Month: February 2012

Health

Poll Watch: Obesity and Chronic Diseases Stable Across the United States in 2011

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According to the latest Gallup Poll.

Colorado had the lowest adult obesity rate in the nation in 2011, as it did last year, and is the only state where fewer than 20% of adults are obese. West Virginia holds onto the negative distinction of being the state with the highest obesity rate; 35.3% of residents living there are obese, the highest for any state that Gallup and Healthways have found since 2008.

The national obesity rate declined slightly to 26.1% in 2011, from 26.6% in 2010. Across states, obesity rates remained statistically unchanged from 2010 to 2011 in all but two — New Jersey and Kentucky — where they declined. This marks a positive change from the recent past. Obesity had inched up in 2009 and 2010 compared with 2008 nationwide and in some states.

These data, collected as part of the Gallup-Healthways Well-Being Index, are based on respondents’ self-reports of their height and weight, which are used to calculate Body Mass Index (BMI) scores. Americans who have a BMI of 30 or higher are classified as obese.

The obesity rate continues high, but at least it did not increase this past year. Is the word getting out about the problem?

Here is a chart about the best and worst states:



High Blood Pressure, Diabetes Rates Also Hold Steady Across States

It is interesting that the states in the South and the Midwest lag the other states and have higher rates of obesity and chronic diseases. They also have the higher rates of smoking.

There needs to be more awareness and education about the needs to eat right, exercise regularly and not smoke – for a more healthy and productive life.

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Dentistry

Medicaid Does Not Improve Access to Dental Services for Poor Children

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According to a new study.

Abstract –  Background:  Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health.

Objective:  To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.

Methods:  The third National Health and Nutrition Examination Survey included 2821 children 2–16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.

Results:  Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (ORNoMDvisit = 2.21; 1.26–3.90), and to need dental treatment (ORDentalNeed = 1.57; 1.13–2.18).

Conclusions:  This USA population-based study found disparities exist within Medicaid’s services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.

Once upon a time, when I treated California Denti-Cal (Medicaid) patients, the no show or broken appointment rate was astounding. These folks were getting “FREE” dental treatment and they continued to not show up.

I have to agree with the conclusions of this study.

If the patient or the parents of the child patient do not have any “skin” in the game, it doesn’t matter that much to them.

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Health

Substituting Smokeless Tobacco for Smoking Will Save Lives?

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Samples of smokeless tobacco

Apparently yes, according to a new study – e-cigarettes too.

Substituting smokeless tobacco products can save smokers’ lives, and there is a scientific foundation that proves it.

That is the message Brad Rodu, D.D.S., professor of medicine at the University of Louisville (UofL) School of Medicine and the Endowed Chair in Tobacco Harm Reduction at UofL’s James Graham Brown Cancer Center, delivered at the Annual Meeting of the American Association for the Advancement of Science Feb. 18. Rodu spoke at the session, “Harm Reduction: Policy Change to Reduce the Global Toll of Smoking-Related Disease.”

“Quit or die: That’s been the brutal message delivered to 45 million American smokers, and it has helped contribute to 443,000 deaths per year, according to statistics from the Centers for Disease Control and Prevention,” Rodu said. “The truth, however, is that total nicotine and tobacco abstinence is unattainable and unnecessary for many smokers.”

There is one interesting part of the study.

“Nicotine is addictive, but it is not the cause of any smoking-related disease. Like caffeine, nicotine can be used safely by consumers,” Rodu said.

And, the evidence?

Decades of epidemiologic research bear out Rodu’s findings. While no tobacco product is completely safe, smokeless products have been shown to be 98 percent safer than cigarettes. In the United Kingdom, the Royal College of Physicians reported in 2002 that smokeless tobacco is up to 1,000 times less hazardous than smoking, and in 2007, further urged world governments to seriously consider instituting tobacco harm reduction strategies as a means to save lives.

To see the proof of what tobacco harm reduction can do, look to Sweden, Rodu said. “Over the past 50 years, Swedish men have had Europe’s highest per capita consumption of smokeless tobacco as well as Europe’s lowest cigarette use. During the same time, they also have the lowest rate of lung cancer than men in any other European country.”

While I would not recommend my patients to start smokeless tobacco or e-cigarettes, the evidence is there that if they cannot quit using smoking cessation programs at least recommend that they switch to another nicotine delivery system.

Rodu is well aware of the controversy his research findings generate. Opponents of any use of nicotine delivery products maintain that smokeless tobacco puts the user at great risk for oral cancer, a position not supported by research.

“The risk of mouth cancer among smokeless tobacco users is extremely low — certainly lower than the risk of smoking-related diseases among smokers,” he said. “The annual mortality rate among long-term dry snuff users is 12 deaths per 100,000 and the rate among users of more popular snus, moist snuff and chewing tobacco is much lower. For perspective, the death rate among automobile users is 11 per 100,000 according to a 2009 report from the National Highway Traffic Safety Administration. Compare those to the rate among smokers: more than 600 deaths per 100,000 every year.”

“The data clearly show that smokeless tobacco users have, at most, about the same risk of dying from mouth cancer as automobile users have of dying in a car wreck.”

In summary, as far as far as death is concerned: cigarettes (smoked tobacco)> smokeless tobacco> e-cigarettes> or = car wreck.

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Polling

Hawaii Continues as the Best State for Well-Being

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According to the latest Gallup Poll.

Hawaii residents had the highest wellbeing in the nation in 2011 with a Gallup-Healthways Well-Being Index score of 70.2, maintaining that state’s No. 1 status for a third consecutive year. North Dakota, Minnesota, Utah, and Alaska rounded out the top five states. West Virginia residents had the lowest wellbeing, with a score of 62.3, slightly improved from 61.7 in 2010.

Here is the chart.

There are definite regional differences with the Western states doing better than those in the South.

I suspect smoking and diet which are culturally based are larger factors than are discussed in the report. But, read it all.

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Diet

New Anti-Obesity Drug Qnexa Receives FDA Advisory Panel Approval

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Although I have lost my weight through the long drawn out process of diet and exercise, a drug, Qnexa, is showing some promise.

The second time’s a charm for Vivus’s experimental obesity drug Qnexa, at least when it comes to FDA advisory panel votes.

As the WSJ reports, one of the agency’s advisory panels today backed approval of the drug by a decisive 20-2 vote. The FDA — which often but not always follows the advice of its outside panels — is due to make its decision by April 17.

If the drug is approved, it would be the first new prescription weight-loss drug in over a decade. Qnexa combines low doses of two existing drugs: phentermine, which cuts appetite, and topiramate, now used to combat seizures and migraines.

Back in July 2010, FDA advisors voted against approving Qnexa by a margin of 10-6. The FDA itself nixed the drug later in the year, requesting more safety information.

Vivus submitted additional clinical data to the FDA in an attempt to allay its concerns. It’s not clear whether that will be enough to satisfy the agency, though. In briefing documents released ahead of today’s meeting, the FDA raised concerns about possible effects on the heart and about birth defects.

But it also noted that Qnexa produced “significant” weight loss in the first year of treatment, with some regain in the second year.

So, we will see if the FDA grants full approval.

This drug may provide the jump start that people need to start on the road to better health. It is probably not a panacea.

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