Short Bout of Exercise Might Boost Your Memory

News Picture: Short Bout of Exercise Might Boost Your MemoryBy Alan Mozes
HealthDay Reporter

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MONDAY, Sept. 24, 2018 (HealthDay News) — Just a little bit of light exercise can immediately improve a person’s memory, new Japanese research suggests.

How little? The small study involved 36 healthy college-aged men and women and found that just 10 minutes of relaxed cycling on a stationary bike was all it took to improve recall during memory testing conducted right afterwards.

Why? Brain scans on 16 of the participants indicated that short bouts of mild exercise appeared to trigger an instant uptick in communication between the hippocampal dentate gyrus and the cortical brain regions. Both brain areas are key to processing memory.

Study author Hideaki Soya characterized the findings as “striking evidence” of how a “very light [exercise] protocol indeed has beneficial effects on brains and cognition.” He is chair of the Advanced Research Initiative for Human High Performance at the University of Tsukuba in Ibaraki, Japan.

Soya also said the results are “good news for people who do not like to exercise,” including those in poor physical health or older folks.

And even though the study only measured the exercise dividend among young men and women, Soya stressed that his team’s earlier research suggests that mild exercise seems to produce broad results, “not only with the young, but also with the elderly.”

But just how long might the memory affect linger? Soya said it’s too soon to say for sure. “But at this time,” he added, “we can say that the exercise effect lasts at least 15 minutes after 10 minutes of exercise.”

Soya and his colleagues report their findings in the Sept. 24 issue of the Proceedings of the National Academy of Science.

In the study, all participants randomly underwent memory testing twice, once after completing 10 minutes on a stationary bike and once after no exercise of any kind.

Memory testing began within five minutes following the exercise/no exercise task. Testing initially involved showing each participant images of everyday objects, at which point all were asked to indicate if the object was typically used indoors or outdoors.

In turn, all were then shown a second round of images and asked to recall if they had been shown the image before, or if the image was similar or entirely new.

A little less than half of the group had memory testing while also undergoing high-resolution f-MRI brain scans.

In the end, the research team found that when participants engaged in a short bout of light exercise, there was a “rapid enhancement” in their ability to recall information accurately.

What’s more, the scans suggested that the observed enhancement seemed to reflect an increase in “functional connectivity” between brain centers critical to memory performance. The more such brain communication went up post-exercise, the more a person’s memory skills improved, the investigators said.

Heather Snyder, senior director of medical and scientific operations with the Alzheimer’s Association, said it remains to be seen to how the exercise-enhanced “brain plasticity” Soya’s team observed among young adults will ultimately play out among seniors.

“While there is widespread consensus that physical activity, even in moderation, is beneficial for brain health, less is known about the specific benefits or the biology of how physical activity works in our brains,” said Snyder, who wasn’t involved with the research.

“The current findings are intriguing, because they suggest physical activity may improve memory,” she acknowledged. And the AA makes a point of advising seniors to stay active, noting that “physical activity is a valuable part of any overall body wellness plan and is associated with a lower risk of cognitive decline.”

Still, Snyder stressed that “an important next step is replicating the study in older adults to see if the same results are achieved.”

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SOURCES: Hideaki Soya, Ph.D., professor, laboratory of exercise biochemistry and sports neuroscience, and chair, Advanced Research Initiative for Human High Performance, faculty of health and sport sciences, University of Tsukuba, Ibaraki, Japan; Heather Snyder, Ph.D., senior director, medical and scientific operations, Alzheimer’s Association, Chicago; Sept. 24, 2018, Proceedings of the National Academy of Science.


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Exercise May Delay Rare Form of Alzheimer’s

News Picture: Exercise May Delay Rare Form of Alzheimer's

Latest Alzheimer’s News

TUESDAY, Sept. 25, 2018 (HealthDay News) — Regular exercise might delay a rare form of early onset Alzheimer’s disease, a new study suggests.

Researchers found that 2.5 hours of walking or other physical activity a week thwarted mental decline tied to autosomal dominant Alzheimer’s disease (ADAD). This is an inherited form of disease that leads to dementia at an early age.

“The results of this study are encouraging, and not only for individuals with rare genetically caused Alzheimer’s disease,” said Maria Carrillo, chief science officer for the Alzheimer’s Association.

“If further research confirms this relationship between physical activity and later onset of dementia symptoms in ADAD, then we need to expand the scope of this work to see if it also is true in the millions of people with more common, late-onset Alzheimer’s,” Carrillo said in an association news release. She wasn’t involved in the study.

