Monday, March 2, 2009

News Clipping Archives

 

Maryland / Regional

Maryland program covering more uninsured, despite slow start (amednews.com)

Some Md. agencies squeezed despite federal stimulus (Baltimore Sun)

Flu Season Brings Deaths, School Closures (ABC News Medical Unit)

Classes Out for Influenza (ABC News Medical Unit)

Beating Flu to the Punch (ABC News Medical Unit)

Indoor air can be risk for kids with asthma (Baltimore Sun)

National / International

Why the Flu Thrives in Winter (New York Times)

Congress renews push to regulate cigarettes (Washington Post)

Former Clinton official to head WH health efforts (Washington Post)

Uncertainty over new health safety net for jobless (Wasington Post)

Fewer kids have high lead levels than 20 years ago (Washington Post)

Indian Youth Festival Puts Sexy Back in Dialogue About Safe Sex (Washington Post)

Flu viruses growing resistant to key weapon Tamiflu (USA Today)

Opinion

Deaths put flu in spotlight (Carroll County Times)

 

Maryland / Regional

 

Maryland program covering more uninsured, despite slow start

Plan managers seek to enroll 2,000 uninsured adults in a Howard County initiative.

 

GOVERNMENT & MEDICINE

 

By Doug Trapp

amednews.com (American Medical News)

Monday, March 2, 2009

 

One Maryland county's program to provide health care to moderate-income uninsured adults actually has been more successful at enrolling lower-income people in state public health coverage. But officials running the Healthy Howard Access Plan are not disappointed.

 

The plan is an effort to connect uninsured adults earning 300% of the federal poverty level or less with an array of health care available in or near Howard County, located west of Baltimore. Only about 250 people -- fewer than initially expected -- have either signed up for Healthy Howard or are in the application process as of mid-February, said Howard County Health Officer Peter Beilenson, MD, MPH. Still, that pace puts the program on target for a goal to enroll 2,000 adults in 2009, he said. Enrollees began receiving care in January.

 

The program charges a monthly fee of at least $50 in exchange for medical and dental care plus discounted prescription drugs. Healthy Howard is similar to a San Francisco program in that it's not health insurance but is instead a local safety net for people without access to coverage. The Howard County program differs in that it relies more on grants and donated care than the San Francisco effort and does not tax businesses that don't provide health coverage.

 

"Our goal is that a significant number of [Healthy Howard] participants will never need to set foot in the hospital emergency room, not only saving all of us money, but freeing up the resources of the hospital for true emergencies," said Howard County Executive Ken Ulman.

 

Dr. Beilenson said Healthy Howard is benefiting from a significant amount of charity care. About 200 physicians in 18 practices in a wide variety of specialties have agreed to provide free care to program enrollees. Three area hospitals also have agreed to participate.

 

Finding uninsured people in the county has not been difficult. More than 1,100 adults without insurance turned up last October during an eight-day Healthy Howard enrollment drive, but only 50 qualified. About 750 others were eligible for Medicaid, the Children's Health Insurance Program or a Maryland program that offers coverage to uninsured low-income adults. Another 300 received coverage through Kaiser Permanente's Bridge program, which offers three years of nearly free health insurance to people earning 250% of poverty or less.

 

Some of the uninsured people might not have known that Maryland increased Medicaid eligibility in July 2008, said John M. Colmers, secretary of the Maryland Dept. of Health and Mental Hygiene.

 

More efforts could help Healthy Howard reach its enrollment goal. The county is waiving the requirement that applicants be uninsured for six months for people who have lost jobs, Dr. Beilenson said. The county also plans to offer finders' fees of $20 to $25 to people or organizations who find uninsured people who complete the Healthy Howard enrollment process.

 

"That would encourage community organizations who are already seeing vulnerable populations for food stamps or for day care to say, 'Hey, go online and try out the easy [eligibility] screening tool,' " Dr. Beilenson said.

 

Healthy Howard caught the attention of U.S. Sen. Barbara Mikulski (D, Md.), who on Feb. 17 chaired a Senate Health, Education, Labor and Pensions Committee field hearing on the program at Howard County Community College.

 

Roughly 20 of the 250 Healthy Howard enrollees have visited Chase Brexton Health Services' Columbia office, the federally qualified health center serving as the program's primary care medical home, said Kari Alperovitz-Bichell, MD, the site clinical director. A few dozen others have scheduled appointments. The health center is paid for treating Healthy Howard patients. Many enrollees probably wouldn't come to the clinic outside of the program because most earn too much to qualify for significant discounts, she said.

 

Partnering with the county to care for low- to moderate-income people makes sense because the Columbia health center's four family physicians are likely more knowledgeable about the health care safety net than the average private physician in an area as wealthy as Howard County, Dr. Alperovitz-Bichell said. "I have the Wal-Mart $4 [generic drug] list memorized."

 

She isn't sure how viable Healthy Howard will be because it relies on donated specialty care. But the program is terrific for the people the clinic can serve, she said. "It's part of what needs to be done."

