United States (KaiserHealth) – In the heated debate over to what extent religiously affiliated employers should be required to provide free contraception for workers, no one has talked much about what methods are available to women who want to prevent pregnancy and how their choices might change if cost were removed from the equation. But it’s an important subject.

With prices ranging from about $1 for a condom to more than $800 for an intrauterine device (IUD), some of these women, maybe a lot of them, might switch methods if they could afford to.

That’s exactly what many women’s health advocates hope. Long-acting methods such as the IUD and the hormonal implant are nearly 100 percent effective, require no effort after insertion and protect against pregnancy for up to 10 years. (In contrast, birth control pills are about 92 percent effective, and many other common methods are even less reliable in everyday use.)

Some women worry that having a device inserted in the uterus or under the skin is riskier than methods such as a pill, a patch or a vaginal ring that they can discontinue at will.

But experts such as Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a nonprofit research center on reproductive policy, point out that IUDs and implants “eliminate the possibility of inconsistent use.”

They’re also among the most cost-effective methods available in the United States, according to research by James Trussel, a professor of economics and public affairs at Princeton University. Among other things, Trussell factored in the cost of particular methods, their effectiveness at preventing pregnancy, and the costs of unintended pregnancy or other events during a five-year period. IUDs and vasectomies were found to be the most cost-effective. Implants were somewhat less cost-effective but still a better bet than oral contraceptives, the patch, the vaginal ring or injectable contraceptives, among others.

These longer-acting methods, however, carry a hefty upfront price tag of between $500 and $1,000 for the device itself and its insertion. Meanwhile, insurance coverage is uncertain. Although the vast majority of employer health plans cover contraception, they don’t necessarily cover all methods and they generally don’t cover them for free. A 2004 study found that 40 percent of companies covered IUDs.

“For most plans, the devices aren’t considered part of the drug formulary, so you might have coinsurance of some amount like 20 percent,” Sonfield says.

Health Care Reform

Under the new health care law, starting this August, new employer health plans or those that change their benefits substantially will be required to cover all FDA-approved contraception methods and related counseling without co-pays. Catholic bishops and others strenuously objected to imposing this requirement on employers who objected to contraception on religious grounds. The Obama administration last week offered a compromise that would allow women who work for religious organizations to obtain contraception directly from an insurer — still without co-pays. But the debate continues.

Although eliminating cost concerns may help encourage the use of longer-acting methods, that’s only half the battle. Educating women and providers is also critical, say experts. Many people still associate IUDs with the Dalkon Shield, a device marketed in the early’70s that led to severe infections, infertility and death, resulting in hundreds of millions of dollars in legal

claims.

“The Dalkon Shield put a chill on IUDs for the next four decades,” says Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico.

Only 5.5 percent of women practicing birth control used an IUD in 2006-2008. An even smaller percentage used hormonal implants, which received FDA approval in 2006. In contrast, 28 percent of women used birth control pills.

The longer-acting methods currently approved by the FDA are considered safe and effective. They include two IUDs, Mirena and ParaGard. These small T-shaped devices are inserted into the uterus and release hormones or small amounts of copper to prevent fertilization for five or 10 years, respectively. Implanon is a matchstick-sized hormonal implant that, once inserted under the skin of the upper arm, prevents pregnancy for three years.

Education Effort

The Contraceptive Choice Project is testing the idea that by educating women about longer acting methods and removing cost barriers, more will decide to use them and fewer will become accidentally pregnant.

In 2007, researchers at Washington University in St. Louis began to enroll 10,000 women in that region, offering them free contraceptives of any type for three years and focusing on educating them about longer-acting methods.

Seventy-five percent chose IUDs or implants, a much higher proportion than the 5.5 percent in the general population. After a year, 86 percent of those using IUDs or implants decided to continue with the longer acting method; only 55 percent of the women who were taking birth control pills continued with that method, according to preliminary figures from the researchers.

“Women should be able to control their reproductive lives,” says Jeffrey Peipert, principal investigator for the project who is vice chair for clinical research in the department of ob/gyn at the Washington University School of Medicine. “But with our current system, so many people are uninsured or unable to pay for their birth control.”