A team led by Dr. Christoph Laske at the University Hospital of Tubingen in Germany examined data on 275 people who carry a genetic mutation for ADAD. The participants’ average age was 38.

The investigators wanted to see if at least 150 minutes per week of walking, running, swimming or other exercise could help delay or slow disease progression.

It may. Those participants who got more physical activity scored higher on brain function assessments, the study found.

They also had lower levels of key biological markers of Alzheimer’s disease in their cerebrospinal fluid, including tau — a protein that builds up in the brains of people with Alzheimer’s.

“A physically active lifestyle is achievable and may play an important role in delaying the development and progression of ADAD,” Laske and his team wrote. “Individuals at genetic risk for dementia should therefore be counseled to pursue a physically active lifestyle.”

The World Health Organization and the American College of Sports Medicine recommend the exercise target of 150 minutes a week.

The study was published online Sept. 25 in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

— Mary Elizabeth Dallas

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SOURCE: Alzheimer’s Association, news release, Sept. 25, 2018


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Prostatectomy plus radiotherapy associated with greater survival in prostate cancer patients

High-risk prostate cancer, that which has continued to grow but not yet metastasized, is commonly treated with combination therapies. Each method has pros and cons, but there is little clarity whether one might be more effective than the other. For the first time, researchers have shown that more patients live longer if treated with the combination of prostate removal plus radiation therapy. The research was published September 25th in the journal Cancer.

“There’s a lot of debate about whether to remove the whole prostate and follow up with radiation therapy. Or, as a second option, to spare the prostate and treat it using radiation therapy plus hormone-blocking therapy,” said senior author Grace Lu-Yao, PhD, Associate Director of Population Science at the Sidney Kimmel Cancer Center – Jefferson Health, one of only eight NCI-designated cancer centers nationwide with a prostate cancer program of excellence. “Our study suggests that removing the prostate followed by adjuvant radiotherapy is associated with greater overall survival in men with prostate cancer.”

The risks of prostate removal, or prostatectomy, are well known and include higher chance of developing incontinence and erectile dysfunction. There are some risks associated with radiation treatment and hormone therapy, but they are less common, and are typically thought to have a lower impact on quality of life. “Prostatectomy is an unpopular treatment,” said Lu-Yao. “Our study showed that only six percent of men with high-risk cancer were treated with it.” It’s not just the risk of side effects.For some men, especially those who are not fit enough for the surgery, prostatectomy is not an option. However, this may be an option for some patients to reconsider.”

In the largest population-based retrospective study to date, Dr. Lu-Yao and colleagues examined the records of 13,856 men in the Medicare-SEER registry diagnosed with locally advanced prostate cancer — cancer growth that had not yet metastasized to distant sites in the body. Dr. Lu-Yao and colleagues looked at the patients who were treated either with prostatectomy plus adjuvant radiation as one group, and compared them to another group who were treated with radiation therapy plus hormone-blocking therapy. They matched the comparison groups by age, race and co-morbidity to control for factors that may influence patient outcomes, and analyzed which group did better 10 to 15 years after their procedures.

They found that 10 years after treatment, 89 percent of the prostate removal plus radiation group was still alive. That compared with the 74 percent survival at ten years in the group that received only radiation plus hormone therapy, amounting to a 15 percent survival advantage in the group that was treated with prostate removal.

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“For high-risk prostate patients we started the use of aggressive radiation therapy after surgery 20 years ago,” said Adam Dicker, Senior Vice President and Chair of the Department of Enterprise Radiation Oncology at Jefferson Health, who was not involved in the study. “We recognized that it may have curative potential.”

“However, the proportion of men undergoing prostatectomy plus radiation therapy decreased significantly over time and there were trade-offs for the survival advantages,” said Dr. Lu-Yao. Men who received the combination of surgery and radiotherapy had higher rates of erectile dysfunction (28 percent vs 20 percent) and higher rates of urinary incontinence (49 percent vs 19 percent).

Another interesting finding from the research was that slightly more than half of men diagnosed with the disease did not receive combination therapies for their prostate cancer. “Two modes of treatment are recommended by both United States and European guidelines for cancer treatment. It was surprising to see only 29 percent of patients received the recommended combination therapies, and as many as 20 percent are not getting any treatment six months after their diagnosis,” said Dr. Lu-Yao. “Our data can’t tell us the reason for this deviation from guidelines and further studies are needed.”