 

Representatives from other Maryland counties have contacted Dr. Beilenson about Healthy Howard, but they generally conclude the program requires a lot of work. "Mostly it's a wait-and-see attitude."

 

This content was published online only.

 

 

Copyright 2009 American Medical Association. All rights reserved.

 

Some Md. agencies squeezed despite federal stimulus

Prisons, mental health, juvenile justice programs face cutbacks

 

By Laura Smitherman

Baltimore Sun

Monday, March 2, 2009

 

Even a $3.7 billion federal lifesaver isn't enough to solve all of Maryland's budget quandaries.

 

While the state is now flush with federal dollars for education, Medicaid and infrastructure projects, other state functions, among them the prison system, mental health programs and juvenile justice, are facing significant cutbacks. In some cases, lawmakers and advocates have questioned how agencies will be able to function within constrained budgets.

 

Meanwhile, the economy continues to deteriorate and state officials are bracing for more bad news later this month when the latest estimates of tax revenues are due. Analysts have warned that annual collections have fallen as much as $500 million below expectations for the current budget year and next.

 

Copyright 2009 Baltimore Sun.

 

Flu Season Brings Deaths, School Closures

Unrelated Incidents Punctuate a Devastating Flu Season

 

By Dan Childs

ABC News Medical Unit

Monday, March 2, 2009

 

In Maryland, a 13-year-old boy dies after a brief but violent battle with what doctors believe is influenza. A week later, a school in Virginia shuts down for a day when nearly 200 of its students are absent due to sickness.

 

The headlines make it impossible to deny that we are in the middle of the flu season. And infectious disease experts say that similar stories could be in store for the weeks to come.

 

The flu season, during which the disease is most rampant, is generally thought to run from November through April. According to estimates from the U.S. Centers for Disease Control and Prevention, the influenza virus sends more than 200,000 Americans to the hospital every year. And each year, more than 36,000 people die from the flu and its complications.

 

Most vulnerable are the elderly, infants and those with conditions that cause their immune systems to be compromised. But even young, healthy individuals can die from a severe infection.

 

Such was the case with 13-year-old Ian Willis of Frederick, Md. Ian's father, Robert Willis, said that on Feb. 13, Ian woke up and said he was not feeling well.

 

Ian's mother, Michelle Willis, took the boy's temperature, but after finding that he did not have a fever she let him go to school. Later that afternoon, Ian said he still felt under the weather; yet after downing a foot-long Subway sandwich, he spent the evening playing video games with friends.

 

On Saturday, he began having a fever. And on Sunday, his condition got worse.

 

"We noticed a change in his color," Willis said, adding that the boy appeared to be having trouble breathing. Willis rushed his son to Frederick Memorial Hospital, where doctors determined that the boy was going into respiratory distress.

 

In a sequence of events that Willis now describes as a "rollercoaster," doctors at Frederick Memorial administered life-saving treatment before transferring Ian to Children's Hospital in Washington, D.C., where more treatments were needed.

 

On Feb. 19, Ian passed away.

 

"We've tried to rehash this in our minds," Willis said. "We've seen the posters in the doctor's office -- 'If you have these symptoms, you have the flu. Get fluids and rest.'

 

"By the time we noticed he had trouble breathing, it was less than four to five hours before he was in critical condition in the hospital."

 

Ian is not the only casualty of the flu season thus far. According to the weekly flu report by the CDC, his death was just one of eight flu-associated deaths among children reported so far in the week ending Feb. 21.

 

Often, there are other infections that accompany the flu, making it even more deadly -- infections like the superbug MRSA, for example. But Dr. William Schaffner, chair of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, Tenn., said that in all too many cases, influenza alone is enough.

 

"Fortunately, this is rare, but it is incredibly tragic," Schaffner said. "These are often healthy children -- not necessarily children with underlying medical conditions. Within 24 hours or less, they are often ill enough to be admitted to the intensive care unit.

 

"This is not the common cold; it's a really bad [virus]."

 

Copyright © 2009 ABC News Internet Ventures.

 

Classes Out for Influenza

 

By Dan Childs

ABC News Medical Unit

Monday, March 2, 2009

 

A state away, in Virginia, one private school is dealing with its own influenza catastrophe. Peter Bender, principal of the upper school at Walsingham Academy in Williamsburg, Va., said he and other administrators were forced to shut down the school on Friday when more than a quarter of the student body was absent Thursday with flu-like symptoms.

 

"We started noticing absences this past Monday -- maybe 60 or 62 students were out," Bender said. "The lower school principal told me that she had 30 out."

 

With each day, the number of illness-related absences grew. By Thursday, 118 out of 314 upper school pupils and 80 out of about 440 lower school pupils children were absent with symptoms consistent with either a respiratory infection or gastrointestinal illness.

 

Bender said that it was at that point the administrators decided to close down the school on Friday -- to the praise of the students' parents.

 

Bender, who has 35 years of experience working in various school systems, said he has never seen a wave of illness-induced absence of this magnitude.

