Posted by on November 28, 2012 - 11:45am

The re-election of President Obama ensured that the Affordable Care Act  will move forward in 2013. In the coming months and years American’s will see a series of sweeping changes that begin with state-level action for health care reform, impacting millions of American women.

However, with each passing day it seems that more and more states and policymakers are changing their minds about what the respective plans are for the future.

Within the first few weeks of 2013 states must make decisions about whether they will set up a health insurance exchange, what essential health benefits must be covered by insurance plans in their region, and whether the states will expand their Medicaid programs.

Due to the number of health reform changes coming, the complexity of these issues and regulations and the huge impact on women’s health, it is easy for anyone to fall behind. Even health policy experts see changes every day that alter our analysis and projected outcomes. To help sort through the chaos, a few experts have created tables, maps and blogs to help the rest of us out.

* A broad range of policy changes (in an easy to understand chart!) can be found on the new State Reform website. This website is a state-based online network that frequently updates the avowed intentions of each state.

* For visual people, the best new source for information is the ProPublica website which has created “The Outlook of ObamaCare in Two Maps” being widely circulated and the Wright on Health blog where writers (including myself) keep readers updated on changes weekly.

* The Kaiser Family Foundation has also created an entire tab on their website devoted to diagrams and updates on health reform. The search function within this tab further makes it easy to find exactly which issue of change one wants to see in visual form.

* More information on federal government extensions being granted to states and insurance plans can be located on the Department of Health and Human Services website.

Posted by on November 25, 2012 - 1:46pm

As many as 129 million--or 1 in 2--non-elderly Americans have some type of pre-existing health condition, ranging from a life-threatening illness like cancer to chronic conditions like heart disease, diabetes, or asthma.   In most states, these individuals can be denied individual health insurance coverage or have benefits for certain conditions excluded by insurance companies.   Even if some small groups desire to cover all conditions, there is little that can be done to prevent exorbitant premium increases.

Starting in 2014, the proposed rule  of The Affordable Care Act (ACA) prohibits denying coverage because of pre-existing conditions.  It does state that individuals would have to buy coverage during open enrollment periods.  In addition, individual would have new special enrollment opportunities in the individual market when they experience certain losses of other coverage.

Health insurance issuers in the individual and small group markets would only be allowed to vary premiums based on age, tobacco use, family size, and geography.   All other facts--such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation and small employer size and industry---would no longer be able to be used by insurance companies to increase the premiums for those seeking insurance.

Under the ACA, states can choose to enact stronger consumer protections than the above minimum standards.  In addition, starting in 2017, states have the option of allowing large employers to purchase coverage through the Exchanges*.  For states that choose this option, these rating rules also would apply to all large group health insurance coverage.   These proposed rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.

Health insurance issuers would be required to maintain a single statewide risk pool for each of their individual and small employer markets, unless a state chooses to merge the individual and small groups into one pool.   Premiums and annual rate changes would be based on the health risk of the entire pool.  This provision prevents insurers from using separate insurance pools within markets to get around the market reforms and to charge people with greater health problems higher rates for their pool,   than rates in other healthier pools (Note:   This practice has often been called "cherry-picking" , i.e, limiting certain pools to  healthy people in a.)

This proposed rule also covers individual and employee renewals, prohibiting issuers from refusing to renew coverage because an individual or employee suddenly becomes ill with a chronic or severe condition.  There is also a provision for enrollment in catastrophic plans, providing affordable individual coverage options for young adults and people for whom coverage would otherwise be unaffordable.  To see the proposed rule, visit http://www.ofr.gov/inspection.aspx.

*Exchanges are the mechanism through which low and moderate-income individuals receive premium and cost-sharing subsidies to make health coverage more affordable. Many states have started implementing them, some have not.   They must be implemented by January 1, 2014.  In states who have not established an exchange, a federally-facilitated exchange will be implemented.  Some states are delaying action until all lawsuits against the ACA have been settled.

 

 

Posted by on November 24, 2012 - 11:30am

Remember the telephone game where people take turns whispering a message into the ear of the next person in line? By the time the last person speaks it out loud, the message has radically changed. It’s been altered with each retelling.

Turns out your memory is a lot like the telephone game, according to a new Northwestern Medicine study.   Every time you remember an event from the past, your brain networks change in ways that can alter the later recall of the event. Thus, the next time you remember it, you might recall not the original event, but what you remembered the previous time. The Northwestern study is the first to show this.

