Newspapers / The Carolina Times (Durham, … / July 14, 1990, edition 1 / Page 9
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SATURDAY, JULY 14, 1990—THE CAROLINA TIMES-9 pjMA Head Looks At The Future Of Medical practices And Impact On Minorities WASHINGTON, D.C. — jjjary care medicine — pscially family practice and i,5ral internal medicine — must emphasized for future physician telopment and better delivery of jith care. Dr. Vivian Pinn- iggms sates in the June 1990 of the Journal of the National Association. ■'5^ Pinn-Wiggins, of jshington, D.C., is president of , National Medical Association jjA), and her article is a dification of a presenation idc at the 1990 Conference on linority Participation in Graduate jlical Education in New York ly'' She quotes Dr. Robert lersdorf, president of the iociation of American Medical illcges, who gives the following isons for the need for more jiary care physicians: ' Managed health care systems juire more primary care ysicians. High technology idicine, as practiced by jspecialists, is escalating health i costs. t Even with an increase in ysician supply, problems in ;ess to health care persist. • The Council on Graduate idical Education has categorized oily medicine and global internal idicine as specialties in lersupply. ’ There is a growing conviction il individuals should have as j principal contact with the ilth care system a physician who loncemed about their total well ing rather than a specialist. ’ll is also obvious that the major iditions that are disparately teting blacks and other lorities are those which access the health system through maty care medicine would idily abate," Dr. Pinn-Wiggins trts. ilie major diseases contributing the disparity of black and lority Americans are: cancer, idiovascular disease, chemical pendency, diabetes, homicide d accidents and infant mortality, let diseases which affect blacks re than whites are AIDS and ft related disease, tuberculosis !of the cases are in the minority palation), and blindness and iion impairment due to iicoma, diabetes and retinal eases. Yet all these conditions can be iy addressed by primary-care jsicians. The author notes that 11985 Task Force on Black and lotity Health reported that more than 60,000 black and minority excess deaths occur yearly. One example is infant mortality; in 1987 black infants died at twice the rate of white infants — 17.9 deaths per 1000 births vs. 8.6 deaths per 1000 for white infants. Despite this crucial need for primary-care physicians, the number of medical students choosing primary care specialties declined in the years 1986-1990: 1986 1990 Family Practice 1680 1418 Categorical internal Medicine Programs 3776 2829 Pcdiauics 1366 1288 In conclusion. Dr. Pinn-Wiggins said: "We, as minority physicians, must participate in the adminisuation of health care, in the planning of health care, in the formation of health care laws and regulations, and in the delivery of health care such that our families, our communities, and all Americans have equal access to health care and enjoy improved health status. We must call upon our clcctetl officials to assist us in these endeavors." Dr. Pinn-Wiggins is chairman of the Department of Pathology at Howard University College of Medicine in Washington, D.C. The Journal of the National Medical- Association is a monthly publication of the 95-ycar-old NMA, a national organization comprised of some 16,000 minority physicians, with headquarters in Washington, Durham County General Receives Grant to Improve Indigent Health Care Durham County Hospital Corporation received a S21,900 grant from the Kate B. Reynolds Health Care Trust to develop effective strategies to address medical care of the indigent during an 18 month project. The study is expected to cost $54,990. The medically indigent are defined as those who ate uninsured or underihsured. They are divided into two categories: those who are unable to pay and those who are able to pay, but refuse to do so. Indigent care, a hotly debated national and local issue, "is t the heart of the discussion on Medicaid reform," DCHC President Richard L. Myers said in a letter to the health care trust. "Since North Carolina hospitals spent $1.1 billion in 1988 on uncompensated care, it is a top priority for the North Carolina Hospital Association," according to the letter. Estimates put that figure at $1.5 billion for 1989. DCHC spent nearly $1.3 million on uncompensated care last year. In light of the recent,Supreme Court decision giving hospitals the right to sue states, this project may result in limiting legal action by giving hospitals methods to avert huge losses, thus avoiding potential problems before they occur. According to a June 17 article in the Durham Morning Herald, "Although some states have come to blow's with hospitals over Medicaid payments, the N.C. When You’re Ready To Go Home... ...We’U Be Going With You. Durham County General Hospital Now Makes Housecalls We know that you want to leave the hospital as soon as possible... *go home... to your family and your friends. Hospital stays are getting shorter, and we are ready to help you leave as soon as possible by following you home and giving you the kind of health care service we have become well known for. Whether it’s high-tech nursing, physical therapy or one of many other health care services, We are ready to work with your doctor. Home Treatment and Life