Saturday, November 21, 2009
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Health | Politics and Government
Rural, Urban Democrats Tussle Over Medicaid
01/29/2009

Rural and urban members of Congress are fighting over how goodies in the stimulus package will be divided, according to the Wall Street Journal. (The Journal is subscription only, so if the link below doesn't work, that's why.)

The Journal's Health Blog reports:  "Democrats from rural and urban areas are wrestling over the formula to divvy up $87 billion in Medicaid funding. In the House bill, 52.5% of the funds would be doled out under the typical formula that’s used annually, and the rest would be given out under a new “bonus” program that favors states with high unemployment rates. This is worrying the folks in poor rural states where the unemployment numbers are already high, but where the rate of decline in jobs isn’t as steep as in urban areas. “We are getting killed,” said Sen. Kent Conrad of North Dakota."

This is a fight within the Democratic Party. The Yonder reported last week that while unemployment in rural areas is higher than in urban counties, in fact job declines have been steeper in the cities than in rural communities.

Health
Recession Is Making People Unhealthy
01/25/2009

There's nothing particularly rural in this story we saw in the Boston Globe. It's just interesting. Stephen Smith reports that hospital admissions are way up now over a similar period last year and doctors are blaming the economy. "In hospital wards and medical clinics across Massachusetts, doctors see growing evidence that the ill economy is making patients sick, spawning headaches and churning stomachs, and even causing bouts of anxiety and depression among people who never before sought psychiatric help," Smith writes.

The McLean hospital, one of the nation's best psychiatric institutions, 31 percent more patients were admitted last month than in December 2007. "I've been stunned by how pervasive the impact of the current economic downturn is on the health of my brood," said Dr. Stephen Hoffmann, whose medical practice in Framingham has nearly 3,000 patients.

Some patients are cutting back on medication to save money. (Smith found this to be particularly true for people with psychiatric troubles.) Others may not be eating as many fruits and vegetables, gobbling down more processed, salty foods that raise blood pressure. People who had managed to find a time and place for exercise during good times were back in their no-exercise ways now. Still others drink more alcohol. "The addiction business is booming," said one doctor.

Health
Black Lung is Back — And Nobody Knows Why
01/12/2009
Black lung is back and nobody knows exactly why. Black lung is a disease afflicting underground coal miners. They breath in coal dust and, over time, miners' lungs are so damaged they stop working. Laws passed in the 1960s helped cut down the number of miners with black lung by controlling the amount of dust in the air. But Carole Bass reports in an online publication that now those gains are starting to erode.

Bass said federal officials have focused on several reasons for the resurgence of black lung disease among underground coal miners. First, the dust standards are still too lenient. There's too much dust in the air and the federal government has refused to lower the standards — to clean up the air in the mines. Also, miners are working longer hours. Instead of a 40 hour week, miners are underground sometimes 60 hours or more. They breath in more dust, and they have less time out of the mines for their lungs to clean themselves.

Finally, researchers believe that as miners dig thinner seams of coal, they are cutting into more rock, mixing silica dust with coal dust. Silica is 20 times more harmful than coal dust and so miners are breathing more toxic air.

Health
Injury Rates are Higher in Rural, Seatbelt Use is Lower
01/07/2009
Who said living in rural America was easy? Turns out, country living is downright dangerous, compared to life in the metros, according to a recent study.   "The perception is that life in rural areas is peaceful, tranquil, serene," said Jeffrey H. Coben, M.D., a professor in the WVU Injury Control Research Center. "If you just look at violence - person against person - the rates are higher in urban areas. But for virtually every other cause of trauma, the risks are substantially greater in rural areas."

As the population density decreases, hospitalization rates for injuries increases. Hospitalization rates for injuries were 35% higher in sparsely populated rural counties compared to urban counties. Large urban counties carried the highest hospitalization rates for assaults. But rural counties led in hospitalizations for motor-vehicle crashes, falls and poisonings. Self-inflicted injuries were also higher in rural counties, with poisons, knives and guns the instruments of choice.

