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A NEW WINDOW INTO THE DISCUSSION ON HEALTH CARE POLICY
by Dan Weintraub

After more than 25 years covering public policy and politics for California newspapers, Dan Weintraub begins a new online journalism initiative that promises to report on California's government and its communities in new ways.

HealthyCal.org, a nonprofit web site I'm creating with initial funding from the California Endowment, will cover public health policy from inside the Capitol and from communities across California. The goal is to connect the two in a conversation that will inform both.

Despite a general belief among physicians that extreme obesity is too difficult to treat, except with bariatric surgery, researchers at the Pennington Biomedical Research Center have learned a substantial proportion of individuals with extreme obesity can lose 10-percent or more of their body weight through medical treatment that does not include surgery.

10% Loss Improves Risk Factors and Health

Furthermore, even though those individuals are still obese, they have improvements in risk factors and other health markers.

Weight Loss Surgery Not Often Affordable or Reimbursed by Insurance

"This is important, because surgery is not often affordable or reimbursed by insurance," said leading scientist Dr. Donna Ryan. "In fact, many medical treatments are frequently not reimbursed by insurance if they are for obesity. So this research is needed to show that primary care doctors are capable of helping obese patients lose weight to improve health, even those with extreme obesity. "

Ryan said losing only five-percent of body weight can reap healthy benefits for the extremely obese, and nearly 61-percent of those in her clinical trial achieved that. More than 40-percent lost 10-percent body weight or more.

Physicians Trained in Intensive Medical Intervention

Ryan and her team spread out across Louisiana to recruit and train practicing physicians and their office staffs in eight cities in what she called "intensive medical intervention," in which physicians used a combination of medication, low-calorie diets and behavior changes. All of the techniques were endorsed by national guidelines for obesity management. Training of physicians and their staffs took about a day and a half.

Funded by the Louisiana Office of Group Benefits, which provides health coverage for state employees, the research team contacted state employees, seeking participants to screen for and enroll in the trial. Nearly 400 participants enrolled in the two-year trial, called LOSS, using the nearest trained physicians.

About half of the participants received the intensive medical intervention, the other half received what Ryan called "usual care." 

Program Starts with Low-calorie Liquid Diet

Those in the intense intervention group were immediately placed on a low-calorie liquid diet. They gradually moved to a low calorie, highly controlled diet using meal replacements, and received weight loss medication and group behavioral therapy that included lessons in exercise, activity, self-monitoring and recommendations for walking, water exercise and weight training. The group sessions were supervised by office staff.

Recommended Activities

• exercise
• activity
• self-monitoring
  
• recommendations for walking
• water exercise
  
• weight training

Success in Daily Routine of Doctor's Practice

"We conducted this trial as close to the reality of a typical clinic setting as we could," Ryan said, "We didn't want to learn just if these strategies worked, but if they would work in the daily routine of a doctor's practice."

Challenge of Keeping Weight Off

Ryan noted that the continual challenge in weight loss is keeping weight off, and that means sticking with a routine.

More than 50% of the LOSS participants stuck with it for two years or more, keeping much of the weight off, but Ryan said that does leave room for improving weight loss maintenance.

The LOSS trial results were published in the current issue of the Archives of Internal Medicine.

The Pennington Biomedical Research Center is a campus of the Louisiana State University System and conducts basic, clinical and population research.

More information about recalled food products is available on the Food Safety and Inspection Service Web site at http://www.fsis.usda.gov/

Federal Food Safety and Inspection
The Food Safety and Inspection Service (FSIS) is the public health agency in the U.S. Department of Agriculture responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged.

Product Recall Specifics:  Call the Manufacturing  Company
Consumers with questions regarding recalled items should contact companies that issue recalls.

Testing Products for Safety
The Hygienic Laboratory in Iowa is one example of food testing to prevent outbreaks spreading. With techniques such as DNA fingerprinting, lab testing can identify specific contaminants, such as Salmonella.

