Saturday 30 August 2008

Alabama Board Approves Plan To Charge State Employees For Obesity, Health Problems


The Alabama State Employees' Insurance Board last week approved a plan that will demand state employees who are obese or have health problems to make progress to address those issues or give a monthly charge for health insurance, the AP/Philadelphia Inquirer reports.

Under the plan, state employees must undergo a health screening at no cost by January 2010 or give a $25 monthly consign for health insurance, which all workers currently welcome at no cost. In the event that the screenings find serious problems with blood pressure, cholesterol, glucose or obesity, state employees testament have one year to visit a physician at no price, enroll in a health program or take steps on their own to improve their health. In the event that reexamination screenings do not point progress, united States Department of State employees will have to begin to pay the monthly charge in January 2011. The board will consider state employees with a BMI of at least 35 obese. The board has not determined the quantity of advance that state employees will have to make to avoid the monthly charge.

According to William Ashmore, administrator director of the indemnity board, the plan will cost an estimated $1.6 zillion next year for screenings and health programs just likely will result in significant nest egg over the long term. Ashmore said that individuals with a body pile index of 35 to 39 account for $1,748 more in annual health guardianship costs than those with a normal BMI of less than 25.

Board member Robert Wagstaff said, "We ar trying to get individuals to turn more aware of their health." Mac McArthur -- executive manager of the Alabama State Employees Association, the union that represents state employees -- called the be after "positive," only workers criticized the plan as unfair (Rawls, AP/Philadelphia Inquirer, 8/24).

Editorial
Summaries of deuce editorials around the plan appear below.



Miami Herald: The plan is a "bad approach to an confessedly worrisome problem," a Herald editorial states. "Yes, it is a good estimation to encourage employees to improve their health, grow in condition, be fit," the editorial states, adding, "However, being overweight -- even weighty -- is not necessarily linked to one's diet" and frequently is "more than about genes. The editorial states, "This is a situation where the cultivated carrot is punter than the stick" because a plan that offers rewards for "improvement creates positive incentives and good karma," adding, "Assessing a cash penalty for lack of melioration ... can make for, but at that place may non be wide buy-in of the concept." In addition, "many hoi polloi who ar of 'average' weight ar afflicted with the kind of medical issues ... typically associated with obesity," the editorial states. "If the concern is about poor health, why not focus on wellness issues rather of system of weights?" the editorial states (Miami Herald, 8/25).



Rochester Democrat and Chronicle: The plan is "extreme," simply "is anyone really surprised?" a Democrat and Chronicle editorial states. The editorial adds, "With health care costs continuing to volute, it was just a matter of time before employers took out the hammer to achieve nest egg." According to the editorial, "this thomas Nelson Page would rather see incentives that reward healthy behaviors" because some "people are genetically predisposed" to obesity. However, the editorial concludes, "there is no denying that, when Alabama has a population that ranks only second to Mississippi in obesity, exceptional measures are necessary" (Rochester Democrat and Chronicle, 8/26).

Reprinted with tolerant permission from http://www.kaisernetwork.org. You tin can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for electronic mail delivery at http://www.kaisernetwork.

Wednesday 20 August 2008

Low-Income, Minority Women Face Health Disparities In California, Report Finds


Low-income and minority women in California ar more likely to be in poor health, rotund and uninsured than whites and higher-income women, according to a University of California Center for Health Policy Research report released on Thursday, the Fresno Bee reports. The report, "Women's Health in California," is based on more than 50,000 telephone interviews conducted in 2001 and 2005.

The report constitute that:
Statewide, low-income Hispanic women are three times more than likely to be uninsured than whites;


Low-income women are four times more likely than higher-income women to be uninsured;


Low-income women 'tween ages 18 and 64 are troika times more likely than higher-income women to report that they are in fair to poor health;


Low-income women ar more potential to feature health conditions such as arthritis, high blood insistence, heart disease and diabetes, which bear on their quality of life, compared with higher-income women; and


More than 20% of low-income women statewide ar obese and 25.5% are corpulence.

Erin Peckham, a researcher at the center and author of the report, said, "People might want to do better with their health, but the lack of money, the lack of medical care and the lack of access in low-income neighborhoods to salubrious foods and safe physical activity are the things that low-income people in Fresno and the Valley areas face." She added, "Bottom line, if you're poor or a minority, you ar potentially in trouble health-wise. California needs to regenerate its efforts at seeking a root to our lack of health indemnity overall" (Anderson, Fresno Bee, 8/7).

The report is available online.


Reprinted with kind permission from hTTP://www.kaisernetwork.org. You can view the full Kaiser Daily Health Policy Report, search the archives, or sign up for email obstetrical delivery at hypertext transfer protocol://www.kaisernetwork.

Sunday 10 August 2008

Comprehensive Treatment Of Extensively Drug-Resistant TB Works, Study Finds

�The dying sentence that too often accompanies a diagnosis of extensively drug-resistant tuberculosis (XDR-TB) can be commuted if an personalized outpatient therapy program is followed - even in countries with limited resources and a heavy burden of TB.


