More young kids going under anesthesia to fix bad dental problems

Preschoolers are increasingly having to undergo extensive surgery to get fix the cavities they've gotten from lack of brushing, get root canals or have teeth extracted.

Five years ago, the Centers for Disease Control and Prevention found the number of preschoolers with cavities had increased — the first time that had happened in 40 years. "Dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more," reports Catherine Saint Louis for The New York Times. "The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake." (Times photo by Stuart Isett)

"We have had a huge increase in kids going to the operating room," said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. "We're treating more kids more aggressively earlier."

Causes for the increase can be linked to lots of snacking and juice or other sugary drinks before bedtime; kids drinking bottled water rather than tap water; a lack of knowledge that infants should go to the dentist by age 1 to be assessed for cavity risk.

Parents can sometimes confused dental decay with teething and don't realize there is a problem until teeth break or the pain becomes so bad the child cannot sleep. (Read more)

Bill passed that would require fingerprint background checks at nursing homes

The state House has approved a bill requiring long-term care facilities to run background checks using fingerprinting technology, a move that would be mostly funded by a $3 million federal grant. The state will kick in $1 million.

The House approved the measure 62-36, though many lawmakers are worried about who is going to pay for the effort when the grant runs out in three years. Background checks cost between $60 and $80.

Now, long-term care facilities must "do a name-based background check," reports Beth Musgrave for the Lexington Herald-Leader. "However, those background checks only look at state records. A fingerprint check can search nationally for criminal records."

Rep. Carl Rollins, D-Midway, said he was unsure if House Bill 250 will pass in the Republican-controlled Senate. (Read more)

Columnist wants 'healthy labels, not stealthy labels' on groceries

Research has shown shoppers spend an average of just 1 second looking at the nutrition labels on food packages, which lends credence to an argument that the labels need to be easier to digest in a short amount of time.

In January last year, the Grocery Manufacturers Association said its members would soon start adding nutrition information to the front of packages showcasing the quantity of calories, saturated fats, sodium, sugar and nutrients inside, writes Ezekiel J. Emanuel in a column for The New York Times: "Not much happened until September, when the GMA announced that 'Facts up Front' would be the theme for the initiative, and began a second public relations blitz about the forthcoming labels."

But since then, nothing has changed. Emanuel points to failed negotiations between the GMA and the federal government that happened in fall and early winter of 2010 in which the Food and Drug Administration wanted calories, salts, sugars and saturated fats put on the front of labels. The GMA was amenable to the idea, but wanted to also post positive information about vitamins and minerals. The government balked, and negotiations fell through.

But the GMA "knew it had to do something, or risk a more stringent label rule in the future," Emanuel writes. "So it announced its own voluntary label." That label will be flawed, Emanuel argues, because "There is no reason to include positive information on Vitamin C or fiber along with the crucial information on fats, salt and calories. A lack of fiber doesn't lead to the same health crisis as an overdose of salt. And including so many facts results in information overload, diluting the label's impact. A cynic might say that is precisely what the GMA wants."

Walmart has responded by creating its own symbol system called "Great for You," which Emanuel says is a step in the right direction, "but if every company and grocer goes the independent Walmart way, we could end up with many different, confusing icons." (Read more)

Kids are still eating too much sugar, regardless of parents' income, and they're getting most of it at home

By Tara Kaprowy
Kentucky Health News

American children's sugar consumption is down, but kids are still eating too much sugar, and they are getting most of it at home.

So says a new study from the National Center for Health Statistics, which also found parent income is not playing a part in how much sugar kids are consuming. "We found that all kids are eating a lot of added sugars," said Cynthia Ogden, the study's co-author and an epidemiologist with the Centers for Disease Control and Prevention. (One study found kids in low-income families are drinking more juice than recommended, however.)

The study found sugar consumption has dropped to 17 percent of total caloric intake, from 22 percent, but 17 percent is still well higher than federal guidelines, which say total discretionary calories, including added sugar and solid fat, should account for only 5 to 15 percent of total daily caloric intake.

Sugar consumption may have declined because kids are consuming less sugar when they're not at home, thanks to bans or limits on sugary drinks at schools, said Dr. Wendy Slusser, an associate clinical professor of medicine at the Mattel Children's Hospital at the University of California. Kentucky has such a ban.

Most of the sugar is coming from food, not beverages, Linda Carroll reports for MSNBC. About 16 percent of kids' calorie intake comes from "added sugars," such those added to breads, cakes, jams, chocolate and ice cream. Those numbers do not include sugars that naturally occur in food, such as in fruit or fruit juice.

Going forward, the goal is to address how parents are feeding their children. "This is an opportunity for families," Slusser said. "There are estimates now that we could shift children's weights back to 1970s levels if we could just take 350 calories out of a kid's diet each day."