Happy With Her Choice

Lydia and Drew Huston have three children and don’t want any more. When Lydia, now 44, heard about the research project at the university near their home in Florissant, Mo., she signed up. Three years of free contraceptives sounded like a good deal.

Until she enrolled in the study, Huston had been getting hormonal Depo-Provera shots every three months to prevent pregnancy. Her co-pay was $20 each time. Although it was better than having to take a pill every day, getting to the doctor even once every three months was tough given her family commitments and her job working in development at a nonprofit organization.

Before meeting with the university researchers, Huston never understood the longer-acting options that were available. “They gave me this array of information,” she says. “It was so empowering.” After discussing the methods, Huston decided on a hormonal implant, which would last for three years. It was an easy transition from the injections she’d been receiving earlier.

Huston is happy with her choice. “Knowing what I know now, if I had to pay for a longer-acting method I would.”

That’s a choice many women like Huston soon won’t have to make.

Please send questions or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

– Provided by Kaiser Health News.

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Jerusalem, Israel Arieh O’Sullivan / The Me – Descending the Tower, the imposing new state-of-the-art inpatient hospital at Hadassah’s Ein Kerem Medical Center, Joseph Mapa was impressed. The chief executive officer of Toronto’s Mt. Sinai Hospital said he’s seen innovations he would like to bring back to Canada.

“It’s leading edge. Just the thinking behind it! Healing gardens, patient rooms, square feet, two beds per room, one bed per room, one window per patient…I mean these are huge developments,” Mapa told The Media Line. “It’s not something we wouldn’t do in the States, or in Canada, and it’s something you certainly want to see and showcased,” he adds.

Mapa was part of a first-ever delegation of CEOs from the top hospitals and medical centers across North America that were visiting Israel this week. This was the brainchild of Rafael Harpaz, director of the Economic Department for America and Africa at Israel’s Foreign Ministry.

“We think we have a lot to share with our friends and colleagues from the USA and Canada on medical technologies, cutting-edge technologies, readiness and preparedness and managing medical science through computers. I think these are areas where Israel has good experience,” Harpaz told The Media Line.

Israel’s life expectancy is much higher than the U.S. and its systems of socialized medicine ensures that everyone has access to basic healthcare while Israel spends a smaller percentage of its gross domestic product on health. There still are problems, most recently with doctors striking for higher wages last year. Its major hospitals are equipped with some of the latest medical technologies, which impressed the delegates.

“The American system has many great things, but also many things to learn from this country and I think that the level of medicine here and the level of training is every bit as good as medicine that I see now at the States,” Kevin Tabb, the CEO of Beth Israel Deaconess Medical Center in Boston, told The Media Line.

“In the States, for better or for worse, medicine in many ways is a business,” Tabb said. “It’s about making patients better, but it is also a financial business. But in Israel that really is not the case, and that is very interesting for people, especially for people from the United States, less so for Canada.”

Tabb said they shared data on costs and saw how care similar to that offered in the U.S. was extended with fewer resources in Israel.

“It’s amazing to see the relatively small budgets for an Israeli hospital, doing tremendous amount things, on what would be considered a pittance in the U.S. and that’s fascinating,” Tabb said.

The Tower at Hadassah is slated to be opened later this month and crews are busy scuttling around clearing away scaffolding and supplies. Not all of the floors are finished, but the fifth floor is spectacular with parquet floors and equipment still in plastic.

“This has been a tremendous exchange of North American healthcare leaders with Israeli healthcare leaders,” Amir Dan Rubin, president and CEO of Stanford University Medical Center. “While our political and reimbursement and systems are different, and the organization of our health systems are different, at the core we have common missions; taking care of patients and … research and education.”

“The challenges are similar here,” Rubin said. “We all have issues of how do we provide insurance coverage so there is the payment issue and there is the delivery system, there are access issues, there is improving quality and innovations and while our mechanisms are slightly different those themes are common.”

The group was briefed at Sheba Medical Center and is slated to visit Sourasky Medical Center, Beilinson Hospital — all in Tel Aviv — and Rambam Hospital in Haifa as well as the IDF Medical Forces center in Tzrifin where they will see the emergency unit that deploys at crises around the globe.

