Archive for December, 2009

eHealth Ont. pushes on after scandal rocks agency, costs cabinet minister’s job

TORONTO – Electronic medical records would be a huge help during pandemics because they allow doctors to quickly identify patients in high-risk categories, either by age or by underlying medical conditions, says interim eHealth Ontario president and CEO Rob Devitt.

Doctors in Peterborough are “pioneers” in using computerized records for their patients and had a much easier time identifying people who were in priority groups for the H1N1 vaccine than doctors who are still using paper records for every patient, Devitt said in a recent interview.

“Pre-(electronic medical records), if I wanted to call all my patients who were under six and those six to 18 with a chronic medical condition, I would have had to have someone come in and pull all these paper charts and go through each one, and of course miss stuff,” he said.

“Probably you wouldn’t even do it because it would be such a huge task, but (with electronic records) a couple of key strokes and it’s done.”

Ontario already has 3,300 physicians using electronic medical records for about four million patients. It plans to get that number up to 10,000 doctors covering 80 per cent of the province’s nearly 13 million people by 2012.

“We often hear Ontario is behind,” said Devitt. “That (four million) is more people covered by an electronic medical record than any other province.”

Devitt’s vision of an electronic records system that streamlines health care delivery in the province follows a challenging first year for eHealth.

Created after its predecessor agency, Smart Systems for Health, was quietly shut down after achieving very little in its first six years, the agency was mired in a scandal involving hundreds of millions of dollars in untendered contracts given to consultants.

The controversy cost a health minister his job – along with the CEO and the chairman of the eHealth board – and saw the auditor general issue a damning report on the agency’s spending and procurement practices.

It got so bad that employees at eHealth – the unsung “heroes” of electronic health records in Devitt’s eyes who had nothing to do with untendered contracts or expense account abuses – were afraid to tell people where they worked.

“I’ve had a number of staff tell me stories about what it was like going to the grocery store or the hockey rink and they’d be chatting with someone and say they worked at eHealth and suddenly the tone would turn,” he said.

“We’ve started a lot of work in trying to restore our internal mood and morale.”

Health Minister Deb Matthews, who was appointed after David Caplan was forced to step down, said the province won’t slow progress on electronic health records despite a $24.7-billion deficit.

Doctors can save on staff because they don’t need someone to copy and file all their paperwork after they switch to computerized records, said Matthews.

“It’s actually so cost-effective I think it’s one of those investments we just have to continue to build,” she said.

“Making investments that are transformational in nature, that down the road will deliver a more effective and stronger health-care system, that’s the kind of investment we just have to make.”

Still, getting doctors using computerized records is only one step towards creating a provincewide electronic health records that can be accessed and updated not only by physicians, but also by hospitals, community health centres, private clinics and pharmacies.

It’s a massive challenge that Devitt says will likely never really end as technology keeps improving.

The data that can be mined from the information gathered by eHealth can be pure gold and help save lives as well as precious health-care dollars, adds Devitt.

For example, it turns out there are 906,577 people with diabetes in Ontario – something no one knew before – and only one-third get the basic tests they should have for blood sugar levels and cholesterol as well as regular eye exams.

Regular tests can help reduce their greater risk of heart disease and blindness, and the data gathered will be turned into a diabetes registry for the province that eHealth hopes to have online by the fall of 2010.

Gathering similar data on other chronic conditions will be crucial, especially as the health-care system deals with the increasing demands of the aging baby boomers, said Devitt.

“The literature is crystal clear that chronic disease management is something health systems have not done well across the developed world and are also the way we’re going to be able to sustain our health systems,” he said.

“In the face of that demographic wave, the ability to have this sort of information to give better care is going to be crucial to sustain it.”

eHealth also plans to create electronic prescribing, where easily-forged paper prescriptions are eliminated and the doctor sends the prescription directly to the pharmacist, which will also help eliminate medication errors.

The Progressive Conservatives are still demanding a public inquiry into the problems at eHealth, saying taxpayers deserve to know why so little progress was made after $1 billion was spent on the effort to create electronic health records.

“The inquiry is necessary to take a look at what happened in the past and to find out exactly where the problems are and then plan forward,” said Opposition critic Christine Elliott.

