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Medicare Part D coverage significantly reduced nondrug medical spending for beneficiaries who had limited drugcoverage prior to the start of the federal prescription drug plan, Harvard Medical School researchers reported inJAMA. PAGE 2

Foods to Eat for Healthy, Glowing Skin PAGE 10

More U.S. Men Die From Cancer ThanWomen: Study

PAGE 8

22nd annual Wellington RegionalMedical Center Residency Programgraduation PAGE 13

Medicare Part D Reduced

Spending on Medical Care......2

Heal that wound, Save

Your Leg, Save Your Life ........3

A Safe Tan? No Way,

Experts Say.............................4

More U.S. Men Die From

Cancer Than Women: Study ...5

The anatomy of a healthy

office.......................................6

Top 10 Skin Myths

Debunked................................7

Advances in Cancer

Treatment: IMRT and IGRT .....8

Foods to Eat for Healthy,

Glowing Skin ........................10

Testimonials from our

patients .................................11

Life Tweaks That Will Make

You Happier and Healthier ....12

22nd annual Wellington

Regional Medical Center

Residency Program

graduation ............................13

Help Your Kids Stay

in Shape This Summer .........14

Medicaid Coverage

'Substantially' Improves

Access to Care: Study...........15

Medicare Part D ReducedSpending on Medical Care

In dollars, Medicare spent nearly$306 per quarter less than expectedon beneficiaries who previously had

a limited drug coverage.

Medicare Part D ReducedSpending on Medical Care

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The results also highlight a need for bettercoordination between all parts of Medicare,the investigators wrote.

goal of closing the "doughnuthole," the gap in drug coverageunder Part D, he added. "The costof closing the doughnut hole couldbe less than what we might expectbecause of these partially offset-ting reductions in spending onnondrug medical care."

The results also highlight a needfor better coordination between allparts of Medicare, the investiga-tors wrote.

"Even though Part D plans func-tion completely separately fromPart A and Part B of the Medicareprogram, and even though theyhave no financial incentive to lowercopayments, particularly for bene-ficial medications, clearly providingthis benefit to seniors through stand-alone Part D plans has been quiteeffective," Dr. McWilliams said.

Medicare Part D cove-rage significantly re-duced nondrug med-ical spending for

beneficiaries who had limited drugcoverage prior to the start of thefederal prescription drug plan, Har-vard Medical School researchersreported in JAMA.

The 10.6% savings was mostlydue to a decrease in spending onacute and postacute care underMedicare Part A

"These reductions in nondrugmedical spending suggest that PartD has not cost as much as what weinitially thought," Dr. J. MichaelMcWilliams, the study’s lead au-thor, said in an interview.

The findings could also lend sup-port to the Affordable Care Act’s

The authors used data from theHealth and Retirement Study andlinked it to Medicare claims datafrom 2004 to 2007 on 6,001 ben-eficiaries, then categorized thebeneficiaries as having had gener-ous (2,538) and limited (3,463)drug coverage prior to implemen-tation of Part D. NontraditionalMedicare beneficiaries, such asthose who qualified for Medicare

before age 65 or those with veter-ans’ health benefits, were ex-cluded.

For the control cohort, they se-lected a similar group of 5,988beneficiaries who had generous(2,537) and limited (3,451) drugcoverage in 2002. They studiedthe group up to 2005.

They found that total nondrugmedical spending before Part Dimplementation was not signifi-cantly higher for beneficiaries withlimited drug coverage comparedwith those who had generous drugcoverage (7.6% relative differ-ence).

However, after implementation ofPart D, nondrug medical spend-ing for beneficiaries who previ-ously had limited drug coveragewas 3.9% lower than those whopreviously had generous drug cov-erage, leading to a significant dif-ferential reduction of 10.6%.

In dollars, Medicare spent nearly

$306 per quarter less than ex-pected on beneficiaries who pre-viously had a limited drug cove-rage.

"The economic and clinical bene-fits suggested by these reductionsmay be enhanced by further ex-pansions in prescription drug cov-erage for seniors, improvementsin benefit designs for drug-sensi-tive conditions, and policies thatintegrate Medicare payment anddelivery systems across drug andnondrug services," the authorswrote.

Previous studies have shown thatthe implementation of Part D hasbeen associated with reduced out-of-pocket costs, increased med-ication use, and better medicationadherence as well as decreasedhospitalization for ambulatorycare-sensitive conditions.

The authors had no conflicts of in-terest to disclose. The study wassupported by grants from severalcharitable foundations.

Sometimes Sleeping on the Job May Be a Good ThingPeople who powernap perform muchbetter, sleep expertssay.

Top U.S. officials who havetaken a hard line against airtraffic controllers napping

on the job are missing an opportu-nity to improve air safety, sleepexperts say.

Studies have shown that short"power naps" have a rejuvenatingeffect, improving reaction timeand critical thinking for people im-paired by drowsiness, said Dr.Alon Avidan, associate professorof neurology and associate direc-tor of the sleep disorders programat the University of California, LosAngeles.

"The data show if people take ashort power nap, it actually makesthem perform much better," Avi-dan said. "It doesn't disrupt theirsleep. It doesn't make them wakegroggy."

The U.S. transportation secretary,Ray LaHood, has expressed op-position to napping by air trafficcontrollers. Under his guidance,

the U.S. Federal Aviation Admin-istration has added an extra hour tothe amount of time controllersmust be off between shifts, afterincidents this spring when con-trollers were found sleeping whileon overnight duty. But, the agencyhas kept its zero-tolerance policyfor sleeping on the job.

However, Avidan said that an ex-tra hour does not address the coreproblem. Air traffic controllers,like others working late shifts, arefighting against a number of bio-logical factors that encourage theirbodies to sleep -- factors that onlygrow stronger as they remainawake.

"The longer we are awake, themore drive we have for sleep,"Avidan said. "It gets stronger and

stronger as the day goes by."Chief among these factors is thebody's circadian rhythm, whichhelps set each person's cycle ofwaking and sleeping.

The circadian rhythm tends to dipduring late mid-day, at around 3p.m. to 4 p.m. for someone workingdaytime hours. The dip makes theperson drowsy, reducing their alert-ness and capabilities, Avidan said.

"That's why we all go to Starbucksaround 3 to 4 p.m.," he said.

People eventually shrug off the ef-fects of the circadian dip, but whileit has them in its grip, he said,they'll be slightly impaired.

Sleep experts believe it's better ifpeople don't fight the circadian

rhythm, particularly those whosejobs demand constant vigilance.Instead, they believe that employ-ers should set aside space, such asa break room or duty area, whereworkers can go to grab a quick nap.

"All you need is about 15 or 20minutes to have a significant im-pact on performance," Avidansaid.

The nap needs to be short. Any-thing longer than 30 minutes startsto encroach upon actual sleep andcan have a detrimental effect on aperson's alertness, said Dr. HeleneA. Emsellem, director of the Cen-ter for Sleep & Wake Disorders inChevy Chase, Md.

"Long naps can be difficult towake up from and are not as pro-ductive as short naps," Emsellemsaid. Avidan agreed, adding thatpeople who take longer naps aremore likely to wake up groggy.