“We didn’t anticipate that so many of the CEOs of the big hospitals in North America would come and we are blessed with a delegation which is close to 50 top heads of hospitals and medical centers,” Harpaz said.

“We share the same challenges that we are facing in our medical treatment, and they appreciate that we are doing this, but on the other hand they are really impressed by all which Israel has to offer. And we have a lot to offer when it comes to medical technologies.”

At Sheba, the group observed a simulation of a mass casualty event, something that Israeli hospitals constantly drill for. Catherine Zahn, CEO of Toronto’s Centre for Addiction and Mental Health, found the spirit of Israelis compelling.

“There is a societal receptivity to open mindedness and forward thinkingness,” Zahn told The Media Line. “Like Israel, Canadians believe health care is a basic right of a citizen, a basic human right, rather than a commodity to be bought and sold. There is definitely a kinship there, but I think we have a lot to learn from the perspective of the ‘innovation nation’,” Zahn said.

“It’s also interesting to see how the situation in the Middle East, and the involvement of the military in the country actually probably contributes to that resilience and the attitude that if this doesn’t work out let’s pick up and do something else,” she added. “Picking up on the advances from military science and translating them into health care advances. Those are all very remarkable.”

These sentiments were echoed by her fellow Canadian, Mapa.

“The Israeli system is spectacular — from clinical care to service, to IT in particular, clinical technology, to crisis management,” Mapa said. “It’s state-of-the-art, I mean, its fantastic. We’re excited, but I tell you this not because I am excited, but you see it is evidence based…and that’s what turn us on. Turns me on for sure.”

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Washington, D.C., United States (AHN) – The United States on Monday confirmed issuance of visa to ailing Yemeni President Ali Abdullah Saleh for a limited time to undergo medical treatment but refused to divulge time-period for which the visa is issued.

“We have issued a visa for Ali Abdullah Saleh,” said Victoria Nuland, the State Department spokesperson, adding, “It is strictly for medical treatment, and our expectation is that he will leave the United States when his medical treatment is complete.”

Asked to comment on the time period for which this visa is issued, Nuland said, “He’s got a visa for the period that he anticipated the medical treatment would last. If the treatment goes on longer and he needs to apply for an extension, he would do that with Homeland Security.”

Yemeni political players are expecting to utilize President Saleh’s absence to move the country “on a concrete transition plan to a more democratic Yemen,” said Nuland, adding, “We do believe that Saleh’s absence from Yemen at this critical juncture might, in fact, facilitate that dialogue and facilitate the transition process.”

Agreeing that, “it might be helpful to the transition process that he’s out of the country now,” Nuland reiterated, “It (the visa application) was not approved for political purposes. It was approved for medical treatment. The timing, we think, is fortuitous, however, and we hope that the Yemenis will use the time well.”

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Boston, MA, United States (KaiserHealth) – Nearly two years after the passage of the federal health law, more than 40 percent of people say they know little or nothing about how the law will affect them, according to the Kaiser Family Foundation’s latest monthly health tracking poll, published in December. That figure hasn’t budged since April 2010, just after the law was signed.

Jonathan Gruber, an economist at the Massachusetts Institute of Technology, aims to change that with a book, “Health Care Reform: What It Is, Why It’s Necessary, How It Works,” that explains the ins and outs of the law in an innovative way: an adult comic-strip form similar to graphic novels.

Gruber was one of the architects of the Massachusetts’ health care overhaul, which included many features that appear in the federal law, and he advised the Obama administration and Congress on the Affordable Care Act. I spoke with him about his new book, which he co-authored with HP Newquist. The book is illustrated by Nathan Schreiber.

Q. What made you decide to write a book for consumers about health reform?

A. I think what really inspired me was hearing that when you polled consumers about the Affordable Care Act they were split in their support. But when you polled them about individual pieces of the law, they liked it. As an educator, you didn’t have to do any more than explain what the law did [to gain support]. It needed to be explained in a way that people understood.

Q. Why did you choose a graphic novel format?

A. The publisher approached me about doing it that way. At first I wasn’t that enthusiastic. I didn’t think it would be that effective. But the publisher said they had done a graphic novel about the 9/11 Report. My son likes graphic novels, he’s 17. He said it’s a great opportunity, it’s a great medium. When you’re on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call.