 

He noted that state health officials have not yet determined the exact cause for the illnesses. Currently, he said, the health department is offering the families of sick children screening kits to detect norovirus -- a type of bug that causes gastrointestinal illness.

 

Schaffner said that it is difficult to determine the exact nature of the illness without knowing more about the individual cases. But he said that the influenza virus is a likely suspect, given the symptoms described.

 

"You would think that the influenza virus is the more likely cause this time of year," he said.

 

Schaffner added that while norovirus is generally more associated with intestinal symptoms, influenza can also bring about gastrointestinal effects such as diarrhea in younger children.

 

"It would be extremely unusual to have two prominent viruses in one institution simultaneously," he said. "That would be very, very odd."

 

Copyright © 2009 ABC News Internet Ventures

 

Beating Flu to the Punch

 

By Dan Childs

ABC News Medical Unit

Monday, March 2, 2009

 

In the aftermath of the infections at Walsingham Academy, workers are scrubbing down the school -- a step that Schaffner said will not likely help if an influenza bug is to blame, but which Bender said he welcomes.

 

"My No. 1 concern is the health of the students," he said. "This extra day is intended to give everyone a rest and the opportunity to clean the buildings."

 

For Willis, the week to come will be one in which he struggles to cope with his loss.

 

"It's like I'm waiting to wake up from a nightmare," Willis said.

 

Since his son's death, he has talked openly to the media about his experience. Talking about it, he hopes, will help him deal with his grief -- and alert other families to the danger of the flu.

 

"If it helps one family avoid going through what we're going through, then it's worth it," he said.

 

Copyright © 2009 ABC News Internet Ventures.

 

Indoor air can be risk for kids with asthma

Air they breathe at home can be worse than pollution, pollen outdoors

 

By Stephanie Desmon

Baltimore Sun

Monday, March 2, 2009

 

Parents have long known that the polluted, pollinated air outdoors can bring on asthma attacks in their children. Now it turns out that many asthmatic inner-city kids are under assault inside their homes - where cigarette smoke, dust mites, mold and even cooking smells can make them sicker than car exhaust or ragweed.

 

Researchers are finding a direct link between the air children breathe at home and the asthma attacks that are the source of hundreds of thousands of emergency room visits in the U.S. every year. The latest study, published last month by Johns Hopkins researchers, quantified the increase in asthma symptoms for every increase in air pollution particles inside Baltimore homes.

 

Such findings have begun a movement of health professionals who are going door to door to educate families about the potential dangers of indoor air and helping them clean up their homes. Their goal is to reduce childhood asthma by 50 percent by 2012.

 

"We tend to think of outside as being the polluted place and indoors being the sanctuary," said Dr. Gregory B. Diette, a director of the Johns Hopkins Center for Childhood Asthma in the Urban Environment. In many of the Baltimore homes he surveyed, Diette found that inside air is a problem.

 

As many as one in five Baltimore children are believed to suffer from asthma, the most common chronic childhood disease but one that disproportionately affects inner-city African-American children. Scientists don't yet know exactly what causes asthma, a lung condition that temporarily narrows the airways and causes wheezing, coughing and difficulty breathing. The number of children with asthma has risen significantly over the past two decades.

 

"What is then responsible for this dramatic increase in asthma over the past 20 years? That's the million-dollar question," said Dr. Elizabeth Matsui, a pediatric allergist at the Johns Hopkins Children's Center and, along with Diette, an author of the study.

 

Matsui said allergists have known for years that the home - where children spend most of their time - holds hidden dangers for those with asthma. But only recently, she said, have pollution scientists started to research the relationship between indoor air and asthma.

 

Syeadda Spears says she tried to do all she could to protect her children, two of whom suffer from asthma. She kept her sons inside their Northeast Baltimore home. She was constantly sweeping the floors. She even bought plug-in air fresheners to make everything smell nice.

 

Then she got a visit from Hopkins researchers doing another study - and learned she was doing a lot of things wrong. She was kicking up dust that made her sons wheeze every time she swept. The air fresheners were triggering symptoms in 9-year-old Da'Shawn. She even made him sick when she tried to bake a treat of snickerdoodles because of her kitchen's poor ventilation. The indoor air, Spears was learning, could be worse than the pollution and pollen outdoors.

 

"I thought, 'The house is clean. You've got wood floors. It smells fresh.' But no," she said.

 

Not every parent listens. Last spring, outreach workers from the Coalition to End Childhood Lead Poisoning began visiting the homes of 250 Baltimore children as part of a program aimed at keeping asthma in check. Kevin Gummer and Gia Wilkerson come armed with special particle-removing vacuums and pest management advice and new windows - whatever a home needs. The idea is that a $100 HEPA vacuum might save $1,500 in doctor or emergency room visits avoided.

 

The workers say that showing a family how they can make changes is far more effective than just handing out pamphlets about how to make a home healthier.

 

"We'll go in and ask people, 'Do you smoke?' and they say, 'No,'" Wilkerson said. "But the child sleeps in the same bedroom as they do and the ashtray is right there."

