Cases of insulin-requiring type 1 diabetes rose sharply in children under the age of five in Philadelphia over a two-decade span – similar to increases seen across the U.S. and Europe, according to new research.

“Why are we seeing this large increase in type 1 diabetes in very young children? Unfortunately, the answer is we don’t know,” said lead study author Terri Lipman, a professor at the University of Pennsylvania School of Nursing.

In research published in Diabetes Care, Lipman and her colleagues updated a registry started in 1985 of Philadelphia children diagnosed with type 1 diabetes.

By 2004, cases in children under the age of five increased by 70 percent as the number of diagnosed cases among all kids up to age 14 rose by 29 percent.

In 1985, 13.4 out of every 100,000 children in Philadelphia was newly diagnosed with type 1 diabetes, and in 2004, the rate was 17.2 cases per 100,000.

Hispanic children had the highest diabetes rates across all ages whereas cases in black children aged 4 and under, which had historically been very low, rose by 200 percent over the past two decades. Cases among white kids under 4 rose by 48 percent in 2000-2004, however, making theirs the fastest recent increase.

Of the two most common forms of diabetes, type 2 typically affects adults who can still produce insulin, but whose bodies cannot use the hormone to regulate blood sugar. Type 1, previously known as juvenile diabetes, typically strikes children whose immune systems have killed off insulin-producing cells in the pancreas. The disease is usually fatal if left untreated.

Type 1 diabetics must take insulin but many type 2 diabetics can control the disease with medications, diet and exercise.

Type 1 diabetes tends to start in adolescence, but especially in light of the rising number of cases in very young children, experts said parents need to be aware that toddlers and preschoolers are also susceptible.

Children from Chicago to Colorado to Finland have similarly increased rates of type 1 diabetes, though the cause eludes researchers.

“This younger group is a mystery,” said Dr. Carol Levy, a type 1 diabetes specialist at Mount Sinai Hospital in New York who was not involved in the new study. “Make sure your child has a healthy lifestyle and maintains normal body weight; whether that’s a guarantee we’re going to reduce risk, we don’t know at this point.”

Several theories vie to explain the recent rise in diabetes among youth, including vitamin D deficiencies, lack of breastfeeding and overly-hygienic environments that might cause the immune system to backfire.

“The data is controversial so that’s why I’m certainly very reluctant to propose a theory when nothing has been proven,” Lipman told Reuters Health.

“The take home message is not to be alarmist. These data confirm what has been reported worldwide and in other parts of the United States,” said Dr. Lori Laffel, of the Joslin Diabetes Center in Boston, who was not involved in the study.

“It is important to be aware of the symptoms of diabetes,” Laffel told Reuters Health. Symptoms can include extreme thirst, bed wetting or accidents in toilet-trained children or excessively wet diapers in babies, she said.

By the time the disease gets diagnosed, many infants and toddlers are very sick and the degree of illness tends to be more severe the younger the patient, experts noted.

“The young child isn’t able to talk about symptoms,” Laffel said. “A young child may be in diapers, you may not notice because diapers are often wet.”

SOURCE: bit.ly/YGkBuW Diabetes Care, online January 22, 2013.

Uninsured Americans were less likely to get the best treatment for heart troubles than those with insurance in a new study that hints the blame may lie with the quality of physicians who typically treat the uninsured.

In a group of about 61,000 Americans, researchers found that those without any health insurance were between 6 percent and 12 percent less likely than people with either public or private insurance to be prescribed drugs that are considered standard care for heart disease.

“There is some difference of treatment. It only applies – interestingly enough – to uninsured patients,” said the study’s senior author Dr. Paul Chan, of Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.

In the past, studies found uninsured Americans have worse health outcomes, compared to the insured. They’re also less likely to get screenings and preventive care – possibly because they don’t often go to a doctor.

Less is known, though, about uninsured people who do go to doctors and whether they receive worse care than insured people.

For the new study, Chan and his colleagues used data from 2009 on 60,814 heart patients at 30 doctors’ offices around the U.S.

