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Largest Pediatric Study Shows Obesity Increases Asthma Risk in Children

Largest Pediatric Study Shows Obesity Increases Asthma Risk in Children

ORLANDO – Ten percent of pediatric asthma cases could be avoided if childhood obesity were eliminated, according to research led by Nemours Children’s Health System. The research, published in Pediatrics, the journal of the American Academy of Pediatrics, reported on the analysis of medical records of more than 500,000 children. The study is among the first to use the resources of PEDSnet, a multi-specialty network that conducts observational research and clinical trials across eight of the nation’s largest children’s health systems. PEDSnet is funded by the Patient-Centered Outcomes Research Institute (PCORI), a government-supported nonprofit.

“Pediatric asthma is among the most prevalent childhood conditions and comes at a high cost to patients, families and the greater health system. There are few preventable risk factors to reduce the incidence of asthma, but our data show that reducing the onset of childhood obesity could significantly lower the public health burden of asthma,” said Terri Finkel, M.D., PhD, Chief Scientific Officer at Nemours Children’s Hospital in Orlando and one of three Nemours researchers participating in the study. “Addressing childhood obesity should be a priority to help improve the quality of life of children and help reduce pediatric asthma.”

In this retrospective cohort study design, researchers reviewed de-identified data of patients ages two to 17 without a history of asthma, receiving care from six pediatric academic medical centers between 2009 and 2015. Overweight or obese patients were matched with normal weight patients of the same age, gender, race, ethnicity, insurance type, and location of care. The study included data from 507,496 children and 19,581,972 encounters.

In their analysis, the researchers found that the incidence of an asthma diagnosis among children with obesity was significantly higher than in children in a normal weight range and that 23 to 27 percent of new asthma cases in children with obesity are directly attributable to obesity. Additionally, obesity among children with asthma appears to increase disease severity. Being overweight was identified as a modest risk factor for asthma, and the association was diminished when the most stringent definition of asthma was used. Other significant risk factors of an asthma diagnosis included male sex, age of under 5 years old, African-American race, public insurance.

With 6 to 8 million cases of pediatric asthma previously reported in the United States, the study’s data suggest that 1 million cases of asthma in children might be directly attributable to overweight and obesity and that at least 10 percent of all U.S. cases of pediatric asthma might be avoided in the absence of childhood overweight and obesity.

“This is the first study of its kind, looking at obesity and the risk of developing asthma entirely in a pediatric population, and is made possible through the PEDSnet data collaboration,” said Finkel. “The PEDSnet collaboration brings the power of Big Data to pediatric research and medicine – as well as the expertise to structure the data and understand how to extract the most meaningful points.”

Several limitations of the study are noted, including the retrospective design using electronic health data, which prevent the researchers from drawing absolute conclusions regarding the causal nature of the association between obesity and asthma. Additionally, while the study includes data from a large, geographically diverse population of children, rural children may be underrepresented in the study results.

The research team hopes in the future to use PEDSnet’s capabilities to continue to gain new epidemiologic insights into the relationship between pediatric obesity and asthma, including measures of lung function, comorbidity, and medication data. Each PEDSnet member institution is able to map its own data onto the common data model, creating an enormous resource across the network with the power to produce findings relatively quickly.

Posted in: Research

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As CHIP Funding Lags, Doctors And Parents Scramble To Cover Kids’ Needs

As CHIP Funding Lags, Doctors And Parents Scramble To Cover Kids’ Needs

Dr. Mahendra Patel, a pediatric cancer doctor, has begun giving away medications to some of his patients, determined not to disrupt their treatments for serious illnesses like leukemia, should Congress fail to come up with renewed funding for a key children’s health program now hostage to partisan politics.

In his 35 years of practice, Patel, of San Antonio, has seen the lengths to which parents will go to care for their critically ill children. He has seen couples divorce just to qualify for Medicaid coverage, something he fears will happen if the Children’s Health Insurance Program (CHIP) is axed. He said: “They are looking at you and begging for their child’s life.”

The months-long failure on Capitol Hill to pass a long-term extension to CHIP that provides health coverage to 9 million lower-income children portends serious health consequences, with disruption in ongoing treatments.