Q. Who’s the primary audience for this book?

A. I wrote it for the person who is confused and open-minded about this bill. The person who doesn’t understand it. The two groups I really hope will read it and benefit from it are the independent voter who was inclined to like Obama and knows it’s a big, transformative bill and wants to learn more, and the disaffected Democratic voter. I’m stunned that many don’t support it.

Q. Do you think it will change any minds? Turn opponents into supporters?

A. I don’t think it’s going to change the minds of anyone who’s convinced it’s a bad piece of legislation. But it could change the minds of those who are wary and concerned.

Q. You showcase Massachusetts as an example of how health reform can work, noting that it employs some of the same elements that appear in the federal law, like the individual mandate that requires people to have insurance. What should readers be aware of about Massachusetts’ experience with health reform? Has anything surprised you?

A. I would say the point the book tries to make is that Massachusetts was successful in what it tried to do. It reduced the number of uninsured and lowered non-group insurance premiums. Premiums for individual market plans fell by 50 percent relative to national trends. The biggest surprise to me is that employer-sponsored health insurance actually went up after reform when it was falling everywhere else in the country. It speaks to the power of the [individual] mandate. People said, “Give me health insurance,” and they did.

Q. You talk about how health care reform will help Anthony, Betty, Carlos and Dinah, all of whom have different health insurance situations. But you don’t discuss what will happen to Emilio the undocumented worker, who won’t get coverage under the new law. Did you consider talking about who loses out under health reform, including the roughly 11 million illegal immigrants?

A. You hit on a great issue: Who loses out under the law. People don’t lose out. Emilio doesn’t lose out, he just doesn’t gain. A lot of people don’t gain. By design, the bill leaves a lot of people alone, including those with employer-sponsored insurance. They don’t lose but they don’t gain either. As for undocumented immigrants, there was no support to help them. Unfortunately, the law leaves them out in the cold. That was just a political reality.

Q. I know it’s a big piece of legislation and you were trying to cover a lot of ground, but I couldn’t help thinking as I read the book that in some places you oversimplified in such a way that it made the law look better than it is. Can you talk a bit about concerns some may have that you may confuse readers by making sweeping statements about the benefits of this law?

A. Certainly I wrestled a lot with where to simplify and where not to. I think I tried my best to never be misleading. At the end of the book there’s a set of references where people can go to learn more about the law. I think the truth is that most people don’t want that level of detail. It’s for people who just want to know what the heck is this bill.

Q. In the book you discuss the long-term care program created under the law, the CLASS Act, which the administration has decided not to implement, at least not at this time. Obviously, this law is changing and evolving. Depending on what happens in the next election, it could change a lot. What do you think is going to happen? Do you have any plans to update the book?

A. I am fairly confident, I think there’s a better than 50 percent chance, for the Supreme Court not to turn down the mandate, and voters not to kick Obama out of office. If both those things go that way, I think it will be an incredibly positive thing for the Democrats in 2016. It will be good for them because the law will be doing good things by then. States need to move more quickly if we’re going to implement the law smoothly. I can see it starting out roughly and being in great shape in a year or two.

My guess is I wouldn’t want to update [the book]. I haven’t really thought about that.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

– Provided by Kaiser Health News.

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SaanaSana’a, Yemen (IRIN) – Aid workers hope “shocking” new malnutrition figures from a survey conducted in western Yemen will help highlight the serious humanitarian situation in the country and prompt donors to act immediately.

Until now, aid workers say some donors have been unconvinced of the extent of the problem because of a perceived lack of evidence.

“It’s been a challenge,” one Yemen-based aid worker told IRIN. “Every time we sit down with donors, they say ‘Where are the figures? Where is the data?’”

Geert Cappelaere, head of the UN Children’s Fund (UNICEF) in Yemen, said donors have asked him for more evidence that malnutrition was such a priority.

“That kind of question – each and every time – kills something in me. Why do you want children to die first before you’re going to give any credibility to a disaster looming here in Yemen?”