Of those patients, about 9 percent were uninsured, 71 percent had private insurance, and 20 percent had public insurance, such as Medicare or Medicaid.

The researchers, who published their findings in the Journal of the American College of Cardiology, looked to see which patients received the recommended medications for their heart conditions and whether the treatment they got was linked to their insurance status.

Overall, patients with public or private insurance received about the same number of prescriptions, but the uninsured patients were less likely to be prescribed drugs, compared to the insured patients.

For example, about 73 percent of uninsured patients were prescribed beta-blockers after a heart attack, compared to about 81 percent of privately insured patients. And about 89 percent of uninsured patients received medication for high cholesterol, compared to about 95 percent of privately insured patients.

But those differences seemed to disappear when the researchers took into account where the patients were being treated.

“That seems to suggest that at lot of this is being mediated by the clinics that are seeing lots of uninsured patients. They’re underperforming compared to clinics that are seeing insured patients,” said Chan.

“It speaks to the idea that the higher the number of uninsured patients in your practice, the more financially unstable it is… and quality goes down,” said Dr. Ed Havranek, a cardiologist at the Denver Health Medical Center in Colorado.

Havranek, who wrote a commentary accompanying the new study, told Reuters Health, “If it’s just the lack of insurance, it should not affect the physicians’ decisions to sit down and prescribe (a drug).” It could be driven by doctors’ perceptions of their patients, he said.

Chan added that uninsured people tend to be sicker and their other conditions may take priority over their heart problems.

“Truth be told, when many of these patients come in it’s not just cardiovascular disease. It’s diabetes, obesity and smoking too,” Chan said.

Havranek said the first step to solving the problem is doing what Chan and his colleagues did by shining a light on it, and then finding a practical solution.

“You have to be open to the possibility that you’re not doing things accurately or fairly across patient populations,” he said.

SOURCE: bit.ly/WHGbw0 Journal of the American College of Cardiology, January 2013.

The most extensive study yet by the U.S. government on suicide among military veterans shows more veterans are killing themselves than previously thought, with 22 deaths a day – or one every 65 minutes, on average.

The study released on Friday by the Department of Veterans Affairs covered suicides from 1999 to 2010 and compared with a previous, less precise VA estimate that there were roughly 18 veteran deaths a day in the United States.

More than 69 percent of veteran suicides were among individuals aged 50 years or older, the VA reported.

“This data provides a fuller, more accurate, and sadly, an even more alarming picture of veteran suicide rates,” said Democratic Senator Patty Murray of Washington state, who has championed legislation to strengthen mental health care for veterans.

The news came two weeks after the U.S. military acknowledged that suicides hit a record in 2012, outpacing combat deaths, with 349 active-duty suicides – almost one a day.

That was despite sharper focus at the leadership level at the Pentagon and VA on the suicide problem, and came during an overall rise in suicides in the United States. The number of suicides in the United States rose 11 percent from 2007 to 2010, the VA said.

The VA did not provide raw data and acknowledged its national figures were still estimates. The new study was based on data collected from 21 states in which military status is reported on the death certificate. It said more data from more states were being processed.

Reuters last year obtained less-detailed data for the 2005-to-2010 period from 32 states, also showing a significant rise in the number of suicides among the country’s 23 million veterans.

The VA said that while the number of veteran suicides had risen, the percentage of all suicides in America identified as “veteran” declined from 1999 to 2003 and had remained relatively constant in recent years.

The VA said the data would help it better identify where at-risk veterans may be located and improve targeting of specific suicide intervention and outreach activities.

“We have more work to do and we will use this data to continue to strengthen our suicide prevention efforts,” Veterans Affairs Secretary Eric Shinseki said in a statement.

(Reporting by Phil Stewart; Editing by Peter Cooney)
source : http://www.reuters.com/article/2013/02/02/us-usa-veterans-suicide-idUSBRE9101E320130202

Toxicity caused by debris from a metal-on-metal hip implant meant that the device had to be removed from a 66-year-old man who is suing manufacturer Johnson & Johnson, according to expert testimony heard at the trial on Friday.

