The Salina Journal from Salina, Kansas on April 1, 1998 · Page 6
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The Salina Journal from Salina, Kansas · Page 6

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Salina, Kansas
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Wednesday, April 1, 1998
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Page 6
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A4 WEDNESDAY, APRIL 1, 1998 HEALTH THE SALINA JOURNAL T HEART FAILURE Study: Pump up use of heart drug Higher dose of drug does better job of treating heart failure By DANIEL Q. HANEY The Associated Press ATLANTA — Doctors could avoid 250,000 hospital admissions ih the United States each year by sharply increasing doses of a standard medicine used to treat con- .gestive heart failure, a major study concludes. Researchers said they hope their findings will result in an immediate change in the way doctors prescribe the medicines, known as ACE inhibitors. ACE stands for angiotensin con- yerting enzyme. • "We are asking physicians to take a drug they know works and use it the right way," said Dr. Milton Packer of Columbia Universi- t BIRTH RATES ty, who directed the study. Packer released the results of the study, conducted on 3,164 patients in 19 countries, at a meeting Monday of the American College of Cardiology. Heart failure is a rapidly growing problem, in part because so many more people have been saved from heart attacks and are living with damaged hearts. An estimated 4.9 million Americans have heart failure, up from 3.4 million eight years ago. Heart failure is not what happens when the heart stops beating. Rather, it typically is a gradual ebbing of the heart's power to pump blood and supply the body with oxygen, often resulting in shortness of breath, swelling and an increased risk of death. The usual medicines for this disease are diuretics, which help relieve swelling; digitalis, which makes the heart contract more Drop in male births blamed on pollution Male fetuses are more vulnerable to pesticide exposure, study says By LINDSEY TANNER "file Associated Press - CHICAGO — The search for Mr. Right may be getting even harder. The ratio of boys to girls born in the United States and Canada dipped ever so slightly between 1970 and 1990, and a study suggests environmental factors — such as prenatal exposure to pesticides — may be why. ; The declines began even earlier in several other industrialized countries and corresponded with increases in some male birth defects and prenatal exposure to pesticides and industrial chemicals, said Devra Lee Davis, an environmental epidemiologist at the World Resources Institute, a Washington-based policy-research institute. -" Davis and her colleagues examined information on birth ratios and increases in male birth defects, such as misplaced urinary openings, and testicular cancer. ; "Some, as yet unrecognized, environmental health hazards are affecting the sex ratio of births as well as other unexplained defects in male reproduction," they con- T CONGRESS eluded. Their analysis appears in today's Journal of the American Medical Association. Some studies have indicated male fetuses are more vulnerable than females to prenatal exposure to toxic substances and either die before birth or are born with defects or a susceptibility to cancer. Other studies have suggested environmental factors can cause harm even before gender has been determined and may block embryos from developing into males. Although the death rate for males tops that of females at nearly every age, the worldwide human sex ratio hovers around 106 male births for every 100 female births. That is, about 51.5 percent of births are males. In the United States, the percentage dropped from about 51.34 percent to 51.21 percent between 1970 and 1990, the researchers reported. That's a decrease of one male birth per 1,000 live births, or 38,000 males over the 20-year period, the researchers reported. In Canada, the loss was 2.2 male births for each 1,000 live births, or 8,600 males, during the 20-year period. Similar declines were noted in the Netherlands, Scandinavia, Finland and Germany; some began as early as 1950 and lasted into the mid-1990s. Democrats introduce bill to overhaul managed care By The Associated Press WASHINGTON — Emergency room care and access to specialists would be guaranteed under •managed care legislation Democrats introduced Tuesday. '. - The bill, one of several intro- 'd'uced to overhaul managed care, •is aimed at providing consumer protections for people using health maintenance organizations. . The legislation also would prevent "inappropriate interferences by insurance companies in the doctor-patient relationship," said House Democratic leader Dick ; Gephardt of Missouri. •' "I'm co-sponsoring this legislation because, right now, we have a system where HMOs make more money when they deliver less care," Rep. Sam Gejdenson, D- Conn,, said. "To stop the abuses that HMOs inflict on their patients and to make health care affordable, we have to ensure that patients and their doctors, not accountants, have control of the health care system." The bill includes provisions that would: • Requires that plans cover the cost of emergency medical care, even if performed without prior authorization, in any situation that a "prudent lay person" would regard as an emergency. • Allow patents to go out of the plan's network for specialty care at no extra cost if there is no appropriate provider in network. • Require timely appeals and independent external appeals when plans deny a course of treatment. • Provide enrollees understandable information about their health plan. CUSTOMER SERVICE FROM THE HEART. Windsor Estates of Salina will make you feel right at home with our staff of professional caregivers. Individualized attention begins at the moment of admission 24 hours a day, 7 days a week. We have semi private rooms available. Call now! SPECIAL SERVICES • 24-hour skilled nursing services • Specialized skin and wound care • Medicare certification • Physical therapy • Occupational therapy • Speech therapy • Therapeutic recreation • Around the clock admissions • Day care service with transportation available. Complete Living Facility for Retired Persons \ irvindsor Estates We "The question is, are we giving the right doses to do anything?" Dr. Edwin Alderman Stanford University forcefully; and ACE inhibitors, which relax blood vessels, reducing the resistance to circulation. Several studies have shown that ACE inhibitors slow the progression of the disease when given in high doses. However, the drugs sometimes cause kidney problems and dangerously low blood pressure. So doctors typically give much smaller doses in the belief that this is safer and works just as well. "The question is, are we giving the right doses to do anything? Are we fooling ourselves?" asked Dr. Edwin Alderman of Stanford University, who was not involved in the study. Packer said his study shows two standard assumptions by doctors are wrong: The low dose is not nearly as effective and the side effects are similar. Packer estimated that across the United States, routine use of the higher dose would translate into 250,000 fewer hospitalizations annually and a savings of $2 billion. ACE inhibitors cost about $1 a day. There is little difference between the price of high and low doses. A coauthor of the study, Dr. John Cleland of the University of Glasgow, said that because fewer people who took the higher doses were hospitalized, switching everyone to the higher dose would average out to a savings of $350 per patient per year. 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