“The government keeps pushing back their end date for completion (of electronic health records) and we don’t really have a clear idea why.”

The New Democrats say they too have concerns that the culture of entitlement at the agency hasn’t been completely stamped out.

“I don’t know that we’re there yet to be frank,” said NDP Leader Andrea Horwath.

“You can change people around, but if you still have that kind of culture there then you’re not going to get much change at all.”

Both Matthews and Devitt say the changes the government has made to eliminate untendered contracts and to have more work done by eHealth staff rather than consultants will help restore public confidence in the agency.

Israeli study suggests Mozart's music may help speed up weight gain in premature babies

JERUSALEM – Is Mozart good for babies?

A group of Israeli doctors have plunged into this long-running debate with a small study that found the soothing sounds of the 18th century composer may help premature babies grow faster.

Doctors at the Tel Aviv Sourasky Medical Center measured the energy expenditure of 20 infants born pre-term while listening to Mozart in their incubator. They compared that figure with the amount of energy they expended without the music. But the scientists did not test a control group to measure the energy used by babies who didn’t listen to Mozart at all.

Among the babies in the study, the findings showed Mozart lowered the quantity of energy they used, meaning the babies may be able to increase their weight faster.

“While listening to this specific music, a baby can have a lower energy expenditure and hopefully he will gain weight faster than without music,” said Dr. Ronit Lubetzky, one of the main researchers in the study, which was published in the current issue of the medical journal Pediatrics.

The researchers used as a starting point a controversial 1993 study that showed college students improved their IQs by listening to Mozart’s sonatas for 10 minutes. Those findings sparked a craze that saw droves of parents buy Mozart CDs in a bid to boost their children’s brain power.

Later studies challenged what became known as “the Mozart effect,” saying classical music can’t increase basic intelligence among children or adults.

The purported positive effects of Mozart’s music is what drew the Israeli researchers to the topic. In their article, they note that the repetition of the melody in Mozart’s compositions, which resonates with a particular part of the brain, is less frequent among other classical composers and may account for the potential benefits stemming from his music.

Each of the 20 babies was played Mozart for 30 minutes, and the amount of energy they spent was measured simultaneously. The next day, the energy expenditure of the same 20 babies was observed, but without the music.

With Mozart, the energy use was reduced by at least 10 per cent for each baby. Data from two of the infants were not counted because of unrelated variations that could have skewed the results.

The study did not measure the infants’ weight gain and only speculated that its findings could translate into a quicker weight increase.

Lubetzky said the reasons the babies used less energy listening to Mozart aren’t entirely clear, but it appeared to have relaxed them.

“They might be more calm while listening to music, or they might have fewer stress hormones. All those things mean they have a lower heart and respiratory rate,” she said, meaning they spend less energy.

Prior research studying the effect of music on premature babies has been conducted using other sounds, including live music and harps.

But this study is unique because it appears to be the first to have quantified the amount of energy spent while listening to the music, one neonatologist said.

Dr. Arthur Eidelman, a retired former head of pediatrics at Jerusalem’s Shaare Zedek hospital who did not participate in the research, praised the new study but did not credit Mozart for the positive results.

“What’s unique about Mozart is it’s rhythmical, the range of decibel level is minimal,” Eidelman said. “One could almost make the case that appropriate rap music may do the same thing if you have it within the right range of volume.”

Lubetzky and the other researchers plan to conduct similar studies in the coming months that will test the effects of other music genres – anything from ethnic tunes to Israeli pop – on premature babies.

WHO: Pregnant Cambodians get hooked on chewing tobacco to quell morning sickness

HANOI, Vietnam – When pregnant Cambodian women suffer morning sickness, they often reach for an unlikely source of relief: a wad of chewing tobacco.

Many become hooked, and the World Health Organization warned Thursday it is a tradition putting the health of both mothers and babies at risk.

The largest tobacco survey ever conducted in Cambodia found that about half of all women older than 48 regularly chew tobacco, and about one in five rural women first took up the habit during pregnancy, to soothe their prenatal nausea.

The survey conducted by WHO and other researchers found that midwives are the country’s biggest users of smokeless tobacco, with 68 per cent chewing it. About half of traditional female healers use it as well.

