Report: Disabled Mass. Residents Face Major Health Disparities

health disparities

A new report highlights the many ways in which Massachusetts residents with disabilities “fare worse” than those without disabilities when it comes to their own physical and mental health as well as access to quality medical care from doctors sensitive to their needs.

This phenomenon isn’t new. Previous research found that many barriers still exist that prevent disabled patients from accessing specialty medical care. And for those with developmental and intellectual disabilities, sometimes finding a doctor willing to treat even common medical conditions can be difficult.

The latest report, by researchers at UMass Medical School’s Disability, Health and Employment Unit working and the Health and Disability Program at the state Department of Public Health, also suggests that the state could do more to ensure that disabled patients have access to health care providers who both understand and can help with the specific medical challenges of this population.

I asked the researchers, led by Monika Mitra, PhD, assistant professor in UMass Medical School’s Department of Family Medicine and Community Health, to lay out the key messages of the report. Here are some of their findings:

• 24% of those with disabilities are current smokers compared to 16% of adults without disabilities.
• Both men (7%) and women (24%) with disabilities were more likely to report lifetime sexual violence compared to men (4%) and women (19%) without disabilities.
• Adults with disabilities (64%) were twice as likely to report being overweight as those without disabilities (34%).

In addition, people with disabilities surveyed in the study reported the following health-related concerns:

• Affordable housing (77% of respondents reported this was a problem);​
• Adequate dental care (64%);
• Adequate mental health services (62%);
• Finding a doctor who is sensitive to disability issues (55%);
• Transportation to doctor’s appointments (54%);
• Communication supports, such as large print, Braille, Computer Assisted Realtime Translation (CART) readers, etc. (52%);
• Managing chronic conditions, such as diabetes (50%);
• Paying for prescription medications (48%);
• Finding a doctor who accepts public health insurance (48%); and
• Accessible gyms (45%).

Continue reading

Heat Takes Marathoners By Surprise

It was hotter than expected on Marathon Monday, and there may have been more charity or first-time runners than usual. Both these things could help explain why almost 4,000 runners and a few spectators walked or were wheeled into a medical tent along the course.

The Mecca Of Marathon Medicine

As temperatures rose above 70 degrees and the sun blazed, Clyde Dickey, from Rockwall, Texas, said he downed too much Gatorade.

“I just threw up a little bit, and I felt faint” as I crossed the finish line, Dickey said. “I thought I had heat exhaustion. I gave [the race] all I had, but the heat just got to me.”

Clyde Dickey from Texas tried for a personal record, pushed too hard and was treated for heat exhaustion. (Martha Bebinger/WBUR)

Clyde Dickey from Texas tried for a personal record, pushed too hard and was treated for heat exhaustion. (Martha Bebinger/WBUR)

Dickey was underground, waiting for the T when the bombs went off last year and regrets that he wasn’t able to help those wounded. He added Boston TV stations to his cable package so he could watch all the specials in the year since.

“I love coming here,” Dickey said. “This is the mecca of marathons.”

And perhaps the mecca of marathon medicine. So when a guy from Michigan, who trained all winter in 20-degree weather, collapsed at the finish line, a volunteer scooped him into a wheelchair and had him on a cot with an IV in his arms within minutes. Another volunteer caught a woman from Washington, D.C., who started spinning as she slowed down.

“I wasn’t quite expecting it but today we saw quite a bit of hyperthermia, people overheating,”
said Dr. Pierre d’Hemecourt, one of the marathon’s medical directors. He said the tents, which were larger with more staff and equipment than last year, were busy most of the day.

“Most of [the activity] being relatively minor, dehydration, things like musculoskeletal complaints,” d’Hemecourt said. “So overall it’s been a pretty good day.”

Which, in contrast to last year, was a relief for many of the doctors, nurses and other volunteers who staffed the medical tents. Continue reading

OBs: No Link Between Labor Induction And Autism

The nation’s most influential group of obstetrician-gynecologists concludes that there’s no connection between labor induction and autism. Earlier reports suggested that there’s was a possible link, but even that research, published in JAMA Pediatrics, was complicated and somewhat murky.