“A memory is not simply an image produced by time traveling back to the original event -- it can be an image that is somewhat distorted because of the prior times you remembered it,” said Donna Bridge, a postdoctoral fellow at Northwestern University Feinberg School of Medicine and lead author of the paper on the study recently published in the Journal of Neuroscience. “Your memory of an event can grow less precise even to the point of being totally false with each retrieval.”

The findings have implications for witnesses giving testimony in criminal trials, Bridge noted.  “Maybe a witness remembers something fairly accurately the first time because his memories aren’t that distorted,” she said. “After that it keeps going downhill.”

The published study reports on Bridge’s work with 12 participants, but she has run several variations of the study with a total of 70 people.

“Every single person has shown this effect,” she said. “It’s really huge," said Bridge.   The reason for the distortion, Bridge said, is the fact that human memories are always adapting.

“Memories aren’t static,” she noted. “If you remember something in the context of a new environment and time, or if you are even in a different mood, your memories might integrate the new information.”

For the study, people were asked to recall the location of objects on a grid in three sessions over three consecutive days.  “Our findings show that incorrect recollection of the object’s location on day two influenced how people remembered the object’s location on day three,” Bridge explained. “Retrieving the memory didn’t simply reinforce the original association. Rather, it altered memory storage to reinforce the location that was recalled at session two.”

“This study shows how memories normally change over time, sometimes becoming distorted,” Bridge noted. “When you think back to an event that happened to you long ago -- say your first day at school -- you actually may be recalling information you retrieved about that event at some later time, not the original event.”

Author:   Marla Paul, Northwestern NewsCenter

Posted by on November 21, 2012 - 11:20am
Last week the epic movie Lincoln was released in the United States.   My husband, a historian and huge fan of Doris Kearns Goodwin whose book Team of Rivals contributed greatly to the screenplay of the movie, went to see it last weekend!  But what does this movie have to do with Thanksgiving, you ask?    First, many families go to movies over the long Thanksgiving holiday, and I strongly recommend this one---you actually learn something about our history and that political intrigue is not a modern phenomena !
Second, Sarah Josepha Hale, an American magazine editor and author of the children's rhyme "Mary Had a Little Lamb,"  persuaded Abraham Lincoln to declare Thanksgiving a national holiday!
So on October 3, 1863, Abraham Lincoln issued a Thanksgiving Proclamation and officially set aside the last Thursday of November as the national day for Thanksgiving.  It wasn't until December 26, 1941 that Congress passed a law ensuring that all Americans would celebrate a unified Thanksgiving on the fourth Thursday of November every year.
Since 1947, the National Turkey Federation has presented a live turkey and two dressed turkeys to the President. The President does not eat the live turkey. He "pardons" it and allows it to live out its days on a historical farm.
On a final note, if you are inclined to deep fry your turkey be sure to read some of the safety tips on our popular BLOG from last year!   On behalf of all of us at the Women's Health Research Institute, we wish you a HAPPY THANKSGIVING!
Posted by on November 20, 2012 - 3:07pm

Men may not have ovaries, but that doesn’t mean they can’t develop some of the features of polycystic ovary syndrome (PCOS). That’s one of the reasons Andrea Dunaif, MD, Charles F. Kettering Professor of Endocrinology and Metabolism, would like to change the way scientists think about the complex genetic disease.

“It should really be seen as a metabolic disorder affecting men as well as women across the lifespan, rather than a female reproductive disorder with metabolic features,” Dunaif said.The current definition of the disorder is rooted in history. PCOS was first identified in 1935 as a gynecologic condition known as Stein-Leventhal syndrome, named after the physicians who described it. Since then, the understanding of PCOS has evolved. Symptoms in women often first become apparent in adolescence and may include irregular periods and excess hair on the face, chest, or back – all caused by high levels of male hormones. The syndrome is seen as a major health concern because it is frequently associated with obesity and substantially increases risk for type-2 diabetes and, perhaps, heart disease. It is also among the most common disorders of reproductive-age women, affecting up to 10 percent of the population worldwide.

PCOS runs in families, indicating that there is likely a genetic susceptibility to the disorder. This observation first raised the question as to whether men in PCOS families might also be affected. Dunaif’s research group has been able to show that brothers and fathers of women with PCOS also have elevated male hormone levels and face the same long-term health risks, such as diabetes, obesity, and heart disease. 

“Because this is a genetic condition, our research studying families has provided a powerful resource for finding causal genes,” said Dunaif. “We are very fortunate to have recruited more than 500 families over the years. Many of these families are ideal for the application of the newest technologies for identifying disease genes, such as whole genome sequencing, because we have DNA available from affected and unaffected sisters, as well as both parents.”

Andrea Dunaif, MD, is co-chair of the steering committee for the first NIH-sponsored evidenced-based methodology workshop on PCOS.