Results

Yemen’s Ministry of Public Health and Population, with the support of UNICEF, surveyed 3,104 households in Hudeidah Governorate in October and collected data on 4,668 children under five.

The survey found a global acute malnutrition (GAM) rate of 31.7 percent – meaning nearly one third of children surveyed suffered from either moderate or severe acute malnutrition – of which nearly 10 percent were severe cases. These figures are more than double the internationally recognized emergency threshold of 15 percent. The survey also found that nearly 60 percent of children were underweight and 54.5 percent stunted, meaning their height was too low for their age, a sign of longer-term malnutrition.

These results are consistent with recent surveys conducted in other parts of the country.

In the southern Abyan Governorate, a battleground in ongoing fighting between government troops and al-Qaeda affiliated militants, a UNICEF survey in September found a GAM rate of 18.6 percent, of which 3.9 percent were severe cases. In the northern Hajjah Governorate, a government survey in June found a GAM rate of 31.4 percent, of which 9.1 percent were severe cases. Nearly half of the children surveyed in Hajjah were underweight and 43.6 percent were stunted.

“Wherever we go, wherever we survey, wherever we assess, we come to the same conclusions,” Cappelaere told IRIN. “The levels of acute malnutrition in Yemen are incredibly high.”

Yemeni Minister of Health Ahmed Al-ansi says half a million children suffer from acute malnutrition across the country. Hundreds of thousands of farmers are at risk of losing their livelihoods because of floods and drought, he added. According to the NGO Oxfam, many Yemenis live off tea and bread.

The UN says some seven million people (a third of the population) are food insecure, meaning they go to bed hungry or do not know where their next meal is coming from. This number is expected to rise significantly when the World Food Programme carries out a new national Comprehensive Food Security Survey in January. Aid workers expect the humanitarian situation in Yemen to continue getting worse next year.

The mortality formula

While malnutrition rates in parts of Yemen are comparable to those in parts of Somalia, they have not yet resulted in the same mortality rates, only because – until recently – Yemen had a functioning, if imperfect, primary health care system, including vaccination.

But in the past 10 months, during which anti-government demonstrations led to a violent crackdown and a political crisis, some areas have seen up to 40 percent fewer children immunized, UNICEF’s Cappelaere said.

Combine the high rates of malnutrition, the low levels of vaccination and sporadic outbreaks of diseases like measles, and “a disaster may be around the corner.”

The Hudeidah survey found that three in every four children suffered from diarrhoea, acute respiratory infections or fever in the two weeks preceding the survey; and 2.5 percent of mothers reported symptoms of measles in their children in the past three months. The survey found measles vaccination coverage of 74 percent in Hudeidah, well below the 90 percent coverage rate needed to prevent an outbreak.

“Why is it that the international community gets mobilized primarily when it sees the dramatic outcome of a situation or a crisis that we could have seen coming for many, many years?” Cappelaere asked. “This is not a blaming and shaming [exercise], but this is a collective question we need to ask ourselves.”

The UN has appealed for US$154 million for food and agricultural programmes and $70 million for nutritional programmes, the largest sectoral demands amid an overall appeal of $447 million for Yemen in 2012.

Government capacity

Government officials admit dealing with the dramatic levels of malnutrition will be a challenge for the interim Yemeni cabinet which emerged after a peace deal signed in late November pulled the country back from the brink of civil war.

The cash-strapped government is charged with organizing presidential elections by February 2012, while trying to maintain stability. Pro-democracy protesters, and an armed opposition, had been clashing with government forces on and off since February 2011. The peace deal has brought some calm to the capital Sana’a and the second city Taiz, but rebels, separatists and al-Qaeda affiliated-militants are still opposing the government in different parts of the country.

Majid Al Jonaid, deputy minister of health, said one of the government’s priorities is to address issues affecting the daily life of Yemenis, including malnutrition. The government plans to open clinics and run education campaigns, as part of a multi-sectoral national government strategy on malnutrition approved by the cabinet last year, before the latest crisis.

But “it depends mainly on the availability of resources and the overall situation,” he told IRIN. “We will start our work with the hampered resources that we have.”

