Mentally ill people in California are more likely to be imprisoned than hospitalized, according to a recent analysis conducted by the Treatment Advocacy Center and the National Sheriff’s Association.

The recent study compared the most current data available on inmates and hospitals and estimated the odds of mentally ill Californians ending up in jail rather than receiving treatment in a medical facility are 3.2 to 1.

“Jails and prisons are not created to be de facto psychiatric hospitals and the situation is getting worse in California,” said Carla Jacobs, of the California Treatment Advocacy Coalition, “Some of our most in need citizens are suffering from both the state’s fiscal crisis and the effects of failed mental health public policies.”

As a result of cost-cutting efforts, many California counties have simply eliminated large numbers of hospital beds formally dedicated to mentally ill patients. In the past year, Sacramento County closed 50 acute care psychiatric beds. Three years ago San Francisco General Hospital had 87 acute care psychiatric beds; now it has 42. Orange County’s UCI Medical Center shut down 19 acute care psychiatric beds in the past year.

“This increasing hospital bed shortage affects everyone,” said John Rouse, M.D., a San Francisco emergency psychiatrist, “Untreated mental illness is overburdening medical and emergency rooms, endangering both mentally ill individuals and those with other medical disorders. Hospital emergency rooms are filled with untreated mentally ill patients who simply have nowhere else to go.”

According to the California Hospital Association, 25 of California’s 58 counties have no acute care adult in-patient psychiatric beds at all. The Association estimates the number of acute care psychiatric hospital beds declined by nearly 800 beds between the years 2005 and 2007 alone.

“California can solve its bed shortage crisis if it has the political will to do so,” said Randall Hagar, Government Affairs Director of the California Psychiatric Association, “In 2002, the California Legislature passed one of the nation’s most forwarding thinking statues – Laura’s Law — to provide its severely mentally ill citizens community care to stop the revolving door of hospitalization and jailings.” Laura’s Law provides for assisted outpatient treatment that can act as a safety net by enhancing community-based services as acute care psychiatric hospital beds are reduced.

“Assisted Outpatient Treatment could reduce the use of hospital emergency rooms,” said Jacobs. “But so far, only two Boards of Supervisors among California’s 58 counties have passed a resolution to use it in their counties. If Laura’s Law is not implemented, more mentally ill people will be arrested and jailed; people will stack up in emergency rooms and remain untreated in the back bedrooms of family homes.”

A national survey of U.S. women ages 40 and older revealed good news and bad news about women’s overall knowledge of breast health and how to reduce their risk of cancer. Seventy-four percent indicated they have had a mammogram with 66 percent indicating they get mammograms on a regular basis. That’s the good news in the face of concerns that controversial breast screening guidelines issued by the U.S. Preventive Services Task Force would discourage women from getting regular mammograms. The bad news is that 95 percent of women ages 40+ do not know their breast density and nearly 90 percent did not know it increases the risk of developing breast cancer.

Compounding the issue was the fact that doctors have spoken to less than one in 10 women ages 40+ (9%) about breast density. The low awareness of breast density and the fact that doctors are not talking to patients about its link to increased cancer risk is particularly troublesome to breast cancer survivor turned advocate Nancy M. Cappello, Ph.D., founder of Are You Dense, (www.areyoudense.org), a non-profit organization dedicated to informing the public about dense breast tissue.

“Prior to finding out I had advanced breast cancer, I had annual mammograms, I ate healthy and exercised, and didn’t have a first-degree relative with breast cancer. But I didn’t have all the information I needed,” said Cappello. “What I didn’t know was that I have dense breast tissue and like two-thirds of pre-menopausal women and one quarter of post menopausal women, I have a much lower chance of having breast cancer detected by a mammogram. The survey underscores the need for women to have more information about their risk and what they can do to find cancer at its earliest stage when it is most treatable.”

The national survey of 599 adult women ages 40 and older was conducted online from April 28-30, 2010, by Harris Interactive^®, a global market research and consulting firm. It was commissioned by U-Systems, the leader in developing automated breast ultrasound systems and the sponsor of the SOMO•INSIGHT study, a nationwide multi-center clinical study designed to evaluate whether digital mammography in combination with the Automated Breast Ultrasound System is more accurate than a routine screening mammogram alone in detecting breast cancer in women with dense breast tissue.

A growing body of research demonstrates a strong link between breast density and increased cancer risk of 4-6 times. One study, published in the New England Journal of Medicine (356:227-236), showed 35 percent of breast cancer goes undetected by mammography in women with dense breasts as density masks appearance of tumors. Since both dense breast tissue and cancer appear white on a mammogram, it is difficult to detect cancer when there is a lot of dense breast tissue. Analogous to looking for a specific cloud in a cloudy sky, as breast density goes up, the accuracy of the mammogram goes down.

