The Public Eye

Reports from the Bee's investigative team

June 23, 2011
New national, state statistics on the uninsured

Fresh data from the Centers for Disease Control shows 48.6 million Americans of all ages (16.0 percent of the population) lacking health insurance at the time of the survey in 2010. Also at that point in time 7.8 percent of children under 18 and 33.9 percent of young adults (19-25) were uninsured.

CDC researchers also crunched the 2010 numbers for the 20 largest states. The percentage of uninsured people ranged from 4.0 percent in Massachusetts to 26.1 percent in Arizona. California came in bit above the national average at 18.6 percent.

In 2010 60.2 percent of Americans had health insurance coverage provided by private (non-governmental) sources; 31.4 percent had coverage provided by government -- including Medicaid, Children's Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, Medicare (disability), and military plans. In California the private/public split was 56.1 and 28.8 percent, respectively.

June 14, 2011
Ambulance diversions impacting heart attack mortality

The practice of rerouting ambulances away from crowded emergency rooms is tied to higher mortality of heart attack victims. A new study published in the Journal of the American Medical Association estimates that frequent diversions are correlated to an increase in avoidable patient deaths.

ambulance.JPGThe number of emergency rooms has dropped in the past 20 years and hospitals now are often forced to temporarily divert ambulances when facilities are crowded with patients waiting for beds.

Researchers studied 14,000 elderly patients in four California counties and found a three percent difference in death rates (15 versus 18) between ERs that did not divert and those that diverted at least 12 hours out of the day.

They also warn that high ambulance rerouting is symptomatic of the bigger problem of providing care to a growing number of patients with finite medical resources.

In 2002 The Bee reported on efforts to reduce the chronic overcrowding that caused routine diversions at Sacramento-area hospitals at that time. See attached articles.

PHOTO CREDIT: A patient arrives by ambulance at Sutter General Hospital. 2002 Sacramento Bee photo by Dick Schmidt

June 1, 2011
Over one-third of California teens not getting gym classes at school

PE.JPGMore than 38 percent of the California's adolescent students (12-17) are not receiving any physical education at school -- despite state mandates. In addition only 42 percent of teens participate in PE on a daily basis, according to a study by the UCLA Center for Health Policy Research.

School-based PE add an average of 18 minutes of exercise per week to the overall physical activity needed to maintain good health. UCLA researchers found only 19 percent of state teens getting the 60 minutes of activity per day recommended by the U.S. Department of Health and Human Services.

Student participation physical education has been reduced -- if not cut completely -- at many schools due to budget cuts and various exemptions (such as making room for driver's training). The study suggests that PE class requirements be re-instituted for teens of all ages. (Participation tends to fall dramatically as students get older.)

PHOTO CREDIT: Sheldon High School students begin their PE class with calisthenics and stretching exercises in the school's main gymnasium. 1999 Sacramento Bee photo by Jay Mather

May 6, 2011
Food allergies costing nation half billion a year

Around one to two percent of U.S. adults and four to six percent of U.S. children suffer from allergic reactions of milk, eggs, peanuts and other foods. The resulting visits to hospitals, emergency rooms and doctors' offices, plus lost productivity, cost the nation a lot of money -- an estimated $500 million a year, according to a new study.

CDC researchers, writing in the Journal of Allergy and Clinical Immunology, say total medical costs associated with food allergies range from $225 to $307 million of which $45 million goes to emergency room visits. Non-medical costs, such as lost work days, are estimated at $115 to $203 million every year.

Another CDC study found that the number of children with food allergies increased 18 percent between 1997 and 2007. A helpful CDC brief on food allergies in young people lists symptoms and summarizes essential statistics.

April 27, 2011
Maternal mortality rising in California

Back in December this blog noted the steady increase in U.S. maternal mortality (pregnancy-related deaths) since dropping to its lowest point in 1986. Now the California Public Heath Department is reporting that the mortality rate in the state has almost doubled between 1999 and 2008 (8.0 to 14.0 deaths per 100,000 live births.

Maternal mortality is rare, but the rising rates are a warning sign of increasing health risk factors among women (obesity, hypertension, diabetes, etc.) and of problems with maternal health care.

The CDPH report found disparities in mortality related to race, income and education:

* The risk of maternal death was four times higher for African American women than for other groups in 2002-03 (46.1 deaths per 100,000 live births, compared to 12.8 for Hispanic women, 12.4 for White women, and 9.3 for Asian women).

* Low-income women in the state died at a higher rate than others. Fifty-seven percent of maternal deaths involved Medi-Cal recipients, though this group constituted only 45 percent of all women giving birth.

* Although women with less than a high school diploma constituted 11 percent of women who gave birth in the state, 31 percent of all maternal deaths occurred within this group.

April 20, 2011
California lags nation in "wireless" households

landline.JPGMore than a quarter (26.6 percent) of U.S. households use no landline telephones, relying solely on wireless (cell or mobile) phones. In addition, people in 15.9 percent of homes with landlines report that they use wireless phones for all or nearly all of their calls.

Those figures were compiled by the National Center for Health Statistics, which has been tracking telephone equipment preferences since 2007. Why does a federal health agency care what phone you use? Well it matters a lot to people who conduct health (and political) surveys, since up to recently these were directed only at people with wired phones, thereby missing a growing segment of the population. Consider that the percentage of wireless-only households has increased significantly in just four years, from 13.6 percent in Jan-June 2007 to 26.6 percent in Jan-June 2010.

Surprisingly, tech-savvy California in 2010 ranked low in terms of the proportion of U.S. adults living in wireless households. Arkansas was tops with 35.2 percent. Rhode Island was at the bottom with 12.8 percent. And the Golden State was 41st with 18.2 percent.

