Caroline Hagan, MS 1Debra McGaha, Occupational Health nurse

What You Need to Know About the Flu

Influenza activity has been increasing in Louisiana and across the country. Local activity has markedly increased this past week. LSU Health Shreveport faculty members have found through the University Health Diagnostic Virology Laboratory that 16% of respiratory specimens submitted this past week from patients were positive for influenza. As is being seen in the rest of the country, the majority have been influenza A H3N2.

If you have not received the influenza vaccine and are eligible, you should be immunized as soon as possible. It takes about one to two weeks following vaccine administration to gain immunity.

For many, the flu is mainly inconvenient and uncomfortable, but it should be taken seriously—thousands of Americans die from it each year and hundreds of thousands are hospitalized.

One of the biggest myths out there is that the flu shot can give you the flu. It is impossible. A small group of people may experience mild side effects that they mistake for the flu. Or, some people will have already been infected with the flu or a similar virus and symptoms will coincide with getting the vaccine.

The flu shot is not completely effective but it’s the best tool we have to prevent it. Washing your hands often and thoroughly is also recommended, as is good cough hygiene (sneezing or coughing into a tissue or your upper arm elbow–not your hand).

If an adult or child develops flu-like symptoms the person’s doctor should be contacted. Based on the age of the person, how severe the symptoms are, and whether the person has a medical condition which increases the chance that they will suffer complications due to influenza, the person’s physician will decide whether treatment with an antiviral medication is needed. The medication works best when given within 2 days of when symptoms begin. In addition, people with influenza should drink plenty of fluids and rest.

People at high risk for complications of influenza include: children younger than 2 years old, adults 65 years and older, pregnant women, persons with chronic medical conditions of the lungs (including asthma), heart, liver or kidneys; persons with hematological disorders (including sickle cell disease), persons with metabolic disorders (including diabetes), persons with neurologic conditions, muscular problems or spinal cord injury; persons with immunosuppression, American Indians/Alaska Natives, persons who are morbidly obese and residents of nursing homes and other chronic care facilities.

The Centers for Disease Control & Prevention has more information on the flu and flu vaccine.

Scale with tape measure bow

Treating Obesity

You don’t have to be a medical expert to know that obesity is a huge problem in Louisiana and across the country. Carrying extra weight has many health implications. In counseling patients and teaching others how to broach the subject, I’ve discovered that it’s hard sometimes to discern weight loss facts from fiction.

Here are some common ones—see if you can call tell the difference.

1. Walking one mile per day and maintaining your current diet will net a 50 lb weight loss over 5 years.

FICTION- You will only lose about 10 lbs.

Popular apps like Lose It and MyFitnessPal use the 3500kcal rule to estimate caloric expenditure.  The amount of calories varies by the individual and the intensity of the activity.

2. Shakes and other meal replacements promote greater weight loss.

FACT- But for them to be effective, they have to replace two meals a day.   There is good evidence in the literature to support this.  Meal replacement options vary from protein shakes like Ideal Protein to prepackaged options like Medifast.  In the end, they all limit caloric intake.

3. Setting realistic weight loss goals is important because otherwise patients will become frustrated and lose less weight.

FICTION- Setting ambitious weight loss goals has been discouraged by some in the past with the thinking that more attainable goals will yield better results.  There are no studies to support this.  Any weight loss goal should be encouraged, both big or small.

4. Slow gradual weight loss is associated with better long term outcomes.

FICTION- Any weight loss is going to be good.   The rate of weight loss does not affect the overall efficacy of the program.  The minimum weight loss in an obese person that is limiting calories by 500-1000 per day from normal eating patterns should be 1-2 pounds per week.

5. Sexual activity burns 100-300 calories per round.

FICTION – The average bout of sexual intercourse is only 6 minutes according to the New England Journal of Medicine.  That type of physical activity burns about 21 calories in a 154 pound man.  Sitting on the couch for the same 6 minutes would have burned about 7 calories, or only a 14 calorie difference.

6. Physical activity and exercise promote weight loss maintenance.

FACT – Exercise has been proven to help with weight loss maintenance and can even be relied on to lose weight without dieting.  However, the doses of exercise needed to lose weight without changing eating patterns is substantial and often unattainable for most people.

7. Breastfeeding your child is a protective factor for the baby’s future development of obesity.

FICTION – Breastfeeding has a lot of benefits, but this isn’t one of them. There’s no data to show that a breastfeed baby is less likely to be obese.