There are tons of reasons for the higher injury rates. More people are engaged in high-risk occupations in rural areas, like mining and logging. Injuries in car crashes are higher because people drive more and because seatbelt usage is lower.
Health
Rural Hospitals Search for General Surgeons
01/01/2009
In a front page story on New Year's Day, the Washington Post finds that a dwindling number of general surgeons are to be found in rural communities. General surgeons are the "essential ingredient that keeps full-service medical care within reach" of rural residents, reports David Brown. But the number of general surgeons graduating each year hasn't increased since 1980,   even though the country's population has increased by 79 percent. There are shortages of general surgeons everywhere.

"Nevertheless, it's in rural America -- where some places have only half as many surgeons per capita as cities -- that the problem is most acute," Brown writes. "And it's likely to get worse. More than half of rural general surgeons are older than 50, and a wave of retirements is expected in the coming decade." Without surgeons locally, hospitals have to fly patients to metro facilities. That's hard on patients, and it's hard on the finances of rural hospitals that are losing business.
Health | Politics and Government
Daschle Attends Health Forum in Town of 700
12/30/2008
It will only be one of 8,500 community forums the Obama Administration will hold on the nation's health care system, but this was among the first, it was attended by incoming Health and Human Services Secretary Tom Daschle and it took place in a town of just 700 people. Some 35 people turned out in Dublin, Indiana, yesterday to talk about health care. A woman asked what her 13-year-old son would do for health insurance, given his congenital heart problem, according to a report in the Indianapolis Star. A family practice office manager told of the mountainous number of forms he had to fill out to be paid by insurance companies. The fire chief wondered who would pay for new equipment his volunteer outfit would need by 2010.

Daschle (above, at the meeting) asked questions and took notes. He said the stories he heard will help change the minds of some in Congress. The Washington Post sees the forums as part of an elaborate, grass-roots campaign similar to the effort that elected the Democrat. With other issues, it seems the Obama transition team has scant understanding of rural needs. Not so with health care, it appears.

Health
Drug Overdoses Spike across West Virginia
12/16/2008
oxycodoneA study of 2006 fatalities from drug poisoning in West Virginia shows that, with more powerful opioids in circulation, rural communities have caught up with a big city problem.
Health
Study Inconclusive on Lead in Processed Venison
11/06/2008
A study that attempted to determine if venison eaters had higher levels of lead in their blood was released this week. The results were inconclusive. Last year a Bismarck, North Dakota, doctor and hunter X-rayed venison collected from food pantries around the state. In May, a more formal study of 738 North Dakota residents began, reports the Bismarck Tribune .

The epidemiologist who conducted the study said the tests indicated that those people who eat a lot of venison killed with lead ammunition "tended to have higher lead levels than those who ate little or none." However, none of those tested had lead levels that would be considered elevated.

State officials recommended that people could minimize their consumption of lead by following safe processing procedures. The state's recommendations can be found here.

Health
Rural Dental Care: The Younger, the Better
10/29/2008
dentist thumbMany rural children are federally eligible for free dental care but fail to receive it, for many reasons and with dire consequences. Judy Owens reports on innovations in rural dentistry that are serving the young.
Health
Idaho Needs a Few Good Doctors, and Then Some
10/15/2008
idaho doctor thumb
These days you don't read many 5000-word feature stories -- they're nearly as hard to find as a doctor in rural Idaho. So thanks to the Boise Weekly and writer Carissa Wolf for an excellent article about the state's shortage of physicians and the Family Medicine Residency program that's had some success bringing doctors in.

Idaho ranks last in the nation in physicians-per-patient. Susie Pouiiot, head of the Idaho Medical Association (IMA), told Wolf "if all Idahoans had health insurance, many would still have a tough time accessing medical care," even in Boise, the capital. In rural parts of the state, the doctor shortage is staggering. Wolf interviews a number of country doctors: "Everybody needs you and you're the only show in town," says one. Another makes his weekly rounds via airplane.

Wolf describes a breathless day in the life of a rural physician. She also explains the difficulties attracting new doctors and a number of state efforts to turn the problem around: a possible Idaho medical school, reduced tuition at med schools in neighboring states, analysis of rural physicians' "personality types." But Pouliot of the IMA has found, residency programs "give you the best bang for your buck."

Wolf writes that "physicians tend to establish practices near their residency programs. Fifty-four percent of the graduates of the Family Medicine Residency of Idaho program practice in Idaho. The majority of those physicians practice in rural areas."

Daily Yonder | Keep It Rural
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