Feds urge Midwesterners to stop eating ‘cannibal sandwiches’

Residents in the upper U.S. Midwest should ditch their seasonal tradition of eating “cannibal sandwiches” made of raw ground beef, health officials warned, citing multiple outbreaks of foodborne illnesses since the 1970s and cases last year. Gobbling up raw ground beef spread on sandwich bread or crackers with onions and … Read more →

Published Dec. 06, 2013, at 7:19 a.m.     |    

Feds urge Midwesterners to stop eating ‘cannibal sandwiches’

Published Dec. 06, 2013, at 7:19 a.m.

Residents in the upper U.S. Midwest should ditch their seasonal tradition of eating “cannibal sandwiches” made of raw ground beef, health officials warned, citing multiple outbreaks of foodborne illnesses since the 1970s and cases last year.

Gobbling up raw ground beef spread on sandwich bread or crackers with onions and other seasoning led to more than 50 cases of foodborne illness in 1972, 1978 and 1994 in Wisconsin, the Centers for Disease Control and Prevention wrote in a report released this week.

Raw beef “cannibal sandwiches” have also been linked to at least four cases, and possibly more than a dozen, of sickness tied to E. Coli bacteria in the central region of Wisconsin over the 2012 winter holiday season, the CDC said.

The bacteria can cause dehydration, bloody diarrhea and abdominal cramps and, in the most severe cases, kidney failure.

“Despite ongoing outreach efforts addressing the dangers associated with consuming undercooked or raw ground beef, this regional holiday tradition continues to be associated with outbreaks,” the CDC said.

Jubilant amateur chefs can be seen in Web videos dining on blood-red beef chunks dusted with pepper, topped with onions, packed with capers, and piled onto sandwich bread with cheese and mustard.

The CDC urged retailers to discourage customers from consuming raw ground beef, which it said should be cooked to an internal temperature of 160 degrees Fahrenheit.

 

Sedentary lifestyle linked to depression

NEW YORK — A new analysis of previous studies ties too much sitting at the computer or lying around watching TV to a greater risk of depression. Based on dozens of studies covering hundreds of thousands of participants, Chinese researchers found that sedentary behavior was linked to a 25 percent … Read more →

Published Sept. 18, 2014, at 9:43 p.m.     |    

Sedentary lifestyle linked to depression

Published Sept. 18, 2014, at 9:43 p.m.

NEW YORK — A new analysis of previous studies ties too much sitting at the computer or lying around watching TV to a greater risk of depression.

Based on dozens of studies covering hundreds of thousands of participants, Chinese researchers found that sedentary behavior was linked to a 25 percent higher likelihood of being depressed compared to people who were not sedentary.

The research has limitations, Long Zhai, of Qingdau University Medical College in Shangong, and his coauthors write, but it suggests that physical activity would be a good prescription for preventing depression.

“Although it was a thorough investigation of a relatively new research area, a number of unanswered questions still remain,” said Megan Teychenne from the Centre for Physical Activity and Nutrition Research at Deakin University in Melbourne, Australia.

Among these is “whether sedentary behavior increases the risk of depression; or whether it is that those with depression are just more likely to engage in sedentary behaviors such as computer use or television viewing,” said Teychenne, who wasn’t involved in the study.

For their report, published in the British Journal of Sports Medicine, Zhai and colleagues combined and re-analyzed the findings for a total of 193,166 participants from 24 previously published observational studies that looked at levels of sedentary behavior and risk of depression.

Two of the studies were conducted in Australia, four in Asia, seven in the Americas and 11 in Europe.

Across continents, the researchers found that people with the most sedentary behavior were 25 percent more likely to be depressed overall compared to those who were the least sedentary.

The study team also saw differences depending on people’s preferred type of inactivity. Those whose most frequent sedentary behavior was watching TV were 13 percent more likely to be depressed, while those who spent their sedentary time using the computer or Internet, had a 22 percent higher depression risk.

The analysis didn’t look at the reasons behind the links. And, the study team points out, most of the included studies accounted for other factors, like illnesses, that might explain the sedentary behavior, the depression, or both, but those studies may not have taken every possible factor into account.

The research team also notes that they cannot rule out the possibility that depression leads to sedentary behaviors rather than the other way around.

Nonetheless, that the two go hand in hand is enough to suggest that more activity might be the antidote, they conclude.

Teychenne also said that even though the study results are inconclusive regarding the connection between sedentary behavior and mental health, researchers do know that being sedentary is linked to other poor health outcomes like cardiovascular disease and type 2 diabetes.

“Therefore, the message we really need to get out to the public is ‘Move more and sit less,’” she said.

“I think it’s certainly an important study, and it shows that there are links but it does point out some issues that we need to think about,” Jennifer Brunet told Reuters Health.

Brunet is a researcher with the School of Human Kinetics at the University of Ottawa in Ontario Canada, who was not involved with the study.

She added that she doesn’t think all sedentary behavior is a bad thing, and it could provide some escape from the stress of a hard day.

“Sometimes people read; people go on the Internet, and unfortunately, the measures that were used in the reviewed studies didn’t always differentiate what we can call healthier sedentary behaviors versus unhealthy sedentary behaviors,” Brunet pointed out.

Still, she said, there’s clear evidence that physical activity is good for the management of depression symptoms as well as clinical levels of depression.

There’s not enough good evidence to suggest that any one specific form of physical activity is best, she added, but research indicates that moderate exercise is most effective.

“I often tell people to pick activities that are enjoyable, and that’s the key to it,” she said. “We don’t want to pressure people to do physical activity, we want them to choose it and one way of choosing it is if they feel it’s an enjoyable activity.”

 

It’s not a small world after all: Experts say world population will soar

WASHINGTON — Contrary to some earlier projections, the world’s population will soar through the end of the 21st century thanks largely to sub-Saharan Africa’s higher-than-expected birth rates, United Nations and other population experts said on Thursday. There is an 80 percent likelihood that the number of people on the planet, … Read more →

Published Sept. 18, 2014, at 9:42 p.m.     |    

It’s not a small world after all: Experts say world population will soar

Published Sept. 18, 2014, at 9:42 p.m.

WASHINGTON — Contrary to some earlier projections, the world’s population will soar through the end of the 21st century thanks largely to sub-Saharan Africa’s higher-than-expected birth rates, United Nations and other population experts said on Thursday.

There is an 80 percent likelihood that the number of people on the planet, currently 7.2 billion, will increase to between 9.6 billion and 12.3 billion by 2100, the researchers said. They also saw an 80 percent probability that Africa’s population will rise to between 3.5 billion and 5.1 billion by 2100 from about 1 billion today.

The study, led by U.N. demographer Patrick Gerland and University of Washington statistician and sociologist Adrian Raftery and published online by the journal Science, foresees only a 30 percent chance that earth’s population will stop rising this century.

“Previous forecasts did indeed forecast a leveling off of the world population around 2050, and in some cases a decline,” Raftery said.

Raftery said the new projections arise from data that clearly establishes that birth rates in sub-Saharan Africa have not been decreasing as quickly as some experts had expected, a trend that was “not as clear when previous forecasts were made.”

Raftery said the researchers used data on population, fertility, mortality and migration from every country and then predicted future rates using new statistical models. Some of the figures, such as the median projection of the population hitting 10.9 billion by 2100, mirror a U.N. report published in 2013.

U.N. demographer Gerland said sub-Saharan Africa countries already with big populations and high fertility levels are expected to drive population growth, including Nigeria, Tanzania, Democratic Republic of the Congo, Niger, Uganda, Ethiopia, Kenya, Zambia, Mozambique and Mali.

The world’s population reached 1 billion in the early 19th century, doubled to 2 billion in the 1920s and doubled again to 6 billion in the 1990s. It hit 7 billion in 2011.

The findings underscore worries expressed for decades by some experts about a planet growing more crowded and humankind exhausting natural resources, struggling to produce enough food or cope with poverty and infectious diseases.

Raftery said African nations could benefit by intensifying policies to lower fertility rates, with studies showing that greater access to contraceptives and more education for girls and women can be effective.

The researchers projected that Asia’s population, now 4.4 billion, will peak at around 5 billion people in 2050, then begin to decline. They forecast that the populations of North America, Europe and Latin America will stay below 1 billion each by 2100.

Among the experts who had predicted the global population rise would peter out was a 2010 report by Austrian demographer Wolfgang Lutz. He forecast it likely would reach 8 billion to 10 billion by 2050 but “population stabilization and the onset of a decline are likely” in the second half of the century.

 

Eight bodies found after attack on Guinea Ebola education team

CONAKRY — Eight bodies, including those of three journalists, were found after an attack on a team trying to educate locals on the risks of the Ebola virus in a remote area of southeastern Guinea, a government spokesman said on Thursday. “The eight bodies were found in the village latrine. … Read more →

Published Sept. 18, 2014, at 9:39 p.m.     |    

Eight bodies found after attack on Guinea Ebola education team

Published Sept. 18, 2014, at 9:39 p.m.

CONAKRY — Eight bodies, including those of three journalists, were found after an attack on a team trying to educate locals on the risks of the Ebola virus in a remote area of southeastern Guinea, a government spokesman said on Thursday.

“The eight bodies were found in the village latrine. Three of them had their throats slit,” Damantang Albert Camara told Reuters by telephone in Conakry.

However, Guinea’s Prime Minister Mohamed Saïd Fofana, speaking in a television message that had been recorded earlier, said 7 bodies of 9 missing people had been found.

He said six people have been arrested following the incident, which took place on Tuesday in Wome, a village close to the town of Nzerekore, in Guinea’s southeast, where Ebola was first identified in March.

Since then the virus has killed some 2,630 people and infected at least 5,357 people, according to World Health Organization, mostly in Guinea, neighboring Sierra Leone and Liberia. It has also spread to Senegal and Nigeria.

Authorities in the region are faced with widespread fears, misinformation and stigma among residents of the affected countries, complicating efforts to contain the highly contagious disease.

Fofana said the team that included local administrators, two medical officers, a preacher and three accompanying journalists, was attacked by a hostile stone-throwing crowd from the village when they tried to inform people about Ebola.

He said it was regrettable that the incident occurred as the international community was mobilizing to help countries struggling to contain the disease.

 

Larry Crimi (foreground) of Scranton, Pennsylvania, a conservation law enforcement major at Unity College, raises a locally grown organic pumpkin to the sky at the Common Ground Country Fair in this 2011 file photo.

