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.
Researchers surprised by concussion study
Filed under: Health data, Hot Health Headline, Public health, Studies
Writing for Sports Illustrated, David Epstein tells the story of a small-scale Indiana football concussion study in which in which the youth in the control group unexpectedly became the headliners. The researchers were using functional MRIs and the popular ImPACT test, along with helmet-mounted accelerometers, to figure out what sort of hits cause concussions and how the consequences of such hits vary.
Photo by Les_Stockton via Flickr
Their first discovery? That “no particular magnitude of hit correlated with a concussion.” In fact, the youth they studied were suffering from very few concussions. It wasn’t until they started testing the unconcussed youth, as a sort of control, that they started seeing the results that have come to define their study, the full text of which is available online. Epstein again:
Of those eight [unconcussed youth], four nevertheless showed significant declines in visual memory. In fact, the players with the most impaired visual memory skills were not coming from the concussed group but from a group that in the week preceding the test had taken a large numbers of hits—around 150—mostly in the 40 to 80 G range
If the test scores were accurate, the researchers had inadvertently documented, in real time, a new classification of high school athlete: a player who was never concussed, was not verbally impaired and was asymptomatic even as far as his parents could tell, but whose visual memory was more impaired than his amnesic, headachy, light-sensitive, concussed teammates.
Researchers discovered one other surprise: The players who were asymptomatic but had impaired visual memory had suffered hits to the upper forehead, “which houses the dorsolateral prefrontal cortex – where linemen get hit, play in and play out,” as opposed to the heavy hits to the side of the helmet that most of us associate with concussions.
It’s a very small-scale study – only 21 boys completed the study conducted over one football season – but the researchers are expanding their work this season. Nevertheless, Epstein indulges in some speculation:
Consider this: Concussions as we know them involve a hit that rattles a part of the brain involved in language processing or motor skills. Hits to the forehead that might be every bit as damaging hide their nefarious effects in the frontal lobe, a part of the brain primarily involved in visual memory, planning and cognition, rather than motor or sensory function, and thus not taxed by sideline concussion exams. Indeed, it’s possible that all along, while brain trauma questions have focused on concussions, the real damage is being inflicted by minor impacts that chip away at the brain.
In another piece in Sports Illustrated, Peter King looks at recent violent hits in the National Football League that have attracted attention, the NFL’s attempts to make the game safer and the fans’ and players’ attitudes about the game.
Online guide focuses on covering medical studies
Reporters are inundated with lures to cover the latest medical study or scientific conference paper. And there are some significant milestones being reached in medical research. But, more often, the information reaching the public is way too preliminary or even misleading, say those behind a new AHCJ reporting guide on covering health studies.
The guide will help journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals and it includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
As school starts, so do youth sports injuries
Filed under: Children, Health journalism, Hot Health Headline
The University of Michigan’s new Michigan NeuroSport Concussion Program seems to be cropping up everywhere, and as far as I can tell, it’s all part of a coordinated effort by the University. They already claim to have one of the only pediatric sport programs in the country, and now they’re expanding it with a clinical and research focus on “neurological sports injuries.”
In related news, the latest CDC Morbidity & Mortality Weekly Report includes an analysis of the numbers for “Heat Illness Among High School Athletes” from 2005 to 2009. The study examined 100 schools and nine sports, and found that heat-related illness was most common in football, and that August was the worst month for such afflictions.
AHCJ has a rich pool of resources for journalists looking to report beyond the press releases on stories like these, including:
Tip sheets
Concussions in young athletes
Reporting on sports injuries in school-age children
Health and education: Two intersecting beats
Health and education: Reporting resources
Blog posts
Tougher concussion rules from high school assn.
GAO evaluates youth concussion databases
Concussion more likely when hit is unexpected (Youth hockey study)
Attention focuses on football’s neurological effects
AP story: Hundreds of PTSD soldiers likely misdiagnosed
Concussion-related trauma masquerades as ALS
The New York Times‘ Alan Schwarz reports on what he says is “the first firm pathological indications that brain trauma results in motor-neuron degeneration.” The headline behind that conclusion, of course, is that researchers say some athletes with concussion and impact-induced brain injuries may have been misdiagnosed as ALS victims.
Photo by peterjr1961 via Flickr
In interviews, the study’s authors even speculate that Lou Gherig, who gave the disease its popular name, may have instead suffered from a similar disease caused in part by brain injuries.
The finding was not unexpected, given that ALS seemed to occur at much higher rates in concussion-heavy populations like athletes and soldiers.
Schwarz’s summary of the study:
Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicate that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.