Nonetheless, power naps are notfor everyone. Some people find ithard to wind down while they're atwork, Emsellem said. And somepeople simply will not nap, even ifthey need it, because of societalperceptions of people who sleep

on the job, she said.

"Unfortunately, I think there's astigma attached to taking a nap,so many people don't take advan-tage of the opportunity," she said."We tend to think of sleepy peopleas lazy people."

On the other hand, workers shouldnot burn the candle at both endsand expect to successfully substi-tute on-the-job naps for actualsleep.

"A nap is a Band-Aid, in a sense,"Emsellem said. "You don't wantto Band-Aid grossly misallocatedsleep with a power nap. Employ-ees need to understand their sleeprequirements."

But for those who could use aworkday nap, research has foundthat employers are beginning tocatch on, with a growing numberoffering workers a place to powernap, she said.

"I don't think it's an unreasonableoption to have available," Em-sellem said. "As we move towarda 24/7 society, we have to be care-ful to give people the opportunityto get the sleep they need."

Dr. J. Michael McWilliams.

FLORIDAHEALTHNEWS-ONLINE.COM AUgUST ISSUE • 2011 3

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Heal that wound, Save Your Leg, Save Your Life

Do you are someone youknow have a stubborn sorethat just will not seem toheal? A scratch, blister,

open wound, or an area that seems tobleed when you knick it and it doesn’tseem to heal? If so, you may have achronic wound. With the constantdevelopment of new treatments, newdrugs, earlier diagnoses , and preven-tive education we, as a population,are living longer, even with diseasesand maladies that before wouldshorten our life spans. Most chronicwounds are associated with systemicdisease processes that inhibit thewound healing. Therefore, since ourpopulation is living longer with thesesystemic disease processes, thechronic wound care population is in-creasing.

A chronic wound is a wound that failsto heal or show significant improve-ment within a time frame, usually 4weeks. It can present to the woundcare physician in a number of ways.Wounds can present as open draining

sores, a break in the skin that just doesnot heal, a recurring blister or openarea that bleeds, or an open drainingsore. Chronic wounds, without ap-propriate treatment, are likely to be-come infected and unfortunately manylead to leg amputations. Following abelow knee amputation mortality ratesof the patient increase significantlyover the next 5-15 years.

The wound care physician must firstdetermine expected outcomes of anywound. The outcome is healing. How-ever, many factors influence the out-come measurement of a chronicwound, therefore, a comprehensive as-sessment is the sentinel starting point.The patient's health history is the firstcritical indicator of one's ability toheal. Disease processes such as pe-ripheral arterial disease, pulmonarydisease, diabetes, immune deficien-cies, poor nutrition, collagen vasculardiseases, and malignancies are allknown to impede wound healing andmust be identified and addressed.

Therefore, determining the cause ofthe wound is first and foremost fol-lowed by identifying any complicatingfactors associated with the patientshealth, care setting, financial situa-tion, and/or the patient's expectations.Once all of the above considerationshave been taken into account, then anaggressive plan of action can be de-veloped specific to the patient.

Some characteristics of commonchronic wound factors that we identifywhen first developing a treatment planare outlined below:

Pressure Wound

• Bony Prominence

Nonblanchable erythema of intact

skin

Partial thickness skin loss involvingepidermis and/or dermis

• Full thickness skin loss involvingdamage or necrosis of subcuta-neous tissue down to but notthrough fascia

• Full thickness skin loss with ex-tensive destruction, tissue necro-sis or damage to muscle, bone, orsupporting structures

• Chronic Illnesses• Poor Nutrition• Decrease mobility• Decrease activity

Decrease sensory perception

Extrinsic factors-- presence of mois-ture friction and shear traumaVenous Wound

• Medial lower leg and ankle• Malleolar area• Foot warm• Edema• Brawny skin pigment changes• Varicose veins• BI greater than 1.0 ("normal" range

0.95-1.3)• Obesity• History of DVT, trauma, varicose

veins or malignancy• Multiple pregnancies

Arterial Wound

• Between toes or tips of toes• Over phalangeal heads• Sites of trauma, ie., rubbing of

footwear• Pain (walking and/or at rest)• Absent or diminished pulses• Foot cool or cold• Absence of leg or foot hair• Thin, shiny dry skin• Thickened toenails• Ankle-brachial index (ABI)

0.5-0.95 Mild to moderate Peripheralarterial disease

Ability to heal wound usually main-tained<0.5 Severe arterial insufficiencyWound healing unlikely unless revas-cularization

1.3 Abnormally high range, typicallybecause of calcification of the vesselwall in the diabetic.

• Elevation pallor/dependent rubor• Diabetes• HTN• Smoking• claudication• History of foot trauma

Diabetic Wound

• Planter aspect of foot• Over metatarsal heads• Heel• Poorly controlled blood glucose• Peripheral neuropathy--both sen-

sory and motor• Charcot deformity--abnormal

shape of foot/mid foot collapse• Peripheral arterial disease• Atherosclerosis• Smoking

Hypertension

When developing a treatment plan wealways consider the following:

Pressure Wound

• Reduce pressure--select appropri-ate pressure reduction support sur-face for both chair and bed.

• Minimize skin exposure to mois-ture from incontinence, perspira-tion, or wound drainage.

• Minimize environmental factorsleading to drying of skin, such asexposure to cold.

Chronic Venous Insufficiency

• Surgical obliteration or ligation ofveins

• Valvular repair• Compression therapy• Elevation

Arterial Wound

• Measures to improve tissue perfu-sion: surgical revascularization

• Hyperbaric oxygen• Pharmacologic options

Non-Wound Specific

• Optimize nutrition/hydration• glucose control• Measures to support tissue oxy-

genation• Smoking cessation

At LA Podiatry we view healingwounds as a priority. Our physiciansoffer services at three local woundcare centers and have working rela-tionships with other specialists thataid in wound healing.

As wound care specialists, we knowthat healing wounds and saving legssaves lives.

FLORIDAHEALTHNEWS-ONLINE.COM4 AUgUST ISSUE • 2011

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A Safe Tan? No Way, Experts Say

From wrinkles to skincancer, risks increase withexposure to UV raysindoors or out.

Young women say they flock totanning salons to gain a healthyglow that adds to their naturalbeauty, protects them from the

sun's rays and fills them with self-confi-dence.

Except none of it is true or lasting.

A deep tan may help project beauty andconfidence for a while, but health expertsstress that it will eventually give way topermanent skin damage caused by the ul-traviolet rays emitted by a tanning bed --damage up to and including potentiallydeadly skin cancer.

"We're seeing more young women withtmelanoma," said Dr. Len Lichtenfeld,deputy chief medical officer for the Amer-ican Cancer Society. "Based on recent re-search, we believe it is linked to use of tan-ning beds."

Also, any notion that a "base tan" can pro-tect a person from a nasty sunburn is justplain wrong, he said.

And though most people spend more time inthe sun during the summer months, expo-sure to ultraviolet light has become in-creasingly a year-round danger.

