Dental Care – Unavailable for Many

Not able to afford dental care? Are there no dental clinics near where you live? If so, your are like about 33 million other Americans. In a report from the Institute of Medicine (IOM) and the National Research Council (NRC) they stated that the 33 million Americans live in areas with too few dentists to meet their needs, and millions of children and retirees lack access to good oral health care because they cannot afford it.

Under current economic conditions, it is doubtful that the recommendations of the report will have much success. Still you need to know what the report said:

According to the report:

• 33.3 million people reside in areas where there aren't enough dental health professionals to meet the population's needs; 
• In 2008, 4.6 million children went without needed dental care because their families lacked the financial means to pay for it; 
• In 2006, almost two-thirds (62%) of U.S. retirees did not have dental health care coverage (Medicare does not cover dental health). 

To read the full report (242 pages) go to this link. A free downloadable PDF file is available in a box in the left column. Click on the download button and you will need to complete and form and then you will be able to download the file to your computer.
I have completed the first 100 pages, but the first approximately 30 pages covers most information and then the detail starts.

The experts stated that, “deteriorating dental health can have broader consequences for overall well-being. For example, poor oral health has been linked to heightened odds for respiratory illness, heart disease and diabetes. Rates of inappropriate use of emergency services also rise for those with poorer dental health.”

This is important to read and understand what may happen and if something appears in the news you will have some understand about what it may mean. Good luck and good dental health.

2011 Healthy Living Innovation Awards Winner

I was not even aware of this happening until I received an email about the awards. Apparently if you live east of the Mississippi River, there are places that want you to be healthy. St. Paul is the western most place give an award. Rather than duplicate this, I will let you read the press release here.

If you live in or near the award winners, check them out and see what they are doing for the health of the areas. As HHS Secretary Sebelius Kathleen states, “The 2011 Healthy Living Innovation Awards represented an exciting chance to foster the spread of effective, community-based efforts that employ innovative approaches to promote healthy weight, physical activity and nutrition,” said Secretary Sebelius. “Communities across the United States submitted creative, replicable and sustainable innovations that demonstrate outstanding leadership and promising results.”

Enjoy!

HIPAA Rules Being Enforced in Hollywood

It is about time! I just hope that the snoopers got enough money from passing on private medical information about the involved celebrities – they are going to need it for their defense. At lease the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) handed down a penalty of sizable value and ordered the University of California at Los Angeles Health System (UCLAHS) to submit a corrective action plan to close the holes in its compliance with the rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

This reflects the policies and procedures required by HIPAA and lets hospitals and medical offices know that the HHS is serious about enforcing the rules. Covered entities must reasonably guard medical records from prying eyes. Employees that chose to disregard these rules must be sanctioned, i.e. either authorized under strict rules, or penalized for violations. All employees must be aware of the rules and trained about the confidential nature of private medical records.

UCLAHS is responsible for the actions of its employees and must now train said employees in meaningful policies and procedures, including audit trails to insure access is by authorized personnel only. There must also be a clear plan in place to deal with employees that choose to violate the rules. Casual viewing of patient health information is unacceptable and against the law and employees can be prosecuted. OCR will continue to vigorously enforce the protections.

This is also an important reason to check your records once the new addition allowing patients of obtain a list of people viewing their records and for what purpose. I blogged about this a short time ago and you may read about it here. The press release about the UCLAHS violation can be read here.

Low Carb Diabetes Community Not Happy With Hope Warshaw

Hope Warshaw says in her June 12, 2011 blog “As a DHCP I’ve long realized I can’t walk a mile in a PWD shoes. I can’t know what it is like day in, day out to deal with this challenging and relentless disease.” DHCP stands for diabetes educator/healthcare provider. She wisely left out educator in the acronym because she has raised the ire of many bloggers and Type 2 people with diabetes in her latest pronouncement on Diabetes Health on June 28, 2011.

So it is obvious that Mz Warshaw is not a person with diabetes. But her article did stir up feelings about low carb when she advocated high carb. What it may have done is get something out in the open to be debated by people in the know about the benefits of low carb and let the general populace know what is needed to put a stop to the obesity epidemic in our country.

In the first part of her two part article, Hope Warshaw also missed the mark by not emphasizing that prediabetes can be managed with diet and exercise if detected early enough and people are educated about this and taught to work on weight reduction and not eating high carb as she directs in part two. She seems to advocate a one size fits all approach which for Type 2 diabetes just does not work.

I will not carry this farther, but will let you read some of the articles this has spawned and the anger in some of the comments. The best and most objective blog is by Laura Dolson of about dot com. The two Hope Warshaw articles are here and here. Another excellent blog about what may be happening is here.

It Is All About The Money for Hospitals

Hit them in the pocket book seems to be the only way the get the attention of Hospitals. This is exactly what the Centers for Medicare and Medicaid Services (CMS) has done and it is having widespread impact. While this needs to be expanded and incentives put in place, it is proving to have an effect and may lead to more actions.

Although I take my shots at the CMS for its euthanasia policies, for once I have to praise them to being on the right path. Those in the medical professions working in hospitals have ignored medically caused infections as just the cost of doing business, when if fact, this is caused by sloppy procedures and carelessness on the part of the people themselves.

Now we need to be concerned about hospital coding procedures and the fraudulent practices of some hospitals. While they say that they are working for coding accuracy, I think this is hospital talk for coding to hide the actual happenings. The survey has one gigantic fault – it did not look at whether the CMS policy actually caused a reduction in infections. The CMS no-payment policy appears to have had a positive impact on hospital infection prevention and control efforts though.