8. Diet readiness (a patient’s motivation) is important in predicting success when the patient starts a weight loss program.

FICTION: Degree of motivation is not linked to success; the fact that the patient has showed up is what is important.

iStock_000015521410Small

Stopping the Revolving Door of COPD Readmissions

Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem among both women and men. In fact, the World Health Organization predicts it may be the fifth leading cause of death in the world by 2020 and jump to third by 2030.

It may be hard for some to grasp what exactly COPD is—and for good reason. COPD is not one single disease but a general description of chronic airflow limitations. You may be familiar with “emphysema” or “chronic bronchitis.” Those terms are no longer used as a diagnosis and now fall under the COPD umbrella.

Smoking is what most people associate with COPD, but it can be caused by other factors too like childhood respiratory infections, dust & chemicals, genetics and air pollution.

Big changes to COPD maintenance went into effect earlier this month. Medicare will now hold physicians and hospitals accountable for the readmission of patients with COPD within 30 days post discharge. Doctors and hospitals now have another incentive to prevent readmissions.

Let’s look at how things stand now: 

  • 20-30% of COPD admissions are readmitted in 30 days
  • 76% of these are unnecessary
  • 40% receive less than ideal care
  • 50% receive inappropriate care
  • Some readmissions are not due to COPD
  • Will see more patients with COPD due to the Affordable Care Act
  • Many patients go home with incomplete recovery

We have an opportunity to look at what works and implement it.

Having a COPD team made up of physicians, home health, respiratory therapists, occupational therapists, physical therapists and nurses to discuss post-hospital care is crucial and proven effective. Ensuring that the patient understands the instructions on oxygen therapy or other at-home therapies will also lead to better outcomes. It goes without saying that smoking cessation should be a priority if the patient still lights up.

There should be telephone calls to patients a few days after hospital release to make sure they are doing well and to see if they have any questions. Within two weeks, patients should also come in for a follow- up appointment.

Treating COPD should no longer be an isolated relationship between a patient and a doctor. By synchronizing efforts among all health care professionals, patients will fare better causing hospital readmissions to decline.

 

 

SONY DSC

Babies, Sleep & Safety

It’s a taboo topic among parents of young kids; many people are doing it but not many people talk about it. I’m referring to co-sleeping, or having a child sleep in the bed with his or her parents. The baby’s safety, sleep for exhausted parents, comfort for babies and convenience for breastfeeding moms all come into play.

First, let’s take a look at how common co-sleeping is and why it is so popular despite its negative stigma.

It is thought that as many as 45% of families co-sleep. The prevalence is much higher among African-Americans (50 to 70%), as well as in Asian and Indian cultures.  Breastfeeding mothers are three times more likely to create a family bed (another expression used for co-sleeping).

Proponents say that it encourages breastfeeding, babies seem to sleep better, sleep cycles are more in synch and it has a calming effect on the infant. The effects may not just be immediate, according to some. A retrospective study showed that male college students who co-slept as children had higher self-esteem and reported less anxiety in general.

At the other end of the spectrum are the concerns regarding the danger of co-sleeping. It has even been compared in popular media to putting a knife in the bed with a baby.

The US Consumer Product Safety Commission, among many other groups, says do not place infants in adult beds. Period. And there is ample evidence to back up their stance, starting with concern for risk of suffocation and strangulation and increase in the chance for SIDs (sudden infant death syndrome).

Between 1990 and 1997, there were 515 deaths linked to sleep in adult beds, most in babies under three months of age. Parental smoking, drug and alcohol use and obesity increase the risk of death.

So, parents face a conundrum:  During the daytime, you are supposed to provide support, security and encouragement while accommodating the individual needs of children, but at night, you should put children in dark rooms alone and let them “cry it out?” All are just trying to navigate a way for everyone to get some sleep—safely.

A compromise for exhausted parents may be to keep your baby in the same room but in a bassinet or crib for up to the first year of his or her life. In fact, “room sharing” without bed sharing can decrease the rate of SIDS by 50% and does make breastfeeding more convenient in those early months (also combatting SIDS).

For more information from the American Academy of Pediatrics on babies and safe sleeping, visit their website.

 

Mother and son reading

A Prescription to Read

The American Academy of Pediatrics (AAP) has come out strong in support of reading to kids, calling early literacy promotion an “essential component of primary care pediatric practice.”