 

Sometimes, families trying to make things better only make them worse. For example, in trying to get rid of mice and cockroaches - which, among other ills, can trigger asthma attacks - families often use foggers or other chemical sprays. Gummer says those don't solve the problem, and they can aggravate asthma symptoms.

 

The childhood lead coalition moved into the realm of asthma as a complement to its successful efforts to reduce lead paint in city homes. "When we were leaving homes in the late '90s, cleaning up the lead, our guys were replacing windows ... [but] the kids were still getting sick - not necessarily from lead but asthma and injuries," said Executive Director Ruth Ann Norton. "In those families, about 50 percent of their kids had asthma."

 

The problem of poor indoor air quality appears to be most serious in low-income city households. Reasons for that aren't fully understood, but researchers point out that city homes tend to be smaller than those in the suburbs, so bad air has less chance to be diffused. And in older houses, there is more likely to be dust from old plaster and wood. City children also tend to spend lots of time indoors, often because their parents fear the potential for violence outside.

 

But, health officials say, there are steps families can take to improve the air in their homes.

 

Madeleine Shea, an assistant Baltimore health commissioner, said her office is launching a program this month similar to the coalition's. The city got a four-year grant from the federal Centers for Disease Control and Prevention to do six home visits each with 250 Baltimore schoolchildren with asthma.

 

"A lot of assaults to health in homes are behavioral," Shea said. "Theoretically they should be easier to address."

 

While she knows change takes time, she thinks that once people know what improvements they can make on their own, they will. "Almost everyone really loves their child," she said.

 

Still, it can be very intrusive to have someone come inside your home and criticize your personal habits and your housekeeping.

 

"The issues are balancing privacy versus health," said Dr. Peyton Eggleston, a pediatric allergist at the Johns Hopkins Children's Center. "With ambient air quality control and water quality control and pollution control in general, there's not really a question. We all share the air. We all share the water.

 

"But when you get to the conditions inside someone's home ... you get to the conflict between individual rights and the rights of the community."

 

The Hopkins study, published in the journal Environmental Health Perspectives, looked at 150 asthmatic preschoolers in Baltimore over six months. It found that for every 10-microgram-per-cubic-meter increase in coarse air particle pollution, such as that produced by dusting and cooking, there was a 6 percent increase in the number of days of coughing, wheezing or chest tightness.

 

For every 10-microgram-per-cubic-meter increase in finer air particles indoors, there was a 7 percent increase in wheezing severe enough to limit speech, and a 4 percent increase in the number of days rescue medication was needed.

 

In many cases, the researchers found, the level of indoor fine particle pollution was twice as high as the standard for outdoor pollution established by the U.S. Environmental Protection Agency. There is no such standard for indoor air.

 

Diette points out that sometimes in the summer, officials warn of bad air quality days and suggest children with asthma stay inside.

 

"Depending on where you're staying inside," he said, "it may not be a better environment."

 

Copyright 2009 Baltimore Sun.

 

National / International

 

Why the Flu Thrives in Winter

 

5 Questions

 

By Karen Barrow

New York Times

Tuesday, March 3, 2009

 

Scientists have long wondered why the flu virus spreads so much more effectively in winter than in summer. Part of the explanation has to do with the obvious seasonal differences: In 2007, researchers reported that the flu virus is more stable and stays in the air longer when air is cold and dry. Now Dr. Jeffrey Shaman, an atmospheric scientist at Oregon State University, and his colleagues have found more evidence that high humidity may help to stave off the flu virus. Their study, published recently in the Proceedings of the National Academy of Sciences, also shows that measuring absolute humidity, versus relative humidity, may help scientists better understand the spread of influenza and why there are seasonal spikes of the disease.

 

1. What is the difference between absolute humidity and relative humidity?

 

Absolute humidity is the amount of water vapor in the air; relative humidity is the ratio of the amount of water vapor in the air to the humidity level of the air were it saturated. Above this saturation level dew and fog begin to form; however, the saturation level of air is highly dependent on temperature. Warmer air has a higher saturation level. As a result, air with a relative humidity of 50 percent at 80 degrees Fahrenheit has much more water vapor than air with a relative humidity of 50 percent at 40 degrees Fahrenheit.

 

A car’s gas tank provides a useful analogy. A gas gauge only indicates how close the gas tank is to full, much as relative humidity only indicates how close the air is to saturation. The actual amount of gas in the tank, the number of gallons, is analogous to absolute humidity.

 

2. What made you wonder if absolute humidity was more important in flu transmission and survival than relative humidity?

 

All the laboratory studies I have seen examine how influenza survival and transmission vary with changing relative humidity conditions; none of them examine the effect of absolute humidity. Relative humidity is a physically meaningful variable, and for some organisms it can be biologically significant; however, relative humidity does not provide a fixed measure of atmospheric water vapor content. Absolute humidity is the actual atmospheric water vapor content which for some disease systems can have greater biological significance than relative humidity.