“One of the strengths of retrospective studies of patient data is that it reveals what happens in the real world, rather than the carefully controlled context of a clinical trial,” said Dr. Lu-Yao. “Our data is revealing the real-world practice as well as some of the advantages and disadvantages of those medical preferences.”

“This important study demonstrates that many men with high-risk prostate cancer derive a survival advantage through a multi-modality approach to their disease. Several large clinical trials are nearing completion that should validate these retrospective findings of the benefits of primary radical prostatectomy followed by additional therapies such as adjuvant radiation,” said Leonard Gomella, Chair of the Department of Urology at Jefferson (Philadelphia University + Thomas Jefferson University), who was not involved in this research.

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5 Things To Know About Trump’s New ‘Public Charge’ Immigration Proposal

A proposed rule from the White House would make it harder for legal immigrants to get green cards if they have received certain kinds of public assistance — including Medicaid, food stamps and housing subsidies. Green cards allow them to live and work permanently in the United States.

“Those seeking to immigrate to the United States must show they can support themselves financially,” Homeland Security Secretary Kirstjen Nielsen said in a statement.

The proposal, announced Saturday night, marks a new frontier in the administration’s long-term effort to curb immigration, both legal and illegal. It already has spurred intense criticism from Democrats, anti-poverty activists, health care organizations and immigrants’ rights advocates, who call its restrictions unprecedented.

“We are operating in an overall climate of tremendous fear and anxiety as a result of the administration’s overall approach to immigration enforcement and immigration policy,” said Mark Greenberg, a senior fellow at the Migration Policy Institute, which studies migration and refugee policies at local, national and international levels. He is also a former Obama administration official.

But what effect would this proposal have?

It’s a complicated question, touching upon vast government programs, with billions of dollars at stake. While the implications aren’t all immediately clear, Kaiser Health News breaks down some of the key elements.

1. First Thing First: What Is The White House Proposing?

The Trump administration wants to redefine a status known as “public charge” — a category used to determine whether someone seeking permanent resident status is “likely to become primarily dependent on the government for subsistence.”

In the past, people have been at risk of being defined a “public charge” if they took cash welfare — known as Temporary Assistance for Needy Families, or Supplemental Security Income — or federal help paying for long-term care. (Immigrants must be in the country legally for five years before being eligible for TANF or SSI.)

And that “public charge” designation could undermine their applications for permanent residence.

The new rule would expand the list to include some health insurance, food and housing programs. Specifically, it would penalize green-card applicants for using Medicaid, a federal-state health plan for low-income people. (Penalties would not apply for using Medicaid in certain emergencies or for some Medicaid services provided through schools and disability programs.)

Using food stamps, Section 8 rental assistance and federal housing vouchers would also count against applicants. Enrollment in a Medicare Part D program subsidy to help low-income people buy prescription drugs would work against them, too.

The proposal “is definitely a dramatic change from how public charge works today,” said Kelly Whitener, an associate professor at Georgetown University’s Center for Children and Families who specializes in pediatric health benefits and managed-care systems.

A leaked version of the rule from March suggested officials then were also considering penalizing those who receive subsidies to buy health insurance on the Affordable Care Act marketplaces. But that idea was not in the proposal published this weekend. The marketplace subsidies are aimed at people at a generally higher income bracket than the beneficiaries targeted in the Trump plan, Whitener noted.

“They’re really homing in on low-income immigrants,” she added.

Nielsen said the proposed rule is “intended to promote immigrant self-sufficiency and protect finite resources.”

2. Is This As Unprecedented As Critics Say?

Yes.

Public charge is an old idea. In the 1990s, lawmakers expanded it to consider explicitly whether people had received cash-based welfare.

But including programs like Medicaid and food stamps, which are much wider in scope, is a significant change. It would more likely hit working people — the majority of people on Medicaid are themselves employed, and almost 80 percent live in families with at least one working member, according to data compiled by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Children who are American citizens but whose parents are immigrants could be more likely to suffer repercussions, said some experts. When parents opt out of public assistance for fear of their own legal status, their kids are less likely to be enrolled in programs such as the Children’s Health Insurance Program, or CHIP, for which they would qualify.

To be clear, receiving public aid wouldn’t necessarily stop people from getting a green card. But it would tilt the odds against them.

“Another piece is the enormous discretion the administration will have under its proposal in making judgments about who gets admitted to the country and who gets a green card,” said the Migration Policy Institute’s Greenberg.

3. When Will The Policy Shift Take Effect?

This is an early step in the complex federal rule-making process. And a lot could still change.

Once the proposed rule appears in the Federal Register, a 60-day countdown starts, during which anyone can weigh in with comments.