Rachel Brem, MD, SOMO•INSIGHT principal investigator, and professor of radiology, Breast Imaging and Interventional Center, The George Washington University Medical Faculty Associates in Washington, DC, agrees that while breast density is a major health issue, there is good news out there as well.

“Mammography is an effective modality for screening for breast cancer, and women aged 40 and above should have annual screening mammograms. However in women with dense breasts, the breast density can obscure a cancer. This is particularly problematic as women with dense breasts have an increased risk of breast cancer. Therefore, we need additional approaches to improving breast cancer detection in women with dense breasts.

“Several studies have shown that for women with dense breast tissue, supplementing mammograms with ultrasound can increase detection from 48 to 97 percent. While ultrasound is a proven tool throughout the diagnosis and treatment of breast cancer, it has not typically been used during the screening process. Establishing a solid scientific basis for the use of breast ultrasound as a cancer screening tool in certain populations, like women with dense breasts, is one of the primary reasons we’re conducting the SOMO•INSIGHT study,” added Dr. Brem.

When asked whether they would consider having an ultrasound exam or other additional imaging testing if they had increased breast density, nearly one-third (32%) of women ages 40+ indicated they would. Despite the fact that only five percent of women ages 40+ knew their own breast density prior to the survey, a significant number indicated that it is important for women over 40 to know their breast density (26%) and want to know their own breast density (23%).

To help women learn more about breast density and gather information for conversations about their breast health with their doctors, U-Systems also announced the launch of a dedicated web site for the SOMO•INSIGHT Study. Offering detailed information on the study, participation guidelines and an online eligibility quiz, the SOMO•INSIGHT web page also provides detailed background on breast density and Automated Breast Ultrasound. For more information and a list of participating clinical sites, call 866-364-6777 or visit http://www.somoinsightstudy.org.

Only 12% of adults think they had the flu this past winter, fewer than the 15% to 21% who thought they had the flu in other winters since 2004. We emphasize “think” because it is widely believed that not everyone who has flu-like symptoms actually has the flu.

However, there is no evidence that flu shots should get the credit for the decline in the number of people with the flu. The 39% of adults who had flu shots is almost the same as those who had them in two previous winters (40% in 2008-2009, and 36% in 2007-2008). Furthermore, for the third year running – the proportion of adults who believe they got the flu was the same (12%) among those who did and did not get flu shot.

These are some of the findings of a new Harris Poll® survey of 2,755 U.S. adults, surveyed online between April 12 and 19, 2010 by Harris Interactive.

This is a complicated subject and there are several reasons for caution in interpreting these findings – for example, it would be erroneous to conclude that the flu vaccines used last winter had no effect. However, it is probably safe to conclude that the flu vaccines used to protect people over the last three winters were less effective than the vaccines used to protect people in the winters of 2006-07, 2004-05, and 2003-04. In each of those winters, people who received shots were significantly less likely (especially in 2004-05) to get the flu (or to believe they got it) than were those who did not have flu shots.

Reasons for Caution

There are two reasons to be careful when analyzing these data.

Other findings of this Harris Poll include:

• Men and women were equally likely to have had flu shots (38% for men, 39% for women) and equally likely to believe they had the flu (12% for both men and women).
• People under 40 were more likely than people over 40 to report having had the flu. This may be a result of the higher incidence of flu shots among older people or the higher levels of immunity built up over time by older people.
• African-Americans (6%) are much less likely than Whites (12%) and Hispanics (19%) to report having had the flu, although similar proportions of these three groups received flu shots.
• Most (66%) of those who report having had the flu this winter believe they had a “regular flu.” Only 13% believe they had the H1N1 flu virus. More than a fifth (22%) were not sure.
• The proportion of adults who think they will have a flu shot next winter is the same as those who had one this last winter (39%), and they are mostly the same people. Only 3% of those who had a flu shot say they will not get one for this coming winter.

Mayo Clinic researchers have found that the kidneys of healthy adults show signs of chronic mild injury that increase with age. This damage is present even though the adults showed no clinical signs of kidney disease. The findings are reported in the current issue of the, Annals of Internal Medicine.

“This was a surprise,” says Andrew Rule, M.D., M.Sc., a Mayo Clinic nephrologist and epidemiologist who led the study. “These patients’ kidneys are functioning normally, and this damage doesn’t show up on the tests doctors routinely use to assess kidney health. It means we need to come up with new tests to detect mild kidney injury more accurately.”