While funding promises and estimates of dates for it disappearing vary from week to week and state to state, treatment plans for serious diseases span months into the future, leaving some doctors, like Patel, to jury-rig solutions. The challenges are particularly great for kids with chronic or ongoing illnesses such as asthma or cancer.

Dr. Joanne Hilden, a pediatric cancer physician in Aurora, Colo., and past president of the American Society of Hematology-Oncology, said cancer patients who are worried their CHIP funding will run out can’t schedule care ahead of time.

A San Antonio pediatrician, Dr. Carmen Garza, is advising parents to be sure to keep their children’s asthma medications and other prescriptions current and fill any refills that they can so they don’t get left without vital medicines if CHIP expires.

Federal funding for CHIP originally ran out Oct. 1. In December, Congress provided $2.85 billion to temporarily fund the program. That was supposed to help states get through at least March, but it is coming up well short. The Centers for Medicare & Medicaid Services (CMS) last week said it couldn’t guarantee funding to all states past Jan. 19.

About 1.7 million children in 20 states and the District of Columbia could be at risk of losing their CHIP coverage in February because of the shortfall, according to a report Wednesday by the Georgetown University Center for Children and Families.

A few states, including Louisiana and Colorado, plan to use state funds to make up for the lack of federal funding. But that is a drastic step, since the federal government pays on average nearly 90 percent of CHIP costs. Most states cannot afford to make up the difference and will have to freeze enrollment or terminate coverage when their federal funding runs out.

Virginia and Connecticut can promise to keep their CHIP program running only through February, officials said.

The largest states seem to be in the best shape, though even that guarantees only a few months of care. Florida, California and Texas officials said they have enough CHIP funding to last through March. New York officials said they have enough money to last at least into mid-March.

Before the short-term funding was passed in late December, CHIP programs survived on the states’ unspent funds and a $3 billion redistribution pool of CHIP dollars controlled by CMS.

Republicans and Democrats on Capitol Hill say they want to continue CHIP, but they have been unable to agree on how to continue funding it. The House plan includes a controversial funding provision — opposed by Democrats — that takes millions of dollars from the Affordable Care Act’s Prevention and Public Health Fund and increases Medicare premiums for some higher-earning beneficiaries.

The Senate Finance Committee reached an agreement to extend the program for five years but did not unite around a plan on funding.

But two key Republican lawmakers — Sen. John Cornyn of Texas, who is part of the Senate leadership, and Rep. Greg Walden of Oregon, who chairs the House Energy and Commerce Committee — told reporters Wednesday that they think an agreement is close.

Alabama and Utah are among several states unsure how long their federal CHIP funding will last, according to interviews with state officials. Part of the problem is they have not been told by CMS how it will be disbursing money from the redistribution pool. Under the pool restrictions, states with excess dollars would have to give money to states running low.

Although health care provider groups and child health advocates have for months been sounding the alarm about CHIP, the Trump administration has kept quiet, saying it’s up to Congress to renew the program.

When Marina Natali’s younger son broke his arm ice-skating last year, she did not have to worry about paying: CHIP footed all of his medical bills.

Had that accident happened this year, though, Natali, 50, of Aliquippa, Pa., might be scrambling. She cannot afford private coverage for her two children on her dental hygienist pay.

“It’s creating a lot of anxiety about not having insurance and the kids getting sick,” she said.

Dr. Todd Wolynn, a Pittsburgh pediatrician, said families are reacting with “fear and disbelief” to CHIP’s uncertain future. The group practice hasn’t changed any scheduling for CHIP patients, but he said “families are terrified” about the program having to be terminated.

Pennsylvania officials sent a notice to CHIP providers in late December — who then sent it to enrollees — saying it would have to end the program in March unless Congress acts.

“These families don’t know if the rug is being pulled out from them at any time,” he said.

Dr. Dipesh Navsaria, a Madison, Wis., pediatrician and vice president of the state’s chapter of the American Academy of Pediatrics, said many parents and doctors have been told for months that Congress would firm up long-term funding for CHIP, but those promises have been dashed.

“If CHIP coverage disappears, we run the risk of kids going without care or emergency room visits going up,” he said.