Still, Al Jonaid said he was concerned malnutrition may not get the attention it deserves amid competing government priorities and big constraints. For example, the Ministry of Health was virtually shut down for weeks because of insecurity in and around the building.

Cappelaere said it was unrealistic to expect the government to take over much of the international community’s humanitarian work in the next year.

Long-term effects

The economic situation in the country has been set back 5-10 years by the events of this year and Yemen will continue having substantial humanitarian needs for 3-5 years, according to the UN humanitarian coordinator in Yemen, Jens Toyberg-Frandzen. Cappelare said the country will probably continue needing some form of assistance for two to three decades.

Addressing malnutrition is a complex task, as the problem relates to poverty, lack of education, bad sanitation, and cultural practices, like chewing khat and resisting exclusive breastfeeding. In Hudeidah, only 9 percent of infants under six months were exclusively fed breast milk.

The Ministry of Health report from the nutrition survey recommended establishing out-patient therapeutic programmes in community health facilities and considering “radical strategies” like blanket, rather than targeted, distribution of supplementary food.

Investments in lifesaving humanitarian assistance, as well as longer-term development work, are required immediately, Cappelaere said, to prevent both high mortality rates and longer-term effects of chronic malnutrition, like retardation in cognitive development, which will affect the country’s ability to move forward.

“Yemen is entering a new phase in its history,” said Pete Manfield, deputy head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Yemen, “but it’s critical that humanitarian needs are met in 2012, not only to prevent the loss of life, but also to support the stabilization of the country.”

“We appeal not to let Yemen become another catastrophe,” Toyberg-Frandzen added.

ha/cb/bp

– Provided by Integrated Regional Information Networks.

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United States (KaiserHealth) – Dr. Donald Berwick, who oversaw Medicare and Medicaid until earlier this month, defended the programs Monday, but said they are trapped in a U.S. health system that promotes wasteful spending and inefficient care.

“Health care is broken,” Berwick said in an interview with Kaiser Health News. “… We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”

Berwick said the 2010 federal health law is changing how doctors and hospitals are paid and deliver care though such new arrangements as accountable care organizations, which are designed to improve coordination and lower costs.

But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries. “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”

Despite being considered one of the foremost authorities on health quality and safety, Berwick was a controversial pick as administrator of the Centers for Medicare and Medicaid Services after Republicans accused him of supporting rationing care. Berwick denies the charge, but noted both private insurers and government programs impose limits on what they will cover.

After Republicans said they would not confirm his appointment, President Obama appointed him during a congressional recess in July 2010, which meant he could serve only for 18 months. His last day was Dec. 2.

Berwick previously led the Cambridge, Mass.-based Institute for Healthcare Improvement.

On other topics, Berwick told KHN:

• His failure to be confirmed did not affect his ability to get things done, though he would have preferred a longer term. “An agency of this size will do better with longer-term leadership commitment,” he said. Knowing his tenure could be short gave him a greater sense of urgency to achieve things, he said.
• His most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form accountable care organizations to work more closely, while not making the requirements overly burdensome.
• He criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. “It’s a nonsensical idea,” he said. “If a patient needs twenty days, the patient should get twenty days,” he said.
• Managed care done right is the best way to provide care, he said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need. Early in his career, Berwick worked for Harvard Health Plan, a nonprofit HMO based in Boston.

Berwick said he has not yet decided what to do next beyond spending more time with his family in Boston.

– Provided by Kaiser Health News.

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Atlanta, GA, United States (AHN) – U.S. teens are not eating enough fruits and vegetables, according to a new study by the U.S. Centers for Disease Control and Prevention.

The findings, based on data complied from nearly 10,800 students in grades nine through 12 who took part in the National Youth Physical Activity and Nutrition Study 2010, found median consumption was 1.2 times per day for both fruits and vegetables.

Median fruit consumption was much higher among males than females, and much higher among grade nine students than among students in grades 10 and 12.

A little more than 28.5 percent, or one in four, of the high school students ate fruit less than once a day, and 33.2 percent ate vegetables less than once a day.

Only 16.8 percent of students ate fruit at least four times a day, and only 11.2 percent ate vegetables at least four times a day.

Vegetable consumption was lowest among Hispanic and black students, the study found.