"The bottom line is excessive UV exposureincreases your risk of skin cancer, whetheryou are indoors or outdoors," said Dr. JamesSpencer, a dermatologist in St. Petersburg,Fla., who's on the board of directors of theAmerican Academy of Dermatology.

Tanning beds have become a particular haz-ard. The World Health Organization's Inter-national Agency for Research on Cancerhas classified the devices as within its high-est cancer risk category -- basically as po-tentially carcinogenic as cigarettes.

Nonetheless, about a third of the 3,800young women questioned in an AmericanAcademy of Dermatology survey releasedin May said they had visited a tanning salonwithin the previous year. About a fourthsaid they used indoor tanning beds at leastonce a week.

The survey also found that 81 percent of theyoung women said they also tanned out-

doors, either frequently or occasionally.

Exposure to UV light at a relatively youngage appears to come at a cost. The WorldHealth Organization released a study thatfound a 75 percent increased risk formelanoma in people whose first exposure toa tanning bed occurred before age 30, Licht-enfeld said.

Researchers also have found an increase inmelanoma occurrence on specific parts ofthe body, particularly the chest and trunk."They believe it's due to the widespread useof tanning beds," Lichtenfeld noted.

College-age women are most at risk for UVexposure through indoor tanning. TheAmerican Academy of Dermatology sur-vey found that women 18 to 22 years oldwere almost twice as likely as 14- to 17-year-olds to have used a tanning bed.

These women are responding to a messagethat permeates modern society, Spencer andLichtenfeld said.

"It's a societal norm that a tan is attractiveand desirable," Spencer said. "People likehow it looks. They're worried about theprom this weekend."

Add to that the perception of invincibilitythat young people share -- the idea that noth-ing can harm them, so there's no reasonwhy they shouldn't use a tanning bed toturn their bodies bronze.

"They don't connect tanning at age 17, 18,19 with what's going to happen to them atage 40," Lichtenfeld said.

The true irony, experts agree, is that tanningmay indeed help them look and feel beauti-ful when they're young, but it will causetheir looks to deteriorate as they grow older."UV light causes wrinkled, leathery skin,"Spencer said. "It's not a consequence of age.Their tan might last a week or two, but theywill have wrinkles earlier."

Proponents of healthy skin have tried edu-cating young women about the risks asso-ciated with tanning bed use, but many nowbelieve that legislation may be needed toprotect them.

Lichtenfeld said he believes that lawmakersshould undertake legislation to restrict accessto tanning beds for anyone younger than 18.Laws also should be considered, he said, totighten regulation of the devices, includinghow much UV light they emit and the lengthof exposure during a tanning session.

FLORIDAHEALTHNEWS-ONLINE.COM AUgUST ISSUE • 2011 5

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More U.S. Men Die FromCancer Than Women: StudyBut disparity mirrors differences inincidence, not ability to fight disease,researchers say.

Men in the UnitedStates are muchmore likely thanwomen to die of

cancer, a new report from the U.S.National Cancer Institute found.

gender differences in cancer inci-dence -- more men than womendevelop cancer in the first place -- rather than differences in cancersurvival appeared to drive thefindings, the researchers said.

"If we can identify modifiablecauses of sex difference in cancerincidence and mortality then pre-ventative actions could reduce thecancer burden in both men andwomen," said lead researcherMichael B. Cook, a National Can-cer Institute epidemiologist.

Cook said that for many cancers,male and female incidence rates,and by extension death rates, havechanged disproportionately overtime.

This is likely because of differ-ences in "carcinogenic exposures,

metabolism and susceptibility," hesaid. Increased rates of smokingamong men, and differences in in-fections, hormones and contactwith toxic metals may all comeinto play, he said.

In terms of survival, however, thegender gap was minimal, the re-searchers found.

The study is published in the Au-gust issue of Cancer Epidemiol-ogy, Biomarkers & Prevention.

To look for gender differences incancer deaths and survival rates,Cook's team used informationfrom the NCI's Surveillance, Epi-demiology and End Results data-base, which includes informationon survival and deaths for 36 dif-ferent cancers.

Lip cancer, for example, killed5.51 men for every 1 woman. Lar-ynx cancer claimed the lives of5.37 men for every 1 woman;throat cancer, 4.47 men for eachwoman; and urinary bladder can-cer, 3.36 men per 1 woman.

Examining cancers with the high-est death rates overall, the re-searchers again found higher mor-tality among men than women.For example, lung and bronchuscancer killed 2.31 men for every 1woman. Liver cancer killed 2.23men for every woman; colon andrectum cancer took 1.42 males'lives for every woman; pancreaticcancer, 1.37 men for each woman;and leukemia, 1.75 men for everywoman.

The research team found that gen-der was not a major factor in five-year survival when age, year ofdiagnosis and tumor stage weretaken into account.

"But, for certain cancers we didobserve slight sex differences insurvival," Cook said, adding it isdifficult to assign any root cause tothat observation.

"This is not really a novel find-

ing," said Rebecca Siegel, an epi-demiologist at the American Can-cer Society, commenting on thestudy.

"We know that men have a higherrisk of developing and dying fromcancer for a variety of reasons, andsome reasons which we don't fullyunderstand," she added.

"The fact they didn't find large dif-ferences in survival is comfort-ing," she said.

The death rates reflect differentsmoking and drinking patterns,Siegel pointed out. Also, cancersrelated to work exposures aremore common among men, shenoted.

Because smoking among womenpeaked in the 1970s and 1980s,Siegel said she expects to see thegender difference in cancer deathsstart to narrow.

Men may get diagnosed later thanwomen because they tend to seetheir doctors less often, and thiscould affect mortality rates, Siegelalso suggested.

Future studies should explore thefactors responsible for the dispar-ity, the study authors said.

FLORIDAHEALTHNEWS-ONLINE.COM6 AUgUST ISSUE • 2011

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The anatomy ofa healthy office

A back-friendly seatLook for a chair with lower-backsupport and adjustable height andarm rests so you can sit up straightwith your knees level. And leanback now and then: New researchsays it’s good for you.

A well-placed monitorYour neck and eyes will thank youif the top of your screen is at eyelevel and about 18 to 28 inchesaway from you. To avoid fatigue-inducing glare, don’t park yourcomputer in front of a window.

Calming colorTo lower your stress level, workcooler hues, such as aqua or laven-

der, into your office, says LeatriceEiseman, executive director of thePantone Color Institute and authorof Color Messages and Meanings.

Typing tricksPrevent carpal tunnel syndromewith a cushioned wrist support(wrists should be in a straight, notbent, position).

Soothing soundsMinimize irritating backgroundracket (which can actually makeyou eat more!) by getting a fan, asound machine, an iPod, orearplugs to help block it out.

Green power

The right plant can add oxygenand humidity to dry office air. Or,go with flowers to enhance cre-ativity.

Sunny-side upNatural sunlight can increase thebrain’s levels of the calmingchemical serotonin and also helpsuppress the sleep-inducing hor-mone melatonin.

Typing tricksPrevent carpal tunnel syndromewith a cushioned wrist support(wrists should be in a straight, notbent, position).