It’s in the emergence of that second disease that really seems to have attracted Schwarz’ attention. It behaves similarly to ALS, but shows a distinct protein pattern that only seemed to emerge in patients with a history of head injury. There is not, however, a 1:1 relationship. Other factors seem to also be at play, Schwarz writes.
Gary Schwitzer of HealthNewsReview.org examines the story more closely and concludes that, while this is an “important and fascinating area of research,” the story “did not exhibit the best of health/medical/science journalism.” He lists seven points of criticism and includes comments from one of the site’s medical editors.
John Gever of MedPage Today offers more scientific coverage of the study and points out that there was no mention of Gehrig in the study but that “a New York Times reporter coaxed McKee into suggesting that Gehrig may have been among those misdiagnosed – even though, as a first baseman, he did not routinely experience violent collisions. (He was, however, beaned at least twice during his 14-year career with the New York Yankees.)”
Tougher concussion rules from high school assn.
The National Federation of State High School Associations has released tougher rules about removing players with potential concussions from the field. The initial release outlines the changes:
Photo by Les_Stockton via Flickr
The previous rule directed officials to remove an athlete from play if “unconscious or apparently unconscious.” The previous rule also allowed for return to play based on written authorization by a medical doctor. Now, officials are charged with removing any player who shows signs, symptoms or behaviors consistent with a concussion, such as loss of consciousness, headache, dizziness, confusion or balance problems, and shall not return to play until cleared by an appropriate health-care professional.
The Tampa Tribune’s Mary Shedden and Katherine Smith reported on how the change would affect Florida high school football and on how implementations of the new rule vary from district to district.
Language in the new rule is vague, stating a player can’t return until cleared by a “health-care representative.” In Hillsborough and Pinellas counties, players will need a doctor’s clearance, but Pasco officials may interpret the rule to include medical officials who were at the game, said Phil Bell, Pasco’s supervisor of athletic programs and facilities.
The best-known guidelines for returning to the game come from a sports medicine expert consortium in Zurich. It recommends athletes gradually return to activities, from light aerobic activity to noncontact drills to game day. Each step takes a minimum of 24 hours, and if symptoms return, an athlete must revert to the previous step.
Texas, Oregon and Washington have state laws mandating when players should be taken off the field; many other states rely on their athletic associations to format such rules. With the school year and football season getting under way, this would be a good time for reporters to check on the policies at local schools. Read more about concussions, including some recent reports and Congressional testimony.
NFL to post concussion warning in locker rooms
In The New York Times, football concussion reporter Alan Schwarz examines the content and ramifications of a new warning poster the NFL will be putting in every locker room. An image of the poster can be seen here.
Photo by Eagle102.net via Flickr
The poster lists symptoms that players should look out for, including headaches, confusion, memory problems and feeling more emotional, and warns them not to ignore symptoms.
In addition to strictly medical information — including the most starkly worded warnings yet from the league — the poster reminds players that concussions can also have long-term negative impacts on their families and on the health of those youngsters who idolize pro athletes.
Greg Aiello, a league spokesman, said in an e-mail message that the poster, spearheaded by the league’s new head, neck and spine medical committee and written in collaboration with the players union and the Centers for Disease Control and Prevention, “is intended to present the most current and objective medical information on concussions and will be distributed to the players and clubs in the near future.”
GAO evaluates youth concussion databases
Filed under: Health data, Hot Health Headline, Public records, Studies
In a recent report, the Goverment Accountability Office reviewed national efforts to track concussions in youth sports (highlights). The report evaluates local and national laws designed to keep young athletes safe, but the most immediately useful component may be the identification and evaluation of three incomplete national databases now being maintained.
High School Reporting Information Online database
Provides national estimates of occurrence of concussion, it covers only 20 sports for high schools with certified athletic trainers. It may underestimate occurrence because some athletes may be reluctant to report symptoms of a possible concussion to avoid being removed from a game.
The Consumer Product Safety Commission’s National Electronic Injury Surveillance System
Provides national estimates only on concussions treated in an emergency room.
The National Center for Catastrophic Sports Injury Research database
Provides information only on cases of concussion with serious complications and cannot provide national estimates of the occurrence of all concussions.
Related
- Last week, the House of Representatives’ Education and Labor Committee held a hearing to examine the prevalence of concussions among high school athletes and how the injury can impact academic achievement.
- Previous coverage of concussions
Concussion more likely when hit is unexpected
There’s anecdotal evidence that athletes are less likely to get concussions if they were ready for the impact before it arrived, but it’s not an easy premise to test. The primary concerns are ethical ones, of course, as it’s hard to justify enrolling patients in a condition that calls for “sneaking up and, when they’re least expecting it, whacking them in the skull hard enough to deliver a concussion.”