The medical records of 1,203 people who donated kidneys at Mayo Clinic from 1999 to 2009 were used for the cross-sectional study. The donor kidneys were examined with a needle biopsy once they were transplanted into the recipient as part of a routine procedure to gather baseline information about the new kidney.

The researchers looked at four signs of nephrosclerosis, or chronic kidney injury: glomerulosclerosis (scarring of the kidney’s filtration units), tubular atrophy (loss of the tubes that process urine), interstitial fibrosis (general scarring of the kidney tissue), and arteriosclerosis (narrowing of tiny blood vessels).

Researchers discovered that the percentage of donors with nephrosclerosis ranged from 2.7 percent for men and women ages 18–29 years to 73 percent for those ages 70–77 years. The greater damage with older age was not explained by differences in kidney function or risk factors for kidney disease.

“Even though there are signs of damage, the kidneys were functioning within normal parameters,” says Dr. Rule. “These findings do not mean that older people shouldn’t donate kidneys. As far as we know, this mild kidney injury is an inevitable consequence of aging. Instead, we need an age-specific cut point for kidney function to identify early kidney disease. Right now, doctors use the same cut point for a 20-year-old as for a 70-year-old. This does not take into consideration the normal decline in kidney function that comes with aging. With older age there may be decreased demand for kidney function since the changes in kidney function do not reflect kidney injury on biopsy.”

Dr. Rule is working with an international team to develop a new test for nephrosclerosis. He says that people can lessen damage to their kidneys by preventing and treating diabetes and controlling their blood pressure. “Even when kidney function tests are normal, people with high blood pressure have kidneys that look eight years older on biopsy than the kidneys of people with normal blood pressure,” Dr. Rule says.

The GE Foundation – the philanthropic organization of GE – and the GE Corporate Diversity Council today announced the award of $1.25 million in total to five Houston community health centers toward the goal of increasing access to primary care for uninsured and underserved populations across the city.

The donations expand the reach of the GE Developing Health program, a 3-year, $25 million commitment that provides grant funding and GE employee engagement to selected health centers across the United States. The grant announced today in Houston is the largest grant to date for the Developing Health Program.

“GE recognizes there is a critical need in the U.S. healthcare system and the Developing Health program seeks to help fill the gap in access to quality care for underserved communities,” said Bob Corcoran, president of the GE Foundation. “Our partnership with these Houston health centers is a great example of the positive impact that can be made by combining funding with GE’s volunteer support.”

The four Houston medical centers are:

• El Centro de Corazon (Eastwood clinic)
• Good Neighbor Health Care (Heights Blvd. location)
• Spring Branch Community Health Center (Hillendahl location)
• Two Legacy Community Health Services (Southwest and Westheimer)

Each of the five health centers will receive $250,000, in two installments over two years. Grant funds will be used by each health center to increase access to primary care; specific grant programs will be identified through a collaborative dialogue between the health center leadership and community stakeholders. Houston is the third city to receive grants through the GE Foundation’s Developing Health initiative after New York City and Milwaukee. It is also the largest grant to date under the program, which will eventually extend to 10 cities across the United States.

“Houston is the fourth largest metropolitan area in the country. By partnering with these clinics to increase access to primary care we can help more people get the care they need when they need it,” said Mike Barber, VP, GE healthymagination. “This program and the volunteers supporting it are a living example of GE’s healthymagination strategy to help change the world’s approach to healthcare by touching more lives and improving quality of care.”

In addition to the grants themselves, the program announced today includes volunteering from area GE employees drawing on their business management skills. Complementing the financial donation, this unique approach ensures that the health centers also benefit from GE’s expertise including process improvement and business management based on the needs of clinic.

“We are honored to be recognized by GE for this funding and the supporting volunteers, which will allow us to increase access and improve our services for the more than 33,000 patients and almost 130,000 visits we have annually,” said Legacy Community Health Services executive Katy Caldwell. “Legacy Community Health Services offers a comprehensive range of services aimed at removing barriers, reducing health disparities, and improving health and the quality of life in the community.”

Developing Health is a partnership between GE Corporate Citizenship and GE Corporate Diversity Council teams that designed and launched the program in October 2009.

“GE recognizes that a diverse, healthy workforce and community is critical for a company to thrive in today’s competitive environment,” said Deborah Elam, VP and Chief Diversity Officer, GE. “Through Developing Health, GE’s Diversity Council aims to help underserved communities of all cultures across the US gain access to quality primary healthcare.”

Under the program guidelines, the GE Foundation will provide grants to the selected health centers. Grant recipients were selected based on criteria that include, but are not limited to, need, community impact, leadership, and willingness to partner with GE volunteers, transparency and accountability. The GE Foundation will not accept unsolicited requests for support.