“I concluded that his hip failed because of the toxic exposure,” said Robert Harrison, an occupational medicine specialist at the University of California, San Francisco, who was not involved in treating plaintiff Loren Kransky but did review the medical records.

The testimony was heard in Los Angeles Superior Court in the first lawsuit to go to trial involving all-metal hips made by J&J’s DePuy unit. More than 10,000 U.S. lawsuits have been filed since the hips were recalled from the market in 2010.

As many as 500,000 Americans are estimated to have received metal-on-metal hip replacements.

Lawyers for Kransky argue that J&J was aware of the defects in the ASR hip implants, including the risk of poisoning from cobalt and chromium metal debris, even before it started selling the devices in 2004.

Kransky’s blood tests showed that his levels of cobalt and chromium reached as much as seven times normal after he received the ASR hip.

The Food and Drug Administration last month proposed that companies making all-metal hip replacements provide additional information proving they are safe and effective before being allowed to continue selling them.

The agency said it was not recommending a specific level of metals in the blood as a trigger for revision surgery because there was not enough evidence to demonstrate a correlation between those levels and patient outcomes.

J&J attorney Alex Calfo said the amount of cobalt measured in Kransky was not enough to cause any adverse systemic health effects.

Trial testimony earlier in the week included DePuy executives explaining that the ASR hip was tested in the laboratory at a single angle of implantation. Plaintiffs’ lawyers contend that they should have tested it using multiple angles.

All-metal hip implants were developed to be more durable than traditional implants with ceramic or plastic components, but have been shown to fail at a higher rate than traditional implants.

A J&J study presented at the trial showed that the company had estimated that 37 percent of the devices would fail within about five years of implant surgery.

(Reporting By Deena Beasley; Editing by Jilian Mincer and Matthew Lewis)
source : http://www.reuters.com/article/2013/02/01/us-jj-hip-trial-idUSBRE91019V20130201

Vegetarians are one-third less likely to be hospitalized or die from heart disease than meat and fish eaters, according to a new UK study.

Earlier research has also suggested that non-meat eaters have fewer heart problems, researchers said, but it wasn’t clear if other lifestyle differences, including exercise and smoking habits, might also play into that.

Now, “we’re able to be slightly more certain that it is something that’s in the vegetarian diet that’s causing vegetarians to have a lower risk of heart disease,” said Francesca Crowe, who led the new study at the University of Oxford.

Still, she noted, the researchers couldn’t prove there were no unmeasured lifestyle differences between vegetarians and meat eaters that could help explain the disparity in heart risks.

Crowe and her colleagues tracked almost 45,000 people living in England and Scotland who initially reported on their diet, lifestyle and general health in the 1990s.

At the start of the study, about one-third of the participants said they ate a vegetarian diet, without meat or fish.

Over the next 11 to 12 years, 1,066 of all study subjects were hospitalized for heart disease, including heart attacks, and 169 died of those causes.

After taking into account participants’ ages, exercise habits and other health measures, the research team found vegetarians were 32 percent less likely to develop heart disease than carnivores. When weight was factored into the equation, the effect dropped slightly to 28 percent.

The lower heart risk was likely due to lower cholesterol and blood pressure among vegetarians in the study, the researchers reported this week in the American Journal of Clinical Nutrition.

Meat eaters had an average total cholesterol of 222 mg/dL and a systolic blood pressure – the top number in a blood pressure reading – of 134 mm Hg, compared to 203 mg/dL total cholesterol and 131 mm Hg systolic blood pressure among vegetarians.

Diastolic blood pressure – the bottom number – was similar between the two groups.

Crowe said the difference in cholesterol levels between meat eaters and vegetarians was equivalent to about half the benefit someone would see by taking a statin.

The effect is probably at least partly due to the lack of red meat – especially meat high in saturated fat – in vegetarians’ diets, she added. The extra fruits and vegetables and higher fiber in a non-meat diet could also play a role.

“If people want to reduce their risk of heart disease by changing their diet, one way of doing that is to follow a vegetarian diet,” Crowe told Reuters Health.