Navsaria also worries that many parents will be surprised if their children are suddenly without coverage. They may not know the state-branded programs they use, such as BadgerCare Plus in Wisconsin, Healthy Kids in Florida and All Kids in Alabama, are part of the CHIP program.

Ariel Haughton of Pittsburgh said she’s upset her federal lawmakers have left CHIP in flux for her two children and millions of kids around the country. “They seem so cavalier about it,” she said.

If CHIP gets canceled by the state, she likely won’t bring Javier, 2, for his two-year checkup if nothing seems wrong. “We will have to decide between their health and spending the money on something else,” she said.

Article reprinted from Kaiser Health Network. KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation

Posted in: CHIP

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Children’s Insurance, Other Health Programs Funded — For Now — In Bill

Children’s Insurance, Other Health Programs Funded — For Now — In Bill

The bill passed by Congress in late December to keep most of the federal government funded for another month also provided a temporary reprieve to a number of health programs in danger of running out of money, most notably the Children’s Health Insurance Program, or CHIP.

Funding for CHIP technically expired Oct. 1. States have been operating their programs with leftover funds provided by the Department of Health and Human Services since then. But nearly half of the states were projected to run out of money entirely by the end of January, putting health coverage for nearly 2 million children at risk by that point.

The funding provided by Congress for CHIP — $2.85 billion — is for six months, but it is back-dated to Oct. 1, so it will run out at the end of March 2018. The program covers 9 million children across the country.

This week, Alabama announced it would curtail enrollment and renewals starting Jan. 1, and start disenrolling children currently in the program Feb. 1. On Friday, the state posted a notice on its website that those plans were now canceled. Several other states, including Colorado, Virginia and Utah, have begun the process of notifying families that their coverage could end unless Congress acts.

The funding bill also provided a temporary reprieve for a raft of other health programs that were running out of money, most notably the nation’s community health centers, which provide basic primary care to 27 million Americans. Many centers are already freezing hiring, laying off staff and closing sites due to the uncertain funding stream from Washington.

Other health programs that were set to expire but have been funded, for now, include the National Health Service Corps, which places health practitioners in medically underserved areas, and the teaching health centers program, which trains medical residents in community health centers.

Backers of CHIP complain that short-term funding fixes are disruptive to the program.

“By failing to extend long-term funding for the Children’s Health Insurance Program, Congress falls far short of the reassurance and relief families deserve,” said a statement from the American Academy of Pediatrics.

A coalition of children’s groups, including the Children’s Defense Fund and the March of Dimes, agreed, saying the short-term funding “only causes more chaos and confusion on the ground.”

Both Republicans and Democrats strongly support CHIP, which was created in a 1997 budget bill. What they disagree on is whether its funding — expected to be roughly $8 billion over the next 10 years — should be paid for by cutting other health programs. The House in November passed a five-year renewal that would finance CHIP primarily by reducing the Affordable Care Act’s Prevention and Public Health Fund and by raising some people’s Medicare premiums. Democrats question why CHIP needs to have its funding offset while Republicans are adding $1.4 trillion to the deficit through their tax cut bill.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation. Article by Julie Rovner, jrovner@kff.org, @jrovner

Posted in: CHIP

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Legislative Update: What Happened This Week in Washington…

Legislative Update: What Happened This Week in Washington…

From President Trump’s new tax plan to renewed funding for the Children’s Health Insurance Program to former President Obama’s Independent Payment Advisory Board, health care has been at the center of a lot of discussions this week on Capitol Hill.

Vote Expected Today for CHIP — The House is expected to vote today to pass legislation to refund Children’s Health Insurance Program and send federal funds to community health centers. However, questions remain about how to pay for the funding efforts. The original funding legislation for CHIP expired a month ago leaving state programs scrambling to extending their budgets to cover millions of covered children. It’s expected that the bill will face party opposition in the Senate. While both parties have agreed to renew CHIP, how to pay for the program remains the sticking point.