Researchers said the findings show that most high school students do not meet the daily fruit and vegetable recommendations, and more needs to be done to see the recommendations are met.

The researchers wrote in the Nov. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, “The infrequent fruit and vegetable consumption by high school student highlights the need for effective strategies to increase consumption.”

Steps have already been taken at schools throughout the country to remove sugary snacks, sodas, high fat, high salt and low nutrient dense foods. New programs such as farm-to-school initiatives, school gardens and salad bars aim to improve access to both fruits and vegetables.

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Washington, DC, United States (KaiserHealth) – By agreeing today to hear challenges to President Obama’s 2010 health care law, the Supreme Court set the stage for a decision — probably in late June and in the midst of the presidential campaign — that could be among its most important in decades.

The case, which will probably be argued in March on a date still to be announced, is especially momentous because it not only will determine the fate of President Barack Obama’s biggest legislative achievement but also will cast important light on the Supreme Court’s future course under Chief Justice John Roberts on issues of federal government power.

The central issue — but not the only important one — is whether Congress exceeded its constitutional powers to regulate interstate commerce and to levy taxes when it adopted the so-called “individual mandate” at the heart of the health care law.

That provision would require millions of people starting in 2014 to buy commercial health insurance policies or pay financial penalties for failing to do so.

The court also agreed to decide a challenge to the Affordable Care Act’s provision essentially requiring states greatly to expand their Medicaid spending.

The court made clear that if it decides to strike down the individual mandate or Medicaid provision, it will also decide which of the 975-page law’s hundreds of other provisions should go down too, by divining whether Congress would have wanted some or all of them to be effective even without the voided provision or provisions.

Finally, the court agreed to decide whether — as one federal appeals court ruled — the litigation surrounding the individual mandate must be deferred until 2015 because of the 1867 “Anti-Injunction Act,” which bars courts from striking down tax laws before they take effect.

The court allocated an extraordinary five and one-half hours — the most time in many decades for related challenges to a single new law — for argument on all these issues combined.

How The Case Got Here

The court’s announcement Monday centered on a challenge to the law by 26 state governments. The 11th Circuit Court of Appeals in Atlanta voted in August to strike down the individual mandate but to leave standing the rest of the health law, including the Medicaid expansion. All three of the petitions granted today involve that case.

In other action, though, the D.C. Circuit and the 6th Circuit, centered in Cincinnati, have upheld the individual mandate, with opinions supporting the Obama position by two of the nation’s leading conservative judges, the D.C. Circuit’s Laurence Silberman and the 6th Circuit’s Jeffrey Sutton.

Another appeals court, the 4th Circuit, said courts have no power to decide the individual mandate issue until 2015, when the first monetary penalties will be due for failing to comply with the individual mandate to buy health insurance. This decision held that the penalty provision is a “tax” within the meaning of the Anti-Injunction Act, as described above.

If the justices agree that the Anti-Injunction Act applies, this year’s case will be perhaps the greatest anticlimax in Supreme Court history. And, the justices’ assignment of a full hour of oral argument to this question suggests that some take this issue very seriously.

Meanwhile, the purpose of the individual mandate is to force millions of Americans to obtain health insurance — whether they want to or not — in order to offset the costs that health insurers would bear under the health care law’s requirement that they sell insurance to everyone without charging those with especially costly health problems more than healthy people.

The lower court judges who have struck down the mandate have cited as their reasoning the lack of any precedent for Congress to require people to buy a commercial product they don’t want and the government’s failure to show how — if the individual mandate is upheld — a limit enforceable by the courts could be applied to this exercise of congressional power.

As background, the two Supreme Court decisions since’37 that have struck down acts of Congress as exceeding the commerce power, one in’95 and one in 2000, stressed that Congress’ commerce power must be restrained by some principle that could be enforced by the judicial branch of government.

Defenders of the individual mandate stress other Supreme Court precedents suggesting that even economic decisions that have a tiny direct effect on interstate commerce — such as a person’s decision not to buy health insurance — cumulatively have major effects on interstate commerce and thus can be regulated by Congress.