“Chewing tobacco appears to be strongly influenced by beliefs passed on by older relatives,” lead author, Dr. Pramil N. Singh from Loma Linda University in California, said in a statement. “The behaviour is seen as a rite of passage into womanhood. Further research is needed to find out whether village health workers actively promote its medicinal use.”

The tobacco leaves are typically mixed with lime and betel nut, a mild natural stimulant that produces a bright red juice and has been used for centuries across the Asia-Pacific. Cambodian women place the concoction inside their mouths for an extended period, increasing their risk of suffering oral cancer.

As with pregnant women who smoke, those who chew tobacco also put their babies at risk for problems such as low birth weight, decreased lung function and stillbirth.

“Some women believe that when they chew tobacco, they look better,” said Dr. Mom Kong, director of the non-profit Cambodia Movement for Health. “And some start chewing tobacco when they get pregnant to cope with morning sickness in the first trimester of pregnancy. Some crave something sour. But some women get addicted while using it during the pregnancy.”

As many as three-quarters of all men in some Southeast Asian countries smoke cigarettes, but fewer than 20 per cent of the region’s women ever pick up the habit. While about half of older women chew tobacco, only about 4 per cent of them smoke, compared to nearly half of all men.

The rate of Cambodian women using tobacco increased with age. Similar trends have been observed in Indonesia, Malaysia, Bangladesh, Taiwan, India, Palau and China.

Dr. Susan Mercado, WHO’s tobacco control adviser for the Western-Pacific region, said it’s common for women, men and children across the region to chew tobacco with betel nut, especially in the Pacific islands where cigarettes are sometimes unrolled and chewed. However, she was unaware of pregnant women using tobacco to lessen morning sickness symptoms anywhere but Cambodia.

“It’s very, very concerning because the impact is not only on the woman but also on the unborn child, and the risk could be quite severe,” she said. “Countries need to have very specific programs that target whatever kind of tobacco use is prevalent. Just because everyone is saying the big problem is second-hand smoke … the problem may not be second-hand smoke for women, it’s actually chewing.”

The study, conducted from 2005 to 2006, involved about 14,000 adult Cambodians nationwide. It was published online in the Bulletin of the World Health Organization.

Study: Preschoolers watching TV at home-based daycare may spend hours in front of TV screen

SEATTLE – Parents who thought their preschoolers were spending time in home-based day cares, taking naps, eating healthy snacks and learning to play nicely with others may be surprised to discover they are sitting as many as two hours a day in front of a TV, according to a study published Monday.

When added to the two to three hours many parents already admit to allowing at home, preschoolers in child care may be spending more than a third of the about 12 hours they are awake each day in front of the electronic baby sitter, said Dr. Dimitri Christakis, a pediatrician at Children’s Hospital and Regional Medical Center in Seattle and a researcher at the University of Washington.

That’s double the TV time he found in a previous study based on parental reports of home viewing, according to findings published Monday in the journal Pediatrics. The study is the first to look at TV watching in child care in more than 20 years.

The figures come from a telephone survey of licensed child care programs in Michigan, Washington, Florida and Massachusetts. Christakis said he thought television use was probably underreported.

Of the child care programs surveyed, 70 per cent of home-based child cares and 36 per cent of centres said children watch TV daily. The children were watching TV, DVDs and videos. The study did not track what kind of programs were shown.

“It’s not what parents have signed up for,” Christakis said. “I’m not sure how many parents are aware of this.”

The American Academy of Pediatrics discourages any television viewing of any kind in the first 2 years of life and recommends a daily limit of 1 to 2 hours of quality programming for older children.

Children go to day care to develop social skills, build on cognitive abilities and enjoy imaginative play, as well as allowing their parents to work, Christakis said.

“We know what’s good for children and we know what’s not,” Christakis said. “High quality preschool can make a very, very positive difference. We’re so far from meeting that, that we really have a lot of work to do.”

His research found a difference between the amount of TV watching at home daycares and larger child care centres, although both reported some TV time.

The study found that among preschool-aged children, those in home-based day cares watched TV for 2.4 hours per day on average, compared to 24 minutes in centres. Toddlers watched an average of 1.6 hours in home care and about 6 minutes in centres. Only home-based day cares admitted putting infants in front of the TV, for an average of 12 minutes a day.