In a June 2014 policy statement, the AAP recommends that all pediatricians advise families that reading aloud and talking about pictures and words with their young children has many benefits—increased language and vocabulary; reading readiness skills; enhanced brain development; and positive parent-child relationships.  This means that parents should be talking and reading to their infants and toddlers even before children can talk.

As an educator with a background in reading, I have preached the importance of a language rich environment for infants and young children for years.  I worked for 14 years with the Louisiana Department of Education providing instructional assistance to classroom teachers of young children with delays.  More recently, I developed and supervised the Early Head Start program for high risk, low income children, birth to three, and their families in Caddo Parish.

When I supervised the Early Head Start program, two concepts provided a foundation for our program:

1)      “It’s all about relationships.”  We sought to promote the strong emotional bond between parent and child; to ensure positive relationships between the teachers and young students in our program; and to develop partnerships in the community in order to help our children and families succeed.

2)      “Parents are the first and most important teachers of their children.”  Our Early Head Start team provided quality center-based, year-round programming for our students, but we knew that the families were the key to the continued and future successes of Early Head Start students.

The AAP statement also stresses the relationship between child and parent, of the need to teach parents how best to support their children’s learning; and the policy encourages community partnerships—all directed toward promotion of shared reading experiences in the early childhood years.

Evidence Behind the Problem

The position of the AAP, and of early childhood programs for at-risk children, is based on evidence-based research from the field of early education.  Betty Hart and Todd R. Risley’s research in the 1990’s found that children, between birth and age four, from low income homes hear much less talk (a restricted number and type of words) compared with children from middle income and higher literacy homes.  The language the lower income children hear is too often directive language (“No,” “Stop that,” “Hush).”   The low-income child also experiences fewer storybook routines.

Thus, the researchers calculated that by age four, children of poverty may have been exposed to 13 Million fewer words than children from working class families and 30 Million fewer words than children from language-rich, higher income homes.  More recently, the 2011-2012 National Survey of Children’s Health found that only 60% of American children from birth to 5 years of age whose families make 400% of poverty level were read to daily, suggesting that many middle income young children also lack a language rich, print rich environment. Today many parents feel pressed for time and have come to rely on electronic media to entertain their children.

What Parents, Pediatricians Can Do

Pediatricians are in a unique position to promote the value of early literacy to parents and to demonstrate appropriate methods of shared storybook reading.  Techniques to enhance the reading experience with young children can be modeled for families in the pediatric health setting.  Adults may start out reading or singing nursery rhymes or simple songs to infants.  As the baby gets older, the adult points to pictures in simple books and names objects for babies.  Older infants will eventually point to pictures when asked and attempt to imitate the parent.  The child will start to enjoy hearing the parent read a short predictable book or talk about the pictures in a familiar book.

However, young children may lose interest fairly quickly.  Pediatric staff should emphasize to parents that this is normal and should be accepted by the parents.  Reading with Mom, Dad, Grandma or Grandpa should first and foremost be a pleasurable experience, creating a warm bond of trust and comfort between child and adult.

The Five R’s

This AAP early literacy policy statement echoes an earlier AAP technical report on “School Readiness” in the promotion of the 5 R’s of early education:

  • Reading together is encouraged as a daily fun family activity
  • Rhyming, playing, talking, singing and cuddling together throughout the day promotes language development, as well as strong social-emotional bonds.
  • Routines are important to young children–meals and bedtimes–because it makes their lives more predictable and it is easier for children to comprehend and know what is expected of them.  This is why many children with problem behaviors rarely exhibit extreme behavioral issues in good early childhood classrooms.  Once the child is enrolled in a structured, nurturing, and developmentally appropriate learning environment, he adjusts to and often welcomes the daily consistency.  Moreover, experienced caregivers recognize that a certain amount of boundary testing is age appropriate and is a child’s way of asserting independence.
  • Rewards for successes are important—recognition for the child’s making honest efforts toward common, age-appropriate goals like helping or kindness to others.  Children love praise from the important adults in their lives.  Praise should be specific, an acknowledgement that the child’s efforts are recognized.  “You put your toys in on the shelf.  Thank you for helping to keep your room clean and safe.  I don’t want anyone to trip and fall over a toy.”  “You let your sister ride your tricycle.  That was a kind thing to do.”
  • Relationships that are constant, consistent, positive, and purposeful lay the foundation for healthy early brain development and learning.