 

3. Can you describe your results?

 

We re-examined the data from those laboratory investigations of influenza virus survival and transmission and looked for a connection with absolute humidity. During our investigation, we found that both the survival and transmission of influenza virus increase markedly in lower absolute humidity conditions. While relative humidity only explains a small amount of this variability of influenza virus survival and transmission (36 percent and 12 percent, respectively), absolute humidity accounts for much more (90 percent and 50 percent, respectively).

 

Additionally, in temperate regions both outdoor and indoor absolute humidity are at a minimum during winter months, conditions that favor influenza survival and transmission. The same is not true for relative humidity, which is at a maximum outdoors during winter. These findings indicate that absolute humidity provides a single, coherent and more physically sound explanation for observed changes in the survival, transmission and seasonality of influenza.

 

4. Would that mean that flu rates would be higher in dry, temperate climates than in "humid," temperate climates? Is temperature less of a factor than humidity?

 

The results indicate that the influenza virus, once expelled from a host into the environment, would survive longer in drier air conditions. As a result, transmission proceeds more efficiently. However, humid conditions certainly don’t preclude transmission — they just seem to work against it.

 

Temperate regions of the world, such as the U.S., have seasonal absolute humidity cycles. The air in New York City on a typical summer day has four times as much water vapor as the air on a typical winter day. That large humidity difference greatly favors outbreaks during winter, when humidity levels are lowest and influenza survival is greatest. Even in South Florida, there is a large seasonal absolute humidity cycle that favors wintertime influenza transmission.

 

We have also examined the effect of temperature on influenza survival and transmission. Our analyses indicate that temperature does not exert the same level of control as absolute humidity. Like relative humidity, the effect of temperature is much more marginal.

 

5. Should people raise the humidity in their homes in the wintertime to stave off the flu?

 

The best line of defense against influenza remains vaccination. Our results do suggest that during an influenza outbreak, it may be worthwhile to humidify the home and workplace. However, there are many pathogens, such as mold, that proliferate in higher humidity conditions. There is a trade-off, so I would not recommend increasing humidity without consideration of the effect on these other potentially harmful agents.

 

Interview conducted and condensed by Karen Barrow.

 

Copyright 2009 The New York Times Company.

 

Congress renews push to regulate cigarettes

 

Associated Press

By Erica Werner

Washington Post

Monday, March 2, 2009

 

WASHINGTON -- With support from a president who's been trying to kick the habit himself, lawmakers renewed their efforts Monday to require government regulation of cigarettes.

 

President Barack Obama has been an occasional smoker who acknowledged recently that quitting hasn't been easy. While in the Senate last year he co-sponsored legislation that would have given the Food and Drug Administration authority to regulate cigarettes and other tobacco products, to reduce the harm from smoking.

 

The broadly popular legislation passed the House last summer but faced a veto threat from then-President George W. Bush and didn't get a vote in the Senate.

 

Rep. Henry Waxman, D-Calif., who's fought for years for government regulation of tobacco products, announced plans Monday to reintroduce the legislation.

 

"Tobacco has never been, and should never be, a partisan issue," Waxman said. "I believe most members of Congress share my desire to pass meaningful and truly effective tobacco legislation to reduce youth smoking."

 

After Congress' session was abbreviated Monday due to snow, the actual bill reintroduction was delayed until Tuesday. Waxman planned to bring the bill to a vote Wednesday in the Energy and Commerce Committee, which he chairs, and said he was optimistic it would become law during this session of Congress.

 

Advocates applauded the news.

 

"Federal government oversight is necessary to hold the industry accountable," said Nancy Brown, head of the American Heart Association. "We hope this will lead to swift congressional action."

 

Opponents of the legislation contend the FDA is not up to the job.

 

"I believe it's going to gut the agency's resources and distract it from its core mission," said Dr. Scott Gottlieb, policy expert at the American Enterprise Institute and a deputy FDA commissioner during the Bush administration.

 

Sen. Edward Kennedy of Massachusetts, who chairs the Senate's health committee, plans to reintroduce a Senate version of the bill in coming weeks. Last year his bill had 60 co-sponsors, including Obama - enough to overcome a filibuster. Now there are even more Democrats in the Senate, probably increasing the likelihood of passage.

 

An earlier version of the bill passed the Senate in 2004.

 

While the legislation would not let the FDA outlaw tobacco or nicotine, the agency could demand the reduction or elimination of cancer-causing chemicals in cigarette smoke. The bill would prohibit candy-flavored cigars and cigarettes, and would give the FDA authority to ban menthol.

 

The bill that advanced last year was a compromise between major tobacco control groups and Philip Morris USA, the nation's largest tobacco company.

 

© 2009 The Associated Press.

 

Former Clinton official to head WH health efforts

 

Associated Press

By Ricardo Alonso-Zaldivar

Washington Post

Monday, March 2, 2009

 

WASHINGTON -- A former Clinton administration official is being tapped to head the White House's office of health reform.

 

Nancy-Ann DeParle will take the job of working on President Barack Obama's health care reform agenda, according to an administration official who spoke on condition of anonymity because the appointment has not yet been officially announced.