All hail the Common Ground Country Fair

UNITY, Maine — From low-impact forestry to Scottish Highland cattle to contra dancing, the 38th annual Common Ground Country Fair is a celebration of Maine’s rural and agricultural traditions. Tens of thousands are expected to gather this weekend on 50 lush acres in Unity for the three-day fair that captures … Read more →

Published Sept. 18, 2014, at 4:41 p.m.     |    

All hail the Common Ground Country Fair

Published Sept. 18, 2014, at 4:41 p.m.     |      Modified Sept. 19, 2014, at 6:20 a.m.
Larry Crimi (foreground) of Scranton, Pennsylvania, a conservation law enforcement major at Unity College, raises a locally grown organic pumpkin to the sky at the Common Ground Country Fair in this 2011 file photo.
John Clarke Russ | BDN
Larry Crimi (foreground) of Scranton, Pennsylvania, a conservation law enforcement major at Unity College, raises a locally grown organic pumpkin to the sky at the Common Ground Country Fair in this 2011 file photo. Buy Photo
Ben Falk, of Whole Systems Design, will about land regeneration at the Common Ground Country Fair 11 a.m. Saturday.
Courtesy of Common Ground Country Fair
Ben Falk, of Whole Systems Design, will about land regeneration at the Common Ground Country Fair 11 a.m. Saturday.
People visit the Common Ground Country Fair in 2013.
Brian Feulner | BDN
People visit the Common Ground Country Fair in 2013. Buy Photo

UNITY, Maine — From low-impact forestry to Scottish Highland cattle to contra dancing, the 38th annual Common Ground Country Fair is a celebration of Maine’s rural and agricultural traditions. Tens of thousands are expected to gather this weekend on 50 lush acres in Unity for the three-day fair that captures the essence of Maine and the bounty of the harvest season.

“We strive for community and education while highlighting agriculture,” April Boucher, fair director, said.

Run by Maine Organic Farmers and Gardeners Association, the fair unites leaders in agriculture like Ben Falk, author of “The Resilient Farm and Homestead,” with locals like Lisa Fernandes, who runs The Resilience Hub, a permaculture center in Portland.

Both are speaking about permaculture, this year’s theme, which focuses on designing ecological landscape systems that work in harmony with nature to restore balance. As more and more people embrace the do-it-yourself lifestyle across Maine and the country, these age-old practices of homesteading and low-energy use are being re-examined for modern times.

“These techniques are ancient, done by indigenous people. But permaculture really synthesized in 1970s,” said Fernandes, who teaches classes on ecological design, which she described as “an extremely practical and hands-on way to take action outside your kitchen door.”

Beyond conserving and preserving the land’s dwindling resources, Fernandes said, “we can make this place sing with abundance” by creating optimal growing conditions and planting harmonious crops.

In her talk, “Eat the Suburbs! A case study in edible landscapes,” held Friday and Saturday, Fernandes will share tips on how she turned one-third of an acre in Cape Elizabeth from a lawn into an edible, perennial ecosystem.

The specialty talk is among many held under tents and in open air this weekend. Others tackle topics like cider making and goat rearing. An estimated 60,000 people are expected to come together for the celebration of the land.

“A large part of why people want to come to the Common Ground Country Fair is to find that community,” Boucher said. “If you go to a talk, there are so many people that are interested in that topic, be it on tinctures, herbalism, textiles — it’s a shared enthusiasm.”

Just beyond the fair gates, farmers showcase the fruits and vegetables of the season.

“As soon as you come in, you are greeted with the bounty of Maine,” Boucher said, adding that many shop at farm stands and picnic on the fairgrounds.

Some come to relax, others to get edified or learn a new way to stay warm during the upcoming winter. Dedicated zones, such as energy and shelter, showcase new and sustainable heating methods, and a fiber marketplace provides a window to the weavers and the woolers among us.

A host of others come to relax, meet their neighbors and sample all Maine has to offer. Food and entertainment is a top draw.

There are four stages with live performances, from Vaudeville acts to puppeteers to roving performers. This year, a group will attempt to pull off the largest drum circle in the world on Saturday at 10 a.m. They are going for the Guinness Book of World Records. All are welcome.

And, of course, there is food, too. Nearly 50 food vendors, from a local tofu producer to farmers selling raw food wraps, nori rolls and strawberry shortcake, will be on hand.

“All food at the fair has to adhere to the MOFGA food policy. Many vendors source the food for the festival,” Boucher said.

Days before the fair, first-timer Kate Seaver was feverishly cutting vegetables from her organic Up-Beet Farm in Porter. Seaver and her husband, John, will create an “all raw menu, [with] nothing cooked over 118 degrees,” for the weekend.

Look for Seaver’s The Raw Food Mobile, where you can find hummus made with summer squash, lettuce wraps and raw noodle dishes consisting of cucumbers and zucchini drenched in raw coconut curry sauce that will keep fair-goers sated.

“People will be surprised at how filling these meals are and the clean energy you get from eating raw,” Seaver said.

For more food entertainment, two Bar Harbor chefs also are competing in a reality show-style mystery fish throwdown on Sunday.

“People come to keep that community going through the year. It’s a big refresh. A highly anticipated event to get excited for the winter and keep refueled with new energy and ideas and share what you have to offer,” said Boucher. “People just inhale it.”

The Common Ground Country Fair takes place Friday, Saturday and Sunday. Gates open at 9 a.m. Vendors close at 6 p.m. Friday and Saturday and 5 p.m. Sunday. Tickets are $10 for adults in advance and $15 at the gate. For more information, visit mofga.org.

 

Dr. Michael Noonan

Wellness: Healing the patient instead of attacking disease

Whenever we get sick or have a health problem, our first instinct is to attack the disease. We do surgery to cut out the parts of our bodies that are diseased; we take drugs to lower blood pressure, stop inflammation and pain, and kill bacteria; toxic chemicals and radiation are … Read more →

Published Sept. 18, 2014, at 12:57 p.m.     |    

Wellness: Healing the patient instead of attacking disease

Published Sept. 18, 2014, at 12:57 p.m.
Dr. Michael Noonan
Dr. Michael Noonan

Whenever we get sick or have a health problem, our first instinct is to attack the disease.

We do surgery to cut out the parts of our bodies that are diseased; we take drugs to lower blood pressure, stop inflammation and pain, and kill bacteria; toxic chemicals and radiation are used to attack cancer and other conditions.

But there is another way to come at the problem: improving the healing process. This is the approach wellness care takes. While it sounds similar to attacking disease — both involve treating the patient, after all — at the core they are quite different.

Because of our focus on disease, and despite the fact that healing is one of the most important functions of our bodies, it is amongst the least studied and understood. It is telling that we have spent countless millions on disease — the ALS Ice Bucket Challenge has raised over $100 million so far — but still know very little about the process of healing.

It is even more telling that what little we do know about healing, the chemical steps in the inflammation process, was used to produce drugs to stop it. These are the anti-inflammatory drugs, including aspirin, ibuprofen (sold as Motrin and Advil), Aleve, and Celebrex. They are amongst some of the most commonly used medications in the world. But because they stop inflammation, they also interrupt healing. Studies have shown they interfere with fracture and soft tissue healing. One surgeon commented that these drugs are actually used when doctors want to prevent a bone from growing back.

As a wellness provider, I was taught to look at health and disease a little differently. Most health problems, especially the chronic ones, are due to a failure of the healing process, rather than the overpowering force of disease. Rather than attack the disease, our approach is to restore this healing function.

This is especially evident with acupuncture. Many patients ask if the needles are tipped with chemicals or drugs. Otherwise, how could acupuncture produce the changes that it does?

The answer is that acupuncture does not produce the healing, only the body can do that. What it does is somehow jump start a stalled healing response in the body, and it is not unusual for this to happen instantly. I compare it to starting a car. Turning the key does not directly cause electricity to flow to the plugs and gas to the cylinders, etc., but instead it activates a system that is all set up to go. Our innate healing response is there all the time, but for some reason — injury, poor diet — it is stopped and the patient does not heal.

One of the principles of wellness care is that a single treatment may have many benefits, because it does not attack one problem, but rather helps the body heal. This is common in chiropractic, where treating low-back joint problems has been known to improve the patient’s digestion, bladder function, or even hormone balance. Again, the manipulation does not directly affect these other bodily functions, but improving joint alignment seems to reenergize a stalled healing process in the patient’s body, which can restore several problems to normal.

The approach of attacking the condition has led to great advances in health care, especially in emergency care and dealing with infections. But our over reliance on this more aggressive and dangerous form of health care is leading to a different form of health crisis — this one entirely manmade.

Logically, most conditions should not be treated as enemies to attack, but as blockages to the body’s own healing potential. This requires a big change in our way of thinking about health and disease, but if we are to reverse the decline in our nation’s health, it is a necessary change.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.

 

Dr. Philip Caper

The troubling way we pay hospitals in Maine and throughout the US

A study published in the current issue of Health Affairs found that hospitals in the U.S. spend about twice as much per capita on administration as the seven other countries studied. If spending on administrative costs were reduced to the average level of spending in the other countries, we could … Read more →

Published Sept. 18, 2014, at 12:43 p.m.     |    

The troubling way we pay hospitals in Maine and throughout the US

Published Sept. 18, 2014, at 12:43 p.m.
Dr. Philip Caper
Dr. Philip Caper

A study published in the current issue of Health Affairs found that hospitals in the U.S. spend about twice as much per capita on administration as the seven other countries studied. If spending on administrative costs were reduced to the average level of spending in the other countries, we could reduce by about $150 billion the $750 billion a year we waste in health care.

These findings reminded me of my recent trip to Nova Scotia. While there, I visited a small hospital on Cape Breton. I asked the hospital’s director what they charge for a CT scan. “We don’t charge for every test,” she replied, “but simply bill the provincial health fund for each day in the hospital. The cost of the CT scan is bundled in. The only time we charge individually for CT scans is if we treat a visiting American and think it is worth the trouble to bill their insurance company.”

“May I speak to somebody in your billing department about CT scan prices?” I asked.

“Sure, but you’ll have to come back another day,” the hospital’s director replied. “She (meaning the billing ‘department’) only works part-time.”

Compare that to the gargantuan billing departments in U.S. hospitals.

In talking to the long-serving doctors at that Canadian hospital about their experience practicing medicine, I was struck by how much their focus is on patient care, not money. Money is almost all I hear about when I talk to American doctors and hospital directors.

In Canada there is only one insurance company: the provincial government. A bill for each patient is sent to the province and is paid (no questions asked) within several weeks.

Like most other wealthy countries, they have simplified a lot of costs out of their health care system. In contrast, U.S. hospitals must deal with scores of insurance plans (each playing by their own rules); submit detailed bills for every test, procedure, drug or other supply; and then be prepared to justify them as hospitals try to maximize their revenues and insurance companies try to minimize their “medical losses.” Unfortunately, the Affordable Care Act is complicating things even more.

All of this fighting about money costs plenty of it and contributes to the unconscionable amount of waste documented by the Health Affairs study while actually interfering with patient care. The effects of this money-driven system on the quality of care may be even more damaging than the financial costs.

In the U.S., hospital managers spend huge amounts of time, effort and money chasing and maximizing profitable revenue. They do this in two ways. The most obvious is fighting directly with insurance companies over payment — when and whether to pay and if so, how much.

But less well-known and understood are the powerful ways our insurance-based system affects the types of services hospitals offer and promote, and the ways doctors practice. Caregivers are strongly encouraged by hospital managers to promote services that are profitable and discouraged from recommending those that are not, often without much regard to the actual needs of patients.

A physician employed by a large Maine hospital recently complained to me about her resentment at being pressured by hospital management to order completely unnecessary tests and procedures in order to meet the hospital’s revenue goals. Doctors throughout Maine, and the U.S., can relate to that.

That’s why we have hospitals with too many scanners and other fancy and expensive gadgets and too few primary care physicians. That’s why physicians are forced to see too many patients and spend too little time with each of them. That’s why more and more physicians are burning out and retiring. This will not change until we change the ways we pay hospitals and our “healthcare is a business” culture.