However, she added, you also don’t have to cut out meat altogether – just scaling back on saturated fat can make a difference, for example. Butter, ice cream, cheeses and meats all typically contain saturated fat.

SOURCE: bit.ly/YGvv40 American Journal of Clinical Nutrition, online January 30, 2013.

House Republicans on Friday set a deadline for the U.S. Food and Drug Administration to produce documents related to the deadly meningitis outbreak that swept across the nation in late 2012.

Leaders of the House Energy and Commerce Committee first requested, in October, documents related to FDA’s oversight of New England Compounding Center, the now defunct, Boston-area compounding pharmacy that was at the center of the outbreak.

But it says the agency produced few documents so far and that those it has “raise new and troubling questions” about the agency’s oversight of NECC.

“If FDA does not produce all the responsive documents by 5:00 p.m. on February 25, 2013, the committee will move forward with a business meeting to compel their production,” the committee said in a release.

“We hope a subpoena will not be necessary for the FDA to cooperate and help us determine what went wrong,” said Oversight and Investigations Subcommittee Chairman Tim Murphy of Pennsylvania.

The meningitis outbreak to date has killed 45 people and sickened almost 700 in 19 states, according to the U.S. Centers for Disease Control.

(Reporting by Ros Krasny; Editing by Leslie Gevirtz)
source : http://www.reuters.com/article/2013/02/02/us-usa-health-meningitis-idUSBRE9101DF20130202

The Obama administration on Friday sought to settle a dispute with religious leaders over whether employees at faith-affiliated universities, hospitals and other institutions should have access to health insurance coverage for contraceptives.

The new set of proposals would instead guarantee that employees at religious nonprofits would get access to birth control coverage without out-of-pocket costs through separate plans with insurers picking up the tab.

The rules follow months of protest and legal action by groups representing Roman Catholics, Protestant evangelicals and private employers.

They have argued that President Barack Obama’s 2010 Patient Protection and Affordable Care Act forces them to violate their own religious tenets against contraception.

For more than a year, the Obama administration has grappled with how to balance its desire to guarantee universal contraceptive coverage with religious freedoms provided by the U.S. Constitution.

Faced with the ire of religious leaders and social conservatives in the midst of a heated presidential campaign, Obama said last February that he would create an accommodation for religious employers under the law.

The new rules from the Department of Health and Human Services consolidate many of the ideas administration officials voiced then, but in greater detail.

“Today, the administration is taking the next step in providing women across the nation with coverage of recommended preventive care at no cost, while respecting religious concerns,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

“We will continue to work with faith-based organizations, women’s organizations, insurers and others to achieve these goals.”

Some leading religious figures offered a muted response. Cardinal Timothy Dolan of New York said he would study the proposal. So did the Catholic Health Association of the United States, which represents more than 1,200 hospitals and other healthcare facilities.

Other religious and social conservative groups expressed disappointment, particularly over the administration’s decision not to extend the accommodation to for-profit employers.

AN UNNECESSARY ONUS

“This proposal does nothing to change the scope of religious employer exemption,” said Kyle Duncan, general counsel for the Becket Fund for Religious Liberty, which is assisting in a number of legal challenges to the policy.

“The proposal has nothing to do with millions of family businesses and owners who are having their rights violated by the mandate and are currently in litigation,” he said.

Women’s rights advocates such as Planned Parenthood and the American Civil Liberties Union generally backed the regulations. But some rights groups said that separating contraceptives coverage from other health benefits posed an unnecessary onus for women to satisfy disapproving employers.

The liberal group Catholics for Choice also warned that some employees could be left in the dark about their benefits, because of a new definition for religious employers that exempts houses of worship even if they operate soup kitchens, parochial schools and other social services that are open to non-members.

“Many, if not most, of the parochial schools, social service agencies and other organizations directly affiliated with the diocesan offices and parishes are exempted from coverage completely,” concluded the group’s president, Jon O’Brien.

HHS said in the regulations that the change would not expand “the universe of employer plans that would qualify for the exemption” beyond what administration originally intended.

The mandate contained in Obama’s Affordable Care Act requires most employers to provide coverage for contraceptives and sterilization procedures approved by the U.S. Food and Drug Administration, including the so-called morning-after pill.