 

DeParle will work with Kansas Gov. Kathleen Sebelius, who was being nominated later Monday as secretary of health and human services.

 

Former Sen. Tom Daschle, Obama's first pick as HHS secretary, had been expected to assume both roles before he withdrew from consideration over tax issues.

 

DeParle served in the Clinton administration as head of the agency that oversees Medicare and Medicaid, and also worked in Clinton's budget office.

 

© 2009 The Associated Press.

 

Uncertainty over new health safety net for jobless

 

Associated Press

By Erica Werner

Washington Post

Monday, March 2, 2009

 

WASHINGTON -- Cassandra J. Kelsey has tried to cut back on all her expenses since losing her job in January. But suffering from degenerative arthritis, she can't do without health care.

 

That's why the 55-year-old District of Columbia resident was excited when President Barack Obama's economic stimulus bill included a provision to slash costs for laid-off workers' health insurance.

 

And that's why she was distressed to learn that, because the Obama administration has yet to tell employers exactly how to make the benefit work, it'll be weeks or months before she can claim it.

 

"I don't know how I'm going to make it," Kelsey said.

 

At issue is a program known as COBRA that allows workers to keep their company's health insurance plan for 18 months after they leave their job, if they pay the premiums.

 

The policies are so expensive that only a minority of eligible workers sign up, and they are often those with medical conditions that demand attention. Costs for a family of four can top $1,000 per month.

 

A $25 billion provision in the stimulus bill aims to cut COBRA's price tag, reducing its cost by 65 percent for workers laid off as far back as Sept. 1.

 

The bill gives eligible workers 60 days to apply. Then they get the reduced-cost premium for nine months.

 

But it's not going to happen right away.

 

Employers are waiting for instructions from the Labor Department and the Internal Revenue Service on how to put the program into place. Both agencies posted some information online Thursday.

 

Until employers get the guidance they need and notify potentially eligible ex-employees, most workers will not be able to apply for the new benefit. Many probably will not know it exists.

 

"Too many people are still trying to figure this out," said Heath Weems, director of human resources policy at the National Association of Manufacturers, an industrial trade association. "There is a lot of confusion."

 

Left waiting are people like Kelsey, who is now unemployed after spending nine years working for Verizon.

 

On a recent morning Kelsey stood leaning on her cane outside a Washington career center, clutching copies of her COBRA invoice, clippings from a local newspaper about the stimulus bill and a form letter she received from the White House after writing to Obama about her troubles.

 

Kelsey knew about the reduced premium and said it would bring her COBRA costs from a nearly unreachable $550 a month to below $200. But when she called her benefits department, she learned that she probably wouldn't get the reduced cost until May.

 

"I can't take advantage of it now, which I think is totally unfair," Kelsey said.

 

Under the stimulus bill, workers unable to get the reduced premium immediately may be reimbursed later.

 

That would be little help to Kelsey and others who need the benefit now.

 

An IRS spokesman said the agency is moving as fast as it can. A Labor Department spokeswoman responded to questions by e-mailing a link to a short agency fact sheet.

 

One question that employers are struggling with is how to find employees laid off as far back as September.

 

Also, the legislation says only workers who were "involuntarily terminated" are eligible, but never defines that term. Does it include only people who are laid off? Or those who take buyouts offered by their employers?

 

No one knows how many people will actually seek a share of the stimulus money to pay their COBRA premiums. Congressional experts estimated 7 million, but that may be too high.

 

Advocates fear that even cut-rate COBRA could prove too little, too late for some jobless Americans.

 

"For many people it will remain unaffordable," said Ron Pollack, executive director of Families USA, a liberal advocacy group that has worked for years to expand health care coverage.

 

On the Net:

White House:http://www.whitehouse.gov/

 

COBRA:http://www.dol.gov/ebsa/COBRA.html

 

IRS:http://tinyurl.com/cozxx6

 

© 2009 The Associated Press.

 

Fewer kids have high lead levels than 20 years ago

 

Associated Press

By Lindsey Tanner

Washington Post

Monday, March 2, 2009

 

CHICAGO -- In a stunning improvement in children's health, far fewer kids have high lead levels than 20 years ago, new government research reports _ a testament to aggressive efforts to get lead out of paint, water and soil.

 

Lead can interfere with the developing nervous system and cause permanent problems with learning, memory and behavior. Children in poor neighborhoods have generally been more at risk because they tend to live in older housing and in industrial areas.

 

Federal researchers found that just 1.4 percent of young children had elevated lead levels in their blood in 2004, the latest data available. That compares with almost 9 percent in 1988.

 

"It has been a remarkable decline," said study co-author Mary Jean Brown of the Centers for Disease Control and Prevention. "It's a public health success story."

 

The 84 percent drop extends a trend that began in the 1970s when efforts began to remove lead from gasoline. The researchers credited continuing steps to reduce children's exposure to lead in old house paint, soil, water and other sources.