The Hygienic Laboratory is the state of Iowa's environmental and public health laboratory, with facilities located at the University of Iowa's Research Campus in Iowa City and at the Iowa Lab Facilities in Ankeny, a Des Moines suburb. For more information about the laboratory and its programs and services, visit http://www.uhl.uiowa.edu.

EnviroFacts is an online tool that maps your area of choice with specific details about water quality, hazardous waste, air and land toxics, compliance issues and more.

Pollution Map...Online

The free online tool is based on GIS (Geographic Information Systems) where data is input into a visual format like a map. You can customize the type of information to display on your map or even map by topic instead of location to learn more about that issue. Search by Zip Code, City or County.

Check on the UV Index for your area... or who produces air emissions!
Identify Brownfields, or Hazardous Waste Sties... or Water Discharges... or Public Water Systems Violations...

It pays to know where invisible or hidden dangers lurk...

Research a neighborhood before you move there!
Reserach what's IN YOUR current neighborhood!
Find a community service project to clean up for your family and neighbors...

Learn about the natural systems in your community...and how they affect your health:

• Air
• Land
• Facilities
• Water
• Toxics
• Waste
• Radiation
• Compliance
• ...Other

Visit http://www.epa.gov/enviro/ to explore this newly updated program.

The possibilities are endless as you explore your world on a different level. This resource can be used for school or for your own personal interests. Maybe it could lead to community service projects based on the pollution issues in your area or a great visual for a class project. You can also take a look at the Community Service Projects page on EPA's High School Website or just see the resources out there for you to use.

Learning WHAT is in your community is the first, vital step to doing something about the problem -- and avoiding what can be harmful to you and your family.  Knowledge is power!

Learn more

Lead-based Paint Dangerous for Children

Young children are particularly susceptible to lead poisoning since they are more likely to ingest lead paint chips, flakes, or dust and are more sensitive to the adverse health effects of lead. Elevated lead levels in young children can trigger

• learning disabilities
• decreased growth
• hyperactivity
• impaired hearing
• brain damage

Lead can be found in a number of places inside and outside the home. For example, lead can be found in household dust from deteriorating lead-based paint or from soil tracked into the house. It can also be found in drinking water coming from old lead pipes, fixtures and solder.

"Childhood lead poisoning is easily preventable with the right information and awareness. This grant will help Arizona tribal communities raise awareness about preventing lead's adverse health effects," said Administrator Jackson. "This project is an important example of the efforts happening across the country to protect our children from a major health threat."

Lead-based Paint Outreach to Native American Tribes

The Inter-Tribal Council of Arizona is developing culturally specific outreach materials to educate tribal families, especially parents of young children, and tribal staff on the health risks to children from exposure to lead-based paint.

Lead Awareness for Facility Maintenance Personnel

The program specifically reaches out to facility maintenance personnel to stress the importance of using lead-safe work practices when renovating buildings.

The use of lead-based paint in U.S. residential housing was banned in 1978.

Approximately 75% of the U.S. housing stock built before 1978, or 64 million homes, contain some lead-based paint.

For information on EPA's lead paint program, go to: http://www.epa.gov/region09/toxic/lead

For information on lead in paint, dust and soil, visit: http://www.epa.gov/lead

For information on protecting your family from lead hazards, visit: http://www.epa.gov/lead/pubs/leadinfo.htm#where

Did You Know?

• About 76 million cases of food poisoning occur in the United States every year.
• Simply keeping cold foods cold and hot foods hot before serving can prevent many cases of food poisoning.
• Salmonella is better known, but another bacterium called Campylobacter (found on foods like raw chicken) is the No. 1 cause of food poisoning in the United States and the world.
• There are two main kinds of food poisoning. One results from toxins or poisons produced by microbes in food before consumption. The other results from microbes in food that infect the body and grow after consumption.
• Most cases of "24-hour flu," with its vomiting and diarrhea, actually are food poisoning.

