better health outcomes in Black communities. “People need to learn how to access better health practices in order to live healthier lives,” said Calvin Smith, chairman of the UMC Foundation, which is working with Healing Our Village, the National Kidney Foundation, the Lung Cancer Association and the D.C. Department of Health to increase ongoing education in pulmonary, kidney and heart diseases. At the center of the initiative, Foundation representatives said, was the shocking statistics about childhood obesity that has emerged in recent years. “The screening was started on the basis of an internal background study indicating that obesity has become an epidemic that must be curbed,” said UMC employee Lateicia Harrisson, who works on community outreach. And it’s an epidemic that is disproportionately prevalent among lower-income communities of color, research has shown. A 2006 study funded by the national Institute of Diabetes and Digestive Kidney Diseases shows that approximately one-third of American children and adolescents are overweight or obese, especially those of Latin, African-American and low-income backgrounds. C.W. Harris Elementary represents this demographic. According to physical education teacher Benjamin Davis, 100 percent of C.W. Harris students are African American, of which 99 percent qualify for free or reduced lunch. Twenty-seven percent of students in grades 2 through 4 are at risk of becoming overweight or obese, Davis added, ranking between the 85th and 95th percentile in the body mass index by age. And, 21 percent in grades 2 through 4 are overweight or obese and rank in the 95th percentile or higher in the body mass index. There is at least one easy way to change those statistics, the PE instructor said. “Physical activity is a cheap, sustainable, and efficient method of reducing and preventing overweight and obesity,” Davis said. “Physical activity habits are learned, with schools being the optimum environment for the teaching of these ideals.” Sadly, the children who need to learn such lifestyle lessons the most are the ones who don’t show up to school and are otherwise most afflicted by the “education gap.” And, they are unlikely to obtain those lessons at home. “Students practice for the test instead of taking physical education,” said Davis, who helped conduct the screenings at the fair. “They come to school with chips and candies… They play video games at home.” The health fair was therefore aimed to elevate students’ minds, create healthy lifestyles habits in order to maximize social and economic opportunities. Davis said, “It is imperative that we focus on educating both the mind and bodies of our students in order to help them become well-rounded, healthy adults.” Studies show that the adverse health consequences of childhood obesity can follow a person into adulthood. “Obesity has been linked to hypertension, elevated cholesterol, type 2 diabetes, coronary heart disease, orthopedic disorders, and respiratory disease; [it] has a significant negative effect on childhood emotional development, has been shown to track to adult obesity and increases the risk of adult mortality,” Smith said. Many factors can be blamed for these numbers, but the solution is clear, said Davis, who outlined several initiatives CW is pursuing including, creating a Health Promotion Program; partnering with the Alliance for a Healthier Generation, United Medical Center, The First Tee National School Program, DC SCORES, City Dance Dream Program, Chartwells Fresh Fruit and Vegetable Program and Quick Fit, an in- class exercise initiative. He said, “We need to implement quick and decisive action now…to assist our students in living healthier lives.” Copyright 2009 Baltimore Afro-American. *National / International* A Policy Cocktail for Fighting HIV By Anthony S. Fauci Washington Post Thursday, April 16, 2009 Nearly 30 years after the first cases were recognized in the United States, HIV/AIDS remains an incurable disease that is devastating large swaths of our country and the rest of the world. To understand the magnitude of the destruction, look around our nation's capital. Last month, D.C. health officials announced that 3 percent of city residents had full-blown AIDS or were infected with HIV. Not only is that infection rate on a par with rates in some African countries, but the D.C. data were based only on those who have been tested for HIV; the actual rate is probably much higher. Globally, an estimated 33 million people carry the virus. In 2007 alone, about 2.7 million new infections occurred. The annual number of new HIV infections in the United States -- about 56,000 -- has remained fairly constant for more than a decade. That's right, 56,000 people are infected in this country every year. Clearly, our efforts at HIV prevention have been insufficient. Drastic action and new approaches are urgently needed. Vaccines have historically been mankind's best weapon against the worst infectious diseases. But HIV's unique and formidable nature has presented challenges to the development of an effective vaccine. Although we remain committed to the research necessary to find a preventive HIV vaccine, a licensed product is not likely to be available in the near future. In the absence of a vaccine, three bold new approaches to controlling the HIV/AIDS pandemic are being discussed by those working in medicine and public health. These approaches are still in the conceptual and testing phases, but if applied as a group, it's possible they could have a dramatic effect. The first approach would provide a daily dose of antiretroviral medicines to people who are not infected with HIV but are at high risk of becoming infected. This strategy, known as pre-exposure prophylaxis, or PrEP, is based on the concept that blocking HIV's replication immediately after exposure to the virus may prevent infection. A somewhat similar strategy of treating HIV-infected mothers before and during delivery and treating their newborns for a limited time afterward has virtually eliminated mother-to-child HIV transmission in the United States. The National Institutes of Health and other organizations are conducting clinical PrEP trials among various at-risk populations. Initial findings are expected later this year. Of course, safety and cost-effectiveness will be important factors to consider even