Canada and most other wealthy countries have shown that there are better ways to do things. Hospitals there are on a lump-sum budget or something very similar. The pursuit of revenue that is so consuming in U.S. hospitals is mostly eliminated.

If we were to adopt a similar system here, doctors and hospital managers in the U.S. would be able to focus on how to best provide care to their communities. Most would likely jump at the chance if they believed the corporate interests and their political enablers who are blocking real reform would allow it to happen.

That would save money and improve the quality of care at the same time. What’s not to like about that?

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com or through his website at philcaper.net.

 

&quotThe best part of the day is when my son comes to visit," said Lindsey Lafferty of O'Fallon, Mo., whose son Oscar, 3, kisses his yet-to-be born sisters on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis. Doctors placed Lafferty on bed rest 8 weeks ago when she 22 weeks pregnant, due to a thinning cervix. To the right is Lafferty's mother Denise Tiemeyer.

Changing guidelines: Does bed rest help or hurt a pregnancy?

ST. LOUIS, Mo. — When Lindsey Lafferty was 22 weeks pregnant with triplets, her body showed signs that it was preparing for delivery, so her doctor prescribed one of the most common interventions used to prevent preterm birth: bed rest. For most of the past eight weeks, seven of which … Read more →

Published Sept. 18, 2014, at 12:41 p.m.     |    

Changing guidelines: Does bed rest help or hurt a pregnancy?

Published Sept. 18, 2014, at 12:41 p.m.
&quotThe best part of the day is when my son comes to visit," said Lindsey Lafferty of O'Fallon, Mo., whose son Oscar, 3, kisses his yet-to-be born sisters on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis. Doctors placed Lafferty on bed rest 8 weeks ago when she 22 weeks pregnant, due to a thinning cervix. To the right is Lafferty's mother Denise Tiemeyer.
Laurie Skrivan | MCT
"The best part of the day is when my son comes to visit," said Lindsey Lafferty of O'Fallon, Mo., whose son Oscar, 3, kisses his yet-to-be born sisters on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis. Doctors placed Lafferty on bed rest 8 weeks ago when she 22 weeks pregnant, due to a thinning cervix. To the right is Lafferty's mother Denise Tiemeyer.
Lindsey Lafferty of O'Fallon, Mo., passes time by reading an e-Book during lunch as hospital employee Mary Williams cleans the floor on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis. Doctors placed Lafferty on bed rest 8 weeks ago when she was 22 weeks pregnant due to a thinning cervix. She is expecting identical triplets.
Laurie Skrivan | MCT
Lindsey Lafferty of O'Fallon, Mo., passes time by reading an e-Book during lunch as hospital employee Mary Williams cleans the floor on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis. Doctors placed Lafferty on bed rest 8 weeks ago when she was 22 weeks pregnant due to a thinning cervix. She is expecting identical triplets.
&quotThis best part of the day is when my son comes to visit," said Lindsey Lafferty of O'Fallon, Mo., who plays with her son Oscar, 3, on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis.
Laurie Skrivan | MCT
"This best part of the day is when my son comes to visit," said Lindsey Lafferty of O'Fallon, Mo., who plays with her son Oscar, 3, on Thursday, Sept. 11, 2014, at Mercy Hospital St. Louis.

ST. LOUIS, Mo. — When Lindsey Lafferty was 22 weeks pregnant with triplets, her body showed signs that it was preparing for delivery, so her doctor prescribed one of the most common interventions used to prevent preterm birth: bed rest.

For most of the past eight weeks, seven of which have been in the hospital, Lafferty has lain in bed, only getting up to use the bathroom, shower or go on a short wheelchair ride. She eventually got to sit upright in a chair for 30 minutes a day, and recently got the OK to walk down the hallway of the antepartum unit at Mercy Hospital St. Louis.

“It was exhausting,” said Lafferty, 31, of O’Fallon, Mo.

She is worried about being strong enough to take care of three newborns. She misses being home with her husband and 3-year-old son. But she’s thankful she’s made it past 30 weeks, she said. “I think if I was not on bed rest, the babies would’ve already been here.”

The scientific evidence, however, paints a different picture. Mounting research shows the century-old prescription of bed rest does not improve outcomes and, worse, is causing more harm than good.

Recently the nation’s society of high-risk obstetricians issued a new guideline recommending against the routine use of bed rest in pregnancy. The Society of Maternal-Fetal Medicine guideline said bed rest has not been proven to benefit any pregnancy condition.

“We have to stop,” said Dr. Anthony Sciscione, the director of the Christiana Care Health System in Delaware and co-author of the guideline.

Bed rest is often recommended for potential complications, such as preterm contractions, dilated cervix from preterm labor, a short cervix, premature rupture of the amniotic sac, elevated blood pressure, pre-eclampsia, inadequate growth of the baby, placenta complications, risk of miscarriage and pregnancies of multiples.

Also referred to as “modified bed rest” or “activity restriction,” bed rest varies in definition, and how and when it is used among practitioners. It can range from resting for a few hours a day to not even being allowed to stand up to shower.

Researchers started to question the use of bed rest in the 1980s, and researchers concluded as early as 1994 that doctors should sharply reduce ordering bed rest. Ten years later, nursing professor Judith Maloni called for the use of bed rest to be discontinued until evidence supported its use. More than a half dozen comprehensive reviews of studies have been done, each concluding that bed rest has not been shown to achieve its goals.

Despite the research, the use of bed rest has changed little over the years. About one in five women are placed on bed rest during their pregnancy — or about 1 million women a year. Surveys show nearly all obstetricians report prescribing it, while at the same time, they admit expecting little benefit from the intervention.

“It’s like obstetric heroin,” Sciscione said, “We don’t want to tell anyone we use it, but we all do.”

Sciscione said he suspects that’s because medicine lacks good interventions for preterm birth, the leading cause of infant mortality and morbidity, and doctors have a hard time doing nothing.

“It’s like Linus and his blanket. They just can’t rid of it,” he said. “Patients want it, and we want to give it to them, but this is just a bad thing to give them.”

The new guideline, researchers hope, will accomplish what study after study hasn’t — send a clear, unified message that bed rest is out.

“We feel like we so really needed to put out a statement to put practitioners up to speed, but also it’s important to educate the public as well,” said Dr. Alison Cahill, chief of the maternal-fetal division at Washington University School of Medicine. “It’s hard to believe it’s true that something we’ve been doing for a long time is not good, but that really is the case with bed rest.”

Most large hospitals have had antepartum units, caring for high-risk pregnant women like Lafferty, for decades. The director of maternal-fetal medicine at Mercy Hospital St. Louis, Dr. James Bartelsmeyer, said his staff discussed the new guideline at their weekly meeting. He said they agreed the key word in the guideline was “routine,” and it should be reserved for rare cases.

“We don’t believe that routine use of bed rest is appropriate, but patient care needs to be individualized,” Bartelsmeyer said. “In some cases, it is appropriate to use activity restriction.”

While bed rest has not been proved to benefit any condition, more stringent studies could prove otherwise, he said. “I think we all would like more data in these areas, but it is lacking.”

Cahill, who cares for patients at Barnes-Jewish Hospital, said the antepartum unit is no longer used to make sure women are adhering to bed rest. Patients in the unit have conditions that require close monitoring and frequent tests or need immediate access to intensive care for their babies. Except in extremely rare cases of severe heart disease, patients are encouraged to stay as active as possible, she said. “Bed rest is not something we prescribe any more,” she said. “It simply doesn’t work.”

While bed rest might have been first used under the assumption that it didn’t hurt to try, studies show several harmful side effects.

After just a few days of immobility, muscle and bone loss begins. Blood volume decreases, and every major organ system is affected. Blood pressure tends to rise. Women are at an increased risk of weight loss because of these changes and are more likely to have low birth weight babies.

Recovery from birth is also more difficult. In one of Maloni’s studies, she found that 71 percent of women struggled going up and down stairs, 71 percent needed assistance sitting, and 14 percent needed help walking. Researchers fear this could lead to a downward spiral of inactivity across a woman’s lifetime.

Bed rest may increase the risk of developing blood clots in the legs. The clots can move to the lungs, a leading cause of maternal death, and increase the risk of gestational diabetes.

Some studies even show that active women have a significantly lower risk of preterm birth, Maloni reported in her 2011 review. Regular leisure physical activity also appeared to protect against low birthweight babies, gestational diabetes and pre-eclampsia — perhaps because exercise improves blood flow and reduces oxidative stress and inflammation.

Women on bed rest are at increased risk of anxiety and depression, which is also associated with poor birth outcomes, studies show. Patients report feeling isolated, scared and out of control. Other family members are stressed, and a majority faced financial difficulties because of loss of income.

While hospital antepartum units offer counseling and have activities such as crafts and pedicures, bed rest is most commonly prescribed to women at home.

After having gone through bed rest herself, Elizabeth Lowder started Sage Tree Therapy a few years ago to help women struggling emotionally from being on bed rest. She commonly sees women confined at home because of a thinning cervix, high blood pressure or placenta problems.

“There’s a lot of guilt and shame,” Lowder said, “that they didn’t do something right, that they can’t play with their kids, keep up with cleaning the house, or check emails related to work.”

Bed rest, however, is so prevalent that many pregnant women come to expect it or even self-prescribe it, Sciscione said, especially when pregnant with twins. Mothers send him letters calling him crazy, he said, because they believe bed rest saved their babies.

Because the practice is so ingrained, Sciscione is not hopeful the new guideline will have much impact.

“Until there is a large study that looks at this,” he said, “they are not going to stop.”

Sciscione is applying for a federal grant to study 1,700 women at high risk of preterm birth. Half would go on bed rest, while the other half would continue normal activities. All would be outfitted with a device that accurately measures their movement.

“What I think we are going to find,” he said, “is that it doesn’t do anything except cause problems for moms, and that’s it.”

 

A billboard from the Marijuana Policy Project urging adults to &quotconsume responsibly" in states where marijuana is legal is seen in a handout picture taken in Denver, Colorado and released to Reuters Sept. 17, 2014. The Washington, D.C.-based MPP unveiled a billboard which shows a distressed woman sitting in a gloomy hotel room, alongside the slogan: &quotDon't let a candy bar ruin your vacation. With edibles, start low and go slow."

‘Start low, go slow’: Pro-pot activists launch ‘Consume Responsibly’ campaign

DENVER — Taking a cheeky jab at a New York Times columnist who had a bad experience with marijuana-infused candy on a visit to Colorado, pro-pot activists launched a campaign urging adults to “consume responsibly” in states where the drug is legal. The Marijuana Policy Project, the largest U.S. pot … Read more →

Published Sept. 17, 2014, at 6:41 p.m.     |    

‘Start low, go slow’: Pro-pot activists launch ‘Consume Responsibly’ campaign

Published Sept. 17, 2014, at 6:41 p.m.
A billboard from the Marijuana Policy Project urging adults to &quotconsume responsibly" in states where marijuana is legal is seen in a handout picture taken in Denver, Colorado and released to Reuters Sept. 17, 2014. The Washington, D.C.-based MPP unveiled a billboard which shows a distressed woman sitting in a gloomy hotel room, alongside the slogan: &quotDon't let a candy bar ruin your vacation. With edibles, start low and go slow."
Marijuana Policy Project via Reuters
A billboard from the Marijuana Policy Project urging adults to "consume responsibly" in states where marijuana is legal is seen in a handout picture taken in Denver, Colorado and released to Reuters Sept. 17, 2014. The Washington, D.C.-based MPP unveiled a billboard which shows a distressed woman sitting in a gloomy hotel room, alongside the slogan: "Don't let a candy bar ruin your vacation. With edibles, start low and go slow."
Edible forms of medical marijuana are on display at Blum Dispensary in Oakland, California, on Aug. 22, 2014. The Golden State, with its already outsize medical-pot market, could soon be entering a Golden Era of commercialized cannabis.
Dan Honda | MCT
Edible forms of medical marijuana are on display at Blum Dispensary in Oakland, California, on Aug. 22, 2014. The Golden State, with its already outsize medical-pot market, could soon be entering a Golden Era of commercialized cannabis.