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"Killer spices" provide eco-friendly pesticides for organic fruits and veggies

Rosemary, thyme, clove, and mint are well-known spices that are emerging as organic agriculture's key weapons against insect pests.

Scientists in Canada are reporting new research on these so-called "essential oil pesticides" or "killer spices." These pesticides have added to the crop-preserving arsenal of organic growers and offer several advantages over their counterparts -- they're readily available and don't require lots of regulatory approval.

And they're safer for gardeners and farm workers, who are at high risk for pesticide exposure.

Murray Isman, Ph.D., of the University of British Columbia is developing these pesticides.

So, just what is it exactly about these spices that allow them to work their magic outside the kitchen? Here's Dr. Isman again:

"It turns out that some of these oils and some of the chemical constituents in the oils are neurotoxic to many types of insects. At least one of their actions, and we're not certain about all of their actions, one of their actions is they interfere with a neuromodulator in insects called octopamine. It's sort of an internal valium for insects, it sort of calms them down so their nervous systems
don't get overstimulated by external stimuli. If you remove that octopamine, which is what
some of these oils do, they get hyperexcited and eventually die."

These pesticides, usually a combination of spices diluted with water, have added to the crop-preserving arsenal of organic growers and offer several advantages over their counterparts. First, they are readily available and don't require lots of regulatory approval. Also, insects exposed to the spices are less likely to evolve resistance to the toxins. And, they're safer for farm workers, who are at high risk for pesticide exposure. 

"Some of these oils, as some other people have mentioned, are very good antimicrobials,
so they could be very useful against food spoilage organisms, for example. They are useful
against certain plant pathogenic fungi and bacteria, and they do have this phytotoxic effect
on plants, so at high concentrations they can be used as natural herbicides."

 

Lead Disclosure Required for Rental & Sale Properties

Property owners are required to disclose whether reports about lead-based paint or lead hazards existed for apartments prior to tenants signing lease agreements. Violations are subject to hefty fines via the federally regulated Toxic Substances Control Act.

Childhood lead poisoning from exposure to lead-based paint chips or dust continues to be an environmental challenge. Without adequate information about lead hazards, tenants and home owners cannot protect themselves and their families from the significant risks that these hazards present.

Many homes built before 1978 have lead-based paint.

The federal government banned lead-based paint from housing in 1978.

When you are home hunting, be sure to ask:

• When was this property built?
• Has it been tested for lead?  For mold?
• Do you have the required EPA disclosure information? 

Hazardous substances affect children, in particular.

Children with high levels of lead in their bodies can suffer from damage to the brain and nervous system, behavior and learning problems, such as hyperactivity, slowed growth, or hearing problems.

Federal law requires that persons and entities who sell or rent housing built before 1978 must

• provide an EPA-approved lead hazard information pamphlet;
  
• include lead notification language in sales and rental forms;
• disclose any known lead-based paint hazards and provide reports to buyers or renters;
• allow a lead inspection or risk assessment by home buyers;
• and maintain records certifying compliance with applicable federal requirements for three years.

Lead hazards may be controlled through specific maintenance practices or eliminated through abatement. For additional information on lead in paint, dust and soil, see: http://www.epa.gov/lead/.

HHS Secretary Kathleen Sebelius released $2.6 billion to states to help low income citizens with their heating bills during October, November and December of this year. These funds represent grants to states, tribes and territories under the Low Income Home Energy Assistance Program (LIHEAP).

"By releasing this money now, we are helping to provide needed assistance to millions of Americans who otherwise might not be able to afford heat this winter," Secretary Sebelius said. "This program helps to offset seasonal energy costs for low income families, leaving more of their income to use for other necessities."

LIHEAP helps eligible families pay the costs of heating and insulating their homes in the winter, and cooling their homes in the summer. HHS is releasing such a large allocation of LIHEAP funds now in order to ensure that states have resources available to support their energy assistance programs as the weather turns colder.