Care, A Home Health Care Service of Durham County General Hospital continuing the tradition of high quality health care you’ve come to expect. CaU 493-3220 or N. C. Toll Free 1-800-433-7511 IfaBncwal % / ' ■ 4 % CLEVELAND, OHIO — Beckilyn Doland, 14, who has a rare disea.se called primary oxalosis, is recovering from a liver-kidney transplant at Rainbow Babies and Children’s Hospital, it was the second liver-kidney transplant since her defect was discovered in 1983. (UPI Photo) Exercise, Diet Key To Weight Loss Hospital Association and state division of Medical Assistance in North Carolina are working together to improve the Medicaid payment system." According to a March 14 article in The Durham Sun, "Noith Carolina’s working poor are caught between two extremes when it comes to medical care, with paychecks too large to qualify for Medicaid but too small to afford health insurance. "They let medical problems accumulate, and they don’t want to beg for care, but once the problems reach a certain point, they’re going to be in the hospital," said Christopher J. Conover, a research associate with the Center for Health Policy Research and Education. "The irony is that the most expensive component of the health care system-a visit to the hospital- is accessible, and the least expensive-a visit to a doctor’s office-is thq most difficult to get," he said. According to the Durham Morning Herald as many as 68,000 poor North Carolinians are unable to qualify for Medicaid and therefore are under- or uninsured. One problem is that the six month deductible is often too high for low-income individuals to pay. If the deductible is not paid, those individuals do not get coverage. Thus a cycle of not being able to afford the deductible and not receiving benefits continues. lllllllllillllMIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIIII possibly resulting in people going without needed medical care. "This project represents an important effort on behalf of hospitals to impiove indigent care. There are no simple solutions to a problem of this magnitude, but with tliis grant, Durham Couniy Hospital Corporation is attempting to develop long-term solutions that will benefit padents, hospitals and the slate," said Myers. DCHC plans to utilize Lincoln Commuii.ty Health Center, whose mission is to provide primary care to underserved populations in the Durham community, as a resource to develop the strategies. Specifically, DCHC has three goals for the indigent care project. The first goal is to provide policy makers with a workable definition which enhances tlie understanding of the scope and intensity of indigent care provided by community hospitals. The second goal is to demonstrate appropriate initiatives which hospitals can indeper.dently undertake to develop solutions to the problem. ITie final goal is to illustrate the potential impact of alternative health insurance structures on large employers in terms of coverage demographics and costs. The Kate B. Reynolds Health Care Trust, of Winston-Salem, was created to help improve health care for the people of North Carolina. Approximately $10 million is awarded annually in grants to nonprofit organizadons around the state. By the UNC School of Pharmacy Up to 80 percent of adult women in the United States say they are watching their weight or dieung every day. The desire to maintain or reach an "ideal" weight has led to a large market for appetite suppressants: anything that will make that Twinkle a little harder to resist. "To lose weight, you have to do two things," said June McDermott, clinical assistant professor at the University of North Carolina at Chapel Hill School of Pharmacy. "You have to cut down on’ the calories you eat and you have to increase the number of calories you spend by exercising." Some people use diet aids, or appedte suppressants, to help keep from feeling hungry while they change their styles of eating, McDermott said. "You really need to make mental adjustments about the way you eat — how much, what kinds of foods — and how you feel about exercise. "People don’t always eat because they are hungry. They eat becau& they are depressed or frustrated, then just become more depressed because they have eaten too much, and the whole cycle begins again," she said. "You can’t eat fast food for lunch every day and expect to stay thin." McDermott said losing a pound or bvo a week was ideal; any faster that: that and you probably won’t keep the weight off. "You don’t gain weight overnight, so you can’t expect to lose weight overnight." YOU AND YOUR HEALTH By Dr. Robert DeMarco 7 Dear Dr. DeMarco: After a long period of testing and examin ing, our doctor has decided my mother’s problems were not caused by Alzheimer’s Disease, but by something he classified as “infarcts.” He now feels treat ment may permit Mother to be cared for at home. We’re con fused and would appreciate your help in explaining this. Answer: I realize you must be in a difficult situation as you try to understand a complex diagno sis, and the implication it has for you and your family. A few defi nitions may help. The condition your mother is suffering from is called “multiin farct dementia” (MID). Demen tia is defined as a decline in intellectual function as seen in the loss of memory, loss of language, impaired judgment or mathemati cal abilities, as well as other men tal activities. An infarct is an area of dead tissue