“It’s alarming to find that so many children in the United States are watching essentially twice as much television as we previously thought,” he said.

Other research has connected excessive TV watching during the preschool years with language delay, obesity, attention problems and aggression.

Dr. Michael Rich, director of the Center on Media and Child Health at Children’s Hospital Boston, wasn’t surprised by the findings in this study but he was forgiving of the parents and child care providers who put kids in front of the TV.

“In general, we still have a culture that sees television as benign,” said Rich, who is also an associate professor of pediatrics at Harvard University. “This is an area where we’re learning more and more all the time.”

He compared society’s growing knowledge of the impact of TV on child development to the early days of seat belt use. Today’s parents and child care providers grew up on TV, Rich said, so it’s understandable that they do not recognize the problem.

“We can always do better,” he said.

Christakis said one of the main problems with TV for young children is that it takes away time that could otherwise be spent playing outside, being read to, playing with blocks and talking with adults and other children.

The study did not include passive TV time, when the TV is on in the background but no one is actively watching it. Christakis said any time a TV is on, children speak less and adults interact with them less frequently.

Instead of urging parents to turn off the TV, President Barack Obama might want to start sending the same message to child care providers, Christakis said.

“Hopefully this will serve as a wake-up call,” he said.

Bangladeshi mother says formerlyconjoined twins should grow up in Australia

DHAKA, Bangladesh – The mother who gave up conjoined Bangladeshi newborn twins for adoption said Saturday she is overjoyed the toddlers have been successfully separated and wants them to grow up in Australia.

“My babies are alive and doing well. It’s the best news I’ve ever got in my life,” a tearful Lovely Mollick told The Associated Press in a telephone interview from her home in Khulna district, 85 miles (137 kilometres) southwest of Dhaka.

The twins, who turn 3 next month, had been joined at the top of their heads and shared brain tissue and blood vessels. They were separated Tuesday after 25 hours of delicate surgery in a hospital in Melbourne, Australia’s second largest city, and then underwent an additional six hours of reconstructive work.

The charity that brought Trishna and Krishna to Australia two years ago for the surgery, Children First Foundation, has said it will support the twins as they undergo further medical treatment in Australia for at least the next two years.

Trishna awoke from a medically induced coma Thursday and Krishna regained consciousness late Friday.

Their 23-year-old mother said she made the heartbreaking decision to give up her daughters to a Dhaka orphanage after giving birth by cesarean section because she could not properly care for their special needs.

While she and her factory worker husband, Kartik Mollick, 35, wanted to maintain a relationship with their daughters, both parents hoped the twins would be raised in Australia.

“I am from a poor family and am not able to take care of them,” the mother said. “I want them to get a proper education and live a good life.”

“I want them to maintain a relationship with me, no matter where they live, when they are grown up,” she added. “They have come from my soul.”

The girls’ Australian legal guardian for the past two years, Moira Kelly, the charity’s founder, said Saturday she has not considered adoption. “I haven’t even thought about it,” Kelly told reporters.

Adoptions could be stymied since Australia restricts the adoption of foreign children with medical problems that could burden its health care system.

Kelly said the prognosis that both sisters were neurologically sound “gives me shivers down my spine.” The twins’ cots will be pushed together so they could again touch, she said.

Krishna is expected to have a longer period of adjustment as the separation brought more changes to her body and brain’s blood circulation. Both girls were in serious but stable condition.

Doctors had earlier said there was a 50-50 chance that one of the girls could suffer brain damage from the complicated separation.

Australian aid worker Danielle Noble first saw Trishna and Krishna in an orphanage when they were a month old, and contacted the Children First Foundation.

“I got to see the girls for the first time today since their separation and it’s the most incredible feeling to think that three years ago, this was just a dream,” the 27-year-old volunteer told reporters.

“Now they are going to have a fantastic life,” she added.

The foundation raised almost 250,000 Australian dollars ($229,000) for the cost of caring for the twins in between numerous earlier surgeries to separate blood vessels connecting their brains. A mystery benefactor funded all hospital costs, Smith said.

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