One way to do so is using water to replace sports drinks and those with 10 percent fruit juice. Giving kids Cheerios rather than Honey Nut Cheerios — or any cereal that's lower in sugar — also helps. Reading nutrition labels, avoiding processed foods and planning ahead for healthy snacks and nutritious dinners can also solve the problem. "Once there's a routine, parents can integrate healthier foods into their children's diets," Slusser said. "When you're always eating on the fly, you end up eating too many processed foods." (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Electronic patient records may not save money, study finds; critics question methodology

Though officials tout otherwise, a study has found electronic health records do not cut costs "and may actually encourage doctors to order expensive tests more often," reports Steve Lohr for The New York Times. (Photo by Keith Srakocic for The Associated Press)

The study, published in the journal Health Affairs, found doctors using EHRs to track tests, such as X-rays and MRIs, ordered 40 percent more tests than those using paper-based records. Doctors with access to a patient's previous image via a computer "ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits," Lohr reports. And when it came to more expensive and advanced tests, like MRI and CT scans, doctors using EHRs ordered more tests 70 percent of the time.

The study was based on a survey conducted by the National Center for Health Statistics, and included data from 28,000 patient visits to more than 1,100 doctors in 2008. It contradicted a 2005 study from RAND Corp., which estimated that EHRs could save as much as $80 billion a year. The Obama administration used that study as justification for $19 billion in federal spending to help providers switch to digital technology.

EHR supporters were critical of the latest study for using the NCHS data, which they say is used to assess how medical care is practiced, not how well computerized patient records work. It also "included any kind of computer access to tracking images, no matter how old or isolated the function," Lohr reports. Modern EHRs are more integrated in their function and must meet federal standards for "meaningful use" — guidelines that were not in place in 2008.

Dr. David Blumenthal, professor at Harvard Medical School and former national coordinator for health information technology for the Obama administration, found 92 percent of articles published in professional journals on EHRs were "positive over all" regarding whether the technology would improve efficiency and quality of care. Dr. Danny McCormick, lead author of the new study and assistant professor at the same school, argued his analysis "looked at not just a few cutting-edge institutions, but a nationally representative sample." (Read more)

Medicaid recipients displaced by tornadoes can get emergency 30-day refills of prescriptions

Kentuckians on Medicaid who were displaced by last week's storms can get a 30-day supply of needed medicine from their pharmacy, the Department of Medicaid Services announced yesterday.

The right to receive an emergency refill applies to residents living in Ballard, Bath, Carroll, Campbell, Grant, Grayson, Hardin, Johnson, Kenton, Laurel, Lawrence, McCracken, Magoffin, Martin, Menifee, Montgomery, Morgan, Muhlenberg, Ohio, Owsley, Pendleton, Rowan, Russell and Trimble counties. Those counties have declared a state of emergency.

The state's four managed-care organizations are informing pharmacies of the policy, which was part of an executive order signed by Gov. Steve Beshear last weekend. Medicaid recipients who are not enrolled with an MCO can also receive replacement medications at their pharmacy. Co-payments will be waived.

"Many Kentuckians depend on regular maintenance medications, like blood pressure pills, and skipping a few days could cause unnecessary hardship or possible poor health outcomes for some citizens," Beshear said. "This order will allow people to contact a pharmacist to restore their regular medications." (Read more)

Cost of an MRI in America? $1,080. France? $280. Why? providers 'largely charge what they can get away with'

Why does getting an MRI in the United States cost $1,080 when it only costs $280 in France? The answer comes down to how the prices are set, reports Ezra Klein for The Washington Post.

"That may sound obvious," he writes. "But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978."

The difference in expenditures isn't linked to the idea that Americans just use more health-care services (the opposite is actually true) or that we are sicker. A 2003 study on international heath-care costs and a survey released Friday by the International Federal of Health Plans both concluded it comes down to pricing. The latest survey showed that in 22 of 23 medical services, whether that was a routine doctor visit or coronary bypass surgery, Americans paid more than other developed countries.

The difference is based on the way the pricing is set. "Other countries negotiate very aggressively with the providers and set rates that are much lower than we do," said Gerard Anderson, who was involved in the 2003 study. In Canada and Britain, prices are set by the government. In Germany and Japan, the prices are "set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail," Klein reports.

Outside of Medicare and Medicaid, which are cheaper than the commercial average, "it's a free-for-all" in the U.S., Klein wriotes. "Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured."

Because the customer often doesn't have choice in whether or not he or she will purchase health care — one could be unconscious or very ill — "sellers of health-care services in America have considerable power to set prices, and so they set them quite high," Klein reports.

Fixing the problem is fraught with complication, Klein writes, because "centralized bargaining cuts across the grain of America's skepticism of government solutions." The prices are also set by very powerful industries. The federal health care reform law is not expected to fix the issue, Klein writes, though might spread awareness since there are provisions to expand transparency; hospitals will have to publish their prices, for example. "But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don't think we'll be paying anything like what they're paying in other countries anytime soon," Klein write. (Read more)