A final rule likely wouldn’t take effect until 2019.

And DHS is still seeking input on some details. For instance, it hasn’t decided whether CHIP would be counted as one of the “public charge” eligible programs.

In the interim, people who had received public benefits before the rule took effect would not be penalized for doing so.

4. Already, Though, The Proposal Is Having Effects.

DHS estimates that 2.5 percent of eligible immigrants would drop out of public benefits programs because of this change — which would tally about $1.5 billion worth of federal money per year. But others expect a much larger impact.

“The chilling effects will be vastly greater than the individuals directly affected,” Greenberg said. “There’s considerable reason to believe that [the White House estimate] may be a significant understatement.”

In the proposed rule, DHS notes that the changes could result in “worse health outcomes,” “increased use of emergency rooms,” “increased prevalence of communicable diseases,” “increased rates of poverty” and other concerns.

Given the complexity of these programs and the proposed rule — and the high stakes at play — low-income immigrants would be much more likely to avoid public benefits altogether, immigration experts said. Millions of immigrants are likely to be affected directly or indirectly, according to the Center for Law and Social Policy, a D.C.-based nonprofit organization.

That could have stark health implications.

Take free vaccines, for which children are often eligible and which would not be subject to the public charge rule. Families afraid of jeopardizing a green card could still be more likely to opt out of that service, Whitener said.

Already, she added, there are reports of people declining federal assistance — even though nothing has yet happened.

“The fear factor cannot be underestimated,” she said.

5. Will People Sue?

Legal action is likely.

Officials such as California Attorney General Xavier Becerra, who has frequently clashed with the White House, are weighing challenges to the rule.

“The Trump Administration’s proposal punishes hard-working immigrant families — even targeting children who are citizens — for utilizing programs that provide basic nutrition and healthcare. This is an assault on our families and our communities,” Becerra said in a statement.

But these actions depend on the final shape of the regulation, which could change through the rule-making process.

“They are likely to receive a very large number of sharply critical comments, and there is no way to know what changes they might make as a result,” Greenberg said.


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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Cases of newborns with syphilis doubles in four years – CDC

(Reuters) – The number of newborns born with syphilis has reached a 20-year high, the Centers for Disease Control and Prevention said on Tuesday, tracking a general increase in several sexually transmitted infections.

The CDC said reported cases of congenital syphilis, which is when the disease is passed from mother to baby, jumped 153 percent between 2013 and 2017, from 362 cases to 918.

The research institution blamed at least some of the cases on inadequate screening and health care access, noting that a third of women who gave birth to a baby with syphilis contracted the disease after doctors screened for it.

Such syphilis cases carry higher risks of miscarriage, newborn death and lifelong health issues.

The biggest increases were reported in western and southern states, the CDC said.

Syphilis can be easily treated with antibiotics, even during pregnancy, but if it is untreated, women have an 80 percent chance of transmitting it to their babies.

The CDC has attributed the general rise in sexual transmitted infections to lack of awareness about such diseases, inadequate screening and cuts to public health funding.

Reporting by Makini Brice; Editing by Alistair Bell

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French bioethics body backs IVF for all women who want children

PARIS (Reuters) – Lesbian couples and single women who want to bear children should have access to medically assisted reproductive treatments such as in-vitro fertilization, France’s highest bioethics body said on Tuesday.

The topic has stirred political debate in France, which legalized gay marriage in 2013 in the face of often virulent opposition from the more conservative parts of the country, where the Catholic Church still commands influence.

“During the public consultation, we heard how contentious this issue is, there was no consensus,” said Jean-Francois Delfraissy, president of the National Consultative Committee on Ethics (CCNE).

“After listening to all of the arguments, the CCNE decided to stand by its position”, set out in June 2017, that lesbian couples and single women should have the right to such medically assisted reproductive methods, he said.

Amandine Giraud and her wife Laurene Corral pose with their children Makenzy and Leandre conceived with fertility assistance during an interview with Reuters in Paris, France, September 25, 2018. REUTERS/Christian Hartmann

The government is expected to make a final ruling later this year, which could be followed by legislation. President Emmanuel Macron’s government said last year it wanted to change the law, which currently limits the treatment to heterosexual couples.

IVF assistance is widely available to all women, independent of sexual orientation, in countries including Britain, Belgium, Spain and Israel.

Campaigners welcomed the CCNE’s announcement, calling it a victory over discrimination. Alice Coffin, media director for the European Lesbian Conference, said that as the law now stands, lesbian and straight couples were not treated equally.