PHOTO CREDIT: Dorothy Hawkinson is one person who doesn't even have a cell phone. She holds her rotary dial, ivory with gold trim phone, she bought in 1981. 2009 Sacramento Bee photo by Paul Kitagaki.

April 7, 2011
Antimicrobial resistance is a growing health threat

Antibiotics and other medicines that fight bacterial, viral and fungal infections have saved a lot of lives since their introduction in the 1940s. But some bugs are becoming resistant to antimicrobial drugs making them increasingly ineffective. The threat is serious enough that international health officials made antimicrobial resistance the focus of the recent World Health Day.

According to the World Health Organization, some 440,000 cases of multidrug-resistant tuberculosis occur every year, killing at least 150,000 globally. Further, resistance to older generation antimalarial medicines in growing in countries battling the disease. And a high percentage of hospital-acquired infections are now caused by resistant bacteria, such as Staphylococcus aureus (MRSA). (More than 12,000 Californians die from hospital-borne infections annually.)

The Centers for Disease Control warns that overuse and inappropriate use of antimicrobials contributes to germ resistance, leading to undue medical complications and deaths. Patients can protect themselves by:

* Talking with your doctor about the best treatment for you or your child's illness.
* Not demanding antibiotics or other medications when a doctor says they are not needed.
* Not taking medications prescribed for someone else.
* Taking medications as directed.
* Not skipping doses of prescribed medicines.
* Not saving medicines for a future illness.

March 18, 2011
Survey: 22.4 percent obesity in Sacramento region

More than a fifth of adults are obese in almost all the metropolitan areas surveyed by Gallup in 2010. The survey company found that 177 of 188 MSAs have at least 20 percent of residents who are seriously overweight. Evansville, Ind. leads the way with 38.7 percent. Boulder, Colo. has the least with 12.9 percent. Sacramento is about average with 22.4 percent.

The obesity data is part of the Gallup-Healthways Well-Being Index, a collection of indicators that includes: diabetes, frequent exercise, frequent consumption of produce, city optimism, and the uninsured. There's also an overall well-being score which is calculated from "an average of six sub-indexes: life evaluation, physical health, emotional health, healthy behavior, work environment, and basic access."

In terms of overall well-being, Boulder leads again with a score of 73.7 in 2010. Bringing up the rear is Huntington-Ashland, W.Va. at 58.1. Sacramento lands in the top third of metropolitan areas with a score of 67.0.

You can easily see detailed health stats for each of the MSAs with Gallup's interactive tracking chart which has data from 2008 and 2009, as well as 2010.

March 14, 2011
Prescription drug costs rising faster than other health sectors

The cost of prescription drugs is increasing at a much faster rate than that of other medical services, according to the non-partisan Government Accountability Administration.

The GAO today released a report estimating that a "basket" of "100 commonly used prescription drugs increased at an average annual rate of 6.6 percent from 2006 through the first quarter of 2010 compared with a 3.8 percent average annual increase in the consumer price index for medical goods and service."

Escalating drug prices have significant implications for efforts to control the U.S. budget deficit, since the federal government spent $78 billion, or 31 percent, of the total $250 billion spent on prescription medicines in 2009.

March 9, 2011
Report: most nursing facilities employ employees with criminal backgrounds

Ninety-two percent of nursing facilities studied in a new federal report have employed at least one individual convicted of a crime. Nearly half of the facilities employed five or more people with at least one conviction.

U.S. Health and Human Services Department inspectors used FBI criminal history records to examine the backgrounds of workers at a sampling of Medicare-certified nursing facilities. Even though most states require some type of background check, HHS found that overall five percent of employees had at least one criminal conviction.

Most of these convictions--43.6 percent--involved crimes of property (burglary, shoplifting, A much smaller number--13.1 percent--were for crimes against persons (homicide, rape, assault, etc.). Most convictions--84 percent-- occurred prior to the start of employment at the nursing facility.

March 7, 2011
Report: hospital costs higher in northern California than in southern counties

Hospital stays in northern California tend to be higher than those in the southern half, according to a new analysis by the Los Angeles Times. Using data from the Office of Statewide Health Planning, the Times found that cost per patient per day was 56 percent greater in the north's largest counties than in the south's.

Leading the way were San Francisco and Santa Clara with an average of $7,300, followed by Contra Costa with $6,900. Sacramento is the fourth highest county at $6,700. In contrast, San Bernardino is the most economical at $3,900.

Times writers attribute the difference to greater consolidation and relative lack of competition in hospital services in the north. For example, Sutter Health, with its huge system of 24 hospitals, 500 doctors in 100 cities, is one of the big players which tends to negotiate higher reimbursements from insurance providers.

Back in April, a Bee investigation concluded that California hospitals overall "are charging insurance companies, and by extension their customers, billions of dollars for expenses not directly related to care. These include new hospital wings, new technology and services for the uninsured."

March 4, 2011
Third of U.S. adults have sleep problems

Can't sleep? You're not alone. A new Centers for Disease Control study estimates 50-70 million American adults get less than the recommended 7-9 hours a night.

Researchers asked nearly 75,000 people in 12 states about their sleep habits and found "48.0% reported snoring, 37.9% reported unintentionally falling asleep during the day at least 1 day in the preceding 30 days, and 4.7% reported nodding off or falling asleep while driving in the preceding 30 days.

Sleep issues vary by age group. Adults, 25-34, are most likely to not get enough sleep (39.4 percent) and to fall asleep at the wheel (7.2 percent). Snoring most affects those 55-64 (62.4 percent). Seniors over 65 are most likely to fall asleep during the day (44.6 percent).

Of the 12 states studied, Hawaii has the highest percentage of people who lack proper sleep (44.6 percent) and Minnesota, the lowest (27.6 percent). California is about average (34.5 percent).

Aside from difficulties with concentration and memory, the CDC warns that sleep problems are correlated with chronic diseases, mental disorders, health-risk behaviors, limitations of daily functioning, injury, and mortality.

