Monthly Archives: May 2013

Easy to Do, Inexpensive; Music Calms Some ICU Patients

By Leslie Harris O’Hanlon

(Getty Images)

(Ryan McVay/Getty Images)

The adage stems from the 18th century: music has charms to sooth the savage breast. It’s probably safe to say that someone in an intensive care unit, who needs a machine to help them breathe, is in need of soothing. Usually, doctors and nurses administer drugs, powerful sedatives to help calm patients. Now, a study shows that a different kind of intervention might help: music. The study, published Monday in the Journal of the American Medical Association, adds to a growing body of research on how listening to music has a host of health benefits.

Patients in the music group received 38 percent fewer doses of sedatives.
Researchers at Ohio State University looked at ICU patients on mechanical ventilators for respiratory failure. Those who listened to the music of their choice not only had greater reduction in anxiety but also used fewer sedation drugs and lower doses compared to patients who did not have access to music — they received usual ICU care. Mechanical ventilation, or ventilatory support, is when a patient is connected to a machine, called a ventilator, to help him or her breath.

Researchers call this “patient-directed music” because patients could select their own music and put headphones on whenever they wanted.

The “intervention empowered patients to use music to manage their own anxiety whenever they felt they needed the use of music to help them relax or when they desired some quiet time,” said lead author Professor Linda L. Chlan at Ohio State. “Music does not induce adverse side effects, which are sometimes evident with sedative agents administered to these patients.” Continue reading

Quick Read: When Medicare Launched, Nobody Had Any Clue Whether It Would Work

Washington Post WonkBlog reporter Sarah Kliff tweeted Friday morning that this piece is “fun with newspaper archives.” And indeed it is.

Kliff embedded and artfully linked together clips from newspapers past, clips that tell the story of the Medicare rollout.

It’s almost as if today’s Obamacare rollout news is ripped from yesterday’s headlines: “5,000 Aged To Be Hired in New Medicare Drive” or “Selling Elderly on Medicare is Not Easy.”

“Medicare workers in Washington are learning that door-to-door selling is a rugged job,” a writer in this newspaper declared 47 years ago.
It was March 3, 1966, after a Washington Post reporter had spent the day trailing Medicare workers who tried to sign seniors up for new program. Some didn’t answer the door.

Read more at:

Alameda County Details How Transit Cuts Harm Health

By Rachel Dornhelm

(Getty Images)

(Getty Images)

At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation. Continue reading

What’s a BRCA Gene Anyway?

(Gage Skidmore/Flickr)

(Gage Skidmore/Flickr)

The first thing you need to know about the BRCA gene is that you have it.

Don’t panic. Everyone does. In fact, we all have two of them — the BRCA1 and 2 genes. They are normal genes that “have an important function in the cell. They are involved in repairing DNA damage,” explained Dr. Robert Nussbaum, a medical geneticist at UCSF. “When they’re functioning normally, they do a good job for us.”

We all have two copies of the BRCA genes. Men, too.
The problem is what happens when they don’t function normally. We’ll get to that in a minute. But first, in our call, Nussbaum gave me a helpful primer in basic genetics.

For starters, we all have two copies of each of the BRCA genes. Men, too. We get one copy from each parent.  These genes are “like sentences,” Nussbaum said. “They are made up of words.” When they’re spelled right, all is well.

But “you can have all kinds of misspellings,” Nussbaum said. “Red becomes reed. All kinds of things can happen that will alter the meaning of that sentence.” Continue reading

Brown Backs State-Run Medi-Cal Expansion

By Mina Kim

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials.

Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system.

But Brown anticipates recouping more than $300 million from the counties next fiscal year — money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms.

Farrah McDaid Ting with the California State Association of Counties says Brown’s proposal makes no sense. She says plenty of people will still rely on county services in 2014.

They are “people who qualify for Medi-Cal but don’t sign up, people who have a hard time signing up or staying on programs, the undocumented in our communities and those who are in between private health plans,” McDaid Ting said. “We need to retain enough funds to serve those people.” Continue reading

California’s Health Insurance Exchange Builds Critical Outreach Network

Covered California, the state’s health insurance exchange, announced the recipients of $37 million in education and outreach grants on Tuesday. It’s a critical step in the drive toward the full implementation of the federal health law on Jan. 1. “This program now belongs to California … and to Californians, and we have to make it work,” said Dr. Robert Ross, a Covered California board member.

The grants were awarded to 48 lead organizations, which will be supported by 226 community partner groups. They will focus on education and outreach to the 5.3 million Californians the exchange seeks to enroll, with an estimated 2.6 million of those people eligible for subsidies to help them afford insurance. Five of the recipients will target their outreach to small businesses.

Californians will be able to shop for insurance on the new marketplace starting Oct. 1, with coverage going into effect on Jan. 1. Most people must have insurance or pay a penalty. In 2014 the penalty is $95 per person or 1 percent of income (whichever is greater), and the penalty rises to $695 or 2.5 percent of income (again, whichever is greater) by 2016.  Continue reading

Why Angelina Jolie’s ‘Medical Choice’ Is Likely Not Yours

(Foreign and Commonwealth Office/Flickr)

(Foreign and Commonwealth Office/Flickr)

Angelina Jolie lit up social media Tuesday morning with her announcement that she recently had a preventive double mastectomy. She took this route, she says, because she carries a specific BRCA1 mutation — putting her at an 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer. You can read everything about her history in her New York Times piece, “My Medical Choice.”