But while the new rule allowed exemptions for church-run social services, the regulations did not alter the Obama position that employees and students at religiously affiliated nonprofit groups should have access to contraceptive coverage even if their institutions object.

The rule, which requires the institutions to self-certify their status as religious nonprofits, calls on private insurers to cover contraceptives through separate individual plans with the insurer covering the cost. Officials said insurers would be compensated by lower healthcare expenses due to fewer births.

A similar accommodation for religious institutions that provide their own health insurance for workers and students would be insulated by third-party administrators.

The administrators would find an outside insurer to provide the contraceptives coverage. Those insurers’ higher costs would then be compensated by lower user fees for participating in state-based healthcare exchanges, which are scheduled to begin operating on January 1, 2014.

The proposed regulations are open for public comment through April 8.

(Additional reporting by Atossa Abrahamian in New York; Editing by Karey Wutkowski, Jackie Frank and Eric Walsh)
source : http://www.reuters.com/article/2013/02/02/us-usa-healthcare-contraceptives-idUSBRE9100ZL20130202

Snacks sold in U.S. schools would need to be lower in fat, salt and sugar and include more nutritious items like fruits, vegetables and whole grains, under standards proposed on Friday by the U.S. Department of Agriculture.

The proposal, more than a year overdue, also calls for a limit of 200 calories on items sold during the school day at vending machines or other venues outside the school lunch line.

The proposed rules are the second step in a larger effort to improve the foods U.S. students have access to during the school day under a 2010 child nutrition law. One-third of U.S. children and teenagers are overweight or obese.

The proposed rules would cover some 50 million children attending more than 100,000 schools that are part of the school lunch program. Many U.S. children eat more than half of their calories at school.

There was wide agreement by food and beverage companies, consumer advocates and public health experts on the need to offer students healthier choices

“If a student buys a snack from a vending machine or a slice of pizza from the a la carte line, it should be healthy,” said Risa Lavizzo-Mourey, head of the Robert Wood Johnson Foundation, which focuses on health care. “These proposed nutrition standards, the first update in more than 30 years, are long overdue and badly needed.”

“ENOUGH JUNK FOOD FOR 2 BILLION CANDY BARS”

Children buy an estimated 400 billion calories of junk food a year at school, the same calorie count that could be found in 2 billion candy bars, said a group of retired military leaders who back the proposed rules.

The group, called Mission: Readiness, has warned that one in four young Americans is too heavy for military service.

Agriculture Secretary Tom Vilsack, who has described his own struggles with weight as a child, said the higher standards for snack bars, vending machine and cafeterias will mean “the healthy choice is the easy choice for our kids.”

USDA said the rules would not cover items sold at after-hours activities, such as sporting events. They also would allow for “important traditions,” such as parents sending cookies or cupcakes to school for a child’s birthday, or “occasional fundraisers and bake sales.”

In general, foods sold at school could not provide more than 35 percent of their calories through fat or sugar. Salt content also would be limited.

For beverages, USDA called for schools to be able to sell water, low-fat and fat-free milk, and 100 percent juices, with smaller 8-ounce (240-ml) portions created for younger students.

High school students could buy 20-ounce servings of various calorie-free beverages, and 12-ounce servings of drinks that have 75 calories or less but not during lunch or breakfast.

The soft drink industry said it has shifted to lower-calorie drinks in school vending machines and it welcomed USDA’s proposal. The number of calories shipped to schools in beverages is down by 90 percent in six years, it said.

The public has 60 days to comment on the proposal before USDA issues any final ruling. USDA said schools will have at least one full school year after the final rule is issued to implement the changes.

Vending machines are in just 13 percent of U.S. elementary schools but are in two thirds of middle schools, where student are 11 to 14 years old, and in 85 percent of high schools. USDA says more than 80 percent of school districts have restricted or banned sugary drinks and more than 75 percent put limits on snack foods or banned them.