DENVER — Taking a cheeky jab at a New York Times columnist who had a bad experience with marijuana-infused candy on a visit to Colorado, pro-pot activists launched a campaign urging adults to “consume responsibly” in states where the drug is legal.

The Marijuana Policy Project, the largest U.S. pot policy organization, opened the drive on Wednesday in Colorado, which, along with Washington state, allows recreational weed sales to adults under a highly regulated and taxed system.

Since the first stores opened this year, much of the public debate has focused on marijuana-infused edibles such as chocolates and cookies, given their potential to attract children and pot novices with potentially dangerous consequences.

New York Times columnist Maureen Dowd recounted in June how an “innocent” looking candy bar left her “panting and paranoid” at her Denver hotel and convinced she had died. She said she later learned she had eaten several times the recommended dose.

Alluding to Dowd’s column, the Washington, D.C.-based MPP unveiled a billboard in Denver that shows a distressed woman sitting in a gloomy hotel room, alongside the slogan: “Don’t let a candy bar ruin your vacation. With edibles, start low and go slow.”

It also directs people to a website, ConsumeResponsibly.org, which features information on marijuana products, their effects, including how to prevent over- and accidental consumption, and the laws surrounding them.

MPP communications director Mason Tvert said that for decades, marijuana education campaigns had been characterized by exaggeration, fear mongering and condescension.

“They have not made anyone smarter or safer,” he said.

“Like most Americans, Ms. Dowd has probably seen countless silly anti-marijuana ads on TV but she has never seen one that highlights the need to ‘start low and go slow’ when choosing to consume marijuana edibles.”

The campaign also will include print and online ads, as well as materials in retail marijuana stores.

MPP plans to roll out its campaign in Colorado and Washington, and then in other states if they adopt similar laws. Marijuana initiatives will be on ballots in Alaska, Oregon and the District of Columbia in the fall.

The idea of responsible consumption was questioned by substance abuse and addiction expert Janina Kean, who said it was futile to try to urge it upon those with a propensity toward an addictive disorder, or those suffering from addiction.

“The legislature in Colorado put greed before safety and failed to set any real standards,” said Kean, president and chief executive officer of the Connecticut-based High Watch Recovery Center, a medical facility that treats substance use disorders. “How do you gauge what qualifies as responsible use? Based on what measures?”

 

A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2013 photo illustration.

Premiums for Obamacare plans in Maine dip or remain flat for 2015

Mainers who buy insurance through Healthcare.gov can expect to pay less or the same amount on average each month for benefits taking effect next year, according to filings with the Maine Bureau of Insurance. Health advocates applauded the news but urged consumers to reassess their options in the second year … Read more →

Published Sept. 17, 2014, at 5:43 p.m.     |    

Premiums for Obamacare plans in Maine dip or remain flat for 2015

Published Sept. 17, 2014, at 5:43 p.m.     |      Modified Sept. 17, 2014, at 7:09 p.m.
A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2013 photo illustration.
MIKE SEGAR | REUTERS
A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2013 photo illustration.

Mainers who buy insurance through Healthcare.gov can expect to pay less or the same amount on average each month for benefits taking effect next year, according to filings with the Maine Bureau of Insurance.

Health advocates applauded the news but urged consumers to reassess their options in the second year of the health insurance marketplace. Most people who bought insurance through healthcare.gov for 2014 will be automatically re-enrolled in the same plan in 2015. Consumers could miss out on lower costs or more attractive benefits, or get stuck with a lower government subsidy based on outdated information, health advocates warned.

On Sept. 5, the state insurance bureau approved monthly premium costs and plans for health insurers that will sell policies in Maine through the federal insurance marketplace in 2015. The federal government is expected to issue final approval.

The plans will be available during an open enrollment period kicking off on Nov. 15 and ending Feb. 15, 2015.

The marketplace, a key component of President Barack Obama’s landmark health reform law, allows consumers to shop for private health plans and, depending on income, qualify for federal financial assistance to offset their premiums and out-of-pocket costs. That financial help means many consumers will pay less than the costs the state has approved.

Healthcare.gov serves people who buy their own health coverage in the “individual market” — such as the self-employed and part-time workers — rather than get health insurance through work or government programs such as Medicare and Medicaid.

Maine Community Health Options, a member-run health insurer based in Lewiston, sold more than 80 percent of the plans Maine consumers bought for coverage in 2014, the first year of Healthcare.gov. After a troubled rollout of the site, about 44,000 Mainers signed up for coverage.

Next year, premium costs for Maine Community Health Options plans will hold steady on average.

“Our rates demonstrate our commitment to returning value to our members and doing our part to make affordable coverage available to Maine people,” Kevin Lewis, CEO of Maine Community Health Options, said in a news release. “With our competitive premiums and health-focused benefits, we are well positioned as Maine’s only member-led insurance solution to help transform and improve the health of individuals and positively affect the local economy.”

While the rates will remain the same on average, some customers could see premium drops or increases.

Maine Community Health Options will raise rates on a single plan, with relatively low membership, by just under 1 percent, according to Lewis. The monthly premium for the startup insurer’s best-selling plan will fall by about half a percentage point, he said.

The other insurer that sold plans through Healthcare.gov in the state this year, Anthem Health Plans of Maine, will reduce premium costs by 1.1 percent on average.

“We have been committed to the exchange since the beginning and thank those who purchased Anthem plans,” the company said in a statement. “We will again be offering a number of ACA-compliant products on and off the exchange in 2015 and are pleased to have filed for an average rate decrease of 1.1 percent. We look forward to welcoming new exchange members when open enrollment starts in November.”

Anthem rates are decreasing on average, though some customers will experience a premium drop as low as nearly 13 percent or an increase of up to 12.1 percent.

Harvard Pilgrim Health Care will become the third player in Maine’s marketplace in 2015, offering four individual plans.

All three insurers, plus Aetna, will also offer health plans outside of the exchange, directly to consumers and through health insurance brokers. Those plans aren’t eligible for federal subsidies.

The subsidies for Healthcare.gov plans are available to those earning between the poverty level and four times that amount, or between $23,850 to $95,400 per year for a family of four.

In Maine, premium costs — before insurers plug in factors such as consumers’ ages and geographic areas — range from $152 per month for a basic Anthem plan to $381 monthly for a Harvard Pilgrim plan with more comprehensive benefits. Consumers who qualify for subsidies could pay far less than those rates.

The plans offer varying benefits and carry different deductibles and out-of-pocket costs, such as co-pays.

Insurers may have changed their plans from last year, such as by adjusting which doctors or medications are covered. Consumers should revisit Healthcare.gov to take stock of all the options and find a plan best suited to their needs, said Emily Brostek of Consumers for Affordable Health Care, an Augusta advocacy group.

The federal government’s choice to automatically re-enroll consumers will prevent anyone from getting dumped from coverage inadvertently, she said.

But people should log on to Healthcare.gov to update any changes in their income, or risk getting stuck with an incorrect financial subsidy, she said. The subsidies are based on consumers’ projected income for 2015, but the site will pull earnings information from 2013 tax returns, which could vary greatly from the amount some people expect to make next year, Brostek explained.

Incorrect information could lead to sticker shock when premium bills arrive next year, she said.

“Go back to the marketplace, update your income, and make sure you’re in the right plan,” Brostek said.

To view a calculator that estimates monthly premiums for the various plans, visit the Maine Bureau of Insurance website at maine.gov/pfr/insurance.

The nationwide Polaris Project released its 2014 ratings of state human trafficking laws Wednesday. This map shows Maine as being a Tier 2 state in the organization's rankings, a step below the highest ranking available, but the same tier as in last year's rankings.

Annual report draws attention to trafficking of children, others in Maine

PORTLAND, Maine — An annual report by the national Polaris Project ranks Maine near its top level in terms of efforts to combat human trafficking. But that same study finds that Maine has stalled at its Tier 2 ranking while several other states have increased protections for victims and taken … Read more →

Published Sept. 17, 2014, at 2:42 p.m.     |    

Annual report draws attention to trafficking of children, others in Maine

Published Sept. 17, 2014, at 2:42 p.m.
The nationwide Polaris Project released its 2014 ratings of state human trafficking laws Wednesday. This map shows Maine as being a Tier 2 state in the organization's rankings, a step below the highest ranking available, but the same tier as in last year's rankings.
Courtesy of the Polaris Project
The nationwide Polaris Project released its 2014 ratings of state human trafficking laws Wednesday. This map shows Maine as being a Tier 2 state in the organization's rankings, a step below the highest ranking available, but the same tier as in last year's rankings.

PORTLAND, Maine — An annual report by the national Polaris Project ranks Maine near its top level in terms of efforts to combat human trafficking.

But that same study finds that Maine has stalled at its Tier 2 ranking while several other states have increased protections for victims and taken other measures to drive down trafficking.

Destie Sprague, a program coordinator for the Maine Coalition Against Sexual Assault, said the yearly Polaris Project report doesn’t always capture the work being done to prevent trafficking in the state. But she said it draws valuable attention to the subject of human slavery and sexual exploitation in Maine, where she said minors are particularly at risk.

“Maine has made tremendous strides in recent years around addressing our human trafficking response infrastructure,” she said. “Among those projects, many are not picked up on in an objective 10-point list. That said, we certainly have work still ahead of us.”

Sprague said anti-trafficking advocates and police are learning Mainers are being coerced into prostitution and forced labor at younger and younger ages, and are working to find ways to identify victims or at-risk situations earlier.

“It’s always surprising to find out our children are being exploited in this way. We know from law enforcement that the average age of entry into sexual exploitation and trafficking is 12 or 13,” she said. “We’re not seeing victims of exploitation or trafficking until they’re in their late teens or early 20s, and we know it’s quite possible that they’ve been in the life for several years at that point. We also know that foster youth are one of the highest-risk populations for experiencing sexual exploitation.”

The Polaris Project is a Washington, D.C.-based organization that works to raise awareness of and abolish human trafficking. In its annual report, it rates each state based on its anti-trafficking laws and policies, with Tier 1 states considered to have the best in place and Tier 4 having the worst.

The Polaris Project states in its report that the ratings are “based on 10 categories of laws that are critical to a basic legal framework that combats human trafficking, punishes traffickers and supports survivors.”

A year ago, Maine was among 12 Tier 2 states — Washington, D.C., also is included in that group — while six states were ranked at the Tier 3 level and one at Tier 4. This year, there are only 10 Tier 2 states, two Tier 3 states and none at Tier 4.