The National Sleep Foundation provides helpful information on all aspects of sleep disorders and their treatment. 

February 22, 2011
Study: hearing loss a significant problem for the middle-aged

The relatively high prevalence of hearing loss among seniors is no surprise, but a new study published in the latest Archives of Otolaryngology indicates the problem is significant among middle-aged adults, 45-54.

Researchers tested the hearing of some 3,300 adults ranging in age from 21 to 84. Overall, 14.1 percent were found to have some level of impairment. According to the study, hearing loss tends to increase with age:

21-34 -- 2.9 percent
35-44 -- 6.4 percent
45-54 -- 10.9 percent
55-64 -- 25.1 percent
65-84 -- 42.7 percent

In addition to age, other correlates to hearing impairment include noisy employment environment, lower educational level, being male, ear surgery history and diminished blood vessel health.

February 16, 2011
Latest CDC annual report on the nation's health

The U.S. Department of Health and Human Services today released its 34th annual report to Congress on the nation's state of health. Health, United States, 2010: With Special Feature on Death and Dying is a large compendium of statistics on disease, mortality and medical care.

Among the report's highlights:

* Heart disease continued to be the leading cause of death in 2007, accounting for 25 percent of all deaths. Cancer followed closely behind with 23 percent.

* Between 2000 and 2007, life expectancy rose 1.3 years for males (to 75.4) and 1.1 years for females (to 80.4).

* The prevalence of obesity increased in all age groups over the past two decades. About 33 percent of adults over the age of 20 were obese in the period 2007-08.

* The percent of adults who smoke cigarettes has stayed flat at 21 percent for several years.

* Total visits to hospitals and doctors' offices increased from 861,000 in 1995 to 1.2 million in 2008. The number of visits per 100 persons rose from 329 to 405 over the same period.

* In 2007 health care spending accounted for 16 percent of U.S. Gross Domestic Product (compared to 11 percent in France). Between 1990 and 2008, per capita health expenditures rose $2,814 to $7,681 (in current dollars).

February 10, 2011
PPIC: slight majority of Californians support Obamacare

Californians support the national health care reform bill by a margin of 51 to 36 percent. That's one of the findings of a state survey of health-related issues by the Public Policy Institute of California.

PPIC also reports that overall 81 percent of Californians judged their own health as "good," "very good" or "excellent." But there are significant demographic differences in that perception. Respondents were more likely to rate their health as "fair" or "poor," if they are low income, have less education, lack health insurance or are a member of a minority group.

Those surveyed generally rated local health and medical services as "good" or "excellent." But when asked if local services struck the balance between treatment and prevention, 60 percent wanted more focus on prevention.

Read the full report here.

February 8, 2011
Smoking shown a lot in TV shows popular with teens

A study published yesterday in the Archives of Pediatrics and Adolescent Medicine finds substantial depictions of tobacco use in television programs with high teen viewership.

Researchers examined more than 70 episodes of prime-time shows like Family Guy and Gossip Girl and found 40 percent of them contained at least one instance of smoking, mostly of cigarettes. Fox lead the networks with 44 percent, followed by CBS with 41 percent.

All these episodes were rated TV-PG and TV-14 (the more stringent rating). Surprisingly, more TV-PG episodes showed smoking (50 percent) than ones rated TV-14 (26 percent).

The study was conducted by Legacy, a public interest group dedicated to reducing tobacco use by people of all ages.

Hat tip: Los Angeles Times Booster Shots blog.

February 3, 2011
Survey: adults often get unnecessary heart screening tests

Recently this blog noted a CDC study that found many Americans with hypertension and high cholesterol --risk factors for heart disease -- are not receiving proper treatment. Of course proper treatment is based on early discover for these conditions and accordingly doctors do recommend regular blood pressure and cholesterol screening tests.

But according to a Consumer Reports survey, many individuals are seeking and getting additional tests that experts say are unnecessary, even harmful, for adults with low or normal risk for heart disease. The CR poll shows 44 percent of healthy people getting ill-advised screenings, such as an electrocardiogram (EKG), a blood test for C-reactive protein (CRP), and an exercise stress test.

To help you understand the appropriateness of various tests, CR provides a free online health calculator which takes factors such as age, gender, BMI, blood pressure and cholesterol level, and figures your overall risk of heart problems. Then you can consult a handy table listing each test, its benefits, liabilities, costs and who should get it, based on age, gender and disease risk.

February 1, 2011
Most people with hypertension and high cholesterol aren't properly treated

High blood pressure and cholesterol are major risk factors for heart attacks, strokes and related diseases, which kill more than 800,000 Americans annually. Despite the relative low-cost and effectiveness of treatment, the majority of people with these conditions aren't getting proper care, reports the Centers for Disease Control in a new report.

Individuals lacking health insurance are most likely to lack treatment. But even among those who are insured, many aren't controlling their hypertension and cholesterol adequately.

By the numbers:

High Blood Pressure
1 in 3 Adults has high blood pressure
1 in 3 Adults with high blood pressure does not get treatment
1 in 2 Adults with high blood pressure does not have it under control
High Cholesterol
1 in 3 Adults has high cholesterol
1 in 2 Adults with high cholesterol does not get treatment
2 in 3 Adults with high cholesterol do not have it under control

January 21, 2011
CDC: past rise in childhood obesity leveling off

Obesity affects some 12.5 million U.S. children and teens, or about 17 percent of that population. The incidence of childhood obesity as been rising steadily since the 1960s, when it was around 5 percent.

But according to a new report issued by the Centers for Disease Control, childhood obesity rates appear to have leveled off in the few years. That's the good news. The bad news is there is a significant increase in obesity among the heavier boys, with the heaviest getting heavier. In addition, there are significant differences between racial, ethnic and age groups. Hispanic boys and non-Hispanic black girls, for example, are more likely to be obese. So are older children and teens, compared to preschoolers.