Thus far, the research points to the likelihood that the same gene defect is responsible for both the reproductive and the metabolic abnormalities. Sponsored by several National Institutes of Health grants, Dunaif and her co-investigators, Margrit Urbanek, PhD, associate professor of medicine-endocrinology, and M. Geoffrey Hayes, PhD, assistant professor of medicine, are leading an international collaboration to map genes for PCOS.

“Ultimately, we hope that we can find what causes the condition so we can develop drugs to reverse or prevent PCOS,” Dunaif said.

Dunaif is also co-chair of the steering committee for the first NIH-sponsored evidenced-based methodology workshop on PCOS, which will be held in December on the NIH campus. An independent panel with broadly-based expertise will develop a scientific statement based on the information presented at this conference. The consensus statement will advance both clinical care and future research in the field. In addition, Dunaif hopes that this statement will highlight the major health implications of PCOS so that the condition is recognized as an important medical disorder.

“PCOS is a major women’s health problem, and the fact that it is genetic means that the male relatives of affected women are at increased risk for the adverse metabolic outcomes associated with PCOS,” she said.

 

Posted by on November 16, 2012 - 2:48pm

Regular mammography screening can help narrow the breast cancer gap between black and white women.

Earlier studies have shown that black women in Chicago are more than twice as likely to die of breast cancer compared to white women. Black women with breast cancer reach the disease’s late stages more often than white women, and their tumors are more likely to be larger and more biologically aggressive.

But according to the study, when women of both races received regular breast cancer screening — a mammogram within two years of breast cancer diagnosis — there was no difference in the rate of how many of them presented in the disease’s later stages.

This study was conducted over six years in Chicago at Rush University Medical Center and Northwestern Memorial Hospital. It compared women who were regularly screened by mammograms with women who were only irregularly screened. This study reinforces the fact that regular screening by mammography can improve outcomes for all women.

An important finding – breast cancer diagnoses after regular screening were found (more likely) to be hormone receptive (tumors that contain receptors for estrogen and progesterone).  Hormone receptive breast cancers more often lead to better survival rates because of the various treatment options that have a proven record, such as Tamoxifen and Aromatase inhibitors. This leads to suggesting that early and regular screening can inhibit development of some negative biological characteristics of breast tumors.

Sources:   Rush Medical Newsletter

http://content.govdelivery.com/bulletins/gd/USCDC-5c7249

 

 

Posted by on November 14, 2012 - 2:42pm

The Patient Protection and Affordable Care Act has cleared two major hurdles in the recent past: the Supreme Court ruling on constitutionality and the reelection of President Obama. However, there is a very good chance that the Supreme Court has not seen the last of the health care reform law. Despite the bill's legal successes in the past, there are (at publication) more than 35 different cases on file against the contraception mandate in the bill filed by individual companies and religious organizations.

Thanks to the health care law, insurance plans are required to cover birth control and other women's preventive health services with no co-payments or deductibles at the start of their next plan year. For proponents of the bill, this means more health plans come under the law's reach, and that more women will be able to keep their wallets closed when they pick up their birth control.

Proponents further assert that gender equality means women having complete control over their reproductive lives. However, some organizations do not believe funding such services align with their organizational missions. Most filing amicus briefs are using the Religious Freedom Restoration Act, and it’s unanimous support by the Supreme Court, to say that the mandate violates religious organizations right to not pay for contraception.

The Religious Freedom Restoration Act requires that the federal “government may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person 1. Is in furtherance of a compelling governmental interest and 2. Is the least restrictive means of furthering that compelling governmental interest.”

Those in support of the mandate, like the American Civil Liberties Union (ACLU), believe that the mandate will be upheld. The ACLU specifically states in their amicus brief that the plaintiffs are trying to “discriminate against women and deny them benefits because of [the employer’s] religious beliefs.”

No matter where a woman falls in her beliefs about what the health reform bill should and should not require, it is clear that the Affordable Care Act still has many hurdles before full implementation. For more information about the impact of these state-level decisions on your contraception and access to reproductive health care, contact your local Congressional leaders and employer mission statements.

Posted by on November 14, 2012 - 11:28am
Carol Marin Accepting Voice for Women Award

Yesterday, at their Fifth Anniversary event,  the Women's Health Research Institute selected Chicago reporter Carol Marin to receive their first-ever Voice for Women Award.  "If you look back at her history, she has been a trailblazer in reporting----she makes sure that women's health is on the agenda," stated Institute Director Teresa K. Woodruff, PhD.   Marin is a political columnist for the Chicago Sun-Times, an editor for the Chicago NBC affiliate (WMAQ-TV), and a contributor to WTTW-TV Chicago Tonight.