Soothing soundsMinimize irritating backgroundracket (which can actually makeyou eat more!) by getting a fan, asound machine, an iPod, orearplugs to help block it out.

Green powerThe right plant can add oxygen andhumidity to dry office air. Or, gowith flowers to enhance creativity.

Sunny-side upNatural sunlight can increase thebrain’s levels of the calmingchemical serotonin and also helpsuppress the sleep-inducing hor-mone melatonin.

Channel the chiA minifountain on your shelf ordesk taps into the Chinese practiceof feng shui balance; moving wa-ter is a symbol of wealth and em-powerment.

Soothing smellsget the calming effects of aro-matherapy at work with a bowl ofpotpourri, a bouquet of sweet-smelling flowers like lilies, a jas-

mine plant, or a scent diffuser foryour office.

The right lightOverhead lighting can cause glareand make you look like you pulledan all-nighter. Turn off the over-heads and use task lighting.

A neck-saving phoneget a headset to avoid neck andshoulder pain from cradling thephone between your shoulder andear.

A feel-good momentA special photo of an importantperson, place, or pet can helpmake even a bad day tolerable.

Temperature controlHot office? Cold outside? Or viceversa? Keep a wrap handy so youcan stay comfortable.

These 13 must-haves will make youhealthier—and your space work harder.

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FLORIDAHEALTHNEWS-ONLINE.COM AUgUST ISSUE • 2011 7

Are you approachingyour regimen allwrong?Dermatologistsexpose commonblunders that couldbe sabotaging yourcomplexion.

MYTH 1: A complete skincareroutine must have three steps.

TRUTH: Cleanse, tone, thenmoisturize has been drilled intoour heads, but feel free to skip thesecond step, says Cambridge,Massachusetts, dermatologist Dr.Ranella Hirsch: "People think thattoning an oily complexion willmake it better, but oil is protectiveand the body produces it in re-sponse to injury. When you stripyour skin, it reacts by making a tonof grease."

MYTH 2: You need to cleanseyour face at least twice a day.

TRUTH: Using a face wash inthe morning is just an excuse to gothrough more product, accordingto Hirsch, who advises avoidingantibacterial soaps at all costs be-cause they're too harsh for yourface. "In the morning, the bestthing is water and your fingers,not a cleanser," she says.

MYTH 3: Scrubs make skinglow.

TRUTH: Overexfoliating leads toextra oil production, so the glowyou see the first week will even-tually turn into a greasy mess."Skin is actually a good exfoliatoron its own, so I rarely recommendmanual scrubs," says Hirsch.

MYTH 4: Dryness causes finelines.

TRUTH: People confuse drynessand flaking with wrinkles, saysHirsch, who suggests smoothingthings out visually with a little lo-tion: "Just moisturizing will makewrinkles look better. The lines arestill there, but you won't see themanymore."

MYTH 5: You should buy yourbest friend's favorite eye cream.

TRUTH: "Everyone has differenteye issues, so one size does not fitall," reveals New York City der-matologist Dr. Anne Chapas. Ifyou have puffiness, choose a gel(heavy creams can boost swelling)with caffeine and store the tube inthe fridge to maximize benefits. Ifyou have dark circles, look for aproduct with a lightening ingredi-ent like vitamin C and a collagen-builder like retinol.

MYTH 6: Leaving a mask onovernight gives you more for

your money.

TRUTH: Masks deliver a potentdose of active ingredients or mois-ture quickly into the skin, but youcan overdo it, causing irritation orbreakouts. "You should use thingsas directed. Rarely do you out-smart the people who have donethe clinical testing for a product,"says Hirsch.

MYTH 7: Wearing foundationwith an SPF means you're be-ing sun safe.

TRUTH: You should still apply asunscreen underneath, says Cha-pas. "Unless you're slathering on amask of makeup, you're not get-ting enough protection. You needto wear an SPF of at least 30 onyour face every day, and nobodyputs on enough foundation to getthat SPF value out of it."

MYTH 8: Nano-size titaniumdioxide sunscreen causes cancer.

TRUTH: "The majority of studiesshow that titanium dioxidenanoparticles are not absorbedthrough the normal skin," explainsDr. Chapas. "There are animalstudies that show a link betweennano-size titanium dioxide and or-gan damage, but the mice testedwere ingesting or inhaling multi-ple times the amount that youwould put on your skin. As far aswe know, nano-size sunscreens

that are applied topically are safe."

MYTH 9: More wrinkle creamyou apply, the better your results.

TRUTH: Morning and eveningapplications are a waste of money,says Hirsch. Most active ingredi-ents work really well once a day,and antiaging retinols should beused only at night (because they'rebroken down by sunlight). Plus,slathering on too many retinols

will cause irritation and make yourskin look worse, leading to red-ness, peeling, and inflammation.

MYTH 10: The best way to getrid of blackheads is extractions.

TRUTH: Pulling and pressing onpores can cause scarring, warnsChapas. "After extractions, skinjust fills right back up with oil. Us-ing retinols and gentle acid peels athome is enough to unclog pores."

Top 10 Skin Myths Debunked

FLORIDAHEALTHNEWS-ONLINE.COM8 AUgUST ISSUE • 2011

Advances in Cancer Treatment:IMRT and IGRT

Radiation therapy hasbeen in use as a cancertreatment for morethan 100 years, with its

earliest roots traced from the dis-covery of x-rays in 1895 by Wil-helm Röntgen.

The field of radiation therapy be-gan to grow in the early 1900slargely due to the groundbreak-ing work of Nobel Prize-winningscientist Marie Curie, who dis-covered the radioactive elementspolonium and radium. This be-gan a new era in medical treat-ment and research. Radium wasused in various forms until themid-1900s when cobalt and ce-sium units came into use. Med-ical linear accelerators have beenused too as sources of radiationsince the late 1940s.

With godfrey Hounsfield’s in-vention of computed tomography(CT) in 1971, three-dimensionalplanning became a possibilityand created a shift from 2-D to3-D radiation delivery; CT-basedplanning allows physicians tomore accurately determine the

dose distribution within the pa-tient. Megavoltage linear accele-rators, useful for their penetra-ting energies and lack of physicalradiation source, have replacedthe older machines, such ascobalt units.

The advent of new imaging tech-nologies, including magnetic re-sonance imaging (MRI) in the1970s and positron emission to-mography (PET) in the 1980s,has moved radiation therapyfrom 3-D conformal to intensity-modulated radiation therapy(IMRT) and image-guided radia-tion therapy (IgRT) Tomother-apy. These advances allowed ra-diation oncologists to better seeand target tumors, which have re-sulted in better treatment out-comes, more organ preservationand fewer side effectsIntensity-modulated radiationtherapy (IMRT) is an advancedtype of high-precision radiationthat is the next generation of3DCRT. IMRT also improvesthe ability to conform the treat-ment volume to concave tumorshapes; for example, when the

tumor is wrapped around a vul-nerable structure such as thespinal cord or a major organ orblood vessel. Computer-con-trolled x-ray accelerators distri-bute precise radiation doses tomalignant tumors or specific ar-eas within the tumor. The patternof radiation delivery is deter-mined using highly tailored com-

puting applications to performoptimization and treatment simu-lation (Treatment Planning). Theradiation dose is consistent withthe 3-D shape of the tumor bycontrolling, or modulating, theradiation beam’s intensity.