A study conducted in Peru between 1999 and 2002 shows that more than 60 percent of XDR-TB patients not co-infected with HIV were healed after receiving the bulk of their personalized treatment at home or in community-based settings. The paper appears in the August 7, 2008 issue of The New England Journal of Medicine.


"It's essential that the world know that XDR-TB is not a expiry sentence," says lead source Carole Mitnick, instructor in the Department of Global Health and Social Medicine at Harvard Medical School (HMS). "As or even more significantly, our study shows that effective treatment does non require hospitalization or indefinite confinement of patients."


In some parts of the world, however, patients with XDR-TB and other drug-resistant forms of the disease are confined against their will in TB hospitals that resemble prisons, Mitnick adds.


Researchers from HMS, Brigham and Women's Hospital, Partners In Health, Harvard School of Public Health, and the Massachusetts State Laboratory Institute, along with Lima, Peru-based organizations Socios en Salud, the Peruvian Ministry of Health, and Hospital Nacional Sergio E. Bernales, had already demonstrated that aggressive, outpatient treatment could cure multi-drug resistant tuberculosis (MDR-TB), which is resistant to two first-line anti-TB drugs. That pilot film program has been adoptive as a national attempt by the Peruvian government activity.


A like protocol was used for the recent study of XDR-TB, which is caused by TB bacteria that are repellent not only to the same first-line anti-TB drugs, but likewise to the two most important second-line drug classes.


A number of 810 patients with unsuccessfully treated tuberculosis were referred for free personalised drug treatment and additional services as needed, including surgery, adverse-event management, and nutritional and psychological funding. Sputum civilisation and drug-susceptibility testing results, performed at the Massachusetts State Laboratory Institute in Boston, were available for 651 patients. Based on susceptibility results for 12 anti-TB drugs, clinicians developed regimens that included five-spot or more drugs to which the infecting strains were potential to respond. Forty-eight patients had XDR-TB; 603 had MDR-TB. None of the XDR-TB patients were co-infected with the HIV virus.


At the end of treatment, 60.4 pct in the XDR-TB radical were vulcanized; 66.3 percent with MDR-TB were cured. The outcomes among XDR-TB patients were bettor than about reported from hospital settings in Europe, the U.S., and Korea, Mitnick says.


Frequent contact with healthcare workers afforded many benefits and was an important element of success. Daily, supervised treatment was delivered in patient homes and at biotic community health centers. The community health workers ensured a high point of treatment adherence and promptly detected circumstances requiring additional attention, including contrary events. Psycho-social needs were also assessed continuously and addressed through a range of interventions.


"It's authoritative for people to infer that this ambulatory form of treatment exists, is successful, and can be widely enforced in resource-poor settings," Mitnick says.


Community-based interventions as well protect infirmary patients and staff from transmission of TB and allow TB patients to remain with their families during this protracted treatment. If hospitals have to accommodate only those with serious aesculapian needs, this intervention tush be enforced widely, and earlier in the disease course.


The benefits would be profound, Mitnick says. In addition to reduced morbidity and mortality among patients, an epidemiologic impact could be expected: a decrease in the incidence of immune TB has been reported only in places where universal showing and treatment for DR-TB are offered at first TB diagnosing.


"DR-TB is everywhere in the mankind it's been looked for and it's not going away without additional resources," Mitnick says. According to a posting issued by the World Health Organization this year, ever since it was first described in 2006, XDR-TB has been reported in 49 countries, including the United States. Approximately 1.5 million people are estimated to have MDR-TB, "just no one really knows how many have XDR-TB." Expanded community-based delivery of improved handling is essential to stem this epidemic.


This study was funded by The Bill & Melinda Gates Foundation. Additional collaborators in the delivery of concern included the U.S. Centers for Disease Control & Prevention, the World Health Organization, and the U.S. Task Force for Child Survival and Development.

Citation:
"Extensively Drug-resistant Tuberculosis: A Comprehensive Treatment"

Harvard Medical School: Carole D. Mitnick, Hamish S.F. Fraser, Mercedes C. Becerra; Brigham And Women's Hospital: Sonya S. Shin, Sidney S. Atwood, Jennifer J. Furin, Garrett M. Fitzmaurice, Rocio M. Hurtado; Partners In Health: Kwonjune J. Seung, Michael L. Rich, Sharon Choi, Darius Jazayeri, Keith Joseph, Joia S. Mukherjee; Harvard School Of Public Health: Sasha C. Appleton, Molly F. Franke; Massachusetts State Laboratory Institute: Alexander Sloutsky; Socios En Salud: Felix A. Alcantara Viru, Katiuska Chalco, Dalia Guerra, Karim Llaro, Lorena Mestanza, Maribel Munoz, Eda Palacios, Jaime N. Bayona; Peruvian Ministry Of Health: Cesar A. Bonilla; Hospital Nacional Sergio E. Bernales: Epifanio Sanchez.

The New England Journal of Medicine, August 7, 2008

Harvard Medical School


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