CDC researchers warn that severe overweight in youngsters can lead to psychological problems and medical risk factors, such as hypertension, high cholesterol, and abnormal glucose tolerance or diabetes. They point to a decline in healthy eating and exercise as primary determinants of obesity. So they recommend a multipronged strategy of encouraging more exercise, less television watching, greater consumption of fruits and vegetables and less of high-caloric foods.

January 14, 2011
Cost of cancer projected to rise 27 percent in ten years

Although cancer incidence is declining and cancer survival is increasing, the cost of treating cancer in the United States is expected to jump from $125 billion in 2010 to at least $158 billion in 2020. That's due in large measure to an aging population, say the authors of a new National Cancer Institute study.

NCI researchers note that cancer strikes older people disproportionately and so they project the number of cancer survivors rising 13.8 milion to 18.1 million in the next ten years. The biggest contributor to the overall cost in 2020 is care of prostate and breast cancer patients which will grow 42 and 32 percent, respectively.

Hat tip: Los Angeles Times Booster Shots blog.

January 5, 2011
Retiring doctors could cause health care shortage in rural areas

As the eldest baby boomers hit 65 this year, California's older doctors will being to retire in troves -- and that could cause a health care crisis in sparsely-populated areas if these retirees aren't sufficiently replaced by younger professionals. That's the warning in a new investigation by the Center for Health Reporting, the nonprofit journalism team sponsored by the California HealthCare Foundation.

Statistics complied in the 2009 CHCF report, Fewer and More Specialized: A New Assessment of Physician Supply in California, bear out the problem. Not only does the doctor-patient ratio tend to be lower in rural counties, but the relative age of doctors tends to be higher in those areas. Trinity County leads the state in the percentage of active physicians over the age of 55 (73.3 percent). It's followed by Modoc (68.6 percent), Lassen (52.6 percent), Amador (52.1 percent) and Inyo (51.2 percent).

December 30, 2010
Report: dialysis oversight in California weakest in nation

Almost 40 years ago Congress expanded Medicare to cover dialysis treatment for all Americans suffering from kidney failure--regardless of age or income. Today taxpayers shell out $20 billion annually to provide the life-saving procedure for some 400,000 patients. Although the United States spends more per patient than virtually every other country, its mortality rate for dialysis care is among the highest in the industrialized world, according to the watchdog group ProPublica.

In an ongoing investigation, ProPublica discovered an alarming number of clinics that provide substandard care in unsanitary conditions. The result are needless hospitalizations and avoidable deaths. Equally troubling is the weak oversight of the dialysis industry. Checks of clinics, known as recertification surveys, are supposed to be conducted by state regulators every three years. But the frequency of government inspections of these 5,000+ facilities varies widely by state. In California--which has the biggest backlog in the nation--at least half the dialysis clinics haven't been inspected in five years or more. And some 10 percent haven't been checked since 2000.

Federal authorities have pressed California to boost its inspections or face withholding of funds. But federal money for recertification hasn't kept up with the growing number of clinics. That and the state's budget crisis has hampered oversight. And so the backlog continues to grow.

December 28, 2010
State data shows drop in preventable hospitalizations

New statistics by the Office of Statewide Health Planning and Development show a significant decline in preventable hospitalizations over the period 1999-2008. The OSHPD report looked at 14 medical conditions "for which quality outpatient care or early intervention can potentially prevent the need for hospitalization or complications leading to a more severe illness."

Ten of these conditions, including chest pain, pediatric gastroenteritis and chronic obstructive pulmonary disease, showed decreases in hospitalization rates. The rate for diabetes (short-term complications) stayed the same. Diabetes (long-term complications), urinary tract infections and hypertension increased. 

The OSHPD study examined the hospital data at the county level and the results are displayed in color-coded maps for easy comparisons. Of particular concern are the hospitalization rates for childhood asthma in Alameda County, which 2.5 times that of the state's, as well as hypertension rates in South Central Los Angeles, which are 3.3 times that of the state's.  

In general, the four counties of the Sacramento region show average or below average hospitalization rates for the 14 preventable conditions.

Hat tip: HealthyCal.

December 27, 2010
The Center for Health Reporting, state medical care watchdog

Today The Bee published the last of a 2-part series on baby boomer medical care produced by the California HealthCare Foundation Center for Health Reporting. CHR is a non-profit journalism team based at the USC Annenburg School, which "partners with news organizations across the state to produce in-depth reporting on health-care issues of importance to consumers and policymakers."

The Center began operation in October 2009 and has shared some 20 news investigations with over 30 California news outlets, including the San Francisco Chronicle, Oakland Tribune, San Jose Mercury News, Bakersfield Californian, Modesto Bee and Fresno Bee. Here are the latest projects published by CHR:

At Last, California Fights Infections With Disclosure. "Hospital infections kill an estimated 13,500 Californians a year, but critics say the state's hospitals and health department remain far behind other states in waging war against this largely preventable scourge."

Riverside County: Medi-Cal's Worst. "No county in California has a worse record than Riverside County for processing Medi-Cal applications."

Medicare Testing Ground: Lower Prices, Rising Concerns. "The Inland Empire is a new testing ground for whether the federal government and health consumers can finally do something about rising health costs."

Young Adults Get a Break with Their Parents' Insurance. "Health reform offers up a big benefit for young adults who haven't been able to get their own health insurance."

Broken Hearths: How the Economy is Endangering the Health of Our Families. "Joblessness is a scourge that hits hard at workers trying to make a life for their families. But it also hits hard at the families themselves, including the children."

Clinic Shutdowns Hit Tiny Towns Hard. "Kern County, with some of the state's highest rates for diabetes, heart disease and obesity, is home to a test case for the federal government's new Health Care Coverage Initiative."

