Just Sip It: More Than Half Of U.S. Kids Not Properly Hydrated

(sara_girl22/Flickr)

(sara_girl22/Flickr)

One statistic jumped out at me from this study by researchers at the Harvard School of Public Health about whether U.S. kids are drinking enough water: “Nearly a quarter of the children and adolescents in the study reported drinking no plain water at all.”

When you think about the kinds of serious health problems your kids might have, not drinking quite enough water may not top your list.

But it’s serious: beyond the physical problems related to insufficient water-drinking, there are cognitive implications as well, researchers report:

Inadequate hydration has implications for children’s health and school performance. Drinking water can improve children’s performance on cognitive tests. Two studies have found that children’s cognitive performance improved as their urine osmolality [a measure of urine concentration] decreased. Increasing drinking water access in schools may be a key strategy for reducing inadequate hydration and improving student health, because schools reach so many children and adolescents and that they typically provide free drinking water to students.

The study was published online in the American Journal of Public Health.

I asked Erica Kenney, a postdoctoral researcher and one of the study authors, a few questions about the work. Here, lightly edited, is what she said, via email.

RZ: What’s the takeaway here?

EK: We often take for granted that kids will keep themselves hydrated automatically and will drink when they’re thirsty, or that their schools, summer camps, afterschool programs, child care centers, etc. will be providing them with enough opportunities to drink water during the day. But our study indicates that this may not be the case — over half of all children and adolescents in the U.S. are estimated to be inadequately hydrated. We need to do a better job of getting safe, clean, appealing drinking water to kids (and by “we” I don’t just mean parents and families — I also mean the places where kids learn and play during the day) and keeping them hydrated so that they have the opportunity to be at their best in terms of well-being, cognitive functioning, and mood.

Where do we go from here? Continue reading

MassHealth Squandered More Than $500 Million, Audit Finds

The state Medicaid program squandered more than $500 million through unnecessary payments or missed savings opportunities in its managed care program, according to an audit released Tuesday.

The review by State Auditor Suzanne Bump found MassHealth, the state Medicaid program, made $233 million in unnecessary payments for medical services that should have been covered by managed care organizations between October 2009 and September 2014. The audit also says the state could have saved $288 million more through more detailed structuring of managed care contracts.

Bump said that during the five years covered by the audit, MassHealth paid managed care organizations about $12 billion to provide health services to 1.6 million members. Managed care organizations are private health care insurers that agree to fixed, per-member rates to administer and pay for specific categories of health care claims on behalf of MassHealth.

Continue reading

I Bought Narcan, And Here’s What I Learned

Evzio's "Trainer" (Jesse Costa/WBUR)

Evzio’s “Trainer” (Jesse Costa/WBUR)

I walked into a CVS across the street from WBUR this week to get some naloxone, which you might know by the brand name, Narcan. It temporarily reverses the effects of an opioid overdose and restores breathing.

For me, the purchase is not urgent. But I saw a woman in a cafe restroom recently who was in rough shape, I have a cousin who’s managing his addiction to heroin, I’m reporting on this issue, and I have three teenagers. I decided I wanted to be ready to help.

I asked the pharmacist for Evzio. It’s a newish option, an injectable form of naloxone, kind of like an EpiPen. Mark Herzog, a VP at Kaleo, the company that makes Evzio, handed me the “trainer” (pictured above) at a conference. It comes in a kit along with two injection canisters. Continue reading

In Defense Of The VA: Doctor’s Reality Check On Congressman’s Bad Experience

This from our friends at Radio Boston:

Dr. Henry Feldman (courtesy)

Dr. Henry Feldman (courtesy)

It’s a sad truth that we’ve come to expect some hassles when it comes to health care — long waits to see the doctor, confusing paper trails and maybe poor communication about prescriptions. But when U.S. Rep. Seth Moulton dealt with all of the above at the Department of Veterans Affairs, he decided to take some action.

The Salem Democrat and Iraq War veteran, who earned two medals for valor, needed treatment for a hernia, and his experience with the VA was so frustrating (he discussed it on Radio Boston) that he’s now looking to pass legislation that he hopes will improve things.