 

The study was being released Monday in the March edition of the journal Pediatrics. It is based on nearly 5,000 children, ages 1 to 5, who were part of a periodic government health survey.

 

The government considers levels of at least 10 micrograms of lead per deciliter of blood to be elevated, although research has shown that levels less than that can still cause problems including attention and reading difficulties. There is no known "safe" level, the study authors noted.

 

Caroline Cox, research director of the Center for Environmental Health, a California-based advocacy group, noted that lead poisoning "is entirely preventable."

 

"There's no reason even one child in the United States should be poisoned by lead," Cox said. "It's great there aren't as many now as there were, but there are still too many."

 

By 2004, racial disparities among children with blood-lead levels higher than 10 micrograms had mostly disappeared: About equal numbers of white, black and Mexican-American children had levels in that range.

 

However, disparities at lower levels remained. For example, almost 18 percent of white children had levels of less than 1 microgram per deciliter, versus 11 percent of Mexican-Americans and 4 percent of blacks.

 

Children from lower-income families also had higher lead levels than those from wealthier families.

 

Dr. Bruce Lanphear, a lead specialist at Cincinnati Children's Hospital Medical Center who wasn't involved in the government study, said lead levels have probably continued to decline since 2004. But the findings show "we need to still continue to be aggressive" with prevention efforts, he said.

 

Lead-based paint in old housing, which can contaminate house dust and soil, is the main source. Children also can be exposed to lead in water, mostly from old plumbing pipes, as well as toys and certain folk medicines.

 

The CDC recommends that pregnant women and young children avoid housing built before 1978 that is undergoing renovation. Other recommendations include regularly washing children's hands and toys; frequent washing of floors and window sills, where paint dust can collect; and avoiding hot tap water for drinking, cooking and making baby formula. Hot tap water generally contains higher lead levels from plumbing than cold water.

 

On the Net:

Pediatrics:http://www.pediatrics.org/

 

CDC:http://www.cdc.gov/

 

© 2009 The Associated Press.

 

Indian Youth Festival Puts Sexy Back in Dialogue About Safe Sex

 

By Rama Lakshmi

Washington Post

Monday, March 2, 2009; A12

 

NEW DELHI -- A recent youth festival aimed at raising awareness about health issues and HIV in India did something unique to draw visitors. Amid all the sobering talk of at-risk communities, safe sex and health care, the festival invited bashful attendees to talk about pleasure.

 

At one booth, visitors were urged to leave tips in a drop box under a sign that asked, "Can safe sex be sexy?" In another booth nearby, the use of the female condom was demonstrated to curious onlookers.

 

But talking about sex can be an uphill task in India's traditional and patriarchal society. Even though India gave the world the "Kama Sutra," the ancient Sanskrit text about sexual behavior, open conversations about sex remain taboo in the country.

 

"The whole debate about safe sex has been conducted around fear, danger, disease and death. It is negative. We forgot the pursuit of pleasure. We have to put the sexy back into safer sex," said Anne Philpott, the British founder of the Pleasure Project, an international educational program that promotes safe sex that "feels good."

 

The program was born out of Philpott's experience promoting female condoms in India, Sri Lanka, Senegal and Zimbabwe as an "erotic accessory." In the past four years, she has pushed the pleasure principle at AIDS conferences in Bangkok, Sri Lanka and Mexico, and she is teaming up with Indian health groups to re-spin the safe-sex message.

 

"Health workers often address the issue of safe sex in a clinical manner or like a teacher wagging their finger. It is more effective when they find creative ways to incorporate pleasure and desire into the sexual-health dialogue," she said.

 

About 2.5 million Indians were living with HIV in 2006, according to a report by the United Nations, and one-third of them were ages 15 to 24. Fifteen years after India began a national anti-AIDS program, the government is still confronting the basic challenge of getting people to even utter the word "condom." An advertisement campaign called "Condom Bindaas Bol" or "Say Condom Freely" urges people to say the word without fear of stigma.

 

"In our culture, there are so many wedding songs that are full of playful sexual connotations. Women sing it, but when you ask them to talk, they go shy," said Rituparna Borah, project associate for Nirantar, a group that works on rural women's health issues in northern India. "But once they begin to speak, the walls come down."

 

One area in which Philpott's pleasure principle is being implemented successfully in India is the promotion of the female condom.

 

At the youth festival, held last month and dubbed Project 19, the volunteers led a game in which they asked amused visitors to describe their first impression of the female condom.

 

"We tell the sex workers to have fun with the female condom. We tell them, 'You spend money on makeup, jewelry, jasmine flowers for your hair. This female condom is another ornament for you,' " said Kavita Potturi, national program manager with Hindustan Latex Family Planning Promotion Trust, a division of a company that sells the female condom.

 

Two years after a limited introduction, India will scale up the distribution of female condoms among 200,000 sex workers. According to a study by the governmental National Aids Control Organization, sex workers said they often persuaded their clients to use protection by citing enhanced pleasure from it. The number of nongovernmental groups using the pleasure rationale to promote safe sex is slowly growing in India.