December 21, 2010
2009 teen births drop to record low

The birth rate for U.S. girls aged 15-19 fell to 39.1 births per 1,000 in 2009. That's the lowest it's been since recordkeeping began in 1940, says the Centers for Disease Control. Birth rates for teens of all ages, races and ethnic groups dropped to historic levels.

In its new preliminary report, the CDC also found the first decline since 2002 in total births to unmarried mothers. But since total U.S. births declined even more, the percentage of births attributed to unmarried mothers actually rose to 41.0 percent in 2009 from 40.6 percent in 2008.

Married or not, women in their early 20s showed a 7.0 percent drop in birth rate in 2009. It's the biggest decrease for that age group since 1973. The birth rate also fell for women in their late 20s and 30s, but increased for women in their 40s. 

December 6, 2010
Pregnancy-related deaths creeping up in U.S.

Although it's rare for U.S. women to die of complications in pregnancy, a Centers for Disease Control study shows that such deaths are increasing in this country.

Researchers found that between 1998 and 2005 the national pregnancy-related mortality rate was 14.5 deaths per 100,000 live births. In 1986, the rate fell to a low of 7.4 per 100,000 before experiencing a gradual rise. (A pregnancy-related death is considered any death occurring during, or within a year after pregnancy, that is caused by a complication of pregnancy.)

The study doesn't identify a precise cause for the increase in these materal deaths. But it notes that in recent years more women of child-bearing age are dealing with obesity and chronic health issues such as hypertension and diabetes.

Back in February, California Watch reported that the rate of pregnancy-related deaths in the state tripled over the past ten years.

November 30, 2010
CDC: foodborne diseases cause 5,000 U.S. deaths a year

In a strong bipartisan showing, the U.S. Senate today passed legislation bolstering the nation's food safety laws. The Food Safety and Modernization Act, among other things, gives the Food and Drug Administration greater authority to respond to disease outbreaks such as those affecting beef, spinach, peanuts and other products in recent years.

To get a sense of the scale of the problem, take a look at the CDC statistical report Food-Related Illness and Death in the United States. Drawing from multiple data sources, the authors estimate that "foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year." According to the tables, the biggest causes of illness are the Campylobacter and Salmonella bacteria, Giardia parasite and Norwalk-like viruses. The deadliest agents are Salmonella, Listeria and Toxoplasma gondii, a parasite found in undercooked meat.

November 22, 2010
Illegal tobacco sales to children fall to historic low in the state

The California Public Health Department announced last week that sales of tobacco products to minors have dropped to an all-time low. That's based on an annual compliance check at retail outlets (supermarkets, drugstores, liquor stores, service stations, doughnut shops, etc.) The state began monitoring stores in 1995. Minors participating in the study were able to purchase cigarettes 37 percent of the time. That percentage has steadily fallen in the past 15 years. In 2008 the rate was 12.6 percent. In 2009, 8.6 percent. And this year, 7.7 percent.

That's good news. But it begs the question: is use of tobacco by children also dropping? CDC statistics indicate that it is. One report, Cigarette Use Among High School Students -- United States, 1991-2009, shows the percentage of students who have ever tried cigarettes falliing from 70.4 percent in 1999 to 46.3 percent in 2009. In addition, the percentage of students who reported current cigarette use also fell from 36.4 percent in 1997 to 19.5 percent in 2009.

November 8, 2010
Authorities not tracking hospitals with potential quake risk

More than a dozen hospitals in the state run the highest risk of collapse during a severe earthquake, according to the investigative reporting group California Watch. And further, state authorities and hopital officials have done little to alert the public to these hazards. Nor have they determined the quake risk for many of the of the 700 hospital buildings identified in the 1990s as being potentially dangerous.

Under law the state can shut down hospitals that don't address serious seismic issue by a certain deadline. But knowing which face the biggest risks is problematic. Only 90 structures have been evaluated for "collapse risk" (i.e., the probability of collapse -- based on the building's condition, distance from a fault and likely ground motion -- during the biggest potential quake for that region).

The facility on the list with the greatest risk is Kindred Hospital in Ontario (31.75 percent), followed behind by Citrus Valley Medical Center in West Covina (30.36 percent). Closest to Sacramento is Rideout Memorial Hospital in Marysville. Its West Wing and Nouth Wing buildings have modest risk indices of 2.56 and 1.81 percent, respectively. 

October 24, 2010
Many doctors shun e-mail

Before shooting off an e-mail to your doc, think again.

A new study shows that only 6.7 percent of office-based physicians routinely e-mail patients. "While patients appear ready to embrace e-mail, physicians are markedly less ready," says the Center for Studying Health System Change. About two-thirds of the doctors it surveyed said they did not have access to e-mail systems at their practices.

Billions of dollars are being invested on electronic medical records as part of a national drive to improve safety and efficiency. The doctor-patient relationship was supposed to be enhanced by electronic communication: no need to visit the doctor's office, and no more phone tagging when you can e-mail.

Doctors who have access to electronic medical records and those who work for HMOs are more likely to use e-mail, the center says. About half said they regularly used e-mail with their patients.

Impediments are: cost of acquiring office e-mail systems, heavy e-mail concerns, privacy, data security and medical liability.

- Bobby Caina Calvan

October 6, 2010
Projected doctor shortage bigger than previously reported

The Association of American Medical Colleges has revised its physician shortage predictions, and the figures are pretty grim. Instead of a shortfall of 39,600 doctors in 2015 as previously thought, the AAMC now estimates a deficit of 63,000 physicians in five years. In addition, the nation will face a shortage of 33,100 specialists in cardiology, oncology and other non-primary care fields. The AAMC reports that one-third of today's physicians will retire within 10 years.