if the approach proves effective in preventing infection. The second approach would involve universally available, voluntary, annual testing for HIV infection and immediately providing antiretroviral therapy to those who test positive. The potent combinations of antiretroviral medicines available today can suppress the amount of HIV in an infected person's body to extremely low levels, resulting in longer lives and better health. Plus, it has been clearly shown that those who have less HIV in their blood are less infectious to others. In fact, when a drug regimen suppresses HIV to certain low levels, the risk that the infected person will infect another through sexual contact appears to be greatly reduced, even though the virus has not been eradicated. New modeling research suggests that implementing a voluntary "test and treat" approach could dramatically reduce new HIV cases beginning within a decade and ultimately halt the pandemic. Universal voluntary testing and treatment potentially could have a transformational effect on public health. Before this approach can be implemented, however, we must pursue a research agenda that includes studies of feasibility, efficacy, the benefits to individual patients vs. the benefits to society, and cost-effectiveness. The third approach relates to the lifelong treatment that most people with HIV eventually need. Certainly, this care imposes financial and other burdens on patients, their families and health-care systems. But now, for the first time, AIDS researchers are pursuing major efforts to cure HIV infection. This might entail purging all vestiges of the virus from a person's body, a difficult challenge. Perhaps more likely, though still difficult, would be a "functional cure" -- therapies that suppress the virus to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the residual virus in check. The latter result would be more likely if therapy were initiated early in the course of infection, when significant immune function remains. The NIH plans soon to launch an initiative designed to solicit novel ideas for an HIV cure from the scientific community. It is too early to predict the success or even the feasibility of such a three-pronged approach. Just the research to determine feasibility would be extremely costly. It is clear, however, that new methods of fighting infection must be pursued, and it is encouraging that new NIH funding provided through the American Recovery and Reinvestment Act offers the chance to at least explore such an approach, with the hope that an end to the HIV/AIDS pandemic could be within our reach. The writer is director of the National Institute of Allergy and Infectious Diseases, a part of the National Institutes of Health. Copyright 2009 Washington Post. The Reluctant Organ Donor By Tara Parker-Pope New York Times Thursday, April 16, 2009 Most licensed drivers don’t sign up to be organ donors, and it may be due to fears about the organ donation process, a new survey suggests. Only 38 percent of licensed drivers are registered to be organ donors, despite the fact that many states offer a simple registration process that typically just requires a signature when obtaining or renewing a driver’s license. An online survey of 5,100 people conducted by the advocacy group Donate Life America found that many people still harbor fears about what organ donation really means. * 23 percent of people fear they are not healthy enough or are too old to donate their organs. * 50 percent of respondents are concerned that doctors will not try as hard to save them if they are known to be an organ donor. * 44 percent believe there is a black market in which people can buy or sell organs or tissue. * 57 percent question whether or not a person can recover from brain death. Donate Life chairwoman Sara Pace Jones said common misconceptions about organ donation may be due, in part, to inaccurate media portrayals of the process. “Some fears are perpetuated by dramatic television shows that, because they have to tell a complete story in an hour or less, don’t have time to show the accurate and entire process of donation,” Ms. Pace Jones said. “Many times I have seen a story unfold where the same physician treats the patient when admitted to the hospital, takes them to surgery, pronounces the patient dead, accesses the transplant list and does the organ recovery and transplant. But this is not how the donation process happens. The doctor who is trying to save the life of the injured patient is not the same doctor who recovers organs for transplantation.” Helping people understand exactly how the process of organ donation works is the first step toward alleviating fears that doctors don’t work as hard to save organ donors, she said. For instance, many people don’t realize that the organizations that check donor and patient registries and coordinate donations are separate from the hospital where a patient is treated. “People are reassured that everything will be done to save their lives after an accident when they understand that the doctors who treat them have nothing to do with the transplantation process,” she said. Donate Life America is launching a page on Facebook at www.facebook.com/donatelife to make it easier for users to register as donors. Just click on the link and then click on the “Register” tab. Copyright 2009 The New York Times Company. Q & A - Heartfelt Changes By C. Claiborne Ray Baltimore Sun Tuesday, April 14, 2009 Q. If, after many years of a high-fat, high-cholesterol, low-fiber/fruit/vegetable diet, one shifts to a healthy diet, can one repair some of the damage presumably done to blood vessels? If so, how much? A. While diet is not the only factor in cardiovascular health, some studies have found that a very low-fat diet that is also high in fiber, fruits and vegetables can repair the damage to narrowed blood vessels, in at least a limited but measurable amount. But such improvements were found only in conjunction with other changes in the subjects’ overall lifestyle, like regular exercise and stress reduction, and such changes are difficult to maintain over a long period. A widely publicized study published in 1990 in the British journal The Lancet, led by Dr. Dean Ornish, was the first controlled study to find such a benefit. The changes studied included a low-fat vegetarian diet, cessation of smoking, stress management training and moderate exercise. In the 22 patients who followed this regimen for a year, images of blood vessels made after a dye was injected found that, on average, the narrowing of damaged coronary arteries was reduced to 37.8 percent of the vessel from 40 percent; in the control group of 19 patients, the narrowing of the vessel increased, to 46.1 percent from 42.7 percent. Some later studies have found similar results. Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com. Copyright 2009 The New York Times Company. *Opinion* A Patchwork Safety Net Could the Jacks family's tragedy have been prevented? Washington Post Thursday, April 16, 2009 A GALAXY of public and private organizations tried to help Banita Jacks and her family. A new report by the city's inspector general lists 20 groups that over two years provided everything from food to health care to housing assistance. The fact that this troubled family was known to the agencies and nonprofit groups that comprise the District's social safety net makes the tragedy suffered -- the deaths of Ms. Jacks's four daughters -- all the more horrific. Equally troubling is that it is not entirely clear that enough has been done to prevent similar failures. D.C. Inspector General Charles J. Willoughby this month released results of an investigation that faults city social services agencies, police, schools and nonprofit support groups for "errors of omission and commission" leading to the deaths. The bodies of the girls were found Jan. 9, 2008, by U.S. marshals dispatched to evict the family from their Southeast Washington house. The girls apparently had been dead for months, and Ms. Jacks is awaiting trial on murder charges in the case. Most striking was the inspector general's finding that this was not a story of a family living in isolation but rather of one that sought and received numerous services and benefits from a generous city. But different groups worked separately, oblivious to the efforts of others, with the result that no one entity knew the whole story. It is heartbreaking to read how social workers investigating a complaint about possible neglect reported not being able to find the family even as the family was interacting with multiple other agencies. Also recounted are unforgivable instances of individual workers not doing their jobs; indeed, anyone who thinks Mayor Adrian M. Fenty was wrong to fire employees he found derelict should read this report. Mr. Fenty initiated a number of laudable reforms in the immediate aftermath of the girls' deaths, such as mandating that no investigation into child abuse or neglect be closed until social workers locate families and ensure the safety of children. But it is clear from the recommendations in the inspector general's report that more action is needed. The report cites, for instance, problems with policies governing the absence or withdrawal of students from charter schools and the need for better guidance for police on responding to and documenting calls from troubled families. Most important is establishing a system that would allow various parts of the social support network to share information; to do that, confidentiality laws may need to be changed. We are all for protecting privacy, but the absurdity of laws that keep information from the people who need it was aptly illustrated by the censorship in the inspector general's report -- including not showing the names of the girls who died. Copyright 2009 Washington Post. Back in the Hospital Again New York Times Editorial Wednesday, April 16, 2009 An alarming one-fifth of all Medicare patients discharged from the hospital end up back in the hospital within 30 days, and fully a third return within 90 days. If this yo-yoing could be greatly reduced, Medicare could save billions of dollars. Many patients would certainly benefit from the better care. High rates of rehospitalization are partly the fault of the hospitals. The more fundamental problem is the fragmented nature of the American medical system: too often, health-care providers fail to communicate with one another, patients fall between the cracks and no one seems clearly in charge of a patient’s welfare. A new analysis by three researchers, published in The New England Journal of Medicine, estimated that unplanned rehospitalizations among fee-for-service beneficiaries cost Medicare $17.4 billion in fiscal year 2004, which is a big chunk of the $102.6 billion that Medicare paid hospitals that year. Most patients were readmitted for problems other than those that led to their original hospitalizations. Surgical patients, for example, were typically readmitted for such medical conditions as pneumonia, heart failure or bacterial infections. Some of these readmissions may have been unavoidable in an elderly, sick population. But many could surely have been prevented through better planning and coordination. The most disturbing finding was that half of the medical (nonsurgical) patients readmitted within 30 days had not seen a physician for follow-up care after they were discharged. They were apparently left on their own, perhaps with poorly understood instructions from the hospital on how to take care of themselves. There was also wide variation in readmission rates between hospitals and between states: only 13 percent of patients were readmitted within 30 days in Idaho, compared with 22 percent in Maryland. That suggests that there is plenty of room for improvement. The rates were adjusted to compensate for the severity of patients’ illnesses, so hospitals and states with high readmission rates can’t easily blame caring for sicker patients. Proposed solutions include better discharge planning by hospitals, more effective education of patients and closer cooperation between hospitals and physicians to ensure follow-up care. The Obama administration, as part of its ambitious health care reform, has proposed that Medicare use incentives and penalties to encourage hospitals and doctors to cooperate in overseeing care from hospitalization through the first 30 days after discharge. The administration estimates the approach could save $26 billion over 10 years. It is a sound idea that should also improve the lives of patients. Copyright 2009 The New York Times Company. BACK TO TOP


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