“If I fall in love with a woman… if I can’t have a child, I’m told ‘No, we won’t do anything to help you. We’re not going to help you have a child, go and look somewhere else’,” she said. “It’s very brutal.”

Some political commentators regard the issue as similarly socially divisive as the decision by the Socialist government to legalize same-sex marriage five years ago, a move that led to nationwide protests, some of which turned violent.

Amandine Giraud and her wife Laurene Corral pose with their children Makenzy and Leandre conceived with fertility assistance during an interview with Reuters in Paris, France, September 25, 2018. REUTERS/Christian Hartmann

At the time, campaigners were also pushing for the legalization of surrogacy for gay couples, but the government decided to retain the ban, deeming the issue to be too incendiary.

Reporting by Julie Carriat, writing by Sudip Kar-Gupta, editing by Geert De Clercq and Ed Osmond

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Study: Optimizing dopaminergic treatment improves non-motor symptoms and quality of life

Non-motor symptoms are common in late stage Parkinson’s disease (PD) as the frequency and severity of most of these symptoms increase with advancing disease. Optimizing dopaminergic treatment in the most severe stages can affect non-motor symptoms and improve quality of life, report scientists in the Journal of Parkinson’s Disease.

PD is generally considered a disease that affects movement, but it also involves a large number of non-motor symptoms, which previous research has shown to have a greater impact on health-related quality of life than motor symptoms. Common non-motor symptoms include cognitive impairment, mood-related symptoms such as depression, apathy, sleep/daytime sleepiness, fatigue, and autonomic dysfunction such as urinary urgency, incontinence, and erectile dysfunction. The frequency and severity of most of these symptoms increase with advancing disease. Previous research has shown that the frequency and severity of non-motor symptoms as a whole are the most important predictors of health-related quality of life in patients with PD.

“Patients in late stage PD – the last four or five years of the disease – are a forgotten group, whose situation we do not know much about,” explained lead investigator Per Odin, MD, PhD, Professor, Department of Neurology, Lund University, Lund, Sweden, and Chairman, Department of Neurology, Central Hospital, Bremerhaven, Germany. “There is reason to believe that relatively many patients in the late stage of PD may be insufficiently treated. Since the effect of dopaminergic therapy may not be as obvious in the late stage as in earlier disease stages, there is a clear risk for undertreatment. The general aim of the present research is therefore to learn more about this group of patients, to get a basis for improving their situation.”

The goal of the present study was to find an optimal pharmacological treatment for patients with late stage PD. Investigators assessed the effect of dopaminergic therapy on non-motor symptoms in 30 patients. Participants were recruited from the southern region of Sweden through neurology departments and the municipality-based health care system. The patients were in “Hoehn and Yahr” stages IV and V; the Hoehn and Yahr scale is a commonly used system for classifying how the symptoms of PD progress.

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The dopaminergic effect on non-motor symptomatology was assessed using a Non-Motor Symptoms Scale (NMSS) in the “off” and the “on” state during a standardized L-dopa test and assessing non-motor symptoms in parallel with motor function. Motor symptoms fluctuate between an “on” state, during which the patient experiences a positive response to medication, and an “off” state, during which the patient experiences a re-emergence of the Parkinson symptoms suppressed during the “on” state.

The study found that non-motor symptoms were common and many of the symptoms occurred in more than 80% of the individuals. The highest scores (frequency x severity) were seen within the NMSS domains 3: mood/apathy and 7: urinary in both the “off” and the “on” states. The differences in the NMSS score between the “off” and the “on” state were larger in general for motor responders than for motor non-responders.

The investigators concluded that there is often an L-dopa effect on both motor and non-motor symptoms even in the most severely ill PD patients, and that even if there is not a significant motor response, there was often a non-motor effect, particularly on mood or depressive symptoms. They emphasize the importance of optimizing L-dopa treatment in the late stage of the disease to give patients the best possible quality of life.

“We encourage colleagues who treat PD to pay attention so that the treatment is optimized throughout the disease progression and into the most severe disease stages,” commented Dr. Odin. “The knowledge that sufficient dopaminergic treatment may have important effects on both motor and non-motor symptoms in severe PD patients can hopefully help treating physicians improve quality of life for their patients with late stage PD.

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‘Physicians Of The Mouth’? Dentists Absorb The Medical Billing Drill

DUBLIN, Calif. — On a recent Friday morning, more than 30 dentists and dental staffers gathered in a conference room to learn an arcane new skill: how to bill medical insurers.