(popularpatty/flickr)

(popularpatty/flickr)

Here’s ACOG’s latest guidance on the matter, from the news release:

Current evidence does not support a conclusion that labor induction or augmentation causes autism spectrum disorder (ASD) in newborns, according to a new Committee Opinion released by the American College of Obstetricians and Gynecologists (the College).

While some studies have suggested an association between ASD and the use of oxytocin for labor induction or augmentation, available evidence is inconsistent and does not demonstrate causation, according to the opinion, which also found important limitations in study design and conflicting findings in existing research.

Given the potential consequences of limiting labor induction and augmentation, the College’s Committee on Obstetric Practice recommends against changes to existing guidance regarding counseling and indications for, and methods of, labor induction and augmentation.

“In obstetric practice, labor induction and augmentation play an essential role in protecting the health of some mothers and in promoting safe delivery of many babies,” said Jeffrey L. Ecker, MD. Dr. Ecker is chair of the Committee on Obstetric Practice, which developed the new Committee Opinion. “When compared with these benefits, the research we reviewed in assembling this Committee Opinion, relative to the utilization of oxytocin, had clear limitations. Because of this, these studies should not impact how obstetricians already safely and effectively use labor induction and augmentation when caring for their patients.” Continue reading

Can You Run Hard While Weeping? Some Boston Marathoners Will Find Out

On the eve of the Boston Marathon, some runners said this year’s race may be as taxing emotionally as it is physically.

Tom Pfleeger, of Gulfport, Miss., finished the marathon about 40 minutes before two bombs went off last year, having completed what he thought was a perfect race. Then, the euphoria was snatched away.

“You went from the top of the mountain to lowest, low,” Pfleeger said, to being “so sad for all the people who were killed and injured.”

Carrie Lundell (left) and her niece Becky Anderson have been crying a lot as today's race approaches, but hope to keep tears at bay while they run. (Courtesy Carrie Lundell)

Carrie Lundell (left) and her niece Becky Anderson have been crying a lot as Monday’s race approaches but hope to keep tears at bay while they run. (Courtesy Carrie Lundell)

Pfleeger is one of many runners who say they are back to take care of unfinished emotional business. Beverly Dwight, from Belchertown, Mass., is running her first Boston Marathon. Last year, she was a volunteer at the finish line.

“I was able to walk away from what happened,” Dwight said slowly. “Not a day goes by where I don’t think about those who are much less fortunate.”

Dwight is prepared to cry while she runs.

They “could be tears of joy,” Dwight said, “just joy to be part of it and a sense of kind of one with the city of Boston.”

Some runners worry about becoming overwhelmed.

“It’s going to be insane. I’m hoping it doesn’t tip me over to the emotional part because it’s super hard to run when you’re like feeling verklempt,” said Carrie Lundell, from Orange County, Calif. She clutched at her throat, using the Yiddish word that means “choked with emotion.”

“I just need to take it right up to that level, but not over until we cross the finish line, and then there’s going to be a lot of tears,” Lundell said.

Lundell will be running with her niece Becky Anderson from Eagle Mountain, Utah. Anderson ran the marathon last year, finishing 15 minutes before the first explosion. Continue reading

Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading

Mom’s Memo To Schools: Please, Make These Random Half-Days Stop

May I share with you the delights of my children’s April school schedule? They get out at 12:40 because of parent-teacher conferences on these days sprinkled through the month: Tues., April 1; Weds., April 9; Tues., April 29. Oh, yes, and just when you thought it was safe, one more on May 7. (Plus they’re off April 18-25 for spring vacation.)

That’s in addition to our new regular Friday early dismissals at 1:40. When we got word of that, one mother I know said to the superintendent, “You must really hate parents.”

I don’t think the administration hates us, but I do think that perhaps we haven’t spoken up loudly enough about the logistical stress these half-days create. And they’re common around the state, from year-round early-release Tuesdays in Newton to April half-Wednesdays in Westwood.

They’re an old tradition. Many of us remember the joys of occasional half days from our own school years. You know, back when our mothers were mostly housewives. Now, virtually all mothers work, and I venture to say that virtually all working parents wish that all our public schools provided universal, affordable after-school care.

