Enhanced early childhood education pays long-term dividends in better health

Enhanced early childhood education pays long-term dividends in better health

New study is the first randomized, controlled trial to show that early educational enrichment can bring improved health and healthier behaviors in early adulthood

From a January 14, 2011 Eureka news alert

January 14, 2011 — Intensive early education programs for low-income children have been shown to yield numerous educational benefits, but few studies have looked more broadly at their impact on health and health behaviors. A new study conducted by researchers at Columbia University’s Mailman School of Public Health examines this issue, using data from a the well-known Carolina Abecedarian Project (ABC), a randomized control study that enrolled 111 infants in the 1970s and continued to follow them through age 21. Researchers found that individuals who had received the intensive education intervention starting in infancy had significantly better health and better health behaviors as young adults.

The study is only the second to explore the relationship of early childhood education and adult health benefits. The first study, based on the Perry Preschool Program, also was conducted by Columbia professors Peter Muennig, MD, and Matthew Neidell, PhD, on a similarly small cohort of children, and found behavioral benefits, but no overall health benefits. The current study is the first randomized control study to definitively show the health benefit of education. Findings are online in the American Journal of Public Health.***

The original study enrolled infants from 1972 to 1977 at the Frank Porter Graham Child Development Institute in Chapel Hill, NC, where they received an age-appropriate curriculum designed to enhance cognition and language development starting in infancy. Researchers had found that infants enrolled in the program had higher IQ by age three and higher reading and math achievement by 15 years of age, lower rates of teen depression and greater likelihood of college enrollment compared with a control group.

 

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‘A stark warning:’ Smoking causes genetic damage within minutes after inhaling

From a January 15, 2011 Eureka news alert

WASHINGTON, Jan. 15, 2011 — In research described as “a stark warning” to those tempted to start smoking, scientists are reporting that cigarette smoke begins to cause genetic damage within minutes — not years — after inhalation into the lungs.

Their report, the first human study to detail the way certain substances in tobacco cause DNA damage linked to cancer, appears in Chemical Research in Toxicology***, one of 38 peer-reviewed scientific journals published by the American Chemical Society.

Stephen S. Hecht, Ph.D., and colleagues point out in the report that lung cancer claims a global toll of 3,000 lives each day, largely as a result of cigarette smoking. Smoking also is linked to at least 18 other types of cancer. Evidence indicates that harmful substances in tobacco smoke termed polycyclic aromatic hydrocarbons, or PAHs, are one of the culprits in causing lung cancer. Until now, however, scientists had not detailed the specific way in which the PAHs in cigarette smoke cause DNA damage in humans.

The scientists added a labeled PAH, phenanthrene, to cigarettes and tracked its fate in 12 volunteers who smoked the cigarettes. They found that phenanthrene quickly forms a toxic substance in the blood known to trash DNA, causing mutations that can cause cancer. The smokers developed maximum levels of the substance in a time frame that surprised even the researchers: Just 15-30 minutes after the volunteers finished smoking. Researchers said the effect is so fast that it’s equivalent to injecting the substance directly into the bloodstream.

“This study is unique,” writes Hecht, an internationally recognized expert on cancer-causing substances found in cigarette smoke and smokeless tobacco. “It is the first to investigate human metabolism of a PAH specifically delivered by inhalation in cigarette smoke, without interference by other sources of exposure such as air pollution or the diet. The results reported here should serve as a stark warning to those who are considering starting to smoke cigarettes,” the article notes.

Survey finds health-care reform bad for patients, worse for doctors

Survey finds health-care reform bad for patients, worse for doctors

Nearly 3000 doctors surveyed believe the Patient Protection and Affordable Care Act will hurt care quality and doctor pay

From a January 18 Eureka Health news item

he newly released 2011 Thomson Reuters – HCPlexus National Physicians Survey (NPS) links doctors’ fears that their pay will go down under the Patient Protection and Affordable Care Act (PPACA), commonly called Healthcare Reform Act (HCRA), with their concerns that the quality of care will also deteriorate. The study includes responses from 2,958 doctors of varying specialties and practice types, from all 50 states plus the District of Columbia.

The NPS is the most comprehensive survey of physicians surrounding their thoughts on the future of healthcare, including ideas on the PPACA, Electronic Medical Records (EMR), and Accountable Care Organizations (ACO).

Lower Pay Means Lower Quality Care

The NPS data show doctors’ fear that the quality of care will deteriorate under PPACA and that their reimbursements (pay) will go down as well. When asked about the quality of healthcare in the U.S. over the next five years, 65 percent of the doctors believed it would deteriorate with only 18 percent predicting it would improve. Interestingly, consumer perception is far more optimistic, with close to 30 percent of consumers believing care will improve under PPACA.

When asked who would treat the 32 million Americans receiving healthcare under PPACA, 55% suggested a Nurse Practitioner or Physician Assistant would administer care.