Pacing back and forth, the Florida dentist leading the two-day course advised the participants to stop thinking of themselves as tooth technicians and reposition themselves as “physicians of the mouth.”

“There is a medical part of our practice and a dental part,” said the presenter, Chris Farrugia, as audience members tapped on their keyboards or scribbled notes. “You have teeth, [and] you got the ‘other stuff.’ It’s the other stuff that medical insurance pays for.”

Faruggia’s seminar is a sign of a growing trend in dental offices, as providers seek greater reimbursement for expensive services and patients balk at big bills. Around the internet, firms have popped up claiming expertise in medical billing for dentists and offering courses and consulting services.

The reason is simple: Medical insurance is generally much more generous in its coverage than dental insurance.

Unlike medical coverage, dental insurance is mostly geared to the healthy — something many people don’t realize until they experience serious oral problems and get socked with unexpected costs. Standard dental insurance covers cleanings, fillings and other routine care. But major work like a crown or a bridge is often covered only at 50 percent and implants generally aren’t covered at all. And dental insurance is usually capped at $1,000 or $1,500 per year.

As a result, people who require extensive reconstructive work often pay many thousands of dollars, or sometimes tens of thousands, in out-of-pocket expenses. Many other people, even with dental coverage, go without care because they cannot afford the large balances or co-pays for crowns, root canals and other major procedures.

Because of these differences in reimbursement, Farrugia told his seminar attendees, dentists should first consider what medical insurance might cover and then bill the dental plan for the rest.

For example, he said, dentists should seek medical coverage for the full head, neck and mouth exams they perform when they see a new patient, since the goal is to assess more than just the teeth. Medical insurers should also cover oral problems attributable to an underlying medical condition, such as diabetes or dry mouth, a common side effect of many medications, Farrugia said.

Besides sparing patients the pain of big bills, the strategy can also boost income for dentists, said Farrugia, who estimated that revenues for his practice rose almost 10 percent the first year he fully implemented medical billing. Patients, too, can learn to file claims for medical reimbursement if their dentists won’t, he said.

On its website, the California Dental Association explains that health insurance should cover costs that are “medically necessary” and lists more than a dozen categories of procedures that could qualify. Among them: treatment related to inflammation and infection, dental repair due to injury, certain periodontal surgery procedures and appliances for sleep apnea.

Kristine Grow, a spokeswoman for America’s Health Insurance Plans, the industry trade association, did not dispute that some dental procedures could be covered by medical insurance. However, she cautioned that medical insurers were always on the lookout for abuse.

“Claims that are billed inappropriately or submitted fraudulently hurt everyone because they raise costs,” Grow said. “It’s important to note that procedures not related to an emergency event or trauma may not be medically necessary, and therefore would not be covered by medical insurance,” she added.

Asked about the potential for abuse, Farrugia said: “There are unethical providers in all health care services, and dentistry is not immune to that. You will always have some that try to game the system.”

Farrugia adopted medical billing several years ago after paying more than $100,000 for a CT scanner that produces 3-D images of the bone in the mouth and jaws.

“It occurred to me that this was a medical device,” he said of the CT scanner. “I’m a licensed health care provider, I’m providing this within the scope of my license. They can’t discriminate against me.”

Once he investigated the matter, Farrugia discovered that medical insurance could be asked to cover not just CT scans but a wide range of services regularly performed by dentists. He buried himself in the arcana of coding, ultimately writing three workbooks for dentists about medical billing.

At first it was trial-and-error, and Farrugia learned that claims often get rejected if they do not cite a medically legitimate reason for the procedure as well as the appropriate code.

These days, Farrugia bills medical plans $744 for a CT scan (medical code: CPT 70486), receiving an average reimbursement of about $500. Medical plans generally require pre-authorization for non-emergency CT scans, he said, so his office staff had to learn how to explain why the scan was medically required — such as to assess bone quality.

The same procedure can be billed to a dental plan (dental code: D0367), but the average reimbursement is $125 — if the plan covers CT scans at all.

Others are following his example. Iowa dentist Richard Downs attended one of Farrugia’s medical billing seminars last year in Chicago. “I’d never heard these things before,” he said.

He said he recently sought and received prior authorization from a medical insurer for $60,000 to cover multiple implants and other costs for a woman whose dental woes stemmed from severe atrophy of the jaw and other medical problems.

During a break in the seminar, San Ramon, Calif., dentist Rashpal Deol said Farrugia’s approach made sense. “We look at the soft tissues in the mouth, the muscles, the bone, the TM [temporomandibular] joint, and the head and neck area,” he said. “You always check the lymph nodes, we do oral cancer screening, so that is a comprehensive medical exam.”