Resources

Pediatric offices are urged to identify economic ways to provide developmentally, culturally and linguistically appropriate books at well child visits for high-risk, low-income children.  Displaying colorful posters, provision of simple written materials and sharing information about library programs and services is also helpful in getting the word out to parents.

The AAP recommends that pediatric providers partner with other child advocates to develop and support policies and programs that promote the goals described in the early literacy policy statement.

The Reach Out and Read program at LSUHSC, started in 1998, promotes early literacy by making books a routine part of pediatric primary care.  Between 6,000 and 7,000 low-income children receive a book at each well-child visit from 6 months to 5 years of age.  A volunteer reads to children once a month in the well-child waiting room.

Another source of free books for young children is Dolly Parton’s Imagination Library, currently available to families in select zip codes (71103, 71109, 71106, 71064, 71111) in Shreveport and Bossier thanks to sponsorship by United Way of Northwest Louisiana.  Parents sign up on-line for their children to receive free books monthly from birth to age five.

The AAP provides a literacy toolkit for pediatric providers, educators and parents.

Woman walking trail

A Leg Up on Varicose Veins

Summer is prime time for breaking out shorts, skirts, dresses and bathing suits. It can also be a time when those with varicose veins most wonder where they came from and how to prevent or minimize their appearance.

Where do varicose veins come from?

Veins carry oxygen-depleted blood from the body back to the heart. One-way valves within normal veins help combat gravity’s effect on blood flow – blood pooling in your feet – and maintain one-way flow back to the heart. Your calf muscles also help return blood to the heart by squeezing the leg veins as you walk.

When venous valves are damaged, blood pools in your legs. This excess pooling of blood then causes increased pressure leading to even more valve damage. It quickly turns into a vicious cycle of vein damage. As vein disease worsens, damage to vein valves can lead to skin and tissue changes (thickening and discoloration) and in the most severe cases ulcers.

Are my veins varicose veins?

Vein disease is very common, but not all people with visible veins have varicose veins.  True varicose veins are larger and bulge out when standing.   Other types of visible vein disease include smaller reticular veins which are blue-ish purple and typically do not bulge out as much as true varicose veins.  Even smaller are telangiectasias or spider veins. These are bright red or purple and are very near the surface of the skin.  They are less than 1 mm in diameter and do not bulge out of the skin.

A common misconception is that people with varicose veins are only bothered by their appearance.  In some cases, they can actually be painful and bothersome. Symptoms may include dull aching pain, heaviness, swelling, restless legs at night, and itching or burning.

Reticular veins and spider veins typically do not cause symptoms unless they are associated with other vein disease and are considered to be cosmetic problems.

Who gets varicose veins?

Varicose veins are very common, but there are factors that increase your chances to develop them. Some are almost universal: increasing age, family history, smoking, and sedentary lifestyle. Other risk factors are more specific to venous disease: previous blood clots, history of injury, pregnancy, and wearing high heels (which prevents the calf muscles from squeezing the leg veins normally during walking).

What can I do to prevent varicose veins?

  • Leg Elevation:
    • Elevate your legs when sitting or lying down.  The ideal position to prevent pooling of blood in the lower legs is to elevate the legs higher than the heart.
  • Compression stockings:
    • Most people think of their great-grandma’s stockings when they think about compression stockings, but now many companies offer an array of styles and colors to match your lifestyle and needs.
    • Compression stockings are not the same as TED hose.  True compression stockings should have the amount of compression printed on the package as a gradient of pressure.  (e.g. 15-20mmHg, 20-30mmHg, etc.)  If you are wearing compression stockings to prevent development of varicose veins, knee high stockings at the lowest amount of pressure are probably sufficient.
    • A surgical supply store should be able to measure your legs to make sure you get the right size stockings.  If you get swelling in your legs, be sure to be measured for your compression stockings at the beginning of the day BEFORE your legs are swollen.

What if I already have varicose veins?  What treatments are available?

Treatment of vein disease will depend on type, severity, and cause. Many patients can be managed by wearing properly fitting compression stockings.  Some patients may require surgical removal of the offending vein. However, advancement in technology has allowed some patients to take advantage of minimally invasive treatments which require fewer, smaller or no incisions.

Radiofrequency and laser ablation are used in the larger varicose veins and deliver focused energy through a special catheter inserted into the abnormal vein. These treatments cause the vein to warm and collapse.

