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Health reform losing support, especially among Republicans and independents
Americans' confidence in being able to buy and access health care hasn't changed much in the last year, but their opinion of the national health reform law has fluctuated, mostly among Republicans and independents. Overall, 45% of those surveyed in the August Kaiser Health Tracking Poll opposed the health law. That's 10 percentage points higher than those who said they opposed the law in July. Correspondingly, support for the law dipped to 43%, down from half of those surveyed in July. The dip in popularity was driven in part by Republicans, who were much more likely than Democrats to have a negative view of the health reform law. Among those surveyed, 77% of Republicans opposed the law and 68% of Democrats favored it. Independents were divided, with 48% opposing the law and 41% favoring it. Republicans and independents may be responding to the increasingly partisan atmosphere in the months before the November elections, said Claudia Deane, associate director for public opinio [Read more]
Testing urine protein in blacks may slow kidney disorder
Measuring urine protein in blacks who have chronic kidney disease related to high blood pressure might help physicians slow the disease progression in some patients, a new study says. The research, published in the Sept. 2 New England Journal of Medicine, found that lowering blood pressure below recommended goals delayed end-stage renal disease in blacks with a baseline urinary protein-to-creatinine ratio greater than 0.22. No benefit of aggressively decreasing blood pressure was seen in patients whose protein-to-creatinine ratio was 0.22 or less. Elevated levels of protein in urine indicate greater kidney damage. "Here's a group of patients where it's worth the extra effort to put them on additional medication to get their blood pressure lower," said lead study author Lawrence J. Appel, MD, MPH, professor of medicine, epidemiology and international health at Johns Hopkins University School of Medicine in Maryland. "Kidney disease is a common problem, and it's particularly pre [Read more]
Drug industry gifts OK with some physicians
Most physicians and doctors-in-training still have a positive attitude toward marketing-oriented activities by pharmaceutical companies and device manufacturers, even though some institutions and national specialty societies have adopted policies that limit or ban such practices, a new study shows. For example, 72% of 590 surveyed doctors and medical students said sponsored lunches were appropriate, according to the study in the June Archives of Surgery. Nearly 60% said samples improve care for their patients, and 71% said pharmaceutical and device company money is useful for funding residency programs. There were limits, though. About three in four respondents believed gifts valuing more than $50 were unacceptable. Nearly 90% thought vacations were inappropriate. Study authors in 2008 polled faculty and medical trainees at the Mount Sinai School of Medicine consortium, which includes 11 hospitals throughout New York City (www.ncbi.nlm.nih.gov/pubmed/20566978/). Mount Sinai [Read more]
San Francisco plan for uninsured withstands final legal challenge
U.S. Supreme Court justices declined to consider a legal challenge to Healthy San Francisco, a health access program that has enrolled tens of thousands of uninsured city residents. The June 28 decision leaves in place appeals court rulings upholding the employer mandate at the heart of the program. Healthy San Francisco, which offers primary and preventive care to the uninsured, requires businesses either to offer health coverage for their workers or contribute to a city fund that helps pay for the program. It also means the end for a lawsuit against the program by the Golden Gate Restaurant Assn. The organization had argued that the employer mandate violated the Employee Retirement Income Security Act by imposing the type of patchwork local coverage directives that ERISA was designed to prohibit. San Francisco Mayor Gavin Newsom said the high court's decision not to hear the case ensures that the city will continue providing care to uninsured residents who otherwise would go [Read more]
Flu vaccine recommendations for young children updated
Young children who were not immunized against the 2009 influenza A(H1N1) will need two doses of the 2010-11 seasonal flu vaccine to assure they are protected, according to the Advisory Committee on Immunization Practices. The seasonal vaccine will include a pandemic 2009 H1N1 virus, as well as an A/Perth/16/2009 (H3N2)-like virus and a B/Brisbane/60/2008-like virus. * Links * See related content The ACIP, a 15-member committee that advises the Centers for Disease Control and Prevention on vaccine issues, released the new recommendation for children age 6 months to 8 years on June 24 at a meeting in Atlanta. Some committee members raised concerns that the new recommendation would complicate influenza vaccination for physicians. As an example, they asked what doctors should do if parents can't remember whether their child received at least one dose of the H1N1 vaccine. In such instances, the committee recommends administering two doses of the 2010-11 seasonal flu [Read more]
Prescription drug overdose cases skyrocket at emergency departments
With newly released data showing that prescription drug misuse now rivals illicit drug use as a cause of emergency department visits, the Food and Drug Administration in June released a long-awaited proposal aimed at curbing recreational use of opioid analgesics. Physicians and advocates for pain patients hailed the FDA's proposal for addressing the growing opioid abuse problem while not impeding legitimate access to pain treatment. Fatal poisonings from opioid overdoses tripled to nearly 14,000 deaths from 1999 to 2006, the Centers for Disease Control and Prevention reported in September 2009. The tally of near-deadly incidents involving opioids is far higher and growing rapidly, as revealed in the CDC's June 18 Morbidity and Mortality Weekly Report. Emergency department visits related to misuse of prescription or over-the-counter drugs doubled from 500,000 in 2004 to 1 million in 2008, said the report, based on estimates from the Substance Abuse and Mental Health Services Ad [Read more]
Teen girls advised to see a gynecologist before age 16
Young women should first see a gynecologist between age 13 and 15, and the visit should focus primarily on education and guidance, according to an updated Committee Opinion by the American College of Obstetricians and Gynecologists. The initial visit should not include a pelvic exam or a speculum exam unless there is a medical reason for one or both, states the four-page opinion in the July Obstetrics & Gynecology. St. Louis ob-gyn Diane F. Merritt, MD, chair of ACOG's Committee on Adolescent Health Care, said the minute she tells a new teen patient that a Pap smear is unnecessary, "everything changes. That glassy or sullen look dissipates and the mother's shoulders relax." "I've always tried to make the first visit to the gynecologist a learning experience that is age appropriate," she said. "Let up on these kids. Let them come in and ask questions. Teach them about their body. Teach them about their anatomy. Teach them good hygiene." Guidelines advising when teens should [Read more]
Primary care boosted in proposed Medicare pay rule
The Centers for Medicare & Medicaid Services has issued a proposed Medicare physician fee schedule rule that it says will expand preventive services for Medicare beneficiaries, improve payments for primary care services and promote access to health care. The proposed rule, announced June 25, would implement provisions in the national health reform law that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including a new annual primary care visit benefit, CMS said. However, it also projects a 6.1% reduction to physician payment rates in 2011 as mandated under the sustainable growth rate formula -- and that would be on top of a roughly 23% cut that is planned for the end of November. "Beginning in 2011, Medicare will cover an annual wellness visit that will offer an opportunity for the physician and patient to develop a more comprehensive approach to maintaining or improving the patient's health and reducing risks of chronic disease," said Jonathan [Read more]
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