The situation is made worse by the aging of the American population which will see a 36 percent increase in people over 65. The expanding elderly cohort will greatly increase the demand for medical care, especially specialist care. Demand will also rise as an estimated 32 million more people get insured as a result of federal health care reform.

The doctor shortage will be felt by everyone, but especially underserved groups in rural and inner-city settings.

Hat tip: Los Angeles Times Booster Shots blog.

October 5, 2010
A quarter of high school students, young adults binge drink

According to a new report by the Centers for Disease Control, 25 percent of high schoolers and young adults, 18-34, indulge in binge drinking (as defined as consuming multiple alcoholic drinks -- four or more for women, five or more for men -- in space of a few hours). Further, some 60 percent of those youths who drink alcohol have engaged in binge drinking at some time in the 30 days prior to the survey.

Among adults, men binge drink more than women do, 21 versus 10 percent. Such behavior, says the CDC, increases the risk of accidents, violence, drug overdose and sexually-transmitted disease. Binge drinking causes more than half of the 79,000 deaths attributed to excessive alcohol use during the period 2001-2005. 

The prevelance of binge drinking among adults varies among the states. It ranges form 6.8 percent in Tennessee to 23.9 percent in Wisconsin. California is in the middle at 15.8 percent.

October 1, 2010
A child well-being scorecard for California counties

kids.JPGThe Children Now advocacy group released its new 2010 California County Scorecard of Children's Well-Being, a collection of 26 data indicators reflecting the well-being of youngsters in California's 58 counties. The scorecard covers specific measures of health, safety, crime, abuse and education.

County rankings can be easily browsed using CN's color-coded table. The counties are grouped by their rural/urban and low/middle/high income status. Performance in each of the 26 indicators is illustrated by color: red for bottom third of county rankings; yellow for middle third; and green for top third.

You can also view the specific data for individual counties. Sacramento County, for example, falls in the middle tier for most indicators, but ranks in the bottom third in seven measures, including road safety, truancy and 8th-grade Algebra enrollment.

PHOTO CREDIT: Students and their parents arrive for the first day of school at the newly-built Cosumnes River Elementary School in Sloughhouse, August 2010. Jose Luis Villegas / Sacramento Bee

September 30, 2010
Substance use is up in the U.S., lead by marijuana

As Californians mull the pros of cons of marijuana legalization, the US. Health and Human Services Department released a national survey which shows illegal drug use rose between 2008 and 2009 from 8.0 to 8.7 percent of the population (over 12 years old). The report -- which also covers "past-month" use of alcohol and tobacco -- says the hike in marijuana consumption (6.1 to 6.6 percent) largely drove the overall increase in illicit substances.

In 2009 21.8 million people took some type of illegal drug (marijuana, cocaine, heroin, hallucinogens, and inhalants, and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives). Of these, 16.7 million used pot. Among young adults (18-25), the percentage using illicit drug grew 19.6 to 21.2 percent between 2008 and 2009. The percentage using marijuana increased 16.5 to 18.1 percent over the same period. Among youth (12-17), overall illicit drug use rose 7.3 to 8.3 percent, and marijuana use rose 6.0 to 6.3 percent.

September 14, 2010
Brookings: obesity costs the U.S. $215 billion annually

Obesity is said to have researched epidemic proportions. According to the World Health Organization, "Globally, there are more than 1 billion overweight adults, at least 300 million of them obese." In the United States, 27.6 percent of adults are obese (as self-reported to the Centers for Disease Control in 2009).

In a new report, the Brookings Institution attempts to calculate the direct and indirect costs of obesity to the U.S. economy. The authors analyze the economic impact in terms of four major categories: "direct medical costs, productivity costs, transportation costs, and human capital costs." Direct costs relate to the elevated risk of serious medical conditions, such as hypertension, heart disease, diabetes, stroke, arthritis, etc. Productivity costs refer to employment problems such as absentism or presenteeism, shortened work life, increased disability claims, etc. Transportation costs point to to bigger vehicles, increased fuel consumption, etc. due to elevated body weight. Human capital costs consider the measurable negative impact on educational attainment and quality of schooling of obesity.

The bottom line for Brookings? Taken all together these factors point to an economic impact of more than $215 billion a year.

September 13, 2010
Report: for-profit hospitals doing more c-sections than non-profits

The investigative reporting group California Watch analyzed state birth data and found that for-profit hospitals are performing more cesarian sections that non-profit institutions in the state. All things considered, a woman has a 17 percent greater chance of a surgical birth versus a vaginal delivery at profit-making facility. Cesarians bring in up to 100 percent more revenue for hospitals than normal births. CW also found some hospitals have increased the number of cesarians performed for "non-medical" reasons, including the impatience of staff.

You can browse the data for individual hospitals here. The hospitals are ranked by the average number of cesarians per 100 "low-risk" births. Los Angeles Community Hospital is tops with 48.4 in 2007. St. Helena Hospital Clearlake is at the bottom with 6.7. Sacramento County's eight hospitals tend to rank in the middle, ranging from Kaiser South (9.2) to Mercy General (17.4).

September 10, 2010
CDC: prescription drug use continues to rise

pharm.JPGAnother stat that bodes ill for the effort to contain health care costs is this recent datum from the Centers for Disease Control: in the past decade the percentage of Americans taking at least one prescription drug per month rose 44 to 48 percent. Those taking two or more grew 25 to 31 percent. And those taking five or more increased 6 to 11 percent.

Of course the aging population contributed to the trend. In the period 2007-2008, 88.4 percent of people 60 and over were taking at least one prescription. Compare that to people aged 20-59 (48.3 percent), 12-19 (29.9 percent) and children 0-11 (22.4 percent).

According to the CDC, asthma medications are the most commonly prescribed drugs for children. For adolescents: nervous system stimulants (as treatment for attention deficit disorder). For adults: antidepressants. For older adults: cholesterol-lowering medicines.