But Dr. Henry J. Feldman argued in a letter to The Boston Globe that Congressman Moulton had unrealistic expectations, and was presenting “an almost impossible service expectation:”

Let’s put what he did in non-VA terms. He is outside of his home state, and shows up at a random, but somehow in-network, clinic. He presents, not with an emergency, but as a walk-in for a routine surgical evaluation (hernia), without his insurance cards or records. His records are at a far-away hospital, and while he is insistent that he has insurance, the local clinic is unable to easily verify this.

Dr. Feldman has a rare perspective on the issues involved: He works part-time at the VA in West Roxbury; he is also a hospitalist at Beth Israel Deaconess Medical Center and its chief information architect of the division of clinical informatics, meaning he builds and analyzes electronic medical records. He expanded on his defense of the VA in a persuasive Radio Boston segment on Friday.

On the VA’s initial inability to find Rep. Moulton’s records, Dr. Feldman says that was likely a computer glitch, because the VA is a leader in its ability to access patient records from anywhere in the network. (The VA has declined to comment, citing patient privacy; Dr. Feldman is sharing his personal opinions.)

Listen to the full segment above. Highlights, lightly edited:

Host Meghna Chakrabarti: So it might have been that Congressman Moulton just ran into a series of unusual glitches — that is a possibility because ultimately, the VA in Washington did find out that Seth Moulton is a congressman and he got his surgery, but he says that they still sent him home with the wrong medication after the surgery. Here’s what he said: “If I was sent home without all the medications that I needed, just imagine the care that the average veteran often gets at the VA.”

Do you think that’s a fair concern for him to have?

“[Y]ou go to war with the army you have, but for God’s sake, you should be able to come back to a different VA than you went to war with.”

– Dr. Henry Feldman

Dr. Henry Feldman: I would like to take that statement apart into two parts:

One, we do not provide superior care just because you’re a congressman. In fact, he should not receive any better care than a homeless veteran. In fact, the homeless veteran should probably get better care because he’s more at risk

I don’t have any access to what happened — it’s hard to know. There could be three errors that resulted in him getting the wrong medication: Continue reading

After A Death, Crackdown On Drowsy Teen Drivers Led To Fewer Crashes, Study Finds

(KaritoGlam/Flickr)

(KaritoGlam/Flickr)

By Marina Renton
CommonHealth Intern

It was to be Maj. Robert Raneri’s last day of work before his wedding the following week. On June 26, 2002, Raneri, a member of Army Reserves, left his home in Nashua, New Hampshire for the Devens Reserve Forces Training Area in Ayer, Massachusetts. But he never arrived.

Raneri was killed by a 19-year-old drowsy driver who admitted to having stayed up through the night playing video games. Shortly after Raneri’s death, his fiancée, Maj. Amy Huther, learned she was pregnant with his child.

In accordance with Massachusetts law at the time, the teen driver faced misdemeanor charges, leading to five years probation, a 10-year license suspension and 140 hours of mandated community service, The Boston Globe reported in 2004.

Drowsy Driving

But the tragedy brought attention to the problem of drowsy driving and, in 2007, led to new rules that govern the way young drivers grow into their adult licenses: the graduated driver-licensing program.

Those rules (amendments to already existing law) included stiffer nighttime driving penalties, driver’s education on drowsy driving and tougher penalties for negligent or reckless driving. And it seems the strict new rules have worked, dramatically decreasing the number of drowsy driving accidents involving teenagers, according to a new study out this month in the journal Health Affairs.

Indeed, the results are striking: Among junior operators (ages 16-17), the overall rate of car accidents fell by 18.6 percent, the rate of night crashes decreased by almost 29 percent, and there was an almost 40 percent decrease in car crashes resulting in a fatal or incapacitating injury, researchers report. The study focused on data from one year before and five years after the implementation of the new amendments.

Legal Crackdown

This is the first study of its kind to look at the effects of individual components of a driver licensing law, such as more exacting penalties, the authors state.

Dr. Charles Czeisler, chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital in Boston and co-author of the study, said in an interview that researchers are “confident that these features of the law were critical in the decline in the teen fatal and incapacitating injuries as well as the overall crash rate that we observed.”

Like young drivers everywhere, Massachusetts teens don’t have the same privileges as adult drivers. They aren’t allowed to drive at certain times of night; they can’t have friends in the car right away; and they have to drive with a parent or other adult in the car when they’re first starting out. Continue reading

Mass. Health Connector Website Costs Rise To $281 Million

The cost of setting up the Massachusetts health insurance website under the rules of Obamacare is rising again, this time by $47.2 million.