But first, lets use some of the terms for clarity. Infection preventionists is for a medical professional specializing in preventing infections in the hospital settings. This is a recent addition for many hospitals. The next is hospital-acquired conditions (HAC) and this includes much of what is targeted by CMS policy. Healthcare-associated infections (HAI) at present is not targeted by CMS. Catheter-associated urinary tract infections (CAUTIs) is a large concern and catheter-associated bloodstream infections (CLABSIs) bothers me as well.

The Association for Professionals in Infection Control and Epidemiology (APIC) is the professional organization which was conceived in 1972 in recognition of the need for an organized, systematic approach to the "control" of infections acquired as a result of hospitalization. Originally called The Association for Practitioners in Infection Control, the name was changed to the Association for Professionals in Infection Control and Epidemiology, Inc. in 1994 to recognize the organization's maturation and evolution into the broader context of health care delivery in this country. This includes the study of non-infectious adverse outcomes and the movement of care outside the traditional health care system, specifically the hospital. They have even expanded to include activities in Bioterrorism.

In the first paragraph, I mentioned putting incentives in place. This could mean that the hospitals that actually (and not by coding) reduce HACs could receive a bonus for a reduction. I'll leave this to the experts to determine a formula, but this could also help. Would I assess a penalty for an increase in HACs – by all means, even up to losing all CMS monies. Patient safety needs to be a number one priority.

The press release is here for your reading.

Food Industry Tells Obama Goals Unrealistic

Of course the food industry is not going to give in to the Obama administration. They are going to test the water and hold out for not reducing much of anything in the name of taste and getting the public to eat their food. It would be economic suicide to to otherwise. According to the food industry, the public just would not eat the food if it had to follow the suggested guidelines of the Obama administration.

Of course, they have not gone far, as they are only setting the standards for foods that can be advertised to children. In this category, they are reducing sugar, salt, calories, and fat. And this is only the nation's largest food makers. It does not include the rest of the food manufacturers. Whether all will follow these standards remains to be seen.  If a food falls in sales, I would guess it will return to what it was.

In April, the U.S. government issued guidelines it said it hopes the food industry will adopt for lower amounts of sugar, salt and fats in foods advertised to children. Those guidelines are lower than the new industry guidelines just issued. The spokeswoman for the food industry called the guidelines “unrealistic and unattainable” and said “the government should modify its guidelines”.

She stated, "We share the same goals as these government agencies. We all want healthier kids," she said. "But we think the government's proposal is unworkable and unrealistic."

It is unfortunate that the food industry has taken this stance as the Obama administration will now probably step in and we will have government in the food industry more that it already is.

Obesity expert Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said "No one with a modicum of real-world common sense is surprised that the home-grown standards of food companies are less restrictive than the government standards the same companies rejected."

"The right approach, which the industry does not even seem to be considering, would be to link marketing to a reliable measure of overall nutritional quality, not just a select nutrient or two. One-nutrient-at-a-time guidance can be entirely misleading," Katz added.

When we are told that an estimated one-third of U.S. children are now considered overweight or obese, the food industry has an obligation which they are abdicating in favor of profits. Children that weigh too much are at risk for high blood pressure, high cholesterol, type 2 diabetes, breathing problems, such as sleep apnea, and asthma, joint problems, and fatty liver disease. Then to these you may add discrimination, and poor self-esteem, which can continue into adult life.

So the food industries have said no to doing anything meaningful to help the problem for our children. Read the press release here.

Are You Ready For Nanomedicine?

Well, it seems that the Federal Drug Administration is willing to admit when it has short comings. But it is going to regulate the latest entry – nanotechnology. Noting the “critical need to learn more” about the impact of nanotechnology on medicines and medical devices, the FDA has asked for help.

Speaking out in support of this action by FDA, is Gang Bao, director of the Center for Pediatric Nanomedicine, a joint project of the Georgia Institute of Technology, Emory University, and Children's Healthcare of Atlanta.

Jamey Marth, PhD, director of the Sanford Burnham Center for Nanomedicine at the University of California, Santa Barbara said that the application of this technology is truly revolutionary.

In nanomedicine it is difficult, but important, to understand the scale of the nano. A nanometer (nm) is a billionth of a meter. For example a single sugar molecule in 1 nm in diameter, the DNA helix is 2 nm in diameter, a typical virus in 75 nm in size and a red blood cell is 7000 nm.

According to Jamey Marth, we have not been able to answer all question about a lot of diseases. These diseases, diabetes, cardiovascular disease, disease of aging, and cancer have some genetic bearing, but this is only part of the answer. With nanomedicine we will be able to identify and discover those processes that are outside our genetic makeup. Nanomedicine give us new tools to treat disease.

The FDA has already approved two cancer drugs based on nanotechnology. Besides better treatment with few side effects, the second generation drugs of this type will carry nanoparticles on their surfaces that not only target the drugs to cancer cells, but also allow them to penetrate deep into tumors.

Marth says that nanomedicine will speed the discovery of biomarkers that identify diseased cells. Once these biomarkers are found, they can be used to bind therapeutic nanoparticles only to the cells that need them, leaving normal cells alone.  Bao's team is pioneering another approach: using nanoparticles to repair genetic mutations. Their first target will be the mutation that causes sickle cell disease.

The major task ahead for the FDA will be to set guidelines for demonstrating that new nanomedicines are safe. But Marth says there are both toxic and nontoxic approaches to nanomedicine. Even so, Bao says the FDA guidance will be important, as materials that behave one way on a normal scale can behave quite differently at a nanoscale.

"There might be some unique features of nanoparticles that induce some toxic effects," Bao suggests. "If they could get into the body, stay in the cells, not be cleared, there might be some harmful effects down the road, and we need to understand that. We do not think the particles we use have any intrinsic toxicity, but we need to know this for sure."

Read the article here or a very similar one here.