that results when the blood circulation to the area has been closed off or obstructed. As the number and size of these areas increase, and more brain tis sue is lost, the symptoms become more evident. Alzheimer’s Disease is certainly the most common cause of de mentia and is responsible for 25 percent to 55 percent of the cases, while MID is the second most common cause and is diagnosed in from 10 percent to 30 percent of patients with dementia. If there is a history of small or large strokes, the chances that the cause of the mental decline is MID in creases. High bloc d pressure is another risk factor. So are diabe tes, high cholesterol levels and smoking. An important consideration in your mother’s case is the hope that appropriate treatment can stop the progression of the dis ease, by stopping the develop ment of small clots in her brain that are causing the condition. If this can be accomplished, than caring for her at home permits her to remain in familiai surround ings, where she is best able to function. Anoth'r common com plication of M^D is a mild to seri ous depression, with loss of appetite, insomnia, feelings of guilt and suicide. This may occur up to 70 percent of the time and requires additional care and treat ment. You will need frequen* on- sullations with your me'*, ir’s physician, so each decision about care may be based upon a thor ough understanding of this condition. Dear Dr. DeMarco: With “crack” all over the place, do people still use drugs like PCP? Answer: Unfortunately, yes. In some areas of the country, PCP is used by teen-agers of all races and economic groups. It seems a ma jority of them are from middle or upper-middle class, two parent families. Of any of the abused drugs, PCP produces the highest inci dences of terrible effects. Those who use it, even a few times, can suffer memo.'v damage that can never be repaired, violent and reckless behavior, and harmful — to themselves and to ethers — aggressive actions. PCP users say they usually buy a small envelope of loose, PCP impregnated, crumbled dry mari juana. Some smoke it laced with dried mint or parsley. It also is available in particle form (called dust), as a liquid, or disguised as psilocybin mushrooms or mescaline. Believe me, what PCP can take from you, can NEVER be returned. Your heart beats more than 85,000 times a day as it sustains life, yet most people don’t think about this vital organ until illness strikes. Learn how to main tain a healthy heart in a new booklet, THE HUMAN HEART: AN OWN ER’S MANUAL. To order your copy, send $2.95 to HEART, P.O. Box 4406, Orlando, Fla. 32802-4406. Make checks payable to Newspaperbooks. 1990, Tribune Media Services Most drug stores and some grocery stores carry over-the- counter appetite suppressants such as Dexatrim, which contain the ingredient phenylpropanolamine (PPA), which is used in many cough and cold products. "It’s important to remember that 75 milligrams is the maximum amount of PPA you should take in a day," McDermott said. "These products should be used only as an aid, to help break the cycle of needing food at certain times of the day." Taking PP A alone will not: make you lose weight, she said. Yoi J have to change your eating habits and increase your exercise. Although PPA has a long r ecord of safety, McDermott said she still does not recommend it for ptrople who have diabetes, heart disiease, high blood pressure, glaucom.a or depression. If you are more than 40 perc.cnt above your ideal body weight for ycur height, be sure to talk to ytiur doctor before starting a dilet regimen, especially if it includics taking a appetite suppressant. Besides products with PPA, other appetite suppressants include' fiber and products with benzocaine. "Fiber products, when used followed by a glass of water, bulk up in the stomach, giving a feeiing of fullness," she said. These products have not been medically proven to help with weight loss. ■fp Pharmacy & Your Health GUI\^EY’S Discount Drugs 206 W. Main St 688-1368 Medicines, Sunlight, and Photosensitivity Several medicines are capable of causing skin reactions referred to as photosensitivities. There arc two typc.s of photosensitivities. The more common type is called photo toxicity. Phototoxic reactions are thought to occur when exposure to the sun or ultraviolet rays, such as those produced by tanning beds, causes a release of energy from the m^cine. This reaction, \ hich may occur following a few minutes ol exposure, often results in acute red ness and localized swelling. The second type of photosen sitivity is called/t/iotoa/Zergy. This is an allergic response that requires at least one previous exposure to the sensitizing medicine. Pho toallergies may cause an immediate redness to the skin or a delayed inflammatory response to sun- exposed areas of the skin. A partial list of medicines which may be involved in photosensitivi ties include diuretics, the tetracy clines, oral diabetes medicines, anti depressants (e.g., amitriptyline and desimpramine), and certain anti- cancef medicines, such as metho- trexatei Topical acne medicines (e.g., benzoyl peroxide and treti noin) and topicalpsorosi is medicines (e.g., coal tar) may cause the most severe reactions becauite.they also dry the skin.
The Carolina Times (Durham, N.C.)
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July 14, 1990, edition 1
9
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