PHOTO CREDIT: Frank Cable is a long time independent pharmacist at Leader Pharmacy in South Sacramento. Drug stores are expanding even in a bad economy. Sacramento Bee / Lezlie Sterling

September 9, 2010
Did drug company promote HRT with journal ghost writers?

A Georgetown University researcher asserts in a study published Tuesday that phamaceutical firm Wyeth employed ghost-written material in medical journals to "to promote unproven benefits and downplay harms of menopausal hormone therapy". The author, Adriane Fugh-Berman, claims that Wyeth (now owned by Pfizer) paid the medical communications company DesignWrite to produce reviews and commentaries that would counter research that HRT increases the risk of breast cancer. This material, published under the names of various physician-researchers, also touted the uproven benefits of HRT in preventing heart disease, dementia, Parkinson's and other illnesses.

According to Fugh-Berman medical ghost-writing has been used to manage perception of other drugs and "may infest articles in every medical journal". She calls on journal publishers, authors and academic institutions to renounce the practice.

September 8, 2010
RAND: diverting ER patients to clinics could save big bucks

urgent.JPGIt's no secret that too many people seek medical care unnecessarily at hospital emergency rooms. Those visits are not only costly -- to patients and the health care system as a whole -- they also lead to longer wait times at ERs. (A recent story from the Merced Sun-Star reported that wait times in 2009 rose to an average of four hours, seven minutes nationally and four-and-half hours in California.)

Yesterday the RAND organization released a study asserting that 16.8 percent of ER visits could have been handled by retail medical clinics or urgent care centers, saving the nation some $4.4 billion annually. Retail clinics can treat non-emergency conditions such as colds or urinary tract infections. Urgent care facilties can respond to more significant problems, such as minor fractures and serious cuts.

Limited hours at clinics and urgent centers restrict the percentage of ER visits that can be diverted. RAND researchers estimate that 27.1 percent of visits could be handled at alternative venues, if the latter were open longer hours.

PHOTO CREDIT: Viorica Bantea sees Lucille Cannon of Sacramento for her broken ankle at an after-hours urgent care clinic for the Family Medical Clinic office on L Street in 2008.  Autumn Cruz / The Sacramento Bee

August 25, 2010
Household health care spending leveling off?

It's a little counterintuitive. Although the portion of an average family's budget devoted to medical expenses rose from 1998 to 2003 (6.2 to 6.8 percent), the share fell slightly in 2008 (to 6.7 percent). That factoid comes from a recent U.S. Bureau of Labor Statistics Focus on Prices and Spending report analyzing consumer health care spending during years 1998, 2003 and 2008.

Between 1998 and 2008 the proportion of household health care dollars going to medical services versus medical insurance flipflopped. Medical services, as a percentage of total household health spending, fell from 31.1 to 25.9 percent, whereas insurance costs rose 51.5 to 57.9 percent of the total.

Not suprisingly, older people tend to spend much more of their money on health care. Households, whose "reference person" (head of household) was older than 65, spent on average 12.9 percent of their budgets on health expenses in 2008. Compare that to households with a reference person aged 35-44 that spent only 4.7 percent on average.

August 17, 2010
ESPN investigates health violations at sport venues

VLADE.JPGESPN reporters recently examined 2009 health inspection reports for food concessions and restaurants at all 107 major league sports stadiums and arenas in North America. They found that at 30 venues, more than half of vendors had been cited for at least one "major" violation. The problem, say experts, is the sheer quantity of food and drink sold to fans at such places where conditions are less than ideal.

The ESPN report What's Lurking in Your Stadium Food? includes an interactive map that ranks each stadium/arena in terms of the percentage of vendors found with serious violations. The most troubled venue is the Verizon Center (home of the Washington Wizards) with a score of 100 percent. All of the other 75-100 percent venues are located in Florida.

California ranks relatively well in the statistics with scores ranging from 4 percent (AT&T Park in San Francisco) to 34 percent (McAfee Coliseum in Oakland). Our own Arco Arena comes in at 25 percent of vendors with "critical" violations. You can read health inspection reports of individual Arco vendors with the Sacramento County Environmental Management Department's online database. (Just enter "Arco Arena" in the Facility Name search box.)

PHOTO CREDIT: Vlade Divac, of the Sacramento Kings, helps sell water at one of the concession stands in Arco Arena during the Kings Fandemonium in October 2001. Hector Amezcua / Sacramento Bee

July 20, 2010
Fresh data on the well-being of seniors

elderly.JPGAs the demographic bulge of baby boomers moves toward retirement, there's increasing interest in the physical, emotional and economic condition of seniors as they age. To help academics and public and private service providers understand the challenges ahead, a coalition of federal agencies published a new compendium of statistics on people aged 65 and up. Older Americans 2010: Key Indicators of Well-Being contains the latest data on 37 measures that best describe the status of seniors today. The volume is divided into five sections: population, economics, health status, health risks and behaviors, and health care. Some highlights:

The older population is projected to grow from 35 million in 2000 to 72 million in 2030, with their portion of the total population increasing from 13 to 20 percent.

The percentage of seniors (65+) with "functional limitations" (e.g., inability to walk a few blocks or lift a moderate weight) fell from 49 to 42 percent between 1992 and 2007.

Life expectancy among U.S. seniors has increased but has trailed behind other industrialized countries.

Obesity among seniors has increased 22 to 32 percent between 1988 and 2008.

Health care costs for seniors, adjusted for inflation, grew significantly from $9,224 in 1992 to $15,081 in 2006.

PHOTO CREDIT: Mavis Spotts raises her arms during exercise at the Sutter Respite and Recreation program held at the Twelve Bridges Library, July 15, 2010. Sacramento Bee / Randy Pench.