The radiation dose intensity is el-evated near the gross tumor vo-lume while radiation among theneighboring normal tissue is de-creased or avoided completely.The customized radiation dose isintended to maximize tumor dosewhile simultaneously protectingthe surrounding normal tissue.

This results in better tumor tar-geting, lessened side effects, andimproved treatment outcomesthan even 3DCRT.

3DCRT is still used extensivelyfor many body sites but the useof IMRT is growing in morecomplicated body sites such asbrain, head and neck, prostate,breast and lung. Unfortunately,IMRT is limited by its need foradditional time from experiencedmedical personnel. This is be-cause physicians must manuallyoutline the tumors one CT imageat a time through the entire dis-ease site which can take muchlonger than 3DCRT preparation.Then, medical physicists anddosimetrists must be engaged tocreate a viable treatment plan.Also, the IMRT technology hasonly been used commerciallysince the late 1990s even at themost advanced cancer centers, soradiation oncologists who did not

learn it as part of their residencyprogram must find additionalsources of education before im-plementing IMRT.

Proof of improved survival bene-fit from either of these two tech-niques over conventional radia-tion therapy (2DXRT) is growingfor many tumor sites; and, itsability to reduce toxicity is gene-rally accepted. Both techniquesenable dose escalation, potentiallyincreasing usefulness. There hasbeen some concern, particularlywith 3DCRT, about increased ex-posure of normal tissue to radia-tion and the consequent potentialfor secondary malignancy. Over-confidence in the accuracy of im-aging may increase the chance ofmissing lesions that are invisibleon the planning scans (and there-fore not included in the treatmentplan) or that move between orduring a treatment (for example,due to respiration or inadequatepatient immobilization). Newertechniques have developed to bet-ter control this uncertainty—forexample, real-time imaging com-bined with real-time adjustmentof the therapeutic beams. Thisnew technology is called image-guided radiation therapy (IgRT)or four-dimensional radiationtherapy.

Both IMRT and IgRT are someof the latest tools we have tofight cancer. These new tech-niques are proving to improvecure rates for many types of can-cers while reducing side effectsfor patients.

Anthony E. Addesa, M.D.

Board-Certified Radiation Oncologist.

Completed his fellowship at Harvard

Joint Center for Radiation Oncology

Kishore K. Dass, MD.

Board-Certified Radiation Oncologist

Has been trained at Cleveland Clinic,

Ohio

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FLORIDAHEALTHNEWS-ONLINE.COM10 AUgUST ISSUE • 2011

Foods to Eat for Healthy,Glowing SkinThese nutrient-rich foods will give your skina replenishing boost.

It may be a cliché, but the sim-ple truth is that you are whatyou eat. Just as radiant, glow-ing skin is an indicator of

good health and a nutrient-richdiet, a lackluster complexion re-flects poor diet choices and over-all health. Your skin is an indica-tion of what’s going on inside thebody, and great skin starts fromthe inside.

If you eat high quantities ofprocessed foods, sugar, caffeine,and fried foods, chances are, yourskin is not going to be looking itsmost radiant. But, loading up onfruits and veggies, whole grains,and vitamin-rich foods makes fora healthy body and, in turn, health-ier, more radiant skin.

Check out these skin-boosting su-per foods that contribute to overallgood health, and contain proper-ties which help your skin becomeits most healthy and radiant:

AlmondsOne of nature’s greatest gifts tothe skin, almonds are packed withantioxidant vitamin E—whichprotects your skin from UV raysand helps build collagen—fiber,and omega-6 and omega-9 fattyacids, which help maintain theskin’s elasticity and suppleness.Snack on raw almonds, add al-mond milk to your morning gra-

nola, or top off salads, cereals, andstir fries with sliced almonds. PS:they’re also great for healthy,shiny hair!

AvocadosIf you tend to steer clear of avoca-dos because of their fat content,think again. The healthy monoun-saturated fats found in avocadosmake them one of the best foodsfor your complexion. Thesehealthy fats keep skin from dryingout and help to maintain its youth-ful appearance. Avocadoes are alsohigh in B vitamins (particularlyvitamin B3) which contain anti-inflammatory properties.

StrawberriesHigh in fiber and low in sugar,strawberries are the perfect sum-mer snack and a potent skin-booster. With their high concen-tration of Vitamin C—anantioxidant essential to healthyskin, which combats aging and theeffects of sun exposure—they’re adelicious way to get glowy. Vita-min C has an important role in col-lagen production, the key to keep-ing your skin elastic, fresh andyoung-looking. Strawberries con-tain even more Vitamin C perserving than oranges or grapefruit,and with fewer overall calories.They’re also high in alpha-hy-droxyl acid, which helps eliminatedead skin cells and helps the bodybuild collagen.

Green TeaPacked with antioxidants and freeradical-fighting agents, you candrink your way to great skin withgreen tea. It’s high in vitamins C,D, and K, as well as the essentialminerals riboflavin, zinc, calcium,magnesium, and iron. Try swap-ping your morning coffee, whichdehydrates the skin, for green tea— your complexion will thankyou.

SalmonWith its high concentration ofomega-3 fatty acids, oily fishessuch as salmon and tuna aid in de-creasing the occurrence of cloggedpores. Plus, salmon is loaded withselenium, a trace mineral thathelps smooth the skin and acts asa powerful antioxidant whenjoined with its fellow skin-booster,vitamin E.

Hemp SeedsIt’s a little-known nutritional se-cret that hemp seeds are one of thebest things you can eat for skinand overall good health. These lit-tle seeds are loaded with protein,iron, vitamin E, and omega-3 andomega-6 fatty acids, which helpkeep the skin looking supple.

Hemp seeds are also great for ve-gans and vegetarians, as they boastone of the highest protein contentsof any plant-based food, with 25-20% protein. Like almonds, youcan enjoy them raw, toss them intosalads or enjoy hemp milk withwhole-grain cereal for a healthybreakfast.

Whole GrainsAn essential part of a healthy diet,whole grains are as much a friendto the skin as any other part of thebody. Their high fiber contenthelps your body stay hydrated andflushes out toxins, while their highconcentration of B vitamins aidsmetabolism. Be sure to incorpo-rate whole grains into every mealfor improved digestive health andskin that reflects it.

Sweet potatoesHigh in antioxidant beta-carotene,vitamin E, vitamin C and fiber,sweet potatoes are delicious, fun tocook with, and great for your com-plexion. Vitamins C and E are apowerful combo—Vitamin Ehelps maximize the effectivenessof vitamin C because it aids thebody in the regeneration of vita-min C.

Low-fat Yogurt and CottageCheeseLow in fat and high in vitamin A (amajor player in skin health) andselenium, cottage cheese is a nu-tritious and low-calorie food thatalso has significant skin-boostingproperties. In yogurt, the live enzymes andhealthy bacteria contributes togood intestinal health and ahealthy digestive tract, both ofwhich are important to healthyskin.

