"Most distressingly," the people who need emergency care the most are the least likely to be getting it in time, Drs. Leora I. Horwitz and Elizabeth H. Bradley of Yale University School of Medicine in New Haven, Connecticut, say.

Over half of patients deemed to need emergency care — meaning they should see a doctor in 14 minutes or less — actually saw a physician in this time frame, Horwitz and Bradley found.

To investigate trends in wait times, the researchers looked at data representing nearly 540 million ED visits in the US between 1997 and 2006. They analyzed how often patients in each triage category were seen within the recommended time. "Triage," a term borrowed from military medicine, means ranking patients based on how soon they need to receive medical care.

"Emergent" patients must be seen within 14 minutes, while "urgent" patients require care in 15 to 60 minutes. "Semi-urgent" patients should receive care within two hours, while "non-urgent" patients can wait longer.

In 1997, the researchers found, 59 percent of emergent patients were seen within 14 minutes, compared to 48 percent in 2006. For urgent patients, the likelihood of being seen on time went from 84 percent in 1997 to 76 percent in 2006. Semi-urgent patients also were less likely to be seen in a timely fashion over time; 91 percent were seen within the recommended amount of time in 1997, but 85 percent were in 2006.

Hispanic patients and African-American patients were less likely to be seen in the recommended amount of time than whites, the researchers found, but whether or not a person had health insurance didn’t influence their likelihood of getting care on time.

In an editorial accompanying the study, Drs. Renee Y. Hsia and Jeffrey A. Tabas of the University of California, San Francisco, point out that the problem of ED wait times must be seen as a problem of the entire health care system.

"Most importantly, the ED is the sole true ’safety net’ of the health care system, where patients cannot be denied care," they add. While no one solution will solve the problem, they add, "health care reform offers some promise of help," while improving electronic health care information systems could also add efficiency.

"The problem is serious and worsening, and we must implement a variety of solutions in the areas of ED input, throughput, and output as well as broader health system reform," the editorialists say. "Otherwise our patients will remain waiting, waiting, waiting."

SOURCE: Archives of Internal Medicine, November 9, 2009.

http://www.reuters.com/article/healthNews/idUSTRE5A954C20091110

Asthma is a chronic disease of the airways that makes breathing difficult. Many things in the environment can trigger an attack, including air pollution, secondhand smoke, and pollen. Asthma affects one in 5 Americans and is on the rise. While there are no asthma-free cities, some are more challenging than others for people living with asthma. The Asthma and Allergy Foundation of America (AAFA), a nonprofit patient organization, has released their "2009 Asthma Capitals."  Here are the top 10. Click link at bottom for slideshow.

10. Little Rock, AR

9. Atlanta, GA

8. McAllen, TX

7. Knoxville, TN

6. Memphis, TN

5. Charlotte, NC

4. Chattanooga, TN

3. Birmingham, AL

2. Milwaukee, WI

1. St.Louis, MO

Asthma Pictures Slideshow: Images of the 10 Worst Asthma Cities

CDC 2009 H1N1 Flu | 2009 H1N1 U.S. Situation Update

Hidden Stashes of Fall Foliage – The New York Times > Escapes > Slide Show > Slide 1 of 14

You, of course, are the consumer. And you’re being directed to save your employer a lot of money — so much so that many employers are offering workers lucrative incentives to make the switch into a consumer-directed plan.

Should you bite? And if you don’t have a choice — General Electric, for example, is forcing 75,000 of its salaried employees in the United States to choose one of three consumer-driven options — how can you best navigate this new landscape?

via Patient Money – Making Sense of High-Deductible Health Plans – NYTimes.com.

WASHINGTON — The Food and Drug Administration announced plans Thursday to study the scope of problems connected with laser eye-correcting surgery, which include blurred vision and dry eyes.

The FDA says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following surgery.

Soda Taxes Not Making a Dent in U.S. Waistlines

Current state taxes and levies on soft drinks are slowing consumption, but not enough to curb the obesity epidemic in the United States, researchers say.

In an analysis of 16 years of data (1990 to 2006) on how various forms of soft drink taxation affected body mass index, researchers found that taxation has only a minor effect on BMI, which is a measurement based on weight and height. For example, a 1 percent tax increase causes a BMI decrease of 0.003 points — less than a tenth of a pound for a man of average height.

Tylenol May Weaken Infant Vaccines

Acetaminophen, the active ingredient in Tylenol, weakens infants’ immune responses to vaccines, a compelling new study suggests.

Infants often get a mild fever after getting vaccines. Some pediatricians routinely use acetaminophen to prevent vaccine-related fever.

But that’s not a good idea, finds an international research team led by Roman Prymula, MD, of the University of Defense, Czech Republic.

In a study looking at whether acetaminophen really prevents vaccine-related fever, Prymula and colleagues found that the common over-the-counter pain remedy dampens vaccine-induced immune responses.

It’s not yet clear whether other fever-reducing drugs, such as ibuprofen, have the same effect. But the researchers warn doctors and parents to try to avoid using acetaminophen, ibuprofen, or other fever-reducing drugs to prevent vaccine-related fever. And of course, aspirin should never be given to a child with fever.

Asthma Most Common Condition In Hospitalized Swine Flu Patients

An analysis in 10 states of people hospitalized with the pandemic strain of H1N1 influenza shows that asthma is by far the most common underlying condition associated with severe cases of the disease.

In children, other, much rarer chronic conditions, such as sickle cell anemia, cerebral palsy and muscular dystrophy, are also predisposing patients to life-threatening bouts of the virus, federal health officials said.

THE FACTS Old prescription habits apparently die hard.

Studies have suggested that most doctors say they would prescribe an antibiotic if a child with sinus symptoms also had green nasal discharge. The habit stems from the notion that green indicates a bacterial infection.

But other studies show that green is no more common in a bacterial infection than a viral one, for which antibiotics are ineffective.

In a definitive study from 1984, scientists put 142 children with green nasal discharge into groups, including one that was treated with antibiotics and another that received a placebo. They found that the drugs had no effect on “potentially pathogenic organisms” or on symptoms. About 35 percent of subjects treated with antibiotics showed improvement, compared with 31 percent in the placebo group. More recent studies have bolstered that conclusion.

According to the Centers for Disease Control and Prevention, when cold viruses infect the respiratory tract, the body makes clear mucus that helps wash away germs from the nose and sinuses. After about three days, the body’s immune cells fight back, changing the discharge to a white or yellow color. “As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes to a greenish color,” the agency says. “This is normal.”

The only time antibiotics are needed for a runny nose, experts say, is when the diagnosis is bacterial sinusitis.

THE BOTTOM LINE The color of nasal discharge should not dictate the medicine.

Really? – The Claim – With a Runny Nose, Green Calls for an Antibiotic – Question – NYTimes.com

• 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The 2009-10 influenza season officially begins October 4, 2009.

Now we know why they’ve stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.

Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.

But, overall, the leading bills and the President’s proposal are, like the dog that didn’t bark, more notable for what is missing.

Here are 13 problems with the current health care bills (partial list):

1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.

2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.

3. No restrictions on insurance denials of care that insurers don’t want to pay for. In case you missed it, the California Nurses Association/National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.

4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.

5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.

6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.

7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.

8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.

9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.

10. No definition of covered benefits.

11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn’t want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.

12. Long delay in implementation. Many reforms don’t go into effect until 2013.

13. Nothing changes in basic structure of the system; health care remains a privilege, not a right.

Read the entire article at: http://www.commondreams.org/view/2009/09/29-0