(Editing by Marguerita Choy and David Gregorio)
source : http://www.reuters.com/article/2013/02/01/us-usa-schools-snacks-idUSBRE91019720130201

It seems like a no-brainer.

Since about 75 percent of healthcare spending in the United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart disease, providing more preventive care should cut costs.

If only.

In a report released on Tuesday, the non-profit Trust for America’s Health outlined a plan “to move from sick care to health care” by putting more resources into preventing chronic disease rather than treating it, as the current system does. There is a strong humanitarian justification for prevention, argued Trust Executive Director Jeffrey Levi in an interview, since it reduces human suffering.

But the report also makes an economic argument for preventive care, highlighting the possibility of reducing healthcare spending — which in 2011 reached $2.7 trillion, just shy of 18 percent of gross domestic product — by billions of dollars. And that has health economists shaking their heads.

“Preventive care is more about the right thing to do” because it spares people the misery of illness, said economist Austin Frakt of Boston University. “But it’s not plausible to think you can cut healthcare spending through preventive care. This is widely misunderstood.”

A 2010 study in the journal Health Affairs, for instance, calculated that if 90 percent of the U.S. population used proven preventive services, more than do now, it would save only 0.2 percent of healthcare spending.

Some disease-prevention programs do produce net savings. Childhood immunizations, and probably some adult immunizations (such as for pneumonia and the flu), are cost-saving, found a 2009 analysis for the Robert Wood Johnson Foundation. The vaccines are cheap, and large swaths of the population are vulnerable to the diseases they prevent. The cost of providing them to everyone is less than that of treating the illnesses they prevent.

Counseling adults about using baby aspirin to prevent cardiovascular disease also produces net savings. The counseling is inexpensive, the aspirin even cheaper and the costs of heart disease, which strikes one in three U.S. adults, are enormous. Screening pregnant women for HIV produces net savings, too.

Those, however, are exceptions.

HIGH COSTS, NO BENEFITS

One big reason why preventive care does not save money, say health economists, is that some of the best-known forms don’t actually improve someone’s health.

These low- or no-benefit measures include annual physicals for healthy adults. A 2012 analysis of 14 large studies found they do not lower the risk of serious illness or premature death. But about one-third of U.S. adults get them, said Dr. Ateev Mehrota, a primary-care physician and healthcare analyst at RAND, for a cost of about $8 billion a year.

Similarly, some cancer screenings — including for ovarian cancer and testicular cancer, and for prostate cancer via PSA tests — produce essentially no health benefits, causing the U.S. Preventive Services Task Force to recommend against their routine use. The task force bases its recommendations on medical benefits alone, not costs.

The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.

“It seems counterintuitive: If you provide care to prevent all these expensive diseases, it should save money,” said Peter Neumann, an expert on health policy and professor of medicine at Tufts University School of Medicine. “But prevention itself costs money, and some preventive measures can be very expensive, especially if you give them to a lot of people who won’t benefit.”

If preventive care could be provided only to those who are going to get the illness, it would be more cost-effective. “But in the real world, the number needed to screen or to treat in order to prevent one case of illness can be huge,” said BU’s Frakt, who blogs at theincidentaleconomist.com.

Currently, many people who do not benefit from a preventive service receive it, paying something for nothing. Studies have calculated those numbers, which can be surprisingly high.

For instance, 217 high-risk smokers would have to undergo a CT lung scan for one to be spared death from lung cancer, according to a database of studies maintained by Dr. David Newman, an emergency physician at Mount Sinai School of Medicine in New York City. One hundred post-menopausal women who have had a bone fracture would have to take drugs called bisphosphonates in order for one to avoid a hip fracture.

By comparison, only 50 people with heart disease must be treated with aspirin for one to avoid a heart attack or stroke, making this a good buy.

The numbers of people who need to be treated for one to benefit are so high because so few will get the disease the preventive is meant to avert. It’s like treating every house for termites, said Neumann, co-author of the Robert Wood Johnson report: The vast majority would never have gotten infested in the first place, so the thousands spent to avoid the infestation is money for nothing.

The failure of many preventive services to improve health, plus the large number of people who have to receive preventive care for one to be spared an illness he or she would otherwise get, limit the economic savings.