With the court’s announcement today, none of the justices recused themselves from hearing the case. Some conservative opponents of the health care law have suggested that Justice Elena Kagan should recuse herself because of her prior work as President Obama’s Solicitor General. And some liberals have suggested that Justice Clarence Thomas should recuse himself because of his wife Virginia Thomas’s political activities opposing the health care law. But the decision on recusal is left to each individual justice and it would have been announced with today’s order.

Meanwhile, as is customary, the Court announced the grants of review with no comment or indication of the vote. Any four justices can agree to review a case. And, given the importance of the issues, with federal appeals courts divided, today’s announcement was widely expected.

Most but not all Supreme Court experts predict — some very confidently, some cautiously — that the Court will uphold the law. The Supreme Court’s four liberals are certain to uphold the law. They would need only one more vote to prevail. While Justice Clarence Thomas seems a sure vote to strike the law down, Chief Justice John Roberts and Justices Anthony Kennedy, Antonin Scalia and Samuel Alito are harder to call.

A decision in June — or before — would help make the future of health care law a central issue in the 2012 presidential campaign.

Taylor, an author and journalist, is a nonresident fellow at the Brookings Institution.

– Provided by Kaiser Health News.

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Bangkok, Thailand (IRIN) – Hospitals warn of possible drug shortages as prolonged flooding in Thailand has disrupted local production and delivery of medical supplies.

“Hospitals are panicking now, though they are not necessarily running out of supplies,” Pongpan Wongmanee, deputy secretary-general of the government’s Food and Drug Administration (FDA) told IRIN, adding that most hospital stocks could last for at least a month.

Official predictions for how long it will take to drain waterlogged areas vary from 10 days to weeks.

Though flooding has disrupted the production of 393 registered medicines in more than 10 factories in Bangkok and neighbouring provinces, there is no report of drug shortages yet, according to the Health Ministry on 31 October.

But some hospital officials are concerned their supplies will dwindle quickly as operations at these pharmaceutical plants are suspended, and demand for scarce medicines is expected to increase.

“At this point, the biggest limitation is medication. There are lots of volunteers and nurses, but very little medication,” said Pranya Sakiyalak, assistant dean of public relations at Siriraj Hospital in Bangkok. The hospital is sending a mobile medical team daily to one of the most hard-hit provinces 70km north of the capital, Ayutthaya.

Most urgently needed are aspirin, antibiotics and saline solution as patients in flood-affected areas report common minor illness and injuries, he added.

Delivery of medicines is difficult as some main roads are inaccessible, forcing operators to use indirect routes for transportation, said Pongpan from the FDA.

As of 31 October, 73 highways in 15 provinces were unusable and 223 roads in 30 provinces impassable, says the government.

The Ministry of Public Health is proposing three options for stockpiling medicines to the government on 1 November, which includes recruiting new local drug manufacturers, importing drugs and speeding up the distribution of undelivered medicines still sitting in flooded factories.

Drug manufacturers hit by flooding were providing less than 10 percent of the country’s drugs, according to the FDA.

As of 26 October, the Health Ministry has begun coordinating drug imports from Malaysia and Japan.

Authorities are also looking for new ways to deliver drugs through the deluge, said Pongpan.

sh/pt/mw

– Provided by Integrated Regional Information Networks.

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New York, NY, United States (AHN) – And yet another reason for women not to light up.

Researchers say that women who smoke may hit menopause about a year earlier than non-smokers.

The study, published in the journal Menopause, reviewed data from several pervious studies that included roughly 6,000 women from the United States, Poland and Turkey and Iran.

On average, non-smokers hit menopause between the ages of 46-51. Smokers however, reached menoucpase overall at around 43-50.

Both early and late menopause have been linked with health problems. Women who hit menopause later in life are believed to be at a greater risk for breast cancer because one risk for the disease is exposure to estrogen.

Earlier menopause is linked to a host of medical conditions including osteoporosis, cardiovascular disease, diabetes mellitus, obesity, Alzheimer’s disease and others. Also, smoking may, overall, slightly increase of woman’s risk of death in years to follow.

In addition to smoking. alcohol use, weight gain or loss, and whether a woman has ever given birth may also effect a woman’s timing of menopause. The evidence for all the risk factors, except smoking, have been mixed.

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