For smaller veins, sclerotherapy is another treatment option. A medication is injected into the vein and causes irritation to the vein. Compression therapy then allows the vein to scar closed and decreases the unsightly appearance.

Very small veins like telangiectasias, may allow for laser treatment. The high powered focused light heats and damages the spider vein. Though laser seems like an easy enough solution, there are considerations and limitations involved with laser treatment – skin pigmentation, size and depth of the vein, etc. Not everyone will be a candidate and there are potential complication as with any procedure.

Talk to your doctor if your veins bother you – physically or cosmetically. They will be able to give you the best information as to what will work best for YOU and your veins.

For more information on venous disorders visit the American Venous Forum’s Handbook on Venous Disorders.

iStock_000010919339Small

To Induce or Not to Induce?

Over a year before actually having a baby, I stuffed a pillow under my shirt and pleaded to several OB/GYN residents for an induction. The exercise, during which I was an actor and supposedly 38 weeks pregnant, was intended to give the residents practice in saying no to expectant moms who are pushing for their babies to arrive before 39 weeks for a number of non-medical reasons.

So I entered pregnancy not knowing much about what to expect except that inductions before 39 weeks would not happen without medical cause. The State of Louisiana and professional groups like the American College of Obstetrics & Gynecology and the March of Dimes all back the “39 Week Initiative” for good reason—it’s best for babies.

The efforts seem to be paying off. Yesterday, the CDC’s National Center for Health Statistics came out with a report showing that for the first time in many years, the rate of inductions is declining–particularly at 38 weeks.  Louisiana saw an 8% decrease between 2006 and 2012 in inductions of single babies.

OB/GYN Assistant Professor Danielle Cooper, MD, says that the report is good news across the board, noting that “term” includes a range of dates between 37 and 42 weeks pregnant.

“Infants change, mature and develop exponentially in a very short time, she said. “The differences you see as a parent in the sleeping, eating and interacting habits of a newborn versus a six week old are astounding.  Why wouldn’t those same changes also be occurring in the womb?  There is good evidence that infants less than 39 weeks gestational age have a greater morbidity than their 39+week counterparts.  As an OB it is our job to protect both the mother and her unborn child from harm, so it’s refreshing to see that in Louisiana we are protecting both our patients.”

Induction after 39 weeks was on my mind a lot throughout the last trimester of pregnancy. My thoughts on the subject ranged from pro-induction for out of town family to be there and to maximize my husband’s time off to leaning toward letting nature take its course. I ultimately decided that I was going to make it to my due date and then figure it out. Luckily, my daughter decided to come on her own just shy of 39 weeks.

Many of my friends opt for inductions right at 39 weeks. Those same professional groups don’t take a position against this, so is there anything wrong with it?

Back to Dr. Cooper: “There is no scientific evidence that supports or refutes an elective induction at 39 weeks. The process and release of the chemical signal from baby to mom that initiates labor is poorly understood, hence our inability to stop preterm labor.  There are risks involved with the artificial initiation of labor, but there are also risks involved with continuing pregnancy and even going beyond your due date.”

In conclusion, Dr. Cooper says there are benefits to inductions as well as benefits to waiting for spontaneous labor.  “I believe if you present those to the patient, she and her doctor can come to a decision that is best for mom and baby.”

An airplane flying in the blue sky

Flying & Your Health

About 2.7 billion people fly annually. Most are concerned more with the logistics of it all–flight schedules, costs, packing–and don’t think about how air travel may affect their health. Air health emergencies are uncommon, but air travel is not without risks.

As a doctor, screening patients for medical fitness before flying generally entails looking at the patient’s medical history and finding out the length of flights(s) and experiences on past trips. Some physicians use if the patient can walk 50 yards or climb a flight of stairs as a rule of thumb.

So what exactly does a medical emergency look like? A New England Journal of Medicine study showed that there is one flight emergency per every 604 flights. Syncope or fainting was responsible for over a third of these cases, followed in popularity by respiratory symptoms (12.1%) and nausea/vomiting (9.5%). A doctor assisted 48% of the time, and the aircraft only had to be diverted 7.3%.  Of that, about a quarter were transported to the hospital.