Additional fixes bring the total price tag for the Connector site that failed two years ago and the new flawed replacement to $281 million. And this isn’t the final bill.

Connector leaders are considering two significant changes — a new payment tool and an easy physician search option — which could push the costs over $300 million. Continue reading

Related:

In Test Tube, ‘Pulse-Doses’ Of Antibiotic Wipe Out Lyme Disease Bacteria Persisters

Northeastern graduate student Bijaya Sharma has worked on recent Lyme disease experiments that may have found a new way to kill "persister" bacteria cells. (Robin Lubbock/WBUR)

Northeastern graduate student Bijaya Sharma has worked on recent Lyme disease experiments that may have found a new way to kill “persister” bacteria cells – at least, in a Petri dish. (Robin Lubbock/WBUR)

From the Northeast to the Midwest and beyond, it’s high season for Lyme disease. An estimated 300,000 Americans are diagnosed with the spreading, tickborne disease every year. Most can be successfully treated with antibiotics, but for some, symptoms persist for months and even years — pain, fatigue, arthritis.

For me, Lyme disease news tends to range from horrifying — stories of insidious, life-ruining symptoms — to just depressing, like recent speculation that New England’s massive snowfall this winter may have insulated ticks and helped them survive.

So, though it’s still extremely early research, I was gladdened by a report just out from Northeastern University that a prominent germ-fighting scientist may have found a new way to kill off Lyme disease bacteria even when it persists after antibiotics. In test tubes, at least.

Prof. Kim Lewis, chief of the Antimicrobial Discovery Center at Northeastern University (Robin Lubbock/WBUR)

Prof. Kim Lewis, chief of the Antimicrobial Discovery Center at Northeastern University (Robin Lubbock/WBUR)

Prof. Kim Lewis, chief of Northeastern’s Antimicrobial Discovery Center, made a big splash just this January in the journal Nature with the discovery of a potent new antibiotic.

Now, he reports finding not a new compound but a new anti-Lyme timing regime for dosing of antibiotics.

“We decided, ‘OK, let’s look at, what are the potential vulnerabilities of this seemingly invincible pathogen?” he says. “It has all these strengths, but what are its vulnerabilities?”

That powerful pathogen is Borrelia burgdorferi, the Lyme disease bacterium. Until recently, Lewis did not include it in his research repertoire. But a couple of years ago, he was invited to a conference on Lyme disease, and unlike his usual scientific gatherings, it included some long-suffering patients.

“That probably was a tipping point,” he says, “that suggested to me that we should really get into this, and maybe try to do something.”

Lewis had long researched other hard-to-eradicate infections. “What we found, and published over the years,” he says, “is that in chronic infections, you have a small subpopulation of dormant, spore-like cells — these are called persisters,” he says. “So when antibiotics kill off the regular cells, persisters survive to live another day.”

“Of course, the word of caution is, this was in the test tube. It has not been tested in animals, nor has it, obviously, been tested in humans.”

– Dr. Harriet Kotsoris,
Global Lyme Alliance

There’s long been debate about whether the long-lasting symptoms that some Lyme patients experience could stem from Borrelia persisters, somehow hiding out in the body. Lewis had seen how latent tuberculosis could lie low. He suspected Lyme disease might be similar, and decided to look at persisters.

His research team attacked some Borrelia with antibiotics and then waited…and waited…a very long time in the world of bacteria — three weeks. They found that with time, regular cells were killed but persisters remained completely intact.

“That was expected,” Lewis says. “Also satisfying, that this may be an important culprit explaining at least part of the difficulty of treating Lyme disease.

Once he’d homed in on the persisters, Lewis wanted, naturally, to obliterate them. His team tried several compounds that had worked on persisters in other bacteria — in staph, for example, and E. coli — but with no luck. Continue reading

Mass. Prisoners Sue For Better Hepatitis Care

Prisoners in Massachusetts are not being given expensive new medications to treat hepatitis C, according to a prisoner rights group that is suing the state, WBUR’s Martha Bebinger reports:

The lawsuit says new drugs that can cure Hep C are now standard care, especially for patients at risk of death from the disease. It’s not clear how many of the 1,500 state prisoners with Hep C are in an advanced stage that would warrant use of the $80,000-90,000 treatment.

But Joel Thompson at Prisoners’ Legal Services says all prisoners are entitled to adequate medical care under the Constitution.