Maine continued to receive credit this year for having provisions in place that specifically criminalize human trafficking, allow the seizure of assets from convicted human traffickers, and lower the burden of proof in cases of trafficking minors, among other Polaris Project plus points.

However, Polaris argued that the state still does not provide sufficient training on human trafficking for law enforcement officials, have a localized human trafficking hotline, vacate previous convictions for human trafficking victims or have enough programs in place to support survivors of the crime.

“Moving forward, it’s critical that states build upon the strong foundation of anti-human trafficking law that exists by ensuring victims have the services and resources they need to rebuild their lives,” said Britanny Vanderhoof, Polaris policy counsel, in a statement. “We urge those states that continue to lack vacating conviction and safe harbor laws to make them a top priority, as well as to ensure that efforts are made to post the National Human Trafficking Resource Center hotline number so victims know there is help when they are ready to reach out for it.”

State Rep. Amy Volk, R-Scarborough, introduced legislation last year that aimed to expunge the records of prostitutes found to be forced into the work by traffickers, but Sprague said lawmakers found that, despite Volk’s best efforts, wiping criminal records clean in that way was “not constitutional under Maine law.”

A backup plan to create a special pardon process for those trafficking victims also ran into complications, Sprague said, because many of the victims have drug-related or other crimes on their records instead of prostitution, and because the Maine board overseeing pardons can’t be required to apply a different set of criteria to certain applicants.

When it comes to children, Sprague said the state still needs to find safe places for victims of trafficking to be located, and to provide state child protective services the flexibility to intervene in more situations and earlier on.

“State-by-state, we have made a considerable amount of progress to prevent trafficking, prosecute those who enslave or purchase our children, and help survivors recover,” said U.S. Rep. Kristi Noem, R-South Dakota, in a statement distributed by the Polaris Project. “While we should take note of the progress, tens of thousands of kids remain at risk. We must continue to stand between evil and innocence, pushing forward to protect the most vulnerable and bring those buying or selling our children to justice.”

 

Urine test for cervical cancer virus offers less invasive alternative to cervical smear

LONDON — A simple urine test for the virus that causes cervical cancer could offer a less invasive and more acceptable alternative to the conventional cervical smear test, researchers said Tuesday. In a study comparing the accuracy of urine sample testing with smear testing conducted by a doctor, scientists from … Read more →

Published Sept. 16, 2014, at 8:50 p.m.     |    

Urine test for cervical cancer virus offers less invasive alternative to cervical smear

Published Sept. 16, 2014, at 8:50 p.m.

LONDON — A simple urine test for the virus that causes cervical cancer could offer a less invasive and more acceptable alternative to the conventional cervical smear test, researchers said Tuesday.

In a study comparing the accuracy of urine sample testing with smear testing conducted by a doctor, scientists from Britain and Spain found the results were good and said using the urine test to detect human papillomavirus, or HPV, could lead to more women agreeing to be screened.

“The detection of HPV in urine is non-invasive, easily accessible and acceptable to women, and a test with these qualities could considerably increase uptake,” the researchers said Tuesday in thebmj.com, the online version of the British Medical Journal.

The study, which analyzed 14 studies involving 1,443 sexually active women, was led by Neha Pathak of the women’s health research unit at Queen Mary University of London.

Compared with cervical smear samples, urine HPV testing had an overall sensitivity — the proportion of positives correctly identified — of 87 percent, and a specificity — the proportion of negatives correctly identified — of 94 percent.

Urine testing for the particularly high risk strains of HPV that cause the majority of cervical cancer cases had an overall sensitivity of 73 percent and a specificity of 98 percent compared with cervical samples.

HPV is one of the most common sexually transmitted infections, with up to 80 percent of sexually active women infected at some point in their lives.

Infection with specific high-risk strains of HPV can cause cervical cancer, which kills around 266,000 women a year globally, according to the World Health Organization.

By the far the vast majority of cervical cancer deaths are in poorer countries where access to screening and prevention methods is less widely available.

In a smear test, an instrument called a speculum is inserted into the vagina to allow access to the cervix and a brush is used to collect cells from the surface of the cervix.

In wealthier developed countries, cervical screening for HPV has been in place for many years and has been able to catch many potential cancer cases before they develop.

More recently, national immunization programs using vaccines from drugmakers Merck and GlaxoSmithKline have been launched to protect girls from HPV.

Yet in developing nations, where some 445,000 cases were diagnosed and 230,000 women died of cervical cancer in 2012, infrastructures have not yet been established to run national screening programs and HPV vaccination is still rare.

In a commentary on Pathak’s study, Henry Kitchener, professor and chairman of gynecological oncology at Manchester University, noted that even in developed countries such as Britain, for example, cervical screening coverage has fallen below 80 percent in recent years.

This is partly due to some complacency about cervical cancer as it starts to become less common, he said, but also partly due to emotional factors such as embarrassment or fear of an invasive speculum examination.

Using a urine test instead of a smear could persuade those reluctant women to come for regular screening, Kitchener said, while in lower income countries that lack infrastructure “self sampling [urine testing] might even be beneficial and cost effective for all women who are eligible for screening.”

 

A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this Oct. 2, 2013 photo illustration.

Census: More Maine residents without health insurance

The share of Mainers without health insurance rose from 2012 to 2013, making the state one of just two nationally to record an increase, according to new U.S. Census data. The data was included in one of three health insurance surveys the federal government released Tuesday. Maine’s uninsured population rose … Read more →

Published Sept. 16, 2014, at 3:20 p.m.     |    

Census: More Maine residents without health insurance

Published Sept. 16, 2014, at 3:20 p.m.     |      Modified Sept. 16, 2014, at 8:53 p.m.
A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this Oct. 2, 2013 photo illustration.
MIKE SEGAR | REUTERS
A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this Oct. 2, 2013 photo illustration.

The share of Mainers without health insurance rose from 2012 to 2013, making the state one of just two nationally to record an increase, according to new U.S. Census data.

The data was included in one of three health insurance surveys the federal government released Tuesday.

Maine’s uninsured population rose from 135,000 individuals in 2012 to 147,000 in 2013, an increase of 12,000 people, according to the U.S. Census Bureau’s American Community Survey. Last year, 11.2 percent of Mainers lacked health insurance, up from 10.2 percent in 2012.

Going without coverage puts Mainers’ health at risk and threatens their economic security when high medical bills hit, said Emily Brostek of Consumers for Affordable Health Care, an Augusta-based advocacy group.

“We know that people who don’t have health insurance are more likely to have a number of negative health outcomes … There have been some recent studies that show a higher death rate even, ultimately, for people and communities with high uninsurance rates,” she said.

New Jersey was the only other state to record an increase in its uninsured population, which ticked up by 47,000 people.

While Maine’s uninsured rate increased, it remained lower than rates in many other states. The national average was 14.5 percent, dipping by 0.2 percentage points.

The American Community Survey included a margin of error in Maine of 10,000 people. With a sample of 3 million households, it asks whether families are covered at the time of the survey.

Experts noted that the results reflected little about the impact of the Affordable Care Act, which aims to bring health insurance to millions more Americans. The survey was administered prior to the law’s broad expansion of health insurance coverage through private insurance marketplaces and largely before states began expanding their Medicaid programs under the ACA.

Private health insurance policies available through Healthcare.gov and state-run insurance marketplaces took effect on Jan. 1 of this year.

While Maine was one of 21 states that opted against expanding Medicaid, the health insurance program for the poor, the effect of that decision on uninsured rates won’t play out until 2014 data is available next year, said Genevieve Kenney, co-director and senior fellow in health policy at the Urban Institute in Washington, D.C.

“I don’t think this is being driven by state decisions with respect to the Medicaid expansion,” she said. “It’s a question of timing.”

But in addition to refusing to expand Medicaid, Maine Gov. Paul LePage and the 125th Maine Legislature, led by Republicans, also tightened eligibility criteria for the program in 2011 and 2012. Those changes prevented many low-income adults from qualifying or keeping their coverage.

Enrollment in the program, known as MaineCare, fell by nearly 15,000 people from December 2012 to December 2013, according to the Kaiser Family Foundation. That could prove a significant factor in Maine’s higher uninsured rate, Kenney said.

Other possible reasons include the economic recession, which may have prompted employers to drop or limit expensive health insurance benefits, she said. Most Mainers get health coverage through their jobs.

The share of Mainers with private health insurance — either accessed through work or purchased on their own — fell 6 percent from 2012 to 2013, according to the state insurance bureau.

Private health insurance also grew more expensive in Maine over many of the last few years, though premium costs for new Affordable Care Act plans are significantly lower.

A separate Census report released Thursday, the Current Population Survey, found that the nation’s uninsured rate was 13.4 percent in 2013, or about 42 million people. That survey asked 10,000 households if they were uninsured for the entire previous year.

Because it reflects the year leading up to the ACA’s coverage expansion, that survey similarly sheds little light on the impact of the law, health policy experts said.

Additionally, the Census announced earlier this year a change to how it asks households about their health insurance coverage in the survey, in order to more accurately gauge coverage. That makes comparing rates from 2012 to 2013 unreliable, but Census officials said the data provides a good baseline of the country’s health insurance landscape prior to the law’s implementation.

The Census numbers came out on the same day as a third federal report, conducted by the U.S. Centers for Disease Control, which marked the first federal survey of the nation’s uninsured rate since the health insurance marketplaces opened to consumers. That survey found the country hit a new low in the number of American adults without coverage. In the first quarter of 2014, 18.4 percent of Americans lacked health insurance, down from 20.4 percent in 2013.

Young adults between 19 and 25 years old showed the biggest drop in uninsured rates, at 20.9 percent in early 2014 from 26.5 percent in 2013. The ACA allows parents to keep children on their insurance plans until age 26.

The survey, which sampled 27,627 people, reflected much of the open enrollment period for health exchange plans, which began in January. But it didn’t account for a late rush of signups for plans that wouldn’t have taken effect until April.

Despite the flood of data released Tuesday, the ACA’s impact on the uninsured hasn’t come into clear focus just yet, according to Brostek.

“I think we’ll see the full picture as we get more time and get more data that covers all of 2014,” she said.

 

A health worker brings a woman suspected of having contracted the Ebola virus to an ambulance in Monrovia, Liberia, September 15, 2014. Airlines have halted many flights into and around West Africa, where governments have closed some borders and imposed travel restrictions in a bid to fight an Ebola outbreak that has killed over 2,400 people.

Citing security threat, Obama expands U.S. role fighting Ebola

ATLANTA — President Barack Obama on Tuesday called West Africa’s deadly Ebola outbreak a looming threat to global security and announced a major expansion of the U.S. role in trying to halt its spread, including deployment of 3,000 troops to the region. “The reality is that this epidemic is going … Read more →

Published Sept. 16, 2014, at 1:15 p.m.     |    

Citing security threat, Obama expands U.S. role fighting Ebola

Published Sept. 16, 2014, at 1:15 p.m.     |      Modified Sept. 16, 2014, at 6:52 p.m.
A health worker brings a woman suspected of having contracted the Ebola virus to an ambulance in Monrovia, Liberia, September 15, 2014. Airlines have halted many flights into and around West Africa, where governments have closed some borders and imposed travel restrictions in a bid to fight an Ebola outbreak that has killed over 2,400 people.
STRINGER | REUTERS
A health worker brings a woman suspected of having contracted the Ebola virus to an ambulance in Monrovia, Liberia, September 15, 2014. Airlines have halted many flights into and around West Africa, where governments have closed some borders and imposed travel restrictions in a bid to fight an Ebola outbreak that has killed over 2,400 people.