July 15, 2010
Report: not enough primary care physicians in parts of state

doc.JPGThe number of physicians in California has grown faster than the population since 1998. But with baby boomers aging, health reform opening insurance to more people and many doctors approaching retirement, the state may face a shortage of doctors in the future -- particularly a shortage of primary care physicians (PCPs) in certain parts of the state and among certain population groups. That's the conclusion of California Physican Facts and Figures, a new report by the California HealthCare Foundation.

Even now, most areas of Califoria barely meet national standards for primary doctors per 100,000 population, says the CHCF. Only the greater Bay Area, Orange County and the Sacramento region have the recommended supply of PCPs. In addition, the ethnic makeup of California physicians doesn't mirror the state's diversity. The biggest disparity is among Latinos, who comprise 40 percent of the population, but only five percent of doctors.

Hat tip: Healthy Cal

PHOTO CREDIT: Dr. Miguel Lizarraga looks at the knee of patient Traci Lucia at the Oak Park Primary Care Center. The Sacramento Bee / Anne Chadwick Williams.

July 12, 2010
Hold the salsa and guacamole, please. It may be tainted.

GUACAMOLE.JPGHere's a depressing finding for Mexican food lovers. Research from the Centers Disease Control suggests that "nearly one out of every 25 restaurant-associated foodborne outbreaks with identified food sources between 1998 and 2008 can be traced back to contaminated salsa or guacamole." That's more than double the rate of the previous decade.

Apparently the likely source of the contamination in fresh salsa and guacamole is diced raw tomatoes, hot peppers and cilantro -- each of which has been connected to past outbreaks. Improper storage and refrigeration aggravates the problem and was reported in 30 percent of such cases originating at restaurants and delis. Food workers are thought to be the source of contamination in 20 percent of cases.

The CDC says awareness of the health risk associated with fresh salsa and guacamole will help remind cooks at restaurants and at home to follow guidelines for safe preparation and storage. This will go a long way in reducing the incidence of contamination and pathogen growth.

June 24, 2010
CDC releases new stats on health risks and health care

fitness.JPGEarly Release of Selected Estimates Based on Data From the 2009 National Health Interview Survey is a large compendium of new data on American health and health care posted last week by the Centers for Disease Control. The report presents 2009 updates of 15 health measures along with prior data from 1997 through 2008 for comparison. Categories cover medical insurance, chronic disease, health risks like smoking and lack of exercise, vaccination and other factors affecting individual health. Some highlights:

Between 2008 and 2009, the percentage of uninsured Americans of all ages rose 14.7 to 15.4 percent. Hispanics in 2009 led non-Hispanic whites and blacks in the the percentage of uninsured (30.7 percent versus 11.1 and 17.0 percent, respectively).

Percentage of people who failed to obtain needed medical care due to cost rose from 4.5 percent in 1997 to 6.9 percent in 2009.

Smoking among U.S. adults generally declined from 1997 to 2009 (24.7 to 20.6 percent).

Percentage of adults who engage in regular leisure-time physical activity ranged from 29.8 percent in 1998 to 34.7 percent in 2009.

Prevalence of diagnosed diabetes among adults rose from 1997 to 2009 (5.1 to 9.0 percent).

PHOTO CREDIT: John Goddard of Sacramento trains at 24 Hour Fitness in this 2008 photo by Renee C. Byer.

June 12, 2010
Bing, Google launch dueling health data maps

Last week rival search engines Bing and Google debuted two different map mashups of health data. (Hat tip to Search Engine Land.)

Google's offering, called Hospital Finder, displays important consumer information about individual hospitals across the country. The data includes "heart healthy" and "people friendly" evaluations. The former covering things like "aspirin on heart attack arrival" and "beta-blockers on heart attack discharge". The latter showing patient judgments about doctor/nurse communication, pain control, noise, etc. Among the local hospitals feature on the map are: Sutter General, Mercy General, UCD Med Center and the main suburban facilities.

Bing Health Maps shows county-level statistics on essential community health factors: birth measures (premature births, low birth weight, older mother, etc.); death measures (infant mortality, fatal accidents, diseases, etc.); health risk measures (hypertension, obesity, smoking, etc.). The interactive map is color-coded so you can easily see how your county compares to others in each category.

--Pete Basofin

June 1, 2010
Scam warning for seniors seeking Medicare rebates

The federal government next week will begin issuing rebate checks to help seniors recoup money spent to bridge a Medicare drug coverage gap.

Eligible seniors will receive the money automatically, Medicare officials said, and they advised seniors to be wary of anyone offering services - for a fee - to help Medicare beneficiaries claim the rebate.

"Our message is: You don't have to do anything. We have the data. We will mail out the checks," said David W. Sayen, administrator for Medicare's San Francisco regional office.

"Anytime there is a new program, people will see it as an opportunity" to take advantage of the potentially vulnerable, he said.

Several million Medicare beneficiaries qualify for the one-time rebates. The checks are part of the massive health care legislation signed into law earlier this year.

The $250 rebate is intended to begin to plug the Part D doughnut hole - the drug coverage gap that requires seniors to pay the entire cost of prescriptions until they hit the catastrophic coverage level.

With public confusion over the Patient Protection and Affordable Care Act, Medicare beneficiaries will soon be receiving mailers about what they can expect.

Marilyn Tavenner, the acting national administrator for the federal insurance program for seniors, warned of "scam artists" who could try to defraud seniors.

He urged seniors to call the Department of Health and Human Services' inspector general to report possible scams: (800) 447-8477.

For more information, visit

-- Bobby Caina Calvan

About The Public Eye

Welcome to The Bee's newest blog: Public Eye. In the coming months, you will see us breaking news here as well as following up on investigations we have published with tidbits, news breaks and behind-the-scenes descriptions of our news-gathering process. Know of a wrong we could right? Send our fraud squad your tips at:

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