Of course, air travel can affect you in ways that are not emergencies. Here’s a look at some conditions and how they may affect air travel:

  • Chronic Heart Failure: Studies show flying with well-managed CHF is okay. The length of the flight may matter in relation to how severe CHF is.
  • Pacemaker: Make sure to fly with the pacemaker’s identifying card. It is also recommended that you opt for a hand search rather than the x-ray machine when possible.
  • Seizures: Epilepsy in and of itself isn’t a limiting factor but do not fly if seizures are not well controlled.
  • Migraines: Air travel can trigger migraines. Eat well, stay hydrated and have your medication nearby if one does strike.
  • Respiratory Issues: Optimal humidity is about 40 to 70%, and humidity in air cabins ranges from 10 to 20%. This can trigger respiratory complaints in people with severe asthma and COPD.
  • Other: As many people can probably attest, flying can irritate the middle ear. It also can affect your GI tract.

A few other common health concerns with flying:

  • Surgery: In general, you should not travel within two weeks of having surgery. Your doctor may recommend a longer period depending on the type of surgery and your recovery.
  • Pregnancy: Women with an uncomplicated pregnancy should be cleared for travel. A note is generally needed from an OB if flying past the 36/37 week mark.
  • DVT (or blood clot): Flying, especially long flights, does increase risk of blood clots. In fact, travelers are 3.2 times more likely to get one than their healthy, non-flying peers. Walk around, drink lots of water, avoid alcohol/caffeine, don’t cross your legs and consider compression stockings—or at least loose clothing—to reduce your risk.
  • Medication: Talk to your doctor beforehand about adjusting the schedule of your medication if you’re crossing into another time zone.
  • Communicable Diseases: Most aircrafts recirculate up to 50% of cabin air, so risk of infection goes up on flights 8 hours or more. Luck may have something to do with it too. You are most likely to catch an infection from passengers seated within two rows. This is one area where perceived risk is likely greater than actual risk.

Talk to your doctor about any concerns, and safe travels!

Medical Costs

Doctor, How Much Will That Cost Me?

Imagine taking a flight across the country without knowing how much the fare will be until you land. That is by and large how our healthcare industry operates now—patients see a doctor, receive tests and then find out later (often much later) what the tab is. The landscape may be changing though—and with good reason.

Healthcare expenditures are outpacing the economy. Spending in 2011 came in at $2.7 trillion—14 times the amount in 1965. In another staggering statistic, a day spent as an inpatient in a US hospital is approximately $4,000, which is five times more than in other developed countries. The main reason for the difference is fiscal, not medical.

Patients need more “skin in the game,” but it’s often an uphill battle since hospitals don’t have to tell patients prices beforehand. Hospital costs vary widely. In the US, we have no uniform price schedule. Hospitals can set prices at any level they want. Patients’ out of pocket cost vary by setting, insurer, intervention, choice of pharmacy and radiology service.  Physicians often don’t know the costs of frequently performed procedures either.

Polls show that the majority of patients do want to speak with doctors about costs of treatment options, but less than 20 percent actually follow through. Should disclosing costs become as standard as disclosing side effects of treatments? Yes, but we have some work to do to get there.

Doctors don’t broach the topic oftentimes because they don’t have the time or training and are unprepared to answer the questions. In an ideal world, healthcare costs would be transparent to patients and physicians and every visit requiring further evaluation or treatment would include the question, “do you have concerns about the cost of treatment?”

In the meantime, you as a patient can be empowered to get a handle on expenses upfront. Don’t be afraid to ask your doctor or hospital about costs of medicine, tests and procedures.

Health Insurance (also known as health coverage or health benefits) can also be confusing. Most Americans (87%) have health insurance commonly through their employer and an increasing number of people are reliant on public insurance (36%). Currently there are hundreds of insurance policies that often vary for no reason. Health insurance needs to be simplified. Families need to more easily understand their choices, how to best use their coverage and exactly how much it will cost them.