Photo by sphilp1225 via Flickr
Fortunately, researchers for a study published in the June issue of Pediatrics found a clever way to isolate those conditions in a place where they “naturally” occur, namely a youth hockey game.
They started by fitting the young players’ helmets with monitors to measure impact data, then let them play. Researchers then divided the impacts into two categories: Those that occurred along the boards where players expect to be checked, and those that happened mid-ice and were thus more likely to come as a surprise.
Chicago Tribune blogger Julie Deardorff, who alerted us to the study, describes the results:
Of 666 body collisions, 421 took place along the playing boards, and the remaining 245 hits occurred on the open ice. On average, the open-ice collisions were more severe than those occurring along the playing boards, the study authors found.
Deardorff then evaluates youth hockey impacts relative to those in other sports, and ends with the recommendation that youth hockey players “skate through” checks, and keep moving instead of staying put along the boards and absorbing all the kinetic energy of the blow.
Focus on hockey’s head injuries grows
Poynter Institute’s Al Tompkins takes a look at hockey injuries, especially head injuries.
Photo by Alex Kehr via Flickr
He points to an article in the Globe and Mail about the long-term effect of concussions and what Canada is doing to combat the issue, contrasted with what some places in the United States are doing to better treat and prevent concussions.
The article cites a study in the March 2009 issue of Brain that found former athletes were still suffering the effects of their head injuries more than 30 years after their last concussion.
Tompkins also notes the National Hockey League – which had 10 players out with head injuries in November – is confronting the problem by banning “blindside hits” to the head.
Attention focuses on football’s neurological effects
Friday Night Lights author Buzz Bissinger, writing in Time, looks at two things he claims are being overlooked during the most recent uproar over football injuries: High school athletes and spinal injuries. Bissinger has strong opinions and two anecdotes, one of which includes a source who said that roughly two Texas high school football players suffer catastrophic spinal injuries each year.
Bissinger praises Alan Schwarz’ work on concussions at The New York Times, but openly doubts whether the advances Schwarz is helping force at the professional level will ever translate to high school.
I know the focus will not trickle down to where it is needed most: the high school level. Research has shown that young players are far more susceptible than older ones to serious injuries. …
There should be an ambulance at every high school game. There should be trainers. But don’t bet on it, as school districts cry a lack of money. Kids will continue to suffer serious head injuries. Kids will continue to become paralyzed because they never learned how to properly tackle, with their heads up. The game’s violence will continue because that’s exactly why we like it, our gladiatorial lust still intact 16 centuries after the Romans. The bigger the hit, the greater the roar.
Not a new concern
In an Op-Ed piece in The New York Times, Deborah Blum, a professor of science journalism at the University of Wisconsin, writes about a warning published in The Journal of the American Medical Association that said the medical profession can no longer ignore that “There is a very definite brain injury due to single or repeated blows on the head or jaw which cause multiple concussion hemorrhages” in a report about professional athletes.”
But what really makes the research and its conclusions so interesting is its timing: it appeared in The Journal of the American Medical Association on Oct. 13, 1928. This raises the question – at least for me – as to why we are announcing the athlete concussion-dementia link as a new, and still somewhat debatable, issue some 80 years later.
House Judiciary forum
Watch a video webcast of the Feb. 1 “House Judiciary Committee Forum on Head Injuries and Other Sports Injuries in Youth, High School, College and Professional Football,” or read about Republican’s reluctance to hold said forum in Houston.
Dan Rather report
Dan Rather’s latest investigative effort was a far-reaching look at concussions and football, with emphasis on both the high school and professional games. He frames it as part of the pre-Super Bowl concussion awareness push (PDF Transcript).
ESPN to air ‘Head Games’
ESPN reporter Greg Garber, on “Outside the Lines,” will look at the issue of concussions and the NFL at 8 a.m. ET on Sunday. Harold Donald Carson, a former linebacker and inductee into the Pro Football Hall of Fame, “has become one of the leading spokesmen for the NFL’s retired players. Passionate and eloquent, he is in some ways the league’s conscience on the subject.”
Carson, who played 13 seasons for the New York Giants, estimates he suffered about a dozen concussions during his career, but none of them were documented. While he believes concussions among former football players will escalate into an epidemic, Dr. Joseph Maroon, the Steelers’ neurosurgeon for nearly three decades and a member of the NFL’s concussion committee for the past three years, disputes that:
“Because we know that there are millions of high school kids, college kids, youth leagues, as well as other who play football annually, I think we are not seeing the epidemic at that level people are speculating about,” Maroon said.
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