But the key here is a specific BRCA1 mutation. There are many different mutations that can occur in the BRCA gene. Jolie is very careful to walk through all her personal decisions stemming from her unusually high risk, but emphasizes that “the risk is different in the case of each woman.”

About 10 percent of all breast cancers are due to those many BRCA mutations. Dr. Otis Brawley, chief medical officer with the American Cancer Society, explains in more detail what individual women should consider, in a response to Jolie’s piece:

This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist. Continue reading

Valley Fever Cases Soar in West, Yet ‘Off The Radar’ of East Coast Policymakers

By Rebecca Plevin, NPR

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

When she was just 6, Emily Gorospe became very tired and sick. The spunky girl, now 8, developed a fever that wouldn’t go away, and red blotches appeared across her body.

“She’s got so much energy usually,” says Emily’s mother, Valerie Gorospe. “Just walking from one part of the house … she was drained.” The little girl was also very pale. “She just didn’t look like herself,” Valerie recalls.

Emily, who lives in the Central Valley town of Delano, was eventually diagnosed with valley fever, also known as coccidioidomycosis. She’s one of an estimated 150,000 people nationwide who get the fungal disease every year. There is no cure and no vaccine.

Valley fever has afflicted about four times more people than West Nile virus, with thousands more going undiagnosed.

Valley fever is well known in the Central Valley and other areas of California and Arizona. Tiny fungal spores live in the soil throughout much of this arid region. When the spores are disturbed, they can be inhaled into the lungs.

James McCarty, the medical director of infectious diseases at Children’s Hospital Central California, says most people feel nothing, or experience symptoms similar to the flu. Common symptoms include fever, night sweats, weight loss, chest pain, cough and sometimes skin rashes.

Valley fever can be a very serious disease for some people, McCarty says. It can spread from the lungs to other parts of the body, like the central nervous system, bones or skin. It can be life-altering or even fatal. Continue reading

Mark Bittman Talks Up Part-Time Veganism (and Delivers 3 Easy Recipes)

(Getty Images)

(Getty Images)

It all started with a prescription from his doctor, but not for a drug.

“You should probably become a vegan,” New York Times food writer Mark Bittman says his doctor told him. That was six years ago. Then 57, Bittman says he was 40 pounds overweight, and his cholesterol and blood sugar which had always been normal, had moved into the “danger zone.”

Bittman had built his career around food, and being a vegan didn’t appeal to him, as he recounted this week on KQED’s Forum. “I wanted … something do-able, something I could stick with,” he said.

He hatched the idea of being vegan until dinner — “you’re only postponing gratitude” until then.

It seems to have worked. Today, he’s 35 pounds lighter and he says his blood sugar and cholesterol are back in the normal range.

Now he has recounted his experience in a new book, “VB6: Eat Vegan Before 6:00 to Restore Your Health and Lose Weight … for Good.Continue reading

Open-Campus Policies Eat Away at School Nutrition

By Katharine Mieszkowski, Center for Investigative Reporting

Scott Sowko, a sophomore at Berkeley High School, leaves Bongo Burger after lunching off-campus. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

Berkeley High School students have lunch off-campus at Bongo Burger. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

At lunchtime, hundreds of Berkeley High School students rush off campus, leaving behind healthy meals served in the cafeteria. Many of them head to Bongo Burger, Top Dog and other joints selling high-fat, high-sugar alternatives.

Six miles away at Oakland High School, the cafeteria is mobbed. There are not enough seats for everyone, so some students eat lunch outside on picnic tables while others eat in classrooms. No one goes off campus to pick up food from Wingstop or the AMPM convenience store.

The difference? The Oakland High students are no longer allowed to leave campus during lunch.

At Berkeley High, where famed chef Alice Waters’ nonprofit, the Edible Schoolyard Project, has consulted on the menu, school officials say one-tenth of the students take advantage of the healthy lunch on campus.

“Kids could be eating a good meal for free, or they could be running off campus, and in a hurry … they’re going to buy the Flamin’ Hot Cheetos and a Coke.”

In recent years, lawmakers, regulators and school districts have tried to improve students’ health by curbing the sale of junk food and tightening nutritional standards for school food. But those efforts are undermined when students can leave campus to eat whatever they want, as they can at dozens of Bay Area high schools. Based on the experience in Oakland, closing campuses while offering free lunches can be an effective strategy.  

First lady Michelle Obama has made improving what students eat a signature cause. Just this school year, cafeterias nationwide have been implementing new nutritional standards for the lunches they serve. The U.S. Department of Agriculture is working on new regulations for all other foods sold in schools, including from vending machines. But the idea of keeping kids on campus so that they eat healthy lunches is not part of the national debate.

The Oakland Unified School District closed the Oakland High campus last fall to cut down on absenteeism after lunch and reduce break-ins, drug use and trespassing in surrounding neighborhoods, said then-Principal Jeffrey Rogers.

Continue reading