WaterOkay, so it’s not technically afood, but water is hands-down thenumber one skin-booster. It’s asimple equation: hydrated skin ishealthy skin, and healthy skin isbeautiful skin. Dry, dehydrated skin looks older,has more lines, and is more proneto breakouts.

For your beautiful skin, make sureto stay hydrated and eat a balanceddiet that incorporates these skin-boosting super foods. Your healthwill shine through your radiantskin, and have everyone wonder-ing how your face has such a gor-geous, healthy glow.

Study: Potassium Boosts Heart Health, Salt Harms ItCombo of highsodium, lowpotassium called'double whammy'for cardiovascularrisk.

Too much salt and too littlepotassium in your dietmay boost your risk for

cardiovascular disease anddeath, a new study shows.

Earlier studies had found an as-sociation between high bloodpressure and high levels of saltconsumption and low levels ofpotassium intake. The combina-tion of high salt -- sometimescalled sodium -- and low potas-sium appears to convey astronger risk for cardiovasculardisease and death than each min-eral alone, the study authorssaid.

"The combination of highsodium and low potassium is re-

ally a double whammy for cardio-vascular risk and for mortality,"said lead researcher Dr. Frank B.Hu, a professor of medicine atHarvard Medical School.

Although sodium and potassiumact independently, high potassiumlevels can counteract some of theeffect of high sodium, Hu said."But the adverse effects of highsodium cannot be completely off-set by a high potassium diet," hesaid.

To find out the role of salt andpotassium and the risk of cardio-vascular disease and death, the re-searchers looked at the levels ofthese minerals and the ratio be-tween them. Over an average of14.8 years of follow-up, 2,270people died. Of these, 825 diedfrom cardiovascular disease --which includes stroke -- and 443died of heart disease.

After taking into account variablessuch as gender, race and ethnicity,weight, high blood pressure, edu-cation and physical activity, Hu's

group found that high salt intakewas associated with a 20 percentincreased risk of death, while highpotassium intake was associatedwith a 20 percent decreased risk ofdying.

What's more, high salt consump-tion coupled with low potassiumintake was a significant risk factorfor cardiovascular disease andheart disease, the researchersadded.

"We should continue to reduce theamount of sodium in our diet, es-pecially in processed foods," Husaid. "We should also promotehigh consumption of potassium,especially from fruits and vegeta-

bles," he added. "Those thingsshould go hand-in-hand."

While the study uncovered an as-sociation between heart diseaseand the two minerals, it did notprove a cause-and-effect.

Commenting on the study, LonaSandon, an assistant professor ofclinical nutrition at the Universityof Texas Southwestern MedicalCenter at Dallas, said, "The find-ings are not surprising to me."

The benefits of potassium to coun-terbalance the effects of salt forcontrolling high blood pressurehave been known for years, butget little attention, Sandon said."There have been hints in the pastresearch literature that the ratio ofthe two may be more importantthan the nutrients individually,"she said.

Diets with plenty of fruits and veg-etables are associated with betterheart health, Sandon said. "Fruitsand vegetables are your best natu-ral sources of potassium and they

are naturally low in sodium,"she explained.

"The DASH (Dietary Ap-proaches to Stop Hypertension)diet does just that and has beenaround for quite some timenow," she stated. "It encouragespeople to eat more foods high inpotassium (fruits, vegetables,low-fat dairy) while eating lesssodium-laden foods."

Sandon noted that this is con-sistent with the 2010 Dietaryguidelines for Americans,which encourage increased fruitand vegetable intake while low-ering intake of foods high insodium.

Those guidelines recommendthat Americans limit their dailysalt intake to less than 2,300milligrams (about a teaspoon)for most people, and to less than1,500 milligrams for people 51or older, all blacks, and peoplewho have high blood pressure,diabetes or chronic kidney dis-ease, regardless of their age.

FLORIDAHEALTHNEWS-ONLINE.COM AUgUST ISSUE • 2011 11

Palm Beach Primary care

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Brush Your Teeth with Your Other HandUsing your nondominant hand to do simple chores can improve

your mood and your memory; that's because the action stimu-lates the production of brain-derived neurotrophic factor

(BDNF), a protein that encourages the growth of neuronslinked to long-term memory and mood. "When you're

depressed or under stress, your brain's productionof BDNF plummets," says Moses Chao, PhD,

professor of neuroscience and psychiatry atNew York University School of Medicine.(One of the lesser-known effects of antide-pressants, he says, is to raise the levels of

BDNF.) Anything unexpected—smelling rosemary first thing in the morning,for example—can activate BDNF.

FLORIDAHEALTHNEWS-ONLINE.COM12 AUgUST ISSUE • 2011

Hospice of Palm Beach County provides care to all who needand want it, regardless of insurance or financial status.Donations, grants and proceeds from fundraising eventssupplement the insurance reimbursement to ensure that costfor services is never an issue for our patients or their families.Nearly 900 highly trained employees and more than 600 caringvolunteers make this a program that excels in innovative careand quality service to our community.

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Life Tweaks That Will Make YouHappier and HealthierEat an Apple...

Researchers from Pennsylvania State University found that peoplewho ate an apple before lunch consumed nearly 190 fewer

calories at the meal than those who'd taken in the same num-ber of calories (125) in the form of applesauce, fiber-fortifiedapple juice, and plain apple juice. "All calories are not cre-ated equal," says Mark Hyman, MD, author of Ultrametabo-lism: The Simple Plan for Automatic Weight Loss. "A wholeapple feels like more. It has more fiber and nutrients, and

makes you feel full longer." The Penn State volunteers atetheir apple about 15 minutes before lunch—and the authors sus-

pect the effects might have been even more dramatic had theyeaten the peel (which was removed), thanks to the extra fiber.

Drink Filtered CoffeeA growing body of evidence islinking unfiltered coffee to higherlevels of both LDL and total choles-terol. The reason, scientists suspect,has to do with terpenes—com-pounds found in the oil from coffeebeans. Unfiltered coffees such asthose made in an espresso machine orwith a French press or a percolatorhave more terpenes, which interferewith cholesterol metabolism. "Fil-ters catch surface oils," saysNancy Snyderman, MD, chiefmedical editor at NBC News and au-thor of Medical Myths That Can Kill You:And the 101 Truths That Will Save, Extend,and Improve Your Life. "I learned the hardway that gold filters do very little. Paper fil-ters are far more effective."

Power Up Your WalkIf you've been anywhere near a gym lately,you've probably heard the word "core". Tar-geting the abs and back, core work developssupple muscles and decreases the risk of injuries.It also improves athletic performance and easeslower back pain, according to a review from theUniversity of Colorado School of Medicine.You can easily slip in a little core condi-tioning while you're walking, saysMichelle Demus, program director at NewYork's Pure Yoga studio. Take a deep inhalation, then, with astrong exhalation, pull in your navel toward your spine; hold fora count of five, and release. Do this 10 times while you're walk-ing, take a short rest, and do two more sets. Another way to addcore conditioning to your walk is to throw in a few lunges:Keeping the spine long and abdominals engaged, step about 3feet forward with the right foot—the knee must stay directlyabove the ankle—and draw the left foot up, so you're balancingon the right leg for a moment. Repeat with the other foot.