“It is likely that with increased demand for general surgeons, rising overhead costs and decreasing reimbursement, there will be many of us simply retiring or finding other opportunities rather than accept the risks of surgical practice and below minimum wage benefits,” said a surgeon from Arizona.

Patient Impact Shows Slightly More Positive Outlook

But when it comes to patients, doctors have a slightly different view. When asked about the impact of reform on patients, only 58 percent were negative with 27 percent saying reform would be positive. They also believe that PCPs and NP’s will end up treating most patients.

“I believe that specialists feel that the PCP’s will allocate the majority of their time to the patients with commercial insurance or sources that have higher re-imbursements and leave the lower level payers for their PA’s and Nurse Practitioners to manage the majority of the time. These patients also have a history of being less likely to take an active role in their own care and have more ‘self inflicted problems,’ i.e. smoking, obesity, etc,” responded an Illinois-based orthopedic surgeon.

“It is clear that many physicians feel strongly that the proposed future state is counter to what they believe is the best way to serve patients,” said Raymond Fabius, MD, Chief Medical Officer at Thomson Reuters. “As practicing physicians are genuinely concerned for the health of their patients and their ability to serve them, any sustainable efforts to reform health care delivery would benefit from their inclusion and support.”

During the next 5 years, the quality of health care in this country will improve (18%) stay same (17%) deteriorate (65%)

The Affordable Care Act will result in physician reimbursement becoming more fair (9%) neither fair nor unfair (17%) less fair (74%)

Overall, the impact of the Affordable Care Act for patients will be positive (27%) neutral (15%) negative (57%)

Overall, the impact of the Affordable Care Act for physicians will be positive (8%) neutral (14%) negative (78%)

“The National Physicians Survey tells us that physicians have not been enlisted in the healthcare reform process,” said David L. Shrier, CEO of HCPlexus. Shrier continued, “The message they’ve taken from healthcare reform appears to be ‘Do more with less’. Doctors are telling us they feel disenfranchised and overburdened. In order for healthcare reform to succeed, physicians need to be engaged in dialog, and need to be communicated the benefits of the PPACA as part of a continuous messaging campaign.”

In addition to the broad answers, the survey data includes breakdowns of responses in different specialty areas, including those in primary care (such as internal medicine, Ob-GYN and pediatrics), medical specialties (including cardiology, dermatology and psychiatry), and surgical specialties. The data also includes breakdowns by group practice size. A complete copy of the survey can be accessed through the HCPlexus website at http://www.HCPlexus.com/survey.

 

 

 

CDC Health Disparities and Inequalities Report – United States – 2011 (And Link About Recent WHO Report on Inequities and Avoidable Deaths)

In my humble opinion, a strong argument for affordable, accessible health care for all regardless of one’s income or where one lives. Health disparities   are not found only within groups of people who have the ability to pay for treatments or who are able to get needed treatment quickly.

While this train of thought may be labeled as creeping socialism, health care cost/access challenges are  a matter of justice and fairness for all.  Is there agreement on what is just or what is fair? Well, no. However, I believe we all can put differences aside in working for what is best for all.

 

From the Centers for Disease Control and Prevention (CDC) January 13th news release

Americans’ differences in income, race/ethnicity, gender and other social attributes make a difference in how likely they are to be healthy, sick, or die prematurely, according to a report by the Centers for Disease Control and Prevention.

For instance, state-level estimates in 2007 indicate that low income residents report five to 11 fewer healthy days per month than do high income residents, the report says. It also says men are nearly four times more likely than women to commit suicide, that adolescent birth rates for Hispanics and non-Hispanic blacks are three and 2.5 times respectively those of whites, and that the prevalence of binge drinking is higher in people with higher incomes.

The data are in the new “CDC Health Disparities and Inequalities Report — United States, 2011”. The report also underscores the need for more consistent, nationally representative data on disability status and sexual orientation.

“Better information about the health status of different groups is essential to improve health. This first of its kind analysis and reporting of recent trends is designed to spur action and accountability at the federal, tribal, state and local levels to achieve health equity in this country,” said CDC Director Thomas R. Frieden, M.D., M.P.H.

The report, the first of a series of consolidated assessments, highlights health disparities by sex, race and ethnicity, income, education, disability status and other social characteristics. Substantial progress in improving health for most U.S. residents has been made in recent years, yet persistent disparities continue.

Released as a supplement to CDC’s Morbidity and Mortality Weekly Report, the report addresses disparities at the national level in health care access, exposure to environmental hazards, mortality, morbidity, behavioral risk factors, disability status and social determinants of health – the conditions in which people are born, grow, live and work.

Findings from the report’s 22 essays include:

In 2007, non-Hispanic white men (21.5 per 100,000 population) were two to three times more likely to die in motor vehicle crashes than were non-Hispanic white women (8.8 per 100,000). The gender difference was similar in other race/ethnic groups.