"Each year LIHEAP helps more than five million low income households deal with energy costs," said Carmen Nazario, assistant secretary for children and families. "We will continue to work with states, tribes and territories to assure their heating assistance programs work effectively."

For a complete list of state allocations of the funds released today go to http://www.acf.hhs.gov/news/press/2009/liheap_2010.html.

Individuals interested in applying for energy assistance should contact their local/state LIHEAP agency. For more information, go to http://www.acf.hhs.gov/programs/liheap/ or http://www.acf.hhs.gov/programs/ocs/liheap/brochure/brochure.html.

Improving Care in Nation's Ambulatory Surgical Centers

To reduce healthcare-associated infections (HAIs) in stand-alone or same-day surgical centers, the HHS Secretary Kathleen Sebelius  announced the availability of up to $9 million in funding from the American Recovery and Reinvestment Act (ARRA) to state survey agencies in 43 states.

Healthcare-associated infections (HAIs) are infections some patients acquire when they are in a health care setting such as a hospital or outpatient clinic.

"Because of the Recovery Act, millions of patients who go to stand-alone surgical centers will have greater assurance that they won't come home with a new infection," said Health and Human Services' Secretary Kathleen Sebelius.  "Residents in these 43 states will continue to see the benefits from the Recovery Act not only by addressing health care associated infections, but by putting people to work to solve an important issue and improve the quality of life for Americans."

Healthcare Jobs in HAV Prevention

Healthcare-Associated Infections kill nearly 100,000 people and add an extra $30 billion in healthcare costs every year. 

"With a little bit of knowledge, and some extra effort, much of that can be prevented.  I'm glad to see these funds going to help put people to work combating this tragedy around the country," said Congressman Dave Obey (D-WI), the Chairman of the House Appropriations Committee, who was a lead author of the Recovery Act and has been an outspoken advocate for efforts to reduce HAIs.

CMS-approved private accrediting organizations

Accredited facilities are surveyed by CMS-approved private accrediting organizations.  As part of the new initiative, surveyors in the 43 states will survey approximately 1,300 ambulatory surgical centers (ASCs) across the nation, one-third of the more than 3,800 non-accredited ASCs across the country during the next 12 months. 

State surveyors will employ a new CMS survey process for ASCs that uses an infection control tool developed in conjunction with the Centers for Disease Control and Prevention (CDC). 

Healthcare Trends: Across the United States, health care services are being shifted to outpatient settings such as ambulatory care facilities, long term care facilities, and free-standing specialty care sites. 

The number of ASCs participating in Medicare grew from about 3600 in calendar year 2002 to 5200 in early 2009, a 44 percent increase. 

ASCs account for more than 43 percent of all same-day (ambulatory) surgery in the United States, amounting to about 15 million procedures every year. 

Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies, orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries. 

HAI outbreaks in outpatient settings continue to occur according to the CDC.

Solution:  Employ basic infection control practices

In several ASC-related communicable disease outbreaks, failure to employ very basic infection control practices were implicated, leading CMS to identify this as an area for additional oversight.

In the last fiscal year, 12 states volunteered to get a head start on this nationwide effort to reduce healthcare-associated infections in stand-alone or same-day surgical centers by beginning to survey ASCs with funding of nearly $1 million provided through the Recovery Act.

Solution: create or expand state-based HAI prevention and surveillance efforts

In addition to the funds being made available for the inspection of ASCs, the CDC has also made $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs. 

These funds support activities outlined in HHS' 2009 Action Plan to Prevent Healthcare-Associated Infections. The plan also establishes national goals, prioritizes recommended clinical practices, and coordinates a national research agenda. Development of this national plan, available at http://www.hhs.gov/ophs/initiatives/hai, is coordinated by HHS' Office of Public Health and Science, and involves participation from the Agency for Healthcare Research and Quality, CDC, CMS, the Food and Drug Administration, the Indian Health Service, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, and other HHS offices, and the Department of Veterans Affairs.