“And the treatment of Hepatitis C, given all the changes that have come, in the treatment of the disease, is no longer adequate. It violates their constitutional rights,” Thompson says.

There is no comment yet from the state or the private group that handles prison medical care.

Here’s the full news release from Prisoners’ Legal Services and the National Lawyers Guild:

Hundreds of prison inmates are in danger of losing their lives because the Department of Correction refuses to provide the medicine that will cure their potentially fatal disease. A class action lawsuit filed in federal court today by lawyers for the National Lawyers Guild and Prisoners Legal Services says it is Massachusetts’ legal responsibility to provide adequate medical care to state prisoners. Urszula Masny-Latos, Executive Director of the Massachusetts chapter of the National Lawyers Guild, said: “It is the responsibility of the state, which spends millions to incarcerate thousands of people, to provide adequate medical care for them. Without such care, many of them will develop serious complications of this disease, and some will die. These people were sentenced to incarceration, not to death.” The lawsuit seeks to compel the Department of Correction (DOC) and its health care contractor, the Massachusetts Partnership for Correctional HealthCare, LLC (MPCH) to provide inmates in their custody with new, lifesaving medications for Hepatitis CHepatitis C, an infectious disease which causes progressive damage to the liver and ultimately liver failure, is widely prevalent in prisons and jails. New medications approved by the FDA in 2014 represent a dramatic improvement over their predecessors, curing nearly one hundred percent of patients, with far fewer side effects. The DOC and MPCH have stopped using the now-outdated medications, but have failed and refused to provide prisoners with the new treatment. Continue reading

Mass. Adopts Final ICU Nurse Staffing Rules

The 2014 nurse staffing law will apply to burn units and intensive care for newborns along with intensive care units for adults, under final regulations adopted by the Health Policy Commission on Wednesday.

Passed by the Legislature in part to avoid a ballot referendum, the law required each ICU nurse be assigned only up to two patients, and only one patient if that is what is required.

An acuity tool would be used to determine the nursing needs of patients, under the regulations approved on a voice vote Wednesday.

The final regulations designate March 31, 2016, as the acuity tool deadline for academic hospital ICUs, and push back the deadline at community hospitals and in neonatal ICUs to Jan. 31, 2017.

“All of us are committed to really high quality patient care, and I would really prefer to not see this have to be rigidly written in law and regulation, but that’s where we are,” Health and Human Services Secretary Marylou Sudders, who is on the commission, said after the vote.

The regulations drew a mixed response from nurses and a warning from a health care workers against cutting hospital jobs. Continue reading

Big Study Finds Autism Risk Higher If Teen Mom Or Parental Age Gap

In this 2014 photo, Colleen Jankovich works with her 11-year-old autistic son, Matthew, who is non-verbal and requires 24/7 care, in Omaha, Neb. (Nati Harnik/AP)

In this 2014 photo, Colleen Jankovich works with her 11-year-old autistic son, Matthew, who is non-verbal and requires 24/7 care, in Omaha, Neb. (Nati Harnik/AP)

This we already knew: That the children of older parents, particularly older fathers, are at heightened risk for autism. Now, a big new study just out in the journal Molecular Psychiatry, funded by Autism Speaks and encompassing more than 5 million children across five countries, adds some new age factors ito the risk equation. From the press release:

• Autism rates were 66 percent higher among children born to dads over 50 years of age than among those born to dads in their 20s. Autism rates were 28 percent higher when dads were in their 40s versus 20s.
• Autism rates were 15 percent higher in children born to mothers in their 40s, compared to those born to moms in their 20s.
• Autism rates were 18 percent higher among children born to teen moms than among those born to moms in their 20s.
• Autism rates rose still higher when both parents were older, in line with what one would expect if each parent’s age contributed to risk.
• Autism rates also rose with widening gaps between two parents’ ages. These rates were highest when dads were between 35 and 44 and their partners were 10 or more years younger. Conversely, rates were high when moms were in their 30s and their partners were 10 or more years younger.

The study notes that it seems clear why an older father might heighten autism risk: Sperm mutations accumulate over the years. But if older age heightens risk, why in the world should the autism rate be higher when mothers are in their teens? And why should a gap in age between parents matter?

Stay tuned for further research to follow these leads. These latest findings “suggest that multiple mechanisms are contributing to the association between parental age” and autism risk, the study’s authors write.