Here are some common terms that will help you cut through some of the confusing lingo:

Premium – Amount you pay for health insurance (often monthly)

Deductible – Full price you pay for health care services before your plan pays anything (may differ with in network and out of network); Services not covered by plan, monthly premiums & co-pays not counted toward deductible

Co-Pay – A fixed amount you pay for a covered service when you receive care

Co-Insurance (cost-sharing) – Fixed percentage of total costs (may differ with out-of-network providers)

Covered Services – Goods/services insurance will help pay for as outlined in your plan

Out-of-Pocket Expenses – The total after co-pays, deductible and co- insurance costs

Out-of-Pocket Maximum – The most you pay during a policy period before your health insurance picks up 100% of the cost

Federal Poverty Level (FPL) – Measure of income level as set by the Federal Government

In-network/Out of network – In-network providers /hospitals contracted by insurance companies to offer lower rates than out-of-network providers

Boy Holding Blue Iced Puzzle Piece Cookie

The Latest in Autism Research

One in 68 kids has autism, according to a recent release by the Centers for Disease Control. This startling statistic shows us that we will all be touched by this condition in some way—as parents, friends, family members or co-workers.  Below are some of the most exciting changes and research findings in the field of autism.

Did you know there is no more autism or Asperger’s Disorder?  That’s correct, it is now all considered to be part of an autistic spectrum disorder (ASD).

In May 2013, there was a major revision in the Diagnostic Statistical Manual of Mental Disorders (DSM-5) impacting the major way in which clinicians would diagnose autism.  First, the DSM-5 collapsed previously distinct autism subtypes – including autistic disorder and Asperger syndrome – into one unifying diagnosis of autistic spectrum disorder (ASD).  The diagnostic criteria symptoms also changed.

Did you know that ground breaking studies are beginning to examine the possible link between autism and environmental pollutants?

Historically, environmental studies have been underfunded.  In 2012, researchers at University of California’s MIND Institute reviewed previous research on pesticide exposure, brain development and ASD.  Researchers published findings in the Archives of General Psychiatry that supported a link between exposure to certain pesticides and an increase in the risk for autism.  They noted, however, that other variables, such as the timing of the exposure or the dose of the exposure, could impact risk and too little was known about these variables.  In a landmark study, researchers at the University of Southern California’s Keck School of Medicine published research associating exposure to high levels of air pollution during pregnancy and the first year of life with a three-fold increase in autism risk.

Did you know that advanced paternal age is a risk factor for ASD?

While we have failed to find the “one gene” that causes autism (it is believed that multiple genes are involved), recently scientists have shown that tiny genetic mutations may result in increased risk for autism.  In four papers published in the journal Nature, scientists sequenced the genomes of families with one child affected by autism.   Specifically, they scanned for tiny mutations in the active or protein coding part of the genome.  All people have some tiny mutations in their DNA and most prove harmless.  However, all four Nature studies indicated that such mutations were significantly more common in those with autism.  In addition, children of older fathers had significantly more tiny mutations in their DNA.   Those authors speculated that increased age may bring cumulative exposure to influences that produce gene changes in the father’s germ cells.  These genetic glitches could then end up in the child’s DNA.

Did you know that early intervention can actually alter brain activity?

Clinicians in the field of ASD have long supported and emphasized the importance of early intervention.  It was unclear, however, if behavioral intervention merely reduced autistic symptomatology or if it actually “treated” the disorder.  Could the early programming a child receives actually alter the brain biology that underlies the autistic spectrum disorder?  Of all the recent research finding, for those of us who work ‘in the trenches’ providing front line therapy, this is the most exciting.  An article published in the November issue of the Journal of the American Academy of Child & Adolescent Psychiatry demonstrated that early behavioral intervention for autism is associated with changes in brain function as well as positive changes in behavior.  Researchers looked at children who received services utilizing the Early Start Denver Model (ESDM), which is a program which incorporates Applied Behavioral Analysis training as well as interactive play between the child and their parents.  These children were compared to a group that received standard early intervention services available within their community. Both groups received 20 hours of weekly therapy for 2 years.  The ESDM group showed greater increases in IQ, language and adaptive behavior than children in the community intervention group.  Both groups were given noninvasive electroencephalography (EEG), and their responses to faces verses objects were studied.  For the ESDM group, their brain activity patterns were virtually identical to those of children without autism.  This more typical pattern of brain activity was associated with improved social behavior including better eye contact and social communication.  By contrast, the community intervention group showed greater brain activity when viewing objects than faces.  This finding has been found in previous research on individuals with ASD.

The American Academy of Pediatrics recommends two autism screenings for all children before 24 months at varying points in their development. Given the above mentioned prevalence rates, it is imperative that we have effective therapies to recommend to such families once their child has been identified.  The LSUHSC-S Children’s Center, located on the 1st floor of the Allied Health Building, is the only multidisciplinary treatment facility in the region providing comprehensive autistic spectrum evaluations to children as young as 24 months.