Leaded aviation fuel a threat to public health, children
Filed under: Children, Health data, Hot Health Headline, Public health, Public records
KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.
Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.
Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”
Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.
Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”
Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”
Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”
The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.
Antipsychotic use booms among Canadian kids
Filed under: Children, Hot Health Headline, Pharmaceuticals
Writing for The Vancouver Sun and Postmedia News, Sharon Kirkey and Pamela Fayerman, report that, in an environment where the rate at which physicians are recommending certain antipsychotics for children has doubled since 2006, a local children’s hospital has launched what the reporters call “the world’s first clinic to help children cope with the side effects of such medications.”
The clinic, which helps children and their parents prepare for antipsychotic use or cope with its side effects, opened in April and has a four-week waiting list.
(Dr. Jana Davidson, a child and adolescent psychiatrist who helped establish the specialized clinic) said she helped create the clinic because of her increasing alarm over the side effects of treatment in her patients. While she believes the medications are sometimes prescribed inappropriately, they are often useful for a range of disorders including severe aggression, mania in bipolar disorder and schizophrenia. But the side effects can be serious.
“I would see kids with psychosis in the emergency department and then I would see them again 10 months later and they would be 30 to 50 pounds heavier,” she said.
Despite sometimes serious neurological side effects, more Canadian families are turning to the drugs and antipsychotic drug recommendations for youth jumped 114 percent in Canada from 2005 to 2009.
The drugs — which have not been approved in Canada for use in children under 18 — are being used for attention-deficit/hyperactivity disorder, conduct disorders, irritability related to autism, mood disorders, physical or verbal aggression and other behavioural problems.
Follow up on $95 million just awarded to school-based clinics
Periodically, I get an email or press release from a well-intentioned organization telling me why I should be writing about school-based clinics, and I make a mental note to myself or file the email and say, yes, this is something I don’t know that much about, and there’s probably a good story – or stories – there, including how the clinics will be affected by health reform.
Well, this week I (and many of you) got a press release from the Department of Health and Human Services telling me quite a bit about funding for school clinics and health reform. Before I tuck it away or put it on the never-ending “to do” list, it’s worth sharing some thoughts and some resources.
First of all, school-based clinics are not the same thing as the “school nurse” some of us remember – the lady (and it was a lady in those days) who kept us company when we ran a fever or had a tummy ache and were waiting for our mom (and it was mom in those days) to pick us up, take us home, and tuck us in. These school-based clinics are where about 790,000 patients get their health care – sometimes including dental care. The $95 million in awards announced this week (July 14) will allow for a 50 percent expansion to cover another 440,000 patients.
Here’s the list of clinics getting the grants. For more details, here’s the HHS press release and background from the Health Resources and Services Administration, an under recognized federal health agency. The HRSA page includes a link to an eight-page national school clinic census that provides a lot more detail on what services are offered in what setting and to what populations).
As usual, there are politics and funding fights. As Jane Norman of CQHealthbeat reported, the new grants go for the physical plant – not for medical care itself. The law allows for Congress to also appropriate money for care and operating expenses, but Congress hasn’t done so, given the current budget pressures. Republicans have backed repealing the clinic expansion, saying there isn’t money right now. HHS says the clinics getting the new expansion funding, however, have to show they have a way of paying for the other clinic expenses.
If someone has reported on these clinics, or seen good stories, please comment and share the links below. But some of the questions I’d ask of any clinic, in the context of health reform, would include:
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
- How early do they open and how late do they close? (i.e. how easy is it for working parents to stop by the clinics?)
- What kind of wellness programs and preventive care do they offer? What is their approach to childhood obesity?
- Are those that serve adolescents getting caught up in any of the abortion/abstinence/contraceptive politics? (HRSA has some data on how many clinics offer some of these services to teens.)
- What kind of outreach are they doing for immunization?
- What kind of relationship do they have with other health providers in the community, including specialists? As regions and communities develop interoperable health information technology, are the school-based clinics linked in?
- Who are the health care providers - doctors, nurses, nurse practitioners? Do state laws allow them to practice “at the top of their license” or are they unable to fully use their training? Is there a move underway to change that?
- How do they care for young people with chronic diseases (asthma, diabetes, etc) and how does this compare to the sometimes fragmented and uncoordinated care people get elsewhere? Are they keeping their patients well enough to avoid unnecessary emergency room visits (and how solid is the data they have to support that?)
- How do they integrate primary care and mental health care? (The clinics also do some substance abuse counseling, I do not know how or where they refer for further treatment or counseling or what kind of follow up they can provide.)
- What role do they anticipate in 2014, when more people have access to health insurance and Medicaid?
- All these questions, I suppose, could add up to one bigger question. Can we think of school-based clinics as medical homes? And if so, what can we learn from them?