Other seminar attendees also were enthusiastic, if a bit daunted. “People go to school to learn medical coding,” said Kelly Bradshaw, a staff member at a Santa Rosa, Calif., dental practice. “To try to bridge that gap in order to help our patients is intimidating. You have to be open-minded to look at things in different ways.”

Margaret Busch, an office manager for an Arizona dentist, said she planned to start medical billing as soon as she returned from the seminar.

“I’ve been making a list of people that we can go back and probably get money for,” she said, mentioning patients who have had CT scans and those with dental problems related to medical conditions like diabetes.

“I think they’ll be excited,” she said.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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Blood, Sweat And Workplace Wellness: Where To Draw The Line On Incentives

Workplace wellness programs that offer employees a financial carrot for undergoing health screenings, sticking to exercise regimens or improving their cholesterol levels have long been controversial.

Next year, they may become even more contentious. Two recent court rulings have cast uncertainty over what is the appropriate limit for financial incentives that employers can offer workers to participate in programs that require clinical testing or disclosure of personal health data. The dollar amount is subject to debate because it raises questions about when the incentives become so high that employees feel they don’t have a choice about participating.

As a result, workers may find programs offer smaller incentives, consultants say. Also, programs might give employees options for qualifying for those incentives — a choice, for instance, between undergoing a medical exam or completing online health education modules.

About 4 in 10 employers participating in an informal survey by benefits firm Mercer said “they really were not sure what they would do,” said Steven Noeldner, its senior consultant in total health management specialty practice. “Some are modifying … others are taking a wait-and-see-attitude.”

Eighty-five percent of large employers offering health insurance included a wellness program designed to help people stop smoking, lose weight or take other healthful actions, according to a 2017 survey by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) Just over half of those included some type of medical screening. Rewards or incentives to participate vary. The most common are gift cards, fitness trackers or other merchandise, or discounts on what workers pay toward their health insurance coverage.

The Cleveland Clinic’s version is more extensive than most, said Dr. Bruce Rogen, chief medical officer for the effort. He described it as a “population health program,” with differing goals for workers who have chronic diseases like diabetes versus those who don’t.

Full participation, which may mean losing weight, keeping blood sugar levels in check or hitting a gym at least 10 times a month, can save workers 30 percent in insurance premiums. That could be as much as $1,443 a year.

“Part of what makes the plan work is the fact we can offer that benefit discount,” Rogen said.

That 30 percent amount is the ceiling set in a 2016 Equal Employment Opportunity Commission (EEOC) rule for what an employer can offer.

But it’s also the point that leads critics to question when incentives become significant enough that employees no longer feel that participation is voluntary.

“You and I can look at the same incentive and you will find it’s truly voluntary and I would say, given my financial circumstances, I feel I’m being compelled,” said Tom Luetkemeyer, an attorney specializing in employment law at Hinshaw & Culbertson in Chicago.

Shortly after the EEOC’s guidance was issued, the AARP challenged it in court, arguing that workers who did not want to provide medical information could feel coerced to do so because not participating would cost them substantial sums, ranging from hundreds to thousands of dollars.

In his first ruling, D.C. Circuit Court Judge John Bates noted that the EEOC had failed to provide justification for how it settled on that percentage. He also pointed out that 30 percent of a worker’s health insurance costs could be “the equivalent of several months’ worth of food for the average family, two months of child care in most states, and roughly two months’ rent.”

Bates ultimately ordered the 30 percent limit vacated as of Jan. 1, 2019, after the EEOC said it would not produce that justification or a new number until 2021.

Employers now putting together next year’s health benefit programs don’t have specific rules to follow.

The advice they are receiving from benefit consultants ranges widely, from “drop all incentives and penalties” to “stay the course.”

Few expect employers will outright stop offering wellness programs because they hope the programs will hold down health costs by getting workers to take steps to improve their well-being. Critics, however, point out that studies show little evidence that workplace wellness programs achieve these goals.

The ruling does not affect some wellness program efforts, such as offering financial incentives for going to the gym or walking a certain number of steps per day. Substantial financial incentives to get people to quit tobacco are also not covered by the ruling, so long as there is no medical test required to check for nicotine use.

But “you can’t fine them for not getting their weight down, because then you have to measure their weight and that becomes clinical,” said Al Lewis, a frequent critic of workplace wellness programs who runs a company that offers an alternative.