New Tax Plan Proposed — The proposal repeals the student loan interest deduction — a policy that helped more than 12 million students with education loans save up to $2,500 on their tax bills in 2015. Taxpayers aren’t required to itemize their deductions to claim it, but it’s available to anyone paying interest on either private or public student loans and makes less than $80,000 in a year. Many of those student loan holders are recent medical school graduates, who make a median $54,600 in their first year of residency, according to the Association of American Medical Colleges.

No More IPAB? — The House voted Thursday to abolish the Independent Payment Advisory Board (IPAB), a federal panel that was intended to find ways to curb Medicare spending with little Congressional oversight. It was a creation of the ACA, yet the IPAB’s presidentially-appointed members were never named. The bill now moves to the Senate where Republicans may have difficulty finding the necessary votes to pass it as a stand-alone bill before the end of the year.

Posted in: Advocacy

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Flu Shots Recommended for Those 6 Months of Age and Older

Flu Shots Recommended for Those 6 Months of Age and Older

The Alabama Department of Public Health encourages annual vaccination of all persons 6 months of age and older against influenza. One major change for the 2016-2017 season is that children and adults should receive a flu shot instead of nasal spray vaccine. This national recommendation was made because the nasal spray vaccine did not work well for the past three flu seasons.

“It is important for parents to protect their children and themselves by taking flu shots. My advice as a physician is to immunize all eligible family members,” Assistant State Health Officer Dr. Karen Landers said. “The consequences of influenza are worse in certain age groups, both young and old. An annual flu vaccine is the first and most important step in protecting individuals and the community against this serious disease.”

Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people 65 years and older.

“Flu season” in the United States can begin as early as October and end as late as May. During this time, flu viruses are circulating at higher rates. A person with the flu may have some or all of these symptoms: fever, cough, sore throat, runny or stuffy nose, headache, muscle aches and often extreme fatigue.

An annual seasonal flu vaccine is the best way to reduce the chances of getting flu and spreading it to others. Vaccination can reduce the risk of influenza-associated hospitalizations for children and adults. It is also associated with a lowered risk of hospitalizations for people with chronic health conditions including heart disease, diabetes and chronic lung disease. Vaccination also helps protect women during and after pregnancy.

In addition to immunization, the public is reminded to follow basic infection control measures to help prevent the spread of the flu. These include covering the mouth and nose with a tissue or cloth when coughing and sneezing, washing hands frequently, and staying at home when sick.

Contact your private physician or your local county health department for a flu clinic schedule. For more information, contact the ADPH Immunization Division at (334) 206-5023 or toll-free at 800-469-4599.

Posted in: Health

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Reading Gives You Wings with Marsha Raulerson, M.D.

Reading Gives You Wings with Marsha Raulerson, M.D.

BREWTON — According to Dr. Seuss in I Can Read with My Eyes Shut!, “The more that you read, the more things you will know. The more you learn, the more places you’ll go.” That’s a philosophy Brewton pediatrician Marsha Raulerson can easily get behind.

For more than 30 years, Dr. Raulerson has celebrated her young patients and encouraged their sense of adventure through reading by providing them with new books during their visits to her clinic. What began as the STARS program, or Steps to Achieve Reading Success, has for the past 20 years been affiliated with the National Reach Out and Read Program. Ten years ago, Dr. Raulerson, working with Polly McClure, launched the Alabama Chapter, American Academy of Pediatrics’ Reach Out and Read Alabama, that gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together.

“We’ve given out truckloads of books to our patients,” Dr. Raulerson said. “I give a book to every child for every visit, no matter what the age of the child. My community probably contributes about $10,000 a year so we can buy new books because every patient can have a new book.”

In fact, no child who visits Dr. Raulerson’s clinic leaves empty handed. The books she chooses for her patients are not only age appropriate, but also story appropriate to each patient’s particular situation. The majority of her patients have special needs, and each book is intended to give her patients hope.

“I was a reading specialist before I went to medical school, and I would give books to my patients when I was a resident at the University of Florida. I’ve been giving books away since 1978, so my whole career, really. My feeling is that if you can read, you can do anything. I tell my patients that I majored in English in college, not science or math. But, when I went to medical school and had to take biology and chemistry, I could never have done that without the ability to read. If you can read, you can do anything you want!”