In 2007, men (18.4 per 100,000) of all ages and races/ethnicities were approximately four times more likely to die by suicide than females (4.8 per 100,000).

In 2007, rates of drug-induced deaths were highest among non-Hispanic whites (15.1 per 100,000) and lowest among Asian/Pacific Islanders (2.0 per 100,000).

Hypertension is by far most prevalent among non-Hispanic blacks (42 percent vs. 29 percent among whites), while levels of control are lowest for Mexican-Americans (31.8 percent versus 46.5 percent among non-Hispanic whites).

Rates of preventable hospitalizations increase as incomes decrease. Data from the Agency for Healthcare Research and Quality indicate that eliminating these disparities would prevent approximately 1 million hospitalizations and save $6.7 billion in health care costs each year.

Rates of adolescent pregnancy and childbirth have been falling or holding steady for all racial/ethnic minorities in all age groups. However, in 2008, disparities persist as birth rates for Hispanic adolescents (77.4 per 1,000 females) and non-Hispanic black adolescents (62.9 per 1,000 females) were three and 2.5 times those of whites (26.7 per 1,000 females), respectively.

In 2009, the prevalence of binge drinking was higher in groups with incomes of $50,000 or above (18.5 percent) compared to those with incomes of $15,000 or less (12.1 percent); and in college graduates (17.4 percent), compared to those with less than high school education (12.5 percent). However, people who binge drink and have less than $15,000 income binge drink more frequently (4.9 versus 3.6 episodes) and, when they do binge drink, drink more heavily (7.1 versus 6.5 drinks).

The report supports the Healthy People 2020 goals and the forthcoming National Partnership for Action (NPA) to End Health Disparities. The report also complements the upcoming AHRQ National Healthcare Disparities Report *** and underscores the need to connect those working in clinical care and public health, especially at the local level.

“CDC publishes this report today not only to address gaps in health between populations in our country but also to begin to measure progress in years to come in reducing these gaps and inequities going forward,” said Leandris Liburd, Ph.D., M.P.H., M.A., recently appointed director of CDC’s Office of Minority Health and Health Equity. Dr. Liburd will provide leadership for the office and CDC’s public health programs, policies, surveillance and research efforts in achieving health equity.

The full “CDC Health Disparities and Inequalities Report — United States, 2011”, is available at http://www.cdc.gov/mmwr.

*** AHRQ National Healthcare Disparities Report Fact Sheet
AHRQ- Measure Healthcare Quality, including section on National Healthcare Disparities Reports (2003-09) with related documents

Related articles

• Inequities and Avoidable Deaths (thirdworlddd.wordpress.com)
  Excerpts
  • When there are disparities, especially in health, there result avoidable deaths. The WHO estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70% (WHO, 3). That means that we already have much of the needed solutions, but why are we not implementing them? For example, Diarrheal Disease is a preventable, avoidable disease; with basic sanitation and access to clean water, a huge difference could be made in eradicating the affliction. Why are these things not being put into place?
  • What we can take from this is that we need to change the way we look at the disparities, by getting our hands dirty. We need to get into these places and ask questions, not answer them ourselves. The extent of human suffering is vast, but it needs to be witnessed in order to gain solutions. If these people can bare to live their lives full of inequities, inequalities, and misfortune, we can bare to listen to what they have to say.
• Disability as a Disparity (couragecenter.wordpress.com)

Poverty May Keep Kids from Full Genetic Potential

Poverty May Keep Kids From Full Genetic Potential

Study finds disparities between rich, poor show up by age 2

From a January 17 Health Day news item by Robert Preidt

MONDAY, Jan. 17 (HealthDay News) — Being poor can prevent young children from reaching their full genetic potential of mental ability, a new study shows.

Researchers at the University of Texas at Austin looked at 750 sets of twins who took a test of cognitive ability at ages 10 months and 2 years. During the tests the children were asked to perform such tasks as pulling a string to ring a bell, placing three cubes in a cup, and matching pictures.

At 10 months, children from all socioeconomic backgrounds performed the same on the test. But by 2 years, children from richer families scored significantly higher than those from poorer families, the investigators found.

The study results, published in the January issue of the journal

Psychological Science***

, don’t suggest that children from wealthier families are genetically superior or smarter. These children simply have more opportunity to reach their potential, explained study author Elliott Tucker-Drob, an assistant professor of psychology, in a university news release.

These findings indicate that “nature” and “nurture” work together to affect a child’s development and that the right environment can help children begin to reach their genetic potential at a much younger age than previously thought, he added.

“You can’t have environmental contributions to a child’s development without genetics. And you can’t have genetic contributions without environment. Socioeconomic disadvantages suppress children’s genetic potentials,” Tucker-Drob said.

SOURCE: University of Texas at Austin, news release, Jan. 10, 2011

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