MAKING HEALTHCARE DOLLARS GO FURTHER

A better gauge of the value of preventive medicine is bang for the buck; that is, not whether it reduces healthcare spending but whether it buys more health than treating the disease does. “We don’t ask whether cancer treatment or heart disease treatment saves money,” said Dr. Steven Woolf, professor of family medicine at Virginia Commonwealth University Medical Center in Richmond. “But it is reasonable to ask how to make our healthcare dollar go further.”

On that score, screening for hypertension and for some cancers (such as colorectal and breast) are good investments, he said, at less than $25,000 per year of healthy life. In contrast, such common treatments as angioplasty cost $100,000 or more per healthy year of life.

There are two glimmers of hope in this bleak picture. For preventive medicine to help rein in the nation’s soaring healthcare spending, it should be provided someplace other than doctors’ offices.

“Some of the most common chronic, preventable diseases might be best addressed outside the clinical setting,” said the Trust’s Levi, such as through wellness programs at YMCAs and health education and screening programs at houses of worship. “But that requires Medicaid to be more flexible in who they’ll reimburse.”

It also requires a more expansive definition of preventive medicine. The Trust suggests such steps as extending bus lines to parks so people without cars can go someplace pleasant for physical activity and other “community-based” efforts. These strategies save more money in healthcare spending than they cost.

For instance, at a program in Akron, Ohio, profiled in the new report, physicians and others coordinate care for patients with Type 2 diabetes. It reduced the average cost of care by more than 10 percent, or $3,185 per year, largely by reducing pricey emergency-room visits.

And at Boston Children’s Hospital, an asthma program that sends community health workers into patients’ homes to reduce the environmental triggers of asthma has saved $1.46 in healthcare costs for every $1 invested. It has reduced asthma-related hospital admissions by 80 percent and asthma-related emergency department visits by 60 percent, reports the Trust.

The other promising approach is to target preventive care at those most likely to develop a chronic disease, not at low-risk people. Such “smart” prevention increases the chances of preventing expensive diseases and saving money.

In contrast, unthinking expansion of preventive medicine is the wrong prescription, say experts.

“If you start giving preventive care to more people, many of whom won’t benefit from it, it’s going to be very, very expensive,” said Tufts’ Neumann.

(Reporting by Sharon Begley; Editing by Jilian Mincer and Douglas Royalty)

source : http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129

Governments must not allow financial constraints caused by the current global economic crisis to stop them keeping their guard up against avian flu, the Food and Agriculture Organisation (FAO) said on Tuesday.

The agency, one of three international bodies that lead the global response to bird flu, warned of a repeat of the 2006 outbreaks, when the highly pathogenic H5N1 virus killed 79 people around the world and sparked fears of a pandemic.

Investment was vital to prevent a repeat of such a crisis, the FAO said.

“I am worried because in the current climate governments are unable to keep up their guard,” FAO Chief Veterinary Officer Juan Lubroth said in a statement. “I see inaction in the face of very real threats to the health of animals and people.”

Scientists fear avian flu, which is carried by water fowl and poultry and can be transmitted between birds, and from birds to people, could cause a catastrophe if it mutates to be able to spread between humans.

The virus has infected more than 600 people since it was first detected in Hong Kong in 1997 and is usually fatal. Bird deaths from the disease or culling cost economies $20 billion between 2003 and 2011, FAO said.

The UN agency, whose task is to coordinate the global response to outbreaks of avian flu in animals, said that while progress had been made in fighting the virus, outbreaks continue to occur in Asia and the Middle East.

The FAO also warned against a growing threat from Peste des Petits Ruminants (PPR), a highly contagious disease that can decimate flocks of sheep and goats, which is expanding in sub-Saharan Africa.

A vaccine against the disease is available but tight finances, a lack of political will and poor planning mean PPR continues to spread, the agency warned.

(Reporting by Naomi O’Leary; Editing by Sonya Hepinstall)

source : http://www.reuters.com/article/2013/01/29/us-birdflu-fao-idUSBRE90S0LK20130129