In her acceptance, Marin stated "We're still way behind the eight ball in terms of being as progressive as we might be about gender.  A lot of health issues are simplified.  We don't go into them deep enough."  To learn more about this event visit the Institute's redesigned website.

 

Contributor:   Will Grunewald/Medill

Posted by on November 10, 2012 - 10:53am

Heavy drinking during pregnancy disrupts proper brain development in children and adolescents years after they were exposed to alcohol in the womb, according to a study supported by the National Institutes of Health. The study is the first to track children over several years to examine how heavy exposure to alcohol in utero affects brain growth over time.

Using magnetic resonance imaging (MRI) scans, researchers found that brain growth patterns in children whose mothers drank heavily while pregnant differed from normal patterns of development seen in children who were not exposed to alcohol before birth.

The findings suggest that children with heavy alcohol exposure have decreased brain plasticity – the brain's ability to grow and remodel itself based on experience with the outside world. Such adaptation continues throughout one’s life and is crucial to learning new skills and adapting to the environment.

"This study documents the long-term impact of heavy prenatal alcohol exposure on brain development," said Ken R. Warren, Ph.D., acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which provided most of the funding for the study.

"It underscores that heavy drinking during pregnancy often has lasting consequences for the child’s growth and development, and reminds us that women who are, who may be, or who are trying to become pregnant, should not drink alcohol."

The study currently appears online in the Oct. 31, 2012 issue of The Journal of Neuroscience.

During normal development, brain volume increases rapidly at a young age as new neural connections are formed, and then decreases in certain regions during adolescence as underused brain connections are cleared away to increase efficiency. While unexposed children showed this pattern of robust growth and reduction in the brain’s outmost layer, known as the cerebral cortex, those heavily exposed to alcohol typically only lost cortical volume.

In addition, heavier alcohol exposure was linked to lower intelligence, greater facial abnormalities, and little change in brain volume between scans.

The study findings may have implications for developing early treatments that could correct or improve these patterns of abnormal brain development.   The study authors write that this work may also help to understand and treat other disorders with abnormal brain growth in childhood and adolescence, such as autism.

This study was performed in conjunction with the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, a consortium of FASD researchers supported by NIAAA. (More information at: www.cifasd.org)

 

 

 

Posted by on November 9, 2012 - 12:54pm

Women who exercise regularly spend as much time sitting as women who don’t, according to a new Northwestern Medicine study. Emerging research shows that prolonged sitting has significant health consequences that even being a dedicated exerciser doesn't prevent women from spending too much of their day sitting.

This research is the latest indication that public health recommendations should be established to encourage Americans to limit the amount of time they spend sitting every day, said Lynette L. Craft, first author of the study and an adjunct assistant professor in preventive medicine at Northwestern University Feinberg School of Medicine.

“We all know someone who gets a good workout in every day, but then spends a large portion of their day sitting in front of a computer with few breaks,” Craft said. “If these people could replace some of the sitting with light activity---just getting up, moving around, maybe standing up when talking on the phone, walking down the hall instead of sending an email---we do think they could gain health benefits.”  Past studies have shown that people who sit for extended periods of time---even those meeting exercise recommendations---are more likely to develop chronic conditions such as diabetes, obesity, cardiovascular disease and some cancers.

This was the first study to use an objective measuring device to examine the relationship between the type of exercise recommended in the government’s Physical Activity Guidelines for Americans and sitting. The guidelines recommend adults engage in a minimum of 150 minutes of moderate intensity aerobic activity every week.

While many of the women in the study met or exceeded 150 minutes of physical activity per week, in reality only a fraction of the women’s days were spent being physically active. The women in the study spent an average of nine hours a day sitting. That number is consistent with previous results from much larger studies that examined the number of hours Americans spend sitting every day.

“I think some people assume, ‘If I’m getting my 30 to 40 minutes of physical activity a day, I’m doing what I need to do for my health,’” Craft said. “Of course, exercise is very important and is associated with many positive health benefits, but negative health consequences are associated with prolonged sitting, and this study shows that just because you’re physically active doesn’t mean you’re sitting less.”

Trying to replace some sitting time with more light activity throughout the day---along with the recommended bouts of moderate and vigorous exercise---is an approach more Americans should try to take, Craft said.

The Northwestern research was done in collaboration with Ted Zderic, of the Pennington Biomedical Research Center and was published in the International Journal of Behavioral Nutrition and Physical Activity.

Source: Northwestern NewCenter (Erin White)

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