Some employers say they will stick with their existing programs — even if they hit the 30 percent level — because the EEOC is unlikely to challenge those that stick with the rescinded percentage until new rules come out.

The Cleveland Clinic’s Rogen, who credits the wellness program for holding medical costs almost flat for the past five years, said clinic officials plan to leave it at that level next year, despite the uncertainty.

Not all benefit consultants would agree with that choice.

“The way we interpret the ruling is that financial incentives that relate to physical exams, including questions about health history, would not be allowed starting Jan. 1,” said Noeldner, of Mercer.

Others suggest that is taking the judge’s ruling too far. After all, the Affordable Care Act provides a precedent for the 30 percent threshold — and the EEOC may well come back with a rule that reaffirms that amount. The ACA included a provision that raised the limit on health-contingent wellness incentives to that amount.

“People may be overreacting to this by saying with these rules null and void, we are out in the Wild West,” said Todd Hlasney, senior vice president and director of health risk solutions at Lockton Companies, a benefits consultancy. “We are advising clients to be more conservative … but don’t panic and say [you] can’t do anything because of EEOC.”

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Kids may pick up marijuana at younger age if mom uses

(Reuters Health) – When mom uses marijuana, kids are more likely to try the drug at a younger age, a new study shows.

When mothers used cannabis during the first 12 years of a child’s life, there was a 40 percent higher likelihood the kid would start using the drug earlier than peers whose moms weren’t using, researchers reported in the American Journal of Preventive Medicine.

On average, children whose mothers used marijuana tried it themselves an average of two years earlier than peers whose mothers didn’t use the drug.

That puts those kids at risk for a host of marijuana-linked problems, said lead study author Natasha Sokol, who was a doctoral student at the Harvard T.H. Chan School of Public Health when the research was done.

Kids with mothers who used marijuana were at increased risk of starting to use the drug themselves before age 17. Their peers were more likely to start at 18.

The time between 16 and 18 “is a critical period of development,” said Sokol, who is now at the Center for Alcohol and Addiction Studies at the Brown University School of Public Health. “Marijuana might be disrupting certain aspects of brain development, including the development of the endocannabinoid system. It’s been associated with depression and, in predisposed individuals, there seems to be an increased risk of the development of psychosis.”

Marijuana use at this age can also affect a child’s ability learn, Sokol said. “Missing school or functioning at a lower level in school is a big deal,” she said. “Especially if it’s for an extended period of time.”

Sokol and colleagues analyzed data from participants in the National Longitudinal Survey of Youth and their biological children who signed on for the NLSY Child and Young Adults survey. The NLSY is a nationally representative survey that included 12,686 individuals living in the U.S. in 1979 between the ages of 14 and 21. NYSL participants were interviewed annually up until 1994 and then biennially after that. Out of 4,440 mother-child pairs identified by the researchers, 2,983 children, or 67 percent, and 1,053 moms, or 35 percent, said they used marijuana.

One limitation of the study, Sokol said, is the researchers didn’t have information on whether the kids knew their moms were using cannabis.

While that is a limitation of the study, “we also know that children are much more aware than we think they are,” said Dr. Michael Lynch, a toxicologist and emergency medicine physician and medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center. “That’s been proven again and again.”

Lynch said he wasn’t surprised to see children imitating behaviors modeled by their parents. But, “it’s nice to have a peer-reviewed work that identifies the risk that children are more likely to start using marijuana if they grow up in homes with a mother who uses the drug,” he added.

The findings are “concerning” Lynch said. “That’s because it’s in the context of expanding use and a more permissive culture around marijuana use,” he added. “All – even proponents – agree that younger initiation is unhealthy. That’s been fairly well studied, from an academic and career standpoint and from a cognitive development standpoint.”

Moreover, Lynch said, people who start marijuana at a younger age are at greater risk of addiction to either marijuana or prescription opioids.

“The finding is important but not surprising,” said Dr. Salomeh Keyhani, a professor of medicine at the University of California, San Francisco. “Studies of maternal tobacco smoking and adolescent initiation have had similar findings.”

“The results are particularly concerning given the unresolved debate on the association of adolescent use of cannabis and decreases in IQ,” Keyhani said. “The results are also concerning because there is no coordinated public health campaign that is informing the public of the potential risks of cannabis use.”

Sokol hopes her new findings won’t be misused.

“I don’t think this study needs to be evidence against legalization,” she said. “That’s not a successful public health policy.”

SOURCE: bit.ly/2Q3DvJ2 American Journal of Preventive Medicine, online September 24, 2018.

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