(Photo: Rachel Zimmerman)

(Photo: Rachel Zimmerman)

Or at the very least, reliable after-school care on random half-days. At our school, a team of mothers has created a “half-day matinee,” gathering all the children who need looking after for a movie that runs until the normal 2:30 dismissal time. But their altruistic efforts are in danger of being overwhelmed by demand: More than 200 children have been coming to the movies this month, straining even their heroic volunteer powers.

“First-world problems,” you may say, and I’d agree but go a step further: This is specifically a first-world middle-class problem. Continue reading

Project Louise: When The Best Thing To Do Is … Nothing

Stress can get in the way of doing the right thing. But stopping to breathe can help. (skyseeker via flickr)

Stress can get in the way of doing the right thing. But stopping to breathe can help. (skyseeker via flickr)

By Louise Kennedy
Guest contributor

Some days, all you can do is keep breathing. At least that’s what it feels like this week.

Both my work and home lives chose this particular moment to ratchet up the pressure by about 100 percent; I had some completely unbreakable deadlines, with a ton of work to be done in order to meet them. The professional ones I’ve (mostly) met, and the home-front ones I’m still working on, but so far things are more or less under control.

Meanwhile, the Project Louise commitments – you know, exercising three days a week; eating well at least five days a week; learning to love, trust and respect myself all the time – well, something had to give. And, as seems to be my lifelong pattern, when I have to choose between my obligations to others and my obligations to myself, it’s Louise who has to give.

I confess there’s a big part of me that considers this the right way to live. Selfishness is one of the sins I find hardest to forgive in others, so it’s also one I strive hardest to avoid myself. But I do know – and coach Allison Rimm keeps reminding me – that there’s a difference between selfishness and self-care. Continue reading

What Teens Say Teens Should Know About Sexually Transmitted Diseases

(Planned Parenthood)

(Planned Parenthood League of Massachusetts)

By Joey Boots-Ebenfield
Guest contributor

I’ve gotten used to hearing myths and misinformation when I talk about sex with fellow teens.

And I talk about sex often in my role as an 17-year-old peer educator with the Planned Parenthood Get Real Teen Council (GRTC) — a year-long high school sexual health program for 10th-12th graders who are trained to facilitate sex education workshops and serve as resources for peers, families and communities.

If teens are uncomfortable talking about topics related to sex and sexuality, or don’t have a trusted source of information about their health, it’s easy for all kinds of misinformation to spread. And of course, there’s the Internet, where bad information is often rampant, so it’s not always a reliable place to find accurate health information.

The subject of sexually transmitted diseases (STDs) is no exception. I’ve heard some pretty interesting misconceptions about what STDs are and what it’s like to get tested. One myth is that STDs have obvious symptoms, like localized pain or some other physical sign.

In fact, this is quite the opposite! STDs often show NO symptoms. This myth is especially dangerous because it means that someone can have an STD and not even know it. As a result, many STDs go untreated, which can cause cause some pretty nasty complications. Continue reading

Study: Young Adults’ Casual Marijuana Use Causes Brain Changes

(prensa420/Flickr)

(prensa420/Flickr)

A new study by Boston researchers is believed to be the first that shows that young adults who even occasionally smoke marijuana could be damaging their brains.

The study, just published in The Journal of Neuroscience, found abnormalities in areas of the brain related to emotion, motivation and decision-making.

The researchers say the degree of brain changes appeared to be directly related to how frequently the study’s participants smoked pot.

The authors write in their paper:

The results of this study indicate that in young, recreational marijuana users, structural abnormalities in gray matter density, volume, and shape of the nucleus accumbens and amygdala can be observed. Pending confirmation in other cohorts of marijuana users, the present findings suggest that further study of marijuana effects are needed to help inform discussion about the legalization of marijuana.

The study comes with a plurality of Massachusetts residents supporting the legalization of marijuana for recreational use, and as the state is in the process of opening medical marijuana dispensaries.

Here & Now has more on the study this afternoon.

And hat-tip to The Boston Globe, which has more on the findings.