 

"When we begin to talk about HIV and AIDS, people run away. They think we are preaching celibacy," said G. Krishna, a gay health worker with a group called Suraksha Society in the southern city of Hyderabad. "I have now begun conducting rapport-building exercises by asking people how and what they enjoy."

 

At the festival, a giggly group of college students who stopped at Philpott's stall excitedly wrote down tips, drew sketches and asked questions.

 

"We can totally relate to this. We are tired of moral lecturing about safe sex all the time," said Swedha Singh, 18, a mathematics undergraduate at Delhi University.

 

Health workers said they faced barriers in communicating with young people.

 

"Talking about disease and fear haven't worked very well. People believe they are in a safe relationship and that disease does not apply to them," said Arushi Singh, a resource officer for the International Planned Parenthood Federation, which trains health educators in South Asia.

 

"But pleasure," she said, "applies to everybody."

 

Copyright 2009 Washington Post.

 

Flu viruses growing resistant to key weapon Tamiflu

 

By Steve Sternberg

USA Today

Monday, March 2, 2009

 

Evidence that flu viruses are becoming more resistant to the drug Tamiflu has sown deep concern among doctors who are worried that their best flu treatment is losing its punch.

 

The spread of resistance also has potentially weakened a pillar of the stockpiles of drugs that will be used to combat global flu outbreaks, doctors say.

 

The first in-depth analysis of Tamiflu resistance during last year's flu season found that about 12% of people with one of the three strains that caused the most illness, influenza A/H1N1, were infected with resistant viruses. One in five of last year's patients caught the strain, doctors reported Monday.

 

This year, Tamiflu resistance in that class of viruses has reached almost 100%, turning the tables on a drug designed to defeat resistance. "They're the most common viruses circulating this year," says flu expert William Schaffner of Vanderbilt University. "There are calls coming in from all over the country to infectious-disease doctors and public health specialists asking them how to proceed."

 

The evidence of growing resistance prompted the Centers for Disease Control and Prevention in December to alter its treatment recommendations. The CDC now urges doctors to use Tamiflu for patients with influenza B viruses or, when they haven't identified the flu type, with rimantadine, one of two drugs from an older class of flu fighting agents.

 

Relenza, a close cousin of Tamiflu, is still broadly effective, doctors say, but the drug isn't recommended for children younger than 7, those with asthma and those unable to use an oral inhaler.

 

Doctors say the rapid spread of Tamiflu resistance underscores the value of vaccination. "That's your best protection," says Alicia Fry of the CDC, who is a leader of the government's Tamiflu resistance working group.

 

Fry's team tested 1,155 A/H1N1 viruses from 45 states. They found that 142 viruses from 24 states were resistant to Tamiflu, or 12.3%. So far this year, 264 of 268 viruses tested were Tamiflu-resistant, or 98.5%, they report in The Journal of the American Medical Association.

 

The study provoked immediate concern among those in charge of outbreak preparedness, says Robin Robinson, who directs the emergency-response stockpile for the Department of Health and Human Services. Robinson says experts now are considering whether to change the stockpile to be better prepared to deal with Tamiflu resistance.

 

 

Copyright 2009 USA Today.

 

Opinion

 

Deaths put flu in spotlight

 

Carroll County Times Editorial

Monday, March 2, 2009

 

The deaths of two teenagers in Maryland attributed to the flu and an increase in absenteeism in schools has officials urging parents and people of all ages of the importance of getting flu shots.

 

Spring may be just around the corner, but in recent weeks the flu, as well as other viruses, seem to have been picking up.

 

The deaths of teens in Howard and Frederick counties have sparked some concerns, but officials say that there is no evidence to suggest that this year’s flu virus or the spread of the flu is greater than in past years.

 

According to the Centers for Disease Control and Prevention, nine other youngsters have died as a result of the flu this year.

 

In Carroll schools, officials say that there was an increase in absenteeism in recent weeks, likely attributable to illnesses. On Feb. 18, eight schools reported absentee rates greater than 10 percent, which is the point where the numbers have to be reported to the county health department. The following day seven schools reported that rate.

 

While many students don’t want to miss school or fall behind, staying home is the best thing that they can do if they are feeling sick. That way, they aren’t infecting others.

 

And for those who haven’t gotten sick, officials reiterate that hand-washing is a good way to reduce the chance of picking up a virus. Hands should be scrubbed at least 20 seconds or people should use a hand sanitizer to get rid of bacteria.

 

People should also get flu shots to reduce the chance of catching the virus. While some past years have seen shortages of vaccines, that is not the case this year.

 

Hopefully the increase seen in recent weeks was the peak of the flu season, and illnesses related to the flu will begin to decrease. But other illnesses can be transmitted in similar fashion, so getting into a routine of good handwashing and help reduce the chance of picking up someone else’s virus all year.

 

And, regardless of it is the flu or some other illness, staying home — either from school or from your job — can minimize the chance of you infecting other people.

 

Copyright © 2009 Carroll County Times. All Rights Reserved.

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