ATLANTA — President Barack Obama on Tuesday called West Africa’s deadly Ebola outbreak a looming threat to global security and announced a major expansion of the U.S. role in trying to halt its spread, including deployment of 3,000 troops to the region.

“The reality is that this epidemic is going to get worse before it gets better,” Obama said at the U.S. Centers for Disease Control and Prevention’s Atlanta headquarters.

“But right now, the world still has an opportunity to save countless lives. Right now, the world has the responsibility to act, to step up and to do more. The United States of America intends to do more,” Obama added.

The U.S. plan, a dramatic expansion of Washington’s initial response last week, won praise from the U.N. World Health Organization, aid workers and officials in West Africa. But health experts said it was still not enough to contain the epidemic, which is quickly growing and has caused local health care systems to buckle under the strain of fighting it.

U.S. officials said the focus of the military deployment would be Liberia, a nation founded by freed American slaves that is the hardest hit of the countries affected by the crisis.

Obama’s plan calls for sending 3,000 troops, including engineers and medical personnel; establishing a regional command and control center in Liberia’s capital, Monrovia; building 17 treatment centers with 100 beds each; training thousands of health care workers — up to 500 per week for six months or longer; and establishing a military control center for coordinating the relief effort.

“We have to act fast. We can’t dawdle on this one,” Obama said.

The White House said the troops will not be responsible for direct patient care. Obama also said the “chances of an Ebola outbreak here in the United States are extremely low.”

The worst Ebola outbreak since the disease was identified in 1976 has already killed nearly 2,500 people and is threatening to spread elsewhere in Africa.

Obama said that if the outbreak is not stopped now, hundreds of thousands of people may become infected, “with profound political and economic and security implications for all of us.”

“This is an epidemic that is not just a threat to regional security. It’s a potential threat to global security, if these countries break down, if their economies break down, if people panic. That has profound effects on all of us, even if we are not directly contracting the disease,” Obama added.

The WHO praised the U.S. plan for providing support to the United Nations and other international partners to help authorities in Guinea, Liberia, Sierra Leone, Nigeria and Senegal contain the outbreak.

“This massive ramp-up of support from the United States is precisely the kind of transformational change we need to get a grip on the outbreak and begin to turn it around,” Dr. Margaret Chan, WHO’s director-general, said in a statement.

Earlier, a senior WHO official said the Ebola outbreak requires a much faster response to limit its spread to tens of thousands of cases.

“We don’t know where the numbers are going on this,” WHO Assistant Director-General Bruce Aylward told a news conference in Geneva, calling the crisis “unparalleled in modern times.”

Obama’s announcement marks his second within a week of a new mission for the U.S. military, after last week’s speech outlining a broad escalation of the campaign against the Islamic State militant group in Iraq and Syria.

Liberians hailed the word that U.S. troops were coming, recalling a military operation in 2003 that helped stabilize the country during a civil war.

“This is welcome news. This is what we expected from the U.S. a long time ago,” Anthony Mulbah, a student at the University of Monrovia, said in the dilapidated oceanfront capital. “The U.S. remains a strong partner to Liberia.”

In Liberia, a shortage of space in clinics for isolating victims means patients are being turned away, then infecting others.

The initial U.S. response last week had focused on providing funding and supplies, drawing criticism from aid workers for not deploying manpower as in other disasters such as earthquakes.

Ebola spreads rapidly, causing fever and uncontrolled bleeding. The latest outbreak has killed more than half its victims. Its impact has been greatest in Liberia and neighboring Guinea and Sierra Leone.

The virus has so far killed 2,461 people, half of the 4,985 people infected, and the death toll has doubled in the past month, WHO’s Aylward said.

The outbreak was first confirmed in the remote forests of southeastern Guinea in March, then spread across Sierra Leone and Liberia. A handful of Ebol deaths have been recorded in Nigeria, Africa’s most populous country.

The disease has crippled weak health systems, infecting hundreds of local staff in a region chronically short of doctors. The WHO has said that 500 to 600 more foreign experts and at least 10,000 more local health workers are needed.

“It is not enough to provide protective clothing when you don’t have the people who will wear them,” Ghana’s President John Dramani Mahama said during a visit to Sierra Leone.

The U.S. deployment revives memories of Liberia’s war years, when Monrovians piled bodies of the dead at the U.S. Embassy to persuade Washington to send troops. In 2003, a U.S. mission helped African forces stabilize Liberia after 14 years of war, in which some 250,000 people are thought to have died.

Liberia’s President Ellen Johnson Sirleaf, who wrote to Obama last week to plead for direct U.S. intervention, was due to address her country Wednesday.

The U.S. intervention comes as the pace of cash and emergency supplies dispatched to the region accelerates.

Washington has sent about 100 health officials and committed some $175 million in aid so far. Other nations, including Cuba, China, France and Britain, have pledged medical workers, health centers and other forms of support.

Critics, including regional leaders, former U.N. Secretary-General Kofi Annan and Peter Piot, one of the scientists who discovered Ebola in 1976, have said international efforts have so far fallen woefully short.

“It is now up to other governments to equally scale up their support in Sierra Leone and Guinea,” Piot, now director of the London School of Hygiene and Tropical Medicine, told Reuters.

Many neighboring African countries have closed their borders and canceled flights to affected countries, making the humanitarian response more difficult.

A draft U.N. Security Council resolution on Ebola, obtained by Reuters, calls on U.N. member states, particularly in the region, to lift general travel and border restrictions.” The resolution could win approval later this week.

In a speech to the United Nations, the president of medical charity Medecins Sans Frontieres, which has some 2,000 staff members fighting the disease in the region, said other countries need to follow the U.S. lead.

Pictured is the Eastern Maine Healthcare Systems Cianchette building in Brewer.

EMHS to eliminate more than 40 jobs in IT department

BREWER, Maine — Eastern Maine Healthcare Systems plans to eliminate more than 40 positions in its information systems department as part of a long-term effort to overhaul operations and avoid a $100 million shortfall in 2019, according to information obtained by the Bangor Daily News. The Brewer-based health care system, … Read more →

Published Sept. 15, 2014, at 5:37 p.m.     |    

EMHS to eliminate more than 40 jobs in IT department

Published Sept. 15, 2014, at 5:37 p.m.     |      Modified Sept. 15, 2014, at 7:15 p.m.
Pictured is the Eastern Maine Healthcare Systems Cianchette building in Brewer.
Kevin Bennett | BDN
Pictured is the Eastern Maine Healthcare Systems Cianchette building in Brewer. Buy Photo

BREWER, Maine — Eastern Maine Healthcare Systems plans to eliminate more than 40 positions in its information systems department as part of a long-term effort to overhaul operations and avoid a $100 million shortfall in 2019, according to information obtained by the Bangor Daily News.

The Brewer-based health care system, parent to Eastern Maine Medical Center in Bangor, expects to eliminate 43 positions in the department, according to a July PowerPoint presentation EMHS prepared for employees. Of those, 15 are vacant positions that would be left unfilled and five represent jobs that would become obsolete, according to the presentation.

Employees in several of the remaining positions targeted for elimination may be reassigned to other jobs within the system, according to EMHS spokeswoman Suzanne Spruce. She noted the job figures haven’t yet been finalized with strategic planning still in progress.

“Forty-three positions may change, but that doesn’t mean 43 people are without a job,” she said.

The targeted positions represent about 12 percent of the workforce in the department, which employs 360 people with a wide range of technology duties, from overseeing electronic medical record and clinical information systems to an employee help desk. The majority of the department’s staff work in the Bangor-Brewer area, though several are employed at member hospitals throughout the state, Spruce said.

Better aligning the department’s functions would slash operating costs by $4.5 million through fiscal year 2015, according to the presentation.

The structural changes are part of a broader effort EMHS announced in November 2013 to “reinvent” how the system provides health care and improve its services and business functions. Without the changes, the system could face a $100 million financial gap by the end of fiscal year 2019, according to EMHS.

The system began re-examining its departments two years ago, work its top executive described as necessary to meet the health care needs of EMHS communities while saving costs.

In March, the system’s flagship hospital EMMC announced it faced a $7 million shortfall as a result of shrinking government reimbursements, fewer patients than expected and a surge in unpaid care.

The parent system already has reworked operations in its human resources and credentialing departments, Spruce said.

Several jobs may be redesigned or relocated.

“We’ve been very transparent with our employees regarding this work and what the future may hold, so there really shouldn’t be any surprises,” she said. “We don’t have things finalized.”

Information systems employees were notified of the potential for staffing changes in the spring, Spruce said. EMHS hopes to reach a definitive plan for the department this fall, she said.

Affected staffers will be referred to the system’s career center to help them find other opportunities within EMHS, she said.

 

Dr. Michael Noonan

Treating sciatica with chiropracty

Sciatica can be an extremely painful condition. It is a “pinched nerve” pain that radiates down the leg, and it occurs when problems in the joints, muscles and discs of the back progress to the point that they start to affect the nerves. The “pinched nerve” leg pain may come … Read more →

Published Sept. 15, 2014, at 1:04 p.m.     |    

Treating sciatica with chiropracty

Published Sept. 15, 2014, at 1:04 p.m.
Dr. Michael Noonan
Dr. Michael Noonan

Sciatica can be an extremely painful condition. It is a “pinched nerve” pain that radiates down the leg, and it occurs when problems in the joints, muscles and discs of the back progress to the point that they start to affect the nerves. The “pinched nerve” leg pain may come on suddenly, but most cases have a history of low back pain before the onset of the leg pain.

Current medical treatment usually starts with painkillers and anti-inflammatory meds. If those aren’t effective, the patient goes “up the scale” to more aggressive treatments, such as oral steroids to reduce swelling of the disc, to cortisone shots to the spine (called an epidural); a few go on to surgery.

Of course, the further up the scale you go, the greater the chance of serious side effects. And even the “entry level” meds have risks, including digestive, liver, kidney, and heart damage. Oral steroids seem to interfere with healing of tendons throughout the body, steroids damage tendons and can cause osteoporosis with longer term use. Epidural shots are only about 50 percent effective, and are considered a short-term treatment at best. Recently the FDA required label changes for epidural steroid shots to include warnings of “rare but serious” complications. (Because epidural steroid shots to the spine are not FDA approved, docs who do them are not required to report problems to the FDA. This makes the frequency of problems from the shots difficult to estimate.)

Most sciatic cases I see have already been through this cycle of care and are looking for more help. They did not consider trying chiropractic care first. Many are nervous about having a physical treatment when they are already in a lot of pain, while others just follow the medical process without questioning it. But chiropractic care can be very effective for sciatica; because sciatica is primarily a mechanical process, using chemical treatments (meds or shots) will not be helpful for the problem, especially in the long run.