Obese women are more likely to have breast cancer detected at a later stage and to have lymph node metastases when diagnosed than women who are not obese, according to a study presented this week at the Annual Meeting of the American Society of Breast Surgeons.

“Obese women in our study had larger tumors than the non-obese women, but were less likely to find these cancers through a self breast exam. The majority were diagnosed through mammography, suggesting breast cancers may be more difficult to palpate in obese women. These results were significant,” said lead researcher Danielle Haakinson, MD, Surgical Resident at the Mayo Clinic in Arizona.

The research also found obese women had a lower overall cancer survival rate, probably due to later stage disease at diagnosis. However, other illnesses associated with obesity may also affect survival.

This study underscores the importance of regular mammograms for obese women. “Without mammogram screening, breast cancer diagnosis may be delayed,” Dr. Haakinson comments. “This information must be shared with both women and their primary care providers. Other studies have found that obese women are less likely to comply with regular breast cancer screening practices. This, combined with possible increased difficulties in finding a lump in large breasts, may contribute to the poorer breast cancer survival rate among obese women.”

In the study, researchers compared 327 women classified as obese by accepted body mass index standards (BMI>30) with 1025 patients not considered obese who were treated for invasive breast cancer from 2000 to 2008 at the Mayo Clinic in Arizona. They found that 10 % fewer obese women were seen by doctors for evaluation of a mass found on a self breast exam than were non-obese patients.

“While a number of factors may come into play, another possibility is that obese women simply are less likely to examine their breasts thoroughly, possibly because they are uncomfortable with their body image,” comments Dr. Haakinson.

Noting that other research has uncovered links between breast cancer and obesity, Dr. Haakinson says that her findings may result from a combination of factors. “Obese women already have increased breast cancer risk,” she comments. “Now, this study shows they present with more advanced stages of breast cancer.”

“Interestingly, we did not find an increase in tumor characteristics associated with poor survival in obese women. Therefore finding their cancers when smaller might boost their survival rate.”

Experts agree that obesity is a significant, growing health risk and has been linked to numerous cancers. Dr. Haakinson says, “The message is clear—obese women must be particularly vigilant in pursuing breast cancer screening through annual mammograms and check ups. The good news is that these are relatively easy steps to take once a woman understands the positive impact on her health.”

A year-long collaboration between professionals and parents has resulted in Missouri’s first guidelines dealing with autism. Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment is geared toward clinicians, educators, service providers and parents and is the most current document of its kind in the U.S.

With the Centers for Disease Control reporting that autism affects one out of every 110 children in the U.S., these Guidelines provide clear, consistent recommendations designed to facilitate the critical first steps toward treatment.

“Research shows that early diagnosis and treatment results in improved quality of life for most children with autism. The Guidelines focus on getting to those interventions faster through more consistent protocols for screening, diagnosis and assessment,” explains Bill Thompson, president of the Thompson Foundation for Autism. The foundation sponsored the Missouri Autism Guidelines Initiative along with the Division of Developmental Disabilities of Missouri Department of Mental Health.

The Guidelines combine current research, clinical experience and knowledge of Missouri practice in one document. It includes case examples and a series of easily referenced best practice recommendations. Georgina Peacock, M.D., M.P.H., of the Centers for Disease Control, notes, “It is essential for all those working or living with children with ASD to have access to thorough, comprehensive information, which these Guidelines provide. Children with ASD and their families will definitely benefit from this information and thoughtful collaboration.”

“The Guidelines keep the child and the family at the center of every step toward intervention,” says Bernard Simons, director of the Division of Developmental Disabilities. “The Guidelines respect and value the role of families in effective care and recognize that every person with autism is different and requires individualized supports, services and intervention. Community collaboration is key – that means clinicians, educators and service providers working hand in hand with families.”

Marilyn Cox, Cape Girardeau, Mo., is the parent of a son diagnosed with ASD in the mid 1980s. She served on the Missouri Autism Guidelines Initiative, a group of 42 professionals and parents. “I have seen much progress in the diagnosis of autism. However, this document in the hands of parents can serve as a road map for seeing the red flags, seeking diagnosis and being directed to expedient treatment. It is a fact that early intervention is the answer to the most effective treatment.”

The Guidelines can be downloaded at no cost at www.autismguidelines.dmh.mo.gov.

Approximately 57.2 million people under the age of 65—more than one in five (22.4 percent) of America’s non-elderly population—have a diagnosed pre-existing condition that could lead to a denial of coverage in the individual health insurance market, according to a report released today by the consumer health organization Families USA.