Related
A panel at the 2007 Urban Health Journalism Workshop explained school health programs, while a field trip at the 2008 Urban Health Journalism Workshop allowed journalists to visit school-based clinics.
Reporter’s narrative illuminates little-researched birth defect
When Wisconsin State Journal reporter David Wahlberg investigated what appeared to be rural Wisconsin’s increase in gastroschisis, a rare birth defect in which the intestines grow outside of an infant’s body and must be replaced after delivery, the lack of institutional research, statistics or easy answers seemed to raise far more questions than it answered, particularly in relation to rural incidence and pesticide use.
Wahlberg’s solution to this roadblock is to dive headlong into the human component of the story. In a two-part narrative (Part 1, Part 2), he puts these larger questions on the back burner and instead follows a family, in real time, as they deliver an infant boy who had been diagnosed with the condition during an ultrasound. No amount of summary would do Wahlberg’s piece justice, so I encourage you to simply invest a few minutes and bury yourself in the details. You’ll exit with an understanding of the condition and the toll it takes that no amount of statistical analysis could match.
Battle against childhood obesity is complicated
Maureen O’Hagan and her colleagues at The Seattle Times have put together a sprawling package of stories on the fight against childhood obesity in their new series, “Feeling the Weight.” We’ll break it down story-by-story.
Kids battle the lure of junk food
Local agencies are spending millions to provide healthy alternatives to Seattle-area youth, but they — to say nothing of the youth themselves — are faced with a seemingly insurmountable deluge of tasty treats that tempt teens at every turn.
State still seeks winning strategy against childhood obesity
For a decade, Washington’s anti-obesity strategy has focused on providing kids with access to health alternatives.
So far, the results are discouraging. A push to put more fresh produce in poor neighborhoods’ corner stores, for instance, is struggling. And recent studies suggest the proliferation of farmers markets has done little to change diets or behavior. The number of overweight and obese kids continues to climb.
In other words, we might be spending a whole lot of money on efforts that miss the mark.
How to help your kids lose weight healthfully
The trick, she writes, is to focus on healthy behavior rather than on weight loss.
Parents stand between kids and junk food
O’Hagan’s profiles of parents of obese children shatter a few stereotypes and illustrate just how complex the issue is.
What readers had to say about childhood-obesity topic
Readers weighed in with advice, criticism, observations and more.
Related
Covering Obesity: A Guide for Reporters
The prospect of covering such a broad, engaging and important topic as obesity can be overwhelming. This guide, supported by the Robert Wood Johnson Foundation, is designed to help journalists cover a wide range of stories, whether writing on deadline or researching a multipart series. It offers assistance on calculating body mass index, finding obesity statistics on the state level, gauging the quality of school district wellness policies, finding innovative school nutrition policies and much more.
Program for disabled kids has unintended effects
Patricia Wen, of The Boston Globe, examines the Supplemental Security Income (SSI) program for children and finds the program “has gone seriously astray” and describes it as “a fast-growing alternative welfare system.”
And once a family gets on SSI, it can be very hard to let go. The attraction of up to $700 a month in payments, and the near-automatic Medicaid coverage that comes with SSI approval, leads some families to count on a child’s remaining classified as disabled, even as his or her condition may be improving.
Wen found that the program, which was intended to serve children with severe physical disabilities, now mainly serves children with behavioral, learning and mental conditions and carries financial incentives to put children on psychotropic drugs. She writes that preschoolers are the fastest-growing group to qualify for SSI, “largely because of a 12-fold spike in cases of speech delay. The government is aggressively trying to help these young children, but spends little time to see if they’re getting any better.”
Another, unintended, effect of the program is that teenagers on the program are declining to take part-time jobs despite their desire to start careers and not be dependent on the government. Wen explains “they fear working will jeopardize their disability checks. Their families are poor and need the money.”
Of interest to reporters interested in localizing the story, the package contains a data-driven interactive map that shows how many children in each state are receiving SSI assistance, the percentage who became eligible because of mental disabilities and the top five diagnostic categories.
Researchers examine long-term effects of vitamins, vaccines on children’s immune systems
Filed under: Children, Europe, Hot Health Headline, Public health
For a 40-minute documentary broadcast on BBC Radio 4 and produced by Anthony Baxter, reporter Richard Phinney visited a small, long-running public health outpost in Guinea Bissau where a team of Danish and African researchers has studied the long-term effects of vaccines and vitamin supplements on the immune systems of children. The team has published reams of research and influenced WHO policy, but Phinney focuses on what he calls their most “explosive” findings.