From a chiropractic perspective, the underlying problem with sciatica involves the joints of the spine. The immediate symptoms may be from a disc pressing on the nerve, but discs are affected by the surrounding spinal joints. Realigning these joints can improve disc function and take pressure off the nerve. In the beginning of care, the treatment has to be gentle, because the area is so inflamed, and patients are often nervous about manipulation. But it is a very effective treatment; one study of 148 sciatic patients who were treated by doctors of chiropractic using manipulation found that after a month of care, 80% were better or much better, and only 1.6% were slightly worse. The improvement was maintained, with 88% doing better after a year. It is also very safe; according to the authors of the same study, “there were no adverse events reported” meaning no patients were made worse by the treatment.

Another review of the safety of chiropractic manipulation for sciatica found only one case out of 3.7 million treatments was made significantly worse (other than temporary soreness). This safety record is far better than even over the counter drugs.

Of course not every sciatic patient with sciatica responds to manipulation; some cases do need to go on to the more aggressive treatments. But it only makes sense to start with the most effective and safest treatment before the other treatments are tried. And while I am not aware of any studies on this, it makes sense that going into these more aggressive treatments with a spine in alignment will have a better outcome.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.

 

State fines Maine doctor who hosted marijuana clinics in Orono hotels

A state licensing board has reprimanded and fined a Maine doctor who issued medical marijuana certificates to nearly 60 patients over two days at seminars he hosted at hotels in Orono. Dr. William Ortiz, an internist, was disciplined by the Maine Board of Licensure in Medicine for failing to create … Read more →

Published Sept. 15, 2014, at 1:02 p.m.     |    

State fines Maine doctor who hosted marijuana clinics in Orono hotels

Published Sept. 15, 2014, at 1:02 p.m.

A state licensing board has reprimanded and fined a Maine doctor who issued medical marijuana certificates to nearly 60 patients over two days at seminars he hosted at hotels in Orono.

Dr. William Ortiz, an internist, was disciplined by the Maine Board of Licensure in Medicine for failing to create and maintain adequate medical records for those patients and for the “manner and location” of his medical marijuana clinics, held in March 2013.

Ortiz signed a consent agreement with the board on Sept. 9.

The Maine Medical Marijuana Program alleged to the board in April 2013 that Ortiz saw patients who traveled from all over the state to obtain a medical marijuana certificate, charging each $200 cash. Ortiz allegedly provided certificates for a three-month period, then required patients to make a follow-up visit, at a cost of $175 cash, to obtain a subsequent one-year certificate, according to his consent agreement.

He hosted the clinics at a rented conference room at the University Motor Inn on March 20 and 21, 2013, seeing 44 patients, some as late as 3 a.m., the state program told the board. The hotel’s owner/manager asked Ortiz to stop the activity.

In a written response to the complaint, Ortiz said he also saw another 15 patients on March 21, 2013, at the Black Bear Inn in Orono.

Forty of the 59 individuals he saw over the two days were new patients.

The board issued a subpoena to Ortiz to obtain the patients’ medical records, finding 44

records lacked any documentation that he performed an examination. The records also contained “sparse information regarding Dr. Ortiz’s medical decision making” and included no treatment plan, according to the consent agreement.

The board ruled that “by conducting these clinics at local hotels, through all hours, and with too numerous a patient load, Dr. Ortiz created a negative impression of his activities that reflects badly on the medical profession.”

He was ordered to pay a $2,000 fine and reimburse the board $1,412 for the cost of its investigation. Ortiz agreed to refrain from similar conduct in the future.

He described to the board his personal experience using medical marijuana to relieve chronic pain, and said he understood the importance of establishing a doctor-patient relationship, according to the consent agreement.

On his website, The Health Clinic LLC, Ortiz lists a corporate office in Caribou, with additional locations in Holyoke and Northborough, Massachusetts.

Ortiz has been licensed to practice medicine in Maine since February 2012. His license was temporarily suspended during the board’s investigation.

Ortiz may renew his license upon payment of the fine and reimbursement costs, the consent agreement states.

 

Maine child being tested for respiratory virus spreading in Northeast

A respiratory virus that has sickened nearly 100 people across the United States may have infected at least one child in Maine, according to Dr. Sheila Pinette, director for the Maine Centers for Disease Control and Prevention. The virus, named enterovirus D68, has been confirmed in 97 cases in Colorado, … Read more →

Published Sept. 15, 2014, at 12:50 p.m.     |    

Maine child being tested for respiratory virus spreading in Northeast

Published Sept. 15, 2014, at 12:50 p.m.     |      Modified Sept. 15, 2014, at 4:01 p.m.

A respiratory virus that has sickened nearly 100 people across the United States may have infected at least one child in Maine, according to Dr. Sheila Pinette, director for the Maine Centers for Disease Control and Prevention.

The virus, named enterovirus D68, has been confirmed in 97 cases in Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri since mid-August. Suspected cases have also been reported in New York, Connecticut and Massachusetts over the last week, Pinette said.

This is the first suspected case in Maine.

“We have had a case that is concerning,” Pinette said. “That hasn’t been positively identified as enterovirus D68. We will be sending out a sample to the [federal] CDC.”

Enterovirus D68 causes fever, runny nose, sneezing, cough and muscle aches, with recent cases also including difficulty breathing and/or wheezing in children who have a history of respiratory problems, such as asthma, according to the CDC.

The CDC also said that among the cases confirmed in Missouri and Illinois, children with asthma seem to be at a higher risk. An advisory released by the Maine CDC Monday afternoon indicated that two-thirds of confirmed cases of enterovirus D68 were in patients with a medical history of asthma or wheezing.

“Ages ranged from 6 weeks through 16 years, with median ages of 4 and 5 years in Kansas City and Chicago, respectively. Most patients were admitted to the pediatric intensive care unit,” the release stated.

However, only the most severe cases have been tested for this strain of the virus so this might not be reflective of the full spectrum of the virus, the Maine CDC said.

Pinette said the enterovirus is common and highly contagious. It spreads from person to person through coughs, sneezes and touching contaminated surfaces. Children are most vulnerable to the virus, but cases have been reported in teens as well.

“Anybody who is immunocompromised is at risk,” Pinette said.

However, since contact is necessary for the spread of the disease, adults with impaired immune systems who aren’t regularly in contact with children are less likely to contract the virus.

“Most importantly, if they are having symptoms, they [must] get evaluated and treated,” Pinette said.

She said if someone with symptoms experiences an “acute change in health status,” they should be taken to the hospital right away as it could be a severe case of enterovirus D68, like the ones making news right now.

To prevent the spread of enterovirus D68, Pinette recommends frequent hand washing and coughing into your elbow to prevent mucus spray. Also, loved ones should avoid kissing, sharing cups and utensils and also should regularly wipe down surfaces with bleach to prevent the spread of germs.

She cautioned that antibacterial gels like Purell are alone insufficient — handwashing with soap and water is necessary.

Parents of young children in diapers also should take care to wash well after changing diapers. Pinette said the virus is “carried in the stool for weeks,” so when changing diapers, be sure to wash hands and properly dispose of diapers immediately.

Enterovirus refers to a variety of strains of the virus, which include everything from polio-causing viruses to D68, which does not cause polio.

“There’s over a hundred different strains of enterovirus,” Pinette said. “The disease spectrum is very broad. The ones that are the most concerning is this particular viral strain [D68]. We are looking at it very closely right now.”

Testing for enterovirus D68 is done via a nasal or oral swab. If it is confirmed to be an enterovirus, Pinette said the sample goes to the Federal CDC for typing — how the strain of the virus is determined.

There is no vaccine and no antiviral treatment for this illness, Pinette said. Treatments for enterovirus D68 now includes intravenous fluids, oxygen and sometimes steroid treatments, she added, with fewer than 10 percent of cases so serious as to require a ventilator.

While the virus can cause severe symptoms, Pinette said there have been no deaths from it since it was first discovered in California in 1962. That year, four children were diagnosed.

This outbreak is more widespread than previous ones, said Amesh A. Adalja, MD, an infectious disease physician at the University of Pittsburgh Medical Center.

“In the past [enterovirus D68] has caused sporadic infections and clusters. This outbreak, by contrast, is much larger and likely represents a change in the pattern of infection. It will be important to understand what has changed (better diagnostic ability vs. the virus vs. some other factors),” said Adalja, in an email to the Bangor Daily News.

Gubernatorial candidate Mike Michaud unveiled a 10-point healthcare plan in Portland on Monday which includes lowering costs by expanding Medicaid.

‘We need to think about people not as a collection of ailments’: Michaud unveils his health care plan

PORTLAND, Maine — As part of a wide-ranging 10-point health care plan he unveiled Monday, Democratic candidate for governor Mike Michaud reiterated his support for expanding Medicaid to 70,000 uninsured Mainers and making investments in preventative health care programs. The plan earned positive responses from health care advocates, though they … Read more →

Published Sept. 15, 2014, at 12:25 p.m.     |    

‘We need to think about people not as a collection of ailments’: Michaud unveils his health care plan

Published Sept. 15, 2014, at 12:25 p.m.     |      Modified Sept. 16, 2014, at 11:46 a.m.
Gubernatorial candidate Mike Michaud unveiled a 10-point healthcare plan in Portland on Monday which includes lowering costs by expanding Medicaid.
Gubernatorial candidate Mike Michaud unveiled a 10-point healthcare plan in Portland on Monday which includes lowering costs by expanding Medicaid. Buy Photo
Gubernatorial candidate Mike Michaud shakes hands with reporters after he unveiled a 10-point healthcare plan in Portland on Monday which includes lowering costs by expanding Medicaid.
Gubernatorial candidate Mike Michaud shakes hands with reporters after he unveiled a 10-point healthcare plan in Portland on Monday which includes lowering costs by expanding Medicaid. Buy Photo

PORTLAND, Maine — As part of a wide-ranging 10-point health care plan he unveiled Monday, Democratic candidate for governor Mike Michaud reiterated his support for expanding Medicaid to 70,000 uninsured Mainers and making investments in preventative health care programs.

The plan earned positive responses from health care advocates, though they said there is little in it that has not been discussed before.

“It’s not Earth-shattering,” said Gordon Smith, executive vice president of the Maine Medical Association, which does not endorse political candidates. “It’s all good stuff. It’s not particularly innovative, but it’s thoughtful, and there are a lot of positive things in it.”

Michaud has long said one of his first goals as governor would be to accept federal dollars offered under the Affordable Care Act, something that Gov. Paul LePage has refused to do — vetoing five such proposals sent to him by Democratic legislators in the past two years. LePage, Republican lawmakers and their supporters have argued that past expansions of Medicaid eligibility caused major debts to Maine’s hospitals and funneled money away from other health care programs.

“Michaud’s health care plan is centered around the expansion of welfare, just like the one he pushed while in the Maine Senate that caused our massive, welfare hospital debt,” said LePage campaign spokesman Alex Willette, repeating a claim the LePage campaign has been making for months.

Michaud fired back by calling LePage “fiscally irresponsible” for both the way he paid back the hospital debt — by borrowing — and for opposing Medicaid expansion, which Michaud said puts more financial pressure on hospitals to deal with uncompensated care.

“Yes, the hospitals got paid back, but [LePage] borrowed money from Wall Street to pay the hospitals back, and he’s paying interest,” said Michaud. “I would have paid that back with money. I would not have borrowed the money.”