Once the newly-enacted health reform law is implemented, these people will gain significant protections: The new law prohibits insurance companies from denying health coverage to people due to pre-existing conditions; from charging discriminatory premiums based on health status; and from excluding benefits that would treat their health conditions.

The report shows that, while individuals in all age groups have pre-existing health conditions, this is a problem that grows with age:

• Nearly one in six (15.9 percent of) young adults aged 18 to 24 have a diagnosed pre-existing health condition that could lead to a denial of coverage.
• More than one-third (35.3 percent) of adults aged 45 to 54 have a diagnosed pre-existing condition that could lead to a denial of coverage.
• In the 55 to 64 age group, the portion of adults with diagnosed pre-existing conditions climbs to more than two in five (45.5 percent).
• Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adult groups, there are nearly 5 million children with such conditions.

“The tens of millions of Americans with diagnosed health conditions, and the many others who at some point may receive such a diagnosis, are the people most in need of health care coverage,” said Ron Pollack, Families USA’s Executive Director. “Thankfully, the new health reform legislation will protect all these individuals from the most harmful insurance company abuses that deny such critical coverage.”

In its analysis, Families USA indicated that the 57.2 million number may understate how many people have pre-existing conditions because it only reflects those with diagnosed pre-existing conditions. Americans who are currently uninsured or underinsured, and who cannot afford care, often do not seek treatment and, as a result, their health condition may not be diagnosed.

The uninsured and those who do not have access to job-based coverage are at greatest risk; however, even those who now have coverage at work could be at risk if they lose or leave their jobs and have to find coverage in the individual market.

Income is no protection against an individual’s having a pre-existing condition that could lead to a denial of coverage, and the 57.2 million Americans with diagnosed pre-existing conditions range across all income levels.

• The lowest-income Americans are most likely to have a pre-existing condition. Nearly one-quarter (24.2 percent) of those individuals in families with incomes below 100 percent of the federal poverty level—less than $22,050 for a family of four—are affected.
• Approximately 21.9 percent of individuals in families with incomes between 100 and 199 percent of poverty—between $22,050 and $44,100—are affected.
• While the lowest-income Americans are slightly more likely to be affected by pre-existing conditions, more than two-thirds (69.8 percent) of those with pre-existing conditions that could lead to a denial of coverage are middle class and higher-income Americans. These are individuals in families with incomes above 200 percent of poverty, or more than $44,100 for a family of four in 2010.

Individuals in every racial and ethnic group have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

• Approximately one-quarter (24.4 percent) of non-Hispanic whites have pre-existing conditions.
• Nearly one-quarter (23.4 percent) of African Americans (non-Hispanic) have such a condition.
• Slightly more than one-quarter (25.9 percent) of American Indians and Alaska Natives are affected.
• More than one in six (16.9 percent) Hispanics are affected. It is important to note, however, that disparities in access to care and in the delivery of care may mean that many individuals have a pre-existing condition that has not been diagnosed. For example, more than a quarter (25.2 percent) of Hispanic adults had no health care visits in 2007, compared to 14.7 percent of non-Hispanic adults.

“As our study shows, more than one-fifth of the non-elderly population will now gain protections that they need to secure affordable health coverage,” said Pollack. “As more and more people learn about these protections, they will no doubt cherish the enactment of health care reform.”

The data for the report were based on data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau’s Current Population Survey (CPS). Families USA commissioned The Lewin Group to analyze the data.

Kids and teens often think they know what’s best. When it comes to preventing childhood obesity, maybe we should listen to them, says Baker Harrell, executive director of ACTIVE Life, a non-profit organization that seeks to combat obesity with social activism. Empowering kids to help families be healthier is more effective than lecturing our children on the importance of good nutrition, he says. Harrell and other experts recently spoke to BeSmartBeWell.com about the childhood obesity epidemic, its causes and solutions.

BSBW: How do we talk to today’s kids—the so-called ‘M generation’—about healthy choices?

Harrell: Young people in this generation seek out empowering experiences—experiences that allow their voice to be heard. For parents, what’s important is not talking down or telling a child to do something and instead becoming a collaborative partner with that young person. Let their voice be heard, let their perspective be heard and let their fears and desires be heard.

BSBW: How do we do that when it comes to food and nutrition?

Harrell: Look for opportunities to be active together as a family or to talk about food, and talk about healthy, nutritious food around the dinner table. But engage and then empower your children to become part of the family’s conversation. Admit to your child, ‘Hey, I need your help, our family needs your help and we need your voice. We need you to play a lead role in helping our family live a healthy, active lifestyle.’ That’s not something a young person hears very often.