Have a Few WalnutsIf you're dragging, consider anunusual suspect: your liver.Thanks to the fatty, carb-heavy American diet, mil-lions of adults are "increas-ing their odds of liver inflammation andputting themselves on the path toward cirrho-sis—and they might never have touched adrink," says Jan garavaglia, MD, host of theDiscovery Health Channel's Dr. g: MedicalExaminer and author of How Not to Die: Sur-prising Lessons on Living Longer, Safer, andHealthier from America's Favorite Medical Ex-aminer. Fatigue and malaise are early symp-toms of nonalcoholic fatty liver disease; to helpprevent or reverse it, try eating an ounce ofwalnuts daily; they contain liver-healthyomega-3s. In general, try to replace junk foodwith fruit, vegetables, fish, and whole grains.

FLORIDAHEALTHNEWS-ONLINE.COM AUgUST ISSUE • 2011 13

Wellington RegionalMedical Center held its22nd annual Wellington

Regional Medical Center Resi-dency Program graduation on June15, 2011. Wellington RegionalMedical Center Residency pro-grams are affiliated with the LakeErie College of Osteopathic Medi-cine. The ceremonies were led byJeffrey Bishop, DO Director ofMedical Education and ChiefMedical Officer of Wellington Re-gional Medical Center.

We are proud to announce eightphysicians graduated from our res-idency program this year. Thephysicians are as follows:

Adam Weiner, DO- Dermatology,Adam is taking over a Dermatol-ogy practice in Melbourne, FL

Thomas J. Singer, DO- Dermatol-ogy, T.J. will be practicing Moh’sSurgery with a Dermatology groupin Fort Myers, FL

Kim Sussman, DO – InternalMedicine, Kim is opening her ownpractice in Boynton Beach, FL

James Landero, DO – InternalMedicine, James is continuing onin our Dermatology ResidencyProgram

Hadi Siddiqui, DO – InternalMedicine, Hadi will continue on ina gastroenterology Fellowship inIllinois.

Renee Young, DO – TraditionalRotating Internship, Renee wasaccepted into an Anesthesia Resi-dency Program in Pittsburgh,Pennsylvania

Ben Tishman, DO – TraditionalRotating Internship, Ben was ac-cepted into an Emergency Medi-cine Residency Program in Cuya-hoga Falls, Ohio

Vik Belous, DO – Traditional Ro-tating Internship, Vik was ac-cepted into an Anesthesia Resi-dency Program in California.

The Wellington Regional Resi-dency Program, which began onJuly 13, 1989, trains Osteopathic

22nd annual Wellington Regional Medical CenterResidency Program graduation

physicians in Internal Medicine,Traditional Rotating Internship andDermatology. Our residency pro-grams have produced approxi-mately 150 graduates, with manystaying in the community to prac-tice. The Internal Medicine pro-gram is led by Joanna Widdows,D.O and the Dermatology programis led by Brad glick, DO, MPHand Richard Rubenstein, MD.

The evening graduation ensuedwith Chief resident AlissaTomaiolo, DO receiving the MostValuable Resident award and BenTishman, DO receiving the MostValuable first year resident award.Four of our Clinical Professors re-ceived awards as follows:

Joanna Widdows, DO receivedthe Distinguished Teaching award.

Chief Resident Alissa Tomaiolo, DOpresents Ishan Gunawardene, MDwith the The Golden Apple award.

Program Director Brad Glick, DOMPH presents Dermatologyresident Thomas Singer, DO withDiploma.

Robert Fernandez, DO fromLECOM presents Adam McDaniel,DO with the LECOM Residentaward

Program Director Brad Glick, DOMPH presents Dermatologyresident Adam Wiener, DO withDiploma

William Stechschulte, DO receivedthe Andrew Egol, DO Osteopathicaward.Gordon Johnson, DO received theResident’s Choice Award.Ishan Gunawardene, MD receivedthe Golden Apple Award.

Our affiliate college also presentedtwo awards for the evening. AdamMcDaniel, DO a second year res-ident received the Resident Awardand David Weissberger, MD re-ceived the Physician Teacheraward.

Jeffrey Bishop, DO, Chief Medical Officer and Director of MedicalEducation and Joanna Widdows, DO, Program Director present WilliamStechschulte, DO with the Andrew Egol, DO Osteopathic Award

Chief Resident Alissa Tomaiolo,DO presents Internal MedicineProgram Director JoannaWiddows, DO with DistinguishedTeaching award

Robert Fernandez, DO presentsDavid Weissberger, MD withLECOM’s Faculty award

Physical Activity Levels Linked to Employment StatusMen's and women'sexercise levelsaffected differentlyby being unemployed,study finds.

People's employmentstatus has an impact onhow physically activethey are during the

workweek, but men and womenare affected differently, new re-search shows.

The study from the U.S. Na-tional Institute on Aging meas-ured the levels of physical ac-

tivity in people participating in theU.S. National Health and Nutri-tion Examination Survey, whichgathers data on about 5,000 peopleeach year. Physical activity datawas collected with the help of anaccelerometer, a device wornaround the waist that detects body

movements and their intensity.

The investigators found that full-time employed men in either ac-tive or sedentary jobs were moreactive than healthy unemployedmen during the work week. Incomparison, women with seden-

tary jobs were less physically ac-tive Monday through Friday com-pared to unemployed women.These differences in activity levelsbetween employed and unem-ployed people did not extend toweekends, the researchers noted.

The study authors also pointed outthat, not surprisingly, workingpeople with sedentary jobs wereless active than those in more ac-tive professions. gender, however,still played a role in this finding:22 percent of the men and 30 per-cent of the women who held deskjobs were less active than those inmore active positions.

As a result, the study authors con-

cluded that people who are un-employed, particularly men, andthose with sedentary jobs, par-ticularly women, should takesteps to become more physicallyactive to reduce their risk of obe-sity, heart disease and high bloodpressure. Moreover, exercisemight boost morale among menwho are job hunting.

Dane R. Van Domelen, post-baccalaureate fellow at the U.S.National Institute on Aging Lab-oratory of Epidemiology, De-mography and Biometry, andcolleagues published their find-ings in the online edition of theAmerican Journal of PreventiveMedicine.

Front: Jeffrey Bishop, D.O., Ishan Gunawardene, M.D., Melissa Mora, D.O., Alissa Tomaiolo, D.O., MariannaZelenak, D.O., Renée Young, D.O., Joanna Widdows, D.O., Back: Vyacheslav Belous, D.O., Adam McDaniel, D.O.,Kanwal Akhtar Kamal, D.O., Kelvin Akhigbe, D.O., and Gregory Polar, D.O.

FLORIDAHEALTHNEWS-ONLINE.COM14 AUgUST ISSUE • 2011

Help Your Kids Stay in Shape This Summer

Experts share tips onplanning for exercise, funand healthy eating.