LePage, backed by bipartisan support in the Legislature, paid past Medicaid debt to the state’s hospitals by renegotiating the state liquor contract and using the increased state profits to repay a 10-year revenue bond. The $220 million bond was taken with an interest rate of about 3.8 percent.

LePage has talked about health care very little on the campaign trail, and his campaign website makes virtually no mention of it, other than his opposition to Medicaid expansion. Willette said the governor and Republicans took a major step in 2011 with the passage of PL 90, which among other things created a high-risk insurance pool funded by a monthly fee on insurance premiums and eliminated the requirement that insurance rate hikes of less than 10 percent be reviewed by the Bureau of Insurance. Asked how LePage would cover the state’s uninsured poor, Willette said many of them are eligible to buy government-subsidized policies through the Affordable Care Act.

“The reality is that the governor has already pushed through reforms with PL 90,” said Willette. “Unfortunately, the Affordable Care Act has really taken over health care and insurance and made it a national issue to the point that the state can do less and less to impact the price of health insurance.”

Michaud also said Monday that his health care plan goes deeper and looks further into the future than those of LePage or independent Eliot Cutler, his rivals in the Blaine House race. One way it does that is with a focus on preventing sickness in the first place.

“My plan takes a broader view and puts individuals at the center of our efforts,” Michaud said. “The most efficient way to contain health care costs is to reduce chronic diseases.”

Cutler, who is polling a distant third behind his major-party rivals, said Monday afternoon that there is little that separates himself and Michaud when it comes to health care policy.

“There’s not enough differences between the two of us to really say that it’s dramatic,” said Cutler on Monday afternoon in an interview with the BDN. Cutler released his health care plan last year and said the major difference between it and Michaud’s is the person standing behind it.

“I think this is a huge challenge for Maine’s next governor, and I don’t think Mike is up to it,” said Cutler, repeating an often-used campaign theme.

Michaud said his strength, when it comes to health care or solving any other problem, is that he’s a consensus builder. It’s a narrative he and his supporters have pushed with greater frequency in recent weeks as they have increased their focus on LePage’s leadership style.

“For nearly four years, Gov. LePage has sought to divide people and turn them against one another,” said Michaud, who proposes partnering with other governors in the Northeast to tackle the state’s opiate addiction problem. “I know that by working together, we can help Mainers live healthier lives.”

Michaud’s plan also calls for partnering with Maine businesses for the development of a results-based health insurance system, reforming the way hospitals and doctors are paid for their services so they are rewarded for good health outcomes for their patients, and training insurance enrollees about programs available to them through their policies.

Nancy Morris, a spokeswoman for the Maine Health Management Coalition, said most of the members of her organization — which also doesn’t endorse political candidates — are particularly interested in Michaud’s proposal to change how doctors and hospitals are paid through a move away from a service-by-service-based billing system to one that focuses on certain medical outcomes. However, she said just because many people recognize the solutions doesn’t make them easy to enact.

“We could see significant savings,” she said. “Any candidate who’s running just has to recognize that if this was simple to fix, it would have been fixed long ago.”

Michaud said Maine’s economic future depends on creating a stronger health care system.

“We need to think about people not as a collection of ailments, to be treated as cheaply as possible, but as members of our community who want to be healthy, live independently and be treated with respect at all stages of their lives,” Michaud said. “Health care is not a privilege for those who can afford it. It’s a right that all Mainers deserve.”

 

Ripe, juicy tomatoes are perfect for stuffing and are very inviting served on a platter with White Bean Salad for the simple vegetarian meal.

‘Meatless Monday’ is not an evil vegetarian plot

The meat industry has a serious case of the Mondays. A growing number of school districts, including ones in Los Angeles, San Diego and Miami, are committing to keep meat off the menu for one day a week to combat childhood obesity. These “Meatless Monday” initiatives have drawn the ire … Read more →

Published Sept. 13, 2014, at 6:45 a.m.     |    

‘Meatless Monday’ is not an evil vegetarian plot

Published Sept. 13, 2014, at 6:45 a.m.
Ripe, juicy tomatoes are perfect for stuffing and are very inviting served on a platter with White Bean Salad for the simple vegetarian meal.
Linda Gassenheimer | MCT
Ripe, juicy tomatoes are perfect for stuffing and are very inviting served on a platter with White Bean Salad for the simple vegetarian meal.

The meat industry has a serious case of the Mondays. A growing number of school districts, including ones in Los Angeles, San Diego and Miami, are committing to keep meat off the menu for one day a week to combat childhood obesity. These “Meatless Monday” initiatives have drawn the ire of America’s beef, poultry and pork interests, which see them as the first, flesh-free volley in a war against America’s meat peddlers. The less-meat movement has also proved to be a flashpoint for elected officials, namely those from farm states, who seem to be placing the economic interests of their home-state industries above the health and wellbeing of their states’ populaces.

This story played out somewhat quietly on the national stage several years ago, when a few grandstanding politicians caught wind of an interoffice newsletter at the U.S. Department of Agriculture suggesting employees consider eating less meat. Now, it’s getting more attention at the local level. This week Todd Staples, the head of Texas’ Agriculture Department, unleashed a blistering — if largely fact-free — jeremiad against the Meatless Monday movement after learning that it had been enacted by elementary schools in Dripping Springs, an Austin suburb. (He apparently was unaware that several schools in Houston have been experimenting with the idea for some time.)

“Restricting children’s meal choice to not include meat is irresponsible and has no place in our schools,” Staples wrote in an op-ed published by the Austin American-Statesman. “This activist movement called ‘Meatless Monday’ is a carefully orchestrated campaign that seeks to eliminate meat from Americans’ diets seven days a week — starting with Mondays.”

An elected official like Staples can, of course, stake out a position that aligns with a particular industry without simply being a mouthpiece for it. But the agriculture commissioner’s overblown rhetoric echoes the official company line of the meat industry, which has filled his campaign coffers with at least $116,000 since 2010, according to public records. It’s hard to fault meat producers for wanting people to eat more meat. It’s a different story, though, when someone like Staples spouts such talking points at a time when the nation is battling both an obesity epidemic and a global climate crisis — two problems driven, at least in part, by resource-intensive meat production.

In some corners of the country, neither of those concerns is seen as much of a reason to impose mandates from above. The irony here is that the Dripping Springs initiative is a local one — the very type of decision that small-government advocates say is under attack from the national school-lunch standards championed by Michelle Obama. “Are we having a war on meat in Dripping Springs? Definitely not,” John Crowley, the head of nutrition services for the school district, told a local CBS affiliate this week. “We’re trying to think outside the box, and we serve a lot of Texas beef on our menus. We’ve had requests for more vegetarian options, and I thought, ‘Why don’t I give it a try and see how it’s received by kids?’ “

This is a message that kids should be receiving. According to the 2011 National Survey of Children’s Health, nearly one-third of American kids are either overweight or obese, a classification linked to Type 2 diabetes and myriad other health problems. The meat industry, meanwhile, is one of the top contributors to climate change, with the United Nations estimating that it directly or indirectly produces about 14.5 percent of the world’s anthropogenic greenhouse gas emissions. Everyone from the American Heart Association to the Norwegian military has touted the health and environmental benefits of eating less meat.

Such endorsements mean little to Staples and his meat-minded allies, who either downplay or downright deny the benefits of curbing meat consumption. But their dire warnings of The End of Meat aside, their argument also fails on a smaller scale. Opponents routinely overlook the fact that meatless meals are not by definition protein-free, a claim at the heart of Staples’ op-ed.

“It is important to remember that for many underprivileged children the meals they eat at school often represents their best meals of the day,” the Republican commissioner wrote. “To deprive them of a meat-based protein during school lunch is most likely depriving them of their only source of protein for the day.”

That makes no sense given that Meatless Monday menus include items like bean-and-cheese burritos and cheese pizza, meals that come with a hefty serving of protein — and, thanks to dairy, animal protein at that. Meanwhile, the national school lunch program requires schools to offer a weekly menu that meets a minimum threshold for protein, so a Dripping Springs student who goes meatless on Monday is in little danger of being protein-deprived come Friday. Kids who want a ham sandwich, meanwhile, are still welcome to bring one from home — and there are obviously no restrictions on what a child can eat outside school. The participating cafeterias, meanwhile, continue to serve up a variety of meats the rest of the week.

Following Staples’ logic will take you to an absurd place. If a lunch menu is an edict from on high as he suggests, then when a cafeteria serves a hamburger but not a hot dog, it is “forcing” kids to eat beef while “denying” them pork — or any number of food items not on that particular day’s menu, for that matter, be it chicken, fish, or a tarragon shallot egg salad sandwich with a side of butternut squash soup with chestnuts.

As commissioner, Staples oversees the agency that administers the school lunch programs in his state. There appears to be little he can do, at least formally, to stop the cafeterias’ Meatless Mondays from spreading their steak-free sentiments across the rest of Texas.

“As long as [the schools] follow the requirements of the National School Lunch Program, they can serve anything they want,” says Humane Society of the United States food policy director Eddie Garza, who worked with the Dripping Springs cafeterias to implement the program. “Staples doesn’t have any real weight on this other than writing op-eds.”

While Staples’ formal power may be limited, his industry allies have managed to score meaty victories in the past. Last summer they managed to squash a small-scale Meatless Monday program in Capitol Hill cafeterias in a matter of days by branding it “an acknowledged tool of animal rights and environmental organizations who seek to publicly denigrate U.S. livestock and poultry production.”

One of their more notable wins came in 2012, after the U.S. Department of Agriculture published that interoffice newsletter. It read, in part: “One simple way to reduce your environmental impact while dining at our cafeterias is to participate in the ‘Meatless Monday’ initiative.”

The backlash from the industry — and the backtracking from the agency that followed — was strong and instantaneous. Almost immediately after the National Cattlemen’s Beef Association publicly voiced its anger, farm-state lawmakers like Iowa Republicans Chuck Grassley and Steve King scrambled to fall in line. Sen. Grassley tweeted, “I will eat more meat on Monday to compensate for stupid USDA recommendation [about] a meatless Monday.” Rep. King was even more specific with his plan, promising to stage his own “double rib-eye Mondays” in protest.

“With extreme drought conditions plaguing much of the United States, the USDA should be more concerned about helping drought-stricken producers rather than demonizing an industry reeling from the lack of rain,” Kansas Republican Sen. Jerry Moran told Agriculture Secretary Tom Vilsack in a statement that appeared all the more short-sighted given the realities of climate change.

Before the day was out, the newsletter was taken offline, and the USDA issued a statement saying that it “does not endorse Meatless Monday.” The newsletter — which also offered a variety of other small-scale energy-efficiency tips for agency employees — “was posted without proper clearance,” according to the department.

Unwilling to forgive and forget, Staples chimed in by calling for the employee who wrote the newsletter to be fired, calling the very suggestion that people eat less meat “treasonous.”

“Last I checked,” Staples said then, “USDA had a very specific duty to promote and champion American agriculture. Imagine Ford or Chevy discouraging the purchase of their pickup trucks. Anyone else see the absurdity? How about the betrayal?”

That type of twisted logic only works in a world where agriculture officials serve the food industry and not the American public. Unfortunately, that feels like it’s the case all too often.

Josh Voorhees is a Slate senior writer. He lives in Iowa City.