Dr. Raulerson laughed when she first realized how long she had been practicing in Brewton, and how many patients had come through her clinic. She shook her head and smiled an easy smile when she admitted that it didn’t initially dawn on her just how many generations of patients she had treated.

“I have grand-patients!” she laughed! “I have a lot of families of three generations of patients, and I remember them all. All my patients are so special to me, and they’ve all received so many books from the clinic. Now, when they tell me that those books helped to create a special bond with their children and grandchildren, that’s heartwarming.”

Given her years of advocacy for children, it’s difficult to imagine the landscape of medicine in Alabama without Dr. Raulerson, but she in fact very nearly did not get accepted into medical school. A native of Jacksonville, Fla., she took her qualifying exams for her doctorate when she ultimately settled on medical school. While she said she felt she was always meant to be a medical doctor, one person sealed the deal for her. Her name was Robbie.

Dr. Raulerson taught school to help put her husband through medical school, and then her husband was drafted and sent to Vietnam. While there, the Raulersons decided to adopt a Vietnamese child. When her husband found the youngest female child in the nursery of an orphanage, he knew this was their child. She was only a few weeks old. The Catholic priest agreed to the adoption to the Baptist couple, and Dr. Raulerson flew to Tokyo to meet her daughter, Robbie.

When Dr. Raulerson got home with Robbie, she was 5 months old and weighed only 8 lbs., was malnourished and very ill. She knew exactly what to do to take care of her daughter, but if any doubt was left as to whether she could be a physician, she wouldn’t doubt much longer. Dr. Raulerson said when she began applying to medical school, she knew the odds would not be in her favor. It was a time when there were not many women in the medical field, and she had a family. Every school she applied to turned her down, except one.

“I was accepted at Emory because of Robbie. They had a different way of interviewing at Emory. They would interview three applicants sitting at a long table. Each applicant was asked what was an event in your life that was really important. There was a football player at the end of the table that talked about being a quarterback. The other girl at the table talked about being homecoming queen. Then they asked me,” Dr. Raulerson paused. The story hanging in her throat fighting to get free. “I told them about when I saw my daughter for the first time. And, I got a telegram that night admitting me to Emory.”

Ironically, Dr. Raulerson transferred to one of the schools that initially rejected her application. Dr. Raulerson’s husband was already a standout fellow at the University of Florida, and his department petitioned the admissions committee to consider an applicant from Emory. She still laughs when she tells the story of being admitted to a school that initially rejected her because she had a family.

Many in Alabama haven’t had the pleasure of meeting this woman who loves to laugh and read to her patients. But after her work with the #IAmMedicaid social media campaign this spring, more people in the state definitely know her name. She estimates between 70 and 80 percent of her patients are Alabama Medicaid recipients, and many of the children in the campaign are her patients. In the end, BP oil money was partially used to reinstate the physician cut that was implemented on Aug. 1 and to shore up the embattled Medicaid budget. Still, according to Dr. Raulerson, it won’t be enough.

“That campaign had to work. It had no choice BUT to work,” she said. “Many of my patients’ families can’t pay their bills. We don’t have enough doctors now, so what happens when we can’t fund the ones who choose to stay? The system is broken.”

During the Regular and Special Legislative Sessions, Dr. Raulerson’s editorials about the importance of fully funding Alabama Medicaid appeared in many of the state’s newspapers. Although the Alabama Legislature is not in session today, there is still work that can, and should, be done, according to Dr. Raulerson.

Perhaps it’s because of her and her husband’s early struggles with starting their own family, or seeing so many of their patients live below the poverty level in Escambia County. Either way, as long as Dr. Raulerson can string together her outspoken words, the children of Alabama will always have another advocate.

“I’m doing a lot more writing now,” she explained. “I feel like I have to. An article I wrote in 1997 about the importance of fully funding Medicaid is just as important today as it was 20 years ago. Nothing has really changed in all that time other than the number of our patients on Medicaid. Something has to change. We have to change. We have to choose to support our kids.”

Dr. Raulerson is a past president of the Medical Association of the State of Alabama, the Alabama Chapter, American Academy of Pediatrics, and VOICES for Alabama’s Children. She is a board member of The Children’s First Foundation.

Posted in: Physicians Giving Back

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