They show that the world’s most commonly used vaccines can strengthen - or weaken - a child’s immune system in the long term, and affect their ability to fight off disease. The results directly challenge the WHO’s global health advice, followed by most countries in the developing world, and could mean that thousands of young lives, in Africa and beyond, are needlessly at risk.
Programming note: The program will only be available to download worldwide for a few more days.
Update: The audio is no longer available at the earlier link but it is available, in two parts, on this page. Search the page or scroll down for “Vaccine Detectives.”
New health-related state laws for 2011
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Public health
Many thanks to Melissa Preddy for pointing out, in a post on the Reynolds Center’s businessjournalism.org, the National Conference of State Legislatures’ roundup of new laws that have already go into effect in 2011, or will soon. It’s a national list loaded with localization-ready ideas and issues that should be surfacing throughout the year. Hot-button topics include expanding medical coverage and several nutrition-related laws.
Here are a few highlights, taken directly from the NCSL’s list.
Connecticut will soon be requiring health insurance policies that cover anticancer medications to cover the oral drugs at least as favorably as it does the IV ones. The law prohibits insurers from reclassifying anticancer medications or increasing the patient’s out-of-pocket costs as a way to comply.
A new Missouri law requires all group health benefit plans to cover the diagnosis and treatment of autism spectrum disorders. Coverage is limited to medically necessary treatment ordered by the insured’s treating physician. The law also requires the Department of Insurance and other institutions to submit a report to the legislature regarding the implementation of this coverage, including specified costs.
California became the first, on Jan. 1, 2010, to prohibit oil, shortening or margarine containing artificial trans fats in restaurants and other food facilities. Beginning Jan 1, 2011, the original law will extend to other foods containing artificial trans fats, primarily baked goods.
Retailers in Minnesota will now be banned from selling cups and bottles intended for children age 3 or younger that contain bisphenol A (BPA). These same restrictions went into effect for in-state manufacturers and wholesalers on Jan. 1, 2010.
California lawmakers have also enacted a new law requiring free drinking water for students in school cafeterias or food service areas. Schools must comply by July 1, 2011.
California will soon require all children under the age of 18, including patrollers and resort employees, to wear helmets while skiing or snowboarding. Resorts will be required to post notice about the law, including on trail maps and resort websites.
$95 million to figure out proper doses for kids
On The Wall Street Journal’s Health Blog, Katherine Hobson profiles the Pediatric Trials Network, a seven-year, NIH-funded effort to determine pediatric dosing information for things like hypertension drugs and antibiotics. The $95-million initiative will fund 16 clinical trials, most of which will enroll 100 to 200 participants, Hobson reports.
Even then, Hobson said, the new study will only make a “dent” in the larger problem. She found that, at present, “virtually all” pediatric drug use is off-label, and that physicians get pediatric dosing wrong about a third of the time. The FDA already does some baseline work to make sure drugs are kid-safe, but the PTN represents a large step beyond present efforts.
Some brand-name drugs do get scrutinized under a program that gives drug makers an extra 6 months of patent protection for conducting FDA-requested studies in kids. And experimental drugs up for FDA approval must assess the effects in kids if they’re likely to use them. But that leaves a big knowledge gap for the host of generic drugs used to treat everything from infectious diseases to cancer.
School lunches, obesity and causality
Filed under: Children, Health journalism, Hot Health Headline
Miller-McCune magazine’s Washington correspondent Emily Badger explains how a study found that the National School Lunch program is linked to youth obesity.
Photo by bookgrl via FlickrBadger takes great pains to put that finding into context, and doesn’t put forth the key causal relationship until the tenth paragraph. In the interim, she talks about the correlation between weight and school lunches, and about the methods the researchers used to tease out causation – namely, the kids’ birth weights and the type of meals they likely received at home. Only then does she deliver the kicker.
Controlling for those two factors, they found that children who participate in the school lunch program are more likely to become obese than those who don’t. In a surprising twist, though, the federally subsidized School Breakfast Program has the opposite effect. (And children who eat both school breakfast and lunch are less heavy than those who participate in neither program.)
That said, and with the caveats already out of the way before the key paragraph, Badger then explores the backwards incentives of the a la carte ice cream sandwich and why a school benefits financially from selling piecemeal junk food.
Miller McCune magazine is an effort of the nonprofit Miller-McCune Center and is dedicated to long-form, in-depth reporting on academic research.
Related
Covering Obesity: A Guide for Reporters
The prospect of covering such a broad, engaging and important topic as obesity can be overwhelming. This guide, supported by the Robert Wood Johnson Foundation, is designed to help journalists cover a wide range of stories, whether writing on deadline or researching a multipart series. It offers assistance on calculating body mass index, finding obesity statistics on the state level, gauging the quality of school district wellness policies, finding innovative school nutrition policies and much more.
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