Abit of planning can help parentsensure their children eat rightand get enough exercise duringthe summer, experts say.

To start, parents can seek a minimum com-mitment from their children of one hour ofphysical activity a day, suggested Dr.Stephenie Wallace, an assistant professorof pediatrics at the University of Alabama atBirmingham.

"Set an expectation of doing something inthe house -- chores, set some goals and re-wards for your young person," she said in auniversity news release. "get them to playbasketball with their friends or spend sometime in the neighborhood, and really en-courage them to do so."

Parents should remember that active chil-

dren need to stay hydrated with water, notcalorie-laden sugary drinks, Wallace added.Summer is also a good time for parents toreinforce healthy eating habits among chil-dren.

"One key is to keep healthy foods in thehouse, such as fruits, vegetables and wholegrain granola bars, but don't deprive thekids either," Beth Kitchin, an assistant pro-fessor of nutrition sciences at UAB, said inthe news release.

"get the kids involved in choosing foods.Take them grocery shopping. Show themhealthy choices and have them choose," sherecommended.

The authors said they hope that parent in-volvement will help prevent more childrenfrom becoming overweight or obese. Poordiet and lack of physical activity have led toa tripling of obesity among American chil-dren over the last 30 years, according tothe U.S. Centers for Disease Control andPrevention.e not required to see Me-dicaidpatients.

Higher Folic Acid Levels in TeensTied to Academic SuccessFolate levels should bemonitored to ensure kidsare getting enough,researchers say.

Teens who have high levels of folicacid appear to do better in schoolthan those with lower levels,

Swedish researchers report."Folate intake had a positive asso-ciation with academic achieve-ment" in the students studied, theauthors wrote in the report publishedin the online edition and the Augustprint issue of Pediatrics.Not only should health providersmonitor folic acid levels in teens, but thefindings should influence school meals,school teaching and information given toparents, according to the researchers.Teens often have high levels of the bloodprotein homocysteine, an amino acid linkedto heart disease, and low levels of folic acid.In previous studies, folic acid levels havebeen linked to mental ability; however, un-til now this had not been linked with im-proved school performance, the study au-thors said."We know that folate plays a really criticalrole in brain development and brain func-

tion," said Dr. Daniel Armstrong, associatechair of pediatrics at the University of Mi-ami Miller School of Medicine."We know that, in young children, folate de-ficiencies are associated with poorer neu-rocognitive function and neurocognitive de-velopment," he noted. In fact, folatedeficiencies may be involved in the devel-opment of autism, he added.To find out whether folate might do some

good, a team led by Dr. Torb-jorn K. Nilsson, from the de-partment of laboratory med-icine at Orebro UniversityHospital in Sweden, collected

data on folic acid levels in 386teens aged 15 years. The re-searchers also looked at any

possible effects of socioeconomicstatus and genetics.The investigators found that teens who hadthe highest levels of folic acid also got thebest grades. None of the other factors theyexamined accounted for their finding, Nils-son's team noted."These results provide new information thatpoints to the importance of keeping a closerwatch on folate status in childhood and ado-lescence. They may also have direct impli-cations for school meal provisions, schoolteaching programs and information to par-ents," the authors concluded.

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Medicaid Coverage 'Substantially'Improves Access to Care: Study

Expanding Medicaid cov-erage among low-in-come adults increaseshealth care use, im-

proves health and well-being andreduces the financial strain forpeople with the publicly fundedhealth coverage, according to newresearch.

"This study shows that Medicaidsubstantially expands access toand use of care for low-incomeadults relative to being uninsured,"co-principal investigator Kather-ine Baicker, professor of healtheconomics at Harvard School ofPublic Health, said in a Harvardnews release.

She and her colleagues looked at10,000 low-income, uninsuredadults in Oregon who were ran-domly selected in a 2008 state lot-tery to accept additional peopleinto its Medicaid program. Thehealth outcomes of these peoplewere compared to the 80,000 ap-plicants who weren't selected inthe lottery.

The first year of the ongoing studyshowed that Medicaid coverageincreases the likelihood of outpa-tient care by 35 percent, the use ofprescription drugs by 15 percent,and of hospital admission by 30percent. This leads to about a 25percent increase in annual healthcare spending.

Medicaid coverage also increasesthe use of recommended preven-tive care such as mammograms by60 percent and cholesterol moni-toring by 20 percent. It also in-creases access to care. For exam-ple, people with Medicaid were70 percent more likely than thosewithout insurance to have a regu-lar doctor's office or clinic for pri-mary care, and were 55 percentmore likely to have a particulardoctor that they usually see.

Compared to uninsured people,those with Medicaid coveragewere 40 percent less likely to haveto borrow money or skip payingother bills to pay for health care,and 25 percent less likely to have

an unpaid medical bill sent to acollection agency.

The researchers also found that theadults with Medicaid coveragewere 25 percent more likely to re-port they were in good to excellenthealth, and 10 percent less likelyto report being depressed.

The findings are published as aworking paper (number 17190) onthe website of the National Bu-reau of Economic Research. Sup-port for the study was provided bythe U.S. National Institute on Ag-

ing, the Centers for Medicare &Medicaid Services, the CaliforniaHealthcare Foundation, and otherfoundations and government agen-cies.

"Some people wonder whetherMedicaid coverage has any effect.The study findings make clear thatit does. People reported that theirphysical and mental health weresubstantially better after a year ofinsurance coverage, and they weremuch less likely to have to borrowmoney or go into debt to pay fortheir care," co-principal investiga-

tor Amy Finkelstein, a professor ofeconomics at MIT, said in thenews release.

The researchers will follow thelottery participants for anotheryear and directly measure healthoutcomes such as obesity, bloodpressure, cholesterol and bloodsugar control.

Under the Obama administration'sAffordable Care Act, Medicaidcoverage will be expanded tocover additional low-incomeadults in all states in 2014.

Coverage resulted in better outcomes, moreuse of health services among low-incomeadults, researchers say.

Golf-Cart Head Injuries on the Upswing, Study FindsResearcherssurprised to findalcohol involved inmany cases.

golf carts are a popularmode of transportation onand off the links, but they

also are a growing cause of serious

head trauma, a new study finds.Researchers identified 68 peopletreated for golf cart-related injuriesfrom 2000 to 2009 at the level 1trauma center at georgia HealthSciences University in Augusta,not far from the setting of the Mas-ters golf Tournament. More thantwo-thirds had suffered significanthead injuries, defined as loss of

consciousness, hemorrhage orskull fracture. About 60 percent ofthe injuries occurred in childrenage 9 years on average.Alcohol was detected in about 59percent of injured people over age16, the investigators reported.The study, published in the issueof Otolaryngology -- Head andNeck Surgery, noted that golf carts

and similar slow-speed buggiesare used at some retirement com-munities, college campuses andsporting events, and more fre-quently by children. But riders andpassengers rarely wear helmets orother protective gear and, unlikemotor vehicles, golf carts typicallylack doors and safety features suchas seat belts, mirrors and lights.

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